So when the lacteals have their motions inverted, as during the operation of strong purges, the urinary and cutaneous absorbents have their motions increased to supply the want of fluid in the blood, as in great thirst; but after a meal with sufficient potation the urine is pale, that is, the urinary absorbents act weakly, no supply of water being wanted for the blood. And when the intestinal absorbents act too violently, as when too great quant.i.ties of fluid have been drank, the urinary absorbents invert their motions to carry off the superfluity, which is a new circ.u.mstance of a.s.sociation, and a temporary diabetes supervenes.

16. I have had the opportunity of seeing four patients in the iliac pa.s.sion, where the ejected material smelled and looked like excrement. Two of these were so exhausted at the time I saw them, that more blood could not be taken from them, and as their pain had ceased, and they continued to vomit up every thing which they drank, I suspected that a mortification of the bowel had already taken place, and as they were both women advanced in life, and a mortification is produced with less preceding pain in old and weak people, these both died. The other two, who were both young men, had still pain and strength sufficient for further venesection, and they neither of them had any appearance of hernia, both recovered by repeated bleeding, and a scruple of calomel given to one, and half a dram to the other, in very small pills: the usual means of clysters, and purges joined with opiates, had been in vain attempted. I have thought an ounce or two of crude mercury in less violent diseases of this kind has been of use, by contributing to restore its natural motion to some part of the intestinal ca.n.a.l, either by its weight or stimulus; and that hence the whole tube recovered its usual a.s.sociations of progressive peristaltic motion. I have in three cases seen crude mercury given in small doses, as one or two ounces twice a day, have great effect in stopping pertinacious vomitings.

17. Besides the affections above described, the stomach is liable, like many other membranes of the body, to torpor without consequent inflammation: as happens to the membranes about the head in some cases of hemicrania, or in general head-ach. This torpor of the stomach is attended with indigestion, and consequent flatulency, and with pain, which is usually called the cramp of the stomach, and is relievable by aromatics, essential oils, alcohol, or opium.

The intrusion of a gall-stone into the common bile-duct from the gall-bladder is sometimes mistaken for a pain of the stomach, as neither of them are attended with fever; but in the pa.s.sage of a gall-stone, the pain is confined to a less s.p.a.ce, which is exactly where the common bile-duct enters the duodenum, as explained in Section x.x.x. 1. 3. Whereas in this gastrodynia the pain is diffused over the whole stomach; and, like other diseases from torpor, the pulse is weaker, and the extremities colder, and the general debility greater, than in the pa.s.sage of a gall-stone; for in the former the debility is the consequence of the pain, in the latter it is the cause of it.

Though the first fits of the gout, I believe, commence with a torpor of the liver; and the ball of the toe becomes inflamed instead of the membranes of the liver in consequence of this torpor, as a coryza or catarrh frequently succeeds a long exposure of the feet to cold, as in snow, or on a moist brick-floor; yet in old or exhausted const.i.tutions, which have been long habituated to its attacks, it sometimes commences with a torpor of the stomach, and is transferable to every membrane of the body. When the gout begins with torpor of the stomach, a painful sensation of cold occurs, which the patient compares to ice, with weak pulse, cold extremities, and sickness; this in its slighter degree is relievable by spice, wine, or opium; in its greater degree it is succeeded by sudden death, which is owing to the sympathy of the stomach with the heart, as explained below.

If the stomach becomes inflamed in consequence of this gouty torpor of it, or in consequence of its sympathy with some other part, the danger is less.

A sickness and vomiting continues many days, or even weeks, the stomach rejecting every thing stimulant, even opium or alcohol, together with much viscid mucus; till the inflammation at length ceases, as happens when other membranes, as those of the joints, are the seat of gouty inflammation; as observed in Sect. XXIV. 2. 8.

The sympathy, or a.s.sociation of motions, between those of the stomach and those of the heart, are evinced in many diseases. First, many people are occasionally affected with an intermission of their pulse for a few days, which then ceases again. In this case there is a stop of the motion of the heart, and at the same time a tendency to eructation from the stomach. As soon as the patient feels a tendency to the intermission of the motion of his heart, if he voluntarily brings up wind from his stomach, the stop of the heart does not occur. From hence I conclude that the stop of digestion is the primary disease; and that air is instantly generated from the aliment, which begins to ferment, if the digestive process is impeded for a moment, (see Sect. XXIII. 4.); and that the stop of the heart is in consequence of the a.s.sociation of the motions of these viscera, as explained in Sect. x.x.xV. 1. 4.; but if the little air, which is instantly generated during the temporary torpor of the stomach, be evacuated, the digestion recommences, and the temporary torpor of the heart does not follow. One patient, whom I lately saw, and who had been five or six days much troubled with this intermission of a pulsation of his heart, and who had hemicrania with some fever, was immediately relieved from them all by losing ten ounces of blood, which had what is termed an inflammatory crust on it.

