4. _Expectoratio frigida._ Cold expectoration. Where the pulmonary absorption is deficient, an habitual cough is produced, and a frequent expectoration of thin saline mucus; as is often seen in old enfeebled people. Though the stimulus of the saline fluid, which attends all secretions, is not sufficient to excite the languid absorbent vessels to imbibe it; yet this saline part, together with the increased quant.i.ty of the whole of the secreted mucus, stimulates the branches of the bronchia, so as to induce an almost incessant cough to discharge it from the lungs. A single grain of opium, or any other stimulant drug, as a wine-posset with spirit of hartshorn, will cure this cold cough, and the cold catarrh of the preceding article, like a charm, by stimulating the torpid mouths of the absorbents into action. Which has given rise to an indiscriminate and frequently pernicious use of the warm regimen in coughs and catarrhs of the warm or inflammatory kind, to the great injury of many.

M. M. Half a grain of opium night and morning promotes the absorption of the more fluid and saline parts, and in consequence thickens the mucus, and abates its acrimony. Warm diluent drink, wine-whey, with volatile alcali.

5. _Urina uberior pallida._ On being exposed naked to cold air, or sprinkled with cold water, a quant.i.ty of pale urine is soon discharged; for the absorbents of the bladder become torpid by their sympathy with those of the skin; which are rendered quiescent by the diminution of external heat; but the kidnies continue to secrete the urine, and as no part of it is absorbed, it becomes copious and pale. This happens from a similar cause in cold fits of agues; and in less degree to many debilitated const.i.tutions, whose extremities are generally cold and pale. The great quant.i.ty of limpid water in hysteric cases, and in diabaetes, belongs to Cla.s.s I. 3. 1. 10. I.

3. 2. 6.

M. M. Tincture of cantharides, opium, alum, sorbentia. Flannel shirt in cold weather. Animal food. Beer. Wine. Friction. Exercise. Fire.

6. _Diarrhoea frigida._ Liquid stools are produced by exposing the body naked to cold air, or sprinkling it with cold water, for the same reason as the last article.

But this disease is sometimes of a dangerous nature; the intestinal absorption being so impaired, that the aliment is said to come away undiminished in quant.i.ty, and almost unchanged by the powers of digestion, and is then called lientery.

The mucus of the r.e.c.t.u.m sometimes comes away like pellucid hartshorn jelly, and liquefies by heat like that, towards the end of inirritative fevers, which is owing to the thinner part of the mucus not being absorbed, and thus resembles the catarrh of some old people.

M. M. Opium, campechy wood, armenian bole. Blister. Flannel shirt in cold weather. Clysters with opium. Friction on the bowels morning and night.

Equitation twice a day.

7. _Fluor albus frigidus._ Cold fluor albus. In weak const.i.tutions, where this discharge is pellucid and thin, it must proceed from want of absorption of the mucous membrane of the v.a.g.i.n.a, or uterus, and not from an increased secretion. This I suspect to be the most frequent kind of fluor albus; the former one described at Cla.s.s I. 1. 2. 11. attends menstruation, or is a discharge instead of it, and thus resembles the venereal o.r.g.a.s.m of female quadrupeds. The discharge in this latter kind being more saline, is liable to excoriate the part, and thus produce smarting in making water; in its great degree it is difficult to cure.

M. M. Increase the evacuation by stool and by perspiration, by taking rhubarb every night, about six or ten grains with one grain of opium for some months. Flannel shirt in winter. Balsam copaiva. Gum kino, bitters, chalybeates, friction over the whole skin with flannel morning and night.

Partial cold bath, by sprinkling the loins and thighs, or sponging them with cold water. Mucilage, as isingla.s.s boiled in milk; blanc mange, hartshorn jelly, are recommended by some. Tincture of cantharides sometimes seems of service given from ten to twenty drops or more, three or four times a day. A large plaster of burgundy pitch and armenian bole, so as to cover the loins and lower part of the belly, is said to have sometimes succeeded by increasing absorption by its compression in the manner of a bandage. A solution of metallic salts, as white vitriol, sixty grains to a pint; or an infusion of oak-bark may be injected into the v.a.g.i.n.a. Cold bath.

8. _Gonorrhoea frigida._ Cold gleet. Where the gleet is thin and pellucid, it must arise from the want of absorption of the membranes of the urethra, rather than from an increased secretion from them. This I suppose to be a more common disease than that mentioned at Cla.s.s I. 1. 2. 10.

