UC-NI

flfl7

m

THE LIBRARY

OF

THE UNIVERSITY
OF CALIFORNIA

PRESENTED BY

PROF. CHARLES A. KOFOID AND
MRS. PRUDENCE W. KOFOID

ZOONOMIA;

OR,

THE LAWS

Ofr

ORGANIC LIF

IN THREE PARTS.

By ERASMUS DARWIN, M.D.RR.S*

AUTHOR OF THE BOTANIC GARDEN, PHYTOLOGIA, &C.

Principio ccelum, ac terras, campofque liquentes,
Lucentemque globum lunae, titaniaque aftra,
Spiritus intus alit, totatnque infufa per artus
Mens agitat molem* et nlagno fe corpora mifcet.

VIRG. JEn.

Er^rth, on whofe lap a thoufand nations tread,

And Ocean, brooding his prolific bed,

Night's changeful orb, blue pole, and filvery zones.

Where other worlds encircle other funs,

One mind inhabits, one diffufive Soul

Wields the large limbs, and mingles with the v

COMPLETE IS TWO VOLUMES.

VOL. II.

•Second American, from the third London Edition, corre&ed by the Author.

Printed at Bofton, by D. CA&LISLE,
FOR THOMAS AND ANDREWS.

d at their Bookftore, No. 45, Newbury Street; by I. THOMAS, Worcefter ; and
tv THOMAS fe? THOMAS, Walpole, N. H. — Sold alfo by T. &f J. S\vo-
Nevv York ; WHITING, I.,RAVEN\VORTH & WHITING, Albany;
O- PENNIMAN £? Co. Troy ; and THOMAS,
? BUTLER, Baltimore.

Fi ;

""P

z o o N o M i A;'*

Ll

OR,

THE LAWS OF ORGANIC LIFE.
PART II.

CONTAINING

A CATALOGUE OF DISEASES,

DISTRIBUTED INTO

NATURAL CLASSES,
0

ACCORDING TO THEIR PROXIMATE CAUSES,

WITH THEIR SUBSEQUENT

ORDERS, GENERA, AND SPECIES,

AND WITH THEIR
METHODS OF CURE.

Haec, ut potero, explicabo ; nee tamen, quafi Pythius Apollo, certa ut fint et fixa,
qiue dixero ; fed ut Homunculus unus e multis probabiliora conjeelura fequens.

Cic. Tusc. DISP. I. i. 9.

365943

PREFACE.

difeafes originate in the exuberance, deficiency^
or retrograde a&ion, of the faculties of the fejiforiumt
as their proximate caiife ; and confift in the difordsred
motions of the fibres of the bodya as the praxiRWUs e£
feel: of the exertions of thofe difordered faculties,

i

The fenforium polfeffes four diftin£t powers^ or
ties, which are occafionally exerted^ and produce all the
motions of the fibrous parts of the body j thcfe are the
faculties of producing fibrous motions in ccmfequenee of
Irritation, which is excited by external bodies $ in con*
fequence of fenfation, which is excited by pleafure or
pain ; in confequence of volition, which h excited by de*
fire or averfion ; and in confequence of aflbdatioHi
which is excited by other fibrous motions, We ar«
hence fupplied with four natural clafles of difcafes df«
rived from their proximate caufes j which we ftall term
thofe of irritation, thofe of fenfation, thofe of voli1
thofe of affociation,

vi PREFACE.

In the fubfequent clarification of difeafes I have not
adhered to the methods of any of thofe who have pre-
ceded me ; the principal of whom are the great names
of Sauvages and Cullen ; but have neverthelefs availed
myfelf, as much as I could , of their definitions and dif~
tinctions.

The effential characteristic of a difeafe confifts in its
proximate caufe, as is well obferved by doctor Cullen,
in his Nofologia Methodica, T. ii. Prolegom. p. xxix.
Shnilitudo quidem morborum in fimilimdine caufse
eorum proximse, qualifctinque fit, revera confiftit. I
have taken the proximate caufe for the claffic character.
The characters of the orders are taken from the excefs,
or. deficiency, or retrograde action, or other properties,
of the proximate caufe. The genus is generally derived
from the proximate effect. And the fpecies generally
from the locality of the difeafe in the fyfhem.

Many fpecies in this fyftem are termed genera in the
fy Items of other writers ; and the fpecies of thofe wri-
ters, are, in confequence, here termed varieties. Thus,
in Dr. Cullen's Nofologia, the variola or fmall-pox is
termed a genus, and the diftinct and confluent kinds are
termed fpecies. But as the infection from the diftinct
kind frequently produces the confluent kind, and that of
the confluent kind frequently produces the diftinct ; it
would feem more analogous to botanical arrangement,
which thefe nofologifts profefs to imitate, to call the dif-
tinct and confluent fmall-pox varieties than fpecies.
Becaufe the fpecies of plants in Botanical fyftems prop-

agate

PREFACE. vii

agate others fimilar to themfelves ; which does not uni-
formly occur in fuch vegetable productions as are term-
ed varieties.

, In fome other genera of nofologifts the fpecies have
no analogy to each other, either in refpect to their prox-
imate caufe, or to their proximate effect, though they may
be fomewhat fimilar in lefs effential properties ; thus
the thin and faline difcharge from the noftriis on going
into the cold air of a frofty morning, which is owing to
the deficient action of the abforbent veflels of the nof-
trils, is one fpecies ; and the vifcid mucus difcharged
from the fecerning veflels of the fame membrane, when
inflamed, is another fpecies of the fame genus, Catarrhus.
Which bear no analogy either in refpect to their imme-
diate caufe, or to their immediate effect.

The ufes of the method here offered to the public, of
clafling difeafes according to their proximate caufes, are,
firft, more diftinclly to underfland their nature by com-
paring their eflential properties. Secondly, to facilitate
the knowledge of the methods of cure ; fince in natural
claflification of difeafes the fpecies of each genus, and in-
deed the genera of each order, a few perhaps excepted,
require the fame general medical treatment. And laftly,
to difcover the nature and the name of any difeafe previ-
oufly unknown to the phyfician ; which I am perfuaded
will be more readily and more certainly done by this
natural fyftem, than by the artificial clarifications alrea-
dy publifhed.

The

till 1?RE¥ACE,

The common names of difeafes are not well adapted
to any kind of claffification, and leaf! of all to this, from
their proximate caufes. Some of their names in com*
mon language are taken from the remote caufe, as
worms, (tone of the bladder ; others from the remote
efFefi:, as diarrhoe^ falivation, hydrocephalus 5 others
from fome accidental fymptom of the difeafe, as tooth-
ach> head-ach, heart-burn ; in which the pain is only a
concomitant circumftance of the excefs or deficiency of
fibrous aftionSj and not the caufe of them. Others
again are taken from the deformity occafioned in confe-
ijuence of the unnatural fibrous motions, which confti-
tute difeafes, as tumours, eruptions, extenuations ; all
thefe therefore improperly give names to difeafes ; and
fome difficulty i« thus occafioned to the reader in en*
deavouring to difcover to what clafs fuch diforders
belong*

Another difSculty attending the harries of difeafes is:<
that one name frequently includes more tlian one difeafe^
either exiftlng at the fame time or in fucceflion. Thus
the pain of the bowels from worms is caufed by the in»
creafed action of the membrane from the flimulus of
thofe animals k> but the convulfionSj which fometimes fuc-
^ceed thefe pains in children, are caufed by the confequent
Volition, and belong to another clafs;

To difcover under what clafs any difeafe fliould be ar-
ranged, we mud firft invefligate the proximate caufe 5
thus the pain of the tooth-ach is not the caufe of any
difeafed motions, but the eiteft ; the tooth-ach there-
fore

PREFACE. ix

fore does not belong to the clafs of Senfation. As the
pain is caufed by increafed or decreafed action of the
membranes of the tooth, and thefe actions are owing to
the increafe or decreafe of irritation, the difeafe is to be
placed in the clafs of Irritation.

To difcover the order it muft be inquired, whether
the pain be owing to increafed or defective motion of
the pained membrane ; which is known by ihe concom-
itant heat or coldnefs of the part. In tooth-ach without
inflammation there is generally a coldnefs attends the
cheek in its vicinity ; as may be perceived by the hand
of the patient himfelf, compared with the oppofite cheek.
Hence odontalgia is found to belong to the order of de-
creafed irritation. The genus and fpecies muft be found
by infpecting the fynopfis of the fecond order of the clafs
of Irritation. See Clafs I. 2. 4. 12.

This may be further elucidated by confldering the
natural operation of parturition ; the pain is occaiioned
by the increafed action or diftention of the veffels of the
uterus, in confequence of the ftimulus of the fetus ; and
is therefore caufed by increafed irritation ; but the ac-
tions of the abdominal mufcles in its exclufion are cauf-
ed by the pain, and belong to the clafs of increafed fen-
fation. See Clafs II. i. i. 12. Hence the difficulty of
determining, under what clafs of difeafes parturition
mould be arranged, confifts in there being two kinds of
difeafed actions comprehended under one word ; which
have each their different proximate caufe,

VOL. II. b In

x PREFACE.

In Sea. XXXIX. 8. 4. and in Clafs II. i. i. i. we
have endeavoured to give names to four links of animal
caufation, which conveniently apply to the clafTification
of difeafes ; thus in common nictitation, or winking with
the eyes without our attention to it, the increafed irrita-
tion is the proximate caufe ; the ftimulus of the air on
the dry cornea is the remote caufe ; the clofmg of the
eyelid is the proximate effect ; and the diffufion of tears
over the eyeball is the remote effect. In fome cafes two
more links of caufation may be introduced ; one of
them may be termed the preremote caufe ; as the warmth
or motion of the atmofphere, which caufes greater
exhalation from the cornea. And the other thepoft-re-
mote effect;; as the renewed pellucidity of the cornea;
and thus fix links of caufation may be expreffed in
words.

But if amid thefe remote links of animal caufation any
of the four powers or faculties of the fenforium be intro-
duced, the reafoning is not juft according to the method
here propofed ; for thefe powers of the fenforium are
always the proximate caufes of the contractions of an-
imal fibres ; and therefore in true language cannot be
termed their remote caufes. From this criterion it
may always be determined, whether more difeafes than
one are comprehended under one name ; a circumftance
which has much impeded the inveftigation of the caufes,
and cures of difeafes.

Thus the term fever, is generally given to a collection
of morbid fymptoms ; which areiadeed fo many diftinct

difeafes,

PREFACE. xi

difeafes, that fometimes appear together, and fometimes
feparately ; hence it has no determinate meaning, except
it fignifies fimply a quick pulfe, which continues for
fome hours j in which fenfe it is here ufed.

In naming difeafes I have endeavoured to avoid the
affectation of making new compound Greek words,
where others equally expreffive could be procured : as
a mort periphrafis is eafier to be underftood, and lefs
burdenfome to the memory.

In the Methodus Medendi, which is marked by M. M.
at the end of many of the fpecies of difeafes, the
words incitantia, forbentia, torpentia, &c. refer to the
articles of the Materia Medica, explaining the operations
of medicines.

The remote caufes of many difeafes, their periods,
and many circumitances concerning them, are treated
of in the preceding volume ; the defcriptions of many
of them, which I have omitted for the fake of brevity,
may be feen in the Nofologia Methodica of Sauvages,
and in the Synopfis Nofologiae of Dr. Cullen, and in the
authors to which they refer.

In this arduous undertaking the author folicits the
candour of the critical reader ; as he cannot but forefec,
that many errors will be difcovered, many additional fpe-
cies will require to be inferted ; and others to be tranf-
planted or erafed. If he could expend another forty
years in the practice of medicine, he makes no doubt, but

that

six PREFACE.

that he could bring this work nearer perfection, and
thence render it more worthy the attention of philofo-
phers. As it is, he is induced to hope, that fome ad-
vantages will be derived from it to the fcience of medi-
cine, and confequent utility to the public, and leaves the
completion of his plan to the induftry of future genera-
tions.

DERBY, Jan. i, 1796.

ZOONOMIA ;

Z O O N O I A.

PART II.

CLASSES OF DISEASES.

I. DISEASES OF IRRITATION.
II. DISEASES OF SENSATION.

III. DISEASES OF VOLITION.

IV. DISEASES OF ASSOCIATION.

The Orders and Genera of the Firft Clafs of Dlfeafes,
CLASS I.

DISEASES OF IRRITATION,

ORDO I.

Increofed Irritation.
GENERA.

1 . With increafed actions of the fanguiferous fyflem.

2. With increafed actions of the fecerning fyftem.

3. With increafed actions of the abforbent fyftem.

4. With increafed actions of other cavities and membranes,

5. With increafed actions of the organs of fenfe.

ORDO II.

Decreafed Irritation.
GENERA.

1 . With decreafed actions of the fanguiferous fyftem.

2. With decreafed actions of the fecerning fyftem.

3. With decreafed actions of the abforbent fyftem.
VOL. II. B .

DISEASES CLASS I. i. 2,

4. With decreafed a&ions of other cavities and membranes-

5. With decreafecl actions of the organs of fenfe.

ORDO III.

Retrograde Irritative Motions,
GENERA.

1. Of the alimentary canal.

2. Of the abforbent fyftenru

3. Of the fanguiferous fyftem.

The Orders, Genera, and Species, of the Firft Clafs ofDif-

eafes.

CLASS I.

DISEASES OF IRRITATION.

ORDO I.

Increafed Irritation.

GENUS I.

With increafed Actions of the Sanguiferous Syjlem.
SPECIES.

1 . Febris irritativa. Irritative fever.

2. Ebrietas. Drunkennefs.

3. Hamorrhagia arterhfct. Arterial Haemorrhage.

4. Hamoptoe arteriofa. Spitting of arterial blood.

5. Hamorrhagia narium. Bleeding from the note.

GENUS II.

With increafed Actions of the Secerning Syjlem.
SPECIES.

j. Calor febrills . Febrile heat.

2. Ruborfebrilis. Febrile rednefs.

3. Sudor Caliduf. Warm fweat.
Sudorfebrilis. Sweat in fevers.

a labore. from exercife.

ab igne. from fire.

~ a medicamentis. from medicines.

4. Ui'ina ulterior cokrata. Copious coloured urine.

5. Diarrhoea

CLASS I. i. 3. OF IRRITATION.

5. Dirrbcea calida. Warm diarrhcsa.

. febrilis. Diarrhoea from fever.

. crapulofa. • from indigeition.

infantum. of infants.

6. Salivatio calida. Warm falivation.

7. Catarrhus calidus. — catarrh.

8. Expecioratio calida. expectoration.

9. Exfudatio pone aures. Difcharge behind the ears.
jo. Gonorrhoea calida. Warm gonorrhoea.

1 1 . Fluor albus calldus. fluor albus.

12. Hamorrhois alba. White piles.

13. Serum e veficatorio. Difcharge from a blifter.

14. Perfpiratio foetida. Fetid perfpiration.

15. Crines novi. New hairs.

GENUS III,

With itureafed Actions of the Abforbent Syjlem.
SPECIES.

1 . Lingua arida. Dry tongue.

2. Fauces arid<z. Dry throat.

3. Nares aridi. Dry noftrils.

4. Expefioratio folida. Solid expectoration.

5. Conflipatio a/vi. Coltivenefs.

6. Cutis arida. Dry (kin.

7. Urina parcior colorata. Diminifhed coloured urine*

8. Calculus felleus et icJerus. Gall-ftone and jaundice.

9. • rents. Stone of the kidney.

jo. • <vefic£. Stone of the bladder.

11. , arthriticus. Gout-ftone.

12. Rheumatifnius chronicus. Chronic rheumatifm.

13. Cicatrix vulnerum. Healing of ulcers.
J4. Cornea obfufcatio. Scar on the cornea.

GENUS IV.

With increafed A5lions of other Cavities and Membranes.
SPECIES.

1. Niftitatio irritativa. Irritative nictitation.

2. Deglutitio irritativa. Irritative deglutition.

3. Refpiratio et tuffis. Refpiration and cough.

4. Exclufio bills. Exclufion of the bile.

5. Dentitio. Toothing.

6. Priapifmus. Priapifm.

7. Diftcnfio mammularum. Diflention of the nipples.

8. Defcenfa-.

# DISEASES CLASS I. j. 5,

.8. Defcenfus uttri. Defcent of the uterus.

9. Prolapfus ani. Defcent of the rectum*

10. Lumlricus* Round worm.

11. Tania. Tape- worm.

12. Afcarides. Thread-worms.

13. Dracunculus, Guinea- worm.

14. Morpiones. Crab-lice.

15. fediculi. Lice.

GENUS V.

With increased

AElions of the Organs ofSenfe*

SPEqES.

I. Vifus acrior.

Acuter fight.

2. Audit us acrior.

• hearing.

3. Qlfaflus acrior.

. fmell.

4. Guflus acrior.

tafte.

5. Tact us acrior.

— touch.

6. Senfus colons acrior.

• — -» fenfe of heat.

- extenfanis acrior, fenfe of extenfioin,

8. Titillatio.

Tickling.

9. Pruritus.

Itching.

lo. Dolor urens.

Smarting.

II. Confternatio.

Surprife.

ORDO II.

jDecreafed Irritation.

GENUS I.
-With decreased Actions of the Sanguiferous Syflem,

SPECIES.
'I. Felris inirritativa. Jnirritative fever.

2. Par efts inirritativa. • debility.

3. Somnus interrupt™. Interrupted fleep.

4. Syncope. Fainting.

5. Hamorrhagia venofa. Venous haemorrhage.

6. Hamorrhois cruenta. Bleeding piles.

7. Hamorrhagia renum. — from the kidneys.

8. hepatis. Bleeding from the liver.

9. Hzmoptoe venofa. Spitting of venous blood.

10. Palpitatio ccrdis. Palpitation of the heart.

11. Mencrrhagia. Exuberant menftruation.
\ 2. Dyfmenorrhagia. Deficient menftruation.
33. LocJjia nimia. Too great lochia.

j^. Abortio fpontanea. Spontaneous abortion.

jc. Scorbvtus*

CLASS I. 2. 2.

OF IRRITATION.

I£. Scorbutus*

j6. Vibicet.

17. Petechia.

1 8. Aneurifma.

19. Varix*

Scurvy.

Extravafations of bloodc
Purple fpots.
Aneurifrn.
Swelling of veins.

GENUS II.

With decreafed Actions of the Secerning Syjlent*
SPECIES.

1. Frigits febrile.
chronicum.

2. Pallor fugitivits.
permanens.

3. Pus parents.
/(. Jll ucus pa rcior*

5 . Urifia par dor pailida.

6. Torpor hepaticus.

7. Torpor p finer eatis.

8. Torpor renis.

9. PunElz muccfe vultus.
lo. Macula cutisfuhx.

I f . Candies,

12. Callus.

13. Cataracla.

14. Innutritio offiitm.
J5« Rachitis.

1 6. 5/>/w^ diftortio.

1 J. Claiidicqtio cox aria.

1 8. S/>/fl0 protuberans.

19. S/>/'flrt bifida.

20. DefecJus palati.

Coldnefs in fevers.
- permanent.
Palenefs fugitive.
, -- permanent.
Diminifhed pus.
Diminifhed mucus.
Pale diminifhed urine.
Torpor -of the liver.
Torpor of the pancreas.
Torpor of the kidney.
Mucous fpots on the face*
Tawny blots on the fkin»
Grey hairs.
Callus.

Innutrition of the bones.

Rickets.

Diftortion of the fpine.

Lamenefs of the hip.

Protuberant fpine.

Divided fpine.

Defccl: of the palate.

GENUS III.

With decreafed Actions of the Abforbent Svftem,
SPECIES.

Mucus fauciamfrigidus.
Sudor frigidus .
Gatarrhusfrigidus.
Expeftoratio frigicla.
Urina uberior pallida.
Diarrhcea frigid a.

7. Fluor albus frigidus,

8 . Gonorrhoea frigidn.

Cold mucus from the throaty

fweat.

catarrh.

expectoration.

Copious pale urine.
Cold diarrhoea.
— — Fluor albus.
gonorrhoea.

9. Hepaiis

DISEASES

CLASS I. 2* 4,

9-

"/j tumor.

10.

Cbhrofis.

Ji.

Hydrocele.

12.

Hydrcct'pkahts interims.

J3-

JJjclUs.

14.

Hydrotborax.

*5-

Hy drops ovarii.

16.

Analnrca pulmcmrm.

*7-

Qbefiifis'*

1 8.

Splenis turner.

19.

Get ut tumor all us.

20.

Broncbccele.

21.

Scrofula*

22.

Scirrh'tf.

23.

refli.

24.

, t/f*&tJuf*&

' cefoph

Laaeornm imrritabilita,

2 7 . Z- ymphaiicoru m inlri'iia bill-

Swelling of the liver.

.Green ficknefs.

Dropiy of the vagina teftis.

• of the brain.

of the belly.

of the cheft.

of the ovary.

• — of the lungs.

Corpulency.

Swelling of the fpleen.

White {welling of the knee.

Swelled throat.

King's evil.

Scirrhus.

of the return.

of the urethra.

• of the throat.

Inirritability of the lafteals.
Inirritability of the lymphatics,

tas.

GENUS IV.

Wtih decreajcd Actions of other Cavities and Membranes.
SPECIES.

I.

Sifts calida.
— ' -- frigula.
Efuries.
Nanfeajicca.
JR grit udo vetttricuK.
Cardialgia*
6. Arthritis ventriculi.
"j. Colicajtatu'etita.
8. Colica faturnina.
^. Tympanitis.
lo. Hypochondriajis.
1 1 . Cefihalaa idiopathica.
I 2- Hcmicrania idiopathica.
_ •. tydontalgia.

'pa.

1 4 . Pleurodyne chronica.
1 5. Sciatica frigida.

. L n in oago frrnda.
17. .Hv/leriilgia frigida*
•I 8. 1 * ^clc.lgia frigidn.

Third warm.

cold.

Hunger.

Dry naufea.

Sicknefs of ftomach,

Keart-burn.

Gout of the ftomach.

Flatulent colic.

Colic from lead.

Tympany.

Hypochondriac ifm.

Idiopathic head-ach.

Idiopathic hemicrania.

Tooth -ach.

Ear-ach.

Chronical pain of the fide/

Cold fciatica.

lumbago.

pain of the uterus.

pain of the reclium.

19

CLASS I. 3. i. OF IRRITATION. 7

19. Vefic£ fdle<z inirritabilitas Inirritability of the gall-blacIJer
etifterus. and jaundice.

GENUS V.

With decreafed AH ions of the Organs ofSenfe.
SPECIES.

1. Stultitia inirritabilis. Folly from irritability.

2. Vifus imminutiis. Impaired vifion.

3. Mufce volitantes. Dark moving fpecks.

4. Strabifmus. Squinting.

5. Amaurcfis. Palfy of the optic nerve,

6. Auditus imminutiis. Impaired hearing.

7. Olfatlus imminutus. fmell.

8. Gujlus immmutus. — tafte.

9. Taclus imminutus. touch.

lo. Stupor. Stupor.

ORDO III.

Retrograde Irritative Motions.

GENUS I.

Of the Alimentary Canal.
SPECIES.

1. Ruminatio. Chewing the cud.

2. Ruflus. Eru&ation.

3. Apepfia. Indigeftion, water-qualm.

4. Vomitus. Vomiting.

5. Cholera. Cholera.

6. Ileus. Iliac paflion.

7. Globus hyjiericiis. Hyfteric ftrangulation. %

8. Vomen di conamen inane. Vain efforts to vomit.

9. Borborigmus. Gurgling of the bowels.

10. Hyfteria. Hyfteric difeafe.

1 1 . Hydrophobia. Dread of water.

GENUS II.

Of the Abforbent Syftem.

SPECIES.

1. Catarrhus lymphaticus. Lymphatic catarrh.

2. Sa/ivatio lympbatica. Lymphatic falivation.

3. Naufea humida. Moift naufea.

4. Diarrhea lympbatica. Lymphatic flux.

5. Diarrhoea chylifera. Flux of chyle.

6. Diabetes.

i DISEASES, &c, CLASS I. 3. 31

6. Diabetes. Diabetes.

7. Sudor lymphaticus. Lymphatic fweat.
8- Sudor afthmaticus. Afthmatic fweat.

9. Tranjlatio puris. Tranflation of matter.

j0. laftis. of milk,

II. . — — urina. of urine.

GENUS III.

Of the Sanjrttiferouf Syfteni*
SPECIES. '

1. Capillarium motus refrogref- Retrograde motion of the ca~
fus. pillaries.

2. Palpitatio cordis. Palpitation of the heart.

3. Anhelatio fpflfmodica* Spafmodic panting.

CLASS

CLASS I. i, r. DISEASES, £c. 9

CLASS I.

DISEASES OF IRRITATION.

ORDO I.

Increafed Irritation.

GENUS I.
With increafed aclions of the Sanguifirous Syjlem,

THE irritability of the whole, or of part, of our fyftem is per-
petually changing ; thefe viciffitudes of irritability and of inir-
ritability are believed to depend on the accumulation or exhauf-
tion of the fenforial power, as their proximate caufe ; and on the.
difference of the prefent ftimulus, and of that which we had
previoufly been accuftomed to, as their remote caufe. Thus a
fmaller degree of heat produces pain and inflammation in our
hands, after they have been for a time immerfed in fnow ;
which is owing to the accumulation of fenforial power in the
moving fibres of the cutaneous vefiels during their previous qui-
efcftice, when they were benumbed with cold. And we feel
ourfelves cold in the ufual temperature of the atmofphere on
coming out of a warm room ; which is owing to the exhauftion
of fenforial power in the moving fibres of the veffels of the (kin.
by their previous increafed activity, into which they were exci-
ted by unufual heat.

Hence the cold fits of fever are the occafion of the fucceedmg
hot ones ; and the hot fits contribute to occafion in their turn
the fucceeding cold ones. And though the increafe of ftimulus,
as of heat, exercife, or diftention, will produce an increafed ac-
tion of the ftimulated fibres ; in the fame manner as it is pro-
duced by the increafed irritability which was occafioned by a
previous defect of ftimulus ; yet as the excelles of irritation from
the ftimulus of external things are more eafily avoided than the
deficiencies of it ; the difeafes of this country, except thofe which
are the confequences of drunkennefs, or of immoderate exercife,
more frequently begin with torpor than with orgafm j that is*
with inactivity of fome parts, or of the whole of the fyftem, and
confequent coldnefs, than with increafed -activity, and confe-
quent heat.

If the hot fit be the confequence of the cold one, it may be
aflced if they are proportionate to each other : it ft probable that

VOL. II. C the*

io . DISEASES ^ CLASS I. i. i. *„

they are, where no part is deftroyed by the cold fit, as in morti-
fication or death. But we have no meafure to diftinguifli this,
except the time of their duration •, whereas the extent of the
torpor over a greater or lefs part of the fyftem, which occafions
the cold fit ; or of the exertion which occafions the hot one •, as
well as the degree of fuch torpor or exertion, are perhaps more
material than the time of their duration. Befides this, fome
rnufcles are lefs liable to accumulate fenforial power during their
torpor, than others, as the locomotive mufcles compared with
the capillary arteries j on all which accounts a long cold fit may
often be followed by a fhort hot one.

As the torpor, with which a fit of fever commences, is feme-
times^ owing to defeft of ftimulus, as in going into the cold-
bath 5 and fometimes to a previous exhauflion of the fenforial
power by the action of fome violent ftimulus, as after coming
out of a hot room into cold air •, a longer time muft elapfe, be-
fore there can be a fufficient accumulation of fenforial power to
produce a hot fit in one cafe than in the other. Becaufe in the
latter cafe the quantity of fenforial power previoufly expended
rnuft be fupplied, before an accumulation can begin.

The cold paroxyfm commences, when the torpor of a part be-
comes fo great, and its motions in confequence fo flow or feeble,
as not to excite the fenforial power of affociation 5 which in
health contributes to move the reft of the fyftem, which is •ite-
nated with it. And the hot fit commences by the accumulation of
the fenforial power of irritation of the part firft affected, either
ib as .to counteract its deficient ftimulus, or its previous wafte of
fenforial power ; and it becomes general by the accumulation of
the fenforial power of afTociation ; which is excited by the reno-
vated-actions of the part firft affeded j or becomes fo great as to-
overbalance the deficient excitement cf it. On all thefe accounts
the hot fit cannot be fuppofed to bear any proportion to the cold
one in length of time, though the latter may be the confequence
of the former. See Suppl. I. 16. 8.

SPECIES.

1. Felris irritativa. Irritative fever. This is the fynocha of
fome writers, it is attended with ftrong piilie without inflama-
tion ; and in this circumftance differs from the febris inirritativa
ofClalsI. 2. i. T. which is attended with weak pulfe without
inflammation. The increafed frequency of the pulfation of the
heart and arteries conftitutes fever ; during the cold fit thefe
pulfations are always weak, as the energy of action is then de-
d throughout the whole fyftem •, and therefore the gener-
al

CLASS I. i. i. 2. 07 IRRITATION. n

al arterial ftrength cannot be determined by the touch, till the
part of the parcxyfm ceafes. This determination is fome-
times attended with difficulty ; as ftrong and weak are only com-
parative ae grees of the greater or Ids refiftance of the pulfation
of the artery to the compreilion of the finger. But the greater
or lefs frequency of the pulfations affords a collateral evidence
in thofe caies, where the degree of ftrength is not very diftin-
guifhable, which may arTift cur judgment concerning :c. Since
a moderatelv ilrong pulfe, when the patier.t is in a recumbent
pofture, and not hurried in mind, feldom exceeds 120 ilrokes in
a minute ; whereas a weak one often exceeds 130 in a recum-
bent poflure, and 150 in an eredl one, in thofe fevers, which
are termed nervous or putrid. See Seel. XII. i. 4.

The increafcd frequency of the pulfatien. of the heart and ar-
teries, as it is occafioned either by excefs or defect of ftimiilus, or
of fenforial power, exifls both in the cold and hot fits of fever ;
but when the cold fit ceafes, and the pulfe becomes ftrong and
full as well as quick, in confequence of the increafed irritability
,of the heart and arteries, it conftitutes the irritative fever, or fy-
nocha. It is attended with confiderable heat during the parox-
yfm, and generally terminates in a quarter of a lunation, without
anydifturbance of the faculties of the mind. SeeClafsIV. i. 1.8.

M. M. Venefetlion. Emetics. Cathartics. Cool the patient
in the hot fit, and warm him in the cold one. Reft. Torp,

2. Ebrittas. Drunkennefs. By the ftimulus of wine or opi-
um the whole arterial fyftem, as well as every other part of the
moving fyftem, is excited into increafed action. All thefe fe~
cretions, and with them the production of fenforial power itfelf
in tlvj brain, feem to be for a time increafed, with an additional
quantity of heat, and of pleafurable fenfation. See Seel:. XXI.
on this kibjecl. This explains, why at the commencement of
the warm paroxyfm of fome fevers the patient is in greater fpir-
its, or vivacity ; becaufe, as in drunkennefs, the irritative motions
are all increafed, and a greater production of fenfation is the con-
fequence, which, when in a certain degree, is pleafurable, as in
the diurnal fever of weak people. Sect. XXXVI. 3.1.

3. Hcemorrbagia arteriofa. Arterial haemorrhage. Bleeding
with a quick, ftrong, and full pulfe. The hemorrhages from
the lungs, and from the nofe, are the molt frequent of thefe -, but
it fometimes happens, that a fmall artery but half.divided, or the
puncture of a leech, will continue to bleed pertinacioufly.

M. M. Venefe£lion. Cathartic with calomel. Divide the
wounded artery. Bind fponge on the puncture. If coffee or
, internally ? If air, with leis oxygen ?

4. Hjemtyt-:? arteriofa. Spitting of arterial blood. Blood fpit

4.2 DISEASES CLASS I. i. *. 5,

.up from the lungs is florid, becaufe it has juft been expofed to the
influence of the air in its paiTage through the extremities of the
pulmonary artery •, it is frothy, from the admixture of air with it
in the bronchia. The patients frequently vomit at the fame time
from the difagreeable titillatipn of blood aboutthe fauces ; and are
thence liable to believe, that the blood is ejected from the ftomach.
Sometimes an hsemoptoe for feveral fucceffive days returns in
gouty perfons without danger, and feems to fupply the place of
the gouty paroxyfms. Is not the liver always difeafed previous
to the hsmioptoe, as in feveral other haemorrhages ? See Clafs

I. 2. I. 9.

M. M. VenefecUow, a purge, a blifter, diluents, torpentia ;
and afterwards forbentia, as the bark, the acid of vitriol, and
opium. An emetic is faid to flop a pulmonary haemorrhage,
which it may efFe£l, as ficknefs decreafes the circulation, as is
very evident in the great ficknefs fometimes produced by too large
a dofe of digitalis purpurea.

Dr. Rum fays, a table-fpponful or two of common fait is fuc-
cefsful in haemoptoe ; this may be owing to its ftimulating the
abforbent fyftems, both the lymphatic, and the venous. Should
the patient refpire air with lefs oxygen ? or be made fick by
•whirling round in a chair fufpended by a rope ? One immer-
fion in cold water, or a fudden fprinkling all over with cold
water, would probably flop a pulmonary hcemprrhage. Sec
Sea. XXVII. i.

5. H&morrhagia narium. Epiftaxis. Bleeding at the nofe in,
elderly fubjects moft frequently attends thofe, whofe livers are
enlarged or inflamed by the too frequent ufe of fermented liquors.

In boys it occurs perhaps fimply from redundancy of blood ;
and in young girls fometimes precedes the approach of the cata-
jnenia ; and then it (hews a difpofition contrary to chlorofis ;
which arifes from a deficiency of red blood.

M. M. It is flopped by plunging the head into cold water,
with powdered fait haftily diflblved in it ; or fometimes by lint
ftrewed over with wheat flower put up the noftrils ; or by a folu-
tion of fteel in brandy applied to the vefTel by means of lint. The
cure in other refpeclis as in hjemoptoe ; when the bleeding recurs
at certain periods, after venefecl:ion, and evacuation by calomel,
and a blifter, the bark and fteel muft be given, as in intermittent
fevers. See Sedion XXVII. i.

The tindlure of digitalis given in proper quantities, as 30
drops from a two-ounce phial every fix hours for two or three or
four dofes, is probably an efficacious medicine. See Dr. Ferri-
ar's Treatife on Digitalis. He flopped ad~live haemorrhages by
the exhibition of digitalis,

ORDCX

tlsLj.2. i. OF IRRITATION. T3

-ORDO I.

Increafed Irritation.

GENUS II.
With Increafed Afiipns of the Secerning Syfem.

THESE are always attended with increafe of partial or of gen*
tral heat ; for the fecreted fluids are not (imply feparated from
the blood, but are new combinations ; as they did not previoufly
exift asfuch in the blood veflels. But all new combinations give
out heat chemically ; hence the origin, of animal heat, which
is always inc^eafed in proportion to the fecretion of the part
affected, or to the general quantity of the fecretions. Neverthe-
lefs there is reaibn to believe, that as we have a fenfe purpofely
to diftinguilh the prefence of greater or lefs quantities of heat,
as mentioned in Seel. XIV. 6. fo we may have certain minute
glands for the fecretion of this fluid, as the brain is believed to
fecrete the fenforial power, which would more eafily account for
the inftantaneous production of the blufh of (hame, and of an-
ger. This fubjeft deferves further investigation.

SPECIES.

1 . Color felr ills. The heat in fevers arifes from the mcreafc
of fome fecretion, either of the natural fluids, as in irrita-
tive fevers ; or of new fluids, as in infectious fevers ; or of new
veflels, as in inflammatory fevers. The pain of heat is a confe-
quence of the increafed extenfion or contraction of the fibres
expofed to fo great a ftimulus. See Clafs I. i. 5. 6.

2. Ruborfebrilts. Febrile rednefs. When the cold fit of fe-
ver terminates, and the pulfations of the heart and arteries be-
come ftrong as well as quick from the increafe of their irritabili-
ty after their late quiefcence, the blood is impelled forwards in-
to t'he fine extremities of the arteries, and the anaftainofmg ca-
pillaries, quicker than the extremities of the veins can abforb
and return it to the heart. Hence the pulfe at the wriil becomes
full, as well as quick and ftrong, and the (kin glows with arte-
rial blood, and the veins become empty and lefs vifible.

In elderly people the force of the heart and arteries becomes
lefs, while the abforbent power of the veins remains the fame ;
whence the capillary veflels part with the blood, as foon as it is
Deceived, and the fkin in confequence becomes paler \ it is alfo

probable,

:4 DISEASES CLASS I. i. 2. 3.

probable, that in more advanced life fome of the finer branches
of the arteries coalefce, and become impervious, and thus add to
the opacity of .the fkin.

3. Sudor calidus. Warm fweat may be .divided into four va-
rieties, according to its remote caufes. Firfty the perfpirable
matter is feoreted in as great quantity during the hot fit of fever,
as towards the end of it, when the fweat is feen upon the fkin.
But during the hot jit the cutaneous ab foments act alfo with in-
creaied energy, and the exhalation is likewife increafed by the
greater heat of the fkin j and hence it does not appear in drops
on the furface, but is in part re-abforbed, and in part diflipated
in the atmofphere. But as the mouths of the cutaneous abforb-
ents are expofed to the cool air or bedclothes ; whilft thofe of
the cr.piiiary glands, which fecrete the perfpirable m.itter, are ex-
pofed to the warmth of the circulating blood ; the former, as
foon as the fever-fit begins to decline, lofe their increafed action
•firft, and hence the abiorption of the fweat is diminiihed, whild
the incr.eafed fecretion of it continues for fome hours afterwards,
which occafions it to ftand in drops upon the fkin.

As the /kin becomes cooler, the evaporation of the perfpira-
ble matter becomes lefs, as \vell as the abforption of it. And
hence the diffipation of aqueous fluid from the body, and the
confequent third, are perhaps greater during the hot fit, than
during the fubfequent fweat. For the fweats do not occur, ac-
cording to Dr. Alexander's experiments, till the {kin is cooled
from 1 12 to 1 08 degrees of heat ; that is, till the paroxyfm be-
gins to decline. From this it appears, that the fweats are not
critical to the hot fit, any more than the hot fit can be called
critical to the cold one -, but fimply, that they are the natural
confluence of the decline of the hot fit, commencing with the
decreafed action of the abforbent fyftem, and the decreafed evap-
oration from the (kin. And from hence it may be concluded,
that a fever-fit is not in general an effort of nature to reftore
health, as Sydenham confidered it, but a neceffary confequence
of the previous torpor ; and that the caufes of fevers would be
lefs detrimental, if the fever itfelf could be prevented from exj(l>
ing •, as appears in the cool treatment of the fmall-pox.

It muft be noted that the profufe fweats on the 1km are more
frequent at the decline of fever-fits than the copious urine, or
looie ilools, which are mentioned below ; as the cutaneous ab-
forbents, being expofed to the cool air, lofe their increafed ac-
tion {boner than the urinary or inteflinal abforbents *, which
open inro the warm cavities of the bladder and inteftines ; but
which are neverthelefs often affected by their fympathy with the
cutaneous abforbents. Hence few fevers terminate without a

moiilure

CLASS I. r. 2. 3. OF IRRITATION. :;

moifture of the (kin ; whence arofe the fatal practice of
forcing fweats by the external warmth of air or bed-clothes in
rs ; for external warmth increafes the action of the cutane-
ous capillaries more than that of the other fecerning veflels ; be-
caufe the latter are habituated to 98 degrees of heat, the inter-
nal warmth of the body ;- whereas the cutaneous capillaries be-
inc; nearer the furface are habitually kept cooler by the contact
ofthe external air. Sweats thus produced by heat in confined
rooms are (till more detrimental ; as the air becomes then not
only deprived of a part of its o.v frequent refphation,

but is loaded wirh ?.nimal effluvia as well as with moifture, till
it can receive no more ^ and in confequence, while the cutane-
ous fecretion (lands upon the fkin in drops for want of exhala-
tion, the lungs are expofed to an infalubrious atmofphere.

I do not deny, that fweating may be fo managed as to be
ferviceable in preventing the return of the cold paroxyifm of fe-
vers , like the warm bath, or any other permanent ftimulus, as
wine, or opium, or the bark. For this purpofe it ihould be con-
tinued till paft the time of the expected cold fit, fupported by
moderate dofes of wine-whey, with fpirit of hartmorn, and mod-
erate degrees of warmth. Its falutary effect, when thus man-
aged, was probably one caufe of its having been fo much attend-
ed to ; and the fetid fmell, which when profufe is liable to ac-
company it, gave occafion to the belief, that the fuppofed mate-
rial caufe of the difeafe was thus eliminated from the circulation.

When too great external heat is applied, the fyftem is weak-
ened by excefs of action, and the torpor which caufes the cold
paroxyfm recurs fooner and more violently. For though fome
flimuli, as of opium and alcohol, at the fame time that they ex-
hauft the fenforial power by promoting increafe of fibrous action,
may alfo increafe the production or fecretion of it in the brain,
yet experience teaches us that the exhauftion far out-balances
the increafed production, as is evinced by the general debility,
which fucceeds intoxication.

In refpect to the fetor attending copious continued fweats, it
is owing to the animalized part of this fluid being kept in that
degree of warmth, which molt favours putrefaction, and not fuf-
fered to exhale into the atmofphere. Broth, or other animal
mucus, kept in fimilar circumftances, would in the fame time
acquire a putrid fmell ; yet has this error frequently produced
miliary eruptions, and increafed every kind of inflammatory or
fenfitive fever.

The cafe, which the patient experiences during fweating, if
it be not produced by much external heat, is fimiiar to that of
the warm bath j which by its ftimulus applied to the cutaneous

veflels,

1 6 DISEASES CLASS!, i.:

veffels, which are generally cooler than the internal parts
fyftem, excites them into greater action ; and pleafurable fenfa-
tion is the confequence of thefe increafed actions of the vefiels
of the (kin. From confiderrng all thefe circumftances, it ap-
pears that it is not the evacuation by fweats, but the continued
ftimulus, which caufes and fupports thole fweats, which is fer-
viceable in preventing the returns of fever-fits. And that fweats
too long continued, or induced by too great ftimulus of warmth,
clothes, or medicines, greatly injure the patient by increafmg in-
flammation, or by exhaufting the fenforial power. See Glafs I.
I. 2. 14.

Secondly, The fweats produced by exercife or labour are of
the warm kind ; as they originate from the increafed action of
the capillaries of the (kin, owing to their being more powerfully
itimulated by the greater velocity of the blood, and by a greater
quantity of it paffing through them- in a given time For the
blood during violent exercife is carried forwards by the action
of the mufcles fafter in the arteries, than it can be taken up by
the veins ; as appears by the rednefs of the fkin. And from
the confequent fweats, it is evinced, that the fecretory veiTels of
the fkin during exercife pour out the perfpirable matter fafter,
than the mouths of the abforbent veifels can drink it up. Which
mouths are riot expofed to the increafed mufcular action, or to
the ftimulus of the increafed velocity and quantity of the blood*
but to the cool air.

Thirdly^ the increafed fecretion of perfpirable matter occafion-
ed by the ftimulus of exteral heat belongs likewife to this place 5
as it is caufed by the increafed motions of the capillary veffels 5
•which thus feparate from the blood more perfpirable matter,
than the mouths of their correfpondent abforbent veffels can take
up ; though thefe alfo are ftimulated by external heat into more
energetic action. If the air be ftationary, as in a fmall room,
or bed with clofed curtains, the fweat {lands in drops on the fkin
for want of a quicker exhalation proportioned to the quicker fe*
cretion.

A fourth variety of warm perfpiration is that occafioned by
llimulating drugs, of which opitfm and alcohol are the moft
powerful ; and next to thefe the fpices, volatile alkali, and neu-
tral falts, efpecially fea-falt ; that much of the aqueous part of
the blood is diffipated by the ufe of thefe drugs, is evinced by the
great thirft, which occurs a few hours after the ufe of them. Sea
Art. III. 2. i.

We may from hence underftand, that the increafe of this
fecretion of perfpirable matter by artificial means, muft be fol-
lowed by debility and emaciation. When this is done by taking

much

CLASS I. i. 2. 3. OF IRRITATION. 17

inach fait, or falted meat, the fea-fcurvy is produced ; which
confiit i in the inirritability of the bibulous terminations of the
Veins arifing from the capillaries j fee Clafs I. 2. i. 14. Tha
fcrofula, or inirritability of the lymphatic glands, feems alib to be
occafion-illy induced by an excefs in eating fait added to food of
bad nouri foment. See Clafs I. 2'. 3. 21. If an excefs of per-
fpiration is induced by warm or ftimulant clothing, as by wear-
ing flannel in contact with the (kin in the fiimmer months, a per-
petual febricula is excited, both by the preventing the accefs of
cool air to the {kin, and by perpetually goading it by the numerous
and hard points of the ends of the wool j which when applied to
the tender fkinsof young children, frequently produce the red
gum, as it is called ; and in grown people, either an eryfipe-
las, or a miliary eruption, attended with fever. See Ciafs II.
i. 3. 12.

Shirts made of cotton or calico ftimulate ths (kiri too much
by the points of the fibres, though lefs than flannel ; whence
cotton handkerchiefs make the note fore by frequent ufe. The
fibres of cotton are, I fuppofe, ten times fhorter than thofe of
flax, and the number of points in confequence twenty times the
number; and though the manufacturers fmge their calicoes on a
red-hot iron cylinder, yet I have more than once teen an eryiip-
elas induced or increaied by the ftimulus of calico, as well as of
flannel j and have during the lail fummer prevailed on two, who
were confined to their beds by fevers, and three, who were in a
ftate of great debility, to difencumber themfeJves of the flan-
nel Hurts, which they had worn for fome time j all of them be-
came immediately and confiderably relieved ; and found no in-
convenience afterwards by difcontinuing an unneceflary ftimulus,
•which had nothing to recommend it to thofe patients but the
frivolous fafhion of the day.

The inconvenience^ which weak conftitutions experience frorri
wearing flannel fhirts, arifes from this circumitance 5 that the ex-
tremities of their limbs are more liable to become cold, than the
furface of the cheil and abdomen, and that hence they fhould in
preference wear warmer (lockings, (hoes, and focks, or gloves.
By ilimulating the warmer parts of the (kin into too ftrong and
iifelefs exertion, as by the hard points of a flannel fnirt at ali iea-
fons, and by its confining the warmth of the (kin too much i:i
the fummer months, a part of the fcnforial power becomes un-
neceflarily expended ; and in weak conftitutions, where there is
none to fpare, fome other parts of the fyftem mud act with Icfs
energy ; and thus I believe the extremities of feeble people be-
come colder by the ufe of a flannel fliirt ; in ftronger people, and
perhaps in warmer climates, this increafsd cakiaefs of the e.t-

Vol. II. D treuiiti".,

1 8 DISEASES CLASS I. i. 2. £

tremities may not be perceptible ; as flronger perfons can better
bear fome iucreafed exertion, and the confequent unneceflary lofs
of fome fenforial power ; and in warmer climates the extremi-
ties may not be fo liable to become cold.

Analogous to this I remember to have feen an inoculated child
about fix years old, whofe bofom and face, at the beginning of the
eruptive fever, were of a fiery red colour, and exceedingly hot to
the touch ; and whofe feet were at the fame time pale, and cold
to the touch. When on expofmg the bofom and face to colder
air with the feet only {lightly covered, the colour of the former in
a few minutes became nearly natural, with little excefs of tangi-
ble heat, and at the fame time the feet became as warm as natural.

Whence I conclude, that all unneceffary increafe of ftimuli, as
of warm clothing, wine, and opium, is more injurious to fee-
ble conftitutions than to robuft ones ; and that fuch ilimuli alone
are falutary to weak perfons, ao increafe thofe actions of the fyf-
tem, which are immediately neceflary to life and health, as the
clafs of medicines termed forbentia, as peruvian bark, and other
bitters, and very fmall quantities of fteel, as thefe feem to increafe
the activity of the abforbent fyftem, both of the lymphatic and
venous ones, and thus fupply more nutrition, with all its falutary
confequences. And that the ufe of thefe forbentia, as well as of
the occafional ufe of warmer clothing, wine, and opium, fhould
be difcontinued, as foon as the fyftem can acquire the natural
habit of acling with fufficient energy without them. See Article
II. 2. 2. i. of the Materia Medica.

The increafe of perfpiration by heat either of clothes, or of fire,,
contributes much to emaciate the body ; as is well known to jock-
eys, who, when they are a ftone or two too heavy for riding,
find the quickeft way to lefTen their weight is by fweating them-
felves between blankets in a warm room j but this likewife is a
pradtice by no means to be recommended, as it weakens the fyf-
tem by the excefs of fo general a ftimulus, brings on a premature
old age, and mortens the fpan of life ; as raay be further deduced
from the quick maturity, and fhortnefs of the lives, of the inhab-
itants of Hindoftan, and other tropical climates.

When the heat of the body in weak patients in fevers is incrcaf-
ed by the ftimulus of the points of flannel, a greater eonfequent
debility fucceeds, than when it is produced by the warmth of
fire ; as in the former the heat is in part owing to the increafed
activity of the (kin, and confequent expenditure of fenforial pow-
er ; whereas in the latter cafe it is in part owing to the influx of
the rluki matter of heat.

So the warmth produced by equitation, or by rubbing the body
and limbs with a frnooth bruih or hand,, as is done after bathing

CLASS L i. 2. 4- OF IRRITATION. 19

in fome parts of the Haft, does not expend nearly fo much
! power, as when the warmth is produced by the loc
tion of the whole weight of the body by mufcular action, as in
walking, or running, or fwimming. Whence the warmth of a
fire is to be preferred to flannel {khts for weak people, and the

.tion of a horfe :to exereife on foot. And I fuppofe v
who are unfortunately loft in fnow, who are on foot, are
to perifli fooner by being exhaufted by their mufcular exertions ;
and might frequently preferve themfelves by lying on the ground,
.and covering themfelves with fnow, before they were too much,
exhaufted by fatigue. See Botari. Garden, Vol. II. the note on
netz.

M. BuiTon made a curious experiment to (hew this
fiance. He took a numerous brood of the butterflies of
worms, fome hundreds of which left their eggs on the fame day
and hour ; thefe he divided into two parcels ; and placing on
eel in the fouth window, and the other in the north window -
houfe, he obferved, that thofe in the colder iituation lived many
days longer than thofe in the warmer one. From thefe obferva-
tioni.it appears, tLat the wearing of flannel clothing next the fkin,
which is now fo much in falhion, however ufefui it may be in
the winter to thofe, who have cold extremities, bad digeftions, or
habitual coughs, muft greatly debilitate them, if worn in the warm
months, producing fevers, eruptions, and premature old age.
See Sea. XXXVII. 5. Clafs I. i. 2. 14. Art. III. 2. i.

4. Urina uberior colorata. Copious coloured urine. To-
wards the end of fever-fits a large quantity of high coloured
urine is voided, the kidneys continuing to act ftrongly, after the
increafed action of the abforbents of the bladder is fume;
diminifhed. If the abforbents continue alfo to aft ftrongly, the
urine is higher coloured, and fo leaded as to depofit, when cool,
an earthy fediment, erroneoufly thought to be the material caufe
of the difeafe j but is fimply owing to the fecretion of the kid
being great from their increafed action ; and the thinner parts
of it being abforbed by the increafed action of the lymphatics,
which are fpread very thick on the neck of the bladder ; for the
urine, as well as perhaps all the other fecreted fluids, is produced
from the kidneys in a very dilute ftate ; as appears in thofe,
who from the ftimulus of a ftone, or other caufe, evacuate their
urine too frequently; which is then pale from its not having
remained in the bladder long enough for the more aqueous part
to have been re-abforbed. The general ufe of this urinary ab-
forption to the animal ceconomy is evinced from the urinary blad-
ders of fifh, which would otherwife be unneceflary. High col-
oured urine in large quantity fhews only, that the fecreting vef-

20 DISEASES CLASS I. i. 2. 5,

fels of the kidneys, and the abforbents of the bladder, have a^e t
with greater energy. When there is much earthy fediment, it
ihews, that the abforbents have acled proportionally ftronger,
and have confequently left the urine in a lefs dilute frate. Iii
this urine the tranfparent fediment or cloud is mucous •> the
opaque fediment is probably coagulable lymph from the blood
changed by an animal or chemical procefs. The floating fcum
is oil. The angular concretions to the fides of the pot, iormed
as the urine cools, is microcofmic fait. £)oes the adhefive blue
matter on the fides of the glafs, or the blue circle on it at the
edge of the upper furface of the urine, confift of Pruffian blue ?

5. Diarrhoea calida. Warm diarrhoea. This fpecies may
be divided into three varieties, deduced from their remote caufes,
under the names of diarrhoea febrilis, diarrhoea crapulofa, and
diarrhoea infantum. The febrile diarrhoea appears at the end
of fever-fits, and is erroneoufly called critical, like the copious
urine, and the fweats ; whereas it arifes from the increafed action
of thofe fecerning organs, which pour their fluids into the intef-
tinal canal (as the liver, pancreas, and mucous glands,) contin-
uing longer than the increafed action of the inteftinal abforbents.
In this diarrhoea there is no appearance of curdled chyle in th$
ilools, as occurs in cholera. I. 3. i. 5.

The diarrhoea crapulofa^ or diarrhoea from indigeftion, occurs
•when too great a quantity of food or liquid has been taken ;
which not being completely digeiled, flimulates the inteftines
like any other extraneous acrid material ; and thus produces an
increafe of the fecretions into them of mucus, pancreatic juice,
and bile. When the contents of fhe bowels are flill more flim-
ulant, as when draftic purges, or very putrefcent diet, have been
taken, a cholera is induced. See Seel:. XXIX. 4.

The diarrhoea infafitum, or diarrhoea of infants, is generally
owing to too great acidity in their bowels. Milk is found
curdled in the ftomachs of all animals, old as well as young, and
even of carnivorous ones, as of hawks, (Spallanzani.) And
at is the gaftric juice of the calf, which is employed to curdle
milk in the procefs of making cheefe. Milk is the natural food
for children, and muft curdle in their ftomachs previous to di-
geflion ; and as this curdling of the milk deftroys a part of the
acid juices of the ftomach, there is no reafon for difcontinuing
the ufe of it, though it is occafionally ejected in a curdled ftate.
A child of a week old, which had been taken from the breaft of
its dying mother, and had by forne uncommon error been fuf-
fered to take no food but water-gruel, became fick and griped
in twenty-four hours, and was convulfed on the fecond day, and
died on the third ! When all young quadrupeds, as well as

children,

,s I. i. 2. 6. OF IRRITATION. 21

children, have this natural food of milk prepared for them, tK*

; fo itrong in favour of its falubrity, that a perfoa

lei have powerful teftimony indeed of its difagreeing before

Ivifes the difccr.linuance of the ufe of it to young children

in health, and much more fo in iickneis. The farmers lofe many

of their calves, which are brought up by gruel, or gruel and

old milk ; and among the poor children cf Derby, who are

thus fed, hundreds are flarved into the fcrqfula, and either perifli,

or live in a (late of wretched debility.

When young children are brought up without a bread, they
(houid for the firft tv/o months have no food but new miJk ;
fince the addition of any kind of bread or flour is liable to fer-.
ment, and produce too much acidity ; as appears by the confe-
quent diarrhcea with green dejections and gripes ; the colour is
owing to a mixture of acid with the natural quantity of bile, and
the pain to its itimulus. And they ihould never be fed as they
lie upon their backs, as in that pofture they are neceffitated to
iwailow all that is put into their mouths ; but when they are fed,
as they are fitting up, or raifed up, when they have had enough,
they can permit the reft to run out of their mouths. This cir-
cumftance is of great importance to the health of thofe children,
who are reared by the fpoon, fince if too much food is given
them, indigeition,and gripes, and diarrhoea, are the confequence;
and if too little, they become emaciated ; and of this exact
.<ju.mt.ity their own palates judge the beft.

M. M. In this laft cafe of the diarrhoea of children, the food
fhould be new milk, which by curdling deftroys part of the acid,
which coagulates it. Chalk about four grains every fix hours,
with one drop of fpirit of hartihorn, and half a drop of lauda-
r.u;Ti. But a blifter about the fize of a milling is of the greateit
ferviceby reftoring the power of digeftion. See Article III. 2.
i . in the Materia Medica.

6. Salivatio callda. Warm falivation. Increafed fecretion of
fiiliva. This may be eifecled either by (limulating the mouth
of the gland by mercury taken internally ; or by ftimulating the
excretory duel: of the gland by pyrethrum, or tobacco; or (im-
rly by the movement of the mufcles, which lie over the gland, as
in maflicating any taftelefs fubftance, as a lock of wool, or
'Lie.

In about the middle of nervous fevers a great fpitting of fali-

vi foretimes occurs, which has been thought critical ; but as it

com.in.ues fometimes two or even three weeks without the relief

<<f the patient, it may be concluded to arife from fome acciden-

•rcumftance, perhaps not unfimilar to the hyfleric ptyalifms

•ioncd in Clais I. 3. 2. 2. See Sed. XXIV.

M, M. Coo]

22 DISEASES CLASS 1.1.2. 7:

M. M. Cool air, diluents, warm bath, evacuations.

7. Cxtarrkus calidus. Warm catarrh. Confifts in an in-
creafed Tecretion of mucus from the noftrils without inflamma-
tion. This difeafe, which is called a cold in the head, is fre-
quently produced by cold air acting for forne time on the mem-
branes, which line the noftrils, as it pafles to the lungs in refpi-
ration. Whence a torpor of the action of the mucous glands
is firlt introduced, as in Clafs I. 2. 3. 3. ,and an orp;afm or in-
creafed action fucceeds in confequence. Afterwards this orgafm
and torpor are liable to alternate with each other for fome time
like the cold and hot fits of ague, attended with deficient or exu-
berant fecretion of mucus in the noftrils.

At other times it arifesfrom reverfe fympathy with fome ex-
tenfive parts of the {kin, which have been expofed too long to
cold, as of the head, or feet. In confequence of the torpor of
thefe cutaneous capillaries thofe of the mucous membrane of the
noftrils act with greater energy by reverfe fympathy ; and thence
fecrete more mucus from the blood. At the fame time the ab-
forbents, acting alib with greater energy by their reverfe fym-
pathy with thole of fome diftant part of the fkin, abforb the
thinner parts of the mucus more haftily ; whence the mucus is
both thicker and in greater quantity. Other curious circumftan-
•ces attend this difeafe ; the. membrane becomes at times fo thick-
ened by its increafed aclion in fecreting the mucus, that the pa-
tient cannot breathe through his noftrils. In this fituation if he
v/arms his whole Ikin fuddenly by fire or bed-clothes, or by-
drinking warm tea, the increafed aclion of the membrane ceafes
by its reverfe fympathy with the fkin ; or by the retraction of
the fenforial power to other parts of the fyftem ; and the patient
can breathe again through the noftrils. The fame fometimes oc-
curs for a time on going into the cold air by the deduction of
heat from the mucous membrane, and its confequent inactivity
or torpor. Similar to this when the face and breaft have been
very hot and red, previous to the eruption of the fmall-pox by
inoculation, and that even when expoled to cool air, I have cb-
ferved the feet have been cold ; till on covering them with warm
flannel, as the feet have become warm, the face has cooled. See
Sea. XXXV. i. 3. Clafs II. 1.3.5. IV. 2. 2.10. IV. 1.1.5.

M. M. Evacuations, abftmence, oil externally on the noie,
warm diluent fluids, warm fhoes, warm night-cap.

8. Expeftwr.tio calida. Warm expectoration confifts of the
Increafed fecretion of mucus from the membrane, which lines
the bronchia?, or air-cells of the lungs, without inflammation.
This increafed mucus is ejected by the action of coughing, and

CLASS I, i. 2. 9. OF IRRITATK 23

is called a cold, and refembles the catarrh of the preceding arti-
: with which it is frequently combined.

M. M. Inhaling the (team of warm water, evacuations, warm
bath, afterwards opium, forbentia.

9. Exfiuiatio pvie aures. A difcharge behind the ears. This
chiefly affects children, and is a morbid fecretion ; as appears
from its fetcr ; for if it was owing to defect of abforption, it
would be faline, and not fetid ; if a morbid action has continued
a confiderable time, it (hould not be flopped too fuddenly ; fmce
in that cafe fome other morbid action is liable to fucceed in its
itead. Thus children are believed to have had colics, or even
convulfions, confequeBt to the too fudden healing of thefe mor-
bid effufions behind their ears. The rationale of this is to be ex-
plained from a medical facl, which I have frequently obierved ;
and that is, that a bliiler on the back greatly ftrengthens the
power ofdigeftion, and removes the heart-burn in adults, and
green (lools in children. The ftimulus of the blifter produces
ienfation in theveiTels of the fkin \ with this additional fenfori-
al power thefe veflels acl: more flrongly \ and with thefe the vef-
fels of the internal membranes of the ftomach and bowels ac~l
with greater energy from their direct fympathy with them.
Now the acrid difcharge behind the ears of children produces
fenfation on that part of the fkin, and fo far acts as a fmall blif-
ter. When this is fuddenly flopped, a debility of the digeftive
power of the ftomach fucceeds from the want of this accuilom-
ed ftimulus, with flatulency, green flools, gripes, and fometimes
confequent convulfions. See Clafs II. i. 5. 6. and II. i. 4. 6.

M. M. If the matter be abforbed, and produce fwelling of the
lymphatics of the neck, it mould be cured as foon as poffible by
dufting the part with white lead, cerufla, in very fine powder ;
and to prevent any ill confequence an iffiie {hould be kept for
about a month in the arm j or a purgative medicine {hould be
taken every other day for three or four times, which mould con-
fift of a grain of calomel, and three or four grains of rhubarb,
and as much chalk. If there be no appearance of abforption,
it is better only to keep the parts clean by warning them with
warm water morning and evening ; or putting fuller's earth on
them ; eipecially till the time of toothing is pail. The tinea, or
fcald head, and a leprous eruption, which often appears behind
the ears, are different difeafes.

10. GonorrKtiea calida. Warm gleet. Increafed difcharge of
mucus from the urethra or proftrate gland without venereal de-
lire, or venereal infection. See Clafs I. 2. 3. 8.

M. M. Camharidcs, balfams, rhubarb, biifler on perineum,

cold

2. 1 DISEASES CLASS I. r. i. iis

cold bath, injections of metallic falts, flannel fhirt, change of
the form of the accuftosned chair or faddle of the patient.

1 1. Fluor albus calidus. Warm fluor albus. Increafed fecre-
tion of mucus in the vagina or uterus without venereal defire of
venereal infection. It is diftinguiihed from the fiuor albus fn-T-
idus by the increafed fenfe of warmth in the part, and by the
greater opacity or fpiffitude of the material difcharged ; as the
thinner parts are re-abforbed by the increafed action of the ab-
ibrbents, along with the faliiie part, whence no fmarting or ex-
coriation attends it.

M. M. Mitcilage, as ifinglafs, hartfhorn jelly, gum arabic.
Ten grains of rhubarb every night. Calico or flannel fhift, Opi-
um, balfams. See Clafsl. 2. 3. 7.

12. Htzmorrhois alba. White piles. An increafed difcharge
of mucus from the rectum frequently miftaken for matter ; is
faid to continue a few weeks, and recur like the bleeding piles 5
and to obey lunar influence. See Clafs I. 2. I. 6.

M. M. Abflinence from vinous fpirit. Balfam of copaiva.
Spice fwallowed in large fragments, as ten or fifteen black pep-
per-corns cut in half, and taken after dinner and fupper. Warci's
pafte, confiding of black pepper and the powdered root of He-'
lenium Enula.

13. Serum e veficatoric. Difcharge from a blifler. The ex-
cretory duels of glands terminate in membranes, and are endu-
ed with great irritability, and many of them with fenfibility ; the
latter perhaps in confequence of their facility of being excitable
into great action ; inftances of this arc the terminations of th<;:'
gall-duel: in the duodenum, and of the falivary and lachrymal
glands in the mouth and eye ; which produce a greater fecre-
tion of their adapted fluids, when the ends of their excretory
duels are flimulated.

The external fkin confifts of the excretory duets of the capil-
laries, with the mouths of the abforbents ; when thefe are flim-
ulated by the application of cantharides, or by a flice of the frelh
root of bryonia alba bound on it, the capillary glands pour an
increafed quantity of fluid upon the fkin by their increafed ac-
tion ; and the abforbent veflels imbibe a greater quantity of the
more fluid and faline part of it j whence a thick mucous or fe-
f-bus fluid is depofited between the ikin and cuticle.

14. Perfpiratio foetida. Fetid perforation. The ufes of the
perfpirable matter are to keep the fkin foft and pliant, for the
purpofes of its eafier flexibility during the activity of our limbs iri
locomotion, and for the prefervation of the accuracy of the fenfo
of touch, which is difFufed under the whole furface of it to
guard us againfl the injuries of external bodies; in the fame

manner

CLASS!, i. 2. 14. OF IRRIGATION. 25

manner as the fecretion of tears is defigned to preferve the cor-
nea of the eye moift, and in confequence transparent ; yet has
this cutaneous mucus been believed by many to be an excre-
ment ; and I know not how many fanciful theories have been
built on its fuppofed obftruction. Such as the origin of catarrhs,
soughs, inflammations, eryfipelas, and herpes*

To all thefe it may be fufficient to anfwer, that the ancient
Grecians oiled themfelves all over ; that fome nations have
painted themfelves all over, as the Pi6ts of this ifland ; that the
Hottentots fmear themfelves all over with greafe. And laftly,
that many of our own heads at this day are covered with the
flour of wheat and the fat of hogs, according to the tyranny of a
filthy and wafteful fafhion, and all this without inconvenience.
To this muft be added the ftricl: analogy between the ufe of the
perfpirable matter and the mucous fluids, which are poured for
fimilar purpofes upon all the internal membranes of the body ;
and befides its being in its natural ftate inodorous ; which is
not fo with the other excretions of feces, Or of urine.

The quantity of perfpirable matter being greater than that of
the excrementitious matters voided by ftool and urine, has been
ufed as an argument in favour of its being an excrement ; the force
of which I de not fee : but can readily underftand, that there
muft of neceffity be a great exhalation of a fluid which is difFu-
fed over the whole external furface of the warm fkirt, and per-
haps warmer lungs, for the purpofe of keeping them moift and
pliant, and which is perpetually renewed as it evaporates ; but,
if it be conceived to be an excrement, there feems to have been
no neceffity for its quantity being fo great.

The evaporation of this great quantity of fluid, fecreted on the
farface of the fkin and lungs, muft carry off much heat from
the body ; and as both this fecretion and confequent evaporation
will be in proportion to the aclivity of the cutaneous veflels, and
the heat occafioned by their increafed fecretion, it would feem,
that this evaporation of perfpirable matter is the caufe which
preferves the animal body at the uniform degree of heat of 98 ;
in the fame manner as the evaporation of boiling water preferves
it at 2 1 2 degrees of Farenheit's fcale.

The peculiar ufe of the perfpirable matter in preferving the
membranes moift, which line the air-pipes of the lungs, appears
from the curious difcovery of Dr. Prieftley, that the oxygen of
the atmofphere will pafs through moift animal membranes, but
not through dry ones, fo that if the membranes of the trachea
were to become dry, the animal muft as immediately perifh as-
if he was to breath azotic gas alone. See Sect. XXVITI. 2. cf
the preceding volume.

VOL. II. E la

16 DISEASES CLASS 1. 1.2. 14.

In fome conftitutions the perfpirable matter of the lungs ac-
quires a difagreeable odour ; in others the axilla, and in others
the feet, emit difguilful effluvia ; like the fecretions of thofe
glands, which have been called odoriferse ; as thofe, which con-
tain the. caftor in the beaver, and thofe within the rectum of
dogs, the mucus of which has been fuppofed to guard them
again f I the great coftivenefs, which they are liable to in hot
fummers ; and which has been thought to occafion canine mad-
nefs, but which, like their white excrement, is more probably
owing to the deficient fecretion of bile. Whether thefe odorif-
erous particles attend the perfpirable matter in confequence of
the increafed action of the capillary glands, and properly be
called excrementitious ; that is, whether any thing is elimina-
ted, which could be hurtful if retained ; or whether they may
only contain fome of the eflential oil of the animal ; like the
fmdl, which adheres to one's hand on {broking the hides of
fome dogs ; or like the effluvia, which is left upon the ground,
from the feet of men and other creatures ; and is perceptible by
the nicer organs of the dogs, which hunt them, may admit of
doubt.

Add to this, that fome parts of the fkin are liable to more
profufe perfpiration than other parts without poffeiling any fetid
fcent, as the {kin of the face, on any more violent exercife. This
feenis to have been obferved very early in the hiftory of man-
kind, as it was faid, that our firft parents mould earn their bread
by the fweat of their brow. Why this circumftance does not
attend other animals is a curious inquiry. Mankind foon learn-
ed to cover their bodies, except their faces, with clothes •, when
the face, by being more frequently expofed to greater variations
of heat and cold, acquired greater irritability, or fenfibility, or
afibciability, and thus has become more excitable into greater ac-
tion by the ftimulus of exercife, or by that of food, or by the va-
riolus infection, than other parts of the fkin, as fpoken of m
Ciafs IV. i. 2. 1 2-, which alfo appears by its fympathy with
difeafes of the liver or ftomach by fenfitive aiTociations, as in the
gutta rofea. From all thefe analogous facts the profufe fweat,
which exudes from the face on exercife, does not appear to be
an excrementitious fluid, but fimply the confequence of more
violent action of the cutaneous or perfpirative glands.

M. M. Wafh the parts twice a day with foap and water ;
\vith lime water ; cover the feet with oiled filk locks, which
mult be waihed night and morning. Cover them with charcoal
recently made red hot, and beaten into fine powder and fifted,
as foon as cold, and kept well corked in a bottle, to be waflic-d

off

CLASS I. i. 2. 15. OF IRRITATION. 27

off and renewed twice a day. Internally rhubarb grains vi. or
viii. every night, fo as to procure a itool or two extraordinary
every day, and thus by increafing one evacuation to decreafe an-
other. Cool drefs, diluting liquids ?

15. Crines now. New hairs. The black points on the faces
of fome people confift of mucus, which is become vifcid, aiul
which adheres in the excretory du£ts of the glands of the fkin \
as defcribed in Clafs I. 2. 2. 9. and which may be prefled out
by the fingers, and refernbles little worms. Similar to this
would feem the fabrication of filk and of cobweb, by the filk-
worm and fpider ; which is a fecreted matter prefled through
holes, which are the excretory ducts of glands. And it is prob-
able, that the production of hair on many parts of the body, and
at different periods of life, may be effected by a fimilar procefs ;
and more especially as every hair may be confidered as a Header
flexible horn, and is an appendage of the fkin. See Seer.
XXXIX. 3. 2. Now as there is a fenfitive fympathy between
the glands, which fecrete the femen, and the throat, as appears
in the mumps ; fee Hydrophobia, Clafs IV. i. 2. 7. and Paroti-
tis, Clafs IV. i. 2. 19. the growth of the beard at puberty feems
to be caufed by the greater action of the cutaneous glands about
the chin and pubes in confequence of their fympathy with thofe
of the teftes. But this does not occur to the female fex at their
time of puberty, becaufe the fenfitive fympathy in them feems. to
exift between the fubmaxillary glands, and the pectoral ones ;
which fecrete the milk, and afford pleafure both by that fecre-
tion, and by the erection of the mammilla?, or nipples ; and
by delivering the milk into the mouth of the child ; this fen-
fitive fympathy of the pectoral and fubmaxillary glands in
women is alfo obfervable in the Parotitis, or mumps, as above
referred to.

When hairs grow on the face or arms fo as to be difagreea-
ble, they may be thus readily removed without pain or any ill
confequence. Warm the ends of a pair of nippers or forceps,
and ftick on them a little refin, or burgundy pitch ; by
thefe means each fmgle hair may be taken fafi hold of ; and
if it be then plucked off flowly, it gives pain ; but if plucked
off fuddenly, it gives no pain at all ; becaufe the vis inertia
of the part of the fkin, to which it adheres, is not overcome ;
and it is not in confequence feparated from the cellular mem-
brane under it. Some of the hairs may return, which are
thus plucked off, or others may be induced to grow near them ,
but in a little time they may be thus fafely deftroyed ; which
is much to be preferred to the methods faid to be ufed in Turkey

28 DISEASES CLASS I. i. 2. 15.

to eradicate hair 5 fuch as a mixture of orpiment and quick
lime ; or of liver of fulphur in folution •, which injure the fkin,
if they are not very nicely managed ; and the hair is liable to
grow again as after (having ; or to become white, if the roots
of it have been much inflamed by the caufticity of the applica-
tion. See Clafs I. 2. 2. i.i. on grey hairs.

pRDO

CLASS I. i. 3. i. OF IRRITATION, 29

ORDO I.

Increafed Irrit

GENUS Hf.
With increafed AElions of the Alforbent Syjlem.

THESE are not attended with fo great increafe of heat as in the
former genus, becaufe the fluids probably undergo lefs chemical
change in the glands of the abforbent fyftern j nor are the glands
of the abforbent vefiels fo numerous or fo extenfive as thole of
the fecerning ones. Yet that fome heat is produced by the in-
creafed aftion of the abforbents appears from the greater gener-
al warmth of the {kin and extremities of feeble patients after the
exhibition of the peruvian bark, and other medicines of the arti-
cle Sorbentia.

SPECIES.

I. Lingua arida. Dry tongue occurs in thofe fevers, where
the expired air is warmer than natural ; and happens to all thofe,
•who fleep with their mouths open ; the currents of air in refpi-
ration increafmg the evaporation. There is alfo a drynefs in
the mouth from the increafed action of the abforbent veflels,
when a floe or a crab-apple is mafticated ; and after the perfpi.
ration has been much increafed by eating fait or fpice, or after
other copious fecretions j as after drunkennefs, cathartics, or
fever fits, the mucus of the mouth becomes vifcid, and in fmall
quantity, from the increafed abforption, adhering to the tongue
like a white flough. In the diabetes, where the thirft is very
great, this flough adheres more pertinucioufly, and becomes black
or brown, being coloured after a few days by our aliment or
drink. The iiifpiflated mucus on the tongue of thofe, who fleep
with their mouths open, is fometimes reddened as if mixed with
blood, and fometimes a little blood follows the expuition of it
from the fauces owing to its great adhefion. When this mucus
adheres long to the papillae of the tongue, the faliva, which it
contains in its interilices, like a fponge, is liable to become pu-
trid, and to acquire a bitter tafte, like other putrid animal fub-
ftances ; which is generally miilaken for an indication of the
prefence of bile.

M. M. Warm fubacid liquids. See Clafs I. 2. 5. 8.

A-. Fattcfs aridx* Dry throat. The expuition of a frothy

mucus

30 DISEASES CLASS I. i. 3. 3.

mucus with great and perpetual hawking occurs in hydrophobia,
and is very diftreffing to the patient ; which may be owing to
the increafed irritability or fenfibility of the upper part of the
cefophagus, which will not permit any fluid to reft on it.

It affects fome people after intoxication, when the lungs re-
main flightly inflamed, and by the greater heat of the air in ex-
piration the mucus becomes too haliily evaporated, and is expec-
torated with difficulty in the ftate of white froth.

I knew a perfoa, who for twenty years always waked with his
tongue and throat quite dry ; fo that he was neceflitated to take
a fpoonful of water, as foon as he awoke ; otherwife a little blood
always followed the forcible expuition of the indurated mucus
from his fauces. See Clafs II. 1.3. 17.

M. M. Steel-fprings fixed to the night-cap fo as to fufpend the
lower jaw and keep it clofed ; or fprings of elaftic gum. Or a
pot of water fufpended over the bed, with a piece of lift, or
woollen cloth, depending from it, and held in the mouth ; which
will act like a fyphon, and flowly fupply moifture, or barley wa-
ter fhould be frequently fyringed into the mouth of the patient.

3. Nares aridi. Dry noftrils with the mucus hardening up-
on their internal furface, fo as to cover them with a kind of
ikin or fcale, owing to the increafed action of the abforbents of
this membrane ; or to the too great drynefs of the air, which
paiTes into the lungs j or too great heat of it in its expiration.

When air is fo dry as to lofe its tranfparency -, as when a trem-
ulous motion of it can be feen over corn-fields in a hot fummer's
day ; or when a dry mift, or want of tranfparency of the air, is
vifible in very hot weather \ the fenfe of fmell is at the fame
time imperfect from the drynefs of the membrane, beneath which
it is fpread.

4. Expefioratio fotida. Solid expectoration. The mucus
of the lungs becomes hardened by the increafed abforption, fo
that it adheres and forms a kind of lining in the air-cells, and is
fometimes ipit up in the form of branching vefTels, which are
called polypi of the lungs. See Tranfact. of the College, Lon-
don. There is a rattling or wheezing of the breath, but it is
not at firft attended with inflammation.

The Cynanche trachealis, or Croup, of Dr. Cullen, or Angina
polypofa of Michaelis, if they differ from the peripneumony of in-
fants, feem to belong to this genus. When the difficulty of ref-
piration is great, venefection is immediately neceffary, and then
an emetic, and a blifter. And the child fhould be kept nearly
upright in bed as much as may be. See Tonfillitis, Clafs II. I.
3. 3. and II. I. 2. 4.

M. M. Diluents, emetics, efTence of antimony, foetid gums,

onions,

CLASS I. i. 3. $. OF IRRITATION. 3 1

onions, warm bath for half an hour every day for a month. In-
haling the fteam of water, with or without volatile alkali. Soap.

5. Cotiftipatio al-vi. Coltivenefs from increafed action of the
inteftinal abforbents. The feces are hardened in lumps called
fcybala ; which are fometimes obliged to be extracted from the
rectum with a kind of marrow fpoon. This is faid to have hap-
pened from the patient having taken much ruft of iron. The
mucus is alfo hardened fo as to line the interlines, and to come
away in fkins, rolled up as they pafs along, fo as to refemble
worms, for which they are frequently miftaken ; and fometimes
it is evacuated in itill larger pieces, fo as to counterfeit the form
of the inteftines, and has been miftaken for a portion of them.
Balls of this kind, nearly as heavy as marble, and confiderably
hard, from two inches to five in diameter, are frequently found in
the bowels of horfes. Similar balls found in goats have been
called Bezoar.

M. M. Cathartics. Diluents, fruit, oil, foap, fulphur, warm.
bath. Sprinkling with cold water, cool clothing. See Clafs I.
2. 4. 18.

6. Cutls arida. Dry fkin. This dry fkin is not attended with
coldnefs as in the beginning of fever-fits. Where this cutaneous
abforption is great, and the fecreted material upon it vifcid, as
on the hairy fcalp, the fkin becomes covered with hardened mu-
cus ; which adheres fo as not to be eafily removed, as the fcurf
on the head ; but is not attended with inflammation like the
Tinea, or Lepra. The moifture, which appears on the fkin be-
neath refmous or oily platters, or which is feen to adhere to fuch
plafters, is owing to their preventing the exhalation of the per-
fpirable matter, and not to their increafing the production of it,
as fome have idly imagined.

M. M. Warm bathing, oil externally, oil-fkin gloves, refm-
ous plafters. Wax.

7. Urina parca colorata. Diminiihed urine, which is high col-
oured, and depofits an earthy fediment, when coM, is owing to
the great action of the urinary abforbents. See Clafs I. i. 2.
4. In fome dropfies the cutaneous abforbents are paralytic, as
well as thofe opening into the cellular membrane ; and hence,
no moifture being acquired from the atmofphere, or from the
cellular membrane, great thirft is excited -9 and great abforption
from all parts, where the abforbents are (till capable of a6tion.
Hence the urine is in very fmall quantity, and of deep colour,
with copious fediment ; and the kidneys are erroneoufly blamed
for not doing their office ; itimulant diuretic medicines aregiv-.
en in vain ; and very frequently the unhappy patient is reftrain-
e-d from quenching his thirft, and dies a martyr to falfe theory.

M. M. Diluent

32 DISEASES CLASS I. 1.3. g.

M. M. Diluent liquids, and warm bathing, are the natural
cure of this fymptom ; but it generally attends thofe dropfies,-
which are feldom curable ; as they are owing to a paralyfis both
of the cutaneous and cellular lymphatics.

8. Calculus felleus. Gall-done. From the too hafty abforp-
tion of the thinner parts of the bile, the remainder is left too
vifcid, and cryftallizes into lumps ; which, if too large to pafs,
obftracl the du&us choledochus, producing pain at the pit of
the ftomach, and jaundice. When the indurated bile is not
harder than a boiled pea, it may pafs through the bile-du£t with
difficulty by changing its form ; and thus gives thofe pains,
•which have been called fpafms of the ftomach ; and yet thefe
vifcid lumps of bile may afterwards dirTolve, and not be vifible
among the feces.

In two inftances I have feeii from thirty to fifty gall-ftones
voided after taking an oil vomit as below. They were about
the fize of peas, and diftinguifhable when dry by their being in-
flammable like bad wax, when put into the flame of a candle*
For other caufes of jaundice, fee Clafs I. 2. 4. 19.

M. M. Diluents, daily warm bathing. Ether mixed with
yolk of egg and water. Unboiled acrid vegetables, as lettuce,
cabbage, muftard, and crefies. When in violent pain, four
ounces of oil of olives, or of almonds, ihould be fwallowed ; and
as much more in a quarter of an hour, whether it itays or not.
The patient Ihould lie on the circumference of a large barrel,
firit on one fide, and then on the other. Electric (hocks through
the gall-duel. Factitious Seltzer water made by dilTolving one
dram of fal foda in a pint of water ; to half a pint of which made
luke-warm add ten drops of marine acid ; to be drunk as foon
as mixed, twice a day for fome months. Opium muft be ufed
to quiet the pain, if the oil does not fucceed, as two grains, and
another grain in half an hour if neceflary. See Clafs IV. 2. 2. 4.

9. Calculus rents. Stone of the kidney. The pain in the loins
and along the courfe of the ureter from a flone is attended with
retraction of the tefticle in men, and numbnefs on the infide of
the thigh in women. It is diftinguiflied from the lumbago or
fciatica, as thefe latter are feldoiri attended with vomiting, and
have pain on the outfide of the thigh, fometimes quite down to
the ancle or heel. See Herpes and Nephritis.

Where the abforption of the thinner parts of the fecretion
takes place too haftily in the kidneys, the hardened mucus, and
confequent calculous concretions, fometimes totally flop up the
tubuli uriniferi, and no urine is fecreted. Of this many die,
who have drunk much vinous fpirit, and fome of them recover
by voiding a quantity of whit? mucus, like chalk and water ; and

CLASS I. i. 3. 9. OF IRRITATION. 33

others by voiding a great quantity of fond, or fmall calculi. This
ned mucus frequently becomes the nucleus of a ftone in the
bladder. The falts of the urine, called microcofmic fait, are of-
ten iniftaken for gravel, but are diftinguifhable both by their an-
gles of cryftallization, their adhefion to the fides or bottom of
the pot, and by their not beingformedtill the urine cools. Where-
as the particles of gravel are generally without angles, and always
drop to the bottom of the veflel, immediately as the water is
voided.

Though the proximate caufe of the formation of the calculoua
concretions of the kidneys, and of chalk-ftones in the gout, and
of the infoluble concretions of coagulable lymph, which are found
on membranes, which have been inflamed in peripneumony, or
rheumatifm, confifts in the two great action of the abforbent
veffels of thofe parts ; yet the remote caufe in thefe cuies is
probably owing to the inflammation of the membranes ; which
at that time are believed to fecrete a material more liable to co-
agulate or concrete, than they would otherwife produce by in-
creafed action alone without the production of new veflels,which
conftitutes inflammation. As defined in Glafs II. I. 2.

The fluids fecreted from the mucous membranes of animals
are of various kinds and confiftencies* Hair, filk, fcales, horns,
finger-nails, are owing to natural proceflfes. Gall -ftones, ftones
found in the interlines of horfes, fcurf of the {kin iii leprofy,
ftones of the kidneys and bladder, the callus from the inflamed
periofteum, which unites broken bones, the calcareous cement,-
which repairs the injured (hells of fnails, the calcareous cruft on
the eggs of birds, the annually renewed melts of crabs, are all in-
ilances of productions from mucous membranes, afterwards in-
durated by abforptioxi of their thinner parts.

All thefe concretions contain phofphoric acid, mucus, and
calcareous earth in different proportions ; and are probably fo
far analogous in refpect to their component parts as well as their
mode of formation. Some calcareous earth has been difcovered
after putrefaction in the coagulable lymph of animals. Fordyce's
Elements of Practice. A little calcareous earth was detected
by Scheele or Bergman in the calculus of the bladder with much
phofphoric acid, and a great quantity of phofphoric acid is fhewn
to exift in oyfter-fhells by their becoming luminous on expofmg
them a while to the fun's light after calcination ; as in the ex-
periments of Wilfon. Botanic Garden, P. i. Canto i. 1. 182,
note. The exchange of which phofphoric acid for carbonic acid,-
or fixed air, converts (hells into lime-ftone, producing mountains
of marble, or calcareous ftrata.

Now as the hard lumps of calcareous matter, termed crabs'
Vol. II. F eyes,

34 DISEASES CLASS I. i. 3, 9;

eyes, which are found in the ftomachs of thofe animals previous
to the annual renewal of their (hells, are rediffolved, probably
by their gaftric acid, and again depofited for that purpofe ; may
it not be concluded, that the (tone of the bladder might be dif-
folved by the gaftric juice of filh of prey, as of crabs, or pike •, or
of voracious young birds, as young rooks or hawks, or even of
calves ? Could not thefe experiments be tried by collecting the
gaftric juice by putting bits of fponge down the throats of young
crows, and retracting them by a firing in the manner of Spal-
lanzani ? or putting pieces of calculus down the throat of a liv-
ing crow, or pike, and obferving if they become digefled ? and
lailly, could not gaftric juice, if it fhould appear to be a folvent,
be inje&ed and borne in the bladder without injury by means of
catheters of claftic refin, or caoutchouc ?

M. M. Diluents. Cool drefs. Frequent change of pofture.
Frequent horizontal reft in the day. Bathe the loins every morn-
ing with a fponge and cold water. Aerated alkaline water in-
ternally. Abftinence from all fermented or fpirituous liquors.
Whatever increafes perfpiration injures thefe patients, as it dif-
fipates the aqueous particles, which ought to dilute the urine.
When the conftitution begins to produce gravel, it may I believe
be certainly prevented by a total abftinence from fermented or
fpirituous liquors ; by drinking much aqueous fluids ; as toaft
and water, tea, milk and water, lemonade -, and laftly by thin
clothing, and fleeping on a hardifh bed, that the patient may not
lie too long on one fide. See CJafs IV. 2. 2.- 2. There is reafon
to believe, that the daily ufe of opium contributes to produce
gravel in the kidneys by increafing abforption, when they are
inflamed •, in the fame manner as is done by fermented or fph>
ituous liquor. See Clafs I. 3. 2. n.

When the kidneys are io obftructed with gravel, that no urine
paflfes into the bladder ; which is knov/n by the external appear-
ance of the lower part of the abdomen, which, when the bladder
i:> full, feems as if contracted by a cord between the navel and
the bladder •, and by the tenfion on the region of the bladder
diftinguiihableby the touch ; or by the introduction of the ca-
theter 5 the following methods of cure are frequently fuccefsfuL
Vene feel ion to fix or eight ounces, ten grains of calomel, and
an infufion of fenna with falts and oil, every three hours, till
ilools are procured. Then an emetic. After the patient has
been thus evacuated, a blifter on the loins fnonld be ufed ; and
from ten to twenty eleclric fhocks fhould be paffed through the
kidneys, as large as can be eafily borne, once or twice a day.
Along with this method the warm bath fhould be ufed for an
hour once or twice a day. After repeated evacuations a clyfter,

confifting

CLASS I. i. 3. 10. OF IRRITATION. 35

confifting of two drams of turpentine diflblved by yolk of egg,
and fixty drops of tincture of opium, mould be uied at n:
and repeated, with cathartic medicines interpofed, every ni
or alternate nights. Aerated folution of alkali fh; '.iken

..rally, and balfam of .copaiva, three or four times a day.
Sonic of thefe patients recover after having made no water for
jiine or ten days.

If a ftone (licks in the ureter with incefiant vomiting ten gr
of calomel mult be given in fmall pills as above ; and feme b
afterwards infufion of fenna and ialts and oil, if it can b? made
to itay on the (loinadi. And after : has operated four

.or five times, an opiate is to be given, if the pain continues, con-
fiiling of two grains of opium. If this does not fucceed, tf.
twenty electric (hocks through the kidney fhould be tried, and
the purgative repeated, and afterwards the opiate. The patient
ihoiild be frequently put into the warm bath for an hour at a
time. Eighty or a hundred dfops of laudanum given in a ..
ter, with two drams of turpentine, are to be preferred to the
two grains given by the flomach as abovej when the pain and
vomiting are very urgent.

jo. Calculus veficz. Stone of the bladder. The nucleus, or
kernel, of thefe concretions is always formed in the kidney, as
above defcribed ; and paflin^ clown the ureter into the bladder,
is there perpetually increaled by the mucus and falts fecreted
from the arterial fyftem, or by the mucus of the bladder, difpo-
fed in concentric ftrata. The (lories found in the bowels of
liorfes are alfo formed on a nucleus, and coniiil of conce.
fpheres ; as appears in fawing them through the middle. Bi^t
as thefe are formed by the indurated mucus of the in.teftines
alone without the urinary falts, it is probable a difference \yould
be found on their analyfis.

As the (tones of the bladder are of various degrees of hardnefs,
and probably differ from each other in the proportions at lead of
their component parts ; when a patient, who labours under this
afflicling difeafe, voids any fmall bits of gravel ; thefe mould be
kept in warm folutions of caudle alkali, or of mild alkali well
aerated ; and if they diffolve in thefe folutions, it would afford
greater hopes, that that which remains in the bladder, might be
affected by thefe medicines taken by the (lomach, or inj'
into the bladder.

To prevent the increafe of a ftone in th* bladder much diluent
drink (hould be taken ; as half a pint of water warmed to about
eighty degrees, three or four times a day : which will r;.ct only
prevent the growth of it, by preventing any mi . : falts

from being precipitated from the urine, and by keeping the mu-

CUi

$6 DISEASES CLASS!, r. 3. 10.

cus fufpended in it ; but will alfo diminim the ftone already
formed, by foftening, and warning away its furface. To this
muft be added cool drefs, and cool bed-clothes, as directed above
in the calculus renis.

When the ftone is puflied againft or into the neck of the blad-
der, great pain is produced ; this may fometimes be relieved by
the introduction of a bougie to pufh the ftone back into the fun-r
dus of the bladder. Sometimes by change of pofture, or by an
opiate either taken into the ftomach, or by a clyfter.

A dram offal foda, or of fait of tartar, dillblved in a pint of wa-
ter, and well faturated with carbonic acid (fixed air), by means
of Dr. Nooth's glafs apparatus, and drunk every day, or twice a
day, is the moft efficacious internal medicine yet difcovered,
which can be eafily taken without any general injury to the con-
ftitution. An aerated alkaline water of this kind is fold under
the name of factitious Seltzer water, by J. Schweppe, at No. 8,
King's-ftreet, Holborn, London ; which I am told is better pre-
pared than can be eafily done in the ufual glafs-veflels, probabljr
by employing a greater preflure in wooden ones.

A curious account is given in a letter to Sir John Sinclair from
Colonel Martin 5 who afTerts, that, after ufing bougies and in-
fections into the bladder, the paflage of the urethra became left
fenfible to pain, and he was enabled to introduce fmall files (I
fuppofe, with their backs fmooth) j and that by thefe he gradu-
ally filed away the ftone, as it lay in the neck of the bladder.
When the ftone did not properly prefent itfelf, he introduced
warm water by injection into the bladder, and thus, by again, en-
deavouring to difcharge it, brought forward the ftone to the neck
of it. He ufed the file three times in twenty-four hours from
April till October. Medical Journal, No, II. p. 121. If this
procefs mould be again attempted, perhaps the file might be intro-
duced through a flexible canula, with a metallic hood at the in-
ternal end of the canula to cover the back of the file, fo as to
prevent the friction of it againft the urethra, or neck of the blad-
der. If the urethra, by frequent trials, fhould become fp infen-
fible as to admit eafily the frequent introduction of a metallic
canula, might not two fine fteel wires properly tempered be join-
ed at one end by a hinge", and thus introduced through the can-
ula into the bladder ; and when protruded beyond the extremity
of the canula, they might open by their elafticity fo as to receive
the ftone, and confine it againft the end of the canula, by re-
tracting them ? The proper direction of the wire-fprings, fo as
to open when they are pufhed through the canula, muft be pre-
vioufly given them. If this could be managed, a fmall file or
borer might at the fame time be introduced through the canula,

the

a ASS I. i. 3- 1 1 OF IRRITATION. 37

the handles of which might confift of joints to permit" them to
i in all directions, and thus the 11 one might be broken to
• ; by a few trials ; or if it was a loft or fragile ftone, the re-
traclion of the wire -bow might divide it at every trial, till it be-
almoft reduced to powder. A little mechanical ingenuity
might be neceflary in rhe conftrufrJon and ufeof this machine-
ry ; but I believe it not to be impracticable, fince I read the above
account of Colonel Martin, though I had often before thought
of it with defpair of its fuccefsful application.

Lithotomy is the lail refource. Will the gaftric juice of ani-
mals diflblve calculi? Will fermenting vegetable juices* as
fweet-wort, or fugar and water in the a£l of fermentation with
yeaft, diflblve any kind of animal concretions ?

1 1 . Calculus artlriticus. Gout-ftones are formed on infla-
med membranes, like thofe of the kidneys above defcribed, by the
too hafty abforption of the thinner and faline parts of the mucus.
Similar concretions have been produced in the lungs, and even
in the pericardium ; and it is probable, that the omfication, as it
15 called, of the minute arteries, which is faid to attend old age,
arul to precede fome mortifications of the extremities, may be a
procefs of this kind.

As gout-ftones lie near the furface, it is probable, that ether,
frequently applied in their early ftate, might render them fo li-
quid as to permit their re-abforption ; which the ilimulus of the
ether might at the fame time e ncourage.

12. Rheumatifmus cbronicus. Chronic rheumatifm. After the
acute rheumatifm fome mfpifTated mucus, or material fimilar to
chalk-ftones of the gout, which was fecreted on the inflamed
membrane, is probably left, owing to the too hafty abforption of
the thinner and faline part of it ; and by lying on the fafcia, which
covers fome of the mufcles, pains them, when they move and rub
againil it, like any extraneous material.

The pain of the fhoulder, which attends inflammations of the
upper membrane of the liver, and the pains of the arms, which
attend afthma dolorificurn, or dropfy of the pericardium, are dif-
tinguifhed from the chronic rheumatifm, as in the latter the pain
only occurs on moving the affected mufcles.

M. M. Warm bath, cold bath, bandage of emplaftrum de
minio put on tight, fo as to comprefs the part. Cover the part
with flannel. With oiled (ilk. Rub it with common oil fre-
quently. With ether. A blifter. A warmer climate. Ven-
efection. A grain of calomel and a grain of opium for ten fuc-
ceflive nights.. The Peruvian bark.

13. Clcatrix vulnsrum. The fear after wounds. In the heal-
uf ulcers the matter is firit thickened by increafmg the

abforption

3$ DISEASES CLASS I. r. 3. 14,

abforption in them ; and then leffened, till all the matter is ab-
forbed, which is brought by the arteries, inftead of being depo-
ied in the ulcer.

M. M. This is promoted by bandage, by the forbentia exter-
nally, <is, powder of bark, white lead •, folution of fugar of lead.
And by the forbentia internally after evacuations. See Seel:.
XXXIlt. 3. 2

In thofe ulcers, which are made by the contact of external
lire, the violent action of the tiures, which occafions the pain, is
liable to continue, after the external heat is withdrawn. This
fhould be relieved by external cold, as of mow, fait and water
recently mixed, ether, or fpiritsof wine, fuffered to evaporate on
the part.

The cicatrix of aa ulcer generally proceeds from the edges
of it ; but in large ones frequently from the middle, or com-
mences in feveral places at the fame time j which probably con-
tributes to the unevennefs of large fears,

14. Corner obfufcatio. Opacity of the cornea. There are
few people, who have pafled the middle of life, who have not at
fome time fuffered fome flight fcratches or injuries of the cornea,
which by not healing with a perfectly fmooth furface, occafion
fome refractions of light, which may be conveniently feen in the
following manner : fill a tea-faucer with cream and tea, or with
milk, and holding it to your lips, as if going to drink it, the im-
perfections of the cornea will appear like lines or blotches on the
furface of the fluid, with a lefs white appearance than that fur-
face. Thofe blemifhes of the eye are diftinguifhed from the
mufcse volitantes defcribed in Clafsl. 2. 5. 3. by their being in-
variably feen at any time, when you look for them.

Ulcers may frequently be feen on the cornea after ophthalmy,
like little pits or indentations beneath the furface of it j in this
cafe no external application mould be ufed, left the fear fhould
be left uneven ; but the .cure fhould be confined to the internal
ufe of thirty grains of bark twice a day, and from five to ten
drops of laudanum at night, with five grains of rhubarb, if
neceiTary.

After ulcers of the cornea, which have been large, the ine-
qualities and opacity of the cicatrix obfcure the fight : in this cafe,
could not a fmall piece of the cornea be cut out by a kind of
trephine about the fize of a thick briftle, or a fmall crow-quill,
and would it not heal with a tranfparent fear ? This experiment
is worth trying, and might be clone by a piece of hollow fteel
wire with a fharp edge, through which might be introduced a
•d fteel fcrew ; the fcrew to be introduced through the
;ue cornea to hold it up, and prefs itagainft the cutting edge

of

CLASS I. i. 3. 14- OF IRRITATION. 3§>

of the hollow wire or cylinder ; if the fear mould heal without
lofmg its tranfparency, many blind people might be made to fee
tolerably well by this flight and not painful operation. An ex-
periment I wifh ftrongly to recommend to fome ingenious fur-
geon or oculift.

Or it may be attempted by preffing one end of a fmall canula
on the centre of the cornea, and paffing down it a bit of luna
cornea, fixed in the end of a fmaller canula, and thus introdu-
ced : the eye may be held fteady by paffing a thread by means
of a fmall curved needle through a part of the tunica adjunfti-
va, which may be held by an affiftant, or by preffing on it the
end of the canula as above, which might have a flat circular rim.
round its extremity for that purpofe.

40 , DISEASES CLASS I. i. 4. i,

O&DO I.

Increafed Irritation.

GENUS IV.

With Increafed Actions of other Cavities and Membranes.
SPECIES.

1. Niflitatio irritativa. Winking of the eyes is performed
every minute without our attention, for the purpofe of cleaning
and moiftening the eye-ball j as further fpoken of in Clafs II. i .
I. 8. When the cornea becomes too dry, it becomes at the fame
time lefs tranfparent j which is owing to the pores of it being
then too large, fo that the particles of light are refracted by the
edges of each pore, inftead of pafling through it ; in the fame
manner as light is refracted by pafling near the edge of a knife.
When thefe pores are rilled with water, the cornea becomes
again tranfparent. This want of transparency of the cornea is
vifible fometimes in dying people, owing to their inirritability,
and confequent negledft of nictitation.

The increafe of tranfparency by filling the pores with fluid is
feen by foaking white paper in oil ; which from an opaque body
becomes very tranfparent, and accounts for a curious atmofpher-
ic phenomenon ; when there exifts a dry milt in a morning fo as
to render diflant objects lefs diftincl:, it is a fign of a dry day ;
when diftant objecls are feen very diftin6t,, it is a fign of rain.
See Botan. Garden, Part I, add. note xxv. The particles of air
are probably larger than thofe of water, as water will pafs
through leather and paper, which will confine air, hence when
the atmofphere is much deprived of moifture, the pores of the
dry air are fo large, that the rays of light are refracted by their
edges inftead of pafling through them. But when as much moif-
ture is added as can be perfectly diflblved, the air becomes tranf-
parent \ and opaque again, when a part of this moifture collects
into fmall fpherules previous to its precipitation. This alfo ac-
counts for the want of tranfparency of the air, which is feen in
tremulous motions over corn-fields on hot fummer-days, or over
brick-kilns, afref the flame is extinguilhed, while the furnace
itill remains hot.

2. Deglutitio irritativa. The deglutition of our faliva is per-
formed frequently without our attention, and is then an irritative
aclion in confequence of the ftimulus of it in the mouth. Or

perhaps

CLASS I. i. 4. 3. OF IRRITATION. 41

perhaps fometimes for the purpofe of diffufmg a-pirt of it over
_ihe dry membranes of the fauces and pharynx ; in the fam-3
manner as tears are diffufed over the cornea of the eye by the
act of nictitation to clean or moiften it.

3. Refpiratio et TuJJis irritative. In the a£ts of refpiration
and of coughing there is an increafed motion of the air-cells of
the lungs owing to Come ftimulating caufe, as delcribed above
in Clafs I. i. 2. 8. and I. I. 3. 4. and which are frequently per-
•formed without our attention or confcioumefs, and are then ir-
ritative actions j and thus differ from thofe defcribed in Clais II.
i. i. 2. and 5. To thefe increafed actions of the air-cells are
fuperadded thofe of the intercoital mufcies and diaphragm by
irritative aflbciation. When any unnatural ftimulus acts fo vi-
olently on the organs of refpiration as to induce pain, the fenfo-
rial power of fenfation becomes added to that of irritation, and
inflammation of the membranes of them is a general confequence.

4. Excltifto bills. The exclusion of the bile from the gall-blad-
der, and its derivation into the duodenum, is an irritative ad ion
in confequence of the ftimulus of the aliment on the extremity
of the biliary duel, which terminates in the inteftine. The in-
creafed fecretion of tears is occafioned in a limilar manner by
any ftimulating material in the eyes ; which afFetts the excretory
duels of the lachrymal glands. A pain of the external membrane
of the eye fometimes attends any unufual ftimulus of it, then the
fenforial power of fenfatioa becomes added to that of irritation,
and a fuperficial inflammation is induced.

5. Dentitis. Toothing. The pain of toothing often begins
much earlier than is fufpecled ; and is liable to produce convul-
fions •, which are fometimes relieved, when the gum fwells, and
becomes inflamed ; at other times a diarrhoea fupervenes, which
is generally efteemed a favourable circumitance, and feems to
prevent the convulsions by fupplying another means of relieving
the pain of dentition by irritative exertion ; and a confequent
temporary exhaustion of fenforial power. See Clafs I. 1.2. c.
Sea. XXXV. 2. i.

The convulfions from toothing generally commence long be-
fore the appearance of the teeth ; but as the two middle incii*-
ors of the lower jaw generally appear firft, and then thofe of
the upper, it is advifable to lance the gums over thefe longitudi-
nally in refpecl: to the jaw-bones, and quite down to the perios-
teum, and through it.

As the convulfions attendingthe commencement of toothing are
not only dangerous to life in their greatdl degree, but are liable to
induce ftupor or infenfibility by their continuance even in a lefs
degree, the moft efficacious means ihould be ufed to cure them.

Vol. II. G IVL M. Lance

42 DISEASES CLASS I. t. 4. 6.

M. M. Lance the gum of the expected teeth quite through
the periofteum longitudinally. Venefeclion by the lancet or by-
two or three leeches. One grain of calomel as a purge. Tinc-
ture of jalap, five or fix drops in water every three hours till it
purges, to be repeated daily. After evacuations a fmall blifter
on the back or behind the ears. And laftly, two or three drops
of laudanum according to the age of the child. Warm bath.
See Clafs- III. i. i. 5. and &

6. Priapifmus chronicus. I have feen two cafes, where an
erection of the penis, as hard as horn, continued two or three
weeks without any venereal defires, bat not without fome pain ;
the eafieft attitude of the patients was lying upon their backs
with their knees up. At length the corpus cavernofum urethrre
became fo.ft, and in another day or two the whole fiibftded. In
one of them a bougie was introduced, hophag to remove fome
bit of gravel from the caput gallinaginis, camphor, warm bathing,
opium, lime-water, coW afperfion, bleeding in the veins of the
penis, were tried in vain. One of them had been a free drinker,
Lad much gutta rofacea on his face, and died fuddenly a few
months after his recovery from this complaint. Was it a paral-
yfis of the terminations of the veins, which abforb the blood
from the tumid penis ? or from the flimulus of indurated femen
in the feminal veiTels ? In the latter cafe fome venereal defires
fliould have attended. Glafs III. I. 2. 16.

The priapifmus, which occurs to vigorous people in a morn-
ing before they awake, has been, called the fignum falutis, or
banrier of health, and is occafioned by the increafe of our irri-
tability or fenfibi! it y during flesp, as explained in Sect. XVIII. 15,

7. Diftentio mamrmtlarum. The diftention of the nipples of
laetefcent women is at firfl owing to the flimuius of the milk.
See Sea. XIV. 8. and Sed. XVI. 5. See Clafs II. i. 7. 10.

8. Dcfcenfus uteri. This is a very frequent complaint after
bad labours, the fundus uteri becomes inverted and defcends
like the prolapfus ani.

M. M. All the ufual peiTaries are very inconvenient and in-
effectual. A piece of foft fponge about two inches diameter in-
troduced into the vagina gives great eafe to thefe patients, and
fup ports the uterus ; it mould have a firing put through it to
retract it by.

There are alfo peflaries now made of elaftic gum, which are
f?jd to be eafily worn, and to be convenient, from their having
a perforation in their centre.

9. Prolapfus atil. The lower part of the reclum becomes in-
verted, and defcends after every ilool chiefly in children ; and
thus flimulates the fphindter ani like any ether extraneous body.

M. M. It

CLASS I. i. 4. 10. OF IRRITATION. 43

M. M. It mould be d ufted over with very fine powder of
gum fandarach, and then replaced. Aftringent fomentations ;
as an infufion of oakbark, or a flight iblution of alum. Hori-
zontal reft frequently in the day.

10. Lumbricus. Round worm. The round worm is fuf-
petled in children when the belly is tumid, and the countenance
bloated and pale, with fwelling of the upper lip. The genera-
tion ofthefe worms is promoted by the too dilute (late of the
bile, as is evident in the fiukc-worm found in the biliary duels
^nd fubftance of the liver in (heep ; and in water-rats, in the
livers of which laft animals they were lately detected in large
numbers by Dr. Capelle. Tranfactions of the college at Phila-
delphia, v. i.

Now as the dilute (late of the bile depends on the deficiency
of the abforption of its thinner parts, it appears, that the tumid
belly, and bloated countenance, and fwelled upper lip, are con-
comitant circumflances attending the general inactivity of the
abforbent fyftem ; which is therefore to be efteemed the remote
caufe of the generation of worms.

The fimplicity of the ftru&ure of worms probably enables
them to exift in more various temperatures of heat ; and their
being endued with life prevents them from being deftroyed by
digeftion in the ftomach, probably in the fame manner as the
powers of life prevent the fermentation and putrefaction of the
ftomach itfelf. Hence I conclude, that worms are originally
taken into our alimentary canal from without •, as I believe finv
ilar worms of all kinds are to be found out of the body.

M. M. The round worm is deftroyed by a cathartic with
four or fix grains-of calomel ; and afterwards by giving fix or
eight grains of filings of iron twice a day for a fortnight. See
Hepatis tumor, Clafs I. 2. 3. 9. As worms are liable t» come
away in fevers, whether of the hectic or putrid kind, could they
be removed by purulent matter, or rotten egg, or putrid flefh,
fmce in thofe fevers from the enfeebled action of the inteftines
the faeces become highly putrid.

The (harp fpiculx or hairs, which are found on the pods of
cowhage, (truolobium filiqua hirfuta, have been recommended
in worm-cafes, and faid to deftroy them by mechanical puncture ;
the late Mr. Power of Polefworth, aiTured me, he had had great
fu^cefs with this medicine and gave about fix or eight grains in
a bolus three or four times on one day, with a brifk cathartic
on the next day. Some have recommended chopped hair or
bridles for this purpofe. There are numerous (harp fpiculx in
the fruit of the wild rofe, which might be worth try ing it this

difeafe,.

44 DISEASES CLASS!, r. 4. ix.

difeafe, and the hairs en full grown hairy caterpillars, if the ani-
mal be laid on the hand, efpecially between the fingers, are liable
to flick in the (kin, and to produce flight inflammation and itch-
ing, and might alfo be worth trying in worm-cafes. But it is
aflerted in M. Vaillant's Travels in Africa, that when thefe in-
fects feed on poifonous plants, they become themfelves fo venom-
ous, that the natives collecl: a juice from them, with which

a putrid they fmear their war weapons to poifonthem.
. "'atria. Tape-worm confills of a chain of animals ex-
tending from the ftomach to the anus. See Seel. XXXIX. 2. 3.

-quently exifis in cats, rats, and geefe, and probably in many

r animals.

The worms of this genus poffefs a wonderful power of re-
taining life. Two of them, which were voided by a pointer
dog in confequence of violent purgatives, each of which were
feveral feet in length, had boiling water poured on them in a
bafin ; which feemed not much to inconvenience them. When
the water was cool, they were taken out and put into gin or
whi&ey of the ftrongeft kind, in which their life and activity
continued unimpaired ; and they were at length killed by adding
to the fpirit a quantity of corrofive fublimate. Medic. Comment,
for 1791, p. 370. ^

The tape-worm is cured by an amalgama of tin and quickfilver,
fuch as is ufed on the back of looking-glaiTea ; an ounce fhould
be taken every two hours, till a pound is taken ; and then a brilk
cathartic of Glauber's fait two ounces, and common fait one
ounce, diflblvcd in two wine pints of water, half a pint to be taken
every hour till it purges. The worm extends from the ftomach
to the anus, and the amalgama tears it from the inteltine by me-
chanical prefiure, a&ing upon it the whole way. Electric {hocks
through the duodenum greatly aflift the operation. Large dofes
of tin in powder. Iron filings in large dofes. The powder of
fernroot feems to be of no ufe, as recommended by M. Nouffli-
er. This worm, as well as the lumbricus or round-worm, is
fomctimes brought up by vomiting ; when either of thefe worms
is in the ftomach it gives a tickling fenfation about the fauces,
which parts fympathize with the cardia ventriculi. See Annals
cf Medicine, 1 797. "Give an emetic oftartarized antimony, or
of vitriol of zinc.

12. Afcarides. Threadworms. Thefe worms are faid to be more
frequent in fome parts of this kingdom than in others, as near
the fens of Lincolnfhire. Do they efcape from the body and be-
come flies, like the bott-worm in horfes ? Do they crawl from
one child to another in the fame bed ? Are they acquired from
flies or worms, which are feen in putrid neceflary houfes, us

CLASS Li.* 12. OF IRRITATION. 45

-ms as wallas the tap?, -verms, are "probably acquired
from without ? this may account for their re-appearance a few-
weeks cr months after they have been destroyed ; or can this
happen from the eggs or -parts of them remaining ?

Afcaiides appearto be of two kinds, the common fmall one
like a thread ; which has a very {harp head, as appears in the mi-
crofcope ; and which is fo tender, that the cold air foon renders
it mqrionlefo ; and a larger kind above an inch long, and. nearly
as thick as a very fmall crow-quill, and which is very hard in re-
fpect to its texture, and very tenacious of life. One of thefe laft
was brought to me, and was immediately immerfed in a ftrong
foiution of fugar of lead, and lived in it a very long time without
apparent inconvenience.

1VI. M. Afcarides are faid to be weakened by twenty grains
of cinnabar and live of rhubarb taken every night, but not to be
cured by this procefs. As thefe worms are found only in the
rectum,' variety of clyfters have been recommended. A clyfter
confiding of one eighth or one fourth of an ounce of fuccotrine
aloes in powder boiled in 3 pint of milk cr of gruel, till it is dif-
folved, and injected once a week for many weeks, I believe has
fometimes effected a cure. I was informed of 3 cafe, where fo-
Jutions of mercurial ointment were ufed as a clyfter every night
for a month without fuccefs. Clyfters of Harrowgate water arc
recommended, either of the natural, or of the factitious, as de-
fcribed below, which might have a greater proportion of liver
of fulphur in it. As the cold air foon deftroys them, after they
are voided, could clyfters of iced water be ufed with advantage ?
or of fpirit of wine and water ? or of ether and water ? Might
not a piece of candle, about an inch long, or two fuch pieces,
fmeared with mercurial ointment, and introduced into the anus
at night, or twice a day, be effectual by compreiling their nidus,
as well as by the poifon of the mercury ?

The clyfters (hould be large in quantity, that they may pafs
high in the rectum, as two drams of tobacco boiled a minute in
a pint of water. Or perhaps what might be (till more effica-
cious and lefs inconvenient, the fmoke of tobacco injected by
a proper apparatus every night, or alternate nights, for fix or
eight weeks. This was long fince recommended, I think, by
Mr. Turner of Liverpool ; and the reafon it has not fucceeded,
I believe to have been owing to the imperfections of the joints
of the common apparatus for injecting the fmoke of tobacco, fo
that it did not pals into the inreftine, though it was fuppofed to
do fo, as I once obferved. The fmoke fhould be received from
the apparatus into a large bladder ; and it may then be certainly in-
jected like the common clyfter with fufficient force ; otherwife

oiled

4-6 DISEASES CLASS I. 1.4. 13.

piled leathers fhould be nicely put round the joints of the ma-
chine 5 and a wet cloth round the injecting pipe to prevent the
return of the fmoke by the fides of it. Clyfters of carbonated v
hydrogen gas, or of other factitious airs, might be tried ; or of
the hairs of filiqua hirfuta.

Harrowgatc water taken into the ftomach, fo as to induce fix
or feven llools every morning, for four or fix weeks, is perhaps
the moli efficacious method in common ufe. A factitious Har-
rowgate water may be made probably of greater efficacy than
the natural, by difiblving one ounce of marine fait, (called bay
fait) and half an ounce of magnefia Glauber's fait, (called Epfom
fait, or bitter purging fait) in twenty-eight ounces of water. A
quarter or half a pint of this is to be taken every hour, or two
hours in the morning, till it operates, with a tea-fpoonful of a
folntion of liver of fulphur, which is to be made by putting an
ounce of hepar fulphuris into half a pint of water. See Clafs

IV. I. 2. 9.

13. Qracunculus. A thin worm brought from the coaft of
Guinea. It is found in the interftices of the mufcles, and is
many yards long j it makes a fmall ulcer-, which is cured by
extracting an inch of the worm a day, and wrapping the extract-
ed part ilowly round a bit of tobacco-pipe till next day, fo as not
to break it. I have twice feen long worms, like a thick horfe
hair, in water in July in this country, which appeared hard and
jointed.

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

M. M. Spirit of wine. Mercurial ointment, (having the part.
Oil deflroys other infects, if they be quite covered with it, as the
ticks on dogs, and would probably therefore deflroy thefe. Its
manner of operation is by (lopping up or filling their fpiracula,
pr breathing pores ; a few drops of oil poured on a wafp, fo as
to cover it, deflroy it in a few feconds.

15. Pedkidl. Lice. There is faid to be a difeafe, in which
thefe animals are propagated in indeftructible numbers, fo as to
deflroy the patient.

M. M. Cleanlinefs, mercurial ointment, ftavisacria in powder,
pr the tincture of it in fpirit of wine. Spirit of wine alone. ?
Uath of oil ?

ORDO

CLASS I. i. 5. i. OF IRRITATION. 47

ORDO I.

Increnfid Irritation.

GENUS V.

With incrcafid Afiions of the Organs afSenfe.
SPECIES.

1. Vifus acrior. Acutcr fight. There have been inltanccs of
people, who could ice better hi the gloom of the evening, than'
in the (Ironger light of the day ; like owls, and bats, and man?
quadrupeds, and flying inlets. When the eye is inflamed, great
light becomes eminently painful, owing to the incrcafcd i;
tive motions of the retina, and the coniequent incrcafed fcnia-
tion. Thus when the eye is dazzled with fuddcn light, the pain
is not owing to the motion of the iris ; for it is the Contraction
of the iris, which relieves the pain from fudden light \ but to the
too violent contractions of the moving fibres, which cunflitute
the extremities of the optic nerve.

2. Audit us acrior. The irritative ideas of hearing are fo in-
creafed in energy as to excite our attention. This happens in
fome difeafes of the epileptic kind, and in fome fevers. Hence
the whifpering of the currents of air in a room, the refpiration
of the company, and noiies before unperceived, become trouble-
fome ; and founds louder than ufual, or uaexpeded, produce
ftarting, and convulfions.

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

3. Olfaclus acrior. The irritative ideas of fmeli from the in-
creafed action of the olfaclive nerve excite our attention. Hence
common odours are difagreeable ; and are perceived from vari-
ety of objects, which were before thought inodorous. Theie
are commonly believed to be hallucinations of the fenfe.

M. M. SnufFftarch up the noftrils.

4. Gujlus acrior. The irritative ideas of tafte, as of our own
faliva, and even of the atmofpheric air, excite our attention 5 and
common taites are difagreeably ilrong.

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

5. Tnclus acrior. The irritative ideas cf the nerves of touch

excite

48 DISEASES CLASS I. i. 5. 6.

excite our attention : hence our own pveflure en the parts, we
reft upon, becomes uneafy with univerfal forenefs.

M. M. Soft feather-bed. Combed wool put under the pa-
tients, which rolls under them, as they turn, and thus prevents
their friction againft the meets. Drawers of foft leather. Plat-
ters of cerate with caiamy.

6- Senfus caloris acrior. Acuter fenfe of heat occurs in fome
difeafes, and that even when the perceptible heat does not appear
greater than natural to the hand of another perfon. See Ciafs
I. i. 2. See Seel:. XIV. 8. -All the above increafed actions of
cur organs of fenfe feparately or jointly accompany fome fevers,
and fome epileptic difeafes ; the patients complaining of the per-
ception of the leaft light, noifes in their ears, bad fmells in the
room, and bad taftes in their mouths, with forenefs, numbriefs,
2nd other uneafy feels, and with difagreeable fenfations of gen-
eral or partial heat.

7. Senfus extenftonis acrior. Acuter fenfe of extenfion. The
fenfe of extenfion was fpoken of in Se£l. XIV. 7. and XXXII.
4. The defecl: of diftention in the arterial fyftem is accompani-
ed with faintne£s 5. and its excefs with fenfations of fulnefs, or
weight, or preffure. This however refers only to the vafcular
mufcles, which are di (tended by their appropriated fluids ; but
the longitudinal mufcles are alfo affecled by different quantities
of extenfion, and become violently painful by the excefs of it.

Thefe pains of mufcles and of membranes are generally
divided into acute and dull pains, The former are generally
owing to increafe of extenfion, as in pricking the Ikin with a
needle ; and the latter generally to defect of extenfion, as in
cold head-aches ; but if the edge of a knife, or point of a pin,
be gradually preiTed againft the fibres of mufcles or membranes,
there would feem to be three Mates or flages of this extenfion of
the fibres ; which have acquired names according to the degree
or kind of fenfation produced by the extenfion of them ; thefc
are i. titillation or tickling ; 2- itching ; and the 3. fmarting,
as defcribed below. See Sea. XIV. 9,

8. Titillatio, Tickling is a pleafurable pain of the fenfe of
extenfion above mentioned, and therefore excites laughter ; as
defcribed in Sea. XXXIV. r. 4. The tickling of the nortrils,
which precedes the efforts of fneezing, is owing to the increafed
irritation occafioned by external ftimulus ; and is attended with
a pleafurable fenfation in confequence of the increafed aaion of
the part. When this aaion is exerted in a greater degree, the
fenfation becomes painful, and the convulfion of fneezing en-
fues ; as the pain in tickling the foles of the feet of children is
relieved by laughter.

A

CLASS I. i. 5. 9- °F IRRITATION. 4y

A lady after a bruife on her nofe by a fall was affected with
incefiant fneezing, and relieved by fnufling ftarch up her noftrils.
Perpetual freezings in the mealies, and in catarrhs from cold,
are owing to the ftimulus of the faline part of the mucous effu-
(inn on the membrane of the noftrils. See Clafs II. i. 1.2.

9. Pruritus. Itching feems to be a greater degree of titilla-
tion, and to be owing to the ftimulus of fome acrid material, as
the matter of the itch ; or of the herpes on the fcrotum, and
about the anus ; or from thofe univerfal eruptions, which attend
fome elderly people, who have drunk much vinous fpirit. It
occurs alfo, when inflammations are declining, as in the healing
of blifters, or in the cure of ophthalmia, as the action of the vef-
fels is yet fo great as to produce fenfation ; which, like the titil-
lations that occafion laughter j is perpetually changing from plcaf-
ure to pain.

When the natural efforts of fcratching do not relieve the pain
of itching, it fometimes increafes fo as to induce convulfions and
madnefs. As in the furor uterinus, and fatyriafis, and in the
fphinfter ani and fcrotum. See Clafs II. 1.4. 14. IV. 2. 2. 6.

M. M. Warm bath. Fomentation. Alcohol externally.
Poultice. Oiled filk. Mercurial ointments on fmall furfaces at
once. See Clafs II. 1.4. 12. Solutions of lead on fmall fur-
faces at once.

10. Dolor urens. Smarting follows the edge of a knife in ma-
king a wound, and feems to be owing to the diitention of apart
of a fibre, till it breaks. A fmarting of the fkin is liable to af-
fcLt the fears left by herpes or fhingles ; and the callous parts of
the bottoms of the feet \ and around the bafes of corns on the
toes •, and frequently extends after fciatica along the outhde of
the thigh, and of the leg, and part of the foot. Ail thefe may
be owing to the ftimulus of extenfion, by blood or ferum being
forced into vefleis nearly coalefced.

M. M. Emplaftrum de minio put like a bandage on the part.
Warm fomentation. Oil and camphor rubbed on the part. Oil-
filk covering. A blifter on the part. Ether, or alcohol, fuffer-
ed to evaporate on the part.

n. Confternatio. Surprife. As our eyes acquaint us at the
fame time with lefs than half of the objects, which furround us,
we have learned to confide much in the organ of hearing to warn
us of approaching dangers. Hence it happens, that it any found
itrikes us, which we cannot immediately account for, our fears
are inftantly alarmed. Thus in great debility of body, the loud
clapping of a door, or the fall of a fire-movel, produces a!.
and fometimes even convulfions ; the fame occurs frr
peeled fights, and in the dark from unexpected ob' . ..

VOL, II. H la

co DISEASES CLASS I. i. 5. i r.

In thefe cafes the irritability is lefs than natural, though it is
erroneoufly fuppofed to be greater j and the mind is bufied in
exciting a train of ideas inattentive to external objefts ; when
this train of ideas is difievered by any unexpected ftimulus, fur-
prifeis excited ; as explained in Sect. XVII. 3. 7. and XVIII.
17. then as the fenfibility in thefe cafes is greater, fear becomes
fuperadded to the furprife ; and convuliions in confequence of
the pain of fear. See Sect. XIX. 2.

The proximate caufe of furprife is the increafed irritation in-
duced by fome violent ftimulus, which dilTevers our ufual trains
of ideas ; but in difeafes of inirritability the frequent ftarting or
furprife from founds not uncommon, but rather louder than ufu-
al, as the clapping of a door, mews, that the attention of the pa-
tient to a train of fenfitive ideas was previoufly ftronger than
natural, and indicates an incipient delirium j which is therefore
worth attending to in febrile difeafes*

ORDO

CLASS I. 2. i. OF IRRITATION. 5 1

ORDO II.
Decreafed Irritation*

GENUS I.

With decreafed AB'wn -of the Sangitiferous SyJIem.

THE reader mould be here apprized, that the words flrength
and debility, when applied to animal motions, may properly cx-
prefs the quantity of refiftance fuch motions may overcome ; but
that, when they are applied to mean the fiifecptibility or i:
reptibility of animal fibres to motion, they become metaphorical
terms ; as in Sect. XII. 2- i. and would be better expreiled by
the words activity and inactivity.

There are three fources of animal inactivity ; firft, the d
of the natural quantity of ftimulus on thofc fibres, which .
been accuftomed to perpetual ftimulus ; as the arterial and fe-
cerning fyftems. When their accuftomed ftimulus is for a
while intermitted, as when fnow is applied to the ikin of the
hands, an accumulation :of fenforial power is produced \ and then
a degree of ftimulus, as of heat, fomewhat greater than th
prefent applied, though much lefs than the natural quantity, ex-
cites the vefTels of the fkin into violent action. We muft ob-
ferve, that a deficiency of ftimulus in thofe fibres, which arc
not fubject to perpetual ftimulus, as the locomotive mufcllk
is not fucceeded by accumulation of fenforial power -, thefe
therefore are more liable to become permanently inactive after
a diminution of ftimulus ; as in ftrokes of the palfy, this may
be called inactivity from defect: of ftimulus.

2. A fecond fource of animal inactivity exifts, when the fen-
forial power in any part of the fyftem has been previouily ex-
haufted by violent ftimuli ; as the eyes after long expofure to
great light ; or the ftomach, to repeated fpirituous potation ;
this may be termed inactivity from exhauftion of fenforial pow-
er. See Sed. XII. 2. i.

3. But there is a third fource of inactivity owing to the defi-
cient production of fenforial power in the brain ; and hence
ftimuli ftronger than natural are required to produce the accuf-
tomed motions of the arterial fyftem ; in this cafe there is 1,10
accumulation of fenforial power produced ; as in the inactivity
owing to defect of ftimulus ; nor any previous exhauftion of it,
as in the inactivity owing to excefs of ftimulus.

This third kind of inactivity caufes many of the difeafes of
this genus j which are therefore in general to be remedied by

fucl>

S2 DISEASES CLASS I. 2. r. ri

fuch medicines as promote a greater production of fenforial i
er in the brain ; as the incitantia, confuting of wine, beer and
opium, in finall repeated quantities ; and Secondly of fuch as
fimply ftimulate the arterial and gbnduhr fyftem into their nat-
ural actions ; as fmall repeated blifters, fpices and eiTential oil:;.
And laftly the forbentia, which contribute to fupply the more
permanent ftrength of the fyftem, by promoting the abforption
of nouriihment from the flomach and inteftinesj and of the fu~
perfluous fluid, which attends the fecretions.

SPECIES.

I. Febris mirritativa. Inirritative fever. This is the typhus
mitior, or nervous fever of fome writers j it is attended with
weak pulfe without inflammation, or fymptoms of putridity, as
they have been called. When the production of fenforial pow-
er in the brain is lefs than ufual, the pulfe becomes quick as well
as weak ; and the heart fometimes trembles like the limbs of
old age, or of enfeebled drunkards ; and when this force of the
contractions of the heart and arteries is diminimed, the blood is
puihed on with lefs energy, as well as in lefs quantity, and thence
its ftimulus on their (ides is diminifhed in a duplicate ratio. In
compreflions of the brain, as in apoplexy, the pulfe becomes
flower and fuller ; for in that difeafc, as in natural ileep, the irri-
tative motions of the heart and arteries are not diminiihed, voli-
tion alone is fufpended or deftroyed.

If the abforption of the terminations of the veins is not equal-
ly impaired with the force of the heart and arteries, the blood is
taken up by the veins the inftant it arrives at their extremities ;
the capillary veflels are left empty, and there is lefs reliftance to
the current of the blood from the arteries ; hence the pulfe be^
comes empty, as well as weak and quick \ the veins of the fkin
are fuller than the arteries of it ; and its appearance becomes
pale, bluifti, and {hrunk. See Clafs II. 1.3. I.

When this pulfe perfifts many hours, it conftitutes the febris
inirritativa, or typhus, or nervous fever, of fome writers ; it is
attended with little heat, the urine is generally of a natural col-
cur, though in lefs quantity ; with great proftration of ftrength,
and much difturbance of the faculties of the mind. Its imme-
diate caufe feerns to be a deficient fecretion of the fenfcrial pow-
er from the inaction of the brain \ hence almoft the whole of
the fenforial power is expended in the performance of the mo-
tions neceflary to life, and little of it can be fpared for the volun-
tary actions cf the locomotive mufcles, or organs of fenfe, fee
'Clafs I. 2. 5. 3. Its more remote caufe may be from a paraly-

CLASS I. 2. K 2. OF IRRITATION. 53

fis. or death of iome other part of the body ; as of the fpleen,
when a tumour i;, felt on the left fide, as in fome intennittents ;
or of th>; - when the urine continues pale and in imall

•tity. Docs the revivefcence of theie affected parts, or their
torpor, recurring at intervals, form the paroxyfms of theft fevers ?
and their permanent revivefcence eftabliih the cure ? See Clais
IV. 2. I. 19.

The inirritative fever differs from the puerperal and from the
hectic fever, by the permanent inactivity of the ftomach, which
in this difeafe admits of no folid nutriment. See Clafs II. i. 6.
1 6. and Suppl. I. 12.

M. M. Wine and opium in fmall quantities repeated every

' three hours alternately j fmall repeated blifters ; warm but f re ill

air; forbentia ; nutrientia ; transfufion of blood. Small electric

ilioc". ihvough the brain in all directions. Oxygene air ?

2. Purefts imrritaii'va. Inirritative debility. A defective ac-
tion of the irritative motions without increafe of the frequency
of the pulfe. It continued three or four weeks like a fever, and
then either terminates in health, or the patient finks into one kind
of apoplexy, and perifhes. Many fymptoms, which attend ini;
tive fevers, accompany this difeafe, as cold hands and feet ai
riodic times, fcurf on the tongue, want of appetite, muddy
urine, with pains of the head, and fometimes vertigo, and vom-
iting.

This difeafe differs from the inirritative fever by the pulfe
not being more frequent than in health. The want of appetite
and of digeftion is a principal fymptorn, and probably is
cr.ufe of the umverfal debility, which may be occafioned by the
want of nouriihrnent. The vertigo is a fymptom of inirritabil-
ity, as fhcwn in Clafs IV. i. 2. 6. the muddy urine is owing to
increafcd abforption from the bladder in ccnfequence of the di-
minifhed cutaneous and cellular abforption, as in anafarca, ex-
plained in Sect. XXIX. 5. i. and is therefore a confequence of
the inirritability of that part of the fyftem ; the foul tongue is
owing to an increafed abforption of the thinner part of the mu-
cus in confequence of the general deficiency of fluid, which
fhould be abforbed by the (kin and ftomach. The ficknefs is ow-
ing to decreafed action of the ftomach, which is probably the
primary difeafe, and is connected with the vertigo.

M. M. An emetic. Calomel, grains iv. once or twice. Then
a bliiter. Peruvian bark. Valerian. Columbo. Steel. Opi-
um and wine in fmall quantities, repeated alternately every three
hours. Small electric percuffions through the ftomach.

3. Somnus interritptiis. Interrupted ileep. In fome fevers,
where the inirritability is very greai> when the patient falls afleep,

the

54 DISEASES CLASS!. 2. i. 4."

the pulfe In n few minutes becomes irregular, and the patient
awakes in great diforder, and fear of* dying, refufing to ileep again
from the terror of this uneafy fenfation. In this extreme debil-
ity there is reafon to believe, that fome voluntary power during
our waking hours is employed to aid the irritative ftimuli in
carrying on the circulation of the blood through the lungs ; in
the lame manner as we ufe voluntary exertions, when we liften
to weak foimds, or wifh to view an object by a fmall light ; in
ileep volition is fufpended, and the deficient irritation alone is
not fufficient to carry on the pulmonary circulation. This ex-
planation feems the moft probable one, becaufe in cafes of apo-
plexy the irritative motions of the arterial fyflem do not feem to
be impaired, nor in common fleep. See Incubus III. 2. i. 13.
M. M. Opium in very fmall dofes, as three drops of lauda-
num, A perfon (hould watch the patient, and awaken him fre-
quently j or he mould meafure the time between 11 umber and
fiumber by a ftop- watch, and awaken the patient a little before he
would otherwife awake ; or he mould keep his finger on the
pulfe, and fhould forcibly awaken him, as foon as it becomes ir-
regular, before the diforder of the circulation becomes fo great
as to diflurb him. See Clafs I. 2. i. 9. and Sect. XXVII. 2.

4. Syncope. Fainting confifts in the decreafed action of the
arterial fyitem \ which is fometimes occafioned by defecl: of the
ftimulus of detention, as after venefeclion, or tapping for the
clropfy. At other times it arifes from great emotions of the
mind, as in fudden joy or grief. In thefe cafes the whole fenfo-'
rial power is exerted on thefe interefting ideas, and becomes ex-
haufted. Thus during great furprife or fear the heart flops for
a time, and then proceeds with throbbing and agitation ; and
fometimes the vital motions become fo deranged, as never to re-
cover their natural fucceffive action ; as when children have been
frightened into convulfions. See Seel:. XII. 7. i.

Mifs , a young lady of Stafford, in travelling in a chaife

was fo affe6ted by feeing the fall of a horfe and poftillion, in go-
ing down a hill, though the carriage was not overturned, that
{he fainted away, and then became convulfed, and never fpoke
afterwards ; though me lived about three days in fucceffive con-
vulfions and ftupor.

5. Hamorrhagia vcncfa. A bleeding from the capillaries ari-
£ng from defect of venous abforption, as in fome of thofe fevers
commonly termed putrid. When the blood ftagnates in the cel-
3-jlnr membrane, it produces petechice from this torpor or paraly-

•i:rhe abforbent mouths of the veins. It muft be obferved,
that thofe people who have difeafed livers, are more liable to this
kind of hsemorrhagesj as well as to the hiemorrhagia arteriofa ;

the

CLASS I. 2. i. 6. OF IRRITATION. 5$

the former, becaufe patients with difeafed livers are more fubjeft
to paralytic complaints in general, as to hemiplegia, and to drop-
fy, \vhich is a paralyfis of the lymphatics ; and the latter is
probably owing to the delay of the circulation in the vena por-
ta by the torpor of this hepatic vefTel, when the liver is not
much enlarged j and to its preffure on the vena cava, when it is
much enlarged.

I have feen two elderly men, and one middle aged woman, all
of whom had drunk too much fermented or fpirituous liquors,
and had been for fome months gradually finking, were feized
with a ceafclefs haemorrhage from their mouths, and from every
part of the Ikin, where they happened to fcratch themfelves,
which continued fome days till they died. See Sect. XXVII. 2.
M. M. Vitriolic acid, opium, fteel, bark. Sponge bound
on the part. Steel diflblved in fpirit of wine externally. Flour.
6. Hamorrhois cruenta. In the bleeding piles the capillary
veffels of the rectum become diftended and painful from the de-
fect of the venous abforption of the part, and at length burft ;
or the mucous glands are fo dilated as to give a pafTage to the
blood ; it is faid to obferve lunar periods.

M. M. Venefection, poultices, cathartics, fpice, cold bath,
and forbentia. External comprefllon by applying lint, fponge,
or cotton. Internal compreffion by applying a bit of candle
fmeared with mercurial ointment. Strangulate the tumid piles
with a filk firing. Cut them off. See Sed. XXVII. 2.

Mrs. had for twelve or fifteen years, at intervals of a

year or lefs, a bleeding from the rectum without pain ; which
however flopped fpontaneoufly after fhe became weakened, or
by the ufe of injections of brandy and water. Lately the bleed-
ing continued above two months, in the quantity of many ounces
a day, till fhe became pale and feeble to an alarming degree.
Injections of folutions of lead, of bark and fait of fteel, arid of
turpentine, with fome internal aftringents, and opiates, were ufed
in vain. An injection of the fmoke of tobacco, with ten grains
of opium mixed with the tobacco, was ufed, but without effect
the two firfl times on account of the imperfection of the machine ;
on the third time it produced great ficknefs, and vertigo, and nearly
a. fainting fit ; from which time the blood entirely flopped.
Was this owing to a fungous excrefcence in the rectum ; or to
a blood-veflel being burft from the difficulty of the blood pafTing
through the vena porta from fome hepatic obftruction, and
which had continued to bleed fo long ? Was it flopped at laft
by the fainting fit ? or by the flimulus of the tobacco ?

7. Hxmorrhagiarenum. Hemorrhage from the kidneys, when
attended with no pain, is owing to defect of venous abforption in

the

5 6 DISEASES CLASS!. 2. i. 8.

the kidney. When attended with pain on motion, it is owing
to a bit of gravel in the ureter or pelvis of the kidney ; which is
a much more frequent difeaie than the former. See Sect.
XXVII. i.

M. M. i. Venefe£Kon in fmall quantity, calomel, bark, fteel,
an opiate ; cold immerfion up to the navel, the upper part of
the body being kept clothed. Neville-Holt water. 2. Alcali-
xed water aerated. Much diluent liquids. Cool drefs. Cool
bed-room.

Cows ate much fuhject to bloody urine, called foul water by
the farmers ; in this difeafe about fixty grains of opium with or
without as much ruft of iron, given twice a day, in a ball mixed
with flour ahd water, or difTolved in warm water, or warm ale,
are, I believe, an efficacious remedy, to which however mould be
added about two quarts of barley or oats twice a day, and a cover
at night, if the weather be cold.

8. H&morrhagia hepatis. Haemorrhage from the liver. It
fometimes happens in thofe, who have the gutta rofea, or para-
lytic affections owing to.difeafed livers induced by the potation
of fermented liquors, that a great difcharge of black vifcid blood
occaflonally comes away by ftool, and fometimes by vomiting :
this the ancients called melancholia, black bile. If it was bile, a
fmall quantity of it would become yellow or green on dilution
with warm water, which was not the cafe in one experiment
which I tried ; it muft remain fome time in the interlines from
its black colour, when it pafles downwards, and probably comes
from the bile-ducts, and is often a fatal fymptom. When it is
evacuated by vomiting it is lefs dangerous, becaufe it (hews great-
er remaining irritability of the inteftinal canal, and is fomerimes
falutary to thofe who have difeafed livers.

Two elderly men, who had loft their appetite for animal food,
which is always a dangerous fymptom, when it occurs to ,:hofe
who have drank too much fermented liquor, obferved, that they
parted with black ftools. One of them alfo had the mucus of
his noftrils occaiionally ftained with blood. The black ftools
appeared evidently to confift of the coagulum of blood, fome-
times without other feces. After a few weeks> they both funk
under this difcharge, which I fuppofed to proceed from the liv-
er, as it never appeared florid in any part of it. See Section
XXVII. 2.

M. M. An emetic. Rhubarb, fteel, wine, bark, opium.

9. Hamoptoe venofa. Venous hsemoptoe frequently attends
the beginning of the hereditary confumptions of dark-eyed peo-
pie ; and in others, whofe lungs have too little irritability. Thefe
fpittings of blood ave generally in very frmli quantity, as a tea-

fpoonful ;. -

CLASS 1. 2. T. 10. OF IRRITATION. 57

fpoonful ; and return at fir (I periodically, as about once a
month ; and are lefs dangerous in the female than in the male
fox ; as in the former they are often relieved by the natural pe-
riods of the menfcs. Many of thefe patients are attacked with
this pulmonary haemorrhage in their nrft deep ; becaufc in
ble people the power of volition is neceiiary, befides that 01"
tation, to carry on refpiration perfectly •, but, as volition is iul-
pended during fleep, a part of the blood is delayed in the
fels of the lungs, and in conlequence effufed, and the pa:
awakes from the diiagreeable fenfation. See Clais I. 2. i. 3.
II. 1.6.6. III. 2. i. 10. and Sea. XXVII. 2.

M. M. Wake the patient every two or three hours by an
alarum clock. Give half a grain of opium at going to bed, or
twice a day. Onions, garlic, flight chalybeates. Ifiues. Lee
applied once a fortnight or month to the hemorrlicidal vein:? to
pro'duce a new habit. Emetrcs after each period of hsemoptoe,
to promote expectoration, and difiodge any effufed blood, which
might by remaining in the lungs produce ulcers by its putridity.
A hard bed, to prevent too found fleep. A periodical emetic or
cathartic once a fortnight.

10. Pdlpitatio cordls. The palpitation of the heart frequently
attends the hx map toe above mentioned ; and conilils in an in-
effectual exertion of the heart to pufh forwards its contents in
due time, and with due force. The remote caufe is iVcquently
ibme impediment to the general circulation ; as the torpor of
the capillaries in cold paroxyfms of fever, or great adhehons oi"
the lungs. At other times it -.-in the debility of the action

of the heart owing to the deficient icmbrial power ^L irnLaiion
or of affociation, as at the approach of death.

In both thefe cai i the heart feels large to the

touch, as it does not completely empty itfelf at each contraction j
and on that account contracts more frequently, as defcribed in
Sect. XXXII. 2. 2. Another kind of palpitation may fome.
arife from the retrograde motions oi" the heart, as in fear. SLV
Clafsl, 3. i. 2. and IV. 3. i. 6.

n. Menorrhagia. Continued flow of the catamenia. Ths
monthly effufion of blood from the uterus or vagina is owin^ to
a torpor of th~ f thofe membranes in coniequci,

defecl; of venereal ftimulus -, and in this refpect refeai ^
mucus difcharged in the periodical venereal orgaftn - nale?

quadrupeds, which are fecluded from the males. Tiic menor*
rhagia, or continued flow of this difcharge, is owing to a con-
tinued defecl: of the venous abforption of the membranes of the
uterus or vagina. See Clafs IV. 2. 4. 7.

M. M. Vencficliou in (mall cuant-tv. A cathartic. Then

VOL. II I onmm

5$ DISEASES CLASS 1. 2. *. 12,

opium, a^rain^every night. Steel. Bark. A Wider. Topi-
cal afperlion with cold water, or cold vinegar.

One caufe of exceffive menflruation, which fometimes recurs
monthly, and continues for a fortnight at each period, and is
fucceedecl by fiuor albus during the intervals, I have fufpec~led to
arife, like the bleeding piles, from enlargement of the liver, which
is liable to occur about the age of forty to thole who have drank
much flrong fmall beer, or wine 5 or to thofe who have unfor-
tunately been long accuflomed to the ufe of tight flays, or other
bandages round their bowels. In thefe fituations 6 or 8 grains of
rhubarb mould be taken every night for months, or even years.
Calomel, 4 or 6 grains mould be taken as a cathartic one a month.
A flannel drefs on the legs, thighs, and lower body may be ufe-
ful in the cold feafon, but injurious in the warmer months.
Weak acid of vitriol ten drops, two or three times a day ; fleel
in very fmall quantity ; and a very loofe drefs round the body -y
are recommended.

12. Dyfmenorrhagia. A difficulty of menftruation attended
with pain. In this complaint the torpor of the uterine vefTels,
which precedes menflruation, is by fympathy accompanied with
a torpor of the lumbar membranes, and confequent pain ; and
frequently with cold extremities, and general debility. The
fmall quantity and difficulty of the difcharge is owing to arterial
inactivity, as in chlorofis. Whence it happens, that chalybeate
medicines are of efficacy both to flop or prevent too great men-
ftruation, and to promote or increafe deficient menflruation ;
as the former is owing to inirritability of the veins, and the lat-
ter of the arteries of the uterus. See Article IV. 2. 6. in the Ma-
teria'Medica.

M. M. Opium, fleel, pediluvium. Warm bath.

13. Lcchia nimla. Too great difcharge after delivery. In that
unnatural practice of fomehafty accoucheurs of introducing the
hand into the uterus immediately after the delivery of the child,
and forcibly bringing away the placenta, it frequently happens,
that a part of it is left behind ; and the uterus, not having pow-
er to exclude fo fmall a portion of it, is prevented from com-
plete contraction, and a great haemorrhage enfues. In this cir-
cumflance a bandage with a thick comprefs on the lower part of
the belly, by appreffirig the fides of the uterus on the remaining
part of the placenta, is likely to check the haemorrhage, like the
application of a pledget of any foft fubilance on a bleeding veflcl.

In o'.her cafes the lochia continues too long, or in too great
quantity, owing to the deficiency of venous abforption.

M. M. An enema. An opiate. Ablifter. Slight calybe-
ates. Peruvian bark. Cloths dipped in cold vinegar and applied

externally.

CLASS I. 2. i. 14- OF IRRITATION. 59

externally. Bandages on the limbs to keep more blood in them
for a time have been recommended.

14. Abortlo Spontanea. Some delicate ladies are perpetual1.-;
liable to fpontaneous abortion, before the third, or after the lev-
enrh, month of geitation. From tome of thefe patients I have
learnt, that they have awakened with a flight degree of dip
refpiration, fo as to induce them to rife haitily up in bed 5 and
have hence fufpedted, that this was a tendency to a kii-
ma, owing to a deficient abforption of blood in ti
of the pulmonary or bronchial veins ; and have conclu
thence, that there was generally a deficiency of venous abforp-
tion ; and that this was the occasion of their frequent abortion.
Which is further countenanced, where a great fanjjuinary dif-
charge precedes or follows the exclufion of the fetus.

Mifcarriages are fometimes induced by what is termed a re-
troverfion of the uterus, in which the fundus uteri is retrov
and prefled down between the rectum and the vagina.
can only occur in the fir ft or fecond month of geitation, and is
generally preceded by a difficulty of making water, and a confe-
quent tumour of the bladder ; a violent pain about the per'uueum
or rectum is thus caufed, and a mifcarriage is liable to follow.
Draw off the urine with a catheter; inject an enema with fixty
drops of tincture of opium, if it can be done. If it recurs fre-
quently after the mifcarriage, a wax candle, or a peiTary, made
by rolling fome emplaftrum de minio fpread on linen, may be
introduced into the rectum, and worn as a comprefs to
vent the return for a few days, till the parts recover their ftrengtru
See London Medical Obfervations, Vol. IV. p. 388. and Dr.
Hunter's Tables of the Gravid Uterus.

M. M. Opium, bark, chalybeates in fmall quantity. Change
to a warmer climate. I have directed with fuccefs in four cafes
half a grain of opium twice a day for a fortnight, and then a
whole grain twice a day during the whole geftation. One of
thefe patients took befides twenty grains of Peruvian bark for
feveral weeks. By thefe means being exactly and regularly per-
lifted in, a new habit became eitablilhed, and the ufual mifcar-
riages were prevented.

Mifcarriages more frequently happen from eruptive fevers, and
from rheumatic ones, than from other inflammatory difeafes. I
faw a moft violent pleurify and hepatitis cured by repeated vene-
fection about a week or ten days before parturition ; yet another
lady whom I attended, mifcarried at the end of the chicken pox,
with which her children were at the fame time affected. Mifcarri-
ages towards the termination of the fmall-pox are very frequent,
yet there have been a few inll-mces of children, who have been

barn

£» DISEASES GtAssI. 2. i. is.

born with the eruption on them. The blood in the fmall pox will
not inoculate that difeafe, if taken before the commencement of
the fecondary fever ; as fhewn in Sect. XXXIII. 2. 10. becaufe
the contagious matter is not yet formed, but after it has been
oxygenated through the cuticle in the puftules, it becomes con-
tagious ; and if it be then abforbed, as in the fecondary fever,
the blood of the mother may become contagious, and in feel: the
child. The fame mode of reafoning is applicable to the chicken
pox, See CJafsIV. 3. i. 7.

15. Scorbutus. S.ea-fcurvy is ca.ufed by fait diet, the perpet-
ual itimulus of which debilitates the venous and abforbent fyf-
tems ; and may alfo be promoted by the fea-air, which is known
to be fo injurious to moft vegetables, which grow near the coafts,
and has been perhaps incaurioufly recommended to confumptive
patients. See Clafs II-. i. 6. 7. Hence the blood is imperfect-
ly taken up by the veins from the capillaries, whence browi*
and black fpots appear upon the Jkin without fever. The limbs
become livid and edematous, and laftly ulcers are produced from
deficient abforption. See Sect. XXXIII. 3. 2. and Clafs II. i.
4. 13. For an account of the fcurvy of the lungs, fee Seel.
XXVII. 2.

M. M. Frefli animal and vegetable food. Infufion of malt.
New beer. Sugar. Wine. Steel. Bark. Sorbentia, Opium ?

1 6. Vibices. Extravafations of blood become black from their
being fecluded from the air. The extravafation of blood in
bruifes, or in fome fevers, or after death in fome patients, ef-
pecially in the parts which were expofed to prerTure, is owing
to the fine terminations of the veins having been mechanically
comprefled fo as to prevent their abforbing the blood from the
capillaries, or to their inactivity from difeafe. The blood when
extravafated undergoes a chemical change before it is fufficient-
ly fluid to be taken up by the lymphatic abforbents, and in that
procefs changes its colour io green and then yellow.

17. Petechia. Purple fpots. Thefe attend fevers with great
venous inirritability, and are probably formed by the inability
of a fingle termination of a vein, whence the correfponding
capillary becomes ruptured, and effufes the blood into the cellu-
lar membrane round the inert termination of the vein. This is
generally efteemed a fjgn of the putrid (late of the blood, or that
ilate contrary to the inflammatory one. As it attends fome in-
flammatory difeafes which are attended with great inirritability,
as in the confluent fmall pox. But it alfo attends the fcurvy,
where no fever exifts, and it therefore {imply announces the. in-
activity of the terminations of fome veins 5 and is thence int.

a bad fymptom in fevers, as a mark of approaching inactivity of

:

I. 2. i. 1 8. ' OF IRRITATION. 61

the whole fanguiferous fyftem, or death. The blue colour of
fome children's arms or faces in very cold weather is owing in
manner to the torpor of the abforbent terminations of the
the veins, whence the blood is accumulated in them, and fome-
times burfis them. See Hsemorrhagia venofa, and Suppl. i. 2. 7.

In forne cafes of fever attended with petechise, Dr. HalJ, of
Colcheil'er, directed the body to be warned with cold vinegar and
water twice a day, with great advantage. The petechise became
aily lefs numerous and lefs livid, the pulfe flower and ftrong-
r, with lefs delirium, and more fieep. 'He has treated twenty
cafes in this manner, and not loft one. JVledical Review, Vol.
III. p. 8.

In thefe cafes not only the application of external cold feems
to have been of iervice, by preventing the unneceiTary expendi-
ture of animal power ; but as the flimulus of vinegar renders
the lips pale, when applied externally, and in confequence ftim-
ulates the terminations of the veins into greater action j it feems
alfo to have contributed to remove the Petechise.

1 8. Aneurifma. Arreurifm is probably owing to the want of
due irritability of a part of the coat of an artery. As living
raufclesare known to refift diruption more than dead ones, ac-
cording to the experiments (I think) of Dr. Langrifh, it follows
that when a part of the coat of an artery ceafes to contract by
the (limulusof the blood, that it will foon become diftended by
the force of it, till it widens into a fack, and at laft becomes
ruptured.

M. M. Venefedion repeatedly in fmall quantities. Reft.
Diluent, mild nutriment. Daily evacuation by a pill confifting
of rhubarb eight grains, and foap four grains.

It is poflible alfo, that an aneurifrn may be produced by the
reliftance to the circulation, and the force of the heart being
greater than the fides of the arteries can counterbalance.

Mr. Gimbernat is faid to have cured fome cafes of aneurifm
in the popliteal artery by comprefTmg it by means of an adapted
machine, confifting of a fteel ring above and below the knee,
which are joined by a plate, beneath which is placed a proper
cufhion, which can be preffed on the diftended part of the arte-
ry more or lefs by of means a fcrew. The other method of cure
is by a double ligature above the aneurifm, as firft pra&ifed by
Mr. J. Hunter.

19. Varlx. The varix of veins occurs frequently in the legs
of women, poflibly fometimes from tight garters, and has for its
proximate caufe the inirritability of the coat of the vein ; whence
it becomes diibnded, till it burits, by the power with which the

blood

62 DISEASES CLASS 1. 2. i.

blood is thrown into it by the abforbent mouths, which take it
up from the capillary arteries.

M. M. Tie the vena faphena below the joint of the knee, and
the blood will then circulate by the internal veins ; and that flop-
ped in the veins beneath the ligature will be abforbed.

The piles may be termed varixes, and may be deftroyed by
ex'Cifion or ligature. See Haemorrhois,

i

ORDO

ss I. 2. 2. i. OF IRRITATION.

ORDO II.

Decreafed Irritation.
GENUS if.

Decreafed Aclion of the Secerning

j

THESE are always attended with decreafe of partial, or of gen-
1 heat •, for as the heat of animal bodies is the confequence
f their various fecretions, and is perpetually paffing away into
e ambient air, or other bodies in contact with them ; when
thefe fecretions become diminimed, or ceafe, the heat of the part
or of the whole is foon diminimed, or ceafes along with them.

SPECIES.

i. Frigtts febrile. Febrile coldnefs. There is reafon to be-
lieve, that the beginning of many fever-fits originates in the qui-
efcence of fome part of the abforbent fyftem, efpecially where
they have been owing to external cold ; but that, where the
coldnefs of the body is not owing to a diminution of external
heat, it arifes from the inaction of fome part of the fecerning
fyftem. Hence fome parts of the body are hot whiht other
parts are cold ; which I fuppofe gave occafion to error in Mar-
tyn's Experiments ; where he fays, that the body is as hot in the
cold paroxyfms of fevers as at other times.

After the fenforial power has been much diminimed by great
preceding activity of the fyftem, as by long continued external
heat, or violent exercife, a fudden expofureto much cold produ-
ces a torpor both greater in degree and over a greater portion of
the fyftem, by fubtracting their accuftorned ftimulus from parts
already much deprived of their irritability. Dr. Franklin in a
letter to M. Duberge, the French tranfiator of his works, men-
tions an inftance of four young men, who bathed in a cold
fpring after a day's harveft work ; of whom two died on the
fpot, a third on the next morning, and the other furvived with
difficulty. Hence it would appear, that thofe, who have to trav-
el in intenfely cold weather, will fooner periih, who have pre-
vioully heated themfclves much with drams, than thofe who
have only the llirnulus of natural food ; of which I have heard
well attefted inftance. See Article VII. 2.3. Clafs IIL
z. i. i 7.

Frzguj chromcum. Permanent coldnefs. Coldnafs of the ex-
tremities,

64 DISEASES GLASS L 2. 2.

tremities, without fever, with dry pale (kin, is a fymptom of
general debility, owing to the decreased aftion of the arterial
lyilem, and of the capillary veiiels ; whence the perfpirable
matter is fecreted in lefe quantity, 2nd in confequerice the fkin is
lefs warm. This coldnefs»is obfervable at the extremities oi
limbs, ears, and nofe, more than in any other parts : as a larger
furface is here expofed to the contact of the air, or clothes, and
thence the heat is more haftily carried away.

The pain, which accompanies the coldnefs of the fkin, is
owing to the deficient exertion of the fubcutaneous veffels, and
probably to the accumulation of fenforial power in the extremi-
ties of their nerves. See Sutl. XII. 5. 3. XIV. 6. XXXII. 3.
and Clafs I. 2. 4. I.

M. M. A blifter. Incitantia, nutrientia, forbentia. Exey-
cife. Clothes. Fire. Joy. Anger.

2. Pallor fugitiv us. The fugitive palenefs, which accompa-
nies the coldnefs of the extremities', is owing to a lefs quantity
of blood pafling through the capillaries of the (kin in a given
time ; where the abforbent power of the veins is at the fame
time much diminished, a part of the blood lingers at their June-;
tion with the capillary arteries, and a bluifh tinge is mixed with
true palenefs ; as is feen in the loofe fkin under the eye-lids, and
is always a mark of temporary debility. See Clafs II. i. 4. 4.
Where the palenefs of the ikin is owing 'to the deficiency of red
globules in the blood, it is joined with a yellowim tinge -, which
is the colour of the ferum, with which the blood then abounds,
as in chlorofis, and in torpor or paralyfis of the liver, and is of-
ten miftaken for a fuperabundance of bile.

A permanent palenefs of the Ikin is owing to the coalefcence
of the minute arteries, as in old age. See Clafs I. 2. 2. 9.
There is another fource of palenefs from the increafed abforption
of the terminations of the veins, as when vinegar is applied to the
lips. See Seel:. XXVII. i. and another from the retrograde
motions of the capillaries and fine extremities of the arteries.
See Clafs II. 3. i. i.

M. M. A blifter, nutrientia, incitantia, cxercife, oxygene gas.

3. Pus par cms. Diminimed pus. Drynefs of ulcers. In
the cold fits of fever all the fecretions are diminiihed, whether
natural or artificials as their quantity depends on the actions of
the glands or capillaries, which then (hare in the univerfal inac-
tion of the fyftem. Hence the drynefs of iflues and blilters in
great debility, and before the approach of death, is owing to de-
ficient fecretion, and not to increafed abforptiou.

M. M. Opium, wine in very fmall quantities, Peruvian bark.
4- Mucus parcior. Dinimilhed mucus. Drynefs of the

mouth

CLASS I. 2. 2. 5- OF IRRITATION. 65

mouth and noftrils. This alfo occurs in the cold fits of interrait-
tents. In thefe cafes I have alfo found the tongue cold to the
touch of the finger, and the breath to the back of one's hand,
when oppofed to it* which are very inaufpicious fymptoms, and
generally fatal. In fevers with inirritability it is generally el-
teemed a good fymptom, when the noftrils and tongue become
moid after having been previoufly dry •, as it (hews an increafed
aftion of the mucous glands of thofe membranes, which were be-
fore torpid. And the contrary to this is the fades Hippocr.uica,
or countenance fo well delcribed by Hippocrates, which is pale,
cold, and ihrunk ; all which are owing to the inactivity oi: the
fecerning vefiels,the palenels from there being lefs red blood pail-
ing through the capillaries, the coldnefs of the fkin from there
being lefs fecretion of perfpirable matter, and the ihrunk appear-
ance from there being lefs mucus fecreted into the cells of the
cellular membrane. See Glafs IV. 2. 4. 1 1.
M. M. Blifters. Incitantia.

5. Ur'ina parcior pallida. Paucity of pale urine, as in the cold
fits of intermittents ; it appears in fome nervous fevers through-
out the whole difeafe, and feems to proceed from a palfy of the
kidneys ; which probably was the caufe of the fever, as the fever
fometimes ceafes, when that fymptom is removed : hence the
ftraw-coloured urine in this fever is fo far falutary, as it (hews
the unimpaired action of the kidneys.

M. M. Balfams, eiTential oil, afparagus, rhubarb, a blifter.
Cantharides internally.

6. Torpor hepaticus. Paucity of bile from a partial inaction
of the liver •, hence the bombycinous colour of the fkin, grey
{tools, urine not yellow, indigeftion, debility, followed by tym-
pany, dropfy, and death.

