It appears from hence, that the pains enumerated in this genus are consequences of the inactivity of the organ; and, as they do not occasion other diseases, should be cla.s.sed according to their proximate cause, which is defective irritation; there are nevertheless other pains from defect of stimulus, which produce convulsions, and belong to Cla.s.s III. 1. 1.; and others, which produce pains of some distant part by a.s.sociation, and belong to Cla.s.s IV. 2. 2.

SPECIES.

1. _Sitis._ Thirst. The senses of thirst and of hunger seem to have this connection, that the former is situated at the upper end, and the latter at the lower end of the same ca.n.a.l. One about the pharinx, where the oesophagus opens into the mouth, and the other about the cardia ventriculi, where it opens into the stomach. The extremities of other ca.n.a.ls have been shewn to possess correspondent sensibilities, or irritabilities, as the two ends of the urethra, and of the common gall-duct. See IV. 2. 2. 2. and 4.

The membrane of the upper end of the gullet becomes torpid, and consequently painful, when there is a deficiency of aqueous fluid in the general system; it then wants its proper stimulus. In the same manner a want of the stimulus of more solid materials at the other end of the ca.n.a.l, which terminates in the stomach, produces hunger; as mentioned in Sect.

XIV. 8. The proximate causes of both of them therefore consist in deficient irritation, when they are considered as pains; because these pains are in consequence of the inactivity of the organ, according to the fifth law of animal causation. Sect. IV. 5. But when they are considered as desires, namely of liquid or solid aliment, their proximate cause consists in the pain of them, according to the sixth law of animal causation. So the proximate cause of the pain of coldness is the inactivity of the organ, and perhaps the consequent acc.u.mulation of sensorial power in it; but the pain itself, or the consequent volition, is the proximate cause of the shuddering and gnashing the teeth in cold fits of intermittent fevers. See Cla.s.s I. 2. 2. 1.

Thirst may be divided into two varieties alluding to the remote cause of each, and may be termed sitis calida, or warm thirst, and sitis frigida, or cold thirst. The remote cause of the former arises from the dissipation of the aqueous parts of our fluids by the increased secretion of perspirable matter, or other evacuations. And hence it occurs in hot fits of fever, and after taking much wine, opium, spice, salt, or other drugs of the Art.

incitantia or secernentia. The thirst, which occurs about three hours after eating a couple of red herrings, to a person unaccustomed to salted meat, is of this kind; the increased action of the cutaneous vessels dissipates so much of our fluids by insensible perspiration, as to require above two quarts of water to restore the fluidity of the blood, and to wash the salt out of the system. See Art. III. 2. 1.

M. M. Cold water. Vegetable acids. Warm bath.

The remote cause of sitis frigida, or cold thirst, is owing to the inaction of the cutaneous, pulmonary, urinary, and cellular absorbents; whence the blood is deprived of the great supply of moisture, which it ought to receive from the atmosphere, and from the cells of the cellular membrane, and from other cysts; this cause of thirst exists in dropsies, and in the cold fits of intermittents. The desire of fluids, like that of solids, is liable to acquire periods, and may therefore readily become diseased by indulgence in liquids grateful to the palate.

Of diseased thirst, the most common is either owing to defect of the action of the numerous absorbent vessels on the neck of the bladder, in which the patient makes much paleish water; or to the defective absorption of the skin and lungs, in which the patient makes but little water, and that high-coloured, and with sediment. In both the tongue and lips are liable to become very dry. The former in its greatest degree attends diabaetes, and the latter anasarca.

M. M. Warm water, warm wine, warm bath. Opium. Cold bath. Iced water.

Lemonade. Cyder.

2. _Esuries._ Hunger has been fancifully ascribed to the sides of the stomach rubbing against each other, and to the increased acidity of the gastric juice corroding the coats of it. If either of these were the cause of hunger, inflammation must occur, when they had continued some time; but, on the contrary, coldness and not heat are attendant on hunger; which evinces, that like thirst it is owing to the inactivity of the membrane, which is the seat of it; while the abundant nerves about the cardia ventriculi, and the pain of hunger being felt in that part, gives great reason to conclude, that it is there situated.

