14. _Innutritio ossium._ Innutrition of the bones. Not only the blood effused in vibices and petechiae, or from bruises, as well as the blood and new vessels in inflamed parts, are reabsorbed by the increased action of the lymphatics; but the harder materials, which const.i.tute the fangs of the first set of teeth, and the ends of exfoliating bones, and sometimes the matter of chalk-stones in the gout, the coagulable lymph, which is deposited on the lungs, or on the muscles after inflammation of those parts, and which frequently produces difficulty of breathing, and the pains of chronic rheumatism, and lastly the earthy part of the living bones are dissolved and absorbed by the increased actions of this system of vessels.

See Sect. x.x.xIII. 3. 1.

The earthy part of bones in this disease of the innutrition of them seems to suffer a solution, and reabsorption; while the secerning vessels do not supply a sufficient quant.i.ty of calcareous earth and phosphoric acid, which const.i.tute the substance of bones. As calcareous earth abounds every where, is the want of phosphoric acid the remote cause? One cause of this malady is given in the Philosophic Transactions, where the patient had been accustomed to drink large quant.i.ties of vinegar. Two cases are described by Mr. Gouch. In one case, which I saw, a considerable quant.i.ty of calcareous earth, and afterwards of bone-ashes, and of decoction of madder, and also of sublimate of mercury, were given without effect. All the bones became soft, many of them broke, and the patient seemed to die from the want of being able to distend her chest owing to the softness of the ribs.

M. M. Salt of urine, called sal microcosmic.u.m, phosphorated soda. Calcined hartshorn. Bone-ashes. Hard or petrifying water, as that of Matlock, or such as is found in all limestone or marly countries. The calcareous earth in these waters might possibly be carried to the bones, as madder is known to colour them. Warm bath. Volatile or fixed alcali as a lotion on the spine, or essential oils.

The innutrition of the bones is often first to be perceived by the difficulty of breathing and palpitation of the heart on walking a little faster than usual, which I suppose is owing to the softness of the ends of the ribs adjoining to the sternum; on which account they do not perfectly distend the chest, when they are raised by the pectoral and intercostal muscles with greater force than usual. After this the spine becomes curved both by the softness of its vertebrae, and for the purpose of making room for the disturbed heart. See Species 16 of this genus.

As these patients are pale and weak, there would seem to be a deficiency of oxygene in their blood, and in consequence a deficiency of phosphoric acid; which is probably produced by oxygene in the act of respiration.

Mr. Bonhome in the Chemical Annals, August, 1793, supposes the rickets to arise from the prevalence of vegetable or acetous acid, which is known to soften bones out of the body. Mr. Dettaen seems to have espoused a similar opinion, and both of them in consequence give alcalies and testacea. If this theory was just, the soft bones of such patients should shew evident marks of such acidity after death; which I believe has not been observed.

Nor is it a.n.a.logous to other animal facts, that nutritious fluids secreted by the finest vessels of the body should be so little animalized, as to retain acetous or vegetable acidity.

The success attending the following case in so short a time as a fortnight I ascribed princ.i.p.ally to the use of the warm bath; in which the patient continued for full half an hour every night, in the degree of heat, which was most grateful to her sensation, which might be I suppose about 94. Miss ----, about ten years of age, and very tall and thin, has laboured under palpitation of her heart, and difficult breathing on the least exercise, with occasional violent dry cough, for a year or more, with dry lips, little appet.i.te either for food or drink, and dry skin, with cold extremities. She has at times been occasionally worse, and been relieved in some degree by the bark. She began to bend forwards, and to lift up her shoulders. The former seemed owing to a beginning curvature of the spine, the latter was probably caused to facilitate her difficult respiration.

M. M. She used the warm bath, as above related; which by its warmth might increase the irritability of the smallest series of vessels, and by supplying more moisture to the blood might probably tend to carry further the materials, which form calcareous or bony particles, or to convey them in more dilute solution. She took twice a day twenty grains of extract of bark, twenty grains of soda phosphorata, and ten grams of chalk, and ten of calcined hartshorn mixed into a powder with ten drops of laudanum; with flesh food both to dinner and supper; and port wine and water instead of the small beer, she had been accustomed to; she lay on a sofa frequently in a day, and occasionally used a neck-swing.

