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^V ItGE DKDERWOOD. 


1 ^1^ m 



THB 

STUDY OF MEDICINE. 

BY JOHN MASON GOOD, 

H.D. F.R.K. r.R.S.L. 

MBL AM. nm. 80C ANDKi.a. or rHiLAOELnuA. 



COKrAnnMo all 
THE AUTHOR'S FINAI, CORRECTIONS AND ISIPROVEMENTS. 



€fiiv^ laltUion, 



MUCH ADDITIONAL MODF.RN mFORMATtON OK PITVaiOLOOT, 
PRACTICE, PATHOLOGY, AND THE NATURE OP DISEASES IN 
GENKK-U.. 



BY SAMUEL COOPER, 

airHcEOy TO TKIXINC'S BENCH AHl>ri.EI^!'ll[«OM«;RVlUlEnN TOTIlTFOIU'Elt 
ALiTHOK or TUH l>UTim*llV or rUAtTICAL ■liBt^KKVl IIOKOllARI FKLLOW 

or Tus AL-ADUfY or natukal kikkcrb at gataioa ; (ku. &c. 



« 
> 



JN FJVK VOLUMES. 
VOL. I. 



LONDON : 
TilOMAS AND GEORRE UNDERWOOD, 

fLKXT-STKKKT, 

1829 ^ 



uj 



t. 





LONDON! 

PaiKTID Ur TUOMAI DATUDK, WUlIZrKIAM*. 



TO 

SIR HENRY HALTORD, BART. 

M.D. F.R.S. F.A.5. 

PRESIDENT OF THE ROYAL COLLEGE OF FHYSICIAH8 OF 
LONDON, 

PHYSICUN TO THE KlNGj 

THIS WORK 
II 

INHCRIBEU 

■■ 

A TRIBUTE OF GRATITUDE AND FRIENDSHIP. 

AUGVMT Tl, NDCCCXXll. 




ADVERTISEMENT 



TO TBB 



H 



THIRD EDITION. 



When the learned and vcr}' distinguished autiior 
of die " Study of Medicine," much to the regret 
of every lover of lalent and worth, went to that 
bourn from which no traveller returns, he had 
already advanced a considerable way in prepara- 
tions for the present edition. This was so mucJi 
the case, that he had revised all the live volumes, 
and introduced into them a great number of ob- 
servations tending to augment their utility and 
correctness. Various parts of the work, however, 
still demanded further attention, and none more so 
than iU surgical articles. The autlior's bad health 
had, indeed, materially interfered with his laud- 
able and anxious wish to bring the corrections 
down to the btest period, and to omit nothing that 
was new, and, at the same time, truly valuable. 

In the bumble attempt which I have made to 
improve a work, already honoured with extensive 
approbation and high reputation, my chief fear has 



^ 



VI 



ADVERTISEMENT. 



been tliat of exceeding the bounds within which 
every discreet editor ought to confine himself. On 
this account, I have not presumed to encroach 
much upon the author's plan, which, whatever may 
be the defects in its execution, rests upon a solid 
foundation, and has the pleasing recommendation 
of originality. But although, with few exceptions, 
the arrangement of the subject* treated of has not 
been changed, I have sometimes ventured to ex- 
press reasons for thinking some of them misplaced. 
WitJi tltc same frankness, I have also stated the 
considerations, which liave now and then inclined 
rae not to adopt precisely the \new8 entertained by 
the author on certain points in physiology, patho- 
log}', and the U'eatment of diseases. As far as my 
knowledge extends, no celebrated writers on me- 
dicine have yet been able completely to avoid hy- 
pothesis i and, if the pre<wnt author occasionally 
soar into the regions of conjecture, he has only 
imitated all the greatest of his predecessors. For 
such flights, every man conscious of the difficulties 
of medical science, and aware of the zeal, per- 
severance, and active mind of the late Dr. Good, 
will readily find an cxcu.sc. If the general tenor of 
his book be good; if, indeed (what seems to me 
to he the fact), it be so excellent, that no other 
modera system is, on tlie whole, half so valuaUe 



AOVEBTISEMENT. Vll 

as the " Study of Medicine," its imperfections will 
be indulgently disregarded by every liberal critic, 
and its genuine merit warmly admired. 

In closing this short address, it is proper to 
mention, that the new matter, which I have taken 
the liberty to incorporate in the text, is marked 
in such a manner, that the reader will immediately 
perceive the passages, for which my own cha- 
racter, and not that of Dr. Good, is responsible. 
The notes now introduced have the word " Editor" 
annexed to them. 

S. COOPER. 



71, Great RHueU-ttrcel, 
BlaoKubuT!/, 



PREFACE 



TO 



THE FIRST EDITION. 



The object of the present work is to unite the 
difterent branches of medical science, wbicli, wlieii 
carried to any considerable extent, have hitherto, 
by most writers, been treated of separately, into a 
general system, so that tlie whole may be contem- 
plated under a single view, and pursued under a 
common study. These branches are the following : 

I. Physiology, or the doctrine of the natural 
action of the living principle. 
II. Pathology, or the doctrine of its morbid 
action. 

III. Nosology, or the doctrine of the classifica- 

tion of diseases. 

IV. Therapeutics, or the doctrine of their 

treatment and cure. 

All these are of high, if not of equal, importance. 
As it is impossible for a workman to set about re- 
storing a machine to order, with any rational hope 
of success, without knowing the full extent and 



^ 



PIIEFACE. 

nature of tJie injury it has sustained, so is it 
equally im|K>ssiblc for him to acquire this know- 
ledge, unless he ha.s aUo a knowledge of the struc- 
ture of the machine, and has studied its several 
parts methodically, and in reference to the bearing 
which one part has upon another. 

It is this ad\'antage of the study of one part in 
relation to another that constitutes, or should con- 
stitute, in the art of medicine, the basts of noso- 
logical arrangement; for by grouping diseases, 
not arbitrarily, but in the order of connexion in 
which tlicy make their appearance in different 
functions, and tJie organs on which those func- 
tions depend, it iii almost impossible to obtain 
an intiight into tlie nature of any one disease he- 
longing to Riich groups, without obtaining some 
insight into the nature of the rest, or tracing out 
some of the laws of morbid action which are com- 
mon to the whole. 

If it Im- convenient to concentrate the diseases 
of the nervous department into one division, as 
has been attempted by many nosologists, and ably 
accomplished by Dr. Cullen, it is to be tamcntetl 
that the same principle has not been allowed to 
pervade the whole of the nosological plan; and 
that the diseases of the other chief departments of 
the animal frame have not been concentrated in 
the same way, instead of being scattered, as we 
too often lind tJicm, over different divisions of a 
classification that is itself peqictually nhifling from 
one ground of arrangement to another : which in 
one division, m in the Synopsis of Dr. CuUen, by 



I'llKPACE. 



XI 



far the best of his Huy, is derived from the tem- 
perature of the body} in a second, from its ana- 
tomical structure j in a third, from its chemical 
depranties ; and in a fourth, from its topography; 
thus offering us in each division a new principle, 
and one that lias no common clew, or analogy with 
tiic rc-it. 

It was the hope of obtaining a clearer and more 
connected metliod than hod hitherto been studied 
in tlie schools of medicine, tliat induced the present 
author to turn his attention to this subject many 
years ago, and at length enabled him to submit to 
tJie public a System of Nosology founded entirely 
on a physiological basis, in which the diseases of 
the respective functions of the animal frame are 
connected in classes derived from those functions, 
and follow each other in the order in which physio- 
logists have usually treated of them. 

It was not, however, from a mere hope of ob- 
taining a more exact and comprehensive synopsis 
of diseases that tJie author was induced to under- 
take this new arrangement, but witli a view of em- 
ploying it as a text-book for the collateral branches 
of the Art of Healing already adverted to, as soon 
as be should find leisure to enter upon them, and 
to which no other synopsis be was acquainted with 
seemed equally adapted. 

This work was published in the beginning rf 
I8I7, under the title of a "Physiological System 
of Nosology, with a correctetl and simplified No- 
menclature;" and the favourable opinion which 
has been forme<l of it -, its adoption as a text-book 




xii 



PREPACC. 



in various medical schools of high reptitition in 
our own country, und on tJic Continent ; the ap- 
pUcation which lias been made to the author hy 
some of the oldest and most established lecturers of 
this metropolis to print a syllabus of its classiiica- 
lion for the purpose of lecturing from; and. above 
all, the approbation which the Royal College of 
Physicians has bestowed upon it, by permitting it 
to be dcdicatetl to tliat learned body, aHet having 
been circulated amidst the Fellows of the College, 
under an express order of the late President, for 
an examination of its contents by every individual 
at his own house, are, he trusts, a sufficient apology 
for his adhering to his original intention, and taking 
this system, instead of any other, as the ground- 
work of the ensuing arrangement. 

It is not necessary in the present j)lace to enter 
into a minute explanation of the subordinate parts 
of this HyNtcm, nor of tlic occasional changes in 
medical nomenclature which are to be found in 
it; and which a close attention to correctness 
and simplicity seemed to render indispensable. 
All these are fully illustrated in the Preliminary 
I)isscrtati<m to the volume of Nosology, which 
the author 'm desirous of having regarded as a 
part of the general design. An alteratiou in the 
distribution of one or two of the diseases, as 
originally laid down, may be noticed by an atten- 
tive eye in the present volumes. They arc changes 
which have Iwcn made out of deference to the 
opinions of others, or from a maturer consideration 
of tJio subject by the author himself: but, upon 



PREFACE. 



xia 



, the whole, they arc too lew nnit of too little im- 
portance to render it necessary to indicate them 
in the present place. 

A pretty active spirit of puysiolooy will be 

I found to pervade the entire work ; but the author 
has, beyond this, availed himself of the advantage 
which his arrangement so readily allows, of i)re. 
fixing to every class a summary of the most im- 

Iportant laws and interesting discoveries of physio- 
logy that relate to, or can elucidate, the subjects 
which constitute its scope. And he lian occa- 
sionally enriched the dissertation by a glance at 
tlie more striking analogies of the animal and even 
of the v^etable world at large, wherever they 
could add to the illustration. 

In the PATHOLOGICAL DEPAKTMENT, if the reader 

'meet with an occasional development of new prin- 

! cipies, a question as to several that have been long 
before the public, or a further uxtension of many 
that are well established, the author trusts that 
whatever doctrines are advanced ^^dll, at least, 
be found true to themselves, and form a digested 
Bystem, operating in accordance tlirough the entJre 
work, in what way soe\'er they may be affected by 
future investigations. He trusts it will also be 
found, that nothing is newly started for the mere 
sake of novelty, or controverted from a mere love 
of disputation : and that, whenever it ha-i been his 
misfortune to differ from high autltorities which 
have preceded him, he has done it with tlie candour 
which should peculiarly characterize a liberal pro- 
fcsJiion. His main object has been to explain to 



i 



lUV 



PRCFACE. 



the Student the difTerent subjects tliat pass before 
him, and to illustrate them by unologies, instead 
of confining liinisvlftu a dry and vvearisonie history 
of morbid symptoms and operations. 

In THERAPEUTICS the author has allowed himself 
a liberal range, and has, occasionally, introduced 
into his Materia Mcdica, substances tliat are highly 
esteemed abroad, though little valued or even 
known at home, or that seem, without reason, to 
have fellen into temporarj' disrepute. There are 
some practitioners who think that all the articles 
which arc of real use in the cure of diseases lie 
within a small compass, and may be learnt without 
burlliening the memory. This remark may be 
allowed io those who are limited to a portable 
dispensary, as in travelling, or on shipboard ; but 
when uttered under other circumstances, it savours 
less of wisdom, than of indolence. If the pharma- 
copoeias of former times were too voluminous, and 
were occasionally loadcil with medicines of trifling 
Importance, the lopping and topping that must 
hereupon ensue would make a destructive inroad 
upon their boundaries, and take from them much 
ttiat is good as well as something that can be spared. 
We may easily, indeed, substitute one medicine 
for another, but it is very rarely that we can hereby 
obtain an integral representative ; a remedy, pos- 
sessing not only the general but tlie particular 
qualities of that whose place is supplied, so as to 
be equally adapted to the exact state of the disease 
or the express chanicter of the idiosyncrasy. Sir 
Geoi^e Baker was engaged as rcuyunably and scieu- 




PREFACE. 

Ufically in examining into the virtues of the car- 
damiiie pratensis, or Iwiy's smock, as Dr. Stoerck 
in proving, upon his own person, the violent powers 
of colchicum and .stramonium. A common fate 
ha.s, indeed, attended the whole of these expert- 
rocnts. From attracting and concentrating the 
attention of the public, the medicines to which 
they were directed became equally overvalued; 
were employed upon all occasions j produced fre- 
quent disapiwintment ; and gi'adtially fell into dis- 
use. The colchicum has been fortunate enough to 
ascend once more to its full zenith of popularity; 
many efforts have been made on behalf of the stra- 
monium ; and the cardamine, though at present less 
successful tlian cither of the othoni, still liolds in 
abeyance its post in the established pharm.ncopoeias, 
waiting for some lucky trial to bring it once more 
into general esteem. 

A work, erected upon scientific principles, should 
know nothing of these accidental reverses, and still 
lesfl of tlie varying and too oflen capricious taste 
of the day. To judge by the sentiments of some 
writers, the reputation of the bark seems at pre- 
sent on the wane, while the seeds of the croton 
tiglium, after a long neglect, are again rising into 
notice. In the remedial part of the present work, 
the author has endeavoured to allow to every me- 
dicine its proper value, as far as he has been able 
to estimate it, whatever may have been the era of 
its credit ; and as there can be no stronger ground 
for the study of botany, orjxtology, or chemistry, 
than the advantage they afford to the art of heal- 



^ 



XVI 



PREFACe. 



ing, and as these are provinces cultivated in our 
own day by almost every one, be ]ias fult himself 
called upon by the general voice of the times to 
range with some latitude over the medicinal stores 
afforded by art and nature, and to discriminate the 
respective properties of each, rather than to limit 
himself to a few leading productions^ or to refer to 
the whole under the general divisions of stimu- 
lants, sedatives, and cathartics, or whatever other 
names may serve for a medicinal cliuisification. 

It is this, indeetl, that after alt mii^t chiefly con- 
stitute the Thkhai'ia, or Pmactice op Medicine, 
to which every tiling else, though of the utmost 
moment, is but introductory. "The First Lines" 
of Dr. Cullen, when read, as they were delivered, 
in connexion witJi his " Treatise on the Materia 
Medica," constitute the most important course of 
instruction tliat has ever, perhaps, been laid down 
and completed by the same individual. But, for 
tliis purpose, they must be read together, though 
they were not published together, nor for the ex- 
press design of forming a contemporaneous study: 
for it is a singular fact, that tlte First Lines of the 
Practice of Physic, though full lM)th of mind and 
of matter, of clalioratc axioms and theoretical prin- 
ciples, contain Uttle of what the title suggest^; 
while the Treatise on the Materia Medica, without 
making any pretensions to the subject, in altoge- 
ther a practical work, replete w*itii practical princi- 
ples, and founded u{>on a practical investigation. 

Whatever may be the theory or the practice ad- 
vanced in lite ensuing volumes, the author will go> 




fREfACR. 



nerally be found to leave nothing upon trust ; but 
to support or illustrate his assertions by autJiori- 
ttes which he has endeavoured to give, with some 
degree of copiotisnct>-i, fi-oni ancient as well as mo> 
dern times : so as to render tlie work ir> a certain 
sense a summary of the general history of medicine 
in most agci and countries. 

To tlje labours of our own countrymen, how- 
ever, he professes to be chiefly indebted for his 
supplies : to the illustrious dead and to the illus- 
trious living : to all of whom he has conscientiously 
cndeavouFL'd to do justice, even where he Ikik been 
under the misfortune of differing from any of them 
in opinion. Willi the former he can have no con- 
troversy; and, with the latter, he has taken the 
most gratifying means of avoiding it, and at the 
same time of adding considerably to the value of 
liiB work, by submitting to the most distinguished 
of tliem, and especially to those witli whom he has 
the honour of a personal acquaintance, the suc- 
cessive sheets of the woi'k, while passing through 
the press, that contain a notice of their respec- 
tive opinions or publications; with a request that 
tliey would correct any incidental mis-statement, 
or communicate any valuable hint that may since 
Iiave occurred to tJiem on the subject. It would 
occupy too much space to enumerate ail the indi- 
viduals to whom the author has been indebted for 
asKiatance of this kind : but there are several whose 
names the pubUc ought to be made acquainted 
with, as adding, in no ordinary degree, to the au- 
thority of the work itself. 

VOL. I. b 




xvut 



FRCFACE. 



He lias, in the Brst place, to return his very 
grateful thanks to the President of the Koyat Col- 
lege of Physicians, without whose fostering en- 
couragement his health and strength, considerably 
encroached upon by the laborious and unremitring 
study with which it has been necessary to prose- 
cute the subject, would liardly have held out to its 
close; and who has not only taken the trouble of 
examining the sheets that relate to his own valua- 
ble labours, but uf watching the progress of the 
work generally, and of perusing many parts of it 
as they have issue<I from tlic press. He ha^ next 
to offer his acknowledgments to his highly distin- 
guished and venerable friend Dr. Perceval, of Dub* 
Un; who has been so kind as to favour himwitli a 
valuable manuscript series of notes, in the form of 
a running commentary, upon the entire volume of 
Nosology-, in illustration of its definitions or opi- 
nions; the whole of which will be found embodied 
into the present work, with a reference to the real 
author in every instance. To the liberality of Sir 
James M'Grigor he is indebted for importimt as- 
sistance on several occasions, and particularly for 
his munificent offer of a free and facilitated access 
to all the medical documents of the army, ad* 
dresse<l to him as Director-General. To his kind 
friend, Sir John Webb, he U also largely indebted 
for similar assistance from the Ordnance Depart- 
ment, and |Mirticularly in respect to the subject of 
plague, upon which he has proved himself 
so perfectly conversant. The kindness of Dr. 
can never be erased from tlie autlior's memory 



bject of H 
If to be M 
r. BaiUie ■ 
[iemory» ^^H 



PREFACK. 



XIX 



but he lias particularly to thank liim on the pre- 
sent occaaion for reviewing the article on s{Hismo- 
dic stricture of the rectum as well as several 
others, which, without his previous labours, would 
not ]>erhapK have been found in the pre^nt work, 
or have been found but very imperfectly. To Dr. 
Latliam he u> under obligation!; on various accounts; 
but, in the present work, he Is especially indebted 
to him for his friendly revision of the article pti- 
mria meUita, or diabetet. The volumes will dis- 
play abundant instances in which he has derived 
assistance from the comprehensive mind of Sir 
Gilbert Blane, but the friendliness witJi which he 
has consented to furnish him witli a description of 
his own case, in a very singular and obstinate at> 
tack of prurigo, and to revise the statement when 
printed, demands an especial acknowledgment. 
To Dr. Bree the author is indebted for perusing 
the article on asthma, and his very liberal opinion 
on the same. To Dr. Young for a like attention 
to tliat on phthisis, and the vaUiable hints with 
which his opinion was accompanied. To Dr. 
Cooke, whoNe friendship he has experienced in 
many important instances, he is under a similar 
obligation for perusing, and, in a few instances, 
correcting the account of apoplexy and palsy: and 
to his excellent and judicious friend Dr. James 
Johnson, for various hints concerning tropical dts< 
' eases, and a perusal of some parts of the present 
volumes in which they are treated of. 

The author has entered with a considerable 
dcfp'ce of fulness into the different modificjUions 

A 2 



XX 



PHBPACE. 



of diseases, in order to adapt the work to foreign 
climates and stations as well as to domestic prac- 
tice: for a system of medicine, to be complete, 
should be of miiversal application. To render it 
«ucb, however, it is seldom necessary to (\o more 
than follow up the common diseases of a country 
into their respective varieties : for the general 
laws of the morbid action of the living principle 
are as permanent and universal as those of its 
natural action, and a really new species of disease 
is, perhaps, as much a phenomenon as a really 
new species of plant or animal. We see all these 
infinitely diversified by accidental circumstances, 
and particularly the circumstances of habit and 
climate ; but the specific outlines are still pro- 
served, and we are still capable of reducing them, 
under every disguise, to their proper relations, and 
of assigning them their proper posts. From a 
fevf nondescript skeletons occasionally found in 
the bowels of the earth, and particularly from the 
interesting museum of such established by M. 
Cuvier at Paris, we have reason to believe that a 
few species of animals have totally disappeiired ; 
as we have also, from the classifications of recent 
naturalists compared with thosi; of earlier times, 
that a few species are now in being which bad no 
existence in remote ages. And in like manner, 
whilst a few species of diseases arc now no longer 
to be found which are descrilicd by earlier writers, 
a few seem to have supplied their place, which are 
comparatively of modern origin. Yet, upon the 
whole, the march of nature is but little interfered 



PKUPACE. 



XXI 



with in either case ; and hence the prognostics and 
aphorisms of Hippocrates, the medical histories of 
Aretieus and Galen, of Rhazes and Avicenna, and 
the natural histories of Aristotle and Pliny, are 
transcripts of animal life in our own day, as well 
as in the times in wliich they were severally com- 
posed ; and form important ^nhjects of modern as 
it is well known they did of ancient study. The 
extensive family of fevers and spasmodic affections 
are, in tlie main, the same now as they are repre- 
senteil in tlie most ancient writings that have de* 
scended to us ; the plague of Athens, a-s described 
by 'I'luicydides, we skill find in the ensuing pages 
to be the prototype of what still occasionally takes 
place in Kgypt and along the Barbary coast ; and 
even the leprosy of tlie Levitical law, so minutely 
described by Moses, will be found, when the 
passage is closely and accurately rendered, still to 
retain its hold in the K;tst, and to exhibit even the 
very same modifications as are noticed by the 
Hebrew legislator, and have been intermediately 
assigned to it by Celsiis. 



J 



TABLE 



or 



CLASSIFICATION. 



CLASS I. CCELIACA. 

DISEASES OF THE DIGESTIVt FUNCTION. 

ORD. I. ENTERICA. 

AFFECTING THE ALIMENTARY CANAL. 

GEN. I. ODONTIA. 

MISDENTITJON. 

SPEC. 1. O. DENTITIONI& 

Teething. 

S. DOLOROSA. 

Tooth-aehe. 

3. STUPOR18. 

Tooth-edge. 

4. DEPORMIS. 

D^ormity of the Teeth. 

5. EDENTULA. 

Toothlettneu, 

6. INCRUBTANS. 

Tartar of the Teeth. 

7. EXCRESCEN& 

Excretcenl Gtimt. 



XXIV TABLE OF CLASSIFICATION. 

CLASS I. CCELIACA. 

ORD. I. ENTERICA. 

OBN. II. PTYALISMUS. 
PTYALISM. 

SPEC.1. P.ACUTUB. 

Stdivation. 

S. INER& 

DrivdUng, 

III. DYSPHAGIA. 

DYSPHAGY. 

BPEC. 1. D. CON8TRICTA. 

Conalrictive Dt/tpkagy. 

8. ATONICA. 

Atonic Dyiphagy. 

3. OLOBOSA. 

Nervous Qyinty. 

♦. UVUL08A. 

Uvular Dytphagjf. 

S. LINOUOSA. 

Lingual Dytphagy. 

IV. DIPSOSIS. 

MORBID THIRST. 

ISPEC. 1. D.AVBN8. 

Immoderate Thirtt. 

S. EXPERB. 

Thirsllcstnest. 



TABLE OF CLASSIFICATION. XXV 

CLASS I. CCELIACA. 

ORD. I. ENTERICA. 

GEN. V. UM09IS. 

MORBID APPETITE. 

SPEC. I. L. A YENS. 

Voracily. 

5. BXPERS. 

Long Fatting. 

3. PICA. 

Depraved Appetite. 

4. CAADIALGIA. 

Heart-bum. fVattr4>Tath, 
Cardialgy. 

«. FLATUS. 

FUUuUneg. 

6. EMESIS. 

Stctnett. Fomiting. 

7. DYSPEPSIA. 

Indigeilion, 

VI. COLICA. 
COLIC. 

SPEC. 1. C. ILEUS. 

Tleac Pattion. 

5. RHACHIALGIA. 

Coiic of PoU<m. 
Painter't CoUc. 

3. CIBABIA. 

Surfeit. 

4. FLATULBNTA. 

fVind-Colic. 

6. CON8TIPATA 

Coiutipated Colic. 

C CONSTBICTA. 

Contlriclive Colic. 



XXVI TABLE OF CLASSIFICATION. 

CLASS I. C(ELIACA. 

ORD. I. ENTERICA. 

GEN. VII. COPBOSTASIS. 

COSTiyENESS. 

SPEC. I. C. OONSTIPATA. 

CoHttipation. 

9. OB8TIPATA. 
Obitipaiion. 

VIII. DIARRHCEA. 

LOOSENESS. 

SPEC. 1. D. FUSA. 

Feculent Looatneu. 

S. BILI08A. 

BilioMa Looitntm, 

3. MffCOSA. 

Mttcmig LoQstnest, 

4. ALBA. 

WlUte Lowaieu- 

5. LIENTERIA. 

Lientery. 

6. SEROSA. 

SeroHS Looeeneu. 

7. TUBULARIS. 

Tubular Looeenttt. 

IX. CHOLERA. 

CHOLERA. 

SPEC. 1. C. BILI03A. 

Bilioui Cholera. 

9. FLATULENTA. 
Wind CkoUra. 

3. &PASMODICA. 

Spatmodie Cholera. 



TABLE OF CLASSIFICATION. XXVU 

CLASS I. CCELIACA. 

ORD. I. ENTERICA. 

OEN. X. ENTER0UTHU8. 

INTESTINAL CONCRETIONS. 



SPEC. 1. 


£. BEZOAKDUS. 




Beioar. 


» 


CALCULUS. 




Intestinal Calevlvt. 


3. 


8CYBALUM. 




Seybalum. 


XI. HELMINTHIA. 




WORMS. 


SPEC 1. 


H. ALVI. 




Alvuu Worms. 


a. 


PODICIS. 




Anal WoTDu. 


3. 


ERR4T1CA. 




Erratic Wonu. 


XII. PROCTICA. 




PROCTICA. 


8P£C. 1. 


P. SPABMODICA. 




Spatmodic Stricture of lie 




Recltmt, 


S. 


CALLOSA. 




Calloui Stricture of the 




Rectum. 


3. 


TENRHMUS. 




Tenemut. 


«. 


MARISCA. 




PiUs. 


i. 


KXANIA. 




Protapte of the FuHdameni. 



XXVIU TABLE OF CLASSIFICATION. 

CLASS I. CCELIACA. 

ORD. II. SPLANCHNICA. 

AFFRCTINQ TUB COLL ATI TIOUS VISCERA. 

GEN. I. ICTERUS. 

YELLOW JAUNDICE. 

SPEC. I. I. CHOUEUS. 

Biliary JauKiUee. 

S. CHOLOLITHICUB. 

GallsKme Jmudice. 

3. 8Pj«MODICUa 

Spagmodie Jawȣee. 

4. HEPAT1CU& 

Hepatic Jaumdice. 

i. INFANTUM. 

Jaundice of Inftmti. 

II. MEL^NA. 

MELENA. 

SPEC. L M. CHOUEA. 

Black, or Green Jiumdice. 

5. CaUENTA. 

Black Vomit. 

III. CHOLOLITHUS. 

GALL-STONE. 

SPEC. I. C. QDIESCEN8. 

Quiescent Gall-ttoM, 

9 MEANS. 

Pasting of Gall-tttmei. 

IV. PARABYSMA. 

VISCERAL rURGESCBNCE. 
SPEC. L P. HEPATICUM. 

I^rgescence of the Liver. 

% 6PLENICUM. 

Turgetcnce of the Spleen. 

3. PANCREATICUM. 

Tnrpetctnce of the Panereat. 



TABLE OF CLASSIFICATION. 

CLASS I. CCELIACA. 

ORD. II. SPLANCHNICA. 
GBN. IV. PARABVSMA 



xxix ^^1 



8PBC. 4. P. MESENTEIUCUM. 

TurgrKrnm of the Mafnlirry, 

* INTESTINALE. 

7\iri/esffncf of the Intettiaei, 
«. OMENTALE. 

Turgetcenee of the OmentJnn. 
7. COMPLICATl'M. 

Targfsrfnre compounded of 
variatM organt. 



CLASS IL PNEUMATICA. 

DISEASES OP TUS RESPIBATOHT FUNCTION. 

ORD. I. PHONICA. 

AFFECTINO TIIK VOCAL AVBNUKS. 

OEN. I. CORYZA. 

SUNNING AT THE NOSE. 

SPEC. 1. C ENTONICA. 

Entonie Corysa. 
% ATONICA. 

Atonic Coryza. 

II. POLYPUS. 

POLYPUS. 

SPEC. 1. P. ELASTICUS. 

Comprettihle Polgpvt. 

a. COBIACEt/S. 

CarlilagiHous Potypva, 

III. RHONCHUS. 

RATTLING IN THE THROAT. 

SPEC. I. R. STERTOR. 
Snoring. 
8. CEHCUNOeL 



J 



XXX TABLE OT CLASSIFICATION. 

CLASS II. PNEUMATICA. 

ORD. I. PHONICA. 

GEN. IV. APHONIA. 

DUMBNESS. 

SPEC. 1. A. ELINGCIUM. 

EUngtml OunAnti*. 

9. ATONICA. 

Atonic Dumbnegg. 

3. SURDORUM. 

Deaf Dumbneu. 

V. DYSPHONIA. 

DISSONANT VOICE. 

SPEC. I. D. 8U8UBRANS. 

WhisptTtTig Voice. 

S. PUBBRUM. 

Vokt of Puberty. 

3. IMMODULATA. 

Immelodioiu Voice. 

VI. P8ELLISMUS. 

DISSONANT SPEECH. 

SPEC 1. P. BAMBALIA. 
Stammering. 

8. BLSISITAS. 

Miserainciation. 

ORD. II. PNEUMONICA. 

AFFKCTINQ TUX LUNGS, THEIR MEMBRANES, OR 
MOTIVE POWER. 

GEN. I. BEX. 

COUGH. 

SPEC. 1. B. HUMIDA. 

ComnwH or hinnid Coui/h, 

& SICCA. 

Dry Cotiyh. 

S. CONVULSIVA. 

Hoojnng-CoKgi. 



TABLE OF CLASSIFICATION. %%Xl 

CLASS II. PNEUMATICA. 

ORD. 11. PNEUMONICA. 

GEN. II. LARYNGYSMUS. 

LARYNGIC SUFFOCATION. 

SPEC. 1. L. STRIDULUS. 

Stridulotu eotutriction of the 
Larfiue. 

III. DYSPNCEA. 

ANHELATION. 

SPEC. I. D. CHRONICA. 

Shorl-ireath, 
2. EXAOERBANS. 

Exacerbatiitg Anhelatitm, 

IV. ASTHMA. 

ASTHMA. 

SPEC. 1. A. 8ICCUM. 

Dry or Nervout Asthma. 
a HUMIDUM. 

Humid or commoH Atlhma. 

V. EPHIALTES. 

INCUBUS. 

SPEC. 1. E. VIGILANTIUM. 

Daif-Mare. 
S. NOCTURNU3. 

Night-Mare. 

VI. STERNALGIA. 

SUFFOCATIVE BREAST-PANG. 

SPEC. 1. S. AMBULANTIUM. 

Acute Breaat-paitg. 
t. CHRONICA. 

Chrome Breaat-pang. 



XXXll TABI.B OF CLASSIFICATION. 

CLASS II. PNEUMATICA. 

ORD. 11. PNEUMONICA. 

OEN. VII. PLEURALGIA. 

PJIN IN THE BIDS. 

SPEC. 1. P. ACUTA. 

Slilch. 

8. CHRONICA. 

Chronic pain in tie SiJe. 



CLASS IIL H^MATICA. 

DISBASEB OF THE SANGUINEOUS FUNCTION. 

ORD. I. PYRECTICA. 

FETEBS. 

OEN. I. EPHEMERA. 

DIARY FEVER. 

SPEC. 1. E. MITIS. 

Mild Diary Fever. 

9. ACUTA. 

Acvle Diary Fever. 

3. SUDATORIA. 

Steeatiitg Fever. 

II. ANETUS. 

INTERMITTING FEVER. 
AGUE. 

SPEC. 1. A. QUOTIDIANUa 
QuotiditM Ague. 

8. TERTIANUSl 

Tertian Ague. 



TABLE OF CLASSIFICATION. XXXlll 

CLASS III. H^MATICA. 
ORD. I. PYUECTICA. 

GEN. U. ANETUS. 

^ SPEC. 3. A. QLARTANUS. 
* Quartan Agat. 

*. F.RRATICU& 

i. COMPLICATU8. 

Comptkatri Ap», 

lit. EPANETUS. 

REMITTENT FEVER. 

SPEC. I. E. Mirr* 

MilJ Remillcal. 

& MALIflKUS. 

Miitigiumt Remilieni*' 

3. IIBCTICfS, 

Hectic Fevtr. 

IV. ENECIA. 

COST! SUED FEVER. 

fiPBC. I. B. CAt'MA. 

lajtammalory Fever. 

9. TYPHUS. 

TtrphoH* Fever. 

3. syXOCHUSL 

SfitocAiit Frv«r. 

ORD. II. PllI.OGOTICA. 

INrLAMMATIOHS. 

OEN. I. APOSTEAIA. 

APOSTBME. 

SPEC. I. A. a)MML'NE. 

CoRinum Apottfmf. 



* BAnmmtuJRemiiicnr. S Velio* Fcvtf. ^ Buining RcmiHmt tAMbenle 
R<bIiuii(. 



VOL. I, 



i 



XXXIV TABLE OF CLASSIFICATION* 

CLASS III. HEMATIC A. 

ORD. II. PHLOGOTICA. 
GEN. I. APOSTEMA. 



SPEC. 


. 2. 


A. PSOATICtfM. 




3. 


HEPATICUM. 

Abtceat of t^ Liver. 




4. 


EMPYEMA. 

Lodgment of Matter in fie 
Chest. 




s. 


VOMICA 

Vomica. 


II. 


PHLEGMONE. 






PHLEGMON. 


SPEC. 


1. 


P. COMMUNIS. 

Common PhleffmoH. 




8. 


PARUL18. 

Gupi'-boil. 




3. 


PAHOTIDEA. 
Parotid Phlegmon. 




«. 


MAMMA. 
Ab$ceii of the Brttut. 




& 


BUBO. 

Btd>o. 




6. 


PHIMOTICA. 

Phimolic Phlegmon- 


III. 


PHYMA. 






TUBER. 


SPEC. 


. 1. 


V HORDEOLUM. 
Sly. 




a 


FURUNCULUS. 
Boil. 



TAB!.!: OF CLASSIFICATION. 

CLASS in. H^MATICA. 

ORD. II. PHLOOOTICA. 
OEN. III. PUVMA. 

SPiBC. 3. P. svcosia. 



XXXV ^^B 





Ficnue Phyma. 




*. ANTHR-VX. 




CarliUHcle. 


IV. 


IONTUU& 




WHELK. 


tMc 


1. I. VARUS. 




Stont-pock. 




S. OORYMBVFER. 




Carbtmded Fare, Row 


^ ' 




urop. 


V. 


PH LYSIS. 




PH LYSIS. 


8PBa 


I. P. PARONYCHIA. 




Whhtow. 


VI. 


ERYTHEMA, 




INFLAMMATORY BLVSIl. 


SPEC 


1, E. {EDEM.\TOSDM. 




EdrmatQUf Frylicmn. 




» ERYSIPEL.\TOStIM. 




Erytipplatou* Eri/tknxn, 




S. GANGR-BNOSUM. 




CimgrfHovi Erythfmn. 




4. VESICULARE, 




Vatiailor Erylhrma. 




5. ANATOMICI'M. 




Errflhrma from VistKlioH. 




6. PERNIO. 




Chilblain. 




1. INTERTRIGO. 




Frtl. 



f 2 




XXXVl TABLE OF CLASSIFICATIOH. 

CLASS III. H^MATICA. 

ORD. 11. PHLOGOTICA. 

GEN. \1L ESIPRE8MA. 

VISCERAL ISFLAMMATIOH. 



SPEC. 1. 


E. CEPHALITIS. 




InflamwiatiM of the Arm*. 


s. 


OTITIS. 




Ear-ache. 


3. 


PAROTITI& 




Mmitp». 


4. 


PAHISTHMITIS. 




Quiiuf. 


i 


LARYNGITIS. 




Inflammation of the Larynx, 


9. 


BRONCHLEMMITIS. 




Cr&»p. 


7. 


PNEUMONITIS 




Ptripnemrnnti/. 


8. 


PLEURITIS. 




Pleurigy. 


9. 


CARDITIS. 




Inflammation of the Heart. 


10. 


PERITONITIS. 




Inflammation of the Perit»' 




Hteum. 


It. 


GASTRITIS. 




Inflammation of the Stomach. 


12. 


ENTERITia. 




Inflammation of the Boieelt. 


13. 


HEPATITIS. 




Inflammation of the Uver. 


li. 


SPLENITIS. 




Inflammation of the Spleen. 



' ■ Bnin-Fu'cr, S Acute Drops; of the Head. 



TABLE OF CLASSIFICATION. XXXVil 

CLASS III. H^MATICA. 

ORD. II. PIILOGOTICA. 

OEN. Vn. EMPRE8MA. 

SPEC. li. E. NEPHRITIS. 

/n^irininaiiM of the Kidneifii. 

Ifl. CYSTITIS. 

In/tammalion of the Bladder, 

17. HYSTKRITIS. 

Injlaiinnatian of the Womb. 
IB. ORCHITia 

Itfiammatioa of the Testicles. 

Vm. OPHTHyVLMlA. 
OPl/TflALHr. 

SPEC. 1. OPIITIlALAIlTia. 

Injlainmiilion of the whoh 
Kyc-ball. 

* EXTERNA. 

Iiijinmmntion nf the External 

3. INTERNA. 

Tn/tammalion of the Internal 
Parts of the Eye. 

*. STAPHYLOMA. 

Protuhfranl lij/e, 

i. BCTBOPIUM. 

Everted Eyelid, 

n. ENTROPIl'M, 

InverleJ Bfe-lU. 

IX. CATARRHUS. 

CATARRH. 

SPEC. L C COMMI.MS. 

Cold in the Head or Che»t. 

a. EpfnKMici'i 




XXXVUl TABLE OF CLASSIFICATIOH. 

CLASS III. H^MATICA. 

ORD. 11. PHLOGOTICA. 

GEN. X. DYSENTBiUA. 

DYSENTERY. 

SPEC 1. D. ACUTA. 

Acute Dyienlery, 

2. CHRONICA. 

CArottic Dj/tentery. 

XL BUONEMIA. 

TUMW LEG. 
SPEC. 1. B. SPARGAN0SI3. 

Puerperal tutaid Ley. 
a. TROPICA. 

Tumid Leg 0/ hot CUmalei. 

XII. ARTHROSIA. 

ARTICULAR INFLAMMATION. 
SPEC I. A. ACUTA. 

Acute Rheumatitm. 

8. CHRONICA. 

Chronic Rheumatiem, 

3. PODAGRA. 

Gout. 

4. HYDABTHRU8. 

Wiile-noelliiu/. 

ORD. in. EXANTHEMATICA. 

ERUPTIVE FEVERS. EXANTHEHS. 

OEN. I. ENANTHESI8. 

RASH EXANTHEM. 

SPEC. 1. E. ROSALIA. 

Scarlet Fever. 

9. RUBEOLA. 

Measlee. 
3. URTICARIA. 

Keltic Rath. 




TABLE OP CLASSIFICATION. XX3 

CLASS III. H^MATICA. 

ORD. III. EXANTHEMATICA. 
GBN. II. EMPHLVSIS. 

ICHOROUS EXAh'TUEM. 
Sraa I. K MILIARIA. 

Miliary Fevrr. 
a. APHTHA. 

TAnuA. 

3. V.^CCINIA. 

4. VARICELL.\. 
fVaitr Pm. 

a. PEMPH1GU& 

feaiaiUrr, or B/aiUcri/ Fever. 

6. ERVSIPKLAS. 

Si. Anthontf* Fin. 

III. EMPYESIS. 
PUSTULOUS EXANTHBM. 

SPEC. 1. E. VARIOLA. 
Small-Pox. 

IV. ANTHRACIA. 

CARBVSCirLAS. EXASTUKM. 
8PB0: 1. A. PESTia 
Plagvc. 

a. BL'BUL^ 

YaiBt, 

Oaa IV. DYSTHETICA. 

CACHEXIES. 

GEN. I. PLETHORA. 

PLETHORA. 
8PHX 1. P. ENTONICA. 

Saitfuinf Plethora. 
& ATONICA. 

Sirout Plclliora, 



3(1 TABLE OF CLASSIFICATION: 

CLASS III. H^MATICA. 

ORD. IV. DYSTHETICA. 

GEN. 11. H^MORRHAOIA. 

HEMORRHAGE. 

SPEC. 1. H. ENTONICA. 

EtUonie Hemorrhage. 

2. ATONICA. 

Alonie Hemorrhage. 

III. MARASMUS. 

EMACIATION. 

SPEC. 1. M. ATROPHIA. 

Atrophy. 

9. ANH^MIA. 

Exaangiiiitity. 

3. CUUACTERICUS. 

Decay of Naturt. 

4. TABES. 

Declint- 

5. PHTHISIS. 

Coiuumption. 

IV. MELANOSIS. 

MELANOSE. 

SPEC. 1. M. TUBERCULAHI& 

Tubercular Melanoae, 

V. STRUMA. 

SCROPHVLA. 

SPEC. 1. S. VULGARIS. 
King'e Evil. 

VI. CARCINUS. 
CANCER. 

KPEC. I. C. VULGARIS. 

Cum in ON Cancer • 



■TABLE OF CLASSIFICATION. 

CLASS III. H^MATICA. ^'^ 

ORD. IV. DYSTHETICA. 
OBN. VII. LUES. 

VKSHRKAL DISEASE. 
SPEC. I. I- SVPHILia 

It 9VPHIL0DB& 

Bastard Ptu. 

VIII. ELEPHANTIASIS. 
ELEPHANT SKIN. 

SPEC. 1. E. AR.\BICA. 

Arabian Elephanliant. 
Black Leprofff. 
it IT A Lie A. 

Italian Elephanliatis> 
S. ASTURIENSIS. 

Aiturian E/ephanliotit. 

IX. CATACAUSIS. 

CATACAUSIS. 
SPEC I. C. EBRI08A. 

Inebriate Calacaufit. 

X. PORPHYRA. 

sciiRrr. 

SPEC. I. P. SIMPLEX. 

Pplechial Snny. 
«. HJEMORRHAGICA. 

Laitd Scurvy. 

a. NAUTICA. 

Sea Scurcff. 

XL EXANOIA. 
EXANGIA. 
SPEC. 1. E. ANEURISMA. 
Aneurism. 



'J 



Xlu TABLE OF CLASSIFICATION. 

CLASS III. H^MATICA. 

ORD. IV. DYSTHETICA. 
OEK XI. EXANGIA. 

8P£a 2. £. VAREL 
Varix- 
a. CYANIA. 

XII. OANORSNA. 
GANGRENE. 

SPEC I. O. SPHACELU& 
Moriifieation, 
9. USTILAGINEA. 

ifUdeKMortifictttum. 

3. NECROSIS. 

Dry Gangme. 

4. CARIE& 

XIU. ULCU& 
ULCER. 

8PBC 1. V. INCAANANB. 

Simple healing Ulcer. 

5. VITIOStJM. 

Depraved Ulcer. 
3. 8INU08UH. 

SiiuMa Uker. 
*. TDBERCDLOfiDM. 

(Tarty excreiceiU Uleer. 

6. CARI08CM. 

Cariotci Ulcer- 




AFPECTINO TIIE INTELLECT. 

OKN. I. BCPHRONIA. 

INSANITY. CHAZINESS. 
SPEC. I. B. MELANCHOLIA. 

Matancholy, 

% MANIA. 

Madness. 

n. EMPATHKMA. 

UNGOVERNABLE PASSION. 
8PBC. 1. E. ENTONICUM. 

Enipmgiontd Excite ment, 

2. ATONICUM. 
Empainoned VrprnMion, 

3. INANE. 
Hart-bniwd Patshn. 




III. ALUSIA. 
ILLUSION. 



HALLUCINATION. 



SPEC. 1. A. ELATIO. 

Senlimenlalinii. Mental 
Sglravayance, 

3. HYPOCHONUniASL 

Ilypochondnsm. Low 
Spiritt. 

IV. APIIELXIA. 
RE VERY. 



SPBC: I. 



A. SOCOR8. 

Absence of Mind. 

INTENTA. 
AhttntrtioH of Mind. 

0TI08.\. 
Arc urn Staiy. 




jdir TABLE OF CLASSIFICATION. 

CLASS IV. NEUROTICA. 
ORD. I. PHRENICA. 

GEN. V. PABONIRIA. 

SLEEP DISTURBANCE. 

SPEC. I. P. AMBULANS. 

Sleep-walking. 
S. LOQUENS. 

Sleep-talking. 
3. SALAX. 

Night PoUutioK 

VI. MORIA. 

FATuirr. 

SPEC I. M. IMBECILI& 

Imbeeilitif. 

S. DEHENB. 

Imtiimaiitif. 

ORD. II. ^STHETICA. 

AFFECTIHO THE SEMSATIOM. 

OEN. I. PAROPSI8. 

MORBID SIGHT. 
SPEC. 1. P. LUCIFUOA. 

Night-Sight. 
S. NOCTIFUGA. 

Day-Sight. 

3. LONOINQUA 

Long-Sight. 

4. PROPINQUA. 

Short-Sight. 

5. LATERALIS. 

Skve-Sight. 
& ILLUSORIA. 

Falte-Sight. 
7. CALIGO. 

Opake Cornea, 



TABLE OF CLASS! PIC ATION. 



(xbr 



CLASS IV. NEUKOTICA. 
ORD. n. jESTIIETICA. 



OEN. I. PAROPSIS. 
SPEC. e. p. glaucosisl 

Humonl Opacilf. 

a. CATABACTA. 

Catarart, 

10, SYNIZESia 

Vio*fii Pupil. 

11. AMAUROSIS. 

Drty Sfrfitt. 

I«. STRABISMUS. 

n. PARACUSIS. 

MORBID HEARISG. 

SPEC. I. P. ACRiS. 

Acrid HMrUg. 

It OBTUSA. 

Hardiuu 0/ Hearing. 

5. PERVERSA. 

Pfrvrrse tfearhuf. 

♦. DUPLICATA. 

Doubh Hearing. 

i. ILLUSORIA. 

Imaginary Soundt. 

6. HUR1>1TA9l 

Div/ntat. 

lU. PAROSMI8. 

MORBID SMELL. 

SPEC. I. P. ACHI& 

Acrid Smfll. 

a OBTUSA 

06tiut Smell. 

3. EXPKRa 

Wamt o/Sme/l. 



I 



Xlvi TABLE OF CLASSIFICATION. 

CLASS IV. NEUROTICA. 
ORD. II. ^STHETICA. 

GEN. IV. PARAGEUSIS. 

MORBID TASTE. 

SPEC. 1. P. ACRI8. 

Acrid Taite. 

9. OBTUSA. 

OMtue Tmte. 

3. EXPERS. 

WaHl of Tattt. 

V. PARAPSI8. 

MORBID TOUCH. 

SPEC. I. P. ACRIS. 

Acrid Saue of To»ch or 
general Feeling. 

S. EXPERS. 

InsentibiiHy of Touch or 
gentral Feeling. 

3. ILLUaORIA. 

Itlutory Senae of Towh or 
getural Feeling. 

VI. NEURALGIA. 

NERVE-ACHE. 

SPEC 1. N. FACIEI. 

Nerte-Hiche of the Fact. 

v. PEDISl 

Nerve-ache of the Foot. 

3. MAMMiG. 

Ncrvc-achc of the Bretut. 



TABLE OF CLASSIFICATION. kItu 

CLASS IV. NEUROTICA. 
ORD. III. CINETICA. 

AFFECTIHQ TUX M08CLES. 

GEN. I. ENTA8IA. 

CONSTRICTIVE SPASM. 

SPBC. 1. E. PRIAPISMUS. 
Pria^tm. 

5. LOXU. 

Wry-neck. 

3. RHACHTBIA. 

Mmcular DUtorlioit t^lke 
Spine. 

4. ARTICULAR18. 

Mutcuiar Sliff-joinl. 

6. STSTREHMA. 

Cramp. 

6. TRISMUS. 

Locked-jan>. 

7. TETANUS. 

Tetanuf. 

B. LY86A. 

Babies. Canine Madnetw. 

9. ACROTISMUS. 

Sitppruied PuUe. 

11. CLONUS. 

CLONIC SPASM. 

SPEC. 1. C. SINGULTUS. 

Hiccough. 

% 8TEENUTATIO. 
Sneezing. 

a. PALPITATIO. 
Paipitafion. 

4. NICTITATIO. 

Tminkling of Ike Ege-lidt. 



Xlvili TABLE OF CLASSIFICATION. 

CLASS IV. NEUROTICA. 
ORD. III. CINETICA. 
OEN. 11. CLONUS. 

SPEC. B. C. 8DB8ULTUS. 

TmiichiMff of the Tauloiu. 

a. PANDICULATIO. 
Stretehitig. 

III. SYNCL0NU8. 

SYNCLONIC SPASM. 

SPEC. I. S. TREMOR. 
TrembHnti. 

9. CHOREA. 

St. Vituii tkmet. 

3. BALLISMUS. 

Shaking Palty. 

4. RAPHANIA. 

JZapAonia. 

5. BERIBERIA. 

Surbiers. 

ORD. IV. SYSTATICA. 

AFFECTING SEVERAL OR ALL TR£ BEK30SIAL 
POWERS SIUULTANEOUSLV. 

OEN. I. AORYPNIA. 

SLEEPLESSNESS. 

SPEC. 1 A.EXCITATA. 

Irritative WttkefuliUBi. 
S. PERTJESA. 

Chronic Wakrfvlnas. 

II. DYSPHORIA. 

RESTLESSNESS. 

SPEC. 1. D. SIMPLEX. 
Fidgets. 
S. ANXIETAS. 



TABLE OP CLASSIFICATION. 



xltK 



CLASS IV. NEUROTICA. 
ORD. IV. SYSTATICA. 

GEN. III. ANTIPATHIA. 

AXTIPATHY. 

SPEC. I. A. 6BNSILI8. 

Srnsi/e Antipathy. 
a INSKN9IL1S. 

Insentile Antipathy. 

IV. CEPHM,«A. 

HEAD-ACHE. 

8!*Ea I. C GRAVAN9. 

Stupid Head-arht. 
8. INTENPA. 

Chronic Head-aehe. 

3. HB^IICRANIA. 
Mryrim. 

4. PULSATILI8. 
Throbbiny li fad-ache. 

5. NAUSKOSA. 
Sick Head'tiehe. 

V. DINU8. 

DIZZISESS. 

SPEC. 1. D. VERTIG(». 

VI. SYNCOPE. 

SY^'COPF. 

SPKCL 1. a SIMPLE-X- 
SttioORi»g. 

«: RBCTRRENS. 

Fttintin'j-fit. 

VII. SYSPASIA. 

COMATOSE SPASl^. 
SPEC. I. S-CONVULSIO. 
ConpH/tioN. 

vol,. I, rf 



^ 



i 



I TABLE OP CLASSIFICATION. 

CLASS IV. NEUROTICA. 

ORD. IV. SYSTATICA. 

GEN. VII. SYSPASIA. 

SPEC. S. S. HYSTERIA. 
HytUrics. 

3. EPILEPSIA. 

Epilepsff. 

VIII. CARUS. 
TORPOR. 

SPEC. 1. C. ASPHYXIA. 

Atphyxy. Stupeniled 
Animation. 

e. EC8TASIS. 

Ecslac^. 

3. CATALEPSIA. 

Calalepay. 

♦. LBTHARGUS. 

Lelhartfy. 

5. APOPLEXIA. 

Ajioplexi). 

6. PARALYSIS. 

Pahv. 



CLASS V. GENETICA. 

DISEASES OF 1 HE SEXUAL FUNCTION. 

ORD. I. CENOTICA. 

AFFECTING THE FLUIDS. 

GEN. I. PARAMENIA 

MISMBNSTRUATION. 
SPEC. 1. P. OBSTBUCTIONIS. 

Obflrucfed Menatntafim. 



TABLE OF CLASSIFICATION. li 

CLASS V. GENETICA. 
ORD. I. CENOTICA. 

GEN. I. PARAMENIA. 

SPEC 2. P. DIFFICILIS. 

Laborious Menstruation. 

X 8UPERFLUA. 

Excessive Menstruation, 
*. ERRORIS. 

Vicarious Menstruation. 

5. CE8SATI0N1S. 

Irregular cassation of the 
Menses. 

II. LEUCORRHfEA. 

WHITES. 
SPEC. 1. L. COMMUNia 

Cotnmon Whites. 

8. NABOTHI. 

Labour-show. 

3. SENE8CENTIUM. 

Whiles of advanced Life. 

III. BLENORRHCEA. 

GOJ^QRRH(EA. 
SPEC. I. B. SIMPLEX. 

Simple urethral Running. ' 

8. LUODES. 
Clap. 

3. CHRONICA. 
Gleet. 

GEN. IV. SPERMORRHCEA. 

SEMINAL FLUX. 

8PBC. 1. S. ENTONICA. 

Entonic Seminal Flux. 

3. ATONICA. 

Atonic Seminal Fltu. 
d2 



lii TABLE OF CLASSIPICATIOK. 

CLASS V. GENETJCA. 
ORD. I. CENOTICA. 

GEN. V. GALACTIA. 

MISLACTATJON. 

SPEC. 1. G. PRfUATURA. 

Prtmature Milk-fimo. 

a. DEFECTIVA. 

Defcint Milk-fiov. 

3. DEPRAVATA. 

Depraved Milk-flov- 

4. ERRATICA. 

Erratic Milk-Jtow. 

5. VIRORUM. 

Milt-fiow in Males. 

ORD. 11. ORGASTICA. 

AFFECTIKG THE ORGASM. 

OEN. I. CHLOROSIS. 

GREEN-SICKNESS. 

8PEa I. C. ENTONICA. 

EntonU Green-Siehuts. 

8. ATONICA. 

AtOHtc Green Sickneu. 

II. PRCEOTIA. 

GENITAL PRECOCITT. 
SPEC. 1. P.MASCULINA. 

Male Precocity. 

9. FEMININA. 

Female Precocity. 

III. LAGNESIS. 

LUST. 

SPEC. 1. L. SALAC1TA8. 
Salacity. 

a. FUROR. 

LatcivioM Madtuu. 



TABLE OF CLASSIFICATION. UU 

CLASS V. GENETICA. 

ORD. II. ORGASTICA. 

GEN. IV. AGENESIA. 

MALE STERILITY. 

SPEC. 1. A. IMP0TEN8. 

Mate Impolency. 

2. DY8PEBMIA. 

Seminal Mitemitsitm. 

$. INCONGRUA. 

Copulative IncongruUy. 

V. APHORIA. 

FEMALE STERILITY. 
BARRENNESS. 

SPEC. I. A. IMP0TEN8. 

BarreniKM of Impotencg. 

S. PARAMENICA 

Barreiutesa of MU-mautrwt~ 
turn. 

3. INPERCITA. 

Barremieu of Irreipondence. 

*. INCONGRUA. 

Barreraugg of Inautgndtg- 

VI. SDOPTOSIS. 

GENITAL PROLAPSE. 

SPEC- I. A UTERI. 

Falliag dotoH of the mornb. 

«. VAGIN.*;. 

Prolapte of the Vagina. 

S. VESICA 

Prolapse of the Bladder. 

«. COMPLICATA 

Complicated Genital Prolapte. 

S. POLYPOSA. 

Genital ExcrewMue. 



liv TABLE OF CLASSIFICATION. 

CLASS V. GENETICA. 

OR0. III. CARPOTICA. 

AFFECTING THE IMPREGNATION. 

GEN. I. PARACYESIS. 

MORBID PREGNANCY. 

SPEC. I. P. IRRITATIVA. 

Conitittiliotul denmgemeiU of 
Pregnancy, 
ft. UTERINA. 

Local derangement of Presnancf- 

3. ABORTUS. 

Abortion. 

II. PABODYNIA. 

MORBID LABOUR. 

SPEC. I. P. ATONICA. 

Atonic Labour. 

% IMPLASTICA. 

Urtpliaia Labour. 

S. SYMPATHETICA. 

Complicated Labour. 

4. PERVERSA. 

PretematMral Preientatio*. 

5. AMORPHICA. 

In^acticabie Labour. 

«. PLURALIS. 

Mtdtiplicate Lahowr. 
7. SECUNDARIA. 

Sequential Labour. 

III. ECCYESIS. 

EXTRA'VTERINE FETATION. 

SPEC. L E. OVARIA. 

Ovarian Etf elation. 



TABLE OP CLASSIFICATION. Iv 

CLASS V. GENETICA. 

ORD. III. CARPOTICA. 

GEN. III. ECCYBSIS. 

SPEC. S. E. TUBALIS. 

Tubal Exfttation. 
3. ABDOMINALI& 

Abdominal Ex/elation. 

IV. PSEUDOCYESIS. 

SPURIOUS PREGNANCY. 

SPEC. 1. P.MOLARIS. 

Mole. 

8. INANia 

Faltt Qmctptipn. 



CLASS VL ECCRITICA. 

DISEASES OF THE EXCERNENT FUNCTION. 

ORD. I. MESOTICA. 

AFFECriKQ THE FABENCHTUA. 

GEN. I. POLYSABCIA. 

. CORPULENCY. 

SPEC I. P.ADIPOSA. 
Obarity. 

U. EMPHYMA. 

TUMOUR. 

SPEC. 1. E. SARCOMA. 

Sarcomatotn Tumour, 

9. BNCVSTIS. 

Eneyattd Tunumr. 

3. EXOSTOSIS. 

Bony TuMour. 



in TABLE OP CLASSIFICATIOK. 

CLASS VI. ECCRITICA. 
ORD. I. MESOTICA. 

OEN. III. PAROSTIA. 

MISS-OSSIFJCATION. 

SPEC I. P. FBAGILI& 

Froffilitg o/ lie Semt. 

8. FLEXIUS. 

Flexilily of the Baug. 

IV. CYRTOSIS. 

CONTORTION OF THE BONES. 

SPEC. 1. CRHACHIA. 
RkieU. 

a. CRETINISMUS. 

V. OSTHEXIA. 
OSTHEXr. 

SPEC.1. O. INPARCIENS. 

Paraichymatoiu Ottke*). 

% IMPLEXA. 

Vatcular Otihexy- 

ORD. II. CATOTICA. 

AFFECTtHO INTBRNAL SURFACES. 

GEN. I. HYDROPS. 

DROPSY. 

SPEC. !. II. CELLULARIS. 

Ceihlar Droftf. 

% CAPITIS. 

Drojtfi/ of Ike Head, 



TABLB OF CLASSIFICATION. ivil 

CLASS VI. ECCRITICA. 
ORD. II. CATOTICA. 
GEN. I. HYDROPS. 

6PBC. 3. H. 8PIN£. 

Dropsy of the Spine. 

*. THORACIS. 

Ihap^ of the Chetl. 

S. ABDOMINia 

Dropsy of the Belly. 

«. OVARII. 

Dropty of the Ovaries. 

1. TUBALI8. 

Dropsy of the Fallopian Tubes. 

8. UTERI. 

Dropsy of the Wona. 

3. SCROTI. 

Dropsy of the Scrotum. 

II. EMPHYSEMA. 

INFLATION. WIND-DROPSY. 

SPEC'.t. JB. CELLULARE. 

Cellular Inflation, 

2. ABDOMINIS. 

I)finpany. 

111. PARURIA. 

MIS-MICTUaiTION. 

SPEC. 1. P.INOP& 

Destitution of Urine. 

a RETBNTIONIS. 

Stoppage of Urine. 



Iviii TABLE OW CLASSIFICATION. 

CLASS VJ. ECCRITICA. 

ORD. II. CATOTICA. 
OEN. lU. PARURIA. 

SPECS. P. STILLATITIA. 

Slrangurff. 

4. MSLLITA. 

Saccharine Urine. Diahettt. 

5. INCONTINENS. 

Incontinence of Urine. 

•. INCOCTA. 

Unammilated Uriite. 

7. ERRATICA. 

Erratic Urine. 

IV. LITHIA. 

UIUNAXr CALCULUS. 

SPEC 1. L. RENALIS. 

Renal CakilM. 

8. VESICALIS. 

Stone in the Bladder. 

ORD. III. ACROTICA. 

AFFBCTIKQ THE BXTEBHAL SURFACE. 

OEN. I. EPHIDROSIS. 

MORBID SWEAT. 

SPEC 1. E. PBOFUSA. 

Pro/Mie Sveat. 

S. CRDENTA- 

Bloody Stoeta. 

i. PARTIALI& 

Partial Sveat. 



TABLE OF CLASSIFICATION. lix 

CLASS VI. ECCRITICA. 

ORD. III. ACROTICA. 

GEN. I. EPHIDROaiS. 

SPEC. 4. B. DISCOLOR. 

Ctloirtd Sttteat, 

S. 0LEN8. 

Scented Sweat. 

S. ARENOSA. 

Sundy Sweat. 

n. EXANTHESIS. 

WTANEOVS SLUSH. 
8PEC. 1. E. ROSEOLA. 
RoM-Ratk. 

III. EXORMIA. 

PAPULOUS SKJN. 

iFEC. I. E. STROPHULUS. 
Gum-Raeh. 
9. LICHEN. 

Lkhenoia-Riah. 

3. PRURIGO. 

Prurtginoue'Rtuh. 

4. MILIUM. 

MUht-Raai. 

IV. LEPID08IS. 

SCALB-SKIN. 

8FBC. 1. L PITYRIASIS. 
Datidriff. 

% LEPRIASia 

Leprosy. 

3. PSORIASia 
Dry-Scall. 

♦. ICHTHYIASIB. 

Fuh-Skin. 



Ix TABLE OF CLASSIFICATION. 

CLASS VI. ECCRITICA. 

ORD. III. ACROTICA. 

GEN. V. BCPHLYSIS. 
BLAINS. 

SPEC. 1. E. POMPHOLYX. 
Waier-blebt. 

S. HERPES*. 

Tetter, 

. S. RHYPIA. 

Sordid Blaiit. 

4. ECZEMA. 

Heat Eruptum. 

VI. BCPYESIS. 

HVMJD SCALL. 

SPEC 1. E. IMPETIGO. 

Rmuung Scalt. 

9. PORRIGOf. 

Scably ScaU. 

3. ECTHYMA. 

Papuloiu ScaU. 

4. SCABIE& 

Itch. 

VII. MALIS. 

CUTANEOUS VEnMINATION. 

SPEC I. M. PEDICULI. 

Lmmneai. 
«. PULICIS. 

FUa-bitei. 
3. ACARI. 

Tick'Bile. 
i. PILARIS. 

Guinea IFomi. 

• > ShbgW I RiDit-wunii. t ^ ScalkdJtmd, 



TABLE OF CLABSIFICATIOH. Ixi 

CLASS VI. ECCRITICA. 
ORD. III. ACROTICA. 
GEN. VII. MALIS. 

SPEC. 5. M. (ESTRI. 

Gttd-fy BUe. • 

6. GORDII. 

Hair Worm. 

VIII. ECPHYMA. 

CUTANEOUS EXCRESCENCE. 

SPEC. 1. E. CABUNCULA. 
CarvHcle. 
' a. VBRIUJCA. 

Wart. 

3. CLAVOS. 

Com. 
*. CALLUS. 

Callvt. 

IX. TRICHOSIS. 

MORBID HAIR. 
SPEC 1. T, 8EN0SA. 

Bristly Hair. 

a PLICA 

Matted Hair. 
3. HIRSUTIE8. 

Extraiuotu Hair, 

*. DI8TRIX. 

Forkff Hair. 

6. POLlOSia 

Gray Hairt. 

6. ATHMX. 

BatdHe$$. 

7. AREA 

Areated Hair. 

8. DECOLOR. 

Miacoloured Hair. 

9. 8ENSITIVA 

Seiuitiw Hair. 




lui TABLE OF CLASSIFICATtOH. 

CLASS VI. ECCRITICA. 
ORD. III. ACROTICA. 



GEN. X. £FICHROSIS. 


MACVLAR-SKIN. 


SPEC. 1. 


E. LEUCASMU8. 




VettlSkiK. 


S. 


8PIL0S. 




Moh. 


1 


LENTICULA. 




Frecklet. 


4. 


BPHELIS. 




Svn-bum. 


6. 


AURIGO. 




Orangt'Skin. 


6. 


PfBCILIA. 




Pye-ballei-Skin. 


7. 


ALPHCmiS. 




Albino-Skin. 



CLASS I. 



CLASS I. 

CCELIACA. 



DISEASES OF THE DIQESTIVB FUNCTION. 



ORDER I. 

ENTERIGA. 



DISEASES AFFECTING THE ALIHENTART 
CANAL. 

II. 

SPLANCHNIC A. 

DISEASES AFFECTING THE COLLATITIODS 
TIBCERA. 



CLASS I. 



PHYSIOLOGICAL PROEM. 



AccoRDiMO to the pliy Biological arrangement proposed 
in tJiis work, the lirst class of diseases consists of those 
f'lrhicb primaitly afTect or commetice in the digestive 
[organs, and inipcdo the digestive function. I saypriiiiarili/ 
[alfect these organs, because they msiy be nfl'ected in a 
■econdary manner, by sympathy or induction, in conse- 
quence of diseases which onginate elsewhere, and on this 
ccount do not belong to tlie present class. 
Now, in order to obtain a clear idea of the nature of the 
^diseases before us, it ia necessary to have a distinct know- 
Lledge of the organs which are the seat of them, and of the 
^Ainction which they embrace. To follow up this inquiry 
ito a very minute detail, is the joint province of anatomy, 
[ physiology, and animal chemistry; and a finished prac- 
i-titioncr must derive his information from these three 
fiftourcea collectively, pursued through an extent of many 
^volumes. But, for our immediate purpose, it may be 
^'Builicient to give a general view of the subject. 

No animal function displays a greater diversity of means 
I for it« performance than that of digestion; and, perhaps, 
Ithe only point, in which animals of all classes agree upon 
I this subject, is in the posseasion of an internal canal or 
^cavity, of some kind or other, into which tlie food is 
VOt. I. 8 



chnnxKr of 
of Ihl,' cliM. 



nrjcuu. 



[unclion. 



PHYSIOLOOICAL PROHM. 



Altmciuty 
c«*lfr in 

uiinuU. 



introdticecl, nib) prepared for nutrition : an agreement, 
which may be rcgardt-d lus one of the lending feuluri^ii by 
which the animal Htructiirc i» cliKtingiiiithcd from the vege- 
table. [Dr. Boatock, to whotte chcmicul mid physiological re- 
searches science isdccply indebted, has noticed that certain 
animals of the inferior ordcni arc not fumiitlKxl with any 
receptade for food, but, like vcgetnblcK. imbibe tlieir nutri- 
ment from the surface of Uie body*. The words of BIu- 
iDenbach, however, to whom he refen tut the authority on 
this point, do not Ju^ttily the pofiitioii that some sniomls 
have no stomachic cavity, but only that they ho»e no 
mouthf. Thus, the infusory animalculce are merely little 
living vesicles, absorbing their nutriment into their minute 
cavity, tlirougb their panotes, without any mouth. To 
thc«e approximate the medti!ta-Uke animaU (bcrcmce, 
rhizoBtoma, &c.) which sometimes absorb their nutri- 
ment without K month, Mmetimcs by numerous apertures. 
In tlie true mcdusse, on the contrtiTy, there is a single 
aperture for suction, on the inferior surface of the body, 
the cavity of which, in the mtJtisa attrila, leads by four 
apertures into a like number of such, or stomachs, exca- 
valed in the gelatinous substance of the body, which, in a 
manner almost inconceivable, are capable of digesting 
very hard bodies, t.g. small prickly fishes (. 

Some form of an alimentary cavity is, perhaps. tJie b«st 
criterion of an animal hitherto suggested. Cuvier di- 
stinctly stales tlint he knows of no animal unprovided 
with such anorgan^. On the other hand. pliinl* contain 
no large or separate internal cavity for the reception of their 
nourishment, which they absorb by pores on their surface, 
andf-HpFcially by their roots and leaves. As the generality 
of animals piwsess the power of locomotion, they cannot 
have roots, by wliich they would be fixetl in one situation. 
Moat of them take their supply of food at once, according 
to need and opportunity, carry it about with them, and 
digfst it at their leisure. This object is fnllilli-^ by ao 
nlimentani' cavity, of which the internal pores, fur imbibing 
the nutriment, may be compared to vegetable roots, which 



I 



I 



■ WUm. Sfil. of rhjilologj, *0l. )i. p. HS. 
f »n lluw't ('umpi. Aiul. Tol. It p. 2. 
I Diet. 4m SckocN MU. (otn. U. p. H& 



I Cmipsr. AiwL p> 



fHYSIOLOGlCAL ftlUSM. 



r 

B take op food from llie soil. Hence. B^erhaaTe uxcd U 
Hay thai aiiimals have roots within them. A diatJnct ali- 
meatary cavity, generally having a reference to locomotion, 
w then, asCuvicr remarks, cue of tbe most invariable cha- 
ntctcra of an aniwiit. A single mouth, he says, which some 
iiutumlists haw lixcd upon as a criterion, and contrasted 
with the multiplicity of the pores of the roots of vegelahIeK, 
is lasB constant; for. as we have noticed, some animula uf 
tlie fiunily of medusa tiave several mouths, yet only one 
common stocuachic cavity.] 

Let UK nextlrace thiHcavily aaitcxistH inninn and some 
other animals, and obterve the organs that are supposed 
' to be Auxiliary to it, and the powent by which it accom- 
^plishc* its important trust. 

The alimentaiy cavity in man extends from the moulli tn man. 
' tlirough the whole lange of the intestinal canal ; luid 
h«i)cc its ditforent |>arU arc of very different diameters. In 
the mouth, nhero it commences, and in tlie pharynx, it is 
compnnitivcly wide ; it contracts in the (esophagus; then 
[•giin widens to form the stomach, and afleivvard-i con- 
tracts ngaii] into the tube of the intestines. This tube 
it«elf is also of variouii dianietent, in ditfereut parts of its 
extent; at>d it is ehicdy on tins diversity of magnitude 
(hat anatomists have established its divisions. Its t^nurnl 
lengU) is five or six times that of the man himself; and. 
I in children not less than t«n or twelve times ; [digestion 
I in them being particularly active, from the greater necesisity 
of growth au<l reparation. Meckel has found that the 
length of the amall intestines is very irregular in diHerenl 
ipersons, varying frxim thirteen to twenty-seven feet, wilh- 
tout any proporti<miil difi'ercnce in the stature of the body *. 
In some aittmalt tlie intestinal canal is imperforate, theimomc 
I dross of the food beine rejected by the mouth. It is so ''"'""J* 
— casjonally in birds and huhcs; and this was once sup- 
ed to be the case in the medicinal leech : but Cuvier, 
[Blumenbuch,andCarus all agree, in opposition to DumerU, 
J that tlie leech has a very small open anus, from, which, 
^however, only a Utile fecul matter is discharged, most of it 
.being voided by the mouth, ^o anus has yet been satisfac- 



3 



Manud d'Anauinilc, tcm. 111. p. 300. 



ii2 




PUVSIOLOOICAL PROEM, 



torily detected in the t«pe*wortn». In the actiniie, one 
apprtiire comliines the two offices of mouth and aiuis+.] 

In the human tubjecL it ik som<-ttmf!i iinp«rrorntc nt 
birth, tvith a [ireterrnitural outlet to !iiip|>ly (he plBc« of an 
anus io some neighbouring part or or^n, as the bladder, 
in which case the fecci) have been discharged by the ure- 
tbra, the vigioa, the navtl, or the groin. An cxtniordinnry 
instance of such accouimodation is that of a girl who 
from birth wait imperforate in tht; anus nnd mcatun uri- 
nariuB; in fact, in the uholc dirision of the vulra; and 
who, to the age of foiirtcrn. had regularly diacharg^ed ber 
urine by the breaAts, and her fccea by a natural vomiting 
or rejection from the stomach};. 
R*bi]n Generally speaking, the extent of the digestive cnviiy 

liuHimnit ^^^'^ ^ relation to the nature of ihe alimeut§ ty which 
u7iarHj. the individual ia designed to be nounshod. The tesii 
analogous tliesc altmenta are to the subHlanct- of tJte animal 
they arv to recruit, the longer they muM remain in the 
body, to undergo the chants that uro to asHimilnic them. 
Hence, the intestinal tube of herbivorous unimnia ia for the 
moHt part {for wc still meet with exceptions) very long; 
or, in particular portions, verj' capacious ; in varioua kinds 
ver)- complicated, and often double or triple. Thus, in the 
borae, the large intestines are of enormous Hi&e, and dilated 
into iiacculi, while the ccECum is as capacious aa the att^ 
mach. In the ruminant animals, besides tlie peculiar 
complexity of the stomach, the alimentary canal is twenty- 
seven limes the length of the body. On the contrary, 
carnivorous animals have a short and straight canal ; their 
food being already of their own nature, containing a larger 
quantity of nourishment in letta bulk, and hetKc demand- 
ing a smaller proportion of time and itpace to become fit 
for use. [In them every cirrumatancc concurs to aceelerato 
the passage of the alimentary mutter. It undergoes no 
mastication ; it is retained for a v«ry short lime in the 
Ktouiach : the intestine has rra folds nor valt-es; it» dta* 
meter is small; and the whole cimnl, when compered to 
the body, ia extremely short, being only as three or fire to 
ooe. Whales, however, have a longer canal tlian other 



I 

II 



• t:uu*'« Coiiip. Anal. rot. U. p. IA. f IblJ. f. 3. 

$ NamiL Med. WMimriim. h. ttil. p. 10. 



PHYSIOLOGICAL rRUKH. 

cumivorous mBmnxLlia : tbeir stomach U complicated, and 
the iolesUiic has luiigitudinni folds. Indi-cd, caniivorouB 
tsammaiia, of aquatic habile, are obevrved generally to 
poMBM » oODsiderable length of intestine; a point, in 
which they differ from tno«t other animals of that class. 
I otunivurou!) nnim»lB, the ciuiul is not bo long us it is in 
herbivorous, nor so sliort us it is in the carnivorous. 
Iius, in the nit, its proportion to the body is uk eight to 
one; in tJie pig, thirteen to one; and in luaji, six or 
svven to one. In him the dimtniilion in len);th is com- 
pensated by the numerous vulvulw conniventiM and the 
preparation of the food by cookery". The domestic cat, 
which eat* bread as well as desh, lias an alimentary oanal 
conbiderably longer than that of the wild cat.] 

The digaslive canal of man itt lesa capacious and com- OninWorDu* 
plex than that of most mammaUa which take only vege- jl"°,'n'^ 
table food ; yet latter and more complicated than that of lunnuti. 
other inamtulia which hve entirely on desh. Hence, man 
aeems to be capable of subsisting either on animal or 
vegetable food; and, from tlie nature of ht» digestive as 
well an of various other organs, is better (pialified for every 
diversity of ulimeut and climate than uny other animal. 
Thas, many nations in u savage state live alntost, perhaps 
altogether, on fniits nnd roots ; as those of the yam, beet, 
Mtd potato, tlic bread -fruit- tree, breud-nut (6>vsimum 
alUtiUrvm). swc«t>i<hestnut, banana, cabbage<tree ptdin* 

\artca oitrtaaa), and meal-hark (ctfcat circiiiatit). Others 
live on raw animal tlesh. or deah of the coarsest kind, as 
Ihalofmie species at least of the walrus ((rtMccHu t/utloiiff), 
ibe nea-bear. and sea-calf. The Grcenlandcr feeds vora- 
ciously on the skin and lins of the nord-capon, and on the 
flesh of whales. Many African tribes ore tiaid to hve on 
UcimI lions and hippopotami. IJogs are eaten in the 
South Seft lidands, horses in Tartary, and caU in many 

.parts us a substitute for rabbits. Among numerous tribes of 
sarugea. indeed, tlio Hesh of man hini^If is still dressed 
for food: the custom may hare been more extensive Cor- 
merly tlian in the present day; but it still prevails in 
several of the Australasian isles, and is even exhibited in 
New Zealand, where the inhabitnnts are nevertheless 



■ BlumcQbach'tCviDp. AnM- |>. I7S- 




PHYSIOLOGICAL PKUUM. 



^p^utiarly ititi'lligcnt, and itinpnAcd to adopt tlic maniu 
W Ktiro|)eiini4. The Kindun ftubsist chiotly on lici: nnd 
tuaite, aiid will not touch l]esh of «ny kind. Mnny tribvK 
ofnandehng or nomadic Moors on gums, pnncifwlly gum 
seneca. The Katuschadaleii, aud the wretched inhabttuats 
of the neight>ouni)f; itliores, on fishes, or ooarec fiflh-oil 
mixed into a ftrnte with saw-dust, or the rasped fibre* of 
indigenous pUmia : while the more polished and luxurious 
natioDs of Europe live on solid and liquid foods of every 
deHcription. Yet, it hUouUI not be foi^oitcn that, in 
Ireland and «otne oUier places, the only aliment subsisted 
upon in extensive and populous communities, whose 
poverty prevents them from obtaining any otlior, is the 
potato. 

Man, therefore, is omnivoroos ; but be is not tho only 
oauuTorous animal in the world : for iho great Author of 
Nature is perpetually showing us that, though he operates 
by general principlen, he is in every instance the lord, and 
not the slave, of bis own laws. And hence, among qoadro* 
perls, the swine, aod, among insects, the ant (and more 
examples might be adduced if necessary), posseas m 
oninivorausa power as man himself, and feed equally on the 
fleshy parts of animals, and on grain, and Ihe sweet juicM 
of plants. [In this respect, nature has in some degree tk 
power of accommodation, where it wo<i!d not ^ priori he 
expected. Tlius, certitin animals which, from tlie structure 
of tJicir digestive orgttns, are plainly designed to live 
entirely either on vegetable or animal food, will subsist, oa 
a matter of necemity, altogether on the particular kind 
not intended for them by Nature, especially when the 
change is made in a gxadnal manner. Thus, in tbo 
northern puts of Asia, where grain is scarco. horses and 
oxeti are Nonietimcs fed on fish * . Spallanzani habituated 
an eagle to live on bread, and a pigeon on flesh t. If 
fresh water mollnsca arc put at onto into sea water, or sea 
water mollnvca into fresh water, they perish ; but, if the 
chat^ b* gndnally made, they live very well:^.] 



I 



* 8m flomc'* Lml on Ogn^ AmL 

t Elpcritnot* (ur te IHipMhin, t.JtttTX 

* Adii. lb Chimie, ttK. xtiL u. p. 93, uul IMuDicnliKfa-* fhy^ltgr, 
cdlL f. aoo. 




PHYSIOLOGICAL PKOKH. ^ 

It u MUnetiiBeH cuMpectecl, that no &aimal can derive nu- wiiMhn 
trineot from tiny nialiarinl that does iiol contain some por- ""« ** 
boa of ftwlc, which is an enafintial element of tlie aiiiaial uiiiial du- 
body, and exists in it far mora la^ly than in plants, "^nun^ 
[Thu doctrine, undoubtedly, cannot be correct, if spidcns 
can lire on aulphate of zinc*, and the Otoiuacs cat little 
else some mouths in the year than large quantities of eartli. 
A sudden change from a diet gf fully azotiicd subKtancvH, 
like tiuiat, bieutli &lc. to one composed of vegetables con- 
taining little or no azote, certainty cannot always be borne 
by the human constitution nitb impunity. ThiM was 
jiroTcdin the eastern part of Fiance, in lJieyearl817, where 
the failure of the crops produced such a famine that the 
poor were couipellcd to contend, as it werv, with the beasts 
of the field for whatever vegetable productions could be 
found. The couHcijucnccH were gcueral anaaarca, interrup- 
tion of tlie menneH, » diuiinution of the ordiuary number of . 
conceptions by one half, as carefully estimated by paruchiul 
docuRteiits, and permanent injuiy of the hcaltli. l£v«n the 
sudden return to the use of barley bread, after the con- 
tinuance of this miserable regimen for tlirce months, was 
found not to be unattended with perilt.} 

It has often been a question, whether the abundance of 
azote in animals is derived partly from the atmosphere, 
either by respiration or absorption, or by both these pro- 
oessea ; or whether it is produced by the action of life 
itself; or is obtained from articles of food. 

The experiments of M. Mngendte rather tend to provCt 
that the great rouicc of nzutc in tlic animal body in the 
food; for, on fceiliiig animals of various ktndn on Hub- 
slances tliat contain no sensible portion of azote, as sugar, 
f^um, olive-od, and butter, together witJi distilled water, 
atul confining thein to thin kind of diet, tliey gniiUmUy Ik- 
caue atrophous and died. The secretions nssiimed tlie 
character of those of herbivorous animals : the food wa;s 
digested, but the muscles were reduced to oii<>sixth of their 
proper volume. It is singular timt all the unimulw before 
death exhibited an ulcer of the cornea, which Kometinics 
spread through the membrane, and let out the htimoursof tJte 



■ Tbonuon'i AdmU of riiilocoiihy, *oL xU. p. HU. 
t Gupud, In Mag«ntUc'> Juvm. I- L p. Hil, Kt. 



i 



PHVSIOLOOICAI. PRORM. 



IniulKcl- 
I'nfv of « 
illcl canlit- 

mcMildo. 



tivc ki«lb 
of ilu ^i< 

nKtiury 



eye. [It IN conceived, bjr Dr. Bo8tock,howcv«r, that lhc«e 
cxpcriineDls only prove, that ihc Btomftch is not capable of 
digpstint;; the abore-spccitii-d siihstancos in an unmixvd 
form. Halter obecrves that certain animals arc dcstioyc<l 
by the use of sugar, although nutritious and salataiy to 
others. In Slurk's experiments, ivo have many examples 
of the indigestible nature of u diet composed of a single 
article, which was eaaily digMted when mixed with other 
subetanccs. In order to render M. Miigcndie's experiments 
onexc«]Hion«bIc, Dr. Boxtock* thinkit a diet Khotild havo 
t>cen tried, composed of a mixture of sulwlonceit dcMitule of 
nitrogen. In fWct, M. Mngtndie himitelf admits, thnt tho 
question is not yet settled, whether life can be long sap* 
port<-d by the Bok- use of nny one species of aliment, how- 
CTcr nulritivef. At the same time, it deserves pfirliculnr 
notice tbat, in 1750, a canviui of abore ono thousand 
Abyssinians, in consequence of having coiisumMl nil iheir 
pTOvisions, are aUoged to hare 8ut>KiNti-<i for two montiis 
entirely on gum arobic, which happened to be amongst their 
mercliandise:^. If this be true, it prove*, that man can lire 
on a single substance that was found by Magciidie to be 
insufficient nourishment even for dogs.] 

In general, the length of the alimentaiy canal is grenter 
in munmalta than in tjie subordinate clasaea. 1 1 diminisltes 
successively in birds, amphibia, »nd fishes; l>eii)g in some 
fishes even shorter than the body iUtelf, which is never the 
case in the first three classes; and in insects and womw 
is so diversified as almost to bid defiance to any kind of 
scientific arrangement ; being, in many instanoca short and 
narrow, as in the dragon-fly {libeilula); and in others, as 
proper hydatids and infusory worms, constituting the glo- 
bular membrane in which the entire structure of the animal 
consists, [On the whole, a long and complicated intestinal 
tube denotes that ttie iniM^ct feeds on vegetables ; while the 
contnry character indicates animal food. So capricious 
baa Nature b«en in the lower beings tbat, in the animals of 
corals and sponges, tho intestines of several individuals fte- 
quently communicate (c. g. in the animals of the pennatuta. 



* Etwi. Sr^ o' PhjiloltfO', ml li. p. MJ. 

; UmmHoK Voj^im, *c In llH Lonai, p. MM. 



PHTSIOLOUICAL VROKH. ^^ 

feadior) wliere tbo DUtrimcDt of all is derived fnnn a 
cominun source*.] 

AttacliEHl to tlic checks in some quadmpedB, m the Bucod 
monkey and mumot tribes, is n pouch or pocket, wliich ^^ ' 
conveniently hohh tht-ir Kp«irc food, or cii<ibl«i them to 
convey it to Uictr winter hoards. 

The moutti comtnuiiiciitcs with the stomach by the iong, <E»i>hii^>u. 
narrow membmnouit and muKcular canal, denominated the I^"„''^'' 
a!80[>haga«, OTguUet. 'I'hix in many animals is so dilatable 
lu to enable them to swallow animals much lari^r than 
themselres. 

[In thoM carnivorous animals which swallow voraciously, 
as the wolf, il it* very l»rg»; but in many herbivorous ones 
of considerable ttiite, and particularly such as ruminate, its 
muscular fibres are proportionably stronger, and capable of 
volontAr^' motion. The procew of rumination implies a 
power of rohinliiry motion in the ajsophaipis ; and indeed 
the inflocnce of tlie will throughout the whole operation is 
inconlestnble. Rumination is not confined to any particular 
time ; since the animal can delay it, according to circum- 
•(anoM, when the ])aunch in <]uite full. In the occasional 
examplM of the power of rumination in roan, the oporation 

nlaa found to be quite voluntary. The opening of the 
phai^ua into the stomach is markt;d by &ome diti'erences, 
witli regard to its size and mode of teriuination ; cir- 
eumstancea explaining why some animals, as the d<^, 
vomit very easily ; while others, as the horse, are scarcely 
Miiceptible of this operationt, which in the latter is aUo 
partly hindered from taking pluce through the mouth by 
the complete manner in which this cavity admits of being 
separated from tbe gullet by the velum palati.] 

We hare not time to follow up these playful diversities 
of Nature ; and must confine ourselves to a brief glaitoe 
»t the general structure of the buman stomadi, to 
which the oesophagus conducts. This is situated on the 
left side of the diuphrugni of midritf: in its figure it re- 
aembles the pouch of a bagpipe; its lofi end ta most 
capaoioos ; its upper »ido is concave, and its lower convex ; 
the two orifices for receiving and discharging tbc food arc 



■ Sot CaraCt Camp. Antt. wl. I. p. U. 

■^ Blunxnbwli'B Camp. Anut. p. ta— S7. 9i nlic 



I 



PHTSIOLOlilCAL rnoBM. 

SUBuh. siUiated in the upper part. In its Hubstaace it consistfi of 
three principal coats or layers, tlie cxtcmu) and intcniul of 
which lire iiivmbrunous, and tlio middle muscular. The in- 
temnl coat, moreover, i« liiivd with a villous or downy ap- 
puratuK, and iit extrvaicly convoluted or wrinkled; th« 
wrinkloH iiicreu.siti^ in »he as (he diimieter of llie atomach 
contractu. [Few pitrts are more largely supplied with blowl- 
veasels than tlie stomach, and it not only pnrtakes of the 
^langlionic nerves with the iteiglibouring vixcem, but it 
likewise derives another supply of nerves frvm the itpinal 
GOnl. and is dislingtuHhcd from every other purl, except 
the Qi^ns of sense, by hnvinf; a pair of cercbnii nerves 
almost entirely devoted to it, though it is situated at so 
great a distance from the brain*.] In an adult it will 
commonly contain three pints, or rather more ; [and, ac- 
cording to Soemmening, when it is moderately disteitded, 
it will hold from five to eleven pints. In opening some 
camivoroua aniniaitt directly after death, a middle rauacular 
constriction is noticed, dividing the organ imperfectly into 
two compartments. Sir Everard Home deems a similar 
constriction natural to the human subject, and dwells much 
upon it in bis theory of digestion : but, according to Socm- 
merriiigt, it is only occasionally met with iu female*, in 
whom he supposes it to be caused by the pressure of the 
central bone of their stays ; an opinion hiinlly to be credited. 
M. Itillman, ofOaasel. faw recently nolici-d the curioiut fact, 
that Uic stomach of the negro is rounder and shorter than 
that of the Eurapi-an ; and a still more rcnturknblo round- 
IKM exislit in Uic stomuclis of apes, as is rcprcseutod in 
Duubcnton's excellent plates. 

With respect to the uiuscutar fibres of the human 
stomach, the cpiestion is frequently agitated, whether they 
have any share or not in rejecting tlic contents of that 

VMniiing. vIbcus in the net of vomiting ? In IG^fi, M. Chirac gave 
to • dog; some corrosive sublimate on a piece of bread, 
which was alnxMt inimcdmtely vomited up, though a violent 
retching aftornurd<i continiietl. In thin state of things, 
tiie animal's aUlomcn ivn* opened, and tiie peristaltic 
BCliou of Uie stomach appeared to bo so feeble, that Chirac 



I 



•SmBomocIi'i Klrni. 6jrtLi>flt.r.kil(ig7. nU.ILp.443. 
^ fi w witiri afr in Uou. «( Utmu. AcmL of Jkamca. 




rilYSIOLOOICAL PnoBM. 



11 



was led to inter that the cxpolifion of its cont«ntK could 
ool be owing to it. Another statement », thnt when the 
cxpcrimentcr'tt finger was applied to the Btomach while the 
rvlching wan going on, no contraction of this organ could 
b« felt. Duv«mey also reganled the stomach as entirely 
pAMive in the act of Toroiting. Mr. Hunter, if b« did 
not go so far as the latter conclusion, certainly refers the 
chief part of the operation to the action of muscles*. This 
doctrine has received of late important corroboration from 
the experiments of M. Magendie. Two grains of tartarized 
antimony, diKKolvcd in an ounce and a half of water, 
were introduced into a dog's crural vein. Nausea waK 
quickly excited. The stomach was then made to protrude 
tlirough a wound in the abdomen; when the spasm of 
retching was plainly *etn to depend upon the action of the 
diaphnigm and abdominal mu»ck-H ; the xtomach itMclf re- 
mained free from contraction, and its contents were not 
discharged. Aft«r the stomach had been returned into its 
natural situation again, so as to be capable of being acted 
dpon by the above muscles, vomiting took place, and at 
the same time that viscus was felt with the fmger to be 
relaxed. When the nervi vagi were divided, vomitmg was 
not thereby prevented from being the consecjiience of the 
introduction of the (artari/ed antimony into the venous 
Ajratem ; a fact confirming the result of some expcrimenta 
le long 14^0 by Dr. Haigltton. Neither was vomiting 
liiikdered from being produced by this use of tartarized an- 
timony, when the Hbdominal muticles were removed, pro- 
vided the liuea alba remained entire, between which and 
the diaphragm, the ittomnch was yet subjected to the ne- 
ecuury comprf_4sion. When the phrenic nerves were cut, 
u)d the diaphragm was lell with only a supply of nervous 
influence from a few filaments of the eleventh and twelfth 
doml nerves, it was so weakened, that it no longer duly 
Utagonixed tlie abdominal muscles, and vomiting could 
only take place in a feeble way. Perhaps, however, the 
aiost curious experiment was that, in which M. Magendie 
removed the stomach, substituted for it a bladder com- 
municating with the oesophagus, and then threw llie solution 
of lartarizcd antimony into a vein : even under these cir- 



■ Animal Etanaiij. p.300, MeUu 



i 



PflVSIOLOOlrAL PRUBM. 



Valve of 

(he ratnn. 



ctunitanccs rctchinfr came on, and tlic contcatA of the 
bladder wore vomited up'. Aguinst tbcM experiments, 
others are recorded by Miiingiiult; nnd the subject cmo 
hardly be said to bo yet determined. It appeara howcrer 
tolerably clear, that, trea if the oonUoction or thi; Rtomftch 
Boiuetimea bappctiH in ordinary vomilitif;, it i» not ra»enltul; 
and that the action of tlio diuphragiii kiud al»doniinal muiiclcB 
are indispensable to the opciulion.] 

In the morv perfect claaaes of animeh, the division be- 
tween the large and sniull intestines ia dixtinctly indicated 
by a muscular vnlve, Tonned jointly of tlie eoiil« of (lie 
colon and the ileum by a short nattirnl introeuucptton of the 
terminating portion oflhulatturintotJie commencing portion 
of the former ; the important use of which is to moderale the 
Bow of the contents of the smaller intestines into the latter, 
and to prohibit a regurgitation of feces into the former 
And hence we never meet with fecal matter in the stomach, 
excefri in caaea in which this valvo or sphincter has lost the 
whole or a coDaidemblc portion of its muscular power. In 
the hedgehog, and several other cjuadnipeds, the valve of 
the colon does not exist ; nnd in a few others, as the sloth 
and armadillo, the coccum is wnnting. in birds, the rectum, 
at the tvnninntion of itK canal, forms an oml or elongated 
pouch, called imraa Fabricii, from the oanic of its dis- 
coverer: and then expands into a c^irily, which has been 
named cloaca, from its receiving the extremities of the 
ureters and geniul organs and their •eerciiona ; so that the 
fluids from all thoic are discharired from one common 
emunctury. 'Ilie same mcchnniAui is exlvndctl to a few 
cjuadrupeds, as tlie orMilhorhtfmhut paradaxH*. nnd the 
hgUrix : the penis of the mnle, ami the homa uf the uterus 
in the female being equally lodge<l in its interiorf . 

Contributory to the function of digestion which is per- 
formed in the stomach nnd the parts of the alimentary 
canal immediately adjoining to it, are several organs which 
Hurronnd it, and are connected with it in a peculiar manner. 
Of these the chief are the tmncrvnn, the liver, thu spleen, 
and the omentum. The two Inal are lesa consUntly found 
in the animal kingdom Uian iJie liver, to which they are by 



■ 

I 



* Aloci. (ur Ic V(aini«nisM H Phjilal. U It' p. 13IL 
t tsu t. Iloniu bi PtiU. Tiuu. 1B03, pL I ud 3. 



PHTSIOLOCICJIL PROEM. 

many pliysiolofjista suppoBod to be Bubservient. TIicj- ge- 
nvrally become more obecurv ordiiuimsh in size Crom qtia- 
dnipvclH to tislies : n remark that will equally apply to thr 
pancrcns, which u|>on thv whole disuppcars sooner than thv 
Kple^u. It is Touml in tlic xhark und the skate : but, in 
other tUhes. its pliice sccdih to be occupied and supplied 
by the ccECal appeiidicics and pyloric cixca. 

Th« laigcst and moM tai|)onftnt of all these organs is tJie tint. 
liver, by vfhich the bile \* prepared. U is the seat of a 
great variety of diseasea. mid appears to produce a very 
powwfol eflect on the biood itself, by the removal of fwvcral 
of iu principles, indepcodenlly of its office as a digCiitire 
organ. It devccnds, under some modification or other, fixnn 
mna to the class of worms ; and, in the? snail and several 
other gaateropodous mollusca is compuriitively very large; 
but, io vorkia* kinds, is dv^litute of a gnll-bladdcr, as well 
among quadrupeds as birds, fishes, mid womig ; though 
thia appcndn^ is common to all llic amphibia, many of 
which, aa the salamander, have livers of gicut miignitude, 

Alt thete organs co-opemtc in digestion, though tlie pc- Knvuloptnii 
coliar effect [>roduced by several of them is still a subject ""■'"'"W""- 
of inquiry'. They preiiotU to our observation a variety of 
curious stnictures, which wc shall notice more at large id 
treating respectively of llictr deviations from health ; and 
their surface is covered by a merabrnnous , plate, or sheet, 
KupiMMcd by Hnller to l>c of condcnseil celluliir membrane. 
Bichat has divided the proper membranes of the uniiiial Blchai'i 
fram« into three kinds ; Mrous, mucous, and fibrous. Tlie <'''""™ 

' ' of pIOpCT 

fint forms a common external coating for the viscera, mcmbnnn. 
wbMher subet«Dlial or hollow : it is possessed of few Scnnu. 
Derves, and is lubricated by a perpetually ascending hali- 
tus. The second, or mucous menibraneB, form »n internal Mueoiuk 
coating to the larger tubes and hollow viscera, mostly con- 
nected with tile skin at their extremities, as the mouth, 
nostrils, CTOOphagus and inte«tincs, the cavities of the 
urinary and the uterine systems. They are enrichinl witti 
numnous nerves, and tlieir structure iit loaded with minute 
glands, which secrete a muculenl fluid, with wliich the 
interior surface of the organs is constantly moistened. The 
third, or fibrous diviitioii of membranes, belongs to another Pibraua. 
set of organs, and consistv of the dura mater, which lines 
the skull, the membranous expansions of the muscles, the 
capftulea of the joints, and the sheaths of the tendons. 




14 



PHYSIOLOCIVAL mOBM. 



iwn. 



Ckjit. 



UtIMll. 



The aolid materials of th« food itrv usually first masti' 
cated and moiiitcned in th« mouth and lauctw. aod in this 
mtale am introduced into the stoiDEtcli.ivlicrc they are con- 
verted into a homogeneous pulp or paste, which is called 
fihyau : ihcy are then in thia pultooooua form introduced 
into th<! duodenum, ami, hy an uddttioiuil operation, trans- 
muted into u fluid, oHen prcMCUting a milky upiwarunce, 
and denominati'd chyle; in which state they are absorbed 
or drunk up by thousands and tens of thousands of little 
moutlia of very minute vessels, which nrc sparingly if at 
all found in tlio stomach, but which line the whole of 
the interior coating of the small intestines into which 
the stomach empties itself. These vessels constitute a di- 
stinct part of the lymphatic system. From the frequently 
milky appearance of their contents, tlicy are known by 
the name of lacteals; [but. as the chyle is not always 
white, perhaps a better name for them is chyliferous ves- 
aela]. They anastomose, or unite together gradually, and 
at lenglli terminate in one or two common trunks, the 
chief of which is tomiod the llionictc duct. Their office 
ia to convey the ditfercnt strcauiH tlius collected from the 
alimentur)- canal, as well as from other part» of the iKKly, 
to the siinguiferous system, to be still farther operated 
upon by the action of the heart and lungs. 

[The saliva, or spittle, the fluid with which Uie food is 
first blended in the mouth, wus lately extunincd by MM. 
Lcurot and Laesaigne, who found it to contain one |>er 
cent, of solid matter, consisting of free soda, muriates of 
soda and potass, and carbonate and phosphate of lime, a 
trace of albumen, and much mucus. However, the most 
remarkable fact, recently detected respecting the suhva, is 
one for which animal chemistry is indebted to Professors 
Tiedcmann and Gmolin, namely, the presence of the 
sulpho-cyanie acid in it, a poison of the greatest activity. 
All tlicsc physiologists, iu their account of the uses of tfao 
sidiTii, represent it ns lubricating the ahmcnt pieparatory 
to dc(;Uititioii ; lut brin^ingsapid bodies under the influeoce 
oftheor^nof taste, and as softening the food fordigeatton. 
I'iedemnnn and Gmolin further conceive, tJiat its animal 
principles aorve to asaimUale unazotixed aliments. 

In the above sketch of digestion, tlie function of the 
Iact4)«]s or chyliferous vessels has been curHorily noticed. 
It must now lie mentioned, that modem pliysiologistsdis- 



IMIVSIOLOUtCAt PKOEM, W 

agno very much about the extent of the office and power 
of tliCHC veKscU. Thus, M. Magendie's vxpcriioenu lead 
him to doubt, iu oppositiou to the Htntcmcnts of Hunter, 
whether they ever absorb any tltin^ tint chyle; and it is 
one of his doctrines, that all other sultHlunccii, und particu- 
larly drioka, are conveyed from thii iiliuicntary cannl into 
the circulation l>y the reins. It is the villi of tltc intvslines, 
he observes, formed in part by the orif^ina of thi; veins. ' 
which aliHorb all the licjuids in the small intestines, except 
the chyle. From the commencement of nbKoq>lion until its 
conclusion, the jiroperliea of those liquidg arc discoverable 
in the blood of the branches of the vena portsc, but not in 
the lymph, or chyle, till long after absorption has begun. 
Magendte's experiments also tend to prove, ibnt they then 
rench tlie thoracic duct, not through the ehylifcrous vctwcJs, 
but by the cnnmiunication of the artcrief with the lym- 
phntics. The vena poitse. which is the trunk of nil the veins 
of the dicCHlivc organs, divides and subdivides in the tiseue 
oftbe liver. Mow, certain other experiments, of which M. 
Magendie gives the particulars, induce him to conclude, 
that this arrangcmt^nt in tin: human economy has the eflect 
of mixing the matter absorbed in the intestinal canal by 
the veins, intimately with the blood ; and that, if large 
quantities of drink »iid other Ktibstimces, not chyle, were 
to be at once tnnsmittcd to the Hource of the circulation 
by the thoracic duct, without linviug undvr|:^ne a prelimi- 
nary change in the liver, seriouii and fatal couseijuences 
would arise. Tlic facts, on which this rcaHonlng is founded, 
are highly interesting. 

Sir Everard Home formerly entertained a particular 
theory, that fluids passed from the stomach directly into 
the spleen. Thnuirh his observations diwagrce very much 
with those of Mng<rndi«?, they corroborate one point main- 
tained by the latter physiologiat. namely, that fluids pass 
from the alimentary cantil into the circulation by some 
other channel than that of (he chylil'eroui; vessels. Strong 
arguments against ^ir Everard Home's thcor\' arc deduciblc 
from the fact tliat, if it were true, animals certainly could 
not exist and even enjoy good health without a spleen. 
Sometimes the spleen ts wanting in man*; and sonietimes 
it has been removed from aitimnln, which recovered and lived 

■ IJnuud. nm. i. p- S34. 




PHYSIOLOOICAL moEM. 



lion. 



1ndi|tatlbk 




very wolt*. The hy]>oth«flis ithm appears to be scarcely 
consi-stoiit wiUi what happens in the horse, whose stomach, 
which iH uikiill in propoftion to the size of the animal, could 
not contnin the immense tguantity of hay, grass, oats, and 
water, often consumed in a very short time; and it was 
nientione<l by Mr. Orecn, in his It-cturee at the college in 
1828, that ProfcHsor Coleman hud itsccrtained by experi- 
ments, that the paseag* of the drink into the inti-stineEOf a 
horse was frequently equal to llie rate often feet in a minute. 
In this animal, therefore, the intestines must at least psr- 
ticipale in the functiun, under onlinary circumstance*.] 

The means by which the food In broken down into pulp, 
after buing received into the stomacli, are various, in the 
lirat place, llie muscular tunic of the atomach acts u|>on it 
by a Blight contraction of iu tibres; and, in connexion 
with « certain degree of pressure, derived from the sur- 
rounding orerans, produces, so lar a.s this cauov operates, a 
mechanical resolution. Secondly, the hi}{h temperature in 
the stomach produces a concoctive resolution. And, thirdly, 
the stomuch it*clf sccreluM and pours forth fromihe mouths 
of its minute urteric» a wry powerful solvent, which it 
by far the chief u^cnt in the process, and thus ctTectaa 
chcmicid lesolution. In this manner, ibc moistenod and 
masticated food is convcrtetl into chyme, li (hen posse* 
into the duodenum, and beooues mixed with the secretions 
|)oure<) into this organ frooitbe pancreas, the liver, aodlho 
duodenum ilxclf.and subject to their action; and hence its 
converiiion into chyle. 

The whole process of digestion, therefore, OM it occurs 
in the human body, to which the description now given 
chiefly upplics, conKists of three act«; mastication or chew- 
ing, chymihcation, and cbylittcation. 

Many substances are so hard nod intmctublc as to m»- 
tuin iJie action of the digestive organs without any other 
change than that of being softened or otlicrwise partially 
affoGled, instead of being entirely 8iil«cted, and reduced 
tochyme or chyle. Such especially iirc the seeds of plant*: 
and it is well worth observing, though it has not yet been 
noticed by physiologists, that, while birds or other animals 
derive from this kind of food a very valuable nutriment. 



•Th. BMUMlini AnM. ^ l(UL LugO. 
FbjnfaOtBi, p. NS. 



Bm. Htno. Harit'* OvOmm tl 



PHVSIULOtllCAL PROEM. 



iiotwilliittandiiig its passing through them tvilhoiit being 
complctuly digested, the seeds themsclveti that are tbuK 
ucted u]>on deiivc niso a reciprocal Itenclit in many iii- 
«tiinces; aiid nrc hereby rendered mon.- easily capable of ex- 
panding in the soil into which they are afterwards thrown 
ax by accident, and have their productive power very 
greatly increased. The olivo-troe has till of late years Sinp>w 
only been raiwd in the south of France by cuttings, or ^^"^ 
wild plants obtained from the woods. It was remarked by dUtc*. 
an attentive inhaMlant of Marseilles that, when prodnced 
ncturolly, it is by means of kernels carried into the woods, 
nnd sown there by birds which had swallowed the olives. 
By thi- net of di[;<-stion, he further observed, theso ohvea 
are deprivt^ of llicir naturul oil, and the kernels hence be- 
come pcrmeshle to the moisture of the earth; the dung of 
the bird at the same time scning for manQrc, and perhaps 
tlie soda which the dun;; contains, by comhinin>r with ii 
imrtion of the oil that lias escaped digestion, still further 
favouring gerntinalion. Following up this fact, a number 
of turtkcys were made by the experimenter to swallow ripe 
olives; the dung wa<i collected containing the swollowecl 
kernels, the whole was placed in a stratum of earth, and 
frequently watered. The kernels thus treated vegetated 
easily, and a number of young plants were procured. And 
in order to produce upon olives an eflect similar to that ex- 
perienced from the digeBtire power of thestomnch, a quan- 
tity of them wert- afterwurds roaeemted in an alkaline lixi- 
vium ; tliry vtvrv then sown, and proved highly productive. 

Moat of the plants found on coral ifilands, and in various v«(E«iaiinn 
other plhcos, arc propagated by the same mertnw of gmEsing f™™"'"! 
through the difjcstivc cunal ; nnd it is prob.ihle that the di-jecii^* 
seeds of many of them are equally asBiBtod by (he smne 
process. And even when they are completely disorganized 

'■nd dtgested, the material to which their refuse is con- 

fverted, and which, combined with the animal secretions 
that accompany it. is called dung, very powerfully con- 

[tributes, as every one know*, to render the soil productive. 

I So that, by the wisdom of Providence, unimni digestion 
artd vegetable fniclificalion are cqnally dependent on each 

I other, and are alternately caiiices and ctfects. 

Considering the comparatively 6>lender texture of the 

ichief digesting organ, and the toughness and solidity of 
VOL. I. (! 



i 



18 



rMYSIOLOtiirAL PBOBM. 



hypMhcM 

Mtumlng 
■he Hf^. 
1m pin>«r. 



Thar 
nilililjr. 






the suhAlancM it ov«rcom«fi, it cannot nppcar tmrprUin^ 
thu maDkind should, ntdiflcrcnt times, have run into ft 
Tiiricty of mistaken theories in accounting for itit modi: of 
action. Gnipedoclcs and Hippocrates supposed llie food to 
Itecooie softened by a kind of putrefaction, (iaien, wlu 
doctrine dettcenif ed lo recent times, nnd was zealously eui 
ported liy (irew atul Santarelli, attcribvd tb« eflcct to con 
c«H.'tion, produced, like tlicripcningtind softening of fruitv] 
bcncuth u Eumnirr sun, by the liij^h temperature of tti 
stomach. Pringle and Mucbndc advocated the doctrin 
of f<.-nnt'RtatJon ; thus uniting the ln-i> causes of heat and 
putrefaction aaaigned by tbe Greek nriterti: wltile ilorelli^ 
Keil, and Pitcairo reaoked the entire proceM into mc 
chanical action, or trituration; thus mnkint; llic tuuKcuIarl 
coating of the stomach an enormous mitlatone, which Dr. I 
INtcaini wiis extmvagnnt enough toconceivc ground down , 
the food with u pressure equal to a weight of not leasj 
than a hundred and seventeen tllousand )M>utMls, assist 
at the same time in its gigantic labour by an equal pre 
ure derived from the surrounding muscles. 

Each of the«e hy]>otheses, however, being encumi: 
witJi insupcriiblc objections, Boifrhaave endeavoured tO| 
give tlicm force by interunion, and heticc united the nio< 
chanicalthcory of pressure with the chemical theory ofcou 
coction ; while Hallcr contended for the process of luaccra- 1 
lion Still a Eometliing eW was waiiling. and continut'd tol 
be so, till Cheselden, in lucky hour, ihrevr out the bint, for j 
at first it was nothing more than a hint, of a inenstruum < 
secreted in some (>artof the digestive system; n hint which ' 
was Houn eagerly laid hold of, and successfully followed! 
lip, by lluller, Kenumur, Spallanzani, and other celebrated | 
physiologists. Although Cheselden was nrntidtcn in tb«{ 
peculiar fluid to which he a&cril>ed the solvent energy, 
namely, the sahva. still he led forward to the >iu)>orlnnt 
fact; and the gastric juice was soon aftervrurds clearly 
dcteclmt, and its power incontroverlibly established. 

[The doctrine of digestion by trituration, or mechanical 
principles, was founded in n great measure upon an im- 
perfect ncquuintance with the digc«tive oi^ana of birds. 
Although hinis are not fumishwl with leellt, many of them 
frd u]Hin hard substances, which, if they were unbroken, 
tlie gastric juice could not dissolve. lU-nce Uiey are fur- 




rnvsioLoctCAi. pdorm. 



19 



niahed with a crop, which ia a lar^ membranoug cavity nt l>i|cc«ivr 
the lower end of the gullet, for the rpcoplkm of the food j)^'"' 
when it is Rnt swallowed, and whe-re it is Koften«d by ihc 
wcreted fliiidu of the part. They are aliso provided with a 
frraian), into which the food, after being luacernted in the 
crop, \» transmitted. The gizzard in a cavity of a. moderate 
and tintliith nplK^rical form, romposcd of four strong 
des. Twoof thcNc, which coimitntc the grentest part 
itx bulk, are of an hemictpherical shape, of a dense and 
firm texture, and lined with a tliick callous membrane. 
The ctfect of their nction is to move them laterally and 
oblii]ueIy upon each other, so that whatever is placed be- 
tween them is subjected to a vory powerful combination of 
friction and presBure. The force is such, indeed, na not 
only to break down the hardest grains, and reduce tliem 
to & complete pulp, but even to grind to powder pieces of 
glau,aDcl to net upon siliceous pebbles and masaea of metal, 
while the cuticular lining is so tough as not to be injured 
by the presence of lancets or other sharp instruments, 
which have been introduced into the cavity by accident, 
or for the sake of experiment. As Dr. Ilostock remarks, 
boweyer, the action both of the crop and tJic gizzard must 
be considered as essentially mcchunical. the latter being 
equivnlent to the teeth, and the former serving merely for 
the purpose of maceration. A strict connexion is always 
remarked between the food of birds sind the nature of their 
■tnmtch* ; thoKc alone possessing the gizzard which swallow 
substances that the gastric juice could not dissolve in the 
entire state. Many writers, in describing the muscular eto- 
nachsof grunivorous birds, speak of the gizzard as ana> 
logoiiK to tlie digesting stomach of man, «r of non niminnnt 
r|i)ndni[)edk, whereas it is only a substitute for the organs of 
in^licnlion. Spnilanzani proved, however, that the tritu- 
rated substance in the giijard is acted upon by the gnstric 
[Jnice, which is fumislied by a glandular apparatus, the 
f nulbuB gtandulosus, siluntcd at the lower end of the gullet; 
the fltructure of the gizznnl being evidently not adapted 
to itii secretifHi. In birds, therefore, digestion is produced 
by a powerful solvent, just as it is in the human subject.} 

The gastric juice, this wonderful mcmlruum, the most Qu^nili'rf 
BCtire we are acquaintod with in nature, is secreted, ati 
I hare already observed, by the capillary arteries that in- 

c2 



JULCV. 




PHYSIOI.OGICAI. PROEM. 



finit«Bimally intersect the cellular texture of the stomacb, 
wid decussate each other io their ramificntioas. Thv quun- 
lityaecretfddHringcIigcstion isconsideraWe: MM. Leuret 
aitd Lassaigne found, liiat when the gullet of a horac was 
tied, ao OS to prevent the secretions of the mouth and fillet 
rrcim entering the stomach , n full nica) of oats beciune com- 
pletely liflturHted with gastric juice in four or five hoan. 
Mr. Cniickshnnk suppoiics the quantity of the fluid thus 
secrctixl to ho about a pound in every twenty-four houra. 
Yet the quantity Beems to yary very considerably according 
to the dcmmid uf the i^ystcm, or the state of the rstomach 
itiiclf. In carnivorous birds, whose stomachs are called mem- 
branous from having Uttle muscularity, and, consequently, 
whose food is turned into chyme pnnei]Kil]y by the action 
of the gastric juice, without any coUaleral aa.i)i>tai>ce or 
previous mastication, this fluid is secreted in a much larger' 
abundance; as it is alio in those who lal>our uitder that 
morbid state of the stomach which is called cnnine ap)>e- 
titc, and will be dibtingui^hed in the present clatmifieatioti 
by llie name of /uncuii tivem: as iikewtxe when, on re- 
covery from a fever, or after long abntiueitce, the syxtcin la 
reduced to a statv of great exhaustion, and a keen sensti 
of hunger induces a desire U> devour food voraciously and 
almost perpetually. 

[Lcurct and LassaiKuv invariably found the gastric juice 
Uw unoit to be acid ; and they state iU coiiiponeiit parts to be water, 
i")**- hydrocbloratc of ammonia, chloride of Hodium, mucus, an 
animal principle soluble in water, phosphate of lime, and 
lactic acid; and ihvy impugn the accuracy of Dr. Prout'a 
experiments, who concluded the free acid evolved duriii^ 
digestion to be tJie hydrochloric. On the other hand. 
Tiedemano and Gmeliu observe that, if the contents of the 
stouiacb be examined afWr a lon^ fast, and uilhout any 
stimulus being applied to its villous membrane, the fluid 
found'ia it is a clear, ropy, rntJicr opaque liquid, nearly or 
quite destitute of acidity. But if any stimulus, even of 
(he simplest kind, be applied to ibe inside of the stomach, 
then tlie lluid secreted is unifoimly acid. Pure gaalrio 
juice wan best procured by making animals swallow quartz 
(icbbloi after a long fast, luid killing them in an hour. It 
was generally gTayi»li-whi(e, rnpy, and decidedly acid. 
When taken froui the dug uihI the hone, itcgnluined soulo 



niTSIOLOGICAI, PIIORM. 



21 



Finucut;,<Kma2iime, and salivary mntter, alkaline sulphstot, 

[ami liydrocltlorutvs, the alkati being chiefly soda, bcKidt^ 

[phosphate and nuiiiatc of lime, with other salts in minute 

[proportion ; and the acidity was owing to the hydrochloric 

[bikI acetic acids in the dog, and to these conjoined with the 

rbutyric ucid in the horse. As the lactic acid of [.curet iind 

He is now acknowledgfid by Derzeliusto ben variety 

' the noetic. »ll (larticit may bu re^;arded aa agreeing about 

Jie presence of that acid in the gastric juice. The re- 

irchc« of Prout, Children, and Graves, confirmed as they 

have been io amply by Tiudeiminn and Unielin, itlxo fully 

tablish tlie pn'«encc of the hydroc4ilaric scid. When 

Khe liecrelion of the gwitric juice is elicited by its natural 

^tiiuulus, food of various kinds, the chymons mnss is in- 

bljacid; and Tiodumann and Guielin furthermaintain, 

I the re^tull of their experiments, that its acidity i* gresit- 

Ix't whtD the focHi i» most difficult of digeMion. in do^ 

I mnd caU, the greatest acidity was remarked when they wore 

ihd wUh coagulated albumen, fibrin, bones, or gristle; it 

liflH when they took utarcli, gelatin, potatoes, or rice; 

id when they were fed with liquid albumen, the alkaline 

judity of the food nas nearly sufficient to neutralize Uie 

cidtty of the gastric juice.] 

Tliis singular secretion has the peculiar property of 
Lcoagiilaling milk, as well as all albuminous substances. 
[which it id«o as comj>Ietely dissolvcR; and hence: tlio milk 
up from the stomach of an infant, shortly after 
king, is always found in a curdled sWie. [By infusing 
tatx or seven grains of the inner coat of the stomach in 
IwBter, a liquor is produced, which, according to Dr. For- 
Jyc«, will coa$^lale 100 ounces of milk ; or, according to 
'Dr. Young, of Edinburgh, fiH/iT tiraea iu weight of milk.] 
[But the two grand and characteristic properties of the ga> 
■trie juic« arc its astonishing power of counteracting and 
Icorrecting putrefaction, and of dissolving the toughest 
land most rigid substances m nature. 

Of its antiseptic power, abundant proofs may be ad- Amiirptlc 
luccd from every class of animals. Among mankind, an<i ^p™ ^ 
Ijeapecially in civilized life, tlic food is usually eaten in n juke. 
Istate of sweetiie»( and freshness : but fashion and the 
f luxurious desire of having it subacted and mellowed to our 
rbands. tempt us to keep several kinds, an gumc and venison 
for example, as long as wc can endure the suidl. The 




l-UVSIOLOUlCAI. moKM. 




wandcfing lionle* of gipaUw, however, and the inhabitants 
ol' various Hitvage eoantriot, nml etipvciulljr tlioM nbout t)ie 
mouth of the Oraiigo Kivcr in Africa, curry thin tort of 
luxury to a much hijchor pitch; for tlicy eecni to regard a 
fetor aa a perfume, ftud value their food in proportion as it 
approaches putrefaction. 

Now, all ihwe foods, whatever bo the degree of their 
putridity, arc t-qually restored to a state of sweetncu by 
the action of tho gastric juice, a ihort time after they 
have bvcn introduced into the stoiniich. Dr. Fordyco 
made u vuriety of experiment* in reference to this Bubjeet 
upon the do<r; and found, in every instance, that the moat 
putrid meat it could be made to swallow wan iu u very 
short period deprived of it* puln-wency. We cannot, 
therefore, be surprised that crows, vultures, and hyenas, 
which find u plcaeurcin tainted flesh, should (iitten upon so 
impure a diet ; nor that the dunghill should have ila 
courtiers, among insectti, as well as the flower-garden. 

The gastric juice has hence been employed as an anti- ' 
■eptic in a variety of cases out of the body. Spallaniani has 
ISceitaincd tltat the gastric juire of the crow and the dog 
will |)reserve veal and mutton perfectly sweet, and without 
loes of weight, thirty-seven dayit in winter; whilst the 
■amc meats, immersed in water, emit a feti<l stnell as early 
as tlie seventh day, and by th<! thirtieth are resolved into 
a state of most olfensive putridity. 

PhysiciarM and surgeons have, in like manner, aToiled 
themselves of this corrvclivv quality ; and occasionally cm- 
ployed the i^stric juice of various animals, intonially, in 
eased of indigestion from a debilitated stomach; wmI ' 
externally, as a check to gangrenes, and a stimulus to \ 
indolent ulcers. 

Yet the gastric juice is as remarkable for its solvent as] 
for its antiputrescent property' Of this any ioditstriousj 
observer may satisfy hiinstilf by attending to the economy i 
of digestion in niiiny of our most common HiiiniiiU. But it | 
has been strikingly exemplified in the ex|>crim4!nts 
Reaumur, Spallamcani, and Stevens*. Pieces of tlw] 
toughest meats, and of the hardest bones, enckMad iaj 



tct Dt. Swraw** (■ptrlmcnia, *t)kh <rr nuuiovui anl nU.<«nlMl(*l(i 
N* kU IHwtuUo nrtdnlORka liaugwnlU; n mi toulpli cT ii la Mihj 
.*0L*. P.IM. 



rHVttoi.ocirAi. rnoiM. 



33 



small pCTforatc^l tin caaes, to guard agvinst all mui«:u)ar 
action, were rc|>oale<]ly. by the two former of the«e |>hy- 
tuologifits, thruttt into the stomach of a btnzard. Tho 
meats were unitbrmly found dimiiiiehct) to three- fourths of 
their bulk in the space of twenty-four hours, and reduced 
to slender threads; and the bonea were wholly digeHted 
either upon the first trial, or a few repetitions of it. The 
f^astiicjuiceof iidot; iIih^oIvcs ivory and the enamel of the 
teelh i that of a heii has been found to dissolve an onyx, 
atul diminish a louin^d'or. And it ix uot many years ago 
that the handles of several clanp-lcnivcs were fouii<l hulf- 
digested, and the bliidex blunted, in the atomach and 
intestines of n man who hud Komc lime before swallowed 
tlieae subslanccH out of hnrdihood, and ut IlikI died in oiie 
of the huMpilab of thi« metropolis, [The recent exjieri- 
laentM of l^uret, LH»».n^ic, Tiedemnnn, and Gmelin. all 
coofint the utatcnienu of !^pallan}.ani, Stevens, Goase. 
and ollieni, and contradict tJiofic of Montvgrc, who su)>< 
poted that the guKtiic juice did not act out of the body, 
MM. Leuret and LaMuigne remarked, that tlie fluid 
procured by Ion):; sponges from the Mtmnach of a duck 
wliiltf fuKting, when kept upon bread cruuut, at a tcni< 
peraturc of 88 degrees Fahrenheit, soon divided them into 
xoiiiute particles, and formed with them a homogeneous 
BUBS, precisely like chyme; and that, whea flesh was 
mixed with the gastnc juice of a dog, it was quickly 
Mftened, and deprived of weight. The observations ofTiedc- 
maiin and Gmelin are more particular. The fluid found 
in the stomach of ii dog, during the digestion of bones and 
cougulated albumen, was made the Mubject of experiment, 
and comparative observations were made with water and 
with milk. Vurious kinds of food were tried, such as 
bread, coagulated albumen, raw fle*h, and boiled llesh; 
and in every instance it was observed, that the bread was 
broken down, in tlie courac of eight or ton hours, into 
a pap, and the surface of the beef and albumen was con> 
verte<l into a pulp, which could be easily scraped off. 
Mont^gre in supposed to have failed in procuring simihir 
rtstdts, bccuose the fluid with which be operated was not 
gastric juice, secreted in consequence of the application 
of some stimulus to the stomiicli, but a mixture of saliva, 
the mucus of the gullet, and the kind of fluid found by 
Ticdomann and Gmelin in the litouucii while empty and 



i 



PUYSIOLOUICAL PROEUi 



^^^^ notclimuliiU-il. Yet MM. Lcurct nnd Luaaigne, it » to 
^^^B bo obwnred, succeeded with the i;iuitric juice of b duck. 
^^^^M though the animal was in the fasting «tutc. Aconvtncing 
^^^^1 ]>i*M>r ol' tlio power of tlic gastric juice to dixiwli-e sub- 
^^^H etuDces oat of the body, as well as of iu great untiEeptic 
^^^^1 properly, ban lulely been jitit upon record. A lad had. 
^^^^p a fUtulouB opening leading into the stomach, from which 
^ the gaHlric juice vrsu readily procured, by meaua of a 
^^^^ hollow bougie and cltutic iKitile. A piece of beef, con> 
^^^H nected witJi a. thread, wtus itiira<Iuced into the Htomach, 
^^^^1 and nnothcr piece wn<i put iiilf) a phial of gastric juiee, thu 
^^^V teniperjturc of which was 100^ the Kniue n» that within 
^H^ the Mtomftdi iteelf. The piece in the phiul underwent m 
^H perfect diseoiution, though more slowly than that in the 

^H stomach, probably in consequence of the latter being con- 

^^■H tinually exposed to freab ({a&tric juice, and the peristaltio 
^^f Hction of the stomach. Solutions of heef and chicken 
^H thus procured, remained a whole month iu hot weather, 

^H free from fetor and sourness*. Ticdcmann and Gmelin 

^H even attempted to accomplish, by means of Ihc Hiinptc sub- 

^1 stances contained in the gastric juice, the same ftulution or 

^H digestion that is elfuctcd by this secretion itself; uml they 

^^^^ found tiiat dilute acetic acid, dilute hydrochloric ncid, 
^^^^P a weak aolulion of acetate of ammonia, will severally di«- 
^^^^ «olve inoHt animnl anbiilances used aa food. The expvri- 
^H incnt«, however, tire incomplete, because tlie e)f<-ct of the 

||H tbrogoing articles united together as Uiey are in Uic gastric 

"■ juice, was not tried.] 

l\n«Tor It is in consequence of thia wonderful |>owcr that the 
"'"dtolT'* s'o"™^"*' '' sojuelimes found in the extraordinary action of 
itM^ digesting its own sclfj and of exhibiting, when examined 
in dissMtion, various erosions in different partK of it, and 
cspuciiilly iibout the upper hiilf into which the gustric juice 
is supiKMod to tlow mo«t freely. It was thu opinion of 
Mr. Hunter t, however, tliat such a fact can never lak« 
place except in cmwit of sudden dcvth, when ttic stomach ia 
i a full beulth, and itie gastric sccretiuii, now just poured 
forth, is surrounded by a dead organ. For be argtiM 
plausibly, tliat the moment the stomach begins to be dis- 
eased, it ceases to secrete this fluid, at loisl in a statu of 




■ Annlcan UUkai newdtr, Jinauy, IBSO. 
t PUL Tan. 177% >i>l. Uii. f> UJ. 



(•UVBIOLUUICAI. I-KOEM. 



as 



[perfect Activity ; Aiwl tlint no long a* it itt itself alirc. it ist 
[capable, by iw living i>riiiciplc. of coiiiilcructinK ihn flTwt 

4' this HotveDt power. Yet it lias been found thus eiYKlcd, in 
[wme caaes. wlicre death has followed long oonstitulional 

Jlne:». But in such ioataneea it has be«n euB;g:cgted, tJiat 
lie stomach itself might have been free from the general 
^diMaute ; (a HUppOKitiwi much nt variance with certain cases 
{•lid ditiseclioiis * RiuiitioiMKl by l>f. Armstrong.] Dr. 
IWibon Philip has occHxionally found similar erowons in 
Itltc stomachs of r-ibbits-t-, and apparently from the cauRe 
LBUfipccted by Mr. Hunter. 

Jt is only [icrhaps upon the principle here laid don'n by j|,^ji- ^f 
I Mr. Hunter, tliiit when the stomach is in a state of dtaense «uiiiii.«fr 
ceased to seetctc a gastric juice of full vigour and ac- UJ^^^, 

jvity, that we can account for the existence of exotic worms 
land Uie laivfE of insecta and other nnimaU for a const- 
[derable period of time without destruction. Thus Collini 

give* na example of n laeerta ai/unlica found alive in the 
[stomach two days after it had been kwuI1owc<!]:. Frogs and 

serpents haw fur a lon<;;er period uf time bcuu equally able 

to resist the action of the stomach; leeches sivnllowetl uii- 

intentiunally. in a draught of muddy water, have thriven 
[and grown to an enormous size; the eggs and larvni of 
I Viirioae insecU, and CApecially of the munnt ciharia, and 

even of the spider, liave been hntched or perfected in the 
[Btomacli or intestines, and tlte kernels of plum and 

cfaeny stones hsve gcrmiiitttod there; all which we shall 
I have occasion to notice more at lenc:lh when treating of 

invennination iuid the diseases of the stomach ■ 

Muscular action, however, to n certain extent, seems HowCk 

Rtill retjuUite as an auxiliary in man, und even coniiidcTably ^^^ ^^^ 
^more so in many uiumals, especially in graminivorous and iiutau. 
fgnuiivorouH birds ^. I have already stated this as one 
Lcawc of digestion: but M. Magendie has endeavoured to 
T restore it to a much higher importance than fair and 

oncquivocal experiments justify ; for he iisMcrt^ thiit, what 

he CAilnartf^ciai digestion, or that of alimentary substances 
.mixed with th<f gastric juice, ajid exposed to the tcm- 



■ U<>TbldAaat.Dr:licIkmli,«ir. p.43.iIkiiinURll))FpUCc9,'ltn.Laril. I8SS. 

t TmiuB on IndiKncion, &c, p. U2. Ont. LihmI. 111^4. 

t JtiatD. ie M*i- tam.lt.f. 40v. 

j Ate Hti E. llonHi'i uucId, riiil. Tnuu. vol, xcvL p. 3^7 i uvii. 




■•IIYSIOLUUKTAI. rilOEM. 



InHuouc 
oritK pii 



peniture of the Rlomach, doeit not )tuccc«d in reducing 
the food to a xtatc of chyme. But lliix, admitting the 
fact, would only iihow us the use of » living principle, 
and its influence upon every orgun, nnd the ojwntioa 
or fuiwlioii ofercry organ; and which cannot be imitated 
outofthebody. The aHsertimt, however, is only advancal 
upon the Hiiigle authority of M. MunU^gre, [the fnilurv 
of whose experiments, at we have already noticod, ia 
imputed by otliers to the fact, th»t the fluid with which 
be opcTuliMl was not gastric jutcc, secrtted in codk- 
<|ucnc« of the upplicution of some stimulus to the stomach, 
but a mixture of saliva with the mucus of the gullet, 
and the fluid found in the stomach while destitute of food, 
and not stimulated. In the artificial imilatione of tbcpro- 
cefw of digestion, Uie chuniing action of the stomach, how- 
ever, ought ccrtninly to have been taken intocoiuideration, 
and a substitute for it adopted. 

Tlie influence of the par r^um on digestion is ati in- 
teresting subject, that has excited conudeniblc attention. 
Mr. Brodie divided these nerves on the eardia, yet tlie food 
still continued to be tiansfonned into chyme. M. Ma- 
gendie took out a ]>ortion of a rib, and divided the par 
vagnm on the crsophagus immediately above the dia- 
phiagm. Still the convention of the food liolh into chyme 
and chyle wait not interrupted. However, when the same 
nerves are divided in the neck, and imrticularly when a 
portion of them is removed, the formation of chyme is 
either very iraporftct, or even quite prevented. The in- 
vestigations of Dr. W. Phibp, Breschct, and Kdwarda, 
Ualnaunn. prove, that galvanism applied to the stomach, after tlie di- 
vision of tJie par vagum in the neck, restnrea the digeatitc 
proccM ; and hence, the doctrine that digestion depends 
upon galvanic principles. The fact, however, may only 
prove, that ^Iviinisni is a sufficient stimulus to the veaaob 
of ihe stotuach lo cniiblv them to continue for a lime the 
secretion of the gastric juice. 

Witli respect to the power of the nervous avHtem over 
digection, a curious fact was domonstratei] by the experi- 
ments of M. Magcndie; namely, thiit when the bmin ami 
a large portion of tlic cerebellum of a duck is removed, 
though the instinct of seeking food and even tlic power of 
deglutition mity be lo<it, yet, if food bo conveyed into the 
stomach, it will be dij^Cbled. 




PBYSIOLOOICAk PROEM. 



87 



It u frequently statod, that durinii; cbymificuLtion both 
orifices of the Etomacli are closed : but, according to 
M.Magei>dic, this point requires confinnalioD. Hie ex> 
pcrimetits leach him, that the return of food into the (r«o- 
phaguB IB prevented by an alternate motion of this tube, 
th« oontmction of which becomes titrongcr, and the relaxa- 
tion shorter, the more thv Hlomuch is dtstcudod. The 
contraction happens at the moment of inspiration, when the 
stomach receives the greatest degree of pressure. With 
respect to the pylorus, its resistance was found by M. 
Magcndie to be ditlcrcnt. In livin<^ animaltt, whether the 
ctomacb be empty or fall, the pylorus is ahnt. Another 
constriction ia frequently seen an inch or two from it, seem- 
ingly di'signcd to hinder the food from rencbint; it. Irre- 
^lar and peristaltic actionit xre -lUo noticed, bc^innin!; in 
the duodenum, and extending to tlic pyloric portion of the 
•tOBMch, the eflect of which must be to pre«s tJie food to- 
vunU the cxaopbagMl end of this orgwi*. On the other 
liand, Sir E. Home repreMmts the stomach an divided into 
two compartments, dnriag digestion, by a muscular con- 
striction ; the cesophageal one betii^ for the reception of 
duids, which he conceives paiis thence directly to tlie spleen. 

If, however, we are to believe other accoantx, the cardiac 
portion of the stomach m the chief seat of diirention ; and 
when a part nf the food hiw there been acted upon in a 
certain degree, it in conveyed al<Hig the large curvature to 
the jiylortc portion, where the procc&s is completed. It 
■wmt also now to be established, that the digestive process 
doMQOtgoon equally through the whole mass of the food, 
but piincipally where this in in contact with the stomach ; 
tiiat it proceeds gradually from the surface to the centre of 
tlie mass, and that, an soon as a (wrtion is reduced to a 
ImiuogcncouE conHiatence, it in transmitted into the duo- 
deuuro, without the delay that would reMult from awaiting 
a simUar change of the whole+. 

The food hitving undergone a sufficient degree of ma- 
ceration and mastication, or other mechanical process, by 
which it is reduced to a stale of sulTiciently minute division, 
it is acted upon by the gastric juice and the peristaltic 
contmctions of the stomach, and the result is a complete 



U'tirtlm 
I lie iiririm 
a( Oic •■»• 
niich in 
clowdf 



DilCnlion 
lalil la ukc 
I'lwc 
chlL-ltr In 
[IlL- oudiiic 
IHrriioii. 



llMiion. 



■ nice IMiptoL tniuL tiy MlIltKin, 3d «dit, 
t Ftoui, ia AjumIs uI Plitlot. 1SI9. 




PIITSmi.or.lCAL I'ROEM. 



change in iu properties, ils convemon into ch^-mc ; an al- 
b^mtioii in every respect nualogous to a chouiicol change. 
During (h« process of chymiGcation, hent is occasionally 
extricated, snd not unfrequenlly gas is cvoKcd. Dr. Bo- 
stock, however, regards these not as necessary steps in the 
process, but rather »» the consequence of a inorbid state 
of tlic function. Prcvionsly to Dr. Proul's experiments, 
tlie gooeration of acid in the stotiiach useil to be considered 
in the same [>oint of view; but these lead us now to believe 
it to be GsscntiAl to the fonnstwn of chyme *. 
niinw. Chyme is not always of Uie ume quality, its properties 

dopendmg vciy much upon the nature of the food. Ac- 
cording to recent experiments, made on dogs and horses, 
it appeant tJtal hquid albumen fonns umter the natural 
|)rocv))-t of digcstiou a homogeneous fluid, in whicli the 
albumen remains quite unaltered ; and this sort of chyme 
passea tJie pylorus more rapidly thiin any olher. Coagulated 
albumen is much more slowly dissolved, and tltc lluid ]>ro- 
duced posaosHS the properties of coagulated albumctt dis- 
solved in acetic ncid. Fibrin and vegetable gluten undergo a 
himilar change. Gelatin is converted into a (.-leur brownish 
fluid, in which neither gelatin nor albumen can bcdiscovcrDd. 
White cheese forms an opaque dirty wbitcfluid, containing 
much animal mailer, which, however. Is nciUicr the case 
with gelatin nor albumen. Starch is gradually dissolved. and 
loses its reaction witti iodine, being converted into sugar 
and siaidine. The results obtained with compound articlea 
of food, such as milk, beef, bread, and oats, in various 
states of mixture, were such as (he foregoing facts would 
lead one to anticipate. Bones gave a liquid tliat contained 
not only animal matter, but likcwiMi a large quantity of 
lime. The general tesult is, that nil the anininl principks, 
except liquid albumen, undergo a material change during 
chymification, which change generally consists in their 
being made to approach nearer in their nature to albu- 
men +.] 
INgMiw So far, therefore, as the or^ran of the stomach is con- 
Jl^^i^' corood in the digestive function, wo have some insight into 
1^1^ the process. But beyond this, that is to aay. of tho naUin 



• BIcn. Spl. «f FhyM. n\. i\. p. 401. 

tSee dii writing of MSI. l,cuni uid l^aaiKnc. and of Tt u i in i in 
iMib, «t £dhL Med. and Surg. Joun. No. 93, ^»(l. 




PHYSIOLOOICAL PRORM. 



59 



for chylitication. we have lilUe or no knowledge that can 
I be dcfKiided upon. 

The alimctit having been reduced to chyme in the ato- Chyliks- 
Imuch, in prupcllcd into tho diiodenimi, where it is cun- '^' 
f Verted purtly into chyle, which is absorbed into the system 
from Uic small iutetitines, and partly into a reeidual niatter, 
tthat assumes the nature of feces in the large intestiiieK, nnd 
Ije tutimately rejected from the system. As it u into th« 
duodenum that the biliary and pancreatic ducts dischai^ 
I their respective fluids, chylilication is [^nerally preAumod 
' be ewentialiy connected with tltc action of the hilo and 
Qcrmtic liquor. 

[The conKtuncy of the liver in almost all animals, its mag- Funnion 
Initude, and tlie destructive and grievous consequences''^'''*''^''' 
[•rioini; from its diseases, arc very convincing proofs of its 
hi|;h importance in the animal economy. With thctx facts 
' before us, it may seem rather vxtraordinury that physiolo- 
I Hhouid not he in possession of some clear information 
ting the functions of the liver, and the uses of tlie 
Fbite. In particular, the action of the latter secretion in 
[chyhfication is yet very imperfectly understood. Its or- 
' dinary production from venous blood is a peculiarity that 
does not beion<; to any other sccrclion ; while the ^reat 
ditlerence of il« chemicul qnatitics from thu»e of every 
otlier Huid in the body is a point not lens remarkable, and 
worthy of observation. According u> tJie generally re- 
ceived opinion , the bile contiibules in some way or another 
to the process of digestion. Fourcroy believed, that its 
saponaceous property made it capable of uniting the oily 
parts of the alimentary matter to water ; thnt its bittcnieNs 
was an indication of its being a stimulus to the intestines ; 
and that it was decomposed by the acids usually produced 
in the digestive organs. At the same time, bethought that 
the bile served another purpose, besides that of promoting 
digeslJon. He conceived that the blood, in its circubtion 
tliroughthe veins of the liver, acquired a fatty quality, and 
that the bile was a kind of reservoir of hydrogen, which, 
if loo copiously diHused in the Rystcm, might produce a 
disturbance of the vital functions. The liver seemed to 
him to be intimately connected in function with the lungs; 
for, in the fectus that has not brenthed, its size iN very con- 
siderable, and whatever might be the operation of the bile 
in digestion, he concluded that the liver deprived the blood 




PHYSIOLOGICAL PROEM. 



Die or t)ic 
bile. 



circulftting thruugh it of some redundant parts. In short. 
he bdiered that the liver pcrfonncd an cxcrGmentitiou* ope- 
ntion in tlic abdomen, whilst the lungs vrvi« doin^ u "imihir 
office in the ch«st. The hkehhood of this hypothesis was 
thought to be inereaned hy two considerations : 1st, that 
of the large size of the liver in animals of limited respira- 
tion ; 2dly, that of its being by far the most voluminoua 
gland in man am) quBdrupcds. 

One obvious mode of forming a judgment of the nses of 
the bile, is to remark what ill effects result from the stop- 
page of ilit flow into the intestinal canal. On this [>oint, 
however, the moxl dincordnnt atatemenbt previiil. If we 
ar« to give credit to tJie account of Dt. G. Fordyce, when 
the ductus communis choletlochus is tied, or Itlockcd up by 
a calculus, the formiition of chyle is not prevented, and 
ooiuequently the bihary secretion is not essentially necea- 
sary for digestion. The same conclusion, with respect to 
iut haviniT no share in the formation of the chyle, is alvo 
adopted by some distinguished physiologists of the present 
time, as will be presoully explained. On the other hand, 
Mr. Brodte, after tying the common biliary duct in young 
cats, WU.1 led to espouse an opinion long ago prrviilent, 
that tlie principal use of the bile wan to Heparate the chyle 
from the chyme ; for he found, that when tliat duct waa 
tied, and foo<l i;ivcii, chyniificntion w^-nl on in the Mtomach 
aM HHtial, hut that no chyle could be detected in tlic int^fr- 
tinea, or the lact«uls, which only co»t»ined a tmuKparent 
fluid, imagined to be lymph, and the watery part of the 
chyme. (See Journal of Science and the Arts, to), xiv. 
p. 343.) Mr. Mayo's experiments also corroborated thit 
view of the aubjecl. 

MM. Lcuret and Lansaigne tied the common dnct in 
n dof;, and cleared out the intestinfit by giving the animal 
u httle castor oil. Twelve hours after the operation, they 
ihrioo gave it bread and milk with Bugar, at intervab of 
six hour*; and ei>;hl hount after the UhI meal it was 
strangled, and inimediiitcly opened. The stomach con- 
tained an acid pulp, and a very soft whitish sweet chyrae 
adhered to the villous coat of the duodenum, and increased 
in couHtfltence downwards. In the great intestines, it was 
firm, bfit had the snme colour, and was nearly destituti.' of 
iHstc and smell. The tlioracic duel was distended with a 
yclluwi«h re<l trant>|Kurenl fluid, which coagulate<l on ex- 



rilYKIOLOOICAL pnocH. 



ira to the nir.niulyicUlcNlthc usual proportion of fibrin, 
llbnoien, and saline matters. 
The experiments of Tiedemann and GmcUn are much 
Imom elaborate and precise. They rcmnrkod, tlial nni- 
iialK were nltuckcd with vomiting &oon after the operation ; 
Jien with thirst and aversion to food ; on the second or 
[tJiinl day, llic conjimclivii of llic eyv* bcciim« yellow, the 
[Btoolg chalky iin<l very fetid, iiiid the urine yellow, and 
[coDvertible to hlui-, and thvn red, by nitric acid. Some of 
' tlio animals died, othcrn were killed. Of the Intler, some 
id previously recovered from the jaundice, owing to tlie 
itablishment of the duct by the elfuaion of lymph around 
'le tied part, and the auhaequent discharge of the ligature; 
fact, also noticed hy Mr. Brodie in hiM expenmenta. In 
lie caies ia which the biliary duct continued impervioiia, 
fthc colouring matter of the bile waa found in the blood, 
the MrouB mcmbmnes, the cellulitr timue, titc conta of the 
artenus and veinw, and in th« fat. They further olwervcd 
that chymiticution went on as perfectly as in » sound ani- 
\mal. In llie small intestines they found nearly the s.ime 
[prindples as in the healthy stale, with the exception of 
I tlioM derived from the bile; and, in particular, they found 
,in the duodenum, end in contact with ita membrane, the 
■oFt mucous flakes which aome physiologiols consider, 
though, as Gnielin and Tiedemann think, erroneously, to bo 
chyle. With the exception of the niKtencv of certain 
biliary principte«, the contenbi of the great intestines were 
likcwiKe umilar to those metwiUi in the bowels of healthy 
animalx ; hut they had an exceedingly fetid smell. In such 
animals as were fed n little while before dentli, the thoracic 
duct and the lactcals always contained an abundant Huid, 
which was generally of a yellowish colour. It coagulated, 
hke ordinary chyle; the crassamentum acquired the utiual 
red colour; ita difference from the chyle of a sound animal 
was, that, after tying the ductus choledochns, il was never 
white. The reason of the dilference iK ai^rlbed to tJie cir- 
cumstance of tlie white colour depending upon fatty matter 
taken up from tlie food hy means of the bile, which pos- 
seMCB the power of dissolving fut, and probably, therefore, 
utds in eifecling it« solution in the chyle ut the mouths of 
the lacteals. It is supposed that Mr. Brodie was deceived 
by the absence of the white colour, which, it is true, the 



n 



I 



32 



PIIYSIOLOnlCAL l>RORH. 



