M. M. Digitalis. See Art. V. 2. 1. Tobacco. Squill. Emetic tartar (antimonium tartarizatum). Then Sorbentia. Chalybeates. Opium half a grain twice a day. Raisin wine and water, or other wine and water, is preferred to the spirit and water, which these patients have generally been accustomed to.

The usual cause of anasarca is from a diseased liver, and hence it most frequently attends those, who have drank much fermented or spirituous liquors; but I suspect that there is another cause of anasarca, which originates from the brain; and which is more certainly fatal than that, which originates from a diseased liver. These patients, where the anasarca originates from, or commences in, the brain, have not other symptoms of diseased liver; have less difficulty of breathing at the beginning; and hold themselves more upright in their chair, and in walking. In this kind of dropsy I suspect the digitalis has less or no effect; as it particularly increases the absorption from the lungs.

17. _Obesitas._ Corpulency may be called an anasarca or dropsy of fat, since it must be owing to an a.n.a.logous cause; that is, to the deficient absorption of fat compared to the quant.i.ty secreted into the cells which contain it. See Cla.s.s II. 1. 1. 4.

The method of getting free from too much fat without any injury to the const.i.tution, consists, first, in putting on a proper bandage on the belly, so that it can be tightened or relaxed with ease, as a tightish under waistcoat, with a double row of b.u.t.tons. This is to compress the bowels and increase their absorption, and it thus removes one princ.i.p.al cause of corpulency, which is the looseness of the skin. Secondly, he should omit one entire meal, as supper; by this long abstinence from food the absorbent system will act on the mucus and fat with greater energy. Thirdly, he should drink as little as he can with ease to his sensations; since, if the absorbents of the stomach and bowels supply the blood with much, or perhaps too much, aqueous fluid, the absorbents of the cellular membrane will act with less energy. Fourthly, he should use much salt or salted meat, which will increase the perspiration and make him thirsty; and if he bears this thirst, the absorption of his fat will be greatly increased, as appears in fevers and dropsies with thirst; this I believe to be more efficacious than soap. Fifthly, he may use aerated alcaline water for his drink, which may be supposed to render the fat more fluid,--or he may take soap in large quant.i.ties, which will be decomposed in the stomach. Sixthly, short rest, and constant exercise.

18. _Splenis tumor._ Swellings of the spleen, or in its vicinity, are frequently perceived by the hand in intermittents, which are called Ague-cakes, and seem owing to a deficiency of absorption in the affected part.

Mr. Y----, a young man about twenty-five years of age, who lived intemperately, was seized with an obstinate intermittent, which had become a continued fever with strong pulse, attended with daily remission. A large hard tumour on the left side, on the region of the spleen, but extending much more downward, was so distinctly perceptible, that one seemed to get one's fingers under the edge of it, much like the feel of the brawn or shield on a boar's shoulder. He was repeatedly bled, and purged with calomel, had an emetic, and a blister on the part, without diminishing the tumour; after some time he took the Peruvian bark, and slight doses of chalybeates, and thus became free from the fever, and went to Bath for several weeks, but the tumour remained. This tumour I examined every four or five years for above thirty years. His countenance was pale, and towards the end of his life he suffered much from ulcers on his legs, and died about sixty, of general debility; like many others, who live intemperately in respect to the ingurgitation of fermented or spirituous liquors.

As this tumour commenced in the cold fit of an intermittent fever, and was not attended with pain, and continued so long without endangering his life, there is reason to believe it was simply occasioned by deficient absorption, and not by more energetic action of the vessels which const.i.tute the spleen. See Cla.s.s II. 1. 2. 13.

M. M. Venesection. Emetic, cathartic with calomel; then sorbentia, chalybeates, Peruvian bark.

19. _Genu tumor albus._ White swelling of the knee, is owing to deficient absorption of the lymphatics of the membranes including the joint, or capsular ligaments, and sometimes perhaps of the gland which secretes the synovia; and the ends of the bones are probably affected in consequence.