This paralyfis or inirritability of the liver often deftroys thofe
who have been long habituated to much fermented liquor, and
have fuddenly omitted the ufe of it. It allo deitroys plumbers
and houfe-painters, and in them feems a fubilitute for the colica
iaturnina. See Seel:. XXX.

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

7. Torpor pancreatis. Torpor of the pancreas. I law what
I conjectured to be a tumour of the pancreas with indigeilion,
and which terminated in the death of the patient. He had been
for many years a great confuiner of tobacco, infomuch that he
chewed that noxious drug all the morning, and fmoked it all the
afternoon. As the fecretion from the pancreas refembles iuliva

VOL. II, K in

66 DISEASES CLASS I. 2. 2. 8*

in its general appearance, and probably in its office of affifting di-
geftion, by preventing the fermentation of the aliment ; as would
appear by the experiments of Pringle and Macbride ; there is rea-
fon to fufpect, that a fympathy may exifl between the falivary
and pancreatic glands ; and that the perpetual ftimulus of the
former by tobacco might in procefs of time injure the latter.
See Tobacco, Article III. 2. 2.

8. Torpor renis. Inirritability or paralyfis of the kidneys is
probably frequently miftaken for gravel in them. Several, whc»
have lived rather intemperately in refpect to fermented or fpir-
ituous liquors, become fuddenly feized about the age of fixty, or
later, with a total ftoppage of urine ; though they have previ-
oufly had no fymptoms of gravel. In thefe cafes there is no-
water in the bladder ; as is known by the introduction of the
catheter, of which thofe made of elaftic gum are faid to be pref-
erable to metallic ones •, or it may generally be known by the
fhape of the abdomen, either by the eye or hand. Bougies and'
catheters of elaftic gum are fold at No. 37, Red Lion-ftreet,
Holborn, London.

Mk M. Electric mocks, warm bath. Emetics. See calcu-
lus renis, Clafs I. i. 3. 9. When no gravel has been previoufly
obferved, and the patient has been a wine-drinker rather than
an ale-drinker, the cafe is generally owing to inirritability of
the tubuli uriniferi, and is frequently fatal. See Clafs I. 2. 4. 20.

9. Punfta muccfa vultus. Mucous fpots on the face. Thefe
are owing to the inactivity of the excretory ducts of the mucous
glands ; the thinner part of this fecretion exhales, and the re-
mainder becomes infpiiTated, and lodges in the duct ; the ex-
tremity of which becomes black by expofure to the air.

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

10. Macula cuth fulvx. Morphew or freckles. Tawny
blotches on the fkin of the face and arms of elderly people, and
frequently on their legs after flight eryfipelas. The freckles on
the face of younger people, who have red hair, feem to be a fim-
ilar production, and feem all to be caufed by the coalefcence of
the minute arteries or capillaries of the part. In a fear after a
wound the integument is only opaque ; but in thefe blotches,
which are called morphew and freckles, the fmall veflels feem
to have become inactive with fome of the ferum of the blood ftag-
nating in them, from whence their colour. See Clafs III. I. 2. i 2.

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

11. Canities. Grey hair. In the injection of the veflels of
animals for the purpofes of anatomical preparations, the colour
of the injected fluid will not pafs into many very minute veflels ;.

which

CLASS I. 2. 2, 1 1. OF IRRITATION. 67

•which neverthelefs uncoloured water, or fpirits, or quickfilvers
will permeate. The fame occurs in the filtration of fome col-
oured fluids through paper, or very fine fand, where the colour-
ing matter is not perfectly diflblved, but only diffufed through
the liquid. This has led fome to imagine, that the caufe of the
whitenefs of the hair in elderly people may arife from the dimi-
nution, or greater tenuity, of the glandular veffels, which fecrete
the mucus, which hardens into hair ; and that the fame differ-
ence of the tenuity of the fecerning veflels may pofTibly make the
difference of colour of the filk from different lilk- worms, which
is of all (hades from yellow to white.

•But as the fecreted fluids are not the confequence of mechan-
ical filtration, but of animal felection ; we muft look out for
another caufe, which muft be found in the decreafing activity of
the glands, as we advance in life ; and which affects many of
our other fecretions as well as that of the mucus, which forms
the hair. Hence grey hairs are produced on the faces of horfes
by whatever injures the glands at their roots, as by corrofive blif-
ters; and frequently on the human fubject by external injuries
on the head ; and fometimes by fevers. And as the grey col-
our of hair confifts in its want of tranfparency, like water con-
-verted into fnow -, there is reafon to fuppofe, that a defect: "of fe-
creted moifture (imply may be the caufe of this kind of opacity,
as explained in Cataracta, Clafs I. 2. 2. 13.

M. M. Whatever prevents the inirritability and infenfibility
of the fyftem, that is, whatever prevents the approach of old age>
will fo far counteract; the production of grey hairs, which is a
fymptom of it. For this purpofe in people, who are not corpu-
lent, and perhaps in thofe who are fo, the warm bath twice or
thrice a week is particularly ferviceable. See Sect. XXXIX. 5.
i. on the colours of animals, and Clafs I. i. 2. 15.

As meohanical injury from a percuffion, or a wound, or a cauf-
tic, is liable to occafion the hair of the part to become grey; fo
I fufpect the compreffion of parts againft each other of fome an-
imals in the womb is liable to render the hair of thofe parts of
a lighter colour ; as feems often to occur in black cats and dogs.
A fmall terrier bitch now (lands by me, which is black on all
thofe parts, which were external, when fhe was wrapped up in
the uterus, teres atque rotunda ; and thofe parts white, which
were moft conftantly preffed together ; and thofe parts tawny,
which were generally but lefs conftantly preffed together. Thus
the hair of the back from the forehead to the end of the tail is
black, as well as that of the fides, and external parts of the legs,
both before and behind.

As in the uterus the chin of the whelp is bent down, and lies

6$ DISEASES CLASS I. 2. 2. if.

in contaft with the fore part of the neck and bread ; the tail is
applied clofe againft the divifion of the thighs behind ; the infide
of the hinder thighs are preffed clofe to the fides of the belly, all
thefe parts have white hairs.

The fore-legs in the uterus lie on each fide of the face ; fo
that the feet cover part of the temples, and comprefs the prom-
inent part of the upper eye-brows, but are fo placed as to defend
the eye-balls from preffure ; it is curious to obferve, that the
hair of the fides of the face, and of the prominent upper eye-
brows, are tawny, and of the infide of the feet and legs, which
covered them ; for as this pofture admitted of more change in the
latter weeks of geftation, the colour of thefe parts is not fo far
removed from black, as of thofe parts, where the contacl or
compreflion was more uniform.

I have lately alfo infpecled a male cat ; who is quite black all
over,except thofe parts which appear to have been folded together
in the uterus ; all which are perfectly white. In both thefe ani-
mals the parts comprefTed together are fo diftinftly defined by
their colour, that the difference of the curvature and fituation
of them in the uterus may be nicely difcerned : the hinder feet
of the cat lay in the arm-pits of the fore-legs, and are white ;
her fore-legs croffed over the hinder thighs, and left on them a
white mark ; but the fore-feet, at lead the hind part of them,
lav under the tail ; whence the fore-feet are tipped with white.
Where the foetus is lefs tender, I fuppofe, this compreflion in
the uterus does not affecT: it ; as (Jogs and cats are perpetually
feen, which are totally black.

Where this uterine compreffion of parts has not been fo great
as to gender the hair white in other animals, it frequently hap-
pens, that the extremities of the body are white, as the feet,
and nofe, and tips of the ears of dogs and cats and horfes, where
the circulation is naturally weaker ; whence it woukkfeem, that
the capillary glands, which form the hair, are impeded in the
firfl inftance by compreffion, and in the laft by the debility of
the circulation in them. See Glafs I. 1.2. 15.

This day, Auguft 8th, 1 794, I have feen a negro, who was
born (as he reports) of black parents, both father and mother, at
Kinglton in Jamaica, who has many large white blotches on the
fkin of his limbs and body ; which I thought felt not fo foft to
the finger, as the black parts. He has a white divergent blaze
from the fummit of his nofe to the vertex of his head ; the up-
per part of which, where it extends on the hairy fcalp, has thick
curled hair, like the other part of his head, but quite white. By
thefe marks I fuppofed him to be the fame black, who is defcri-
bed, when only two years old, in the Tranfaclions of the Ameri-
can

CLASS I. 2. 2. 12. OF IRRITATION. 69

can Philofophical Society, Vol II. page 292, where a female one
is likewife defcribed with nearly fimilar marks.

The joining of the frontal bones, and the bregma, having been
later than that of the other futures of the cranium, probably
gave caufe to the whitenefs of the hair on thcfe parts by delaying
or impeding its growth.

12. Callus. The callous (kin on the hards and feet of laborious
people is owing to the extreme vefTels coalefcing from the per-
petual prefiure they are expofed to.

As we advance in life, the finer arteries lofe their power of
aclion, and their fides grow together ; hence the palenefs of the
ftins of elderly people, and the lots of that bloom, which is ow-
ing to the numerous line arteries, and the tranfparency of the
| flctn, that enciofes them.

M. M. Warm bath. Paring the thick fkin with a knife.
Smoothing it with a pumice (lone. Cover the part with oiled
filk to prevent the evaporation of the perfpirable matter, and
thus to keep it moid.

13. Catarafta is an opacity of the cryftalline lens of the eye.
It is a difeaie of light-coloured eyes, as the gutta ferena is of
dark ones. On cutting oft' with fciflars the cornea of a calf>
eye, and holding it in the palm of one's hand, fo as to gain a prop-
er light, the artery, which fupplies nutriment to the cryftalline
humour, is eafily and beautifully feen ; as it rifes from the cen-
tre of the optic nerve through the vitreous humour to the cryf-
talline. It is this point, where the artery enters the eye through
the cineritious part of the optic nerve, (which is in part near the
middle of the nerve,) which is without fenfibility to light ; as
is fhewn by fixing three papers, each of them about half an inch
in diameter, againft a wall about a foot diftant from each other,
about the height of the eye ; and then looking at the middle one,
with one eye, and retreating till you lofe fight of one of the exter-
nal papers. Now as the animal grows older, the artery becomes lefs
vifible, and perhaps carries only a tranfparent fluid, and atlengthin
fome fubjecls I fuppofe ceafes to be pervious ; then it follows, that
the cryftalline lens, lofmg fome fluid, and gaining none, becomes
dry, and in confequence opaque ; for the fame reafon, that wet or
piled paper is more tranfparent than when it is dry, as explained in
Clafsl. 1.4. i. Thewantof moifture in the cornea of old people,
when the exhalation becomes greater than the fupply,is the caufe
of its want of tranfparency ; and which like the cryftalline gains
rather a milky opacity. The fame analogy may be ufed to explain
the whitenefs of the hair of old people, which lofes its peliucidity
along with its moifture. See Clafs I. 2. 2. 1 1.

M. M. Small electric (hocks through the eye. A quarter of

a

7® DISEASES CLASS I. 2. 2. 13;

a grain of corrofive fublimate of mercury difTolved in brandy, or
taken in a pill, twice a day for fix weeks. Couching by depref-
fion, or by extraction. The former of thefe operations is much to
be preferred to the latter, though the latter is at this time fo
fashionable, that a furgeon is almoft compelled to ufe it, left he
ihould not be thought an expert operator. For deprefiing the
Cataract is attended with no pain, no danger, no confinement,
and may be as readily repeated, if the cryftailine fhouid rife again
to the centre of the eye. The extraction of the cataract is at-
tended with confiderable pain, with long confinement, generally
with fever, always with inflammation, and frequently with irre-
parable injury to the iris, and confequent danger to the whole
eye. Yet has this operation of extraction been trumpeted into
vmiverfal fafhion for no other reafon but becaufe it is difficult to
perform, and therefore keeps the bufinefs in the hands of a few
empirics, who receive larger rewards, regardlefs of the hazard,
which is encountered by the flattered patient.

A friend of mine .returned yefterday from London after an
abfence of many weeks 5 he had a cataract in a proper flate for
the operation, and in fpite of my earned exhortation to the con-
trary, was prevailed upon to have it extracted rather than depreff-
ed. He was confined to his bed three weeks after the operation,
and is now returned with the iris adhering on one fide fo as to
make an oblong aperture ; and which is nearly, if not totally,
without contraction, and thus greatly impedes the little vifion,
which he poiTeffes. Whereas I faw fome patients couched by
depremon many years ago by a then celebrated empiric, Cheva-
lier Taylor, who were not confined above a day or two, that the
eye might gradually be accu domed to light, and who faw as well
as by extraction, perhaps better, without either pain, or inflam-
mation, or any hazard of lofing the eye.

As the inflammation of the iris is probably owing to fdrcing
the cryftailine through the aperture of it in the operation of ex-
.tracting it, could it not be done more fafely by making the open-
ing behind the iris and ciliary procefs into the vitreous humour ?
but the operation would ftill be more painful, more dangerous>
and not more ufeful than that by deprefling it.

If extraction of the cryftailine be ufed, Dr. Reimarus of Ham-
burgh advifes to drop into the eye previous to the operation,
fome extract of belladonna diflblved in water, which he has found
to produce a temporary paralyfis of the retina, and thence a total
inaction of the iris, fo that it remains perfectly expanded, and
is thence lefs liable to be injured by the operation, and the eye
perhaps lefs liable to inflammation. Might not this be of advan-
tage in fome ophthalmies ?

14. InnutrltiQ

CLASS

14.

bo

•

ASS I. 2. 2. 14. OF IRRITATION. 71

14. Innutntio offtum. Innutrition of the bones. Not only
the blood effuled in vibices and petechise, or from bruifes, as well
as the blood and new veffels in inflamed parts, are reabforbed by
the increafed action of the lymphatics ; but the harder materials,
which conftitute the fangs of the firft fet of teeth, and the ends
of exfoliating bones, and fometimes the matter of chalk-ftones
in the gout, the coagulable lymph, which is depofited on the
lungs, or on the mufcles after inflammation of thofe parts, and
which frequently produces difficulty of breathing, and the pains
of chronic rheumatifm, and ladly the earthy part of the living
bones are diffolved and abforbed by the increaied actions of this
(tern of veffels. See Seel. XXXIII. 3.1.
The earthy part of bones in this difeafe of the nutrition of
em feems to fuffer a folution, and reabforption ; while the
veffels do net fupply a fuflkient quantity of calcareous
earth and phofphoric acid, which conftitute the fubita-nce of bones.
As calcareous earth abounds every \vhere, is the want of phof-
phoric acid the remote caufe ? One caufe of this malady is
given in the Philofophic Tranfactions, where the patient had
been accuftomed to drink large quantities of vinegar. Two cafes
are defcribed by Mr. Gouch. In one cafe, which I faw, a con-
fiderable quantity of calcareous earth* and afterwards of bone-
aflies, and of decoction of madded, and alfo of fublimate of
mercury, were given without effect. All the bones became foft,
many of them broke, and the patient feemed to die from the
want of being able to diftend her cheft owing to the foftnefs of
the ribs.

M. M. Salt of urine, called fal microcofmicum, phofphorated
foda. Calcined hartfhorn. Bone-afhes. Hard or petrifying
water, as that of Matlock, or fuch as is found in all limeftone
or marly countries. The calcareous earth in thefe waters might
poffibly be carried to the bones, as madder is known to colour
them. Warm bath. Volatile or fixed alkali as a lotion on the
fpine, or effential oils.

The innutrition of the bones is often firft to be perceived by
the difficulty of breathing and palpitation of the heart on walking
a little fafter thanufual, which I fuppofe is owing to the foft-
nefs of the ends of the ribs adjoining to the fternum j on which
account they do not perfectly diften-d the cheft, when they are
raifed by the pectoral and intercoftal mufcles with greater force
than ufual. After this the fpine becomes curved both by the
foftnefs of its vertebrae, and for the purpofe of making room for
the difturbed heart. See Species 16 of this Genus.

As thefe patients are pale and weak, there would feem to be
deficiency of oxygene in their blood, and in confequence a defi-
ciency

72 DISEASES CLASS I. 2. z- 14.

ciency o£ phofphoric acid ; which is probably produced by ox-
ygene in the act of refpiration.

Mr. Bonhome, in the Chemical Annals, Auguft, 1 793, fup-
pofes the rickets to arife from the prevalence of vegetable or
acetous acid, which is known to fofien bones out of the body.
Mr. Dettaen feems to have efpoufed a fimilar opinion, and both
of them in confequence give alkalies and teftacea. If this the-
ory was juft, the foft bones of fuch patients mould (hew evident
marks of fuch acidity after death ; which I believe has not been
obferved. Nor is it analogous to other animal facts, that nu-
tritious fluids fecreted by the fined veflels of the body fiiould be
fo little animalized, as to retain acetous or vegetable acidity.

The fuccefs attending the following cafe in fo fhort a time as
a fortnight I afcribed principally to the ufe of the warm bath ;
in which the patient continued for full half an hour every night,
in the degree of heat, which was mofl grateful to her fenfation,

which might be I fuppofe about 94. Mifs , about ten years

of age, and very tall and thin, has laboured under palpitation of
her heart, and difficult breathing on the leaft exercife, with oc-
eafional violent dry cough, for a year or more, with dry lips,
little appetite either for food or drink, and dry fkin, with cold
extremities. She has at times been occafionaliy worfe, and been
relieved in fome degree by the bark. She began to bend for-
wards, and to lift up her ftioulders. The former feemed owing
to a beginning curvature of the fpine, the latter was probably
caufed to facilitate her difficult refpiration.

M. M. She ufed the warm bath, as above related ; which by
its warmth might increafe the irritability of the {mailed feries
of veflels, and by fupplying more moifture to the blood might
probably tend to carry further the materials, which form calca-
reous or bony particles, or to convey them in more dilute folu-
tion. She took twice a day twenty grains of extract of bark,
twenty grains of foda phofphorata, and ten grains of chalk, and
ten of calcined hartmorn mixed into a powder with ten drops
of laudanum; with flefti food both to dinner and fupper •, and
port wine and water inftead of the fmall beer me had been ac-
cuftomed to ; (lie lay on a fofa frequently in a day, and occafion-
aliy ufed a neck-fwing.

There is no fituation, where the foftnefs of the bones and
consequent deformity of them is fo frequently attended with
calamitous confequences, as when it affects the bones of the
pelvis, fo as to contract the form of it; whence many unfortu-
nate women have loft their infants, or perifhed themfelves. In
this miferable fituation of the pregnant uterus, fome have deftroy-
ed the child, others have undergone the Cefarean operation,

and

GLASS I. 2. 2. i£. OF IRRITATION. 73

and have thence generally periihed themfelves. But Dr. Den-
man has ingenioufly introduced a new practice, which has faved ,
in fuch cafes, both the mother and child ; which is by promo-
ting a premature delivery between the feventh and eighth months,
before the child has acquired its full growth, which has been at-
tended with fuccefs. See Denman's Midwifery, and Medical
journal, Vol. III. No. 1 1.

In one inftance, nature feems to have had a fimilar expedient,
md perhaps to overcome a fimilar difficulty, in the premature
>irth of the progeny of the kanguroo ; whofe young are exclu-
led from the uterus in a very early ftate of their growth, and re-
ceived into an exterior bag ; which is furnimed with teats, to
which they long adhere by their mouths, till they are ready for
a fecond birth.

15. Rachitis. Rickets. The head is large, protuberant chief-?
ly on the forepart. The fmaller joints are fwelled ; the ribs de-
preffed ; the belly tumid, with other parts emaciated. This dif-
cafe from the innutrition or foftnefs of the bones arofe about two
centuries ago •, feems to have been half a century in an increaf.
ing or fpreading itate ; continued about half a century at its
height, or greateit diffufion ; and is now nearly vanifhed : which
gives reafon to hope, that the fmall-pox, meafles, and venereal
difeafe, which are all of modern production, and have already-
become milder, may in procefs of time vanifh from the earth,
and perhaps be fucceeded by new ones ! See the preceding
Species.

1 6. Spina dijlortio. Diftortion of the fpirfe is another difeafe
originating from the innutrition or foftnefs of the bones. I once
faw a child about fix years old with palpitation of heart, and
quicknefs of refpiration, which began to have a curvature of the
fpine •, I then doubted, whether the palpitation and quick refpi-
ration were the caufe or confequence of the curvature of the
fpine j fufpe&ing either that nature had bent the fpine outwards
to give room to the enlarged heart ; or that the malformation of
the cheft had compreiled and impeded the movements of the
heart. But a few weeks ago on attending a young lady about
ten years old, whofe fpine had lately begun to be distorted, with
very great difficulty and quicknefs of refpiration, and alarming
palpitation of the heart, I convinced myfelf, that the palpitation
and difficult refpiration were the effect of the change of the cav-
ity of the cheft from the diftortion of the fpine ; and that th<-
whole was therefore a difeafe of the innutrition or foftnefs of the
bones.

For on directing her to lie down much in the day, and to

take the bark, the diftortion became lefs, and the palpitation and

VOL. II. L quick

74 DISEASES CLASS I. 2. 2. 16.

quick refpiration became lefs at the fame time. After this ob-
fervation a neck-fwing was directed, and fhe took the bark,
madder, and bone-afhes ; and (he continues to amend both in
her Ihape and health.

Delicate young ladies are very liable to become awry at many
boarding-fchools. This is occafioned principally by their being
obliged too long to preferve an erect attitude, by fitting on forms
many hours together. To prevent this, the fchool-feats mould
have either backs, on which they may occafionally reft them-
felves ; or delks before them, on which they may occafionally lean.
This is a thing of greater confequence than may appear to thofe,
who have not attended to it.

When the leaft tendency to become awry is obferved,they fhoulcf
be advifed to lie down on a bed or fofa for an hour in the middle of
the day for many months ; which generally prevents the increafc
of this deformity by taking off for a time the preflure on the fpine
of the back, and it at the fame time tends to make them grow
taller. Young perfons, when nicely meafured, are found to be
half an inch higher in a morning than at night ; as is well
known to thofe who inlift very young men for foldiers. This
is owing to the cartilages between the bones of the back becom-
ing comprerTed by the weight of the head and moulders on them
during the day. It is the fame preflure which produces curva-
tures and diftortions of the fpine in growing children, where
the bones are fofter than ufual ; and which may thus be relieved
by an horizontal pofture for an hour in the middle of the day,
or by ."being frequently allowed to lean on a chair, or to play on,
the ground on a carpet.

Young ladies {hould alfo be directed, where two deep in a
bed, to change every night, or every week, their fides of the bed ;
•which will prevent their tendency to fleep always on the fame
fide •, which is not only liable to produce crookednefs, but alfo
to occafion diieafes by the internal parts bein-g fo long kept in
uniform contact as to grow together. For the fame reafon they
{hould not be allowed to fit always on the fame fide of the fire
or window, becaufe they will then be inclined too frequently to
bend themfelves to one fide.

Another great caufe of injury to the fhape of young ladies is
from the prefTure of ftays, or other tight bandages, which at the
fame time caufe other difeafea by changing the form or fituation
of the internal parts. If a hard part of the flays, even a knot
of the thread, with which they are fewed together, is prefTed
hard upon one fide more than the other, the child bends from
the fide moft painful, and thus occafions a curvature of the fpine.
To counteract this effect, fuch itays as have feweft hard p

and

CLASS I. 2. 2. 1 6. OF IRRITATION. 7*

and efpecially fuch as can be daily or weekly turned, are pref-
erable to others.

Where frequent lying down on a fofa in the day-time, and
Twinging frequently for a fhort time by the hands or head, with
loofe drefs, do not relieve a beginning diftortion of the back ; re-
courfe maybe had to a chair with fluffed moveable arms for the
purpofe of fufpending the weight of the body by cufhions under
the arm-pits, like reiting on crutches, or like the leading-fl;
of infants. From the top of the back of the lame chair a curv-
ed fteel bar may alfo project to fufpend the body occafion ally,
or in part by the head, like the fwing above mentioned. The
ufe of this chair is more efficacious in ft raightening the fpine,
than fimply lying down horizontally ; as it not only takes off the
preffure of the head and (boulders from the fpine, but at the
fame time the inferior p?.vts of the body contribute to draw the
fpiae (Iraight by their weight ; or laftly, recourfe may be had
to a fpinal machine firil defcribed in the Me moires of the acad-
emy of furgery in Paris, Vol. I'll. p. 600, by M. Le Vacher, and
iince made by Mr. Jones, at No. 6, Nortk-ftreet, Tottenham
court-road, London, which fufpeuds the head, and places the
weight of it on the hips. This machine is capable of improve-
ment by joints in the bar at the back of it, to permit the body to
bend forwards without diminishing the extenfion of the fpine.

The objections of this machine of M. Vacher, which is made
by Mr. Jones, are firil, that it is worn in the day-time, and has
a very unfightly appearance. Mr. Jones has endeavoured to
remedy this, by taking away the curved bar over the head, and
fubftituting in its place a forked bar, rifmg up behind each ear,
\vith webs fattened to it, which pafs under the chin and occiput.
But this is not an imprdvement,but a deterioration of M. Vacher' s
2nachine,as it prevents the head from turning with facility to either
fide. Another objection is, that its being worn, when the muf-
cles of the back are in action, it is rather calculated to prevent
the curvature of the fpine from becoming greater, tha,nto extend
the fpine, and diminifh itj curvature.

For this latter purpofe I have made a fteel bow, which re-
ceives the head longitudinally from the forehead to the occiput ;,
having a fork furniftied with a web to fuitain the chin, and an-
other to futtain the occiput. The fummit of the bow is fixed
by a fwivel to the board going behind the head of the bed above
the pillow. The bed is to be inclined from the head to the feet
•about twelve or fixteen inches. Hence the patient would be
conflantly Hiding down during ileep, unlefs fupported by this
bow, with webbed forks, covered alfo with fur, placed beneath
the chin, and beneath the occiput. There are alfo proper webs

7 6 DISEASES CLASS 1.2.2.16.

lined with fur for the hands to take hold of occafionally, and aL
fo to go under the arms. By thefe means I mould hope great
advantage from gradually extending the fpine during the inac-
tivity of the mufcles of the back ; and that it may be done with-
out difturbing the fleep'of the patient, and if this fhouid hap-
pen, the bow is made to open by a joint at the fummit of it, fo as
to be inftantly difengaged from the neck by the hand of the
•wearer. This bow I have now ufed with advantage on one pa-
tient, and it may be had from Mr, Harrifon, whitefrnith, Bridge-
gate, Derby.

It is alfo poflible that a flight comprefs on the prominent part
of a curved fpine might be applied with advantage both in fleep
and in waging hours, if it could be nicely held on the part by a
weak and very flexible fpring, with a proper counter-prefiure on
fome diftant part , but this would require more art than could
be managed, except by thofe who have very accurate mechanical
ideas, and mull differ with every kind- of curvature. Thus if
the prominent part of the curve of the fpine be on one fide, a,
fluffed cufhiqn fixed to the centre of a long thin fleel fpring
fhould be applied on the prominence 5 one end of this long
fpring fhould be bent by a flrap joined to a waiftcoat on the op-
pofite fhpulder, and the other end of it by a ftrap joined to draw-
ers on the oppofite hip ; the degree of preffure to be adjufled
by the tightnefs of thefe {traps. If the prominent part of a
curved fpine be exaclly behind, the ends of the long fpring
ihould extend from the loweft bone of the neck to the os cocci-
gis3 and fhould have its two ends attached to the jtop of a waift-
coat, and to the waiftband of a pair of drawers.

It will be from hence eafily perceived, that all other methods
of confining or directing the growth of young people fhould be
ufed with great Hull ; fuch as back- boards, or bandages, or flocks
for the feet ; and that their application fhould not be continued
too long at a time, left worfe confequences ihould enfue, than
tjie deformity they were defigned to remove. To this maybe
added, that the fliff erecl: attitude taught by fome modern danc-
ing mafters does not contribute to the grace of perfon, but rather
militates again ft it ; as is well feen in one of the prints in Ho-
garth's Analyfis of Beauty ; and is exemplified by the eafy grace
of fome of the ancient ftatues, as of the Venus de Medicis, and
the Antinous, and in the works of fcrne modern artifls, as in a
beautiful print of Hebe feeding an Eagle, painted by Hamilton,
and engraved by Egintop, and many of the figures of Angelica
J.vauffman.

Where the bone of one of the vertebrae of the back has been
Dwelled on both fides of it, fo as to become protuberant, iffue&

near

CLASS I. 2. 2. 17. OF IRRITATION. 77

near the fwelled part have been found of great fervice, as men-
tioned in Species 1 8 of this Genus. This has induced me to
propofe in curvatures of the fpine, to put an iflue on the outfide
of the curve, where it could be certainly afcertained, as the bones
on the convex fide of the curve muft be enlarged •, in one cafe I
thought this of fervice, and recommend the further trial of it.

In the tendency to curvature of the fpine, whatever ftrength-
ens the general conftitution is of fervice ; as the ufe of the cold
bath in the fummer months. This however requires fome re-
ftri&ion both in refpeft to the degree of coldnefs of the bath,
the time of continuing in it, and the feafon of the year. Com-
mon fprings, which are of forty-eight degrees of heat, are too
cold for tender conductions, whether of children or adults, and
frequently do them great and irreparable injury. The coldnefs
of river- water in the fummer months, which is about (ixty-eight
degrees, or that of Matlock, which is about fixty-eight, or of
Buxton, which is eighty-two, are much to be preferred. The
time of continuing in the bath mould be but a minute or two,
or not fo long as to occafion a trembling of the limbs from cold.
In refpeft to the feafon of the year, delicate children mould
certainly only bathe in the fummer months ; as the going fre-
quently into the cold air in winter will anfwer all the purpofes
of the cold bath.

17. Claudicat'io coxaria. Lamenefs of the hip. A nodding
of the thigh-bone is faid to be produced in feeble children by the
foftnefs of the neck or upper part of that bone beneath the car-
tilage ; which is naturally bent, and in this difeafe bends more
downwards, or nods, by the preflure of the body ; and thus
renders one leg apparently fhorter than the other. In other
cafes the end of the bone is protruded out of its focket, by in-
flammation or enlargement of the cartilages or ligaments of the
joint, fo thai it reits on fome part of the edge of the acetabu-
lum, which in time becomes filled up. When the legs are
ftraight, as in (landing erect, there is no verticillary motion in
the knee-joint ; all the motion then in turning out the toes fur-
ther than nature defigned, muft be obtained by draining in fome
degree this head of the thigh-bone, or the acetabulum, or cavi-
ty, in which it moves. This has induced me to believe, that this
misfortune of the nodding of the head of the bone, or partial
•diflocation of it, by which one leg becomes fhorter than the other,
i;i fometimes occafioned by making very young children (land in
what are called {locks ; that is with their heels together, and
their toes quite out. Whence the focket of the thigh-bone be-
comes inflamed and painful, or the neck of the bone is bent
downward and outwards.

In

?S DISEASES CLASS!. 2. 2. iS.

' In this cafe there is no expectation of recovering the ftraight-
nefs of the end of the bone ; but thefe patients are liable to
another misfortune, that is, to acquire afterwards a diftor^
tion of the fpine ; for as one leg is fhorter than the other, they
fmk on that fide, and in confequence bend the upper part of
their bodies, as their moulders, the contrary way, to balance
themfelves; and then again the neck is bent back again towards
the lame fide, to preferve the head perpendicular ; and thus the
figure becomes quite diftorted like the letter S, owing original-
ly to the deficiency of the length of one limb. The only way
to prevent this curvature of the fpine is for the child to wear a
high-healed (hoe or patten on the lame foot, fo as to fupport that
fide on the fame level with the other, and thus to prevent a
greater deformity.

I have this day feen a young lady about twelve, who does not
limp or waddle in walking ; but rteverthelefs, when me ftands
or fits, me finks down towards her right fide, and turns out that
toe more than the other. Hence, both as me 'fits and ftands,
{he bends her body to the right ; whence her head would hang
a little over her right fhoulder •, but to replace this perpendicu-
larly, me lifts up her left fhouider and contracts the mufcles on
that fide of the neck ; which are therefore become thicker and
ilronger by their continued aftion 5 but there is not yet any very
perceptible diftortion of the fpine.

As her right toe is turned outward rather more than natural,
this mews the difeafe to be in the hip-joint ; becaufe, when the
limb is ftretched out, the toe cannot turn horizontally in the
leaft without moving the end of the thigh-bone ; although when
the knee is bent, the toe can be turned through one third or half
of a circle by the rotation of the tibia and fibula of the leg round
each other. Hence if children are fet in flocks with their heels
touching each other as they fit, and are then made to rife up,
till they ftand erect, the focket or head of the thigh-bone becomes
injured, efpecially in thofe children, whofe bones are foft ; and
a fhortnefs of that limb fucceeds either by the bending of the
neck of the thigh-bone, or by its getting out of the acetabulum ;
and a confequcnt rifing of one moulder, and a curvature of the
fpine are produced from fo diflant a caufe.

M. M. An el a Hi c cufhion made of curled hair mould be pla-
ced under the affected hip, whenever (he fits ; or mould be fit-
ted to the part by means of drawers, fo that fhe cannot avoid
fitting on it. A neck-fwing, and lying down in the day, mould
be occafionally ufed to prevent or remove any curvature of the
fpine. The reft as in Species 1 3 and 1 5 of this genus.

1 8. S uberam* Protuberant ijpine. One of the bones

of

CLASS I. 2. 2. 19- OF IRRITATION. 79

of the fpine fwells, and rifes above the reft. This is not an un-
common difeafe, and belongs to the innutriton of the bones, as
the bone muft become foft before it fvvells •, which foftnels is
owing to defect of the fecretion of phoiphorated calcareous earth.
The f welling of the bone compreifes a part of the brain, called
the fpinal marrow, within the cavity of the back-bones ; and in
confequence the lower limbs become paralytic, attended fome-
times with difficulty of emptying the bladder and rectum.

M, M. IfTues put on each fide of the prominent bone are of
•eat effect, I fuppofe, by their ftimulus ; which excites into
ction more of the' fenibrral powers of irritation and fenfation,
nd thus gives greater activity to the vafcular fyftem in their
icinity. The methods recommended in diftortion of the fpine
re alfo to be attended to.

19. Spina bifida. Divided fpine, called alfo Hydrorachitis, as
well as the Hydrocephalus e,xternus, is probably owing in pare
to a defect of offification of the fpine and cranium ; and the col-
lection of fluid beneath them may originate from the general de-
bility of the fyftem j which affects both the fecerning, and ab-
forbent veflfels.

A curious circumftance, which is affirmed to attend the fpina
bifida, is, that on compreffing the tumor with the hand gently,
the whole brain becomes affected, and the patient falls afleep. I
fuppofe the feme muft happen on compreffing the hydrocephalus
externus ? See Sett. XVIII. 20.

20. Offis palati defeftus. A defect of the bone of the palate,
which frequently accompanies a divifion of the upper lip, oc-
curs before nativity •, and is owing to the deficient action of the
fecerning fyftem, from whence the extremities are not comple-
ted. From a fimilar caufe I have feen the point of the tongue
deficient, and one joint of the two leaft fingers,' and of the two
lead toes, in the fame infant ; who was otherwife a fine girL
See Sect. XXXIX. 4. 4.

The operation for the hare-lip is r.efcribed by many furgical
writers ; but there is a perfon in London, who makes very ingeni-
ous artificial palates ; which prevent that defect of fpeech, which
attends this malformation. This factitious palate confifts of a
thin plate of filver of the ihape and form of the roof of the mouth ;
from the front edge to the back edge cf this filver plate four
or five holes are made in a ftraigrft line large enough for a needle
to pafs through them -, on the back of it is then fewed a piece of
fponge ; which when expanded with moifture is nearly as large
as the filver plate. This fponge is flipped through the divifiou
ef the bone of the palate, fo as to lie above it, while the filver

plate-

DISEASES

CLASS I. 2. 2.

plate covers the aperture beneath, and is fufpended by the ex-
panding fponge. This is removed every night and wafhed, and
returned into its place in the morning j on this account it is con-
venient to have five or fix of them, for the fake of cleanlinefs. I
have been more particular in defcribing this invention, as I do
not know the name, or place of refidence, of the maker.

ORDG

:LASS I. a. 3. i. OF IRRITATION, *i

ORDO II.

Decreafed Irritation.

GENUS III.
With decreafed Aclion of the Abforbent Syjlem.

SOME decreafe of heat attends thefe difeafes, though in a lets
;gree than thofe of the laft genus, becaufe the abforbent fyftem
" glands do not generate fo much heat in their healthy ftate of

tion as the fecerning fyftem of glands, as explained in Clafs

i- 3-

SPECIES.

1. Mucus faucium frigidus. Cold mucus from the throat*
Jvluch mucus, of rarher a faline tafte, and lefs mfpifiated than
ulual, is evacuated from the fauces by hawking, owing to the
deficient abibrption of the thinner parts of it. This becomes a
habit in feme elderly people, who are continually fpitting it out
of their mouths ; and has probably been brought on by taking
ihuff, or fmoking tobacco ; which by frequently ftimulating the
fauces have at length 'rendered the abforbent veiTels lefs excita-
ble by the natural ftimulus of the faline part of the fecretion,
•which ought to be reabforbed, as ibon as fecreted.

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

2. Sudor frigidus. The cold dampnefs of the hands of fome
people is caufed by the deficient abforption of perfpirable matter ;
the clammy or vifcid feel of it is owing to the mucous part being
left upon the (kin. The coldnefs is produced both by the de-
creafed action of the abforbent fyftem, and by the evaporation of
a greater quantity of the perfpirable matter into the air, which
ought to have been abforbed.

M. M. Warn the hands in lime water, or with a fmall quan-
tity of volatile alkali in water.

3. Catarrhus frigidus. The thin difcharge from the noftrils
in cold weather. The abforbent veflels become torpid by the
diminution of external heat, fooner than the fecerning ones,
which are longer kept warm by the circulating blood, from
which they felecl: the fluid they fecrete j whereas the abiorb^nt

VOL. II. M veiieis

DISEASES CLASS I. 2.

vefTels of the noftrils drink up their fluids, namely the thin and
faline part of the mucus, after it has been cooled by the atmof-
phere. Hence the abforbents ceafing to act, and the fecerning
yeiTeJs continuing fome time longer to pour out the mucus, a
•copious thin discharge is produced, which trickles down the
noitrils in cold weather. This difcharge is fo acrid as to inflame
the upper lip ; which is owing to the neutral felts, with which
it abounds, not being reabforbed ; fo the tears in the fiftula lach-
rymalis inflame the cheek. See Clafs I. i. 2. 7.

4. ExpeEloratio frigida. Cold expectoration. Where the
pulmonary abforption is deficient, an habitual cough is produced,
and a frequent expectoration of thin faline mucus ; as is often
feen in old enfeebled people. Though the ftimulus of the faline
fluid, which 'attends all fecretions, is not fufficient to excite the
languid abforbent veflels to imbibe it ; yet this faline part, to-
gether with the increafed quantity of the whole of the fetreted
mucus, flimulates the branches of the bronchia, fo as to induce
an almoft inceflant cough to difcharge it from the lungs. A
lingle grain of opium, or any other ilimulant drug, as a wine
poffet with fpirit of hartftiorn, will cure this cold cough, and the
cold catarrh of the preceding article, like a charm, by ftimula-
ting the torpid mouths of the abforbents into action. Which
has given rife to an indifcriminate and frequently pernicious ufe
of the warm regimen in coughs and catarrhs of the warm or
inflammatory kind, to the great injury of many.

M. M. Half a grain of opium night and morning promotes
the abforption of the more fluid and faline parts, and in confe-*
quence thickens the mucus, and abates its acrimony. Warm
diluent drink, wine- whey, with volatile alkali.

5. Unnanberior pallida. On being expofed naked to cold
air, or fprinkled with cold water, a quantity of pale urine is foon
diicharged ; for the abforbents of the bladder become torpid by
their fympathy with thofe of the {kin *, which are rendered qui-
cfcent by the diminution of external heat ; but the kidneys con-
tinue to fecrete the urine, and as no part of it is abforbed, it be-
comes copious and pale. This happens from a finiilar caufe in
.cold fits of agues ; and in lefs degree to many debilitated confti-
tutions, whole extremities are generally cold and pale. The
great quantity of limpid water in hyfleric cafes, and in diabetes,
belongs to Clafs I. 3. i. 10. I. 3. 2. 6.

M. M. Tincture of cantharides, opium, alum, forbentia.
Tlatmel (hirt in cold weather. Animal food. Beer. Wine.
Friction. Exercife. Fire.

6. Diarrhoea frigida. Liquid {tools are produced by expofing

the

,ss I. 2. 3- 7- OF IRRITATION.

the body naked to cold air, or fprinkling it with cold water, for
the fame reafon as the laft article.

But this diie^-e is fometimes of a dangerous nature ; the in-
-teftinal abforption being fo impaired, that the aliment is faid to
come away unJiminifhed in quantity, and almoft unchanged by
the powers of digeflion, and is then called lientery.

The mucus of the rectum fometimes cemes away like pellu-
.cid hart (hoi n jelly, .and liquefies by heat like that, towards the
end of inirritative fevers, which is owing to the thinner part of
;the mucus not bting abforbed, and thus refenables the catarrh of
feme old people.

M. M. Opium, campechy wood, armenian bole. Blifler.
-Flannel iliirt in cold weather. Clyfters with opium. Friction.
on the bowels morning and night. Equitation twice a day.

7. Fluor albus frigidus. Cold fluor albus. In weak conftitu-
tions, where this discharge is pellucid and thin, it muft proceed
from want of abforption of the mucous membrane of the vagina,
or uterus, and not from an increafed fecretion. This I fufpect
to be the moft frequent kind of fluor albus ; the former one de-
icribed at Clafs I. I. 2. n. attends menftruation, or is a dif-
charge inftead of it, and thus refembles the venereal orgafm of
female quadrupeds. The difeharge in the cold kind being more
faline, is liable to excoriate the part, and thus produce fmarting
in making water ; in its great degree it is difficult to cure.

M. M. Increafe the evacuation by ftool and by perfpiration,
by taking rhubarb every night, about fix or ten grains with one';
grain of opium forfome months. Flannel fhirt in winter. Balfarn
copaiva. Gum kino, bitters, chalybeates, friction over the whole
jkin with flannel morning and night. Partial cold bath, by
fprinkling the loins and thighs, or fponging them with cold
water. Mucilage as ifinglafs boiled in milk ; blanc mange,
hartfhorn jelly, are recommended by fome. Tincture of can-
tharldes fometimes feems of fervice given from ten to twenty
drops or more, three or four times a day. A large plafler of
burgundy pitch and armenian bole, fo as to cover the loins and
lower part of the belly, is faid to have fometimes fucceeded by
increasing abforption by its compreflion in the manner of a ban-
dage. A folution of metallic falts, as white vitriol, fixty grains
to a pint ; or an infufioa of oak-bark may be injected into the
vagina. Cold bath.

8. Gonorrkxa frigida. Cold gleet. Where the gleet is thin
and pellucid, it muft arife from the want of abforprioii of the
membranes of the urethra, rather than from an increafed fecre-
tion from them. This I fuppofe to be a more common difeafe

that mentioned at Clafs I. i. 2. 10.

M. M. Metallfc

8~4 DISEASES CLASS I. 2. 3. 9^

M. M. Metallic injections, partial cold bath, internal method
as in the fluor albus above defcribed. Balfam of copaiva. Tine-*
ture of cantharides. Introduce a few inches into the urethra a
bougie fmeared with balfarn of copaiva. See Home on urethra,
p. 105.

9. Hepatis tumor. The liver becomes enlarged from defect
of the abforption of mucus from its cells, as in anafarca, efpeci-
ally in feeble children ; at the fame time lefs bile is fecreted
from the torpid circulation in the vena portge. And as the ab-
forbents, which refume the thinner parts of the bile from the
gall-bladder and hepatic ducts, are alfo torpid or quiefcent, the
bile is more dilute, as well as in lefs quantity. From the ob-
ftruclion of the pafiage of the blood through the comprefled ve-
na porta the fe patients have tumid bellies, and pale bloated coun-
tenances ; their palenefs is probably owing to the deficiency of
the quantity of red globules in the blood in conference of the
inert flate of the bile.

Thefe fymptoms in children are generally attended with worms,
the dilute bile and the weak digeftion not deilroying them. In
iheep I have feen fluke-worms in the gall-duels themfelves among
the dilute bile 5 which gall-duels they eat through, and then
produce ulcers, and the hectic fever, called the rot. See Clafs
L 1.4. 10. and Article IV. 2. 6.

M. M. After a calomel purge, crude iron filings are fpecific
In this difeafe in children, and the worms are deftroyed by the
returning acrimony and quantity of the bile. A blifter on the
Tegion of the liver. Sorbentia^ as worm-feed, fantonicum. Co-
lumbo. Bark.

The nitrous acid has been ftrongly recommended by Mr. Scot
5n tumours of the liver, which frequently occur in the eaft, where
this gentleman refides ; he gives two drachms of ftrong nitrous
acid mixed with two pounds of water, to be drunk daily at in-
tervals. See Syphilis, Clafs II. i. 5. 2.

10. Chlorofis. When the defect of the due action of both the
abforbent and fecerning veflels of the liver affects women, and is
attended with obftruclion of the catamenia, it is called chlorofis ;
and is cured by the exhibition of fteel, which reftores by its fpe-
cific ftimulus the abforbent power of the liver ; and the men-
ftruation, which was obftructed in confequence of debility,
recurs.

Indigeftion, owing to torpor of the ftomach, and a confequent
too great acidity of its contents, attend this difeafe ; whence a
defire of eating chalk, or marl. Sometimes a great quantity of
pale urine is difcharged in a morning, which is owing to the in-
jicticn of the abforbents, which are distributed on the neck of

the

CLASS I. 2. 3. ii. OF IRRITATION. 8^

the bladder, during fieep. The fwelling of the ankles, which
frequently attends chlorofis, is another effect; of deficient action,
of the abforbent fyitem ; and the pale countenance is occafionecl
by the deficient quantity of red globules of blood, caufed by the
deficient quantity or acrimony of the bile, and confequent weak-
I nefs of the circulation. The pulfe is fo quick in fome cafes of
chlorofis, that, when attended with an accidental cough, it may
be miftaken for pulmonary confumption. This quick pulfe is
owing to the debility of the heart from the want of ftimulus oc-
cafioned by the deficiency of the quantity, and acrimony of the
blood.

M. M. Steel. Bitters. Conftant moderate exercife. Fric-
tion with flannel all over the body and limbs night and morn-
ing. Rhubarb five grains, opium half a grain, every night.
Fle(h diet, with fmall beer, or wine and water. The difeafe
continues fome months, but at length fubfides by the treatment
above defcribed. A bath of about eighty degrees, as Buxton
Bath, is of fervice ; a colder bath may do great injury.

ii. Hydrocele. Dropfy of the vagina teftis. Dropfies have
been divided into the encyfted and the diffufed, meaning thofe of
the cellular membrane, the cells of which communicate with each
other like a fponge, and thofe of any other cavity of the body.
The collections of mucous fluids in rhe various cells and cavities
of the body arife from the torpor of the abforbent veflels of thofe
parts. It is probable, that in dropfies attended with great third
the cutaneous abforbents become paralytic firft ; and then from
the great thirft, which is thus occafioned by the want of atmof-
pheric moifture, the abforption of the fat enfues ; as in fevers
attended with great thirft, the fat is quickly taken up. See Obe-
fitas I. 2. 3. 16. Some have believed, that the cellular and adi-
pofe membranes are different ones ; as no fat is ever depofited
in the eyelids or fcrotum, both which places are very liable to
be diftended with the mucilaginous fluid of the anafarca,and with
air in Emphyfema. Sometimes a gradual abforption of the ac-
cumulated fluid takes place, and the thinner parts being taken
up, there remains a more vifcid fluid, or alrnoft a folid in the
pa'rt, as in fome fwelled legs, which cannot eailly be indented by
the preflure of the finger, and are called fcorbutic. Sometimes

»the paralyfis of the abforbents is completely removed, and the
whole is again taken up into the circulation.
The Hydrocele is known by a tumor of the fcrotum, whick
is without pain, gradually produced, with fluctuation, and a de-
gree of pellucidity, when a candle is held behind it ; it is the
mod fimple incyfled dropfy, as it is not in general complicated
other difeafes, as afcites with fcirrhous liver, and hydro-

cephalui

£<$ DISEASES CLASS I. 2. 3. i*,

cephalus interims, with general debility. The cure of this dif-
.cafe is effected by different ways ; it confifts in difcharging the
water by an external aperture ; and by fo far inflaming the cyft
and tefticle, that they afterwards grow together, and thus pre-
vent in future any fecretion or effufion of mucus 5 the difeafe is
thus cured, not by the revivefcence of the abforbent power of the
lymphatics, but by the prevention of fecretion by the adhefion of
the vagina to the teftis. This I believe is performed with lefs
pain, and is more certainly manageable by tapping, or difcharg-
ing the fluid by means of a trocar, and after the evacuation of it
to fill the cyft with a mixture of wine and water for a few min-
utes till the neceflary degree of ftimulus is produced, and then to
withdraw it ; as recommended by Mr. Earle. See alfo Medical
Commentaries by Dr. Duncan for 1793.

1 2. Hydrocephalus mternns^ or dropfy of the ventricles of the
brain, is fatal to many children, and fome adults. When this
difeafe is lefs in quantity, it probably produces a fever, termed a
nervous fever, and which is fometimes called a worm fever, ac-
cording to the opinion of Dr. Gilchrift, in the Scots Medical
Eifays. This fever is attended with great inirritability, as appears
from the dilated pupils of the eyes, in which it correfponds with
the dropfy of the brain. And the latter difeafe has its parox-
yfms of quick impulfe, and in that refpect correfponds with oth-
er fevers with inirritability.

The hydrpcephalus internus is diftinguifhed from apoplexy by
Its being attended with fever, and from nervous fever by the
paroxyfms being very irregular, with perfect intermiflions many
times in a day. In nervous fever the pain of the head generally
affects the middle of the forehead ; in hydrocephalus internus it
is generally on one fide of the head. One of the earliefl crite-
rions is the patient being uneafy on raifing his head from the pil-
low, and wifhing to lie down again immediately ; which I fup-
pofe is owing to the preilure of the water on the larger trunks
of the blood-veffels entering the cavity being more intolerable
than on the fmaller ones ; for if the larger trunks are compreff-
ed, it mufl inconvenience the branches alfo ; but if fome of the
fmall branches are compreflbd only, the trunks are not fo imme-
diately incommoded.

Blifters on the head, and mercurial ointment externally, with
calomel internally, are principally recommended in this fatal dif-
eafe. When the patient cannot bear to be raifed up in bed with-
out great uneaiinefs, it is a bad fymptom. So I believe is deaf-
nefs, which is commonly miilaken for (tupor. See Clafs I. 2.
5. 6. And when the dilatation of the pupil of either eye, or the
fquinting is very apparent^ or the pupils of both eyes much dila-
ted^

CLASS I. 2. 3. 12. OF IRRITATION'. 87

ted, it is generally fatal. As by ftimulating one branch of
lymphatics into inverted motion, another branch is liable to ab-
forb its fluid more haftily ; fuppofe ftrong errhines, as com-
mon tobacco fnuffto children, or one grain of turpeth mineral,
(hydrargyrus vitriolat'us), mixed with ten or fifteen grains of fu-
gar, were gradually blown up the noftrils ? See Clafs I. 3. 2. I.
I have tried common fnuff upon two children in this difeafe ;
one could not be made to fneeze, and the other was too near death
to receive advantage. Whpn the mercurial preparations have

I reduced falivatiort, I believe they may have been of fbrvice, but
doubt their good effect otherwife. In one child I tried the
ncture of digitalis ; but it was given with too timid a hand,
nd too late in the difeafe, to determine its effects. See Seel.
XXIX. 5. 9.

As all the above remedies generally fail of fuccefs, I think
frequent, ahnolt hourly, (hocks of electricity from very fmall
charges might be pafied through the head in all directions with
probability of good event ; as by Volta's rods of zinc and filver
defcribed in Clafs I. 2. 5. 5, A folution of hydrargyrus muria-
tus, corrofive fublimate of mercury in rectified fpirit of wine,
three grains to an ounce, is faid to produce inftantaneous and
violent falivation ; as defcribed in Clafs II. 1.5. I. on Gonor-
rhoea. Could a fmall quantity of this violent ftimulus be
ufed according to the age of the child with probable good ef-
fect ? Could the trephine be ufed with fafety or advantage
•where the affected fide can be diftinguiihed ? See Strabifmus,
Clafs I. 2. 5. 4. When one eye is affected, does the difeafe ex-
rft in the ventricle of that fide ?

The following extract from a letter of Dr. Beddoes on hydro-
eephalus internus, is well worthy to be attended to.

" Mafter L , aged 9 years, became fuddenly ill in the

night about a week before I faw him. On the day before the
attack, he had taken opening medicines, and had bathed after-
wards. He had complained of violently acute pain in his head,
fhrieked frequently, ground his teeth hard, could not bear to
have his head raifed from the pillow, and was torpid or
deaf. His tongue was white, pulfe 1 10 in the evening and full.
As yet the pupil of the eye was irritable, and he had no ftrabif-
mus. He had been bled with leeches about the head, and blifter-
ed. I directed mercurial inunction, and calomel from 3 to 6 grains
to be taken at firft every fix, and afterwards every three hours.
This plan produced no fenfible effect, and the patient died on
the 1 8th day after the feizure. He had convulfion-fits two days
preceding his death, and the well-known fymptoms of hydro-
cephalus internus all made their appearance. From what I had

feen

S3 DISEASES CLASS I. 2. 3. 13,

feen and read of this difeafe, I believed it to belong to inflamma-
tions, and at an earlier period I ihould be tempted to bleed as
largely as for pneumonia. The fluid found after death in the ven-
tricles of the brain I impute to debility of the abforbents indu-
ced by inflammation. My reafons are briefly thefe : i. The
acutenefs of the pain. 2. The (late of the pulfe. In the above
cafe for the firft 9 or 10 days it did not exceed no, and was
full and ftrong. 3. To find out whether any febrile alternations
look place, Mailer L.'s feet were frequently felt, and they were
found at times cold, and at other times of a dry heat. I have
many times feen this difeafe, but the patients were too young, or
too far advanced, to inform me, whether they had chillnefs iuc-
ceeded by heat at its onfet. 4. The diforders to which the
young are more peculiarly liable afford a prefumption, that hy-
clrocephalus interims is an inflammatory difeafe ; and this is
confirmed by the regularity of the period, within which it fin-
iihes its courfe. And laftly, does not happen more frequently
than is fufpecled from external injury ?

" I have juft now been well informed, that Dr. Rufh has
lately cured five out of fix patients by copious bleedings. I
relate here the reafons for an opinion without pretending to a
difcovery. Something like this doctrine may be found in cer-
tain modern publications, but it is delivered in that vague and
lUfFufe ftyle, which I trufl your example will banilh from medi-
cal literature."

To this idea of Dr. Beddoes may be added, that the hydrocele
generally fucceeds an injury, and confequent inflammation of
the bag, which contains it. And that other dropfies, which
principally attend inebriates, are confequent to too great action
of the mucous membranes by the itimulas of beer, wine, and
ipirits. And laftly, that as thefe cafes of hydrocephalus end fo
fatally, a new mode of treating them is much to be defired, and
deferves to be ferioufly attended to.

This idea of inflammation preceding hydrocephalus was men-
tioned by Dr. CVu'n, and afterwards in a pamphlet of Dr. Pat-
erfon, of Dublin.

13. Afcites. The dropfy of the cavity of the abdomen is
known by a tenfe fwelling of the belly *, which does not found
on being (truck like the tympany ; and in which a fluctuation
can be readily perceived by applying one hand expanded on one
fide, and ftriking the tumour on the other.

Effufions of water into large cavities, as into that of the abdo-
men or thorax, or into the ventricles of the brain or pericardi-
um, are more difficult to be re-abforbed, than the effufion of
fluids into the cellular membrane •, becaufe one part of this ex-

tenfivc

CLASS I. 2. 3. 14. OF IRRITATION.

ten five fpongc-like fyftem of cells, which connects all

of the body, may have its power of abforption ii
at the fame time that fomc other part of it may flill reta-.-i UKIL
power, or perhaps poiTefs it in an increafed degree ; and as all
cells communicate with each other, the fluid, which abounds
in one part of it, can be transferred to another, and thus be re-
forbed into the circulation.

[n the afcites, cream of tartar has fometimes been attended
fuccefs ; a dram or two drams are given every hour in a
lorning till it operates, and this is to be repeated for feveral
days ; but the operation of tapping is generally applied to at laft.
Dr. Sims, in the Memoirs of the Medical Society of London,
Vol. III. has lately propofed, what he believes to be a more fuc-
cefsful method of performing this operation, by making a punc-
ture.with a lancet in the fear of the navel, and leaving it todif-
charge itfelf gradually for feveral days, without introducing a
canula, which he thinks injurious, both on account of the too
fudden emiffion of the fluid, and the danger of wounding or ftim-
ulating the vifcera. This operation I have twice known per-
formed with lefs inconvenience, and I believe with more beitgiit
to the patient, than the common method.

After the patient has been tapped, fome have tried injections
into the cavity of the abdomen, but hitherto I believe with ill
event. Nor are experiments of this kind very promifmg of fuc-
cefs. Firft, becaufe the patients are generally much debilitated,
jnofl frequently by fpirituous potation, and have generally a dif-
eaie of the liver, or of other vifcera. And fecondly, becaufe
the quantity of inflammation, necefiary to prevent future fecretion
of mucus into the cavity of the abdomen, by uniting the perito-
neum with the interlines or mefentery, as happens in the cure
of the hydrocele, would I fuppofe generally deflroy the patient,
either immediately, or by the confequence of fuch adhefions.

This however is not the cafe in refpect to the dropfy of the
4)varium, or in the hydrocele.

14. Hydrops thoracis. The dropfy of the cheft commences
with lofs of fle(h, cold extremities, pale countenance, high col-
oured urine in fmall quantity, and general debility, like many
other dropfies. The patient next complains of numbnefs in the
arms,. especially when elevated, with pain and difficulty of fwal-
lowing, and an abfolute impombility of lying down for a few
minutes, or with fudden darting from fleep, with great difficulty
of breathing and palpitation of his heart. It is often confound-
ed with anafarca pulmonum, which fee.

The numbnefs of the arms is probably owing more frequent-
ly to the increafed action of the pectoral mufcles in refpiration,
VOL. II. N whence

<^ DISEASES CLASS I. at. 3. 14;

whence they are lefs at liberty to perform other offices, than to
the connexion of nerves mentioned in Seel:. XXIX. 5. 2. The
difficulty of fwallowing is owing to the comprefiion of the
cefophagus by the lymph in the cheft ; and the impoffibility o£
breathing in a horizontal pofture originates from this, that if any
parts of the lungs muft'be rendered ufelefs, the inability of the
extremities of them muft be lefs inconvenient to refpiration j
fmce if the upper parts or larger trunks of the air-veflels mould
be rendered ufelefs by the compreffion of the accumulated lymph,
the air could not gain admitance to the other parts, and the ani-
mal muft immediately perifh.

If the pericardium is the principal feat of the difeafe, the
pulfe is quick and irregular. If only the cavity of the thorax is
hydropic, the pulfe is not quick nor irregular.

If one fide is more affected than the other, the patient leans
moft that way, and has more nurnbnefs in that arm.

The hydrops thoracis is cliftinguifhed from the anafarca pul-
monum, as the patient in the former cannot lie down half a min-
ute ; in the latter the difficulty of breathing, which occafions
him to rife up, comes on more gradually ; as the tranfition of
the lymph in the cellular membrane from one part to another of
it is flower, than that of the eiTufed lymph in the cavity of the
cheft.

The hydrops thoracis is often complicated with fits of con-
vulfive breathing ; and then it produces a difeafe for the time
very fimilar to the common periodic afthma, which is perhaps
owing to a temporary anafarca of the lungs ; or to an impaired,
venous abforption in them. Thefe exacerbations of difficult
breathing are attended with cold extremities, cold breath, cold
tongue, upright pofture with the mouth open, and a defire of
cold air, and a quick, weak, intermittent pulfe, and contracted
hands.

Thefe exacerbations recur fometimes every two or three hours,
and are relieved by opium, a grain every hour for two or three
dofes, with ether about a dram in cold water 5 and feem to be a
convulfion of the mufcles of refpiration induced by the pain of the
dyfpncea. As in Clafs III. I. I. 9.

M. M. A grain of dried fquill, and a quarter of a grain of
blue vitriol every hour for fix or eight hours, unlefs it vomit or
purge. A grain of opium. Blifters. Calomel three grains
every third day, with infufion of fenna. Bark. Chalybeates.
Pim£hire in the fide.

Can the fluctuation in the cheft be heard by applying the ear
to the fide, as Hippocrates aflerts ? Can it be felt by the hand or
by the patient before the difeafe is too great to admit of cure by

the

CLASS I. 2. 3. 15. OF IRRITATION.

paracenrefis ? Does this dropfy of the cheft often c<

!peripneumony ? Is it ever cured by making the p
• by tincture of digitalis ? Could it be cured, if on one fide only,
i by the operation of puncture between the ribs, and afterwards
by inflaming the cavity by the admiffion of air for a time, like
cure of the hydrocele ; the pleura afterwards adhering whol-
ly to that lobe of the lungs, ib as to prevent any future effuiioa
of mucus ?

I fufpecl: the anafarca of the lungs, as well as the hydrops
thoracis, to be molt frequently difeaies of thofe membranes on-
fy, and noc to depend on the general paralyfis of the abforbent
fyilem ; and that they are then not accompanied with fwelled
kgs, till the patient becomes univerfally weak ; and that they
have for their caufe a rheumatic or gouty peripneumony or pleu-
rify ; that is, that the lungs or pleura have been inflamed from
eir fympathy with fome other vifcus, and have depofited much
agulable lymph on the furface of their inflamed membranes,
hich could not readily become abforbed, and has thus caufed
the dropfy of the cavity of the cheft, like the coagulable lymph
cr chalky matter left after the gout and rheumatifm in other
parts ; or that the cellular membrane of the lungs becomes fill-
ed with a fluid from the prefent inaction of their abforbent vef-
fels, which had previoufly been excited too violently ; and that
the anafarca of the lungs is thus produced like the anafarca.
•which, frequently in weak conftitutions, exifts after the gout in
the feet and knees, and after rheumatic inflammations of the
joints. See Peripneumonia, Clafs II. 1.2. 4. whence it appears,
•why the hydrops thoracis and anafarca pulmonum fo generally
occur in gouty conftitutions.

15. Hydrops ovaru. Dropfy of the ovary is another encyfted
dropfy, which feldom admits of cure. It is diftinguilhed .from
afcites by the tumour and pain, efpecially at the beginning, oc-
cupying one fide, and the fluctuation being iefs diftinclly per-
ceptible- When it happens to young fubjects it is Iefs liable to
be miftaken for afcites. Jt affects women of all ages, either
named or virgins ; and is produced by cold, fear, hunger, bad
food, and other debilitating caufes. I faw an elegant young la-
dy, who was fhortly to have been married to a fenfible man, with
great profpeft of happinefs ; who, on being overturned in a
chaife in the night, and obliged to walk two or three miles in
wet, cold, and darknefs, became much indifpofed, and gradually
afflicted with a fwelling and pain on one fide of the abdomen j
which terminated in a dropfy of the ovary, and deftroyed her in.
two or three years. Another young woman I recollect: feeing>
was about feventeen, and being of the very inferior clafs

DISEASES CLASS I. 2. 3. i&

of people, fee'med to have been much weakened by the hardfhip
of a cold floor, and little or no bed, with bad food ; and who to
thefe evils had to bear the unceafmg obloquy of her neighbors,
and the perfecution of parifh officers.

The following is abilratied from a letter of my friend Mr.
Power, furgeon, at Bofworth in Leicefterfhire, on examining the
body of an elderly lady who died of this difeafe, March 29,
1793. " On opening the abdomen 1 found a large cyft attach-'
ed to the left ovarium by an elaftic neck as thick as the little rin-
ger, and fo callous as not to admit of being feparated by fciiTars
without confiderable difficulty. The fub(tance of the cyft had
an appearance much refembling the gravid uterus near the full
period of geftation, and was as thick. It had no attachment to
the peritoneum, or any of the vifcera, except by the hard callous
neck I have mentioned ; fo that the blood muft with difficulty
have been circulated through it for fome time. Its texture was
extremely tender, being eafily perforated with the finger, was of
a livid red colour, and evidently in a fphacelated ftate. It con-
tained about two gallons of a fluid of the colour of port wine,
without any greater tenacity. It has fallen to my lot to have
opened two other patients, whofe deaths were occasioned by en-
cyfted dropfy of the ovarium. In one of thefe the ovarium was
much enlarged with eight or ten cyfts on its furface, but there
was no adhefion formed by any of the cyfts to any other part ;
nor had the ovarium formed any adhefion with the peritoneum,
though in a very difeafed ftate. In the other the difeafe was
more fimple, being only one cyft, without any attachment but
to the ovarium.

" As the ovarium is a part not neceflary to life, and dropfies
of this kind are fo generally fatal in the end, I think I mall be
induced, notwithstanding the hazard attending wounds, which
penetrate the cavity of the abdomen, to propofe the extirpation
of the difeafed part in the firft cafe, which occurs to me, in
which I can with precifion fay, that the ovarium is the feat of
the difeafe, and the patient in other refpecls tolerably healthy ;
as the cavity of the abdomen is often opened in other cafes
without bad confequences."

An argument, which might further countenance the opera-
tion thus propofed by Mr. Power, might be taken from the dif-
eafe frequently affecting young perfons ; from its being gener-
ally in thefe fubjecls local and primary \ and not like the afcites,
produced or accompanied with other difeafed vifcera ; and laft-
Jy, as it is performed in adult quadrupeds, as old fows, with
fafety, though by awkward operators.

16, Anafarca pulmcnum* The dropfy of the cellular mem-
brane

CLASS I. 2. 3. i o. OF IRRITATION. ^

brane of the lungs is ufually connected with that of the other
parts of the fyftem. As the cells of the whole cellular mem-
brane communicate with 'each other, the mucilaginous fluid,
which remains in any part of it for want of due abforption, finks
down to the moft depending cells ; hence the legs f well, though
the caufe of the dileafe, the deficiency «f abforption, may be in
other parts of die fyftem. The lungs however are an exception
to this, fince they are fufpended in the cavity of the thorax, and
have in confequence a depending part of their own.

The anafarca of the lungs is known by the difficulty of ref-
piration accompanied with fwelled legs, and with a very irregu-
lar pulfe. This laft circumftance has generally been afcribed
to a dropfy at the fame time exifting in the pericardium, but is
more probably owing to the difficult paflage of the blood through
the lungs ; becaufe I found on diffecHon, in one inftance, that
the moft irregular pulfe, which I ever attended to, was owing to
very extenfive adhefion of the lungs •, infomuch that one lobein-
tirely adhered to the pleura ; and fecondly, becaufe this kind of
r.Topfy of the lungs is fo certainly removed for a time along with
the anafarca of the limbs by the ufe of digitalis.

This medicine, as well as emetic tartar, or fquill, when given
fo as to produce fickncfs, or naufea, or perhaps even without
producing either in any perceptible degree, by affe&ing the lym-
phatics of the ftomach, fo as either to invert their motion, or to
weaken them, increafes by reverie fympathy the action, and con-
iequent abforbent power of thefe lymphatics, which open into
the cellular membrane. But as thefe medicines feldom fucceed
in producing an abforption of thofe fluids, which ftagnate in
the larger cavities of the body, as in the abdomen, or cheft, and
do generally fucceed in this difficulty of breathing with irregu-
lar pulfe above defcribed, I conclude that it is not owing to an
effufijon of lymph into the pericardium, but fimply to an anafar-
ca of the lungs.

M. M. Digitalis. See Art. V. 2. I. 2. and IV. 2. 3. 7.
Tobacco. Squill. Emetic tartar (antimonium tartarizatum).
Then Sorbentia. Chalybeates. Opium half a grain twice a
day. Raifm wine and water, or other wine and water, is pre-
ferred to the fpirit and water, which thefe patients have general-
ly been accuitomed to.

I have feen two cafes, which were efteemed to be hydrotho-

rax, but which I believed to be anafarca pulmonum, though they

were attended with irregular pulfe ; for I do not undciTcand,

why an irregularity of pulfe mould be occafioned by water in

pericardium any more than by water in the lungs, or by

any

$4 DISEASES CLASS 1. 2. 3. 17;

any other obftruc"lion to the circulation. See Clafs IV. 2. i. 18.
Pulfus intermittens, and Palpitatio cordis.

In both thefe cafes the patients could not fleep above one min-
ute at a time ; which I aicribed to the debility of the action of
the heart compared with the refillance to the circulation, and
that fome voluntary exertion became neceflary to carry on the
circulation, which does not exift in fleep. See Clafs I. 2. I. 3.
Somnus interruptus.

Thefe two cafes of patients about fixty years of age are here
mentioned from a curious circumftance, that both the patients
became in fome degree infane after being relieved by the tinc-
ture of digitalis taken to the quantity of thirty drops three or four
times a day for two or three days ; and remained in a flight de-
gree of infanity for fome months, and then as this increafe of
voluntary exertion ceafed, they again became afflicted with the
anafarca pulmonum, and fwelling of the legs, and this repeat-
edly for two or three years. I have before feen a common an-
afarca repeatedly cured by infanity for a year or two, and two
fevers I have feen attended with great debility cured by the ac-
cefs of infanity, which was called delirium by the attendants j
and I lately witnefled the prefent cure of what was believed to
be confumption by the accefs of infanity. All which were
probably effected by the increafed energy of fome parts of the
fyftem owing to the addition of volition to the fenforial powers
of irritation or afTociatiorL

The ufual caufe of anafarca is from a difeafed liver, and hence
it moft frequently attends thofe, who have drunk much ferment-
ed or fpirituous liquors ; but I fufpecl that there is another
caufe of anafarca, which originates from the brain ; and which
is more certainly fatal than that, which originates from a difeaf-
ed liver. Thefe patients, where the anafarca originates from, or
commences in, the brain, have not other fymptoms of difeafed
Jiver ; have lefs difficulty of breathing at the beginning j and
hold themfelves more upright in their chair, and in walking. In
this kind of dropfy I fufpecl the digitalis has lefs or no efre6t ;
as it particularly increafes the abforption from the lungs.

17. Obefitas. Corpulency may be called anafarca or dropfy
of fat, fmce it mult be owing to an analogous caufe; that is, to
the deficient abforption of fat compared to the quantity fecreted
into the cells which contain it. See Clafs II. i . i . 4.

The method of getting free from too much fat without any
injury to theconftitution, confifls, firft, in putting on a proper
bandage on the belly, lo that it can be tightened or relaxed with
eafe, as a tightifh under waiflcoat, with a double row of buttons.
Xhis is to comprefs the bowels and increafe their abforption 5

and

GLASS I. a. 3. i8L OF IRRITAtlON. 93

and it thus removes one principal caufe of corpulency, which b
the loofenefs of the (kin. Secondly, he fliould omit one entire
meal, as fupper ; by this long abftinence from food the abforb-
ent fyftem will aft on the mucus and fat with greater energy.
Thirdly, he fliould drink as little as he can with eafe to his fen-
fations ; fmce, if the abforbents of the ftomach and bowels fup-
ply the blood with much, or perhaps too much, aqueous fluid,
the abforbents of the cellular membrane will aft with lefs ener-
gy. Fourthly, he fhould ufe much fait or falted meat, which
will increafe the perfpiration and make him thirfby ; and if he
bears this thirft, the abforption- of his fat will be greatly increaf-
ed, as appears in fevers and dropfies with thirft ; this I believe to
be more efficacious than foap. Fifthly, he may ufe aerated al-
kaline water for his drink, which may be fuppofed to render the
fat more fluid, — or he may take foap in large quantities, whiclt
will be decompofed in- the ftomach. Sixthly, ihort reft, and
conftant exercife.

Vinegar has been faid to reduce corpulency, but as it con-
tains much vinous fpirit, it may injure the general health with-
out previoufly inducing leannefs. Perhaps cryftals of tartar
might fucceed better ufed daily in water at meals.

The moft efficacious method of reducing the quantity of the
fat I fufpeft may be by the life of the tincture of digitalis in
fmall quantity, as twenty or thirty drops twice a day, as direct -
ed in Article IV. 2. 3. 7. As the effect of this medicine, when
given in greater quantity, as in forty drops twice or thrice a day
in hydrothorax or general anafarca,evidently confifts in weaken-
ing the natural actions of the ftomach, perhaps by previoufly
ftimulating that vifcus too violently ; in confequence the heart
and arteries aft lefs powerfully from their fympathy with the
ftomach ; and the capillary vefTels, and abforbents, act more
powerfully in confequence of the lefs expenditure of fenforial
power by the inert action of the heart and arteries ; and will
confequently ablbrb the accumulated fat from the cellular mem-
brane, as explained in Supplement I. 12. 10.

1 8. Splenis tumor. Swellings of the fpleen, or in its vicinity,
are frequently preceived by the hand in intermittents, which are
called Ague-cakes, and feem owing to a deficiency of abforption
in the affected part.

Mr. Y , a young man about twenty-five years of age,

who lived intemperately, was feized with an obftinate intermit-
tent, which had become a continued fever with ftrong pulfe, at-
tended with daily remiffion. A large hard tumour on the left
fide, on the region of the fpleen, but extending much more
downward, was fo diflinftly preceptible, that one feemed to get

one s

Qfi DISEASES CLASS 1 2. 3. 194

one's fingers under the edge of it, much like the feel of the brawn
or fhield on a boar's (boulder. He was repeatedly bled, and
purged with calomel, had an emetic, and a bliiter on the part,
without diminiihing the tumour ; after fome time he took the
Peruvian bark, and flight dofes of chalybeates, and thus became
free from the fever, and went to Bath for feveral weeks, but the
tumour remained. This tumour I examined every four or five
years for above thirty years. His countenance was pale, and to-
wards the end of his life he differed much from ulcers on his
legs, and died about fixty, of general debility ; like many others
who live intemperately in refpecl to the ingurgitation of fer-
mented or fpirituous liquors.

As this tumour commenced in the cold fit of an intermittent
fever, and was not attended with pain, and continued fo long
without endangering his life, there is reafon to believe it was
fimply occafioned by deficient abforption, and not by more en-
ergetic action of the veffels which conftitute the fpleen. Sec
ClafsII. i. 2. 13.

M. M. Veneiedion. Emetic, cathartic with calomel ; then
forbentia, chalybeates, Peruvian bark.

19. Genii, tumor albus. White fwelling of the knee, is owing
to deficient abforption of the lymphatics of the membranes in-
cluding the joint, or capfular ligaments, and fometimes perhaps
of the gland which fecretes the fynovia -, and the ends of the bones
are probably affected in confequence.

I faw an inftance, where a cauflic had been applied by an
empyric on a large white fwelling of the knee, and was told, that
a fluid had been difcharged from the joint, which became an-
chylofed, and healed without lofs of the limb.

M. M. Repeated bliilers on the part early in the difeafe are
faid to cure it by promoting abforption ; faturnine folutions ex-
ternally are recommended. Bark, animal charcoal, as burnt
fponge, opium in fmall dofes. FricYion with the hand. Four
or fix leeches applied on or beneath the knee alternately with the
blifters, and a cupping glafs put over the wounds made by the
leeches are much recommended.

20. Bronchocele. Swelled throat. An enlargement of the
thyroid glands, faid to be frequent in mountainous countries,
where river water is drunk, which has its fource from difiblving
fnovvs. This idea is a very ancient one, but perhaps not on
that account to be the more depended upon, as authors copy
one another. Tumidum guttur quis miratur in Alpibus, feems
to have been a proverb in the time of Juvenal. The inferior
people of Derby are much fubject to this difeafe, but whether
more fo than other populous towns, I can not determine , certain

it

CLASS I. 2. 3. 2i. OF IRRITATION. 97

it is, that they chiefly drink the water of the Dsrxvent, which
arifes in a mountainous country, and is very frequently blacken-
ed as it paries through the moraiTes near its fourcc ; and is gen-
erally of a darker colour, and attended with a whiter foam, than
the 'Trent, into which it falls ; the greater quantity and white-
nefs of its froth I fuppofe may be owing to the vifcidity com-
municated to it by the colouring matter. The lower parts of
the town of Derby might be eafdy fupplied with fpring water
from St. Alkmond's well •, or the whole of it from the abun-
dant fprings near Bowbridge : the water from which might be
conveyed to the town in hollow bricks, or clay-pipes, at no very-
great expence, and might be received into frequent refervoirs
•with pumps to them ; or laid into the houfes.

M. M. Twenty grains of burnt fponge with ten of nitre made
with mucilage into lozenges, and permitted to diffblve flowly un-
der the tongue twice a day, is averted to cure in a few months ,
perhaps other animal charcoal, as candle-fhuffs, might do the
fame.

I have direcled in the early date of this difeafe a mixture of
common fait and water to be held in the mouth, particularly
under the tongue, for a few minutes, four or fix times a day for
many weeks, which has fometimes fucceeded, the fait and water
33 then fpit out again, or in part fwallowed. Externally vinegar
of fquills has been applied, or a mercurial plafter, or fomentations
of acetated ammoniac ; or ether. Some empyrics have applied
cauftics on the bronchocele, and fometimes, I have been told,
with fuccefs ; which (hould certainly be ufed where there is
danger of fuffbcation from the bulk of it. One cafe I faw, and
one I was well informed of, where the bronchocele was cured by
burnt fponge. and a he£ltc fever fupcrvened with colliquative
fweats ; but I do not know the final event of either of them.

De Haen affirms the cure of branchocele to be effected by
flowers of zinc, calcined egg-fhells, and fcarlet-cloth burnt to-
gether in a clofe crucible, which was tried wirh fuccefs, as he.
aiTured me, by a late lamented phyfician, my friend, Dr. Small
of Birmingham ; who to the cultivation of modern fciences add-
ed the integrity of ancient manners ; who in clearnefs of head,
and benevolence of heart, had few equal?, perhaps no fuperiors.

21. Scrofula. Kind's evil is known by tumours of the lym-
phatic glands, particularly of the neck. The upper lip, and di-
vifion of the noftrils are f-.vdled, wirh a florid countenance, a
fmopth fkin, and a tumid abdomen. Cullen. The abf
ids in their courfe to the veins in the fcrofuln are arrefted in tli-
lymphatic or conglobate glands ; which fwell, and after a trreac
length of time, inflame and fuppurate. Materials of a pec

VOL. II. O

9S DISEASES GLASS I. 2. 3. 21',

kind, as the variolous and venereal matter, when abforbed in a
wound, produce this torpor, and confequent inflammation of
thofe lymphatic glands, where they firft arrive, as in the axilla
and groin. There is reafon to fufpeft, that the tonftls frequent-
ly become inflamed, and fuppurate from the matter abibrbed
from carious teeth ; and I faw a young lady, who had both the
axillary glands fwelled, and which fuppurated j which was believ-
ed to nave been caufed by her wearing a pair of new green gloves
for one day, when me had perfpired much, and was much ex-
haufted and fatigued by walking •, the gloves were probably dyed
in a folution of verdker.

Thefe indolent tumours of the lymphatic glands, which con-
ftitute the fcrofula, originate from the inirritability of thole
glands ; which therefore fooner fall into torpor after having
been ftimulated too violently by fome poifonous material ; as
the mufcles of enfeebled people fooner become fatigued, and
ceafe to aft, when exerted, than thofe of ftronger ones. On the
fame account thefe fcrofulous glands are much longer in acquir-
ing increafe of motion, after having been ftimulated into inac-
tivity, and either remain years in a fiate of indolence, or fup-
purate with difficulty, and fometirnes only partially.

The difference between fcrofulous tumours, and thofe before
defcribed, confifts in this ; that in thofe either glands of differ-
ent kinds were difeafed, or the mouths only of the lymphatic
glands were become torpid ; whereas in fcrofula the conglobate
glands themfelves become tumid, and generally fuppurate after
a great length of time, when they acquire new fenfibility.
See Sea. XXXIX. 4. 5.

Thefe indolent tumours may be brought to fuppurate fome-
times by paffing electric {hocks through them every day for two
or three weeks, as I have witnefled. It is probable, that the al-
ternate application of fnow or iced water to them, till they be-
come painfully cold, an^l then of warm flannel or warm watery
frequently repeated, might reftore their irritability by accumula-
tion of fenfoml power ; and thence either facilitate their difper-
fioii, or occafion them to fuppurate. See Clafs II. i. 4. 13.

This difeafe is very frequent amongft the children of the poor in
large towns, who are in general ill fed, ill lodged, and ill clothed ;
and who are further weakened by eating much fait with their
fcanty meal of infipid vegetable food, which is feldom of better
quality than water gruel, with a little coarfe bread in it. See
diarrhoea of infants, Clafs I. I. 2. 5. Scrofulous ulcers are
difficult to heal, which is owing to the deficiency, of abforption
on their pale and flabby furfaces, and to the general inirritability
of the fyftem. See Clafs I. i. 3. 13.

M. M. Plentiful

CLASS I. 2. 3. 22. OF IRRITATION. 99

M. M. Plentiful diet of flefli meat and vegetables with fmall
beer. Opium, from a quarter of a grain to half a grain twice
a day. Sorbentia. Tincture of digitalis, thirty drops twice a
clay. Externally fea-bathing, or bathing in fait and water, one
pound to three gallons, made warm. The application of Peru-
vian bark in fine powder, feven parts, and white lead (cerufla),
in fine powder one part, mixed together and applied on the ul-
cers in. dry powder, by means of lint and a bandage, to be renew-
ed every day. Or very fine powder of calamy alone, lapis ca-
laminaris. If powder of manganefe ? See Clafs II. i. 4. 13.

22. Sclrrhus. After the abforbent veins of a gland ceafe to
perform their oiHce, if .the feeerning arteries of it continue to
act fome time longer, the fluids are pufhed forwards, and ftag-
nate in the receptacles or capillary vefiels of the gland ; and the
thinner part of them only being refumedby the abforbent fyftem
of the gland, a hard tumour gradually fucceeds ; which contin-
ues like a Hfelels mafs, till from fome accidental violence it gains
fenfibility, and produces cancer, or fuppurates. Of this kind
are the fcirrhus glands of the breafts, of the lungs, of the mefen-
tery, and the fcrofulous tumours about the neck and the bron-
chocele.

Another feat of fcirrhus is in the membranous parts of the
fyftem, as of the rectum mteftinum, the urethra, the gula or
throat ; and of thus kind is the veruca or wart, and the clavus pe-
dum, or corns on the toes. A wen fometimes arifes on the back
ef .the neck, awd fometimes between the moulders ; and by dif-
tending the tendinous fafcia produces great and perpetual pain.

M. M. Mercurial ointment. Cover the part with oiied filk.
Extirpation. Electric ihocks through the tumour. An iiiue
into, the fubftance of the wen. Opium. Ether externally.

23. Scirrbus re'fti inteftini. Scirrhus of the rectum. A
fcirrhus frequently affects a canal, and by contracting its diam-
eter becomes a painful and deplorable difeafe. The canals thus
obltructed are the rectum,- the urethra, the throat, the gall-;ciucts,
and probably the excretory ducts of the lymphatics, and of oth-
er glands.

The fcirrhus of the rectum is known by the patient having
pain in the part, and being only able to part with liquid feces,
«nd by the introduction of the finger j the fwelled part of the
teftine is fometimes protruded downwards, and hangs like a
valve, fmooth and hard to the touch, with an aperture in the
centre of it. See a paper on this fubject by J. Sherwin. Me-
moirs of a I^ondon Medical Society, Vol. II. p. 9.

M. M. -To take but little foiid food. Aperient medicines.

Introduce

DISEASES CLASS L 2, 3. 24.

Introduce a candle fmcared with mercurial ointment. Sponge-
tent. Clyfters with forty drops of laudanum. Introduce a.
leathern canula, or gut, and then either a wooden nmnidril, or
blow it up with air, fo as to diftend the contracted part as much
as the patient can bear. Or fpread mercurial platter on thick
foft leather, and roll it up with the plafter outwards to any thick-
nefs and length, which can be eafily introduced and worn ; or
two or three luch pieces may be introduced after each other.
The fame may be ufed to comprefs bleeding internal piles. Ses
Clais I. 2. i. 6. Rub mercurial ointment on the fphincter ani
every night for a fortnight.

May not this difeafe 'be cured by lunar cauftic applied on the
end of a peiiary or bougie, in the fame mariner as ufed by J.
Hunter, and fmce by Mr. E. Home, in Uriel: ures of the urethra;
when, on introducing the finger, a kind of membranous valve can
be diflinguifhed rather than an extenfive fcirrhus or induration.
See the next article.

24. Scirrhus urethra. Scirrhus of the urethra. The pafTage
becomes contracted by the thickened membrane, and the urine is
forced through with great difficulty, and is thence liable to dif-
tend the canal behind the ftri&ure ; till at length an aperture is
made, and the urine forces its way into the cellular membrane,
making large fmufes. This fituation fometimes continues many
months, or even years, and fo much matter is evacuated after
making water, or at the fame time, by the aclion of the mufcles
in the vicinity of the finufes, that it has been miflaken for an in-
creafed fecretion from the bladder, and has been erroneouily
termed a catarrh of the bladder. See a paper by Dr. R. W.
Darwin in the Medical Memoirs.

M. M. Diiiend the part gradually by catgut bougies, which
by their compreflion will at the fame time diminim the thicknefs
of the membrane, or by bougies of elailic gum, or of horn boil-
ed foft. The patient fhould gain the habit of making water
flowly, which is a matter of the utmoit confequence, as it pre-
vents the diftention and confequent rupture, of that part of the
urethra, which is between the itridture and the neck of the blad-
der.

When there occurs an external ulcer in the perinasum, and
the urine is in part difcharged that way, the difeafe cannot be
miftaken. Ojherwife, from the quantity of matter, it is gener-
ally fuppofed to come from the bladder, or prod-ate gland ; and
the urine, which escapes from the ruptured urethra, mines its
way amongflrthe mufcles and membranes, and the patient dies
tabid, owing to the want of an external oriiice to difcharge the
matter. See ClafsIL i. 4. u.

Mr. Home

£LASS!. 2. 3. 25. OF IRRITATION. rot

Mr. Tfime has publifhed a very ingenious and ufefu* work, en-
titled, u Diflertation on Strkl tires of the Urethra, in which he has
recorded many eales fuccefsfully treated by lunar cauftic, initrt-
in tlie end of a bougie, and applied to the contracted part of
the urethra, fo as to deilroy the ftridl lire.

From the form of the caviiy of the urethra, taken by injecting
wax into it, there appears naturally to exift a kind of valve im-
mediately behind the bulb of the urethra, which when the penis
is creel, liiuts up the orifice, and prevents the reg.urgitation of
the femen into the bladder during the action of the accelerator
mufcles in the act of its expjulfion ; and this natural conflriction.
or valve appears generally to be the firil feat of ftricture.

Above the bulb, about two or three inches from the orifice
of the glans, the cavity of the urethra appears allo lefTened j and
in fome cafes the orifice of the very extremity appears lefs than,
other parts of the canal ; thcfe parts are therefore more contract^
ed during the emiilio ferninis, and add to its velocity at its exit ;
and are thence more liable to fcirrhofity or ilriclure. And by
fome observations, Mr. Home has (hewn, that a fympathy exifts
between the ftrictures of thefe parts ; and that the more for-
\vard ftrictures are frequently produced in confequence of that
behind the bulb ; and finds it neceiTary to deftroy them all, by-
frequent application of the cauftic.

By the ufe of which, (which .was firfl propofed by Wifeman,
firft applied by John Hunter, and fo greatly improved by Mr.
Home) the lives of great numbers are rendered happy, who oth-
erwife gradually periih by a mod painful and hopelefs malady.

25. Srirrbns aefiphagi. A fcirrhus of the throat contracts the
pafiiige fo as to render the fwallowing of folids impracticable, and
,of liquids difficult. It affects patients of all ages, but is probably
molt frequently produced by (wallowing hard angular fubflan-
when people have loft their teeth ; by which this membrane
is over-diftended, or torn, or otherwile injured.

M. M. Put milk into a bladder tied to a canula or catheter ;
introduce it palt the ftriclnre, and prefs it into the ftomach.
Diftend the liriclure gradually by a fponge-tent faftened to the
end of whalebone, or by a plug of wax, or a fpermaceti candle,
about two inches long ; which might be introduced, and left
there with a Itring only fixed to it to hang out of the mouth, to
keep it in its place, and to retract it by occafionally ; for which
purpofc the firing mull be put through a catheter or hollow pro-
bang, when it is to be retracted. Or laftiy, introduce a gut
fixed to a pipe ; and then diftend it by blowing wind into it.
The fwallowing a bullet with a firing put through it, to retract
iv on the exhibition of on emetic, has alto been propofed. Ex-

tern ally,

DISEASES CLASS I. 2. 3. 2$,

ternally, mercurial ointment has been much recommended.
Poultice. Oiled filk. Clyfters of broth. Warm bath of broth.
Transfufion of blood into a vein three or four ounces a day ?
SeeClafsIII. i. i. 15.

I directed a young woman, about twenty-two years of age,
to be fed with new milk put into a bladder, which was tied to a
catheter, and introduced beyond the ftricture in her throat ; af-
ter a few days, her fpirits iunk, and (he refufed to ufe it further,
and died. Above thirty years ago, I propofed to an old gentle-
man, whole throat was entirely impervious, to fupply him with
3 few ounces of blood daily from an afs, or from the human an-
imal, who is ftill more patient and tractable, in the following
manner : To fix a filver pipe about an inch long to each extrem-
ity of a chicken's gut, the part between the two filver ends to be
meafured by filling it witjli warm water ; to put one end into
the vein of a perfon hired for that purpofe, fo as to receive the
blood returning from the extremity ; and when the gut was quite
full, and the blood running through the other iilver end, to in-
troduce that end into the vein of the patient upwards towards
the heart, fo as to admit no air along with the blood. And
laftly, to fupport the gut and filver ends on a water-plate, fill-
ed with water of ninety-eight degrees of heat, and to meafure
how many ounces of blood was introduced by paffingthe finger,
fo as to comprefs the gut, from the receiving-pipe to the deliv-
ering-pipe ; and thence to determine how many gut-fulls were

given from the healthy perfon to the patient. Mr con-

iidered a day on this propofal, and then another day, and at
length anfwered, that " he now found himfelf near the houfe of
death •, and that, if he could return, he was now too old to have
much enjoyment of life ; and therefore he wiihed rather to pro-
ceed to the end of that journey, which he was now fo near, and
v;hich he nmft at all events foon go, than return for fo ftiort a
time." He lived but a few days afterwards, and feemed quite
carelefs and eafy about the matter. See Suppl. I. 14. 4.

A difficulty of fwallowing food, and a rejection foon after, of
the whole or a part of it, may be often owing probably to a fort
of valve made by a part of the membrane which lines the cefoph-
agus ; and may thus referable Ibictures of the urethra ; which
hit are fo frequently cured by the nice application of lunar cauf-
tic, as defcribed by Mr. jEverard Home, in his Treatife on Stric-
tures of the Urethra. Suppofe a thick bougie, made of linen
fpread with adhefive plafler, and rolled up, was armed at the
end with a bit of lunar cauflic, with which the ftriclture of the
cefophagus could be touched repeatedly, till an unarmed bougie
could be palled readily into the (tooiach ? Could iuch a valve DQ

burft,

GLASS I. 2. 3. 26. OF IRRITATION, 103

burft, or inverted, by pouring a pound or two of crude mercury
into the cefophagus ?

26. LaEleontm inirritabilitas. Inirritability of the la&eals is
defcribed in Sect. XXVIII. under the name of paralyfis of the
lafteals ; but as the word paralyfis has generally been applied to
the difobedience of the mufcles to the power of volition, the
name is here changed to inirritability of the la&eals, as more
charafteriffic of the difeafe.

27. Lymphaticorum inirritabilitas. The inirritability of the
cellular and cutaneous lymphatics is defcribed in Seel:. XXIX. 5.
i. and in Clafs I. 2. 3. 10. The inirritability of the cutaneous
lymphatics generally accompanies anaiarca, and is the caufe o£
the great third in that malady. At the fame time, the cellular
lymphatics acl: with greater energy, owing to the greater de-
rivation of fenforial power to them, in confequence of the lefs
expenditure of it by the cutaneous ones •, and hence they abforb
the fat, and mucus, and alfo the thinner parts of the urine*
Whence the great emaciation of the bodyr the muddy fediment,
and the fmall quantity of water in this kind of dropfy,

ORDO

104 DISEASES CLASS I. 2. 4.

ORDO II.

Decreafed Irritation.

GENUS IV.
With deer e fifed AEiions of 'other Cavities and Membranes.

MANY of the difeafes of this genus are attended with pain,
and with cold extremities, both which ceafe on the exhibition
of wine or opium 5 which (hews, that they originate from de-
iicient action of the altered organ. Thefe pains are called ner-
vous or fpafmodic, are not attended with fever, but are fre-
quently fucceeded by convuKionsandmadnefs ; both which be-
long to the clafs of volition. Some of them return at periods,
and when thefe cari be afcertained, a much lefs quantity of opi-
um will prevent them, than is neceflary to cute them, when they
are begun ; as the vefTels are then torpid and mirritable from
the want of fenforial power, till by their inaction it becomes
again accumulated.

Our organs of fenfe, properly fo called, are not liable to pain
from the abfence of their appropriated ftimuli, as from darknefs
or filence j but the other ienfes, which may be more properly
called appetites, as thofe by which we perceive heat, hunger,
thirft, luft, want of frefh air, are affected with pain from the de-
fect or abfence of their accuftomed ftimuli, as well as with pleaf-
ure by the pofTeffion of them ; it is probable that fome of our
glands, the fenfe or appetite of which requires or receives fome-
thing from the circulating blood, as the pancreas, liver, teftes,
proftate gland, may be affected with aching or pain, when they
cannot acquire their appropriated fluid.

Wherever this defett of flimulus occurs, a torpor or inaction
of the organ enfues, as in the capillaries of the fkin, when expo-
fed to cold ; and in the glands, which fecrete the gaftric juice,
when we are hungry. This torpor however, and concomitant
pain, which are at firft owing to defect of ftimulus, are after-
wards induced by other affociations or catenations, and confti-
tute the beginning of ague-fits.

It muft be further obferved, that in the difeafes of pain with-
out fever, the pain is frequently not felt in the part where the
caufe of the difeafe refides ; but is induced by fympathy with a
diftant part, the irritability or fenfibility of which is greater or
lefs than its own. Thus a ftone at the neck of the bladder, if its
ftimulus is not very great, only induces the paiu of itrangury at

the

CLASS I. 2. 4. i. OF IRRITATION. loj

the glans penis. If its ftimulus be greater, it then induces pain
at the neck of the bladder. The concretions of bile, which are
protruded into the neck of the gall-bladder, when the difeafe is
not very great, produce pain at the other extremity of the bile-
duel:, which enters the duodenum immediately under the pit of
the ftomach ; but, when the difeafe is great -from the largenefs
of the bile-ftone, the pain is felt in the region of the liver ac the
neck of the gall-bladder.

It appears from herrce,* that the psircs enumerated in this ge-
nus are confequences of the inactivity of the organ •, and, as they
do not occaiion other difeafes, ihould be claffed according to
their proximate caufe, which is, defective irritation ; there are
neverthelefs other pains from defect of ftimulus, which produce
convulfions, and belong to Clafs III. i. I. ; and others, which
produce pains of fome diftant part by aflbciacion, and belong to
Clafs IV. 2. 2.

SPECIES.

I. Sitif. Thirft. The fenfes of thirft and of hunger feeni
to have this connexion, that the former is fituated at the upper
end, and the latter at the lower end of the fame canal. One
about the pharinx, where the cefophagus opens into the mouth,
and the other about the cardia ventriculi, where it opens into the
ftomach. The extremities of other canals have been (hewn to
poflefs correfpondent fenfibilities, or irritabilities, as the two ends
of the urethra, and of the common gall-duet. See IV. 2. 2. 2.
and 4.

The membrane of the upper end of the gullet becomes torpid,
and confequently painful, when there is a deficiency of aqueous
3uid in the general fyftem ; it then wants its proper ftimulus.
In the fame manner a want of the ftimulus of more folid mate-
rials at the other end of the canal, which terminates in the ftom-
ach, produces hunger ; as mentioned in Seet. XIV. 8. The
proximate caufes of both of them therefore confift in deficient
irritation, when they are confidered as pains •, becaufe thefe pains
are in confcquence of t-he inactivity of the organ, according to
the fifth law of animal caufation. Seel:. IV. 5. But when they
are confidered as defires, namely, of liquid or folid aliment,
their proximate caufe confifts in the pain of them, according to
the fixth law of animal caufation. So the proximate caufe of
the pain of coldnefs is the inactivity of the organ, and perhaps
the confequent accumulation of fenforial power in it ; but the
pain itfelf or the confequent volition, is the proximate caufe of the

VOL. II. P (huddering

io6 DISEASES CLASS I. 2. 4. 2,

fhuddering and gnafhing the teeth in cold fits of intermittent fe-
vers. See Clafs I. 2. 2. i.

Thirft may be divided into two varieties, alluding to the re-
mote caufe of each, and may be termed fitis calida, or warm
thirft, and fitis frigida, or cold thirft. The remote caufe of the
former arifes from the diflipation of the aqueous parto of our
fluids by the increafed fecretion of perfpirable matter, or other
evacuations. And hence it occurs in hot fits of fever, and after
taking much wine, opium, fpice, fait, or other drugs of the Art.
incitantia or fecernentia. The thirft, which occurs about three
hours after eating a couple of red herrings, to a perfon unaccui-
tomed to falted meat, is of this kind ; the increafed action of the
cutaneous veflels diilipates fo much of our fluids by infenfible
perfpiration, as to require above two quarts of water to reftore
the fluidity of the blood, and to waih the fait out of the fyftem.
See Art. III. 2. i.

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

The remote caufe of fitis frigida, or cold thirft, is owing t&
the inaction of the cutaneous, pulmonary, urinary, and cellular
abforbents ; whence the blood is deprived of the great fupply of
moifture which it ought to receive from the atmofphere, and
from the cells of the cellular membrane, and from other cyfts ;
this caufe of thirft exifts in dropfies, and in the cold fits of inter-
mittents. The defire of fluids, like that of folids, is liable to ac-
quire periods, and may therefore readily become difeafed by in-
dulgence in liquids grateful to the palate.

Of difeaied thirft, the moft common is either owing to defect
of the aft ion of the numerous abforbent veifels on the neck of
the bladder, in which the patient makes much paleiih water ; or
to the defeclive abforption of the fkin and lungs, in which the
patient makes but little water, and that high-coloured, and with
fediment. In both the tongue and lips are liable to become very
dry. The former in its greateft degree attends diabetes> and the
latter anafarca.

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

2. Efuries. Hunger has been fancifully afcribed to the fides
of the ftomach rubbing againft each other, and to the increafed
acidity of the gaftric juice corroding the coats of it. If either
of thefe were the caufe of hunger, inflammation muft occur, when
they had continued fome time •, but, on the contrary, coldnefs
not heat is attendant on hunger; which evinces, that like third
it is owing to the inactivity of the membrane, which is the feat
of it ; while the abundant nerves about the cardia ventriculi,

and

CLASS I. 2. 4. 3. OF IRRITATION, 107

and the pain of hunger being felt in that part, gives great reafon
to conclude, that it is there iituated.

The fenfe of hunger as well as of thirft, is liable to acquire
habits in refpect to the times of its returning painfulnefs, as well
as in refpect to the quantity required to fatiate its appetency,
and hence may become difeafed by indulgence, as well as by
want of its appropriate flimulus. Thofe who have been accuf-
tomed to diftend their ftomach by large quantities of animal and
vegetable food, and much potation, find a want of diftenticn,
when the ftomach is empty, which occafions faintnefs, and is
miltaken for hunger, but which does not appear to be the fame
fenfation. I was well informed, that a woman near Litchfield,
who eat much animal and vegetable food fora wager, affirmed,
that fince diftending her ftomach fo much, (he had never felt
herfelf fatisfied with food ; and had in general taken twice as
much at a meal, as (he had been accuftomed to, before (he eat
fo much for a wager.

3. Naufeajicca. Dry naufea. Confifts in a quiefcence or
torpor of the mucous or falivary glands, and precedes their in-
verted motions, defcribed in naufea humida, Clafs I. 3. 2. 3.
In the fame manner as ficknefs of the ftomach is a quiefcence
of that organ preceding the action of vomiting, as explained in
Sect. XXXV. i. 3. This is fometimes induced by difagreeable
drugs held in the mouth, at other times by difguftful ideas, and
at other times by the affociation of thefe actions with thofe of
the ftomach ; and thus according to its different proximate
caufes may belong to this, or to the fecond, or to the fourth
clafs of difeafes.

M. M. Lemonade. Tafteful food. A blifter. Warm bath.

4. JEgritudo ventriciili. Sicknefs of ftomach is produced by
the quiefcence or inactivity of that organ, as is explained in
Sect. XXXV. i. 3. It confifts in the (late between the ufual
periftaltic motions of that organ, in the digeftion of our aliment
and the retrograde motions of it in vomiting ; for it is evident,
that the direct motions of it from the cardia to the pylorus muft
flop, before thofe in a contrary direction can commence. This
ficknefs, like the naufea above defcribed, is fometimes produced
by difguftful ideas, as when nafty objects are feen, and nafty
(lories related, as well as by the exhauftionof the fenforial pow-
er by the ftimulus of fome emetic drugs, and by the defect of
the produdtion of it, as in enfeebled drunkards.

Sicknefs may likewife confift in the retrograde motions of the
lymphatics of the ftomach, which regurgitate into it the chyle or
lymph, which they have lately abforbed, as in Clafs I. 3. 2. 3. It
is probable, that thefe two kinds of ficknefs may be different fen-

fations*

io8 -DISEASES GLASS I. 2. 4. $.

iations, though they have acquired but one name ; as one of them
attends hunger, and the other repletion ; though either of them,
jmay poffibiy be induced by affbciation with naufeous ideas.

M. M. A blifier on the back. An emetic. Opium. Crude
rnercury. Covering the head in bed. See Sect. XXV. 16. Clafs
IV. i. i. 2. and 3.

5. Cardialgla. Heartburn originates from the inactivity of
the flomach, whence the aliment, inftead of being fubdued by
digeftion, and converted into chyle, runs into fermentation, pro-
ducing acetous acid. Sometimes the gaftric juice itielf becomes
fo acid as to give pain to the upper orifice of the ftomach ; thefe
acid contents of the ftomach, on falling on a marble hearth,
have been feen to produce an efferyefcence on it. The pain of
heat at the upper end of the gullet, when any air is brought up
from the fermenting contents of the ftomach, is to be afcribed
to the fympathy between thefe two extremities of the cefophagus
rather than to the pungency of the carbonic gas, or fixed air j
as the fenfation in fwal lowing that kind of air in water is of a
different kind. See Clafs I. 3. JL. 3. and IV. 2. 2. 5.

M. M. This difeafe arifing from indigeftion is often very per-
tinacious, and afflicting ; and attended with emaciation of the
body from want of fufficient chyle. As the faliva fwallowed
along with our food prevents its fermentation, as appears by the
experiments of Pringle and Macbride, fome find considerable re-
lief by chewing parched wheat, or maftic, or a lock of wool, fre-
quently in a day, when the pain occurs, and by fwallowing the
faliva thus efFufed ; a temporary relief is often obtained from an-
tiacids,or aerated alkaline water, Seltzer water, calcareous earths,
alkaline falts made into pills with foap, foap alone, tin, milk,
bitters. More permanent ufe may be had from fuch drugs as
check fermentation, as acid of vitriol ; but ftill more permanent
relief from fuch things as invigorate the digeftion, as a blifter on
the back ; a due quantity of vinous fpirit and water taken
regularly. Steel. Temperance. A fleep after dinner. A waift-
coat made fo tight as ilightly to comprefs the bowels and ftom-
ach. A flannel fliirt in winter, not in fummer. A lefs quan-
tity of potation of all kinds. Ten black pepper-corns fwallow-
ed after dinner. Half a grain of opium twice a day, or a grain.
The food fhould confift of fuch things as do not eafily ferment,
as flefti, fhell-fifli, fea-bifcuit, toafted cheefe. I have feen toaft-
ed cheefe brought up from the ftomach 24 hour^ after it had
been fwallowed, without apparently having undergone any-
chemical change. See Clafs II. i. 3. 17. and IV. i. 2. 13.

It is probable that violent cardialgia is moil frequently owing
to increafe of the quantity or acidity of the gaftric juice, rather

than

*s I. 2. 4. 6. OF IRRITATION. 109

than to the acetous acid produced by fermenting aliment ; be-
caufe in violent afepfy, as in low fevers, and total want of di-
geftion, no fuch violently ftrong or painful acidity occurs. Sec
I. 3. i. 3. See Anorexia II. 2. 2. i. And fecondly, becaufe
in all thefe cafes, which have come under my eye, the difeafc
was not increafed by vegetable food, or even by acid fruits, when
taken in their ufual quantity; and I have uniformly oblerved,
that the food which fuited the palate, and that water alone, or
fmall wine and water, agreed with thefe patients better than
ilronger mixtures of fpirit and .water, efpecially when they v/erc
more agreeable to the palate.

6. Arthritis Veninciili. Sicknefs of the -ftomach in gouty
cafes is frequently a confequence of the torpor or inflammation
of the liver, and then it continues many days or weeks. But
when the patient is feized with great pain at the ftomach with
the fenfation of coldnefs, which they have called an ice-bolt, this
Is a primary affection of the ftomach, and deftroys the patient
m a few hours, owing to the torpor or inaction of that vifcus fo
important to life.

This primary gout of the ftomach, as it is a torpor of that
vifcus, is attended with fenfation of coldnefs, and with real de-
fect of >heat in that part, and may thence be diftinguimed from
the pain occafioned by the paiTage of a gall-ftone into the duod-
enum, as well as by the weak pulfe, and cold extremities ; to
which muft be added, that it affects thofe only, who have been
long afflicted with the gout, and much debilitated by its numer-
ous attacks.

M. M. Opium. Vinous fpirit. Volatile alkali. Spice.
Warmth applied externally to the ftomach by hot cloths or fo-
mentation.

7. Golica fatulenta. The flatulent colic arifes from the too
great diftention of the bowel by air, and confequent pain. The
caufe of this difeafe is the inactivity or want of fuiEciently pow-
erful contraction of the coats of the bowel, to carry forwards the
gas given up by the fermenting aliment. It is without fever,
and generally attended with cold extremities.

It is diftinguifhed, firft, from the pain occafioned by the paf-
fage of a gall-ftone, as that is felt at the pit of the ftomach, and
this nearer the navel. Secondly, it is diftinguifhed from the
colica faturnina, or colic from lead, as that arifmg from the tor-
por of the liver, or of fome other vifcus, is attended with greater
coldnefs, and with an aching pain ; whereas the flatulent colic
being owing to diftention of the mufcles of the bowel, the pain
is more acute, and the coldnefs lefs. Thirdly, it is diftinguifli-
<ul from inflammation of the bowels, or ileus, as perpetual vomr

king

DISEASES CLASS I. 2. 4. 8.

itingand fever attend this. Fourthly, it is diftinguifhed from
cholera, becaufe that is accompanied with both vomiting and di-
arrhoea. And laftly, from the colica epileptica, or hyfteric col-
ic, as that is liable to alternate with convulfion, and fometimes
with infanity ; and returns by periods.

M. M. Spirit of wine and warm water, one fpoonful of each.
Opium one grain. Spice. Volatile alkali. Warm fomenta-
tion externally- Rhubarb.

8. Colica faturmna. Colic from lead. The pain is felt about
the navel, is rather of an aching than acute kind at firft, which
increases after meals, and gradually becomes more permanent
and more acute. It terminates in paralyfis, frequently of the
mufcles of the arm, fo that the hand hangs down, when the
arm is extended horizontally. It is not attended with fever, or
increafe of heat. The feat of the difeafe is not well afcertain-
ed ; it probably affects fome part of the liver, as a pale bluifh
countenance and deficiency of bile fometimes attend or fucceed
it, with confequent anafarca ; but it feems to be caufed imme-
diately by a torpor of the interline, whether this be a primary or
fecondary affection, as appears from the conftipation of the
bowels, which attends it ; and is always produced in confe-
quence of the great (limulus of lead previoully ufed either inter-
nally for a length of time, or externally on a large furface.

A delicate young girl, daughter of a dairy farmer, who kept
his milk in leaden cifterns, ufed to wipe off the cream from the
edges of the lead with her finger ; and frequently, as fhe was
fond of cream, licked it from her finger. She was feized with
the faturnine colic, and femi-paralytic wrifts, and funk from
general debility.

A feeble woman about forty years of age,fprained her ancle,
and bruifed her leg and thigh ; and applied by ill advice a folu-
tion of lead over the whole limb, as a fomentation and poultice
for about a fortnight. She was then feized with the colica fa-
turnina, loll the ufe of her wrifts, and gradually funk under a
general debility.

There are various means by which lead finds its way into the
fyftem ; in the cyder counties of this country this difeafe has
been frequently almoft epidemic from the ufe of fome lead about
their mills, or by the pernicious uie of it to correct the acidity
of weak cyder. This difeafe has been fo frequent in fome of the
wine countries, that in France the punifhment of death is di-
rected for thofe, who ufe lead to deflroy the acidity of wine.

There is a bad cuftomin almoft all families and public houfes
of warning out their bottles by putting a handful of (hot corns
into them, and by fhaking them about forcibly, by which the

lead

CLASS I. 2. 4. 8. OF IRRITATION. 1 1 1

had may in part adhere to the fides of the bottle, and become
difiblved >n the acid of the wine or cyder. Milk kept in lead is
highly pernicious, as in the in fiance above related. Nor {hould
coppers for brewing be edged at the top of them with lead, which
is frequently done ; nor fhould fleth-meat be falted in leaden
citterns. Another way by which lead is liable to be taken into
the ftomach is by broth, which is boiled in copper veil el*
tinne;l within. Now the lining of thefe vefTels confifts, I am
•well informed, of nearly half lead mixed with the tin j which is
very foluble in hot greafe. From this caufe thofe, who live
much on foupb long boiled, as the French, ars perpetually fub-
jecl to complaints of the ilomach and intettines. When a
fauce-pan has been new tinned, if the ringer be rubbed hard on
it, it becomes black 5 which is owing to the lead, which is mix-
ed with the tin. Hence the broth for all lick people fhould be
boiled but a fhort time, and be immediately put into a china-
bafon.

In an ingenious pamphlet lately publifhed by Mr. Clutterbuck,
feveral cafes are given of the fuccefsfui ufe of mercury in tha
conftipation, colic, and paralyfis of the wrifts, produced by lead*
In fome of thefe patients a drachm of ilrong mercurial ointment
was rubbed morning arid night on the wrifts, till the mouth be-
came fore. In others calomel one grain was given daily with ol.
ricini ; and mothers a quarter of a grain ofhydragyrum muria-
tum, fublimate of mercury, was given three times a day with
great apparent advantage. The author ingeniouily aflcs, if
imall doles of fome preparation of lead might not be given inter-
nally to counteract: the ill effects fometimes believed to refult
from the too long ufe of mercury. On the Poiibn of Lead,
Boofey, Lond. See Clafs III. 2. i. 4.

The effecl: of metals in deftroying or preventing the acidity
of wine or cyder, may be nicely obferved in attending to the
colour of fyrup of violets ; which, if it ferments, is changed by
the acid thus produced from blue to red : but if it be kept in a
tin veffel, this does not occur ; as the acid is attracted by the
metal producing an oxyde. Other metals are laid by M. Guy-
ton, to have the fame effedl in preferving the colour of fyrup
of violets.

M. M. Firft opium one or two grains, then a cathartic of
fenna, jalap, and oil, as foon as the pain is relieved. Oleum
ricini. ^ Alum. Oil of almonds. A bliiler on the navel. Warm
bath. The ftimulus of the opium, by reftoring to the bowel its
natural irritability in this cafe of painful torpor, ailiils the aclion
of the cathartic. A clylter of the fmoke of tobacco puttied high

up

DISEASES CLASS 1. 2. 4* 9.

up and continued, or repeated frequently for ah hour or two, or
longer, is faid to remove the pain, and totally to cure the difeafe.

9. Tympanitis. Tympany confifts in an elaftic tumor of the
abdomen, which founds on being ftruck. It is generally attend-
ed with coftivenefs and emaciation. In one kind the air is faid
to exift in the bowels, in which cafe the tumor is lefs equal,
and becomes lefs tenfe and painful on the evacuation of air. In
the other kind the air exifts in the cavity of the abdomen, and
fometimes is in a few days exchanged for water, and the tympa-
ny becomes an afcites.

Air may be diftinguifhed in the ftomach of many people by
the found on ftriking it with the ringers, and comparing the
found with that of a fimilar percuffion on other parts of the
bowels : but towards the end of fevers and efpecially in the
puerperal fever, a diftention of the abdomen by air is generally
a fatal fymptom, though the eafe, and often cheerfulnefs of the
patient, vainly flatters the attendants.

M. M. In the former cafe a clyfter-pipe unarmed may be in-
troduced, and left fome time in the reftum, to take off the re-
fiftance of the fphincter, and thus difcharge the air, as it is pro-
duced from the fermenting or putrefying aliment. For this
purpofe, in a difeafe fomewhat fimilar in horfes, a perforation is
made into the rectum on one fide of the fphincter •, through
which fiftula the air, which is produced in fuch great excefs
from the quantity of vegetable food which they take, when their
digeftions are impaired, is perpetually evacuated. In both cafes
alfo, balfams, effential oil, fpice, bandage on the abdomen, and,
to prevent the fermentation of the aliment, acid of vitriol, faliva.
See Clafs I. 2. 4. 5.

10. Hypochondriacs. The hypochondriac difeafe confifts in
indigeftion and confequent flatulency, with anxiety or want of
pleaiurable fenfation. When the action of the ftomach and
bowels is impaired, much gas becomes generated by the ferment-
ing or putrefcent aliment, and to this indigeftion is catenated
languor, coldnefs of the ikin, and fear. For when the extremi-
ties are cold for too long a time in fome weak conftitutions, indi-
geftion is produced by direct fympathy of the fkin and the ftom-
ach, with confequent heartburn, and flatulency. The fame oc-
curs, if the Ikin be made cold by fear, as in riding over dan-
gerous roads in winter, and hence converfely fear is produced
by indigeftion or torpor of the ftomach by affociation.

This difeafe is confounded with the fear of death, which is
an infamty, and therefore of a totally different nature. It is al-
fo confounded with the hyfteric difeafe, which confifts in the

retrograde

• ss I. 2. 4. 1 1. OF IRRITATION. 113

••£rade motions of the alimentary canal, and of fome parts of
the abforbent fyiteivi.

liypochondriafis, like chlorofis, is fometimes attended
with very quick pulfe j which the patient feems to bear fo eaii-
ly in theie two maladies, that if any accidental cough attends
them, they may be miitaken for pulmonary confumption ; which
is not owing primarily to the debility of the heart, but to ics di-
rect fympathy with the actions of the ilomach.

M. M. Blifter. A philer of Burgundy pitch on the abdo-
men. Opium a grain twice a day. .Rhubarb fix grains every
night. Bark. Steel. Spice. Bath-water. Siefta, or fleep
after dinner. Uniform hours of meals. No liquor (tronger
than fmall beer, or wine and water. Gentle exercife on horfe-
back in the open air uniformly perfifted in. See Cardialgia, I.

2. 4- 5-

ii. Cephaltta idiopathica. Head-achs, which are attended
with inflammation, are termed phrenitis, defcribed in Clafs II.
i. 2. 3. Thofe, which are not attended with inflammation,
may be divided into fuch as affect the whole head, to which the
word cephalsea is applied, and into fuch as affect one fide of the
head only at a time, which is termed hemkrania. The former
of thefe may be divided into cephalaea idiopathica, and cephalxa
fympathetica ; and the latter into hemkrania idiopathica, and
hemkrania fympathetica. Befides thefe there exifts a cephalsea
fomniofa, a eephafaea fyphilitica, and a cephalxa hydropica.

The idiopathic head-ach frequently attends the cold paroxyfm
of intermittents j afflicts inebriates the day after intoxication ;
and many people who remain too long in the cold bath. In all
which cafes there is a general inaction of the whole fyftem, and
as thefe membranes about the head have been more expofed to
the variations of heat and cold of the atmofphere, they are more
liable to become affected fo far as to produce fenfation, than
cr membranes ; which are ufually covered either with clothes,
or with mufcles, as mentioned in Sect. XXXIII. 2. 10.

The promptitude of the membranes about the fcalp to fym-
pathize with thofe of other parts of the fyftem is fo great, that
this cephalaea without fever, or quicknefs of pulfe, is more fre-
quently a fecondary than a primary difeafe, and then belongs to
Clafs IV. 2. 2. 7. The hemkrania, or partial head-ach, I be-
li-eve to be almoft always a difeafe from aJTojciation ; though it
is not impoffible, but a perfon may take cold on one fide of the
Lead only. As fome people by fitting always on the fame fide
of the fire in winter are liable to render one fide more tender
than the other, and in confequence more fubject to pains, which
have been erroneoufly termed rheumatic.

VOL. II, M. M. The

1 14 DISEASES CLASS L 2. 4. i * <

M. M. The method of cure confifls in rendering the habit
more robuft, by gentle conftant exercife in the open air, fleth
diet, fmall beer at meals with one glafs of wine, regular hours
of reft arid rifing, and of meals. The clothing about the head
fhould be warmer during fleep than in the day ; becaufe at that
time people are more liable to take cold ; that is, the membra-
nous parts of it are more liable to become torpid ; as explained
in SecL XVIII. 15. In refpecl to medicine, two drams of va-
lerian root in powder three or four times a day are recommend-
ed by Fordyce. The bark. Steel in moderate quantities. An
emetic. A blifter. Opium, half a grain twice a day. Decay-
ed teeth mould be extracted, particularly fuch as either ache or
are ufelefs. Cold bath between 60 and 70 degrees of heat.
Warm bath of 94 or 98 degrees every day for half an hour du-
ring a month. See Clafs IV. 2. 2. 7. and 8. and IV. 2. 4. 3.
A folution of arfenic, about the fixteenth part of a grain, is re-
ported to have great effecT: in this difeafe. It mould be taken
thrice a day, if it produces no griping or ficknefs, for two or
three weeks. A medicine of this kind is fold under the name
of taftelefs ague-drops ; but a more certain method of afcer-
taining the quantity is delivered in the preceding Materia Med-
ica, Art. IV. 2. 6. 8. Five grains of the powdered leaves of
Atropa Belladonna are recommended in fome foreign publica-
tion to be repeated once in two days, and are faid to be fuccefs-
ful in the dolor faciei, or hemicrania idiopathica.

Cephal<ea fomniofa. Head-ach from fleep. This difeafe has
not been defcribed,Ibelieve,by any writer, though it affects fome
invalids for years. After fome hours of fleep the patients are
afflicted with diftreffing dreams, and awake with pain of the.
head, which continues for fome time after they awake ; and fo
circumflanced furnifhes the diagnoftic fymptom of this fpecies of
cephalaea.

The paroxyfms or repetitions of many drfeafes are lbl>le ta
commence in fleep, fome from the increafe of fenfibility during-
ileep, as explained in Seel:. XVIII. 5. and 1 5 . of the firfi part of
this work, as thofe of fome epilepfies, of fome afthmas, and of
the gout. Other difeafes are liable to return during fleep from
the debility of the pulmonary circulation, or of pulmonary ab-
forption, as in fomnus interruptus, Clafs I. 2. I. 3. and in in-
cubus, or night-mare,. Clafs III. 2. I. 13. and in haemoptoe
venofa, Clafs I. 2. i. 9. and probably in the- humoral afthmaj
Clafs II. I. ,1,8.

The cephalaea fomniofa I fufpedl: to bear the fame analogy to
the hydrocephalus iuternus, as I believe the 'afthma humorale to
.bear to the anafarca pulmonum 5 and to confrft in this circum-

ftances

: ,- OF IRRITATION. 115

re, tint during fleep in the cephalxa fomniofa a temporary
•congeftion of fluid may occur in fome part of the brain, as a
permanent one occurs in the hydrocephalus internus •, in the
feme manner as I believe in the afthma humorale a temporary
congeflion of fluid occurs in fome part within the cheft, and a
permanent one in the anafarca of the lungs.

M. M. The patient mould fleep with his head raifed high
•en many pillows, and wear drawers to prevent his flipping down
in bed. 2. He fhould fleep on a hardifh bed, or mattrefs, to
prevent his fleeping too profoundly, cr too long together. 3.
Or he may be wakened, after having flept a certain number of
hours by an alarum clock. 4. Any carious teeth mould be ex-
traded, as the matter from putrid bones, fwallowed with the
faliva, weakens the fyftem by its effect on the ftomach. 5.
Twenty drops of faturated tincture of digitalis may be taken
twice or thrice a day for three or four weeks. 6. Half a grain
of opium and fix grains of rhubarb fhould be taken every night
for many weeks or months. 7. Oxygen gas may be refpired
daily for a time, till its£fFec"i can be known.

12. Hemifrania idiopatbica. This difeafeis defcribed by Sau-
vage, under the name of trifmus dolorificus, or tic douloureux, in
Clafs IV. ord. i. gen. 2. fpec. 14. of his elaborate work. But
the word trifmus is an improper name, as no fixed fpafm like the
locked jaw exifts in this malady, nor any flridor dentium, or con-
vulfion of the mufcles of the face, or trick, attends thefe patients
in the few cafes which I have witnefled, though this may poffi-
.-•ccur occafionally asthe confequence of difagreeable fenfation,
or to relieve it. I fuppofe the word tic douloureux is a vulgar
French exprefiion, like megrim in Englifh.

The caufe of this afflicting difeafe is yet unknown. As it
does not appear to fympathize with a difeafed tooth, like the he-
micrania fymparhetica, defcribed in Clafs IV. 2. 2. 8. I fuf-
pecl: the caufe to confift in a difeafed flate of the nerve itfelf, or
of its covering or theca, and to refemble the fciatica frigid?.,
mentioned below ; or to refemble fome of thofe pains, which are
•fucceeded or relieved by epileptic convulfions, defcribed in Clafs
III. i. i. 8. and that it thus differs from the hemicrania fym-
pathetica ; as in this the caufe of the difeafe, and the feat ef the
pain, exift in the fame place.

One cafe, which occurred to me long ago, of this difeafe, was
of an elderly gentleman, Mr. W. of Litchfield, who had long
loft all his teeth ; the pain began chiefly about the cheek-bone,
and extended fometimes to the ala of the nofe, and to other parts
of the face on the fame fide ; on examining the gums of the up-
per jaw, there was no fufpicion of any flump of a decayed tootb

remaining

1 1 6 DISEASES CLASS I. 2. 4. 1 2.

remaining in the alveolar procefles ; nor was there any reafon to
fufpect any difeafe of the maxillary finus. Whence this did not
appear to be any kind of fympathetic hemicrania. He was af-
flicted with it for many years till his death.

The cafe of Mr. B. a gentleman between 20 and 30 years of
age, whom I was lately concerned for, in this difeafe, is well
worthy a minute defcription ; I (hall therefore copy a letter, which
I wrote on his cafe to Mr. Cruikfhank, and an anfwer J receiv-
ed fome time after from his partner, Mr. Leigh Thomas, who I
hope will publifli the fuccefsful method of cure, with adapte4
prints.

To Mr. Cruikjbank.

Sir, Derby, Dec. 1798.

Mr. Bofworth, whofe cafe I wifh to remind you of, confulted
you fome time ago in London, and I believe that you then told
him, that his head-ach was owing to a difeafe of the third branch
of the fifth pair of nerves. He came under my care at Derby a
few weeks ago, and complained of much pain about the left
cheek-bone ; Ifufpe&ed the antrum maxillare might be difeafed,
and as the fecond of the dentes molares had then been lately ex-
tracted, I defired a perforation might be made into the antrum,
-which was done by Mr. Hadley, of this town, and kept open
for two or three days without advantage. Afterwards, by fric-
tion about the head and neck with mercurial unguent, he was
copioufly falivated for a few days, and had another tooth extract-
ed by his own defire, and had laftly an incifion made by Mr.
Hadley, fo as to divide the artery near the centre of the ear next
the cheek, hoping to divide a branch of the affected nerve, but
without fuccefs ; and internally, opiates in large quantity were
given, when the pain was exceedingly violent, the bark alfo was
ufed for a time in large Quantity without effect.

On attending, as much as I could, to his fenfations when in
pain, he feems to exprefs the commencement of the periods of
pain to exift about the part of the left cheek before the middle
of the ear ; and then draws his finger from thence to the fore
part of the lower jaw fometimes, and to the ala of the nofe on
that fide ; and at other times he draws his finger from the fame
part of the cheek before the ear upwards to the orbit of the eye,
and from thence downwards, a little way on the nofe ; and alfo
he complains of pain under his tongue on the fame fide. The
pain returns many times in an hour on fome days, and continues
many minutes, during which he feems to ilretch and exert hir
arms, and appears to have a tendency to epileptic actions ; am

his

CLASS I. 2. 4. 12. OF IRRITATION. 117

his life is thus miferable to himfelf, and uncomfortable for his
friends to witnefs.

I write this to you to beg that you will acquaint Mr. Bof-
worth, whether you think you could divide by incifion the dif-
tafcd nerve ; as he is willing to undergo fuch an operation, if
you think it practicable, as I believe it to be the only means,
which promiies to cure him ; and have therefore advifed him
again to apply to you ; and if you think this can be done with
eitect, he defigns to wait on you in London.

I am, fir, &c.

E. DARWIN.

The following anfwer of Mr. Leigh Thomas (hews the difeafe
to have exifted in every branch of the affected nerve.

Sir, Leicefter-fquarg) May> 1799.

About the middle of December laft, you did Mr. Cruikfhank
the favour to write him an accounj: of Mr. Bofworth, a young
gentleman, fome time under your care at Derby, with a painful
affection of the nerves of his face. The patient foon after carme
to town in a much worfe (late, than you defcribed him to be at
that time ; as the pain was extremely acute and almoft unremit-
ting, opiates, which he had been in the habit of taking occafion-
aliy, afforded him now little or no relief, though taken to the
quantity of fix tea-fpoonfuls of laudanum at a time. After pay-
ing every attention to the cafe, your fuggeftion of the neceffity
of dividing the difeafed nerve appeared obvious.

As the pain was felt more acute in the left ala of the nofe, and
the upper lip of the fame fide, we were induced to divide the
fecond branch of the fifth pair of nerves, as it pafles out at the in-
fraorbital foramen. He was inftantly relieved in the nofe and
lip ; but towards night the pain from the eye to the crown of
the head became more acute than ever. Two days after, we
were obliged to cut through the firft branch pailing out at the
fupra-orbital foramen ; this afforded him the like relief with the
firft. On the fame day the pain attacked, with great violence,
the lower lip on the left fide, and the chin ; this circumftance
induced the neceffity of dividing the third branch palling out at
the foramen mentale. During the whole period, from the firft
divifion of the nerves, he had frequent attacks of pain on the
fide of the tongue ; thcfe however difappeared on diviiion of the
laft nerve.

Mr. Cruikfhank performed the above operations, but being
particularly engaged at this time with lectures and other bufi-
nefs, he now gave up the cafe to my management. The patient
was evidently bettered by each operation ; (till the pain was very

fevere,

1 i * DISEASES CLASS I. 2. 4. z 2;

fevere, paffing from the ear under the zygoma towards the nofe
and mouth, and upwards round the orbit. This route proved
pretty clearly, that the portio dura of the auditory nerve was al-
fo affected ; at lead the uppermoft branch of the pes anferinus.
Before I proceeded to divide this, I was willing to try the effect of
arfenic internally, and he took it in fufficienc quantity to excite
naufea and vertigo, but without perceiving any good effeih

I could now truft only to the knife to alleviate his mifery, as
the pain round the orbit was become moft violent ; and therefore
intercepted the nerve by an incifion acrofs the fide of the nofe,
and alfo made fome fmalier incifions about the ala nafi. To di-
vide the great branch lying below the zygomatic procefs, I found
it neceffary to pafs the fcalpel through the maffeter mufcle, till
it came in contact with the jaw-bone, and then to cut upwards 5
this relieved him as ufual. Then the lower branch was affect-
ed, and alfo divided : then the middle branch running under the
parotid gland. In cutting this, the gland was confequently di-
vided into two equal parts, and healed tolerably well after a co-
pious difcharge of faliva for feveral days.

I hoped and expected, that this laft operation would have ter-
minated his fufferings and my difficulties ; but the pain ftill af-
fected the lower lip and fide of the nofe, and upon coughing, or
fwallowing, his mifery was dreadful. This pain could only arife
from branches from the fecond of the fifth pair paffing into the
cheek, and lying between the pterygoideus internus mufcle, and
the upper part of the lower jaw. The fituation of this nerve
rendered the operation hazardous, but after fome attempts it
was accompli flied, and this day hefet out for Leicefterfhire per*
fectly reftored.

I am, fir, &c.

LEIGH THOMAS,

Since I wrote the above, I have feen an equally deplorable and
inflructive cafe, of hemicrania idiopathica, of an elderly perfon,
defcribed by Dr. Haighton, under the name of tic douloureux,
with an equally fuccefsful cure, by dividing the difeafed nerves.
Medical Records and Refearches. Cox, London.

Two cafes of tic douloureux are related by a Dr. Watfon, in
the Recueil periodique de Medecine, Paris, 1798, torn. IV.
which are faid to have fubmitted to mercurial frictions and warm
bathing. Thefe pains were probably venereal fymptoms, as the
author fufpccts ; but would perfuade us again to try the ufe of
mercury, though itfaibd in the cife above related, and efpecially
:is it fometimes fucceeih in the hemicrania fympathetica, as men-
tioned in Clafs IV. 2. 2. 8. Five grains of the powdered leaf of

belladonna

CLASS I. 2, 4. 13. OF IRRITATION. 1 19

belladonna are faid to have been fuccefsful. See Cephalsea idio.
pathica.

13. Odontalgia. Tooth-ach. The pain has been erroneoufly
fuppoled, where there is no inflammation, to be owing to fome
acrid matter from a carious tootli ftimulating the membrane of
the alveolar procefs into violent action and confequent pain ;
but the effect Teems to have been miftaken for the caufe, and
the decay of the tooth to have been occafioned by the torpor
and confequent pain of the diieafed membrane.

Firft, becaufe the pain precedes the decay of the tooth in re-
gard to time, and is liable to recur, frequently for years, without
certainly being fucceeded at laft by a carious tooth, as I have
repeatedly obferved.

Secondly, becaufe any ftimulant drug, as pyrethrum, or oil of
cloves, applied to the tooth, or ether applied externally to the
cheek, is fo far from increasing the pain, as it would do if the
pained membrane already acted too ftrongly, that it frequently
gives immediate relief like a charm.

And thirdly, becaufe the torpor, or deficient action of the
Kiembrane, which includes the difeafed tooth, occafions the mo-
tions" of the membranes moil connected with it, as thofe of the
cheek and temples, to act with lefs than their natural energy ;
and hence a coldnefs of the cheek is perceived eafily by the hand
of the patient, comparing it with the other cheek ; and the pain
of hemicrania is often produced in the temple of the affected fide.
This coldnefs of the cheek in common tooth-ach evinces, that
the pain is not then caufed by inflammation ; becaufe in all in-
ilimnuuions fo much heat is produced in the fecretions of new
Is and fluids, as to give heat to the parts in the vicinity.
And hence, as foon as the gum fwells and inflames along with
the cheek, heat ij produced, and the pain ceafes, owing to the
increafed exertions of the torpid membrane, excited by the ac-
tivity of the fenibrial power of fenfation ; which previoufly exift-
ed in its pafiive flute in the painful torpid membrane. See
Odontitis, Ciais II, 1.4. 7. and IV. 2. 2. 8.

M. M. If the painful tooth be found, venefection. Then a
cathartic. Afterwards two grains of opium. Camphor and
opium, one grain of each held in the rnou:h ; or a drop or two
o.;: oil of cloves put on the painful tooth. Ether. If the tooth
imall hole in it, this fhould be widened within by eu. inUru-
nient, and then (lopped with leaf-gold, or leaf-lead ; but the truth
ihould be extracted, if much decayed. It is probable that half a
drop of a ilrong folution of arfenic, put carefully into the
hollow of a decayed aching tooth, would deilvoy the nerve with-
out giving any additional pain : but this experiment requires

great

12© DISEASES CLASS I. 2. 4. 13.

great caution left any of the folution fhould touch the tongue or
gums.

Much cold and much heat are equally injurious to the teeth,
which are endued with a fine fenfation of this univerfal fluid.
The beft method of preferving them is by the daily ufe of a brufh,
which is not very hard, with warm water and fine charcoal dud.
A lump of charcoal mould be put a fecond time into the fire till
it is red hot, as foon as it becomes cool the external afhes mould
be blown off, and it fhould be immediately reduced to fine pow-
der in a mortar, and kept clofe (topped in a phial. It takes away
the bad fmell from decayed teeth, by warning the mouth with
this powder difFufed in water, immediately. The putrid fmell
of decaying (lumps of teeth may be deflroyed for a time by warn-
ing the mouth with a weak folution of alum in water. If the
calcareous cruft upon the teeth adheres very firmly, a fine pow-
der of pumice-ftone may be ufed occafionally, or a tooth-inftru-
ment.

Acid of fea-falt, much diluted, may be ufed j but this very
rarely, and with the greateft caution, as in cleaning fea-fhells.
When the gums are fpongy, they mould be frequently pricked
with a lancet. Should black fpots in teeth be cut out ? Does
the enamel grow again when it has been perforated or abraded ?

Qtalgia. Ear-ach fometimes continues many days without ap-
parent inflammation, and is then frequently removed by filling
the ear with laudanum, or with ether ; or even with warm oil,
or warm water. See Clafs II. I. 4. 8. This pain of the ear,
like hemicrania, is frequently the confequence of aflbciation with
•a difeafed tooth •, in that cafe the ether mould be applied to the
cheek over the fufpecled tooth, or a grain of opium and as much
camphor mixed together, and applied to the fufpected tooth. In
this cafe the otalgia belongs to the fourth clafs of difeafes.

14. Pleurodyne chronica. Chronical pain of the fide. Pains
of the membranous parts, which are not attended with fever,
have acquired the general name of rheumatic ; which fhould,
neverthelefs, be reflricted to thofe pains which exifl only when
the parts are in motion, and which have been left after inflam-
mation of them ; as defcribed in Clafs I. I. 3. 12. The pain of
the fide here mentioned affects many ladies, and may poilibly
have been owing to the prefTure of tight (lays, which has weak-
ened the action of the veflels compofing fome membranous part,
us, like the cold head-ach, it is attended with prefent debility ;
in one patient, a boy about ten years old, it wa^ attended with
daily convulfions, and was fuppofed to have originated from
worms. The difeafe^is very frequent, and generally withftands
the ufe of bliflers on the part ; but in fome cafes I have known

it

CLASS I. 2. 4. 14. OF IRRITATION. i.-r

:noved b; rks repeated every day fora

ugh the atTec"led i',

•:is of rhe fide may be fometimes occasioned by the adhe-
fion of the lungs to the 'pie,. an inlla

• the aclhefioa of fome abdominal vifcera to their cavity, or
to each other; which alfo are iu!>re liable to aire-il ladies from
the unnatural and Ungraceful preflure of tight itays, or by fil
'or lying too long in one po'iture. But in theic cafes the pain
fiioukl be more of the im art ing, than of the dull kind.

M. M. Ether. A Milter. A plaller of Burgundy pitch.
An iifue or feton on the part. Electric i'hoeks. Fridion on
the part with oil and camphor. Loole drefs. Frequent ch.m ^
of poflure both in the day and night. Internally, opium, vaj»-
rian, bark.

15. SciitL-a jrigidfi. Cold fciatica. The pain along the
courfe of the fciatic nerve, from the hip quite down to the top
of the foot, when it is not attended with fever, u improperly
termed either rhetimatifm or gout •, as it occurs without inilani-
rnation, is attended with pain when the limb is at reft ; and as
the pain attends the courfe of the nerve, and not the courfe of
the mufcles, or of the fafcia which contains them. The theory
of Cotunnius, who believed it to be a dropfy of the (heath of the
nerve, which was compreiTed by the accumulated fluid, Ins not
been confirmed by difleclion. The dileafe ieems to coniiil of a
torpor of this fheath of the nerve, and the pain ieems (o be in
confequence of this torpor. Sse Clafs II. 1.2. 17.

IvI. M. Venefe£tioii. A cathartic. And then one grain of
calomel and one of opium every night for ten fucceil^ve nights.
And a blilter, at the fame time, a little above the knee- joint on
the outfide of the thigh, where the fciatic nerve is nol

.1. Warm bath. Cold bath. Cover the limb with -
iilk, or with a plafter-bandage ofempladrum de mi:ii:).

1 6. Lumbago frigida. Cold lumbago. Yv'hen no fever or
inflammation attends this pain of the loins, and tiie pain exiits
without motion, it belongs to this genus of difeaies, and TV

die pain of the loins in the cold (it of ague. As th.
branes are extenfive, and more eafily fall into qu'u- iher

by fympathy, or wlien they are primarily affecled, th-
becomes yery afflicling, and of great per. ifs II.

I. 2. I?.

M. M. Venefecl:ion. A cathartic. IfTues on the Icins.
five plafter fp the loins. Blifter on the c urn,

bath. Cold bath. Remove to a warmer climate in the v/incer.

x>ut the waiil. Fri-ftioii daily wl-:i:
r-!ior.

VOL. II. R 1. H-^-aliih

1 2 2 DISEASES CLASS I. 2. 4. 1 7,

i 7, Hyjlerdlgia frigida. Cold pain of the uterus preceding or
accompanying menftruation. It is attended with cold extremi-
ties, want of appetite, and other marks of general debility.

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

1 8. Protf algia frigida. Cold pain at the bottom of the rec-
tum previous to the tumor of the piles, which fometimes extends
by fympathy to the loins ; it feems to be fimilar to the pain at
the beginning of menftruation, and is owing to the torpor or
inirritability of the extremity of the alimentary, canal, or to the
obftru£tion of the blood in its paflage through the liver, when
that vifcus is afFefted, and its confequent delay in the veins of
the rectum, occafioning tumours of them, and dull fenfations of
pain.

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

19. Vefica fdlex inirritabilitas. The inirritability of the gall-
bladder probably occafions one kind of icterus , or i^undice ;
which is owing to whatever obftructs the paflage of bile into the
duodenum. The jaundice of aged people, and which attends
fome fevers, is believed to be moft frequently caufed by an irri-
tative palfy of the gall-bladder; on^Khich account the bile is
not prefled from the cyil by its contraction, as in a paralyfis of
the urinary bladder.

A thickening of the coats of the common bile-duct by inflami-
ination or increafed action of their vefTels fo as to prevent the
paflage of the bile into the inteftine, in the fame manner as the
membrane, which lines the noftrils, becomes thickened in ca-
tarrh fo as to prevent the paflage of air through them, is proba-
bly another frequent caufe of jaundice, efpecially of children;
and generally ceafes in about a fortnight, like a. common catarrh,
without the aid of medicine ; which has given rife to the char-
acter, which charms have obtained in fome countries for curing
the jaundice of young people.

The fpiffitude of the bile is another caufe of jaundice, as men-
tioned in Ciafs I. r. 3. 8. This alfo in children is a difeafe of
little danger, as the gall-ducts are diilenfible, and will the eafier
admit of the exclufion of gall-ftones ; but becomes a more feri-
ous difeafe in proportion to the age of the patient, and his habits
of life in refpect to fpirituous potation.

A fourth caufe of jaundice is the compreflion of the bile-duct
by the enlargement of an inflamed or fcirrhous liver j this attends

thofe

CLASS I. 2. 4. 20. OF IRRITATION. 123

thofe who have drunk much fpirituous liquor, and is generally
fucceeded by dropiy and death.

M. M. Repeated emetics. Mild cathartics. Warm bath.
Electricity. Bitters. Then lieel, which, when the pain and
inflammation are removed by evacuations, a£ts like a charm in
removing the remainder of the inflammation, and by promoting
the abforption of the new veflels or fluids ; like the application
of any acrid eye-water at the end of ophthalmia ; and thus the
thickened coats of the bile-daft become reduced, or the enlarge-
ment of the liver leflened, and a free paiTige is again opened for
the bile into the inteftine. Ether with yolk of egg is recom-
mended, as having a tendency to diflblve infpiflated hile. And
a decoction of madder is recommended for the fame purpofe ;
bscaufe the bile of animals, whofe food was mixed with madder,
ound always in a dilute flate. Aerated alkaline water, or
Seltzer" water. Raw cabbage, and other acrid vegetables, as
\vatcr-cr jfles, muftard. Horfes are faid to be fubject to infpif-
fked bile, with yellow eyes, in the winter feafon, and to get vv.eii
as Toon as they feed on the fpring grafs.

The largeft bile-ftone I have feen was from a lady, who had
parted with it fome years before, and who had abilained above
ten years from all kinds of vegetable diet to prevent, as the
fuppofed, a colic of her ftomach, which was probably a pain
of the biliary duct ; on reluming the ufe of fome vegetable diet,
{he recovered a better ftate of health, and formed no new bilious
concretions.

A ftrong aerated alkaline water is fold by J. Schweppe, No.
8, King-ftreet, Holborn. See Clafs I. I. 3. 10.

20. Pelvis renalis inirritabilitas . Inirritability of the pelvis
of the kidney. When the nucleus of a (tone, whether it be in-
fpiflated mucus, or other matter, is formed in the extremity of
any of the tubuli uriniferi, and being detached from thence falls
into the pelvis of the kidney, it is liable to lodge there from the
want of due irritability of the membrane ; and in that fituation
increafes by new apportions of indurated animal matter, in tli2
fame manner as the ftone of the bladder. This is the general
caufe of haemorrhage from the kidney ; and of obtufe pain in it
on exercife ; or of acute pain, when the (lone advances into thr
ureter. See Clafs I. i. 3. 9.

ORDO

1 24 DISEASES ,Ci-A3s I. 2. 5. i.

ORDO II.

Decreased Irritation.

GENUS V.

Decreafed A&icn of the Organs of Scnfc.
SPECIES.

I. Stxhittainirritabititaf. Folly from inirritability. Dulneu
of perception. When the motions of the fibrous extremities
of the nerves of fenfe are too weak, to excite fenfation with fuf-
ficient quicknefs and vigour. The irritative ideas are neverthe-
performed, thongli perhaps in a feeble manner, as fuch peo-
ple do not run againtl a poft, or walk into a well. There are
three other kinds of folly ; that from deficient fenfation, from
deficient volition, and from deficient affociation, as will be men-
tioned in their places. In delirium, reverie,and fleep, the pow-
er of perception is abolifhed from other caufes.

2. Vifus hnwinutus. Diminifhed vifion. In our approach to
old age our viilon becomes imperfect, not only from the. form cf
the cornea, which becomes lefs convex, and from' its decreafed
tranfparency mentioned in Clafs I. I. 3. 14 ; but alfo from the
decreafed irritability of the optic nerve. Thus, in the inirritative
or nervous fever, the pupil of the eye becomes dilated ; which in
this, as well as in the dropfy of the brain, is generally a fatal
iyinptom. A part of the cornea as well as a part of the albugi-
iiea in thefe fevers is frequently feen during fleep , which is ow-
ing to the inirfitability of the retina to light, ov to the general
parefis of mufcylar aQion, and in confeqence to the lefs contrac-
tion of the fphincter pf the eye, if it may be fo called, at that
time.

In fome eyes there is an inaptitude to adapt themfelves t
the perception of objects at different diftarices, which I fuppofe
may be owing to the inirritability of thofe mufcular fibres, which
conftitute the ciliary procefs, fo well defcribed and explained by
Dr. Porter field, afcd in the Scots Medical EiTays, and fo elegany-
ly feen in a differed eye. It was formerly believed, and has in-
deed lately been again pretended, that the focus of the cryftal--
1'ine humour was adapted to objects at different diftances by a
change of the fhape of the whole eye by the action of the exter-
nal mufcles, which are inferted into the tunica albuginea, and
j_;ive motion to it in every direction : but in an f ' is may be

obferved|

CI.ASS I. 2. 5. 3. OF IRRITATION. 125

oofen ' common afHons of the mufcles affected the

focus of the eye, every motion of the eye-ball, when we attend
to objects at any diflance, mud diilurb our vifion. At the fame
time though it is pofiible, that a violent action of ail the mufcles
together, fo as to counter-balance each other, and keep the eye
motionlefs, as when we look painfully at a very diftant object,
may in fome degree afreet the form of it ; yet that the contrac-
tion of the ciliary procefs perpetually adapts the focus of the cryf-
talliiie lens to the diftance of the retina is not to be difputed.

There have bcen.inftances of fome, who could not diftinguifii
certain colours ; and yet \\hcfe eyes, in other refpecls, were not
imperfect. Philof. Traufact. Which feems to have been
owing to the want of irritability , .or the inaptitude to action, of
fome clafles of fibres which compofe the retina. Other perma-
nent defects depend on the difeaied ftate of the external organ,
i. i. 3. 14. 1. 2. 2. 13. IV. 2. i. n.

3. MnfLiE wiitantes. Dark fpots appearing before the eyes,
and changing their apparent place with the motions of the eyes,
are owing to a temporary defect of irritability of thole parts of
jthe retina, which have been lately expofed to more luminous ob-
jects than the other parts of it, as explained in Seel. XL. 2.
Hence dark fpots are feen cm the bed-clothes by patients, when
the optic nerve is become lefs irritable, as in fevers with great
debility j and the patients are perpetually trying to pick them off
with their fingers to difcover what they are ; for thefe parts of
the retina of weak people are fooner exuaufted by the ftimulus
of bright colours, and are longer in regaining their irritability.

Other kinds of ocular fpectra, as the coloured ones, are alfo
more liable to remain in the eyes of people debilitated by fevers,
and to produce various hallucinations of fight. For after the
contraction of a mufcle, the fibres of it continue in the kft fitu-
ation, till fome antagonift mufcles are exerted to retract them ;
whence, when any one is much exhaufted by exercife, or by want
of deep, or in fevers, it is eafier to let the fibres of the retina re-
main in their lad fituation, after having been ftimulated into
contraction, than to exert any^antagoniit fibres to replace them.

As the optic nerves at their entrance into the eyes are each of
th,em as thick as a crow-quill, it appears that a great quantity of
fenforial power is expended during the day in the perpetual ac-
tivity of our fenfe of viiion, befides that ufed in the motions of
the eye-balls and eye-lids ; as much I fuppofe as is expended in
the motions of our arms, which are fupplied with nerve ; of
about the fame diameters. From hence we may conclude, that
the" light fhould be kept ,rom patients in fevers with debility, to
prevent the unneceifary exh ; of the fenfcvial power.

And

126 DISEASES CLASS I. 2. $. 4.

And that on the fame account their rooms fhould be kept filent
as well as dark j that they ihould be at reft in a horizontal pof-
ttire ; and be cooled by a blaft of cool air, or by wafhing them
with cold water, whenever their fkins are warmer than natural.

4. Strabifmus. Squinting is generally owing to one eye be-
ing lefs perfect than the other ; on which account the patient
endeavours to hide the worft eye in the fhadow of the nofe, that
his vilion by the other may not be confufed. Calves which
have an hydatide with infects inclofed. in it in the frontal finus
on one fide, turn towards the affected fide j becaufe the vifion
on that fide, by the preflure of the hydatide, becomes lefs per-
fect ; and the difeafe being recent, the animal turns round, ex-
pecting to get a more diftinct view of objects.

In the hydrocephalus internus, where both eyes are not be-
come infenfible, the patient fquints with only one eye, and views
objects with the other, as in common ftrabifmus. In this cafe
it may be known on which fide the difeafe exifts, and that it
does not exift on both fides of the brain ; in fuch circumstances,
as the patients I believe never recover as they are now treated,
might it not be advifeable to perforate the cranium over the ven-
tricule of the affected fide ? which might at lead give room and
ilimulus to the affected part of the brain ?

M. M. If the fquinting has not been confirmed by long habit,
and one eye be not much worfe than the other, a piece of
gauze flretched on a circle of whale-bone, to cover the beft eye
in fuch a manner as to reduce the diftinctnefs of vifion of this
eye to a fimilar degree of imperfection with the other, fhould be
•worn fome hours every day. Or the better eye ihould be total-
ly darkened by a tin cup covered with black filk for fome hours
daily, by which means the better eye will be gradually weak-
ened by the want of life, and the worfe eye will be gradually
ilrengtheried by ufing it. Covering an inflamed eye in chil-
dren for weeks together, is very liable to produce fquinting, for
the fame reafon.

5. Amaurofis. Guttaferena. Is a blindnefs from the inirritabil-
ity of the optic nerve. It is generally efteemed a palfy of the nerve,
but fhpuld rather be deemed the death of it, as paralyfis has gener*
ally been applied to a deprivation only of voluntary power. This
is a difeafe of dark eyes only, as the cataract is a difeafe of light
eyes only. At the commencement of this difeafe, very minute
electric fhocks mould be repeatedly paffed through the eyes ; fuch
as may be produced by putting one edge of a piece of filver the
fize of a half crown piece beneath the tongue, and one edge of a
piece of zinc of a fimilar fize between the upper lip and the gum,

and

CLASS I. 2. 5. 6. OF IRRITATION. 1 27

and then repeatedly bringing their exterior edges into contact,
by which means very fmall eleftric fparks become vifible in the
eyes.

Mrs. T had for fome weeks complained of imperfect

fight. For the laft fortnight lhe could not in lefs than a minute
fpell out a fingle word in a large print. Her eyes black, and the
pupils large. Very flight electric (hocks, not fparks, were pafled
through the forepart of her forehead twice a day, and the zinc
and filver pencils as mentioned below were ufed many times a
day. iShe took valerian and columbo internally, and regained her
fight very perfectly in about three weeks.

I ufed in the above cafe a more convenient and efficacious
method of galvanifm by employing two rods, one of them of zinc
about the fize of a writing pencil, and the other a filver pencil-
cafe about the fame (ize ; and by putting the end of the zinc
rod in contact with the external corner of one eye, and the end
of the filver pencil-cafe in contacl; with the external corner of the
other eye, and then repeatedly making the other ends touch each
other ; fparks will be vifible in the eyes both at the time of con-
tacl: and at the time of feparation of the two rods. This experi-
ment was publifhed by Volta fince the former one by Galvani.
See Sea. XIV. 5. of Vol. I.

A foreign phyfician, proferTor Arnemann, has lately recom-
mended the production of vertigo in gutta ferena, as he fays, to
accumulate more blood in the head. If this mould be really
found of advantage the patient might lie on a large mill-done,,
which might be fuffered to turn flowly, but a very great velocity
of the whirling ftone might occafion ileep, apoplexy, and death.
See Supl. I. 15. 7.

M. M. Minute electric mocks. A grain of opium, and a
quarter of a grain of corrofive fublimate of mercury, twice a day
for four or fix weeks. Blifter on the crown of the head. Er-
rhines, fo as to induce violent fneezing. twice a day for a week.

6. Audltus itnmiiiutus. Diminifhed hearing. Deafnefs is a
frequent fymptom in thofe inflammatory or fenfitive fevers with
debility, which are generally called putrid ; it attends the general
ftupor in thofe fevers, and is rather efteemed a falutary fign, as
during this ftupor there is lefs expenditure of fenforial power.

In fevers of debility without inflammation, called nervous fe-
vers, I fufpecl: cleafnefs to be a bad fymptom, arifing, like the di-
lated pupil, from a partial paralyfis of the nerve of fenfe. Sec
ClnfslV.2. i. 15. '

Nervous fevers are fuppofed by Dr. Gilchrift to originate from
a congeftion of ferum or water in feme part of the brain, as many
of the fymptoms are fo fimilar to thofe of hydrocephalus inter-

128 DISEASES CLASS I. 2. 5. 6.

nus, in which a fluid is accumulated in the ventricles of the
brain ; on this idea the inactivity of the optic or auditory nerves
in thefe fevers may arife from the compreffion of the efFufed llukl ;
While the torpor attending putrid fever may depend on the me-
ninges of the brain being thickened by inflammation, and thus
compreliing it ; now the new veflels, or the blood, which thick-
ens inflamed parrs^ is more frequently re-abforbed, than the ef-
fufed fluid from a cavity ; and hence the ftupor in one cafe is
lefs dangerous than in the other.

In inflammatory or fenfitive fevers with debility, deafnefs may1
fometimes arife from a greater fecretioil and abforption of the
ear-wax, which is very firnilar to the bile, and is liable to fill the
meatus auditorius, when it is too vifcid, as bile obftrucls the gall-
duels.

M. M. In deafnefs without fever, Dr. Darwin applied a cup-
ping-glafs on the ea'r with good effecfl, as defcribed in Phil.
Tranf. Vol. LXIV. p. 348. Oil, ether, laudanum, dropped into
the ears. Errhines. Ele£r.ricity.

If ether when dropped into the ears be not very pure, it is lia-
ble to give pain ; it has otherwife the property both of diflblvirig
the ear-wax, and of Simulating torpid parts into their accuftom-
ed activity, as is known from its relieving pains from inactivity
of the pained part, as tooth-ach and head-ach. If unredlifiedr
ether be dirtilled from the oxyde of manganefe, the oxygen dif--
engaged from the manganefe is afierted to convert the fulphurous
into fulphuric acid, which is then not difpofed to rife in diltilla-
tion. Journal de Phyfique, April, 1 798. And that this is the
great fecret of procuring pure ether, and it will then give no pain
on being dropped into the ear. See Art. II. 2. 3.

Deafnefs is believed fometimes to arife from obflruclion of the
Euftachian tubes, which communicate from the fauces to the in-
ternal ear behind the tympanum ; if this obftruclion be llight, as
by infpiffated mucus, it has been propoied to inject the Eufla-
chian tubes ; and it is faid, that if the deaf perfon frequently
has recourfe to the fimple action of fhutting his mouth and of
clofing his noilrils by pinching them together with his finger and
thumb, and then forcibly endeavours to prefs the breath through
his nofe, that air will pafs into the internal ear through the Eu-
ftachian tubes, condenfing that air which exifls behind the tym-
panum ; which the patient will himfelf be fenfible of, by a fen-
fation of found in his ears. And that this has relieved many.

Where an eruption occurs in the ear, followed by a dry fcale
®r fcab at the bottom of the meatus auditorius, a foliation of
corrofive fublimate of mercury, hydfargyrus muriatus, about, one
grain to an ounce of water, dropped into the ear, frequently has

been

CLA 7 OF IRRITATION. 129

ufed with advantage by Dr. Darwin of Shrewibury. See
IV. 2. i. 15.

7. Qlfaclus imminutus. Inactivity of the fenfe of fmell.
i our habits of trufting to the art of cookery, and not exam-
ining our iocd by the fmell as other animals do, our fen
fmell is lefs perfect than theirs. See Sett. XVI. 5. Gab i V . z.
i. 16.

M. M. Mild errhines.

8. Guftus imminutus. Want of tafte is very common in fevers,
owing frequently to the drynefs or fcurf of the tongue, or exter-
nal organ of that fenfe, rather than to any injury of the nerves of
taire. See Clafs I. i. 3. i.lV. 2. i. 16.

M. M. Warm fubacid liquids taken frequently.

9. Tafius imminutus. Numbnefs is frequently complained of
in fevers, and in epilepfy, and the toilch is fometimes impaired
by the drynefs of the cuticle of the fingers. See Clafs IV. 2. i . 16.

When the fenfe of touch is impaired by the compreilion of the
nerve, as in fitting long with one thigh croffed over the other,
the linlb appears larger, when we touch it with our hands,
which is to be afcribed to the indiltinctnefs of the fenfation of
touch, and may be explained in the fame manner as the appar-
ent largenefs of objects feen through a milt. In this laft cafe
the minute parts of an object, as iuppofe of a diitant boy, are
feen lefs diftinctly, and therefore we infiantly conceive them to
be further from the eye, and in coniequence that the whole fub-
tends a larger angle, and thus we believe the boy to be a man.
»So when any one's fingers are preiTed on a benumbed limb, the
fenfation produced is lefs" than it mould be, judging from vifible
ciicumftances ; we therefore conceive, that fomething interve-
ned between the object and the fenfe, for it is felt as if a blank-
et wasv put between them; and that not b^ing vifibiy the .
\ve judge that the limb is fwelled.

The fenfe of touch is alfo liable to be deceived from the ac-
quired habits of one part of it acting in the vicinity of another
part of it. Thus if the middle finger be crofted over either of
the fingers next to it, and a nut be felt by the two ends of the
fingers Ib croiTed at the fame time, the nut appears as if iL was
two nuts. And Jaftly, the fenfe of touch is liable to be deceived
by preconceived ideas j which we believe to be excited by exter-
nal objects, even when we are awake. It has happened to n-c
more than once, and I fuppoie to rnoft others, to have put my
hands into an empty bafon, (landing in an obfcure corner of a
loom, to warn them, which I believed to contain cold water, ami
haveinftantly perceived a fenfaiion of waniuli, cuiifi-ary to th.it
which I expected to have felt.

VOL. II. S la

13° DISEASES GLASS 1. 2. 5. 10,

In fome paralytic affections, and in cold fits of ague, the fen-
fation of touch has been much impaired, and yet that of heat has
remained. See Seel. XIV. 6.