Another instance of this a.s.sociation between the motions of the stomach and heart is evinced by the exhibition of an over dose of foxglove, which induces an incessant vomiting, which is attended with very slow, and sometimes intermitting pulse.--Which continues in spite of the exhibition of wine and opium for two or three days. To the same a.s.sociation must be ascribed the weak pulse, which constantly attends the exhibition of emetics during their operation. And also the sudden deaths, which have been occasioned in boxing by a blow on the stomach; and lastly, the sudden death of those, who have been long debilitated by the gout, from the torpor of the stomach. See Sect. x.x.xV. 1. 4.

SECT. XXVI.

OF THE CAPILLARY GLANDS AND MEMBRANES.

I. 1. _The capillary vessels are glands._ 2. _Their excretory ducts.

Experiments on the mucus of the intestines, abdomen, cellular membrane, and on the humours of the eye._ 3. _Scurf on the head, cough, catarrh, diarrhoea, gonorrhoea._ 4. _Rheumatism. Gout. Leprosy._ II. 1. _The most minute membranes are unorganized._ 2. _Larger membranes are composed of the ducts of the capillaries, and the mouths of the absorbents._ 3. _Mucilaginous fluid is secreted on their surfaces._ III. _Three kinds of rheumatism._

I. 1. The capillary-vessels are like all the other glands except the absorbent system, inasmuch as they receive blood from the arteries, separate a fluid from it, and return the remainder by the veins.

2. This series of glands is of the most extensive use, as their excretory ducts open on the whole external skin forming its perspirative pores, and on the internal surfaces of every cavity of the body. Their secretion on the skin is termed insensible perspiration, which in health is in part reabsorbed by the mouths of the lymphatics, and in part evaporated in the air; the secretion on the membranes, which line the larger cavities of the body, which have external openings, as the mouth and intestinal ca.n.a.l, is termed mucus, but is not however coagulable by heat; and the secretion on the membranes of those cavities of the body, which have no external openings, is called lymph or water, as in the cavities of the cellular membrane, and of the abdomen; this lymph however is coagulable by the heat of boiling water. Some mucus nearly as viscid as the white of egg, which was discharged by stool, did not coagulate, though I evaporated it to one fourth of the quant.i.ty, nor did the aqueous and vitreous humours of a sheep's eye coagulate by the like experiment: but the serosity from an anasarcous leg, and that from the abdomen of a dropsical person, and the crystalline humour of a sheep's eye, coagulated in the same heat.

3. When any of these capillary glands are stimulated into greater irritative actions, than is natural, they secrete a more copious material; and as the mouths of the absorbent system, which open in their vicinity, are at the same time stimulated into greater action, the thinner and more saline part of the secreted fluid is taken up again; and the remainder is not only more copious but also more viscid than natural. This is more or less troublesome or noxious according to the importance of the functions of the part affected: on the skin and bronchiae, where this secretion ought naturally to evaporate, it becomes so viscid as to adhere to the membrane; on the tongue it forms a pellicle, which can with difficulty be sc.r.a.ped off; produces the scurf on the heads of many people; and the mucus, which is spit up by others in coughing. On the nostrils and fauces, when the secretion of these capillary glands is increased, it is termed simple catarrh; when in the intestines, a mucous diarrhoea; and in the urethra, or v.a.g.i.n.a, it has the name of gonorrhoea, or fluor albus.

4. When these capillary glands become inflamed, a still more viscid or even cretaceous humour is produced upon the surfaces of the membranes, which is the cause or the effect of rheumatism, gout, leprosy, and of hard tumours of the legs, which are generally termed s...o...b..tic; all which will be treated of hereafter.

II. 1. The whole surface of the body, with all its cavities and contents, are covered with membrane. It lines every vessel, forms every cell, and binds together all the muscular and perhaps the osseous fibres of the body; and is itself therefore probably a simpler substance than those fibres. And as the containing vessels of the body from the largest to the least are thus lined and connected with membranes, it follows that these membranes themselves consisted of unorganized materials.