I saw an instance, where a caustic had been applied by an empiric on a large white swelling of the knee, and was told, that a fluid had been discharged from the joint, which became anchylosed, and healed without loss of the limb.

M. M. Repeated blisters on the part early in the disease are said to cure it by promoting absorption; saturnine solutions externally are recommended.

Bark, animal charcoal, as burnt sponge, opium in small doses. Friction with the hand.

20. _Bronchocele._ Swelled throat. An enlargement of the thyroid glands, said to be frequent in mountainous countries, where river water is drank, which has its source from dissolving snows. This idea is a very ancient one, but perhaps not on that account to be the more depended upon, as authors copy one another. Tumidum guttur quis miratur in alpibus, seems to have been a proverb in the time of Juvenal. The inferior people of Derby are much subject to this disease, but whether more so than other populous towns, I can not determine; certain it is, that they chiefly drink the water of the Derwent, which arises in a mountainous country, and is very frequently blackened as it pa.s.ses through the mora.s.ses near its source; and is generally of a darker colour, and attended with a whiter foam, than the Trent, into which it falls; the greater quant.i.ty and whiteness of its froth I suppose may be owing to the viscidity communicated to it by the colouring matter. The lower parts of the town of Derby might be easily supplied with spring water from St. Alkmond's well; or the whole of it from the abundant springs near Bowbridge: the water from which might be conveyed to the town in hollow bricks, or clay-pipes, at no very great expence, and might be received into frequent reservoirs with pumps to them; or laid into the houses.

M. M. Twenty grains of burnt sponge with ten of nitre made with mucilage into lozenges, and permitted to dissolve slowly under the tongue twice a day, is a.s.serted to cure in a few months; perhaps other animal charcoal, as candle-snuffs, might do the same.

I have directed in the early state of this disease a mixture of common salt and water to be held in the mouth, particularly under the tongue, for a few minutes, four or six times a day for many weeks, which has sometimes succeeded, the salt and water is then spit out again, or in part swallowed.

Externally vinegar of squills has been applied, or a mercurial plaster, or fomentations of acetated ammoniac; or ether. Some empirics have applied caustics on the bronchocele, and sometimes, I have been told, with success; which should certainly be used where there is danger of suffocation from the bulk of it. One case I saw, and one I was well informed of, where the bronchocele was cured by burnt sponge, and a hectic fever supervened with colliquative sweats; but I do not know the final event of either of them.

De Haen affirms the cure of bronchocele to be effected by flowers of zinc, calcined egg-sh.e.l.ls, and scarlet cloth burnt together in a close crucible, which was tried with success, as he a.s.sured me, by a late lamented physician, my friend, Dr. Small of Birmingham; who to the cultivation of modern sciences added the integrity of ancient manners; who in clearness of head, and benevolence of heart, had few equals, perhaps no superiors.

21. _Scrophula._ King's evil is known by tumours of the lymphatic glands, particularly of the neck. The upper lip, and division of the nostrils is swelled, with a florid countenance, a smooth skin, and a tumid abdomen.

Cullen. The absorbed fluids in their course to the veins in the scrophula are arrested in the lymphatic or conglobate glands; which swell, and after a great length of time, inflame and suppurate. Materials of a peculiar kind, as the variolous and venereal matter, when absorbed in a wound, produce this torpor, and consequent inflammation of those lymphatic glands, where they first arrive, as in the axilla and groin. There is reason to suspect, that the tonsils frequently become inflamed, and suppurate from the matter absorbed from carious teeth; and I saw a young lady, who had both the axillary glands swelled, and which suppurated; which was believed to have been caused by her wearing a pair of new green gloves for one day, when she had perspired much, and was much exhausted and fatigued by walking; the gloves were probably dyed in a solution of verditer.