M. M. Metallic injections, partial cold bath, internal method as in the fluor albus above described. Balsam of copaiva. Tincture of cantharides.

9. _Hepatis tumor._ The liver becomes enlarged from defect of the absorption of mucus from its cells, as in anasarca, especially in feeble children; at the same time less bile is secreted from the torpid circulation in the vena portae. And as the absorbents, which resume the thinner parts of the bile from the gall-bladder and hepatic ducts, are also torpid or quiescent, the bile is more dilute, as well as in less quant.i.ty.

From the obstruction of the pa.s.sage of the blood through the compressed vena porta these patients have tumid bellies, and pale bloated countenances; their paleness is probably owing to the deficiency of the quant.i.ty of red globules in the blood in consequence of the inert state of the bile.

These symptoms in children are generally attended with worms, the dilute bile and the weak digestion not destroying them. In sleep I have seen fleuke-worms in the gall-ducts themselves among the dilute bile; which gall-ducts they eat through, and then produce ulcers, and the hectic fever, called the rot. See Cla.s.s I. 1. 4. 10. and Article IV. 2. 6.

M. M. After a calomel purge, crude iron-filings are specific in this disease in children, and the worms are destroyed by the returning acrimony and quant.i.ty of the bile. A blister on the region of the liver. Sorbentia, as worm-seed, santonic.u.m. Columbo. Bark.

10. _Chlorosis._ When the defect of the due action of both the absorbent and secerning vessels of the liver affects women, and is attended with obstruction of the catamenia, it is called chlorosis; and is cured by the exhibition of steel, which restores by its specific stimulus the absorbent power of the liver; and the menstruation, which was obstructed in consequence of debility, recurs.

Indigestion, owing to torpor of the stomach, and a consequent too great acidity of its contents, attend this disease; whence a desire of eating chalk, or marl. Sometimes a great quant.i.ty of pale urine is discharged in a morning, which is owing to the inaction of the absorbents, which are distributed on the neck of the bladder, during sleep. The swelling of the ankles, which frequently attends chlorosis, is another effect of deficient action of the absorbent system; and the pale countenance is occasioned by the deficient quant.i.ty of red globules of blood, caused by the deficient quant.i.ty or acrimony of the bile, and consequent weakness of the circulation. The pulse is so quick in some cases of chlorosis, that, when attended with an accidental cough, it may be mistaken for pulmonary consumption. This quick pulse is owing to the debility of the heart from the want of stimulus occasioned by the deficiency of the quant.i.ty, and acrimony of the blood.

M. M. Steel. Bitters. Constant moderate exercise. Friction with flannel all over the body and limbs night and morning. Rhubarb five grains, opium half a grain, every night. Flesh diet, with small beer, or wine and water. The disease continues some months, but at length subsides by the treatment above described. A bath of about eighty degrees, as Buxton Bath, is of service; a colder bath may do great injury.

11. _Hydrocele._ Dropsy of the v.a.g.i.n.a testis. Dropsies have been divided into the incysted and the diffused, meaning those of the cellular membrane, the cells of which communicate with each other like a sponge, and those of any other cavity of the body. The collections of mucous fluids in the various cells and cavities of the body arise from the torpor of the absorbent vessels of those parts. It is probable, that in dropsies attended with great thirst the cutaneous absorbents become paralytic first; and then from the great thirst, which is thus occasioned by the want of atmospheric moisture, the absorption of the fat ensues; as in fevers attended with great thirst, the fat is quickly taken up. See Obesitas I. 2. 3. 17. Some have believed, that the cellular and adipose membranes are different ones; as no fat is ever deposited in the eye-lids or s.c.r.o.t.u.m, both which places are very liable to be distended with the mucilaginous fluid of the anasarca, and with air in Emphysema. Sometimes a gradual absorption of the acc.u.mulated fluid takes place, and the thinner parts being taken up, there remains a more viscid fluid, or almost a solid in the part, as in some swelled legs, which can not easily be indented by the pressure of the finger, and are called s...o...b..tic. Sometimes the paralysis of the absorbents is completely removed, and the whole is again taken up into the circulation.