15. _Rachitis._ Rickets. The head is large, protuberant chiefly on the forepart. The smaller joints are swelled; the ribs depressed; the belly tumid, with other parts emaciated. This disease from the innutrition or softness of the bones arose about two centuries ago; seems to have been half a century in an increasing or spreading state; continued about half a century at its height, or greatest diffusion; and is now nearly vanished: which gives reason to hope, that the small-pox, measles, and venereal disease, which are all of modern production, and have already become milder, may in process of time vanish from the earth, and perhaps be succeeded by new ones! See the preceding species.

16. _Spinae distortio._ Distortion of the spine is another disease originating from the innutrition or softness of the bones. I once saw a child about six years old with palpitation of heart, and quickness of respiration, which began to have a curvature of the spine; I then doubted, whether the palpitation and quick respiration were the cause or consequence of the curvature of the spine; suspecting either that nature had bent the spine outwards to give room to the enlarged heart; or that the malformation of the chest had compressed and impeded the movements of the heart. But a few weeks ago on attending a young lady about ten years old, whose spine had lately began to be distorted, with very great difficulty and quickness of respiration, and alarming palpitation of the heart, I convinced myself, that the palpitation and difficult respiration were the effect of the change of the cavity of the chest from the distortion of the spine; and that the whole was therefore a disease of the innutrition or softness of the bones.

For on directing her to lie down much in the day, and to take the bark, the distortion became less, and the palpitation and quick respiration became less at the same time. After this observation a neck-swing was directed, and she took the bark, madder, and bone-ashes; and she continues to amend both in her shape and health.

Delicate young ladies are very liable to become awry at many boarding schools. This is occasioned princ.i.p.ally by their being obliged too long to preserve an erect att.i.tude, by sitting on forms many hours together. To prevent this the school-seats should have either backs, on which they may occasionally rest themselves; or desks before them, on which they may occasionally lean. This is a thing of greater consequence than may appear to those, who have not attended to it.

When the least tendency to become awry is observed, they should be advised to lie down on a bed or sofa for an hour in the middle of the day for many months; which generally prevents the increase of this deformity by taking off for a time the pressure on the spine of the back, and it at the same time tends to make them grow taller. Young persons, when nicely measured, are found to be half an inch higher in a morning than at night; as is well known to those, who inlist very young men for soldiers. This is owing to the cartilages between the bones of the back becoming compressed by the weight of the head and shoulders on them during the day. It is the same pressure which produces curvatures and distortions of the spine in growing children, where the bones are softer than usual; and which may thus be relieved by an horizontal posture for an hour in the middle of the day, or by being frequently allowed to lean on a chair, or to play on the ground on a carpet.

Young ladies should also be directed, where two sleep in a bed, to change every night, or every week, their sides of the bed; which will prevent their tendency to sleep always on the same side; which is not only liable to produce crookedness, but also to occasion diseases by the internal parts being so long kept in uniform contact as to grow together. For the same reason they should not be allowed to sit always on the same side of the fire or window, because they will then be inclined too frequently to bend themselves to one side.

Another great cause of injury to the shape of young ladies is from the pressure of stays, or other tight bandages, which at the same time cause other diseases by changing the form or situation of the internal parts. If a hard part of the stays, even a knot of the thread, with which they are sewed together, is pressed hard upon one side more than the other, the child bends from the side most painful, and thus occasions a curvature of the spine. To counteract this effect such stays, as have fewest hard parts, and especially such as can be daily or weekly turned, are preferable to others.