The sense of hunger as well as of thirst is liable to acquire habits in respect to the times of its returning painfulness, as well as in respect to the quant.i.ty required to satiate its appetency, and hence may become diseased by indulgence, as well as by want of its appropriate stimulus.

Those who have been accustomed to distend their stomach by large quant.i.ties of animal and vegetable food, and much potation, find a want of distention, when the stomach is empty, which occasions faintness, and is mistaken for hunger, but which does not appear to be the same sensation. I was well informed, that a woman near Lichfield, who eat much animal and vegetable food for a wager, affirmed, that since distending her stomach so much, she had never felt herself satisfied with food; and had in general taken twice as much at a meal, as she had been accustomed to, before she eat so much for a wager.

3. _Nausea sicca._ Dry nausea. Consists in a quiescence or torpor of the mucous or salivary glands, and precedes their inverted motions, described in nausea humida, Cla.s.s I. 3. 2. 3. In the same manner as sickness of the stomach is a quiescence of that organ preceding the action of vomiting, as explained in Sect. x.x.xV. 1. 3. This is sometimes induced by disagreeable drugs held in the mouth, at other times of disgustful ideas, and at other times by the a.s.sociation of these actions with those of the stomach; and thus according to its different proximate causes may belong to this, or to the second, or to the fourth cla.s.s of diseases.

M. M. Lemonade. Tasteful food. A blister. Warm bath.

4. _aegritudo ventriculi._ Sickness of stomach is produced by the quiescence or inactivity of that organ, as is explained in Sect. x.x.xV. 1. 3. It consists in the state between the usual peristaltic motions of that organ, in the digestion of our aliment, and the retrograde motions of it in vomiting; for it is evident, that the direct motions of it from the cardia to the pylorus must stop, before those in a contrary direction can commence. This sickness, like the nausea above described, is sometimes produced by disgustful ideas, as when nasty objects are seen, and nasty stories related, as well as by the exhaustion of the sensorial power by the stimulus of some emetic drugs, and by the defect of the production of it, as in enfeebled drunkards.

Sickness may likewise consist in the retrograde motions of the lymphatics of the stomach, which regurgitate into it the chyle or lymph, which they have lately absorbed, as in Cla.s.s I. 3. 2. 3. It is probable, that these two kinds of sickness may be different sensations, though they have acquired but one name; as one of them attends hunger, and the other repletion; though either of them may possibly be induced by a.s.sociation with nauseous ideas.

M. M. A blister on the back. An emetic. Opium. Crude mercury. Covering the head in bed. See Sect. XXV. 16. Cla.s.s IV. 1. 1. 2. and 3.

5. _Cardialgia._ Heartburn originates from the inactivity of the stomach, whence the aliment, instead of being subdued by digestion, and converted into chyle, runs into fermentation, producing acetous acid. Sometimes the gastric juice itself becomes so acid as to give pain to the upper orifice of the stomach; these acid contents of the stomach, on falling on a marble hearth, have been seen to produce an effervescence on it. The pain of heat at the upper end of the gullet, when any air is brought up from the fermenting contents of the stomach, is to be ascribed to the sympathy between these two extremities of the oesophagus rather than to the pungency of the carbonic gas, or fixed air; as the sensation in swallowing that kind of air in water is of a different kind. See Cla.s.s I. 3. 1. 3. and IV. 2. 2.

5.

