Miscarriages more frequently happen from eruptive fevers, and from rheumatic ones, than from other inflammatory diseases. I saw a most violent pleurisy and hepat.i.tis cured by repeated venesection about a week or ten days before parturition; yet another lady whom I attended, miscarried at the end of the chicken pox, with which her children were at the same time affected. Miscarriages towards the termination of the small pox are very frequent, yet there have been a few instances of children, who have been born with the eruption on them. The blood in the small pox will not inoculate that disease, if taken before the commencement of the secondary fever; as shewn in Sect. x.x.xIII. 2. 10. because the contagious matter is not yet formed, but after it has been oxygenated through the cuticle in the pustules, it becomes contagious; and if it be then absorbed, as in the secondary fever, the blood of the mother may become contagious, and infect the child. The same mode of reasoning is applicable to the chicken pox. See Cla.s.s IV. 3. 1. 7.

15. _s...o...b..tus._ Sea-scurvy is caused by salt diet, the perpetual stimulus of which debilitates the venous and absorbent systems. Hence the blood is imperfectly taken up by the veins from the capillaries, whence brown and black spots appear upon the skin without fever. The limbs become livid and edematous, and lastly ulcers are produced from deficient absorption. See Sect. x.x.xIII. 3. 2. and Cla.s.s II. 1. 4. 13. For an account of the scurvy of the lungs, see Sect. XXVII. 2.

M. M. Fresh animal and vegetable food. Infusion of malt. New beer. Sugar.

Wine. Steel. Bark. Sorbentia. Opium?

16. _Vibices._ Extravasations of blood become black from their being secluded from the air. The extravasation of blood in bruises, or in some fevers, or after death in some patients, especially in the parts which were exposed to pressure, is owing to the fine terminations of the veins having been mechanically compressed so as to prevent their absorbing the blood from the capillaries, or to their inactivity from disease. The blood when extravasated undergoes a chemical change before it is sufficiently fluid to be taken up by the lymphatic absorbents, and in that process changes its colour to green and then yellow.

17. _Petechiae._ Purple spots. These attend fevers with great venous inirritability, and are probably formed by the inability of a single termination of a vein, whence the corresponding capillary becomes ruptured, and effuses the blood into the cellular membrane round the inert termination of the vein. This is generally esteemed a sign of the putrid state of the blood, or that state contrary to the inflammatory one. As it attends some inflammatory diseases which are attended with great inirritability, as in the confluent small pox. But it also attends the scurvy, where no fever exists, and it therefore simply announces the inactivity of the terminations of some veins; and is thence indeed a bad symptom in fevers, as a mark of approaching inactivity of the whole sanguiferous system, or death. The blue colour of some children's arms or faces in very cold weather is owing in like manner to the torpor of the absorbent terminations of the veins, whence the blood is acc.u.mulated in them, and sometimes bursts them.

ORDO II.

_Decreased Irritation._

GENUS II.

_Decreased Action of the Secerning System._

These are always attended with decrease of partial, or of general heat; for as the heat of animal bodies is the consequence of their various secretions, and is perpetually pa.s.sing away into the ambient air, or other bodies in contact with them; when these secretions become diminished, or cease, the heat of the part or of the whole is soon diminished, or ceases along with them.

SPECIES.

1. _Frigus febrile._ Febrile coldness. There is reason to believe, that the beginning of many fever-fits originates in the quiescence of some part of the absorbent system, especially where they have been owing to external cold; but that, where the coldness of the body is not owing to a diminution of external heat, it arises from the inaction of some part of the secerning system. Hence some parts of the body are hot whilst other parts are cold; which I suppose gave occasion to error in Martyn's Experiments; where he says, that the body is as hot in the cold paroxysms of fevers as at other times.

After the sensorial power has been much diminished by great preceding activity of the system, as by long continued external heat, or violent exercise, a sudden exposure to much cold produces a torpor both greater in degree and over a greater portion of the system, by subtracting their accustomed stimulus from parts already much deprived of their irritability.