M. M. Friaion alone, or with camphorated oil, warm bath.
Ether. Volatile alkali and water. Internally, fpice, fait. In-
citantia. Secernentia.

lo. Stupor. The ftupor, which occurs in fevers with debili-
ty, is generally efteemed a favourable fymptom ; which may arife
from the lefs expenditure of fenforial power already exifting in
the brain and nerves, as mentioned in fpecies 6 of this genus.
But if we fuppofe, that there is a continued production of fen-
forial power, or an accumulation of it in the torpid parts of the
fyftem, which is not improbable, becaufe fuch a production cf
it continues during fleep, to which flupor is much allied, there
is ftill further reafon for believing it to be a favourable fymptom
in inirritable fevers ; and that much injury it often done by
blifters and other powerful ftimuli to remove the ftupor. See
Seel:. XII. 7. 8. and XXXIII. i. 4.

Dr. Blane, in his Croonian Lecture on mufcular motion, for
1788, among many other ingenious obfervations and deductions,
relates a curious experiment on falmon, and other fifh, and which
he repeated upon eels with limilar event.

" If a fiih, immediately upon being taken out of the water, is
ftunned by a violent blow on the head, or by having the head
crufhcd, the irritability and fweetnefs of the mufcles will be pre-
ferved much longer, than if it had been allowed to die with the
organs of fenfe entire. This is fo well known to nfhermen,
that they put it in practice, in order to make them longer fufcep-
tible of the operation called crimping. A falmon is one of the
fiih leaft tenacious of life, infornuch, that it will lofe all figns of
life in lefs than half an hour after it is taken out of the water, if
fuffered to die without any farther injury ; but if, immediately
after being caught, it receives a violent blow on the head, the
mufcles will fhew vifible irritability for more than twelve hours
afterwards.

Dr. Blane afterwards well remarks, that, u in thofe diforders
in which the exercife of the fenfes is in a great meafure deftroy-
ed, or fufpended, as in the hydrocephalus, and apoplectic palfy,
it happens, not uncommonly, that the appetite and degeftion are
better than in health."

CLASS!. 3. i. OF IRRITATION. 131

ORDO III.

Retrograde Irritative Motions.

GENUS I.
Of the Aliment dry CanaL

THE retrograde motions of our fyftern originate either from
.defect of ftiinulus, or from defeat of irritability. Thus ficknefs
is often induced by hunger, which is a want of ftimulus ; and
from ipecacuanha, in which lad cafe it would feem, that the
ficknefs was induced after the violence of die ftimulus was aba-
ted, and the confequent torpor had fucceeded. Hence, fpice,
opium, or food, relieves ficknefs.

The globus hyftericus, falivation, diabetes, and other inver-
fions of motion attending hyfteric paroxyfms, feem to depend
on the want of irritability of thofe parts of the body, became
they are attended with cold extremities, and general debility, and
are relieved by wine, opium, fteel, and fleih diet ; that is, by
any additional ftimulus.

When the longitudinal mufcles are fatigued by long action, or
are habitually weaker than natural, the antagonift mufcles re-
place the limb by ftretching it in a contrary direction ; and as
thefe mufcles have had their actions aflbciated in fynchronous
tribes, their actions ceafe together. But as the hollow mufcies
propel the fluids, which they contain, by motions aflbciated in
trains ; when one ring is fatigued from its too great debility, and
brought into retrograde action ; the next ring, and the next,
from its aflbciation in train falls into retrograde action. Which
continue fo long as they are excited to act, like the tremors of
the hands of infirm people, fo long as they endeavour to act.
Now as thefe hollow mufcles are perpetually (timulated, thefe
retrograde actions do not ceafe as the tremors of the longitudi-
nal mufcles, which are generally excited only by volition.
Whence the retrograde motions of hollow mufcles depend on
two circumflances, in which they differ from the longitudinal
mufcles, namely, their motions being aflbciated in trains, and
their being fubject to perpetual ftimulus. For further eluci-
dation of the caufe of this curious fource of difeafes, fee Sect.
XXIX. ii. 5.

The fluids difgorged by the retrograde motions of the various
vafcular mufcles maybe diftinguilhed, i. From thofe, which
are produced by fecretion, by their not being attended by increafe

nni

132 DISEASES CLASS!. 3.

of heat, which always accompanies increafed fecretion. 2. They
may be diftinguifhed from thofe fluids, which are the confe-
quence of deficient abforption, by their not poiTeiTmg the falin
acrimony, which thofe. fluids pofiefs j which inflames the {km. u
other membranes on which they fall ; and which have a ialine
tafte to the tongue. 3. They may >e diitinguifhed from thofe
fluids, which are the confequence both of increafed fecretion and
abforption, as thefe are attended with inCreafe of warmth, and
are infpiflated by the abftraction of their aqeous parts. 4.
Where chyle, or milk, is found in the feces or- urine, or when
other fluids, as matter, are tranflated from one part of the fyftem
to another, they have been the product of retrograde action of
lymphatic or other canals. As explained in Seel. XXIX. 8.

SPECIES.

T. Ruminatio. In the rumination of horned cattle the retro-
grade motions of the cefophagus are vifible to the eye, as they
bring up the foftened grafs from their firi't ftomach. The veg-
etable aliment in the firft ftomach of cattle, which have filled
themfelves too full of young clover, is liable to run into ferment-
ation, and diftend the ftomach, fo as to preclude its exit, ari<j
frequently to deftroy the animal. To difcharge this air the
farmers frequently make an opening into the ftomach of the
animal with fuccefs. I was informed, I believe by the late Dr.
Whytt of Edinburgh, that of twenty cows in this fituation two
had died, and that he directed a pint of gin or whiiky, mixed
with an equal quantity of water, to be given to the other eigh-
teen j-all of which erupted immenfe quantities of air, and recov-
ered.

There are hiftories of ruminating men, and who have taken
pleafure in the act of chewing their food a fecond time. Phi-
lof. Tranfaa.

2. Ruclus. Eructation. An inverted motion of the ftomach
excluding through its upper valve an elaftic vapour, generated
by the fermentation of the aliment ; which proceeds fo haftily,
that the digeitive power does not fubdue it. This is fometimes
acquired by habit, fo that fome people can eru6t when they pleale,
and as long 'as they pleafe ; and there is gas enough generated
to lupply them for this purpofe ; for by Dr. Hales's experiments,
an apple, and many other kinds of aliment, give up above fix
hundred times their own bulk of an eiaftic gas in fermentation.
When people voluntarily eject the fixable air from their ftom-
achs, the fermentation of the aliment proceeds the fafter ; for
flopping the ve{fels3 which contain new wines, retards their fer-

mentationj

CLASS I. 3. i. 3. OF IRRITATION. 133

1 opening them again accelerates it ; hence where

thsdi;>e!'Uon is impaired, and the ftomach fomewhat diftended

with air, it is hetter to reftrain than to encourage eructations,

^t the quantity makes it necefiary. When wine is confined

in bottles, the fermentation ftill proceeds flowly even for years,

till all the fugar is converted into fpirit ; but in the procefs oi

i< n, the faccharme part is abforbed in the form of chyle

by" the bibulous months' of the numerous lafteals, before it has

time to run into the vinous fermentation.

3. Apepjia. Indigeition. Water-qualm. A few mouthfuls
of the aliment are rejected at a time for fome hours after meals.
When the aliment has had time to ferment, and become acid, it
produces cardialgia, or heart-burn. This difeafe is perhaps gen-
erally left after a flight inflammation of the ftomach, called a fur-
feit, ocoiifioned by drinking cold liquors, or eating cold vegeta-
bles, when heated with exercife. This inflammation of the
ilomach is frequently, I believe, at its commencement removed
by a critical eruption on the face, which differs in its appearance
as well as in its caufe from the gutta rofea of drunkards, as the
ikin round the bale of each eruption is lefs inflamed. See Clafs
II. i. 4. 6. This difeafe differs from Cardialgia, Clafs I. 2. 4.
5. in its being not uniformly attended with pain of the cardia
ventriculi, and from its retrograde motions of apart of the ftom-
ach about the upper orifice of it. In the fame manner as hyfte-
ria differs from hypochondriaGs ; the one confiding in the weak-
nefs and indigeftion of the fame portions of the alimentary canal,
and the 'other in the^inverted motions of fome parts of it. This
apepfia or water-qilalm continues many years, even to old age ;
Mr. G of Litchfield fuffered under this difeafe from his in-
fancy ; and, as he grew old, found relief only from repeated dofes
of opium.

M. M. A blifter, rhubarb, a grain of opium twice a day.
Soap, iron-powder. Tin-powder.

4. Vomit us. An inverted order of the motions of the* flom-
ach and cefophagus with their abforbent veifels, by which their
contents are evacuated. In the act of vomiting lefs fenforial
power is employed than in the ufual periftaltic motion of the
ftomach, as explained in Seel. XXXY. i. 3. Whence after
the operation of an emetic the digeftion becomes ftronger by an
accumulation of fenforial power during its decreafed aclion.
This decreafed action of the ftomach may be either induced by
want of ftimulus, as in the ficknefs which attends hunger ; or it
may be induced by temporary want of irritability, as in cold fits
<?f fever •, or from habitual want of irritabilitv, as the vomiting

of

134 DISEASES CLASS I. 3. i.

of enfeebled drunkards. Or laftly, by having been previoufly
too violently ftimulated by an emetic drug, as by ipecacuanha.

M. M. Abliiler. An emetic. Opium. Warmth of a bed,
covering the face for a while with the bed-clothes. Crude mer-
cury. A poultice with opium or theriaca externally.

5. Cholera. When not only the ftomach, as in the laft arti-
cle, but alfo the duodenum, and ileum, as low as the valve of the
colon, have their motions inverted ; and great quantities of bile
are thus poured into the ftomach ; while at the fame time fome
branches of the lacleals become retrograde, and difgorge their
contents into the upper part of the alimentary canal ; and other
branches of them difgorge their contents into the lower parts of
it beneath the valve of the colon ; a vomiting and purging com-
mence together, which is called cholera, as it is fuppofed to have
its origin from increaied fecretion of bile ; but I fuppofe more
frequently arifes from putrid food, or poifonous drugs, as in the
cafe narrated in Se<£r,. XXV. 13. where other circumftances of
this difeafe are explained. See Clafs II. r. 2. 11.

The cramps of the legs, which are liable to attend cholera,
are explained in Clafs III. i. i. 15.

6. Ileus. Confifts in the inverted motions of the whole intefti-
nal canal, from the mouth to the anus ; and of the lacleals and
abforbents which arife from it. In this pitiable difeafe, through
the valve of the colon, through the pylorus, the cardia, an
pharynx, are ejected, firft, the contents of the ftomach ar:
teftines, with the excrement and even clyfters themfelves j t^ea
the fluid from the lacleals, which is now poured into the intef-
tines by their retrograde motions, is thrown up by the mouth ;
and, laftly, every fluid, which is abforbed by the other lymphatic
branches, from the cellular membrane, the fkin, the bladder, and
all other cavities of the body ; and which is then poured into
the ftomach or inteftines by the retrograde motions of the lacle-

.als; all which fupply that amazing quantity of ftttid, which is
in this difeafe continually ejected by vomiting. See Seel:. XXV.
15. for a further explanation of this difeafe.

M. M. Copious vene.fecHon. Twenty grains of calomel in
fmall ptlisj or one grain of aloe every hour till ftools are procur-
ed. BlifterS. Warm bath. Crude mercury. Clyfter of ice-
water. Smear the fkin all over with greafe, as mentioned in
Sea. XXV. 15.

As this malady is occafioned fometimes by an introfufception
of a part of the inteftine into another part of it, efpecially in
children, could holding them up by their heels for a fecond or
two of time be of fervice after venefecl:ion ? Or the exhibition
of crude quickfilver two ounces every half hour, till a pound is

taken,

CLASS I. 3. i. 7- OF IRRITATION. 13;

taken, be particularly ferviceable in this circUmftance ? Or
could half a pound, or a pound, of crude rrfercury be injected as
a clyfter, the patient being elevated by the knees and thighs fo
as to have his head and fhoulders much lower than his bottom,
or even for a fhort time held up by the heels ? Could this alfo
be of advantage in ftrangulated hernia ?

Where there exifts an introfufception of the inteftine, or in
obftinate coitivenefs, perhaps a forcing pump, fuch as gardeners
employ to water their trees, might be ufed with advantage, by
driving water forcibly up the rectum, as is mentioned by Mr.
Ad air ; and was ufed by Dettaen in experiments on dogs, who
found the valve of the colon did not prevent warm water being
pulhed along the whole courfe of the alimentary canal by a
forcing fyringe. This is well worthy trial, as well as the quick-
filver introduced by the anus in inflammations of the inteftines,
where no paflage downwards can be procured.

Where an introfufception of the inteftine exifts, as is believ-
ed frequently to occur in thofe inflammations of the bowels of
children, which are not owing to fome indigestible material, as
to plum ftones or cherry ftones, it is probable that a quantity of
air alone, or of the fmoke of tobacco, might be injected fo forci-
bly as to dilate, and in confequence to pals the valve of the co-
lon ; and might pufh into its place the flrang'ulated duplicating of
the inteftine. Air might be thus injected from a large brown
bladder by means of a clyfter-pipe covered with foft leather
moiftened with oil or mucilage, or by means of bellows, or the
common apparatus for injecting the fmoke of tobacco, or by a
fyringe ufed for condenfmg air in philofophical experiments. I
have feen fchool-boys blow air through a grafs-ftem into the bow-
els of frogs, fo as to prevent their diving, without injuring them.

Where the difeafe is owing to ftrangulated hernia, the part
fliould be fprinkled with cold water, or iced water, or fait and
water recently mixed, or moiftened with ether. In cafes of
ftrangulated hernia, could a cupuncture, or puncture with a ca-
pillary trocar, be ufed with fafety and advantage to give exit to
air contained in the ftrangulated bowel ? Or to ftimulate it in-
to action ? It is not uncommon for bafhful men to concent
their being afflicted with a fmall hernia, which is the caufe of
their death ; this circumftance fhould therefore always be in-
quired into. Is the feat or caufe of the ileus always below the
valve of the colon, and that of the cholera above it ? See Clafs

II. I. 2. II.

7. Globus hyftericus. Hyfteric fuffocation is the perception
of a globe rolling round in the abdomen, and afcending to the
ftomach and throat, and there inducing ftrangulation. It con-
fids

DISEASES CLASS I. 3. i. 1

Cfts of an ineffe&ual inverfion of the motions of the cefophaguS,
and other parts of the alimentary canal ; nothing being rejected
from the liomach.

M. M. Tincture of caftcr, tinct. of opium, of each 1 5 drops.
See Hyfteria, Clafs I. 3. i. 9.

8. Vomendi conamen inane. An ineffectual effort to vomit.
It frequently occurs, when the ftomach is empty, and in fome
cafes continues many hours-, but as the lymphatics of the ftom-
ach are not inverted at the fame time, there is no fupply of mate-
rials to be ejected \ it is fometimes a fymptom of hyttena, but
more frequently attends irregular epilepfies or reveries ; which
however may be diftinguimed by their violence of exertion, for
the exertions of hyfteric motions are feeble, as they are caufed
by debility ; but thofe of epileptics, as they are uted to relieve
pain, are of the mod violent kind ; infomuch that thofe who
have once feen thefe ineffectual efforts to vomit in fome epilep-
fies, can never again miftake them for fymptoms of hyftetia.
See a cafe in Sett. XIX. 2.

M. M. Biiiter. Opium. Crude mercury.

9. Borborigmus. A gurgling of the bowels proceeds from a
partial invertion of the periitaltic motions of them, by which the
gas is brought into a fuperior part of the bowel, and bubbles
through the defcending fluid, like air rufhing into a bottle as the
water is poured oat of it. Thr* is fometimes a diitreffing fymp-
tom of the debility of the bowels joined with a partial inverfion
of their motions. I attended a young lady about fixteen, who
\vas in other fefpects feeble, whofe bowels almoft inceffantly
made a gurgling noife fo loud as to be heard at a confiderable
diflance, and to attract the notice of all who were near her. As
this noife never ceafed a minute together for many hours in a day,
it could not be produced by the uniform deicent of water, and
afcent of air ihro'ugh it, but there muit have been alternately a
retrograde movement of a part of the bowel, which mud again
have pufhed up the water above the air ; or which might raife
a part of the bowel, in which the fluid was lodged, alternately
above and below another portion of it ; which might readily hap-
pen in fome of the curvatures of the fmaller inteftiries, the air
in which might be moved backward and forward like the air-
bubble in a glafs-level.

M. M. Eilential oil. Ten corns of black pepper fwallowed
whole after dinner, that its effect might be flower and more per-
manent \ a fmall pipe occafionally introduced into the rectum
to facilitate the cfcape of the air. Crude mercury. See Clafs I.
2. 4. 8.

10. Helena. The three b& articles, together with the lv

phatic

CLASS I. 3. t- 10. OF IRRITATION. 137

phatic diabetes, are the moft common fymptoms of the hyfteric
difeafe ; to which fometimes is added the lymphatic falivation,
and fits of fyncope, or convulfion, with palpitation of the heart
(which probably confifts of retrograde motions of it), and a great
fear of dying. Which laft circumftance diftinguiihes thefe con.
vulfions from the epileptic ones with greater certainty than any
other fmgle fymptom. The pale copious urine, cold ikin, palpi-
tation, and trembling, are the fymptoms excited by great fear.
Hence in hyfteric difeafes, when thefe fymptoms occur, the fear,
which has been ufually aflbciated with them, recurs at the fame
time, as in hypochondriaiis, Clafs I. 2. 4. 10. See Sect. XVI.
8. i.

The convulfions which fometimes attend the hyfteric difeafe,
are exertions to relieve pain, either of fome torpid, or of fome
retrograde organ •, and in this refpect they refemble epileptic
convulfions, except that they are feldom ib violent as entirely to
produce infenfibility to external ftimuli ; for thefe weaker pains
ceafe before the total exhauftion of fenforial power is produced,
and the patient finks into imperfect fyncope ; whereas the true
epilepfy generally terminates in temporary apoplexy, with per-
fect infenfibility to external objects. Thefe convulfions are lets
to be dreaded than the epileptic ones, as they do not originate
from fo permanent a caufe.

The great difcharge of pale urine in this difeafe is owing to
the inverted motions of the lymphatics, which arife about the
neck of the bladder, as defcribed in Sect. XXIX. 4. 5. And
the lymphatic falivation arifes from the inverted motions of the
falivary lymphatics.

Hyfteria is diftinguifhed from hypochondriaiis, as in the latter
there are no retrograde motions of the alimentary canal, but lim-
ply a debility or inirritability of it, with diftendon and flatulency.
It is diftinguifhed from apepfia and cardialgia by there being noth-
ing ejected from the ftomach by the retrograde motions of it,
or of the cefophagus.

M. M. Opium. Camphor. Aiafcetida. Caftor, with fin-
apifms externally ; to which muft be added a clyfter of cold wa-
ter, or iced water ; which, according to Monf. Pomme, relieves
thefe hyfteric fymptoms inftantaneoufly like a charm -, which it
may effect by checking the inverted motions of the inteftinal ca-
nal by the torpor occafioned by cold j or one end of the intefti-
nal canal may become ftrengthqned, and regain its periftaltic
motion by reverfe fympathy, when the other end is rendered
torpid by ice-water. (Pomme des Affections Vaporeufes, p. 25.)
Thefe remove the prefent fymptoms j and bark, fteel, exercife,
coldifh bath, prevent their returns. See Art. VI. 2. i .

VOL. II. T ii. Hydnpkobia.

13,8 DISEASES CLASS 1. 3. r* Hi

II. Hydrophobia. Dread of water occafioned by the bite of a
mad-dog, is a violent inverfion of the motions of the cefopha-
gus on the contact or even approach of water or other fluids.
The pharynx feems to have acquired the fenfibility of the larynx
in this difeafe, and is as impatient to reject any fluid which gets
into it. Is not the cardia ventriculi the feat of this difeafe ? As
in cardialgia the pain is often felt in the pharynx, when the acid
material ftimulates the other end of the canal, which terminates
in the ftomach. As this fatal difeafe refembles tetanus, or lock-
ed jaw, in its tendency to convulfion from a diftant wound, and
affects fome other parts by afibciation, it is treated of in Clafs
III. i. i. 15. andlV. 2. i. 7.

M. M. I fhould recommend the trial of one grain and a half
of corrofive fublimate of mercury, hydrargyrus muriatus, dif-
folved in half an ounce of rectified fpirit of wine, to be given
undiluted, if poflible, as defcribed in Clafs II. i. 5. I. and to be
repeated according to its operation.

ORDO

i I. 3. -. i. OF IRRITATION. 13$

ORDO III.

^Retrograde Irritative Motions,

GENUS II.

Of the Abforbent Syjlem.

SPECIES.

1 . Catarrhus lymphaticus. Lymphatic catarrh. A periodic-
al defluxion of a thin fluid from the noftrils, for a few hours,
occafioned by the retrograde motions of their lymphatics ; which
may probably be fupplied with fluid by the increafed abforption
of fome other lymphatic branches in their vicinity. It is dif-
tinguifhed from that mucous difcharge, which happens in frofty
weather from decreafed abforption, becaufe it is lefs fait to the
tafte ; and from an increafed fecretion of mucus, becaufe it is
neither fo vifcid, nor is attended v/kh heat of the part. This
complaint is liable to recur at diurnal periods, like an intermit-
tent fever, for weeks and months together, with great fneezing
and very copious difcharge for an hour or two.

I have feen two of thefe cafes, both of which occurred in deli-
cate women, and feemed an appendage to other hyfteric fymp-
toms ; whence I concluded, that the difcharge was occafioned by
the inverted motions of the lymphatics of the noilrils, like the
pale urine in hyfteric cafes ; and that they might receive this
fluid from fome other branches of lymphatic veflels opening into
the frontal or maxillary cavities in their vicinity.

Could fuch a difcharge be produced by ftrong errhines, and
excite an abforption of the congeftion of lymph in the dropfy of
the brain ?

2. Sa/ivatio lymphatica. Lymphatic falivation. A copious
expuition of a pellucid infipid fluid, occafioned by the retrograde
motions of the lymphatics of the mouth. It is fometimes peri-
odical, and often attends the hyfteric difeafe, and nervous fevers ;
but is not accompanied with a faline tafte, or with heat of the
mouth, or naufea.

3. Naufea humida. Moid naufea confifts in a difcharge of
fluid, owing to the retrograde motions of the lymphatics about
the fauces, without increafe of heat, or faline tafte, together
with fome retrograde motions of the fauces or pharynx along
with this naufea, a ficknefs generally precedes the act of vomit-
ing ; which may confift of a fnnilar difcharge of mucus or chyte

int*

i4® DISEASES CLASS 1, 3. 2. 4.

into the ftomach by the retrograde motions of the lymphatics or
ladteals, which open into it. See Clafs I. 2. 4. 3. and I. 2. 4. 4.
M. M. Subacid liquids. Wine. Opium. A blifler.

4. Diarrhoea lymphatica. Lymphatic diarrhoea. A quantity
of mucus and lymph are poured into the inteftines by the in-
verted motions of the inteftinal lymphatics. The feces are lefs
fetid and more liquid ; and it fometimes portends the commence-*
rnent of a diabetes, or dropfy, or their temporary relief. This
lymphatic diarrhoea fometimes becomes chronical, in which the
atmofpheric moiflure, abforbed by the cutaneous and pulmona-
ry lymphatics, is poured into the inteftines by the retrograde mo-
tions of the lafteals. See Section XXIX. 4. 6. where fome
cafes of this kind are related.

5. Dmrrbcc.a chylifera, cxtiaca. Chyliferous diarrhoea. The
chyle drank up by the lacleals of the upper inteftines is poured
into the lower ones by the retrograde motions of their lafteals,
and appears in the dejections. This circtmftance occurs at the
beginning of diarrhoea crapulofa, where the patient has taken
and digefted more aliment than the fyftern can conveniently re-
ceive, and thus eliminates a part of it ; as appears when there is
curdled chyle in fome of the dejections. SeeSeft. XXIX. 4. 7,
It differs from the lymphatic diarrhoea, as the chyliferous diabe-
tes differs from the aqueous and mucaginous diabetes.

6. Diabetes. By the retrograde motions of the urinary lym-.
phatics, an immenfe quantity of fluid is poured into the bladder.
It is either termed chyliferous, or aqueous, or mucaginous, from
the nature of the fluid brought into the bladder ; and is either a
temporary difeafe, as in hyfteric women, in the beginning of in-
toxication, in worm cafes, or in thofe expofed to cold damp air,
or to great fear, or anxiety, or in the commencement of fome
dropfies ; or it becomes chronical.

When the urinary lymphatics invert their motions, and pour
their refluent contents into the bladder, fome other branch o£
the abforbent fyftem a£ts with greater energy to fupply this flu-
id. If it is the inteftinal branch, the chyliferous diabetes is pro-
duced : if it is the cutaneous or pulmonary branch, the aqueous
diabetes is produced : and if the cellular or cyftic branches, the
mucaginous diabetes. In the two laft the urine is pellucid, and
contains no fugar.

In dropfies the fluid is fometimes abforbed, and poured into
the bladder by the retrograde motions of the urinary lymphatics,
as during the exhibition of digitalis. In the beginning of the
dropfies of infirm gouty patients, I have frequently obferved,
that they make a large quantity of water for one night, which
relieves them for feveral days. In thefe cafes the patient prcvi-

oufly

I

CLASS I. 3 OF IRRITATION. 141

[y feels a fulnefs about the prrecordia, \vith difficult refpira-
I, and fymptoms fimilar to thofe ofhyfteria. Perhaps a pre-
vious defect of abforption takes place in ibme part of the body in
thofe hyfteric cafes, which are relieved by a copious difcharge of
pale urine. See Diabetes explained at large, Section XXIX. 4.

A difcharge of blood fometimes attends the diabetes, which
was occafionally a fymptom of that difeafe in Mr. Brindley, the
great navigable canal maker in this country. Which may be
accounted for by the communication of a lymphatic branch with
the gaftric branch of the vena portarum, as difcovered by J. F.
Meckel. See Section XXVII. 2.

M. M. Alum. Earth of alum. Cantharides. Calomel.
Bark. Steel. Refin. Opium. Seq Sett. XXIX. 4.

Since the publication of the firft edition of this work, I have
feen two patients affefted with diabetes, who were both of them
between fixty and feventy years old, and had formerly lived rath-
er freely, though very temperately latterly for many years. The
water they made had not been accurately meafured or evapora-
ted ; but one of them obferved that his terrier bitch lapped his
urine in large quantities, and preferred it much to common water;
whence he concluded, it muft contain fome nutritious matter.

They both complained of thirft, and had drunk two or three
times as much as ufual, during the time they had been affected
with the diabetes ; which was about four months in one, and
about three in the other. As I efteemed thefe cafes to be ow-
ing to the patients fwallowing more fluid than could be fo hafti-
ly taken into the circulation, and that therefore a part of it was
conveyed to the bladder by the retrograde action of the lymphat-
ics, as in the beginning of intoxication ; I prevailed on them to
drink no more than their ufual quantity, or lefs ; and both thefe
mild cafes of diabetes ceafed immediately by this fimple treat-
ment of them.

A (imilar event fe^ms to have exifted in the two cafes of dia-
betes firlt published by Dr. Rollo ; on thofe days the patients
drank but little, the quantity of urine was not more than natural.
Both from thefe cafes, and from others related by Dr. Rollo, it
appears, that when the patient lived on Animal food, lefs faccha-
rine matter was detected in the urine, and alfo that the quanti-
ty of the urine abated j the former of thefe circumftances is read-
ily accounted for, as vegetable materials are probably more co-
pioufly convertible into fugar, either chemically or by the power
of digeftion, than animal materials ; and the latter feems proba-
bly owing to the patients drinking lefs in quantity, when they
were retrained from beer and milk, and were allowed only broth
in their (K

In

*42 DISEASES CLASS I. 3. 2. 7;

In the .cafe from Liverpool, publifhed by Dr. Rollo, the pa-
tient did not weigh heavier after fitting ten minutes in a bath
of i io degrees of heat ; which fhews that no part of the diabe-
tic urine was owing to increafed cutaneous abforption, and that
this difeafe was not the aqueous but the chyliferous diabetes ;
and I fuppofe the patient's weighing heavier or not after ufmg
a warm bath may depend on the quantity of fluid previoufly
taken by the mowrh ; as the ikin may thence be either in an ab-
forbent or exhalent (late, and owing to a greater or lefs degree
of heat, which may render the quantity of perfpiration in the
bath greater than the quantity abforbed. See Seel. XXIX. 4. 5.

7. Sttdor lymphaticus. Profufe fweats from the inverted mo-
tions of the cutaneous lymphatics, as in fome fainting fits, and
at the approach of death •, and as perhaps in the fudor anglica-
nus. See Seel:. XXIX. 5. Thefe fweats are glutinous to the
touch, and without increafed heat of theftdn ; if the part is not
covered, the Ikin becomes cold from the evaporation of the fluid.
Thefe fweats without heat fometimes occur in the act of vomit-
ing, as in Seel:. XXV. 9. and are probably the caufe of the cold
fweaty hands of fome people. As mentioned in Seel. XXIX.
4. 9. in the cafe of R. Davis, which he cured by frequent ap-
plication of lime. Though it is poflible, that cold fweaty hands
may alfo arife from the want of due abforption of the perfpirable
matter effufed on them, and that the coldnefs may be owing to
the greater evaporation in confequence.

The acid fweats defcribed by Dr. Dobfon, which he obferved
in a diabetic patient, and afcribes to the chyle effufed on the
{kin, mull be afcribed to the retrograde action of the cutaneous
lymphatics. See Sea. XXIX. 6.

' 8. Sudor afthmaticus. The cold fweats in this difeafe only
cover the head, arms, and breaft, and are frequently exceeding-
ly profufe. Thefe fweats are owing to the inverted motions of
the cutaneous lymphatics of the upper part of the body, and at
the fome time the increafed abforption of the pulmonary abfor-
bents : hence thefe fweats when profufe relieve the prefent fit of
afthma. There is no other way to account for fweats appear-
ing on the upper parts of the body only, but by the fluid having
been abforbed by the lymphatic branch of the lungs, and effufed
on the fkin by the retrograde movements of the cutaneous lym-
phatics ; which join tliofe of the lungs before they enter into
the venous circulation. For if they were occafioned, as gener-
ally fuppofed, by the difficulty of the circulation of the blood
through the lungs, the whole fkin muft be equally affected, both
of the upper and lower parts of the body j for whatever could
obftruct the circulation in the upper part of the venous fyftem,

muft

CLASS I. 3. 2. 9. OF IRRITATION. 143

muft equally obftruct it in the lower part of it. See Sect. XXIX.
6. In the convulfive afthma thefe fweats do not occur ; hence
they may be diftinguifhed ; . and might be called the hydropic
•afthma, and the epileptic afthma.

9. 'Tranjlatw puns. Tranflation of matter from one part o£
the fyftem to another can only be explained from its being ab-
forbed by one branch of the lymphatic fyftem, and depofited in
a diftant part by the retrograde motions of another branch ; as
mentioned Sect. XXIX. 7. i. It is curious, that thefe tranfla-
tions of -matter are attended generally, I believe, with cold fits ;
for lefs heat is produced during the retrograde action of this
part of the fyftem, as no fecretion in the lymphatic glands of the
affected branches can exift at the fame time. Do any ineffec-
tual retrograde motions occafion the cold fits of agues ? The
time when the gout of the liver ceafes, and the gout in the foot
commences, is attended with a cold fit, as I have obferved in two
inftances, which is difficult to explain, without fuppofing the
new veflels, or the matter produced on the inflamed liver, to be
abforbed, and either eliminated by fome retrograde motion, or
carried to the newly inflamed part ? See Glafs IV. i. 2. 15.

10. Tranjlatio laElis. Tranflation of milk to the bowels irt
puerperal fevers can only be explained by the milk being abforb-
ed by the pectoral branch of lymphatics, and carried to the
bowels by the retrograde motions of the inteftinal lymphatics or
lacleals. See many inftances of this in Seel. XXIX. 7. 4.

1 1. Tranjlatw urinx. Tranflation of urine. There is a curi-
ous cafe related in the Tranfaclions of the College of Phyficians
at Philadelphia, Vol. I. p. 96. of a girl, who labouring under an
ifchuria vomited her urine for many months ; which could not
be diftinguifhed from that which was at other times drawn off
by the catheter. After having taken much opium, (he feemsat
length to have formed gravel, fome of which was frequently-
brought up by vomiting. Dr. Senter afcribes this to the retro-
grade motions of the lymphatics of the ftomach, and the increaf-
cd ones of thofe of the bladder, and refers to thofe of Sect.
XXIX. of this work ; which fection was firft publifhed in 1780;
and to Macquer's Dictionary of Chemiftry, Art. Urine.

The patient above defcribed fometimes had a difcharge of
urine by the navel, and at other times by the rectum, and fome-
times by urinous fweats.

ORDO

144 DISEASES CLASS I. 3. 3. r.

ORDO III.

Retrograde Irritative Motions*

GENUS III.

Of the Sanguiferous Syjtem,

SPECIES.

I. Capillanum mctus retrogreffus* In micrbfcopicr experi-
ments it is ufual to fee gfobules of blood regurgitate from the ca-
pillary veflels again and again, before they pafs through them 9
and not only the mouths of the veins, which arife from thefc ca-
pillaries, are frequently feen by microfcopes to regurgitate fome
particles of blood during the ftruggles of the animal ; but a re-
trograde motion of the blood in the veins of thefe animals, from
the very heart to the extremities of the limbs, is obfervable by
Intervals during the diftrefles of the dying creature. Haller,
Elem. Phyf. T. i. p. 216. See Sedion XXIX. 3. 8.

2. Palpitatio cordis. May not the ineffectual and weak une-
qual motions of the heart in hyfteric cafes be afcribed to the re-
trograde motions of it, which continue for a fliort time, or ter-
minate in fyncope ? See Clafs IV. 3. i. 6.

3. Anhelatwfpafmodica. In fome afthmas may not the difficul-
ty of refpiration arife from the inverted action of the finer branch-
es of the bronchia, or of the pulmonary artery or vein, like thofc
of the capillaries above defcribed in No. i. of this genus ?

CLASS It i. i. DISEASES, &c. 145

"the Orders and Genera of the Second Clafs of Difeafes*
CLASS II.

DISEASES OF SENSATION.

ORDO I.

lucreafed Senfation.

GENERA.

1. With increafed action of the mufcles.

2. With the production of new veffels by internal membranes

or glands with fever.

3. With the production of new veflels by external membranes

or glands with fever.

4. With the produdion of new veiTels by internal membranes

or glands without fever.

5. With the production of new vefiels by external membranes

or glands without fever.

6. With fever confequent to the produ&ion of new veflels or

fluids.

7. With increafed adions of the organs of fenfe.

ORDO II. ,

Decreafed Senfation.
GENERA.

1. With decreafed actions of the general fyftem.

2. With decreafed actions of particular organs.

ORDO III.

Retrograde Senfitive Motions.

GENERA.

1. Of the arterial fyftem.

2. Of the abforbent fyftem.

3. Of the excretofjr duels.

VOL. II.

DISEASES CLASS II. i. i*

The Orders, Genera, and Species, of the Second Clafs of

CLASS II.

DISEASES OF SENSATION,

ORDO r.

Increafed Senfation.

GENUS I. j

With Increafed Aftion of the mufcles,
SPECIES.

1. Deglutitio. Deglutition.

2. Refpiratio. Refpiration.

3. Sternutatio. Sneezing.

4. Anhelitus. Panting.

5. Tujffts ebriorum. Cough of inebriates.

6. Singuttuf. Hiccough.

7. Crapula ventriculi. Indigeftion.

8. AJlhma humorale. Humoral aflhma.

9. Ni&itatio-fetjptiva. Winking from pain.

I o. Ofcitatio et pandiculatio* Yawning and ftretchinga

1 1 . Tenefmus. Tenefmus.

12. Stranguria. Strangury.

13. Parturitio. Parturition.

GENUS II.

With the ProduElion of new Feffels by internal Membranes or
Glands, with Fever.

SPECIES.

1. Febris fen/itiva irritata. Senfitive irritated fever.

2. Ophthalmia internet. Inflammation of the eye.

3. Phrenitis. of the brain.

4. Peripneumonia. . — , of the lungs.

trachealis. The croup.

5. Pleuritis. Inflammation of the pleura.

6. Diaphragmitis. of the diaphragm.

7. Carditis. ^- — of the heart.

8. Peritonitis. , of the peritone-

um.

9. Mefenteritis^ of the mefentery-

IO. Gajlritis,

CLASS II. 1.3-

OF SENSATION.

10. Gaftritis.

1 1 . Enteritis.

1 2. Hepatitis. '

1 3 . Sp/enitis.
li\. Nephritis*

15. CyJIitis.

16. Hyfleritis.

17. Lumbago fenfttiva.

1 8. 7/27^/.

j 9. Paronychia internet*

Inflammation of the flomach.
of the bowels,
of the liver,
of the fpleen.
of the kidney,
of the bladder,
of the womb,
of the loins.
of the pelvis,
beneath the nails.

GENUS III.

With the Produftion of new Vcjjels by external Membranes or
Glands, with Fever.

SPECIES.

Senfitive inirritated fever,
Eryfipelas, irritated.

. inirritated.

., fenfitive. ^

I. Febris fenfitiva inirritata.
1. Eryfipelas irritatum.

inirritatum.

•fenfitivum.

3- Tonfillitis interna.

, — fuperficialis.

inirritata*

4. Parotitis fuppitrans.

. mutabilis.

felina.

Catarrhus fenfitivus.

contagiofus.

— equinus ei cani-

nus.

Peripneumonia fuperficialjs.

Pertujjis.

Variola difcreta.

confluens.

• inoculata.

Rubeola irritata.

• inirritata.

1 1 . Scarlatina mitis.
maligna.

1 2 . Miliaria fudatoria.

• irritata.
" • inirritata.

13. Pejlis.
vaccina.

14. Pemphigus.

6.

10.

Angina, internal.

fuperficial.

i inirritated.

Mumps, fuppurative.

. mutable.

. of cats.

Catarrh, inflammatory.

• contagious.

among horfes and dogs.

Superficial peripneumony.
Chin-cough.
Small-pox, diftincl:.

• confluent.

inoculated.

Meafles, irritated.
- inirritated.

Scarlet fever, mild.

• malignant.

Miliary fever, fudatory.

" . irritated.

inirritated.

Plague.

of horned cattle.

Bladdery fever.

15. Varicellr

DISEASES

CLASS II. i. 4.

l£. Varicella.

1 6. Urticaria.

17. Aphtha fenfitiva.

— irritata.

inirritata.

1 8. Dyfenteria.

1 9 . Gaftriiis fuperfaialis.

2 o . Enteritis fupe rficialis.

Chicken-pox.
Nettle-raih.
ThruiTi, fenfitive.
; — — — irritated.

imrritatejl.

Bloody flux.
Superficial inflam. of the ftom-
acli.

ofthebowelsc

GENUS IV.

With the Production of New Vejjels by internal Metnbranes or
Glandsy •without Fever.

SPECIES.

Ophthalmia fuperfcialis.
-- lymphatica.

Ptengion.

Tarfitis pal pebr arum.

Hordeolum.

Pa romch'ia fuperfclalis .

6. Gutta rofea hepatica.
— — - fomatica.
-- hereditaria.

7. Odontitis.

8. Otitis.

9. Fiftula iacrymalis.
I p. Fijlula in ano.

Hapatitis chronica.

Scrofula fuppurans.

Scorbutus fuppurans.

Scirrhus fuppurans.

Carcinoma.
1 6. Arthrocele.
17. Arthropuofis .
1 8. Caries ojfium.

Ophthalmy, fuperficial.
— - . — lymphatic.

- --- of horfes.
Eye-wing.

Red eyelids.

Stye.

Whitlow.

Pimpled face, hepatic.

- - • flomatic.

- -- hereditary*
Inflamed tooth.

1 1 .
1 2.
1 3 .

14.
15

Fiftula Iacrymalis.
Fiftula in ano.
Chronical hepatitis.
Suppurating fcrofula.
Suppurating fcurvy.
Suppurating fcirrhus.
Cancer.

Swelling of the joints.
Suppuration of the joints.
paries of the bones.

GENUS V.

With the Production of new VeJTeh by external Membranes or
Glands^ imthout Fever.

SPECIES.

1. Gonorrhoea venerea. Clap.

2. Syphilis. Venereal difcafe.

3. Lepra*

CLASS II. 1.6. OF SENSATION. 149

•3. Lepra. Leprofy.

4. Elephantntfts. Elephantiafis.

5. FrambirftA. Frambcefia.

6. Pfora. Itch.

.7. Pfora ebriorum. Itch of drunkards.

8. Herpes. Herpes.

9. Tsona ignea. Shingles.

10. Annulus repens. Ring. worm.

11. Tinea capitis. Scald-head.

1 2. Crufta laBea. JMilk-cruft.

13. Tricboma. Plica polonica.

GENUS VI.

With Fever confequent to tie Production of new Vejfels or Fluids*
SPECIES.

1. Febris fenfiiiva. Sen fitive Fever.

2. a pure claufo. Fever from concealed matter.

3. a vomica. ' from tomica.

4. ab empyemate. from empyema.

5. mefenterica. — — mefenteric.

6. a pure aerato. from aerated matter.

7. a phthifi. from confumption.

8. fcrofukfa. fcrofulous.

9. ifchiadica. from ifchias.

IQ. arthropmdica. from joint-evil.

1 1 . a pure contagiofo. — < — from contagious matter.

12. variolofa fecundaria. fecondary of fmall-pox.

13. carcinomatofa. cancerous.

14. venerea. venereal.

15. afanie contagiofa. from contagious fanies.

1 6. puerpera. puerperal.

j 7 . afphaceh. from fphacelus.

GENUS VII.

With increafed Afticn of the Organs cfSenfe.
SPECIES.

1 . Delirium febrile. Delirium of fevers.

2. maniacale. maniacal.

3. ebrietatis. of drunkennefs

4. Somnium. Dreams.

5. Hallufinatio vifus. Deception of fight.

^. auditys. of hearing.

7. Rubor a calve. tyluih from heat.

8. Ruhr

DISEASES CLASS II. 2. i.

8. Rubor jucunditalis. Blufh from joy.

9. Priapifmus amatorlus. Amorous priapifm.

IQ. Dtftentio mamularum. Detention of the nipples,

ORDO II.

Pecreafed Sen/at ion,

GENUS I.

With dec-reafed AElion of the general Syjlern.
SPECIES.

1. StuJtitia infenfibilis. Folly from infenGbilityv

2. Tadium vita. Irkfomenefs of life.

3. Par efts fenfitiva. Senfitive debility.

GENUS II.

With decreafed AElions of particular Organs.
SPECIES.

1 . Anorexia. Want of appetite,

2. Adipfm. Want of thirft.

3. Impotentia. Impotence.

4. Sleri/itas. Barrennefs.

5. Infenfibilitas artuum. Infenfibility of the ^mbs.

6. Dyfuria infenfitivq. Infenfibility of the bladder^

7. Accumulatio afoina. Accumulation of feces.

ORDO III.

Retrograde Senfitive Motions.

GENUS I.
Of Excretory DuEls.

SPECIES.
Motus retrogreffiis. Retrograde motion.

i. ureterum. - — of the ureters.

2. urethra. , of the urethra.

3. duclus coledocL • — of the bile-du£l.

CLASS

CLASS II. i. i. OF SENSATION. 151

CLASS II.

DISEASES OF SENSATION.

ORDO I.

Inert afed Setifatwn.
GENUS I.

With increafed Action of the Mufcles.

THE actions belonging to this genus are thofe which are im-
mediately excited by the fenfations of pain or pleafure, but
which are neither followed by inflammation nor by convulfion.
The former of which belong to the fubfequent genera of this
order, and the latter to the clafs of voluntary motions.

The criterion between the actions, which are the immediate
confequence of painful fenfation, and convuUive actions prop-
erly fo called, confifts in the former having a tendency to dif-
lodge the ftimulating caufe, which induces the painful fenfation ;
and the latter being exerted for the purpofe of expending the
fenforial power, and thus dulling or deftroying the general fen-
fation of thefyftem. See Clafs III. i.

There is a degree of heat produced in the affected part by
thefe fenfitive actions without inflammation, but in much leis
quantity than when attended by inflammation ; as in the latter
there is production of new vefTels. See Sett. XXXIII. 2. 3.

Some of the fpecies of this genus cannot properly be termed
difeafes in their natural ftate, but become fo by their defeat or
excefs, and are here inferted to facilitate the explanation of the
others.

SPECIES.

i. Degltttiiio. Swallowing our food is immediately caufed
by the pleafurable fenfation occafioned by its iiimulus on the
palate or fauces, and is acquired long before the nativity of the
animal. Afterwards the pain of hunger previoufly produces
the various voluntary exertions to procure the proper material,
but the actions of mafiicating and of fwallowing it are effected
by the fenforial power of fenfation ; which appears by their not
being always controlable by the will, as when children in vain
attempt to fwallow naufeous drugs. See Clafs IV. i. 3. i.

The-

152 DISEASES CLASS n. i. 2.

The mallicated food ftimulates the palate, which is an organ of
fenfe, into fo much aftion, as to produce agreeable fenfation ;
and the mufcles fubfervient to deglutition are brought into ac-
tion by the fenfatioiV thtfs produced. The pleafurable fenfa-
tion is the proximate caufe ; the action of the fibres of the ex-
tremities of the nerves of tafte is the remote caufe •, the fenfo-
rial power of irritation exciting thefe fibres of the nerves of taile
into increafed action is the pre-remote caufe ; the action of the
mu'fcles of deglutition is the proximate effect ; the pufhing the
food into the ftomach is the remote effe£t ; and the nutrition
of the body is thepoft-remoteeffe6t.

Though the mufcles fubfervient to deglutition have their ac-
tions previouily afibciated, fo as to be excited into fynchronous
tribes or fucceifive trains, either by volition, as when we fwal-
low a difagreeable drug ; or by fenfation, as when we fwallo\V
agreeable food ; or by irritation, as when we inattentively fwal-
low our faliva ; yet do all thofe three kinds of deglutition belong
to the refpetHve clafTes of volition, fenfation, and irritation;
becaufe the firib links of thefe tribes or trains of mufcular aclion
are excited by rhofe fenforial powers, and the aifociated links,
which accompany or fucceed them, are excited by the combined
powers either of volition, or of fenfation, or of irritation, along
with that of affociation.

2. Refpiratto. Refpiration is immediately caufed by the fen-
forial power of fenfation in coniequence of the baneful want of
vital air ; and not from the accumulation of blood in the lungs,
as that might be carried on by inhaling azote alone, without the
oxygenous part of the atmofphere. The action of refpiration is
thus fimilar to that offwallowing our food to appeafe the pain
of hunger ; but the lungs being furrounded with air, their prop.
er pabulum, no interimmediate voluntary exertions are requir-
ed, as in hunger, to obtain and prepare the wanted material.

Refpiration is fimilar to flow combuftion •, the oxygenous part
of the atmofphere is received through the moift membranes,
which line the air-cells of the lungs, and uniting with the in-
flammable part of the blood generates an acid, probably the
phofphoric acid ; a portion of carbonic acid is likewife produ-
ced in this procefs ; as appears by repeatedly breathing over
lime water, which then becomes turbid. See Botanic Garden,
P.I. Canto I. 1. 40 1. note.

3. &ttrnutatio. Sneezing confifts of mufcular a&ions produ-
ced by the fenforial faculty of fenfation ; and is an effort to dif-
Jodge, by means of air forcibly impelled through the noftrils,
fome material ; which {limukites the membrane, which lines

them,

CLASS II. i. i. 4- OF SENSATION. 153

them, into too great action, and might thence injure the fenfe
of fmell which is diffufed on it.

In this operation the too great action of the veffds of the
membrane of the noilrils is the remote caute , the feniation
thence induced is the proximate caufe ; and the mufcular ac-
tions are the proximate effect.

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

It is produced in fome people by fudden light, as by looking
up at the iky in a morning, when they come out of a gloomy
bed-chamber. It then becomes an aiTociate action, and beiong-i
to Clafs IV. i. 2. 2.

M. M. When it is- exerted to excefs it may be cured by
fnuffing ftarch up the noftrils. See Clafs I. i. 2. 13.

4. Anhelltus. Panting. The quick and laborious breathing
of running people, who are not accuitomed to violent exerciie,
is occafioned by the too great conflux of blood to the lungs. As
the fanguiterous fyilem, as well as the abforbent fyllem, is fur-
niflicd in many parts of its eourfe with valves, which in general
prevent the retrograde movement of their contained fluids ; and
as all thefe veffels, in fome part of their courle, lie in contact
with the rnufcles, which are brought into action in running, it
follows that the blood mult be accelerated by the intermitted
fwelling of the bellies of the mufcles moving over them.

The difficulty of breathing, with which very fat people are
immediately affected on exercife, is owing to the preffure of the
accumulated fat on the veins, arteries, and lymphatics ; and
which, by diftending the {kin, occafions it to act as a tight ban-
dage on the whole furface of the body. Hence when the muf-
cles are excited into quicker action, the progrefs of the blood in
the veins, and of the lymph and chyle in the abforbent fyllem,
is urged on with much greater force, as under an artificial ban-
dage on a limb, explained in Art. IV. 2. 10. and in Sect.
XXXIII. 3. 2.- Hence the circulation is inftantly quickened to
a great degree, and the difficulty of breathing is the confequence
of a more rapid circulation through the lungs. The mere-died
fecretion of the perfpirable matter is another confequence of
thisrapid circulation ; fat people, when at reft, are believed toper-
fpire lefs than others, which may be gathered from their generally1
having more liquid (tools, more and paler urine;, and to their
frequently taking lefs food than many thin people •, and laitly,
from the perfpiration of fat people being generally more inodo-
rous than that of lean ones ; but when corpulent people are put
in motion, the fweat (lands in. drops on theii Ikins, and they
' Vot, II, W «Urd

154 DISEASES CLASS II. i. t. $*

lard the ground" as they run. The increafe of heat of corpulent
people on exercife, is another confequence of their more rapid
circulation, and greater fecretion. See Clafs I. 2. 3. 17.

Other caufes of difficult or quick refpiration will be treated
of under Afthma, Pertuflis, Peripneumonia, Tonfillitis.

5. Tuffis ebriorum. Senfitive cough is an exertion of the
mufcles ufed in expiration excited into more violent action by
the fenforial power of fenfation, in confequence of fomething
which too powerfully ftimulates the lungs. As the faline part
of the fecreted mucus, when the abforptionof it is impeded ;or
the too great vifcidity of it, when the abforption is increafed ;
or the too great quantitiy of the mucus, when the fecretion is
increafed ; or the inflammation of the membranes of the lungs -y
it is an effort to diflodge any of thefe extraneous materials.

Of this kind is the cough which attends free-drinkers after a
debauch ; it confifts of many fhort efforts to cough, with a fre-
quent expuition of half a tea-fpoonful of frothy mucus, and is
attended with confiderable thirft. The thirft is occafioned by
the previous diflipation of the aqueous parts of the blood by fen-
fible or infenfible perfpiration ; which was produced by the in-
creafed action of the cutaneous and pulmonary capillaries during
the flimulus of the wine. In confequence of this an increafed
abforption commences to replace this moifture, and the (kin and
mouth become dry, and the pulmonary mucus becomes infpiffa-
ted ; which ftimulates the bronchia, and is raifed into froth by
the fucceflive currents of air in evacuating it< This production
of froth is called by fome free-drinkers " fpitting fixpences" af-
ter a debauch. This fubfequent thirft, dry mouth, and vifcid
expectoration in fome people fucceeds the flighted degree of in-
toxication, of which it may be efteemed a criterion. See Clafs
IV. 2. i. 8.

As coughs are not always attended with pain, the mufcular
actions, which produce them, are fometimes excited by the fen-
forial faculty of irritation, as in Clafs I. i. 2. 8. I. i. 3. 4.
I. i. 4. 3. I. 2. 3. 4. Coughs are alfo fometimes convulfive,
as in Clafs III. i. i. 10. and fometimes fympathetic, as in Clafs
IV. 2. i. 7.

M. M. Venefection, when the cough is attended with in-
flammation. Mucillages. Opium. Torpentia. Blifter.

6. Singultus. Hiccough is an exertion of the mufcles ufed
in infpiration excited into more violent action by the fenforial
power of fenfation, in confequence of fomething which too pow-
erfully ftimulates the cardia ventriculi, or upper orifice of the
itomach. As when folid food is too haitily taken without fuf-
ficient dilution. And is an effort to diflodge that offeniive ma-
terial,

CLASS II. i. i. 7. OF SENSATION. 155

rial, and pufh it to fome lefs fenfible part of the ftomach, or in-
to the middle of the contained aliment.

At the end of fatal fevers it may arife from the acrimony of
the undigefted aliment, or from a part of the ftomach being al-
ready dead, and by its weight or coldnefs affe£Hng the fiirviving
part with difagreeable fenfation. The pain about the upper
orifice of the ftomach is the proximate caufe, the too great or
too little action of the fibres of this part of the ftomach is the re-
mote caufe, the action of the mufcles ufed in infpiration is the
proximate effect, and the repercuffion of the offending material
is the remote efFecl:.

Hiccough is fometimes fympathetic, occafioned by the pain
of gravel in the kidney or ureter, as in Clafs IV. i. i. 7. and
is fometimes a fymptom of epilepfy or reverie, as in Seel:. XIX. 2.

M. M. Oil of cinnamon from one drop gradually increafed
to ten, on fugar, or on chalk. Opium, Blifter. Emetic.

7. Crapula ventriculi. Indigeftible fubftances in the ftomach.
This frequently occurs in children, who are reftrained by their
ill-adtive friends from fruit or other fweet things ; and thus the
rational mind is taught to fuperintend the fatiety of the fenfation
of the fenfe of hunger, or of the pleafure of the palate, which
is contrary to nature, and a much more erroneons guide. Hence
children are liable to fwallow more plums and cherries than
their ftomachs can digeft •, and if thefe run haftily into ferment-
ation, much air, or gas, is generated ; and produces an incon-
venient diftention of the ftomach, as well as a difagreeable fenfa-
tion, which generally terminates in ejecting the offending mat-
ter by vomiting.

In cows which have eaten too much young clover, the faccha-
rine and mucilaginous matter, which it contains, runs into fo
violent fermentation as by diftention to deftroy the animal.
Whence it has been cuftomary with fome to perforate the fir It
ftomach, and thus let out the air. Dr. White, of Edinburgh,
afierted, that he witneffed about twenty beafts in this fituation,
two were dead before the medicine could be adminiftered, but
to the other eighteen he direcled half a pint of fpirits, called gin
or whifky, mixed with as much water, to be given ; and they
all parted with much air by eructation, and recovered. An in-
genious gentleman has lately put a flexible pipe down the efoph-
agus into the diftended ftomach of thefe animals with certain
fuccefs, as related in fome late publication. A flexible tube for
this purpofe might be made of wire wrapped round a flick about
half an inch in diameter, and afterwards covered with leather.

A boy about 8 years old fwallowed a halfpenny, which was
believed to pafs through him at fchool, fome weeks afterwards,

but

156 DISEASES CLASS II. i. i. S.

but he has not recovered his health. I was informed, that an
idiot had fwallowed a half-crown piece, and directed crude
quickfilver to be given him in repeated quantities, but never
heard the event of the cafe.

A lady in my prefence was eating a cuftard out of a tea-cup,
and put 3 or 4 pins into her mouth, which were fuppofed to
have been carelefsly left in the cup, and fwallowed one of them :
now, though needles have found their way out of the body, and
other lharp indigefdble materials, yet pins being terminated
with heads are faid often to have occafioned dangerous and pain-
ful difeafes, and fometimes death. What then Ihould be done ?
It occurred to me, that as the head of the pin would have fo
much greater friftion than the point, that if it was carried for-
wards by a dream of mucilaginous fluid, the head muft go firft ;
and I therefore immediately directed an emetic, and the pin was
brought up without any pain, or any ftains of blood in the eject*
cd fluid.

8. Afihma humor ale. The humoral afthma probably confifts
In a temporary anafarca of the lungs, which may be owing to a
temporary deleft of lymphatic abforption. Its caufe is never-
thelefs at prefent very obfcure, fince a temporary deficiency of
venous abforption, at the extremities of the pulmonary or bron-
chial veins, might occafion a fimilnr difficulty of refpiration. See
Abortio, Clafs I. 2. i. 14. Or it might be fuppofed, that the
lymph effufed into the cavity of the cheft might, by fome addi-
tional heat during fleep, acquire an aerial form, arid thus com-
prefsthe lungs ; and on this circumftance the relief, which thefe
patients receive from cold air, would be readily accounted for.

The paroxyfms attack the patient in his firft fleep, when the
circulation* through the lungs in weak people wants the afliftance
of the voluntary power. Clafs I. 2, i. 3. And hence the ab-
forbents of the lungs are lefs able to fulfil the whole of their
duty. And part of the thin mucus, which is fecreted into the
air-cells, remains there unabforbed, and occafions the difficult
refpiration, which awakes the patient. And the violent exer-
tions of the tnufcles of refpiration, which fucceed, are excited by
the pain of fufFocation, for the purpofe of pufhing forwards the
blood through the comprefTed capillaries, and to promote the ab-
forption of the efFufed lymph.

In this the humoral differs from the convulfive aflhma, treat-
ed of in Clafs III. i. i. 10. as in ihat there is probably no ac-
cumulated fluid to be abforbed ; and the violent refpiration is
only an exertion for the purpofe of relieving pain, either in the
lungs or in fome diftant part, as in other convulfions, or epilep-
fy ; and in this refpecl the fits of humoral and convulfive afthma

eflentially

CLASS II. 1. 1. 8. OF SENSATION. 147

Mtially differ from each other, contrary to the opinion ex-
\\ without fufficient confideration in Seel:. XVIII. 15.

The patients in the paroxyfms both of humoral and convullive
afthma find relief from cold air, as they generally rife out of
bed, and open the window, and put out their heads ; for the
lungs are not fenfible to cold, and the fenfe of fuffocation is fome-
\vhat relieved by there being more oxygen contained in a given
quantity of cold freih air, than in the warm confined air of a
ciofe bed-chamber.

I have feen humoral afthma terminate in confirmed anafarca
and deftroy the patient, who had been an exceflive drinker of
fpirituous potation. And M. Savage aliens, that this difeafe
frequently terminates in diabetes ; which feems to (hew, that it is
a temporary dropfy relieved by a great flow of urine. Add to
this, that thefe paroxyfms of the afthma are themfelves relieved
by profufe fweats of the upper parts of the body, as explained in
Clafs I. 3. 2. 8. which would countenance the idea of their be-
ing occasioned by ccngeftions of lymph in the lungs.

The congeftion of lymph in the lungs from the defective abr
forption of it is probably the remote caufe of humoral afthma ;
but the pain of fuffocation is the immediate caufe of the violent
exertions in the paroxyfms. And whether this congeftion of
lymph in the air-cells of the lungs increafes during our ileep, as.
above fuggefted, or not ; the pain of fuffocation will be more
and more diftremng after fome hours of fleep, as the fenfibility
to internal ftimuli increafes during that time, as defcribed in
Sect. XVIII. 15. For the fame reafon many epileptic fits, and
paroxyfms of the gout, occur during ileep.

In two gouty cafes, complicated with jaundice, and pain, and
ficknefs, the patients had each of them a (hivering fit, like the
commencement of an ague, to the great alarm of their friends ;
both which commenced in the night, I fuppofe during their
fleep ; and the confequence was a (reflation of the jaundice, and
pain about the ftomach, and ficknefs; and inftead of that the
gout appeared in their extremities. In thefe cafes I conjecture,
that there was a metaftafis not only of the difeafed action from
the membranes of the liver to thofe of the foot ; but that fome
of the new veflels, or new fluids, which were previoufly produ-
ced in the inflamed liver, were tranil.ited to the feet during the
cold fit, by the increafed abforption of the hepatic lymphatics,
and by the retrograde motions of thofe of the affected limbs.

This I think refembles in fome refpecls a fit of humoral afth-
ma, where ftronger motions of the ablbrbent veflels of the lungs
are excited, and retrograde ones of the correfpondent cutaneous
lymphatics ; whence the violent fweats of the upper parts of the

body

158 DISEASES CLASS II. i. i. 9.

body only are produced ; and for a time the patient becomes re-
lieved by the metaftafis and elimination of the offending material
by fenfitive exertion. For a further account of this intricate
fubjea feeClafsIII. i. i. 10.

M. M. To relieve the paroxyfm a tea-fpoonful of ether may
be given mixed with water, with 10 drops of laudanum, to be
repeated three or four times. Venefedion. An emetic. A
bliiler. Afterwards the Peruvian bark, with a grain of opium
at night, and two or three of aloes. A flannel fhirt in winter
but not in fummer. IlTues. Digitalis ?

In this fpecies of afthma, there is great reafon to believe, that
the refpiration of an atmofphere, with an increafed proportion of
oxygen, will prove of great advantage ; fome well obferved and
well attefted cafes of which are publimed by Dr. Beddoes ; as
this purer air invigorates the circulation, and the whole fyftem
in confequence, perhaps not only by its ftimulus, but by its fup-
plying the material from which the fenforial power is extracted
or fabricated. In fpafmodic afthma, on the contrary, Dr. Fer-
riar has found undoubted benefit from an atmofphere mixed with
hydrogen. See Sed. XVIII. 15. and Clafs III. i. i. 10.

9. NiHitatiofenfitiva. Winking of the eyes is performed eve-
ry minute, without our attention, for the purpofe of difFufing
the tears OVCIF them, which are poured into the eye a little above
the external corner of it, and which are afterwards abforbed by
the lachrymal points above and below the internal corner of it.
"When this operation is performed without our attention, it is
caufed by the faculty of irritation, and belongs to Clafs I. 1.4.
i. but when it is produced by a ftronger ftimulus of any extra-
neous material in the eye, fo as to caufe pain, the violent and fre-
quent nictitation is caufed by the faculty of fenfation.

This difeafe is fometimes produced by the introverfiori of the
edge of the lower eyelid, which bends the points of the hairs of
the eyeladi upon the ball of the eye, which perpetually (limulate
it into painful fenfation. This introverfion of the eyelid is gen-
erally owing to a tumour of the cellular membrane below the
edge of the eyelid, and though a very troublefome complaint may
often be cured by the following fimple means. A little common
plafter fpread on thin linen, about a quarter of an inch long,
rnuft be rolled up fo as to be about the fize of a crow-quill ;
this mull be applied immediately below the eyelafh on the out-
fide of the eye, and muft be kept on by another plafter over it.
This will then aft as a flight compreilion on the tumor under
the eyelafh, and will prevent the hairs from touching the eye-
ball. In a week or two the comprcffion will diminiih the tu-
mor it lies over, and cure this painful deformity.

I o. Of at at id

CLASS II. i. 1. 10. OF SENSATION.

10 Qfcitntio et patidiculatio. Yawning and ftretching of the
limbs is produced either by a long inactivity of the mufcles now
brought into action, as fometimes happens after deep, or after
liftening a long time to a dull narrative ; or it is produced by a
too long continued action of the antagonift muicles. In the
former cafe there is an accumulation of fenforial power during
the quiefcence of the mufcles now brought into action ; which
probably conftitutes the pain or wearifomenefs of a continued
attitude. In the latter cafe there is an exhauftion of fenforial
power in the mufcles, which have lately been acting violently,
and a confequent accumulation in the mufcles, which are antag-
onifts to them, and which were at reft.

Thefe involuntary motions are often feen in paralytic
limbs, which are at the fame time completely difobedient to the
will ; and are frequently obfervable in very young children ; and
from thence we may conclude, that thefe motions are learnt be-
fore nativity ; as puppies are feen to open their mouths before
the membranes are broken. See Seel. XVI. 2.

Where thefe motions are obferved in limbs otherwife paralyt-
ic, it is an indication that electric fhocks may be employed with
advantage, as the excitability of the limb by irritation is not ex-
tinct, though it be difobedient both to volition and fenfation.

n. Temfmus confifts in violent and frequent ineffectual ef-
forts to difcharge the contents of the rectum, owing to pain of
the fphincter. The pain is produced by indurated feces, or by
fome acrid material, as the acidity of indigefted aliment ; and
the efforts are attended with mucus from the pained membrane.
The feces muft fometimes be taken away by the end of a mar-
row-fpoon, as cathartics and even clyfters will pafs without re-
moving them. It is fometimes caufed by fympathy with the
urethra, -when there is a ftone at the neck of the bladder. See
ClafsII. 2. 2. 7. and IV. i. 2. 8.

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

The common exclufion of the feces from the rectum is a pro-
cefs fimilar to this, except that the mufcles of the fphincter ani,
and thofe of the abdomen, which act along with them by the
combined powers of fenfation and affociation, are in tenefmus
excited by painful fenfation, and in the latter by a fenfation,
which may in fome inftances be almoft called pleafurable, as re-
lieving us from a painful one in the exclufion of the feces.

1 2. StraagurJa. Strangury confifts in painful efforts to dif-
charge the contents of the urinary bladder. It is generally ow-
ing to a ftone in the fphincter of the bladder ; or to the inflam-
mation of the neck of it occafioned by cantharides. It is fome-
times caufed by fympathy with the piles ; and then is liable in

women

!6o DISEASES CLASS II. i. i. 13.

women to occafion convulfions, from the violence of the pain
without inflammation. See Clafs IV. 2. 2. 2. and 3.

M. M. Fomentation clyfter with oil and laudanum, pivfh the
flone back with a bougie ; if from cantharides, give hall' a pint
of warm water every ten minutes. Mucilage of gum arabic and
tragacanth.

The natural evacuation of the urine is a procefs fimilar to this,
except that the mufcular fibres of the bladder, and the mufcles
of the abdomen, which act in concert with them by the combi-
ned powers of fenfation and of aUbciation, are, in the former
cafe of ftrangury, excited into action by painful fenfation j and
in the latter by a fenfation, which may almoft be termed pleafur-
able, as it relieves us from a previous uneafy one.

The ejectio feminis is another procefs in fome refpects fimilar
to ftrangury, as belonging to the fame fenfible canal of the ure-
thra, and by exciting into action the acceleratory mufcles ; but
in the ftrangury tliefe mufcles are excited into action by painful
fenfation, and in the ejection of the femen by pleafurable fenfa-
tion.

13. Parturitto. Parturition is not a difeafe, it is a natural pro-
cefs, but is more frequently unfortunate in high life than amongft
the middle clafs of females ; which may be owing partly to
fear, with which the priefts of LUCINA are liable to infpire the
ladies of faftiion to induce them to lie-in in town j and partly
to the bad air of London, to which they purpofely refort.

There are however other caufes, which render parturition
more dangerous to the ladies of high life j fuch as their greater
general debility from neglect of energetic exercife, their inexpe-
rience of the variations of cold and heat, and their feclulion
from frem air. To which mult be added, that great fource of
the destruction of female grace and beauty, as well as of female
health, the tight ftays and other bandages, with which they are
generally tortured in their early years by the active folly of their
friends, which by difplacing many of the vifcera impedes their
actions, and by compremng them together produces adhefions of
one part to another, and affects even the form and aperture of
the bones of the pelvis, through which the nafcent child mud
be protruded.

As parturition is a natural, not a morbid procefs, no medicine
fhould be given, where there is no appearance of difeafe. The
abfurb cuftom of giving a powerful opiate without indication to
all women, as foon as they are delivered, is, I make no doubt,
frequently attended with injurious, and fometimes with fatal
eonfequences. See Clafs II. i. 2. 16.

Another thing very injurious to the child, is the tying and

cutting

CLASS II. i. 1. 13. OF SENSATION. i£i

cutting the navel-firing too foon ; which fhould always be left
till the child has not only repeatedly breathed, but till all pulfa-
tion in the corci ceafes. As otherwrfe the child is much weaker
than it ought to be -, a part of the blood being left in the pla-
centa, which ought to have been in the child 5 and at the fame
time the placenta does not fo naturally collapfe, and withdraw it-
felf from the fides of the uterus, and is not therefore removed with
fo much fafety and certainty. The folly of giving rue or rhu-
barb to new-born children, and the danger of feeding them with
gruel inflead of milk, is fpoken of in Clafs I. i. 2. 5. and II. i.
2, 16. 4

Many ladies become difeafed by an unnatural refufal of giving
fuck to their child, which ought to relieve their breads of the
load of milk, arid give confolation to their minds by the floras
or love to their infant. Many ladies indeed experience a diiR-
culty in nurfing their children from their not having nipples to
their breafls -, which have been often inflamed and deftroyed iu
their early years, even in their infancy, as I have fecn, by the
hard edge of (tiff flays rubbing againfl them, and fomedtnes, I
believe, by the fmall-pox.

M.Herholdt, of Copenhagen, has announced a difcovery which
he thinks highly interefling to humanity ; which is, that the
apparent death of new-born infants arifes from the trachea, or
wind-pipe, being filled with water ; and that they may be gen-
erally faved by giving them fuch an inclined poOtion, that the
water may run out. Of thirteen children, which were fuppofed
to be dead or flill-born, he fays, that twelve recovered by thefe
fimple means. As the trachea may not have acquired due fen-
fibility before delivery, in fome feeble or premature births, this
circumflance may poflibly arife, though it feldom occurs even in
drowned people. Medical Review, July, 1799.

VOL. 11 X OR5DO

i6a- DISEASES CLASS II. 1.2.

ORDO I.

Increafed Senfattati.
GENUS II.

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

IN the firft clafs of difeafes two kinds offerers were defcri-
bed, one from excefs, and the other from defect of irritation ;
and were in confequence termed irritative, and inirritative fevers.
In this fecond clafs of difeafes another kind of fever occurs,
which is caufed by excefs of fenfation, and termed in confe-
quence Senfitive Fever. But there is no fever from defect of
fenfation, becaufe the circulation is carried on in health without
our confcioufnefs, that is, without any fenfation attending it.

But as excefs of fenfation may exift with excefs or defect of
irritation, two other kinds of fever arife from a combination of
fenfitive fever with the irritative, and inirritative ones. Making
five kinds in all.

1. Irritative fever, defcribed in Clafs I. I. I. i.

2. Inirritative fever. Clafs I. 2« i. I.

3. Senfitive fever. Clafs II. 1.6. i.

4. Senfitive irritated fever. Clafs II. 1.2. I.

5. Senfitive inirritated fever. Clafs II. i. 3. i.

As the fenfitive irritated fever attends all the difeafes enumer-
ated under the genus about to be defcribed, it is placed at the
head of it. And as the fenfitive inirritated fever accompanies
the greateft number of the fpecies enumerated under the third
genus of this order, it is placed at the head of them. And as
the fenfitive fever attends the difeafes of the fixth genus, it is
placed at the head of them. But as every febrile paroxyfm con-
fids of difordered tribes or trains of aflbciated motions, it may be
doubted, whether they ought not all to have been placed in the
fourth clafs, amongft the difeafes of afTociation. See Clafs IV.
2.4. n.

All the fubfcquent fpecies of this genus are attended with fen-
fitive irritated fever ; there are neverthelefs fome fuperficiai in-
flammations, which affect the fame fituations without much fever,
as the fcrofulous ophthalmy and fpurious peripneumony,
which belong to other genera.

Inflammation is uniformly attended with the production or
fecretion of new fibres conftituting new vefiels 5 this theieibre

may

CLASS II. i. 2. i. OF SENSATION. 163

fli-y be eilecmed its eflential character, or the criterion of its
exiftence. The extenfion of the old veflels feems rather 3 con-
fequence than a caufe of the germination, or puli'ulation, of thefe
ncu ones; for the old veflels may be enlarged, and excited with
ial energy, without any production of new ones, as in the
bluih of (hame or of anger.

When thefe new veiiels are formed, if they are not reabforbed
into the circulation, they fecrete a new fluid called purulent
matter ; which generally opens itfeif a paflage on the external
(kin, and produces an ulcer, which cither gradually h?ab, or
fpreads, and is the caufe of hectic fever ; or they fecrete conta«-
gious matter, which has the property of exciting the fame kind
of inflammation, and -of producing the fame kind of contagious
matter, when inferted by inoculation into the fkin of other per-
fons. Thefe contagious matters form ulcers, which either heal
fpontaneoufly, or by art ; or continue to fpread, and dcftroy the
patient, by other kinds of hectic lever.

In this genus there is an increafe of the fenforial power of ir-
ritation as well as of fenfation ; whence great arterial energy is
produced, and the pulfe becomes ftrong and full, as well as quick;
and the coats of the arteries feel hard under the finger, being
themfelves thickened and diftended by inflammation. The
blood drawn, efpecially at the fecond bleeding, is covered with
a tough fize ; which is probably the mucus from the inflamed
internal furface of the arteries, increafed in quantity, and more
coagulable than in its natural (late ; the thinner part being more
perfectly abforbed by the increafed action of the inflamed abforb-
ents. See Seel. XXXIII. 2. 2. This is rendered more prob-
able, becaufe the hard feel of the pulfe, and the abundance of
coagulable lymph commence, exift, and ceafe together.

Great heat is produced from the new chemical combinations
arifing in the fecretion of new fibres, and great pain from the
diftention of old ones, or from their increafed adlion. The in-
creafed quantity of fenfation from a topical inflammation or
phlegmon is the immediate caufe of the febris fenfitiva irritata,
or inflammatory fever ; as when it arifes from the pain of pleu-
rify, or paronychia ; but generally an irritative fever precedes
this topical inflammation, which occurs during the hot fit of it ;
and then the irritative fever is changed into a fenfitive irritated
fever, by the additional caufe of the fenforia-1 power of fenfation
befides that of irritation.

SPECIES.

I. Febns fenfitiva irritata. Senfitive irritated fever, or in-

flammatorr

i<54 DISEASES CLASS II. i. 2.1,

flammatory fever. Phlegmafia. A flrong full pulfe, with in-
flammation of the coats of the arteries, conftitutes this difeafe.
Jt originates from fome topical inflammation, whieh, if the fever
is not fubdued, terminates in fuppuration ; and differs from ir-
ritative fever in refpeft to the painful fenfation which accompa-
nies it. For as pleafurable fenfation i* the caufe of the growth
of the new veflels, and diftention of the old ones, in the natural
enlargement of the body during our infancy ; fo a painful fenfa-
tion is the caufe of the unnatural production of new veffels, and
enlargement of old ones in inflammatory difeafes.

When matter is thus formed in any internal vifcus, or in
the cellular membrane, as in the lungs or liver; fo long as this
abfcefs remains without admiffion of air, this inflammatory fever
is Jiable to continue, recieving only temporary relief by bleeding
or emetics, or cathartics •, till the patient, after a month, or two,
or three, expires. But, if air be admitted to thefe internal ab-
fcefles, this kind of fever is changed into a heftic fever in a fin-
gle day. It alfo fometimes happens, that when the abfcefs re-
mains unopened to the air, if the matter has become putrid, hec-
tic fever iupervenes, with colliquative fweats, or diarrhoea ; the
matter in both cafes is fometimes abforbed, and the fides of the
abfcefs grow together again without an external aperture. See
ClafsII. 1.4. i. and 2. Another termination of inflammation
is in gangrene, but this belongs to the inflammation of the ex-
ternal ikin *, as the production of purulent matter belongs to in-
flammation of the internal or mucous membranes. Thus when
the external fkin is the feat of inflammation, as in erythema, or
eryfipelas, and produces fenfitive irritated fever, no collection of
purulent matter can be formed ; but a material oozes out, and
lies upon the furface, like that in the confluent fmall-pox, and
the cuticle at length peels off, or gangrene fupervenes. It mutt
be noted, thnt thefe kinds of inflammation can exitl together ;
and fome parts of the cellular membrane may fuppurate at the
fame time that the external Ikin is affected with erythema, or
eryfipehs.

M. M. Venefeclion. Cathartics. Diluents. Cool air.
Torpentia. Cold bath ? See Sett. XII. 6.

The increafed arterial a6Hon in this fenfitive irritated fever is
not fimply owing to the increafed irritability of the arterial fyf-
fem, or to the ftimuius of the diftention of the veiTels, but aifo
to the increafed acrimony or pungency of the blood ; which
has now fo far changed its nature as to become more fluid,
rnore denfe, and to be loaded with coagulable lymph. Hence
it becomes neceffary not only to leflen the quantity of blood
by venefetlion and by cathartics, but alfo to dilute its acrimo-
ny*

CLASS II. i.2. 2. OF SENSATION. 165

rv, or pungency, by the introduction of aqueous and mucilagin-

:!uids, iuch as barley water, cream and water, fugar and

water, weak broths ; to which may be added fo much of fome

vegetable eflential oil, as may render them grateful to the (tom-

and thus promote their abforption ; as by infufing parfley

;ilery and turnips in the broth ; or by balm, mint, or fage

teas.

The following fpecies of this genus only diftinguifli the fitua-
tion of the part previoufly inflamed, and which is the remote
caufe of the fenutive irritated, or inflammatory fever, which at-
tends it.

2. Ophthalmia interna. Inflammation of the eye is attended
with the production of new veflels, which fpread over the tunica
adjunctiva, and over the cornea ; thefe new veffels are eafily
feen,as they lie on a white ground, an.d give ocular demonftra-
tion of their production in inflammation. When this inflamma-
tion of the cornea fuppurates, it is liable to leave little ulcers,
which may be feen beneath the furface in the form of little ex-
cavations ; and as thefe heal, they are liable to be covered with
an opaque fear. This fear, in fome months or years, is liable to
wear away, and become tranfparent, without the afliilance of
any polifhing powder, as of very finely levigated glafs, as fome
have recommended. But when the cornea is affected through
all its thkknefs, the return of its tranfparency becomes hopelefs.
See Clafs I. i. 3. 14.

la violent degrees of ophthalmy the internal parts, as the reti-
na, optic artery, iris, ciliary procefs, become inflamed, as well
as the external ones ; hence the leaft light admitted to the eye
occafions intolerable pain. This curious circumftance cannot
be owing to the action of light on the inflamed veflels of the
cornea ; it therefore mews, that the extremity of the optic nerve
or retina is alfo rendered more exquifitely fenfible to light, by
partaking of the inflammation ; arid I have been told, that red
colours are in thefe cafes fometimes painfully perceived even
in perfedt darknefs. This (hews that the retina is excited into
motion by the ftimulus of light ; and that, when it is inflamed,
thefe motions give great pain, like thofe of other inflamed parts,
3S the mufcles, or membranes. And fecondly, that the ideas
of colours confiil in the motions of the retina ; which ideas
occafion pain, when the extremity of the moving nerve is in-
flamed.

M. M. Venefe&ion. Cathartics. Diluents. Torpenfia.
Frequently moiften the eye with cold water by means of a rag.
Cool airy room. Darknefs. When the inflammation begins to
4ecline, white vitriol gr. vi. in an ounce of water is more effica-
cious

DISEASES CLASS II. i. 2.

c:o»: ,? to moiften the eye than folutions of lead. Tincture of
plum diluted. Extracb of belladonna. New veffels from the
inflamed tunica adnata frequently fpread like a fly's wing upon
the tranfparent cornea, which is then called Pterigium. To
ftop the growth of this, the principal veflels ffoould be cut through
with a lancet. When the inflammation begins to decline, after
tiue evacuation any ftimulating material put into the eye increaf-
es !• i, which foon removes the new red veflels £

en rife to a hundred famous eye-waters, and eye-
do tiers; it 'thefe ftimulating materials are ufed too foon, the
inflammation is increafed by them. See Seel:. XXXII. 2. icr
Ciafs I. 2, 2. 13.

There is another ophthalmia, which attends weak children,
avid is generally efteemed a fymptom of fcrofula, as defcribed
-inClafstl. i. 5. 3. and another, which is of venereal origin,
mentioned in Clafs II. i. 5. 2. both which may be termed
ophthalmia fuperficialis.

3. Pbrenitis. Inflammation of the brain is attended with in-
tolerance of light and found j which (hews, that the extremities
of the nerves of thofe fenfes are at the fame time inflamed ; it is
alib attended with great pain of the head, with watchfulnefs, and
furious delirium. The violent efforts, thefe patients are fatd
fometimes to exert, are owing to the increafed fecretion of fenfo-
power in the brain; as all other inflamed glands have a
greater circulation of blood parting through them, and a greater
iecretion in confequence of their peculiar fluids, as in the hepa-
titis much more bile is generated.

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

4. Peripneumonia. Inflammation of the lungs. The pulfe is
not always hard, fometimes foft ; which is probably owing to a
degree of ficknefs or inaction of the ftomach j with dull pain of
the cheft ; refpiration conftantly difficult, fometimes with erecl:
pouure-, the face bloated and purplifh; cough generally with
moiit expectoration, often ftained with blood.

When the difficulty of refpiration is very great, the patient is
not able to cough ; in this fituation, after copious bleeding, the
cough is liable to return, and is fo far a favourable fymptom, as it
ihews fome abatement of the inflammation.

A peripneumony frequently occurs in the chin-cough*
and deftroys the patient, except immediate recourfe be had to

the-

CLASS II. i. ft. 4. OF SENSATION.

the lancet, or to four or five leeches ; when blood cannot be
otherwife taken.

The peripneumony is very fatal to young children, efpec!
as I believe it is frequently miftaken for a fpaimodic afthma, or
for the croup, or cynanche trachea 1 is oi Cullen. Both w.
-however, when they occur, require immediate venelection by
*he lancet or by leeches, as well as the peripneumony j as i
tioned below.

Inflammation of the lungs is alfo liable to occur in the meafles,
•and in the hooping-cough, and inuft be attacked by venefeclion
at any time of the difeafe ; otherwife either a preient death, or
an incurable confumption, is the confequence.

The peripneumony is frequently combined with inflammation
of the pleura, and fometimes with that of the diaphragm j cither
of thefe may generally be diftinguifhed, not only by the" pain
which attends inflammation of thefe membranes, but by infpect-
ing the naked cheft, and obferving whether the patient breathes
more by elevating the ribs, or by deprefling the diaphragm.

A crifis happens in children about the fixth day with much
pale urine, which mud be waited for after evacuations have been
ufed, as far as can be done with fafety ; in this fituation the
warm bath twice a day, and fmall blifters repeatedly in fuccef-
fion, are of peculiar fervice.

After the termination of peripneumony a collection of coag-
ulable lymph is frequently left in the cavity of the cheft unabforb-
€d-, or a common anafarca of the lungs occurs from the prefent
inaction of the abforbent veiTels, which had previoufly been ex-
cited too violently. This difficulty of breathing is cured or re-
lieved by the exhibition of digitalis. See Art. IV. 2. 7.

M. M. The lancet is the anchor of hope in this difeafs ;
which inuft be repeated four or five times, or as often as the fe-
ver and difficulty of breathing increafe, which is generally in
the evening ; antimonials, diluents, repeated fmall blifters about
the cheft, mucilage, pediluvium, warm bath. Is a decoction
of feneca-root of ufe ? Do not neutral fahs increafe the tenden-
cy to cough by their ftimulus, as they increafe the heat of urine
in gonorrhoea ? Children in every kind of difficult breathing,
from whatever caufe, fhould be kept as upright in bed as may-
be, and continually watched ; fmce, if they ilip down, they are
liable to be immediately fufFocated : to prevent which a pillow
fhould be put beneath the undermoft (beet half way down in the
bed, fo as to receive the pofteriors of the child, and thus coun-
teract its (lid ing down lower ; or drawer:* on the thighs might
be occafionally ufed for this purpofe, as mentioned in Clafs III*
2. i. 10. And children fhould have no cap ft ring tied under

their

i68 DISEASES CLASS II. i. 2.

their chhls, in any cough or difficulty of refpiration, fince if the]
ilip down in their bed the friction of the night-cap on the pil-
low is liable to draw the tape or ribbon under the chin too tight,
and fuffocate them. After the patient is greatly debilirated, fc
that no further evacuation can be admitted, and the difficult:
breathing and cough continue, I have given four or five drops
of tincture of opium, that is, about a quarter of a grain of folid
opium, with great advantage, and I believe in feveral cafes I
have faved the patient. A greater quantity of opium in this
flate of debility cannot be ufed without hazarding the life of the
perfon. This fmall quantity of an opiate mould be given about
{ix in the evening, or before the accefs of the evening paroxyfrn,
and repeated three or four nights, or longer.

There is a peripneumony with weak pulfe, which may be
termed peripneumonia inirritata, as defcribed in Seel:. XXVII. 2.
which belongs to this place. See alfo Superficial Peripneumo-
ny, Clafs II. i. 3. 7.

Peripneumonia arthritica. Gouty peripneumony. I believe,
that there exilts a peripneumony, and a pleurify which owe their
inflammation to the fympathy of thofe membranes with fome
other parts of the fyftem, and may then properly be termed
rheumatic or gouty peripneumony, or pleurify. And that the
coagulable lymph left upon the inflamed membranes has gener-
ally been owing to thefe fympathetic inflammations, and that hy-
drops thoracis, and anafarca pulmonum are generally caufed by
gouty affections of the lungs, or rheumatic affections of the pleu-
ra, and not by the more common idiopathic inflammations of
thofe membranes. See Oafs I. 2. 3. 14. and Clafs IV. i. 2.
1 6. and Clafs IV. i. 2. 9.

Peripneumonia tracbealis. Croup. The croup is an inflam-
mation of the upper part, and the peripneumonia of the lower
part of the fame organ, viz. the trachea or wind-pipe. Sec
Clafs I. 1.3. 4. But as the inflammation is feldom, I believe,
confined to the upper part of the trachea only, but exifts at the
fame time in other parts of the lungs ; and as no inflammation of
the tonfils is generally perceptible, the uncouth name of cynan-
che trachealis fhould be changed for peripneumonia trachealis.

Dr. Wichmann, of Hanover, believes, that the acute afthma
of Millar, or hives, has been confounded with the angina polypofn,
or croup, which has occaiioned the great difference in the treat-
ment recommended by authors *, as the difeafe has been efteem-
ed inflammatory by fome, and fpafmodic by others.

The convulfive afthma, which I have witneffed in one child,
was readily diftinguiftied from the croup ; as there wasfimply a
great exertion in breathing, but without the harih found which

attends

CLASS II. i. 2. 4. OF SENSATION. 1*9

attends the infpirations in the latter, and there was no attendant
fever ; and the difeafe was cured by one venefection, and a
moderate dofe of opium after the venefe&ion. See afthma
convulfivum. Clafs III. i. I. 10.

A conwtlfive difficulty of refpiration may thus be eafily dtf-
tiriguifhed from the croup ; as in the former the patient draws
in the breath eafily, and then voluntarily clofes the larynx, and
voluntarily ufes great exertion in forcing out the breath, with
defign to relieve f$me pain by this violent exertion, as in parox»
yfms of eptlepfy.

On the contrary, in the croup the breath is eafily expired,
but the infpirations are attended with the utmoft difficulty.
This difficulty of infpiration may be feen by viewing the region
of the ftornach i as when the child raifes the fternum for the
purpofe of drawing in its breath, the preflure of the atmof-
phere on the pit of the ftomach prefles the diaphragm upwards,
and makes a fudden and great hollow in the fcrobiculus cordis^
This difficulty of infpiration, and not of expiration, is alfo known
by the harfli found , which only attends the infpiration.

This difficulty of infpiration may in part be owing to this cir-
cumftance. In directing thofe children who have died of the
croup, I believe the upper part of the adherent coagulable lymph,
or indurated mucus, formed within the trachea, is found to be-
come loofe, and to feparate from the upper part of the trachea
before the lower part of that adhefive membranous cruft begins
to feparate, and hence the loofe upper part at the time of infpira-
tion is bent downwards into the trachea, and thus becomes dou-
ble, and obftrucb the paflage ; but this duplicature of it does
not happen in expiration. See Tranfact. of a Society, Vol. II.
Account of Croup, by Henry Ram ley, cafe the 8th. Might not
this be prevented from being fatal, by an aperture into the wind-
pipe beneath the larynx ?

I have very lately feen a mod diftinct cafe of this peripneu-
monia trachealis, or croup. The child, about ten months old,
had great difficulty in drawing in its breath, with much noife ;
but had much lefs difficulty in its expiration, with little or gener-
ally no found. On obferving its naked cheft, the fternum, or
breaft-bone, was feen to be raifed with great force -, and then the
diaphragm, and the bowels under it, rofe haftily up into the low-
er part of the cavity of the cheft ; and the air ruined with diffi-
culty, and with great found, through the contracted larynx into
the upper part of the cheft ; both thefe effects were evidently
owing to the prelTure of the atmofphere, to fupply the vacuity,
which muft otherwife fucceed the forcibly railing of the fternum.
Why the difficulty of infpiring was fo much greater than
VOL. II. Y of

173 DISEASES CLASS II. i. 2. 4>

of expiring, requires to be further explained. During irifpira-
tion, the preflure of the atmofphere, when the cavity of the
cheft is enlarged by raifing the fternum, and depreffing the dia-
phragm, a£ls upon the external part of the larynx, as v/ell as on
the aperture of it, and thus contracts it, and affifts the difeafe j
whereas in expiration there is no increafe of atmofpheric pref-
fure on the outfide of the larynx, or trachea, to prevent the ex-
clufion of the air. In the fame manner, if a flexible pipe of foft
leather was extended upwards a few inches through the bottom
of a bucket of water, but very little of the water could be dif-
charged by it ; as the preiTure on its fides would foon comprefs
the pipe, and thus flop np its mouth.

After repeated venefection, and a cathartic of calomel, a blifl
ter was applied oh each fide of the larynx, and the difficulty of
breathing became greatly relieved ; and though the child had in-
tervals of eafier refpiration, and without noiie, yet it died on the
fucceeding day.

Where the difficulty of breathing is very urgent in the croup,
bronchotomy is recommended by Mr. Field. , Memoirs of a
Medical Society, London, 1773, Vol. IV.

After repeated venefedion, and cathartics, perhaps a drop or
two drops of tinfture of opium, about fix in the evening, might
be of ufe to prevent the return of the evening paroxyfm, and this
efpecially if the difficulty of refpiration has an interval or remif-
fion, as mentioned below.

A ftrong decoclion of feneca root is recommended by Dr.
Archer, of America. He boils half an ounce of the root, from
eight ounces of water to four, and gives a tea-fpoonful every
hour or half hour, fo as to produce vomiting or purging, and
then gives it in fmaller quantities. He alfo rubs mercurial
ointment about the throat, and ufes calomel internally, fo as to
afFe£t the glands of the throat as quickly as poffible, when the
difeafe is more advanced, and the difficulty of breathing with
harm and thrill infpiration is more urgent. Medical and Phyfic-
al Journal, No. I. p. 83. Asa decodtion of feneca root partic-
ulary ftimulates fome parts of the throat, occafioning a difagreea-
ble fenfation in it, it may in fome cafes contribute to loolen or
difcharge the adheiive coagulable lymph, which has been fecre-
ted on the inflamed membrane of the wind-pipe, and occafioris
the difficulty of infpiration by contracting its aperture ; and
may therefore be worth trial after repeated venefecStion, and
cathartics, and blifters on each fide of the throat.

Dr. Wichmcmn of Hanover, above mentioned, aiTcrts, that in
the croup the difeafe continues regularly to increafe, from the
commencement of it, without intervals of relief from the great

difficult'^

-•5 II. 1.2.5- OF SENSATION.

iilty of breathing; and gives this as a criterion to diftin-

; the angina polypola from the afthma acutum. Annals of

Medicine, Vol. I. But in the cafes of true croup, peripneumo-

•rachealis, I have ken with furprife the difficulty of refpira-
tion to ceafe for a time, and return again with unabated violence.
Thefe remiiTions of the diilicult reiptration are alfo mentioned
by Dr. Ferriar, who then terms it a fpurious croup, but which
I fufpecl: to be owing fimply to the following circumflances.

In a common catarrh, when the raucous membrane of the
noftrils is much inflamed, it becomes fo thickened as totally to
prevent refpiration through them ; yet on fuddenly warming the
Ikin, by drinking tea or by a fire, and fometimes l>y only cooling
the membrane of the noftrils by going into the cold air, the fwel-
Kng of this membrane will fuddenly fubfide, fo as to permit the
air to pafs through quite eafily for a time, as explained in ca-
tarrhus calidus. Clafs I. i. 2. 7. The fame circumftance may
occur to the inflammation of the membrane, which lines the up-
per part of the trachea, or it may happen from the doubling of
the loofencd upper part of the adhefive mucus.

M. M. Frequent bleeding by the lancet or leeches. A few-
grains of calomel. Seneca. Blifters about the throat. An
opiate in fmall quantity at night after previous evacuations.
Mercurial ointment. Warm bath. Breathing over the fteam
of warm water, with or without volatile alkali, or ether, or vine-
gar. Particular attention fhould be ufed to keep the child raifed
high in bed. Might the fkin be kept agreeably warm, and at
the fame time might quite cold air be breathed through a tube
coming from without, through a broken window, or hole in a
door ? Or might the child be carried out into the cold air very
warmly clad ? If a folution of fublimate could be fafely ufed,
as in gonorrhoea, Clafs II. 1.5. I ?

After evacuation by copious venefeclion, might not the fre-
quent application of ether externally to the throat be ferviceable ?
And where there occur intervals of eafy refpiration, might not
breathing over the duft of powdered Peruvian bark prevent a re-
turn of the thickening of the membrane, as defcribed in Clafs II.
.. 6. 7.

5. Pleuritis. Pleurify. Inflammation of the pleura, with
liard pulfe, pain chiefly of the fide, pungent, particularly increaf-
ed during infpiration ; lying on either fide uneafy, the cough
very painful, dry at the beginning, afterwards moift, often bloody.

One caufe of pleurify is probably a previous adhefion of the
lungs to a part of the pleura, which envelopes them. This in
many cafes has been produced in infancy, by flittering children
to lie too long on one (ide. Or by placing them uniformly on one

fidp

172 DISEASES CLASS II. i. 2.

fide of a fire, or window, to which they will be liable always t
bend themfelves.

When matter is produced during peripneumony or pleurify
Jn one fide of the cheft, fo long as it is a concealed vomiea, the
fever continues, if the difeafe be great, for many weeks, and even
months ; and requires occafional venefe&ion, till the patient
•finks under the inflammatory or fenfitiye irritated fever. But if
air be admitted, by a part of the abfcefs opening itfelf a way in-
to the air-veffels of the lungs, a heclic fever, with colliquative
fweats or diarrhoea, fupervenes, and frequently deftroys the pa-
tient ; or the abfcefs heals, the lungs adhering to the pleura.
See pleurodyne rheumatica. Clafs IV. 1.2. 16.

M. M. The lancet muft be ufed copioufly, and repeated as
often as the pain and difficult refpiration increafe. A blifter on
the pained part. Antimonial preparations. Diluents. Cool
air. Do neutral falts increafe the tendency to cough ? PedU
luvium or femicupium frequently repeated.

6. Dlaphragmitis. Inflammation of the diaphragm. Pain,
round the lower ribs as if girt with a cord. DiiHcult refpira-
tion performed only by elevating the ribs and in an erecl: pof-
ture. The corners of the mouth frequently retracted into a dik
agreeable fmiJe, called rifus Sardoriicus.

Thofe animals, which are furnifhed with clavicles, or collar^
bones, not only ufe their foremoft feet as hands, as men, mon-
keys, cats, mice, fquirrels, &c. but elevate their ribs in refpira-
tion as well as deprefs the diaphragm for the purpofe of enlarg-
ing the cavity of the cheft. Hence an inflammation of the dia-
phragm is fudden death to thofe animals, as horfes and dogs,
which can only breathe by deprefling the diaphragm ; and is I
fuppofe the caufe of the fudden death of horfes that are over-,
worked ; whereas, in the human animal, when the diaphragm
is inflamed, fo as to render its motions impoijible from the pain
they occafion, refpiration can be carried on, though in a lefs per-
fe£t manner, by £he intercoftal mufcles in the elevation of the
ribs. In pleurify the ribs are kept motionlefs, and the refpira-
tion is performed by the diaphragm, as may be readily feen on
infpe<£\ing the naked cheft, and which is generally a bad fymp-
tom ; in the diaphragmitis the ribs are alternately elevated, an4
deprefled, but the lower part of the belly is not feen to move.

M. M. As in pleurify and peripneumony. When the pa-
tient becomes delirious, and fmiles difagreeably by intervals, and
is become fo weak, that evacuations by the lancet could be ufed
no further, and I have almoft defpaired of my patient, I have
found in two or three inftances, that about five or fix drops of
jincl:. thebaic. given an hour before the evening exacerbation,

have

CLASS II. i. 2. 7, OF SENSATION. 173

have had the happiefl effefr, and cured the patient in this cafe,
as well as in common peripneumony •, it mult be repeated t\vo
or three evenings, lee Clafs II. I. 2. 4. as the exacerbation of
the fever, and difficult refpiration, and delirium, generally in-
creafe towards night.

The ftimulus of this fmall quantity of opium on a patient
previoufly fo much debilitated, acts by increafing the exertion of
the abforbent veflels, in the fame manner as a folution of opium,
or any other ftimulant, pui on an inflamed eye after the veflels
are previoufly emptied by evacuations, fhmulates the abforbent
fyftem, fo as to caufe the remaining new veflels to be immediate-
ly reabforbed. Which fame ftimulants would have increafed
the inflammation, if they had been applied before the evacua-
tions. See Ciafs II. i. 2. 2. Sea. XXXIII. 3. I. When the
fanguiferous fyftem is full of blood, the abforbents cannot act fo
powerfully, as the progrefs of their contents is oppofed by the
previous f ulnefs of the blood-veflels ; whence ftimulants in that
cafe increafe the action of the fecerning fyftem more than of the
abforbent one ; but after copious evacuation this refiftance to
the progrefs of the abibrbed fluids is removed ; and when ftim-
ulants are then applied, they increafe the action of the abforb-
ent fyitern more than that of the fecerning one. Hence opium
given in the commencement of inflammatory difeafes de-
ftroys the patient ; and cures them, if given in very fmall .dofes
at the end of inflammatory difeafes.

7. Carditis. Inflammation of the heart is attended with un-
equal intermitting pulfe, palpitation, pain in the middle of the
ftornum, and conftant vomiting. It cannot certainly be diltin-
guiihed from peripneumony, and is perhaps always combined
with it.

8. Peritonitis. Inflammation of the peritonaeum is known
jby pain all over the abdomen, which is increafed on erecting the
body. It has probably moft frequently a rheumatic origin. See
Clafs II. i. 2. 17.

9. Mef enteritis. Inflammation of the mefentery is attended
with pains lijie colic, and with curdled or chyle-like ftools. It
is a very frequent and dangerous difeafe, as the production of
matter more readily takes place in it than in any other vifcus.
The confequence of which, after a hard labour, is probably the
puerperal fever, and in fcrofulous habits a fatal purulent fever,
or hopekfs confumption.

M. M. VenefecHon. Warm bath. Emollient clyfters.

10. Gaftritis. In inflammation of the ftomach die pulfe is
generally foft, probably occafioned by the iicknefi which attends

it.

174 DISEASES CLASS II. r. 2. it,

it. The pain and heat of the ftomach are Jncreafed by what-
ever is fwallowed, with immediate rejection of it. Hiccough.

This difeafe may be occafioned by acrid or indigeftible mat-
ters taken into the ftomach, which may chemically or mechanical*
ly injure its interior coat. There is however a (lighter fpecies of
inflammation of this vifcus, and perhaps of all others, which is
unattended by much fever ; and which is fometimes induced by
drinking cold water, or eating cold infipid food, as raw turnips,
when the perfori has been much heated and fatigued by exercife.
For when the fenforial power has been diminifhed by great ex-
ertion, and the ftomach has become lefs irritable by having been
previoufly ftimulated by much heat, it fooner becomes quiefcent
by the application of cold. In confequence of this flight inflam-
mation of the ftomach an eruption of the face frequently enfues
by the fenfitive aflbciation of this vifcus with the (kin, which is
called a furfeit. See ClafsIV. i. a. 13. and II. i. 4. 6. and II.
1.3. 19.

M. M. Venefe&ion. Warm bath. Blifter. Anodyne clyf-
ters. Almond foap. See Clafs II. 1.3. 17.

IT. Enteritis. Inflammation of the bowels is often attended
with foft pulfe, probably owing to the concomitant ficknefs ;
which prevents fometimes the early ufe of the lancet, to the de-
ftrudion of the patient. At other times it is attended with
ftrong and full pulfe like other inflammations of internal mem-
brrtnes. Can the feat of the difeafe being higher or lower in
the inteftinal canal, that is, above or below the valve of the co-
lon, produce this difference of pulfe by the greater fympathy of
one part of the bowels with the ftomach than another ? In en-
teritis with ftrong pulfe the pain is great about the navel, with
vomiting, and the greateft difficulty in procuring a ftool. In the
other, the pain and fever are lefs, without vomiting, and with
diarrhoea. Whence it appears, that the enteritis with hard
quick pulfe differs from ileus, defcribed in Clafs I. 3. i. 6. only
in the exiftence of fever in the former and not in the latter, the
other fymptoms generally correfponding ; and, fecotidly, that
the enteritis with fofter quick pulfe, differs from the cholera de-
fcribed in Clafs I. 3. i. 5. only in the exiftence of fever in the
former, and not in the latter, the other fymptoms being in gen-
eral fimilar. See Clafs II. i. 3. 20.

Inflammation of the bowels fometimes is owing to extraneous
indigeftible fubftances, as plum-ftones, efpecially of the dama-
fin, which has fharp ends. Sometimes to an introfufception of
one part of the inteftine into another, and very frequently to a
ftrangulated hernia or rupture. In refpec~l to the firft, 1 knew
an initance where a damafin {tone, after a long period of time,

found

CLASS II. i. 2. 12. OF SENSATION. 175

found its way out of the body near the groin. I knew another
child, who vomited fome damafm (tones, which had lain for near
twenty hours, and given great pain about the navel, by the exhi-
bition of an emetic given in repeated dofes for about an hour.
The fwallowing of plum-ftones in large quantities, and even of
cherry- ftones, is annually fatal to many children. In refpecfc
to the introfufception and hernia, fee lieus, Clafs I. 3. i. 6.

M. M. Repeated venefedtion. Calomel from ten to twen-
ty grains given in fmall pills as in ileus ; thefe means ufed early
in the difeafe generally fucceed. After thefe evacuations a blif-
ter contributes to Hop the vomiting. Warm bath. Crude mercu-
ry. Aloes one grain-pill every hour will frequently (lay in the
flomach. Glauber's fait diUblved in pepper-mint water given by
repeated fpoonfuls.

When the patient is much reduced, opium in very finall do-
fes may be given, as a quarter of a grain>as recommended in pleu-
rify. If the pain fuddenly ceafes,and the patient continues to vom-
it up whatever is given him, it is generally fatal; as it indicates,
that a mortification of the bowel is already formed. Some au-
thors have advifed to join cathartic medicines with an opiate in
inflammation of the bowels, as recommended in colica faturnina.
This may fucceed in llighter cafes, but is a dangerous practice
in gc ;ice} if the obftruction be not removed by the e-

vacuation, the itimulus of the opium is liable to increafe the
action of die veflels, and produce mortification of the bowel, as
I think I have fcen more than once. Mercury injected by the
anus, or water by a forcing-pump. See Ileus I. 3. i. 6.

12. Hepatitis. Inflammation of the liver is attended with
Itrong quick pulfe j tenfion and pain of the right fide ; often
pungent as in pleurify, oftener dull. A pain is laid to afreet
the clavicle, and top of the right fhoulder ; with difficulty in ly-
ing on the left fide ; difficult refpiration ; dry cough j vomiting ;
hiccough.

There is another hepatitis mentioned by authors, in which the
fever, and other fymptoms, are wanting, or are lefs violent ; as
defcribed in Clafs II. i. 4. n. and which is probably fome-
times relieved by eruptions of the face -, as in thofe who are ha-
bituated to the intemperate ufe of fermented liquors.

M. M. Hepatic inflammation is very liable to terminate in
fuppuration, and the patient is deftroyed by the continuance of
a fever with lizy blood, but without night fweats, or diarrhoea,
as in other unopened abfceifes. Whence copious and repealed
venefeclion is required early in the difeafe, with repeated dofes
of calomel, and cathartics. Warm bath. Towards the end of
the difeafe fmall dofes of opium before the evening paroxyims,

and

17$ DISEASES CLASS II. . r. 2. 13,

and Jaftly the Peruvian bark, and chalybeate wine, at firft in
finall dofes, as 20 drops twice a day, and afterwards, if neceflii-
ry, in larger. See Art. IV. 2. 6.

Towards the end of hepatitis, after repeated venefe£lion and
catharfis, an eruption fometimes appears round the lips, which
is generally a falutary fymptom : and the decoction of Peruvian
bark given at this time, in the quantity of about two ounces ev-
ery fix hours, removes the remaining inflammatory tendency,
and cures in a day or two.

Mrs. C. a lady in the laft month of her pregnancy, was feiz-
ed with violent hepatiti «, with fymptoms both of peripneumony
and of pleurify, for it felclom happens in violent inflammations,
that one vifcus alone is affected ; (he wanted then about a fort-
night of her delivery, and after frequent venefeftion, with gen-
tle cathartics, with fomentation or warm bath, fhe recovered and
was fofely delivered, and both herfelf and child did well. Rheu-
matic and eruptive fevers are more liable to induce abortion.

13. Splenitis. Inflammation of the fpleen commences with
tenfion, heat, and tumour of the left fide, and with pain, which
is icreafed by pretTure. A cafe is defcribed in Clafs I. 2. 3. 18.
where a tumid fpleen, attended with fever, terminated in fcir-
rhus of that vifcus.

14. Nephritis. Inflammation of the kidney feems to be of
two kinds ; each of them attended with different fymptoms, and
different modes of termination. One of them I fuppofe to be
an inflammation of the external membrane of the kidney, ari-
fmg from general caufes of inflammation, and accompanied with
pain in the loins without vomiting ; and the other to confift in an
inflammation of the interior parts of the kidney, occafioned by
the ftimulus of gravel in the pelvis of it, which is attended with
perpetual vomiting, with pain along the courfe of the ureter, and
retraction of the teflis on that fide, or numbnefs of the thigh.

The former of the fe kinds of nephritis is diftinguifhed from
lumbago by its fituation being more exactly on the region of the
kidney, and by its not being extended beyond that part ; after
three or four days I believe this inflammation is liable to change
place ; and that a herpes or eryfipelas, called zona, or (hingles,
breaks out about the loins in its (lead j at other times it is cured
by a cathartic with calomel, with or without previous venefec-
tion.

The other kind of nephritis, or inflammation of the interior
part of the kidney, generally arifes from the pain occafioned by
the ftimulus of a ftone entering the ureter from the pelvis of the
kidney ; and which ceafes when the ftone is protruded forwards
into the bladder j or when it is returned into the pelvis of the

kidney

CLASS IL i. 2. i$. OF SENSATION. 177

kidney by the retrograde action of the1 ureter. The kidney is
neverthelefs inflamed more frequently, though in a lefs degree,
from other caufes ; efpecially from the intemperate ingurgitation
cf ale, or other fermented or fpirituous liquors. This lefs de-
gree of inflammation is the caufe of gravel, as that before men-
tioned is the effect of it. The mucus fecreted to lubricate the
internal furface of the uriniferous tubes of the kidney becomes
fecreted in greater quantity, when thefe veflels are inflamed ; and,
as the correipondent abforbent veflels aft more energetically at
the fame time, the abforption of its more fluid parts is more
powerfully affected ; on both thefe accounts the mucus becomes
both changed in quality and more indurated. And in this man-
ner ftones are produced on almoft every mucous membrane of
the body •, as in the lungs, bowels* and even in the pericardium,
as fome writers have affirmed. See Clafs I. i. 3. 9.

M. M. Venefjeftion. Ten grains of calomel given in fmall
pills, then infufion of fena with oil. Warm bath. Then opi-
um a grain and half. See Clafs I. I. 3. 9. for a further ac-
count of the method of cure.

i^.CyJlitis. Inflammation of the bladder is attended with
tumor and pain of the lower part of the belly ; with difficult
and painful micturition ; and tenefmus. It generally is produ-
ced by the exiftence of a large ftone in the bladder, when in a
great degree ; or is produced by -common caufes, when in a
ilighter degree.

The ftone in the bladder is generally formed in the kidney,
and pafling down the ureter into the bladder becomes there grad-
ually increafed in fize ; and this moft frequently by the appofi-
tion of concentric fpheres, as may be feen by few ing fome of
the harder calculi through the middle, and polifhing one furface.
Thefe new concretions fuperinduced on the nucleus, which de-
fcended from the kidney, as defcribed in Clafs I. i. 3. 9. and in
the preceding article of this genus, is not owing to the micro-
cofmic fait, which is often feen to adhere to the fides of cham-
ber-pots, as this is foluble in warm water, but to the mucus of
the bladder, as it rolls along the internal furface of it. Now
when the bladder is (lightly inflamed, this mucus of its internal
furface is fecreted in greater quantity, and is more indurated
by the abforption of its more liquid part at the inftant of fecre-
tion, as explained in Clafs I. i. 3. 9. and II. i. 2. 14. and
thus the ftiniuius and pain of a ftone in the bladder contribute
to its enlargement by inflaming the interior coat of it.

M. M. Venefec\ion. Warm bath. Diluents. Anodyne
clyfters. See Cfcfs I. i. 3. 9.

1 6. Hyjleritis. Inflammation of the womb is accompanied

VOL. II. Z

278 DISEASES CLASS IL 2. i. 17.

with heat, tenfion, tumour, and pain of the lower belly. The
os uteri painful to the touch. Vomiting. This difeafe is gen-
erally produced by improper management in the delivery of
pregnant women. I knew an unfortunate cafe, where the pla-
centa was left till the next day ; and then an unfkilful accouch-
eur introduced his hand, and forcibly tore it away ; the confe-
quence was a moft violent inflammatory fever, with hard throb,
bing pulfe, great pain, very fizy blood, and the death of the pa-
tient. Some accoucheurs have had a practice of introducing
their hand into the uterus immediately after the birth of the
child, to take away the placenta j which they faid was to fave
time. Many women I believe have been victims to this unnat-
ural practice.

Others have received injury, where inflammation has been
beginning, by the univerfal practice of giving a large dofe of o-
pium immediately on delivery, without any indication of its
propriety ; which, though a proper and ufeful medicine, where
the patient is too feeble, when given in a fmall dofe, as 10
drops of tincture of opium, or half a grain of folid opium, muffc
do a proportionate injury, when it is given improperly ; and as
delivery is a natural procefs, it is certainly more wife to give no
medicines, except there be fome morbid fymptom, which re-
quires it ; and which has only been introduced into cuftom by
the ill-employed activity of the priefts or prieftefles of LUCINA ;
like the concomitant nonfenfe of cramming rue or rhubarb into
the mouth of the unfortunate young ftranger, who is thus foon
made to experience the evils of life. See Clafs II. I. I. 12.
and I. i. 2. 5. Juft fo fome over-wife beldames force young
ducks and turkeys, as foon as they are hatched, to fwallow a
pepper corn.

M. M. Venefection repeatedly ; diluents ; fomentation ; the
patient mould be frequently railed up in bed for a fhort time,
to give opportunity of difcharge to the putrid lochia ; mucilag-
inous clyfters. See Febris Puerpera.

17. Lumbago fenfitiva. Senfitive lumbago. When the exten-
five membranes, or ligaments, which cover the mufcles of the
back are torpid, as in the cold paroxyfm of ague, they are attend-
ed with pain in confequence of the inaction of the veflels, which
compofe them. When this inaction continues without a confe-
vjuent renewal or increafe of activity, the difeafe becomes chron-
ical, and forms the lumbago frigida, or irritativa defcribed in
Clafs I. 2. ,4. 1 6. But when this cold fit or torpor of thefe
membranes, or ligaments or mufcles of the back, is Succeeded by
a hot fit, and confequent inflammation, a violent inflammatory
fever, with great pain, occurs, preventing the erect pofture of

the

CLASS II. i. 2. 1 8. OF SENSATION. 179

the body, and the affected part is liable to fuppurate, in which
cafe a very dangerous ulcer is formed, and a part of one of the
vertebrae is generally found carious, and the patient finks after a
long time under the hectic fever occafioned by the aerated or
oxygenated matter.

This difeafe bears no greater analogy to rheumatifm than the
inflammation of the pleura, or any other membranous inflam-
mation 5 and has therefore unjuftly been arranged under that
name. It is diftinguiflied from nephritis, as it is feldom attend-
ed with vomiting, I fuppofe never, except the ureter happens
to be inflamed at the fame time.

The pain fometimes extends on the outfide of the thigh
from the hip to the ankle, heel, or toes, and is then called fci-
atica ; and has been thought to confift in an inflammation of the
theca, or covering of the fciatic nerve, as the pain fometimes fo
exactly attends the principal branches of that nerve. See Clafs
I. 2. 4. 15. 16.

M. M. Venefection repeatedly ; calomel ; gentle cathartics ;
diluents ; warm bath ; poultice on the back, confirming of camo-
mile flowers, turpentine, foap, and opium j a burgundy-pitch
plafler. A debility of the inferior limbs from the torpor of the
mufcles, which had previoufly been too much excited, frequent-
ly occurs at the end of this difeafe ; in this cafe electricity, and
iffues on each fide of the lumbar vertebra, are recommended. See
Clafs I. 2. 4. 1 6.

1 8. Ifchias. The ifchias confifts of inflammatory fever, with
great pain about the pelvis, the os coccygis, and the heads of the
thigh-bones, preventing the patient from walking or (landing
erect, with increafe of pain on going to ftool. This malady, as
well as the preceding, has been afcribed to rheumatifm ; with
which it feems to bear no greater analogy, than the inflamma-
tions of any other membranes.

The patients are left feeble, and fometimes lame after this
difeafe ; which is alfo fometimes accompanied with great flow
of urine, owing to the defective abforption of its aqueous parts ;
and with confequent thirft occafioned by the want of fo much
fluid being returned into the circulation ; a lodgment of faeces
in the rectum fometimes occurs after this complaint from the
leflened fenfibility of it. See Clafs I. 2. 4. i$.

M. M. Venefection ; gentle cathartics ; diluents ; fomenta-
tion ; poultice with camomile flowers, turpentine, foap, and
opium; afterwards the bark. See Clafs I. i. 3. 5.

When this inflammation terminates in fuppuration the matter
generally can be felt to fluctuate in the groin, or near the top of
the thigh. In this circumftance, my friend Mr. Bent, furgeon,

near

1 8* DISEASES CLASS II. i. 2. 19.

near Newcaftle in Stafford (hire, propofes to tap the abfcefs by
means of a trocar, and thus as often as neceffary to difcharge the
matter without admitting the air. Might a weak injection of
wine and water, as in the hydrocele, be ufed with great caution
to inflame the walls of the abfcefs, and caufe them to unite ?
SeeClafsII. 1.6.9.

T 9. Paronychia interna. Inflammation beneath the finger-nail.
The pain occafioned by the inflammatory action and tumor of
parts bound down between the nail on one fide and the bone on
the other, neither of which will yield, is faid to occafion fo much
pain as to produce immediate delirium, and even death, except
the parts are divided by a deep incifion ; which muft pafs quite
through the periofteum, as the inflammation is faid generally to
exift beneath it. This difeafe is thus refembled by the procefs
of toothing in young children ; where an extraneous body lodged
beneath the periofteum induces pain and fever, and fometimes
delirium, and requires to be fet at liberty by the lancet.

GRDO

CLASS II. i . 3. OF SENSATION, I g i

ORDO i.

Increafed Senfation.
GENUS III.

With the Production of new Veffeh by external Membranes of
Glands i with Fever.

THE difeafes of this genus are perhaps all produ&ive of con-
tagious matter •, or which becomes fo by its expofure to the air,
either through the cuticle, or by immediate contact with it ;
fuch are the matters of the fmall-pox and meafles. The puru-
lent matter formed on parts covered from the air by thicker
membranes or mufcles, as in the preceding genus, does not in-
duce fever; and cannot therefore be called contagious ; but it
acquires this property of producing fever in a few hours, after
the abfcefs has been opened, fo as to admit the air to its furface,
and may then be faid to confift of contagious miafmata. This
kind of contagious matter only induces fever, but does not pro-
duce other matter with properties fimilar to its own ; and in
this refpecT: it differs from the contagious miafmata of fmall-pox
or meafles, but refembles thofe which have their origin in crowd-
ed jails ; for thefe produce fever only, which frequently de-
flroys the patient ; but do not produce other matters fimilar to
themfelves j as appears from none of thofe who died of the jail-
fever, caught at the famous black aflizes at Oxford, at the be-
ginning of this century, having infedted their phyficians or at-
tendants.

If indeed the matter has continued fo long as to become pu-
trid, and thus to have given out air from a part of it, it acquires
the power of producing fever -, in the fame manner as if the ul-
cer had been opened, and expofed to the common air ; inftan-
ces of which are not unfrequent. B And from thefe circumftan-
ces it feems probable, that the matters fecreted by the new veflels
formed in all kinds of phlegmons, or puftules, are not conta-
gious, till they have acquired fomething from the atmofphere,
or from the gas produced by putrefaction ; which will account
for fome phenomena in the lues venerea, cancer, and of other
contagious fecretions on the fkin without fever, to be mention-
ed hereafter. See Clafs II. i. 4. 14.

The theory of contagion has been perplexed by comparing it
with fermenting liquors •, but the contagious material is (hewn
in Seclion XXXIII. to be produced like other fecreted matters

by

DISEASES CLASS II. 1.3.

By certain animal motions of the terminations of the vefTels,
Hence a new kind of gland is formed at the terminations of the
reffels in the eruptions of the fmall-pox j the animal motions of
which produce from the blood variolous matter ; as other glands
produce bile or faliva. Now if fome of this matter is introdu-
ced beneath the cuticle of a healthy perfon, or enters the circula-
tion, and excites the extremities of the blood-veffels into thofe
kinds of difeafed motions, by which it was itfelf produced, either
by irritation or affociation, thefe difeafed motions of the extremi-
ties of the veffels will produce other fimilar contagious matter.
See Sect. XXXIII. 2. 5. and 9. Hence contagion feems to be
propagated two ways ; one, by the ftimul us of contagious mat-
ter applied to the part, which by an unknown law of nature ex-
cites the ftimulated veffels to produce a fimilar matter ; as in
venereal ulcers, which thus continue to fpread ; or as when va-
riolous matter is inferted beneath the cuticle ; or when it is
fuppofed to be abforbed, and diffufed over the body mixed with
the blood, and applied in that manner to the cutaneous glands.
The other way, by which contagion feems to be diffufed, is by
fome diilant parts fympathizing or imitating the motions of the
part firft affected j as the ftomach and fkin in the eruptions of
the inoculated fmall-pox, or in the bite of a mad dog ; as treat-
ed of in Sea. XXII. 3. 3.

In fome of the difeafes of this genus, the pulfe is Itrong, full,
and hard, conftituting the fenfitive irritated fever, as defcribed
in the preceding genus ; as in one kind of eryfipelas, which re-
quires repeated venefection. In others the arterial action is
fometimes moderate, fo as to conftitute the fenfitive fever, as in
the inoculated fmall-pox ; where the action of the arteries is
neither increafed by the fenforial power of irritation, as in the
fenfitive irritated fever j nor decreased by the defect of that pow-
er, as in the fenfitive inirritated fever. But in the greateft num-
ber of the difeafes of this genus the arterial action is greatly di-
minilhed in refpect to ftrength, and confequently the frequen-
cy of pulfation is proportionally increafed, as explained in Sect.
XXX1L 2, i. Which is owing to the deficiency of the fenfo-
rial pov/er of irritation joined with the increafe of tnat of fenfa-
tion, and thus constitutes the fenfitive inirritated fever •> as in,
fcarlatina with gangrenous tonfils.

From this great debility of the action of the arteries, there
appears to be lefs of the coagulable lymph or mucus fecreted on
their internal furfaces ; whence there is not only a defect of
that buff or fize upon the blood, which is feen on the furface of
that which is drawn in the fenfitive irritated fever ; but the
blood, as it cools, when it has been drawn into a bafm, fcarcely

coagulates j

CLASS II. t. 3. OF SENSATION. igj

coagulates ; and is faid to be diflblved, and is by fome fuppofed
to be in a (late of actual putrefaction. See Sect. XXXIII. I.
3. where the truth of this idea is controverted. But in the fe-
vers of both this genus and the preceding one, great heat is pro-
duced from the chemical combinations in the iecretions of new
veflels and fluids, and pain or uneafmefs from the diftention of
the old ones -y till towards the termination of the difeafe fenfa-
tion ceafes, as well as irritation, with the mortification of the
affected parts, and the death of the patient.

Dyfenteria, as well as tonfiliitis and aphtha, are enumerated
amongft the difeafes of external membranes, becaufe they are
expofed either to the atmofpheric air, which is breathed and
fwallowed with our food and faliva ; or they are expofed to the
inflammable air, or hydrogen, which is generated in the intef-
tines ; both which contribute to produce or promote the conta-
gious quality of thefe fluids ; as mentioned in Clafs II. i . 6.

It is not fpeaking accurate language, if we fay, that, in the
difeafes of this genus the fever is contagious ; fmce it is the ma-
terial produced by the external membranes which is contagious,
after it has been expofed to air ; while the fever is the confe-
quence of this contagious matter, and not the caufe of it. As
appears from the inoculated fm all-pox, in which the fever does
not commence, till after fuppuration has taken place in the in-
oculated arm, and from the difeafes of the fifth genus of this
order, where contagion exifts without fever. See Clafs II. i.
5. and II. i. 3. 1 8.

The exiftence of contagious miafmata in the atmofphere was
believed even in the time of Homer, and was allegorized under
the title of the arrows of Apollo. See catarrhus contagiofus,
II. i. 3. 6. Of thefe it is probable, that fome contagious mat-
ters are only cliffufed in the atmofphere, as that of the fmall-
pox, as it feems only to infect thofe who are very near the va-
riolous patient ; and feems to be fwallowed with the faliva, and
thence to affect the tonfils. Other contagions may be diffolved
in the atmofphere, as that of the meafles, and of epidemic ca-
tarrhs, which therefore firft affect the membranes of the noftrils
in men, and of the maxillary fmufes alfo in dogs and horfes.

Contagious materials have been alfo believed from remote
antiquity to lodge in the walls of rooms where the fick have
been confined ; as in the wards of hofpitals, jails, {hips, as well
as in the bedding or clothes of the infected. The methods of
purifying infected houfes feem alfo to have been ftudied in the
remote times ; the Levitical law directs the walls of the houfe
of a leprous perfon to be fcraped ; and in. modern times white-

waftiings

184 tolSEASES CLASS II. i. 3.

waftiirigs with li-me and painting with oil have been dtfedted, I
beiieve with great fuccefs.

Mr. Cruickfhank has lately recommended two or three parts
of fulphur with one of nitre to be mixed together, and fet in a
room clofe (hut up, and ignited by dropping a lighted coal up-
on it ; as the nitre will fupply fufficient oxygen to inflame the
fulphur in a clofe apartment, and thus to fill the whole with the
fulphurous vapour 5 fo as to pafs into every minute aperture of
the walls or furniture.

Another means of fweetening the air of hofpitals, where ma-
ny ulcerous patients are crowded together, has been alfo recom-
mended, and might perhaps be ufed with falutary effecl: to re-
ilore the air of play-houfes, churches, clofe parlours, courts of
law, and other places, where many people refort without due
ventilation, which confifts in well mixing four ounces of com-
mon fait with two ounces of pulverized manganefe in a bafm,
to thefe are then to be added about two ounces of water, and af-
terwards three ounces of concentrated fulphuric acid, in fmall
portions ait a time ; and when managed in this way the gas is
faid not to be in the lead offenfive itfelf, and at the fame time
deflroys difagreeable fmells, and perhaps alfo infectious miaf-
mata. Medical Review, No. 32.

The white vapours, not the red ones, of nitrous acid have been
employed with wonderful fuccefs, by Dr. C. Smyth, in the hof-
pital (hips, without removing the patients -, fome fand is made
hot in crucibles, many of which are brought into the rooms to
be fumigated ; in this hot fand is then fet a tea-cup containing
about half an ounce of concentrated vitriolic acid, to which, af-
ter it had acquired a proper heat, an equal quantity of nitre in
powder is gradually added, and the mixture flirred with a glafs
ipatula, till the vapour arifes from it irt confiderable quantity.
The crucible or pipkin is then carried about the wards by the
nurfes or convalefcents, who walk about with them, like incenfe-
pots, in their hands, and by thus fumigating the (hip morning
and night, with the care of warning the beds and clothes, and
expofmg them to the air, the contagion appeared to be quickly
flopped, and the patients already affected foon recovered.

If any metalic vefTel be ufed, the white nitrous vapour be-
comes red, and what was falutary before becomes now noxious,
as is obferved by Mr. Keir, in his letter on this fubjecl, who
adds, that though much vital air is extricated from the mixture,
he rather afcribes its good effect to the known property of ail
mineral acids in flopping the procefles of fermentation and pu-
trefaclion ; as the contagious miafmata are prefurned to confift

of

CLASS II. 1.3.1- OF SENSATION. 185

of animal matter in fome vicious kind of fermentation. Medi«
cui Review, Vol. III. p. 17.

SPECIES.

I. Febris fe nfttiva inirritata. Sensitive inirritated fever. Ty-
phus gravior. Putrid malignant fever. Jail fever. The imme-
diate caufe of this difeafe is the increafe of the fenforial power o!
fenfation, joined with the decreafe of the fenforial power of ir-
ritation ; that is, it confifts in the febris fenfitiva joined with the
febris inirritativa of Clafs I. 2. i. I. as the febris fenfitiva irri-
tata of the preceding geniis confifts of the febris fenfitiva joined
\viththefebrisirritativa of Clafs I. i. i. i. In both which
the words irritata, and inirritata, are defigned to exprefs more
Or lefs irritation than the natural quantity ; and the fame when
applied to fome of the difeafes of this genus.

This fever is frequently accompanied with topical inflamma-
tion, which is liable, if the arterial ftrength is not fupported, to
end in fphacelus ; and as mortified parts, fuch as floughs of the
throat, if they adhere to living parts, foon become putrid from
the warmth and moifture of their fituation ; thefe fevers have
been termed putrid, and have been thought to owe their caufe
to what is only their confequence. In hot climates this fever is
frequently induced by the exhalations of ftagnating lakes or
marfhes, which abound with animal fubftances ; but which in
colder countries produce fevers with debility only, as the quar-
tan ague, without inflammation.

The fenfitive inirritated, or malignant, fever is alfo frequently
produced by the putrid exhalations and ftagnant air in prifons ;
but perhaps moft frequently by contact or near approach of the
perfons who have refided in them. Thefe caufes of malignant
fevers contributed to produce, and to fupport for a while, the
feptic and antifeptic theory of them; fee Seel;. XXXIII. i. 3.
The vibices or bruifes, and petechiae or purples, were believed
to be owing to the diffblved (late of the blood by its incipient
putrefaction ; but hydroitatical experiments have been made,
which mew the fizy blood of the patient in fenfitive irritated or
inflammatory fever, with ftrong pulfe, is more fluid, while it is
warm, than this uneoagulable blood taken in this fenfitive inir-
ritated, or malignant fever ; from whence it is inferred, that thefe
petechiae, and vibices, are owing to the deficient power of abibrp-
lion in the terminations of the veins. See Clafs I. 2. I. 5.

This fenfitive inirritated fever, or typhus gravior, is diftin-
gniihed from the inirritative fever, or typhus mitior, in the ear-
ages of it, by the colour of the {kin ; which in the latter is

VOL. II. A A

1 86 DISEASES CLASS II. i. 3. i,

paler, with lefs heat, owing to the lefs violent action of the ca-
pillaries ; in this it is higher coloured, and hotter, from the great-
er energy of the capillary action in the production of new vef-
fels. In the more advanced (late petechise, and the production
of contagious matter from inflamed membranes, as the aphthae
of the mouth, or ulcers of the throat, diftinguim this fever from
the former. Delirium, and dilated pupils of the eyes, are more
frequent in nervous fevers *, and ftupor with deafnefs a more
frequent attendant on malignant fevers. See Clafs I. 2. 5. 6.

There is another criterion difcernible by the touch of an ex-
perienced finger ; and that is, the coat of the artery in inflamma-
tory fevers, both thofe attended with ftrength of pulfation, and
thefe with weak pulfation, feels harder, or more like a cord ;
for the coats of the arteries in thefe fevers are themfelves infla-
med and are confequently turgid with blood, and thence are lefs
eafily comprefled, though their pulfations are neverthelefs weak :
when the artery is large or full with an inflamed coat, it is called
hard ; and when fmall or empty with an inflamed coat, it is
called fharp, by many writers.

M. M. The indications of cure confift, i. In procuring a
regurgitation of any ofFenfive material, which may be lodged in
the long mouths of the lacteals or lymphatics, or in their tumid
glands. 2. To excite the fyftem into necellary action by the
repeated exhibition of nwtrientia, forbcntia, and incitantia ; and
to preferve the due evacuation of the bowels. 3. To prevent
any imneceffary expenditure of fenforidl power. 4. To prevent
the formation of ulcers, or to promote the abforption in them,
for the purpofe of healing them.

1. One ounce of wine of ipecacuanha, or about ten grains of
the pow'der, ihould be given as an emetic. After a few hours-
three or four grains of calomel iliould be given in a little mu-
cilage, or conferve. Where fomething fwallowecfinto the ftom-
ach is the caufe of the fever, it is liable to be arrefted by the lym-
phatic glands, as the matter of the fmall-pox inoculated in the arm
is liable to be Hopped by the axillary lymphatic gland ; in this
fituation it may continue a day or two, or longer, and may be
regurgitated during the operation of an emetic or cathartic into
the ftomach or bowel, as evidently happens on the exhibition of
calomel, as explained in Seel. XXIX. 7. 2. For this reafon
an enietic and cathartic, with venefection, if indicated by the
hardneis and fulnefs of the pulfe, will very frequently remove
fevers, if exhibited on the firft, fecond, or even third day.

2. Wine and opium, in fmall dofes repeated frequently, but
fo that not the leal! degree of intoxication follows, for in that
cafe a greater degree of debility is produced jroni the expendi-
ture

CLASS II. i. 3. i. OF SENSATION. 187

ture of fenforial power in unneceflary motions. Many weak
patients have been thus ftimulated to death. See Se<fh Xfl. 7.
S. The Peruvian bark ihould be given alfo in repeated doles
in fuch quantity only as may ftrengthen digeftion, not impede
it. For thefe purpofes two ounces of wine, or of ale, or cyder,
fhould be given every fix hours ; and two ounces of decoction
of bark, with two drachms of the tincture of bark, and fix drops
of tincture of opium, fhould be given alfo every fix hours alter-
nately ; that is, each of them four times in twenty-four hours.
As much rhubarb as may induce a daily evacuation, Ihould be
given to remove the colluvies of indigefted materials from the
bowels ; which might otherwife increafe the diftrefs of the pa-
tient by the air it gives out in putrefaction, or by producing
a diarrhoea by its acrimony ; the putridity of the evacuations
is owing to the total inability of the dige (live ^powers ; and their
delay in the interlines, to the inactivity of that canal in refpect
to its perifbltic motions.

The quantities of wine or beer and opium, and bark, above-
mentioned, may be increafed by degrees, if the patient feems
refrefhed by them ; and if the pulfe becomes flower on their
exhibition ; but this with caution, as I have, feen irrecover-
able mifchief done by greater quantities both of opium, wine,
and bark, in this kind of fever ; in which their ufe is to ftrength-
en the drgeftion of the weak patient, rather than to flop the par-
oxyfms of fever ; but when they are adminiftered in intermit-
tents, much larger quantities are necefTary.

The ftimulus of fmall blifters applied in fucceffion, one every
three or four days, when the patient becomes weak, is of great
fervice by flrengthening digeftion, and by preventing the cokl-
nefs of the extremities, owing to the fympathy of the fkin with
the flomach, and of one part of the fkin with another.

In refpect to nutriment, the patient mould be fupplied with
wine and water, with toafted bread, and fugar or fpice in it ; or
with fago with wine ; frefh broth with turnips, cellery, parfley,
fruit ; new milk. Tea with cream and fugar ; bread-pudding,
with lemon-juice and fugar ; chicken, fifh, or whatever is grate-
ful to the palate of the fick perfon, in fmall quantity repeated fre-
quently ; with fmall beer, cyder and water, or wine and water,
for drink, which may be acidulated with acid of vitriol in fmall
quantities.

3. All unneceflary motions are to be checked, or prevented.
Hence horizontal pofture, obfcure room, filence, cool air. All
the parts of the fkin, which feel too hot to the hand, mould be
expofed to a current of cool air, or bathed with cold water,
whether there are eruptions on it or not. Warn the patient

twice

x«8 DISEASES CLASS II. i. 3.2.

twice, a day with cold vinegar and water, or cold fait and water,
or cold water alone, by means of a fponge. If fome parts are
too cold, as the extremities, while other parts are too hot, as the
face or breaft, cover the cold parts with flannel, and cool the
hot parts by a current of cool air, ^r bathing them as above.

4. For the healing of ulcers, if in the mouth, folution of
alum in water about 40 grains to an ounce, or of blue vitriol
in water, one grain or two to an ounce may be ufed to touch
them with three or four times a day. Of thefe perhaps a folu-
tion of alum is to be preferred, as it inftantly takes away the
flench from ulcers I fuppofe by combining with the volatile al-
kali which attends it. For this purpofe a folution of alum of an
ounce to a pint of water mould be frequently injected by means
of a fyringe into the mouth. If there are ulcers on the exter-
nal (kin, fine powder of bark feven parts, and ceruffa in fine
powder one part, mould be mixed and applied dry on the fore,
and kept on by lint, and a bandage.

As floughs in the mouth are frequently produced by the pre-
vious drynefs of the membranes which line it, this drynefs mould
be prevented by frequently moiftening them, which may be ef-
fected by injection with a fyringe, or by a moift fponge, or laft-
ly in the following manner. Place a glafs of wine and water,
or of milk and fugar, on a table by the bedfide, a little above the
level of the mouth of the patient; then, having previoufly moif-
tened a long piece of narrow lifting, or cloth, or flannel, with
the fame liquor, leave one end of it in the glafs, and introduce
the other into the mouth of the patient ; which will thus be fup-
plied with a conftant oozing of the fluid through the cloth,
which acts as a capillary fyphon.

The vifcid phlegm, which adheres to the tongue, mould be
coagulated by fome auflere acid, as by lemon-juice evaporated
to half its quantity, or by crab-juice ; and then it may be fcra-
ped off by a knife, or rubbed off by flannel, or a fage-leaf dipped
in vinegar, or in fait and water.

2. Eryjipelas. St. Anthony's fire may be divided into three
kinds, which differ in their method of cure, the irritated, the in-
irritated, and the fenfitive eryfipelas.

Eryfipelas irritatum is attended with increafe of irritation be-
lides increafe of fenfation ; that is, with ftrong, hard and full
pulfe, which requires frequent venefection, like other inflam-
mations with arterial ftrength. It is diftinguifhed from the
phlegmonic inflammations of the laft genus by its fituation on
the external habit, and by the rednefs, heat, and tumour, not be-
ing distinctly circumfcribed ; fo that the eye or finger cannot
exactly trace the extent of them.

Whcg

GLASS II. i. 3. 2. OF SENSATION. 189

When the external ikin is the feat of inflammation, and pro-
duces fenfitive irritated fever, no collection of matter is formed,
as when a phlegmon is fituated in the cellular membrane beneath,
the fkin 5 but the cuticle rifes as beneath a blifter-plafter, and
becomes ruptured ; and a yellow material oozes out, and be-
comes infpifiated, and lies upon its fur face ; as is feen in this
kind of eryfipelas, and in the confluent f mall-pox ; or if the new
vefleis are reabforbed the cuticle peels off in fcales. This differ-
ence of the termination of eryfipelatous and phlegmonic inflam-
mation feems to be owing in part to the lefs diftenfibility of the
cuticle than of the cellular membrane, and in part to the ready
exhalation of the thinner parts of the fecreted fluids through its
pores.

This eryfipelas is generally preceded by a fever for two or
three days before the eruption, which is liable to appear in fome
places, as it declines in others ; and feems frequently to arifc
from a previous fcratch or injury of the fkin ; and is attended
ibmetimes with inflammation of the cellular membrane beneath
the fkin ; whence a real phlegmon and collection of matter be-
come joined to the eryfipelas, and either occafion or increafe
the irritated fever, which attends it.

There is a greater fympathy between the external fkin and
the meninges of the brain, than between the cellular membrane
and thofe meninges •, whence eryfipelas is more liable to be pre-
ceded, or attended, or fucceeded, by delirium than internal
phlegmons. I except the mumps, or parotitis, defcribed below ;
which is properly an external gland, as its excretory duel: opens
into the air. When pain of the head or delirium precedes the
cutaneous eruption of the face, there is fome reafon to believe,
that the primary difeafe is a torpor of the meninges of the brain ;
and that the fucceeding violent aftion is transferred to the fkin
of the face by fenfitive affociation ; and that a fimilar fympathy
occurs between fome internal membranes and the Ikin over them,
when eryfipelas appears on other parts of the body. If this cir-
cumftance mould be fupported by further evidence, this difeafe
fhould be removed into Clafs IV. along with the rheumatilin
and gout. See Clafs IV. 1.2. 17.

This fuppofed retropulfion of eryfipelas on the brain from
the frequent appearance of delirium, has prevented the free ule
of the lancet early in this difeafe to the deftruftion of m.iny;
as it has prevented the fubduing of the general nfiamm^
and thus has in the end produced the particular one on the
brain. Mr. B , a delicate gentleman about fixty, Ir.id an ery-
fipelas beginning near one ear, and extending by degrees over
the whole head, with hard, full, and itrongpuilc ; blood was ta-
ken

190 DISEASES CLASS II. i. 3. 2.

ken from him four or five times in confiderable quantity, with
gentle cathartics, with calomel, diluents, and cool air, and he
recovered without any figns of delirium, or inflammation of the

meninges of the brain. Mr. W , a ftrong corpulent

man of inferior life, had eryfipelas over his whole head, with
ftrong hard pulfe : he was not evacuated early in the difeafe
through the timidity of his apothecary, and died delirious. Mrs.

f had eryfipelas on the face, without either ftrong or weak

pulfe ; that is, with fenfitive fever alone, without fuperabun-
dance or deficiency of irritation ; and recovered without any but
natural evacuations. From thefe three cafes of eryfipehs on the
head, it appears that the evacuations by the lancet muft be ufed
with courage, where the degree of inflammation requires it ;
but not where this degree of inflammation is fmall, nor in the
eryirpelas attended with inirritation, as defcribed below.

M. M. Venefeclion repeated according to the degree of in-
flammation. An emetic. Calomel, three grains every other
night. Cool air. Diluents, emetic tartar in fmall dofes, as a
quarter of a grain every fix hours. Tea, weak broth, gruel, lem-
onade, neutral falts. See Seel. XII. 6.

Such external applications as carry away the heat of the fldn
may be of fervice, as cold water, cold flour, fnow, ether. Be-
caufe thefe applications impede the exertions of the fecerning
Teflels, which are now in too great a£Hon ; but any applica-
tions of the ftimulant kind, as folutions of lead, iron, copper,
or of alum, ufed early in the difeafe, muft be injurious •, as they
ftimulate the fecerning veffels, as well as the abforbent veflels,
into greater action ; exactly as occurs when ftimulant eye wa-
ters are ufed too foon in ophthalmy. See Clafs II. 1.2. 2.
But as the cuticle peels offin this cafe after the inflammation ceaf-
es, it differs from ophthalmy ; and ftimulant applications are
not indicated at all, except where fymptoms of gangrene appear.
For as a new cuticle is formed under the old one, as under a blif-
ter, the ferous fluid between them is a defence to the new cuti-
cle, and mould dry into a fcab by exhalation rather than be re-
abforbed. Hence we fee how greafy or oily applications, and
even how moift ones, are injurious in eryfipelas ; becaufe they
prevent the exhalation of the ferous effufion between the old
and new cuticle, and thus retard the formation of the latter.

Eryfipelas inirritatum differs from the former in its being at-
tended with weak pulfe, and other fymptoms of fenfitive inir-
ritated fever. The feet and legs are particularly liable to this
eryfipelas, which precedes or attends the fphacelus or mortifica-
tion of thofe parts. A great and long coldnefs firft affects the
limb, and die eryfipelas on the fldn feems to occur in confe-

quence

CLASS II. i. 3. 2. OF SENSATION. 191

quence of the previous torpor of the interior membranes. As
this generally attends old age, it becomes more dangerous in
proportion to the age, and alto to the habitual intemperance of
the patient in refpecl: to the ufe of fermented or fpirituous liquor.

When the former kind, or irritated eryfipelas, continues long,
the patient becomes fo weakened as to be liable to all the fymp-
toms of this inirritated eryfipelas; efpecially where the menin-
ges of the brain are primarily affected. As in that cafe, after
two or three efforts have been made to remove the returning
periods of torpor of the meninges to the external {kin, thofe
meninges become inflamed themfelves, and the patient finks un-
der the difeafe ; in a manner (imilar to that in old gouty patients,
where the torpor of the liver or ftomach is relieved by afTocJa-
tion of the inflammation of the membranes of the feet, and then
of other joints, and laftly the power of aflbciation ceafing to a6t,
but the excefs of fenfation continuing, the liver or ftomach re-
mains torpid, or becomes itfelf inflamed, and the patient is de-
ftroyed.

M. M. Where there exifts a beginning gangrene of the ex-
tremities, the Peruvian bark, and wine, and opium, are to be
given in large quantities *, fo as to ftrengthen the patient, but
not to intoxicate, or to impede his digeftion of aliment, as men-
tioned in the firft fpecies of this genus. Clafs II, i. 2. I. But
where the brain is inflamed or opprefled, which is known either
by delirium, with quick pulfe ; or by ftupor, and flow refpira-
tion with flow pulfe ; other means muft be applied. Such as,
firft, a fomentation on the head with warm water, with or with-
out aromatic herbs, or fait in it, mould be continued for an hour
or two at a time, and frequently repeated. A blifter may alfo
be applied on the head, and the fomentation neverthelefs occa-
fionally repeated. Internally very gentle ftimulants, as camphor
one grain or two in infufion of valerian. Wine and water, or
fmall beer, weak broth. An enema. Six grains of rhubarb and
one of calomel. Afterwards five drops of tin£lure of opium,
which may be repeated every fix hours, if it feems of fervice.
Might the head be bathed for a minute with cold water ? or
•with ether ? or vinegar ?

Eryfipelas fenfttivitm is a third fpecies, differing only in the kind
of fever which attends it, which is fimply inflammatory, or fen-
fitive, without either excefs of irritation, as in the firft variety ;
or the defect of irritation, as in the fecond variety : all thefe
kinds of eryfipelas are liable to return by periods in fome people,
who have pafled the middle of life, as at periods of a lunation,
or two lunations, or at the equinoxes. When thefe periods of
eryfipelas happen to women, they feem to fupply the phce of

the

ip-2 DISEASES CLASS II. i. 3. 3.

the receding catamen;a ; when to men, I have fometimes be-
lieved them to be aflbciated with a torpor of the liver ; as they
generally occur in thole who have drunk vinous fpirit excefTive-
ly, though not opprobrioufly ; and that hence they fupply the
place of periodical piles, or gout, or gutta rofea.

M. M. As the fever requires no management, the difeafe
takes its progrefs fafely, like a moderate paroxyfm of the gout ;
but in .this cafe, as in fome of the former ; the eryfipelas does
not appear to be a primary difeafe, and ihould perhaps be re-
moved to the Clafsof Aflbciation.

3. Tonfillitis. Inflammation of the tonfils. The uncouth term
Cynanche has been ufed for difeafes fo diffimilar, that I have di-
vided them into Tonfillitis and Parotitis •, and hope to be excufed
for adding a Greek termination to a Latin word, as one of thofe
languages may juftly be confidered as a dialecl: of the other.
By tonfillitis the inflammation of the tonfils is principally to be
wnderftood ; but as all inflammations generally fpread further
than the part fir ft affected ; fo, when the fummit of the wind-
pipe is alfo much inflamed, it may be termed tonfillitis trachea-
lis, or croup. See Clafs I. i. 3. 4. and II. I. 2. 4. ; and
when the fummit of the gullet is much inflamed along with the
tonfil, it may be called tonfillitis pharyngea, as defcribed in Dr.
Cullen's Nofologia, Genus X. p. 92. The inflammation of the
tonfils may be divided into three kinds, which require different
methods of cure.

Tonfillitis internet. Inflammation of the internal tonfil. When
the fwelling is fo confiderable as to produce difficulty of breath-
ing, the fize of the tonfil fhould be diminifhed by cutting it with
a proper lancet, which may either give exit to the matter it con-
tains, or may make it lefs by discharging a part of the bleed.
This kind of angina is frequently attended with irritated fever
befides the fenfitive one, which accompanies all inflammation,
and fometimes requires venefeclion. An emetic fhould be giv-
en early in the difeafe, as by its inducing the retrograde aclion
of the veflels about the fauces during the naufea it oecafions, it
may eliminate the very caufe of the inflammation ; which may-
have been taken up by the abforbents, and flill continue in the
mouths of the lymphatics or their glands. The patient mould
then be induced to fwallow fome aperient liquid, as an infuGon
of fenna, fo as to induce three or four evacuations. Gargles of
all kinds are rather hurtful, as the action of ufing them is lia-
ble to give pain to the inflamed parts *, but the patients find gre;;!
relief from frequently holding warm water in their mouths, and
putting it out again, or by fyringing warm water into the mouth,
as this acls like a warm bath, or fomentation to the inflamed

part.

CLASS II. i. 3, 3- OF SENSATION. 193

part. Laftly, fome mild ftimulant, as a weak folution of fait
and water, or of white vitriol and water, may be uied to wafli
the fauces with in the decline of the difeafe, to expedite the ab-
forption of the new veflelsj if neceflary, as recommended in
ophthalmy.

Tonftllitis fuperfii-ialis. Inflammation of the fu^-face of the
tonfils. As the tonfils and parts in their vicinity are covered
with a membrane, which though expofed to currents of air, is
neverthelefs conftantly kept moift by mucus and faliva, and is
liable to difeafes of its furface like other mucous membranes, as
well as to fuppuration of the internal fubftance of the gland ;
the inflammation of its furface is fucceeded by imall elevated
puftules with matter in them, which foon diiappears, and the
parts either readily heal, or ulcers covered with Houghs are left:
on the furface.

This difeaie is generally attended with only fenfitive fever,
and therefore is of no danger, and may be dillinguithed with
great certainty from the dangerous inflammation or gangrene
of the tonfils at the height of the fmall-pox, or fcarlet fever, by
its not being attended with other fymptoms of thofe difeafes.
One emetic and a gentle cathartic is generally fumcient ; and the
frequent fwallowing of weak broth, or gruel, both without fait
in them, relieves the patient, and abfolves the cure. When
thefe tumours of the tonfils frequently return I have fometimes
fufpetled them to originate from the abforption of putrid matter
from decaying teeth. See Glafs I. 2. 3. 21. and II. 2. 2. I.

Tonftllitis inirritata. Inflammation of the tonfils with fenfi-
tive inirritated fever is a iymptom only of contagion-; fever,
v/hether attended with fcarlet eruption, or with confluent fmall-
pox, or otherwilc. The matter of contagion is generally diff.i-
fed, not dilTolved in the air ; and as this is breathed over the mu.
caginous furface of the tonfils, the contagious atoms are liable
to be arreited by the tonh'l ; which therefore becomes the neit
of the future difeafe, like the inflamed circle round the inocu-
lated pundlure of the arm in fuppoiltious fmall-pox. The fuell-
ing is liable to furTocate the patient in fmali-pox, and to become
gangrenous in fcarlet fever, arid fome other contagious fevers,
which have been received in this manner. The exigence of in-*
{lamination of the tonfil previous to the fcarlet eruption, as ths
arm inflames in the inoculated fmnll-pox, and fuppu-.-acej before:
the variolous eruption, fliould be a criterion of the fcarlet fever
being taken in this manner.

M. M. All the means which ftrengthen the patient, as in

the fenfitive inirritated fever, Ciais II. i. 2. i. As it is li ibb

to continue a whole lunation or more, great attention fliould b-*

Voi,. II. B a Ufed

194 DISEASES CLASS II. i. 3. 4.

ufed to nourifh the patient with acidulous and vinous panada,
broth with vegetables boiled in it, fugar, cream, beer ; all which
given frequently will contribute much to moiften, clean, and heal
the ulcufcles, or floughs, of the throat ; warm water and wine,
or acid of lemon, mould be frequently applied to the tonfils by
means of a fyringe, or by means of a capillary fyphon, as de-
fcribed in Clafs II. i. 2. I. A flight folution of blue vitriolr
as two grains to an ounce, or a folution of fugar of lead of about
fix grains to an ounce, may be of fervice •, efpecially the latter,
applied to the edges of the floughs, drop by drop by means of
a fmall glafs tube, or final! crow-quill with the end cut off, or
by a camePs-hair pencil or fponge \ to the end of either of
which a drop will conveniently hang by capillary attraction ; as
folutions of lead evidently impede the progrefs of eryfipelas on
the exterior {kin, when it is attended with feeble pulfe. Yet a
folution of alum injected frequently by a fyringe is perhaps to
be preferred, as it immediately removes the fetor of the breath,
which rnuft much injure the patient by its being perpetually re-
ceived into the lungs by refpiration.

4. Parotitis. Mumps, or branks, is a contagious inflamma-
tion of the parotis and maxillary glands, and has generally been
clafled under the word Cynanche or Angina, to which it bears
no analogy. It divides itfelf into two kinds, which differ in the
degree of fever which attends them, and in the method of cure.

Parotitis fuppurans. The fuppurating mumps is to be diftin-
guifhed by the acutenefs of the pain, and the fenfitive, irritated,
or inflammatory fever, which attends it.

M. M. Venefectiori. Cathartic with calomel three or four
grains repeatedly. Cool air, diluents. This antiphlogiftic treat-
ment is to be continued no longer than is necefFary to relieve
the violence of the pain, as the difeafe is attended with conta-
gion, and mull run through a certain time, like other fevers
with contagion.

Parotitis mutalilis. Mutable parotitis. A fenfitive fever on-
ly, or a fenfitive irritated fever, generally attends this kind. And
when the tumour of the parotis and maxillary glands fubfides,
n new fwelling occurs in fome diftant part of the fyftem ; as
happens to the hands and feet, at the commencement of the fec-
ondary fever of the fmall-pox, when the tumor of the face fub-
fides. This new fwelling in the parotitis mutabilis is liable to
afreet the tefles in men, and form a painful tumor, which fhould
be prevented from fuppuration by very cautious means, if the
violence of the pain threaten fuch a termination ; as by bathing
the part with coldilh water for a time, venelection, a cathartic j
or by a bliller on the perinDeum,, or fcrotum, or a poultice.

CLASS II. i. 3.' 4- OF SENSATION- W

.When women are affected with this complaint, after the
f welling of the parotis and maxillary glands fubfides, tumor with
pain is liable to affect their breads ; which, however, I have nev-
er feen terminate in fuppuration.

On the retroceflion of the tumor of the teftes above defcribecl,
and I fuppofe of that of the breads in women, a delirium of the
calm kind is very liable to occur ; which in Come cafes has been
the firft fymptom which has alarmed the friends of the patient-;
and it has thence been difficult to difcover the caufe of it with-
out much inquiry ; the previous fymptoms having been fo flight
as not to have occafioned any complaints. In this delirium, if
the pulfe will bear it, venefeclion mould be ufed, and three or
four grains of calomel, with fomentation of the head with warm
water for an hour together every three or four hours.

Though this difeale generally terminates favourably confide.r-
ing the numbers attacked by it, when it is epidemic, yet it is
dangerous at other times in every part of its progrefs. Some,
times the parotis or maxillary glands fuppurate, producing ul-
cers which are difficult to cure, and frequently deflroy the pa-
tient, where there was a previous fcrophulous tendency. The
teftis in men is alfo liable to fuppurate with great pain, long con-
finement, and much danger ; and ladly, the affection of the
brain is fatal to many.

Mr. W. W. had a fwelled throat, which after a few days
fubfided. He became delirious or ftupid, in which date he was
dying wAen I faw him ; and his friends afcribed his death to a
coup de foleil, which he was faid to have received fome months
before, when he was abroad.

Mr. A. B. had a fwelling of the throat, which after a few
days fubfided. When I faw him he had great dupor, with flow
breathing, and partial delirium. On fomenting his head with
warm water for an 'hour thefe fymptoms of dupor were greatly
leflened, and his opprefied breathing gradually ceafed, and he re-
covered in one day.

Mr. C. D. I found walking about the houfe in a calm delir-
ium without ftupor ; and not without much inquiry of his friends
could get the previous hidory of the difeafe ; which had been
attended with parotitis, and fwelled tedis, previous to the deliri-
um. A few ounces of blood were taken away, a gentle cathar-
tic was directed, and his head fomented with warm water for
an hour, with a fmall blider on the back, and he recovered in
two or three days.

Mr. D. D. came down from London in the coach alone, fo
that no previous hidory could be obtained. He was walking a-
bout the houfe in a calm delirium, but could give no fenfible

anfwerf

r DISEASES CLASS II. j. 3. 5.'

anfwers to anything which was propofed to him.. His pulfe
was weak and quick. Cordials, a blifter, the bark, were in vain
exhibited, and he died in two or three days.

Mr. F. F. came from London in the fame manner in the
coach. He was mildly delirious with confiderable ftupor, and
moderate pulfe, and could give no account of hirnfelf. He con-
tinued in a kind' of cataleptic ftupor, fo that he would remain
for hours in any pofture he was placed, either in his chair, or
in bed ; and did not attempt to fpeak for about a fortnight, and
then gradually recovered. Thefe two laft cafes are not related
as being certainly owing to parotitis, but as they might probably
liave that origin'.

The parotitis fuppurans, or mumps with irritated fever, is at
times epidemic among cats, and may be called parotitis fe Una ; as
I have reafon to believe from the fwellings under the jaws,
which frequently fuppurate, and are very fatal to thofe animals;
In the village of Hay wood, in S taffordflnre, I remember a
whole breed of Perfian cats, with long white hair, was deftroy-
ed by this malady, along with almoft all the common cats of the
neighbourhood ; and as the parotitis or mumps had not long b^-
fbre prevailed amongft human beings in that part of the coun-
try, I recollect being inclined to believe, that the cats received
the infection from mankind ; though in all other contagious dif-
eafes, except the rabies canina can be fo called, no different gen--
era of animals naturally communicate infection to each other ;
and I am informed, that vain efforts have been made to commu-
nicate the fmall-pox and meafles to fome quadrupeds by inocu-
lation. A difeafe of the head and neck deftroyed almoft all the
cats in Weftphalia. Savage, Nofol. Clafs X. Art. 30. 8.

Since the above was firft published, the cow-pox, variolse vac-
cinse, has been fuccefsfully inoculated on the human fubject,
and produced a difeafe in fome refpects fimilar to the fmall-pox;
See Variolse.

5. Catarrhus fenjitivtis confifts of an inflammation of the
membrane, which lines the noftrils and fauces. It is attended
•with fenfitive fever alone, and is cured by the fteani of warm
water externally, and by diluents internally, with moderate ven-
e fection and gentle cathartics. This may be termed catarrhus
fenfitivus, to diftinguifh it from the catarrhus contagiofus, and
is in common language called a violent cold in the head ; it dif-
fers from the catarrhus calidus, or warm catarrh, cf Clafs I. I.
2. 7. in the production of new veflels, or inflammation of the
membrane, and the confequent more purulent appearance of
the difcharge.

Raucedo catarrhalis,or catarrhal hoarfenefs, is a frequent fymp*

tern,

CLASS II. i. 3. C. OF SENSATION. % 197

torn of this difeafe, and is occafioned by the pain or forenefs
M'hich attends the tliickened and inflamed membranes of the
larynx ; which prevents the mufcles of vocality from fufficienr-
ly contracting the aperture of it. It ceafes with the inflamma-
tion, or may be relieved by the fteam of warm water alone, or
of water and vinegar, or of water and ether. See Paralytic
Hoarfenefs, Clafs III. 2. 1.4.

6. Catarrkus contagicfus. This malady attacks fo many at the
fame time, and fpreads gradually over fo great an extent of coun-
try, that there can be no doubt but that it is difieminated by the
atmofphere. In the year 1 782 the fun was for many weeks ob-
fcured by a dry fog, and appeared red as through a common mitt.
The material, which thus rendered the air muddy, probably cauf-
ed the epidemic catarrh, which prevailed in that year, and which
began far in the north, and extended itfelf over all Europe. See
Botanic Garden, Vol. II. note on Chunda, and Vol. I. Canto IV.
line 294, note ; and was fuppofed to have been throws out of.a
volcano, which much difplaced the country of Iceland.

In many inftances there was reafon to believe that this difeafe
became contagious, as well as epidemic ; that is, that one perfon
might receive it from another, as well as by the general unfalu-
tary influence of the atmofphere. This is difficult to compre-
hend, but may be conceived by confidering the increafe of conta-
gious matter in the fmall-pox. In that difeafe one particular of
contagious matter flimulates the fkin of the arm in inoculation
into morbid action fo as to produce a thoufand particles fimilar
to itfelf; the fame thing occurs in catarrh, a few deleterious
atoms ftimulate the mucous membrane of thenoftrils into mor-
bid actions, which produce a thoufand other particles fimilar to
themfelves. Thefe contagious particles difFufed in the air muft
have confided of animal matter, otherwife how could an animal
body by being ftimulated by t].~m produce fimilar particles ?
Could they then have had a volcanic origin, or muft they not rath-
er have been blown from putrid marfhes full of animal matter ?
But the greateft part of the folid earth has been made from ani-
mal and vegetable recrements, which may be difperfed by volca-
noes.— Future difcoveries muftanfwer thefe queftions.