These indolent tumours of the lymphatic glands, which const.i.tute the scrophula, originate from the inirritability of those glands; which therefore sooner fall into torpor after having been stimulated too violently by some poisonous material; as the muscles of enfeebled people sooner become fatigued, and cease to act, when exerted, than those of stronger ones. On the same account these scrophulous glands are much longer in acquiring increase of motion, after having been stimulated into inactivity, and either remain years in a state of indolence, or suppurate with difficulty, and sometimes only partially.

The difference between scrophulous tumours, and those before described, consists in this; that in those either glands of different kinds were diseased, or the mouths only of the lymphatic glands were become torpid; whereas in scrophula the conglobate glands themselves become tumid, and generally suppurate after a great length of time, when they acquire new sensibility. See Sect. x.x.xIX. 4. 5.

These indolent tumours may be brought to suppurate sometimes by pa.s.sing electric shocks through them every day for two or three weeks, as I have witnessed. It is probable, that the alternate application of snow or iced water to them, till they become painfully cold, and then of warm flannel or warm water, frequently repeated, might restore their irritability by acc.u.mulation of sensorial power; and thence either facilitate their dispersion, or occasion them to suppurate. See Cla.s.s II. 1. 4. 13.

This disease is very frequent amongst the children of the poor in large towns, who are in general ill fed, ill lodged, and ill clothed; and who are further weakened by eating much salt with their scanty meal of insipid vegetable food, which is seldom of better quality than water gruel, with a little coa.r.s.e bread in it. See diarrhoea of infants, Cla.s.s I. 1. 2. 5.

Scrophulous ulcers are difficult to heal, which is owing to the deficiency of absorption on their pale and flabby surfaces, and to the general inirritability of the system. See Cla.s.s I. 1. 3. 13.

M. M. Plentiful diet of flesh-meat and vegetables with small-beer. Opium, from a quarter of a grain to half a grain twice a day. Sorbentia. Tincture of digitalis, thirty drops twice a day. Externally sea-bathing, or bathing in salt and water, one pound to three gallons, made warm. The application of Peruvian bark in fine powder, seven parts, and white lead, (cerussa) in fine powder one part, mixed together and applied on the ulcers in dry powder, by means of lint and a bandage, to be renewed every day. Or very fine powder of calamy alone, lapis calaminaris. If powder of manganese?

22. _Schirrus._ After the absorbent veins of a gland cease to perform their office, if the secerning arteries of it continue to act some time longer, the fluids are pushed forwards, and stagnate in the receptacles or capillary vessels of the gland; and the thinner part of them only being resumed by the absorbent system of the gland, a hard tumour gradually succeeds; which continues like a lifeless ma.s.s, till from some accidental violence it gains sensibility, and produces cancer, or suppurates. Of this kind are the schirrous glands of the b.r.e.a.s.t.s, of the lungs, of the mesentery, and the scrophulous tumours about the neck and the bronchocele.

Another seat of schirrus is in the membranous parts of the system, as of the r.e.c.t.u.m intestinum, the urethra, the gula or throat; and of this kind is the verucca or wart, and the clavus pedum, or corns on the toes. A wen sometimes arises on the back of the neck, and sometimes between the shoulders; and by distending the tendinous fascia produces great and perpetual pain.

M. M. Mercurial ointment. Cover the part with oiled silk. Extirpation.

Electric shocks through the tumour. An issue into the substance of the wen.

Opium. Ether externally.

23. _Schirrus recti intestini._ Schirrus of the r.e.c.t.u.m. A schirrus frequently affects a ca.n.a.l, and by contracting its diameter becomes a painful and deplorable disease. The ca.n.a.ls thus obstructed are the r.e.c.t.u.m, the urethra, the throat, the gall-ducts, and probably the excretory ducts of the lymphatics, and of other glands.

The schirrus of the r.e.c.t.u.m is known by the patient having pain in the part, and being only able to part with liquid feces, and by the introduction of the finger; the swelled part of the intestine is sometimes protruded downwards, and hangs like a valve, smooth and hard to the touch, with an aperture in the centre of it. See a paper on this subject by J. Sherwin.