[Ill.u.s.tration]

Where frequent lying down on a sofa in the day-time, and swinging frequently for a short time by the hands or head, with loose dress, do not relieve a beginning distortion of the back; recourse may be had to a chair with stuffed moveable arms for the purpose of suspending the weight of the body by cushions under the arm-pits, like resting on crutches, or like the leading strings of infants. From the top of the back of the same chair a curved steel bar may also project to suspend the body occasionally, or in part by the head, like the swing above mentioned. The use of this chair is more efficacious in straightening the spine, than simply lying down horizontally; as it not only takes off the pressure of the head and shoulders from the spine, but at the same time the inferior parts of the body contribute to draw the spine straight by their weight; or lastly, recourse may be had to a spinal machine first described in the Memoires of the academy of surgery in Paris, Vol. III. p. 600, by M. Le Vacher, and since made by Mr. Jones, at N^o 6, North-street, Tottenham-court Road, London, which suspends the head, and places the weight of it on the hips.

This machine is capable of improvement by joints in the bar at the back of it, to permit the body to bend forwards without diminishing the extension of the spine.

The objections of this machine of M. Vacher, which is made by Mr. Jones, are first, that it is worn in the day-time, and has a very unsightly appearance. Mr. Jones has endeavoured to remedy this, by taking away the curved bar over the head, and subst.i.tuting in its place a forked bar, rising up behind each ear, with webs fastened to it, which pa.s.s under the chin and occiput. But this is not an improvement, but a deterioration of M.

Vacher's machine, as it prevents the head from turning with facility to either side. Another objection is, that its being worn, when the muscles of the back are in action, it is rather calculated to prevent the curvature of the spine from becoming greater, than to extend the spine, and diminish its curvature.

[Ill.u.s.tration]

For this latter purpose I have made a steel bow, as described in the annexed plate, which receives the head longitudinally from the forehead to the occiput; having a fork furnished with a web to sustain the chin, and another to sustain the occiput. The summit of the bow is fixed by a swivel to the board going behind the head of the bed above the pillow. The bed is to be inclined from the head to the feet about twelve or sixteen inches.

Hence the patient would be constantly sliding down during sleep, unless supported by this bow, with webbed forks, covered also with fur, placed beneath the chin, and beneath the occiput. There are also proper webs lined with fur for the hands to take hold off occasionally, and also to go under the arms. By these means I should hope great advantage from gradually extending the spine during the inactivity of the muscles of the back; and that it may be done without disturbing the sleep of the patient, and if this should happen, the bow is made to open by a joint at the summit of it, so as to be instantly disengaged from the neck by the hand of the wearer.

This bow I have not yet had opportunity to make use of, but it may be had from Mr. Harrison, whitesmith, Bridge-gate, Derby.

It will be from hence easily perceived, that all other methods of confining or directing the growth of young people should be used with great skill; such as back-boards, or bandages, or stocks for the feet; and that their application should not be continued too long at a time, lest worse consequences should ensue, than the deformity they were designed to remove.

To this may be added, that the stiff erect att.i.tude taught by some modern dancing masters does not contribute to the grace of person, but rather militates against it; as is well seen in one of the prints in Hogarth's a.n.a.lysis of Beauty; and is exemplifyed by the easy grace of some of the ancient statues, as of the Venus de Medici, and the Antinous, and in the works of some modern artists, as in a beautiful print of Hebe feeding an Eagle, painted by Hamilton, and engraved by Eginton, and many of the figures of Angelica Kauffman.

Where the bone of one of the vertebrae of the back has been swelled on both sides of it, so as to become protuberant, issues near the swelled part have been found of great service, as mentioned in Species 18 of this genus. This has induced me to propose in curvatures of the spine, to put an issue on the outside of the curve, where it could be certainly ascertained, as the bones on the convex side of the curve must be enlarged; in one case I thought this of service, and recommend the further trial of it.

In the tendency to curvature of the spine, whatever strengthens the general const.i.tution is of service; as the use of the cold bath in the summer months. This however requires some restriction both in respect to the degree of coldness of the bath, the time of continuing in it, and the season of the year. Common springs, which are of forty-eight degrees of heat, are too cold for tender const.i.tutions, whether of children or adults, and frequently do them great and irreparable injury. The coldness of river water in the summer months, which is about sixty-eight degrees, or that of Matlock, which is about sixty-eight, or of Buxton, which is eighty-two, are much to be preferred. The time of continuing in the bath should be but a minute or two, or not so long as to occasion a trembling of the limbs from cold. In respect to the season of the year, delicate children should certainly only bathe in the summer months; as the going frequently into the cold air in winter will answer all the purposes of the cold bath.