As the fenfitive fever attending thefe epidemic catarrhs is fel-
dom either much irritated or inirritated, venefection is not al-
ways either clearly indicated or forbidden ; but as thofe who
have died of thefe catarrhs have generally had inflamed livers,
with con fequent fuppuration in them, venefection is adviiable,
wherever the cough and fever are greater than common, fo as to
render the ufe of the lancet in the lead dubious. And in fome
cafes a fecond bleeding was necefiary, and a miid cathartic or two

with
• •*
V

DISEASES CLASS II. i. 3. 6.

with four grains of calomel ; with mucilaginous fubacid dilu-
ents •, and warm {team occasionally to alleviate the cough, fin-
iihed the cure.

The catarrhus contagiofus is a frequent difeafe amongfl horf-
cs and dogs ; it feems firft to be difleminated amongft thefe ani-
mals by miafmata difFufed in the atmofphere, becaufe fo many of
them receive it at the fame time j and afterwards to be communi-
cable from cue horfe or dog to another by contagion, as above
defcribcd. Thefe epidemic or contagious catarrhs more fre-
quently occur amongit dogs and horfes than amongil men \
which is probably owing to the greater extenfion and fenfibility
of the mucous membrane, which covers the organ of fmell, and
is difFufed over their v/ide noftrils, and their large maxillary and
frontal cavities. And to this circumftance may be afcribed the
greater fatality of it to thefe animals.

In refpect to horfes, I fufpeft the fever at the beginning to be
of the fenfitive, irritated, or inflammatory kind, becaufe there is
fo great a difcharge of purulent mucus ; and that therefore they
will bear once bleeding early in the difeafe ; and alfo one mild
purgative, confiding of about half an ounce of aloe, and as much
white hard foap, mixed together. They fhould be turned out
to grafs both day and night for the benefit of pure air, unlefs the
weather be too cold (and in that cafe they fhould be kept in an
open airy ftable, without being tied), that they may hang down
their heads to facilitate the difcharge of the mucus from their
noftrils. Grafs (hould be offered them, or other frem vegeta-
bles, as carrots and potatoes, with mafhes of malt, or of oats, and
with plenty of frelh warm or cold water frequently in a day.
When fymptonos of debility appear, which may be known by
the coldnefs of the ears or other extremities, or when iloughs can
be feen on the membrane, which lines the nottrils, a drink
con fi (ting of a pint of ale with half an ounce of tincture of opi-
um in it, given every fix hours, is likely to be of great utility.

In dogs I believe the catarrh is generally joined with fymp-
toms of debility early in the difeafe. Thefe animals fhould be
permitted to go about in the open air, and {hould have conftant
accefs to frefh water. The ufe of being as much as may be in
the air is evident, becaufe all the air, which they breathe, pafT-
es twice over the putrid floughs of the mortified parts of the
membrane, which lines the noftrils, and the maxillary and fron-
tal cavities ; th.it is, both during infpiration and expiration ;
and muft therefore be loaded with contagious particles. Frem
new milk, and frefh broth, fhould be given them very frequently,
and they {hould be fuffered to go amongft the grafs, which they
fometimes eat for the purpofe of an emetic ; raid if poffible fhould

have

:

CLASS II. i. 3. 7. OF SENSATION. 199

have accefs to a running flream of water. As the contagious
mucus of the noftrils, both of thefe animals and of horfes, gener-
ally drops into the water, they attempt to drink. Bits of raw
flefh, if the dog will eat them, are preferred to cooked meat ; and
from five to ten drops of tincture of opium may be given with
advantage, when fymptoms of debility are evident, according ta
the fize of the dog every fix hours. If Houghs can be feen in
the noftrils, they fhould be moiilened twice a day, both in horf-
es and dogs, with a folution of fugar of lead, or of alum, by
means of a fponge fixed on a bit of whale-bone, or by a fyringc.
The lotion may be made by diffolving half an ounce of fugar of
lead, or of alum, in a pint of water.

Ancient philofophers feem to have believed, that the conta-
gious miafmata in their warm climates affected horfes and dogs
previous to mankind. If thofe contagious particles were fup-
pofed to be diffufed amongft the heavy inflammable air, or car-
bonated hydrogen, of putrid marmes, as thefe animals hold their
heads down lower to the ground, they may be fuppofed to have
received them fooner than men. And though men and quadru-
peds might receive a difeafe from the fame fource of marlh-pu-
trefa&ion, they might not afterwards be able to infecl: each other,
though they might infecl: other animals of the fame genus -, as
the new contagious matter generated in their own bodies might
not be precifely fimilar to that received ; as happened in the jail-
fever at Oxford, where thofe who took the contagion and died,
did not infecl others.

On mules and dogs the infection firft began,
And, laft, the vengeful arrows fix'd on man.

Pore's Homer's Iliad, I.

7. Peripneumcnia fuperfidalis . The fuperficial or fpurious
peripneumony confifts in an inflammation of the membrane,
which lines the bronchia, and bears the fame analogy to the true
peripneumony, as the inflammation of other membranes do to
that of the parenchyma, or fubftantial parts of the vifcus, which
they furround. It affecls elderly people, and frequently occa-
fions their death ; and exifts at the end of the true peripneumo-
ny, or along with it; when the lancet has not becji uied fulfi-
• ciently to cure by reabforbing the inflamed parts, or what is term,
ed by refolution.

M. M. Diluents, mucilage, antimonials, warmifh air conftant-
ly changed, venefeclion once, perhaps twice, if the pulfe will
bear it. Oily volatile draughts. Balfams ? Neutral falts in-
creafe the tendency to cough. Blifters in fucceflion about the
cheil. Warm b*ith. Mild purgatives. Very weak chicken

brotfi

200 DISEASES GLASS II. i. 3. 8.

broth without fait in it. Boiled onions. One grain" of cal-
omel every night for a week. From five drops to ten of tintture
of opium at fix every night, when the patient becomes weeL
Digitalis ? See ClafsII. I. 6. 7.

8. PertuJJls. Tuilis convulfiva. Chin-cough refembles pe-
ripneumonia fuperficialis in its confifting in an inflammation of
the membrane which lines the air-veifels of the lungs ; but dif-
fers in the circumftance of its being contagious j and is on that
account of very long duration ; as the whole of the lungs arc
probably riot infecled at the fame time, but the contagious in-
flammation continues gradually to creep on the membrane. It
may in this refpedl: be compared to the ulcers in the pulmonary
confumption ; but it differs in this, that in chin-cough fome
branches of the bronchia heal, as others become inflamed.

This complaint is not ufually clafled amongft febrile diforders,
but a fenfitive fever may generally be perceived to attend it du-
ring fome part of the day, efpecially in weak patients. And a
peripneumony very frequently fupervenes, and deftroys great
numbers of children, except the lancet or four or fix leeches be
immediately and repeatedly ufed. When the child has perma-
nent difficulty of breathing, which continues between the cough-
ing fits ; unlefs blood be taken from it, it dies in two, three, or
four days of the inflammation of the lungs. During this perma-
nent difficulty of breathing, the hooping cough abates, or
quite ceafes, and returns again after once or twice bleeding \
which is then a good fymptom, as the child now poiTeffing the
power to cough (hews the difficulty of breathing to be abated.
I dwell longer upon this, becaufe many lofe their lives from the
difficulty there is in bleeding young children ; where the apoth-
ecary is old or clumfy, or is not furnilhed with a very fharp and
fine pointed lancet. In this diftreffing fituation the application
of four leeches to one of the child's legs, the wounds made by
which mould continue to bleed an hour or two, is a fuccedane^
um j and faves the patient, if repeated once or twice, according
to the difficulty of the refpiration.

The chin-cough feems to refemble the gonorrhoea venerea in
feveral circumftances. They are both received by infection, are
both difeafes of the mucous membrane, are both generally cured
in four or fix weeks without medicine. If ulcers in the cellular
membrane under the mucous membrane occur, they are of a
phagedenic kind, and deftroy the patient in both difeafes, if no
medicine be adminiftered.

Hence the cure mould be fimilar in both thefe difeafes •, firft
general evacuations and diluents, then, after a week or two, I
have believed the following pills of great advantage, The dofe

for

CLASS II. i. 3. 9= OF SENSATION. 201

for a child of about three years old was one-fixth part of a grain
of calomel, one-fixth part of a grain of opium, and two grains
of rhubarb, to be taken twice a day.

The opium promotes abforption from the mucous membrane,
and hence contributes to heal it. The mercury prevents ul-
cers from being formed under the mucous membrane, or cures
them, as in the lues venerea ; and the rhubarb is neceflary to keep
the bowels open.

M. M. Aniimonial vomits frequently re'peated. Mild ca-
thartics. Cool air. Tincture of cantharides, or repeated blif-
ters ; afterwards opiates in fmall dofes, and the bark. Warm
bath frequently ufed. The fleam of warm water with a little
vinegar in it may be inhaled twice a day. Thirty drops of fatu-
rated tincture of digitalis puerpurea, purple foxglove, were giv-
en twice a day to a lady, feventy years of age, in this difeafe,
with great and almofl immediate -advantage. I have fmce giv-
en from five to ten drops twice a day to two children, with alib
great apparent advantage. See Art. IV. 2. 3. 7. Arfenic
has lately been recommended in the hooping cough* See Art.
IV. 2. 6. 9. And externally a folution of 20 grains of emetic
tartar, antimonium tartarifatum, in two ounces of water, to
•which is to be added one ounce of tincture of cantharides, is rec-
ommended, by Dr. Struve of America, to be rubbed very fre-
quently on the region of the ftomach. Could the breathing of
carbonic acid gas mixed with atmofpheric air be of fervice ?
Copious venefetlion, when a difficulty of breathing continues be-
tween the fits of coughing ; otherwife the cough and the expec-
toration ceafe, and the patient is deltroyed. Ulcers of the lungs
fometimes fupervene, and the phthifis nulmonalis in a few
weeks terminates in death. Where the cough continues after
fome weeks without much of the hooping, and a fenfitive fever
daily fupervenes, fo as to referable hectic fever from ulcers of
the lungs ; change of air for a week or fortnight a£ls as a charm,
and reftores the patient beyond the hopes of the phyfician.

Young children fhouldlie with their heads and fhoulders raif-
ed j and mould be conftantly watched day and night j that when
the cough occurs, they may be held up eafily, fo as to ftand upon
theirfeet bending a little forwards ; or nicely Supported in that pof-
ture which they feem to put themfelves into. Abo w of whalebone,
about the fize of the bow of a key, is very ufcful to extract the
phlegm out of the mouths of infants at the time of their coughing ;
as a handkerchief, if applied at the time of their quick inspirations
after long holding their breath is dangerous, and may fuffbcate
he patient in an inftant, as I believe has fome times happened.

9. Variola difcrtta. The imall-pox is well divided by Syden-
II. C c ham

102 DISEASES CLASS II. i. 3. 9.

ham into diftinct and confluent. The former confifls of diftin£t
puftules, which appear on the fourth day of the fever, are cir-
cumfcribed and turgid j the fever ceafmg when the eruption is
complete. Head-ach, pain in the loins, vomiting frequently,
and convulfive fits fometimes, precede the eruption.

The diftinct fmall-pox is attended with fenfitive fever only,
when very mild, as in mod inoculated patients ; or with fenfi-
tive irritated fever, when the difeafe is greater : the danger in
this kind of fmall-pox is owing either to the tumor and forenefs
of the throat about the height, or eighth day of the eruption ;
or to the violence of the fecondary fever. For, firft, as the nat-
ural difeafe is generally taken by particles of the duft of the con-
tagious matter dried and floating in the air, thefe are liable to be
arrelled by the mucus about the throat and tonfils in their paffage
to the lungs, or to the ftomach, when they are previoufly mixed
with faliva in the mouth. Hence the throat inflames like the
arm in inoculated patients ; and this increasing, as the difeafe
advances, deftroys the patient about the height.

Secondly, all thofe upori the face and head come out about
the fame time, namely, about one day before thofe on the hands,
and two before thofe in the trunk ; and thence, when the head
is very full, a danger arifes from the fecondary fever, which is a
purulent not a variolous fever ; for as the matter from all thefe
of the face and head is reabforbed at the fame time, the patient
is deftroyed by the violence of this purulent fever ; which in the
diftinct fmall-pox can only be abated by venefeclion and cathar-
tics j but in the confluent fmall-pox requires cordials and opi-
ates, as it is attended with arterial debility. See Sect. XXXV.
i. and XXXIII. 2. 10.

When the puftules on the face recede, the face fwells ; and
when thofe of the hands recede, the hands fwell ; and the fame
of the feet in fucceffion. Thefe fwellings feem to be owing ta
the abforption of variolous matter, which by its ftimulus excites
the cutaneous veflels to fecrete more lymph, or ferum, or mucus,
exactly as happens by the ftimulus of a blifter. Now, as a blif-
tev fometimes produces ftrangury many hours after it has rifen,
it is plain, that a part of the caritharides is abforbed, and carri-
ed to the neck of the bladder ; whether it enters the circulation,
or is carried thither by retrograde movements of the urinary
branch of lymphntics ; and by parity of reafoning the variolous
matter is abforbed, and fweils the face and hands by its ftimulus.

Variola confluent. The confluent fmall-pox confifts of numer-
ous puilules, which appear on the third day of the fever, flow
to Aether, are irregularly circumfcribed, flaccid, and little eleva-
ted j the fever continuing after the eruption is complete ; con-

vulfions

CLASS II. i. 3. 9. OF SENSATION. 103

vulfions do not precede this kind of fmall-pox, and are To far to
be efteemed a favourable fymptorn.

The confluent fmall-pox is attended with fenfitive inirrritatcd
fever, or inflammation with arterial debility ; whence the
ger of this diieaie is owing to the general tendency to gangrene,
with petechke, or purple fpots, and haemorrhages •, befides the
two fources of danger from the tumor of die throat about the
height, or eleventh day of the eruption, and the purulent fever
after that time ; which are generally much more to be dreaded
in this than in the diltincl fmall-pox described above.

M. M. The method of treatment muft vary with the degree
and kind of fever. Venefeclion may be ufed in the dii.
fmall-pox early in the difeafe, according to the ftrength or harci-
nefs of the pulfe ; and perhaps on the firft day of the confluent
fmall-pox, and even of the plague, before the lenforial power is
exhaulled by the violence of the arterial aclion ? Cold air, and
even wafliing or bathing in cold water, is a powerful means in
perhaps all eruptive difeafes attended with fever ; as the q
tity of eruption depends on the quantity of the fever, and
activity of the cutaneous veflels ; which may be judged of by
the heat produced on the fkin ; and which latter is immediately
abated by expofure to external cold. Mercurial purges, as three
grains of calomel repeated every day during the eruptive fever,
fo as to induce three or four ftools, contribute to abate inflam-
mation ; and is believed by fome to have a fpecific effect on the
variolous, as it is fuppofed to have on the venereal contagion.

It has been faid, that opening the pock and taking out the
matter has not abated the fecondary fever ; but as I had conceiv-
ed, that the pits, or marks, left after the fmall-pox, were owing
to the acrimony of the matter beneath the hard fcabs, which
not being able to exhale eroded the fkin, and produced ulcers,
I directed the faces of two patients in the confluent fmall-pox
to be covered with cerate early in the difeafe, which was daily
renewed ; and I was induced to think, that they had much lefs
of the fecondary fever, and were fo little marked, that one of
them, who was a young lady, almoft entirely preferred her
beauty. Perhaps mercurial plafters, or cerates, made without
turpentine in them, might have been more efficacious in pre-
venting the marks, and efpecially if applied early in the difeafe,
even on the firft day of the eruption, and renewed daily. For
it appears from the experiments of Van Woenfel, that calomel
or corrofive fublimate, triturated with variolous matter, incapaci-
tates it from giving the difeafe by inoculation. Calomel or
fublimate given as an alterative for ten days before inoculation,
and till the eruptive fever commences, is faid with certainty, to

render

204 DISEASES CLASS II. i. 3. 9;

render the difeafe mild by the fame author. Exper. on Mercu-
ry by Van Woenfel, tranflated by Dr. Fowle, Salifbury.

C .DefFarts, in the fitting of the French national inftitute is faid
to have adduced a number of fads to prove, that the natural
fmall-pox is rendered much milder by the ufe of mercurial rem-
edies ; which I fuppofe is probably true, as mercurials increafe
the abforption in many other ulcers, and confequently diminifh
the acrimony of the matter, and forward their healing.

Variola incculata. The world is much indebted to the great
difcoverer of the good effects of inoculation, whofe name is un-
known ; and our own country to lady Wortley Montague for
its introduction into this part of Europe. By inferting the vario-
3ous contagion into the arm, it is not received by the tonfils, as
generally happens, I fuppofe, in the natural fmall-pox ; whence
there is no dangerous fwelling of the throat, and as the puftules
are generally few and diftincl:, there is feldom any fecondary
fever ; whence thofe two fources of danger are precluded 5
hence when the throat in inoculated fmall-pox is much infla-
med and fwelled, there is reafon to believe, that the difeafe had
been previoufly taken by the tonfils in the natural way : which
alfo, I fuppofe, has generally happened, where the confluent
kind of fmall-pox has occurred on inoculation.

I have known two inftances, and have heard of others, where
the natural fmall-pox began fourteen days after the contagion
had been received ; one of thefe inftances was of a countryman,
•who went to a market-town many miles from his home, where
he faw a perfon in the fmall-pox, and on returning the fever
commenced that day fortnight : the other was of a child, whom
the ignorant mother carried to another child ill of the fmall-pox,
on purpofe to communicate the difeafe to it ; and the variolous
fever began on the fourteenth day from that time. So that in
both thefe cafes fever commenced in half a lunation after the
contagion was received. In the inoculated fmall-pox the fever
generally commences on the feventh day ; or after a quarter of
a lunation ; and on this circumftance probably depends the
greater mildnefs of the latter. The reafon of which is difficult
to comprehend ; but fuppofing the facts to be generally as above
related, the flower progrefs of the contagion indicates a greater
inirritability of the fyftem, and in confequence a tendency to
malignant rather than to inflammatory fever. This difference of
the time between the reception of the infection and the fever in
the natural and artificial fmall-pox may neverthelefs depend on
its being inferted into a different feries of veffels ; or to fome un-
known effect of lunar periods. It is a fubject of great curiofity,
and defervcs further inveftigation.

Whca

CLASS II. i. 3. 9. OF SENSATION. 205

When the inoculated fmall-pox is given under all the moil fa-
vourable circumftances, I believe lefs than one in a thoufand
milcarry, which may be afcribed to fome unavoidable accident,
fuch as the patient having previoufly received the infection, or
being about to be ill of fome other difeafe. Thofe which have late-
ly mifcarried under inoculation, as far as has come to my knowl-
edge, have been chiefly children at the breatl ; for in thefe the
habit of living in the air has been confirmed by fo fhort a time,
that it is much eafier deftroyed, than when thefe habits of life
have been eftablifbed by more frequent repetition. See Seel:.
XVII. 3. Thus it appears from the bills of mortality kept in
the great cities of London, Paris, and Vienna, that out of every
thoufand children above three hundred and fifty die under two
years old. (Kirkpatrick on Inoculation.) Whence a ftrong
reafon againft our hazarding inoculation before that age is pafP-
ed, efpecially in crowded towns •, except where the vicinity of
the natural contagion renders it neceflary, or the convenience of
inoculating a whole family at a time ; as it then becomes better
to venture the lefs favourable circumftances of the age of the pa-
tient, or the chance of the pain from toothing, than to rifk the
infection in the natural way.

The mod favourable method confifts in, firft, for a week be-
fore inoculation, reftraining the patients from all kinds of fer-
mented or fpirituous liquor, and from animal food ; and by giv-
ing them from one grain to three or four of calomel every oth-
er day for three times. But if the patients be in any the leaft
danger of taking the natural infection, the inoculation had bet-
ter be immediately performed, and this abftinence then begun ;
and two or three gentle purges with calomel fliould be given,
one immediately, and on alternate days. Thefe cathartics
fhould not induce more than two or three ftools. I have feen
two inftances of a confluent fmali-pox in inoculation following
a violent purging induced by too large a dole of calomel.

Secondly, the matter ufed for inoculation {hould be in a fmall
quantity, and warm, and fluid. Hence it is beft when it can
be recently taken from a patient in the difeafe j or otherwife it
may be diluted with part of a drop of warm water, fince its flu-
idity is likely to occailon its immediate abforption ; and the
wound mould be made as fmall and fuperficial as poilible, as
otherwife ulcers have been fuppofed fometimes to enfue with
fubaxillary abfceiTes. Add to this, that the making two punc-
tures either on the fame or one on each arm, fecures the fuccefs
of the operation in refpeft to communicating the infeclion.

Thirdly, at the time of the fever or eruption, the application
of cool air to thofc parts of the ikin which are too warm, or ap-
pear

26<5 DISEASES CLASS II. i. 3. 9,"

pear red, or are covered with what is termed a rafh, fliould be
ufed freely, as well as during the whole difeafe. And at the
fame time, if the feet or hands are colder than natural, thefe
fhould be covered with flannel. See Clafs IV. 2. 2. 10.

Where the matter ufed is not procured quite frefh, the man-
ner of preferving it iliould be nicely attended to : as I have been
informed that a furgeon procured fome matter in a fluid (late,
about a tea-fpoonful, which had been kept fome time in a quill,
and afterwards in a fmail phial, which he carried fixteen hours in
his breeches-pocket ; with this he inoculated many children,
moft of whom had not the fmall-pox in confequence, but were
affected with typhus, one of whom died. Whence it appears,
that the variolous matter 'had undergone by putrefaction a de-
compofition, and that another kind of contagious material had
been produced ; which agrees with the ingenious obfervations
of Dr. Jenner, in his treatifes on the variolre vaccinse, or cow-
pox ; and of Mr. Kite, related in the Memoirs of the Medical
Society of London, Vol. IV.

May not the confluent fmall-pox proceed from the contagious
matter having undergone a partial putrefaction, fo as to contain
both the variolous and the typhus contagion ? and that, whether
the difeafe be taken naturally or by inoculation ? and that hence
the confluent kind confiils of the fmall-pox, with the fever com-
monly termed putrid ? and that, laftly, as Dr. Jenner obferves,
xvhere the fmall-pox has been faid to recede, or not to rife, the
difeafe has been fimply a malignant or typhus fever, febris fenfa-
tivn. inirritata, miitaken for the fmall-pox ?

Variola vaccina. Cow-pox. Cows are liable to an eruption
on their paps or udders, in fome counties, as in Glouceftermire ;
which was occafionally communicated to the hands or arms of
thofe who milked them, producing an ulcer, and fome degree of
fever : and it had been long obferved by the people of thofe
counties, that thofe who had undergone this difeafe, which was
called the cow-pox, were not liable to the fmall-pox.

Dr. Jenner, an eminent phyfician in Gloucefterfhire, fortu-
nately attended to this difeafe, found it to be much milder than
the fmall-pox, and that the fact: was true, that it fecured thofe
who had been infected with it from afterwards being liable to
the variolous infection. He alfo obferved, that the vaccine-pox
is not infectious, but by careful inoculation ; and that, on this
account, it might be inoculated in a family, without endanger-
ing others. A circumftance of great confequence to the public,
as the inoculation of the fmall-pox is known frequently to prop-
agate that difeafe ; and alfo to private families, when there hap-
pens to be a pregnant woman in them, who has not had the

fmall-pox :

CLASS II. i. 3. 9. OF SENSATION. 207

f mall-pox : to all whom in that fituation it is dangerous, as it
generally produces mifcarriage, and frequently death. Dr.
Cappe, in an ingenious paper in the York Herald, obferves, that
the vaccine difeafe is never communicated but by contact, and
then only when the matter lies on the broken ikin -9 and that
many women during pregnancy have paffed through this dif-
eafe, and none have fuffered from it ; and that inftead of behi£
peculiarly dangerous to young infants, as the fmall-pox is, it
feems to be peculiarly mild to them.

From all thefe circumftances it may be hoped, that the inoc-
ulation of the cow-pox may become fo general, and performed
fo early in life, as totally to eradicate the fmall-pox ; by which
latter difeafe above two thoufand perfons are (hewn by Dr.
Cappe, by the bills of mortality, to be annually deftroyed in a
part of London only.

As the cow-pox is fo much lefs infectious than the fmall-pox,
it requires much more care in the inoculation to give the difeafe
with certainty ; whence it fometimes has happened, that a flight
inflammation from the puncture of the lancet has been miftaken
by the unfkilful for the vaccine difeafe : and I have heard of four
fuch patients in this country who have afterward taken the
fmail-pox. But as Dr. Woodville inoculated a thoufond people
with the fmall-pox, who had previoufly received the cow-pox,
without one of them taking the infection, there can be no doubt
but that the four patients above mentioned had not previoufly
undergone the vaccine difeafe ; and ought not therefore to dif-
credit this fortunate and wonderful difcovery.

In the counties where the cows are fubject to this difeafe, the
milking is performed principally by men-fervants ; and it is
there believed, as Dr. Jenner mentions, that the difeafe was pre-
vioufly given to the paps of the cows by the hands of the men
who milked them, and who had previoufly acquired the infec-
tious matter from the heels of horfes, which difcharged an acrid
fames, when they had a difeafe called the greafe. This may be
worth further investigation ; as the prefervation of people from
the fmall-pox, by their having undergone the cow-pox, is fo won.
derful a phenomenon, fo contrary to our previous knowledge of
any analogy between the infectious difeafes of men and quadru-
peds, that other facts equally furprifing may exift. May not the
fmall-pox have been originally acquired from the cow-pox ?
which latter, having been a much older difeafe, may by procefs
of time have become milder than the former : as the fmall-pox
is believed alfo to have become much milder than formerly ; ow-
ing probably to the incapacity of receiving it, which exifls in
thofe who have undergone that diicaie, having in procefs of time

become

DISEASES GLASS IL i. 3. 10;

become hereditary. Which incapacity of receiving a lecon'd
time the {"mall-pox may be explained from the general law of an-
imation, that ftimuli greater than natural lofe their effect by
habit, or from their being too violently or too frequently applied.
As the cow-pox is faid to be fo favourable to infants, great
benefit might accrue to mankind by their early inoculation,
-which might in time exterminate the fmall-pox. This might
be perhaps effected by eftablifhing a difpenfary in towns, and
even villages, and allowing a premium of a few (hillings to eve-
ry one of the poor who mould be thus inoculated, as well as their
daily fuitenance for eight or ten days, that their arms might be
infpedted by a furgeon, to afcertain that they underwent the
genuine difeafe.

10. Rubeola irritata, morbilli. The meafles commence with
fneezing, red eyes, dry hoarfe cough, and are attended with fen-
fitive irritated fever. On the fourth day, or a little later, fmall
thick eruptions appear, fcarcely eminent above the .fkin, and, af-
ter three days, changing into very fmall branny fcales.

As the contagious material of the fmall-pcrx may be fuppofed
to be diffufed in the air like a fine dry powder, and mixing with
the faliva in the mouth to infect the toniils in its paffage to the
ftomach ; fo the contagious material of the meafles may be fuppo-
fed to be more completely diflblved in the air, and thus to impart
its poifon to the membrane of the noftrils, which covers the fenfe
of imell ; whence a catarrh with fneezing ufhers in the fever ;
the termination of the nafal duel: of the lachrymal fac is fubject
to the fame flimulus and inflammation, and affects by fympathy
the lachrymal glands, occafioning a great flow of tears. See
Sect. XVI. 8. And the rednefs of the eye and eyelids is pro-
duced in confequence of the tears being in fo great quantity,
that the faline part of them is not entirely Teabforbed. See
Sea. XXIV. 2. 8.

The contagion of the meafles, if it be taken a fufficient time
before inoculation, fo that the eruption may commence before
the variolous fever comes on, ftops the progrefs of the fmall-pox
in the inoculated wound, and delays it till the meafle-fever has
finifhed its career. See Sedt. XXXIII. 2. 9.

The meafles are ufually attended with inflammatory fever
with ftrong pulfe, and bear the lancet in every ftage of the dif-
eafe. In the early periods of it, venefection renders the fever
and cough lefs ; and, if any fymptoms of peripneumony occur,
is repeatedly neceffary ; and at the decline of the difeafe, if a
cough be left after the eruption has ceafed, and the fubfequent
branny fcales are falling of, venefection mould be immediately
uied j which prevents the danger of confumption. At this time

alfo

CLASS II. i. 3. n. OF SENSATION. 209

aifo change of air is of material confequence, and often removes
the cough like a charm, as mentioned in a fimilar iuuation at
the end of the chin-cough.

Rubeola inlrntata. Meafles with inirritated fever, or with
weak pttlfe, has been fpoken of by fome writers. See London
Med. O'bferv. Vol. IV. Art. XL It has alfo been faid to have
been attended with fore throat. Eduib. Effays, Vol. V. Art. II.
Could the fcarlet fever have been miflaken for the meafles ? or
might one of them have fucceeded the other, as in the mcafles
and fmall-pox mentioned in Seel:. XXXIII. 2. 9. ?

From what has been faid, it is probable that inoculation might
difarm the meafles as much as the fmall-pox, by preventing the
catarrh, and frequent pulmonary inflammation, which attends
this difeafe •, both of which are probably the confequence of
the immediate application of the contagious miafmata to theic
membranes. Some attempts have been made, but a difficulty
feems to arife in giving the difeafe ; the blood, I conjecture,
would not infect, nor the tears ; perhaps the mucous difcharge
from the noftrils might fucceed ; or a drop of warm water put
On the eruptions, arid fcraped off again with the edge of a lan-
cet ; or if the brariny fcales were collected, and moillened with
a little warm water ? Further experiments on this fubject would
be worthy the public attention.

1 1. Scarlatina mitis. The fcarlet fever exifts with all decrees
of virulence, from a flea-bite to the plague. The infectious
material of this difeafe, like that of the fmall-pox, I fuppofe to
be diffufed, not diffoived, in the air ; on which account I fui-
pecl: that it requires a much nearer approach to the lick for a
well perfon to receive the infection, than in the me;i!!i>. ; the
contagion of which I believe to be more volatile, or diffufible,
in the atmofphere. But as the contagious miafmata of fmall-
pox and fcarlet fever are fuppofed to be m#re fixed, they may
remain for a longer time in clothes or furniture ; as a thread dip-
ped in variolous matter has given the difeafe by inoculation after
having been expofed many days to the air, and after having been
kept many months in a phial. This alfo accounts for the flow or
fporadic progrefs of the fcarlet fever, as it infects others at but
a very fmall diftance from the lick ; and does not produce a
quantity of pus-like matter, like the fmall-pox, which can ad-
here to the clothes of the attendants, and when dried is hao!o
to be (haken off in the form of powder, and thus propagate the
infection.

This contagious powder of the fmai!-pox, and of the fcarlet
fever, becomes mixed with filiva in the mouth, and is thus car-
ried to the tonfils, the mucus of which arrefts fome paiuacs of

VOL. II. D i>

DISEASES CLASS II. i. 3. i •«,

this deleterious material ; while other parts of it are carried into
the ftomach, and are probably decompofed by the power of dt-
geftion ; as feems to happen to the venom of the viper, when
taken into the ftomach. Our perception of bad taftes in our
mouths, at the fame time that we perceive difagreeable odours
to our noftrils, when we inhale very bad air, occafions us to fpit
out our faliva ; and thus in fome inftances, to preferve ourfelves
from infection. This has been fuppofed to originate from the
fympathy between the organs of tafle and fmell; but any
one who goes into a fick-room clofe (hut up, or into a crowded
aflembly-room, or tea-room, which is not fufficiently ventilated,
may eafily mix the bad air with the faliva on his tongue fo as to
tafte it ; as I have my felf frequently attended to.

Hence it appears that thefe heavy infectious matters are more
liable to mix with the faliva, and inflame the tonfils, and that
cither before or at the commencement of the fever ; and this is
what generally happens in the fcarlet fever, always I fuppofe in
the malignant kind, and very frequently in the mild kind. But
as this infection may be taken by other means, as by the ikin,
it alfo happens in the moft mild kind, that there is no inflamma-
tion of the tonfils at all ; in the fame manner as there is gener-
ally no inflammation of the tonfils in the inoculated fmall-pox.

In the mild fcarlatina on the fourth day of the fever the face
fwells a little, at the fame time a florid rednefs appears on vari-
ous parts of the fkin in large blotches, at length coalefcing, and
after three days changing into branny fcales.

M. M. Cool air. Fruit. Lemonade. Milk and water.

Scarlatina mallgna. The malignant fcarlet fever begins with
inflamed tonfils ; which are fucceeded by dark drab-coloured
floughs from three to five lines in diameter, flat, or beneath the
furrounding furface ; and which conceal beneath them fpreading
gangrenous ulcers. The fweliings of the tonfils are fenfible to
the eye and touch externally, and have an elaftic rather than an
cedematous fee], like parts in the vicinity of gangrenes. The
pulfe is very quick and weak, with delirium, and the patient
generally dies in a few days \, or if he recovers, it is by flow de-
grees, and attended with anafarca.

M. M. A vomit once. Wine. Beer. Cyder. Opium.
Bark, in frnall repeated dofes. Small fucceffive blifters, if the
extremities are cooler than natural. Cool air on the hot parts
of the fkin, the cool extremities being at the fame time covered.
Iced lemonade. Broth. Cufhrds. Milk. Jellies. Bread
pudding. Chicken. Touch the ulcers with a dry fponge to
abforb the contagious matter, and then with a fponge filled with
vinegar, with or without iugar of lead diflblved iu it, about fix

grains

CLASS II. i. 3. 12. OF SENSATION. tit-

grains to an ounce ; or with a very little blue vitriol diflblved in
it, as a grain to an ounce ; but nothing fo inftantaneoufly cor-
re&s the putrid fmell of ulcers as a folution of alum, about half
an ounce to a pint of water, which fhould be a little warmifh,
and injected into the fauces gently by means of a fyringe. Thefe
fhould be repeated frequently in a day, if it can be done eafilyv
and without fatigue to the child. A little powder of bark taken
frequently into tke mouth, as a grain or two, -that it may mix
with the faliva, and thus frequently ftimulate the dying ton-
fils. Could a warm bath made of deco&ion of bark, or a
cold alluviation with it, be of fervice ? Could oxygene gas mix-
ed with common air ftimulate the languid fyftem ? Small elec-
tric (hocks through the tonfils every hour ? ether frequently
applied externally to the fwe41ed tonfils •?

As this difeafe is attended with the greateft degree'of debility,
jmd as ft imulant medicines, if given in quantity, fo as to produce
more than natural warmth, contribute to expend the already too
much exhaufted fenforial power ; it appears, that there is noth-
ing fo neceflary to be nicely attended to as to prevent any un-
neceflary motions of the fyftem ; this is beft accomplished by the
application of cold to tho e parts of the fkin, which are in the
leaft too hot. Dr. Mofman* of Bradford, directed a boy of
eight years of age, who was very hot, and covered with the icar-
let eruption, to be taken naked out of bed, and moiftened his
ikin all over with cold vinegar, by means of a fponge, with great
and good event. It is probable that cold vinegar might dimin-
ith the infiammation and confequent heat of the fkin more ef-
fectually than cold water, as its application to the lips renders
them pale, probably by ftimulating the abibrbent extremities of
the veins into greater action. Annals of Medicine, Vol. IV.
1 799. Secondly, that the exhibition of the bark in fuch quan-
tity as not to opprefs the ftomach and injure digeftion, is next to
be attended to, as not being liable to increafe the actions of the
fyftem beyond their natural quantity ; and that opium and wine
ihould be given with the greateft caution, in very fmall repeated
quantity, and fo managed as to prevent, if poflible, the cold fits of
fever ; which probably occur twice in 25 hours,obeying the luna-
tions like the tides, as mentioned in Seel:. XXXII. 6. that is,
I fuppofe, the cold periods, and confequent exacerbations of fe-
ver, in this malignant fcarlatina, occur twice in a lunar day j
which is about ten minutes leis than 2 5 hours ; fo that if the
commencement of one cold fit be marked, the commencement of
the next may be expected (if not difturbed by the exhibition of
or opium, or the application of blifters) to occur in about

twelve

212 DISEASES CLASS II. i. 3. 12.

twelve hours and a half from the Commencement of the former ;
or if not prevented by large dofes of the bark.

No one could do an act more beneficial to fociety, or glorious
to himfelf, than by teaching mankind how to inoculate this fa-
tal difsafe ; and thus to deprive it of its malignity. Matter
might be taken from the ulcers in the throat, which would prob-
ably convey the contagion *, or warm water might be put on the
eruption, and fcraped off again by the edge of a lancet. Thefe
experiments could be attended with no danger, and fhould be
tried for the public benefit, and the honour of medical fcience.

Dr. Harwood, profeflbr of anatomy, at Cambridge, favoured

me with the following curious cafe of this infection : Mr. N

had a violent delirium in the fcnrlet fever, with the {kin cracked
in many places, exuding an ichorous matter ; he was attended
by a poor man who had recently cut his hand with a glafs bottle,
and in the ftruggle of confining him to bed his wounded hand
•was frequently applied to the patient's body. This happened
on the Friday night j his hand was inflamed and the arm i well-
ed the next day ; pn the Monday following he was feized with
the fame fever, and died on the Wednefday morning after. This
would feem to (hew, as far as a fmgle cafe can be relied on, that
the fcarlet fever may be communicated, like the fmall-pox, by
inoculation, and probably with fimilar fuccefs, if the matter be
diluted with warm water, ufed in fmall quantity, and by fuper-
ficial incifions only, through the cuticle.

12. Miliaria. Miliary fever. An eruption produced by the
warmth, and more particularly by the ftimulus, of the points
of the wool in flannel or blankets applied to the (kin, has been
frequently obferved ; which, by cool drefs, and bed-clothes with-
out flannel, has foon ceafed. See Clafs I. i. 2. 3. This, which
may be called miliaria fudatoria> has been confounded with other
miliary fevers, and has made the exiftence of the latter doubted.
Two kinds of eruptions I have feen formerly attended with fe-
ver, but did not fufficiently mark their progrefs, which I con-
ceived to be miliary eruptions, one with arterial ftrength, or
with fenfitive irritated fever, and the other with arterial debility,
or with fenfitive inirritated fever.

In the former of thefe, or miliaria irritata, the eruptions were
diflincl: and larger than the fmall-pox, and the fever was not fub-
dued without two or three venefedHons, and repeated cathartics
with calomel.

The latter, or miliaria inirritata, was attended with great ar-
terial debility ; and during the courfe of the fever pellucid points
appeared within the fkin, particularly on the foft parts of the
fingers. And, in one patient, whom I efteemed near her end,

CLASS II. i. 3. 13. OF SENSATION.

I well recolleft to have obferved rpund pellucid globules, like
\vhat are often feen on vines in hot-houtes, no larger than the
fmalleft pins' heads, adhere to her neck and bofom ; which were
to the touch, but were eafily rubbed off. Thefe difeafes,
if they are allied, do not differ more than the kinds of fmall-pox ;
but require many further obfervations.

The eruption Vo often feen on children in the cradle, and call-
ed by the nurfes red-gum, and which is attended with fome de-
gree of fever, I fufpeft to be produced by too great warmth, and
the contact of flannel next their tender (kins, like the miliaria
fudatoria ; and like that requires cool air, cool clothes, and lin-
en next their ikin."

13. Peftis. The plague, like other difeafes of this clafs, feems
to be fometimes mild, and fometimes malignant ; according to
the teftimony of different writers. It is faid to be attended
with inflammation, with the greateil arterial debility, and to be
very contagious, attended at an uncertain time of the fever with
buboes and carbuncles. Some authors affirm, that the conta-
gion of the plague may be repeatedly received, fo as to produce
the difeafe ; but as this is contrary to the general analogy of all
contagious clifeafes, which are attended with fever, and which
cure themfelves fpontaneoufly •, there is reafon to fufpecl:, that
where it has been fuppofed to have been repeatedly received,
fome other fever with arterial debility has been miftaken for it,
as has probably univerfally been the cafe, when the fmall-pox
has been faid to have been twice experienced.

M. M. Venefeftion has been recommended by fome writers
on the firft day, where the inflammation was fuppofed to be at-
tended with fufficient arterial flrength, which might perhaps
fometimes happen, as the bubo feems to be a fuppuration ; but
the carbuncle, or anthrax, is a gangrene of the part, and (hews
the greateft debility of circulation. Whence all the means be-
fore enumerated in this genus of difeafes to fupport the powers
of life are to be adminiftered. Currents of cold air, cold water,
ice, externally on the hot parts of the fkin.

The methods of preventing the fpreading of this difeafe have
been much canvaffed, and feem to confift in preventing all con-
gregations of the people, as in churches, or play-houfes ; and to
remove the fick into tents, on fome airy common, by the fide of
a river, and fupply them with freih food, both animal and veg-
etable ; with beer and wine, in proper quantities ; and to encour-
age thofe who can, daily to waih both their clothes and them-
felves.

The pejl'is vnccina, or difeafe amongfl the cows, which afflict-
ed this ilhnd about half a century ago, feems to have been a

contagious

2H DISEASES CLASS II. i. 3. 14,

contagious fever, with great arterial debility ; as in fome of them,
in the latter ftage of the difeafe, an emphyfema could often be
felt in fome parts, which evinced a confiderable progrefs of gan-^
grene beneath the Ikin. In the fenfitive inirritated fevers of
tliefe animals, I fuppofe about fixty grains of opium, with two
ounces of extract of oak-bark, every fix hours, would fupply
them with an efficacious medicine ; to which might be added
thirty grains of vitriol of iron, if any tendency to bloody urine
fhould appear, to which this animal is liable. The method of
preventing the infection from fpreading, if it fhould ever again
gain accefs to this ifland, would be immediately to obtain an or-
der from government to prevent any cattle from being removed,
which were found within five miles of the place fuppofed to be
infecled, for a few days j till the certainty of the exillence of
the peftilence could be afcertained, by a committee of medical
people. As foon as this was afcertained, all the cattle within
five miles of the place mould be immediately flaughtered, and
confumed within the circumfcribed diflricl: ; and their hides put
Into lime-water before proper infpec"tors.

14. Pemphigus is a contagious difeafe, attended with blad-
dery eruptions, appearing, on the fecond or third day, as large as
filberts, which remain many days, and then effufe a thin ichor.
It feems to be either of a mild kind, with fenfitive fever only, of
which I have feen two inilances ; or with irritated, or with in-
irritated fever ; as appears from the obfervations of M. Salabert.
See Medical Comment. By Dr. Duncan, Decad. II. Vol. VI.

15. Varicella. Chicken-pox is accompanied with fenfitive
fever, puftules break out after a mild fever, like the fmall-pox,
feldom fuppurate,and generally terminate in fcales without fears.
I once faw a lady who mifcarried during this difeafe, though all
her children had it as fiightly as ufual. It fometimes leaves
fears or marks on the fkin. This difeafe has been miflaken for
the fmall-pox, and inoculated for it ; and then the fmall-pox has
been fuppofed to happen twice to the fame perfon. See Tranf.
of the College, London. It is probable that the pemphigus and
urticaria, as well as this difeafe, have formerly been difeafes of
more danger ; which the habit of innumerable generations may
have rendered mild, and will in procefs of time annihilate. In
the fame manner as the fmall-pox, venereal difeafe, and rickets,
feem to become milder or lefs in quantity every half century.
While, at the fame time, it is not improbable, that other new
difeafes. may arife, and, for a feafon, thin mankind !

1 6. Urticaria. Nettle-ram begins with mild fenfitive fever,
which is fometimes fcarcely perceptible. Hence this eruption
has been thought of two forts, one with and the other without

fever.

CLASS II. i. 3. 17. OF SENSATION.

fever. On the fecond day red fpots, like parts ftung with net.
ties, are feen ; which almoft vanim during the day, and recur in
the evening with the fever, fucceeded in a few days by very mi-
nute fcales. See Tranf. of the College, London.

17. Aphtha. Thrufh. It has been doubted, whether aphtha
or thrufh, which confifts of ulcers in the mouth, mould be enu-
merated amongft febrile difeafes ; and whether thefe ulcers are
always fymptomatic, or the confequence rather than the caufe of
the fevers which attend them. The tongue becomes rather
fwelled 5 its colour and that of the fauces purplifh ; floughs or
ulcers appear firft on the throat and edges of the tongue, and
at length over the whole mouth. Thefe floughs are whitifh,
fometimes diftincl:, often coalefcing, and remain an uncertain
time. Cullen. I fliall concifely mention four cafes of aphtha,
but do not pretend to determine whether they were all of them,
fymptomatic or original difeafes.

Aphtha fenfttiva. A lady during pregnancy was frequently
feized with ulcers on her tongue and cheeks, or other parts of
the mouth, without much apparent fever ; which continued two
or three weeks, and returned almoft every month. The thrufh
in the mouths of young children feems to be a fimilar difeafe.
Thefe ulcers refemble thofe produced in the fea-fcurvy, and have
probably for their caufe an increafed action of the fecerning
fyftem from increafed fenfation, with a decreafed action of the
abforbent fyftem from decreafed irritation. See Clafs I. 2. i. 14,

M. M. Solutions of alum, of blue vitriol. Powder of bark
taken frequently into the mouth in very fmall quantity. See
Clafs II. i. 3. i.

Aphtha Irritata. Inflammatory aphtha. A cafe of this kind
is related under the title of fuppurative rheumatifm. Clafs IV.
2. i. 16.

Aphtha inirritata. Slotighs or ulcers of the mouth, attended
•with fenfitive fever with great arterial debility. They feem to
fpread downwards from the throat into the (lomach, and proba-
bly through the whole inteftinal canal, beginning their courfe
•with cardialgia, and terminating it with tenefmus ; and/might
perhaps be called an eryfipelas of this mucous membrane.

M. M. Cool air. A fmall blifter on the back. Bark. Wine.
Opium in fmall repeated quantities. Soap neutralizes the gaf-
tric acid without cffervefcence, and thus relieves the pain of car-
dialgia, where the ftomach is affected. Milk alfo deftroys a part
of this acid. Infufion of fage-leaves two ounces, almond-foap
from five grains to ten, with fugar and cream, is generally both
agreeable and ufefui to thefe patients. See I. 2. 4. 5.

Where the flomach may be fuppofed to be excoriated by poi-

ibns

£16 DISEASES CLASSII. i.-3. ifc

fons containing acid, as fublimate of mercury or arfenic ; or if
it be otherwife inflamed, or very fenfible to the ftimuius of the
gaftric acid j or where it abounds with acid of any kind, as in
cardialgia •, the exhibition of fcap is perhaps a preferable man-
ner of giving alkali than any other, as it decompofes in the itom-
ach without effervefcencc ; while the cauftic alkali is too acrid to
be adminiftered in iuch cafes, and the mild alkali produces car-
bonic gas. If a drop of acid of vitriol be put on cap-paper, it
will be long before it deftroys the paper -, but if a drop of mild
alkali be added, a iudden effervefcence arifes, and the paper is
inftantly deilroyed by the efcape of the fixed air j in the fame
manner as lumps of folid lime are broken into powder by the ef-
cape of the fteam produced from the water, which is poured on
them. This (hews why a fucceffion of acid and of alkaline cauf-*
tics fooner deftroys a part, than either of them applied feparately.
1 8. Dyfenteria. Bloody-flux is attended with fenfitive fever,
generally with arterial debility ; with frequent mucous or bloody
ftools, which contain contagions matter produced by the mem-
branes of the inteftines ; the alimentary excrement being never-
thelefs, retained ; with griping pains, and tenefmus.

Linneus obferved microfcopic animals in the ftools of dyfen-
teric patients, and concluded from thence that they were the
caufe of the difeafe ; in the fame manner the animalcula, feen
by microfcopes, in the puftules of the itch, have been fuppofed
to be the caufe of thofe eruptions. See Article IV. 2. i. 3.
Thefe animalcula are neverthelefs feet! in almoft all animal fluids
which have for a time ftagnated ; as in the femen, and in all
liquid evacuations from the inteftines, as aflerted by Buffon ;
who efteems them to be organized beings, though not perfect
animals, in his ingenious treatife on generation. Hiftoire Nat-
urel.

M. M. Emetics. Antimonials. Peruvian bark. Opium
and calomel, of each a grain every night. Bolus armenire.
Earth of alum. Chalk. Calcined hartfhorn. Mucilage. Bee's
wax mixed with yolk of egg. Cerated glafs of antimony.
Warm bath. Flannel clothing next to the fkin. Large clyfters
with opium. With ipecacuanha, with fmoke of tobacco ?
Two dyfenteric patients in the fame ward, of the infirmary at
Edinburgh, quarrelled, and whipped each other xvith horfewhips
a long time, and were both much better after it, owing perhaps
to the exertion of fo much of the fenforial power of volition ;
which, like real infanity, added excitement to the whole fyftem.
The prevention of this contagion muft coniift principally in
ventilation and cleanlinefs ; hence the patients fhould be re-
moved into cottages diftant from each other, or into tents ; and

their

CLASS II. i. 3. 19. OF SENSATION. 217

their fseces buried as foon as may be ; or conveyed into a running
ftream ; and themfelves fhould be xvafhed with cold or warm
water after every evacuation. For the contagious matter confifts
in the mucous or purulent difcharge from the membrane which
lines the inteftines ; and not from the febrile perfpiration, or
breath of the patients. For the fever is only the confequence
and not the caufe of contagion ; as appears from Genus the
Fifth of this Order, where contagion exifts without fever.

19. Gaflritis fuperficialis. Superficial inflammation of the
ftomach. An eryfipelatous inflammation of the ftomach is men-
tioned by Dr. Cullen from his own obiervations \ which is dif-
tinguimed from the inflammatory gaftritis by lefs pain and fever,
and by an eryfipelatous rednefs about the fauces. Does this
difeafe belong to aphtha ?

20. Enteritis fuperficlalis. Superficial inflammation of the
bowels is alfo mentioned by Dr. Cullen, from his own obferva-
tion, under the name of enteritis erythematica \ and is faid to
be attended with lefs pain and fever, without vomiting, and with
diarrhoea. May not this difeafe be referred to aphtha, or to
dyfentery ?

VOL. II. E * ORDO

DISEASES CLASS II. i. 4. i,

ORDO I.

Increafed Senfation.
GENUS IV.

^ Production of new VeJJels by internal Membranes or
Glands y •without Fever.

WHERE inflammation is produced in a fmall part, which has
not great natural fenfibility, the additional fenfation does not
produce an increafed action of the arterial fyftem ; that is, the
aflbciated motions which are employed in the circulation of the
blood (thofe for inftanee of the heart, arteries, glands, capillaries,
and their correfpondent veins), are not thrown into increafed ac-
tion by fo fmall an addition of the fenforial power of fenfation.
But when parts which naturally poflefs more fenfibility become
inflamed, the quantity of the fenforial power of fenfation becomes
fo much increafed, as to afFecl the affociated motions belonging
to the circulation, occafioning them to proceed with greater fre-
quency ; that is, a fever is induced. This is well exemplified
in the internal and fuperfkial paronychia ; one of which is at-
tended with great pain and fever, and the other with little pain
and no fever. SeeClafs II. i. 2. 19. and II. i. 4. 5.

From hence it appears, that the fenfitive fever is an accident-
al confequence of the topical phlegmon, or inflammation, and
not a caufe of it ; that it is often injurious, but never falutary j
and lliould therefore always be extinguifhed, as foon as may be,
either by the lancet and cathartics, and diluents, and cold air,
when it is of the irritated kind ; or by the bark, opium, cool air,
and nutrientia, when it is of the inirritated kind.

SPECIES.

i. Ophthalmia fuperficialis . As the membranes, which cover
the eye, are excluded from the air about one third part of the
twenty-four hours, and are moiftened by perpetual nictitation
during the other fixteen, they may be confidered as internal
membranes ; and, from the analogy of their inflammation to
that of other internal membranes, it is arranged under this ge-
nus ; whilft the tonfillitts is eileemed an inflammation of an ex-
ternal membrane, becaufe currents of air are perpetually palling
both day and night over the fauces.

The fuperficial ophthalmy has generally been eileemed a

fymptom

CLASS II. i. 4. i. OF SENSATION. 219

f ymptom of fcrofula, when it recurs frequently in young per-
fons; but is probably only a concomitant of that difeafe, as a
fymptom of general debility ; ramifications of new red veffels,
and of enlarged old ones, are fpread over the white part of the
eye ; and it is attended with lefs heat, lefs pain, and lefs intoler-
ance of light than the ophthalmia interna, defcribed in Clafs II.
i. 2. 2. It occurs in thofe of feeble circulation, efpecially chil-
dren of a fcrofulous tendency, and feems to arife from a previ-
ous torpor of the veflels of the tunica albuginea from their being
expofed to cold air ; and from this torpor being more liable to
occur in habits, which are naturally inirritable ; and therefore
more readily fall into quiefcence by a fmaller deduction of the
ftimulus of heat, than would affect ftronger or more irritable
habits ; the confequence of this torpor is increafed action, which
produces pain in the eye, and that induces inflammation by the
acquifition of the additional fenforial power of fenfation.

Ophthalmia lymphatica is a kind of anafarca of the tunica adna-
ta ; in this the veflels over the fclerotica, or white part of the
eye, rife confiderably above the cornea, which they furround, are
lefs red than in the ophthalmia fuperficialis, and appear to be
f welled by an accumulation of lymph rather than of blood ; it
is probably owing to the temporary obilruclion of a branch of
the lymphatic fyftem.

M. M. If the pain be great, yenefeftion by leeches on the
temple, or cutting the temporal artery, and one purge with three
or four grains of calomel ihould -be premifed. Then the Peru-
vian bark twice a day. Opium from a quarter to half a grain
twice a day, for fome weeks. Bathe the eye frequently with
cold water alone, or with cold water to a pint of which is added
half an ounce of fait. White vitriol, fix grains difTolved in one
ounce of water ; a drop or two to be put between the eyelids
twice a day. Take very fmall electric fparks from the eyes eve-
ry day for a fortnight. Bathe the whole head with fait and wa-
ter made warm, every night, for fome months. Send fuch chil-
dren to a fchool near the fea, for the convenience of fea- bathing,
for many months, annually ; fuch fchools are to be found in or
near Liverpool.

When a child is afflicted with an inflamed eye of this kind,
he fhould always fit with his back to the window or candle ;
but it is generally not neceflary to cover it, or if the uneafy fen-
fation of light makes this proper, the cover fhould (land off from
the eye, fo as not much to exclude the cool air from it. As
covering an eye unneceflarily is liable to make that eye weaker
than the other, from its not being fufficiently ufed, and thenje
to produce a fquinrjng forever afterwards.

Never thelefs*

220 DISEASES CLASS II. i. 4. 2.

Neverthelefs, when the pain is great, a poultice mud be ap-
plied to keep the eyes moift, or a piece of oiled filk bound light-
ly over them. Or thus, boil an egg till it is hard, cut it longi-
tudinally into two hemifpheres, take out the yolk, few the backs
of the two hollow hemifpheres of the white to a ribbon, and
bind them over the eyes every night on going to bed •, which, if
nicely fitted on, will keep the eyes moilt without any difagreea-
ble preflure. See Clafs I. i. 3. 14.

Ophthalmia equina. An inflammation of this kind is liable to
affect the eyes of horfes ; one cauie of which is owing to a filly
cuftom of cutting the hair out of horfes' ears ; by which they
are not only liable to take cold at the ear, but grafs-feeds are li-
able to fall into their ears from the high racks in ftables ; and
in both cafes the eye becomes inflamed by fympathy. I once
directed the temporal artery of a horfe to be opened, who had
frequent returns of an inflamed eye ; and I believed it was of
eflential fervice to him ; it is probable that the artery was after-
wards contracted in the wounded part, and that thence lefs blood
was derived to the eye : the haemorrhage was flopped by two
perfons alternately keeping their fingers on the orifice, and after-
wards by a long bandage of broad tape.

2. Pterigion. Eye-wing. A fpot of inflammation fometimes
begins on the in fide of the lower eyelid, or on the tunica albu-
ginea, and fpreads an intertexture of red veflels from it, as from
a centre, which extend on the white part of the eye, and have
the appearance of the wing of a fly, from whence its name.

M. M. Cut the ramifications of veflels again and again, with
the point of a lancet, clofe to the centre of inflammation. Touch
them repeatedly with lunar cauftic. See Home on the urethra.
Page 10 1.

Mr. Hadley of Derby procured an ingenious inftrument to be
made to cut the veflels, which had fpread their numerous
branches over an opaque cornea, after a violent inflammation ;
by which they were repeatedly divided, with little pain to the
patient, as there was no neceflity to hold them by a forceps.
The instrument v/as in the form of a corn-fickle, or the early
crefcent of the new moon, about an inch in length, the inner
edge of the curve was (harp, and the point fine ; the back was
rounded and fmooth, and the other end fixed in an ivory han-
dle. The point of this was fuddenly introduced under the
branches of the new veiTels, which were thus cut upwards, and
there was no occafion to hold the eye, or the trunks of the veflels.

3. Tarfitis palpebrarum. Inflammation of the edges of the
eyelids. This is a difeafe of the glands, which produce the hairs
pf the eyelafhes, and is frequently the caufe of their falling off.

After

CLASS II.. i. 4. 4. OF SENSATION. ?.2t

After this inflammation a hard fear-like ridge is left on the •
of the ev :h fcratches and ia flames the eyeball, and be-

•ry troublefome difeafe.

Turkiih ladies are faid to colour the edjje of the f
itimony in very fiat not only:,

lip.mond fet on a black foil, but may pre-

t "roni being reflected from thefe edges into

:)fe of the black feathers about

:. XXXIX. 5. i. and may

••eiids from being inflamed by the

:m. Black lead in fine powder

s than antimony, and might

I's "'air brufli

•intment fmeared at night on the edges

!tYi fixty grains, hog's greafe half an

j an ointment to be fmeared on them in

t './ . Cold water irequentiy in the day. See Clafs II.
i

Stye. This inflammation begins either on

of the eye-lids, or in the looie (kin of them,

very flow either in coming to fuppuration or

in d The (kin beneath the lower eyelid is the moft

••s tumor, which ibmetimcs never fuppurates

omes an encyfted tumor : for as this {kin is very

urpofe of admitting great motion to the eyelid, the

abforbent posver of the veins feems particularly weak in this

part ; \vhence when any perfon is weakened by fatigue or other-

wife, a darker (hade of colour is feen beneath the eyes ; \vhich

is o-.ving to a lefs energetic atlioa of the abforbent terminations

of the veins, whence the currents of dark or venous blood are

delayed in them. This dark (hade beneath the eyes, when it is

permanent, is a fyrnptom of habitual debility, or inirritability of

the circulating fyftem. See Clafs I. 2. 2. 2.

M. M. Smear the tumors with mercurial ointment, moiften
them frequently with ether.. To promote their fuppuration they
may be wounded with a lancet, or flit down the middle, or they
may be cut out. A cauflic leaves a large fear. •

5. Paronychia fuperficialis. Whitlow. An inflammai
bout the roots of the nail beneath the ilcin, which fuppurates
without fever, and fometimes deftroys the nail ; which is, how-
ever, gradually reproduced. This kind of abfcefs, though not
itfelf dangerous, has given opportunity for the inoculation of
venereal matter in the hands of accoucheurs, and of putrid mat-
ter from the difleclion of difeafed bodies ; and has thu.-
caufe of difeafe and death. When putrid matter has bee a

thus

222 DISEASES CLASS II. i. 4. 6,

thus abforbcd from a dead body, a livid line from the finger to
the fwelled gland in the axilla is faid to be vifible ; which (hews the
inflammation of the abforbent veflel along its whole courfe to the
lymphatic gland ; and death has generally been the confequence.

M. M. In the common paronychia a poultice is generally
fufficient. In the abforption of putrid matter rub the whole
hand and arm with mercurial ointment three or four times a
day, or perpetually. Could the fwelled axillary gland be exfecV
ed ? In the abforption of venereal matter the ufual methods of
cure in fyphilis muft be adminiftered, as in Clafs II. I. 5. I.

6. Gutta rofea. The rofy drop on the face is of three kinds.
Firft the gutta rofea hepatica, or the red pimples on the faces of
drunkards, which are probably a kind of crifis, or vicarious in-
ii animation, which fucceeds, or prevents, a torpor of the mem-
branes of the liver. This and the fucceeding fp^cies properly
belong to Clafs IV. i. 2. 14.

Secondly, the pimpled face, in confequence of drinking cold
water, or eating cold turnips, ot other infipid food, when much
heated with exercife ; which probably arifes from the fympathy
between the Ikin of the face and the ftomach ; and may be call-
ed the gutta rofea Jlomatlca. Which is diftinguimed from the
former by the habits of the patient in refpe6r, to drinking ; by
the colour of the eruptions being lefs deep ; and by the patient
continuing generally to be troubled with fome degree of apepfia.
See Clafs I. 3. i. 3. I knew a lady who had long been afflict-
ed with pain about the region of the ftomach ; and, on drinking
half a pint of vinegar, as a medicine, {he had a breaking out
commenced on her face ; which remained, and fhe became free
from the pain about the ftomach. Was this a ftomachic, or an
hepatic difeafe ?

Thirdly, there is a red face, which confifts of fmaller pimples
than thofe above mentioned ; and which is lefs liable to fuppu-
rate ; and which feems to be hereditary, or at leaft has no appar-
ent caufe like thofe above mentioned ; which may be termed
gutta rofea hereditaria, or punfta rofea.

Mrs. S. had a pimpled face, which I believe arofe from pota-
tion of ale. She applied alum in a poultice to it, and had foon
a paralytic ftroke, which difabled her on one fide, and termina-
ted in her death.

Mrs. L. had a red pimpled face, which feemed to have been
derived from her mother, who had: probably acquired it by vi-
nous potation ; (lie applied a quack remedy to it, which I believe
was a folution of lead, and was feized with epileptic fits, which
terminated in palfy, and deftroyed her. This (hews the danger
of ufmg white paint on the face, which is called bifmuth, but is

in

CLASS II. i. 4. 6. OF SENSATION. 223

in reality white lead or ceruiTa j and if it be bifmuth, it may be
equally deleterious.

Mr. Y had acquired the gutta rofea on hisnofe, and ap-
plied a faturnine folution on it for a few nights, and was then
feized with paralyfis on one fide of his face -, which however he
gradually recovered, and has fmce acquired the gutta rofea on
other parts of his face.

Thefe fatal effects were probably caufed by the difagreeable
fenfation of an inflamed liver, which ufed before to be relieved
by the fympathetic action and confequent inflammation of the
fkin of the face, which was now prevented by the (tronger ftim-
ulus of the application of calx of lead. The manner in which
difagreeable fenfations induce epilepfy and palfy is treated of in
Clafs III. In fome cafes where habitual difcharges, or eruptions,
or ulcers, are flopped, a torpor of the fyflem may follow, owing
to the want of the accuftomed quantity of fenfation or irritation.
See Clafs I. i. 2. 9. and II. i. 5.6. In both thefe fituations
fome other ftimulus mould be ufed to fupply the place of
that which is taken away •, which may either be perpetual, as an
iffue ; or periodical, as a cathartic repeated once a fortnight or
month.

Mifs W. an elegant young lady, of about twenty, applied a
mercurial lotion to her face, which was covered with very fmall
red points (which feemed to have been not acquired by any
known or avoidable means) ; (he was feized with inflammation of
her lirer, 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 cathar-
tic, five grains of rhubarb and a quarter of a grain of emetic tar-
tar every night for many weeks. With this preparation mer-
curial plafters, made without turpentine, and applied every
night, -and taken off every morning, will fometimes fucceed, and
may be ufed with fafety. But bliftering the face all over the
eruption, beginning with a part, fucceeds better than any other
means, as I have more than once experienced.- — Something like
this is mentioned in the Letters of Lady Mary Wortley Mon-
tague, who bliftered her face with balfam of Mecca.

Mrs. F. had for many years had a difagreeably looking erup-
tion on her chin. After a cathartic with calomel, (he was ad-
vifed to blifter her whole chin ; on the healing of the blifter a
few eruptions again appeare^, which ceafed on the application
of a fecond blifter. She took rhubarb five grains, and emetic
tartar a quarter of a grain every night for many weeks.

Mifs L. a young lady, about eighteen, had tried variety of ad-
vice, for pimples over the greateft part of her face, in vain. She

-

*24 DISEASES CLASS II. i. 4. 7.

took the above medicines internally, and bliftered her face by de-
grees all over, and became quite beautiful. A fpot or two now
and then appeared, and on this account flic frequently ilept with
parts of her face covered with mercurial plafter, made without
turpentine, which was held'On by a pafteboard maflt, and taken
off in the mornings ; if any part of the plafter adhered, a little
butter or oil deftroyed the adhefion. If there be turpentine, or
any other native balfam, mixed with the mercurial plafter, it is
very liable much to inflame the face (I fuppofe like the balfam of
Mecca) ; but if a fmall quantity of flour of brimftone be added,
I believe it will readily mix. As' a mercurial ointment is faid
to be quickly made by adding only fix grains of flour of fulphur
to fix drachms of mercury, and two ounces of hog's greafe.

7. Odontitis. Inflammatory tooth-ach is occafioned by in-
flammation of the membranes of the tooth, or a caries of the
bone itfelf. The gum fometimes fuppurates, otherwife a fwell-
ing of the cheek fucceeds by aflbciation, and thus the violence
of the pain in the membranes of the tooth is relieved, and fre-
quently cured ; and when this happens the difeafe properly be-
longs to Clafs IV. as it fo far refembles the tranflations of mor-
bid actions in the gout and rheumatifm.

At other times the tooth clies without caries, efpecially in peo-»
pie about fixty years of age, or before ; and then it ftimuiates its
involving membrane, like any other extraneous fubftance. The
membrane then becomes inflamed and thickened, occafioning
fome pain, and the tooth rifes upwards above the reft, and is
gradually pufhed out whole and undecayed ; on its rifmg up a
pus-like mucus is feen difcharged from the gum which furrounds
it ; and the gum feems to have left the tooth, as the fangs or
roots of it are in part naked.

M. M. Where the tooth is found it can only be faved by
evacuations, by venefeclion, and a cathartic ; and after its op-
eration two grains of opium. A blifter may alfo be ufed behind
the ear, and ether applied to the cheek externally. In (lighter
cafes two grains of opium with or without as much camphor
may be held in the mouth, and fufFered to diflblve near the af.
fecled tooth, and be gradually fwallowed. See Clafs I. 2. 4.
12. Odontalgia may be diftinguimed from otitis by the appli-
cation of cold water to the affected tooth ; for as the pain of
common tooth-ach is owing* to torpor, whatever decreafes ftimu-
lus adds to the torpor and confequent pain ; vrhereas the pain of
an inflamed tooth, being caufed by the increafed action of the
membranes of it, is in fome meafure alleviated by the applica-
tion of cold.

8. Otitis. Inflammation and confequent fuppuration of fome

membranes

CLASS II. i, 4- 9 * OF SENSATION. 125

membranes of the internal ear frequently occur in children, who
fleep in cold rooms, or near a cold wall, without a night-cap.
If the bones are affected, they come out in a long procefs of time,
ni:d the child remains deaf of that ear. But in this cafe there is
generally a fever attends this inflammation j and it then belongs
r.o another genus.

M. M. A warmer night-cap. Warmifh water {hould be
gently fyringed into the ear, to keep it clean, twice a day ; and
if it does not heal in a week, a little fpirit of wine {hould be
added ; firft about a fourth parr, and it {hould be gradually in-
creafed to half rectified fpirit and half water : if it continues
long to difcharge matter with a very putrid fmell, the bones arc
injured, and will in time find their exit ; during which time
the ear fhould be kept clean, by filling it with a weaker mixture
of fpirit of wine and water, or a folution of alurn in water ;
\vhich may be poured into the ear, as the head is inclined, and
fhook out again by turning the head, two or three times morn-
ing and evening. See Clafs II. 1.4. 10.

9. Ftftula lacrymalis. The lacrymal fack, with its punfla lac-
rymalia and nalal duel:, are liable to be deftroyed by fuppuration,
•without fever ; the tears then run over the eyelids, and inflame
the edges of them and the cheeks, by their perpetual moiilure
and faline acrimony.

M. M. By a nice furgical operation, a new aperture is to be
naade from the internal corner of the eye into the noftril, and a
filver tube introduced, which fupplies the defect by admitting
the tears to pafs again into the noftril. See Melanges de Chir-
urgie, par M. Pouteau ; who thinks he has improved this oper-*
ation.

10. Fiftula in ano. A mucous difcharge from the anus, call-
ed by fame white piles, or matter from a fuppurated pile, lias
been miftaken for the matter from a concealed fiftnla. A bit of
cotton-wool applied to the fundament to receive the matter, and
renewed twice a day for a week or two, fhould always be ufed
before examination with the probe. The probe of an unfkilful
empyric fometimes does more harm in the loofe cellular mem-
brane of thefe parts than the original ulcer, by making a fiitula
he did not find. The cure of a fiitula in ano, of thofe who have
been much addicted to drinking- fpirituous liquor, or who have
a tendency to pulmonary confumption, is frequently of danger-
ous confequence, and is fucceeded by ulcers of the lungs, and
death*

M. M. Ward's pafte, or 20 black pepper-corns taken after
/each meal twice a day ; the pepper-corns fliould be cut each in-
to two or three pieces. The late Dr. Munro, of Edinburgh,

VOL. II. F * aflerted

*5tf DISEASES Clafs It i. 4. if}

sflerted, in his le&ures, that he had known a fiftula in ano cured
by injecting firft a mixture of rectified fpirit of wine and water ;
and, by gradually increafmg the ftrength of it, till the patient
could bear rectified fpirit alone •, by the daily ufe of which, at
length, the fides of the fiftula became callous, and ceafed to dif-
charge, though the cavity was left. A French furgeon has
lately affirmed, that a wire of lead put m at the external open-
ing of the ulcer, and brought through the rectum, and twifted
together, will gradually wear itfelf through the gut, and thus ef-
fect a cure without much pain. The ends of the leaden wire
irtuft be twifted more and more as it becomes loofe. Or, laftly,
it muft be laid open by the knife.

1 1 . Fiftula urethra. Where a ftrieture of the urethra exifts,
from whatever caufe, the patient, in forcing the dream of urine
through the ftritture, diftends the urethra behind it ; which,
after a time, is liable to burft, and to become perforated \ and
fome of the urine is pufhed into the cellular membrane, occa-
fioning fiftulas, which fometimes have large furfaces producing
much matter, which is prefied out at the time of making water,
•and has been miftaken for a catarrh of the bladder ; thefe fiftu-
las fometimes acquire an external opening in the perinaeum, and
part of the urine is difcharged that way.

Can this matter be diftinguifhed from mucus of the bladder by
the criterion delivered in Clafs II. i. 6. 6. ?

M. M. The perpetual ufe of bougies, either of catgut or of
caoutchouc. The latter may be had at No. 37, Red-lion-ftreet,
Holborn, London. The former are eafily made, by moiftening
the catgut, and keeping it ftretched till dry, and then rounding
one end with a pen-knife. The ufe 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 luccefsful in one cafe ;•
the extenfive fiftulas completely healing. The patient fhould
introduce a bougie always before he makes water, and endeavour
to make it as flowly as poflible. See Clafs I. 2. 3. 24*

1 2. Hepatitis chronica. Chronical inflammation of tHs liver.
A collection of matter in the liver has frequently been found on
diflecftion, which was not fufpecled in the living fubjecl:. Though
there may have been no certain figns of fuch a collection of
matter, owing to the infeniibility of the internal parts of this
vifcus ; which has thus neither been attended with pain, nor in-
duced any fever ; yet there may be in fome cafes reafon to fuf-
pecl the exiftence of fuch an abfcefs ; either from a fenfe of ful-
iiefs in the right hypochondre, or from tranfient pains fometimes
felt there, or from pain on preiTure,'or from lying on the left fide,
and iometimes from a degree of fenfitive fever attending it.

Dr. Baunders-

CLASS II. i. 4. 13. OF SENSATION.

Dr. Saundcrs fufpefts the acute hepatitis to exift in the in-
flammation of the hepatic artery, and the chronical one in that
of the vena poriarum. Treatife on the Liver. Robinlbns.
London.

13. Scrofula fuppiirans. Suppurating fcrofula. The indolent
tumors of the lymphatic glands are liable, after a long time, to
regain their ienfibility ; and then, owing to their former torpor,
an increafed aclion of the vefTels, beyond what is natural, with
inflammation, is the conference of their new life, and fupnura-
tion fucceeds. This cure of fcrofula generally happens about
puberty, when a new energy pervades the whole fyftem, and un-
folds the glands and organs of reproduction.

M. M. SeeClafsI. 2. 3. 21. Where fcrofulous ulcers about
the neck are difficult to heal, Dr. Beddoes was informed, in Ire-
land, that an empyric had had lome fuccefs by inflaming them by
an application of wood forrel, oxalis aceto fella, the leaves of which
are bruifed in a mortar, and applied on the ulcers for two or
three days, and then fome more lenient application is ufed.

A poor boy, about twelve years old, had a large fcrofulous ul-
cer on one fide of the cheft beneath the clavicle, and another
under his jaw ; he was directed, about three weeks ago, to pro-
cure 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 fhew me that both the ulcers are quite healed. The con-
ftant application of linen rags, moiftened with a folution of an
ounce of fugar of lead in a pint of water, I think I have feen.
equally efficacious.

Small dofes internally of a folution of arfenic have been faid
to contribute to cure thefe ulcers. I fhould recommend from,
one drop to five of a faturated decoction of arfenic, as directed
in Mat. Med. Art. IV. 2. 6. 8. for children, twice or thrice a
day, according to their age, and from five to ten to grown per-
fons, diminifhing the quantity if it affects the bowels. Tinc-
ture of Digitalis is recommended in Clafs I. 2. 3. 21.

14. Scorbutuf fuppurans* In the fea-fcurvy there exifts an
inactivity of venous abforption, whence vibices and petechise,,
and fometimes ulcers. As the column of blood prefling on the
origins of the veins of the lower extremities, when the body is
creel, oppofes the afcent of the blood in them, they are more
frequently liable to become enlarged, and to produce varixes, or
vibices, or, laftly, ulcers about the legs, than on the upper parts
of the body. The expofure to cold is believed to be another

of ulcers on the extremities j as happens to many of the

poor

DISEASES GLASS II. r. 4. 15.

poor in winter, at Lifbon, who fleep in the open sir, without
blockings, on the fteps of their churches or palaces. See Clafs I.

2. I. 15.

M. M. A bandage fpread with plafter to cover the whole
limb tight. Rags dipped in a folution of fugar of lead. A
warm flannel itccking or roller. White lead and oak-bark?
both in fine powder. Horizontal reft. An ingenious treatife
on the ufe of bandage, in the cure of ulcers, has lately been pub-
limed by Mr. Baynton, of Briftol ; and another, on the fame fub-
je6t, by Mr. Whately, of London, who fucceeds without ufmg
•plafter on the bandage.

15. Scirrhus fuppuruns. When a fcirrhus affects any gland
of no great extent or fenfibility, it is, after a long period of time,
liable to fuppurate without inducing fever, like the indolent tu-
mors of the conglobate or lymphatic glands above mentioned ;
whence collections of matter are often found after death, both in
men and other animals j as in the livers of fwine, which have
been fed with the grounds of fermented mixtures in the diftil-
leries. Another termination of fcirrhus is in cancer, as defcri-
bed below. See Clafs I. -2. 3. 22.

1 6. Carcinoma. Cancer. When a fcirrhous tumor regains
its fenfibility by nature, or by any accidental hurt, new veffels
{hoot amongft the yet infentible parts of it, and a new fecretiorj
takes place of a very injurious material. This cancerous mat-
ter is abforbed, and induces fwelling of the neighbouring lymph-
atic glands j which aUp become fcirrhous, and afterwards
cancerous.

This cancerous matter does not feem to acquire its malignant
or contagious quality, till the cancer becomes an open ulcer ;
and the matter fecreted in it is thus expofed to the air. Then
it evidently becomes contagious, becaufe it not only produces
hectic fever, like common matter in ulcers open to the air, but
it alfo, as it becomes abforbed, fwells the lymphatic glands in its
vicinity ; as thofe of the axil] a, when the open cancer is on the
breaft. See Clafs II. i. 3.

Hence exfeclion before the cancer is open is generally a cure ;
but after the matter has been expofed to the air, it is feldom
of fervice ; as the neighbouring lymphatic glands are already in-
fe£ted. I have obferved feme of thde patients after the opera-
tion to have had difeafed livers, which might either have previ-
oufly exifted, or have been produced by the fear or anxiety at-
tending the operation.

Erofion with arfenic, after the cancer is become an open ul-
cer, has generally no better effeft than exfeclion, but has been
fuccefjjful before ulceratioa. The bcft manner of ufmg arfenic,

€LASS H. i. 4. 16. OF SENSATION.

is by mixing one grain with a drachm of lapis calminaris, and
(brewing on the cancer iorne of the powder every day, till the
whole is deftroyed.

Cancers on the face are faid to arife from the periofteum, and
that, unleis this be deftroyed by the knife, or by cauftics, the
cancer certainly recurs. After the cancer becomes an open
ulcer of fome extent, a purulent fever fupervenes, as from other
open ulcers, and gradually dedroys the patient. See Clafs II. i.
6. 13.

Two very intereding cafes have been lately publifhed by Dr.
Ewart, of Bath, in which carbonic acid gas, or fixed air, was •
kept conftantly in contact with the open cancerous ulcers of the
bread ; which then healed like other common ulcers. This
is rather to bealcribed to the exclufion 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 expofed
£o the air, and then probably united with oxygen.

The manner of applying the fixed air, is by including the can-
cer in one half, or hemifphere, of a large bladder ; the edges are
made to adhere to the (kin by adhefive plafler, or perhaps a mix-
ture of one part of honey with about twenty parts of carpenter's
glue might better fuit fome tender {kins. The bladder is then
kept conftantly filled with carbonic acid gas, by means of a pipe
in the neck of it ; and the matter let out at a fmall aperture be-
neath.

M. M. Where extirpation is not advifable, as in mod open
cancers of the bread, keep the ulcer carefully from the air, either
by applying carbonic acid gas, as above ; or by covefing it with
(charcoal in powder, and a double oiled (ilk. The charcoal-pow-
der mould be renewed once in two or three days, and at thofe
times itihould be pufhed ofFby frefh charcoal-powder on lint, fo as
not for a moment to expofe it to the air. The charcoal mould
be frefh taken from the fire, and powdered very fine as foon as
cool, and kept in a bottle to be as little expofed to the air as pof-
£ble.

The tumor fhould be fufpended by a fafh or foft cufhion, f*
as to keep it as eafy as poflible night and day, and mould be kept
jieither too warm nor too cold, as both extremes are injurious.

Internally, fix grains of rhubarb every night, for many months,
and to drink nothing ftronger than common weak fmall beer,
confiding of three drike of malt to the hogfhead, or wine diluted
with thrice its quantity of water.

If cauftics cannot be applied fo as to deftroy the whole, even
before ulceration, I fufpect that they aggravate the evil, and
Jooner deftroy the patient j as, I was well informed, occurred

to

23° DISEASES CLASS II. i. 4. 17.

to a quack who was for a time much refortcd to, in this part of
the country.

Another method of ufmg charcoal-powder is by mixing it with
boiled oil, to the confidence of common paint ; and to foak a
piece of flannel with this, and cover the ulcer j and daily to
ihove or thruft this off by applying the edgt of another piece of
flannel, foaked with the oil and charcoal, to the edge of that up-
on the ulcer, fo as to change them without the poffibility of let-
ting any air come into contact with the cancerous fore.

1 7. Arthrocele. Swelling of the joints feems to have its remote
caufe in the foftnefs of the bones, for they could not fwell unlefs
they were previoufly foftened, fee Clafs 1. 2. 2- 1 2. The epiphy-^
fes,or ends of the bones, being naturally of a loofer texture, are
moil liable to this difeafe, and perhaps the cartilages and capfu*
lar ligaments may alfo become inflamed and fwelled along with
the heads of the bones. This malady is liable to diftort the fin-
gcrs and knees, and is ufu-ally called gout or rheumatifm ; the
former of which is liable to dilable the fingers by chalk-ftones,
and thence to have fomewhat a fimilar appearance. But the
arthrocele, or fwelling of the joints, affects people who have not
been intemperate in the ufe of fermented or fpirituous liquors ;
or who have not previoufly had a regular gout in their feet ; and
in both thefe circumftances differs from the gout. Nor does
it accord with the inflammatory rheumatifm, as it is not attended
with fever, and becaufe the tumors of* the joints never entirely
fubfide. The pain or fenfibility, which the bones acquire when
they are inflamed, may be owing to the new veffels, which (hoot
in them in their foft ftate, as well as to the diltention of the;
old ones.

M. M. Half a grain of opium twice a day, gradually increafed
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-ames, or calcined hartfhorn, twice a day, with decoction
of madder ? Soda phofphorata ?

1 8. Arthropuofis. Joint-evil. This differs from the former,
as that never fuppurates; thefe ulcers of the joints are gener-
ally efteemed to arife from fcrofula ; but as fcrofula is a difeafe
of the lymphatic or abforbent fyftem, and this confifts in the
fuppuration of the membranes, or glands, or cartilages about
the joints, there does not feem a fufficient analogy to authorize
their arrangement under the fame name.

The white fwelling of the knee, when it fuppurates, comes un-
der this fpecies, with variety of other ulcers, attended with cari-
ous bones.

19. Caries ojjlum^ or Necro/is ojfium. A caries of the bones

may

it. i. 4. i$; OF SENSATION;

may be termed a fuppuration of them ; it differs from the above,
as it generally is occafioned by fome external injury, as in decay-
ing teeth ; or by veneral 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 feparation of the dea'd bone from the living is a work of
fome time. See Sect. XXXIII. 3.1. A new and able work on
the necrofis of bones is publifhed by I. Ruflel, Edinburgh' 5
London, Robinfons. And another by I. P. Weidmann, de Ne-
crofi Oflium at Francfort ; Boofey, London ; which is alfo a
val uable work.

M. M. When this difeafe is not formed in fyphilis, or by
metaftaiis in fever, but is {imply an inflammation of the periofte-
um, or of the folid bone, or of its medullary cells, the method of
cure mould confift in evacuations by bleeding and cathartics,
and by leeches applied to tlie painful or tumid parts ; and after-
wards by taking inwardly foda phofphorata and a decoction of
rubia tinftorum, madder-root ; as the former is believed to give
folidity to bones, and the latter, as it colours the bones of young
or growing animals, is known to be carried thither during their
fofter or more fenfitive ftate, and may be therefore worth: a triaL
See Innutritio oflium. Clafs I. 2. 2. 14.

QRDO

£32 DISEASES CLASS it i. 4. if

> ORDO I.

Increafed Senfation.

GENUS V.

With the Production of new Vejjjels by external Membranes or
G lands > Without Fever.

THE ulcers, or eruptions, which are formed on the external
fkin, or on the mouth or throat, or on the air-cells of the lungs,
or on the inteftines, all of which are more or lefs expo fed to the
contact of the atmofpheric air, which we breathe, and which in
feme proportion we fwallow with ow food and faliva 5 or to
the contact of the inflammable air, or hydrogen, which is fet at
liberty by the putrefying aliment in the intellines, or by putre-
fying matter in large abfcefies * all of them produce contagious
matter ; which, on being inoculated into the fein of another
perfon, will produce fever, or a fimilar difeafe.

Irt fome cafes even the matter formed beneath the fkin be-
comes in fome degree contagious, at lead fo much fo as to pro-
duce fever of the hectic or malignant kind, as foon as it has pierc-
ed through the (kin, and has thus gained accefs to fome kind of
air ; as the frefh pus of a common abfcefs ; or the putrid pus
of an abfcefs which has been long confined ; or of cancerous
ulcers.

From this analogy there is reafon to fufpect that the matter of
all contagious difeafes, whether with or without fever, is not in-*
fedtious till it has acquired fomething from the air ; which, by
oxygenating the fecreted matter, may probably produce a new
acid. And, fecondly, that in hectic fever a part of the purulent
matter is abforbed ; or acts on the furface of the ulcer ; as va-
riolous matter affects the inoculated part of the arm. And that
hectic fever is therefore caufed by the matter of an open ulcer ;
and not by the fenfation in the ulcer independent of the aerated
pus, which lies on it Which may account for the venereal mat-
ter from buboes not giving the infection, according to the exper-
iments of the late Mr. Hunter, and for fome other phenomena
«f contagion. See Variola difcreta, Clafs II. I. 3.9.

SPECIES.

I. Gonorrhoea venerea. A pus-like contagious material dif-
charged from the urethra after impure cohabitation, with fmart-

CLASS II. i. 5. i. OF SENSATION. 233

ing or heat on making water ; which begins at the external ex-
tremity of the urethra, to which the contagious matter is appli-
ed, and where it has accefs to the air •, which probably height-
ens its acrimony.

M. M. In this (late of the venereal difeafe, once venefecfHon,
with mild cathartics of fenna and manna, with mucilage, as al-
jnond emulfion, and gum arable, taken for two or three weeks,
abfolve the cure. Is camphor of ufe to relieve the ardor urinre ?
Do balfams increafe or leiTen the heat of urine ? Neutral falts
certainly increafe the fmarting in making water, by increafmg
the acrimony of the urine.

Can the difcharge from the urethra be foon flopped by faturnine '
injections, or mercurial ones, or with folution of blue vitriol, at
firft very dilute, and gradually made ftronger ? And at the fame
time, left the fyphilis, or general difeafe, mould fupervene, the
patient might take a quarter of a grain of corrofive fublimare of
mercury twice a day, as directed below ?

There is a curious paper by Mr. Addington, of Weft Bromage,
In the Contributions of Medical Knowledge, publifhed by Dr.
Beddoes, on the cure of gonorrhoea virulenta, by large dofes of
corrofive fublimate of mercury, hydrargyrus muriatus. Three
grains of corrofive fublimate of mercury are diffolved in one ounce
of rectified fpirit of wine. Half of this mixture is taken undi-
luted at going to bed ; it produces a copious falivation for an
hour and a half, or longer, during which the patient fpits a
quart. Some Glauber's falts are to be taken on the fecond day
after this operation, and on the evening of that day he is to re-
peat the draught, and the falts on the day but one following.
And Mr. Addington witneffed that three or four fuch dofes fre-
quently cured a venereal gonorrhoea in fo ihort a time, without
any difagreeable confequence, and was informed that hundreds
had been cured by it.

The probable mode of action of this medicine is owing to the
confent of parts between the throat and the urethra, of which
many inftances are given in Clafs IV. i. 2. 7. on Hydrophobia.
Mr. Wright, an elderly furgeon in Derby, thirty years ago, af-
fured me that he had frequently given half a drachm of corrofive
Sublimate as an emetic, without any inconvenience to the patient ;
and that it was the famous emetic of a celebrated empyric, and
had been faid to do wonders.

Might not this dofe of one grain and a half, diffolved in half
an ounce of rectified fpirit, be given repeatedly, with profpett
of advantage, in Hydrophobia1 ? And perhaps, in an adapted
flrength and quantity, in Hydrocephalus ? If in Croup, Perip-
aeumonia trachealis ?

VOL. II. G G 2. Syphilis.

234 DISEASES CLASS II. i. 5. 2.

2. Syphilis. Venereal difeafe. The contagion (hews itfelf
in ulcers on the part firil inoculated, as chancres ; ulcers on the
tonfils fucceed, with eruption on the {kin, efpecially about the
roots of the hair ; afterwards on other parts of the {kin, termin^
iating in dry fcabs ; and, laltly, with pain and fwelling of the
bones.

: The corona veneris, or crown of Venus, confifts of the erup-
tions at the roots of the hair appearing molt round the forehead $
which is occaftoned by this part being more expofed to the air ;
which we obferved, at the beginning of this genus, either produ-
ces or increales the virulence of contagious matter. But it is
difficult to conceive, from this hiftory, why the throat fhould be
firft afte&ed ; as it cannot be iuppofed, that the difeafe is fa
often taken by the faliva, like the fmail-pox, though this may
fometimes occur ; perhaps very often. The connection be-
tween the genitals in men and the throat, is treated of in Clafs
IV. i. 2, 7. Hydrophobia.

M. M. A quarter of a grain of corrofive fublimate of mer-
cury, taken thrice a day for five or fix weeks, made into a pill
with bread-crumbs, or diflblved in a fpoonful of brandy and
water, is a Very efficacious and almoft certain cure. When it
does not fucceed, it is owing either to the drug being had,
or to its having precipitated from the brandy, or from its being
fpoiled in the pill by long keeping. Opium contributes much
to expedite the cure, both of the fimple gonorrhoea and of ve-
nereal ulcers, by increafing abforption both from the mucous
membrane and from the furface of ulcers. A quarter of a grain,
or half a grain, may l>e given with every dofe of the fublimate.

Nitrous acid has been lately ftrongly recommended, by Mr.
Scott, in venereal cafes ; from an idea that the oxygen, which
it confiils of m part, is loofely combined, and may be feparable in
the animal fyftem ; and that it may be the oxygen, only, which
exifls Icofely in mercurial calces or oxydes, that acls fo fuccefs-
fully, when'mercurials are exhibited. Some fuccefsful exhibi-
tions of this acid in venereal cafes are publifhed ; the dofe is one
drachm and a half, or two drachms, of the ftrong nitric acid
mixed in two pounds of water, to be drunk daily at repeated in-
tervals. Mr. Scott has fince ufed the nitrous acid much diluted
with water externally as a warm bath, either partially or gener-
ally, with great fuccefs, at Bombay, in venereal cafes. See Ar-?
tide II. 2. 4. and IV. 2. 7. i. in the Materia Medica.

It has been now ufed in this country with fuccefs by fome,
and without fuccefs by others, and may perhaps aflift the ufe of
mercurials as well as opium in the cure of veneral ulcers ; but
fhould not yet be folcly depended upcn.

3.

& A?S II. i. 5. 3. OF SENSATION.

3. Lepra. Leprofy. Leprofy of the Greeks. The (kin is
rough with white branny fcales, which are full of chinks ; often
moiil beneath, and itching. Th.e fcales on the head or arms of
fome drinking people are a difeafe of this kind. The perfpirnble
matter defigned for the purpofe of lubricating the external ikin is
fecreted in this difeafe in a too vifcid (late, owing to the inflam-
mation of the fubcutaneous veflels ; and, as the abforbents act
too ftrongly at the fame time, a vifcid mucus is left adhering to
the furface of the fkin.

In the leprofy of the Jews, defcribed in the thirteenth and four-
teenth chapters of Leviticus, the depreflion of the fore beneath
the furface of the fkin, and the hairs in it becoming \vhite, •
to have been the principal circumftances, which the prielt wa*
directed to attend to for the purpofe of afcertaining the dif-
eafe.

M. M. EfTenc*: of antimony, from 20 drops to 100, twice or
thrice a day, with half a pint of decoction of elm-bark ; or of
malt-tea ; or tincture of .cantharides, from 20 to 60 drops, four
times a day ; or fublimate 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 drunk in large quantities. Warm bath.
Oil-lkin bound on the part to confine the perfpirable matter.
Ointment of tar and fuet ; or poultice for two or three days, and
then cerate with lapis calaminaris. Diet of raiiins and bread.
Abflinence from wine^ beer, and all fpirits, is indifpehfably nec-
eflary to the cure.

4. Elephantiqfis; Leprofy of the Arabs. A contagious dif-
eafe ; the fkin is thickened, wrinkled, rough, unftuous, defti-
tute of hair,- without any fenfation of touch in the extremities
of the limbs ; the face deformed with tubercles ; the voice hoarfe,
and with a nafal tone. Cullen.

5. Framboejia. Yaws is faid to be contagious and hereditary,
It principally affects the negroes in the Weft Indies. Edinb.
Eflays,Vol,VI.

6. Pfera, Itch. A contagious prurient eruption. There
are two kinds of itch : that which appears between the finders
and under the joints of the knees and elbows ; and that \\
feldom is feen in thefe places, but all over the other parts of the
body. The latter is feldom thought to be the itch, as it does
noteafily infect even a bed-feljow, and refills the ufual mea
cure by brimftone.

If the itch be cured too haftily, by rubbing mercurial or ar-
fenical preparations over the whole body, or on too great a pare

DISEASES ciafe n. i. 5. 6,

of it, many bad fymptoms are produced ; as weaknefo of digef-
tion, with pale bloated countenance, and tendency to dropfy.
I have twice feen St. Vitus's dance occur, from the ufe of a mer-
curial girdle , and once a fwelled liver. I have alfo feen a fwell-
ed fpleen and fwelled legs from the external ufe of arfenic in the
cure of the itch. And very numerous and large phlegmons
commonly fucceed the too hafty cure of it by other means.

There does not appear a ftri£l analogy between the hafty cure
of the itch, and the retroceffion of the puftules in the feeondary
fever of the fmall-pox ; becaufe in that the abforption of the
matter is evinced by the fwelling of the face and hands, as>
the puftules recede, as explained in Clafs II. i. 3. 9. Variola
difcreta. And a fever is produced by this abforption ; neither
of which happen, when the puftules of the itch are deftroyed by
mercury or arfenic.

Nor can thefe inconveniences, which occur on the too hafty
cure of the itch, be explained by thofe which follow the cure of
fome kinds of gutta rofea, Clafs II. i. 4. 6. as in thofe the erup-
tions on the face were an aflociated difeafe with inflammation,-
of the. liver or ftomach, which they were accuftomed to* relieve ;
whereas the itch is not known to have had any previous catena-
tion with other difeafes.

In the itch there exifts not only great irritation in the produc-
tion of the puftules, but great fenfation is caufed by their acri-
mony afterwards ; infomuch that the pain of itching without the
interrupted fmarting occafioned by fcratching, would be intol-
erable. This great excitement of the two fenforial powers o£
irritation and fenfation is fo great, when the puftules are diffufed
over the whole furface of the body, that a torpor fucceeds the
fudden ceafmg of it ; which affects thofe parts of the fyftem
which were moft catenated with the new motions of the fkin,
as the ftomach, whence indigeft'on and flatulency ; or which
are generally moft liable to fail into torpor, as- the numerous
ids, which form the- liver. Whence the difeafes confequent
to the hafty cure of the itch are difeafes of debility, as tumid vif-
cera, csdematous fwellings, and St. Vitus's dance, which is a
debility of afibciation. In the fame manner indigeftion, with
green evacuations, are faid to follow an injudicious application
of ceruffa to (top too haftily the exfudation behind the ears of
children, Clafs I. i. 2. 9. And dropfies are liable to fucceed
the cure of old ulcers of the legs, which have long ftimulated
the fyftem..

M. M. The fize of a large pea, of an ointment confiding of

cne part cf white precipitate of mercury, to fix parts of hog's

•-.veil triturated together, to be rubbed on a part of the body

every

CLASS II. i. J. 7. OF SENSATION. 237

every night, and wafhed off with foap and water next morning,
till every part is cleared •, with lac fulphuris twenty grains to be
taken every morning inwardly, Warm faline bath, with white
vitriol in it. Flowers of fulphur mixed with thick gruel, or with
hog's fat. With either of which the body may be fmeared all
over.

Mr. Grille fays, that thofe who get manganefe from its mines
are not fubjeft to the itch ; and that he found an ointment, com-
pofed of fix parts of finely levigated manganefe and of fixteen
parts of lard, a more efficacious remedy for the itch than thole in
common ufe. Parmentier.

7. Pfora ebriorum. Elderly people, who have been much ad-
dicted to fpirituous 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
fcratching themfelves. I faw fatal effects m one fuch patient*
by a too extenfive ufe of a folntion of lead ; the eruption dif ap-
peared, he became dropfical, and died ; I fuppofe from the too
ifuddenly' ceafmg of the great ftimulus caufed by the eruptions
Over the whole fkin, as in the preceding article.

M. M. The patient mould gradually accuftom himfelf to half
his ufual quantity of vinous potation. The warm bath, with one
pound of fait to every three gallons. Mercurial ointments on
fmall parts of the fkin at a time. A grain of opium at night in-
ftead of the ufual potation of wine or beer.

8. Herpes. Herpes confifts of gregarious fpreading excoria-
tions, which are fucceeded by branny fcales or fcabs. In this
difeale there appears to be a deficient abforption of the fubcuta-
neous mucus, as well as inflammation and increafed fecretion of
it. For the fluid not only excoriates the parts in its vicinity by
its acrimony, but is very faline to the tafte, as fome of thefe pa-
tients have aflured 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 fcratching themfelves.

It is liable to affect the hands, and to return at diftant periods 5
and is probably a fecondary difeafe, as well as the zona ignea, or
Ihingles, defcribed below.

M. M. Poultice the eruption with bread and milk, or ra\r
carrots grated, for two or three whole days, to dilute or receive
the difcharged fluid, and abate the inflammation ; then cover the
parts with frefh cerate mixed with lapis calaminaris. On the
parts not excoriated mercurial ointment, made of one part of
white calx cf mercury and fix of hog's fat. Internally, after vene-

feciiozs,

3-1$ DISEASES CLASS II. i. g. $.

feclion, gentle repeated cathartics. Laftly, the bark. Acid of
vitriol. Bolus Armenia, or teftacea. Aritimonials. Decoc-
tion of interior bark of elm:

9. Zona ignea. Shingles. This eruption has been thought a-
fpecies of herpes by ibme writers, and by others a fpeeies of
eryfipelas. Yellow or livid veficles appear, producing a corrofive
ichor, which is fomedmes attended with a degree of fever. It
is faid to infeft fometimes the thorax an'd ribs, but its' moft gen-
eral fituation is on the fmall of the back, over one kidney, extend-
ing forward over the courfe of one of the ureters.

There is reafon to fufpecl, that this alfo is a fecondary or fym-
pathetic difeafe, as well as the preceding one ; but future
obfervations are required, before it can be removed to the fourth
clafs, or difeafes of affociation. In three patients I have been-
induced to believe, that the eruption on the*loi'ns was a tranila-
tron of inflammation from the external membrane of the kidney
to the fkin. 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 diftinguifhed
from nephritis interna, or gravel ; and without pain down the
outfide of the thigh, by which it was diftinguifhed from fciatica*
In other fituations the fhingles may fympathize with other inter-
nal membranes, as in a cafe publifhed by Dr. Ruflel (De Tabe
Glandulari), where the retroceflion of the ihingles was fucceed-
ed by a ferious dyfpnoca.-

M. M. Venefeclion, if the priilfe is flrong. 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 diffolved in a pint of water, and taken fo as to emp-
ty the ftomach and inteftines, is faid much to haften the cure ;
compreffes foaked in a faturnine folution are recommended ex-
ternally onthe eruption ; and cerate where there are ulcerations.
Defanet^s Surgical Journal, Vol. II. p. 378. If this be a vicari-
ous difeafe, it iliould continue half a lunation ; left, on its ceaf-
ing, the bad habits of motion of the primary difeafe fliouid not
have been fo perfectly diflevered, but that they may recur.

10. Annulus repens. Ring- worm. A prurient eruption
formed in a circle, affecting children, and would feem to be the
work of infects, according to the theory of Linnaeus, who afcribes'
the itch and dyfenterv to microfcopic animalcula. Thefe ani-
malcula are probably the effect, and n6t the cau fe, of thefe erup-
tions ; as they are to be feen in all putrefcent animal fluids. The
annular propagation of the ring-worm, and its continuing to en-
large its periphery, is well accounted for by the acrimony of the'
ichor or faiine fluid eroding the ikin in its vicinity.

M. M. Cove?

.£LAK il. i. 5. n. OF SENSATION. 259

M. M. Cover the eruption daily with ink. With white mer-
cmial ointment, asdeicribed above in herpes. "With foiution of

lie vitriol ten grains to an ounce. Thefe metallic calces .dim-
ul.ire the abforbents into ftronger action, wlience the fluid lias
its faline part reabforbed, and that before it has acceis to the air,
which probably adds to its acrimony by oxygenating it and thus
producing a new acid.

1 1. Tinea. Scald head. This contagious eruption affefts
the roots of the hair, and is generally mod virulent round the
edges of the hair on the back part of the head ; as the corona
veneris appears moft on the edges of the hair on the fore part of
the head : for in thefe parts the eruption about the roots of the
hair is mod expofed to the external air, by which its acrimony
or noxious quality is increafed.

The abforption of the matter thus oxygenated fwells the lymph-
atics of the neck by its ftimulus, occafioning many little hard
Jumps beneath the feat of the eruption ; when this happens, the
fooner it is cured the better, left the larger lymphatic's of the
neck (hould become affected.

M. M. The art of curing thefe eruptions confifls, fifft, in
abating the inflammation, and confequent fecretion of a noxious
material. Secondly, in preventing its accefs to the air, which fo
much increafes its acrimony. And thirdly, in promoting the ab-
forption of it, before it has been expofed to the air. For thefe
purpofes venefeclion once, and gentle cathartics, which promote
abforption by emptying the blood-veffels. Next poultices and
fomentations, with warm water, abate inflammation by diluting
the faline acrimony of the fecreted fluid, and abating the painful
fenfation. Afterwards cerate joined with fome metallic calx, as
of zinc or lead, or foiution of lead, mercury, or copper, or iron,
which may ftimulate the abforbent fyftem into ftronger action.

Cover the fhaved head with tar and fuet, and a bladder ; this,
by keeping the air from the fecreted fluid, much contributes to
its mildnefs, and the ftimulus of the tar increafes its abforption.
See the three preceding fpecies of this genus.

Mr. Morifon of Dublin cures the tinea capitis'by what he terms
an adhefive pafte, which is made by boiling half a pound of fine
flour in two pounds of common ale, and then adding four ounces
of yellow refin in fine powder, and {lining them well together,
until they are perfectly incorporated. After removing the hair,
and poulticing the head for a day or two, to take off the hard
fcabs, this patte is fpread on flips of linen, which are applied
over the whole affected part, and removed and frefh ones appli-
ed every morning, — after one or two days, I fufpecl, that re-
moving the platters feldomer might be more advantageous.

12. Cru/la

£4® DISEASES CLASS II. i. 5. 12.

1 2. Cntfta lafien. Milk-cruft is a milder difeafe than tinea,
affecting the face as well as the hairy fcalp of very young chil-
dren. It is not infectious, nor liable to fwell the lymphatics in its
vicinity like the tinea.

M. M. Cover the eruption with cerate made with lapis cala-
minaris, to be renewed every day. Mix one grain of emetic tar-
tar with forty grains of chalk, and divide into eight papers, one
to be taken twice a day, or with magnefia alba, if (tools are want-
ed. The child {hould be kept cool and much in the air.

13. Trichoma. Plica polonica. A contagious difeafe, in
which the hair is faid to become alive and bleed, forming inex*
tricable knots or plaits of great length, like the fabled head of
Medufa, with intolerable pain, fo as to confine the fufferer QQ.
his bed for years.

?s II. x.- 6. i; OF SENSATION.

ORDO I.

Increafed Senfation*

GENUS VI.

With Fever confequent to the Production of new Veffels or Fluids

SPECIES.

I . Febrisfenfttiva. Senfitive fever, when unmixed with either
irritative or inirritative fever, may be diftinguifhed from either
of them by the lefs comparative diminution of mufcular ftrengthj
or in other words, from its being attended with lefs diminution
of the fenforial power of irritation. An example of unmixed
fgnfitive fever may generally be taken from the pulmonary con-
fumption ; in this difeafe patients are feen to walk about with
eafe, and to do all the common offices of life for weeks, and even
months, with a pulfe of 1 20 ftrokes in a minute ; while in other
fevers, whether irritated or inirritated, with a pulfe of this fre-
quency, the patient generally lies upon the bed and exerts no
mufcular efforts without difficulty.

The caufe of this curious phenomenon is thus to be under-
ftood ; in the fenfitive fever a new fenforial power, viz. that of
fenfation, is fuperaddedto that of irritation ; which in other fevers
alone carries on the increafed circulation. Whence the power
of irritation is not much more exhaulted than in health ; and
thofe mufcular motions, which are produced in confequence of
it, as thofe which are exerted in keeping the body upright in
walking, riding, and in the performance of many cufhomary ac-
tions, are little impaired. For an account of the irritated ienfi-
tive fever, fee Clafs II. i. 2. i. ; for the inirritated fenfitive fever,
ClafsII. i. 3. i. IV. 2. 4. ii.

2. Febris a pure claiifb. Fever from enclofed matter is gener-
ally of the irritated fenfitive kind, and continues for many weeks,
and even months, after the abfcefs is formed ; but is didinguifh-
ed from the fever from aerated matter in open ulcers, becaufe
there are feldom any night-fweats, or colliquative diarrhcea in
this, as in the latter. The pulfe is alfo harder, and requires oo
cafional venefetlion, and cathartics, to abate the inflammatory
fever ; which is liable to increafe again every three or four days,
till at length, unlefs the matter has an exit, it deflroys the patient.
In this fever the matter, not having been expofed to the air, has
riot acquired oxygenation ; in which a new acid, or lome other

VOL. II. H H rioxiout

242 DISEASES CLASS II. r. 6. ^

noxious property, is produced ; which acls like contagion on the
conftitution inducing fever-fits, called hectic fever, which termin-
ate with fweats or diarrhoea ; whereas the matter in the clofed
abfcefs is either not abforbed, or does not fo affect the circula-
tion as to produce diurnal or he&ic fever-fits 5 but the ftimulus
of the abfcefs excites fo much fenfation as to induce perpetual
pyrexia, or inflammatory fever, without fuch marked remiiuons.
Ncverthelefs there fometimes is no fever produced, when the
inatteris lodged in a part of little fenfibility, as in the liver ; yet
a white pus-like fediment in thofe cafes exifts I believe general-
ly in the urine, with occafional wandering pains about the region
of the liver or cheft.

3, Vomica. An abfcefs in the lungs is fometimes produced
after peripneumony, the cough and fhortnefs of breath continue
in lets degree, with difficulty in lying on the well fide, and with
fenfitive irritated fever, as explained in the preceding article.

The occafional increafe of fever, with hard pulfe and fizy
blood, in thefe patients, is probably owing to the inflammation
of the walls of the vomica ; as it is attended with difficulty of

breathing, and requires venefeclion* Mr. B j a child about

feven years old, lived about feven weeks in this fituation, with a
pulfe from 150 to 170. in a minute, without fweats, or diarrhoea,
or fediment in his water, except mucus occafionally; and took
fufHcienjL nourimment during the whole time. The blood ta-
ken was always covered with a ftrong cupped fize, and on his
death three or four pints of matter were found in one fide of the
cheft ; which had probably, but lately, been effufed from a vom-
ica. This child was frequently induced to fwing, both in a re-
ciprocating and in a rotatory fwing, without any apparent abforp-
tion of matter ; in both thefe fwings he exprefled pleafure, and
did not appear to be vertiginous.

M. M. Repeated emetics. Digitalis ? Perfeverance in ro-
tatory fwinging. SeeClafs II. I. 6. 7.

Mr. I. had laboured fome months under a vomica after a pe-
ripneumoiiy, he was at length taken with a catarrh, which was in
feme degree endemic in March 1795, which occafioned him to
fneeze much, during which a copious haemorrhage from the lungs
occurred, and he fpit up at the fame time half a pint of very fe-
tid matter, and recovered. Hence errhines may be occafionally
a fed with advantage.

4. JSmpyema. When the matter from an abfcefs in the lungs
finds its way into the cavity of the cheft, it is called an empye-
nia. A fervant man, after a violent peripneumony, was feized
with fymptoms of empyema, and it was determined, after fome
lime, to perform the operation ; this was explained to him, and

the

CLASS II. 1.6.5. OT SENSATION. 143

the ufual means were employed by his friends to encourage him,
« by advifing him not to be afraid." By which good advice Le
conceived fo much fear, that he ran away-early next morning,
and returned in about a week quite well. Did the great fear
promote the abforption of the mutter, like the ficknefs occafion-
cd by digitalis ? Fear renders the external ikin pale j by this
continued decreafe of the action of the abforbents of the fldn
might not thofe of the lungs be excited into greater activity ':
thus produce increafecl pulmonary abforption by reverie iympa-
thy,as it produces pale urine, and even flools,by direct fympathy?
M. M. Digitalis ?

5. Febris Mefenterica. Fever from matter formed in the mef~
cntery is probably more frequent than is fufpected. It commen-
ces with pain in the bowels, with irritated fenfitive fever ; and
continues many weeks, and even months, requiring oecafional
venefection, and mild cathartics; till at length the continuance
of the pyrexia, or inflammatory fever, deflroys the patient. This
is an affection of the lymphatic glands, and properly belongs to
fcrofula ; but as the matter is not expofed to the air, no hectic
fever, properly fo called, is induced.

6. Febris a pure aerato. Fever from aerated matter. A great
collection of matter often continues a long time, and is fome-
times totally abforbed, even from venereal buboes, without pro-
ducing any diforder in the arterial fyftem. At length, if it be-
comes putrid by its delay, and one part of the matter thus be-
comes aerated by the air given out by the other part ; or if the
ulcer has been opened, fo that any part of it has been expofed
to the air for but one day, a hectic fever is produced. Whence
the utility arifes of opening large abfcefles by fetons, as in that
cafe little or no hectic fever is induced ; becaufe the matter is
Squeezed out by the fide of the fpongy threads of cotton, and lit-
tle or no air is admitted ; or by tapping the abfcefs with a tro-
car, as mentioned in ifchias, Clafs II. 1.2- 18.

In this fever the pulfe is about 1 20 in a minute, and its accefg
is generally in an evening, and fometimes about noon alfo, with
fweats or purging towards morning, or urine with pus-
like fediment -, and the patients bear this fever better than
any other with fo quick a pulfe : and laftly, when all the matter
from a concealed ulcer is abforbed, or when an open ulcer is heal-
ed, the hectic fever ceafes. Here the abforbed matter is fuppo-
fed to produce the fever, and the diarrhoea, fweats, or copious
muddy urine, to be fimply the confequence of increafed fecretion,
and not to confift of the purulent matter, which was fuppofed to
fce abforbed from the ulcer. See Sudor calidus, Clafs I. i. 2. 3.

The action of the air oa ulcers, as we have already (hewn, in*

creafei

?44 DISEASES Clafs II. r. 6. 6.

creafes the acrimony of the purulent matter, and even converts
it- into a weaker kind of contagious matter ; that is, to a mate-
rial inducing fever. This was afcribed to the union of the azotic
part of the atmofphere with the effufed pus in Seel:. XXVIII. 2.
but by contemplating more numerous facets and analogies, I am
pow induced to believe, that it is by the union of oxygen with it ;
firft,becaufe oxygen fo greedily unites with other animal fubftances,
as the blood, that it will pafs through a moift bladder to combine
with it, according to the experiment of Dr. Prieftley. Secondly^
becaufe the poifons of venomous creatures are fuppofed to bd
acids of different kinds, and are probably formed by the conta£b
of air after their fecretion. And laflly, becaufe the contagious
matter from other ulcers, as in itch, or fmall-pox, is formed ori
external membranes, and are probably combinations of animal
matter and oxygen, producing other new acids.

Since having written the above, Dr. Mitchill, of New York,
has fpoken much of the feptic quality ©f azote, or nitrogen ; and
thinks that it is the union of this part of the atmofphere with
the matter of ulcers, which produces or increafes its contagious
or fever-exciting property j which I had myfelf at firfl believed,'
as mentioned jn Part I. Seel: XXVIII. 2. In fupport of this
opinion, it may be faid, that proper ventilation with purer air is
believed certainly to diminifh or deflroy infection ; as fpoken of
in Clafs II. i. 3. where it is propofed to difengage oxygen from
manganefe, for the purpofe of purifying crowded apartments.
But further experiments muft determine this curious inquiry ;
which might be attended with important confequences^f azote,
and not oxygen, could be fhewn to prevent the healing of pul-
monary ulcers ; as oxygen might be refpired alone, or mixed
with hydrogen or with carbonic acid gas, inftead of with azote.

It was thought a fubjecl: of confequence by the jEfculapian
Society at Edinburgh, to find a criterion which fhould diftin-
guifh pus from mucus, for the purpofe of more certainly dif-
covering the prefence of ulcers in pulmonary difeafes, or in,
the urinary paflages. For this purpofe that fpciety offer-
ed their firft gold medal, which was conferred on the late Mr.
Charles Darwin, in the year 1778, for his experiments on this
fubjecl:. From which he deduces the following conclufions :

" i. Pus and mucus are both foluble in the vitriolic acid,
though in very different proportions, pus being much the lefs
ibluble.

" 2. The addition of water to either of thefe compounds de-
compofes it ; the mucus thus feparated, either fwims on the mix-
ture, or forms large ilocci in it ; whereas the pus falls to the
bottom, and forms on agitation a uniform turbid mixture. «

« 3. Pus

CLASS II. i. 6. 7. OF SENSATION. 145

« 3. Pus is diffufible through a diluted vitriolic ncid, though
mucus is not ; the fame occurs with water, or a folution of fea
fait.

« 4. Nitrous acid diflolves both pus and mucus ; water added
to the folution of pu£ produces a precipitate ; and the fluid a-
bove becomes clear and green ; while water and the folution of
mucus form a dirty coloured fluid.

" 5. Alkaline lixivium diflolves (though fometimes with dini-
jculty) mucus, and generally pus.

" 6. Water precipitates pus from fuch a folution, but does not
jmicus.

" 7. Where alkaline lixivium does not diflblve pus, it ftill dif-
tinguimes it from mucus ; as it then prevents its diiFufion through
water.

" 8. Coagulable lymph is neither foluble in diluted nor con-
centrated vitriolic acid.

" 9. Water produces no change on a folution of ferum in al-
kaline lixivium, until after long (landing, and then only a very
/light fediment appears.

" 10. Corrofive fublimate coagulates mucus, but not pus.

" From the above experiments it appears, that ftrong vitri-
olic acid and water, diluted vitriolic acid, and cauftic alkaline
lixivium and water, will ferve to diftinguim pus from mucus ;
that the vitriolic acid can feparate it from coagulable lymph, and
alkaline lixivium from ferum.

" And hence, when a perfon has any expectorated material,
the compofition of which he wifhes to afcertain, let him diflblve it
in vitriolic acid, and in cauftic alkaline lixivium ; and then add
pure water to both folutions : and if there is a fair precipitation in
each, he may be aflured that fome pus is prefent. If in neither a
precipitation occurs, it is* a certain teft, that the material is en-
tirely mucus. If the material cannot be made to diflblve in al-
kaline lixivium by time and trituration, we have alfo reafon to be-
lieve that it is pus." Experiments on Pus and Mucus. Cadell.
London.

Dr. Cappe, of York, in his inaugural treatife de Heclica, and
Dr. Ryan, of Dublin, in his Eflay on Confumption, have repeat-
ed thefe experiments of Mr. Darwin with nearly fimilar refults.

7. Pbthijis pulmonalis. In pulmonary confumption the fever
is generally fuppofed to be the confequence of the ftimulus of
abforbed matter circulating in the blood- veflels, and not fimply
of its (limulus on their extremities in the furface of the ulcers ;
as mentioned in Clafs II. i. 5. and Clafs II. i. 3. 9. The ul-
cers are probably fometimes occafioned by the putrid acrimony
<rf effufed blood remaining in the air-cells of the lungs after an

hsemoptoe.

246 DISEASES CLASS II. i. 6". 7.

fisemcptoe. Sec Clafs I. 2. i. 9. The remote eaufe of con-
fumption is ingenioufly afcribed by Dr. Beddoes to the hyper-
oxygenation of the blood, as mentioned Section XXVIII. 2.

As the patients liable to confumption are of the inirritable
temperament, as appears by the large pupils of their eyes ; there
is reafon to believe, that the haemoptoe is immediately occafioned
by the deficient abforption of the blood at the extremities of the
bronchial vein ; and that one difficulty of healing the ulcers is
occafioned by the deficient abforption of the fluids effufed into
them. See Sett XXX. i. and 2"

The difficulty of healing pulmonary ulcers may be owing, as
its remote caufe, to the inceflhnt motion of all the parts of the
lungs ; whence no fcab, or indurated mucus, can be formed fo
as to adhere on them. Whence thefe naked ulcers are perpet-
ually expofed to the action of the air on their furfaces, conver-
ting 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
fpread them wider. See the preceding article, and Seel. XXXIII.
2. 7. where the pulmonary phthifis is fuppofed to be infectious.
This acidifying principle is foun4 in all the metallic calces,
as in lapis calaminaris, which is a calciform ore of zinc ;
and in minium, which is a calx of lead ; two materials
which are powerful in healing excoriations and - ulcers, in a
fhort time, by their external application. How then does it
happen, that the oxygen in- the atmofphere fhould prevent pul-
monary ulcers from healing, and even induce them to fpread
wider ; and yet in its combination with metals, it (hould facili-
tate their healing ? The healing of ulcers confifts in promoting
the abforption of the fluids effufed 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
ftimulus ; and the metallic oxydes not being decompofed by
their contact with animal matter, no new acid, or contagious
material, is produced. So that the combined oxygen, when ap-
plied to an ulcer, fimply I fuppofe promotes abforption in it,
like the application of other materials of the articles forbentia or
incitantia, if applied externally ; as opium, bark, alum. But
in the pulmonary ulcers, which cannot protect themfelves from
the air by forming a fcab, the uncombined oxygen of the atmof-
phere unites with the purulent matter, converting it into a con-
tagious ichor ; which by infection, not by erofion, enlarges
the ulcers, as in the itch or tinea ; which might hence, accor-
ding to Dr. Beddoes's ingenious theory of confumption, be in-
duced to heal, if expofed to an atrnofphere deprived of a part of its

oxygen.

Clafs II. i. 6. 7. OF SENSATION. 147

oxygen. 1f6s 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 moil fatal malady.

M. M. Firfl, the refpiration of air lowered by an additional
quantity of azote, or mixed with fome proportion of hydrogen,
or of carbonic acid air, may be tried ; as described in a late pub-
lication of Dr. Beddoes o> the medicinal ufe of factitious airs,
Johnfon, London. Or lailly, by breathing a mixUire of one-
tenth part of hydrocarbonate mixed with common air, according.
to the difcovery of Mr. Watt, which has a double advantage in
thefe cafes, of diluting the oxygen of the atmofpheric air, and
inducing ficknefs, which increafes pulmonary abforption, as
mentioned below. An atmofphere diluted with fixed air (car-
bonic acid) might be readily procured by fetting 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 ul-
cers by combining with the purulent matter.

Another eafy method of adding carbonic acid gas to the air
of a room, would be by means of an apparatus invented by Mr.
Watt, and fold by Bolton and Watt, at Birmingham, as defcri-
becl in Dr. Beddoes' Treatife on Pneumatic Medicine. John-
fon, London. It confifts of an iron pot, with an arm projecting,
and a method of letting water drop by flow degrees on chalk,
-which is to be put' into the iron pot, and expofed to a moderate
degree of heat over a common fire. By occafionally 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 fame
manner a difFuiion of folution of flowers of zinc might be pro-
duced and breathed by the patient, and would be likely much to
contribute to the healing of pulmonary ulcers ; as obferved by
Mr. Watt. See the treatife above mentioned.

Breathing over the rapour of cauftic volatile alkali might eaflly
be managed for many hours in a day ; which might neutralize
the acid poifon formed on pulmonary ulcers by the contact of
oxygen, and thus prevent its deleterious quality, as other acids
become lefs cauftic, when they are formed into neutral falts with
alkalis. The volatile fait (hould be put into a tin canifter, with
two pipes like horns from the top of it, one to fuck the air from,
and the other to admit it.

Secondly, the external ulcers in fcrofulous habits are pale and
flabby, and naturally difmclined to heal, the depofition of fluids
in them being greater than the abforption ; thefe ulcers have
their appearance immediately changed by the external application

of

DISEASES CtfAis IT. i. 6. ^

of metallic calx'es, and the medicines of the article Sorbentia,
fuch as cerufla and the bark in fine powder, fee Clafs I. 2. 3. 21.'
and are generally healed in a (hort time by thefe means. Indu-
ced by thefe obfervatiohs, I wifhed to try the external application
of fuch powders to ulcers in the lungs, and conitrucled a box
with a circulating brufti in it, into this box two ounces of fine
powder of Peruvian bark were put, and two drachms of cerufla
in fine powder ; on whirling the central brufh, part of this was
raifed into a cloud of powder and the patient, applying his mouth
to one of the tin pipes rifirig out of the box, inhaled this powder
twice a day into his lungs. I obferved it did not produce any
cough or uneafmefs. This patient was in the laft ilage of con-
iumption, and was fcon tired of the experiment, nor have I had
Aich patients as I wifhed for the repetition of it. Perhaps a
fine powder of manganefe, 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 mod comminuted flate, might be a better way of
applying this powder to the lungs, as difcovered by Mr. Watt.
See Dr. Beddoes on Pneumatic Medicine. Johnfon.

Thirdly, as the healing of an ulcer confifls in producing a
tendency to abforption on its furface greater than the depofitiort
on it •, fee Seel. XXXIII. 3. 2. Other modes of increafing pul-
monary abforption, which are perhaps more manageable than
the preceding ones, may be had recourfe to ; fuch as by pro-
ducing frequent naufea or ficknefs, See Seel. XXIX. 5. i. and
Art. IV. 2. The great and hidden abforption of fluid from the
lungs in the anafarca pulmonum by the ficknefs induced by the
exhibition of digitalis, aftonifhes thofe who have not before at-
tended to it, by emptying the fwelled limbs, and removing the
difficulty of breathing in a few hours.

The moil manageable method of ufirrg digitalis is by making,
a faturated tinelure of it, by infufing two ounces of the powder
of the leaves in a mixture of four ounces of rectified fpirit 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 fo managed as not to induce
violent ficknefs. If ficknefs neverthelefs conies on, the patient
muft for a day or two omit the medicine ; and then begin it
again in reduced dofes.

Mr. , a young man about twenty, with dark eyes and

large pupils, who had every fymptom of pulmonary ulcers, I
believed to have been cured by digitalis, and publimed the cafe
in the Tranfaclions of the College, Vol. III. But I heard,
that about two years afterwards he relapfed and died. Mr.

CLASS U. i. 6. 7. OF SENSATION. 245}

L , a corpulent man, who had for fome weeks laboured

under a cough with great expectoration, with quick pulfe, and
difficulty of breathing, foon recovered by the ufe of digitalii
taken twice a day j and though this cafe might probably be a
peripneumonia notha, or catarrh, it is here related as (hewing
the power of pulmonary abforption excited by the ufc of this
drug.

Since the publication of the above5 fome fuccefsful cafes of
the treatment of confumption by the tinfture of digitalis are re-
lated in Medical and Phyfical Contributions, edited by Dr. Bed-
does, Longman, London. Two of the fuccefsful cafes are from
Dr. Drake, who obferves, " that by gradually increafing the dofe
of the faturated tin&ure of digitalis from 20 drops to 100 twice
a day, all the fymptoms of fever, cough, pain, and dyfpncea, daily
grew better, and at length totally ceafed, and that on the quanti-
ty and quality of the expectorated matter the digitalis foon exert-
ed a very remarkable effe£t, either promoting its abforption, or
diminifhing its fecretion, or perhaps both, in a rapid manner j
while at the fame time it deprived it of its fetor." Many cafes
with great relief, or with profperous event, are related byDr.
Fowler, and by Dr. Beddoes. One I have alfo lately feen my-
felf, whom I believed to be confumptive, and who is of a con-
fumptive family, and after having ufed the faturated tincture
about fix weeks, or two months, in various dofes, is now believed
by herfelf and friends to be perfectly reftored to health, but there
has not been time enough yet elapfed to determine, whether (he
may not relapfe, now me difcontinues the medicine.

Neverthelefs as the digitalis has been given in many cafes
without fuccefs, there is reafon to believe, that it mould be taken
early in the difeafe, before too great ulcerations are produced,
and too great debility exifts. As thefe patients are fubjett to
flatter themfelves more than mod others, and are liable, on that
account, not to apply foon enough for proper adiftance, they
mould be warned that a cough attended with a pulfe, that beats
1 20 times in a minute, is always a difeafe of danger.

Another method of inducing ficknefs, and pulmonary abforp-
tion in confequence, is by failing on the fea ; by which many
confumptive patients have been faid to have received their cure i
which has been erroneoufly afcribed to fea-air, initead of fea-
ficknefs ; whence many have been fent to breathe the fea-air on
the coafts, who might have done better in higher fituations, where
the air probably contains lefs oxygen gas, which is the heaviest
part of it. See a Letter from Dr. J. C. below.

A third method of inducing ficknefs, and confequent pulmo-
nary abforption, is by the vertigo occafioncd by f winging ; which

VOL. II. I i hat

DISEASES CLASS II. x. 6. 7.

has lately been introduced into practice by Dr. Smith, (Eflay on
Pulmonary Confcimption), who obferved that by Twinging the
hectic pulfe became flower, which is explained in Clafs IV. 2.
i. 10. The ufual way of reciprocating fwinging, like the of-
cillations of a pendulum, produces a degree of vertigo in thofe,
who are unufed to it ; but to give it greater effect, the patient
(hould be placed in a chair fufpended from the ceiling by two
parallel cords in contact with each other, the chair fhould then
be forcibly revolved 20 or 40 times one way, and fuffered to re-
turn fpontaneoufly ; which induces a degree of ficknefs in moft
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 abforption in ulcers, and
of thickening the matter in confequence, by taking the bark
and opium internally, or by metallic falts, as of mercury,
fleel, zinc, and copper, in fmall quantities, have been repeatedly
ufed in pulmonary confumption ; and may have relieved fome
of the fymptoms. As mercury cures venereal ulcers, and as pul-
monary ulcers refemble them in their not having a difpofition to
heal, and in their tendency to enlarge themfelves, there were
hopes, from analogy, that it might have fucceeded. Would a
folution of gold in aqua regia be worth trying ? When vinegar
is applied to the lips, it renders them mftantly pale, by promo-
ting the venous abforption ; if the whole fkin was moiflened with
warmifli vinegar, would this promote venous abforption in the
lungs by their fympathy with the fkin ? The veryabftemious di-
et on milk and vegetables alone is frequently injurious. Flefli
meat once a day, with fmall wine and water, or fmall beer, is pref-
erable. Half a grain of opium twice a day, or a grain, I believe
to be of great ufe at the commencement of the difeafe, as appears
from the fubfequent cafe.

Mifs — , a delicate young lady, of a confumptive family,
when fhe was about eighteen, had frequent cough, with quick
pulfe, a pain of her fide, and the general appearances of a begin-
ning confumption. She took about five drops of laudanum
twice a day in afaline draught, which wasincreafed gradually to
ten. In a few weeks fhe recovered, was afterwards married,
bore three or four children, and then became confumptive and
died.

The following cafe of hereditary comfumption is related by
a phyfician of great ability and very extenfive practice -, and, as
it is his own cafe, abounds with much nice obfervation and ufe-
ful knowledge j and, as- it has been attended with a favourable
event, may give confolation to many, who are in a fimilar fitua-
tioij and {hews that Sydenham's recommendation of riding as

CLASS II. i. 6. 7. OF SENSATION. 251

a cure for confumption is not fo totally ineffectual, as is now
commonly believed.

J. C. aged 27, with black hair, and a ruddy complexion, was
fubjecl: to cough from the age of puberty, and occafionally to
fpitting of blood. His maternal grandfather died of confump-
tion under thirty years of age, and his mother fell a victim to
this difeafe, with which fhe had long been threatened, in her
43d year, and immediately after (he ceafed to have children. In
the fevere winter of 1783-4, he was much afflicted with cough ;
and being expofed to intenfe cold, in the month of February he
was feized with peripneumony. The difeafe wrs violent and
dangerous, and after repeated bleedings as well as blifterings,
•which he fupported with difficulty, in about fix weeks he was
able to leave his bed. At this time the cough was fevere, and
the expectoration difficult. A fixed pain remained on the left
fide, where an iflue was inferted ; regular hectic came on every-
day about an hour after noon, and every night heat and reftlefT-
nefs took place, fucceeded towards morning by general perfpi-
ration.

The patient, having formerly been fubject to ague, was flruck
with the refemblance of the febrile paroxyfm, with what he had
experienced under that difeafe, and was willing to flatter himfelf it
might be of the fame nature. He therefore took bark in the in-
terval of fever, but with an increafe of his cough, and this requir-
ing venefection, the blood was found highly inflammatory. The
vait quantity of blood which he had loft from time to time, pro-
duced a difpofition to fainting, when he refumed the upright
pofture, and he was therefore obliged to remain almoft conftant-
ly in a recumbent pofition. Attempting to ride out in a carriage,
he was furprifed to find that he could fit upright for a confider-
able time, while in motion, without inconvenience, though, on
flopping the carriage, the difpofition to fainting returned.

At this time, having prolonged his ride beyond the ufual
length, he one day got into an_ uneven road at the ufual period
of the recurrence of the hectic paroxyfms, and that day he mifP-
ed it altogether. This circumftance led him. to ride out daily
in a carriage at the time the febrile acceflion might be expected,
and fometiroes by this means it was prevented^ fometimes de-
ferred, and almoft always mitigated.

This experience determined him to undertake a journey of
fome length, and Briftol being, as is ufual in fuch cafes, recom-
mended, he fet out on the i9th of April, and arrived thereon
the 2d of May. During the greater part of this journey (of
175 miles) his cough was fevere, and being obliged to be bled
three different times on the road, he was no longer able to fit up-

right,

25* DISEASES CLASS II. i. 6. 7.

right, but at very fhort intervals, and was obliged to lie at length
in the diagonal of a coach. The hectic paroxyfms were not in-
terrupted during the journey, but they were irregular and indif-*
tinct, and the falutary effects of exercife, or rather of geftation,
were imprefled on the patient's mind.

At Briftol he flayed a month, but reaped no benefit. The
weather was dry and the roads dufty ; the water infipid and in-
ert. He attempted to ride on horfeback on the downs, but was
not able to bear the fatigue for a diftance of more than a hundred
yards. The neceffity of frequent bleedings kept down his
ftrength, and his hectic paroxyfms continued, though lefs fe-
vere. At this time, fufpecting that his cough was irritated by
the weft winds bearing the vapour from the fea, he refolved
to try the effects of an inland fituation, and fet off for Matlock
in Derby(hire.

During the journey he did not find the improvement he ex-
pected, but the nightly perfpirations began to diminifh ; and
the extraordinary fatigue he experienced proceeded evidently
from his travelling in a poft-chaiie, where he could not indulge
in a recumbent pofition. The weather at Briftol had been hot,
and the earth arid and dufty. At Matlock, during the month
of June 1784, there was almoft a perpetual drizzle, the foil was
wet, and the air moift and cold. Here, however, the patient's
cough began to abate, and at intervals he found an opportunity
of riding more or lefs on horfeback. From two to three hundred
yards at a time, he got to ride a mile without flopping ; and at
length he was able to fit on horfeback during a ride from Mafan's
Bath to the village of Matlock along the Derwent, and round
on the oppofite banks, by the works of Mr. Arkwright, back to
the houfe whence he darted, a diftance of five miles. On dif-
mounting, however, he was feized with diliquium, and foon after
the ftrength he had recovered was loft by an attack of the haem-
orrhoids of the mod painful kind, and requiring much lofs 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 bet-
ter be obtained in the courfe of a journey than during his refi-
dence at any particular place. This, and other circumftances of
a private but painful nature, determined him to fet out from
Matlock on a journey to Scotland. The weather was now much
improved, and during the journey he recruited his ftrength.
Though as yet he could not fit upright ?,t reft for half an hour
together without a difpofition to giddinefs, dimnefs of fight, and
diliquium, he was able to fit upright under the motion of a poft-
during a journey of from 40 to 70 miles daily, and his

appetite

Clafs II. i. 6. 7. OF SENSATION. 253

appetite began to improve. Still his cough continued, and his
hectic flumings, though the chills were much abated and very
irregular.

The falutary effects of motion being now more ftriking than
ever, he purchafed a horfe admirably adapted to a valetudinarian
in Dumfriesfhire, and being now able to fit on horfeback for an
hour together, he rode out feveral times a day. He fixed his
refidence for a few weeks at Moffat, a village at the foot of the
mountains whence the Tweed, the Clyde, and the Annan, de-
fcend in different directions ; a fituation inland, dry, and healthy,
and elevated about three hundred feet above the furface of the
fea. Here his ftrength recovered daily, and he began to eat an-
imal food, which for feveral months before he had not tafted.
Perfevering in exercife on horfeback, he gradually increafed the
length of his rides, according to his ftrength, from four to twenty
miles a day ; and returning on horfeback to Lancafhire by the
lakes of Cumberland, he arrived at Liverpool on the firft of Sep-
tember, having rode the laft day of his journey forty miles.

The two inferences of moft importance to be drawn from this
narrative, are, firft, the extraordinary benefit derived from gefta-
tion in a carriage, and ftill more the mixture of geftation and
exercife on horfeback, in arrefting or mitigating the hectic par-
oxyfm -, and fecondiy, that in the florid confumption, as Dr.
Beddoes terms it, an elevated and inland air is in certain circum-
ftances peculiarly falutary ; while an atmofphere loaded with
the fpray of the fea is irritating and noxious. The vicinity of
the fea appears very injurious to almoft all vegetables, and fliould
on that account be fufpected in refpect to its general falubrity,
though it may neverthelefs be medicinal in fome difeafes, if re-
forted to for a time in the fummer months, but muft be ineligible
as a permanent refidence. See Clafs I. 2. i. 15.

The benefit derived in this cafe from exercife on horfeback,
may lead us to doubt whether Sydenham's praiie of this remedy
be as much exaggerated as it has of late been iuppofed. Since the
publication of Dr. C. Smyth on the effects of fwinging in low-
ering the pulfe in the hectic paroxyfm, the fubject of this nar-
rative has repeated his experiments in a great variety of cafes,
and has confirmed them. He has alfo repeatedly feen the hectic
paroxyfm prevented, or cut ihort, by external ablution of the
naked body with tepid water.

So much was his power of digeftion impaired or vitiated by
the immenfe evaucations, and the long continued debility he un-
derwent, that after the cough was removed, and indeed for fev-
eral years after the period mentioned, he never could eat animal
food without heat and flufhing, with frequent pulfe and extreme

drowfinefs.

254 DISEASES Clafs II. i. 6. 7.

drowfinefs. If this drowfinefs was encouraged, the fever ran
high, and he awoke from difturbed fleep, wearied and deprefled.
If it was refolutely refitted by gentle exercife, it went off iir about
an hour, as well as the increafed frequency of the pulfe. This
agitation was however fuch as to incapacitate him during the
afternoon for ftudy of any kind. The fame effects did not fol-
low a meal of milk and vegetables, but under this diet"his ftrength
did not recruit ; whereas after the ufe of animal food it recov-
ered rapidly, not with (landing the inconvenience already men-
tioned. For this inconvenience he at laft found a remedy in the
ufe of coffee immediately after dinner, recommended to him by
his friend Dr. Percival. At firft this remedy operated like a
charm, but by frequent ufe, and indeed by abufe, it no longer
pofieiTes its original efficacy.

Dr. Falconer, in his Differtation on the Influence of the Paf-
fions and Affections of the Mind on Health and Difeafe, fuppo-
fes that the cheerfulnefs which attends hectic fever, the ever-
fpringing hope, which brightens the gloom of the confumptive
patient, increafes the difeafed actions, and haftens his doom.
And hence he is led to inquire, whether the influence of fear
might not be fubflituted in fuch cafes to that of hope with ad-
vantage to the patient ? This queftion I fhall not prefume to
anfwer, but it leads me to fay fomething of the ftate of the mind
in the cafe juft related.

The patient, being a phyfician, was not ignorant of his dan-
ger, which forne melancholy circumftances ferved to imprefs
on his mind. It has already been mentioned, that his mother
and grandfather died of this difcafe. It may be added, that in
the year preceding that on which he himfelf was attacked, a
fifter of his was carried oi? by confumption in her i yth year ;
that in the fame winter in which he fell ill, two other lifters
were feized with the fame fatal diforder, to which one of them
fell a victim during his refidence at Briftol, and that the hope
of bidding a laft adieu to the other was the immediate caufe 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 duft I It may be" conjectured
from thefe circumitances, that whatever benefit may be derived
from the apprehenfion of death, muft in this cafe have been
obtained. The expectation of this ifTue was indeed for fome
time fo fixed that it ceafed to produce much agitation 5 in con-
formity to that general law of our nature, by which aim oft all
men fubmit with compofure to a fate that is forefeen, and that
appears inevitable. As however the progrefs of difeaie and de-
bility feemed to be arreited, the hope and the love of life reviv-
ed,

CLASS II. i. 6. 3. OF SENSATION. 255

ed, and produced, from time to time, the obfervations and the
exertions already mentioned.

Wine and beer were rigoroufiy abftained from during fix
months of the above hiftory ; and all the blood, whicfc was ta-
ken, was even to the laft buffy. Feb. 3, 1795.

It has lately been aflerted, that the people of Holland are lefs
liable to confumption of the lungs, than thofe of many other
parts of Europe, which has been aicribed to their warmer cloth-
ing. I am aware of the difficulty of making fuch eilimates with
any great degree of certainty, but if fuch be the fact, it may in-
deed be afcribed with fome degree of probability to their ufing
very warm clothing, but not very warm rooms during the winter
feafon. Whence the lungs are not fo much expofed to the
great and fudden tranfition from very warm rooms into frofty
air, as in this country. And though the lungs have not a fen-
fation of cold or of chilneis like the external Ikin, in pafiing from
very warm air into great cold, often much below the freezing
point, yet they are liable to inflammation, like other parts of the
fyftem. But to this may be objected, that the hereditary pul-
monary confumption attacks the patient fo infallibly a few years
after puberty, that it does not appear to depend much on exter.
nal circumftances.

8. Febrisfcrofuloja. The hectic fever occafioned by ulcers of
the lymphatic glands, when expofed to the air, does not differ
from that attending pulmonary confumption, being accompanied
with night-fweats and occafional diarrhoea.

M. M. The bark. Opium internally. Externally cerufla
and bark in fine powder. Bandage. Sea-bathing. See Clafs
I. 2. 3. 21. and II. i. 4. 12.

9. Felris ifchiadica. A hectic fever from an open ulcer be-
tween the mufcles of the pelvis, which differs not from the pre-
ceding. If the matter in this fituation lodges till part of it, I fup-
pofe, becomes putrid, and aerates the other part ; or till it be-
comes abforbed from fome other circum fiance j a fimilar hectic
fever is produced, with night-fweats, or diarrhoea.

Mrs. , after a lying in, had pain on one fide of her loins,

which extended to the internal part of the thigh on the fame
fide. No fluctuation of matter could be felt ; fhe became hec-
tic with copious ntght-fweats, and occafional diarrhoea, for four
or five weeks ; and recovered by, I iuppofe, the total abforption
of the matter, and the reunion of the walls of the abfcefs. See
Clafs II. i. 2. 18.

10. Febris Arthropucdica. Fever from the matter of difeafed
joints. Does the matter from fuppurating bones, which gener-
ally

DISEASES CLASS II. i. 6, if-

ally has a very putrid fmell, produce heftic fever or typhus ? See
ClafsII. 1.4. 1 6.

1 1 . Febris a pure contagiofo. Fever from contagious pus.
When the contagious matters have been produced on the exter-
nal habit, and in procefs of time become abforbed, a fever is
produced in confequence of this reabforption j which differs
with the previous irritability or inirritability, as well as with the
fenfibility of the patient.

1 2. Febris variolofa fecundaria. Secondary fever of fmall-pox.
In the diftincl: fmall-pox the fever is of the fenfitive irritated or
inflammatory kind ; in the confluent fmall-pox it is of the fenfi-
tive inirritated kind, or typhus gravior. In both of them the
fweliing of the face, when the matter there begins to be abforb-
ed, and of the hands, when the matter there begins to be ab-
forbed, ftiew, that it ftimulates the capillary vefTels or glands,
occafioning an increafed fecretion greater than the abforbents
can take up, like the aclion of the camharides in a blifter ; now
as the application of a blifter on the fkin frequently occafions
the ftrangury, which mews, that fome part of the cantharides is
abforbed ; there is reafon to conclude, that a part of the matter
of fmall-pox is abforbed, and thus produces the fecondary fever.
See Clafs II. 1.3.9. And not ^mply by its ftimulus on the
furface of the ulcers beneath the fcabs. The exfudation of a
yellow fluid from beneath the confluent eruptions on the face
before the height is fpoken of in Clafs II. I. 3. 2.

The material thus abforbed in the fecondary fever of fmall-
pox differs from that of open ulcers, as it is only aerated through
the elevated cuticle ; and fecondly, becaufe there is not a con-
flant fupply of frefh matter, when that already in the puftules
is exhaufted, either by abforption, or by evaporation, or by its
induration into a fcab. Might not the covering the face af-
fiduoufly and exactly with plafters, as with cerate of calamy, or
with minium plafter, by precluding the air from the puftules,
prevent their contracting a contagious, or acefcent, or fever-pro-
ducing power ? and the fecondary fever be thus prevented entirely.
If the matter in thofe puftules on the face in the confluent fmall-
pox were thus prevented from oxygenation, it is highly proba-
ble, both from this theory, and from the facts before mentioned,
that the matter would not erode the fkin beneath them, and by
thefe means no marks or fears would fucceed.

13. Febris carcinomatofa. Fever from the matter of cancer.
In a late publication the pain is faid to.be relieved, and the fe-
ver cured, and the cancer eradicated, by the application of car-
bonic acid gas, or fixed air. See Clafs II. i. 4. 16.

14. Febris

CLASS tt. i. & 14. OF SENSATION.

14. Felrts wnerea. From the abforption of the matte* from
Venereal ulcers and fuppurating bones. See Syphilis, II. i. 5. 2.

M. M. Any mercurial calx. Sarfaparilla ? Mezereon ?

15. Febris a fame putrida* Fever from putrid fanies. When
parts of the body are deitroyed by external violence, as a bruife,
or by mortification, a putrefaction foon fucceeds j as they are
kept in that degree of warmth and moiilure, by their adhefioli
to the living parts of the body, which moil forwards that proc*
efs. Thus the floughs of mortified parts of the tonfils give fe-
tor to the breath in fome fevers ; the matter from putrefying
teeth, or other fuppurating bones, is particularly offenfive j and
even the fcurf, which adheres to the tongue, frequently acquires
a bitter tafte from its incipient putridity* This material differs
from thofe before mentioned, as its deleterious property depends
on a chemical rather than an animal procefs.

1 6. fiebris puerpera. Puerperal fever. It appears from fome
late diflections, which have been publifhed, of thofe 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
fome blood or fanies. Thefe parts are fuppofed to have beeri
injured by the exertions accompanying labour ; and as matter in
this vifcus may have been produced without much pain, this
difeafe is not attended with arterial ftrength and hard full pulfe,
like the inflammation of the uterus ; and as the fever is of the
inirritative or typhus kind, there is reafon to believe, that the
previous exhauftion of the patient during labour may contribute
to its production ; as well as the abforption of a material not
purulent but putrid j which is formed by the delay of extrava-
fated or dead matter produced by the bruifes of the omentum,
or other viicera, in the efforts of parturition, rather than by pur-
ulent matter, the confequence ot fuppu ration* The pulfe i$
generally about 1 20 when in bed, and in the morning ; and is
increafed to 134, or more, when the patient fits up, or in the
evening paroxyfm. The pulfe of all very weak patients incrcai-
es in frequency when they fit up ; becaufe the expenditure ol
fenforial power neceflfary to preferve a» erect polture deducts fo
much from their general ftrefigth ; and hence the pulfe becomes
weaker* and in confequence quicker. See Sect. XII. i. 4.

Whence I fufpect that the puerperal fever is diftinguiilted
from the hectic fever, by the former being produced and fup-
ported by the abforption of a putrid fanies, aiifing from dead
parts of the omentum or rnefentery ; and the latter being pro-
duced and fupported by the abforption of purulent nutter,
which is the confequcncc.' of inflammation, after it h::s b6en ox-
ited l?y expofure to ihc- air; and rlru hau'; they differ in
"Voj.. \\ the

25 8 DISEASES CLASS II. i. 6. 16.

the greater debility, and confequent quicker pulfe, and more
rapid progrefs of the former than the latter ; but agree, in the
few patients which I have attended, in the circumitance of the
patients bearing the quantity of thefe fevers better than the
typhus, as i;; feen in their frequent rifing from their beds for
hours, and even attending to their occupations with a pulfe of
more than 120 in a minute ; and alfo in another important cir-
cum (lance, which is, that they take folid food, as bread, and
eggs, and oytlers, and even chicken, in great quantities ; which
in the inirritative fever, or typhus, is refufed during the whole
courfe of the difeafe. And hence it feems probable, that the
caufe or comrrencement of the inirritative fever, or typhus, may
have been from the torpor or paralyfis of the ftomach, owing to
the fwallowing of contagious matter along with our faliva ; and
the actions of the heart fuffer in confequence from fympathy.
And that hence thefe three kinds of fever may be diftinguimed
from each other : the typhus, by the total lofs of appetite for
folid food ; the heftic fever, by the pulfe being feldom above
1 20, and with attendant inflammation ; and the puerperal fever,
by a quicker and weaker pulfe ; but both the latter exifting
without the inability to take fome folid nourifhment.

In this fever time muit be allowed for the abforption of the
matter. Very large and repeated quantities of the bark, by
preventing fufficient food from being taken, as bread, and wine,
and water, I have thought, have much injured the patient ; for
the bark is not here given, as in intermittent fevers, to prevent
the paroxyfro, but (imply to ftrengthen the patient by increafing
the power of digeflion. About two ounces of decoction of
bark, with four drops of laudanum, and a drachm of fwect fpir-
it of vitriol, once in fix hours, and a glafs of wine between thofe
times, with panada, or other food, I have thought of mod ad-
vantage, with a fmall blifter occafionally.

Where not only the ftomach but alfo the bowels are much
diftended with air, fo as to found on ftriking them with the fin-
gers, the cafe is always dangerous, generally hopelefs ; which
is more fo in proportion to the quicknefs of the pulfe. Where
the bowels are diftended two drops of oil of cinnamon piould
be given in the panada three or four times a day, with ten grains
of alum.

In one cafe of puerperal fever, which lafted above forty days,
and was attended for the laft fortnight with perpetual fubfultus
of the tendons, and even twitching of the hands with unceafing
delirium, and inability to fleep, mufk given in the dofe of ten
grains every fix hours, with five drops of tincture of opium,
teemed to be of fervice \ and when the abdomen became tumid

with

CLASS II. i. 6. 16. OF SENSATION. 259

with air, about the 36th day from the commencement of the
fever, alum given in dofes of about feven grains every three
hours, Deemed of uncommon fervice, as the tumour of the abdo-
men much fubfided in one day, and the patient immediately be-
came able to fleep two or three hours at a time ; but the event
of the difeafe was fatal.

In this fituation I fuppofe the fever to have been kept up by
the abforption of a putrid material in the abdomen, on the
outfide of the inteftines ; and as alum inftantaneoufly deitroys
the volatile alkali which occafions a part of the fmell, and per-
haps the whole of the gas of putrid matter ; which alkali pre-
cipitates the argillaceous earth from the vitriolic acid ; I iup-
pofe this effect would be produced by alum, . though it might
not be produced by vitriolic acid, as the latter would unite witli
the contents of the ftomach ; but the alum would not unite
with any thing, till it became expofed to exhalations of putrid
matter. See Clafs II. I. 3. i. Might not a puncture by a lan-
cet into the tumid abdomen, through the fear of the navel, be
of ufe, when it is much diftended with air ?

The want of fleep was owing to debility, and ceafed when
that became leflened. As fome motions of the hands were the
confequence of her delirious ideas, thefe became tremulous, like
the hands of very old men, or drunkards, from debility whenev-
er they were exerted.

A very interefting account of the puerperal fever, which was
epidemic at Aberdeen, has been lately published by Dr. Alexan-
der Gordon. (Robinfons, London.) In feveral directions of
thofc who died of this difeafe, purulent matter was found in the
cavity of the abdomen ; which he afcribes to an eryfipelatous
inflammation of the peritonseum, as its principal feat, and of its
productions, as the omentum, mefentery, and peritonaea! coat
of the inteftines.

He believes, that it was infectious, and that the contagion
was always carried by the accoucheur, or the nurfe, from one ly-
ing-in woman to another.

The difeafe began with violent unremitting pain of the abdo-
men on the day of delivery, or the next day, with fhuddering,
and very quick pulfe, often 140 in a minute. In this fituation,
if he faw the patient within 12 or 24 hours of her feizure, he
took away from j6 to 24 ounces of blood, which was always
fizy. He then immediately gave a cathartic, confiding of three
grains of calomel, and forty grains of powder of jalap. After
this had operated, he gave an opiate at night ; and continued
the purging and the opiate for federal days.

He aliens, that almoft all thofe, whom he was permitted to

DISEASES CLASS II. i. 6. i&

treat in this manner early in the difeafe, recovered, to the num-
ber of 50 ; and that almoft all the reft died. But that when
two or three days were elapfed, the patient became too weak
for this method j and the matter was already formed, which de*
ftroyed them. Except that he faw two patients who recovered,
after difcharging a large quantity of matter at the navel. And
p. few who were relieved, by the appearance of external eryfipe-
Jas on the extremities.

This difeafe, confiding of an eryflpelatous inflammation, may
occafion the great debility fooner to occur than in inflammation
of the uterus $ which latter is neither eryfipelatous, I fuppofe,
nor contagious. And the fuccefs of Dr. Gordon's practice
feems to correfpond with that of Dr. Rufh, in the contagious
fever or plague at Philadelphia ; which appeared to be much ak
fifted by early evacuations. One cafe I faw, fome time ago,
where violent unceafmg pain of the whole abdomen occurred, a
few hours after delivery, with quick pulfe j which ceafed after
the patient had twice loft about eight ouncqs qf blood, and had
taken a moderate cathartic with calomel.

This cafe induces me to think, that it might be fafer, and
equally efficacious, to take lefs blood at firft than Dr. Gordon
mentions, and to repeat the operation in a few hours, if the
continuance of the fymptoms fhould require it. And the fame
in refpedl to the cathartic, which might perhaps be given in lefs
quantity, qnd repeated every two or three hours.

Nor ihould I wifti to give an opiate after the firft venefecHon
and cathartic ; as! fufpecl: that this might be injurious, except
thofe evacuations had emptied the veflels fo much, that the ftim-*
ulus of the opiate fhould acl: only by increafmg the abforption
of the new veflels or fluids produced on the furfacesof the infla-
med membranes. In other inflammations of the bowels, and
in acute rheumatifm, I have feen the difeafe much prolonged,
and I believe fometimes rendered fatal, by the too early adminik
tration of opiates, either along with cathartics, or at their inter-*
vals *, while a fmall dofe of opium given after fufficient evacua«
tions produces abforption only by its ftimulus, and much can-?
tributes to the cure of the patient. We may have vifible teftif
mony of this efFecl: of opium, when a folution of it is put into
an inflamed eye ; if it be thus ufed previous to1 fufficient evacun-*
tion, it increafes the inflammation ; if it be ufed after fufHcient
evacuation, it increafes abforption only, and clears the eye in a
very fmall time.

I cannot omit cbferving, from confidering thefe circumftances,
Jicw unwife is the common practice of giving an, opiate to every
* woman.

CLASS II, 1.6, 17. OF SENSATION- 261

woman immediately after her delivery, which muft often have
been of dangerous confequence,

17. Febris a fphaceh. Fever from mortification. This fever
from abforption 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, fo as to induce confecjuent debility, and to oppref*
the power of digeftion,

OUDO

262 DISEASES CLASS IT. i. 7. i.

ORDO I.

Increafed Senfation.
GENUS VII.

With increafed Aftion of the Organs ofSenfe.
SPECIES.

I. Delirium febrile. Paraphrofyne. The ideas in delirium
confift of thofe excited by the fenfation of pleafure or pain,
which precedes them, and the trains of other ideas aflbciated
with thefe and not of thofe excited by external irritations or by
voluntary exertion. Hence the patients do not know the room
which they inhabit, or the people who furround them ; nor have
they any voluntary exertion, where the delirium is complete ; fo
that their efforts in walking about a room or rifing from their
bed are unfteady, and produced by their catenations with the im-
mediate affections of pleafure or pain. See Section XXXIII. i. 4.

By the above circumftances it is diftinguimed from madnefs,
in which the patients well know the perfons of their acquaint-
ance, and the place where they are ; and perform all the volun-
tary actions with fteadinefs and determination. See Seel:.
XXXIV. 2. 2.

Delirium is fometimes lefs complete, and then a new face
and louder voice ftimulate the patient to attend to them for a
few moments ; and then they relapfe again into perfect delirium.
At other times a delirium affects but one fenfe, and the perfon
thinks he fees things which do not exift ; and is at the fame
time fenfible to the queftions iwhich are alked him, and to the
tafte of the food which is offered to him.

This partial delirium is termed a hallucination of the difor-
dered organ; and may probably arife from the origin of one
nerve of fenfe being more liable to inflammation than the others ;
that is, an exuberance of the fenforial power of fenfation may af-
fect it ; which is therefore thrown into action by {lighter fenfi-
tive catenations, without being obedient to external ftimulus, or
to the power of volition.

The perpetual flow of ideas in delirium is owing to the fame
circumttance, as of thofe in our dreams ; namely, to the defect
or paralyfis of the voluntary power 5 as in hemiplegia, when one
fide of the body is paralytic, and thus expends lefs of the fenforial
power, the limbs on the other fide are in conltant motion from

the

Clafs II. i. 7. 2. OF SENSATION. 263

the exuberance of it. Whence lefs fenforial power is exhaufted
in delirium, than at other times, as well as in fleep ; and hence in
fevers with great debility, it is perhaps, as well as the ftupor,
rather a favourable circumftance ; and when removed by numer-
ous blifters, the death of the patient often follows the recovery
of his underftanding. See Clafs I. 2. 5. 6. and I. 2. 5. 10.

Delirium in difeafes from inirritability is fometimes preceded
by a propenfity to furprife. See Clafs I. I. 5. 12.

M. M. Fomentations of the fhaved head for an hour repeat-
edly. A blifter on the head. Rifing from bed. Wine and
opium, and fometimes venefeclion in fmall quantity by cupping,
if the ftrength of the arterial fyftem will allow it.

2. Delirium maniacale. Maniacal delirium. There is anoth-
er kind of delirium, defcribed in Se&. XXXIII. i. 4. which has
the increafe of pleafurable or painful fenfation for its caufe,
without any diminution of the other fenforial powers ; but as
this excites the patient to the exertion of voluntary actions, for
the purpofe of obtaining the object of his pleafurable ideas, or
avoiding the object of his painful ones, fuch as perpetual prayer,
when it is of the religious kind ; it belongs to the infanities de-
fcribed in Clafs III. i. 2. i. and is more properly termed hal-
lucinatio maniacalis.

3. Delirium ebrietatis. The drunken delirium is in nothing
different from the delirium attending fevers except in its caufe,
as from alcohol, or other poifons. When it is attended with an
apoplectic ftupor, the pulfe is generally low ; and venefection
I believe fometimes deftroys thofe, who would etherwite have
recovered in a few hours.

M. M. Diluting liquids. An emetic.

4. Somnium. Dreams conftitute the mod complete kind of
delirium. As in thefe no external irritations are attended to,
and the power of volition is entirely fufpended ; fo that the
fenfations of pleafure and pain, with their aflbciations, alone ex-
cite the endlefs trains of our fleeping ideas j as explained* in
Sea. XVIII. on fleep.

5. Hallucinatio vifus. Deception of fight. Thefe vifual hal-
lucinations are perpetual in our dreams ; and fometimes pre-
cede general delirium in fevers ; and fometimes belong to rev-
erie, and to infinity. See Clafs III. i. 2. i. and 2. and muft
be treated accordingly.

Other kinds of vifual hallucinations occur by moon-light ;

when objects are not feen fo diftinctly as to produce the ufual

ideas affociated with them, but appear to us exactly as they are

feen. Thus the trunk of a tree appears a flat furfac^, inftcad of

-

DISEASES CLASS II. i. 7. 6.

a cylinder as by day, and we are deceived and alarmed by fee-
ing things as they really are feen. See Betkley on Vifion.

6. Hallucinate audit&S* Auricular deception frequently oc-»
curs in dreams, and fometimes precedes general delirium in fe-
vers j and fometimes belongs to vertigo, and to reverie, and to
infanity. See Sett. XX. 7. and Clafs III. i. 2. 1. and a.

7. Rubor a calore* The blufh from heat is occafioned by the in-
creafed action of the cutaneous veffels in confequence of the iu-
creafed fenfation of heat. See Clafs I. i. 2. I. and 3.

8. Rubor jucuttditatis. The blufh of joy is owing to the in-
creafed action of the capillary arteries, along with that of every
moving veifcl In the body, from the increafe of pleafurable fen-
fation.

9. Priapifmus atnatorius. Amatorial priapifm. The blood
is poured into the cells of the corpora cavernofa much fafler than
it can be reabforbed by the vena penis, owing in this cafe to the
pleafurable fenfation of love increafmg the arterial action. See
Clafs I. 1.4.6.

i o. D'tftentio mamularitm. The teats of female animals, when
they give fuck, become rigid and creeled, in the fame manner as
in the laft article, from the pleafurable fenfation of the love of
the mother to her offspring. Whence the teat may properly be
called an organ of fenfe. The nipples of men do the fame when
rubbed with the hand. See Clafs I. I. 4, 7.

ORDQ

i

Clafs II. a. i. i. OF SENSATION. 265

ORDO II.

Decreafed Senfation.

GENUS I.

Of the General Syjlem.

SPECIES.

1. Stultitia injenftbilis. Folly from infenfibility. The pleaf-
ure or pain generated in the fyftem is not fufficient to promote
the ufual activity either of the fenfual or mufcular fibres.

2. Txdium vita. Ennui. Irkfomenefs of life. The pain of
lazinefs has been thought by fome philofophers to be that prin-
ciple of action, which has excited all our induftry, and diftin-
guifhed mankind from the brutes of the field. It is certain that,
where the ennui exifts, it is relieved by the exertions of our
minds or bodies, as all other painful fenfations are relieved ;
but it depends much upon our early habits, whether we become
patient of lazinefs, 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 lefs owing to deficiency of the pleaf-
urable fenfation, than to the fuperabundancy of voluntary pow-
er which occafions pain in the mufcles by its accumulation ; as
appears from the perpetual motions of a fquirrel confined in a
cage.

