When the const.i.tution begins to produce gravel, it may I believe be certainly prevented by a total abstinence from fermented or spirituous liquors; by drinking much aqueous fluids; as toast and water, tea, milk and water, lemonade; and lastly by thin clothing, and sleeping on a hardish bed, that the patient may not lie too long on one side. See Cla.s.s IV. 2. 2.

2. There is reason to believe, that the daily use of opium contributes to produce gravel in the kidnies by increasing absorption, when they are inflamed; in the same manner as is done by fermented or spirituous liquor.

See Cla.s.s I. 3. 2. 11.

When the kidnies are so obstructed with gravel, that no urine pa.s.ses into the bladder; which is known by the external appearance of the lower part of the abdomen, which, when the bladder is full, seems as if contracted by a cord between the navel and the bladder; and by the tension on the region of the bladder distinguishable by the touch; or by the introduction of the catheter; the following methods of cure are frequently successful.

Venesection to six or eight ounces, ten grains of calomel, and an infusion of senna with salts and oil, every three hours, till stools are procured.

Then an emetic. After the patient has been thus evacuated, a blister on the loins should be used; and from ten to twenty electric shocks should be pa.s.sed through the kidnies, as large as can be easily borne, once or twice a day. Along with this method the warm bath should be used for an hour once or twice a day. After repeated evacuations a clyster, consisting of two drams of turpentine dissolved by yolk of egg, and sixty drops of tincture of opium, should be used at night, and repeated, with cathartic medicines interposed, every night, or alternate nights. Aerated solution of alcali should be taken internally, and balsam of copaiva, three or four times a day. Some of these patients recover after having made no water for nine or ten days.

If a stone sticks in the ureter with incessant vomiting, ten grains of calomel must be given in small pills as above; and some hours afterwards infusion of senna and salts and oil, if it can be made to stay on the stomach. And after the purge has operated four or five times, an opiate is to be given, if the pain continues, consisting of two grains of opium. If this does not succeed, ten or twenty electric shocks through the kidney should be tried, and the purgative repeated, and afterwards the opiate. The patient should be frequently put into the warm bath for an hour at a time.

Eighty or an hundred drops of laudanum given in a glyster, with two drams of turpentine, is to be preferred to the two grains given by the stomach as above, when the pain and vomiting are very urgent.

10. _Calculus vesicae._ Stone of the bladder. The nucleus, or kernel, of these concretions is always formed in the kidney, as above described; and pa.s.sing down the ureter into the bladder, is there perpetually increased by the mucus and salts secreted from the arterial system, or by the mucus of the bladder, disposed in concentric strata. The stones found in the bowels of horses are also formed on a nucleus, and consist of concentric spheres; as appears in sawing them through the middle. But as these are formed by the indurated mucus of the intestines alone without the urinary salts, it is probable a difference would be found on their a.n.a.lysis.

As the stones of the bladder are of various degrees of hardness, and probably differ from each other in the proportions at least of their component parts; when a patient, who labours under this afflicting disease, voids any small bits of gravel; these should be kept in warm solutions of caustic alcali, or of mild alcali well aerated; and if they dissolve in these solutions, it would afford greater hopes, that that which remains in the bladder, might be affected by these medicines taken by the stomach, or injected into the bladder.

To prevent the increase of a stone in the bladder much diluent drink should be taken; as half a pint of water warmed to about eighty degrees, three or four times a day: which will not only prevent the growth of it, by preventing any microcosmic salts from being precipitated from the urine, and by keeping the mucus suspended in it; but will also diminish the stone already formed, by softening, and washing away its surface. To this must be added cool dress, and cool bed-clothes, as directed above in the calculus renis.

When the stone is pushed against or into the neck of the bladder, great pain is produced; this may sometimes be relieved by the introduction of a bougie to push the stone back into the fundus of the bladder. Sometimes by change of posture, or by an opiate either taken into the stomach, or by a clyster.