UTftand 

tungi 

AlMtlMMlly 



chylo usually poawMCS, but which, as is well known, 
does not exliibit iinleu th« food ooaUin fulty muttvr. 
The only use of ihc bilv io chyliltcotioD, it RStricMd bf'j 
TicdL-niann and Gmelin to tlmt of Bccomptieliing the solu- , 
tiuR of fatty subataQces. 

The following are the u»es ascribed to the bile by thewliitt | 
celebrated phyitiolugistii : First. By itHstiuiiilanipropiMtiM' 
it excites the flow of the inte^Unal fluids, uk is proved by 
the unusuul dryncst. of tlie fecea in jaundiced pereons, and 
in animals whose common duct hatt been tied. Secondly, 
It probably stimulates the intc»liiial muscular fibres to 
action. Thirdly, An it contuins nn abundance of azotir^d 
principles, it may contribute to animalize tiiose articles oT { 
foo<l which hare no azote in iheir compositioa. Fourthly, 
It tends to prevent the putrefaction of tlie food during 
its course through the intestines; because, when it is pre- 
vents) from flowing into them, their contents are much 
further advanced in decay than in the healthy statv. 
Pilihly, It probably tends to liquefy and render soluble 
the fatty part of the food. IjiAtiy, It is to be regarded as 
an important exerction. 

According to the researches of Ihc same physiologist*, 
many of the principles of the bile, such as its resin, colour^ 
ing mnttcf, fatty matter, mucus, and salts, are thrown out 
of the body with the feces, in the natural state of the Itiliary 
system, or by tlic urine, or into the cellular tiuuc, nlien 
the excretory duct of the lirer is obslructod. These phn* 
ctples co4itaiii a large proportion of carbon, and would 
appear, therefore, to be intended to carry otf the exccMs of 
that clement which is introduced into the system with 
vegetable food, and not thrown ofl' by the lungs. In the 
lung«, it is thrown off in the stale of oxidation; in the lirer 
chiefly in union with hydrogen, and in tlie form of resin 
and fatty matter. That tlie liver is thus inteudc<l to assist 
the lungs in decarbonizing the blood seems to Ginelin and 
Tiedemann confirmed by the fnllowint; facts. The rvsJn of 
the bile abounds most in hfrbivorous animals, whose food 
contains a lorge proportion of carbon and hydrogen, tn 
various tribes of animals, thepidmonary and biliary orgMM 
are in n slate of antagonism In one another; a fact pMr- 
ticuUrly insisted upon by Fourcroy. The sixc of the liver 
and Ihc quiuitity of the bile are not projMrtionalc to the 



PKY»[OLOIilCAL PRORM. 



33 



WHantityofthe food uiul fretlHCncy of eating; but inversely 
the *ac and pcrffction of the lunp*. Tiui»i, in those 
•blooded unimnU, wliicL have cupaciouit lungs, and 
! always io air, the Uvcr, compared with tlie body, is pro- 
ionately tesB than in such a» liv<- |mrtly in water. Tlie 
ia proportionately larger in roptiluK, which have lungs 
with large cells incapable of rapidly decarbonizing the 
; abo in tishes, which ducarbonizo the blood but 
rly by the gilla ; and, abore all, in mollu»cous animals, 
rhich efl'cct tlie i^amc change very slowly, either by gillti, 
Hintll, impL-ifectly developed lungs. Another thing 
aiDt«cL oat as highly deserving notice, is the increased 
]nanlitY of blood transmitted tltrougb the liver, when the 
lintonarysyslciit iH-conK-s let<» perfect. In mammalia and 
Is. the vena portiv it* fonned by the veins of the stomach, 
atcatiDeR, spleen, and pancreas; in the tortoiitc, it receives 
the veins of the hind legs, pclviit, tail, an<l vena 
;ak In serpents, it receives the right renal, nnd all the 
itercostal veins ; in fishes, the lenal veins, and those of 
tail and genital organs. 
Anotlier observation, made by the same professors, is, 
lat during the hybernation of certain animaU of the class 
mammalia, when respiration ts suspended, and no food 
^K taken, tlie secretion of bile goes on. An additional ar- 
jmcnl, in favour of the preceding; hypothesis, is deduced 
the physiology of the fmtus, in which the liver is pro- 
F|K>rl ionately n great deal larger than in the adult, and in 
■which the bile is secreted abundantly, as appears from the 
It increase of the meoonium during the latter months of 
Ipn-gnancy. Finally, miother argument is derived from pn- 
lokigical facts. According to Tiedcmann and Gmeliu, in 
pneumonia and jihtliisis the secretion of the bile is in- 
creased ; in diseasv>« of the heart the liver is enlarged ; and 
the morbus cteruleus the liver retains its fatal state of 
Jisproportion. In hot clinmles, where, in the opinion of 
physiologists, respiration is leas perfectly carried on 
ttfaan in aJd ones, owing to the greater rarefaction of the 
lir, a vicnrious decarbnnizntion of the btood is established 
' an increased flow of the bile. 

The foregoing hypothesis is, perhaps, better supported 
[than that of Sir Everard Home, who considers one of the 
^offices of the bile to be that of convening mucus, or the 

VOL. I. D 



« 



34 



PHYSIOUtCRAL PitneM. 



r 



rcruee nuittcr of ttte ohyle, as it pusec along the colon, into 1 
fut. which K iibxorbcd into the ttyitteiD. Thin inderatigaihU 1 
W^*" '»* physiologist wan partly imliiCfil to adopt thie opinion by 1 
Aon bile!' tJie example which he met with of a child, in which th« j 
peri»tiiUic action of the bowels had been duly coatinaed, j 
aiul stoola KgulaHy produced, without any int«rmixtuio of j 
bile, and even when no gall-l>ladder, nor any duct leading j 

■ ftom the tiver into tlic duodenum, existed *. The mere cir- j 

■ cumstance of tliis child beiog in a state of marasmus at ita I 
I deatli, without any mnnil'cat intestinal disease, however, I 
I scarcely warrants the theory attempted to he built upon it; j 
I and which may he rej^rded a<i ihc revenc of what ia in- I 
I culcatcd by Fourcroy and Prof«ssor>i Qniclin and Tiode- j 
I mann, who rcprcMent the bile tiA depriving the ^tcmof ill I 
I redundant carbon and hydrogen, and not as n mcana ofj 

■ supplying a larger quantity of these elements to it. Morfr I 
I over, on what chemical principles, and by what expen«l 
f munt, is it pociaiblc to prove, that fat can be formed byl 

mbcing bile with mucus, or the refuse matter of the chyle 1 1 
Besides the secretion of the domlenum itself, which iai 
supposed to bo concerned in chyltfication. the pancreatic I 
juice ia another Ituid apparently intended for the same pur- 1 
po«e. The common opinion han been, that, in its nature, it I 
isvery liimiliir Ut saliva. Tiedemann and Gmelin, however, I 
who hare recently examined il with (p«at attention, reprcMot I 
it OS differing materially from suUva, and never containing 4 
any sutpho-cvMiic acid, free soda, or mucas; la being ] 
naturally acid ; containing a much larger quantity of solid i 
matter, and especially a much larger proportion olalbunient I 
and, in the dog at least, a peculiar principle, soluble in water I 
and in alcohol, and, when pure, precipitated ro!ie-rc<] by | 
chlorine ; andsometimcs containing a good deal uf phuKphate I 
ofuxla, and acetate of soda. Tlic pancreatic fluid ofthe dog, I 
borne, and sheep yields a lar^ quantity of coagulum wben I 
heated, which the saliva docs not. Magendie states Utall 
the particular use of the pancreatic secretion in digestion j 
is unknown; and tlie subject has received no vlucidabou 
from MM. Leuret and Laasoigne. ProftMors Tiedei^^l 
and Gmclin, reasoning from the lai^ quantity of azotmn 



Juln. 




•PUI.Tno*-lBI3,utSI. 




PHYStOLOOICAL PROKH. 36 

principles whicli it contains, presume thai its use may be 
to animalize the unazotizeci principlcfi of vegetable lliod. 
They rwiiark, lis a con6nnation of this opinion, that th« 
paocreas is much lai^r in herbivorous than camivorou* 
aoiniaU*. 

Of the action of the oniinitum an<i epliM-n tve know ^hImo. 

ootliing certain. Tlic firat may possibly serve tLo purpoae Thc^'o^'*' 

of Jubricutrng the viMceni to which it is attached. The<'<'oi'oi 

Itplccn «ccrct«s no pocultiir fluid; its blood is of a dark "°'^' 

I'livtd colour, and coai^utates with difficulty. It is even 

' destitute of 8D excreting duct ; and, in some instances, has 

been extirpated without injury to the general health. It!?p'f«>not 

is iiot found in any tribes below the class of fisUea. [To io«ihcciiH* 

some of the hy|>otJieftea concerning theuseoftht: spleen, "^ "»''*■ 

reference has already been iniule. The subject htw l>een 

i ngaio recently cxaminc<) by MM. Lcurvt and Lassaigiie, 

wboae experimfiitM kad tlicni to adopt the revived hy|>o- 

thesis that the spleen is a mere diTerticulum for the blood 

(luring digestion. When the stomach and intestines arc 

distended with food, and the process of digestion i» going 

on. the blood 6ows in an increased quantity to the villous 

membrane of the whole alimentary canal, and consequently 

more venous blood retguires to be returned by the hepatic 

[ireaaelt. These, however, being presumed to be inadequate 

to the purpose, tlte splenic veins and cells become gorged. 

Leuret and Lussuignc have found, that the spleen of the 

dog, which gcm-ralty weighs but a few ounces, acquired 

the weight of a pound and a half two hours and a half aAer 

"ft ligature had been applied to the vena ports. In the 

do^, cat, rabbit, guinea-pig, and other mammalia, they 

f»uiKl that tlte s|)lecn had a rosy or vermilion tint while 

the anintaU were touting; tliat after chymtficatiuu has 

begun, it assumes a blue colour, and is wmewliat tinged; 

bat that it docs not acquire it§ deep bluish black colour and 

! gnatcst turgescenco till the ciiymc has passed the pylorus, 

t.'vrhen the intestinal membrane participates in the activity 

previonalycoafined to the stomach. This hypothesis isliablc 

to the objection, that, if true, the abxeiice or removal of the 

Bpleen from animals or the human Kubject ought certainly 



■ Stc Edin. Med. *nil Sui^ Jntm. Nib. 91 Kod 93. 



d2 




rHYSIOLOUlCtL PRUKM. 



Cb}lr. 



always to oocftsion ntorc Mrioiw contoquenc«« thnn it ia 
Eaid t» do. 

Tiedetuann and Gniclin represent th« structure of the 
spleen oa eftsentially resembling that of the lyinpluttw 
glandjt, aiul regiurd it aa an organ which is merely in ap- 
peiida^ lo ilie abaortMtnt »yMt<>iii. They twlievi- thiit il« 
Bpvcific function ix to secrete from the blood a reddish fluid 
that has iJic property of coagulating, is carried to the tho- 
racic duct, and, being there united with lite chyle, changes 
it into blood. The facts elucidated by tht^ ex[)«nn>entjt of 
tbnc pIiyKi«lof;i)it3* arc of ^at value : but it must be con- 
fessed tliut tlieir hypothesis, relative to the Mplt-i-n being 
an CBsential oi^n of uiDguificntion, is seriouxly shaken by 
the foclii that a rast di^erenco really exists between the 
atfucture of the spleen and that of an absorbent gland ; 
that the chyle does not invariably exhibit a reddish hue ; 
snd that the nlueiicfi or removal of the spleen may happen, 
not only witliout fntal eirects, but even without much sub- 
sciquent disturbance of tlic animal economy. 

Notwitbetandins: (he pro^^ress of animal chemistry, ami 
the miilltplinition of cxpi-rimenlJi un living animnis, wu 
arw obli^d to confess that oar knowledge of the ratioaals 
of chylilicntion is otill involved in considerablt^ (lerplexity 
und obscuiity. But though we know not the exact vray in 
which this process is etVected, our antiusintance with the 
praperliett of the chyle ii^li'ia nioiesatislactory. Ilowereri 
it is only very rwpnlly that nny accurate information con- 
cerning the rbyin ban bwn ohtaim.^, and we are much in- 
debted U) l>upuyti«n, Vtnirpiclin, Kinmert. Marc«t, l*rout, 
and Timlemsnn and Gmelin *, for this very desirable ad- 
vanccmenl. If the animal, from which the chyle is ex- 
Iracti-d, has eaten animal or vegetable substances of a fatty 
nature, th« liquid drawn from the thoraoic duct is of ft ] 
milky appearance, a little heavier than distilled water, oft ' 
strong spermatic odour, of a ttali ta^ilo, slightly viscid, and 
plainly alkaline. It soon separate* into three [taiis : a 
solid one, tliat remains at the bottom ; a licjuid one, at tho 
top; and a thinl, which forms a vcr)- tliin layer on tht 
surface. At the same time the chyle assumes a bright roae . 



* Kn lUdmthw KxpfrimtoMlti, Ac. lui U Ulgatlwi itnt la qi 





■•HysioLocicAt puop.u. 37 

colour. WHieu, however, it iw dprivvd from food that is 

void of fat, it is opalioe, and iiciirly tmnspiircnt, instead of 

being of nn 0|iw|iie wliile colour, and the layer on the Riir- 

{.fftC* ix lc*» evident. Chyli; never takes the hue of colour- 

ine Mulwuuicn in the food. M. ilollj^ has proved this 

by diK-ct ci£pen«i«iil». Ma^eiidie has also made aiiiiiudK 

eat indigo, snfl'ron, and toadder, witliout the colour of thi-Ho 

I articles being communiciited to the chyle. This fact. 

[whiob iBCO«firmc<l by the exptTimpnts of Tiedemanji and 

Oinelin in Genn»ny, Andrews at Edinbui^h, and Ijiwrence 

I kad Coat«H in Anwrica, ik vory impoTtant. becatuc it ia at 

J variance with Mr. Hunter's statement, ami upon its cor> 

I nctneu the truth of the theory, which restricts the function 

lofthc UdenU entirely to the abiorption of chyle, and of 

[bo other matter, very mainly depends. Chyle derived 

[frooi Bugar conlHtn); hnrdly any fibrin, \i'hile that from 

: flecll Iws a great deal of il. The appearances and ([uality 

of iJiii fluid are. therefore, considerably modified by the 

of food; and it deserves particular recollection that, 

is not nlvfuVH white, iu pink or Irunxparcnt look is 

tn be rei^rtlcd uk n proof, eitlier of ihe Inctcnl)! having 

liuibibrd mudder, or of the imperfect formation of the 

{chyle.] 

M. Mu);cndtc*s experiments induce him to calculate that '<* iluuiiii; 
[b dog, upon an average, forms about &ix ounces of chyle' ' ' 
[every hour. 

The subject is highly interesting : but to pursue it fur- 
ther, and especially into that diversity of structure which 
tbe lUgestive organs present in almoitt all the diflercnl 
classes tnd orders, ada]>tcd, as it is in each of them, with 
the iDOSt skilful uttcnlion. to the gcnenil economy of their 
nature, and the mode of bfe they are destined to lead, 
would occupy more space than we can spare, and carry u* 
into the regions of general physiology. Enough has per- 
haps lieen said, and this is all that has been aimed at, to 
give a compendious view of the organs which form the sent 
ofthatcltuH of idiopathic diseases, with which the no«o> 
logical Hystem about to be unfolded commences, and con- 
•oqtMmtly to i-Jiable thv reader to follow up thone diseases 
with greater cleaniess and comprehension iu their di- 
stinctive characters lutd descriptions. 




38 PHYSIOLOGICAL rXOEM. 

Clan Uinii. [ hare liaaited the above remaxk to idiop^Ue diseases; 
jatiiic ^°<^ '^ i' necessaiy the limitation abonld be atteided to. 
^uoKi- For, from the intimate conneiion which the organs of di- 
gestimi maintain with other OTgaos, and sets of organs, 
there are few general complaints in which the first do not 
Stonadi erincc some pfmpatkttk affection. This is particularly the 
mStuaJ '^"^ '"^ '^^ stomach, which, in the opinion of Mr. Hunter, 
rrn^Mfar. is the seat and centre of universal sympathy : a doctrine 
which appears to have been taught in France by M. de 
Bonrden*, though with less caution, and from fewer pre- 
mises, at the very time Mr. Hunter was teacfaii^ it in 
London. 

Soch sympathetic afiections cannot fall within the range 
of the present class ; but must necessarily appertain to 
those diseases, and divisions of diseases, under which they 
rank as peculiar symptoms, and which can only be removed 
by removing the idiopathic malady. 



■ Sec In Them, " An Onma Ciipcrii Ptnm DigcMianl «!<'■'■"'■ T~ 
Parte, 17H- 



CLASS I. 
C <E L 1 A C A. 



ORDER I. 
ENTERICA. 



DISEASES AFFECTrSG THE ALIMENTARY 
CANAL. 



DISQUIET OB DISEASED ACTION IN SOME PAST OF THE 
PASSAGE FOK THE RECEFTIUM AND DETRITION OF 
FOOD. 

The diseases of the Digestive Function form the Clas»i. 
first class in the Nosological System about to be unfolded ; ^[^"^ 
and to these, from the Greek term koiai'a, " alvus," orfera. 
"venter," or " the lower beUy," I have applied the classic 
name of Cceliaca. 

By an easy and natural arrangement, this class is divi- 
sible into two orders: the first embracing those disorders 
which affect the alimentary canal; and the second, those 
which affect the coUatitious or auxiliaiy viscera. The 
former I have distinguished by the term Entekica, and 
the latter by the term Splanchnica, both of which are 
Greek adjectives ; the one being a derivation from Eirifoi, 
" intestinum," " alvua ;" and the other from evXd'yx.^v, 
" viacus," " a bowel, or entrail." 



40 



1-3 



CCKLIACA. 



[ORD. 1. 



The present order embraces the following genera : 



I. Odontia. 
II. Ptvalismvs. 

III. Dysphagia. 

IV. Dipsosis. 

V. LiHOSlS. 
VI. COLICA. 
VII. COFROSTABIS 
VIII. DlARKH(EA. 

IX. Cholera. 
X. Ekterolithus. 
XI. Helhimthia. 
XII. Pboctica. 



HI8DENT1TION. 

PTVALISM. 

DYSPKAGY. 

MORBID THIRST. 

MORBID APPETITE. 

COLIC. 

COSTIVENESS. 

LOOSENESS, 

CHOLERA. 

INTESTINAL CONCRETIONS. 

WORMS. 

PROCTICA. 



CL. I.] 



niaSSTIVB PDNCTION. 



[OHU. I, 



GENUS I. 

ODONTIA. 
MISDENTITION. 

PAIN, OR DERANUKMBKT OV TIIE TCHTU OR THKIR 
INVOLUCRES. 



Tiiiii genus hu by souk; wriu-ns bvcn called odontalgia. Orir. 1. 
and oduxiKmus. But, aa both Uicw terms have been "j'"'^' 
liinited by other writora to a single species of tbe genus, 
thatofodoiitiu dolorosa, or touUi-uchc, in onlcr to prevent 
confuHiuii, I tiikvv vrntuied tu give it the mime under which 
it itoar appears ; dehvol I'roin eAiin, " u tooth," which in fact 
is Uk common root of idl the terms, and is here preserved 
in its ftimplest form. 

The involucres of the teeth are their gums, membranes, 
and sockets, or alveoli. The last, altliough an immediate 
apophysis of the Jaw-bones, are rather to be regarded as an 
uppuitcnance of llie teeth, than of the botieH from which 
thi-y itwue. They are altogether liuiiled to the dtirulion 
of the teeth, sprouting forth at their eomnienccmont, and 
being carried away by absorption, on their decay or 
removal. They are also in every iuatance modelled by the 
•diapc of the teeth; and, like the gums, participate in 
almost all their discaHett. 

The ehiiraeler of the prejtcnt genus is therefore made SpodM. 
sufficiently general to ouihrace the dtttorders of these 
adjuncts of the teeth, us well us of tlie teeth themselves ; 
all which, as distinct species, may be conveniently arranged 
in the fc^lowing oider : 



I. ODOKTlA DKNTITIONIS. 




UOLOKOSA. 
STUrOKIK. 
DErORHlS. 
BOENTL-LA. 
is-(:ni'srA:de. 
EXCRESCKNS. 



TEfTlllMG. 

TOOTII-ACHE. 

TOOT R -EDGE. 

UKroBMITV OP THE TEETH. 

TOOT M LESS!! ENS. 

TAHTAK OF tllE TEETH. 

EXCKESCEKT CUM». 



d 



4:1 



CI.. I.} 



COtLIACA, 



[i»RI>. 



SPECIES 1. 

(HK)NTIA DENTITIONIS. 

TEETHING. 



Gkk l 
Snc. I. 
DdoMk. 

TcMhlBg. 
bovlhta 

■cdon. 



tlMoTOK 

hamin 



irhitation fkom cutting trk teeth. 

DR.Cut,t,i(N did not allow dentition tocntcrintolhelist 
of diseases : but, this is to BuppoM the procvEs of teething 
to take place at all times, instead of ouly occasionally, 
with perfect case, and without irriution of any kiud. 
Whenever it occurs in ihta manner, there ia undoubtedly oo 
(liHcasc, and so far Dr. Cnllen w correct. But, in a rery 
largv number of cases, perhaps, in refined and intonvrutod 
socidy, in the largvr number, th«re is not only diHCUMc, but, 
in many instances, disease of un ulonning and tatul cha- 
racter; strikingly severe in its proj^Tess bik) complicated in 
its symptoms. The organism of the teelA, indeed, ta 
pecuharly dialinj^uished by the following feature: that 
there is no other part of the human atracture so brief in ita 
duration, and none, with the cxct-ption of tlie utenia, so 
fiigiiali/ei) hy pain and inronveniencc during its progress. 
Yet, their nicchaaiMii. nutwithstimdiu); these cviU, is most 
admirable. No effort of human wit has ever boen able 
improve upon it, even in imagination, and no organ is 
strikiti<;ly iuipreit^d with niuikjt of >«u]icnial goodneaa 
intelligence. [The human Levtlidiftcr from those of animalai 
ill being nil of one length, and liikving imroimidcnihleintcr- 
8p;ices betwvcn them. Anolhor of iJicir peculiarities ia tba 
perpendicular direction of the lower incisors. In animals, 
these teeth slant backwards, and the jaw also slopes back- 
wards directly from the alveoli, so that tJio full prominent 
chin is found only in man, while in animals it scetas as if it 
were cut oil'. In man, the obtuse tubercles of the gnoden 
are very |>nnicular, not reacmbling the flat crowns wilb 
rioing ridges of intermixed enamel, belonging to herbi- 
vorous uniniiits, nor the catting and tearing gnndera of the 
carnivflfa.] 

Ilittro arc throe [wriods of life, in which dentition, or 



I L 





niCKSTIVK PUKCTIOK. 



[OBD. I. 



43 



the breeding aiul cutting of teetli, unifonnly take* piocc : iltx. l. 
in iiifiincy, in boyhood, and adult age. Besides which, wc (^J^ '' 
nic«t with iuslancos occiuionally ofa reprodnction of teeth Iiuititkna. 
in ndwnced life. Each of thtKc romiatioiiis i» accompanied Twtl'ing. 
with cirauniatanceM peculiar to itself; wnd, when attended 
with pain, or morbid action of any kind, aSbrds a diatinct 
modification of the present species of disease, and consfr- 
(|ueotly lays a foundation for the four following rarietiea : 



« Lacte&iium. 
Milk Itrcthing. 

Puerilis. 
Permanent tcetlting. 

7 Adaltorum. 
Adult teething. 

1 Senilium. 
Climacteric te«thing. 



Cutting the milk or shedding 
t-itth. 

Cultinp; the second set or per- 
manent teeth. 

Cutting the adult or nriite teeth. 

Cutting teeth in A<lvanCGd life 
or old age. 



Before we enter upon the symptoms ofthesc vKrietics, it F^nmmv 
it iwceMary to give some explanation of the causes which "f"'™'''™- 
produce them ; or, in other words, to take a brief glance 
at tlic order and economy of dentition. 

As the jaw-bones of youtli are both wider and longer (■;„, ^.^ 
than those of infancy, it is obnous that tlie teeth which ofunili- 
are cut in the first year must be incapable of filling up the 
bcmy arch of the fourteenth. They might, indeed, hav« 
been m> contrived as to grow in proportion to the increased 
range of the jaw-bones; but, from their being extraneous 
bodies, this must have been a very complex proretts, while 
the tery circumBtanoe of their gronth, and the internal 
change which must have continually taken place, woukl 
have expfrtcd ihem to many more diaeaMN than they are 
subject to itt present. 

A much simpler plan has been devised ; and the teeth 
of man, as indeed of most iiianimalia. are composed of two 
diatmct sets, differing both in number and structure : the 
first, or smaller set, consistmg of ten for each jaw, which 
are cut between the [sixth and twenty-lburtb montli after 
birth ; ihc moKt common period of tiieir Itrst nppearanoe> 
howevef, Ix-in^ the commencement of the seventh*,] shed 



NnkiJ, Uwucl d'AiiM. wtn. UL ^ 301. 





CI.. ..] 



CCKLtAfA. 



[OHII. I. 



litn. 1. 
SpKC. I. 

4>donU» 
DmMiiMiU. 



Rndlmniiii 
pffldttocd IP 
ibeCMiu. 



PiDcni by 
vhidiihn 



between the seventh and fourleenlli year, nnd from the 
period of their protnision called milk-teeth ; and the 
second, or tarfrer set, consistini^ of fotirtccn, liftccn, or 
sixteen for each jaw, for they occasionally van- in number, 
which are cat proti^essirely, upon the shedding of the 
firat set, between the seventh or eighth, and llic seven- 
teenth or eighteenth year; and which, from their con- 
tinuing till otd age, except in cases of accident or diaease, 
arc denominated permanent teeth, llie farthest grinder 
on each Hide, however, is seldom cut so early as the 
eightecrill) year, gcnentlly nftcr ttic twentieth, and eome- 
timea not till the thirtieth; on which nvcount, ihew teeth 
fire deitoniiitated rUtUt* tapicntia:, or teeth of wiMdom. 

The rudiments of all the first get, and of four belon^ng 
to each jaw of the second set, are produced in the f(E4us, 
and may be distinctly seen when it i» about four ntontbs 
old : M. Serres declares that he has traced Ihem. and even 
the teeth, at tliree*. [Thejawofa new-bom child contains K 
number of cells, separated from each other by imperfect boay 
septa. By removing the extenial or interna) plate of the jaw, 
the contents of these cells arc exposed . They consist of mew 
branous bags, named the capsitUs of the teeth, enclosing 
the mdimentx of the bodies of these oi^ns, and cvrtnin 
soft Taacular substances, termed the piilpt, oti which the 
bodies of the teeth arc forming. The bone of ttio body of 
Uie tooth is the part lintl formed ; tlie enamel is added to 
tbi» ; and the fang nppeani the last in order. The pulp, 
which, accurdiiif:; to Mctckcl, $^ows up from the bottom 
of the capsule, about the fourth month of fo-tal existence, 
accurately resembles in shape the body of the tooth which 
is to be formed on it. It is a soft vascular HubKtnnce, and 
its vesseU are moat numerous in that |>art which is covered 
by tlie |>ortion oJ' tooth already formed. The capsule ia a 
whitish mcmbnine, but very vaa<ruiar on il« inner surface. 
ll includes the pulp, round the baaia of which it adheres. 
•imI the rudiments of the imperfect tooth. On its outer 
aurfnco it adheres lirmly to the gum ; su that, if we attempt 
to tear the last-mentioned part away from the jaw of a 
ffctus, the capsules and their contents will come awmjr at 
tile same lime. Tliesu meuibraim adhere lew clonly to 

• Bm4vurAmttm^ttThjtiiilafikiKtDtuu,f.X»fo. Pari*, 181}, 




DICRSTIVE PVirCTtOK. 



[ORD. t. 



45 



[tlie bony cells in which they nre contained. Tliu offic« of fixw. I- 
the cnpMiilc is that of Mcrninn th(! «ntinic) : in iu cnvily is dj"^ ^' 
ft sinnll quantity of Hiiid. Tliu oiwifiriitioit commcncw by ivntitianit. 
th« fonimtion of lhi> cutting cdgt* of th« incisors, unci the ''''"''''* 
grinding buses of Hie inuhirc«. The bony stibRtnnce being 
depOKittid on the pulp, as on it mould, tlu- rudiments of the 
)> teeth are n^-ce«Annly hollow ; utid the bony liiyent first 
^Ibnnod urv those which will be in contact with the 
I eium«) vhoD it is deposited. As the formatioo of the 
t'tooth advances, the pulp is gradually surrounded, til) the 
nholu is covere*! by bone, except it§ ba§e. 

The adhesion of the pulp to the newly-formed tooth or 

I bo«e in very tdight, und no tcmcIs can be di«ccrned going 

[from one to the other: it is, however, most strongly 

attached round tlic thin elastic edi^e, which is the last part 

formed. When the bone has covered all the pulp, it 

begins tocontracta little, and becomes eometvhat rounded. 

making that part of the tooth which is called the neck, and 

from this place the Jtin/is begin. The formation of the 

make« the bodies of Uie teelh ascend through the 

|«ockets.andafterwnnlithrou:;h the gum. which is absorbed 

I in eonse(|iionc« of the preivturc of the tooth. 

The pulp has oiiginally no procoM answering to the 
^fang: but, as the cavity in the body of the tooth is filled 
ap by tlie ossification, the pulp is lengthened, and the 
fang fonna over it. The latter part grows in length till 
the whole body of the tooth is pushed through the gum, 
the socket nt the name time contracUt at it« bottom, and 
frra><|M the neck or iM'giniiing fang, adheres to it, and 
riseii wtlh it. Thu« the alveolna is raised with the fang, 
and the fang docs not itself sink or descend into the jaw. 

If two or more fangs arc to he funnet), tlie process is rather 

more complicated. When the bo<ly of itmolaris is completfd, 

there is but one general cavity iu the tooth, from Uie brim of 

} which the OHsiAcation is to shoot, so ait to form two or tlirec 

l&n^: if two only, then the opposite parts oftiie margin of 

Uhe cavity shoot across where the pulp adheres to the jaw, 

'meet in the middle, and tliureby divide the mouth of the 

cavity into two openings, from the edges of which the two 

fangs grow. It is a curious circumstance, however, tiiat at 

the verj- time when tlie pulp is rcslriclcsl to the crown of 

the tooth, the number of future fangs is already denoted 



1 



46 



CL. I.] 



COILIACA. 



foRn. I. 



Otv. 1. by tliut of diatinct branches givcrn off* by the dental 

f^^^ ' Ffswb*. When the smrface of the tooth first appears 

pwditol* througli the Etira, its body it yet more hollow than that of 

* a pcffecl tootlt, and ihc ^ng in only in an incipient state. 
In proportion ns the tooth rises through the gum, how- 

K ever, the hollow is gradually tilled up, and the fang is 

^^ lengthened. When the bone of tho body of the tooth is 

^1 aomewhat advanced in itn formation, the enamel begin* to 

H be deposited on itM Rurfuce from the vettscU of the capsule. 

H Tliia deposition commences on the roaHticating surface of 

H tlie tooth, and thence extends towards the root. The 

H enamel is complete when the fang of the tooth begins to 

H be produced, for at that time tlie body penetrates the 

^1 gum, and Uiereby lays open the capsule, which at this 

H period im found to have undergone threat alteration in its 

^B texture and appearance. Instead of the Hofi vascular aur- 

^1 face which it exhibited whilf tlir ih-posilion of thu cnumel 

H was gving on, it ia now dense, and almost tendinous, with 

H very few blood-vessels. When the fang begins to grow, 

H the cajiAulc ulxo beoomes connected to it, and fbrana iti < 

^^ pcfiuMteuni.] 

H Fromwhatlia8bcenBnid.it appears that the alveolus, or 

^M socket, shoots up from the jaw-bone as the tooth advcmces. 

H It accompanies its growth, and tit first onlirely surrounds 

^B it; by which adniimblc contrivance a firm support is given 

^1 to the gums from the lime of birth, and tlie infant ta 

H enabled to make a sufficient pressure for the purpose of 

H sucking, without interfering with the fonn which the teeth, 

H yet soft and amorphous, are destined grudually to naaiime. 

H In due time, however, the alveolus yields in its upper sor- 

H face, ttit the tooth, in consequence of the eradual clnnga- 

H tion of it* hag or fangs, is forced through, and cuts not 

H only the socket hut llie gum ; and when the finit eel, 

H having answered its temporary piiT^>OM:, loasM Its fangs by 

^1 absorption, and the body of each tooth ia shed or cast ont 

H by the gums, the altcndant sockets are equally absorbed, 

and disuppou- at the same time. 
SMoadM This wonderful change begins to take place, ns I have 

pftenh. already observed, about the se^-cnth year, the artery of th« 
milk teeth and its canal undergoing a more or less perfiMtt 



• BlMkrl, Muiuttd'Anit. lom, HL f. MS. 



DIflKSTIVS PVNCTIOH. 



[otto. t. 



47 



obliumtion*; at which time wc po«eH fiar more t««lh, 
, indiuUn^ holh the grown and the growing, than at any 
k other period whatever: Tor wc hftvc in vuch juw li-n tem- 
porary teeth complete, ten incoin|>lote to iiucct-ed thcin, 
and Uie two pennaiient ^rindcra, whonv titaniinu were 
fbnned during fcetal life, making not lens thui forty-four in 
liho whole. Other uriteni than Mr. Hunter [ilace tlus 
I change at an earlier period: Dr. Bliik<:, indeed, uh citrly 
' u the fourth yt-nrt; ond M. tcmaire, who follows Blake 
I in moat other pointe, follows him in this also|. The pei^ 
I manenl let-th have afparale »ockeU of their own ; and, in 
couiioquencc of tile prolongation of tlie jaw-bones, do not 
[lie immediately under tlie corresponding ihcdding teeth, 
I'jtnr directly contribute to Ihc prooew of slicddiug. whidi 
jcbiefly tftkea place in cotuvipicnct^ of the nbiiorption of the 
kDgi and aockeU of the temporary Hct, though their 
ucent contributes in some degree to th« general process. 

1 have obserred that the alveoli, or socketa, though fixed 

upon tlie jaw-boneii, and indeed iwuiog from thcin, are 

|ntbe«' (o be regarded n» appendngcK of the teeth than 

\of iho boucN from which they "pring ; tliat tlicy participate 

tin moHt of thi^ diseiiKeit of llie teeth, and are strictly coev'al 

[ with them ; Mpruutiug forlli on their origin, modelled by 

their i<h>i|)e, iiiid diHuppearing on their decay or removal. 

It is thi» disuppcniance, which is the work of absorption , 

that principally produces that change in the character of 

the face which |ieculiarly distinguitdies the period of old 

8ge- It follows closely upon the Iohs of all the teelli ; and 

when these have unifonnly given way, and their tespcctive 

sockets are no lunger in existence, as not being vmotcd, 

tJte upper jaw becomes considerably diminished in its 

rattge, the tinder jaw reduced to a thin bone merely corered 

by tbo guniH, luid the roof of the niottth, instead of being 

ucbed, ia rendered ulmoKt flat. And from this loss of 

BubMance, which In nearly etitial to »n inch and a half in 

depth, tlie face Ijccoiucn Hhurleoed, the cheeks wrinkled, 

and the chin ptojocting. 

It is cuiiout) to observe how differently the teeth are 
situated in different animala. In the more perfect, they 
are placed in sockets in the jaw-bones some of which are 

* Scnrt, f. Ilk f Dlucrui. Iiuugur. i Ttauc lui la l>cnui Rto. )>ui>i, 102'i. 



o». r. 

ercc. I. 
OdunOii 
DoMiiiooli. 



Smni Id 

\-»Ty in 
dmc of 
ociumncF. 



( 'hunfin 111 
life. 



DMaml 
piHltion 
uf U*Ui in 

(liflinnl 



4 



4H 



CL. U] 



CCBLIACA. 



[ORD. I. 



GxH. I. in many kinds rontlered movcubte, an the two fore teeth 
Qjgg^ ' of the lower Juw of the mikj marilimus, or African rat, the | 
I>aiM>nU loi^est KpccicH of the genua hitherto discovered. Tho 
^^"*' same iL-fth arc eciually moreable in tJie kangaroo; and tha j 
holluvr tufiks or poisoning fangs of the rattlesnake, andj 
oilier venomous serfienth, are capable of depression or cle- | 
ration at the option of the animal. In the lamprey and 
myxine, the teeth, which arc almost tnmiiuerkble.aie placed 
on the surface of the tongue; in lliv cancer genus, in the 
stomach ; where we likewise bitl them in the common ear- i 
wig. Ill theciiltlc-iiiih. thoyure oUo pincwl in tht- middle, 
or lower pnrt of the body, two in number, and homy, and i 
in their figure re«en)ble the bill of u parrot. In the echinus, 
or sea-hedgehog, they tire 6vcin niniibcr, arnmged around i 
tho opening uf the andcr part of Uic MhcU. nnd being move-* j 
able by ditfervut muscles, they form a very complete organ j 
of mastication. In the aphrodita atuleata, or »ea-mou*e,j 
they arc fixed upon the proboscis, four in number, and are i 
con.4e<)uently extended or retracted with this organ at' 
pleasure. The leech haw three pointed cartilaginous Leeth^J 
which it is able to employ in the same way, and by neeiul 
of which it drawn blood freely*. 

The form of the Icelb is so difiercnt, cvenin thedifiereut , 
genera of animals that possess them in a tnie or porfectj 
state, that this diversity has been laid hold of by many 
naturalists, as adistinguishingcharactehslic of their kinds 
or orders. Lionatus, coutining himself to the fore-teeth, . 
has hereby formed ncven distinct orders for tlic class of J 
mammalia; and M, do Blainvillc, carrying the basis of, 
this diflUnction farther than to tho form and structure of] 
the fore-tc«th. has made it a foundation for the sub- . 
divisions of theHe orders into generaf. 

Whatever be (he time in which teeth ai'e gcuemtetl aod 
protruded, the piocess is oden so gradiiul (hut little or no 
))tiin or other inconvenience is experienced; nnd oonse-J 
quenlly, under such circumstJineo!, there is no disease. 
But 1 hnvu already observed, that there is often tK>t only 
pain and irritation, and tliervfoTQ disease, but, in rarious 
instances, disease of a severe, complicated, and aiaimiiig. 



Otitnet 
sstaiils 



Ueih«Aoa 

dotnd 

ftonilisir 



■ dec n>r who pocullMilla, Phil. Tnr.%. ral. Itiiiv. fL ZS7 i »i. r>. »•• 
tNoavMs IHrt.<l'tliM.>'anud1e, ml bu ul. Dzxis. Ptris, IBI7. 




1.5 



niaBiTtVB FUNCTION. 



[o»D. 1. 



4» 



And it iti to drntitiou iindcT lliesc circn Distances, Ok«. I, 
lai I nm now ubout lo liiri'd llic reader's attentkiii. ^'*''"" "* . 

It will rviidily bo Kiip[io«cd thut thv most violent tiym- a O. IVmI^ 
ptans of dentition «n; thiwe producod under the first slaire Jin'JIui*'" 
t'frrri'd to in the preceding histon*, or during the urowtli Miik-w«lw 
iiid [irotruition of the milk or sHt^DDiMo tebth; for'"^ 
the system lo then in its tenderest rxaXa of infancy, and 
|>roiie to diiwrdcr from very slight cauMs of irritation. 
The iinuiediiilc rau«i; of irritation in the present in- 
ance is the pressure of the tevth in the gums; and the 
egree of irritation depends upon the peculiar tempera- 
lent of the child. Ah the teeth push forward, the EU])er^ 
Encumbent ^wn wastes in consequence of absorption, and 
at last cut through, and the tooth makes ita appearance. 
Iiis pmsure is not, however, uniformly exerted through 
He whole course uf tci-iliint^, but is divided into distinct 
[pciiods or tttitges; uh tliough tlie vital ur iusttnctive prin- 
ciple, which is what we mean by nature, becomes ex- , 
L|lsBated by a certain extent of action, and t])en requirCA 
RMt and a state of intennission. The tirst attive Ktagc of t'l"' x^n 
fi**lhing is usually about the third or fourth montli of in- thc''!ii^!."' 
[iaitcy; and conntitnle* what is called breedint; the tenth, 
|or tJie prcxtucliun of their bone from the ptdpy rudiment, 
baried in the uuni. nn<l rorDii'ddurini; fwtal life, which iit 
ibe sauw lime shoou downwards, and (;)vcs lo every tooth 
. B DCck and fan^. The tirst and moM usual s>-mptom of 
|this change is the loo»vneim with which the infant grasps 
[the nipple, anil the frequency with which it lets go its 
bold, accompanied with fretlulnesai and crying, and auc- 
L needed by a copious dischargcof saliva, the sidiviiryglandK 
ing of tlic irritation of tlic gums. Next, the iiii- 
^MnaeM of the gum» is found to he relicred by the presaurc 
of any hard subxtniice upon them which benumbs tlieir cx- 
I oitetluusiibility; and heucethechild is pleased with having 
I its unms rubbed with the tin|;ers, a coral, or a gold ring. 

lliia last is perhaps the oldest method, and it may be 

tlio best: for the cx{)eriments of Dr. Chrestien, of Mont- 

pfUier, who hux of latv endeavoured to revive itiu old pre- 

pitr.itions of giild as a part of the materia medica, show 

, Eufhciently that this metal, in very slight quantities of 

Ivome of its simplivit I'urniK, i* peculiarly active, and a 

' powerful exciter of llioeo M-vict>r>us which have a tendency 

VOL. t. B 




A 



§0 



CL.1,3 



rfZLIACA. 



[OKD. I. 



Oea.l. to (liminiiih irritation and stib<Ju« iatlaniiuatury aclioa. 

• o. D^nd- H<' h"> provpti before a coamittvc of tlie Royal Academy 

«w»^M- of Scier»rcj(, at Paris, Oial friction of the tongue and gums 

unk-iMb. *"'*'' I*)' more than four ^aiiis of powder of gold pro- 

if- duces sometimes a copioiia ptyalisra, somctinaea abundaot 

alvine evacuatkinit, and wjinctiincs profus« pewpiruiioM*. 

M. Auubi, liowover, dissuade from the use of friction by 

tlic finger or any other uMons, from an idea that the %um 

will hereby become more callout, and coiiBequenlly more 

difficult to be cut throu^ht- But, Hofaras I haw olMUrvvd. 

tfaie idea i« not supported by facu. In many TCipectsH. Lai- 

lemand has since confinued Dr. Oireeticn't obaervation^t. 

If the irritation become rery coDsiderable, the garas 

awelt, the chiM in^w» still more fretful, and starts in iu 

tlmp; or, on uwnkiii|; suddenly, there i» ht^at, thirst, and 

other oonoomittnta of pyrexy. with perhaps dtdnesa or 

drownineds; the bovreta are affected, which t» a usuu) sym- 

ptoin, nnd a rash appears on tltc skin, atually tlic rrd-f^um, 

and if the irritation extend to ttic muscles of tiie chest, 

there isadryaiMl troublesome cough. It is tlie opinion 

of Dr. Withers, »* i^ivcn in his treatise on sstlimu, that a 

couKh, durini; dentition, never takes place but from primary 

aiTcctiuti of the respiratory organs : yet 1 hare often seen 

this effect produced as evidently from mere itynipaitlty, ai 

iiirrenHcd flow of saliva, or looseness of (he bowels, lo 

nlK)nt ten days or a fortnight, ihesu symptoms subside; 

•imI though the infant may ocoasionally be teased with 

sliirht paroxyftinM of uncasiiicsa, it generally passes on witb« 

^*f"^ out iniKh incnnvrnif nee till the arrival of the second staeeL 

nidr«ilM or pehixl of cutting the teeth, which we may expect to tako 

****^ |»hice between the wvenlh and lliccloseof Ihentnthroonth, 

tliougli Komeliniesthisdoeenot occur till a few months later< 

This is tho usual pro<ness; but here, an in many other 

organs of the syatem, wc sometimes meet with a siogul 

pntcocity of action, and at other Umes with as cxtraordiiuuf 

^1**!*** a hebetttde : and hence, while it is no uncommon thing for 

uMuKlj. Bn infant to Iw Imth witli several of lU ntilk-tevth already 

ctil: a fact which haa in various instaooea oconrnd MJ 



,* RMbMch«H<nM.M>h*K<M»dMPr<V«utnMa'0(. RMLFtMh. 

t Tndii d'CMml*]^ ai \'«\ prbenle un rjuime oounau wt 1' 

d U bnoMlM 4« Dm, fte. LyoM. 

t /ouf» GMisl* dn Mnma MMtailli, A«Al, tBSl. 




'0 bICRBTIVt FrNCTIOW. [oRD. 1. SI 

iiy»clf, and is upecinlly noticert by Hdwig* and other 9«»«1- 
rritera. Somciiiuvs, Imwpvcr. the milk twth arc found to be „ a'n™ii. 
Ktretnct^ lordy in their iij>|iiMniiicc, nnd in one instance """'• '•»«- 
' BBid not to liave been protrudwl before the child was M|ilt"^h- 
jreanoldf. [Acconlin^ lo Meckel, the appearance of'og. 
■t Innh ie pnrticulurly frequent in such infants as 
ive not been bom till after the usual period f.] 
It ia on obserrntion of Mr. Fox, that tlieae premature 
1, which arc uiuially the central int:ii«or)i of the under 
jnw, are nothing more than the oppcr parts or crowmt of 
teeth without the appralua of fnngn; that ihey have con- 
^Blequently a weak attachment to the gums, soon oet Ioom, 
tml produce a runKidcrcihle inllammation in the mouth of I he 
^lild, as well a^ great inconvenience to the mother § : and 
recommends, accordingly, that they be immediattiiy ex* 
Speaking (!;enerally. thia account is correct ; but 
there are instances in which teeth of this premature 
awth are (lOwcHevd of fani^s and are perfect, it la better 
' to wait before we eictr»rt them, till some incooventence 
irisoB which may call for their remoTul. 

tit t» fMimcwhat singolar, that the natural growth of the 
i»t set of teeth does not wem to be raried, at least, ac- 
ording to any gencml rule, by the degree of strength of 
llic inlnnt; for wenkly children often cut their teelh even 
— man rapidly than those in robust health, though the tv- 
^■rerae i« perhaps more generally the case ; and hence the 
stimulus of ini la tion in the process of dentition very nearly 
keeps pace with that of healthy vigour. 
■ At this dmc the gum la often extremely sensible, and, M-mpmni' 
instead of being eMed by the pressure of a hard substance, ' " 
cannot endure the sUglitest touch. .4t the iKtse it is florid 
smd dist^nditl , biit paler nnd whiter at the edge or upper 
|>art, and when the tooth in on the point of protnision, 
■eemn covered with n flat and whitiKh Mister. The othur* 
Mymplome arc a repetition of thwe }»nt described, wi(h n 
omWiy cniption about the lips or bend, erythcmatic in- 
flaimnntion behind the cars, and oconRionaJly Dpnsmodic 
nnvemenlit of the mouth undjuws, roi)viilMionK,orepili'psv> 

The grand point is here to m^Hleruti' the local iiritnlioii. o™«»i 

uouncM. 

• (VtH. 3a. t Epli' N"!- t'ur. Vtt. II. Anu. ir. Ota. 3ft. 

;^M«Micl d'Aut. MID. iU. p. UdO- 4 Uut. of th« Tatih, p.t. ■ 

e2 



\ 





ss 



CL. I.] 



eOLlACA. 



[OKJ>. I. ■ 



huMH, 

when umAiI 



Okx. 1. A dianhcea or full dinchurgi: of salivs does tbia oaturallv, 

■ o. Dtnti' and hence these are Tavouruhle Hymptoiua. And if lh« 1 

tlonklM- fontier tie too violent, or ucvoiupanied with iTipimr. itJ 
icnUuni. Ill, , , , . ; ," „ 1 

MilktwdH should lie itwffly corrccUid by ntagneaia or jireporcd chalk. I 

"■>- If the bovreU be confined, we louit employ cooling Iilxb-J 

tivGs ; »nc] the discharge of a snuill tguuntity of blood fron I 
th<; >!innB ill tlie lir^l Mttf^e, by lancing them, will oftea] 
ufibrd efluctual roltef. If the symptoma of oppression or] 
spasmodic action be severe or incumbent, as drow^neu^J 
ditiiculty of breathing, stertor, or irregular luottoa of tfatj 
jaws, anliuionial emelica and leecheti should be bad recoarM] 
to, and occasionally repeated ; after which, blistering wilij 
be found uweful behind the earn or on tlic lack. Andf 
when (he boneU h^ve been thoroughly vm|itied. tbv ubc oTi 
unodyncM niay be allowed, and will Kcnendly prove highly! 
mrvicmble ; tbough they should be employed with gnatj 
judgment, and never intrusted to nurses. Uyoscya 
in mOAl of itii forms, has oAen succeeded here as well g 
adult tootli-acbe, when judiciously adniinislercd. 

In tlie second stage, or when the teeth are on the point] 
In Uit ac- °f protrusion, the lancet will olten ufford immcdtute relief, < 
cuni) uigr. oM by u discharge of blood, for the u|tpcr part of tlie gum 
M now become so ttiin hikI wasted ttmt liule or t>onv will 
follow, but by giving u direct opening to the tooth, which 
will ftcqiiently make ita appearance in the course of ft Eew 
hours. In tliiet xtagc. however, if we cannot at onc» enl 
down directly upon tlie tootli, the lancet had beUcr be 
withheld, for we rdiall l>e lerliiin of giving pain, lliougli 
very uncertain of afiWdiu}^ rtlii^f. 

U is singular that the use of the lancet sboold bo ob- 
jected to so generally. The tooth is imprisoned by s 
loenibrane that surrounds it on a full ntretch, and that is 
in a stale of iiiftamniiition. Lancing the gum, or ruber 
the titftnined meinbrfuie below tlie gum, tnkes off the tan* 
sion, and sets tJic tooth free. The pain is slight and trtos* 
ient, end by no means to Ix; computed with the permanent 
unciuinuss which the operation undertakes to relieve. It 
has been conceived, that a tough indurated cicatrix will 
be forim-i) if the divided edges of the guiu should unite 
udi-r the Imtcet has been iipplied. Vet in the spongy tex- 
ture of thb orgMi no such eflbct is found to follow ; Iwi. 
on the cuntmry, the recently united edges of the gum, ss 



m 



DIUEtTIVB PDKCTION. 



[ORO. 



sa 



[in all oUier parttt, far mon vtisily give my to the procc&s 

tibeor|iiioii tltiin they would otherwise have done; by 

rhich niCiiiia tlte passage of the tooth ii) facilitated. 

Ab the otythcmatic inflammation, which oceasioiially 

ftalce« place hchind the eai's, proves often UHeful as a re- 

veitent, it haa also been found sometimes ftcrvicenble to 

litate it by a friction with aavin ointment, or oth«r rube- 

licicnts. But I cnnnot adviittt that tliis or Buy other cnip- 

M, when produced mituriiUy, sUotdd be Kufiered to run 

ficir course wiUiotit restmini : for I have often knonn them 

come ft worse evil than the original disorder. In this 

BOM, thoy should unqucetionnbly be exchanged for some 

Dthcr more convenient diwliarge. 

In cutting the sKco.sn or pekmanf-nt set op teeth, 

is not often that much uneaainesa is encountered; for, 

iratly. their progress is much slower than that of the sheil- 

iing-ieeth; nnd.next, the constitution, with the arqiugilion 

Ts^frMter degree ofstrength.ixal thiit time become much 

irrilnblc. In a few cu«e«, however, they pni»h forward 

rapidly, and urge the fihedding-teeth i>):^int<t (he siiper- 

ncumbcnt gums ko forcibly an to excite considerable 

aain ; and hvto o free application of the lancet afTords the 

ifwediest and most efficacious relief. And not unfrequently 

lie permanent teeth ascend with great inegolaiity, and 

kprew against the crown or fangs of those above them in 

RefToneons directions; whence another tmurce ofoonwidcr- 

■blc petin. In this case, the best and indeed the only 

{ndieal cure i» to extract the upper or cutliiii^ toolli. and 

[thus allow freedom to the under tootli to rif^ht itself*. 

[The milk-teeth occuHtonitUy continne in the jnw long 

L-af^er the common period of their being Khi-d; und. as this 

circumstance does not necessarily prevent the permanent 

ynn from being ctit, the jaw seems at first realty to c'intnin 

IB pretemnliirol number of teeth ; but, in most inslnnces of 

[this kind, the appearsnce of the permanent teeth is returded, 

they are even wanlin^r, a circnntKlnnce fully Recounting 

or the anomaly of the eximordinary continuance of the 

thers't'. The permanent teeth occasion the railing out of 



Oca. 1. 

8rEC. I. 
a O. tknii- 
donu L>w> 
MDliuni. 
MOk-tMh- 
Ing. 

Rubcfli. 
denu. 



lionli Pu«(- 
PrnDsncnU 



" D.' i'Arfwgrtirnt ilo SrConilt" Dotits nii la illiliiMl'' N'niirrlk lie iia^a 
I draxlAne Dmtltlon, Ac pat M. DnviJ BiMh, On. PvU, 11130. 
itwftal. JlMurl 4' Ami. hid. lii. p. asu. 




6-1 



CL, 1.] 



V«XI.IACA. 



[ORU. I A 



»». I. 

Srac. I. 

O. Ddiii- 
donl* Putt- 
Ilk 
PanDUMaN 

leMMng. 

llunii 
AdutMnJtli. 

Adutu 
Mfthing. 



laDmti. 

ilnriiBenl- 

Uum. 

CUiMttoic- 



the milk ones principaJly by deetroyiog wilti their pn-a- 
atire the vc8s«U and nerves of the latter, a§ well as the 
adltciiiou to the niveoli. The deHtnicUAii of llie faag* 
not «n iitruriable ell'cct, mit the milk-t«etlt, wiien tiiey mr 
shed, M>mctiiiie8 have voiry perfect fangii *.] 

In thi! fonuiktioii, Hiid cspecinlly in the cutting, of th«j 
third wt, or wtsu tektk, wc ordinarily meet Vritb a (* 
more considerable degree of pain and inconveniettce, andj 
tbiK too for many iveeka; and the pain npreatU by sympathy | 
to the var, which is often niofe alfected than the toothJ 
ibMir. Such is especially the c««e where th« forantMsJ 
takeK pluce late, and after tlie jaw-boiic» have censed 
grow, nixl \hr. gum hew become thick and callous; for 
buvii hvTc u want of sufficient room, and little power oft 
largin^ it by absorption. In tbv upper jaw. moreover, 
tooth on each side is frequently obliged to incline b«ck<' 
ward, by which means it presses on the anterior edge of I 
coronoid piocess in shutting the mouth, which caoaeii 
additional degree of uiicasiQew; while, in the lower javr^l 
»onie pnrt of the tooth ooatinucs to lie bid tmdcr the 
lufid pruccM, tnd the portion of tfa« gum Uiat covers il 
perpetually liable to be Hqueczed by the tootli below, : 
the corrctiponding tooth in the jaw above, in this 
nolliing but a very free crucial opening will suttice; audi 
often nothing but an excision oJ' a very conaiderable 
of the callous gum : while tlicre arc oilier instAnocs, in) 
which llie evil can only be cured by rvmoring the toot 
itaeir. 

We sometimes, though rarely, meet with playful attempt 
on the part of nature to reproduce T£KTH at a vkki 
LATE PERion nv LIFE, aud aOer the permanent tect 
bave t>een lost by accident nr natimd decay. 

This mo«t commonly taken place between the aixty-tbir 
and the eighty-first year, or the intvrTal which fills op thfti 
two grand climacteric years of the tireek physiologisia ; alj 
which period tlio eonalitntion apjjeArs occauooally to ma 
an effort to repair other defccln titan hmt toeth, on whicl 
we shall have occasion to treat more at large, when do-' 
scribing thatvsriety of decay, which in the present system 
is dcnomiaated climactericf. 



> 



op. cil. f. 101. 



t Km thm II). (M. rr. (kn. tii. SpM. t. 



CL. I.] 



OICRSTIVB rtiNCTion. 



For the most part, the teeth, in thin case, aboot foitli 
imgulnrly, t'eur jn nuuibtfr, nnd witliout proper Tsngs; and 
vrtn, where fungs are produced, without u renewal of 
fiockets. ilcncc they are ofWn loose, and rrecjuently more 
injurious than useful, by interfering with the unirorut line 
of the indurated and callous guma, which, for innny year* 
perhaps, bad been ein])lo)'ed as a suhntitute for the teeth. 
A COM of this kind is reJ&lod by Ur. Uitucl of Knayton, in 
wbicb the patient, a female in her ninety-eighth year, cut 
tMelre molar teeth, mostly in tbu lower jaw, four of which 
were thrown out soon aftcrwardtr, while the rest, at ihe time 
of examination, were found more or leas loose*. 

In one instance, thout'h never more than in one, Mr. Hun- 
tcr+ wiuieni^d the reiiroductton of a complete »et in both 
jawH, apparently with u renewal of their sockets. " From 
which circuniKlunco," xays he, " and another that some- 
times happens to women at this age, it should appear that 
titers is some effort in nature to renew the body at tliat 
time." 

He alludes to a restoration of the catamenia, and to the 
climacteric ohnnge. which we shall hare ocon^ion to notice 
hereafter. The author of thin work once attended a lady 
iu the country, wfao cut Bereral struggling teelJl at tlie age 
of aeventy-four ; and at the same time recovered such an 
ocutettess of vision as to throw uway her spectacles, which 
she had made use of for twenty years, and to be able to 
read with eaw Ihe smallest print of the newKpnpers. In 
another caite that occurred to him, a Indy of seventy-six, 
mother of the late Henry Hughes. Usq. printer of the 
Jotimals of the House of Commons, cut two molurcs, and 
Bt the same time completely recovered her hearing, after 
havinw for ttome years been so deaf as to be oblij;e<( to feel 
the clap|>er of 2 small hand-hell, which wus always kept 
by her, in order to determine whether it rang or not. 

The Oerman Ephemertdcs contain numerous cxaniplce 

of the same kind ; m some of whicli, leelli were produced 

■at the advanced age of ninety, a hundred, and even a 

hoadred and twenty. One of the most singidar instances 

on record is tlnit given by Dr. Slade X- which occurred to 

* Ellin. Mix), ('nmincni. i«I. vili. p. IITA- 

t Nil. Ill«. ofthcTnth. 

I no. Tnnt. ToL xxtIi. jw 1713. 




£liin]>tn 
ur linuiiUt 
r«]in>Jiic. 
liunt. 



i 



80 



CL. I.] 



ca:LiACA. 



[OBD. I. 



tit 
■ STB 



ueh. t. his father ; wbo, at tlie it^c of screntjr-fire, reproduced an 
>CL Umii- incisor, lost twcnty-fivv ycura bi-furo; UDd at scvcnty-ffCrCD 
^*^'' re|>r(Kluced another to supply a simitar vacancy, so that at 
^i^^aui^ eiglily b« bad hereby a peit'ecl row of teeth in both jaws. 
""''^ At eighty-two they all dropped out micceesively ; twoy«an 
aAenvnrdt they were all suecetaively reaewed, flo that tt 
eighty-fivi; he had ouce more an entire Het. H\^ hair at 
the eaiDc time changed from a white to * dark liuc ; ttnd 
his constitution sceiued in some dci^rce more heulthy tind 
vigorous. Uc diud stiddcnly. nt the ngc of ninety-ninu or 
a. hundred. 

Sometimes these teeth are reproduced with wonderfal 
rapidity; but, in such cases, with very great pain, from 
the callosity of the guros, through which ihey have to 
force thfMiAelves. The Edinburgh Medical Commentaries* 
supply us with an instance uf tJiis kind. Tlie individual 
was in his Mi\ty-fir>it year, and nltogcthcr tootlile:<!t. At 
this period hie guiits and Jaw-bonc» buoamc ptiinful, aikd 
the pain was nt length excruciating. But, within the 
apace of twenty-one days from its commencement, both 
jaws were fumuhed with a new set of teeth coinjilete in 
number. 
Pnundtd The jugglers on the continent, a century or two ago, 
bT!^"]^ were in the habit of taking advantage of Uii» occiuioaal 
playfulnc«« of nature, and utiiTiii!;, a» natural phenooteiM 
in the formation of teeth, singuluritieii which nature never 
dreamed of. Thus, a boy was at times started and hawked 
about the country with a golden tooth, much lo the tiito- 
niAhmculofboth the learned and the unlearned; for though 
the tooth waa in reality a natural one, and only oovertd 
over vritli on inlay of gold, yet the gilding wus in une ot 
two instances ko eKijuisitely ellecied um to deceive almost 
every spectator, when the trick wan firvl brought forward, 
and to lay a foundation for no small number of teamed de> 
uriptioos and profound explanations upon the subjectt. 



* V«L Ul, p. lo». 

t HmMmu. U« Anno Dmu*, Lipt. IIRM. 8ni. IngiJnMUt. DcAntoi Dmu 
Silc*i«d Pucri, lAj- )00l>, livo. TflkoUkir, DiMjuUilo duoram Piwraniah 
uniu cuiD DcDtt Aiuw, dts ana Capiu Uignleo, il LituanU lini*, OMn^ 
■too. 



by jugj{l«n- 




■TO 



t>ICR*TIVB PVHCTION. 



[nun. i. 



.17 



SPECIES II. 

ODOKTIA DOLOROSA. 

TOOTll-ACUE. 

ACt'TR PAIN 1» THE TEETH OR THEIB lN»OLtICttE«. 

TiiKKR ie oftun a considi-niblc dt-gree of paio of a por- „""*■/: 
ticalnr kind tlmt accom{>aiiies the irritation of the Inst 

[ttpecics: l»it it is rarely, if ever, of an acute character ; uriJ 
rather a sense of soreness about the ttjoth than an ache 
rithin it: and hence the delinilionR now oflered are 

[ftufficienUy distinct. 

Fain of this kind may be produced by various cnuaes, ns Ctuwi. 

Is cftlarrh, or cold; im t'XostoHii or deposit of earthy matter 
on the nidcK ofn tooth or it« socket; n cnrics or decay; a 

I |Meuliar affection of the nerves of the sockets or jnw-bone. 

lading upon a tooth by contiguous sympathy, nnd hence 

I not relieved by extracting the tooth that is suspected. It 

Isnay be produced also by ftome remote influence, as that of 
pregnancy, or sordes in the stomach; by a peculiar dia- 
tbesiB. as thatof rheuniatiitm, oritcun'y; by the long use of 

t luereury ; or by a traniifer of action, M in Bome cases of 
gout, in which the pain i« often most vehement and ngo- 
ntring, and in various instances h»8 produced eonvulitions, 

-■Ddin others delirium ; or, in the language of tho sufferert) 
UienMlTOS, has actually driven them mad. In several of 
Umm cues, it occurs as a mere symptom of some other 
diteasi'; and can only be cured by a removal of the dis- 
(■UH« that gives riKo to it. The following varieties, however, 
seem well worth attending to, and will generally be found 

' to result from a primary affection : 



' « Catarrltttlis. 

Catarrhal tooth-ache. 
* fi Cnriosa. 

Carious looth-ache. 
y Exostosn. 

Node lite tooth -ache. 
i Xeivoiruni. 
Nervous tooth-aclic. 



From cold. 

From decay or caries. 

From Qsaific <lepoait. 

l-roin irrilaliility of the dental 
or adjoining nerves. 




CL. I,] 



C<XLIACA. 



[OKO. I. 



o». I. Erery lootli has an int«mnl caTitv which commences at 
■ O. l>alih tbi: point of iu fang, and «nlar(;M us it asccndo into tte 
mmChut- body. This cavity is not cellular or tugged, bnt Hmouth 
'pnamld. ^o 't^ surface: it contains no marrow, but appears to be 
filled with blood -resae Is, aocoiupauied with nerres, which 
miiKt necesHarily be derived from the second and tliird 
brunches of the fifth pair, tliough they have oever been 
diMinctly traced. In the interior of thin cavity the (c«tb 
appear to be peculiarly Kewtiblc; tuul honcv direct or in- 
Cbmm. direct Bxi'(>si;iiR TO 1'itK ExTKfi N At. AMI ; or, in Other 
words, a curiouii opcninf^, or a current of sharp air without 
euch opening (for tho air eccms in many instances to act 
through the aubstunccofasound tooth), will produce acute 
pain, and is, in fact, the common cause of toolh-acbe. The 
pain thus produced nill sometimes cease very Biiddcniy, 
and e&pecially upon the application of an o^uate, or •on* 
acrid essential oil. Hut the irritation in often coiimuini- 
catcd to tlie periosteum of (he tooth, awl thence to the 
membrane that lines the socket which is only a duplicature 
of it. And hence, the pain will oft«ti become perntaneni 
from influni million excited m tliesc tunics, now thickened 
and tense, and at the same time incapable of relieving 
themselves by stretchini;; while, if a rhvuntatic or •;i>»ty 
diathc-Mis prevail, tlie piiin may become intennittent or 
pcriodiciil. 

Ttoimtnt. In all ihese cases, whcrt-vcr wc can trace in the lootb ft 
bole opening cKtemnlly, the readiest and most efTectuaJ 
modes of cure will consist in stopping up the hole with a 
metallic or some other aubstftnce, so a.s to defend the tootii 
from the occitks of cold; or in destroying the aflected nerve 
by caustics or caiitunes intrQ<luc^l through the hole itself. 
The pain may nl»o be ucc3i*ioimlly dimiuished by the ap- 
plication of opium or the more acrid aromatic oils, espttdtlljr 
tJiat ofcajoptit. which Is a distillation of the leaves of hw 
laleuca Uueodetidron, either directly lo the nerve in tlw 
tooth, or to the extremity of those nervec in the dcin, which 
are branches of the same grair. [An application, parlicn- 
larly recommended by Ur. Blake, at one of the meetings of 
the London Medical Society, is a solution of two dmchna 
of alum in seven of ihe nitrous spirit of ether.] These 
medicines act by exhausting the sensibility of the nerve; 
and henc* ralief is procured by volatile alkalies and ruhe- 



I 
I 
I 



1. 1.3 



DICB8TIVB PUXCTION. 



[OBD. I. 



59 



facienta ; or by a blister behind the ear of the affected side ; ax*. I. 
by burning: the edge of the hetix of the ear; nibbing the_^,"'j|^^ 
chcekn with tbe t€rambi/z mMfbalus. which posseoaes a «»■ Ciur- 
TCMCAtoiy power nevly eqiial to tliat of the lytta; hotdine J?^''™!.!. 
brtindy or hoi wiit«r in (hit moiilJi ; or applyinir the sedative |„{,.,nii> 
! jiiicct ol the ludy-binl or cuixinrlla xrpKm-putictala. as well p-ncmlljr. 
lu that of Mvcrul other insects, to the tooth or guni», after 
bnustng tbuni for tht« purpose between the thumb and 
fingera. The lOot of the peleveria aiiacea, or ^iiiiua-h<-n- 
weed, a very acrid plant, is employed for the satne purpoHc 
by the inbalntants of Jamaica, who put a small plug of it 
into the diiieascd caTity*. 

So the inasucation of vhrious other iiromntic or ittimu- 
kiting plants will often produce a similar effect, and especially 
thoM that at the same time rouse the ducts of the saliva) 
gbiads to increased action, as the bulbs of iKc alliuceoua 
plants, the root of several of the seselis, particularly the 
tetrii vuigart, the common hartwort, or laterpitittm sUer, 
Litm. which baa lon(T been celebrated both aa a eialagog^ue 
and a remedy tor the tooth-ache. 

Such masticatoricH, however, arc chiefly of uae in the Jtixii>;>- 
tootb-ache produced by rheuniatiiim, or where congestion ^ 
has taken place in the neighbourina; parU from inflam- 
mation of any other kind. The sensibility of the nerves 
may hereby, indeed, be in some degree exhausted, bnt it in 
the evacuation that principally nffonh relief. And it is 
hence that relief ijt abto not u 11 frequently obtained by 
Kmoking or chewing tobacco, and, as Dr. CuUen conceives, 
by the use of cumphori-; though it appears probable that 
hotli the camphor and tobacco may portly opomlc by the 
se«la(ive power tlicy possess. And as errliines promote 
the name secretion as BialagogucB, these have also been 
fitcquently employed with considerable succesti, as weil in 
tooth-aches as opbtlialniics; in both which cases, however, 
preparations of asarum have generally been found to pro- 
duce more alleviation than those of tobacco, which is the 
basis of our common snufls. A local application of can- Oimm il« 
tharidcs in powder or ointment is inconvenient, but the ,|,"|,"„J,''^ 
tiitctuni caiitlmridts may be often used etiectually wJtlt 



■ Twit. .'itxcUi. AMd. 1«M, jktBJ. 
t >lM. Mnl.vol.U.li.aM. 



i 



:i.. I.] 



ra(i,iACA. 



toBD. II 



Okx. I. 

Spkc. II. 
. O. IVOi. 
ra** (raut. 

KramMld. 



Ekcuidij. 
Mtgattitm- 



Anlmkl 



the orlnut 




little trouble; yet the moot elegant form of this stimnlflnt 
for the present puqwic is thnt of the French Phnrninco- 
|Kcia, under the mime of Oleum de CantUaridilniM. It i» 
made by dige«ting for six houra with a genlie bent, one 
pari of powder of cunthnride^ in eigi)t \\an» of ohT« oil • ; 
the oil thuK impregnated is to be Altered, and is then 
fit for use. 

Electricity hns nlM been tried, nnd occuiioQally with 
succesM. On the continent, roi^etiMii has been & still 
more favourite remedy ; and has at least more writers in 
its recommendation t, whatever be the actual beiieflt it 
may huvc produced, of which 1 cannot epcnic from p<n^ 
Honal knowledge. Animal magnetism seems at one time, 
iodccd, to have been very extensively employed for this as 
well as for other severe pams ; and if we may credit the 
wrileTS of a century or a cootury and a half ago, with 
instant and s|>ecitic effecll;. The grand magnetiser of the 
dny was the then celebrated Valentine Grealrake. who 
operated by stroking hia hands over the parts afiecled, 
much in the same manner as Mr. Perkins of America not 
many years ago employed his melnllic tractor^^. And ns 
stroi^ emotions of the tnind are wl-11 known to every 
one to produce « more imnwdiatc influence on the tooth- 
Bclte than on any other diiwasc whatever, we may readily 
tccount for the curea hereby produced in some caaea. 
Confident hope is as strong n stimulant as terror ; and tbo 
latter is well known to operate bo gcnemily, that it ie a 
rare fact for a penton to be actually suffering pnio just 
before the operation of extraction. 

The stopping of « carious opening in a tooth should 
only be attempted when there is no p^iin ; for otherwiso the 
pain will be incTcaited by the introduction of a foreign 
body. The substance* chiefly employed for this purpoM 
arc gum-lsc. bccs'-wax, sc«ling-wax, tin. lead, and gold. 



* Ceil* AtcdUuncnlMliH, MM Phawnieifalt (IiIIIcl Varit, IRIK. 

t Pi U CmlaiidM, J«U(n. it MU. imu iitiI. p. KM. Glaubnctit, Dtak 
.\udt«ei 4* (MonulKls. «>atqaa rtint^lU wlU. pr«clp»t Mi^mb. Argiw. 
i;iHI. Vmkt, Nmct Venucht in Cuilniitit da ZttitmOuamim* viwjImIm 
(laa it»(pne^Atti ^uhli. Konigib. IJW-S. 

1 SdMllMniiMr, OIm. it Odunul||ift iMifl HilrTKli. Jen. 1701. 

I fluHok Anaccaunt of (vraal mimllaui cars ^nfotinnlbf ibeMMklof 
of A* limU of ValniiliK IlKMnkc Lmd. HHM. Mt 




U.fc] 



OlOESTIVB PUHCTION. 



[OltU. I. 



e\ 



Theawtals, and eap«ciully tiitfoU, ure amongst the most Gtic. t. 
useful, lui ihey nffonl tlie hwl ■;iianl. wiiil far less frequently , aVidii. 
require to bo renewed. Vet none of them can be easily woP""- 
letsined in cases when tlte opening is wider at the top rtotn cdii. 
thnn tttc bottom; and altlioii<;h uttemptH hnve been made 
to keep them in the proper situation by drilling a small 
hole through the sides of the teeth, and rivetting a proper 
pin into the metallic substfuice, they BOon become loone, 
and admit air, food, and other acrimonious matcriAls. 

Mr. Kox make« mention nf a compound metnllic «ub- 
Ktancv that had been rccontniciided to hitn, a« far better 
cnlcuhitcd to answer the purpose of a permanent plug than 
any of the preceding. It is, he tells us, obtained by mix- 
ing several metals together, which by the process made 
use of, become fluid at the temperature of boilini^ water; 
on which account it ban been culled fusible metal. It i^ Foiible 
supposed that this may in consiecjuence be employed in "" 
a liquid tttnte, «nd thus have nn opportunity of slrikin^r, 
before it becomes cool, into nil the nullifications of the 
carious part, so as to lill up the cavity completely, and 
form a 6xtuie not easily to be detached. [A more practi- 
cable method, perhaps, is that of Mr. Fay, who also 
employs some kmd of amalgam, that melts at a low 
tempernture. A nmall piece of it Iwinv placed in the 
tooth, an instnimcnt hcuti^d in die flame of a spirit lamp 
is apphed to the metal, and molls it. In this manner 
the metal takes the exact shape of the hollow, every part 
of which becomes tilled up.J 

It has often occurred to me that some of the drj'ini^ Indutuiu- 
carlha employed as ocments by our stonc-mafton*, and p'Xni' 
which harden into an indiwtalublc plate or mass under 
water, might be used with more success for this purpose 
than any other substance ; cspectaUy tufa or tuflwacke, 
as Schmeisser calls it, and tarras, which are compounds of 
iron, alumine, silex, and carbonate of litne. Introduced 
into the cavity of a carious tooth in the form of woft paste 
or mortar, they will easily dry and harden and adhere, and 
no motstnre of the moutli will dissolve them. 

If these methods should not succeed, we may attempt N»f»» •""- 
a cure by endeavouring to stupify the nerve of the tooth S^^^. 
by a frequent use of hot essential oils intermixed with 



I 



CL. ..] 



CtKLIACA. 



[OKD. I. 



UM. I, 
«PKC. II. 

. it. Dohb 
(«• Caur> 
rhklit. 
Pnmaald. 

oTihe u. 

riousuKith. 



II«nMr. 

WbHMUcd. 



contpbor and opium, or ne may destroy it directly by n 
bot iron. And ir these methods fail, and the i<xci»iot) of 
the croHu of tlic tooth, as practised by .Mr. Fiiy. nhuuld not 
be deemeti advisable, the otily allcrnulive 'i» extraclton 
whicli, ]iowever, »liould n«v«r b« bad reeounw to till the 
abovv ))l;iii)t haw Itecii xkiirully tried ; for, first, th« pain 
may proceed rioni an utlV-ction of the eoclEGt, and in tbi« 
case the pam of tooth-dniwing will have been incurred for 
Do purpose; and, next, a carious tooth, whoae uenrc 
baa been destroyed or rendered torpid, may be of ray 
essential service, an well a» oroanient, for iiiftDy ytan, 
perha)>s through llie whole of life. Vet if tho carmi be 
tuxompanifld with iuHnmiiutlion in the tnirrounding parts, 
tho tooti) should bo removed without loss of time ; aa the 
mischief may spread, and the adjoiuing teeth be hurt*. 

[Witli respect to Mr. Fay's practice of excising the <)u* 
flued tooth at it« nvck, its oliief rccoiunictuUtiun is the 
KToidaDco of thupainof extraction. The oporution, which of 
course is ordy warrantable wbeo tlio fang is free Gnon 
disease, is perlbrmod with cutting forceps, expressly coo* 
trive<l for the ))urpose. Directly after its execution a 
piece of cotton wool dipped in od of cajeput is applied. 
According to Mr. Fay, ll><; canal in the centre of the tootii 
nftvrwurds bccomts filK-d up with liony nuilter, a point 
which it would be interesting to deU-miinc miiIi certiunty, 
not only with reference to the pennaiient ethcacy of the 
operation, but to the disputed subject of the vasculoritj 
of the teeth. The first of these subjects, however, must, 
after ail, require the sanction of geiit-ial and large ex- 
perience i whUv the latter would not be altof^etlier settled 
iu favour of tlic vascularity of thtt bony subslnnce of the 
teeth, even were the cnnal in the fimg proved to bu filled 
up by ft bouy stibetancc uftor the excision of thu crown. 
Iu eoneequcnco of what Mr. Fay cousidcrs as happening 
he inserts the stylet or pivot in the canal directly aflcr tlio 
excision whenever it ia inteudexl to tix an artificial tooth.J 

In extracting a tooth, a very Iroublesome bemorrhags 
will occoaionaUy follow; sumeUntes profiiM and of long 




■ Muud da DoKlMc, poor I'liiplliiUiM dn IktiH anlOdelki lmiW|l 
ikdlo, ac t'ttC Mvmj, ft faulOcit tn. Parii. IRaa 




Ul.] 



DIGESTIVE PVKCTIOK. 




[OBJ). I. 



I coattDQance. Plater, Schonck, and others, bavu ukIcukI Okm. j. 

■giwn cues in which it has proved fatal*. [Mr. Blft(;il«tit ^I'^iaU.'. 

\h»» rtcoixlcd tlie purticiiliirs of one very rcinitrknble inu ('nwr. 

inslaiicc. in which tlic uuc of Myptici*, th« actual cauU-ry. pjjljj'ojd 

s plug in the socket, and even a ligutuTO on the carotid 

I artery, (ailed to euppreaa the bleeding, which proved fatal 

' a wwk lifter the removal of the tooth.] The best ordinary 

L styptic is pressure witli an elastic Rubittance, a» a piece of 

I Sponge covered with wax, touchwood, apunk, or some other 

, spongy bolettie, or a dossil of lint dippin) in u Htrong 

, solution of alum or sulphuric acid. I nas not long ago 

I lequestcd to see a young man, who had been profusely 

bleeding from the gums and socket of an extracted toolh 

for five dnyn without cessation, and without sleep, till )iii« 

WBO cheeks and faint emaciated frame aeeraed to indicate 

that he had scarcely any blood left in his vessels. He was 

l«o Tfcnk as to be incapable of rising from his bod or taking 

ifeod ; and hin stools, from the quantity of blood he was 

lally swallowing, had all the appettrancv of a 

!l»na. On opening his montlt I found it craratned full 

'lint waddinv, one piece having every honr been added 

I'lo another, without a removal of the preceding, lest the 

bemorrha{;c Khotild be increased, whilst the blood in which 

the waddin;; wn« A^^oakod, nnd which hud remained in the 

■ocket and over the gums for so long a period, was becotuti 

grnmouB, putrid, and intolerably ofTonsivfl, 

1 first removed the witole of this nauscRting load from 

the patient'K mouth, and gave him some warm brandy and 

^ water to wash it with. I next directed him to take a 

^ ^blet of negus with a little biacuit aopped in it, a part of 

which he soon contrived to swallow. The bleeding still 

continued : but as I had iio doubt that this proceeded 

I mtirely from a total want of power in the lacerated orterieii 

'to contract, I applied no pressure of any kind, but pr^ 

'acrityd a gargle of equal parts of tincture of catechu nnd 

[ vunn water ; and the hcmorrhAge won ceased. 

It ta not easy to explain by what means teeth become ('ori»,iiinr 
carious. Out of the body they ar« indestructible, except ^^^^ 
by very powerful chemical agents; and yet, in the opinion 

• PblcT, Olx. Lib. HI. p. 77:1- Srhamk, Uh I. Obi. 4«3. 105, p. HO. 
t H«l. Cliir, Trana. wil. viii. |>, -iSi. 




t 



C4 



ct. i] 



CtELIACA. 



tUb. 
ftomttid. 



ncviu boil}' 



Uev. I. ol' many pliy»iol(^iito. th«y ara nearly in the stone Btale ul 

•. (^*bal». *'"^ '"^y "'^ ^'" '*'' '^< e'ctnuiMiu Bubstaoccfi, formed com 
nwCiMt- plflc ut first, without vascularity, groffih, or interatiliaL; 
action, and even (le»titute of absorbent^. 

Id caiiea of tJie boaes. observes M. Auz«bi,thedwftyed,{ 
part is thittvrn oir, and give« place to n new growth f 
while, ill the tccUi, if tlic tiiamcl be broken, aud a carica 
ooiiiuicncc, the carious part ii never thrown olT as in the 
boitcs, but coDlinues its pn^rcss through ibe parts ad^i 
joining; nor can any remedy we know of produce a ncpa 
ration between the purl tiiat is soutid and tbiit wliiclt ii 
WhgthtT unsound. And wc Uuvc hence, say6 he, u proof tliat tliertt 
tilt mill bfi arc DO vessels in tliv Mubftttuicc of tJie teeth, and thiit they 
have a distinct conformation from other bones*. NoC 
widely diSVrent was the opinion of Mr. J. Hunter, when 
composing his Natural History of the Human Teeth; an 
opinion drawn from the impossibility of injeclin<; thenir^i 
the perfection in whicli they ure produced -4t fintt, ami 
their retaining their natiiml colour iiftcr lo lonj; a nse of 
madder as food tliut ull t]>e other bones of the body liara 
become thsroiigbly tinged with it. " But they have most 
certainly," says he, "a living principle, by which meMi* 
lliey make part of the body, and are capable of unitinj;-'' 
with any part of a living body ; and it is to be ob«vrved, 
tJiut aiicctiotiB of tlic whole body hiive liws infltieiicc upoii 
the teeth than upon any oth'T part of the body. Thus, ia 
children affected with the rickets, the teeth grow equally 
well AS in Iicsdlh, Ihouirh all the other bones arc inach 
affected ; and hence th«(r tec^th iif-iiig of a larger *.iza in 
proportion to the other partit, their mouths ara protu' 
riint." Cuvier, who has udopleil all Mr. Hunter's views, 
*UJ^*v°^ hns employed ihc asme remwmingt ; and M. de BlainvUJ* 
' has apparently gone beyond both ; for he has denied DOfe^ 
only a vascular stnicture, but even a living principit t»j 
the teeth]. 

Mr. Fox, however, is sraid to have succeeded in iiijoeting^ 
botl) the external nod internal layer uf the dental gonn. 



I 



■ Ttiilt d*Oili)*>ulgtc. od Ton fitiMitc un wptim nouvtw* nr 1*<w1(Im t< 
U (iniiaiian 4m Ihnn. Ac lifoiMi 
• l>ici-<k>6dmeMHUkalM,vt.Ufi)iT*. 
; NuutcBU Dki. d'lIlM NaMMllc, he fot n. Li vuiio. 



}L. b] 



OI0E6TIVE FUNCTION. 



[wuij. I. 



I 

Hiuwl even Mr. Hiintcr himwclf npixsirt to »pcnk with some 

Hdcgiev of fiu«itittioii in llic trcittifte before »s; nnd in his sub- 

'ecquont Irvutiso "On the UifiuuKcs of the Tueth," ufTureub* 

- urrations that scvm to sliow he liatl Ht that time embraced 

,B ditFcrent opinion. In (he firHt c-i^-suy, iwlectl.huttllows that 

["the fangs of teeth are liable toeiwlhngs, scenttnglyof the 

jiioa veotosa kind, like otltor bones;" but ho immediately 

^ndda. that " ther« may be a deception hero, for the swelling 

lay l>e an original formation." Yet, in the second essay, 

le treats of this swelling as one of tiic diseases to which 

|he teeth are |)er)xitually liublo; bo regards the teeth ag 

nibject to the common indammation of other bones, aiid, 

ikeotherlwncs, evincing, at tiroes, great sensibility Uirough 

entire substance of tlie oigan, as well as in Uic central 

ity ilwir*. 

^folmbly Bomo internal action is continually taking 

in the tecUi, though we are not nblu to truce it very 

i-ntly. The chief cnuscfi of a caric; arc undoubtedly 

Ktcmul, but it niny be sometimes produced by nn internal 

lUM. We have already noticed exposure to cunents of 

>ld air.ind tlio medical practitioners of GernmnyaiHl the 

sppoal to tlie opposite extreme of the habitual use 

hot uUments, as a still more general and mischievous 

aurce of the same evil. In the Swedish Amaiiilatti Aca- 

<iitet\ nc have an clubomtc examination of this nubjcct 

BI. Ribe, who tolls us. among other things, tliat "man 

the onlv animal accustomed to hot foods, and ainiost 

lie only animal alVecled with carious teeth," Whence iho 

luthor takes occasion to condemn, in an cspociul manner. 

lie cuatom of drinking hot tea and coffee; and, in ac- 

Jancewith tiiia remark and recommendation, M.TilltBUs. 

mother celebrated writer in the same interesting journal, 

JU us from Kalm, in his paper entitled I'olus 'i'hea, that 

Indiaiw of North America knew nothing of the in* 

ivonicncc of curious lueth or dcbilitiited Momuchs till 

I was introduced among them. There Ciin be no question 

liat the two extremes of heat and cold must be greatly, 

erha|>fl equally injurious to the health ; and as httle, that 



65 

Orx.L 
tSpcc I(. 
a O. Doto. 

TllktiL 

VraatwM. 



PoMMaa 

iDWnial 

action. 



Hoi hew. 
ragn inju- 

Hciui. 



* Ai the tnJ nf (hit toctlim tlic ijiivi liiu tiiiioiluixij (lit cbicf aii^intiita 
I ihc futubriljr «r thi' tnilli. 

VOL. I. » 



I 



66 



CL. I.] 



CCELUCA. 



[ORD. T( 



Okx. I. 

Srcc. It. 

aO. DolD. 
nmCmw- 
rluU*. 
FNMeeU. 

Umtkt 

iugu It 
injuflouj« 



llwMrth. 



(he inhabjianu of high northern Intitodeo miiHt niiffermr 
th»n olhcrA from the UM of hot alitnentii, in conwquene 
of the grrattr coJilncss of ilieir ntmofpherical tein()«niitir 

To thu nbnei' of hot beverage* b8 a cnnte of rarieii. 
de U Sallo adds the abuM or exeecsivc employment 
Btigar; and neeme to imagine that thi-Hc are the two prie 
cipal means by which teeth arc retKlvred black in tltt 
enamel, and carious in their eubstaocc*. 

If §iiirar act at all, it must be by means of tlie principl 
of acidily which is contained in it; and, oouK>L-r|iicmly. il 
proportion to the degree of affinily which thru [niiicipl 
bears to the earthy matter, or calcareoua bausof the tMlf 
and their enamel, beyond that of the acids which 
into their natural onni|H»ilion. And (he same may b« ofc 
served in respect to any otlier exotic acid whatever. 

If. then, wc examine the com|>oHition of teeth chemicallj 
wCKlinllfntd, thnt in theirstnicture they consist verylarget 
of pboHphntc of lime, with a small proportion of anitna 
matter, and a much smaller of caj1>onRte of limo; and 
their enamel, which ia altogether of the nature of iror 
that they conttist almost cntin^y of phosphate of lime, wit 
a small proportion of animal matt4>r, and a minute trace < 
filiate of lime. And admitting that the same dcconipositic 
take place in an organized living structure, or a aimply i 
ganitcd Rtntcture in > living fmme, as nheii the principl64 
life has no concern, «c have next to imjitire whether 
bo any acids that have a stronger affinity for liiiw Uiun 
phosphoric, for it is scarcely necessary to evtcriid our 
search to the cnrbonic, since this can never be attacked ' 
the enamel into which the phosphoric so largely imtera I 
deeompoBod. and witlidraws iU prot^-clion. 

Now, by examinin<; the tables of elective altractiona ' 
shall lind that there an- four, and only four, acids that 
cedu tiio phosphoric in their alHnily for lime; iho oxalic 
•tilphiirio, tartaric, and anecinic. We have daily pr 
that the teolh, in the tiviii'- HuKject, are greatly injured 
the fivquenl or hiibitual nw nf several of these acids. 
have at this mouwnt a lady under my care, who till of fati 
poasHBod OH sound and nno a wl of teeth us can any vf In 
be boaated of. From a |K:culiur delicacy of constttutic 



* jDuin. dt Mid. Mm. KUilL upptn^ii, p. 31KI, 



CI. I.] 



DtCEBTIVR rUNCTrOK. 



[OHD. I. 



67 



Ifaoworer, it haa liecn jii<l<;Gd reqaisitc thnt she sliould, Gest. I. 
I anting olher aiediciiie*, inse a very larsje (inantity of s"'- a^'o^^Oo'iol 
[phnric acid. Thru preiicnption ha» been continued for'wtCawr- 
many months, and her gviicrul heiillh is oonsidernbly esla- i,-,Jj'„|j, 
fKlinhud; l>ut, owing to iior not Imvinj; lalcon nil IJii> pw- Suinhutta 
etiution (liat U requisite to guurd tlic tri-tli while swnllowing ' 
Itbe acid, the pcariy ennincl is becoming yellow, and its 
[coaling very coiwidenibly diininii;hv>d in tliicknvve, so that 
lat tiie ap<nc of the incitMTs it is almost ns tliin as a razor, 
[and is frequently chipping off. 

8u£nf ain liure very little cffijct in dpslroying the enamel s-'pnr noi 
lof a tooth ; for, thovgli it contain ii principle of acidity, it ^^'^ *" 
[cannot with propriety be regarded as nn acid. It may give 
'>rtli tlii* principle by fvrnienution, in which case it will 
II acetous ncid ; or it moy give fortli the aame principle 
|by diHiilliition with nilric ncid, when it will foi-m genuine 
nlic ucid (for thnt which exists nirciidy formed in the 
h/m Mrtotffta, 'or wood-forrel, is |>rectsely of the anmo 
I); nnd, in this combination, will evince a stronger at- 
Btioii for lime than any other acid whntever. But of 
itself, and witJiout this combinution, wo have no reason In 
^^Uppom that its action, if there bo action at all, cun lie 
^■UwrwiM than extremely weak. [Goncml dc Beaufort ate 
a pound of wugnr cwry duy for forty years, und livid to 
tlie age of seventy. After death his tcclh wore foiind to 
bfi quitA Mund*. Plenck kept a healthy tooth in some 
diluted synip two months, at thu end of which timt it had 
Mndorgonono change -f-.] If, in truth, it were a Holvenl of 
calcareous matter of any kind, it would first show itself in 
<litisolving, and consequently preventing a lodgment of the 
carbonate, or phosphate of lime, which the salivary t^lnnds 
uru so continually Necretin^, and which is perpetually in- 
crusting on the neck of the teeth in mankind, ami sepa- 
lating thera from the surrounding gums ; and honeo sugar 
would l»o one of the best presetralives agaiiiBl such vn 
encroachment. But an we do not find that tJiose who use 
a large quantity ofuigar are freer from this excrementitious 
matter than thuw who nlHtain from it iiltogclher, we have 
a^rain no rcuHoii lu sujipoin^ that it is a solvent of the enamel 
ol' the tenth in any material degi«e. '* 




* A nifJali < <1f MnUcinc. loin, ti, |h 'Jit. 
f Llociilna <lt^ Min\>. DmiUuih, j<. ii. 



f2 




C8 



CL, ij 



CdLIACA. 



[nno. ti 



o«». I. It will be well lo bear thcee rtmarkB in memory in th^Tl 

*'o*DtSol composition of dcnlilric** coiitaiiUHg ncida of any kind. I 

TOMCauT- For the reasons alrcn(lyHKxi^ni.-(l, llic oxalic, ftiil|>lniric, and-] 

noutt^ tartaric acids, ooglit at nil tiniiw to be sedukmsly avotilwltj 

Cution in ""' ''«"*^6 creani of turtar, wbicli cnKint no generally tntiX| 

tiwrnmrM. tht^ir compoHilioa, sbuuld in like manni-r be rigidly pro J 

dmlfricM. ^"'"'"'l '■ **>''« thow which h»vc Uic kiiRt cbnncc of doingJ 

miMhtef from their vvry iili£;ht affinity for lime, aro UmJ 

citric, benzoic, acetous, ond iKimcic. Yet even liiCHC hnrcJ 

a otrouger attraction than the carbonic ncid; iiiid benceJ 

B whenever teeth arc deprived of their ciinmcl, or the tiakedl 

B fangs become «x|>o«cd l>y adecay ofthesarroundiiiggumsJ 

H dime also must in like manner bv abstnined from. J 

nn« a By whatever mvaiu a decay or caries of iho teeth njajl 

t™^"?*- bo produced, it appears to operate iu tbrw diD'erent wayaJ 

Horoctimcs commencing in the internal cavity, and voritingi 

its course outwards; sometimes commencing outwards, tnfl 

working its course within; and aomciiines by a wasting ofl 

■ the enamel, and conseciucnt denudation of the bony |>artJ 
W The lir&t, which ia the least common affection (its reahtn 
I being denied by several writers), ia discoverable by an apil 
I |)earancc of blackness within llie whiter atu^acc of thfl 
L tooth; the tbirrl is often to be met with; but Uie itoooDd !■ 
I (he moAt frequent of the wbolc; evincin;; atiu eonuome*! 
I tnent the nppo^itiuicc of n» opa^iue white i>|>«>t tluotic^ the 
I enamel, which grtdually crumbles away about lhc»pot , and 

■ tJiug disckues that port ofthcbotly of the tooth which fo 

■ the original scat of tlie nflection. The diiMftsc, by its cc 
I tinuance, converts the spot into a hole, and at Icji^^h df 
H stroys the tooth altogether, or at leoxt down to its neck, un 

■ le«3 the pain produced by the morbid pro(^-es compel tiiepa 
K tient to have it extracted before the dtMuiso advances thus fai 
^^^1^ u) Caries of the teeth does not appear to be a diaeaae i 

S^p •nd any particular age, or l«m|>erameiit. or Btnte of health. 

tuBML^ exists in infancy, and in tlte firmest manhood, aa well m i 
old age. In tlie lant, indee<], Uic Icelli that drop out fr 
abaofption of their alveoli, uic ofu-n as sound aa when tin 

■ were fir^t formed ; while in childhood it has Rom«tin< 
H spread from tooth to tooth to extensively, and at tJ)« i 
P time piYMlucetl so much torture, that it hait been nt 

to extract almost every tooth before the sixth or MvmCh 
year. Mr. John Hunter hence conceived that n decay of 
the teeth was rather « disease of early than of advanced 



u. 




CL. I.] 



DIOK^TIVE FVHCTION. 



[OBD. I. 



69 



life; and 4hat the tcctli did not bocomo carious afl«r fiUv Cru. I. 
yenrs of age. Mr. Fox. however, observes, that lie hag met /a jjoiil 
M-kh several per«oii8, who hnd not only passed fifty yeara <«• Cawr. 
vritliout having had a carivs in ibis organ, but who hnd ivlili^'coid. 
been obliged after havinir arrived at sixty to have several 
teeth extracted lii coJisi-fiucncc of tooth-ache produced by 
a cafioH. In •ome general diseases of the connlitution, tho 
teeth »eeni to i>ome»« a Hiti[^]ar degree of hcalUi nnd even 
luxuriance. Thus in phtJiiiiiB it Is almost a proverbial re- prtriyBlmi 
uarlc, thnt tlic white and pearly g\oaft of the ciiatiic-l.«'''<T'''''' 
^*fbich in peculiarly chm-nclcristtc of soundncHR. 't» more'" ' 

onliniirily clear and bright; while in rickets, in which 

'oie whole frame of the bonce is shaken, and many of them 

Iwconic soft uud s|>oiif^, tlio teeth ascend aa firmly and 

ns regularly as if tho system were in a state of the most 

'fif^orcitts health. 

If (he teeth be vascular, tlierc is no great difficulty ia ^0. iMo- 
Concetving thai, like other Iwncs, they may be subjeot to '^' K*"- 
I xxosTOHis, or a deposit of o«siflc mnttcr on their surface, ^^ ^ig^ 
[ »nd particularly on the surface of tlieir roou or fangs; [a <>>^!>ii- 
<aitc, which the non-bclii-ver« in the vuscuUirity of the 
, («.-clh ascribe to original niulfomiation. What is called an 
exo«to«ifi of the fang exhibits no irrc^laritics on its surface, 
!«!( otht.'r exostoses usually do; nor is its substance at all 
[drtf'crciit from tlie rest of th9 fang. It is, in sliort. merely 
Jan accidental difference of form, whore, us the ofHces of the 
[part rerjuirc no definite figure, variations in form are quite 
f common *.] The author conceives, however, that whether T«ib p.*. 
I the crown or Ixxly of the teeth bo poceeased of seccnients ^''**"'*" 
tin a mature »tate, tliey must have abeorbcnts, since we 
Lt>ehuld their fanj^, in very numerous instances, diminished, 
tiortencd, and truncated, and aomotimcs entirely carried 
Qllway. which it in difTicult tu conceive can be done by the 
■iMorbents of any adjoining organ. And we may lay iiAndhnia 
lown MS a gcneml rule, that tlierc is no organ in possession bi; IJ^ * 
~" alMorbont vessels, which doc« not at the same time |io»- o'lu. 

secemcnts, so as to maintain a balance of action. Wc 
ind on extracting a tooth that has long been a cause of 
inaidcrablc pain, that the fangit at least are considerably 
:)crusted with a deposit of oKoifie matter. m> as to give it 

• Sec Km'* Cfdciwdi*, mi. Csakivm. 




70 



CL. I.] 



COtLIACA. 



OxM. I. an appearance of that disease which woh rormetly butJ 
Htx%a»- ^"^^ incorrectly denominated a spina vimtosa. And oal 
"»■ E»*. cxiiminin^ the state of the alveoli after death, vfc find siral 
I'KMMtUk ''i'*^ similar morbid npophyses have pullulutcd oocoBionuUjr] 
dspodt. from the face of the alvooli. 
EijuqiiMii. Wherever such effects occur, whether in the alveoli 

Ihe tcetli. a considerable di^jTOO of pain, ai>d (;c»crolly aoj 
inoroasing decree, must be the result, from the prewun ' 
the bony projections against the pvriotitvuni or alves 
inenibnine. At first this pahi is not quite so ncutc u ii 
carious or ncn-ous tooth-ache, for the imprisonnl tuuic il 
not at this time in a state of irritation. But, by n 
tinuance of the pieseure, it b soon reduced to tliis Mat 
whcii the pain will be as severe as on any otiivr occftsk 
mid far less mitigablc. 
Tft&uncst. \^'herever we can satisfactorily decide upon tlio caai 
and the complaint is recent, wo may often put a check 
it by a free ap)>lication of leeches, and the local use 
merciiriiU ointment, or a mercurial plaster. But in 
of long Mtanding, the only cure is an extraction of tli 
tooth; for eren if the disease )>e Mated in the socket, it 
will be instantly arrested by this process, as the substac 
of the socket, no longer of any use, wilt from this time 
in a state of absorption, and be at length entirely renwre 
fO.poiih There is sometimes a peculiar iRRiTAtiiLiT\ in nil 
^ "^'nkhvbs op thf. tketh themselves, or of those jtarla 
Finn ffriik. which they are immeilialcly surrounded, uid with whic 
j,i^„ they participate in action, that exciter the sensatiou 
* <l^^ aeirere and even agonizing tooth-ache, without caries 
•ny otlier concomitant. In this vm-icty tlie exact seat < 
pain is leai cosily defined Uian in ilic ]>reccding ; and i 
being no black H|)ot or other external mark to dtnjct in i 
it, the tooUi is ohen raiataken in the eontinuoiis tyatf 
excited, mid a sound tootli m extracted in its stoadj 
that the torture remains unulalcd. And tlicrc arc inst 
in which the plan of extraction haa bi-en followed up fn 
tooth to tooth without any alleviutiun whatever, till 
jaw has bvcu entirely divested of lU teeth on the disordc 
side. 

This is often an idiopathic affection de|)endent upon i 
peculiar initability. from a cause we cannot cosily Into, i 
the nerves Bubscrvioni to the ucliing UKilh,OTtlic ttuucal 



K) 



OICBSTIVB FUNCTION. 



[OBD. 1. 



ullicJi it in covered, or tbo pcrioetoum, at the fine mem- Ocm. I. 
Lmnc Lhst Hues the interior of the alveoli. But it is more 'o'imoI 
frequently a disease of sympathy, produced by ))rognancy, to** n«i. 
ot cliroaic ihcumntiiini, or disorder of the stomach, ta ncr- 1?""";, 
vons ol an irntablc habit- tor this remote or indirect in- ubtiiiyoT 
lluenoe it is not difUcuU to accoonl, nben we rellect that ''"' 'l'"."^ 
the great intereoatal uerve, emphatically called the syukpu- nam. 
thclic, and connected by I'ainilioulioiin with every vinctu of 
tho chtst and lower belly, is connected also, by its union 
witli a branch of tlie lifth pair, with the nervoa tJiut im- 
mediateiy uiipply Uic tucth, ajid wliich hence become it« 
indirect i-xuvmitios. 

It is Mill loM to be wondered at Uial tbc ncn-ea of the 
teeth should often associate in the maddening pain of 
nruriilpii fatw, or tic douloureux; for hcio the connexion NiunlMb 
is botli direct and imiticdiuto. In coasequence of thiti the ^"'^^ "'^'- 
Itatient, in ino«t inetancc-i, regards the teeth thewKelvcs as iimth-actic 
tha salient poiat of pain (and they may uii<[ue!«tioi)utj]y bo 
[bo in some east*), and rents his only hope of rehef upon 
' ex(nc4ion, althouf^li, when he has applied to tlie operator. 
lie 18 nt a loss to fix ujion any one tooth iu particular. 
Mr. Fox frivrs a striWinf; example of this in u pcrton from 
whom he extirpated n stump, which afli'irdccl httic or no 
relief; in conscqiK-nce uf which hiit patient applied to him 
,o«ily two days aftcrwardit. and requested tlie removal of 
•cvt-nil iidioining teeth which were perfectly itoinid. This 
he obJL-ctvil to, and MUMpcctiu^ the rcul nature ofthodis- 
Icnse, he immediately took him to Sir Airtley Cooper, who, 
\hy dividing the nffectcd uerve, produced a radical cure in 
few days. 

Where the )>ain, therefore, proceeds fiom sympathy, it is 

[^f tiio utiaoHt importance to trace it home to tho ot^n 

I idiopathically at)ectc<l, for to this the attention sliould be 

CehioHy directctl. Where it exiula aa a primary disease, it 

lis often of long duration, and dillicnlt removal. .SouiO- 

[ times narcotics, and sometiiues stimulants, have been found 

tnost Hiiccesiiful : bliiters have occasionally relieved; and 

(the buniini; of a littlo cono of moxu behind the ear, more 

fre(iucally and more cffoctually. Of narcotics applied 

[locally, hyoecyamus appears to be one of the best. Ita 

seeds may be put to the check in the rorm of a cataplasm; 

or their lunuke ooavoycd by a funnel to the tooth ilaclf- In 



i 



CI. I,] 



COtLIACA. 



[ORD. I. 



(iKif. 1. this l(i8t form, it will often nllaytlio p«iiiof a carious toolh. 

auotomii. Where the pain is romiUcnt or periodical, a free unc of the 
bark with chan^ of air has prowd moKt snilutary. 

Vaanilarln [From tht; pn-coding obccnatioiis it Appears tliat tht 
'**'^ author of the preKCut work joins Uioac pliysiol<^8t« wUo 
regard the teeth an vaiacuW, and eveD carric<t thi^ belief m 
fcir wt to cxpreiM a saspicion that these ortrniio HomctimM 
undergo an increase of Hizc, whereby the inlcrH|mce pro* 
duccd between two of them, by t)ic extraction of one, amy 
be considerably lOBscned. In tliv last edition of tJiis book, 
he mentioned tlie fact ns huvin;^ occurred tn his own Jaw, 
aflcr tlic removal of one of the biciiHpiduti, when he was a 
boy. Tliat the tooth frequently tipproad) encli other, bo aa to 
lecsen, and even nearly fill tip, tlic iiitempucc ocoisionud by 
tfao extraction of one of tliCKc ori^aiif , n an inidoiibtcd truth ; 
but the correct explanation of it« cauw in not the enlarge- 
ment of the te«lh, but the change that follow* in the 
wtuution of the socket. Hence, when a tooth ia removed 
ftonri ft young subject, whoee jaw is yot growing, the inter* 
epnce may become in lime nearly obliterated. If the ^p 
were filled up by the expansion of the adjoiDJi^ tcotJi, tJiia 
could only happen from the enbirgcment of the crowns; 
but, tiiough spwiiucns of exostotes and swelling of liut 
fangs of teeth arc contained in museums, the editor has i 
yet mot with n tooth, whoHO crown or body was cnlai 

The question whetlier ihc teeth arc vascular is ox> 
tromely curious uiid interesting; nud ko unnatural is the 
iden uf an harmonious connexion between dead and livii^ 
Hulmtances, that the common opinion of the teeth being 
funiished with vcaaels ftod tterves in not at all surprising. 
Nay, the exooniTe pain often seated in these orgwu. aui 
the remote, divcrsilicd, and very severe disorders which they 
appear to excite sym])atheticaliy in the imimal ccoaomy, 
are eireumBlancea presenting souiclliing like a confirmatum 
of the doctrine. Nor can it bu dcnioti, that much dilliculty 
occurs in accounting for certain change* in the tvetli, nnlou 
tliis doctrine be admitted. Hut it is nut because we cannot 
explain pr»cisvly the nature of every particular alleraiion or 
^pcamnco of thcso organs, without supposing them to be 
vascular, that they miutt really be so; for, if sonw of the 
|ihengmemi >u iptcHtion tike place uliu> in artificiul teeth, und 
w tt:cUi whii;h li;ive been boiled, or kc|>t ho long m a diawor 



DICKSTIVE PUHCTION. 



tu) not to admit of the suspicion of tb«tr beinp; alive, the doc- 
trine then immediately becomes a questionable hyi»othc«iH. 
The tltffictilty of accounting for caries of the teeth, and 
for tlio absorption of their fanj^, unless the bchef in the 
vutwuhirily of these or;ranjt be adopted, iwemK to have had 
grcfit influence in detenuining Uie author of the " Study of 
Medicine " to consider the substance of the teeth as vas- 
cular. That he vraa also correct in his notice of the dis- 
agreement between Mr. Hunter's Natural History of tho 
Human Teeth, and the Essay on their Diseases by the 
same distinguished mun, iit a tnith of which no person 
wIh) has rend thcite workit can doubt. The subject was 
difliciilt, no difli'cull ax even to tuvolve Hunter in hesilution, 
if not contradiction. Our author hast not mentioned, how- 
ever, some of the priucipal facts and arguments which such 
, modem physiologists aa disbelieve the vascularity of the 
le«th gfiiMiratly bring forward : a short account of thom in 
ttns place may not, therefore, bo uninteresting. 

In tho last edition of this work, it was rentarkcd by the 
. author that, " admitting the eoumlncss of Mr. Hunter's 
I. experiments, and tho accuracy of his reasoning, it socius 
[impossible that the tcclh, when once perfectly produced in 
the gums, should ever decay; for no action of the living 
' principle ctin occasion a &ccrctiun of thotie chemical agents 
[ which would atone, in such case, bo capable of destroyin);; 
1." We have seen, also, that our author dcscrihos one 
of caries as beginning within tho tooih. OtherH, 
however, deny tho reality of the latter case, an<I, if tliey 
[are right, the answer is nt once given to the foregoing 
. ar^gumcnl. They distinctly allege that caries never begins 
within the tooth; but a speck is first scon upon the 
enamel, a portion of which being destroyed, the decay ex- 
tends to the bone of tlie tooth, and proceeds from the sur- 
fiice into the ciivity. As soon as the bono begins to be 
sHcctcd, the progress of tlio decay is much more rapid ; an 
, excavation is produced; and the enamel in lull in the form 
.of a hollow shell. Tho following considerations arc mon- 
[ tioned aa proofs that the <)ecay is not the cHect of vuscnbtr 
action. It first attacks the enamel, which is confessedly 
not vascular; for though Dichat regarded tliis Rubtitimcc 
, as svnsiblo and on^anized, because acids set the tectii on 
e, Uio fact IB, that tho di&aj^ocablc scniiation here ud- 




[ORD. I. 



OSW. I. 
flricc.II. 

O-lMonm. 



I 



CL. ].] 



CtELUCA. 



[OBO. i. 



J''^".' h v'vtieil to is not situated in tbo oianicl itself, nor i» it cvvr 
OJMmma. BKcilcd l>y ao acid merely applied to it. I'ho acid mutt Itt 
tbe aame time como into contact witb the organ of taste, 
or extend itfi action dirwUy to the seuiuble patia within 
tJio cavity of llic tooth. 

Hiroughout thtt wholi; procoM of oaries. tliera ia no 
attempt at rapnrntioii. Artificiul tcclti arc as much subject 
to dooiy %B natunil wivn. The diitcoiurutiun tia«, indeed, 
been Mtoctuncx thuught to ba nioi-e (lvi:|> in the arttficiul 
teotli, made of the tooth of the hip)>o|>ot«iiiua, than in the 
butnan teeth; but, in engrafted human teeth, the decay in 
acknowledged to be procieeiy similar to that of tbe natural 
cues*. 

The alleviation of tooth-ache by tbe application of mu- 
riatic acid, nitrate ofBilvcr, and other catistics to tlio curious 
surface, has bwn eitti-cnicd a proof that the caiifn ia an 
ulcer, and tJiat its irrjuibility may bo deElroyod by such 
trvatment. Since, however, tlie reincdiee way act upon 
the exposed vascular content* of the cavity of tlie tootli, or 
Mkay ulleot thcM contents by i>€nclrating through the Uiiu 
medium which remains, il is manifest Uiat they can aOurd 
no proof of tbe point in (|ueelion. At the same time, it is 
to be taken into the account, that tooth-ache from caries 
may frc(|iictit]y Im rclit'vcd by a plan nearly umomitiiig to 
u demoiiKtralion tluit the pniu doeo not ariiiv from the 
ulcerated surface, but from the nerves in the cavity; 
iiAoiely. lot tbe dectyed bulv be tttopfied up (which is 
rathi--r u rude motliod of treating on initublc u[ccr)so oa to 
prevent the accewt of tbe external air, and of foreign bodios, 
aud the pain will ccuse. 

Tlie writer from whom the editor has borrowed tbeao judl* 
ciouu rellectioii!( fiirtli«r oliscn'es, that it is not pctbap* so 
cosy to determine what the decay it, as wliut it is not. TbosO 
who coneidsr tbe teeth as dcsLituU} of vofiseU oacribc their 
decay to the clifiuical action of Uic secrctionc in tlio moulli, 
aitd of ibo articloi of food. Here it is dillicult to compre- 
bond bow a cauao, which must neces«arily be so genenil in 
its apphcatioo, should be so circumscribed in its cll'vcl«i 
never producing decay at onco in an eitenitive surfiicf, but, 
is its commencement, limiting iu action to a small spot. 



■ Rm'i Crdvpall^ W. CBAXieii- 



DIOBSTIVB rVHCTION. 



[oni>. I. 



76 



However, in nrtificiul levUi, a large »urface mmutiniM Okh. I. 
d«enys under cifcumitADceH favouring an accumulation ot"o.iWotwi 
fluids in aparticular part; vit. the portion that coTTes))oi)dn 
to the gum, atKl is usually grooved, arid also the Lateral 
parts of Buch teeth. 

Various coDaidGrat>oiu> atrongthon the inference that the 
decay of thv natural tucth must di-pviul u[>ou u chemical, 
nnd not a viiacuhir op4:mtion. ll comuiunccit in those 
sitaattons whi>re food or extrancoux mttttcrs are most liahlo 
to lodge, aa betwocii the teeth, nnd near tlie neck, just 
where the gum adheres. It >a checked by sloppiug up the 
hole, and preventing the entrttnce of the food aitd secre- 
tions of the muulh into it. It is ruost frequent in the 
higher claKMS of xocicly, whose food is of tiie most un^ 
natural and miacellancous kind. It is very rare in the teeth 
of savagCK, nud it ik ttUi-^ud never to occur in animals. In 
twelve or foitrU^n stkulb, discovered in two burrows opooed 
io Glouceslei'fihire, not a ain<;lc decayed tooth wok noticed. 
Now, as this mode of burinl has not l>cen eiu|iloy«d for tlw 
last ai\ centuries, these skuUn must have belonged to a 
lime when the modem habits of luxury, in respect to food, 
were unknown ; and when the eSecta of such habits on the 
teeth were, of course, not discernible*. One fact con- 
nected with the foregoing stalctncnt«i and perhaps in some 
degree throwing a doubt on part of them, is the extraordi- 
nary prevalence of caries of the tcvlh in particular families, 
8ocniiut{ly tut if ihcrc wore some original licretlitary im|>or- 
fcction in them, whereby tlie cuuimm of euiii^s, whatever 
they may be, very readily produce their destructive clicct«. 
Another fact, universally acknowledged, is tlic frec|U«nt 
nnd almost regular occurrence of fine seta of teetli in cei lain 
families tlirough a long series of years; a fact that itcems, 
like the preceding one, to imply some hereditary difierouces 
ID Uie degree of perfection of these organs. That persons 
who smoke tobacco generally have discoloured carious 
tsath is a fact universally recorded. PerhapA, ihorefore, 
th« ingenious author of the present work vras mistaken in 
supposing that the production of caries of the teeth could 
not be obemically accounted for, unless the secretion of 
chemicid ^ents within them were admitted as u fact, 
nhich fact would, of course, imply vascularity. The 

* Jtcn'a Cyclopmlli, tfl. CsAXtttx- 




Cl. I.] 



CCBLtACA. 



[oiii>. 



^"'h ^i*"^' ■■)8(^<' ^^ beginning somcUtncs internally, dm ho 
dJWinM. Htipposcil, always commences externally in the cnamd, und 
proceeds ftota it into tlic t>une uf the tooth, so tlimt tlie 
fluids, and other mattcre in tlit- moiilh, hnvc direct bdccm 
to the aRectcd surfitcc. An inward decay of the tcoth, 
with t)ie whole Khcll of enamel pcHiict, is tulkcd of by 
dcnti*t«; but, though the external tipertiirc may be minute 
and concealed, ita exintoncc uuiit not l>c denied, until a 
oontmry cose can be fully demonstrated. 

Our author supiwsod that madder and anatomical injec- 
tions might not bo BufEcicnIly attenuate to enter the vcwela 
of the tcoth, aiid was not di<i|K>iied to receive the fact of 
those substances not entering tlieni, as a proof of their non- 
existence. Certuirily, in several instances, to conclude that 
parts are not vusculiir bceatise the vessels cannot be in- 
jected, would he decidedly cTToncoiiH. Hut, in these jiiir- 
tieular cases, tlic phenomena of diseatte enlighten us, and 
correct our judgment; which can hardly be said to oecnr 
with reipect to tJie teeth, for their changes, whcllicr rilal 
or cheininil, arc enveloped in the deepest mystery. Aa for 
the oxperunenta witJi madder, however, they furnish Uie 
strot^at argument of all againsb the vasculnrily of the 
fully formed substance of tlic teeth, without even affording 
the least room fur the argument that madder is not subtile 
enough to enter the vessels of tlioee orgaiiK. Tim will bo 
iuimodiutcly evident, when it is recollecte<l, that while the 
tooth of n young animal xa only pnrtly fomicd, if madder 
Ije given with the food, it is really transmitted by the 
vessels of tlie pulp, not indeed to the portion of the tooth 
already complete and void of vessels, but to that part of 
lite organ which in developed subsefiuently to the begin- 
ning of tlie cxperinvcnt, and is the work of tlic vessels of 
tlie pulp. Here, however, a most interesting fact was 
pointed out by Mr. Hunter; namely, tliat when thcloolh 
of a young animal has thus been tinged with madder, the 
stain is never afterwards removed, which is exactly the 
reverse of what occurs in bones dyed by feeding animals 
wit!) the same subHianec. The bones, therefore, muHt have 
vesaols for the conveyanee of the madder into them, and 
other vessels by which it is ogain removed from them. 
On the other hand, though the vessels of the pulp seem 
capable of communicating the rc<l tinge of madder to the 
bone of the tooth, upon its Gtsl deposition, they appi-ar 




DIUBSTITK PUHCTION. 



directly adenrarda to have no furilier communkalion with 
the new fornialion, which remains incapaMe of every 
change usually produced in other parts through the medium 
of arteries, veins, and absorbents. n 

These conclusions, deduced from oxpcrimcntR with mad- 
der, may be set down ax. tinnly established, without being 
■t nil weakened by an observation made by the lute Mr. 
Gibt»on ; namely, tJiuit Uie fact of the power of uinddt-r to 
rcddvn tlic bonea in no dcinoniitTutioti that u continual re- 
novktion of their particles takes place*. Alciddcr com- 
nunicatM to tlic bones n red liiigc, which is afterward^ 
gnuliiaJly removed : these two fucts prove, at all events, an 
tnterslilinl action, ns fur aa that substance is concerned, 
and thus are explicable only on the principles of vascn* 
larity and life. Just so the communication of a red tinge 
by madder to the phoKphute of lime of a tooth that is 
nodei^ng development is a tolerably convincing proof 
that veasvla then deposit both the earthy and the colouring 
matter; while tlie permanency of the tinge as clearly shows 
that tJic coloured particles of lime in the tooth are not 
■bsorbcd ugaJn, and that no vascular interstitial changes 
afterwards occur. 

In confirmation of the preceding view, it deserves por- 
, Itcnhir notice, that the teeth never exhibit any appear- 
ances of reparation, under circumstances of accidental 
injury or snppoM-d disease. Tlie toss of substance occa- 
sioned by the friction of mastication is not repaired ; a 
part broken olT Is not renewed, but the fractured surface 
remains unchan^^cd ; a hole, caused by decay, is never filled 
up again. The union of a fracture near the neck of a 
tooth, even if it be poaaible, as M. Duvalt and others 
declare, does not at all invalidate the foregoing state- 
ment, because the union is ascribed to the action of th« 
pulp, and not U> tliat of vessels within the substance of 
the tooth itself. 

The non-existence of vessels in the teoth may be inferred 
from another particular case ; a violent blow sometimes 
causes a general discoloration of a tooth, as if blood were 
efiuaed llirough all its texture. This appearance is expli- 



OCK. I. 

ftrRc. II. 
O.Vohma. 



• 8m Mem. of the l^ienuy Sotiay of Miuiclic»tcr, 3(1 Scrio, tuL i. p, 1 tG. 
t mo. dM Stkato MU. Mm. lUl. p.33a. 



80 CL. t.] CffiLIACA. [ORD. 

oex I. convey red blood nor coloured injection; y«t they nr 
0,^4,y,»l. capable of carrying 90 much bile, as to tin^ the tooih 
an uniform yellow to a certain distance from Ok cavity, 
tliis coIdui' bo then owin;:; to a yellow fluid, contuined 
ressfiU. these muat be so numerous as to reader tha 
much more vascular than any other l)on«. Thv fact 
tJlut tJlc veSBoU of the |)ulp contain bile, and dye lliitportt 
an unifonn yellow colour, which is mechanically imparted I 
the adjacent bono in the neighbourhood of ihu cavity ; 
ell'ect gradually ceasing at a Httlc dititauce from it. TI14 
Btniii M produced, just as it ia by immoning Ulu teeth ii 
bile adcr death. 
Promthdr Anolhcr proofof Uic Tiucularity of tlic teeth iaatlcropte 
mmpbni. ^Q j^g taken from their Rucce«itful tranK)>Untiiitiou from lh4 
jaw of oi)c pentoii to tliut of anotlier, or to parts of anot 
onimars body, as tlie comb of u cock. TboM oxperimoat 
however, will succeed with dead tectli. The writer ofthf 
atticle C»AMt!U in KueJt's CyclopaMlia has seen a cock, ii 
whoHc comb the lato Mr. Aloor, the dcntJU, had inserted 
toolh that bad previously lain many months in a dr&wwg"' 
«ud it waa fimdy adherent. This adhesion tlion does not 
Bcem to require even the living principto, of which il 
was rcgaided by Mr. Iluntor as a proolL 
Fram ihc But no argumenia have been more coiifidcnlly cmployad 
^°T^*^ by the l>eUovcT8 in tlio vascularity of the icctii than tJiOM 
tnthcgUra. deduced fiom comparative anatomy. Animals of the clan 
gltrcA, as the beaver, bare, mbbit, itquinel, rat, mouse. Sec. 
have two very large inctHor teetli in each jaw, which, being 
employed in cutting various hard bodies, w«ar down r^ry 
rapidly. Hence, if these uniiuubi W kept entirely on soft 
(bod, their teetli grow out to a grcnt length : and if thMa 
teeth be lost from otiojaw, the oppovitc ones grow out in tlio 
same way. This constant growth is efTccted in the same man- 
ner as their original formation. They arc hollow, and coDtoin 
a pulp, which continues to deposit fre^h subatanca b«low, in 
proportion lUt their up|>tT part wears away. The tusks of tlie 
elephiint and hippopotaiiiuH have a similar |>ower of k;rowlJi*. 
It Doenui now, indeed, to be the common belief of aome of 
tbo first physiologists, that tlie teeth really present a 



* '• So ]>(«■'■ C7d*f«4ia. «t CsjtxirM. 



r 



t 



.1.] DIGKSTfve FL'KCTtON. [OHD. t. ST 

strong analogy in their development to the hair, na!1ic, Riir. t. 
and homs of the animal body, and iiIko as M. Geoffrey (^^,^;,'|^^ 
St. Hilairc has f«Uy ascertained, to the beaks of bird*. In Anniojo' 
the human subject, the process by which the teeth arc [^I|j^^j 
formed confinns this doctrine; but, as we have noticed, Wnt, 
what happens in the incisor teeth of the gnawing nnimaU ""^ ** 
ifl a still cloiicr anaJotO'i since the pulp retains for an 
indefinite period ihc power of secreting additionul matter, by 
which the eifccts of ttie losrt of the tooth at its catting 
end are conntcr«ct«d, and an incessant tendency to elonga- 
tion, or growth, kept up in the organ. A list of di- 
fctingnishfd authorities, and a brief notice of some of tlie 
arguments in support of this physiological view of thft 



rture of the teeth, are given by Meckel*. 
Ballet* have been occasionally found imbedded in the E<pU- 
tuska of elephants. Now the advocates for the vosculnrity [1 ""^ 



i 



of the teeth have argued, that the closure of the openiiiir, rfihf 
by which the hall entered the tuak, and the swelling soni«- '^*"^^,'^ 
timts observed in these cases opposite the foreign body, builto 
could not have taken place without the agency of vessels. J^'^j',""" 
However, these occurrences ire now satisfactorily ex- ctvphnnu' 
|>lained, wiUiont having recourse to this hypothesis. The '" 
tusks are con§tant1y growing during ttic nninial'ti life, by a 
deposition of successive laminsc within the cavity, while 
the outer surface and the point are gradually worn away ; 
and for this purpose the cavity is filled with a vascular 
pulp, similar to that in which the teeth are originally 
formed. If a ball penetrate the side of a tusk, cross its 
cavity, and lodge on the opposite side, it will become 
covered towards the cavity by the newly deposited layers 
of ivory, while no opening will exist between it and the 
surface to account for its entTancet> All the various 
appearances, attending the lodgement of ballets, and pieces 
of other weapons, in the tusks of elephants, can be 
accounted for by the power of the pulp connected with 
these organs. 

As for the author's supposition, thot (hi occasiona! A'*"?""" 

' ' of fanp no 

^ ^_^^_^.^^^^^^^^^^.^_ P'*"' **' 

fauuloriiy , 

• Stwiud dMniu. torn. ill. p. 3flJ. H« alui ftr^. lui rw:«rolBcn>«il ten- *"'''"' '^'''■ 
tinuv fl U rfptDdiiclioi da Denis d>t> l« lopius. &«. |>ir HI, l)uili-l, in 
Uagendle'i Joum. Cc I'liyilol. lam. ill. cl iv. a 

f ttfc Hm't Cjcloro^ ■"• Cbaviuii. 

VOL. ft. *t " • 



I 



82 



r-L. I.] 



CatLIACA. 



[ORP. 



absorption nf Uic Aings of teeth n a proof of nbsotbcnts ti 
ibcin, tbc fact only ttliows thiil tluwc parts are c»|iiiblc o( 
t>ciii[; uctctl upon by Ibt.- organs uf ubKOrptiun, wbti-.h iimj 
be Kitualtil in the nlvoob, or in the cavilies uf iJiv Tuni^ia^ 
witbout being nctUitUy in tbc substance of ibc boiic of tin 
lootb.] 



SPECIES in. 

ODONTU STU1\)1US. 
TOOTlf.EDGE. 

TINCLtNO UNEASINESS OF Til R TBBTII FHOM UHATIN1 
BOONDS OR rRICTIOKS. 

Gbn. I. TiiRRE is Bomeliincit a pccubiir sensibility in tlic tc«t 
6rzc. HI. Of tiicii- ftheathfl iJiat induces « kiiul of vibmKwy i^iH, in 
which tlicyarc colloquially said to be 'iV.r <>» iioub ; atu 
that in two wnyo, as follows : 



a A stridore. 
6Ab aerittidine. 



From j airing noises. 
From velltcalivG or acrid Mil 
fttanccH. 



■ O. Rat- 

fotit i 

Mnleo. 
Fran jiN 
ifaigMMindi. 

«O.Siu- 

|wt!*sb 

•CTilDdinr. 

FiomTclli- 

Mtlvect 

■oMMib. 




In many cases tbc t«clb Kympatbize with the viir, OS i 
cxpOBUre to liareh, diHsoniiitt, or sUnlnlouM sound*, u ' 
grating of a file, the creaking of a door on its hingos, or i 
a swinging sign in the street. 

The same effect in produced whenever tlic t«0Lb ars< 
vellicated by smooth substances, aa a piece of silk of, 
velvet. Or oxasperatol by acid or other ncnd materials. 

To explain thoso effects, it is necessary to observe, id Iho 
fust place, that a close reciproeily of reeling in at all Linnoa 
maintained between the teeth and the lympi&num of (he 
oar. by an union nf their rexpcclive iicrveH ; an one of ibft | 
branches of the Knventh (tair, dextinM) to supply Uiu lyni- 
panum, anastomnNe-o with the lin{;ual brnii<:h uf the GtU), 
which sends odsot.s lo the teeth : by which means 
Ititter become indirecllv an or<nn of Kounds as wHI as 





CL. I.] 



OIUBSTIVK VUNCTIOK 



[ORD. I. 



mastication. It u for this reason, nmong others, tbat deaf "'^*'- '• 
pcnoos opi-n tlieir moutlis to ciitcli up sjieech they cannot o!"siuporit 
Otberwiw Ileal ; und that, bb aliuaily olmcrvtid, ill cutting TooUi-cUitc. 
the wi»e or &duH t«etb, the tyinpnnum not unfrequently ^*JJ^ 
CDdurea more pain than the f^ta or mutiibmiic by which 
the tooth is covered ; and hence, the tuner of a niuskal 
instrument is olWa in the hsbit of applying his tuning- 
pipe to his teeth, as soon as ho has put it into a slat« 
of vibration, to determine tlic more accunitcly upon its 
pitch. 

Now, as the last action is a source of pleasure to the 
t«eU), from the vibrating tone proving ngrecable to (he 
ear, we can ri^idily Nfc why tone* or miiiiuIk of any kind 
tJiat are tuiteful to the cur i<houUl he hati-ful also to the 
teeth. 

This is the general piinciple : and it is sufficient to 
explain why all jM-Tsons nro in a certain degree subject to 
the tootb-edge upon an expceure to the mora coroniun 
causes that produce it. Itut, in constitutioos of a peculiar 
kind, or where the ordinary a.sNociation between the two 
organs has been spociidly and huhittially cultivated, or 
sooie early and very powerful iniprcfeiion has been even 
accidentally commiinicutiHl from the one to tlic other, the 
KCn>iationufto)jt!i-cdgvwillbe produced farnioro froquonlly 
and acutely thun in other co&es. And when in such 
persons t>m teeth are in a state of pretemalunil suniiibility 
from any kind of discascil action, or from irritatini; sub- 
xtanccs apgilied to them mid the guniH, 4is acerb or acid 
juices, the sensation may become so acute as to be 
intolerable. Barthotino hasrccordeda case, in which theCMeac- 
(tharpening of a knife so highly excited not the teeth ^'JJJ^^,_ 
only, but the surrounding gum, that, along with a very ihtfti:. 
sensible jiirring of the teeth, a profuse hemorrhage from 
the gum WHS occasioned*. 

In many instances, the power of the iinat;in!ition alone, smnninui 
from a long habit of association, is suflicivnt to call upaj'"*'"*"! 
rery considerable degree of this painful feelingt; a* when .?„".""*' '*" 
we see a knife drawn across a chimcplatc, thiiiii;h ho ^viilly 
as to jiroduce no sound whiitcvcr; and tJicre arc inKUiiicc* 



• r.piit.lV.p..W3, 

t Duwtn, ZoMwm. HTt, XTi, la uul cLu ir. i; % 3. 

o2 



d 



84 



c... ..] 



CtRUACA. 



{^ORD. I. 



•dp. 
Mode of 
tmimniL 



Gsv. I. of poreoiM in a high d«gree of excitcnvcnt, nho, by this 
o.'stuMrb^ action uloiic. hare been suddenly thrown into convulsions. I 
XoiiOi- Where this alfeclioD is ftermancnt. or very frequent ami 

troublesome, and jtrocevdn from a morbid state of the teetli 
or their iiirolucres, our attention must be puticulwly di- • 
reeled lo the nature of the cause with a. view lo il« re- 
moval: if the gdim be influiued, ft]>ongy. or otiicrwiw 
irribibU;. ncarilicalion will oneii b« found Mifvioeubk: and 
if the disease he Mentod in thv body of the teeth, ttcveral 
of the remodica recommended under the preceding s[>ecieH 
may baresn equally good cSect iu the present case. If it 
be a symptom of some other complaint, it can only be re* 
mored by a removal of the orijjinal disorder. ForeMun*, 
Kurtcellit, and otlicr wrilen. »«»ert that relief may often 
be ubtaini-d by chewing purslane leaves. Wbcii it is the 
more result of au association of ideas, or of gnat etreng<h i 
of sympathy, with an ear delicately alive to harmony of 
soundu, it i« I>ckI cnn'il by an halulual exjMXjure to lite 
cause of the nflection, which graihndly blunts the feeliiig. 
The grating souikI. produced by filing; » mw. iviih probably 
at one time harsh and abhorrent lo the ears of the sawyer; 
but, by being inured to it, he at length hears it with in- 
diftereiice. 



SPECIES IV. 

ODONTIA DEFORMIS. 

DEFORnfin Of THE TEETH. 

TEETU IRRBGUI.AR IK SMAPt:, POSITION, OU MJHB.CH. 

(isx.I. DRroKNiTiKtt of the teeth arc for the mo«t part pro- 
h"*^ '*'■ duced naturally and in cniiy life. Hither set may be too 
■liKvd. large or too small, or some of tlieni much larger or soudler 
than the rest, or they may be irr^ular in their line of 
a»cct)t. They may be misplaced by incurvtiiion, or pro* 



• lib. xh. Ota. 9. 



t llortut Ovntalb, p. S37- 




eunntioiit or obliquity. They may be crowded aiid con- 
fused, or, as has sontctimcE occurred, be mulli|tiied in crops 
of double or triple rows *. In all which ca^ta tht-y cnimot 
loo Hoon become a aubject of artificial iirmti^eiuent, which 
in young persons may nccomjiIiKh much, and oFlen, by 
skilfiil tiitin»gemen(, not only correct tlic error of shupo or 
tiuniber, but give a ]>n>per inclination, not merely to the 
teeth, as Utey start from their natural line, but even to the 
niifuttiupcn sockets. 

Mwny of thrac irrcculantics proceed from a natural 
excess or deficiency of the cal<?areous matter which enters 
into the structuio of the teeth. This has been tH>iiielinics 
t^o defective as to leave tlie teeth CDitilnE^nuus, or potsesflOtt 
of tlieir aititual part -.done: and in a few cases, as I have 
alrnuty obEterved, to retard Uie appearance of even the first 
or xhcdditi^ set till ten or twelve years of aKe. [PIcnck 
extracted from a tpri, seven years of age. a canine milk- 
touth of the lower jaw, which was livid, as sofl us cartilage. 
and compressible by the ttngerti, especially at the fang f. 
This case was no doubt a specimeii of imperfect original 
deveIo]>ment.] But the opposite extreme is by far the 
most frequent ; nnd where this cxiiits in a considerable de- 
gree, we not only find occasionally all the irrcgubritieit 
already noticed as resulting from plurality, but sDuictinics 
a direct symphysis^, or inseparable union between the 
teeth and iheir aocketa, so that it is imposMbie to extract 
Uiom in the case of tuoth-ache or any other malady with- 
out fracturing the socket : sometimes a perfect continuity 
or oodttioD between all the teeth §, insomuch that in one 
instance the whole was found to constitute a single bone 
or curb o( ivory l|. Then again, wc sumulimcs niuvt with 
s production of teeth in other parts of the mouth than the 
gums, and particulEtrly in the palate, of wliicb exaiuplos 
are to be found in Sehenck^fand DorclU**, as well as in 
■eveml of the continental journals. Albinus records an 



Oix. I. 
Hfrf. IV. 
O. Do. 

Iklbnnlljr 
of tlKlenh. 



Cilamoni 

DiAinr oAff) 
RTOCHive or 
ddkiciiL 



* Bhik, UcdkfnlKhc Dcmcrkungm, f. 19. 
1 1>« Hmb. DanduBi. p. ;i9. 

* CniHoli, I>tiiii)e« OtxctvaKur. 

i BwibeUn. Iliii. Af»i. Stat. U lilit. SX 
CUi. Anmrk-iDgcn, vii. N. IS. 
nKc>iaKk,llb.LObL4l3. 
^ Id. Ota. 411. 



For oihcrt, u« NcwJiig. in loc 



llcnckcl, Snoiniliuig MoL imd 



•■Oeiit.it.Obt.lil. 



i 



CU I.) 



CCXLtACA. 



[ORD. I. 



Ota. I. 

Hr«c. IV. 
O. IM. 



flfMMd 
■MMMt MC 



Snood Kt 
wMcillMe 



instance, in which ri tooth grew out of tfad nnxilkiy pro- 
cCM below the orbit*. 

Another cauM of inegvtarity in the aaoeat of the per- 
manent teeth IB BO ioaccordnncc of lime or manner in the 
ibsorption of tbe fangs of the first set of te?tb, and the 
protruftion of those of the second set. Ae the Latter fang^ 
are thrown forth, (he fonner, in all cases of regulimty, are 
carried away: and hence the permanent teeth, preaaed 
forward by the grafluiil prolon^tion of their rani's, bear 
before them the mere crowns of the shodding-lvelh, and 
find httle resistance to their ascent. [In the last edition, 
the author refers to these circumstancea in proof of the 
vascularity of the teeth, observing that, as the fangs pul- 
lukte from the bodies of the teeth, the latter paria muK i 
have vessels. Tlie truth tti, however, tltat the fangs am 
fbntted from tlio vessels of the pn>lon|<atious of tJie pnlp.} 
Now, if the fangs of the upper set be not sufficiently car- 
ried off, or, in other words, the cronii of the teeth be not 
safficiently detached and set at Ubcrty, as the under set, 
or any particular teeth in the under set. press forward, the 
latter uiuat neceasarily be thrown out of their j>ro[>er line, 
and rise within, or wltliout. or whenn-er they nin (bceij 
their way. 

The tiecond set of teeth is also wider than the first; 
and bonce, viith tlie exception of the bicuapidntt, which 
from tliis very circumstance line under t)ie shedding mo* , 
laras, every single tooth in its ancvnt nniiit be oppoaod to I 
more than :t sini^Ie tuoth ubove it; whence unother aouroo 
of difficulty uikI ofu>n of irrcgalarity. In conscc|ucnce of 1 
Hilwhich,itia rather to be wondered at, that we do not meet 
with more fretguent iiiHlatices of deranged or mtssh^Mn I 
teeth than actually occur to us. And notliing can h* . 
clearer, than the necessity of a close and skilful wntcb over 
them during the slicddine; season, so as to remove any of 
tlie first set when tliey t<>nn an undue decree of re»istanc« 
to tlic pcnnanent, axKl have a tendency to throw them out 
of tlieir proper line; and any of the Kceond set tJint may 
exceed their pr(^>cT number, and, by their surplus, crowd 
and inut]>Ince the rest. 



■ Aanot Aud. tcm. L p. M. 





frL. i'] 



DIOBSTIVE FUNCTION. 



[uSD. I. 



87 



SPECIES V. 

ODONTIA EDENTULA. 

TOOTH LESSNESS. 

LOSS OR WANT OP TBBTII. 

This is also a very cotnmon afTcction, ami oflccs the oe». r. 
^following varieties: Svkc. v. 

Pcctiliari.t. From constitutioitnl defect. 

A vi cxtrinseca. From vxtoroal viotcDCc. 

ty A earic. From dccny. 

t9 Senilium. From old age. 

As the teeth arc often (inxtucctl sujicniuincroiiKly, kobO. kJcd. 
ire tlipy often naturally doflciciit in number. [The dciit43s j'-^^''"^"" 
aipicntiu;, nhich aru tlio luKt cut, are those which arc moot Krum am. 
pirciucnlly not produced al all; however, there is hardly ^'"™^ 

uy particular toolh that has not sometimes failed in its 

Idevelopmcnt.] This is sometimes Uie case with the bicuEi- 

Ipidati, as it ia not uncommon to meet with a. person in 

|«hoin one, two, or more of these havo never made their 

kppcanuice. But it occurs more friKiuenlly in the iiiciuors, 

nrticularly of the lower jaw : and Mr. Pox refers to an 

astanec tn which this defect appcilained to several iudi- 

riduabi of the same family, uono of whom hod ever cat 

liesc incisors. [In one example on record, there were only 

[four permanent teeth in each jaw. Another person hud 

'tut n single incisor in the upper jaw; and cases have been 

let with iu which all the teeth were wantinc^.l flo. Eilin. 

But the other varieties of cause are more obvious and innKOb 
jmmon: bcinc nj^,j^ 

Violvncc, by which they are suddenly miepluced, or-fO. E^cn. 
knocked out; fw,^^'' 

Caries, or inflammation of the surroniiding sheaths, by to. Kdcn. 
rliich tliey liccome looeened in tlicir sockets; and lukScni. 

The natural abHorption of their sockctit in advanced life, fnm oU 

age. 



* F«x an Ibc T«(h. i^^lulicr, Aiui. torn. i. f. JB. 




CL. 1.1 , 



CtKllACA. 



[OKtI. I. 



OCH.I. 
Srsc. V. 
O. Etek. 

tut*. 

Hcna 
wpnaUd 

tcRhflflat 
BumL 



TnuB- 

plunMlon 

oCucth. 



Dajifnetet, 



In many inetances, therefore, the sepantcd tc«tb are io 
a sound state ; and, in a few iiuttiKes, where the alveolus 
is abo perfect, and the tooth has only heen out of it for an 
hour or two, ko that ita living |>rinciple hu not Hltogttbcr 
cra«v(l, it nuty be replaced, Bud will take a fresb faotd and 
becomi- «cn-iccuhlc for many years; though it nirtly. per- 
haps nerer. forms ho firm and pencanent an attachment as 
before the accident which threw it out. 

Mr. Hunter extended this mode of supply to a tran«- 
plantation of teeth from other persons : and at one lime 
this method also was carried u> a considerable extent of 
practice. Too much caution, however, cannot beem{)loyed 
in ascertaining tlie health of the individual by whom the 
scion-tooth is to be furnished: for syphiliii, and other dis- 
eases, may bo transplanted at the same time. Aa an iit- 
Btnictive ca»c upon this subject, I may refer to the fallowing, 
drawn up by Dr. Wat&on, tind inserted in the Medical 
Transactions *. An incivor tooth of the up|>er jaw, from an 
unknown cause, becoming carious in a youn^ unmarried 
lady about twenty-one years of age, itvnia eximcted.and the 
phc« very dexteroutdy supplied by a like tooth from on- 
other young uomau, who, upon examination for tlic purpow, 
appeared to be in good health. The scion-tooth very 
rapidly took u firm hold, and soon bid fair to be of great 
service and ornament. In about a month, however, th« 
mouth became painful, the gums inflaniol, discoloured, and 
ulcerated. The ulccriktion isprcud very liwt. the gums of 
the upper jaw were corrodol, and the alveoli left bare. 
Before the end of another month, the ulceration stretched 
outwardly under the upper lip and nose, and inwardly to 
tliL- cheeks and throat, w hich were corroded by large, deep, 
and fetid sores. The alveoli soon became carious, several 
of tJic teeth gradually dropped out, and at length the 
transplanted tooth, which had hitlicho remained Bnu ia iU 
place. 