Dr. Franklin in a letter to M. Duberge, the French translator of his works, mentions an instance of four young men, who bathed in a cold spring after a day's harvest work; of whom two died on the spot, a third on the next morning, and the other survived with difficulty. Hence it would appear, that those, who have to travel in intensely cold weather, will sooner perish, who have previously heated themselves much with drams, than those who have only the stimulus of natural food; of which I have heard one well attested instance. See Article VII. 2. 3. Cla.s.s III. 2. 1. 17.

_Frigus chronic.u.m._ Permanent coldness. Coldness of the extremities, without fever, with dry pale skin, is a symptom of general debility, owing to the decreased action of the arterial system, and of the capillary vessels; whence the perspirable matter is secreted in less quant.i.ty, and in consequence the skin is less warm. This coldness is observable at the extremities of the limbs, ears, and nose, more than in any other parts: as a larger surface is here exposed to the contact of the air, or clothes, and thence the heat is more hastily carried away.

The pain, which accompanies the coldness of the skin, is owing to the deficient exertion of the subcutaneous vessels, and probably to the acc.u.mulation of sensorial power in the extremities of their nerves. See Sect. XII. 5. 3. XIV. 6. x.x.xII. 3. and Cla.s.s I. 2. 4. 1.

M. M. A blister. Incitantia, nutrientia, sorbentia. Exercise. Clothes.

Fire. Joy. Anger.

2. _Pallor fugitivus._ The fugitive paleness, which accompanies the coldness of the extremities, is owing to a less quant.i.ty of blood pa.s.sing through the capillaries of the skin in a given time; where the absorbent power of the veins is at the same time much diminished, a part of the blood lingers at their junction with the capillary arteries, and a bluish tinge is mixed with the paleness; as is seen in the loose skin under the eye-lids, and is always a mark of temporary debility. See Cla.s.s II. 1. 4.

4. Where the paleness of the skin is owing to the deficiency of red globules in the blood, it is joined with a yellowish tinge; which is the colour of the serum, with which the blood then abounds, as in chlorosis, and in torpor or paralysis of the liver, and is often mistaken for a superabundance of bile.

A permanent paleness of the skin is owing to the coalescence of the minute arteries, as in old age. See Cla.s.s I. 2. 2. 9. There is another source of paleness from the increased absorption of the terminations of the veins, as when vinegar is applied to the lips. See Sect. XXVII. 1. and another from the retrograde motions of the capillaries and fine extremities of the arteries. See Cla.s.s II. 3. 1. 1.

M. M. A blister, nutrientia, incitantia, exercise, oxygene gas.

3. _Pus parcius._ Diminished pus. Dryness of ulcers. In the cold fits of fever all the secretions are diminished, whether natural or artificial, as their quant.i.ty depends on the actions of the glands or capillaries, which then share in the universal inaction of the system. Hence the dryness of issues and blisters in great debility, and before the approach of death, is owing to deficient secretion, and not to increased absorption.

M. M. Opium, wine in very small quant.i.ties, Peruvian bark.

4. _Mucus parcior._ Diminished mucus. Dryness of the mouth and nostrils.

This also occurs in the cold fits of intermittents. In these cases I have also found the tongue cold to the touch of the finger, and the breath to the back of one's hand, when opposed to it, which are very inauspicious symptoms, and generally fatal. In fevers with inirritability it is generally esteemed a good symptom, when the nostrils and tongue become moist after having been previously dry; as it shews an increased action of the mucous glands of those membranes, which were before torpid. And the contrary to this is the facies Hippocratica, or countenance so well described by Hippocrates, which is pale, cold, and shrunk; all which are owing to the inactivity of the secerning vessels, the paleness from there being less red blood pa.s.sing through the capillaries, the coldness of the skin from there being less secretion of perspirable matter, and the shrunk appearance from there being less mucus secreted into the cells of the cellular membrane. See Cla.s.s IV. 2. 4. 11.

M. M. Blisters. Incitantia.

5. _Urina parcior pallida._ Paucity of pale urine, as in the cold fits of intermittents; it appears in some nervous fevers throughout the whole disease, and seems to proceed from a palsy of the kidnies; which probably was the cause of the fever, as the fever sometimes ceases, when that symptom is removed: hence the straw-coloured urine in this fever is so far salutary, as it shews the unimpaired action of the kidnies.