The Hydrocele is known by a tumor of the s.c.r.o.t.u.m, which is without pain, gradually produced, with fluctuation, and a degree of pellucidity, when a candle is held behind it; it is the most simple incysted dropsy, as it is not in general complicated with other diseases, as ascites with schirrous liver, and hydrocephalus internus, with general debility. The cure of this disease is effected by different ways; it consists in discharging the water by an external aperture; and by so far inflaming the cyst and t.e.s.t.i.c.l.e, that they afterwards grow together, and thus prevent in future any secretion or effusion of mucus; the disease is thus cured, not by the revivescence of the absorbent power of the lymphatics, but by the prevention of secretion by the adhesion of the v.a.g.i.n.a to the testis. This I believe is performed with less pain, and is more certainly manageable by tapping, or discharging the fluid by means of a trocar, and after the evacuation of it to fill the cyst with a mixture of wine and water for a few minutes till the necessary degree of stimulus is produced, and then to withdraw it; as recommended by Mr. Earle. See also Medical Commentaries by Dr. Duncan, for 1793.

12. _Hydrocephalus internus_, or dropsy of the ventricles of the brain, is fatal to many children, and some adults. When this disease is less in quant.i.ty, it probably produces a fever, termed a nervous fever, and which is sometimes called a worm fever, according to the opinion of Dr.

Gilchrist, in the Scots Medical essays. This fever is attended with great inirritability, as appears from the dilated pupils of the eyes, in which it corresponds with the dropsy of the brain. And the latter disease has its paroxysms of quick pulse, and in that respect corresponds with other fevers with inirritability.

The hydrocephalus internus is distinguished from apoplexy by its being attended with fever, and from nervous fever by the paroxysms being very irregular, with perfect intermissions many times in a day. In nervous fever the pain of the head generally affects the middle of the forehead; in hydrocephalus internus it is generally on one side of the head. One of the earliest criterions is the patient being uneasy on raising his head from the pillow, and wishing to lie down again immediately; which I suppose is owing to the pressure of the water on the larger trunks of the blood-vessels entering the cavity being more intolerable than on the smaller ones; for if the larger trunks are compressed, it must inconvenience the branches also; but if some of the small branches are compressed only, the trunks are not so immediately incommoded.

Blisters on the head, and mercurial ointment externally, with calomel internally, are princ.i.p.ally recommended in this fatal disease. When the patient cannot bear to be raised up in bed without great uneasiness, it is a bad symptom. So I believe is deafness, which is commonly mistaken for stupor. See Cla.s.s I. 2. 5. 6. And when the dilatation of the pupil of either eye, or the squinting is very apparent, or the pupils of both eyes much dilated, it is generally fatal. As by stimulating one branch of lymphatics into inverted motion, another branch is liable to absorb its fluid more hastily; suppose strong errhines, as common tobacco snuff to children, or one grain of turpeth mineral, (Hydrargyrus vitriolatus), mixed with ten or fifteen grains of sugar, was gradually blown up the nostrils?

See Cla.s.s I. 3. 2. 1. I have tried common snuff upon two children in this disease; one could not be made to sneeze, and the other was too near death to receive advantage. When the mercurial preparations have produced salivation, I believe they may have been of service, but I doubt their good effect otherwise. In one child I tried the tincture of Digitalis; but it was given with too timid a hand, and too late in the disease, to determine its effects. See Sect. XXIX. 5. 9.

As all the above remedies generally fail of success, I think frequent, almost hourly, shocks of electricity from very small charges might be pa.s.sed through the head in all directions with probability of good event.

And the use of the trephine, where the affected side can be distinguished.

See Strabismus, Cla.s.s I. 2. 5. 4. When one eye is affected, does the disease exist in the ventricule of that side?

13. _Ascites._ The dropsy of the cavity of the abdomen is known by a tense swelling of the belly; which does not sound on being struck like the tympany; and in which a fluctuation can be readily perceived by applying one hand expanded on one side, and striking the tumour on the other.

Effusions of water into large cavities, as into that of the abdomen or thorax, or into the ventricules of the brain or pericardium, are more difficult to be reabsorbed, than the effusion of fluids into the cellular membrane; because one part of this extensive sponge-like system of cells, which connects all the solid parts of the body, may have its power of absorption impaired, at the same time that some other part of it may still retain that power, or perhaps possess it in an increased degree; and as all these cells communicate with each other, the fluid, which abounds in one part of it, can be transferred to another, and thus be reabsorbed into the circulation.

