Hence it appears that these heavy infectious matters are more liable to mix with the saliva, and inflame the tonsils, and that either before or at the commencement of the fever; and this is what generally happens in the scarlet fever, always I suppose in the malignant kind, and very frequently in the mild kind. But as this infection may be taken by other means, as by the skin, it also happens in the most mild kind, that there is no inflammation of the tonsils at all; in the same manner as there is generally no inflammation of the tonsils in the inoculated small-pox.

In the mild scarlatina on the fourth day of the fever the face swells a little, at the same time a florid redness appears on various parts of the skin, in large blotches, at length coalescing, and after three days changing into branny scales.

M. M. Cool air. Fruit. Lemonade. Milk and water.

_Scarlatina maligna._ The malignant scarlet fever begins with inflamed tonsils; which are succeeded by dark drab coloured sloughs three or five lines in diameter, flat, or beneath the surrounding surface; and which conceal beneath them spreading gangrenous ulcers. The swellings of the tonsils are sensible to the eye and touch externally, and have an elastic rather than an oedematous feel, like parts in the vicinity of gangrenes.

The pulse is very quick and weak, with delirium, and the patient generally dies in a few days; or if he recovers, it is by slow degrees, and attended with anasarca.

M. M. A vomit once. Wine. Beer. Cyder. Opium. Bark; in small repeated doses. Small successive blisters, if the extremities are cooler than natural. Cool air on the hot parts of the skin, the cool extremities being at the same time covered. Iced lemonade. Broth. Custards. Milk. Jellies.

Bread pudding. Chicken. Touch the ulcers with a dry sponge to absorb the contagious matter, and then with a sponge filled with vinegar, with or without sugar of lead dissolved in it, about six grains to an ounce; or with a very little blue vitriol dissolved in it, as a grain to an ounce; but nothing so instantaneously corrects the putrid smell of ulcers as a solution of alum; about half an ounce to a pint of water, which should be a little warmish, and injected into the fauces gently by means of a syringe.

These should be repeated frequently in a day, if it can be done easily, and without fatigue to the child. A little powder of bark taken frequently into the mouth, as a grain or two, that it may mix with the saliva, and thus frequently stimulate the dying tonsils. Could a warm bath made of decoction of bark, or a cold fomentation with it, be of service? Could oxygene gas mixed with common air stimulate the languid system? Small electric shocks through the tonsils every hour? ether frequently applied externally to the swelled tonsils?

As this disease is attended with the greatest degree of debility, and as stimulant medicines, if given in quant.i.ty, so as to produce more than natural warmth, contribute to expend the already too much exhausted sensorial power; it appears, that there is nothing so necessary to be nicely attended to, as to prevent any unnecessary motions of the system; this is best accomplished by the application of cold to those parts of the skin, which are in the least too hot. And secondly, that the exhibition of the bark in such quant.i.ty, as not to oppress the stomach and injure digestion, is next to be attended to, as not being liable to increase the actions of the system beyond their natural quant.i.ty; and that opium and wine should be given with the greatest caution, in very small repeated quant.i.ty, and so managed as to prevent, if possible, the cold fits of fever; which probably occur twice in 25 hours, obeying the lunations like the tides, as mentioned in Sect. x.x.xII. 6. that is, I suppose, the cold periods, and consequent exacerbations of fever, in this malignant scarlatina, occur twice in a lunar day; which is about ten minutes less than 25 hours; so that if the commencement of one cold fit be marked, the commencement of the next may be expected, if not disturbed by the exhibition of wine or opium, or the application of blisters, to occur in about twelve hours and a half from the commencement of the former; or if not prevented by large doses of the bark.

No one could do an act more beneficial to society, or glorious to himself, than by teaching mankind how to inoculate this fatal disease; and thus to deprive it of its malignity. Matter might be taken from the ulcers in the throat, which would probably convey the contagion. Or warm water might be put on the eruption, and sc.r.a.ped off again by the edge of a lancet. These experiments could be attended with no danger, and should be tried for the public benefit, and the honour of medical science.

12. _Miliaria._ Miliary fever. An eruption produced by the warmth, and more particularly by the stimulus of the points of the wool in flannel or blankets applied to the skin, has been frequently observed; which, by cool dress, and bed-clothes without flannel, has soon ceased. See Cla.s.s I. 1. 2.

3. This, which maybe called _miliaria sudatoria_, has been confounded with other miliary fevers, and has made the existence of the latter doubted. Two kinds of eruptions I have seen formerly attended with fever, but did not sufficiently mark their progress, which I conceived to be miliary eruptions, one with arterial strength, or with sensitive irritated fever, and the other with arterial debility, or with sensitive inirritated fever.