About this time blotches appeared in tbo face, neck, and'l 
various parts of the body, several of which became painful 
and extensive ulcers; a coasideniblc degree of fevt-r, ap- 
jMirently hvctic, was excited ; a copious and fetid discharge 



• Vet UL «t. u. 




[CL. I.] 



DI0E8T1VK FDNCTION, 



[ORD. I. 



89 



awed froa) the mouth and Uiroat, which impcdi-d Klocp, Oex. I. 
Eaiid the HorciMMW of the Iuucck prcvviitud a Bufliciciicy ^^ ^'fI^' 
QourUhmcnt from being Kwnllowed. luia. 

Tlie wisest plan would probably have been to have com- 'r""iiii™». 
[ntcnccd from Uie tirst with a mercurial process, before the 
Fsyntem was ho fur debilitated, and the general health so 
lecply encroncbcd upon us to render niiy plan of very little 
ae. All itnliseptic course, howwer, of bnrtc and other 
Hooks was Tint tried and persevered in till found to be of 
Fbo Hcrviccwhjitcver; and calomel pills in an alterative pro- 
[jKMlion were then had recourse to io their stead. This 
rplan wus found to soften every symptom, and totally to 
[eradicate many : but the bowels were soon Hllected with 
Itvverc pain and purging; and the calomel was exclinn<^ 
ffor stixHig mercurial ointment; which, from the present 
[debility of the patient, soon produced a like effect, and an 
fcfli'ct thftt could not be corrected by opium; and, in the 
fend, the patient fell a victim to the experiment. The pcr- 
Fboii from whom the tooth had been taken, had in the mean 
[time continued in perfect health ; and upon a minute in- 
rB]ie«tiou, as well of the 8cxufd organs as of the mouth, 
evinced not the slightest syphilitic atfecljon. 

The case is mysterious, and Icitves much ground for the 
[imagination to work upon. If it be difficult to conceive 
it to have been syphilitic, it is more difficult to conceive it 
to have been any tbini; else. But the grand lesson to bo 
learnt from it on the present occasion, is that of the wariest 
caution, and a caution anioimting almost to a prohibition, 
; in remedying a deficiency of teeth by Lnmsplantation. 

Other cases might be advanced, but it is unnecessary. Such c«iit 
Mr. Uunler, partial to his own invention, endeavoured to ^"* IJJi' f„, 
l^unt for most of these upon the principle of local irri- by Mr. J. 
lioD exciting remote evils, or univef«al sympatliy. Yet "°"'' 
iHe casea of mischief have been so severe and numerous, 
that the practice hit» long fallen itito great disrepute, aad 
u now seldom ventured upon. 

A transfer, however, of the mere crowns or bodies ofMnr 
sound teeth, with the fangs filed off, does not seem to have „„nd tccdi 
been productive of the same evil effects; and hence these °>*T ** 
may be conveniently made use of when the body of one or um^cmd. 
more leelh has bocu destroyed by caries; while the fangs 
have remained sound: fur by screwing apitxe of gold wire 



I 



90 



CL. I.] 



CCKLIACA. 



IK Him- 
mu. 



into the crown of tlie Bcion-(ootl), And boring a IikAc iat 
Uio fang of the lost tooth, tlic fonncr niny be mode to takf 
a firm hold without any Etttachmcnt to ttit ailj(»Qii)g teelhu 
anil, if due caro be taken in the ficlcction, it will nuikt 
thu best match, and produce tlic most perfect supply, tba 
human art can lieslow. 

When natural teeth arc not Cniployetl, Ihe dentUt hm 
rocounic tourtiriciul teeth, commonly obt^iicd from th^ 
tusk of the hippopoturauB; lliough, in order to confer 
frreater durability, they have of late years been iugeniouidj| 
rnrnu^d of u coinpoutioo of porccIuD earth jMropurly inoJ 
ilellcd uiid bunil. 



SPECIES VI. 
ODONTIA INCRUSTANS. 
TARTAR OF THE TEETH. 

THE TEETH INCmiSTED WITH EXTHAN EOUS M ATTRI 



Okh. I. 
Stkc VL 



Chemical 

prindplauT 

•hclaur. 




Thk teeth arc always subject to be covered over wit 
laycn* of an earthy material, secreted as a constituent pad 
of the Kulivii, and denominated tartar. 

Simple a» this substance seeim to be, no very clear exJ 
plunation either of its origin or character has hither 
been given. According to I'rofetMor IJenjlius, tartar, wlwB 
it first settles on the teclh, in mere hardenwl mucus : " bil( 
during the destruction of the mncuB," my* he, " we ir 
sibly traco pbosphato of lime on Ihc enamel of the tootbd 
which is somedmcs increased to a cniist of the ihiclcncM i 
from a lourth to the tudf of a litM : and in this state it 
tains. Ijcsidi.':^ the phosphate, about a fifth part of its woigfil 
of mucus which has been exsiccated in the earthy masa ' 

Tartar of the teeth, therefore, as far os it has 
analyKed, consists of concrete or dried Kilivn, hardened 
tl» own earthy matcriaU. As it flows frotn iho naJivi 

* Anlnil Ctmnbuir, !>- *>)• 



t 



L. ij DIUESTIVE PDNCTIOM. [ORD. I. 



acts, it u( nlways foiiitil mrmt aceiimiihtfid Around those Oek. T. 
tctth which art situatrct ncaTe«t to their npeningn. M . ^'^''^ ,jj'_ 
SciTCjf. indt-ed, has ventured to assert that this material is ctuibc*. 
M-crctcd by a «ct of minute and diatinct glanda, of which J^'Jt*^ 
he has pircn an cngniving, and thei\ gravely affirms, "ce M'hcihcr 
tartro n'cst douc pas un produit de boUvc*-" But till J"^"" 
soano otli«r analoniiat besides himself has met witli thc|.ii,^ 
sanie glandular structure, it is by no means worth while to 
relinquish the established belief. In Home persons, how- ^'"'o >■> 
ercr, the salira ia much more loaded with earthy materials kcmS! ' 

»thaii in others; for while some have very little trouble in 
keeping their teeth frre from this deposit, in others it forms 
HKMOtously, that notliing but an unremitted attention will 

Pfiiuif^ their teeth from bcini^ covered with it. 
While thiit maturiit) coiitinueK soft, it has a yellowish Pmffmiof 
api>caxancc; but as it hiirdenw, it chanfjca to a dark brown "^ 

or u black; iind often, in children, to a dark green. By 
^He<;re(-x tliu (c-eth lose all their beauty to the eye, the gums 
arc dvtiichcd from their respective necks, are irritated and 
intlamcd; the ah-eolar processes of the teeth arc exposed, 
absorption takes place, and the teeth become loosened: 
^t while the breath is loaded with a disagreeable fetor, from 
l^the decomposition ofnuch a maxK of animal matter. In 
MNnc cases, the accunuilntion has been so enormous ns to 
be htdf an inch in thickness both on the outside and inside 
of the teetlif, or to cover the whole range of teeth, and 

» unite them into a solid heap^. 
It is almost superfluous to point out the necessity of at- ituw iirc. 
tenttOD to prevent so foul a disfigurement. The daily use I^J^' 
of a tooth-brush with any of the ordinary tooth-powders jutcnilon. 
will, however, in most cases l>e suiBcicnt for this purpose. 
e baas of tliesc powders is of htllc importance, provided 
ey contain nothing Umt may injure the cnam^. Pui- 
crixvd fish-shelk, cuttle -fish -bone, boles, bark, myrrh, 
mastic, soot, and charcoal, may be used with etiua! ad- 
vantage, rtccording to the fancy; and when an odour is 
ishcd for, it may bo obtained from ambergris or orris- 



wil 
Rbe 
m 

I 



• Kuti lui TAniUiDiic tt b Phydnlocle dc« Dcnu. fnia, 1017. 

I EmOitlriM, TiMt. lii UcQiibiu, cap. xiis, SlOckr, Bcubucbiuogcii, &c> 
M,X 



i 



92 



CL. I.] 



CtKLIACA. 



[OKD. 



OBH. I. 

8rtc.V(. 

mittaiM 

the iMth. 

MiUcr 
jtddi Bujr 



rais- 



RahDg. 



AwMmnta- 

lioii» htfv 
imvcniitl 
in India. 



root. It i« only n«C0SHnry to ohserva, tliat the powder 
innooont io its quality, and impalpable in ibt rcclnctioo. 

If the taitar yield not to these, we may. without ra 
chief, add a small ciiianlity of Home of the milder acids in. 
order to render it more efficacioiu. All dentista oppose t)l^| 
HMC of ncids of every kind ; but this i« from an inacquunt- 
aace with the grndution of chemical affinities. 1 fasve 
alnady observed, that there are but four known acids f<fl^| 
which the lime of the teeth has a stronger attraction thai^^ 
for the phosphoric with which it is combined; and theae 
lour aie, the oxalic, sidphuric, tartaric, and ttticcinic. Fi 
these, tJierefore, we ought sedulou^y to abstain ; but nii 
of the rest may be used very harmlesaly, and will often 
found, by the friction of a toolh-bnish, to dissolve 
tartar of the teeth witJiuut nuiking the IcuKt imprcnl 
upon their substance. 

But if (he dejwKit still bid defiancQ to our exertions, 
must be removed by the operation of scaling; nnd tl 
guina afterwards be wushed witlt some pleasant astringi 
lotion. 

In India the accumulation of tartar is prevented by 
application named mitfte, which produces indeed a bla 
jet upou tJie teeth, but leaves the enamel untoiichevt, w 
it destroys tlie tartar and hardens the gums. Its id 
dientfi nr« not known. 



SPUCIES VII. 

ODONTIA EXCRESCEN8. 

EXCRESCENT GVMS. 

tat SOnilTAHCB or THE SUKlOUKntXC GUMS 

BXCKBSCBNT. 



nxn, I. ^^f <w'y ^y ^^^^ concrete deposit, called tartar, arr tht 
yK. VII. iccth occusioiially iiicriistnt and htiried, tnit sometimes ' 
a prurient i^wth of llic substimce of their own gu 




DIGESTIVE FUNCTION. 




[ORD. I 



Willi distinct cxtulieranccs 
o» the Hurracv. 



rhicli from diffuront citcumstaiiccn apitears under the two Okh. i. 

„ . r " Srtc. VII. 

[>U<ming lorms: 

SpoRgiosn. Fungous or spongy giims. 

Scurvy of the gums. 
' Extuberans. 

Extuberant guma. 

The guma bomelimes assume a soft fungous or spongy aO. Excr*. 
ippearonce: and this too. am Mr. lluDtor has ob«cr*-cd in S^.***""* 
penoiu who are in all other respects perfectly well * : anil Smny of 
tbi« case, though vulgarly called a acurvy of the gums, is '^^ *"""" 
IwlisUnctly an idiopathic affection. It may however 1>a 
^Symptomatic of dyspepay or some other disorder of the 
stomach, or iionie eqiiaily remote orgiin; or tlie result of a 
Kptorbid «tat« of the alveoU, or teeth thcniaclvex ; and, un- 
^* questionably, it may appear m a symptom of porphyrn, or 
real scurry, afiecling the syttem generally. 

^If theciaggystumpofa tooth be llic source of irritation, ScnriflmWi 
will be in vain to attempt a cure till the relic of thcj^^' 
>t]i be removed : nnd if the socket be in fault, it will be 
necessary to expouc and examine it. But in all cases in 
which the disease originates in tlie gums, aitd depends 
Avpon a lax state of tlieir texture, fcaritication, freely and 
repeatedly made use of, will be the best, and, in many in- 
stances, the only remedy. It disgorges the overloaded 
UnxMeU, and leads both to iminediutc ea«u and a radical 
Hpure. I have freeiucntly found it ncccsitary to follow up 
Btlie Marification into ihc roof of the mouth, which often 
partiikc^ of tlic irritation, and is puckered into WTinkles of 
vxtjutsite tenderness, that cannot endure the slightest touch. 
After scoiification, the gums and mouth should be washed 
with some warm and resinous tincture, aa that of bark and 
myrrh; and be graduaJly accustomed to tlie friction of a 
tootb-bfush, and some astringent tooth-powder, in UieAitrin;^! 
^^hoico of which the patient may be allowed to plcusc his ■Pp''"'^*'* 
l^kmn fancy; though perhaps the best ai'e thoH prepared 
from several of tlie more astringent funguKCtc, and especially 
the cynontorion coccineum of LiimcuH, better known by ttic 
tULDie of /uHgHs McUiteuiis. And if tbis plan be not suf- 
ficiently stimulant, it will be necessary to wash the mouth 

■ Dlkwe* of the Tccdi, eli. iu. 




<J4 



CL. 1.] 



0<ELIA(-A. 



ukw. I. and guma nith a very dilute Kolntioii of uitrutcorkilTor; or 
Sritc VII. ^^ apply it with a pcnciUbnMtli to Uio |>untH lUooe in • much 
stronger Htatc. Dr. Puri^ rvcomineiid)! an u dcntinicv wiual 
]iatte of powdered catt-cliu and Iwirk, nitli oDC-fourlli tlio 
qunntity of powdered iiiynh ■. 
AO-Exoc- The extuberant excrescence, wliicli fonua oar BecoD<l 
JJJJU^'"' Tnriety, is soDjelimes fimi und um-iclding. rising into di-j 
Vinncg^u- Elinct und har<U-ncd knobs inatcud of assuming tlie appcar-j 
J^JI^ onco of soft ftn<l spongy germinations. In ihcBc coBes, Oil 
general texture mid coiiiu&tence ia that of the gums th«ai«j 
Belvcs: und the only nuUcitl cure coiiHiHis in extir^nlii 
them witli the knife, n ligature, or cuustic. Even 
extirpation, tlicy urc very liable to grow iigsin, and frith] 
great obstinacy and porecvcrancc. Mr. Hunter tneotic 
a case in which they were ropro<luced six tintes, u ht\ 
suspected, from a cancerous disposition. They are also, in ' 
general, very largely supplied with blood-veeads of coo-j 
»i<lenihle nin^iitude, which often produce a troiiblcMoma 
hcmorrhai;u iiftor the opi-mtion. [Hence, a hgature, w 
caustic, has souietinicii been preferred ana means of extir- 
pation. When tlic knife is usod, it is ofleo necessary after 
the opi'iation to use the actual cautery for the sapprMciOD of j 
the bleeding; for, as Mr. Huotur observes, arteries, eoiag^l 
to increased parts, are themselrcs increased, aiid,]iocomiog 
diseased, have not tho contractile power of a aound | 
artery t. 

Excrescences from thegunu sometimes have so cancerooi 
an npiR-arance, that surgeons arc fearful of meddling tnUi i 
them. Here a remark, made by Mr. Hunter, is extremely I 
valuable to the practitioner; namely, that when the swellin;^ 
aiiso at once from the gum. which appears to be the onlydis* . 
eased part, they have no malignant disposjlion.Whcn, bo<r*i 
ever, there is stronir evidence of a tumour haviii-; originated ' 
deoply in the alveoli, the teeth, perfect as ihcy may bO 
in appearance, must be aacriticed, as well aa the alveolaryj 
procesM itself. The won't diseased of the |;ums. aa Mr, C. ' 
Kcll has rcmatlied. do not proceed from tho irriliition of I 
bad teelli. We frequently see, indeed, a carious tooth at-] 
tended witli ulcer and gumboil, abscess of iho jnw. rtin|;oiM| 



■ PlunDKoL *<d. ii. |>. I»l. .Vl> Mu llUX 

t Set Ntiiunl IUi«. of iW T«tiJi, |>. I7i)i 3il nUi. 




CL. I.] DIGESTIVE FUNCTION. [OBD. I. 95 

tumour of the gunu, and even necrosis of the bone. We Oeit. I. 
find the pain of the inflamniation equal to that of tic dou- *'*''■ ^*^' 
loureuz; but the case is not to be compared, in point of 
danger, with the tumour, which has a deeper source, and 
is frequently seen growing up beneath sound teeth. The 
hemorrhage that follows may generally be stopped with a 
dossil of lint, dipped in muriated tincture of iron, and 
pressed into the bottom of the wound *. 

There cannot be a doubt that many cases on record, 
which are described as malignant diseases of the gums, 
and as having proved fatal, by extending themselves up to 
the base of the brain, werci in fact, fungous diseases of the 
antnunt'] 



* 8w C. Bdl'i Butftlcy Ob«. voL t. p. 413, &c luid Oibwn'i lutltutc* of 
tmgKj' voLIi. p. SES. 

t Far "^mpi— of the tktil ntv^ca of tome dlMue* of the gumi, eonnlt 
J. Bdl'l Fimcfplei of 811^07, toL 111. ; C BeU'i Qiurterl^ BepcM, mL L ; 
mn, ta Edinb. Ucd. and Surg. Joum. No. 61 ; and Qibwn, iu PUladcIphia 



CL. ..] 



COCLIACA. 



£ORD. I. 



GENUS II. 

PTYALISMUS. 

PTrALISM. 




INVOLWNTAIIT FLOW OF SALIVA FROM TUB WOrTII. 

GKx.n. The saln-a issues from ihrce distinct seta of glands dis- 
Anktnitor t"**"'^ ^^^ different parts of the uionth, m the parotid, 
uiii*. the submnxilUry, and the suhlingunl; [and, orcOTdins^ to 
BcrEcliuD, a quantity of it ()(|ub] to 100(>, cotmiitts of wttcr 
992-9; a peculiar animal matter 2-9; mucua U-l; ulkajine 
muriates 1-7; lactate of soda and animal matt«r0-9; pare 
Boda 0-2 •. What nerzelins sets down as mucus, is con- 
sidered by Profe^Mir Thom&on and Dr. Bostock to be albu- 
men. Thisisinsolubleinwat«r,and,wh«n incinerated. aSorda 
a large portion of phosphate of lime. The taitar of the teeth 
U derifcd from its gradual diwomposition upon them. The 
recent inrostigations of TiL-dcmnnn and Giiiclin. hotrever, 
to which I'cfercnco has been made in the phyttiologictl 
proem, prove suHvu to be a more compound fluid than was 
fonoerly supposod; and one of their principal discoveries 
is, that the sulpbo-cyanic acid, a most active poiBon. com- 
bined nilli potass, enters into ita composition. Its sohd 
contents are found to be ^ per cent. The quantity of 
saliva secreted daily is considerable. Nuck and Lainooi 
estimated it at a pound in tweke hours; Mr, Cruickslmok 
at a pound in twenty-four hours; but it must vary according 
to circum.Hiancea, The secretion is morecopious in children 
and old persons tliait in adults; in cold tlian in wmnn 
chmatea; in the day than tlie ni<;ht. Tbc smell or sight 
of any agreeable food makes the saliva flow into the mouth 
«itli considerable rapidity- Tlic same efTect rosults frooi 
the irritation of smoking tobacco ; and from that of bitter. 
aonr, or salt substances in tbc moutb. Th« habit of fre- 
quently ejecting spittle from the mouth renders an aug- 



■ S« U«d. rhb. Tnni. nl. Si. p. 343. 




CL. t.] 



DICBSTIVK FVKCTION. 



mented secretion of it ncceiaary. A pcrHOii's talking much 

hiiH A Hiuiilar consequence ; atitl so large is the quantity of 

saliva secreted during meals, that Sitbaticr saw n t»utdicr, 

who, at these periods, used to wet eteveral totveln with what 

was discharged fTom a fistula communicating with the 

parotid duct*. In disease, tfa« quiuitity of Biihva is some- 

I times increased, somctinaes ftlniOMt suppri'sscd.] Its office 

I is twofold: that of moisteninir the mouth in coml>in<ttion 

JLlt a small ]>oniun of iuucuk sccruti-d by the lubinl uid 

eknds, and that of contributing to the digestion of 

in the stomach and duodenum. 

Under tJie influence of the iriitatinp; pnanions, and espe- 

kcially of violent rage, it assumes a frothy appearance, and 

[in many animats becomes poisonous. It is said, indeed, to 

^become so Bometimes in man himselft. 

When the saliva ia secreted in a healthy proportion, and 

[the various muscles of the mouth perform their proper 

[ofTice, it is never discharged from the mouth, unless volun. 

[tarily; hut paflsea readily from the fnuces into the oei«o- 

'.|>bagus. But it may be secreted immoderately, or tlie 

^muscles of deglutition may not properly perform their 

' functions: and, in either case, the mdiva will flow from iJie 

niouth involuntarily, accompanied with a specific diflerencc 

of tyraptoiDs. And liencc ptyalism, ax u genus, oilers the 

titvro following species of diiteusc. [Another specie* was 

enumerated in tlie last edition, under the name of ptyalis- 

' mus cbronicus; but, as the remarks upon it were not im- 

, portanl, and the reality of the CAfifi iis questtounUe, tJie 

editor has now omitted it.] 



[onn. I. 97 ■ 

ng much Okv. II. ■ 
'entity of Rji'ir 



IIo> 

ndlol. 



Iiiiinodp. 
nilcly >•• 

acKd in 

tmioui 

wap. 



1. PTYALISMttS ;ICDTUS. 

[2. INEFS. 



SALIVATIOH. 
OBIVELLtHG. 



* Tnilt d'Amt mm. U. p. 171. 

t HcAun, Din. dc Solirl cjiuqoc AJotbii, p. M. 



VOL. I. 



1 



100 



CL. I.] 



CISLIACA. 



tOBU. U 



oix. n. 

Sprc. I. 
■P, hfdra>> 

?yntvui. 
itrcuiial 
Mlivalion. 

praluml bjr 
tnrrtutf, 
homra 
inmducEil 
Hiu tlic 



Tbemlf 
nMdletnc 
■hai dnu 
•cu. 



Ui<mir7 on 



tltR only Mulistnnce we know of, which, introduced in- 
ternally, untversally acts in tliio manner. Nitric aod other 
acids have bi-vii ousiwcted to produce a like opvnition. 

[Tile author of this work and Dr. Paris, however, botli 
con«deT the opinion groundless *. Yet, accofding to ti 
eridence of Dr. Scott, if the nitro-muriatic acid lolicm. 
bath, be employed to a certain exleul. tcndcruess in th 
palate and moutli, and ptyalisra, are sometimes pioduced; 
but without any otien&ive ameJI of the breath, or looscoiti: 
of the teeth, an from mercury. He slates, that lli< 
ctTectx were excited in himself and others, and that lie 
seen as violent a salivation thus raised, as he has evei 
noticed ftom mercuryt.] 

Antimony h».« also ht-cn thon<;ht by a few practilinnei 
to hare some MUch influcttcc upon the salivary gland 
" Dr. Jamejt lately informed inc." »iiy« Sir George Baker 
" that for sixlcrn ycurK past hi« fover-powder hnH routainn 
no mercury; iunt yet, that within that spmcc of lime hf 
known at leaxt itix instances of a salivation niised by his 
nvedicine. He added, that the pntionia who were tlius aiw, 
livated had lu-ilhcr their tvetli loosciu-d nor their brcatbi 
uiiide offensive, us happens in a metcurSa) ptyulism. 
FuHch tells us, that he has occasionally observed a lik 
effect §; as docs Willich, when tarlahzed antimony h: 
been cn)ployed||. [According to Dr. Paris, the latter me-' 
dk'iiM} in nauseating dosett certainly promotes a salivatioi 
by mercury; and so doea the accidental BUjwrvention 
any discnse of debilitylf. The editor, in hi* pmclic« 
nuiongHt (he ptisoiiers of tlie Kin|;'s Deneh antl Fleet pri' 
sonM, has seen four or five coses, in which rcdnc«s 
Bwelling of the gums, and salivation, procec<lcd from iIm 
free wtc of the compound squill |>ill. A similar fact is re- 
corded by Quarini •• .] 

I'rom U\« general tendency of mercury to produce tfab 
epeoiric vfTect, tliosc who are engaged in working quick- 
ailver mines, aa tJiose of Idria or Now Spain, are ^moot 

* Fh*rniu»1ii)(u, tviL i. |i. 3(K!. Olh olic. 

t S«v Mod. rhir. Tniu. fdL nii. p. 189, aad tMilm*') C»nlribulfaa», |>. JStt, 
i M(dinl TrviMcliuni oT Uic CoUcf^ toL I. p. SJd 
I DlilSt. dc .\n<ncliiru Joi. 1881. 
I BddkfM, N. Mtwuin. bind vtiL p. iKl. 
V naBKuln^ia. vdI. 1. p. aSU. CJi i^it. 
•* JitkMAn n iant* Pnck VIcnnc, I7S& 



ler 

i 




CL. I>] 



OIUESTIVB ruMCTIOK. 



continually in a utate uf salivation; and when, wliicb is 
otien the case, condemned aj* criniimlis to such lahour for 
life, drag on k niwerable exiittciicv, in cxtrttnc debility and 
emaciation, with stiff incurvatcd limbs, total loss of teeth, 
and equal loss of a|)|>Dtiie, till death in a (ew years, nilh a 
rrieiuily stroke, put* a period to their sufferings. 

From Uie facility with which quicksUver evaporates, and 
combines, not only with other metals, but with aluioat nil 
other subataiiceei, and etipeciully with many of the elastic 
gases, a conaidcrable degree of injury ih often Kustained 
b>' workman in mnnuructortc« in which quickiiilvor is occa- 
itioiinlly employed, without their being for a loni; time 
aware of the cause. An instance of a similar kind oe- 
coned not long ago on board the Triumph man-of-war, 
which had received on board thirty tons of quicksilver 
contained in leathern bags of filly jmiuikU each, that had 
been picked up on the shore at Cadiz from the wreck of 
two Spanish line^f-batUe ships, that had been lost during 
II ttlonii in March 1810. The bagM were stowed in the 
hold, and other low partit of tlic ship; but lieing iialumlcd 
with sea water, they twon decayed, and burst. The quick- 
silver tlius let loose wus collected an well as it could be, and 
committed to proper casks : but much of il CNcapcil into 
tJie r«cc«»c» of the ^ihip; and not a littlo wiih Mctcretcd by 
the miloi«. who amused ihcmselvis with it in various ways. 
The (juicksilvur timt had escaped unnoticed sunk into the 
bilgc-watcr, became partially docomposod, and ascending 
HOOn after, nmtd»t <iii intoleruble stench, witi) the vapour 
of tlw water, coati»] every metallic substance in the ship 
with ft black hue; nnd ul the eumv time a f^'ncral aflPoctioa 
uf Ihc mouth took place amon{; the men and ufHcers. to 
eucb an extent, tliat ao less than two hundred became se- 
verely salivated, and did not recover till the ship, being 
carried into Gibraltar, was docked and cleaned to its lowcat 
planks. 

Alercury, however, produccK very different degrees ol' 
effect ujton diflerent constitutions or states of the body. 
In a few rare instances, it has exerted no sensible influence 
whatever upon the excretorics of tlic fuucc*: iu others, a 
very small quantity of almost any of its preparatioiut has 
•timubited them at once to a cupioiiit discharge. 

In perwonit of a highly nertuuit ur irritable teiupcramvut. 




ifltd nil 
bouil ihe 
Triuniph. 



Kflinnl 
rfllnt on 

diSrrcni 
consiku- 
Uon*. 



r6«tt. I. 

UrK. II. I haw known Kiilivation produced by n wngl* dose of c*- 
iP.hnlnr- l<^i>i-''> Di>d tlistt it Is Homctimcs v»uhm) hy dresning ulcers 






with icd pti-cipitate, is a fact mentioupd by Hildanna, and 
woll kiiuwa U) all expcmitccd surgeons. In Hoorbutic, 
scrofulous, Kud other debilitated habits, very small quan- 
tities of mercury will Koaiotimoa act in the tKunv manner; 
uid beiicc u cuiuiiderahle degree of caution ix requisite in 
all cttnes of lliis kind. Even the wearbg of a lestbem 
girdle, or the occasional iipplicntion of white precipitate or 
mercurial ointment to the hnid to destroy vermin, has 
often excited sal i ration. 

When mercurial salirution is produced, it ta accomp«niMl 
with a high degree of irriutiun, not only of the mouth and 
fauces, but of tlic syi^lcm ftenerally. The common course 
of syiDptonis in u foUowa: the mout]i fcehi unuiiually hot, 
and \i wnaible of a coppery or metallic taste; the lingual 
and sublingual glands swdi ; aphthous vc«icK-s appear, aod 
totmtnate in minute and oticnsive uxulce rations; the tongue 
totuefies; the throat becomes sore; pyicxy and tdeeplesa- 
ness supervene, and are, indeed, often present from aji early 
Hpliiriij- period of the disease: while in idkwrnCTasies, or habits 
*•" of great irritability, we frequ«niiy find tlie suiiace of the 

body wholly, or in particular parts, reddened with a pecu* 
linr erythcmatic inDammation, continuous or in patebes, to , 
nhich tile name of hydrargj-ria has been giren by mbuI 
writers, and that of eryt/iema mercuriale by other*. [Gan- 
grene and necroda may be the consequences of immodcnte | 
inercurial aaiiratloD. Ijirge slouglis of the parts in tba' 
mouth are very common. Oull«ri«'r has seen a paitialj 
necrosis of the lower jaw produced in this manner, and. iaj 
one young woman, a comploto necrosis of llie upper and] 
lower alvcoiary arches*. Tlio cditof of this work hm\ 
wilneaaed several melancholy examples of the same kind.] 
Dia(uli]p«r It is diffloult to determine by what means mercury pRHJ 
^''*"* duces iU effect on the salivary glands. Dr. CuUcn at-] 
CnltaiW. tempted one explanation of Uie subject; namely, thi 
" meieuTyltaH a pntlicnlnr disposition to unite with ami: 
iiiucal salts, and that such salts are diK]>osed to pass offl 
the uilivary glands more copioosly than by any other 



• IKm. d« StfcoMi KM. tMa. mBs. p. 4BB. 



ct. .0 



OICKSTIVK FUNCTION. 



[oho. t. 



100 



[ 



CMlion." But as Dr. Murray haa remaiked. mercury liiw *!*^"' ''• 
not any peculiar tendcucy of this kind. Indeed, if it had, « p.iijjmr. 
no nmniotiiiical Halls are ineiitioiied . «ilhei' by BentoliiiN, or c**^ 
by Tiedenianti mid <imc)iii, aA entering into the coiii|iotiil ion 
of the aalivB. Dr. ('ullen i«irAnln luercury a.s nolliing ttioro 
than a g«D«ml irritant, opflruting €qn»lly upon ull tbe sen- 
HibleaQd moving fibrt^s af the body, and henc« powerfully 
operating upan all the cxcrvtorivs of the t>y«tcni, without 
having a dpeoiol affinity to otte sot more than to enother. 
" It prove* often," says he, " diuretic ; and I have particular 
prooiiiofitM reaching; and acting upon the organs of per- 
ipirtUoo*." Auothrr hypoth«(ii< iit that of iSir Gilbert 
filantl*, who considers the salivuiy ghmds u one of the 
outlets for the rainenta of tlic bones, txicauw! liiiic is de- 
tected in the aaJiva, and even concretes on ihc teeth. Now, 
as mercury is known to ptoducu an active ab«orption of 
tbe sohds, it ia ingenionsty conoutved that the lact in some 
measure explninit its elVect upon the salivary glands. How- 
ever, ait tlie kidneyN and other excretory (glands also furnish 
outlets for tlic old particles of the body, and yet are not 
affected by mercury in Uic same degree as tlie salivary 
glands, thia theory cannot be retained |. The fact, how- 
ever, ivmains the same; namely, that mercury, whellier it 
powcw a specilic alhnity or not for tlic exci-etories of the 
ndira, acts, from some cause or otlier, more readily and 
powerfully upon them than upon any other excretories 
whatever. 

In attempting a cure of salivation from mercury, ourMcdidiJ 
attention is to be directedVo the local state of the IWuces "~"na«- 
ami tlie gfiR-ral state of the system. 

If the throat be not much inflamed, acidulous gargle» o«gl«*nd 
and acerb fruits, as the sloe, may be employed with great P*"*'""*' 
advantage, and should lie used freely ; hut if there be con- 
siderable irritation, we must at first content our»elve» witli 
emollient gargles of barley-water or quince-seeds: and 
in either case employ, at the same time, purgatives of 
Epsom or other ncutnd HidtK. When the system i* much Opiumand 
atlected, sulphur and opium liavp Iwen strongly iccom- 



■■'> Oniu 
1. fulpbur. 



• Mm. Mrd. to], iL. p. UX 

t Trinit. (ct Uic linpn<T?iT>int of Mol. KiMinlcdgc, voL 111. p. ItS. 

] 6ct Pirii'i niiruinmlDgik, vol. i. p. t08, tHh nLt 




)(M 



CL. I.] 



CCiLIACA. 



[ORU. I. 



Gem. II. 

SrKC. I. 

■ P. hjint' 



Purtalt 
■lid mild 
dUonttk 



Bintticti 



Mcnuty 
Talunbls M 

a intdidne, 



f) P. Hn^. 
If till. 
Mouth. 
mtering. 



□tended, and seem to many cases to have been succewiful. 
Th« formn- is tnisted ta, chiefly from ita being well known 
to diminish the activity of mercury out of the body; — 
a doubtful retuon. however, for our employing it inter- 
nally. The latter iit cvrtninly of consideiablc us« ia alluyinj; 
the general rcstlo«snt;>ui -jnd irritation of the »yi(tem. Pure 
air ttnd a milk diet are highly s^-rviccablo; but, perhaps, 
tlierc is ao d'vasme in which the Lisbon diot*drink, or com- 
pouod decoction of sarKapnnlla, may be used with better] 
effect. Taken in the quantity of a tguart a day, it carries I 
off the effect* of the poison, and siip]X>rts the system. 

[Some case* of inordinate Kalimtion, recorded by Dr., 
Haskina, tend to prove, that emetics have considerable I 
power in ri-litvinir the disorder*.] 

Like most other poisons, mercury, when properly directed, 
may be rendered a mOflt valuable medicine ; and is at 
moment, in its muIlifuriouR forma, one of the most commoo. I 
sa well OS one of the most efficacious, in the Matemj 
Hedien. In thia place, however, we can only eontemplata | 
it as a sotirce of dtscoee. 

A certain degree of active ptyulism is ai«o well known to j 
be produced by nny high degree of mental or sensorial ex- ] 
citement; in which case the discharge luosl commonly : 
aasunies a frothy appearance. This is particularly thai 
cose with violent rage, which slinmlates lliesiilivary glaiidsj 
almost as much as grief does the lachrymal. And as thai 
same mtutdeaof the mouth and throat ore strongly roused I 
in epilepsy and lyssa, we have here also a like increase oCl 
saliva, worked into the «unie xort of foam, and accc 
p«nied with a similar biting of tlie lips and gnashing ofj 
the tcfith. Bat the most striking proof of tliia eit'ect is| 
produced by an cnger longing for agreeable food of any-l 
kind, whether seen, smelt, or only thought of; ajid which 
t« vulgarly denominated moutii-w ATttRiN«. 

(r man, this increase of secretion is seldom loconsidcr-j 
able as to occasion an involuntary flow from the month;' 
but, in dogn, it flows freely nnd coutinuoutily; for hero thO' 
«a!tvary glands are peculiarly inritable, so that the «niaMl| 
is almost votistantly slavering ; the discharge appearing to 



• rhiLdclphIa JmimI. No. S. 




>CL. I.] 



DIGESTIVE PIINCTIOM. 



[ORD. I. 



I^annwer tlic purpose of insensible perxpinttioii in other Oeh-II- 
[quadrupeds. J,'"'^'- 

We meet also occasionally witli nn incmwcd «ucrct!on of Uuu 
tcUivn from a cauM ieiis ol>viou.'*, <)iKtin):ni>>d><^tl by u succt 
tor loaiirkiRli taste*; to which sonic writers have given the 

|^aUInO of SWE£T-SI>ITTLB-t-. It IS th« tiulctdo apMlWtim ^^Ktt. 

of Professor Frank J. It may possibly exist, at times, as*'''"''' 
Laa idiopathic complaint, but is more usually connected 
^with » morbid Male of the stomach, and accompanied with 
seiuw of iiausva; the saccharine matter being formed, 
rhaps, by a like autimilatiuir power ns< that pot(Me»KO>l by 
tio kidneys in dinbetoi. It u relieved by magnesia, 
^tnd other absorbents ; but is most eBectuolly cured by an 
^emetic, followed by wamt stomachics. A lady of delicate 
habit, under my care, has been subject to this variety for 
ae years. It returns irregularly, for the most part once 
kin about a month or six weeks, and generally yielda to a 
)urse of rhubarb, taken sometimes in conjunction with 
Itwo or three grain* of calomel. Hloch mentions a caxc in 
rhich it returned at perioda still more regular^. This 
tmriety of ptyalisnt >« also occnsionnlly the result of n Rcor- 
l>butic diuthesi.t, but more fre<)uently of phthisis; und 
apecially in the last stage, when, as Frank observes, it is 
ttftcn " insignis et ad nauseam usque molestn." 
A pt>'alism frequently occurs during dentition; and is PtraUjnii 
r no means an uncommon seouelorcriftbt of other diKcatic^. f ""'P'- 
la all these, as I have already hinted, it proves sululury, tiu-m ; 
h«i*d tenninalea the disorder that exc>tc« it. Feven* afford, anj itnta. 
^perhaps, the mom numerous cxanipk-t) of this ; and the fol- 
lowing case is worth relating : A hidy, ai^ed iwenly-four, 
'Of a delicate constitution, was attacked witJi a typhus, in 
'the spring of 1788, which ran on for three weeks. She 
(■appeared to be in great danger; but, on the Iwentietli day, 
sudden and copious salivation took place that unac- 
^countably afforded her great relief. It conliuucd for iip- 
['«ards of a week, the daily tlow from the nioiith hcini: never 



■ Act. NaL Cur. n>l. i>. Oba. Al. OD ] *oL v. Obh ?■■ Dcgiyo, Din. dc 
<Morl et Vta S«llvc AIomik). I7IEI. 
t tWIIiul, Cent. i.UI>h81. 

t Ite Cut. llcon. Sloib. Kpki. loni. v. )>. 03. 80. Mannh. Svo. IJD^ 
f BctDcrkuiincii, p. sua. 




106 



CL. 1.) 



COS LI AC A. 



foND. I. 



iitJt. II. 
8lTC. I. 

tiu. 

A criii* of 

RMlJroptjr. 



CImnIc 
TCndlhig 
hnTbr 
rdifitd. 



Ie«8 thnn a pint and a quarts-. In the mean while, abej 
increased in stren^li, recovered her appetite, and spit well.- [ 

Wo huve nuiiHToiis instances in wliirh thia discharge 1 
pnired equally serviceable about tile acme of small-jpOK* 
though in one or two cases death has succcededf. 
fluid of dropnieit is aaid to hare bven carried ofTat timoi hf\ 
the »aniecbiuniRl. 

in the Meilical 0\». und InquiriM, rol. lii- p. 241,1 
there i« n KinGnii^'' ^**^ "f ■»! oKitinate vomiting of five 
uiDnUix' stundinR boinf: relieved, upon a return of Mili- 
vation, which for this pcrio<l had eiaiKod. lint |>i;rhH|)«i 
one of the most extraordinar}- inttanoca to be met with isj 
related by Dr. Uuxhnni. in the Phil. IVana. v(^. xxxiii,! 
for 1734. The patii-nt wns a man aged forty, uf n xpure,] 
bilious habit, who had an aUack of jaundice. Iblloweil by I 
a piiroxyHni of cholic, thitt last beint;; produced by driDkuig] 
too freely of cider. Anionc: othvr medicine* nas ^veu a 
bolus, containing a scruple of jalap, eight grains of calomel, 
and a grain of opitim. Co|)ioU8 dejections followed ; and | 
a few hours aherwards the patient complained of pain and ' 
Kweliing in the fauce«,Bpat up a little thick, brown saliva, 
which was soon considerably increased in quantity, of a 
deep colour, reaemhiiog greenish bile, thuui^h somewhat 
thinner. This Hux of green and bilious saliva continued 
for almiil forty hours; during which lime tlie ([uantityj 
dischtu-ffci) amounted to four pints. The colour of 
saliva then changed to yellow, like a solution of gamh 
with an incrciuw rather than a diminution of the quant 
It continued of this colour for the space of forty hours 
more, aAer which it gradually became |>cllucid, and the 
salivation ceased as suddenly as it came on. During ths 
flow of the saliva, the toctli and fauces were as green m if 
they had been stained with verdigris, und tlio leetll 
retained the same colour for a fortnight aftor the ptyaltan 
had ceased. The patient had a few years before boon sud- 
denly attacked by a spontaneous salivation, so excessive as 
to endanger hts lifi'. In the prCM^ut instance, then-fore, it 
is probable that the dose of calomel co-operated with ths 



■ Art. N»(. C*r. nl. »ll. OU. tOO. 
prcclpuF VifiDlanaii. Jm. 171^ 
t KkdUn, UlL Med. lUSn, p, 384, 



Fich, DtM. it MivuSoM ninniil 
M'rbci. IJbt. Hid-fMlt.i 



.J.} 



nicesTivB roHCTioN. 



[ORD. t. 



i;uliarity of the constitution in exciting the distchargo. Ok*. IL 

lit. whatever wan its cause, it proved critical hoth of the pf^i'ijii. 

Ifaundice tind the cholic; for, from the moment it took ciu. 

place, the pain of the boweU ceased, and the greenish 

olour of the skin be^n to Niikaide, the orinc being 

the same time secreted more abundantly, and of a 

blackish hue. 



SPECIES II. 



PTYALISMUS INERS. 

DRIVELLISO OR SLA VERISG. 

Involdntarv plow op saliva phom a slugcisiinehb 

'op DEOLl'TITION WITirOUT 1NCRKA8BD HP.CKBTIOH. 

TiiKRC is a second species which belong to tiiii genus, Gkn.!!. 
the present system distinguished by the name of imrt *'^'^- "■ 
Vi'jiiu, and which depends upon a want of command or 
rer over die inusclex of dc<>:lutttion, rather thxn on any 
QcreaNe<l action of llie ealivnry i^xcretories. lu vulgar 
ignage it is deuoiniiiated nKtVF.i.LiKo or slavbuimo. 
. occurs under tlie Uiree following inodiAcatioiis : 



« Infttnlilis. 
d Sciiili:!. 
y AloriiD. 



or infancy. 

Of old t^. 

Of dotards or idiots. 



It is found, tliercforo, in three states of life: among Cuhi. 
lAuiti, before the will has acquired a power over tJio 
nuticles ordc«;intition, and is altogether distinct from the 
ilivary &nx of dentition; In advanced life, in which the 
rill has lost its power; and in idiots, who possess the 
owcr, but seldom or never exercise it. In the first case, 

time is tlie best physician j in the two last, no pliysician 

can be of any avHil. 




108 



Cl. I,] 



CtKLIACA. 



[OKtt. I. 



OENUS 111. 
DYSIMIAOIA. 
mSi'llAGY. 



new. III. 

LimilBlidu. 



klTcclcil. 



McrfwnlMi 

tiM. 



PAIN Oil ORSTtlUCTlON IN SWALLUWIKII, WITItOVT 
IMTLAMMATION, AND MOSTLY WITHOUT IMrRDBII 
ItRKPIRATIOK. 

It ill necossaiy to limit the cfinniclcr of tliiK genuB, as in 
the above dcAnition, bidcb inflamniutory nflVctioiu, in 
u'h(il«Ter jKirt of the Hysteiu Ihey occur. conBtitut« one 
iiuttiiml unicr ; uimI ilyA]inettc afTection-i, or thuMi ctMCnttnUy 
impeding the restpiralioD, another OnJor; utid «huu]d, 
tlterafore, be arroitgcd and coni>idcrc-d in tlicir rCTipvclire 
HMOciiitions : the former under the diseiucs of Hit! sun- 
gitinmua function, and the latter under thoHe of Um 
rotpiratory. 

[De^utitJoii is • very complex o|>cration, requiring 
concurrence of mimy ng«»ts, fruin the mouth, where 
begins, down t<> the cnrdiac orifire uf the aionuich, wlu 
it tenninatCK. M. Magradic divide* deglutition into thr 
elageti; in the lintt, tlte food pnK)i«H from tlie mouth 
the pharynx ; in the svcond, it piiMMCtf tlie u|>cning oft 
^ottia, »i)d the nasal apertures in the fauces, and 
cnrnod into the (ZMpbagus ; in the tliin), it paititvH Uiroii{ 
this tube, and enlem the Hlomach. When n portiom 
food hu» been sufficiently chewed, it i* pluced by 
actions of mastication uimn the dorsum of thu longM 
Mastication itt then Kitspcndefl, and the tonguu applied 
the roof of the mouth in Kucce««iion, from its point to il 
base. The alimentciry bolus is thu« pressed towards 
|>barynx, and soon neeu with the velum palati, which 
taiaed up by it into the horizontal position, and miule i 
continuation of the palate. As the tongue oontiiioni Io| 
|>i«M tlie food, it m>uld |kusb it townnlK the nasal opeti 
inga in the fuucvs, if it were not for the tension of th« 



i 



U 



CL. l] mcutitk rr!icTio:f. [oK». i. 109 



TtJ— prfrti, fiw ii w l br the ctt— fca — dt» lad ihe j BKm.m . 
cnatnelMMaftWpKEbn. WnktbeexccpdMaftWHaboa ^ 

of the nl ^, Aet actioM in tW fint staer of deelaQtioa 
are slow, TB tMUii , fie«, umI HieeesKt*. In iW secoad 
stage, lfaeaeiiii^sR&mihuMa«>,miihiplwd. invdcntniy. 
and npd ; tbe bod is ccarered bv tfaem cnlr fivB tbe 
middle to the baOoai at tike phaiyu ; but qnickncas » 
fenrid, in ndcr that the aliment tot not lasinaate 
ilaelf into the glaUia, impede itapintion, or elide iniQ the 
nan] openings in the bnecs, or the apertaras of tbe 
Eoctadiian tabes. The alimentary bolos no sooner tooehes 
the phaijnx, than it ii embraced by this pan and the 
TduB paktL At tbe nme imtant, tbe base of the tongue, 
the oa ^oidca, and the laiynx, are raised and cairied A>r- 
wud to meet tbe mond of food, and tnnsmit it rapidly 
oier the g^oCtis, which is now shot, and abo covered 1^ 
the deacent of the epizk)Ui&. By the conunned pwnie 
of the pharynx and Tcliun palati. the food is next poshed 
iafa) the cEMpbagus, the laiynx descends, the epiglottis 
nea, and the glottis itself is t^xned ^ain for ics{ttntion. 
In the thiid ctage of deglutition, tbe aninl <^ tbe food in 
the Kppcr part vt the <es<^hagua causes the sapoior eir- 
eokr fibres of this canal to contract, and propel die aliment 
tmnids the stomach. The subsequeDt fibres, now dis- 
teoded, contract in their tnni ; and the same changea are 
eon t inned in succesaion, until the food gets into the 
•tonaeb. The experimeuts of Mageodie convince him 
that the alimetU passes very slowly down the oesophagus, 
and, when its ready entrance into the stomach is pre- 
vented, it will BtHoetimea rise and descend again several 
time* bdine it is ejected *. From the preceding account 
it raiHt be manifest, that many different causes may be 
ooocecned in bringing on a difficulty of swallowing ; and 
that dyspfaagy, strictly speaking, is not a disease itself, 
but otdy one of the mo&t dangerous effects of the diseases 
to which the oigans of deglutition are subject. The 
history of every form of dyspbagy would make a very long 
detail, comprising an account of most of the diseases of 
the mouth, throat, nasal cavities, pharynx, and OBSophagua, 
as well as of rarious accidental injuries of parts about the 

• Stc H^Bdk'i VbjMoa, >>T Milligu, 2d cait. p. SSa 



110 



CL. I.] 



CCBLUCA. 



.[tlKD. I. 



Out. 111. throat, and of many Horts of tumotire within or atxu tho 
Ufiphigb. tm^t|,_ tjjp pharynx, or ceeopbagUB". In the present part 

of this work , the author enlers into the considentioii of tho 

fir« foUowiog apecicB ;J 






1. DYSl'llACIA CONSTIIICTA. 



3. 



4. 

fi. 



— ATOrClCA. 

— nl-OUOKA. 



UV(TL08A. 
LIMCVOSA. 



CONSTRtCTlVB Dt»- 

rilAGV. 
ATONIt DYSI'IIACr. 
SPASMoniC DY8- 

fllACY.OK NERVOt'Si 

QVI^SY. 
UVDLAB DYSPHACV. 
I.IKGUAL DYSPHAOV. 



[I'he several caG<eB of dyRphagia, ariKtn|r from a dimina- ' 
lion of the capacity oftheresophagUHbyditiniM of iti«t«rx- 
tufc, or fro«n its being occupied or compr«Bsed bjr tuinoan 
of different koU, are ut 6re( ko itiniJlar in their Hymptonu i 
and progresK, that n ttuccemrtil diKCriminution of them is < 
not almys easy. In all of them, one of the earliest sj-mp- 
toms is a difficulty of xwtillowin^ eolidit, followed, aft«r a 
time, by that of swallowing fluids. This inconvenience 
makes more or less rapid advances, and if not relieved \ty 
medical treatment (which is too ollen impracticable), ter- 
minates in a fata) interruption of the function of deglntition. 
With the exception of >i))<asmodic dysphngy, and caaea fhm i 
mechnniciil injuries of the jnwand |iiirtii about the mODttf) 
and throat, alnioat all tlie specie* of dysfAagy come oo 
very grudiinlly, and with w tittle annoyance, that at fint 
tbey arc a])t to l>e disre^rded, more especinlly as tha 
health is genenilly gwd, and tbc inconrenienre in swd- 
lowinf^eomctinies ubaicn for a time, or even quite ceases. 
Mot in general eun any defect be »ecn or felt in the mouth 
or phurynx ; tJie food pusscK the iMbmus of the fuucea 
very well, and proceeds duly towards the stomach ; but it 
MOon rises into the mouth again, with a large (|aantity of 
snliva, unuccompanied by any effort of tbc stomach, dia* 



* njiphafiy, fnm ilklocaitnii of ih» ot hj oMm, ti ■ cme tlial lua bcca 
lloncd hy vrticM, bui t* ermrUlr diMttdltcd h; pncdilonai i lunmw, Mi.C. 
Bill had • pnpanliim nhibiting a ptnjectkm of mm at (he haoit tt limwi 
bjodn Uuo ihe phaiyiu, in caucqucoce of ulnrMion. Ttu iwaalUUlj rf 
ApqibaO ''*■■■ AtplaCfDiMit of ih* «• hfoliln t> Ihnvfun pwicd. Sw tof. 



niCEETIV£ FUNCTION. 



[OBD. I. 



phrngm, and abdomioal muscles. The patient again tries Uev. ill. 
b> isM'uUow, antl. pcitiaps, after repeated attempt-i. succeeds [^i^j_|^ 
ill jotting the I'ood into the stomach, in siuull <{uantiliei< at 
B tamv. Thus the diseaae is allowed to go on unreKUttiid 
for a long period. The kind of rumination, resulting fioin 
Uie inverted p«rist«llio action of the <e»ophn){u», differs 
frum comniuii vomitin|>;. imiHmuch nit tho food is ejected 
, witJiout anxiety, indiitpOMtioii, or cold hwi»iIs. Notwith- 
I standing thv ditliculty of swallowing, the np)ictit« oft«n 
1 continues good, almost until tlie very approach of death.] 



SPECIES I. 
DYSPHAGIA CONSTHICTA. 
COSSTRICTIVB DYSPItAGY. 



IniPriCDt-TY t>P SVALLOWING. FROM A rERHANKNT 
CONTKACTION "P TIIK tKSOI'll All VS. 

SoMKTiMKii tlic diameter of the canal is diminished in Oex.III. 
punicuUr pArU by u ihicLening of the inucoMS membrane, d^^,,'^ 
flvsliy fxcrcKceiiceii, or fuiigoua, or scirrliouii Uimourfl. The 
same etfcct may proceed from tumours formed between 
tbe coatsoftlie oesophagus*. Somi'tinies A itcinhouB thick- 
ening of its coats, or of the cellular membrane connecting 
thcmt, extend* through itii entire length ; and sometimes 
it becootM contracted by tlie conversion of a portion of it 
into canilagc or bone. Ue^idea these ca&es, there are 
other casual and symptoinatic obsttuctions, which do not 
fnll under our present mirvey, produced by hyMtena, and 
pother spasmodic Htlcctionv; entiietti-s or the lodgement of 
iorcigii bodie:i in tJie canal; or external tumours, as in 
broncbocele, abscosecs:!:, or anourism of the aorta, presising 
inst its sides. 



• IfrtV. BeU'i SoTg. niM. p. (HI, 

f SfB AnrMTOiix't '^''t''") ■^"'■'- ruriciiliK 3i pi. *. lif;. 2. 
$ Mr. CannidiMl hm nmrdcri two faml mmplcs et dpphagj. tVom sbKnv 
die mdplMfil* Hid Mrrlcftl TCWi li rwi «1icrv IMdi ihc Minaiiiin bihI 
■DMMMn dT thi JUciBe, m (bund on dlMcctiim, Iw (onccivn Out the 
pMlmw' liTBinlKbl li«vebeciiMvcil,hiulilietaUMilaner(nauirbetnili>cluiflc<l 
viih ■ enrval ipinr — Sm Tni». of AmatMou of Phftkiaat af IrcUnd, 
««L W. p. 170, *e. 




\1'2 



CL. I.] 



CCKLIACA. 



[U»D. 1. 



ciKN. III. [Th« liniikg of the <£«ophagiui, like all other raucott* 

ILCtnl rncnibraDes, is linblc to lie tliickened by inflammation; 

Mritia. ilic<liiim«tvr of tliu pan^ngt) is thervliy Ictaenedi tiiv miw* 
l>yq^wV <^'^'''" fil>ie»c«miol act u|>on it witli thuiruvual puwiTj aod 

^ukturr. the conroyuncv of th« food into the stomach it mon or 
Ices obstnict«(l. AccordiDg to Sir Evcninl Ilome, tnie 
strictures of the cesopbagus, like those of the urethra, 

^B generally occupy but a Hwal) extent of the canal, and an; 

^M tor a long time atien<led with very liltJe thickening of the 

H adjacent parts. The (Ivrangeuieut is in the inner Q>eDibraiie 

H of the tube; there is no a]){>arGnt diiieaM: of the tunica 

^M mj^iultg gultc; nor any degree of thickening of the glan- 

H dulur structure of the cesophagus*. Sthclurea may occur 

^1 inany portion of the- tiib«; btit ihcir moKt frvt]uent situation 

^^ is immodiatcly behind the cricoid ciirlilugc at the tenuioa- 

H tion of tlic pharynx. Sometimes the pharynx and begia- 

^m ning of the onopbagus is studded with scirrhous tumonra 

H of great firmness and wbitoocss, nuirly closing the latter 

H canal; white a general disposition to disease of its meta-i 

H brane is denoted by tumours of a similar nature lower down 

H the pamtge. At the itame lime the membmne, rcflvcicd 

^P over tlic glottis into the trachea, may be thickened, and' 

^K eren swellings of Uio above description present theruselvei 

H within the latter organf- Another form of Ktrrhus of the- 

H ccBopbagus is very unidogous to the disease called the- 

H BcirrhO'^ontractcd rectum; it involves all the coats of tha 

H tube, and, though it may aliect the greater part of tha' 

^t pas«ngv, it gciicrully commences' either in the upper portioa 

H of it behind the cricoid curtiliigu, or fur down near tbs' 

H c&rdia, where the structure is very g1andulart> Scirrhtu 

H changes the texture of the a^sophagus sometijiMa into a 

H hard uniformly flesliy substance, and sometinnB into a 

H substance of a gristly nature, or intersected by mcmbraoea^ 

V Under such circumstances the canal is always rondortd 

M narrower, and often nearly closed. Tbcdiaeaae ia also fra* 

H quciitly complicated with ulceration, which in mostly SMn ' 

^1 either alwve or below the most constricted jioint. not exactly 

H in il||. A fact, meriting attention, is, that ubatructiooa 



* U Ikll, Suqiiat Obi. p. n. 

t C—t by C. tWIl. >■ T' (!■■ P' Mt 

i 8m Monn'i {Idubid AnM. tt Oit 0«1Im. Ice p. SSO. 

I MMk*! V«Am bf WuAnf. xA. II. ^ 99. 

Bibid. 





w^ 



bIGBtTtVK PVHCTION. 



[OKD. I. 113 



situated high up m the cesophagua, fre<iuentlif ^ve Hm Orm. lU. 
rto ulceration of the lower jiart of it near the stoniach, D^V'on.'' 
iuat u Mrlcturea i» the urethra (Vequcnlly produce utccrci- tuicuk 
tioD of tlnit canal townixlH the bladder. In the aitopha- 
ruM, this kind of ulceration ii mo«tt liable to occur when 
ic obntruction htui existed a long time; and the frequent 
liing u conjectured to be the occasion of it. Though 
ilceration docs not gcnumtly iittnck the most constricted 
tion of tho tubf, it does ho in pnrticulaj' examples, just 
I it doc« in the urethra, and this in Kuch a manner that 
lie obstruction is more or less removed. Relief only fol- 
ates this event. Itowcvcr, in cases of common stricture of 
te mucous membrane ; for when the disease is of a scirrhous 
latiire, ulceration always proves an aggravation of the com> 
jlaint, instead of a possible meana of relief. Indeed, when 
lie cesophaguH has been rendered even more capncioiiK timn 
latuial, by the eftecls of scirrhous ulceration, the continuity 
>f the muscular action, by which the food is transmitted to 
the stomach, is interrupted, and a disesise, very diiTcrcnt 
[from stricture, resembles it in its moat essentia! ciicum- 
[•(ance, the incapacity of swallowing*. By ulceration 
[ of the (saophagus, preternatural communications may lie 
, forated between that tube iind the tnichcal-. lungsj, or 
: morta^. The latter state may also be the result of disease 
I first commencing in tho great arterial trunk itself |[. Here 
bIso the remarkable case of Admiral Wassenaer deaeT*'ea to 
be mentioned, who, according to Boerhaave, died suddenly 
,in tha act of attempting to vomit soon after dinner, and 
[ whoaa oeaophagu.i was found to have given way in the seat 
of an olcer, so that nil the food and drink taken at dinner 
liad beconte effused in tho cavity of the che«t. A similar 
tM»e, in which the msophagus was perforated near the car- 
Ldia, Bod the contents of the stomach, together with a lum- 
[bricooa worm, four inches in length, were efl'used in tlie 
Reheat, ie recorded in a modern periodical work^. 



■ C BfU, In Svif. ObL p. ei. 

t Van lirtfvmn. Ohi. AnU. PMhuL Liigd. ITSO, ob>. 3.; tni Manro'i 
Morbid AaaMimj of ibc Human (iullcL, p. 32A, pi. in. 
i BIniUiul, ilv Dlllidli Alinxnt. dqiulaioiM, ob*. 1. p. 4a fi|(. 112. 
§ Tin Dorvcrcn. obs. 3- 
II Mfckd. Maiiuet <l'An*L loni. lu. |>. 377- 
% Rcvuc MM. Pifiiia, lints. 
VOL. I. I 




114 



<:t. I.] 



Cai-IACA. 



[OBD, I. 



Urm. in. Or. Bailli« once met with a rery unusual stricture in the 
I^C<in. t— opb*g"*» arituug from the puckered Mate of tb« macou* 
■tricu. tnciiiliniiic, wliioti, a» well as the DiuHoularGbree, wits quite 
froD fruui hU iiioil>><l olteratNOi 

Whpn tbv diameter ot ilio lower portion of the teeopba- 
gus is much diiuiitishwl. tlic food oficci nccumulates above 
itiu piOKt roDtractcd portion of tho pees^e, which b»- 
cuiuOM tlilale<l above the obstruction, and is nmetiioee Mta- 
vvttcd into a kind of {much, nearly as capacious an the 
Btoiiitich iUeir. CasoK of tliis di-»cfiptio» ure recorded by 
BlasiuH and Ilallcr. In most i-xuiiiplvti, tbi; dilatation le a 
lEMpiMgui general ouo, oonprisinK the whole circumlerenoc of the 
diuicd tube. The formauon of a cui-de-tae pouch at some uai^ 
aba) ruction, tjciilar point IS luore rare". ilowev«r. in i>r. W. Hunter K 
inuuum inay be «e«n a pouch of this liind formed at the 
lower end of the pharynx, and oxtenditig down behind the 
oesophagus, lu origin was ascribed to a eherry'Staneb 
vhich remaiDcd three days in the lower part of the pbatytu^ 
where it made a depression, in which the victuiiht afterwarda 
lod|^> In about five years, the pouch was largo enougk 
lo hold eevecal ounces of tiuid. It» situation and iba* 
partiriilarly when diMcnded with food, occasioiMd extiecne 
dillicully of swallowing, by which the patient was nlt»* 
wutcly dwtroyedt. Ad example of a pouch nt tlte lover 
and bnck porl of the pharynx, and extendmi; brlwrcu thl 
Bpine and ufsophagus, so as to cause great ditiicuUy ' 
swallowing:, is rvcwded by Mr. C. Bell. After death th« 
bag; wan not found to be covered by muuular fihres. at in 
Mr. Ludlow's ease, but constated uf a prDlntsioa of lb* 
inner coat between the stroog muscular fibres of the pha> 
rynx. Tho patient used to suffer as much froin fl atiil<»e> 
as from dysphagy. and, in consequence of ihc entraaeaef 
boogies ioto tho oponia^ of the sac. it w»a dithcult lo paa 
then^ Pouches of this descnpuon are sometimes the re- 
Hutl of abecenoA, which bunt into the pharynx. An in- 
stance, in which there wrre two lai^ imics reaching Aim 
the pharynx aloni; the sides of the oaophagus and liaohia, 
and betwixt the foruer and th« vertebne of the neck, wu 
seen by Mr. C. Hell. The tnechnnical opetltion of thsH 
|iouchrs, and their valvnbr ci'>nii>iuuicatlooB with tho phs- 

• NmM, HMiilSarh <h> PMhaliglMtak Am. mm. &. 
1 1 III Ml II. h iii*. (Hfc nl 1^ f^ ■■ ^ B. 
I C BrfK Bm«kal Uta. p. C*. 



Cln. 



DICF-STIVC PDNrTION. 



[ORD. I. 



115 



ryuT, by which the fowl that imtinuntcd ilwJf into them **"- HI. 
m» eolifinttd (tiefo, oecAsioDed the pittiont'H death frotu d, ^'^ 
\ hribition and inanition *. •>net«> 

Cdwis of dysph^^, attended with th« fonnation of the 
above kind of sacs, liave l>Gcn pronounced inevitably mar- 
la) t. This melancholy prognosis, it is to be pieaumed, 
' would bo fully warranted where the sao was the cona&> 
queDf« of a scinhou^ disease of the oewphagus; yet, if 
l>r. Odier han taken a cofm:t view of a case that occurred i^hifculw 
Lm Genera, an example, in which the atoophagns wna in ftjiuludmt 
laoirrhouji Mate, and there wa« a large prominent pouch on fawur^yi 
iMch Ride of the neck, yielded to nwdical treatment.] The 
I food which the ]>ntiont, ayoungnobloman, took, commonly 
|icmain«)in thcHOHacs an hour or two, and was then thrown 
Ivp. Hemlock pills were prescribed, and a bandage ap- 
[plied to the protuberance. As soon as the pills were re- 
jjected, which, like the food, they were sure to be in an 
I hour or two, their place was supplied by others, so as to 
■ let tht- hendock constantly act on the neat of the disease. 
I The imtiotit soon became relieved, and was frmdually cured ; 
rtbe ponchea disappeared, the aliments descended into the 
|uomaeh,and the a^tophacftifl recovered its former calibre]:. 

[In cases of stricture from chronic thickening of the Snnpwini 
j Wacoua membrane, the patient experiences, instead of "• """'"•• 
I actual pain, a soK of pressure or tightness, either in th« 
I emirse of the intestinal canal, or about the shoulders. He 
points out the exuct part of the fPsophaG:uB in which the 
Lobstniction is situated; and the lower this point is, the 
|gmt«v reason has the practitioner to suspect a thickened 
state of the eoats of the canal. The unpleasant scneations 
Immetinea extend to the cardiac oritiee of the stomach ; 
[lut they are only felt when the patJent mokes attempts to 
[■wallow. In the early stni;e, the food does not return into 
Lihe nowth till lon<r after a moal, Homctimcs not till four or 
[five hours afterwards. As the disease makes pru{:^M, 
[however, tlie return b quicker, and the quantity of alt- 
[aienl brought np again lat^r. Lastly, when the case ap- 
ches its fatal termination, the food is oftvn rejected 
'^ypMMt as soon as the eH'ort is made to swallow it. 



■SoiglalObi. p. 71. 

t Jonnkn, bi IMci. dt< i^citncn MM. torn. i. p. iSB. 

t Bdlnb. Med. Connn. >al. lil. p tiO. 




116 



rr.. I.] 



CdtLIACA. 



[ORD. 



OlEK. 111. 

Hmc. I. 

tuku. 



■nlkMj. 



Dysjihn^. arising from acirThus of the <pfioph^UB. isi 
t«ncl«l with eymptoius Tery similar to those of stiicture.| 
Pain, ami inabititv to swallow solidE, arc tlie enrly syi 
l>toiii». Ada a lime the |tas(«age of Duids is anestetl i th«yl 
reiaain for a short tiai« in the canal, and, distending it 
cr«atc a sen»e of suffocation. At length, they arc portjj 
rejected by an inverted action of the urwo]>liB^is thiougbj 
the noso and mouth, and the rest passes down with 
gurglin); noise*. l)y careful and expcrivitc«d obserreriij 
however, some circumstances have been noticed by which i 
Hcirrhus of the (esophagus is more particularly charac-| 
terited. The patient is conscious of a dull pain an<l op>| 
presaive tightness, not only when he attempts to swallow,! 
but at other limes; and, if credit can b« given to Wk 
nann, who titMl made this remark, Uie disagreeable i 
tiOQ and the difficulty of swallowing c«ue in a great 
sure when the patient lies down upon his back. In iidditi< 
to these particulars, Richerand's observation mvntu atten- 
tion, namely, that a bougie is generally more easy of int 
dnclioti, than in cases of stricture. The diMaae it rc|>or 
to be somi'times met with in very young tubjectaait well 
otiwrs. Pereival huvinirolK>«fved it in a child only thir 
ycaint of age, and Wichrounu in three children under eight 
A ifuestion, however, here presents itself. naui«ty. whc 
ihet^ were cxumpli-s uf scirrhous disease of the glaitdt 
structure of ihu (esophagus, or only scrofulous HwslUaj 
of the lymphatic glands, which are well known to be 
liculnrly common in young subjects.'] 

Where onthexia. or an osailic diathesis, in prewnt* 
stricture sometimes assumes a bony hardness; and Mc 
gives a pitiable case of this kind , in which the passage i 
so narrow tliat the uithiippy patient perubrd oltogetbar ' 
hungerf. At limes, iodecd. tlie a>M>pliagiM baa beoomtj 
ODtinly im|iorfomte. either from the incncwing cootnotJoftj 
or the oolargement of internal or rarroundmg tul 
of the former. lUradius relates a aiogaUrciM^ £xi 
of the latter have occaeiooally fbUMred «iiiall-pox( 
strumous iodurabonsg. 

• 8m Umm\ HwbU A>a»r ^ <^ H-bu G.lhi. *«. p. 3X1. 
fAdMn-Utd. <«!.(. p. m. : CM. iL 0«>. ««. 

t An. llaAk *«l L its. IM. Klph. Nu. Om. Die. ii. Am. b. ola. 4A. 
I HsuAsfh l>M. attMramlfEwpkatti. l-UfaqM (-«^k. Ac Tatrins. ITtt 




CL. I.] 



DICKSTIVR FUNCTION. 



[ORO. I. 117 



In a Tew ioi^lancea hair the length of the ccsophogus has 
been completely gorgod by a single fieshy or glandifonn 
excrescence; an instance of which is given in the Edin- 
burgh Medicnl b»nyi>; the pittient died of roarainnus in 
the seventh month from tlt« commencement of tlitt <iiHeft«e, 
and in (Ik- primt; of \m Ufc. The tumour renchod from 

[the middle of the canal to the cardin, ami m thoroughly 
blocked it up that a probe was with difficnUy pasNCtt into 

[ the atoinach on exumittini^ tlic part al^cr deatli *. An ana- 

^logoua caxc i» recorded by Mr, C. Bdlt. 

Of ftlriclurc of tliv teeophaa^us tt is often dillicult to trace 
he remote cause. A neglected catarrh ^ common sore 

[throat; amall-pox: syphilis; a highly nervous or spasnio- 
dic diatheaia; the amoke of tobacco;^; tlie use of the i/a- 
tura SlramoNium^: the abuao of nl^TC1lrinl preparations; 
tlrinkintr too lai^ly of cofTce, ur any other Haiti immo- 
derately hut or coldH; and an intliimmnttonof (he pharynx 

[and oesophagua ])roduced by swallowing Boap-leeef, or other 
injuries; are various remote causes mentioned by writer*. 
A tein[)orury eontmction of the (a«ophii<^iH ix itaid to have 

' abo been produced by worms in the atomnch and intcs- 

■lines; and, in one or two inittanccs. apparently by worms 
lodged in the hepatic and common duct**. [With respect 
to some glandular Nwellings and tubercles, by which the 
(BsophaguB becomes obstructed, there can be no doubt that 
they depend upon scrofula. Of the causes of Hcirrlum of 
|>hnrynx and (Esophagus, nothing certain in known. 
ler the head of dypliagia corulricla, tlie learnetl au- 
thor of this work has included many diseases of very dif- 
foronlchanictem, as common ritricture, from a thickening 
of the mucous membrane of the (Ksophagua; scirrhous and 
various sarcomutoua indurations and thickening of the 
parietes of the canal ; and obstruction of it by ghmdutar 
swellings and other tumoura, either situated between its 
coats or growing from them. 

It ia now almost universally admitted by practitioners, 
that no medicine haa any power to remove a permanent 



o*w. in. 

Srtc. I. 
D. Cm. 



RcdHiU 

Cauio. 



i 



I 



• Vid, U. wt. xiir. 

I Epb. Nm. Car. Dec tii. Ann. I. ola. 79l 
^ Ibia. Ann. il. nt*. 6a 

II EtUuUnd, Do wni n i»orlH>u U^phogi ^truciutl. 
^ C Dell, Id Sur^ta] Obi. p. lO. 

** btlicnbuch, Vvmiudllit ItcuuTiujigea, U 



t Siu^ioJ Ob*, p. 79. 



I 



llfl 



tl. I.] 



C'CELIACA. 



[ORD. 1. 



Om.ill. Btriclure o( Ihc owofihitgtM «nsing from it thickcoed bdcI 
v'cSL contracted sUUe of the mucous mvmbrano. I'hts is n caee 
■iricu. vny <lit!itrcnt from apusmotiic conNtriclion of (he eiuinJ, 
Tiaimcni wlicrc iiu ofgiinic di»eD»o prevaih, and tho power of onti- 
jjj^'^'"™' spasmociio raediciaes. emetics, cold drinks, coW lotioo*, 
«napliiif;iu. blisters, and filterattves. is oonnideTable. In the inatanoe 
of {lemiancQt Htricturt;, aa >lr. C. Ueil truly obserre*, Uw 
proper course is the ufie of the botisio, aod where the at- 
tempt to dilate the part brin^ on violent opaftm and ^»t 
di8turbanc« of the constilutioii, e^-en the apphcation of 
cauatic bouses ia rccomnteitdcd, after the example of Sir 
Everard Home. In general, however, (he common bougie 
Uiould be preferred, and the untied one employed only ill 
formidable aiul unyiddiiig eaten. In proportion aa tbe 
Htricturt! gives way, the size of the bougie niuat be iu- 
creased. If an example were to preseot itfielf, in which 
the dysphagy was known to depend n|mn tlie cuniicxion 
of one or more preternatural pouches wiiii Uic pharynx ot 
iSBophagus, combined or not with a etrioturo or other dia- 
eaae of the passage, c«rtainly the means ftxun which (be 
greatest relief might be expocwil would be the introducbon 
uf un eluMic ^m tube, by which the food might be pr«- 
v«aled from diMtendiog the poach, and the vtrictuic nt the 
mma time diluted. Whether altio the oblitonition of th« 
pouch might bo nufoly attempted by throwing an aittnn- 
gcnt injection into it, aa suggested by Mr. C. IMI*, futarv 
experience must determine. ItoUow bougies ar» very km* 
portant instruments in diaeasea of the ceaophagua, not only 
iia meanH of ejecting a dilatation of strictures, but aa a 
contrivance for feeding the patient without any action or 
disturbance of (he diseased part itself. 

In tlie eitrly Htiigc of n ncirrhous or sarcomatous ohstnw 
tiou of the <siiophaguB, leches, blistetv, or iasuuM on the 
tbrout nuy be tried t. blether with an emetic, a counie of 
the conipouiul calomel pill, and occaaional aporieiit lucdi- 
ciiK-fl. I'be iseusH in the mdea of the throat, and tlie use 
of bougie*, Mr. C. Bell aaaures us, will ullect a cum what 
there is a mere thtckeiitng from coounuu iiiflammatioo or 
HCrofulous actiou. Were a case of this deacription tu pre- 
sent itself to the editor, he would be disposed lu give the 
l«duM. iult-niiil nnd vxti^riial toe of iodine a foir tnal, an it 



IS a 




* Ihiriika) ObKmUKini, p. <iB. 




CL. J.] 



DICEITIVK ruttCTIOK. 



nicdiciDc that ceriainly has great power in Ui« disponion 
of various other chronic awelliii^it. Except in the ahove 
exMupl«<i, howuver, little hcndfit ciin be expected from thiit 
or Mtj other plun. In thvso cases, as well ea in those or 
oonimon stricture, the patient should generally be fed by 
mouM of an elastic gum tube, passed from the nottiil 
down the oesophagus. The apparatus of the at'iinnch* 
pump, when the pipe is not too large for introductioo, U 
very oODTenieut for the purpose.] Id an early period of 
the disease, some benefit hatt been derived from hem- 
lock and aiDmoniati^ copper. And sometimeM mercury, 
carried to the point of naliviition*, baa been found highly 
serviceable. 

Dr. M unkley rebte-t ono caMe of great severity, and ttveo 
of aonie years' standinE;, in which mercury, carried to the 
effect of ptyaliHrn, provcil perfectly successrul. 

A stomach syringe, for diluting and washing away various 
poisons introduced into the .itomach, whether by design or 
accident, was [fir»t sug^e&ted by Renault in his work on 
poUoQS. Dr. Monro afterwards gave drawings of instru- 
ments for the n.'aK>val of laudanum from tJie stomach f. 
Uowever, until Ur. I'hyHic ^ proved the utility of the sto- 
mach-pump in the cane of a child, poisoned with laudanum, 
the invention gained little attention. Ax now perfected by 
Mr. Read and others] itappearstobendmirtbly adttfytcdto 
the joint object of ciihirging the diameter of the tusophaguB 
by a gnuluul pressure, and of conveying any quantity of 
liquid foo4l that may be desirable. The instrument, as 
brought into notice by Mr. Jukes, consists of an eluslic gum 
tube, a quarter of an inch in diameter, and two feet and a 
halfin length, terminating in the lower extremity, or that 
introdaced into tlie stomach, in a minute globe of ivory with 
various perforations, which for the present purpose must 
he omitted, and fitted at the upper end either by a act«w 
or a plug to an elastic bottle of sufficient size to contain 
At le«at a quart of liquid, with a sto]>-cock fitted to it, as 
in the hydrocele botUe. Instead of the bottle, a pewter 



HcRlllKk 

vid oihcr 



Cum) hy 
niRCUr)'. 



■y rings iniijF 

be lllTIUI. 



Deacrip- 
(ioo. 



■ B>uh, Inqulrica »ad Obmritiaiu. BrialMne, SeIki Cuts. Dobwin, 
Sled. IMm. uid 111!]. vL 

t Tbui* ds Dfiphagia. Edinb. 1797. 

i BdtMk Bttmmj, vol. lU. p. 1 1 1. Abo GibMo'i Imniniui of Suigny, 
*aLU.|i.36a. 



1 



lao 



CL. l.J 



COtLtACA. 



[0RI». t. 



uu. in. ftyringe may be adapted, of equal capacity, and aaed m< 

D*^!-*' ^ Botoc manner. 

The bottle or syrin^ being filled H-ith wann water, and 
fitted U> the tube already introtluccd into the Etoroacb by' 
tlie mouth or a nostnl, on taming the stop-cock the water 
or other hquid may easily be forced into the stomach, and 
witJidrawa by a reverae action: and hence lauilajium, oc) 
any other poi&ou capable of dilution, may be pumped npJ 
ill a diluted state tilt the stomach is entirely unloaded; < 
and liquid food may be iutroducet) to any ext«al at option. 
Mi. Jukos hB« triul Uie instniincot oii bimMlf, m well at] 
OD various putiviit^, willi complete micccBa, in one or Vt 
cases after ten draclima of Uiudaoiuu had bevn «walloweiij 
for the purpose*. 



SPECIES a. 

DYSPHAGIA ATONICA. 
ATONIC DYSPIUGY. 

bIFFlCDLTY OF SWALLOWING PKOU UBBILITY UF TUSj 

UVSCLBS OF DEdLUTITtON. 

OiM.Ill. TiiK external tunic of tlie ceaophagus U muticular, uuil 
^"■^"^tho muKolar fibre* uro both tmnsvereu and longitudioaL 
dfglutiuon. The propuUioQ of the food from the fuucc« into tbe 
mach commeuces in the action of the circular librcfl of < 
pharynx, which contract in Bucocseiou, and iu a dawnw* 
dircetion; and aa ibis direction is continued to the inu»>] 
cularfibrci8oftheii:Mphagu4, tlie Nwallowed morsel ta earned 
forward into the stomach by a progreiHive or 
action. 

Now, in all cases of debility in the muaclea of dcgln 
tition, the contractile action ofthcir fibres, and conaeqtunUy] 
their prupulsivc power, is lo»t or eofecbled, and a diflicultf 1 
of swallowing must be tlie neccnory consequence. [Per*] 



■ Lmi. aldt ua Php. JMm. No. iS, ^ 3M. 




DIOESTIVK FUNCTION. 



[oao. 1. 



BOM of aclvaticH ycnre nr« moMt Kiibjecl to dysph«gy IVum Osh. in. 

pnnlysis of llic oesuphugus; tUou);h tliv di«vaac eomcttiiK-ii u'^woiL. 

ocoura in tlic middle period of life, and even in youth. ^ 

_,, T» .. , »■ , 1 - Sjinpronis 

Thus, Dr. Monro records on« itutanee of it, brought on in nf Aionic 
a country lad, nineteen years of age, by a previous febrile ^*V^'ff- 
attack ; and another case where it came on »>uddeoly in a 
Boklier, aged tliirty-two, whose moutli was aUo drawn a 
little to the left side*, indicating the connexion of the 
complaint with apoplexy. In atonic or paralytic dys- 
pbagy, patients generally flwnllow solids more easily than 
fluids, the conveyance of which into the stontach requires 
ft greater eBort and a more complete agreement amonf^t 
all the organs oimoernod. A probang may readily be in- 
troduced down tlio piissage, without producing any aggra- 
vation of the complaint, as it docs in cases of spasm. The 
patient cannot fix upon uny particular point as tbc situation 
of obstruction, and he in not sensible of luiy pain, tight- 
ness, or feeling of weight, except at tJie |>enodH of making 
an attempt at deglutition. When tlic paralysis is com^ 
plete, nothing can be swallowed, and it is indispensable to 
feed tlic patient by means of a tube- When liquids pass 
down a certain way, and arc then forced up, the paralysis 
probably occupies only a part of the oesophagus. Atonic Cmm*. 
or paralytic dyi>pliagy may be the cJfect of apoplexy and 
other discabcs, ur injury of tlic brain; also of fevers; of ex- 
posure to cold and damp ; and of disorder of the digestive 
organs. It is a symptom of the last stages of fever and 
phtbiius pulroonalis. In such cases, a small quantity of 
f aiqr fluid fretjuentty cannot be swallowed, because it docs 
not give a suHicient stimulus; but deglutition will be 
executed if a large spoouful be given f. The treatment of Tnouuaiu 
atonic dyspbagy must vary according to the nature of the 
cause. When the disease is the cooaequeuee of apoplexy, 
the means, best calculated to lessen the difficulty of swal- 
lowing, are tlie »anie as tbo»e required fur the relief of lite 
original complaint. When tlie dyspliagy has been awo- 
ciatetl with pain at the pit of tlie stomach, difficulty of 
breathing, palpitition, and flatulence, a cure has been ac- 
coiitphithed by cordial volatile medicines, blisters, isitucK, 



• Klutlild Aui. o( ilia HumM Ihillei, &c. p. 231, S33. 
t Monro, oji- dl. \: tSt. 



J 



133 



CL. I.] 



COLIACl. 



[ORD. 



oiM. ni. and Ave grainR of tbe pill myrrha eomp. gtveaevrryntj 

Hidiol In muti'i' ciutcR, npeatcd blisters to the throat an<l ehl 

whicli stimulate rram without, aod tonic and OBtriii^ 
g&rglts, as of alum, c«t«chu, rhatany, port-witw, uid de 
ooction of cinchona, which stimalata from within, wil 
•fiord relief. Slimolatiug etala^trgues may also bo 
ployed with adrantage. 

A draught of cold water drunk frequently duiing 
day-time, and especially at iii);ht and momiuir, baa als 
»» a toaic been frequently found uwfu). And if the hubil 
be related or irhtabia, the Bauie touie plan should be re 
dovd gvaenl as welt as local ; aiid be eapecially combti: 
with exfi-cistt, sea-air, sea^Mthiog, [elcctrici^, galv 
aiultheuse of spirituous ronMntatioiu,oraln)iigoaiia|ibor 
liniment*, to the throat and neck. In aomc caHeit, ra 
by Todo aiKl Wichmanii, a cure wait ed'ccted by the frvo ex* 
hibition of qanuiat.] Hard study mnsl bo rcUaquitJied. 
luid, if possible, anxiety of mind. 



SPECIES III. 
DYSPHAGIA GLOBOtiA. 

NERVOUS QUINSY. 

tllPPICUtTT Oy SWALLOWINO FROM WIND IN 

STOMAOH, SPAHMOniCALLY COMPKKBSRD IHTO Tflt1 
rEKMKO or A IIAI.L A9CKKDINO INTU TUK OtSOPII A- J 
eU8, AND VSODVVINO A HRNSR OP STUANOQLATIOH. J 

new. Iir. Fkom this feolinc; of a hard boll in the thront, the irpe> , 

UrKc. ■ll.^es im in the pRwenl nystcm distinguished by the speciSej 

fijMnriiii. name of ghbota. It tH pcculinriy rnmroon to peraona oTj 

a nervous or spasmodic tcmpciumcnt : and ia hence eallad \ 



t 6m Uid. teSckiKis MU. Mm. >. p. 444- 



CI- I.] 



DlUBtTlV* fOUCTlOK. 



[»Eb. [. 



123 



by Dr. Darniu and oiuny other wriUTw ghhut htfitrricui, 
and by Dr. licberden iterooiu i/uitiof. 

MoHt frcfinenlly it occur* n» a mere Hymptom o( the 
hysteric or hypochondriacs] affection; and on thn account 
ix r«{;im]etl iin sucli tlono by umny nosotojnnts. It is, 
however, ofU'ti to bo traced in sudden ^uitta of ptiiMioii. u 
feu, gtieft Bud ftngor, espccialiy in young eubjecta whose 
pMBNIH have novor been disciphned ; and at tiniott vxhibito 
BO BMuh viokncc aa to threaten suffocation. In nervous 
hibite, I have lre(]uently met with it as a pure idiopathic 
adectioa : and, in a few instaooes, in per»0D& who were not 
tha* eonstitutionally predispoMd to it. 

Two clergymen of this metropolis, who bcnr an cquitlly 
high cl>artct«r for pulpit eloquence, and have a very suf- 
6ci9nt wIf-poMcsston, have been occaitioaally under my 
care for some years in coiist-quciice of tht» complaint. 
One of them has most cooiinonly been attacked during 
dinner; the rcf^lar action of the muscles, in swallowing, 
being converted, from debility of the organ, into the irre- 
gular action of spasm. The other received the first pa- 
roxysm while readini; the tiervice in his own parish-church, 
»*ad was incapable of proceeding with it. In this case, the 
■tngalif action of the muxcles of tlie glottis, in speaking, 
excited irregular action in those of the oisophngtiw from 
contiguous sympathy. And the eflect was so conHidcrablc, 
that, when the clergyman came to tJic aame passage of the 
liturgy on the ensuing Sunday, hL- was obliged to stop 
again, for he found he could not get tliiough iL But he 
preached with as much fluency as ever ; and this, too, with 
nothing more than a syllabus of his discourse before him. 
It was many weeks before he could summoa courage to 
make another attempt in the desk ; and hia first efibrt was 
even theo made in another church, and beiore another con- 
gregation. In this h« waji fortunate enough to succeed; 
■d he has now entirely overcome the morbid habit. 
'in both these cases, 1 have found the most effectaal 
Minedy at the moment to be a tumbler of cold water swal- 
lowed gradually, and the application of a handkerchief 
dip{)ed in cold wau-r to the throat. The spasm thus coun- 
teracted soon ceases; and, in the cases before us, has re- 
Uum-d not only less frrquinlly, but with fur lewt vi(4enc<-. 
Yet, during thv tntcivalB, genual loniOi, a light diet at 



nEx. in. 
SrsL-. tri. 
D.OIob<]» 

Cauaca. 



.sitijtuLir 



RFmcd; >l 
this momeat. 



i 



1*24 



CL. I.] 



COtLIACA. 



[ORD. 



utx. 111. n-gulM houn, and m much as poesible horse eierctse, hav 

j^'mi'ri III! ^^*^ '""^ rt'course to, and contributed their nwpcctiv 
services. 

The ttfual anti-apasmodics, aa volaliie alkali, ether, can 
pbof, assafu-tida, nn<l eren huidanuia, had Toniierly be 
tried, but, I was tokl, with little miccoes. 

Wlicn etlicr i« hod n^courvi; to, whether in thin or an] 
other atlection, the best means of dissolving it ix a jir 
parntion little kaown in our ovrn coanlry. but which is it 
tnxluced into the current French PharmacopiEia * unde 
the name of Oleum de vitelUa ovi, obtained by evaporatii: 
the mixed yolks ofeggii to about halt'^ tlie oil is produc 
from this by pressure, but It uitist be aAerwuxls filt 
tliraugh pa|wr to become reJiticd. 



ftiidriiw 

■hittaf 



SPECIES IV. 

DYSPHAGIA inOIJX^A. 

UVULAR DYSPUJGY. 

SWALLOWINO OB8TNUCTBD OB TROUULKKOMB FMOI 
RELAXATION AMD RKLARCBM K^T, OR VKUM OBSTIO 
TUTION OF THE UVULA. 



Okk. IIL Tilt omla is s<Hti€tiuie8 enlarg;cd front inflnmmatioa 
*""^*; but, in such case, the disease, for reasons ulrcndy sU 
fiiMiiil belo^^H to another class. In the intlammutory state, 
™^;.^ uviila iit hot, acutely iminful, of n red or livid colour, aiMl| 
dcrtuleM, nx it cnlnrj^s, from its proper form. 1b 
S|)GrieH before u», its natural form and colour are 
ititvrfcretl with, excepting that, as it ji^rowa largwi 
lon|j;cr, it also grows paler. It is soft, relaxed. Bod < 
tous. [The patieut has a aensation, as if the throat 
blocked up by some largi.-di ImmIv; the annoyance it 
sidcrable; and he is compelled to be continually airaUawiligl 




DItiBHTIVE rVMCTtON. 



[ORD. I. 



bis apiUk. The complniiit depends u\mn ralaxntion of 
tlic azygo«, or Iwutor niiisclf of tlio uvulii.] 

Tile coni])liiint, therefore, in this variety, requires to be 
tieated with ipiritaouB und astringent stimulanlji. Qsrglt-B 
of alum or port-wine form, perhaps, the best local appli- 
CfttiotiH; and ftliould b<; combined with cnlliartieH and ^^^ 
Dcral tonics. If tlie diaeaso do not yield to this pbni, the 
elongated and pendulous part niii«t be entirputcd. 

[q u few rare in^tunces, the uvulii and even the toiiHiU 
> become hiinl and ciirtilu|;inous ; aiid, in such cmcm, tlie 
luorbid portion must be cut auuy. 

Hie uvuta in its natural state appears to be concerned in 
|;lutition; and, [us one of its purposes is to examine, as it 
are, the nature of the aliment previously to its being 
swallowed, and by its sympathetic relations to excite an 
aversion in the gnstrio ortfans to substances not of a fit 
consistence and <jtiality to be conveyed into the stomach, 
it is endued with a much higherdegree of sensibility' than Uie 
.ofthc Koftp^duto. By means of this quiclc sennibitity, 
the sympalliy of the rcitt of the organ* of deglutition 
I it, they are, in nil probability, excited duly to perform 
the harmonious and successive actions, by which the 
function of deglutition is accomplished.] And hence, when, 
from ulceration or any other cause, the uvula int lost or de- 
ficient, deglutition is rendered more or k'ss troublesome, 
and even difficult. In this case, the healing art can ad- 
minister nothing, and habit becomes tiie only pliysician. 
Examples are related, however, of so total a loss of the 
uvula, I'foin gangreue, or the barbarous cruelty of cutting; 
out the tongue, that the sad suti'erer has been com]>elled to 
forc« tlie fuod in every meal into the wsopha^s with his 
fore-linger. 



Conirs 

r?n« of 
uvuU 
bnoming 
Int. 




COttlATA. 



SPECIES V. 

DYSPHAGIA LINOUOSA. 

UNGUAL DYSPHJGY. 



SWALLOWING nflMTRUCTEO OK TROUBLKSOHF. PXOV 
PROTRWSIOX OR MAGNITUDE OF TlIK TONCre. 

OKir. nr. Tins specie* exhibtta ttaelf under tlie two followiog fornu 
Srw;.V. orrariettes: 



<i Exwrtoria. 
Lolling tongue. 

Ilanula. 
Frog-tongue. 



Tongue extended from the tuoutli.: 
o1\i-n nilh cDlurgcment of its nub* 

lotumcsccnco of the salivary gliuuU , 
or ductK. 



('■nniccntui It IS ncccsssrT. as in the last ipocies, to dintinguish both 
J^r^"" t^e^ affections from inflamniatoryenlBrf^nients. [Accord-> 
■ntuuorthcing to the editor's viewft of thia MuSjoct. ()k^ only cawcx, 
""V^- which strictly accord to the author")! classification, am 
oertnin chronic, and frequently congenital enlargemeata of 
the tongue; for the examples produced by mcrctirv and 
po«MMu, though they were mchided in this suction )>v Dr. 
Good, nre in reality inftammiitMas, and ought, tbersfbre, 
to bo nrrani^ed with other cases of inflnmmation. Oalen 
l^tiuafltu mentionB an example of a piwligiously large lon^e, whirb 
was neither in a scirrhous, OHlcinntous. nor ioftamed Kral«*. 
Scaliger abo refers to a man. whose tongue was of so eK>- 
traordinary a site, at mentJacH tuspicio tiUntium ituHealf. 
MarcelluH Donatus was acquainti'd with a merchant at 
Mantua, who was in the same coDdilioa^. T. Uartholioe 
qnotcs a case communicated to him by J. Valuens. in wfakb 
a girl's ton<;tie was an thick as her arm, and required to 
have a portion of it removiKl. Hie tiame author likewin 
describes a child, whose tongtio, which was from the tint 
larger than those of other children, [>ecame at length 



* l.ih. L cap. V. De ilili: mnrta. 

X UiM. Mtnb. lib. ri. Of-X 



t EicMii. IW. cap. I 




QL. 1.] 



DlOKtTlVS FCNCTIOX. 



[OID, I. 



127 



equal in site to a calTa heart*. SimiUr imtunces ofepon- fltx. lit. 
tan<>oi)H pretArDalura) i^uwUm of the tongue are recorded %'j'y' 
by HnriJet't' and Khmnintj;. Another example of con- guoit tx.* 
genital enlargement of the tongue is described by Percy. '***'•• 
I'hc maJformation had increased bo much by the time the 
patient reached her eighteenth year, that it was impossible 
to see the aides and under Burface of the tongue; and, 
tJiough she could speak and sing, ahe waa obli|;ed to putdi 
her victuals to the back of her mouth with her fingers, in 
otder to be able to Kwidlnw them^. A rery interesting 
CMC is that of Phtlibert Hxnhumer, who was bom wit!) a 
vefy Uirge tongnv. pendulous from the mouth. No material 
iDcnaseoftlic part was afterwards perceived till the boy 
WW eight yearn of age. At this period it waH of a poiple 
colour, and covered with a thick fou) coat of mucus. It 
descended three inches below the chin; its apex was 
rounded; the teetJi of tlic lower jaw were displaced by it; 
its base was two inches and a half thick; and the whole 
cavity of the mouth was filled by it; so that respiration 
could only be carried on through the nostrils, and nothing; 
l)tit liquids could be swallowed. The patient was relieved 
by the amputation of about a pound of tho tongue, and 
the extraclioo of the misplaced teeth ||. 

In another very similar case, nearly nn En^jdi pound of 
the tongue was extirpated with ltgnturi.-s hy Dr.Mirosu. In 
this instance, not only did the four lower incisor teeth 
project with their edges forward in the horizontal position, 
but the alveolary process was also displaced. 

It is juKtly remarked by MM. Percy and Laurent, that Khmilil b« 
cases of the above description must all be referred to the ■"'■^"V- 

■ ■111 I .■ n»lra lonn 

nrmcipKi, by which other lustis naturte and extraordmary an of 
eontrenital cnlargementa of piirW are produced; and that 'f''^''''' 
they arc widely different from the inslaneee more com- 
moaiy recorded, whieh ara specimens of glossitis, and ge- 
Dendly occasioned by acrid, venomous substnnc«B, inflam- 
niation, or. what used to be tcmieil, inetuslaecs. In many of 



^ 



•Ccnt-a. Hl>I.AnM.39. 

t BuDriln At U Sn-. d'Eviriiii, No. 2X p. 07. 

t Joum. Jc MAI, m 1712, lom, xv. 

i Dkt. tin Sdoicra Alnl. tnm. ixvli. p. 7M. 

n BIM. Pck; uid Lnureni, toI. ni. p. X4I!. 




I'ie 



CL. 1.] 



C<XI.IACA. 



[OHD. 1. 



Mrww of 
rditf. 



0«x. in. the congenita) esses, however, it appcara, that a furtber 
a D. lift.' increase of tbo tongue proceeded froiD tlie iiritatioo of tbe 
P"««a- part by the teeUi of the lower jaw, and the conwquenUy 
augmented detcrniiimtion of lilotid to it. 

Il^Hides the impediment to deglutition, the enlarged and 
protruded state of the ton^itegives rise taaconfltontlosaof 
salirii, M'itli wliich the victiiida arc thrr<cftHu not duly im- 
pregnated; digCKtion 18 impairod. mid tJie health tmffcis. 

The operation of removing the redumlunt portion ofthc 
tongue is the only itiewns of rdieriiig tlie above dvM^riptioR 
of cases. Whether it idiould be done or not, must depend 
upon tlie degree of inconvenience cau^ by the swolbng 
luid size of tlic part. In enses of glomitis. on the con- 
trary-, this practice is quite improper; for, when they will 
not yield to the removal of their particular cause, otiil the 
employraeDt of antiphlogistic treatment, one or more fr«e 
and dt-ep incisions in tlie dorsum of the tongue will gen^ 
ndly itflbrd prompt rvbcf. Tlie merit of making the eScaey 
of this method properly known to the surgical profemoa 
belongs to M. Uelamalle, who wrote some interesting ob- 
•ervaliona on the subject in the Mem. de t'Acad. de Chir. ; 
but the practice was tirst introduced by Camerarius, Za- 
cutua Lunitanufl, and other older surgeons. In the modem 
perio<ltcal journals, we are constantly meeting with proof 
of it* »ucce««*. Sometimes, however, the. mc-OMily for 
dee]) incisions has been aupeneded by btcvdint; from the 
noinal veins, Uistering the throat, and other antiphlogistic 
measurcsf. In one very singular instance, where tbo 
enormous swelling was confined to the lefi half of Uw 
tongue, and bounded by the middle line, the application 
of mx leeches two or three times to the inflamed part pro* 
duG*d a speedy subsidence of the swelling];. In all cases of 
obstructed deglutition by enlargement of the tongue, tbe um 
of elastic gum tubes for the conveyance of food and medi* 
einea into the stomach, utkder urgent circumstanoea, shouUl 
never be neglected^. 



* Sm MaRin't cut, in Edlnlt. Klid. anil Surg. Joum. Na V3.p.^S. 
t See Sdlnk MnL and Suri;. Jmm. No. 'Kl. p. -Ul. 
$ llnvM, ia l>i>t>tln llwpiut Hrporu, ml. Ii. |i. *S. 
tSMOMbr U. Uwourr- Jvuni. dc Hid, Mm. luuri. 



I 





M. Magcndiv, in the BuUi^tin of tb« Philoniathic Society 
i jtfPurii, for $>eptctiih«r, 1KI7, r(uot«s the cqev of a Jew, 
who was able to double his tongue backwards, and plungt^ 
it with the greatest caao into the pharynx; lUid tells us of 
a rhild who noqiiiK-d thesnmc pow<>T by imttoling; Ihi: Jew. 
The fihit efforta of tlic child were unsucccMfiil: but at 
length ho rupttiird the frscnulnui, and a homonlra^' en- 
L-vued, which, ntrcrtltclcKK, did not nlFinn ibe boy, for he 
f^foond, from that moment, tliut he conid pursue the imita- 
tion more perfectly; till, by continued rrpclition, he too 
> acquired the singular faculty of swallowing, in the same 
aner, his own tongue, without the lenut inconvenience 
^to hie respiration. 

But (he substance of the tongue under this variety la 
not always enlarged. M. Foumier knew a handaome 
yonng womsm, sixteen ycnrn of (n;e, who, although ?ihe hud 
^a long neck , had a slendt-r and titill longer tongue, insomuch 
that nhe could protrude uik) extend it to her bosom without 
Itooping her head. And he ictls lu of another female 
rhom he saw at Berlin, with a tongue aatonishmgly uide, 
'^'but u thin oa a cat's. When this woman laught-d, (he 
)n^« covered Uie whole of hur mouth, and hung out like 
>lds of tlnpery. It was ahiays cold, and communicated 
mo«t frigoriftc Kensatioii to the hand ofanotlier pereon*. 
[The Rnnuin, or J'rug'loHgue, as it is commonly called, is 
tumour under the tongue, consisting sometimes of a di- 
atalion of the cxcretoiy duct of the sublingual gland; 
Laometimfts of a dilatation of the excretory duct of the sub- 
maxillary gland. The firetcuHC is denoted by iUt globular 
shape. ai>d its situation exactly under the tongue; the 
\>od by its oblong figure, and iM lying towards the aide 
sftlwt organ. Tlic diH<-HKc ix most frequent in children; 
}ut ia also met with in adultit. The saliva contained in 
le swelling ia generally of a very thick oonststence, the 
effwt of its long retention. The disease ari*ca from an ao- 
tcidenud ub»(ruction or ol)li[or;ittou of one of the above- 
[ mentioned <)uctA. When neglected, the tumour aomctimea 
^Iwcomr-K KO large that it occupies the greatest part of the 
[mouth; forees the tongue backwards; impedes suction, 
[ma&tication, and deglutition ; obliges the patient to breathe 



PrKc.V. 

irL4(Anfv of 
llic Uttgiie. 



Not livtyt 
tiiltt/ftH, 

thuujth 



KIIOM 

ruiuU. 
tongue. 



I 



^ 



> l>in, ila Kcloica Itliitloiln, on. CAt R^at*. 



VOL. I. 




130 



CL. I.} 



CaLIACA. 



[ORD. I.' 



fuoaa 

noiuU- 

Trcumcni. 



Obm. ni. entiixily througli the noetiils [ propels outwardB Uie cnnin« 
» I). Ivin*' *»(! cutting teeth ; and even fonrw a prominent swelling 
lielow the chin*. 

When thi; tumour i« recent, and not rery large, it may 
he cured by tnaking rt fi^c opening id it, and maintaining 
the aperture for sonic time by means of a small tube or 
tent. When, however, tiie swelling is of a eoasidcmble 
size, and of long standing;, and the cytit is thick and indu- 
rated, a portion of tlie lutter part must be removcil.j 

The irritation and enlargement proceed occasionally 
from a morbid socn-tion of calculous matter. Hence. wImb 
n ninuln has been opened, the surgeon should alwaya 
mine with a probe whether any onlculoua matter is lodged' 
in it; and, if it be so, it should be at once extracted. 
M. Foiirtiivr records the ca»e of a stone which was liereby 
formed under the toni^ic of it man only (liirty-seven yean 
of age, and at length acquired tlie me of a pigeon's agg. 
It was accompanied with great pain and profoM aaliva-' 
tion; but the disease yielded to a remorol of the inorbMl 
concretion +. 

[In tJio last edition of this work, the nutlior adverted 10 
a cnw communicntMl to him by Dr. Percival, of Dubtin, 
and deKcrihed it us a painful ranula : tlie diseu»e, however, 
was cvi<lL-ntly an enlargement of the tongue : ** A horrid 
case of dytpfiagia /inguoM has lately occurred in a yoong 
girl, who took a large drink of cold water whilst her noutk 
was aura from mercury. Tlio prolrndcd tonciii? lolled out 
on the chin, and was half cut through by the pressure of the 
lower teeth. The ulcer was exceedingly foul: but its ap- 
pearance soon chiingod lor the better by ihe use of hmI 
rosai and carboniis fcrri." A ranula alwaya pushea ^s 
lOBgUB back, and not out of the mouth.] 



• r«i« by Prtit, Tntil <lc* .ltd. CMr. Mm. I. p. IM. 
t iMM. Amfdmnt UUiaii*. an. Cm Haass. 




Ct. I.] OtOKBTlVR rUNCTtOK. [ORR, I. IIII 

• O 

GENUS IV. 

DIPSOSIS. 

MORBID THIRST. 

THK OESIBE FOR DRINKING P.XCESSIVE OR IMrAIURb. 

BsTWBEH the preKDt anJ the ensuing genus, entitled Ozx. iv. 
LiMoais, or uoRBiD appetite, there is it cloae natural 
' connexion, thougli their position in in difTerent and even 
. diatincl organs, 

Tbe tense of hunger is well known to be Bcatcd in ihc Dnitfn of 
I Womach ; and that ol" thirst in the mouth and fauces. ^„'"' ""* 
I [Thirst is n feeling of a still more urgent kind, and rv- 
I quiring instant satisfaction still more iniperioualy, than 
ibur^r; ]>articulai'ly in warm climates, or whc» any of the 
I watery secretions are atif^ented, aa in dropsy and diabetes, , 

I It is one of lh« most distressing symptoms in fevvrs and 
in du minatory oomplainta, especially in inflammation of 
I the Btootach. Hot spices, saline substances, and, in partf, 
[ ticular, commtm salt, increase it, as do all causes augment- 
iing the different secretions. The end of drinking seems, 
Itbereforc, tobe for thorepairoftbelossesofour fluids. If thirst 
: not MtiaGed, a general irritation comes on; the sensation 
' dryneas in the mouth and fauces increases, and is ac- 
'^compimied vritli a burning feel, and a quickened pulse. 
[But. although thirst appears at Urn very oppressive, drink 
by no means so ncccKsary to the continuance of the life 
[tf every animal, as food. Several species of wami-bloodod 
Iftnimals, as mice, quails, purrots, &c. can subsbt without 
Irinking; and individuals of the human rooo have been 
' Vnown, by perseverance, to conquer tlic sensation of thirst. 
Sir (J. Baker has recorded a memurable example, in the 
Trans, of the College of Physicians, of a man, who lived 
in perfect health for many years, without drinking. 

Thirst and hunger may be compared to two sisters, 
united together for the common purpose of rcndenng the 
animal attentive to the preservation of its own existence. 
When their call is obeyed, they are a source of pleasure; 

k2 




132 



n.. ..1 



CCRLIACA. 



Thei 
■llBeitnooi. 



OiBT. IV. when it ia neglected, or reiisted. Uiey arc a cause of great 
and even fatal sufTeriiig. But, in (he production ortheatt] 
two rery difTercnt results, pleasure and pain, thirst ia fa: 
more enl^^gelic and intense than hunger. The quicknc 
with which the taking of drink ap|>eaMa the first of I 
itensations, contrasted vritli the Alownesd with which solid] 
aliment is neceBaarily conveyed into the stomach. perbapi,J 
may tend in some measure to e]())lain the really greater «n-| 
joymont, generally felt in quenching thirst, than in satiify»j 
ing hunger. 

In llie gre«t object for wliich thirst and hnnfrer arc in-] 
Ktittited, nnniuly, the noiiri«hmcnt of the IxMly. the 
portance of the latter sensation is sonietin>ce rcprcMnt 
njt i^rcatvr and more evident th:;in tltat of the second. Sotid 
aliment, it is suid. yields the essential constituent pnrU of^ 
lhcbloo<); and the utility ofdrinks, in relation to thiH fluids 
is not always so manifest. Yet, how can litis view 
adopted, unless we shut our eycc to the large proportion 
aqueous fluid in the blood, and to the in)men^<- quantity i 
watcrcontinually thrown out of the circulation by the lung 
kidneys, skin, and the secreting organs in gen«nl> Theces- 
satinn of plensnre, however, the crisis to which the aatiafyii: 
of either of these nensations leads, it is (rue, is k«astron| 
marked with respect to tliirst, than hunger; and thedit 
cxpciieiiced from cramming the stomach wi(h solid food, can^ 
scarcely be said lobe producible by taking a redundant quan-*i 
tily of beverage. Indeed, with regard to thirsl, drunkard* 
apiwar incapable of reaching that point> which, in the uaeofij 
solid aliments, may be regarded ax satiety. This dirti>renc 
probably depends upon the stomach immediately ridtlu 
itself of drink, while chvmification requires the food to I 
retained in itaoonftiderabletime. Hunger and tliiratdtf 
Htrikingly from one another in the time unA situation 
their devclo]>ment, ns well as in their loc;il and giiooal'l 
phenomena. Thirst, contna(od with hnuger, coniM aii>[ 
suddenly, and, if it be not quenched, it creates a slatt oTI 
suffering. — rc«l pain ; it is not at all hkc what, in rclatian 
to hunger, is called nn ap{)eiite. which enters into the class 
of agreeable sensations. In thirst, the mouth, and eapoci* 
ally ibe (hmat, are atlected ; in hunger, the stomach is thn 
seat of uneasiness. Thirst, even when not very ardeiU. 
is accompanied with a true local and general excitemcnl; 




DIOBSTIVB FUNCTION. 



[ORU. I. 



[while hun;^r,if »t nil prolmcted.occasioiiscliillinwM. jnle- 
aiid II dispositiou to fuinting. The ditlcriMicus bo- 
feen hmif^ur «nd thirst, when long contmu(.>d, and us* 
[•uiniiig Uie character of dbetiscs, or rallti>r, butweun the 
IjeHeob of a total abtttinencv from drink and those of » 
I eompleta ab»tin«ncc from solid food, nrc Ktill more strongly 
[jnarkcd. To u«« « tonn employed by Brown, the etatc of 
l^hcitla, of er«thi«tuuti. of dryness, and of local and general 
I beat; Uic iitcreuscd activity in tlie general and capillary 
I circulatioiu ; thecnei^ofthc external BcnsL's, of the whole 
I nervous sjtitofli, end of the muiKiular organs ; the result* of 
I thint, form a vuiy manifest contrast to the prostration of 
every power of iho constitution, to the languor of all the 
I (functions, and to tiie true adynamia, produced hy un- 
t appeased hunger. Death, which is the end of botli these 
Mccoea, takes place much sooner from thirst, and the mure 
1, because no remission occurs in the cruel and progress- 
t«ve course of its symptoms. Death fton want of solid 
'ibod always comes on more tardily, and its ptionomena, 
which are chiiracterixed by irregular iiaroxysnis, arc at- 
tended with remissions of greater or less duration. 

fiut nothing is a better illuBtration of the dill'ereuces be- 
tween huti}(«r and thirst, than the iiiHueuce of disease over 
' tliem. NVho does not know that one of the first effects of 
oioiit diseases is to augment thirst, and to make the patient 
laced ft larger quantity of drink, while the appetite is 
rtnoro or less completely nanihilated, and a necessity for 
[.•bstitwnce produced t Throughout the course of diseases, 
while tlitrst continues, the appetite cannot return; and 
I .«vcn if it were to do so, in this state of things, it would only 
.'bo a fallacious indication of a fictitious want that could 
[not be safely satisfied. The decline of indiaposjtion, and 
'|tbe approach of convalescency, denoted by the subsidence 
of thirst, have also, as one of their surest harbingeni the 
return of appetite. And, with regard to tlierapeuiic means, 
is it not equally a fact, that beverages which assuage 
thirst, create appetite ? that certain mcdicincit, particularly 
Aiiic-spasmodics and opium, which diminish bugger, excite 
a good deal of thirst? and, lastly, that nil geueroua alcoholic 
wines, which appeiwe or dtrlude Uie sciiKation of hunger, 
produce at tlie ^mc time tiuilc lui opiiosite eilect upon 
thirst.' 



Qsx. tv. 



DlflcKncc 

bithccflixu 

otauaae 

thInlanJ] 

hunger. 



1 



Icillucnct ot 
ugiuii lluMii. 




134 



CL. I.)' 



CW-LIACA. 



[OHD. I. 



OCK. IV. Though the scftt of thirst in now gciienlly nsm^rued 

th« mooUi and fauces, some physiologiRls so far disapol 
ScuoTihe frooi this doctrine as ,to tofor the scut of thint partly aJso^ 
Uihini. B»d ^'*^n principally, to the stomach. Thoy argue, that 

this organ ia tho inntntrocm of hung«r, it must, by uaaiogf, 
be likewise thnt of thirst; and tlmt heating drinkg arid' 
food, which merely glide over the throat, produce thirst 
chiefly by thdr action on the stontach, n» is proved by tltt 
cireumstance of thirst not being felt till digeition i» going 
on in the stomach, and long after their application to th« 
phnrynx. They further argue, tliat the thtnit, following ft 
meal, is Hctuuily quenched b)' beverages which aMnly 
touch (he parts in the mouth and throat momentarily, bnt 
remain more or less time tn the stomach. They likcwiso 
take into considenitiou, that various ahments of ruild qualt- 
tiea, like farinaceous aubslancee, which do not at all irritata 
the pharynx in deglutition, eitcilo a considerable degree ol 
thirst after their iulioduction into the stomach. The ontf 
means of relieving thirst, so brought on, is to swallow 
plenty of fluid; for every other attempt at deceiving the 
patient's feeling is to little purpose. 

It is conceived, that other observations tend to raiso 
additional uncertainty respecting the tmc seat of tliirvt. 
Dropsical diseases, diabetes, profnsc suppumtion, copious 
hemorrhages, &c. are cases, in which thr unimul economy 
is deprived of a large ciuantity of fluid, without the phy- 
sical state of the pharynx or stomach appearing to b« 
more particularly aff"ecle(l, than any other part of the body. 
Nay, it in asserted that some rare examples hiivo been m«C 
with, in which an irritation, a dryness, and redness of tb«Ba 
organs were not accompanied with the least degr«e of 
thirst ; and it is remarket), that whatever may be the caim 
and intensity of this sensation, it may certainly l>e appealed 
by the warm bath, clystors, and the injection of liquid 
into the veins; plans which replenish the syatem with 
fluids, but have uo specific action either on the throat or 
stomach. j 

Although these reflections seem to the editor to bear ■ 
more upon the questiou concerning the caust-s of thirsl. 
than that relating to its seat, they are highly interest! n);, 
confirming the fact, that the present subject is involved 
in a great deal of mystery, artd pointing out the obifcunly 





DltieSTIVS rUHCTlOH. 



(bat tttendx our internal sensations, compared with euch as 
sre derived from without. 

Miny vague hypothesea have been suggeMtcd, nit ex- 
plnnntioiHi of the imiuediute caubc of tiitrHt. The loaat 
pUwiible ones inuftt here be passed ovvr in itiloiice. Oy 
•oine phyKiologiata, thirst is imputed to the drynetta of the 
nervouH piipilli& of the pharynx, nriiin^ from n dirniuution 
of the salivary and mucous sccrelionit. Yet, in nunicroua 
cues, thirst exists quite independently of k want of 
monture in the pharynx; while such beverage* as are cul- 
culated to prevent tlio dry state of that organ, do not 
alu-aVB succeed in quenching thirst; and, in many in- 
stances, the best meansof .iBauagingit.whatevcrmay beita 
violence, arc certain general therapeutic plans, which cannot 
possibly operate by mutBtening the pharynx, or its nerves.] 
In thirst, there is, perhaps, ulways a ficuBc of dryness in 
the fauces; and yet drynum of this organ docs not appear 
to be the cause of thirst; at least the intensity of the 
feeling doe* not appear to depend on the intensity of the 
dryness: for there is sometimra but little thirst, whore (he 
tongue, to its very roots, is covered with a thick and dry 
crust, OS in the acme of continued fevertii while it is oflon 
vehement under the influence of violent passiuns, and in- 
tolerable ou a Kurchiirged stomuch, when iliu tongue and 
luuces hare no dryness whatever. 

[Another class of physiologists, considering, on one 
hand, the purpose of thirst, which leads um to take only 
such fluids aa are fitted to dUute the blood and Uie iiecre- 
tious; and observing, on the other, the powerful influence 
that copious evacuations, by perspiration, diarrhcca, dia- 
betes, and serous cxlravasntions, have over this sensation, 
attribute the immediate cause of thirst to the iibstTactJon 
of the aqueotw part of tlie blood. Bichat inclined to this 
theory, imd conjectured that llie intitKluctton of water into 
the veinn would, by its mixing with the venous blood, have 
the efTeot of quendiing thir»t in the same manner iw drink 
taken in the ordinary way. This conjecture ia now ascer- 
tained to be a fact. By injecting water, milk, whey, and 
other fluids into the veins, Uaron Uupuytren has freipiently 
appeased the thirst of animals subjected to experiment, and 
long exposed to a burning sun. By varying such esperi- 
fficuts with liquids, known to be agreeable or disagreeable 



Okm. IV. 



CtUM 

of ihinl. 



ihcfaiMK 



Diminudon 
of rli« 

E«ii of iho 



Duniijr- 
iraH w(- 

pcnmniit. 




136 



a». IV 



CI,. I.] 



4^a<l,IAC^. 



[out*. I. 



Oi iU'> tx. 



to ilogo, lie found, that the aoimalB derirvtl fmm tli 
liquids, 80 employed, the aame senaation of taAt« m if tli«y. 
had beeo given by the mouth. In liict, when milk was 
thrown into the jugular vein, the dogm made a lapping^ 
motion with ibdr tongu«8, just as if tlivy woro takiug the 
milk up with them. 

Soma onalogoiu exp^rimenta were made by PrufisMor 
Orfila. In hia vuluul>lc rfe«arcbeB oq Toxicology, ho hud 
frequent occintiou to tic iJic owK^baguH in doga, in order to 
hinder the cxpulition of tiie poisons which Uiey bad 
ftwollowed. For the purpoM of appeasing their tbirat, 
excited by the fever resulting from tliu oxteufrivc wound in 
their necks, he injected water into ihvir ju^ilar vciaa. 
This method of quenching thirst, the only one pruclicublo 
while the oesophagus was tied, wrk practiftod in n great 
number of instances, and alwayn tiiic<r<^'<k-<l in giving im- 
mediale relief. Professor Orfila aluio nubmitu-d lite blood 
of animals, which bad been long in a thirsting Mate, to 
distillation, and found that the diminution of ita aquoous 
part was always in pioportion to the length of tlieir ubtr- 
tinence from drink * . The principal fact, interfering with 
the foregoing theory, is that of the froquontly sudden pro> 
duction of tliiral, without any previous abstinence from 
drink. Mutlicient to justify die suspicion of the watery p«rt 
of the blood having been in any way particularly leooned- 
Biit, as a well*informed writer reniarka, although much 
olwcurity prevails, concerning tlie efhcicnt cautc of hunger 
and thint, their final cause is sufficiently obvious; th«y 
ant the means, by which we are warned of the m^ceasily of 
Kupplyini; the nystcm with nialenals rcquiHitc for its sx* 
ixtence. They belong to that class of actions which art 
temiml npjietile*: where an efTect, which is u cvuq>uund of 
» piiyKiciit nml a mental o|)enttion, in connected with an 
evident useful purpose in the animal ecoDOmyt'.] 

The common modes of quenching thew ij^iiKiug seit- 
sations nnr well known to be eating and drinking: yvt, 
wh«n these cannot be indulged in, other niodn may uuwcf 
as n itnb«titute. Thus, violent pressure against tli« coata of 
tlie stomach, whether extvmully or inlemally, is well knowu 



• Hn IHcl. lU* SiknM* HU. Mm. \Lf.m 



i 



Ct. 1.] 



DICBSTITK FUNCTION. 



[ORD. I. 



137 



Out. IV. 



to take olTlho gnswing sensation of hunger; and stitnu- 
letting the faucL-*. tn takcofl'lho burning fainUicss ofthiret. 
It M on lUi» lust account that chewing a mouthful of hay, 
alone, or merely moiatened with water, proves so fcfreshing 
to a tired horee, and is found so aervicaabie when wo dare 
not allow him. in the midst of a long stage, to slake lita 
thinit in the natural way. 8aragcs and savage beaitta aru 
equally sensible of the bcnvltt of pressure in the caae of 
hunger, and resort to it upon nil occuk ions where they have 
no ofiportunity of takin<T ofi' the pain in the usual way. 
The manis, or pnn<^olin, that Rwall»w!i it« food whole, will Pnuui* 
swallow stoaea, or coals, or any other Kubstanci^, if it can- J^Sj^J^ 
not obtain nutriment; not that its inntiuct deceives it, but bungn by 
for the purpose of acquiring such a pressure a» way blunt ^)^^ 
the sense of hunger which it finds intolerable. Almost all 
carnivorous beasts pursue the same method ; and a mixed 
mass of pieces of coal, stone, slate, and c<irlh, or other hard 
materials, is often met with in Uie ntomnch of o:<trichos, 
casaowaries, and even toads. 'I'he Kamscadale obtaimt tlie The umc 
aaue end Ity swallowing saw-dwt; and noine of the^)''^'"- 
nortbern Asiatic tribeH, by a board placed on the region of 
the Btomach, and rudely laced behind with cords, diftim 
tighter and tighter according to the urgency of the un- 
easiness. In our own country-, wc often have recourse to 
a similar expedient, and only exchange the tightened 
stomach-board for a tightened handkerchief. 

It is possible, therefore, temporarily to overcome these OvcKome 
natural sensations without the nutumi means: and the^^^^m^ 
passions of the mind have as Ktrong nn influence on both 
ai any of the substitutes just adverted to. Thus both are 
completely ioMt beneuth tlie sudden communication of news 
that overwhelm utt with grief or disappointment. So 
Van Helmont tell-s us that, happening to dislocate his 
ankle while walking with a good appetite to dine with a 
friend, his uppetite immediately forsook him, but roturned 
as aoon as the joint was replaced, though the pain con- 
tinued for some time with little alteration. ThcTe arc some Th'"i In- 
passions, however, as tho»c of rage and eager desire, which, nrnt pu- 
wbiJfl they repel the sense of hung«r, increase tliat of thirst. •*<«>•■ 
But they prove equally the close connexion of botli feelings 
with tJic state of the nervous system gcutridly; and the 




138 



CL. 1.3 



CtSLtACA. 



[ORD. 1. 



Okm. IV. strong and extcHMvo influence which ii syiupiithcUcBlly 

exercised over them. 
Uortsa Morbid TIMH8T, as a genua, is new to the ticieDce of 

liMiiil I r ' Noeology; «nd hence the two species which belong to it 
hure hitherto, in almost every instance, been separated 
from each other, and thrown loosely into remote parln of 
the clasiifioition. Dr. Young, however, offers an exception 
to this remark : for, with bis accustomc-d accuracy, he hac 
united them under a common head. The gonuH being 
new, it has hence been necesMiry to create a new name for 
it : and that of Dipsoais, from ii-i-au, " to thirst," has ap- 
peared not only must pertinent, but most coD§onant with 
the nomenclature in common use, which has naturalised 
various terms derived from Uio same root; as adipsia, 
po)ydip«ia, phobodiptiu ; tliis last being a synonym for 
hydrophobia. 
The two species of the genus are tlie following: 



1. nlPKO»l9 AVRM8. 

2. i SXPBRS. 



lUMnnr-RATB tuirst. 

TlltKHTLKSSNBSS. 



spucni:s 1. 

DIPSOSIS AVEN8. 
IMMOJiERAT£ THIRST. 

CONSTANT DRStRB OV DRINKINO; WITH A CKNSB Of 
URTKESS IN THE MOUTH AND TIIROAT. 



On. IV. 
8nc. I. 



SiMPLK thirst is a natural; — immo<)enit4i or ituxtio* 
gunhable thirst a morbid, feelini;. Yet even the 1att«ris 
lew fre(|uenlly an idiopathic disteaae, than an individual 
gymptom of some other complaint, or some peculiar atale 
of hody. the removal of which will alone cdcct its ctin, 
[Whether, ia the strictest wniie of (he exprewiion, inuDO* 
derate thirst iH ever an original idiopathic diMiMV, uppcan 
to the editor very doubtful ; and. in tlic cases where it ha* 




Ct. I.] 



DIOESTITK tUHCTlOK. 



[OSD. I. 



UQ 



been assumed to hnvc been no, probacy, ihi* iDference 
was drawn merely from the circinii!itaiicc of no other dU- 
order in the aysteni being npparenu How ofien, however, 
U the practitioner compelled to observe only nymploms, 
ond remain ignorant of their primary cause!] 

I have at this lime under my care a young tady of about 
thirteen years of age, in other rea])ecta in good bealtli. who 
id tormented with a thirst go perpetual that no kind or 
quantity of beverage seeme to quench it for more than a 
few minutes. Hmt-ticu and pur^tives have been tried in 
vain. Squillit and other nauiieatiu^ expectorants seem to 
promise more success. It has now laittcd for several 
weeks. 

Th« most grateful pulliutive* arc tlte vegetable acids, 
and ospeciaily acescent fruiU, and a decoction of aorrel- 
iMves (rumex acetma, Lin.) slightly inspissated with gum- 
'■nbic or some other mucilage, and sweetened to meet the 
palate. Liquorice, which, among the Greeks, had so high 
n reputation for quenching tliirst aa to be honoured with 
the name of i.hi'i«*, " the thirst extinguisher," has little or 
no effect. And it is most probably true, as suggested by 
Dr. Cullen, that it only act* in tljia manner when the root 
ia well chewed, by which means the salivary excretories 
become stimulated to an increased secretion ofBuid. 

lo « foreign medical miscellany we have reported to Ui 
a ease of the same kind, brought on by drinking a cold 
berenge during the paroxysm of a fever, that continued 
for more tlian a twelvemonth *. And in another foreign 
journal, we bare an account of this disease as epidemic 
among children t- 

The quantity actually drunk is sontctimes enonnous. 
Four hundred pints of wine and water have, in some cases, 
been swallowed daily. 

As a symptom, excesstve thirst is chiefly found in the 
hot fit of fevers, in dropsy, dysentery, diabetes, dianho^, 
and other discharges. It is also frequently excited in 
wet-nurses, as soon as the chUd takes hold of the nipple ; 
but perhaps is felt most intolerably under the torture 
inflicted to compel a confession of guilt; in which case it 



Okx. IV. 
tirtc. I. 



Striking 
immiicc «f 
iiliopathis 
lUpMai*. 



(Juanllir 
iltunk 

cnannouv 

(ifiiiploni- 
■tic iblnt. 



* Ilmnniun. DnncTkun^ii, i. {■. 20. 
t UkMtiu lie &I1M, 1777, p. 'Ji. 



1 



140 



CL. ij ? 



r COILIACA. 



[oKU. Ii 



Oek. IVt ft Mttd to form Uio worst part of the suffering. The agon) 
DIsMwk ^^ violent thirHt, brought on by bodily suffcrtDg, is we 
depicted in the description of the Aitul Kcoe in tht 
jnentomble Black. Uolo of Calcutta*. 



SPECIES 11. 
DIPftOaiS EXPERa 
THIRSTL £5A\£iS. 

CONSTANT WANT OV TIMHST. 



OKK. IV. 
Hrte. II. 



0(aw«nl. 
<lriak. 



ThlnllcM- 
iKHlnMhcT 



CoNsiDBRiKc thnt thirst iR a natural feoUng, and con-i 
t«m|tlatiii!r the voliciiicnc*) of thia feeling when cxtreitu;, | 
it in not a little cxtroordinnr^', that inntaiices of ita total | 
ubseuct.- should ever occur. Vet there are many animals, 
and wann-blooded nninialii too, that never require drink, 
and cotwiyitiently never tltimt ; as mice, quuib, parrola. 
Mere, however, the want of thirst, or deaire to drinlc, is n 
natural condition in (he economy of tJiesc aaiinaU. In 
niHn, nnd animalit conHtiluted hkc man, with a couKti- 
ttilioRitl pTonene4H to Ihintl, and an instinctive urgency to 
qoench it by drinking, this want of dcairc con never take 
place without disease. [Whctlior this, however, aliookl 
be referred to diHeasc, or a nnturul idiosyncrusy, inay be 
<]uesl ion able. Wjijle imniodemte thirst, unattended with 
any other raanifevt disortlcr of the constitution, haa been 
wt down by ooaologists as an oftKinal idiopathic diMMM; 
thirHtlc«t>ness, we perceive, is not viewed in (his light, but 
regaixled liere us an effect of disease. In oppoeitiuii lo 
this conclusion, it should bo recollected that some iudi- 
^duaU have lived, seemingly in good health, uithoul 
drinkinn. M. Bouffard records one instanoe, in whieh a 
young ladv, twenty-two yeara of age, passed whole 
months wtUiout drink, yet appeared to be well in every 



• AoBiul lUgtiu, 17a*. 



1 



CL. I.] DIGESTIVE FUNCTION. [OHD. I.. Ml 

other respect*. Facta of the same kind are reported by Okh.IV. 
Sir G. Bakeri".] Cases of thirstlessneBS are not by any d;!^ ' 
means frequent. Saurages mentions two instances that A*aw. 
occurred to himself. In the, one, the patient, a learned E«mpl». 
and excellent member of the Academy of Toulouse, never 
thirsted, and passed months at a time without drinking, 
even in the hotteat part of the summer : in the other, the 
patient, who was a female of a warm and imscible tern* 
perament, abstained from drinking for forty daya, not 
having the smallest degree of thirst through the whole of 
this period |. Neergaard, as quoted by Blumenbach, has 
furnished us with other examples^; and M. Foumier 
informs us, that one of his most intimate friends reached, 
not long since, the age of forty -eight, without ever having 
drankofanyfluid,orbeen thirsty; but he was aocustomed; 
to eat voraciously. It is singular, that he should -have'died. 
of liropv/ of the chest, apparently the result . of a second, 
bleeding for some accidental malady ||. 



• See Diet, da StiencM MtJ. torn. M. p. 4BS. 
t Ued. Tiww. Tol. ii p. SGfi, Ac 

X Noaol. Uetliad. iraL 1. p. 770, 4u> edit. ■,'■.:■■ 

§ BhUDcnb. FhjuoL mcl xiL K2. J. W. NeergMrd, Va^^endD 
Anaumie uod Phriiolcigic, dea Veidsuungawerkieuge, Ac, . ' 

]| Diet, dn Seicnot Midlcalea, art C*i Rakes. 



CL. I,] 



COILUCA. 



[ORD. I. 



GENUS V. 

LIMOSIS 

MORBID APPETITE. 



THE APPRTITB FOB POOD lUPAlBXD, FXCB$SIVK. OB 

DEPBAVBR. 

Oa«.v. Tirp. KCnsntton of hunger, aa obaetrcd already, b seated 
in the Btomsch ; and, like thai of tfaJr&t, is u aatu»l or 
instinctive desire. It may, howcrcr, become diseaBw), 
and loHft its natural character; and this in vmrioas ways, 
uiid acconipaaied with various seta of symptoms, each of 
which lays a foundation for a distinct species. Like the 
species of tho last gcniix, howover, they have hitherto been 
omitted in most N<»»>logics, or looeuly KC■att<!^l^d over 
ditTcrcnt parts of the cliiMification, though ihcy evidently 
belong to n common family, und should be contemplatwl 
in a concentrated view. It is for this ptirpoM they- an 
now united under the banners of a single genus, to wbidt 
1 have ventured to give the name of limosis, from >afd(, 
" hunger," being the root of various terms current in the 
medical Tocabular)-; as, bulimia, alimia.alimon, alimonia, 
aiimentnm ; though the three last have been commonly 
mis-derived by the lexicographers from alo, " to nourish j" 
unless u/o itself be from the same source. 

The species that properly appertain to it are the fol* 
lowing : 



I. LIMOSIS AVBNS. 
3. 

3. 

4. 



VOBACITV. 
EXPEB8. tONO CASTING. 

P)CA. DBPUAVIIU API-BTITB. 

CAKDIALOtA. IIKABT-llt'KN, WATKR-DKASH. 
FLATUS, PLATltLKNCY. 

RMEBIS. SICKNKSS, VOMITIKO. 

DYSPEPSIA. INDICESTIOK. 



CI. J.] 



DIIIKSTIVB FUNCTION. 



[ORD. !• 



143 



SPECIES I. 

LIMOSIS AVEN8. 

VOliACITY. 



INSATIABLE CBATINO FOR FOOD. 

Tins nflection may be produced by a aciiM of fainlness 
and inanition, without any known caiiHe of exhaustion ; 
probably in consetjuencc of some ori^iic error in tJie 
stomach ; by gluttony, or an habitual indul<;enoe in large 
and frequent meals; or by exhaustion from hart) exercise, 
long fasting, fevers, or exce)i»ivc diMrhargcbt: thus olTer- 
iog the three following varieties of this species : 



« Organica. 

Canine appetite. 
fi Uelluonum. 

Gluttony. 
7 Exhaustorum. 

Hunger of exhaustion. 



From a feeling of faintnesa 
and inanition. 

From an habitual indulgence 
in large and frequent meab. 

From exhaustion, as the con- 
sequence of hard exercise, 
fevers, or excessive di»- 
charges. 



Out. V. 
Srtc. I. 



There are many persons who from birth, or a particular , i^, Avm* 
period of Ufe, without any habit of indulgence, are capable oie»?"<»- 
of taking into the stomach an enormous quantity of food, sppeitu. 
and cannot be aatisfiod without it, from a constant sense of 
faintness and inanition ; and who by no means increawe in 
bulk in proportion to the quantity swallowed ; being often, 
on the contrary, slender and emaciated. 

It is difficult to account for this efTect in every caae;8upp««4 
but, thtrc is great reason to believe, that in general il""*^ 
depends upon Koroe error in the structure or position of the 
stomach, by which means the food passes out of this organ 
as soon as it is introduced into it. [A very curious 
example of an approach of the stomach to the perpen- 
dicular direction, attended with a singular structure of that 
organ, has been lately recorded by Mr. Hart; but. unfor- 



i 



144 



ct, I.] 



taUACA- 



[OMtl. 



Okk. v. 

Srxc. I. 

• L. A*tiu 




OHtric 



nfcnibleu) 
•nodwr 



tunatdy, the pttrttcuhn of tlie appetite and digestion 

thia subject could not be a«cerlaiui.'^*.] KuyiM;Ji ((iv«a 
cai««, in which Iho diameter of the pyloruo watt coiikidt 
ably enlarged ffom rel3i:.:tion ; ami Uiece are otiien. ti 
which il has been changed from ita natural to a lowai 
dcpendi-nl poailiou, in con&cquence of the left side of Uh 
stomach being derated by a dropsy of the ovahuoi, or anl 
cnlargcnient of the liver. The osiatence of a doubtaj 
stomach, or of an immediate insertion uf the doctua com-J 
ninnia cholodochus into tjic Gtonmch, though noticed aa| 
causTO by BbeiuB and Botict, nru niort doubtfiiL In 
hunger of gcneml cxhouBlion, furmiitg our third i'sriot]j>| 
vn know it to be produced by the secretion of sui. cxtraorvlt- 
nary qunntily of gastric juice, by which the food is digested] 
almost as soon as it reaches the digestive orj^an. Tlja 
mimic feohng which is comiuonly known by the name 
Jahe appetite, was supposed by Culcn to be produced b] 
some acrimony in the stomach. Upon the thcjory of Dr.J 
Wilson Philip, it« ichI cause should be an cxccssiva] 
secretion of gastric juice itself; for it is the flow of thi«] 
material over llic iutorior of tlie tunic of tlic stomach that*] 
according to him, excites the sense of hunger|'. 1 1 should, 
however, be recollected, that, if this scosatioo b« nolj 
indulged within a few hours, and in freakstf>mHcbsmt~ ' 
b much shorter period of time, after its commeneement, it) 
suddenly dies away, and is succeeded by anurexy ; although [ 
it is reasonable to suppose, t]ial tlicre is then in the eniptxj 
stomach a much larger quantity of Uie tiecrclion. 

[Some cases of voracious appetite seem explicable, oa j 
suother principle, connected with the tlieory frei(uently 
entertained of the proximate cause of hunger, namely, thatj 
it it a s«oflatioo excited in tlie stomach by sympathy with { 
the vrants of the constitution at lorgc. For if any circum* 
stance impede the nutrition of the body, hunger still' 
remains, although the stomach be distended. Thus, in n om] 
recorded by Morton, where the thoracic duct was ruptured, 
the child died in a horrible state of marmnmuii. nolwith> 
standing it was continually taking enonnous quantitiei of J 




■ Sm l)uUln lltaplml RcpflfU, mi. It. p. 334, tU^ 



CL, I.] 



DIUKHTrvt FVKCTIOX. 



[OHD. I 




food to sippeaae the riolent cravingit of its hunger. Tlie 
exeoMm Toracitjr of peraoDs afH)ct«cl with n scirrhoiist 
pykuiH*, or wiUi diiieiisc of tho mesenteric gInncU, is well 
knovra. In a r«ry interevtiiig cnitc recorded by M. Oon- 
drw, where tlw whoJe of the Ktomuch wuk tliickened by 
iKirrhiu, aiid itii copucily so reduced, that it was scarcely 
capable of holding eight or teo oancea of fluid, the 
j>ntient suflwred much from a continual and painfid sen- 
nation of hungerf. The game fact ia also exemplifieil in 
iudiTiduals, whou) intestinal canal is preteniaturally short, 
as in the renuirkable example deitcribed hy Cubrol. And 
even in convalescents, ndly emncinted by Beverc diseuseo, 
■nd whose appetite is KomotimoH almost inoatiuble, it seems 
as if a full state of the stomach could hardly lull the 
general feeling of inanition.] 

Whatever be the cause, the r)uaiitily of foo<i, devoured by 
pereoits labouring under thia ntiection, iK enormous, and in 
■ooM imtuices almost incredible. Dr. Mortimer]: rtrlaieii 
thccaiw of a boy of only twelve years old, who, from ti feeling 
of iuunitiun, hud so strong a craving that he would gnaw 

I litH own flesh when not supplied with food ; when awake, 
he was conitantly eating : the food given him consisted of 
fai«ad, meat, beer, milk, water, butter, cheese, sugar, 
treacle, puddings, pies, fruits, broths, potatoes; and of 
these he swallowed, in six successive days, three hun- 
dred and eighty four pounds eight ounces avoirdupois; 
l»cing isixly-four pounds a day on the average. Tlie disease 
continued for a year : and in this case we hare a clear 
proof, that the feeling of hunger did not depend upon any 
cximordinary secretion of gastric juice producing n rapid 
ffigt'stion: for the food was usually rcJMlod soon after it 

\maa swallowed, but whether without passing, or after 
having passed into the duodenum, it is impossible to say. 

! And tltere are other C3.ses, related by Lonunius, of a similar 

tilund. 

In various iutances, however, the food thus voraciously 
swallowed does appear to be digested, and that ulmoet us 



OSK. V. 

8rit. I. 
a I A Avcni 



QuMtftr 
or Toed 
tirvourtd 

tnormom. 



Some, 
lima nM 
digfMnL 



I 



In ot1<(T 



* See ate by Mr. A. Buna, in Mauo't Sloibld Annt. o/ Uuniut Gullet, 
Ac. p. 334. 

t MigcnUic, Juuni. dt Pli^uut. li-tfit. lotn. i. p. SHI. 
$ Fha. Tnuu. voL lUlL f.antl. 

VOt. 1. L 




14fl 



IL. 1.] 



CfllLMCA. 



foRD. I. 



(m. V. 

SpiC. 1. 

a I* A*ni« 




■pJMIilt. 



tiMie 



«oon u token. Of this the cnseof the notorious Tanur«, m 
relatvd to the Niiiiooal Institute by M. Percy, ie a striking 
ilia eirat ion. Before his CDlistment, tie was in the habit of 
ilevourtii)^ eitormous <{Uiuilitie8 of the coantrat flenh, fniitA, 
Knd roota: and, subeequently, he was fouod, after awaU 
lowing bia own rations, to fv«d on tJie refuse of his com- 
ntdes' meases, or olileRsin: inent tlirown on the dunghills ; 
and to devour cuu, dogM, nnd serpents. M. Foumi«r tells 
us, that at neventL-cn yeiirs of age, when he wcis;hed only 
one hundred pounds, he could devour, in the space of 
tweniy-four hours, a quarter of beef aa heavy as his l«t)y ; 
iiod that, on one occasion, when in the unny, he devoured 
in a few ininutea a dinner prepared for hfbeen German 
lahoiircni, imd compo«cd of vohous sulietaiilinl disbm. 
llicro xs -.\ siitgular story, that the French commander 
•ttcniptcd to torn this wonderful voracity and extant of 
stoniDch to ft (;ood account, by employing it as a aali» 
deposit for a letter of secrecy which he wished to aead to a 
French officer, at that time in the hands of tJie enemy. U* 
sent for themnn.Hhowed htm a wood<-n case contnining the 
letter, and having put bim into good humour by truating 
him with thirty pounds of liver and lights, prevailed upon 
him to swallow it, end to depart with all speed to the 
enemy's quarters. Tamre, however, was taken prisoMT 
in the attempt; and while in prison paM<'d the hnx by 
Ktool before he oould meet with the oSoer, but iwaiediattly 
swallowed it again, to pceveat it trom (iilling into the 
onemy'a bands. He wasstrouflysospected ofcumiboliBni 
and WHS often repulsed with diflicdty Aom the ward appi» 
priated to the dead. He at length i)ed from the army in 
cnosequeoee of a mmoiir tliat he had devoniod ■ chiU 
sixtceo months old, wduch had Kudd4-uly diaappcmnd. TIm 
nlvine evacuntious of thiM man were not inmndentt-; but 
kftir^rging his stomach, ho slept and emitlc<l lotreots 
of perapiralion, a fympiom common to the diaeuM. He 
Tell ■! length into a hectic, and died of mamtntas *. 

Voracity is often a ^nptom oT mmw other alliDctioa : 
it will sometines oeeor, in the n»o*t capnciona oMoav, 
during pregnancy, often in the middle of the night, or at 




HonM otliH- unexpected period ; when tho patient, with Okv. v. 
a sudden seme of faintness and inanition, will perhaps, ^,^^^'. 
devour an inordinate quantity of almost any food that can or^uioh 
be obtained at the moment ; though, in many caseR, there 
in a fiiiiciful longing for a pnrliGular kind, as for herringfi, 
of which Tulpius gives on intttancv of a lady, who in thia 
I devoured four liundrod at a meal*. lo these inatanoM, 
it U probable, that the urgent licn'in becomes a stimuluM to 
the aeeerDenla of the stotnach, and that n (greater quantity 
■ifgutric juice i* in cooB«queac« poured ftwth. 

In like manner, voracity and the itcn«c of huo^rcr occur 
ftUo UK a nymploin in many cases of hclinintliia, or wormv 
in the stomach or duodenum. But from tJio emaciation 
which usually accompanies such pereons, it ia moat fIi^^ 
bablc, that the inanition or emptiness of the stontach is 
here produced, not by a rapid or elaborate <lige8tiou, but 
by an irrilabli: state of the muscles of the stomach, which 
contract Loo readily, and force tho food into tho inteatincB 
before chymification haa taken place. In the Phil. TranB. 
Or. Burroti^ha relaleti the case of a patient, who, from this 
cause alone, was rendered capable of devouring an ordinai^r 

; of mutton at a meal for several daya together, and fed 
lily at the Kame time on sow-thisttes and other coarae 
vegctablcit. 

The be«t means of treating idiopathic voracity, must be Tnaunnit 
aa variable as the efficients that produri; it. When we have 
reason to ascribe it to a morbid state of the stomach in 
respect to tone or secretion, purgatives, and especially 
thoae that ure warm and bitter, as aloes, may be found suc- 
fmftd. Stiinnlatiiiir ittomachics have been found equally 
w>; whence Onion very judiciously recommends rrequent 
and lunal) dows of brandy, luid Rivenus, of ambcrgria. If 
these do not succeed, the stomach should be kept for some 
days in a stale of constant nausea : and, with this view, as 
wejl as with that of destroying the morbid irritation on 
which the voracity dependx, opium will often be found a 
hif;hly salutary medicine. If the disease be produced by 
woRUH, or any other remote irritation, it can only be con> 
quered by conquering the primary affection. And if it 



' Lib.it. 



ti 



1 



Hft 



cut.]' 