M. M. Balsams, essential oil, asparagus, rhubarb, a blister. Cantharides internally.

6. _Torpor hepaticus._ Paucity of bile from a partial inaction of the liver; hence the bombycinous colour of the skin, grey stools, urine not yellow, indigestion, debility, followed by tympany, dropsy, and death.

This paralysis or inirritability of the liver often destroys those who have been long habituated to much fermented liquor, and have suddenly omitted the use of it. It also destroys plumbers, and house-painters, and in them seems a subst.i.tute for the colica saturnina. See Sect. x.x.x.

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

7. _Torpor Pancreatis._ Torpor of the pancreas. I saw what I conjectured to be a tumour of the pancreas with indigestion, and which terminated in the death of the patient. He had been for many years a great consumer of tobacco, insomuch that he chewed that noxious drug all the morning, and smoaked it all the afternoon. As the secretion from the pancreas resembles saliva in its general appearance, and probably in its office of a.s.sisting digestion, by preventing the fermentation of the aliment; as would appear by the experiments of Pringle and Macbride; there is reason to suspect, that a sympathy may exist between the salivary and pancreatic glands; and that the perpetual stimulus of the former by tobacco might in process of time injure the latter. See Tobacco, Article III. 2. 2.

8. _Torpor renis._ Inirritability or paralysis of the kidnies is probably frequently mistaken for gravel in them. Several, who have lived rather intemperately in respect to fermented or spirituous liquors, become suddenly seized about the age of sixty, or later, with a total stoppage of urine; though they have previously had no symptoms of gravel. In these cases there is no water in the bladder; as is known by the introduction of the catheter, of which those made of elastic gum are said to be preferable to metallic ones; or it may generally be known by the shape of the abdomen, either by the eye or hand. Bougies and catheters of elastic gum are sold at N^o 37, Red Lion-street, Holborn, London.

M. M. Electric shocks, warm bath. Emetics. See calculus renis, Cla.s.s I. 1.

3. 9. When no gravel has been previously observed, and the patient has been a wine-drinker rather than an ale-drinker, the case is generally owing to inirritability of the tubuli uriniferi, and is frequently fatal. See Cla.s.s I. 2. 4. 20.

9. _Punctae mucosae vultus._ Mucous spots on the face. These are owing to the inactivity of the excretory ducts of the mucous glands; the thinner part of this secretion exhales, and the remainder becomes insp.i.s.sated, and lodges in the duct; the extremity of which becomes black by exposure to the air.

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

10. _Maculae cutis fulvae._ Morphew or freckles. Tawny blotches on the skin of the face and arms of elderly people, and frequently on their legs after slight erysipelas. The freckles on the face of younger people, who have red hair, seem to be a similar production, and seem all to be caused by the coalescence of the minute arteries or capillaries of the part. In a scar after a wound the integument is only opake; but in these blotches, which are called morphew and freckles, the small vessels seem to have become inactive with some of the serum of the blood stagnating in them, from whence their colour. See Cla.s.s III. 1. 2. 12.

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

11. _Canities._ Grey hair. In the injection of the vessels of animals for the purposes of anatomical preparations, the colour of the injected fluid will not pa.s.s into many very minute vessels; which nevertheless uncoloured water, or spirits, or quicksilver will permeate. The same occurs in the filtration of some coloured fluids through paper, or very fine sand, where the colouring matter is not perfectly dissolved, but only diffused through the liquid. This has led some to imagine, that the cause of the whiteness of the hair in elderly people may arise from the diminution, or greater tenuity, of the glandular vessels, which secrete the mucus, which hardens into hair; and that the same difference of the tenuity of the secerning vessels may possibly make the difference of colour of the silk from different silk-worms, which is of all shades from yellow to white.

But as the secreted fluids are not the consequence of mechanical filtration, but of animal selection; we must look out for another cause, which must be found in the decreasing activity of the glands, as we advance in life; and which affects many of our other secretions as well as that of the mucus, which forms the hair. Hence grey hairs are produced on the faces of horses by whatever injures the glands at their roots, as by corrosive blisters; and frequently on the human subject by external injuries on the head; and sometimes by fevers. And as the grey colour of hair consists in its want of transparency, like water converted into snow; there is reason to suppose, that a defect of secreted moisture simply may be the cause of this kind of opacity, as explained in Cataracta, Cla.s.s I. 2. 2. 13.