M. M. This disease arising from indigestion is often very pertinacious, and afflicting; and attended with emaciation of the body from want of sufficient chyle. As the saliva swallowed along with our food prevents its fermentation, as appears by the experiments of Pringle and Macbride, some find considerable relief by chewing parched wheat, or mastic, or a lock of wool, frequently in a day, when the pain occurs, and by swallowing the saliva thus effused; a temporary relief is often obtained from antiacids, as aerated alcaline water, Seltzer's water, calcareous earths, alcaline salts made into pills with soap, soap alone, tin, milk, bitters. More permanent use may be had from such drugs as check fermentation, as acid of vitriol; but still more permanent relief from such things as invigorate the digestion, as a blister on the back; a due quant.i.ty of vinous spirit and water taken regularly. Steel. Temperance. A sleep after dinner. A waistcoat made so tight as slightly to compress the bowels and stomach. A flannel shirt in winter, not in summer. A less quant.i.ty of potation of all kinds.

Ten black pepper-corns swallowed after dinner. Half a grain of opium twice a day, or a grain. The food should consist of such things as do not easily ferment, as flesh, sh.e.l.l-fish, sea-biscuit, toasted cheese. I have seen toasted cheese brought up from the stomach 24 hours after it had been swallowed, without apparently having undergone any chemical change. See Cla.s.s II. 1. 3. 17. and IV. 1. 2. 13.

6. _Arthritis Ventriculi._ Sickness of the stomach in gouty cases is frequently a consequence of the torpor or inflammation of the liver, and then it continues many days or weeks. But when the patient is seized with great pain at the stomach with the sensation of coldness, which they have called an ice-bolt, this is a primary affection of the stomach, and destroys the patient in a few hours, owing to the torpor or inaction of that viscus so important to life.

This primary gout of the stomach, as it is a torpor of that viscus, is attended with sensation of coldness, and with real defect of heat, in that part, and may thence be distinguished from the pain occasioned by the pa.s.sage of a gall-stone into the duodenum, as well as by the weak pulse, and cold extremities; to which must be added, that it affects those only, who have been long afflicted with the gout, and much debilitated by its numerous attacks.

M. M. Opium. Vinous spirit. Volatile alcali. Spice. Warmth applied externally to the stomach by hot cloths or fomentation.

7. _Colica flatulenta._ The flatulent colic arises from the too great distention of the bowel by air, and consequent pain. The cause of this disease is the inactivity or want of sufficiently powerful contraction of the coats of the bowel, to carry forwards the gas given up by the fermenting aliment. It is without fever, and generally attended with cold extremities.

It is distinguished, first, from the pain occasioned by the pa.s.sage of a gall-stone, as that is felt at the pit of the stomach, and this nearer the navel. Secondly, it is distinguished from the colica saturnina, or colic from lead, as that arising from the torpor of the liver, or of some other viscus, is attended with greater coldness, and with an aching pain; whereas the flatulent cholic being owing to distention of the muscles of the bowel, the pain is more acute, and the coldness less. Thirdly, it is distinguished from inflammation of the bowels, or ileus, as perpetual vomiting and fever attend this. Fourthly, it is distinguished from cholera, because that is accompanied with both vomiting and diarrhoea. And lastly, from the colica epileptica, or hysteric colic, as that is liable to alternate with convulsion, and sometimes with insanity; and returns by periods.

M. M. Spirit of wine and warm water, one spoonful of each. Opium one grain.

Spice. Volatile alcali. Warm fomentation externally. Rhubarb.

8. _Colica saturnina._ Colic from lead. The pain is felt about the navel, is rather of an aching than acute kind at first, which increases after meals, and gradually becomes more permanent and more acute. It terminates in paralysis, frequently of the muscles of the arm, so that the hand hangs down, when the arm is extended horizontally. It is not attended with fever, or increase of heat. The seat of the disease is not well ascertained, it probably affects some part of the liver, as a pale bluish countenance and deficiency of bile sometimes attends or succeeds it, with consequent anasarca; but it seems to be caused immediately by a torpor of the intestine, whether this be a primary or secondary affection, as appears from the constipation of the bowels, which attends it; and is always produced in consequence of the great stimulus of lead previously used either internally for a length of time, or externally on a large surface.