'caciiArji. 



[ORn. t. 



ttrcc. I. 



alt. Arm* 

iMOMMln. 



nuuc 



■Mnlof liic 
Momwh 
oft™ hiitljy 
pmliKnl. 



depend on-« pri'tcmaturol ciilurgcniont of tlie pylorut^s 
perfect cure » beyond the reacli of art ; dwugh mum I 
beoelit mny be derived from ^Irong external pressure. 

The second variety, resulting iVoiti a gluttonous habit, ii | 
far more common, and very resdily produced ; insarDucb, 
that there is not [lerhaps a corporate town in the kLDgdom 
tliat doe« not ofler abuiid*»t exniiiplcit of it. It is, in fact, ' 
one of the numerous cviU t<:i which idlencKK is perpetually 
giving birth; for, let a man hnvc notliing to do. and b<| 
will be almost sure, whenever he lias an opportunity, to HII 
up his timo by filling up his stomach : tind hence the litzy 
Ir^in of servants that vegetate from day to day. almost | 
without locomotion, in' the TCstibtde, hall, aod other! 
avenues of a great mui's hou»e, eat three or four time* U] 
niany meals a* their master*, who nay pottihly Iiu enit-] 
|>I(^-0(1, from morning till evening, in the courts c^ law, th«J 
committee- rooms of parliament, or in a fatiguing mue < 
conttneiciul traniuictiona. 

In tracing iho cause of this *-oluntary disease, wo Iuit«] 
no difficulty whatever. When the stomach becomes accu»-J 
tomed to distention, it is never eaxy without it; nodal 
length rfxjuires to be constJUitly full to l>e free from dis.] 
quiet. It ia al»o well known, that every sense grows rooroj 
acute, the more it is employed: and hence the taste aoA' 
loiigini; of the glutton become more alive to what iij 
rvlisliing und savoury : he enjoys such indulj^noio* mora I 
than other men, and tumswith ditiguNt from foods that uT%\ 
plain and siinplt?. On this account, the dillcrcncc between i 
the rmving of u pampered appetite and (hat of real hunger 
it extreme : the former, whatever be its longing, can onlf 
aatiate itself on delicious and high-seasoned dishes ; the < 
Utter is content with a fare of any kind, and enjoys the 
plainest more than the richest. 

Uy constant distention the mpacity of the stomach nwj 
become enlarged, timl not only hoUl, but require for satioty,] 
a fur more copious ciuiintity of food than in its nohml 
state ; and hence one niuse of that enormous bulk of tin 
organ which has often been mistaken for dropsy. Boost 
gives a c:ine, in which, owing In a mistake of this kind. iJm 
pnlie'it was actually tapped, and tliecontentaof ihexluuucli 
hereby discharged, di-utli fultowing toon nflcrnunbi. Me- 
gendiu relaivs an iiiBttince that occurred to lunikclf, in 




DIOKSTIVB rVMCTION. 



[OBU. I. 



vrhicb liic paliont, then seventy^two years of age, vomited iicti.v. 
m a few piiiiiiUs, from a stomach enormously distended, ^'J^/a*™* 
tut much as filled two large paiU. lidlufnuin. 

It ia not often tliat we are acked to attempt a ciire of Mrmiof 
thin compliiint : it generally |iroc<>cils till the lone of the (^,1^"'' 
slomncli is exhaiistad by its liurd labour, and the cure is mbchioDuj 
effectctl by the introduction of dropsy, or some other ' " ' ■ 
disorder worse than itself, which utterly extinguishes all 
appetite whatever. The man, Devcrtl]<dles», who would 
huiifT^tly undertake to reclaim himself froiji this mis- 
chievotut habit, and to acciuire a butter, should proceed in 
liis career i^raduutly ; for organs that have long Iieen under 
tlic inHueuoe of pcrptrtual excitement would Iiipnc into 
ntony upon the sudden adoption of a sererc counterplau. 
Tlie food should gradually be plainer, loss in quantity, and 
rcpi'atcd at a greater distance of time ; while the intcrvala 
should be filled up with some pleasant and active pursuit 
that may wholly engross the attention ; for the auiesl way 
for such a man to produce faintness. flatulency, and mieasi- 
ueaa in his stomach, is to think about it. The bowels wtU 
at fli-si, perbapit, be costive; but tliis may eunily bo 
remedied by occasional do»cs of the warmer and bitt«r 
purgatives, as aloes, coIocynUi, and rhubnrb; which will 
u|)cmtc as usefully by their tonic as by their aperient 
qualities. 

Tbo voracity, produced by an exhausted state of the ?''■*•«» 
system, it rarely of difficult removal ; for, in general, it JJ,,,, 
requires good plain food, nnd abundance of it. It is must 
usually consequent upon rapid growtlt of the body in the 
period of youth, fcvent, exccstuve discharges, especially Ordlnwy 
from the bowels or blood-v(^8scls, long fusting, severe and '"" 
uninterrupted exercise; and particuUrly tJic uuion of the 
lasl two, as often occurs in shipwreck, or the retreat from 
an enemy. It happens not unfrvquently tliat, in such caxeit, 
tlic stomach occasionally oveiloads itself, ajid thrown back 
•oiue part of what has been swallowed, llut this is of 
little importance, and often proves serviceable, by uioru 
■ vflectiudly inculcating moderation, tlian can be accom* 
plisbed by medical jirecepu. 



I 



2 



160 



t. I.J 



CfBLIACA. 



[UK». I. 



SPECIES U. 

LIMOSIS EXFEKS. 

LONG FASTING. 



LOIS OR WANT OF APPRTITK, WITHOCT ANT UTHKR 
APPAURNT APFKCTION OP THR STOMACH. 

«■«. V. Tub eaxmea that lay a roundation Tor thix sp^^ics 
Inc. II. ntuMTOaii. ud tomo Of litem bic (ieo(>m[ianti.-d with 

itliKlit iliTChtily of nytnptoius. Tbc f<rflowini; arc the chiefl 

wivtiw it ofTciH to ua : 



a Dofniwoniin. 
Wuit of «ppotjt0 Cnmi 
oxbttutioa. 
PathMnktica. 

Wuit iif np|>ctit« from 
RK-ntMl Ginotioo. 
y Prutrnota. 
UUroiiic fiuUng. 



From too ereat fatigue i 
protvacted faating. 

From violent pwBion or 
other absofptioB of i 
nuBd. 

FitKii hubit.orothcrtjMee^*^ 
eiubling iho system to i 
awttoin almost total ftb-j 
Uineivcc for a loogaiicl 
uu)«fimte time u ithout | 
raintncM. 



■ l>.KlpM* 



W*M<f 

fnwn Ti- 
lowMluit. 



MtUNulor Mortion and luo^ faitiitg, in a vigorout eoa- 
•liluliiNi, |irn«(> ufloi, hk 1 hare just obserpcd, thv roort 
pciwt-rfiil tii<?<-i)tivi-« to hunger. But, even in the moat 
nihuiil fmm«, if Ihtiio ara carried beyond a certain limit, 
th« n|>)Htito |<alU. and ii noorand with jrreat diffienl^ti 
while, in the feiOile and daKeata, a very little exerdte, tail ( 
n >li)tht |irotraol)<>n of a meal bryond the accustomed hour, 
Hn<l m^iccially wheta the attontion is directed to it, and 
hsn^i u|>on th« dalay. is productive of the same eAck 
In nil theM' oaMw. the stomach is best re-excited to Ha 
|tm|Mr I'lwliii); by half a wine glan of sherry or 

\«illi a ftusl of broad or |ii«» of hiscait; ot. if I 

vary onat Unj^uor, by a lew drops of taodaiitiiu in a tOh 
tpooiinil or two uf atvwabc apirit of uuBoiuai while tbc 



^ 



Cl» I.] 



DIOESTIVB FUNCTION. 



[OBD. I. lul 



iiitcirvftl HhouM be fliled u[> hy what is m<ml likely to at- ^>^x> V'. 
Inicl the alt«riti(ii) ; for one of the surest rerclU-ntx in un- ' "' 
casiiie>acs of the stotuach i> a strong excitement of the 
mind. 

I have just said, iJwt a strong excitement of the mind r> !•. Etpcn 
» one of tile surest remcdieB for general oneasiQcss of the P"''^'"*' 
KtoiDQch; ami GTi>ry day shows us how powerfully this \ruiti>r*ii. 
acts in reprfwing or taking away thu painful scnHation of P'"'" ''"^' 
hiinf^r. No man. perhaps, ever had an appetite for food unn. 
under a full influence of the depressing passions, as fear or 
l^ricf: he muy eat from pereuaaiou, or a senae of duty; but 
ho catti witliout desire, or any craving sense of hunger. 
lieiicc those who are suddenly depnved of their aeosos by Caiun »f 
an overwhelming and unexpected evil, pass days and nighta '''*' "''")'■ 
without food of any kind, exclaiming perhaps in the lan- 
^tagc of King Lear — 

\Fhai ihe mind '» free. 

The li«i!y "i dcKciii: ! iho linii[init In my iniiid 
Colli fratn my ktik« ukn ktl lecUng dxt 
8m what bcali iber> 



I 



I 



I 



Even where the mind '\» simply but entirely abstracted, 
and lost in itself while pursuing an abslntse problem or 
pro|io»ilion, or adjusting a long train of intricate accounts 
in a banking-house, the individual hm no Kctmation of 
hunger; and, if left alone, may [ferlinps persevere without 
knowing how the lim« proceeds, till warned by the dark- 
nns of the evening. And hence, I.a Bruyil-rc, if I mistake Kxamplu* 
not, in one of his pictures of an abeent man, describes ^^" 1^ 
him. without any deviation from nature, as totally mis- 
taken ugion the subject of bit) dinner. Being summoned 
by his servant to the dinner-table, he answers that he will 
come immediately, but still continues in tbc same place, 
and indulges in the siimi.- reverie, for an hour; when, being 
summoned a second time, he shows himself angry at the 
interruption, and stiti more so at the servant's stoutly in- 
siatiDg upon it that he had not dined, and that the dishes 
were still ujwn the table untouched, while the master con- 
tended, on the contiary, that be had actmUly made his 
dinner, and that too in the dining-room. 

In simple coscft of Uiis kind, nicdiLme is not wanted ; nencnl 
and in the severer, it in of no use ; for it is not in the heal- '^'^' 




152 



CL. I 



-1 



CWLIACA. 



[OBO. I. 



Om. V. 

tirKc. II. 



yt^Expcn 

chimlc 



Miwu of 

for long 
ftoidg. 



ing urt, uikIct sudi circumttlances, to " mintetor to a miiul 
cli»ciuH.-d." Tliis inu«l be left U> Ume, the paUiati«'es of 
friendship, und u change of teene. 

The n>odificiitioi», liowcter, thun far contemplated, may 
be rv^nlcd nit xMte )mn»syHas, or turiite ca«e> of foating. 
I1ie oioBt singular variety of th« Bp«cic« coiuiete in what 
may be Giill«d the chronic fonn of afTcclioD. exhibited in 
th<wc who uc able to endure an unbroken abstinence from 
food , for « loi)^ niid indt^nite period of tinw, without fatut- 
ness or inconveuicrice of tuiy kind. i .•« 

The mvdtcul journals and vphemeridea of different iia* 
tions, and the tmniwctioiiK of learned itooieUes, (U>uund 
with cxamplL-K of tliin la»l and luoct cxlniortiinary tuodili- 
cation : uianv of ihcin t^^xtemling to a tcnn of tiiuc m> up- 
parently extravat^nt aa almost to repulse belief, ootwith- 
atsiitding the respectability of the aothorilics appealed to> 
It ia necessary, thcrclure, before any such histories are no- 
ticed, tliat 1 should lay down a few general principles, loo 
well established to allow of controversy, which by their 
conjoint fiirce may lead us more readily to an admission of 
such as are founded upon tmst-northy evidence. 

1. As the stomach is capable of acquiring a habit of 
gluttony, or of craving too much, so it may acquire a 
habit of fasttDg, or of craving too little: or, in oilier 
worda, wo are as capable of triumphiog over the appetite of 
hunger, as we are over any otlier appetite whatever. 

The desire for food, or the sense of hunger, is very |aiii- 
ful fur the ILr>t two or three dnyis after which it ceaiw, 
and does not return unless stimulated by fresh food. The 
Chipeywans, or native savages of Canada, according to 
Mr. Long, give striking ])roofs of the power of the atrauoob 
in both extremes—that of hard eating, and thnt of hard 
fluting — and aa ncariy as may be at the wtnie time : for 
whca uiM) of these i» on tlie |>oint of commt-ncinf; a jonr- 
iwy, he devouni bs much as he would otherwise take in a 
whole week. The daily allowance of animal foo<l alone 
bcini;, on such occasious, as Captain Franklin telia us. 
ei(;hl pounds * ; and having gorged the stomadi, he atarts 



' Jmimcjr in ibc Sbon* cf the IVtlar iJM in ttu pmn IBISJV, f, tW 
LtHid. 4ta. IS-a. 



:i. 1.} 



DIOBSTIVK rUNCTION. 



[onu. I. 163 



upon his expedition, wid comincnces a long moikh) of Oed. V. 
Lwvere abttiDtncc ^T^JL 

2. Most of tiic casus of long ftuiting, tbnt arc credibly prmncu. 
ie<l, have he«n intioduccd by a htibit of this kind, Rroughiim 
ir, indeed, have been brought on suddenly; as the re- di^^^'' 

: of Ml accidental Hhock, inducing an iustantaoeous and n"<-lr nid- 

MiDconquentbli; untipnthy ty foo<i: but by f«r the grtiutcr "''' 
tuinber are of the fonuer kind; and have had ihuir origin 
1 MTcre ahotraotionof the mind, by intfinse study, rigid 
nortiRcution of Uie natural feelings in a course of retigiuug 
liscipline, or M»n« growing obstruction, orotlier nlfection, 
in the passage from thv mouth to the stomach, or in the 
Btomach itself, producing great tineasiness in deglutition, 
Br digestion. 

3. WbcM a habit of thix kind in once established, and n Sin»ll<juui. 
life of indolence or jR'rfect quiet is ossocinlcd with it, the ^'f^^'^ 
juantity of food capable of supporting tlic aniinttl frame ^iiuuidtil. 
say be reducol to a trifle, and may pcrhnps consist of 
rater alonvi for weeks, or «ren months. We see examples 

Hf this in other animals than man. It forms a well-«sta- wnur Rxr. 
^bti&hod fuel in the history of fishes of various kinds. Even 'l'"'"^ '^™^ 

Jie pike, the most voracious, perhaps, of all fishes, when .niin-i,, 
klio has no longer an opportunity of indulging bia ghtt- 
loua propensity, will both live and thrive upon water 

it) a marble basin. The mere air of the atmosphere Air luiB. 
. to afford nourishment enough for many forma of for''m»ny 
itiiml life. SnaiU and chameleons have been often known mlnuU in 
live upon nothing else for years. Qnnnini averts it to JSSiBn. 
'kBuflicicnt f'wd for the greedy spider; and tclU us that, 
;b tile spider will ravenously devour Rie* and oUicr 
[|>rey, whenever he can seize it, he will not starve upon the 
Bp« re regimen of air alone. Latrcille confirms this asscr- 
jn by an experiment of bia own. He stuck a spider to 
piece of cork, and cut him off from all food whatever 
lor four montbit; at the end of which period he appeared 
be as lively as at firvt. Mr. Baker in like manner con* 
fined a beetle under u glass for not less than three yearn; 
allowing him nothing but air for his diet; at the expira- 
tion of tliis period he was not only alive, but fortunate 
enough to eflect his escape, and go in pursuit of a uiori; 
substantial repast. And wc are hence prepitred to receive 
with Ic&s licbitatiou than wc tihould utlieiwise do, tlio won- 




154 



CL. l.j 



CCBLUCA. 



[OBD. I. 



Srec. II. 

Pomcf 

inmtd- 
blocdcd 



dcrfiil tales of frogs, toads, lizanU, and other reptiles, 
fouod imbedded in trunks of trees, or blocks of niarbli 
6o deeply seated, thai, though <-xhil>iting life and activitj 
on cx[>cwiure to tJie iLtniosphcre, they must have bee 
blocked up in ihpir r\rsp(«(tTC cavities for fifty, and in i 
instances for a hundred years; cut oH' IVoni every kiod 
food except the moiKture by which perhaps th«y have 
tturroiiiided , and frotn all direct oooimunication with 
atmuHpherv ilfldf: tlioujjh, from expcriatenb* lately mad 
by Dr. Edwards, it is abeoluloly ncccsHiy that there 
AD indirect commanication of air throuijh the pore« 
In fiiboL MtncotJicropening ofthc surrounding BuWlaiioo*. Fishe 
when rendered torpid by being suddculy frozen, are i 
known tu live in tliis manniT tlirougti the winter in 
Polar Seas, and to be re-quickened into activity by tha i 
turning wxrmth of the summer. " Tlie fiKh,"aayR Cn| 
tain Fmnklin, describing the winter he paased at Fo 
Chipeywan, on the skirts of the Polar Sea, " froic n» 
were taken out of their notit, and in a short time lice 
a solid mass of ice ; and by a blow or two of the bate 
wore easily split open, when the intestines might b« re- 
mored in ottc lurop. If, in thiii completely frozen st 
tlicy were thawed before the fire, lliey recovered llieir ; 
mution. This waa particularly the case with the cn 
W'c have seen a carp recover »o far as to loup aboi 
with much vigour, after it had beeii frozen for thirty-a 
hours t." 

4. It may possibly be obscn-ed that these cuunpU 
drawn, for the inost part, fnm cold-blooded or 9* 
gaineoasaiumalit,nii(Hhut,in Kuch cases, there is no waste) 
living nuiUfir by the skin, the gieU rdiiclf ordiAcbargoi 
animals of a higher nitk. But they are drawn from 
mala that, in their common customs and habits, have 
fliUDe iiutinctive craving for food, and the sumo faculty 1 
converting it into their own substance, by the prooe« 
digestion, aa animals of any supenor class ; while • lil 
power of enduring long periods of i'siittng in a stata 
inactivity, without any injury to the geneval health. 



* MiinotiM aui rAiphyi.^, c«niiidcr'« Jaiu lo Bunfimt. I'arb, ISIf. 
I JouTnoy lu Uic Slwra of llu Pcdju Stm, In the jwn IOtI>>Zt:. p<. Mt^ 




UIOBSTIVE rUNCTIOM. 



[OkD. I. 



i 






I 



I) u itc ni conspicuous and inconlrovcrtiblc in many kinds P^^.'Yf 
of wnmi-blnoded animals, and especially til 0B« thitt skep ^ i^ Kipcn 
trough thr winter nenson. prowete. 

[A oombinntton of oiroumstanoes is generally esBetitial 
to the occurrence, nuch as a diminution of sensibility and 
animiil hdit, » suKjieiiaiou of many of the functioos, and 
[•■peciitlly a stoppage of the secretions and excretions. In 
in condition, individuals have been known to remain so- 
wteks, nod even whole months, without taking any 
food. Such cases arc rare in the human race; but aoimats 
prcMHt us with aonuul vxnnipleH of them. At the ap- 
proach of winter, when they are large and fat, they fall 
into u torpid fiUitc, and continue fto until the warmth of 
the spnug Tetunu), During uU this time they take no 
food, their respiration is surprisingly slow; the blood has 
rather a gentle niidutntion, than a circulation ; and the tri- 
vial losses which take place are repaired entirely by the 
(radu&l absorption of (at. Hence, ut the end of the torpid 
•eason, tlie emaciation of animals subject to its influence 
ui very considerable. The emaciation, which an accideutu) 
or u foTCfd iibstincnce of long duration brings on man, and 
tbo generality of quadrupeds, is also notorious. A hog, 
weighing about 1601b. was buried in its sty, for one hun- 
dred and sixty days, under a j^eat mass of the chalk of 
Dovcr-cliff. When dug out, il weighed oidy 40lb. No 
food nor water happened to be in the tity when the por- 
tioa of the clilf fell. The animal hn^l nibbled the wood of 
tho sty, and eaten some Ioohc chalk, which, from the up- 
peannce of the excrement, had passed moro than once 
through the body*.] 

5. We have reason, therefore, as well from analogy asApolbd 
from recorded facts, to believe it possible for man himself, JJ^^J ' 
under certain circumstances, not indeed to pans life alto- 
gether without food, but to lose all relinh for il, and to 
habituate himself to fasttingM of v«^ry ocnsidenible length, 
and only interrupted by itlcndor jiortiuns of the spsirost and 
dilutest aliment. [That liunger is a nervons sensation of 
the stomach seems probable, from its being inHucnced, like 
all llic phenomena dopcndcDt on neivoiiM action, by habit 



* I.inDBui Tiiiu. nd. U. 




<:u I.] 



CfKlAAC*. 



Qmw4Vi Hodby ment(Llciiiisc&; from ita beioi; incrcaaetJ ftn<l cxei 
rl^^pm **>" ^■'"^ whicli »ct on Uie aeosibitity of th« o<iRKn, lu b; 
[innwik spirituouH drinka aitd spices, even wh«n lh« tttonuch 
(illed; aud by iubeinfrdimintsihetl by mi.'mi« of lliocuntrftr 
kiiMJ, lu we know that opium nill act in di-nilL-iiini; 
uculo fe<'b[it^ of hunger, and lb:ii Uic TurkUh and Imdii 
fu»atic« culled MolhihM nnd pMquin are «nablvd by Uii 
meiiDs to 8Up|>ort fasts uf KKtoni^biii^ duration. The Uir 
to whicli life may b« prulaiigvd without abuent, ia Uti 
tain. Ab Dr. Percival has obwrved, k varies witb liii' 
cidental circumstanf^OH of the ca^e, and the cooKtitulioaa 
powi-n of Uie individual. It is remarkable, liowrircr, thft| 
dvprivfittOQ of food is better boriw iu some apectus of da 
MM, tliiui in robust health. In certain hysterical 
and licirrhous atftictionx of tliu cutlia and (Bsophag;i», 
(icirree of abstinence has been endured for many inonllu 
wbich, in otbvr circumstance*, could hardly liave beci 
sustained for as many weeks. In catalepsy and nttnil 
a very ri^^id abstinence may be bonie fur a con^idur 
period*.] The cases are innumerable in which fantini; I 
been endured ten, twelve, or ftfieendays; and, when; tberwl 
haa been aeoe« to water, twenty ur thirty daynf ; R4iilin-1 
meotions One of fifty-twu days, wutt.-.r alone being drunlc 
during Uie timei : and l>r. Willan attcndoi) a patieul. wl 
bad fasted sixty-ono days, with the exception of drinkiai 
from half a pint to a pint of water daily, mixed will) a vi 
aoiall quantity of oraugo-juice, two oranges hutinf 
for a week, without any employment of the pulp^. Bttlil 
there are other cases related at full lengtlt, and u)Mn aiH ] 
thority altotrelher unimjiMeballlc, of faMttit; ctintinuod fotl 
twunly-tive mou(lM||; ihrM^. t«n, flftoen, and oighlee* 
yoare; utdrwitL a very spare and only occaaioaal t«al«afj 
Hobd fuo«l, tbrou^b the oiitirv life. In the mniiitig 
tneiitary to the volume on Noiraiogy, I have given 



Supporlnl 

bDfbMlng. 




■ mn OkbUa Iluf"Wl tle^tm, i«L L |b IM. 

t no. Tlw. raL >iT. f. Vtl. lUwafeM fc Tbvbut, ■■ ITaS. 



I UMal CWiw nlwilMM. nL i. 



^ mi Turn, ijii in;- 



CU. li] 



DICFBTIVB FUHCTIOM. 



[»BD. I. 



167 



of tbeK histories nt aomo length. And thv reader may 
mtiiinr hiniHcir with them at his leiaiire*. 

In iiioAt ciwr«, otid jirobalily iu all, if they had bocn cri- 
ticully inTcstigated, water, t«a, or some otlter fluid Beoma to 
have been indiajienubly neccasary: and such was (ound 
to be the tact in the iiott-d iuKlanct; of Ann Moore of let' 
bury that hiu occurrt'd wtthinour own day. Thatahewux 
«niu]>o«tor.inpret«ndingtolivi- without anyfood whiitevcr. 
JM unquestionable; but an very spare was the qiinnlity 
she had aceuBtomed herself to, from ver>- i;rcnt dltKciilty 
And pain in deglutition, timt there i« rviison for bclievinir 
that, for uiMuy yean before nhc submitted to the teat pro- 
posed, she had swallowed very little fuud of any kind, ex- 
cept tea and spring water. And such is, in truth, tlie re- 
corded opinion of the active and very intelhgent committee, 
which undertook the trouble of watching hernight and dny 
(or u whole motith, in rotation. Abeoluiely cut otT from all 
fluids as well hs solitb, this woman was on the point of 
expiring when ithe reached the tenth day. and had scarcely 
Btreogth enough left to confess ihc fmud she had been iit- 
duce«l to ptiictise. Vet the committee thus close iJtcir re- 
port of her hiHlory: "On the whole, though this woman 
Jan bnso impostor with respect to her pretence of total abs- 
tittencc from all fowl whatever, liquid or solid; yet she 
«ao, perhaps, endure the pnvvtiioa of solid food longer thsn 
any other person. It is thought by tboM^ best acquainted 
with her that she eviMed on a mere trifle, and that from 
hence came the temptation to Kay that. -ihe did not take any 
thin^. If, ihfteCore, any of her friendu cowld have con- 
veyed a bottle of wati.T to her, unsevn by tJiu watch, and 
■he could have occasionally drunk out of it, little doubt is 
entertained that she would hare gone through the montli'M 
(rial with credit. The daughter says, that her mother's 
principal food is tcu, and there is reason to believe this to 

be truct-" 

It is rmnarkod by Hippotirates, that most of thooc, who 
atnctly abstain from food for seven days, die within that 



Or*. V. 

Spkc. II. 
y Ii. Kxjwm 

KIuiiIfi piwin 

iiccnury. 

woinjit) of n 



• Set 4ltn Mvin. Jc I'Aoid. da* fldcnc*^ I'an I7<I^ SuJpirt \ai dci 
Wid, ObMTT. Uar. Msni. of thii Lit, k&il Phil. Soc uf Miuichater, mL ii. 

t run tiinun of Ann Moon-, th* pNUiuM fMtng wooimi ef TMtofy. 



i 



I5H 



CL. t,] 



C CELIAC*. 



[OKD. 



thnt.V. 

irxc. U. 
yL. Eipcn 
Brolncu. 
Okm 
judpncnt 
nrcwry in 

KKV of food 

(ottve/rrerj. 



period ; arul tbtil il' they tio not, untt even begin to eat 
tlmik again, still they pehab. 

When) persons rrom famine, trnperatition, Kvere gricr" 
or any oilier cause, have peracvcre<l iti a counie of rigid 
fasting for many dayn, and the frnmc is become frightfall 
emaciated and vreaJteneid, the greatest care is neOMstry 
the ndiiiinistrution of food ; which at first should bo ligb 
iHjuid, and small in quantity; for not only the stoms 
but tlic organs of assimilatioii lose uU power by dc 
and if once renjuickened are very apt to be unduly 
cited, and indnce delirium aitd levi-r. Il was in Ihiit wi 
Dr. WiUiin lost his piitient on tlic fifleeiitti d»y alter 
return to food, tltough t]ie njgimen adopted was peculta 
promising and judicious. 



SPECIES III. 

LIM0SI8 PICA. 

DEPRjtVllD APPETITE. 

APPETITIt rntl IMPROPRH ANO INDIOBflTtBl.S SOI 

STANCES. 



In this speciPH there is no vrnnt of appetite, oftea i 



utth ihc 



•Hi 



awr. V. 

Plil^n 'deed iin inordinate cravinp; but instead of its di 
urmnpaml ifa,) pnUrnt, ns in the firat specie", to paUt^tble nod 

Rtantial food, whenever such can bo obtajned, i( nrgM hi 
in preferenc« to the nimt whinistcal and tnnulritiT« 
teriab. Tlnschitmctcr fonus the »{)ecific definition. 
specHic name here givun is pica. >Iot that the term 
any particular or very obvious merit ; for, its orifrin 
prininr)- meaning are doubtful: but th»t. out of many 
with which nosology has been encumbered to vXprOM 
dinease, pica appears to be the most general, and there 
no sufficient reuson for changing it. 

Now. an appetite for improper and iud^catiblo sab- 
stances maybe of two descriptions. It may proceed rrooi 
u want of taste or discrimination, as in infants or idiots: 




UruBSTIVB rUNCTION. 



[URU, I. 



169 



mfiOMicnmiptUutcorcomipl indiiU^ace.ofUtn founded uek.V. 
(on rmpirifal or ollicr <]iii)':^-rou8 advice, ag iho vnting of '**^' 
Lclialk or scids to produce a fair skiD} a»d wc bare hence 
le two foUovring vftriettex: 
a InsuUa. From wwit of correct taste or 

I'nwitting ptOK, dtRcriniinaLiuii. 

$ Perversa. From n corropt Untlu or in- 

PvTvorse pica. dnlgenco. 

Tlie depraved appetite, which is sometimes manifesl in « I" Pit* 
linfants, ciui only procoird from want of proper manage* "'" 
Jment and direction : for nothing is more tractable than the 

hrgan of taste in eariy life. And lience, indeed, it is that Pmlucnl 
[the different nations of Uic wmM arc brought by habit. P^^' ''* 
land habit almost coeval witit their birth, to prefer such 
flciods of food as their respective climates proclnee in 
jcnatent abundance, or ax they obtain by an eaay barter of 
ligenouH substances. Thus, t)kC Hindoos live cntiiely 
I on fruilii and grain ; the Tonguses, on berried, the refuM 
I lichen fouud undigested in the stomach of the rein-ileer. 
I dried iiihv*, and l>eafctB of prey; the Califoniinns, on 
■nakcs, mtH, lixarda, rabbits, intermixed with the wild * 
berbe of the soil. But pcrlinptt there is no stronger proof 
of the force of habit in forming an acquired taste to be 
met with in any part of the world, than in our own coun- 
try; in our exchanging the natur^ and instinctive desire 
ofa bland and sweet Huid, as milk, for the bitter beverage 
of tea for brenkfnst, ami beer for dinner. 

On ih'is account it ii<nott» be wondered at that children, 
irithout a guidance, or with an improper one. should often 
acquire depraved or vicious taxtcs, and be longing for sub- 
ftlancea that are innutritivcor even hurtful to the general 
health. Whens this propensity has obtained a footing, it 
I may In successfully opposed by discipline, and overpowered 
I by a eovnter-hnMt. Among idiou it im incorrigible. 

A longing for improper and indigestible substances, g i.. Via 
however, is often produced by other means, and occurs in F"™*" 
[^yersons who are possessed of a sound judgment. It is 
frequently (o be traced as a symptom of some otlier dis- 
ease, lu pregnancy, chlorusi*, and perhaps some species of t;a„^;n^ 
ital emotion : iu all which cases, it is only to be cured produotdbjr 
l)y curing the primary disorder. But it. oometimm exists m„biii rx. 
an a iiriinary malady, and is then most coinmooly brought <''<™"i- 




IGO 



CL. I.] 



CtELIACA. 



[ORW. 



h 



OfUBbf 



SutnuKn 



tixm. V. on by a rain desire of improving the beantyof the 
fi i^itM ' ^^ giv''^ c graceful slendemeon to the fonn, or 
guishinglmimessio the akin, thn»i);h the mediamoft 
acids, or other ttiipirical inateriiila. la cMiMqueiMS 
which, the Greek physician*, in wboM day the 
seemn to bnvc beeo more common than ovon in oar ov 
and this, loo, nmonf; yoitng nu-n tw vrell »n yonng wc 
gave to this variety of the disease the naioa of 
softuat or efeminacy. 

Whatever the cause, whea this morbid propensity hi 
(Icvoundof once obtaini-d n triumph over the nutural taste, the sot 

^di^'uJnic stances for which it excites a desire are often not only i 
■lualitj. iho Rwat indigCBtible but diiiguBtin)E quality. We ha« 
hud examples of an inchnation for devouring dirt, cinder 
^t^ ordure, fir*?, rt|ii(lt;ra, lice, toads, Herpents, leeches, bib> 
^^F wood, Hquills, hair, cnndlea, and more bterature, in 
^^^ form of paper and printed books, than is devoured by 
L tirsl Hcholnn in Chrixtrndom. 

I Borelli giveM um tiumerouii exampleH of most of the 

' and Home of them of a very extravagant kiitd * : and the 

who are deeirouM of jrratifying thendtelveii ftttll forUwt 
may have full indul^occ by cotiKiiliiii<f the Kphc 
Dbt-caim of Nature Curiosities. Mr. John Hunter deacribaa 
offc Woi longing for dirt, in the form of clay or loam, to have 

an endemic disease among the blacks in Jamaica^. Bl 
Sini^utir '>e is surpassed by Ur. l>arwin. who tells us that bo 
pM n-iucd suw a young lady, about ten years of age, that had fil 

1'^ ' her stomach with earth out of a tlower-pot, and 

vomited it up with small atones, bits of wood, and 
of inHccts anioitgitt it{. 
Shadtf 'n»cre are other persons who have had a taste for bar 

nw*pl«a rffubsianccs, and have glutted themselves with etoiMif 
^1',;^"^ KluMJI. ami cvL-n leaden hulleU'f. Others, again, bm 
tiihiiviRt feasted on pieces of money, vrhidi have •ometintca Ibnatd 
a very expensive repast; for Borelli gives ds an instajwc 
of a pantophagtst who smdlowed a liundrvd louisKl'on 



• Caa. L ob*. S4. Ut U. 37 i ir. 3a. 

t <>b4. on lh< Wmnfm at lb* Aniijr in Jamaica. 

tz«DnHii.<:i. m. 1. 3- la. 

t A<u IlnAi. ml. T. tl Cammriiu, M«nMnb. i 

q tlan«(, Htdic StpMnuion. Ub. t. p. AI9. ItinnlsfM, ebt. ctnl. IL 




■Lrrouiinl. 





CL. ij 



VICKSTIVB PUMCTION. 



£oBD. I. 



161 



tV'.SMBlf'- V^< perhaps, aftei all, lh« most nULnrtKoas, 

(inly one nt' tiie mriHt common cxlnbitions of 

BMd>ta£te, in un a)f|MiUti^ lur kiiiviM. 'i'favrc is not a 

^couQlxy itt £tuo|ie bui biu furniBhcd vxum(>lG» of this ia 
both sextui: aud K«uco the uiedicul journiiln und miscellK- 
nies uientmiuiouA iu tli«ir tlvM:n)>tiviis ol' Loodon knife- 

ieat«n,tf fiu^aii kuJt'«-<:atiirvl: ; liolivouui ktiifixiatcTa^; 

|<^'4UIP>4ijOiUtu«f iiurope, Bmziliaa knirtt-c<itorg|i. The 
(MtticiiU have sotnctimi-M pcnshvd »l>gitty alter 
tlie vKUuurdiiiitrir font; and fiomcttoicH dra^pied on a mi- 

. MuuUu I'UAtcon; iVjt » few yuan;, bclare they fell victiiuK 

Ifto^UHrtDikduuiSor uialady. ia&ftiw instancee. they have 

)T«!cavareil. 

. kuAa extniofduiaTy iRBtaiice oftliie kind, that not long 

Ittinoe DODuned in oui own oounlty, the knire-fancier. Cum- 
ip lytiOltaat and by craft a sailor, lived tL-n yiars aller 
i||M {fPtiWVRUtcnt, and occusioDally persevered lu ihe same 

\ trick during the whole of this time. The ruwh act i« some- 

; timafr overoomc, and the tnaterialii diiichar^^Kl picce-iucal ; 

f audit ought have been bo iu thiii man. but for the fool- 
hardincss that oDido him insensible to the earlier waniitigs 
given him, and urgc-d hiiu to a repetition of the oll'ence ^. 
£v,eD the Aaierican States soem of late to have fiimtiihed 
tis with a siniUac example, in a young man who had long, 
tve arc told, been in the habit of ^Hallowing various indi- 
gesttbie subatanoea, oa biittooR, muakct-bullote, and bil- 
liard'bolU ; and bein<; thuH initiated in the art, on Junt.- 22, 
1K22, KwalloMed not lean than fourteen knives within the 
counc of tliv day. Repentance canio too Int«. lie etuik 
gnuluidly beneath hie exploit, and died on the ensuing 
26th of AuKust. Two of tile knives had been diM:liarged 
fnttu the bcMly, one wao found in the txsophagun, and the 
reiU. in tlte atuniitch. The sunKi individual ia taid. on one 
ocflwuon. to have BWuUowcd u gold watch, willt it« chain 
Bjul Wftl, and to have evacuated tliem on the ninlli day, 
dtrkfUMd in colour, but not otheru'tsc mjua-d *'. 



»vKe. 111. 



Cu<ninlii|[t, 
tbr knifi!- 



knife-aval- 



• Coil. U. Olw. ». t A<(. Itirfn. *. 107. 

t Dolavt, Enqrd. Chir. p. C7V. 

} rndUiu, BmUIc Chjui. praf. p. 1 19. || Itinnlngtr, Cent. v. Oh. *. 
4 Manvi, Tmik. o( (hi' Alediral >ni] <'1iii. .snricty, riri. lii p. 03 
•• NVw York Mdirsl liq<«utory, Oct. Illla. 
VOL. I. H 



169 



CL. 1.] 



CiSUttCA. 



[ORD. 



{in. V. 
Skc.III. 

fiUFita 



cAMi whin 
linlMd vilh 
pica ■mil. 



HdUcal 



>iece m 
rood, 0^^ 



If tbis variety should hapiwii to bo united, u it 
timeii in. with pita avetts. or voracity, there may be no boor 
to Uic flcgltititioi). cither in quantity or (]iiality. M. Four 
nier, id his Cain Rare*, has (riven uk »n iiMlancc of thi 
kind, flo extraordinary, that if it had not b«en mo«t onei 
ceptionaUy atteiiited, it would not have biM-n credible. 
galley-ahivD. he tells us, of this dcaeriptioii, and who 
disordered in his intellects, fell at len^h a awvifice to a 
colic, accompnnic<l with n cotigh ; and. on opcoin); him. 
t)ic Ktoiniich wna found to occupy the IclV hv-pochondriuu, 
the himbar and iliac regions of the same side, and to 
stretch down into the pelvis. It was of a long, square 
form, and contained the following subatancee: a piece of 
stave, mnrieen inches long, and half an inch in diai 
a piece of a broom-stick, six inches long, and half an 
in diameter; another piece of the same, eight inchea 
dillo, Hix inches '<"<g; tweiUy-tuo other pieces of wood, ' 
threv, four, and five inches in length; a wooden cpooo. 
Arc inches long; the pifx.* of nn iron funnel, three \acht 
long, and one in diameter; another piece of funnel, 
inches and a half long; a pewter spoon entire, Mytn inche 
lon^; another, three inches long; another, two inches 
a half long; a square piece of iron, weighing nearly li 
otinceH; various other article*, among which were ni 
bucklnt, honis, knives. Sec; the whole weighing 
twenty-four ounces avoirdupms*. So that the at 
of this u[Uia])py being beoame gradually enlarged iai 
a wikrehouse for all M>rtJt of marine stores, as tJie term 
applie<l in the present day. 

This tnoibid action \% best oppo«cd by giving a countM^^ 
action to the organ in which it cxiste. And hence enictMl 
and purgatives are highly useful. RhuKirh \% |>erha|i* 
the best medicine for the latter purpose j and in mode- 
rate doses it should he continued daily; and in combina- 
tion with it, hark, steel, and other tonics. An neid hti 
oAon been suspected ns the cause of the disease, and the 
absorbent earths, as chalk, magneaia, and Armenian bole, 
have been tried in hirge quantities; but the relief tbey 
affon) is seldom more than temjmrary. In the Dial d'oMo* 



• DM. 4m SctnMt HUkdM, sn. Ca*. Kaiu 




CL. I.] 



DiOKSTIVK FtlNCTION. 



[onn. I. 



16.1 



niae, orcachtxi* AfnMtta, as it has been called, which is Orw. v. 
thediseiLKC of fiirt-ealing among the negroes referred t«sLl'pi«' 
by Mr, J. Hunter, pcrhiips great ncidity may exist, and pcfwn. 
insbnctively call for the drier earthit, an absorbents. 



ii^ SPECIES IV. 

LIMOSIS CARDIALGIA. 
CARDIALGY, 

IMPAIRED APPETITE, WITH A ONAWINO OR BDRNING 
PAI.N IX TlIK STOMACH OR EPIOASTRIVM, AND A 
TENOESCT TO FAtMT. 

The symptoms, laid down in this definition, arc euffi- "oifdutin. 
cieotly marked to separate cardinlgy from dyspepsy, inft^mdy*. 
L which it ia merged hy Dr. Cullen and various other l-n"!- 
[vrriterH: for in the last there is not necessarily a gnawing 
■ burning pain; and the appetite is ruthcr fustidioitii, Uian 
atially, or at all times impaired. Curdialgia is cer- 
ftahily sometimes fomid as a symptom in dyspppin, a« it 
f Is also in a mnltitude of other complaints; as flaluK-ncy, 
scirrhus, or inflammation of the stomach, worms, relrocc- 
[ dent gout, suppressed menstruation, and various diseases 
'of the heart, liver, pancreas, kidneys, and intestines; in 
hypochondrias, and in sudden aiid violent emotions of the 
mind: but it is likewise found, in m.tny instances, as an 
idiopttbic affection, and should therefore be described as 
■neb. 

Cardialf^ia admits of the three following varieties : 
a Mofdens. 
Heart-bum. 



fi Syncoptica. 

Sinking heart-bum. 



Gnawing or burning tinttinincss, 
felt chiefly at the cardiu, tJi« 
tendency to faint Iwing sliglit. 

The pain or utieaitinciut extend- 
ing to tlic pit of the stomach ; 
with anxiety, nausea, coldness 
of the extremities, failure of 
strength, and great tendency 
to faint. 

h2 



1G4 t-1.. l.J CO'LIACA, [ORD. I. 

Orti. V. ■/ Sputatoria. Burning pain extending over the 

Uw^^ ' Black-water. epigastrium ; and accompa- 

CaiduigiB. AVatcr-brasli. nied with an eructation of 

watery fluid, usually insipid, 
sometimes acrid. 
■ i,.r>tdi. The first variety is perhnps the most common form of 
1^ mor- (^jjp disease. And as the gnawing or burning pain is in 
this cnse felt chiedy at the cardia, or upper orifice of the 
stomach, the specific name of cardialgia is derived from 
this symptom. The cardia is indeed generally &u]>posed 
to be the immediate seat of aflection : but this is an erro- 
neous view. It is from the greater sensibility of tbe 
upper orifice of the stomach than any other part of it, that 
wc are most sensible of uneasiness in that region : but ir- 
ritability of the whole, or of any other part of the organ, 
and perhaps of the adjoining organs, as the pancreas, 
sjileen, and liver, will often produce the same local {ais; 
and in some instances it has been a^icerlained after death 
to have been uccastoned by a sctrrJious, or some other, otn 
struction of the pj-lorus. 
f uranlE- In the second variety, we find the pain or uneasinen 
^JJ5^' somewhat less intense, but far more general ; reaching, in- 
deed, over the whole range of the stomach and epigastrimn, 
accompanied with nausea and anxiety; and, by sympathy 
tirally alTecting the geueml system, attended with coIdneM 
of the extremities, failure of strength, shortness of breath, 
and great tendency to faint, which continues till the syateoi 
re-acquires warmth and perspiration. 

From the wider ctrcunilVTCnce of tbe atfection, Hip- 
pocrates denominated it periodynia stomachi. It is diatin- 
^uisht'd ill populuT language by the name of siiiktMg heart- 
fmiii. 
, I.r4niu The third viiripty is disiin^ruishcil by a morbid increue 
aldu>.]>uia- j„ the quantilv ot'ihe iltiids scci-rned; and beuce the pe- 
(iiliar syniptoiu of an enKlation. friH|uent]y in consider- 
able abundance, of a thin watiiy liipior; cbietly in the 
tiioniih^^ aftiT ttMHl b.is been abstained from for many 
hours, atiil till' siuiiKii'h has iK>thin;i in its cavity but iu 
i:\r.lK'>i Kwti Miixl^i. Dr. Ciilli'ii has ^iilinir.ilily described the di»- 
hTi'ulii'u,' ''■"'''■ ''"'"■-•' I"' ''■■'' *!n->iil.'i-1y s.'iMiLitiHl it to a great di- 
sIluiii' iVmii iU>-;ir|il!i,' iilii'ctii'ii^. n.utstt'rred it to another 
ordrr, and clvclctl >l. a]'|>.irciil)y contrary' to his own mode 



CI.. 1.] 



DICBSTtTE FUNCTION. 



[OID. I. 



165 



or reasoning, into a dUttnct genus. " It appears most Osm. v. 
commonly," says he, " in persona under middle age. but ^'j^ cJrti- 
seldoDQ in any pereons before tlio age of puberty. When algujimui. 
it has once taken place, it ia ready lo recur occasion- '"'*■ 
allyforalong time after; but it seldom appears in per- 
sons considerably advanced in lifo. It afTccta both kcxi-s, 
but more fretjiicntly the female. The fits of this disease 
uaunlly come on in the morning and forenoon, when the 
Stomach is empty. The dr^t symptom is a pain at the pit 
of Uic stomach, with a sense of constriction, as if the sto- 
mach were drawn towards Uic back : the pain is increased 
by raising tJiu body into an cn-et posture, nud therefore 
the body is bended forward. This pain is olUn severe; 
and, after continuing for some time, brings on an eructa- 
tion of a thin watery fluid in considerable quantity. This 
fluid ha.s sometimes an aeid taste, but is very otXcn absu- 
liitvty in;«tpid. The eructation is for some time frequently 
Tcpcntcd ; and dotfs not immediately ^ve relief to the pain 
which prea-ded it, but doeif so at length, and puts an end 
to the fit*.*' To this de»criplion it may bi; added, that, 
when the watery discharge is altogether insipid, there is 
merely an increased secretion of the tluids poured into the 
Btomach, apparently in a thinner or more dilute condition ; 
and that, when this discbarge is of an acrid taste, the 
gastric or other juices, which exist umply and uitliout 
fooi or other intermixture in the stomach at the lime, 
i^Omess an acidity in themselves; a fact which closely con- 
nects pyrosis with cartliulgia as a species, and rendily re* 
duces it to the rank of a variety under iu banner. In tlie 
colloquial tongue of England, it is cnlled bhrk-water ; in 
that of Scotland, water-brash, and waier'tftiatm. It in the 
pyroKis of Sauvages and many other writers. 

Most of these varieties have sometimes returned period!- "iwisl 
tally t, especially in the spriug|: and as their general ',"151^ 
causes and mode of treatment do not essentially differ, itrarinic 
Ss more convenient to consider them jointly than imdor de- 
tnched heads. Dr. Perceval, of Dublin, in the miinuscript 
cotunicnt with which he has obUged me on the Nosology, 



* Tint I.inm. ml. i*. p. 13. 

t BHthoIui. Ilbi. Anu. Cent, iii llisl. M. ZuxUo*, CmiXl. N. SI. 08. 

X Eph- Nu. Cut. pnujnb 



im 



CL. I.] 



COCLIACA. 



[ORD. 



thtx.V. 
flru. IV. 
UdiwU 



Ofwnl 

CBUIO. 



Gnml 



Wdllhc 
TarUllcs. 



uuie 

3 



ingeniously inqnirefl, " Doc6 it crcr arise from an AtTcctiooi 
of the pcncreiui?" I think it likely that it docs, from coo- 
teoiplntiiig the structure and o(fic« of (his organ ; and 
)nv« vftrious cases in Mhich. alUr death, tbe pancrcu fa: 
tM!«n found considerably enlarged. 

The remote caust-s then of tJie present species, uod 
whatever variety it shows itself, which b chieily regula 
by the habit or idion'ncrasy of tbe individuul, ure loi 
gestible food or otber ingesta; and habitual and copious 
use of very cold or very bot beverages, but especially llie 
latter; indulgence in spirituous potations; worms, hydatids, 
and insects, or ttioir larvtr; drastic purges; ob^tnicted 
perspiration; rc]x>lted cutaneous eruplioiw; nnd bile do- 
pmved, or oxeossivc iti itA secretion. Of the indigestible 
foode, tlio most common are animal fat, oil, butter, or cb 
eaten in excess; which last has produced a canlial| 
that continued for three years*. The stones or kemelt 
fruits have often laid a foundation for the complaint, es 
eially where they have reroaincd, ns they hare occasionalljr 
been found to do, and particularly cbcrr)--stonea, for two, 
or even for three yean>, «ilh little or no chani^ what- 
everf. It occurs also, aa already observed, not unfro- 
<]uenlty as a sequel or sym|itom of some otlier aliectioos. 

All these causes have a direct tendency to produce inH 
bccility of the stomach, especially a loss of tone, or weaker 
action in its muscular fibres; and a morbid condition 
the duids secreted by, or poured into it. 

Acidity secms to be common to all its vnrictiM; 
ibis lo such a degree that, as Dr. Darwin observe^ 
contents of the stomach, when regttrf^lated on a mafUo 
hearth, have often been scon to produce an eflttrvesceset 
on it 

I'he acid, according to the experiments of M. Perperes, 
is chiefly tlte acetous, and be bftH found that not less than 
two ounces and six drachms of it have been producod by 
ei|;ht oimcea of roasted cbealnuts. an uhmcnt that fermaoti 
io tlic Htomach Ibr an hour and a half; wid is avea tlm 




* Piullni, t>t Nuce KEoMhau, mm. UL p. S. £(«. Nm. Ok the. a. 
Am.v.t.pp.11. 

t BmO. 8mU^ itai. L p. 37- litooau Conmett. Utu. No*. 1J31. 






I 

I 



[OBD. I. 

In soma cases the rormation "'=''-^* 
of acetous acid 8e«in3 to be furounid by thv natuic of tht: i,^,t.i. ' 
gafllric fluid it&eir, whicli uppuure to bo socrctod in too ^^'•"'["Mi'^ 
dilute or weakly a condition for the purposes of digestion; ^'^' 
on which account, tb« food, instead of being converted 
into chyme, runit readily into a state of fcnaeatation, so 
that NOiiiv p«nto»i4 caiiiiot titkc citlicr honey or nugar with- 
out producinf; this eJlect: while, in others, the gastric juice 
itaeir, when flint secreted, may possibly contain too large 
a proportion of l1i« murinlic acid, which, acconling to 
the latv valuable rescarcht^ of Dr. Prout, is found In the 
ittonuich during digestion. 

It tH not improbable, that the third variety, tardialgia 
spulaloriu, may, in some instances, be produced by in- 
activity of the proper absorbents of the stomach. The ex- 
periments of M. Magcndio show that, in a state of health, 
sli fluids disappear from the stomach with great rapidity, 
in consequence of the urgency of their abaorption, in- 
sDmuch that n ligature on the pylorus does not in the 
least retard their vanishing. 

In applying to this disease the resources of the art of '^*'*P*''* 
hcnling, it is obvious tliat our intention should be two- i^J'tuu. 
fold: to p«Iliute the present distrcsx, and to prevent a r«- 
currcncc of the paroxysms. The first may he obtained by ^'"'i^^?'' 
Miiull doses of opium, and sometimes by other anti-spasmo- anai lni» 
dies, as tlw ethers and volatile alkali; and where acidity ia^*"- 
unquestionable, by calcareous and saponaceous earllia. 
Lime-water, or acidulous alkaline waters, or the different 
alkalies of the alkalescent earths, magnesia and lime, have 
been almost the only ones that have hitherto been employed, 
or atieast the otlient have not been submitted to a sufficient 
trial, and under »ittintcicnt variety of modifications, to enable 
us to speak of iheui with accuracy. It is a comniou belief 
that clialk. with an acid in the stomach, produces an 
ustringent, and magnesia a laxative neutral. This idea is 
doubted by Dr. Cullen : but it seems to have a foundation, 
and should regulate our practice. Chalk, however, when n«wianal 
used in large (|unntities,and long persevered in, has an in- "!|^L_, 
disputable evil, which does not equally belong to magnesia ; euiht 
und that is. its aptitude to fonn ball* or calculi hi some """"U™ 
part of the iutestinul canal; ujid thus produce a very 



■OOM I 



168 



CL. I.j 



CCKLIACA. 



[ORU. 



8l<BClV. 



WhethCT 
an add cm 
cnMiinui 
thcdND- 
lallov fluid* 



trouUcsome obalructioA, auiJ occaaionally <c6tie> ' 1 bai 
kaowa various tiMtuiCM of this; nnd, in tflmo CMW,^ 
tended with nlarmiiii; i«yni[»loms bi'forc the bulb vrero dc 
jei;!^ j many of nliich I Imvn hIho l^nown to b« evacuulc 
iu nitUMVit of niore tiian an ounc« weight euch. Thi>rv it 
DO irriduoce ttmt aa acid is found below the duodciium,^ 
and hence it is chiefly in the upper part of tlie alimentary 
cnnml that tlieee calculous concrelioiDi are unpacted aodfl 
agghilinated. Dr. Parr «nd ftome otlicnt a»cert, that va™ 
acid rnrniod in the stomach certainly never mten* the cir- 
culating tln'u]. It is indeed, tniu, ihnt wc h»vc no Mosibld 
trace of it in tlic counu of tlic circulation : but the boneftl, 
which baa htt«Iy ke«n disoorercd, and which we shnll have 
occasion to advert to tuore fully here^Rer, of introducing 
nka^ciiia into the fttoniach, in habits po&sc&^ing a tcndenc 
to form calculi in the kidueyfi aitd bladder from a 8U[ 
abundant secretioD of litJiic acid, seems to show that all'' 
acid pnitciple, or boac, still ])a«ses fToni the stomach into 
the circulation in cenain cased, though too uiinulely dividi-d 
U> he dcttxted by chemical testa; and that the intnMioc- 
tion of mngiiMta into the stomach dFstro)-H or neutrulixea 
itntthefountain-hi-ud. (S<.-i-KNTF.ttoMTH(.'snndL.)Tiii*.)j 
M. PcrTicnn, in taking olf acidity from the Moinnch, unite 
the calcareous eartlis with a warm bitter; and rccomniendi 
as the medicine ho haft found moM successful, coltimba 
root witlt ina^iMin, in doftesof ten grains of Uio funuori 
twelve of the latter*. 

It is observed by Dr. Darwin that, as the BaUvaswallowod 
alon<;with our food prevenU its fcnncntation, considerable 
relief is EouiL-tiiucii dcrivod from frequently cltewing piircltod 
wbvat, mnstic, or u Lock of wool, and Bwalluwing the lalit 
Urns procured. 

Olnif^nouB prcpurutions have also been had recouTW< 
and in some habits apparently with success. !n 
eases, it is most probable, that they act. firet, byconvcittB 
a part of the acid into soap ; and next, by proving niM^rieot 
and tlius accelerating tlie passage of the acid mntorml ii 
the- inicstinal cannl. The complaint may abo bo piiiliat«l 
by inncilafpnoHS subfitnnce«, such as S|qmiiOi lii^uorioc. or 



• ttftn dIaU, tcL U. 



icingH 
encyfl 

QtO 

led 

oc- 





■ cui.3 



DIGESTIVE PUNCTIOir. 



[UBD. I. 



169 



gum arable. In mftny caitea, sjipedy and efTectnal relief tB 0*y. Vj 
obuinnl by the simple and pleasant remedy of enting nix un^j-U 
or eight almonds. S*^!*^*- 

Yet n-lmre we have full proof of ncidity a« the exciting; *" '*^" 
cause, there are ffivr mt-dtcines we can more fully depend otvmp. 
upon ihan soap: probably because in its decomposition it 
lets loose the (^ea^noua principle, which may in some de- 
grm obtuiMJ the pain, and at the eametime unites its alkali 
witli the ncid of the stomach; thus neutralising iu acri- 
mony, and forming a valuable aperient. " It is often "says 
Dr.Cullcn, " a more convenient remedy than common ub- 

»torbents or simple alkalic**." If the pain be very severe, 
>rc sliiill much improve the beneficial operation of the soap 
bv combining it with opium. This I have already mi-n- 
lionnl aii a very valuable medicino in all the varieiies of 
ihe disease; but it is peculiarly so in water-brasli. or the 
third variety. The di.itinguished writer I have just quoted 
asserts, indi-ed, ihat he has found nothing but opium that 
mil give it real relief: but this, he afU'rtvurds adds, relievca 
only the present fit. and contnbutes nothing to the preven- 
tion of future attacks. 

It is hence neccHsary. in every case, to direct our view ^eonA 
to the second intention I Lave pointed out : 1 mean, that ™""" 
of prevontm^ n recurrence of the paroxysm. 

Now, this can only be done etlectuatly by restoring the 
Etomach to its proper tone: nnd hence, the entire process 
we shidl have to notice nndcr Dtspefsia, fonning the 
Mvenlh species of the present genus, nill here be found 
equally advantageous. The wanner bitters, the metallic 
oxyds, and enjwciaUy the oxyds of zinc and bixmutli, firet 
mentioned by Odier, bid fairest for success. Of the 
bitters, one of the most elegant, as well as most effectual, 
is the extract of cliamomilo. Yet the timtncaria chatnumllla , 
or dog's chamomile, seems to rival its powers; niid lius 
oAen been found avery activeand useful stomachic in most 
dcbilitict^ of the stomach. The nux vomica, long since ex- y^^^ 
tolled by LiuncuM, remains yet to be fairly experimented vomtah 
with in this country. It has the peculiar property of di- 
niinisliing the scDsibility, while it increases the irritability 



• Mat. Hcd. wl. ii. p. 4VU. 



170 



CL. I.] ■ 



CffiLIACA. 



[OVD. U 



'""'iv °^ ^° uiimul frame — n property of whi«h I stttU «( 
LiioMto * oaore at large wiiun discuseing tlic subject of pAitALvitia. 
^^•nl**'s>^ It if) said to haT« been givea in doses of ten grains thretl 
tiuioa a day. But thin I very much queation, wh<-re tltai 
drug ha» t>cen sound and genuine. In polity, 1 have D«Ter 
boftn Me to ruii^ it ubovv ftcvva gnua» without mukta^H 
the bead stupid and veiti^inous. ^^ 

• t Among the &roinatics,i)mny of the terebiathinate bnlsuns 
Miwni. will be found liitjhly uiieful. Tbe baLtani of Gilead. and 

tliat of .Mcccii, amvris GiUadtmis, and a. OpohaUamum, 
wen; onoc highly cxtollvd, ui>d pcrhu|m <l«cn*oclly ; but are 
tooduur for common use. The Turks take i-tghl or toa 
drops as a dose; hut th« quantity may be considerably 
iiicr>'3s«d. lu Honienf the pharmacopcBiaa, cubebs, as luucki^H 
chcu))cr, hav« been onlercd instead of lh« bakama. ^^ 

• 'I'ho diet ihould consist of articles least dispoMcl to dor- 
tnent; as nniuinl food gcncnilly, ehell-liKh(?«, bi«c)iilH; und 
the drink be, small bnndy and water, lua«t uud 
lime-water, or most of the mineral watcra. 



■I" 



SPECIES V. 

LIMOSIS FLATUS. 

TLATVLLiiCY. 



laiPAiBRn ArrsTiTB, with an accumulatiok ol 

W1N1» IK Tint STOMACH OH INrKSTINAL CANAL| 
AND rKBQVBNT UBOUROtTATtON. 



Qax.V. It is supposed by Mr. Hontcr, that air is occasionallj 
*"KuV. Hccicted from the moutba of the secernents into cwrtais 
■ir.vticatc cnrities in which it is fouitd : but, in the pr««e»t inatattee, 
obuiMd. ii,^,^ can bo liule or no doubt ilml it is luvroly sepanlcd 
ftt>tn the ninteriab introduced into the stomach in the fom 
of food, and (ending towards fennentation. Whoo lbs 
fluidii, whtob ora poured niitumlly into the nromacb. arc 
socrctvd in a alalo of health, they concur, and perhaps 




A 



CL. I J 



DICKKTIVC FVMCTION. 



[OBD. I. 171 



tqiully ao, in diccktng funiMiitHtioii. But wliea. fmm O'u. V. 
imbecility of Uiin or^an, or iu cuDsociate viscera, they are i,i„^ ' 
secreted in it dtluU.- or other imperfect state, they lo«fi thdr i-^<>i^ 
corrective power. ferioeutatioD rapidly comntcnces, and the " '^'^ 
I ttotuaoh is overloaded, diatended, ami Hometinm leady to 
! burst witli tlie air, for Uie moat jwrt ciirbonic acid gaa, that 
ia hereby let looiie; n-licf being only obtained by frequent 
tmciatioH, or rejection upu-ards; f rT7>i/(iJtoN, or rejeetioa 
downwardH, which the GtccIls denominated Si/iCot, w tba 
lAtina did cnpilva: or its combining looaely with «ucll 
fluids rut may exi&t in the large intvstincft, wlicr« it often 
rolls about in an ascending or descendint^ direction, nccord- 
iag to tJie action of the diaphragm itnd uliduminal muscke; 
Mmetimes iritli a rumbling sound, where the intestinal flaid 
I ia but small in quantity, and sotnetimoe, where it ia con- 
aiderable, with a giir[;ling noise hkc air rushing into a 
bottle as the water contained in it is poured outj and 
benoe by the Greeks denominated borbori/gtHus. We have, 
in consequence, the three following varieties, under which 
this species presents itself to us: 



m Borborygmus. 

Rumbling of the bowels. 
/3 Kiuciatio, 

ErucLitiun, 
y Crepitus. 

Dejection of wind. 



With frequent rumbling of 

the howek. 
With frequent rejection np- 

M-ardH. 
With frequent rejection 

downwards. 



[ 



The quantity of air separated in the manner just de-QusKi^of 
BCribcd is ttometimes prodigious, and may amount to an ^^,1^5™ 
eructation of many hogsheads in an hour. Nor need we he caonnoui. 
surprised at this; for. by the experiments of Dr. Hales, it 
appears that a single apple, during fermentation, will give 
up above six hundred times itii bulk of air: while many of 
the ve<:vlRble materiala inUoduced into the stomach po«ses« 
far moic veotoeity than apples. 

FlatuleiKy. luder one or other of the fonas now enu- mrmpunib- 
Toerated, ia often found as a symptom of other dis ea a ca ; "*• 
especially in dyspepsy, cholera, colic, hysteria, and hypcK 
choodrias. But there »» iw doubt that it occaaionally 
exists by itself, and ia strictly idiopathic, occurring after IdiupBthle. 
th« deglutition, and even ciijoynieut, of a full meal, without 



172 



CL. k] 



CtKLlACA. 



[ORD. I. 



l.iiiiiMi* 

FLUVL 
RtOCfBl 

akOmT 




a%v. V. any other e^mptom of indi^tion, and ceasing ax bood aa 
'""■ ■ thu proocM or digOKtioii is complcto<l. '" 

f Flatulpncy pr(xilucL>9t vHnoiii fi-ciintr« of flistrcss, nc- 
cording to tJi« piirt of the aiinivtiUry cunal in which llio 
wind is i^ncralc-d, or pent op, When it is copiously g«^ 
Detat«d in the stonmcb. And is not oxpclk-^t by eructation, 
it)^vm rise tu ull Mm diiUruiising coni«c(|iieiic«s atwuys re- 
sulting from gr<.>at dislciilion of (hot oi^an. In somol 
instances, eoTcro p»ia is excited by (lie simple extension of 
its fibres, or their spasmodic contractions. Id others, 
■spocially in Uystcricnl liubits, tho adjoitiini* organs 1114 
considerably aHccted by the prcssare of thu distended stCM 
tnadi; whence gr«at anxiety and oppression are felt ii 
tho cheat from tKe inipediment to the free motion of iho 
lunge and heart; llie respiration becomes laborious and 
difficult, with a sense of euBbcation, and the action of 
heart intermits, or violent |>alpitations occur. 

When tho bowels aro inHated, a aense of micasiness i 
«)q;ierienced, with a rumbling or gurgling noise. SonD»* 
tiiiws colic is an attendant oa the complaint, and flooielimfis 
ibfiwholo abdomen is enlarged by the general distentioa of 
tbe intctttines wiUi air, accompnnieii with coostipatioib 
Wliun this distention has been of some duration. D degree 
(ff paralyais of tbe muBCoJar fibres of the bowels is pro- 
ducc-d; their power of expelling the wind is lost; the akin 
9f the boUy becomes aa tight a^ Oiv inirchmonl of a dntm 
apd the patieut fall* into a state of {jreat enmciutioit. Thi 
disease is Called tympaniles.'} 

A very common cause of flatulence is drinking a Imfgo 
«Sl*ilrt»h <l'"^'^tity of some Cold fluid while the system i» Ubotuinc 
ujidcr groat heat. Another is eating raw nigelablea, 
cucumbers, radishes, sabds, &c.| or cabbages mod otfav 
Vcgclubles not duly boiled. 

,, InfauU are |>eculiarly subject to this affection, front the 
natural delicacy of the «toinach, and pAftkulariy whoa 
biDughl up witliOHt their natural sustenance, and upon fnoil 
which ru(|uirci» more labour of the stomach to digest. In 
many cusm it must necessarily be combined witli acidity ; 
for this, us alroMdy observed, is a geaetal clfect of iapaind 
action in tbe chylific tiscera : and when both thaw eamw 
concur, l)i« infant will also be tormen)c<) with ncverA 
gripings, and great iirvgularity in the bowcU; a dulrvaiing 




« 



^ 



CL. I.] 



niCK:ITIVE FUNCTION. 



[oitD. I. 173 



I end watery diarrhtca; M an obatinatc ooetivenaaB; and 

HODiotimes with both in Kuccehsion. Eosential oiU, nb- 

>sotl)eulp«\vde{ft, aiKl a))«iiuiiu may palliate UieM)-Di|]tomt. 

[but ibo buit;.cure will alwuya bu tbuDd in a bc*lthy bivast 

Fof'miU, I ■■•I 

(iypuchoadnucA. and otiicrg of wmak digMtive puwet^ 

i are very apt to acquire a habit of eructing; and sie.pciv 

petually »ttiving to throw up Ktud tVoiu ihc etoniacli iii an 

expeclatiou of relieving tliotiiitelv^ from iho ciasiic va|i(iiir 

with which they »e«in to ha buntint;. It waa iibvenreil by 

Dr. Danviii, Hint whvri poof^e voluntarily eject carbonic 

acid gas from their istomsch, tha I'cruitntiition oftheuli- 

atis accelerated; just in the sanic manner as Rtopping 

Ftho tcmoIm which contain new wines retards their feravoit- 

iation, and opening them a{;ain ({uickenB it. [I'hia ictcii, 

applied to the cum: of flm iilf nc«, may be tn!><trniou»; but. 

probably, it will never persuude a single (wticnt to rvprees 

' bis endcarouni to relieve hiDiHclf by eruclations. Tho 

[twdity also of the ill cHccIh of the practice ie donbtfal.] 

lir cardialgy attend, the air ia sonielimes eructcd with a 

} Benae of burning so violent, as to make tlie patient imagine 

'he ia actually, like a volcano, bclohing forth flames and 

fire from Im entntiU. 

There are some cas^s on record, in which persons nppefir 
to have ft power of dietcnding the stomach ami ubdomon 
to an enormous size at pleasure; and advantage has been 
taken of this by oneortwofemale impostors, who, for parti- 
cular purposes, have hereby pretended to be prc-^uant, and 
have succeeded by such an imposition. But a djatonljon 
of this kind does uoi belong to the disease before u4.' ' i 
The cure in (liis xpecieit, am in the hitt, dejMMtds upon 
^ring tone to the muscular fibres of the stoinaeh and in- 
tcstinitl cunsd; and hence the pinn Itiid donR alreiuly, and 
the course to be described under dytipcpsiu. will huvo Iho 
greatest chance of auccess. 

Emetics have occasionally been recommended, witli a 
view of giving a change to the action of tlie stomach, but 
they are of doubtful efiicacy. They have becai of great 
service, however, incidentully, by diiicharging Mine Inrktng 
body which hen ititelf been a chief cause of the disease. In 
this maimer womis have at times been thrown up; and at 



SvKc. V. 
l.>>nKi«li 
Fbliu. 
Ilnw IT' 

niodlvU. 



Smpr of 
belch i UK 
iUniDi iriih 
ihcvind. 

^'olunury 
illilrfi Hull 
VII I ployed 
HI trick. 



Plinnr 
cmc. 



Emriin, 
liow fur 
uicful. 



174 



CL. I.] 



CtSLIACA. 



[ORD. I. 



Vntifill»l« 

onciiu- 
tirco. 



Conifctout 

(amlnk- 

Clna. 



itn*. 




ttiUFs nlso moncls of indigested fruit or other materi&lii. 
plum-stotiefl, or frairinents ofa praror upple*. 

The dificasc may be palliated by an innumfmblc liost 
c»rminatirp plants, which vary in their scrcnil oft'ccl* (i(>J 
cording to the variety of the idiosyncrasy, or the nctua 
state of the stomach. Tlie verticinale order nfTorda aa*] 
nbandant stock, from which w« may select at |ileni«ure; aAj 
marjoram, thyme, nuMmnry, lavender, speur-mint, pc))|] 
mint, and penny-royal: the aroma of all which rceidt 
chie6y in the leaves or caltces. The coniferous order offer 
perhaps, nearly as many, including the terebintliinate atiJ 
jtiniper tribes; but of less activity than the precedinc 
exoept in the instance of the csitentinl oil of juniper, 
pleanntest of nil the turpL-ntine family. The medicinal 
vitlBe of lx)th tliesc orders is that of camphor, which th< 
all contain very largely, especially the pepper-mint, 
•hown by the experiments of Gaubiii«i+, TIte pung 
of this plant, however, is so acrid, as to exhaust the se 
hility of the nerves of the tongue and palate for a moment 
and benee to give a feeliiip; of coldness in sncoesaioni 
that of heat. Its he«t f"rm iu what is called its 
which, as conjectured by Dr. Cullen, appears to be nothin 
more than its rectified essential oil dissolved in spirit* 
wine. On account of the acritude of this plant, it is )( 
vahinble, ait well »fl less palatable, than sj^ear.inint ; whicll 
last actH bettor, and is more plcasnnt to the taste whc 
fresh in infusion thnn when distilled. 

The Dmbellnto order uflords also a rich variety orcttraS4 
Dativw, whose virtue, with a few exceptions, resides almo 
entirely in their seeds. The aroma of several of tlteae 
very pleasant, as the coriander, anise, and dill; while, in ! 
fow, as in the fenntrl, it approaches the nauseous smell i 
tnate of the fetid guma. Hiin, however, is an advantas 
in flatulencies occurring in byKteric or other ncrvon- '< 

To these may be added many of the arumatn . 
from hoi climatn in veiy dilTerent forms; as barka, 
berrieH, pods, and se«ds, particularly ginger, cloves, cuA4 
momx, cinnamon, pinHmta, pepper, and cupscicum. Liki 
those already noticed. Hiey nil owe thoir virtue to mi 



■ RUdUn, Lb. M«d. mm. k. r. 



tA4< 




'CL. I.] 



DICBSTIVB PUKCTION. 



{ohd, I. 



•■•eniitl oil, in whaterer part of the plant such virtue may *'«"■ ^■ 
reside: but Kcveial uf tliem have likewise some gtht-r pro- !,(«««[» 
, perty. which may render theni more or less eligible in dif- fT*"* 
'nrent cues. OoneraUy speaking, tJie stimuliiiits wo aro 
now C4)iitcnip1uttnt; arc more strictly entitled to the imuie 
of cordials titan the nmbellate or verticillate plants; for, 
[ by exciting tbc dcitoub enei^ iii a greater degree, tbey 
: increase the action of the heart, and quicken the pulse. 
I And hence, when the circulation i* wcotk and languid, they 
' have an advantage over the preceding; but when tlie pulse 
is already too frequent, lliby shotdd be abntuincd from. 
To tbiH {general remark, however, tficrc may be one or 
exoeptiMis. Ncwmann and Ganbius, reasoninc; from 
< general use of pepper among the Hindus an<l Javancad 
i witliout any pairticijur marks of excitement, have conteoded 
that it produces less effect on the i-iin^uiferoas systcoi than 
many other camiinalives ; but this maybe resolved into 
lubh. Br. Lewis, from soute less obvious train of ai^u- 
nwnt, came to n like conclusion in reapect to ginger; which 
to many ui an hrating as any of the «p)ecs whatever. But sdui-n 
it secmiB generally conceded, that nutmeg is entitled to the ^"'^„^|^I^ 
character of a sedative and even of an hypnotic; audofauitni^ 
I bence, where flatulency itt accompanied with great irrito- 
bihty, it becomes peculiarly valuable. UontJus flpeaka of 
b this influence aa a matter of frequent occurroncc in the Kast 
lies, and one which had often fallen under hu own ob- 
Bcrration; and in the German EphemerJdcs* we have an 
account of some extraordinary eti'ecLs on the nen'ons system, 
occaxioned by swallowing a lar^ quantity of tliiit wpioe. 
To which I may add the following coolinnalory evidence 
of Dr. Cullen, di.'rive<l from hit own practice. " A pet>on 
by mistake," says he. " took two drachms or a little more^ 
of (wwdered nutmeg. Hu folt it warm in his stomach, 
without any uneasiness; but, in about an hour a1\er he 
btd taken it, he was seized with a drowsiness, which gra- 
dually inerenAed to a complete stupor and imiensibdity ; 
and not long after he was found fallen from his chair, lying 
on the Hoorof his chamber, in the Ktate mentioned. Being 
laid a-bed, he fell asleep; but waking a tittle from lime to 




170 



CI., 1.] 



CCELIACA. 



[OBD. 4t 



QKW. V. 

Jnc.V. 



woniitiot 



Btbalrnf 
biunuih. 



time, he waa quite delirious; aiul he thus coutioaed altor- 
natelif sleeping nnd delirious for several hours. By il( 
grecs, however, botli tliese s)>mptoius dinunished ; so ihii 
in about six hourn Ctom the time of Lakiu^ the nutuieg, 
vm ]>retty \t ell recovered from both : although he sliJI cc 
plained orbcad-nche uml sutue diowsiue^H, he t^lept aalu 
ndly unil c|uietly tbrout;h the fuliowing night, awl oei 
day wiut quite in his urtliimry hu^llJi." 

No doubt, this effect hbs ootjrely produced by iho out 
mrg ; and it in probable, tltat Bcvend other aromatics, laki 
in large doses, and niueh Utt^r tlian we are in the hnbi| 
of giving ihcin, might produce a like result. And hniKi)^ 
Or. Cullon procoed* to caution us against uiunf; them vory 
copiously in apoplectic or pnntlytic cases. Vet, in Um 
alTectinn before us, it is a quaUty that may oftt-n ho tuniod 
to a very good account. 

Mnnyofthcfoi-egoingrcmedieR haw oftfn been conibtoe^_ 

i«4| 



pecialljj^l 



4MltllniUl, 



with tlic oxydo or nitrate of bismuth; and a« lli«?y ba« 
commonly bc«n more Bucoessfal with itiich luljuticts than 
when given ulone, thew prepuabODS of hismulh itM-lf auyj 
be regarded ait a useful carminative. Tbcy are especialll 
serviceable when the flatulency is chronic, aud aocomp 
willi dixtreSKing puin. 

Before quilting this subject, I will just notice two otlwr 
remedies for flatulency, because tliey not only aHbrd bciiffit 
at the time, hut hy tlieir ionic virtue have some tendency i 
to corrwt the distorder radically. ^H 

The fintt of tbe»e ia the tincture of aspahthms c*«e^^ 
ricitm, the ro»-wood, or Uhwlium hguum. of the dJ 
writers. Thin Nhrub rcndily yields its fragrant essential oil 
to rectified spirit ; and the tincture i« commonly mtule bi 
macerating four ounces of the wood in a pint of the Hpir 
It proTL-s a warm, balsamic, and plotuut cordial itt dc 
of from twcnry or thirty drops to n drachm. 

Tlio second n-mcdy I have alluded to is the otherial 
&s it is now called, or the oleum vini, as it was calli 
IbrmeHy, which is found in the rciiiduum of sulphuric otbvrJ 
and is easily made to float on the surface by the additio 
of natcr. It has a stronf*, penetrant, and aromatic 

and readily dissolves in alkuhol and ether. It is power 

ecdative as well as cordial, and m Kutlicicntly known In he 
the basis of lloifman's cclebralcd anodyne liqnor. In lbs, 




CL. I.] 



DIGKSTIVK rUNCTIO.N. 



[URP. I. 



177 



current Plianuacopceia of Iho London Collc^, tliiM luioclyne Ocv. V. 
is imitiitod in the preparation called compound Hpirit of j/^^, ' 
etber. tb« only form in which Uie etherial ml is employed Ftauu. 
' 'as an ingredient. For the pnrpo«>e I am now speiiking of, 
liowcver, it HhotiM be dissolved, nnd in double thcqunntity 
contuined in llie preceding ])repiiralion, in the uromutic 
tpirit of eUicr. [Indeed flatulency admit* of being relieved StimuUnii. 
I kll HliiniiLuil and anti-HpaKiModic niedicineii ^nerally, 
as asirfifauida, the strong smelling gums, nmmonis, 
'©iMUin, ether, &C. Together with iDleraiid remedies. Dr. 
Darwin iipplit^I lomcnlHtionx to llio cpi^^tric region, Knd 
Dr. Whytt, «timulutiiiij liniments.] 



SPECIES VI. 

UMOSIS KMESIS. 

SICKNESS OF THE STOMACIf. 



ICTIOM or TIIB rONTBNTS OP THE STOMACH, OK 

TENKENtV TO REJECT. 

I A DISPOSITION to regurgitate, or even the act of regur- 

igitotion itself, is not necessarily a morbid alTection ; and 

Eto render it xuch, it must be combined with the aymptoraa 

r/onning tlie generic character, which, though not speci- 

[flc«]|y repented, arc alwAys supposed to comtitutc n pri- 

[inuy part of the description ; and which in the present 

enus is an "impaired, cxci^fisivc, or depraved appetite." 

lius a regnrgitation of food is natural to all grazing qua- 

[drupeds, possessing complicated or numerous stomachs, as 

the abeep and ox ; and it constitutes what is called rumi* 

nation or chewing the cud ; the inverted action taking 

(place at the will of the animal, and the food being thrown 

nek from the firAl HtouiiK'h.or paunch, into the mouUi, for 

^hv purpose of further muKtication. Tlicre are instancea of 

rumination, or n Kim|>li; vulunlury regurgitation of the food 

into tlie mouth, among mnnkind. The Ocrmuii writers upon 

this subject nre nnmerons, and their collections of coses 

abundant. But one of the best examples on record is that 

roL. I. N 



Oex. V. 
Si-M.-. VI. 



limr IHM 



Inuancisof 
nirainaiioa 



i 



IVtf 



tL. I.] 



CtKLIACA. 



[URU. 




B]r>h« 

po«cn 
rqeokn Is 



tam»ot 
llnninuid 



«XM. V. given by Dr. ^an*. Tlw lobject wius an ftdult tnui, 
Uiimii^'' go^l g®"*'*' beallh J the niiDination re^larly took p! 
itetciit. about a quarter o(v> bour after eatinsi at which time 
food felt h«ikvy in tbe lovrer end ot'tb« tEDophagitij. It' 
did iKit rurainate at the ]iropfir time, be i»ooq 
Ifttiguid and atck. 

It i« aquestioa that has raised much controversy in 
present day, which are the partit chiefly coooenied 
exciting the Htonmch to vomil .' Haller, aitd tbe pb) 
logtiitii of his time, were wont to rcJ'er us to tbe Ktotaaol 
itself. UwaH tbe opinion of Mr. John Hunter, Uui 
action is performed alone by tbe miucleB surrotinding 
Htonmch, and that the stomach itself is at the tima 
piLKsive a& the lungs in expiration. 

For the determinBttoa of (his point, M. Magcndie Ulelj 
inslituled a eeries of highly cuHouh expcrimeuls. of wl 
a brief account has been given in the pJtyBiologiciU {ii 
Froin these it would appear, that, in nausea, the ectiw id 
confined to ihc oi^n of 1)k^ Momach alonv, 0( porbapa i 
conjunction with the u-fophH^UK ; that retching id produ 
by the contraction of the abdominal muscles, and rejeclic 
by the contraction of Uie dia]>hr)igm alone, or tu conjiii 
tion with that of the abdominal muscles ; and consf(|ui.'nll| 
that an emetic docs not cause vomiting by irritiiting i 
fibrtis, or nerves uf tlie stomucb. but, itn suspi-cted by MrJ 
J. Hunter, by means of ubMrption aitd trrJlatioti on 
ncrrcs of tbe niUKclcs tliut euiround the stuwacbt 
ratJier by the atimulus pro*liicud on tliv bmin, iostcad of i 
the ttonmcb, and especially tiLiuKuiittud to tbew tnt 

These experimenu, however, biive since bacn culled i| 
question by M. Portal, as not conducted aritb nuflicic 
strictoeM, and leading to cunoliisious too gQU«ntlly luid 
hastily drawn. Al. Portal is led tomninlsin Unit voiuiun 
commences by a particular aclioo of the stuuiuch, and i 
then aided and continued by the uction of the abdoe 
luuBcIcs, and of the duiphmgiu : but Uiut, in many < 
this auxiliary aesistance is by no means iiccosuty ; 
according to bis eKperimeota, vomiting may be prodne 
in the stomach when ihe ab<IuuiiiiHl parietes Iibvo 



eSMSiteni 
b]r PoruL 




• nUL Thh. nL XTlL lANKJ. 



[J?L. I.} 



niOEGTIVE PUXCTIOX. 



[ORD. I. 



reniortd *. Aad. coasisUotly beratvilh. Dr. Parr iiirornis 

UH. Uiikt UiQ ()iuphragtu " lia«. Wiu wouiKled, torn, aixl iu 

■perdiros uiiltir;;u(l, »u «<4. oitliei by laccralioii oi dila- 

itiuM, (o<a(]uiitof lliu passage oi' the Ktow^cli^ora part of 

htlii: culoii into |hc tJiarax witliout «uy luicoutuioii »yiii- 

|itoiiitii-," [111 ttte e\ani|>le of incessant rgmitiiig, recorded 

I Ji;iGondrei4^ wltere t\w QOfetA of Ihqisloiuacli »;ere fitund 

j after dwth irKltiltujriiUh'ilily blended. tggellier, and con- 

I'^Mta) into a liomv-fcneuus itcii'itiauft moert, it may l)c 

;doiibtiHl, wlK-llii-r tlic ofgun ilseli' Uad any ^bare in thtt 

LroJeoUoii ul Jta coateutn. In tb« enoi'moua dUatntioaii of 

\f.bt Klotaiacb, wbicb Boruvtiniea fill Uic gtcalvr part of tlic 

BtKlomi-n, M-Jtltotit »ny tlisoiuc or ubKlruction of iliv pylo- 

, TUK, Doiiie cases and dissections of wbicli me noli di^^cribod 

[|>y M . Andral, it iM cosily noncoivablc, liuw n idigbt pMiHsuro 

luced ou litoftloniacli by tbo nlKloiDinul uuhcIcm, uiigbt 

loeMiion the fi-etiiKiit TOiniUnc by llic ]>urtiul vKjiuUion 

[bf itA contents, nntHillistaudiiis tlie parulytic Htuti.- uf it). 

«wn muitcttlar fibre*, Uie cauao to wlucb this uulbor, n-ilb 

great plaaitibility.uxcnbcd its prodi^iovs dilatntJon^. This 

I'liowi^ver, wM a ftlHt« ofdiMnitie; and various coniiidciations 

Ii«hI to support tlic- opinion lliut, under ordinary circum- 

jetanoeB, thv etouuclt itself, as well as the muscles of 

I titet>i ration, osiisls in ihecxpiiiiion uf its contents-] 

K>''1[ is not diAicult to nieuncile ibtMe up|)urently oou- 

licting fiwt«; for sHcb ia tho cloao oonrwxioa and syoi- 

ath;^ lliMexiMs between the 'stoinacb and its wirrounding; 

luft^-lew, )h»t, M the irritation couinionc« in wbicb§Qevcr 

nnit may. it will b« instantly prupagatcd to the other. 

Ve have the >«iino proofs of .<iyni|iMtJiy in the stomach, 

the tteinn, th« rcKophagn", nnd the fnucea. And we can 

I'^ri'icntly tT«f« ilru reWogreiwive action, commpncing in 

lilfeTcnt diH^KKM and undvr ditrerL>nt oircuni«lunce», sonie- 

timcs in on« of tttc«fe orgaha tuid s«n)etiiiic« io Lho other. 

TAiid w«' can sOFnclinies moreover »« thin iiciion limited 

kjbo It parlimlar prt ; i(nmctime«« running through a certuia 



Oek. V. 
Srrt. VI. 

Llinmlt 
Kmoli. 



How 

RtanriJcd. 



'*'BImi. ilc'l*tn«lnii Kofol At Vimtt, Hid IB, Ifli;. Mlitno'imMir U 
Nalurr dlr TmlBYieiK lie |ilu«iinirt MaladiiK. Mini. iv. r«ri% ISIII. Ilvo. 
t IhH. >\|i|Kticl. p. lal. 

S AlaiinUic, Jnwn. 4> I'hTunl. Kt|.it, toni. L p. iB6. 
% Of. cit. uxn. IL p. MB. 

n2 




ito 



CI.. I.] 



rOtLIACJt. 



[UBO. I, 



ElD< 



ilifTmnt 



Gtn. V. length of the ctuin, and somQlinica through the whok. 
ij^^ ' The idvu of swallowing a nauseouti dose of medicine, Cf Ml 
irritation of the fauces by a hair, will often ucile • 
retrograde action in the wHophagua alone ; a discharge of 
wind iu cardialgia, or of a small portion of acid, or oil, or 
any other substance floatinj; on the surface of wfialcwr 
mtiy he contained in the stomach, seema to .cxCite Lh« 
fitweit of the cardia alone, and ihcy arc cspdU-d by iU 
simple and unrntsisted vflbrt, producing a single act of 
eructation or belching. The sulphate* of sine lUuJ copper, 
and perhaps all the metatlic emetics, act uiiqiic>«tionaMy 
upon Uic fibres of the stoumcli gencnilly ami primarily; 
and prohubly all the ipecacuans, whetlicr of the psychotria, 
the callicoccu, or the violn gcnug, arc first abeorh^ols, a* 
nsHerled by M. Mageitdie, aiul then produce vomitii^ by 
irritating tlic fibres of the Mirrounding mui^cles. Sea- 
sickness, undruriousall'i^ctionH of the head, appitrently act 
in the aamo manner; and the contractile and inr«rted 
action only talto* place after a paroxyMin of intolerabU 
sinking and languor. In ileus, the reiiogretsivc Diovcment 
commencing in the bowel which gives riac to the nam« of 
ihifi diMiasv, runs with great violence through the whole 
chain of the ahmcntnry canal; insomuch tliat mi>dtcta«s 
intruduccd into the rectum arc rejected by the moulh. In 
few words then, " vomiting," to adopt tlic laiigungc of Mr. 
C. BoU, " is an action of the rcspirutury niUKclvs, exatod 
by irritation of the stomach* ;" or, as we should add, of 
those muscles themselves. ^ 

Sickness of, ih^ atoniMJ) occurs under diSercilt forms: 
the three following are Uie.t^hief varieti^ : 



a NauHca. 

Lo«thtng. 
8 Voniitunliu. 

Retching. 
Y ViKuitus. 

Vomiting. 



Tendency to reject, but witl^t 

regurgitation., 
Ini-llectuul efrort to voriiit. 

, J' > ''I'li'.'-.V'f »<■•« ilj .. 

Act ^f yomiting,. or nji^cliiiig 

from the f touiHch. 



SauvMgcft and Linni'us rtigarn the llrei ^liil' Ihini ef 



* Etptrimnu on lb* lUUetUM uM tuimlmit id the nwvtb Phil- Tn.i>' 



CL. 1.3 



DICKSTIVE FfNTTION. 



[oRn. 



lAI 



theM varklira as distinct genem of disease, anJ I'vcn oks. I*. 
■rrongcthcmassiicli. This appears highly incorrect : for, ^,^^^j^^''- 
if minutely cxiimincd, thf y nil! be found, in every cax^, to KmisLb 
be Hulc iitorc than different degrees or modificationx of 
the Mmc nfTection, produced by a greater or leaii inveniion 
of th« peristaltic motion of the stomach and (xsophagus, 
whatei'n- be the cause of such inversion, and allayed or 
overcome by the very name meana. Where the stimulus, Ti«« 
and consequently the degree of inversion, is slight, the^^^^"""' 
effect IB confined to nausea; if beyond thi«, the nouaca >i>rclo. 
becomes retching; and ihen the retching become* vomit- 
ing. They may, indeed, exist acparatelyi for the cause 
mayte bf' a'kihd or atfength HOflicient to throw tlic sto- 
mach at once into a slate «f violent inversion, tind coUsc- 
cjuentty lf> produce vomitin<; without the common inter- 
ihediatA changes; as in the case of various metalline 
emetics^ symitatlietic irritation from pregnancy, or the 
swalloniDg putrid vapour. While, on the contrary, minute 
dos«8 of squills, or ipecacuan, or any other cause that pro- 
duces but a slight de(i;ree of action, will excite nothing 
more than nausea, or the first stage alone of the inverted 
action upon which the cenerat affection depends. 

It is nevertheless curious, and of grctit importance, to jtiiTtmit 
■tXtutn the different and opposite effects produced on the 'ff-xt* pro. 
•niinal frame by these two Bta^CB of one and the same ,h, mwm 
disease. Nausea lowers the puUe. contracu the small 17™"^ 
vessels, occasions cold perspiration, acvcre rigors, and ^.^ ^"^"'• 
trembling, and diminishes, as long as it lasts, the action 
and even tlie general powers of life. The act of vomiting, 
on tlio contrary, rouses rather than depresses; puts to 
flight all the preceding symptoms, and restorer llic KyMtcm 
to itself. There arc few persons so debilitated a« not to 
bear vomiting;, but mnny who would sink tinder nuusc;i. It 
is obvious, therefore, that these two different Htatt-K of llic 
fitontuch may be employed as powerful instruments in 
attaching a variety of general, an<l eien of remote local 
diseaaet; this orfi^aa being juatlycoii»idered a«the common 
centre of sympntby, and producing opposite results, accord- 
ing as it is excited to different modes or degrees of action. 
As nausea diminishes the action of the system generatly, NaoMs. 
and particularly that of the small vessels, it has been often "''?T 
had rvcourse to witli success in inflammation of vnrious 




182 



CL. 1.] 



cruLlAr*, 



[OHD. 



Enon. 

VoQiiting 
•here 



tfftauof 
vcj^abld 
tintlio 
<lair«drroni 



Ukk. V. orgnns, |>nrt)Culnrly of iheoye* nn<l lun^; aSitha«HlM'i 
iJJi^ ' llie approach of thorirstfilorinlcmiittinafiT^nt, ofthip ac 
cession of ihosciifilcoiitiiiiied lypo, nnd that tlm'ftlt'n ncoif 
siderublcdegrtMJ of violence. Pull vomiting, (>r aus:men1in| 
the i^encRil HCtion. mnd conKCriiierilly giving s^rmit arlditinftfl 
eofi^y to the nlworV-nt nj-mem, h,ui hIbo Hm^ very nHntr 
tn^OH«ly omployod (o roiiiove ioflnmmiiioi), though in 
difTerent manner ; nwl particilhrly inflnmRmUnn of th«<n| 
pMralivc kind . Orehitw and punilonl ophthalmy hnve wft« 
yielded to il Its 9 chnnn ; nnd we hare vflritms inntnnrt-i 
in M'hich the fluid of extctniive ahxciW'ps haa been he 
carrii-d off in a (avi hotira. Frtiio tlie pi^asivc violence < 
the action, H hnit alifo hcen hij^hly t>enHieial hi inaii;^ 
of oTMirurlion, or chronic torpitudc: and hence its Acca 
sional nitlity in nmntiroititi and caligo ; attd still more so il 
congMtionn of the liver, an<l otlier ahdominal viscera. 
• As diftVnent cnipiicit, however, produce not only 
different action on the «toniiieh, but alto on the Byatom i 
large, or different [wrts of it, they arc by no means to I 

used indiscriminiitcty, but in reference to tht- particm 

vnnof iticii object we Im/e in view. This difference of effect dej 
"^^'"'^ gpon ihc peculinrity of their tinrtiHe. as the Frenn 
writers denominate it, or emetic principle, of which 
require further instruction than has been obtninod 
pri-*ciit ; thoiij^h the cxpcrinicnta of MM. ^T ■ ■ * ■• tv 
Pvllcticr Iiavc given us amw infommtioti ct" j n 
principle, &» \l exists in tlio brown tpecacnan tp\i/rhatrH 
cmrtka), the gray {fvtluotca Iprcttruatika), uid ifce whil' 
(t-jo/a emttiea). 

ipMuuaiw. The ipecncuaiw, howcvef, though powcwinjf somo dtv« 
BilicB of power, concur in operating reiy geneniLK iipoB ' 
skin, Dt the same tinift thnl (hey cxcito the aHmqu 
increasing, in a slight (le|rree. the di»ch:iri;c of mncufll 
tJie lungs, end adding a little to thi' |>eristultic mot' 
the bowels. The anitnionial emcticx, \a % fall 
Mt tuore vidlrntly upon the stoni^ich, bowi-ls, iind''l 
but IcM upon the mucoue 8e>cerneiits. While in 
doses, the nausea th«y produce fs tccompunied witii 
ffloat deadly languor, und with an Atony, thitl. in numer 
CWN, has been HUoceedeil with inoro iniHchiuf tbaa 
degree of benefit that could have bcon propotod by 
Me : " Monv in thi* manner," sav« I>r. Perceval, 




wlihuilU 
■ncokl 



CL. I.] 



DmSSTIVR FUNCTION. 



[OR». I. 



188 



Dublin, in Win manuscript remarks on the Tolume of Osy. V. 
Kotmiegy, "hdvc sunk under the nauseating doses f*f iJ^^,i^^' 
emetic turtar, omplajred upon the liypotlu-sis of Dr. Cullen, Einais. 
in low fevt-rs. The heait of a frog is so torpeficd by ihia 
antimonini, as not to \te excit«d by galvanism, which is not 
the case with npiiim. The fraction of a grain of tartar- 
emetic, in a gottty habit, subject to ruelnna and palpita- 
tion, prodtic^d an alanulntr d^hquinni. In the same subject, 
It «iuiilttr vii'ect. atleiideit the use of other antimonials." 

The squUl and seneka root act very gmerally; proving Sijuiii and 
not only etnelie», btit catharlira and expectorants. Tho""''^ 
aaaruDi, which wa^ once extensively employed for romit- ^■■"'^ "■ 
ing, both in ita root and leaves, at the same time that ^ 
it iaverls the ittniiiach, acta powcifuUy on the olfactory 
, Berre«, and becomes a pungent emetic. It is hence by 
far the l)e»t emetic we can select in afiections of the eyea, 
•lul iH'verul Bpeciue of ocphnlea. Hot wat«r operateit only UoiwtMr 
, ■■ a aiinple (ttimulant to the stomach; nnd he»c«, unless 
tlierc bo other irritants in its cavity, mrely tiikej" t-fFcct 
I (ill the stontfich becomes disti^ndcd, and the nervous fibres 
I of the pylorus are inordinately excited by the f|uantity 
,'twal)owcd. If, however, we infuse in the hot water aPowwio- 
certxtin portion of horsc-mdish, mtiMturd-sccd , the root of ^^!^^ 
, inncreon.ora handful of chiimoitiileHowerH. we increase il» pUitimu- 
I vtimulanl power, und a much MRiAlkrfpiunlity iK Muflicient. iJ^" 
And it '» probaUe that all thcitR HuhMtitnces net, in like tsdbhi&c. 
ntanuer, rnt Kimplu MtimuhintK alone ; for, in Kinall doHCs, they 
, tend rather to uke oft' than to excite sickness. 'Hiere ist 
, little doubt that air acts in the same way : for some per- Air. 
Bona, as Mr. Qo()«, of Geneva, by swallowing end distending 
their stouiiich with air, are at any time ahle to discharge 
.its contents. The sulphates of zinc and copper, and the ninsiilns 

aore powerful preparations of antimony, are probably """"**" 
'simple etimulanta also, but of a high degree of activity. 
They act on the stomach nimoiit nn soon as they are in- 
troduced ; and hence are peculiarly eligible for a rapid 
expulsion of poisons that have been taken inadvertently. 
If taken, tmwever, in too large n dose, they become qnite 
ns mischievous as any poison they are intcndud lo remove; 
for they prove violently corrosivo to the coats of the 
alomach, and excite htematemcsis, or vomiting of blood. A1U<n« 
There are some of iho alkaline salts that uct in the same <«><•- 




OCK. V. 

0K«.V]. 



NknMf/ 



Modcof 



CI.. I.] 



CMZLIATA. 



(ORD. lj| 



manaer whfta btkctb jiwttx(«aa,( (uui < Lhraw not unly Ui« 
Btomacb, but ntlier paite of the Bvetent, into rieleqb 
naodio motions. Two oancca of mini werv tafcan,' 
DMUkc, for one ounce of Epsom sftlts. Ad eUumM ar. 
caMsat romithig for two dti^ft warn the nWDlt..aei>ani|: 
with n copious rliiK-hurgc of grunious blood -fn 
exconatfid mucotu mcmbnuc of tho stomacli t oc 
standing lliat very larKc quiintities of waim wnlor 
iTpcatedly drunk., nnd altcrnatod witb equal quJiDUUcan 
giitd and Miiicilage of guin*anbic, to defend tfae miifa 
of th« stomach by an ortilicia] mucilage. M r. UoUm, ^ 
relatoi Uiie coHf. informs u*. tlmt tho putiont reeot 
bnt was' long uflerwurda subject to ohraoie Hpnuus 
reaembling ohorva*. 

Many of the concentrated acids act in the aamc man 
a«tht alUalino aaltJtt and aonie far mora generally and «s* 
t«tuivrly, Capeciolly the l^iiiiaic acid, wbioh exhausts tiwJ 
whole ncn-oiM Ky$tt<rm, alotoitt liku a Htntk« of lifi^httiing, 
at the i>ame time that the aConmch ia bunt up. 

1 . When introduced into the Monioch in iargt data, i 
hiff^fg eonreftlmteii, it irritatca or corrodes it, by dimohnn^ 1 
the ^latiii of itx coat«, and death tukca |>bkc« by a ayni' ' 
pnthi-(ic injury of ihv norvouit iiystom. 

2. When dilut«;d, it uetM neither by irriintion nor syn* 
pathy, but by ubRorption. o)H-ralini^ on distant oripuM - aui), 
ctelerit pnrihmi, it ilcIk much more rapidly ivhen diluted, 
than wltcn c»iiOfntrat«d. 

3. It is very dilHcult of detection when abaoibedin any 
of the flnida. being probably d«oompoMd< in paaung 
tfaratigfa the -Ivngii, nnd it« eleuenla oombinio; mth the 
blodf. . ; !. 

4. It i« H direct i^ative. Th« organs it acU upon 
throD||;))'aljoor(itinn are Iho spint^ and bntin primarily, and 
the lunf^K and heart aecondarily : and the immediate coum 
of deuth it ROmetiuiCH piinily^it! of tho he^iit, sumetiuic* 
slow asphyvy, and •ometimeB a combination of both. 

The Anrt symptom it pfoduc«« in the Btomarh is an ■»• 
itant burning [mln, of\en alito existing in tlM thnrwt; vio- 
lent Tomitint; gcnemlly folloMs: (he matter dincliurj^i'd \^ 
oonmionly dark, rhoc<^te-htied, and soiigninoh^nt. The 




CI.. ..) 



DIAESTIVe rUNCTION. 



[OHD. I. 



18f 



bowela an> little nAccLed : Uie pulse is very feebie, almost 
iiiipflFceptililo. with cold claramy twcati, tnd liriditjr at' the 
itailsaDd Hiigen. The stomnch, on uxntsiiiation. ^ucrally 
contains a quihtity of the coiilirrinl vomited, being extra- 
>-asaied blooil, altored by the poison u in the caso of 
other acids- 

ifa'attackiUg thia poison, a rapid and natural voniittog is 
ailvflDtBgeeus, by rentovin^ a piut of the unitvriid: but 
dilutto^ it'Unifitfi in promoting iu nliaorption, and render- 
ing it more iniachievous. The oxalntes of the ptx>p*r alka- 
li as I ammonia and potash, aru as dangerous ueariy xa tlie 
acid itself, and hence alkalies must not be used; but tlie 
alkaline cattha, clialk and maj^neaia. make insoKible gom- 
pounds, and afford immediate reliet": they should be us«d 
witli the most powerful stimulants*. 

TliB lp4icacuaUH, and indeed most of Uie piecAding 
enutics, excitu vomiting as vHbctually by bciug introduced 
iiito the blood-v4iHel», und conscqucoUy oxoiling the ab- 
dominal niUKclcs through the roediuni of the bruin, as by 
being conveyed into the HtoiiiMch. Hut lliurc arc »ome ar- 
ticles of tliv Mati-iia Medica that will produce this vflect 
on beinfr applied to tlio aurfuce of the epigastric region, or 
the hypochondria alone; aa the oil of croton, tobacco, and 
what vre ohould far less expect to possess auch activity. 
the leavea of groundsel beat up into a cataplasm. Mr. 
Stedman, of KincrosH, who, 1 believe, first pobliahed an 
account ofthia power in both plants, availed himself of it as 
a remedy for agues, and parabyaratc tumours of the livert. 

As tile stomaoh is the common centre of Kympiilliy, it ik 
not to bo wondered ut, tliat nausea or alckaettt should be a 
symptom common to a variety of diseases seated in oi^nc 
more or leas remote from itaelf. And lieuc« we find it oc- 
jcurring in colic, cholera, »toiie, the acceaet^iu of levers, 
rapeUed gout, and t arioua afTections of the head. 

The East is. indeed, a very frequent, perhaps the most 
frequent, of all the aym{)iaUietic causes whatever; for no- 
thing can disturb the reigularity of the sensorial function 
without disturbing the atomach; and hence sickness is 



Okk. v. 
Srrc. VI. 

I.iiiioi)* 






TobuM 
upplicil 



firvHindiol 
applied 
CO the 
4UMiiaeh. 



from ijin* 
pMhjf; 



tioiu of ihc 
hod. 



■ Kxpitinwbial Inquii; on Puiiuning by Oxilk Acid. Uj Itobcri ChritU. 
•CO. M.D. ami Cliula U'.Cuiniln, .M.D. IMin. Slwl. and Surg. Joum. 
Apr. taSS. 

t Edin. Med. Eogyx. ol. \t. in. \. 2ar>. 




CI.. 



CatlAACA. 



[WBD. 



I 






Okh.v. tore to follow opiirMBwo of the Ijrain, whether prodticMl 

f'mTi7^ tntemiilly, by hanging, drowning, or «popkxy: or exterJ 

lUoaif. n«lly. I)y & rreciuTo of che craainni &c«oinpanied with <)»4 

prauioD. A ftevere jar of the brain, an in ihe caJie of coa-'j 

enasioo. even wilboot cxtmraRation, is certain of exciting] 

Fiotn iSco the same elTect. Nny, any slighter motion to which ibn 

li^ head has not been accustonittd , as that of moving it rapidljj 

fron) ahuutdtrr to should«r in a half rotatory dir«cti6it, aed 

couijilifihes the samo purpose. And hence wc B«e the r«M 

son of the vomiting induced by running, or riding a horrti 

Bcom ftnni rouod a uitall circle ; by the action of swinging, of ndinM 

J^^V*"*' Imckward in a coach j and all ihi; languor and deep rM 

gurgiuttOR of *««-(iickn«M. The living frame, lioweven 

mis ft moM wnnderful inatlnclive power of nccnuimodttinfl 

ili^f to circiiu&taiiceii: and hence, by hnbit, we arc ctM 

ftblcd to undergo the new nwtion without any inoonveJ 

nicnce to the aen«urium, tini cuowtiuenlly without «n« 

SiniruUt in. !(>ckoes» of the stomach. And this power of accouireM 

*^*^*' dnt)<in Ih ho oonaidenble that we have numerous inataaoed 

tetaa. of i-xu-u»tre deprenioi]*, and even of bolleta end otlM 

foreign aubatances lodged in the brain, which, though iM 

firal prtxluctive not only of incwant sickneiM, but uf tJiM 

inoAl dangerouu Hvniptonut of compresaion. have by liubicj 

been borue without any evil to this organ; and hence llm 

without any disquiet to the stomach. I 

To pNdMw In all these casea, however, the brain must still r«taia a 

thto^iht certain decree of excitabilitv : for if this be cnttrehr on 
h&ttu wait o . M 

frrr- very neariy lost, neither the muscles surrounding the aln^ 

•?'■'*«'" mach, nor even the vtomuch itself, posscas energy enoui[M 

Wiif. to produce an inversion of this orgnn. If(^nce, in an ex'l 

iTciuc atnte nf apoplexy, or asphyxy, there is no vomitiiigl 

whutever, nor ti it |>nssible to excite it in the profuse andj 

■uddea exhanxtion of the nervooa power which fnilixrfl 

upon Bwallowing liirge do«cs of the atnpa MlmlnnrntrA 

and varioiia other narcotic; in combaiing the elTeco on 

which fourteen grsina of tttrtariiied antimony have bMn] 

I administered to no pirpow*. " Now, if in snch n ca*e.*1 

^^^K aaya Dr. Paha, "acopiutntfaatighi nfHome rentable acidl 

^^^V be given, the emetic will be ODOttv likely to nncceed." An4| 

^F ii|[TeeabIy with the principle* jntt biid down, "hero tfafn,"! 

^^ aaya he, " we perceive thai the bmin, l>eing parolyuU by ti 

^^^^^^^^ narcotic poieoo, is uaaUc to lend iu aid to tha mH^tJ 

Ci J 



h 




CI.. I.] DIOR»Tlvr FUNCTIOS. (l>RI>. I. 

requisite for the operation of ^-onutlng, until its cnfrgpeo are okh. v. 
rcatofed by the aiili-narcotic powcmofa vegetnbleftcid*." l'^^ 

In ail affcrtjon resuliin^ (Vom snrli an infinite niriirty of Emal* 
caosea, no om* Tcniedy or even pinn of treatment ran apply Trcouncni 
generanj'. Synipallietic sickncs* can only be radically re- (^rf!!^^ 
raoved bv removing the idiopathic disease upon which it is •'>« ""U"- 
de[K!(idiriit, llioHj;fi it may often bo mitigated when very 
distre«»in{r, and the primury dinorder is likely to bo of long 
standing. Tlie be&t palliativCK in moHt canes of this kind 
will be found in carbonic acid nir; the Raline draught, as it 
is called, in a utitte of effci^'Meerice, whether made with 
lemon Juice, or, aa first proposed by Riverjiis. with snlphwrir 
acid; the more (rr^teftil eiVmrnattves ; and small dooea of 
opium. When the stomach is overloaded, or irritated by 
bile or any other material that aits uneasily, the offi;nding 
matter mtist bu first dixchnrged, and then the stomach re- 
stored to its proper tunc and action by some aromatic ew 
dial, or if necessary by narcotics. Pood should at first be 
given in the smallest (piantity and of the lifihltst kind. 
A little toast and water alone, takeu in small sippings, or a 
small spoonful of brandy and \rater, with a single mon&l 
of sopped biscuit, will oAen sit easy when nothing else 
will remain; and gnidu»lly solicit the stomach to a healtli- 
ful rc-flction. Stimulant ciitapKsms applied to the epi- 
gofttriiim are also freiiutntly (tcrviceablo. 

When the sickncsn proceeds from a chronic debility of 
this orgAn, the lighter and warmer bitters, as the infusion 
of orangC'pcel, cascarillu. or colunibo; or, when a more 
actire stimulant is necessary, that orieopurd'i' bane (tfrmcn 
monftiiia) may be found useful. The einehona [excej)! in 
the form of tlje sulphate of quinine disttolvivl in tbo com- 
(wund infuston of roses] rarely agrees frith tbi^ itoitiatjh. 
The flxydes of nine add biamiilh are frequently tli»pfn!. 
Sea-sicknesa is only to be cured by h^ihit: yet it hn« often 
been rendered less distressing by small quantities of hnmdy, 
the aromatic spirit of ammonia, or laudanum. 

[Vomiting is frequently only n symptom of di»«iw of 
the stomach itself. This ik the cn«c in chronic tnflftirtma- 
tion of the organ, in scirrhus of the pylorat, and in ulcera- 



• rhumacoJnp*, f. 134. Siti tilt. te3& 



Q 



IHfl 



'■1 



CWLUCA. 



fORD. 1. 



(Km. V. tiou of the mucous coat. When the latter iQemimitieii^ 
n™i«^'' '-''''""' "'(-'erated, or merely weakened liyany prieriou* inor-] 
bid change, tlio effort of vomiting Bomctinics ooraBJoas al 
lacoralioti of the other coats of th<^ stomach, nnd a ratal] 
eflbsttMi or iU cotit^rits in the abdomen is tht liamedntti} 
rtmilt*. 



Uiimto. 



SPECIES vrt. 

UMOSIS DYSPEPSIA. 
IXDrGESTfOW 






Tim AI-PKTITK rA9Tln)0US; THE rOO n DlCESTKp.l 
WlTll DIFnClLTV; HABITVAI. fOSTllENESs! 

-y TiHs iH by fur th« moRt complicAted of nil tliv diitunle 
Vll. belonging to tho prewnt gtous. The ihret preceding 
speeicA mny often br tnred by themvlves, or in n nato of I 
MCpimtc exislence. Dyepepsy may be regarded as coa- 
Miting in a combinatioa of their reapectire nrnpionu inv-'j 
l^nlarly intrmiiird ; xocnetiaicR one set of ^'mptoms taknijr 
the lead, »nd iMMnetin>c« aimtber; with a peculiar tendenrr 
to tMtire boarel^. and especially that specin of coatiTenos 
which we idiall hemtftrr hare oocaxioD to detKuainate 
ffiftriMlam ohstifMita, dr|>endrnt OD ■ weakly temperament 
or a »edNitary habit, and io which ilic dixcbari^ed ft-ce«. 
instead of bein^ congcstire and voluninooa. are hnrd, 
atfndet, *t)d t>nen acybaloas. 

Dyap^p■y. ihereToir, in tbe langaagt of Dr. C'tdlcn. 
may bcdrMfibed as "a wanKiTafiwlitt. a iqiieaniitiinraB, 
MMMltAtM a vowltim;, sttdden atkd tntneicot i'talttnnoim 
of i|w MiMMidi. practatiein of Tarkms kintb. bcsTt-bim. 
miiM in tttfi report of tba atamact. and a txnnd belly.' 
V*l none of th«r ai» anifcnntT prrw«t, mod aH of ibrm 
aahioat. So that. «a abvadT ofavorrod, tbc ■ymptoim of 



L 



. l«1kMMl, m^, Rrrrrar, In IMn. 




4rL. I.] DtaasTive ruscTioN. [obd. 

cardialgin, fintus, Knd ciocuh, wiU) a few ottieis, cater in Osm.v. 

irregular modific«tiori» into dyspvpsia. as those of ''y»-^J^^"' 
popsia enter into hypochondriaa. [In tbc opinion of Dr. Djiptpfk 
Aijaifitrofig, the luwt coDsUnt Ryniptoms of dyspepvia aro 
tt fiiired tongue, flatuli'itce of tbe Htomuch, and fictrulnew, 
or depression of spirilA. They niiiy ari*c priumrily from 
disorder or diaease in the Momnch iutelf; or they may de- 
pend upon an alfection of the brain, liver, bowels, or some 
other remote or adjacent (larl*. Tbe nece«aityof a care- 
ful discrimination of the original alTcction by the prac- 
titioner i§ quite manife&t.j 

There is also another complaint, wliich frequently enters onrdatm 
into the multiform coiubination of inaladieii, of ivbich dys- • ')"ni*'in, 
pe[)«y i« the genenil expression, and which has rarely bc«n "' '^"' ' 
noticed by vrritcre, although it is ofton a very troubtesome 
ayinptom, and that is gravel. In treating of gravel or 
lithin, an an idiopatJiic ntTection, wc shall have to notice, 
that one of its chief and most common cauwa is au excess 
of acidity in the prima: vire ; and, as such execM is almost 
constantly to he found in dyspcpsy, gravel must frequently 
iitlend or follow, and is even a nccc&sury cHcct where there 
<VMiit» wbat has been called a calculous diathesis. And SnimUmn 
fof a like reason, where there is a podagric diathesis, gout ^"'- 
in some form or other is a frequent concomitant. 

The graiul proximate cause of the three preceding Con^mon 
Bp^iea is debility of the stomach, whence, among other ^™'" 
evils, an impaired secretion of gastric fiuid. In the present 
instance, the debility is not ofileii confined to Uie stomach, 
but extends to the intestinal canal, and the colUUtious 
visccia, as the mesentery, the spleen, and tfic pantreas, 
especially the lirer, iQ which it most frequently ^mmences; 
and hence another cause of the great, complexity of this 
disuse. 

Tbfi debility, an4 4>)d«4 torpjtude, of tbe intc#lionl p™*" "' 
canal is cviduht from the habitual costivcncss, which so pe- lilf'iniL." 
culiarly characterizes tliis atVectioo. Whether this be dl-'iiJaniL 
rect or indirect, intrinsic or sympatlielic, ns haniiORiiing 
with the wealtne^H of the stomach, it is not easy to deter- 
mine: but nothing can be a stronger proof of the i;r«at 



' Dec AtoulMng'i Mwliiil Aul. of ilic SiouiKlk &c. p. SR. 




lUO 



cu I.J 



(lOihUtCA. 



[OKD. t. 



^ 



n«>«. V. 

»n*.. VII. 
liiniMt) 

PiMTof 



ibcllmi 




bi ihc nuv 
KtiMfyi 



cnwwd 






k 






iDMCtivity of U)c iiilcetiul lube, I'rom whalerer cause 
(luci-d, Uuii tlie foobioDeui of iU p«rUtaltie mo4ion, not 
witliBUuiclitt^ the uctimoniousntultera tJtilaniMft«t|UBiUl] 
(litfui»e(l ovvr iU inner surfuco. 

Tliu iiubcuility ol' (hu liver in oquwliy obvioua iik inoa 
CUM. frwui tlie Noiull (juuntitj of biW Utnt hcvi»» to be 
errtjud. or ibs alloriNl imd nioibitl hue, &8 evinced by 
Ooluur iif llit ftvcc*. wbicli. in aome iu&Laiineti, u« of 
utHliily (luik, uikI ill otiient of an unduly light tint; 
IMMubly frgni Uie inactivity of the inlcBliaes tbeioMl* 
whom |)emtftltic motion it tonceivetl by Ur. Suundera and] 
alh«r pAlbokigiMii to be, iu n grgat meitsure, kvpt up by itti 
sliuiulusi. 

Whcu tlw oiaient«ry in aHcctci), tbo cbyiue ugencCBll] 
ub^trucicoi in iL< iNuaitgs to the thomcio dud, nud th^J 
gfliWBtl fniiu«, d«f>riwd of lU iiMdfi[| nnlritioti, bvooOMll 
BMCid aud «uii>ciia<Kl i itiuJ, frotu u co1Ui|im of the aiisD 
vwacUoo the aurfxM). uuuincM a wan or Mllowcoaif 

Jl IK biitlily pixtbuUv, tliut the psnciciu ftnd «plMn 
bulli ttlao atlvcl«U ta nuny ciul-k of dyxpttpaiit* Of 
(Mjtuul |)iut tdtcu by tUhvi- in tbe [>roc«M of dilution, 
littvc idrvuily hiid occuiiun to obxcnrc that we know but] 
UttJ«: but we do knun- that the pancn-u pours lottk t\ 
oonaidvr.iblv portiwi of lite fluid wbicJi holdk tlio •t>bi| 
|NUt of uur uluueut iii solution: while ia a>u«t of Ui« i 
of dy«|i>ip»y, Uouj^ht on by u bmbit of drtnkiii|; 
U4]U4»K, the uplew wevideoUy aflvcted a» wtU iu tiw i 

It i« in 1^ atatt of tbe dtuase that w« ftet^ocntiy . 
with that teitdeaiMB or other uQCiwiitcsa in the «f ' 
KQgioM. Wild that peculiar hardness of tbe pubo. oAca i 
mnnnniiiil by fvbrile ^yuiptoms, which Dr WiImq PliQip.1 
IkW pointed out as lathogoouuc of what bv calls a i 
vtn^ of thv disease *. 

It ha» abw been well obccrvod by Ur. Pbilip. thai 
luoaan, iu atany iasiaooes. apt to at wciate m iha i 
aetioaof th»digattm oigaaa. Mbcaitbaa becowchfww^j 
and to pioduce. a« a MMtlt. a peculiar vaCMty <with 
iptem) of cotuumptioti, to which be has girai th*.J 
of dyiytfiic phlhisist. The dyapeptie 




CL. 1.} 



DIUB8T1VS FVHCTION. 



[OltU. I. 



I 



diseuM, tiowever, apd wpeciujly the licpaLio syinploms, to- Oek. v. 
i;i'llmr with tJiOW of Iuwhcsh i>f tipinU, flntul«nt.-y, uod i^^i^"' 
olfan ltyp(x;lititHlrittcul atTeclioiM, nirvly fail lo uccompuiiy Vjtptftin. 
it when complicated witli plitbisiii, and point out iln rciU 
CQurc«i aud tJie ciin: must be ckic% directvd lo tlia pri- 
nuiry iiiaLidy, liow much soever the induced eymptems 
may alitu demand our attviitioii : for it will bo in vain to 
Kubduc ibc Litter while the fonuer is still Buffered to bear 
sway- 
It moMt iierMtbolesB be aduiitted, that in somo instunces ^^^^ 
tliu sccondnry disvasc ^cems to atford relief to thv primnry. tamtibam 
uikI tliat the orpin fintt utfecled recoverB iu hcidtb tn pro- «'"'nll»)'- 
portion UH tbnt Kub^i-fiuently allect«a yields to the Eitltick: 
in the same uiaoner as in «ryai|w)itH an<) the migratory 
formB of liccpcB, the eruptitm traTeU forvrard, the port re- 
liiKiuished hvals, and fresh parta are atFecud iDSucce&oion. 
In all such ewes, the secondary <;omplaint becomvb u new x^it 
malady, aitd must olian be followed up under anotlier prin- ■■fcciinn b». 
ciple and another mode of treatment. And not uafre-^^_ " 
<)ueiitly we cau very advanugeoualy lake a lesson from 
tbia peculiar march of nature; and by exciting an artj- 
ticial irritation in some neighbouring and less vital part, 
can draw oi£ the morbid action into such tinarter. It M 
by thiit means tlial bli^utrH, setooa, and other counter- 
irritantx are so frequcnlly found guoductjve of th>e beat ad* 
vMrtagc And aa a disuake of the alimentary oanal is thw 
MinetimM communiealod or tnthMfcrred to the lungs, so a 
moi'bid Htnta of the lungi; is sornvtinics I'Xtcndod to the 
stomach, of which Dr. Gardiner hnit latvly furnifihud u« 
with a striking example*. 

In chronic indummation of the stomach, and even in 
that form of it Hhi<-h terminates in ulceration of l\w 
organ, und » futal elfu&ion of itacontenU in theahdomeiif, 
wc also muel with 8eveial> and sometimes all tJie sym* 
ptoma of dyspepsy i but as dyapepsy occurs here merely us 
a secondary or iiHiuced uliecliuu, it will be more regular to 
examine the nature and etfecU of this cause hcT«a(lter}:. 



* TiMUKL. of ihe Mtdm-CUt. £oc of Edlaboicb, tol. k. I|n>. 1024. 

t 9n AbcKicmbii on the patholog; of ilis lunutfa, tiiC- in Ediob. M«L 
kml ttuiglul Jnitn. N'o. TBt EUioMm'* nn of rupUnd (tanKh, b Md. 
t^iir. Tram. vnl. illLp. HI i abo Louii, In Archlva Gfn. d« AIM.imu. v. 

t Vol ii. U. iii. Vsi. a. litn- >IU eipM. i.i. 



^ 






I 



(ORD. I. 

whatever form, mud rrom whatever cauae Uic 
thnv tt a coiuudcnible d«gTM of gnncml 
Bxeroise or exertion of *ay kind 
i; dht |nIw u weak ; tb» sleep disturbed ; the 
an mU, or rendered ao on iHght ocMMtooi ; 
iir the most part is furred or eoverad wttli 
ia the morning. Yet thia last aynptom 
a» ba depended upon ; for it ia souietiiiMa 
the disoaM, and Mtnetinwa common to tboae 
such diHeiutc whatever, and ure in the anjoy* 
«f habitat) health. 
Jyifp a y should be connected with a morbid eon- 
•T any of the adjoining organs, is by no means 
It lo conceive, ifhen wo rtflect that they are all coo- 
directly or indirectly, in completing the great 
of the digestive pioccw, which is t]iat of fumishing 
a tOMbuit eupl^y of nutrilion for the system at large- 
Piaaifinn is commonly supposed lo take place in the 
■maanh alooe ; but this is an erroneous view, thougll lite 
ttrwai'*' my be regarded as the chier link in the gnat 
aaaociate chain. In th« stomach, as we have already saHi 
in thi< pTOom lo tlie present class, the food i« only hrakan 
tK'Wii into the ptiltact^ouit mass cftlled chyne, aiHl tlm 
cooverted into the mixed principles of oil, gelatine, and 

X, and little else ; for though we have some traces of 
iliiiition, they are rudiments and nothing mor«. Yet 
lliii. which \* the first, i<i the most importitnt stage nr 
dJtfiMlion -, nud its perfection depends upon the vital 
tiowtr. Whvre this is small or enfeebled, the proeaaaof 
I- h ¥■»■''"''""*'' '" nccc»i(urtly impaired or intemiptrd : tbe 
Wondrrrul machinery of the stomach, which finds ao 
parallel, not only without the body, but in any other part 
of It. M (liMurbed or impeded in its operation ; and its 
IlllidM BTO poored forth too sparingly or too iucouditcly. 

Tlio next stage of the digestive procees takes pbm in 
link dun«li-num. which easily admits of distention, and 
iM'sit'CJi ihi; food in the form of chyme from the stomach. 
((era the bile, the most hichly animuliiod of all the 
airriittons, and abundance of the pancreatic juice, meet il. 
iind a new pity *>f affinities commences ; the bile, as snp- 
miM'il hy Foiirrroy. being Mparated into two paita, ill 
0B |>nnc<pk» and its resin. The lattar ia diacbtiBri. 





[OKD. t. 



Iwitli. Mid girea a colouring inattCT to, (he cxcrcnienU ; tho Onn. V. 
Ifomier become <1eootnpo9«l, nttcnuatc the chyme, commu- ^"f^i^"' 
ptiictit« ihoir azote, nnd thus complelo its Aiiimiilizutioii; Djnpcpda. 
rwhilc (he juica of the i«incr*'n» dilutes smd holds llic 
I'tnateria) in ftohition, find probably contributes to some 
Mhcr eflVet, Imt which has not yet been deteclecl. In this 
lifptid itate it is culled chytc. The recrementory' part, thyie- 
rhtfh HMceiidB into the larper intestines, i.t attaclted. as it 
proceeds, b\- the mouths of a considerable number of lac- 
IteaU, that drink up whatever small quantity of the chyle 
nay be accidentally intermixed with it; while the great 
■of this fluid is absorbed in the duodenum il«clf, by 
innumemble host of the same vessels which concentrate 
lieir mouths on its inner surface. 
Vfv thos see how largely the digestive process rfingcs, 
and from what a wide S]ircad of cir<:^nii, closely syni- 
pathiting; with each other, the disease of dyspepsy iimy chylc jta m 
|,]>rficeed. But the finishing touch still i-emains to be *" "I™"* 
added ; the absorbed chyle, before il becomes completely vcntiiatiun. 
asRimilated, has to he exposed to (he action of the atmo- 
sphere, and for this purpose has to travel to the lungs. 
P'Whnt change it sustains in conaerjucnco of this exposure, 
«H l>c (he subject of a subsequent inquiry. At present it llmw clow 
is antfieient to show the connexion which subsisU between """"""; 
the Moinnch and the lungs in the common function of pro- >iania<;liiuid 
vjding for the snatenance of the animal machine ; and to '^* '"""^ 
indicate the means, by which a morbid notion of the former 
may be communicated to, or lay u foundation for impaired 
action in, the latter ; since, to sny nothing; of the sympathy ' 
of approximation, or of thot sympathetic influence which ' 
is always found to take place between (lie extreme links of 
a chain that runs through any ptiit of the luiimul machine, 
it ninst be obvious that if the chyle, which originates in 
the stomach, and when in a state of health, communicates 
a pccalinr slimnlus to the lungs, as It enters their substance 
in combination with the recurrent and exhausted blood, 
should b« conveyed to them in an unhealthy condition, ' 
this peculiar stimulus may be changed in its mode or 
degree of action, and the lungK in consequence become a 
Muflcrer; more esjwcially where they arc predisposed to 
any kind of morbid action. And hence another orijjin of Whene* 



^ 



dyspeptic phthisis, which, like every other wodiltcation of pj^!^^ 



ii.e 
•il. 



VOL. I. 



194 



cu I.] 



CSLUCA. 



[onu. u 



Bpk. VII 
LlianU 

iMdud 
gnxni. 



hool 

nninu 



rcmoie 

OMINS. 



the (liMOHe, may depend, thcrafore, upon imbecility oft 
or more of the digestive organs. 

The common citiiscsof lliis inihccility, whether confii 
to the stomucti, or co-c^xiensive with the astocittte Tiscer 
may be contemplated under two beads, loeat and nenerait 
undor both which they are still further resolvable into ihi 
tno opposite extremes of deticient and excessive Btituula 
lion ; and conaequently into a divergency af any kind fr 
that medium of excitement and activity upon which liealt 
is made to depend. 

Thf local remote cauge?) are, a too targe indulgence il 
scdatiro and diluting sabstunces ; ag tea, coflce, and ' 
water, or itimilar liquids taken as a beverage ; or an eqi 
indulgence in stimulant and acrid materials, na ar 
apirits, apices, acids, tobacco whether uniokcd or eliewedij 
snufiB, a daily habit of distending the Momach by 
eating or drinking; or a rigid absbemiooHneM. and 
prolnictci ])criods of fasting. 

The Rcncral remote cauBca are, an indolent or aedent 
life, in which no exercise is afiordi'd to the mu&cular (ifanal 
or mental faculties. Or, on the other band, habitual ox-l 
hauBtion from intense study, not properly allemated with] 
cheerful convenation ; becoming a prey to the vioteD 
patinions, and cRpecially those of iho depressing kind, i 
fear, grief, deep anxiety, immoderate libidinous irtdulgCTced 
and a tifo of too great muMular exertion. Perhaps thl 
most cominOD of thi« lallcr clusa of cauaea, are late h« 
and the use of spiritwous liquon. 

Dys[>e[>!iia is hence prcmnted to us under M*«nll 
rarietica, of which the two following are the chief: 



« Organ ica. 
Organic indigestion. 

$ Enervia. 

Rnerrote indigestion. 



Originating in the di$ 

organs and principally con-j 

tilted to them. 

Originating in a relaxed staM] 

of the constitution htm] 

causes acting gcnv 



For both (hesc. the general (trmciples thai shou 
vem us in attempting a cnrc are the samn, tlioa| 
means of carrying inch principlea into ellectwill admit i 
diwraity. 




CL. I.] DIGKSTIVB fUNCI ION, [ORI>. I. 



what tihape ftoevor the di&eaee may ptos«nt lUelf, Oku. v. 
thing to be enjoined is a relinquishmcRt of what- 1'*^^ 



Under 

the fimt thir 

ever cause has laid a t'oundutiuii lor il : wc must next l>]riprpu>. 

pkllialo the syiDptoms that iiggrftvate and continue the ^f*<]ioi 

disease; and, lastly, we must restore the debilitutcd uri^uns 

to their proper tone ; or, in other words, wo must correct 

or Rmove what is called, though not rery precisely, the 

proxininte caune of the muludy. 

The patient muut, in the lirat place, be convinced of the Kimintcn- 
necenity of putting himself under a new nile of conduct, ^^^j'J),. 
and he deeply impressed with the idea, thnt though lic">^"^ 
may have continued Iiis Intc plan of life for » coii«idcmbIe * f^^ 
period of tiniu without having Hcnsibly sulfered for it, yet *>"» ■>» 
now that he is suflering, nothing but his confonniog to ™^ 
nnother plan wUl remove his iireaent complaint. 

Severe and loii^ conltnued study, protracted, as I have 
often known it, through ten hours a-day for many months. 
vritJiout any relaxation or interchange of pursuit, must give 
way to the exercise nf walking or riding, and this not KxncUr 
occawonally, but tluily; and to the xlill belter corUhI of ^„f;^;^"' 
Awrful conversation. The liiHt is of very great im- >u>«i. 
portuiee; and witliout it even exercise itself will be of 
litllo avail : for the luuul. accustomed to a certain Inick 
of intellectual labour, will otherwise relapse, even while 
riding or walking, into the same habitual course, be dead 
to the most fascinating prospects around it, and become 
exhausted by its own abstraction. And it is to characters 
of thia kind, perhaps, more than to any other, that the 
aniDseineata of a watering-place promise ample success ^ 
when tbe general bustle and hilarity, and the voluntary 
fofgetfalnesK of care, the novelty of new scenes, and new 
facM, and new family aneedotcM, and the peqictual routine 
of engagemenUi Uiat (ill up the time witJi what would utlier- 
wiw be trilles and frivolities, reverse the mischievous order 
and monotony of the past, break the sturdy chain of habit 
and osDociatioo, and give leisure to the worn-out sensory Co 
reftvsh it«elf. 

Where the same effect has proceeded from a town-life of 
fashionable follies and dissipation, nothing is more common 
than to recommend a like change of residence. But in this 
case, though it may he a change of residence, it is not a 
change of liiej and hence it is too ofUa made witliout any 

o2 




196 



CL. I.] 



CtBtlACA. 



[OBO. I. 



Qh. V. 
flncVtl. 

LimMEi 

F«Tlb«di». 

rmvM DVNU 

fahioMhle 

1Mb. 



TmUatKc 

fare Mid 
oulj koun. 



Bui ruJdsn 
■ml (ilitiiie 

nucnicTDu* 



ItowUi 

die IMC of 

tobaenl) 



benefit whatever. A total retreat from the world, Uie un> 
broken secliiRioD of a remote haiulet, the itober eociety of n 
few intiiunte fnend*. ttitniile meaU and early botm ; inKt«ad 
of close anil healv^ rooiUM, crowded and motley routu, 
coAtiy fetmUf nml midnight madrigals, uro what arr 
sfiecially called fur in thix instance, but nre not always to 
be m<!t with in the rcMort of n wuterin^-plucc. In audi as 
nre HtitI distinj^iuhed for thi;ir rgiiiet nnd unfrcqiunleil 
KhorCK, where all is rude and simple, nnd uprucc squares 
nnd long-drawn parades have nut yet put to Hight the 
BCAtlercd and irregular cottagcti of former times, these 
sdvantageH may still be obtained. But it is rarely that 
patients, who are suffering from a life of dissipntion, wHl 
cnniwnt to relinquish the hij^her attractions of our gayer 
and mure pulihc tvtreats, fur what llicy arc apt to wtflfm 
the dulnese of an iinfrcqiiented const, tall it in of littla 
importance wketlier they go any where, or remain nt their 
own homes. 

Id like manner, the hnbitual use of hard eating anil 
drinking must give way to a wholesome plainness of diet; 
though I am afraid, that not a little oiischief hast often en* 
surd from rigidly compelling the man who is aiiD'crin); fnai 
a long hubit of the former, to abandon this hiibit ut oncib. 
and run to nn extieme of nbtitemiousneas. Notltingi 
be more injurioilK. Even in full |ic;;dtli, tlie antnml fn 
though it may be bron^ht to any vxtreme by ik-grecs, 
ill brooks abrupt changes; and 1 hove often seen wl 
mich changes have been attempted in an enfeebled coi 
stitution. that they have introduced worse complnints ' 
they have l>ccn intended to remove. The use of tob 
is not, in our own day, employed very often to 
nxctsn. whether in smoking or chewing, as to bwama 
ven,' nliiniiint; enufC of dynpcpsy: but I have kt 
instances nhcrc the former has been suspuclcd. the 
pertiaiM unjustly, of having beeit ihft cause of thia 
plaint, and where an abrupt prohibition of its entira 
Imt inltoduccd a dangerous atrophy. 

It is certain, however, that a free use of tobacco uttdor) 
either or any form has produced very Bevure dy^iaptM 
afrectiuns, and consequently, in such cases, it oaght to b« 
relinqnitthed by degrees. Nor is it ditlieult to conceive b; 
wliHt menns tobacco thus acts; for. like opimu, i( m i 



1 



CL. tj OIOESTIVB FVNCTIOK. [OSD. I. 107 

stimulant readily producing a narcotic cITect, or, in other Ota. V. 
words, mpidly «xKaustiug the aenaorinl powfir. In cbcw- |,i',^ 
ing, a conxidorable portion of tobacco isi conveyed to the l>yRj>vp*lk 
stomnch along with the saliva: in siuoking, a tiouiewhat * 

■nallfif c]uuntity ih conveyvd iit the Hamv manner; and, in 
both, tJie sutirur\- i^IuikU are excited to a great wtiHlc of 
secretion; which cnnnot tnkv pluco without impairing the 
chymifuctivc prorcss indirectly, u« the introduction of the 
tobacco into the Htomuch inipuirst it more immediately. 
The nrecu, or Malabar uut, thoiigh a good bitter, when Arvi-vnr 
chewed for a long time i« well known to impair it in the „^, "' 
«amc manner. Even in tlie form orituuti', tobacco has not 
uufrequcntly been found to produce the fitimc result; partly 
perhaps tVom the pureeis of the olfactory nerves, in which 
the stomach participates by HViiipatliy. and partly from 
the portion of tobacco thut is constantly passing into it 
from the no&lriU. " 1 have found," says Dr. Cullen, " all 
the symptoms of dyspepsia produced by snuffing, and par. SnuflBui;. 
ticulurly pnins of the sstomaoli occurring every diiy. The 
dG|>endencc of these uiion the u»v of snull' became veiy 
evident from henee, that, upon an accidental interruption 
of snuffing for some dnys, these pains did not occur; but 
upon a return to snulling (he pains also recurred ; and thin 
altcmation of paina of the stomach and of snufling hnving 
occurred again, the ftiiuffwas entirely hiid aside, aud the 
p^iins did not occur for many montlis afterwardii, nor, so 
far as 1 know, for the rest of life*."* 

Dr. CuUcn tells us in another place, in proof of the 
same fact, but in proof also that the habit is sometimes 
variable in its intlueuce. that he knew a lady, who had 
been for more than twenty years accustomed to take snuiT, 
and that at every time of day ; but who came at length to cue in 
observe that snuSine a Kood deal before dinner took awav *''**'' '' 
her upjietiie; aud that even a ttin^Ic jmich taken at any a,,p<iiiv, 
time ill th« morning, destroyed ahnoHt entirely her rulisli 
for that meal. When however nhe ab»>taine<l entirely from 
snulf before dinner, her appetite continued as usual; and 
after dinner, for the rest of the day. she took tmutf pretty 
freely without any mconveuicncoi'. 



' JIiL Ucd. vol. ii. |i. 373- t Op. duu p. S14. 



J 



IQ6 



<L. I.] 



CaLIAC.4. 



[otto. I. 



0*a. V. 
S-ntr.VU. 



■wauMri 
ftr. 



ctow, but 
irhaunr 
dlMgim 
■iih it to 
fcfMoidcd. 




I 



T«B ninnlic 
10 wine I 

MffjjaiU ID 
nthcn. 

SeModln. 
lenilM, 10 

tffllipUBIL 



Kmtila, 
ho* fu 




Omtic 




This siagolarity may partly have depended, tm Dr. Col--' 
len stipposeH, on the inequality of the power of habit in' 
exerting ito efleclsibat it most probably depended nlaoj 
upon some peculiar change in the stomach at the time; 
apparently on an incrcaaed irritability which made it mora-l 
auftocptibic, in an empty state, to the nauseating quality 
which tob«oco poMecsea in oommon with m&ny other I 
narcotics. 

Not in manner of lire alone, bat in manner of foodfl 
■hoiild we rigidly pruacribc whatever wc find to be n cause] 
of indigestion. And lionce dyspeptic pntientji idiould payj 
a particular attention to thvmsvlvcti, m) a» to diMcriminate 
between the viands that sit easy on the xAonuch and those ! 
that rcttder them uncomfortable: for nothing in a morbid 
state i.i moi« capricious than this organ, and twenty dif^, 
feretit cases may perhaps demand ai> many vancties of ie*j 
gtmcn. Thua t«a of all kin<li>, and especially green tea^i 
is gviierally accounted n nnrcotic. l>r. Smith and Dr. Lett- J 
som c»d«ovourcd to trnco up it* narcotic principlo by, 
cxperiuienu. and, it i^ to thift principle that Dr. CaUeotj 
ascribes the delctenoiis eBcct« it pioduccs upon mma ■tOi'J 
machs. Yot while it acts as n narcotic upon many [ 
upon othere, and myself among the rest, it proves 
fully agrypnic ; and if taken on going to bed, keeps up wake>^ 
fulness through a great part of the nigbt. 

We must first then prohibit, in our eodeavount to efiect' 
a cure, whatever we know to be a local or general cauM oT.i 
the disease. Our next intention should be to palliate 
symptoms that aggravate and continue it. 

As the stomach is of^en overloaded with ciuditiea and 
acidity. Dr. CuIIen recommends an emetic at the outseb] 
I have rarely found this of use: it often adds to the 
bility of the stomach ; and at ntoxt is only of service fnr s ' 
few hours. For so long as the cnuse conlinuea by which 
ail accumulation of undue materials is produced, ihis cdiMt 
nil] Iw perpetually taking place, and an emetic might be 
tieceuary every day. I'he most rational mode of [trevni- 
tion is, to limit the stomach to such food as it will tne 
easily digest; to idlow it in small quantities; to quiciun' 
its removal by gcn(l« aperient:' that muy incrcii^c the pen- 
staltic actioti, nnd warm tonics that miiy invigornte th« 
digestive organs. A Mpaic diet, however, though oAnn 




CL. I,] DIOESTIVR FUNCTION. [(ftD. r^ 190 

rocommondcd. is rarely foui»l of wjrrioc, and TCiy gene- a''"*™", 
rftlly addH to the digease: for as the stomach and boneU ijnim<> 
have been accufttomed to the stimulas of food, and a ccr- l'ri»i»'»- 
tain degree of impletioi), if this be not maintained, the 'V''"'"''"' 
atony will be increased, the natural function atill further juriaui. 
impaired, and all the symptoms of uneaainesK be aggra- 
▼■t«d. A moderate proportion of excitement and iniple- 
tion is hence imperiously called for; uiul our discretion is 
principally to he exerted in detorminiiig the nnturt) of the 
Tiandi and the degree of impletion which will host agree 
with the stomach, and which it may moat euttily master. 

For the correction of flatulency, most of tlio camiina- Fltiulcncr 
^tive» noticed under the fifth species of this genus may he J^j,^*"'^' j 
|< conveniently had recourse to; and for that of acidity, lime- hour. 
^ water, the acidulous alkaline waters, tho alkahne salts, Addiijr a 
absorbent earths. Magnesia is a remedy of peculiar ^JJI^^^, 
rvalue for this last intention. In some cuses of great ob- n^piaiia, 
latinacy, but evidently dependent upon a cbronic teodoncy >>* u«r. 
|lo an acetous fermentation, magnesia, given in the propor- 
I tion nf an ounce a-dny, has ejected an entire cure * : and 
Mn all cases it resists the eostivciiess aa well as the acidity, 
and is far least disposed to coacervate in the alimentary 
canal than the calcareous eurtlis. It Ih also, aa I have al- 
ready obKerved, a powerful antidote against tliut clu«s of 
calculous concretions in the kidneys end bladder that de- 
pend u)>on an acid princi)>lc. 

The eructations that occur in dyspepsy, however, are 
not alwayi* acid. They are often of a compound and very 
offensive taste, and give to the breath tho sroell of earbu- 
rettcd hydrogen gas, or rotten eggs: as though tlio gastric 
juice were incapable of performing its proper ofticc. and 
the food were retarded in the stomach till the process of 
putrefaction had commenced. In this case, instead ofAdibwbm 
avoiding acids, wc should recommend a free use of them, ""'^"'' 
from whatever quarter they may be obtained; as they not 
only tend to correct the fetor, but to strengthen the sto- 
ntnch. The mineral are the most powerful; and of these luimTiJ 
the sulphuric is by fat the pleasnntest. It may advaiH '*'^*- 
tageously be employed as a medicine; but for acidulated 



' Hoe Dr. Wabmt commuuitMiwi, UMe. Ob»cn>. toL iiL 



I 




200 



CL. 1.] 



CISLIACA. 



Um. V. dict-drinks, it must yield to the ref;ebtble scida. Theu, 
Jj^j)""' arc of three kinds, nalire, distilled, and such as are ob 
Djniwpulo. (uinod by fermentation. Tbo firet are commonly the 
Vcttcubii; grateful, and especially when they exist in the fonn 
"' *' fniita: but they are apt in weak Btomacbs to set Ttm 
livTSM '^T '""E* quantity of air, and consequently to prodoce 
ofihedlt'. rety tronMesoDie fliituluncy, and even promote the 
''^''''"'^"■Ci'iit dieposition of the orgna. The citric and the 

may be exceptions; and there may be dIm a Aw oth« 
but they are not numurous; and where theto cannot 
procured, we must have recourse to the acids elaborat 
by distillation, or a rerinentiog process. The last 
called vinegars, whether obtained from malt, n-eak TrioesJ 
or sugar; nnd bein^ of themiielvea, when properly relined,j 
very pure and dilute, they are cagiable, with a little carc^ 
of beinp rendered hii^hly gnitcl'ul. 