A dram of sal soda, or of salt of tartar, dissolved in a pint of water, and well saturated with carbonic acid (fixed air), by means of Dr. Nooth's gla.s.s-apparatus, and drank every day, or twice a day, is the most efficacious internal medicine yet discovered, which can be easily taken without any general injury to the const.i.tution. An aerated alcaline water of this kind is sold under the name of fact.i.tious Seltzer water, by J.

Schweppe, at N^o 8, King's-street, Holborn, London; which I am told is better prepared than can be easily done in the usual gla.s.s-vessels, probably by employing a greater pressure in wooden ones.

Lythotomy is the last recourse. Will the gastric juice of animals dissolve calculi? Will fermenting vegetable juices, as sweet-wort, or sugar and water in the act of fermentation with yest, dissolve any kind of animal concretions?

11. _Calculus arthriticus._ Gout-stones are formed on inflamed membranes, like those of the kidnies above described, by the too hasty absorption of the thinner and saline parts of the mucus. Similar concretions have been produced in the lungs, and even in the pericardium; and it is probable, that the ossification, as it is called, of the minute arteries, which is said to attend old age, and to precede some mortifications of the extremities, may be a process of this kind.

As gout-stones lie near the surface, it is probable, that ether, frequently applied in their early state, might render them so liquid as to permit their reabsorption; which the stimulus of the ether might at the same time encourage.

12. _Rheumatismus chronicus._ Chronic rheumatism. After the acute rheumatism some insp.i.s.sated mucus, or material similar to chalk-stones of the gout, which was secreted on the inflamed membrane, is probably left, owing to the too hasty absorption of the thinner and saline part of it; and by lying on the fascia, which covers some of the muscles, pains them, when they move and rub against it, like any extraneous material.

The pain of the shoulder, which attends inflammations of the upper membrane of the liver, and the pains of the arms, which attend asthma dolorific.u.m, or dropsy of the pericardium, are distinguished from the chronic rheumatism, as in the latter the pain only occurs on moving the affected muscles.

M. M. Warm bath, cold bath, bandage of emplastrum de minio put on tight, so as to compress the part. Cover the part with flannel. With oiled silk. Rub it with common oil frequently. With ether. A blister. A warmer climate.

Venesection. A grain of calomel and a grain of opium for ten successive nights. The Peruvian bark.

13. _Cicatrix vulnerum._ The scar after wounds. In the healing of ulcers the matter is first thickened by increasing the absorption in them; and then lessened, till all the matter is absorbed, which is brought by the arteries, instead of being deposed in the ulcer.

M. M. This is promoted by bandage, by the sorbentia externally, as powder of bark, white lead; solution of sugar of lead. And by the sorbentia internally after evacuations. See Sect. x.x.xIII. 3. 2.

In those ulcers, which are made by the contact of external fire, the violent action of the fibres, which occasions the pain, is liable to continue, after the external heat is withdrawn. This should be relieved by external cold, as of snow, salt and water recently mixed, ether, or spirits of wine suffered to evaporate on the part.

The cicatrix of an ulcer generally proceeds from the edges of it; but in large ones frequently from the middle, or commences in several places at the same time; which probably contributes to the unevenness of large scars.

14. _Corneae obfuscatio._ Opacity of the cornea. There are few people, who have pa.s.sed the middle of life, who have not at some time suffered some slight scratches or injuries of the cornea, which by not healing with a perfectly smooth surface, occasion some refractions of light, which may be conveniently seen in the following manner: fill a tea-saucer with cream and tea, or with milk, and holding it to your lips, as if going to drink it, the imperfections of the cornea will appear like lines or blotches on the surface of the fluid, with a less white appearance than that surface. Those blemishes of the eye are distinguished from the muscae volitantes described in Cla.s.s I. 2. 5. 3. by their being invariably seen at any time, when you look for them.

Ulcers may frequently be seen on the cornea after ophthalmy, like little pits or indentations beneath the surface of it: in this case no external application should be used, lest the scar should be left uneven; but the cure should be confined to the internal use of thirty grains of bark twice a day, and from five to ten drops of laudanum at night, with five grains of rhubarb, if necessary.