A delicate young girl, daughter of a dairy farmer, who kept his milk in leaden cisterns, used to wipe off the cream from the edges of the lead with her finger; and frequently, as she was fond of cream, licked it from her finger. She was seized with the saturnine colic, and semi-paralytic wrists, and sunk from general debility.

A feeble woman about 40 years of age sprained her ancle, and bruised her leg and thigh; and applied by ill advice a solution of lead over the whole limb, as a fomentation and poultice for about a fortnight. She was then seized with the colica saturnina, lost the use of her wrists, and gradually sunk under a general debility.

M. M. First opium one or two grains, then a cathartic of senna, jalap, and oil, as soon as the pain is relieved. Oleum ricini. Alum. Oil of almonds. A blister on the navel. Warm bath. The stimulus of the opium, by restoring to the bowel its natural irritability in this case of painful torpor, a.s.sists the action of the cathartic.

9. _Tympanitis._ Tympany consists in an elastic tumor of the abdomen, which sounds on being struck. It is generally attended with costiveness and emaciation. In one kind the air is said to exist in the bowels, in which case the tumor is less equal, and becomes less tense and painful on the evacuation of air. In the other kind the air exists in the cavity of the abdomen, and sometimes is in a few days exchanged for water, and the tympany becomes an ascites.

Air may be distinguished in the stomach of many people by the sound on striking it with the fingers, and comparing the sound with that of a similar percussion on other parts of the bowels; but towards the end of fevers, and especially in the puerperal fever, a distention of the abdomen by air is generally a fatal symptom, though the ease, and often cheerfulness, of the patient vainly flatters the attendants.

M. M. In the former case a clyster-pipe unarmed may be introduced, and left some time in the r.e.c.t.u.m, to take off the resistance of the sphincter, and thus discharge the air, as it is produced from the fermenting or putrefying aliment. For this purpose, in a disease somewhat similar in horses, a perforation is made into the r.e.c.t.u.m on one side of the sphincter; through which fistula the air, which is produced in such great excess from the quant.i.ty of vegetable food which they take, when their digestions are impaired, is perpetually evacuated. In both cases also, balsams, essential oil, spice, bandage on the abdomen, and, to prevent the fermentation of the aliment, acid of vitriol, saliva. See Cla.s.s I. 2. 4. 5.

10. _Hypochondriasis._ The hypochondriac disease consists in indigestion and consequent flatulency, with anxiety or want of pleasureable sensation.

When the action of the stomach and bowels is impaired, much gas becomes generated by the fermenting or putrescent aliment, and to this indigestion is catenated languor, coldness of the skin, and fear. For when the extremities are cold for too long a time in some weak const.i.tutions, indigestion is produced by direct sympathy of the skin and the stomach, with consequent heart-burn, and flatulency. The same occurs if the skin be made cold by fear, as in riding over dangerous roads in winter, and hence conversely fear is produced by indigestion or torpor of the stomach by a.s.sociation.

This disease is confounded with the fear of death, which is an insanity, and therefore of a totally different nature. It is also confounded with the hysteric disease, which consists in the retrograde motions of the alimentary ca.n.a.l, and of some parts of the absorbent system.

The hypochondriasis, like chlorosis, is sometimes attended with very quick pulse; which the patient seems to bear so easily in these two maladies, that if an accidental cough attends them, they may be mistaken for pulmonary consumption; which is not owing primarily to the debility of the heart, but to its direct sympathy with the actions of the stomach.

M. M. Blister. A plaster on the abdomen of Burgundy pitch. Opium a grain twice a day. Rhubarb six grains every night. Bark. Steel. Spice.

Bath-water. Siesta, or sleep after dinner. Uniform hours of meals. No liquor stronger than small beer, or wine and water. Gentle exercise on horseback in the open air uniformly persisted in. See Cardialgia, I. 2. 4.

5.