The distilU-d nciiU of ve'rctublcH have not yet been suf-l 
ficiently tried to delcnuinc nhctlicr auy of thuiu poeseaJ 
any specific virtue. They were ot one time very generally] 
Add of ur. made use of under the guise of tar-water, which, when thai 
"'"' taste i)* not di^ilced, will ol\en be found useful iu indf J 
gestion.4 attended with offensive eructations. 

^PD«•Vro^ I will just mention another remedy which deserves 
much more extensive trial tlian it has hitherto received loci 
the symptom before us: and that is, (wwder of chaieoal. 
From the expcrinienta of Lowitz and others, (his is tw*^ 
■ well known to be the most powerful corrector, next perhnpaj 

to the gastric juice, of putrid substances out uf the sto. | 
mach; and we can hence account for the success wiih^ 
which it has been occasionally employed as an intemtli 
medicine on the continent : the dose may be from half a J 
scnqije to a acruple, re])eated thn.* or four times a-day. 

Before I quite drop the subject of crudities in the ato-l 
mnch, I must ohiicrve, that our object shwdd not fae tod^l 
iimimmT^ siroy all ancescency whatever; for a certain proportion la-j 
^L natural to the organ from the early period of lactation, and' 

^B ap|>earB necessary to the digestive process; and hnica wfl 

^M are only called upon to moderate this quahty whci) in ex- 

^^^K ouaa: u{M>n which t;rnund abHorhent ]>uw<Ii.-ni, and tiimi 

^^^^^ niagnesiit itMulf, when not ncluully ucccsitury, m:ty add la 

^^^K the mischief instead of removing it. 

^^^^^^ Costivencaa is a symptom of dyspepsy stilt more cum- 



fTM of 

•cidity In 



CL. 1.) 



DIOBSTIVE FONCTIOK. 



[OBR. I. 



201 



mou Uiati acidity, and one that requires a very vi^ant at- ^'"'- ^■ 
teation. In our atteinpta to remove it, we ehould always ^iirioiii 
bear in mind that it is a chronic and not a temporary con- Dypty'ia- 
coiuitant; and, contcquently, that violent |iiiri^tivi;H nre ' ""''"'"''™ 
of all thin;^ to be avoided; and that Much tipcricnt^ should rrcdii, and 
be preferred whidi net gcnlly, and rather by soliciting the ■" "•"•«- 
peristaltic motion of the bowels to the regularity of health, 
than by irritutinc them to u laborious excilcnicnt. 

Rhubarb is, for this purpo§e, one of thu best aiticles In Bhubvbt 
the Hftteria MedJca; for while by its aperient power it re- 
lieves the present distress, we cannot have a much better 
tonic than its bitter. Where the boweU are merely slug- 
gish, it will prove sutticient without any other cathartic; 
ttbongh it is better to combine it with soap and such aro- rocbirMd 
niBtics u agree with the patient. It i» often however in- "i'h iiimu. 
com|)ctont of itself; and in such cases derive", in the form "** 
of an extract, a v^uablo assistance from half the <]i«>ti- ud aOirr 
tity of tJie extract of aloes, or the compound e.\tract of mniicinn. 
colooynth. 
Since the publication of M. Uaubcnton'it little tract in Small ilma 
an English dress, very small doses of ipccacuan, not ex-^.J"^, 
cceding a grain or a grain and a half, have been uxtensivcly fir lueful. 
tried, upon the recommendation of this celebrated physio- 
logitt. The intention appears to be tliat of exciting a 
change of action in the secernents of the stomach: but 
notwithstanding the advantage which is said to have been 
derived from this medicine by the writer himself, it does 
not seem to liavu Hiicceeded in this country; and indeed 
the dose ia so small that little effect of any kind seems 
capable of being produced by iui u-se. By some writeni it 
ia supposed, that in Much minute proportions, it will abp 
over the pylorus, Rud prove aperient by acting on tlie in- 
testines- I have rarely, however, fonnd it to do this alone. 
though it is a useful auxiliary with aperients of u more 
decidud character. And where there has been great irri> 
tability of the stomach, I have known it even in the dose 
of a single grain excite so much nausea an to prohibit its 
further use. Far more service has occasionally been pro- Tarur- 
duced by »n external application of the tartnr-enietic oinl- ™nJU^n,. 
ment, made in the proportion of four scniplcs of the tnr- 
Uituxd antimony to uii ounce of Kpurmaceti cerule; the 
<]uuutily of n huzel-nut being ruU>cd iu evcty uijjht titi 




203 



CL. I.] 



CffiLIACA. 



[OR», 



SmcVIT. 
Djrqtcpsi*. 



gukkillicr 
pill. «hcri 
■ilriublo. 






CMrflnlco- 
tktt, Uiv- 
■Mflltw 
Noeof iIm 
Nowarh 
■id tjwtn 

Both Ob- 



the eruption coitxequent upon this application ap; 
In numerous dUca-teK of the cligeative or^rans, and paitici 
Inrly thoev of tlie stomach and liver, tliU kind of coun' 
irritation hftti li«eii found highly uselul, probably from 
infliii-ticv which ia often produced through the whole len: 
of a nervouH tibre and its coonoctiug branches or inte; 
tionx, in consequence of exciting its extremity. It ia 
Dr. Jenner we are chiefly indebted fw the attention, uhi 
ha-H lately been bestowed upon the oaturo and elfectn 
tbiii singular remedy*, though it was occasionally long 
use bt^fore his time. 

The <]uickKilvcr or blue pill will also geneniily *ds 
a good purpoKc; but \» chiefly to be employed when 
have mason to apprehend, that the one or hotli tbi- 
of the stomach, and especially tlic pylorus, is in a ecirri 
state; or thut the djrspepsy is connected with a raorhid 
condition of the liver, or some other allied viscas. In t 
case ntuch benefit has also been derived from the w 
oxyde of bismuth, now more generally known as n o 
metic, under the name o( pearl-uhile. For scirrhoiui 
fections of the stomach it has been tried successfully 
Caniiinati, of Pavia; and ap[>3Tenlly with ecjual advui 
in Fraucef- Independently of its discutient power, it 
the virtue of allaying initatioa in general; and, oa this 
account. Dr. Odier, of Paris, has employed it utisfaci 
in moet of the acute diseases of the alimentary caual, 
ctally in pains of the stomach, dianhcEa, and colic, oa 
has also in hysteria, and even in tooth-ache j:. The beat 
form of giving it is that of pills, in doses of from four le 
ten or twelve grains, four or hve times a-day. 

In the meanwhile, we must never forget, that our prii 
object is to restore the stomach, or the system at 
where the stomach is only secondarily affected, to tto 
proper lone and atrengtli. 

The general plan, as I have already hialed, tntuc be thii 
sauie; for as tJio virtues of medicines can only be coaum- 



ur le I 



•LmwuCB. FU17, lil.D.,F.II.«.,«aiht lallumM of aiUSctal i 
din* In «cnaln Dimmo, kc. 4ta. 102i. 
t ncMumi, JouiiL di Mid. MM. U&iir, HiifeUnd, Ncue. Annska, imi I 

^ut. 

* Jmrn, itc Hid. MIB. UtW. 




CL. ].] 



UIKESTITB PVKCTION. 



[OKO. 



nicated to tho system at Large through the medinm of tho Oxs. V. 

stomach; and aa the state of ihc latter has at all times a ],t,^,^ ' 

ponerTul iiifliience upoii tho former ; there can be little UfiiKptU. 

doubt that, by improving the dii^t^Mtive fuiictton, the vigour 

of tl)« syittem will he improved g«ncmlly at the same time, 

uid consequently that the energy of the whole of the mor- 

ing fibres will be increaeod: while the oolUtenil means of 

cure lliiil are applied externally, as those of uir, exercine, 

and Hca-batliing, and which arc chiefly designed to operate 

on the system at large, will convey an equal advsntnge h> 

the Htomach. 

Tho principal evils we have to encounter in dyspepay 
are, deficient action, and a relaxed atatc of the librea. For 
these, there are three classes of remedies to which we may 
have recourse : fitimulantx, to iiicren.te the action ; and bit- .HUmuUnu. 
ten and aatringents, to au^ent the tone. The first, how- 
ever, are of very doubtiul advantage; for a Ux stale of 
fibre* will bear very little increase of action without in- 
currini» an equal incrcaw of debility; and hence stimulurits 
can never be rt-comroended alone, except in cases of emer- 
gency, as to remove a severe fit of pain or other inconve- 
nience, and then only for a short period of time ; but they 
may be combined very advantageously with either astrin- 
gents or bitters, and particularly with those medicines that 
possess these qunliticK jointly. 

Bitters, beside)) restoring tone where it is wanted, hare Aiirbgciits 
another and more immediate advantage in the disease be- ""' ''lnci». 
fore us : for they directly attack that tendency to fermenta- 
tion in the stomach which is one of the most prominent 
features of dyspepsy, and which is, indeed, the chief cause 
of the flatulence ami acidity that so gcncnUly accompany 
it. Of this we have no doubt ; for the experience of every 
ddy brings itt testimony: and we employ bitters, as hops 
and quassia, for thiK very purpose in our fermentable 
beveragea. 

How far it may be true, as conjectured by Dr. Cullcn, Whstho- 
that bitters, Ixkv stimulants, possess also some deleterious •'"'X'lwtroy 
property; and that a too free and long-contmued use ol myciicum- 
thera destroys that very tone of ll>e slomnch* which « »'*"«*• 



• JUac Med. vaL li. p. fit. 




204 



CL. I.] 



CdLIACA. 



[OBO. 1. 



Or*. V. 

Srrc.VII. 

Thrb n(U> 
tlntovti 

bnlv ptin' 



nulHiila 
of niuti 
*crric« in 
uniaon vilh 



Mrrrh uw> 
tut ta I 
nimabal 
and UticT. 



C— luiwr. 



WhcMlbc 
tofhyti- 



Bhorter and more moderate emplojroDCBt bu esUblishtd, it 
is not at preseot wotth while to inquire, as vn nhiill bare 
occasion to r<!turu to the Hulijt^ct wlirti treating of the na- 
ture and cure of gout. Thnt m>nie of them contain a mt»- 
diievous and even a sedative power in union with a bitier 
pfincijile ia unrgiiettioiutblv, for we tee it distinctly iu (he 
hop, Uie igiiiifia amafo or Dnx vomica, and more especially 
in opium; but to oMribe tliis sedative or narcotic qnstity 
to the biltor principle itKcIf, oa Dr. Cullen does in bis ex- 
pliinntion of the nnturc of gout, 18 only to tttart one bypo* 
lhi.iti« in sup)>ort of nnullier. And iim the ^ood i» uiK|iict> 
tioiuible and inimcdintc, and the evil doubtful and retnota, 
and in every view niuy be easily avoided by a careful at- 
tention Iu lime or 11 ciircful n^jcclion of such bittera aa may 
be suspected, it is to tonics of lliix kind we ought to ban 
recoBTse without hesitation, and to look up with a coo* 
fideiKO of success. 

Stimulants, astringents, and bitters, are, thcD, the tbtee 
classes of medicine, with which wc are to make inrotd 
against the intrenchment of dyepepfiy. They may oftea 
be conveniently united, and bave tlieir forces hereby in- 
creased in a more than double proportion, llie stimulanU, 
indeed, ought rarely to be employed by themselves, exi 
in spasmodic pains, or some otlier temporary extrenit; 
Many of these may be found in the list of canninaii' 
already described under the species Cahoialcia. 

One of the most valuable medicines of the kind 
under con temptation in myrrh. In dosea of itix or 
grains, it will olltm excite an agreeable warmtli in the 
much witiiout increasing the pulse; and, when it does sot 
sit cosy in tlio iwwder, it should be givvn in an exi 
loade witJi water, in which form it is |>uculiiirly mild. 

Tliere is ait o!<l medicine, whose virtues upproaoh 
those of myrrh, now no longer in use, which also pccali 
deserves a trial in this discuHe, and thnt is the cassatnum 
or oismunar, a tuberous Indian root, bu«rin)r from its j> 
or circles sonic resvmblsncu to galnngnl. It bos the 
of ginfrer, with a mixed taste of xvdoaiy and campbor. 

I have observed thai d)'spc|)isy is often gntfted upon 
hysterical or hypochondriacal dialhostK; luid in thcMt 
we nuiy indidgc in stimulants of a much wmmicr charaeler. 
IIS cumphur itself, auafoitida. the alliacen, the spicy *n- 




L 



M 



ct. t.] 



DIOKSTIVE FUNCTIO:*. 



[on». I. 



I 



tnatice, and ercn CHp«ic»m. Of Ihc last it may be re- 
raarked that, though tlic liottvst of si) the pe{>]>eTH, it has 
ft less tendency to product- coniplnint« of the head than 
any of the rest. ItU onoof the bestcimninnlivei* possible 
in the case of flatulency from vcgctiible fond; and ad- 
mirably calculated to remove that »loiiy coldness, which 
dialreues a weakened stomach when attacked by a transfer 
of gout. 

In Kdlccling from among the simple bittcr«, vre need not 
Iw particularly nice, for their principle is the same; the 
quassia pvrliaps possesses it in the highest degree, though 
Mmc have doubted of this; then the gentians; and next 
to tliew columbo. Of the gentians ihe most powerful 
MCiDs to be the g. purpurea, Rrat imported into this coun- 
try by Dr. Home, from Norway, and then known by the 
name of ciirsuin, from its Norwegian name skarsotc. Aa 
a simple bitter ttnt Ijcst to unite it with some aromatic. The 
tincture of gentian of the London College, which is an 
improvement upon Stoughton's or the stoniaebic elixir, by 
exchanging Ihe cochineal for the smaller cardamom seeds, 
is an execUent form for occasional use: but iis alcohot 
should be habitually abstained from in the disease before 
U8, it cannot bo employed alone in such quantity as to pro- 
mifto any real benefit, though it may be allowed to enter as 
nn ingredient into more compound rpmedics. 

The bitter of Ihe columbo is combined with a slight and 
not disagreeable jiungt-ncy. and has an aromatic smell. It is 
hence peculiarly calcubited for dyspeptic allections, and 
in most cases will sit eany on the stomach, in the form of 
powder in doaes of fifteen or twenty grains; and will 
often give a check to sickness, where bile is not pnesent, 
more than any other medicine we can employ. It is singu- 
lar, that, to the present hour, we are unacquainted with the 
plant that furnixhcs this excellent dni<r. Commeraon be- 
lieved it to be a species of meni^pennnm ; and Wildenow 
a species of brionia. [Formerly, the root was erroneously 
Bupposcd to be named from the capital of Ceylon, which 
was regarded as the place from which it was exported. 
But, according to Dr. A.T.Thomson, it is now known to 
be a staple article of export willi the Portuguese ut Mo- 
KBn)bi({ue. whence an entire root was taken to Madras by 
M. Fortiit, in 180&, and a plant raised from it there by Dr. 



SimjilB 
biiitn. 



Otntita, 



(.*uluu]bo. 




-^OG 



CL. I.] 



C<Ki.lACA. 



[OSD. 



gnu. vir. 



romptiuiiil 
Iriltm. 

Niu 
toiiiIm. 



n onn* 

VDUll. 



iiic> 




AndexHon. From a drawing in tho pwiwJOft of the LiB 
Dtean Society, the plant appears to bo of the nutumJ orda 
or M«niap«riUGc, but the geuus caonot be determined, 
co<i«equen<» of the female Bowers not having been as y« 
seen *.] It seems to have been first noticed by Redi 

There are several other plants that possess a bitter 
ciple in a more intense degree than any of iheae, aa 
nux voniicn, and wormwoud: but they are not simt 
bitters. .The first is a stimulant narcotic; it takes offl 
sensibiltly, but rendent tho hvad coiifused; and at 
same liine excitvx ihv irrilublu fibrot U> irregularity of actio 
It Iiao no preteiiiiionB to be employed in the d)»order before 
us. Whether wormivood possess any thing of the satntj 
principle, I cannot satisfactorily determine. If it be pt 
at all, however, it exists only in a very small proportioi 
sad the plant as a stomachic is greatly improved by 
possession of a stimulant essential oil. It is poriiaps 
gralefuJ than the hop, though at one time very gener 
employed in the compoflition of purl; but so far as I haf 
been able to judge, it hai« all the medtoiual propertias 
the hop in a much higher degree. 

Ah a plant uniting Uto two principles of an estontial 08 
wann without being unduly stimulant, and a poweritd 
bitter, tho chamomile is, for the purpose before us, one 
the best remedies that we can select. It may be lukni 
a watery infusion, or an extract; but if in the fDrmnr. 1 
nien^ruum idioutd be clo«ely covered, that as little 
possible of its volatile nroma may fly off. And it ^ouU 
be farther obsenod, that the infusion sliould not be con- 
tinued for longer tlian an hour; and perhaps a 
period may suffice. 

As wu Itarc medicinra that unite tho two ifuatitioa 
bitterness, and a stimulant or aromatic warmth, so wa i 
those also that unite the two qualities of a bitter tuid u 
astringent ; uf which thct cinchona fumtshn lu witli > 
striking example : and hence this medicine baa been lone. 
and dcMcrve<lly, one of tbe most popular of any fur debib- 
tics of all kinds, whether of the digestive o^;ank uJone, or 



■ Lmlon WifMHii'/. M cM. p. 78. 
t ExpcriaMto dm ft« NaMsbs p. I4X 




CL. U] 



UiaCSTIVE PUMCTIOK. 



[OHD. I. 



of the Kystem generally. The cascarillu burk hiu prvtctw 
»ions of a like kiad. but far infvriar in degree, notivitti- 
8li>ii(liiig lliu Iiigli eucomiunis thut have been paid tu it by 
the Stahliin school, which ondoavourod to bold it op w a 
rivtil to the cinchona. There are many stomachs, however, 
which will not bear the latter, even in decoction or infusion, 
and in such caaes, eitlier the sulphate of quinine, or, in lieu 
of ihiH, the cascarilla, may be preticribed. 

The acids, botli mineral and vegetable, are valuable 
eslnngeots in particular states of the stomach reHultiog 
i'l-oni dyspepsia: for it is obvious, that from the tendency 
of this organ to co-opemtc in ho mnny cases in the {uro- 
duction nf m supcrnbundant ncetouK fermentation, ucids 
cannot at all times be hiid recoiirae to. I have occasionally, 
indeed, employed the mineral acids, and pnrticubrly a 
mixture of the nitric and muriatic acidn. in the proportion 
of one part of the former to two of the latter, (or the 
I purpose of checking this tendency to acidity, in several in- 
stancee with success; but the plan has not answered ge- 
nerally; and it will hence be better to limit thb class of 
medicineii to the intention I have already [tointed out, or to 
delay titrm till we have by other means overcome tlic dis- 
poaition of the stomach to tliis morbid action. 

Tlie other miners) astringents, wliieh have been employed 
bvsidcK acids, are not numerous; and may be limited In the 
preparatiotiB of iron and zinc. As j^neral tonics, these, 
under different forms, have proved very extensively suc- 
cessful ; but tbey are less adapted to dyspepsy proceeding 
from primary imbecility of the stotiiBch or its adjuvant 
oreaos; or I should rather, perhaps, s«iy, that they are apt 
to disagrw with these organs till they have been restored 
to some increaaod degree of lone, tx-yond what they usually 
possess when medical aid is nought for, 

I have observed, that there is always some degree of acid 
existing in the stomach in a healthy state, and wo have 
Men. thiLt one of the otost troublosonie Byn)plx)ms of dys- 
pepsia is a morbid increase of tliis principle. And hence, 
upon an idea that the aeid, if thus formed in the atwnach, 
may of itself be eutHcienl to answer the purpoM of the 
8ulphorio and reduce the particles of the niclul to a due 
degree of tenacity, botli the zinc and Uic iron are also fre- 
quently employed iu Uic simple form of (iUngs, rust, oxydes. 



Acidi u 



^ 



P n pitr . i. 

lioi't of iran 

JilJ ODC, 




206 



CL. I.] 



CCBUACA. 



Oeh.V. 
Sr(c. VII. 

Simple me- 
uUlcprc- 

udIic irldi 
thcitcld of 
the iM- 
niacb. 



Sulpliain 

imietiblcti) 

oxyia. 




or caloeii; and often with the happiest 8nccn«. And tt 
an acid adequate to this end does id most caws exwt in < 
stomach, is sufficiently proved wh«ro the ruM of iron i» en 
ployed, by tlio black colour of the stools, which may be 
garded as a test of the proper solution of the iron ; as it 
may be also of the existence of bile in a state of health] 
bittemeaa: for it is by a combination of tlio iron with 
bittpr principle of the bile that this blackness, vrtiicb isi 
natural ink, and obtained by the same means as artificii 
ink, is produced. There are some animals that have 
power of forming this sort of natural ink at cation, as 
BCpia or cuttle-fish, but whvther by a solution of iron ! 
cannot undertake to say. This, howerer, is very probal: 
if it be used, as it is E^encrally understood to be, by i 
Chinese, as an ingredient in the nianvifacture of Indian Je 
The cuttle-fish, when exposed to danger from the attacli i 
an enemy, throws it forth ver)' freely, employing it, ind* 
as a means of defence; and efiecting his escape by' 
converting the water around him into a black inuddii 
that KutKciently conceals him from fiew. 

It is on this principle that the tlovren or oxyde of lie 
have by many physicians of great reputation been prefer 
to the sulphate : and it is certain, that, in the fonn of 
oxy<ie, we can introduce a mnch larger quantity cither • 
7.inc or iron, than in that of a salt: but it doeit not folloi 
from this fact, that the metal may be more etTicacious; fa 
from the doubtful measure and strength of t]ic acid esistin 
in a free stale in thu stoniach, there may not be enough 
dissolve or form n sail, with the whole of the dose, i 
consequently a considerable portion of it may be lost or i 
main inert. And on this account I think it better to hal 
recourse at once to the sulphate of both these mi-tnls, wbea 
ever it be judged expedient toOBpIoy them, than totrusM 
the chemical changes that may take place with so mac 
precariousncss in the atomach. 

Ill employing the metallic salts, and, indeed, totuc 
every kind, in disahUities of the stomach, it is a good . 
to begin with small quantities, mod advance to a full dc 
by degrees; thus reversing the method that it may ' 
be found advantageous lo follow in acute diseaan, wb< 
the life of a patient may depend upon a bold practic 
adopted instantaiHWUsly, and grndually re»iitl«d, as totm 




CL. t.] DldBSTITB rUKCTIOM. [OAD. t. 209 

aa the object lia« been obtuincil. The chronic characler Ock. v. 
of dyspepey OQ ihe contnuynllows us time; am) an no two jj,^^, 
atomacbs will perlwpH bmr tlic tnmt! ])r«oUe ilottu ul a VjtptfaM. 
remedy, with the sftme procitic cD'uct, on account of the 
caprice of this organ in a deranged Btate, it is better to Ted 
our way before ub, and to reach the proper point by de- 
grees; for if we orerKloec the patient at find, wo add to 
the diftease instead of opposing it, and requiro many days, 
perhaps weeks, to bring him buck to tlie acttiul state in 
which we found him. 

In conjunction with thi» inlernal treatment it is pro- Volulim 
beUe, also, that an cxtumal application of llio voltaic ff^'^Lllii, 
|>ower to the stomach may incrotiso it« vncrgy. In the 
band.i of Dr. WiUon Pliilip, it appears to have been of 
decided advantage. 

[According to the reports of Dr. A. T. Thomeon, Dr. Ptuaii 
CranYilIe*,and Dr. Klliotsoni-, the prussic or hydrocyanic*^ 
acid is a valuable medicine in many cases of dyspepsia. 
Eighty years ago, it seems that nurses were in the habit of 
rehering the tfatulencc of infants by putting into the pap 
e laiiret-lear];, the virtue of which is supposed to have de- 
ftended upon its containing a minute quantity of the acid 
under con^dcration. This remedy, howeTer, was diatincily 
praised by Sprcngcl, in 1814, for its good ed'ccL* in com- 
plaints of tlie stomach, dyspepsia, and hypochundricixiK^; 
and even at earlier periods, for these and other cases, by 
Ilufeland, Ilallor, Swodinur, and others. The dose for com- 
mencement may be three minims of the diluted acid, thrice 
a day. One of the most distressing symptoms, sometimes 
attending dyopcpoia, ix iinefltiiness in the chest, with occa- 
sional AtH of palpitation; while, in prinuiry organic diseases 
of the heart, many of the most troublesome symptoms of 
dyspepsia also occur, particularly flatulence. In such cases. 
Dr. Macleody recommends the exhibition of hydrocyanic 
or prussic acid, hr a means by which the jiativnt's KniTer- 



* Ilbiorical and Pmnital Trcttue nn ihi; lljnliucj-injc Arid ia Pulmanuy 
OoMwrnpiion, fcc Sa edit. flvo. ISSO. Alxi, l-'utlin Oliiervatioiu. &c. lUID. 

^ NuDicnnif Cum, DltutiMlTC of thr KIHcdc^ d( ilic llyilnxjwiic oi Pruini: 
Acid in .^fftctlnn* of the Klnciiacli. tiC flvp. Iffijlr. 

I lAopiih, Phyv Exp. oa Dniw*. { l*hintiMalicla. 

II M«d. Fkfi. Jmirn. 

VOL. I. r 



310 

Okn. v. 
Sne. VII. 



:l. 1.] 



CIZLIACA. 



(lencnl 

nilcs. 



Dili anil 



in^ may be considerably lessened. In one iiiaUuice of 
diMiaBCil ti«wt, uccoiiipunicd by dyflpcptic cvinplniiiU, Ua 
drops of dilated prussic acid were prescribtd in u fivo> 
ounce mixture, ofwhicli two table spoonfuls wi-rc taken at 
first three times a day. and afterwards ibc whole quantity 
in the course of twenty-four hours. From Dr. Macleod't 
account, the medicine rendered the patient's journ^ ta 
the grave much more bearable, than it would othonria* 
have bceo-] 

U'liile, however,' a proper course of niciliciiie is pimiudi 
a proper counse of diet and regimen niutit nccwnpaiiy it, or 
with the utmost profeseional skill we ftliall make no ino- 
greaa. And hcnco to the remarka already made at tha 
oulMt, that where the disease has been brought oo by t 
life of indolence, sedentary occupation, or too free iii> 
dnlgence of any kind, the general habit niust be chaDgvd, 
and regularity of meaU. sleep, and exercise be rigidly in- 
atHted upon, it is necessary to add a few other obserratioM 
to the «iune purport. 

One substantial meal of solid animal food daily u anffi* 
cient for a man in full healtli, engaged in a life of ordinary 
hihour. Yet there are maiiy who, witlioul any lalmur. ara 
from A long habit obliged to lake two or even three. But 
tJie hubit U bad, and cannot too ftoon be broken throa^ 
ItfoUows therefore, of neceesily. that, where the atonmdiia 
weak, the toil of digesting one full meal of nninui) food it 
the most that should bo put ujton it. This kIiouM Iske 
place as nearly as may be to iho hour of noon, cerlamly 
aot later than one or two o'clock, so as to occupy the 
middle of the wakeful period. The animal food atiaaU 
cotuttHt of one dish only; and be confined to such as ii- 
lightest of digestion, or as tlie peculiar state of the aiomcfc 
may call for: for, in both these rcsjiecta, there ii a coe^ 
siderable diflerence. Thus shellfishes do not alwaya agrct 
with weak stomachs, and miU sonielimes excite 
easiness, wilii pyrcclic bent, and even throw out a 
rash, or aome other cutaneous eniptton. Yet where Htf 
ait easy and are relished, several of them, at llie crah and 
lobster, arc found to neutralize acidity in the atouincb aura 
readily and efl'eetually, than any other kind of animal fbod : 
on effect we should little predict, considering that the* 
give out, on a chemical annlyis, a smaller proportion "^ 





CL.I.] D)«B8TtVI VVKCTION. [OHO. I. 



tHBienia than the fletih of quadrupeds, birds, orevou '^^' J*'^''' ^U 
phibialft. The food o( young uiiniaJs ia kss nutritive than luu»ii 
that (if old, but it is, ill gt^nerel, digested with Ipsa irritation' Dppcpila. 
Mitny writers have nrraniffd the difTerenl animals ih&t fur* 
nifh food in taUw, founded upon their supposed degree of 
Qiitriinenl. But tliey have drawn them up with consider- 
mhle vtiriations; in some instances apparently nccording to 
their own fancy. I hav« not space to enter into a coio- 
pariflon of these, nor ia it necessary. Those who hare 
leisure for such a study may turn to Dr. Danvin's. which 
is perhaps one of the best, and which they wiU find in hiti 
Zoonomia. Generally speaking, the tcnderest food is that wim toait 
of the gallinaceous birds: then that of the ungulated cjua- *■""«'" 
drupedrt; among which the sta<r, orcervua kind, cKiinis IheamflnR 
pre-etnineucc; and to tJiiit succeed the ox, xheop, and hnrv, k"''"^ 
in the order in which they are here placed. Yet it should 
be observed, that the last, though leas nutritive than the 
preceding, is more eattily digested than several of them ; as 
it should alHo, that the flc»h of niiiniulM in Uieir wild or 
native state, though less covetod by n pun>i>cfed palate- 
ofTeiB a more whoK-iuiinc and dii^cHtible aliraeiil, and ia 
more perfectly animidized, tluiii that uf animula cooped up 
and fattened for the tnhlc. Kulow the hare, we may place 
the web-footed birds that arc ordinarily brought to market; 
and below these, the oyKtcr and lobster tribes, and lastly 
the numerous »enc-rH of fishm. The simpler the cookery Cnkfry 
of all these the Iwtler; for the comnlirattd proces«?6 em-'^'","'^ 
ploi>'ed to gtve new torms to tite productions of nature, or 
even tn hreiik them down for the use of the stomach, and 
thus keep the masticatory organs in a state of indolence, 
injure, instiiBd of promoting the health of a dyspeptic pa- 
tient. We have already observed, thai the saliva forms an 
important part in the chemistry of digestion, and it in best 
applied to the food when 6rst secreted and in the act of 
aiaatication ; and hence if this act be prevented or sup- 
pvBBsed.the food is without one of its auxiliaries. It h on 
this account, that concentrated jellies, and all mnithcd 
dislics, sit more uneasily on a weak stomach, than meat 
taken in a solid form. 

The regetable nutriment should he mich as ik leuit dis- Mlui rto'- 
po«ed to fbrmeni in t)ie stomach: and hence all kinds of '^1''' *?? '" 
new bread, sweet preserves, confectionary, and pastry must 

p2 



1 



^ 



f 



212 



CL. I.} 



COtLUCA. 



[oRD. r. 



Okw. V. 

SPKC. VII. 

Iilmtxta 



MMfaWmu 
MfMHonail 
ariMlob 
able mnl). 




be HedutouMy avoided; atMl Uie crust or brcftd, tottsted 
bread, aud unleavened biscuits uke tlicir jUncc- Tli« Ta- 
riitacea, nhcther seeds or rouls, as rice, wlicut, flour, in the 
form of light and simple pudding, and polatocH, may b« al- 
lotvcd in modcmtion. Water loo is llic bent beverage; but 
whcro there is great flatulency, n small portion of biaiidy 
may occasionally be added. The only contlimenta Uiat can 
be conceded ue salt and spicce: pickles niiglit be admitted 
where acids constitutv a part of ttic medic.il treatment; but 
they are disposed to provoke a faUc appetite, and hence to 
weaken tlie stomach by ovcrlondinj; it*. 

From fixing tlic principal mculxo near tlie hour of noon, 
it is clear that we Buppo»e the day to commence at a very 
diflcrcnt period from the ordinary refrulatioiift of Toithionable 
life; in which tlic bed w rarely quitted before nine or per- 
haps ten o'clock, after a night of impcrrvct and revcriab 
sleep, when the languid idler immediately proceed* to it 
breakfast of tongue, ham. and eggs, in addition to tlie 
ordinary materials of his meal, as though he hkid been alr«ttdy 
labouring in the tield for two hours; and by uiL-ans of tJieir 
combined stimulus, fills his stomach wilh a lo«d, which 
might indeed do good to the husbandman, but to himself 
proves nothing more than a mittchievous oppression. Yet 
to this morning toil of the stomach succceils, at about (wo 
o'clock, the ordinary luncheon in a still more solid shape; 
followed in the evening by a dinner of numctous counwa, 
with high seasoned condiments and a stimulating change 
of wines; the real business of Ibis vain and frivolous IJlb 
perhapt not commencing till the better-diaciplined peatant 
has begun his quiet sleep : when, roused by a flow of fac- 
titious spirits, and primed for gaiety and gallantry, the 
votary of pleasure, &a it is cullod, sallica forth to join hie 
comradra at the allotted place of rendezvous, and to paaa 
the midnight in hot and crowded ball-rooms, or in orgira 
of a still more exhausting nature. Of the whole of this 



■ On the aibje« of Ditwba, (he luaer taiij cmmoIi ArirathnM m ihe Ni 
cf Allmceu, Itio. txMiil. i;.ll ; Kord]r(« M tAg»titiat Rro. Lent. ITMt 
J. Abmnhjr on IxKii Dumw, including Dawfoiicnit of ih* 
(hipUMi A. P. W. Philip on Ind^Ucm. Bra. Lond. WCt X A. 
DiM. tMHi. \«nt J. JtbMUai vn Mmm Swribilkr <tf ibt SiuRiMb, 1 
1037— Cot 10 a. 






CL. 1.] DICeSTtVE FUNCTION. [URD. I. 

career, ihc only ratioitul pari of it is the luncheon n little Oex. V. ' 
after mid-day ; thU may be copied hy the invalid buforc un, LtaoilT' 
fttt his dinner, but Troin nil the n-Kt wc miiKt carefully ithtit t>j*pqMb. 
kim out. He should quit hi« bed by six or seven o'clock R'i'ik. 
in the morning ill tbe ttummcr, iind by itcvcnorcight in the ^.j^,' 
irinttr; and, after iiuvingriscn for an hour, he may purtake of ""n't mJ 
a li^t brenkfaiit of milk , cocoa, saesnfrns. or any other aro- 
Ruttic or wunn-flavourcd tea, with toasted bread, tlie cruftt 
of bri-Hil, orsea-biscuiu, at) obeL-rvcd already. Tbe morning 
may be devoted to sucii cxcTciBes or rcctcutions as may be 
most u|!^cnble without producing fatigue. To this will 
eucceed the chief mcnl of the day, upon the plan already 
laid down; and a li^ht rcfrcMlununt of the same nature as 
the breakfast should conclude the daily diet, a fuw hours 
befoTo retiring to rest, which should never be hiter than 
eleven o'clock. Sca-bathini^, or (he showLi-bath, before 
breakfast will considerably add to the mcanii of improve- 
ment wherever these advantages can be enjoyed, and par- 
ticularly when the warmth of the season may give tbem 
the character of luxuries. 

[The Hv^'tcnti) of dietetics oflerod to the world are iunu- No«y»inii 
meraUe, and marvellously contRwlictory to each otJier. ^ ' ,'[^],'" 
Some, looking with an evil eye on the refinements of so- m every 
ciety, would bring UKback to tliesimplieily of savages, and'"^"' ""' 
have us live " acconling to nature." Though, when we 
ask, witii the Frince Kussclns, what it is to live according 
to nature, we are snre to meet with no more satisfactory 
answer, tlian what was vouchsafed to timt noble inquirer. 
Tlie truth is. however, that our bodies would be as little 
bettered aaonr minds, by going back bo the state of savages; 
for it is now ascertained that savages are universally ahort- 
live<l, and subject to sudden and violent diseases. Popu* 
lalioD incre:iso8 slowly amongst them, and the henlthtest 
luid ttrongcst of them, if compared with the average of 
vrcll-fdi civilized Europeans, will be found inferior Iwlh In 
strength and henlth. Some theorists again would have uk 
live solely on animal food, and assert, that the human 
viac«ra bear vegetables " only in a grumbling way;" 
while otliers would reduce us to the diet of NebucliJud- 
iiezzar, and not leave a flesh>pot in our kitchens. The 
diRcrcnt notions on dietetics by uo means end here. Some 
sago doctors will never allow us to fill our atomacliK, and 
some hold that they should never be altogether empty; 




^ 



CL. ■.] 



CCKLIACA. 



[OKD. I. 



Qkm. v. 

SfKc. vn 




norne rcclaoe tlie whole inyatery of nutrition to a skilfal ex- 
hibition of Hiicce«Hivc Btimulanl*, and nthera to the exclu- 
aton of all that can intvrfcru with the balsntnic ttimplicity 
of the iuEJpid chyle; some hoM idl fermented substaaccs 
pcrnic ions, and others think fermentation the best prcpar»* 
tive for digestion. But, as the Judicious critic, to whom 
we are indebted ior the above reflections, baa observed, 
bow is it passible to say what is absolutely th« best diel 
for human beings, when vrc consider under what an inHnite 
variety of ditlcreiit LnbitH fuch beinprK are found to live in 
health and vi<rour, and by bow many opposite causea their 
health and vigour arc impinired? The same diet that is 
■aimtive to one, whose di^Htion haa been weakened by 
scanty and penurious living, cannot |>oatiibly be suitable to 
another, who has sufforcd from a long course of repletion 
and excess. The re^men that is most wholesome for 
youth is not likely to be well fitted for old age; nor can 
that which answers fur the active and Labottous be ptoper 
for tlio sladious aitd sedentary. Nay, yonr dry and adust 
subject plainly rcsjuirwt a dilTcrent regimen from that of 
the pltimp and Kucculent. A lover should not be dieted as 
a mister; nor a champion of the fancy like n prime singer 
at ttie opera. Every luan dill'ers from every other in somv 
of the important attributes of age, habit of body, occupa^ 
tion, temperament, and dispoailion, to which may be added 
climate; so that all rulca of diet nioM pluinly require itt- 
numerable modifications to accouimodute them to the ean> 
dition of those classes of persona, even if it were powtibU to 
reduce them to certain classes. Besides all this, tltero are 
special and apparently ca]>riciouH varietiea of digestiTc 
power, which tlie learned call idiosyncnisy, by which the 
appliciitiou even of those vmgue and variable nilea must be 
cotistaDtly frustrated*. All direotiona, which arc rational, 
must be foundi-d en the circumstances of tlie individual to 
whom they are oflefcd; and even then cannot be deemed 
valid, until tliey hare \h'vh confinned by hia particular ex- 
perience. Thegencndinitlrucliuns, given by the author of 
this work, with reference to the diet of dyspeptic peraons, 
may be conaidered aa good atwl valuable.] 




* 8e« Bilinb. tlciieir, NV SO. p. 39. 




DI6BSTIVB rVNCTIOK. 



[ono. I. 




. Ptopor U'lDpcraturo and clothing arc nUo subjects of some Oeh. v. 
iUportaDco; but as wc shali have occiisiun to cnlar^o upon if^n''-""" 
tiiesfl, more particularly when treating or riniiists, 1 shaJl l>r*p*[Hi». 
only obs«rve at present, that the feet and dicst should be Tcmpcn- 
kept especially warm, and that all extremes of heat and daUiinf. 
cold Ahotild be s^i'iliilouHly niroided; a i^cnerul glow on tlic 
•iirfaoc, when produced by cxerciJtc, will bo advantagcoun, 
but it should not be carried to the extent of much sensible 
perspiralion, as ti>i» might tcnniDale in r debilitating chill. 
And where (he lanj^uor is ho extreme an to prevent exercise I'-'enSK i 
abroad, tlial of a 8iving or rocking-horse may he had "j^;,^_ 
recourse lo at borne; or where these cannot be endured, 
that of general friction, in any oTtite multiplied forms now 
in uw, and i.-«pccially friction uf tlie stomach and belly, Frictiun of 
may be often cmpluyod an an ndvaotaneous sahslilute. ''""™™*' 
Every tender mother is well aoqunintt-d with the bcjielit of 
such an exlemiil stimulant to her infant; and when judi- 
ciously applied, it may often be rendered so to an adult in 
cases of great dyspeptic languor and wonkncss. 

[In the valuable paper by Dr. Abcicrombie on chronic lu- 
flammation and ulceration of the stomach, many judicious 
observations may be found relative to dyspepsia. From 
the fiicto which he has related, il appears that the above Dppqxic 
dangerous uflections of the stomach may exint with much ("'"piunt* 
divenity of symptoms. These may be severe and indicative u^uiie 
of serious disease, or they may be such as, without very^'"***- 
great Attention, are likely to be considered ait inemly dys- 
|>optic. In one case of extensire malignant ulccratioa of 
tlio mucous coat of the stomach, which was under the care 
of Dr. Chambers, no nausea and sickness exiitted, and all 
the symptoms, such as tormina, tenesmus, and frequent 
discharge of lunal) liquid bloody motions seemed to indicate 
disease of the bowels; yet tlie latter parts were found after 
death very little atfected*. There may be hardness iu tba 
region of the stomnch, or nolhinii may bo discoverable by 
the most attentive evaminiitiou ; and it is in fact cxtri:mely 
difficult to propose any rules, by which chronic inflammation 
of this organ can bo distinguiKhed in its carlit-r kIu^C3>i. It 
may be suspected, when there is cither permanent uii- 



* MM. GiuAu, vd. i. f. 63. 





CL. ,.] 



CtSLIACA. 



[OBO. I. 



Okk, y. eaaineaa in tlie rcerioii of th« Htonucli, or pain racurring 
iJm^ ' **''^* regularity after aieabt, luid incapable ol* preveution by 
DnKfifa. altentiwi to diet; when tlicrc is tcndemotx on preiMure, 
Mpecinlly if the pain and tvodcrncas be nln-uys rcl'errDd to 
It particular spot of small extent, and distinctly defined; 
wfaCDt along with tho sj-mptoms, vomiting occurs lit short 
periods n ft ur mcnls, and after food of Ihc mildest quality; 
ami when, without any urgent or defined eymptoms, a pa- 
tient, with aflcctions of the stomach, becomes progressirely 
weakened and emaciated, iu a manner which hiii symptoms, 
ifcoDsidci«d as merely dyspeptic, could not account for. 
As Dr. Abercrombie confessett, however, none of these 
symptoms can be depemled upon ; rooftt or all of them may 
exist in connexion with a i>tat« of the stomach which is 
merely dyi^peptic; and, under a more serious form, tliey 
may end fatally, with every ap|>cantnce of extensive diseaae, 
and yet no morbid change be discovered in the stomach or 
n<!ighbotirin^ pnrts. Vet lie rightly urges the rcnuntbrane* 
of the imgiortant practical truth, that symptoms, which at 
first sight appear to be merely dyK|>eptic, often depend 
upon chronic inflammation of the stomach. When tltfn 
are irroiinda for this itUKpictnii, he ihinktt that, though ge- 
neral btuediiig iit seldom admisiuUe, much benefit may 
result from topical bleeding, blistcn, issues, anlimonial <Hat> 
ment, food of the mildest kind, and in very small quantity, 
and tlie avoidance of stimuli and bodily exertion*. 

The foregoing obsiirvutions derive much confirmation from 
llic statements of Mr. Annesley. in the pracltcal workf 
which he has lately published. In warm climatc:«, he says, 
inflammation of the mucous membrane of tJie stomach is 
a very common form of disease; niid it takes place to a 
greater or lc«s extent in tlie advonoed stages of dyspepsia, 
the dyspeptic symptoms being truly the eHect of gastric 
inflammation. 

Some highly interesting obecn-ations on this subject 
have biteiy been ptdilished by Dr. Armstrong^; and, if 
they be oorreot. a part of the Jitrcrence in the symptoms, 



■ Sn Killnb. Mc4. mil Sut^, JounuJ, No. ^6. p. 12. 
t KnnudM* lM» llw CauK*, A^c. uf ibn Pttr^eai DlaMua of lodli, rol. I. 
linU. 4IO. 

Sr MmIiiJ Abu. «f tht Bavtb, Uta, mi9WBi^,p. tS. tu. tJaai. I ev. 






IIIOKSTIVK F13WCTIOM. 



[ultU. I. 



, in diAerent cawa, may in ftome <le!;ree be explained by the 

ketiionic iiifl animation belii^ Komctini«s Kituated iti the 
Mrous, Bometimos in the mucoui^, membrane of the Hto- 

I mach ; a topic, which will be further noticed in treating of 
gaatritis. Aa the above judicious phydictan has remarked, 
there is soroetbing forcibly striking iti tlie expresBion of the 

: countenance and colour of the »kin in most organic dis- 
eaoea. Thus, in tubercular diiteaitc of tlie lunj^ and cUc- 
wheie, the cornea becomes more shining, an^l tlic con- 
junctira more pearly and blanched than nntiiml, with a 
■oflness and almoKt pensiveneM of expression; while the 
&ce grows more and more sharp, and thcitkin ac(|uirc9a 
much more delicate huv- In scirrhus, the expression ia 
that of more or \etH solicitude, and Uic skin commonly hns 
a sallow tint, hke that of the pale yellowish willow; 
whereas, in fundus, the skin hoM neither the delicacy at- 
tendant on tubercle, nor the KuUowneMtt iicccnipanyiug 
fecirrhus; but it in often of a dull muddled white, almost 
resembling tlial of tiiUow, or putty. Some change about 
the face and akin will frcr|uentiy lead tlie ex]icriencc(I cyo 
at OMC to suH|>t:ct (\ve\i visceral demngemcni. Without 
bciog led away by first impressions, however, the patho- 
logist will be careful not to confound the rcatricular dis. 
talfaanoe and aallowi&h aspect of the sedentary and studious 
djrapcptic with any organic disease of the ntomach ; for, 
though in him the face be " sicklied o'er with the pule cast 
of thought," yet it ia moat frec^uently an indication merely 
of disorder which admits of cure, and. even if continued, 
may not at all shorten life*.] 



Qk». V. 
SPKC. vil. 
LlniDiU 



' AniuuDtig, Of. di. [1, 08. 



I 



CL. I.] 



ClBLtACA. 



[ORQ. 1. 



GENUS VI. 

COLiCA. 

COLIC. BELLY-ACHE. 



ORlPINfl FAIN IN TIIC ItOWRL^, CIIIKVLY ADOUT THI 
KAVBI., WITH VOUITINC AHU CO&TtVBNBSS. 

OsM.VI. TllKRK Are vaiiotiii dineases to which thiitdefuulion wUI 

_ np]>ly; but whicli, iierortheleM, dillcr from each other in 

twatf^^ teteni )aHic»lara. M. de Saiirages thought the*c pBi^ 

'™°'t^ tionlara of so much importance as to juBLify hioi in ul- 

vnnciiic; each of theae coi»{>laint8 to the rank of o <li8ttnct 

genus, uodei the namea ofgaatrodynia, coUca, rhacliial^a, 

CaUni'*u. and ileuH. Dr. Cullea, however, judged differently and 

ni>);fRi(ni. ^Qf^ correctly. Ue regarded their di&tiactioiiB as of nib- 

ordinftte moiuent, and in their prominoDt symptoois traced 

w eloBO a rMemblance as to iodicutu thoir bting a sort of 

natural tribe or femily; and he has cODsequently simpUfied 

them into one genus under the name here adopted, of 

coLtCA. In the rumi&cfttionx of hta xpvcics, however, he 

seems a little too difi'usu, and he hait uniwce«ttirily, and 

eontewbat capricioualy. varied a few of the ordinnry opuciAc 

Bunes, BB those of itEVs and nHACiiiALciA. Mhich. for 

reoBons assigned in the volume of Nosology, are here r^ 

stored. In other rospcct«, the present anangeuicut doeit 

not especially differ from Dr. Cullcn'ii clawilicatioa. The 

species that seem fairly entitled to attention are the 

following : 



1. CULICA ILKV8. 



ILBAC PASSION. 



2. 

3. 
4. 
6. 

a. 



BHACIIIALUIA. COLIC or FOITOll,OB PAIN- 



CISAHIA. 
FLATDLENTA. 
CUNSTII'ATA. 
COMSTKICTA. 



THUS COLIC. 
SIKFBIT. 
WIND-COLIC. 
COS)iTll>ATCO L'OLIC. 
CONSTKIC'TIVB COLIC. 




DIUESTIVB FUHCTIOM. 



[oii». I. 



219 



SPECIES I. 
COLICA ILEUS. 
ILEAC PASSti)?J. 

oniriNO PAri«, VOMtTIMO, AJID C08TIVRNRSS ACCOM- 
FANIKD WITH RRTRACTtOM OP THE NAVRt, AND 
SFASUS OP TUB MirSCLBS OP THE BELLY. 

Tbb nnme of n««»(ni«( or tlxU;, for it wm written both obk. vi. 
way») is entitled to veneration, as it lias dei^ceiidcd to us ^''*=*^ *• 
from the earlicet Orpck writers, wlio thus denominated it, Ithmcc 
eithfr from ihut introsuBocption or convolution of the intes- ^^w*'- 
tinni iuIk*. vrhich so of^cn accompanies the disease, and 
which is the direct meaning of the terra; or from the ileum 
or amiiU intestine in which the diseaae Is principally or 
most nHiinll)- waled, Saurages, and nearly al! the con- 
tinental writers, continue the tenn. Dr. CuIIcn ha» ex- 
changed it for spasmodica, an an adjunct to c-otica: but by 
perusing the comment to the Nosological Synopaiiji iu»t re- 
feired to, it will be seen that he has gained nothing hereby, 
either in regard to preci§ion or elegance. 

The griping pain or bellyache in tJiis apecies i« very Vomiting 
acute, and the vomiting is acconi[>ianied with a dischrvrgc, "ttcttt. 
not only of bile from the duodenum, but of fttvrcontccous 
matter from the large intentinea, or of injections introduced 
into the rectum; forcing their vrtty tlirough the titrong 
muscular valve of the colon, which wc have already no- 
ticed as being formed by a natural prolapwc of the ileum, 
for the purpose of preventing a regnrgitntion of the feces 
into this last intestine ; and evidently proving a powerful 
inversion of the jwridtnUic action through the whole or 
nearly the whole length of the intestinal canal. While gpumoOk 
the obstinate coetivenCES, which attends at the some time, '^•tric''°i> 
pretty clearly indicates a spanmodic constriction, though buwdi. 
rarely producing a total occlusion, of that part of the 
canal where the pmin is most violent, oAcn indeed extend- 
ing to nthcr purls, and even to thv bilc-duclit. And in this 
laat case, even whore ihc feces are discharged by the 




flao 



CL. 1.] 



CfSLIJtCA. 



[OBD. I. 



axN. VL mouth, they arc nntin^cl vritli bile, while all the sym- 
rSSiL . '. ptomK of jaundice supervene*. Hieiuorbid action is, in- 
deed, not uiirrc<)uentjy bo violent as to excite infianimation 
over u considcriiblc \tait of the inluHtine chiefly aflected; 
and coiMcqncntly to aggravate all tiie other ttyinptoma. 

And hoiice the disease is presented to us under the two 
following varieties : 



« Faicom. 
Stefcoraoeous colic. 

$ Inffaminatorix. 
Inflammatory colic. 



CMllicMl 

ducdl. 



The vomiting aoeompaQied with 
feces or substances injected 
hy the anus, 

Acoouipanied with eymptoms oJ* 
iuJIammatioo. 



The dissection of persons who have died of either of 
these varieties has shown uh, in some caaea at leant, that 
one portion of the aflectcd intestine, conatrin^l and less- 
ened in its diameter, has fallen into another (lortion be- 
low it, and thus produced what is called an intbosi's- 
CF.pTiON, or involution of its coats; but we dare not say 
tliat such an involution is common to every case of the 
disease, and we have reason to believe tliut in the slighter 
attacks it is not so. The fact is not dilHcuH to l>e ac> 
counted for; and it will readily explain the cause of the 
l^at torture which is often sul}ere<l under the influence 
of this grievous mnlaily. In every case in which the in- 
tettinol tube is WGukcned, llicrc is a very copious extri- 
eatioa of air. producing in many instances a pidpablc di»- 
tcntion of the parietes of tlio abdomen. In ileus, however, 
there is also, as wo have already observed, in conjunction 
with this, a strong inversion of the peristaltic action ope- 
rating from the rectum to tlie stomach, and forcing back 
whatever recrentent or other nuiteriaitt ore oo-acervated in 
miy jtart of the intestines, lliese, by intermixing with the 
vhtfitic vii)>oiir of the intestinal tube, b«ooaie very Tolii- 
minous, an<l distend it to its utmost rango wherever disten- 
tion can be accomplished. In one or more parts, however, 
of ils entire length, wo have aUo seen tlmt there is a vio- 
lent spasmodic constriction, through wliich the distentivo 



■ UmlwUn. Iliit. AtuL Cent- >. OS. Kphcm. N>l. Cw. Dk. i. Ann. 
»v.v. 




CL. 1.] 



OICBSTIVB PDNCTtON. 



[OBD. 1. 




force cannol prevail, excepting perhaps by soalchcs, or ncM.vi. 
(luring a remission of the spcinm. The two powcnt "re j^'^^'j^'^ 
h<:nc« brought into immedinte contactj and while the f^it VdmliinHof 
i» in consequence rigidly conlnictcd nhove. it is witU-ncd lK«indlii> 
almost to hursting below; nnd. during iJic fttrugfftc whit;h ^^^ 
ci)*ue>, a part of tlie imprisoned content* of the expfindtrd tounud ftr. 
intestine is forced upwards, nnd the coUnpflod portion of 
ihe superior intestine nt the etimc time slides downward al 
ic point of the Hlricture. 

In the midst of this spasmodic commotion there is also 
iher extraordinary change, which has been sometimes 
to take place in the relative positions of different 
fiart* of the intestinal tube. For from tiie urgency of the 
moving power that works upwards, the natural effect of 
i« gravitating power that works downwaTds, and the 
enesa of the convoluted canal il«c)f in many pctrls, and 
tightness from adhesions in others, it lias Bometimes 
nic twisted into nooses and knoti:; in which the por- 
tion forming an encircling cord or bridle has been drawn 
■o tight as to produce strangulation, nn<l render gangrene Oe«»i<m»l- 
inevitable *. In one instance, indeed, the spasmodic aclion liuJ^Sd" 
was so extreme, that the bridle not only produced slran-8»n(i«"<- 
guhktion and gangrene, but cut through all the coats of 
the intestine on the opposite side to the mesentery, and 
made an o)>ening of ahout an inch in leng;lh'l-. 
, Geoenilly speaking;, however, there i* more dnnger inScnmdr*. 
(he second variety than in U>e fintt: the symptoms, if not m™ir^ore 
MTJy opposed, are more rapid in their progress, and gau- dwRcraun 
grene ia produced in n slnrtcr period of time. Yet when n^ 
«n active and well disoriminaled courxe of triNilment is 
pursued, the inllammaliott it very frequently subdued, and 
the patient escapes without further injury. 

It is a i>ingulnr fact, that llioun:h ileus is no uncommon 
result both of introausception and intliimmalion, it »ome* 
limes takes place without either of them, or at least with- 
out intestinal pain or other manifest symptoms of inflam- 
mation or spasm; for which we have llit- authority of 
StoU^, lliidcr^, nnd Morgagni{|. Even where inHamma- 



• Mtm. lit I'AuuL KojsU. «ilU, par SI. 4< la PoTtouM. 

+ M«J- Ob«i.. .oL ir. J Ruio MtdnuU, *IU. 11*. 

) Ccnimcni. Movii, Oottlng, lilLL y I>c 8<illbu*. &c mii. IftSI. 33. 




294 



CL. I.] 



CCKLIACA. 



[OBD. 



n(<ulnJ 
taltt. 

DfMdn 
unadvU- 
■blc 



E'ltiii.-lini 

aimmnnlf 

Injurioui. 



Okv. VL gate tbo tpuo) and duntniHli Uie pttin. it will commonly 
CcTi^titai. '"^ 'ound «ii uwrul adjuuct, aiwl a jerkin or two of it mfty 
be given every six bouiB. Calomel, however, though sure, 
in Blow ill ita operation; and should hence, where tjie Ktu- 
maeli will bear it, bo united with some other and brinlcer 
unikd Bid) aperient. Of these the neutral salts seem to answer b««l : 
but if they cannot be rctninml, we must exchange titem 
for crystals of tartar, which are less likely to be thrown 
back. It is seldom (hut the dnistic purgutirra can be re- 
commended ; because if they do not Bucceod, tbey are apt 
by their Btimulux to excite inflammation where it does uot 
exist, nnd to iucrentie it where it does. 

Tlte relief, derived from the symptom of vomiting, is apt 
to lead a practitioner to prescribe cmotics; and the lari^ 
quantity of green and variegated filth thrown up by them, 
would sL^um to show that the plan ik judicious. But the 
benefit hence obtained ia very (ran»icnti and the moH>id 
iteeretton of feculent and bilious matter is promoted and 
augineitted by the irritation of emetics ; so that a itiiccofr- 
aion of thia porraceous recrement may be coolioually pro- 
cured by vomits, and the medical attendant may flatter 
himseirthat he is removing the cause, while he ia only in- 
creasing the disorder. And hence, wc should mtlier en- 
deavour to abate the itecretion by opiulcs utid other suda- 
tivcM, than excite it by emetici*. 1 do not mvun to »uy tliat 
ooneticD have never been serviceable, for where tlie disease 
(iroceeda from a foul iitoinach. they are adviwhle; and, 
by producing a determination to the skin, ihey have aW 
BOuietiniea succeeded as revellents : but they cannot be re- 
lied upon, except in special cases, and have oRcnttmes ag- 
gravated tlie spasm. The practice of vomiting is never- 
theless supportod by high authorities, though chiefly after 
bleeding. Dr. Stoll was in the habit of u^ing and re- 
|>eaUng emetics, three, four, and oven five time< with little 
interval*. 

Dr. Cullen, on the advice of De Hoen, recommends a 

rinnd'^ifa <™"*'''"^ stream of vrarm water tlirown forcibly and with 

•umvaier. a proper syringe into the rectum, so that it may play like 

water from an engine upon the constricted |>ortion of the 



RMtnm 



Rat. Mvd. pMi. il. p. lit. lU. 





CL. I.] 



DICP.STIVe rCMCTION. 




[oho. I. 



ititedttne; and <)«clur€s, Ihut he has Ibund this remedy to Okm. VI. 
be oiie of (he njo«t powerful anH cffpctunl. When the or- .^T,"^:,^ 
dmaty ineaiis, wio |iiirtiouliirly IIiobl- oI nurin "'JPCtionB^.j,,^ u_ 
Bod tbe warm batb, fail, Hotne pmctttioMrs hnvc been cou- ttaam a. 
rngeouB enouirh lo ti\ cold a|.plication» both extcniul iind ['"^,'j~' 
iatemal. Sir Geoi^e Baker ttlls us, ihal a pbytiicinn of 
credit informed him be had once pre!)cri)>e(l the cohl bath 
%rith success. And Citois al&rms, that, in several apeciea 
of colic, this was his constunt practice, even in the niidat 
or winter, and calls upon u)l his fellow-citizens to attest 
that most of hi* patienu thus treated had been restored to 
beallb*. Sacciuwaiii relatCKthc case of a person, inattntly 
cured by drinking a large draught of cold watcri". Pro- 
fessor Ploucqiit-t aflirnia, that be bait found it equally ser- 
viceable!, and Y.iicuiuH Lusitanus numitcs the history of 
a patient who apeedily got well by being rolled in snow^. 
But these are extreme iniitances; and, notwithRtanding tin 
occuional iiucce«s, the pnictic« is not ta be depended 
upon. It will prove mwt eAecttial where the colic is ac- 
companied witli, or produced by, hysteria. While,on the 
iry, where it has been occasioned by too violent diines 
Inatic purgatives, warm stiniulanis, as the oil of tur- 
pentine, and even brandy||, have been taken with grcit 
Mlraotagew 

In HD irthritic diathesis, the discogie has suddenly censed 
upon the foot being attacked with a ttcvetje paroxysm of 
gout, which in one instance effected n rulical cure where 
the oolic had recurred periodically for six yetrs^. 

Dr. Percival, Dr. W'airen, and various other writers Ho»f»r 
upon their authoiiiy, advise that the antispasmodic plan, *"|,'['^^ 
whetlier by the stomach or tbe rectum, or both, should rito-^U' 
take the lead, and the purgative plan follow. This will >'"'^^** 
always be found the proper order in utiuckiiig tiic painters' 
colic: but wo should luce much important time, and often 
allow the inflammatory symptoms lo gel fatally u-heud, 
if we were to adopt this tis a getieml rule in ileac passion ; 



* F> CtuU OpuKuU MfdliN, p. t\i. 

t Kfin. *. Hillcr. Bihi. .Ilctl. Pi. >ii. ]>. 001. ; Inli. uni. IL Colicx. 

I Piu. Adm. Ilbr. U. obi. -iX || ClOMlut. obt. i?. 

% Van Zalti, LiIkHui tisRul"^ ^ Pod^ri ti Colieo DoliM. Lauunuc, 



vol. I. 



J 



[UKO. I. 

e». VI. In wlttcli ihtt nymploms, if not more dimerous, are more 
C^aia *'^*'*'- "'"' tlemaocl n mow mpid march of treatmenl. 



SPECIKS II. 



COLICA RHACHIALOIA. 




OCX. VI. 

Srcc. 11. 
Sptdfi« 
lumc, 
vhcnce 
dniitid. 



|>CKCli|>- 



coLic OF porrov. pai>jters' colic. 

DEVONSHIRE COUV. 

THK PAIN .\T FIRST BOLt AND HUM ITTI f((t : BWT PRO- 
URKSStVBLY GROWING MOKK VIULKNT A S CON- 

tinvkd; extending to tiik hack and ARHR, ANIt 

AT LAGT PRODUCING PAKAt,Y*IS. 

From the painn striking through to the back. A«tmc 
first iJistiiigiiiBhed thiK xpecies hy th« nuiie of Riiaviiiai^ 
oiA (jhi^tiXf m), literally. " bnck*bon»-acheorapine-sche;" 
and ftfi the term in highly c-V|iresHivo, and baa been cdn- 
tiuuod by most of the cootiiit^iital vriitera, it is retained b§ 
a specific uamc in Uie arrangement before uh, uotwitii- 
standing that it has been dropped, or varied, or exchanged 
for some other, by neveral writers of our own country*. 

The pnin ia most commonly seated, from the beginnin^to 
the end of the attack, nt the pit of tlie ntomach. It iiat . 
first dull, but gradually grows niorfi mvere; and as it ia-{ 
crcasiw, extends apwards to the arniK, and downward* to 
th« navel, back, loins, rcc-Uini. imd bladder; and freqnaaUy 
to the ihighK ittui leK*. From tli« navel it •oraetiinea ahoots | 
with so much violence to cuch side that the jmticnl (Ma^ I 
ai>d HO cxpreiMK himxclf. hk if some panton wcfS cirtlia|;j 
him ui I wo. AlmoHt nil the •xtcrnal nuacha are rcndarsd 
aore by the great violence of the pain, as though they had 
be<.'n nl1'eeie<l with rlicumatiHin, and can scarcely t>car tho 
weight of the bMWlolhen or the HlightMt lonrli of a fingtr. , 



[* AtcoriUng (o Dr. Moara, the pailuiiinfliTiaiik (junpiDma n( iwinta's Mlic 
ai« ih« wiiw IwUlic^ ftin ibciul Iba util, nM iiKnaad b^ pnwutci ih* i 
tng^tKg Invar^ of ilic iLMoaiiiMl inuImoi, vhkh Imv: ■ ban] t^ i tmiamm 
nit<luW<MiiaMiili«iie». M(n^. Annl-nr Human (lulld. Ai. |i. 34C>^.fin.] 




:l. t.] 



ntr.KSTiiB ruMcTioN. 



[oKD. 1. 



227 



' ^(CDietiniea, however, the Hcat nf pain nltcmntM Iwtwfien obh. vi. 
tfw Momach, uhicb iieverllieleot, »n Juki observi-d, it never f^^ "' 
entirely quits, and the extciiiiil iiui-tclm: iti« violent in the rhKhUlffk. 
atoinacli, while the lower bowoU iiml thi: externa] ujuscles 
are at ease; or it nearly quit« it« hulil on the ntomnch nnd 
lower bowels, and rages through the tixu-rnal inu.-<«le8. 
SicliDesa is an early syinptom, as well as cotftivenem; and 
aa the jiaia in the stomach increases, the stickneu inereiutM 
also; even on the second day from the attack, the retohin^ 
are violent, and the dinchni^e thrown uj> consists of acrid 
slime and porniceou» bile. A momentury relief is hereby 
usually obtained, and the [lalicnt flatters himiwir that he 
ia about to recover. I'oo soon, howevc^r, <luc« he find him- 
self disapjiointed : au long as the {rain cotitiuiies, thii Hamt! 
morbid matter issecreted, and thrown into the stomach, and 
the retchings return with perhaps accumulated violence; or, 
if they do not, their place is supplied will) bitter cruclatiuns 
and hiccuiigha. The puUc, notwitliHtandinfr the sevmty 
of thi: suH'cTings, is little atlc-cteil at Hint, und for nevorAl 
days continues as quiet ns in liunith. After tlic I'ourtli or 
lillLJi day, however, it Bomcltnies becomes quiclccr, but not 
always: and it may admit of a questioD.whclhor the acce- 
lerutioa be not even at this period rather the cfTect of the 
tuedicincs taken toprocure relief, than of the diiieaKe itself*. 
[The Kkin. though generally cold nnd damp, U occasionally 
rather hot; Inil, in thU difLeatie, there appears to be no 
tendency U) inllnmmation.J 'I'he urine varios so much in 
difierent individuals that no stress can be laid upoa it. [In 
sofuecuses, the xphincter muBclc« of the bladder and anus 
aroMocontructirtl, tbiit the utirie and feces cannot be voided, 
and a cly«t«r>p)pe is difficult of introduction f.] Towards 
thecloM of the disease, there is generally s pain rcwnd the 
edges of the feet and at the extremities of the toes, which 
art) ol^ii red. and sw^jUen, and to appearance gouty. Re- 
lieving sweats breiik fortii, Mtnietimes accompanied with 
an clBorescenoe. About tlie same time, a griping of a 
difierenl kind from what has hitherto been endured, nnd 
which is more easily bearable, takes place, attended witli 
a disposition to go to stool: and after \nxf^ discbarges of 



• Di. Wbtto, Mfll. Tttna. ™l. H. p. W 

t f>n Mirnn'n Hubkd Aimi. ot tlic Ilwnwi iMln, A(. p. %**. 













.ctt^^^^^- 



COUC'^'' „.,^TEBS' 









'J2» 



C'L. I.] 



C<SLIACA. 



[OHD. 1. 



GBK.VI. 

8ri:i. 11. 
CcJin rh>- 
ddklgU. 

fan])' tic 
iiir.ttion of 
the upper 
nuemiif. 



Pnynotii. 



IK'VlHulliK 

nlic, bihI 
oilic I'f 
Poluni. 

Hcnot 

palnun' 
tMe. 



Kirious kini^B of cKcrcnit-nt, rn>quentiy of ncyliiifai or hard 
Ihidjih, ill shape resembling abeep's dun^, togctlicr with 
bluck and dirt -coloured sliiue, occasioually nitxcd with 
blood, the patient is peilectly relieved. {After ecvctal at- 
tiirJcii of this disease, a paralysis cominoiily afiiwU the fin- 
gera, or the whole band and fore-arm. so tbal the fonner 
becomv contracted, and the hand, when tite mm is ex- 
tended horixontaUy, han^ at a right angle to the arm, the 
exterior niuxclea being in both ca»ea more paralyzed than 
ttic flejcors. llie {KiLsietl limb shrinka rery much ; and tlie 
mueclcs lo«e not only their natural size, but also their natural 
structure, being convert*^ into a luioly subatance*.] 

In a mild degree and under the best tberapeut»c piftn, 
the dtHease can seldom be removed iiixler fire or Mix dnya; 
but if it be violent, neglected , or ilUlreated, it will continue 
for weeks or even nwnths, with now and then a IniM tor k 
few d:iy«; and will teiminalc in the above peculiar sort of 
pftUy of the upper extremitieM; or in douth, preceded by 
deafncwt, blindness, delirium, or epileptic fibt. 

The remote cause appeartt in almost every instance to be 
lead intro<iuced into the system, either by the stomach, the 
lun^s. or the skin: snd hence the disease is found moM 
fretgivently in those conntries. and under thoHecircumstAncM, 
in which this metal is most freely lucd or most radily di»> 
solved, In the neig-hbourhooH of smelling furnaces, pigs, 
poulti)', and other oniniuls evince the same complaiul. 
ThuB, too, in Poitou and Devonshire, in which leaid wu 
formerly employed to destroy the acidity of the weak winc« 
and <:iders for which these provinces are celebmtcd, it was 
at one time so common as to obtain the name of Devon* 
shire c«lic, and colic of Poitou. And hencoliouAO>[iaint«ra, 
whose occupation leads them to a constant um of lead, and 
who are, often, loo little attentive to |>erftonal cleanliiveta, 
an- to the present hour so frequently aH'cctvd by it as to 
give it the Ktill more general name of jMinlerR' colic. 
Phimtwrs. potters, el'i^i^rS' workers in glass, gilders, 
cheniiiMK, miners, mid priiitoi's, are, in like manner, exposed 
to its attack from the larerc quantity of lead contained in 
the mnieriaU they are continually handling. I attended 




* Sm llonro'a M«fl>iil Am. of Uic Ilunui tiuUtt. At. |>- 947' 



DIueSTIVB FUNCTIOK, 



[orb. I. 



some yean a^ n printer, who had Heverel times been af- <^>(. vi. 
flicb^d wilh ihis disease, but had fbrtunatcly recovered r^liMrtiiii 
fioni ever)- attack, though each return provi-d if«vcrcr lliun dilBlgik. 
the preceding. The cause had never been suttpeoted till I 
pointed it out to him, by inquiring whether, after leaving 
the printing-olHce, he was careltil tu wash his hands before 
he Nat douQ to his meala; to which be replied, that he h»(l 
never been put upon his guard on thix subject, and had, 
tfaerelbre, never attended to it. I rigidly enforced upon 
him the nece4wity of doing ko, and he continuuil for six or 
•efen yMn without tJie sligbteitt return. At tliis period, 
he u^in |*rew careleua and conlident; he again xuAered, 
and loat htR life. 

[The )»owiT of lead to excite colic and panilyeiit has 
been long known, tlu-Mc elfectB having been frecitiently 
traced to the necideutul or designed use of the metal as 
medicine, or in the fuod a»d drink. During the sixteenth 
und neventecnth centuritx, when prefiaralions of lead used 
to be given in hrgc doaes medicinally, tlie cohca pictonum 
ftod paralysis, in tlicir sevtrest forms, appear to have been 
very frecjaent. Ncvertht-Icaii, it wtia not tintil the invcstt- 
galtofui of SirGeorge Baker wi^re publiiihed, that the poison 
of lead was suspected even to bo thecommon, much lei«»the 
excluiivo caoM of colica pictorum. In countries where 
the disesw was endemic, it was attributed to n free use of 
tile Mub-aeid wineii, or other ncidulnuA liquora, peculiar to 
the resfwctive dlntricUi with which, in fact, it was very 
obviotisly connected. In the Weftt Indies, the endemic 
colic, called the dry belly-ache, is observed to be the con* 
sequence of drinking freely of newly distilled rxim; and 
this li(|uor is llierefore universally considered as the cause 
of the diM«»c, But, besides these peculiar fermented 
liquont, and other melidlic poisons as well as lead, certain 
authors give credit to several other causes; viz. imperfectly 
cured fevers, gout, thcumatism, tnleTrupled iMMvptnttioii, 
•curry, melnucholiii, and emotion* of the mind*. To 
titese latter circumstance*, however, no one now atlributefi 
the origin of the <iisctuse. As Dr. Bateman remarks, the 
only doubt which can exist at present is. whether sub-acid 

* TioKliin in CDlUa Ptct. p. 33. 




230 



tu I.] 



trati.iACA. 



[OMU. I. 



it ■ mm man 



OtM. VI. and flpiritaous liquors piwsoes any property, capaUs of 

(^ii^'ibi prwluc'ng tho (liseaBC iodcpenclenUy of ui impregualion 

chai^ ffitb lead? 

Various fncU, ndrerled to by thi» pliysician, Und to 
Mipport iho inference, Uitt lend, under Home modification 
or another, is the rciil cause of the discaM. The cider 
of Devonshire produced the colic mticli more frequently 
aod exteosirely than that of other countrieii, un of Here- 
fordshire; and tlio wines of some districtK on the cwi- 
tinont excited the dieease, when similar wineo of otbcT 

Thki loiil districts did not. Sir Oeorgo B;iker asceruined, thot ■ 
■mull quantity of load was employed in Mreral of the 
mills, iti which the apples were bruised for Ihc manttfacture 
of cider, tu fnstcn ilic iron cmnk>i wtiich connected the 
Ktoiie-work. Itiswcll known, too, that in severid coiiiitriM 
oil the continent, the praclico of awoctonini^ the wines 
witJi litharge, nud other prrpamtions of lead, wan very 
oonnwn, and thai, in thusc distiicu, the colic wtui par- 
ticularly prevulcnt. Dr. Mo«oloy was cautionrd by Dr. 
Mvugbin, of Inspmck, to avoid all sweet wines whatsoever, 
but pftiticutarly the common tavern wines, upon the road 
ill the Tyro) and in Italy. He never deviated I'rom this ad- 
vice but once, at Viterbo, and ifaeu be paid denrly for his 
iodiacrction *. Colica pictonum is very prevalent in thii 
metropolis and other large ti>wn8; yet Dr. Bateman never 
saw lui inMancG which naa not decidedly iracMl to the 
opuratiou of lea<l. A greot proportion of lious^psinteis 
and plumbers, he observes, have tlie dtaetise at some period 
of their liveft; nnd. in particular conHlitutionit, a very mi- 
nute quantity of lend will brinv it on. Dr. Fothergill haa 
recorded several cams, in which it took pliic« iti permm 
who painted in watcr-coloura, and were iu Ihc habit of 
pointing the {x-nci) in their nioullM. In addition to thcM 
facts, it dcftervrs notice that, in many specimctiH of cider, 
which were analj-ud by Sir. O. Baker, a small portion ol' 
lead wna detectt-d. Ami in the new rum of tlio West 
Indies, which excited the colic throughout Kcveralr»ginMmUi. 
while others were totally free from it. Dr. Hnntn' disco- 



TnailM on TmfWil Diicww, |i. >37> 



CL. i.] 



DICK8TIVB FUNCTIOK. 



[ORU, 



331 



vorcd by analysis the pTO«cncc of lead. Tliis lend nppcars 
to be clopoiMUd after a certain lime, uimJ tlic riiiii IcHtce ila 
noxiouB quality *.] 

The question was next &tait«d, aitd it bait been •larUd 
ugaiQ ia our own timeE, whether pure water, a^ well as ucici 
wine, be not capable of di&BoIviiig lead in a uietaliic state; 
»nd, coiiHe<iuciitly, whether the coniuiunity be not daily 
running o great risk of being poisoned by employing ihU 
oicul in pumps and rcservoim? The public mind wan for 
a long time vury much agitated by tbia discu&aion, and Dr. 
Percival tliought it ri|^ht to institute a variety of nice ex- 
periments to uUuy the gcnoml appreliension, by ftliowiiig 
that pure water im not in any respect a solvent of metallic 
leadt. Yet it wns a course hiirdly iiecuiiaary, aince lite 
daily use of lead in water-cistoins by upwaida of a mil- 
lion of inhabitants in this metropolis, without any inoon- 
venicncc whatever, was then, and still continues to )>e, Ute 
most dcciKivo and satiafa<:tory proof that can be ullorded 
of the insolubility of metallic lead in rain or river water. 
Ercn saturnine lotions a))plicd to the surface of tlie body 
have nirely, if ovor, been found dt-letvrious, allhotiijh tlie«e 
aim wore iit one time suspected of being highly mi»- 
chiilvous. lliey may pcrhapM prove ko in a few stingular 
■dioqrDcrasies, but tliey do not ali'ect maiikiml in general. 

Lead, however, m minutely divided as to impieguate 
the RUiio«(>liero with i(« effluvium, has frequently laid a 
foundation for liie diaeflW. But whether any preparation 
under the form of cosmetics hiiit proved injurious I cannot 
mkdertake to say. 1'he disease has certainly been produced 
by sleeping in newly-painted rooms, of which a btriking 
instance occurred a few years ago to myself. Tlic pationt 
was a siu^eon of highly distinguished cbnracler in ttiis 
iuvtJO|>oli.-(. When I saw hiui, at his particular request, 
he had bevn ill for a fortnight j ajid, the cau^ not having 
be«n suspected, his complaint was conceived to be obscure 
and anomalous. Tho symptoms, as they struck me, were evi- 
dently those of rhachialgia from lead; and upon |>oiiiting 
out to him my view of the case, I found that, about n mwtth 



UEK.Vl. 
SVKC. II. 

pun inier 
will diaolro 
IcMllns 
meullle 

•UK. 



I 



VTbdhn 

loiloni be 



Almn- 
hpliciT Im- 

with lead 
I III* giro, 
iliiinl I lie 
(litnuc. 



IDuBtntcil J 
tatt. 



• to BIc^TniH. v«J. UL Md Ucd. Ob*, wd Inq-iuL v-tstidm. (;oLi(.m 
ia ftn*'* rjilinmilh 
t Ubi. vwt GiiL on ibc I'uiH.i M' l<Md, bj T. FMelv«I. U.D. 1T67. 



383 



«L. I.] 



COtMACA. 



foRD. 1. 



Gcit.VL 
SriL-- II. 



PnnUu 
tll'ca on 

»Qnic con- 
•iilulIunL 



Oilier 
TUniplc*. 



Wutr, 
whca 
■MMnl, 
ra^nbli' of 




aotecedcntly, be IukI Mtut i)ie vholo ofhift ramily into the 
couutry, us liiti houM was ubuut to undergo a iKorougfa 
rei>air iu painting, wliilo Iiq himself rcnuiinMl at homo and 
siefH there. The cauM vnjt admitted awl act«l upon, but 
the diset^M had gained too much ground, a»d wma im- 
movable; his spiriu became deeply dejected, tavi he f«U 
a aacrilice in about two months Trom the attack. 

In thi.- Mvdico-Chir. Trans, is a case communicated by 
Dr. Badeley, in which Uie patient, a domestic in his own 
house, lost her speech and became paralytic from being 
only six hours lo a newly-painted room, but quickly re- 
covered from both upon being removed • ; evidently provinjj 
the deleterious influence of lead iu a state of vapour ; and, 
at the same time, that in dilferent conatilutions it wilt sliow 
it« eifecta upon diHereul organs or in a difforvnt manner. 

Sir George &aker asserts, that he has known the disease 
originate fioui minute corpuscles thrown otl' from (ho 
clotlicfi which have been worn by plumbers while at vrork't. 
And in corroboration of this remark, Dr. Kejnolds observed, 
when he wuH phyKiciun to St. Thomas's IIo«piUi, that the 
colic of all the workers in lead frequently returned, under 
any munagGmcnt whnlCTcr, whiUt they were allowed to 
wear the clulhen in which they hiid been accustomed to 
labour: gn which account such clothe* were nevereutTered 
to lie on the patient's bvd. Scntin wan ii witneaa of Uic 
mme eflect frum hangia^r up labourers' wallets, Riled witli 
food for the day, in jilaceit iuijiie^nated with the vapoura 
of Icrtid^. And tlie pre.'Mint author has oocasionally met 
with other instances of tlie disease Irani an habitual re- 
aidence in clo«e damp rooms, filled with newiif-printeH or 
foioured iKigier: fur the emanation of Dako-while, which 
HAually enten into the colour, xcema to have tlto same 
power of affecting or being aflbcted by the surrounding 
atmosphere, as that of lead in a finely attenuatcxl metallic 
state ^. 

I have raid that pure water does not net upon lead in a 
melallic form: but wbdo we see h»d tlius ciuily diainte* 



■ Vi>l iv, |i. 't3ll. S« alw Sf^uiii, Anuk* ilrrliiioir, lilvvill. IMS. 
t KiMjr cfln«nntiiK il>c Cuuc of ilic Kndanlal Loltc Iu Dcfonihiw. ITM- 
* JIviiHinli. p. IN. 
$ M.iL Ttuu. nd. m p. «n 



et. I.] 



»IORHTIVB FUTfCriON. 



[OHD. 



grated and reduc«d to nn oxyde or a mrbonate by acids Okw.vt. 
existing in the atmoftpltere, w even by the «tfno«plipre ^i|"|^j^ 
iUclf, we may readily conceive, thnl aemted wtitcre nrc ciiialgta. 

able of decom]>ofiing it in a fdight di>groc, nnd of form- 
incr oxydM or tialts (hat may be injurious to the health. 
And hence, where lead is required in the form of reaervoira Hj^^ 
for watvn of tliin kind, or for culinary vesaeU, it Bhoutd, l«ul<n r- 
by all means, be united with tin in equal ^roportionR, nSmi'tJ "* 
recommended by M. Prout*, or with a alight aurjilua of "'in' 
the latter, as proposed by M. Vnuqwclint. For, first, tin ^l^ 
is a harmless metal, as well in its suits and oxydes aa in its c<>mbincd 
rogulinv Btate. at least in any quantity in which we can " "" 
conceive it possible to be awallowed by mistake. And, 
next, as it is more readily <M(ydal>le, and has a closer affinity 
for all the acids than lead, when united with the latter it 
mnst completely draw away all tlic acid it can come in 
contact with, and detach every atom of oxygen which 
might even previously have l)een united with the lead. 

Tlie imnnlytic effect produced by the action of lead is aicdloil 
one of the most formidable Kymptoms to be encountered in i™""'""- 
pAe thenipeutic proccM: in Inyinij down which, our ftrst 
' MbrtK should not be different from those in the precetling 
8peci«B, excepting that, in an attempt to remove the wpns- 0|>ium and 
modic pain, opiates may be allowed to precede the use ©f P"'*"''*''*- 
purgatives. [Colieti piclonum is attended with obstinate 
costiveness, and. therefore, one would be inclined to have 
recoDRte nt once to the moat active purgatives. The boat 
phyMtcians have rliffered, however, respecting the propriety 
of beginnin!^ with cathartics. Sir George Baker directs 
purgatives; Dr. Darwin and Dr. Warren opiates^. Dr. 
Itatcman was also satisfied that, whenever colic coald be 
decidedly irwcwl lo the operation of lead, the mostefl'eclual 
Ireutnient is the ndininii'tnition of II large dose of opium, 
and repeated at short intervals until the pain and apas- 
modto atricltire are relieved, afler which the bowels may 
in general he easily opened, and the cure completed by 
tonics and cordials §. One of the latest and best writers 



■ Annald de Chlmk, ivm. loii. jh 8i. 
t 111. iiu!.{>. 243. 

J Zoaoamla, vol. ii- ami MbI. Tiaub voL tl. 
% Alt, CoLica, Hcf*'> rx^loix^^U*- 




234 



CL. I.] 



COtLIACA. 



[»RD. 



K. vt. on Uie subject. Dr. Pembertoo, has reconuuended au uiuoa 
'^ of CMlor oil and laudanuu. Dr. Cheyne bsu generally 
sBcceeded id rdieiriiig coliea pictonum by following Sir 
Geofge Baker's practice; yet occasionally he has found it 
neceMaiy to give opium, and that too in large doeee, 
porticola/ly wbeo ob§tinate vooutiog occurrad. Dr. Pon- 
bertoa* statea, that, iu som« examples, opium itself will 
act as a purg-^tive, as he auppottvA, " by resolving the spas- 
modic aiiectioii of the colon, by which tlie feces are locked 
up between itit circular bands." And one critical writer 
recoounendi a large dote of opium with the same view, as 
after it« exhibition ike difficulty of procuring sLools, be 
wy«, iit not grentf . With Dr. Cbeyne, howerer, a doubt 
may be onlvitainnl, whether the C(Mlivcncra be owing 
to •pauii. " Froin thv toraiiiui wc know that tlterc ia «x- 
citement in some part of the canal ; from the vomiting wv 
infer inverted pcriataltic action; but from the obetntction 
wv can infer do more than torptH- of a particular |KUt, tuid, 
judppng from the symptoms which afWmards occur, thin 
torpor would appear to be paralytic." This view of the 
state of the caiial enables ua, without the aid of spasm, as 
Dr. Cheyne conceives, to understarul how benedi results 
from opium. Hih plan is to adinlBister purgHtives in ibe 
slighter cases, and opium witli purgative* and stimulating 
Pmmms. elyateiv, in the more severe ones};. Fumcntatioue to the 
tiMi,o|tev abdomen, the warm bath, and emoUiunt lujcctiotu coo* 
^^11^ tsining laudanum, are ueefu) means; and vtnceeclMti^ if 
ilao. Mgiie of indamiiMtum of any of the abdominal viscera be 

present. IncaMS produced hy the vapour of Icud. Orlila 
says, the antiphlogistic tteatment should be abandoned |.] 
aswteilH^''*^ parulytic eSect has been attempted to be subdued 
•Aoisr by the oonnteraction of other metals introduced into the 
uuiiiCT^) "y^'^u) f'^ tliJB piu^>ose : and (Specially mercury and silver. 
^S" Both lisv*;, indeed, been gireu from the commencement 

UtfMrT' *^ *^^ attack by many practitioncn; and, as ihemselvai 
relate, with great success. Dr. W'nrren and Dr. Bias were 



• On DUemo «f tlw At-kmiiMl TitMn. 

t Bdls. Mid. tad SufK. Jmm. fvL UL p. 79. 

t Op ck. toL it. p. 314. 

I fce O ni«iy1> KIwuwm W V%pit. p. am. M nL 



i 



Ct,. I.] DIOKSTIVB rtlNCTION. [ORD. I. 

iu (Jio babit uf poracvcnDg in the iiiefcunal |>roceMi» till Okx. vi. 
tli«y obuiniMl a aalivation ; and aswrt. Uifiit Uiey found ihc cJjJJ^'^ 
dull griping pain give way as ftoon h& thin wuh uccom- e)iU%ia. 
(diihi-d. The silver employed in ihacliialgia Imk uKUnlly ii4iv«T. 
been in tlie form of ito niuate, or lunar caiiittc, lo the 
anxHint of four or live gmirut in llie course of the dny. 
Dr. Koborts huo published two cnaesof a cure obtained 
by this remedy; the one, Ihnt of a youn<r, tbc otlier 
of an old man. The casea were both of ooiuidenble 
standing, and the joints of the wriatH were weak ulmoMt to 
paralysie. Even this symptom, however, yielded by de- 
grees. The ealt was given iVom three to five grains at a 
dose tJiree times a day in the form of pilU: and in the hi*t 
case 6ve grains every six hours. It lias the ndvantiige of 
being a laxative as well as an aiitispasnuKlic: so much so, 
that u nuiiill ijuantity of opium va* on this account added 
to the nitrate when given in its mo«t frequent doaes*. * 

In treating of passive hemorrhage we rthell have oc- f*tiam 
cwMon to ob«ervei that whatever deleterious property the ,^|^i^' 
•cctAte of lead may posKem, it in entirely remored by a 
judicious mixture of opium with it, tio n« in this tttntc of 
union to bixoine n meet \-i\lunltlc tilyptic. It it poseible 
that, under the form of An acetutc, lead may be Iosn injurious 
than nndur sonw others, for it has not unfroquently been 
given bIouc in the Mine complaint without any rhachialgic 
pains whcro the bowcti have b(.xn kept iu it iwUiblo state. 
But with opium every mischief accms cH'cctually to be 
guarded agatOBt: and the benefieiat inflneitca of opinm 
u]H>n lead in this caiKt should induce us to emjiloy it, and 
tlial very freely, as an antidote in every case, and eitpceially 
in the disease before us; end to counteract its constrin- 
gency by an union with calomel. This rational practice, rim 
winch has been pursued in our ovni country by several ^'p"' ""' 
physicians, over since Dr. Reynolds lirst called the atten- itnioMt. 
tion of the profes.sion to tlie corrective power of opium 
when combined with lead in tlie case of hemorrhage, has 
now for many yeani been also tried with success in variotis 
parts of the continent. In France the dose of opium has 
been usually only a grain or a grain and a half c\'cry ni;;ht ; 



Usi. Tnna. nt. '. til. r. 




J 



Ct. I.] 



CtKLIACA. 



[OBD. 1. 



VI. but in Spaii 



diUiila 



B wn Icam trom (he memoirs of the Rest 
Academiii Medtca </«• Madrid, ii much bolder and more 
H>t if fur lory' vmployinrnt of thi« iiiodtrinc has been ex- 
hibiteicl by a |ihyHiciim of dixtinguiHhed jitd^meot, Don 
Ignaoio de LiiMiriap^, who [H«srnbed a gmiD of opian 
every Ibree hoiini ; nnd it trill often be found necessary to 
nugni^'nl this <]itnntily *. 
Aiicii>i><"«> Aa ihu «ul|)hate of lead is a compoand inkolnhle in fli« 
"JU"*" fttomach, and consequently altosotbor inert, M. OrfHa 
tn;^ttiouKly ullci)ipt<?d to reduce tJic uceUte and other 
prepnnilioiiit of this metal to the form of a Rulphttte, liy 
giving \fktf;e quantities of sulphate of muGinemci ; and be 
think« he hereby sacceedcd in effecting a decompoKition 
in the atonmch of two dogK upon which he made experi- 
ments to ascertain this poiut; and in pioducing sutpiutc 
of lead in their stead. The experiments, however, proved 
fatal in both instancw, though some portion of sulphate 
of lead teems to have been fonned, and (he death of the 
•oeond dog to have bcvn retarded. As the want of eocn- 
|)l«te suocew may be uKcribe<l to tJie want of a Ritffieieuey 
of sulphuric acid in the re-agent employed, it would be 
lietier to try tlie experiment for the futura by giniig (he 
piin<ntiiro salt in infusion of roses, or any other liquid 
adequately charged with the acid to answer the purpoae ; 
or by a IWo exhibition of the acid in a diluted state atone. 
(Alum was h( one time a popular remedy for paintw^i 
colic, bill it has not maintained its groand ; a fta 
rather against the efficacy of the sulphate of magnesta, as 
(ho merits of both depend upon the same chemical prin- 
ri[»Je. Where, bowerer, the colic arises from the presence of 
roei-titly swallowed acetate of lead in the alimentary canal, 
and not from absorption by the skin, the method suggested 
by Orfiln. with Dr. Good's improvement of i[. aeens tin 
most promising of any of the plana hitherto reoommandad 
lor eounteractiug the poison of kad. In cooAnutiaa of 
thiii obaerratioii, tbo editor begs leave to reauod the icadir 
of a atatement made by Dr. Pam; namely, that be fan 
fbMud, in tile treatment of hmmoptyais, the effects of Iha 
aMtaie of lead quite iuvaiidated by eombiaalMO with 





DIGRSTtTB PDNCTION. 



[OAD. I. 



237 



alum, or by being |>r«Kcribed with acidulated mTa&ion of Obm-VL 
neaa.ta with aniall dcwux of sulphate of magnesia*.] i^iSlai'ihi 

Tbe best pUTgalives, u hcru tli<: custivcncso is scrcrft, arc chialgb. 
those impregnated with thv principlo of camphor, as thcHiiufiur. 
essential oil of tur(>entiiic ; and where these foil, the oil of JJ^^ 
croton in doses of one or two drope in the form of pills. 

[Two casesf of violent j>ainti'rs' colic soon yielded to 
the apjilicatton o( tobacco Ntiipes to the abdomen, followed 
by the exhibition of cailinrtic pills, with crotoii ml, and of 
B purt^ve etyitter. Tcibttcco inji^itions itre mid to have 
be«a tint recoiniiteiided in this diite^se by Lcnttwj;.] 

Those who have hml thiH dise.'iHe aiv liable for a long Fttioncs 
time to freah paroxyKtuH ; luid the MU>^ht>r«t eitpo»ure to the .ui^l^mi 
same cause will be sure to lepraduoe it; yet the appear- puruivniit. 
anew indiAerenl piTsuiu, a* well ul^rnnnla as duiing Ihc 
aUaek, are extremely variuble, i'rom did'eretice of idioayn- 
onay : a correet idea of which may be best, perhapti, 
obtained from I)r. Warreji's de&cription of ihiitytwo 
domeMticaof tlie Duke of Newcniitle's family, then residing 
at Hanover, who weie all seized willi rhacbialgia after 
having uKcd, as their common drink, a small white wine 
that had bc-en adulterated with xoine of the oxydea of lead. 
They were nil utincked in the common way, except one, 
whose first aesaull wait nn epileptic fit. This patieut, as aoon 
as the puin in tlic bowck which succeedeil to the fit had 
ceaMKl.bnd his bead Lt^ain tiUV-clcd.wits troubled with a St. 
Vitua's dftDce. and died epileptic in less than u furtiiighb 
Three wer« feverish from the beginning to the end of the 
disftoM;. The rest were without fever till the fourth or 
fifth day, tlieir pulae becoming quicker as the pain began 
to abate. In some the mouth was made sore by the 
acrimony of the matter vomited up. Four full into a 
Mlivatioii for several houn every day, uml said that their 
pain was abatc<l during the spitting. Many had profuse 
sweats, and a fvw an eruption of red and white pimples 
just before the disorder terminated. One was delirious 
during a part of the time, but recovered. All rekpNcd 



■ Sm FhanoKol. rnl. i. p. 338. 6lh edit. 
f Dr. fiTBTcs, (n Dublin IIcwplol RqiorU. vnL U. p. i.V 
t MtoumbllU «l(ta Aoon, vluc genu). Ax. CtouilluikiMliun. 
177*- 



Oiinlag. 




J 




C(KLUC«. 



foHlt. 



tioMMtbc 







HMfcMlnl 

mppcvt 

DMil. 



within foar or five dnvs tfter they MCBwd to he cwv*l. 
Some relapsed Mvcra) buMs for MveruJ VMtn. One oaly 
vna rendered penwinently ])or»!yti<! and contive*. 

The n>'j«( useful meati'a of guarding ogniuHt a paralytic 
diathcns, or of removiog tlic pttrmlftw sequel, where re- 
oonrse ctia be had to them, are the Buth watere. And 
whers the circomstanceft or the patient n-iil not allow him 
to have the benefit of these, the spine may be adran- 
tageoQsly nibbed night and morning with the warm bal* 
saios or resins dissolved in spirits; and the commoB 
restorative process of air, exercise, friction, and tonic 
mcdicinea should at the satne time be hud recourM to, 
and pcnevenxl in for many weeks or even month* without 
ftntHion. [Acoonltng to Dr. Orcf;or\*, the continued uM 
ofapefionts ban great ufTect in preventing a ndapaei'. It 
is obvious, tJiat the return of colica pictonum oui ower be 
effectually prcvcntt-d, unless (hose avocatiooa and beve- 
mges are rt-Iinqtiinhed, which exposed the patient to tli« 
influenoe of the poitonous metal by which the diMMB 
was excited. 

With respect to the paralytic aflectioD of the hand and 
frngers. Dr. Pembcrton found it much t)enefi(ed by keeping 
iheae ports cxtciMied on a kind of hantl-board, apliut, or 
battledore. M. Alagcndie recomm^HU. for the removat of 
paralysis, tlie ukv of atrychnioe, which has been socecaa- 
fuUy tried by Dr. Graves}.] 



• McdkalTn«MilMi,niL«.|i.M. 
; [tablBll«qHWia<pau.f«l.(f.^M. 




DIUeSTIVB PUNCTIOK. 



[cmn. I. 239 



SPECIES III. 

COLICA CIBARIA. 

SVRFEJr. 



THE PAIK ACVUMFAMIED WITH NADSBA, HBAD'ACHE, 
AND DlZXINKllS UKFOKIi VltMlTtNU, ASU APTEB- 
WAIttlS TEHUINATlhU IH A URIflNC LOOSENESS. 

1 HAVE alieady hatl occaaiou to remark, that the »lo- 
out^ is one of the most capricious organs of the entire 
«y«teu; and hence we often find persons in an un«u&> 
peeled state of health complaining, that even tlie ordinary 
Ukul, to which they are accustomed, siU upon it with a 
leas degree of comfort and satisfaction than usual. And 
it U bcDCC not at all to he wondered nt that, whea the 
ktontach is ovvrlou^cd with plain food, and still more with 
high seasoned dishes and hundy malt liquon and wiuea, 
the pain and sickness of colic shonld ensue, and that 
those organs, which arc in clos&'(t sympathy with the sto- 
mach, und particularly the head, ahould participate in the 
afTeclion. 

T)i« Maine efTect it not anfrequenUy produced by swal- 
lowing the husks, sloneii, or kernels of fruit with tlie fruit 
that is eaten, all which the stomach may at the time, or 
perhaps at all times, be incapable ofdigesting, and someof 
which have in a few instances remained so long as to ger< 
nrinnte before their rejection; examples of which are given 
in the anthor's voltnne on Nosology. 

When the stomach of the ncw-boni infant is filled with 
any other food than its mother's first flow of milk, which 
is pui^atire and removes the viscid meconium with which 
tba Alimentary canal is gorged, tormenting; puins ofa Itkc 
Itind follow : and if much uir be extrioiited, the infnnt is 
orerpowered with flatulency ; nnd the present species be- 
comes connected with the onsning, and exhibits the op- 
pressive distention of wind-colic- 

These are the common cauncs of the species before us, 
which is characUtriicd by a greater or less intensity of the 
symptoms enumerated in the definition. But we often find 



Gcx. VT. 
Srit'. til. 



or rood. 



Imtigrtlililc 
IiuaLi or 
krintli of 
fnitti. 



In«mf[iu- 
om Ism 

infancy. 




I 



I 



240 

iinf.VI. 
Drxc. II L 
Calks 

Thtteed 
Uriam 



ci.. I.] 



CCELIACA. 



[oiin. I. 



» 



<Vk, 



HmiMiincii 
narciMir 




it ulao ofiginatinf; after me»\» from catuM thut uc nore 
oLmcuk, uid with various cith«T syin|>toin» of a still oioK 
violent and distcewJug iialur«, as though tbc food ru«lf 
hitd proved poisoooua, or some [loi&ououa oubaMaos liul 
been iiitcnnixed with iu These additional aympluiui' are 
of two kinds: in the goc, wc meet with an intolciablo neoie 
of BuSbcntion. ttii; lliroat constricted, th« I'ilou biuI eyea 
swollen, iocxtiiigtiiHliublcthiret, a banting hual all ovm| 
body, a quick KaiallpulMi.on intolcmbU itching or prkV 
in the itkin, and an efflorescence on the mirfitcc, MKnetunefe 
ID the forni of miuiite ml inillct-«eiiKl popnltc, souietiaMM in 
tbul of wc^ai (witching of (h« te»dou», and a pcouUai 
ki[>d of delirium ; the cuticle peeling olf oo the subM(l«MW 
of the attack: the u hole evincing great malignity of u* 
lion, an though the cause were of a »epiic nature^ Under 
the other set of symptoms, in addition to thooe noticed in 
the definition, we meet with great anxiety and didifiuUy 
of breathing, dejection of the spirits. B|)a&ms in the limba, 
us well as in the abdominal organs and muBcIos, teueywus, 
coldnext of tlie extremities, loss of sight and heoriiig, oon- 
vubiom or coma. 

The symptoms, however, vary considerably according 
to the gcDcnil nature of the coustihitiou. I'or the mofll 
part, they are BiifhcientJy distinct; but, in many porsoM, 
they are strangely united ; and the lethargy, teneftmus, 
or coldness of the extremities, may be combined with the 
cutani'ouK eruption. And hence esculent colic may be 
jiutiy cuiitcniplutcd as ramifying into the throe following 
varieties : 



a Crapiilosn. 
Common surfeit. 



$ BfHoroaeens. 
Eruptir« sntftlL 



Cunuktonn. 
('onatato surfeit. 




The ttymptoniK indicating nn 
overloaded stomach, and 
nsniUly ceasing on the en- 
cuation of its oonteoti. 

The symptoms evincing s 
highlymaJignantac rimony , 
the ekin covered wiUi Ul 
efflorcsccnco, 

. < , I I r» 

The Kyinptoms evincing gtwt 
nervous irritaLion, with a 
rapid vxliauatJoii of the 
sennibililv. 



El. ..] 



DIoetTlirK rVNCTION. 



[ORD. 1. S4l A 



1X0C4 



Id the viRBT OR simflk form of tliediMaM. the vio- Okm. VT. 
Bn«e of tho BVinptome gpncralty works its cure. Btil if p'.^*^' '"' 
e iiBUNea should exist nithoiit vomiting, a simple emstir dbtii*. 
ipecacuan shonld be given to exciu the fitomacb to aaCtibkri* 
perfect iii*«reion of its action, which should 1« fol- <™i"'''*»- 
the n«xt morning by a brisk pniTEalive. In the '''"•taia.i. 
of new-bom infants, from viscid meconium, the ptir- 
itiv« alone will be suflicicnt, and the best medicine for 
is purposo i» mstor oil. if the congestion shooJd pro- 
an enfeebk-d Mute of the stomach, and too ton)^ 
of the food in ita cavity, it will he afterwards 
aidte to put the patient on n course of stomuchic or ga- 
1 Ionics, of which we have taken a sufficient survey in 
pre«ediD|^ de»criptioit of dyspcpsy. 
It is possibli;, tliat the second varikty may occa-0 r:.ciii»ii> 
ionally proceed from a morbid irritability of the stomach •""'""**"•■ 
— crating upon a tolerably fall meal of the most lilnnd and "***' 
mona viands ; but it more generally proceeds from 
f/ foods of a particular description, or eaten tinder 
icolar circumstancea, as cotuatoee surfeit does from 
poisonous t^gflaliiet iutemiixtd with common food. The 
animal subeiancea that chietly operate in the manner Dclirwrioui 

described, producing a dreadful feeling of suffoca- J^n."" 
]on. swelling of the face and eyes, intoterable thirst, a 
llmnung heat on the surface, pricking or itching on the 
altin, succeeded by an eruption of some kind or other, and 
companied with tho specific sj'mploms of griping pain, 
wrtigo. and vomiting — are shell fishes, and Ssht-« of a few 
her kindis. as musclt-s, which aru perhaps the most fre- 
quent of all causes, souto species of scallops and other coarse 
.traceous worma, the latKl-crab {canctr mricoia), lobater 
e* ^auMuruA), coiiger eel {ntttrir»a major sulmlivofea of 
G6gido), gTay-snapper [cniaciuHS Juuu* riuijor). and 
yellow-billed sprat {ciupta TAryssa Lin.), the barucuta,the 
king-fish, and several other species or varictieui of scomber, 
the bottlft-nose and ambar, the smooth bottlc-tisli (oifrrj> 
eioH gtaMtum), and the rock-li«h {pfrui marina of 
Catosby). There are also many othcn, bat these are suf- 
i«nt as specimens. 

As all these are among tho edible pmllWtiona of the rndcrvhii 
ocean, and hence arc eaten very gvncr^tjT u nutritious .unM ibey 
foods, it is a question of great importance, and which in ^''^^ 

*^ (tMDMll. 




i 



34S 

lirx. VL 
tine. III. 
dCdbuk 



CL, I.] 



Ca-LIACA. 



[ono. 



mlmuionof 

poilMWU* 

mutdek 




yet npen to diHCnmiOD, wKnt are tlic ciirutnsimncai, in which 
they QCcaHtonitlly dixagrcc wilh the siom&ch, and produce 
llie above symptoms ? 

It has bwn nupposed by innny pathologists, thnt the 
mischief is oc<MHiontd by KniK poisonous property being 
conveyed into the body of the fwh in the fomi of food : by 
iithera, that it is the re«u1t of a change taking place in it> 
genCTnl frame by the nppronch of the epawninfr MtMon or 
some other period of life, or in conncqufncc of its removal 
into a different climate: and by ocht-rs agiiin, that it de> 
[h-imIs allogi-ther tipoii the idiosyncrasy or pcculinr state of 
the constitution, ur of the digestive or^» of the ptiaaas 
ihnt ars thus (iffecled. ■ ■ - 

[From a vcrj- interesting paper by I>r. Combe of Lellb. 
on the jioiBonuiis effect* of muHolcH, we learn, lliat muscles 
which had prmluccd Huch consi^ueuccs, and had been token 
from a wooden bar in tlie wet-dock, hud no very posi tire mark, 
by which they could be distin<,nit«hcd from other muscles 
irnthered elsewhere. H in fiicnd Dr. Ctddstroam was of opi- 
nion, however, that their livent were diseasod, being dnrkat 
and larger than nntural. ThtN dittagrces with tlte iuvoMlgt* 
linns of Dr. FergitMon*, who arrived ot tlte conclusion, that 
the deleterious etfectH are not connected with aiiy organic 
change in the onitual ; but, as Dr. Combe has remarkedt 
some change may hnpp<m in the structure or secretions of 
iho animal, beyond Uie xpheri; ui' our detection. The ani- 
mals were quite frcHh, and had no peculiar smell nor taste. 
The most delicate chemtcul tents gave no indications of 
ciiprcniis impregnation ; iior couM a comparative chemical 
analysts of the poiHonoust and healthy hsh, undertaken by 
Dr. Christison, discover any pccuhar principle in the 
former, or any difference in chemical nature between then. 
The poiRonotis effects of the muscles, gatheTod from the 
above wooden bar, were not conlined to the human raoe,a 
cat and dog having also been kilted by eating them, 
though other muscles, gathered in the vicinity of the dock, 
wf^re eaten by auch animals with impunity t. The suppoai- 
tion of a cupieous impregnation of the poisonous 6ah in 



• R4ln. Ftill. Jmrn. vol. L 

f ih. Or**™ m *« poiwmmut (•«§ at ihi Mutk (Mjtflm cAlb), h 
Mln. Mel. unJ liwg. Jnm. K«. ». ^ H 



lb 



EL. t.3 



DIOBSTIVK FONOTION. 



foKD. I. 



243 



the W««t Indivs, Iiuk beco itbly rofutccl by Dr. UurraM* •. 

__ Tbe above paiticulnrs scn'c also to weaken the notion of 

Infulrcfactioo.] 

That many uf tlic uniniulK which prove thiiH noxious 
have (Jerivcd their mischicvoiui quality iVom Bome poisonous 
mineral, vegetable, or animalcule on which they have fed, 
sMOU probable froro the well-known fact. Unit many of 
tfa« moat harmless and easily digesiible apeciiM, \( eaten 

ffcrithout t>ciii<; (ItHCntrailed, grievously disorder the atoniach. 

^^nnd occaHion many of the symptoma abov« noticed ; while 
even the baracuta, which is ordinarily one of the most do- 
leteriouM in ita efi'ect^ when eaten whole, l>ecoities blaiul 
and innocuous to most persons when thorou>;bIy cleuiicd, 
gutted, and salted. There is also, in many caitcs of tbo 
disorder hereby |>roduced, a strong melallic and vitpmully 
u coppery taste in (he otlVniliiig substance when rejected 
into the moutJi, and which continues to atlect Uie fauccK 
Tor a long time afterwards ; [though, as ia ut>ove related, 
no copper can b« detected in poisonoua niuHcles.] iM.Orfila 
haa accumtely noticed thi« last symptom in several of th« 
cases be has enumerated ; and especially in au example of 
this diHorder originating in a mixed company of wlntvn 
and blacks, who Jiad fed on the conger eel, in the ibilnnd of 
Grenada, in April, 17yl. " The negroea," say* he, " suf- 
fcrad more tlian the whites ; they all experienced a cop|)ery 
taste in tbe moutli, and a sensation iti the oMophagua, tut if 
it were excoriatedf." 

It in in vaintourge, that what is thtia poisonous to man, 
ntuiit have been at leant as noxious to the animalM that fed 
upon it : for potaon is n relative term, and it itt hi<;hly pro- 
bublv. that there in scarcely a vegetable or mineral Mub> 
stance but may be eaten, I do not say harmlessly, but even 
aa a Mfc and nutritious food by animaUt of Komu kind, 
however deatmctive to others. The land-crub i* well 
known to fnul on the manchineel tree (Aippomaiie inatici- 
me/la); the loxta or gross-beak of the Bahumns'un the fruit 
of the amtfrit loxifera, or poiNon'Ssh; ptirtridgcs on tlie 
lcav4!&. and bees on the flowers of the l;alinm latijhlia. 



Giv. VI. 
Spec. III. 

clHarMCfn*. 

Kmxic JK)i. 
■iii> inlro- 
tlinvil into 
llir ■Ioii>n(li 
of G>h» 

thki dii. 



liijiirlout ID 
thcinidvc«> 




* London M«d. R«poaiurT. ml. iii. p. 443. 

t 7WU iiur let Vt^umt, ftr. inm. iL (ni, |nn6. 

i2 




244 



CI., t.] 



C<SLtACA. 



[ORO. I. 



Gey. VI. which arc denth to she^>, to liomcd cnttle, nnd to mau. 
a" eibilr'ii ^° *''* rieuta vtrtaa, or long-loitved wntor-licmlock, the 
tmem<m% moel viriilont (itant that growtt spontaneously in linglandH 
though fiittunately not very common 10 oar ptuMuret, is 

I fatal to cowa, wliile sheep and horses «at il with impuaity. 

^H^^to mnd gontii devour it with greediness; a tact uell known, 

^^^^H nvarly two thouf^and yettre ago, to the first natiiraltBl of. 

^^^^1 ancient Rome, and thus fully described in his poein. Dn 

^^^^H Kerum datura: 



tlN>bi)tcnu peoiJci, luaiiDl qu> «>i tat («nniuin* 



N 



Hwcdii'h 



logi 



i.U. 



P 



On the eontrar)-, while horses feed with avidity and tbrira 
to fatnesB on the agrett'u amndtnaeea, or reed bent-gruCf 
Lion^us, as he tellH us in his Travols in Shiine, found * 
number of goats perishing in un island in which tliis was 
the chief herbage. 

This interesting subject is pursued tvith ^reat spirit, and 
wWi '■'o'' advantage to the most important purposes of practical 
i^ varioui husbandry, in suvcral articles published in the i^wediih 
Amcenitatcs Acndcmiceu; which ({ivc us tables of the beat 
and most agreeable foods for cattle and other domestia 
animals, deduced from an exercise of that wonderful in- 
stinctive power of iwlcciion, which enublco them to disceni 
aud to crop those that are a nutiitious food for their own 
Thrlr iRiif- spocics, and to reject the re»t. Ity one of these tabtea it j 
niniuli. appears, that, of four hiinilred and ninety-four species of I 
indigenous plants uf Sweden, three-fourtliK of them com- 
mon to our own country, which were oH'ured to homed 
cattle, two hundred and Mventy-six were eaten, and Uitl 
rest refus<-d ; that goau, out of four Imndred and forty- I 
nine sjiecies, rejected a hundred and twenty-six; sheep.] 
nf three hundred and eighty-tteven, would not touch a 
hundred and forty -on e : horses turned away from two 
hundred aud twelve out of two hundred and sixty-two; 
and swine, out of two hundred and forty-three, 
choice of only seventy-two f- In another volume of UmI 
■anie interesting work, we have a like series of vx|)cri-j 
menta on a great diversity of in»ecu and norms, with a | 

• liik T. nvj. 

t Vol. tt. 111,99. Pan Sunkui.H«]i..N. L. HtMdtmt. 174*. 





[ORD. t. 



si 

t 



iew of ascertaining how many of them iire devoured or Oen. VI. 
by our eommon poultry •; lo which, however, 1 g"riiiM^ 
oiii only rerer, and must kavQ tlie render to consult it at cffioRwoiu. 
In leisure. 
It is hence perfectly clear, that no argument i^init 
e existence of esculents in the interior of aiiimaU, dele> 
lerious to the health of man, can be drawn from the po- 
sition, that such esculents must aUo prove noxious to the 
nimala that feed on them. 

It is at the same time well known, that a coneiidemhie Simc liihn 
ibange takes place in the taste and nutritive cjunlities of (^,'^''l^„ 
many species of fishes, at various seasons and periods afatfvnudet 
iife, by which they ai-e divested oC their nutritive [WMer, "^ 



§^ 









are rendered far less easily digestible; and which 
consequently lays a foiindntion for various aifcclions of the 
stomach. This is particularly the case with the more Kiunpla. 

■ouBoroily kinds; as the herring, mackarel, eel, and 
•elmon, all of which are unwholcsomo, if not pernicious, 
vrlien out of season. Wc may also reasonably conclude, 
that climate has a considerable influence upon them, since 
the most pernicious species are those that exist in the 
intertropical seas. 

It is, however, equally certain, that the disorder before ThcilluMe 
B is, in many instances, rather dependent upon 'dio- " ^JJ^^'' 
■yoerB»y, or a peculiar condirion of the stomach at the upon iiiin. 
time, than upon any quality essentially noxious in the fish ^'^^^.^^ 
itself: for out of twelve or more persons dining together *uw of ihe 
from the same diet, wc often find only a single individual •""""'• 
aflected with the disease before us, while all the rest not 
only escape, but have made a nutritious and a healthy 
meal. Even in the same family we occasioDiilly meet witli 
sJmoat as many distinct idiusyncmsies in this respect as 
icre are individuals. Of three sistent, M. Orfila tells us, 
that one was incapable of eutinp; muscles, at any lime, 
without great disorder of the syttuni at largo, as well as 
of the stomach ; that the second experienced a hke effect 
from herrings: and the third, from feeding on str.iw- 
berries. And hence many pathologists have been induced 
to ascribe every case of colic, from the variety of surfeit 



* VdL viU. an. 163. Etca ■vium ilonimicanuii. Bap. P. ifaloibcnid, 
1774, 



J 






: -tT.crnsv ilone. But the frequent ex. 
T-:s r ±e affection extending through 
-■ . ~-"j» Mrty that ha^ fed on the eame 
- .=;: 'ur iscription of the disease to 
T'.u syoiptoms caused by poisonous 
tL^ -.-rr-uled by Dr. Combe. In general, 
.,-i^ :iu:r; any ill consequences are felt; 
0--TS consist rather in uneasy feeUngs 
.: .-, lay cociplaint about the stomach. 
:. ::.-^. au'wever, a shght tension of the 
:=.-.x2ei of. Cardialgia, nausea, and 
L— :- -iii? piai:e, but not generally, nor 
.r -Ji-z. A prickly feeling in the hands; 
..: .The mouth and fauces; some dif- 
^: swillowin^: numbness about the 
;-.i:.;:-^- to the arms; and great debi- 
;. .s ire the ordinary symptoms. Some 
;■: :c c^ippery taste in the mouth. In 
c:: :--;ia is experienced, which is in- 
- . ■.■ir.;jularly in the region of the 
■. i .:' which are variously disturbed. 
:. ^ or.Ti.-'ii nf urine is suspended: in 
? : ■.•.■.>5;.l with [lain and eflbrt. The 
> :,t'-;e: tik- breathing unafiifcted; the 
■■.; ^:is:oi!:. ; the skin cold ; the mental 






-. -■ -. .--> .: -■-.ri' are of oasiiT comprehension than 
., ..^- r". v.v.Ai-! matter must first be (liachaniod 
,... ,-, ^t. .■..:.• ':;. .Utiuoiic of rapid action, as about 
,. ^-..\-. : -■ :c »-.:rA>I: shortly after which, the 
.-. *:;.v.-,:!aicii lo a like discharge, so 
.■.■.:i-,i". a* (Visible that disagrees with 
,^ _^t-^: .■ ..V- ■* ■ •-> ^I'-'.-iia in them. The history of 
.« -* . -v .- > >■." ■ - - J. ''~y- 'he living power is rapidly, 
.p.vt^'^"*'' *■ ■" * ■.■..:-.v.i-.il.)nuiiigly exhausted, whence 
.*,i«i. 1 ;- ' " ••■•'-■''■ ■ ■• iremors. sense of suftbcation, 

:,..^ -^ i •- -■■":■'- -, -.:!«. ;>iid general depression of 

^ ... ,, . ^ ■ ■ >..tv'ui!;s that (ako place throuirh 
, ,. ., ,t : '. (."fl^'iar subsl-.tuco exists in cou- 



, . -■.*»• 



I: is hence hljily important to 



.^ » 'I,-,' i~-\ ^itTg. .'uiin;. Ni'. m, p Kt. 



CI- l.j 



UIGBSTIVK FVNCTIUN. 



[oBD. 1. 347 



I 



rouae the fiystom with all speed, by mcaitH of the most 
difi'ituble stimuIanU, and warmest conliaU niiil toniCH, 
which may be comoienccd as aoon as the stomuch han 
been enwuated ; the moat uxeful of which are sulpliuric 
ether, nitroua ellier, ammonia, ca[)Hicuiu. and viiK-^ur di- 
luted with water, Kweetcned and druuk iit ubundanct:. 
The acida obtained by fernieotation answer butter in this 
case than any others, because they postccaa tuorc of an «!• 
coholic prlncijjie. And it is truly striking tu notice the 
almost miraculous power which is sometimes exhibited by 
this cordial plan of attack. Upon the administration of a 
single strong dose of ether, the patient, apparently in the 
act of expiring, has in various cases feit all his symptoms 
vanish in a very few minutes a^ by enchantment*; the 
pains have ceased ; the absorbentii, and indeed every other 
eet of organs, recovered their wonted energy; the general 
mtnipeaoaDce has subaidt-d, and the nettle or other rash 
diM|)peared. If, however, the system have been shaken 
more deeply, and the symptoms do not yield with niucli 
rcadineos, the tonic plan must be persevered in for many 
dtya or even weeks. 

llie TiiiHi> VAHtETY IS Usually produced by pernicious 
vegetables, instead of animals, that have been taken for 
food, or along with food ; or esculent vegetablea that dis- 
agree with the stomach, as in the preceding variety, from 
a morbid state of this oi^ran, or from a peculiarity of con- 
•tibitton. 1 have already observed, that the aymploms in 
this modification of the diseaso evince great nervous irri- 
tation with a raiiid exhaustion of the sensibility. There is 
tevero apasmodic pain in the intestinal canal, witii cramp, 
ipaams, or convulsions, extending over the system more or 
ku generally, accompanied with or succeeded by u lu- 
thargic drowsiness, from which it is often difficult to rouse 
the patient; and from which, also, when roused, he in- 
stantly relapses into convulsive agitations: evidently prov- 
ing that an acrid and a narcotic principle arc combiuvd in 
the unuu9[>i!Cted cause. This cause is usually musbrooms 
or rather deleterious funguses that have hwn mistaken for 
the genuine edible mushroom, or agaricus i-tcuUulu*. The 
agaric is so extensive a genus, and many of its B))ecieB l^ 

■ Orflb, Mm. f*. tea. IWIR. Dulong, (luxue it Sanlt, Oct. I, ISI'J. 



USH. VI. 

SrE€. IIL 
i> C dbuU 
ifflumc«ui. 

DilTuutils 

■limuluiu, 
ind cordial 



TbiTti npU 
bcrirfli In 
101 DC cues. 



> C dlum 
ciiniiiuu. 

ComnioEilf 

twin tH)Xu 
out vrgTta. 
bin. 

Myinptonii. 



Funitl ilw 
man cmir. 





^48 



Cl,. I.] 



« » * 



LlACA. 



[OKD. I. 



UW.VJ. 

I>»tl. Ill- 

Y (J. dboiia 
tamtam. 



SOOMIIBM 

thcoUbli 
muBliraoai 
iMl/4 

OUMk 



OMlgmfn 

■■A mini 

Biutluooiiia- 



nbln than 
pliuu. 



an nnpnctMed ey« )iftv« to nciir « r«!*ecnbl*nm to racb 
otlwr, tliHt it cnunot l>e wmidi^red nt thnt miCli a mistake 
liM IwRD o(Mniiiitt«(l : though perhuiva the plants that, 
tlironi{)i Kucli na sriw, harelxton mmt tVoqucnth- gathered, 
lire, the hiilbuiiKiit^ric, the Mtiiltisu'shcud. (huravea'8«ye. 
Uie h«fnliock>miishTooin, uiMJ the agaricm ntNtcarius. It ia 
pMnbtc, indeed, that cren the genuine mtuhroom iteelf 
may prove duklohou)! to tcomv idioKyncraitiv)*, or to some 
UoDiuchK in a morbid »tate of constitution ; but then the 
iniiMshtef is in nlmott evevy instaooe confined to an tndivi- 
dnnl alone, the rent of the compsaiy eating ofth«samedi«h 
with KattKfac lion and pleasure. 

Ak there is no critical mark to determine at oiice be- 
twpcti potaoROUS and s«lutur\- uiuNhroonut, we may lay it 
down as a general rule, that thooe nhould b« mapictcd and 
avoidr^ that grm«' in iiioiHt and marshy gmiiTtda, and eape- 
cinlly HI the shuide ; that huvv a dirty looking enrfiuM, and 
whose gill* are eoft. moiat, and poroo*. For the moat part 
t]io emoll oftlxvc 'm virulent, and tliey are eoi-er«d with a 
valyptiv ur vvil. 

i'herD are, huwcTer, a 0()n«idemblc number of other ve- 
ISctablea tliat produce » liko f44ect vhc« taken braeoideat 
fur food, or along witli fooil; an ihtfUulavinM, orwattr- 
hvmlock, the leaves of which have been mintakcn for 
smallagc. and the tap-rootx for pannipa; the alhuta cyna- 
pium. or foora parsley, which hiu been culled for conuDon 
pualoy: and the f.tcaU eornutum, or flporred rye. The last 
IS productive of very Berious evita in different forms, and 
we shall hence hnre oecMion to return to it when de> 
scribing crytheniutic pcstia, and mildew-mortification, both 
which al«o result from its as*. Rye becomes spurred or 
homed in tlic shape of its MT, apparently from having 
numoroua punctures made by difierent insects in the fresh 
|KtUula(iog grains of the glume m a nidua for their minute 
rges, in tlie same manner as the nut-weevil (eurcuita 
niicif) piereva thu young and tender nut of the haiel for 
the same purpose. And as the eftecta, produced by the 
grain thus dieeaiMJ, are very ditTervni in ditlereut scMOOs 
"T climutfF, we hare rea&on to beheve, that its juices are 
iheiusclvea rendered noxious in n dificreni manner Re- 
cording to tJie speci«« of insect that makes the attack. It 
is aho said that the common garden rur (mta graveolcnt). 




OL. I.] 



BtCKtTIVB rUMCTlON. 



U Mco««ded by tb* 



[UBD. t. 



249 



dEl Wljiuiila^ |>MIW> •{■auiHKltc Kction Bodoonm, thougb in ^'/"^ '"' 



Bvmploin* Oxx. VI. 
Srw. III. 

a. Ins d«gne : but 1 h»vo never seen nicb eoasa()u«)ce«. 
ud luvc maon to tbink (hat tb«]r bare beem oT«r> 
nttad. 

. Moat of tbe»« Byniplonw are also produced by feeding on 
flOups, or oUicr <]iftbc«. ihut have been cooked in <»Ppw^*J^'° 
vesselo coDtnining vcrdi^s. We bare the same violent mnii 
gripings and muscuiai commotions, excited by lite acid 
cjuality of the plant juit noticed, and in almost all iiistanoea 
beadacb and confuHon of intellect, and Bometimfls coma. 
In all these casca, however, wt^ can easily detect the nature 
of the poiBOD. by the intwlumble Coppvf}' taste of the 
uoutb, and the greca or greenuh-ycUow coloar of the 
matter rejected from the stomach. 

The cure, as in the precediufr variety, must be pro- >iti)inl 
tooted by evacuation, in t)ic first instance, the poieouous tfMoiiMi. 
principle, aa laig«ly as po»Kible, frum the stomach. Where 
tlte local irritation i« great, demulcent mucilage* abould 
n»cecd : or soup where the etToct has bceii produced by 
«Uts of copper. After which, if there be much general 
convoJaioo or other irritation of the nervous syateu, U 
muat be aUaycd by opiates. 



I 



I '■ 



SPECIES IV. 



at 



a>LICA KLATULENTA. 



FAIN ACUTE, £XTK^DINO TO THB flT OF THB HTO- 
MACH. OFTHH IMI-SDINO B IISPI KATION ; ACCOM- 
It. FAMED WITH UBEAT (ULNKSS AM) VLATVLEN CY ; 
itiliND RELIEVKU BY rUKSSUKIi. BliNUtMU THB BOI>T 
•ftfUKWARD, OB BXPULslVN or WIND, 

Tins ttpcciea ia produced by crude and |]atuUint fruits, orm. vl 
and whatever lowerit Uie tone of the alinienury canaJ ; as ^"f^ "• 
too long fualing, fcui, or gtief, suid all the caui>ea of dys- 





«.) 



COLIACA. 



[OBD. I. 




<mhxk u U often complJcatetl, Ktul to which 

Ijke dyspepsy, indeed, it seoine to 

1 debility, whose seat ia iii Uio nnall in- 

ijueotly iji the direct neighbourhood of 

I. It is often accompanied with great cos- 

,ft«Bilfae«p«siiiodicactioD, which runs, in a larger 

■M degrM, through the whole of th« intestinal canal, 

I ooMiimUy adds to the torture, and iocrcasee the 

tad ten&cnL-BS of the alxtoiitcn; uhich are 

so extensive as to resemhle empAjftfrna abdo- 

. or tyuputy. 

Tb« kat symptom is peculiarly striking and oppreaiuve 

I poMiw of an hysteric diatbe«is, who arc attaokod wilii 

eonapJaint from rory slight causes; and with whom 

it is often combined with syncope, or clgnic spasmB of 

vanooc kinds. 

In attending to the means of cure, wc may here pro- 
ceed at once with some degree of boldnem ; since, oot- 
withstundmg the violence of the pain, it is not often tluU 
lutiommalion is to be »pprehen<Ied, nt least in the com- 
niencemeni of the disease : and hence the wannest car- 
ninatiTfls. und even alcohol, may be lind n-coursc to : for 
whatever will curry olT the tlattilency, will carry olf Uie 
pain and costiveneu- Heuce a spoonful of brandy, or. 
which is bettor, u dose of tincture of rhubarb, volatile al- 
kali. infu»iouB of herbs containing cssontial oils, as mint, 
pepper* mint, penny-royul, arc generally consoling and s»- 
lutiiry. I'or the sama rooMiD, the aromatic spices may be 
had recourM to witlt succ«sb, sikI particularly in oou- 
iMxion with opiates. Of the spices, the nutmeg, on ac- 
oovni of its greater volatility than motit othen;, and espe- 
eiiilly on account of itK established reputation for producii^ 
niiiwiKni Mv\ evi-n Kli-op, u.s I have already had occasion to 
otserve w hen la-utiiig of dyHpe{My, has a peculiar claim to 
■itsalion. 
■ )m« Th« only disadvantage of opium is, thai it has a tend- 
M«**^ «Ocy t» dimmish the intestinal, and indeed ali the secrc- 
tiODS, oxccpting tbut of aiveat : ami, on this account, it has 
boon objecte*! to by uiuny physicians : but, from iu power 
or*lliying spusowdic irritation, and consequently of pio- 
ilueinc cftuc. it bcroiuos of so much imporianre, that it 
iiuuhl iiniiucstniinibly to be called into Uao ; awl there arc 




CL. I.] 



UlOSCTIVlt ruNCTION. 



[OBD. t. 



S61 



cases in which, from this tery power alone, it may indi- ob». vi. 
recUy act the |Kirt of an aperient. The opiate confection, ^J^'^^' 
u combining an aromatic witJi a narcotic principle, is b lulonia. 
highly rajuahle as well &r an ele.E^iit preparation. And 
after the pain has auhiiided, an nctirc purgative, necording 
to the course recommended by Dr. Cullun*, may bcadmi- 
tU8te4«d with great adrantage. 

Opium may aUo he given in the form of an injection, 
which §bould not exceed live or fux oanccit, for otherwise 
it will probably be t]irowu back. It will be often of great 
use to unite with the narcotic a pretty free dose of tur- 
pentine, or some of the warmer baUams, especially that 
of copaiba ; and to apply nibefacienta to the epigastric 
RSOn. 

The convalescent treatment may be the «ame aa already 
rccomntcndcd under dynpepHia. 



SPECIES V. 

COLICA CONSTIPATA. 
CONSTiPATlVE COLIC. 

THE ORIPINd PAIS SKVRRP. ; TftP. CUSTIVBNRSS OB- 
■TINATR; GRP.AT TENSION, WITH LITTLE FLATU- 
LltNCY : THE VOMITING BOMKTIM^S ACCOMPANIED 
WITH PRCES ; Till! fOSTlVP.NESS WITH BLOODY 
BTRAIMNCS; TEttMINATING, WHERE NOT PATAL, IS 
A PHEE DEJECTION OF THE INFARCTED MATTKH. 

The pain ia here produced hy indurated meconinm, or o,^_ y(_ 
fccca, or other inteatirinl ooncretioiw, and especinlly lho«c Srrc. V. 
which are known hy Ihe name of bezAards, and will be 
hereafter dewribed under the genu* EKTKUOLirinis: and 
we hence obtain the following varieties: 




(^*^eL *^'"= *>f new-born infanta. 
•""^ 8 Favosa. 

Stcrcoraccous colic. 




CCK1.IACA. 



[ORD. 1. 



7 Eat«rolithica. 
Slonv colic. 



From viscid Dieconium. 

From iodurulcd feccK. 

From bezoards, and other 
iateiitiiial coucretioiis. 



T«o Aim 

twktlcmiU. 

pcnlrnion 

ihaiuuot 

Mtbnoftlw 

InmiiiMl 

ibMrbnita. 



BxampI* 




The first two of these varieties are the result of a super- 
abundaat action of the intestinal abaoi bents, or of a de6ci- 
ency in the peristaltic power of the intestinal tube; in 
conite<)uencc of which, from the length of tinu; the confined 
uiatcriaU occupy in complt-tin|r their dc:>«ent, the meconium 
in ittfiinti* becomes ho viscid uk not to be urgcnl downwards, 
and remains in the intestines till it grows acrid from 
acidity or pulresccncj* : and the fccc-s of later life, ex- 
haustcd of moisture, hardened into one solid mass, possess- 
ing the figure of the intestine; or, separating into smaller 
pieces, ajipoar, when discharged, in the ehapo of balls or 
buttons, of^n as hard as sun-burnt clay, and hare been 
called, though not quite accurately, seybala; yet sometime* 
they make a near approach to this substance, and consist 
of masses of indurated feces, combined with a certain por* 
tion of mucus or oleaginous matter secreted into tbe 
intestines, and producing a cetaceous or soapy feel. 

Of the itony variety, the following is an extraordinaty 
example related hy Dr. Konig, of Bern, and inserted in the 
Philosopliica] Tranaactionii *. A young woman of tiventy- 
five years of age, by name Margaret Lawer. after an ano- 
malous and general disorder, discharged continually the 
conlenU of the intCKtities, and even the clysters tlmt were 
injected, by the mouth, and at lengtli a aamber of stooe* 
as hard as flint, itomc in fragmente, some of the stic of 
peas, others of that of filberts. A clashing of sUmea 
iiguinat each otlicr was felt by pressing the hand upon the 
abdomen : tlierc was great constipation, severs gripings, 
and dysury ; and the urine, when voided, was often loaded 
witli II gravelly matter. The aliment and injections being 
coiistiiutly relumed by the mouth, Ur. Kiinig desisted fur 



■ flitU TtsM. you lias. 



ct. 1.] 



DIOIfiTIVS FUHCTION, 



[ORD. I. 



«3 




four months from ofl«nii^ her vitlicr moat, drink, or td«di- Oik. VI. 
cine of any kind, escej)tiii[; occttiionally a spoonful of oil ^^^'^^ 
of nlmonds. Blood whs now and t1i«n vomit«d, from the nipate. 
violence ofllic s|Kixiiiodic action of the stomach; and fre- 
quently urine to the unount of throe or four ounces at a 
time, of 01 Htrong tMtc and smell. The disease seems to 
have lasted with remiwions from Janaary 168) toFcbruftry 
1663, at which |>cTiod the history is abruptly dropped, 
thon^It Uie patient ftccms to have been in a state of re- 
cover)'. It tt-as preceded by the appearance of vesicular 
eruplionii on the Kkin, nnd was probably produced by their 
repulsion. The chemical examination of the catcall la 
loo«e and unsmisfuctory. 

The olcii^nous purgatives, soap injections, and mucila- Pnxcu 
ginous diluents, to diminish the irritation of the intestinal " '""' 
absorbents, will here be found most succe^sfitl. Small 
doses of neutral salts, sulphur, and acidulated drinks, may 
also be of service in promoting the latter intention. If the 
griping be severe and the case urgent, terebinthinate in- 
jections, in the last two rarietien, will aUo be highly ex- 
pedient, and not unfrequently produce speedy relief. In 
theae cniies, the injections Khould be copious, ao that the 
fluid may readily invimiuilc it«clf between the imprinonvd 
matter and the coots of the intestines : nnd the turpentine 
should not be less than from half an ounce to an otmce, 
diliEendy trilumtcd with yolk of ege. so as to be perfectly 
dilfusiKl and euspendt-d in the menstruum. " Thus pre- 
pared, wc have found it." says Dr. Cullen, " to bo one of 
the moat certain laxatives that can be employed in colics 
and other cases of obalinate costiveness*." 



Mai. Altd. TOL n. p. 181. 




26t 



CL. I.] 



COtLIACA 



[ORIt. 1. 



SPECIES VI. 
COLICA CONSTRICTA. 
CONSTRICTIVE COLIC. 



obm. vr. 

Rwtt. vr. 

I low i1»lin> 
euiihfd 
Ttom pme- 



^rnipumik 



IVurimait 



A SBKKB or 8TRICTVBB IN SOME PABT OF TUB INTSS- 
TlNAt. CAKALi OFTKN OP PLATULHNCY. GM A I>t; ALLY 
FAKSIKO OFF BV TUB STRICT II RB^ THE DOWELS 
TAKDY; DISCIIAROING VflTIl DIFFICULTY SHALL 
LIQl'ID STOOLS. 

Tais species bnn « n«ar approach to proclica calloui, 
or the callous contractioit of the rectum ; which last, how> 
orer, as nccou])>iiiiiv(l witli less fj^riping and tiatulcncy, and 
consequently having less of the chsrncter of colic, uid 
mure particuIiiHy from its being in most cases within the 
reach of manual ujicamination iu>d surgical aid, ai>d capable 
«r n^Himance by a different mode of treatment, is entitled 
to a distinct conitideratioD. 

[A)( Pi'ofeseor Monro observes, stricture of the intestines, 
in the early stnge of the disease, gives rise to colic paini, 
and co^tivencKH, alternating with bitions diurrhaa. After 
some tJme. solid feces are very rarely passed, uikI only 
aAer a great efibrt; and the)* are of an extremely slender 
calibre,] 

I'he proximate cause of the disease before us is a perma- 
nent stricture existing:; in sumo part of the intestinal canal 
beyond the reach of the finger, from callosity, seirrfio&ity, 
a ring of tubercles or caruncles, or whatever else has a 
tendency to thicken its coiiU and diminish its diameter. 
[Strictures are more frequently met with in the colon and 
rectnm, than in the small intestinesi and Dr. Monro has 
Mvn thv natunil dtitmutcr of the colon so much reduced, 
that an ordinary quill would hardly pass the constriction. 
When tlie stricture is greut, the bowel is generally enlarged 
above it*, and even ulcerated. Sometimes, indeed, it 
gives way; its contents are efitised; and the patient, after. 



* DalllK'* WnrLi, tij U'wdnp, nri. iL p. IM. 



CL. t.3 



DICESTIVK rVNCTIOH. 



[OBR. I. 



?6& 



lalwuring under colic for a fvw hcHiTK, in ttutdenly KciMil Ak^.vi. 
Mitli v«ry acuW pain in the nlKloiiii-n, mpidly followed by i"^'^ 
iL audden KiDkin^ ofthi- pMlse, cold Hweiite, nnd doiith •. una*. 
When AcirrhuH nHccU thcbovrelH, the dixenMcd portion of the 
tube is alwftyx rendered narrower, and ROTiictime« nearly 
imperviouH. Acoording to Meckel, ihe discaw beginii in 
the jwritoncal coat and i;)andula! mucipamt, whence it 
afterwards extends to the muscular and villous coats. The 
eHect of it u to confottnd ti^tbcr all the tunica, to thicken 
and harden (ht^ni. nnd, in the end, to produce cancerous 
uloerabont. The mnsctdnr coat is alt>o subdirided liy 
OMinbranous eeplu, and the internal one sometimes projects 
in thti fonn of hard irregular folds. In persons of ad- 
vanced agi\ HcirrhuB of the large intestines is not un- 
conimoii, and it iiKMtly nttncka the tigmoid flexure of tlte 
colon, or the rectum. The reason of thin fact is referred 
by Dr. llaillic piartly to tlte villou* coat of the lower end of 
thft fpvit int«Ktine> contiunin;; many Klanda, and {Kiitir to 
the ngmoid flexuri: of Uic colon brini; naturally it^ mirrowest 
{■art, and most liaUe to be irritated by the pansaf^ of hard 
substances. Hut. though stnclures ar>; nioRt freriuent in 
the colon and rectum, they are MitnetimeK met with in the 
small inlcstincs. In the Museum of the Unireraity of I'Min- 
burgfa is n 8|>ccimeti of a stricture, extending seven inches 
nlon^ the ileum |. 

Hesidcs the fore^in^r scinbous dii9casc, by which tJie in- 
tcsttnul tube may be obstructed, there are other morbid 
allcrations by which the same consequence may bo pro- 
duced. One is an elevation of the mnconn membrane into 
thickened folds by an accumulalion of tlie cellnJar mem- 
brane^. Another b a thickening of the mucous or villous 
coat alone, ooagulable lymph boing etfuM'd upon it. In 
tbe collection of Mr. A. Uunis im a specimen, taken from a 
child, where a gelatinous substance, mixed with congulable 
tymph, ndhcrci.1 very intimately to the villous coat of the 
sigmoid flexure of the ctdon nnd the rectum; atMl above 
the sigmoid ilcxure, the intestine had given way. In sorao 
instanccB, the intestine is completely tilled with coagulable 
lymph, which may either be voided by stool, or remain and 



• MoriiU Ammbt of ^ UBinin Oullit. tit. p. 301. SOS. 

t BouNlao. Ben* MM. Mu,llBt. huI MkIuI, Alanud d'Anw. L til. p. 443. 

J itmn.9r. m. p.301. i B«UU-.M-«1», «itt. f. isfc 



J 



CL. I.] 



cqiLiACA. 



[OIO. I. 



Ont.VL 

Bi-cc. VI. 







prove the cause of death *. The inlcntinul canal, and par- 
ticularly th« colon and nctnm, are nometimea the wat of 
polypi, or of vanoos other «xcrctcenc«», mnot of wbiolt are 
Laid and solid ; othcn, spongy, loose, and wftf. One ie 
termed roiltltke by ProrcsMr Monro, and haa a very fetid 
amell : Meckel expresses a conTictiori thai the diaeue bere 
alluded to is in reality fung;us hieoialodGsi but on this 
point be must be mistaken. Tlie ca»o is rare, and baa 
ntT«r been aeen by Mr. Wardrop^.] 

Hw colon and rectum, highly sensible in a state of 
hmlth, are peculiarly initable from the diseased action, and 
the Hpcvitic fiymptoms are the consequence of irritation 
produced by the mechanical pressure of the feces; and 
often by acrimony fmin their ratention. In most caaes, 
the stricture lies beyond the reach of topical appIicatioDs. 
[Purgatives afford but temporary relief^.] The cicuta baa, 
of late, been chiefly trusted to in conjunction with the met- 
curial pill. But I am not aware, that in any case these 
have proved decidedly advantageous. The spasnodic 
attacks must be encountered by the remedies already n- 
commended in spnsmodic and flatulent colic; and the 
babitaal uneasiness felt in the intervals will be beat alle- 
viated by a rigid attention to a light, liquid, and apenent 
dial. Unfrequent rut this disenm is in i^neta) practtoa, I 
happen to have at this time two patients labonring ondar 
it: om a lady of about thiny-five years of age, who bM been 
subject to it for ten years, and is incapable of passing 
feoea more voluminous than those of an infant; and the 
other a man, forty-nine years old, who has laboured under 
the disease for twenty-one yean, an<) can never pass a motion 
larger than a crow-quill. Yet, by strict attention to diet, 
both are able to exist with only occasional inconvenienoe 
and pain; the laat niarrieil al>out two yean ainoe, and his 
wife hm lately brought him twins. Ue hves upon liquids 
altogether. 

[As the Mignwid flexure of the colon, near its termination 
in the rvclum||, is frequently the seat of the disease. Dr. 
VUlkn has very properly recommended, that this part 
■bonld be carefully examined in every case of total ob- 

* Moni«*i MoibJd Abmodij, Ac. p. t IS— Id. 
tH«lwl.•f.cll.^444. tfhOlto-.WMkvral.H p. lOI- 

i Moofo'stlwUd AnM. nftlH Humm Outlet, Ac p. MS. 
I! Mm Kir. Pfnkrril'* tw*. in tMit. Il<d. tnA Sunt. JmRmI. No. T%. 





CL. t.] 



utctsTiri: ru>«cTiOH. 



[oiiD. 1. 257 



■traction of tlie bowels, not arising from hernia. It is. P>»' Vj. 
requisite for tlie jmrpow. mujs hu, to employ ii bougio roii.a «iit. 
thirteen inches lotig. an<! of a proportionntc etrcnfi^h. lie ■»'!>•'»- 
adds, " I lately saw a lady thus rcUeved, who had l>een 
twenty-six days niltioiit any t-viiciiuliun from the Imwclit. 
lUid who Mn-nii-d neiirly cxhaustetl by vioIenL-c ofpuin imd 
dittcntioti of the »1>doinep. hiccoogli, cold sweat, &c. It is 
rcDiurkable 1)0vr long iiatitnts subsist under thcM' dijiin-s— 
in^ circutnstiincvs. In one inetaiice, l})c time van tiveitty- 
nine dayv ; in another, tJiirty*threc days. Ah the latter yik- 
tient reeovt-red, tidcri-ndiinnguvcr}- torture such a disorder 
eould inflict, pnictilionfn luuy be rncournged to penevere 
steadily in ihejr uttentiuus*." Mflien tins species of eolic 
de{»ends u()un the presetK-e of ii polypus, oi other excre- 
scence in the inicstinnl cunal, beyond th« reach of surgiciJ 
mean^, the palliation uf symptoms is all tliat can be at- 
tempted. Till' true nulure of such casas is «cai«elyvcv«r 
aacertained till after death.] _^^ ^^ 



.«.*( 






n- 'ti i. 