For however small we may conceive the diameters of the minutest vessels of the body, which escape our eyes and gla.s.ses, yet these vessels must consist of coats or sides, which are made up of an unorganized material, and which are probably produced from a gluten, which hardens after its production, like the silk or web of caterpillars and spiders. Of this material consist the membranes, which line the sh.e.l.ls of eggs, and the sh.e.l.l itself, both which are unorganized, and are formed from mucus, which hardens after it is formed, either by the absorption of its more fluid part, or by its uniting with some part of the atmosphere. Such is also the production of the sh.e.l.ls of snails, and of sh.e.l.l-fish, and I suppose of the enamel of the teeth.

2. But though the membranes, that compose the sides of the most minute vessels, are in truth unorganized materials, yet the larger membranes, which are perceptible to the eye, seem to be composed of an intertexture of the mouths of the absorbent system, and of the excretory ducts of the capillaries, with their concomitant arteries, veins, and nerves: and from this construction it is evident, that these membranes must possess great irritability to peculiar stimuli, though they are incapable of any motions, that are visible to the naked eye: and daily experience shews us, that in their inflamed state they have the greatest sensibility to pain, as in the pleurisy and paronychia.

3. On all these membranes a mucilaginous or aqueous fluid is secreted, which moistens and lubricates their surfaces, as was explained in Section XXIII. 2. Some have doubted, whether this mucus is separated from the blood by an appropriated set of glands, or exudes through the membranes, or is an abrasion or destruction of the surface of the membrane itself, which is continually repaired on the other side of it, but the great a.n.a.logy between the capillary vessels, and the other glands, countenances the former opinion; and evinces, that these capillaries are the glands, that secrete it; to which we must add, that the blood in pa.s.sing these capillary vessels undergoes a change in its colour from florid to purple, and gives out a quant.i.ty of heat; from whence, as in other glands, we must conclude that something is secreted from it.

III. The seat of rheumatism is in the membranes, or upon them; but there are three very distinct diseases, which commonly are confounded under this name. First, when a membrane becomes affected with torpor, or inactivity of the vessels which compose it, pain and coldness succeed, as in the hemicrania, and other head-achs, which are generally termed nervous rheumatism; they exist whether the part be at rest or in motion, and are generally attended with other marks of debility.

Another rheumatism is said to exist, when inflammation and swelling, as well as pain, affect some of the membranes of the joints, as of the ancles, wrists, knees, elbows, and sometimes of the ribs. This is accompanied with fever, is a.n.a.logous to pleurisy and other inflammations, and is termed the acute rheumatism.

A third disease is called chronic rheumatism, which is distinguished from that first mentioned, as in this the pain only affects the patient during the motion of the part, and from the second kind of rheumatism above described, as it is not attended with quick pulse or inflammation. It is generally believed to succeed the acute rheumatism of the same part, and that some coagulable lymph, or cretaceous, or calculous material, has been left on the membrane; which gives pain, when the muscles move over it, as some extraneous body would do, which was too insoluble to be absorbed.

Hence there is an a.n.a.logy between this chronic rheumatism and the diseases which produce gravel or gout-stones; and it may perhaps receive relief from the same remedies, such as aerated sal soda.

SECT. XXVII.

OF HaeMORRHAGES.

I. _The veins are absorbent vessels._ 1. _Haemorrhages from inflammation. Case of haemorrhage from the kidney cured by cold bathing.

Case of haemorrhage from the nose cured by cold immersion._ II.

_Haemorrhage from venous paralysis. Of Piles. Black stools. Petechiae.

Consumption. Scurvy of the lungs. Blackness of the face and eyes in epileptic fits. Cure of haemorrhages from venous inability._

I. As the imbibing mouths of the absorbent system already described open on the surface, and into the larger cavities of the body, so there is another system of absorbent vessels, which are not commonly esteemed such, I mean the veins, which take up the blood from the various glands and capillaries, after their proper fluids or secretions have been separated from it.

The veins resemble the other absorbent vessels; as the progression of their contents is carried on in the same manner in both, they alike absorb their appropriated fluids, and have valves to prevent its regurgitation by the accidents of mechanical violence. This appears first, because there is no pulsation in the very beginnings of the veins, as is seen by microscopes; which must happen, if the blood was carried into them by the actions of the arteries. For though the concurrence of various venous streams of blood from different distances must prevent any pulsation in the larger branches, yet in the very beginnings of all these branches a pulsation must unavoidably exist, if the circulation in them was owing to the intermitted force of the arteries. Secondly, the venous absorption of blood from the p.e.n.i.s, and from the teats of female animals after their erection, is still more similar to the lymphatic absorption, as it is previously poured into cells, where all arterial impulse must cease.