17. _Claudicatio c.o.xaria._ Lameness of the hip. A nodding of the thigh-bone is said to be produced in feeble children by the softness of the neck or upper part of that bone beneath the cartilage; which is naturally bent, and in this disease bends more downwards, or nods, by the pressure of the body; and thus renders one leg apparently shorter than the other. In other cases the end of the bone is protruded out of its socket, by inflammation or enlargement of the cartilages or ligaments of the joint, so that it rests on some part of the edge of the acetabulum, which in time becomes filled up. When the legs are straight, as in standing erect, there is no verticillary motion in the knee-joint; all the motion then in turning out the toes further than nature designed, must be obtained by straining in some degree this head of the thigh-bone, or the acetabulum, or cavity, in which it moves. This has induced me to believe, that this misfortune of the nodding of the head by the bone, or partial dislocation of it, by which one leg becomes shorter than the other, is sometimes occasioned by making very young children stand in what are called stocks; that is with their heels together, and their toes quite out. Whence the socket of the thigh-bone becomes inflamed and painful, or the neck of the bone is bent downward and outwards.

In this case there is no expectation of recovering the straightness of the end of the bone; but these patients are liable to another misfortune, that is, to acquire afterwards a distortion of the spine; for as one leg is shorter than the other, they sink on that side, and in consequence bend the upper part of their bodies, as their shoulders, the contrary way, to balance themselves; and then again the neck is bent back again towards the lame side, to preserve the head perpendicular; and thus the figure becomes quite distorted like the letter S, owing originally to the deficiency of the length of one limb. The only way to prevent this curvature of the spine is for the child to wear a high-heeled shoe or patten on the lame foot, so as to support that side on the same level with the other, and thus to prevent a greater deformity.

I have this day seen a young lady about twelve, who does not limp or waddle in walking; but nevertheless, when she stands or sits, she sinks down towards her right side, and turns out that toe more than the other. Hence, both as she sits and stands, she bends her body to the right; whence her head would hang a little over her right shoulder; but to replace this perpendicularly, she lifts up her left shoulder and contracts the muscles on that side of the neck; which are therefore become thicker and stronger by their continued action; but there is not yet any very perceptible distortion of the spine.

As her right toe is turned outward rather more than natural, this shews the disease to be in the hip-joint; because, when the limb is stretched out, the toe cannot turn horizontally in the least without moving the end of the thigh-bone; although when the knee is bent, the toe can be turned through one third or half of a circle by the rotation of the tibia and fibula of the leg round each other. Hence if children are set in stocks with their heels touching each other as they sit, and are then made to rise up, till they stand erect, the socket or head of the thigh-bone becomes injured, especially in those children, whose bones are soft; and a shortness of that limb succeeds either by the bending of the neck of the thigh-bone, or by its getting out of the acetabulum; and a consequent rising of one shoulder, and a curvature of the spine is produced from so distant a cause.

M. M. An elastic cushion made of curled hair should be placed under the affected hip, whenever she sits; or should be fitted to the part by means of drawers, so that she cannot avoid sitting on it. A neck-swing, and lying down in the day, should be occasionally used to prevent or remove any curvature of the spine. The rest as in Species 13 and 15 of this genus.

18. _Spina protuberans._ Protuberant spine. One of the bones of the spine swells, and rises above the rest. This is not an uncommon disease, and belongs to the innutrition of the bones, as the bone must become soft before it swells; which softness is owing to defect of the secretion of phosphorated calcareous earth. The swelling of the bone compresses a part of the brain, called the spinal marrow, within the cavity of the back-bones; and in consequence the lower limbs become paralytic, attended sometimes with difficulty of emptying the bladder and r.e.c.t.u.m.