3. Parefis fenfttiva. Weaknefs of the whole fyftem from in-
fenfibility.

VOL. II. - L i, ORDO

266 DISEASES Clafs II. 2. 2. i.

ORDO II.

Decrfafed Senfatlon*

GENUS II.

Of particular Organs.

SPECIES.

I . Anorexia. Want of appetite. Some elderly people, and
thofe debilitated by fermented liquors, are liable to lofe their
appetite for animal food ; which is probably in part owing to
the deficiency of gaftric acid, as well as to the general decay of
the fyfteni : elderly people will go on years without animal food ;
but inebriates foon (ink, when their digeftion becomes fo far im-
paired. Want of appetite is fometimes produced by the putrid
matter from many decaying teeth being perpetually mixed with
the faliva, and thence affecting the organs of tafte, and greatly-
injuring the digeftion.

M. M. Fine charcoal powder diffufed in warm water, held in
the mouth frequently in a day, as in Clafs I. i. 4. 4. or folution
of alum in water. Extract the decayed teeth. An emetic. A
blifter. Chalybeates. Vitriolic acid. Bile of an ox infpiiTated,
and made into pills ; 20 grains to be taken before dinner and
fupper. Opium half a grain twice a day.

All the ftrength we poflefs is ultimately derived from the
food, which we are able to digeft ; whence a total debility of
the fyfteni frequently follows the want of appetite, and of the
power of digeftion. Some young ladies I have obferved to fall
into this general debility, fo as but juft to be able to walk about ;
which I have fometimes afcribed to their voluntary fading,
when they believed themfelves too plump ; and who have thus
loft both their health and beauty by too great abftinence, which
could never be reftored.

Two young ladies applied to me, who had experienced many
months of great debility, and of almoft total want of appetite,
from another caufe, \vhich was from bathing 0n a warm day iri
a cold fountain of water, which was covered from the fun and
fupplied by a powerful fpring; but gradually afterwards recov-
ered their health by the ufe of fix grains of rhubarb with one
gniin of opium every night for fome weeks, and a bitter draught
twice a day with a flight chalybeate. See Clafs III. 2. i. 17.

I have feen other cafes of what may be termed anorexia epi-

Icptica,

I

CLASS II. 2. 2. 2. OF SENSATION. 267

leptica, in which a total lofs of appetite, and of the power of di-
geftion, fuddenly occurred along with epileptic fits. Mifs B. a
girl about eighteen, apparently very healthy, and rather plump,
was feized with fits, which were at firft called hyfterical ; they
occurred at the end of menftruation, and returned very fre-
uently with total lofs of appetite. She was relieved by vene-
"eclion, blifters, and opiates ; her ftrength dirninimed, and af-
ter fome returns of the fits, the took to her bed, and has furvi-
ved 15 or 20 years; fhe has in general eaten half a potato a
day, and feldom fpeaks, but retains her fenfes, and had many
years occafional returns of convulfion. I have feen two fimilar
cafes, where the anorexia, or want of appetite, was in lefs degree ;
and but juft fo much food could be digefted, as fupplied them
with fufficient ftrength to keep from the bed or fofa for half a
day. As well as I can recollect, all thefe patients were attend-
ed with weak pulfe, and cold pale fkin ; and received benefit by
opium, from a quarter of a grain to a grain four times a day.
See ClafsIII. i. i. 7. and III. i. 2. 20. and Suppl. I. 14. 3.

2. Adipfia. Want of third. Several of the inferior people,
as farmers' wives, have a habit of not drinking with their dinner
at all, or only take a fpoonful or two of ale after it. I have
frequently oberved thefe to labour under bad digeftion, and de-
bility in confequence ; which I have afcribed to the too great
ftimulus of folid food undiluted, deftroying in procefs of time
the irritability of the ftomach.

3. Impotentia (agene£a.) Impotency much feldomer happens
to the male fex than {rerility to the female fex. Sometimes a
temporary impotence occurs from bafhfulnefs, or the interfer-
ence of fome voluntary exertion in the production of an effect,
which ihould be performed alone by pleafurable fenfatiori.

One, who was foon to be married to 3 lady of fupenor con-
dition to his own, exprefled fear of not fucceeding on the wed-
ding night ; he was advifed to take a grain of opium before he
went to bed, and to accuftom himfelf to fleep with a woman
previously, but not to enjoy her, to take off his baihfulnefs ;
which fucceeded to his wifh.

Mr. John Hunter in his work on the Venereal Difeafe,has given
an ingenious feclion on this fubjecl of mental impotence, in which
he relates a fuccefsful mode of treatment. He prevailed on aperfon
in this fituation to promife on his honor to pafs fix nights in bed
with a young woman without attempting to have connection with
her, whatever might be his power or inclination. He after-
wards affured Mr. Hunter, that this refolution had produced
fuch a total alteration in the ftate of his mind, that the power of
connection foon recurred, for inftead of going to bed with the

fear

265 DISEASES CLASS II. 2. 3. 4.

fear of inability, he went with fears, that he ftiould be poflefT-
ed with too much defire, and too much power, fo as to become
uneafy to him, which really happened, as he would have been
happy to have (hortened the time ; and when he had once
broken the fpell, his mind and powers went on together ; and
his mind never returned to its former ftate.

A gentleman about 50 years of age, who had lived too freely,
as he informed me, both in refpecl: to wine and women, com-
plained, that his defire for the fex remained, and that he occa-
fionally parted with femen, but with defect of a perfect tenfio
penis, and that he had tried 20 drops of laudanum, and 20 drops
of tincture of cantharides on going to bed without efFecl: ; and
that as the debility or inirritability of the fyftem in this cafe
rather than any mental affection feemed to be a part of the
cuufe, he was advifed to ftimulate the fphin£ler ani by the in-
troduction of a piece of the root of ginger, as is done by the
horfe-dealers to fale-horfes. And, however ridiculous the oper-
ation may appear, he allured me, that it fucceeded ; which I
fuppofe might be owing to the fympathy between the fphindler
am and the penis -, which is fo often the caufe of painful fenfa-
tion in the former, when a done at the neck of the bladder af-
fects the latter j and converfely when painful piles affect the
rectum, a ftrangury is fometimes produced by fympathy.

For reftoring the venereal power M. Le Roy thinks phofpho-
rus taken in a dofe of a quarter of a grain rubbed with oil or
yolk of egg, or honey ; or even the aci|^)f phofphorus, to pof-
fefs great efficacy. Med. Review, Vol.'^v. p. 204. The water
in which phofphorus has been kept fome time, probably pof-
feifes fome of this acid, and is alfo recommended by M. Le
Roy. I ought here to add, that I have been lately informed,
that a gentleman directed four grains of phofphorus to be made
into pills with conferve, with defign of increafmg his venereal
power. He was feized with intolerable fenfe of heat at his
ftomach, pulfe feeble, but not quickened, livid countenance,
forenefa of his bowels to the touchvand incefiant vomitings, by
which he at lafl brought up fome blood. His illnefs laded five
or fix days. He did not acknowledge any caufe of his fudden
illnefs, but faid he was certain emetics would cure him, and took
two by his own requeft. After his death, the apothecary men-
tioned his having directed the pills as above, which were made
three days before lie was taken ill 5 and he was believed to have
taken about half of them.

M. M. Chalybeates. Opium. Bark. Tincture of can-
tharides,

4. Sterilitas. Barrennefs. One of the ancient medical wri-
ters

CLASS II. 2. 2. 5. OF SENSATION. 269

ters aflerts, that the female fex become pregnant with mod cer-
tainty at or near the time of menftrmtion. This is not im-
probable, fince thefe monthly periods feem to refemble the
monthly venereal orgafm of feme female quadrupeds, which be-
come pregnant at thofe times only ; and hence the computation
of pregnancy is not often erroneous, though taken from the lad
menftruation. See Section XXXVI. 2. 3.

M. M. Opium a grain every night. Chalybeates in very
fmall dofes. Bark. Sea-bathing.

5. Infenfibilitas artuum. As in fome paralytic limbs. A great
infenfibility fometimes accompanies the torpor of the (kin in cold
fits of agues. Some parts have retained the fenie of heat, but
not the fenfe of touch. See Sect. XVI. 6.

M. M. Friction with flannel. A blifter. "Warmth.

6. Dyfiiria infenfttiva. Infenfibility of the bladder. A diffi-
culty or total inability to make water attends fome fevers with
great debility, owing to the infenfibility or inirritability of the
bladder. This is a dangerous but not always a fatal fymptom.
SeeCJafsIII. 2.1.6.

M. M. Draw off the water with a catheter. Afiift the pa-
tient in the exclufion of it by comprefling the lower parts of the
abdomen with the hands. Wine two ounces, Peruvian bark
one dram in decoction, every three hours alternately. Balfam
of copaiva. Oil of almonds, . with as much camphor as can be
diflblved in it, applied as a liniment rubbed on the region of the
bladder and perinaeum, and repeated every four hours, was ufed
in this difeafe with fuccefs by Mr. Latham. Med. Comment.
1791, p. 213.

7. Accumulate alvina. An accumulation of feces in the
rectum, occafioned by the torpor, or infenfibility, of that bowel.
But as liquids pafs by thefe accumulations, it differs from the
conftipatio alvi, which is owing to too great abforption of the
alimentary canal.

Old milk, and efpecially when boiled, is liable to induce this
kind of coftivenefs in fome grown perfons ; which is probably
owing to their not poflefiing iufficient gaftric acid to curdle and
digeft it ; for as both thefe procefles require gaftric acid, it fol-
lows, that a greater quantity of it is neceflary, than in the digef-
tion of other aliments, which do not previoufly require being
curdled. This ill digefted milk not fufficiently ftimulating the
rectum, remains till it becomes a too folid mafs. On this ac-
count milk feldom agrees with thofe, who are fubject to piles,
by inducing coftivenefs and large ftools.

M. M. Extract the hardened fcybala by means of a marrow-
fpoon j or by a piece of wire, or of whale-bone bent into a bow,

and

27* DISEASES CLASS II. «. 2/7.

and introduced. Injections of oil. Caftor oil, or oil of al-
monds, taken by the mouth. A large clyfter of fmoke of to-
bacco. Six grains of rhubarb taken every night for many
months. Aloes. An endeavour to eftablilh a habit of evacua-
tion at a certain hour daily. See Clafs I. i. 3. 5.

ORDO

CLASS II. 3. i. i. OF SENSATION. 271

ORDO III.

Retrograde Senfttive Motions.

GENUS I.
Of Excretory Dufts.

THE retrograde action of the osfophagus in ruminating ani*
mals, when they bring up the food from their firft ftomach for the
purpofe of a fecond maftication of it, may probably be caufed by
agreeable fenfation ; fimilar to that which induces them to fwal-
low it both before and after this fecond maftication ; and then
this retrograde action properly belongs to this place, and is er-
roneoufly put at the head of the order of irritative retrograde
motions. Clafs I. 3. I. 1.

SPECIES.

1. Ureterum motus retrogrejfus. When a (lone has advanced
into the ureter from the pelvis of the kidney, it is fometimes lia-
ble to be returned by the retrograde motion of that canal, and
the patient obtains fallacious eafe, till the ftone is again puflied
into the ureter.

2. Urethra motus retrogrejffus. There have been inftances of
bougies being carried up the urethra into the bladder moft prob-
ably by an inverted motion of this canal ; for which fome have
undergone an operation fimilar to that for the extraction of a
ftone. A cafe is related, in fome medical publication, in which
a catgut bougie was carried into the bladder, and, after remain-
ing many weeks, was voided piece-meal in a femi-diflblved ftate.
Another cafe is related of a French officer, who ufed a leaden
bougie ; which at length found its way into the bladder, and
was, by injecting crude mercury, amalgamated and voided.

In the fame manner the infection, from a fimple gonorrhcea,
is probably carried further along the courfe of the urethra ; and
fmall ftones frequently defcend fome way into the urethra, and are
again carried up into the bladder by theinverted action of this canal.

3. Duff us choledocki motus retrogrejffus. The concretions of
bile, called gall-ftones, frequently enter the bile-duct, and give
violent pain for fome hours ; and return again into the gall-blad-
der, by the retrograde action of this duct. May not oil be car-
ried up this duct, when a gall-ftone gives great pain, by its re-
trograde fpafmodic action ? See Clafs I. i. 3. 8.

M. M. Opium a grain and half.

72*

27* DISEASES CLASS III. i. i

The Orders and Genera of the Third Clafs of Difeafes.
CLASS III.

DISEASES OF VOLITION.

ORDO I.

Increafed Volition.

GENERA.

I. With increafed aftions of the mufcles.

2* With increafed aclions of the organs of fenfe.

ORDO IL

Decreased Volition,
GENERA.

1. With decreafed actions of the mufcles.

2. With decreafed actions of the organs of fenfe.

The Orders, Genera, and Species, of the Third Clafs of

Difeafes.

CLASS III.

DISEASES OF VOLITION.

ORDO I.

Increafed Volition.

GENUS I.

With increafed Aftions of the Mufcles.

SPECIES.

1. Ja&itatio. Reftleflhefs.

2. Tremor febrilis. Febrile trembling.

3. Clamor.

CLASS III. 1.2*

OF VOLITION.

273

Clamor.

Rifus.

Convtiljio.

3-
4-

5-

6. -

7. Epilepfia.

9-
10.
II.

12.

debilis.
dolcrifica,

14.

dolorifica.
Somnambulifmus.
Afthma convulfivum.
• dolorificum.

Stridor dcntium.
Tetanus trifmus.

dolorificus.

15. Hydrophobia.

Screaming.

Laughter.

Convulfion.

weak.

painful.

Epilepfy.

- painful.
Sleep-walking.
Afthma convulfive.

painful.

Gnafhing of the teeth.
Cramp of the jaw.

painful.

Dread of water.

GENUS II.

With increafed Actions of the Organs of Senfe*
SPECIES.

Mutable madnefs.
Reverie.
Watchfulnefs.
Sentimental love.
Vanity.

Defire of home.
Superftitious hope*
Pride of family.
Ambition.
Grief.

Irkfomenefs of life.
Lofs of Beauty.
Fear of poverty.

of death.

of Hell.

Luft.

Anger.

Rage.

Depraved appetite.

Averfion to food.

Imaginary pox.

itch.

tabes.

Pity.

Heroic education.

1. Mania mittabilis.

2. Studium inane.

3. Vigilia.

4. Erotomania.

5. Amor fm.

6. Noftalgia.

7. Spes religiofa.

8. Superbia jlemmatis.

9. Ambitlo.

10. Mosror.

1 1 . Txdium vita.

1 2. Deftderium pulchritudinis.

13. Paupertatis timor.

14. Let hi timor.

15. Orel timor.

1 6. Satyriafts.

17. Ira.

1 8. Rabies.

19. Citta.

20. Cacofttia.

2 1 . Syphilis imaginana,

22. Pfora imagitiaria.

23. Tabes imaginana.

24. Sympathia aliena.
2. E due at lo here/-

VOL. II.

M M

ORDO

274

DISEASES

CLASS II. 2.

7-
8.

9-

10.

ii.

12-

ORDO II.

Decreafed Volition.

GENUS I.

With decreafed Aclions of the Mufcleu
SPECIES.

1. LaJJitudo.

2. Vacillatio fenilis.
Tremor fenilis.
Brachiorum paralyfis.
Raucedo paralytica.

3

4
5
6* Vefica urinaria paralyftf.

RecJi paralyfis.

Pare/is voluntaria.

Catalepjts.

Hemiplegia.

Paraplegia*

Somnus.

13. Incubus.

14. Lethargits.

15. Syncope epileptic a.
1 6. Apoplexia.

17. M.QYS a f rigor e.

Fatigue.

See-faw of old age.

Tremor of old age.

Palfy of the arms.

Paralytic hoarfenefs.

Palfy of the bladder.

Palfy of the reftum.

Voluntary debility.

Catalepfy.

Palfy of one fide.

Palfy of the lower limbs<

Sleep.

Night-mare.

Lethargy.

Epileptic fainting.

Apoplexy.

Death from cold.

GENUS II.

With decreafed Actions of the Organs of Senfe.
SPECIES.

1 . RecollecJionis jacJura.

2. Stultitia voluntaria.

3. Credulitas.

Lofs of recolledlioit
Voluntary folly.
Credulity.

CLASS

CLASS III. 1. 1, OF VOLITION. 275

CLASS III.

DISEASES OF VOLITION.

ORDO I.

Increafed Volition,
GENUS I.

Increafed Aftions of the Mufcles.

WE now ftep forward to confider the difeafes of volition,
that fuperior faculty of the fenforium, which gives us the pow-
er of reafon, and by its facility of action diftinguiflies mankind
from brute animals ; which has effected all that is great in the
world, and fuperimpofed the works of art on the fituations of
nature.

Pain is introduced into the fyftem either by excefs or defecl:
of the action of the part. (Seel:. IV. 5.) Both which circum-
ftances feem to originate from the accumulation of fenforial
power in the affected organ. Thus when the (kin is expofed to
great cold, the activity 04 the cutaneous veflels is diminifhed, and
in confequence an accumulation of fenforial power obtains in
them, becaufe they are ufually excited into inceilant motion by
the ftimulus of heat, as explained in Seel:. XII. 5. 2. Contra-
rywife, when the veflels of the fldn are expofed to great heat,
an excefs of fenforial power is alfo produced in them, which is
derived thither by the increafe of ftimulus above what is natural.

This accounts for the relief which is received in all kinds of
pain by any violent exertions of our mufcles or organs of fenfe ;
which may thus be in part afcribed to the exhauftion of the fen-
forial power by fuch exertions. But this relief is in many cafes
fo inftantaneous, that it feems neverthelefs probable, that it is
alfo in part owing to the different manner of progreffion of the
two fenforial powers of fenfation and volition j one of them com-
mencing at fome extremity of the fenforium, and being propa-
gated towards the central parts of it ; and the other commenc-
ing in the central parts of the fenforium, and being propagated
towards the extremities of it ; as mentioned in Seel. XL 2. i.

Thefe violent voluntary exertions of our mufcles or ideas to,
relieve the fenfation of pain conftitute convulfions and madnefs ;
and are diitinguifhed from the mufcular aclions owing to in-
creafcd fenfation, as in freezing, or coughing, or parturition, or

ejedlio

DISEASES CLASS III. i.r.

eject io feminis, becaufe they do not contribute to diflodge the
caufe, but only to prevent the fenfation of it. In two cafes of
parturition, both of young women with their firft child, I have
feen general convulfions occur from excefs of voluntary exer-
tion, as above defcribed, inflead of the actions of particular muf-
cles, which ought to have been excited by fenfation for the ex-
clufion of the fetus. They both became infenfible, and died af-
ter fome hours ; from one of them the fetus was extracted in
vain. I have heard alfo of general convulfions being excited
inftead of the actions of the mufculi acceleratores in the ejectio
ieminis, which terminated fatally. See Clafs III. i. i. 7.

Thefe violent exertions are moft frequently excited in cori-
fequence of thofe pains, which originate from defect of the
action of the part. See Sect. XXXIV. i. and 2. The pains
from excefs and defect of the action of the part are diftin-
guifhable from each other by the former being attended with
increafe of heat in the pained part, or of the whole body ;
while the latter not only exift without increafe of heat in the
pained part, but are generally attended with coldnefs of the ex-
tremities of the body.

As foon as thefe violent actions of our mufcular or fenfual
fibres for the purpofe of relieving pain ceafe to be exerted, the
pain recurs ; whence the reciprocal contraction and relaxation
of the mufcles in convulfion, and the intervals of madnefs.
Otherwife thefe violent exertions continue, till fo great a part of
the fenibrial power is exhaufted, that no more of it is excitable
by the faculty of volition ; and a temporary apoplexy fucceeds,
with fnoring as in profound ileep ; which fo generally termin-
ates epileptic fits.

When thefe voluntary exertions become fo connected with
certain difagreeable fenfations, or with irritations, that the ef-
fort of the will cannot reftrain them, they can no longer in com-
mon language be termed voluntary j but neverthelefs belong to
this clafs, as they are produced by excefs of volition, and may
{till not improperly be called depraved voluntary actions. See
Sect. XXXIV. i. where many motions in common language
termed involuntary are fhewn to depend on excefs of volition.
When thefe exertions from excefs of volition, which in com-
mon language are termed involuntary motions, either of mind
or body, are perpetually exerted in weak conftitutions, the pulfe
becomes quick ; which is occafioned by the too great expendi-
ture of the fenforial power in thefe unceafmg modes of activity.
In the fame manner as in very weak people in fevers, the pulfe
fometimcs incrcafes in frequency to 14® ftrokes in a minute,
when the patients ftand up or endeavour to walk ; and fubfuies

to

CLASS III. i. i. OF VOLITION. 277

to no, when they lie down again in their beds. Whence it
appears, that when a very quick pulfe accompanies convulfion
or infanity, it limply indicates the weakness of the patient ; that
is, that the expenditure of fenforial power is too great for the
fupply of it. But if the ftrength of the patient is not previoufly
exhaufted, the exertions of the mufcles are attended with tem-
porary increafe of circulation, the reciprocal fwellings and elon-
gations of their bellies pufh forwards the arterial blood, and
promote the abforption of the venous blood ; whence a tempo-
rary increafe of fecretion and of heat, and a ftronger pulle.

A correfpondent acquaints me, that he finds difficulty in un-
derftanding how the convulfions of the limbs in epilepfy can be
induced by voluntary exertions. This I fufpect firft to have
arifen from the double meaning of the words " involuntary mo-
tions ;" which are fometimes ufed for thofe motions, which are
performed without the interference of volition, as the pulfations
of the heart and arteries ; and at other times for thofe actions,
which occur, where two counter volitions oppofe each other,
and the ftronger prevails ; as in endeavouring to fupprefs laugh-
ter, and to (top the mudderings when expofed to cold. Thus
when the poet writes,

video meliora, proboque,

Deteriora fequor.

The ftronger volition actuates the fyftem, but not without the
counteraction of unavailing fmaller ones ; which conftitute de-
liberation.

A fecond difficulty may have arifen from the confined ufe of
the words " to will," which in common difcourfe generally
mean to choofe after deliberation ; and hence our will or voli-
tion is fuppofed to be always in our own power. But the will
or voluntary power, acts always from motive, as explained in
Sea XXXIV. i. and in Clafs IV. i. 3. 2. and III. 2. i. 12,
which motive can frequently be examined previous to action,
and balanced ngainlt oppofitc motives, which is called delibera-
tion ; at other times the motive is fo powerful as immediately
to excite the fenforial power of volition into action, without a
previous balancing of oppofite motives, or counter volitions.
The former of thefe volitions is exercifed in the common pur-
pofes of life, and the latter in the exertions of epilepfy and in-
fanity.

It is difficult to think without iuordrt which however all thofe
mud do, who difcover new truths by reafoning •, and (lill more
difficult, when the words in common ufe deceive us by their

twofold

278 DISEASES CLASS III. 1. 1. 1.

twofold meanings, or by the inaccuracy of the ideas, which they
fuggeft.

SPECIES.

\.JaBitatw. Reftleflhefs. There is one kind of reftleflhefs
attending fevers, which confifts in a frequent change of pofture
to relieve the uneafmefs of the preflure of one part of the body
upon another, when the fenfibility of the fyftem, or of fome
parts of it, is increafed by inflammation, as in the lumbago;
•which may foinetimes be diftinguifhed in its early ftage by the
inceflant defire of the patient to turn himfelf in bed. But there
is another reftleffhefs, which approaches towards writhing or
contortions of the body, which is a voluntary effort to relieve
pain ; and may be efteemed a (lighter kind of convulfion, not
totally unreftrainable by oppofite or counteracting volitions.
.. Thus when a fquirrel is confined in a cage, he feels uneafi-
nefs from the accumulation of fenforial power, in his mufcles,
which were before in continual violent exertion in his habits
of life ; and in this lituation finds relief by perpetually jump-
ing about his cage to expend a part of this accumulated fenfo-
rial power.

For the fame reafon thofe children, who are conftrained to fit
in fome fchools for hours together, are liable to acquire habits of
moving fome mufcles of their faces, or hands, or feet, which are
called tricks, to exhauft a part of the accumulated fenforial pow-
er. Hence reftleflhefs is occafioned by increafe of ftimulus, or
by accumulation of fenforial power.

M. M. A blifter. Opium. Warm bath. Bandage on
the moving mufcles. See Convulfio debilis, Clafs III. i. i. 5.
exercife.

2. ^Tremor febnlts. Reciprocal convulfions of the fubcu-
taneous mufcles, originating from the pain of the fenfe of
heat, owing to defeat of its ufual ftimulus, and confequent
accumulation of fenforial power in it. The actual defi-
ciency of heat may exift in one part of the body, and the
pain of cold be felt mod vividly in fome other part aflbciated
wit-h it by fenfitive fympathy. So a chilnefs down the back is
iirft attended to in ague-fits, though the difeafe perhaps com-
mences with the torpor and confequent coldnefs of fome inter-
nal vifcus. But in whatever part of the fyftem the defect of
heat exift s, or the fetifation of it, the convulfions of the fubcu-
taneous mufcles exerted to relieve it are very general ; and, if
the pain is ftill greater, a chattering of the teeth is added, the

more

CLASS III. 1.1.3. OF VOLITION. 279

more fuddenly to exhauft the fenforial power, and becaufe the
teeth are very fenfibie to cold.

Thefe convulfive motions are neverthelefs reftrainable by vi-
olent voluntary counteraction ; and as their intervals are owing
to the pain of cold being for a time relieved by their exertion,
they may be compared to laughter, except that there is no in-
terval of pleafure preceding each moment of pain in this as in
the latter.

M. M. Seel. 2. 2. i.

3. Clamor. Screaming from pain. The talkative animals,
as dogs, and fwine, and children, fcream mod, when they are in
pain, and even from fear ; as they have ufed this kind of exer-
tion from their birth moft frequently and molt forcibly ; and
can therefore fooner exhauft the accumulation of fenforial pow-
er in the affected mufcular or fenfual organs by this mode of
exertion ; as defcribed in Sea. XXXIV. 1.3. This facility of
relieving pain by fcreaming is the fource of laughter, as explain-
ed below.

4. Rifus. The pleafurable fenfations, which occafion laugh-
ter, are perpetually pafRng into the bounds of pain ; for pleaf-
ure and pain are often produced by different degrees of the
fame ftimulus ; as warmth, light, aromatic or volatile odours,
become painful by their excefs ; and the tickling on the foles
of the feet in children is a painful fenfation at the very time it
produces laughter. When the pleafurable ideas, which excite
us to laugh, pafs into pain, we ufe fome exertion, as a fcream,
to relieve the pain, but foon (top it again, as we are unwilling
to lofe the pleafure ; and thus we repeatedly begin to fcream,
and flop again alternately. So that in laughing there are three
ftages, firft of pleafure, then pain, then an exertion to relieve
that pain. See Sett. XXXIV. 1.3.

Every one has been in a fituation, where fome ludicrous cir-
cumftance has excited him to laugh ; and at the fame time a
fenfe of decorum has forbid the exertion of thefe interrupted
fcreams ; and then the pain has become fo violent, as to occa-
Con him to ufe fome other great action, as biting his tongue,
and pinching himfelf, in lieu of the reiterated fcreams which
conftitute laughter.

5. Convulfw. Convulfion. When the pains from defect or
excefs of motion are more diftrefling than thofe already defcrib-
ed, and are not relievable by fuch partial exertions, as in fcream-
ing, or laughter, more general convulsions occur ; which vary
perhaps according to the fituation of the pained part, or to fome
previous affociations formed by the early habits of life. When
thefc convulfive motions bend the body forwards, they are term-
ed

;3o DISEASES CLASS III. i.i.g.

ed emprofthotoiioi \ when they bend it backward, they are term-
ed opifthotonoi. They frequently fucceed each other, but the
epidhotonoi are generally more violent ; as the mufcles, which
erect the body, and keep it creel, arc naturally in more conftant
and more forcible action than their antagonifts.

The caufes of convulfion are very numerous, as from tooth-
ing in children, from worms or acidity in their bowels, from
eruption of the diilinct fmall-pox, and laftly, from breathing
too long the air of an unventilated bed-room. Sir G. Baker,
in the Tranfactions of the College, defcribed this difeafe, and
detected its cauie ; where many children in an orphan-houfe
were crowded together in one chamber without a chimney, and
were almoft all of them affected with convulsion ; in the hof-
pital at Dublin, many died of convulfions before the real caufc
was underilood. See Dr. Beddoes's Guide to Self-prefervation*
In a large family, which I attended, where many female fervants
Uept in erne room, which they had contrived to render inacceffi-
ble to every blaft of air ; I faw four who were thus feized with
convulfions, and who were believed to have been affected by
fympathy from the iirft who fell ill. They were removed into
more airy apartments, but were fome weeks before they all re*
gained their perfect health.

Convulfion is diitinguifhed from epilepfy, as the patient does
not intirely lofe all perception during the paroxyfm. Which
only mews, that a lefs exhauftion of fenforial power renders tol-
erable the pnins which caufe convulfion, than thofe which caufe
epilepfy. The hyftcric convulfions are diltinguifhed from thofe,
owing to other caufes, by the prefence of the expectation of
death, which precedes and fucceeds them, and generally by a
flow of pale urine ; thefe convulfions do not constantly attend
the hyfleric difeafe, but are occafionally fuperinduced by the
cUfagreeable fenfation arifing from the torpor or inverfion of a
part of the alimentary canal. Whence the convulfion of laugh-
ter is frequently fuflicient to reftrain thefe hyfteric pains, which
accounts for the fits of laughter frequently attendant on this
difeafe.

M. M. To remove the peculiar pain which excites the con-
vulfions. Venefection. An emetic. A cathartic with calo-
mel. Warm-bath. Opium in large quantities, beginning with
fmaller ones. Mercurial frictions. Electricity. Cold-bath in
the paroxyfm ; or cold afperfion. See Memoirs of Med. Soci-
ety, Lon. Vol. III. p. 147. a paper by Dr. Currie.

5. Convulfto debilis. The convulfions of dying animals, as of
fchofe which are bleeding to death in the flaughter-houfe, are an
efTort to relieve painful fenfatiou, either of the wound which

occafions

CLASS III. i. i. & OF VOLITION. 281

occafions their death, or of faintnefs from want of due diften-
tion of the blood velTels. Similar to this in a lefs degree is the
fubfultus tendinum, or ftarting of the tendons, in fevers with de-
bility j thefe actions of the mufcles are too weak to move the
limb, but the belly of the acting mufcles is feen to fwell, and
the tendon to be ftretched. Thefe weak convulfions, as they
are occafioned by the difagreeable fenfation of faintnefs from
inanition, are fymptoms of great general debility, and thence
frequently precede the general convulfions of the act of dying.
See a cafe of convulfion of a mufcle of the arm, and of the fore-
arm, without moving the bones to v/hich they were attached*
Sea. XVII. i. 8. See twitchingsof the face, Clafs IV. i. 3. 2.

6. Convulfio dolorifica. Raphania. Painful convulfion. In
this difeafe the mufcles of the arms and legs are exerted to re-
lieve the pains left after the rheumatifm in young and delicate
people ; it recurs once or twice a day, and has been miftaken for
the chorea, or St. Vitus's dance ; but differs from it, as the un-
due motions in that difeafe only occur, when the patient endeav-
ours to exert the natural ones ; are not attended with pain ; and
ceafe, when he lies down without trying to move : the chorea,
or dance of St. Vitus, is often introduced by the itch, this by the-
rheumatifm.

It has alfo been improperly called nervous rheumatifm ; but
is diftinguifhed from rheumatifm, as the pains recur by peri-
ods once or twice a day ; whereas in the chronic rheumatifm
they only occur on moving the affected mufcles. And by the
warmth of a bed the pains of the chronic rheumatifm are in-
creafed, as the mufcles or membranes then become more fenfi-
ble to the ftimulus of the extraneous mucaginous material de-
pofited under them. Whereas the pains of the raphania, or
painful convulfion, commence with coidnefs of the part, or
of flie extremities. See Rheumatifmus chronicus. Clafs I.
i. 3. 12.

The pains which accompany the contractions of the mufcles
in this difeafe, feem to arife from the too great violence of thofe
contractions, as happens in the cramp of the calf of the leg 5
from which they differ iu thofe being fixed, and thefe being re-
iterated contractions. Thus thefe convulfions are generally of
the lower limbs, and recur at periodical times from fome unea-
fy ienfation from defect of action, like other periodic difeafesj
and the convulfions of the limbs relieve the original uneafy pain-
ful fenfation, and then produce a greater pain irom their own
too vehement contractions. There is however another way of
accounting for thefe pains, wheq they fucceeci the acute rheu-
matifm ; and that is by the coagulable lymph, which may be

VOL. II. NN left

DISEASES CLASS HI. r. i. 7,

ftill unabforbed on the membranes 5 and which may be in too
fmall quantity to affeft them with pain in common mufcular
exertions, but may produce great pain, when the bellies of th«
mufcles fwell to a larger bulk in violent action.

M. M. Venefeetion. Calomel. Opium. Bark. One grain
of calomel and one of opium for ten fucceffive nights. A ban-
dage fpread with emplaflrum de minio put tight on the affected
part.

7. Epilepfta is originally induced, like other convulfions, by a
voluntary exertion to relieve fome pain. This pain is molt fre-
quently about the pit of the ftomach, or termination of the bile-
duct j and in fome cafes the torpor of the ftomach, which prob-
ably occafion&I the epileptic fits, remains afterwards, and pro-
duces a chronical anorexia ; of which a cafe is related in Clafs
II. 2. 2. I. There are inftances of its beginning in the heel,
of which a cafe is publifhed by Dr. Short, in the Med. Effays.
Edinb. I once faw a child about ten years old, who frequently
fell down hi convuifions, as fhe was running about in play j on
examination a wart \vas found on one ancle, which was ragged
and inflamed •, which was directed to be cut off, and the fits
never recurred.

When epilepfy firft commences, the patients are liable to ut*-
ter one fcream before they fall down ; afterwards the convul-
fions fo immediately follow, the pain, whrch occafions them,
that the patient does not recollect or feem fenfible of the pre-
ceding pain. Thus in laughter, when it is not exceffive, a per-
fon is not confcious of the pain, which fo often recurs, and cauf-
es the fucceffive fcreams or exertions of laughter, which give a
temporary relief to it.

Epileptic fits frequently recur in fleep from the increafe of
fenfibilky at that time, explained in Seel. XVIII. 1 4. In two
fuch cafes, both of young women, one grain of opium given at
night, and continued many months, had fuccefs ; in one of them
the opium was omitted twice at different times, and the fit re-
curred on both the nights. In the more violent cafe, defcribed
in Seel:. XVIII. 15, opium had no effect.

Epileptic fits generally commence with fetting the teeth, by
which means the tongue is frequently wounded ; and with roll-
ing the eye-balls in every kind of direction ; for the mufcles
which fufpend the jaw, as well as thofe which move the eyes,
:ire in perpetual motion during our waking hours •, and yet con-
tinue fubfervient to volition ; hence their more facile and forci-
ble actions for the purpofe of relieving pain by the exhauftion
of fenforial power. See Section XXXIV. i. 4.

Epileptic convulfions are not attended with the fear of death,

as

CLASS III. 1.1.7. OF VOLITION. 283

as in the hyfteric difeafe, and the urine is of a ftraw colour.
However it muft be noted, that the difagreeable filiations in
hyfteric difeafes fometimes are the caufe of true epileptic con-
vulfions, of fyncope, and of madnefs.

The pain, which occafions fome fits of epilepfy, is felt for a
time in a diftant part of the fyftem, as in a toe or heel ; and is
faid by the patient gradually to afcend to the head, before the
general convulfions commence. This afcending fenfation has
been called aura epileptica, and is faid to have been prevented
from affeding the head by a tight bandage round the limb. In
this malady the pain, probably of fome torpid membrane, or dif-
eafed tendon, is at firft only fo great as to induce flight fpafms
of the mufcular fibres in its viciuity ; which flight fpafms ceafe
on the numbnefs introduced by a tight bandage ; when no band-
age is applied, tHb pain gradually increafes, till general convul-
fions are exerted to relieve it. The courfe of a lymphatic, as
when poifonous matter is abforbed ; or of a nerve, as in the
fciatica, may, by the fympathy exifting between their extremi-
ties and origins, give an idea of the afcent of an aura or va-
pour.

In difficult parturition it fometimes happens, that general con-
vulfions are excited to relieve the pain of labour, inftead of the
exertions of thofe mufcles of the abdomen and diaphragm, which
ought to forward the exclufion of the child. See Clafs III. I. i.
That is, inftead of the particular mufcular adions, which ought to
be excited by fenfation to remove theoffending caufe,general con-
vulfions are produced by the power of volution, which ftill the
pain, as in common epilepfy, without removing the caufe ; and,
as the parturition is not thus promoted, the convulfions con-
tinue, till the fenforial power is totally exhaufted, that is, till
death. In patients afflided with epilepfy from other caufes,
I have feen the moft violent convulfions recur frequently dur-
ing pregnancy without mifcarriage ; as they did not tend to
forward the exclufion of the fetus.

Pains of this kind have been called falfe pains by fome writers
on midwifery, and are directed to be relieved by an opiate, and
then they fay the true pains will commence. M. Daventer di-
rects the accoucheur to attend to the os tincse, to diftinguifh
them from each other, which dilates with every true pain, but
contracts with every falfe one, that is, the voluntary actions of
other mufcles to relieve pain are attended with thofe of the os
uteri, as mentioned in Genus I. of this Clafs and Order prece-
ding the defcription of the Species.

M. M. Venefedion. A large dofe of opium. Delivery.

The later in life epileptic fits are firft experienced, the more

dangerous

284 DISEASES CLASS III. 1. 1. 7.

dangerous they may be efteemed in general ; as in thefe cafes
the caufe has generally been acquired by the habits of the pa-
tient, or by the decay of fome part, and is thus probably in an
increafing Hate. Whereas in children the change in the fyk
tern, as they advance to puberty, fometimes removes the caufe.
So in toothing, fits of convulfion with ftupor frequently occur,
and ceafe when the tooth advances ; but this is not to be ex-
pected in advanced life. Sir , about fixty years of

age, had only three teeth left in his upper jaw, a canine tooth,
and one on each fide of it. He was feized with epileptic
fits, with pain commencing in thefe teeth. He was urged to
have them extracted, which he delayed too long, till the fits
were become habitual, and then had them extracted in vain,
and in a few months funk under the difeafe.

Mr. H. M. was feized with pain in the adductor mufcle of
the right thumb, and had epileptic convulfions in confequence ;
thefe gradually increafed in ftrength and frequency ; a bandage
on the arm, drawn very tight as foon as the pain of the ball of
the thumb commenced, prevented the epileptic fits, I fuppofe
by leflening the pain by the numbnefs occafioned by comprefting
the nerve. I advifed the nerves of this mufcle to be cut, which
was done or attempted, and was fuppofed for a time to have
cured the difeafe, as I was informed. Afterwards it recurred
and deftroyed the patient, who might have probably been faved
by the lofs of a hand, which I (hould have advifed, but was not
again confulted.

I have to add, that the tic douloureux, or hemicrania idio-
pathica, I believe to be a difeafe of this kind, owing to a torpor
of the extremity of fome branch of a nerve, and fhould recom-
mend, when the nerve cannot be bifected, to pafs through it
for many hours or even days, a current of galvanic electricity
from Volta's pillar of zinc, and filver, and cloth moiftened with
fait and water.

Mr. F , who had lived intemperately, and had been oc-

cafionally affected with the gout, was fuddenly feized with epi-
leptic fits ; the convulfions were fucceeded by apoplectic fnor-
ing ; from which he was, in about 20 minutes, diflurbed by
frem convulfions, and had continued in this fituation above four-
and-twenty hours. About eight ounces of blood were then taken
from him : and after having obferved, that the apoplectic tor-
por continued about 20 minutes, I directed him to be forcibly raif-
ed up in bed, after he had thus lain about fifteen minutes, to gain
an interval between the termination of the fleep, and the reno-
vation of convulfion. In this interval he was induced to fwal-
low forty drops of laudanum. Twenty more were given him

in

CLASS III. 1.1.7. OF VOLITION. 285

»

in the fame manner in about half an hour, both which evidently
(hortened the convulfion fits, and the confequent ilupor ; he
then took thirty more drops, which for the prefent removed the
fits. He became rather infane the next day, and after about
three more days loft the infanity, and recovered his ufual ftate
of health.

The cafe mentioned in Sect. XXVII. 2. where the patient
was left after epileptic fits with a fuffufion of blood beneath the
tunica adjuncliva of the eye, was in almofl every refpect fimilar
to the preceding, and fubmitted to the fame treatment. Both
of them fuffered frequent relapfes, which were relieved by the
fame means, and at length periflied, I believe, by the epileptic fits.
In thofe patients, who have not been fubjecl to epilepfy be-
fore they have arrived to about forty years of age, and who
have been intemperate in refpe<!t to fpirituous potation, I have
been induced to believe, that the fits were occafioned by the
pain of a difeafed liver ; and this became more probable in one
of the above fubje&s, who had ufed means to repel eruptions
on the face ; and thus by fome ftimularrt application had pre-
vented an inflammation taking place on the fkin of the face in-
ilead of on fome part of the liver. Secondly, as in thefe cafes in-
fanity had repeatedly occurred, which could not be traced from
an hereditary fource ; there is reafon to believe, that this as well
as the epileptic convulOons were caufed by fpirituous potation ;
and that this therefore is the original fource both of epilepfy
and of infanity in thofe families, which are afflifted with them.
This idea however brings fome confolation with it; as it mayj»e
inferred, that in a few fober generations thefe difeafes may be
eradicated, which otherwife deftroy the family.

M. M. Venefeclion. Opium. Bark. Steel. Arfenic.
Opium one grain twice a day for years together. See the pre-
ceding article, and the fucceeding one.

Anorexia epilepticat as mentioned in ClafsII. 2. 2. I. is a dread-
ful difeafe, originating, I believe, from a paralyfis of the ftorh-
ach, and generally occafioned by the application of great exter-
nal cold to the fkin. A young lady, whom I faw yefterday, who
had long experienced a weak fiate of health, went to church on
an uncommonly cold Sunday, when the thermometer was faid
to ftand below 20 during the whole day. "She became immedi-
ately indifpofed, and was feized in a day or two with tremors
and convulfions in her fleep ; and which returned every two or
three days. Her extremities are now always uncommonly cold,
and her appetite to food totally defective. She took three drops
of a faturated folution of arfenic and a bitter draught twice a day
for a fortnight, and gradually recovered her former ftate of health.

Another

286 DISEASES CLASS III. i. i. 8.

Another young lady, whom I lately faw, began to ftart fome-
what like a violent hiccough many times in an hour, after ufing
a very cold fhower-bath repeatedly. This had continued daily
at uncertain times for many months, and received temporary
advantage from one drop of oil of cinnamon, three or four
times a day, on powdered fugar ; this cafe belongs to convulfion
rather than epilepfy, but was attended, like the former, with
great defea of appetite. In both thefe cafes I fufpeft, that the
great torpor of the ftomach was caufed by too violent or too
long continued coldnefs applied to the fkin ; whence the fenfo-
rial power of alTociation, which ought to have been excited by
the action of the cutaneous veflels, and to have then contributed
to the aclion of the ftomach, did not exift ; and that the ftom-
ach in confequence became torpid. See Suppl. I. 14. 3. and
Art. IV. 2. 6. 8. and Clafs III. 2. i. 17.

Dr. Wilfon, of Spalding, has lately much recommended the
argentum nitratum in epilepfy ; he gives two grains and a half
three times a day, mixed with bread crumbs into pills, as he af-
ferts, with the happieft fuccefs. Annals of Medicine, 1797.

8. Epilepfia dolorifica. Painful epilepfy. In the common
epilepfy the convulfions are immediately induced, as foon as the
difagreeable fenfation, which caufes them, commences ; but in
this the pain continues long with cold extremities, gradually in-
creafmg for two or three hours, till at length convulfions or mad-
nefs come on ; which terminate the daily paroxyfm, and ceafo
themfelves in a little time afterwards.

This diieafe fometimes originates from a pain about the lower
edge of the Hver, fometimes in the temple, and fometimes in the
pudendum ; it recurs daily for five or fix weeks, and then ceafes
for feveral months. The pain is owing to defecl: of adlion, that
is, to the accumulation of fenforial power in the part, which
probably fympathizes wkh fome other part, as explained in
Sea. XXXV. 2. XII. 5. 3. and Clafs II. i. i. 1 1. and IV. 2. 2. 3.

It is the moft painful malady that human nature is liable to ! —
See Sea. XXXIV. i. 4.

Mrs. C was feized every day about the fame hour with

violent pain on the right fide of her bowels about the fituation
of the lower edge of the liver, without fever, which increafed
for an hour or two, till it became totally intolerable. After
violent fcreaming me fell into convulfions, which terminated
fometimes in fainting, with or without ftertor, as in common
epilepfy \ at other times a temporary infanity fupenvened ;
which continued about half an hour, and the fit ceafed. Thefe
paroxyfms had returned daily for two or three weeks, and were
at length removed by large dofes of opium, like the fits of re-
verie

CLASS III. 1. 1. 8. OF VOLITION. 287

verie or fomnambulation. About half an hour before the ex-
pelled return of the fit three or four grains of opium were ex-
hibited, and then tincture of opium was given in warm brandy
and water about twenty or thirty drops every half hour, till the
eyes becarre fomewhat inflamed, and the nofe began to itch,
and by the {harp movements of the patient, or quick fpeech, an
evident intoxication appeared ; and then it generally happened
that the pain ceafed. But the effects of this large dofe of opium
was fucceeded by perpetual ficknefs and efforts to vomit, with
great general debility all the fucceeding day.

The rationale of this temporary cure from the exhibition of
opium and vinous fpirit depends on the great expenditure of
fenforial power in the increafed actions of all the irritative mo-
tions, by the ftimulus of fuch large quantities of opium and vi-
nous fpirit ; together with the production of much fenfation,
and many movements of the organs of fenfe or ideas in confe-
quence of that fenfation ; and laftly, even the motions of the
arterial fyftem become accelerated by this degree of intoxica-
tion, all which foon exhaufted fo much fenforial power as to re-
lieve the pain ; which would otherwife have caufed convuiiions
or infanity, which are other means of expending fenforial pow-
er. The general debility on the fucceeding day, and the partic-
ular debility of the ftomach, attended in confequence with fick-
nefs and frequent efforts to vomit, were occafioned by the fyf-
tem having previoufly been fo flrongly ftimulated, and thofe
parts in particular on which the opium and wine more imme-
diately a&ed. This ficknefs continued fo many hours as to
break the catenation of motions, which had daily reproduced
the paroxyfm ; and thus it generally happened, that the whole
difeafe ceafed for fome weeks or months from one great intoxi-
cation, a circumftance not eafily to be explained on any other
thoiry.

Ths excefs or defect: of motion in any part of the fyftem oc-
cafions the production of pain in that part, as in Seel:. XII. i . 6'.
This defect: or excefs of fibrous action is generally induced by
excefs or defect, of the ftimulus of objefts external to the mov-
ing organ. But there is another fource of excelfive fibrous ac-
tion, and confequent pain, which is from excefs of volition,
which is liable to affect thofe mufcles, that have weak antago-
rufts ; as thofe which fupport the under jaw, and clofe the mouth
in biting, and thofe of the calf of the leg ; which are thus liable
to fixed or painful contractions, as in trifmus, or locked jaw, and
in the cramp of the calf of the leg ; and perhaps in fome colics,
as in that of Japan : thefe pains, from contraction arifing from
excefs of volition in the part from the want of the counteraction

DISEASES CLASS III. 1.1*8.

of antagoniil mufcles, may give occafional caufc to epileptic fits,
and may be relieved in the fame way, either by exciting irrita-
tive and fenfltive motions by the flimulus of opium and wine ;
or by convulfions or infunity, as defcribed above, which are only
different methods of exhaufting the general quantity of fenfori-
al power.

Confidering the great refemblance between this kind of pain-
ful epilepfy and the colic of Japan, as defcribed by Kaempfer ;
and that that difeafe was faid to be cured by acupuncture, or the
prick of a needle j I directed fome very thin fteel needles to be
made about three inches long, and of fuch a temper, that they
wowld bend double rather than break ; and wrapped wax thread
over about half an inch of the blunt end for a handle. One of
thefe needles, when the pain occurred, was pufhed about an
inch into the painful part, and the pain inflantly ceafed j but I
was not certain, whether the fear of the patient, or the ftimulus
-of the puncture, occafioned the ceffation of pain ; and as the
paroxyfm had continued fome weeks, and was then declining,
the experiment was not tried again. The difeafe is faid to be
very frequent in Japan, and its feat to be in the bowels, and
that the acupuncture eliminates the air, which is fuppofed to
diftend the bowel. But though the aperture thus made is too fmall
to admit of the eduction of air ; yet as the ftimulus of ib frfiall
a puncture may either excite a torpid part into action, or caufe
a ipafmodic one to ceafe to act ; and laftly, as no injury could
be likely to enfue from fo fmall a perforation, I fhould be in-
clined at forne future time to give this a fairer trial in fimilar
circumftances.

Another thing worth trial at the commencen^ent of this de-
plorable difeafe would be electricity, by paffing itr^ng mocks
through the painful part ; which, whether the pain was owing
to the inaction of that part, or of fome other membrane aflbci-
ated with it, might ftimulate them into exertion ; or into inac-
tivity, if owing to fixed painful contraction.

And laftly, the cold bath, or afperfions with cold water on the
affected part, according to the method of Dr. Currie in the Me-
moirs of a Med. Sot. London, Vol. III. p. 147, might produce
great effect at the commencement of the pain. Neverthelefs
opium duly adminiftered, fo as to precede the expected parox-
yfm, and in fuch dofes, given by degrees, as to induce intoxica-
tion, is principally to be depended upon in this deplorable mala-
dy. To which fhould be added, that if venefection can be previ-
oufly performed, even to but few ounces, the effect of the opium
is much more certain ; and ilill more fo, if there be time to pre-
mifc n. briilc cathartic, or even an emetic. The effect of increaf-

ed

CLASS III. i . i . $. OF VOLITION. 289

ed ftimulus is fo much greater after previous defect of ftimulus ;
and this is ftill of greater advantage, where the caufe of the d\i-
cafe happens to coniift in a material, which can be abforbed.
See Art. IV. 2. 8.

M. M. Venefection. An emetic. A cathartic. Warm
bath. Opiurri a grain every half hour. Wine. Spirit of wine.
If the patient becomes intoxicated by the ^bove means, the fit
ceafes, and violent vomitings and debility fucceed on the fubfe-
quent day, and prevent a return. Blifters or (inapifms on the
fmall of the leg, taken off when they give much pain, are of ufe
in /lighter convulfions. Acupuncture. Electricity. Afper-
fion with cold water oil the painful part. A bag of mow or ice
applied on the pained part.

9. Somnambulifmus. Sleep-walking is a part of reverie, or
ftudium inane, defcribed in Seel:. XIX. In this malady the pa-
tients have only the general appearance of being afleep in re-
fpedt to their inattention to the ilimulus of external objects, but,
like the epilepfies above defcribed, it confiils in voluntary exer-
tions to relieve pain. The mufcles are fubfervient to the will,
as appears by the patient's walking about, and fometimes doing
the common offices of life. The ideas of the mind alfo are obe-
dient to the will, becaufe the patient's difcourfe is confident,
though he anfwers imaginary queftions. The irritative ideas of
external objects continue in this malady, becaufe the patients do
not run againft the furniture of the room ; and when they ap-
ply their volition to their organs of fenfe, they become tenfible
of the objects they attend to, but not otherwise, as general fen-
fation is deftroyed by the violence of their voluntary exertions.
At the fame time the fenfations of pleafure in confequence of
ideas excised by volition are vividly experienced, aad other
feem to be excited by thefe pleafurable lenfations, as anpej*
the cafe of Matter A. Sea. XXXIV. 3.1. where a hiftory of a
hunting fcene was voluntarily recalled, wifh all the pleafurable
ideas which attended it. In melancholy madnefs the patient is
employed in voluntarily exciting one idea, with thofe which are
connected with it by voluntary aflbciations only, but not fo vio-
lently as to exclude the ftimuli of external 'objects. In reverie
variety of ideas are occafionaliy excited by volition, and tliofe
which are connected with the ~n Cither by fenfitive or voluntary
aiibciations, and that fo violently as to exclude the ftimuli <:
ternal objects. Thefe two fitu.tions of cur fenfuai motion.?, or
ideas, referable convulfion and -piiepfv ; as in the former the
ftimulus of external objects is ftill perceiv lat-

ter. Whence this dileafe, fo far from being connected with
fleep, though it has by univerfal miflake acquired ifs name from

VOL, II. O o it,*

DISEASES CLASS III. 1.1.19.

it, arifes from excels of volition, and not from a fufpenfion of it ;
and though, like other kinds of epilepfy, it often attacks the pa-
tients in their fieep, yet thofe two, whom I faw, were more fre-
quently feized with it while awake, the fleep-walking being a
part of the reverie. See Sett. XIX. and XXXIV. 3. and Clafs

II. I. 7. 4. and III. I. 2. 1 8.

M. M. Opium in large dofes before the expected paroxyfm.

10. AJlhma convulflvum. The fits of convulfive afthma return
at periods, and are attended with cold extremities, and fo far
refemble the accefs of an intermittent fever ; but, as the lungs
are not fenfible to the pain of cold, a fhivering does not fuc-
ceed, but inftead of it violent efforts of refpiration ; which have
no tendency, as in the humoral afthma, to diflodge any offend-
ing material, but only to relieve the pain by exertion, like the
(huddering in the beginning of ague-fits, as explained Clafc.

III. I. I. 2.

The infenfibility of the lungs to cold is obfervable on going
into frofty air from a warm room j the hands and face become
painfully cold, but no fuch fenfation is excited in the lungs ;
which is another argument in favour of the exiftence of a peculiar
fet of nerves for the purpofe of perceiving the univerfal fluid
matter of heat, in which all things are immerfed. See Sect.
XIV. 6. Yet are the lungs neverthelefs very fenfible to the de-
ficiency of oxygen in the atmofphere, as all people experience,
when they go into a room crowded with company and candles,
and complain, that it is fo clofe, they can fcarcely breathe ; and
the fame in fome hot days in fummer.

There are two difeafes, which bear the name of afthma. The
firft is the torpor or inability of the minute vefTels of the lungs,
confifting of the terminations of the pulmonary and bronchial
arteries and veins, and their attendant lymphatics ; in this cir-
cumftance it refembles the difficulty of breathing, which attends
cold bathing. If this continues long, a congeftion of fluid in
the air-cells fucceeds, as the abforbent actions ceafe completely
before the fecerning ones ; as explained in Clafs I. i. 2. 3.
And the coldnefs, which attends the inaction of thefe vefiels,
prevents the ufual quantity of exhalation* Some fits ceafe be-
fore this congeftion takes place, and in them no violent Tweet-
ing nor any expuition of phlegm occurs. This is the humoral
afthma, deicribed at Clafs II. i. I. 7.

The fecond kind of afthma confifts in the convulfive actions
in conference of the difagreeable fenfations thus induced ;
which in fome fits of afthma are very great, as appears in the
violent efforts to raife the ribs, and to deprefs the diaphragm,
by lifting the (houlders. Thefe, fo long as they contribute to

remove

CLASS in. i. x. i«. OF VOLITION. 291

remove the caufe of the difeafe, arc not properly convulfions,
but exertions immediately caufed by fenfation ; but in this kind
of afthma they are only efforts to relieve pain, and are frequent-
ly preceded by other epileptic convulfions.

Thefe two kinds of afthma have fo many refembling features,
and are fo frequently intermixed, that it often requires great at-
tention to diftinguim them ; but as one of them is allied to ana-
farca, and the other to epilepfy, we (hall acquire a clearer idea
of them by comparing them with thofe diforders. A criterion
of the humoral or hydropic afthma is, that it is relieved by copi-
ous fweats about the head and breaft, which are to be afcribed
to the fenfitive exertions of the pulmonary veffels to relieve the
pain occafioned by the anafarcous congeftion in the air-cells 5
and which is effected by the increafed abforption of the mucus,
and its elimination by the retrograde action of thofe lymphatics
of the fkin, the branches of which communicate with the pul-
monary ones ; and which partial fweats do not eafily admit of
any other explanation. See Clafs I. 3. .2. 8. Another criterion
of it is, that it is generally attended with fwelled legs, or other
fymptoms of anafarca. A criterion of the convulfive afthrrra
may be had from the abfence of thefe cold clammy fweats of the
upper part of the body only, and from the patient having occa-
fionally been fubject to convulfions of the limbs, as in the com-
$non epilepfy.

It may thus frequently happen, that in the humoral afthma
fome exertions of the lungs may occur, which may not contrib-
ute to difcharge the anafarcous lymph, but may be efforts fimply
to relieve pain ; befides thofe efforts, which produce the increaf-
ed abforption and elimination of it ; and thus we have a bodily
difeafe refembling in this circumftance the reverie, in which
both fenfitive and voluntary motions are at the fame time, or in
fucceffion, excited for the purpofe of relieving pain.

It may likewife fometimes happen, that the difagreeable fen-
fation, occafioned by the congeftion of lymph in the air-cells in
the humoral or hydropic afthma, may induce voluntary convul-
fions of the refpiratory organs only to relieve the pain, without
any fenfitive actions of the pulmonary abforbents to abforb and
eliminate the congeftion of ferous fluid ; and thus the fame
caufe may occafionally induce either the numeral or cjjjJR'ulfive
afthma.

The humoral afthma has but one remote caufe, which is the
torpor of the pulmonary veffels, like that which occurs on going
into the cold bath ; or the want of abforption of the pulmonary
lymphatics to take up the lymph effuled into the air-cells.
Whereas the convulfive afthma, like other convulfions, or epi-

lepfies,

292 DISEASES CLASS III. i. i, io<

lepfies, may be occafioned by pain in almoft any remote part of
the fyftem. But in fome of the adult patients in this difeafe, as
in many epilepfies, I have fufpecled the remote caufe to be a
pain of the liver, or of the biliary dufts.

The afthmas, which have been induced in confequence of the

recefs of eruptions, efpeeially of the leprous kind, countenance

this opinion. One lady I knew, who for many years laboured

under an ailhma, which ceafed on her being afflicled with pain,

fwelling, and diftortion of fome of her large joints, which were

eReemed gouty, but perhaps erroneously. And a young man,

i I faw yefterday, was feized with afthma on the retrocef-

or ceafmg of eruptions on his face.

The convulfive all<vr,a, as well as the hydropic, is more lia-
ble to re r; weather ; which may be occafioned by the
lefs quantity oi ox -gen exifting in a given quantity of warm air>
of cold, which can be taken mto the lungs at one infpira-
tion. They are bora p oh liable to occur after the firfl ileep,
which is therefore a general criterion of afthma. The caufe of
this is explained in Sett. XVIH- 15. and applies to both of
them, as our feniibility to internal uneafy fenfation increaies
during fleep.

When children are gaining teeth, long before they appear,
the pain of the gums often induces convulfions. This pain is
relieved in fome by fobbing and fcreaming ; but in others a la-
borious refpiration is exerted to relieve the pain j and this con-
ilitute* the true afthma convulfivum. In other children again
general convulfions, or epileptic paroxyfms, are induced for this
purpofe j which, like other epilepfies, become eftablifhed by
Iiabit, and recur before the irritation has time to produce the
painful fenfation, which originally caufed them.

The afthma convulfivum is alfo fometimes induced by worms,
or by acidity in the ftomachs of children, and by other painful
fenfations in aduhs j in whom it is generally called nervous
aiihma, and is often joined with other epileptic fymptoms.

This ailhma is diftinguifted from the peripneumony, and
from the croup, by the prefence of fever in the two latter. It
is diftinguiflied from the humoral afthma, as in that the patients
are more liable to run to the cold air for relief, are more fubjeft
to cold extremities, and experience the returns of it more fre-
quently after their fuft fleep. \It is diftinguiflied from the hy-
drops thoracis, as that has no intervals, and the patient fits con-
iiantly upright, and the breath is colder ; and, where the peri-
cardium is affected, the pulfe is quick and unequal. See Hy-
drops Thoracis, I. 2. 3. 14.

M. M. Venfec~Uon once. A cathartic with calomel once..

Opium.

CLASS III. i . i . 1 1 . OF VOLITION. 293

Opium. Afafcetida. Warm bath. If the caufe can be detect-
ed, as in toothing or worms, it (hould be removed. As this
fpecies of afthma is fo liable to recur during ileep, like epileptic
fits, as mentioned in Section XVIII. 15. there was reafon to be-
lieve, that the refpiration of an atmofphere mixed with hydro-
gen, or any other innocuous air, which might dilute the oxygen,
would be ufeful in preventing the paroxyfms by decreafing the
fenfibility of the fyftem. This, I am informed by Dr. Beddoes,
has been ufed with decided fuccefs by Dr. Perriar. See Clafs
II. i. i. 7.

n. AJlhma dohrificum. Angina pe<^oris. The painful
afthma was firft defcribed by Dr. Heberden in the Tranfaclions
of the College ; its principal fymptoms confift in a pain about
the middle of the fternum, or rather lower, on every increafe of
pulmonary or mufcular exertion, as in walking fafter than ufual,
or going quick up a hill, or even up flairs ; with great difficul-
ty of breathing, fo as t& occafion the patient inftantly to ftop.
A pain in the arms about the infertion of the tendon of the pec-
toral mufcle generally attends, and a defire of refting by hang-
ing on a door or branch of a tree by the arms is fometimes ob-
ferved. Which is explained in Clafs I. 2. 3. 14. and in Seel.
XXIX. 5. 2.

Thefe patients generally die fuddenly ; and on examining the
thorax no certain caufe, or feat, of the difeafe has been detect-
ed •, fome have fuppofed the valves of the arteries, or of the
heart, were imperfect ; and others that the accumulation of fat
about this vifcus or the lungs obftrutted their due action ; but
other obfervations do not accord with thefe fuppofitions.

Mr. W , an elderly gentleman, was feized with afthma

during the hot part of laft fummer ; he always waked from his
firft fleep with difficult refpiration, and pain in the middle of
his fternum, and after about an hour was enabled to fleep again.
As this had returned for about a fortnight, it appeared to me to
be an afthma complicated with the difeafe, which Dr. Heberden
has called angina pecloris. It was treated by venefe&ion, a ca-
thartic, and then by a grain of opium given at going to bed, with
ether and tincture of opium when the pain or afthma recurred,
and laftly with the bark, but was feveral days before it was per-
fectly fubdued.

This led me to conceive, that in this painful afthma the dia-
phragm, as well as the other mufcles of reipiration, was thrown
into convuliive action, and that the fibres of this mufcle not hav-
ing proper antagonifts, a painful fixed fpafm of it, like that of
the mufcles in the calf of the leg in the cramp, might be the
caufe of death in the angina pectoris, which I have thence ar-
ranged

294 DISEASES CLASS III. i . i . 1 1 .

ranged under the name of painful afthma, and leave for further
investigation.

From the hiftory of the cafe of the late much lamented John
Hunter, and from the appearances after death, the cafe feems to
have been of this kind, complicated with vertigo and confequent
affection of the ftomach. The remote caufe feems to have arifen
from offifications of the coronary arteries ; and the immediate
caufe of his death from fixed fpafm of the heart. Other hifto-
ries and directions are ftill required to put this matter out of
doubt ; as it is poffible, that either a fixed fpafm of the dia-
phragm, or of the heart, which are both furnifhed with but
weak antagonifts, may occafion fudden death ; and thefe may
conftitute two diitinct difeafes.

Four patients I have now in my recollection, all of whom I
believed to labour under the angina pectoris in a great degree j
which have all recovered, and have continued well three or four
years by the ufe, as I believe, of iffues on the infide of each
thigh ; which were at firft large enough to contain two peafe
each, and afterwards but one. They took befides fome flight
antimonial medicine for a while, and were reduced to half the
quantity or ftrength of their ufual potation of fermented liquor.

The ufe of femoral iflues in angina pectoris was firft recom-
mended by Dr. Macbride, phyfician at Dublin, Med. Obferv.
and Enquir. Vol. VI. And I was further induced to make trial
of them, not only becaufe the means which I had before ufed
were inadequate, but from the ill effect I once obferved upon
the lungs, which fucceeded the cure of a fmall fore beneath the
knee ; and argued converfely, that iffues in the lower limbs
might affift a difficult refpiration.

Mrs. L , about fifty, had a fmall fore place, about the fize

of half a pea on the infide of the leg a little below the knee. It
had difcharged a pellucid fluid, which (lie called a ley-water,
daily for fourteen years, with a great deal of pain y on which
account fhe applied to a furgeon, who, by means of bandage and
a faturnine application, foon healed the fore, unheedful of the
confequences. In lefs than two months after this I faw her with
great difficulty of breathing, which with univerfal anafarca foon
deftroyed her.

The theory of the double effect of iffues, as above related,
one in relieving by their prefcnce the afthma dolorificum, and
the other in producing by its cure an anafarca of the lungs, is
not eafy to explain. Some fimilar effects from cutaneous erup-
tions and from bliiters are mentioned in Clafs I. 1.2. 9. In
thefe cafes it feems probable, that the pain occafioned by iffues,
and perhaps the abforption of a fmall quantity of aerated puru-
lent

CLASS III. i. 1. 12. OF VOLITION. 205

lent matter, ftimulate the whole fyftem into greater energy of
aclion, and thus prevent the torpor which is the beginning of
fo many difeafes. In confirmation of this effect of pain on the
fyftem, I remember the cafe of a lady of an ingenious and ac-
tive mind, who, for many of the latter years of her life, was
perpetually fubjecl; to great pains of her head from decaying
teeth. When all her teeth were gone, (he became quite low
fpirited, and melancholy in the popular fenfe of that word, and
after a year or two became univerfally dropfical and died.

M. M. Iflues in the thighs. Five grains of rhubarb, and an*
fixth of a grain' of emetic tartar every night for fome months,
with or without half a grain of opium. No ftronger liquor
than fmall beer or wine diluted with twice its quantity of water.
Since I wrote the above I have feen two cafes of hydrops tho-
racis attended with pain in the left arm, fo as to be miftakpi
for afthma dolorificum, in which femoral iflues, though applied
early in the difeafe, had no ef&cl.

12. Stridor dentium. The clattering of the teeth ongoing
into cold water, or in the beginning of ague-fits, is an exertion
along with the tremblings of the (kin to relieve the pain of cold.
The teeth and fkin being more fenfible to cold than the more
internal parts, and more expofed to it, is the reafon that the
mufcles which ferve them, are thrown into exertion from the
pain of cold rather than thofe of refpiration, as in fcreaming
from more acute pain. Thus the poet,

Put but your toes into cold water,
Your correfpondent teeth will clatter.

PRIOR.

In more acute pains the jaws are gnaflied together witli great
vehemence, infomuch that fometimes the teeth are faid to have
been broken by the force. See Sett. XXXIV. 1.3. In thefe
cafes fomething mould be offered to the patient to bite, as a
towel, otherwife they are liable to tear their own arms, or to
bite their attendants, as I have witnefled in the painful epi-
lepfy.

1 3. Tetanus trifmus. Cramp. The tetanus confifts of a fix-
ed fpafm of almoft all the mufcles of the body ; but the trifmus,
or locked jaw, is the moft frequent difeafe <jf this kind. It is
generally believed to arife from fympathy with an injured ten-
don. In one cafe where it occurred in confequence of a broken
ancle from a fall from a horfe, it was preceded by evident hy-
drophobia. Amputation was advifed but not fubmittcd to ;
two wounds were hid into one with fciflbrs, but the patient di-
*-d about the feventh day from the accident. In this cafe the

wounded

296 DISEASES CLASS in. i, i, 14.

wounded tendon, like the wounds from the bite of a mad dog,
did not produce the hydrophobia, and then the locked jaw, till
feveral days after the accident.

I twice witnefTed the locked jaw from a pain beneath the
flernum, about the part where it is complained of in painful
afthma, or angina pe&oris, in the fame lady at fome years dif-
tance of time. The laft time it had continued two days, and
{he wrote her mind, or expreffed herfelf by figns. On obferv-
ing a broken tooth, which made a fmall aperture into her mouth,
I rolled up five grains of opium like a worm about an inch long,
and introducing it over the broken tooth, pufned it onward by
means of a fmall crow-quill *, as it diiTolved I obferved (he fwal-
lowed her faliva, and in lefs than half an hour flie opened her
mouth and converfed as ufual.

Men are taught to be afhamed of fcreaming from pain in
their early years j hence they are prone to exert the mufcles of
the jaws inftead, which they have learnt to exert frequently and
violently from their infancy ; whence the locked jaw. This
and the following fpafm have no alternative relaxations, like the
preceding ones ; which is perhaps owing, firit, to the weaknefs
of their antagoniil mufcles, thofe which elevate the jaw being
very ftrong for the parpoie of biting and mafticating hard fub-
ftances, and for fupporting the under jaw, with very weak an-
tagonift mufcles ; and fecondly, to their not giving fufficient re-
lief even for a moment to the pain, or its preceding irritation,
which excited them.

M. M. Opium in very large quantities. Mercurial oint-
ment ufed extenfively. Electricity. Cold bath. Dilate the
wound, and fill it with lint moiltened with fpirit of turpen-
tine ; which inflames the wound, and cures or prevents the con-*
vultions. See a cafe, Tranfacl. of American Society, Vol. II.
p. 227.

Wine in large quantities in one cafe was more fuccefsful
than opium ; it probably inflames more, which in this difeafe
is defirable. Between two or three ounces of bark, and from
a quart to three pints of wine a day, fucceeded better than opi-
um. Ib.

14. Tetanus dolorifctis. Painful cramp. This kind of fpafm
moft frequently attacks the calf of the leg, or mufcles of the
toes ; it often precedes paroxyfms of gout, and appears towards
thv end of violent diarrhoea, and from indigeflion, or from acid
di . c. In thefe cafef it feems to fympathize with the bowels, but
is aifo frequently produced by the pain of external cold, and by
tl j too gr«at previous extension of the mufcles, whence fome
people get the cramp in the extenfor mufrle* of the toes after

w al kin 2

CLASS III. t. 1. 15. OF VOLITION, 297

walking down hill, and of thofe of the calf of the leg after walk-
ing up a deep eminence. For the reafon why thefe cramps
commence in fleep, fee Sect. XVIII, 15.

The mufcle in this difeafe contracts itfelf to relieve fome
fmaller pain, either from irritation or aflbciation, and then falls
into great pain itfelf, from the too great action of its own fibres.
Hence any mufcle, by being too vehemently exerted, falls into
cramp, as in fwimming too forcibly in water, which is painfully
cold ; and a fecondary pain is then induced by the too violent
contraction of the mufcle ; though the pain, which was the
caufe of the contraction, ceafes. Which accounts for the con-
tinuance of the contraction, and diftinguimes this difeafe from
other convulfions, which are relaxed and exerted alternately.
Hence whatever may be the caufe of the primary pain, which
occafions the cramp of the calf of the leg, the fecondary one is
relievable by ftanding up, and thus by the weight of the body
on the toes forcibly extending the contracted mufcles. For the
caufe which induces thefe mufcles of the calf of the leg to fall
into more violent contraction than other fpafmodic mufcles,
proceeds from the weaknefs of their antagonift mufcles ; as
they are generally extended again after action by the weight
of the body on the balls of the toes. See the preceding article.

M. M. Rub the legs with camphor diflblved in oil, and let
the patient wear (lockings in bed. If a foot-board be put at
the bed's feet, and the bed be fo inclined, that he will reft a
little with his toes againft the foot-board, that preflure is faid
to prevent the undue contractions of the mufculi gaftrocnemii,
which conftitute the calf of the leg. In gouty patients, or
where the bowels are affected v/ith acidity, half a grain of opi-
um, and fix grains of rhubarb, and fix of chalk, every night.
FlenVmeat for fupper. A little very weak warm fpirit and
water may be taken for prefent relief, when thefe cramps are
very troubleforrte to weak or gouty patients.

15. Hydrophobia. Dread of water generally attending ca-
nine madnefs. I was witnefs to a cafe, wheje this difeafe pre-
ceded the locked jaw from a wound in the ancle, occafioned by
a fall from a horfe ; as mentioned in the preceding article. It
came on about the fixth day after the accident ; when the pa-
tient attempted to fwallow fluids, he became convulfed all
over from the pain of this attempt, and fpurted them out of his
mouth with violence. It is alfo faid to happen in fome hyfterical
cafes. Hence it feems rather the immediate confcquence of %
pained tendon, than of a contagious poifon. And is fo far anal-
ogous to tetanus, according with the opinions of Dr. Rulh and
Dr. Percival.

VOL. II. P t In

*9* DISEASES CLASS III. 1.1.15.

In other ?efpe£h, as it is produced by the faliva of an enrag-
ed animal inftilled into a wound, it would feem analogous to
the pbifon of venomous animals. And from the manner of its ac-
cefs fo long after the bite, and of its termination in a fhort time,
it would feem to refemble the progrefs of contagious fevers.
SeeSea. XXir. 3. 3.

If the patient was bitten in a part, which could be totally cut
away, as a finger, even after the hydrophobia appears, it is prob-
able it might cure it ; as I fufpeft the caufe" ftill remains in the
Bounded tendon, and not in a difFufed infection tainting the
blood. Hence there are generally uneafy fenfations, as cold of
numbnefs, in the old cicatrix, before the hydrophobia commenc-*
£s. See a cafe in Medical Communications, Vol. II. p. 190.

If the difeafed tendon could be inflamed without cutting it
out, as by cupping, or cauflic, or Hitter after cupping, and this
m the old wound long fmce healed, after the hydrophobia com-
mences, it might prevent the fpafms about the throat. As in-
flaming the teeth by the ufe of mercury is of ufe in fome kinds
of hemkrania, Put fpirit of turpentine on the wound, walh it
well. See Clafs I. 3. i. 1 1. IV. r . 2. 7.

M. M. Wine, mufk, oil, internally. Opium, mercurial oint-
ment, ufed extenfively. Mercurial fumigation. Turpeth min-
eral. To falivate the patient as foon as poflible. Exfe&ion or
;i cauflic on the fear, even after the appearance of hydrophobia.
Put a tight bandage on the limb above the fear of the old wound
to benumb the pained tendon, however long the wound may
have been healed. Could a hollow catheter of elaflic gum, ca-
outchouc, be introduced into the cefophagus by the mouth or
noftril, and liquid nourifhment be thus conveyed into the flom*
ach ? See Default's Journal, Cafe I. where in an ulcer of the
mouth, fuch a catheter was introduced by the noftril, and kept
in the oefophagus for a month, by which means the patient was
nourifhed and preferved.

It is recommended by Dr. Bardfley to give oil internally by a
fimilar method contrived by Mr. John Hunter. He covered a
probang with the ilcin of a tmall eel, or the gut of a lamb or cat.
It was tied up at one end above and below the fponge, and a flit
made above the upper ligature ; to the other end of the eel fkin
or gut was fixed a bladder and pipe. The probang thus cover-
ed was introduced into the flomach, and the liquid food or med-
icine was put into the bladder and fqueezed down through the
cel-lkin. Mem. of Society at Manchester. See Clafs I. 2. 3. 25.

Dr. Bardfley has endeavoured to prove, that dogs never ex-
perience the hydrophobia, or canine madnefs, without having
;ireviouily bitten or infected ; and fecondly, that the dif-

eafa

CLASS III. 1. 1. 15. OF VOLITION. 299

cafe in this fpecies of animal always £hews itfelf in five or fix
weeks ; and concludes from hence, that this dreadful mahdy
might be annihilated by making all the dogs in Great Britain
perform a kind of quarantine, by fhutting them up for a certain
number of weeks. Though the difeafe from the bite of the mad
dog is perhaps more analogous to thofe from the wounds inflict-
ed by venomous animals than to thofe from other contagious
matter, yet thefe dbfervations are well worthy further atten-
tion ; which the author promifes.

In Dr, Hamilton's elaborate treatjfe on hydrophobia, Long-
man, London, it is propofed to try the effedT: of arfenic in this dii-
eafe, which is faid to be the principal ingredient of the TVinjore
pill, which is faid to cure thofe who are difeafed by the bite of
ferpents, and to cure the hydrophobia,

A folution of fublimate of mercury in rectified fpirits is
worthy a trial, as mentioned in CJafs I. 3. i. i 1.

ORDO

DISEASES CLASS III. i. a,

ORDO I.

fncreafed Volition.

GENUS II.
With incrtftfed AB'tons of the Organs of Senfe.

IN every fpecies of madnefs there is a peculiar idea either of
defire or averfion, which is perpetually excited in the min4 with
ill its connections. In fome conftitutions this is connected with
pleafurable ideas without the exertion of much mufcular action,
in others it produces violent mufcular action to gain or avoid the
object of it, in others it is attended with defpair and inaction.
Mania is the general word for the two former of thefe, and
melancholia for the latter ; but the fpecies of them are as nu-
merous as the ^efires and averfions of mankind.

In the prefent age the pleafurable infanities are moft fre-
quently induced by fuperftitious hopes of K[eaven, by fentimen-
tal love, and by perfonal vanity. The furious infanities by
pride, anger, revenge, fufpicion.y And the melancholy ones by
fear of poverty, fear of death, arid fear of Hell ; with innumer-
able others.

Quicquid agunt homines, votum, timqr, ira, voluptas,
Gaudia, difcurfus, noftri eft farrago libftlli.

JUVEN. I. 85.

This idea, however, which induces madnefs or melancholy,
is generally untrue ; that is, the objecl: is a miftaken fact. As
when a patient is perfuaded he has the itch, or venereal difeafe,
of which he has no fymprtom, and becomes mad from the pain
this idea occafions. So that the objecl: of madnefs is generally
a delirious idea, and thence cannot be conquered by reafon ; be-
caufe it continues to be excited by painful fenfation, which is a
ilrongcr ftimulus than volition. Moft frequently pain of body
is the caufe of convulfion, which is often however exchanged for
madnefs j and a painful delirious idea is moft frequently the
caufe of madnefs originally, but fometimes of convulfiou. Thus
I have feeri a young lady become convulfed from a fright, and
die in a few days ; and a temporary madnefs frequently termin-
ates the paroxyfms of the epilepfia dolorifica, and an infanity of
greater permanence is frequently induced by the pains or bruif-
es of parturition.

Where the patient is debilitated a quick pulfe fometimes at-
tends

CLASS III. i. 2. OF VOLITION. 3ct

tends infane people, which is neverthelefs generally only a fymp-
tom of the debility owing to the too great expenditure of fenfo-
rial power ; or of the paucity of its production, as in irritative,
or infenfitive inirritated fever. See Clafs III. i. i.

But neverthelefs where the quick pulfe is permanent, it flhewg
the prefence of fever ; and as the madnefs then generally arifes
from the difagreeable fenfations attending the fever, it is fo far
a good fymptom ; becaufe when the fever is cured, or ceafes
fpontaneoufly, the infanity molt frequently vaniihes at the fame
time.

The ftimulus of fo much volition fupports infane people un-
der variety of hardihips, and contributes to the cure of diieafes
from debility, as fometimes occurs towards the end of fevers.
See Seel:. XXXIV* 2. 5. And, on the fame account, they bear
Jargc dofes of medicines to procure any operation on them ; as
emetics, and cathartics, which, before they produce their effect
in inverting die motions of the flomach in vomiting-, or of the
abibrbents of the bowels in purging, muft firft weaken the natur-
^1 actions of thofe organs, as (hewn in Sect. XXXV. 1.13.

From thefe confiderations it appears, that the indications of
pure muft confift in removing the caufe of the pain, whether it
arifes from a delirious idea, or from a real fact, or from bodily
difeafe -9 or fecondly, if this cannot be done, by relieving the
pain in confequence of fuch idea or difeafe. The firit is fome-
times effected by preferring frequently in a day contrary ideas
to (hew the fallacy, or the too great eftimation, of the painful
ideas, adly. By change of place, and thus prefenting the itim-
iilus of new objects, as a long journey, sdly. By producing
forgetfulnefs of the idea or object, which caufes their pain •, by
removing all things which recal it to their minds ; and avoiding
all converfation on fimilar fubjects. For I fuppofe no difeafe
of the mind is fo perfectly cured by other means as by forget-
fulnefs.

Secondly, the pain in confequence of the ideas or bodily dif-
eafes above defcribed is to be removed, firft, by evacuations, as
venefection, emetics, and cathartics -, and then by large dofes
of opi^m, or by the vertigo occafioned by a circulating fwing, or
by a fea-voyage, which, as they affect the organs of fenfe as well
as evacuate the ftomach, may contribute to anfwer both indica-
tions of cure.

Where maniacs are outrageous, there can be no d£ubt but co-
ercion is neceffary ; which may be done by means of a f trait
waiftcoat ; which difarms them without hurting them ; and by
tying a handkerchief round their ankles to prevent their efcape.
la others there can be no doubt, but that confinement retards

rather

3«* DISEASES CLASS III. ^.

rather than promotes their cure ; which is forwarded by change
of ideas in confequence of change of place and of objects, as by
travelling or. failing.

The circumftances which render confinement necefiary, are
firft, if the lunatic is liable to injure others, which muft be judg«
ed of by the outrage he has already committed. 2dly, If he is
likely to injure himfelf ; this alfo muft be judged of by the def-
pondency of his mind, if fuch exift s. 3dly. If he cannot take
care of his affairs. Where none of thefe circumftances exift,
there fhould be no confinement. For though the miftaken idea
continues to exift, yet if no actions are produced in eonfequence
of it, the patient cannot be called infane. He can only be tern>
ed delirious. If every erne, who poflefles miftaken ideas, or who
puts falfe eftimates on things, was liable to confinement, I know
not who of my readers might not tremble at the fight of a mad-
houfe !

The moft convenient diftribution of infanities will be into
general, as mania mutabilis, ftudium inane, and vigilia $ and
into partial infanities. Thefe laft again may be fubdivided into
defires and averfions, many of which are fucceeded by pleafura-
ble or painful ideas, by fury or dejection, according to the de-
gree or violence of their exertions. Hence the analogy between
the infanities of the mind, and the convulfions of the mufeles
defcribed in the preceding genus, is curioufly exact. The con-
vulfions without ftupor, are either juft fufficient to obliterate the
pain, which occafions them 5 or are fucceeded by greater pain,
as in the convulfio dolorifica. So the exertions in the mania
mutabilis are either juft fufficient to allay the pain which occa«
(ions them, and the patient dwells comparatively in a cjuiefc
{late j or thofe exertions excite painful ideas, which are fucceed-
ed by furious difcourfes, or outrageous actions. The ftudium
inane, or reverie, refembles epilepfy, in which there is no fenfi-
bility to the ftirnuli of external objects. Vigilia, or watchful*
nefs, may be compared to the general writhing of the body ;
which is juft a fufficient exertion to relieve the pain which occa-
fions it. Erotomania may be compared to trifmus, or other muf-
cular fixed fpafrn, without much fubfequent pain •, and mceror
to cramp of the mufcles of the leg, or other fixed fpafm with
fubfequent pain. All thefe coincidences contribute to mew, as
explained in Sect. III. 5, that our ideas are motions of the im-
mediate organs of fenfe obeying the fame laws as our mufcular
motions.

The violence of action accompanying infanity depends much
on the education of the perfon ; thofe who have been proudly
educated with unreftrained paflionsj are liable to greater fury ;

CLASS III. i. a. OF VOLITION, 303

and thofe, whofe education has been humble, to greater defpqn*
dency* Where the delirious idea, above defcribed, produces
pleafurable fenfations, as in perfonal vanity or religious enthufi-
afm ; it is almoft a pity to match them from their fool's para-
dife, and reduce them again to the common lot of humanity ;
left they (hould complain of their cure, like the patient deforib-
ed in Horace,

»*.•»• • Pol i me occidiftia, amid,

Non fervaftis, ait, cui fie extorta voluptas,
Et dcmptus per vim mentis gratiflimus error !

As infanities arife from excefs of actjon of the fenforial pow*
nr of volition, this excefs of action may be owing either to the
increafe of motive or ftimulus, or to an increafed quantity or
accumulation of that fenforial power. And hence, though the
greateft number of infanities originate from increafed motive to
voluntary action, as to avoid pain or to acquire pleafure j yet
there appear to be fome, which have for their caufe an accumu-
lation of the fenforial power of volition.

Thus thofe, who have been accuilomed to perpetual exer-
tions of volition in carrying on fome extenfive employment or
profeflion during the firft half of their lives, are liable to be-
come melancholy, and eren to deftroy themfelves, if they fud-
denly leave off their very active and anxious exertions, and re-
tire to a fituation without employment, of which many inftances
have occurred. This feems to originate from the pain occafion*
ed by the accumulation of the fenforial power of volition, which
now ceafes to be expended for want of motive. The tsedium
vitse defcribed in No. X. of this genus of difeafes affects indo»
lent people, who poffefs accumulated fenforial power, but want
motive to excite it into fuch actions of the mufcles or ideas, as
might in part expend ft.

The accumulation of fenforial power from the defect of ac*
Cuftomed actions feems to give rife to fome inordinate mufcular
motions, as the inceflant jumping of a fquirrel confined in a cage,
And fome of the motions of children confined too long in fchools>
which are called tricks. See Clafs III. i. i. I. and IV. i. 3. 2.
And I am inclined to think, that thefe infanities, which are term-
ed melancholy, where no previous misfortune has occurred, as in*
grief or difappointed love, but where the patient fits perpetually
brooding over fome pain/ul idea, which was not previoufly ex-
cited by any external event, as in the tsedium vitx, are in g< '
al occafioned by accumulations of fenforial power 5 and the
Jem infanities to increafe of motive; that is, to thofe pi ins -or
u-ant of pleafure, which excite averllon or dcfirc.

o

304 DISEASES CLASS III. r. 2,

There is finally reafon to believe, that not only fenforial power
in general is capable of accumulation in thofe parts which
have been accuftomed to almoft perpetual action ; but alfo that
each kind or fpecies of fenforial power, as that of irritation,
fenfation, volition, and alTociation, is feparately capable of accu-
mulation in the parts, which have almoft perpetually been actu-
ated by it : which I hope fometime to confider more at large, as
I fufpecT: it may fupply a key to many of the phenomena not
only of infanities and convulfions, but to thofe of fever.

The difpofition to infanity, as well as to convulfion, is believ-
ed to be hereditary ; and in confequence to be induced in thofe
families from /lighter caufes than in others. Convulfions have
been (hewn to have besn moft frequently induced by pains ow-
ing to defecl: of ftimulus, as the (huddering from cold, and not
from pains from excefs of ftimulus, which are generally fucceed-
ed by inflammation. But mfanities are on the contrary gener-
ally induced by pains from excefs of ftimulus, as from the too
violent actions of our ideas, as in common anger, which is an
infanity of (hort duration ; for infanities generally, though not
always, arife from pains of the organs of fenfe ; but convulfions
generally, though not always, from pains of the membranes or
glands. And it has been previoufly explained, that though the
membranes and glands, as the ftomach and Ikin, receive great
pain from want of ftimulus ; yet that the organs. of fenfe, as the
eye and ear, receive no pain from defeft of ftimulus.

Hence it follows, that the conftitutions moft liable to convul-
fion, are thofe which moft readily become torpid in fome part
of the fyftem, that is which poiTefs lefs irritability ; and that
thofe moft liable to infanity, are fuch as have excefs of fenfibil-
ity ; and laftly, that thefe two circumftances generally exift in
the fame conftitutioii ; as explained in Seel. XXXI. 2. on Tern*
perajnents. Thefe obfervations explain why epilepfy and infan-
ity frequently fucceed or reciprocate with each other, and why
inirritable habits, as fcrofulous ones, are liable to infanity, of
which I have known fome inftances.

In many cafes however there i$ no appearance of the difpofi-
tion to epilepfy or infanity of the parent being tranfmitted to
progeny. Firft, where the infanity has arifenfrom fome vi-
lent difappointment, and not from intemperance in the ufe of
fpirituous liquors. Secondly, where the parent has acquired the
infanity or epilepfy by habits of intoxifcation after the procrea-
tion of his children. Which habits I fuppofe to be the general
e of the difpofition to infanity in this country. See Clafs
til. i. i. 7.

As the difpofition to gout, dropfy, epilepfy, and infanity, ap-

pears

CLASS III. i. 2. r. OF VOLITION; 305

pears to be produced by the intemperate ufe of fpirituous po«
tation, and is in all of them hereditary ; it feems probable, that
this difpofition gradually increafes from generation to generation,
in thofe families which continue for many generations to be in-
temperate in this refpecl •, till at length thefe difeafes are produc-
ed ; that is, the irritability of the fyftem gradually is decreafed
by this powerful ftimulus, and the fenfibilitv at :he fame time
increafed, as explained in Seel. XXXI. I. and 2. This difpofi*
tion is communicated to the progeny, and becomes ftill increaf-
ed, if the fame ftimulus be continued, and fo on by a third and
fourth generation ; which accounts for the appearance of epilep-
fy in the children of fome families, where it was never known
before to have exifted, and could not be afcribed to their own
intemperance. A parity of reafoning {hews, that a few fober
generations may gradually in the fame manner reftore a due de-
gree of irritability to the family, and decreafe the excefs of fenfi-
bility.

From hence it would appear probable, that fcrofula and drop-
fy are difeafes from inirritability ; but that in epilepfy and infan-
ity an excefs of fenfibility is added, and the two faulty temper-
aments are thus conjoined.

SPECIES.

I. Mania mutabilis. Mutable madnefs. Where the patients
are liable to miftake ideas of lenfation for thofe from irritation,
that is, imaginations for realities, if cured of one fource of infan-
ity, they are liable in a few months to find another fource in
fome new miftaken or imaginary idea, and to acl: from this new
idea. The idea belongs to delirium, when it is an imaginary or
miftaken one ; but it is the voluntary actions exerted in confe-
quence of this miftaken idea, which conftitute infanity.

In this difeafe the patient is liable carefully co conceal the
object of his defire or averfion. But a ..vnftant inordinate fuf-
picion of all people, and a careleflhefs of cleanlinefs, and of de-
cency, are generally concomitants of madnefs. Their defigns
cannot be counteracted, till you can inveftigate the delirious
idea or object of their infanity ; but as they are generally timid,'
they are therefore lefs to be dreaded.

Z. Z. called a young girl, one of his maid-fervants, into the
parlour, and, with cocked piftols in his hands, ordered her to
ftrip herfelf naked ; he then infpected her with fome attention,
and difmified her untouched. Then he ftripped two of his
male fervants in the fame manner, to the great terror of the
neighbourhood- After he was fecured, with nyich difficulty he

VOL. II. CL was

DISEASES CLASS III. 1.2.1,

was perfuaded to tell me, that he had got the itch, and had ex-
amined fome of his fervants to find out from whom he had re-
ceived it ; though at the fame time there was not a fpot to be
feen on his hands, or other parts. The outrages in confequence
of this falfe idea were in fome meafure to be afcribed to the
pride occafioned by unreftrained education, affluent wealth, and.
dignified family.

Madnefs is fometimes produced by bodily pain, particularly
I believe of a difeafed liver, like convulfion and epilepfy ; at
other times it is caufed by very painful ideas occafioned by ex-
ternal circumltances, as of grief, or difappointment j but the
nioft frequent caufe of infanity arifes from the pain of fome
imaginary or miftaken idea ; which may be termed hallucinatio
rnaniacalis. This hallucination of one of the fenfes is often
produced in an inftant, and generally becomes gradually weak-
ened in procefs of time, by the perpetual ftimulus of external
objects, or by the fucceflions or other catenations of ideas, or by
the operations of medicines ; and when the maniacal hallucina-
tion ceafes, or is forgotten, the violent exertions ceafe, which
were in confequence of it, and the difeafe is cured.

Mr. , a clergyman, about forty years of age, who was

rather a weak man, happened to be drinking wine in jocular
company, and by accident fwallowed part of the feal of a letter,
which he had juft then received ; one of his companions feeing
him alarmed, cried out in humour, " It will feal your bowels up."
He became melancholy from that inftant, and in a day or two
refufed to fwallow any kind of nourishment. On being preiTed to
give a reafon for this refufal, he anfwered he knew nothing would
pafs through him. A cathartic was given, which produced a
great many evacuations, but he flill perfifted, that nothing pant-
ed through him ; and though he was frightened into taking a
little broth once or twice by threats, yet he foon ceafed intirely
to fwallow any thing, and died in confequence of this infane idea.

Mils , a fenfible and ingenious lady, about thirty, faid

fhe had feen an angel ; who told her, that (he need not eat,
though all others were under the neceffity of fupporting their
earthly exiftence by food. After fruitlefs perfuafions to take
food, fhe ftarved herfelf to death.-— It was propofed to fend an
angel of a higher order to tell her, that now ihe muff begin to
eat and drink again ; but it was not put into execution.

Mrs. ,/ a lady between forty and fifty years of age,

imagined that fhe heard a voice fay to her one day, as fhe was
at her toilet, " Repent, or you will be damned." From that
moment fhe became melancholy, and this hallucination affe&ed

her

CLASS III. i. 2. i. OF VOLITION. 307

her in greater or lefs degree for about two years ; fhe then re-
covered perfectly, and is now a cheerful old woman.

Mrs. -, a farmer's wife, going up ftairs to drefs, found

the curtains of her bed drawn, and on undrawing them, {he be-
lieved that fhe faw the corpfe of her fifter, who was then ill at
the diflance of twenty miles, and became from that time infane ;
and as her fifter died about that time, fhe could not be produc-
ed to counteract the infane hallucination, but fhe perfectly re-
covered in a few months.

Mrs. , a moil elegant, beautiful, and aceomplifned la-
dy, about twenty-two years of age., had been married about two
months to an elegant, polifhed, and affluent young man, and it
was well known to be a love-match on both fides. She fudden-
ly became melancholy, and yet not to fo great a degree, but
that fhe could command herlelf to do the honours of her table
with grace and apparent eafe. After many days intreaty, fhe
at length told me, that fhe thought her marrying her hufband
had made him unhappy ; and that this idea fhe could not efface
from her mind day or night. I withflood her being confined,
as fome had advifed, and propofed a fea-voyage to her, with ex-
pectation that the ficknefs as well as,change of objects, might
remove the infane hallucination, by introducing other energetic
ideas ; this was not complied with, but fhe travelled about Eng-»
land with her friends and her hufband for many months, and
at length perfectly recovered, and is now I am informed in health
and fpirits.

Thefe cafes are related to fliew the utility of endeavouring to
inveftigate the maniacal idea, or hallucination ; as it may not
only acquaint us with the probable defigns of the patient, from
whence may be deduced the neceffity of confinement ; but alfo
may fome time lead to the moil effectual plan of cure.

I received good information of the truth of the following cafe,
which was publifhed a few years ago in the newfpapers. A
young farmer in Warwickfhire, finding his hedges broke, and
the flicks carried away during a froily feafon, determined to
watch for the thief. He lay many cold hours under a hay-
flack, and at length an old woman, like a witch in a play, ap-
proached, and began to pull up the hedge ; he waited till fhe had
tied up her bottle of flicks, and was carrying them off, that he
might convicl her of the theft, and then Ipringing from his con-
cealment, he feized his prey with violent threats. After fome
altercation, in which her load was left upon the ground, fhe
kneeled upon her bottle of flicks, and raifing her arms to Heaven
beneath the bright moon then at the full, fpoke to the farmer al-
ready fhivering with cold, « Heaven grant, that thou never mnyefl

know

3oS DISEASES CLASS III. i. 2. i.

know again the bleffing to be warm.** He complained of cold
all the next day, and wore an upper coat, and in a few days
another, and in a fortnight took to his bed, always faying nothing
made him warm, he covered himfelf with very many blankets,
and had a fieve ever his face, as he lay ; and from this one in-
fane idea he kept his bed above twenty years for fear of the cold
air, till at lengih he c;

M. M. As mania arifes from pain either of our jrmfcles or
organs of fenfe, the arts of relieving pain muft conftitute the
method of cure. See Sea. XXXIV. 3. 4. Venefedion.
Vomits of from five grains to ten of emetic tartar, repeated ev-
ery third morning for three or four times j with folution of
gum ammoniac, and folubie tartar, fo as to purge gently every
day. Afterwards warm br.ch for two or three hours a day.
Opium in iarj.;e dofes. Bark. Steel.

Dr. Binns gave two fcruples (40 grains) of folid opium at a
dofe, and twenty grains four hours afterwards ; which reftored
the patient. Dr. Brandreth gave 400 drops of laudanum to a
maniac in the greateft poflible furor, and in a few hours he be~
came calm and rational. Med. Comment, for 1791, p. 384.

Prognoftic.

THE temporary quick pulfe attending fome maniacal cafes is
(imply a fymptom of debility, and is the confequence of too
great exertions ; but a permanent quick pulfe {hews the pref-
$nce of fever, and is frequently a falutary fign ; becaufe, if the
life of the patient be fafe, when the fever ceafes, the infanity
generally vanifhes along with it, as mentioned above. In this
cafe the kind of fever muft direct the method of curing the in-
fanity ; which muft confift of moderate evacuations and diluents,
if the pulfe be ftrong ; or of nutrientia, bark, and fmall dofes
of opium, if the pnlfe be weak.

Where the caufe is of a temporary nature, as in puerperal
infanity, there is reafon to hope, that the dileafe will ceafe,
when the bruifes, or other painful fenfations attending this ilate,
are removed. In thefe cafes the child (hould be brought fre-
quently to the mother, and applied to her breaft, if fhe will fuf-
fer it, and this whether me at firft attends to it or not ; as by a
few trials it frequently excites the ftorge, or maternal affection,
and removes the infanity, as I have witneffed.

When the madnefs is occafioncd by pain of the teeth, which
I believe is no uncommon cafe, theie muft be extracted ; and
the cure follows the extinction of the pain. There is however
iome difficulty in detecting the delinquent tooth in this cafe3 as

in

CLASS III. i. 2.2. OF VOLITION. 30?

in hemicrania, imlefs by its apparent decay, or by fome previ-
ous information of its pain having been complained of ; be-
caufe the pain of the tooth ceafes, asfoon as the exertions of in-
fanity commence. In this cafe falivation might be tried.

When a perfon becomes in fane, who has a family of fmall
children to folicit his attention, the prognoftic is very unfavour-
able ; as it (hews the maniacal hallucination to be more pow-
erful than thofe ideas which generally intereft us the moft.

When an infane young man {hews no lafcivious idea, when
an opportunity of gratifying the paflion of love is preiented to
him, as in the cafe above mentioned of Z. Z. or when an in-
fane young lady (hews no fymptom of attachment, when ad-
dreffed honourably by a proper lover, the prognoftic is unfa-
vourable, as it (hews the maniacal hallucination to affect the
mind flronger than the natural paffton of love, which in civilized
fociety is ftrengthened by reftraint.

Paralytic affections are faid by Mr. Haflam, to be frequently
fucceeded by infanity, and that in thefe cafes the inactivity of
fome paralytic mufcles about the face or limbs with "defective
memory continue along with the infanity ; and he adds that thefe
patients are feldom relieved. Obfeiyations on Infanity by J.
Haflam, 8vo. Rivington. It was before obferved, that when
fome limbs become paralytic, as in the common hemiplegia,
that the other limbs are liable to be for fome time in almoft per-
petual action, owing to the fuperfluity of volition, which was
previoufly expended by the action of thofe mufcles, which are
how rendered dilbbedient to the fenforial power of volition,
though they may continue to be excitable by irritation or fenfa-
tion, as in the act of pandiculation, or by electric (hocks. Now
if this fuperfluity of voluntary activity be exerted on the organs
of fenfe, delirious hallucinations and infane actions are the con-
fequencc ; and as the power of life is already injured in a part
of the fyftem, they are lefs liable to recover, and die like other
paralytic patients. And thus the infanities in confequence of
paralytic affections, as well as thofe in confequence of pain-
ful fenfations or ideas, countenance the theory, that they
arife from the exceflive activity of the fenforial power of voli-
tion.

2. Stitdium inane. Reverie confifts of violent voluntary c
tions of ideas to relieve pain, with all the trains or tribes con-
nected with them by. fenfations or affociations. It frequently
alternates with epileptic convulfions ; with which it corresponds,
in refpect to the infenfibility of the mind to the ftimuli of ex-
ternal objects, in the fame manner as madnefs correfponds with

common

DISEASES CLASS III. i. 2. 2.

common convulfion, in the patient's pofTefllng at the fame time a
fenfibility of the ftimuli of external objects.

Some have been reported to have been involved in reverie fo
perfectly, as not to have been dilturbed by the difcharge of a
cannon ; and others to have been infenfible to torture, as the
martyrs for religious opinions ; but thefe feem more properly
to belong to particular infanities than to reverie, like noftalgia
and erotomania.

Reverie is diftinguifhed from madnefs as defcribed above ;
and from delirium, becaufe the trains of ideas are kept confid-
ent by the power of volition, as the perfon reafons and delib-
erates in it. Somnambulifmus is a part of reverie, fomnambu-
lifm confifting in the exertions of the locomotive mufcles, and
reverie in the exertions of the organs of fenfe , See Clafs I. I .
j. 9. and Seel. XIX. both which are mixed, or alternate with
each other for the purpofc of relieving pain.

When the patients in reverie exert their volition on their or.
gans of fenfe, they can occafionally perceive the ftimuli of ex.
ternal objects, as explained in Seel. XIX. And in this cafe it
refembles fometimes an hallucination of the fenfes, as there is a
mixture of fael and imagiriation in their difcourfe ; but may be
thus diftinguifhed : hallucinations of the fenfes are allied to de-
lirium, and are attended generally with quick pulfe, and other
fyinptoms of great debility; but reverie is without fever, and
generally alternates with convulfions ; and fo much intuitive
analogy (fee Seel:. XVII. 3. 7.)is retained in its paroxyfms, as to
preferve a confiftency in the trains of ideas.

Mifs G , whofe cafe is related in Seel. III. 5. 8. laid as

I once fat by her, " My head is fallen off, fee it is rolled to that
corner of the room, and the little black dog is nibbling the nofe
off." On my walking to the place which (he looked at, and
returning, and afluring her that her nofe was unhurt, me be-
came pacified, though I was doubtful whether me attended to
me. See Clafs III. i. 1.9. and Clafs III. I. 2. 2.

M. M. Large dofes of opium given before the expedled par-
oxyfm, as in epilepfia dolorifica, Clafs III. i. i. 8.

The hallucinatio ftudiofa, or falfe ideas in reverie, differ
from maniacal hallucinations above defcribed, as no infane ex-
ertions fucceed, and in the patients whom I have feen they
have always been totally forgotten, when the paroxyfm was
over.

Mafter , a fchool-boy about twelve years old, after he

came out of a convulfion fit and fat up in bed, faid to me,
« Dont you fee my father Handing at the feet of the bed, he is
come a long way on foot to fee me." I anfwered, no : " What

colour

CLASS III. 1.1.3. OF VOLITION. 3 1 i

colour is his coat ?" He replied, « A drab colour." « And
what buttons ?" " Metal ones," he anfwered, and added, " how
fadly his legs are fwelled." In a few minutes he faid, with ap-
parent furprife, " He is gone/* and returned to his perfect mind.
Other cafes are related in Seft XIX. and XXXIV. 3. and in
Clafs III. i. 2. 2. with further obfervations on this kind of
hallucination $ which however is not the caufe of reverie, but
conftitutes a part of it, the caufe being generally fome uneafy
fenfation of the body.

3. Vigilia. Watchfulnefs confifts in the unceafing exertion
of volition ; which is generally caufed by fome degree of pain
either of mind or of body, or from defect of the ufual quantity
of pleafurable fenfation ; hence if thofe, who are accuftomed to
wine at night, take tea inftead, they cannot fleep. The fame
happens from want of folid food for fupper, to thofe who are
accuftomed to ufe it j as in thefe cafes there is* pain or defeft of
pleafure in the ftomach.

Sometimes the anxiety about fleeping, that is the defire to
fleep, prevents fleep ; which confifts in an abolition of defire or
will. This may fo far be compared to the impediment of fpeech
defcribed in Seel. XVII. i. 10. as the interference of the will
prevents the efFecl defired.

Another fource of watchfulnefs may be from the too great
fecretion of fenforial power in the brain, as in phrenzy, and as
fometimes happens from the exhibition of opium, and of wine ;
if the exhauftion of fenforial power by the general actions of the
fyftem occafioned by the ftimulus of thefe drugs can be fuppo-
fed to be lefs than the increafed fecretion of it.

M. M. i. Solid food to fupper. Wine. Opium. Warm
bath. 2. The patient (hould be told that his want of fleep is of
no confequence to his health* 3. Venefection by cupping. Ab-
flinence from wine. 4. A blifter by ftimulating the (kin, and
rhubarb by ftimulating the bowels, will fometimes induce fleep.
Exercife. An uniform found, as of a paufing drop of water,
or the murmur of bees. Other means are defcribed in Sect.

XVIII. 20.

4. Erotomania. Sentimental love. Defcribed in its excefs
by romance writers and poets. As the object of love is beauty,
and as our perception of beauty confifts in a recognition by the
fenfe of vifion of thofe objects, which have before infpired our
love, by the pleafure they have afforded to many of our fen ft s
(Sect. XVI. 6.) ; and as brute animals have lefs accuracy of
their fenfe of vifion than mankind (ib.) ; we fee the reafon why
this kind of love is not frequently obfervable in the brute crea-
tion, except perhaps in fome married birds, or in the affection of*

the

$12 DISEASES CLASS III. i. 2. 3.

the mother to her offspring. Men who have not had leifure to
cultivate their tafte for vifible objects, and who have not read the
works of poets and romance-writers, are lefs liable to fentimen-
tal love ; and as ladies are educated rather with an idea of being
chofen, than of choofing ; there are many men and more wom-
en, who have not much of this infinity ; and are therefore more
eafily induced to marry for convenience or mtereft, or from the
flattery of one fex to the other.

In its fortunate gratificatjon fentimental love is fuppofed to
fupply the pureft fource of human felicity ; and from the fud-
dennefs with which many of thofe patients, defcribed in fpecies
I. of this genus, were feized with the maniacal hallucination,
there is reafon to believe, that the moft violent fentimental love
may be acquired in a moment of time, as reprefented by Shakf-
peare in the beginning of his Romeo and Juliet, as originally
written.

Some have endeavoured to make a diflinction between beau-
ty and grace, and have made them as it were rivals for the pof-
feflion of the human heart ; but grace may be defined beauty in
action ; for a fleeping beauty cannot be called graceful in what-
ever attitude me may recline ; the mufcles mutt be in action to
produce a graceful attitude, and the limbs to produce a grace-
ful motion. But though the object of love is beauty, yet the
idea is neverthelefs much enhanced by the imagination of the
lover ; which nppears from this curious circumftance, that the
lady of his paffion feldom appears fo beautiful to the lover after
a few months feparation, as his ideas had painted her in his
abfence ; and there is on that account, always a little difappoint-
ment felt for a minute at their next interview from this halluci-
nation of his ideas.

This pafllon of love produces reverie in its firft Mate, which
exertion alleviates the pain of it, and by the affiftance of hope
converts it into pleafure. Then the lover feeks folitude, left
this agreeable reverie (hould be interrupted by external flimuli,
as defcribed by Virgil.

Tantum inter denfas, umbrofa cacumina, fagos
Aflidue veniebat, ibi hxc incondita folus
Montibus et fylvis ftudio ja&abat inani.

When the pain of love is fo great, as not to be relieved by the
exertions of reverie, as above defcribed ; as when it is mifplaced
on an object, of which the lover cannot poflefs himfelf ; it may
ftill be counteracted or conquered by the ftoic philofophy, which
ftrips all things of their ornaments, and inculcates " nil admira-
ri." Of which leflbns may be found in the meditations of Mar-
cus

CLASS III. 1.2.4- OF VOLITION. 3 1 3

cus Antoninus. The maniacal idea is faid in fome lovers to
have been weakened by the aftion of other very energetic ideas ;
f'uch as have been occafioned by the death of his favourite child,
or by the burning of his houfe, or by his being fliip wrecked. In
thole cafes the violence of the new idea for a while expends fo
much fenforial power as to prevent the exertion of the mania-
cal one ; and new catenations fucceed. On this theory the lov*
cr's leap, fo celebrated by poets, might effecT: a cure, if the pa-
tien't efcaped with life.

The third ftage of this difeaie I fuppofe is irremediable ; when
a lover has previoufly been much encouraged, and at length
meets with neglect or difdain ; the maniacal idea is fo painful
as not to be for a moment relievable by the exertions of reverie,
but is inftantly followed by furious or melancholy infanity ; and
fuicide, or revenge, have frequently been the confequence. As
wa< lately exemplified in Mr. Hackman, who Ihot Mifs Ray in
the lobby of the playhoufe. So the poet defcribes the paffion
of Dido,

-Mommur inultx ? —

At moriamur, ait, — lie, lie, juvat ire fub umbras !

The fiery of Medsea feems to have been contrived by Ovid>
who was a good judge of the fubjecl:, to reprefent the favage
madnefs occafioned by ill-requited love. Thus the poet,

Earth has no rage like love to hatred turn'd,
Nor Hell a fury like a woman fcorn'd.

DRTDIN.

I I-nce it appears that though fentimental love does not fo
frequently arife fpontaneoufly in female bofoms, yet that it is
liable to become as violent, when it has been excited by the
courtfhip of the other fex, and though, when it is rejected, after
courtfhip has produced it, it is not always fucceeded by fuch vi-
olent effects as thofc above mentioned ; which may be afcribed
to the greater modefty and referve of their education ; yet the
difappointed pailion is liable to prey upon their minds even to
the hazard of their lives, of which I have witneiTed two inftan-
ces, in both which the effecls approached to that occafioned by
great grief. See Mceror, Clafs III. i. 2. 10.

One of thefe ladies, about 30 years of age, was defertedby an
Irii~h gentleman, who was foon to have married her ; ihe was
fetzed fuddenly with a flupor, which by thole, who were not
acquainted with the caufe, was miftaken for a kind of apoplexy ;
(he gradually recovered fo as to apply to her ufual habits of life,

VOL. II. R R and

314 DISEASES CLASS III. 1.2.$.

and in four or five years regained her cheerfulnefs, and married
another man. The other was affe£ted with long ftupor, lofs of
digeftion, and total inability of mind and body, which contin-
ued a year or two, and from which fhe alfo gradually re-
covered.

5. Amorfui. Vanity confifts of an agreeable reverie, and is
well ridiculed in the itory of NarcifTus, who fo long contemplat-
ed his own beautiful image in the water, that he died from neg-
3e£t of taking fuftenance. I once faw a handfome young man,
who had been fo much flattered by his parents, that his vanity
rofe fo near to infanity, that one might difcern by his perpetual
attention to himfelf, and the difficulty with which he arranged
his conversation, that the idea of himfelf intruded itfelf at every
comma or paufe of his difcourfe. In this 'degree vanity muft
afford great pleafure to the pofleflbr ; and when it exifts with-
in moderate bounds, may contribute much to the happinefs of
focial life.

My friend Mr. once complained to me, that he was

much troubled with bafhfulnefs in company, and believed that
it arofe from his want of perfonal vanity ; on this account he de-
termined on a journey to Paris, when Paris was the centre of
.politenefs 5 he there learnt to drefs, to dance, and to move his
hands gracefully in converfation •, and returned a moft confum-
mate coxcomb. But after a very few years he relapfed into ruf-
ticity of drefs and manners.

M. M. The .cure of vanity may be attempted by excefs of
flattery, which will at length appear ridiculous, or by its famil-
iarity will ceafe to be defired. I remember to have heard a
itory of a nobleman in the court of France, when France had a
court, who was fo difagreeably vain in converfation, that the
king was pleafed to direct his cure, which was t'hus performed.
Two gentlemen were directed always to attend him, one was
to fland behind his chair, and the other at a refpeclful diftance
before him ; whenever his lordfhip began to fpeak,one of them al-
ways, pronounced "Lord G.dlimaafre is going tofay the bed thing
in the world/'' And, as foon as hisLordfhip had done fpeaking,the
other attendant pronounced, <f Lord Galiimaufre has fpoken the
belt thing in the world." Till in a few weeks this noble lord
was fo difguited with praife that he ceafed to be vain ; and his
majefty difmifled his keepers.

6. Nofta/gta. Maladie de Pais. Calenture. An unconquer-
able defire of returning to one's native country, frequent in long
voyages, in which the patients become fo infane as to throw
themfelves into the fea, miftaking it for green fields or meadows.
The Swils are faid to be particularly liable to this difeafe, and

when

CLASS III. i. 2. 7. OF VOLITION. 315

when taken into foreign fervice frequently to defert from this
caufe, and efpecially atter hearing or tinging a particular tune,
which was ufed in their village dances, in their native country,
on which account the playing or finging this tune was forbid by
the punifliment of death. Zwingerus.

Dear is that fhed, to which his foul conforms,
And dear that hill, which lifts him to the ilorms.

GOLDSMITH.

7'. Spes religiofa. Superstitious hope. This maniacal Hallu-
cination in its milder ftate produces, like fentimental love, an
agreeable reverie ; but when joined with works of fupereroga-
tion, it has occafioned many enormities. In India devotees con-
fign themfclves by vows to moil painful and unceafmg tortures,
- fuch as holding up their hands, till they cannot retract them 5
hanging up by hooks put into the thick (kin over their moulders,
fitting upon {harp points, and other felf torments. While iu
our part of the globe failing and mortification, as flagellation,
has been believed to pleafe a merciful Deity ! The ferenity, with
which many have faffered cruel martyrdoms, is to be afcribed to
this powerful reverie.

Mr. , a clergyman, formerly of this neighbourhood, be-
gan to bruife and wound himfelf for the fake of religious morti-
fication, and patied much time in prayer, and continued whole
nights alone in the church. As he had a wife and family of
fmall children, I believed the cafe to be incurable ; as otherwife
.the affection and employment in his family connections would
have oppofed the beginning of this infanity. He was taken to
a madhoufe without effect, and after he returned home, continu-
ed to beat and Bruife himfelf, and by this kind of mortification,
and by fometimes long fading, he at length became emaciated
"and died. I once told him in converfation, that " God was a
merciful being, and could not delight in cruelty, but that I fup-
pofed he worfhipped the devil." He was (truck with this
idea, and promifed me not to beat himfelf for three days, and
I believe kept his word for one day. If this idea had been fre-
quently forced on his mind, it might probably have been of
fervice.

When thefe works of fupererogation have been of a public
nature, what cruelties, murders, mafTacres, has not this infanity
introduced into the world ! — A commander, who had been very
active in leading and encouraging the bloody deeds of St. Bar-
tholomew's day at Paris, on confefhng his fins to a worthy ec-
clefiaftic on his death-bed, was afked, " Have you nothing to
fay about St Bartholomew ?" " On that day," he replied, « God

Almighty

3 1 6 DISEASES CLASS III. 1.2.8.

Almighty was obliged to me !" — The fear of Hell is another
infanity, which will be fpoken of below.

8. Superbiaflemmath. Pride of family has frequently form-
ed a maniacal hallucination, which in its mild ftate has confifted
in agreeable reverie, .but when it has been fo painful as to de-
mand homage from others, it has frequently induced infane ex-*
ertions. This infanity feems to have exifted in the flourifhing
ftate of Rome, as now all over Germany, and is attacked by Ju~
venal with great feverity, a fmall part of which I (hall here

as a method of cure. Sat. 8.

Say, what avails the pedigree, that brings
Thy boafted line from, heroes or from kings ;
Though many a mighty lord, in parchment roll'd,
Name after name, thy coxcomb hands unfold ;
Though wreathed patriots crowd thy marble halls,
Or fleel-clad warriors frown along the walls ;
While on broad canvas in the gilded frame
All virtues flourifh, and all glories flame ?—
Say, — if ere noon with idiot laugh you lie
Wallowing in wine, or cog the dubious die,
Or aft unfliamed, by each indignant buft,
The midnight orgies of promiscuous luft ! •• •

Go, lead mankind to Virtue's holy Ihrinc,
With morals mend them, and with arts refine,
Or lift, with golden characters unfurl' d,
The flag of peace, and fave a warring world !—
— So fhall with pious hands immortal Fame
Wreathe all her laurels round thy honour'd name,
High o'er thy tomb with chiflel bold engrave,

" THE TRULY NOBLE ARE THE GOOD AND BRAVE."

9. Ambitio. Inordinate defire of fame. A carelefihefs about
the opinions of others is faid by Xenophon to be the fource of
impudence ; certainly a proper regard for what others think of
us frequently incites us to virtuous actions, and deters us from
vicious ones ; and increafes our happinefs by enlarging our
fphere of fympathy, and by flattering our vanity.

AbflraiSl what others feel, what other* think,
All pleafures iicken, and all glories fink.

POPE.

When this reverie of ambition excites to conquer nations, or
to enflave them, it has been the fource of innumerable wars, and
the occafion of a great devaftation of mankind. Csefar is re-
ported to have boafted, that he had deftroyed three millions of
his enemies, and one million of his friends.

The works of Homer are fuppofed to have done great injury to
mankind by hifpiring the love of military glory. Alexander was
to fleep with them always on his pillow. How like a mad

butcher

I

CLASS lit. i. 2. 10. OF VOLITION. 317

butcher amid a flock of flieep appears the hero of the Iliad, in
the following fine lines of Mr. Pope, which conclude the twen-
tieth book.

His fiery courfers, as the chariot rolls,
Tread down whole ranks, and crufh out heroes' fouls ;
Bafli'd from their hoofs, as o'er the dead they fly,
Black bloody drops the fmoking chariot dye ; —
The fpiky wheels through heaps of carnage tore,
And thick the groaning axles dropp'd with gore ;
High o'er the fcene of death ACHILLES ftood,
All grim with duft, all horrible with blood ;
Yet ftill infatiate, ilill with rage on flame,
Such is the luft of never dying fame !

The cure muft be taken from moral writers. Woolafton
fays, Csefar conquered Pompey ; that is, a man whofe name
confided of the letters C, se, f, a, r, conquered a long time ago
a man, whofe name confided of the letters P, o, m, p, e, y, and
that this is all that remains of either of them. Juvenal alfo at-
tacks this mode of infariity, Sat. X. 166.

I, demens, et faevas curre per Alpes,
Ut pueris placeas, et declamatio fias !

Which is thus tranflated by Dr. Johnfon,

And left a name, at which the world grew pale,
To point a moral, or adorn a tale !

10. Mceror. Grief. A perpetual voluntary contemplation
of all the circumftances of fome great lofs, as of a favourite
child. In general the painful ideas gradually decreafe in ener-
gy, and at length the recollection becomes more tender and lefs
painful. The letter of Sulpicius to Cicero on the lofs of his
daughter is ingenious. The example of David on the lofs of his
child is heroic.

A widow lady was left in narrow circumftances with a boy
and a girl, two beautiful and lively children, the one fix, and
the other feven years of age ; as her circumftances allowed her
to keep but one maid-fervant, thefe two children were the fole
attention, employment, and confolation of her life ; (lie fed
them, drefled them, flept with them, and taught them herfelf ;
they were both fnatched from her by the gangrenous fore throat
in one week : fo that (he loft at once all that employed her, as
well as all that was dear to her. For the firft three or four
days after their death, when any friend vifited her, (he fat up-
right, with her eyes wide open, without medding tears, and af-
fected to fpeak of indifferent things. Afterwards me begnn to
weep much, *nd for fome weeks talked to her friends of noth-
ing

3i* " DISEASES CLASS III. i. 2. n.

ing elfe but her dear children. But di.^1 not for many years,
even to her dying hour, get quite over a gloom, which was left
upon her countenance.

In violent grief, when tears flow, it is efteemed a good fymp-
tom ; becaufe then the actions caufed by fenfitive aflbciation take
the place of thofe caufed by volition ; that is, they prevent the
voluntary exertions of ideas, or mufcular actions, which confti-
tute infanity.

The fobbing and fighing attendant upon grief are not convul-
five movements, they are occafioned by the fenforial power be-
ing fo expended on the painful ideas, and their connections,
that the perfon neglects to breathe for a time, and then a vio-
lent figh or fob is neceflary to carry on the blood, which opprefles
the pulmonary veflels, which is then performed by deep or quick
infpirations, and laborious expirations. Sometimes neverthelefs
the breath is probably for a while voluntarily held, as an effort to
relieve pain. The palenefs and ill health occafioned by long
grief are fpoken of in Clafs IV. 2. 1.9.

The melioration of grief by time, and its being at length even
attended with pleafure, depends on our retaining a diftinct idea
of the loft object:, and forgetting for a time the idea of the lofs
of it. This pleafure of grief is beautifully defcribed by Aken-
fide. Pleafures of Imagination, Book II. 1. 680.

-Afk the faithful youth,

Why the cold urn of her, whom long he loved,

So often fills his arms ; fo often draws

His lonely fooriieps at the lilent hour

To pay the mournful tribute of his tears ?

Oh ! he will tell thee, that the wealth of worlds

Should ne'er fcduce his bofom to forego

That facred hour ; when, Healing from the noife

Of care and envy, fweet remembrance foothes

With Virtue's kindeft looks his aching breaft,

And turns his tears to rapture.

M. M. Confolation is beft fupplied by tfye Chriftian doctrine
of a happy immortality. In the Pagan religion the power of
dying was the great confolation in irremediable diftrefs. Seneca
fays, u no one need be unhappy unlefs by his own fault." Arid
the author of Telemachus begins his work by faying, that Ca-
lypfo could not confole herfelf for the lofs of •Ulyfles, and found
herfelf unhappy in being immortal. In the firft hours of grief
the method of confolation ufed by uncle Toby, in Triftram
Shandy, is probably the beft ; " he fat down in an arm chair by
the bed of his diitrelied friend, and faid nothing."

11. tadsitm vita. Ennui. Irkfomenefs of life. The inani-
ty of fublunary things has afforded a theme to philofophers,

nioralifts,

I

CLASS III. i. 2. 1 1. OF VOLITION. 319

moralifts, and divines, from the earlieft records of antiquity ;
" Vanity of vanities [" fays the preacher, « all is vanity !" Sol-
omon. " Man is the dream of a (hadow !" Sx<»j ma.? xvfyaw,,
Pindar. O ! quantum eft in rebus inane ! Juvenal. Nor is
there any one, I fuppofe, who has palled the meridian of life,
who has not at fome moments felt the nihility of all things.

Wearinefs of life or ennui in its moderate degree has been ef-
teemed a motive to action by fome philofophers. See Sect.
XXXIV. 2. 3. But in thofe men, who have run through the
ufual amufements of life early in refpect of their age j and who
have not induftry or ability to cultivate thofe fciences, which af-
ford a perpetual fund of novelty, and of confequent entertain-
ment, are liable to become tired of life, as they fuppofe there is
nothing new to be found in it, that can afford them pleafure ;
like Alexander, who is faid to have fhed tears becaufe he had not
another world to conquer.

Mr. , a gentleman, about fifty, of poliflied manners,

who in a few months afterwards deftroyed himfelf, faid to me
one day, " A ride out in the morning, and a warm parlour and
a pack of cards in the afternoon, are all that life affords." He
was perfuaded to have an iflue on the top of -his head, as he com-
plained of a dull head-ach, which being unfkilfully managed,
deftroyed the pericranium to the fize of an inch in diameter ;
during the time this took in healing, he was indignant about it,
and endured life, but foon afterwards (hot himfelf.

Mr. , a gentleman of Gray's Inn, fome years ago was pre-
vailed upon by his friends to difmifs a miftrefs, by whom he had
a child, but who was fo great ji termagant and fcold, that (he
was believed tq.ufe him very iil,:3^even to beat him. He be-
came melancholy in two days from the want^|phis ufual ftimu-
lus to action, and cut his throat on the third fo completely, that
lie died immediately.

Mr. A nfon, the brother to the late lord Anfon, related to me

the following anecdote of the death of lord Sc . His lord-

fliip fent to fee Mr. Anfon on the Monday preceeding his
death, and faid, " You are the only friend I value in the world,
I determinlHjherefore to acquaint you, that I am tired of tl^|
infipidity ofWPe, and intend to morrow to leave it." Mr. A
faid, after much converfation, that he was obliged to leave town
till Friday, and- .added, "As you profefs a friend (hip for me, do
me this laft favour, 1 entreat you, live till I return." Lord

Sc believed this to be a pious artifice to gain time, but ncv-

erthclefs agreed, if he mould return by four o'clock on I
Mr. Anfon did not return till five, and perceived by the coun-
tenances of the domcftics, that tfie deed was done. He :-

32° DISEASES CLASS III. 1.2. u.

into his chamber and found the corpfeof his friend leaning over
the arm of a great chair, with the piflol on the ground by him,
the ball of which had been difcharged into the roof of his mouth,
and pafied into his brain.

Mr. and Mr. , two young men, heirs to confiderable

fortunes, iliot themfelves at the age of four or five and twenty,
without their friends being able to conjecture any caufe for thofe
ram actions. One of them I had long known to exprefs himfelf
with diffatisfaclion of the world ; at eighteen years of age he
complained, that he could not entertain himfelf; he tried to
ftudy the law at Cambridge, and afterwards went abroad for a
year or two by my advice ; but returned difiatisfied with all
things. As he had an eruption for fome years on a part of his
face, which he probably endeavoured to remove by external ap-
plications ; I was induced to afcribe his perpetual ennui to the
pain or difagreeable fenfation of a difeafed liver. The other
young gentleman mot himfelf in his bed-room, and I was inform-
ed that there was found written on a fcrap of paper on his table,
" I am impotent, and therefore not fit to live." From whence
there was reafon to conclude, that this was the hallucinatio ma-
niacalis, the delirious idea, which caufed him to deflroy himfelf.
The cafe therefore belongs to mania mutabilis, and not to tsedi-
um vitse.

Thofe, who have been employed during the firft half of their
lives in fome very active bufmefs, and fuddenly leave it, are li-
able to this kind of infanity, and even to fuicide ; of which I
have known two inftances, one of them a Birmingham manu-
facturer, and the other a great and fuccefsful commander. This
may be afcribed to the accumulation of the fenforial power of
volition, and the want of motive to exert or expend it, and
which thence becomes painful. See pain of cold from the
want of ftimulus. III. 2. I. 17.

This may afford confolation to thofe, whofe fituation in life
obliges them to ufe perpetual indufhy in their occupations : they
may fay, that as they have been long in the habit of exerting
much voluntary action, they muft continue to employ them-
4felves ; other wife that they mall link into low fpirits, as it is call-
ed, and become unhappy. And as the continuance of activity
is now neceflary to their happinefs, they had better employ
themfelves on fuch objects, as are ufeful to themfelves or their
connections, than to confume their time, and mifapply their la-
bour, in card-playing, wine-drinking, or fox-hunting, which are
other methods of relieving ennui or the irkfomenefs of life by
exertion, and confequent expenditure of voluntary power.

>fs degrees of this malady are errcneoufly termed hypochon-

driacifm,

-iii.i.2.ii. OF VOLITION. ^

driacifm, fee Clafs 1. 2. 4. 10. by the people, and are general-
afcribed to the want of voluntary power, or of induftry ; but
I believe it is generally owing to want of motive or ftimulus |
and that the pain attending this flate of our ideas or mufcles is
occafioned by accumulation of voluntary power, as above men*
tioned. The cure of this difeafe, is popularly known to confift
in any kind of voluntary exertion of the mind, or of the body \
one of our poets has perfonified hypocliondriacifm, and well ad-
vifes the ufe of exercife, or exertion to oppofe the monfter,andfays>

tt Throw bat a {fo'ne; die giant dies."

To this fhould be added, that thofc, who have been educated
in indolence, do not find or feel ennui, or the pain of exiftencej,
when they are inactive ; like our domeftic animals, as dogs and
cats, who deep by the fire without inclination to hang or drown
themfelves ; as thefe beings, not having been long accuftomed
to expend much voluntary power, are not liable to much accu-*-
mulationof it, and uneafinefs in confequence; which is not fo
however with the more active fquirrel before mentioned.

But on the contrary, thofe, whofe education has induced them
16 ufe much voluntary exertion, and have afterwards had no
aclive employment, as happens to fome unmarried ladies, are
more liable, as I have repeatedly wimefTed, to this malady ; art
idea, which fhould be attended to in female education.

Another fource of ennui or taedium vitse is alfo derived from
wrong education, and is immediately owing to the want of ftim*
ulus rather than to the great accumulation of voluntary power ;
and is liable to attend fome ladies in high life, whcfe exertions
during their early years were excited by the flattery of numer*
ous menial fervants. And afterwards, when this flattery ceafes
by their living with their equals, they want their accuftomed
motive to activity, and in confequence become indolent and un*
happy, as further defcribed in Clafs III* 2. I. 8. under the name
of Parefis voluntaria»

M. M. The prevention of this malady mud confift in the
due care of education. Thofe who are not defigned for very
active life, particularly young ladies, {hould not be forced in
their early years to ufe too violent or too conftant voluntary ex-
ertions- They {hould not be flattered into al! their exertions,
but ihould be taught to act from duty to themfelves and others,
or for their future advantage as well as for their prefent amu fo-
ment.

Some reftraint in exhaufting the ufual pleafures of the world
in early life fhould be laid on young men of fortune 5 and after-
wards the pleafures and folitudes of a matrimonial liie arc

VOL, II. S s ftrongly

322 DISEASES CLASS III. i. 2. 1 2*

ftrongly to be recommended ; and finally the cultivation of fci-
erice, as of chemiftry, natural philofophy, natural hiftory, which
fupplies an inexhauflible fource of pleafurable novelty, and re-
lieves ennui by the exertions it occafions.

In many of thefe cafes, when irkfomenefs of life has been the
oftenfible caufe of fuicide, there has probably exifted a maniacal
hallucination, a painful idea, which the patient has concealed
even to his dying hour ; except where the mania has evidently
arifen from hereditary or acquired difeafe of the membranous or
glandular parts of the fyftem.

12. Pulchritudinis dejiderium. The lofs of beauty, either by
difeafe, as by the fmall-pox, or by age, as life advances, is fome-
tinie'3 painfully felt by ladies, who have been much flattered on
account of it. There is a curious cafe of this kind related in
le Sage's Bachelor of Salamanca, which is too nicely defcribed
to be totally imaginary.

In this fituation fome ladies apply to what are termed cofmet-
ics under various names, which crowd the newfpapers. Of
thefe the white has deftroyed the health of thoufands ; a calx,
or magiflery, of bifmuth is fuppofed to be fold in the mops for
this purpofe ; but it is either, I am informed, in part or entirely
white lead or cerufla. The pernicious effects of the external
uie of thofe fatunline applications are fpoken of iri gutta rofea,
Clafs II. i. 4. 6. The real calx of bifmuth would probably
have the fame ill effect. As the red paint is prepared from
cochineal, which is an animal body, lefs if any injury arifes
from its ufe, as it only lies on the fkin like other filth.

The tan of the fkin occafioned by the fun may be removed by
lemon juice evaporated by the fire to half its original quantity,
or by diluted marine acid ; which cleans the cuticle, by eroding
its furface, but requires much caution in the application ; the
marine acid rnuft be diluted with water, and then put upon the
hand or face, after a fecond of time, as foon as the tan difap-
pears, the part muft be wa'fhed with a wet towel and much
warm water. Freckles lie too deep for this operation, nor are
they in general removable by a blifter, as I once experienced.
See Clafs I. 2. 2. 9.

It is probable, that thofe materials which flaiil filk, or ivory,
might be ufed to (lain the cuticle, or hair, permanently ; as they
are all animal fubftances. But I do not know, that any trials of
this kind have been made on the fkin. I endeavoured in vain
to whiten the back of my hand by marine acid oxygenated by
manganefe, which fo inftantly whitens cotton.

The cure therefore muft be fought from moral writers, and

CLASS III. i. 2. 13. OF VOLITION. 323

the cultivation of the graces of the mind, which are frequently
a more valuable poffeflion than celebrated beauty.

13. Paupertatis timor. The fear of poverty is one kind of
avarice ; it is liable to affect people who have left off a profita-
ble and active bufmefs » as they are thus deprived of their ufual
exertions, and are liable to obferve the daily expenditure of mon-
ey, without calculating the fource from whence it flows. It is
alfo liable to occur with a fudden and unexpected increafe of

fortune. Mr. , a furgeon, about fifty years of age, who

was always rather of a parfimonious difpofition, had a large
houfe, with a fortune of forty thoufand ppunds, left him by a
diftant relation 5 and in a few weeks became infane from the
fear of poverty, lamenting that he fhould die in a jail or a work-
houfe. He had left off a laborious country bufmefs, and the
daily perception of profit in his books j he alfo now faw greater
expenfes going forwards in his new houfe, than he had been
accuftomed to obferve, and did not fo diftinctly fee the fource
of fupply ; which feems to have occafioned the maniacal hallu-
cination.— This idea of approaching poverty is a very frequent
and very painful difeafe, fo as to have induced many to become
fuicicjes, who were in good circumflances ; more perhaps than
any other maniacal hallucination, except the fear of Hell.

The covetoufnefs of age is more liable to affect fingle men,
than thofe who have families ; though an accumulation of wealth
would feem to be more defirable to the latter. But an old man
in the former fituation, has no perfonal connections to induce
him to open his purfe ; and having loll the friends of his youth,
and not eafily acquiring new ones, feels himfelf alone in the
world : feels himfelf unprotected, as his ilrengtji declines, and
is thus led tq depend for affiftance on money, and on that ac-
count wimes to accumulate it. Whereas the father of a family
has not only thofe connections^ which demand the frequent ex-
penditure of money, but feels a confojation in the friendfhip of
his children, when age may render their good offices neccffary
to him.

M. M. I have been well informed of a medical perfon in
good circumftances in London, who always carries an account
of his affairs, as debtor and creditor, in his pocket-book j and
looks over it frequently in a day, when this diieafe returns upon
him ; and thus, by counteracting the maniacal hallucination,
wifely prevents the increafe of his infanity. Another medical
perfon, in London, is faid to have cured himfelf of this difeafe
by ftudying mathematics with great attention \ which exertion
of the mind relieved the pain of the maniacal hallucination.

Many moral writers have ftigmatifed this infanity \ the covet-
ous,

3 ^ DISEASES CL^SS HI. t. a. i^

ous, they fay, commit crimes and mortify themfelves without
Jiopes of reward 5 and thus become miferable both in this workf
and the next. Thus Juvenal ;

Cum furor haud dubius, cum fit manifefta phrenitis,
U't locuples moriaris., egenti vivere fato 1

The covetous man thought he 'gave good advice to the;
fpendthrift, when he faid, « Live like me/' who well anfweredi
hjrn.

Like you, Sir John ?

^ That I can do, when all I have is gone 1"

Pan

14. Leihi timer. The fear of death perpetually employs the
thoughts of thefe patients : hence they are devifing new medi-
cines, and applying to phyficians and quacks without number*
Jt is confounded with hypochondriafis, Clafs I. 2. 3. 9. in pop^
ular converfation, but is in reality an infanity.

A young gentleman, whom I adyifed to go abroad as a cure
for this difeafe, aflured me, that during the three years he was
In Italy and France he never paffed a quarter of an hour with-
out fearing he mould die. But he has now for above twenty
years experienced the contrary.

The fufferers under this malady are generally at once difcov-
erable by their telling you, amidft an unconnected defcription,
of their complaints, that they are neverthelefs not afraid of dy-
ing. They are alio eafily led to. complain of pains in almoft any
part of the body, and are thus foon difcovered-

M- M» As the maniacal hallucination has generally arifen in
early infancy from fome dreadful account of the ilruggles and
pain of dying, I have fometimes obferved, that thefe patients
have received great confolation from the inftauces I have re-
lated to them of people dying without pain. Some of thefe,
which I think curious, I {hall concifely relate, as a part of the
niethod of cure,

Mr. * , an elderly gentleman, had fent for me one whole

day before I could attend him ; on my arrival he faid lie was
glad to fee me, but that he was now quite well, except that ho
was weak, but had had a pain in his bowels the day before. He
then lay in bed with his legs cold up to the kneesj his hands
•and arms cold, and his pulfe fcarcely difcernible, and died in
about fix hours. Mr. — •. — , another gentleman about fixty, lay in
the aft of dying, with difficult refpiration like groaning, but in a
kind of ftupor or coma vigil, and every ten or twelve minutes*
while I fat by hirrjj he. wakedj looked up* a.n.4 faida <« who is it

CLASS III. i. 2. IS- OF VOLITION.

groans fo, I am fure there is fomebody dying in the room," and
Then funk again into a kind of ileep. From thefe two cafes
there appeared to be no pain in the aft of dying, which may
afford confolation to all, but particularly to thofe who are afflict-
ed with the fear of death.

15. Orcitimor. The fear of Hell. Many theatric preachers
among the Methodifts fuccefsfully infpire this terror, and live
comfortably upon the folly of their hearers. In this kind of
madnefs the poor patients frequently commit fiucide ; although
they believe they run headlong into the Hell, which they dread !
Such is the power of oratory, and fuch the debility of the hu-
man underftanding !

Thofe, who fuffer under this infanity, are generally the moft
innocent and harmlefs people 5 who are then liable to accufe
themfelves of the greateft imaginary crimes, and have fo much
intellectual cowardice, that they dare not reaibn about thofe
things, which they are directed by their prieils to believe, how-*
ever contradictory to human apprehenfion, or derogatory to the
great Creator of all things. The maniacal hallucination at length
becomes fo painful, that the poor infane flies from life to be»
pome free from it.

M. M. Where the intellectual cowardice is great, the voice
of reafon is ineffectual j but that of ridicule may fave many
from thofe mad-making doctors ; though it is too weak to cure
thofe, who are already hallucinated. Footed Farces are recenv
mended for this purpofe,

1 6. Satyriajts, An ungovernable defire of venereal indul-
gence. The remote caufe is probably the ilimulus of the fe-
rnen ; whence the phallus becomes diftended with blood by the
arterial propultion of it being more ftrongly excited than the
correfpondent venous abforption. At the fame time a new fenfe
is produced in the other termination of the urethra ; which, like
itching, requires fome exterior friction to facilitate the removal
of the caufe of the mamacal actions, which may probably be in-
creafed in thofe cafes by fome afTociatecl hallucinations of ideas,
It differs from priapifmus chronicus in the deilre of its appro-*
priated object, which is not experienced in the latter, Chfs I.
I. 4. 6. and from the priapifmus amatorius, Clafs II. j. 7, 9. in
the maniacal actions in confequence of defire. The furor ute«
rinus, or nymphomania, is a fimilar difcafe,

M. M. Venefection. Cathartics. Torpentia. Marriage.
17. /r/7. Anger is caufed by offended pride. We are not
angry at breaking a bone, but become quite infane from the
fmulleft ftrcke of a whip from an inferior/ Ira furor brcvis. An-
ger is not only itfelf a temporary roadnefs, but is a frequent at-
tend ar.t

326 DISEASES CLASS III. i. 2. iS.

tendant on other infancies, and as, whenever it appears, it dif-
tjnguifhes infanity from delirium, it is generally a good fign in
fevers with debility.

An injury voluntarily inflicted on us by others excites our ex-
ertions of felf-defence or of revenge againft the perpetrator of
it ; but anger does not fucceed in any great degree unlefs our
pride is offended ; this idea is the maniacal hallucination, tha
pain of which fometimes produces fuch violent and general ex-
ertions of our mufcles and ideas, as to difappoint the revenge
we meditate, and vainly to exhauft our fenforial power. Hence
angry people, if not further excited by difagreeable language,
are liable in an hour or two to become humble, and forry for their
violence, and willing to make greater conceflions than required.

M. M. Be filent when you feel yourfelf angry. Never ufe
loud oaths, violent upbraidings, or ftrong expreflions of counte-
nance, or gefticulations of the arms, or clenched fifts ; as thefe
by their former aflbciations with anger will contribute to in-
creafe it. I have been told of a fergeant or corporal, who be-
gan moderately to cane his foldiers, when they were awkward
in their exercife, but being addicted to fwearing and coarfe lan-
guage, he ufed foon to enrage himfelf by his own expreflions of
anger, till toward the end he was liable to beat the delinquents
unmercifully.

1 8. Rabie*. Rage. A defire of biting others, moft frequent-
ly attendant on canine madnefs. Animals in great pain, as in
the colica faturnina, are fa^d to bite the ground they lie upon,
and even their own ficfh. I have feen patients bite the attend-
ants, and even their own arms, in the epilepfia dolorifica. It
feems to be an exertion to relieve pain, as explained in Se&.
XXXIV. 1.3. The dread of water in hydrophobia is occafion-
ed by the repeated painful attempts to fwallow it, and is there-,
fore not an eiTemial or original part of the difeale called canine
madnefs. See Clafs III. I. i. 15.

There is a mania reported to exift in fome parts of the eaft,
In which a man is faid to run a muck ; and thefe furious mani-
acs are believed to have induced their calamity by unlucky gam-
ing, and afterwards by taking large quantities of opium •, whence
the pain of defpair is joined with the energy of drunkennefs -,
they are then faid to fally forth into the moil populous ftreets,
and to wound and flay all they meet, till they receive their own
death, which they defire to procure without the greater guilt,
as they fuppofe of fuicide.

M. M. When there appears a tendency to bite in the pain-
ful epilepfy, the end of a rolled up towel, or a wedge of foft
wood,, ftiould be put into the mouth of the patient. As a bui-

let

CLASS UI. i. 2. 19. OF VOLITION. 327

let is faid fometimes to be given to a foldier, who is to be ie-
verely flogged, that he may by biting it better bear his punifli-
ment.

i p. Citta. A defire to fwallow indigeftible fubftances. I
once faw a young lady, about ten years of age, who filled her
ftomach with the earth out of a flower-pot, and vomited it up
with fmall (tones, bits of wood, and wings of infects arnongft it.
She had the bombycinous complexion, and looked like a chloro-
tic patient, though fo young ; this generally proceeds from an
acid in the ftomach.

M. M. A vomit. Magnefia alba. Armenian bole. Rhu-
barb. Bark. Steel. A blifter. See Clafs I. 2. 4. 5.

20. Averfion to food. This may arife, without
difeafe of the ftomach, from connecting naufeous ideas to our

ufual food, as by calling a ham a hog's a . This madnefs

is much inculcated by the ftoic philolophy. See Antoninus*
Meditations. See two cafes of patients who refufed to take
nourimment, Clafs III. i. 2. i.

Averfions to peculiar kinds of food are thus formed early in
life by aflbciation of iome maniacal hallucination with them, I
remember a child, who on tafting the griftle of fturgeon, afked
what grift le was ? And being told it was like the divifion of
a man's nofe, received an ideal hallucination ; and for twenty
years afterwards could not be perfuaded to tafte fturgeon.

The great fear or averfion, which fome people experienc
the fight of fpiders, toads, crickets, and the like, have generally-
had a fimilar origin.

M. M. Afibciate agreeable ideas with thofe which difguil ;
as call a fpider ingenious, a frog clean and innocent j and reprefs
all expreffions of difguft by the countenance, as fuch exprefTions
contribute to preferve, or even to increafe the energy of the ideas
aflbciated with them ; as mentioned above in Species 17. Ira.

2 1 . Syphilis wiaginarm. The fear that they are infeded v
the venereal difeaie, when they have only deferved it, is a very
common infanity amongft modeft young men ; and is not to be
cured without applying artfully to the mind ; a little mercury
muft be given, and hopes of a cure added weekly and gradually
by interview or correfpondence for fix or eight weeks. Many
of thefe patients have been repeatedly ialivated without curing
the mind !

22. Pfcra itnaginaria. I have twice feen an imaginary :.
and twice an imaginary diabetes, where there was not the
veftige of either of thofe difeaies, and once an ir

nefs, where the patient heard perfectly well. In all thefe caf.
hallucinated idea is fo powerfully excited, that it is nor to be

<iged

CiSEASES CLASS tti.i.t.434>

changed Suddenly by ocular fenfation, or reafotl. Yet gfeaf,
perfeverance in the frequently preferring contrary ideas will
fometimes flowly remove this hallucination, or in great length
of time oblivion, or forgetfulnefs, performs a cure> by other
means in vain attempted.

23. Tabes imaginar'm. This imaginary difeafe, or hallucina«
tion, is Cdufed by the fuppofed too great frequency of parting
with the femen, and had long impofed upon the phyfician a?
well as the patient, till Mr. John Hunter rirft endeavoured to
(hew, that in general the morbid effects of this pollution were
in the imagination ; and that thofe were only liable to thofe ef*
fec~t.s in general, who had been terrified by the vilianous books,
which pretend to prevent or to cure it, but which were purpofely
written to vend fome quack medicine. Moft of thofe unhappy
patients, whom I have feen, had evidently great impreflion of
fear and feJf-condemnatiott on their minds, and might be led to
make contradictory complaints in almoft any part of the body,
and if their confeflions could be depended on, had not ufed this
pollution to any great excefs.

M. M. i. Allure them if the lofs of the femen happens but
twice a week, it will not injure them. ^. Marry them. Thd
lad is a certain cure ; whether the difeafe be real or imaginary^
Cold partial bath, and aftringent medicines frequently taken, on-
ly recal the mind to the difeafe, or to the delinquency ; and
thence increafe the imaginary effects and the real caufe, if fuch
exifrs. Mr. — — deftroyed himfelf to get free from the pain
of fear of the fuppofed ill confluences of felf-pollution, without
any other apparent difeafe ; whofe parents I had in vain advifed
to marry him, if poflible.

24. Sympathta aliena* Pity. Our fynipathy with the pleaf-
ures and pains of others diflinguifhes men from other animals }
and is probably the foundation of v/hat is termed our moral fenfe \
and the fource of all our virtues. See Sect. XXII. 3. 3.
When our fympathy with thofe miferies of mankind, which we
cannot alleviate, rifes to excefs, the mind becomes its own tor-
mentor ; and we add to the aggregate fum of human mifery,
\vhich we ought to labour to diminifh ; as in the following elo»
quent lamentation from Akenfide's Pleafures of Imagination,
Book II. 1. 200.

Dark,

As midnight ftorms, the fcene of human things
Appear'd before me ; deferts, burning fands,
Where the parch'd adder dies ; the frozen fouth \
And defolation blafting all the weft
With rapine and with murdrr. Tyrant power
Here fits enthroned in blooa ; the baleful

CLASS III. i. 2. 25. OF VOLITION.

Of fuperftition there infe£ the fides,

And turn the fun to horror. Gracious Heaven !

What is the life of man ? Or cannot thefe,

Npt thcfe portents thy awful will fuffice ?

That, propagated thus beyond their fcope,

They rife to act their cruelties anew

In my affii;$ed bofom, thus decreed

The univerfal fenfitive of pain,

The wretched heir of evils not its own !

A poet of antiquity, whofe name I do not recoiled, is faid to
have written a book defcribing the miferies of the world, and to
have deftroyed himfelf at the conclufion of his tafk. This fym-
pathy, with all fenfitive beings, has been carried fo far by fome
individuals, and even by whole tribes, as the Gentoos, as not
only to reftrain them from killing animals for their fupport, but
even to induce them to permit infects to prey upon their bodies.
Such is however the condition of mortality, that the fir ft law of
nature is, " Eat or be eaten." We cannot long exift without
the deflruction of other animal or vegetable beings, either in
their mature or their embryon ftate. Unlefs the fruits, which
furround the feeds of«fome vegetables, or the honey ftolen from
them by the bee, may be faid to be an exception to this affer-
tion. See Botanic Garden, P. I. Cant. 1. 1. 278. Note. Hence,
from the neceffity of our nature, we may be fuppofed to have a
right to kill thofe creatures, which we want to eat, or which
want to eat us. But to deftroy even infects wantonly {hews an
unreflecting mind or a depraved heart.

Neverthelefs mankind may be well divided into the felfifh and
the focial ; that is, into thofe whofe pleafures arife from grati-
fying their appetites, and thofe whofe pleafures arife from their
fympathifmg with others. And according to the prevalence of
thefe oppofing propenfities we value or diflike the poffefTor of
them.

In conducting the education of young people, it is a nice
matter to infpire them with fo much benevolent fympathy, or
compaflion, as may render them good and amiable ; and yet not
fo much as to make them unhappy at the fight of incurable dif-
trefs. We (hould endeavour to make them aiive to fympathize
with all remediable evils, and at the fame time to arm them with
fortitude to bear the fight of fuch irremediable evils, as the acci-
dents of life muft frequently prefent before their eyes. About
this I have treated more at large in a plan for the conduct of a
board ing-fchool for ladies, which I intend to publim in the courfe
of the next year.

25. Editcatio heroica. From the kinds and degrees of infan-
ities already enumerated, the reader will probably recolkft ma-

VOL. II. T T ny

33® DISEASES CLASS III. i. 2. 25.

ny more from his own obfervation ; he will perceive that all
extraordinary exertions of voluntary action in confequence* of
fome falfe idea or hallucination, which ftrongly affects us, may
philofophically, though not popularly, be termed an infanity ;
he will then be liable to divide thefe voluntary exertions into
difagreeable, pernicious, deteftable, or into meritorious, delecta-
ble, and even amiable, infanities. And will laftly be induced
to conceive, that a good education confifts in the art of produc-
ing fuch happy hallucinations of ideas, as may be followed by
fuch voluntary exertions, as may be termed meritorious or ami-
able infanities.

The old man of the mountain in Syria, who governed a fmall
nation of people called Aflaflines, is recorded thus to have edu-
cated thofe of his army who were defigned to aflaflinate the
princes with whom he was at war. A young man of natural
activity was chofen for the purpofe, and thrown into a deep
fleep by opium mixed with his food ; he was then carried into
a garden made to reprefent the paradife of Mahomet, with flow-
ers of great beauty and fragrance, fruits of delicious flavour, and
beautiful Houries beckoning him into ihe fhades. After a
while, on being a fecond time ftupified with opium, the young
enthufiaft was reconveyed to luYapartment ; and on the next day
was aflured by a prieft, that he was defigned for fome great ex-
ploit, and that by obeying the commands of their prince, im-
mortal happinefs awaited him.

Hence it is eafy to collect how the firft impreflions made on
us by accidental circumftances in our infancy continue through
life to bias our affect ions, or miflead our judgments. One of
my acquaintance can trace the origin of his own energies of ac-
tion from fome fuch remote fources, which juftifies the obferva-
tion of M. RouiTeau, that the feeds of future virtues or vices
are oftener fown by the mother than the tutor.

CLASS III. 2.1. OF VOLITION. 3 3 '

ORDO II.

Decreafed Volition.

GENUS I.
With decreafed AElions of the Mufcles.

OUR mufcles become fatigued by long contra&ion, and ceafc
for a time to be excitable by the will ; owing to exhauftion of
the fenforial power, which refides in them. After a fhort inter-
val of relaxation the mufcle regains its power of voluntary con-
traction 5 which is probably occafioned by a new fupply of the
fpirit of animation. In weaker people thefe contractions ceafe
fooner, and therefore recur more frequently, and are attended
with fliorter intervals of relaxation, as exemplified in the quick-
nefs of the pulfe in fevers with debility, and in the tremors of
the hands of aged or feeble people.

After a common degree of exhauftion of the fenforial power
in a mufcle, it becomes again gradually reftored by the reft of
the mufcle, and even accumulated in thofe mufcles, which are
moft frequently ufed ; as in thofe which conftitute the capilla-
ries of the fkin after having been rendered torpid by cold. But
in thofe mufcles, which are generally obedient to volition, as
thofe of locomotion, though their ufual quantity of fenforial
power is reftored by their quiefcence, or in fleep (for ileep af-
fecls thefe parts of the fyftem only), yet but little accumulation
of it fucceeds. And this want of accumulation of the fenforial
power in thefe mufcles, which are chiefly fubfervient to voli-
tion, explains to us one caufe of their greater tendency to para-
lytic affection.

It muft be obferved, that thofe parts of the fyftem, which
have been for a time quiefcent from want of ftimulus, as the
veflels of the fkin, when expofed to cold, acquire an accumula-
tion of fenforial power during their inactivity ; but this does
not happen at all, or in much lefs quantity, from their quief-
cence after great expenditure of fenforial power by a previous
exceflive ftimulus, as after intoxication. In this cafe the muf-
cles or organs of fenfe gradually acquire their natural quantity
of fenforial power, as after fleep ; but not an accumulation or
iuperabundance of it. And by frequent repetitions of exhauf-
tion by great ftimulus, thefe veflels ceafe to acquire their whole
natural quantity of fenforial power ; as in the fcirrhous ftom-
ach, and fcirrhous liver, occafioned by the great and frequent

ftimulus

3 3 * DISEASES CLASS III. 2. i . i .

ftimulus of vinous fpirit ; which may properly be termed irrita-
tive paralyfis of thofe parts of the fyftem.

In the fame manner in common palfies the ina&ion of the
paralytic mufcle feems not to be owing to defecT: of the ftimu-
lus of the will, but to exhauftion of fenforial power. Whence
it frequently folio ws^great exertion, as in Seel:. XXXIV. i. 7.
Thus ibme parts of the fyftem may ceafe to obey the will, as in
common paralyfis •, others may ceafe to be obedient to fenfation,
as in the impotency of age ; others to irritation, as in fchirrous
vifcera j and others to aifociation, as in impediment of fpeech \
yet though all thefe may become inexcitatye, or dead, in refpedi
to that kind of ftimulus, which has previoufly exhaufted themf
whether of volition, or fenfation, or irritation, or aflbciation,
they may ftill in many cafes be excited by the others.

SPECIES.

i . LaJJltudo. Fatigue or wearinefs after much voluntary ex-
ertion. From the too great expenditure of fenforial power the
mufcles are with difficulty brought again into voluntary con-
trattion j and feem to require a greater quantity or energy of vo-
lition for this purpofe. At the fame time they ftill remain obe-
dient to the ftimulus of agreeable fenfation, as appears in tired
4anc rs rinding a renovation of their aptitude to motion on the
acquisition of an agreeable partner ; or from a tired child riding
on a gold-headed cane, as in Seel:. XXXIV. 2. 6. Thefe muf-
cles are like wife ftill obedient to the fenforial power of aflbcia-
tion, becaufe the motions when thus excited, are performed in
their defigned directions, and are not broken into variety of gef-
ticulation, as in St. Vitus's dance.

A laflitude likewife frequently occurs with yawning at the
beginning of ague-fits ; where the production of fenforial pow-
er in the brain is lefs than its expenditure. For in this cafe the
torpor may either originate in the brain, or the torpor of fome
diftant parts of the iyftem may by fympathy affect the brain,
though in a lefs proportionate degree than the parts primarily

2. Vacillatio fenilis. Some elderly people acquire a fee-faw
motion of their bodies from one fide to the other, as they fit,
like the ofcillation of a pendulum. By thefe motions the muf-
cles, which preferve the perpendicularity of the body, are alter-
nately quiefcent, and exerted ; and are thus lefs liable to fatigue
or exhauftion. This therefore refembles the tremors of old
people above mentioned, and not thofe fpafmodic movements ot
the face or lirnbs, which are called tricks, defcribed in Clafs IV.

3-

CLASS III. 2. i. 3. OF VOLITION.

3.2. 2. which originate from excefs of fenforial power, or from
efforts to relieve difagreeable fenfation, and are afterwards con-
tinued by habit.

3. Tremor fenilis. Tremor of old age confifts of a perpetual
trembling of the hands, or of the head, or of other mufcles,
when they are exerted •, and is erroneoufly called paralytic •, and
feems owing to the fmall quantity of animal power rending in
the mufcular fibres. Thefe tremors only exill when the affect-
ed mufcles are excited into action, as in lifting a glafs to the
mouth, or in writing, or in keeping the body upright •, and ceafc
again, when no voluntary exertion is attempted, as in lying
down. Hence thefe tremors evidently originate from the too
quick exhauftion of the leffened quantity of the fpirit of anima-
tion. So many people tremble from fear or anger, when too
great a part of the fenforial power is exerted on the organs of
fenfe, fo as to deprive the mufcles, which fupport the body
creel, of their due quantity.

4. Erachiorum paral\fis. A numbnefs of the arms is a fre-
quent fymptom in hydrops thoracis, as explained in Clafs I. 2.
3.14. and in Seel. XXIX. 5. 2. ; it alfo accompanies the afthma
dolorificum, Clafs III. i. i. 11. and is owing probably to the
fame caufe in both. In the colica farurnina a paralyfis affects
the wrifts, as appears on the patient extending his arm horizon-
tally with the palm downwards, and is often attended with a tu-
mor on the carpal or metacarpal bones. See Clafs IV. 2. 2. 10*
and I. 2. 4. 8.

Mr. M , a miner and well-Tinker, about three years ago,

loft the power of contracting both his thumbs ; the balls or muf-
cles of the thumbs are much emaciated, and remain paralytic.
He afcribes his difeafe to immerfing his hands too long in cold
water in the execution of his bufmeis. He fays his hands had
frequently been much benumbed before, fo that he could not
without difficulty clench them ; but that they recovered their
motion, as loon as they began to glow, after he had dried and
covered them.

In this cafe there exifted two injurious circumflances of dif-
ferent kinds •, one the violent and continued action of the muf-
cles, which deftroys by exhaufting the fenforial power ; and the
other, the application of cold, which deftroys by defect of ftim-
ulus. The cold feems to have contributed to the paralyfis by-
its long application, as well as the continued exertion j but as
during the torpor occafioned by the expofure to cold, if the de-
gree of it be not fo great as to extinguish life, the ienforial pow-
er becomes accumulated ; there isreafon to believe, that the ex-
pofing a paralytic limb to the cold for a certain time, as by cov-
ering

334 DISEASES CLASS III. 2. i. 5.

ering it with fnow or iced water for a few minutes, and then
covering it with warm flannel, and this frequently repeated,
might, by accumulation of fenforial power, contribute to reftore
it to a ftate of voluntary excitability. As this accumulation of
fenforial power, and confequent glow, feem, in the prefent cafe,
feveral times to have contributed to reftore the numbnefs or ina-
bility of thofe mufcles, which at length became paralytic. Sec
Clafsl. 2. 3. 21.