-Mtr 



* MllUa on Dimtn in f,ondun. |>. IBn. 



k^mr Mf fM Ik o* »>(*•• 

■« .««Mi<r «t>f>- r '*<>«J *il MNMi> Ml ' 
.11 M omIi Hf*' 



• ll »ll AUJWt U' 



■ . It lim .•• ■ 



vol., I. 



i 



CL. I.] 



roiLIACA. 



[ORD. !• 



GENUS VII. 

COPROSTASIS. 
COSTtVF.\JSSS. 



\rhaita 
( Abenc. 



obbtihatk kbtestion op thr fecbs in the in- 
testines. 

Ovx.Vir. The generic eharacler i« t'X(>r<*»c<l in the generic nune, 
whicb is a compound leriu in)|>urliiig e4miii6)on or luWntioa 
of feces — )urfitTittn, from m^Ic nttd i«rvw, whence the 
well-knovm iind o])fw«itc terms copragoga aiid fifoproliea, 
to cxptviM purgativcM, or such medicinu^ as quicken the 
]>aHS3ge of the feces. 

WhetJicr mere tardiness of evacuation should always be 
K^rdcd UA a disease may be quvstioiiublt: : itome persotia 
■re ftceuatomed to have t)ii-ir bowels moved not ofWoer than 
twice a week; end to such, n week's coativeness is attended 
witJi DO inconvenience. [As Dr. Hatouian * has remarkad, 
the proximnte 4:aus« of coastipstioD of the tmwels may 
consist in au uniuuat slowucss of tlie peristaltic niotioii. 
or in an obstruction to the passage of tlie feces, wbile the 
proper peristaltic motion continues to propel llieni. Tl»e 
natural motion of the bonels is considerably different in io- 
dividuals of different constitutions, and even in the same 
individuals at dillijrciit periods; so tbut it is not easy to 
say when the periKtultic motion can be considered as pfe> 
temalurslly slow, while the general hcaltli continues good. 
But it is probable, that, in most habitii, a §tool should 
occur once in twenty-four boura, alUiough many pcrsoaa 
retain their feces much longer without incunveuience. 
Dr. Cuileo believt-d thut every deviation from a diurnal 
stool is sn approach to an unnatural state.] Rhodius 
gives a cane of feces retained nearly a montlii'; iind Pana- 
rolus, one of three months' retention witliout niindiieft- 



* Rca'i Cfvlepadia, uL VotTiyt.xT.a% 
; Janloi;. t'ciitenxl. I. Ob». 1 . 



tOmt It. Ob*. SI. 




CI.. 1.] 



DMIBSTIVB FUNCTION. 



[OBA. I. 



■2Sti 



Chaplai relates the histonf of a femaJe who for four months 
hftd no dijwhnrjrfi cith«r from the bowels or the kidneys, 
and M littl« «vucuittion by Nweat, notwithstanding that 
hlff diet was oonftned to milk-wlivy »tid ttrnths. She was 
■t hin^h cured by using th« cold-bath for eight davH ituo- 
ccsairely. When but a very email quuitity of food is 
tnkeii habitually, the egeata bear a like proportion, are 
Httiftll in amount, nnd ui^uully slender in vobtme. This is 
porticnlttriy tlie ease with those who are enabled to endure 
long periods of fasting', us wc have already hud occtution 
lo obaervc under IJmom txper* protracta: and heiifo th« 
collectors of medical curiogitiea have furnished ub with 
various emnples of feces retained for half a year*, two 
yearai-, and in one or two insuncea not kes than Mven 
yearaj, without serious mischief. 

In all such cases, the feces are discharged in indurated 
ind minute hitiU, something like sheep's dung. Hut it 
does not uUvayx happen that tboxe who labour under this 
aflection cat sparingly. Professor Thomuwsini of Purnia, 
in 1808, attended a man, thirty yearn of age, who laboured 
nnder an habitual coslivenesa of thin kind, though his ap- 
petite was good, and he was accustomed to eat twice as 
much as other men. He bnd l>een costive from his youth, 
bat the torpor of his bowels had iitcreased yearly. From 
hifl twentieth to his twcnty-fourlli year, he had had only 
oat cvacuiilion every eight or ten days, which interval was 
■ ft cnr aid s increased to twelve. At thirty, when M. Tho- 
mosani saw him. his intervals were extended to twenty>two 
daya. No regiaien or medicinal process had produGe<) any 
beneflt. Pur^tivCK, indeed, operated, but occasioned •ocb 
debility that they could not be persisted in. Th« heat was 
natural but the pulse frequent ^. 

[A very remarkable cum; has been puhliiihed by Dr. 
Ciampton. The patient was a female in hcr37tli year, 
who had had no evacuation from her bowels for eight 
montho, nnd only two or three motions in the year pre- 
ceding that in which the particulars were drawn up. She 



l)>».VII, 



111 thou 
litlk. 



Vmkhi»- 
tlniaoetun 
In greu 



L^Ut of 
onljr iwo 
at ihnc 
motion* In 
ft jou. 



• Salroulh, CaxU t. ob>. !4. ii. IkV 08. ni. 3«t. ti. 
"t Iwnml. Mnlic. W»liinr;liinui>g:cn, liiirit it. ]k Wt, 
X N. SiMunl. MkL n'khmthni, band i. p. 4X3. 

I Did. 4m Mnoa MUkaIn, an. r*>. iUaEs. 



s2 




260 



CL. I.] 



eauACA. 



[oio. !• 



(isH.ViI. alM pamed scarcely aay urine, ami thU witb fMiD. Her 
CoproMMlL ^^ iHi8t«nance was tea, lout, mtlk, hikI gruel. The ib- 
domen was free rroiii fiilnCM or Mwvlling. in the intervBiM 
of meal*, she oncn voided from the stomach matter of tter- 
corac«oua qiialit)-, and aometiiBeK of ao urinary smdi*. 
The saoie jjhyiiician refers also to imotlH-r similar example 
which was under hU care, and in which a &too) vna cou- 
aidered quite an extraonlinary occurrence. Alter death, 
the colon waa found imm(.'n«<;ly dlstcmlod, nearly iiu]>cr- 
vioua at ila lower part, and the bladder diseased. In the 
first of theae two cases, a stricture of the colon b likewise 
suspected.] 

SUybMome Cosliveiiess ia mt necessarily oonnucted witb oolic, 
t^Zid flatulcitcy, or any severe puins; though, us already ol>- 
iUibIcdct. served, under psrticular ctrcumHtunces, it luuy heconw a 
•inpler' ^^^^ ot'ull tlicsc. In its simple and constiUitionul form, 
nwirtT it is generally rather a troublesome, than a violent or dan- 
uoubUMiD*. g^fo^^ complaint. But this is not invariably the cose^ 
and a constipated state of the bowels, whether idiopathic. 
or the coiiconiitaut of other discasra, is rre<iuently highly 
injurious to the comitilntioD ; producing, when it is idio- 
pathic, a variety of disorders; and ag^raratbg, when 
symptomatic, the diseases of which it is a symptom. Coe- 
tiv<:ni'Mt may [>n>ceed froo) two very dttuiuct aourcesj and 
as each of these possesses symptoms of its own, and is cod* 
aiderably discicgianl from the other, we are enabled witb 
case to contemplate tJte geous under the two fbHowing 
epeciea: 



1. COrKOBTA»IS CONSTIPATA. 

2. _— . OBSTIFATA. 



COKSTirATlOH. 
OBSTtl-ATIO.N. 



' Sec Dublin llotpltd Rrjiatu, ml. it. p. 3iU. tu. 




CL. I.] 



DIOBSTIVB FDNCTIOM. 



[ORD. 1. 



261 



SPECIES I. 

COPROSTA8I8 OOXSTIPATA. 

CONSTIPATION. 

Tlie FECKS WHEN DISCtlil RORD CONOKSTITE K»U 
VO LUMINOUS : THE TCMfERAMKKT rittU AND 
BICIU. 

In pcmona ofa compact and mbust Ituliit, with hcnrty Ukh.vii. 
iip|>elite luwl strong digestive powers, (he inte«tin»I ab- '"' 
soibcnts occiiKioniilly evince im excess ornction; and tlie 
fecrs, while they become hiirdened in consequence of such 
action, assume, from their copiousness, the figure and 
volume of the larc;e inteatinen through which they \iass.. 

The increa^d action of the nhsorbcnW, which in the o«a«dn»i 
common proximate cause of the preiuMit ttpCcies, may be "'"** 
produced by violent exercise, which beats the blood and 
throws ofTan excess of fluid in the form of perspiration 
from the surface; or by too stimulant a (Jii.:t, particularly 
of rough port-wine. [Travelling in a carriage, or on the 
water, is siiit! to have greater effect in brinK'"g •>» costivo- 
ness, than more considerable bodily activity. The editor 
is inclined to believe, that it is rather tJie coufiuement, and 
the want of usual exercise, which should here be regarded 
M the cause of costivvncss ; and that the complaint may 
b« imputed, with more pioliubility, to a defective stale of 
tlic biliary and other abdominal tieeretiona, and to ineffi- 
cient peristaltic motion, than to un iitcrca««l action of the 
intestinal absorbents. Ur. Culleu iiKcribod costiveness, 
■ in such cases, to the abstraction of the inlestitial ftnids, 
secreted from the mucous glands and oxhalant arteries *. 
With respect to horse-cxerclse, the editor suspects that 
the accounLs of im producing costivenesa are founded on a 
miatake, and that it generally promotes regularity in the 
functions of tJie bowels, provided its beneficial operation 



* UucrU Medic*) vol u. p. 108. 



263 CL. I.] C(KLtACA. [oil*. I, 

Ceh. VII. 1)6 not counteracted Ity intvmpenuicc. Many persona who 

Cdpmiult ""^ '" ^'"' liabit of riding, are also in tlw habit of drinking 

(OMiipau. port, brandy and water, and other a^lringent heating be- 

vcragM; and if they stifTer froni costiTcnest), the exercUe 

on horseback beam tb« blame that otigbt to be laid upon 

their diet.] 

CostivcncH may be tlie reault of too astringent a diet; 
w where htcad, for instance, ia aduitefftt«d with a coo- 
ftiderable quantity ofuluin : for the mouths of the secernent 
vessels of tlio intvslini-M, which should pour forth a large 
portion of fluid, become hereby contractod, and secrete hut 
a small proportion. Astringents, ul«o, by giving some de> 
gree of rigidity to the muscular fibres of the intestine*, 
retard the pcriKtnltic action, and thus become a second 
cause of constipation, 
niminiihcd As the feces arc forced forward by the peristaltic aclion 
f|JJ["f'''' of the int£s(ineB, it is obvious that, whenever tliis actwn 

^t» weakened, there must necessarily be a retardation, and 
conM^iuenLly an accumulation of the fecca. Tliis sluggish- 
ncM or txHrpitude of the boweU ia produced by various 
Cttuws: for somelimcn the food is tr*o iuisipid and destitute 
of Btiinulants. und sometimes there is u deficiency in tfa« 
secn-tion of hilo, whicti uppours to be a natural stimulus to 
the internal surfiiire of the intestines; and wc have reason 
lo believe, that Uitt latter is sometimes secreted with its 
qualities iinpcrfccl; and sometimes, also, the muscuUu' 
iibre* of Uie larger inte-ttitic^t lose a considerable degree of 
healthy irnliibility, and aru reduced to an cUrcnie of 
FewM- P*'^'' tJ">t amounts almost to paralysis. And, if this 
■uiniiUiitl occur, as it does occasionally, without much failure of the 
prwli-w "Ppctite, the accumulation of fecea will be in sonio io- 

I stances prodigious. In the ease of « young vromaii aged 

twenty-eight, the distention of the ab<lomen froin this 
cause was so general aa to be mistaken fur pregnancy, 
e!tj>04:ially as there wnit occasional sickness, with menstrual 
suppreHsiun, and a Hym|iiithetic enlargement of tlie browtts. 
'ITie disease tenuiniite<l fatally in about throe years from il« 
commcncomcnl. The colon, which was among the late 
Mr. TauiilouV pr(rp:ir.itiotiK, ho was so obUgin<; nn to 
show me: it mcaKure<l in circumference wore than iwenlv 
inches, and on dissection was found to contain three gallons 
of fecM. 



> 



CL. I.] 



UlCEfiTIVK FUNCTIOM. 



[OID. I. 



363 



[Tha caosM which may ututruct the parage of the foaa, 
without any doJicicncy of ]>cristnltic action, occur either 
io the iiitestintri tht'iiiM-WvM, ur ihu nuiglibuunng )>arU. 
la the intestines, & mechanical impcdimeot is sooteliincs 
oocftoioiMd by a thickening of the coata, winch Birnittios the 
puuge, or by scirrhous tumouis, eBpecially near thu lower 
extrcutity of the canal. SonketimeH thu cAvity w partly 
filled by calculotM concretiona. The coativcntuHt attending 
eotciitit has «l«o hmsn referred to a l«»iciiint{ of the calibre 
of the bowels by eposni; but no doubt now oxiftts that it 
ia rather owing to nn intemiptiun of the eecretions natu- 
nlly poured into tlie int«stincii, and to a diminutjoa in the 
action of their muKcular fibrcii ; for, ns Bichat fully ascer- 
taioed, it in not the ttmracter of an intlauied muacle to 
contract efco with its onlinoTy vigour. Tumours in the 
neigbbouring parta, cooiprcissing tbe iiitestiDes, necvssarily 
impede the p«»sage of the contained feces. Hence, in 
pragnaocy, costivenesa in a common uoosequence of the 
prauure of the enlarged uterua on the great tnl«stinc»; 
and a ateatomatous (umour in ttie onientuui has boen 
known to produce the Maine clfect.] 

A stricture io any part of the intestinal canal, from 
whatever cause, has a tendency to produce an accumu- 
lation of feces, in the Humc luunner im it produces one 
species of colic. But colic does not always follow ; for 
the bowels are occaaionally leas irritable than usual, and 
the stomach continues sound. Strictures in the colon 
hare sometimes exist«d without being suspected. Dr. 
fiaillte has given a striking example in a case related to 
liim by Sir Everard Home, but a still more striking one 
frani his own ptactice *. la the last, the patient, a stioe- 
inaker, aged thirty, subject to habitual costivencas, be- 
came at length much more so; and, from having motions 
three or four times a week, passed them not oftener than 
once or twice in it week or a fortniirlit, and tht«, moreover, 
with considemble jHiin in the lower part of the belly; and 
at length won incapable of passing a motion by any means. 



OBM.VIt. 
I<P<C. I. 



Why luM 

■IWBIl (ol- 

InwrJ ]yf 
colic 



Inuirlul 
•triciunn 
mon (n- 
tpitnt in I ha 

uagt irilrk 
tinn. 

Example* 
of ihf ill*. 
rsK (ma 
ilii* cauw. 



* Tnat. alt J^odntj ttn BInl. and Chit. Impottnunb 8m alto ■ our, raj 
■iaialu in cttaf pmknlw, RTorud V; Mr. simj. In ihc MeA RcpadHrr br 
Uar, III33. 



i 



2ti2 



CL. I,] 



CdUAiiA. 



[obh. I. 



Om.vII. 1)0 not coiinleracted l»y inicmi-" 
(^|^;Ji, iirfl in thfi habit of riding:, m. 
corn 1^1 1 |><>rt, brandy and water. 

vereges; and irilicv &ul' 

on lionebaok boar* the Mui 

their did.] 
CoHtifcueM nmy fap '' 

as where bread, fi-r 

■idflrabldi)!! 

vessels nf ' 



•«y clenrly aus- 
Toii to bill), botJi 

, m five grainit of , 
I" (if nlouivl and 
r ^nit or elaterium, 
"1 r.thcr effect. Two 1 
' I 'Uii ui iin injection, i 
ill iji'tlicr in vain; oft 
». ^uK.ikMlvvr by the moaUi, I 
^r' Uio abdomen, undthuatl'usioa I 
■An, iifipctita miA but little in- 
1 wtiter freely. A scoop waa 
liut tliiH i^ul was round empty, i 
'Jit* belly bWclUd giadually, iiiiil i 
.1, iinoussixe, and the patient ilic4 
■ •mi the last evacuation. Aa vxntui- 
wood the reitl na(ur» of Uiv cunst.- ; fur ] 
. iJic si|finoi<l Acxurv of tlii; colon thertt , 
^tf, which wuuld hardly admit the pas»- 
..-^viU, ikcconi]>uniod with an ulcer, wiiich 
Mk utuauon of the stricture, and partly in 
'Vhw iiitcvtine w«H peculiarly loaded 
_ uutjctnouely dielcndod ; the mean of the 
..Mv4*r being above six inches. All the hug* 
L •« ihi' distention was considerable, had Uicir 
4 ii^ox) deul Ktiengthened, and the longitu- 
,4! l>«couie twice aa bioad and thick w in 
A.,U': the system thiu wonderfully aceom- 
' ir many week*, to circumstanceH which 
, ii'l'lr with llic cmitinuaiteo of life. [Tbia 
_^M»-<-kU« (he value ufthe advice given by Willao 
. jH^ liii- UM of a long bougie, as mcntionMl in the 
. , .i't"<< >'<> <^('licii constricts.] 

t^ -jx'tn uf cunNtipntioo, when long cootinned, U«, 
^ «t ih« head, nausea and aickncaa at the stomach. 

k ti. iifiicml uneasinesA in the abdominal rv 

^ x.ii ill the abdumiual organs; and heoco an 

^|Mkiwl citculalion of the blood, piles, vuioes in the lower 
1^^ itiid, aa we have already sei^n, colic. [Many hy- 
ti^.iv^l ^ttlivlioiiB. chloroMK, and chorea, or St. Vitus* 
loily supposed to be unionnecled with (he state 





I 



[OttD. I. 

txtwels, are now pmved * to be very prajuclicidly <>>«. vii. 
i-'t. if not excited, liy constipation. Even nyui- i^T.'^lJ;. 
' iiriiitrh to cause the case to he svt dawn at raoatipMK. 
patient to lie Hcnt to Madeiia, were 
Uiirthwick to uriftpr from liabitaal cos- 
I ' "< purgative»+.] 
ic-tits it) tlie proscnt species of coativenmx Mcdiui 
quicltt-n t)ie (lesccnt of the feces with m "«cuaii. 
tction us possible ; as diluent drinlcs aweet- 
cii'-'! with ntaona, sugar, or boiiey ; the expressed oils of 
tiitlil V6[^tckbles. as the pistachio, olive, and almond ; the 
okngiuous farina of the cocoa-nut io the common foma of 
chocolate; figs, taroannds, the pulp of cassia alone, or in 
tho compound of lenitive electuary; oeutinl salts. Dr. 
Arbuthnot advised the use of butter, manrow, and fat. 
Dr. Cullen found four ounces of fresh butler, taken in the 
morning;, produce a stool or two more than usual in the 
••dayi' Nauseating doses of calomel and ipecacuan, or of 
calomel imd antiiiionial powtler, will also frequently be of 
use; and thi- patient idinuld habituate hiuiself to evuouiiting 
the hflweN at n certiiin hour of the day, and should wen 
accuHtoin himxclf to un effort to tbi-t effect, tliough he may 
.not alwayx lie sucecssful. And where tliix milder pruce«a 
fails. iJie more powerful purKOtive* must be had reeoiimc to. 

Ill Home iiiKtanccB of very great difficulty, and of an ^{U'lj^^'^ 
anotnnlous kind, an utTusion of cold water hnti been ac- >«wciin« 
COinpanied with i^at success after all common cathartics, ^g^'^ 
quicksdver in its metaUic slate, antimotiials of vanous 
kifMJa, and injectioits of every sort, have been tried in vain. 
Two strikiiii.' oxanipic!) of thtH occur in a letter from Dr. 
Spence of Ouildfoixl to Dr. Keynolds, published in the 
»!ed. Trans, of the CollcRe. 

[By Dr. Daniel, charcoal was found nn efficociouit ro-chvaMO. 
DHKty. Tlie dose was from one to three table -ftpounfiils, 
given in lime-water, or milk, every half-hour or hour J. 
According to another physician of hi^h reputation, noTurpemiM. 
medicine is better for the relief of obstinate constipation 



■ S« HmnHlon on PiirjW'iw MdJirinn. 
t KAln. Mnl. Journiil, No. 0!^, p. ISI. 
* Philxlrlpliii Jiiuinol, No. ». p, llrj. 





266 



CL. I.] 



COtLIACA. 



[OKD. I. 



OUof 
aaton. 



qbx.VII. than spirit of turpentine, in the doM of half «n ounce, 
CwMMiiiii inijced with un c({ual quantity of oleum ricini*. 

Instead of nduptJiig the latter piaiis, the generality of 
modcra practitiouen would adminiater the oil ofcroton^a 
very minute do«e of which haa g;Feat power in r«Uevtng ob- 1 
stinate coitiftiputiuii, when other catliarlics, cvcd in large' 
and nrpvutcd dosCH, Imre no efi'ect. Mi. Ihff has reported 
fouTtwn caMK, in which its usefulness was most deudedly 
provedf. The uremge dose for an adult is one, or, at the ; 
utmoBt, two drops; atvd, pcrhups, tut Mr. Brsuidc ubsmTcSa 
the best, or at leaNt t)io itioMt actire fonn for its exhibilioG, ii 
that of a pill made up with cram of bread. It may also tM 
robbed down with mucilage, and mixed with half au ouik« 
of any aromatic water J. However, according to Mr. Popc^t 
thebnttmodcofEidminiEtGnngtheoilistodissolve itSratii 
a little alcohol, in the proportion of about one drop to 
a dmchin, in which state it may be more easily difioaed ia>1 
M>me simple Huid; and. by acting on an extensive surfacfltJ 
the pni^tivo efiect, he says, ia more speedily 'eoaafcd*-! 
Tboalcoholic tincture, recommended by this grtntlvman, lioi 
baen given ver\- EUccesxfully to children^, in nuiueroiiJ 
instances of difficult deglutition, the simple application ef I 
the oil to the ton^e has answered the purpose. \\'bea [ 
thu Rtonutcli iti so irritable as not to bear onlinaiy cathartio ' 
medicines, the oil of croton is abo a Taloablc remedy. It I 
has sometimes been given in clysters, in which form thti 
dose may be five or tax droits. In one very obstinab: caae^j 
"J •'■'""''" suspected to depend upon tntraeusception. Dr. Cbiaholml 
employed with success a strong s^ulton of common yellow, 
soap, of which more than a large wash-hand bason 
gradunlly, but persevcringly, thrown into the large intai- 
tini-s with Head's syriugelj.] 



InjiciiM 



■ Magtr, is Edis. UnL Jminikl, Ni>. 8S, fn. 307. 

t L«nd. Atol. Htfoaiary, No. 07- 

t Manual af PhaniiMy, pk ICL 

9 liwM<>I.C(>ir. Tnn. <r«t.iln.p.HI. 




I 



TUS rBCKS, WtlCX UIBCHARCKD, HARD, SLBNDRR, AMI 
OFTKN SCYBALOUSi TKB TEMPRRAMKNT WRAK1.Y, 
OR THE HABIT SEDBNTAHY. 

This is in moat cues th« nwult of a iilugguibneee of the geh. Vf i 
pchataltic iiiotioii in persons uf inBnn or delicitte heaJtti ; ■f''"' "* 
in cooveiiiti-iicu ul' wliicli (ho reluae uiattei' of the atimeut, diumi. 
ttiually vioiill in quuntity, is a lon>; ijutu |Ki»»ing throiigli 
the intmliuul tub«, riuI KcucD bocomus ioiluntted, shrunk, 
•raJ siirivelled. so to speuk, by ihv lcni;th of time it U cx- 
poMxl to the power of the iutestinal ubeorbenti), notwith- 
staniling thoy may have no auch iiicrciised actiou an occurs 
ia the precediiig iij>ecieB. Tliia forui of coativenesa is nuoit Mwi Ire- 
fiaquent in persons of advanced life; in whom the feces, ^^[^ j^' 
ninute in quantity and de|»nv«d of moiitlure, are iioiue- 
tines diechur<^d in the form of a scroll, and sornvtiiunx in 
■mall lumps, of Uic shiipv of butUHUf or bidin, m I have 
already obscned wli«n treating of eolica toititip^ta: winch 
affection also, as there remarkod, ia oft«n produced by tbv 
irritation that these retarded tuatoriaU at length excitv. 
So fe«ble, indeed, ia the expulsive power of Uie intestines 
in many cant^ft of old ttf^e, that it ia somelimes necessary, 
as recommended by Dr. Warren, to introduce a sort of 
raaiTow-spoun up thi; rectum, for the puTi>oitc of bringing 
away the dry mnsscs that huvv lodgt-d there. 

[When ft large nccumulntion of fcco!( tukcs place ia the 
rectum or colon, it becomes itself the cause of a moat 
diBtresaing constipation, attended with peculiar nymptoms, 
and sometimes terminating fatally. The disord«;r wiis lirat 
described by nn utionymous writer*, and udditigiial cuhcx 

■ JUnl. OU. ind Aiq. lol. U. p. 123. 





268 



C'L. I.] 



CtKLIACA. 



[OBD. t. 



UKM. vn, 

Umic. II. 
ctadpM*. 



I 

I 



aoonlnry 
hibit in xl- 
vancnl life. 
Itunuk 
or Ccliui 
unui l)ib 
dUcn. 



RmidU 
ttiHiimn. 



of it have b««n aubwequently reported*. As Dr. Btttntn 
ob«en-c(i, il i» thv more iniportitnt to attend to ihia oob- 
)>kiiiit, because it astutnes the nppeanincc of a diarrbcu, 
or nith«r & chronic dysentery, and lias often been «to> 
Deously treated with aBtringents and opiates. Tbe )i«ticnt I 
cmnplainii of nevere pain about the lower region of the 
belly, reniittini* and again returning after frequent but- 
short inlervftlft, and accompanied with a bearing down, and 
idmoMl continual inclination tOf;o to stool. Only a small 
quantity, howercr, of thin diMhiir^. perhaps mixed with 
little hard knobs of excrement, is disdiargt^, after which 
the p«in abates. When from a previous costireneHs, and 
the above-mentioned symptoms, the loaded state of the 
rectum is to be suspected, this bowel should be examined 
per atium. and the feces broken down and extracted with 
(tome convenient instrument. The accumulation that taken 
place is BOiiictimea very great. Thi« case is fn-()uent in 
persons of adranced age, and more frequent in the female, , 
than the male sex- WhU«rcr tend^t to lessen the periiUhle j 
motion of the bowels must tnducr n [ift-diH position to it; 
and it has been ot^n occ^isioned bv thu lon^-continuMl use 
of bark, opium, and other astringent mcdicinesfO 

Itiiometimea happens, however, that a contrary tempers- 
ment prevuih in old ai^ ; that the bowels are irritable and 
the inotinnx loo»e. Cebus hait laid it down as a maxim, 
that when the bowels urc loose in youth, they eommooly ' 
become confined in advanced life, and tluit if conliui^ in 
youth, in advanced life they are ofttrn laxative. Quibtia 
juvonibua Huxit alvus, plenimquc in senectute contrahitur; 
quibua in adolescentia I'utt adstncta, aspe in senectuto 
solvitur|. I cannot say, that I have been able to confirm 
this position by my own obsetTation or expcnence. 

In costivenesfl from this cause, our aperienia must bo de- 
rived from other materials, than those recommended under 
the la»t Hpecies; for here we have far less reason to be 
afraid of the warnit^r and anminlic purgatives. And hence, 
while we allow a freer uiw of winv, wo may succoasfuUy 




■ DuDou*> HiA. ConmntnL nL x. p. 3U; foL km. p. ^88. 
t lUtniiBi, in Km'* f'jrclupadu, mi. CastTirATioH. 
: .HoUdii. bb. 1. (. 3. 



CL. I.] 



DIOBSTIVB FUNCTION. 



[ORD. I. 



260 



haTe recourse to aloes, the compoand pill of this, same, O**- VII. 
and the balsam of copaiba. CopmuM 

The analeptic pill of Dr. Jamee, which combioes a pre- ofait^aia. 
paration of antimony with resinous purgatives, is often a 
very serviceable medicine : as is ako tilie form recommended 
by Dr. Parr, which consists of half a drachm of the gum 
pill, the same quantity of the pilula aloes cum myrrhn, 
with ten grains of antimonial powder, made into fifteen 
piOs. 



270 



CL. I.] 



COtLIArA. 



[ORD. I. 



GENUS VIII. 

DIARRHEA. 

LAX. lOOSESESS. 

THE ALVINE KVACUATIUN8 CHUDX, LOOSE, AND TOO 
FRBQUBMT; with little ok no CBIPINO OB TB- 

HBSMUS. 



Oiw.viil. Op all the specific fornis of this diftease, the chief proxt- 
pnciliMU otate cause, an it is called, or the symptom (hat giveti rise 
to ull thootlier symptoms, is un iocreased peristaltic actwii 
throughout the wbcJe or u great part ofthi- int««tinal cunal : 
nnd as this may be produced by rarious means and under 
different circumstances, it must often stamp a peculiarity 
in the character of the disorder, and lay a fbondation for 
nimicrous HpccieH. 

[Pcrhupi*, iniitead of einptoying the preceding lai^Rgo, 
and representing increaited peri»laltic action as the proxi- 
mate cause, it would be more correct to my, tlint the cs- 
nentiiil part of this dixeosc consists in a |»relcrnatural aug- 
inctittitioit of the peristaltic motion and of Uie intestinal 
BecnitioDs; the predisposing causes being n peculiar irri- 
tability of the intCKtines and of their secerning vesaels. 
To call incrcutted peristaltic iictiun the proximate cauM. 
aeents lo the editor to be inaccurate, since this exist* in 
aereial other cases never comprehended under the name 
uf diarrha^a.] 

The perisultic action of the intestines may be increased, 
kciion ho* and conMqueuUy looseness or diurrhoA occasioned, firstly, 
by irritating materials thrown into tliein by the mouth; 
secondly, by a morbid change in llie fluids which are na- 
turally Bocroted Into the intestinal canal; and thirdly, by 
an irritable state of the intestines themselves, or the uem- 
braiie that lines their inner surface. Indciwndcnlly of 
H'hich, the same effect may follow, in a vancty of ways, 
from Uie readiness with whicli the intestines associate in 
tlic action of remote- of!;an«. 'Vhiis sudden paasioa or 



P(ri>l>)iic 



[CL. ■•] 



UiaitSTlVK FUNCTION. 




[ORO. I. 



commotion of mind will frequently excite looMnen; Bud-dRf-Vlll. 
den cold or henl applied to llie nurfuce of the siltin will do '™'™* 
thu BOiii);. [Ami, iimoiig thv di>tcu«o:; of othvr pnrtx ofth* 
body, which ntTcct the intcstinvii, tbc irritation of dviitition 
in infontji rutty be mentioned as a familiar illustration ; as 
it 16 seldom difficult, without producing diarrhtsa. The 
sympathy, between the akin and the bowels, is particularly 
great in many individuals, ho tliat exposure to damp or 
cold air, or getting wet in the feet, will generally bring ou 
a )oo8eD«it8. Uiarriiwa ix also a frvqucnt and a moxt dan- 
gcrou* a^sailnnt in ihi.* udvunccd stngc of a grent variety 
of dtsCBues, aa fevere, pbtbisis, chronic hepatitis, lumbar 
, afaecMHs. diseased juidIji, Gcc- ; completing thnt prostration 
' of atnngth usually seen a little before their fatal ter- 
mination.] But a& all alfectiona of this last kind are evi- 
dently caaes of mere sympathy, they must be excluded 
from llie history of diarrbcKa considered as an idiojiathic ^iih'oLfaer 
disease; and even in their treatment can only be remedied orgvi>> 
by remedying the primary complaint. 

The subdivisions of diaxrhcea may be resolved into the 
seven following: 

1. UIAKKIKEA FUSA. 



ortoi 

otcun from 



UILIUSA. 

UCCOSA. 

ALBA. 

Llt:.VTK8]A. 

SEBOSA. 

TIJBltLARlS. 



FKCULUNT LOOSENESS. 

BIL10U« LOOSENKSS. 

MtJCOUS LOOSKNKSa. 

WHITE LOUSHNESS. 

tlENT&HY. 

SEROCS LOOSKKESS. 

TUBLLAH LOOSENESS. 




271: vi ;. -o-.-.- .. 



"tit -i— s ^^ 'i'»'»"'» i^ =.i.t~". vr 

' ■ — -:ii-si» ',- Mi-m:.;':*^ via ax Tstne 

r wiirt lif-^ iw» riii:-;ur, iiiii ht tEWWi'Mi 
•>— nift ■» ^r.mv L-fir* ■jtiro. amceBosntr -o 

"rs*^";^— 7 ■".: j'T.^'Tr T.irr i.~'jr.:nttia; 

-■■?r-i en' ~se r.-^.a. — ^ =n> . utrvaur -iwm. ^al 

""'-' " ■ u? .iaffcl : -■ -m • ji.c — vs 1 - inr-- Tal»— H>i at 

~ ---'"• t . ^TiJt 1 T^i-i-c—ir lit -tMi nrvnc^K «^^ 
--??w ■."— 1 — .nii. n -'2^ -T •»•■ lacsarsi- iiIiimi; 

Tr-5 i:^'-^ T- ^i* T">i".ii.vi ^'.-ss-.-wiil* j» miiifim 




! Jfie-T. ".1. >■• , ill. >». .;. 



•L. I.] DICBSTIVK FUNCTION. [UKD. I. 273 

exposure to cold, and wpecinUy by cold bulbing; by great a«x.vm. 
agitation of iiiind, and piirticularly tlmt of fright, or uiiijcT, -^it^h^' 
BOinetimeH cvon wbrii those piiKsiotu linvc merely oxistod ftun. 
in dreaming*; and occasioniiUy nlso by the bare sight of Ki»inpk« 
a purgative or other madioine which th« puticnt is rcluc- ,)JJ|^'^ 
tant to swallow. All these ii re iiislnncoi of sympathetic «ti<»i- 
action, which has soraetimcs »hown itsdf in pcrhups a stilt 
more extraordinary vray, where then: han bcon a peculiar 
iniUbiHty of habit. Thus Borricbiiu relates a case, in 
which it was produced by introducing a globule of blaclc 
hellebore into an issue in the ami-|-. [In certain indivi- 
dtiaU tbts idioeyncrasy U so strong, that particular articles 
of food, quite inoflensive to the generality of people, will 
invariably bring on diarrb<£a. The complaint is fretjuently 
produced by a sudden change of diet, as from an animal 
to a vegetable one ; or by a change of the water, or bread, 
to which we have been accustomed. In this species of 
dinrrhfca, as indigestion and crudiliea in ttie stomach are 
frequently the cause of the complaint, emetics have often 
been found serviceable. But purging inM been Kiipposed 
to be still more necessary to reuiove the i-rudilien that 
hare passed into Ihi^ bowels. The celebrated Cullen bc- 
licTcd, however, that this practice is founded upon very 
erroneous notions. It rests upon the supposition of an 
acrimony present in the intestines, that ought to be car- 
ried out by purging. Gut from whatever source the 
acrimony proceeds which can excite a diarrhcca, it may 
be considered, he says, sufficient to evacuate itself, so far 
as that can be done by purging. Dr. liateman pronounces 
this opinion extremely rational, and observes that, whca 
merely opposed to the indiscriminate use of purgatives ia 
diarrhoea, its juNtnesa is undeniable. But he believed, 
that Ur. Cullen, in avuiding one extieme, gave a sanction 
to another. In a recent case of idiopathic diarrlKca from 
excesses iit tabic, or cold, n gentle purgative is iteldoni, if 
ever, in the slight«st degree hurtful. However pIuuHible 
the supposition, that the irritating matter in Uic bowels 
will invariably purge itself off, experience proves that it 



■ Rphcm. Nu. Cur. Die L Ann. Ili. Ota. 3S4. 

t U* QiuliML Occtaii*, DfMcn. «t Onn. Aod. Hkfn. I7I&, 

VOL. I. T 




M34 



cut.) 



C«U«C*. 



C 




}j Mfv mtfoiiedf TCiAid, aad tkM a fSt of 
it reaMsa befaibd. kasfiag ^ a diyti al mimauam, «Aa 
the riitMi, mi ewm i fiittif m ■•• ^r** 
Wbeaever a^ ■uleral dapu iflaeMw ii ob- 
f, • pwgatife m goicnU; odtaiMi and, if Uw 
I 1m «aj inicaUB. apiaB ■■; baoDafcasd sitk it*. 

rfcabarb.orffaabwbwitli tb* Qncton. or ooaJbctw i 
iMdw b le ■wdt ci pMi. Wbeo Um om hbi 
mm. mmH doaea of the chalk woMSaxt, with the tnsL 
cMccbu. the compoand powder of kino, and tiaet. opn. 
nay be exbibtted ; aad ia ««(y long pratncted. uayieMiag 
esamplea. the camphor tuixture with lutnNia acid aad 
•piom t, or the aoiphatc of «opper joiaed with o|Ma. nay 
be given twice a day, ia the doae of batfa pain, padaally 
incteaaed to that of a ^nin and a half, as nootanMnded 
\pf Dr. EUwtaoat- In every forn oTdianduBa, the diet 
ia a moat important conaideratioD : it abonld eoa aiit af 
milk, nee. anuw-rtxU, Upioca, mgo. jelly, h^ff lea. 9t 
bfMli. In particabr, all tnolt-liquor febould be avoidad, 
nnil very w«ak brandy and water, wine ai»d watet. er 
barley •wat«r, preferred ta drink,] 



SPECIES II. 

DIARRHfKA BILIOSA. 

tfll.lOV.S I.OOSKSESS. 

THR FBCtS LOOSE, COPIOOS, AMD Or A BKtaHT 
YBI.LOW. 

niH.VIII. From the highly biliotu tincture of tbr dejections, t 
»rEc. ri. can bo no doubt thul the bile, lo this species, ia aecrated^ 



* I tMH— m an. DuaanvA, In Rm'i CydfaiU. 

t IV Addl Nitn^ li. Wmrw Cunph. ^tllj, TlncL Opo p. xL C«^ { 
«H^ K, ifufta qnaf ue hom mmcnd. RMranncadcd bj Ur. Uope In Kiia. 
>[*d. Jatra. So. M. 

1 1<M UaL Cliib Thh. md. »JiL 




CL.lJ 



OIOESTIVK PVNCTION. 



[0*0. I. 



in • frreater qunnti^ than u»ual, a»d pcrliaps with an un- 
omal dvgrvc of pungency; iind hciico the excess of p<>n- 
[ staltic actirity. 

The most common reniotc cauae of this spocies of diar- 
rhcBft U a great and suddvn Jncresse in the tempeiuture 
, of the atmosphere, or a less than its meao de^e of heat, 
operaling for some weeks or months. Dr. Lind hait justly 
lemaiked, that a rapid change of chraate, whether from a 
colder to a hotter, or from a hotter to a colder state, is 
I equally apt to excite diarrhoia. But the complaints hi-rehy 
, prodac«d are of very (lttri;rent characters. Thut occa- 
aioocd by vaddcn cold con-tista of an acrid mucous dia- 
chaT);e, and will be trLiitod of und explained under the 
next division. The diurrha-n. excited by passing rapidly 
from a cold into a hut cliniutc. belongs to the division 
, before us, and depends upon an increased secretion of bile 
fbttd quality. The calorific rays of the sun exercise a 
FlMCultar inHuence upon the organ of the liver, and soon 
I ttimulatv it to an augmented action. In the intertropical 
I regions, the quantity of bile hereby secerned is even more 
I than the bile ducts can conveniently carry off"; whence 
aome portion of it retrogrades, and is carried by absorption 
' into the system, and is one of tlie causes, thouj^h not the 
' only cause, of the darker hue of the skin in those quartern. 
In our own country, this species of diarrhrea is therefore 
fuiind nioitt commonly in the earlier part of the »uminer, 
when suddenly and vehemently bursting upon a cold 
•pring; or in the autumn, when the liver has for many 
: weeks been exposed to the effects of a very vigorous sun, 
I and the whole system has become relaxed and debilitated. 
If at this time the atrooaphere be pure, the diaease is sim- 
ple, and may be sulxlued without much difficulty; but if 
tlt« lays of the sun should carry off the greater part, but 
not the whole, of the stagnant water from the fens and 
I marahca of a countiy, and convert thera into corrupt and 
I fld^siTe swamps, the atmosphere will be loaded with an 
elRnriam of deromposcd organised matter, animal or ve- 
getable, or both, and the simple bilious diarrh<Ea will 
be converted into a remittent bilious fever; and hence, in 
few wonis, the common origin of the bihous autumnal 
fevers that so frequently prevail at the close of the summer 
season. 

t2 



OIK.VIII. 

8pk<-.II. 

DUnhm 

bitinu. 

romnioa ' 
cauaei. 



Differ In ihcr 

*vm|>loint 
liicy pro. 
duoc. 



I.tvrr, hciw 
tficnad by 
•uinmiT 
hat. 





27fi 



CI.. I.] 



CtELIATA. 



[ORD. I. 



1 

L 



OlH.VIII. 

8mc. II. 
Dianfuia 
bilioMu 

8onMtliiia 
aMvencd 
tnlo a blU- 
on* tnitti- 
lenircTDr. 

Midkal 



Whore the bilious diarrhoea is simple and unconnected 
with fever, it is seldom a tbrmidable disease; a few doM* 
of ndoincl, with a view of emiilii^iiiK the bilious pores of j 
the liver, correcting tlic irritation of tbe or^an, find taking 
otr its increased action, with tJie aamctance of mild diluents 
and deroulcenttt, u infumons of linReed, (quince seeds, or 
comfrey roots, for lubricating the inlt»ltnal cannl which 
hHK participated in the irritution, will utuatly prove a suc- 
c«naful piacticv. The lust hum nt one time a popular me- 
dicine in diarrhcBas, and Dr. Cullen object* to itM being 
omitted in the Maleiia Mcdica of the CulIegeH. If the flux, 
and consequently tbe excitement of the hver, should sttll | 
continue, opiates may be employed with advantage. 



SPECIES III. 
OIARRUCEA MUCOSA. 
MUCOUS LOOSKSESS. 

THE DBJECTtONK COKXttTINS or. OK COKTAINIKO, 

coriuvs ui»viiARoii or mucdb. 



«E".VIII. 

Mmc. III. 
Cmitn. 



HTijoOlrf 

MItirhiu 

InlcMlno. 

nnB,ei 

dlwriiM 

nMnhallt. 

Paqihg 
uijuriou*. 

Coploui 
dOucoli. 



This specie* bears a striking resemblance to the dc 
fluxion frum the nostrils in catarrh. lt£ common cause n 
cold, particularly in the feet; the motion* are acrid, of 
with but liutti biliouii tinge; and, like tlic noKlriU in 
catairli, the loiver part of the rectum i» excmiatt^d. It 14] 
hence denominated by many nntoncalarr/tut inlrtlinoruM 
and by Dr. Boerhaave t/iarrAaa rahtrrhalii. 

The disease ix, perhaps, also sometimes produced hf\ 
acrid ingeata, aa » coryza is occasionally excited by ster 
nutatories in those not nccustumcd tu tliein. Uere thi 
process of purging will ntllier add to tJie complaint thairl 
diminish it; tind copious diluents and demulcenta aflord-1 
the mo«t rational mode of treatment: with nliich plan ths] 
daily diet should be mude to coincide. 

Thin species of niticous ur c-aturrhal diarrhwa, like the I 
two preceding, is uW frequently produced by any suddggj 



UiaeSTIVE FUNCTION. 



[OBD. 1. 277 



llliucnud. 



^Pchnnge in Uie temperature of the ntniosplicre from great GEx-Vm. 
hwit to (^rwtlchillncES; and hgiicc iu frequency anrf «e- i)i^htti 
verity in puxiiing rapidly from & warmer to u colder cliniHU, amcat*. 
as iDlo liie North Smis in the summer time- " In the out- Ofwn ncc«. 
ward bound passage of the vessels employed in the wlmlc "^p^ 
fishery ou tho coast of Spitzbeiljen," says Mr. Macartnt-y chmgeof 
RoBB, "I have more than once had occasion to 'emai'l' J^p^^ 
the ver\' great effect of a tranEtition into a cold latitude in vdlinit. et 
dcrenving the state of the alvine diacliar^. The vetmels, '"'!'*8'"B' 
detitiiic<l for tluH oflcii perilous voyage, geaeriilly lciiv« Eng- 
land about the end of March, when the weather is com- 
pnratively temperate. A week or two serve* to convey 
them within the Arctic Circle, in the course of which time 
few caien are beginning to appear. Uut aller being fairly 
within the limits of tlie Frozen Sea, and encompiisKcd with 
ico, M> Ihnt the wind even carries with it a Strang and pc- 
nvtriiling frost, the cnwa daily increase both in number 
and severity. The weather becoming progresitively milder 
aAvr the beginning of May, and the seamen by this time 
being more inured to the climate, few or no cattCs are met 

nrith ; and such aw do occtir I have alwayii found to arise 
3m iJic patient having been called suddenly from bed in 
!ie course of duty, and exposed to an intemiely Irvexing 

[■tmosphere," 

Where the looseness, of whatever species, is produced In ifaii ami 
by a sudden chill on the »urfacc, small doses of ipecacuan. '""' •* *" 

'with or without opium, have generally been given with 
advantage*. Feniethuyst "ud Ur. FoihergillJ rccom- 

[inend it aloue: Dr. Slocrck^, with more rctisou, in com- 

Ibinntion. And if the disease should become chronic, the 

[.wanner bitters and astringents should be had recourse to, 

(•oolumbo, — to which also Dr. Stoerck recommends an 

idition of laudanum II, —cuspari a, and arnica {doronirum 

i'ardalianc/its, Linn.), which, though rejected in our own 

I country, maintains its reputation all over t)ie continent. 

[.Of the amira-root, Dr.Stoll used to give a dntchm every 

[two honre^. 

• ToxcBibLi. iLlia. 

f An onuiL ilii fluiul ndU nrulllcndi f Parii, 1706. 

X Med. DbwK. <iiil iLiiiuii. viil. vi. «rl. lU. 

i KlinixliF und Analorni'rhi.' Ili-nTcTkiifi>t>^ I^ 7- 

II Ibid. % M>!. ]Icd, Put II. f. au;. Pan III. p. 163. 



fl 



278 



CL. 1.] 



COILIACA. 



SPECIES IV. 



DIARRH<F,A ALBA. 



WHITE LOOSESESS. 



TUB nSJECTIOXS MILKY, OH RBBF.MBI.ING IK TIIRl 
APPEABAKCX a 

WITH A fhothy bcum. 



HIXTLRK OK WATGK AND LIMBj 



acM-VIII. 

Srrc IV. 

No nidi 



•nd nmoK 



■dopWd by 
(hcMilhor. 




[In the preceding ediliona of this work, the learac 
author described two species under the names of'dtarThc 
chyloaa and dian-hcea gyp»ata. The first is the «ase di 
nominated in Cullen's Noaoltyy " dianfima cceliaca, qi 
tumor lacteus, specie chyli dcjicitar." The appellation 
chylous h>OM!iieMi hud it keen merely uned a» a ftimtl4 
wwild hare bc«n but of Utttc con8«c|Ucnoc ; htit. promul 
gated UK it huH bcvn by various expcricncMJ phyaiciaci 
and even hy Dr. Good tiiniHctf, us dcrivw) from the reaUyl 
ehyloiiH nature of the excrement, it becomes a vehicle 
error, and the judgment of the practJtJooer in the eick<j 
room in too apt to be blinded by it.] 

The colour of the otools, according to Dr. Good, aflbnt 
evident proof, firstly, that the bile, uhich givea the usul 
tinge to the feces, is either not accreted, or impeded in il 
Sow into the intestines; and secondly, thnt the food, 
being convertml into chyle, is not absorbed and 
into the system. 

The non -absorption of the chyle must proceod fn 
tome mischivf in the lactcals or mesenteric glands; whici 
may either labour under such an inertness or toipttnde 
to R-nder them incapable of carrying on their proper funo 
tion, or may be ho obstructed in their coume as to l>e pr 
ventwl from exerciiting their function, notwtthHtnnding the 
being in a Ktatc of health. 

[Dr. Riimmel* has taken an excellent survey of 
various descriptions of this supposed disease given bfl 



" HuMhhI'* JcanMl, Jnnn Ittt. 




OIOESTIVB FUNCTION. 



ftuthon,aDd ftt>lycx|w«Ofithcini&taketbeyKlloommitt«(l in f>K«.viit. 
believing,tliat there was such a disease as iliftrrhccachylcwii, ^tSll^' 
the existeDce of which be completely cliH[>ro««8. It is to db*. 
Ur. GraTeH. of Dtibhn, however, that the iirnfMsion tn thia 
country ii> under [}articular ohli^lioiiK, for Iiia judicwuii 
notice of the erroneous doctrineN, hroached concerning the 
while fomis of iliiirrhocik*. A (;viitk-inan applied to him, 
tfter hnvinij; nuHcrnd ii gixxl deal fiuiii uu epidemic dyit- 
tntery. The lebrile ayniptontH, and dischai<ge of blood, SympioiiK 
had ceased for inaiiy weelts; buttheemiiciulitin and weak- "l^ti"' 

, . till "' "l»mi«» 

ne«s continueil to tnctease. He had one or two iKiiitrnl «!!«. 
stools daily, without teucstiius ; hut, in the courne of «very 
twenty-lour hours, he experienced eight or ten Kuddcn callti 
to stool, attended with an impoAaihility of ii>xi«ting the 
bearing down and weight felt in the rectum. Kiich eva- 
cuation cousialvd merely of two or three tahle-HpoonfuU of 
mtioo-gelatiitouit matter, which varied in colour and con- 
nisteitcc, hut '^i.'nerHlly resembled thieJc milk, or n purifonn 
fluid, und occuHionnlly n transparent jelly. This fluid watt srctrUon 
eTidenlly a secretion (Vom Uie mucous membrane of tlie '^' "■" 
rectuin in a state ot imtntion, or chronic ni(l;immatiou. nrihriii. 
It is obserred by Dr. Uruvot, that such a condition of''l"jJ|r("' 
a mucous n>cmbranc oonKtitutvs the diiteanc denominated «,■«. 
chronic blennorrhim ; and, when it occurs in the rectum, 
produces a disease, which, on account of the white colour 
of the dischart^e, would foniieily hiire been called tluxiis 
costiacuB, and the evacuation attnbuted to the lo&t of chyle 
byatool; for the chyle was supposed to befonned, but not 
absorl^ed, or rHrrte<] into the system. As Dr. Gtaves very 
properly reniitrkii, it in even less surpriaing, that Dr. Uooi] 
should have retained the old species, diarriioni chylovii, 
than that he abould have inserted a now one, whose exist- 
ence reftla upon still more doubtful evidence. This newThomiiiy 
ffMoes he named diarrhosi gypsata. in conBe«)uonce of the ^f^J'"""'' 
tvacDAtions resembling in their appearance a nii:ifture of„npru^. 
water und lime, which nppearuiK« he actually fiuieieil lu 
depend upon the presence of earthy particles in the fluid 
discharged. This view of the subject he aljio fortiHe«l by 
Mvenil ingenious, but premature, reflections on ihe power 



Km llubUn K«flUl RipotB, t«L j«. p. M, &« 





niCBSTtTB rUNCTtOH. [ORD. I. 

a matter resembling in its appearance a mixttira of water Osx.vill. 
and lime, whicK is generally very frothy on itx luHace. DUrth™ 
When the di&eaRe iit violent, the diHctiargeit are copiou* >iba. 
and very tuimoroiiR, of a pule colour and HOur ftincll, nnd 
the Troth lookti like yeaxt. When it cliatigeo to » milder 
form, the evaountionK an still more or less p»lc, but of the 
comtiHtence of puddin^r, nnd do not occur oftener than two 
or three tim<.'!i m twenty-four hour*. Tbe appetite is often 
good, but HonietitiK-ii defective. The countenance thin and 
sallow, but not much emnoiated. The pulse varies but 
littk- from the Ktiiiidard of health, but is rather diKposfd to 
acceleration. The (onf^ie is gcnemlly covere<l with a wlitte 
fur ormoderutethickncsH: the urine of mtoincwhst deeper 
hue tJiiin mittinil, generally clear, occasionally turbid. An 
examination of ihi- abdomen discovers ncjihin« unnatural. 
The bowcla ajv apt u> be distended wiili wind, but llicre is 
no lunionT, nur aenac uf pain upon preasurv." 

The disease occurs mo«t commonly in jieriKHi!) who have rmititu. 
resided for a cooaidemble time in a warm climate, or who UoucbMr 
hare sulfered from aflicctions of the liver: but it i» untie- \,j u, 
times met with in persons who have never left En^rland, or 
been cDuscioua of any hepatic complaint. It lakes place 
more commonly in men than in women, though chiefly so, 
(•eriiaps, because men endure the eviU of hot climates more 
frequently than women. 

Sometimes there will be a state of amendment indicating Piwai 
a cure. Tito motions become ligure<l, and of a darker hue. •''•'• ^ 
but rarely of the deep colour of health. This improremont, nimi oft«n 
bowever, is mostly of only a nhort duration, nml the patient <'«^'''"'- 
MOOD rcla|>«i-s into the Imbit of frutby di^jiNrtiouH. Those 
who aro afflicted often Uve for several years, but tbe disease 
continues with the changes just noticed, and they hardly 
ever fully recover. The mind, as in other disteaMCH ofADonnlbr 
irritable temperatnenlA, seeinit to exercia« Mme ■■iflHcnce;|^^|,^'^ 
for tlie symptoms arc agi^ravated, or the exacerbations 
appear more frvc|uently, under the embanussmentit of htui* 
DB«s,or the agiutions of nnxiety. Repeated returns of the 
OOBplaint St length wear out the constitution, and the , 
p«lient sinks from corporeal exhaustion. 

In the case formerly tenned dianhora chylosa, and sup- Mtdbtl 
posed to depend tx>iuclimei< upon ob<tUuction of tht-bicloaU ''**^*'' 
and meson Leric glujids, and Miiuetimc!! upon a scanty supply 



^ 





38'2 



CL. 1.] 



COCIIACA. 



[OBD. I. 



gkh.viii. of bi1«. Dr. Good rocommetuled th« foUowing piTictic«: 
vi^aa' ''^ ^'^ ^'^ canne. he says, tlie object u to remove the ob- 
struction, which mny be hcst accompliohcd by active sti- 
mulantA. as calomel. In the Hccond, ircalamel be giveou 
all, it Bhould be in ver\' Bmall doites; but the commoo pr»> 
pAnttionsofeinc and iron oflcr a better chance ofsucccM: 
and the rheum rhaponlieum, or English rhubarb, being 
Teiy slightly apenent, and far more astringent than tbo 
rkemn pahnatum, a useful medicine in vahoun kinds of 
looeeness from rdtxation, may here sImo be employed to 
udvantuge. in doAea ofa scruple taken tn-tc« n-day; and, 
where a more powerful vegetable astringent is requiivd, 
we may find it in the leaves and young twigs of the rktu 
coharia, or oonmuin ttumach; whicli, however, are chiefly 
eullivaled in our own country for dyers and tanners. The 
berries possess a like property, and arc acid, austere, and 
cooling. To these medicines may be added bltsters, or 
rubefacients to the abdomen. 

[I'he editor of this work is not inclined to place much 
reliance on any part of the above practice, except the ca- 
lomel at>d blisters. As the disease seems to be connected 
with a scanty aecretioa of bile, and a mofbid state of tha 
secreting veoseU of the mucous coal of the iuteatiius, 
small doMA of calomd, or the blue pill, joined witli opiooi, 
counliT-initalion of the skin of the abdomen, and anodyoQ 
or uMriugcut injections, seem to limi the most adnsablc 
remedies at first; and (hey may be followed by tonics. and 
other nltetmtive*, according to circumstanccK. Id parti- 
cular, the nitrous lelher, and tinct. opii, which have been 
frequently exhibited in th(> camphor mixturtr, in many in- 
veterate caaea of diarrhasa, with au]>cnor cUbct, should be 
recollected.] 

In the examples, characteriied by ilie resemblaoce oftb» 
»Ioo1h to a mixture of lime and water, i>r. Baillio eatimatM 
the influence of medicine as very iocoiutiderable. Haifa 
;;rain of catotnel, throe grains of piluliv hydrargyri, or a 
few of the hydrai^runi cum cretit, taken cvvry night, or 
every second night, have occasionally produced some ad- 
vanta;;f, by stimulating the liver to a better and mor« 
plentiful secretion of bile, witliuut impninng tl>e strengtli 
of the cuoHtilution : and billoro. nM cascarilla or cHSparia, 
combiitetl with a Tew drops of laudanum, liav« abo occa* 




€Ui I.] 



BIOESTtVB VVMCTIOH. 



[OKD. I. 



flionalljr hftd their ewe. But, according to Dr. Baillte. the Ow.vill. 
benefit is often only temporary. [Since the period, how- Di^^la, ' 
crer. when this umincnt physician wrote liia observations, alb^ 
experience has pronounced the antphate of copper to be a 
valnable medicine for the relief of this and other forms of 
obstinate chronic diarrhos. Dr. EUiotaon prescribes, at 
firBt, half a grain of it twice a day, joined with one grain 
of opium. The doae ia alierwarda gradually increased to 
one grain and a iinlf, or two gmins ; and tlie diet oonaists 
of milk, arrow-root, becf>tca, and a little wine*. 

On tfaf authority of Dr. Hummel, who had employed 
the extract of nox romica. Dr. Gnircs resolved to try the 
effect of strychnine in cases of diarrhcea alba. One-twelfth 
of a grain was given, in the form of a pill, twice a day, and 
with a aucceAflful result. Dr. Rummel observes, that, after 
endeavouring to remove the orii^inul cause of the disease. 
the best remedieit arc narcotics, combined with strcngtli- 
cnin^ and astringent medicines. Nux vomica, he says, 
possesses a peculiar power in controlling blennorrhoia of 
the rectum. In the cases recorded by Dr. Rummel, he 
omplojed sulphate of iron and columho, hesides sulphur, 
which has a particular action on mucous siirfnces. The 
eare was generally promoted witli hyosciamus, or opium, 
joined with nux romicaf.J 



SPECIES V. 

DIARRHCEA LIENTERIA. 

LUiM'ERY. 

TRK DKJKCTIONS CO.NiilSTlNR Or TUP. ALIMKNT 
rASSEn BAPIDLT, AND WITH MTTLR rHANOR. 

Thb signs entering into the definition of this HjieotesGtN.vlll. 
prove aufficiently, in the first place, that the Ktomach is in -""""^V; 



* See M«d. Chit. Tunv vol. alU. |>. »l. At. 

+ finvo^ in DnUln Ilaipiul Itc]H)rlis vol. Iv. [i. tO, 




S84 



CL. ..] 



COILIACA. 



[OKD. I. 



! ex. VII I 

Srrc V. 



SpMiflc 



•hoc* 



a. morbid Btat«,und that the gastric juice is not secreted in 
a proper quaotJt>' or with proper qualities ; and next, that 
the bile it) cither not duly secreted, or else obHlructed in it« 
puH«.-ige; for were there a free flux of it. llio feces, however 
exude, would display their common yellow hue, which they 
rarely exhibit. [According to other writere, however, 
lientcricdiarrhfEa depends upon a morbid irritability of the 
stomach and bowels", whence the food is prematurely 
expelled from the former organ into (he intestinal canal, 
in an imperfectly digested state ; and the bowels them- 
selves, being also morbidly sensible, very quickly void 
whatever ihey receive. The motions arc at tile same time 
loose and liquid, the exhatant vessels and excrctorics of the 
mucous glands pouring out an abundant quantity of their 
respective fluids. The diwaso is generally uccompmnied 
with great weakness of the digestive power, as well as 
morbid iniudiility of the stomach.] Uentery {>jiimj;a), 
lubricitas intvstinorum, was the name given to this disease 
by the Greeks, and it is here retained. The Latins, with 
a loose translation of the term, called it levitat ittlali/mmiH: 
and the general idea expreated by both is, that the aliment 
passes lightly or fleetly along, and with littln elaboration 
by the intestines ; whose peristaltic action is ui the same 
time quickened. 

[The view taken by Dr. Qood, of the causes of tfae 
present disorder, led him to recommend the genend plan 
prescribed for dyspepsia. According to other physicians, 
however, the indications are, first, to lessen the irritability 
of the whole alimentary canal, by the exhibition of opium, 
joined with ostringentit and absorbents ; secondly, to 
increase the digestive power of the stomach, by the adini- 
ni«tnttion of tonic bitter medicine*, mt the infusion of c«i- 
curilla, gentian, or orange pc«l, the decoction of cin- 
chona, or small doses of the sulphitte of quinine. Moderate 
exercise, especially on horseback, will tend to re-establish 
the functions of the stomach ; and all cold articles of diet, 
or such iiH are diflicult of digestion, should be avoide'i ; 
particularly salads, and other raw vegetables. Dr. Bate- 
man once wilnessed a severe attack of lientery. brought 
on by eating a little ice-cream, when the patient had been 

• Bmmimi, In Rwi'i CfckipcdU, in. Libki xav. 




CL. I.] 



ni«ssTiv« rrNCTioN. 



[OSD. 



2RS 



h 



prcvioutty miffCTing froin indtg«ation ; th« enfevblnl di- ^''''■^'''• 
gwtivc powi'rn Heemed to flink nt nnce, and the food was diutIw*' 
mchafirisi iklmimt unchan^. When the alimentarj- ninal i-tm""** 
IK in the »l>ovv-mentioned imtiiltle otatv, the invalid »liould 
rerroiii from ex«rcii(e immediately after roealB.] 



SPECIES VI. 



DIARRHCKA SEROSA. 



I 



SEROUS LOOSENESS. 

THE DS;»CTI^^g ALMOST KNTIRELY LIQl'ID AND 
MMftn. 

From tlie thiit fluidity of the btoola in this apecies, 
Hoflinan has described it by the name of tiiarrkira tiqwua. 
It lit cvideiilly dependent upon ft very inritnble rtaie of the 
excretory vcml-Is of the intestines; and §omctimDS holdn 
the same relation to the third species, diarrhtra mucosa, as 
the limpid detluxiou of an inci)>ieRt catarrh does to the 
roueons discharf>« in which it terminatca. Yet the irri- 
tation is here much greatur than in iiiiipoms diurrhn-a, often 
produced by dill'erent cuuses, and fre(|tieiitly requires a 
different mode of (re«tment. The mucoua diarrbcDa, or 
indeed any of tlie preceding, may run intrt it if lon^ con- 
tinued; for the common cat! HA of the iri-i(ation is debility 
of th« excrotoriea. Here, a^in, it must he obviniis that 
purging of any kind would he mischievous : and tlie 
most effectual plan of huccfsk that Iiok occurred in my own 
practice, haa been the use ofwanu astringenu and jrentle 
Btimulanta or Ionics. 

The aimarouha('yuaui<j simarou/Mi) in particularly entitled 
to onr attcnliDn, and will indeed be found usnful in most of 
the species of tlie genun before us ; w will nUo, in many 
caaea, the iopex-ruot {topetia MejriftiHa}, which by Oau- 
biua* wu preferred to the Himarouba, und which seems to 
operate at leatt ax much by tnuiquilli^iiii^ the irre^ulur or 



Qe».VIII. 

Srrc.VI. 
Dtuihoa 

Krau. 



Puwing 
muchieXM* 
Gmdc 
■[imalani* 
•nd MaiM 

UKfuL 

Sinikruubt. 



iMfft-KOl. 



• Adranw. 




286 



CL. I.] 



CCKLIACA. 



[orb. I. 



OEV.VIIt. 

Srtc.VI, 
Diurhsn 



Cujophyl- 



Pomcgn* 



TWmoc 

flhlrLMjr^U 

vididU- 
phomin. 



Truifctof 



Aixl 



CdHnpbor 




efKismodic action of the tiit«»tninl canal, as by any natrin- 
|{ent paw«r it may poftscM. The grvm urbanum, Linn., 
hettvr known by the officinal nitme of caryopbylUta or 
herb biMinut, was lunnurly in bigh repute for uU com- 
plaints of this kind, anil from ita asuingent ami tunic power 
dcHervcs to bi; icvivcd. Its taste is aromatic nnd austere. 

The pHiiita granatttm, balauKtinc or pomcgraiwtc-trte, 
is still cODtinued in several phtrmacopceias, and entpU>y«d 
in practioe in this and tliL- preceding speciea, both in the 
Aow«r and bark : the latter seems to bnvi- been a favourite 
medicine with Dr. Mead, who prescribed a (lecoetion of 
it with red roaes and cinnamon, in laiioua dianhcea.4 pro- 
cee<)ing from debility. Cullea* and Sirandbcrgi- think 
highly of it. It is, indeed, a powerful astringent, and as 
Huch tH entitled to attention ; but it has a rougbneax so 
iinpahtt^le a» to disijualiry it for gencml use. Wberc 
these cannot be retaini^l on the stomach, ultim alone may 
often be had recourse lo with advantage ; and Dr. Cullen 
expresses his surjtrisv that it is not employed more 
frequently or more freely, llis dose is four graine at first, 
and aftervrnids n scruple several times a day. 

Where the disuase is of very long standing, we onert 
gain grcut bcm-fit by uniting a tonic or astringent wilh a 
dinphorclic, thus strcni^tlicntng the bowebt, while we take 
oifimlation by exciting a transfer of action on the skin. 
Upon thiB principle Dr. Fonlyce proceeded when he 
preecribeil a combination of tormenlil and ipccacnan. A 
like transfer of action has soinetimcs been attempted by 
i^uea, blisters, and setons. Hippocrates, wilh more rea- 
aon, employed for the same purpose emetics^, and baa 
been followeil by Kontaino and other pructitioners ; and 
Malvaohini, with tlie same view, recommended diuretics^. 
Dr. I.ii)d|| and Dr. Adair*! have recommended ihe native 
carbonate of zinc, or olhcmal cnlaaiiive in fine (Mwder. 

In a very obstinate case that fell to my lot a few yean 
ngo, in which the patient, a yoting woman of twenty-four, 
hud, for t«^'n yeara, never passed fewer than nine or ten 
watery stools a day, sometimes tinged with blood, and often 
accompanied with great spasmodic pain, I found the di^ 



• Mm. Med. Tdl. II, p. 41. 

* 111(1 luKt. lib. Ul. p. us. 
g rin IMmium In Km CKnaiM. 




t TalomdcFd. ai. 
I Udla ('flllwliann. 
% MnlinI Tinnnirnutin, Ac 




CL. I.] 



DICRSTIVS VUHCTIOH. 



[ORD. I. 



287 



UM of lead. 



M*e yield in s few weeks to ciimplior mixture an<) pillit of oeh.viHi 
tho rwtinoas gums, after that, lui I had n-uKon to belierc, d^;^ ' 
itll tJio usual routine of astringvnt rarllis and bbIu, aatrin- «»«. 
not pu^^atives and narcotics, hiid been tried, mid .tpent 
their force in vain. It is probable that in some cases of 
thie kiod tiip Hupemcetate of lead, in doaes of a grain, Supmcr- 
eombincd with thn-c or four drops of laudanum, might' 
proTe equally useful. [Here, ulso, the sulphate of cupper 
in the dose of half a grain, gradually inereased to u graio 
and a half, joined viitli opium, itnd giriii twice a day, 
tuenls trial, the cxperii-ucc of Dr. Elliutson being strongly 
in its favour*.] 

This disease is ubu occasionally prmluced by drastic 
purges, as elateriuiR ; und is often critically employed by 
nature to eairy ofl' dropsies and some other remote 
uccuinukilioitH of fluids. 



SPECIES VII. 

DIARRH(EA TUBULARIS. 

TUBULAR LOOSENESS. 

THE nEJP.CTIONK CONSittTINO HOKE OR LESS OF MRM- 

nRAKE-LIKE TUBES, VTIIITIBH, VISCUVB, ANft IK- 

onoROva. 

t HAVE never hitherto seen this species arrant;ed. and 
not often d esc riWd ; but it occurs fretjucntly in practice; 
and appears to depend upon a peculiar irrit:ibilily of the 
riltoua membrane of the larger intestines, which, in con> 
Mqucnee, secrete an effusion of coagulating fibrin, fibrin 
mixed with albumen, instead of secreting muca«, occa- 
aionatly accompanied with some degree of chronic inflam- 
mation. It hntt a striking ri.<««mblancc to the tibrous 
exudation thrown forth from the trachea in croup, but is 
usually discharged in longer, firmer, and more compact 

• fi« MbI, Cha. Tnat. «il. vKL 



OeH.VIir. 

8ri€. VII. 

Dburboa 

tubuUria. 

Ncvw 

hilherla 

dmcnbed. 



Exudslion 

likflhM 

Id ciwup. 




288 



ct. I.] 



CtBLIACA. 



[UID. I. 



Obn.viii. tubes. Th«re is commonly a considoruble itcns* of boftt 

j^l^uim ' ^°^ uneaaineSR in the rectum f and upon cvacuUtoiu, tbe 

inMuif. sphincter, partaking of the irritabitity. coatncla so forcibly, 

that the feces are discharired witli i^ruut puin and of very 

gniall calibre. 

Oft<n nb. From the laminated appearance of this effuaion* it baa 

in nlUia. ^"eri'lly bc«n mistaken for a separation of the mucoos 

titmat membninc of the intestines; with which it seenu to be 

^mbnn*. Confounded by Dr. Simson*; but the exudation ba« no 

lloajiH-^^Tascular structure, will iwt bear extension, and lose« ila 

Ulutirattd. f^otm as soon as handled. At the lime of writini^ I have a 

case of thin description under my care, in a lady of delicate 

habit, twanty-cight years of age, who has been long 

labouring under a peculiar irritability of the rectum, giving 

rise to some degree of chronic inflammation, and a forctble 

^ contraction of the sphincter on evacuations. She has 

already discharged this kind of effusion for six weeka, and 

in tubes so perfect, as at first to hare excited no niaO 

atinti in the attendants who noticed it. It is now, in aonie 

de^c, on the decline both in quantity owl tenacity. 

M. Bauer, in his letter to M. de Hahnf, ^vea similar 
cxnnipleH ; and a tike case i^ described by Spindler, in 
which the accretion was worked up into a " materia alba, 
longu, compacts t-" It baa aometimcs assumed the exact 
sha]>cof the intestine, a« though it hud caxt otfatunicl. 

I have'suid, that the dUchar;^ in tliis species pnxeeda 
chiefly from the large intCHlint-s; and I have aeen it ao 
oAen us to have hud sufficient op|>urtunity of determining 
witlt tolernhlc accuracy the part of the canal affected. 
From a valuable article, however, of Dr. PowcH'sf, it 
appears at times to take place in the narrower portion of 
the intestinal tube, as high up, indeed, as the duodenum; 
for wc are told, that it was accompanied with acuta pain 
in the epi^stric rcg;ion ; tlmt the stomach was highly 
irritable; and that it was followed by symptoms of jaun- 
dice or obstritcted bile. 

From a small increase in th« pulse, and a coating on the 
ton^^ie. there seems to have been here also a slight degree 



Dbcfauge 
IniDMt 
CBMi iMnn 

InlcMlna. 



• Edin. MnL Eatj*. vol. t. p. !». t Dc U«b. Intnl. Dn*d. I747. 
t OlM.411. fiAc%. Nsi-Oai. to1.*.OIn.IM, 

I MaL Tnn. ««L vi sit. vlU 




Ch. I.] 



mCESTIVF. rttSCTION. 



fotlD. 



I 



of inflammatory nctimt. though ro iiieon9i<)crnbIe tliiit Dr. 
Powell queM ions, whether thcie vratt any whutevcr; l>ut 
adds, which my own ex|)t:riL>nre leads me ninst fully 1» 
contimi. that the ctiM>a§e is certainly uot " disposed to 
anumo thst peculiar irritative quickness or pulse which 
tnatka enteritis. 

That iJie alTcction described by l)r^ Powell belongs to 
the present species, will appear evident from his deBcnp- 
tion of the tualcvial evacuated, which seemed "to have 
formed p»rfs of iin extensive iidvcntitious membnino of no 
great tenacity or firmni-KK. " In the first of the cuscs," ho 
odda, " which came uncItT my notice, this membrunc wiw 
passed in perfect tubes, some of them full half-a-ytird in 
length ; and certninly sulHcicnt in qunnlity to have lined 
the whtile intCKlinnl canal. In otheiM ulso, the aggregate 
quantity bait been very Inrge, and it bait continued to come 
away for many dnyii, bnt it hns been in thin irreguh\r 
flakes, of not more than two inches extent, and not, as far 
as I couM discover, of the perfect tubular form." And he 
aflerwardit compares the mcmbranmiK materiat thus ex- 
creted to tliat " formed in the trachea, nnder croup; but 
the symptoms." e;iys he. " are (here more rioteiit and 
destructive from locality of situulicm." 

F>om the acute degree of puin, which the disease llius 
sltuftted produced, und mu:^t iieccMsnrily produce, in the 
Mmllcr intestines, as aUo from the spasmodic constriction 
of Ihc bile-duels, and the common symjitoms of jaundice, 
the pasesgc of gall-stones was at flrHt Muxiiectcd, till the 
character of the intcstinni discharge spoke for itself. 

From n like efTusion of fibrin in the uterus, Dlunienbach 
has shown, that a tunica decidua hits been occasionally 
produced through the excitement of nn aphrodisiac passion 
alone, without copulation or itnpregnution*; and Mor- 
gagni bus given exiHiiples of HO perfect a foruwtion oftlic 
same membrane by tlie irritation that takes place in pain> 
f«l nienxlruation (paramenia iiifficUii), as lo render it difli- 
cutt to be distinguished from tliat belonging to an ovum'K 



289 



ciicw.viri. 

SrKc.Vll. 

lubulana- 



Ttwi 

UnnwHiw- 
linifm vrry 
■buiillaiit. 



Hh \ifca 

mlitikenfoc 
fhololiUiui. 



A like f 

CTciSaii 1iu 
natirnA in 
lh« UtvrUb 



* ComnMni. Sac. Rtg. Soicnit* nOllinft. vol. Is. 
t Ds tied, ct Tauk Morb Ep. ulrili. 13. 

VOL. I. 




290 



fh. I 



1 



CatLIACA. 



tfAfi. J 



(JKM.Vlll. 
SPKC.VII. 

IKarihim 
lubuUrii. 

Hiilum of 

I'apulbik 



tnj«ctim>. 



nliit |h1], or 
riaR<"ic('!i. 



Su corpora lutva h:ivc been rormctl. ai^ Uicir cichtricm 
occasioually foitnd, ti» Ihc ovariefl of rirgius. 

The mildpr ]>ri*p»rnliotis of mercury employed tis nltrr- 
ams rather lliun npcricnu. have frcquciiUy provi'd bcc- 
viocablo; and llie bulituiii of copaiba still man mo. Tlie 
last is indeed gcncnilly UKcful in a chronic inflammaliwi 
or irritable condilioii of the MccnicnlK ofiuiicouii mem- 
brnncH ; Qiu) in the diBfOBe before us. wlicrc 1 have not 
been abl« to induce the patient to take it by the moutli, 
I bnvc recommended it in tlic form of injcetioos. In one 
cnae in which I jHrescribcd it in Ihi^ fomt, three dmchuiH, 
intermixed with three ouncea of wucih^c of linsee<l, bemg 
thrown up three times n-day, il proved uinmeiitly owful. 

Coumion emollient injections, moreover, employed in 
much l!ir),'er quantities, where the tiphincler will allow tlie 
pipe to pnss up, nflord teniporar)- ease : and a dilueat ant) 
anodv-no injection of warm water and laudanum alone, re- 
pealed twice n-day, still more benefit. In the mean while. 
the mercurial prejximliuns ju«t adverted to, and especially 
(he blue pill, or Plummer's, which is still belter (the pil. 
hydiui^- oubiuur. comp. of the London Collc;;e), should br 
taken in a dow of four or five gniinK evrry uiKht ; aud. if 
necessary, the bowels kept u|icn by (wo drachms of suit- 
limed sulphur daily. 





GENUS IX. 

CHOLERA. 

VOMtTISG ASD PVHlilNG. 

■ 

ANXIBTy,CRIPINOS,SPAIIM» IN TtlK LKCfl AND AIIMs; 
WITH vnMITIhli AND PCRGINR; or ri,ATIILBNT 
ERL'CTATIOMS AND DEJECTIONS. 

Crolbra has. by HCv«rnl iMc and prcHcnt writCfD ofdi- •V'f-^^ 
stinction, been rcgitrclcd us a mere spccicit uf Komc other oulthcd 
genus, as uiarkiioia, wliich ia the view tnkcn of it by [^ *"*■'' 
Dr. Young; or as a mure variety of sonic particular spis tomii**. 
cies, OLS vomittis, whidi is the place it holds in Dr. Parr's 
Doaology. It is not always, howcrcr, accompanied with 
a diarrhoea; and. even where it is so, the constant tend* 
ency it evinces to an extensive chain of Hpasiuodic actions, 
gives a striking chariicter to the dJseMe, and justifie« its 
b«ing arranged and ti'catod of as a distinct genus. From 
vumilus, it is still more widely tliAcrefxint. 

The term nioLRKA in of ancient uhc, for we trace it in Oiigin nr 
tlie writings of [lippocrates. Celsua derives it from j;eM J^!^""'* 
and fhiu, literally bUe^fiux, and Trallian from -/ti-ii and ^im, 
literally hiUilmal-fiux. aa though iho matter discharged 
fmu the alimentary canal were excerncd by the intestines 
rjlher Itian by the liver. It is highly probable, that, in all niuvt<r. 
iU itpeeiCK, «c shall have to contemplate the liver as m«r- ^jj^"^" 
liidly afreele<l from the commencement, and the bile a« bil« nth« 
Hoine way or other damaged in itK »(*retion, yet not always J^^J"^ 
by too ragad and copions a flow, tu which the disease has inrnsw/ 
been generally referred. This, indeed, will be found ordi-*"*" 
narily (o take place in the f1r«t of the three following spe- 
cies; but. in the second, it appears to be injured by sup- 
pression mlher titan by excewt; and in the tJiird, by a 
change in its natural qunl)lic«, if, indeed, much of the 
Huid discharged in this species be not, as suspeoUtd by 
Trallian, in some instances, secerned by Ll>e excretories of 
the intestines. Under either derivation, however, the term 
ia not incorrect; for the alimentary canal and the liver 

u2 




■J!>2 



ri..,.] 



caLIACA. 



[ORD. I. 



riKK. rx. uniformly co-opertto in the morbid action, and th« fluid 
I*!*"" discharged 'i» the result of such coucurrence. 
hMl'MM^ Soinc writi-rK fonnfrly. and many in ihe present day. 
^^J^*'W hnvc cxprcssrd this iIi^jikc by ihc pleonastic term ofcho- 
'■■nbiu. 'era moibtiK. pvUtuding ihitt cholum, of itaelf, imports 
itttf^er n» well att tlie difleititc before us, and that morbtiit is 
added to diatingiiiab between the two. I am not aware, 
that the word cholera has ever t>een employee! in a meiilat 
ken.se by any Greek writer, though several of its co-deriva- 
tives have bevn. Tt stands nlone in Celsus and Galeii ; and 
if a distinctive udjtinct ucrc not nceessnry iit their ditys. it 
must be wholly superfluous iii ours. The following arv titu 
species that eccm eluirly to belong to this genus: 

1. t'llOLRNA BILinSA. UILIOUS CHOI.KHA. 

2. FLATUl-KNTA. WIKD CHOLXRA. 

3. SPASMOniCA. SPASMOntC CHOLIIRA. 



SPECIES I. 

CHOLEIU BILIOSA. 
lilUOVS CIWLRRA. 



TBB VOMITtNO AND PtlRCIKU FXEgnCKT ANttCO- 
PIOliS, WITH A HF.UtNDANCV i>r IIILR. 

This BpecicK is (>oth sporadic nud epidemic. Under th* 
first form it is naimlly of slighter and shorter duration; 
. and iU common cnuses are, superabundant and perhaps 
■ acrid bile; xuppresswl perspiration, jiarticulaily by cold or 
damp applied to the feet, us in standing long on a moist 
soil in foggy wentlier; cold drinks, especially when tba 
bo<Iy is considerably heated by exercise; cold, indigestible 
fniits, as unripe apples or penrs, cucumbers, melons, mush- 
rooma; drastic purges lakcn in excess; and in one insunce 
an excessive dose of emetic taitar*; a sudden fright, and 



' Htnrtd Dincn. <Ie riwlcta Mntbo, ild. 17*0. 




particularly frotu tliuiij«r*; or any other rapid exhaustion Okk, ly. 
of the Eensorial power. ^?''f*^" '"' 

Ihc causes arc, therefore, manyoftncm the Bame asbiUnt. 
tboee that produce Heveral of the species of diarrhtcu and c«u«. 
colic; parlicnlarly colica eihuria, or surfeit. Svdenhiim, """I'' 

- til I I . . 1 ■ ri'laicd III 

todeed, observes, that the symptoms of the Inst and of colic 
cholera are alike, and the cure the same ; yet adds that 
Ihcdiseuscsare ofadiUV-rent kind. In effect, the last is 
peculiarly disliiiguinhcd l>y it» wandering or universal 
ipasticily; and hence hecomea n far more dangerous, 1>e< 
<.-ausc a far more general, affection. 

The epidemic form of the disease shows itself commonly Kpideouc 
at the close of summer, or the beginning of aHliimti — (^fj^ii^r, 
Sydenham Rays, us certainly as the appearance of hwhIIows 
in the spring, or cuckoos about the dog-days ; [and that it 
very seldom continues longer than the month in which it 
bc;;an. Hut, as Dr. Ruteman observes, this ohservation 
docs not accord with the experience of the present times. 
Cholera is now seen perhaps more frccineiilly in September 
than in Aiij^st ; and cases sometimes occur, though it be 
not epidemic, considerably earlier than Aufjiist; even in 
June, or May+,] One of the immediate effects of the ch- Wh» prin. 
lorific rays of the sun is to stimulate the liver to an e.\- ^.I^i^u^n. 
ceKMvc secretion of bile; hence the alimentary cana) iit 
overloaded with it, and perhaps the blood impregnated. 
And hence again, the greater violence of this complaint 
and itit accompaniment with peculiar symptoms in hot cli- 
mates, OS wc shall bavo occasion to observe presently. In 
addition to this cause, however, which operates directly 
upon the body, there is another which operates indirectly 
upon the body, and directly upon ibe nlmospbere; and 
that is the ascent of on unhealthy effluvium from the de- 
composition of animal and vegetable substances that form 
the face of swamps, marshes, and otiier raoi&t grounds; 
which predispose the body to the action of this and other 
diseases as well: unleH» it be conceived, that the particular 
epidemy results from a particular combination of the de- 
composing elements, so as to produce a choleric miasm. 



I 



• Phil, Tnns. IM7. Flrnrie. DIu. tupiiMib 
t Ittti'i ryflopinUd, ait. CmolSH*> 





tL. 1.] 



CtKLIACA. 



[OBD. I. 



Okn. IX. 

BMC. I. 
ChaloB 
bffiaM. 

VftlMa 

fttoik 

miMia. 

Ttn *n>) 

nplJljr 

fauL 

Otnmi 
(hanctcT ■ 

■mm. 



Nalart of 

(Imrp M 
•tHr!b«d 



8», under anoUier conibiiiiitiou, Utey produce a Tebrile 
miasm ; a subject well vrorUiy of eonsidcralioii as it relolcs 
to the third ftpecics of cholera. 

It is not to be wondered at, therefore, that this discue 
sliould, in many instances, prove peculiarly ecvcre, lu 
symptoms, indeed, »re often dreadfully violent and rapidly 
fatal, as ntiiy be Keen from Dr. Sydenham's description, 
which i» (m foltowft: Vehement vomitings, and difficult 
and painful dejections of ill-conditioned duids; agony, aitd 
inftammuliou of the intestines and abdon>cn, cardialgta, 
,thiri)t, a quick piil&e, often small and unequal, heat and 
anxiety, ii^kusea and colliquative sweat, spasms of the ann"! 
nnd legs, fainting, coldness of the extremities, and other 
itymptouis of equal danger, which terrify the by-standcrs, 
and kill the patient in twenty-four hours*. 

Celsus, who has entered with more minuteness than i« 

common to him into the diagnostics of this species, ex- 

plnitiB, more fully than Sydenham has done, the exact na- 

bf L'dnii. ^^^^ j^j appearance of the ill-conditioned discharges lo 

which the latter refers. " Bilis supra infraque enimpit, 

priniCttn aqua: similis, dcindc ut in c& recens caro Iota esse 

ridciitur, interdum alba, nonnunqiiam nigra, vel rariut." 

" llie bile bursts forth both upwards and downwards: at 

flrat like water, afterwards aa tliough fresh flesh had beea 

washed in it; sometimes white, sometimefi black, or ra- 

negated." Aud be adds, accordantly with Sydenham, 

" quibus concurrentibus, iion mirnm ext, si Kubit<\ quit 

moriatur." " All these aymptonin uKsociating, it is not lo 

be wooderod at that the patient should die auddcnly^," 

U(4kai A* the general commotion of the alimentary oaotd is lo 

"""'*'"■ be referrud in this 8[>ccies to a superabnouance of bile 

thrown into it, and probably possessing a peculiar acri- 

rir»i lnun< mony, our first object In attempting a cure should be, not 

to excite an additional How by stimulants of any kind, and 

bUnKDCi specially by violent purgatives and emetics, but to dihita ', 

Mu^^t ""'^ "^^^ '* ^^* ^^ *'"' "•omach and intestines by a frc^l 

ibaiKiniu. exhibition of mild dcniulciMit Duids, as well injected by 

the anus as given by the mouth. And wheti this tiM 



bnu. 



■ aiA. it. chi|>. li. At klM Kplil. in Uotli. KpUcM. IC73— |0W. 
t Mcdldiu Lib. It. Sttt. xl. ; Imq disL 





CLiti 




bcco necom|jli».hc<l , l)ic spaaniodic action or whatever piiru ^bm. IX. 
are oJicctctl miiy hv. iidvniitageously uttuckcd willi opintcs. f^^ml '" 
Tliiit waR Sydoiiham's practice, and >t cannot n-cU be im- IhUm*. 
proved upon. 

Those <iducnt8 and deinnlcenta are to be preferred which 
agree best with the ittonmch. and sit easiest and longest 
upon it. CclsuB rvcomniendit a free lute of water not quite Wua 
cold, but only just deprived of its chill; " aqua, ncque osi "'""''J'"" 
ipaa fhgida, sed potius egolida, danda est*." Lienard, 
half a century before the time of Sydenham, gave it cold 
and fresh from the fountain, and, as he iiKsures im, with 
great miccess'f. And Cleghorii htut iccuinnictidtrd the 
name practice ereu in hot climates in our own tiuica. Dr. <)*i->'m<l 
Douglas ivaa peculiarly attached to toast and water, which wauT."" 
he made with oai-brcad boiled iti the water; the bread so 
thoroughly toaxted, that the decoction was as brown aa 
coffee. Tliis has a slight astriugency and a little mucilage, 
and may be a useful diluent; Dr. Douglas dcclures that 
he never knew it rejected in any case of cholera. Infusion Mini-Ma 
of 8pear-mint proves, also, a good anti-emetic, but itfj^']^, 
should be made with leaves fre^h from the garden. Sy- 
denham prescribed wcuk chicken -brolli for the Kome pur- 
pose, and uppliod it by injection to tJic rectum, as well as 
to the stomach. Linaeed-tea or barley-water, with a little 
gum>acAcia diswlvcd in it. may answer as well. Ak soon 
as tlie aliniontary niii^ti i» tluis cleared of acrimonious 
■natter, and the nicltni'jiit Kiibiiides, opium, witli or without "P''™< 
relaxants, shotdd be administered in repeutc-d doses, to 
aabduc the spasmodic action. Sydenham employed it 
alone, and in bis favourite form of liquid laudauum, va- 
rying th» done frum tweJve to twenty drops in mint- 
water. Dr. I'Virdyce, with still more jmlgnienl. united it^niiauu- 
with Miiall doses of aniimonials, and thus increased its 
relaxant |<ower. 

But if the onset of the ditiease be very violent, and the ^''"" 
putee and the general health sink rapidly, opium must be apiuiii rvuoi 
given, and very freely, from the eommencement. Cholera '^" ""•■ 
is in all ca^s a very acute disL-itse, and of nhorl duration. 



* l,MO MI|H».CllBI. 

f DiMcn. Kigo t^btrlcTB Moibd ftitptlui Tvlua f IVit, IK20. 




COILIACA. 



[■ 



ORD. t. 



0^,f^ t^%9 tkvuiy obaemed thul it tiaa dMlroyed in twenty- 
~ ' *^ tkiir hHMTSi tKoM cases, liovrcver, iirc nire. Tho Rymptums 
l()M«f«Uy abote ou the second or Uitrd duy, ai>d (he pntieat 
ie4.H>vi.-'r« rupidly. If there be any coitsiderdible degree of 
vfiMkuras on the decline of the dUcaac, it may be uecesKary 
til have recourse to the wariu and bitter tonica, of which 
cutuiiibo will be found one of the best. 

[The following mixture its strongly recomnifiiKled by Mr. 
lloi>c*, ufChnthnm, fur its efficacy in cholera. K Acid. 
Nitrou Ji. Mi^t. Caiuiih. Jviij. Miscc ct tddc Tioct 
Upii xl. 

Qne<fouTth part to be tak«n every three or four hourk.] 



SPECIES II. 

CHOLERA FLATULENTA. 

friSD CHOLERA. 

TUB VOM11INO AND rU■CI^U KARE, OK AKSBHTf 

OREAT A^n orruESsivE i-latulbkck; RBTciiiita; 

FLATl'LENT DEJCCTIONB ANU GRUCTATIONS. 



new IX. 

Krrc. II. 
Tlxcholeni 
■Icni of 
Hippo. 
frMc* ml 
Kfdcntuun. 

Cinnetal 
(li^iriidcT 
■ltd |in>. 

■IlipotliiK 



This species I Itavc continood from Hippocrates, who 
denominates it, from the absence of liquid discharges, 
cholera ^nii, as Sydonham, by translating the Greek tcnn, 
tiiut done, choUra ircrat. 

Iti this species, the bile, instead of being excessive in 
its flow, is obstructed or diminished in its quantity, and 
perhaps secreted with too low instead of too lii^^h w drgreo 
of pungency. The liver is evidently torpid and enfeebled ; 
and as flatulency is always a sign of debility, we have a 
full proof that (he Htomuch and intestinal canal are in the 
sninc state. Wc have here, therefore, cholcm grafted upon 
a dyspeptic htbit; aud us in dyspcpay some quantity of 



• &tt Sdl». UidL aud thirg. Juiia. No. H. p. au. 
t Sen. 1>. oifi. iL 





CL. 1.] 



[ORD. I. 



air is let loose from most fomU, vrhetlier Bolid or li(|uid, atu) 
an iintnen«o portion frotn many kinits, wc arc at nu U»» lo 
account for tlm llntuleiicy. l"Iie itl>»{;ncc of cvacuationsi is 
partly rrom epasmodJc comiriction, niiti portly from a want 
of wholesome bile, and iKc retching docs not pass into vo- 
miting, because the diaphragm, on whose expulsive co- 
oj>cralion the action of vomiting chiefly depends, forms a 
link in the entaslic chain, as is obvious from the incrcasi»l 
anxiety of the prcecordia. 

When cholera, thcrcforo, is an epidemic mniady, it will 
show itself under this form in persons of a highly dyspeptic 
idioeyncmsy. still more generally than when it appears a* 
a Njwradic diKeiisc. But the form is not a common one : 
and li^nce in the epidemic cholera of 1669, Sydenham de- 
clares, that he met witli not more than a diogle inxtance of 
it: " unicum," saye be, " duntaxat exemplum me vidiaae 
memini ineunt« hujua anui autumno*." And ou this ac- 
cooDt Dr. CuUcn has rejected the species altoscthor; as 
others have transferred it to the geaaa Colica. But as the 
disease does exist, tJiough it docs not occur often, and as 
the distinguished symptoms of anxiety and spasms of the 
extri;niities, vrliicli ptx'uliarly draw the line between cholera 
and colic, arc etiually present in this and tlic otlier spocies, 
we cannot disjoin them without confusion. They ore pro- 
duced by the same occasional causes, as surfeit, cold 
drinks upon a heated body, cold vegctublcs. as melons, iur 
edible fungUMS miHtaken for esculent muslirooms, poi- 
sonous animal and mineral substances; they all take place 
sporadically, and all are at times epidemic. 

The cure should be commenced with warm calhorlics 
alone, or intermixed with opium, as the compound tinc- 
ture of rhubarb, or of aloes. Usquebaugh, or the tincture 
of capsicum, has often also been found useful : and when 
the paroxysm is removed, the restorative plan should 
be puruiod, which has been already recotmnendcd fordya- 
pe|wy. 



Mkh. IX. 

Spkc. IL 
Cliolcn 
fluulsnu. 

Fliiinlmef ] 
whpncp 



Constilu. 
tlnO) chirftjr 

twblf u iL 

'rh« dlnu* 

nol roni. 
luon: 



•hfHei* I*. 
jrriHt b« 
Cultro Itiiai 

ficailan i 
and b|r 

nnkctl vjih 
colic ; bui 
im property. 

Ouuional 
caiMci. 



CunllK 
prwi^ 



* (JWb iv. ap. U 




CL. lJ 



cgU4*<:*. 



[oi 



1. 



SPECIES III. 

CHOLKIIA 6PASMODICA. 

HPAH&Wt)IC CHOLERA. 



UtM. IX. 

III. 



lISwfaM 

inodcro 



■rilli |tKJl!Cri««ll WATEHV; tKKPrBCTOAI. nKTcniMot, 
OK VOUITINUH or A WHITIBR PLDIO; •PAaMH •«(% 
(^K»I*IVK A. ■•II VIOLKNT, CIFTKN CXTEMItNC Tn 
CV£IIV OltdAK ; URKAT DESfON DENrY AKD mo- 
RTMATION ur HTIIEAOTH. 

TiiKHR it no Mpeoiu of difleaae that hatt oTIato jlan 
Btlractcd mure. |>eTbB|iH none no much, attention, both at 
liOMio and in the East, as the futal cholera we are nownboat 
to <*onKi(t«r. 

Wo dare not aay thut it is un cpiHcmy of modem oncpn. 
ainco it BfioinH to be dvHcnbtd by UonCiuB, and in suppoMed 
\yf Honifl writADi to be glancod at by several Greek pliy- 
Hieian*. «nd ovvn by t'olsos. [[nde[>cndently of the early 
noticM loA. lu )>y lIoittiuM, uiid the mora recent ones Xry 
Cnrtifl and Puinlcy in 1774, and by Sonnamt from 1774 to 
17MI, Mr. Scott* ondenvotira to prove, thtt it was (l«<- 
Horibed by tU- modioli writen of the Hindooit. and parti- 
culnrly in a work iiacribeil to Dhanwanturi. a mytholof^ieal 
|>erwiiiaf^, curreapoudini; l'> x\\*' Greek KM:uln|>iu«. He 
uIvD iiifonna ua, that an eptdemic prevailed at At«ol nnd 
iilhet pluoca about I7K1, the ooruriniioe of which waa on- 
terod in Iho pvnrcndingii of the Madras Medical Board on 
tlie Sinli of November. 1787. in tlic following terma ; " A 
dtwoH hnvingf iu October last prevailed in Aroot, aitnilar 
to an indumic that raged among the nalivea altoiil P«- 
liaomla in the Amborc Valley in I7(>!) — 1770, in an nnuy 
of observation in January-, 17K:), and in the Rcugal de- 
tachinuit at Gunjnm in 1781, &c., as well a» to an epi- 
demic over the whole coa»t in 1783, under the mpftwuMW 
uf dyHcntcry, ch«lcra niorbiu, or mordt/fim, but attaikdvd 



1 wi <im 'SfUmiU VbOak, ttt. bj W iJcM. &L. Uakat, !■». 




with BpoHins at lb« pfcecordia, and sucldei) profitratton of otn. IX. 
strength, ns churacteiuitic marka," &c. Mr. Scott ad-j^^J 
Tcns (tbiu la thu occur[i>ncu ot cliulcra in the Mauri- »pmum<Um. 
tilts iu I''t>, and iigaiii i» I81LI; at Mndras in l/t^.^ ; 
itt VvUoTu in 1787; at Arcot id ihv liuiiic year; in thv 
Northern Circnrs in 1790 ; and in thv vicinity of 
Titncouiiillcc ahout IH04. Some futnl caw* Ate idM n- 
)>oTted to have occurred at Jauhiitli in 1H14.] Thciubjcct. 
however, is yet uD&ettlcct; and Mr. Annealey will not 
allow, that thg disease alluded to by Dontius, and Rtill more 
lately by Sonnerat, is the exact disease before uft*. But 
wg may at least nffirm, tltut it has of late years aaaurned an 
activity, fatality, luid extent of range, that it does not 
ae«in, from any history tliat has descended to us, to have 
powcsacd incurlier times; and that uiniiot be contemplated 
without horror : oit which account it hus been cuiii|)arcd 
by Mr. OrtMi to the sweating «ick.nv««, and niriou« otlier 
PfHiilcncc«, that, with great fury and mortality, have 
mnged tlie world in former |)eriodst- 

Some of the cases that occurred to ]>r. Sydvnhum tn tlio ^''>» ''> " 
finit specieM of cholera, and which wehavcalreudy noUc«d, _"''j^!),'|,J|^*. 
were xu ra]>i<lly fatal, that this diittlnguiidied )Killiolo)!i*t has 
alwi been conceived to have been iictjuaintcHl wilh Uic pre- 
sent Kpccies, and to have included it under ihcai. Hut his 
description does not seem to warrant any such conclusion. 
Dr. CuUen, in like manner, upon a cursory view, mi^ht or bj Cut. 
appear to have bad his eye directed to it; for he has ' 
loowely copied Sydenham 'x remark, that cholcnt is some- 
times so severe in its symptontH iis to deMtroy life in 
iweiity-fonr hours. But on » more attentive survey, it will TlwJc 
l)e i>erfectly clear, that Dr. Cullcn does not even, under ^'Cl™.« 
this chnractcr, refer to the »i>ccie» before us; for be con- ""ini.pij'W 
sidera aii increased Mcretion and discharge of common or 
yellow bile ns a «iyniptiiin belonging to evf ry xpccics of the 
genus; and contends that those cases, which have not this 
marie, are aamplcs of dinrrliccii, or ^oine otlier <li«otder, but 
do not apprrtain to cholera. 

Sauv8(-cs aeeniM to have r^arded cholera in all its Nm noiiMd 

VHf^ 

* SkcUfaca of lIlB niwl inandiunl D'uKiuiet in liidU, tit. Hiru. ImjiiiI. Iftii, 
t Bh^ *b Ihi Spidsnie OkLm of ladk. pwHoi, i tub- Vto. MadiM, 

■no. 




300 



I.. 1.1 



CCRMArA. 



[ORO. I, 



Gcx. IX. 
StKi-. 111. 

t'holir* 



ihicHy in 
India. 



lictd. 



•II Ml ds 

LblcB. 




Rpcci«8 iix ft leM nwmentouH diacaae than even Cullen; for 
ttiotiQih hfi profe»soH lo follow Sydenham altogether in the 
mode of treatment, he t»Ito§ no notice whiilcver of Syden- 
ham's remark, that it;s «yniplomH iirv sometimes ko violent 
as In destroy life in Iwetity-foiir hoMrx. Hv hnn giren. in- 
deed, from Dcllon. a specit-s which he calls ehaiera ludita, 
hut which ditTorK very materially from the present, in Ixnng 
diatinguiHlicd by delirium, a ttroiig though unc<)iinl pulu, 
and a free flow of uniic, botli rod nnd white, yet nlwnys 
limpid; as though the complaint were aceoropanicd with 
inflamniatory fe.rcr. Yet, in the eumtive process, he wl- 
vises lo abstain from bleeding, and to administer only the 
milder purgatives. 

It is to India, then, and the adjnining countnM, that we 
must look for the most slrikinp. if not the only, form of 
this species of cholera ; nnd our iiiformatton must be de- 
rived from those who, in modern times, have incidentally 
noticed it as traveller;, or professedly written upon it as 
practitioncrK. And from the Inst quarter we have lalcly 
received «> extensivo a mass of communication, much of it 
of i-ery great importance, that we are no longer in any 
degree of ignorance of the general nature of the divease, 
how much aoerer we may aliil tie of ita remote cause. 

Among those who acem distinctly to have noticed it, 
though in a cursory way, are Sonnerat and Barlolomeo: 
the lirst of whom tells us, that it is called by the nativn 
mordeiym, a term which, according to Barlolomeo, Son- 
netat has transformed, rather than translated, into mort de 
ciifN! but which I am more disposed to think is a comip- 

lion of the Arabic Moni>i!K]B or morobciiib (i£J>>;-*). 
the very name by which Dellon says the natives denomi- 
nated it, and which signiticanlly imports " the death- 
blow:" according to Goliua, ocJto infercHt morUm: and 
hence Rynonymous with Is t£jy " mors rejHMitiDn," or 

>^jy* " mors violcnta." 
By the name of mort de rhien, however, in what way 
soever derived, it is, according to Mr. Curtis •, moirt g«- 



* As AMonni nl' iIk tlitMiM* at India, u i>Hy ajipiunl in ihi RnRtith >'lem. 
ami In llivun) lluplikl ^ .Muliu. in \1Si, I7lkl. At. tJlln. \m} 




CL. 1.] 



DICK8T1VK PUNCTIUN. 



[OIID. I. 




n«rully known in Ihv present day, and (Kirticiilarly nt Ubk. TX. 
Madras; and under tlii« name, Uiereforc, he has described ^T',*' "'• 

m t ■ I -111** (-■llfllcTm 

It- To this gcntlcuiRn we arc indebt«d tor one ol Uie tpuuiniiaL 
eariiest hwtorivs of tliv di»ca»c th»t willim Uie last foortetin 
or fifteen ycant have reached our own country; and which, 
added to Dr. <Jirdlc<itutH;'H ftlatemcal*, bv^un first of all 
to draw th« attention of British practitioners to itt truly 
formidnblc character. 

Mr. Curiia, whose history was published in 1807, ro-B^wlwm 
carded it, at that lime, as a new disease ; and, lindini; no """t'fJ'p'^ 
name (or it in ttic nosuto^icaL classihcations, pro|io8ea, from icnu 
ita leading ByDiptonm, to cull it &i-abmudic cuoLRItA ; Naniejua. 
and as a better nimic cuiuiut be itivcntod, it is thus deno- ''^' 
minuted in the present work. From the idiscnce of yellow 
bile, and |>erlia|>a of bile of any kind, by which Ute dis- 
order is peculiarly distinguished, some of the writcm in 
India have objected to the term cholera, as conceiving that 
such a term necessarily imports a redundancy of this fltiid. 
and that, too, of iu natural colour, and otlier(|uulitieM; yet, 
OH I have already had occasion to show, that there is no 
such necessity whatever imposed on the term, but merely 
an understanding that tlic bile is morbidly alfeoted iit tt« 
secretion, «ther in quantity or quality of any kind, Uierc 
is no reiison for changinjx the term on tl:is ground. Nor 
are there always )t])iuiniA in tiny part of the body ; for the 
disease, at least us it has of late shown itself, in some 
cases destroys instantaneously, and before it has assumed 
its regular character ; but I do not rcmenibvr to have met 
with a single instance of its having run on fur twelve hours, 
without having developed this essential symptom. It ap- 
pears, nevertheless, to have raged witli much greater and 
iBore sudden fatality in 1817 and 1818, than when Mr, 
durlis wrote, Hiid it is highly probable, that at that period 
there was no case in which spasms did not occur. 

Mr. Curtis informs ua, that soon after the attack " tlic Dtwrfptinn 
spiisms began to aU'ect themusdesoflhe lbighB,ftbiiomcn,P''™ ^t 
and thorax, and lastly passed to IhoHe of the arms, hands, 
ai>d finger* ; but 1 never," says he. " tlica m uiterwarda Mvr 



-f Sumf an II*p«iiu> aitd ilic ipuiuodic AOccilon* al InctU. I^nid. 1 7^7. 




■Mii 



CL. ■.] 



COILIACA, 



[nil II. I. 



(IKK. IX. 

!^rK«.. in. 

ChtJtn 

•panudkk. 



gn*ia N- 

nrrtry In tc- 



(.Imlrra of 

lulT. 



WMIVWd. 



tlintto of the neck, fuce, or hnok at all ntfeclcH. The m* 
piiUty with which lhc(w Hpiurnfi tincc«m)erl the attMk, hik) 
their serertty, especially »b affecting the rauscleH ot the 
thorax and abdomen, denoted in general the degree of 
danger in the case. The affection ts a fixed cramp in the 
belly of the muscle, which ia gathered into a hard kno* 
with excruciating pain. In a minute or two this relaxes; 
is again renewed, or the aflTection pasiies to others ; letting 
the mieefable suffcror hardly an interval of case ; and 
lastly it paaaes from one set to another, leaving the former 
fn-e." 

This account is Biipporte<d by I>r. Johnmn in his ralaable 
" E«uy on the Influence of Tropical Climates." Yet, as 
a proof, that the eastern cliolont has of late assumed a 
Boveror and more futnl cbanx'tef, not only in the Bengal 
presidency, but in that of Bombay, it is Mt(y neoonmry to 
nh«en'e, tliat the !>nl>i>eqiient cramps re^rded by Mr.Ciirtis, 
iind no <loubl justly ao, as indicative of the highest degree 
ofdaugvr, have since, na will appear in the aeqtiel, been 
hailed as leas ominous, than many of tliu sj'mptoms with 
which the disease now occasioitnlly oponx ; and contem* 
plated us n rcnction of tJie sj-Ktem, stniffgliug ngaiiial the 
flntt shock ; proving that it has not bicn totally and in- 
stantaneously exhausted of sensorial power, as A Leydcn 
phiul ix cxhautiicd of itx electricity by the di»ch;arg;eorthe 
brass rod when applied to it. 

The liUvr and more fatal ravage 1 am now rtferring (o, 
commenced its attack in Augnfit, 1817, at Jcssorc, about 
a hundred milCH to the north-east of Calcutta ; and, 
spreading from village to village, readied Calcutta early in 
September, having de>itroyc<l ihouxandit of inhabit^LUU in 
ita course. Prom Calcutta it extended to Behar, depopu- 
lating many large cities, and compelling the ifsideiit" to 
flee for Hufety to other fipols. Beuarea, Alhhitbad, Oo- 
nickpore, Lucknow, Cawnpore, Delhi, Agra, Muttfn, 
Mecrat. and Barciily. all nuflered In succession ; the pes- 
tilence not diffusing itself at once, but travelling l>y a chain 
of post*, and attacking a second district after it had ravaged 
a lirst. 

At length it reached the grand army, and spread through 
il« dilfcrent diviaions at Mnndellnh. Jubbulpore, and 




CL. 1.] 



DIOKSTIVB FUNCTION. 



[oni>. I. 



303 



Stafgtr, niarrhiiig in terrible nnay over the Deocan. At orx. IX. 
Ilussingabad its havoc was ilrtriidfiil fortwivcrtil duy?"; wlirii J^'ui'^.^ ' 
taking a course iiloiig tlie buiiIcK of the Ncrbtidtlith itnyMmMlk*. 
alighted at Tannali. Having visited Uio laitioiui cities of 
Arungabad and Ahniednuirger, it Kjirtsid in Pooimh, and, 
in tlic direction of tho coast, to Fanwell, where it ramified 
north and twutb, crossed Salsette, and arrived at Bombay 
in the second week of September, 1818, a twelvemonth 
al^r itx nppetuvnce at Calcutta. 

While tliin wiu passing in the wcat of the PcninBul;), the spmdt 
epidemy waminiking a like pr<^es8 to the eiist nnd south, '™'*'>"'- 
|iitigr«iuiively extending over thu nhole Coromandel coast; 
whence it wns ie{>orted to hare apiead, and a report that 
afterwarOn provi-d to Ijc but too true, to Ceylon; to the 
pure air and tvnipernt*- cbmatc of Siam ; to Malacca ; and, 
MTOW (be vinute of Siinda, to China ; since which time it 
hMiMwbod the Mauritius; and mndo its appearance un <?""''"'"'- 
board vesseU both in harbour and at sen. [In the summer 
of 1821, the diseaHC first made its appearance on the 
bonlen of tho Pcisimii gulf, after having raged in the ear- 
lier montJis of that year at Bombay. In 18123. it ext^-nded 
itsvJf, in one dinx'tion, to the ehoi'es of the Caspian sou, 
and, in another, as far as the Mediterranean, making an 
apparent etuiid at Astrachan, and in the neighbourhood of 
ancient Antioch*. It seems, therefore, to have ver\' 
ckeely thmitcncd Europe. It has passed over 90" of lon- 
gitude, and Gti" of latitude; having, in one direction. 
crossed the equator, and approached the Iwuiidnry of the 
southern tropics ; and, in another, traversed the northern 
tix^ic into the temperate zone.] 

The diagnoBtiea of this extraordinar)- peatilence are otl- 
tnirably furnished for iJie pt;riod before us, by Mr. Whyto. 
aatiatanl-surgeon to one uf the diviitiooa of the army, whoM^ 
description I shall copy, premising that, while in the centre 
division the apasniN preceded the vomiting and pnrging, in 
the others they generally came on after the nppcnrance of 
these symptoms. 



• I>r. ItolimiKi, 111 llulVUnd'i Joom, fbr June, \1ti4, m In Edin. Mr<l- 
nnd ^uTB. J«uni. No- Ki umI C-I- 




304 



CL. I.] 



C(Kl.tACA. 



Orh. tX. 
Srso. 111. 



DfKriplion 
ot th(dk> 
vtie br 
Whytt. 



moat dHb 
gcmub 



The diaeue, uys Mr. Whyte, commnnly begins with aj 
wa(eiy purging, unattended with griping or any jjoin. At] 
Bn interval oF, generally, from half an hour to fire or six I 
hours, and sometimes witliout any inti>rval, the pntivntj 
vomits K white fluid uncombincd in any instance with bilr, | 
of which there in abaoduit evidence in every qnarter.1 
The spasms, in the diriiiton of the army from which thit < 
description in drawn, made their ultack at no dctcnninalc 
period of rhe dii^wc, hut in general not for many hour* I 
after the coinmcucement of the vomiting and porgmg. , 
There iv«s soon great debility and sinking of the ptil^i 
the exlremitiea became cold ; the eyes sunk in (heir Bockets; , 
the vessels of the tunica adnata were injected with red ' 
Uood, over which, if the disease adTanced, a film was 
fonuedi the features expressed the deepest anguish; and 
the eyelids were either wholly or half closed. The piitiont 
invariably complained of great heat at the stomach, and 
called incessantly for cold drink, althotigh warned of the j 
danger nttcnding its use- The lenctinius now became vi« 
tent, while nothing was discharged but the fluid juat nc 
ticed, and a substance like the coagulated while of an egg. 
The uucasine«« and jactitation were so irreat, th;it it wu, 
with the utmost difficulty an opportunity could be got 
feeling tlic pulse, whieh by (his time wnH not always per- 
ceptible, although it was generally bo ItU the spasma carat 
on. These were always of the rigid kind, attacking Aral 
the toes and legs, and then extending to the thighs, chcatpj 
and arms. Wheu they ri-ached the ehet>i tbo breathing 
became so difficult, an<l the wnRe of siiflbcation ao ex' 
treme, that the diaphragm most probably associated in (I 
Epai^modic action. [In one cane, mentioned by Mr. ScnK, I 
where a roan bad been paralytic in liis Ituhs, with a total*) 
Duuboess of them, they were neverely allected with apaai 
and became exquisitely sensible.] 

The most unfavourable nod dangerous signs in the 
dinary progress of the diseoae were, a coldness of the sur- 
face, extending over the region of the heart and stomach. 
The skin, under the nails, became ineurrutctl; the longut ' 
was icy cold; an universal colliijuative sweat broke forth, 
\ a shrivelling of the palms of the hands and eoloa oftlM j 
the spasms cradunlly declining a* lliese symptoms 





incrcflMtl. In general all pain nnd spasm kit the patient Orx. IX 
before death; aod e»en when the hitart could not be *e'tfr^^ '^ 
to beat, he expressed himself oa»y, ami said he mis bolter, tpumodte 
Somelimea however he was, at this period, in the greatest 
agony, rolling himself on the ground, groaning, nnd even 
bellowing moat piteously; signs chiefly occurring in pa- 
tients who Ungered three or four daya before death came i 
to their relief. 

[According to Mr. Scott, who has published one of the i 
beiit deM?n)>(ions of this disease, the mind remains clear 
almost to the [ant moment of existence. A fnrourable 
iBsoe is denoted by a rising of the pulse, a return of heat] 
to the surface, an inclination to natuml sleep, and a diniUj 
nutioQ or cessation of vomiting, purging, and spnsms; 
these indications being soon followed by tJie re-appe»rancv 
of f(£C9l matter in the stools, of bile, of urine, and of 
saliva*. The same interesting writer dwells on the rapid 
sinking of the pulse as one of the moat invariable sym- 
ptoms; Ihc exceptions being only ii few, und chiefly where ' 
remedies are promptly administered. In nn early stage 
the pulse generally beconics small and accelerated, and, on 
the accession of ^pn^m or vomiting, suddenly ceases to bo 
distinguishable in the extremities- The length of time, 
during which a patient will sometime* live in a pulseless 
MUte. is extraordinary. Dr. Kellelt relates a case, where I 
the pulse was gone within three hours from the attack ;( 
yet tile man lived in that stale from the 3d of October, at ' 
four p. m., u> the 6t]i, at two p. m. On the ccwntion of 
the spasm or vomiting, and sometimes appurcntly from the 
exhibition of remedies, the pulse will return to the ex- 
tremities for a short time, and again cease. The superficial i 
vein* and arteries are not always collapsed, even when the 
pulse has ceased; and. if opened, they will bleed. Their 
parietes tlicn collapse, and no more blttod can be extracted. 
In every fatal case, the circulation stops, at least in the 
extremities, long before deatlif.] 

The followini; appearances are worthy of notice on dis- App«sr. 
section : an enormous distension of the stomach .md bowels, j]„ocii<m t 
not from air. but a gelatinous substance ; little fianguineons J?^"' 
turgeseenoe on the surface of the organs, but an iibscuce *"'*"■ 



■ Sm ntfctt CD ihc Bfodcmk Clioleni, Ac. |). 31- Mmlnu. IHM. 
t Scolt, op. dl. p. 2y 
VOL. I, X 



CL. I.] 



C<ELIACA. 



[OMD. 



tiry. IX. of the moisture and gloKsy cliarncler of healtli; the lirer, 
l|^5v much enlarged from the quantity of blood contaiaed in ib 
■liinnilki vessels, and, on one purt of its convex surface, a consider- 1 
able cxtraviisution of blood; the gall-bladdiT (illvd with 
bil«, and projcclint; beyond the edge of the liver; the bile i 
of B very dark colour, and tlii: gidl-ductx |>crvicKi8. The ' 
contents of the amall intestines were dark-oolourcd. ap* , 
parvntly from iin admixtuic of bile: (he coiiteni* of the 
large intestines resembled the white albuminous mutter 
that was discliat^ed before dcxtli. The urinary bladder 
waa quite empty and wholly shrunk into the pclvin: the 
kidneys apparently dimiDishcd: the lungs so much col- 
lap«ed as hardly to fill ono half of the cavity of the chest: 
no fluid in the pericardium. 

Such were the appearance* in ihe i)ody of n Sepoy. In 
KuFopcuu. ^^^ European subject they were the kuui-, with the two 
following exceptions: the stomach and intestines were 
distended with wind, instead of with gelatinous fluid, and 
hence collapsed upon puncturing them : tlie veins on the 
outer surface of both, as well as of the uk-socoIou, were 
turgid with blood.] 

[One of the best descriptiofls of ihc appearanccB on di»- 
section ia that published by Mr. ^cott. of Madraa: and it 
shows that tliey vary considerably in different cases. No 
particular nlteralion is found, he saya. in the aerous meni- , 
Inanea; but tlie mucous ones generally exhibit signs of 
disease. Hielnnga are not unfrequently found in a naturs) 
state, but more commonly they are gorged with black 
blood, and assume the appearance of liver or spteen. 
Sometimes, howerer, they are collaiwed, lying in the hol- 
lon- at the sides of the spine, and leaving the thorax nearly 
empty. The heart and large vessels are distended, and 
Kometimes even its left cavities are filled with dark blood. 
In the abdomen, the vessels of the viscem are turgid. 
According lo Mr. Scott, the stomach gcniuaUy pT«iicrv«t 
its ordinary volume, sometimes containing gnenUb or ' 
yellow turbid matter. The intestinal tube is WHnetinea 
collupsed, but more frctguenlly filled with air, distended 
into pmiches containing whilixh, turhid, darlc, or grven 
fluid. No tax&l or other solid matteni are found in the 
tnle«Unes; but, very commonly. Urge 4)uanUlii» of the 
conjeo-looking fluid, or of turbid scroua matter. Tlie 



DisHcliani 




CL. I.] 



ninRftTITK FVKCtiUH. 



toKD. 



307 



duodctiuiii, and occasionally the jejunum, are loaded Gck-IX. 
with uii odbcreiit whitish or greenish mucus; at "ther^"'^" "'* 
times deprived of their Datur<il mucus, and often [|uito.pu,^i(a, 
V"l>'iy- TracoB of bile in the intestines, or of any sub* 
Itiincc that has descended from the stomach, are ■ exceed- 
ngly rare. Sanguineous conj^eetion, and even active in- 
laromalion. Mr. Scott represents as more fr«quent in the 
iwels than in the stomach, yet as being often absent, 
le conlirms the account given by other writers of the 
irge quantity of bile in the gall-bladder; but lie adds, 
Ithat the gall-duci^ are about as often constricted and im- 
permeable as in the opposite state. The appearances of 
the spleen, be says, are so diversihcd, that they throw no 
{ht on the nature of the disease. The vessela of the 
aesfntery are generally very full of blood. In the head, 
appearances of congestion, and even of exlravatmtion, 
liave been frequently observed, but not uniformly. In one 
fease, the sheath of the spinal marrow was inflamed. 

The essential morbid appearances, produced by spasmodic 
pholera, form yet a subject of inquiry; for those which 
Qmelimes occur and sometimes do not, cannot be regarded 
this light. Perhaps the accumulation of the greater pait 
the blood in the vessels of the viscera, the absence of 
til solid or tVrca) matter from tbe intestines, the sup- 
pression of the flow of bile into them, the full Htatc of 
cfac gull blnddcr ; and the presence of n gelatinous or turbid 
Mrouit fluid in the bowclK, arc the changes most inse- 
parably connected with the womt and fatal forms of the 
JUeaftc] 
Tlte diiteaM proved every where more fatal to natives 
lan to Europeans: and among the former no blood could, 
numerous instances, be drawn from tlie arm, however 
irgent the symptoms. 
The Bomliay accounts differ in ODly a few particulars : DImuc m 
le spasms were sometimes clonic or agiutory, ixBt^ad of [|,'^^^^^^^ 
being enlastic or rigid. " In a large proportion,** says Mr. 
Orton, "there is no appearance of spasm in any part of 
the system. In many there is no puiging; in some no 
vomiting; and, in otlicrs, ncitlier of these symptoms. I Scmctimr* 
have already observed, that these last were by far the most "j',™'J^^ 
dangerous caMS, and that the patients died under them, intum 
often in an hour or two; the nervous power appearing *"'''• 

x2 



(isK. IX. 
Itpzc. HI. 
Chain* 



VLolrnl 

■Ign ciNii- 
nimilTilv 
riiiniMibtg. 



InillKhla 
cut* unw- 

bile bi cx< 
on*. 



IlUtUWM 

of luddsn 



to be exhauBted almost iriKlaiittiricnuiily, like the c4e 
fluid from a I^ilen jar. Mr. M'Caln>, dcput-surgeon 
Poonaraallec," says Uie same author, "inronnn me, that 
hut found the cases, which to common obscrvNtinn migt 
appear (he most desperate (those whi<:!i were attende 
with H|)aams and retchings of extrt-me violence) actuilt 
amongst the roost tractable : a tnily va)iiMl)le remark, whi< 
ray own experience folly confirms. Dr. Burrcll save 
eighty-eight out of ninety of bis later cases*," iiieanir 
those of this kind. And io bU general description 
them, he says, "that the retching was constant, and 
ti[)nsniB so violent as to recjuire six men to hold the 
on his cot." On the other haitd, nothing can b« luo 
erident than the intractable and fntiil nature of those caa 
in which the ptiUe, imtead of riting, sinks at once; 
which (here arc no spuDs, and sciir<-cly any Tomitin^i 
piii^jin};; and in which not only the vxcrvtion of bile, 
of nil the secrL-lions, np|>e«rs to be vnlirely snn|)endr<li 
(tt is aI«o partioulatly remarked by Mr. Scott, that, in 
the low and mottt dangerous form of cholcta, whethirr ril^ 
European or nutirv eases, sp«Mn is gcnorally wanting, oi 
is prvicnl in « very slight degree 'J.] 

In a few casc^ there was even an overflow of yellow bile 
itself, makinf; nn approach to our first species: btit thr«c 
Here uniformly of (he slightest kind. "The bile." nys 
Mr. Orton, "appears in excese only in the milder casca^" 
And to the same ofTcct Mr. Cnrtis: "The cases which ap- 
peared after this wcrv all of a dilTeront nature, much less 
severe, and none tunted out fatal. They were all of tliem 
combined u-ilh bilious accuniuIgitionK||." 

The inpid or sudden fatality of ihc dlsense, in ita se- 
verest onsets, is very singuhir. Uven Soniwrat atfirnts, 
"that the p:ilient wna frequently carried off in twenty-four 
hours." Hut, in the lalerepidemy of 1817 and lHI8.thi» 
term was wonderfully abridged, "tn the second, and very 
fatal visitation," says Mr. Orton, "of the eptdeiuio ex- 
perienced by Ilrigadier-General Pritzter's force, I am in- 
formed that vomiting, purging, and spasms were very fi^ 

* Btmbir Rcpun, p CA— M. 

t R*M7 an the EpUkndr Choltn, p. 2S. 

X Htfun on Ux Kpukxaic (.holen, kc; Maim, 1834. 

Jld. i>.71- II DlMan or IndM, p. 00, 




ft.. t.] 



UIOUSTIVK FUNCTION. 



[ORU. I. 



quently, in a great measure, if not eiitirely, absent; all tlw ubit. IX. 
powcfs of Uie system fsiling at once, and ileatli commonly ™"Y' '"' 
ensuing in throe or four houre froiu the attack *." Several Rpuiiir>diai. 
iiuiancM were hunrJ of iit Iloobly, and other places, of 
nalivirs being struck with the itiheaM.- whilst walking in the 
open air: and who, having lullcii down, n^tdied n little, 
coinplninLiI of rorligo, deafness, and blindness, and ex- 
pired in ii few niintiteH. Mr. Gordon gives a history of 
many caae^ oflhiH kind. At itellary a t-iilor was nltuckcd 
with vrhnt na» supjMtted to be cholera, and initlantly ex- 
pired, vrilli his work in liiii haudii, and in the very attitude 
in which he was »itting+. 

The di«M)ction8 in this presidency sueni to hn\c sliuuti An""- 
oren a more extensive range of visceral eirusion, con-jJ^^^„ 
gestion, and extravasation than those in Rengal. Not n in llaiDbiy. 
aingit' thoracic or abdominal organ was to be traceil un- 
marked by v;iw,ular rupture, or turgcscencf of black blood, 
or uuatam]>cd with some other morbid appearnncL-; the 
stomach and liver, however, were chiefly aflecled, and the 
urinaiy bladder was alu'ays shrivelled j;. Tlic blood, when 
drawn from the arm, was found lo coagulate very loosely, 
and sometimes not at all^: and the arterial ftnd veuouti 
blood were of a Hko purple hue|[. 

Of the dreadful sprc<td and havoc uf this cruel Asiulie Edinui of 
scourge we may form some idea, from the lepurt to tlio ""•"■T* 
Medical Board at Bombay, by Geof^e Ogilvy, Ifisq., socrc- 
tary. The population in this district alone iit calculated 
nt from 200,lX)0 to 220,000; the total number of asccr. 
tuined cnscs amounted to 16,^46: giving a proportion of 
seven and a half per cent. Of these cases I2£)4 sick Htrikinji 
had been without medicine or medical aid; and there >s j)^i^,*rLni 
rcaJton to believe, that of these every individual perished, nwliul aid. 
Mr, Ogilvy, indeed, expressly asserts, that it was not as- 
certained that any case bad recovered in which medicine 
had not besn '.i<tministi?red : while it is grmifying lo loam. 



* EmbT on ih« Eptilcntlc ChoLim, p. 4I> 

f Bonil»r Rfpuni, p. Oi. I Kcpom of Dr. DuncU Md Mr. Wh]tu. 

i {>rt«i*> Euay, p. BO. 

II t'm ihc nr*Kt whI irc»iiii>m of thli dlKow In (ho Uwlru PmidtDtr. toe, 
Id addition to Air. Scotl'B Krport, "Skdclia of Ule idibi prevalml DtKua 
of liidii, (Diiiprising » Tk^iiik on ilit Kpidcmle niulcr*. At. By Juuc* 
Aiualfj, Eh).. Mattru iMc<Ucal EilablulunciK. Loud. t)io„ IdlS. 






310 



ft. 1.3 



CtXLIACA, 



[URO. . 



Plumr 




Oitir. tX. ofi the otlicr lianil, tliiit, among tliuM.' wlio liiid tecciva 
(inW* " ihs advBDtageii of the judicious aitd active plan concni 
•pMoialia. Tcntly puisued, the proportion of deaths was reduced 
<).C percent.'; an alarming mortality still, but a uian'ellou 
iroproTooieDt apon the uatural course of the disease, 
other parts of India, indeed, the deaths, under the 
plan of treatment, »eem to have been still fewer: for 
Burrell. surgeon to the sixty-fifth regiment, at Seroor, 
of sixty cases, luaken a return of only four deaths; 
Mr. Critw, 00 the same station, asserts that, on an 
application for relief, the disease, in hia opinion, "is 
futal in more than one in a hundred cased." 

The curative plan, pursued with »o much suecesa, < 
sistcd in bleeding, according to tlic strenglli of tlie patlcc 
calomel in free dos«s of from fifteen to twenty ^ins in 1 
doee; with un« or two grains of opium, re|ieatcdj if nc 
sary, every four, three, and in sonic coses every tvro 
till the urgency of the symptoms abated : to these 
added a liber^ uae of the most diffusible stimuli, a* tb 
spirit of nitric etht-r, ammonia, camphor, hot arrack 
water, Hiixe«l willi i<pices and sugar, camphor-mixtnr 
essential oil of pcp]>enni]il. the hot bath, stimulant 
brocations; and sometimes the aatimonial poxrder in dc 
of fire grains, given in conjunction with the calomel 
We are infonued of a fortunate blunder in one iiist 
capable of being laid hold of and applied with great 
tical advantages. " By mistake, twenty grains of caloc 
and sixty minims of laudanum wero given at nil inlc 
of less than half nn hour. Tlie patient was inclined 
xlccp; nothing more tvaa done; and in two hours imd 
half he was as well as ever he had been in his life." 
Kttluaic oC Mitny of the cases proved succcbsIuI witliout the use 1 
jd.«.UK,. j^^ imicct: but, from a return of Dr. Bnrrell. the ho 
Mttlon. of omitting it, whenever blood could be nutde to 

scents rattier unjustifiable : for, according to this retur 
out of a hundred patients eighty-eight were l)led, ati 
twelve not; of the former, two died. !>ciug one to foity-^ 
four ; of the latter, eight, being two-thifda, or nearly thin) 
to forty-four. The fact npix-ani to Ix), that scarcely an] 
cane occurs without an aluimingoongealion in oneor moroi 
of the larger crgarut; und hence it i» highly hazardous id 
ile|>cnd upon slimulantN nlonc, and to hoatt of their poMt 



CL. I.] 



DICKSTIVK FUNCriON. 



[OBD. I. 311 



to subdue the dtiteaiw without active evocuants in the be- Okk. IX. 
ginning of the CHrntire procws, nn Hufeland, und other ^',^"**' 
writen oil the continent, iippenr to have done, without n ipumo 
Buflicicnt knowledge of the real nature of the disease for- 
merly *, if, indeed, it be this B{)ecie8 which they have un- 
dertaken to dewiibe, of which there ia great reason lo 
doubt : Mid aa Dr. Uankeen of the Bengal stalii^n ban t<^ and Uric 
coRiiuended still more recenlly, who treats calomel with n» ^!^^ 
mncb contempt as the lancet, and depends exclusively, 
from the fimt, upon large doses of opium, and highly pun* 
gent and didusible stimulaDtni-. 

Of the remote cause of this extraordinary nialndy we Kcmou' 
know-nothing. That it is an epidemy, and of a most ma-^JJ^y 
lignanl character, is unquestionable; but whether depend- uniuiown. 
ent upon an intemp<.-ninient of the atmoKphcre, or upon 
specific contagion, is by no means ascertained. Tlic ^rst 
was the most obviouH mode of accounting for it, and that 
which was c;irliv«t adopted ; hut by many |>ractitionera it 
hu been rejected, for llic following rt-asons. The disease, ImtmiK™. 
inat(«d of aprending from a centre to a circumference, or 2mo.phOT' 
following the courH« of the wind, or of the sun, or obeying objwwd lu. 
any otlier meteorological jmwer, marched by a chain of 
pOHtH, often in direct opposition to all kinds of utuiosphe- 
rical in6ucncc, and in the immediate track of human in- 
tereourw. " It prevailed," observes Sir Gilbert Blanc, in 
his remarks upon Mr. Corbyn's letter, " to a degree equally 
violent ut all isL-atons of the y<-ar : in regard to tempemltire, 
from 40 or 50 degrees of Fiihrcnhcil to 90 or 100; in re- 
gard to nwiHture, during the continuance of almost inces- 
sant rvin fur months, to that dry state of tJic atmosphere 
which scarcely leaves a vestige of vegetation on the Hurface 
of the earth X" To which 1 may add, that it often fought 
it« way in the very teeth of tlie niont powerful nionsooiia, 
and left untouched viirtuus districts that bordered on its 
career, and whose less salubrious features seemed to invito 
an acquaintance with it. It appeared also und rnnifthed 
in all the changes of the moon, and in all sutes of atnio- 



' N. Aniwlca. 1. 4IM. OuMW Sdui*irr (Ic Boulllm, nSJ. 
4 Eainb. MmI. iukI Murx- Joum. Jml ISX^ *^ taufat vltl> Dr. Robun'i 
JliM«7, Id. Ocl. Iirj3, |<. «•;■ 
I Mfi- Clilr. Tniu. 




CUI.] 



CIELIACA. 



[ORD. I 



WImAo 




■p h w ic electricity: and at sen as well as at btml. Mr. 
Corii^ni. indeed, givea aa account of its having made an 
. attack apoa the Lasears af un Indiamnn, in its passage 
froaa Eo^and to the Capo of Good Hope, in 1814; and 
that too in the month of January, when Uiu weather was 
iotOMeiy cold *. [It is to be observed, however, tliat this 
alleged attack of cholera requires proof of its being similar 
to the spasmodic case« in India, in which country it had 
not Uwo ariaea in ite worst und most fatal »ha|>eit. It is 
ercB asserted by Mr. Scott, tliut no instance has ever been 
lecordenl of the crew ofu iihip sutl'cnng from cholera, that 
is to say, the real spasmodic cholera, until the vessel had 
eoBte into communicaticm with the landf. But, if Mr. 
Corbyn's account bo correct, it proves, that the origin of 
the dtsea«c cannot be impuUd either to contagion, or to 
pecuharily of soil.] 

Many pathologists, who suppose tiie diHense to be pro- 
uH^ilffd by a specific contagion, have cndeavournl to show, 
tkal it sp{ioarrd in no town ordtstrictwlicie » direct com- 

ff"'"* i""' "ot bc-en tuaintnincd with some place 

ia «bich it was prevalent. [Thuy insist on the considerable 
Moitality ainung&t the attendants on the sick; u point, 
however, on which much conlmry evidence is adduced, 
wwl which may perhaps be generally ciuilv as well cx- 
pluned by tJie ex)»o«iuie of such individuuls to the sane 
«Uiiospl><.-tic cnuites, or other circumstancea by which the 
uationta themselves were aR'ecled. Yet. some fuel* in sup- 
port of contagion are strong: the medical officer, Mr. Scott 
MVtJX repented instances, has been theonly Kuropcwuin the 
our))* or station who has sufiert-d. Dr. Daun and Mr. Gray, 
laMHliiut-surgcon of II. M. 8!)lh n.-)!iment, were botJi seized 
with the diNcnae, aWcr close intercourse with the sick ; and 
twit fiiendi, who attended the latter, wero also alluckvd, 
nhiio »o tilher Uuropeun oflicer of the corps sulierod. 
Aiuitht-r fiict.Ktatixl by Dr. Kennedy if, that in the contaeof 
■ lie iwelvviiiiiiit)) endii>){ Juno, 1K'J(>, fuur medical ofSoers 
uflho Duinbay ostulilisltmeiit out of 116 died of cbokra, 
while atnoiig llio otlier gentlemen, civil and military, so 



• I'raUlM CM Dw Kplilni'li. 



CL. I.] 



OIOBSTIVE FUNCTION. 



[OKD. 1. 



313 



r 

■ (Treat » propurlion of cosualities I'roiu cholera did not occur Obh. IX. 
H in the whole countcorthcepideiiiic from 1617 dutruwiirds*. ^^^ 
I But, in order to «liow the con trail ictory evidence lirotight •p«»moait«. 

■ fonvanl, it is only iieceit&ary to mention, tbut wliile one re- 
H porter states, that every one of the thirty medical attend- 
H sDts of the f)6th regiment was attacked, another declares, 

that only one out of 101 medical attendants of the Royals 
bad the disease. No doubt, therefore, some important 
collateral circumstanceit, adequate to explain this dif- 

Iference, must have existed, though they tveie not traced 
and specified. By some n»uonen«, little importance is at- 
tached to the numerous inatancce recorded, in whid) the 
dtseoM, after appearing tn a dietrict, haM extended it«etf 
over it apparently by communication with the Asick. Facts 
of this kind, an a cnticul writer observes, nrc easily ex- 
plained by the non-contagioni^ts. provided it cannot be 
shown, that Ihe disease spread gradually, and fntm the 
original spot of' ill appearance as a crnlre, except wUtre a 
deviation from ill ixgular course tca% connected with special 

IiNlercommuaicatioH, or special seclusion. As the same 
writer also reminds us, one of the most atriking features of 
B contagious disease is its progrcissive advancement from 
district to district, and from country to country, and more 
especially the slowness with which it advances. He joins 
Sir Gilbert Blane in thebclicf, that nucha character can only 
be derived from the mode of propagation being by human 
intcrcoui-£U. Wh^n viuwed iu relation to this character, 
the histoi'y of the diolera of the East furnishes a very 
powerful argument in support of its contagious nature. Its 
slow progn-KS acroK»and doxvn the Peninsula, iu 1818, can 
hiirdly be explained on any principle, except Ihut of pro- 
pagation by human intercourse. This intercounc. Dr. 
Kennedy ohservoa. was established by means of the troops ; 
and it seems, that since 1817, it has heeii enforced J'rum oite 
end of India to Ihe other bi/ the annual relief of troops* , 
In short, it is argued, that some effectual intercourse must 
be necessary for the propagation uf the discaiic, on account 



*6m Kannetly'* NoM on tbc Epidnnic Cholen. aTii.,<',ilculu, Iir27. Thi* 
KOiki and ihr Dtiiingt otHit Ittlbvrl itUnc, contain Uic botl cxpuitioii or llic 
Djguiiinin in tu|<|iaii of (he ilnciiuic of ronugion. 

t Nola M tllc Kptdcmic Chulv™, p. S3. 




^ 



3M 



CL-I.] 



ctfLIACA. 



[OKD. I. 



ft«s. IX. of Uw mnarksble fJiortoeas of Ha course, and the brief in- 
*'■*' '*■ teml which (if it be really propagated by infection or 
cootagioa) elapan betwixt exposure and seizure. Ttie two 
cbanctcra will not iDterieie with the rapidity of ditiiuion 
of a eootagiooB rtiioaaa orer a town, or thickly-peopled 
diBtrict; bat most tender neariy hanaleaa all ordinary coow 
immieatioa between otie diatrict and another even mo- 
derately remote. The cholera spreads rapidly in a par- 
ticular apot. bat slouly from one part of the country to 
another. Hat by f^ the moet iinequirocal eTtdencc of 
the ptop3(>ation of a disease by intercourse with tlte »cL, 
is that which is enforced by Dr. Allison ; namely, the 
evidence of the disease breaking out in several previoualy 
unaffected districts, at a time correapooding with the 
anival in them and sickening of petaotu. who hdd luter- 
coune with the sick in an infected dixtrict. It is to this 
criterion chiefly, that we mast look for the decision of the 
question of the contugiousneaa both of cholera and other 
discaaes, whose propugatio<i by intercourse i% nt present a 
anbject of dispute*.] Certainly.it is not easy to reconcile 
the snddenness of its appearance and diitappearance with 
the laws of contagion, so far as we are ac(iuainte<l with 
them ; a subject we shall have occa&ion to examine at large. 
when treating of fevers. Mr. Allardyce, surgeon to his 
iiinjei'ty's thirty-fourth, infortna us, that in this refpmut 
the diteaMc uppeiirvd on the tweoty-tir»t of Sejitember. and 
committed dreadful ravages before night. On the twenty- 
fifth it abated remarkably, nod in three days more entirely 
viiniKhedf. In like manner, the severe attack which was 
t-xprricnccd by the Uengal and Madran troops at Nagporc 
occurred at Uie end of May, 18I8. On the tentli of June 
the raiiu ap|>cared witli great violence, when the epideny 
abated, and immcdintely afterwards ceased. Neither in tlie 
idea of a contagious ptopagatiou reconcileable with the 
••cape of the great body of persons exposed to the in- 
fluenri.- of the disKiiM!, considering that, from its not being 
apprehended to l>e conuigious, no means, as is unual in 
other cases, were eiuployed to avoid the iufeclioii. 



I 

I 
I 



• Ww Kilinli. Mnt Jwtnul. Na JO. |^4M— Ol, 

t Rqioiu uouiiiiuniaiud la the Honibajr .^iLxlkal EliunL 




[OKD. t. 

T^e state of the atmiMphcre, ns described by Mr. AJIar- Oxs. IX. 
dyce, did not diflpr mntcriully from that in Nagpore. The c^tn"' 
dificaM made iui attuck in clo»e und sultry wrathcr, and >pMnioaka. 
raiUBhed after thuiider-ntnrms and heavy rainn. But we 
can draw no conclusion from these phenotnenii ; since it 
•MniB to have ahowo itaelf quite tts. IVi-'qiieiilly mid fiitally 
after a long succession of rain; and, a^t already ol>»crved, 
■otnctimes in very cold and dry weather. The remot« 
eaoso, therefore, of this oiyaterioua Kourgc reniainH yet to 
be ascertained; and afiordn further proof, if indeed proof 
were wanting, of our general inacquaintaiice with the 
nature aod economy of epidemies. Mr. Anneidey ascribes 
the disease to an electrical intemperamcnt of the atnio- 
aphore, which morbidly dimioi&hea the flow or |)Owei' of ihw 
nervous influence, whence the functions of vaiiona organs, 
and especially the elaboration of the blood, takes place im- 
perfectly, and the general effects follow which we have 
just contemplated. This hypothesis can be received, bow- 
ever, only as a conjectuit desliluttt of proof. 

Dr. Rankccn, who was with the army on tlic Bengal Nd known 
station in 1818, has referred the disorder to the conjoint ^™^;^ 
operation of sudden changes of weather, humid soil, aud 
damp atmosphere, tn connexion, more especially, with a 
diet of rice or other grain, vitiated by tlic wet of the 
season*. But wo have already traced its existence in cold 
and dry, as well as in swampy quarters, and have seen it 
yield to sudden changes of weather, instead of being in- 
troduced by them : while the grain and other food of such 
wet seasons is usually the produclof the year before, which 
may have been peculiarly dry and healthy. 

With the exception of the plague, there is no epidcmy OencnJ 
on record that seems to have been so strikingly marked by ^^"' 
violence and irregularity of action, and npecially by a 
rapid exhaustion of living power; the patient, as we have 
8cen, often expiring within twelve hours from the attack, 
and sometimes sooner. ' 

The first characteristic feature that occurs to us, on n 
review of the disease, is the total absence of the bile from 
the whole range of the alimentary canal in every case, while 



• KiUnb. Mcil. and i^urg. Joutn. Jin. 18S3. 



CL. I.] 



COLIACA. 



[ORD. 