In the former of these, or _miliaria irritata_, the eruptions were distinct and larger than the small-pox, and the fever was not subdued without two or three venesections, and repeated cathartics with calomel.

The latter, or _miliaria inirritata_, was attended with great arterial debility; and during the course of the fever pellucid points appeared within the skin, particularly on the soft parts of the fingers. And, in one patient, whom I esteemed near her end, I well recollect to have observed round pellucid globules, like what are often seen on vines in hot-houses, no larger than the smallest pins' heads, adhere to her neck and bosom; which were hard to the touch, but were easily rubbed off. These diseases, if they are allied, do not differ more than the kinds of small-pox; but require many further observations.

The eruption so often seen on children in the cradle, and called by the nurses red-gum, and which is attended with some degree of fever, I suspect to be produced by too great warmth, and the contact of flannel next their tender skins, like the miliaria sudatoria; and like that requires cool air, cool clothes, and linen next their skin.

13. _Pestis._ The plague, like other diseases of this cla.s.s, seems to be sometimes mild, and sometimes malignant; according to the testimony of different writers. It is said to be attended with inflammation, with the greatest arterial debility, and to be very contagious, attended at an uncertain time of the fever with buboes and carbuncles. Some authors affirm, that the contagion of the plague may be repeatedly received, so as to produce the disease; but as this is contrary to the general a.n.a.logy of all contagious diseases, which are attended with fever, and which cure themselves spontaneously; there is reason to suspect, that where it has been supposed to have been repeatedly received, that some other fever with arterial debility has been mistaken for it, as has probably universally been the case, when the small-pox has been said to have been twice experienced.

M. M. Venesection has been recommended by some writers on the first day, where the inflammation was supposed to be attended with sufficient arterial strength, which might perhaps sometimes happen, as the bubo seems to be a suppuration; but the carbuncle, or anthrax, is a gangrene of the part, and shews the greatest debility of circulation. Whence all the means before enumerated in this genus of diseases to support the powers of life are to be administered. Currents of cold air, cold water, ice, externally on the hot parts of the skin.

The methods of preventing the spreading of this disease have been much canva.s.sed, and seem to consist in preventing all congregations of the people, as in churches, or play-houses; and to remove the sick into tents on some airy common by the side of a river, and supply them with fresh food, both animal and vegetable, with beer and wine in proper quant.i.ties, and to encourage those who can, daily to wash both their clothes and themselves.

The _pestis vaccina_, or disease amongst the cows, which afflicted this island about half a century ago, seems to have been a contagious fever with great arterial debility; as in some of them in the latter stage of the disease, an emphysema could often be felt in some parts, which evinced a considerable progress of gangrene beneath the skin. In the sensitive inirritated fevers of these animals, I suppose about sixty grains of opium, with two ounces of extract of oak-bark, every six hours, would supply them with an efficacious medicine; to which might be added thirty grains of vitriol of iron, if any tendency to b.l.o.o.d.y urine should appear, to which this animal is liable. The method of preventing the infection from spreading, if it should ever again gain access to this island, would be immediately to obtain an order from government to prevent any cattle from being removed, which were found within five miles of the place supposed to be infected, for a few days; till the certainty of the existence of the pestilence could be ascertained, by a committee of medical people. As soon as this was ascertained, all the cattle within five miles of the place should be immediately slaughtered, and consumed within the circ.u.mscribed district; and their hides put into lime-water before proper inspectors.

14. _Pemphigus_ is a contagious disease attended with bladdery eruptions appearing on the second or third day, as large as filberts, which, remain many days, and then effuse a thin ichor. It seems to be either of a mild kind with sensitive fever only, of which I have seen two instances, or with irritated, or with inirritated fever, as appears from the observations of M. Salabert. See Medical Comment, by Dr. Duncan, Decad. II. Vol. VI.

15. _Varicella._ Chicken-pox is accompanied with sensitive fever, pustules break out after a mild fever like the small-pox, seldom suppurate, and generally terminate in scales without scars. I once saw a lady, who miscarryed during this disease, though all her children had it as slightly as usual. It sometimes leaves scars or marks on the skin. This disease has been mistaken for the small-pox, and inoculated for it; and then the small-pox has been supposed to happen twice to the same person. See Trans.

of the College London. It is probable that the pemphigus and urticaria, as well as this disease, have formerly been diseases of more danger; which the habit of innumerable generations may have rendered mild, and will in process of time annihilate. In the same manner as the small-pox, venereal disease, and rickets, seem to become milder or less in quant.i.ty every half century. While at the same time it is not improbable, that other new diseases may arise, and for a season thin mankind!