Memoirs of a London Medical Society, Vol. II. p. 9.

M. M. To take but little solid food. Aperient medicines. Introduce a candle smeared with mercurial ointment. Sponge-tent. Clysters with forty drops of laudanum. Introduce a leathern canula, or gut, and then either a wooden maundril, or blow it up with air, so as to distend the contracted part as much as the patient can bear. Or spread mercurial plaster on thick soft leather, and roll it up with the plaster outwards to any thickness and length, which can be easily introduced and worn; or two or three such pieces may be introduced after each other. The same may be used to compress bleeding internal piles. See Cla.s.s I. 2. 1. 6.

24. _Schirrus urethrae._ Schirrus of the urethra. The pa.s.sage becomes contracted by the thickened membrane, and the urine is forced through with great difficulty, and is thence liable to distend the ca.n.a.l behind the stricture; till at length an aperture is made, and the urine forces its way into the cellular membrane, making large sinuses. This situation sometimes continues many months, or even years, and so much matter is evacuated after making water, or at the same time, by the action of the muscles in the vicinity of the sinuses, that it has been mistaken for an increased secretion from the bladder, and has been erroneously termed a catarrh of the bladder. See a paper by Dr. R. W. Darwin in the Medical Memoirs.

M. M. Distend the part gradually by catgut bougies, which by their compression will at the same time diminish the thickness of the membrane, or by bougies of elastic gum, or of horn boiled soft. The patient should gain the habit of making water slowly, which is a matter of the utmost consequence, as it prevents the distention, and consequent rupture, of that part of the urethra, which is between the stricture and the neck of the bladder.

When there occurs an external ulcer in the perinaeum, and the urine is in part discharged that way, the disease can not be mistaken. Otherwise from the quant.i.ty of matter, it is generally supposed to come from the bladder, or prostate gland; and the urine, which escapes from the ruptured urethra, mines its way amongst the muscles and membranes, and the patient dies tabid, owing to the want of an external orifice to discharge the matter.

See Cla.s.s II. 1. 4. 11.

25. _Schirrus oesophagi._ A schirrus of the throat contracts the pa.s.sage so as to render the swallowing of solids impracticable, and of liquids difficult. It affects patients of all ages, but is probably most frequently produced by swallowing hard angular substances, when people have lost their teeth; by which this membrane is over distended, or torn, or otherwise injured.

M. M. Put milk into a bladder tied to a canula or catheter; introduce it past the stricture, and press it into the stomach. Distend the stricture gradually by a sponge-tent fastened to the end of whale-bone, or by a plug of wax, or a spermaceti candle, about two inches long; which might be introduced, and left there with a string only fixed to it to hang out of the mouth, to keep it in its place, and to retract it by occasionally; for which purpose the string must be put through a catheter or hollow probang, when it is to be retracted. Or lastly introduce a gut fixed to a pipe; and then distend it by blowing wind into it. The swallowing a bullet with a string put through it, to retract it on the exhibition of an emetic, has also been proposed. Externally mercurial ointment has been much recommended. Poultice. Oiled silk. Clysters of broth. Warm bath of broth.

Transfusion of blood into a vein three or four ounces a day? See Cla.s.s III.

1. 1. 15.

I directed a young woman about twenty-two years of age, to be fed with new milk put into a bladder, which was tied to a catheter, and introduced beyond the stricture in her throat; after a few days her spirits sunk, and she refused to use it further, and died. Above thirty years ago I proposed to an old gentleman, whose throat was entirely impervious, to supply him with a few ounces of blood daily from an a.s.s, or from the human animal, who is still more patient and tractable, in the following manner. To fix a silver pipe about an inch long to each extremity of a chicken's gut, the part between the two silver ends to be measured by filling it with warm water; to put one end into the vein of a person hired for that purpose, so as to receive the blood returning from the extremity; and when the gut was quite full, and the blood running through the other silver end, to introduce that end into the vein of the patient upwards towards the heart, so as to admit no air along with the blood. And lastly, to support the gut and silver ends on a water plate, filled with water of ninety-eight degrees of heat, and to measure how many ounces of blood was introduced by pa.s.sing the finger, so as to compress the gut, from the receiving pipe to the delivering pipe; and thence to determine how many gut-fulls were given from the healthy person to the patient. See Cla.s.s IV. 2. 4. 11. Mr. ---- considered a day on this proposal, and then another day, and at length answered, that "he now found himself near the house of death; and that if he could return, he was now too old to have much enjoyment of life; and therefore he wished rather to proceed to the end of that journey, which he was now so near, and which he must at all events soon go, than return for so short a time." He lived but a few days afterwards, and seemed quite careless and easy about the matter.