UiN- IX. thin fluid was ns gcncnlly found in nbundanco in the gaU- 

RCUdcn ' tilotldcr: ftnd,perhB|». ihc n«xt is, tlie turgid. and in Aone 

•pMmodte. instnncm. the ruptun-d Ktnlt of llie liter, from the quaaiity 

trine- of blood with which it was distcitdi-d. The general battciy 
oraymploma nppmrs, therefore, to have berai opened by a 
Kpaamodic constriction of the bilc-dtictit ; for without such 
on obstnKtioo, w« cannot account for an exclusion of all 
bile from the IntMtines. From this point, as froin a centre, 
llic spiismotlic notion seems to have spread in every di- 
fiNrtion. and under a clonic or ciitastic fonn to have seized 
upon almost every organ: preying with greater violence 
according to the greater degree of debility, and hence, per- 
haps, of irritability of the system ; into which law we ara 
to resolve it, that tho natives, supported by a less rich and 
uuliibvc diet than Europeans, suflcred more severely, 
and died more frequently. The stomach bimI inteatiaes, 
genendly speaking, Rnt participated in the spa^m of the 
bile-canals, and hence the griping pains, the nausea, and 
Ttolent commotions which spread fmm the one to the 
other. 

In all coses of nausea, from whatever cause, we see the 
bmin and tlie rarfuce of the body peculiarly diminished in 

r their cncrg}-, whaice the skin, to the remotest extn:miti«t, 
oollapaes ttenealh n deadly chill, and the heart citiks with 
iitHitpportable languor. lu the ordinary course oTsiekmn, 
thu nitusca cubstdes. and th« general organbatton recovers 
ils balance, or it terminates in full vomiting, which excites 
nti universal reaction. And where any such reactioa oc- 
cuired in the diseaae before us, it vnts hailed as a (svour- 
ablvrbnnge; and hence the wisdom of the stimulant plu, 
so IVn)tic«lly had recoorae to by the medical staff for the 
pur^Mwe of producii^ a nrnkioa. But where tiitA was not 
Ht'cou)plish>tl. the bring power, feebly recniited from its 
fatmlniu ftvni tlie lirst. or not recruited at all, became ex- 
liMusled in rvevy organ apace, the strmgth &led, end hope 
g«>o way to dwiisir. 
In ihr iidaud of Ceyloa. where the disease rsgnl with 
even nMi« violence than un the Indian continent, the 
(Mtinni vvry Ovquoatly expned in Iwrive or fiAren houi 
VimI from it* attack. A di»;MVlinn uf tliosc who perished iht 

***V iMirly in thi» quarter has put us into p onrew iioa of taate in- 
^^flZ-^ (ru'^im;; 1iirt«. vatyiug in a few (urticuiirs fnim those that 




Ct. 1.] 



DIORSTlVB FUKCTION. 



[onn. f. 



occurred on poet-ubit examinatJoiu in the ialnnd of Bom- 
bay. The brain vtaa in thew cnses chiefly (he congested 
organ, the liver sonietimea appearing lo have no congestion 
whatever; and hence the innctivity produced in the bmin 
by the nauHcating state of the stomach tnusL hare been 
greatly augmented by oppression. Consentaneous here- 
with, we are (oM by Dr. Davy, that in some of tho cases 
which he di«iiccted in this region, there nas a Auccidtly of 
alt the muutitar parts, as in animals killed by electticily 
or hunted to deatli. There whk altw n tenderness of the 
tnuKeiilar fibres; while niitecedentty to death, as in many 
oTthe Bombay cvisea, there wok no diU'erence in the colour 
of the arterial and venous blood, and no instance of n huffy 
coal on the blood that was drawn ; which in reality wa« so 
loose and uncoagidable, that when venesection was ncce*- 
sary, the vecHels were opened with the pieatcst cnntion, 
from the difGcutty of restraining the blood afterwards. 

In uH these cases there CTin be little doutit, that the in- 
Oiiencc of the bruin, essential to the continuance of life, 
was spent profusely, and soon altogether exhau»ited: in 
soiDC instances, indeed, nearly momentaneously ; hke the 
eflecta produced upon the animal frame by a stroke of 
lightning, a violent blow on the ntomach, or any other ac- 
cident that occasions instant death by a total and immediato 
diechargv of the vital energy. 

In olhcr cases, the oppreasion on the brain, produced by 
coDgeation, scenis to have put an end to the conflict before 
the living power had completely failed, and while it was 
Btill acting witli irregular accumulation in varioua organs; 
for, in these, the wnscleti of the extremities, and even of 
the face and lower jaw, were observed to move in a con- 
vulsive manner, and sometimes to be drawn into tremulous 
knots, fifteen or even twenty minutes after death had closed 
the sccDO. So the heart of the traitor, when cxlir|intrd 
after he has been beheaded, from a like accumulation 
of sensoiial power, has been seen to palpitate, and even 
to leap up for several timea in succession, after its removal 
from the pericardium. 

Commonly, however, the living principle seems to have 
been exhausted more generally and progressively; and the 
muscles, and, indeed, most of the orgniis, frcod from the 



8rKc-III. 
Chotcta 



iirok* nf 
Ugbuisf. 



The iliiiaw 

Tual hthn 
k taul dlt< 

Ilitnit 
po*cr. 



Uvlng 
potm 
unuUt}' n. 
h»u*i«l 
■noK gim- 



320 n.. lO cffiiiAc*. [oBD. I. 

tiBx.IX. " The atmosphere is generaIIyclear,c<Jd,&Ddhealtby; and 
Clia^"' ^^' *" ^"'^'^ ^ climate, this epidemic commitR such rarageB 
i^nmodla. aa almost to equal its effects in many parts of India, I 
much fear it will extend to Europe, where the crowded 
cities and great population will make it more seTerely felt 
thnn it bos been in the scattered cities and scanty popula- 
tion of Persia*." 

DU, pTOhlbitc tDlou t Dil, lilcm tratim cmuiI 



I Hedico-Clilr. TniH. toL xO. 



DIORSTIVB PWNCTIOV. 



[onD. I. -m 



\ 



I 
I 



GENUS X. 

ENTEHOLITHUS. 

INTESTISAL COSCRETIOMi. 

STONY CONCRRTIONS IN TH8 »TOM,H.-H OB IMTE»- 
TINAI. CA.tAL. 

Wmatf.»-er be the degree of merit or demerit that be- okk. X, 
longs to this genus, the author aiispecta he must take to 
his own shure : since, mi fur m he knows, it is yet new to 
the domainii of nosolof?)'. 

In treatin<^ of thcj^enuBCorBosTASts, we had occasion Tludiwaw 
to observe, that the iivtural feces, under circumstances " '""'jV 
there enplitineil, become at ltmei< indurated, Blirivellcd, Mithuihn 
■lid broken down into Nmail balbi nnd buttons, as hard •"«"'«"■ 
ait sun-burat ciny, occasionally intermixed with mucus or 
oleaginous matter. And, in treating ofcolicu, we referred 
to coiicretiouM of u still hiirder substance, and of a stony 
Bppearance, which, though formed in the intestintil channi>i, 
nre compounded of other niuteriaU tiian the coruilitiient 
principles of feces. 

It is for the purpose of including Hubelancos of this kind. Nnmciuffl- 
nnd which are of very difl'creat do^criptiuns, that the prc-^^if^ 
sent genus has been devised, whose name, bntr itoLtni us, 
or iXTESTiKAL coNCRBTioNK, sutBcicntly indicates a 
comprehensive scope. 

Wo have, indeed, on various occasions, hud to give avulaut 
ciisual glance at this subject before; and wc have par-"""^ 
ticularly observed, that almost all animals nre endued 
with a power of Hoparating or secreting lime and other 
earths from the blood for particular purpoxcs, as t)mt of 
forming a shell-covering in insecUi nnd worms, and of 
giving hLinln<3iK tn the bones in all other nnimoU, Under 
a moT(>id action ofsingic organs, or of the system gencrnlly, 
this secretion often takes place in an undue abundance, 
oihI is poured forth into cavities where its accumulation 
iind crystallization must be attended with mischief. Such, 
at times, is tlie ca.se in respect to the stomach and intes- 

VUL. I. V 





.liruACA. [osD. 1. 

•h.. mrfer>M"l'"'i^ of concretions derived from this 

....^ we oi*f*< n""" ^^ others, produced by an a^lu- 

-■ nirion or rmtJiDiwion of the juices which are contained 

in (he aiimpiit. «nd which, not unfrequently, give imme- 

rf»t.' prwicf thwr origin by the aromatic taste, smell, w 

«ftef owJities which they exhibit. There is also a third 

™.(rt ol" WHKTftion, occasionally to be traced in the alvine 

■jhionel. of a hsrder or softer structure, and of a cetaceous 

.J janoiiaceom feel, which consiEta of feces, or the refuse 

VAiter of the chyle, more or less combined with oil or 

But'us, and sometimes consisting almost entirely of the 

two last. 

As the subject has been nerer before pursued with a 
ricH to any cntical examination or systematic arrangement 
trf'the tribes of substances that appertain to it, we have 
not yet perhaps arrived at a knowledge of all their dif- 
ftnal fomts or combinations, as met with in the intestines 
ofmui, or the animals of the mammalian class, to which 
man is degraded by Linncus : but we may at least venture 
upon the three following, each of which will furnish a 
distinct species : 

1. EKTEBOMTIIUS BEZOABDUS. BEZOAR. 

2. . CALCUHS. INTESTINAI. lAL- 

CULUS. 

3. — SCYBALUM. SCVBALUM. 



CL. I.] 



DIOeSTIVe FUNCTION. 



[vna. I. 



323 



SPECIES I. 

ENTBIlOLITHtJS BEZOARDU8. 

BEZOAIi. 



)1ta IN CONCBNTtllC LAVEBB. Ct.OSKI.V AflOtU- 

ttnatrd or crvstalli zrd ; capable op a fine 
polish; pkkoiirnti,y with a metallic LCKTRK 

ON Tint SDRFACE OP EACH LAYER, AKD AN ACCI- 
DKNTAL MXLKl-8 IN THE CF.NTRE; OF A SFHK- 
HOIDAL FIGtRB: CIIIErLY CON9IBTINO OP V SGC- 
TABLS MATTER. 

Bp.eoARi>vs, or bouHir, U derived from the Pi^ian 

I ^EHDpoui>d j»; jb PaiH-zeber, or Pud-tehr, corTii(>tcd into 

bedzohr, anu bczoiir. Literally translated, it is depeUcm 

vrnenim, and consequently a direct synonym viilli tlic 

Greek teriu alcxi^hannic. 

It \» fouitil occaaiotiully in the stomach oftomr ofUie 
camel tribes, but tuore frequently in that of Uio smaller 
niminatiiig riuitdrui>e<iH, irn tlio goat, uttd two or three 
6pecies of the anlclu[>e genus, as the chunois. or teild- 
goal, MB it is sometimes incorrectly culled (the anitiope 
rtipicapra of Lioni-us), and especially lliut beautiful and 
oleipint animal the gazhat (antelope gaicUa, Linn.), the 
tubi ('av) of the Hcba-w poets, or roe of our Bible 
TctsiouB. 

The beiioar was foriiicTly employed as a febrifuge and 
alexipharmic in medicine, and woni as au amulet by the 
superetitious, »ho have sometiineit purchased a iiingle one 
from 111*! EmI nt m\ tliousami Uvres when very fine, and 
liiMnl tlicin in HoUuud and Portugal on particular occasions 
at a dnait n-duy. 

It is not quite sutitifnctorily osccrtnincd that tliis specie* 
has ever been found in the human stomach; wc have, in- 
deed, assertions to this effect in Tarious foreign miacel- 

v2 



tirKc. I. 
Fi peel lie 
naiiir, 

wliclirr 
Jrtitnl. 



Whm 




EmpltnrnI 
totmeiijr 
mcdlci> 
n>llTI 
And etlrvm- 
nl a( hi^ 



N0I quil* 

whclUo 
(let fuunil 
in null. 




^ 



324 



OBS.X. 

Srac L 



OL. I J} 



CCJtLIACA. 



[UBD. I. 



U MM tn- 



k 



EsutMl 

*nd tb«i- 
(■1 pnK 

fNTlta. 



laniex*. and I liavo ht-nce introduced it into the priwent 
place. But it dot* not oft«a 3ppear, that tite sulwtancoa 
referred to wer^ examined with mifiicient attention, while 
the Buthore *e«iu to have used tho term bezoar in • very 
looee and indefinite sense. In one of the volumes of the 
AnitaW de Chimie, however, the analysM Keeim* to have 
l)een scienlilically conducted. It was made t>v M. II. 
BrHcconot, from n <]uantity of concrete materiala void«d by 
a female iinder the care of Dr. Champion, of Bar-lc-duc, 
which were found to be genuine bcioarst. 

The bezoar. as already observed , is chieHy obtained froin 
theBtoniach of the smaller mtninaiing animala, whose food, 
from the complexity of the organ, Ue* for a long time c|tii- 
escent in a «tiitc of subactiun, and k ihuN vnubled to give 
foTlh the whole urilsjuice« under circumsmnci's that afloni 
thein a much easier opportunity of agglutioating or crys- 
lailtzint^ ihau in many other animaU. In the gtmt kind, 
(hette cnncrclionH arc willed EPgngropilip. a Greek term. 
Kigiiifyiitg mountain -goat balls. They are of different sttea 
and figures, the last being chiefly determined by the nature 
of the nucleus, tvhich, iu differeut iiKlividmU^. i&marcasite, 
talc, flint, gravel, straw, ^lnaa, seeds of plants. iS;e. In 
colour they ure whiter, yellow, or browuifth; that of the 
gaihal la greenish-blue ; and. when recent, highly aromatic, 
from the Odoar of the planta un which tlic aninni feedt. 
The iiKWtahlgubr circumstance belonging to thi-ra, is the 
bronxe or metallic Instre tJiat appears on the surface of the 
diflcrent layent, and docs not strike deeper tlian the sor- 
fave. I'his, howerer, is said to be n property peculiar to 
the western bezoar, nnd seldom or never to be found In 
those of the East, which arc often of as beautiful a gloasy- 
wbite as ivory. Daubeoton ai>eril>ca the gill ap))e«rance 
to a vegetable dye, fixed by the tartaric acid of the plants 
in which the dye exists; and observes, that be ha* re- 
marked a like appearance on the grinding teeth of many 
of the ruminating tribes. A few of them rattle on being 



I 



• Suniid. itti. WahrMbm. k b. p. 4|8.-.rcrri, tWoti 4t Ulocn*. 
KM. 
t Aniuka da Cklmit, uni. xk. 




..]l 



ntGKSTIVK ruNcriOH. 



[oho. r. aSfi 



I 



ehakcn, th« uuclcus lisvin^ contracU^d ami Woonip Iooh. 
La Fosse* asserts, that lip h&a occasionally nirl with pc- 
nuinc bezoars or a?gagTO)>ilffl in th« Riotnurh of the horse i 
and similar concretionB seem at tiracii to he formed not of 
tlio animal body, as ttibcrclos to the rooU or otht^r part* of 
certain piiintx: for I-nurcroy uffirmH, (hat, in thccaliinel of 
Juasieii.hc wax shoivii some cuTious bexonnt of the oiiental 
apfiearancc, white or yeilowiifh, glo&ty as ivory, and of a 
Npheroidai figure, wliich were said to be ^mdiiced by lh« 
eocoa. 

From the suppcwcd i-aliic of ben>Bra in medicine, they 
were at one (into imitated, and tht' falne aold a*i <^fniiine. 
Tlu-fleiiii])|)o<i!t it ioiis stones, arcordiiit; to [loniii re, were com- 
pounded of lob^tere' claws and oyster shells, Icviguted on 
porphyry, made into a paate with inuak and »mbcrgriff, 
and formed into balls of the shape ofbezoars; and, where 
the metallic lines were aimed nt. aftervardH rolled on goM 
leaf. The pierrcs dc Ooa, or do M«lacca, as Ihoy were 
railed, were, at least generally, faclitiotis f>c7^mH of thin 
kind ; and their spurionsnesa was ca|)siblfl of proof, by 
drawing a line with them on a piece of paper prerioiiiiiy 
nibbed over with cerusee, chalk, or lime: the line of the 
genuine bezoar turns g;reeniah, or uf an olive-yellow; that 
of the factitious remains unaltered. The imiMMiiiion, how- 
e¥er, aeema lo have been *ery unscientific, as formed prin- 
cipally of earths, instead of being elaborated from cry*- 
taUii«d vegetable juicea, which produce this change of 
colour. 



Okm. X. 

Sin-. I. 

lllUl HlMlh 

■fdut. 



tSpHrkiui 
bastn. 

Ofwlui 

foil' pm lid. 



(«|mriwi». 
Dm, ho* 
ilriMlrd. 



* Csimd'lllppUuiilur, p. IG8. 



32B 



VL. I.] 



COILIACA. 



[ORb. I. 



NrKC. II. 
Hhan 



SPECIES II. 

ENTER0LITHU8 CALCULUS 

INIESTINJL CALCULUS. 

UAUIATtK« VKU^ A COMMON CENTRE, OB FORMED 
IN COKCBNTHIC LAYEItt; MOSTLY WITH AN ACCI- 
DENTAL NVCLKtS ; MOKE OH LESH 1>OBOU5 ; »PHK- 
HOIDAL OU OIILU^U; AUMrTTl.NU A.\ IMPBRFECT 
fOLlSII ; COMPOSED CKIErLY UF EARTHS AHA 
ANIMAL MATTEU. 

This niwotes is by uo tueacui unfre(|ucntJy found in Uw 
bainnn stotntkcb aiuJ iatErstinea, bat far ofVeRer.n* ivinarked 
above, ill tliL' dilutive cliunncl of oilier uiimiilH, and par- 
ticutarly ia thu turgor ruoiinatiug qukdrupeds, ur UiuM 
with a tong coin|>licut4»l diy^cstirc orgun, where Uie food. 
M in the fonnittion orihcb«K>arN,iiKlowlycikrrii-d forward; 
uml in tardy drau^bt-bunve, psrliculurly those of milleni 
ilial aiv fed largely on bran, which itccnii lo yield a ready 
bRUH for these concrctions*. Ia Dr. Watson's ca&e. thi^ 
dilQBae had existed for yeus: tlie animal die<) aged twvuty- 
twOk near foaliit^; but gave no sign of pain or inconvcaieooe 
till tlirc« nwntlis heforv livr dmtli. The calculus wcigbod 
lolb. 12oz.; uvera<^ diameter 8^ inches by t4 inchw). 

When chemically analywd, the>' are chiefly found to 
consist of a triple or amnioniaco-magnesian phos(>hate, 
like the earthy or white-sand catcuh of tlic human bladder; 
though it is difficult to conceive from what quarter the 
magnesia is oblaine^l. In the ca&<> of millers' horses. soiDe 
portion of this earth niny |)erhajM be derived froui the bnui. 
in which U U always to be tmoed; but th« difficulty still 
remnins with resjwct to otlii^r nniinaU. The figure, what- 
ever be the size of the culculuit. iit usually spheroidal, ex- 
cept where broken into sepumte fragments : the matter is 
deposited for the moet part, as in the former species, upon 



I 



rhl, TiMii. iKtv. 170a, Tbombf. Id. ill*. I7W, IMky Id. thiti. 



DIGKSTIVB PVKCTION. 



[oh It. I. 



327 



a nucleus of suiue sort or other j <i» a ninuU piM« uT Hint, (Itv. X. 



il, a NUL'd or husk. 



of hay 



the 



HtKV. II. 



I 



ftttuctuTu tMHiictimiit nmiatingrrom suchcuiiunon centre toilimCaU 
the Murrftcv, ami KOtnctiitics eviiiciiiji diGtinct plates, more "'"' 
or lesK united to eacK other. In the hutuan subject, the»e 
calculi rary from the size of a pea to that of a filbert, 
dhestnut, or hen's e^g, ami arc often mill larger. In Ihe niminnw* 
«aM of Margaret I^wer (related iiiwier i'oiica comtipala) *, ^l^^ 
they were uHually of the two former umk, n»d appear to 
have hwn fonncd iii great iibundniicc, and witli woitderrid 
facility ; for hci- aMomeii. «pon prciwing it, often rattled, 
tmm the quantity it contained, with the sound of a bng of 
iMtrUcs. Many of tlicse were roogli and shatp-poiiited 
at tlic edge, o»idently fragmenta or nodules of larsfor con- 
cretions, and gave great i>aio in the rejection, whctJivr 
rtbove or Ih'Iow, for they were ilischarged Iwth ways. Tlic 
\*T^T-*ni^ weighed rather more than two dmclinui and 
Dr. Kiini:;. who retiitcH the canc, cnltmlated that the whole 
that were dischnrgefl during the continuunce of the com- 
plaint could not amount to less than bVb. avoirdupoi*. In 
a cane related hy Mr. Murtineau+, some of them, much 
larger than the preCfdint^, were voided per anuni, by n 
poor woman in the third montli of pregnancy, after having 
suft'erwl from colic about fotir or five days: of these, the 
largest, 8 inchfrs in circiiinferenoc, and (i^ inches in length, 
weighed two ounccit, sixteen pentiywcightfl, and twelve 
grains. In this case, and in rarioiis oiIkts, the calcuh 
•cem to have been in the intestines for a cooaidemble 
[teriod of time without inconvenience ; for it is hardly pos- 
wble to conceive, that all thew should have heen piv^duced 
itt the couine of a week. In another case in the same 
journal ![, related by M. Maekarne»>. a cuIcuIuk of ihJK 
kind was extracted with some difficulty from the anun, by 
the Hurgeon who alleudcd, which weighed eight ounces 
aiul a half, and was ten inches and a half in eircumfurenec. 
tt ia dcacrihcd a.t " a hanl, unequal, ragged, fliuly stonfi," 
but w»H not examined chemically. It had been in the 
pelviK, and nvarly of its full bize, for several years before 



t IbU. raLxli.lT3D~174l. 



USK. X. 

ivte. II. 
KniooU- 

otlui. 



tadnw^r- 
fcono, kt. 






iU «Xtfactiba; lor tlie )>aU«nl'ii &toolii wcrv slmye ul»- 
t&uied with difficulty; uad three children, whtcb ah* had 
euccciwively Iwme iu tlie three prvcetling years, were all 
markeil nitli ii large hollow or induiilution in soiue pert 04* 
the head ; iu one iitiduuM. of auRicwut extent to hold the 
moiety of & mid all uruogc. 

Other examples, however, have occurred bolb of u 
large a mix, mid of us finit or flinty » crystal! ixalion. Tha*. 
in a foreign ruiHcelluiiy ofunthonly, nc hate thecaaeof • 
calculus dischargod by the unuK ol' half a, pound weight*; 
ami M. l>aAbal hus puUiGhcd a lull account of f raginettta 
ol' stony calculi (nxcu fra^meiita) evacuated rram the 
Mine oi^anf: as Sir 11. Sloonc has another case in whkh 
the concretions amounted to two hundred |. 

In dr.iu<;l)t-horneii and oxen, this opeciea ofcalculoa is 
generally found lingle and much larger, aod oftco of little 
ioconvvniooc* fur yearw. They vary in »ixe from three 
pounds iiTuinlu|ioiif tu ten or twelve. Of thia last wenght 
the Butlior (i<ic« met with Mt iiL>tuiicc iti a hone beloBgiiig 
Iu Mr. lUynanI, u ri^fK-cUbie miller of Bmndioa, near 
Sudbury, in Suflblk; and Mr. Watson girea an account 
of two conatderaUy heavier, one already noticed, and the 
oll»er weighing tuaeteen pounds, exclusive of the ontwaid 
•hell or crust, which was broken off in several pieeoa, with 
n circumference of twenty-eighl inottea. both thcw wtn 
luiuinnlcd, bul " had the apfMMrutoe of a pebble ; yet tbt 
i>peciltc gravity waa much lighter, the firvt wcighiDg ia 
water not more than six pouiKla. At other timea the crya- 
lallization ia mure like that of f^iunaB, or of grit-atooe, and 
uln>0Ht alwuyi' l<t<lil uitd poruus§. 

Occiuiion:illy, liowfvt-r, this specie* » found gregariooa 
inatead ot solilaty. Mr. Walaoo, in the article just quoted, 
■ueutiona a case of*ewra/ found in the intestines of a aiare, 
and presMitcd to the Royal Society by the Duke of Rich- 
luoMd, iu 1746, the nucleus of two of which was found to 
be nil iron nail. And, by luniing to another volane of the 



i 




• «HMiitlM.Wduii.i«nJU .^Jsr. 

t DboinM AwilMlim d; Euhtrt N.«n. l^ML I7IS^ Vm- 

; lUKh. Illii. ISSS. 

t rtalL TiMk laL UKi>. Ha. ML 



J 




DIGESTIVE FUNCTION. 



[UEI>. I. 



I 



I 
I 

■ 
■ 



»iin« journal*, we find llicw calculi dwchbed by Dr. 
Bailey (lor ihe two uiticlvM itppcsr to relate to the !)»ine 
ease) as consUtii)); of livo in number, of dillmnt »hi!A, 
some triangular, and roecmbling a horse-bean, of an olive 
colour, and finely polished ; and one much larger, weighing 
nearly sixteen ounces troy, and measuring twelve inches 
by eleven. 

Several of th«M ooncretioiMi, we have obaerved, had tlic 
appearance of cryatalliMcl gituits, or of giit-stone ; and it n 
probable, that ihcy were partly of these very minerals; for 
it is of such thut luill-ttlones arc very generally composed . 
and, by the friction they are perpetually undergoing, tliere 
can be little doubt that much of the inill-duitt intermixed 
with bran, with which millers' hontes are fed so largely, iK 
derived from tlie powder furnished by these stonea. 

In man, the calculus is often dependent upon a like 
accidental origin ; for it not unfrcquently follows upon a 
long, free, and injudicious use of prepared chalk, magneaia, 
or other calcareous earths, for the purpose of correcting 
acidity in the stomach. I have known this happen in many 
dyspeptic ca^es; and once attended a lady who, frum the 
eame cauae, laboured under a most painful contitipalion, 
till a large maas of what may be called intestinal mortar 
was removed by a acoop from the rectum. The case, related 
by Dr. S. Fit7^erald, of Mulhngar, was ap[Kircntly pro- 
duced by a like cause. The lady had sneered qrent tor- 
ture in the hypogastric region, particulaily towards the 
back and oa sacrum, for eighteen nionlha; during the last 
three of which she could not leave her bod, except for tepid 
Inthing, which atiorded her tranMiciit oiute. Upon the rejec- 
tion of an emollient anodyne clyster, she dittchargcd with 
it a large hard calcareous ball, of an oval figure, weighing 
eight ounces and three druclims, exceeding in size an ordi- 
nary orange, and so solid tliat nothing leas than tlie stroke 
of a hammer could break it. A total liberation from 
putn immediately followed, and tlic patient progressively 
recovered t. 

The curative process may be omuprised in a few words. 
If the concretions proceed from an injudicious use of c&I- 



S'29 

8ptc It. 
EounJi- 
UiiK (.'»!• 



pnnvnil 
piiin, or 



In nun, 
pttiduced bj 
u InjudU 
clou* u*c at 

oullit. 



niuiUMtd. 



CUBMITC 



* Pliil.Tni». vol. iU>. I7M. 

f Gdin. Mc4l- Cvnunnit. tiiI. viiL fh SN. 



rt_ I.) 



CCRUAC*. 



[ORD. I, 



Km %. nw.«in* or ttwgneuKii cartkB, both tbcae uuHt be ftvoidod 
■^P* lir the fatura : rad the cukuli actually existing l)c dimi- 
,Cd. watlatd in Ukcir iltameUr by the use of mineral acids, and 
"- qaii&ened m liirif pssMge by cnthartics. It' magncMa 
be lb* ■mfciMil'mg bsM, the uilpbiirie nctd will tw pre* 
n thia will h*rc a tendency to convert it into 
, salt*, and thus produce a pur^tivc ns well as a 
, cAct. If we have reaaoii to utispect a caicareons < 
aa a aote cause, lince thia diatl)e«ic uuintty de- 
, dffbiBty, we matt ettdcavonr to invigorate the 
g —a raH y. and the Htifiiuich mori; particulnrly, by 
■h* eonne of re^men and incdicini» lUrcudy pn»ciibed| 
•larEi'sv*. 



SPECIES 111. 

ENTEKOUTHUS SCYBALUM. 

SCiBALVM. 



«MV tit 



tttKcaKTiv.t aoAt-\ ua dnvtuovb; mostly lomti- 
movn; auuKTiMKs in lavkhs; bi-iibroidal oa 
(•MiuKo; tuNaiiriNw iiuki'l^ of mucus or olka- 
t.iKuv> MArraa. MOKK or less intermixed witm 

tNptHATBb r«CK». 

Thik »p»ci<« baa DM hitherto lMi;n Hufliciuitly attt-tided 
bi auvl tmt Fourcfoy and Waltiici hvih to \r*vc luiaUukaa 
U (b« a lulMcy valculMi «tt error which ihe writer hu 
MWM w Mvwal tnatancw rapealod la this metropolis, llir 
iMwetl^ rhai«Ct*r aufficnolly caprMses thu gcnenJ nalorc 
ul iktv i^iMcnrtiiui. ami w drawn up from various example* 
that haw im-anvd tn htouMilf, or have been sbown him by 

'1'Im vwiMtvtiiMM bnlonpni; to this Hpecte«, if oaraiully 
n«h^hv«l Aiwt «u««l>aail. wodd probabty be round very uu- 



Wlt 



[OBD. I. 



331 



^■OL.'!.] UIUEKTIVK r(lN<:TIOK. 

H nwrcms; bnt, in the prexeiit tttnte of our knowledfic tipoti ()■;«. X. 

this subject, we musl confine ourselves to the three modi- ^"^n. 

Jicationa of reciilent, oicaginoiiii, nn<) ambruc«uiis. or thut ihuCi^. 
■ of ambergris. ''•^"■ 

H When, from n kehh peristaltic iictiun, the fi-ccs have Fvmlmt or 
H T«matned long in the colon, they are frequently found to "'?"J°" 
^m undeigo a considerable chnnf^c; for they become harder •■ 
^^ their more liquid parts arc absorbed ; and, in conBequcncc 

of becoming harder, frequently tttimnlnte the mttcoux frlande 

by which they are surrounded to u more copioun secretion, 

■ which intennixes with them; and, ns they break into tn- 
dnrated balls or frairments, gives them a Icse roagh or a 
more greasy or unctuous feci. These arc the common 
(icybala of medicti) writers. 

But we occaaionally meet wilhibnllH, buttons, or globules oioKi'i""* 
of a still more cctnceous, fatty, of oily sub«tnncc, dis-"' "' 
charf^eil, sometimes solitarily, sometimes gri^riously. from 
the rectum, of very different diameters. Occasionally we 
can trace them to a like ori^n, ».« in a case quoted by Sir 
'E»crard Home* from Dr. Birbington, in which the h»dy 
Tfbo Toidftd them had rc^wlarly, before their appearance, 
tiikcn one or more doses of olive-oil to appease severe pains 
I the stomach which were ascribed to the passing of gall- 
aes. for which these concretions were nt fint nitogethcr 
taken . Tliey were of a trlobutiir form, " varj-ing in size 
'fVom that of a small pea to the bulk of a moderate grape, 
of a cream-colour, and slightly translucent, of a sufficient 
'Consistence to preserve their form, and to bear being cut 

I with n knife, like soft wax." 
In general, however, we cannot trace these concretions 
to any unctuous material intro<laccd into the stomach; 
arni have reason to believe them prorUiced by intestinal so* 
erction, or a chemical change effected on the recrement of 
the food after it has panted into the larger intestines. Dr. 
Babtngtun liu« al^ro fumiKhed, in the ttamo ttrticle, a case, 
which can only be rcsolvol into an origin of this kind. 
Ilic piitiant wan here a little girl of four years und n half 
old. At the nij^o of three, " her mother ohrscrved some- 
thing cotne from her ax she u'nlkcd across the room, which. 



PhlL Ttuit. jtai 1813, an. uL 



^ 





»;i3 



CL. I.] 



C0LUACA. 



foKD. I. 



Urn. X. 
Hnc. 111. 
I'jiunill- 



Mbicb ooacKi«d iihni csld. 

pmctttahB 

theq 

at 




la ba r»t in a lii|aid Mau-, | 
Enritncethat time to ib«i 
often Of fuurtf-i-n d«>«, 

«ae M ikne oaoce», aonit-times |>iirr. 

k ten: wben voided, it has an uo- ' 



mdm^fute fluid like oil. Her up- 
I a» kr tpiriu. and lier flesh firm : 

Mt bard: Hbi- ix subject to oc- 
A fa« mvcualion of tlie uuuo kiuij 

of Bcrlipt- 
^ fat, (li«cliarged fiuiu llii; ri-ctum, 
wwlinil cvlloctioiis ot high Hutbotitj 

|b Medical Etimys, we have an 
■obstaiict: lilte tallow or hudcfMNJ 
k aooaicnes of globulcw, piiissed aiiioni; ikv 
tmimmias making the nhe of a waluut; 
tOaBBgbeen passed neveriil days aAemidi 
«a»<iTa» OMny jwuk.^. Tlie Paris Academy of 
p«blisi)«j Kituilar accounts ^. So Dielhcb 
Iff a waxy inucous matter — atateria cemeea 
by the rectum, weighing tuoni tfaaii an 
Pkvlioi nuticcH several iofttances that bad 
tbt nuigc of his obscTvatioii H ; in one of 
t ilk* MBcntioas w«ro of a green hue. Vimder \Vid 
kftcaae of the same appearance": and Zcllcr baa 
ftLiiiullfcMwbmlril r r' rrri rilh hairs ft. probably swal- 
ItwwinaiiiilMtfiUy- So, in tlie Ada Natunc Curioeorainl}. 
t a« iiwlaiice rery like (be Gntl of Dr. Babtngton's 
tb« coueretions were deje«ted in a panutym flf 
gvbu. aud are dewribed an " excreta glokuli. quasi ai^e- 
•Moakcwdviitv doloTQ hyiwchondriorum.'* And I •asptet 
»■ an tu nier (o Ibo mtiiir i'pe<:ieti a caac aacribed by Dr. 
iJHwMC gf Harwich, KoxbtirghKhirc. to bydatida. or 



I 
I 




»V<l.l.rMU.«n.lx>L|ii.l4l. 

[ ih« ■r-'i^ HM. d« i-Af>d. KorOt di tMb li. |k 14. 

Jm>Wi>lUm <|untiH» ■■rlan. &c- Y ChI> I- 0^ U. 

<• Hidran VaMkr M'UI, I'ait. i. Ola. II. 

It IMhmL MuU ilrtki Dtfinorab. TiMi*. I«& 

11 V«l til. IIWAI. 



CL. I.] 



DIOBSTIVB FDNCTION. 



[OID. I. 



I 



thing resent l>li Its: tiiein *. TIio piiticiU Imd for many mniiths 
li«eo occaflionnlty Nuhjeci to colic ami dyiiciilii^ afi(M:tiuii.'>, 
accompanied M'itli grmit puiri and fointncHit. He nt length 
" began to void by stool subittanceM of a brown colour, 
tome about the ittze of nut«, and xomc a» big as wabuts, 
which were ims^ thut contained matter of a yellow hue 
like pu«. l)cMdcs a f^cat many empty 0110:1 tlmt had broken. 
I liave necn ei^Ut or tvti piiHtied in one stool." This contr- 
uued foreiffht or ten dnys, and the palieiit then recovered. 
In all <lu<M> ciiite* ne find proofs of morbid intestinal 

'action, commonly ncconipnnied with pain and enpro*l»uf 
tfkstipola. or cu«tivencwt from weakness and torpitude in 
the vermietilar movement of the inti»itine«. 

[t i» uixler like ciix^uinx lances that the subatance, called 
R, is found in the larger intealincs of the caeha- 
or ape rniaoeti*w hale iphyxelfr tnucronp/ialuii, Linn,), 
which generally contains sixty percent, of fat, and is never 
higher up than six or seven feet from the anus. It ap- 
pears Uy be more completely ehkboruted in proportion as 
the animal is more sickly and affected with costiveness, 
and does not dung on being haipooned; and hence, the 
most valuable, according to the report of the South Sea 
whalers, is that which is extracted from animals that have 
died of ihe complaint. It is found in mn^ws of I'mm four- 
teen to more than a hundred pounds weight; and appears 
ut first to bear a close resoniblniice to the feces of the 
whale, but hardens on ex|>osurv to the air, The lai^est 
Inmpa have probably not been discharged, but separated 
from the boily of the nniinnl during the process of puti«- 
fuction after death. Ncumauii gives an account of one 
mass found on the coast of the island of Tidor, that 
mi^ed not lc«s thiiu a liundr>.'d and i-i^hty-lwo poandst. 

^twas purchased of tlie king of Tidor. by i))e Dutch Kast 
India Company, in 16!l3. for eleven thousand dollars, and 
measured fiTofeet eight inches in thickness. It w.is long 
exhibited ut Amsterdam, and at length broken up and 
sold. Other masses of many pounds weight have been 
found floating; on the sea : and the concretions, thus de- 
lached and of different hulks, arc caTrii-d into every 



333 



OCH. X. 
Srr.c. Ill, 

ihoi Srf . 
ImIuih. 



nii'd null 

COpTIMIull 

obuliutu. 



Aiaimet- 
out •rybaU, 
where t'uynil 
chirfljr. 



Soi'Ktil'W* 



^ 



■ Edin. Bled. Cooiin. *a1. t. p. IHH. 




t PhU. Tniiu. <r»1. for i19i. 




9M 



GL. I.] 



COfLIACA. 



[OKD. 



(H:m. X. quartw by the tides and eutrenU, and liave MMnctimc-, 
Knmiu ' ^'^'^ iouod on tho shon* of tlie WeM IndiM; whenct] 
iliiu Stj\m- Waller : 
Inni. 

OAmlbuml 
on the 



Itcnnuila, «*U'd wWi racki. vhn doa noi know 
Tliu liAppy Ittuil, ohcn hugi- lonoiu gnn ? 
WImk ilUnbg ^H, tenl, and muiT' ■ pound. 

On the rich thoM. of AMaBKOBIBbfMMtd. 



rUU 



Snnctlnici Sometimea, hon'efer, it is traced in great lUiiuidance in 
rl Tl^fa'.'' t^>^ intestines of whales that are harpuunvd, and which, 
probably, would soon have died of an obatruction in the] 
boweU, if Uiey had not beeti taken. A captain in Uiel 
Southern WhaJe FiHliery, exaniiiuHl Ijcfoie the privy coun- 
cil in 1791, rebtcd, that he \yj.d found tlircc huadred aodj 
sixty-two ounces uf this substance i» the intestinas of a] 
female, stntck off the coa»t of Guiuca; part of which woa] 
voided from the rectum on cutting up the bladder, and thej 
T*"^ remainder traced in tlie intestinal canal*. The mass 
MhsrnuL usually ItMidn) with lianl bony fmgmcnts, by the seaiuea| 
called squids, whieh are the beaks of the ciittle-fiah, < 
nliicb the whale is known to feed. 

When recently taken, the smell of ambergris is ' 
strong, and rather fetid, but, by keeping, the ofTonaive 
goca oiT. and it acquires a faint mudltj odour. It 
scarcely any taste. lt« colour is ash-gray, or brown, som^l 
what mottled : its baidoesa is sufHcieut to retMJer it 
friable, but nut to bear a polish ; when broken down, it ha 
a soapy feel Uke steatite. 

Sir Erentd Home has endeaToored to account for 
produclion of sll these vaiiettes of scybala, and to slwi 
ttiut, while it is tlie office of the stomach and ioleatinai 
furnish nutriment for the miucles and membraneii out 
tlie finest part of the food wliieli is separated from tj 
rest for Uiis puriMM, it is in like manner the oflice of Ui«| 
lari;i-r iiitCAtitKii, aitd especially of the colon, to convert aj 
considerable part of thv refuse matter into fat, by couirj 
bining it witlt the bile, and to send it. thus changed in 
ita nature, by rhtaiwlf of whi<;)i we know nothing, into iba 
circulation, and d^MMit it in almoct ercry put of the body, 



• ry,l Ttan. ML IsxsL 



Ifbt 




I 



I 



CL. 1.3 



DtQFSTtVB PVHCTION. 



[Otl>. I. 



to lubricate tlic whole, and especially to promote the 
growth of the animal (irame ia youth •. 

It is noqucationable that, with all our adraoces in tlte 
knowledge of physiologj', we are, to this hour, iu great 
ignorance of the means by which the fat of the dlffereut 
parts of the body In produced, or the quarters from which 
it i» drawn. But it iiiilitutoi nptin«t Uie hypoUienis before 
itst, that we have no iitittance of the existence of fat in the 
larger intestine* when they are to a Mate of health; and 
that to produoc scybula of wery kind, and parti<?ularly 
those that are more okagtiious. a weak and diseased con- 
dition of the intestinal canal appears to be indispcnsabte. 
Whilst in the second caso related by Dr. Dabingtou, in 
which the fatty material seems to have been elaborated in 
its most perfect sutc, the bile docs not appear to have 
beoii at all transformed from its natural to any new cha* 
meter, nor indeed to bare been in any degree operated 
upon; for we arc cxpnviKly toU), thcit Uie material when 
voided hud " an unusually yvllow tinge," notwithstanding 
that it was "quite fluid bke oil." 

The subject, howovef , is worth pursuing : and Sir Everard 
has cndcuvouTod to support his views by a later article in- 
serted in thv snnie work, on the liatumutation of the tad- 
pole into u frt^'h in which, after showiog tJiat the intes- 
tines of the tadpole arc much larger and more complicated 
than those it poMeasea in its frog state, he argues, tliat 
this more extensive and elaborate machinery La for the pur- 
pose of forming a larger abundance of oleaginous matter 
as food, at a period when the animal is less cntpablc of ob- 
taining food liom without; and be observes further, thai 
the intefitinal canal of the tadpole is surmounted with, and, 
in some B)>ecies, imbedded in fat. 



335 

Ues.X. 
Srsc. III. 
EniooU- 
OnaSey- 
baliun. 



ti> tilt hy- 



liy Uw 

Itiininiutii- 
liiin nf iIh) 
uiIjioId. 



* Phil. Tnuii, tor ISia, ttU xxU 



t lb. ISId, p. 301. 





336 



ct. I.] 



CCRLIAtA. 



[4>K1>. !..{ 



GENUS XI. 

HELMINTHIA. 
tyVICRMISATIOS. W0RM6. 



On>. XI. 
Thcwbjtci 

new to noH- 
Wl<al djB- 
ililniiona. 



* 



l>t. Cullfii 
iirnvibk of 
tlm om!*- 
i>iiin,anilin< 
ifixldl to 
Hipplf it. 



Thamik- 
•IdD ^bttod- 

fuMa- 

ntuMttool) 
vteham 
nfrmd 
■iMMdto. 



IVORMS ilK tARV^ or tNSKCTS, INllABITIKCi 1 1I i; 
STOMACH OU ISTF.STINKS. 

TiiK subject of our last geuus, 1 observed, vra^ new, or 
neariy bo, to the scieocu of pathology : that of the present 
is equally new to nosological Brraugomcul : for, it U a sjii- 
guUr fact. that, while almoiit all sy&totus oontain a distinct 
geuus under the name of phthiriasis, or mnlis, or cocyta, 
and some of them two distinct genera, for the purpoee of 
(trranging such insecta, larva>, or TeriuicIcsasarcoccnBion- 
ally found infe&tiiig the surface of the body, and wliicb.lo 
avail ciursclveii of a significant term derived from old Ea- 
glish botany, way be called animal dodders, few or aoiio of 
ihem comprise any division whatever for intestinal lan-ie 
or worms, notwitlntLiiuliiig the inlinitely greater mischief 
they often produce, and the far greater difficulty of gettipg 
rid of ihem. 

Dr. Cullen, indeed, >u tJie latter part of hi» life. viW 
ttenflible of the importuned of this omiiwioD. and would 
nu»t probably have corrected it in his own ayslenj, had be 
found leimire or incliiuiUon for a revisa) of it, aince he 
haa introduced llie term %'RitXBs into hta " Cnlalogiu 
Jforborbm, a nobiii ouiissorum, quos omitiiue fortaMiH non 
oportcUil." 

Ill Di:iuy inslunccs. however, |>hyf>iulogist« mid puUu 
gihtit have abundantly supplied the deficiency ; for the 
•carcely a diacaeo of any kind which ba» not Iwtfn refer 
bysomeoflhem to vermination as its origin. ThiKia por- 
ticolirly true of the Hrhool of Linni'us, though it in not 
confined to that seminary. ThusLinniUG hinisolf lulwum) 
hard to prove, that dysentery isthcetrcclof u peculiar hirva 
or gnib belonging to the acarus or tick genus, n hich he has 
ventured to introduce into his Natural History under the 
name nf eifams difieHtcria. So Kirchor biu wcrlbcd the 




[ORD. I. 

plague to nnothcr kind of tnimulcuU' ; LaDj^uu, the luetuleK ; Ocx. XI. 

variouK fiiithora, the itch; Si^;gl€r, petechia; ; Lusiliinus 
•ad Fonccllus, smull-pox; De Sault, lyssa, orcanincmud- 
ne«i; Hauptmim, syphtlia; Martin and Udmiui.buth ptipUs 
of Lioo^uH, elephantiasis; and Nyander, another pupil of 
tlu naie great teacher, contagious dineases or inoat, if not 
of all ItindH. Some, again, have aw:nbe<l pile* to the Hani« 
source; others, the inspissated and venuilbrm mucus 
squeezed out occasionally from the excretory ducts of the 
mull mucous glands of the forehead, in the present sys- 
lom described under the genn-i and species ionlhui varus: 
and othen again, the tootb-ache: which last opinion 
seems at one tine to have been adopted generally ; for we 
find Shakspeare making onv uf hie best-diawo characters 
exclaim^ 

What ! ilgh for the loath-Mhe ! 
Which U but * humour or n tttimr. 

It is not very wonderful, therefore, to behold the extcn- Eiicmirf 
aive use to which the tunia htfdatia, or hydatid, is applied ^^i'^jj^ 
in modem times, so as to be rr^;nrded as the parent ofAydndf. 

I almoet every limpid cyst discoTerable in the body ; nor that 
cancer of the breast should be ascribed to a similar gene* 
ration ; and the less so, since it ia not a century ago. that 
it was gravely argued by the most enlightened phy«iolo- 

{<gMts of tlie day, and supposed to bit ocularly and irre- 

I'^tagably demonstrated, that man himself is, in every in- Man him. 
stance, the progeny of a aimttar kind of maggot, which, it JI^^J^ , 

[.was Miid, might he eteen by any one who woiibl take the vintvam 
pains to look for it, vivaciously frolicking in (he vast oceu) ''^ ■""•«■ 

, of a drop of ntale semen. 

- We are, at length, approaching to more sobriety in our Miwhicfof 
AMrvations and inquiries ; and it is hi^ time such a !„ .aOt '%. 
period should arrive ; for we were in great danger of nin- v*va,e*n<OT 
ning into the wildest fancies of equivocal generation, and ii^''"°* 
of equally relinquishing all principles and all limits in na- 
tural history. We now know, that au incipient stage of 
putrefaction, or a very short quiescence and exposure of 
animal fluids to a warm atmosphere, is sufficient to load 
them with animaldilcs cif Mjnie kind or other; not,indevd, R'>l«rtji<n 
by fortuitously converting the constituent and drconi)>osing "L^Mt 
principles of such fluids into the simple forms of micro- "it°»l- 

VOL. 1. K «"*■ 



J 



33H 



cu I.] 



CfKLlACA. 



OKD. I. 



GtM. XI. 

lurtaiblo 
l0)[ln iIk 



Pnaroribi 



ghlln 
IcroimiU. 



IIi>iwT< 



ftnd oftlK 

■pbU 

buiiiull. 



Omh ieu- 
faRfatlw 

prabtflytn- 

IcBdM 

■pht*. 



•oopie life (for of t)ii» we hitvc »o proof wlmtvvvr), but J 

ralhvr, by uiloidiDg to ■toiii« fuw at the myriads of iii*i»ibie { 
oTola nitli which ttic Kimo»{>li(;Tv HWamu, and which it 
nay convey to tboni, Uic pro)KT iiidiw, or the (|uickoningl 
fltimulati thoy »tund to D*ed of. [As a judicious writer r«-j 
nuifcs, the hy(M>l)ic«i> of woniui iH'ing tin- protJiict of pQ- ' 
trafaetioD only provut. tiiut Um bdii-vvrs in it had nevvr 
exumined the g«n entire organs uf those aninula*.] 

That the atmosphere is freighted with myriads ofinnect-' 
«gg8 that elude our scD6ea,and that such eggs, when ihvy i 
meet with a proper bed, are batched in a few hotira into a ' 
perfect forui, is clear to any one who has altendMl to the 
rapid and wonderful efl*ectN of what, in common language, 
18 called n blight upon phintationi» and pirdcos. I ban 
seen, as probably many who may roud thi« work have! 
also, a liop-ground complfrtely overrun and deaolated bjr I 
the apith AuMtuli, or hop green-louse, within twelve hoont 
aHer a boncy-dcw (which is n peculiar haze or mtBtl 
loaded with a poisonous miosru) has slowly swept through 
ihr plantation, and stimulated the leavt-s of Uio hop tol 
the morbid accretion of a aacoharine and viscid joioe. 
whirl), while it det>troya the young shoots by exhaustion, ! 
renders them a favourite resort for this insect, nnd aeh«-j 
rishing nidus for the myriads oflittledotMtliat are itH< 
Tho latUT are hatched within ci^))t-»iid-ri:>fty hounnfier^ 
tlK'ir deposit, and succevdcd by hosts nf other egga of thai 
same kind ; or, if Uie blight takt- pluoo in an early pan of j 
thio autumn, by hnatM of the younc insects pn>dncfd vivi. . 
inrouslyi for, in dilloreiit eeaxons of the year, the aphis 
braL>dB both ways. 

Now. it is highly probnble, that there are minute eggn, 
or ovula, of innumerable kinds of animalcules lloatii^ by 
inyriada of myriads through the atmosphere, sodiminutive 
as to bear no larger proportion to the eggs of the aphis than 
time bear to those of the wren, or the hedge-s)iitnx)w ; 
protected iil thi? Hame time from destruction hy the Iflmv 
iotegumt^nt that surrounds them, till they ran utcet with a 
proper nest for their reception, and a proper stimukljiig \ 
power to qaickan theui into life; and which, with respect 



■ aiif»l,laIMct.toMHm*H«l.i«n.ltU.p.tU. 



CI„ I.J 



DtABSTIVB PUNCTtON. 



[oKU. t. 




W mnny of them, are only fouiul obvious to the Momi ia Otx. Xh 
different deacrititimiB of animal fliini*.. The samo fuct 
occora in the mineral kingdom; isliigRunt ^vatcr, utougli nci round 
porilied by diilillation, and confined in a marble bssin, jl"^^!; 
will in a Hhort lime become loaded on iUt surface or about die nmo- 
iu sidcH wiUi vuriouH upecies of conferva* ; while the in- "p'«n«»l 
tenor Will be (leopkd with microscopic aoiiiuilcules. °o, ^.^^^^^ 
while damp cellars ari> covered witit bolotusL-s, iif^irics. and occtuiaoiillr 
other funguses, the diieat bnck-walls an- often lined willi 'n''""'i"'P'' 
1 lichens and mosses. We see nothing of the Auinuil and 
vegetable eggs or seeds by which all this is eflbct<.-d ; hut 
we know, that they exist in tJie atmosphere, and that this 
[is th« medium of iheir circulation. Hon- far the tidrs may pouiblriQ 
fbe true, of living animals found in attscesses in different "^^^t";^^ 
parts of the body, and es|>ccially in scirrhous and pus- thimt. 
cxuntheuiH, this ia not the place to ini^uire; but, 
cding the fuct, we con only account for ii by sup- 
posing their respective orula to have bttiMi admitted into 
the n-Hlem with the air or fowl we take in ; and tn have 
[lieeii Jteiuimted ns soon ** tlu-y nci)uirc<l possRsslon of a 
proper nuntery. 

Wc have slroiif; retuton to believe, however, that many itmccRnt. 
of the flftgs or snimalculeM timt arc traced in animn) duids, '"■'™'»i 
Oeoaiiioinilly find otlicr leceptaelcs out of the IkhIv that ,Kriui« <»■ 
•iMwer their purpose as well, and ntcra to keep up their T*!''' "^ 
reK|>cvtive species; and, consequently, that provide a stock hatched in 
of cge*. Iiinw, or iiiMClis, prepared to take poauasion of"''""'^'- 
aiiy decomposing anininl substsnco ns soon u it is ready animd 
I ferthcir reception. And wc are hencr able to account for ^o^*- 
the presence of animalcules in sucb situations, witliont '^'J^"*' 
being driven to the necessity of supposing tliem to have nucnmUr 
been generated therein ; and see how it is po&sible that p™l<«^ 
they should continue to exii>t in a regular chain of sue- uniuutga- 
oewion. instead of being produced anomalotisly and equi- n™"""- 
vocally by the (niiimi^nlrieh (an t]ie Ci-rman pysiologuts 
call it), or formative eA'nrt of a livin;; principle, in nub- 
aUinccs in which life has confessedly ceased to exist. 

Thus Kolaiider, vrhA, like Linntius, ascribed dyHenlery TliEnpininn 
to tile dyscntcrj-tick. or acarm lii/iCtiteria. and who him- j, "J^ 
self laboured under tliis di^ase while residing in Linn^-us's ovvriM in 
house, contended that he had discovered the same insect JJ^"" ^ 
in a water-vessel made of juniper-wood ; and conceived RoUndch 

z2 



I 



340 



:l, I.] 



CCELIACA, 



[nHO. I. 



Qg»: XI. that 



PdnuHw. 



t wns conrcyeii in grcst mimbera into lits body bjr 
the water which he drunk from the citslcm. So Lister 
atfinnK, that he has seen the asfiirit vfrmirtthrin {the maw 
or throntl-w'omi), which is usually found burrowing in the 
lower part of tlii; intestines, infesting tlie RurfiM:« as well. 
In like manner Palmyras has rendered it at Iciisl [>robahle, 
tliut the young, or ova of the fatriola hrpaliea, or fluke, 
found so abundnntly in the liver of sheep that die of the 
rot, and the origin of which ha^ so much punled the na- 
turalists, are swallowed by the sheep in nwrsli or atagnaat 
waters. And Linn^im himself pointed out. that (he /cmui 
tolium, or tnpe-worm, tlte cause of whose existence in the 
alvine channel han been a »»arce of eiiual difficulty to the 
physioloi^ical inquirer, cxistx, though much smaller, in 
muddy xpriugs ; and notwithitumling that Pallas, at ArM, 
expressed doubt* upon thitt point, the assertion has been 
since confirmed by additional and satisfactory obKcrm- 
lions. 

[The astaris vermicu/arin, which used to be conaidered 
peculiar to the hnmnn body, has been proved by Dr. Barry, 
of <'ork, to he derived from without ; as worms, differing 
from atkrurides vermiculares merely in colour, were traced 
by hiin, in one instance, to the well of a particular country- 
houRe, two uiilcs from Cork, where the whole family, and 
erery other person that drank the water, invariably became 
afflicted with ascarides*. The ar^cument, with which all 
«tatemcnts of tliis kind are generally met, is that intestinal 
worms cannot live out of the ))ody. and therefore they must 
differ from worms, more or les» resembling th«oi| found 
elsewhere : yet, it is possible to concave, that an animal 
that is hatchMl ar>d attain* il« growth in a prticular ten* 
perature, unexposed to the air, niuy not be able to sustain 
the sudden removal from its warm sheltered nuracry. 
though it might have thriven in a much colder and mora 
exposed situation, had it never been made too tender by 
the inHucnce of bnb»l. &c. Worms of the human mte^ 
tines die, not only soon after their discharge from the body, 
but frequently even before they are voided, when the health 



* BsiTT n dw Origin «r InHmIimI Wmim t m Tnw. oftbt AmcMlMsT 
PkrvciuK, kt. InUml. nL IL p 30*. 



cu tJ} 



DIOBSTIVK FVSCTIOH, 



[OHD. I. 



of the iadividua] in much disordi'rvd by rev«rs. They also Obw. xi. 
invariably |ieriHh with the patient; when the supply ot"*'^'"'*'''" 
iJii'it w»utecl nuiriiDcnt may be suppossd locnase, »n<l the 
temperature to which they are accustomed is rapidly les- 
sened. Some writers ittate, that worniK never iiiciUUv 
with liie alimentary matter in the buweln, but dciiru their 
nutriment by auction Trom the substuiicc, or vettaeU of the 
viscera; while others represent those worms, which occupy 
the small iatesliiiett, tis feeding on the chyle itself. The 
editor is not awaro, ihut any decisive evidence, exclu- 
sively supporting either of these opinions, is on record.] 

Is it Dot surprisinn, that doubts should at times exiHl in iMubo 
the mind of the precise and cautious inquirer in mmy "^^,*'' 
cases of Uiis kind, which can only be removed by ii long winnn: do. 
and attentive investi^tion of the history of the minute "***'- 
nnimols which ^ircs rise to them i fur, first, tliu very Hume 
species assumes »o difl'ercnt an appearance in dillerent 
stages ofiu existence, that notliing but the most patient 
prosecution of (he same individual through all his meta- 
morphoses, could imltice us to put any faitli in ils indivi- 
duality. For who, for example, if he did not know it by Finn, from 
the repeated experience of himself or of others, could be- ''"■ 'liff"™!' 
lieve that the black and the while carrion-vulture ofofihcHnw 
America ivn/lur aura, Linn,), which, when teased, emits »"""»■ *" 
a cry like a mouse, are the same bird, merely changing ,u^„rijfe, 
from while to black as it grows old .' Who could divine Kumpic*. 
that the tad-pole. possMsing gills and a fish tail, and with- 
<nit itgs, should be the sam« animal, only younger, as tliu 
four-lcgged frog that has neither tail nor gills 1 or that a 
like identity should apply to the caterpillar, the aurelin, 
and the winged moth f But, secondly, wo often see an Scomdij'. 
almost equal change pro<iaced in a few genemtions of the ^^ f'' 
same species, and occni^ionally in tlie same individual, by appnnnco 
n change of food or habiution. or both. How widely dif- J'j'^^^' 
frrent is the domestic sheep from the argali ; or the ox of r«H). 
from the bi»on ! yot these arc the stocks from which they Exunjilia. 
have proceeded. A difference of food alone produces a 
growth and development of sexual orgnns in tJie honey l>ee, 
and converts what have hitherto been called neuters (but 
which are really imperfect femalen) into queens, or bearing 
bees. In many instances, we can trace changes as con- 
siderable (and shall presently have occasion to remark 





Ct. I.J 



deal oTwine, and other spintuoite Iiquofii.aTe remarked to 
be rarely afflicted n-itb worms. InfanU al&o, while tliey 
tuke no oilier food but their motbcr'i^ luilk, seldom hnre 
worms. The«e circumHtatices, having u cloKe reference to 
the caujwM of wumts, u subject that is yet rcry ob«cure, 
seeniweil-dciicrviiigof tlic niudcr'Kiiltcntioii. At the same 
tituc, it must be obiiervtd, that ihe^c uccouiils nrc not so 
certaia, as not to stand in need of further confirmatioQ.] 

The various kinds of worms traced in the human sto- 
mach and intesiiii«?i have been differently arranged by dif- 
ferent writeRt: but Ibvy have been chieHy aiittorted into 
round and flal worms ; or into inJigrwHt »nd tiotic : in 
other words, into those which we are told are gcrtemtetl in 
the alvine channel, and those which enter itj'rom leit/tout. 
The first method is too Itmitod ; and tlie Hocoiid, as we 
have already xccn, not only hypothetical, but built on a 
false basis; for wc have reason to believe, that everj- spe- 
cies, found in this channel, primarily existed out of it. In 
unfolding, therefore, the subject further, we uliall employ a 
diffenrnt arrangement, and coniprdiend, under the genus 
HKLMiNTiiiA. thrc« Kpeom of diseases, equally distin- 
gniflhed from Cttch other by symptoms, and by tJio different 
thben of animals which give rise to them ; viz. tiiose which 
are nourislied and fmd a proper habi tation throughout every 
put of the alvine canal ; thotic whose projier habitation ia 
limited to the extremity of the canat ; and those which 
have no proper habitation in any part of it, and enter it 
erroneously or by accident. 

I. MELUINTIItA AI.VI. ALVIMK WORM J. 

2. POt>ICIS. ANAI, ivonMs. 

3. ' KKIIATKA. KUKATIV WOnus. 



Otj>. XI. 

tldmiatfaia. 



Diflbmt 

iiicni or hu. 
11^*11 vontki 
by diff.Ttni 
•rriien; 



bill none 

■ufficjcotly 

ratncct. 

New mr. 

nngcmenl 



^ 




344 cL. I.J 



[OBO. I. 



SPECIES I. 
HELMINTHIA ALVl. 



ALVIS'K WORMS. 

I,"'. •< 11(11 

¥(l^)U,eXI«T1M« AM) riMJINU A VltOPKU KlOk'S IK 

..TUB fcTOMACH' UU ALVIN£ UAMAL, CHIEFLY DP 

CIMLDRKN, Attt> eiCKI.Y ADULTS; PROUUVINU KHA- 

CIAT1U\, A SWCLLBD UAHU BELLY, U>1AWINU Ot 

PUJltiUNT VAIN IK THE STOUACU, VALB COUNTIr 

.,NA>CE, VETID BREATH, A^D IKRITATION OF TUB 

,i«(OSTttlL6. 

Om. XI. The worms that chiefly iufesl this regton, and proaoiM 
8«c. I. ijjcsc syiiiptoins, may be arranged under the foUowing 
nirieticH : 



« AifiiriM liimhrivoidca. 

STrkhor^phiduB. 
(r> 'yTmnia'Aolium. 
-''"« TwniB vulgaris. 
'" I' Pasctola. 



I/>nf; m«iiid wofm. 
I^rig thr(4id nana. 
Long tapo ironn. 
Broad tape worm. 
Pluko. 



[So common are certain worms in the human aubJM^, 
that, it u calculated, ooc-hidf of tl)« total number of 
childroit have oitlior the round, or thread-worm. Tuinia is 
more. rare, however; so that an entiuiate is made, that, in 
Frji)c«, only oue individual in ii hundred suHcrs from it*. 
Worm4 urv oUcn only of on<t kind, and most frtMjucitlly of 
the Jong round epccicii; yot it is not very uncotnniou to 
find two Kpcciea existing together in the ulimcninry cunal. 
The record!) of medicine furnish examples of patients, who 
even voided simultaneously ascaridcs, tienis, and Inmbri- 
coi<lc«. Generally speaking, tlio smaller the wvrms, (ho 
more numerous they arc; and the ttenia, the latest, has 
received the epithet of WiMw, from the suppotiilk>n, that it 
is always solitary, which was the notion of Hippocrates; 



' Dkt. dct Sdtfwn M(d- torn. Itii. p. SU. 




cr. I.] 



DIOBIITIVB rVNCTIOH. 



[OKU. I. 



bnt this point requires coolinnation ; for, ld aniaiala, sihI Gen. Xt. 
especially in the canine mcc, tape-worms exist togotlier in *'''**'* ^' 
gnat numbers.J ' 

The head of the long bound worm is sltghtJy ia--.it.Alti 
curved, with u irnnsverso coutruction beaflath it ; mouth J^J^ 
trianj^lur; body tntnr^puTunt. light yellow, with a faint oouIa 
line down the sides; gregnrious and viracioua; fromtwetTe 
to fmmin inches long. Inhabits prtneipally the intestinea 
of thin persona, generally about the ileum, but somettntcs 
ascends into the stomach, and creeps out of the mouth and 
nostrUfi : occasionally travels to the rectum, and poMCs 
away at the anus. Frank notices an instance of eighty of 
tbeao worms rolled up into a ball, and expelled during a 
fsver: and gives another case, in which tlie whole intestinal 
canal, from the duodenum to the rectum, was crammed with 
them*. 

Tliis nnimni will •omctimcs remain »o quiet in its proper HtMiiand 
region, as to girc no signs of it« existence but by its dis- *^"*- 
chargc. Frequently, however, it is a tJDublcsome and 
niischievooB intruder, producing an intolerable feebng of 
faiptpnta, great emaciation, and roost of the symptoms 
enumerated under the specific definition. In its general 
appearance it bears so striking a resemblance to tbe earth- 
worui {lumbricti* lermlrii, Linn.), that by many natu- 
tahntx it liuK been regarde<l aa the same. Yet, to an at- 
tentive obsener, there is u considerable diSerence both in 
tiieir form und movements) +. The body of the inCevliniit HnwdiAhi 
worm is round, its colour is a pale reel, its head is fur- "^^* 
nished with three vesicles placed triangulurly, iukI, in 
moving, it curls its body into circles, from which it extemlK 
its head. The earth worm is flat towards the tail, and has 
briHlles on iu under-«idc, which it can erect at pleasure. 
Its colour i» dusky red ; its head has but one vesicle, aiid 
it novm b)' a iwntinuous course of action propagated from 
lini; to ring. 

Tlic botv of the lono thread worm is, above, it. AIvL 

Trichoo;. 
. Jihilm. 

• De Cue. Mnrb. Honi. Epit. tnm. ri. lib. *l. 

t .-iiv lUiIlk'* Mnrbld AwUHDjr, ma Hoopft on Ipiealiiul Woma, Mrm. 




34ti 



CI.. 1.] 



CaLlACA. 



[OKD. I. 



Ozv. XI. 

Sne. I. 
SII.AiTt 
Trkhcwe- 
ptaolu*. 



Tmiiw- 
Uuoi. 



alij^btlir cr^iate; beneath, smooth; fiiuily Eth&t« on llw 
fore-part: head obttise. aud t'umisbed witli a sivndcrra-l 
tractile proboticts ; tail or thinner part twice as long as 
the thicker, termtDaling in a fine hair-hkc poiot, about two 
incbea long; in colour reaembles the preceding; p^g*- 
rioua,aml found chieiiy iu the intestineBofaickly chihlraa; . 
gonerally m tJie cax-nm. It ia tbtuid al»o iu aiany aoiioali 
beaid«B man, as the horse, boar, fox, and monw. Go 
eonitidcrs the probonciK as the male orguD *. 

In the LoNCi TArE wokm the articulationa are long kod \ 
narrovr, witti marginal pores by which it attsclicH itself to ' 
the intestines, oite on each Joint, ^neratly alternate; ova- 
ries aborescent : head with a terminal mouth aurrounded 
by two rows of radiate books or holders ; and a little beJow* 
on the flalteoed Hurface, four tuberculate orifices or «iick«n, 
two on each side: tail temtiimted by a semicircular joint | 
without any aperture: from thirty to forty feet long, und 
has been found sixty. Inhabits tlic intt-TUincs uf munkiml 
generally at llio upper part, where it feeds on the chyle 
and juices already animaltzed. Is sometimes t>olitary, but 
commonly in coosiderablo numbers ; and ttdberes so brmly 
to the intestines, that it iti rvmored with forest difficulty. ClL 
is Mklom met with in Fmnce, where the broad upe-worm 
prevuilK; but it is common in Italy and Saxony t.J It t» 
said to lutve a power of ro-producing parts whtdi havebMO 
broken oil'; but this awertion wants proof. The animal it 
oviporouB, Bod diaeharges ita numerous eggs from tbe 
apertures on the joints. Werner aisens, that it is bonaa- 
phrodite. The broken-otf joints have, when discharged. 
th« sppeanutce of gourd-weds : and it ia henc« denonu- 
natAd gourd-woim by many ni^ical writers ; and is the 
lumbricut cucur/Mlinut of Dr. Ilcberdcoi. In thu collectioiu 
of the Medical Society of Copenhagen, Dr. Siblmmgaafd 
gives the case of an adult fetnalo patient, who was infeated 
willi o tupc-wonn of enormous length, measuring not Um 
lltun thirty-fi<;ht yards, or on? hundred and fourteen fcoL 
It wiM expelled from tlic nnu^ after taking three duoca of 



■ NWui|Mtrt(hir4cf iniiet««hkw«wr. BbnlMk. IJM. 
1 Mttai, in Pin. 4n Mater* Mwl. Inn. UitiL p. tSJ- 



CL. I.] 



DIRRSTIVB FUNCTION. 



(OBD. I. 347 



ft bolus, consisting of two drochmii of tin filings and half Okk. XI. 
a drachm of jalap niixt up with honey.* '*'''^' ' 

The articulations of the bboad tape-worm are short l,"-,-*'*^ 
and bfoftd, with a pore in the centre of each joint, and g^u. 
MeUate ovaries roond them : body broader in the middle, 
■ad tapering towards both ends; head resemliling the Inst, 
but narrower and smaller ; tail ending in a rounded joint. 
Like the last, inhnbits the upper part of the intestines, and 
feeds ujKJi) the chyle ; from three to tifieen feet long ; 
Wually in femilica of three or four. 

Thtt body of the n.v k r is flattish, with in »pcrtur« or • It. AlvL 
pore at the bead, and generally another beneath; in- *"""'■■ 
le^tines flexuous ; ovaries lateral : hermaphrodite, and 
oripurotis f. 

Of nil intextinal worms, this is one of the mo»t common Kuuniltx. 
to imiiiiiilH of dilVerent classes. It ia sometimes, though '^'^1!!''^'" 
rarely, found in tnaii]:; but in ditterent speciea, or under animili. 
different modifications, we meet with it very frequently 
and very abundantly in quadrupeds of nlmoat all kinds, 
reptiles, liahes, and even in worms themselves of a larger 
growth, for it is occasionally met with in the intestines of 
the ouUle-fbh. Its ordinary seat is in the stomach or 
alvioe ^annet ; but in swine, black-cattle, deer, and sheep, 
ita r«vourit« haunt is the liv<T, u> which it probably creeps 
forward through tlie bile-ducts, and where it burrowa and 
breeds in innumerable hosts. This is particularly the (;„uMnrfr- 
cue witl) iiitj'aadota hepaxtca, aK it is c^led by way of f^" or Ow 
emphasis, found so commonly and so abunduntly in the '^' '" * '"•"■ 
lirer of sheep that labour under tlie disease called the rot; 
though whether it be the cause or theellcct of this disease, 
h«s not yet been u.->cerlaiitcd. Most probably the cflcct: Mwtpro- 
for the rot is certainly an infectious complaint, and is £|^.''" 



* fiocieuiu ^ttdic* II BimuiiulB Collect. toI. U. 8ni> 

t C. A. KuJolphi't wotki, DntlUcd. Eiiiouxinini. dvc Vtmlunt IdimIIds. 
Uum USatorU Nilui^i*. Amsl. 1806 1 wiH KDMcoaruin Synaptic Bcnil. IBIVj 
(houlil be coTuultcd br all vha dciue ihc tnoat cnrrcci ilncrlpiiaii of incnitiiul 
womu. Nor nhniilil itii' writln)^ n( Itlcich, Dune, '/.ritr, Wi-mer. IK-mui^n, 
PiKhtr, Dnn, llmpcr, Lamuck, DaiDcdl, Cnvkr, DIumnibKh, and liMnnut, 
be fiM){uiwn. E<l. 

; Ilocnt, Vitiii. p. S L < tcik, Lunitth. p. 1 19. 



fi 



34H 



CL. I.} 



COtLIACA. 



fORD. I. 



U<M. XI. 

Spkc. I. 

. H.AlvL 

and ihf 
n>l pro. 
iuixi by • 



Flukr rouiul 

In other 
diaowo 
lliiuillicnit. 



tMBtineii 
poalponal 
lill uic rr- 
malnbg 



hamtMcn 



eomc'timeK caught by a whole flock in a single night. The 
catisL- hsu been suppowd U> b« hydro^nou* put ; but of 
this wc have no proof. Tlifrw c«n be lilllc doubt, how- 
ever, that it is produced by some ddcterioui miasm in the 
atmoBphere originaUog in the pasture itself, or oonvt^'ed 
there iu the form of a haze, in the name manner as vcg^ 
table plantations are often blif^hted, of which I haw joat 
Offered an example from hop-grounds. Yet by what ineuM 
tlie liver of sheep, rather than any other ofgan, is hereby 
niTectcd and rendered gangrenous, we hare still to inform 
ountelres. Ah the nnimol is oviparous, the minute egg* 
may be borne by the haze it&clf, or exist in (he stagniint 
atmosphere of the sheep-giound ; or ihcy may already, in 
the body of the parent-worm, be infesting the alimentary 
canal, and only waiting for accidental circumstanceii to 
exert the full raogt- of their prolific powenj for it is not 
in the rot alone, but in other cnites of visceral diseasea, 
thst this animal is traced in sheep, and especially ia 
dropsy, whether connected with the rot or not ; mk). ia 
botli diseases, they arv frequently found vomited np in 
brooks. 

As the treatment of all the species should be eKtablished- 1 
on the same principle — that of invtgoratiog the alimentary 
canal and surrounding viBcera, — and Uie vermifuges udnpted 
to many of the difl'erent tribes, though not to all, are the 
»aroe. it will be better to reserve thin subject till the tumo-- 
logical charactent of the remaining species have passed in' 
review before us. 



CLil.} 



DICKATIVB PUKCTION. 



[ORD. I. 



SPECIES II. 

HELMINTHIA PODICIS. 

AMAL WORMS. 

WOKMS. 0« THE LART£ OF tNSECTS, BXISTING AND 
PINDI.VO A rROPER NlDfB WITIIIK TUB VEUUK OP 
TIIK ANUS, EXCITINfi A TKOUBLESOMK LOCAL IKHI- 
TATION, flOMETIMi;! ACCOMPANIED WITH TLMOVK ; 
FRKQUESTLV PRKVENTINO 8LSEP, AN U PROPCCINC 
PAIN OR FAtNTMSSS IN TUB STOMACH. 

Under thia apeciea lire included the foUowtnc va- ***"■ XT. 
rietiea: «"^- "• 



a Ascaris Termicularis. 





y 



ScarabeeuB. 
(Estnu. 



Tlircad-worm. 
Maw-worm. 
Btwtlc-jnib*. 
Bot«. 



Tlic hrud of ihc TiniKAD-woRH is subidate, nodose, , h. Podu 
and divided into throe vcBiclcs, in the middle of eadi ol' ^ 
which \% ail uportura by which it receives nourishmfiit ; micuiuu. 
skin ut tlic sides of the body finely crcnatc or ivrinkk'il ; 
tail finely tupc-riiig and tcrmiimting in a poiot ; the female 
has a EinuU [luiiclifomi aperture a httle below the head, 
through which it receives nutirisbmcnt : gre^riouit : vivi- 
parous; iibout hulf an inch long; sometimes wnn(l<^r«i into 
the intestines, and occaKionnlly as high as tli« Btomuch. It 
was first obserred by Morgapii*. 

The sexes of tliis vuricty are distinct, but tlte male 
organs have not been discovered. Tliis form of intvsliiitd 
worms was first detected by Ilippocratcst. Goeze con-Oxrurb 
ceivea it lo be viviparous, but Bremser oviparous J. It is j^^* 
the oij/urit vermiaihr'ti of the latter. The animals are of ItKmKr. 



■ Uk siv. 13. t Aphor. lil. 

X Ueba IxbcmU WOimB, 4to. 1810. 




;i6o 



CL. t,] 



COUACA. 



[ORI>. t. 




(Uh. Xt. 
Spec. II. 
■ H. FM. 

AicariiTn. 
miculirit. 

thmd. 

wvm. 

Du* •VDmi. 



Somnlne* 

mrriloibc 

pudaida. 



SoiDCtiinH 
aclto (u- 
nunin In 
ihr uiut. 

HonwUmn 

■IthMha 
klDdfc 



fl II. FWi. 

rb. 

Aicarli 
(EMnu. 



• yi-Uowifth white colniir, and hare a g«twral resemblance < 
to the rrnlf of thread* cut olf, and about half an ioch in , 
leof^h, whence the iianie of TiiRRAn-woRMM. and pro- 
bnhiy uf noTs, which is often, hut crtoiiwiwly, applied to 
il, and whicli I »u|>po«c to bo « corruption of the French 
hautM. " ends" or *' extremities." Hie tend maw-worm, 
nocurdiug to Dr. Hurvcy, i» derive<) from the occasional 
vUit which tliix animal nmkeK to the maw or atomach in 
111^^ ting from iu propt-r iv^ion, which is the rectum*; 
but. more probnbly. from the peculiar ciTcctit which it often 
produces on thv itmw or fitomnch by isyniputhy. And with- 
out quitting its home, an a p<^rp«tual nod gnawing ptkin 
and iniiuppurtable faintncM from the intolerable itching it 
excites in tlic anue. Sometimes these worms wander in 
a dilferenc direction, for they have been found in the pu- 
denda: and by Frank in the urctlira and tite urine f. 
Very generally, however, they remain quiet and inactive, 
conroluled in mucuH and fecef, and arc only known to 
exiisl by their ditcharge. Yet occasionally ifaey produce 
60 much irritaliun vb to cause a sensible tumour, or \ 
congeries of email tumours around the anue. They Mmfr> I 
times co-exist nitb other kinds. Itosenatein gives tbo 
caso of a child, who, in conjiiuclionuitha large nnmbef orl 
ascarides, voided ten long worniit ami a piece of a tienia. 
The little (Wtient died screaming under the most exem- 
ciating jmin and conrulsions. 

The lartie of the second variety embrace several species 
of the KCAKABxiTs OT BEeTLR'^. which have not hitherto 
been accurately described or enmnerated ; but of which 
the following seem to be the chief: grey larva, with yd* 
lowisli legaand fcrruginoushend.of s. nobiliit; nndthoMofj 
». Sch<»!ileri and m. volvcns, which, when out of Iho body. 
depOHil their egf^ in round balls of animal dung, which 
they roll up and burj- with their hind feet. Almost all 
the grubtt of the genus Scarabatua delight in. and fen) 
on dung; and hence the eggs find a convenient nidus 
and the gruba a ready supply of food in tlie rectum. 




* On Connmpiioni. 

t Bi Cur. Ham. Mntfc. Kpii. inm. vi. \A. n. 

I PauUni (;«nl. ir. Otw. «. THnmn. Ou. p. IIIl 



CL. I.] 



DlOKsTIVB VUHCTIOH. 



[URD. 1. 



SSI 



Ancun 



when occideot htut conveyett lh« furaiei' iiito this organ. Ocx. XL 
These grubs hnvi» mx feel; art- uiiniiliitv, h»iry, vesicular ''^'p^l^ 
at the «n<l oi ilm uUiomi-it, utid fumislinl uiUt n horny ci*. 
head. 

The larvK of the uktbuk, hkluke. or uau-ilit, are 
<:iillvd botit, und am of a round tigure ; pale-green ; tail 
obtusely tiiiDCaUi ; head tapering ; mouth horny, u-ith two 
lips, and two recurvfd black clawa on each side of the 
aouth. Found convoluted in the mucus and feces of man. 
but far inorv frctjuenUy of otlier animals, and especially of 
lie borsG. 
Tbo e«aus cestnu \» not numerous, containing in all not %K>'>>iciiy 
rtiwrG than twelve opecics. Of these the grent<T number ao'X.kln 
deposit their egga on the akin of animalR, and are there afMiimals. 
I tiatched. Theeairh ovh Axcm thcni on the inu-rior noslriU 
[of the itlieep; from which, when hatchOfl, they tmvel into 
I tilt: frontal sinuses or horns, and, when full fed, arc dJM- 
I charged tliruucrh thenontrils. They excite great irritation, 
often couipelliog the shec]> to ahake their heads violently, 
and rubor hide ilicirnoses in dust or gravel, and sometimes 
produce inSamniation in the brain. 

There are only three specics, however, whose larvK seem How cnn- 
capableof being hatched in the intestinal canal. TlieaeJ^^,'^ 
are astniit tqtti, a. htemorrhoida/is, and a. velerinut. The Uw inun- 
egga of the last are found deposited on the skin of cattle '""*' 
in general, and those of all on the skin of the horse: the 
part of the liorae preferred by hemorrhoidal breeze, beiii^ 
the lijiH. The egg* excite a tioubleaomc tiiitlation, which 
induc.e« the animal to bite the part and lick it with its 
tongue, in consequence of which the eggs are Imnsferrvd 
from the skin to the tongue it«elf, nnd find a ready coarey- 
ance to the rectum, which is their proper nidus. 

It is llie hemorrhoidal breeie, whorte c«g>t arc chiefly, The vwtaj 
if not solely, hatched in the human intestines, and espe- diiHly ia 
cially those of grooms and other persons, whose duty leadu f^" "i"~- 
them to associate much with horses, and other large do- JJ^",i„i 
mesticated cjundrupeds. And it ia the grubs or lurvtc of ^i™- 
ihifl genus, when discharged from the unii», that con- c^^nlw 
stitute the proper flo/i of relcrinaiy writcr»i, though the pf'T'' '>o'* 
tenn is often nuisappliud to the uicurl* vrrmicularit. as 
observed already, to which, indeed, they have some resem- 
blance. 




352 



CL. I.J 



CCKLIACA. 



Okv. XI. iir. Grecnhiiw hns deHcribcd n very copiomdiaeborgeof 

y b' Fodi^ troospAJr^Dt globalu- msteriils fnat the rMtum of ■ bc^ of i 

('>• . nine yean of age, which he thinks were hydatids*. fllMjr , 

tEimu. were of the me, and niuiiy of them of the colour of Bioaw- 

berriei. The editor was very lately coneulled by Mr. 

Smith, of Tottenhata-court-road, about a patient, who oc- 

euionally voida from the rectum a yellowish fluid, coq- 

tainiDg small globular bodies reaenihling bydatida. The 

patie«t'R chief distress s«euii to depend, however, upon 

iiritalton of the bla<lder, the cause of which ia not very Bp- 

parent, ns he hiis iKr^ithi-r stricture nor Htone. Within tbe 

rectum an a few hemorrhoids, but not of constder&ble siie-J 



SPECIES III. 

HELMINTHIA ERRATICA. 

ERRATIC WORMS. 



Obit. XI. 
Srsclll. 



WORMS, Oi TIIK LAKVJt OF IHatCTS, IKTRODUCtD BY 
ACCIDSNT, AND WITHOtT PINDIKO A FBOPER HABI- 
TATION IN THE STOMACH OR INTBSTtNRa; FRO- 
DUCtNC SPASMODIC COLIC WITH StlVKRK <;RIPII<ICS; 
AND OCCASIONALLy VOMITING OB UBJKCTtON Of 
SLOOD. 

Op this sabdiriiion we know but little ; yet the emaing 
instauces may afford sufficient reason for forming it. it 
mi);ht ca*ilyb« vnlarged; buttheauthoriticH for cxtvnding 
it further are doubtful. 



« GordiuB. 
Uirudo. 
y Musca. 



Hair-worm. 
Erratic leech. 
Ma^ots. 




The ooRDius is the seta e(|uina. or horse-hair-wonn. 
of the old writers. It \* found in soft iitngitant wnt«rs; 

• Bdinb, M«I. ind Hurg, Joum. No. laxtiL |i. 674. 



c, ,.] 



»IGB>Tlf B yUNCTIOM. 



rram four to nix inetica Ion;;, twisted into TBnoun knotfi tmd Oea. XI. 
conlOTlions ; colour, pale brown, wilh dnrk «xU«niitie«. ^^*'" '"' 

ri]iB di6«agc 18 most frecjuetit among ihe [mitftnts ofntio. 
Lapland, and was suspected by Linn^iis, wid hns been '''^''•■ 
sincfl proved, or ihouglit to be proved, by Dr. MuntJn, one 
of bia most celebrated di^iplcs, 1o be oceusioncd by their 
drinking the liolf-putrid wnter of ittngnant manthes or 
ditches inhabited by the t;ordius. ft ia not known on 
the Lapland mountains. Thugripings ere often ho violent 
that the patient rolls and writhes on the ground in severer 
agony than u wonmn in labour, and diHchai^cK bloody 
•urine. I -Afkvr many liours, nonietimes an entire day, the 
disorder terminates in a profuse ptyalism, thnt continues 
for a ({uarter of an hour. The Laplanders call the disease 
U/ttH, or Holme*. 

The sEcoNn vabietv includes several species of thesn.cr- 
LRBcii, swallowed, when minute and young, along with iilmdo. 
the muddy and stagnant water thvy inhabit- 
Apparently both the medicinal nnd the horsc-lcecb 
{h. tangiiittiga) have been thus found; but the exact 
Bpeeicii htix not )>een HulHciently indicated. Sauvages, in 
bis genuH Hwinnteniesis, quotes Galen, Schonck, and 
Wcdel. but docs not describe the species. Upon turning 
to Oaien, iv. 411. D. the reader will find that he briefly 
idTcrts to the diKcase. and quotes from .\sclepi3des and 
Apolloniuti the remedies that were employed in their 
rapecttre dnyR ; but he does not characterise the norm. 

or hclminthia, from this cause, we have numerous ex- Wmdcrrul. 
iimplefl in foreign writent and jounialsf; but wc need not ^„JIJ^Sk« 
Ituvel from our own country for instance*- Of dunie»tic conniwii 
exiimplcfi. eavcral are related in iho comment to the volume j^™" 
of N'osology ; and, though apparently well attested, aie of intauno. 
a truly marvellous character. The fact appears to be, that, 
from fixing on the internal tunic of the stomach, or intes- 
tines, these worms riot on so rich and plentiful a repast, 
that they grow to an enormous size, and evince such a 
deviation from their common shape, as in soma instances 
to be recogniied wilh great difficulty. It is highly pro- 



* Iiino. Flnr. L*p. de AngclifB. Mantin, Am«n. Acail- Spluhnum. ti. tfl, 
t Ejih. Su. Cut. Ctal. tU. Obh 2:, — Rhoditx, Ccni. il, Olw. Jt — 
Bbndiui], CollKt. Med- Phy).r«nL i. 

VOL.1. A A 




364 



cu 1.J 



CtKLUCA. 



[Ull[». I. 



n Hi >^ 



mtN. XI bMblv, bowcvfr, that they cait only livB ill (lyfifi^plit 
{MlieDto, or iHTHnnit whoKv ilip;«»tivc |M>H-<>rd are in6nii : fiit 
Lh«re are few or no mtimafK capable at r(>itiii(irig the Bolvent 
[Kiwrr of th« gnstric joicfl wtuii Mcrvtcd in full health and 
vipmr. 

<)»<; of the most vxlmordinnry instanMii nmoni» thow 
Militkil to nttention, it related by Mr. Pauley in tli« Bdin- 
bnr^h Medical F.«<nys*, In this case, tlicre w^re two 
wtirmn. whose heads the author eompareii (o that of the 
horae-lecch, and which appear to have beet) tolembly 
C)iiie8ccnt in (heir growth, till the geocral syGtcm was 
(littiirbeci by n wound on the breast received by the palitnil 
iu consequence of a duel with the small sword. The 
general aymptoms of this species of hehninlhin appeared 
about the third day aftetwanl:*, and continued with many 
rariations for siiveral weeks, when the pulient di»chargi-d 
inficriorly one of these worms, niMKunnjET a foot and a half 
in length, »nd an inch nnd a half in diamekT, dead, but 
ftdl of blood, and accompanied by a largo dejection of 
fjuniouK blood, " to nppenrance some pounds;" and not 
ninny ucekK nrternanli, the other still larc^-r. A worn. 
Bp|iiirenlly ftiniilar, is slated by l>r. Bond of Philadelphia, 
ii) 1761, to huve hi-i-n diKchnr^rd downwards, by a female 
jiaticDt of hia, who hiid been long subject to nn hepatir 
diteaw, which gradually changed to violent belniiothic 
nymptoms in the stomach. These, at tencth. auddeiily 
vtinishctl, and within twenty-lour hours the worm ww 
dejected, dead.aiHl in two (»rts, the whole making twenty 
inches in length. The patient died soon after; ntwi on 
opening her, this worm appears to have worked its way, 
when Hninll, into the liver, by the cOnrsc of (he common 
duct, to have committed great depredation here, and after- 
wards, with conNiderahle difficulty nnd dilation of the 
duct, to have travelled buck again. Dr. Roitd ventnm 
to call it an firjmtic letcA : though he ealculutes its ooarae 
as now stiitcdf . 

[In Hgypt, the French soldiers, ni^ed by aerere thirst, 
fVequenlly drank the muddy water of lakes itDd poob>; 
an opportunity was thus given lor the insinuation of 



■ Vol. ii. Mt. ixii. 

f London .tied. Obsttt. wid 1ni| I. W. 




cuiO 



DIUKSTIVK rVNCTIUN. 



leeches into tlieir uostiiU, and even into their stomacli . The 
mime aiinoyanrt> likewise belVI the xoldiuni of the aEainc na- 
tioft kI Putt iMuluiri, ill 1767. In one of the lutter ciiMCit, 
tlie pittteut, a(W having iromite<l up thrtc- pinU of blood, 
rec|uv)ttcil of hiw own iiccord tlic proper rt-inwly, niimtly 
sotne vtnc^ur; nml ae «oon iis this had bucn taken, the 
leeches were rejected. According to Larrey, the rcnioval 
of these animals from the nofttrila, when they cannot he 
laid hold of with forceps, is most ellectuiiUy aoconiplisJied 
by means of a lotion, couipottod of nilrc and diluted vinc- 
.gar •. The long continuance of tlie leeches generally pro- 
duced much inditipoailiou, a loss of llc»h, and sometimca 
delirium.] 

The THiBD VARIETY consists of the grubs of difierent 
xpeciea of that aubdivision of the genua musca, or fly, 
vhose iiucker is poBsessed of a aingic briKtlo wiliiout a 
alteath, and nliorl; olavate, rumUhvid with a lateral haii'. 
These deposit tlieir eggx in game and other meats that 
kjhave been long kept, and arc approaching a putrid state, 
earnaria. or flcidi-fly ; m. vomilorta, or blow-fly ; 
'«!. «irtn«, or pantry-fly ; or perforate and lay tlieir eggs 
in cheese, bacon, hums, or otlicr Halted and high-tusted 
viands, us, mi. pulrit, the larvs of wbicli arc known to (he 
housewife by the nmnv of hoppers, as those of all of tlicni 
^kFti by lliHt i^t Hiaggotf : »hicb last has olteii, ihuugii in u 
looser Bcntie, been appliod to the grubs of inscdti generally. 

From Uic deposit of the eggs of tlipse species of the fly 
^in so many branches of the common food of man, tlicre is 
.no difficulty in conceiving how they may pass into tlie 
human intestines. In a sound state of the ittomach, in- 
denJ, we have little reason to believe, that they cuiiid be 
hatched un<l live in that organ; but they may find a cod- 
veuiuut nidus, and hvc comfortably in a debihtated sto- 
nkoch. and apparently through the entire range of the 
intestinal canal. 

The cases of this affection are numerous. One of the 
best related, is that of Dr. White in the Memoirs of the 
Medical Society of London. The patient, aged thirty, 
was emaciated, of a sallow complexion; had giipings and 
tendcnic»8 of the abdomen ; costiveness, rigors, and cold 



tslln. 

MuKX 



vhpTC 

ilqM)«t«l. 



lIlfLIIIOI^ 



Ho* Kadi 



EiaanplfS. 



UsiB.d*Cliln>rgicJUilit*ite, wca.1. p. MS. 



A A 2 




^c 



CI,. I.] 



cauAci. 



[ORD. u-i 



OVH. XI. 

srii. III. 
Ik*. 



B« todgrd 

in the 
InlcMllM*. 



Spider. 



Trilon 
poJuMrli. 

IdCRtB 



nmfkvt 

• gwml 

it tn« 
(lomxli (if 
)iic<a ud 
iiihri 

jIMBlM. 



tstrrmitiGe. Took croliunbo root, nitd 04!eftBiona1ly calom^ ' 
nnd ultior pursalives. In a month wkb better, and the 
appetite good, llie next purgative brought away an iin- 
mpniie number of pupes orchi^-salid wonna: some of which 
bein^ pieserved. were iransfomied intotJie muim ciharia. 

We have also examples of the tarr» of oth«T inaecttrl 
thiit have entered thi- stomiich by some aMident or another. ' 
Thus, .Mr. Church, towho«e cntomologioil skill Dr. White 
confided \\\f i.-vamination of llic u)>ovc paper, uit«eTl.t, that i 
he »i)ce kiicw n child diitchnrgo a Inrvu of the caddy i 
inMct (phryganea grandis); and tlint the phaltena piu- 
jrviW/i.i liTes and i» nourished in tho Ktontach; ami, mftcrj 
sustaining several mctamorphoHcs, \* thrown out, and 
proves its proper genus *. Mr. Caldrrwood hiiit published 
a like casof; Ricdhn. examples of other fly-maggoUXi' 
other writers, of the larrsB of the beetle, or the bee dis- 
charged by the anus after violent gripin^^; while Plan- 
chon de»cribes a live spider thrown forth from tJie same 
openinglf. 

Wciknrd gives an inttlnnce of a trilon patuttrit dw- 
chargcd by vomiting^; and many of the continental 
writers have examples of rejection by the same posaagc of I 
the iatertti aifualita, unqtieslionably stvaltowed when n»- 
ntite and tinperceivcd, with the wiiter obtained front pood) 
and lakes". In one instance not fewer than five of ibwie 
were thrown buck at a timc+i". 

But of all Euch mflrvcls, the most extraordinary, and one 
of the beat attested, is that narrated by Dr. PickelU^I; 
consisting of enormous progenies of apterous, dipterous, 
and coleopterous iniecUi, dischari^ed both by the moutli'i 
and anus. The patient wajc a young woman, who had i 
long been in a melancholy frame «f mind from the loss of a 
beloved mother, nnd who> under a superstitious idea, that 




•V«iH. t Kdin- Mfd. Com. li. S93. { Cml iiL Ota. >& 

I Ota. Med. Cor. At nttt^oae tataia nunquvn ante «cm> WaHM. ' 
I7B. 

II Joura. At MM- 1>. p. 303. 

% Vmniwliir Sclitlflcr. iv. p. H7. KL SArtft. p.M. 

■* Joum. dv Alldcdnv, uoi. ix. (h 44?.— Schnit. :ilnL H'ockMlilaR. 171*. 

No.«. 

tt Obun. MU. Cur. it nmtione nrmii, nt. ui nipi*. WalKnb. 17». 

XX Truii, oi (he Awoiiiiion oT ihr Fi'lluvi and I.ltmtlaua of tht IUq( 4 
OucRi*! Cdtrgi of rhjiicuM iu Iftlmd, ir«l. it. tax, vii. Sriw ISU. 




DltiMTIVB FUNCTION. 



[ORD. ]. 



« ecrlain portion of clay drunk daily, froai the |irav«B o( 
piouB cli'roym«ti, would preserve her from disease as well 
as from sin, contrived La stock her chamber with a large 
qnantity of this mateiial from the graves of two clergymeu 
whom she had known, uiid which ajipt-ars ly have formed a 
bed for the eggs of the insecln thuit hiitclH-d in the Mlomach. 
" Of th« lanroi of the beetle," aays Dr. PickelU, " I tttn 
flare i coDsidcr^ibly underrate when I say that, inde- 
pendently of above a hundred evacuated )>er anuni, not 
leas than Bcveit hundred have been thrown up from tiie 
stomach at diHbrcnt timeH «ince tlie conimenccment uf my 
attendance. A great proportion were dcMtroj'cd from an 
anxiety to evade publicity ; many, too, uacnped imme- 
diately at\er havinj^ been vomited, by extricating lliem- 
eelvea quickly from the vcmcI, and running into htdes in 
the floor. Upwards of ninety were submitted to Dr. 
ThompHon'a examination, nearly all of which, including 
two of the specimens of tenebrio molitor (darklmg), I saw 
myself, thrown up at dilTerent times, Tlie average size 
wiui about an inch and a half m length, and (bur lines and 
11 half in girlli. The larvae of tJie dipterous iiuwct, though 
voided only about seven or eight times, according to her 
account, came up almost literally in myriads. They wctc 
aUvc oimJ moving." [In an interesting appendix* to the 
preceding account. Dr. PickclU atatea, that under a pcr- 
Mvering use of common turpentine, in dosca, gradually 
increaacd to the enormous one of six ounces, the larrie of 
the beetle, which were the principal source of annoyance, 
bad been destroyed, and tliat the patient now enjoys 
almoat total immunity from her long protracted andcompli> 
cateddiseasea. In the course ofa year and a half, frub^ciuent 
to his former communication, she had voided more than 
1300 additional beetle larva, principally from the anus, 
making in the whole nearly 2000 seen by Ur. Pickella, 
besides many others which he did not see. Besides the 
beetle larvat, dipterous ones continued to be voided at 
intervals during the same period, both from the stomach 
and tlic rectum ; sometimes without medicine, but more 
frequently by the eifoct of castor oil, strong doses of lur- 



til-CL-. Ul. 

> II. <r- 



' Op. dL n). *.p. 171, Ac a*o. isas. 




3&& 



ci..iri 



catLIACA. 



[OBD.'r.1 



aty. XI. 
Srvc.III. 

7 H. CfT«- 

HlIMB. 



» 



Pram thrir 

dtffinilif In 
(trunnlnliiii 

(pccio. 



In the l(«!i 
and boat- 
lnfh«spr. 
daDjr. 




Iienline not killing them. AscaridftR, memblm^ tlw 
nscarides fe)U. were kIko <)ii«hargecl upwards nnd dawn- 
wards, as well as numorotiK InrviR of Ua|M. Whence the 
constant supply of the Inttcr wnji deriTett, is a very put* 
sling question in thn hiittory of this exuuofdinar^- otae t 
for, if ihpy propnKate only i» the imafro, or perfect fnate, 
•ft is assertfd, their generation within the body can hardly 
lie Buppoeed, as otilir two inMCtt for advaneadt one aai 
imago, the other a pupa, were known to be diacharjifed, and 
jret larvffi of every f^rodalton continum) to be voided to the 
l&at. Her food and drink were from the same source u 
tboee taken by other ht-Mlthy persons ; and she lived on nn 
upper Uoor where tile kind of beMles, which ^he voided, m»| 
not natially found.] 

Many of the larvie or insects thus thrown up, had bnni 
preserred stive in clay or pill-lmxes, for upward* of a. 
twelremonth at tlte time of writino;. Fain in the Ktoiitach, 
Buppressioit of the mSDMS, irritation of the bhtdder. hnma- 1 
temcsis, occnxionul perrersion of all tlio vzteroal 8e«ae^ . 
Tcrti^>, coiiviiUtnnM, mtalepsy, maniii, dcliriuni, and va- : 
rious other tttl'ections of the nervous system, indicative nf J 
lielmmthic irritation, were the sad train of evil* that al-i 
tenwtely overpowered the pntirnl. fllie qnantitv of blood I 
thrown up from the Ktomach, in tlic course of the caae,! 
was such as to create surpriso that Bho should have been 
able to bear the loss, A retention of urine, wifh which 
nhc was long afflicted, was completely removed after a dow ■ 
of five ovncet of torpentiTte. a great deal of blood at flnt i 
coming away with the urine. The mme medicine alui 
evinced great power in restoring the catatnenta.] 

To all these parasitic vermicica will apply the remari 1 
have already made u])on a single variety ; that they appear, 
from the luxuriance of their haunts and repasts, to be in 
various instances j>cciili«rly nilarffwl. and altered from the 
Btructtm) they exhibit out of the body • : whence the greni 
dilRcalty of determining in many cases the exact external 
species to which a larva, worm, or animalcula found wilhin 
the animal body may belong. Yet of all thu erratic worm* 
and gniba, the Iiorsc-leeeh, hirudo sangnimgti, ffppctrTt te 



•■, Ucbn Ittimdr WUrmor lo ttbcmfati M<B*chrn. 




CL. I.] U10E4T1VK VUttCTION. [ORO. I. 

undergo tbc greatest metaniorjihoitia ; und, lu obcLTved in okh.xi. 
the cojnmont to the Nosology, in rejiortwl in onu mKtaace HSmwilll 
to liavc rcaclic-d the size of a niiui's tist, und to have con- 
laioed a pound aiid a lialf of blood. 

OENKRAL DlACNOStS AND TBKATMENT. 

Wo have had occasion to obaorre, that the xtomach is Diigmu, 
th« great orgnn of sympathy, and aasociatt^s in aircctions 
of the most remote parts or llie HVMten). It followe neces- 
Hsrily that other parts of tlie syitteni must, in various in- 
Ktnnccs, associate in afTections of the stomach. This in 
particularly the case with respect to the irritatiou pradur^d 
by worms, and e&pprially tlioee that exist in the tUotnach 
itself, or the upper part of the alviiie canal, as lying nearest 
to it. 

"The evils* which henco ariao," says Dr. Heherden, ahIi. 
who hu* well drann up the general train of symptoms, J?'^^''' 
" and which cease on their expulsion, are head-achen, ver- 
tigo, torpor, disturbed drcamsi, sleep broken olTby fright, 
and screaming, convulsiuus, reveriohueKS, thirxt, pallid hue, 
bad taste in the nwiitb, offensive breath, cough, difficidt 
brrathin^, itching of tbc nOKtrilit, pains in the stomach, 
nausea, stjueamishneAs, voracity, leanness, tenesmus, itch- 
ing at the anurt towards night, at length dejection of films 
and mucua. Tlie broad tapeworms produce the severest 
mischiefs on thelKKly; the teretes and ascarides (round and 
ihread-wonns) nometiines liirk scarcely suspected, unless 
there is itching of the anus, or they are traced in the feces. 
t have seen n broad tai>e'Worm ex]>elled from the intostinos 
four ell* in Icngtii. The long tape-worm {lumbrieut no^ 
cuiritian*) m-vmit to )>e a i«enea of many worms, u single 
joint of which will sometimes live when separated from the 
rest. The round worms have amended into the moutli, 
and have even lived Imo or three days after they have been 
discharged. In two puticnts, under my caie, there was 
room for sus|)e(Hing, that the gourd-womi had induced 
epileptic tits, mania, and idiotiitm." 

rpon this passage it is oiUy necessary to observe, that 



* SliU, <)a« rx 111* urtuiiiur, t|uatiuc liU i^ipiiUii iLiiiuUiu, gnni ilolcns i 
filk, veligD, urpor, MoinU, Ac ('*(•■ lu. p- i'lX . 






3CU 



CL. 1.] 



VOtLIACA. 



[OBO. I. 



UKK. XI. 

Sric. IIL 
Rtmtaktm 

dtKilfiilM. 



OHKf nib 
tfainau* 



Worm to 

in itbtenc 



SaaiOlait* 
hul. 



the lung upe-wonn, Ionia loJium, or, as Dr. Heberden 
calls it, lum&ricus cucuri/ilinu*, is not a series of many 
wonos, M this elegant wiitcr Bum^iected, and an, indeed. 
is generally suspected at pre^iu; and altbongh iu dif- 
ferent joints, wbeit separated from the rest, are capable of 
maintaining for a short time an independent lil'e, they 
neither continue alive luiig, nor are oooipetent to produce 
any increase. They have, however, been sometimes fboitd 
alive at the time ofexpulitioit. 

There are other mischievous effects than Dr. Ueberden 
halt here |>oiulcd out occasionally to bo traced iu remote 
orgaiu, from tltc sympathetic action of worms lodged in 
the inteslJncfl. Thus the lungs, as well a« the bnin, have 
frequently been found to participate in the disease, and at 
times the uterus; and a profuse tieuionhage has eosued 
from tlie one or the other organ, and very firequontly from 
the noiitriU, and been repeated at uncertain intervals, iu 
some instances without aiiy suspicion of the re^ cause, 
and consequently with an erroneous practice. Mr. Rum- 
KCy, of Bcnconstield, bait pubhshed an instructive paper 
upon this subject *, in which various cases uf sympathetic 
hemorrhage and pulmoimr)- uUcction seem to have be«n 
relieved by an antheltnintic course. 

" In all obscure diseases," says Dr. Swcdinur," attended 
with symptoms that arc chiefly anomalous, tfao suapicion 
of the physician should be directed to intestinal worms. I 
once knew a case, in which the patient, who was miserably 
afflicted with juuiitt in vurious joints of (he body, siuiutat- 
ing those of anhrodynia, by tiiking an aQtholminUc, and 
discbar^ng in consequence hereof, various frBgtncnta oTa 
ticnia with u muss of mucus, became perfectly well. So," 
contiuui-M he, " have I known apoplexy and palsy removed 
by a divchiirge oC worms from the intestines: and bad 
once a |)atii-iit remarkable for a BIthy and fungous ex- 
crescence on the nose; who lost the excrescence sponta- 
neously after a successful course of Tennifugesf." 

[Intestinal norms are sometimes K> omtwrooa, that tbey 
occasion death. This is not uncommon in children from 



* TniMct of Ihc MnliiD-Chir. Dot. nd. It. 
t Nor. NmoL .^IcCh. l^it. vol. U. f. its. 





CL. I.] 



DIUKSTtVB FUNCTION. 



[OBD. I- 



361 



the ef)*ect of lumbrici*; and happens even to adutbi Oem.xi. 
wbow bowela contain tEenia of extraonlinary »ize,] nltoii^iL 

There in yvt great space for imprnveiuent in the mode of 
treating this complaint. The larger norma unqiieslionnbly |!|^,'/ 
arc found most frec)iienlly in yoiino |)enionH, or pcnxjuK of f-"""' mo«t 
weakly and inelastic fibres, and dyslliflic huliits; nnd)J[j^, '* 
hence our fintt intention should b« to inv-igorato tlic system 
graerally, and the iitomach and iatctttines particularly, by 
bitter and other tunic medicines : for it is not often that 
they reftist a very strong living action. And yet J have but not 
M>metime« found the long round worm in persons, who *'*" 
hare made no complaint of ill health, of regular habitx, 
and in the middle of life. [When the editor of this work 
had charge of the Military Hospital at Canterhurj', many 
recniilR, in the prime of life, strong njid healthy, wen at- 
lacltfd with tj-phusund other fevers, in the course of which, 
the discharge of lumbricoid worms of considerable size was 
not an uncommon c ire u instance. His reflections lead him 
to doubt the soundness of the tlieory, which ascribes the 
origin of ivorms either to weakness of the whole xyittem.or 
to that of the digestive organs. An eir«ct seems here to 
have been mistaken for the cause.] Worms have occa- Knmctnna 
sionally infested the alvine channel for years without any Ji' "^'? 
BcrioHs evil — the ascarides, indeed, as Dr.Heberden informs <ihaicimo 
us, for thirty years, or for even the whole of a long life, '>^^*- 
without any reason to suspect, that they had hastened its 
endt: whence some writer* have been fanciful enough to ^y »ine 
conceive, that, in animals of most genera, tJiey fonn n tnuncoiiiiy 
mean of maintaining the general health, and are a regular ^{(tLutc"* 
part of the economy of perfect life. (The celebrated Dr. w Ixalth. 
Rush conceived, that they might sometimes promote health, 
by diminishing the quantity of r«<tundant mucus in the 
intestiiKkl canal.] "Worms," saj-s Dr. Parr, "seem tosuchilie 
form part of a healthy comctitution, and are scarcely inju- j'""'™ "' 
nous but from accidental circumstances." This quaint 
though common paradox, however, ts somewhat shaken by 
the doctrine contained in the next paragraph ; in which a 
very unnecessary and tmtenable distinction is drawn be- 



* Sec iwo out* In Coivuwi'i Joura. Ac H*d. lom- vil. |>. 3. 
t Tnuuacl. «f the CoUqct of Phys. of liondon, vol. i. p. M- 




303 



CL. U] 



CSLIACA. 



[ORD. I. 



Okv. XI, twecn the law which in this re»pect regulates aoimals uul 

u'ui^L ve^^i^l^bles ; and ro)louc<t up l>y a roiuark at varianca not 

Buiai <■- Mily with ^fiirnil obiiervation. I>ul with tbv iDiiKirl of Dr. 

'*™'^ Parr'ii own rcasuiiint; u|ioii itic titibjvct. " This circum- 

nldMtfhu Ktunce." eaya Dr. Parr, " forms a striking disUiKlioa be- ; 

'?P"'"|J twccii aniraaj» nnd plauttt. Panuitic aaioiala attack oiily 

duljiiituted plant*: but Uie healtfat«at aainiak arc cbivdy 

aiffcted with woruie; and the observations, which seen K» 

coutnidict this, urisv from a noglcct of the distinvUou be- 

twi.'on the exi6t4Uicc of worms and their apptaring a source 

ol' disG«ue from their accumalaiioH. Their format ioc is 

assisted by accumulations of mucus; and, oonaeqneolly, in 

children, aometimea in cachectic patieJit*. they become 

iMfoincninil." 

imvintNient in a somewhat pintle tenu for cxprewing 
the fearful host of ciiects which we have ju«t oniuiwtatad 
from Dr. Hcbt.-rdL-n, and which Dr. Parr himsvlf has in 
other places arrayL>d in form and number quite an appallio);. 
But if this incoavt/iiejue be mostly promoted by an aocu< 
nulation of mucus, and if children and cachectic patwola 
be aooetly exposed to »uch accumulation j t}R-«u worms do 
not eeem, properly spuaking;, to form part of a healthy, hut 
rather of a weakly constitution; uttr can the beallhieat be 
said to be diiefly atfected by worms. And the same ge- 
ftMndcMrf '"^'"' '** applies equally to animal and vvt^-lable life. In 
■rmvoki^ both, the most imbecile are the most affected; und the 
l''^!?'**' . strougeat, when alfiicted, are the lea&t injurvd, ibr Uk> wry 
iDkic reaaon that tlioy are the strongest, 
niuimtcd Tlie disotse called rai. in aheep, to which I havo alr^udy 
^^ ^alluded, is a further illuaUation of thi« rvmark. Her« the 
fasciola, or Huke. makes its appearance in prodigious num- 
ber in the hver of the animal, which is somclimcii entirely 
preyed ujion and destroyed. Though there is some doabt 
among pbysiologiata whether this worm betlieoauao qtiIm 
clivct of the diiteaM, all are agrm-d, that the malady amwt 
appcan in a wholtKomc uluKiitphvrc, and a slruog and 
vigorouH elate ol health : and it has of tatc bwcn HUlliciently 
ascertained, that tonic atimuliints, and csjMjcially tJie stimn- 
lunt property of sea-salt, whether mixed with the food bm- 
chanically or chemically, as in salt marshes, is the beat 
and moet eQiictuid mode of cure. The food of iiuvinot, iu 
S|iain, ih t4>vr«fore cututantiy enriched with kaII; and Lord 



l!»ka in 
alin-p 1a- 
bounngun- 
dn the ml. 



.^mlUKii 
taoit ef 

duo. 



i i 




8oni«rvtlle j««Uy nUributes the heultli of hi* flock, of up- Oik. XI. 
wards of two hundred nu-rinoi;, which he purchHMid in ix^^ihU. 
Spain, to the u», uhich hu bas for yi'ars nmdv of thU 
article on hie farm. A ton of salt is the proportion em- 
ployed itnnually for every hundred sheep. 

One ntciin, therefore, and perhaps tlie most powerful in Trmiromi. 
our puHseKitioi), of getting rid of inleslioaJ wormit. is that iimn ihc 
of strengthening Hie system generally, and the alvinc canal ^"^ ^ 
particularly. Our next mean is the use of what have been cotA gmt- 
called ontliRlmintic medicines, or those which either deatroy ^J '■ "'' 
woroiB, or drive them from the body by qualities which ihdniintk*. 
torment or diatiess them. Both these intentions may o, bmh 
MnBCtimea be punued simultaneously; and where they >u«l*i"iul- 
canitot, from the weakness of the patient, wc should com- 
mence witli the former. A decisive vermifugo process is 
yet a dvsidoratum in medical practice : for, first, worms lie worm% A^ 
tor the most part »o low in the inlestines, or are mo com- ttroynl 
ptctely involved in viwcid mucus or other slime, that oil of ^]^[„ ,1,, 
(urpiintitie, toUicco-witter, »nd mercurials, which readily bod^, ukI 
cnou^lt destroy tiiem out of the body, seldom go directly * ^' 
home to them when within it; and next, most of the medi- 
cines tliul pruniiBo to produce this elVecl have a tendency 
at tlte same time to weaken the action of the stomach 
and iiiteslines, and consequently to render them a fitter 
tiuhitaliot) fur sueh unwelcome tenants. 

" So that," says Dr. Hoberden, " tilt some more certain Vmnlfu^ct 
remedy sliall be discovered, notliing will be more service- JJli^ ,ho 
uble than to keep tlie bowels loose, during which tbey may uiioa of 
be aanly submitted to, and by degrees may be safely era- ""'"("■'■ili. 
ctntad." 

By their irritatiou they augment the secretion of muoos. 
in which also tbey involve themselves. Bri-ra says they 
feed upon it, and if deprived of it they die * ; and adds 
that ibe painful itching is chiefly owing to a want of 
muous in tJie inner surface of tlie inieatines. But Ibis is 
ultc^ther iucoiiMittcnt with common facts, which suthci- 
eutiy prove, tlial then; i» usually, if not idwaya, an excess 
uf clime or mucuit. 

By keeping tlkc bowcU loose, we proruut tJic accumula-ApoicnH 
tion of tliis shuy tuiOeital in which the worms burrow : and "f'n*?'^ 

I — i\iy. 

* LoiDi^ ni friecrpali Vmni ilrl Corpo unuiw, IM. Cnmi*) IMOI. 




364 



Cl. I.] 



CfKLIACA. 



[UM». 



OtK. XJ. 

8rw. ni. 



AftervmU 
■nlhdmiu. 
Ho. 

TheIiK«f 
niUDcrauft, 



DIviM 



FInl <1ui 
opTTMina 
bjdkeiiucal 
m iiilMiiil 
Htlon. 



(iper*clii|{ b]p 

■ DKKOUC oc 

other Inier- 

■ul pOKCt. 



•Mhclniln. 
tla. 



Hirafia 



if we )inve reason to bcliuve, tliat Huch accumulatioa his 
takcit |)Iitc«, the liest plua is to give Hctive [mi^», im e*lo- 
ni«I, jnUp, Hcammooy. gamboge, or an intirnnixturc oC 
th«ie> for itJi removal: and having thus, as far as we are 
able, exposed the naked bodies of the worms to the actios 
of ANTtiKLMiNTics, we shouM pTocecd with the latter 
without U)«a of time. 

The list of iheae ii almost innumerable; and (he very 
length of the catalogue serves to xhow us how little we can 
place a positive dopondanee, even at the present hour, upon 
any one of them us a specific. 

Anthelmintics may be conirenienUy divided into Iwo 
ehitsM. Firstly, tho«w; tliat dislodge and drive away intea- 
tinai wonns by some mechanical or othrr external action; 
and, secondly, those that destroy them by some narcotic or 
other internal means. 

In the former we may rank alt the drastic cathartics ; all 
tJie oleaginous vcrmifugeit, as oil of oliros, beech-uttta, 
castor, and turpentine; Kulphur, petroleum, nnd te«-«alt; 
tin-filingfi; crude quicksilver, orPlenck's {^y mucila^of 
it; the lunar pill of Boerhaave, formed from a preparation 
of silver, which may be rc^Tclcx) kh n mild lunar caustic; 
and the brUtly down of the pods of cowhage. In the 
latter we may place the malc-fem. hellebore, fetid helle- 
bore, cevudilla, tansy, savine, rue, dittany, tobacco, worm- 
seed {artemitia ianlonica, I.imi.), bark of the bulge-water 
tree (Oe<^roya inermu). and of the cabbage Ireo {artta 
oUracta); the »pi^tiia». and sfabioia Indieu. 

Simple pui^tives, even the moHt active and drastic, 
seem to have httle other effect than that of clearing away 
the mucouK aitd other viscid materials, in which most of 
the intcHlinnl worms are fond of burrowing, and thus ex- 
posing their naked and tender bodies to the action of other 
and more 'direct antlielmintica. Even coloc^iith, which 
unites a bitter principle to a cathaKic power, and which on 
th)N account wa» for ages regarded as an anthelmintic 
doubly anned for the field, is now well known to be inca- 
pable of poisoning tlieni — as Rod) has exposed raiioua 
kindn of (hem to a strong decoction of this medicine for 
four-aniUtwcnty hours without serious miachref- 

It is, nevertheless, obvious that these mediciuea have 
their tuo, and are in fact of very great importance ; and 



I 



CL. I.] niCKSTIVB rUNCTlON. [ORD. I. 56fi 

Mpecially in the caae of children, whoM boweU ar« more Orv. XI. 

Srtc. 111. 
Hclmlnlhta. 



easily loaded with mucua ihaii those of mliiltfi. and who, on ' '*" 



ihiH nccoutit, bear aclivc ptirgalircs with niucli Ititt incoii- 
venience. In «r attack upon wonns, brisk cathnrtMs 
should atn-nya inke tlic lend. They ought not, however, 
to he too frequently repented, nor continued through » 
long Merieit; as in this ciise, they will rather augment, than 
diminish, the niucutt by their own irritation. 

U|>on the olea^nous vermifui^s we can place but little olca|[uisut 
dependance, if wc except the terehinthinatcg. Olive and J"^'"""' 
castor oil may bo of slight subsidiary benolil, by mixing 
with the surrounding slime and removing it by what pur- 
^ti«e power they poaeess ; but their chief benefit, if they Bow fa 
be servicuablc at all, in probably in greasing the bodtM of <'*'^'( 
the.wonns, and blocking up their stigmitta or respirntory 
pores: in which view, they are better adapted for llie cure 
of worniGt that infext the stonmch and upper intestincK, 
where they can exert their power at once, and without di- 
lution or cheuiicnl change, than for those that take itp 
their habitation lower; and espocinlly for the cure of the "^ •s*'"*' 
long round and the long thrcad-worniK, n» these aro killed fi,,(n"' 
more readily than the tape-womis, which often only perish 
by aepanttc joints. For the cure of vermicular aacaridea, 
or m»w-womis and bota, these oiU have been uHcd in the 
form of injections : but we have no decided proofs uf any 
great benefit that has been derived from their ubo in either 
way. in respect to the worms, for which, indeed, they arc 
rarely to l>c recommended, though they are often useful in 
takin» off the irritation of the mucous membrane itself. 

The tcrebinthinate oils are far better entitled to our at- TmWjuhi. 
tcntion, and appear to act aa purgativev upon the bowels, 
and ais external irritants upon the wormx exposed to them. 
The vermicular ascaris rarely resists their use when given 
in a dntte nufficiently large to reach tJio rectum, or when 
injected into this organ ; and has been discharcred in great 
abundance. The alviiie worms, if not equally adeet«d, are Ho" (^ 
nearly so; even the tn^nias have yielded to their acrimony *. 
Tlie rectified oil of turpentine is that in common eiiiploy- 
n>«nt. [Convincing proofs nf its efficacy in esses of Uenia 



■ DiMMts of Tittplul C«unuin. DjCChitholm. M. D. p.lW. LDad-flt*. 
1RS3. 




366 



CL. I.] 



CCBLIAC*. 



[OBO. I. 



Osn. XI. were pnhliBh«(l by Dr. Fenwick*,of Darhiun, towhtna the 

ijl^j^i.' merit of its first adniiniBtration hu» btrcit vrroneonsly re- 
ferred, not only by the author of th'xt work, but other dis- 
tinguished mcnh Turpentine was rcconituMided for it* 
anthelmintic virtnes pvca by Bnrlholinclti *")<' ^'bnbert'w 
cclobmtcd ncmcHly consisted prtncipidly of tt^.] Tur[w»n- 
tine is usually given in dosce of fmin bjilf a drachm to n 
tea^Bpoonful to nn infant, mid from un ounce to an ounce 
and n hnlf to iidults, nlone, or wiUi u little peppenninl or 



Bf whom 

fitM ««)• 
In wbti 



ptopattiotu cinnamon nnlvr; tliough for infitntK the best medium )■ 
given. milk. Thesu diws, however, may be considembly increa««d. 
and will in tuuny obsitin&te case* be found ineHicacioos. 
[fn the extrao nil nary case, already ijuoted. Dr. Pickella 
gradiully increnitcd the dose of cnminoa turpentine to »ix 
ounces 110 A child of tun or eleven y&in old may take so 
ounce without any evil effect in ordionry cases: bat, in 
deti«nte hubitA. u full dose situ unraty on tlie slomsch, and 
disquietK the systL-m gencrully, though in dtffuretit ways; 
for it sometimes produces a general chill nn<l pateoeM. 
sometimes u tendency to sleep, and sometimra on atarmiaf; 
intoxication. It ts in small doses alone, ns half a drachm 
or u drachm to an tidult, that it ontent into tlic circula- 
tion, and proves an acrid irritant to the bladder. oftvQ ox* 
citing bloody urine. 

Hie stibject ret) iiirch furtber attention tlian it has hitherto 
received ; for it is probable, that some of the teTebiathinatc 
essential oils, while equally deleterious to wonas, are leM 
disposed to disn^>e witli the stomach and affect the sya- 
temi as the Ilun^^arian balnain, or diiitiitixl oil of that va- 
riety of the^Mwi sf/wftm which has been called HtioiioB; 
or tile distilled oil of the trreen cones of the same tne, 
formerly called v/eiim trmpliuum: and ot otie time sold 
at a high pticc, ami us a great secrtt. by Uemuux itine- 
rants under tlie name of Kiti'MMiioi./.oiiL. 

[In 1823. Dr. Kennedy proposed the exhibition of the 
oil of ciotou for compli-Uni; the expulsion of intestiasl 
worms, after their dvstiucliua by oil of turpcDUne. or other 



• Med. Cb\t. TiaM. tdL IL 

t tw Orrftory'i Blvni. of Plijriic, )>.«91, M fllit. 

; Epiit. It. p-SU. ^ Jouni, Enr^lop. ITSI- 

H See Tnni. of Amk. PtirdrUn*, A<. Iiebnd, <ril. v. 




TL. I.] 



DIUBSTIVB FVNCTIOK. 



[ORO. I- 



ftiilliclmintic i»«licin«8*. In llnly, th« oil of crolon has 
faceo itcently tried by I'iiccinott«taH»inoari»<)t'tleHlroying 
tntu«,KS well hit g>roCHrin^ ihnr pninipl. i)i>i4:hnr>;«. One 
drop of Uie inedicinv vva« cxhibibKl in bcof*tea, nt interrnlK 
of two or tlircc diiyii; th« fint dosi- exprllcd rouny frag- 
ments of the worn); snd n liltiv perscvernnce in tb« plnn 
80on eficctcd a perfect cure. This Gii^f^CKtioii proiniKCK to 
be of mucb vkIuc ; for it merits particular tiotico, that thi- 
(hI of croton an&wered in this case, when seveml other 
BCtivc rcmcdit-^ had fnilcd.] 

The pt'trolcuut, pissclu-utn, and ammal oil from horns, 
all of tbem highly esteemed as vermifugea informer limes, 
popcan like virtueB, but in a subordinate degree, and are 
more unmanageable iu prepnritii^ them lor the stomach. 
Chnbert, Ooeze, aod ProfettRor Breniiter];, of Vienna, who 
hax ctdttvated thU subject more nttentivdy, perhaps, than 
any other pathologiet in Europe, unite soino one of these 
empyreumatic oils with the oil of turpentine, giving a third 
part of the former with two-thirds of the latter : one or two 
tea-apoonfuls of thb mixture being the ordinnry dose at 
night and noon. 

[According to Dr. Lnrini'^, the plant called snmphire 
(CrUhmum nuiritimum), is a powerful vemiifugc, especially 
in caMH of lumbrici ; a virtue that Ni-eni)* to depend upon 
its containing an oil rery similar to petroleum,] 

The sulphureous and Harrowg;atc wnlcni appear to net 
in like manner; they are double irritants, and probably 
goad the worms while they sliraulale the Ijowels. [Whether 
pure snlphur, uncombined with oxygen, or llic alkBliefl,haa 
a vermifuge power, is sometimes doubted I}.] But the 
' efficacy of all the.se is far leiis. than that of tlie essential oil 
of turpcntiDc. 

Concentrated sea-water, or a briny solution of Ma-salt 
in spring-water, him been Tecommen<led from very high 
aathorities, and huit bi-en found in many instances highly 
advantageoufi. Il actH upon the ttntue double principle as 



36? 

OtK. XI. 
»».-«:C.HI. 
UtIiiilnlliU. 



Oil of 

CTMlllll. 



Smypttt- 



I 



Sinn|>1iinv 



Siilpliii- 



■ml ollici 

(Dlutlcnu of 
murinlc of 

■odi. 



< Land. M«<l- RqxHlUiry, Feb. 1B33. 

.|- Annali rniTcnall ill Midjclna, Aprilc c llli|m,lll. IBSO, 

; 1 rtlm Iclimtic Wunno (n Isbcndm Alcnidias 4I0. WISL Ifll9. 

P Mfin. •>[ (lie Acwl. »r Tunn, inL xxr. 

i to Diet dct Scicooa Mid. I. K, p. SOI. 




■-I 



CCXLIACA. 



[dBD. I. 



I.... \,l. 



tlwkuM 






iht: iMvcviiog, though probably vriUi more eaergy. TIm 
•ujc of eM-alt n troublesome to every variety of in-i 
UmUimI womis. 1 have alrva^y ubttcrved, tliat it is tlie 
bwt prapbylactic against the attack of IIhUgx in ishocp. 
nttite it gires, at the same ttme, a lie«IU)y atimulus to the 
viflctnl organs; and where lecclies, or iiKleul anyoftba 
«mtic diTisioa of worms or larvs are Buspectad, we ara 
nanrly certain of its proving a ready cure from its eflecu 
OB ths same niiiioaUout of the body. In thecaaeofmatr- 
wwnns, it is belter to throw up tlie brine in tlie fomi of on 
injectioa ; but where these are found lu be mitn^ting up to 
the alomach, it should be taken by the mouth. There '» a 
striking example of the benefit of tliis treatment publtahed 
by Mr. Leigh Thomas, of Hawarden, Flintshire. The 
patient is stated to have been reduced to a very high 
d^ee of danger, and to have suflcnxl from ihc disease, 
ftlmost without intermission, for five ycarx, pcrpoiually 
wUhin^ for death to put an end to hi» tortures. He wu 
cured by the uccidcnUl recommendation of thi» remedy of' 
mU and water, which waa stated to have wrought wouders 
in a Mimitnr case. He accordingly swallowed two pounds 
the next moniiug, dinMulrvd in two quartn of Kprin^ water: 
he was vomited and purged violently, but diKchiirged, by 
both apertures, a prodigious quantity of ascaridc« involved I 
in mucuH. He Huflcrcd, at the same time, much from tht i 
common eflects of so large a portjon of sea-salt, and par- 1 
ticuiarly from strangury ; but finding, tltat he had now 
obtained an engine with which to move the invading host, 
he repeated the same dose a few days afterwards, and with 
the same effects, both good and bad. In a few days, bow>j 
ever, he loi>t every painful symptom, and gradually reco«c 
perfect health*. 

On what the anthelmintic virtue of tin-filings dopi-nds is 
somewhat doubtful : nor can they be regarded a& an efUcivut 
medicine. Yet Or. Alston was much attached to them, umI 
especially as a cure for the t^nias, and gave ihem in doses of j 
front two dmchms to an ounce, in tieacle. He uHcribcd their 
benefit to n idight combination with arsenic ; but it is iraw 
fully ucortuioed, that the metal is at least as succossful iii 



Uid. Tiu*. of thf Cdltge, voU k an. It. p. M. 




CL. t.j 



DICK8TIVB rUNCTION. 



[OHD. t. 



iu purest atalc; and ita effecta are generally supposed to 
*>e altogether mechanical. This is certainly the case with 
crude quicksilver, though not with the grey mucilage of 
mercury, or the lunar pill, which probably stimulate the 
tender akin of intestinal worms, and eajiecially those that 
me fond of burrowing in the mildest niiicus, to some Hpaiitic 
Hnd puinful retraction. The last w«» a ravotirite vermifuge 
witli Bocrhouve; and Buldinger wnit m fond of the first, 
and asserts that it is peculiarly efficacious in expelling the 
long thread worm. 

Perhaps the most powerlul and suecesBful of the irritants 

I that act by an external power, is the prickly and pungent 

down of the pods of thecowhage {Muhoi prurirns, Linn,), 

which has long been held in deserved estimation. Thi» 

. plant IB a native of India. One of the Arnt accovnUt, if 

not the curtiest, publiidied of it in thiit country, is that of 

Mr. Kerr, »t that lime a resident at l*iitna. It wan ad- 

l^.dreitiMHl to the PmfcssorK of Medicine at Kdinhurgh, and 

was given to the vtorld in the Medical CommenUirics*. 

Its powers as an iinthelininlic were at the same time dc- 

tailed by Mr. Cochninc, whose character of it was soon 

afterwards fully confirmed by Dr. Bancroft, from long 

personal observation m South America+. After stating 

the frequency of worms of all kinds in that quarter, and 

endeavouring to account for it, he adds, that, from whal- 

e? er cause the«e worms originate, their number is »o great. 

[.ind their i>ower so prohfic, that the usual remedies arc 

I'insufiicient for their destruction; for which rt-uson the 

I -planters in general have been induced to employ cowhage. 

"Who first suggested it," says Dr. Bancroft. " I know 

J not, but its efficacy is indisputable. The part used is the 

l-Mlaceous hairy substance growin<j at the outside of the 

f pod, which is scraped off, and mixed with common synip, 

or molasses, into an eleptuary : tlie dose, a tea-spoonful to 

! u child, and double to an adult, in the morning, fiasling. 

' and Te|>e3ted the two succeeding mornings, after which a 

dote of rhubarb is usually subjoined." The planlera in 

this manner commonly give it once in three or four months 



Osx. XI. 
ttnc. tir. 

Heltninihia. 

fVudc 

Iuiikillvir. 
lunif pill. 



DoUelioi 

pTUricnt. or 



D^ whom 
fim recom- 
mended. 



uiUutlcnd. 



• Mnl. Truw. of ihc Callige. vol. il p. R3. W& 
t EB«Ton lh( Nuurkl lliHiwy DtUuiana. I,nn<lan, IT70. 
VOL. I. II II 




370 



CL. I.] 



L'CKLIACA. 



[ORO. 



UlM. XI. 

Pointful 



SCCMXI 



A bitin 
ptincipk in 
thoe KM 
wfldou 

!9i«wobr 

MDlonic*. 



to their alkves in geiienU. und CNpeciaUy to ihc children i 
their shLves; and the author tells us, Umt be has koown il 
tlius adminiKtcreil to hunilreds, froia one yrar old atid u|>>l 
words. Tliv piitiviiUt, iil'ter tlic second dose, asually djftj 
charge an incredible number of wonns. mootly the 
round &nd the lonn; thrend-worm, amuunltng to more i 
twenty at 41 time, thu »(vols consisliD^ of hardly any thingi 
else. And irritating as thcee epiculK are to our own tkii 
when involved in the viscid materials with which they art] 
mixed u[i, they do not seem to form an inconvvniiiitniedk-j 
cine; and I>r. Uancrol't never aaw any evil (>fXKiuced by it.1 
Of itn crtectM upon the vemticular aMaiix, he uys. he canno 
spcnk, aa he has not seen it trte<l for tliia variety of iovcT>| 
mination. For thin litHt piirpost-. the best mude of em-| 
ploying it ia in the rurni of mucilaginous injeclioii«. Ill 
waa a favourite mcdicii>e with Dr. Macbride, who boa] 
warmly recommended it*. 

or the vermiruges that seem chiefly tooperBle on wono^] 
by attacking them mternally, and to ex|H-l tlicm bv do>] 
stroying tbeir life, it may be observed, that almost all ■ 
theK pOJuesB great pungency and biltemcss; but that) 
those which have obtained this cluirai-tcr. and are bitter] 
alone, are but httJe entitled to it, und are only of use wbot [ 
combined with some acrimonious irritant. We have al-j 
ready remarked, that even the intense bitter oflhucolo-J 
cynth does not destroy worms: and Dr. Cullen judg;ed] 
the KutM respecting the seoU of tJ>e arlemim umtn 
front their repeated anthelmintic jwnor, vernacularly called] 
vtoKM-Mi'.Ko, Mo wamily vMiwuscd by Baglivt, and aai 
poeeil, at one time, to be a specific against the long-wonnJ 
" It il said," observer Dr. Cullen, " to l>e the luml 
teretes (the loiig-round woim, aicarit lumhrieuidn uf thcl 
pceaent syslam), to which they are eapecially adapied{| 
but, front Redi'a experimenta. it appear* that bittera an 
not an immediate pois^in to tliese animals; nnd ProdDWor 
Af unruy properly observes, that " if the semen santotkknm 
(worm-seed), according to Baglivi'a expenmento, operates 
more quickly, il must l>e by sotnething else than its bittaiv 
ness that this seed opeiatea. I am uncertain if 1 have over 



CL. r.] 



DICRSTIVK VUNCTION. 




been poncsscd of the beat kind of thi« mod, but must any, Otn. xi. 
that what I havo iweii hiis btirdly *;»vr n))p«arcd lo me to .* *'■' ^ i.' .** 
be a powerful tnedii'inc *." So far ns my onn ob^rvultons 
extend, i cnn conlirm this opiiiion. But the needs u« so 
oflei) mlultcrnlvd with those of other planu. aiid eapcciaily 
tho«« of itouthern>WDod. that it is didicult to speuk with 
precioioii. 

The same remark may be made in rtwpcct to tnnav, nthit *». 
savine, nie. bastard dittany, or fraxinoHa (dirlamnui aihux, 'i"'-!'''!'!!!", 
I.inn.), and not the dittany of Crete, which is an orii;a»uni. tiiief *iih 
(he R«edH of the (henopodium anikeittuntieum, or w<trtu~ ■"' "^.''^ 
i;oo«c-foot. an^lica. and many other leaves and seeds of ' """^ 
slighter officacy. which have had their day. and are for- 
gotten, some of them umb^servedly no, Th«y have all 
more or less u bitt«r principle, in eombination with ooitifi 
acrid C|nality, which exacerbiitcs the energy of the hitter, 
and renders it doubly obnoxious lo these internal parasites. 
And it is to these principte« we are to ascribe the efficacy '* 
of the pom^ranate root, one of the moat eoniinon. and, 
according to Dr. Aiantic, one of the beat cstaMi^ed vermi- 
fuge!* in India. LJnnfii'! niwrta the nn^olica (nngeliea 
Arekangelica ) lo be peculiarly serviceable in expelling the 
gordiua, or hair-worm ; and that it is in common nse for 
this purpose in Lapland, where this variety of verminalion 
is indigenotts. 

On what ground aiisa-f<Etida in to be held as nn anihel- Am-fv- 

mintic, I do not exactly know. Hoffman regarded il as Ih^j^t^' 

one of the most powerful medicines in the vermifuge class; pnuiplc 

and Dr. Culleti telU ua, that he has no doubt of iu bein<^ ""wtulni 

entitJed lo a place in the cln»a, ihoui^h he confesses that he 

has seldom found it cfiectwiil; which, however, he imputes 

to our not hitvin<^ it in ho recent and dilfusible a state as 

were to be wijihcd. It is very prolwble. indeed, that it 

loses much of its virtues with the Iohh of itii freahnew ; for 

Kwmpfer informs ir«, from his own observation. Unit a 

Bingh? drachm of ihe rrw-nl juice smHU sinmgtr. thim a but lu 

hundred pounds of such as i« commonly sold in Europe. PT." l"^ 

Like the pfcc«din{; medicines, therefore, it is not improbtildc n>cd CKm 

thai whatever aiithcliuintic virtue assa-fcrlidn posdowes •,'""' """" 

' «f tutun. 



1 



■ M*i. M*d. pkn i. ihap. ti. p. Oi. 



n H ^ 



372 



ct. 1.) 



CtELtACA. 



[ORD. I.< 



Usa. Xi. 

dkc. in. 



TtitlMW. 



OwiilioRr. 






when fr«*li, depend* upon m bitter pdncipte c w ahiDBd wttki 
a punecnt and volatile ftrotna. 

Tbc l»eI)ctM>r(M, hcUdx)ruter. *nd oendilh. vludt ~m\ 
Dvnally rv^urded u u ftpeciM of rentnun, or white 
bore, though the specific cbamcterv have oot been very | 
clearly SKcertnincd, are pungent bitters unitol with kst 
cathartic power, and are hence very active vcftuifugcs; txtkl 
they are too violent (or conunoo lue^ for they onen do mors 
mncbief than the dixease for which tbe>- are a remedy. 
The seeds oC the cevadilla are so pungent as to be caosbfrj 
in their pure atate. for they are usually contaminated wil 
p»nley and hellebore seeds; and are hence often employed { 
in decoction, or son>e other form externally, to deaUoy 
bu^, lice, and other vennin. The dose, fcr a child frouj 
two to fuur yeari old, i» two gmiuK; at eight, five grutu;.! 
from eight to twelve, ten. These are all powerful errbine*. I 
Tobacco i% (xmitnuicd of all ibeoe (|tiahtieB, and unitM 
with tliem a deadly narcotic |>ower. It K hence, therefor*, j 
a dcctHire veirairuMc; but, from ita violence, can rarely j 
be used except in injections, in which fonn it suck 
adniinibly us;ain<t the small usciirides. 

Gamboge seems chiefly to act aa a drastic purf^tive,] 
bearing down ull before it; for tliough, when held antuej 
tinie in the mouth, it diiu:overs coiiMderable acriiuony, i 
it hoH few pretensions to bittemets. Vel, tm it ia mull 
to be peculiarly eJlicacious in detaching and eK|>ellin){ 
the tape'womi rather than the other kiodi, it probably 
acU also by mime specific |>ower witJi which we iirv 
acquainted. 

There are some medicinea, however, that may be re* I 
gardttd n« specific vennifuges; or, inother woids.as actii^j 
upou womiK, and dctachmg on destroying, by some aimplej 
qtiitlily, which proves highly oltensive or poisonous to them, ; 
witliout ullecting tbc bowels; and which, therefore, ptv-i 
pare then) for rejection by any |mrge that may be given > 
ufiorwards : the chief of which Keeiu to be the bark of the 
shoots of the cabbage-tree (areea oienirra, i-iiin.). the bark 
of the bastard cabbage-tr«e(Or>/)^^a twcj-mM, Uno.),MMl 
the mule tern. 

The two fornKT are West Indian and AuKricau plaoix, ' 
and the baikH are employed in the form of infusion, de- 
coction, Kyrup, and even powder. Botli have a miicila- 




CL. I.] 



DICESTIVB FUNCTION. 



I 
I 



[oitu. 1. 



ginous nnd swi-etish taste, and the first a diaagreeable 
Mii«ll. Thvir destructive power dejicndft upou no si-nsibk 
quuliiy; for though, wltoo given in large doses, tJiey uill 
▼omit and purge violently, they prove Tar less Rnthelniintic 
in this proportion than when administered in doses thai lie 
easy on the slomach and bowels, and do not pa^-s away 
with rapidity. By such retardation the worms are exponvd 
to iheir full influence, and are either killed or rendered 
sickly, BO that it is necessary to take a dose of Jalap or 
calomel, or both, for ilieir remoral. The vermifu;{e Is ^iveii 
in the morning, for eight or nine days in Hucceasion. aitd 
the purgative on the day ensuing. From the offensive 
smell of the GeoU'roya, it bns idiio been cnlled bil-^e-wst tor- 
tree. It was firAt brouijht into notice in our own country', 
M n common and ahnost infallible vermifuge in Jnnmicti, 
hf Mr. Uuguid *. and afYcrvrards more fully described and 
reeommend^ by Dr. Wrightf. The decoction is made by 
boiling an ounce of the fresii-driedbark in a quart of water 
till it aoquirex the colour of Madeira wine: the syrup is 
prepared by adding sugar to the decoction. The former 
has found u place in the extant Edinburgh Phamiacopoeia. 
The arrca vleracea lias been long known to the world as 
a valtiable plant, for other purposes than the present. Its 
medulla, or pith, forms an excellent sago; and ita green 
tops are cut, and eaten as cabbages; whence, indeed, ita 
vernacular name of cabbage-tree. For a knowledge of its 
virtues as an anthelmintic, we are, however, chiefly in- 
debted to Dr. Rush, who principally tried it in (lie form of 
syrup, which is of a pleasant taste, and which he asserts 
to be an infallible antidote. It is used, he tells us, very 
geaerally by physicians in the West Indies; and he him- 
self has employed above thirty pounds of ii, without 
knowing it to fail in a single instance. It is espe^'iaily 
available against the long-wonns. It was, antecedently to 
this, tried at Edinburgh, in the fona of powder, but re- 
linquished, as too rough and viol<'iil a mciliciue. In that 
of a syrup, it is sufKcienlly mild, and neilhi-r purEi;ea nor 
Toinila, but in an over-dowe{. l>r, Monro lias since in- 



Oev. XI. 
Srii-.lll. 

llclmlnihift. 



Gcettrnj* 
incRTin, or 
bniard 
nbbagt. 



Ami olv. 
nna, ih 
true tab. 



n 



1 



* Eh>7«, PhfriMl (od lAvrmj, iti. II. 

t Phil, TruKi. Tol. htiii. ; KiKn. AtnL Comni. toI. I. ft. 330. 




374 



i:l. I.] 



COCLIAVA. 



[OBD. I. 



UKK. XI. 
Sricin. 

UdmiMhi* 
FUixnrM. 
m malo 
roe. 



IlldwRUO- 

litvptin- 

wonia iiM 
thoreu^j 

known. 



And hcnee 
phjrnaan*. 



NouOmi. 



llBpMcm 

inrfiHMion. 




troduced it into S(. George's Hospital, and in vuioiu cugb] 

found it a-ucceaaful*. 