In the ascites, cream of tartar has sometimes been attended with success; a dram or two drams are given every hour in a morning till it operates, and is to be repeated for several days; but the operation of tapping is generally applied to at last. Dr. Sims, in the Memoirs of the Medical Society of London, Vol. III. has lately proposed, what he believes to be a more successful method of performing this operation, by making a puncture with a lancet in the scar of the navel, and leaving it to discharge itself gradually for several days, without introducing a canula, which he thinks injurious both on account of the too sudden emission of the fluid, and the danger of wounding or stimulating the viscera. This operation I have twice known performed with less inconvenience, and I believe with more benefit to the patient, than the common method.

After the patient has been tapped, some have tried injections into the cavity of the abdomen, but hitherto I believe with ill event. Nor are experiments of this kind very promising of success. First because the patients are generally much debilitated, most frequently by spirituous potation, and have generally a disease of the liver, or of other viscera.

And secondly, because the quant.i.ty of inflammation, necessary to prevent future secretion of mucus into the cavity of the abdomen, by uniting the peritoneum with the intestines or mesentery, as happens in the cure of the hydrocele, would I suppose generally destroy the patient, either immediately, or by the consequence of such adhesions.

This however is not the case in respect to the dropsy of the ovarium, or in the hydrocele.

14. _Hydrops thoracis._ The dropsy of the chest commences with loss of flesh, cold extremities, pale countenance, high coloured urine in small quant.i.ty, and general debility, like many other dropsies. The patient next complains of numbness in the arms, especially when elevated, with pain and difficulty of swallowing, and an absolute impossibility of lying down for a few minutes, or with sudden starting from sleep, with great difficulty of breathing and palpitation of his heart.

The numbness of the arms is probably owing more frequently to the increased action of the pectoral muscles in respiration, whence they are less at liberty to perform other offices, than to the connexion of nerves mentioned in Sect. XXIX. 5. 2. The difficulty of swallowing is owing to the compression of the oesophagus by the lymph in the chest; and the impossibility of breathing in an horizontal posture originates from this, that if any parts of the lungs must be rendered useless, the inability of the extremities of them must be less inconvenient to respiration; since if the upper parts or larger trunks of the air-vessels should be rendered useless by the compression of the acc.u.mulated lymph, the air could not gain admittance to the other parts, and the animal must immediately perish.

If the pericardium is the princ.i.p.al seat of the disease, the pulse is quick and irregular. If only the cavity of the thorax is hydropic, the pulse is not quick nor irregular.

If one side is more affected than the other, the patient leans most that way, and has more numbness in that arm.

The hydrops thoracis is distinguished from the anasarca pulmonum, as the patient in the former cannot lie down half a minute; in the latter the difficulty of breathing, which occasions him to rise up, comes on more gradually; as the transition of the lymph in the cellular membranes from one part to another of it is slower, than that of the effused lymph in the cavity of the chest.

The hydrops thoracis is often complicated with fits of convulsive breathing; and then it produces a disease for the time very similar to the common periodic asthma, which is perhaps owing to a temporary anasarca of the lungs; or to an impaired venous absorption in them. These exacerbations of difficult breathing are attended with cold extremities, cold breath, cold tongue, upright posture with the mouth open, and a desire of cold air, and a quick, weak, intermittent pulse, and contracted hands.

These exacerbations recur sometimes every two or three hours, and are relieved by opium, a grain every hour for two or three doses, with ether about a dram in cold water; and seem to be a convulsion of the muscles of respiration induced by the pain of the dyspnea. As in Cla.s.s III. 1. 1. 9.

M. M. A grain of dried squill, and a quarter of a grain of blue vitriol every hour for six or eight hours, unless it vomit or purge. A grain of opium. Blisters. Calomel three grains every third day, with infusion of senna. Bark. Chalybeates. Puncture in the side.

Can the fluctuation in the chest be heard by applying the ear to the side, as Hippocrates a.s.serts? Can it be felt by the hand or by the patient before the disease is too great to admit of cure by the paracentesis? Does this dropsy of the chest often come on after peripneumony? Is it ever cured by making the patient sick by tincture of digitalis? Could it be cured, if on one side only, by the operation of puncture between the ribs, and afterwards by inflaming the cavity by the admission of air for a time, like the cure of the hydrocele; the pleura afterwards adhering wholly to that lobe of the lungs, so as to prevent any future effusion of mucus?