After ulcers of the cornea, which have been large, the inequalities and opacity of the cicatrix obscures the sight; in this case could not a small piece of the cornea be cut out by a kind of trephine about the size of a thick bristle, or a small crow-quill, and would it not heal with a transparent scar? This experiment is worth trying, and might be done by a piece of hollow steel wire with a sharp edge, through which might be introduced a pointed steel screw; the screw to be introduced through the opake cornea to hold it up, and press it against the cutting edge of the hollow wire or cylinder; if the scar should heal without losing its transparency, many blind people might be made to see tolerably well by this slight and not painful operation. An experiment I wish strongly to recommend to some ingenious surgeon or oculist.

ORDO I.

_Increased Irritation._

GENUS IV.

_With increased Actions of other Cavities and Membranes._

SPECIES.

1. _Nict.i.tatio irritativa._ Winking of the eyes is performed every minute without our attention, for the purpose of cleaning and moistening the eye-ball; as further spoken of in Cla.s.s II. 1. 1. 8. When the cornea becomes too dry, it becomes at the same time less transparent; which is owing to the pores of it being then too large, so that the particles of light are refracted by the edges of each pore, instead of pa.s.sing through it; in the same manner as light is refracted by pa.s.sing near the edge of a knife. When these pores are filled with water, the cornea becomes again transparent. This want of transparency of the cornea is visible sometimes in dying people, owing to their inirritability, and consequent neglect of nict.i.tation.

The increase of transparency by filling the pores with fluid is seen by soaking white paper in oil; which from an opake body becomes very transparent, and accounts for a curious atmospheric phenomenon; when there exists a dry mist in a morning so as to render distant objects less distinct, it is a sign of a dry day; when distant objects are seen very distinct, it is a sign of rain. See Botan. Garden, Part I. add. note xxv.

The particles of air are probably larger than those of water, as water will pa.s.s through leather and paper, which will confine air; hence when the atmosphere is much deprived of moisture, the pores of the dry air are so large, that the rays of light are refracted by their edges instead of pa.s.sing through them. But when as much moisture is added as can be perfectly dissolved, the air becomes transparent; and opake again, when a part of this moisture collects into small spherules previous to its precipitation. This also accounts for the want of transparency of the air, which is seen in tremulous motions over corn-fields on hot summer-days, or over brick-kilns, after the flame is extinguished, while the furnace still remains hot.

2. _Deglut.i.tio irritativa._ The deglut.i.tion of our saliva is performed frequently without our attention, and is then an irritative action in consequence of the stimulus of it in the mouth. Or perhaps sometimes for the purpose of diffusing a part of it over the dry membranes of the fauces and pharinx; in the same manner as tears are diffused over the cornea of the eye by the act of nict.i.tation to clean or moisten it.

3. _Respiratio et Tussis irritativae._ In the acts of respiration and of coughing there is an increased motion of the air-cells of the lungs owing to some stimulating cause, as described above in Cla.s.s I. 1. 2. 8. and I.

1. 3. 4. and which are frequently performed without our attention or consciousness, and are then irritative actions; and thus differ from those described in Cla.s.s II. 1. 1. 2. and 5. To these increased actions of the air-cells are superadded those of the intercostal muscles and diaphragm by irritative a.s.sociation. When any unnatural stimulus acts so violently on the organs of respiration as to induce pain, the sensorial power of sensation becomes added to that of irritation, and inflammation of the membranes of them is a general consequence.

4. _Exclus...o...b..lis._ The exclusion of the bile from the gall-bladder, and its derivation into the duodenum, is an irritative action in consequence of the stimulus of the aliment on the extremity of the biliary duct, which terminates in the intestine. The increased secretion of tears is occasioned in a similar manner by any stimulating material in the eyes; which affects the excretory ducts of the lacrymal glands. A pain of the external membrane of the eye sometimes attends any unusual stimulus of it, then the sensorial power of sensation becomes added to that of irritation, and a superficial inflammation is induced.