Thv-fi/tT tnas, or male Tern, ia not the only Hpeci«s of thvJ 
feras whwte root* have hwa eiuployed as simple vermifugeiH 
Tor tlie ofiitHJMfia regaiis has acquired, with aome ( 
tionera. s« hif;li ii repuUition; but the favour of the publiol 
has be«n so iniicli irotc (txteiMirely bestowcxl on the foe- 1 
mer, as to cnablu it altof^tticf to eclipse the pretensioaa of ' 
iia rival. It is very difficult to say on w-hut the destructivt 
power of the tualc fern over wonos, and eepectally tbt 
ttRnias, depend:^; for, to the taste, it discovers bat little 
activity, and has little or no aroma. It is glutinous. 
«W6eti«h, very slightly bitter, and sub-astHngeat, may bt 
taken in very large quantics, and appears to be inntpsble 
of expelling womis. hoiv much soever it may destroy tlicni, 
witliout the aid of active cathartics. And hence, many 
wrilere of uutbority. and antong the rent Ur. (Mullen, are 
doubtful of its {Mjoiteiising any aitlhelniinlic power whal- 
ever+. The (Jcrmaii wrilets. however, give vxamplei> ef 1 
iKflias dischar^^ wholr. or i» lon|; portions, and perfectly 
dead, after an exhibition uf repenti^ doses of this tnedi* 
cine, where no cntliartic wtiutcver wiis mudc use of; 
Ur. Parr assi-rts. tliut he hns met with like examplM in\ 
hia own practice. And Iicncc it u|:^>caiB to exercisa some 
poisonous eifvct on worms, lltough hannlcas to the hucnail 
Htomach. 

About the year I77U, the male fera wa» brought 
fCrtat notice ia Switxerland and Frtnoe, by the celobnteilj 
Madame NoufReur. who, under her own process ofnaing^K 
boosted of it iut a specific, but kept the prooeai to herself, ' 
The secret wuk at length ptirchajscd by tbe king of Fmncr. 
and liberally conimuniciitecl t» tbe world. The pntient, 
nccofding to M. Bnume'K statement^, after Iwiog 
pared at tiight by an emollient clyster, and a sapper 
penada. is. e&Hy the next morning, to take tliree drnchou I 
of the fern at a do^e. and to repeat it inatnntly, if tbe 
stootacb should reject it. Two hours afittr nhich he is 
furlher to take a bolus, coiMistin^f of twelve graim nf ] 



• Edin- Med. Cwnni- vol. H -^ tT- t M*l Mai. )ujt iL dwp^ |. p. JL ' 

{ KUmcfu de Phwmelc— Pr^u ilo Tniumcni. h.t. |hiUU par ortic i* 
Ral. Puis I173>. 



CL. 1.3 



OIGBSTIVK FUNCTION. 



[ORD. I. 



376 



calomel, twelve grains of resin of Hcammoiiy, ami five Oim. XI. 
grains of gnmbogc. which, it mual be confessed, seems n'j^'i;,j^J;_ 
nilminibly caloutat«rl for a triumpliatit issue in some way 
or other; for it will {irohuhly either kill the womi or kill 
the putieiit. It in by no mettiis necoesary to give so violeut 
a cathaitic. 

It ia far less difficult to account for the real or iiu[ipo>ie<l i^i«i- 
tpecific virtues of the Indian-piiikB, or worui-|rrahai-», fur^'^,^'" 
there are two species oftbe spigelia that have been employed F***^ 
for Uiis purpose: i. anthelmia, and *. ManflaNdiea\ and 
for those of the Indian scabious shrub, called by the '"^tf" 
natives catlu schiiagaatn. Theiie are all acrid narcotics; ,,, ^ 
in lar^ doses, as above two dnichnis, or two druchnis und n«(«iicfc 
a half, somctiines purging violently, sonielime* producing 
vertigo, dimness of sight, drowsinvA*, and clonic conrul- 
aioiks; and sometimes producini^ uU together: and hence, 
the same violent effects being excited, perhaps in the pa- 
maitic wormtt as in the patient, it is not to be wondered at 
that they slumld fall a saciiflce to tliom, or endeavour to 
save tliemselvea by a timely and rapid escape. The sca- 
bious slirab, however, seems to act mora feebly than the 
Indian-pinks, and it little to be depended ujion ; while the 
latter are far loo aerinionioii!* for general uite. 

Before closing the mibject, I will just observe, thut KIcttriiiijr 
JDr. Friske. of Brunswick, hns lately employed electricity IhJ^^ 
as an anthehinntic, or mlhcr with a view of killing the 
worms in tlieir mucous doiniciloa, by pax-ting powerful 
ghocks through the abdomen. He thinks he has by 
this plan destroyed oven the tittnin^; yet he doc* not 
ohooae to rely upon this pntclicc witliout the use of active 
cathartic*. 

There is also a much milder remedy lliut has for some 
time been adopted in Germany, upon the efficacy of which 
I cannot speak from personal knowledge, hut which is 
vmA\ worthy of attention; and especially in respect to pu- 
tieats of irritable stomachs and emaciated constitutions; 
and that is. the use of mare's milk, particularly in cases of Ms»"«niilh 
tienia. tnl>. 

[Injections, containing; sulphate of iron, are stated tognlphiicor 
net very powerfully in destroying asciirides*.] i""- 



8(c Mtd. Iniclllgoicn, rot It. jh MK 



374 ^■- *'^*- [orb. I. 



Kili. 



r ii N U S XII. 

PROCTICA. 

• ...« = HBST ABOUT THE ANUS, WITHOUT 
-tiMABY INFLAMMATION. 

. -i i'aiA genus has been taken from Linneas; 

.. iskorHle have formed a like genus, under that 

^ ^ *, lu the scope in which it is here employed, 

.. ..Ltutied six species; all of them occasionally 

.> .oiu|>athic diseases, though several of them, 

N.. Lb'V generally as symptoms or sequels of other 

. ..>. I'be species, proctica simplex, or simple pain 

, ....», has now been omitted by the editor as an uii> 

^s^.> otiyuuction, throwing no light either on pathology 

....^^tf. The species are therefore reduced to five 

,mIIiA SPASMOmCA. SFASMOOIC STRICTUB8 

OF THE BECTUM. 

CALLOSA. CALLOUS STKICTURE OF 

THE RECTUM. 

TENESMUS. TENESMUS. 

MARISCA. PILES. 

EXANIA. I'ALI.INU nOWN OF THE 

rUNKAMENT. 



CL. I.] 



DIOKSTtVB rUHCTION. 



[oav. I. 



SPECIES I. 

PROCTICA SPASMODICA. 

SPASMODIC STHICWRE OF THE RECTVH! 

PAIN IN TUB RRCTt'M RKUITTBNT, BOMETIUES INTBB- 
hittbnt; increased during cxphlsion or the 

PEC-Sh; volume op the FHCES fiUEKUEK Bl'T TA- 
BIABLE; Rtr.tD ORASP OF THE SPHINCTER OK IN- 
TBODUCINC THE PINCER; STRUCTURE OF TUB 
BOWEL SOUND. 

Strictureh of the rectum nre pnxlticeH by a spaamo- Okx.XU. 
die contrftction of itu ephineler niusclos, or I>y a thickening p^|^,[; 
ftod indunttion of ita conln. The first forms the speciesi uum. 
before us : it is thi; simplest nnd leunt fonnictahle of the 
two affections, thoueh generally ytry obstinate ; it aUo oc- 
curs by far the least fre<]uently, and has hence Kllractcd 
but little of the attention of medical writen. The second, 
which often terminates in a scirrhous disease, will be found 
to constitute the next species. 

The glandular structure of the rectum renders it pecu- P«diipM- 
liarly irritable, and the natural arrangeinent of the fibres '"^ "»»»■ 
of its sphincters give it an habtluat tendency to contract. „^u',^. 
It iH hence en!>y to conceive, that any undue miinuliDi may nnKciKmi 
excite nn inordinate degree of contraction in tlic Kphincu-rn, ^ [^ "* 
which may be propagated to a greater or lens decree of »i*incw. 
ascent through the muscular tunic of the bowel. Thi« in- 
ordinate action will, at first, be disposed to cense on a 
cessation of the stimulating cause; but if the stinmlating 
cause be frequently repeated, or of long duratiou, the con- 
traction may become permanent, and continue to exist 
after the cause has been removed. 

A like prcdispunition to inordinate and pemtanent con- f^t*" • r«- 
Imction may take place, as Mr. Copclsnd has ingeniously ^|, ,^,° 
reinarkod*, from (he peculiar structure or peculiar extent ""( l"titf- 
of the sphincter fibres in particular individuals. Ana- nduib. 



* OtiKmuxni oil iIm Priiitiiul DittMo of \\te Rtcuiai and Aau*, S«cl. it. 



CkuJ 



cat LI AC*. 



[OBD. I, 



St I 
I'n.. 



ikitcotae to ui unanimoua agieeoient, whetlier 
144a libMMt. ■Hong fVom the exterior and the iriterior sur- 
- -'^o axtreaiit>' ot'th« rectum, uid freely dccussat- 
..■nuixiQg in its substutict-, be two distinct nmt- 
iltiiik«»Qal^a>>Bgle one. llie (Jdcr anatomists seem to 
^U« ttoWk«rthe latter opinion; Dr. Baillie, M. Petit, nnd 
9lk Pbtlal speak (»!' them, and descnl>e them as distinct 
(MJUMtMk Be the fuel lis it may, wv somctjmi-s had, that 
tk» t«N» kyers of fibres do not act corrcspondcntly, and 
llMt tb» coutractile power of the one follows, itwte&d of 
I^MMW P*M with, that of tlic other, or evinces some otfacr 
HHMkof iniccordancy, so that the entire muscle is wldom 
Mk in N state of perfect rest aikd reUixstion. And we also 
IbHl, that, in soidv individunU, cvc-n where the actioa is 
hinuooiouH, the contractile organ is too broad or too 
IMiwerful to be overcome by the expolsory pou-er of the 
itbcUmiiuil muscles; and, conscciuontly, that tlie feces are 
«l|wUed lensi rr«t{uently and less freely than they ougbt to 
bs; wbviice a hal>it of coativencss is ind»ce<l, and the coo- 
lined excrement, becoming acrimonious by its lodgmeat, 
Ibnus a penuanent source of irritubility, and is cooiltvitly 
augmenting the contractile propensity. 

Ally other local irritution, under such an irregularity of 
*'^^ muscnlar structure, must have a like efi'cct: as a daily use 
"*■ of acrid purgatives, in small (jiiaatitics, with a tiow oT 
eounteracting coBtiveness ; irrilublc carunclea, or exores- 
cencee at the verge of the anus; a turgesceiit, and ospecially 
a varicose state of the internal hemorrhoidal vessels. And 
even where there is no such irref;ular constnictiuu gf Um 
sphincters as we are now contemplating, any of tiu*Bi 
cidcntal Bourceit of atipuilus, inn debilitated and init 
habit, or a debilitated and irritable state of ihc ulimentaiy 
canal, in which all of them are moat prooc to occur, may 
lay a foundation for the same complaint. 

Mr. Copeland has favoured the world with 6otais I'alii* 
able remiirkii upon thitt diitcase* ; but tJio onlv writer who 
has hitJicrlo rliniinclly lit^cribcd it. by what may be cnllrd 
a close and full length porlrait, is Dr. Haillici*; and I 



* Ob*rmlioi« nn llic PnTn'i|iiil rtiiiiiiii 1. Ac. SmL IV. 
t Med. Tniu. voL t. ml ix. 




CL. I.] 



DIOeSTIVB PUNCTION. 



[ORD. I. 



379 



shull iivnil tnywlf of his words, as contaiaing a correct 
expression of th« complaint. 

After noticing that UridureH of the rectum are almotit 
ooDstatilly produced )>y a thickening of iu coatK, in the 
progress of which ulccnttion very commonly tiikvs place 
on the inocr surface of the bowel, and the pniient is ulti- 
UKtely dextroyed, u the ule«r hu no u-n<lcncy "r it«clf to 
heal, and the urt of DwdiinDe has hitherto failed in cum- 
mnnicttting to it any healing disposition, this diatinguisJied 
pathologitt proceeds as folh>ws: 

" j\iiothcr kind of Htricturo, however, occasioimlly occunn 
in the rectum, much lesat fonnidable in its nuture, which 
is very rare, and has hitlierto been taken Httlc notice of 
by prac lit i oners. Hits is not attended with any di&eased 
etmcturc of the couts of the rectum, but depends upon a 
contraction, more or less permanent, of the sphincters of 
the anna. 

" A good rnnny years ago, a Tery well marked fa«c of 
thii« kitxl f<ill under my notice, an account of whicli it may 
aot be improper to eommimicate to the College. 

" The patient, in whom thte diKcasc occurred, had been 
long subject to aii herpetic eruption on his right leg. This 
suddenly disappeared, and a certain quantity of blood woa 
then daily eracuated by the boweU at the time of po&aing 
n Htool, for fire or mx monthx. When the discharge 
ecniwd, llieru cnme on a good deal of difficulty in having 
amotion, which was immediately followed by a CMisidur- 
nblu sensation of pain in the very lowest part of the rec- 
tum. This pain generally continued from a qunrter to 
half an hour, and then subsided entirely until the next time 
of having a motion. When the stools were examined, they 
wcTu found lo be very khiuII in their diameter, to be flat- 
tvn^'d u|>on their surfiice, tutd to be KeqK'^utine or twinled. 
In (lie course of the diMiase, when there wait an etl'ort to 
have a motion, the external sphincter of the anmt would 
souetiuHMi hardly open itself, so that fluid feccK only would 
weapc at Huch times, and in small quantity; or if any 
•olid feces were allowed to pass, they were so K(|ueexo<l by 
the very narrow aperture of tlie sphincter, ax to become 
nearly as thin as a riband. At otlicr timrH, the sphincter 
was much more disposed to 0[M:n ititclf, uud llie stools were 
then of u considcnihly Itir^er xize, nnd of a lesx flattened 



Oax. XIL 

8re«. I. 
Pnxtkm 



iftmudka. 




D«Fr:t|rtliwl 
by iUiUt. 



380 



CL. I.] 



COILIACA. 



[ORD. t. 



Ocit.XII 

St-KC. I. 

Practics 



rte- 



Bhape. At no time, however, the motions were of the 
nsual sixe, or of a perfectly cylindrical fomi. An exami- 
nation of the rectum vras occasionally made per anutu, 
and tliu recltmi wait always found to be so mocb oon- 
tiactcd as to admit with ditBculiy the fore-finger. Tbia 
contraction extended to the upper limit of the int 
Kphinclcr of the anus, above which the carity of the 
wax of it« usual iiixc. The internal meml>rane of thv 
turn in tb<! contracted part was perfectly healthy. It waa 
~ soft, not thicker than usual, and moved very readily on the 
inner surface of thv conti^icted sphincter. The patient 
WBB in good general health, looked well in his countenanoCt 
was not the least emaciated, und his putae was of the na- 
tural frequency. 

" The patient was rer\' averse to the introduction of a 
bougie, and tbie instrument was never passed into tb« 
rectum. Nothing therefore was done, except keepittg lb* 
bowels free from coNliveness, and pursning a very tm- 
pemtv mode of livins;. The disease gTuduuUy hocame very 
much less, and although it ban not ultogelher subsided, 
yet hardly any inconvenience la felt frum the remaining 
degree of contraction. It is now nearly seventeen yean 
siitce the comnienccmont of the dif«ase. 

" This case is very different in its nature from the usaal 
stricture of the rectum, and it is of considerable import- 
ance that it should bo dUtinguitUied from it in practice. 
In the one case, the prognostic would he favourable; and 
in the other case, it would be [renenthy very much the 
contrary. U|>oti a slight (li>grev of attention, the two cases 
might be confounded, but when accurately examined, they 
may at all times be clearly distinguisbed from each otlier. 
In both cases, the feces will be found to be (lattcned in 
their shape, small in their kiic, and in some degree aer- 
pentine or twisted; but the other symptoms will be foimd 
to bo very diU'erent. In the common stricture of the no* 
lum, tfao siluntion of the stricture is gvnumlly two or lltnt 
inches above the outer spbinctcr, suhI there is a sound ca- 
pacious portion of Uio Iwwel between the stricture and this 
sphincter. At the scat of the stricture tlie coats of the 
rectum are felt to be more or less Ihii:ken<.-<1, and not ua- 
CMinmonly m the cavity of tlie stricture there is a hard 
ine^ilur ulcer. Altliuut:h this disease ban in .its early 



I 




CL. I.] 



DIUESTIVE FUNCTION. 



[OHD. I. 



^ 



Ktiii^cti littli^ influcncu upon the constitution, yet when it Ocv. Xll. 
hMDoadc a ftirtliiir prof^ss, the powi-re of lbc<;onstitution p^^^ 
beoome very much weakened, great emaciation generally (pumodicb 
takes place, and the patient is destroyed. In the other 
species of stricture prodnced by a contraction of the sphinc- 
ters of the anus, the contraction is found upon examination 
to be ftt the anus, or very lowest extremity of the rectum, 
the inner membrane uf the rectum is diBcovered to be 
sound*, nnd the genera] health i» not impaired." 

In a particularly obHtinato case of spasmodic Ntricture 
of the rectum, that fell under tlie care uf our uutlior, bou- 
frin of all sizes and descriptions were tried; and some tii* 
hercles. which were situated at the rer^e of the anus, were 
repeatedly cut away ; but, without succeas. He addei: 1 Thiipfoh*- 
cannot, however, but regard this as an extreme cast-; and, u/nw^. 
in those of less violence, should still recommend the duity 
use of botipeH of n« Inri^e a Hi'/.n as can at lirMl be bomo In •liKiitvr 
without inncli inconvenience, gradually incrrasitii; them in ^^^' 
diameter: fur whi;rc thereitistancc iscupnble ofbcin"; ovcr-aiik 
come, this is the most eflectual method. In the mean v»nour 
time, vapour hatha, or the warm bath of a bidet, may oc- 
casionally be used with advantage: and where there are 
exaeerbationit of ]>ain, they may often be taken otfby sinul) 
opiAle injections, not exceeding an ounce or an ounce and 
a hairin quantity. 

In the case above referred to, little beneBt was ever de- Loai ap. 
rived from local applications of any kind, whether in tlie J^"^,"^'" 
form of vai>otir, warm water, or cataplasms. It was most tutor ■» 
unrortunntc that opium could not be had recourse to; for "**■ 
in every pro|>urtioii, whether lai^e or small, it threw out a ldl<»]rii. 
lichenous nish over the Jiurface of the body, but more ^I2«nhi 
especially over the extromitiei*. po»ae*sinf; a heat, itching, uh of 
and pricking more intolenible than tlie prickly heat of the '|'"*"' 
West Indies, and which wii« almoKt imtlicicnt to excite rffnu.^ 
madness. From the dilatati'^n produced in the orbicular 
flbreft of the iris by a drop or two of infusion of belladonna, 
I recommended that the bougies, when thoy wore em- 
ployed, should be smeared with a preparation of the same 



■ S« Fr. fUlnun on SiriMun of die Rtaum. f. lo. Lmd. laM- Hm. 



382 



CL. I.] 



CUtLIACA 



[ORD. 



■Ddlt 

hMAmb- 
chlwww. 



OKv.xn. pifint; but no itensible benefit wms liencft obtained. 
J^^ ' belladonna wu aftenrarda emjiloycd in the fonn of pilli 
oftwu^ *Bch containing a ^'rain of the extract. One of th 
trvdiicrd into the rectum by a small ivory tube with 
piston, tliat thrust it out wbea it IikI ascended a 
an inch high, vcim at first employed nciy night aloni 
in a few days, niglit and morning; and then one in 
morning and two at night. No effect of any kind 
experienced till the dose was thus enlarged ; and here 
the mischieTous rvsuits of bellailonna were produced, 
nothing eUe. Tho tongue anelled, and )oRt its power; t 
l»cad was confused and (pddy ; the mind wandered ; aikI 
sight and hearing were obtunded. Having been wamad' 
of such possible effects, and the means of removing tbi 
if they should occur, the friends of the patient had imme- 
diate recourse to the plan laid down ; and. by the aid of 
copious stimuliitiiif^ und cnthitrtie injections, and cordial 
draughts, a recovery was accompli&hed in about tweWe 
hours. 
Bnthnilghi It is obviouK, however, that this caae was governed h« 
an idiosyncrasy not often to be met with : and hence, not- 
withstanding tlie failure both of opium and belladonna in 
n single instance, I should feel it my duty to try either or 
both with uuhesiuting freedom in other examples, und 
should do it with a Kirong confidence of beuefit. Mr. 
Copeland informs nie, that he has often been succowful 
with the latter; and, in some instanees, where eveiy olber 
attempt at relief had failed. 
I I will just notice farther, that, in the iilwve eoac, alto 

"^ a trial of almost all the agierients in the Materia Medicu. 
the most convenient has'l>een found about vight or ten 
grains of the bhick Kulphuret of mercury, with about two 
drachms of sublimed sulphur in addition. 

I have tlicMutisruction of adding, that, since tlic above 
particulars were written, tlie diMuse, titough not entirety 
subdued. ha» licen considerably diminiahed, and cotup^ 
rativcly produces but little iiwonvenienoe. 

Other cases, that faavi; occurred to me of tho aome com- 
plaint, hnve been less painful and fur more cosily overoont. 
In a young lady of eighteen, whom I now sec only oon- 
sionally, and who could never he petsuaded to use ■ bougie. 



be (rtIdc- 
■hit In 
odiB 



« 



mlneiii] 
•nlphut 

Anuida 

•MITD^fllt 



n 



CI.. 1.] 



DIGBSTIVS FUNCTION. 



funo. I. 



it has given wny, »fter nearty two yoafs' standing, princi- 
pally by 11 use of th« hip-bath for half an hour every niorn- 
iug bcfoiu she mad« un vH'oti to evacuate the bowoU. 



SPECIES II. 

PROCTICA CALLOSA. 

CALLOVa STRICTURE OF THE RECTUM. 



DlfnCULT AND rAtNFUL EXPULSION OFTIIF. KECKS; 
rECEH I.AX, OR Ol' INVARIAUI.K »I.BNttF.SNK9»; I'SII' 
MANCNT CONSTKICTION VtUT BV THE fORb-flNO KB 
AUUVE TUB srillNCTKUS; DTRUCTVnEOPTIieuUWBL 
THICKENED AND INUUBATED IN THE CUN»TU1CTED 
PART. 

AcAKBi'UL attention to the pathognomonic chamctors 
laid down in the above definition will easily distinguish 
tliiit species from the preceding, which, though more trou- 
bltooine in it& commencement, is far leae formidable in its 
iisnc ; since the latter, if not timely attended to, is fre- 
quently found tu terminate in an ulcerated Hcirrhus, and 
somutimex a en nee r. 

The diseiisc for the moat port commence* its attack bo 
insidiously, that tlie patient has no suspicion of tlic raal 
nature of tlic case. He fccts a troublesome coslivcncss, 
which he ascribes to almost every thing rather tlian the 
teal cause, and endeavours to alleviate it by various kinds 
of cathartics. These, while they afford temporary relief, 
add, by the habitual irritutioii they produce, to the primary 
and unauspected malady ; and the next symptom, perhaps, 
is that of piles, or nhat is so conceived from a varicose 
state of the hemorrhoidal vessels, and the natural tendency 
of all mucous canals to evince most excitement at their 
extrcmitieai. 

In ih<- moan time, the morbid part of tlie gut continues to 
thicken and burden in its cnutN, its bou- diminishes in diame- 
ter.^nd the cfTotts to expel the rvcrcmcut become nion fi&- 



GEy.XIL 

Sl-KC. II- 



D1»FU* 

tommvncn 
iniidiotulj I 



andhelMB 
afirn ill. 
iicatcil 

ffotn (iiii- 
uke. 



Pngrrnot 
ihtdii 



L 




384 



nL. t.] ' 



CfKl.tACA. 



[ORO. I, 



Qt*. XII. lent, The Ktoolu arc now of a sttU elenderer and often 
Pmctira <* twtated or serpentine form, and have the appeannoe 
"Uo^ convoluted earth-wonnB, or butter squeezed by » pi>toa] 
through a coafcctitincr's gyrioge. 

Thus far, however, the coiiHtitution suRcrs perhaps but 
little; and the patient, to his frienda, may appear to be in 
the zenith of health. But if (he rectum be tried by tb« 
finger or a boug;ie. a morbid change of strueturu will be 
perceived, that threatens the moKt alarming results. Tha 
KuuoT ihc Aphinctera will probably be found pliable and free from 

TwAwtt ^'«*''"^' ^"'l ^^^ P^*"' °^ '''« g^^ iiumediotely nbovo them, 
\t*aionaiii for iwo, three. Of more inches, will l>c cciually healthy; 
Am. [)„( j^p slrictwre, aa soon as it \a reached, will, pcrliapa, 
Rcarcely admit the passage of the finger, and Oppow ill 
entrance by the svmblance of a hard cartiUgiDmu ring; 
or if it be not thus indurated and rendered Kirrhooi, it 
may be studded by a circle of tubercles, or interaecled by 
u nel-work of membranous filaments. Aod if a lound or 
bougie be passed through the neck of the stricture, another 
Ntriclure may be found higher ui>, and again repeated to 
the sigmoid flexure of the colon ; where perhaps the dis- 
ease originated, and whence it has worked its way down- 
wards; the colon possessing iiniurally its least disnieter at 
this p<Hiit, and the feces being here moat easily delayed in 
their pro-;ress, nut only from this increased narrowness of 
the passage, but nlMo from the curved line in wbich tbejT 
have to more forward into the rectum. 

Whether llie stricture be thus complicated or not, the 
narrower its aperture becomes, the greater the difficulty 
of passing the feces, which noceesahly accumulate, and 
distend the bowel above, excite eructations and gripinga, 
and uccasionally lay a foundation for tliat species of ctdic 
which we have already describwl as issuing from this 
source, under the term eoiica cwulrieta. The feces can 
now be discharged orUy in a fluid stale; and there i» ■ 
sanioua ooxing from the anua, accompanied with a certain 
degree of tenoamu», which is latlier truiibleHume, than 
severely painful. 

"At this period," observe* Mr. Copeland. who baa ad* 
mirably described the progress of the disease*. "absoesKi 



Pilnhil 

rfTcvu. 



AbMOM 




mU<a> onilK l>riDfi|*l DiMWMAf ihtRKtnm MdAiWk SniI- 



1 



CL. I.] 



niCliSTlVK FUNCTION. 




[ORD. I. 



■■uUf. 



very lrec|aently Ibna in die neighbourhood or the anus, at k. Xtl 
and aomelimes break into Uie vagina of Ui# feinalfl, and a^i' "' 
lb« feces are dischari^ed through the tiatnlous oriAcc. (n mUom. 
the male, an adhesion takea place to the bladder, and 
the abiicess * dischai^ea itself with tJie urine, and some- 
times feces and wind are voided by the urethra. Uut more 
frequently the matter makes its way through the natn, as 
in cases of common listula, for which diseuM it is not un- 
frequently treated. The patient often continues n long 
time in this dialressing situalion, for none of the vital or- 
gan* are affected; till, al liL^t, worn out with the pain and j^, ic,^ii, 
the diwharge, or perhaps a total obliteration of the rectum, ^l'^,'^"""' 
he yields to his fate. This is usually the progress and issue 
of the disease when it is nut curly discovered ; and, 1 must 
confess uko, sometimes the tcrniinutiou when it is : tliat is, 
when tile parts are attacked with canceroux ulcerution." 

[In one cusc, however, which the editor lately attended 
at Halliford, the Knesmus wus particularly severe. The 
disease indeed corresponded verj- closely to the following 
descfiption. With the usual symptoms of stricture, there 
were the most acute lancinating pains in the part, ex- 
tending through the pelvis to the loins and thighs; and 
every now and then the pains were followed by a sudden 
gush of bloody discharge from the bowel. When any 
feces passed, the sutfenng was extreme; and, for several 
months previous to the fatal temiinalion of the disorder, 
there was a peculiarly fetid discharge from the anus. The 
patient was a gardener, more llian seventy years of age; 
and he did not sink till his stcxnnch became disordered. 
Uuring the latter stages of the disease, tlie functions of 
ihfl bladder were very much disturbed. The passage of a 
bougie into the rectum could iit;vcr be endured, and even a 
glyster pipe was intolerably painful. 

The causes of the present disease are corapldely un- Can*t%. 
known. It is generally remarked by writent that it may 
originate from any kind of irntation ol the rectum; yet, 
without some other circumstances conducive to the 
changes of structure, forming what is usually called a 
scirrho-contiacted rectuni, simple irritation of the bowels 
will not bring on this afflicting disease. The case is some- 



Pcclt, (Eum PofihuiiK*. looi. ii. p. 113. 



V01» I. 



cc 




CI- 1.1 



cauACk. 



[OWLtt. 



Okw. XU 
Mpkc. II. 

PrMk- 



ttmee suspected to arise i'rom a pecuUar morijid cooditioti 
of the mucouB glands of the rectum*. Dr. Baillie enters 
tained tiiis opinion, wtitch he tliouijht was confirmefl by 
the fact, ihat such glands are meet aumcrous st the U)wet 
part of the gat, where the discMe ia akw most frequent. 
If thin be the ctMe, however, it only refer* to the titruciiire 
in which the dkwue commenoes, and throw* no light on 
the cauM; of itx eommenccincnt. The prohability is, that 
the complaint in dependent on oontititulioaal causes, like 
eTcry olhvT form of scirrhu». DvHaull fwmd the diseue 
to be much more common in the femnle than the male sex, 
in the proportion of ten to one: tlie subjects of it nre also 
mostly advanced in years. This teada to support the 
opinion already de1iTeTe<i, respecting the operation of con- 
sulutional causes. A case wa^i communicated to l>r. 
Monro, by Dr. Gregory, where tlie disease was ascribed lo 
(he inMertiori of a fiKh-hone in the coats nf the rectum, a« 
discovcnv) after dmtht. The particulars recorded, how- 
ever, do not warrant this inference, ftince the atrioture 
might have ocirasioncd the sto])p«i^ of the Imiie. ajid not 
the bone the funnBtion of the stricture. TliU, nt least, i* 
the editors view of the subject, and it is conGmivd by 
various examples, in which cherry-stones or otlier foreign 
bodies have been detained in other parts of the tntealtiies 
by strictures^. Tlie idea of the disease ever oripnating 
from syphilis is now abajidoned by every surgeon of judg- 
ment. Mr. Salmon refers to two specimens of the disease 
in an advanced stage: in both cases the mucous and miM> 
cular ooata of the bowel have l>een absorbed, in cons^ 
qtionce of tlie preuure of a itew-formed substance, which, 
in one instance, has made its way into the bbdder, and, in 
the otlier, into the vagina^. Tliesc two caseit, theji, pre* 
sent one feature of carcinoma of the breast, namely, thai 
which consists in the substitution of a new-fonned aub- 
stance for the original texture, which is absorbed. 7*he 
projection of (ho new mass into the bladder and va^na. 
however, would rather indicate a character of fungus 
hsmatoidcs.] 



I 



* tnlmoD, on Alriciun nf die R(c(utn, |i. AS. 

t Sat BIoara*> Blorbiil Ami. oT the Ilumui QuIIm. && )>■ SS. 

i BtB MM bf Minon, op. cIl p. 31 . g Op. dL p. 63. 




CL. 1.] 



UICKSTIVK FDNCnoN'. 



[oun. I. 



3«7 



The existence of tranareree filamonta, like that of can- gek. Xli. 
cer. is generally preceded ijy Rcirrhwity, us remarked in ^^^'' 
tJie following passage of Ur, Daillie. The ttcirrhua "some- uiluu. 
times extends over a conaideraWi; length of the gut, viz. ^^il"^* 
Mveral inchea; but trenerally it it* more circnmBcribcd. dunJuiilit 
The peritoneal, muscular, and internal coals are much "i'""'"'* "^ 
thicker and harder than in a niitiiral Hlate. The muscular, 
loo, is subdivided by membriinoua Hcpta, and the internal 
coat is sometimes formed into hard irregular folds. It 
often happens that lli« surface of the inner membrane ix 
ulccmtcd, prod ucin;^ cancer. Evt^ry vestiajt; of the nulural 
stjucturc is occasionally lost, and the gut appears cliuuged 
into a gristly substance." These remarks are strikingly 
illuElrated by well engraved figures in the author's Morbid 
Anatomy *. 

In a few cases of irritation, the tmnsverBe 6lameitta hare Tnavttm 
been formed before the thickening of the gut has become ^^^^^ 
callous, and have nevertheless been accompanied with nil rormrii 
(he painful AyiuptoiiiHJuai noticed. If, in ihin incipient ^^'''j^''"' 
state of the disease, theae filnments be carefully removed, niumi ai 
it has often happened, that an easy and mdiciil cure has "■"™™'"t- 
followcd in n sliort periud, of which Dr. U. Y. Jameson 
of Baltimore lins lately published » KUiktng and instnictive 
example +. 

Knysch gives nn instance of a scirrhous stricture of the Caui, Bud 
rectum, which produced great agony, and terminate<l j!* 
fatally, cxcit«d, as he supposed, probably without sulhcient 
grounds, by a stricture of the urethra. On dissectiun, the 
pelvis of each kidney, and the middle of ihe right kidney, 
were found loaded witli calculi ; tlie rectum, through ita 
CDtirs length, was nearly of the thickness of the thumb, 
and so indurated as to render it dillicult to say, whether 
the incraa«ation should be called (leiOi or cartila^i?: the 
canal was not wider than « straw ; and so firmly hud rhe 
intestine adhered to the sacrum, that it could unly be se- 
parated by a mallet and chisel, Ihe point of a knife having 
been previously tried in vain|. 

[When the texture of the icirTlio-CDntiacted rectum is 
considered, it must be confessed, that there is not only great 



' Ijj BujtkIi. 



* nw h. t AiMTJcaii Mnlirtl KnvrcWr. Apiil ISSt. * P. 3SS. 

cc'2 




388 



CI.. 1.] 



C(EI.IACA. 



[ORD. I, 



asK. xir. 

Srse. II. 
Pnictka 

nlloKt. 



PtrtitmT. 



lb tit frr- 
tcw*hen 

Hov to bo 




difficuUy in putling faiUi in the cfficHCy of nay intenul 
in«ltcines, but nl»u in giving credit to the Htatvmentsof] 
benefit derived from direct applications to the diseased part 
itself. EnperieiM^e muhi l>c heaid, however, and the au- 
thority of Desault can be brought forward in conhrmation 
of the power of tents and bougies to relieve and even cure 
this formidable disease. Notwithstanding nhat was once 
asserted, pressure will not cure cancer of tbe breast; and 
it K puzziing to underttand why it nhwiM ever succeed in 
cancerouft alTections of the rectunt, unless the latter be 
preMimed to be of « dillerent nature front scirrhoiu aJfec- 
tions of other orgnii«. Yet Desault declares, that the 
diaesM c»n be cunxl, and has recorded examples of the 
•uocMsful treatment of what he conceived to be scirrhiit 
of tbe rectum. It is not cver^' sui^eon, however, ihat 
bows to this doctrine: and Professor Gibson delivers his 
own judgment very unreservedly when he remarks, that,! 
whatever may be said to tbe contrary, genuine scirrbua, or ' 
cancer of tbe rectum, is ab-solutely incurable*. A similar 
prognosis ift given by Mr. Salnionf- In the example,' 
which I attended at Halliford, the bougie could never be 
endured. Some palliation of the sulTeringx wa^ producea) 
by the exhibition of hyosciamus, joined with hemlock, 
opium, or the blue pill; and by tbe occasional use of] 
castor-oil, nnndyne clj-stem, the slipper bath, and foment- 
ations. Our author, lu the uimexed remarks show, had 
confidencs in the bougie.] 

[n tbe earlier stages of this disease, the steady use of % '. 
bougie, hrm but not harsh, and lubricated with oil, of a 
MZG adapted to the diameter of the stricture, so that it m^ , 
press against its sides with a force short of uacasincM, 
will afford, in conjunction with gentle laxatives, the best 
chance of cure, and has in very numerous iustnnccs cooi* 
pletely succeeded. Tbe bougie may be retained at first for 
only n few minutes, as on its curliest um it will probably 
give pain, and irritate; but by degrees it should l>e home 
for B longer period of lime, and at length for several hours 
in a day. Tbe pressure will promote absorption, and con- 
sequently reduce the morbid thickness of tJie coats, and 

• louliam uid Pnclici of Surgtry, rot t p. >•*■ 
t Ur elt. p. S4. 




CL. I.} 



[OHD. I. 



hereby enlarge the diameter of the intestine; and asthisotx. XH. 
last change oecurs, and ndvances, it sliould gradually l»e p"^' "* 
inel by a bougie of larger calibre, till Uic canal is restored aiiau. 
to its proper dimensions. And even after this, it will be 
proper to rcttirn to tlie bougie occasionally, for a few 
minutes at a time, that there may be no relapse from the 
existence of a predisposing habit. 

Nothing is so well calculated as the bougie, moreover, 
to break away that net-work of lil»ment« whid), as we 
have alreudy obKcrved, tit sometimes united with an incrss- 
Mtion of the rectum, and oprciidti frooi one side of it to 
another. In this case there will usually be found at first in ■■>■> »- 
a conaiderahle degree of pain, and Komrtimcs a consider- JJ^n^/ 
able degree of hcmorrhagci but a courageous perseverance UcUU^. 
will triumph over these, and amply reward the patient's 
exertions. And the tubercles, which are so apt to form on 
the loose and inner coating, will ol^n yield and be carried 
off by the same means. 

When, however, the disease does not yield to this plan, 8md«iIbm 
or has reuctiod n more serious stage in iu de«tructive pro- 1^^^ 
greas, it becomes n direct subject of 0]>eratiTC surgery: 'untor 
and a cure may yet be obtitincd by a removal of the ""*' 
tnberclea by ligature or the knife; or a division of the 
thickened ring by a curved and probe-pointed bistoury. 
When, indeed, the disease is of so complicated a chiinic- DivUim 
ter as to embrace at the same time a contraction of the "^^^^ 
Kphincter, M. Boyer has proposed also to divide this 
muscle; and aMOits, that he has oAen done it witli sncccss. 
But ■» it is not lite intention of the present work to enter 
upon the provinc« of practical sui^ery, I .shall not pursue 
the subject any further. 



31i0 Cl.. I.J CIKLIACA. [oRlt. I. 

SPECIKS III. I 

PROCTICA TENESMUS. ' 

STHAIMSG. 

PAINFUL AND PKKt-ETUAl, URGKNCV TO OO TO flTOOL, 
WITH IkBJECTION OF HLTUB ALONE, AM> IK 8MALI. 
gUANTITT. 

OsN. XTT. When this oomplaiiu ia idiopftttiMi. it in the remit of 

8rKc. III. Ij^j^j iniii,ti(,„_ mostly ]>roriuced bycoM: the pa»«aji<^ of 

acrid Kt)iiiul»liii^ m»tter fixmi the boweU; the mechanicaJ 

pKHrori! of confined entvmlilhi. or minute scybala; or an 

injudiciouii u«e of acrid cnttiurticit, cspccitdly of aloe*, 

wliiol) linvL- a pccnliur IvmWicy to Hlimulutc the knrar 

Dncripiiun |)urt of the ivctum. It tH tometiiDtii intolerably vohnnrnt. 

wlKiiHTctiN jijjj uccotnpanicd with u protrusioit of the nut ; the mucova 

disvhiirgc is bloody, und the sintiiiing continues long after 

tho intoslinc Kim emptied itM-lf of every particio of its 

contents. And wvn whe» the putieiit has risen from stool, 

he will Mtill |>erh»ps lie tormented with a burning pungent 

hoiit, and a pvipeiuul urgency lo expulsion. It is ihi* 

violence of attack, indeed, that chiefly di»tjngui&bes thii 

specieH from Uie symptomatic straining that occurs in th« 

preceding;, which it iittcnded with but little ooniparativa 

pain, and generally ceases upon (bo discharge of even ■ 

amall (tartion of feces. Itte oonatant urgency and tonnent 

wear awny tlie sufferer's i«lrcngth, and ■ometiroea extend 

the irrilntjcin to the bladdt^r. 

*■■"*"** Most commonly, however, tenesmus ia nothing nwre 

Mttwtlr. than a syniptomatic ufTcctioii, excited by some <liionler of 

A&dtam the bladder, as inflammation in its neck, or a calculus in 

w^i!^' ''" <^*"'y; o'' *•>■ dysentery, chronic diarrhtrti, coxtivenen, 

iiictn»,«r' piles, worms (especially ascarides), and pregnancy; or, ts 

""••''*■ ju§t observed, by a stricture of tlie rectum, or it» aphineter. 

TrcMintni. In oil theiie cases, tenesmus can only be removed by a 

cure or palliation of ihe disease on which it i» depeadeni : 

but where it is nn idiopathic aifcction, n mora direct confW 

of treatment may be adverted to. If a lodgment of acrid 



I 



L. 




CL. I.] 



DIGESTIVE fSNCTlON. 



[URD. 



m&U-nals rortn thi> cause, lhct>« should be freely discharged, <*Ka. Xll. 
and thp irrilation Uicy have excited be eulxlued by bleedbg p^^ui, 
with kcchcH, and n local upplicatioii of apiuiu, intrrmixetl unnmuR. 
tvtlb Boap and wax to prevent ilA being too cpiickty dU- 
wired ; or by ftmall doses oi" ipecncuan, or of DovtrV pow- 
der. In very painful extremes, opiute and muciliiG^nou* 
injccttona will often alletiaUr Uic di«treMM; or Goulard 
water with oi). Laudanum in n mlution of KtArch i« fr^ 
quentJy employed with great twnefit as a clyster; or the 
extract of opium may be introduced into the rectum as a 
BUppOHitory. 



S1>£C1£S IV. 
PKOCTICA MARI8CA. 




LIVID AND PAINFVL TtlBBKCLBS OH EXCRBSCBNCEfl 
OH THE VBIIOE OF THE AKVS; VSUALLT WITH A 
DISCIIARCB Of MUCUS OR BLOOD. 

Tm% spwien hiw i^nerally been described by modem '^*''', 'J!.'" 
wtitCTs under the name of luemarrhoii, uheitce htmenuU « (lanunaD 
anrodt in old Ftiglitli, nud hrmorrkoidt in the Kugliah of "|™ , "fJ*"* 
our own day. Now tlic lilemi meaning of hamorrkms, iDcermi. 
alfu^c. ii " flux of blood ;" and in this aense the term "^ *>iT' 
waa used by the Greek and Roman writerti, sometimes ge- 
nentlly, and iwmclimcK with a special application of it to 
nicnKtruation, and particularly profuHe menstruation, or 
uterine hemorHiagc, but never with u tftrciat ttfeicnce to 
hemorrhage from the anun, a» I have ulrvady rcraarkod in 
the Preliminary Diswrution to tJic volume of Nosology*. 
to which I rcfiT the reader : and hence -iguin. (Vrintotle de- 
nominates, by the term Ilirmorrhois, a MTpcnl, whow l>ite 
was Baid to be succeeded by a violent and fatal flow of 
blood from the bitten vesacUt. The name in, therefore. 



• INv4i. 



t Dt Paiubua Animal. Uh. U. 



d 



392 



CL. I.] 



COtLIACA. 



tUBP. I. 



ClM. XII. 

Krcc. iV. 

Pfocdo 
Burtan. 



Ilron ra. 
rwd in the 
pnMBt 

■JMCID. 



duoed. 



higbly inudequiiU: to the ptirpuw of ex|>reauDg. with any 
degree of cleunitiw, tulwrcles, or eveo di»clmrgc» from the 
iinuB; yet it l>ccomcM iiot only inadequate, but absord. 
when cmployvd gcncmlty to indicate a family of di»CMW. 
Konui of which hitve u discharge of niniruK instead of a di«* 
charge of blood, und otiieni no discharge of any kiod. 

For thcw) reasons, as well as otiiere Mat«d at large in the 
comment to the volume of Nosology, 1 have deemed it ex- 
pedieot to adopt the Latin teno mariita in lite etead of 
hamorrhou! and to limit the genus to those tumours or 
excrescences about the verge of the anus, which, under 
every view of ibe disease, form its prominent character. 

These enlargements cocumoiily, and perhaps in every in- 
stance, derive their existence from a turgid and varicose 
state of the anal or hemorrhoidal veins i for, in tJieir sim- 
plest forms, piles conitist of nothing more than varices of 
these veinR, covered with a slight thickening of the inner 
membrane of the rectum, as Dr. Uaillie has sufficiently 
shown in bin illustrative plates*. 

[DiKtinguiMhing piles from mere nwelliug of Ute veins, 
termed kemorrhoidat varica, to which the pnotice of ex> 
ciaion is dangeroua, Mr. Calvert Kays, they are first aaca 
in llie form of HOiall flcHliy tubcrclcit, generally of a browiH- 
isli or psilc-rcd colour, and either uluutcd williin the anus, 
or descending from the rectum. They have rather a solid 
und spongy feel, and, when cut into, present a surface 
more or lesit compact and bloody, from which blood oouii^ 
leaving the texture pale and more relaxed. When tUvy 
ar< more external, they are paler, and genoially, also, man 
elastic and transpare^it ; and they appear and disappeu 
more quickly than the funiier. Piles verj- oilen contain a 
central cavity, tilled with fluid, or coagulated blood, aud 
lined with either a smooth or granulated cyst. By lueana 
uf fine anatomical mjeclions. a few minute vessels may 
be dentunstrated, through which the blood exudes into ihe 
central carity. but no direct connexion exists with any of 
the larger vessels. The cavity uaunlly does not exceed the 
size of u pea; but it is sonietimex large enough to liold 
tttvonil drachms of blood. More gciiemlly, however, tbert 
ia no regular cyst, but the substance of tlic tumour ia in- 



4 




ri. I.} DIOKSTIVE FUNCTION. [oHD. I. 393 

ti)tntlc<t widi blood, which «v«nlunlly bccomefl dark and titv. xtl. 
coagulated. Common piles subtitdc and return at wncer- y^^^ ' 
tain periods, und they become liirgcr iind lirraer, in )>TtK niuwa. 
portion to the frcfjtii'RC)' of the uttack. Often, however, 
after some discharge of blood, they collapse, their cavity 
seems to be obliterated*, and they leave merely pendulous 
flaps, formed of stretched skin. But. when they have been 
strangulated for some time by the pressure of the Rphinc- 
ters, repeatedly gorged with fluids, or one of very long 
standing; they acquire more sobdily. and beeoine perma- 
nent, varying but little in size, and forming a source of 
almost constant pain, from protrusion, inflammation, or 
ulceration; or, by occasioningadiatressinKprolapsusoftlw 
anus. This pcmmnent Mute of the tumours is referred by 
Mr. Culvert piirtly to the development of the capillary ves- 
i[«ls, by which the intCTstices are gradually obliterated, and 
partly to the coagulation and organization of the effused 
blood. Hence, the production of condylomatous tumour», 
and what are termed hcmurrhoidal excrescences, all of 
which are solid, and can only be removed by (he knife, or 
ligature. With respect to thi>* ile«criplion. the editor bega 
to observe, that all tlic scvemi foniiK of piles are generally 
conceived by most practitioners, and probably with cor- 
rectness, to be originally mere enellinge of veins, whatever 
may be the solidity they artcrwards acquire, or tlie aeem- 
ingly small or indirect communication of their cavity with 
the venous trunks.] 

Prom local irritation, produced by indurated and re- DMcripiitM. 
tained fecex. or purgative stimulants, and especially aloetio 
purgative)) ; or from an undue determination of the blood 
to the hemorrhoidal vessels, by excessive walking or riding ; 
or their tiirs^seonce, arising from enlargement of the liver 
or adjoining viscera : from the pressure of the gravid 
uterus on the |)elvic veins; from the irritation of atone in 
the bladder ; and often from a peculiarity of the constituliou 
itself; the extremities of the hemorrhoidal veintt are apt to 
become varicoiie, and »well into tumourM; frc')iienlly ac- 
companied with inflammatory action in the surrounding 
mucous follicles; the swellings enlarge gradually into 



* Km Itir A. Cooper'* LcclutM, <ol. il. p, 33<l> 




394 



CL. I.J 



C<£L1ACA. 



[OKO. 1. 



(lEx. XII. cnruncuiar cxcrvscvnnsR, pua-siud, fig-«i»d, or of varioiu 
*^^'^' other ligureB, sprouting ubout ihc verge of the anus within 
unite*. or uithout ; and arc oftcit bo painful bb to prevent eitW 
walking or sitting. Sometimes ttii> caruncles, iJium ft^\ 
duced, are hard, florid, incompressible, without diachurge. 
and intolerably sore to the touch. Sometimes irritntton io- 
duceii a eccretioD of whitish mucus from the nt-i^tilKturing 
glanda. Sometimes the hemorrhoidal vestieU themnclvew, 
that form or su|>ply the sprouting tumoura, are «o tlui- 
teiided as to buTbt, and bleed freely. And occa»ionally lh« 
inflammatory actiou givos rise to the formation of c«ruu- 
cleit nf difl'oreut shapes an<l sixes, eioniotim«» itpreadiii); 
iUiout the perinxum, but mostly exiatiitg within the wr^ 
of the anus. Whence wc obtwn four disliuct vu-ietieB u 
follow : 



Cobca. 
Mucoaa. 
CruenU. 
CaninculanM. 



Blind piles. 
Wliitv piles. 
Itk-c<liite piles. 
Carunculur pites. 



aF.MviKa y/^ have just obscrwoil ihut piles in iheir simpleat i 
PndiriNM. ^"^'"1 '^^ nothing luurt than v-nricoec tumours of ths Nml 
Ittg nuM*. veins, covered with a slight thickening of the inoer !»•«■• 
braiie of the rectum ; and 1 have pointed out a variety of 
causes predisposing to such tumours. The irttialtenurovd, 
or b/iHd, though not peculiarly cxpre^ivc of tho idea in- 
tended to he conveyed, has been applied for age* to thuflrxl 
example IteforcuH, which ixvoidof every kind of <liitchar|;r, 
uliothur mucouK or sanguineous, and ha* iw i/fJrt. or aptt- 
luTc, thmtigh which Mich di-ichargc miiy Sow, and carry cS 
the accumulation. MnritMUiI tumourx, Mr. C(^>claud con* 
cvivos, are moat common in |>crKonK who [xivscsa u very 
strong action of tho sphincter imi, and are hence habitually 
predisposed to a spasmodic stricture of the rectum, luaucti 
pcrMHis, he supposes, thnt on every cxpukion of the feoea, 
the internal membiunc of tho rcctuin, together with tho va»> 
KCis it contains, is protruded, and caught or detained, and 
some of its veins strangled by the forcible coiwtrictiOD of 
the muscle. That this is a frequent cause of piles I have 
no doubt, though, from their occuirint; in such Dunwroiw 
instances in pciwns of lax flbrc6 and debilitated habits il 




CL. '0 



DIoeSTIVB PUNCT10N. 



[odd. I. 



I 



appears to mc to opcretv \e«& fiequcnlljr than is ttiiKpcctcd 
by Mr. Copflnml. 

Marisoai excrtstccncMi are likely to be the hurdest. the 
Korest, and the most florid of the whole, when the result 
of such a canse. Where they proceed from n mere relaxa- 
tion of the vascular system, or a dittcaftcd state of the larger 
aMominal via<;eTa, they will somotiniee acquire a coniti- 
demble bulk without being highly painful ; but,inthiBcase, 
tliey are usually soft and compreseiblc. 

It will be better and more compendious to take a «iinrcy 
of the other varieties before we proceed to the curative in- 
tcntton. 

In some perwona, the mucous follicles of the interior 
membrane of the rectum are far more easily excited to se- 
cretion than in othera; as we see in many individuals tht 
mucous membrane of the nostrils pour forth a readier and 
more abundant dvfliixion. It is in tht« state that the tu- 
mours assume tbc name of whit p. or mucous pilks; and 
as the excretories thus easily evacnatc themselves, there 
is much lesa soreness and irritation, and the tumoura or 
tuberrles are comparatively pale tut well as moist ; and, 
thouirh of\en not admitling of so rapid a core as some of 
the otlier varietiea, are considerably less distressing. 

Tt often happens that, from distention, the walls of the 
anal vnrires give way.and form sLCEniKn piles. Yet it 
doec not always fallow that blood is hereby discliarged, or 
the tumour* arc diminished. For it occasionally occurs 
that the Kurmunding membrane does not give way nt the 
same time, and consequently that the extravasntetl bloo<) 
is accumulated in the contiguous cellular subMtance, and 
the tumours, instead of diminiahing, increase from the 
fine of a pen to th;it of a pullet's Cfrg, block up the entire 
passa^ of the n^ctum, and are a sotucc of very great evil. 
ff. however, this take place at some distance above tha 
sphincter ani, where the parts yield more easily, the pain 
may not be excessive; but if these enlartrcd tumours be 
Mated on the sphincter, or within the range of its contrac- 
tile influence, the torment induced is often intolerable. 

Prom this diflcrence of seat, piles (rom of old have been 
denominated external and internal ; and it was imagined 
by Dr. 8tabl and his di^iplcs, that (he former were pro- 
duced by a gorged state of branches from the vena cava. 



OP.MulMa 

iniicou. 
(.'siun. 

Chanicln'. 



cnidiu. 

Uanor- 
rhuKC not 
tXukft B 
naaliofihc 

■ vrin. 



Extcmil 
nndinwittl 
pila, the 
tacuitng of. 



n 




396 



CL. I.j 



CCKLIACl. 



[oho. t. I 



HODM- 



ST' 

Apt Id 
bcinnc 
iMbltML 



SxK. XIL and the latter from a like eongeatioa m branchu of the 
«P.UMi^ *'**^ portainm. No benefit, bowever, can positibty re- I 
oaaM. BOlt from such a distinction ; nor is the distinction itself] 
foDod^d in lact : for ail the arlenes and veins that apper-| 
tain to the lower pan of the rectum arise m> divcreely, and J 
attaatonkoae no frequently, that an atfeetion of one must bftJ 
communicated to another, ai>d the g«oenl result be par- 1 
tieipated by the whole;. I 

Ir oioet caso). however, in which the varicose vcnmIcJ 
burst, the distended and nttciiiiutcd membrane that mr'l 
nMinds (hem burata at the same time, and the Mood flow* ] 
externally. The hemorrhage is, in some caaen, very consi- 
derable ; and as this variety, more than any of the others, 
is a|>t to ran into a habit, the consittution oceutonally 
becomes greatly debilitated, and oJlen dropsical ; aikd the 
hemorrhage has, in a few instances, been so profuse as te 
endanger the life. When, moreover, a hemorrhoidiil hiibit 
is once estublished, the flux, even if it do nul nndcnuioc 
the hcidth by its quantity, often become* periodica), enters I 
into the chain of comttttutional actions, and becomes a 1 
conditional of the corpomil wvnl ; so that its suppression | 
is attended with ecnous mischief. j 

It often happens, and especially during the first variety, I 
which evinces the highest d^nc of tnHammation, that an I 
cITuaion of coagulablo lymph takes place around the uia- 
riscal rarix, which terminates in VB»cu)arity. and the pro- 
ductton of a fleshy substance that still continues even after 
the ovorload»i veswlB have recovered ihcir proper dia- 
meter iind lone. It is these camum: lbs. which are rather 
the i»c<]uelit of piles than piles themselves, that constitute I 
DtMrlpilim. the fourth variety. They are of different shapes and site*. 1 
bulbous, soft, iitid compressible, red or reddish ; and not , 
untrequtintly the base Nhrivela into a narrow neck, while | 
the body of the caruncle enlarges and elongates ao as to I 
assume a polypous appearance. I 

Caruncles, not very unlike, nic fn'i|iieittly found sprout- I 
ing from the cuticle or cutis that surruumls llic anus, J 
(uuDd^ "in often assuming the appearance and having much of the I 
^^" nature of warts ; solitary or clustering, with a broad «r I 
boothocd. narrow base; and which art somctimcK regartle<l as piles, I 
but are altogclhei of a diflercnt origin. I 

^^«e>">M><- In attempting a cure of this comptaint, our Aral attea- ' 



Cmmbc 

waoBi 
Ataga. 

BP.Hiriic* 

cttunm- 
luu. 

tlov pro* 
dHOid. 



Td be dl- 
tmn oUicn 




CL. ij DIOBSTIVB rONCTION. [ORD. I. 367 

tion miul l>e directed to tlic cause, as fitr as we caii tificer- Ukh. Xll. 
tain it. If the bowels be habitually costive, ^ntle laxa- j'p.jjj^ 
tivcs fiJiould be employed daily ^ and whore the complaint wnincu. 
has bctn induced by cxccuivc walking or other muscular '"^ 
exertion, quiet and a recumbent position must be sedu- 
lously enjoined. The laxatives in either case may be the Ui»ii»». 
cassia or senna confection ; oil of castor, where it will sit 
easy on the stomach with the addition of a little spirit, 
which is its best corrective; and sulphur. Sulphur has Pt^uliit 
long been regarded as a ftpuciAc for piles ; but I <lo not ^J^^^ 
know, that it poiMeflMs uny other virtue- than thut of being 
* mild aperient. It scemK, however, to be an aperient 
peculiarly cnlculiited to act upon the lari;e iiitcMinea; 
KJncc, being xoluhle with difficulty in anicnal fluids, it dis- 
nIvvk »luwly, and does not spend itHelf till it has dc- 
■cended to a considerable depth in the alviae cunal. 

Dr. CuUen was in the Jiubit of employing in thi« com- Tn«unni(. 
plaiDt tJie baUam of copuiva. After observing that, like '*t!|K!^''^ 
turpentine, it prorcs aperient, he proceeds ns follows : — 
" Whether n certain efiect of balsam of ct^aiva is to be 
imputed to this operation, I cannot detcnnino; but must 
observe, that I have learned from an empirical practitioner 
that it gives relief in hemorrhoidal affections, and 1 have 
frequently employed it with success*." His dose was from 
twenty to forty drops, properly mixed with powdered 
sugar, once or twice a day. 

I have tried this medicine often, aitd when it hna np- [n ohm 
peared useful, it bait been chiefly in tJie case of mucouit '^^ "tfal 
piles; I am hence induced to ascribe itd »ulutH^^■ ctrcct 
rather to the coimuou principle, on which it iK well known 
to act in irritations of mucous memhranea generally, thun 
to its laxative power. 

Where the pain and tension are very diHlressing. relaxant <.aupbain». 
cataplaams and fomentations are generally advisable. The 
common bread-poultice with a solution of opium is one of 

tlielMtt. 

The butter of chocolate may bo advantageously em* Butwrf 
ployed for the same purpose, citbei as a most mild emol- ***"'*'^ 
jient ointment, in the form of a suppOBitory, with a small 
portion of spermaceti, or as an exquisitely bland bougie 
with a nucleus of cotton. 

■ MkU Mtd. put it. cap. T. p. 190. 




400 



CL. I.] 



CtRLIACA. 



[ORD. fa 



flKx.xri. appearing to act, as M. Petit ol»erres*. br the ssina' 
^^'*'' mnnner AS the pretuiure of the tMidinous ringa of tb« ab-' 
Muvo. (lominnl ninscles in cases of stren^lated hernia; and pro* 
duciiii; the same elTects of mcesftant biccoui^h, vomiting, . 
abdomiiml inflammation, and gan^ne. Thia, bowern, 
rarely occurs, except when ibe ligature i» applied roond i 
wveral tumours at ibe same time, or during thdr itiflamed ' 
state: for if only one he o[>«mtcd upon at once, ond the 
mt in auccrssion, the irriuition has not been generally ex- 
tensive, or of loni^r duration than two or three days. And 
perhaps even iJiis might be avoided, by denuding the 
tumour of its rxtirmal covering, as M. Petit has proposed. I 
TrMcmait The chief difliculty tliut u t tends tlitr operation of excision 
is a very troublesoDW, obstinate, and dcbibtating hcnMH^] 
rhage, which is apt to follow, and which many aurgeou , 
have found very hard to restrain ; chiefly, perhaps, bccuM . 
the veins of the abdominal viscera are destitute of valreaL 
Sir Astley Cooper has once or twice found it prove fatal, 
and hence, Ihoui^h in hia earlier years an advocate for ex- 
cision, he ufterwardji gave a preference to the ligmturet. 
Excision, therefore, is chiefly calculated for the caruncuW 
variety, and in such cases i^ far preferable to the Ugalurr : 
but where we have reason to believe, that the varicose 
vessels arc of a large diameter, the knife should not be had 
recourse to, [Mr. Calvert, who has written some judiciooai 
observations on piles, makes a practicai distinction )>etweM| 
the firmer swellings, whose cavity or cells have but a small 
or indirect communication with the large veins, and other ' 
tumours, which he calls hemorrhoidal varices, and consut 
entirely of dilated veins. The hitter are the rases, to which 
the practice is inapplicable. According to tltis author, 
hemorrhoidal varices are generally of a dark, or bloish 
colour, soft and elastic to the touch, resemhlini; in Ihit 
reapect ripe grapes; and when compressed by the linger, 
they are evidently diminished, but return to their former 
state as soon as the pressure is removed. Tlieir shape is 
also very different from that of other bemonhoidal tumouia; 
being broader at the base, rounder, and sometimes dis> 



• (Tunn PoilhuirK*, Van. i\. 

t I^KIum, Ac. *lih addliloiul NoM by P. 1>mU, E^ *(d.U. fkS4& ••■. 




I 



SL. 1.] 



UIOeSTtVK rUNCTIOM. 



[URO. II. 



401 



in irreguliir citixtcre, like similar afTectioiis of tliv aEx-Xll. 
JtbeQK^ Tumour* may also be presumed b> bu of p"^,}^' 
ttbianaUi||MtoPti>eycuiibc traced Trom Uieaaujt farupthc M>rlK>. 
[Tectnin*.! Cutaneouti pxcroKCcncfs about the anuji. I'lro- 
ijieotisly t)enoiniuate<l pi\e* \>y the viil|^r, may be Lik«n ofl' 
I with a kaite or a pair of Mctuor*. in any number, or to any 
l«xt«nt, withcMil reserve. 



spkcies v. 
pr(x:tica exania. 

FJLLISG DOnS OF THE FUMiAAtEST. 



IKVGKSKJ.N AND PKULAI'^B OP TIIK VILLOUS TUNIC OF 
THE RBCTUM, VttOH KNTONY OH RULAXATIOK OF 
THE BPH1!<CT8II. 

This is a very commoii and a very troublesome dtseaae: Giir.xi|. 
but it is capable of a poifvct cure in most c^uies, and of ^'scV. 
eat relief perhaps id all. There are two varieties uf it, 
needing from the two opposite eaoMt of utony aad 
ntony, and whicl) demand a very dilTervnt mode of 
catnieot. 

M Atonica. Relaxed Kxania. 

P Spasmodica. Spasmodic Exania. 

: tlie action of the sphincter is feeble, it collapaea 
IDd often imperfectly ; and the part of the rectum 
that always descends towards the verge of the anus upon 
a protniaion of the feces, instead of being retracted with 
elasticity, remainti exposed, or aMendit im|)erfectly. Yet 
there is little pain or tumour, and reduction is eeay. Under 
tuch circuinstanees. exania, or a prolapse of the mner 
membrane of the rectum, will often occur on tbc slightest 
dejective effort: but if, at the same time, the rectum be 



I 



a P. Eiinia 
t^iktis? of 




* ScD Calvcn'* PtMiicil Tntiiie en nonorrhoKli, fte, tm. Lend. t)l3l. 
VOL. I. DO 




-162 -iL. ./ caLi^ck. [OBD. I. 

Cn.xil. uibfjoni^z laAa aar jocihid irntah&tj tnm tbe 

^t « lii be «x:>»«L uii iu kHial^miii will be more iat- 
^^-^ fi'--.it. S«E.euiae», iBde-nL tbe ponioB expoaed has bsM 
•=M TST T*T^- co&s.denitMe : t'>r 3l'Xz*eiu relites » cue, ii «Ueh 
n:KWTc ,t ^ vslT^iia "if -.be colca were hereby brassfat into new*; 
^r.-: H a^n - aroTbcr. is which there was a pmlipnr of tbe 
^r.i.Ti C''^k-a itaeli. 
i p. Ri g a L-a:.^'^t,. howerer. as is the disease b^ore as from kal 
^""^^"^^ or i-«;Der^ debiiity. ;i is perhaps still more freqimt fron 
*tnJ^*^ *^-" hi'j'i^al '.: scciiiatil excess of contractile action in 
tbe spr.'.nti^r oi the an^s. [The editor doabu tbe cocrect- 
ijTSi ct this exijiasatioQ, and bciierec. that tbe ease, hen 
dhscrj-^i'l, d'-.«^ r-vt arise from exce^sire actioa of tbe 
"^fihinct^r, but retber I'rom a bad habit of atUng loa^ at 
st'Xil, and tVou ih^ prbtractcrd i;^i»ti of stiainiiig, in whicft 
r..ariy muscles tend to propel the rectum and ita ccDtenli 
dfivrnnards, the sphincter and cellular connexions of tbe 
t;>it becoming thereby in time so weakened, tbat a pro- 
lapsus ani ensues. The editor conceirea that, in the pR>> 
ductiooofthefirst rariely described by tbe author, apaiB of 
muscles has more share, particularly when there ia irrits=- 
lioo about the rectum from pile!,or other cuise, tboagb,flf 
course, the repealed protrusions will naturaUy, at lai^ 
weaken the sphincter.] If the tumour reaiain down, it h^ 
comes large, irritable, and painful ; and, if assistance be 
not obtained soon, a violent and serious inflammation wiU 
be sure to supervene. 
A Mnn 1° the atonic prolapse, but little aid is necessary, in 
^^T^. ordinary cases, to return the protruded part. A ainple 
uonupio. pressure of the hand a^inst the denuded part of tbeinte*- 
^f**- tines, or sitting upon a plain and hard seat, will ordinaiily 
he BufBcient ; and, if not, an introduction of tbe fbre-fii^^ 
up the anus will always succeed. Hence patients, labounag 
under this variety, commonly return tbe gut Ihiiiiniilica 
after evacuation, and in many instances it will safend ef 
its own accord. 
Mi'nn''' ^^^ '^^^^^ difficulty is in effecting a cure; wbicb ca 
diScuti. — 

■ IK- Scdibus, 6lc. xxiiir. lxv. G. 

t In tJihiocdcr Vrrm. ScIit. band i. )>. MB. 177& 



CL. I.] 



DIUKSTIVB FUNCTION. 



[ORD. 



408 



only be aceomplistied i» two wsyo : by invigomting and ats. xn. 
bruiag tbe loow and relaxed mi'inbraiie; or giving it an |^^|.^''' 
ftdbcsion to the subjticent ccllulnr Bul^stnnce from which it Euni*. 
is dt-tiLched. 

Thu first may Kometimc* be Hcvomptished by local tonics Strvnytlim. 
•nd n«lringeiitH ; na cold vnitcrdniihvd against the buttocks, u^,^!^,^. 
injsctions of cold water, solutionit of nluni, or sulphat« of bwM. 
sine, or an infusiou of cnlecha or gnll-ntitit. 

The second can only be acconipILthud by nrtiftcially ex- i>ndueiiv^ 
citing a slight continuous inflaRiuiation in the cellulnr sub- ^1^,^^ 
■lance, by slipping off a small piece of the proUtidcd niiuUr 
nifmlirane as recommended by Mr, Hey, or piiKHing a liga- '"^JHT' 
ture tlitough a small portion of it, and leltiug it remain 
after the return of the membrane, till the intlaoiui&tory 
action has commenced: by which means a radical cure ih 
often obtained, in the same manner as a like cure i» 
cflecled in scrotal dropDy, by hooking forwards and cutting 
oifa small piece of the tunica raginalis aAer evacuating 
the water. Mr.Copelaud has employed ihiit method in 

I various inMlunces. and with all deAirabU'. kucccsm. 

j Where there is a prolapse of the upper part of (be rectum, prokpae of 

I or of the colon, the disease is of a different kind : fur, in ''" "P}"^ 
. ■ I ■ 1 111 P'"' Of ihe 

tnu case, tbe entire panetes descend, and the upp<°r part ncium. 

is inragiitated in the lower, as in an inlmsusception of the 
■malltr intestiaes; but willi less mischief in the proiwnt 
instance, as there is more ftpoce for jiluy. und as the inu-t>- 
tinal canal evinces less Kemibility, and conKcrjucntly nduiits 
of harsher treatment in it« prugresa towards its lower ex- 
tremity. In thin case, tti« whole we can aim at is to 
strengthen the tibicsof the relaxed bowel, and rc«tore them 
lo a healthy elasticity by the use of tonic and astringent 
injections. 

I Inentonic or spssmodic vxania, it will be oneii necessary LtMbs 

to apply leeches, mid to Weed pcclty freely before a reduc- o*^ n«««- 
tton can be obtained. Aller which, as this is chiefly a Kcoad 
result of spasmodic stricture, or depends u|)on like causes, vwitty. 
tbe mode of treatment already recommended for the one 
will be the bc«t plan to be puroued for the other. 

This complaint is also found occasionally us an efi'ecl m rmindMs 
Jithiaais, proctica marixca, helminthta iwdicis, schirius of ^^^ 
the prostate gland, fistula ani, and other aJlections of the oiiwt di>- 
utenis, vagina, bladder, and neighbouring organs. '****' 

n i>2 




CLASS I. 



C (E L I A C A, 



ORDER II. 



SPLANCHNICA. 



DISEASES JFFECTiSG THE COLLJTITfOVi 
VISCERA. 

OIKQL-IET OR UIBtLAliKU ACTION IN Ttl K OBOAItl 
AVXILIARY TO THS DtGRSTIVK PBOCKSS, WITMOUI 
PBIHAkY IMrLAHMATION. 



Ct-AM r, Thb order of diwasta. upon which we now eiit«r. 



Order It 



Mci, lli 



present clawiflcation denominated 
(snAAraKlKA), M primarily alfecting, and being «■ 
in, ihe vistcvni that ure directly adjuvant to the function 
digi-«iion. The term Stlanckmca ia thus reduced 
ita more limited n»d rniphatic •ense: for, in a Ioomi 
broader aignificntion, it in)|>ort». like its Latiu aytionyi 
viueru, all tiic liirgnr bowelH or iittfinal organs, to wliatct 
cavity they appertaia. and con»equentJy includes the bruini 
1u mcuiing by( in im stricter and nions exact meaning, it was formertyl 
inntfit u- confincij to thowe of the uppvr luid lovi<:r livlly, compristnfj 
'■- whiit wv colloquially call the Kktkailh; itnd more es): 
cialty tho»c which were consultvd by t)>e aruepiccs, 
eoivtlitutcd the chief parta of the aacnticc: in which 
it ia mostly employed by Homer, aud Die Greek tragedianA. 





CL. I.] 



DIOESTIVB FUNCTION. 



[ORD. II. 



405 



The organs, therefore, to which the term is here intended Club i. 
to be applied (for the alvine canal forms the subject of the qI^^ 
first order), are the liver, spleen, pancreas, mesentery, and iDctudad 
omentum ; and as, in the phyBiological proem to the class '™" "• 
before us, we took a genera) survey of the structure of 
these organs; and, so far as we are acquainted with them, 
of the parts they respectively fulfil in accomplishing the 
economy of digestion, we shall proceed, without farther 
delay, to a consideration of the diseases which belong to 
them under the proposed arrangement. 

The order embraces four genera : 



I. ICTEBVS. 

II. HELSNA. 

III. CHOLOLITHUS. 

IV. PARABYSHA. 



YELLOW JAUNDICE. 
BLACK JAUNDICE. 
OALL-STONE. 
VISCERAL TUROESCENCE. 



Of these, several comprise numerous species, which will 
be noticed in their respective places. 



4M 



CL, I.] 



COELIACA. 



[Otfl. 



GENUS I. 

ICTERUS. 

YELLOWS A UNDICE. 



l?av luinnl 

by ihr 
OrMkt anil 
fiomuui 
6iiin un- 
nttain ci;. 



'Pntwble 

OfMnoT 
boihihr 

(Itnk and 
Romui 



IfELI-OWNKSS OP THE EYES AND 8K1N ; WtllTK FECKS; 
UKINK SArFRON-COLOUttED, AND COMM t KICATIKO J 
A SAFFRON DYE; THE CnVKBE OF THE BILK OR>| 
8TUVCTED. 

Til IK disorder uas by the Greeks dciiomtDaled icTSRrsI 
(IKTEi>D2:)as nbovf, and by the Rotiiana, as CeUiu f*t'\ 
ticularly DoUceti, Morbus arquattm, or Morbus regius: but J 
OD what account either of these names baa been ^veo to] 
it, we haw no t^ntisfactory iDformation. Arquus mMM iJ 
rainbow, which requires more explanation than has hithertal 
been given; and the meaning of regius, as expounded 
CeUua, will, 1 apprehend, content very few. " Ita care,"! 
says he, " is to be attempted by exertions oferery kind,] 
luso, joco, ludis, lascivia, per quae mens exhilaretur; os] 
Qvx. itEciius MORBUS DiCTVs vidktl-h':" — ' by pUyJ 
jcstK, sports, and dalUaoco, on which account it seems 
be culled Morbus rcgtus. or Uic royal disease.' It ha« a]« 
been named by many writers, ancient as well as mode 
Aurigo, evidently from its golden hue. But, of the origini 
or meaning of icterus, wc are lefl altogether in the dark b] 
the critics and lexicographers. It appears to the pr 
author, however, probable, if he may venture upon a suli 
jcct which has hitherto bcvn tried in vain, (hat all 
tennit arc expressive of a common idea; and, though 
derived from a common root, arc employed as equivaleotsi 
to ex|>r«s« its meaning. Icterus (lirtpoc), as it seems 
him, is the Hebrew term in: with a formative • producinfj 
•ma* or "icier," and imjwrting us a verb, " tosurrDUod,cir- 
cumfuse, encompas«;" and, us u itoim, "a royal crown, o( 
golden diadeui." Icterus was u term also given to 



■ MdUsin. lib. Hi. wet. ul*. 



CL. I.] 



DIGESTIVE rONCTrON. 



I 



goldfn thrush or golden pheasant, on account of its golden 
plumagf : and hence the bird vrtis fabled to be connecteil 
with the disi»Lsc; and it was believ<^d, accoixling to Fliny, 
that if a person tahouring nndcr the jaundice should look 
at the pheasant, the bird would die. and Ihe pationt re> 
cover. RegiuB, arquatus, aurigo, are not indeed univocals. 
but very clearly equivalents, and equally import gold, 
golden crown, golden bow, or circumfusion : the colour of 
tho diMave, and ita encompuscing the body. There aro 
other diseases, however, that produce, or are accoinpwiicd 
with, a yellow tinge of the surface, as well as jaundice; aa 
aurigo*, and sometimes porphyra or scurvy. I'ranlc men- 
tions n case of the latter, in which there wiik qu intensu 
yellowness of the whole skin, chiefly proceeding froin broad 
macula), even lo the palms of the hands and soles of the 
feet-f-. But, in all these cases, the albnginea is little or 
not at all aflected, and the urine does not communicate the 
saffron dye of jaundice. 

There is, however, a far more important inquiry im- 
roedtateiy connected with this subject, which I am afraid 
will be still less easily settled. We are sufHcienlly ac- 
quainted with (he seat of jaundice, which is the liver, and 
of its protimale cause, which consists in an impeded flow 
of the bile ; but who shall explain to us the real use of the 
bile, or even the final use of the liriT, that scerctce it? 
Considering the large size of llic liver in nil nniuinU tliat 
possess it, und, at the same time, huw generally it in (tofr- 
ses&i-d, being, to nil red-blooded animals, as common aa 
the heart itaclf, there can bo no doubt, that it is of groat 
importance in the nnimnl economy, notwithstanding our 
uncertainly of ihc part it performii. 

Even below the rank of red>blooded aniroaln. we often 
discover it, und of great extent; as in the auail, oyst«r, 
nnd muscle; and frfrquenlly, too, where we cannot trace 
an organ answerablv in structure Mid appearance to the 
liver, we nre obliged to lulmit the existence of an oi^^ 
that supplies ita place; for there are many insects, as the 
larvte of the ci/nips quern, or gall-fly, and that of the 
rnreufio nueit, or nut-weevil. that aeerete bile in sucli 



* CImi VI. Ord. III. tirii. x. Itpcc iv. 

t Dc Cui. Horn- llcnb, Kplt. lam. <rl Ub. ri. 



Ollin diK 

ydiA* ilnits 
aftht »ur- 



WhMt ih< 

UK of lliu 
bile I 



or of [be 

Uiw. 



found in 
■niniil) of 

nay nmki 

tad bfle 

KCNIcd 

tTcn vikcra 
no lint li 



■Uc. 



H 




Am 



CL. ij 



caitiAC«. 



[OBB. II. 



Ok*. I. 



UtO. 



r 4ii»- 



Bob 



rwofd 

Uui in 
-kkhk 
iraanol 



PoHmdo 

Mdmlrw 

bbik. 



WhttWr 
iliF Inlc wl* 
MMlni. 
■utvpw 
■balntt*- 



({ttuibty M to beg* with « brawnuh-jtrUow the trader , 
bnock, Dnt, or oAct substance, in which they fiml m'. 
bsbttaMB. aad to give h • Ua(c •■ btltcr bs ox-galt. 

ne diract aod obyinw oflke of tbe linr is the seerebon 
of bile, which, in moet animola, is Eoffcred to accomolmte 
ia • pear-shaped reaerroir, adhering to itB eoacave surface, 
and deaooiiiialed a ^l)-bladder. Yet in many antBwIa. 
even of difiereat cl— «, we perceire no •aeb reaenroir, m 
tbeelephaot,ihiBOceraa,atag,c&ntel, goat, bone, trichecui, 
porpoiae, rat. oKricb, and parrot: while we do ttot know 
of a reptile that ts deatitntc of il. Upon the whole, how- 
ever, it may be obaemd. that a gall-btaddn- is common 
ia all camiToroaa animaU poasessing a liver, and that it 
aeems to be only wanting in those that feed oa vegetablea 
alotw. Yet, while we fi«e the distinction, w« are ignorant 
of its cause, and incapable of appl\-ing it. In the haman 
sobject, it has sometimes also been wnnting*. or which 
Dr. Chohneley gives an examplct: bnt such a deBcieticy 
has mostly (lectured in infants who have perished soon 
after birth; before which period, as ihcrv is no tnincit of 
feces thnmgh the intestinal canal, and perhaps no peri- 
staltic action, it does not appear to be necessary. Perhaps. 
indeed, atilcccdently to birth there is no bile tccrete«l. lu 
the case rdated by Dr. Chohneley. aliliuut;b the whole of 
tbe bile, as fast as it was Keeretcd. seems to have b««i 
carriml back into the sj-Ktem. the uillownesN of the skin is 
not noticed to have occutTcd till the day after birth ; (Von 
which tniM (he child exhibited a deeper and deeper hoe. 
till it died of conwlwons at tli« end of five weeks. 

[According to Meckel, the want of ii gall-bladder does 
not alwajr* dangeiouflly impair the health f; and an ex- 
ample in which a person, with such mallorniDtion, reache<l 
the adult stale, has l>een lately recorded ^. Cats bear tbe 
renooval of the gali-bladder without fatal conscgnencesU.] 

It »as staled in the physiological proom, that one eup- 



■ Oliticr. now hot I'ntreptile it W rkinik biUuPt, la Awhif . OH. il« MU. 
Mn. I. lb IML 
t H«d TruH. Fol. it Kt. it. 
i HMtwl d'Anttonile, Km. Hi. p. *n. 
9 tUai. dr Mrd, Militaln, imt. it. |>. 4M. 
n tli> H. JJocc PhU- TniM. 1813, |W1 IL 



CL. ij 



DIORITIVK FuncrioN. 



[OBD. II. 



409 



paw^jm of the bile \», (u iimiiil;tiu tli« (wrUtiiltic uclioii of 
the boweU. Yet Sit Kvcnird Home * has given on vxnmpU; 
of a child UiAt feci heartily, seented to digest its food well, 
aod had regular AtooU, and was iieverthele&» without a 
gali-blitdder, or even it <luct of ajiy kind leading fioiu tlio 
liver to the duodenum. 

There urc al»o n few other circunutancos rolatinf; to the 
bile, that yet «taiid in lu-ud of cxplutiatiun. The hepatic 
bile, or that secreted into the hepatic duct, in mild and 
■neet; the bile fouitd in the gidl-bladder is pungent and 
bitter; whence we might infer, that it is the ^ll-bladder 
that s«cr«le!t the bitter |>rinciple. Yot in children the gull- 
Uadder bile is m sweet u« that of the hepatic duct ; and 

I in various insects, «» wo have Already seen, a bile power- 

: fiiUy bitter is secreted without either piU-blttddcr or liver. 
Who »h»U dovekip the cause of these dincrepanriea? Who 
shall unfold to us the use of the bitter principle of the bile, 
or expUin why it is necessary to the luuraal economy in au 
adult state, and not necessary in a tttnte of infancy ? 

Vet, whatover bo the use of the bile, or tlie office of the 
liver, we know that the general symptoms of jaundice de- 
fend upon an obfltniction to the Dow of the bile into the 

jalvine canal, and its retro ^dc pniiMige into the blood. 

I [Thus, in animals, jaundice may be produced by jipplyin;;; 
a ligature to the ductus cbolodochus; and, in the human 
subject, dissection has frequently proved itjt origin from 
the direct or indirect pressure of variuu:; swellings; and in* 
duniliooa, eithcrof the paucrea*, stomach, Mploen. omentum, 
and other organs, against the biliary ducts. The jaundice 
occasionally arising in pregnancy is sometimes ascribed to 
the pressure of the gravtd uterus on the same canal, and 
sometimes to a plethoric statu of the system, and of the 
liver in particular, in consequence of the aupprcesioo of 
the menses, which last opinion was t-jipouaed by Sauvages, 
Portal, and Powell.] It ha* been e>uppased, indeed, tliat 
the bile might, after entering into the intestines, bo ab- 
Rorbed and carried into the blood, and by this moms pro- 
duce a jaundice, and a jaut»diced hue, without any ob- 
struction to its (low into the intestinal channel. But, in 



Hen. I. 
Tint Blnyi 

DCCOMTJ' w 

digetUon. 



DifTcnDOC 

bciUfen 
hcpadi: uid 
cjuic bilr. 



VTbf ibSt 
dlflbuicc!' 



Obifnicud 
Hov or bile 
ihe OMUC tS 



I 



• PtiO. TnM. ISIS. pp. 138. is;. 



410 

OlM. I. 
ICMVI. 



Pteiiuxi 
horn fln 
dlMlixt 



ri.. I.] 



CffiLIACA. 



foBu. n. 1 



this case, it «e«nu impoMiblv, that the Moots iboald not be 
lingvd with a yellow, instead of presenting a white hnr, 
whicli is one of (he common chamctcn of the disease. In 
onk-T to conslitutG jaundice, there mast tlicrefbce be some 
obstruction to the i>aiuage of the hilc through its proper 
ducts into the intestinal canal- And this obstnictioo any 
proceed from five Eourcea, each of which may be nccon- 
panied with peculiar symptoms, and consequently furnish 
ofl with the fire following species: 

1. tCTBBVS CUOLXVS. BILIABY JADKOICB. 

2. • CUOLOLITUICltS. CALL-STONr JAt'NOICI. 

3. • SPASMODICf 8. 

4. BEPATICL-B. 

5. IKFANTtlM. 



SPASMODIC JAtlNDICK. 
IIBFATIC JADNDtCB. 
JAUHOICE OP INPANTS. 



The disease is also found symptomnlicaUy in pregBaocjr. 
colic, and feren of variuus kinds; cspeciBOy fptnuiiu 
ieUroiUi. or yellow ferer. [It is generally a spomdical 
complaint, but instuDces of its being opidemic, [mrtJcolsrly 
at the termination of campaigns, in wet aiitunitial seasons, 
and bIso of ita being endemic. are recorded*. Thedrseue 
o[^e«a to have been epidemic at CraHtndt in 17H4 and 
1785, and at GeueTa in 1814. In the latter city, it oe< 
curred after the hot w either ofaummer.boiogia some aiss 
combined with a bilious lever; in others, noi a«MiaialBd 
with any other manifest diaofder f.] 



• 8« H«m en ihc Qi>IJi af SoVOm, S toll. am. ITSO. Vi^b m 
IlwMM* at dK Any. cain. iBlo. Altben. NtMbfk Nantdk, *c «» 
Pin. I HI 7. *t. 

t tSce Din. ilea Sdcatn UU. Mn. nSL p. 414. 



Ct.. I.) 



OIOESTIYB rUNCTION. 



SPECIES I. 
ICTERUS CHOLJEUS. 
BILIARY JAVymCE. 






THK COCRSB OF THE BILE OBSTKVCTBD; UKKERAI. 

lanvvor; naussa; DY3Pei*sY; and occasional 
rAlK OR CNBASINRSS AT THE STOMACH. 

The specific lena cholacua (xo^^^oc) is here restored 
frDiD the Greek wntere, oinoiig whom it has 1)eeu comiiioa 
firom the time ofHippocntcH. 

Dr. Cullen has not noticed this species: bul it occurs 
in Boitet, Aoaatua Lusitanua, Forestus, Sauvages, and most 
of tlie later writers. It is easy, indeed, to conceive that 
bile (DRy become inspissated from various causes, and 
particularly from an absorption of its ac^ueous or thianer 
parts, by iho lyuiphaticH of the ducts themselves, or of the 
gall-bladder i from an augmented secretion of the albumen, 
or, as Berzclius considers it, the mucus of the galNblsdder 
dissolved in tht- bite; and from too viscid a texture of tho 
bile, in its secretion in the liver. And, in effect, tlicrc arc 
few observant pmctitioncrs but must have remarked Uiut 
the evacuations, whether by tlie mouth or tlic anus, when 
the obstruction is jii>t removed, consixt at liincn of nearly 
pun bile, peculiarly tcnncious and high-coloured. 

[After the bile is secreted, if the hepatic, or the common 
^uet, be olistructed, so that the passage of this fluid into 
the duodenum be prevented, it regurgitates into the liver, 
and is taken up by the absorbent vessels, and carried into 
the mass of tho circulating blood *, in the serum of which 
it becomes dissolved, and thus gives it its own yellow 
colour. The blood, thus tinged, carries the dye with it to 

* The •ciimI prpMcc tt bflc in tbc blood of jaun^nal pmoni la dcnjnl bj 
\l. Devmx (ConiUAailwu CMmlqaa rt HMtotln wr U Mog da Idiriiiuti, 
410. Porii, lonO>i inU dcnibtol cnn hj U. ThsiwnL On the caoonrj, ilia 
nMalcbn of Bt. Cluion (Jouin. ds AI«d. ta \3), Orflla (fdcra. de (.'hiiu, 
•M.), Baund.n, ASbttt (Notot Natiuitle, 1SI7}. and mhin, und n protc 
iIm «on«uiaa ti ihe btllif, ■> anncni m UlppocnUc^ itut Jic litl: pmm* Inw 
I he dtculMloB. 



Gev. I. 
8rEC. L 



Spccica nM 
noilwd bj 
Ilr.Ciaio), 
bul bjr »• 
rlmitMliaL 
Kla n>r be 
luipinaicd 
Froni if»n- 
aua< 



412 



cu. I.) 



CfEtlACA. 



[OSD. tl^ 



GSV. I. 

I>VKC. I. 

Icuni 
ihnlmu. 

Bile ab. 
tmbnl inco 
(be blond. 



Found moat 
rmiuenily 
tn Ac 



he 
juituma. 



every pnrt of the body, und lieDce ibe general hne of jnun-l 

dice is produced. It would eeeua, however, that the bileJ 

in a liver dixtended from ob&tructton of Ibe ducts, is noCl 

only tuken ii]> by the nboorbenta, but is bIao forced intM 

the nioiitli» of the liepatic veins. In di^isections. Dr. I 

Sauiident And Dr. Powell bolb noticed bile in the tbnraciol 

duct; And the first of these physiciauB found llie serum ofl 

the hepatic veins in a dog. in which jaundice had beeo ft] 

short time before produced by a ligature on the couimoa I 

biliary duct, evidently more loaded with the colouriag part I 

of the bile, than the eerum in other veins*. When the 1 

bile reaches the circulation, the intensity of ting«, which I 

different parts receive, will be in proportion to their vaMo- 1 

larity, and the quantity of colouring matter thus carried to J 

ihcm ; or to the niitural liuc of tlic part being more or less I 

calculated to i^how it, an in tlic eye, and white of the nails.] I 

This spccieH is found most generally in the autumn. Id I 

many instuncen it commences slowly and insidioualy; ther« I 

is felt n general rc«tlc!t«neHs, diminution of appetite, dis- I 

I llovoom. turbed (deep at night, and disinclination for exertion of j 

f ^ ^ any kind: the urine ia of a deep-yellow, nnd deposits, I 

ryniptouu. perhnpo, n pitchy fodiment; the ImwcIs grow sluggish, the I 

di-jcctions arc clay-colottred, or nliitish, and have not the I 

I UKual feculent itmcll. In Hotnc examples, however, the I 

^^^^ bowels are loose. The eyes and surface of the body look I 

^^^B yellower than usual, nnd there is n very troublc«omc itching I 

^^^^1 of the skin. In thiii sjH^cies, however, there is little or DO I 

^^^V pain in the right hypochondrium, nnd little or no tickncM I 

^V ut the stomach, though a frequent sense ofnausea. I 

[In all cn»cs of jaundice, exc«pt such nit ore very end- I 

(lonly produced by the bites of reoomous animals, and I 

other particular catiitcs, the yellowness commonly lint I 

shows itaelf about the inner angles of the eyw, iho white I 

of which is tarnished in a very early stage; but the whole I 

P*ra tn cornea eooD becomes manifcHtly yellow. On the temples, 1 

rdi^''M ''g'"-ycllow patches are next seen, which daily assume a I 

Amihov* deeper and deeper tinge. Similar yellow disooloratiofM I 

'**^- then appear on Uio face, neck, and breast, ititd all at len^ih I 



* 8ce >aundm on ihe .■hiucium, Baanom;, and DIwm at lbs Liw ; 
fovtU'i fibi. on ilio llfli, |s. SSj ttaidiiui, in R«a't fjrliipMrtli. uu 

J-tl-kDII E. 





oi,1l.l ■ 



DIoeSTIVR rUNCTIUN. 



[»IID. II. 41$ 



spread aiu) unili', so a» to cauw an universal tinge. Yellow 
iieaitcircluH nt the roots oftbe nails make their appearance 
very cariy. It is a curious circumstance, however, iti the 
faiatoryofjnumlicv, lliut the yellow <lyc of the skin should 
graemlly fin«t »liow ilMclCon the upper partx of the hody, 
which ore likewise the first to rcsuniv their natural colour. 

The tongue, palate, and teeth, have a yellow coating, 
not reniovableby repeated washing. Whatever the patient 
put« into his mouth frt-fiucotly lias a hitter taHtc; and, 
indeed, the bittcnte«s in the mouth is very annoying, even 
not at meaUtimes. A partiaUty to acids and sourish food 
i" aliw Kcnerally exporienei-d. 

In thin nflcclion, the pulse i» ordinarily foehlp. In the 
beginning, howerer, parlicularly if tlierv be any pain in the 
hypochoitdriuiit, it M hard, and even frequent and full. 
But, after the pain Kiibsidcs, the pulse has been known to 
sink to only tliirty strokes in a minute, some examples of 
which are reiwrted by M. Andree*.] 

In on enrly sla^ of the disease, free vomiting is of 
csicentinl service. Duriuj^ this action, the diaphni'^m und 
abdoiitiual muscles contract concurrently; and the whole 
of the viscera of the abdomen are forcibly pressed upon. 
Such a pressure must necessarily, therefore, adect the 
gall-btadder and biliary ductti, and oblige them to pour 
out their contents very freely: nor is there a more ]>owerfui 
mean in our possession of unloading the liver of any viscous 
or stagnant fluid, or of restoring and invigorating its cir- 
culation. For this purpose, tlie antimonial emetics are 
preferable to those of ipccacuan. Tlioy are less readily 
rejected, and excite a stronger stimulus from tlic fintti 
and hence the vomitings they product? will continue for a 
longer period of time. To these should succeed a brink 
purgative or two, with a copious use of dilutiog, sub-acid 
drinks, which, in ordinary cases, will easily remove every 
symptom. Dut if the disorder, from the obscurity of ils 
march, be not sooii sus[iected, the impeded ))as&u^ea will 
become more obstinately ob«tructed, tlie gall-bladder and 
bih:-du(;lx will be distended ; there will be a general feeling 
of fulness in the right side, with great irrilalion and fever; 



liSH. t. 
8prc. I. 

IcMrUt 

cholaiw. 



Sun oft 

Bitia tuie 
in (hr 

Dioulh. 



PulM, 



manniai. 
Toniltiniti 



with uiij. 
monial 



Bilik 
puiftU* 



Emru 

nlwn 
chronic. 



I 



SMDickdMSdenonHU, iDni.uliLp.MB. 




414 



ct. 1.3 



COtLIACA. 



[oitp. II. 



G». L 

Sfic. I. 
iMerui 
<holau>. 
Atfuniutk* 
lion of bile 
In the gall- 
bUitdiT 
MiincUma 
rfroriiiouh 



wliicti last will otiea coutiaue for a M-««k or a fortaigbt 
afti^r the obvtxucting cause lias been rei»ov«d. 

Where the substaoce of the Uver has been free, and th« 
diicta alone obstructed, the quantity of bile that has accu- 
mulated in ibe gall-bladder has sometiRteg been enormoiu. 
In one instance, which terminatod fatally, this reservoir 
vraa found, after death, to be m) considerably dilated, as to 
be loaded with not less than two Scotch pintu, or eight 
pounds, of this fluid*. [Whether this case ought lo be 
received as a confirtnation of the statements of Galen, 
Darnin, and Powell, that jaundice is sometimes the result 
of paralysis, from an immoderate distention of the gall- 
bladder, is a question not easily solved.] There is often a 
paresis or hebetude of action in the bile-ducts themselves; 
and where we have reason to suspect tltis, it will be moat 
eflectually relieved by the blue-pill, or small doses of ca- 
lomel, or Pluoimcr's pill, which is belter than either, con- 
tinued for two or throe weeks at a time. If the Urer par- 
take of this torpitudo, and no acute symptoms occur, the 
disvruM! is apt to run into the fourth species, and must be 
treated accordingly. 



SPECIES ir. 

ICTERUS CHOLOLITHICUS. 

GALL-STONE JAUNDICE. 

THI COURie 0I> IIILK OKSTKUCTEn BY BILIOOS CON- 
CIIKTIONS IX TUB DCCTS. WlltCIt AHK AT LKNGTH 
rROTItUI>eil AKD UISC'HARGKD WITU Til K FECES; 
PIIKQVKNT RBTC'HINO; ACDTB PAIN IK TUB HYPO- 
(iASTRlC REUIUN, INCBEASKD t'FON EATING. 



Ou. I. Tins Species i« the iWcrwc talcuhtut of nioet of the 

»c. I. {iro9ol<^8t». It is 80 closely connected with the genus 

wnniriol cBoLoi.iTHUfl, or OAM.-STOKs, forming the third in the 

«iih gill- ^-^.^^_^^^^^^^^^_^^^__.^_^^^ 

Moncw 

dioWlltiiu. ■ Uln. Mnl. VmijK vol. n. Ht. si«. 




cb, b] 



UICKSTIVB FUNCTION. 



present order, in its general origin, aymptatiis, and mode 
of treatment, tliat the read«r laa^ be referred for almost all 
tliwc lo tJie latter. Yet it is Deceseary to give the two 
afleclkwut diHlincI pUce«: for (lie ycUow dyv of llicHkin 
aiul urino. which foraiB a pathognomic symptom in ictvruB, 
OGCura often, as tve have already seen, withont cbololithus, 
cTcn in its passing species and acute state, and very ge- 
nerally in its quiescent state- The lirer it&cif is. in many 
CUATH, Hound*: but it is often connected with a morbid 
condition of this orgsn, and proceeds, perhaps, in some 
iiuitiinccs, from a morbid secretion of bilv, by which it be- 
comes more disposed to crystallite. Dissection has shown, 
that tho seat of obstruction is most frocjuvntly in the 
cystic duct; next in the ductus choledochus; and iht-n in 
the hepntic. The rest will be explained under the gcniM 
ciiot.oi.iruus. 




SPECIES III. 

ICTERUS SPASMODICUS. 

Sl'ASMOVW JAUNDICE. 



r 



THS COVBSr. OF THE alLB OBSTUUCTEO BY A SPAll- 
MOOIC CONSTBICTION IK TUB COURSE OP THE IDLE- 
diictk; Tiie disrase commonly FHiXEnen nv 

Af^SIMONIUUS INOKKTA, IIVSTKlllA, OK SOUB VIO- 
LENT PASSION OF TIIK MINIt; AKD SPONTA N KOU8LY 
Sl'USIblNC WITUIN A VKVf OAYS AFTER TltSSB ABB 

RKMUVEb. 

Tk e general symptoms of this aCTection are those of the 
preceding s]>eciea,or of Mo/o/rf Auji meanj, which so closely 
agree with the preceding: but the causes and mode of 
treatment are ditlerent; and it is necestiary to attend to 
their specific signs, in order that tbey may be distinguished. 

Spasniotlic jaundice occurs for the moitt part in thoM 
of irritable habits, or whose liver, from a long residence in 



ocH.r. 

SrEc. III. 

Rnnnhtai 
thr pc*- 
otdinK In 
lyiiiptiini), 

bul n« in 
moilc of 
curr. 

Pttholog]'. 



llttXKlrri, M«<I. Tnni. to). IL p. 114. 





416 



CL. l.J 



CISLlACA. 



[OKO. If. 



Okx. I. 

Hire. Ill 
IcirtUi 

ditut. 



hot climates, tmm an undue iitdulgenm ill ipinUiou* |iola- 
' tions, or bigb-seasoned dUb«s, or from any utUet c«uMt is 
tn a state of chronic irritability. So far as I have obwrvvd. 
it occurs more frcqucatly in w-omeo than in men, pn>b«bly 
from thfir paadng a nwre scik-nUry lifv, and chiefly afiuf 
raenBtruRtion has ceued, aiiO the geacnil form a&sumab# 
more corpulent shape. 

Thvrii is abo v«ry commonly, in thosv who arc Bubjoct 
to it, u MillowncM ofthfi skin, indii-ative of irritability and 
increase*] action of the liver, and of a larger rogurgitatioo 
of bile into the blood-vcssoU than ia necca&ary for tlie pur- 
poae of health. Dr. Ht:1>i>idcn faiu obserred that tiic liver 
iit sometimes perft-ctly «ou»di and there is no doubt that 
this is a fact; for the irrit^iUly may originate in, and be 
confined to, the ducts; but it more generally commences 
in the liver itself, and is hence ext^-ndcd to tho ducta, 
which, from lli<?ir ittructure, are far more irritable, as w^l 
as more sensible, tJian the parenchyma, or general subfitoim 
of the liver, and coDKeiiuently far more susceptible tff pajii 
and spasmodic conlructioii. 

[Spasm of the common duct is particularly tuentiotwd 
l>y Dr. CuUen among the causes of jaundice, aad Dr. 
Powell deems the fact well eatabtished, allliough it hu 
often been dented. M. Amlral enumerates four prirHi|NJ 
cituses of the complete or iucomjilete, temporary or per- 
inttnetit, obainiction of the biliary passages, viz. the lodg- 
ment of a foreign body in them; their comprenkm b^ 
membranouit adhesions, or some kind of tumour; their 
Kpwmodic contraction; and the thickening of their mu- 
cous membrane from inflammation *. MM. Jourdan and 
Dreschet, however, have espre&sed their suspicions, that 
the latter stale also prevails in ever)' instance reported to be 
spasmodicf. Jaundice frequently accompanies spamnodie 
diseases. Thus it is said by Sydenham to come on during 
hysterics, a circumstance which the editor has never seen, 
and which is denied by Dr. Heherden. According to Dr. 
Saunders, anger not only augments the quantity of bite, 
but likentfic vitiate.-)) it. Hence, flowing into the doodenam 
in larf^e quantities, and regurgitating into the stonucb, it 



* Ardi. Qin. io MU- torn. vL p. IS. 

t Maniid d'Aiul ]wr J. J. Mwlwl, mm. lit. M*t, f. tfSl 




CL. i:} 



DICBSTIVB rOKCTIOK. 



[ORD. II. 



4r 



prodacoB tin wedc offecU as an emetic ; nn«l hotw«, pro- Urh. i 
lubly, the term ehotrrtc. as applit'd to passionsto peo]>le. ^^"''- '"• 
If the ducttu communis Hhould not transmit it as last as ipumo. 
it ifl aecreted, uid the ^ll-bladdcr bu tOrcady full, then it^'"*- 
will retnra towwda the lirer, and, by eiiteriiig the blood- 
vawek, prodacc jaundice*. Dr. Bfttcnian regarded this 
as tb« most probabk- citplnnmion of the influence of the 
paniODs in producing a temporary jaundice, und of course 
he did not put much fnitli in tho doctrioc of spasmf. 
Among the lcs6 common causes of jaundice, a thickening 
of the biliary ducts is mentioned by Moigugiii, who recorda 
n case of a total obliteration of the common duct}.] 

The primary cause of thia disease we cannot always Chmm. 
trace; but it is easily reproduced in those, who are subject 
to it, by flatulent, acrimonious, or indige^itibte food, or by 
violent mental emotion. It ih often a1»o reproduced, or 
eren primHrily excited, by cold in the feet, drinking cold 
mtcr when the twdy w greatly houtod, and a tr^nisfcr of 
atonic gout from the cxtreinilics to the stomach, ur any 
partoTtbe intestinal canal. We have hence a clear proof^r"^!"- 
of the strong sympathetic connexion, which exists between *X"I^ 
the liver and yarious parts of the body. [The jaundice *>""nhcr 
umetjmes produced by corporeal suffciing, irritation in*"*^ 
the alimentary c«ital, and tho bites of venomous animaU, 
is referred by Hofliuann, Mead, and Bosquillon, to the 
^Msmodic species.] An aflection of the brain will also 
often produce jaundice^; and hence a frequent exciting 
cause is a sudden and violent burst of the depressing pas- 
fiions, as tenor, jealousy, and despondency. It is, indei.^, 
most probtlble, that t}ie torpitude induced directly in the 
organ of the liver, from the exhaustiog heat of tropical 
, is also greatly augmented by the operation of tlie 
^abse on the skin, and the tiympalhy of the liver 
with this organ. 

The disease is ushered in by a sense of fnlness at the Oacriptkn 
stomach, accompanied witli great lanij^uor and nausea; a 
violent pain at the pit of llie stomach noon succeeds, with 



* Smndat, p. 93A. t Rcn'i CrdopodU. «ft. Javvdick. 

t DtOHuitnSnIibuiMorb. Epiit.a7-«t. la 

■I CaMiof Jwindlcc. !lc hy (Icnty M«nh, M.D. Dublin It^pons, vol iii. 
VOL. I. R F. 




I 



4)8 



Obw. I. 

Sne. III. 
Inaw 



CL. I.] 



riRLIACA, 



[o«D. II. 



Volbw 



an almost inccBsant eickneEs, and au utter iit&biU^ of i«- 
Uintng either food or mediciiu! of any kind. The pun 
grows intolerable, and shoots toward* the left shoulder, 
or spreads round the loins, and girds them u mih a cord. 
The epigastric region im gr«Btly di!>t«rul(^, and cttnnot ao. 
dure Ihfi prensure of Uie hand; while tlxt pulse cxbibtu 
little variation. 

The liowela are for the moftt part costirCi and mond 
with dilliciilty. [ThestootaareKanty.orttgrcj-ish, or day 
cf^our, and, as long oit tlic urine in of a deep yellow or 
saffron colour, v»ide<l witli difficulty- But. wJieo this t^ 
cretion becomes puler, they assume their natural yellow* 
n«SB again, are more copious, and the patient begins once 
more to be conscious of the sensation pieceding or nccoa- 
panying their natural expulsion; a sensation, that is lost 
trhile the bile continues to tinge the urine in a consideraUe 
degree. It should be underitood, however, that costive- 
ne!«doe« not always pri-«4-dc, or aitend the fir»t symptooM 
of jaundice; but tut Monro, I*riu!;le, and I'ciwell attcM, 
there is sometimM a eoiisidemhle Iouscmcm, with g;reyiah 
stools of a faint, or rather sour sniell. At lirst the urine i» 
yellow and (|tiitc- limpid ; but it afXeraitrds bvcomcs froiby. 
saflron-colourvd, reddish, and very thick; sometimes ■)• 
moat black, depositing a sediment like brick-dgat, or daik 
blood. In proportion as (he yellowness of the skin Adcw, 
the urine lo^es its satlVon colour, and becomes clear again.] 
This colour shows itself the sooner in proportion to liis 
violence of the other symptoms, and oepecially of Uw 
retching ; aiMl the surface of the t>ody, and espocially llu 
fine Hcterotie ooat of the eye, UHnuiuc the »amo livery. Ai>d 
if the disease Iwcoine chronic, tliu yelluw dye is uot con- 
fine<l to the skin, or even to tlio fluids, but pervades every 
irart of the body, the most coni|>«ct oh well as the nwsl 
porous; ho tlint ihe pericardium, the hL-nrt, the perito* 
neum, the meninges, the substance oftlio brain, the car- 
tilages, and even the bones, are clothed with the common 
colour. Stoll*, Lieutaud^-, Dartliolin j;, and Alorgngni 




■ lUl. Mti. Pact. Hi. p. 360, M pwiia. t H^i- Anu. p. IPS. 

t Kpiw. w. p. 410. $ Do Sed. #( Clu*. )lorU Ef^l. nxrli. an. T. 



1 



CL. t.]' 



niCKSTITE FtlMCTION. 



[»HD. II. 



419 



^ive varioutt cxamplm of tliio ; tliuugli th« lust observoB, 
that a yellow lingc of the brain is a rare occurrence. 

One of the latest fluids that hccomcR tincturt'd » the 
milk in icteric wet-nursefi; probably in cQn!M.>t]ticncc of its 
rapid |>af«ag:e and eJslwration front tho flutdx introduced 
into tJie Ktoniach. Dr. Hcbunleii hax rvinarkod, that, io 
w ct<tiiir&oii, (he milk m never tainted with the bile either in 
taste or colour ; but thut aiufcrtion is too general, and at 
variance witit Uie observaltonn of otliur patbologiHts. 
Reidlin lityn down the fnct tnorc correctly, in affirming that 
ftll th(t humours are wnclimn coloured yellow*. And 
hence, indeed, the only reason we can aseign for the bilious 
aiid bitter taste that is often present in the stomach, inso- 
much that cveiy thing the patient eats or drinks partakes 
of this quality: while tho common bile-duct is locked firm, 
the intestines are without bile, and the stools are whitish 
or clay-coloured. The fact is, that the whole mass of blood 
is so impregnated with bile, that the saliva, and all the 
other lubricating secretions of the mouth, fauces, and oeso- 
phagus, and probably the gastric and pancreatic juices, arc 
loaded with the r-aan: material, so that the sense of taste 
cannot be atherKJ^e than atlected. 

The jaundiced have, from a very early period, been said 
to see all olyects of a yelJow hue, as they appear to us 
when looking through a yollow ohject-glase ; from which 
wo may judge, tJiut the humours of tlie eye, like the other 
fluids oftlic body, are aJso tinged, ojt CeUus observes f, 
with the resorbcd bile, and communicate the tinge to the 
picture thrown upon the retina. Lucretius, so far as I 
know, is the earliBUt writer, of tliosc that have descended 
to our own day, who has made this r«mark, which be in- 
troduces SK iUiistrative of another mbject, and appeals to 
as a familiar fnct : 

LdiuU pttfutet aoni, qiucquomque DHCuir 
Arquaici; i|uU lurorii ilg corfMN conun 
gtmini mulla fluiinl, umulacrii obiia nniiii ; 
UultAi]Uc mat oculli In eotuin dcnl^ttc nlra) 
Qm> oonugt lui palloiflim omiiia fdusual i- 



Onr. I. 
Spic.III. 
Irctnn 

OBI. 

Mtlk iffi^. 
cdUUM. 



Whys 
bltlerufle 
In the 
itiuuUi. 



Wlinhrt 
jtti jrrllow. 



• liin, M(d. iai7. ftht. Ob>. 7. 



t MM&ln. liU. iU. wet iiIt. 

is2 




420 



ct,. I.] 



CUCLIACA. 



[OHD. II. 



Onr.I. 

lelcTui 



(iw. 



dm and 
rnuik. 



AidMtii 



Cltcnm- 
■Imcci ne> 
c m— ry to 
dli>cfl(«l. 



The Jtuodioc*l> ihu(, kc dl ihlngt nnind ifacni ckil 
In jdlam i vrtrj object a< li Don 
MwUhb nev tldv i^ jdlow, fknn tlwir fmnn 
ThNwnlbnbfDciMuit; hmI tb« hitfd ■;<, 
D«tp, MO, Imbued with In taau^ma hot, 
PnnUng ctda imige (hu lu orb muII*. 

Dr. Ueberden, bowevor, nffimm. tliut all the jaundiced 
patients lie hits at any time attended have contradicted 
this opinion, with the exn.-ption of two fcmnU-s, nhaB« tes- 
timony Im lit disposed to hold lightly ; and Profussor Frank 
is di;c>dc<)ly of opinion, tliat no such adcction takes place. 
Yi-t from ft ftingle case in my own person, produced, when 
a student, by hmg-continuod pressure of the epigastriimi 
agaiusl the edge of a tabic in copying my shoTt-band uii- 
nutcfi of mcdicnl lectures, I can conOrm the general opi- 
nion : fur, tlic limt Ktiitpicion I entertained of my Ueinjjaf- 
Teett'd with jaundice was from the yellow liugo with wUich 
every object around me appeared to be arrayed. To pn^ 
ddce thix eliect, however, it is necessary, aa already ob- 
Merved, that the crystalhne letis, and, perhaps, all the hn- 
mouni of the eye, should be tinged, and arf|uire Uie yellow 
hue of the sclerotic coat. ThU certiiinty docx not at all 
times take ptac« ; and where the humours are unafiected. 
objects muBt certainly be seen in their proper coloiim ; b*it 
where tliey are thus tin<!lured. and ioriu a yellow tntiut 
rent medium, it seems difficult lo conceive how n pict 
tninunitied through them can avoid catching thoir 
dye i and hence we may xee why »onie pcrsonv, labonr 
under the jnundicv, jiereeitrc object* coloured with ydluw] 
and otliera in their pro|>er I)ue«. 

{Tliv edituT hax reaHon to think the statement hurv 
by the author, and which iLgrceii with uhiii Murga^ni 
said, relative to ttii« curioun point*, is pcrlcctly cuufinn( 
Dr. Jftnic«, in his Medical Dictionary, numlions bavii 
seen such disorder of vision in two old {Kiiient« aScctt 
wit!) jaundice. Ilollinnnn records two nitinlur cases- 



■ Allqiuuido tuuo^ Md nuiMlnie, fieri potM, ml An* In bat inaAe i 
n^pwtaM, Dimiram ■) tvram timioa bUe tm> atoMU ^ aa^m umi Hiw^1 
(luod u llcKurUU* owMdii, nran «tiHt ri^tunte ocaknoD hmm 
fiirnlint taltal MM. 




CL. I.] 



DI0B9TIVB rUNCTION. 



[ORD. II. 



421 



Alibert iu«t with an additional example in a girl who wiu Otn. I. 
in the Hopital Si. Louih. The rarity of tlitu afleclion of f^I^'"* 
vision io jaundice coiresponda to, and depends upon, llic *pa>nioai. 
rarity of the extennioii of ibe yellowiiestt lo the huinouisof '^"*' 
the eye. with which Htate ProfesHor Blumeiibiich * com- 
bines a rivid perception nnd tippticution of mind, which 
are also very niicoinaioti in jmtndicc.} 

I have said, that Ihi* species of jaundice, and tJie remark ci""""^ 
may be applied to all the spccieo except the last, eome- diicMt. 
tiiDM ■ssumes a chronic form. In this case thedistreasing 
■yaiptomii of eevero spasmodic pains, inlumeacence, snd 
sickness subside ; but the bile does not flow freely into its 
proper channel, and continues in a greater or kits de>i[rce 
to be absorbed and carried into the circulation. The cause 
of tliiH Hceins to be nn insensibility and paresis approaching 
almost to A paralysis in the bilious tubcN, and n chronic 
irriubility in llie hepatic nbsorbenls. Under these cir- 
cunutancCfl, moreover, the bile that thus tardily finds its 
wny into the duodenum must be grosser and more viscous 
than in a healthy stale ; and hence another cause of re- 
tardation and irregular supply. There is also a change in the chuinn 
colour as well a« in the comtiatency of the bile fre(juenlly j'^'' *'"'■ 
to be met »ith in the chronic ittate of the disease i ihc uiic. 
which may Roinetimen be the rexult of a morbid secre- 
tion, but iH ]ierhap!t more generally that of a chemical 
decomjiositton, from the joint influenceof decay and animal 
heat And, under tbetie circumstunces, the bile has at 
different times, and in different persons, been found add, 
acrid, snltish, insipid, whitish, black, green, eruginous, 
Ukd versicoloured. It has been found n* dense and dark 
^etdcr^rob-f-; as tenacious nnd limpid as tbe white of 
X; nnd oa crowded and gianulnr m the spawn of 

In this chronic form, jaundice has sometimes run on for •*•*«" *' 
a long period of time, occasionally for a twelvemonth. It [iniuiwc': 




• Hk Edln. rhU. Jaun. 

t Eph. N4C. Cut. Dk. iii. Ann. i*. Obfc 08- 

t StMRh, Aon. Mid. I. It*. 

q Eph. Nai. Cut. Uct. IL Ann. U. Ota. 9l 



I 



432 



ct, I.] 



CfELIACA. 



[OBD. II 



ciu. 

riou Bib 

Mrt. 



^ 



Omm. L ba» altcniated iteolf with intcnnitteats ; prored a «ali 
£2^ erui* to fevers ; or has itsell' been carried off by exantht 
oT tbe more violent kind; and espeoially by uiliary sti 
scarlet fer«r. The general runclion», when it tius aMsuB 
this foroi, *iid (he coustilution has become hKbibtotad tiiit 
are sometimes so liltlc disturbt-d, that we vx people of thi 
middling and lower ranks of life, who cannot affoRl 
keep at home, and who would certainty be the worse for t| 
if they could , coing about the streets with the jaundice I 
covering their hunds und faces, and not prevented from < 
gaging in any of the ordinary concemii of life in which : 
great degree of exertion is required. 

In tbe treatment of this species, emetics and cathi 
so highly beneficial in icterus chQltcut, are of doubtful ut-l 
K^^^J"""^ rantage. When, however, the boweU are particuL 

contivt:, or there is reason tA suapect the lodgnonl of t| 
KiiiiiU calculus, or of any inspissated bile in the bilinn' durvj 
pur^utiven are indicated in tiie first casie ; and both por-J 

LI gativeit and emetics in the last. But, in all other oxuii| 

they niuH add to the disease by increasing the irrilatHxul 
Sj*""" and tihmild give way to blood-letting, if the jKilicQl be laj 
vigorou» hr^ltli, succeeded by opiates, the ivan»-b»thj 
wnmi und anodyne fonoentutions applied to tho »\ 
trium. Frank, indeed, disapproves of rencsi>clioa, as 
L OS emetics and ptirf^utives ; contcuding that all evacuati< 

r und depletioDS are not only useless but hurtful. Theupiala] 

should be given in pills, for the stomach will often reject] 
li<|uids of every kind. Two or three grains of the exi 
of opium may be tried iil first, and if this be inaulficient. j 
tho same or eren a la^r dose should be repealed half «a 
hour afterwards, and continued till the pain abatee. Blt»- { 
tering tho scat of pain has been advised hy mauy; and I 
have often tried it, but without any decided eH'ccl. If] 
useful at all, it is rather in preveuting a return of th« 
paroxysm, thnn in shortening or mitigating it when pt«- 
sent; and will hence be most wlvanlageously resorted to in 
the interval. 
^'U'**"*' Tile ointtDcnt of tartaiiied antimony, so nannly recooi- 
' mended by Dr. Jenner, has a much fairer chance of sucosm: 
ind. in the author's pmcticc, has ui times effected a mire 
whore other mcjms had been fooud ustlees. A portion uT] 



ThMS|inK»« 



haafn 
■wTnL 



0)iiuin in 
pilk 



HKdcri 
liiOMlr fn. 
(Ccteku*. 




I 



01.1.] DlceSTIVB PVNCTION. [oRD. II. 423 

the oiotntent, eqoal id aize to b hazeUnut, should be Osn. i. 
nibbed every night into tlie epigastric region, till the ordi- f,'^*"' 
nary cniption appears. >lMMiiodl- 

Tbe geueral BOfeuewt upon pressure, and ihe excitement "^ 
of the hepatic absorbcnUt, as already olwwi'ed, continue 
very frequently Tor ticveRi] wccIcr ufter the spaittn ilaelf has 
•ubsided; itaii, C(iiue<)iicntly, there will be great languor, 
indispokitioii to bbour, tuid a tawny i^in. 

For uU this, a gcneroos diet, checrfal company, and c™*™! 
modcratG Dxcrcioc, und especially riding on horseback, go 
Tsry far towards efl'ecting a cure ; and perhaps fartlior 
than any course of medicine wbataver. The boweb, 
however, must be kept open with warm api-rients. and 
the stomach and abdomiiiul viscera invigorated by bitter 
tonics. 

The dandelion {leonlodon taraxacum, Liim.) ha» been puidclioru 
htglily extolled by many writers of estsiblislied reputation 
in all obelruclioos of the liver, and, indeed, in obxlructions 
generally ; af^d has been used in its roots, stalks, und 
leaves. All thes« abound with a milky, bitterish juice, 
which was at firat supposed to bo iui|>ouaccoas, and hene« 
warmly commended as a reiK^vent by Uoertuiavc. Bcrgius. 
Murray, and Dr. I'emberton have since contributed to sap- 
port this chnmcti-r, nnd thi.<y art coiuoqiieiitly in daily use 
even in the |ire»ent diiy. The plant has no doubt, there- 
fore, doobstruent virtues; but it has not fiillon lo my lot, 
though t have many times given it a fair trial, tu add my 
mArage in its favour. Its must obvious character is that 
of increasing the flow of urine. 

Soap and alkalies, however, seem to have much better Smp uiJ 
pretensions to favour; und luive been still more w<<l^y^nutMi 
employed in this disease, and pretty extensively regarded •"•olvcnti 
as general, and hence aa hepatic solvents. Vet. that tliey 
do not act as solvents in hepatic cases, is dear from a 
striking instance related by Dr. Ilebcrden, who tells US 
that be ooce atlcnd<.'<l a person, who, for a stone in the 
nrinaiy bladder, had been in the habit of swallowing an 
ounce of MMp ever)' day for seven years. Him bo<ly was 
opened after his di-ath ; and notwithstanding such an ex- 
traonlinury quantity of soap had been Ijikon, a great 
number of stones were found in the gall-bladder, without 




I 



434 



CL. I.] 



COILIACA. 



[OSD. II. 



k 



Okk. 1. ibv sUffliteat marks of huviiig been operated upon by any 

Im™*"' decomposing power*. ,i t„ .,i ,.,, ,i, i ^..n ,■ 

•P«*modi- Soup, however, and Dthor ilkaline preparations maytl 
"^ pothapfi. bv uteful iu another rcspoci: 1 aieun, m bcconiii^j 

JJ^JjJ^** a BubfitituU) ibr the deficient bilti, iiud clc«iwitig the bo«eJa| 
fitrbiki by tbeii . pusaoMfting sonHthiog otltbv »nma clicmical pi 
pertiea. Vet too much streM muBt.not be law! even uf 
(his virtue; for hrgc qumitilicA of acidit, M lemou-jui 
have at times hcva tiikcu with so much oppareol bout 
but often u to gaii), also, the crodiL of ft cure. There n om <b«« 
]^^^ S ^^ ^ back against wliatcv«r may be th« remedial powers dU)< 
Id Aaiio. ofcoap or of tlie ulkuliuii and iltut is tJicir freqaeot uodJ 
inu I. ^^ deoookpoeiuon ia tb« stomach, in consequence of il 
coiitaiiiitifr at all timea sttme quantity, and occasiouaUy %| 
very lurge pioportion, oluctdity. We may olVn. perluf 
intnxlucc so tuucboftheiie medicines as shall be more tlia 
sufficient to neutralize the acid ; but where a large quan- 
lily ts wanted for this purpose, it is belter to employ 
»lk:di alone than combined uitJi oil. as lum uoubUMOOM i 
thi; stomach. And where thut is doiw, llio )n»t. 
the most manageablv, prepsratioo of the iUluiJi<>6, wiU 
that which iii th« pure-U and mewl concentnitcd, aa 
liquor pot;i>«»ic ; nor doivt it appear, that the other hlV 
would answer better ifwc hud forms for olaboratinK 
dxiMnliKm ill the same manner. Tiie Cheltenham spring haa unqt 
tioiiably been serviccaUe iu the relics or sequeUa of 
discuso, aikd wbere cxqrciw and a tonic plan are dccidedl] 
iudicwtcd. . £ut,w)iitrG we h«vc reason to believe, thi 
bile is secreted in a depraved condition, and partiou 
where the disease is connected witJi fL.By'^'l* (tltittt nf*! 
Baihnict. Uvcr, the Buth waters, u§ed both interiMlLy^ABd «xfl«nMll| 
at the s^e fim^ will bo found juoru buiwtioml than ltKw«| 
of Cheltenham. 

'Viiothcr remedy to be spoken of, which of late yean I 
excited great atteiiliou, is the diluted aqua regia balba u 
vented by the lale Or. Scott. For nearly thirty yev*, < 
was in the habit of using (his preparation, and had liiod il 
in almost every variety of strength, and almost every n^ 



waur 



XcoU'* 
uiaatqtk 



M«lir«I TnuHUMu, r<l. Il p. ISk 




CL. 1.] 



DICEITIVB rUHCTIOM. 



[oiB. II. 436 



I 



I 



I 



ofmcicid*. 



riety of proportioo, whkli the two acids that enter into the u**""",!: 
c<»]i position niity )>e made to bear to each other. He com- icun* 
inviiced ht» expennttala in India, where, on account of the •p**""'^ 
greater defipnMi of torpitttde, tlie liver in apt to ncquire than „ 
in aMrc tempemte cUmatex, he vran in the habit of forming Bimlin 
his bath stronger and making it deeper than he found '""'*' 
it proper to do in our own country : and where, upwards 
of twenty years ago, he plunged dio Duke of Wellington 
into one up to bin chin, for a severe hepatic affection he 
was then labouring under, and thus restored him to hetilth 
in a short tirac. 

In England it wm not oflen. thilt he found it necessary H«> io 
to raise the bath much above th« knct'S, and frequentiy "*"""■ 
contented himself with a mere foot-bath or common wash- 
hand baain alone. In both which cases, however, the at- 
tendanta on the patient should sponge him at the same 
time with the dilute<l a<)ua regia, over the liml>s, and occa- 
sionally over the body. 

The aqua regia should be compounded of three parts in ^jy^^f^ 
measure of muriatic ncid nud two of nitric acid ; nnd in ' 
preparing them for uxe, a pint of the combiued ncid is to 
be mixed with the name measure of water. This consti- 
tutes the diluted ncid, or diluted oqun rogia. The add 
bath is to consist of three ouncea of this diluted acid to 
every gallon of water. It should, however, be observed by 
tbtoe who are inclined to form this mixture exteinpora* 
4riadl^ at their own houses, that, if either of the acids be 
fmitta Smm^diately on the other, a large volume of very 
ofle^lve gas will be disengaged ; on which account, it 
will be better to poor them separately and slowly on their 
proper measure of water. 
"If ttte acids be of adequate strength, the mixture sub- Mtwunof 
diluted for batliing will, to Uic taste, have the sourness ©f ''**"**''^ 
weak vinegar, anil, perhaps, prick the skin slightly, and 
exciUi a peculiar msh. if very delicate, but rarely otherwise, 
after it has been applied to the surface for half an hour. 
Bnt since these acids vary much in their degree of con- 
centration, as distilled by different chemistii, tliore will be 
some variation iii their power. The iitrcngtii of (he bath, 
however, should not be much greater at any time, than the 
proportion here laid down ; for otherwise it nuy excite a 




^ 



436 



ci. I.] 



CatLIACA. 



[OBB. 



Obv. I. troubleeonw) rash, siiul give a yellow hue to the oails ■«■ 
R«c. III. ^j„ ^ ^^^^ Pj^t_ 0, whatever other part u e» po» c d to lud 

'"™ action. A narrow tub for a kne«-btttb, just wide eooogH 
to hold lh« feet urul n-acli th« knees, •botild contsin thna 
gallons of the prepared bath ti-iaor. andcoDMqtieiitljrabocfl 
nine ounces in measure of Uie diluted aqua regia. For d 
foot-bath, half a gallon may be aufficieol, and a oo iw aM 
waah-hand baKin may be emi'loyed aa a venacl for the purA 
pose. The r<.-vt should remain in the bath for twenty nuJ 
mitea or half an hour : and the l«gs, thighs, and abdooicn 
be, in the mean ttnae, fretjueutly sponged with the sameJ 
In the winter, the water may be uaed wanu : bat thii iij 
not necessary in the summer. The bath Bwy ba employed 
at first daily for a fortnight or three wccka, and aftww w fdJ 
every other day or only twice a-week. I 

Dr. Scott affirms, that he has em|>toyed this process witH 
decided advantage in almost all cases dependent on ■ 
morbid secretion of bile ; whether the secretion be sepen 

nxMbUbllc Qhundant, dcffclive. or depraved. He finds it often, wttlirfl 

ta low houra of the first bathing, increase the flow of bila 
and meliorate ita character ; anid. in consc<incncc hereoB 
excite an expulsion of dark-coloured feces. bright>«ototiredj 
bile, or bile of a brnwn, green, or black colour, like ta 
mixed with oil. He bos told roe also, that, when employeJ 
in the midst of a paroxysm of aevere pain from apaam <i 
tlie biliary dact«, or the passing of a gall^tttone, he ha 
often known it oi>Cr»te hkc a churm, and produce almod 
inimediute vai>e*. m 

From the rapidity, therefore, with which it acta in sooj 
cases, he is incbned to think, thut it operates, not by tha 
absorbents, but by the nerveii: and has made various cKS 
perimentK to sltow, that it is the clilorine of the muriatic 
acid idonc, by the present process decomposed and set at 
liberty, tlial produces the benefit of the bath. To pntv* 
this, ho employed a bath of water saturated with chloriui 
obliiincd from the muriatic acid by mixing il in n 
with the black oxydc of miingancsc : und the same 
tary cllects followed ; and he has given this antoraled au- 



la «bM 
tMoncr it 



pw« 

oriufM 
reuaM 



• Scc«lHiM«d.CWt.Tiiw.nL*(ii- 



LA 




CL. I.] 



DIOESTirS FUNCTION. 



[OflD. II. 



lutioii in doses of half or tliroi: quarters of un ounce, three 
or four times a-day, mixed with the saino quantity of 
speennint, or any other diatilliHl water, with evident benefit, 
in Tery numerouH hepatic cases of great obstinacy. 

This account may be rather overcharged, fnmi the ardent 
mind of ita intfilUgent inventor : but the procesa is worth 
following up, and varying in other proportions, as well aa 
employing in other tiiniiliea of diaeawa. My own uite of 
it is at present too limited to speidt with decision; yet, 
BO far as 1 have tiicd it, it has certainly appeared to me to 
allay irritation and produce a tonic efiect. In two or three 
instances, the advantage has been decisive ; and patients, 
who had hitherto been xehlom two months without a severe 
return of the complaint, have entirely escaped, and appa- 
rently lost the morbid pitdi imposition. In a few otlier 
cows, it has completely failed. 

It is now, however, in a course of experiment in tite 
hands of several intelligent practitioners, and we nifty 
hope soon to be put into possession of ita actual powers. 
Ur. Wallace has been employing it in the form of fras. 
obtained by a mixture of muriatic acid with the black 
u.vyde of manganese, as well as diluted with hc|ucour va- 
pour; and he regards the peculiar eruption as n fitvouruble 
sign*. 



Oeh. I. 
Spkc. ill. 
tcienu 

COl. 

The tisle- 
iTwnl pnt- 

bublf DVtT- 

chvipd. 



But no* In 
■ CDuncof 
dMctmliM- 
ctoobr 
Dtha Mpc- 
rinicuu. 



* ttneurfict fnpMllRc ihc medical Pnwm of Clilorinc, ponkululr b D]» 
cw>of tlic Lim, kt. by W. WiUuc, M.K.I.A. Ixnidoo, IS£i. 




428 



CL. I.] 



tSLUCA, 



[ObO. II. 



SPECIES IV. 

ICTERUS HEPATICUS. 

■■I 1 1, 

UEPATIC JAUNDICE. 

THS CODBRE OF TRB >ILB 08STBVCTKD ST A VI 
RANOEMKNT OF THE LIVKR t'KOM ftCIRRttOVS Ol 
OTHEK IN t>tt rations; UCCAblDNAL RETCH IN OS AKI 

dtsfepsy: littlb oh mo pain in tub bight by* 
pochomoriom. 




.1. 

Icteni* 
IwpMlciu- 
8tHof the 



(Ummc. 



Thiiipeckt 

dcKrilml bj 

dUfrreail 
wtiun. 



praiiinale 

CtlJJC*. 



In t\xn ])rcce<Iin(^fl|>ecie«, the appendages to tlie liver. 
Uiu gnlUbiaddbr or gall-ducts, are the cluel' s«at of dtaca 
at l^t' in its conimenccment. In the species before us 
thn diseiiHe t!« chiefly seated in the liver itself. It uuty '. 
a rvKuit of the prec«drag species when tliuy have usami 
a chroiiic form ; Imt, as the liver itself is often oflect 
fntm the firAl, it is entitled to be treated of as a diKtiitr 
specie*. The course of Oie bile, indeed, itt evidiintlyj 
obsiracted, but rather in it-<« secretion or separation fr 
the BulKtaiice of the liver, than in its transmissiOD by 
biliary Uibes. 

This species is noticed by Bocrhoave, by Sauvages. *oi 
by I)r. Cullcn in his Synopsis, tliough he has ofTcnsd n<i 
remarks on it in his First Lines. In iJoerhaavc. liowerer^J 
it iniporu altogether a different disease, for it is jaundics] 
produced by hepatitis*, or inilammation of tho bver; au<j 
ia hence a mere symptom, to be removed alone by 
removal of the idiopathic complaint. 

It in uore iiccumiely describexl by Richtet, who con- 
nnits and illiistrntcs the opinion of VogclaiHl Selle; both< 
whom suppose it to depend upon somo peculiu irritation^ 
in th<; livvr itielf; ot in tlic wtiolc hepatic system; but an] 
irritation not dependent upon or directly leading to 



* Via. Switt. Coinmcni. Ilcpiiiiu ct ltl«nu multiploK, Mm. iU. J Bl^ 



Ott. I.] 



DtOMTIV£ VQNCTION. 



[010. II. 



Rammntioti. This irritation is of various kinds, and pro- Orx. I. 
ducea diftiiretit etrcct*. all of which become cauaes ofj^^.^"^ ' 
obstruction to a free flow of the bile into its proper chan- hciMiicw. 
neU, One of the most common effects, which operate in 
this manner, in a scirrhous enlari^ement of the whole, or of 
soma particular pari, of the Itrer. ' Another is an accu- 
mulation ofcalculous concretions, in its substance ; of which 
Richter givCK a striking and complicated example in a 
person, who, after death, was found to be without a gall- 
bladder, and whose liver wait filled with whitish calculi of 
different forms and »iie8, from that of a pea to thutof acherry. 
In ihiu case there can be no question, tlint the bile, whose 
colouring; matter was ditTuscd over tlir entire body, was not 
only formed in, but immediately absorbed from, the peni- 
cilli, or pores of the liver, in consequence of obstruction, 
without being collected into a reservoir. 

Thi» is the worst state in which jaundice can pouibly imrWtc 
make itit uiipearance : for, thouzh there is little or no pain. •"°<"P>- 
It shown <iiNeuii« m the structure oi the liver, and is fre- du«a. 
queittly a mark of a broken-np constitution. It in in fact 
found rarely in the young and vigorous ; but almost always 
in those who have drunk hard, or lived hard, and eapecinlly 
have been exposed to much labour in hot climat^x, or 
have suffered under repeated attacks of quartans or other 
chronic intermittents- i , f, il 

The art of medicine can here do but little ; and we have Medicine of 
too often to witness tlic picture, drawn so feelingly of the ''"'* ***^ 
Athenians during the plague : 

CorpMki mumUt ladut Medicika linwM*. 

It IS only in an enrly stage of ibis disease, if happily we Ex^pi in 
should be so soon consulted, that mercury has any chance *" *"'? . 
of being successful ; and it should be gi^~«n rather as an '^^ 
alterant in small doses pertinaciously followed up, than in Mrmry 
large proportions so as to excite a ptyalium ; for we have here mi^t^^ 
no strength todraw upon without injury. " 1 think," says 
Ur. Baillie, " that many practitioners of the present day 
have erred in administering mercury too long, and in too 



tuCT. De Rcr. Kit. ri. 1 170. 




430 

Okv. f. 

Spec. IV. 
Icuiw 



CL. I.] 



C<XLIACA. 



Cbaljboic 
(prinftt- 



btth. 



liberal dosos. When mercury is carrifid beyond the point 
that is necess&n,-, it often injure* tlie eoDHtitution by wrak- 
ening it, and rcndi-ring the nervous aystcra very iTTitable*."< 
In some cases, small dose* of calomel in combtn&tion witli 
conitim have been «er\'ic«»l>K' : niid I have certainly foandj 
benefit from covviin); ihc^ hypuclioitihinc region with a lnrg<l 
plaster of the einplastrum hydrurgyri cum ammoniaco. For] 
the reat the patient must be put upon a general tonic plan;! 
his <li«t should be generous without bt-ing highly stimDlantM 
lie should use such kind of exercise and in sach proportioa | 
as best agrees with him ; and the chalybeate spriags, cor^J 
reeled as those of Cheltenham by neutral salts, form tbol 
best mineral invigorant to which he can have recourse." 
Poaaihiy, in this malady also, the diluted aqua regia bath] 
may be of service, employed as recoromended under the j 
last species. 

[In that state of the titer which produces Janndic 
towards the enti of intermittent fevent, mercury ia the boi] 
and only remedy; and mlomel, in smull do»cs, ia the 
under which it is the moM cfTicient. When jaundice 
from congestion of the vessels of the liver, "[cneml blood^^ 
letting, or (if the patient's reduced stale prohibit it) Ic 
bl«e<ding. by the application of ]c«chcs, or ciippng-gli 
lu the right hypochondrium, will be proper.] 



SPECIES V. 

ICTERUS INFANTUM. 

YELLOW GVM. JAUNDICE OP INFANTS. 

THE COVKSE OVTIir. UILE UII«TUUrTEI> IIY VISCID MB-1 

conivm; without vain on DYBPEirsT ; easiltJ 

REMOVED BY PtlROATIVBS. 

Oex.I. This is the mildest form under which jaundice make*! 
SrsG. V. jt^ appoarancc, and that which is carried off with It 

* iMlam and Obrnvkiiiitii on Mcdipin«, IBSO. I'npuUUMiL 




CL. I.] 



DIGKSTIVB rUNCTtON. 




[ORD. It. 



h 



trouble. Ill o»dinary cases, llip only flymptoms arc tlic Orjcl. 
patb<^TM)inic colour, and a degree of Utngiior and drow- j^^*^^* ^' 
siueas b^otid wliat is cocnmoD to infants on btrtJi or inrMituni. 
shortly after. 

■ A yelkw hue, howorcr, on the surface of infanta is not Veilowhuc 
aeOBBaarily a symptora of jaundice, properly »o caUed ; for ^u^^ 
Lentin*, Cullen, and many other*, have well obwtred, ■^"'P'"""''' 
that Kuch a discoloration may nbo l>e the result of aJ*""^'*^ 
peculiar yellowneaa of the aenim of th^hlowl, unconnected 
with liilet; analogous to the i^olden tint, which nc 80 
frc(|iivnt]y find diflVising itn-lf over the surface of a con- 
tusion, when llie finer and more limpid pttrts of tlio: etnised 
fluid have been earned ofl*. and llic colounnjf innlter of 
the sonim that still remains behind is hereby bucoins 
more ooncenuatcd : as wC Khali have to notice more 
at lui^ when treating; of this uficction under tlic name 
ofjiuriffo, coiistiluling the fiflh species of tlie genus 
KPirtiiiuiis^. 

A dose of castor-oil, or any otiier active purgiilive, will TrHtmmL 
generally be Kuflicifnt to remove the obstruction, which in 
alnuMt every instance proceeds from meconium more than 
ordinarily tenacious, and cooscquontly will carry off the 
disease. But frequently the mouth of the ductus choledo- 
chus communis in so completely infarcted with this viscid 
matter that purgatives are insufficient; and. in this case, an 
emetic should be given, and in a few days repeated, if 
necessary. 



I 



Icterus being seldom a disease essentially mortal, and MorMd 
only having, in general, n fatal termination when com- '^"■'™'''- 
bined with some serious organic disc«M, • distioction 
^ould be made between pereonR dyinR with jaundice, and 
those dying from it ; a distinction first made by the cele- 
brated M. Portal. 



■ lk« Jkumc** I)(*criptlan d« I'Icieni do nouvcMX D&, &c. NIiom I7W— 
OilL SjMip*. NcmI. Oen. ul. A. noie. 

fUiiller, Di*. du Ortninc lc>erj, tnulmj t}iu, qui infuMta ntiti* 1 
ottUfM. Jen. Ijas. 

I CI. vl. Oa. lU. flci). I. 




433 



CL. 1.] 



CtKLIACA. 



[osp. tl 



Obv. I. 
Srsc. V. 

M«rUd 
■oMany. 



Saw of (be 



OfltwliTIT. 




0*Il.bUd. 



The bodica of ictericai subjecU ueoally jmscnt the i 
morbkl colour which they cxhibite<l in [tfe. Hoi 
uccflrding to M. Portal, the intensity of the eoloar is i 
tiraeo diminiBhed j while some bodies, whieh dctdt 
*ny marks of jaundice pre\iouBly to dcftUi, 
turn of a very deep yellovr. A lendency to aiusut« i| 
generally noticed, and, when inciuooi an made in 
cellular membmne, a good deal of •cram, which ia of i 
more OT IcH yellow hue, flows out. VTbatever fluid 
found in the ventricles of the brain, or in the cheat, 
abdomen, ih likewite eitlier of that coloikf, or reddiab. 
short, vrery texture, and even the tnoM compact 
prcMOta yellow tinge; ax tJiefftt, the muscles (wbirb wit 
other organa are Mftened), the mcmbnities. especially 
•erooaonea; the lining of the art«rial system ; the tetidonB] 
the cartilages ; tlw periosteum ; and the very bonea. 

According to Morgagni, the lungs, heart, liver, nf 
and kidneya arc softened, their texture containing a limi 
ydlow or rcddUb fluid. Most of the eecretknu p«rtak« i 
the same tinge. 

No part, however, is more frequently affected in jat 
diced subjects, than the liver. Sometimes disaectioo d( 
moostrates it to be cither in a state of chronic inflnniina- 
tion. or uf preternatural volume or smsllnesa, or oooi 
into a fatty matter resembling tallow. AbeceasM, ul< 
tion, biliary concretions within ita substance, and do 
rou9 close adhesions of it to the neighbouring pArta, 
likewise occasionally discovered after death. 

The state, in which the gall-bladder is found, is extrcmelyl 
diversified: very often it contains calculi, of which tbera] 
may be only one or many. The single one is occaiut 
very large ; the numerous ones, sometimes amounting tiij 
hundreds are usually of diminutive size. At the samej 
time, the gall-bladder may contain no bile, or be pro-! 
d!;;iously distended with it. Van Swieten apeaka at aj 
case, in which tlic gall-bludder reached from the liver le' 
the crista of the ilium, and had more than a pint of bile Lb' 
it. In some casca, this fluid bus been found viscid, almost ' 
black, and to contain gritty particles like sand. In Dr.' 
Drighl's recent publication *, Dr. Bostock has given the 



■ Rrpora ofMtAnl C«n. «w. lioodtn, ISS? 



CL. I.] 



OIOHSTIVB VUNCTION. 



[ORD. tl. 



433 



I 
I 



analjraia of the Huid of the gall-bladder ia « cue of Oek. I. 
protracted jaundice, awonipanyinf; tiitwrcular livpr and '^"^c.V. 
dropsy. It had au oraiigc colour, nnd ibiti con&iatencc : Morbid 
the oninud matter in it was almost entirely albumen, with ■""'"''>)'• 
B littk colouring mnlt^r dificront from that of the bile ; and, 
in fact, it containiyl none of the usual biliary principles. In 
particular examples, the gail-blaHdcr exhibits traces of the 
efTectit of innammation, its coats being thickened and 
indurated. In one inAtancc, Bonnet found excrescences 
within itit cnTity*. Sometimes the gall-bladder U adhe- 
rent to tliu neighbouring organs. In one patient, who 
died with jaundice, the gall-bladder and cyatic duct were 
altogether wantingf. 

At various poinu of their coorae, the hepatic, cystic, ^i>MofUu 
and common biliary ducts frequently cmitain calculi of,^^ 
difTercnt sizes. When these concretions lodge either in 
the hepatic or common duct, they completely block it up; 
and hence it ia often found considerably dilated nbove the 
obstruction, and containing a large quantity of bile; a 
circumHtaiice that does not occur when the foreign body 
lodges in the cystic duct. ^ometimeH these seveml ciinals 
are ao contmcted, that a small probe ciiunot be introduced 
into thcia. Stoll met witli the oominon duct in what he 
calls n cartilaginouH state. CabroUus has recorded a case 
of jaundice, in which there was a niulfonnation of the 
coounoD duct, its end towards the liver being very wide, 
and its communication with the bowels as minute as the 
extremity of a capillary- vessc). Lastly, the biliary ducu 
ate often found compressed, and even more or less obli- 
terated by various Icinds of tumours formed in their viciniQr. 
A most remarkable enbrgement of the biliary- ducts, in 
consequence of the pressure of a scirrhous pancreas on the 
coamon duct, is recorded by Mr. Todd. After death more 
than a quar