M. M. Issues put on each side of the prominent bone are of great effect, I suppose, by their stimulus; which excites into action more of the sensorial powers of irritation and sensation, and thus gives greater activity to the vascular system in their vicinity. The methods recommended in distortion of the spine are also to be attended to.

19. _Spina bifida._ Divided spine, called also Hydrorachitis, as well as the Hydrocephalus externus, are probably owing in part to a defect of ossification of the spine and cranium; and that the collection of fluid beneath them may originate from the general debility of the system; which affects both the secerning, and absorbent vessels.

A curious circ.u.mstance, which is affirmed to attend the spina bifida, is, that on compressing the tumor with the hand gently, the whole brain becomes affected, and the patient falls asleep. I suppose the same must happen on compressing the hydrocephalus externus? See Sect. XVIII. 20.

20. _Ossis palati defectus._ A defect of the bone of the palate, which frequently accompanies a division of the upper lip, occurs before nativity; and is owing to the deficient action of the secerning system, from whence the extremities are not completed. From a similar cause I have seen the point of the tongue deficient, and one joint of the two least fingers, and of the two least toes, in the same infant; who was otherwise a fine girl.

See Sect. x.x.xIX. 4. 4.

The operation for the hare-lip is described by many surgical writers; but there is a person in London, who makes very ingenious artificial palates; which prevents that defect of speech, which attends this malformation. This fact.i.tious palate consists of a thin plate of silver of the shape and form of the roof of the mouth; from the front edge to the back edge of this silver plate four or five holes are made in a straight line large enough for a needle to pa.s.s through them; on the back of it is then sewed a piece of sponge; which when expanded with moisture is nearly as large as the silver plate. This sponge is slipped through the division of the bone of the palate, so as to lie above it, while the silver plate covers the aperture beneath, and is suspended by the expanding sponge. This is removed every night and washed, and returned into its place in the morning; on this account it is convenient to have five or six of them, for the sake of cleanliness. I have been more particular in describing this invention, as I do not know the name, or place of residence, of the maker.

ORDO II.

_Decreased Irritation._

GENUS III.

_The Decreased Action of the Absorbent System._

Some decrease of heat attends these diseases, though in a less degree than those of the last genus, because the absorbent system of glands do not generate so much heat in their healthy state of action as the secerning system of glands, as explained in Cla.s.s I. 1. 3.

SPECIES.

1. _Mucus faucium frigidus._ Cold mucus from the throat. Much mucus, of rather a saline taste, and less insp.i.s.sated than usual, is evacuated from the fauces by hawking, owing to the deficient absorption of the thinner parts of it. This becomes a habit in some elderly people, who are continually spitting it out of their mouths; and has probably been brought on by taking snuff, or smoking tobacco; which by frequently stimulating the fauces have at length rendered the absorbent vessels less excitable by the natural stimulus of the saline part of the secretion, which ought to be reabsorbed, as soon as secreted.

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

2. _Sudor frigidus._ The cold dampness of the hands of some people is caused by the deficient absorption of perspirable matter; the clammy or viscid feel of it is owing to the mucous part being left upon the skin. The coldness is produced both by the decreased action of the absorbent system, and by the evaporation of a greater quant.i.ty of the perspirable matter into the air, which ought to have been absorbed.

M. M. Wash the hands in lime water, or with a small quant.i.ty of volatile alcali in water.

3. _Catarrhus frigidus._ The thin discharge from the nostrils in cold weather. The absorbent vessels become torpid by the diminution of external heat, sooner than the secerning ones, which are longer kept warm by the circulating blood, from which they select the fluid they secrete; whereas the absorbent vessels of the nostrils drink up their fluids, namely the thin and saline part of the mucus, after it has been cooled by the atmosphere. Hence the absorbents ceasing to act, and the secerning vessels continuing some time longer to pour out the mucus, a copious thin discharge is produced, which trickles down the nostrils in cold weather. This discharge is so acrid as to inflame the upper lip; which is owing to the neutral salts, with which it abounds, not being reabsorbed; so the tears in the fistula lacrymalis inflame the cheek. See Cla.s.s I. 1. 2. 7.