There is an experiment, which seems to evince this venous absorption, which consists in the external application of a stimulus to the lips, as of vinegar, by which they become instantly pale; that is, the bibulous mouths of the veins by this stimulus are excited to absorb the blood faster, than it can be supplied by the usual arterial exertion. See Sect. XXIII. 5.

There are two kinds of haemorrhages frequent in diseases, one is where the glandular or capillary action is too powerfully exerted, and propels the blood forwards more hastily, than the veins can absorb it; and the other is, where the absorbent power of the veins is diminished, or a branch of them is become totally paralytic.

1. The former of these cases is known by the heat of the part, and the general fever or inflammation that accompanies the haemorrhage. An haemorrhage from the nose or from the lungs is sometimes a crisis of inflammatory diseases, as of the hepat.i.tis and gout, and generally ceases spontaneously, when the vessels are considerably emptied. Sometimes the haemorrhage recurs by daily periods accompanying the hot fits of fever, and ceasing in the cold fits, or in the intermissions; this is to be cured by removing the febrile paroxysms, which will be treated of in their place.

Otherwise it is cured by venesection, by the internal or external preparations of lead, or by the application of cold, with an abstemious diet, and diluting liquids, like other inflammations. Which by inducing a quiescence on those glandular parts, that are affected, prevents a greater quant.i.ty of blood from being protruded forwards, than the veins are capable of absorbing.

Mr. B---- had an haemorrhage from his kidney, and parted with not less than a pint of blood a day (by conjecture) along with his urine for above a fortnight: venesections, mucilages, balsams, preparations of lead, the bark, alum, and dragon's blood, opiates, with a large blister on his loins, were separately tried, in large doses, to no purpose. He was then directed to bathe in a cold spring up to the middle of his body only, the upper part being covered, and the haemorrhage diminished at the first, and ceased at the second immersion.

In this case the external capillaries were rendered quiescent by the coldness of the water, and thence a less quant.i.ty of blood was circulated through them; and the internal capillaries, or other glands, became quiescent from their irritative a.s.sociations with the external ones; and the haemorrhage was stopped a sufficient time for the ruptured vessels to contract their apertures, or for the blood in those apertures to coagulate.

Mrs. K---- had a continued haemorrhage from her nose for some days; the ruptured vessel was not to be reached by plugs up the nostrils, and the sensibility of her fauces was such that nothing could be born behind the uvula. After repeated venesection, and other common applications, she was directed to immerse her whole head into a pail of water, which was made colder by the addition of several handfuls of salt, and the haemorrhage immediately ceased, and returned no more; but her pulse continued hard, and she was necessitated to lose blood from the arm on the succeeding day.

Query, might not the cold bath instantly stop haemorrhages from the lungs in inflammatory cases?--for the shortness of breath of those, who go suddenly into cold water, is not owing to the acc.u.mulation of blood in the lungs, but to the quiescence of the pulmonary capillaries from a.s.sociation, as explained in Section x.x.xII. 3. 2.

II. The other kind of haemorrhage is known from its being attended with a weak pulse, and other symptoms of general debility, and very frequently occurs in those, who have diseased livers, owing to intemperance in the use of fermented liquors. These const.i.tutions are shewn to be liable to paralysis of the lymphatic absorbents, producing the various kinds of dropsies in Section XXIX. 5. Now if any branch of the venous system loses its power of absorption, the part swells, and at length bursts and discharges the blood, which the capillaries or other glands circulate through them.

It sometimes happens that the large external veins of the legs burst, and effuse their blood; but this occurs most frequently in the veins of the intestines, as the vena portarum is liable to suffer from a schirrus of the liver opposing the progression of the blood, which is absorbed from the intestines. Hence the piles are a symptom of hepatic obstruction, and hence the copious discharges downwards or upwards of a black material, which has been called melancholia, or black bile; but is no other than the blood, which is probably discharged from the veins of the intestines.