M. M. Ether externally. Friction. Saline warm batl
Electricity. Mercurial ointment. See Clafs I. 2. 4. 8.

5 . Raucedo paralytica. Paralytic hoarfenefs confifts in the
moil total lofs of voice, which fometimes continues for mont
or even years, and is occafioned by inability or paralyfis of tl
recurrent nerves which ferve the mufcles of vocality, by oj
in;? or clofing the larynx. The voice generally returns fuddenly,
even fo as to alarm the patient. A young lady, who had man]
months been affected with almoft a total lofs of voice, and h;
in vain tried variety of advice, recovered her voice in an inftant
on fome alarm as me was dancing at an aflembly. Was this
owing to a greater exertion of volition than ufual ? like
dumb young man, the fon of Crcefus, who is related to ha>
cried out, when he faw his father's life endangered by the fwoi
of his enemy, and to have continued to fpeak ever afterwarc
Two young ladies in this complaint feerned to be cured by elec
trie (hocks patted through the larynx every day for a fortnight
See Raucedo catarrhalis, Clafs II. i. 3. 5.

M. M. An emetic. Electric (hocks. Mu (lard-feed, a lar£
fpoonful fwallowed whole, or a little bruifed, every morninj
Valerian. Burnt fponge. Blifters on each fide of the Jaryn:
Sea-bathing. A gargle of decoction of feneca. Friction. Fi
quent endeavours to Ihout and (ing.

6. Veftca urinaritc paralyfis. Paralyfis of the bladder is fr
quently a fymptom in irritative fever ; in this cafe the patiei
makes no water for a day or two ; and the tumor of the bla(
der diilended with urine may be feen by the (hape of the abd<
men, as if girt by a cord below the navel, or diftinguifhed
the hand. Many patients in this fituation make no complaint
and fuffer great injury by the inattention of their attendants
the water rnufb be drawn off once or twice a day by means of
catheter, and the region of the bladder gently prefled by tl
hand, whilft the patient is keot in a fitting or erect pofture. S(
Clafs II. 2. 2. 6.

M. M. Bark. Wine. Opium, a quarter of a grain evei
fix hours. Balfam of copaiva or of Peru. Tincture of cai
tharidss 20 drops twice a day, or repeated fmall blifters.

An

CLASS III. 2.1.7- OF VOLITION. 3 3 5

An inability to empty the bladder frequently occurs to elder-
ly men, and is often fatal. This fometiines arifes from their
having too long been reftrained from making water from acci-
dental confinement in public fociety, or otherwife j whence the
bladder has become fo far diftended as to become paralytic ; and
not only this, but the neck of the bladder" has become contracted
fo as to refift the introduction of the catheter. In this deplora-
ble cafe it has frequently happened, that the forcible efforts to
introduce the catheter have perforated the urethra ; and the in-
ftrument has been fuppofed to pafs into the bladder, when it has
only pafled into the cellular membrane along the fide of it j of
which I believe I have feen two or three inftances 5 and after-
wards the part has become fo much inflamed as to render the
introduction of the catheter into the bladder impracticable.

In this fituation the patients are in imminent danger, and
fome have advifed a trocar to be introduced into the bladder
from the rectum ; which I believe is generally followed by an
incurable ulcer. One patient, whom I faw in this fituation, be-
gan to make a fpoonful of water after fix or feven days, aad grad-
ually in a few days emptied his bladder to about half its fize,
and recovered ; but I believe he never afterwards was able com-
pletely to evacuate it.

In this fituation I lately advifed about two pounds of crude
quickfilver to be poured down a glafs tube, which was part of a
barometer tube, drawn lefs at one end, and about two feet long,
into the urethra, as the patient lay on his back ; which I had
previouily performed upon a horfe ; this eafily pafled, as was
fuppofed, into the bladder ; on Handing erect it did not return,
but on kneeling down, and lying horizontally on his hands, the
mercury readily returned ; and on this account it was be!:
to have pafled into the bladder, as it fo eafily returned, when the
neck of the bladder was lower than the fund us of it. But nev-
erthelefs as no urine followed the mercury, though the bladder
was violently diftended, I was led to believe, that the urethra
had been perforated by the previous efforts to introduce a cathe-
ter and bougie ; and that the mercury had pafled on the outfide
of the bladder into the cellular membrane.

As the urethra is fo liable to be perforated by the forcible ef-
forts to introduce the catheter, when the bladder is violently dif-
tended in this deplorable difeafe, I thould ftron^ly recommend
the injection of a pound or two of crude mer the ure-

thra to open by its weight the neck of the bladder previous to
any violent or very frequent eflays with a catheter whether of
metal or of elaftic refin.

7- ReiTiiparaltfis. . Palfy of the rectum. The rectum intef-

tinum,

DISEASES CLASS III. a,

tinum, like the urinary bladder in the preceding article, poflefles
voluntary power of motion ; though thefe volitions are at times
uncontrolable by the will, when the acrimony of the contained
feces, or their bulk, ftimulates it to a greater degree. Hence it
happens, that this part is liable to lofe its voluntary power by
paralyfis, but is (till liable to be flimulated into action by the
contained feces. This frequently occurs in fevers, and is a bad
fign as a fymptom of general debility ; and it is the fenfibility of
the mufcular fibres of this and of the urinary bladder remaining,
after the volantarity has ceafed, which occasions thefe two ref-
ervoirs fo foon to regain, as the fever ceafes, their obedience to
volition ; becaufe the paralyfis is thus {hewn to be lefs complete
in thofe cafes than in common hemiplegia ; as in the latter the
fenfe of touch, though perhaps riot the fenfe of pain, is generally
deftroyed in the paralytic limb.

M. M. A fponge introduced within the fphincter ani to pre-
vent the conftant difcharge, which fhould have a firing put
through it, by which it may be retracted.

8. Pare/is volunlaria. Indolence ; or inaptitude to voluntary
aftion. This debility of the exertion of voluntary efforts pre-
vents the accompli fhment of all great events in life. It often
originates from a miftaken education, in which pleafure or flat*
tery is made the immediate motive of action, and not futue ad-
vantage ; or what is termed duty. This obfervation is of great
value to thole, who attend to the education of their own chil-
dren. I have feen one or two young married ladies of fortune,
who perpetually became uneafy, and believed themfelves ill, a
week after their arrival in the country, and continued fo uniform-
ly during their ftay •, yet on their return to London or Bath im-
mediately loft all their complaints, and this repeatedly ; which I
was led to afcribe to their being in their infancy furrounded with
menial attendants, who had flattered them into the exertions
they then ufed. And that in their riper years, they became tor-
pid for want of this ilimuius, and could not amufe themfelves
by any -voluntary employment ; but required ever after, either
to be amufed by other people, or to be flattered into activity.
This I fuppofe, in the other fex, to have fupplied one fource of
ennui and fuicide. See Clafs III. i. 2. 11.

9. Catalepfts is fometimes uftd for fixed fpafmodic contractions
or tetanus, as defcribed in Sect. XXXIV. i. ^. and in Clafs
III. i. i. 13. but is properly fimply an inaptitude to mufcular
motion, the limbs remaining in any attitude in which they are
placed. One patient whom I faw in this fituation, had taken
much mercury, and appeared univerfally torpid. He fat in a
chair in any pofture he was put, and held a glafs to his mouth

for

„

%fl%c,

CLASS III. 2. i. 10. OF VOLITION.

'.any minutes without attempting to drink, or withdraw
his hand. He never fpoke, and it was at firft neceiTary to
compel him to drink broth j he recovered in a few weeks with-
out relapfe.

10. Hemiplegia. Palfy of one fide con fids in the total difo-
bedience of the affected mufcles to the power of volition. A&
the voluntary motions are not perpetually exerted, there is little
ienforial power accumulated during their quiefcence, whence
they are lefs liable to recover from torpor, and are thus more
frequently left paralytic, or difobedient to the power of volition,
though they are fometimes (till alive to painful fenfation, as to
the prick of a pin, and to heat ; alfo to irritation, as in ftretch-
ing and yawning ; or to electric ihocks. Where the paralyfis
is complete the patient feems gradually to learn to ufc his limbs
over again by repeated efforts, as in infancy ; and, as time is re-
quired for this purpofe, it becomes difficult to know, whether
the cure is owing to the effect of medicines, or to the repeated
efforts of the voluntary power.

The diipute, whether the nerves decuflate or crofs each other
before they leave the cavities of the fkull or fpine, feems to be
decided in the affirmative by comparative anatomy ; as the op-
erves of fome fiih have been fhewn evidently to crofs each
other ; as feen by Haller, Elem. Phyfiol. t. v. p. 349. Hence
the application of blifters.or of ether, or of warm fomentations,
{hould be on the fide of the head oppofite to that of the arTe£ted
mufcles. This fubjett mould neverthelefs be nicely determin-
ed, before any one mould trepan for the hydrocephalus inter-
nus, when the difeafe is (hewn to exift only on one fide of the
brain, by a fquinting affecting but one eye i as propofed in.
I. 2. 5. 4. Dr. Sommering has (hewn, that a true decuf-
iation of the optic nerves in the- human fubject actually exiits,
Eiem. of Phyliology by Blumenbach, tranflated by C. Caldwell,
Philadelphia. This further appears probable from the oblique
direction and infertion of each optic nerve, into the fide of the
eye next to the nofe, in a direct line from the oppofite fide of
the brain.

The vomiting, which generally attends the attack of hemiple-
gia, is mentioned in Sect. XX. 8. and is fimilar to that attend-
ing vertigo in fea-ficknefs, and at the commencement of fome
fevers. Black itools loJte times attend the commencement of
hemiplegb, which is probably an effufion of blood from the
biliary duct, wher, - is previoufly afiv£ted ; or foaie blood

may be derived to rhe intefrines by its efcaping from the vena
cava into the receptacle of chyle during the diltrefs of the para-
lytic attack ; and may be conveyed from thence into the intrf-
VOL. II. U u

333 DISEASES CLASS III. 2. i. 10.

tines by the retrograde motions of the lacteals ; as probably
fometimes happens in diabetes. iSee Sett. XXVII. 2. Palfyof
one fide of the face is mentioned in Clafs II. i. 4. 6. Paralyfis
of the lacteals, of the liver, and of the veins, which are defcrib-
ed in Seel. XXVIII. XXX. and XXVII. do not belong to this
clafs, as they are not difeafes of voluntary motions.

M. M. The electric fparks and fhccks, if ufed early in the
difeafe, are frequently of fervice. A purge of aloes, or calo-
mel. A vomit. Blifter. Saline draughts. Then the bark.
Mercurial ointment or fublimate, where the liver is evidently
fed ; or where the guttarofea has previoufly exiited. Sud-
ilen alarm. Frequent voluntary efforts. Externally ether.
Volatile alkali. Fomentation on the head. Friction. When
children, who have fullered a hemipiegia, begin to ufe the af-
fected arm, the other hand ihould be tied up for half an hour
three or four times a day; which obliges them at their play to
nib more frequent voluntary efforts with the difeafed limb, and
boner to rcitore the difievered affociations of motion.

In hemiple^ia, as well as toward the end of fome fevers with
great debility, the parts about the loins are liable to mortify by
the preiTure of a continued recumbency upon them, and in part
by the fridion of thofe parts againft the meet, as the patient
dides down again after being frequently raifed higher in his bed,
to prevent which a pillow fhould be put beneath the under-
Iheet half way down the bed, as in Clafs II. i. 2. 4. A folu-
tion of fugar of lead, or white lead in fine powder, or a cerate
of lapis ealaminaris contributes to heal or to prevent thefe ex-
coriations. But the mott efficacious preventive confifts in the
patient's wearing a pair of linen drawers ; by which means,
when he Ilides down in his bed, the friction will be between the
t and his drawer.;, not between the (heet and his (kin ; and
this greater friction will in general prevent his fliding down in
bed, when his head and ihoulders are raifed on more pillows,
which will on this account alib contribute much to his comfort;
this is alib worthy the attention of thofe dropfical patients, who
are neceilitated to lie with the head raifed high in bed.

When thefe patients have any difficulty of fwallowing, they
(hould be raifed up when any fluid is put into the mouth, left it
ihould iufiocate them. See Apoplexia, No. 16. Nor mould
young children be fed as they lie on their backs, as they are
then obliged to fwallow as much as the nurfe pleafes; like one
of the punifhrnents formerly ufed in the inquifition, where the
delinquent was made to fwallow many quarts of water, as he
•was chained down on his back, and was fuffocated by it.

In paralyfis of the wrifts from lead, Mr. Clutterbuck has late-

CLASS III. 2. i. 1 1. OF VOLITION. 339

ly publifhed fome fucccfsful cafes of the ufe of mercurial oint-
ment. See Colica Saturnina, I. 2. 4. 8. See Clafe III. 2. i. 4.
Dr. J. Alderfon has lately much recommended the leaves of
rhus toxicodendron (fumach), from i. gr. to iv. of the dried
powder to be taken three or four times a day. Eflay on Rhus
Toxic. Johnfon, Londctfi, 1793. But it is difficult to know
what medicine is of fcrvice, as the movements of the mufcles
mult again be learned, as in infancy, by frequent efforts.

11. Paraplegia. A palfy of the lower half of the body di-
vided horizontally. Animals may be conceived to have double
bodies, one half in general refembling fo exactly the other, and
being fupplied with feparate fets of nerves •, this gives rife to
hemiplegia, or palfy of one half of the body divided vertically ;
but the paraplegia, or palfy of the lower parts of the fyftem,
depends on an injury of the fpinal marrow, or that part of the
bruin which is contained in the vertebrae of the back ; by which
ail the nerves fituated below the injured part are deprived of
their nutriment, or precluded from doing their proper offices ;
and the mufcles, to which they are derived, are in confequence
difobediem to the power of volition.

This fometimes occurs from an external injury, as a fall from
an eminence ; of which I faw a deplorable initance, where the
bladder and recium, as well as the lower limbs, were deprived
of fo much of their powers of motion, as depended on volition
or fenfation ; but I fuppofe not of that part of it, which dep.
on irritation. In the fame manner as the voluntary mufcles in
hemiplegia are fometimes brought into action by irritation, as
in ftretching or pandiculation, deicribed in Sect. VII, i. 3.

But the moil frequent caufe of paraplegia is from a protuber-
of one of the fpinal vertebrae ; which is owing to the in-
nutrition or foftnefs of bones, defcribed in Clafs I. 2. 2. 17.
The cure of this deplorable diieafe is frequently efffcfed by the
ilimulus of an iffue placed on each fide of the prominent foine,
as ririb pubiilhed by Mr. Pott. The other means recommend-
ed in foftnefs of bones ihould alto be attended to ; both in re-
fpect to the internal medicines, and to rhe mechanical methods
of fuppcrting, or extending the fpine •, which laft, however, in
this cafe requires particular caution.

12. Somnus. In deep all voluntary power is fufpencted,
Sec.1. XVIII. An unufual quantity of ilcep is often produc-

>y weaknefs. In this cafe imall dofes of opium, -.
and bark, may be given with advantage. Fur the periods of

, fee Clafs IV. 2. 4. i.
The fublequent ingenious obfcrvations on .• of

340 DISEASES CLASS III. 2. i. 11.

the pulfe, which fometimes occurs in ileep, are copied from a
letter of Dr. Currie of Liverpool to the author.

" Though reft in general perhaps renders the healthy pulfe
flower, yet under certain circumitances the contrary is the truth.
A full meal without wine or other ftrong liquor does not in-
creafe the frequency of my pulfe, while I fit upright, and have
my attention engaged. But if 1 take a recumbent pofture af-
ter eating, my pulfe becomes more frequent, efpecially if my
mind be vacant, and I become drowfy ; and, if I flumber,
this increafed frequency is more confiderable with heat and
fiufhing.

" This I apprehend to be a general truth. The obfervation
may be frequently made upon children ; and the reftlefs and fe-
verifh nights experienced by many people after a full fupper are,
I believe, owing to this caufe. The fupper occafions no incon-
venience, whilft the perfon is upright and awake ; but, when
he lies down and begins to fleep, efpecially if he does not per-
fpire, the fymptoms above mentioned occur. Which may be
thus explained in part from your principles. When the power
of volition is abblifhed, the other fenforial actions are increafed.
In ordinary fleep this does not occafion increafed frequency of
the pulfe ; but where fleep takes place during the procefs of di-
geftion, the digeftion itfelf goes on with increafed rapidity.
Heat is excited in the fyftem falter than it is expended ; and
operating on the fenfitive actions, it carries them beyond the
limitation of pleafure, producing, as is common in fuch cafes,
increafed frequency of pulfe.

" It is to be obferved, that in. fpeaking of the heat generated
under thefe circum (lances, I do not allude to any chemical evo-
lution of keat from the food in the procefs of digeftion. I doubt
if this takes place to any confiderable degree, for I do not ob-
ferve that the parts incumbent on the ftomach are increafed in
heat during the moft hurried digeftion. It is on fome parts of
the furface, but more particularly on the extremities of the body,
that the increafed heat excited by digeftion appears, and the
heat thus produced arifes, as it mould feem, from the fympa-
thy between the ftomach and the veflels of the ikin. The parts
moft affected are the palms of the hands, and the foles of the
feet. Even there the thermometer feldom rifes above 97 or 98
degrees, a temperature not higher than that oi the trunk of the
body ; but three or four degrees higher than the common tem-
perature of thefe parts, and therefore producing an uneaiy fen-
fatibn of heat, a fenfation increafed by the great fen fibility of the
parts affected.

c; That the increafed heat excited by digeftion in flccp is the

caufe

GLASS III. 2. i. 12. OF VOLITION. 341

caufe of the accompanying fever, fecms to be confirmed by ob-
frrvin^, that if an increafed expenditure of heat accompanies
ncreafed generation of it (as when perfpiration on the ex-
tremities or furface attends this kind of fleep) the frequent pulfe
and flufhed countenance do not occur, as I know by experi-
ment. If, during the feverifh fleep already mentioned, I am
awakened, and my attention engaged powerfully, my pulfe
becomes almoft immediately flower, and the fever gradually fub-
fides."

From thefe obfervations of Dr. Currie it appears, that, while
in common fleep the actions of the heart, arteries, and capillaries,
are ftrengthened by the accumulation of fenforial power during
the fufpenfion of voluntary action, and the pulfe in confequence
becomes fuller and flower •, in the feverifh fleep above defcrib-
ed the aclions of the heart, arteries, and capillaries, are quicken-
ed as well as ftrengthened by their confent with the increafed
actions of the ftomach, as well as by the ftimulus of the new
chyle introduced into the circulation. For the ftomach, and all
other parts of the fyftem, being more fenfible and more irritable
during fleep, Seel:. XVIII. 15. and probably more ready to aft
from aflbciation, are now exerted with greater velocity as well
as ftrength, conftituting a temporary fever of the fenfitive irri-
tated kind, refembling the fever excited by wine in the begin-
ning of intoxication ; or in fome people by a full meal in their
waking hours. Sect. XXXV. i.

On waking, this increafed fenfibility and irritability of the
fyftem ceafes by the renewed exertions of volition ; in the fame
manner as more violent exertions of volition deftroy greater
pains ; and the pulfe in confequence fubfides along with the in-
creafe of heat ; if more violent efforts of volition are exerted,
the fyftem becomes ftill lefs affected by fenfation or irritation*
Hence the fever and vertigo of intoxication are leflened by in-
tenfe thinking, Seel. XXI. 8 ; and in fane people are known to
bear the pain of cold and hunger better than others, Seel:,
XXXIV. 2. ^ ; and laftly, if greater voluntary efforts exift, as
in violent anger or violent exercife, the whole fyftem is thrown
into more energetic action, and a voluntary fever is induced, as
appears by the red (kin, quickened pulfe, and increafe of heat ;
whence dropfies and fevers with debility are not unfrequently
removed by infanity.

Hence the exertion of the voluntary power in its natural de-
gree diminifhes the increafed fenfibility, and irritability, and
probably the increafed aflbciability, which occur during fleep ;
and thus reduces the frequency of the pulfe in the feveiiih fleep
r a nil) meal. In its more powerful date of exertion, it di-

miniihes

342 DISEASES CLASS III. 2. i. 13.

minimes or deftroys fenfations and irritations, which are ftronger
than natural, as in intoxication, or which precede convulfions,
or infanity. In its dill more powerful degree, the fuperabun-
dance of this fenforial power actuates and invigorates the whole
moving fyftem, giving ftrength and frequency to the pulfe, and
an univerfal glow both of colour and of heat, as in violent an-
ger, or outrageous infanities.

If, in the feverim fleep above defcribed, the (kin becomes cool-
ed by the evaporation of much perfpirable matter, or by the ap-
plication of cooler air, or thinner clothes, the actions of the cu-
taneous capillaries are lefiened by defect of the ftimulus of heat,
which counteracts the increafe of lenfibility during fleep, and
the pulfations of the heart and arteries become flower from the
leflened ftimulus of the particles of blood thus cooled in the cu-
taneous and pulmonary vefTels. Hence the admiflion of cold
air, or ablution with fubtepid or with cold water, in fevers with
hot (kin, whether they be attended with arterial ftrength, or ar-
terial debility, renders the pulfe flower ; in the former cafe by
diminifhing the ftimulus of the blood, and in the latter by lef-
fening the expenditure of fenforial power. See Suppl. I. 8.
and 15.

13. Incubus. The night-mare is an imperfect fleep, where
the defire of locomotion is vehement, but the mufcles do not
obey the will ; it is attended with great uneafinefs, a fenfe of
fufFocation, and frequently with fear. It is caufed by violent
fatigue, or drunkenncfs, or indigeftible food, or lying on the
back, or perjiaps from many other kinds of uneafinefs in our
fleep, which may originate either from the body or mind.

Now as the action of refpiration is partly voluntary, this com-
plaint may be owing to the irritability of the fyftem being . too
fmall to carry on the circulation of the blood through the lungs
during fleep, when the voluntary power is fufpended. Whence
the blood may accumulate in them, and a painful oppreflion fu-
pervene ; as in fome haemorrhages of the lungs, which occur
during fleep ; and in patients much debilitated by fevers. See
Somnus interruptus, Clafs I. 2. i. 3. and I. 2. i. 9.

Great fatigue with a full fupper and much wine, I have been
well informed by one patient, always produced this difeafe in
hinnelf to a great degree. Now the general irritability of the
fyftem is much decreafed by fatigue, as it exhaufts the fenforial
power ; and fecondly, too much wine and ftimulating food will
again diminiftv the irritability of fome parts of the fyftem, by
employing a part of the fenforial power, which is already too
fmall, in digeiting a great quantity of aliment ^ and in increafing
the motions of the organs of fenfe in confequeuce of foir<

CLASS III. 2. 1. 14- OF VOLITION. 343

gree of intoxication, whence difficulty of breathing may occur
irom the inirritability of the lungs, as in Clafs I. 2. i. 3.

This explains an apparent paradox, why people who are fee-
ble, digeft their dinners beft, if they lie down and fleep, as moft
animals do, when their ftomachs are full. Yet many weak peo-
ple fleep very uneafily after a large fupper. If the debility of
the patient be not very great, and the dinner he has taken, be
moderate, the fufpenfion of voluntary a£Hon during fleep pre-
vents the expenditure of fo much fenforial power, which may
be' employed on the actions of the ftomach, and thus facilitate
the digeftive procefs. If the patient be further exhaufted as in
the evening, or his debility greater, and fleep enfues after a co-
pious or itimulating fupper, fo much fenforial power will be
i'd on the actions of the ftomach for digeftion, that the
circulation of the blood through the lungs will be impeded from
the diminifhed irritability to external ftimuli, and the abfence
of volition, as in the incubus, and fomrms interruptus.

M. M. To fleep on a hard bed with the head raifed. Mod-
erate fupper. The bark. By fleeping on a harder bed the pa-
tient will turn himfelf more frequently, and not be liable to
fleep too profoundly, or lie too long in one pofture. To be
awakened frequently by an alarm clock.

14. Lethargus. The lethargy is a flighter apoplexy. It is
fuppoied to originate from univerfal preffure on the brain, and
is laid to be produced by comprefling the fpinal marrow, where
there is a deficiency of the bone in the fpina bifida. See Seel.
XVIII. 20. Whereas in the hydrocephalus there is only a par-
tial preffure of the brain ; and probably in nervous fevers with
ituporthe preffure on the brain may affect only the nerves of the
fenfes, which lie within the Ikull, and not thofe nerves of the
medulla oblongata, which principally contribute to move the
heart and arteries ; whence in the lethargic or apoplectic ftu-
por the pulfe is flow as in fleep, whereas in nervous fever the
pulfe is very quick and feeble, and generally fo in hydrocephalus.

In cafes of obftrudted kidneys, whether owing to the tubuli
uriniferi being totally obftru&ed by calculous matter, or by
their paralyfis, a kind of drowfinefs or lethargy comes on about
the eighth or ninth day, and the patient gradually finks. See
Clafs I. i. 3.9.

15. Syncope epileptica, is a temporary apoplexy, the pulfe con-
tinuing in its natural ftate, and the voluntary power fufpended.
This terminates the paroxyfms of epilepfy.

When the animal power is much exhaufted by the preced-
ing convulfions, fo that the motions from fenfation as well as
thole from volition are fufpended ; in a quarter or half an hour

the

H44 DISEASES . CLASS III. a. i. 16.

the fenforial power becomes reftored, and if no pain, or irrita-
tion producing pain, recurs, the fit of epilepfy ceafes ; if
the pain recurs, or the irritation, which ufed to produce it, a new-
fit of convulfion takes place, and is fucceeded again by a fyn-
cope. See Epilepfy, Clafs III. i. i. 7.

1 6. Apoplexia. Apoplexy may be termed an univerfal palfy,
or a permanent fleep. In which, where the pulfe is weak, co-
pious bleeding muft be injurious ; as is well obferved by Dr.
Heberden, Tranf. of the College.

Mr. , about 70 years of age, had an apoplectic feizure.

His pulfe was ftrong and full. One of the temporal arteries
was opened, and about ten ounces of blood fuddenly taken from
it. He feemed to receive no benefit from this operation j but
gradually funk, and lived but a day or two.

If apoplexy arifes from the preffure of blood extravafated on
the brain, one moderate venefecTion may be of fervice to pre-
vent the further effufion of blood j but copious venefeclion muft
be injurious by weakening the patient-, fince the effufed blood
mutt have time, as in common vibices or bruifes, to undergo a
chemico-animal procefs, fo to change its nature as to fit it for
abforption ; which may take two or three weeks, which time a
patient weakened by repeated venefeclion or arteriotomy may
not furvive.

Mrs. , about 40 years old, had an apoplectic feizure af-
ter great exertion from fear ; me had lain about 24 hours with-
out Ipeech, or having fwallowed any liquid. She was then forci-
bly raifed in bed, and a fpoonful of folution of aloes in wine put
into her mouth, and the end of the fpoon withdrawn, that me
might more eafily fwallow the liquid. — This was done every
hour, with broth, and wine and water intervening, till evacua-
tions were procured ; which with other means had good efFecl:,
and me recovered, except that a confiderabie degree of hemiple-
gia remained, and fome imperfection of her fpeech.

Many people, who have taken fo much vinous fpirit as to ac-
' quire the temporary apoplexy of intoxication, and are not im-
properly faid to be dead-drunk, have died after copious venefec-
tion, I fuppole in confequence of it. I once faw at a public
meeting two gentlemen in the drunken apoplexy ', they were to-
tally infenfible with low pulfe, on this account they were directed
not to lofe blood, but to be laid" on a bed with their heads high,
and to be turned every half hour ; as foon as they could f wallow*
warm tea was given them, which evacuated their (tomachs, and
they gradually recovered, as people do from lefs degrees of intox-
ication.

M. M. Cupping on the occiput, Yenefe&ion once in mad*

CLASS III. *. 1. 17. OF VOLITION. 345

erate quantity. "Warm fomentations long continued and fre-
qutfhtly repeated on the fhaved head. Solution of aloes. Clyf-
ters with folution of aloes and oil of amber. A blifter on the
fpine. An emetic. Afterwards the bark, and fmall dofes of
chalybeates. Small eleclric (hocks through the head. Errhines.
If fmall dofes of opium ? mercurial ointment rubbed on the
head or neck ?

Where there is a difficulty of fwallowing in apoplectic or par-
alytic patients, or in thofe near death in fevers, or other difeaf-
es, no fluid fhould be put into their mouths as they lie upon
their backs, left it mould choke them ; but they mould be raifed
and fupported upright in their beds, and ftimulated by ftrong
light, and fpoken to in a louder voice, defiring them to Iwallow,
as the fluid is put into the mouth, and the fpoon mould be im-
mediately withdrawn, that they may clofe their mouths. Hence
if they cannot fwallow, it will flow out of their mouths, and not
endanger fufFocating them. See Hemiplegia, Spec. 10, of this
genus.

1 7. Mors a frigore. Death from cold. The unfortunate
travellers, who almoft every winter perifh in the fnow, are much
exhaufted by their efforts to proceed on their journey, as
well as benumbed by cold. And as much greater exercife
can be borne without fatigue in cold weather than in warm ;
becaufe the exceflive motions of the cutaneous veflels are thus
prevented, and the confequent wafte of fenforial power 5 it may
be inferred, that the fatigued traveller becomes paralytic from
violent exertion as well as by the application of cold.

Great degrees of cold afFecT: the motions of thofe veflels moft,
which have been generally excited into *£lion by irritation ; for
when the feet are much benumbed by cold, and painful, and at
the fame time almoft infenfible to the touch of external objects,
the voluntary mufcles retain their motions, and we continue to
walk on ; the fame happens to the fingers of children in throw-
ing fnow-balls, the voluntary motions of the mufcles continue,
though thofe of the cutaneous veflels are benumbed into inac-
tivity.

Mr. Thompfon, an elderly gentleman of Shrewfbury, was
feized with hemiplegia in the cold bath ; which I fuppofe might
be owing to fome great energy of exertion, as much as to the
coldnefs of the water. As in the inftance given of Mr. Nairn,
who, by the exertion to fave his relation, perifhed himfelf. See
Seel. XXXIV. 1.7.

Whence I conclude, that, though heat is a fluid ncceflary to
mufcular motion, both perhaps by its ftimulus, and by its keep-
ing the minute component parts of the ultimate fibrils of the

VOL. II. W w mufclss

34<> DISEASES CLASS!!!. 2. 1. 17.

inufcles or organs of fenfe at a proper diftance from each other j
yet paralyfis, properly fo called, is the confequence of exhauf-
tion of fenibrial power by exertion. And that the accumula-
tions of it during the torpor of the cutaneous veffels by expofure
to cold, or of fome internal vifcus in the cold fits of agues, are
frequently inftrumental in recovering the ufe of paralytic limbs,
or of the motions of other paralytic parts of the fyltem. See
Spec. 4. of this genus.

Animal bodies refift the power of cold probably by their ex-
ertions in confequence of the pain of cold, fee Botan. Gard. V.
i. additional note xii. But if thefe increafed exertions be too
violent, fo as to exhauft the fenibrial power in producing un-
neceffary motions, the animal will probably fooner perim. Thus
a moderate quantity of wine or fpirit repeated at proper inter-
vals of time might be of fervice to thofe, who are long expofed
to excefiive cold, both by increafing the action of the capillary
veflels, and thus producing heat, and perhaps by increafing in
fbrrie degree the fecretion of fenforial power in the brain. But
the contrary muft happen when taken immoderately, and not
at due intervals. A well-'attefted hiftory was once related to
me of two men, who fet out on foot to 'travel in the fnow, one
of whom drank two or three glaffes of brandy before they began .
their journey, the other contented himfelf with his ufual diet
and potation ; the former of whom perifhed in fpite of any af-
fiftance his companion could afford him ; and the other perform-
ed his journey with iafety. In this cafe the fenforial power was
exhaufted by the unneceffary motions of incipient intoxication
by the ftimulus of the brandy, as well as by the exertions of
walking ; which fo weakened the dram-drinker, that the cold
fooneY deftroyed him ; that is, he had not power to produce fuf-
ficient mufcular or arterial action, and in confequence fufficient
heat, to fupply the great expenditure of it. Hence the capilla-
ries of the Ikin firft ceafed to act, and became pale and empty ;
next thofe which are immediately afibciated with them, as the
extremities of the pulmonary artery, as happens on going into
the cold bath. By the continued inaction or thefe parts of the
vafcular fyftem the blood becomes accumulated in the internal
arteries, and the brain is fuppofed to be affected by its compref-
fion ; becaufe thefe patients are faid to fleep, or to become apo-
plectic, before they die. I overtook a fifherman afleep on his
panniers on a very cold froily night, but on waking him he did
not appear to be in any degree of ftupor. See Clafs I. 2. 2. i.
When travellers are benighted in deep fnow, they might fre-
quently be faved by covering themfelves in it, except a fmall
aperture for air ; in which fituation the lives of hares, (heep,

and

CLASS III. 2. 1. 17. OF VOLITION. 347

and other animals, are fo often preferved. The fnow, both in
refpect to its component parts, and to the air contained in its
pores, is a bad conductor of heat, and will therefore well keep
out the external cold ; and as the water, when part of it dif-
folves, is attracted into the pores of the remainder of it, the fit-
uation of an animal beneath it is perfectly dry •, and, if he is in
contact with the earth, he is in a degree of heat between 48,
the medium heat of the earth, and 32, the freezing point j that
is, in 40 degrees of heat, in which a man thus covered will be
as warm as in bed. See Botan. Garden, V. II. notes on Ane-
mone, Barometz, and Mufcus. If thefe facts were more gen-
erally underftood, it might annually fave the lives of many.

After any part of the vafcular fyftem of the body has been
long expofed to the cold, the fenforial power is fo much accu-
mulated in it, that on coming into a warm room the pain of hot-
acnTS produced* and inflammation, and confequent mortifica-
tion, owing to the great exertion of thofe veffels, when again ex-
pofed to a moderate degree of warmth. See Sect. XII. 5.
Whence *the propriety of applying bfit very low degrees of heat
'to limbs benumbee^flgk^old at firft, as~"of fnow in its fiate of
diflblving, which is atjWUfgrees of heat, or of very cold water.
A French writer has obferved, that if frozen apples be thawed
gradually by covering them with thawing fnow, or immerfing
them in very cold water, they do notlofe their tafte ; if this fact
was well afcertained, it might teach us how to preferve other
ripe fruits in ice-houfes for winter confumption. See Suppl. I.

14- 3-

The pain of- cold is probably owing to the accumulation of the
fenforial power of irritation. As the fkins of thofe, who have
been conftantly ftimulated into great action by external heat,
muft foon poflefs an accumulation of that fenforial power, when
the ftimulus of heat is withdrawn. See tsedium vita? from ac»
cumulation of the fenforial power of volition. III. i. 2. 11.

ORDO

34* DISEASES CLASS III. 2. 2. i,

ORDO II.

Decreased Volition.

GENUS II.

With decreased AElions of the Organs of Senfe.
SPECIES.

i . Recolleflionis jaflura. Lofs of recolle£tion. This is the
defeat of memory in old people, who forget the actions of yef-
terday, being incapable of voluntary recollection, and yet re-
member thoie of their youth, which by frequent repetition are
introduced by afTociation or fuggeftion. This is properly the
paralyfis of the mind ; the organs of fenfe do not obey the vol-
untary power ; that is, our ideas cannot be recollected, or acted
over again by the will.

After an apoplectic attack the patients, on beginning to re-
cover, find thernfelves mod at a lofs in recollecting proper names
of perfons or places ; as thofe words have not been fo frequent-
ly aflbciated with the ideas they ftand for, as the common words

of a language. Mr. , a man of ftrong mind, of a {hort-

necked family, many of whom had fuffered by apoplexy, after
an apoplectic fit, on his recovering the ufe of fpeech, after re-
peated trials to remember the name of a perfon or place, applaud-
ed himfelf, when he fucceeded, with fuch a childifh fmile on the
partial return of his fagacity, as very much affected me. — Not
long, alas ! to return j for another attack in a few weeks de-
ilroyed the whole. See Clafs IV. 2. 3. 8.

I :a\v a child after the fmall-pox, which was left in this fitua-
tk i it was lively, active, and even vigorous j but mewed that
of furprife, which novelty excites, at every object it view-
ed 5 and that as often as it viewed it. I never heard the termin-
ation of the cafe.

2. Stu-titia vo/untaria. Voluntary folly. The abfence of
voluntary power and confequent incapacity to compare the ideas
of prefent and future good. Brute animals may be faid to be
in this fituation, as they are in general excited into action only
by their prefent painful or pleafurable fenfations. Hence though
they are liable to furprife, when their pafling trains of ideas are
diifevered by violent ftimuli •, yet are they not affected with
wonder or allonifhment at the novelty of objects ; as they pof-
fefs but in a very inferior degree, that voluntary power of com-
paring

CLASS III. 2. 2. 3. OF VOLITION. 349

paring the prefent ideas with thofe previoufly acquired, which
diftinguifhes mankind ; and is termed analogical reafoning,
when deliberatively exerted ; and intuitive analogy, when ufed
without our attention to it, and which always preferves our
hourly trains of ideas confiftent with truth and nature. Sec
Sea. XVII. 3. 7.

3. Ratiocinatio verbofa. Verbal reafoning. This arifes from
the feeble or inaccurate exertions of the faculty of volition in the
acl of recalling the ideas of things, and thus miftaking the ideas
of words for them. One great imperfection of language con-
fifts in the ufe of what Mr. Home Tooke calls general terms, as
mentioned in Seel:. XV. i. 5. and Se6l. XVI. 17. of this work,
arid which Mr. Locke fuppofed to exprefs aBftracled or general
ideas, fuch as the word caftle or army, which in common con-
verfation includes any part or property of thofe complex things,
and is thus liable to miflead inaccurate thinkers. Thus it was
faid laft night, " That horfe ftrikes fire as he pafles along the
pavement." And it was added jocularly, " that his feet muft'
be as hard as iron," which miftake might arife from the general
term, horfe, including in common converfadon both every part
of the animal and his accoutrements.

A fecond fource of falfe reafoning may arife from the fame
word having two fignifications totally different from each oth-
er ; which may miflead thofe who reafon from ideas of words
inftead of ideas of things. Thefe are generally efteemed witti-
cifms, and are called puns or quibbles ; as the jocular fyllogifm
on the word fpirit. " Brandy is a fpirit •, the Devil is a fpirit ;
therefore brandy is the devil."

A third fource of falfe reafoning is derived from the two-fold
meaning of fome fentences, or phrafes in all languages ; this is
alfo ufed designedly in jocular compofitions, and constitutes the
wit of fome comedies. An old miller riding on his fack of
flour was accolted by two young Cantabs, who rode on each fide
of him, with 4< Gentlemen of your profeflion have ibmetimes a
doubtful character — pray, miller, do you think yourtelf more
knave or fool ?" the witty miller anfxvered, looking firft at one
of them and then at the other, " I think myfelf at prefent be-
tween both." This double entendre of a fentence was ufed by
the priefts of the ancient oracles to deceive the inquirer into fu-
ture events. As that of

Aio te, ^Eacide, Romanes vincere pofic.

I %, that you, -flSacides, the Romans fhall conquer.

There is a fourth mode of verbofe ratiocination, which cou-
fifts in the conclusion of the fyllogifm tontaining an imaginary,

but

350 DISEASES CLASS III. 2. 2. 4.

but not even a verbal analogy to the preceding propofitions.
Thus a ruftic devotee faid to his prieft, " I have often wonder-
ed, why God Almighty called the firft man Adam ?" " Don't
you know," replied the teacher, " that A is the firft letter of the,
alphabet ?" « Aye, ib it is," anfwered the contented inquirer.

Another kind of falfe reafoning is called by logicians a logic-
al vice ; and another kind arifes from the firft propoiition being
untrue in reipecl to its exigence : buc as all thefe, and perhaps
many other fources of falfe reafonings, may be refolved into the
miftaken ufe of ideas of words, or general terms, inftead of ideas
of the things, or parts of things, which they ought to fuggeft ;
they belong properly to this article of ratiocinatio verbofa :
\vhile the rare faculty of reafoning without words by comparing
ideas of things, as in the invention of new machines, and other
new discoveries, diftinguifties the ph'Jofopher from the fophift,

M. ;M. Children mould be permitted to ufe their hands early
in their infancy, and mould be fupplied with pencils, pens, and
various tools ; by which they will acquire accurate ideas of ex-
ternal things by the organ of touch, at the fame time that they
acquire woids ; and will thence be If -o be feriouily de-

ceived by general terms, or by the double meanings of words,
>f fentences, or laftly by falfe propofitions or ineonclufive de~
; and will thus be enabled to compare the analogies of
things, and to think without words ; the faculty, which confti-
tutes genius, and which fo few poiTefs I

4. Credulitas, Credulity. Life is fhort, opportunities of
knowledge rare j our fenfes are fallacious, our reafonings un-
certain,, man therefore ftruggles with perpetual error from the
cradle to the coffin. He is neceflitated to correct experiment
by analogy, and analogy by experiment ; and not always to reft
fatisfied in the belief of fatts even with this two-fold teftimony,
till future opportunities, or the obiervations of others, concur in
their fupport.

Ignorance and credulity have ever been companions, and have
rnifled and enflaved mankind ; philoiophy has in all ages en-
deavoured to oppofe their progrefs, and to loofen the (hackles
they had impoied ; philofophers have on this account been called
unbelievers : unbelievers of what ? of the fictions of fancy, of
witchcraft, hobgobblins, apparitions, vampires, fairies ; of the
influence of ftars on human actions, miracles wrought by the
bones of faints, the flights of ominous birds, the predictions
from the bowels of dying animals, expounders of dreams, for-
tune-tellers, conjurors, modern prophets, necromancy, cheiro-
mancy, animal magnetifm., metallic tra£tors5 with endlefs varie-

CLASS III. 2. 2. 4. OF VOLITION. 35 1

ty of folly ? Thefe they have difbelieved andidefpifed, but have
ever bowed their hoary heads to Truth and Nature.

Mankind may be divided in refpecl: to tljfc facility of their be--
lief or convidl ion into two claries ; thofe, who are ready to af-
fent to fmgle fads from the evidence of their fenfes, or from the
ferious afiertions of others ; and thole, who require analogy to
corroborate or authenticate them.

Our firft knowledge is acquired by our fenfes *, but thefe are
liable to deceive us, and we learn to detect thefe deceptions by
comparing the ideas prefented to us by one fenfe with thofe prc-
fented by another. Thus when we firft view a cylinder, it ap-
pears to the eye as a flat furface with different (hades on it, till we
correct this idea by the fenfe of touch, and find its furface to be
circular ; that is, having fome parts gradually receding further
from the eye than others. So when a child, or a cat, or a bird,
firft fees its own image in a looking-glafs, it believes that anoth-
er animal exifts before it, and detects this fallacy by going be-
hind the glafs to examine, if another tangible animal really exiiis
there.

Another exuberant fource of error confifts in the falfe notions,
which we receive in our early years from the defign or ignorance
of our inftructors, which affect all our future reafoning by their
perpetual intrufions ; as thofe habits of mufcular actions of the
face or limbs, which are called tricks, when contracted in infan-
cy continue to the end of our lives.

A third great fource of error is the vivacity of our ideas o£
imagination, which perpetually intrude themfelves by various
aflbciations, and compofe the farrago of our dreams ; in which,
by the fufpenfion of volition, we are precluded from comparing
the ideas of one fenfe with thofe of another, or the incongruity
of their fucceflions with the ufuaicourfe of nature, and thus to
detect their fallacy. Which we do in our waking hours by a
perpetual voluntary exertion, a procefs of the mind above men-
tioned, which we have termed intuitive analogy. Seel. XVII.

3- 7-.

This analogy prefuppofes an acquired knowledge of things,
hence children and ignorant people are the moil crodulous,as not
poflefling much knowledge of the ufual courfe of nature ; and
fecondly, thofe are mod credulous, whofc faculty of comparing
ideas, or the voluntary exertion of it, is flow or imperfect. Thus
if the power of the magnetic needle of turning towards the north,
or the {hock given by touching both fides of an electrized coat-
ed jar, was related for the firft time to a phibfopher, and to an
ignorant perfon ; the former would be lefs ready to believe them,
than the htter ; as he would find nothing fimilar in nature to

CO."-

3$a DISEASES CLASS III. 2. 2. 4.

compare them to, he would again and again repeat the experi-
ment, before he would give it his entire credence ; till by thefe
repetitions it would ceafe to be a fingle fact, and would there-
fore gain the evidence of analogy. But the latter, as having lefs
knowledge of nature, and lefs facility of voluntary exertion,
would more readily believe the afiertions of others, or a fingle
fact, as prefented to his own obfervation. Of this kind are the
bulk of mankind ; they continue throughout their lives in a ftate
of childhood, and have thus been the dupes of priefts and poli-
ticians in all countries and in all ages of the world.

In regard to religious matters, there is an intellectual coward-
ice inftilled into the minds of the people from their infancy ;
which prevents their inquiry : credulity is made an indifpenfable
virtue •, to inquire or exert their reafon in religious matters is de-
nounced as finful ; and in the catholic church is puniflied with
more fevere penances than moral crimes. But in rcfpecl; to
our belief of the fuppofed medical facts, which are publiihed by
Variety of authors ; many of whom are ignorant, and therefore
credulous ; the golden rule of David Hume may be applied
with great advantage. « When two miraculous affertions op-
pofe each other, believe the lefs miraculous." Thus if a perfon
is faid to have received the fmall-pox a fecond time, and to have
gone through all the ftages of it, one may thus reafon : twenty
thoufand people have been expofed to the variolous contagion
a fecond time without receiving the variolous fever, to every
one who has been faid to have thus received it ; it appears
therefore lefs miraculous, that the afiertor of this fuppofed fa£fc
has been deceived, or wifties to deceive, than that it has fo hap-
pened contrary to the long experienced order of nature.

M. M. The method of cure is to iricreafe our knowledge of
the laws of nature, and our habit of comparing whatever ideas
are prefented to us with thofe known laws, and thus to coun-
teract the fallacies of our fenfes, to emancipate ourfelves from
the falfe impreflions, which we have imbibed in our infancy, and
to fet the faculty of reafon above that of imagination.

CLASS IV. OF ASSOCIATION, 353

The Orders and Gener* of the Fourth Clafs of Difeafes*
CLASS IV.

blSEASES OF ASSOCIATION.

ORDO I.

Increased Affodate Motions.
GENERA.

1. Catenated with irritative motions*

2. Catenated with fenfitive motionSo

3. Catenated with voluntary motions.

4. Catenated with external influences.

ORDO II.

Decreafed Affbciate Motienf*
GENERA.

1. Catenated with irritative motions*

2. Catenated with fenfitive motions.

3. Catenated with voluntary motions.

4. Catenated with external influence*.

ORDO III.

Retrograde Affbciate Motions.
GENERA.

1. Catenated with irritative motions.

2. Catenated with fenfitive motions.

3- Catenated with voluntary motions;

4- Catenated with external influences.

. H.

354 DISEASES CLASS IV. i. i.

The Orders, Genera, and Species, of the Fourth Clafs of

Difeafes.

CLASS IV.

DISEASES OF ASSOCIATION.

ORDO I.

Increased Affociate Motions.

GENUS I.

Catenated •with Irritative Motions.
SPECIES.

r. Rubor whits pranforum. Flufhing of the face after din-
ner.

2. Stidorjlragulis immerforum. Sweat from covering the face

in bed.

3. Ccffatio xgritudinis cute ex- Cure of ficknefs by ftimulating

citata. the fkin.

4. Digeftio auRa f rigor e cuta- Digeftion increafed by cold-

neo. nefs of the fkin.

5. Catarrhus afrigore cutaneo. Catarrh from cold fkin.

6. Abforpt'io cellularis aucta Cellular abforption increafed

vomttu. by vomiting.

7. Singultus nephriticus. Nephritic hiccough.

8. Febris irritativa. Irritative fever.

GENUS II.
Catenated •with Senfitive Motions.

SPECIES,
i. Lacrymarum fluxus fynpa- Sympathetic tears.

theticus.
1. Sternutatio a famine. Sneezing from light.

3. Dolor dentium a Jlridore. Tooth-edge from grating

founds.

4. Rifus fardonicus. Sardonic fmile.

5. Saliva fluxits cibo i)lfo. Flux of faliva at fight of food.

6. Tenfio niammularum i)ifo Tenfioh of the nipples of lac-

puerulo. tefcent women at fight of

the child.

7. Tenfio penis in hydrophobia. Tenfion of the penis in hydro-

phobia.

8. Tenefmus

CLASS IV. i. 3. OF ASSOCIATION.

355

8. Tenefmus calculofus.

9. Polypus narium ex afcaride.

I o. Grampus fur arum in diar-
rhoea.

1 1 . Zona ignea nephritiea.

12. Eruptio variolarum.

13. Gutta rofea Jlomatica.

14. — bepatica,

15. Podagra.

1 6. Rheumatifimts.

17. Eryfipe/as.

1 8 . Teftium tumor in gonorrhoea.

19. ' in parotitide.

Tenefmus from ftone.
Polypus of the nofe from af-

carides.
Cramp from diarrhoea.

Nephritic fhingles.

Eruption of fmall-pox.

Stomatic rofy drop.

Hepatic rofy drop.

Gout.

Rheumatifm.

Eryfipelas.

Swelled teftis in gonorrhoea.

. in mumps.

GENUS III.

Catenated with Voluntary Motions
SPECIES.

Deglutitio invita.
Niflitatio invita.
Rifus invitus.
Lufus digitorum invitus.

Involuntary deglutition.

nictitation.

laughter.

actions with

ths

5. Unguium morjiunculq invita.

6. Vigilia invita.

ringers.

biting the nails,
watchfulnefs.

GENUS IV.

Catenated with External Influences,
SPECIES.

Life of an egg.

Life of winter-fleepers.

Budding of trees.

Periods of venereal defire.

Electric fhock through the arm.

Oxygenation of the blood.

Humeclation of the body.

1. Vita ovi.

2. Vita biemi-dormientium*

3. Pullulatio arborum.

4. Qrgafmatis venerei periodus.

5. Brachii concujjio eleftrica.

6. Oxygenatio fanguinis.

7. Humeftatio corporis.

ORDO II.

Decreafed Ajjbciate Motions.

GENUS I.
Catenated with Irritative Motions.

SPECIES,
i. Cutis frigida pranforuirt. Chillnefs after dinner.

2. Pallor

DISEASES

CLASS IV. 2. i.

8.
9.

TO.
I j .

1 2.

1 6.
1 7.

Pallor urina pranjbrum. Pale urine after dinner.
afrigore cutaneo. from cold fkin.

Pallor ex agritudine.
Dyfpn<zaabalneofrigido.

Palenefs from ficknefs.
Shortnefs of breath from cold

bathing.

Indigeftion from cold feet.
Cough from cold feet.
Liver-cough.
Gout-cough.
Vertigo rotatory.
•. ' ' ' vifual.

• inebriate.

• feverifli.

• • from the brain.

Dyfpepjia a pedibus^
Tujfis a pedibus frigidis*
— hepatica.

arthritica.

Vertigo rotatoria,.

— vifua/if.

•.* ehriofa.

-. .. i. .. febriculofa*

cerebrofa.
Murmur auriutn vertigin- Noife in the ears.

ofum.
Tatlusy gujfas, olfaclns ver- Vertiginous touch, tafte, fmelj*

tiginoji.
Pulfus mollis a vomitione. Soft pulfe in vomitting.

irtermittens a ven- Intermittent pulfe from the

triculo. ftomach.

Ffbris inirritativa. Inirritative fever.

G£NUS II.

Catenated with Sefifitive Motions.
SPECIES.

^ . Torpor gena a dolors dentis. Coldnefs of the cheek from

tooth-ach.
2. Stranguria a ddore veftca. Strangury from pain of the

bladder.
convulfiva. Convulfive ftrangury.

3- —

4. Dolor termini duftus chole-

dochi.

5 . Dolor pbaryngis abacido gaf-

trico.

6. Pruritus narium a vermibus.
j. Cephaltea.

8. Hemicrania et otalgia.

9. Dolor humeri in hepatidide*
\ O. Torpor pfdutn variola erum-

pentf.

II. Teflium dolor nepkriticus.
3 2. Dolor digiti minimi fympa-

theticus*

Pain of the end of the bile-

Pain of the throat from gaftric

acid.

Itching of thenofe from worms.
Head-ach.

Partial head-ach, and ear-ach.
Pain of moulder in hepatitis.
Cold feet in eruption of fmall-

pox.

Nephritic pain of teftis.
Pain of little finger from fym-

pathy.

13. Dolor

CLASS IV. 2. 3. OF ASSOCIATION. 3*7

13. Dolor brachii in hydrope pec- Pain of the arm in drop fy of

tons. the cheil.

14. Diarrhoea a dentitions. Diarrhoea from toothing.

GENUS III.

Catenated 'with Voluntary Motions.
SPECIES.

1. Titubatio lingua. Impediment of fpcech.

2. Chorea fan fti Viti* St. Vitus' dauce.

3. Rifus. Laughter.

4. Tremore ex ira. Trembling from anger.

5. Ruhr ex ird. Rednefs from anger.

6. criminati. Blufli of guilt.

7. Tarditas paralytics. Slownefs from palfy.

8. femlis. of age.

GENUS IV.

Catenated with External Influences.
SPECIES.

1. Somni periodus. Periods of fleep.

2. Studii inanis periodus. of reverie.

3. Hemicrania periodus. _— . of head-ach.

4. Epilepfue dolorificx periodus. of painful epilepfy.

5. Convulfionis dolor ificx peri- of painful convulfion.

odus.

6. Tujfis periodic* pe riodus. of periodic cough.

7. Catamenix periodus. of catamenia.

8. Ha morrhoidis periodus. — of the piles.

9. Podagra periodus. • of the gout.

10. Eryfipilatis periodus. of eryfipelas*

1 1 . Febrium periodus* of fevers.

ORDO III. .

Retrograde Affociate Motions.

GENUS I.

Catenated ivith Irritative AlotionS.
SPECIES.

1. Diabetes irritata. Diabetes from irritation.

2. Sudor frigidus in aflhmate. Cold fweat in afthma.

3. Diabetes a timore. Diabetes from fear.

4. Diarrhoea $ timore. Diarrhoea from fear.

Pallor

35$ DISEASES CLASS IV. 3. *.

5. Pallor et tremor a timore. Palenefs and trembling from

fear.

6. Palpltatlo cordls a timore. Palpitation of the heart from

fear.

7. Abortio a timore. Abortion from fear.
£. Hyfteria a timore. Hyfterics from fear.

GENUS II.

Catenated with Senfitlve Motions.
SPECIES.

1. Nattfea Idealls. Naufea from ideas.

2. a conceptu. Naufea from conception.

3. Vomitio vertiginofa. Vomiting from vertigo.

4. a calculo in ureter e. — — from {tone in the u-

reter.

ab infultu paralyt- from ftroke of palfy.

ico.

a titillatione fau- from tickling the

clum. throat.

•7. . cute fympathetlca. • from fympathy with

the fkin.

GENUS III.

Catenated with Voluntary Motions.
SPECIES.

1. Rummatlo. Rumination.

2. Vomitio voluntaria. Voluntary vomiting.

3. Erufiatio voluntaria. eructation.

GENUS IV.

Catenated -with External Influences.
SPECIES.

1 . Catarrhus periodicus. Periodical catarrh.

2. TuJ/is periodica. Periodic cough.

3. Hyfteria a f rigor e. Hyfterics from cold.

4. Nattfea pluvialis. Sicknefs againft rain.

CLASS

CLASS IV. i. r; OF ASSOCIATION. 359

CLASS IV.

DISEASES OF ASSOCIATION.

ORDO I.

Increafed Ajficiate Motions.

GENUS I.
Catenated with Irritative Motions.

THE importance of the fubfequent clafs not only confifts in
its elucidating all the fympathetic difeafes, but in its opening a
road to the knowledge of fever. The difficulty and novelty of the
fubject mult plead in excufe for the prefent imperfect: ftate of
it. The reader is entreated previoufly to attend to the follow-
ing circumftances for the greater facility of inveftigating their
intricate connections ; which I (hall enumerate under the fol-
lowing heads.

A. Affociate motions diftinguifhed from catenations.

B. Aflbciate motions of three kinds.

C. Aflbciations affected by external influences.

D. Aflbciations affected by other fenforial motions.

E. Aflbciations catenated with fenfation.

F. Direct and reverfe fympathy.

G. Aflbciations affected four ways.
H. Origin of aflbciations.

I. Of the action of vomiting.
K. Tertian aflbciations.

A. Affociate Motions diftingitijhed from Catenations.

Aflbciate motions properly mean only thofe, which are caufed
by the fenforial power of aflbciation. Whence it appears, that
thofe fibrous motions, which conftitute the introductory link of
an aflbciate train of motions, are excluded from this definition,
as not being themfelves caufed by the fenforial power of aflbcia-
tion, but by irritation, or fenfation, or volition. I fhall give for ex-
ample theflulhing of the face after dinner ; the capillary vefltls of
the face increafe their actions in confequence of their catenation,
not their aflbciation, with thofe of the ftomach ; which latter are
caufed to act with greater energy by the irritation excited by
the (timulus ofxfood. Thefe capillaries of the face are aflbcia-

ted

360 DISEASES CLASS IV. i. x,

ted with each other reciprocally, as being all of then! excited
by the fenJforial power of aflbciation ; but they are only catenated
•with thofe of the ftomach, which are not in this cafe aflbciate
motions but irritative ones. The common ufe of the word af-
fociation for almoft every kind of connection has rendered this
fubject difficult * from which inaccuracy I fear fome parts of this
work are not exempt.

B. jAffociate Motions cf 'three Kinds.

Thofe trains or tribes of aflbciate motions, the introductory
links of which confifts of an irritative motion, are termed irrita*
live aflbciations ; as when the mufcles of the eyelids clofe the
eye in common nictitation. Thofe, whofe introductory link
confiftsof afenfitive motion, are termed fenfitive aflbciations ; as
when the pectoral and intercoflal mufcles act in fneezing.
And laftly, thofe whofe introductory link confifts of a voluntary
motion, are termed voluntary aflbciations ; as when the mufclea
of the lower limbs act in concert with thofe of the arm in fencing.

C. AJJociations affected by external Influences.

Circles of aflbciate"1 motions, as well as trains and tribes of
them, are liable to be affected by external influences, which con-
(ift of ethereal fluids, and which, by penetrating the fyftem, act
upon it perhaps rather as a caufa fine qua nonof its movements,
than directly as a ftimulus ; except when they are accumulated
in unufual quantity. We have a fenfe adapted to the perception
of the excefs or defect of one of thefe fluids ; I mean that of
elementary heat ; in which all things are immerfed. See Clafs
IV. i 4. i. But there are others of them, which as we have
no power to evade their influence, fo we have no fenfe to per-
ceive it j thefe are the folar, and lunar, and terreftrial gravitation,
in which alfo all things are immerfed •, the electric aura, which
pervades us, and is perpetually varying. See Clafs IV. i. 4.
5 ; the magnetic fluid, Clafs IV. i. 4. 6 ; and laftly, the great
life-preferver oxygen gas, and the aqueous vapour of the atmof-
phere, fee Clafs IV. i. 4. 6. and 7. and 2.

Of thefe external influences thofe of heat, and of gravity,
have diurnal periods of increafe and decreafe 5 befides their
greater periods of monthly or annual variation. Tke manner
in which they act by periodical increments on the fyftem, till
fome effect is produced, is fpoken of in Sect. XXXII. 3. and 6,

AJJociationt

CLASS IV. 1. 1. OF ASSOCIATION. Z6t

D. AJJbctations affefted by other Senforial Motions,

Circles and trains of affociate motions are alfo liable to be af-
fected by their catenations with other fenforial powers, as of ir-
ritation, or fenfation,or volition •, which other fenforial powers ei-
ther thus fimply form fome of the links of the catenation, or add
to the energy of the aflbciated motions. Thus when vomiting
is caufed by the ftimulus of a ftone in the ureter, the fenfation of
pain feems to be a link of the catenation rather than an efficient
caufe of the vomiting. But when the capillary veffels of the
fldn increafe their action from the influence of external heat,
they are excited both by the ftimulus of unufual heat, as well
as by the ftimulus of the blood, and by their accuftomed affoci-
ation with the actions of the heart and arteries. And laftly, in
the blufh of anger the fenforial power of volition is added to
that of affociation, and irritation, to excite the capillaries of the
face with increafed action. See Clafs IV. 2. 3. 5.

E. djjociations catenated 'with Senfation*

Pain frequently accompanies affociate trains or circles of mo-
tion without its being a caufe, or a link, of them, but fimply an
attendant fymptom •, though it frequently gives name to the
difeafe, as head-ach. Thus in the cramp of the calves of the
legs in diarrhoea, the increafed fenforial power of aflbciation is
the proximate caufe ; the preceding increafed action of the bow-
els is the remote caufe ; and the proximate effect is the violent
contractions of the mufculi gaftrocnemii ; but the pain of
thefe mufcles is only an attendant fymptom, or a remote effect.
See Sect. XVIII. 15. Other fenfitive aflbciat ions are mention-
ed in Clafs IV. I. 2. and IV. i. 2. 15.

Thus, if the flufhing of the face above mentioned after dinner
be called a difeafe, the immediate or proximate caufe is the in-
creafed power of aflbciation, the remote caufe is the increaf-
ed irritative motions of the ftomach in confequence of the ftim-
ulus of food and wine. The difeafe or proximate effect confifts
in the increafed actions of the cutaneous veffels of the face ; and
the fenfation of heat, the exiftence of heat, and the red colour,
are attendants or fymptoms, or remote effects, of the increafed
actions of thefe cutaneous veffels.

F. Direfl andreverfe Sympathy*

The increafed actions of the primary part of the trains of af-

fociated motions are fomctimes fucceeded by increafed actions

VOL. IL Y Y of

3<$2 DISEASES CLASS IV. i. i,

of the fecondary part of the train ; and fometimes by decreafed
aliens of it. So likewife the decreafed actions of the primary
part of a train of aflbciate motions are fometimes fucceeded by
decreafed actions of "the fecondary part, and fometimes by
increafed actions of it. The former of thefe fituations is called
direct fympathy, and the latter reverfe fympathy. In general I
believe, where the primary part of the train of aflbciated motions
is exerted more than natural, it produces direct fympathy in
flrong people, and reverfe fympathy in weak ones, as a full meal
makes fome people hot, and others chill. And where the pri-
mary part of the train is exerted lefs than natural, it produces
direct fympathy in weak people, and reverfe fympathy in ftrong
ones, as on being expofed for a certain length of time on horfe-
back in a cold day gives indigeftion and confequent heart-burn
to weak people, and ftrengthens the digeftion, and induces con-
fequent hunger in ftrong ones. See Sect. XXXV. i.

This may perhaps be more eafily underftood, by confidering
ftrength and weaknefs, when applied to animal bodies, as con-
fifting in the quantity of fenforial power refiding in the con-
tracting fibres, and the quantity of flimulus applied, as fhewn
in Sect. XII. 2. i. Now when defective flimulus, within certain
limits, is partially applied to parts fubject to perpetual motion,
the expenditure of fenforial power is for a while leflened, but
not its general production in the brain, nor its derivation into
the weakly ftimulated part. Hence in ftrong people, or fuch
whofe fibres abound with fenforial power, if the firft tribe of an
aflbciate train of motions be deprived in part of its accuftomed
flimulus, its action becomes diminifhed ; and the fenforial pow-
er becomes accumulated, and by its fuperabundance, or over-
flowing as it were, increafes the action of the fecond tribe of
the aflbciate actions by reverfe fympathy. As expofing the
warm ikin for a moderate time to cold air increafes the action
of the ftomach, and thus ftrengthens the power of digeftion.

On the reverfe, when additional ftimulus within certain lim-
its is partially applied to parts, which are deficient in refpect to
the natural quantity of fenforial power, the expenditure of fen-
forial power is increafed, but in a lefs degree than the increafed
production of it in the brain, or its increafed derivation into the
flrongly-ftimulated organ. Hence in weak people, or fuch
whole fibres are deficient of fenforial power, if the firft tribe of
an aflbciate train of motions be fubjected for a while to greater
ftimulus than ufual, a greater production of fenforial power, or
a greater derivation of it into 'the ftimulated parts occurs ; which
by its excefs, or overflowing as it were, increafes the actions of
the feccmd tribe of the aflbciate motions by direct fympathy.

Thus

CLASS IV. 1. 1. OF ASSOCIATION. 363

Thus when vomiting occurs with cold extremities, a blifter on
the back in a few hours occafions univerfal warmth of the fkin,
and flops the vomiting. And when a diarrhoea occurs with pale
fkin and cold extremities, the pricking of the points of a flannel
(hirt, worn next the fkin, occafions univerfal warmth of it, and
checks or cures the diarrhoea.

In fome aflbchte trains of action neverthelefs reverfe fympa-
thies more frequently occur than direct ones, and in others di-
rect ones more frequently than reverfe ones. Thus in continu-
ed fever with debility there appears to be a reverfe fympathy be-
tween the capillary veflels of the ftomach and thofe of the fkin ;
becaufe there exifts a total averfion to folid food, and conftant
heat on the furface of the body. Yet thefe two fyftems of vef-
fels are at other times actuated by direct fympathy, as when
palenefs attends ficknefs, or cold feet induces indigeilion. This
fubject requires to be further inveftigated, as it probably depends
not only on the prefent or previous plus or minus of the fenfo-
rial power of afibciation, but alfo on the introduction of other
kinds of fenforial power, as in Clafs IV. I. I. D ; or the in-
creafed production of it in the brain, or the greater mobility of
one part of a train of actions than another.

Thus when much food or wine is taken into the ftomach, if
there be no fuperfluity of fenforial power in the fyftem, that is,
none to be fpared from the continual actions of it, a palenefs and
chillnefs fucceed for a time ; becaufe now the expenditure of
it by the increafed actions of the ftomach is greater than the
prefent production of it. In a little time however the ilimulus
of the food and wine increafes the production of fenforial pow-
er in the brain, and this produces a fuperfluity of it in the fyf-
tem *, in confequence of which the fkin now becomes warm
and florid, which was at firft cold and pale •, and thus the reverfe
fympathy is fhortly converted into a direct one ; which is prob-
ably owing to the introduction of a fecond fenforial power, that
of pleafurable fenfation.

On the contrary, when an emetic drug produces ficknefs, the
(kin is at firft pale for a time by direct fympathy with the capil-
laries of the ftomach ; but in a few minutes, by the accumula-
tion of fenforial power in the ftomach during its lefs active ftate
in ficknefs, the capillaries of the ikin, which are aflbciated with
thofe of the ftomach, act with greater energy by reverfe fympa-
thy, and a florid colour returns. Where the quantity of action
is diminifhed in the firft part of a train of motions, whether by
previous diminution of fenforial power, or prefent diminution
of 'ftimulus, the fecond part of the train becomes torpid by di-
rect fympathy. And when the quantity of action of the firft

part

36*4 DISEASES CLASS IV. i. i.

part becomes increafed by the accumulation of fenforial power
during its previous torpor, or by increafe of ftimulus, the actions
of the fecond part of it likewife become increafed by direct fym-
pathy.

In moderate hunger the f]dn is pale, as before dinner, and in
moderate ficknefs, as no great accumulation of fenforial power
has commenced ; but in violent hunger, and in greater torpor of
the ftomach, as from contagious matter, the accumulation of
fenforial power becomes fo great as to affect the arterial and
capillary fyftem, and fever is produced in both cafes.

In contagious fevers with arterial debility commencing with
torpor of the ftomach, why is the action of the heart weakened,
and that of the capillaries increafed ? Is it becaufe the mobility
of the heart is lefs than that of the ftomach, and the mobility of
the capillaries greater ? Or is it becaufe the aflbciation between
the mufcular fibres of the ftomach and thofe of the heart have
been uniformly afibciated by direct fympathy ; and the capilla-
ries of the ftomach and thofe of the fkin have been more fre-
quently aflbciated by reverfe fympathy ?

Where the actions of the ftomach have been previoufly ex-
haufted by long ftimulus, as on the day after intoxication, little
or no accumulation of fenforial power occurs, during the tor-
por of the organ, beyond what is required to replace the defi-
ciency of it, and hence fever feldom follows intoxication. And
a repetition of the ftimulus fometimes becomes neceflary even to
induce its natural action, as in dram-drinkers.

Where there has been no previous exhauftion of fenforial
power, and the primary link of aflbciate motions is violently
actuated' by the fenforial power of fenfation, the fecondary link
is alfo violently actuated by direct fympathy ; as in inflammato-
ry fevers. Where however the fenforial power of the fyftem is
lefs than natural, the fecondary link of afTociated motions be-
comes torpid by reverfe fympathy, as in the inoculated fmall-pox
during the eruption on the face the feet are frequently cold.

G. AJfociatwns offered four Ways.

Hence aflbciated trains or circles of motions may be affected
four different ways. i. By the greater or lefs energy of action
of the firft link with which they are catenated, and from which
they take their names; as irritative, fenfitive, or voluntary aflb-
ciations. 2. By being excited by two or more fenforial powers
at the fame time, as by irritation and aflbciation, as in the in-
flance of the application of the ftimulus of increafed external
heat to the cutaneous capillaries. 3. By catenation with other

fenforial

CLASS IV. i.i. OF ASSOCIATION. 365

ienforial powers, as with pain or pleafure, which are in this cafe
not the proximate caufe of motion, but which, by becoming a
link of catenation, excite the fenforial power of aflbciation into
action j as the pain at the neck of the gall-bladder occafioned
by a gall-ftone is transferred to the other end of that canal, and
becomes a link of catenation between the aft ion of the two ex-
tremities of it. 4. The influence of ethereal fluids, as of heat
and gravitation. To which laft perhaps might be added moif-
ture and oxygen gas as conftituting neceflary parts of the fyf-
tem, rather than ftimuli to excite it into action,

H. The Origin of AJJbciations.

Some trains or circles of aflbciate motions muft have been
formed before our nativity, as thofe of she heart, arteries, and
capillaries ; others have been aflbciated, as occafion required
them, as the mufcles of the diaphragm and abdomen in vomit-
ing ; and others by perpetual habit, as thofe of the ftomach with
the heart and arteries directly, as in weak pulfe during ficknefs \
with the capillaries directly, as in the flufhed Ikin after dinner ;
and laftly, with the cellular abforbents reverfely, as in the in-
creafed abforption in anafarca during ficknefs ; and with the ir-
ritative motions of the organs of fenfe reverfely, as in vertigo,
or fea-ficknefs. Some of thefe aflbciations fnall be here ihortly
defcribed to facilitate the inveftigation of others.

Firft, other congeries of glands occupy but a particular part
of the fyftem, or conftitute a particular organ, as the liver, or
kidneys ; but thofe glands, which fecrete the mucus, and per-
fpirable matter, which are called capillaries, are of very great
extent ; they receive the blood from the arteries, feparate from
it the mucus, which lines every cell, and covers every cavity of
the body ; and the perfpirable matter, which foftens and lubri-
cates the whole furface of the fldn, and the more extenfive fur-
face of the air-veflels, which compofe the lungs. Thefe are
fupplied with blood by the perpetual action of the heart and ar-
teries, and have therefore their motions aflbciated with the form-
er, and with each other, by fympathy, which is fometimes di-
rect, and fometimes reverfe.

One branch of this aflbciation, the capillaries of the fkin, is
very irritable by the increafed quantities of cold and heat ; anoth-
er branch, that of the lungs, has not the perception of cold
and heat, but is liable by direct fympathy to act in concert with
the former, as in going into the cold bath. And it is probable
the capillaries of the internal membranes are likewife directly

affected

366 DISEASES CLASS IV. 1. 1.

affected by their fympathy with thofe of the flcin, as appears from
the defect of fecretion in ulcers during the cold fits of agues.

The motions of this extenfive fyftem of capillaries, thus aflb-
ciated by direct Tympathy, are alfo alTociated with thofe of the
heart and arteries, fometimes by reverfe and fometimes by di-
rect fympaihy •, and thus constitute fimple fever. The cold
paroxyfm of which confifts in their torpor, and the hot one in
their orgafm, or increafed activity.

I. Of the Aftim of Vomiting.

The manner, in which the ftomach and the diaphragm and
abdominal mufcles acquire their aflbciate action in vomiting,
requires fome attention. It is not probable, that this action of
vomiting occurs before nativity ; as the uniform application of
the nutritive liquor amnii to the mouth of the foetus, and the
uniform expenditure of its nourifhment, would not feem to give
occafion to too great temporary repletion of the ftomach ; and
would preclude the deglutition of any improper material. After
nativity the ftomach of the child may be occafionally too much
diftended with milk ; as previous hunger may induce it to over-
gorge itfelf j and by repeated efforts the act of vomiting is learn-
ed, as a means of getting free from a difagreeable fenfation.
Thus when any difguftful material, as a bitter drug, is taken
into the mouth ; certain retrograde motions of the tongue and
lips are produced, for the purpofe of putting the difagreeable
material out of the mouth again.

When the ftomach is difagreeably ftimulated by the diftention
or acrimony of the aliment, a fimilar effort to regurgitate it muft
occur ; and by repeated trials the action of the diaphragm and
abdominal mufcles by fqueezing the ftomach aflifts its retro-
grade exertion to difgorge its contents. In the fame manner
when a piece of gravel is pufhed into the urethra, or a piece of
indurated bile into the neck of the gall-bladder, after they have
been in vain prelFed forward by the ufual motions of thofe
ducts, they return into the bladders of gall and urine by the re-
trograde motions of them.

That this is one mode, in which vomiting is induced, appears
from the inflantaneous rejection from the ftomach occafioned
by fome naufeous drug, or from fome naufeous idea ; and laft-
ly, from the voluntary power, which fome people have been faid
to have acquired, of emptying their ftomachs, much in the fame
manner as ruminating animals bring up the grafs from their
firft ftomach.

There are neverthelefs many modes by which thefe inverted

motions

CLASS IV. i.i. OF ASSOCIATION. 367

motions of the ftomach and cefophagus are induced, and which
it is of confequence to diftinguifh from each other. The firft
is the mode above defcribed, where an effort is made to diflodge
ibmething, which ftimulates the ftomach into cfitagreeable ien-
fation ; and which is returned by repeated exertions ; as when
a naufeous drug is taken into the mouth, or a bit of fand falls
into the eye, or a drop of water into the wind-pipe. In this the
periftaltic motions of the ftomach are firft flopped, and then re-
verted by painful fenfation ; and the abdominal mufcles and di-
aphragm by repeated efforts become affociated with them. Now
as lefs fenforial power is expended on the retrograde actions of
the ftomach, and of the lymphatics, which open their mouths
on its furface, than by their natural motions, an accumulation
of fenforial power in the fibres of the ftomach follows the ex-
hibition of an emetic, and on that account an emetic will fome-
times flop a fpontaneous vomiting which was owing to fenfori-
al deficiency. See Sett. XXXV. 1.3. and Art. V. 2. i.

As bitters and metallic falts, exhibited in fmall dofes, ftimu-
late the ftomach into greater action, as appears by their increaf-
ing the power of digeftion, and yet become emetic, when given
in larger dofes ; one might fufpect, that they became emetic
by inducing debility, and confequent retrograde actions of the
ftomach, by their previoufly exhauiling the fenforial power by
their great ftimulus ; which might be effected in a moment
without producing pain, and in confequence without our per-
ceiving it. But on the contrary, there does not.in general ap-
pear on the exhibition of emetics to be any previous exhauftion
of fenforial power ; becaufe there is evidently an accumulation
of it during the ficknefs, as appears from the digeftion being
ftronger afterwards ; and from the increafed action of the cel-
lular and cutaneous abforbents during its operation. See Art.
V. 2. i.

Another mode by which vomiting is induced, is owing to de-
bility or deficiency of fenforial power, from the previous ex-
hauftion of it ; as on the day after intoxication, or which occurs
in people enfeebled with the gout, and in dropfy, and in fome
fevers with debility. In thefe, when the vomiting ceafes, there
is no appearance of accumulation of fenforial power, as the di-
geftion ftill remains weak and imperfect.

Another mode by which ficknefs or vomiting is induced, is
by defect of ftimulus, as in great hunger ; and in thofe, who
have been habituated to fpice and fpirit with their mer.ls, who
are liable to be fick after taking food without thefe additional
ftimuli. Other means of inducing ficknefs by vertigo, or by
nauieous ideas, will be mentioned below.

We

3<58 DISEASES CLASS IV. i; t.

We fhall only add, that the motions of the mufcular fibres of
the ftomach are aflbciated with thofe of the heart and arteries
by direct fympathy, as appears by the weaknefs of the pulfe
during the exhibition of an emetic ; and that the abforbents of
the ftomach are aflbciated with the cellular and cutaneous abfor-
bents by reverfe fympathy, as is fhewn by the great abforption
of the mucus of the cells in anafarca during ficknefs •, at the
fame time that the abforbents of the ftomach invert their actions,
and pour the mucus and water thus abibrbed into that vifcus.

In cold paroxyfms of fever the ftomach partakes of the gen-
eral torpor, and vomiting is induced by its debility, either by
its aflbciation with the torpid capillaries, or other torpid parts, or
by its own torpor commencing firft, and caufing the cold fit.
The difordered motions of the ftomach frequently feem to be the
caufe or primary feat of fever, as where contagious miafrna are
fwallowed with the faliva,and where fever is produced by fea-fick-
nefs, which I once faw. Neverthelefs a diforder of the ftomach
does not always induce fever, as in that cafe it fhould conftantly
attend indigeftion,and vertigo, and fea-ficknefs ; but is itfelf fre-
quently induced by aflbciation with the difordered movements of
other parts of the fyftem, as when it arifes from gravel in the
ureter, or from a percuffion on the head.

The connexion of the motions of the ftomach with irritative
ideas, or motions of the organs of fenfe, in vertigo, is (hewn in
Seel:. XX. and thus it appears, that many circles of aflbciation
are either directly or reverfely aflbciated, or catenated, with this
s ; which will much contribute to unfold fome of the fymp-
toii-G of fever.

K. Tertian Ajficiations .

The third link of aflbciate trains of motion is fometimes actu-
ated by reverfe fympathy, with the fecond link, and- that by re-
verfe fympathy with the firft link ; fo that the firft and third link
may aft by direct fympathy, and the intermediate one by re-
verfe fympathy. Of this, inftances are given in the fingultus
nephriticus, Ciafs IV. i. i. 7. and IV. 2. r. At other times
the tertian or quartan links of aflbciate motions are actuated by
direct fympathy j and that fometimes forwards and fometimes
backwards in refpect to the ufual order of thofe trains of aflbci-
ate motions, as in Clafs IV. i. 2. i.

SPECIES,

i , Rubor vithiis pranforum. Flufhing of the face after dinner

CLASS IV. i. i. 2. OF ASSOCIATION, 369

is explained in Seel. XXXV. i. In the beginning of intoxica-
tion the whole fldn becomes florid from the afTociation of the ac-
tions of the cutaneous arteries with thofe of the ftomach, be-
caufc vinous fpirit excites the fibres of the ftomach into more
violent action than the ftimulus of common food •, and the cu-
taneous capillaries of the face, from their more frequent expo-
fure to the viciflitudes of cold and heat, poflefs more mobility or
irritability than thofe of other parts of the {kin, as further ex-
plained in Seel. XXXIII. 2. 10. Vinegar is liable to produce
this flufhing of the face, which probably is owing to the quanti-
ty of vinous fpirit it contains, as I believe the unfermented veget-
able acids do not produce this effect. In every kind of blufti
the arterial blood is propelled into the capillaries farter than the
venous abforption can carry it forwards into the veins, in this
refpect refembling the tenfio phalli.

Can the beginning vinous or acetous fermentation of the ali-
ment in weak ftomachs contribute to this effect ? or is it to be
afcribed to the greater power of aflbciation between the arteries
of the face and the fibres of the ftomach in fome people than in.
others ?

M. M. Eat and drink lefs at a time, and more frequently.
Put 20 drops of weak acid of vitriol into water to be drunk at
meals. Let the drefs over the ftomach and bowels be loofe.
Ufe no fermented liquors, or vinegar, or fpice.

2. fudorjlragulu immerforum. Sweat from being covered in
bed. In the commencement of an epidemic fever, in which the
perpetual efforts to vomit was a diftrefling fymptom, Dr. Syd-
enham discovered, that if the patient's head was for a (hort time
covered over with the bed-clothes, warmth was produced, and
a fweat broke out upon the fkin, and the tendency to vomit ceaf-
cd. In this curious fact two trains of affbciated motions are
excited into increafed action. Firft, the veffrls of the lungs are
known to have their motion afibciated with thofe of the fkin by
the difficulty of breathing on going into the cold bath, as defcrib-
ed in Se&. XXXII. 3. 2. Hence, when the veflels of the
lungs become excited into (Ironger action, by the bad air under
the bed-clothes, warmed and adulterated by frequent breathing,
thofe of the external fkin foon become excited by their aflbcia-
uon into more energetic action, and generate more heat along
with a greater fecretion of perfpirable matter. Secondly, the
fympathy between the ftomach and fkin is evident in variety of
circumftances ; thus the cold air of frofty days applied to the
(kin for a fhort time increafes the action of the ftomach by re-
verfe fympathy, but decreafes it if continued too long by direct
fympathy \ fo in the circumftancc above mentioned, the action

VOL. II. Z z of

DISEASES CLASS IV. i. i. 3.

of the ftomach is iricreafed by direct fympathy with that of the
fk'm ; and the tendency to vomit, which was owing to its di-
minifhed action, ceafes.

3. Ceffhtio tfgrhudlms cute excitatd. The cure of ficknefs by
ftimulating the fkin. This is explained in the preceding arti-
cle ; and further noticed in IV. 2. 2. 4. and in IV. i. i. F.

Similar to thefe is the effect of a blifter on the back in reliev-
ing ficknefs, indigeftion, and heart-burn ; and, on the contrary,
by thefe fymptoms being frequently induced by coldnefs of the
extremities. The blifter ftimulates the cutaneous veffels into
greater action; whence ' warmth and pain are produced at the
fame time, and the fibres of the itomach are excited into greater
action by their afTociation with thofe of the (kin. It does not
appear, that the concommitant pain of the blifter caufes the in-
creafed energy of the ftomach, !becaufe the motions of it are not
greater than natural j though it is fometimes difficult to deter-
mine, whether the primary part of fome afTociated trains be
connected with irritative or fenfitive motions.

In the fame manner a flannel fhirt, to one who has not been
in the habit of wearing one, ftimulates the fkin by its points,
and thus (tops vomiting in fome cafes ; and is particularly effi-
cacious in checking fome chronical diarrhoeas, which are not at-
tended with fever ; for the abforbents of the fkin are thus ftim-
ulated into greater action, with which thofe of the inteitines
confent by direct fympathy.

This effect cannot be afcribed to the warmth alone of the
flannel fhirt, as being a covering of loofe texture, and confining
air in its pores, like a fponge, which air is known to be a bad
'conductor of heat, fince in that cafe its ufe fhould be equally
efficacious, if it were worn over a linen fhirt ; and an increafed
warmth of the room of the patient would be equally ferviceable.

4. DJgeftto auftaf rigor e ctttaneo. Digeilion increafed by cold-
nefs of the fkin. Every one has experienced the increafe of
3ns appetite after walking in the cool air in frofty days ; for
there is at this time not only a faving of fenforial power by the
lefs exertion of the cutaneous veflels ; but, as thefe confent with
thofe of the ftomach and bowels, this faving of fenforial power
is transferred by reverfe fympathy from the cutaneous capilla-
ries and abforbent.s to thofe of the ftomach and interlines.

Hence weak people fhould ufe the cold air of -winter as a cold
bath •, that is, they fliould ftay in it but a fhort time at once,
but fhould immerfe themfelves in it many times a day.

5. Gatarrhus a f rigor e cutaneo. Catarrh from cold fkin. This
has been already explained in Clafs I. 1.2. 7. and is further
defcribcd in Sed. XXXV. 1.3, In this difeafe the veflels of

the

CLAssIV. j. i. 6. OF ASSOCIATION. 37;

the membrane, which lines the noftrils, are excited into greater
action ; when thofe of the Ikin, with which they are aflbciated,
are excited into lefs action by the deficiency of external heat,
by reverfe fympathy ; and though the pain of cpld attends the
torpor of the primary link of this aflbciation, yet the increafed
motions of the membrane of the noftrils are ailociated with
thofe of the cutaneous veflels, and not with the pain of them,
becaufe no inflammation follows.

6. Abforptio cellularls aufta vomitu. In the aft of vomiting
the irritative motions of the ftomach are inverted, and of the
abforbents, which open their mouths into it ; while the cutane-
ous, cellular, and pulmonary abforbents are induced, by reverfe
fympathy with them, to a<ft with greater energy. This i.s feen
in cafes of anafarca, when long ficknefs and vomiting are cauf-
ed by fquills, or antimonial falts, or moil of all by the decoction
of digitalis purpurea, foxglove 5 and Mr. J. Hunter mentions a
cafe, in which a large bubo, which was juit ready to break,
was abforbed in a few days by ficknefs at fea. Treatife on the
Blood, p. 501, which is thus accounted forj lefs fenforial pow-
er is expended during ficknefs by the decreafed action of the
fibres of the ftomach, and of its abforbents ; as (hewn in Seel:.
XXXV. i. 3. whence an accumulation of it is produced, and
there is in confequence a greater quantity of fenforial power
for the exertion of thofe motions, which are aflbciated with the
abforbents of the ftomach by reverfe fympathy.

The reverfe fympathy between the lacteal and lymphatic
branches of the abforbent fyftem have been produced by the one
branch being lets excited to act, when the other fupplies fuffi-
cient fluid or nutriment to the fanguiferous veflels. Thus when
the ftomach is full, and the fupply of chyle, and mucus, and
water is in fufficient quantity ; the pulmonary, cellular, and cu-
taneous lymphatics are not excited into action ; whence the
urine is pale, and the Ikin moift, from the defect of abfcrption
on thofe furfaces.

7. Singultus nephriticus. When a ftone irritates the ureter,
and that even without its being attended with pain or fever,
fometimes a chronical hiccough occurs, and continues for days
and weeks, inftead of ficknefs or vomiting •, which are the com-
mon fymptoms. In this cafe the motions of the ftomach are
decreafed by their fympathy with thofe of the ureter, which are
increafed by the ftimulus of the ftone in it •, and the increafed
motions of the diaphragm feem to exift in confequence of their
aflbciation with the ftomach by a fecond reverfe fympathy. This
hiccough may nevertheless admit of another explanation, and
be fuppofed to be a convulfive exertion of the diaphragm to re-
lieve

37* DISEASES CLASS IV. i. i. 8.

licve the difagreeable fenfation of the ftomach in confequence
of its difordered irritative aflbciations ; and in that cafe it would
belong to Clafs III. i. i. See Clafs IV. 2. i. for another ex-
ample of tertiary aflbciation.

M. M. Venefeclion. Emetic. Calomel. Cathartic, opium,
oil of cinnamonj from two to ten drops. Aerated alcaline water.
Peruvian bark.

8. Febris irritatha. Irritative fever, defcribed in Clafs I. i.
i. i. The difeafes above explained in this genus are chiefly
concerning the fympathies of the abforbent fyftem, or the ali-
mentary canal, which are not fo much afibciated with the arte-
rial fyflem as to throw it into diforder, when they are ilightly
deranged •, but when any great congeries of conglomerate glands,
which may be confidered as the extremities of the arterial fyf-
tem, are affected with torpor, the whole arterial fyflem and the
heart fympathize with the torpid glands, and acl with lefs ener-
gy ; which conftitutes the cold fit of fever ; which is therefore
at firft a decreafed a£lion of the afibciate organ ; but as this de-
creafe of action is only a temporary effecl:, and an increafe of
exertion both of the torpid glands, and of the whole arterial
fyftem, foon follows ; the hot fit of .irritative fever, or fever
with ftrong pulfe, properly belongs to this clafs and genus of
difeafes.

ORDO

CLASS IV. i. 2. OF ASSOCIATION. 373

ORDO I.

Increafed Ajficiate Motions,

GENUS II.
Catenated with Senfttive Motions.

THE primary links of the aflbci ated actions of this genus are
either produced or attended by painful or pleafurable ienfation.
The fecondary links of the firft ten fpecies are attended with
increafcd motions without inflammation, thofe of the remainder
are attended with inflammation. All inflammations, which do
not arife in the part which was previoufly torpid, belong to this
genus ; as the gout, rheumatifm, eryfipelas. It is probable many
other inflammations may, by future obfervation, require to be
tranfplanted into this clafs.

The circles of fenfitive afTociate motions confift chiefly of the
excretory duels of the capillaries and of the mouths of the ab-
forbent veflels, which conftitute the membranes ; and which
have been induced into action at the fame time ; or they confift
of the terminations of canals ; or of parts which are endued
with greater fenfibility than thofc which form the firft link of
the aflbciation. An inftance of the firft of thofe is the fympa-
thy between the membranes of the alveolar procefles of the jaws,
and the membranes above or beneath the mufcles about the
temples in hemicrania. An inftance of the fecond is in the
fympathy between the excretory duel: of the lachrymal gland, and
the nafal duel of the lachrymal fac. And an inftance of the
third is the fympathy between the membranes of the liver, and
the (kin of the face in the gutta rofea of inebriates.

SPECIES.

I. Lachrymarum fuxus fympatheticus. A flow of tears from
grief or joy. When the termination of the duel of the lachry-
mal fac in the noftrils becomes affeeled either by painful or
pleafurable fenfations, in confequence of external ftimulus, or
by its aflbciation with agreeable or difagreeable ideas, the mo-
tions of the lachrymal gland are at the fame time exerted with
greater energy, and a profufion of tears fucceeds by fenfitive af-
fociation, as explained in Seel. XVI. 8. 2.

In this cafe there exiits a chain of affociated aelions, the fe-
cretion of the lachrymal gland is increafed by whatever ftimu-

late*

374 DISEASES CLASS IV. i. 2. 3.

lates the furfacc of the eye, at the fame time the increafed abun-
dance of tears ftimulates the pundta lachrymalia into greater ac-
tion ; and the fluid thus abforbed ftimulates the lachrymal fac,
and its nafal duel: in the nofe into greater action. In a contra-
ry direction of this ch.^n of aflbciation the prefent increafe of
action is induced. Firft, the nafal duel: of the lachrymal fac is
excited into increafed action by fome pleafurable or painful idea,
as defcribed in Seel. XVI. 8. 2. 2d. The puncta lacrymalia
or other extremity of the lachrymal fac fympathizes with it (as
the two ends of all other canals fympathize with each other.)
3d. With theie increafed motions of the puncta lacrymalia thofe
of the excretory duel: of the lachrymal gland are aflbciated from
their having fo perpetually acted together. And, laftly, with
the increafed actions of the excretory duel: of this gland are af-
ibciated thofe of the other end of it by their frequently acting
together ; in the fame manner as the extremities of other ca-
nals are aflbciated, and thus a greater flow of tears is poured in-
to the eye.

When a flow of tears is produced in grief, it is believed to
relieve the violence of it, which is worthy a further inquiry.
Painful fenfations, when great, excite the faculty of volition ;
and the perfon continues voluntarily to call up or perform thofe
ideas, which occafion the painful fenfation ; that is, the afflict-
ed perfon becomes fo far infane or melancholy ; but tears are
produced by the fenforial faculty of aflbciation, and fhew that
the pain is fo far relieved as not to excite the exceffive power of
volition, or infanity, and are therefore a fign of the abatement of
the painful (late of grief, rather than a caufe of that abatement.
SeeClafsIII. I. 2. 10.

2. Sternutatio a lumine. Some perfons fneeze from looking
up at the light Iky in a morning after coming out of a dark
bed room. The olfactory nerves are brought into too great ac-
tion by their fympathy with the optic nerves, or by their refpec-
tive fympathies with fome intervening parts, as probably with
the two extremities of the lachrymal fac ; that is, with the punc-
ta lacrymalia and the nafal duet. See Clafs II. I. i. 3.

3. Dolor dcntium aftrichre. Tooth-edge from grating founds,
and from the touch of certain fubftances, and even from im-
agination alone, is defcribed and explained in Sect. XVI. 10.
The increafed actions of the alveolar veflels or membranes are
aflbciated with the ideas, or fenfual motions of the auditory
nerves in the firft cafe •, and of thofe of the fenfe of touch, in
the fecond cafe j and by imagination, or ideas exerted of painful
fenfation alone, in the laft.

Rifusfardonicus* A difagreeable fmile attends inflammations

of

CLASS IV. i. a, 5. OF ASSOCIATION. 375

of the diaphragm arifing from the aflbciations of the reiterated
exertions of that mufcle with thofe of the lips and cheeks in
laughing. See Diaphra^mitis, Clafs II. i. 2. 6.

5. Saliva fuxits cibo vifo. The flow of ialiva into the mouths
of hungry animals at the fight or fmell of food is feen in dogs
{landing round a dinner-table. The increafed actions of the
falivary glands have been ufually produced by the ftimulus of
agreeable food on their excretory duels during the maftication
of it •, and with this increafed attion of their excretory duftsthe
other terminations of thofe glands in the capillary arteries have
been excited into increafed action by the mutual aflbciation of
the ends of canals ; and at the fame time the pleafurable ideas,
or fenfual motions, of the fenfe of fmell and of fight have accom-
panied this increafed fecretion of faliva. Hence this chain of
motions becomes aflbciated with thofe vifual or olfactory ideas,
or with the pleafure, which produces or attends them.

6. Tenfw mammularum vifo puerulo. The nipples of la£tefcent
women are liable to become turgid at the fight of their young
offspring. The nipple has generally been rendered turgid by
the titillation of the lips or gums of the child in giving fuck ;
the vifible idea of the child has thus frequently accompanied
this pleafurable fenfation of parting with the milk, and turgef-
cence of the tubes, which conflitute the nipple. Hence the
vifual idea of 'the child, and the pleafure which attends it, be-
come afibciated with thofe increafed arterial actions, which
fwell the cells of the mammula, and extend its tubes ; which is
very fimilar to the tenfio phalli vifa muliere nuda etiam in in-
fomnio.

7. Tenfio perns in hydrophobia. An erection of the penis oc-
curs in the hydrophobia, and is a troublefome iymptom, as ob-
ferved by Ccelius Aurelianus, Fothergill, and Vaughan, and
would feem to be produced by an unexplained fympathy between
the fenfations about the fauces and the penis. In men the hair
grows about both thefe parts, the voice changes, and the neck
thickens at puberty. In the mumps, when the fwellings about
the throat fubfide, the tefticles are liable to fwell. Venereal in-
fection received by the penis is very fcable to affect the throat
with ulcers. Violent coughs, with forenefs or rawneis about
the fauces are often attended with erection of the penis ; which
is alfo laid to happen to male animals, that are hanged -3 which
laft circumftance has generally been afcribed to the obttruclion
of the circulation of the blood, but is more probably occaGoned
by the ftimulus of the cord in comprefling the throat ; fince if
it was owing to impeded circulation it ought equally to occur in
browning animals.

In

376 DISEASES CLASS IV. i. 2. S.

In men the throat becomes fo thickened at the time of puber-
ty, that a meafure of this is ufed to afcertain the payment of a
poll-tax on males in fome of the iflands of the Mediterranean,
which commences at puberty •, a firing is wrapped twice round
the thinneft part of the neck, the ends of it are then put into
each corner of the mouth ; and if, when thus held in the teeth,
it pafles readily over the head, the fubjecl: is taxable.

It is difficult to point out by what circumftance the fenfitive
motions of the penis and of the throat and nofe become aflbci-
ated ; I can only obferve, that thefe parts are fubjecled to great-
er pleafurable fenfatkms than any other parts of the body j one
being defigned to preferve ourfelves by the pleafure attending
the fmell and deglutition of food, and the other to enfure the
propagation of our fpecies : and may thus gain an aflbciation of
their fenfitive motions by their being eminently fenfible to pleaf-
ure. SeeClafsI. 3. i. u. and III. i. i. 15. andSeft. XVI.
5. See Gonorrhoea venerea, II. i. 5. i.

In the female fex this aflbciation between the face, throat,
nofe, and pubis, does not exift ; whence no hair grows on their-
chins at the time of puberty, nor do their voices change, or their
necks thicken. This happens probably from there being in them
a more exquifite fenifitve fympathy between the pubis and the
breads. Hence their breafts fwell at the time of puberty, and
fecrete milk at the time of parturition. And in the parotitis, or
mumps, the breafts of women fwell, when the tumor of the pa-
rotitis fubfides. SeeClafsI. i. 2. 15. Whence it would ap-
pear, that their breafts poiTefs an intermediate fympathy between
the pubis and the throat ; as they are the feat of a paflion, which
men do not poiTefs, that of fuckling children.

8. Tenefmus calctilofus. The fphincler of the rectum becomes
painful or inflamed from the aflbciation of its fenfitive motions
with thofe of the fphincler of the bladder, when the latter is
(timulated into violent pain or inflammation by a (tone.

9. Polypus narium ex afcandibus ? The ftirnulation of afcari-
des in the reclum produces, by fenfitive fympathy, an itching of
the nofe, as explained in IV. 2. 2. 6 ; and in three children I
have feen a polypus in the nofe, who were all affected
with afcarides ; to the perpetual ftimulation of which, and
the confequent fenfitive aflbciation, I was led to afcribe the
inflammation and thickening of the membrane of the noftrils.

10. Crampus fur arum in cholera. A cramp of the mufcles of
the legs occurs in violent diarrhoea, or cholera, and from the
ufe of too much acid diet in gouty habits. This ieems to fym»
pathize with uneafy fenfation in the bowels. See Clafs III. i.
i. 14, This aflbciation is not eafiiv accounted for, but is anal-
ogous

CLASS IV. i . 2. 1 1 . OF ASSOCIATION. 3 7 7

ogous in fome degree to the paralyfis of the mufcles of the arms
in colica faturnina. It would feem, that the mufcles of the legs
in walking get a fympathy with the lower parts of the inteftines*
and thofe of the arms in variety of employment obtain a fympa-
thy with the higher parts of them. See Cholera and Ileus.

1 1 . Zona ignea nephritica. Nephritic {hingles. The exter-
nal fkin about the loins and fides of the belly I fuppofe to have
greater mobility in refped~l to fenfitive aflbciation, than the ex-
ternal membrane of the kidney; and that their motions are by
fome unknown means thus aflociated. When the torpor or be-
ginning inflammation of this membrane ccafes, the external fkin
becomes inflamed in its (lead, and a kind of herpes, called the
fhingles, covers the loins and fides of the belly. See Clafs II.
i. 5.9.

12. Eruptio variolarum. After the inflammation of the in-
oculated arm has fpread for a quarter of a lunation, it affects the
ftomach by reverfe fympathy ; that is, the actions of the Horn-
ach are affociated with thofe of the (kin ; and as much fenfori-
al power is now exerted on the inflamed fkin, the other part of
this fenfitive afTociatkm is deprived of its natural fliare, and be-
comes torpid, or inverts its motions. After this torpor of the
ftomach has continued a time, and much fenforial power is thus
accumulated; other parts of the fkin, which are alfo affociated.
\vith it, as that of the face firft, are thrown into partial in-
flammation ; that is the eruptions of the fmall-pox appear on
the face.

For that the variolus matter affecls the ftomach previous to
its eruption on the fkin, appears from the ficknefs at the com-
mencement of the fever ; and becaufe, when the morbid motions
affecl the fkin, thofe of the ftomach ceafe ; as in the gout and
eryfipelas, mentioned below. The confent between the ftom-
ach and the fkin appears in variety of other difeafes ; and as
they both confift of furfaces, which abforb and fecrete a quanti-
ty of moifture, their motions muft frequently be produced to-
gether, or in fucceflion ; which is the foundation of all the fym-
pathies of animal motions, whether of the irritative, fenfitive, or
voluntary kinds.

Now as the fkin, which covers the face, is expofed to greater
variations of heat and cold than any other part of the body ; it
probably poflefies more mobility to fenfitive aflbciations, not on-
ly than the ftomach, but than any other part of the fkin ; and
is thence affe&ed at the eruption of the fmall-pox with violent
action and confequent inflammation, by the aflbciation of its mo-
tions with thofe of the ftomach, a day before the other parts of

VOL. II. A A a the

3 7 8 DISEASES CLASS IV. i . 2. 1 3,

the {kin ; and becomes fuller of puftules, than any other part of
the body. See Clafs II. i. 3. 9.

It might be fuppofed, that the fucceflive fwelling of the hands,
when the face fubfides, at the height of the fmall-pox, and of
the feet, when the hands fubfide, were governed by fome un-
known afibciations of thofe parts of the fyftem ; but thefe fuc-
ceflions of tumor and fubfidence more evidently depend on the
times of the eruption of the puftules on thofe parts, as they appear
a day fooner on the face than on the hands, and a day fooner
on the hands than on the feet, owing to the greater comparative
mobility of thofe parts of the fkin.

13. Gutta rofea Jlomatlca. Stomatic red face. On drinking
cold water, or cold milk, when heated with exercife, or on eat-
ing cold vegetables, as raw turnips, many people in harveft-time
have been afflicted with what has been called a furfeit. The
ftomach becomes painful, with indigeftion and flatulency, and
after a few days an eruption of the face appears, and* continues
with fome relief, but not with entire relief; as both the pimpled
face and indigeftion are liable to continue even to old age.

M. M. Venefeclion. A cathartic with calomel. Then half
a grain of opium twice a day for many weeks. If faturated fo-
lution of arfenic three or five drops twice or thrice a day for a
week ?

1 4. Gutta rofea hepatica. The rofy drop of the face of fome
drinking people is produced like the gout defcribed below, in
confequence of an inflamed liver. In thefe conftitutions the
jkin of the face being expofed to greater variation of heat and
cold than the membranes of the liver, poffefles more mobility
than thofe hepatic membranes ; and hence by whatever means
thefe membranes are induced to fympathize, when this fenfitive
afibciation occurs, the cutaneous veflels of the face run into
greater degrees of thofe motions, which conftitute inflammation,
than previoufly exifted in the membranes of the liver ; and then
thofe motions of the liver ceafe. See Clafs II. i. 4. 6.

As inflammation of the liver fo frequently attends the great
potation of vinous fpirit, there is reafon to fufpecl:, that this vif-
cus itfelf becomes inflamed by fenfitive afibciation with the
ftomach ; or that, when one termination of the bile-du6l, which
enters the duodenum, is ftimulated violently, the other end may
become inflamed by fenfitive afibciation.

15. Podagra. The gout, except when it affects the liver or
ftomach, feems always to be a fecondary difeafe, and, like the
rheumatifm and eryfipelas mentioned below, begins with the
torpor of fome diftant part of the fyftem.

The moft frequent primary feat 0f the gout I fuppofe to be

CLASS IV. i . 2. 1 5. OF ASSOCIATION. 3 79

the liver, which is probably affected with torpor not only previ-
ous to the annual paroxyfms of the gout, but to every change
of its fituation from one limb to another. The reafons, which
induce me to fufpeft the liver to be firft affedted, are not only
becaufe the jaundice fometimes attends the commencement of
gout, as defcribed in Seel:. XXIV. 2. 8. but a pain alfo over the
pit of the ftomach, which I fuppofe to be of the termination of
the bile-duel: in the duodenum, and which is erroneouily fup-
pofed to be the gout of the ftomach, with indigeftion and flatu-
lency, generally attends the commencement of the inflamma-
tion of each limb. See Arthritis ventriculi, Clafs I. 2. 4. 6.
In the two cafes, which I faw, of the gout in the limbs being
preceded by jaundice, there was a cold fhivering fit attended the
inflammation of the foot, and a pain at the pit of the ftom-
ach; which ceafed along with the jaundice, as foon as the
foot became inflamed. This led me to fufpect, that there was a
torpor of the liver, and perhaps of the foot alfo, but neverthe-
lefs the liver might alfo in this cafe be previoufly inflamed, as
obferved in Sett. XXIV. 2. 3.

Now as the membranes of the joints of the feet fuffer greater
variations of heat and cold than the membranes of the liver, and
are more habituated to extenfion and contraction than other
parts of the fkin in their vicinity ; I fuppofe them to be more
mobile, that is, more liable to run into extremes of exertion or
quiefcence ; and are thence more fufceptible of inflammation,
than fuch parts as are lefs expofed to great variations of heat
and cold, or of extenfion and contraction.

When a ftone preffes into the fphineler of the bladder, the
glans penis is affected with greater pain by fympathy, owing to
its greater fenfibility, than the fphineler of the bladder ; and >
when this pain commences, that of the fphindler ceafes, when
the ftone is not too large, or pufhed too far into the urethra.
Thus when the membrane, which covers the ball of the great
toe, fympathizes with fome membranous part of a torpid or in-
flamed liver ; this membrane of the toe falls into that kind of
action, whether of torpor or inflammation, with greater energy,
than thofe actions excited in the difeafed liver ; and when this
new torpor or inflammation commences, that with which it fym-
pathizes ceafes ; which I believe to be a general law of aflbciat-
ed inflammations.

The paroxyfms of the gout would feem to be catenated with
folar influence, both in relpect to their larger annual periods,
and to their diurnal periods— See Se£t. XXXVI. 3. 6.— -as the
former occur about the fame feafon of the year, and the latter
commence about an hour before fun-rife 5 neverthclefs the an-
nual

380 DISEASES CLASS IV. i. 2. 15.

nual periods may depend on the fucceflion of great viciflitudes
of cold and heat, and the diurnal ones on our increafed fenfibili-
ty to internal fenfations during fleep, as in the fits of afthma,
and of fome epilepfies. See Sect. XVIII. 15.

In reipect to the pre-remote caufe or difpofition to the goutj
there can be no doubt of its individually arifing from the pota-
tion of fermented or fpirituous liquors in this country ; wheth-
er opium produces the fame effect in the countries, where it is,
in daily ufe, I have never been well informed. See Seel:. XXI.
jo. where this fubject is treated of ; to which I have to add,
that I have feen fome, and heard of others, who have moderat-
ed their paroxyfms of gout, by diminifhing the quantity of fer-
mented liquors, which they had been accuftomed to ; and oth-
ers who, by a total abftinence from fermented liquors, have en-
tirely freed themfelves from this excruciating malady ; which
otherwife. grows with our years, and curtails or renders mifera-
ble the latter half, or third, of the lives of thofe, who are fub-
ject to it. The remote caufe is whatever induces temporary
torpor or weaknefs of the fyftem 5 and the proximate caufe is
the inirritability, or defective irritation, of fome part of the fyf-
tem $ xvhence torpor and confequent inflammation. The great
Sydenham faw the beneficial effects of the abftinence from fer-
mented liquors in preventing the gout, and adds, " if an empiric
" could give fmall-beer only to gouty patients as a noftrum, and
« periuade them not to drink any other fpirituous fluids, he
« might refcue thoufands from this difeafe, and acquire a for-
" tune for his ingenuity." Yet it is to be lamented, that this
accurate obierver of difeafes had not refolution to practife his own

fc iptiun, and thus to have fet an example to the world of
e truth cf his doctrine ; but, on the contrary, recommended

deira, the itrongeil wine in common ufe, to be taken in the
ts of the gout, to the detriment of thoufands ; and is faid him-
felf to have perilhed a martyr to the diieaie, which he knew
how to fubdue !

As example has more forcible effect than fimple affertion, I
{hall now concifeiy relate my own cafe, and that of one of my
moft reipected friends. E. D. was about forty years of age,
when he was firit feized with a fit of the gout. The ball of his
right great toe was very painful, and much fwelled and inflam-
ed, which continued five or fix days in fpite of venefection, a
a brifk cathartic with ten grains of calomel, and the application
of cold air and cold water to his foot. He then ceafed to drink
ale or wine alone ; confining himfelf to fmall-beer, or wine di-
luted with about thrice its quantity of water. In about a year
he fuffered two other fits of the gout, in lefs violent degree. He

then

CLASS IV. 1.2.15. OF ASSOCIATION. 3 8 1

then totally abftained from all fermented liquors, not even tail-
ing fmall-beer, or a drop of any kind of wine ; but ate plenti-
fully of flem-meat, and all kinds of vegetables, and fruit, ufmg
for his drink at meals chiefly water alone, or lemonade, or cream
water ; with tea and coffee between them as ufual.

By this abftinence from fermented liquors he kept quite free
from the gout for fifteen or fixteen years ; and then began to
take fmall-beer mixed with water occafionally, or wine and
water, or perry and water, or cyder and water ; by which in-
dulgence after a few months he had again a paroxyfm of gout,
which continued about three days in the ball of his toe ; which
occafioned him to return to his habit of drinking water, and he
has now for above twenty years kept in perpetual health, ex-
cept accidental colds from the changes of the feafons. Before
he abftained from fermented or fpirituous liquors, he was fre-
quently fubject to the piles, and to the gravel, neither of which
he has fmce experienced.

In the following cafe the gout was eftabliftied by longer habit
and greater violence, and therefore required more cautious treat-
ment. The Rev. R. W. was feized with the gout about the age
of thirty-two, which increafed fo rapidly that at the age of for-
ty-one he was confined to his room leven months in that year ;
he had fome degree of lameneis during the intervals, with
chalky fwellings of his heels and elbows. As the difeafe had
continued fo long and fo violently, and the powers of his d'gef-
tion were fomewhat weakened, he was advifed not entirely to
leave off all fermented liquors ; and as fmall-beer is of fuch va-
rious itrength, he was advifed to drink exactly two wine-glafles,
about four ounces, of wine mixed with three or four times its
quantity of water, with or without lemon and fugar, for his dai-
ly potation at dinner, and no other fermented liquor of any
kind ; and was advifed to eat flem-meat with any kind of boil-
ed vegetables, and fruit, with or without fpice. He has now
fcrupuloufly continued this regimen for above five years, and
has had an annual moderate gouty paroxyfm of a few weeks,
inftead of the confinement of fo many months, with great health
and good fpirits during the intervals.

The following is a more particular account of the hiftory of
this cafe ; being part of a letter which Mr. Wilmot wrote on
that fubjecl at my entreaty.

" I entered into the army with an excellent contlitution at
the age of fifteen. The corps I ferved in was diftinguifhed by-
its regularity, that is, the regular allowance of the meis was on-
ly one pint of wine per man each day •, unlefs we had company
to dine with us ; then, as was the general cuftom of the time,

the

382 DISEASES CLASS IV. i. 2. 15.

the bottle circulated without limit. This mode of living,
though by no means confidered as excefs for men, was certainly
too great for a youth of my age. This ftyle of living I contin-
ued, when with the regiment, till the latter end of the year
1769, when I had the misfortune to fleep in a damp bed at
Sheffield on a journey to York, but arrived there before I felt
the ill effects of it. I was then feized with a violent inflamma-
tory rheumatifm with great inflammation of my eyes, and was
attended by Dr. Dealtry ; fo violent was the diforder, that I was
bled for it eight times in lefs than a fortnight 5 and was three
months, before I could confider my health perfectly reeftablifh-
ed. Dr. Dealtry told me, that I mould be fubject to fimilar at-
tacks for many years ; and that he had no doubt, from the ten-
dency he found in my habit to inflammation, that, when I was
farther advanced in life, I fhould change that complaint for the
gout. He predicted truly ; for the three fucceeding winters I
had the fame complaint, but not fo violently ; the fourth winter
I efcaped, and imputed my efcape to the continuance of cold
bathing during the whole of that winter ; after that I never
efcaped it, till I had a regular and fevere fit of the gout : after
the firft attack of rheumatic fever I was more abitemious in my
manner of living, though when in company I never fubjected
myfelf to any great reftraint. In the year 1774 I had quitted
the army, and being in a more retired fituation, was feldom led
into any excefs ; in 1 776 and 1777! was in the habit of drink-
ing a good deal of wine very frequently, though not conftantly.
After that period till the year 1781, 1 drank a larger quantity of
wine regularly, but very feldom to any degree of intoxication.
I lived much at that time in the fociety of fome gentlemen, who
ufually drank nearly a bottle of wine daily after dinner. I mull
here however obferve, that at no part of my life was I accuftom-
ed to drink wine in an evening, and very feldom drank any
thing more than a (ingle half-pint glafs of fome fort of fpirits
diluted with much water. Till the year 1781 I had always
been aceuilomed to ufe very violent and continued exercife on
horfe-back •, in the winter months I purfued all field diverfions,
and in the fummer months I rode frequent and long journeys ;
and with this exercife was liable to perfpire to great excefs ; be-
tides which I was fubjecl: to very profuie night-fweats, and had
frequently boils break out all over me, efpecially in the fpring
and autumn ; for which I took no medicine, except a little of
the flowers of fulphur with cream of tartar in honey.

" You will obferve I bring every thing down to the date of
1781. In the month of October in that year, when I was juft
-entered into the thirty-fecond year of my age, I had the firft at-
tack

CLASS IV. i. 2. 15. OF ASSOCIATION.

tack of gout ; that fit was very fevere, and of many weeks con-
tinuance. I now determined upon a more abftemious method
of living, in refpedl to wine ; and indeed the fociety, in which
I had before been accuftomed to live, being confiderably chang-
ed, I had lefs frequent temptations to excefs. From this time I
enjoyed the moft perfect good date of health till Auguft 1784,
when I had my fecond attack of gout. I never perfectly recov-
ered from this attack through the fucceeding winter, and in
March 1785, was advifed to try the Bath waters, and drank
them under the direction of one of the faculty of that place.
I was there foon feized with a fever, and a flight attack of gout
in one knee. I fhould obferve, that when I fet out from home,
I was in a weak and low ftate, and unequal to much fatigue ; as
appeared by my having a fainting fit one day on the road, after
having travelled only about fifty miles ; in the courfe of the
fummer I had two or three more flight attacks of eout of lefs
confequence, till the month of October ; when I was afflicted
with it all over me in fuch a manner, as to be without the pof-
fibility of the lead degree of removal for fome days ; and was
about two months without being able to get into the air. This
was the fevereft attack I had then experienced ; though I have
fmce had feveral equally fevere. In the courfe of this fummer
1 had a fall with my horfe 5 and foon after it, having difcovered
an enlargement on one elbow, I concluded I had hurt it at that
time ; but in the courfe of this laft attack having a fimilar en-
largement on the other elbow, I found my miftake, and that
they were collections of gouty matter ; thefe increafed to the
fize of pullet's eggs, and continue in that ftate. I had foon af-
ter fimihr enlargements on my heels ; the right heel being fe-
verely bruifed, I was under the neceflity of having it lanced, and
a large quantity of chalky matter was difcharged from it ; and
have fmce that time frequently had chalky matter taken from
it, and fometimes fmall bits of apparently perfect chalk. My
right hand was foon afHidled in the fame way, and I have fcarce-
ly a joint on thofe fingers now in a natural ftate. My left hand
has efcaped tolerably well. After this laft attack (viz. October
1 785), I had two or three flight attacks before the month of June
1787, when I had a very fevere intermittent fever; from that
time I continued very well till the latter end of the year, when I
began to feel the gout about me very much, but was not con fin-
ed by it. I was in this ftate advifed to try what is called the
American Recipe (gum guaiacum and nitre difiblved in fpirits) ;
it had apparently been of cflential fervice to a friend of mine,
who from the inability to walk a mile for fome years, was be-
lieved to be reflored hv the \if.- of this medicine to a good (late

of

384 DISEASES CLASS IV. i. 2. i$.

of health, fo as to xvalk ten miles a day. In addition to this
medicine I drank, as my common beverage with my meals,
fpruce beer. I had fo high an opinion of this medicine in the
gout, and of fpruce beer as an antifcorbutic, that I contemplated
with much fatisfaftion, and with very little doubt, the perfecl
reftoration of my health and ftrength ; but I was miferably de-
ceived 5 for in September 1788 I was feized with the gout in a
degree that none but arthritics, and indeed but few of thefe,
can eafily conceive. From this time till Auguft 1789 I fcarcely
ever paifed a comfortable day -9 fevcn months of this time I had
been confined, my health feemed much impaired, my ftrength
was diminilhed, and my appetit* almoft gone. In this (late my
friends prefTed me to confult you. I was unwilling for fome
time to do it, as I had loft all hope of relief ; however, when I
had detrmined to apply to you, I likewife determined to give up
every prejudice of my own refpeding my cafe, and to adhere
mod ftriftly to your advice. On the 2oth of Auguft 1789 I
confulted you, on the 25th I entered upon the regimen, which
you prefcribed, and which was as follows.

" Drink no malt liquor on any account. Let your beverage at
" dinner confift of two glafTes of wine diluted with three half-
« pints of water. On no account drink any more wine or fpir-
" ituous liquors in the courfe of the day ; but, if you want more
<£ liquid, take cream and water, or milk and water, or lemonade,
« with tea, coffee, chocolate. Ufe the warm bath twice a week
" for half an hour before going to bed, at the degree of heat
" which is moft grateful to your fenfations. Eat meat conftant-
" ly at dinner, and with any kind of tender vegetables you pleafe.
ff Keep the body open by two evacuations daily, if poflible
" without medicine, if not take the fize of a nutmeg of lenitive
« elecluary occafionally, or five grains of rhubarb every night.
« Ufe no violent exercife, which may fubjeft yourfelf to fudden
" changes from heat to cold ; but as much moderate exercife as
" may be, without being much fatigued or ftarved with cold.
" Take fome fupper every night ; a fmall quantity of animal
" food is preferred ; but if your palate refutes this, take veg-
« etable food, as fruit-pie, or milk ; fomething mould be eaten,
« as it might be injurious to you to faft too long." To the whole
of this I adhered moft fcrupuloufly, and foon found my appetite
improve, and with it my ftrength and fpirits. I had in Decem-
ber a fevere attack, and two or three flight ones in the courfe of
twelve months ; but the improvement in the general ftate of my
health induced me to perfevere. On the i8th of Auguft 1790
I had another fevere attack, but it went off eafier than before,
and I foon recovered fufficicntly to go to Buxton, which you ad-

vifed

i. 2. i$. OF ASSOCIATION. 305

vifed me to, and from which I reaped great benefit ; neverthe-
lefs on the 2pth of December I had a flight attack in compari-
fon of fome that I had before experienced, and from that
time I was free from gout, and enjoyed my health perfectly well
till the fourth week in October 1791 ; from that till the third
week in October 1792 \ from that till the third week in Octo-
ber 1793 j and from that till June 1794. From what happen-
ed for the laft three years I dreaded the month of October 5
but I Heaped then, and have enjoyed my health mod perfectly
ever fmce till within the lad week, that I have had a ilight at-
tack in one knee, which is nearly gone, without any fymptom to
lead me to fuppofe that it will go further.

" I adhered to your advice moft fcrupuloufly for the firft year;
and in regard to the not drinking malt liquor, and taking only
the two glafles of wine with water, I have never deviated but
two days ; and then the firft day I only drank one glafs of ale
and one glafs of champaigne \ on the fecorid only one glafs of
champaigne. With regard to the warm bath, I only ufe it now
when I have gouty fymptoms upon me, and in fuch fituations
I find it of infinite fervice ; and in other refpects I continue to
live according to your direction.

« Many perfons have laughed at the idea of my perfeverance
in a fyftem, which has not been able to cure the gout after five
years' trial ; but fuch perfons are either ignorant of what I be-
fore fu fibred, or totally unacquainted with the nature of the dif-
order. Under the blefling of Providence, by an adherence to
your advice, I am reaping all the benefit you flattered me I
might expect from it, viz. my attacks lets frequent, my fuffer-
ings lefs acute, and an improvement in the general (late of my
health,

" I have been particular in this account of myfelf at your re-
queft, and am,£ir, &c.

MORLEY, near DERBY,
February 10^,1795. ROBERT WILMOT.*'

There are fituations neverthelefs in which a paroxyfm of gou-.
has been believed to be defirable, as relieving the patient from
other difagreeable difeafes, or debilities, or fenfations. Thus
when the liver is torpid, a perpetual uneafmefs and depreflion
of fpirits occur ; which a fit of gout is fuppofed to cure by a
metaftafis of the difeafe. Others have acquired epileptic fits,
probably from the difagreeable fenfadon of a chronically inflam-
ed liver j which they fuppofe the pain and inflammation of gout
would relieve. When gouty patients become much debilitated
by the progrefs of the difeafe, they are liable to dropfy of the

VOL, IT. B B H cheft,

386 DISEASES CLASS IV. i. 2. 15-

cheft, which they fuppofe a fit of the gout would relieve. But
in all thefe cafes the attempt to procure a paroxyfm of gout by
wine, or aromatics, or volatiles, or blifters, or mineral waters,
feldom fucceeds •, and the patients are obliged to apply to oth-
er methods of relief adapted to other particular cafes. In the
two former fituations fmall repeated dofes of calomel, or mer-
curial unction on the region of the liver, may fucceed, by giv-
ing new activity to the veffels of the liver, either to fecrete or
to abforb their adapted fluids, and thus to remove the caufe of*
the gout, rather than to promote a fit of it. In the laft cafe the
tinclure of digitalis, and afterwards the clafs of forbentia, muft
be applied to.

M. M. In young ftrong patients the gout (hould be cured
by venefection and cathartics and diluents, with poultices ex-
ternally. But it has a natural crifis by producing calcareous
matter on the inflamed membrane, and therefore in old enfee-
bled people it is fafeft to wait for this crifis, attending to the
natural evacuations and the degree of fever ; and in young ones,
where it is not attended with much fever, it is cuftomary and
popular not to bleed, but only to keep the body open with aloes,
to ufe gentle fudorifics, as neutral falts, and to give the bark at
the decline of the fit ; which is particularly ufeful where the
patient is much debilitated. See Arthritis ventriculi, Clafs I.
2.4. 6. and Seft. XXV. 17.

Mr. Kelly, furgeon in the navy, in an ingenious treatife,
printed at Edinb. 1797, termed Obfervations on Compreflion
by the Tourniquet, advifes in both inflammatory and chronic
rheumatifrn to comprefs the artery of the affected limb by the
tourniquet, for 15 or 20 minutes, relaxing or tightening the
bandage, as the patient feems to bear it. And in inflammatory
rheumatifm, he advifes to take blood from a vein below the
bandage, which he fays relieves the pain and deftroys the in-
flammation. Could not this experiment be ufed fafely in the
gout of young or ftrong patients ? and perhaps with fpeedy
fuccefs ?

When there is not much fever, and the patient is debilitated
with age, or the continuance of the difeafe, a moderate opiate,
as twenty drops of tincture of opium, or one grain of folid opi-
um, may be taken every night with advantage. Externally a
pafte made with double the quantity of yeft is a good poultice ;
and booterkins made with oiled (ilk,' as they confine the perfpir-
able matter, keep the part moift and fupple, and thence relieve
the pain like poultices.

The only fafe way of moderating the difeafe is by an uniform
and equal diminution, or a total abftinence from fermented

liquors,

CLASS IV. i. 2. 16. OF ASSOCIATION. 387

liquors, with the cautions directed in Sect. XII. 7. 8. The
continued ufe of ftrong bitters, as of Portland's powder, or bark,
has been frequently injurious, as fpoken of in the Materia Med-
ica, Art. IV. 2. n.

One of my acquaintance, who was much afflicted with the
gout, abftained for about half a year from beer and wine ; and
not having refolution to perfift, returned to his former habits of
potation in lefs quantity ; and obferved that he was then for one
winter ftronger and freer from the gout than ufual. This how-
ever did not long continue, as the difeafe afterwards returned with
its ufual or increafed violence. This I think is a circumftance
not unlikely to occur, as opium has a greater effect after its uie
has been a while intermitted ; and the debility or torpor, which
is the caufe of gout, is thus for a few months prevented by the
greater irritability of the fyftem, acquired during the leflened
ufe of fermented liquor.

For the fame reafon an ounce of fpirituous tincture of guaia*-
cum, or of bark, is faid to have for fome time prevented returns
of the gout *, which has afterwards, like all other great ftimult
when long continued, been fucceeded by greater debility, and
deftroyed the patient. This feems to have been exemplified in
the cafe of the ingenious Dr. Brown, fee Preface to his Ele-
menta Medicinse ; he found temporary relief from the ftimulus
of wine, regardlefs of its future effects.

Laftly, as the gouty inflammation, like the rheumatic fwellings
of the wrifts and ankles, is not a primary difeafe ; and is like
them not liable to fuppurate ; there is reafon to believe that opi-
ates may be given with lefs danger than in other inflammations,
and with a profpect of advantage ; fince by preventing the pe-
riods of torpor of the liver, or other part, primarily affected, the
diurnal additional attack, or its producing inflammation of
another limb, may fometimes be prevented. A perfon a few
days ago affured me, that when the gout came into his foot, his
practice was to take thirty drops of tincture of opium ; and in
half an hour thirty drops more ; and even a third dofe, if the
pain did not fubfide ; and that the fit foon ceafed. I fhould
think this a dangerous experiment. A Mr. Warner wrote a
book recommending opium in the gout, but died foon after its
publication.

1 6. Rhcttmatifmus. Acute rheumatifm. There is reafon to
fufpect, that rheumatic inflammations, like the gouty ones, are
not a primary difeafe ; but that they are the confequence of a
tranflation of morbid action from one part of the fyftem to
another. This idea is countenanced by the frequent change of
place of rheumatic-like gouty inflammations, and from their at-
tacking

DISEASES CLASS IV. 1.3.16.

tacking two fimilar parts at the fame time, as both ankles and
both wrifls, and thefe attacks being in fucceffion to each other.
Whereas it is not probable that both feet or both hands fhould
at the fame time be equally expofed to any external caufe of the
difeafe, as to cold or moifture ; and lefs fo that thefe fhould oc-
cur in fucceffion. Laftly, from the inflammatory diathefis in
this difeafe being more difficult to fubdue, and more dangerous
in event, than other common inflammations, efpecially to preg-
nant women, and in weak conflitutions.

From this idea of the rheumatifm being not a primary dif-
eafe, like the gout, but a transferred morbid action owing to the
previous torpor of fome other part of the fyftem, we perceive
why it attacks weak people with greater pertinacity than ilrong
ones ; refilling or recurring again and again after frequent evac-
.is, in a manner very different from primary inflammations 5
:ife the caufe is not removed, which is at adiftance from the
feat of the inflammation.

This alfo accounts for rheumatic inflammations fo very rarely
terminating in fuppuration, becaufe like the gout the original
caufe is not in the inflamed part> and therefore does not con-
tinue to aft after the inflammation commences, Inftead of fup-
puration in this difeafe, as well as in the gout, a quantity of
mucus or coagulable lymph is formed on the inflamed mem-
brane ; which in the gout changes into chalk-ftones, and in the
rheumatifm is either reabforbed, or lies on the membrane, pro-
ducing pains on motion long after the termination of the inflam-.
mation, which pains are called chronic rheumatifm. The mem-
branes, which have thus been once or repeatedly inflamed, become
3efs mobile, or lefs liable to be affected by fympathy, as appears
by the gout affecting new parts, when the joints of the foot
have been frequently inflamed by it 5 hence as the caufe of the
inflammation does not exity in the inflamed part, and as this
part becomes lefs liable to future attacks, it feldorn fuppurates.

Pleurodyne rheumatic a. When rheumatifm affeds the
xnufcles of the cheft, it produces fymptoms fimUar to pleu-
ri<>, but diftinguifhed from it by the patient having previouily
{uffered rheumatic affections in other parts, and by the perti-
nacity or continuance of the inflammatory ftate of the patient.
This fhould be termed pleurodyne rheumatica.

Enter algick rheumatica. When rheumatic inflammation
fects the bowels, it produces a difeafe very different from en-
teritis, or common hrHammation of the bowels, and fhould be
termed interalgia rheumatica, The pain is lefs than in enteri*
tis, and the difeafe of longer continuance, with harder pulfe, and
the blood equally fizy. It is attended with frequent dejections*

with

CLASS IV. i. 2. 16. OF ASSOCIATION, 389

with much mucus, and previous griping pains, but without
vomiting ; and differs perhaps from dyfentery from its not be-
ing attended with bloody (tools, and not being infectious.

Rheumatic inflammations, which I believe to arife from the
fympathy of the inflamed part with the torpor of fome diftant
part, may I think be certainly diftinguifhed from thofe inflam-
mations of the fame part, which have not arifen from fympathy
with the torpor of fome diftant part, but where the caufe of the
inflammation began in the part where the inflammation exifts,
by this circumftance ; that in rheumatic inflammation the hard
or (harp pulfe continues at about 1 1 8 in a minute after the pain
abates or ceafes. Whereas in the latter the inflammatory fever
ceafes along with the pain.

In two cafes of pain of the fide, and difficult refpiration,
which I efteemed rheumatic, as the hard pulfe of 1 1 8 with fized
blood continued after repeated venefection, gentle cathartics,
and mild antimonials, I found ten drops of faturated tincture of
digitalis given every fix hours appear to produce great good ef-
fect, and to abate and remove the inflammatory diathefis in three
or four days.

Hence when a fever has continued more than one lunar pe-
riod, attended with a hard or {harp pulfe of 1 1 8 or 1 20 in a
minute, and is not attended with cough or fymptoms of abforb-
ed matter, it may be efteemed of rheumatic origin, though no
local pain or inflammation at prefent exifts j and this with great-
er certainty, if pain had previoufly exilled : for no fevers, ex-
cept the hectic fevers from abforbed matter, and this attended
with inflammatory diathefis, and which may be called rheumat-
ic, ever properly extend, I believe, beyond one lunation ; though
fymptoms of debility may continue a while longer. This ob-
fervation is worth attending to in practice, as it diftinguimes
the kind of fever, in which when the bark is erroneoufly givrn,
it does no fervice3 and in which I believe faturated tincture of
digitalis given as above to be the moil efficacious medicine.

Rheumatifmtts fuppurans. There is another kind of rheuma-
tifm attended with debility> which fuppurates, and mould be
termed rheumatiimus fuppurans. It is generally believed to be
the gout, till fuppuration takes place on the (Welled joint 5 and,
as the patient finks, there are Houghs formed over the whole
mouth ; and he ieems to be deftroyed by inflammation or gan-
grene of the mucous membranes. I nave twice feen this dif-
eafe in patients about fixty. Some other difcafes are crroneouf-
Jy called rheumatic, as hemicraaia, and odontalgia. See Sect.
«XV1. 3.

M. M. In the three former kinds venefe&ion repeatedly. Ca-
thartics,

390 DISEASES CLASS IV. i. 2. 16:

thartics. Antimonials. Diluents. Neutral falts. Oil. Warm
bath. Afterwards the bark. Opium with or without ipecacu-
anha j but not till the patient is confiderably weakened. Sweats
forced early in the difeafe do injury. Opium given early in
the difeafe prolongs it. In the laft kind, gentle ftimulants, as
wine and water, mucilage, forbentia.

In acute rheumatifm, when the fwelling of the joints firft af-
fected fubfides, a return of torpor in the part primarily difeafed
commences previous to an inflammation of the joints fecondari-
ly affected. Hence when the tumor of the joints firft affected
fubfides, half a grain of opium, every night, and Peruvian bark,
or other bitter medicine, may be given to prevent this return
of torpor with great advantage ; if the patient has previoufly
been properly evacuated, and is not now too much inflamed.

Dr. Fordyce afierts, that when it was the practice to bleed
largely ia acute rheurnntifrn, a metaftafis frequently took place
to the interior parts of the body, and deftroyed the patient. And
adds, that during the laft fit teen years of his practice this has
rarely happened, as he has entirely left off bleeding in the acute
rheumatifm. Third diflertation on fever by G. Fordyce, M. D.
London, Johnfou. On this fubject it may be remar) ,:d, that as
rheumatifm like gout is a fecondary difeafe, the inflammation
of one part being fymptoraatic, the feat of torpor exifting in
ibme other part, it may not be fo conftantly neceffary to bleed
fo copiouily in thofe fecondary inflammatory difeafes, as in thofe
primary ones, where the inflamed part was previoufly the feat
of torpor,, as in pleurify, peripneumony, and intends j but in
rheumatifm, as well as in eryfipelas, I am convinced, that where
the inflammation of the fyftem is great, repeated venefection is
not only ufeful ; but that thofe, who perifh by either of thofe
difeafes, perifti for the want of venefection 'early, where the at-
tack is violent. And laftly, that even in the gout of young and
ftrong ftubjects, as I know by experience on myfelf, a moderate
venefection fhortens the fit, and leflens I believe the hazard of
metaftafis.

The following is a cafe of fuppurative rheumatifm. Mr.

F , about fixty, was fuppofed to have the gout in his hand,

which however fuppurated, and it was then called the fuppurai-
tive rheumatifm. He had lived rather intemperately in refpect
to wine, and was now afflicted with a tendency to inflammation
of the mucous membranes. As he lay on the bed half refupine,
propped up with pillows, and alfo flept in "that pofture, his lower
jaw dropped by its own weight, when the voluntary power of
the mufcles was fufpended. The mucus of his mouth antl
throat became quite dry, and at length was fucceeded by floughs ;

this

CLASS IV. i . 2. 1 7* OF ASSOCIATION, 391

this was a moft diftreflmg circumftance to him, and was in vain
endeavoured to be relieved by fupporting his jaw by Header
fleel fprings fixed to his night-cap, and by fprings of elaftic gum.
The flougha fpread and feemed to accelerate his death. See
Clafs I. i. 3. 2.

In acute rheumatiim Mr. Keliie aflerts that he has had great
fuccefs by putting a tourniquet on the affe&ed limb, fo as to
comprefs the artery, and then by taking blood from a vein below
the bandage, as mentioned above in Podagra. Clafs IV. i. 2. 15.
17. Eryfipelas. The eryfipelas differs from the zona ignea,
and other fpecies of herpes, in its being attended with fever,
which is fometimes of the fenfitive irritated or inflammatory
kind, with ftrong and full pulfe •, and at other times with weak
pulfe and great inirritability, as when it precedes or attends
mortifications. See Clafs II. i. 3. 2.

Like the zona ignea above defcribed, it feems to be a fecond-
ary difeafe, having for its primary part the torpor or inflam-
mation of fome internal or diltant membrane, as appears from
its fo frequently attending wounds 5 fometimes fpreading from
iflues over the whole limb, or back, by fympathy with a tendon
or membrane, which is ftimulated by the peafe in them. In
its more violent degree I fuppofe that it fympathizes with fome
extenfive internal membranes, as of the liver, ftomach, or brain.
Another reafon, which countenances this idea, is, that the in-
flammation gradually changes its fituation, one part healing as
another inflames ; as happens in refpe£l to more diftant parts in
gout and rheumatifm ; and which feems to (hew, that the caufe of
the difeafe is not in the fame place with the inflammation. And
thirdly, becaufe the eryCpelas of the face and head is liable to
afFecl: the memb ranes of the brain ; which were probably in
thefe cafes the original or primary feat of the difeafe ; and laftly,
becaufe the fits of eryfipelas, like thofe of the gout, are liable
to return at certain annual or monthly periods, as further treat-
ed of in Clafs II. i. 3. 2.

Many cafes of eryfipelas from wounds or bruifes are related
in Default's Surgical Journal, Vol. II. in which poultices are
faid to do great injury, as well as oily or fatty applications. Sat-
urnine folutions were fometimes ufed with advantage. A
grain of emetic tartar given to clear the ftomach and bo\vels, is
faid to be of great fervice.

1 8. Tejlittm tumor in gonorrhoea. Mf? Hunter in his Treat! u;
on the Venereal Difeafe obferves, that the tumor of the teiles in
gonorrhoea arifes from their fympathy with the inflammation of
the urethra ; and that they are not fimilar to the actions arifing
worn the application of venereal matter, whether by abforption

or

39* DISEASES CLASS IV. i. 2< 19'*

or otherwife j as they feldom or never fuppurate ; and when
fuppuration happens, the matter produced is not venereal. Trea-
tife on Venereal Difeafe, p. 53.

19. Teftium tumor inparotidiu. The fympathy between fome
parts about the throat and the genitals has been treated of in
Clafs IV". i. 2. 7. The fwelling of the teftes, when that of
the parotis fubfides, feems to arife from the aflbciation of fuo
ceflive aclion ; as the tenfion of the penis in hydrophobia appears
to arife from the previous fynchronous aflbciations of the fenfi-
tive motions of thefe parts ; but the manner of the production
of both thefe afibciations is yet very obfcure, In women a
fwelling of the breads often fucceeds the decline of the mumps
by another wonderful fympathy. See Clafs IV. i. 2. 7. and
I. i. 2. 15. In many perfons a delirium fucceeds the fwelling
of the parotis, or the fubfequent ones of the teftes or breads ;
which is fometimes fatal, and feems to arife from a fympathy of
fuccefTive action, and not of fynchronous aftion, of the mem*
branes of the brain with thofe of the parotid glands. Sometimes
a ftupor comes on inftead of this delirium, which is relieved by
fomenting the fliaved head for an hour or two. See Clafs II.
i. 3. 4.

DRDO

CLASS IV. i. 3. i. OF ASSOCIATION. 393

ORDO I.

Increafed Affodale Motions.

GENUS III.

Catenated with Voluntary Motions.
SPECIES.

1. Deglutitio invita. "When any one is told not to fwal°
low his faliva, and that efpecially if his throat be a little fore,
he finds a neceflity of immediately fwalfowing it ; and this
the more certainly, the more he voluntarily endeavours not to
do fo.

In this cafe the voluntary power exerted by our attention td
the pharynx renders it more fenfible to irritation, and therefore
occafions it to be more frequently induced to fwallow the fali-
va. Here the irritation induces a volition to fwallow it, which
is more powerful than the defire not to fwallow it. See XXIV.
1.7. So in reverie, when the voluntary power was exerted
on any of the fenfes, as of fight or tafte, the objects of thofe
fenfes became perceived ; but not otherwife. Sect. XIX. 6.
This is a troublefome fymptom in fome fore throats.

M. M. Mucilage, as fugar and gum arabic.

Warm water held in the mouth frequently, a fomentation to
the inflamed throat.

2. Niflitatio inviia. Involuntary winking with the eye-lids,
and twitchings of the face, are originally induced by an en-
deavour to relieve fome difagreeable fenfations about inflamed
eyes, as the dazzling of light ; and afterwards thefe motions be-
come catenated with other motions or fenfations, fo as not to be
governed by the will. Here the irritation firft produces a vo-
lition to wink, which by habit becomes ftronger than the anti-
volition not to wink.

This fubjedt is rendered difficult from the common accepta-
tion of the word, volition, including previous deliberation, as
well as the voluntary exertion, which fucceeds it. In the voli-
tions here fpoken of there is no time for deliberation or choice
of objects, but the voluntary act immediately fuccteds the fen-
fatiorj which excites it.

M. M. Cover the affected parts with a flicking plafter or a
blifter. Pafs a fine needle and thread through a part of the
iliin over the mufcle, which moves, and attach the other end of

VOL. II, C c c the

394 DISEASES CLASS IV. 1.3.3,

the thread by a {licking plafter to a diftant part. An iflue be-
hind the ear. To praclife daily by a looking-glafs to ftop the
motions with the hand. See the cure of a cafe of the leaping of
a mufcle of the arm, Sec~l. XVII. i. 8. See Convulfio debi*
lis, Clafs III. i. i. 5. Frequent eleclric fparks, or very flight
(hocks. .

3. Rifus invitus. Involuntary laughter. When the pleafure
ariftng from new combinations of words and ideas, as in puns ;
or of other circumftances, which are fo trivial, as to induce no
voluntary exertion to compare or confider their prefent impor-
tance or their future confeqiience ; the pleafure is liable to rife
into pain 5 that is, the ideas or fenfual motions become exerted
too violently for want of fome antithefiftic ideas ; in the fame
manner as thofe mufcles, which have weak antagonifts,as thpfe of
the calf of the leg, are liable to fall into cramp or painful contrac-
tion. In this fituation a fcream is begun to relieve this pain of
ideas too violently exerted, which is ftopped again foon, as ex-
plained in Sea. XXXIV. i. 4. and Clafs III. i. i. 4. and IV.

2. 3. 3.

The pain, into which this pleafure rifes, which would excite
the fcream of laughter, has been felt forcibly by every one ;
when they have been under fuch circumftances, as have induc-
ed them to reftrain it by a counter-volition ; till at length the
increafed affociate motions produce fo much pain as to over-
come the counter-volition, and the patient burfls out into inde-
cent laughter, contrary to his will in the common acceptation of
that word.

4. Litfus digitorum invitus. An awkward, playing with the
fingers in fpeaking in public. Thefe habits are begun through
bamfulnefs, and feem rather at fir ft defigned to engage the at-
tention in part, and thus prevent the difagreeable ideas of mau*
vaife honte ; as timorous boys whiftle, when they are obliged to
walk in the dark ; and as it is fometimes neceflary to employ
raw foldiers in perpetual manoeuvres, as they advance to the
firft charge.

5. Unguium morjiuncula invita. Biting the nails is a de-
praved habit arifing from fimilar caufes as thofe of the laft arti-
cle.

M. M. Dip the fingers in folutiori of aloes.

6. Vigilia invita. Watchfulnefs, where the perfon wifhes
and endeavours to fall afleep, properly belongs to this place, as
the wifh or volition to fleep prevents the defired effect ; be-
caufe fleep confifts in an abolition of volition. See Clafs III.

I. 2. 3.

ORDO

CLASS IV. i. 4. i. OF ASSOCIATION. 395

ORDO I.

Increafed Affociate Motions,
GENUS IV.

Catenated with External Influences,

SPECIES,

1 . Vita ovi. Life of an egg. The eggs of fowls were (hewn
by Mr. J. Hunter to refift the freezing procefs in their living
ftate more powerfully than"when they were killed by having the
yolk and white fhook together. Philof. Tranf. It may be afk-
cd, does the heat during the incubation of eggs act as a ftimulus
exciting the living principle into activity ? Or does it act fim-
ply as a caufa fine qua non, as an influence, which penetrating
the mafs, removes the particles of it to a greater diftance from
each other, fo as to allow their movement over each other, in the
fame manner as heat is conceived to produce the fluidity of wa-
ter ; not by ftimulus, but by its penetrating influence ? Or may
elementary heat i» its uncombined ftate be fuppofed to act only
as an influence neceflary to life in its natural quantity 5 whence
torpor and death follow the eduction of it from the body ; but
in its increafed ftate above what is natural, or ufual, that it acts
as a ftimulus •, which we have a fenfe to perceive j and which
excites many parts of the fyftem into unnatural action ? Sec
ClafsIV. i. i. C.

2. Vita hiemi-dormientium. The torpor of infects, and birds,
and quadrupeds, during the cold feafon, has been called fleep ;
but I fuppofe it muft differ very much from that ftate of animal
life, fmce not only all voluntary power is fufpended, but fenfa-
tion and vafcular motion have qeafed, and can only be reftored
by the influence of heat. There have been related inftances of
fnails, which have recovered life and motion on being put into
water after having experienced many years of torpidity, or ap-
parent death, in the cabinets of the curious. Here the water as
well as the heat are required not only as a ftimulus, but as a
caufa fine qua non of fluidity and motion, and confequent life.

3. Pullulatio arboruni. The annual revivefcence of the buds
of trees feems not only to be owing to the influence of the re-
turning warmth of the fpring, but alfo to be catenated with fo-
lar gravitation -, becaufe feeds and roots and buds, which are
analogous to the eggs of animals, put forth their fhoots by a lefs

quantity

DISEASES CLASS IV. i. 4. 4,

quantity of heat in fpring, than they had undergone in the lat-
ter part of autumn, which may however be afcribed to their
previous torpid ftate, and confequent accumulation of fenforial
power, or irritability •, as explained in Botanic Garden, Part II.
Cant. I. 1. 322. note. Other circumftances, which counte-
nance the idea, that vegetation is affected by folar gravitation, as
well as by heat, may be obferved in the ripening of the feeds of
plants both in thofe countries where the fummers are mort,
and in thofe where they are long. And by fome flowers clof-
ing their Sells at noon, or foon after ; and hence feem to fleep
rather at folar diurnal periods, than from the influence of cold,
or the deficiency of light.

4. Orgfifmatis venerei periodus. The venereal orgafm of birds
and quadrupeds commences or returns about the vernal or au-
tumnal equinoxes, and thence feems in refpect to their great
periods to be governed by folar influence. But if this orgafm
be difappointed of its object, it is faid to recur at about month-
ly periods, as obferved in mares and bitches, in this refpect re-
fem'oling the female catamenia. See Sect. XXXVI. 2. 3. and
Sed. XVI. 13.

5. Brachti concujjlo eleElrica. The movement of the arm,
even of a paralytic patient, when an electric mock is pafled
through it, is owing to the ftimulus of the excefs of electricity.
When a piece of zinc and another of filver, each about the fize
of a crown-piece, are placed one under the upper lip, and the
other on the tongue, fo as the outer edges may be brought into
contact, there is an appearance of light in the eyes, as often as
the outer edges of thefe metals are brought into contact or fep-
arated \ which is another inftance of the ftimulus of the pafTage
of electric {hocks through the fibres of the organs of fenfe, as
•well as through the mufcular fibres. See Seel. XII. i. i. But
in its natural ftate electricity feems only to act as an influence
pn animal and vegetable bodies \ of the falutary or injurious ef-
fects of which we have yet no prec\fe knowledge.

Yet if regular journals were kept of the variations of atmof-
pheric electricity, it is probable fome difcoveries of its influence
on our fyftem might in time be difcovered. For thispurpofe a
machine on the principle of Mr. Bennet's electric doubler might
be applied to the pendulum of a clock, fo as to manifeft, and
even to record the daily or hourly variations of aerial electricity.
Which has already been executed, and applied to the pendu-
lum of a Dutch wooden clock, by Mr,. Bennet, curate of Wirkf-
worth in Derbyshire.

Befides the variations of the degree or kind of atmofpheric
electricity, fome animals, and fome men, feem to poflefs a great-
er

CLASS IV. i . 4. 6. OF ASSOCIATION. 397

er power of accumulating this fluid in themfelves than others^
Of which a famous hiftory of a Ruffian prince was lately pub*
lifhed ; who, during the clear and fevere frofts of that country,
could not move himfelf in bed without luminous corrufcations.
Such may have been the cafe of thofe people, who have been
related to have taken fire fpontaneoufly, and to have been reduced
to ames. The electric concuffion from the gymnotus electricus,
and torpedo, are other inftances of the power of the animal fyf-
tem to accumulate electricity, as in thefe it is ufed as a weapon
of defence, or for the purpofe of taking their prey.

Some have believed that the accumulation or pafTage of the
magnetic fluid might affect the animal fyftem, and have afierted
that the application of a large magnet to an aching tooth has
quickly effected a cure. If this experiment is again tried in
odontalgia, or hemicrania, the painful membrane of the tooth
or head fhould be included between the fouth and north poles
of a horfe-fhoe magnet, or between the contrary poles of two
different magnets, that the magnetifm may be accumulated on
the torpid part.

6. Qxygenatio fanguinis. The variation of the quantity of
oxygen gas exifting in the atmofphere muft afFecl: all breathing
animals ; in its excefs this too muft be efteemed a ftirnulus ;
but in its natural quantity would feem to aft as an influence,
or caufe, without which animal life cannot exift even a minute.
It is hoped that Dr. Beddoes's plan for a pneumatic infirmary,
for the purpofe of putting this and various other airs to the tefl
of experiment, will meet with public encouragement, and ren-
der confumption, aflhma, cancer, and many difeafes conquera-
ble, which at prefent prey with unremitted devaftation on all
orders and ages of mankind.

7. HumeRatio corporis. Water, and probably the vapour of
water diflblved or diflfufed in the atmofphere, unites by mechan-
ical attraction with the unorganized cuticle, and foftens and en-
larges it ; as may be feen in the loofe and wrinkled fkin of the
hands of wafher women ; the fame probably occurs to the mu-
cous membrane of the lungs in moift weather ; and by thick-
ening it increafes the difficulty of refpiration of fome people,
who are faid to be afthmatical. So far water may be faid to
aft as an influx or influence, but when it is taken up by the
mouths of the abforbent fyftem, it muft excite thofe mouths into
action, and then acts as a ftimulus.

There appears from hence to be four methods by which ani-
mal bodies are penetrated by external things, i. By their ftim-
ulus, which induces the abforbent veflels to imbibe them. 2. By
mechanical attraction, as when water foftens the cuticle. 3. By

chemical

DISEASES CLASS IV. i. 4. 7.

chemical attraction, as when oxygen pafTes through the menu
branes of the air-veflels of the lungs, and combines with the
blood. And laftly, by influx without mechanical attraction,
chemical combination, or animal abforption, as the univerfal
fluids of heat, gravitation, electricity, magnedfm, and perhaps
of other etherial fluids yet unknown.

ORDO

CLASS IV* 2. i. OF ASSOCIATION. 399

ORDO II.

Decreafed AJJociate Motions*

GENUS I.
Catenated with irritative Motion*.

As irritative mufcular motions are attended w ith pain, when
they are exerted too weakly, as well as when they are exerted
too ftrongly •, fo irritative ideas become attended with fenfation
when they are exerted too weakly, as well as when they are ex-
erted too ftrongly. Which accounts for thefe ideas being at-
tended with fenfation in the various kinds of Vertigo defcribed
below.

There is great difficulty in tracing the immediate caufe of the
deficiencies of action of fome links of the aflbciations of irrita-
tive motions ; firft, becaufe the trains and tribes of motions,
which compofe thefe links, are fo widely extended as to embrace
almoft the whole animal fyftem ; and fecondly, becaufe when
the firft link of an aflbciated train of actions is exerted with too
great energy, the fecond link by reverfe fympathy may be affected
with torpor. And then this fecond link may tranfmit, as it
were, this torpor to a third link, and at the fame time regain its
own energy of action ; and it is poflible this third link may
in like manner tranfmit its torpor to a fourth, and thus regain
its own natural quantity of motion.

I (hall endeavour to explain this by an example taken from
fenfitive aflbciated motions, as the origin of their difturbed ac-
tions is more eafily detected. This morning 1 faw an elderly
perfon, who had gradually loft all the teeth in his upper jaw,
and all of the under except three of the molares ; the laft of
thefe was now loofe, and occafionally painful ; the fangs of
which were almoft naked, the gums being much wafted both
within and without the jaw. He is a man of attentive obfer-
vation, and aflured me, that he had again and again noticed,
that, when a pain commenced in the membranes of the alveolar
procefs of the upper jaw oppofite to the loofe tooth in the under
one (which had frequently occurred for feveral days paft) the
pain of the loofe tooth ceafed. And that, when the pain after-
wards extended to the ear and temple on that fide, the pain in
the membranes of the upper jaw ceafed. In this cafe the mem-
branes of the alveolar procefs of the upper jaw became torpid,
and confequehtly painful, by their reverfe fympathy with the

tOO

400 DISEASES CLASS IV. 2. 1. 1*

too violent actions of the inflamed membranes of the loofe tooth 5
and then by a fecondary fympathy the membranes about the
car and temple became torpid, and painful j and thofe of the
alveolar procels of the upper jaw regained their natural quanti-
ty of acHon, and ceafed to be painful. A great many more nice
and attentive obfervations are wanted to elucidate thefe curious
circumftances of affociation, which will be found to be of the
Created importance in the cure of many difeafes, and lead us to
the knowledge of fever.

SPECIES.

1. Cutis frigida pranforum. Chillnefs after dinner frequently
attends weak people, or thofe who have been exhaufted by exer-
cife ; it arifes from the great expenditure of the fenforial power
on the organs of digeftion, which are ftimulated into violent
action by the aliment; and the veiTels of the fkin, which are af-
fociated with them, become in fome meafure torpid by reverfe
fympathy ; and a confequent chillnefs fucceeds with lefs abforp-
tion of atmofpheric moifture. See the fubfequent article.

2. Pallor urina pranforum. The palenefs of urine after a
full meal is an inftance of reverfe aflbciation ; where the fecond-
ary part of a train of aflbciate motions acts with lefs energy in
confequence of the greater exertions of the primary part. Af-
ter dinner theabforbent vefTels of the ftomach and interlines are
ftimulated into greater action, and drink up the newly taken al-
iment; while thofe, which are fpread in great number, on the
neck of the bladder, abforb lefs of the aqueous part of the urine
than ufual, which is therefore difcharged in a more dilute ftate 5
and has been termed crude by fome medical writers, but it only
indicates, that fo great a proportion of the fenforial power is ex-
pended on digeftion and abforption of the aliment, that other
parts of the fyftem act for a time with lefs energy. See Clafs IV.
i. i. 6*

3. Pallor urin* a f rigor e cutaneo. There is a temporary dif-
charge of pale water, and a diarrhoea, induced by expofing the
[kin to the cold air j as is experienced by boys, who ftrip them*
felves before bathing. In this cafe the mouths of the cutaneous
lymphatics become torpid by the fubduction of their accuftom-
ed degree of heat, and thofe of the bladder and inteftines be-
come torpid by direct fympathy ; whence lefs of the thinner part
of the urinary fecretion, and of the mucus of the inteftines, is
reabforbed. See Se&. XXIX. 4. 6. This effect of fuddenly
tooling the (kin by the afperfion of cold water has been ufed
with fuccefs in coftivencfs, and has produced evacuations, when

other

CLASS IV. 2. i. 4. OF ASSOCIATION. 401

other means have failed. When young infants ate afflicted
with griping joined with coftivenefs, I have fometimes directed
them to be taken out of a warm bed, and carried about for i
few minutes in a cool room, with almoft inftant relief.

4. Palkr ex fgritudine. When ficknefs of ftomach firft oc-
curs, a palenefs of the (kin attends it ; which is owing to the
aflbciation or catenation between the capillaries of the ftomach
and the cutaneous ones ; which at firft act by direct fympathy.
But in a ihort time there commences an accumulation of the
fenforial power of aflbciation in the cutaneous capillaries during
their ftate of inactivity, and then the ikin begins to glow, and
fweats break out, from the increafed actions of the cutaneous
glands or capillaries, which is now in reverfe fympathy with
thofe of the ftomach. So in continued fevers, when the ftom-
ach is totally torpid, which is known by the total averfion to
folid food, the cutaneous capillaries are by reverfe fympathy in
a perpetual ftate of increafed activity, as appears from the heat
of the fkin.

5. Dyfpnaea a bafaeo frigido. The difficulty of breathing on
going up to the middle in cold water is owing to the irritative
aflbciation or catenation of the action of the extreme veflels of
the lungs with thofe of the fkin. So that when the latter are
rendered torpid or inactive by the application of fudden cold,
the former become inactive at the fame time, and retard the
circulation of the blood through the lungs, for this difficulty of
breathing cannot be owing to the preflure of the water imped-
ing the circulation downwards, as it happens equally by a cold
(hower-bath, and is foon conquered by habitual immerfions.
The capillaries of the fkin are rendered torpid by the fubduc-
tion of the ftimulus of heat, and by the consequent diminutions
of the fenforial power of irritation. The capillaries of the lungs
are rendered torpid by the diminution of the fenforial power of
aflbciation, which is now excited in lefs quantity by the leflen-
ed actions of the capillaries of the {kin, with which they are
catenated. So that at this time both the cutaneous and pulmo-
nary capillaries are principally actuated, as far as they have any
action, by the ftimulus of the blood. But in a fhort time the
fenforial powers of irritation, and of aflbciation, become accu-
mulated, and very energetic action of both thefe membranes
fucceeds. Which thus refemble the cold and hot fit of an in-
termittent fever.

6. Dyjpepfta a pedibus frigidis. When the feet are long cold,
as in riding in cold and wet weather, fome people are very-
liable to indigeftion and confequent heart-burn. The irritative
motions of the ftomach become torpid, and do their office of di-

VOL. IT, I^D d geftibn

402 DISEASES CLASS IV. 2. i. 7,

geftion imperfe&ly, in confequence of their aflbciation with the
torpid motions of the veflels of the extremities. Fear, as it pro-
duces palenefs and torpidity of the fkin, frequently occafions tem-
porary indigeftion in confequence of this aflbciation of the vef-
fels of the {kin with thofe of the ftomach ; as riding in very bad
roads will give flatulency and indigeftion to timorous people.

A fhort expofure to cold air increafes digeftion, which is then
owing to the reverfe fympathy between the capillary veflels of
the {kin, and of the ftomach. Hence when the body is expofed
to cold air, within certain limits of time and quantity, a reverfe
fympathy of the ftomach and the {kin firft occurs, and after-
wards a direcl: fympathy. In the former cafe the expendi-
ture of fenforial power by the (kin being leflened, but not its
production in the brain ; the fecond link of the aflbciation, viz.
the ftomach, acquires a greater (hare of it. In the latter cafe,
by the continuation of the deficient ftimulus of heat, the torpor
becomes extended to the brain itfelf, or to the trunks of the
nerves ; and univerfal inactivity follows.

7. TuJ/is a pedibus frigidis. On {landing with the feet in
thawing fnow, many people are liable to inceflant coughing.
From the torpidity of the abforbent veflels of the lungs, in con-
fequence of their irritative aflbciatiens with thofe of the (kin,
they ceafe to abforb the faline part of the fecreted mucus ; and
a cough is thus induced by the irritation of this faline fecretion ;
which is fimilar to that from the noftrils in frofty weather, but
differs in refpedl: to its immediate caufe ; the former being from
aflbciation with a diftant part, and the latter from defecl: of
the ftimulus of heat on the noftrils themfelves. See Catarrhus
frigidus, Clafs I. 2. 3. 3.

8. Tuffls hepatica. The cough of inebriates, which attends
the enlargement of the liver, or a chronical inflammation of its
upper membrane, is fuppofed to be produced by the inconveni-
ence the diaphragm fuflers from the compreflion or heat of the
liver. It differs howevex eflentially from that attending hepati-
tis, from its not being accompanied with fever. And is per-
haps rather owing to irritative aflbciation, or reverfe fympathy,
between the lungs and the liver. As occurs in flieep, which
are liable to a perpetual dry cough, when the fluke-worm is prey-
ing on the fubftance of their livers. See Clafs II. i. I. 5.

M. M. From half a grain to a grain of opium twice a day.
A drachm of mercurial ointment rubbed on the region of the
liver every night for eight or ten times.