5. _Dent.i.tio._ Toothing. The pain of toothing often begins much earlier than is suspected; and is liable to produce convulsions; which are sometimes relieved, when the gum swells, and becomes inflamed; at other times a diarrhoea supervenes, which is generally esteemed a favourable circ.u.mstance, and seems to prevent the convulsions by supplying another means of relieving the pain of dent.i.tion by irritative exertion; and a consequent temporary exhaustion of sensorial power. See Cla.s.s I. 1. 2. 5.

Sect. x.x.xV. 2. 1.

The convulsions from toothing generally commence long before the appearance of the teeth; but as the two middle incisors of the lower jaw generally appear first, and then those of the upper, it is adviseable to lance the gums over these longitudinally in respect to the jaw-bones, and quite down to the periosteum, and through it.

As the convulsions attending the commencement of toothing are not only dangerous to life in their greatest degree, but are liable to induce stupor or insensibility by their continuance even in a less degree, the most efficacious means should be used to cure them.

M. M. Lance the gum of the expected teeth quite through the periosteum longitudinally. Venesection by the lancet or by two or three leeches. One grain of calomel as a purge. Tincture of jalap, five or six drops in water every three hours til it purges, to be repeated daily. After evacuations a small blister on the back or behind the ears. And lastly, two or three drops of laudanum according to the age of the child. Warm bath. See Cla.s.s III. 1. 1. 5. and 6.

6. _Priapismus chronicus._ I have seen two cases, where an erection of the p.e.n.i.s, as hard as horn, continued two or three weeks without any venereal desires, but not without some pain; the easiest att.i.tude of the patients was lying upon their backs with their knees up. At length the corpus cavernosum urethrae became soft, and in another day or two the whole subsided. In one of them a bougie was introduced, hoping to remove some bit of gravel from the caput gallinaginis, camphor, warm bathing, opium, lime-water, cold aspersion, bleeding in the veins of the p.e.n.i.s, were tried in vain. One of them had been a free drinker, had much gutta rosacea on his face, and died suddenly a few months after his recovery from this complaint. Was it a paralysis of the terminations of the veins, which absorb the blood from the tumid p.e.n.i.s? or from the stimulus of indurated s.e.m.e.n in the seminal vessels? In the latter case some venereal desires should have attended. Cla.s.s III. 1. 2. 16.

The priapismus, which occurs to vigorous people in a morning before they awake, has been called the signum salutis, or banner of health, and is occasioned by the increase of our irritability or sensibility during sleep, as explained in Sect. XVIII. 15.

7. _Distentio mamularum._ The distention of the nipples of lactescent women is at first owing to the stimulus of the milk. See Sect. XIV. 8. and Sect.

XVI. 5. See Cla.s.s II. 1. 7. 10.

8. _Descensus uteri._ This is a very frequent complaint after bad labours, the fundus uteri becomes inverted and descends like the prolapsus ani.

M. M. All the usual pessaries are very inconvenient and ineffectual. A piece of soft sponge about two inches diameter introduced into the v.a.g.i.n.a gives great ease to these patients, and supports the uterus; it should have a string put through it to retract it by.

There are also pessaries now made of elastic gum, which are said to be easily worn, and to be convenient, from their having a perforation in their centre.

9. _Prolapsus ani._ The lower part of the r.e.c.t.u.m becomes inverted, and descends after every stool chiefly in children; and thus stimulates the sphincter ani like any other extraneous body.

M. M. It should be dusted over with very fine powder of gum sandarach, and then replaced. Astringent fomentations; as an infusion of oak-bark, or a slight solution of alum. Horizontal rest frequently in the day.

10. _Lumbricus._ Round worm. The round worm is suspected in children when the belly is tumid, and the countenance bloated and pale, with swelling of the upper lip. The generation of these worms is promoted by the too dilute state of the bile, as is evident in the fleuke-worm found in the biliary ducts and substance of the liver in sheep; and in water-rats, in the livers of which last animals they were lately detected in large numbers by Dr.