J.F. Meckel, in his Experimenta de Finibus Vasorum, published at Berlin, 1772, mentions his discovery of a communication of a lymphatic vessel with the gastric branch of the vena portarum. It is possible, that when the motion of the lymphatic becomes retrograde in some diseases, that blood may obtain a pa.s.sage into it, where it anastomoses with the vein, and thus be poured into the intestines. A discharge of blood with the urine sometimes attends diabetes, and may have its source in the same manner.

Mr. A----, who had been a hard drinker, and had the gutta rosacea on his face and breast, after a stroke of the palsy voided near a quart of a black viscid material by stool: on diluting it with water it did not become yellow, as it must have done if it had been insp.i.s.sated bile, but continued black like the grounds of coffee.

But any other part of the venous system may become quiescent or totally paralytic as well as the veins of the intestines: all which occur more frequently in those who have diseased livers, than in any others. Hence troublesome bleedings of the nose, or from the lungs with a weak pulse; hence haemorrhages from the kidneys, too great menstruation; and hence the oozing of blood from every part of the body, and the petechiae in those fevers, which are termed putrid, and which is erroneously ascribed to the thinness of the blood: for the blood in inflammatory diseases is equally fluid before it coagulates in the cold air.

Is not that hereditary consumption, which occurs chiefly in dark-eyed people about the age of twenty, and commences with slight pulmonary haemorrhages without fever, a disease of this kind?--These haemorrhages frequently begin during sleep, when the irritability of the lungs is not sufficient in these patients to carry on the circulation without the a.s.sistance of volition; for in our waking hours, the motions of the lungs are in part voluntary, especially if any difficulty of breathing renders the efforts of volition necessary. See Cla.s.s I. 2. 1. 3. and Cla.s.s III. 2.

1. 12. Another species of pulmonary consumption which seems more certainly of scrophulous origin is described in the next Section, No. 2.

I have seen two cases of women, of about forty years of age, both of whom were seized with quick weak pulse, with difficult respiration, and who spit up by coughing much viscid mucus mixed with dark coloured blood. They had both large vibices on their limbs, and petechiae; in one the feet were in danger of mortification, in the other the legs were oedematous. To relieve the difficult respiration, about six ounces of blood were taken from one of them, which to my surprise was sizy, like inflamed blood: they had both palpitations or unequal pulsations of the heart. They continued four or five weeks with pale and bloated countenances, and did not cease spitting phlegm mixed with black blood, and the pulse seldom slower than 130 or 135 in a minute. This blood, from its dark colour, and from the many vibices and petechiae, seems to have been venous blood; the quickness of the pulse, and the irregularity of the motion of the heart, are to be ascribed to debility of that part of the system; as the extravasation of blood originated from the defect of venous absorption. The approximation of these two cases to sea-scurvy is peculiar, and may allow them to be called s...o...b..tus pulmonalis. Had these been younger subjects, and the paralysis of the veins had only affected the lungs, it is probable the disease would have been a pulmonary consumption.

Last week I saw a gentleman of Birmingham, who had for ten days laboured under great palpitation of his heart, which was so distinctly felt by the hand, as to discountenance the idea of there being a fluid in the pericardium. He frequently spit up mucus stained with dark coloured blood, his pulse very unequal and very weak, with cold hands and nose. He could not lie down at all, and for about ten days past could not sleep a minute together, but waked perpetually with great uneasiness. Could those symptoms be owing to very extensive adhesions of the lungs? or is this a s...o...b..tus pulmonalis? After a few days he suddenly got so much better as to be able to sleep many hours at a time by the use of one grain of powder of foxglove twice a day, and a grain of opium at night. After a few days longer, the bark was exhibited, and the opium continued with some wine; and the palpitations of his heart became much relieved, and he recovered his usual degree of health, but died suddenly some months afterwards.

In epileptic fits the patients frequently become black in the face, from the temporary paralysis of the venous system of this part. I have known two instances where the blackness has continued many days. M. P----, who had drank intemperately, was seized with the epilepsy when he was in his fortieth year; in one of these fits the white part of his eyes was left totally black with effused blood; which was attended with no pain or heat, and was in a few weeks gradually absorbed, changing colour as is usual with vibices from bruises.

The haemorrhages produced from the inability of the veins to absorb the refluent blood, is cured by opium, the preparations of steel, lead, the bark, vitriolic acid, and blisters; but these have the effect with much more certainty, if a venesection to a few ounces, and a moderate cathartic with four or six grains of calomel be premised, where the patient is not already too much debilitated; as one great means of promoting the absorption of any fluid consists in previously emptying the vessels, which are to receive it.