9. Tuffis arthritica. Gout-cough. I have feen a cough,
which twice recurred at a few years diftance in the fame per-
!•!!, during his ffts of tke gout, with fuch pertinacity and vio-
lence

CLASS IV. 2. 1. 10. OF ASSOCIATION. 403

lence as to refift venefecfion, opiates, bark, blifters, mucilages,
and all the ufual methods employed in coughs. It was for a
time fuppofed to be the hooping-cough, from the violence of the
action of coughing ; it continued two or three weeks, the pa-
tient never being able to fleep more than a few minutes at once
during the whole time, and being propped up in bed with pil-
lows night and day.

As no fever attended this violent cough, and but little expec-
toration, and that of a thin and frothy kind, I fufpected the
membrane of the lungs to be rather torpid than inflamed, and
that the faline part of the mucus not being abforbed ftimulated
them into perpetual exertion. And laftly, that though the
lungs are not fenfible to cold and heat, and probably therefore
lefs mobile, yet, as they are neverthelefs liable to confent with
the torpor of cold feet, as defcribed in Species 6 of this Genus,
I fufpected this torpor of the lungs to fucceed the gout in the
feet, or to aft a vicarious part for them.

10. Vertigo rotatoria. In the vertigo from circumgyration
the irritative motions of vifion are increafed ; which is evinced
from the pleafure that children receive on being rocked in a
cradle, or by fwinging on a rope. For whenever fenfation arif-
es from the production of irritative motion with lefs energy
than natural, it is of the difagreeable kind, as from cold or hun-
ger ; but when it arifes from their production with greater en-
ergy than natural, if it be confined within certain limits, it is of
the pleafurable kind, as by warmth or wine. With thefe in-
creafed irritative motions of vifion, I fuppofe thofe of the ftom-
ach are performed with greater energy by direct fympathy ; but
when the rotatory motions, which produce this agreeable verti-
go, are continued too long, or are too violent, ficknefs of the
llomach follows 5 which is owing to the decreafed action of that
organ from its reverfe fympathy with the increafed actions of
the organ of vifion. For the expenditure of fenforial power by
the organ of vifion is always very great, as appears by the fize
of the optic nerves ; and is now fo much increafed as to deprive
the next link of aiTociation of its due (hare. As mentioned in
Species 6 of this Genus.

In the fame manner the undulations of water, or the motions
of a fhip, at firft give pleafure by increafing the irritative mo-
tions belonging to the fenfe of vifion ; but produce ficknefs at
length by expending on one part of the alfociated train of irri-
tative actions too much of that fenforial power, which ufually
ferved the whole of it ; whence ibme other parts of the train ac-
quire too little of it, and perform their actions in confequence too
feebly, and thence become attended with difagreeable fenfation,

It

DISEASES CLASS IV. 2. i. ic.

It mufl alfo be obferved, that when the irritative motions are
{timulated into unufual a&ion, as in inebriation, they become
fucceeded by fenfation, either of the pleafurable or painful kind 5
and thus a new link is introduced between the irritative mo-
tions thus excited, and thofe which ufed to fucceed them ;
whence the aflbciation is either diflevered or much weakened,
and thus the vomiting in fea-ficknefs occurs from the defect of
the power of aflbciation, rather than from the general deficiency
of fenforial power.

When a blind man turns round, or when one, who is not
blind, revolves in the dark, a vertigo is produced belonging to
the fenfe of touch. A blind man balances himfelf by the fenfe
of touch, which being a lefs perfect means of determining fmall
quantities of deviation from the perpendicular, occafions him to
walk mpre carefully upright than thofe, who balance themielves
by vifion. When he revolves, the irritative aflbciations of the
mufcular motions, which were ufed to preferve his perpendicu-
larity, become difordered by their new modes of fucceffive ex-
ertion ; and he begins to fall. For his feet now touch the floor
in manners or directions different from thofe they have been ac-
cuftomed to ; and in confequence he judges lefs perfectly of the
lituation of the parts of the floor in refpeft to that of his own
body, and thus lofes his perpendicular attitude. This may be
illuftrated by the curious experiment of crofiing one finger over
the next to it, and feeling a nut or bullet with the ends of them.
When, if the eyes be clofed, the nut or bullet appears to be two,
from the deception of the fenfe of touch.

In this vertigo from gyration, both of the fenfe of fight, and
pf the fenfe of touch, the primary link of the aflbciated irritative
motions is increafed in energy, and the fecondary ones are in-
creafed at firfl by direct fympathy ; but after a time they become
decreafed by reverfe fympathy with the primary link, owing to
the cxhauftion of fenforial power in general, or to the power of
Aflbciation in particular ; becaufe in the laft cafe, either pleafur-
able or painful fenfation has been introduced between the link*
of a train of irritative motions, and has diflevered, or much en-
feebled them.

Dr. Smyth, in his Eflay on Swinging in Pulmonary Confump-
tion, has obferved, that fwinging makes the pulfe flower. Dr.
Ewart of Bath confirmed this obfervation both on himfelf and
on Col. Cathcart, who was then heclic, and that even on fhip-
board, where fome degree of vertigo might be fuppofed previ-
oufly to exift. Dr. Currie of Liverpool not only confirmed this
obfervation frequently on himfelf, when he was alfo phthifical,
but found that equitation had a fimilar effeft on him, uniform-

CLASS IV. 2.1.10. OF ASSOCIATION. 405

ly retarding his pulfe. This curious circumftance cannot arife
from the general effect of exercife, or fatigue, as in thofe cafes
the pulfe becomes weaker and quicker ; it muft therefore be af-
cribed to a degree of vertigo, which attends all thofe modes of
motion, which we are not perpetually accuftomed to.

Dr. Currie has further obferved, that " in cafes of great de-
bility the voluntary mufcular exertion requifite in a fwing pro-
duces wearinefs, that is, increafes debility ; and that in fuch in-
flates he had frequently noticed, that the diminution of the fre-
quency of the pulfe did not take place, but the contrary." Thefc
circumftances may thus be accounted for.

The links of aflbciation, which are effected in the vertigo oc-
cafioned by unufual motion, are the irritative motions of the
fenfe of vifion, thofe of the ftomach, and thofe of the heart and
arteries. When the irritative ideas of vifion are exerted with
greater energy at the beginning of vertigo, a degree of fenfation
is excited, which is of the pleafurable kind, as above mentioned 5
whence the aifociated trains of irritative motions of the ftomach,
and hean, and arteries, act at firft with greater energy, both by
direct fympathy, and by the additional fenforial power of fenfa-
tion. Whence the pulfe of a confumptive patient becomes ftrong-
er and confequently flower.

But if this vertigo becomes much greater in degree or dura-
tion, the firft link of this train of aflbciated irritative motions
expends too much of the fenforial power, which was ufually em-
ployed on the whole train ; and the motions of the ftomach be-
come in confequence exerted with lefs energy. This appears,
becaufe in this degree of vertigo fickuefs fupervenes, as in fea-
(icknefs, which has been (hewn to be owing to lefs energetic ac-
tion of the ftomach. And the motions of the heart and arteries
then become weaker, and in confequence more frequent, by their
direct fympathy with the lelfened actions of the ftomach. See
Supplement, I. 12. and Clafs II. i. 6. 7. The general weak-
nefs from fatigue is owing to a fimilar caufe, that is, to the too
great expenditure of fenforial power in the increafed actions of
one part of the fyftem, and the confequent deficiency of it in
other parts, or in the whole.

The abatement of the heat of the (kin in hectic fever by
fwinging, is not only owing to the increafed ventilation of cool
air, but to the reverfe fympathy of the motions of the cutaneous
capillaries with thofe of the heart and arteries ; which occurs in
all fevers with arterial debility, and a hot or dry fkin. Hence
during moderate fwinging the action of the heart and arteries
becomes ftronger and flower, and the action of the capillaries,
which was before too great, as appeared by the heat of the flcin,

is

406 DISEASES CLASS IV. 2.1.11.

is now leffened by their reverfe fympathy with that of the hearfc
and arteries. See Supplement, I. 8.

1 1 . Fertigo vifualis. Vifual vertigo. The vertigo rotatoria
defcribed above, was induced by the rotation or undulation of
external objects, and was attended with increafed action of the
primary link of the ailbciated motions belonging to vifion, and
with confequent pleafure. The vertigo vifualis is owing to lefs
perfect vifion, and is not accompanied with pleafurable fenfa-
tion. This frequently occurs in ftrokes of the palfy, and is then
fucceeded by vomiting ; it fometimes precedes epileptic fits,
and often attends thofe, whofe fight begins to be impaired by
age.

In this vertigo the irritative ideas of the apparent motions of
objects are lefs diftinct, and on that account are not fucceeded
by their ufual irritative afibciations of motion ; but excite our
attention. Whence the objects appear to librate or circulate
according to the motions of our heads, which is called dizzinefs ;
and we lofe the means of balancing ourtelves, or preferving our
perpendicularity, by viiion. So that in this vertigo the motions
of the aflbciated organs are decreafed by direct fympathy with
their primary link of irritation ; as in the preceding cafe of fea-
(icknefs they are decreafed by reverfe fympathy.

When vertigo affects people about fifty years of age, their
fight has generally been fuddenly impaired ; and from their lefs
accurate vifion they do not foon enough perceive the apparent
motions of objects ; like a perfon in a room, the walls of which
are ftained with the uniform figures of lozenges, explained in
Sect. XX. i. This is generally afcribed to indigeftion ; but it
ceafes fpontaneoufly, as the patient acquires the habit of balanc-
ing himfelf by lefs diftinct objects.

A gentleman about 50 was feized with an uncommon degree
of vertigo, fo as to fall on the ground, and not to be able to turn
his head, as he fat up either in his chair or in his bed, and this
continued eight or ten weeks. As he had many decayed teeth
in his mouth, and the vertigo was preceded and fometimes ac-
companied by pains on one fide of his head, the difeafe of a
tooth was fufpected to be the caufe. And as his timidity was
too great to admit the extraction of thofe which were de-
cayed ; after the trial of cupping repeatedly, fomentations on
his head, repeated blifters, with valerian, Peruvian bark, mufk,
opium, and variety of other medicines ; mercurials were ufed,
both externally and internally, with defign to inflame the mem-
branes of the teeth, and by that means to prevent the torpor of
the action of the membranes about the temple, and parietal bone;
which are catenated with the membranes of the teeth by irrita--

tive

CLASS IV. 2. 1. 12. OF ASSOCIATION. 407

tive aflbciation, but not by fenfitive aflbciation. The event was,
that as foon as the gums became fore with a flight ptyalifm, the
pains about the head and vertigo gradually diminiflied,and during
the forenefs of his gums entirely ceafed ; but I believe recurred
afterwards, though in lefs degree.

The idea of inflaming the membranes of the teeth to pro-
duce increafed fenfation in them, and thus to prevent their
irritative connexion with thofe of the cranium, was taken from
the treatment of trifmus, or locked jaw, by endeavouring to in-
flame the injured tendon ; which is faid to prevent or to remove
the fpafm of the mufcles of the jaw. See Clafs III. i. I. 13.
and 15.

M. M. Emetics. Blifters. Ifiues' about the head. Extrac-
tion of decayed teeth.' Slight falivation. Sorbentia. Incitantia.
Galvanifm.

A lady was fuddenly feized with violent vertigo, fo as to pre-
vent her from walking fafely acrofs the room, this was attended
with confiderable diminution of fight ; and after various evacua-
tions, and other medicines, had been tried without cure, Mr.
Volta's galvanic pillar was ufed, confiding of about 30 plates of
filver, the diameter of about one inch and half, and as many
zinc plates, with interpofed circles of cloth moiftened with brine.
A wire connected with each end of this pillar was approached
repeatedly to her temples, which were previoufly moiftened with
brine, and 100 galvanic fhocks were daily patted through the
optic nerves, which foon appeared to be of great advantage, and
(he foon recovered, both from the vertigo and dimnefs of fight.
12. Vertigo ebriofa. Vertigo from intoxicatign is owing to
the aflbciation of the irritative ideas of vifion with the irritative
motions of the ftomach. Whence when thefe latter become
much increafed by the immoderate ftimulus of wine, the irrita-
tive motions of the retina are produced with lefs energy by re-
verfe fympathy, and become at the fame time fucceeded by fen-
fation in confequence of their decreafed action. See Seel. XXI.
3. and XXXV. 1.2. So converfely when the irritative mo-
tions of vifion are increafed by turning round, or by our unac-
cuftomed agitation at fea, thofe of the ftomach become inverted
by reverfe fympathy, and are attended in confequence with difa-
greeable fenfation. Which decreafed action of the ftomach is
in confequence of the increafed expenditure of the fenforial
power on the irritative ideas of vifion, as explained in Vertigo
rotatoria.

Whence though a certain quantity of vinous fpirit flimulutes
the whole fyftem into increafed action, and perhaps even in-
creafes the fecretion of fenforial power in the brain •, yet .is foon

as

4o8 DISEASES CLASS IV. 2. i. 13,

as any degree of vertigo is produced, it is a proof, that by the
too great expenditure of fenforial power by the ftomach, and its
neareft afibciated motions, the morediftant ones, as thofe ofvif-
km, become imperfectly exerted. From hence may be deduc-
ed the necefTny of exhibiting wine in fevers with v/eak pulfe
in only appropriated Quantity ; becaufe if the leaft intoxication
be induced, fome part of the iyftem muft act more feebly from
the unnecefTary expenditure of fenforial power.

13. Vertigo febriculofa. Vertigo in fevers either proceeds
from the general deficiency of fenforial power belonging to the
irritative aflbciations, or to a greater expenditure of it on fome
links of the trams and tribes of afTociated irritative motions.
There is however a (lighter vertigo attending all people, who
have been long confined in bed, on their firft riling ; owing to
their having been fo long unufed to the apparent motions of ob-
jects in their erect pofture, or as they pafs by them, that they
have loft in part the habit of balancing themfelves by them.

14. Vertigo cerebrcfa. Vertigo from injuries of the brain,
either from external violence or which attend paralytic attacks,
are owing to the general deficiency of fenforial power. In
thefe dirtrefsful fituations the vital motions, or thofe immediate-
ly neceffary to life, claim their fhare of fenforial power in the
iirfl place, otherwife the patient mull die 5 and thofe motions,
which are lefs neceflary, feel a deficiency of it, as thefe of the
organs of fenfe and mufcles ; which conftitute vertigo ; and laft-
ly the voluntary motions, which are (lill lefs immediately necef-
fary to life, are frequently partially deftroyed, as in palfy j or
totally, a$ in apoplexy.

15. Murmur aurium vertiginofum. The vertiginous murmur
in the ears, or noife in the head, is compared to the undulations
of the found of bells, or to the humming of bees. It frequent-
ly attends people about 60 years of age •, and like the vifual ver-
tigo defcribed above is owing to our hearing lefs perfectly from
the gradual inirritability of the organ on the approach of age ;
and the difagreeable fenfation of noife attending it is owing to
the lefs energetic action of thefe irritative motions ; which not
being fufficiently diftinct to excite their ufual aflbciations become
fucceeded by our attention, like the indiftinct view of the ap-
parent motions of objects mentioned in vertigo vifualis. This
may be better und>* flood from confidering the ufe, which
blind men make of thefe irritative founds, which they have
taught themfelves to attend to, but which efcape the notice of
others. The late blind Juftice Fielding walked for the firft
time into my room, when he once vifited me, and after fpeak-
)ng a few words faid, " This room is about 22 feet long, 18

wide,

CLASS IV. 2.1.16. OF ASSOCIATION. 409

wide, and 12 high ;" all which he guefled by the ear with great
accuracy. Now if thefe irritative founds from the partial lofs
of hearing do not correfpond with the fize or ufual echoes of
the places, where we are -, their catenation with other irritative
ideas, as thofe of vifion, becomes diflevered or difturbed ; and we
attend to them in confequence, which I think unravels this in-
tricate circumftance of noifes being always heard in the head*
when the fenfe of hearing begins to be impaired, from whatever
caufe it occurs.

This ringing in the ears alfo attends the vertigo from intoxi-
cation ; for the irritative ideas of found are then more weakly-
excited in confequence of the deficiency of the fenforial power
of aflbciation. As is known by this alfo being attended with
difagreeable fenfation, and by its accompanying other difeafes of
debility, as ftrokes on the head, fainting fits, and paralytic feiz-
ures. For in this vertigo from intoxication fo much fenforial
power in general is expended on the increafed actions of the
ftomach,and its neareft connections, as the capillaries of the {kin ;
that there is a deficiency for the purpofes of the other irritative
aflbciations of motions ufually connected with it. This auditory-
vertigo attends both the rotatory and the vifual vertigo above-
mentioned ; in the former it is introduced by reverfe fympathy$
that is, by the diminution of fenforial power ; too great a
quantity of it being expended on the increafed irritative motions
of vifion ; in the latter it is produced either by the fame caufes
which produce the vifual vertigo, or by direcl: fympathy with it.,
See Sea. XX. 7.

M. M. Stimulate the internal ear by ether, or with eflential
oil diluted with exprefled oil, or with a folution of opium in wine,
or in water. Or with fait and water. Apply a cupping glafs
over the ear. Seel. 2. 5. 6. Galvanic (hocks through the tem-
ples. See IV. 2. i. n.

1 6. TacliiS) gttftttSy olfaEius vertiginofi. Vertiginous touch,
talte, and fmell. In the vertigo of intoxication, when the patient
lies down in bed, it fometimes happens even in the dark, that
the bed feems to librate under him, and he is afraid of falling
out of it. The fame occurs to people, who are fea-fick, even
when they lie down in the dark. In thefe the irritative motions
of the nerves of touch, or irritative tangible ideas, are performed
with lefs energy, in one cafe by reverfe fympathy with the ftom-
ach, in the other by reverfe fympathy with the nerves of vifion,
and in confequence become attended with fenfation, and pro-
duce the fear of falling by other afibciations.

A vertigo of the fenfe of touch may be produced, if any one
turns round for a time with his eyes (hut, and fuddenly flops

VOL. II. EEC without

410 DISEASES CLASS IV. 4. 1. 17.

without opening them ; for he will for a time feem to be ftill
going forwards ; which is difficult to explain. See Sect. XX. 6.
In the beginning of fome fevers, along with inceflant vomit-
ing, the patients complain of difagreeable taftes in their mouth,
and difagreeable odours *, which are to be afcribed to the gen-
eral debility of the great trains, and tribes of affbciated and irrita-
tive motions, and to be explained from their direct fympathy
with the decreafed action of a fick ftomach ; or from the lefs
fecretion of fenforial power in the brain. Thefe organs of fenfe
are conftantly ftimulated into action by the faliva or by the air ;
hence, like the fenfe of hunger, when they are torpid from want
of ftimulus, or from want of fenforial power, pain or difagreea-
ble fenfation enfues, as of hunger, or faintneis, or ficknefs in
one cafe ; and the ideas of bad taftes or odours in the other.
This accords with the laws of caufation, Sect. IV. 5.

17. Pulfus mollis in vomitione. The foftnefs of the pulfe in
the act of vomiting is caufed by direct affociation between the
heart and the ftomach ; as explained in Sect. XXV. 17. A great
flownefs of the pulfation of the heart fometimes attends ficknefs,
and even with intermifiions of it, as in the exhibition of too great
a dofe of digitalis.

1 8. Pulfus intermittent a ventricule. When the pulfe firft be-
gins to intermit, it is common for the patient to bring up a lit-
tle air from his ftomach ; which if he accomplifhes before the
intermiffion occurs, always prevents it 5 whence that this debil-
ity of the heart is owing to the direct aflbciation of its motions
with thofe of the ftomach is well evinced. See Sect. XXV. 17.

I this morning faw Mr. , who has long had at times an

unequal pulfe, with indigeftion and flatulency, and occafional
afthma ; he was feized two days ago with diarrhoea, and this
morning with ficknefs, and his pulfe was every way unequal.
After an emetic his pulfe ftill continued very intermittent and
unequal. He then took fome breakfaft of toaft and butter, and
tea, and to my great furprife his pulfe became immediately per-
fectly regular, about 100 in a minute, and not weak, by this
ftimulus on his ftomach.

A perfon, who for many years had had a frequent intermif-
fion of his pulfe, and occaiional palpitation of his heart, was re-
lieved from them both for a time by taking about four drops of
a faturated folution of arfenic three or four times a day for three
or four days. As this intermiflion of the pulfe is occafioned by
the direct affbciation of the motions of the heart with thofe of
the ftomach, the indication of cure muft be to ftrengthen the ac-
tion of the ftomach by the bark. Spice. Moderate quantities

of

CLASS IV. 2. 1. 19. OF ASSOCIATION. 411

of wine. A blifter. Half a grain of opium twice a day. So-
lution of arfenic ?

19. Febris inirritativa. Inirritative fever defcribed in Clafs
I. 2. i. i. belongs to this place, as it confifts of difordered trains
and tribes of aflbciated irritative motions, with leflened actions
of the aflbciated organs. In this fever the pulfations of the
heart and arteries are weakened or leflened, not only in the
cold paroxyfm, as in the irritative fever, but alfo in the
hot paroxyfm. The capillary arteries or glands have their ac-
tions neverthelefs increased after the firft cold fit, as appears by
the greater production of heat, and the glow of arterial blood in
the cutaneous veflels ; and laftly, the actton of the fhomach is
much impaired or deftroyed, as appears by the total want of ap-
petite to folid food. Whence it would feem, that the torpid
motions of the ftomach, whatever may occafion them, are a
very frequent caufe of continued fever with weak pulfe ; and
that thefe torpid motions of the ftomach do not fufficiently ex-
cite the fenforial power of aflbciation, which contributes in
health to actuate the heart and arteries along with the irritation
produced by the ftimulus of the blood ; and hence the actions
of thefe organs are weaker. And laftly, that the accumulation
the fenforial power of aflbciation, which ought to be expended
on the motions of the heart and arteries, becomes now exerted
on the cutaneous and pulmonary capillaries. See Supplement
I. 8. and Sea. XXXV. i. i. and XXXIII. 2. 10.

I have dwelt longer on the vertiginous difeafes in this genus,
both becaufe of their great intricacy, and becaufe they feem to
open a road to the knowledge of fever, which confifts of aflbciat-
ed trains and tribes of irritative or fenfitive motions, which are
fometimes mixed with the vertiginous ones, and fometimes fep-
arate from them.

ORDO

4 1 9 PISE ASES CLASS IV. 2. 3.

ORDO II.

Decreafed AJJbc'mte Motions.
GENUS II.

Catenated with Senjitive Motions.

IN this genus the fenforial power of aflbciation is exerted with
Jefs energy, and thence the actions produced 'by it are lefs than
natural ; and pain is produced in confequence, according to the
fifth law of animal caufation, Sect. IV. This pain is generally
attended with coldnefs of the affected part, and is feldom fuc-
ceeded by inflammation of it. This decreafed action of the
ifecondary link of the aflbciated motions, belonging to this ge-
nus, is owing to the previous exhauftion of fenlbrial power either
in the increafed actions of the primary link of the aflbciated mo-
tions, or by the pain which attends them ; both which are fre-
quently the confequence of the ftimulus of fomething external
to the affected fibres.

As pain is produced either by exrefs or defect of the natural
exertions of the fibres, it is not, confidered feparately, a criteri-
on of the prefence of either. In the aflbciations belonging to
this genus the fenfation of pain or pleafure produces or attends
the primary link of the affociated motions, and very often gives
name to the difeafe.

When great pain exifts without caufing any fibrous motions,
I conjecture that it contributes to exhauft or expend the gen-
eral quantity of fenforial power ; becaufe people are fatigued
by enduring pain, till at length they fleep. Which is contrary
to what I had perhaps erroneoufly fuppofed in Sect. XXXV.
2. 3. If it caufes fibrous motions, it then takes the name of
fenfation, according to the definition of fenfation in Sect. II. 2.
9. ; and increafed fibrous action or inflammation is the confe-
quence. This circumftance of the general exhauftion of fenfo-
rial power by the exiftence of pain will afiift in explaining ma-
ny of the dileafes of this genus.

Many of the canals of the body, as the urethra, the bile-duct,
the throat, have the motions of their two extremities affociated
by having been accuftomed to feel pleafurable or painful fenfa-
tions at the fame time or in fucceffion. This is termed fenfi-
tive aflbciation, though thofe painful or pleafurable fenfations
do not caufe the motions, but only attend them ; and are thus
perhaps, ftrictly fpeaking, only catenated with them.

SPECIES.

CLASS IV. 2. 2. i. OF ASSOCIATION. 413

SPECIES.

1. Torpor gerix a dolor e dent'is. In tooth-ach there is general-
ly a coldneis of the cheek, which is fenfible to the hand, and is
attended in fome degree with the pain of cold. The cheek and
tooth have frequently been engaged in pleafurable action at the
fame time during the mafticating of our food ; whence they
have acquired fenfitive aflbciations. The torpor of the cheek
may have for its caufe the too great expenditure of fenforial
power by the painful fenfation of the membranes of the difeaf-
ed tooth ; whence the membranes of the cheek aiTociated with
thofe of the alveolar procefs are deprived of their natural (hare
of it, and become torpid ; thus they produce lefs fecretions, and
lefs heat, and the pain of cold is the confequeiice. This torpor
of the veffels of the cheek cannot be produced by the activity
of the fenforial power of fenfation ; for then they would act
more violently than natural, or become inflamed. And though
the pain by exhauiting fo much fenforial power may be a re-
mote caufe, it is the defed; of the power of affociation, which
is the immediate caufe of the torpor of the cheek.

After fome hours this pain occafioncd by the torpor of the
vefiels of the cheek either gradually ceaies along with the pain
of the difeafed tooth ; or, by the accumulation of fenforial pow-
er during their (late of torpor, the capillaries of the cheek act:
with greater violence, and produce more fecretions, and heat,
and confequent tumour, and inflammation. In this ftate the
pain of the difeafed tooth ceafes •, as the fenfovial power of fen-
fation is now expended on the inflamed veffels of the cheek. It
is probable that mod other internal membranous inflammations
begin in a fnnilar manner ; whence there may feem to be a double
kind of fenfitive aiTociation ; firft, with decreafed action of the
• aflbciated organ, and then with increafed action of it j but the
latter is in this cafe fimply the confequence of the former ; that
is, the tumour or inflammation of the cheek is in confequence
of its previous quiefcence or torpor.

2. Stranguria a dolore vefica. The ftrangury, which has its
origin from pain at the neck of the bladder, confifts of a pain in
the external extremity of the urethra or of the glands penis of
men, and probably in the external termination of the urethra or
of the clitoris of women ; and is owing to the fympathy of
thefe with fome diftant parts, generally with the other end of
the urethra ; an endeavour and difficulty of making water at-
tends this pain.

Its remote caufe is from the internal or external life of can-
tharides, which ftimulate the neck of the bladder ; or from a

ft one.

4 1 4 DISEASES CLASS IV. 2. 2. 3.

ftone, which whenever it is pulhed into the neck of the bladder,
gives this pain of ftrangury, but not at other times -, and hence
it is felt moil feverely in this cafe after having made water.

The fenfations or fenfitive motions of the glands penis, and
of the fphincler of the bladder, have been accuftomed to exift
together during the diicharge of the urine •, and hence the two
ends of the urethra fympathize by aflbciation. When there
is a (lone at the neck of the bladder, which is not fo large or
rough as to inflame the part, the fphincler of the bladder be-
comes Simulated into pain ; but as the glans penis is for the
purpoies of copulation more fenfitive than the fphincler of the
bladder, as foon as it becomes affected with pain by the aflbcia-
tion above mentioned, the fenfation at the neck of the bladder
ceafes ; and then the pain of the glans penis would feem to be
aflbciated with the irritative motions only of the fphincler of the
bladder, and not with the fenfitive ones of it. But a circum-
ftanre fimilar to this occurs in epileptic fits, which at firft are
induced by difagreeable fenfation, and afterwards feem to occur
without previous pain, from the fuddennefs with which they
follow and relieve the pain, which occafioned them. From this
analogy I imagine the pain of the glans penis is aflbciated with
the pain of the fphincler of the bladder ; but that as foon as the
greater pain in a more fenftble part is produced ; the lefs paln^ 'which
occafioned it, ceafes ; and that this is one of the laws of fenfitive af-
fociation. See Sea. XXXV. 2. i.

A young man had by an accident fwallowed a large fpoonful
or more of tinclure of cantharides ; as foon as he began to feel
the pain of ftrangury, he was advifed to drink large quantities
of warmifh water : to which, as foon as it could be gotten, fome
gum arabic was added. In an hour or two he drank by inter-
vals of a few minutes about two gallons of water, and difcharg-
ed his urine every four or five minutes. A little blood was
voided towards the end, but he fuffered no ill confequence.

M. M. Warm water internally. Clyfters of warm water.
Fomentation. Opium. Solution of fixed alkali fuperfaturated
with carbonic acid. A bougie may be ufed to pufh back a ftone
into the bladder. See Clafs I. 1.3. 10.

3. Stranguria convulfiva. The convulfive ftrangury, like that
before defcribed, is probably occafioned by the torpor or defec-
tive aclion of the painful part in confequence of the too great
expenditure of fenforial power on the primary link of the affbciat-
ed motions, as no heat or inflammation attends this violent pain.
This kind of ftrangury recurs by ftated periods, and fometimes
arifes to fo great a degree, that convuliion or temporary mad-
nefs terminates each period of it. It atFedts women oftener

than

CLASS IV. 2.2.4. OF ASSOCIATION. 4 1 5

than men, is attended with cold extremities without fever, and
is diftinguifhed from the ftone of the bladder by the regularity
of its periods, and by the pain being not increafed after making
water.

On introducing the cathether fometimes part of the urine will
come away and not the whole, which is difficult to explain ;
but may arife from the weaknefs of the mufcular fibres of the
bladder ; which are not liable fuddenly to contract themfelves
fo far as to exclude the whole of the urine. In fome old peo-
ple, who have experienced a long retention of urine, the blad-
der never regains the power of completely emptying itfelf ; and
many who are beginning to be weak from age can make water
a fecond time, a few minutes after they fuppofed they had emp-
tied the bladder.

I have believed this pain to originate from fympathy with
fome diftant part, as from afcarides in the rectum, or from piles
in women ; or from caruncles in the urethra about the caput
gallinaginis in men ; and that the pain has been in the glans or
clitoris by reverfe fympathy of thefe more lenfible parts with
thofe above mentioned.

M. M. Venefedtion. Opium in large quantities. Warm
bath. Balfams. Bark. Tincture of cantharides. Bougie, and
the treatment for hemorrhoids. Leeches applied to the fphic-
ter ani. Aerated alkaline water. Soap and fal foda. Opium
in clyfters given an hour before the expected return. Smoke
of tobacco in clyfters. Arfenic.

4. Dolor termini inteftinalis duclus choledochi. Pain at the in-
teftinal end of the gall-duct. When a gall-ftone is protruded
from the gall-bladder a little way into the end of the gall-duct,
the pain is felt at the other end of the gall-duct, which termin-
ates in the duodenum. For the actions of the two terminations
of this canal are affociated together from the fame ftreams
of bile patting through them in fucceflion, exactly as the two
terminations of the urethra have their actions aflbciated, as
defcribed in Species 2 and 3 "of this genus. But as the in-
teftinal termination of the bile-duct is made more fenfible for
the purpofe of bringing down more bile, when it is ftimulated
by new fupplies of food from the ftomach, it falls into violent
pain from afibciation ; and then the pain on the region of the
gall-bladder ceafes, exactly as above explained in the account
of the pain of the glans penis from a ftone in the fphinclcr of
the bladder.

The common bile-duct opens into the interline exactly at
what is called the pit of the ftomach ; and hence it has fottle-
fimes happened, that this p-iin from aflbciation with the fcnfa-

tion

4i6 DISEASES CLASS IV. 2.

tion of a gall-done at the other end of the bile-duct has been
miftaken for a pain of the ftomach.

For the method of cure fee Clafs 1. 1.3. 8. to which mould
be added the uie of ftrong electric fhocks pafled through the bile-
duct from the pit of the ftomach to the back, and from one fide
to the other. A cafe of the good effect of eledlricity in the
jaundice is related in Sett. XXX. 2. And another cafe,
where it promoted the paflage of a painful gall-ftone, is defcrib-
ed by Dr. Hall, experienced on himfelf. Tranf. of the Col-
lege at Philadelphia, Vol. I p. 192.

Half a pint of warm water two or three times a day is much
recommended to dilute the infpiiikted bile.

5. Dolor plar \ngls nb acids gafinco. The two ends of the
throat fympathize by fcniitive aflbciation in the fame manner
as the other canals above mentioned, namely, the urethra and
the bile-duct ; hence when too great acidity of undigefted ali-
ment, or the carbonic acid air, which efcnpes in fermentation,
ftimulates the cardia ventriculi, or lower end of the gula, into
pain, the pharynx, or upper end of it, is affected with greater
pain, or a difagreeablc fenfation of heat.

6. Pruritus narliim a vermibus. The itching of the nofe from
worms in the inteftines is another curious inftance of the fen-
fitive afibciations of the motions of membranes ; efpecially of
thofe which conftitute the canals of the body. Previous to the
deglutition of agreeable food, as milk in our earlieft infancy, an
agreeable odour affects the membrane, which lines the noftrils;
and hence an ailbciation feems to take place between the agreea-
ble fenfations produced by food in the ftomach and bowels, arid
the agreeable fenfations of the noftrils. • The exiftence of afcar-
ides in the rectum I believe produces this itching of the noftrils
more than the worms in other parts of the inteftines j as we have
already feen, that the terminations of canals fympathize more
than their other parts, as in the urethra and gall-ducts. See
Clafs I. r. 5- 9. IV. i. 2. 9.

7. Cephalaa fympathetica. Sympathetic head-ach. In cold fits
of the ague, the head-ach arifes from confent with fome torpid
vifcns, like the pain of the loins. After drunkennefs the head-

- very common, owing to direct fympathy of the mem-
branes of with thofe of the ftomach ; which is become
torpid after the too violent ftimulus of the preceding intoxica-
tion ; and is hence removable by fpirit of wine, or opium, ex-
hibited in fmaller quantities. In fome conftitutions thefe head-
achs are induced, when the feet are expofed to much external
cold ; in this cafe the feet fliouid be covered with oiled (ilk,

which

CLASS IV. 2. 2. 8. OF ASSOCIATION. 4 1 7

which prevents the evaporation of the perfpirable matter, and
thence diminifhes one caufe of external cold.

M. M. Valerian in powder two drams three or four times
a day is recommended. The bark. Chalybeates. A grain of
opium twice a day for a long time. From five to ten drops of
the faturated folution of arfenic two or three times a day. See
Clafs I. 2. 4. 1 1. A lady once aflured me, that when her head-
ach was coming on, me drank three pints (pounds) of hot water,
as hailily as me could ; which prevented the progrefs of the dif-
eafe. A folution of arfenic is recomnaended by Dr. Fowler of
York. Very ftrong errhines are faid fometimes to cure head-
achs taken at the times ih~ pain recurs, till a few drops of blood
ifiue from the noftrils. As one grain of tupeth mineral (vitriol-
ic calx of mercury) mixed with ten grains of fine fugar, Eu-
phorbium or cayenne pepper mixed with fugar, and ufed with
caution as an errhine. See the M. M. of the next Species.

8. Hemicraniafympathetica. Sympathetic pain on one fide of
the head. This difeafe is attended with cold Ikin, and hence
whatever may be the remote caufe, the immediate one feems
to be want of ftimulus, either of heat or diftention, or of fome
other unknown ftimulus in the painful part ; or in thofe, with
which it is ailbciated. The membranes in their natural (late
are only irritable by diftention ; in their difeafed ftate, they are
fenfible like mufcular fibres. Hence a difeafed tooth may ren*
der the neighbouring membranes fenfible, and is frequently the
caufe of this difeafe.

Sometimes the ftomach is torpid along with the pained mem-
brane of the head j and then ficknefs and inappetency attend
either as caufes or confequences. The natural cure of hemi-
crania is the accumulation of fenforial power during the reft or

ficknefs of the patient. Mrs. is frequently liable to hem-

icrania with ficknefs, which is probably owing to a difeafed
tooth ; the paroxyfm occurs irregularly, but always after fome
previous fatigue, or other caufe of debility. She lies in bed,
lick, and without taking any folid food, and very little of fluids,
and thofe of the aqueous kind, and, after about 48 or 50 hours,
rifes free from complaint. Similar to this is the recovery from
cold paroxyfms of fever, from the torpor occafioried by fear,
and from fyncope ; which are all owing to the accumulation of
fenforial power during the inactivity of the fyftem. Hence it ap-
pears, that, though when the fenforial power of volition is much
cxhaufted by fatigue, it can be reftored by eight or ten hours of
deep; yet, when the fenforial power of irritation is exhaufted
by fatigue, that it requires two whole folar or lunar days of refh,
before it can be reftored.

VOL. IL F F f Th«

4i8 DISEASES CLASS IV. 2. 2. &

The late Dr. Monro afferted in his lectures, that he cured the
hemicrania, or megrim, by a ftrong vomit, and a brilk purge
immediately after it. This method fucceeds belt if opium and
the bark arc given in due quantity after the operation of the
cathartic ; and with dill more certainty, if bleeding in final!
quantity is premifed, where the pulfe will admit of it. Sec
Sea. XXXV. 2. i.

Mr. Kellie affcrts, that fome kinds of head-achs, efpecially
thofe which arife from defect of ilimulation, may be cured by
comprefhng the two iubclavian arteries, as they pafs over the
firft rib ; which he thinks would produce a preflure on the brain
limilar to that, which rnay be produced by the centrifugal force,
if a perfon was to lie acrofs a mill-done as it revolves. See
Suppl. I. 15' 7- Would fuch a circulating bed remove any
kind of head-ach ?

The pain generally afreets one eye, and fpreads a Ititle way
on that ikie of the nofe, and may ibmetimes be relieved by preff-
ing or cutting the nerve, where it paffes into the bone of the
orbit above the eye. When it affects a fmall defined part on
the parietal bone on one fide, it is generally termed Clavus hyf-
tericus, and is always I believe owing to a difeafed dens mola-
ris. The tendons of the mufcles, which ferve the office of
madication, have been extended into pain at the fame time that
the membranous coverings of the roots of the teeth have been
compreiTed into pain, during the biting or maftication of hard
:s. Hence when the membranes, which cover the roots of
;eth, become affected with pain by a beginning decay, or
perhaps by the torpor or coldncfs of the dying part of the tooth,
the tendons and membranous fafcia of the mufcles about the
fame fide of the head become affected with violent pain by their
live ailbciations :• and as ibon as this aflbciated pain takes
place, the pain of the tooth entirely ceafes, as explained in the
fecond fpecies of this genus.

A remarkable circumdance attends this kind of hemicrania,
viz. that it recurs by periods like thofe of intermittent fevers, as
explained in the Section on Catenation of Motions ; theie peri-
ods ibmetimes correfpond with alternate lunar or folar days
like tertian agues, and that even when a decaying tooth is evi-
dently the caufe ; which has been evinced by the cure of the
difeale by extracting the tooth. At other times they obferve
the monthly lunations, and feem to be induced by the debility,
which attends menftruation.

The dens fapientke, or lad tooth of the upper jaw, fre-
quently decays fird, and gives hemicrania over the eye on the
fame fide. The fird or fecond grinder in the under-jaw is lia-
ble

I

CLASS IV. 2. 2. 3. OF ASSOCIATION. 4 1 9

ble to give violent pain about the middle of the parietal bone, or
fide of the head, on the fame fide, which is generally called the
Clavus hyftericus, of which an inftructive cafe is related in
Sea. XXXV. 2. i.

Since the above was firft publifhed I have feen two cafes,
which were very fimilar, and fecm much to confirm the above
theory of fympathetie hemicrania being perhaps always owing
to the fympathy of the membranes about the cranium with
thofe about difeafed teeth. Lord M. and Mr. B. of Edinburgh,
both of them about the middle of life were afflicted with vio-
lent hemicrania for about two years ; in the beginning of which
time they both affured me, that their teeth were perfectly found,
but on infpecting their mouths I found all the molares were
now fo decayed as to have loft their crowns. After having fuf-
fered pain for fixteen or eighteen months almoft inceiYantly in
different parts of their heads, they had each of them a hemiple-
gia, from which they gradually recovered, as much as paralytic
affections generally do recover. All the {lumps of their teeth,
which were ufelefs, were directed to be extracted ; as the fwal-
lowing fo much putrid matter from decaying bones feemed to
injure their digeftion. They were defired not to drink wine or
ale without its being diluted with twice or thrice its quantity of
water, to prevent any accefs of torpor from too great previous
flimulus, and to take fix grains of rhubarb with three of fonp
made into pills, every night, with fome bitter and very flight
chalybeate medicines. If the teeth which became torpid in fuc-
ceffion, could have been difcovered, and extracted, before they
decayed, and could have been replaced, might not this continu-
ance of pain, and confequent paralyfis, have been prevented ? or
might not a moderate faiivation have effected this purpofe ?

M. M. Detect and extract the difeafed tooth. Cut the af-
fected nerve, or ftimulate the difeafed membrane by acupunc-
ture. Venefection to fix ounces by the lancet or by leeches.
A flrong emetic and a fubfequent cathartic ; and then an opiate
and the bark. Pafs fmall electric (hocks through the pained
membrane, and through the teeth on the fame fide. Apply vit-
riolic ether externally, and a grain of opium with camphor in-
ternally, to the cheek on the affected fide, where a difeafed tooth
may be fufpected. Foment the head with warm vinegar.
Drink two large fpoonfuls of vinegar. Stimulate the gums of
the futpected teeth by oil of cloves, by opium. See Clafs I. i.
4. 4. Snuff volatile fpirit of vinegar up the noftrils. Laflly,
in permanent head-achs, as in permanent vertigo, I have feen
good effect in two cafes by the ufc of mercurial ointment rubbed
on the fhaved head or about the throat, till a mild faiivation com-
mences,

DISEASES CLASS IV. 2. 2. 9.

mences, which by inflaming the membranes of the teeth may
prevent their irritative fympathy with thpfe of the cranium.
Thus by inflaming the tendon, which is the caufe of locked jaw,
and probably by inflaming the wound, which is the caufe of hy-
drophobia, thofe difeafes may be cured, by difuniting the irrita-
tive fympathy between thofe parts, which may not poflefs any
fenfitive fympathy. This idea is well worth our attention.

Otalgia. Ear-ach is another difeafe occasioned by the fympa-
thy of the membranes of the ear with thofe which inveft or fur-
round a decaying tooth, as I have had frequent reafon to be-
lieve j and is frequently relieved by filling the ear with tincture
of opium. See Clafs I. 2. 4.

9. Dolor humeri in hepatidide. In the efforts of excluding the
faeces and urine the mufcles of the moulders are exerted to com-
prefs the air in the lungs, that the diaphragm may be prefTed
down. Hence the diftention of the tendons or fibres of thefe
mufcles is aflbciated with the diftention of the tendons or fibres
of the diaphragm ; and when the latter are pained by the en-
largement or heat of the inflamed liver, the former fympathize
with them. Sometimes but one fhoulder is affected, fometimes
both ; it is probable that many other pains, which are termed
rheumatic, have a fimilar origin, viz. from fenfitive aflbciar
tions.

As no inflammation is produced in confequence of this pain
of the fhoulder, it feems to be owing to inaction of the mem-
branous part from defect of the fenforial power of aflbciation,
of which the primary link is the inflamed membrane of the liv-
er ; which now expends fo much of the fenforial power in gen-
eral by its increafed action, that the membranes about the (houl-
der, which are links of aflbciation with it, become deprived of
their ufual fhare, and confequently fall into torpor.

10. Torpor pedurn in eruptione variolarum. At the commence-
ment of the eruption of the fmall-pox, when the face and breaft
of children are very hot, their extremities are frequently cold.
This I afcribe to fenfitive afTociation between the different parts
of the fkin ; whence when a part acts too violently, the other
part is liable to act too weakly ; and the fkin of the face being
affected firft in the eruption of the fmall-pox, the fkin of the
feet becomes cold in confequence by reverfe fympathy.

M. M. Cover the feet with flannel, and expofe the face and
bofom to cool air, which in a very fhort time both warms the
feet and cools the face ; and hence what is erroneoufly called a
rafh, but which is probably a too hafly eruption of the fmall-pox,
difappears ; and afterwards fewer and more diftinct eruptions
of the fmall-pox fupervene.

1 1. Tejlium

CLASS IV. 2.2.11. OF ASSOCIATION. 421

i i. Teftittm dolor nephriticus. The pain and retracYion of the
tefticle on the fame fide, when there is a ftone in the ureter, is
to be afcribed to fenfitive aifociation ; whether the connecting
caufe be a branch of the fame nerve, or from membranes, which
have been frequently affected at the lame time.

12. Dolor digiti minimi fympatheticus. When any one acci-
dentally ftrikes his elbow againft any hard body, a tingling pain
runs down to the little finger end. This is owing to fenfitive
affbciation of motions by means of the fame branch of a nerve,
as in hemicrania from a decaying tooth the pain is owing to the
fenfitive affociation of tendons or membranes.

13. Dolor brachiiin hydrope peftoris. The pain in the left arm
which attends fome dropfies of the cheft, is explained in Seel:.
XXIX. 5. 2. 10. which refembles the pain of the little ringer
from a percuflion of the nerve at the elbow in the preceding ar-
ticle. A numbnefs of this kind is produced over the whole leg,
when the crural nerve is much comprefled by fitting for a time
with one leg crofled over the other.

Mr. , about fixty, had for two years been affected with

difficulty of refpiration on any exertion, with pain about the fter-
num, and of his left arm ; which lad was more confiderable
than is ufual in dropfy of the cheft ; fome months ago the pain
of his arm, after walking a mile or two, became exceffive, with
coldnefs and numbnefs ; and on the next day the back of the
hand, and a part of the arm fwelled and became inflamed, which
relieved the pain ; and was taken for the gout, and continued
feveral days. He after fome months became dropfical both in
refpect to his cheft and limbs, and was fix or feveri times per-
fectly relieved by one dram of faturated tincture of digitalis,
taken two or three times a day for a few days in a glafs of pep-
permint water. He afterwards breathed oxygen gas undiluted,
in the quantity of fix or eight gallons a day for three or four
weeks without any effect, and funk at length from general de-
bility.

In this inftructive cafe I imagine the prefiure or ftimulus of
one part of the nerve within the cheft caufecl the other part,
which ferves the arm, to become torpid, and contequenily cold
by fympathy ; and that the inflammation was the confequence
of the previous torpor and coldnefs of the arm, in the fame
manner as the fvvelling and inflammation of the cheek in tooth-
ach, in the firft fpecies of this genus •, and that many rheumatic
inflammations are thus produced by fympathy with fome dif-
tant part.

14. Diarrhoea a dentitione. The diarrhoea, which frequently
attends dentition, is the confequence of indigeftion ; the aliment

acquires

422 DISEASES CLASS IV. 2. 2. 14.

acquires chemical changes, and by its acidity acts as a cathar-
tic ; and changes the yellow bile into green, which is evac-
uated along with indigefted parts of the coagulum of milk.
The indigeftion is owing to the torpor of the ftomach and intef-
tines caufed by their aflbciation with the membranes of the
gums, which are now ftimulated into great exertion with pain ;
both which contribute to expend the general quantity of fen-
forial power, which belongs to this membranous aflbciation ;
and thus the ftomach and inteftines aft with lefs than their
natural energy. This is generally efteemed a favourable fymp-
tom in difficult dentition, as the pain of the alveolar membranes
cxhaufts the fenforial power without producing convulfions for
its relief. See Clafs I. i. 4. 5. And the diarrhoea ceafes, as
the tooth advances.

ORDO

CLASS IV. 2. 3. i. OF ASSOCIATION. 4*3

ORDO II.

Decreafed AJficiate Motions*

GENUS III.

Catenated •with Voluntary Motions.
SPECIES.

1. Titubatio lingua. Impediment of fpeech is owing to the
atTociations of the motions of the organs of fpeech being inter-
rupted or diflevered by ill-employed fenfation or fenfitive mo-
tions, as by awe, baiM ulnefs, ambition of mining, or fear of not
fucceeding, and the perfon ufes voluntary efforts in vain to re-
gain the broken aflbciations, as explained in Seel. XVII. i. 10.
and XVII. 2. 10.

The broken afibciation is generally between the firft confo-
nant and the fucceeding vowel ; as in endeavouring to pronounce
the word parable, the p is voluntarily repeated again and again,
but the remainder of the word does not follow, becaufe the af-
fociation between it and the next vowel is diflevered.

M. M. The art of curing this defe£l is to caufe the flam-
merer to repeat the word, which he finds difficult to fpeak,
eight or ten times without the initial letter, in a ftrong voice, or
with an afpirate before it, as arable, or harable ; and at length
to fpeak it very foftly with the initial letter p, parable. This
(hould be praclifed for weeks or months upon every word,
which the Hammerer hefitates in pronouncing. To this mould
be added much commerce with mankind, in order to acquire
a careleflhefs about the opinions of others.

2. Chorea Sti Viti. In the St. Vitus's dance the patient can
at any time lie ftill in bed, which (hews the motions not to be
convulfive ; and he can at different times voluntarily exert every
mufcle of his body -, which evinces, that they are not paralytic.
In this difeafe the principal mufcle in any defigned motion obeys
the will $ but thofe mulcles, whofe motions were aflbciated with
the principal one, do not a£l ; as their aflbciation is diflevered,
and thus the arm or leg is drawn outward, or inward, or back-
ward, inilead of upward or forward, with various geiliculations
exactly refembling the impediment of fpeech.

This difeafe is frequently left after the itch has been too haftily
cured. See ctfnvulfio dolorifica, Clafs III. i. i. 6. A girl
about eighteen, after wearing a mercurial girdle to cure the itch,

acquired

424 DISEASES CLASS IV. 2. 3. 3,

acquired the Chorea St. Viti in fo univerfal a manner, that her
fpeech became affecled as well as her hmbs ; and there was evi-
dently a difunion of the common trains of ideas ; as the itch
was ftiil among the younger children of the family, fhe was ad-
vifed to take her fitter as a bedfellow, and thus received the itch
again ; and the dance of St. Vitus gradually ceafed. See Clafs
II. i. 5. 6.

M. M. Give the patient the itch again. Calomel a grain
every night, or fublimate a quarter of a grain twice a day for a
fortnight. Steel. Bark. Warm bath. Cold bath. Opium.
Venefection once at the beginning of the difeafe. Electricity.
Perpetual How and repeated efforts to move each limb in the
defigned direction, as in the titubatio linguae above defcribed.

3. Rifus. Laughter is a perpetual interruption of voluntary
exertion by the interpofition of pleafurable fenfation ; which not
being checked by any important confequences rifes into pain,
and requires to be relieved or moderated by the frequent repe-
tition of voluntary exertion. See Sect. XXXIV. I 4. and
Clafs III. i. i. 4. and IV. i. 3. 3.

4. Tremor ex ira. The trembling of the limbs from anger.
The interruption of the voluntary aflbeiations of motions by an-
ger, originates from too great a part of the fenforial power being
exerted on the organs of fenfe ; whence the mufcles, which ought
to fupport the body upright, are deprived of their due quantity,
and tremble from debility. See Clafs III. 2. i. I.

5. Rubor extra. Rednefs from anger. Anger is an excefs
of aver(ion,sthat is of voluntarily not yet employed. It is excit-
ed by the pain of offended pride ; when it is employed it be-
comes outrage, cruelty, infanity. The cutaneous capillaries,
efpecially thofe of the face, are more mobile, that is, more eafi-
ly excited into increafed action, or more eafily become torpid,
from lefs variation of fenforial power, than any other parts of
the fyftem, which is owing to their being perpetually fubject to
the vicifTitudes of heat and cold, and of extenfion and corruga-
tion. Hence, when an excefs. of voluntarity exifts without be-
ing immediately expended in the actions of the large mufcles,
the capillary arteries and glands acquire more energetic action,
and a flufhed fkin is produced, with increafed fecretion of per-
fpirable matter, and confequent heat, owing to the paufe or in-
terruption of voluntary action ; -and thus the actions of thefe
cutaneous veflels become ailbciated between the irafcent ideas
and irafcent mufcular actions, which are thus for a time inter-
rupted.

6. Rubor criminati. The blufhing of accufed people, wheth-
er guilty or not, appears to be owing to circumiiances fimilar to

that

CLASS IV. 2.3.7. OF ASSOCIATION. 425

that of anger ; for in thefe fituations there is always a fudden
voluntarily, or wi(h, of clearing their characters arifes in the
mind of the accufed perfon ; which, before an opportunity is
given for it to be expended on the large mufcles, influences the
capillary arteries and glands, as in the preceding article. Whence
the increafed actions of the capillaries, and the confequent red-
nefs and heat, become exerted between the voluntary ideas of
felf-defence, and the mufcular actions neceflary for that purpofe;
which laft are thus for a time interrupted or delayed. ^

Even in the blufh of modefty or bafhfulnefs there is a felf-
condemnation for fome fuppofed defect or indecorum, and a
fudden voluntarity, or wifli, of felf-defence ; which not being
expended in actions of the larger mufcles excites the capillaries
into action ; which in thefe fubjects are more mobile than in
others.

The blufti of young girls on coming into an afTembly room$
where they expect their drefs, and Heps, and manner, to be ex-
amined, as in dancing a minuet, may have another origin ; and
may be confidered as a hot fit of returning confidence, after a
previous cold fit of fear.

7. Tarditas par alytica. By a ftroke of the palfy or apoplexy-
it frequently happens, that thofe ideas which were aflbciated in
trains, whofe firft link was a voluntary idea,have their connection
diflevered ; and the patient is under the neceflity, by repeated
efforts, flowly to renew their aflbciations. In this fituation thofe
words, which have the feweft other words aflbciated with them,
as the proper names of perfons or places, are the moft difficult
to recollect. And in thofe efforts of recollection the word op-
pofite to the word required is often produced, as hot for cold,
v/inter for fummer, which is owing to our aflbciating our ideas
of things by their oppofites as well as by their fimilitudes, and
in fome inftances perhaps more frequently, or more forcibly.
Other paralytic patients are liable to give wrong names to exter-
nal objects, as ufing the word pigs for fheep, or cows for horfes ;
in this cafe the aflbciation between the idea of the animal and.
the name of it is diflevered ; but the idea of the clafs or genus of
the thing remains ; and he takes a name from the firft fpecies
which prefents itfelf, and fometimes can correct himfelf, till he
finds the true one.

8. Tarditas fem/is. Slownefs of age. The difficulty of aflb-
ciating ideas increafes with our age ; as may be obferved from
old people forgetting the bufinefs of the laft hour, unlefs they
imprefs it ftrongly, o*by frequent repetition, though they can
well recollect the tranfactions of their youth. I faw an elderly
man, who could reafon with great clearness and precision, and

VOL. II. G Q g in

426 DISEASES CLASS IV* 2. 3. 8.

in accurate language on fubjects, which he had been accuftomed
to think upon ; and yet did not know that he had rung the bell
by his fire-fide in one minute afterwards ; nor could then recol-
lect the object he had wanted, when his fervant came.

Similar to this is the difficulty which old people experience in
learning new bodily movements, that is, in aflbciating new muf- '
cular actions, as in learning a new trade or manufacture. The
trains of movements, which obey volition, are the laft which we
acquire ; and the firft, which are difibciated.

The fymbols moft in ufe, with which we have aflbciated ideas,
are thofe of vifible and of audible language. It is curious to ob-
(erve in the inftruction of young people, that fome remember
written language the beft, and others vocal language. The fame
thing fometimes occurs in aged people, that is, that fome lofe
the ideas aflbciated with founds fooneft, and others thofe aflb-
ciated with letters. See recollectionis jactura, Clafs III. 2. 2. I.
and Tarditas paralytica above.

The following curious account of this defect of aflbciation of
ideas with audible but not with vifible fymbols was fent me by
Dr. Darwin of Shrewfbury.

« The cafe of an old man lately occurred to me, who was fu*
peranuated ; his hearing and vifion were perfect, but he could
only call up a train of ideas from the latter. When he was told
it was nine o'clock, and time for him to eat his breakfaft, he re-
peated the words distinctly but without underftanding them.
His fervant put a watch into his hand. " Why, William, have
not I my breakfaft, for it is juft nine o'clock r* he would fay
with expreflion, that mewed he felt what he faid.

« On almoft every occafion his fervants converfed with him
by vifible objects, although his hearing was perfect ; and when
this kind of communication was ufed, he did not appear impair-
ed in his intellects. This ftate came on from a ftroke of the
palfy 5 and till he and his attendants ufed this kind of language
he was quite childifti."

ORDO

CLASS IV. 2. 4. OF ASSOCIATION.

ORDO II.

Decrtafed Affbciate Motions,

GENUS IV.
Catenated with External Influences*

As the difeafes, which obey fol r or lunar periods, commence
with torpor or inactivity, fuch as the cold paroxyfms of fevers,
the torpor and confequent pain of hemicrania, and the pains
which precede the fits of epilepfy and convulfion, it would feem,
that thefe difeafes are more generally owing to the diminution
than to the excefs of folar or lunar gravitation ; as the difeafes
which originate from the influence of the matter of heat, are
much more generally in this country produced by the defect
than by the excefs of that fluid.

The periodic returns of fo many difeafes coincide with the
diurnal, monthly, and annual rounds of time 5 that any one, who
would deny the influence of the fun and moon on the periods
of quotidian, tertian, and quartan fevers, muft deny their effect
on the tides, and on the feafons. It has generally been believed,
that folar and lunar effect was exerted on the blood ; which
was thus rendered more or lefs (limulant to the fyftem, as de-
fcribed in Seel. XXXII. 6. But as the fluid matter of gravita-
tion permeates and covers all things, like the fluid matter of
heat 5 I am induced to believe, that gravitation afts in its medi-
um ftate rather as a caufa fine qua non of animal motion like
heat 5 which may diforder the fyftem chemically or mechanical-
ly, when it is dimini(hed ; but may neverthelefs ftimulate it,
when increafed, into animal exertion.

Without heat and motion, which fome philofophers ftill believe
to be the fame thing, as they fo perpetually appear together, the
particles of matter would attract and move towards each other,
and the whole univerfe freeze or coalefce into one folid mafs.
Thefe therefore counteract the gravitation of bodies to one cen-
tre ; and not only prevent the planets from falling into the fun,
but become either the efficient caufes of vegetable and animal
life, or the caufes without which life cannot exift ; as by their
means the component particles of matter are enabled to flide over
each other with all the various degrees of fluidity and repul-
fion.

As the attra&ion of the moon countervails or diminifhes the
terrene gravitation of bodies on the furface of the earth ; a tide

rifes

DISEASES CLASS IV. 2. 4.

rifes on that fide of the earth, which is turned towards the
moon ; and follows it, as the earth revolves. Another tide is
raifed at the fame time on the oppofite fide of the revolving
earth, which is owing to the greater centrifugal motion of that fide
of the earth, which counteracts the gravitation of bodies near its
furface. For the earth and moon may be considered as two can-
non balls of different iizes held together by a chain, and revolv-
ing once a month round a common centre of gravity between
them, near the earth's furface ; at the fame time that they per-
form their annual orbits routed the fun. Whence the centrifu-
gal force of that fide of the earth, which is fartheft from this cen-
tre of motion, round which the earth and moon monthly re-
volve, is confiderably greater, than the centrifugal force of that
fide of the earth which is neareft it ; to which Should be added,
that this centrifugal force not only contributes to diminim the
terrene gravitation of bodies on the earth's furface on that fide
furtheft from the centre of motion, but alfo to increafe it on that
fide, which is neareft it.

Another circumftance, which tends to raife the tide on the part
of the earth's furface, which is moft diftant from the moon, is,
that the attraction of the moon is lefs on that part of the ocean,
than it is on the other parts of the earth. Thus the moon may
be fuppofed to attract the water on the fide of the earth neareft
it With a power equal to three ; and to attract: the central parts
of the earth with a power equal to two ^ and the water on the
part of the earth moft diftant from the moon with a power only
equal to one. Hence on the fide of the earth moft diftant from
the moon, the moon's attraction is lefs, and the centrifugal force
round their common centre of motion is greater ; both which
contribute to raife the tides on that fide of the earth. On the
fide of the earth neareft the moon, the moon's attraction is fo
much greater as to raiie the tides ; though the centrifugal force
pf the furface of the earth round their common centre of mo-
tion in fome degree oppofes this effect.

On thefe accounts, when the moon is in the zenith or nadir,
the gravitation of bodies on the earth's furface will be greateft
at the two oppofite quadratures ; that is, the greateft gravitation
of bodies on the earth's furface towards her centre during the
lunar day is about fix hours and a half after the fouthing, or af-
ter the northing of the moon.

Circumftances fimilar to thefe, but in a lefs degree, muft oc-
cur in reipeti: to the folar influence on terreftrial bodies ; that
is, there muft be a diminution of the gravity of bodies near
the earth's furface at noon, when the fun is over them ; and al-
fo at midnight from the greater centrifugal force of that fide of

the

CLASS IV. 2. 4. i . OF ASSOCIATION. 429

the earth, which is mod diftant from the centre, round which
the earth moves in her annual orbit, than on the fide neareft
that centre. Whence it likewife follows, that the gravitation of
bodies towards the earth is greateft about fix hours after noon,
and after midnight.

Now when the fun and moon have their united gravitation on
the fame fide of the earth, as at the new moon ; or when the
folar attraction coincides with the greater centrifugal motion of
that fide of the earth, which is furtheft diftant from the moon,
as at the full moon ; and when this happens about noon or mid-
night, the gravitation of terrene bodies towards the earth will be
greater about fix hours after noon, and after midnight, than at
any other part of the lunar period ; becaufe the attradlion of
both thefe luminaries is then exerted on thofe fides of the earth
over which they hang, which at other times of the month are
more or lefs exerted on other parts of it.

Laftly, as heat and motion counteract the gravitation of the
particles of bodies to each other, and hence become either the
efficient caufes of vegetable and animal life, or the caufes with-
out which life cannot exift, it feems to follow, that when our
gravitation towards the earth's centre is greateft, the powers of
life fhould be the leaft ; and hence that thofe difeafes, which
begin with torpor, mould occur about fix hours <..fter the folar or
lunar noon, or about fix hours after the folar or lunar midnight ;
and this moft frequently about fix hours after or before the new or
full moon ; and efpecially when thefe happen at noon or at mid-
night ; or laftly, according to the combination of thefe powers in
diminiming or increafing the earth's attraction to bodies on its
furface.

The returns or exacerbations of many fevers, both irritative
and inflammatory, about fix in the evening, and of the periodic
cough defcribed in Sect. XXXVI. 3. 9. countenance this theo-
ry. Tables might be made out to mew the combined powers
of the fun and moon in diminiming the gravitation of bodies on
the earth's furface, at every part of their diurnal, monthly, and
annual periods ; and which might facilitate the elucidation of
this fubjecl. But I am well aware of the difficulty of its appli-
cation to difeafes, and hope thefe conjectures may induce oth-
ers to publiih move numerous obfervations, and more conclu-
five reafonings.

SPECIES.

I. Somni periodus. The periods of fleeping and of waking
are (hortened or prolonged by fo many other circumftances in
animal life, befides the minute difference between diurnal and

nocturnal

43» DISEASES CLASS IV. 2. 4. 2-

nocturnal folar gravitation, that it can fcarcely be afcribcd to this
influence. At the fame time it is curious to obferve, that veget-
ables in refpect to tfieir times of fleeping more regularly obferve
the hour of the day, than the prefence or abfence of light, or of
heat, as may be feen by confuting the calendar of Flora. Bo-
tanic Garden, Part II. Canto 2. 1. 165. note.

Some difeafes, which at firit fight might be fuppofed to be in-
fluenced by folar periods, feem to be induced by the increafing
fenfibility of the fyftem to pain during our fleeping hours ; as
explained in Sett. XVIII. 15. Of thefe are the fits of afthma,
of ibme epilepfies, and of fome hsemoptoes j all which difturb
the patient after fome hours fleep, and are therefore to be af~
cribed to the increafe of our dormant fenfibility. There may
like wife be fome doubt, whether the commencement of the pain
of gout in the foot, as it generally makes its attack after fleep,
ihould be afcribed to the increafed fenfibility in fleep, or to fo-
lar influence ?

M. M. When aflhmatic or epileptic fits or hsemoptoe occur
after a certain number of hours of fleep, the patient mould be
forcibly awakened before the expected time by an alarm clodcf
and drink a cup of chocolate or lemonade. — Or a grain of opi*
um mould be given at going to bed.-*-In one cafe to prevent
the too great increafe of fenfibility by mortening the time of
fleep ; and in the other by increafing the irritative motions, and
expending by that means a part of the fenforial power.

2. Studii inanis periodus. Clafs III. 1.2.2. The cataleptic
fpafm which preceded the reverie and fomnambulation in the
patient, whofe cafe is related in Seel, XIX. 2. occurred at ex-
atUy the fame hour, which was about eleven in the morning for
many weeks ; till thofe periods were difturbed by large dofes of
opium ; and muft therefore be referred to fome effect of folar
gravitation. In the cafe of Mafter A. Sect. XXXIV. 3. as the
reverie began early in the morning during fleep, there may be a
doubt, whether this commenced with torpor of fome organ
catenated with folar gravitation ; or was caufed by the exift-
ence of a previous torpid part, which only became fo painful as
to excite the exertions of reverie by the perpetual increafe of
fenfibility during the continuance of fleep, as in forae fits of epi-
jepfy, afthma, and hsemoptoe mentioned in the preceding article.

3. Hemicranix periodits* Periods of Hemicrania. Clafs IV.
2. 2. 8. The torpor and confequent pain of fome membranes
on one fide of the head, as over one eye, are frequently occa-
fioned by a decaying tooth, and are liable to return every day,
or on alternate days at folar or lunar periods. In this cafe large
quantities of the 'bark will frequently cure the difeafe, and ef-

pecially

CLASS IV. 2. 4. 4. OF ASSOCIATION. 43 1

pecially if preceded by venefection and a briifc cathartic ; but i£
the offending tooth can be detected, the mod certain cure is its
extraction. Thefe partial head-achs are alfo liable to return at
the greater lunar periods, as about once month. Five drops
from a two-ounce phial of a faturated folution of arfenic twice
a day for a week or two have been faid to prevent the returns of
this difeafe. See a Treatife on Arfenic by Dr. Fowler, of York.
Strong errhines have alfo been recommended.

4. Epilepfix dolorifctf periodus. Chfs III. I. I. 8. The pain
which induces after about an hour the violent convulfions or in-
fanity, which conftitute the painful epilepfy, generally obferve
folar diurnal periods for four or five weeks, and are probably
governed by folar and lunar times in refpect to their greater pe-
riods ; for I have obferved that the daily paroxyfms, unlefs dif-
turbed by large dofes of opium, recur at very nearly the fame
hour, and after a few weeks the patients have recovered to re-
lapfe again at the interval of a few months. But more obfer-
vations are wanted upon this fubject, which might be of great
advantage in preventing the attacks of this difeafe ; as much lefs
opium given an hour before its expected daily return will pre*
vent the paroxyfm, than is necefTary to cure it, after it has com-
menced.

5. Convulftonis dolerificx periodus. Clafs III. I. I. 6; The
pains, which produce thefe convulfions, are generally left after
rheumatifm, and come on when the patients are become warm
in bed, or have been for a fliort time a deep, and are therefore
perhaps rather to be afcribed to the increafing fenfibility of the
fyftem during fleep, than to foiar diurnal periods, as in Species
firft and fecond of this Genus.

6. TuJJls periodic* periodus. Periodic cough, Clafs IV. 2. r,
9. returns at exact folar periods ; that defcribed in Sect. XXX\7T.
3. 9. recurred about feven in the afternoon for feveral weeks*
till its periods were difturbed by opium, and then it recurred at
eleven at night for about a week, and was then totally deftroy-
ed by opium given in very large quantities, after having been
previoufly for a few days omitted.

7. Cat amenta periodus. Periods of men flruation. The cor-
refpondence of the periods of the catameuia with thofe of the
moon was treated of in Sect* XXXII. 6. and can admit of no
more doubt, than that the returns of the tides are governed by-
lunar influence. But the manner in which this is produced, k
lefs evident; it has commonly been afcribed to feme effect of
the lunar gravitation on the circulating blood, as mentioned in
Sect. XXXII. 6.. But it is .more analogous to other animal
phenomena to fuppofe that the lunar gravl lately

ailed*

43* DISEASES CLASS IV. 2. 4. &

affefts the folids by its influx or ftimulus. Which we believe
of the fluid element of heat, in which we are equally immerfed ;
and of the electric fluid, which alfo furrounds and pervades us.
See Sea. XXXVI. 2. 3.

If the torpor of the uterine veins, which induces the monthly
periods of the catamenia, be governed by the increafe of terrene
gravitation ; that is, by the deficiency of the Counter-influence
of folar and lunar gravitation ; why does not it occur mod fre-
quently when the terrene gravitation is the greateft, as about fix
hours after the new moon, and next to that at about fix hours after
the full moon ? This queflion has its difficulty -, firft,if the ter-
rene gravitation be greateft about fix hours after the new moon, it
muft become lefs and lefs about the fame time every lunar day, till
the end of the firft quarter, when it will be the leafl ; it muft then
increafe daily till the full. After the full the terrene gravitation
muft again decreafe till the end of the third quarter, when it will
again be the leaft, and muft increafe again till the new moon ;
that is, the folar and lunar counter-gravitation is greateft, when
thofe luminaries are vertical, at the new moon, and full moon,
and leaft about fix hours afterwards. If it was known, wheth-
er more menftruations occur about fix hours after the moon is
in the zenith or nadir •, and in the fecond and fourth quarters of
the moon, than in the firft and third ; fome light would be
thrown on this fubjeft ; which muft in that refpe£l wait for
future obfervations.

Secondly, if the lunar influence produces a very fmall degree
of quiefcence, fuppofe of the uterine veins, at firft ; and if that
recurs at certain periods, as of lunar days, or about 25 hours,
even with lefs power to produce quiefcence than at firft ; yet
the quiefcence will daily increafe by the acquired habit acting
at the fame time, as explained in Sect. XII. 3. 3. till at length
fo great a degree of quiefcence will be induced as to caufe the
inaction of the veins of the uterus, and confequent venous haem-
orrhage. See Se£l. XXXII. 6. Clafs I. 2. i. n. IV. i. 4. 4.
See the introduaion to this Genus.

8. Hamorrhoidis periodus. The periods of the piles depend
on the torpor of the veins of the reaum, and are believed to re-
cur nearly at monthly intervals. See Sea. XXVII. 2. and
Clafs I. 2. i. 6.

9. Podagra periodus. The periods of gout in fome patients
recur at annual intervals, as in the cafe related above in Clafs
IV. i. 2. 15. in which the gouty paroxyfm returned for three
fucceflive years on nearly the fame day of the month. The
commencement of the pain of each paroxyfm is generally a few
hours after midnight, and may thence either be induced by di-
urnal

CLASS IV. 2. 4. 10. OF ASSOCIATION. 433

urnal folar periods, or by the increafing fenfibility during fleep,
as mentioned in the firil fpecies of this genus.

10. Eryftpelatis periodus. Some kinds of eryfipelas which
probably originate from the aflbciation of the cutaneous veflels
with a difeafed liver, occur'- at monthly periods, like the hssmor-
rhois or piles ; and others at annual periods, like the gout ; as a
torpor of fome part I fuppofe always precedes the eryfipelatous
inflammation, the periods fhould accord with the increafing in-
fluence of terrene gravitation, as defcribed in the introduction to
this Genus, and in fpecies the feventh of it. Other periods of
difeafes referable to folar and lunar influence are mentioned in
Section XXXVI. and many others will probably be difcovered
by future obfervation.

11. Febrtum periodus. Periods of fevers. The commence-
ment of the cold- 'fits of intermittent fevers, and the daily exa-
cerbations of other fevers, fo regularly recur at diurnal folar or
lunar periods, that it is impoffible to deny their connection with
gravitation ; as explained in Seel, XXXVI. 3. Not only thefe
exacerbations of fever, and their remiflions, and the diurnal fo-
lar and lunar periods ; but the preparatory circumftances, which
introduce fevers, or which determine their crififes, appear to be
governed by the parts of monthly lunar periods, and of folar
annual ones. Thus the variolous fever in the natural fmall-
pox commences on the I4th day, and in the inoculated fmall-
pox on the feventh day. The fever and etuption in the diftinct
kind take up another quarter of a lunation, and the maturation
another quarter.

The fever, which is termed canine madnefs or hydrophobia,
is believed to commence near the new or full moon ; and, if the
caufe is not then great enough to bring on the difeafe, it feems
to acquire fome ftrength, or to lie dormant, till another, or per-
haps more powerful lunation calls it into action. In the fpring,
about three or four years ago, a mad dog very much worried one
fwine confined in a fly, and bit another in the fame ity in a lefs
degree ; the former became mad, refufed his meat, was much
convulfed, and died in about four days ; this difeafe commenced
about a month after the bite. The other fwine began to be ill
about a month after the firft, and died in the fame manner,

VOL, II. H H h ORDO

434 DISEASES CLASS IV. 3. i.

ORDO III.

Retrograde Affociate Motions.
GENUS I.

4

Catenated •with Irritative Motions.

THOSE retrograde aflbciate motions, the fir ft links of which
are catenated with irritative motions, belong to this genus. All
the retrograde motions are confequent to debility, or inactivity,
of the organ ; and therefore properly belong to the genera of de-
creafed actions both in this and the former clafles.

SPECIES.

1. Diabetes irritata. When the abforbents of the inteftines
are ftimulated too ftrongly by fpirit of wine, as in the beginning
of drunkennefs, the urinary abforbents invert their motions.
The fame happens from worms in the inteftines. In other
kinds of diabetes may not the remote caufe be the too ftrong
action of the cutaneous abforbents, or of the pulmonary ones r
May not in fuch cafes oil externally or internally be of fervice ?
or warm bathing for an hour at a time ? In hyfteric inverfions
of motion is fome other part too much ftimulated ? or pained
from the want of ftimulus ?

2. Sudor frigidus in ajthmate. The caufe of the paroxyfms of
humoral afthma is not well underftood ; I fuppofe it to be ow-
ing to a torpidity or inaction of the abforbents belonging to the
pulmonary veffels, as happens probably to other vifcera at the
commencement of intermittent fevers, and to a confequent ac-
cumulation of fluids in them ; which at length producing great
irritation or uneafy fenfation caufes the violent efforts to pro-
duce the abforption of it. The motions of the cutaneous ab-
forbent veflels by their aflbciation with thofe of the pulmonary
ones become retrograde, and effufe upon the fkin a fluid, which
is faid to be vifcid, and which adheres in drops.

A few days ago I faw a young man of delicate conftitution in
what was called a fit of the afthma ; he had about two months
before had a periprieumony, and had been ever fmce fubject to
difficult refpiration on exertion, with occafional palpitation of
his heart. He was now feized about eight at night after fome
exertion of mind in his bufinefs with cold extremities, and diffi-
culty of breathing. He gradually became worfe, and in about

half

CLASS IV. 3. i. 3. OF ASSOCIATION. 435

half an hour, the palpitation of his heart and difficult refpiration
were very alarming ; his whole (kin was cold and pale, yet he
did not (h udder as. in cold paroxyfm of fever ; his tongue from
the point to the middle became as cold as his other extremities,
with cold breath. He feemed to be in the act of dying, except
that his pulfe continued equal in time, though very quick. He
loft three ounces of blood, and took ten drops of laudanum, with
muflc and fait of hartftiorn, and recovered in an hour or two
without any cold fweat.

There being no cold fweat feems to indicate, that there was
no accumulation of ferous fluid in the lungs j and that their
inactivity, and the coldneis of the breath, was owing to the
fympathy of the air-cells with fome diftant part. There was
no muddering produced, becaufe the lungs are not fenfible to
heat and cold ; as any one may obferve by going from a warm
room into a frofty air, and the contrary. So the fteam of hot
tea, which fcalds the mouth, does not affect the lungs with the
fenfation of heat. I was induced to believe that the whole cold
fit might be owing to fuppuration in fome part of the cheft ; as
the general difficulty of breathing feemed to be increafed after a
few days with pulfe of 1 20, and other figns of empyema. Do
the cold fweat, and the occurrence of the fits of afthma after
fleep, diftinguifh the humoral afthma from the cold paroxyfm of
intermittents, or that which attends fuppuration, or which pre-
cedes inflammation ?— I heard a few weeks afterwards, that he
fpit up much matter at the time he died.

3. Diabetes a timore. The motions of the abforbent veflels of
the neck of the bladder become inverted by their confent with
thofe of the fkin ; which are become torpid by their reverfe
fympathy with the painful ideas of fear, as in Sect. XVI. 8. I.
whence there is a great difcharge of pale urine, as in hyfteric
difeafes.

The fame happens from anxiety, where the painful fufpenfe
is continued, even when the degree of fear is fmall ; as in young
men about to be examined for a degree at the univerfities the
frequency of making water is very obfervable. When this anxi-
ety is attended with a fleeplefs night, the quantity of pale urine is
amazingly great in fome people, and the micturition very fre-
quent.

M. M. Opium. Joy. Confolations of friendfhip.

4. Diarrhoea a timore. The abforbent veflels of the inteftines
invert their motions by direct confent with the (kin ; hence
many liquid (tools as well as much pale urine are liable to ac-
company continued fear, along with coldnefs of the (kin. The
immediate cauie of this is the decreafed fenforial power of afib-

ciation,

436 DISEASES CLASS IV. 3. i. 5.

elation, which intervenes between the aaions of the abforbents
of the cold fkin, and thofe of the inreitinal abforbents ; the mo-
tions of the latter become on that account weakened and at
length retrograde. The remote caufe is theSfcorpor of the vef-
fels of the fkin catenated with the pain of fear, as explained in
Sea. XVI. 8. i.

The capillaries of the fkin confent more generally by direct
fympathy with thofe of the lower inteftines, and of the bladder ;
but by reverie fympaihy more generally with thofe of the ftom-
ach and upper inteftines. As appears in fevers, where the hot
fkin accompanies indigeftion of the fiomach ; and in diarrhoeas
attended with cold extremities.

The remote caufe is the torpor of the fkin owing to its reverfe
fympathy with the painful fenfual motions, or ideas, of fear ;
which are now actuated with great energy, fo as to deprive the
fecond link of aflbciaced motions of their due (hare of fenforial
power. It is alfo probable, that the pain of fear itfelf may con-
tribute to exhauft the fenforial power, even when it produces nq
mufcular action. See Clafs IV. 2. 2.

5. Pallor et tremor a timore. A retrograde action of the ca-
pillaries of the fkin producing palenefs, and a torpor of the muf-
cular fibres of the limbs occafioning trembling, are caufed by
their reverfe afTc. htions with the ideas or imaginations of fear ;
which are now aciuatci: h violent energy, and accompanied
with great pain. The caufe of thefe aflbciations are explained
in Sea. XVI. 8. i.

Thefe torpid aaions of the capillaries and mufcles of the
limbs are not caufed immediately by the painful fenfation of
fear j as in that cafe they would have been increafed and not
clecreafed aaions, as occurs in anger ; where the painful voli-
tion increafes the aaions of the capillaries, exciting a blufh and
heat of the fkin. Whence we may gain fome knowledge of
what is meant by deprcfTing and exciting paffions ; the former
confifting of ideas attended with pain, which pain occafions no
mufcular aaions, like the pain of cold head-ach ; the latter be-
ing attended with volitions, and confequent mufcular exertions.

That is, the pain of fear, and the pain of anger, are produced
by the exertion of certain ideas, or motions of certain nerves of
fenfe ; in the former cafe the painful fenfation of fear produces
no mufcular aaions, yet it exhaufis or employs fo much fenforial
power, that the whole fyftem aas more feebly, or becomes
retrograde ; but fome parts of it more fo than others, according
to their early aflbciahons defcribed in Sea. XVI. 8. i. hence
the tremor of the limbs, palpitation of heart, and even fyncope.
In anger the painful volition produces violent mufcular aaions *,

but

CLASS IV. 3. i. 6. OF ASSOCIATION. 43 7

but if previous to thefe any deliberation occurs, a flufhed co. i-
tenance fometimes, and a red fkin, are produced by this fupera-
bundance of volition exerted on the arterial tyftem ; but at oth-
er times the (kin becomes pale, and the legs tremble, from the
exhauftion or expenditure of the fenforial power by the painful
'volitions of anger on the organs of fenfe, as by the painful fen-
fations of fear above mentioned.

Where the paffion of fear exifts in a great degree, it exhaufts
or expends fo much fenforial power, either fimply by the pain
which attends it, or by the violent and perpetual excitement of
the terrific imaginations, or ideas, that not only a cold and pale
fkin, but a retrograde motion of the cutaneous abforbents oc-
curs, and'a cold fweat appears upon the whole furface of the
body, which probably fometimes increafes pulmonary abforp-
tion; as in Clafs II. i. 6. 4. and as in the cold fweats, which
attend the paroxyfms of humoral afthma. Hence anxiety,
which is a continued pain of fear, fo univerfally debilitates the
conftitution as to occafion a lingering death ; which happens
much more frequently than is ufually fuppofed ; and thefe vie-*
tims of continued anxiety are faid to die of a broken heart.
Other kinds of palenefs are defcribed in Clafs I. 2. 2. 2.

M. M. Opium. Wine. Food. Joy.

6. Palpjtatio cordis a timore. The palpitation of the heart
from fear is owing to the weak adlion of it, and perhaps fome-
times to the retrograde exertion of the ventricles and auricles \
becaufe it ieems to be affected by its afibciation with the capil-
laries, the actions of which, with thofe of the arteries and veins,
conftitute one great circle of ailbciate motions. Now when
the capillaries of the (kin become torpid, coldnefs, and palenefs
fucceed; and with thefe are aflbciated the capillaries of the
lungs, whence difficult refpiration ; and with thefe the weak
and retrograde actions of the heart. At the fame time the ab-
forbents of the fkin, and of the bladder, and of the inteltines,
fometimes become retrograde, and regurgitate their contents ;
as appears by the pale urine in large quantities, which attends
hyfteric complaints along with this palpitation of the heart j
and from the cold fweats, and diarrhoea •, all which, as well as
the hyfteric complaints, are liable to be induced or attended by
fear. f

When fear has ftill more violently affected the fyftem, there
have been inftances where fyncope, and fudden death, or a total
itoppage of the circulation have fucceeded : in thefe laft cafes,
the pain of fear has employed or exhaufted the whole of the
fenforial power, fo that not only thole mufcular fibres generally
exerted by volition ceafe to act, whence the patient falls down ;

and

438 DISEASES CLASS IV. 3,

and thofc which conftitute the organs of fenfe, whence fynco-
pe ; but laftly thofe, which perform the vital motions, become
deprived of fenforial power, and death enfues. See Clafs I. 2.
I. 4. and I. 2. I. 10. Similar to this in fome epileptic fits the
patient firft fuddenly falls down, without even endeavouring to
fave himfelf by his hands before the convulfive motions come
on. In this cafe the great exertion of fome fmall part in confe-
quence of great irritation or fenfation exhaufts the whole fen-
forial power, which was lodged in the extremities of the lo-
comotive nerves, for a (hort time, as in fyncope ; and as
foon as thefe mufcles are again fupplied, convulfions fuper-
vene to relieve the painful fenfation. See Clafs III. i% i. 7.

7. Abortio a timore. Women mifcarry much more frequent-
ly from a fright, than from bodily injury. A torpor or retro-
grade motion of the capillary arteries of the internal uterus is
probably the immediate caufe of thefe mifcarriages, owing to
the affociation of the actions of thofe veflels with the capillaries
of the fkin, which are rendered torpid or retrograde by fear.
By this contraction of the uterine arteries, the fine veflels of
the placenta, which are inferred into them, are detruded, or oth-
erwife fo affected, that the placenta feparates at this time from
the uterus, and the , fetus dies from want of oxygenation.
A flrong young woman, in the fifth or fixth month of her preg-
nancy, who has fince borne many children, went into her cellar
to draw beer ; one of her fervant boys was hid behind a bar-
rel, and darted out to furprife her, believing her to be the
maid-fervant ; fhe began to flood immediately, and mifcarried
in a few hours. See Se&. XXXIX. 6. 5. and Clafs I. 2. i. 14.

8. Hyfterla a timore. Some delicate ladies are liable to fall
into hyfteric fits from fudden fright. The periftaltic motions
of the bowels and ftomach, and thofe of the cefophagus, make
n part of the great circle of irritative motions with thofe of the
ikin, and many other membranes. ^Hence when the cutaneous
veflels become torpid from their reverfe fympathy with the
painful ideas of fear ; thofe of the bowels, and ftomach, and
osfophagus, become firft torpid by direct fympathy with thofe
of the flun, and then feebly and ineffectually invert the order of
their motions, which conftitutes a paroxyfm of the hyfteric dif-
eafe. See Clafs I. 3. 1. 10. Thefe hyfteric paroxyfms are
fometimes followed by convulfions, which belong to Clafs III.
as they are exertions to relieve pain ; and fometimes by death.
See Species 9. of this Genus, and Clafs I. 2. I. 4.

Indigeftion from fear, is to be afcribed in the fame manner
to the torpor of the ftomach, owing to its aflbciation with the
ikin. As in Clafs IV. I. 2. 5. IV. 2. I.

ORDO

.

nco-

CLASS IV. 3. 2. i. OF ASSOCIATION. 439

ORDO III.

Retrograde AJJbciate Motions*

GENUS II.
Catenated •with Sen/it we Motions.

SPECIES.

1. Naufea idealls. Naufea from difguftful ideas, as from
tiaufeous ftories, or difguftful fights, or fmells, or taftes, as well
as vomiting from the fame caufes, confifts in the retrograde ac-
tions of the lymphatics of the throat, and of the cefophagus, and
flomach ; which are afibciated with J:he difguftful ideas, or fen-
fual motions of fight, or hearing, or fmell, or tafte ; for as thefc
are deareafed motions of the lymphatics, or of the cefophagus, or
flomach, they cannot immediately be excited by the fenforial
power of painful fenfation, as in that cafe they ought to be in-
creafed motions. So much fenforial power is employed for a
time on the difguftful idea, or expended in the production of
inactive pain, which attends it, that the other parts of the aflb-
ciated chain of action, of which this difguftful idea is now be-
come a link, are deprived of their accuftomed fhare ; and there-
fore firft ftop, and then invert their motions. Owing to defi«
ciency of fenforial power, as explained more at large in Seel.

xxxv. i. 3.

2. Naufea a conceptu. The naufea, which pregnant women
are fo fubjecl: to during the firft part of geftation, is owing to
the reverfe fympathy between the uterus and ftomach, fo that
the increafed action of the former, excited by the ftimulus of
the growing embryon, which I believe is fometimes attended
with fenfation, produces decreafed actions of the latter with the
difagreeable fenfation of ficknefs with indigeftion and confe-
quent acidity. When the fetus acquires fo much mufcular
power as to move its limbs, or to turn itfelf, which is called
quickening, this ficknefs of pregnancy generally ceafes.

M. M. Calcined magnefia. Rhubarb. Half a grain of opi-
um twice a day. Recumbent pofture on a fofa.

3. Vomitio ijcrtiginofa. Sea^ficknefs, the irritative motions of
vifion, by which we balance ourfelves, and preferve our perpen-
dicularity, are difturbed by the indiftinclnefs of their objeas ;
Which is either owing to the fimilarity of them, or to their dif-

tance,

DISEASES CLASS IV. 3. 2. 4,

tance, or to their apparent or unufual motions. Hence thefe
irritative motions of vifion are exerted with greater energy, and
are in confequence attended with fenfation ; which at firft is
agreeable, as when children fwing on a rope ; afterwards the
irritative motions of the ftomach, and of the abforbent veflels,
which open their mouths into it, become inverted by their af-
fociations with them by reverfe fympathy.

For the action of vomiting, as well as the difagreeable fen-
fation of ficknefs, are mewn to be occafioned by defect of the
fenforial power 5 which in this cafe is owing to the greater ex-
penditure of it by the fenfe of vifion. On the fame account the
vomiting, which attends the pafl~age*of a (tone through the ure-
ter, or an inflammation of the bowels, or the commencement of
fome fevers, is cuufed by the increafed expenditure of the fen-""
forial power by the too great action of fome links of the aflbci-
ations of irritative motions ; and there being in confequenoe a
deficiency of the quantity? required for other links of this great
catenation.

It muft be obferved, that the expenditure of fenforial power
by the retinas of the eyes is very great ; which may be efdmated
by the perpetual ufe of thofe organs during our waking hours,
and during moft of our fleeping ones ; and by the large diam-
eters of the two optic nerves, which are nearly the fize of a
quill, or equal to fome of the principal nerves, which ferve the
limbs.

4. Vomitio a calculo in uretere. The action of vomiting in con-
fequence of the increafed or decreafed actions of the ureter,
when a ftone lodges in it. The natural actions of the ftomach,
which confift of motions fubject to intermitted irritations from
the fluids, which pafs through it, are aflbciated with thofe of the
ureter \ and become torpid, and confequently retrograde, by in-
tervals, when the actions of the ureter become torpid owing to
previous great flimulus from the ftone it contains; as appears
from the vomiting exifting when the pain js leaft. When the
motions of the ureter are thus leflened, the fenforial power of
aflbciation, which ought to actuate the ftomach along with the
•fenforial power of irritation, ceafes to be excited into action ;
and in confequence the actions of the ftomach become lefs en-
ergetic, and in confequence retrograde.

For as vomiting is a decreafed action of the ftomach, as ex-
plained in Sect. XXXV. i. 3. it cannot be fuppofed to be
produced by the pain of gravel in the ureter alone, as it fhould
then be an increafed action, not a decreafed one.

The perpetual vomiting in ileus is caufed in like manner by
the defective excitement of the fenforial power of aflbciation by

the

CLASS IV. 3.2.5. OF ASSOCIATION. 441

--

the bowel, which is torpid during the intervals of pain j and the
ftomach»fympathizes with it. See Enteritis, Clafs II. i. 2. u*
Does this fymptom of vomiting indicate, whether the difeafe be
above or below the valve of the colon ? Does not the fofter
pulfe in fome kinds of enteritis depend on the fympathy of the
heart and arteries with the ficknefs of the ftomach ? See Ileus
and Cholera.

Hence this ficknefs, as well as the ficknefs in fome fevers^
cannot be efteemed an effort of nature to diflodge any offenfive
material ; but like the fea-ficknefs defcribed above, and in Sect.
XX. 4. is the confequence of the affociations of irritative or fen-
fitive motions. See Clafs I.' i. 3. 9.

5. Vomitio ab infultu paralytico. Paralytic affections generally
'commence with vomiting,- the fame frequently happens from a
violent blow with a flick on the head ; this curious connection
of the brain and ftomach has not been explained ; as it refem-
bles the ficknefs in confequence of vertigo at fea, it would feern.
to arife from a fimilar caufe, viz. from difturbed irritative or
fenfitive affociations.

6. Vomitio a titillatlone faucium. If the throat be fiightly tick-
led with a feather, a naufea is produced, that is, an inverted ac-
tion of the mouths of the lymphatics of the fauces, and by di-
rect fympathy an inverted action of the ftomach eiifues. As
thefe parts have frequently been ftimulated at the fame time in-
to pleafurable action by the deglutition of our daily aliment,
their aclions become ftrongly affociated. And as all the food
we fwallow, is either moift originally or mixed with our moift
faliva in the mouth ; a feather, which is originally dry, and
which in fome meafure repels the moift faliva, is difagreeable to
die touch of the fauces ; at the fame time this naufea and vom-
iting cannot be caufed by difagreeable fenfation fimply, as then
they ought to have been increafed exertions, and not decreafed
ones, as (hewn in Section XXXV. 1.3. But the mouths of the
lymphatics of the fauces are ftimulated by the dry feather into
too great action for a time, and become retrograde afterwards
by the debility confequent to too great previous ftimulus.

7. Vomitio cute fympaihetica. Vomiting is fuccefsfully flopped
by the application of a blifter on the back in fome fevers, where
the extremities are cold, and the fkin pale. It was flopped by
Sydenham by producing a fweat on the {kin by covering the
head with the bedclothes. See Clafs IV. i, i. 3. and SuppL
I. if. 6.

VOL. II. 1 1 i ORDO

442 DISEASES CLASS IV. 3* 3. i,

ORDO III.

Retrograde Affociate Motions.

GENUS III.

Catenated with Voluntary Motions.
SPECIES.

1. Rwninatio. In the rumination of horned cattle the food i
brought up from the firft ftomach by the retrograde motions of
the ftomach and cefophagus, which are catenated with the vol-
untary motions of the abdominal mufcles.

2. Vomitio 'uoluntana. Voluntary vomiting. Some human
fubjects have been faid to have obtained this power of volunta-
ry action over the retrograde motions of the ftomach and cefoph-
agus, and thus to have been able to empty their ftomach at
pleafure. See Sect. XXV. 6. This voluntary act of empty-
ing the ftomach is poflefled by fome birds, as the pigeon ; who
has an organ for fecreting milk in its ftomach, as Mr. Hunter
obferved j and foftens the food for its young by previoufly fwal-
lowing it ; and afterwards putting its bill into theirs returns it
into their mouths. See Sect. XXXIX. 4. 8. The pelicans ufe
a ftomach, or throat bag, for the purpofe of bringing the fifli,
which they catch in the fea to (hore, and then eject them, and
eat them at their leifure. See Sect. XVI. 1 1. And I am well
informed of a bitch, who having puppies in a ftable at a diftance
from the houfe, fwallowed the flem-meat, which was given her,
in large pieces, and carrying it immediately to her whelps,
brought it up out of her ftomach, and laid it down before them.

3. Eruflatio voluntaria. Voluntary eructation. Some, who
have weak digeftions, and thence have frequently been induced
to eruct the quantity of air difcharged from the fermenting ali-
ment in their ftomachs, have gradually obtained a power of vol-
untary eructation, and have been able thus to bring up hogf-
heads of air from their ftomachs whenever they pleafed. This
great quantity of air is to be afcribed to the increate of the fer-
mentation of the aliment by drawing off the gas as foon as it i»
produced. See Sea. XXIII. 4.

ORDO

CLASS IV. 3. 4. i. OF ASSOCIATION. 443

ORDO HI.

Retrograde Affbciate Motions,

GENUS IV.

Catenated with External Influences*
SPECIES.

1 . Catarrhus periodicus. Periodical catarrh is not a very un-
common difeafe; there is a great difcharge of a thin faline mu-
cous material from the membranes of the noftrils, and probably
from the maxillary and frontal fmufes, which recur once a day
at exacl folar periods ; unlefs it be difturbed by exhibition
of opium-, andrefembles the. periodic cough mentioned below.
See Clafs I. 3. 2. i. It is probably owing to the retrograde ac-
tion of the lymphatics of the membranes affected, and produced
immediately by folar influence.

2. Tuffis periodica. Periodic cough, called nervous cough,
and tuflis ferina. It feems to arife from a periodic retrograde
action of the lymphatics of the membrane, which lines the air-
cells of the lungs. And the action of coughing, which is vio-
lent for an hour or longer, is probably excited by the ftimulus
of the thin fluid thus produced, as well as by the difagreeable
fenfation attending membranous iuadivity ; and refembles pe-
riodic catarrh not only in its fituation on a mucous membrane,
but in the difcharge of a thin fluid. As it is partly reftrainable,
it does not come under the name of convulfion ; and as it is not
attended with difficult refpiration, it cannot be called aithma ;
it is cured by very large dofes of opium, fee a cafe and cure in
Sea. XXXVI. 3. 9. Clafs IV. 2. 4. 6. and feems immediately
to be induced by folar influence.

3. Hyjleria a frigore. Hyfteric paroxyfms are occafioned by
whatever fuddenly debilitates the fyftem, as fear, or cold, and
perhaps fometimes by external moifture of the air, as all delicate
people have their days of greater or lefs debility, fee Clafs IV.
3. 1.8.

4. Naufea pluvialis. Sicknefs at the commencement of a
rainy feafon is very common among dogs, who aflift themfelves
by eating the agroftis canina, or dog's grafs, and thus empty
their ftomachs. The fame occurs with lefs frequency to cats,
who make ufe of the fame expedient. See Seel. XVI. n. I
have known one perfon, who from his early years has always

been

444

DISEASES, &c. CLASS IV. 3. 4. 4.

Tick at the beginning of wet weather, and ftill continues fo.
Js this owing to a fympathy of the mucous membrane of the ftom-
ach with the mechanical relaxation of the external cuticle by a
moifter atmofphere, as is feen in the corrugated cuticle of the
hands of wafher-women ? or does it fympathize with the mu-
cous membrane of the lungs, which muft be affe&ed along with
the mucus on its furface by the refpiration of a moifter atmof-
phere.

SUPPLEMENT

SUPPLEMENT

TO

CLASS IV.

» — — •—•^M- ^

Sympathetic Theory of Fever.

As fever confifts in the increafe or diminution of direft or
reverfe afibciated motions, whatever may have been the remote
caufe of them, it properly belongs to the fourth clafs of difeaf-
es ; and is introduced at the er\d of the clafs, that its great dif-
ficulties might receive elucidation from the preceding parts of
it. Thefe I fhall endeavour to enumerate under the following
heads, trufling that the candid reader will difcover in thefe ru-
diments of the theory of fever a nafcent embryon, an infant
Hercules/ which Time may rear to maturity, and render fervice-
able to mankind.

I. Simple fever of two kinds.
II. Compound fever.

III. Termination of the cold fit.

IV. Return of the cold fit.

V. Seiifation excited in fever.

VI. Circles of aflbciated motions.
VII. Alternations of cold and hot fits.
VIII. Orgafm of the capillaries.

IX. Torpor of the lungs.

X. Torpor of the brain.

XI. Torpor of the heart and arteries.
XII. Torpor of the ftomach and inteftines.

XIII. Cafe of continued fever explained.

XIV. Termination of continued fever.
XV. Inflammation excited in fever.

XVI. Recapitulation.

I. Simple Fever.

i, When a fmall part of the cutaneous capillaries with their
mucous or perfpirative glands are for a fhort time expofed to a
colder medium, as when the hands are immerfed in iced water

for

4+6 THEORY OF FEVER. SUP. I. i. i

,

for a minute, thcfe capillary veflels and their glands become tor-
pid or quiefcent, Owing to the eduction of the ftimulus of heat.
The fkin then becomes pale, becaufe no blood pafles through the
external capillaries ; and appears fhrunk, becaufe their fides are
collapfed from inactivity, not contracted by fpafm ; the roots
of the hair are left prominent from the feceding or fubfiding of
the (kin around them ; and the pain of coldnefs is produced.

In this fituation, if the ufual degree of warmth be applied,
thefe veflels regain their activity ; and having now become
more irritable from an accumulation of the fenforial power of
irritation during their quiefcence, a greater exertion of them fol-
lows, with an increafed glow of the {kin, and another kind of pain,
which is called the hot-ach ; but no fever, properly fo called, is
yet produced ; as this effect is not univerfal, nor permanent,
nor recurrent.

2. If a greater part of the, cutaneous capillaries with their
mucous and perfpirative glands be expofed for a longer time to
cold, the torpor or quiefcence becomes extended by direct fym-
pathy to the heart and arteries ; which is known by the weak-
nefs, and confequent frequency of the pulfe in cold fits of fever.

This requires to be further explained. The movements of
the heart and arteries, and the whole of the circulatory veflels,
are in general excited into action by the two fenforial powers of
irritation, and of aflbciation. The former is excited by ftimu-
lus, the latter by the previous actions of a part of the vital circle
of motions. In the above fituation the capillaries act weakly
from, defect of irritation, which is caufed by deficient ftimulus
of heat ; but the heart and arteries act weakly from defect of
aflbciation, which is owing to the weak action of the capilla-
ries j which does not now excite the fenforial power of aflbcia-
tion into action with fuflicient energy.

After a time, either by the application of warmth, or by the
increafe of their irritability owing to the accumulation of the
fenforial power of irritation during their previous quiefcence, the
capillary veflels and glands act with greater energy than natural;
whence' the red colour and heat of the fkin. The heart and ar-
teries acquire a greater ftrength of pulfation, and continue the
frequency of it, owing to the accumulation of the fenforial pow-
er of aflbciation during their previous torpor, and their confe-
quent greater aflbciability j which is nowalfo more ftrongly ex-
cited by the increafed actions of the capillaries. And thus a
fit of fimple fever is produced, which is termed Febris irritati-
va ; and confifts of a torpor of the cutaneous capillaries with
their mucous and peripirable glands, accompanied with a tor-

ppr

SUP. I. i. 3. THEORY OF FEVER, 447

por of the heart and arteries ; and afterwards of an increafed
a&ion of all thefe veflels, by what is termed direct fympathy.

This fever, with ftrong pulfe without inflammation, or febrig
irritativa, defcribed io Chfsl. i. i.,i. is frequently feen in ver-
nal intermittents, as the orgafm of the heart and arteries is then
occafioned by their previous ftate of torpor ; but more rarely I
believe exifts in the type of continued fever, except there be an
evident remiffion, or approximation to a cold fit ; at which time
a new accumulation of the fenforial power of aflbciation is pro-
duced ; which afterwards actuates the heart and arteries with
unnatural vigour; or unlefs there be fome ftimulus perpetually
afting on the fyftem, fo as to induce an increafed fecretion of
fenforial power in the brain, as occurs in flight degrees of intoxi-
cation. Since without one or other of thefe circumftances in
continued fevers without inflammation, that is, without the ad-
ditional fenforial power of fenfation being introduced, it feems
difficult to account for the production of fo great a quantity of
fenforial power, as mutt be neceflary to give perpetual increafe
of action to the whole fanguiferous fyftem.

3. On the contrary, while the cutaneous capillaries with their
mucous and perfpirative glands acquire an increafed irritability,
as above, by the accumulation of that fenforial power during
their previous quiefcence, and thus conftitute the hot fit of fe-
ver •, if the heart and arteries do not acquire any increafe of af-
fociability, but continue in their ftate of torpor, another kind of
fimple fever is produced ; which is generally of the continued
kind, and is termed Febris inirritativa ; which confifts of a pre-
vious torpor of the capillaries of the {kin, and of the heart and
arteries by direct fympathy with them ; and afterwards of an
orgafm or increafed a&ion of the capillaries of the {kin, with a
dccreafed aftion, or continued torpor, of the heart and arteries
by reverfe fympathy with them. This orgafm of the cutaneous
capillaries, which -appears by the blufli and heat of the flcin, is
at firft owing to the accumulation of the fenforial power of irri-
tation during their previous torpid ftate, as in the febris irritata
above defcribed ; but which is afterwards fupported or continu-
ed by the reverfe fympathy of thefe capillaries with the torpid
ftate of the heart and arteries, as will be further explained in ar-
ticle 8. of this Supplement.

4. The renovated activity of the capillaries commences a~
foon or iboner than that of the heart and arteries after the cold
fit of irritative fever ; and is not owing to their being forced
open by the blood being impelled into them mechanically, by
the renovated action of the heart and arteries ; for thefe capil-
laries of the Ikin have greater mobility than the heart and arte-
ries,

THEORY OF FEVER. SUP. I. i. $*

ries, as appears in the fudden blufli of fliarne ; which may be
owing to their being more liable to perpetual varieties of a&ivi-
ty from their expofure ft) the viciffitudes of atmofpheric heat.
And becaufe in inirritative fevers, or thofe with arterial debility,
the capillaries acquire increafed ftrength, as is evinced by the
heat of the fkin, while the pulfations of the heart and arteries
remain feeble.

5. It was faid above, that the cutaneous capillaries, when
they were rendered torpid by expofure to cold, either recover-
ed their activity by the reapplication of external warmth ; or
by their increafed irritability, which is caufed by the accumu-
lation of that fenforial power during their quiefcence. An
example of the former of tnefe may be feen on emerging from
a very cold bath ; which produces a fit of fimple fever ; the cold
fit, and confequent hot fit, of which may be prolonged by con-
tinuing in the bath j which has indeed proved fatal to fome weak
and delicate people, and to others after having been much ex-
haufted by heat and exercife. See Sed~t. XXXII. 3. 2. An
example of the latter may be taken from going into a bath of
about eighty degrees of heat, as into the bath at Buxton, where
the bather firft feels a chill, and after a minute becomes warm,
though he remains in the fame medium, owing to the increafe
of irritability from the accumulation of that fenforial power
during the Thort time which the chilnefs continued.

6. Hence fimple fevers are of two kinds ; firfl:, the febris ir-
ritativa, or fever with ftrong pulfe ; which confifts of a previous
torpor of the heart, arteries, and capillaries, and a fucceeding
orgafm of thofe veflels. Secondly, the febris jnirritativa, or fe-
ver with weak pulfe, which confifts of a previous torpor of the
heart, arteries, and capillaries ; and of a fucceeding orgafm of
the capillaries, the torpor of the heart and arteries continuing.
But as the frequency of the pulfe occurs both in the ftate of tor-
por, and in that of orgafm, of the heart and arteries ; this con-
ilitutes a criterion to diftinguim fever from other difeafes, which
are owing to the torpor of fome parts of the fyftem, as parefis,
and hemicrania.

7. The reader will pleafe to obferve, that where the cutane-
ous or pulmonary capillaries are mentioned, their mucous and
perfpirative glands are to be imderftood as included ; but that
the abforbents belonging to thofe fyftems of velTels, and the
commencement of the veins, are not always included ; as thefe
are liable to torpor feparately, as in anafarca, and petechiae ; or
to orgafm, or increafed action, as in the exhibition of ftrong
emetics, or in the application of vinegar to the lips ; yet he will
alfo pU-afe to obferve, that an increased or decreafed action, of

thefe

SUP. I. a. i. THEORY OF FEVER. 449

thefe abforbents and veins generally occurs along with that of
the capillaries, as appears by the dry (kin in hot fits of fever ;
and from there being generally at the lame time no accumula-
tion of venous blood in the cutaneous vefTels, which would ap-
pear by its purple colour.

II. Compound Fever.

1. When other parts of the fyftem fympathize with this tor-
por and orgafm of the cutaneous capillaries, and of the heart
and arteries ; the fever-fit becomes more complicated and dan-
gerous ; and this in proportion to the number and confequence
of fuch affected parts. Thus if the lungs become affected, as
in going into very cold water, a fhortnefs of breath occurs ;
which is owing to the collapfe or inactivity (not to the active
contraction, or fpafm), of the pulmonary capillaries ; which, as
the lungs are not fenfible to cold, are not fubject to painful
fenfation, and confequent fhuddering, like the (kin. In this cafe
after a time the pulmonary capillaries, like the cutaneous ones,
act with increafed energy ; the breathing, which was before
quick, and the air thrown out at each refpiration in lefs quanti-
ty, and cool to the back of the hand oppofed to it, now becomes
larger in quantity, and warmer than natural ; which however is
not accompanied with the fenfation of heat in the membrane,
which lines the air-yeflels of the lungs, as in the Ikin.

2. One confequence of this increafed heat of the breath is
the increafed evaporation of the mucus on the tongue and nof-
trils. A vifcid materal is fecreted by thefe membrane^ to pre-
ferve them moift and fupple, for the purpofes of the fenfes of
tafte and of fmcll, which are extended beneath their furfaces ;
this vifcid mucus, when the aqueous part of it is evaporated by
the increafed heat of the refpired air, or is abforbed by the too
great action of the mucous abforbents, adheres clofely on thofe
membranes, and is not without difficulty to be feparated from
them. This drynefs of the tongue and noftrils is a circumilance
therefore worthy to be attended to ; as it (hews the increafed
action of the pulmonary capillaries, and the confequent increaf-
ed heat of the expired air ; and may thus indicate, when colder
air fhould be admitted to the patient:. See Clais I. i. 3. i.
The middle part of the tongue becomes dry fooner, and recov-
ers its moifture later, than the edges of it ; becaufe the currents
of refpired air pals moft over the middle part of it. This how-
ever is not the cafe, when the dryne's of the tongue is owing
only to the increafed mucous abforption. When however a
frequent cough attends pulmonary inflammation, the edges of

VOL, II. K K k ' the

45 ° THEORY OF FEVER. SUP. I. 2. 3.

the tongue are liable to be as much furred as the middle of it ;
as during the action of coughing the middle of the tongue is de-
prefled, ib as to form half a cylinder, to give a greater aperture
for the emiffion of air from the larynx ; and the edges of it be-
come thus as much expofed to the currents of air as the middle
parts of it.

3 . When the internal capillaries or glands fympathize with
the cutaneous capillaries ; or when any of them are previoufly
affected with torpor, and the external or cutaneous capillaries
are affe&ed fecondarily; other fymptoms are produced, which ren-
der the paroxyfms of fever itill more complicate. Thus if the
fpleen or pancreas are primarily or fecondarily affected, fo as to
be rendered torpid or quiefcent, they are liable to become en-
larged, and to remain fo even after the extinction of the fever-
fit. Thefe in fome intermittent fevers are perceptible to the
hand, and are called ague-cakes j their tumour feems to be ow-
ing to the permanent torpor of the abforbent fyftem, the fecern-
ing veflels continuing to act fome time afterwards. If the fe-
cretory veflels of the liver are affected firft with torpor, and af-
terwards with orgafm, a greater fecretion of bile is produced,
which fometimes caufes a diarrhoea. If a torpor of the kidneys,
and of the abforbents of the bladder occurs, either primarily, or
by fympathy with the cutaneous capillaries, the urine is in fmall
quantity and pale, as explained in Clafs I. 2. 2. 5. 5 and if thefe
fecretory veflels of the kidneys, and the abforbents of the bladder
act more ftrongly than natural afterwards by their increafed irri-
tability or afibciability, the urine becomes in larger quantity, and
deeper coloured, or depofits its earthy parts, as in Clafs I. 1.2.
4. which has been efleemed a favourable circumftaoce. But if
the urine be in fmall quantity, and no fediment appears in it, af-
ter the hot fit is over ; it (hews that the fecerning veflels of the
kidneys and the abforbent veflels of the bladder have not regain-
ed the whole of their activity, and thence indicates a greater
tendency to a return of the cold fit.

4. When the (tomach is affected with torpor either primari-
ly ; or fecondarily by its fympathy with the cutaneous capilla-
ries 5 or with fome internal vifcus ; ficknefs occurs, with a total
want of appetite to any thing folid ; vomiting then fupervenes>
which may often be relieved by a blifter on the (kin, if the fkin
be cool and pale •, but not if it be hot and flufhed. The intef-
tines ceafe to perform their office of abforption from a fimilar
torpor ; and a diarrhoea fupervenes owing to the acrimony of
rheir putrid, or of their acid contents. The loofe undigested or
fetid itools indicate the inability of the inteftines to perform
their proper office ; as the mucus and gaftric acid, which are

vomited

SUP. I. 2. 5. THEORY OF FEVER. 45 *

vomited up, docs that of the ftomach ; this torpor of the ftom-
ach is liable to continue after the cold paroxyfm ceafes, and to
convert intermittent fevers into continued ones by its dire£t
fympathy with the heart and arteries. See article 10. of this
Supplement.

5. If the meninges of the brain fympathize with ocher torpid
parts, or are primarily affefted, delirium, ftupor, and perhaps
hydrocephalus internus, occur, fee Clafs II. 1.7. i. and I. 2. 5.
ID ; and fometimes the pulfe becomes flow, producing parefis
inftead of fever. But if the membranes, which cover the muf-
cles about the head, or of the pericranium, become torpid by
their fympathy with other torpid parts, or are primarily affecl:-
ed, a head-ach fupervenes ; which however generally ceafes
with the cold paroxyfm of fever. For as when the ienforial
power of volition is exhaufted by labour, a few hours, or half a
folar day, patted in fleep recruits the fyftem by accumulation of
this fenforial power ; fo when the fenforial power of irritation is
exhaufted, one or two folar or lunar days of reft or quiefcence
of the affected part will generally reftore its action by accumu-
lation of irritability, and confequent increafe of aflbciation, as in
hemicraniaj Clafs IV. 2. 2. 8. But when the heart and arteries
become torpid, either primarily, or by their fympathy with the
ftomach, this accumulation of the fenforial power of irritation
can take place but flowly ; as to reft is death / This explains the
caufe of the duration of fevers with weak pulfe, which con-
tinue a quarter, or half, or three quarters, or a whole lunation,
or {till longer, before fufficient accumulation of irritability can
be produced to reftore their natural ftrength of aclion.

6. If the abforbent veflels, which are fpread around the neck
of the bladder, become torpid by their difedfc fympathy with the
abforbents of the fldn in cold fits of fever ; the urine, which is
poured into the bladder in but fmall quantity from the torpid
kidneys, has neverthelefs none of its aqueous faline part reab-
forbed j and this faline part itimulates the bladder to empty it-
felf frequently, though the urine is in fmall quantity. Which
is not therefore owing to any fuppofed fpafm of the bladder, for
the action of it in excluding the urine is weak, and as much con-
trollable by the will as in ordinary micturition.

7. If the beginnings or abforbent mouths of the venous fyf-
tem remain torpid, petechice or vibices are produced in fevers,
fimilar to thofe which are feen in fcurvy without fever. If the
ikin was frequently moiitened for an hour, and at the fame
time expofed to the common air, or to oxygen gas, it might con-
tribute to turn the black colour of theie' points of extravafated
blood into icavlet, and thus by increaiing its ftimulus facilitate

its

452 THEORY OF FEVER. SUP. I. 2. 8.

its reabforption ? For oxygen gas penetrates moift animal mem-
branes though not df y ones, as in the lungs during refpiration.
See Clafs I. 2. i. 17.

8. When the fenforial ppwer of fenfation is introduced into
the arteriaj fyflem, other kinds of compound fevers are produc-
ed, which will be fpoken of in their place.

III. Termination of the cold pit.

1 . If all the parts, which were affe&ed with torpor, regain
their irritability, ard ailoc lability, the cold paroxyfm of fever
ceafes i but as fome or the parts affe -ted were previouily accuf-
tomed to inceffant action, as the heart and arteries, and others
only to intermitted action, as the ftomach and inteftines ; and
as thofe, which are fubj^ctsd during health to perpetual action,
accumulate ienforial pt-wer falter, when their motions are im-
peded, than thole which are iubje&ed to intermitted adrion -, it
happens, that fome of the parts, which were affected with tor-
por caring the coid fit, recover their irritability or aflbciability
iboner than others, and more perfectly, or acquire a greater
quantity of them than natural ; as appears by the partial heat
and fiumings previous to the 6e,ieral hot fit.

Hence if all the parts, whioh were previouily torpid, regain
their due degree of irritability, or of aflbciability, the difeafe is
removed, arid health reftored. If fome or all of them acquire
more than their natural degree of thefe fenforial powers ; in-
creafed- actions, and confequent increafed fecretions, and greater
heat occur, and conftitute the hoc fit of fever. If after this hot
fit of fever all the parts, which had acquired too great irritabili-
ty, or affectability, regain their natural degree of it •, the dif-
eafe is removed, and health reftored. But if fome of thefe parts
do not regain their natural degree of thefe fenforial powers, the
actions of thofe p^rts remain imperfecl:, and are more or lefs
injurious to the fyftem, according to the importance of their
functions.

2. Thus if a torpor of the heart and arteries remains ; the
quick pulfe without ftrength, which began in the cold fit, per-
iifts j and a continued fever is produced. If the torpor of the
ftomach and inteftines remains, which is known by ficknefs and
un-iigefted itools, the fever is liable to be of confiderable length
and danger ; the fame if the kidneys and abforbent fyftem re-
tain fome degree of torpor, as is (hewn by the pale urine in not
unufual quantity. If part of the abforbent fyftem remains tor-
pid, as the abfcibent vefTels of the fpleen, a tumour of that vif-
cus occurs, which may be felt by the hand ; the fame fome-

times

SUP. I. 3. 3 THEORY OF FEVER. 453

times happens to the liver ; and thefe from their tendency to
more complete torpor are afterwards liable to give occafion to a
return of the cold fit. If the cellular abforbents do not com-
pletely recover their activity, a pale and bloated countenance
with (welled legs marks their want of action.

3. As the termination of the cold fit is owing to the accumu-
lation of the fenforial power of irritation and of aflbciation du-
ring the previous quiefcence of the fyftem ; and as thofe parts,
which are in perpetual action during health, are more fubjecl:
to this accumulation during their torpor, or quiefcence ; one
fhould have imagined, that the heart and arteries would acquire
this accumulation of fenforial power fooner or in greater degree
than other parts. This indeed fo happens, where the pulfe is
previoufly ftrong, as in febris irritativa ; cr where another fen-
forial power, as that of fenfation, is exerted on the arterial fyf-
tem, as in inflammations. The heart and arteries in thefe cafes
foon recover from their torpor, and are exerted with great vi-
olence.

Many other parts of the fyftem fubjecl: to perpetual motion
in health may reft for a time without much inconvenience
to the whole ; as when the fingers of fome people become cold
and pale ; and during this complete reft great accumulation of
irritability may be produced. But where the heart and ar-
teries are previoufly feeble, they cannot much diminifii their
actions, and certainly cannot reft entirely, for that would be
death ; and therefore in this cafe their accumulation of the fen-
forial power of irritation or of aflbciation is ilowly produced,
and a long fever fupervenes in confcquence ; or fudden death,
as frequendy happens, terminates the cold fit.

Whence it appears, that in fevers with weak pulfe, if the ac-
tion of the heart, arteries, and capillaries could be diminimed,
or flopped for a fhort time without occalioning the death of the
patient, as happens in cold bathing, or to perfons apparently
drowned, that a great accumulation of the fenforial powers of
irritation or of aflbciation might foon be produced, and the pulfe
become ftronger, and confequently flower, and the fever ceafe.
Hence cold ablution may be of fervice in fevers "with weak
pulfe, by preventing the expenditure and producing accumula-
tion of the fenforial power of irritation or aflbciation. Stupor
may be ufeful on the fame account. Could a centrifugal fwing
be ferviceable for this purpofe, either by placing the head or the
feet in the outward part of the circle, as defcribed in Art. 15. 7.
pf this Supplement ?

IV.

454 THEORY OF FEVER. SUP I.

IV. Return of the cold Fit.

1. If the increafed aclion of the cutaneous and pulmom
capillaries, and of the heart and arteries, in febris irritativa, con-
tinues long and with violence, a proportional expenditure or ex-
hauftion of fenforial power occurs ; which by its tendency to in-
duce torpor of fome part, or of the whole, brings on a return of
the cold fit.

2. Another caufe which contributes to iriduce torpor of the
whole fyftem by the fympathy of its parts with each other, is
the remaining torpor of fome vifcus ; which after the laft cold
paroxyfm had not recovered itfelf, as of the fpleen, liver, kid-
neys, or of the ftomach and inteftines, or abforbent veflels, as
above mentioned.

3. Other caufes are the deficiency of the natural ftimuli,
hunger, thirft, and want of frefh air. Other caufes are grej
fatigue, want of reft, fear, grief, or anxiety of mind. And laftly,
the influence of external ethereal fluids, as the defect of exter-
nal heat, and of folar or lunar gravitation. Of the latter the
return of the paroxyfms of continued fevers about fix o'clock in
the evening, when the folar gravitation is the leaft, affords an
example of the influence of it ; and the ufual periods of inter-
mittents, whether quotidian, tertian, or quartan, which fo regu-
larly obey folar or lunar days, afford inftances of the influence of
thofe luminaries on thefe kinds of fevers.

4. If the tendency to torpor of fome vifcus is confiderable,
this will be increafed at the time, when the terrene gravitation
is greateft, as explained in the introduction to Clafs IV. 2. 4.
and may either produce a cold paroxyfm of quotidian fever ; or
it may not yet be fufficient in quantity for that purpofe, but may
neverthelefs become greater, and continue fo till the next period
of the greateft terrene gravitation, and may then either produce
a paroxyfm of tertian fever ; or may ftill become greater, and
continue fo till the next period of greateft terrene gravitation, and
then produce a paroxyfm of quartan ague. And laftly, the pe-
riodical times of thefe paroxyfms may exceed, or fall fhort of,
the time of greateft diurnal terrene gravitation according to the
time of day, or period of the moon, in which the firft fit began ;
tint is, whether the diurnal terrene gravitation was then in an
increafmg or decreafmg ftate.

V. Senfation excited in Fever.

i. A curious obfenration is related by Dr. Fordvc* in his

Trad

SUP. 1. 5. 2. THEORY OF FEVER. 455

Tra£fc on Simple fever, page 168. He aflerts, that thofe people*
who have been confined fome time in a very warm atmofphere,
as of 120 or 130 degrees of heat,. do not feel cold, nor are fub-
jeft to palenefs of their fkins, on coming into a temperature of
30 or 40 degrees ; which would produce great palenefs and
painful fenfation of coldnefs in thole, who had been fome time
confined in an atmofphere of only 86 or 90 degrees. Analo-
gous to this, an obferving friend of mine allured me, that once
having fat up to a very late hour with three or four very inge-
nious and humorous companions, and drunk a confiderable
quantity of wine ; both contrary to his ufual habits of life ; and
being obliged to rife early, and to ride a long journey on the
next day ; he expected to have found himfelf weak and fopn
fatigued ; but on the contrary he performed his journey with
unufual eafe and alacrity ; and frequently laughed, as he rode,
at the wit of the preceding evening. In both thefe cafes a de-
gree of pain or pleafure actuated the fyftem •, and thus a fenfo-
rial power, that of fenfation, was fuperadded to that of irrita-
tion, or volition. See Seel. XXXIV. ^. 6.

2. Similar to this, when the energetic exertions of fome parts
of the fyftem in the hot fit of fever arife to a certain excefs, a
degree of fenfation is produced ; as of heat which particularly
increafes the actions of the cutaneous velTels, which are more
liable to be excited by this ftimulus. When this additional fen-
forial power of fenfation exifts to a greater degree, the pulfe,
which was before full, now becomes hard, owing to the inflam-
mation of the vafa vaforum, or coats of the arteries. In thefe cafes
whether there is any topical inflammation or not, the fever ceaf-
es to intermit ; but neverthelefs there are daily remiflions and
exacerbations of it ; which recur for the moft part about fix in
the evening, when the folar gravitation is the leait, as mention-
ed in Sea. XXXVI. 3. 7.

3. Thus the introduction of another fenforial power, that of
fenfation, converts an intermittent fever into a continued one.
If it be attended with ftrong^ pulfe, it is termedjfebris fenfuiva ir-
litata, or pyrexia, or inflammation ; if with a weak pulie, is is
termed febris fenfitiva inirritata, or typhus gravior, or malignant
fever. The feat of the inflammation is in the glandular or capil-
lary fyftem, as it confifts in the fecretion of new fluids, or new
fibres, which form new vclTels, as they harden, like the iilk of
the filk-worm. See Art. 15. of this Supplement.

VI. Circles of irritative Ajficiaic
J. There are fome aflbciate motions, \vht~h are perjlKualiy

456 THEORY OF FEVER, SUP. 1. 6.

proceeding in our waking hours, and are catenated by their firft
link, or in fome fubfequent parts of the chain, with the ftimuii
or the influence of external things ; which we (hall here enu-
merate, as they contribute to the knowledge of fever. Of thefe
are the irritative ideas, or fenfual motions of the organs of fenfe,
and the mufcular motions aflbciated with them \ which, when
the chain is difturbed or interrupted, excite the fenforial power
of fenfation, and proceed in confufion. Thus if the irritative
ideas of fight are difturbed, the paralaftic motions of objects,
which in general are unperceived, becomes fenfible to us ; and
the locomotive mufcles aflbciated with them, which ought to
preferve the body erect, dagger from this decreafe or interrup-
tion of the fenforial power of afToeiation ; and vertigo is pro-
duced.

When the irritative fenfual motions, or ideas, belonging to
One fenfe are ihcreafed or diminiihed, the irritative fenfual mo-
tioxis, or ideas, of the other fenfes are liable to become difturbed
by their general catenations ; whence occur noifes in the ears,
bad taftes in the mouth, bad odours, and numbnefs or tingling
of the limbs, as a greater or lefs number of fenfes are affected.
Thefe conftitute concomitant circles of difturbed irritative ideas ;
or make a part of the great circle of irritative ideas, or motions
of the organs of fenfe ; and when* thus difturbed occafion many
kinds of hallucination of our other fenfes, or attend on the ver-
tigo of vifion.

2. Another great circle of irritative aflbciated motions con-
fifts of thofe of the alimentary canal ; which are catenated with
ftimuii or with influences external to the fyftem, but continue
to be exerted in our fleeping as well as in our waking hours.
When thefe aflbciations of motion are difturbed by the too great
or too fmall ftimulus of the food taken into the ftomach, or by
the too great excefs or deprivation of heat, or by indigestible
fubftances, or by torpor or orgafm occaGoned by their aflbcia-
tion with other parts, various difeafes are induced under the
names of apepfia, hypochondriafis/ hyfteria, diarrhoea, cholera,
ileus, nephritis, fever.

3. A third circle of irritative aflbciate motions confifts of thofe
of the abforbent fyftem ; which may be divided into two, the
latteals, and the lymphatics. When the ftomach and inteftines
are recently filled with food and fluid, the lacteal fyftem is
ftimnhted into great action ; at the fame time the cellular, cuta-
neous, and pulmonary lymphatics act with lefs energy; becaufe
Icfs fluid is then wanted from thofe branches, and becauie more
fenforial power is expended by the lacteal branch. On this ac-

; thefe tvv-o fyflemR of abforbents are liable to act by re-

verfe

SUP. 1. *. 4. THEORY OF FEVER, 457

verfe fympatfiy ; hence pale urine is made after a full dinner, as
lefs of the aqueous part of it is imbibed by the urinary lym-
phatics ; and hence the water in anafarca of the lungs and limbs
is fpeedily abforbed, when the actions of the lafteals of the
ftonvach or inteftiues are weakened or inverted by the exhibition
of thofe drugs, which produce naufea, or by violent vomiting,
or violent cathartics.

Hence in diabetes the lafteal fyftem a£h ftrongly, at the fame
time that the urinary lymphatics invert their motions, and tranf-
mit the chyle into the bladder -, and in diarrhcea from crapula,
or too great a quantity of food and fluid taken at a time>
the lacleals ad ftrongly, and ab'brb chyle or fluids from the
ftomach and upper iiueftines -, while the lymphatics of the low-
er interlines revert their motions, and tranfmit this over-repletion
into the lower interlines, and thus produce diarrhoea ; which
accounts for the fpeedy operation of fome cathartic drugs, when
much fluid is taken along with them.

4. Other circles of irritative aflbciate motions of great impor-
tance are thofe of the fecreting fyftem ; of thefe are the motions
of the larger congeries of glands, which form the liver, fpleen,
pancreas, gaftric glands, kidneys, falivary glands, and many oth-
ers ; fome of which aft by direcl: and others by reverfe fympa-
thy with each other. Thus when the gaftric glands ac~l moft
powerfully, as when the ftomach is filled with food, the kidneys
act with lefs energy ; as is fhewn by the fmall fecretion of
urine for the firft hour or two after dinner ; which reverfe fym-
pathy is occafioned by the greater expenditure of fenforial pow-
er on the gaftric glands, and to the newly abforbed fluids not
yet being fufficiently animalized, or otherwife prepared; to ftim-
ulate the fecretory vefTels of the kidneys.

But thofe very extenfive glands, which fecrete the perfpira-
ble matter of the (kin and lungs, with the mucus, which lubri-
cates all the internal cells and cavities of the body, claim our
particular attention. Thefe glands, as well as all the others>
proceed from the capillary vdffeta which unite the arteries with
the veins, and are not properly a part of them j the mucous and
pertpirative glands, which anfe irom the cutaneous and pulmo-
nary capillaries, are aflbciated by direcl: fympathy ; as appears
from immerfion in the cold bath, which is therefore attended
with a temporary difficult ref ^intion ; while thole from the ca-
pillaries of the ftomach and heart and arteries are more gener-
ally atTociated by reverfe fympathy with thofe of the cutaneous
capillaries ; as appears in fevers with weak pulfe and indigeftion,
and at the famevtime with hot and dry {kin.

The diilurbe3 aftions of this circle of the aflbciate motions of

VOL. II. L L 1 the

45 3 THEORY OF FEVER. SUP. 1. 6.

,.

the fecerning fyftem, when the fenforial power of fenfation is
added to that of irirtation, frequently produces inflammation,
•which confifts in the fecretion of new fluids or new veflels.
Neverthelefs, if thefe difturbed actions be of the torpid kind,
the pain, which attends them, is feldom productive of inflam-
mation, as in hemicrania ; but is liable to excite voluntary ac-
tions, and thus to expend much fe^iforial power, as in the fhud-
dering in cold fits of fever, or in convulfions ; or laitly the pain
itfelf, which attends torpid actions, is liable to expend or ex-
hauft much fenforial power without producing any increafed
aclions ; whence the low pulfe, and cold extremities, which ufu-
ally attend hemicrania j and hence when inert, or inactive fen-
fation attends one link of aflbciated action, the fncceeding link
is generally rendered torpid, as a coldnefs of the cheek attends
tooth-ach.

5. A fifth important circle of irritative motions is that of the
fanguiferous fyftem, in which the capillary veflels are to be in-
cluded, which unite the arterial and venous fyftems, both pul-
monary and aortal. The difturbed adtion of this fyftem of the
heart and arteries, and capillaries, conftitutes fimple fever ; to
which may be added, that the fecerning and abibrbent veflels
appending to the capillaries, and the bibulous mouths of the
veins, are in fome meafure at the fame time generally afFe£ted.

6. Now, though the links of each of thefe circles of irritative
motions are more ftr icily aflbciated together, yet are they in
greater or lefs degree aflbciated or catenated with each other by
direct or reverfe fympathy. Thus the ficknefs, or inverted irri-
tative motions of the ftomach, are aflbciated or catenated with
the difturbed irritative ideas, or fenfual motions, in vertigo ; as
in fea-ficknefs. This ficknefs of the ftomach is alfo aflbciated
or catenated with the torpor of the heart and arteries by direct
fympathy, and with the capillaries and abforbents by reverfe
fympathy ; and are thus all of them liable occafionally to be dif-
turbed, when one of them is difeafed j and couftitute the great
variety of the kinds or fymptoms of fevers.

VII. -Alternation of the cold and hot Fits.

PY

i . When any caufe occurs, which diminifhes to a certain de-
gree the fupply of fenforial power in refpect to the whole fyf-
tem ; as fuppofe a temporary inexertion of the brain ; what
happens ? Firft, thofe motions are exerted with lefs energy,
which are not immediately neceflary to life, as the locomotive
mufcles ; and thofe ideas, which are generally excited by voli-
tion, at the lame time this deficiency of voluntary motion is

different

SUP. I. 7. 2. THEORY OF FEVER. 459

different from that which occurs in fleep ; as in that the move-
ments of the arterial fyftem are increafed in energy though not
in frequency. Next, the motions of the alimentary canal be-
come performed with lefs energy, or ceafe altogether ; and a
total want of appetite to folid food occurs, or ficknefs or a diar-
rhoea occafioned by the indigefted aliment. Then the abforbent
veflels ceafe to adt with their due energy ; whence thirft, and
pale urine, though in fmall quantities. Fourthly, the fecerning
veflels become affected by the general diminution of f-nforial
power ; whence all the fecreted fluids are produced in lefs
quantity. And laftly, the fanguiferous canals feel the general
torpor ; the pulfations of the heart and arteries become feeble,
and confequently quick ; and the capillaries of the (kin become
inactive, acquire lefs blood from the arteries, and are confe-
quently paler and flirunk.

In this laft circumftance of the torpor of the fanguiferous
fyftem confifts inirritative fever ; as all the others are rather ac-
cidental or concomitant fymptoms, and not eflential ones ; as
fewer or more of them may be prefent, or may exift with a
greater or lefs degree of inactivity.

2. Now as the capillaries of the fkin are expofed to greater
varieties of heat and cold, than the heart and arteries, they are
fuppofed to be more mobile, that is, more fufceptible of torpor
or exertion, or to inflammation, by external ftimuli or influences,
than the other parts of the fanguiferous fyftem ; and as the fldn.
is more fenfible to the prefence of heat, than the internal parts
of the body, the commencement of the cold paroxyfms of fever
generally either firft exifts in, or is firft perceived by, the cold-
nefs and palenefs of the fkin j and the commencement: of the hot
fits by the heat and rednefs of it.

3. The accumulation of fenforial power occurs in thefe or-
gans fooneft, and in greateft quantity, during their quiefcence,
which were mofl perpetually in action during health ; hence
thofe parts of the fyftem fooneft recover from torpor in inter-
mittent fever, and fooneft fall into the contrary extreme of in-
creafed activity ; as the fanguiferous fyftem of the heart and ar-
teries and capillaries. But of thefe the capillaries feem firft to
acquire a renovation of their action, as the heat of the ikin be-
comes firft renewed, as well as increafed beyond its natural
quantity, and this in fome parts fooner than in others ; whicli
quantity of heat is however not to be eftimatcd fimply by the
rife of the mercury in the thermometer, but alfo by the quanti-
ty carried away into the atmofphere, or diffufed amongft other
bodies in a given time ; as more heat paiFes through water,
which boils vehemently, than when it boils gently, though the

rife

..

4< THEORY OF FEVER. SUP. I. 7.

rife of the thermometer in both cafes continues the fame. This
fact may he known by boiling an egg in water, the white of
which coagulates in much lefs time$ if the water boils vehement-
ly, than if it boils moderately, though the fenfible heat of the
water is the fame in both cafes.

Another caufe, which induces the cutaneous capillaries to re-
new their actions fooner than the heart and arteries after im-
merfion In the cold hath, is, that their torpor was occafioned by
defect of irritation : whereas that of the heart and arteries was
occafioned by defect of aflbciation ; which defect of aflbciation
was owing to the decreafed actions of the capillaries, and is now
again excited by their renewed action j which excitement muft
therefore be fubfequent to that increafed action of the capilla-
ries ; and in confequence the increafed action of the heart and
arteries at the commencement of the hot fit of fome fevers is
fubfequent to the increafed action of the cutaneous capillaries.
There is, however, in this cafe an accumulation of the fenforial
power of aflbciation in the heart and arteries, which muft con-
tribute to increafe their orgafm in the hot fit, as well as the in-
creafed excitement of it by the increafed action of the capillaries.

4. Now this increafed action of the fyftem, during the hot
fit, by exhaufting the fenforial powers of irritation and aflbcia-
tion, contributes to induce a renewal of the cold paroxyfm ; as
the accumulation of thofe fenforial powers in the cold fit pro-
duces the increafed actions of the hot fit ; which two flares o£
the fyftem reciprocally induce each other by a kind of librations
or a plus and minus, of the fenforial powers of irritation and
aflbciation.

If the exhauftion of fenforial power during the hot fit of fe-
ver only reduces the quantity of irritability and aflbciability to
its natural ftandard, the fever is cured, not being liable to re-
turn. If the quantity of thefe fenforial powers be reduced only
fo much, as not to produce a fecond cold fit during the prefent
quantity of external ftimuli or influences ; yet it may be fo far
reduced, that a very fmall fubtraction of ftimulus, or of influ-
ence, may again induce a cold fit \ fuch as the coldneis of the
night.air, or the diminution of folar or lunar gravitation, as in
intermittent fevers.

5. Another caufe of the renovation of the cold fits of fever
is from fome parts of the fyftem not having completely recov-
ered from the former cold paroxyfm ; as happens to the fpleen,
liver, or other internal vifcus ; which fometimes remains tumid,
and either occafions a return of the cold fit by direct fympathy
with other parts of the body« or by its own want of action cauf-
cs a diminution of the general quantity of heat, and thus facili-
tates

SUF. I. 8. i. THEORY OF FEVER. 481

tates the renovation of the torpor of the whole iyftem, and gives
caufe to intermittent fevers catenated with lunar or folar influ-
ence.

VIII. Orgafm of the Capillaries.

As the remaining torpor of fome lefs effential part of tke fyf-
tem, as of the fpleen, when the hot fit ceafes, produces after
one, two, or three days a return of cold fit by direct fympathy
with the cutaneous capillaries, when joined with fome other
caufe of torpor, as the defedt of foiar or lunar influences, or the
expofure to cold or hunger, and thus gives origin to intermit-
tent fever ; fo the remaining torpor of fome more eifential parts
of the fyftern, as of the itomach and inteltines, is probably the
caufe of the immediate recurrence of the cold paroxyfm, at the
time the hot one ceafes, by their direct fympathy with the cu-
taneous capillaries, without the ailiftance of any other caufe of
torpor ; and thus produces remittent fever. And laflly the re-
maining torpor of fome dill more efiential parts of the fyftem,
as die heart and arteries, after the hot fit ought to ceafr, is lia-
ble by reverfe fympathy with the cutaneous capillaries to con-
tinue their orgafm, and thus to render a fever continual, which
would otherwife remit or intermit.

Many difficulties here -occur, which we fliall endeavour to
throw fome light upon, and leave to future investigation ; ob-
ferving only that difficulties were to be expe&ed, otherwife fe-
vers would long fince have been understood, as they have em-
ployed the unremitted attention of the phyficians of all ages of
the world.

i. Why do the fame parts of fucceflive trains of action fome-
times affect each other by direcl:, and fometimes by reverfe fym-
pathy ? — i ft, When any irritative motion ceafes, or becomes
torpid, which was before in perpetuaJ action ; it is either de-
prived of its ufuul ftimulus, and thence the fenforial power of
irritation is not excited ; or it has been previoufly too much ftim-
uiated, and the fenforial power has been thus exhaufted.

In the former cafe an accumulation of fenforial power foon
' occurs, which is excitable by a renewal of the ftimulus ; as whert
the fingers, which have been immerfed fome time in inow, are
again expofed to the ufual warmth of a room. Or, fecondly, the
fenforial power of irritation becomes fo much accumulated, that
the motions, which were torpid, are now performed by idi
ftimulus than natural ; as appears by the warmth, which loon-
occurs after the firft chill in going into frofly air, or into the
bath at Buxton, which is about eighty degrees of heat. Or,-

laftly,

462 THEORY OF FEVER. SUP. I. 8. 2*

hilly, this accumulation of the fenforial power of irritation fo
far abounds, that it increafes the action of the next link of the
aifociated train or tribe of motions ; thus on expofmg the fkin
to cold air, as in walking out in a frofty morning, the actions
of the ftomach are increafed, and digeftion ftrengthened.

But where the torpor of fome irritative motion is owing to
the previous exhauftion of the fenforial power of irritation by
too great ftimulus, the reftoration of it occurs either not at all,
or much more flowly than in the former inftances ; thus after
intoxication the ftomaclys very flow in recovering its due quan-
tity of the fenforial power of irritation, and never fhews any ac-
cumulation of it.

2. When an aflbciate motion, as defcribed in the introduc-
tion to Clafs IV. i. i. acts with lefs energy, the fenforial pow-
er of aflbciation is either not fufficiently excited by the preced-
ing fibrous motions ; or it has been expended or exhaufted by
the too violent actions of the preceding fibrous motions. In the
former cafe tbere occurs an accumulation of the fenforial power
of aflbciation ; exactly as, where the ufual ftimulus is with-
drawn, there occurs an accumulation of the fenforial power of
irritation. Thus when the actions of the capillaries of the fkin
are diminifhed by immerfion in cold water, the capillaries of the
lungs are rendered torpid by the want of the excitement of the
fenforial power of aflbciation, owing to the leffened actions of the
previous fibrous motions, namely, of thofe of the fkin. Never-
thelefs as foon as the capillaries of the fkin regain their increafed
activity by the accumulation of the fenforial power of irrita-
tion, thefe capillaries of the lungs act with greater energy alfo
owing to their accumulated fenforial power of aflbciation. Thefe
are inftances of direct fympathy, and conftitute the cold and
hot paroxyfms of intermittent fever ; or the firft paro-xyfm of a
continued one.

3. When the firft link of a train of aflbciated motions, which
is fubjeft to perpetual action, becomes a confiderable time tor-
pid for want of being excited by the previous exertions -of the
irritative motions, with which it is catenated ; the fenforial
power of aflbciation becomes accumulated in fo great a degree
as to affect the fecond link of the train of aflbciated motions,
and to excke it into ftronger action. Thus when the ftomach
is rendered torpid by contagious matter fwallowed into it mixed
with the faliva, the heart and arteries act more feebly ; becaufe
the fenforial power of aflbciation, which ufed to be excited by
the fibrous motions of the ftomach, is not now excited ; and in
eonfequence the motions of the heart and arteries act only by

the

SUP. I. 8. 4. THEORY OF FEVER. 463

the fenforial power of irritation, which is excited by the ftimu-
lus of the blood.

But during this torpor of the ftomach, and lefs aftion of th«
heart and arteries, fo great an accumulation of the fenforial
powers of irritation and of aflbciation occurs, that it adds to the
action of the next link of this vital circle of actions, that is, to
that of the cutaneous capillaries. Whence in this fituation the
torpor of the ftomach occafions a diminimed action of the heart
and arteries by direct fympathy, and may be faidto occafion an
increafed one of the cutaneous capillaries by reverfe fympathy ;
which conftitute continued fever with weak pulfe.

Nor is this increafed action of the capillaries in confequence
of the decreafed action of the heart and arteries, as in fevers
with weak pulfe, a fmgle fact in the animal economy ; though
it exifts in this cafe in the greateft degree or duration, becaufe
the heart and arteries are perpetually in greater action than any
other part of the fyftem. But a fimilar circumftance occurs,
when the ftomach is rendered inactive by defective excitement
of the fenforial power of aflbciation, as in fea-ficknefs, or in
nephritis. In thefe cafes the fenforial power of aflbciation be-
comes much accumulated in the ftomach, and feems by its fu-
perabundance to excite the abforbent fyftem, which is fo nearly
connected with it, into great increafe of action ; as is known by
the great quantity frequently in thefe fituations rejected by vom-
it, which could not otherways be fupplied. It is probable the
increafe of digeftion by walking in frofty air, with many other
animal facts, may by future observations be found to be depend-
ent on this principle, as well as the increafed action of the ca-
pillaries in continued fevers with weak pulfe.

Whereas in continued fever with ftrong pulfe, which may
perhaps occur fometimes on the firft day even of the plague, the
ftomach with the heart and arteries and the capillaries act by
direct fympathy j that is, the ftomach is excited into ftronger
action by increafed irritation owing to the ftimulus of conta-
gious matter ; thefe ftronger irritative motions of the ftomach
excite a greater quantity of the fenforial power of aflbciation,
which then actuates the heart and arteries with greater energy,
as thefe are catenated with the ftomach •, and in the fame man-
ner the ircreafed actions of the heart and arteries excite a great-
er quantity of the fenforial power of aflbciation, which actuates
the cutaneous capillaries with iwcreafe of energy. See Clafi
IV. i. i.

4. I (hall dwell a little longer on this intricate fubject. The
commencement of fever-fits is known by the inactivity of the
cutaneous capillaries, which inactivity is obfervable by the pale-

riefs

464 THEORY OF FEVER. SUP. 1. 8. j.

nefs and coldnefs of the (kin, and alfo by the pain of coldnefs,
which attends it. There is neverthelefs in mod cafes, except
tkofe which are owing to expofure to external cold, a torpor of
the capillaries of fome internal vifcus preceding this inactivity
of the cutaneous capillaries ; which is known by the tumour or
hardnefs of the vifcus, or by an aching pain of it. The capilla-
ries of the lungs are at the fame time rendered inactive or tor-
pid, as appears by the difficulty of breathing, and coldnefs of
the breath in cold fits of fever, and in going into the cold bath ;
but the lungs are not affected with the pain either of coldnefs or
of torpor.

One caufe of this fynchronous or fucceflive inactivity of the
cutaneous capillaries, in confequence of the previous torpor of
fome internal vifcus, may be owing to the deficiency of heat ;
which muft occur, when any part becomes inactive ; becauie
the fecretions cf that part ceafe or are leffened, and the quantity
of heat of it in confequence. But the principal caufe of it I
fuppofe to be owing to the defect of the fenforial power of af-
fociation ; which power of affociation is excited by fome pre-
vious or concomitant motions of the parts of every great circle
of actions. This appears on going into the cold bath, becaufe
the fhortnefs of breath inflantly occurs, fooner than one can con-
ceive the diminution of the heat of the fkin could affect the lungs
by the want of its llimulus ; but not fooner than the defect of the
fenforial power of affociation could affect diem ; becaufe this
mud ceafe to be excited into action on the inftant that the cu-
taneous capillaries ceafe to act ; whence in the firft moment of
contact of the cold water the cutaneous capillaries ceafe to act
from defect of irritation ; which is caufed by defect of the ftim-
ulus of heat ; and in the fecond moment the capillaries of the
lungs ceafe to act from the defect of affociation j which is cauf-
ed by the defect of the motions of the cutaneous capillaries.
Thus the univerfal torpor in the cold paroxyfm of fever is an ex-
ample of direct fympathy, though occasioned in part by defect
of irritation, and in part by defect of affociation.

5. Thus in walking out in a frofty morning the fkin is cool-
ed by the contact of the cold air, whence the actions of its ca-
pillaries are diminifhed for want of their ufual itimulus of heat
to excite a fufficient quantity of the fenforial power of irritation.
Hence there is at firft a faving of the fenforial power of irrita-
tion for the purpofe of actuating the other parts of the fyflem.
with greater energy. Secondly, the fenforial power of affocia-
tion, which ufed to be excited by the motions of the cutar:
capillaries, is now not fo powerfully excited ; and in confequenc^
rh<- pirts.. \vhich ronflitutc the nest links of the circles of aflb-

ciated

SUP. 1. 8. 6. THEORY OF FEVER.

ciated motions, are for a time actuated with lefs energy, and £
temporary general chillnefs fucceeds ; which is fo far fimilar to
the cold fit of intermittent fever.

In this fituation there is a curious circumftance occurs, which
merits peculiar attention : after a fhort time, though the exter-
nal fjcin continues cool by its expofure to the cold air, and the
actions of its capillaries are confequently diminimed, yet the ca-
pillaries of the ilomach act with greater energy j as is known
by increafed digeftion and confequent hunger. This is to be
afcribed to the accumulation of the fenforial power of irritation,
which now excites by its fuperabundance, or overflowing", as it
were, the ilomach into increafed adtion ; though it is at the fame
time excited lefs powerfully than ufual by the fenforial power of
aflbciation. Thus the accumulation of the fenforial power of
irritation in the veflels of the fkin increafes in this cafe the ac-
tion of the ftomach, in the fame manner as an accumulation of
the fenforial power of aflbciation in the heart and arteries in fe-
vers with weak pulfe increafes the action of the capillaries.

If neverthelefs the coldnefs of the fkin be too long continued,
or exifts in too great a degree, fo as in fome meafure to impair
the life of the part, no further accumulation of the fenforial
power of irritation occurs ; and in confequence the actions of
the ftomach become lefs than natural by the defect of the fen-
forial power of aflbciation ; which has ceafed to be excited by
the want of a&ion of the cutaneous capillaries. Whence con-
tinued coldnefs of the feet is accompanied with indigeftion and
heartburn. See Clafs IV. 2. 1.6*

6. Similar to this when the actions of the ftomach are ren-
dered torpid by the previous ftimulus of a violent emetic, and
its motions become retrograde in confequence, a great quantity
of fenforial power is exerted on the lymphatics of the lungs,
and other parts of the body ; which excites them into greater
direct action, as is evinced by the exhibition of digitalis in ana-
farca. In this fituation I fuppofe the emetic drug (timulates the
mufcular fibres of the ftomach into too great action ; and that
in confequence a great torpor foon fucceeds ; and that this in-
action of the mufcular parts of the ftomach is not followed by
much accumulation of the fenforial power of irritation ; be-
caufe that fenforial power is in great meafure exhaufted by the
previous exceflive ftimulus. But the lymphatics of the ftom-
ach have their actions leflened by defect of fenforial power
of aflbciation, which is not now excited into action, owing to
the leflened motions of the mufcular parts of it, with which the
lymphatics are aflbciated. The fenforial power of aflbciation
becomes therefore accumulated in thefe lymphatics of the ftom-

VOL. II, M M m acji,

466 THEORY OF FEVER. SUP. 1. 8. 7,

ach, becaufe it is not excited into action ; exactly as the power
of irritation becomes accumulated in the hand, when immerfed
in fnow ; and this accumulated fenforial power of afTociation
excites the lymphatics of the lungs and of other parts, which are
moft nearly aflbciated with thofe of the ftomach, into more en-
ergetic actions. Thus the mufcular fibres of the ftomach act
with the lymphatics of that organ in direct fympathy ; and the
lymphatics of the ftomach act in reverfe fympathy with thofe of
the lungs and of other parts of the body ; the former of which is
caufed by defect of the excitement of the fenforial power of af-
fociation, and the latter by the accumulation of it.

Befides the efficient caufe, as above explained, the final caufe>
or convenience, of thefe organic actions are worthy our atten-
tion. In this cafe of an acrid drug f wallowed into the ftomach
the reverted actions of the mufcular fibres of the ftomach tend
to eject its enemy ; the reverted actions of its lymphatics pout
ft great quantity of fluids into the ftomach for the piirpofe of di-
luting or wafhing off the noxious drug ; and the increafed ac-
tions of the other lymphatics fupply thefe retrograde ones of the
ftomach with an inconceivable fupply of fluids, as is feen in
Ileus and Cholera.

7. The inquifitive reader will excufe my continuing this
fubjectj though perhaps with fome repetitions, as it envelopes
the very eflence of fever. When the firft link of a train of ac-
tions is excited by exceflive ftimulus, or excefiive irritability, and
thus acts with unufual energy by the increafed quantity of irri-
tation, thefe increafed motions excite a greater quantity of the
fenforial power of aflbciation, which caufes increafed motions
in the fecond link, which is catenated with the firft •, and then
the exceflive action of this fecond link excites alfo a greater
quantity of the fenforial power of aflbciation, which increafes
the motions of the third link of this chain of aflbciation, and
thus the inereafe of the ftimulus on the irritative motions, to
which the chain of aflbciation is catenated, increafes the action
of the whole chain or circle of aflbciated motions.

After a time the irritative motions become torpid by expendi-
ture of the fenforial power of irritation, and then the power of
aflbciation alfo becomes lefs exerted, both becaufe it has been in
part exhaufted by too great action, and is now lefs excited by
the leflened action of the irritative motions, which ufed to ex-
cite it. Thefe are both inflances of direct fympathy, and fre-
quently conftitute the cold and hot fit of intermittents.

But th6ugh the accumulation of the fenforial power of irri*
tation during the quiefcence of fome motion owing to want of*
ftimulus generally induces torpor in the firft link of the train of

afibciated

Sur. I. 8. 8. THEORY OF FEVER. 467

aflbciated motions catenated with it ; as the capillaries of the
lungs become torpid immediately on immerfion of the fkin into
cold water ; yet in fome fituations an orgafm or excefs of action
is produced in the firft link of the aflbciated motions thus cate-
nated with irritative ones ; as ia the increafed action of the
ftomach, when the fkin is for a time expofed to cold air ; which
may in part be afcribed to the genera} increafe of action of the
whole fyftem, owing to the diminifhd expenditure of fenforial
power, but particularly of the parts, which have habitually act-
ed together ; as when one arm is paralytic the other is liable to
more frequent or almoft continual motion ; and when one eye
becomes blind the other frequently becomes ftronger ; which is
well known to farriers, who are faid fometimes to deftroy the
fight of one eye to ftrengthen that of the other in difeafed horfes.

Hence there is fometimes a direct fympathy, and fometimes
a reverfe one fucceeds the torpor occafioned by defect of ftimu-
lus, the latter of which is perhaps owing to a certain time be-
ing required for the production of an accumulation of the fen-
forial power of irritation by the nervous branches of the tor-
pid organ ; which accumulation is now in part or entirely de*
rived to the next link of the aflbciation. Thus in going into a
coldifh bath, as into a river in the fummer months, we at firft
experience a difficulty of breathing from the torpid action of the
pulmonary capillaries, owing to the deficient excitement of the
fenforial power of aflbciation in confequence of the torpor of the
cutaneous capillaries. But in a very fhort time, as in one minr
ute, the fenforial power of irritation becomes accumulated by
the inactivity of the cutaneous capillaries ; and as its fuperabun-
dance becomes now expended on the pulmonary capillaries, the
difficult refpiration ceafes ; though the cutaneous capillaries con-
tinue torpid by their contact with the cold water, and confe-
quently the fenforial power of aflbciation, which ufed to con-
tribute to actuate the pulmonary capillaries, is lefs excited.

8. In like manner when there exilts an accumulation of the
fenforial power of aflbciation, owing to defect of its excitement
by fome previous irritative or aflbciate motions, it is generally
accompanied for a certain time by a torpor not only of the link
firft affected, but of the fubfequent parts, or of the whole train
of aflbciated motions, as in the cold fits of intermittent fevers.
Yet after a time an increafed action of the next links of aflbci-
ated motions fucceeds the torpor of the firft, as the abforbent
veflels of the lungs act more violently in confequence 9f the de-
ficient action of thofe of the ftomach ; and the (kin at the com-
mencement of ficknefs is pale and cold, but in a little time be-
comes flufhed and warm.

Thus

468 THEORY OF FEVER. Sup. 1. 8. 9.

Thus we fee in aflbciate motions, which are rendered torpid
by defect of excitement, that fometimes a direft, and fometimes
a reverfe fympathy fucceeds in the fubfequent links of the chain.
Put I believe where a torpor of irritative or of the aflbciate mo-
tions is caufed by a previous too great expenditure or exhauftion
of the fenforial powers of irritation or aflbciation, no increafe
of action in the fubfequent link ever occurs, or not till after 3
very long time.

Thus when the ilomach becomes torpid by previous violent
exertion, and confequent exhauftion of the fenforial power of
irritation, as after intoxication with wine or opium, or after the
exhibition of fome violent emetic drug, the torpor is communi-
cated to the heart and arteries, as in continued fevers with
weak pulfe. But where the torpor of the ftomach is produced
from defective aflbciation, as in fea-ficknefs ; or in the ficknefs
which occurs, when a ftone flimulates the ureter ; no torpor
is then communicated to the heart and arteries. For in the
former cafe there is no accumulation of fenforial power in the
ftomach, which was previoufly exhaufted by too great ftimulus 5
but in the latter cafe the accumulation of fenforial power in the
ftomach during its torpor is evinced by this circumftance ; that
in fea-licknefs the patients eat and drink voracioufly at inter-
vals ; and the pulfe is generally not affected by the iicknefs oc-
cafioned by a ftone in the ureter. For the action of the ftom-
ach is then leflened, and in confequence becomes retrograde,
not owing to the exhauftion of the fenforial power of irritation, but
to the want of excitement of the fenforial power of aflbciation ;
which is caufed by the defective action of the ureter, which be-
comes occafionally torpid by the great ftimulus of the ftone it
contains ; or which is caufed by the great exhauftion of fenfori-
al power by the pain ; which affects the ureter without exciting
inflammation, or increafed action of it.

9. Thus though the ftomach after the great ftimulus of in-
toxication from excefs of wine or opium will continue many
hours without accumulation of fenforial power, as appears from
the patient's experiencing no appetite at the intervals of fick-
nefs ; yet after long abftinence from food, at length not only
the exhaufled quantity of fenforial power is renewed, but an ac-
cumulation of it at length occurs, and hungerreturns. In this fitu-
ation the ftomach ia generally about a whole day before it regains
its ufual powers of digeftion; but if it has been ftillmore violently
ftimulated, and its actions further impaired, a ftill more perma-
nent torpor, along with a continued fever with weak pulfe is liable
to occur j and a fourth part, or a half, or three- fourths, or a

whole

SUP. I. 8. 10. THEORY OF FEVER.

whole lunar period pafles, before it recovers its due irritability
and confequent action.

In fimilar manner, after a perfon has been confined in a very
warm room for fome hours, the cutaneous capillaries, with their
fecretory and abforbent veflels, become exhaufted of their fenfo-
rial power of irritation by the too great violent exertions occa-
(ioned by the unufual ftimulus of heat ; and in coming into a
colder atmofphere an inactivity of the cutaneous veiTels exifts at
firft for fome time without accumulation of fenforial power ; as
is (hewn by the continuance of the pain of cold and the pale-
nefs ; but after a time both the pain of cold and palenefs van-
ifh, which now indicates an accumulation of the fenforial pow-
er of irritation, as lefs degrees of heat ftimulate the fyftem into
due action.

In the fame manner, after any one has been fome time in the
fummer funfhine, on coming into a dark cell he continues much
longer before he can clearly diftinguifh objects, than if his eyes
had only been previouily expofed to the light of a cloudy day in
winter ; becaufe the fenforial power of irritation, and confequent
fenfation, had in the firft cafe been previoufly much expended
or exhaufted ; and therefore required a much longer time be-
fore it could be produced in the brain, or derived to the cptic
nerves, in fuch quantity as to reftere the deficiency, and to caufe
an accumulation of it j whereas in the latter cafe no deficiency
had occurred.

10. Thus the accumulation or deficiency of fenforial power
in a torpid organ, which had previoufly been accuftomed to per-
petual action, depends on the manner in which it becomes tor-
pid ; that is, whether by great previous llimulus, or great previ-
ous excitement of the power of aflbciation ; or by defect of its
accuftomed ftimulus, or of its accuftomed excitement of the
power of aflbciation. In the former cafe the fenforial power is in
an exhaufted ftate, and therefore is not likely to become fo foon
accumulated, as after drunkennefs, or expofure to great heat, or
to great light ; in the latter a great accumulation of fenforial
power occurs, as after expofure to coldj or hunger, or darknefs.

Hence when the ftomach continues torpid by previous vio-
lent ftimulus, as in the exhibition of digitalis, no accumulation
of fenforial power of irritation fupervenes; and in confequence
the motions of the heart and arteries, which are aflbciated with
thofe of the ftomach, become weak, and flow, and intermittent,
from the defect of the excitement of the fenforial power of aflb-
ciation. But what follows ? as the actions of the heart and ar-
teries are leflened by the deficient action of the fenforial power
of aflbciation, and not by previous increafed excitement of it ;

a

470 THEORY OF FEVER. SUP. I. 8.

.

a great accumulation of the fenforial power of aflbciation oo
curs, which is exerted on the pulmonary and cutaneous abforb-
ents by reverfe fympathy, and produces a great abforption of
the fluid effufed into the cellular membrane in anafarca, with
dry fkin ; conftituting one kind of atrophy.