M. M. Whatever prevents the inirritability and insensibility of the system, that is, whatever prevents the approach of old age, will so far counteract the production of grey hairs, which is a symptom of it. For this purpose in people, who are not corpulent, and perhaps in those who are so, the warm bath twice or thrice a week is particularly serviceable. See Sect. x.x.xIX.

5. 1. on the colours of animals, and Cla.s.s I. 1. 2. 15.

12. _Callus._ The callous skin on the hands and feet of laborious people is owing to the extreme vessels coalescing from the perpetual pressure they are exposed to.

As we advance in life, the finer arteries lose their power of action, and their sides grow together; hence the paleness of the skins of elderly people, and the loss of that bloom, which is owing to the numerous fine arteries, and the transparency of the skin, that encloses them.

M. M. Warm bath. Paring the thick skin with a knife. Smoothing it with a pumice stone. Cover the part with oiled silk to prevent the evaporation of the perspirable matter, and thus to keep it moist.

13. _Cataracta_ is an opacity of the crystalline lens of the eye. It is a disease of light-coloured eyes, as the gutta serena is of dark ones. On cutting off with scissars the cornea of a calf's eye, and holding it in the palm of one's hand, so as to gain a proper light, the artery, which supplies nutriment to the crystalline humour, is easily and beautifully seen; as it rises from the centre of the optic nerve through the vitreous humour to the crystalline. It is this point, where the artery enters the eye through the cineritious part of the optic nerve, (which is in part near the middle of the nerve,) which is without sensibility to light; as is shewn by fixing three papers, each of them about half an inch in diameter, against a wall about a foot distant from each other, about the height of the eye; and then looking at the middle one, with one eye, and retreating till you lose sight of one of the external papers. Now as the animal grows older, the artery becomes less visible, and perhaps carries only a transparent fluid, and at length in some subjects I suppose ceases to be pervious; then it follows, that the crystalline lens, losing some fluid, and gaining none, becomes dry, and in consequence opake; for the same reason, that wet or oiled paper is more transparent than when it is dry, as explained in Cla.s.s I. 1. 4. 1. The want of moisture in the cornea of old people, when the exhalation becomes greater than the supply, is the cause of its want of transparency; and which like the crystalline gains rather a milky opacity. The same a.n.a.logy may be used to explain the whiteness of the hair of old people, which loses its pellucidity along with its moisture.

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

M. M. Small electric shocks through the eye. A quarter of a grain of corrosive sublimate of mercury dissolved in brandy, or taken in a pill, twice a day for six weeks. Couching by depression, or by extraction. The former of these operations is much to be preferred to the latter, though the latter is at this time so fashionable, that a surgeon is almost compelled to use it, lest he should not be thought an expert operator. For depressing the cataract is attended with no pain, no danger, no confinement, and may be as readily repeated, if the crystalline should rise again to the centre of the eye. The extraction of the cataract is attended with considerable pain, with long confinement, generally with fever, always with inflammation, and frequently with irreparable injury to the iris, and consequent danger to the whole eye. Yet has this operation of extraction been trumpeted into universal fashion for no other reason but because it is difficult to perform, and therefore keeps the business in the hands of a few empyrics, who receive larger rewards, regardless of the hazard, which is encountered by the flattered patient.

A friend of mine returned yesterday from London after an absence of many weeks; he had a cataract in a proper state for the operation, and in spite of my earnest exhortation to the contrary, was prevailed upon to have it extracted rather than depressed. He was confined to his bed three weeks after the operation, and is now returned with the iris adhering on one side so as to make an oblong aperture; and which is nearly, if not totally, without contraction, and thus greatly impedes the little vision, which he possesses. Whereas I saw some patients couched by depression many years ago by a then celebrated empyric, Chevalier Taylor, who were not confined above a day or two, that the eye might gradually be accustomed to light, and who saw as well as by extraction, perhaps better, without either pain, or inflammation, or any hazard of losing the eye.

As the inflammation of the iris is probably owing to forcing the crystalline through the aperture of it in the operation of extracting it, could it not be done more safely by making the opening behind the iris and ciliary process into the vitreous humour? but the operation would still be more painful, more dangerous, and not more useful than that by depressing it.