11. _Cephalaea._ Head-ach frequently attends the cold paroxysm of intermittents; afflicts inebriates the day after intoxication; and many people who remain too long in the cold bath. In all which cases there is a general inaction of the whole system, and as these membranes about the head have been more exposed to the variations of heat and cold of the atmosphere, they are more liable to become affected so far as to produce sensation, than other membranes; which are usually covered either with clothes, or with muscles, as mentioned in Sect. x.x.xIII. 2. 10.

The prompt.i.tude of the membranes about the scalp to sympathize with those of other parts of the system is so great, that this cephalaea without fever, or quickness of pulse, is more frequently a secondary than a primary disease, and then belongs to Cla.s.s IV. 2. 2. 7. The hemicrania, or partial head-ach, I believe to be almost always a disease from a.s.sociation; though it is not impossible, but a person may take cold on one side of the head only. As some people by sitting always on the same side of the fire in winter are liable to render one side more tender than the other, and in consequence more subject to pains, which have been erroneously termed rheumatic. See Cla.s.s IV. 2. 2. 7. & 8.

M. M. The method of cure consists in rendering the habit more robust, by gentle constant exercise in the open air, flesh diet, small beer at meals with one gla.s.s of wine, regular hours of rest and rising, and of meals. The cloathing about the head should be warmer during sleep than in the day; because at that time people are more liable to take cold; that is, the membranous parts of it are more liable to become torpid. As explained in Sect. XVIII. 15. In respect to medicine, two drams of valerian root in powder three or four times a day are recommended by Fordyce. The bark.

Steel in moderate quant.i.ties. An emetic. A blister. Opium, half a grain twice a day. Decayed teeth should be extracted, particularly such as either ache, or are useless. Cold bath between 60 and 70 degrees of heat. Warm bath of 94 or 98 degrees every day for half an hour during a month. See Cla.s.s IV. 2. 2. 7. and 8.

A solution of a.r.s.enic, about the sixteenth part of a grain, is reported to have great effect in this disease. It should be taken thrice a day, if it produces no griping or sickness, for two or three weeks. A medicine of this kind is sold under the name of tasteless ague-drops; but a more certain method of ascertaining the quant.i.ty is delivered in the subsequent materia medica, Art. IV. 2. 6.

12. _Odontalgia._ Tooth-ach. The pain has been erroneously supposed, where there is no inflammation, to be owing to some acrid matter from a carious tooth stimulating the membrane of the alveolar process into violent action and consequent pain; but the effect seems to have been mistaken for the cause, and the decay of the tooth to have been occasioned by the torpor and consequent pain of the diseased membrane.

First, because the pain precedes the decay of the tooth in regard to time, and is liable to recur, frequently for years, without certainly being succeeded at last by a carious tooth, as I have repeatedly observed.

Secondly, because any stimulant drug, as pyrethrum, or oil of cloves, applied to the tooth, or ether applied externally to the cheek, so far from increasing the pain, as they would do if the pained membrane, already acted too strongly, that they frequently give immediate relief like a charm.

And thirdly, because the torpor, or deficient action of the membrane, which includes the diseased tooth, occasions the motions of the membranes most connected with it, as those of the cheek and temples, to act with less than their natural energy; and hence a coldness of the cheek is perceived easily by the hand of the patient, comparing it with the other cheek; and the pain of hemicrania is often produced in the temple of the affected side.

This coldness of the cheek in common tooth-ach evinces, that the pain is not then caused by inflammation; because in all inflammations so much heat is produced in the secretions of new vessels and fluids, as to give heat to the parts in vicinity. And hence, as soon as the gum swells and inflames along with the cheek, heat is produced, and the pain ceases, owing to the increased exertions of the torpid membrane, excited by the activity of the sensorial power of sensation; which previously existed in its pa.s.sive state in the painful torpid membrane. See Odont.i.tis, Cla.s.s II. 1. 4. 7. and IV.

2. 2. 8.