15. _Hydrops ovarii._ Dropsy of the ovary is another incysted dropsy, which seldom admits of cure. It is distinguished from ascites by the tumour and pain, especially at the beginning, occupying one side, and the fluctuation being less distinctly perceptible. When it happens to young subjects it is less liable to be mistaken for ascites. It affects women of all ages, either married or virgins; and is produced by cold, fear, hunger, bad food, and other debilitating causes. I saw an elegant young lady, who was shortly to have been married to a sensible man, with great prospect of happiness; who, on being overturned in a chaise in the night, and obliged to walk two or three miles in wet, cold, and darkness, became much indisposed, and gradually afflicted with a swelling and pain on one side of the abdomen; which terminated in a dropsy of the ovary, and destroyed her in two or three years. Another young woman I recollect seeing, who was about seventeen, and being of the very inferior cla.s.s of people, seemed to have been much weakened by the hardship of a cold floor, and little or no bed, with bad food; and who to these evils had to bear the unceasing obloquy of her neighbours, and the persecution of parish officers.

The following is abstracted from a letter of my friend Mr. Power, surgeon, at Bosworth in Leicestershire, on examining the body of an elderly lady who died of this disease, March 29, 1793. "On opening the abdomen I found a large cyst attached to the left ovarium by an elastic neck as thick as the little finger, and so callous as not to admit of being separated by scissars without considerable difficulty. The substance of the cyst had an appearance much resembling the gravid uterus near the full period of gestation, and was as thick. It had no attachment to the peritonaeum, or any of the viscera, except by the hard callous neck I have mentioned; so that the blood must with difficulty have been circulated through it for some time. Its texture was extremely tender, being easily perforated with the finger, was of a livid red colour, and evidently in a sphacelated state. It contained about two gallons of a fluid of the colour of port wine, without any greater tenacity. It has fallen to my lot to have opened two other patients, whose deaths were occasioned by incysted dropsy of the ovarium.

In one of these the ovarium was much enlarged with eight or ten cysts on its surface, but there was no adhesion formed by any of the cysts to any other part; nor had the ovarium formed any adhesion with the peritonaeum, though in a very diseased state. In the other the disease was more simple, being only one cyst, without any attachment but to the ovarium.

"As the ovarium is a part not necessary to life, and dropsies of this kind are so generally fatal in the end, I think I shall be induced, notwithstanding the hazard attending wounds, which penetrate the cavity of the abdomen, to propose the extirpation of the diseased part in the first case, which occurs to me, in which I can with precision say, that the ovarium is the seat of the disease, and the patient in other respects tolerably healthy; as the cavity of the abdomen is often opened in other cases without bad consequences."

An argument, which might further countenance the operation thus proposed by Mr. Power, might be taken from the disease frequently affecting young persons; from its being generally in these subjects local and primary; and not like the ascites, produced or accompanied with other diseased viscera; and lastly, as it is performed in adult quadrupeds, as old sows, with safety, though by awkward operators.

16. _Anasarca pulmonum._ The dropsy of the cellular membrane of the lungs is usually connected with that of the other parts of the system. As the cells of the whole cellular membrane communicate with each other, the mucaginous fluid, which remains in any part of it for want of due absorption, sinks down to the most depending cells; hence the legs swell, though the cause of the disease, the deficiency of absorption, may be in other parts of the system. The lungs however are an exception to this, since they are suspended in the cavity of the thorax, and have in consequence a depending part of their own.

The anasarca of the lungs is known by the difficulty of respiration accompanied with swelled legs, and with a very irregular pulse. This last circ.u.mstance has generally been ascribed to a dropsy at the same time existing in the pericardium, but is more probably owing to the difficult pa.s.sage of the blood through the lungs; because I found on dissection, in one instance, that the most irregular pulse, which I ever attended to, was owing to very extensive adhesions of the lungs; insomuch that one lobe intirely adhered to the pleura; and secondly, because this kind of dropsy of the lungs is so certainly removed for a time along with the anasarca of the limbs by the use of digitalis.

This medicine, as well as emetic tartar, or squill, when given so as to produce sickness, or nausea, or perhaps even without producing either in any perceptible degree, by affecting the lymphatics of the stomach, so as either to invert their motion, or to weaken them, increases by reverse sympathy the action, and consequent absorbent power of these lymphatics, which open into the cellular membrane. But as those medicines seldom succeed in producing an absorption of those fluids, which stagnate in the larger cavities of the body, as in the abdomen, or chest, and do generally succeed in this difficulty of breathing with irregular pulse above described, I conclude that it is not owing to an effusion of lymph into the pericardium, but simply to an anasarca of the lungs.