But if at the fame time the fecerning veflels of the ftomach
are ftimulated into fo violent activity as to induce great confe-
quent torpor, as probably happens when contagious matter is
iwallowed into the ftomach with our faliva, thofe of the heart
and arteries act feebly from the deficient excitement of the pow-
er of aflbciation •, and then the cutaneous and pulmonary fe-
cerning veflels act with greater force than natural, owing to the
accumulation of the fenforial power of aflbciation ; and unnatur-
al heat of the fkin, and of the breath fucceed 5 but without
frequency of pulfe, conftituting the parefis irritativa of Clafs I.
2. 1.2. And laftly, if a paucity of blood attends this parefis or
fome other caufe inducing a frequency of pulfe, the febris inirri-
tativa, or fever with weak pulfe, is produced.

But on the contrary when the ftomach has previoufly been
rendered torpid by defect of ftimulus, as by hunger, if food be
too haftily fupplied, not only great exertion of the ftomach it-
felf fucceeds, but fever with ftrong pulfe is induced in confe-
quence ; that is, the heart and arteries are excited into more en-
ergetic action by the excefs of the power of aflbciation, which
catenates their motions with thofe of the ftomach. For the re»
dundancy of fenforial power of irritation, which was accu-
mulated during the inactivity of the ftomach, and is now called
into action by ftimulus, actuates that organ with kicreafed en-
ergy, and excites by thefe increafed motions the fenforial power
of aflbciation ; which has alfo been accumulated during the in-
activity of the heart and arteries ; and thus thefe organs alfo are
now excited into greater action.

So after the fkin has been expofed fome hours to greater heat
than natural in the warm room, other parts as the membranes
of the noftrils, or of the lungs, or of the ftomach, are liable to
become torpid from direct fympathy with it, when we come in-
to air of a moderate temperature ; whence catarrhs, coughs,
and fevers. But if this torpor be occasioned by defect of ftim-
lus, as after being expofed to frofty air, the accumulation of
fenforial power is exerted, and a glow of the Ikin follows, with
increafed digeftion, full refpiration, and more vigorous circu*
lation.

ii. It may be afked, Why is there a great and conftant accu-
mulation of the fenforial power of aflbciation, owing to the tor-
por of the ftomach and heart and arteries, in continued fever

with

SUP. I. 8. 12. THEORY OF FEVER. 471

with weak pulfe -, which is exerted on the cutaneous and pul*
monary capillaries, fo as to excite them into increafed action
for many weeks, and yet no fuch exuberance of fenforial power
produces fever in winter-fleeping animals, or in chlorofis, or
apepfia, or hyfteria ?

In winter-fleeping animals I fuppofe the whole nervous fyf-
tern is torpid, or paralyfed, as in the deep of frozen people 5
and that the ftomach is torpid in confequence of the inactivity
or quiefcence of the brain 5 and that all other parts of the body,
and the cutaneous capillaries with die reft, labour under a Cm-
ilar torpor.

In chlorofis, I imagine, the actions of the heart and arteriesi
as well as thofe of the cutaneous and pulmonary capillaries, fuf-
fer along with thofe of the ftomach from the deficient ftimulus
of the pale blood ; and that though the liver is probably the feat
of the original torpor in this difeafe, with which all other parts
fympathize from defect of the excitation of the fenforial power
of aflbciation ; yet as this torpor occurs in fo fmall a degree as not
to excite a fhuddering or cold fit, no obfervable confequences are
in general occafioned by the confequent accumulation of fenfori-
al power. Sometimes indeed in chlorofis there does occur
a frequent pulfe and hot fkin ; in which circumftances I fup-
pofe the heart and arteries are become in fome degree torpid by
direct fympathy with the torpid liver ; and that hence not on-
ly the pulfe becomes frequent, but the capillaries of the ikin act
more violently by reverfe fympathy with the heart and arteries,
owing to the accumulation of the fenforial power of aflbciation
in them during their torpid ftate, as occurs in irritative fever.
See Article n. of this Supplement-

In apepfia chronica the actions of the ftomach are not fo far
impaired or deftroyed as totally to prevent the excitation of the
fenforial power of aflbciation, which therefore contributes fome-
thing towards the actions of the heart and arteries, though lefs
than natural, as a weak pulfe always I believe attends this dif-
eafe.

There is a torpor of the ftomach, and of the upper part of
the alimentary canal in hyfteria, as is evident from the retro-
grade actions of the duodenum, ftomach, and cefophagus, which
conftitute the globus hyftericus, or fenfation of a globe riling in-
to the throat. But as thefe retrograde action* are lefs than tl
which induce ficknefs or vomiting, and are not o'ccalioned by
previous exhauftiori of the fenforial power of irritation, they do
not fo totally prevent the excitement of the fenforial power of
laflbciation, as to leflen the motion of the heart and arteries fo
nauch as to induce fever ; yer ia this cafe, as in apepfia, and in

cholorofis,

THEORf OF FEVER. SB*. I. 8. 12.

chlorofis, the pulfations of the heart and arteries are weaker than
natural, arid are fometimes attended with occafionally increafed
action of the capillaries ; as appears from the flufhings of the
face, and hot fkin, which generally form an evening febricula in
difeafes attended with weak digeftion.

12. The increafed aclion, or orgafm, of the cutaneous, pul-
monary, and cellular capillaries, with their fecerning and abforb-
cnt veflels, in thofe fevers which are attended with deficiency
of vital adHon, exhaufts the patient both by the additional ex-
penditure of fenforial power on thofe organs of fecretion, and
by the too great abforption of the mucus and fat of the body ;
whence great debility and great emaciation. Hence one great
indication of cure of continued fever with arterial debility is to
diminifh the too great aclion of the capillaries j which is to be
done by frequent ablutions, or bathing the whole {kin in tepid or
in cold water, as recommended by Dr. Currie of Liverpool
(Philof. Tranf. for 1792), for half an hour, twice a day, or at
thofe times when the fkin feels dryeft and hotteft. Much cool
air fhould alfo be admitted, when the breath of the patient feels
hot to one's hand ; or when the tongue, efpecially its middle
part, is dry, and covered with a cruft of indurated mucus ; as
thefe indicate the increafed aft ion of the pulmonary capillaries ;
in the fame manner as the dry and hot fkin indicates the orgafm
of the cutaneous capillaries 5 and the emaciation of the body
that of the cellular ones.

For this purpofe of abating the action of the capillaries by
frequent ablution or fomentation, water of any degree of heat
beneath that of the body will be of fervice, and ought in accu-
rate language to be called a cold bath ; but the degree of cold-
nefs, where the patient is fenfible, mould in fome meafure be
governed by his fenfations ; as it is probable, that the degree of
coldnefs, which is moft grateful to him, will alfo be of the great-
eft benefit to him. See Clafs III. 2. I. 12. and Article 15. of
this Supplement.

Another great ufe of frequent ablutions, or fomentations, or
baths, in fevers, where the ftomach is in fome degree torpid, is
to fupply the fyftem with aqueous fluid by means of the cutane-
ous abforbents ; which is diffipated fafter by the increafed ac-
tion of the fecerning capillaries, than the ftomach can furnifh,
and occafions great thirft at the intervals of the ficknefs.

IX. Torpor of the Lungs.

i . The lungs in many cafes of contagion may firft be affect-
ed with torpor, and the fkin become cold by fympathy ; in the

fame

bup. 1. 9. 2. THEORY OF FEVER. 473

fame manner as a cold Ikin on going into the cold bath induces
difficulty of breathing. Or the ftomach may become affected
with torpor by its fympathy with the lungs, as in the experi-
ments of Mr. Watt with hydrocarbonate gas j a few refpira-
tions of which induced ficknefs, and even fyncope. When the
ftomach or Ikin is thus affected fecondarily by aflbciation, an
accumulation of fenforial power occurs much fooner, than when
thefe parts become torpid in confequence of previous excefs of
ftimulus ; and hence they fooner recover their accuftomed ac-
tion, and the fever ceafes. The particles of contagious matter
thus received by refpiration fomewhat refemble in their effects
the acid gales from burning fulphur, or from charcoal ; which,
if they do not inftantly deftroy, induce a fever, and the patient
flowly recovers.

2- I was fome years ago Hooping down to look, which way
the water oozed from a morafs, as a labourer opened it with a
fpade, to detect the fource of the fpring, and inhaled a vapour,
which occafioned an inftant fenfe of fuffbcation. Immediately
recoiling I believe I inhaled it but once ; yet a few hours after-
wards in the cool of the evening, when I returned home rather
fatigued and hungry, a fhivering and cold fit occurred, which
was followed by a hot one ; and the whole difeafe began an4
terminated in about twelve hours without return. In this cafe
the power of fear, or of imagination, was not concerned j as I
neither thought of the bad air of a morafs before I perceived it j
nor expected a fever-fit, till it occurred.

In this cafe the torpor commenced in the lungs, and after a
few hours, by the addition of fatigue, and cold, and hunger,
was propagated by direct fympathy to the reft of the fyitem.
An orgafm or increafed action of the whole fyftem was then
induced by the accumulation of fenforial power of irritation in
the lungs, and of aflbciation in the other organs ; and when
thefe fubfided, the difeafe ceafed. It may be afked, could a tor-
por of the capillaries of the air-vefTels of the lungs be fo fud-
denly produced by great ftimulation ? — It appears probable, that
it might, becaufe great exertion of irritative motions may be in-
ftantly produced without our perceiving them ; that is, without
their being attended by fenfation, both in the lungs and ftom-
ach ; and the organs may become torpid by the great expendi-
ture of the fenforial power of itritation in an inftant of time 5
as paralyfis frequently inftantly follows too great an exertion of
voluntary power.

3. When the capillaries of the lungs aft too violently, as in
fome continued fevers ; which is known by the heat of the
breath, and by ihc drynefs of the tongue, efpecially of the mid-

VOL. II. N N n die

...

474 TI0ORY OF FEVER. SUP. I.

I

die part of it ; not only cooler air might be admitted more free-
ly into a fick room to counteract this orgafm of the pulmonary
capillaries ; but perhaps the patient might breathe with advan-
tage a mixture of carbonic acid gas, or of hydrogene gas, or of
azote with atmofpheric air. And on the contrary, when there
exifts an evident torpor of the pulmonary capillaries, which may
be known by the correfpondent chillnefs of the fkin ; and by a
tickling cough, which fometimes attends cold paroxyfms of fe-
ver, and is then owing to the deficient abforption of the pulmo-
nary mucus, the faline parts of which ftimulate the bronchia?,
or air- veflels ; a mixture of one part of oxygen gas with 10 or
20 parts of atmofpheric air might probably be breathed with
great advantage.

X. Torpor of the Brain.

As the inactivity or torpor of the abforbent veflels of the brain
is the caufe of hydrocephalus internus ; and as the deficiency of
venous abforption in the brain, or torpor of the extremities of
its veins, is believed frequently to be the caufe of apoplexies i fo
there is reafon to conclude, that the torpor of the fecerning vef-
fels of the brain, which are fuppofed to produce the fenforial
power, may conftitute the immediate caufe of fome fevers with
arterial debility. And alfo that the increafed action of thefe fe-
cerning veflels may fometimes conftitute the immediate caufe of
fevers with arterial ftrength.

It is neverthelefs probable, that the torpor or orgafm of the
fanguiferous, abforbent, or fecerning veflels of the brain, may
frequently exift as a fecondary effect, owing to their aflbciation
\vith other organs, as the ftomach or lungs ; and may thus be
produced like the torpor of the heart and arteries in inirritative
fevers, or like the orgafm of thofe organs in irritative fevers, or
inflammatory ones.

Where there exifts a torpor of the brain, might not very
(light electric (hocks pafled frequently through it in all direc-
tions be ufed with advantage ? Might not fomentations of 94
or 96 degrees of heat on the head for an hour at a time, and fre-
queatly repeated, ftimulate the brain into action ; as in the re-
vival of winter-fleeping animals by warmth ? Ether externally
might be frequently applied, and a blifter on the fhaved head.

Where the fecerning velTels of the brain act with too great
energy, as in fome inflammatory fevers, might it not be dimin-
ifhed by laying the patient horizontally on a mill-done, and
whirling him, till fleep fhould be produced, as the brain be-
comes

SUP. I. ii. i. THEORY OF FE\PR. 47 $

4

comes comprefled by the centrifugal force ? See Article 15. of
this Supplement.

XI. Torpor of the Heart and Arteries.

1. It was (hewn in Clafs IV. i. I. 6. in IV. 2. I. 2. and in

Suppl. 1.6. 3. that areverfe fympathy generally exifts between
the lacteal and lymphatic branches of the abforbent fyftem.
Hence, when the motions of the abforbents of the ftomach are
rendered torpid or retrograde in fevers with arterial debility,
thofe of the Ikin, lungs, and cellular membrane, aft with in-
creafed energy. But the actions of the mufcular fibres of the
heart and arteries are at the fame time aflbciated with thofe of
the mufcular fibres of the ftomach by direct fympathy. Both
thefe actions occur during the operation of powerful emetics,
as fquill, or digitalis ; while the motions of the ftomach con-
tinue torpid or retrograde, the cellular and cutaneous abforbents
act with greater energy, and the pulfatiens of the heart and ar-
teries become weaker, and fometimes flower.

2. The increafed action of the ftomach after a meal, and of
the heart and arteries at the fame time from the ftimulus of the
new fupply of chyle, feems originally to have produced, and to
have eftablifhed this direct fympathy between them. As the
increafed action of the abforbents of the ftomach after a meal
has been ufually attended with diminifhed action of the other
branches of the abforbent fyftem, as mentioned in Clafs IV.
i. i. 6. and has thus eftablifhed a reverfe fympathy between
them.

2. Befides the reverfe fympathy of the abforbent vellels and the
mufcles of the ftomach, and of the heart and arteries, with thofe
of the Ikin, lungs, and cellular membrane ; there exifts a fimilar
reverfe fympathy between the fecerning veflels or glands of the
former of thefe organs with thofe of the latter ; that is the mu-
cous glands of the heart and arteries act generally by direct fym-
pathy with thofe of the ftomach ; and the mucous glands of
the cellular membrane of the lungs, and of the (kin, act by re-
verfe fympathy with them both.

Hence when the ftomach is torpid, as in ficknefs, this torpor
fometimes only affects the abforbent veflejs of it ; and then the
abforbents of the cellular membrane and the {kin only act with
increafed energy by reverie fympathy. If the torpor affects the
mufcular fibres of the ftomach, thofe of the heart and arteries
act by direct fympathy with it, and a weak pulfe is produced,
as in the exhibition of digitalis, but without increaie of heat.
But if the torpor alfo affects the glands of the ftomach, the cu-
taneous

476 THlbRY OF FEVER. SUP. I. 1 1. 3.

taneous and pulmonary glands aft with greater energy by their
reverfe fympathy with thofe of the ftomach, and of the heart
and arteries ; and great heat is produced along with increafed
perfpiration both from the flcin and lungs.

3. There is fome difficulty in explaining, why the actions of
the extenfive fyftem of capillary glands, which exift on every
other membrane and cell in the body for the purpofe of fecreting
mucus and perfpirable matter, fliould fo generally act by reverfe
fympathy with thofe of the ftomach and upper part of the in-
teftines. It was (hewn in Clafs IV. i. 1.6. that when the ftom-
ach was filled with folid and fluid aliment, the abforbents of the
cellular membrane, and of the bladder, and of the flcin, acted
with lefs energy ; as the fluids, they were ufed to abforb and
tranfmit into the circulation, were now lefs wanted ; and that
hence by habit a reverfe fympathy obtained between thefe
branches of the abforbents of the alimentary canal, and thofe of
the other parts of the body.

Now, as at this time lefs fluid was abforbed by the cutane-
ous ^and cellular lymphatics, it would happen, that lefs would
be fecreted by their correfpondent fecerning veflels, or capillary
glands ; and that hence by habit, thefe fecerning veflels would
acquire a reverfe fympathy of action with the fecerning veflels
of the alimentary canal.

Thus when the abforption of the tears by the puncta lacry-
malia is much increafed by the ftimulus of fnufF; or of an af-
fecting idea, on the nafal ducts, as explained in Sect. XVI. 8.
2. a great increafe of the fecretion of tears from the lacrymal
glands is produced by the direct fympathy of the action of thefe
glands with thofe of their correfpondent abforbents ; and that
though in this cafe they are placed at fo great a diflance from
each other.

4. A difficult queftion here occurs ; why does it happen, that
in fevers with weak pulfe the contractions of the heart and ar-
teries become at the fame time more frequent ; which alfo fome-
times occurs in chlorofis, and in fome hyfteric and hypochon-
driac difeafes, and in fome infanitie$ ; yet at other times the
weak pulfe becomes at the fame time flow, as in the exhibition
of digitalis, and in parefis irritativa, defcribed in Clafs I. 2. i. 2.
which may be termed a fever with flow pulfe ? this frequency
of pulfe cannot depend on heat, becaufe it fometimes exifts
without heat, as towards the end of fome fevers with debility.

Now as apoplexies, which are fometimes afcribed to fulnefs
of blood, are attended with flow pulfe ; and as in animals dy-
ing in the flaughter-houie from deficiency of blood the pulfe be-
comes frequent in extreme ; may not the frequency of pulfe in

fevers

SUP. I. ii. 5. THEORY OF FETOR. 477

fevers with arterial debility be in general owing to pauci-
blood ? as explained in Sett. XXXII. 2. 3. and its 11
parefis irritativa be cauled by the debility being accv
with due quantity of blood ? or may not the former cirx
fiance fometimes depend on a concomitant affection of the brain
approaching to ileep ? or to the unufual facility of the paflage
of the blood through the pulmonary and aortal capillaries ? in
which circumftance the heart may completely empty itfelf at
each pulfation, though its contractions may be weak. While
the latter depends on the difficulty of the pafTage of the blood
through the pulmonary or aortal capillaries, as in the cold fits
of intermittents, and in fome palpitations of the heart, and in
fome kinds of haemoptoe ; in thefe cafes the increafed refinance
prevents the heart from emptying itfeif, and in confequence a
new diaftole fooner occurs, and thus the number of pulfations
becomes greater in a given time.

5. In refpect to the fympathies of action, which produce or
conftitute fever with debility, the fyftcm may be divided into
certain provinces, which are efientient *br oppofite to each oth-
er. Firlt, the lacteals or abforbent veflels of the ilomach, and
upper part of the inteftines ; fecondly, the lymphatics or all the
other branches of the abforbent veflels, which arife from the
Jkin, mucous membranes, cellular membranes, and the various
glands. Thefe two divifions act by reverie fympathy with each
other in the hot fits of fever with debility, though by direct
fympathy in the cold ones. The third division confifts of the
fecerning veflels of the Ilomach and upper intcftinea ; and the
fourth of the fecerning veflels of all the other parts of the body,
as the capillary glands of the flcin, lungs, and cellular membrane,
and the various other glands belonging to the fanguiferous lyr-
tem. Many of thefe frequently, but the capillaries always, act
by reverfe fympathy with thofe of the third divifion above men-
tioned in the hot fits of fever with debility, though by direct
fympathy with them in the cold fits. Fifthly, the mufcular fi-
bres of the ilomach, and upper inteftines ; and fixthly, the muf-
cular fibres of the heart and arteries. The actions of thefe
two laft divifions of moving fibres act by direct fympathy with
each other, both in the cold and hot fits of fevers with debility.

The efficient caufe of thofe apparent fymr.athies in fevers
with weak pulfe may be thus underftood. In the cold paroxyfm
of fever with weak pulfe the part firft affected I believe to be
the ftomach, and that it has become torpid by previous violent
exertion, as by (wallowing contagious matter mixed with faliva,
and not by defect of ftimulus, as from cold or hunger. The
actions of this important organ, which fympathizes withalmoft

every

4)8 THEORY OF FEVER. SUP. I. n. 6.

every part of the body, being thus much diminifhed or nearly
deftroyed, the fenforial power of affociation is not excited ;
which in health contributes to move the heart and arteries, and
all the reft of the fyftem ; whence an univerfal torpor occurs.

When the hot fit approaches, the ftomach in fevers with
ftrong pulfe regains its activity by the accumulation of the fen-
forial power either of irritation, if it was the part firit affected,
or of affociation if it was affected in fympathy with fome other
torpid part, as the fpleen or liver ; which accumulation is pro-
duced during its torpor. At the fame time all the other parts
of the fyftem acquire greater energy of action by the accumula-
tion of the fenforial power of affociation, which was produced,
during their inactivity in the cold fit.

But hi fevers with weak pulfe the ftomach, in which the fen-
forial power of irritation had been previoufly exhaufted by vio-
lent action, acquires no fuch quick accumulation of fenforial
power, but remains in a ftate of torpor after the hot fit com-
mences. The heart and arteries remain alfo in a ftate of tor-
por, becaufe there continues to be no excitement of their power
of affociation owing to the torpid motions of the ftomach ; but
hence it happens, that there exifts at this time a great accumu-
lation of the power of affociation in the lefs active fibres of the
heart and arteries ; which, as it is not excited and expended by
them, increafes the affociability of the next link of the affociated
chain of motions, which confifts of the capillaries or other
glands ; and that in fo great a degree as to actuate them with
unnatural energy, and thus to produce a perpetual hot fit of fe-
ver. Becaufe the affociability of the capillaries is fo much in-
creafed by the accumulation of this power, owing to the leffen-
ed activity of the heart and arteries, as to over-balance the lef-
fened excitement of it by the weaker movements of the heart
and arteries.

6. When the accumulation of the fenforial power of irrita-
tion caufed by defect of ftimulus is greater in the firft link of a
train of actions, to which affociated motions are catenated, than
the deficiency of the excitement of the fenforial power of affocia-
tion in the next link, what happens ? — the fuperabundance of the
unemployed fenforial power of the firft link is derived to the
fecond ; the affociability of which thus becomes fo greatly in-
creafed, that it a£ts more violently than natural, though the ex-
citement of its power of affociation by the leffened action of the
firft link is lefs than natural. So that in this fituation the with-
drawing of an accuftomed ftimulus in fome parts of the fyftem
will decreafe the irritative motions of that part, and at the fame

time

SUP. I. 1 1. 6. THEORY OF FEV&R. 479

time occafion an increafe of the aflbciate motion of another part,
which is catenated with it.

This circumftance neverthelefs can only occur in thofe parts
of the fyftem, whofe natural actions are perpetual, and the ac-
cumulation of fenforial power on thai account very greai,
when their activity is much leflened by the deduction of their
ufual ftimulus ; and are therefore only to be found in the fan-
guiferous fyftem, or in the alimentary canal, or in the glands and
capillaries. Of the firft of which the following is an inftance.

The refpiration of a reduced atmofphere, that is of air mixed
with hydrogene or azote, quickens the pulfe, as obferved in the
cafe of Mrs. Eaton by Dr. Reynolds and Dr. Thornton ; to
which Dr. Beddoes adds in a. note, that " he never faw au in-
ftance in which a lowered atmofphere did not at the moment
quicken the pulfe, while it weakened the action of the heart
and arteries." Confiderations on Factitious Airs, by Thomas
Beddoes and James Watt, Part III. p. 67. Johnfon, London.
By the afliftance of this new fact the curious circumftance of
the quick production of warmth of the Ikin on covering the
head under the bed-clothes, which every one muft at fome time
have experienced, receives a more fatisfactory explanation, than
that which is given in Clafs IV. I. i. 2. which was printed
before this part of Dr. Beddoes's Confiderations was publilhed.

For if the blood be deprived of its accuftomed quantity of ox-
ygen, as in covering the head in bed, and thus breathing an air
rendered impure by repeated refpiration, or by breathing a fac-
titious air with lefs proportion of oxygen, which in common ref-
piration pafles through the moift membranes of the lungs, and
mixes with the blood, the pulfations of the heart and arteries
become weaker, and confequently quicker, by the defect of the
itimulus of oxygen. And as thefe veflels are fubject to perpet-
ual motion, the accumulation of the fenforial power of irrita-
tion becomes fo great by their leflened activity, that it excites
the veflels next connected, the cutaneous capillaries for inftance,
into more energetic actions, fo as to produce increafed heat of
the (kin, and greater perfpiration.

How exactly this refembles a continued fever with weak and
quick pulie ! — in the latter the action of the heart and arteries
are leflened by defect of the excitement of the fenforial power of
aflbciation, owing to the torpor or leflened actions of the ftoni-
ach ; hence the accumulation of the fenforial power of aflbcia-
tion in this cafe, as the accumulation of that of irritation in the
former, becomes fo abundant as to excite into increafed action
the parts moft nearly connected, as the cutaneous capillaries.

la refpect to the circumftance mentioned by Sydenham, that

covering

4 So THEORY OF FEVER. SUP. I. 11. 7.

covering the head in bed in a fliort time relieved the pertina-
cious ficknefs of the patient, it in nil be obferved, that when the
action of the heart and arteries becomes weakened by the want
of the due ftimulus of the proper quantity of oxygen in the
blood, an accumulation of the fenforial power of irritation oc-
curs in the fibres of the heart and arteries, which then is ex-
pended on thofe of the capillary glands, increafing their actions
and confequent fecretions and heat. And then the flornach is
thrown into flronger action, both by the greater excitement of
its natural quantity of the fenforial power of afibciation by the
increafed actions of the capillaries, and alfo by fome increafe of
aflbciability, as it had been previoufly a long time in a Mate of
torpor, or lefs activity than natural, as evinced by its perpetual
ficknefs.

In a manner fomewhat ilmilar to this, is the rednefs of the
Ikin produced in angry people by the fuperabundance of the un-
employed fenforial power of volition, as explained in Clafs IV.
2. 3. 5. Rubor ex irft. From hence we learn how, when
people in fevers with weak pulfe, or in dropfies, become infane,
the abundance of the unemployed fenforial power of volition
increafes the actions of the whole moving fyftem, and cures
thofe difeafes.

7. As the orgafm of the capillaries in fevers with weak pulfe
is immediately caufed by the torpid actions of the heart and ar-
teries, as above explained, this fupplies us with,another indica-
tion 'of cure in fuch fevers, and that is to (limulate thefe organs.
This may probably be done by fome kind of medicines, which
are known to pafs into the blood unchanged in fome of their
properties. It is poffibie that nitre, or its acid, may pafs into the
blood and increafe the colour of it, and thus increafe its ftimu-
lus, and the fame may be fuppofed of other falts, neutral or me-
talic ? As rubia tinctoria, madder, colours the bones of young
animal Sj it muft pafs into the blood with its colouring matter
at leait unchanged, and perhaps many other medicines may
iikewife affe£t the blood, and thus act by ftimulating the heart
and arteries, as well as by ftimulating the ftomach ; which cir-
cumftance deferves further attention.

Another way of immediately ftimulating the heart and arte-
ries would be by transfufing new blood into them. Is it pofliblc
that any other .fluid befides blood, as chyle, or milk, or water,
could, if managed with great art, be introduced fafely or advan-
tageoufly into the vein of a living animal ?

"A third method of exciting the heart and arteries immediate-
ly is by increafing the natural ftimulus of the blood, and is well
worthy experiment in all fevers with weak pulfe j and that con-
fids

SUP. I. 12. i. THEORY OF FEVER, 481

fids in (applying the blood with a greater proportion of oxygen ;
which may be done by refpiradon, if the patient was to breathe
cither oxygen gas pure, or diluted with atmofpheric air, which
might be given to many gallons frequently in a day, and by
patting through the moift membranes of the lungs, according to
the experiments of Dr. Prieftley, and uniting with the blood,
might render it more ftimulant, and thus excite the heart and
arteries into greater action ! May not fome eaGer method of
exhibiting oxygen gas by refpiration be difcovered, as by ufmg
very fmall quantities of hyper-oxygenated marine acid gas very
much diluted with atmofpheric air ?

XII. Torpor of the Stomach and upper Inteftines.

1. The principal circumftance, which fupports the increafed
action of the capillaries in continued fever with weak pulfe, is
their reverfe fympathy with thofe of the ftomach and upper in-
teftines, or with thofe of the heart and arteries. The torpor of
the ftomach and upper inteftines is apparent in continued fevers
from the total want of appetite for folid food, befide the fick-
nefs with which fevers generally commence, and the frequent
diarrhoea with indigefted ftools, at the fame time the third of
the patient is fometimes urgent at the intervals of the ficknefs.
Why the ftomach can at this time take fluids by intervals, and
not iblids, is difficult to explain ; except it be fuppofed, as fome
have affirmed, that the lacteal abforbents are a different branch
from the lymphatic abforbents, and that in this cafe the former
only are in a ftate of permanent torpor.

2. The torpor of the heart and arteries is known by the
weaknefs of the pulfe. When the actions of the abforbents ut
the ftomach are diminimed by the exhibition of fmall dofes of
digitalis, or become retrograde by larger ones, the heart and ar-
teries a£t more feebly by direct fympathy ; but the cellular, cu-
taneous, and pulmonary abforbents are excited into greater ac-
tion. Whence in anafarca the fluids in the cellular membrane

-throughout the whole body are abforbed during the ficknefs,
and frequently a great quantity of atmofpheric moifture at the
fame time ; as appears by the very great difcharge of urine,
which fometimes happens in thefe cafes ; and in ileus the pro-
digious evacuations by vomiting, which are often a hundred
fold greater than the quantity fwallowed, evince the great action
of all the other abforbents during the ficknefs of the ftomach.

3. But when the ftomach is rendered permanently Cck by
an emetic drug, as by digitalis, it is not probable, that much ac-
cumulation of fenforial power is foou produced in this organ ;

VOL. II. Q o o becauie

482 THEORY OF FEVER. SUP. I. 12. 4.

becaufe its ufual quantity of fenforial power is previoufly ex-
haufted by the great ftimulus of the foxglove ; and hence it
feems probable, that the great accumulation of fenforial power,
which now caufes the increafed action of the abforbents, is pro-
duced in confequence of the inactivity of the heart and arteries ;
which inactivity is induced by deficient excitement of the fen-
forial power of aflbciation between thofe organs and- the ftom-
ach, and not by any previous exhauftion of their natural quan-
tity of fenforial power ; whereas in ileus, where the torpor of
the ftomach, and confequent ficknefs, is induced by reverfe
fympathy with an inflamed inteftine, that is, by diflevered or
defective aflbciation ; the accumulation of fenforial power,
which in that difeafe fo violently actuates the cellular, pulmo-
nary, and cutaneous abforbents, is apparently produced by the
torpor of the ftomach and lacteals, and the confequent accumu-
lation of the fenforial power of aflbciation in them owing to
their leflened action in ficknefs.

4. This accounts for the dry Ikin in fevers with weak pulfe,
where the ftomach and the heart and arteries are in a torpid
ftate, and for the fudden emaciation of the body j becaufe the
actions of the cellular and cutaneous abforbents are increafed
by reverfe fympathy with thofe of the ftomach, or with thofe of
the heart and arteries ; that is by the expenditure of that fenfo-
rial power of afibciation, which is accumulated in confequence
of the torpor of the ftomach and heart and arteries, or of either
of them 5 this alfo explains the fudden abforption of the milk in
puerperal fevers ; and contributes along with the heat of the
refpired air to the drynefs of the mucous membrane of the
tongue and noftrils. »

5. Befides the reverfe fympathy, with which the abforbent
veflels of the ftomach and upper inteftines act in refpect to all
the ether abforbent veflels, as in the exhibition of digitalis, and
in ileus ; there is another reverfe fympathy exifts between the
capillaries, or fecretory veflels of the ftomach, and thofe of the
fkin. Which may neverthelefs be occafioned by the accumula-
tion of fenforial power by the torpor of the heart and arteries,
which is induced by direct fympathy with the ftomach ; thus
when the torpor of the ftomach remains in a fever-fit, which
might otherwife have intermitted, the torpor of the heart and
arteries remains alfo by direct fympathy, and the increafed cu-
taneous capillary action, and confequent heat, are produced by
reverfe fympathy 5 and the fever is thus rendered continual,
owing primarily to the torpor of the ftomach.

6. The reverfe fympathy, which exifts between the capilla-
ries of the ftomach and the cutaneous capillaries, appears by the

chillnefs

SUP. I. 12. 7. THEORY OF FEVER. 483

chillnefs of feme people after dinner ; and contrariwife by the
digeftion being ftrengthened, when the fkin is expofed to cold
air for a (hort time ; as mentioned in Clafs IV. i. 1.4. and IV.
2. i. i. and from the heat and glow on the Ikin, which attends
the action of vomiting ; for though when ficknefs firft com-
mences, the ikin is pale and cold ; as it then partakes of the gen-
eral torpor, which induces the ficknefs ; yet after the vomiting
has continued fome minutes, lo that an accumulation of fenfo-
rial power exifts in the capillaries of the ftomach, and of the
(kin, owing to their diminifhed action ; a glow of the (kin fuc-
ceeds, with fweat> as well as with increafed abforption.

7. Neverthelefs in fome circumftances the ftomach and the
heart and arteries feem to act by direct fympathy with the cu-
taneous capillaries, as in the fluihing of the face and glow of the
(kin of fome people after dinner ; and as in fevers with ftrong
pulfe. In thefe cafes there appears to be an increafed produc-
tion of fenforial power, either of fenfation, as in the blufh of
lhame j or of volition, as in the blufh of anger ; or of irritation,
as in the flufhed face after dinner above mentioned.

This increafed action of the capillaries of the fkin along with
the increafed actions of the ftomach and heart is perhaps to be ef-
teemed a fynchronous incrafe of action, rather than a fympathy
between thofe organs. Thus the flu(hing of the face after din-
ner may be owing to the fecretion of fenforial power in the brain
being increafed by the aflbciation of that organ with the ftom-
ach, in a greater proportion than the increafed expenditure of
it, or may be owing alfo to the ilimulus of new chyle received
into the blood.

8. When the ftomach and the heart and arteries are render-
ed torpid in fevers, not only the cutaneous, cellular, and pulmo-
nary abforbents are excited to act with greater energy 5 but alfo
their correfpondent capillaries and fecerning veflels or glands,
efpecially perhaps thofe of the (kin, are induced into more ener-
getic action. Whence greater heat, a greater fecretion of per-
fpirable matter, and of mucus ; and a greater abforption of them
both, and of aerial moifture. Thefe reverfe fympathies coin-
cide with other animal facts, as in eruption of fmall-pox on the
face and neck the feet become cold, while the face and neck are
much flumed ; and in the hemiplegia, when one arm and leg be-
come difobedient to volition, the patient is perpetually moving
the other. Which are well accounted for by the accumulation
of fenforial power in one part of an aflbciated feries of actions,
when lefs of it is expended by another part of it ; and by a defi-
ciency of fenforial power in the fecond link of aflbciation, when
too much of it is expended by the firft.

o.

484 THEORY OF FEVER. SUP. I. 12. 9.

9. This doctrine of reverfe fympathy enables us to account
for that difficult problem, why in continued fevers the increafed
action of the cutaneous, cellular, and pulmonary capillaries pro-
ceeds without interruption or return of cold fit ; though per-
haps with fome exacerbations and remiflions ; and that during
a quarter, or half, or three quarters, or a whole lunation \ while
at. the fame time the pulfations of the heart and arteries are weak-
er than natural.

To this fhould be added the direct fympathy, which exifts be-
tween the periftaltic motions of the fibres of the ftomach, and
the pulfations of the heart. And that the ftomach has become
torpid by the too great ftimulus of fome poifonous or contagious
matter ; and this very intricate idea of continued fever with fee-
ble pulfe is reduced to curious fimplicity.

The direct fympathy of the ftomach and heart and arteries
not only appears from the itronger and flower pulfe of perfons
exhaufted by fatigue, after they have drunk a glafs of wine, and
eaten a few mouthfuls ; but appears alfo from the exhibition of
large dofes of digitalis ; when the patient labours under great
and inceffant efforts to vomit, at the fame time that the actions
of the abforbent fyftem are known to be much increafed by the
hafty abforption of the ferous fluid in anafarca, the pulfations of
the heart become flow and intermittent to an alarming degree.
See Clafs IV. 2. I. 17. and 18.

10. It would aflift us much in the knowledge and cure of fe-
vers, if we could always determine, which part of the fyftem
was primarily affected •, and whether the torpor of it was from
previous excefs or defect of ftimulus ; which the induftry of fu-
ture obfervers muft difcover. Thus if the ftomach be affected
primarily, and that by previous excefs of ftimulus, as when cer-
tain quantities of opium, or wine, or blue vitriol, or arfenic, are
fwallowed, it is fome time in recovering the quantity of fenforial
power previoufly exhaufted by excefs of ftimulus, before any
accumulation of it can occur. But if it be affected with torpor
fecondarily, by fympathy with fome diftant part j as with the
torpid capillaries of the {kin, that is by defective excitement of
the fenforial power of aflbciation ; or if it be affected by defect
of ftimulus of food or of heat ; it fooner acquires fo much ac-
cumulation of fenforial power, as to bt enabled to accommodate
itfelf to its leffened ftimulus by increafe of its irritability.

Thus in the hemicrania the torpor generally commences in a
difeafed tooth, and the membranes about the temple, and alfo
thofe of the ftomach become torpid by direct fynchronous fym-
pathy ; and pain of the head, and ficknefs fupervene ; but no
fever or quicknefs of pulfe. In this cafe the torpor of the ftom-
ach

SUP. I. 12. 10. THEORY OF FEVER.

ach is owing to defect of the fenforial power of affociation,
which is caufed by the too feeble actions of the membranes fur-
rounding the difeafed tooth, and thus the train of fympathy ceaf-
cs here without affecting the motions of the heart and arteries j
but where contagious matter is fwallowed into the ftomach, the
ftomach after a time becomes torpid from exhauition of the fen-
forial power of irritation, and the heart and arteries act feebly
from defect of the excitement of the power of ailuciation. In
the former cafe the torpor of the ftomach is conquered by
accumulation of the power of aflbciation in one or two whole
days ; in the latter it recovers by accumulation of the power of
irritation in three or four weeks.

In intermittent fevers the ftomach is generally I believe af-
fected fecondarily by fympathy witli the torpid cutaneous ca-
pillaries, or with fome internal torpid vifcus, and on this ac-
count an accumulation of fenforial power arifes in a few hours
fufficient to reftore the natural irritability of this organ ; and
hence the hot fit fucceeds, and the fever intermits. Or if this
accumulation of fenforial power becomes exceffive and per-
manent, the continued fever with ftrong pulfe is produced, or
febris irritativa.

In continued fevers the ftomach is frequently I fuppofe af-
fected with torpor by previous excefs of ftimulus, and confe-
quent exhauftion of fenforial power, as when contagious matter
is fwallowed with the faliva, and it is then much ilower in pro-
ducing an accumulation of fenforial power fufficient to reftore its
healthy irritability ; which is a frequent eaufe of continued fe-
ver with weak pulfe or febris inirritativa. Which confifts, after
the cold fit is over, in a more frequent and more feeble action
of the heart and arteries, owing to their direct fympathy with
the mufcular fibres of the torpid ftomach ; together with an in-
creafed action of the capillaries, glands, and abforbents of the
ikin, and cellulular membrane, owing to their reverfe fympathy
with the torpid capillaries, glands, and abforbents of the itom-
aoh, or with thofe of the heart and arteries.

Or in more accurate language, i. The febris inirritativa, or
fever with weak pulfe, commences with torpor of the ftomach,
occafioned by previous exhauftion of fenforial power of irrita-
tion by the ftimulus of contagious matter fwallowed with the
faliva. 2. The whole fyftem becomes torpid from defect of
the excitement of the fenforial power of aflbciation owing to
the too feeble actions of the ftomach, this is the cold fit. -3. The
•whole fyftem, except the ftomach with the upper intettines, and
the heart and arteries, falls into increafed action, or orgafm,
owing to accumulation of fenforial power of aflbciation during

their

486 THEORY OF FEVER. Sup. I. 12. 1 1,

their previous torpor, this is the hot fit. 4. The ftomach and
upper inteftines have not acquired their natural quantity of fen-
forial power of irritation, which was previoufly exhaufted by vi-
olent action in confequence of the ftimulus of contagious
matter, and the heart and arteries remain torpid from defi-
cient excitement of the fenforial power of ailbciation, owing
to the too feeble actions of the ftomach. 5. The accumulation
of fenforial power of afTociation in confequence of the torpor of
the heart and arteries occafions a perpetual orgafm, or increafed
action of the capillaries.

1 1 . From hence it may be deducted firft, that when the tor-
por of the ftomach firft occurs, either as a primary effect, or as
a fecondary link of fome afTociate train or circle of motions, a
general torpor of the fyftem fometimes accompanies it, which
conftitutes the cold fit of fever ; at other times no fuch general
torpor occurs, as during the operation of a weak emetic, or dur-
ing fea-ficknefs.

Secondly. After a time it generally happens, that a torpor
of the ftomach ceafes, and its actions are renewed with increafe
of vigour by accumulation of fenforial power during its quief-
cence j as after the operation of a weak emetic, or at the inter-
vals of fea-ficknefs, or after the paroxyfm of an intermittent
fever.

Thirdly. The ftomach is fometimes much flower in recov-
ering from a previous torpor, and is then the remote caufe of
continued fever with weak pulfe ; which is owing to a torpor
of the heart and arteries, produced in confequence of the defi-
cient excitement of the power of aflbciation by the too weak
actions of the ftomach ; and to an orgafm of the capillaries of
the other parts of the fyftem, in confequence of the accumula-
tion of fenforial power occafioned by the inactivity of the heart
and arteries.

Fourthly. The torpor of the ftomach is fometimes fo com~
plete, that probably the origin of its nerves is likewife affected,
and then no accumulation of fenforial power occurs. In this
cafe, the patient dies for want of nourimment ; either in three
or four weeks, of the inirritative fever ; or without quick pulfe,
by wh,it we have called parefis irritativa. Or he continues ma-
ny years in a ftate of total debility. When this torpor fudden-
ly commences, the patient generally fuffers epileptic fits or
temporary infanity from the difagreeable fenfation of fo great a
torpor df the ftomach ; which alfo happens fometimes at the
eruption of the diftinct fmall-pox ; whence we have termed this
difeafe anorexia epiieptica. See Clafs II, 2. 2. I. and III. i. I.
7. and Suppl. I. 14. 3.

Fifthly,

SUP. I. 12. ii. THEORY OF FEVER. 487

Fifthly. When this torpor of the ftomach is lefs in degree
or extent, and yet without recovering its natural irritability by
accumulation of fenforial power, as it does after the cold fit
of intermittent fever, or after the operation of mild emetics, or
during fyncope j a permanent defect of its activity, and of that
of the upper mteftines, remains, which conditutes apepfia, car-
dialgia, hypochondriaiis, and hyfteria. See Clafs L 3. 1.3. and
I. 2. 4. 5.'

Sixthly. If the torpor of the ftcmach be induced by direcl
fympathy, as in confequence of a previous torpor of the liver, or
fpleen, or (kin, an accumulation of fenforial power will fooner
be produced in the ftomach ; becaufe there has been no previ-
ous expenditure of it, the prefent torpor of the ftomach arifing
from defedl of aflbciation. Hence fome fevers perfectly inter-
mit, the ftomach recovering its complete action after the torpor
and confequent orgafm, which conftitute the paroxyfm of fever,
are terminated.

Seventhly. If the torpor of the ftomach be owing to defect
of irritation, as to the want of food, an accumulation of fenfo-
rial power foon occurs with an increafe of digeftion, if food be
timely applied ; or with violent inflammation, if food be given
in too great quantity after very long abftinence.

Eighthly. If the torpor of the ftomach be induced by defect
of pleafurable ienfation, as when ficknefs is caufed by the fug-
geftion of naufeous ideas ; an accumulation of fenforial power
foon occurs, and the ficknefs ceafes with the return of hunger ,
for in this cafe the inactivity of the ftomach is occafioned by the
fubdu£Uon of agreeable fenfation, which atls as a fubduClion of
ftimulus, and not by exhaufting the natural quantity of fenfori-
al power in the fibres or nerves of the ftomach.

Ninthly. If the torpor of the ftomach be induced by a two*
fold caufe, as in fea-ficknefs. See vertigo rotatoria. Clafs IV.
2. i. 10. in which the firft link of alfociation ads too ftrongly,
and in confequence expends more than ufual of the fen ferial
power of irritation ; and fecondly in which fenfation is produc-
ed between the links of aflbciation, and di'fevers or enfeebles
them •, the accumulation of fenforial power icon occurs in the
ftomach ; as no previous expenditure of it in that organ has oc-
curred. Whence in fea-ficknefs the perfons take food with eu-
gernefs at times, when the vertigo ceafes for a few minu

Tenthly. If the gaftric torpor be induced by previous vio-
lent exertion, as after intoxication, or after contagions matter
has been fwallowed, or fome poifons, as digitalis, or an,
an accumulatipn of fenforial power very ilovvly fucceeds ;

wi

488 THEORY OF FEVER. SUP. I. 12. 12.

whence long ficknefs, ar continued fever, becaufe the quantity
of fenforial power already wafted miifl firft be renewed, before
an accumulation of it can be produced.

12. This leads us to a fecond indication of cure in continued
fevers, which con fids in flrengthening the actions of the ftom-
ach; as the fir ft indication confifted in decreafing the actions
of the cutaneous capillaries and abforbents. The actions of the
iiomachmay fometimes be increafed by exhibiting a mild emet-
ic ; as an accumulation of fenforial power in the fibres of the
ftomach is produced during their retrograde actions. Befides
the evacuation of any noxious material from the ftomach, and
duodenum, and from the abforbents, which open their mouths
on their internal furfaces, by their retrograde motion.

It is probable, that when mild eYnetics are given, as ipecacu-
anha, or antimonium tartarizatum, or infufion of camomile,
they are rejected by an inverted motion of the ftomach and
cefophfgns in confluence of difagreeable fenfation, as duft is
excluded from the eye ; and thefe actions having by previous
habit been found effectual, and that hence there is no exhauftion
of the fenforial power of irritation. But where ftrong emetics
nre admimftered, as digitalis, or contagious matter, the previous
exhauftion of the fenforial power of irritation feems to be a
caufe of the continued retrograde actions and ficknefs of the
ftomach. An emetic of the former kind may therefore ftrength-
cn the power of the ftomach immediately after its operation by
the accumulation of fenforial power of irritation during its ac-
tion. -See Clafs IV. I. i.

Another method of decrenfmg the action of the ftomach for
a time, and thence of increafing it afterwards, is by the accumu-
lation of the fenforial power of irritation during its torpor ; is
by giving ice, iced water, iced creams, or iced wine. This ac-
counts for the plenfure, which many people in fevers with weak
pulfe exprefs on drinking cold beverage of any kind.

A fecond method of exciting the ftomach into action, and of
decreafing that of the capillaries in confequence, is by the ftimu-
lus of wine, opium, bark, metallic falts of antimony, fteel, cop-
per, arfenic, given in fmall repeated quantities ; which fo long
r.s they render the pulfe flower are certainly of fervice, and may
be given warm or cold, as moft agreeable to the patient. For it
is poflible, that the capillaries of the ftomach may act too vio-
lently, and produce heat, at the fame time that the large mufcles
of it may be in a torpid ftate ; which curious circumftance future
obfervations muft determine.

Thirdly. Hot fomentation on the region of the ftomach
might be of moft effential fervice by its ftimulus, as heat pene-
trates

SUP. I. 12. 12. THEORY OF FEVER.

trates the fyftem not by the abforbent veflels, but by external
influence j whence the ufe of hot fomentation to the head in tor-
por of the brain ; and the ufe of hot bath in cafes of general de-
bility, which has been much too frequently neglected from a pop-
ular error occafioned by the unmeaning application of the word
relaxation to animal power. If the fluid of heat could be di-
rected to pafs through particular parts of the body with as lit-
tle diffufion of its influence, as that of electricity in the (hocks
from the coated jar, it might be employed with (till greater ad-
vantage.

Fourthly. The ufe of repeated fmall electric {hocks through
the region of the ftomach might be of fervice in fevers with
weak pulfe, and well deferves a trial ; twenty or thirty fmall
{hocks twice a day for a week or two would be a promifmg ex-
periment.

Fifthly. A blifter on the back, or (ides, or on the pit of the
ftomach, repeated in fucceflion, by ftimulating the (kin frequent-
ly ftrengthens the action of the ftomach by exciting the%fenfo-
rial power of aflfociation ; this efpecially in thofe 'fevers where
the flcin of the extremities, as of the hands or nofe or ears, foori-
er becomes cold, when expofed to the air, than ufual.

Sixthly. The action of the ftornach may be increafed by pre-
venting too great expenditure of fenforial power in the link
of previous motion with which it is catenated, efpecially if the
action of that link be greater than natural. Thus as the
capillaries of the (kin act too violently in fevers with weak
pulfe, if thefe are expofed to cold air or cold water, the fenfori-
al power, which previoufly occafioned their orgafm, becomes
accumulated, and tends to increafe the action of the ftomach -9
thus in thofe fevers with weak pulfe and hot (kin, if the ftomach
be ftimulated by repeated fmall dofes of bark and wine or opi-
um, and be further excited at the fame time by accumulation of
fenforial power occafioned by rendering the capillaries torpid by
cold air or water, this twofold application is frequently attende^
with vifible good effect.

By thus ftimulating the torpid .ftomach into greater action,
the motions of the heart and arteries will likewife be increafed
by the greater excitement of the power of aflbciation. And the
capillaries of the (kin will ceafe to act fo violently, from their
not pofieffing fo great a fuperfluity of fenforial power as during
the greater quiefcence of the ftomach and of the heart and arte-
ries. Which is in fome circumftances fimilar to the curious
phenomenon mentioned in Clafs IV. 2. 2. 10. ; where, by cov-
ering the chill feet with flannel at the eruption of the froall-pox,
the points of the flannel ftimulate the Jkin gf the feet into greater

VOL. II. P P p action/

490 THEORY OF FEVER. SUP. I. 13.

action, and the quantity of heat, which they poifefs, is alfo con-
fined, or infulated, and further increafes by its ftimulus the ac-
tivity of the cutaneous veffels of the feet; and by that circum-
flance abates the too great action of the capillaries of the face,
and the ccnfequent heat of it.

XIII. Cafe of continued Fever.

The following cafe of continued fever which I frequently faw
during its progrefs, as it is lefs complicate than ufual, may il-
luftrate this doctrine. Matter S. D. an a£tive boy about eight
years of age, hadbeerj in the fnow for many days, and fat in the
clafiical fchool with wet feet \ he had alfo about a fortnight at-
tended a writing fchool, where many children of the lower or-
der were inftru&ed. He was feized on February the 8th, 17951
with great languor, and pain in his forehead, with vomiting and
perpetual ficknefs j his pulfe weak, but not very frequent. He
took an emetic, and on the next day had a blifter, which check-
ed the ficknefs only for a few hours ; his Ikin became perpetu-
ally hot, and dry •, and his tongue white and furred ; his pulfc
when afleep about 104 in a minute, and when awake about
1 12.

Fourth day of the difeafe. He has had another blifter, the
pain of his head is gone, but the ficknefs continues by intervals ;
he reftifes to take any folid food, and will drink nothing but milk,
or milk and water, cold. He has two or three very liquid ftools
every day, which are fometimes green, but generally of a dark-
ilh yellow, with great flatulency both upwards and downwards
at thofe times. An antimonial powder was once given, but in-
ilantly rejected ; a fpoonful of decoction of bark was alfo ex-
hibited with the fame event. His legs are bathed, and his
hands and face are moiftened twice a day for half an hour in
\varmifh water, which is neverthelcfs much colder than his
Ikin.

Eighfh day. His (kin continues hot and dry without any ob-
fervabie remiffions, with liquid ftools and much flatulency and
ficknefs j his water when obferved was of a ftraw colour. He
has afked for cider, and drinks nearly a bottle a day mixed
with cold water, and takes three drops of laudanum twice a
day.

Twelfth day. He continues much the fame, takes no milk,
drinks only cider and water, fkin hot and dry, tongue hot and
furred, with liquid ftools, and licknefs always at the fame time >
ileeps much.

Sixteenth day. "Was apparently more torpid, and once rath-
er

SUP. I. 13. THEORY OF FEVER. 49 '

er delirious ; pulfe 1 12. Takes only capillaire and water ; fleens
much.

Twentieth day. Pulfe 100, fkin dry but lefs hot, liquid ilools
not fo frequent, he is emaciated to a great degree, he has eaten
half a tea-cup full of cuftard to day, drinks only capillaire and
•water, has thrice taken two large fpoonfuls of deception of bark
with three drops of laudanum, r^fufes to have his legs bathed,
and will now take nothing but three drops of laudanum twice a
day.

Twenty-fourth day. He has gradually taken more cuftard
every day, and began to attend to fome new playthings, and takes
wine fyllabub.

Twenty-eighth day. He daily grows ftronger, eats eggs,
and bread and butter, and fleeps immediately after his food, can
creep on his hands and knees, but cannot (land erect.

Thirty-fecond day. He cannot yet Hand alone fafely, but
feems hourly to improve in iirength of body, and activity of
mind.

In this cafe the remote caufe of his fever could not be well
afcertained, as it might be from having his feet cold for many
fuccefiive days, or from contagion ; but the latter feems more
probable, becaufe his younger brother became ill of a fimilar fe-
ver about three weeks afterwards, and probably received the in-
fection from him. The difeafe commenced with great torpor
of the itomach, which was (hewn by his total averiion to folid
food, and perpetual ficknefs ; the watery ftools, which were
fometimes green, or of a darkifh yellow, were owing to the ac-
rimony, or acidity of -the contents of the bowels ; which as well
as the flatulency were occahoned by indigeition. This torpor
of the ilomach continued throughout the whole fever, and when
it ceafed, the fever ceafed along with it.

The contagious material of this fever I fuppofe to have been
mixed with the faliva, and fwallo'wed, into the ilomach; that
it excited the veflels, which conflitute the ftomach, iiuo the
greateft irritative motion like arfenic ; which might not be per-
ceived, and yet might render that organ paralytic or inirrifable in a
moment of time ; as animals fometimcs die by one fingle exertion,
and confequent paralyfis, without a fecond druggie ; as by
lightning, or being (hot through the back part of the brain ; of
both which I have feen inftances. I had once an opportunity
of infpecHng two oxen, a few minutes after they were killed by
lightning under a crab-tree on moid ground in long grafs ; and
obferved, that they could not have ftruggled, as the grafs was
not prefTcd or bent near them ; I have alfo feen twohorfes fhot
through the cerebellum, who never once drew in their legs after

they

THEORY OF FEVER. SUP. I. 13,

they firft ftretched them out, but died inftantaneoufly ; in a fim-
ilar manner the lungs feem to be rendered inftantly inanimate
by the fumes of burning fulphur.

The lungs may be fometimes primarily affeclred with conta-
gious matter floating in the atmoiphere as well as the ftomach,
as mentioned in article 9. of this Supplement. But probably
this may occur much lefs frequently, becaufe the oxygene of the
atmofphere does not appear to be taken into the blood by ani-*
rnal abforption, as the faliva in the ftomach, but pafles through
the moift membranes into the blood, like the ethereal fluids of
electricity or heat, or by chemical attraction, and in confequence
the contagious matter may be left behind ; except it may fome-
times be abiorbed along with the mucus ; of which however in
this cafe there appeared no fymptoms.

The tonfils are other organs liable to receive contagious matter,
as in the fmall-pox, fcarlet- fever, and in other fenfitive inirritat-
ed fevers ; but no fymptom of this appeared here, as the tonfils
were at no time of the fever inflamed, though they were in this
child previoufly uncommonly large.

The pain of the forehead does not feem to have been of the
internal parts of the head, becaufe the nerves, which ferve the
ftomach, are not derived from the anterior part of the brain ;
but it feems to have been owing to a torpor of the external mem-
branes about the forehead from their direct fympath)* with thofe
of the ftomach ; that is, from the deficient excitement of the
fenforial power of aflbciation ; and feemed in fome meafure to
be relieved by the emetics and blifters.

The pulfations of the heart were weaker and in confequence
quicker than natural, owing to their direct fympathy with the
torpid periftaltic motions of the ftomach ; that is to the deficient
excitement of the fenforial power of aflbciation.

The action of the cutaneous capillaries and abforbents were
ftronger than natural, as appeared by the perpetual heat and
dryneis of the {kin ; which was owing to their reverfe fympathy
xvith the heart and arteries. This weaker and quicker action of
the heart and arteries, and the ftronger action of the cutaneous
capillaries and abforbents, continued throughout the difeafe,
and may be faid to have conftituted the fever, of which the tor-
por of the ftomach was the remote caufe.

His tongue was not very much furred or very dry, nor his
breath very hot ; which mewed, that there was no great increafe
of the action of the mucous abforbents, nor of the pulmonary
capillaries, and yet fuflieient to produce great emaciation. His
urine was nearly natural both in quantity and colour 5 which

(hewed,

SUP. I. 14. i. THEORY OF FEVER. 49$,

(hewed, that there was no increafe of aftion either of the kid-
neys, or of the urinary abforbents.

The bathing his legs and hands and face for half an hour
twice a day feemed to refreih him, and fometimes made hi$
pulfe flower, and thence I fuppofe ftronger. This feems to
have been caufed by the water, though fubtepid, being much
below the heat of his (kin, and confequently contributing to
cool the capillaries, and by fatiating the abforbents to relieve the
uneafy fenfation from the drynefs of the (kin.

He continued the ufe of three drops of tinclure of opium
from about the eighth day to the twenty-fourth, and for the
three preceding days took along with it two large fpoonfuls of
an infufion of bark in equal parts of wine and water. The for-
mer of thefe by its ftimulus feemed to decreafe his languor for
a time, and the latter to ftrengthen his returning power of di-
geftion.

The daily exacerbations or remiffions were obfcure, and not
well attended to ; but he appeared to be worfe on the four-
teenth or fifteenth days, as his pulfe was then quickeft, and his
inattention greateft ; and he began to get better on the twen-
tieth or twenty-firft days of his difeafe ; for the pulfe then be-
came lefs frequent, and his (kin cooler, and he took rather more
food : thefe circumftances feemed to obferve the quarter period.*
of lunation.

XIV. Termination of continued Fever.

1. When the ftomach is primarily affected with torpor not
by defect of ftimulus, but in confequence of the previous ex-
hauftion of its fenforial power ; and not fecondarily by its aflb-
ciation with other torpid parts ; it feems to be the general caufe
of the weak pulfations of the heart and arteries, and the confe-
quent increafed action of the capillaries, which conftitute con-
tinued fever with weak pulfe. In this fituation if the patient
recovers, it is owing to the renovation of life in the torpid ftom-
ach, as happens to the whole fyftem in winter-fleeping animals.
If he perifhes, it is owing to the exhauftion of the body for
want of nourtmment occafioned by indigeition ; which is haft-
ened by the increafed actions of the capillaries and abforbents.

2, When the ftomach is primarily affected by defect of ftim-
ulus, as by cold or hunger ; or fccondavily by defect of the pow-
er of affociation, as in intermittent fevers ; or laftly in confe-
quence of the introduction of the fenforial power of fenfation,
as in inflammatory difeafes ; the actions of the heart and arte-
ries are not diminifhed, as when the ftomach is primarily af-
fected

494 THEORY OF FEVER. SUP. I. 14. 3.

fected with torpor by its previous exhauftion of fenforial pow-
er, but become greatly increafed, producing irritative or inflam-
matory fever. Where this fever is continued, though with
fome remiffions and exacerbations, the exceffive acltion is at
length fo much leflened by expenditure of fenforial power, as to
gradually terminate in health ; or it becomes totally exhaufted,
and death fucceeds the destruction of the irritability and aflbcia-
bility of the fyftem.

3. There is alib another termination of the difeafes in con-
fequence of great torpor of the ftomach, which are not always
termed fevers ; one of thefe is attended with fo great and uni-
verfal torpor, that the patient dies in the firft cold fit ; that is,
within twelve hours or lefs of the firft feizure ; this is common-
ly termed fudden death. But the quicknefs of the pulfe, and
the coldnefs with fhuddering, and with fick ftomach, diftinguifh-
cd a cafe, which I lately faw, from the fudden deaths occafion-
ed by apoplexy, or ruptured blood-veflels.

In hemicrania I believe the ftomach is always afFe&ed fec-
ondarily, as no quicknefs of pulfe generally attends it, and as
the ftomach recovers its activity in about two whole days. But
in the following cafe, which I faw laft week, I fuppofe the
ftomach fuddenly became paralytic, and caufed in about a week

the death of the patient. Mifs , a fine young lady

about nineteen, had bathed a few times, about a month before,
in a cold fpring, and was always much indifpofed after it ; ihe
was feized with ficknefs, and cold fhuddering, with very quick
pulfe, which was fucceeded by a violent hot fit ; during the
next cold paroxyfm fhe had a cotavulfion fit ; and after that
fyinptoms of infanity, fo as to ftrike and bite the attendants,
and to fpeak furious language j the fame circumftances occur-
red during a third fit, in which I believe a ftrait waiftcoat was
put on, and fome blood taken from her ; during all this time
her ftomach would receive no nutriment, except once or twice
a little wine and water. On the feventh day of the difeafe,
when I faw her, the extremities were cold, the pulfe not to be
counted, and (he was unable to fwallow, or to fpeak j a clyfter
was ufed with turpentine and mufk and opium, with warm fo-
mentations, but {he did not recover from that cold fit.

In this cafe the convuifion fit and the infanity feern to have
been violent efforts to relieve the difagreeable ienfation of the
paralytic ftomach ; and the quick puife, and returning fits of
torpor and of orgafm, evinced the difeafe to be attended with
fever, though it might have been called anorexia maniacalis, or
cpileptica.

4. Might not many be faved in thefe fevers with weak pulfe

for

SUP. I. 15. i. THEORY OF FEVER. 495

for a few weeks by the introduction of blood into a vein, once
in two or three days ; which might thus give further time for
the recovery of the torpid ftomach ? Which feems to require
fome weeks to acquire its former habits of action, like the muf-
cles of paralytic patients, who have all their habits of voluntary
aflbciations to form afrefh, as in infancy.

If this experiment be again tried on the human fubject, it
fliould be fo contrived, that the blood in pafling from the well
perfon to the fick one mould not be expofed to the air ; it mould
not be cooled or heated ; and it mould be meafurcd ; all which
may be done in the following manner. Procure two filver pipes,
each about an inch long, in the form of funnels, wide at top,
with a tail beneatfc, the former fomething wider than a fwan-
quill, and the latter lefs than a fmall crow-quill. Fix one of
thefe filver funnels by its wide end to one end of the gut of a
chicken frefh killed about four or fix inches long, and the other
to the other end of the gut j then introduce the fmall end of"
one funnel into the vein of the arm of a well perfon downwards
towards the hand ; and laying the gut with the other end on a
water-plate heated to 98 degrees in a very warm room, let the
blood run through it. Then prefling the finger on the gut near
the arm of the well perfon, flide it along fo as to prefs out one
gutful into a cup, in order to afcertain the quantity by weight.
Then introduce the other end of the other funnel into a fimilar
vein in the arm of the fick perfon upwards towards the moul-
der ; and by fliding one finger, and then another reciprocally,
along the chicken's gut, fo as to comprefs it, from the arm of
the well perfon to the arm of the fick one, the blood may be
meafured, and thus the exa6l quantity known which is given
and received. See Clafs I. 2. 3. 25.

XV. Inflammation excited in Fever.

i . When the actions of any part of the fyftem of capillaries
are excited to a certain degree, fenfation is produced, along
with a greater quantity of heat, as mentioned in the fifth article
of this fupplement. When this increafed capillary action be-
comes ftili more energetic, by the combined fenforial powers of
fenfation with irritation, new fibres are fecreted, or new fluuis,
(which harden into fibres like the mucus fecreted by the iilk-
worm, or fpider, or pinna,) from which new veflels are con-
ftructed ; it is then termed inflammation : if this exifts in the
capillary veflels of the cellular membrane or (kin only, with fee-
ble puliations of ^the heart and arteries, the febris fenfmva inir-
ritata, or malignant fever, occurs ; if the coats of the ai

are

THEORY OF FEVER. SUP. 1. 15. 2.

are alfo inflamed, the febris fenfitiva irritata, or inflammatory
fever, exifts.

In all thefe fevers the part inflamed is called a phlegmon, and
by its violent actions excites fo much pain, that is, fo much of
the fenforial power of fenfation, as to produce more violent ac-
tions, and inflammation, throughout the whole fyftem. Whence
great heat from the excited capillaries of the fkin, large and
quick pulfations of the heart, full and hard arteries, with great
univerfal fecretions and abforptions. Thefe perpetually con-
tinue, though with exacerbations and remiilions \ which feem
to be governed by folar or lunar influence.

2. In this fituation there generally, I fuppofe, exifts an in-
creafed activity of the fecerning veflels of th^ brain, and confe-
quently an increafed production of fenforial jfower ; in lefs vio-
lent quantity of this difeafe however the increafe of the action
of the heart and arteries may be owing fimply to the accumula-
tion of fenforial power of affociation in the ftomach, when that
organ is affected by fympathy with fome inflamed part. In the
fame manner as the capillaries are violently and permanently ac-
tuated by the accumulation of the fenforial power of affociation
in the heart and arteries, when the ftomach is affected primari-
ly by contagious matter, and the heart and arteries fecondarily.
Thus I fufpect, that in the diftinct fmall-pox the ftomach is af-
fected fecondarily by fympathy with the infected tonfils or
inoculated arm ; but that in the confluent fmall-pox the ftom-
ach is affected primarily, as well as the tonfils, by contagious
matter mixed with the faliva, and fwallowed.

3. In inflammatory fevers with great arterial action, as the
ftomach is not always affected with torpor, and as there is a di-
rect fympathy between the ftomach and heart, fome people have
believed, that naufeating dofes of fome emetic drug, as of anti-
monium tartarizatum, have been adminiftered with advantage,
abating by direct fympathy the actions of the heart. This the-
ory is not ill-founded, and the ufe of digitalis, given in fmall
dofes, as from half a dram to a dram of th£ faturated tincture,
two or three times a day, as well as other lefs violent emetic
drugs, would be worth the attention of hofpital phyficians.

In three cafes of what I believed to be inflammatory rheu-
matifm, two of them attended with pain of the fide, and diffi-
cult refpiration, and the other with fwelled joints, after repeated
venefedtions and moderate cathartics, and mild dofes of anti-
monials, without fuccefs, the tincture of digitalis given in the
fmall dofe of ten drops every fix hours, appeared to abate the
quicknefs and hardnefs of the pulfe in two or three or four
xvithout inducing any degree of ftcknefs.

Sickncfs

SUP. I. 15. 4. THEORY OF FEVER. 49)

Sicknefs might alfo be produced probably with advantage by-
whirling the patient iri a chair fufpended from the ceiling by
two parallel cords ; which after being revolved fifty or a hun-
dred times in one direction, would return with great circular
velocity, and produce vertigo, fimilar I fuppofe to fea-ficknefs.
And laftly the ficknefs produced by refpiring an atmofphere
mixed with one tenth of carbonated hydrogen, difcovered by-
Mr. Watt, and published by Dr. Beddoes, would be well wor-
thy exact and repeated experiment.

4. Cool air, cool fomentations, or ablutions, are alfo ufeful
in this inflammatory fever ; as by cooling the particles of blood
in the cutaneous and pulmonary veflels, they muft return to the
heart with lefs ftimulus, than when they are heated above the
natural degree of ninety-eight. For this purpofe fnow and ice
have been fcattered on the patients in Italy ; and cold bathing
has been ufed at the eruption of the frnall-pox in China, and
both, it is faid, with advantage. See Clafs III. 2. i. 12. and
Suppl. I. 8.

5. The lancet however with repeated mild cathartics is the
great agent in deftroying this enormous excitement of the fyf-
tem, fo long as the ftrength of the patient will admit of evacua-
tions. Blifters over the painful part, where the phlegmon of
topical inflammation is fituated, after great evacuation, is of ev-
ident fervice, as in pleurify. Warm bathing for half an hour
twice a day, when the patient becomes enfeebled, is of great
benefit, as in peripneumony and rheumatifm.

6. When other means fail of fuccefs in abating the violent
excitement of the fyftem in inflammatory difeafes, might not
the (haved head be covered with large bladders of cold water, in
which ice or fait had been recently diiTolved ; and changed as
often as neceflary, till the brain is rendered in fome degree tor-
pid by cold ? — Might not a greater degree of cold, as iced water,
or fnow, be applied to the cutaneous capillaries ?

7. Another experiment I have frequently wifhed to try,
which cannot be done in private practice, and which I there-
fore recommend to fome hofpital phyfician ; and that is, to en-
deavour to ftill the violent actions of the heart and arteries, after
due evacuations by venefection and cathartics, by gently com-
pre fling the brain. This might be done by fufpending a bed,
fo as to whirl the patient round with his head mod diftant from
the centre of motion, as if he lay acrofs a mill-done, as defcrib-
cd in Sect. XVIII. 20. For this purpofe a perpendicular (haft
armed with iron gudgeons might have one end pafs into the
floor, and the other into a beam in the ceiling, with an horizon-
tal arm, to which a fmall bed might be readily fufpended.

VOL. ii. Qj^q Ey

498 THEORY OF FEVER. Sup. I. id. i<

By thus whirling the patient with increafmg velocity fleep
might be produced, and probably the violence of the actions of
the heart and arteries might be diminimed in inflammatory fe-
vers ; and, as it is believed, that no accumulation of fenforial
power would fucceed a torpor of the origin of the nerves, either
thus procured by mechanical compreffion, or by the bladder-
cap of cold water above defcribed, the lives of thoufands might
probably be faved by thus extinguifhing the exacerbations of fe*
brile paroxyfms, or preventing the returns of them.

Iri fevers with weak pulfe fleep, or a degree of flupor, thus
produced, might prevent the too great expenditure of fenforial
power, and thus contribute to preferve the patient. See Clafs
I. 2. 5. 10. on flupor. What might be the confequence of
whirling a perfon with his head next the centre of motion, fo
as to force the blood from the brain into the other parts of the
body, might be difcovered by cautious experiment without
danger, and might probably add to our ability of curing fever.

Mr. Kelly, in his obfervations on compreflion, Edinb. 1797,
aflerts, that by compreffing the two fubclavian arteries, as they
pafs over the firft rib, more blood will comprefs the brain, and
produce a kind of apoplectic ftate fimilar to that, which may
occur by the centrifugal force, if the patient was whirled round
as above defcribed. And adds, that by this compreffion of the
two fubclavian arteries a greater quantity of blood will be cir-
culated through the head, whence the patient foon complains of
drowfmefs and vertigo ; and that hence different fpecies of
head-achs are foon removed, efpeeially thofe which depend on
defect of ftimulation*

XVl. Recapitulation.

i . The fenforial power caufes the contraction of the fibres*
and is excited into action by four different circumftances, by the
ilimulus of external bodies, by pain or pleafure, by defire or
averfion, or by the previous motions of other contracting fibres.
In the firil fituation it is called the fenforial power of irritation,
in the fecond the fenforial power of fenfation, in the third the
fenforial power of volition, and in the fourth the fenforial power
of aflbciation.

Many parts of the body are excited into perpetual action, as
the fanguiferous veflels confifling of the heart, arteries, and
veins j others into nearly perpetual action, as the conglomerate
and capillary glands ; and others into actions flill fomewhat
lefs frequent, as the alimentary canal, and the lacteal and
lymphatic abforbents with their conglobate glands : all thefe are

principally

SI/P. I. 1 6. 2. THEORY OF FEVER. 499

principally actuated by the fenforial powers of irritation, and of
aflbciation ; but in fome degree or at fome times by thofe of
fenfation, and even of volition. There are three kinds of ftim-
ulus, which may eafily be occafionally diminifhed, that of heat
on the fkin, of food in the ftomach, and of the oxygenous part
of the atmofphere, which mixes with the blood in refpiration,
and ftimulates the heart and arteries.

2. When any parts, which are naturally excited into perpetu-
aj action by ftimulus, become torpid orlefs active from decreafe
of that ftimulus ; there firft occurs a decreafe of the activity of
the parts next catenated with them j thus going into cold water,
produces a torpor of the capillary veflels of the lungs, as is
known by the difficult refpiration, which immediately occurs ;
for the fenforial power of aflbciation, which naturally contributes
to actuate the lungs, is now leis excited by the decreafed actions
of the cutaneous veflels, with which they are catenated. This
conftitutes the cold fit of fever.

There next occurs an accumulation of the fenforial power of
irritation in the parts, which were torpid from defect of ftimu-
lus, as the cutaneous veflels for inftance when expofed to cold
air ; and a fimilar accumulation of the fenforial power of aflbf
ciation occurs in the parts which were catenated with the for-
mer, as the veflels of the lungs in the example above mentioned.
Whence, if the fubduction of ftimulus has not been too great,
fo as to impair the health of the part, the activity of the irrita-
tive motions returns, even though the ftimulus continues lefs
than ufual ; and thofe of the aflbciate motions become confid-
erably increafed, becaufe thefe latter are now excited by the pre-
vious fibrous motions, which now act as ftrong or ftronger than
formerly, and have alfo acquired an accumulation of the fenfo-
rial power of aflbciation. This accounts for the curious event
of our becoming warm in a minute or two after remaining in
water of about 80 degrees of heat, as in the bath at Buxton •, or
in the cold air of a frofty morning of about 30 degrees of heat.

But if the parts thus poflefled of the accumulated fenforial
powers of irritation and of aflbciation be expofed again to their
natural quantity of ftimulus, a great excefs of activity fuper-
venes ; becaufe the fibres, which poflefs accumulated irritation,
are now excited by their ufual quantity of ftimulus ; and thofe
which poflefs accumulated aflbciation, are now excited by double
or treble the quantity of the preceding irritative fibrous mo-
tions, with which they are catenated ; this conftitutes the hot
fit of fever.

Another important circumftance occurs, when the parts,
which are torpid from decreafed ftimulus, do not accumulate a

quantity

500 THEORY OF FEVER. SUP. I. 16, 3.

quantity of fenforial power fufficient for the purpofe of renew-
ing their own natural quantity of action ; but are neverthelefs
not fo torpid, as to have the life of the part impaired. In this
iituation the fuperabundance of the accumulated power of irri-
tation contributes to actuate the aflbciate motions next catenated
with them. Thus, when a perfon breathes air with lefs oxy-
gene than natural, as by covering his head in bed, and thus re-
fpiring the fame atmofphere repeatedly, the heart and arteries
become lefs active by defect of the ftimulus of oxygcne ; and
then the accumulation of fenforial power of irritation becomes
initantly very great, as thefe urgans are fubject to perpetual and
energetic action. This accumulation neverthelefs is not fo great
as to renew their own activity under this defect of ftimulus, but
yet is in fufficient abundance to increafe the aflbciability of the
next link of catenation, that is, to actuate the capillaries of the
fkin with great and perpetual increafe of energy. This refem-
bles continued fever with weak pulfe ; in which the accumula-
tion of the fenforial power caufed by the leflened motions of the
heart and arteries, actuates the capillaries with increafe of energy.
3. When the accumulation of the feniorial power of aflbci-
ation, which is caufed as above explained by deficient excite-
ment owing to the leflened quantity of action of the irritative
fibrous motions, with which the aflbciate train is catenated, is
not in quantity fufficient to renew the natural actions of the firft
link of an aflbciate train of motions •, it is neverthelefs fre-
quently fo abundant as to actuate the next link of the aflbciated
train with unnatural energy by increafing its aflbciability ; and
that in a ftill greater degree if that fecond link of the aflbciated
train was previously in a torpid ftate, that is, had previously ac-
quired fome accumulation of the fenforial power of aflbciation.
This important circumftance of the animal economy is worthy
our moft accurate attention. Thus if the heart and arteries are
deprived of their due quantity of the ftimulus of oxygene in the
blood, a weak and quick pulfe enfues, with an accumulation of
the fenforial power of ir/itation ; next follows an increafe of the
action of the capillaries by the fuperabundance of this accumu-
lated power of irritation ; but there alfo exifts an accumulation
of the power of aflbciation in thefe acting capillaries, which is
not now excited by the deficient actions of the heart and arte-
ries ; but which by its abundance contributes to actuate the
next link of aflbciation, which is the fick ftomach in the cafe
related from Sydenham in Clafs IV. i. i. 2. and explained in
this Supplement I. 4. And as this fick ftomach was in a pre-
vious ftate of torpor, it might at the fame time poflefs an accu-
mulation of fome fenforial power, which, if it was of aflbciation,

would

SUP. I. 1 6. 4. THEORY OF FEVER. 501

would be thus more powerfully excited by the increafcd actions
of the capillaries ; which exifted in confequence of the weak
action of the heart and arteries. This alfo refembles in fomc
rcfpects the continued fevers with weak pulfe, and with increaf-
cd activity of the capillaries.

4 4. When a torpor of fome irritative motions occurs from a
previous exhauftion of the fenforial power of irritation by the
action of fome very great ftimulus, it is long before any accu-
mulation of the fenforial power of irritation is produced ; as is
experienced in the ficknefs and languor, which continues a whole
day after a fit of drunken nefs. But nevertheless there occurs
an accumulation of the fenforial power of aflbciation in the firft
link of the aflbciate train of motions, which is catenated with
thefe torpid irritative ones ; which accumulation is owing to de-
ficient excitement of that fenforial power in the firft link of the
aflbciate train. This firft link therefore exifts alfo in a lefs ac-
tive or torpid ftate, but the accumulation of the fenforial power
of aflbciation by its fuperabundance contributes to actuate the
fecond link of the aflbciate train with unnatural quantity of mo-
tion ; and that though its own natural quantity of the power
of aflbciation is not excited by the deficient action of preceding
fibrous motions.

When this happens to the ftomach, as after its irritative mo-
tions have been much exerted from the unnatural ftimulus of
wine, or opium, or of contagious matter mixed with the faliva,
a torpor or inactivity of it fucceeds for a greater or lefs length
of time ; as no accumulation of the fenforial power of irritation
can occur, till the natural quantity, which has been previoufly ex-
pended, is firft reftored. Then the heart and arteries, which are
next in catenation, become lefs active from the want of fuffi-
cient excitement of the fenforial power of aflbciation, which
previoufly contributed to actuate them. This fenforial power
of aflbciation therefore becomes accumulated, and by its fuper-
abundance contributes to actuate the link next in aflbciation,
which has thus acquired fo great a degree of aflbciability, as to
overbalance the lefs quantity of the excitement of it by the tor-
pid action of the previous or firft aflbciate link. This happens
to the capillaries, when the heart and arteries are affected as
above by the torpor of the ftomach, when it is occafioned by
previous great expenditure of its fenforial power, and thus con-
ftitutes fever with weak pulfe, which is here termed ininitative
fever,, typhus mitior.

5. When a deficiency of ftimulus is too great or too long con-
tinued, fo as to impair the life of the part, no further accumu-
lation of fenforial power occurs j as when the fkin is long ex-

poi>d

THEORY OF FEVER. SUP. I. 16. 6,

pofed to cold and damp air. In that cafe the link in catenation,
that is, the firft of the aflbciate train, is rendered torpid by de-
fect of excitement of its ufual quantity of the fenforial power of
ailbciation, and from there being no accumulation of the fenfori-
al power of irritation to increafe its aflbciability, and thus to con-
tribute to actuate it by overbalancing the defect of the excite-
ment of its aflbciation.

Thus on riding long and ilowly on a cold and damp day,
the exhalation of the vapour, which is impinged on the fkin, as
the traveller proceeds, carries away his warmth fafter, than it is
generated within the fyftem ; and thus the capillaries of the fkin
have their actions fo much impaired after a time, that no accu-
mulation of the fenforial power of irritation occurs ; and then
the ftomach, the motions of which are catenated with thofe of
the capillaries, ceafes to aft from the deficient excitement of the
power of aflbciation •, and indigeftion and flatulency fucceed,
inflead of the increafed digeftion and hunger, which occur,
when the cutaneous capillaries are expofed to a lefs degree of
cold, and for a fhorter time. In which latter fitwation the accu-
mulation of the fenforial power of irritation increafes by its fu-
perabundance the aflboiability of the fibres of the ftomach, fo
as to overbalance the defeat of the excitement of their aflbcia-
tion.

6. The ftomach is affected fecondarily in fevers with ftrong
pulfe, as in thofe with weak pulfe it is affected primarily. To
illuftrate this doctrine I fhall relate the following cafe of Mr.

Y- • — . He was a young man rather intemperate in the ufe

of wine or beer, and was feized with a cold fit, and with a con-
fequent hot one with ftroug pulfe •, on examining his hypochon-
drium an oblong tumour was diftinctly felt on the left fide of
the ftomach, which extended fix or eight inches downward, and
was believed to be a tumour of the fpleen, which thus occafioned
by its torpor the cold fit and confequent hot fit of fever with
ftrong pulfe. This fever continued, though with remiflions,
for two or three weeks ; and the patient repeatedly loft blood,
ufetl cathartics with calomel and fenna,and had frequent antimo-
nial and faline medicines. And after he was much weakened
by evacuations, '(the peruvian bark and fmall dofes of fteel re-
moved the fever, but the tumour remained many years during
the remainder of his life.

In this cafe the tumour of the fpleen was occafioned by the
torpor of the abforbent veflels ; while the fecerning veflels con-
tinued fomewhat longer to pour their fluids into the cells of it.
Then the inactivity of this vifcus affected the whole fyftem with
torpor by the deficient excitement of the fenforial power of aflb-r

ciation,

SUP. I. 16. 6. THEORY OF FEVER, 503

elation, which contributes along with the irritation caufcd by
their fpecific ftimuli to actuate the whole fanguiferous, fecem-*
ing, and abforbent veflels ; and along with thei'e the ftomach,
which poflefles perhaps greater mobility, or promptitude co tor-
por or to orgafm, than any other part. And after a time all thelc
parts recover their actions by the accumulation of their fenfori-
al power of affociation. But the fpleen not recovering its ac-
tion from the accumulation of its power of irritation, as appear-
ed from the continuance of the tumour, (till affects the ftomach
by its defective irritative motions ceafmg to excite the affocia*
tion, which ought to contribute to actuate it.

Hence the ftomach continues torpid in refpect to its motions,
but accumulates its power of aflbciation 5 which is not excited
into action by the defective motions of the fpleen ; this accu-
mulation of the fenforial power of ailbciation now by its fuper-
abundance actuates the next link of affociate motions, which
confifts of the heart and arteries, into greater energy of action
than natural, and thus caufes fever with ftrong pulie j which,
as it was fuppofed to be uioft frequently excited by increafe of
irritation, is called irritative fever or fynocha.

Similar to this in the fmall-pox, which is given by inocula-
tion, the ftomach is affected fecondarily, when the fever com-
mences $ and hence in this fmall-pox the pulfations of the heart
and arteries are frequently ftronger than natural, but never
weaker, for the reafons above given. Whereas in that fmall-pox,
which is caufed by the ftomach being primarily affected, by the
contagious matter being fwallowed with die faliva, whether the
tonfils are at the fame time affected or not, the pulfations of the
heart and arteries become weak, and the inirritative fever is
produced, as explained above, along with the confluent fmall-
pox. This unfolds the caufe of the mildnefs of the inoculated
fmall-pox 5 becaufe in this difeafe the ftomach is affected fecond-
arily, whereas in the natural fmall-pox it is frequently affect*
ed primarily by fwallowing the contagious matter mixed with
faliva.

In the meafles I fuppofe the contagious matter to be diffolved
in the air, and therefore not liable to be mixed with the faliva ;
whereas the variolous matter is probably only diffufed in the air,
and thence more readily mixed with the faliva in the mouth dur-
ing refpiration. This difference appears more probable, as the
fmali-pox I believe is always taken at a lefs diftance from the
difeafed perfon than is neceffary to acquire the mealies. The
contagion of the meafles affects the membranes of the noftriis,
and the fecretion of tears in confequence, but never I fuipect
flora ach primarily, but always fecondarily ; whence the pui-

5o4 THEORY OF FEVER. SUP. I. 16. ?,

fation of the heart and arteries is always ftronger Ujan natural,
fo as to bear the lancet at any period of the difeafe.

The great mildnefs fometimes, and fatality at other times, of
the fcaflet fever may depend on the fame circumftance ; that is,
on the ftomach being primarily or fecondarily affected by the
contagious matter, obferving that the tonfils may be affected at
the fame time with the ftomach. Should this prove to be the
cafe, which future obfervations muft determine, what certain ad-
vantage muft arife from the inoculation of this difeafe ! When
it is received by the fkin primarily I fuppofe no fore throat at-
tends it, nor fever with weak pulfe ; when it is received by the
ftomach primarily, the tonfils are affected at the fame time, and
the torpor of the ftomach produces inirritative fever, and the
mortification of the tonfils fucceeds.

We may hence conclude, that when the torpor of the ftom-
ach is either owing to defect of ftimulus, which is not fo great
as to impair the life of the part, as in moderate hunger, or in
fwallowing iced water, or when its torpor is induced by its cat-
enation or aflbciation with other torpid parts, as in the com-
mencement of intermittent fevers, and inoculated fmall-pox, that
the fubfequent action of the heart and arteries is generally in-
creafed, producing irritative fever. Which is owing to the ac*
cumulation of the fenforial power «of irritation in one cafe, and
of affociation in the other, contributing to actuate the next link
of the catenated or aflbciated motions. But when the torpor of
the ftomach is induced by previous exhauftion of its fenforial
powers of irritation or of aflbciation by continued violent action,
as by the ftimulus of digitalis, or of contagious matter, or after
intoxication from wine or opium, a weaker action of the heart
and arteries fucceeds, becaufe there is no accumulation of fen*
forial power, and a deficient excitement of aflbciation. And
finally, as this weak action of the heart and arteries is not in-
duced by exhauftion of fenforial power, but by defect of the ex*
citement of aflbciation, the accumulation of this power of aflb-
ciation increafes the action of the capillaries, and thus induces
inirritative fever.

7. When any part of the fyftem acts very violently in fevers,
the fenforial power of fenfation is excited, which increafes the
actions of the moving fyftem : whereas the pain, which arifes
from decreafed irritative motions, as in hemicrania, feems to ex-
hauft a quantity of fenforial power, without producing or in-
creafing any fibrous actions.

When the ftomach is primarily affected, as in inirritative fevers
from contagion, and in fuch a manner as to occafion pain, the
ailion of the capillaries feems to be increafed by this additional

fenforial

SUP. I. 1 6. 7. THEORY OF FEVER. 505

fenforial power of fenfation, whence extenfive inflammation or
mortification •, but when the ftomach and confequently the heart
•and arteries continue their torpidity of action ; as in confluent
fmall-pox, and fatal fcarlatina j this constitutes fenfitive inirri*
tative fever, or typhus gravior.

But when the ftomach is fecondarily affected, if the fenforial
power of fenfation is excited, as in pleurify or peripneurnony*
the actions of the heart and arteries are violently increafed, and
of all the moving fyftem along with them. Thus the peripneu-
mony is generally induced by the patient refpiring very cold air,
and this efpecially after being long confined to warm air, or af-
ter being much fatigued and heated by exceflive labour or exer-
cife. For we can cover the fkin with more clothes, when we
feel ourfelves cold ; but the lungs not having the perception of
cold, we do not think of covering them, nor have the power to
cover them, if we defired it ; and the torpor thus produced is
greater, or of longer duration, in proportion to the previous ex-
penditure of fenforial power by heat or exercife*

This torpor of the lungs affects the (kin with fhuddering, and
the ftomach is alfo fecondarily affe&ed ; next follows the violent
action of the lungs from the accumulation of the power of irri-
tation, and an inflammation of them follows this violent action.
While the ftomach recovers its activity by the increafe of the
excitement of the fenibrial power of aflbciation, and along with
it the heart and arteries, and the whole moving fyftem. Hence
this inflammation occurs during the hot fit of fever, and no cold
fit fucceeds, becaufe the excefs of the fenforial power of fenfa-
tion prevents a fucceeding torpor.

Thefe new motions of certain parts of the fyftem produce in-
creafed fecretions of nutritious or organic mucus, which forms
new veiTels ; thefe new veffels by their unufual motions produce
new kinds of fluids ; which are termed contagious, becaufe they
have the power, when introduced into a healthy body, of pro*
ducing (iriilar actions and effects, with or without fever, as in
the fmall-pox and meafles, or in the itch and venereal difeafe.

If any of thefe contagious matters affect the ftomach with tor-
por either by their ftimulus immediately applied, or by its fym-
: parts fir ft di Tea led, a fever is produced with fick-
; of appetite ; as in fmall-pox, and fcarlatina. If
the itomach is not affected by contagious matter, no fever fuo
ceeds, as in itch, tinea, fyphilis.

All thefe contagious matters are conceived to be harmlefs, till

they have been expofed to the air, either openly or through a

& membrane ; from which they are believed to acquire oxy-

g rtiid thence to become fome kinds of animal acids. As

H. R R r the

506 THEORY OF FEVER. SUP. I. 16. 8.

the preparations of mercury cure venereal ulcers ; as a quarter
of a grain of fublimate diflblved in wine, and given thrice a
day ; this effect feems to be produced either by its ftimulating
the abforbents in the ulcer to abforb the venereal matter before
it has acquired oxygene ; or by afterwards uniting with it chem-
ically, and again depriving it of its acquired acidity. On either
fuppofition it might probably be given with advantage in fmail-
pox, and in all infectious difeafes, both previous to their com-
mencement, and during their whole progrefs.

8. The cold fits of intermittent fevers are caufed by the tor-
por of fome part owing to deficient irritation, and of the other
parts of the fyftem from deficient afibciation. The hot fits are
owing firft to the accumulation of irritation in the part prima-
rily affected, if it recovers its action, which does not always hap-
pen ; and fecondly to the accumulation of aflbciation in the oth-
er parts of the fyitem, which during health are fubjedt to per-
petual action ; and laftly alfo to the greater excitement of the
power of affociation, when the part primarily affected recovers
its irritability, and acts with greater energy than natural.

The deficient fecretions in the cold fit depend on the torpor
of the glandular fyftem ; and the increafed fecretions in the hot
fit on their more energetic action. The thirft in the cold fit is
owing to the deficient abforptioa from the (kin, cellular mem-
brane, and bladder j the thirft in the hot fit is owing to the too
great diffipation of the aqueous part of the blood. The urine
is pale and in fmall quantity in the cold fit from deficient fecre-
tion of it, and from deficient abforption of its aqueous parts ; it
is high coloured, and fometimes depofits a fediment, in the hot
fit from the greater fecretion of it in the kidneys, and the great-
er abforption of its aqueous and faline part in the bladder. The
drynefs and fcurf on the tongue arid noftrils are owing to the
increafed heat of the air expired from the lungs, and confequent
greater evaporation of the aqueous part of the mucus. The
fweats appear in confequence of the declenfion of the hot fit,
owing to the abforbent veffels of the fkin lofing their increafed
action fooner than the fecerning ones •, and to the evaporation
leffening as the fkin becomes colder. The returns of the par-
oxyfms are principally owing to the torpor of fome lefs effential
part of the fyftem remaining after the termination of the laft fit ;
and are alfo dependent on folar or lunar diurnal periods.

The torpor of the part, which induces the cold paroxyfm, is
owing to deficient irritation occafioned either by the fubduction
of the natural ftimuli of food, or water, or pure air, or by de-
ficiency of external influences, as of heat, or of folar or lunar
gravitation. Or fecondly, in confequence of the exhauftion of

fenforia!

SUP. I. 16. 9. THEORY OF FEVER. 507;

fenforial power by great previous exertions of fome parts of the
fyftem, as of the limbs by great labour or exercife, or of the
flomach by great ftimulus, as by contagious matter fwallowed
•with the faliva, or by much wine or opium previoufly taken into
it. Or laftly a torpor of a part may be occafioned by fome me-
chanic injury, as by a compreflion of the nerves of the part, or
of their origin in the brain ; as the fitting long with one leg
crofled over the other occafions numbnefs, and as a torpor of-
the flomach with vomiting frequently precedes paralytic itrokes
of the limbs.

As ileep is produced, either by defect of ftimulus, or by pre-
vious exhauftion of fenforial power ; fo the accumulation of the
fenforial power of volition in thofe mufcles and organs of fenfe,
which are generally obedient to it, awakens the fleeping perfon j
when it has increased the quantity of voluntarily fo much as to
overbalance the defect of ftimulus in one cafe, and the exhauf-
tion of fenforial power in the other ; which latter requires a
much longer time of fleep than the former. So the cold par-
oxyfm of fever is produced either by defect of ftimulus, or by
previous exhauftion of the fenforial power of fome part of the
fyftem ; and the accumulation of the fenforial power of irrita-
tion in that part renews the action of it, when it has increafed
its irritability fo.much as to overbalance the defect of ftimulus in
one cafe, and the exhauftion of fenforial power in the other ;
which latter requires a much longer torpor or cold fit than the
former.

But in the cold paroxyfm of fever, befides the torpor of one
part of the fyftem from defect of irritation, the remainder of it
becomes torpid owing to defect of excitement of the fenforial
power of aiTociation by the leflened action of the part firit affect-
ed. This torpor of the general fyftem remains, till the accumu-
lation of the fenforial power of aflbciation has increafed the af-
fociability fo much as to overbalance the defect of the ex-
citement of aflbciation ; then the torpor ceafes, and if the firft
affected part has recovered its activity, the other parts are all
thrown into excefs of action by their increafed afTociability, and
the hot fit of fever is produced.

9. In the continued fevers with ftrong pulfe the ftomach is
affected fecondarily, and thus acts feebly from deficient excite-
ment of the power of aflbciation ; but the accumulation of the
power of aflbciation thus produced in an organ fubject to per-
petual and energetic action, is fo great as to affect the next link
of the aflbciate train, which confifts of the heart and arteries ;
thefe therefore are exerted perpetually with increafe of action.

In continued fevers with weak pulfe the torpid ftomach is af-
fected

THEORY OF FEVER. SUP. I. 16. 9.

fe£led primarily by previous exhauftion of its irritability by ftim-
ulus, as of contagious matter fwallowed into it. The heart and
arteries a£l feebly from deficient excitement of the power of
aflbciation, owing to the torpor of the ftomach, with which they
are catenated ; but the accumulation of the power of aflbciation,
thus produced in organs fubjecl: to perpetual and energetic mo-
tion, is fo great, as to affect the next link of the aiTociate train ;
which confifts of the capillaries of the fkin or other glands ; thefe
therefore are exerted perpetually with great increafe of action.

The continued fevers with flrong pulfe terminate by the re-
duction or exhauftion of the fenforial power by violent action
pf the whole fyflem ; which is followed either by return of
health with the natural quantity of irritability, and of aflbciabil-
|ty, or by a total definition of them both, and confequent
death.

In continued fevers with weak pulfe the ftomach remains
torpid during the whole courfe of the fever ; and at length by
the recovery of its irritability and fenfibility effe&s the cure of
it. Which generally happens about the firft, fecond, or third
quarter of the lunar period, counted from the commencement
of the difeafe, or continues a whole lunation, and fometimes
more ; which gave rife to what are termed critical days. See
Sec~V. XXXVI. 4. on this fubjeft. If the ftomach does not re-
cover from its torpor, the patient becomes emaciated, and dies
exhaufted by the continuance of the increafed action of the ca-
pillaries and abforbents, and the want of nourifhment.

The cure of continued fever with weak pulfe confifts firft in
weakening the undue action of the capillaries of the flcin by ab-
lution with cold water from 32 to 80 degrees of heat ; or by ex-
pofmg them to cool air. Secondly by invigorating the actions
of the ftomach, by decreafmg them for a time, and thence ac-
cumulating the power of irritation, as by an emetic, or by iced
water, or iced wine. Or by increafe of ftimulus, as by bark,
wine, opium, and food, in fmall quantities frequently repeated.
Or by renewing the action of the ftomach by flight electric
(hocks. Or by fomenting it frequently with water heated to 96
or 100 degrees. Or laftly by exciting its power of afibciation
with other parts of the fyftem, as by a blifter ; which fucceeds
beft when the extremities are cool ; or by fwinging, as in verti-
go rotatoria.

If by the ftirnulus of the Peruvian bark on the fibres of the
ftomach, they regain their due action, the heart and arteries alfo
regain their due action ; as their fenforial power of ailbciation
js now excited, and expended as ufual. And as there is then
rio accumulation of fenforial power in the heart and arteries, the

capillaries

SUP. I. i& 10. THEORY OF FEVER. 509

capillaries ceafe to act with too great energy, and the fever is
cured.

Thirdly. If the heart and arteries could be themfelves ftim-
ulated into greater action, although the ftomach remained tor-
pid, they might probably by expending a greater quantity of the
fenforial power of irritation, prevent an accumulation of the
fenforial power of aflbciation, (for thefe may poifibly be only
different modes of action of the fpirit of animation,) and thus
the too great action of the capillaries might be prevented and
the fever ceafe. This new mode of cure might poffibly be ac-
complifhed, if the patient was to breathe a gallon or two of pure
or diluted oxygene gas frequently in a day ; which by pafiing
through the moid membranes of the lungs and uniting with the
blood might render it more ftimulant, and thus excite the heart
and arteries into greater action.

Fourthly. Greater energy might probably be given to the
whole fyftem, and particularly to thofe parts which a6t too fee-
bly in fevers, as the ftomach and the heart and arteries, if the
action of the fecerning veflels of the brain could be increafed in
energy ; this is probably one effect of all thofe drugs, which
when given in large quantity induce intoxication, as wine and
opium. And when given with great caution in fmall quanti-
ties uniformly repeated, as from three drops to five of the tinc-
ture of opium, but not more, every fix hours, I believe they fup-
ply an efficacious medicine in fevers with great arterial debility ;
and the more fo, if the Peruvian bark be exhibited alternately
every fix hours along with them. There are other means of ex-
citing the veflels of the brain into action ; as firft by decreafing
the ftimulus of heat by temporary cold fomentation ; fecondly,
increafmg the itimulus of heat by long continued warm fomen-
tation •, thirdly, by electricity, as very fmall (hocks pafled through
it in all directions •, and laftly by blifters on the head. All thofe
require to be ufcd with great caution, and efpecially where there
exifts an evident ftupor, as the removing of that is I believe fre-
quently injurious. See ftupor, Clafs I. 2. 5. 10.

The cure of fever with ftrong pulfe confifts in the repeated
ufe of venefection, gentle cathartics, diluents ; medicines pro-
ducing ficknefs, as antimonials, digitalis ; or the refpiration of
carbonated hydrogen ; or by refpiration of at mo fpheric air low-
ered by a mixture of hydrogen, azote, or carbonic acid gas, or
by compreffing the brain by whirling in a decumbent pofture,
as if lying acrofs a horizontal mill-ftone. See the former part?
of this fupplement for the methods of cure both of fevers with
itrong and weak pulfe.

10. When any difficulty occurs in determining the weak

510 THEORY OF FEVER. SUP. I. 16. 10.

pulfe from the ftrong one, it may generally be aflifted by count-
ing its frequency. For when an adult patient lies horizontally
in a cool room, and is not hurried or alarmed by the approach of
his phyfician, nor ftimulated by wine or opium, the ftrong pulfe
feldoms exceeds 118 or 120 in a minute ; and the weak pulfe
is generally not much below 130, and often much above that
number ; except where a patient has naturally a pulfe flower
than ufual in his healthy ftate. Secondly in fitting up in bed,
or changing tjpe horizontal to a perpendicular pofture, the quick-
nefs of the weak pulfe is liable immediately to increafe 10 or
20 pulfations in a minute, which does not I believe occur in the
ftrong puliif, when the patient has refted himfelf after the exer-
tion of rifing.

I (hall here infert a remark on the general ufe of ftimulating
materials, whether medicinal or culinary, to counteract: or pre-
vent debility. When a ftimulating material is exhibited, as the
Peruvian bark, or opium, or wine ; it fhould be continued but
a certain time, as half a lunation, or a whole lunation. If the
whole fyftem be ftimulated into increafed exertion, as by wine
or opium, there appears to be a temporary increafed fecretion of
fenforial power in the brain, fo long as this ftimulus affects the
fyftem. If a part only of the fyftem be ftimulated, as by the
exhibition of fpices, eflential oils, or bitter medicines, or metal-
lic ones, then the ftimulated organ has derived to it. a greater
quantity of fenforial power, or a greater fecretion* of it is pro-
duced in that part of the brain, where the ftimulated nerves
arife. Which is probably owing to the fympathy of the ftimu-
lated extremity of every nerve, or its organ of fenfe, with the
other extremity of it in the brain, in the fame manner as when
the excretory duct of a gland is ftimulated, a greater fecretion
is produced in the body of it, as when the ducts of the lacrymal
glands in the eyes, or of the falivary glands in the mouth are
ftimulated by duft or acrid materials.

Now if a ftimulating medicine be given at certain intervals of.
time, as the Peruvian bark or wine in fevers, the increafed ac-
tion of a part or of the whole fyftem foon becomes a link of
the aflbciated 'circle of diurnal actions, and may be faid to be-
come habitual.

The quantity of the ftimulating medicine may then be dimin- .
iihed, and yet the increafed activity of the fyftem will continue 5 .
becaufe the increafed exertions are now produced partly by the
fenforial power of a{Tociation, as they are become a part of the .
diurnal circle of actions. And finally the ftimulating medicine
may be totally omitted, and yet the increafed activity of the fyf-
tem continue for the fame reafon.

On

SUP. I. 17. THEORY OF FEVER. 511

On this circumftance depends the power of the bitter medi-
cines, as the bark, and other flimulating materials, as beer and
wine, in preventing the returns of the cold paroxyfmsof fevers,
and in flrengthening the fyftem, which increafe of irritability,
that is of ftrength, continues after the ufe of the medicine is
withdrawn.

But on the contrary, if the ftimulating material be continued
much longer than one lunation, the whole fyftem, or the ftimu-
lated organ alone, is excited into too forcible aclion by the two
fenforial powers of irritation, and of aflbciation*; and confe-
quently in procefs of time lofes in fome degree both its irrita-
bility and its aflbciability ; and inactivity or torpor fucceeds ;
which conftitutes weaknefs, as is feen in all thofe, who accuf-
tom themfelves to dram-drinking.

Hence wine or opium, or Peruvian bark, may be continued
twice or four times a day for half a lunation, or for a whole
one with advantage in difeafes of debility, for the purpofe of
gaining both diurnal and monthly aflbciations of activity. But
ihould not be much longer continued j as a confequent debility
will then be liable to fucceed.

XVII. Conclujton.

Thus have I given an outline of what may be termed the
fympathetic theory of fevers, to diftinguifh it from the mechan-
ic theory of Boerhaave, the fpafmodic theory of Hoffman and
of Cullen, and the putrid theory of Pringle. What I have
thus delivered, I beg to be confrdered rather as obfervations and
conjectures, than as things explained and demonitrated ; to be
confidered as a foundation and a fcaftbldiag, which may enable
future induftry to erect a folid and a beautiful edifice, eminent
both for its fimplicity and utility, as well as for the permanency
of its materials, — which may not moulder, like the ftruclures
already erected, into the fand of which they were compofed ;
but which may (land unimpaired, like the Newtonian philofo-
phy, a rock amid the wafte of ages !

END OF THE SECOND PART.

LINES*

LINES,

TO BE PLACED AT THE EN& dr

Z O O N O M I A

BT A FRIEND.

|

OPUS EXEGI.

The work is done ! — nor Folly's adive rage,
Nor Envy's felf, (hall blot the golden page ;
Time fliall admire, his mellowing touch employ,
And mend the immortal tablet, not deftroy.

ZOONOMIJE AUCTORI

S. P. D.
A M I C U S.

CURRUS TRIUMPHALIS

Currus it Hygeise, Medicus movet arma triumphans,
Undique vidla fugit lurida turma mali.

Laurea dum Phcebi viridis tua tempora cingit,
Nee mortale fonans Fama coronat opus ;

Poft equitat trepidans, repetitque Sene&us in aurern,
Voce canens ftridula, « fis memor ipfe mori !"

INDEX

tO THE

CLASSES OF PART SECOND.

A,

A.

.BORTION, i 2. r. 14.

from fear, iv. 3.

i. 7.
not from epilepfv ,

iii. i. i. 7.
not from hepati-
tis, ii. i. 2 iz.
Abforption of folids, i. 2. 2. 14.

of matter, ii. i. 6. a.

and 6.

cellular, iv. i. i. 6.
from the lungs, iv 3. i.

5. Suppl. i. 8. 6.
Abftinenee of young ladies, ii. ^.

2. I.

Accumulation of feces, ii. a. a. 7.
Acupuncture, iii. i. i. 8.
Adipfia, ii. 2. 2. 2.
j^gritudo ventriculi, i. 2. 4. 4.

See ^icknefs.
Agripnia. See Vigilia.
Ague-cakes, Suppl. i. 2. 3
Alum in ulcers of the mouth, ii. i,

3. i. ii. t. 6. 16.
Ambition, iii. i. 2. 9.
Amaurofis, i. 2. 5. 5.
Anafarca of the lungs, i» 2. 3. 16-
Aneurilma, i. 2. i. 18.
Anger, iii. i. 2. 17.

tremor of, iv. 2. 3. 4.
blulh of, iv. 2. 3. 5.
Angina. See lonftlhtis.

peftoris. See Afthma

painful.

Anhelitus, ii. i. i. 4.
Anhelatio fpafmodica, i. 3. 3. 3.
Annulus repens, ii. i. 5. 10.
Anorexia, ii. 2. 2. i .

maniacalis, SuppKi- 14.^
epileptica, ii. 2. 2. i. iii,

i. i. 7.

Apepfia, i. 3. i. 3. Suppl. i. 8. n.
Aphtha, ii. i. 3. 17.
Apoplexy, iii. 2. i. »6.
Appetite defective, ii. 2. a. i.
depraved, iii. i- a. 19.
from abitinence,ii. 2. 2. t.
VOL- H, Ssf

Appetite destroyed, iii. i. i. io.

from epilepfy, ii. 2. 2. i,
Arm, pain of iv 2. 2 13.
palfy of, iii. 2. 1.4.
Arfenic in tooth-ach, i. 2. 4. 12-
in head-ach,i. 2. 4. u,
Arthrocele, ii 1.4. 17.
Arthrppuoiis, ii. i. 4. 18.
Arthritis. See Gout.
Afcandes, i. i. 4. 12. iv. i. z.g,

iv. 2.. 2. 6.
Afcites, i. 2. 3. T-J.
AlTociations affected four ways, iv.

i. i G
how produced, iv. i,

i- H.

diftincl: from catena-
tions, iv. i. i. A.
Affociations, three kinds of, iv. i.

t. B.

tertian, iv. i. i. K.
of the fauces and pu-

bis, iv. 1.2.7.
fenlitive, a lawpf, iv,

2 a. 2.

fenfitive, iv. 2 i.
accumulates, Suppl. i.

8 3. i. 11.4.
Aflhma humoral, ii. i. i. 8. i. 3,

2. 8

of infants, 1.1.3.4.
convulfive, iii. i. j. 10.
pa ntul, iii. i. i. n.
Auditus acrior, i. i. 5 2.

imminutus, i.%2. 5. 6,
Azote, ^uppl. i. 9. 3 \ n. 4,
fceptic, ii. i. 6. 6.

B.

Bandages, ill effect of, ii. i. i. 11.
promote abibrption, i. K
. 3- '3-

in gout, iv. i. 2. 15.
in rheumatifm, iv. i. y.,

16.

in heinicrania, iv, 2. 2- 8.
in epilepiia, iii. i. i. 7.
Bath,

INDEX TO THE CLASSES._PA*T II.

Bath, cold, i. 2. 2. j, Suppl. r.

.H. 3-

warm, i. i. 2. 3.
Beauty, iii. i. 2. 4.

lofs of, iii. 1-2. 12.
Bile-du£t, pain of, iv. 2. 2. 4.
Bile cryftallized, i. i. 3. 8.
Bitter tafte, i. i. 3. i.

not from bile, i. 1.3. i.
Bleeding. See Hemorrhage.
Bladder, diftenticn of, ii. 2. 2. 6.
ttone of, i. i. 3. 10-
catarrh of, ii. 1.4. n.
Blfcidnefs, i. 2. 5. 5.
Blufh of anger, iv. 2. 3. 5. Suppl.

i. 12. 7.
of guilt, iv. 2. 3.6. Suppl. i,

12. 7._ m
Bones, innutrition of, i. 2. 2. 14.

caries of, ii. i. 4. 19.
Borborigmus, i. 3. i. 9.
Bougies, ii. 1-4. 1 1.
Bowels, gurgling of, i. 3. i. 9.
Brachiorum paralytis, iii. 2. i. 4.
Brain (timulated, Suppl. i. 16. 9.
Bronchpcele, i. 2. 3. 20.
Broth, i. 2. 4. 8.
Burns, i. i. 3. 13.
Butterflies, experiment on, i. i.

2- 3,

Buxton bath feels warm, Suppl. i.
16.

C.

Cacofitia, in- i< 2. 20.

Calculi produ6tio, i. i. 3. 9. ii. i.

2. 14.

renis, i. i. 3. 9. iv. 2.3. 3.
veficae, 1.1.3. 10. iv. 2. 2. 2.
Callico fhirts, i. i. a. 3.
Callus, i. 2. 2, 12.
Canities. See Hair grey.
Calor febrilis, i. i. 2. i.
Calves fed on gruel, i. i. 2. 5.
hydatides of, i. 2, 5. 4.
Cancer, ii. i. 4. 16. ii. i. 6. 13.
Cantharides, large dofe of, iv. 2. 2. 2.
Carbonic acid gas, Suppl. i. 9.3.
Cardialgia, i. 2, 4. 5.
Carcinoma, ii. i. 4. 16. ii. i. 6. 13.
Caries odium, ii. 1.4. 19.
Catara6t, i. 2. 2. 13.
Catarrh, warm, i. i. 2. 7.

cold, i. 2. 3. 3.

lymphatic, i. 3. 2. t.

fenlitive, ii. i. 3- 5-

epidemic, ii. i. 3. 6.

of dogs and horles, ii. i.
3. 6.

from cold (kin, iv. i. i. 5.

periodic, iv. 3. 4. i.
Catamenia, i. 2. i. 10. ivt 2. 4- ?•

Catalepfis, iii. 2. i. 9,
Cats, mumps of, ii. i. 3. 4.
Cephalaea iympathetica, iv. 2. x. 7*

idiopatnica, i. 2. 4. n.

fomniofa, i. 2. 4. n.
Gefarian operation, i. 2. a. 14.
Charcoal tooth-powder, i. 2. 4. 12.
Cheek, torpor of, iv- 2. 2. i.
Chicken-pox, ii. i. 3. 15.
Chin-cough, ii. i. 3. 8.
Child-bed fever, ii. i. 6. 16.
Children, new-born, ii. i. i. 12.

gripes and purging of, i.

I. 2. 5.

Chlorofis, i. 2. 3. 10. Suppl. i.8. 11.
Chorea St. Viti, iv. 2. 3. 2.
Citta, iii. «. 2. 19.
Clamor, iii. i. i. 3-
Clavicular animals, ii. i. 2. 6.
Clavus hyftericus, iv. 2. 2. 8.
Claudicgtio coxaria, i. a. 2. 17.
Cold in the head. See Catarrh.
Cold air in fevers, iii. 2. i. 12. iv.

2. 4. ii.

effeasof, iii. 2. i. 17.
how to be ufed, iv. i. i. 4.
death from, iii. 2. i. 17.
Colic, flatulent, i- 2. 4- 7-
from lead, i. 2. 4. 8.
hyfteric, i. 2. 4. 7. iii. 1. 1. 8.
Compallion, iii. i. 2, 24.
Confumption, ii. i. 6. 7.
ConvuKion, iii. J. i. 5.

weak, iii. 1. 1. 5.
from bad air, iii. 1.1.5.
painful, iii- i. i. 6. iv.

2. 4. 5.

Confirmation, i. i. 5. 12.
Conftipation, i. i. 3. 5. ii. 2. i. 7.
Contagious matter of two kinds, ii.

i- 3
is oxygenated,

ii. i. 5.

produces fever,
how, Suppl. i.
16. 7.

deftroyed by ni-
trous vapour,
ii. i. 3.

deftroyed by ful-
phurous va-
pour, ii. i. 3.
Cornea to perforate, i. 1.3. 14.

fears of feen on milk, i. r.

3- i4-

Corpulency, i. 2. 3. 17.
Coryza. See Catarrh.
Coftivenefs, i. i. 3. 5. ii. 2. i. 7.
Cough of drunkards, ii. i. r. 5.
hooping, ii. i, 3. 8.
hepatic, iv. 2. 1.8,
gouty, iv. 2. i. 9.

Cough

INDEX TO THE CLASSES.-PART II.

5*5

Cough periodic, iv. 2. 4- 6. iv. 3.

4. 2.

from cold feet, iv. 2. i. 7.
Cows, peftilence of, ii. r. 3. 13.

bloody urine of, ii. i. 3. 13.
fwelled by clover, ii. i. 7.
Cow-pox, ii. i. 3. 9.
Crab-lice, i. 1.4. 14.
Cramp, iii. i. i. 13.

painful, iii. i. i. 14.
in diarrhoea, iv. i. 2. 10,
Crapula ventriculi, ii. i. i. 7.
Credulity, iii. 2. 2. 4.
Critics novi, i. i. 2, 15.
Croup; i. i. 3. 4 ii. i, 2. 4. ii. r. 3. 3.
Crufta laclea, ii. i. 5. 12.
Cuds arida, i. 1.3. 6.
Cynanche. See Tonfillitis.

parotidaea. See Parotitis.

D.

Darknefs in fevers, i. 2. 5. 3.
Deafnefs, two kinds of, i. 2. 5.6.
Debility, three kinds of, i. ^. i.
Debility and ftrength metaphors, i.

2. i.

Decuflation of nerves, iii. 2, i. 10.
Deglutition, ii. r. i. i.

involuntary, iv. i. 3. r.
Delirium febrile, ii. i. 7. i.

of drunkennefs, ii. i. 7. 3.
maniacal, ii. i. 7. 2.
in parotitis, iv. 2. i. 19.
Dentition, i. 1.4. 5.
Dentium dolor a ftridore, iv. i. 2.3.
Defcent of the uterus, i. i. 4. 8.
Diabetes, i. 3. 2. 6.

foul tongue in, i. i. 3. i.
irritative, iv. 3. i. i.
from fear, iv. 3. i 3.
Diarrhoea warm, i. i. 2. 5.

of infants, i. 1.2. 5.
lymphatic, i 3. 2.4.
chyliferous, i. 3. 2. 5.
cold, i. 2. 3. 6.
rheumatic, iv. 2, i. 16.
from fear, iv. 3. i. 4.
from toothing, iv. 2. 2. 14.
in fevers, Suppl, i. 2-4.
cure of, iv. i i. F.
Digeftion increafed by cold, i v. 1. 1.4.
decreafed by cold, iv. i. 2.

5-

Digitalis in rheumatifm, iv. i. 2. 16.
Diluents, ufe of, ii. i. 2. i.
Diftention of the nipples, ii. i. 7.

10. iv. r. 2. 7.

Diuretics ufelefs in dropfy,i. i. 3.7.
Dizzinefs. See Vertigo.
Dogs, catarrh of, ii^ i. 3. 6.
Dolor digiti lympathet. iv. 2.2. 12.
dutfus choledocht, iv. 2,2.4.

Dolor humeri in hepatidite, iv. 2. 2.

9-

pharyngis ab acido, iv. 2. 2. 5.
tedium nephriticus, iv. 2. ^.

if.

urens, i. i. 5. 10.
Dracunculus, i. i. 4. 13.
Dreams, ii. i. 7, 4-
Dropfy of the brtun, i. 2. 3. 12.
of the belly, i. 2. 3. 13.
of the chelt, i. 2. 3. 14.
of the ovary, i 2. 3. 15.
of the lungs, i. 2. 3. 16.
of the fcrotum, i. 2. 3. n.
Dyfentery, ii. i. 3. 18.
Dyfmenorrhagia, i. 2. i. 12.
Dyfpepfia, i. 3. i. 3.

a frigore, iv. 2, r. 6.
Dyfpnosa from cold bath,iv. 2. i. 5,

rheumatica, iv. ?. r. 16.
Dyfuria infenfitiva, ii. 2. 2. 6.
paralytica, iii. 2. 1.6.

E.

Ears, discharge behind, i. r. 2. 9.

noife in them, iv, 2. i. 15.
Ear-ach, iv. 2. 2. 8.
Ebrietas, i. i. i. T.T
Education, iii. 2. i. 8. iii. \. 2. 24.

iii. i. 2. ii.
.heroic, iii. r. 2. 25.
Egg boiledSNFor enflamed eyes, ii. i.

4. r.

boiled foonefl, Suppl. i. 7.
life of, iv. i. 4. i.
Eleftric fhocks, iv. i. 4. 5.

in paralylis, iii. 2. 1. 10.
in fcrofula, i. 2. 3. 21.
in hparfenefs, iii. 2. 1.5.
Electrized zinc and filver, i. 2. ;.

5. iv. 2. i. ii.
Empyema, ii- I. 6. 4.
Ennui, iii. i- 2. u. iii. 2. i. 8.
Enteralgia rheumatica, iv. i. 2. 16.
Enteritis, ii. i. 2. n.

fftperficialis, ii. i. 3. 20.
Epilepfy, iii. i. i. 7. iv. 3 i 6.

painful, iii. i. i. 8. iv. 2.

4- 4.
terminates with fleep, iii.

i. i.

in parturition, iii.i. 1.7.
with digeftion, ii. 2. i. i.
Epiflaxis. See Haemorrhagia*
EpouloHs. See Cicatrix.
Erotomania, iii. i. 2. 4.
Eru6lation, voluntary, iv. 3. :
Eruption of fmall-pox, iv. ». i. n.

iv. 2. 2. 10.

Eryfipelas, iv. i, 2. 17. ii. i. 3. 2.
iv. 2. 4. i°«

INDEX TO THE CLASSES.— PART II.

Eryfipelas feldom fuppurates, why,

ii. i 3 . "2
£ furies, i. j 4 a.
Ether, to purify, i. ^. 5. 6.
Evil, i 2. 3 21.

Expectoration, warm, i » 2-8.
folid, i- 1. 3 4«
cold, i. 2 3 4.
Exfudation behind the cars, i. i.

a. 9.
Eyes, blue under the, i. 2. 2. a. ii.

"K 4- 4. .

Eye-wing, n r 4. a.
Eye lids, red, ii. i 4- 3«
Eyelid inverted, cure of, ii- i- 1. *;
coloured with antimony, ii.

i 4-3.
Excoriations, uu a. i. 10-

F.

Face, pimpled, ii i 4 6.

red after meals, Suppl i. is,

flufhed after dinner, iv. 1. 1. 1.
Fat people why ftiort breathed, ii.

i. 1.4.

how to reduce, i. a. 3. 17,
Fear, fyncope from, i 2-1.4..
abortion from, iv i. 3. 7.
produces abforption, ii. i. 6, 4.
paienefs in, iv. I 3 5.
of death, iii. \ a 14.
of hell, iii. i. 2. 15.
of poverty, iii. i 2. 13.
Feet cold produces heartburn,

Suppl. i. 8. 5.
fetid, i. i. 2. 14.
cold in finall-pox, iv. a. a.

JO,

Fevers, five kinds, ii. i. a. Suppl.

i. i ?.
irritative, i. 1. 1. i. iv. i. i.

8.
inirritative, i. a. i. I- iv. a.

I. 19 Mlppl 1- I. 2.

fenfitive, ii i ^ i.
fenfitive irritated-, ii I a- 1.
fen itiveinirritated, ii. 1.3.

i

intermit, why, Svippl.i.
continue, why, Suppl. i.
periods of, iv. i 4. ii.
iimple, Suppl i i.
compound, :uppl i- a.
termination 01 cold fit,

^uppl. i 3.

return of cold fit, Suppl . i. 3.
fenfationin, ^uppl. i 5
circles of motions in, S

i 6

Cold and hot fits, Suppl, 1.
continued, Suppl. i- 8.

Fevers, torpor of lungs in, Suppl. i.

9. i.
not de terminable in cold

fit, i. i.i. i.
frequency of pulfe in, i. x.

i. i.
not an effort to cure, i. i .

a- 3
from enclofed matter, ii.

i 6. a.
from aerated matter, ii. x.

6.6-
from contagious matter, ii.

i 6. n.
from contagious fanies, ii.

i. 6. 15.

puerperal, ii. i. 6. 16.
torpor of the ftomach in,

Suppl- i. 12.
cafe of, Suppl. i. 13
termination of, huppl. i. 14.
inflammation excited in,

Suppl i- 15-
returns of, Suppl i. 4-
when cold air in, Suppl. i.

a. a.
fympathetic» theory of,

Suppl i.
duration of explained,

Suppl. i. a. 5.
Fingers, playing with, iv. i. 3. 4.

pain of, iv. a. 2. 12.
Fire, animal, iv. i, 4. 5.
Fifh live longer with injured brain^

i. 2. 5. 10.
Fiftula in ano, ii. i . 4. 10.

lacrymalis, ii. i 4- 9«
in urethra, ii. i. 4. 11.
Flannel fhirt in diarrhoea, iv. i i. j.
injurious in fummert

i. j. 2. 3.
Fluor albus warm, i. i. a. xi.

cold, i. 2. 3. 7.
Frigus febrile, i. a- a- t.

chronicum, i. 2. a. a.
lethale, iii. a. i. 17.

G.

Galvanifm, i. a. 5. 5- iv. a. i. if,
Gall-flone, i. 1.3- 8.
Gangrene, ii. 1.6. 17.
Gargles, ii. i. 3. 3-
Gaftritis, ii. i. 2. 10.
Gaftritis fuperficialis, ii. i. 3. i«,
Genu tumor albus, i. a. 3. 19.
Gleet. See Gonorrhoea.
Globus hyftericus, i. 3. i. 7-
Gonorrhoea warm, i. i. a. 10.

Cold, i. a. 3. 8.

venereal, ii. i. 5. 2.

ipLi,7. Gout, iv. i. 2.^5. iv. 2.4.9.
8. of the livV, ii. i. i. ?•

GoutA

INDEX TO THE CLASSES.-PART TT,

5r7

Gout, cafes of, iv. i. 2. 15.

cough, 5 v. t. i. 9.

of the ftomach, i. 2. 4. 6.

haemorrhage in, i. i. i. 4.
Grace defined, iii. 1.24.
Gravel diltinguiflied from falts, i-

'•3-9

Gravitation, iv. 2. 4.
Green-iicknefs. See Chlorofis.
Grief, iii i. 2 10-

Heat, not eftimated by thermome-
ters, Suppl i. 7.
of the breath, Suppl. i. 2. 2.
Hemicrania idiopathica, i. 2. 4. 12.
fympathetica, iv 2. 2.
8 iv. ^. 4. 3. SuppK
i. 14.3.
relieved by mercury,

iv. 2, 2 8-
Hemiplegia, iii 2 i. 10.

Gripes of children, i. i, 2. 5. iv. 2. HepatU tumor, i- 2. 3. 9.

Guftus acrior, i. i. 5. 4,

imminutus, i. 2, 5. 8.
Gum, red, i. i. 2. 3. ii i 3. 12.
Gutta rofea, ii. i. 4. 6. iv. i. 2. 13.

and 14.
ferena, i. 2. 5. 5.

H.

Hemorrhage arterial, i. i. r. 3.

of the lungs, i. i. i.

of the nofe, i. x. i.

5-

venous, i. 2. i. 5

Hepatitis, ii 12 12.

chronica, ii. i. 4. 12.
Herpes, ii. 1.5 8.

nephritica, iv. i. 2. n.
Hiccough, ii i. i. t.\v i. i. 7.
Hip-joint injured, i, 2. 2. 17.
Hoarfenefs, ii. i. 3. 5. i i. 2. i. 4.
Hordeolum, ii i. 4 4.
Hooping-cough, ii i. 3. 8.
Horfes, broken wind of, i- 2. 4. 9.

catarrh of, ii i. 3. 6.
Hume&ation of the body, iv, i. 4.

Hunger, i. 2. 4 2.
Hydatides in calves, i. 2. 5, 4.

of the rectum, i. 2. i. Hydrocde, i. 2 3. ri

6.

of thekidnies, i. a. i.

of the liver, i. 2. r.8.
Haemoptoe arterial, i. i. i. 4.
venous, i. 2. i. 9.
Haemorrhois cruenta, i. 2. i. 6. iv.

2.4. 8.

alba, i. i. a. 12.
Hair, grey, i. 2. 2. n.
new, i, r.,2. 15.

Hydrocephalus inter, i. 2. 3. 12. i.
2. 5 4. iii. 2. i.

JO

from inflammation,

i. 2. 3 ii.
Hydrogcnc gas, Suppl. i 9. 3. i-

ii. 4

in fevers, Suppl.
i.i i. 6. i 16 9.

Hydrothorax, i. 2. 3- 14. cafe of, iv.
2 2. 13.

white by uterine preflure, i. Hydro-carbonate gas, Suppl. j. 9.

i. Suppl i- 15 ->
Hy drops ovarii, i. 2. 3. 15.
Hydrophobia, 13. i. xi. iii. i. x.

15 iv. i. 2 7. iv 2 4. ii.
Hypochondriacs, i. 2 4. 10.
Hyneraigia trigida, i 2. 4. 17.
4. Hyfteria, i. 3. i. 10- £uppl. i. x. 8-

ii.

from fear, iv. 3-1.8.
from cold, iv. 3. 3 .3.

convultiousui, iii. r.

2. 2. Ii.

Hallucination of fight, ii. i. 7. 5.

of hearing, ii. J. 7
6.

maniacal, iii i. 2. i.
Hallucinatio ftudiofa, iii. i, 2. 2.
Harrogate water, factitious, i.

12.

Head-ach. See Hemicrania and

Cephalaea.
Hearing, acuter, i. i. 5. 2.

diminiflied, i. 2. 5. 6.
Heart-burn, i. 2. 4. 5.

>.
laughter in, iii. i. i- 5.

Heart Simulated, Suppl. i. n. 7. i. Hyfteritis, ii."j. 2. 16.
16 9

Heat, animal, i. i. 2. i. i. i. 2. 3.
ienfe of acuter, i. i. 5. 6.
elemental, iv. 2.4.

I.

Jaftitatio, iii. i i- i.
Jaundice, i. 1.3- 8. i. a. 4. 19.

hectic leilened by fwinging, Icterus, i. 1.3-8 i. 2. 4. 19

iv 2 i. 10. Ileus, i. 3. i. 6. ii. i. 2. ii.

not perceived by the lungs, Impotentia, ii 2. 2. 3.

ig.

ladigeftion. i. 3. i. 3.

Indigedion,

TO THE CLASSES.— PART II.

Indigeflion. See Anorexia and A-

pepfia.
from cold feetuv. 2. i,

6. Sup. i. 8. 5.
Incubus, iii.2. i. 13.
Infants, green ftools of, i. i. 2. 5.

new born, ii. i. i. 13.
Inflammation of the ; eye, ii. i 2. 2.
Superficial, ii. i. 4. i.
of the brain, ii. i. 2.

of the lungs, ii. i. 2.

4-

fuperficial, ii. 1.3. 7.
of the pleura, ii. i. 2.

of the diaphragm, ii.

i. 2. 6.

of the heart, ii. i. 2. 7.
of the peritoneum, ii.

i. 2. 8.
of the inefentery, ii.

1. 2. 9

of the ftomach, ii z.

3. 10.

fuper-
ficial, ii. i. 3. 19.

of the bowels, ii. i. 2.
n.

fuper-
ficial, ii. i. 3. 20.

of the liver, ii. i. 2.
12.

chronical, ii. 1.4. 12.

of the fplcen, ii. i. 2.
13. Sup. i. 16. 6.

of the kidnies, ii. i,

2. 14.

of the bladder, ii. i.

2. 15.
of the womb, ii. 1.2.

16.
of the tonfils, ii. i. 3.

of the parotis, ii. i. 3.

4

Inirritability of lacteal s,i. a. 3.26.
of lymphatics, i. 2. 3.

27.
of the gall-bladder, i.

2. 4 i?-
of the kidney, i. 2.4.

20.
of the fpleen, Sup. i.

1 6. 6.

viciflitudes of, i- i. I.
Innutrition of bones, i. 2. 2. 14.
Inoculation, ii. i. 3. 9-
lufanity, quick pulfe in, iijkt. i.
from parturition, iii. I. 2.
from paralylis, iii. I. a.

Infanity, with fever, iii. i. 2.

cure of, iii. i. 2.

confinement in, iii. i. 2.

cures other difeafes, i. 2. 3.

16.

Infenfibility, ii. 2. i. i.
Introfufception of the inteftine, i.

T 3 ..i:6.

Ira, 111. i. 2 17.

Ifchias, ii. i. 2. 18. i. 2.4. 15.

I flues, ufeof, i. i. a. 9. iii. i. i. n.

Itch, ii. i. 5. 6.

Itching, i. i. 5, 9.

of the nofe, iv. 2. 2. 6.

K.

Kanguroo, i. 2. 2. 14.

L.

Labour, difficult, i, 2. 2. 14.
Lachrymarum fluxus fym. iv. i. 3.

i.

Lamcnefs of the hip, i. 2. 2, 17.
Latitude, iii. 2. i. i.
Laughter, iv. 2. 3. 3. iii. I. i. 4. iv,

!• 3- 3«

See Rifus.

Lead, pernicious, i. 2. 4. 8.
Leg, one ihorter, i. 2. a. 17.
Lepra, ii. i. 5. 3.
Lethargus, iii. 2. i. 14.
Lethi timor, iii. i. 2. 14.
Lice, i. i. 4- 15.
Lientery, i. 2. 3. 6.
Life of an egg. iv. i. 4. i.

of winter-fleepers, iv. i. 4. 2.
Light debilitates in fevers, i. 2. 5.

Lingua arida, i. 1.3. i. iv. 2. 4. u.
Liver, torpor of, i. 2. 2. 6.
tumor of, i. 2. 3. 9.
inflamed, ii. i. 2, 12.
Lochia nimia, i. 2.
Locked jaw, iii. i. i. 13,
Love, fentimental, iii- i. 2. 4.
Lues venerea, ii. i. 5. 8.

imaginaria, iii. J. 2. 21.
Lumbago, ii. i. 2. 17. iii. i. j. i.

cold, i. 2. 4. 16.
Lumbricus, i- i. 4. 10.
Lunar influence on the folids, i. 2.

i. ii.
Lungs, adhefions of, ii, i. 2. 5.

not fenfible to heat, iii. 1. 1.

10.
Lufus digitorum invitus, iv, 1.3.4.

M.

Maculae vultus, i. 2. i. 9.
Mudnefs, mutable, iii. 1.2. i.
Magnetic fluid, iy. 1.4-5.

Mammarum

INDEX TO THE CLASSES.— PART II.

51*

Mammarum tumor, iv. 2. i. 19.
Mammularum tenfio, iv. 2. i. 6. i.

i. 4- 7-

Mania mutabilis, iii. i. 2. i.
Matter, variolous, ii. 1.3-9-

contagious, ii. i 3. ii. i. 6.

11.

enclofed, ii. i. 6. 11.
oxygenated, ii. i. 6. 6.
famous, ii. i. 6. 15.
Meafles, ii. i. 3- 10. Suppl. i. 16. 6.
Membranes, what, iv. i. 2.
Menorrhagia, i- 2. i. 11.
Mercury crude, as aclyfter, i, 3. i.
6.

in colic from lead, i. 2. 4.

8.
in all contagions, Suppl i.

16. 7.

in vertigo, iv. i. 2. 11.
Miliaria, ii. i. 3. 12.
Milk new, for children, i. i. 2 5.
old, induces coftivenefs, ii. i.

2. 7.

Milk-craft, ii. i. 5. 12.
Mifcarriage. See Abortion.
Maeror, iii. i. 2. 10.
Mobility, iv. i. 2.

of the (kin, Suppl. i. 7.
Mollities odium, i. 2. 2. 14.
Moon, effect of» iv. 2. 4.
Morbilli. See Rubeola.
Mortification, ii. i. 6. 17. iii. 2. i.

10.

Morpiones, i. 1.4. 14.
Mucus diminifhed, i. 2. 2. 4.

of the throat cold, i. 2. 3. i.

of the bowels, i. 2. 3. 6. i.
i. 2. 12.

of the lungs, i. i. 3. 4.

forms ftones, i. 1.3.9.

diftinguifhed from pus, ii. i.

6. 6.

Mumps, ii. 1.3 4.
Murmur aurium, iy. 2. i. 15.
Mufcae volitantes, i. 2. 5. 3.

N.

Nails, bitingpf, iv. i. 3. 5.
Nares aridi, i. i. 3. 3.
Naufea, dry, i. 2.4. 3.

humid, i. 3. 2. 3.
ideal, iv. 3. 2. i.
from conception, iv. 3. 2.

2.

Navel-ftring of infants, ii. i- i. 12.
cut too foon, ii. i. i.

12.
Neck thickens at puberty, iv. i. 2.

-fwing, i. 2. 2. 16.

Nephritis, ii. i. 2. 14. i. i. 3. 9. iii.

2. i. :4.

Nerves decuflate. iii. 2. i. 10.
Nictitation irritative, i. 1.4. i.
fenfitive, ii. i. i. 9.
involuntary, iv. i. 3. £»
Night-mare, iii. 2. 1. 13.
Nipples, tenfion of, i. i. 4. 7. iv. 2*
i. 6.

want of, ii. i. i. 13.
Noftalgia, iii. i. 2. 6.
Noftrib, dry, i. i. 3. 3.

O.

Obefitas, i. 2. 3. 17.
Odontai^ia, i. 2. 4. 13.
Odontitis, ii. i 4. 7.
CEfophagi fcirrhus, i. 2. 3
Olfattusacrior, i. i. 5. 3.

imminutus, i. 2. 5. 7.
Oil deftroys infects, i i. 4. H-
efTential of animals, i. i. 2.14.
why injurious in eryfipelas, ii.

i. 3. 2.
Opthalmy, internal, ii. i. 2. 2.

fuperficial, ii. i. 4. i-
Opium in catarrh, i. 2. 3.3.

in diaphragmitis, ii. i. 2. 6.
Orci timor, iii. i. 2. 15.
Ofcitatip, ii. i. i. 10.
Oflmm innutritio, i. 2. 2. 14.
Otalgia, i. 2. 4. 13. iv. 2. 2. 8.
Otitis, ii. 1.4. 8.
Otopuofis, ii. i. 4. 8.
Ovary, dropfy of, i. 2. 3. 15.

exfeclion of, i. 2. 3. 15.
Oxygen gas Suppl. i. 9. 3.

in fevers, Suppl. i. 11. 7*

i. 16 9.
Oxygenation of blood, iv. i. 4. 6.

P.
Pain exhaufts fenforial power, iv.

greater prevents lefs, iv. 2. 2.

2.

nervous, i. 2. 4.

of the little finger, fymptom,

iv. 2. 2. 12.

of arm in hydrothorax, iv. 2»

2. 13.

of the bile-duCl, iv. 2. n. 4.
of the (boulder, iv. 2. 2. 9.

of the pharinx, iv. 2. 2. 5.
of the tettis, iv. 2. 2. 11.
(inarting, i 1.5. 10.
of the fide, i. 2. 4. i4-iv. i. 2-

of menftruation, i. 2. i.
life of, iii. i. i. 11. i. i. 2. 9.
of the uterus, i. 2. 4. 17.

te, dangerous, ii. 1.46.
Palate,

520

INDEX TO THE CLASSES.-PAkT It

Palate, defeft of, i. 2. 2. 20.
Palenefs, i. 2. e. 2.

from fear, iv. 3. i. 5.

from licknefs, iv. 2. 1.4.

of urine after dinner, iv.

2.1

from cold fkin, iv 2 i. 1.
Palpitation of heart, i. 3. 3. 2. i. 2.

1. iO.

from fear, iv. 3. i. 6,
relieved by arlenic, iv»

2 i. 18.

Pancreas, torpor of, i. «. 2. 7.
Pandiculatio, ii. i. i. 10.
Panting, ii. i. i. 4- i- 3- 3- 3-
Paracente'is at the navel, i. 2. 3. 13.
Paralyiis, iii. a. i. 10.

of the bladder, iii. 2. 1.6.
of the re. Him, iii. 2. i. 7.
of the hands, iii. 2. 1.4.
cure of, iii. 2. 1.4.
Paraplegia, iii. _?. '. 11.
Pareiis inirriiativa, i. 2. i. 2. Suppl.

i. 8. 10.

fenli'iva, i. P.. i. 3.
voluntaria, iii. <2. i. 8.
Paronychia, internal, ii. i. 2. 19.
fuperficial, ii. i. 4. 5.
Parotitis, ii. 1.3.4-
Parturition, ii. i. i. 13. ii- i- 2. 16.
more fatal in high life,

ii i. i. 13-
with convuifion, iii. I.

1. iii i. i. 7.
difficult, i. 2. 2. 14.

Paflions.deprelling and exciting, iv«

3 i-5-

Paupertatis timor, m. i. a. 13.

Pediculus, i i- 4 15-

Pemphigus, ii. i. 3- <4-

Penetration of animal bodies, iv. i.
4. 7.

Peripneumony, n. i. 2. 4-

trachea!, ii. i. 2. 4-
fuperficial , ii- 1. 3 7-
inirritated,ii- 1- 2. 4.

Peritonitis, ii. I. i 8.

Perfpiration not an excrement, i- 1.

2. 14.

greatelt in the hot fit^

i. i. 2. 3.
fetid, i. i. 2. 14.
Pertuflis, ii. i. 3 8.
Peftis, ii. i. 3. 13-
Fetechiae, i- 2 i. 17.

cure of, Suppl. i. i. 7.
Pharynx, pain of, iv. 2. a. 5.
Phofphorus, ii. 2 2. 3.
JPhremtis, ii. i. 2. 3.
Phthilis, pulmonary, ii. i. 6. 7.
Piles, bleeding, i. 2. 1.6.

Pimples on the face, ii. 1.4. 6.
Pins fwallpwed, ii. i. 1.7.
Placenta, ii. i. i. 12. ii. i. a. 16.
PlagueT-iL-j . 3. 13.
Plalters, why moift,i. i. 3. 6.
Pleurify, ii. i. 2. 5.
Pleurodyne chronica, i. a. 4. 14.

rheumati^a.iv. 1.2. it.
Podagra, iv. i. a i5.*v a. 4. 9.
Polypus of the lungs, i, i. 3. 4.

of the nofe from worms,
, iv. i. 2. 9.

Pregna^icy, 11. i. i. 12.
Priapi/rnus, i. i. 4. 6. ii. i. 7. 9.
Proctalgia, i. 2. 4. 18.
Prolapius ani, i. 1/4. 9.
Pruritus, i. 1.5. 9.

narium a vermibus, iv. 2.

2. 6.
Pfbra, ii. i. 5. 6.

imaginaria, iii. i. a.aa.
Pterigion, ii. i. 4. a.
Ptyalifmus. See Salivatio.
Pubis and throat fympathize, iv. 1.

i. 7.
Puerperal fever, i. a. 4. 9. ii. i. 6.

16.

infanity, iii. i. a. i.
Pulchritudinis defiderium, iii. i. 2.-

12.

Pullulation of trees, iv. i. 4 3-
Pulie full, why, i. i. i. i.

ftrong,"how determined, i. i.

1. i. Suppl. i. 16. 10.

foft in vomiting, iv. a. i. 17*
intermittent, iv. 2. i. 18.
quick from paucity of blood*

Suppl. i. 11.4.
quick fbmetimes in fleep, iii,

2. 1. 12.

quick in vyeak people, iii. 1.1.

iii. a. i. Suppl. i. 11. 4.
flower by fwmging, iv. ^. i.

10.

quick in chlorous, i. i. 3. 10*
Punclae mucofae yulrus, i. a. a. 9.
Purging. See ETiarrhoea.
Pus dimirHfhed, i. a. a. 3.

di(tingui(hed from mucus, ii. i«
6.6.

R-

Ratiocinatio verbofa, iii. a. 2. 3-
Rabies, iii. i. a. 18.
Rachitis, i. 2. 2. 15.
Raucedo catarrhal, ii. i. 3. 5.
paralytic, iii. a. i. 5-
Reafoning, falle. iii. 2. 2. 3.
Recollection, lofs of, iii. 2. a. *.
Recti paralyiis,^ iii. 2. i. 7.
lcirrhus,*i. 2. 3. 33.
Red-gum, ii^ i. 3- la. J' 1- »• 3- .
Re

INDEX TO THE CLASSES.— PART It.

fuppi

kednefs from heat, ii. i. 7. 7.

of joy. ii. i. 7. 8.

after-dinner, iv. i. i. i.

of anger, iv. 2. 3. 5.

of guilt, iv. 2. 3. 6.

of modefty, iv. i. 3. 6.
Refpiration, ii. i. 1.2.

diuick in exercife, ii.

1. i. 3.

in foftnefs of bones, i.

2. 2. 14.

Reftleflnefs, iii. i. i. i.
Retroverfio uteri, i. 2. i. 14.
Reverie, iii. i. 2. 2. iv. 2. 4. 2.
Rhaphania, iii. i. 1.6.
Rheumatifm, iv. i. 2. 16.

of the joints, iv.i. 2. 16.
of the bowels, iv. i.

2. 16.
of the pleura, iv. i.

2. 16.
>u rating, iv. 1.2.

16.

from fympathy, iv. 2,

2. 13.

chronical, i. i. 3. 12.

iii. i. i. 6.
venefection in, iv. i.

2. l6.

Rickets, i. 2. 2. 15.
Ring-worm, ii. i. 5. 10.
Rifus, iii. i. i. 4. iv. 2. 3. 3.

fardonicus, iv*. i. 2. 4.

invitus, iv. i. 3. 3.
Jlubeola, ii. i. 3. 10.
Rubor a calore, ii. i. 7. 7.

jucunditatis, ii. i. 7. 8.

pranforum, iv. i. i. i.
Ruclus, i. 3. i. 2.
Kuminatio, i. 3. i. i. iv. 3. 3. i.

S.

Sailing in phthifis, ii. i. 6. 7.
Salivation warm, i. i. 2. 6.

lymphatic, i. 3. 2. 2.
fympathetic, iv. i. 2. 5.
in low fevers, i. i. 2. 6.
Salt of urine, i. i. 2. 4.'i. i. 3. 9.
Satyriafis, iii. i. 2. 16.
Scabies. See Pfora.
Scald-head, ii. i. 5. 11.
Scarlatina, ii. i. 3. 11.
Sciatica frigida,*i. 2. 4. 15.
.Scirrhus, i. 2.3. 22.

fuppurans, ii. 1.4. 14.
of the rectum, i. 2. 3. 23,
of the urethra, i. 2. 3. 24.
of the cefophagus, i. 2. 3.

25-
Scorbutus, i. 2.xi. 15.

fuppuraris, ii. I. 4. 14-
Scrofula, i. 2. 3. 21.
VOL. II, TTt

Sgrofula, fuppurating, ii. x. 4. 13.

produces inianity, iii. i. 2.
Scurf of the head, i. i. 3. 6.

of the tongue, i. 1.3. i.
Scurvy, i. 2. i. 15.

fuppurating, ii. i. 4. 14.
Sea-air in phthifis, ii. x. 6. 7.
Sea-fickneis, iv. 2. i. 10. Suppl. i.

8. 3-

Seat, defcent of, i. i. 4. 9.
Seed, ejection of, ii. i. i. n.
See-faw of old people, iii. 2, x. 2.
Senfation inert, Suppl. i, 6. 4.
Senfitive aflbciation, law of, iv. *•

2. 2.

Setons, ii. i. 6.
Shingles, ii. i. 5. 9.
Shoulder, pain of, iv. 2. 2- 9.
Shrieking, iii. i. i. 3.
Sicknefs, i. 2. 4. 4. i. 3. 2. 3.

cured by a blifler, iv. i.

«• 3-
by warm (kin, iv. x. 2, a,

Suppl. i. ii. 4.
by whirling, i. i. 1.4.
by fwinging, Suppl. i. 15*

by hydrocafbonate gasj

Suppl. 115.3.

See Naufea.
Sight acuter, i. i. 5. x.

impaired, i. 2. 5. 2.
Side, chronical pain of, i. 2. 4, 14.
Sighing and fobbing, iii. i. 2. 10.
Sitis calida, i. z. 4. i.
frigida, i. 2. 4- *•
detectiis, ii. 2. 2. 2.
Skin pale in old age, i. 2. 2. 2.

from cold, i- 2. 2. 2.
Skin dry, i. i 3. 6.

yellowifti, i. 2. 2- 2.
bluifli and flirunk, i. 2. i. 11
reddifh, ii. x. 3. i.
cold after meals, iv. 2, i. i.
Sleep, iii. 2. i.n.

interrupted, i. 2. i. 3-
periods in, iv 2. 4. i.
with quick pulfe, iii. 2. x. it.
difturbed by digeltion, iii. 2.

i. n.

Sleep-walkers, iii. i. x. 9.
Small-pox, ii. i. 3- 9-

\vhydiftin6t and conflu-
ent, Sup. i. 15. j.i. 16.8.
fecondary fever o

1.6* 12

eruption of, iv. T
Smarting, i. i. 5. 10.
Smell acuter, i j. 5. 3.

impaired, i. 2.
Sneezing, ii. 1.1.3. i
Snow iii forofula> \

INDEX TO THE CLASSES.— PART II.

S.now in paralyfis, iii. 2. j. 4.
Snutf iir hydrocephalus, i. 2. 3. 12.
Softnefs or bones, i. 2. 2. 14.
Somnanibulifm, iii. i. i. 9.
Somniumy ii. i, 7-4-
Somnus/iii. 2. i. 12. iv 2.4. i.
interruptus, i- 2. 1.3.
Spafm of diaphragm, iii- i. i. rr.

of the heart, iii. i. i. n.
Spine diltorted, i. 2 2. 16.

protuberant, i. 2. ^. 18.
bifid, i. 2. 2. 19.

Spitting blood, i. i. j. 4- i- 2 i- 9-
Spleen {welled, i. 2. 3. 18. Suppl.

i. 16. 6.

Spienitis, ii. 2. 2. 13.
tpots on the face, i. 2. 2. 9.

feen on bed-clothes, i. 2. 5. 3.
Squinting, i. 2. 5. 4.

in hydrocephalus, i. 2.

5 4.

Stammering, iv. 2. 3. i.
Stays tight, injurious, ii. i. i. 12.
Sterility, ii. 2.2. 4.
Sternutatio, ii. i. 1.3. iv. i. 2. a.
a lumine, iv. 2. i. a.
Stimulants, their twofold effeft, ii.

i. 2. 6.
injure weak people, i.

1.1. 3.

except the for-
bentia, i. i.
*• 3-
Stocks for children dangerous, ii.

a. 2. 17.

Stomach, torpor of,i.«. f i. Suppl.

i \^. i. 8. 10. i. 16. (5.

inflammation of, ii. i, 2.

10. ii. i. 3. 19.
its allbciation, iv. r. i.
caufe of fever, Suppl- i.

8. 8-

Stones in the bladder.. See Calculi,
in liorfes, i. i. 3. 5. i. i. 3.

10-

Strabifmus, i. 2. 5. 4.
Strangury, ii. i. i. 12 iv. 2. 2. 2.
convulfi.ve, iv. 2 2 3.
Strength and debility metaphors,!.

2 i.

Sttidor dentium, iii. i. r. 12.
Studium inane, iii, 1-2. 2. iv. 2. 4.

2.

Stultitia inirritabilis, i. 2. 5. r.

inrenfibili-s, ii. 2. i, i-
voluntaria, iii. 2. 2. 2.

Stupor, i. 2. 5. 10. Suppi. i. 15.

Si. ye, ii. i. 4- 4

Subfuluii. tendinum, iii. i. 1.5.

Sudor. See Sweats.

Suggefiion, flow, iv. 2. 3. 8.

Superannuation, iv 2, .3 b.

Surprife, i. 1.5. 12.
Sweats, warm, i. i. 2-3.
cold, i. 2. 3. 2.
lymphatic, i. 3. 2. 7.
althmatic, i. 3. a. S, iv. 3.

r. 2
covered in bed, iv. i. j. a,

Suppl. i. ii* 6.
of the brows, i. i. 2. 3.
in fever fits, why, i. i . 2- 5.
from exercife, i i. a. 3.
from heat, i. i. a. 3.
from medicines, i i. 2. 3.
Sweaty hanHs cured, i. 3. ^. 7.
Swinging, ii. i 6 7.

makes the pulfe flower,

iv. 2. i. 10.
Swing centrifugal, Suppl. i. 15.

and 3.

Symbols of ideas, iv. 2. 3. 8.
Sympathy direct and reverfe,iv. i.

i F.

•with others, iii. i. a. 24.
of various parts, Suppl.

i. i». 5-

reverfe of lacleals and
lymphatics, Suppl. i.
H 5.
of capillaries, Suppl. i.

n. 5.
direcl: of ftoraach and

heart, Sup. i. 1 1. 5.
how to deftroy, iv. a. a.

8-
of throat and pubis, iv..

Syncope, i. 2. r. 4

epileptic, iii. 2- i. 15-
Syngultus, ii. i. i. 6.

nephriticus, iv. i. i. 7.
Syphilis, ii. 1.5. 2.
Syphilis imaginaria, iii. i. 2. ^^.
Syphon capillary of cloth, ii. 1-3. i.

T.

Taclus acrior, i 5. 5.

imminutus, 1.2.^. 6.
Taedium vitae, ii. 2. i. 2. ni. i, 2- 11.

iii. 2. t. 8.
Taenia, i. i. 4. n.
Tape-worm, T. 4. i. r.
Tapping at the navel, i. 2. 3. 13.
Tarditas fenilis, iv. ^. 3. 8.

paralytica, iv. 2. 3. 7.
Tarfitis, ii 1.4 3.
Taftc. See Gufhts.

bitter, not from bile, i. r.

Tears fympathetic, iv. i, 2. i,iii.i,

i. 10
Teeth, to preferve, i. i. 4. 5.

fall out whole, ii i 4-7-
Teneimus,

INDEX TO THE CLASSES.-PART II.

Tenefmus, ii. i. i. n.

calculofus, iv. i. a. 8.
Tedium dolor nephriticus, iv. a. a.
n.

tumor in gonnorrhcca, iv.

i. 2. 18.
tumor in parotide, iv. i.

i. 19.
Tetanus trifmus, Hi. i. i. 13.

doloriticus, iii- i. i 14.
Thirft. See Sitis and Adipfia.
Thread-worm, i, i. 4. 12.
Throat fwelled, i. a. 3. 20.

thickens at puberty, iv. a,

1.7.

grown up, i. a. 3. 25.
Thiufl), ii i. 3- 17.
Tic doloureux, i. a. 4. 12.
Tickling, i. i. 5. 8.
Timor orci, iii. t- 2. 15.
lethi, iii. i. 2, 14-
paupertatis, iii. i. 2. 13.
Tinea, ii 1.5. n»
Tinnitus aurium, iv. x. i. 15.
Titillatio, i- i. 5 8.
Titubatio linguae, iv. a- 3. i.
Tobacco, fmoke of in piles, i. a. i.

6.

Tongue dry, i. 1.3. i. Suppl. i. 2.
coloured mucus, i. i. 3. ».
Tonfillitis, ii. i. 3. 3.
Tonfils fwelled from bad teeth, i.

2. 3. 21. ii. i. 3. 3.
Tooth-ach, i. 2. 4. la. n. i. 4, 7.
Tooth-edge, iv. i. 2. 3.
Toothing, i. i. 4. 5.
Tooth-powder, i. i. 4. 5.
Torpor of the liver, i. i. a. 6,

of the pancreas, i. a. a. 7.
of the lungs, Suppl. 1.9.
of the flomach, Suppl. i. 10.
of the heart, 6uppl. i. 10-
Touch. See I actus.

deceived three ways,!, a.

5.9. iv. 2. i. 10.
Transfufion of blood, i. 2. 3. 25.

Suppl. i. 14- 4-

Translation of matter, i 3. 2 9.
of milk, i 3 2. 10.
of urine, i. 3. a. u.
Tranfparency of cornea, i. i. 4. i.
of cryftalline, i. a. a.

13-
of air before rain, i.

i. 4. i.

Tremor of old age. iii a. i. 3.
of fever, iii. i. i. 2.
of anger, iv. 3. i. 4.
of fear, iv. i a. 5.
Tricks of the face, iii. i. 1.5. iv. i,

3 2
Trifmus, iii. i. i, 13.

Trifmus, dolorificus, i. a. 4. u.
Twitching^ of the face, iv. i. 3. a.
Tuilis ebriorum, ii. i. 1.5.

convulfiva, ii. i. 3. 8.

hepatica, iy. 2. x. 8.

arthritica, iv. a. 1.9.

periodic*, iy. 3. 4. a.

a pedibus frigidis, iv. a. I. 7,
Tympany, i. a. 4. 9.
Typhus, i. a. »• I. ii. i. 3. |,

U.

Ulcers, healing of, i. 1.3. 13.
of the cornea, i. 1.3. 14.
from burns, i. 1.3. 13.
fcrofulous, ii i. 4. 13,
of the throat, ii. i. 3. 3. H.

i. 3- u.

of the legs, ii. i. 4. 14.
Unguium morfiuncula, iv. i. 3. 5.
Urethra, fcirrhus of, i. a. 3. a4-

riftula of, ii. i. 4. n.
Urine, copious, coloured, i. i. a. 4.
copious, pale, i. 2. 3. $.
diminished, coloured,!. 1.3,

diminifhed, pale, i. 2.2.5.
its mucus, falts, Pruifian

blue, i. *. 2. 4.
why lefs and coloured in

dropfies, i. i. 3. 7.
tranflation of, i. 3. a. n.
difficulty of, iii. 2. i. 6.
. not fecreted,i. 2. 2. 8.
pale after meals, iv. a. x. a.
pale from cold (kin, iv. 2, r.

fediment in fevers, Suppl. i.

2. 3.
pale in fevers, Suppl. i. 2.3.

and 5.

Urticaria, ii. i. 3. 16.
Uteri defcenfus, i. 1.4. 8.
retroverfio, i. a. i. 14.

V.

Varix, i. 2. i. 19.
Vacillatio feniiis, iii. 2. i. 2.
Varicella, ii. i. 3. 15.
Variola, ii i. 3. 9.

eruption of, iv- 2. i. 12.
Vaforuincapil. retrogreilio, i. 3 3.1.
Venereal orgafm, iv. i. 4. 4.
difeafe, ii. i. 5. 2.
imaginary, iii. i. 2. ai.
Ventriculi aegritudo, i. 2. 4. 4.

veficatorio fan-
ata, iv. i. i.

Vermes, i. 1.4. 10,
Vertigo rotatory, iv. 2. r. 10,
of ('ght, iv. a, i. r/.

Vertigo

524

INDEX TO THE CLASSES.— PART II.

Vertigo inebriate, iv. 2. i. 12.
of fever, iv. a. i. 13.
from the brain, iv. 2. 1. 14»
©f the ears, iv. 2. 1.15.
of the touch, tafte and

finell, iv. 2. i. 16.
with vomiting, iv. 2. 3. 2.
produces flow pulfe, iv. *•

1. io.

of blind men, iv- 2. i. io.
life of mercurials in it, iv.

2. i. ii.

Vibices, i. 2, i- 16- Suppl. i. 2. 7.
Vigilia, iii. i. 2 3. iv. i. 3. 6.
Vinegar in petechiae, i. 2. r. 17.

in fcarlet fever, ii. i. 3. ii«
Vifion acuter, i. i. 5. i.

diminished, i. 2. 5. 2.
expends much fenforial pow-
er, i. 2. 5. 3.
Vita oyi, iv. i. 4. j.

hiemi-dormientium, iv. i. 4-

2.

Vitus's dance, iv. 2. 3. 2.
Volition, three degrees of, iii. *• i.

12.

leflens fever, iii. 2. i. 12.

Suppl. i. ii. 6.
produced fever, iii. 2. 1. 12.
without deliberation, iii.

i. i. iv. i. 3. 2.
Vomica, ii. i« 6. 3.
Vomitus, i. 3. i. 4.
Vomendi conamen inane, i. 3. i. 8.
Vomiting (lopped, iv. i. i. 3. iv. i.

i. F.

voluntary, iv. 3. 3-2.
how acquired, iv. i. i.

c. F.

vertiginous, iv. 3. 2. 3.
from (tone in ureter, iv.
3.2.4,

Wh'i

Vomiting from paralytic ftroke, iv,

3- 2. 5.
from tickling the throat,

iv.3. 2. 6.
fympathifes with the

fkin, iv. 3. 2. 7.
in haemaptoe, i. i. 1.4.
from defecto^aflbciation,

iv. 2. i. io.
Vulnerum cicatrix, i. 1.3. 13.

W.

Watch f ul nefs, iii. i. *. 3. iv. 3. 2. 5.
Water-qualm, i. 3. i. 3.
Weaknefs, three kinds of, i. 2. i.
Whirling-chair, Suppl. i. 15. 3.
Whirling-bed, Suppl. i. 15. 7. i. 2

lite fwelling of the knee, i. 2. 3.

ICj.

Whitlow, fuperficial, ii. i. 4. 5.

internal, ii. i. 2. 19.
Wine in fevers, ii. i.3.i.iv. 2. i. u.
Winking, ii. i. 1.8. i. i. 4, i. iv. 3.

2. 2.

Winter-fleeping animals, iv. 1,4.2-
Womb, defcent of, i. i. 4. 8.

retroverfion of, i. 2. 1. 14.
inflammation of, ii, i. 8. 16,
Worms, i. i. 4. io.

mucus counterfeits, i. x,

. 3- 4-

in Iheep, i. i. 4. io.
Wounds, healing of, i. i. $• 13-

y.

Yawning, ii. i. i. 9.
Yaws, ii. i. 5. 5.

Z.

Zona ignea, ii. i. 5. 9. iv. i. 2. si.
ii. x. a. 14.

r

:m.

n*W