26. _Lacteorum inirritabilitas._ Inirritability of the lacteals is described in Sect. XXVIII. under the name of paralysis of the lacteals; but as the word paralysis has generally been applied to the disobedience of the muscles to the power of volition, the name is here changed to inirritability of the lacteals, as more characteristic of the disease.

27. _Lymphaticorum inirritabilitas._ The inirritability of the cellular and cutaneous lymphatics is described in Sect. XXIX. 5. 1. and in Cla.s.s I. 2.

3. 16. The inirritability of the cutaneous lymphatics generally accompanies anasarca, and is the cause of the great thirst in that malady. At the same time the cellular lymphatics act with greater energy, owing to the greater derivation of sensorial power to them in consequence of the less expenditure of it by the cutaneous ones; and hence they absorb the fat, and mucus, and also the thinner parts of the urine. Whence the great emaciation of the body, the muddy sediment, and the small quant.i.ty of water in this kind of dropsy.

ORDO II.

_Decreased Irritation._

GENUS IV.

_With Decreased Actions of other Cavities and Membranes._

Many of the diseases of this genus are attended with pain, and with cold extremities, both which cease on the exhibition of wine or opium; which shews, that they originate from deficient action of the affected organ.

These pains are called nervous or spasmodic, are not attended with fever, but are frequently succeeded by convulsions and madness; both which belong to the cla.s.s of volition. Some of them return at periods, and when these can be ascertained, a much less quant.i.ty of opium will prevent them, than is necessary to cure them, when they are begun; as the vessels are then torpid and inirritable from the want of sensorial power, till by their inaction it becomes again acc.u.mulated.

Our organs of sense properly so called are not liable to pain from the absence of their appropriated stimuli, as from darkness or silence; but the other senses, which may be more properly called appet.i.tes, as those by which we perceive heat, hunger, thirst, l.u.s.t, want of fresh air, are affected with pain from the defect or absence of their accustomed stimuli, as well as with pleasure by the possession of them; it is probable that some of our glands, whose sense or appet.i.te requires or receives something from the circulating blood, as the pancreas, liver, testes, prostate gland, may be affected with aching or pain, when they cannot acquire their appropriated fluid.

Wherever this defect of stimulus occurs, a torpor or inaction of the organ ensues, as in the capillaries of the skin, when exposed to cold; and in the glands, which secrete the gastric juice, when we are hungry. This torpor however, and concomitant pain, which is at first owing to defect of stimulus, is afterwards induced by other a.s.sociations or catenations, and const.i.tutes the beginning of ague fits.

It must be further observed, that in the diseases of pain without fever, the pain is frequently not felt in the part where the cause of the disease resides; but is induced by sympathy with a distant part, whose irritability or sensibility is greater or less than its own. Thus a stone at the neck of the bladder, if its stimulus is not very great, only induces the pain of strangury at the glans p.e.n.i.s. If its stimulus be greater, it then induces pain at the neck of the bladder. The concretions of bile, which are protruded into the neck of the gall-bladder, when the disease is not very great, produce pain at the other extremity of the bile-duct, which enters the duodenum immediately under the pit of the stomach; but, when the disease is great from the largeness of the bile-stone, the pain is felt in the region of the liver at the neck of the gall-bladder.