16. _Urticaria._ Nettle-rash begins with mild sensitive fever, which is sometimes scarcely perceptible. Hence this eruption has been thought of two sorts, one with and the other without fever. On the second day red spots, like parts stung with nettles, are seen; which almost vanish during the day, and recur in the evening with the fever, succeeded in a few days by very minute scales. See Trans. of the College, London.

17. _Aphtha._ Thrush. It has been doubted, whether aphtha or thrush, which consists of ulcers in the mouth, should be enumerated amongst febrile diseases; and whether these ulcers are always symptomatic, or the consequence rather than the cause of the fevers which attend them. The tongue becomes rather swelled; its colour and that of the fauces purplish; sloughs or ulcers appear first on the throat and edges of the tongue, and at length over the whole mouth. These sloughs are whitish, sometimes distinct, often coalescing, and remain an uncertain time. Cullen. I shall concisely mention four cases of aphtha, but do not pretend to determine whether they were all of them symptomatic or original diseases.

_Aphtha sensitiva._ A lady during pregnancy was frequently seized with ulcers on her tongue and cheeks, or other parts of the mouth, without much apparent fever; which continued two or three weeks, and returned almost every month. The thrush in the mouths of young children seems to be a similar disease. These ulcers resemble those produced in the sea-scurvy, and have probably for their cause an increased action of the secerning system from increased sensation, with a decreased action of the absorbent system from decreased irritation. See Cla.s.s I. 2. 1. 15.

M. M. Solutions of alum, of blue vitriol. Powder of bark taken frequently into the mouth in very small quant.i.ty. See Cla.s.s II. 1. 3. 1.

_Aphtha irritata._ Inflammatory aphtha. A case of this kind is related under the t.i.tle of suppurative rheumatism. Cla.s.s IV. 1. 2. 16.

_Aphtha inirritata._ Sloughs or ulcers of the mouth, attended with sensitive fever with great arterial debility. They seem to spread downwards from the throat into the stomach, and probably through the whole intestinal ca.n.a.l, beginning their course with cardialgia, and terminating it with tenesmus; and might perhaps be called an erysipelas of this mucous membrane.

M. M. Cool air. A small blister on the back. Bark. Wine. Opium in small repeated quant.i.ties. Soap neutralizes the gastric acid without effervescence, and thus relieves the pain of cardialgia, where the stomach is affected. Milk also destroys a part of this acid. Infusion of sage leaves two ounces, almond soap from five grains to ten, with sugar and cream, is generally both agreeable and useful to these patients. See I. 2.

4. 5.

Where the stomach may be supposed to be excoriated by poisons containing acid, as sublimate of mercury or a.r.s.enic; or if it be otherwise inflamed, or very sensible to the stimulus of the gastric acid; or where it abounds with acid of any kind, as in cardialgia; the exhibition of soap is perhaps a preferable manner of giving alcali than any other, as it decomposes in the stomach without effervescence; while the caustic alcali is too acrid to be administered in such cases, and the mild alcali produces carbonic gas.

If a drop of acid of vitriol be put on cap paper, it will be long before it destroys the paper; but if a drop of mild alcali be added, a sudden effervescence arises, and the paper is instantly destroyed by the escape of the fixed air; in the same manner as lumps of solid lime are broken into powder by the escape of the steam produced from the water, which is poured on them. This shews why a succession of acid and of alcaline caustics sooner destroys a part, than either of them applied separately.

18. _Dysenteria._ b.l.o.o.d.y-flux is attended with sensitive fever generally with arterial debility; with frequent mucous or b.l.o.o.d.y stools; which contain contagious matter produced by the membranes of the intestines; the alimentary excrement being nevertheless retained; with griping pains and tenesmus.

M. M. Emetics. Antimonials. Peruvian bark. Opium and calomel of each a grain every night. Bolus armeniae. Earth of alum. Chalk. Calcined hartshorn.

Mucilage. Bee's wax mixt with yolk of egg. Cerated gla.s.s of antimony. Warm bath. Flannel clothing next to the skin. Large clysters with opium. With ipecacuanha, with smoke of tobacco? Two dysenteric patients in the same ward of the infirmary at Edinburgh quarrelled, and whipped each other with horsewhips a long time, and were both much better after it, owing perhaps to the exertion of so much of the sensorial power of volition; which, like real insanity, added excitement to the whole system.

The prevention of this contagion must consist princ.i.p.ally in ventilation and cleanliness; hence the patients should be removed into cottages distant from each other, or into tents; and their faeces buried as soon as may be; or conveyed into a running stream; and themselves should be washed with cold or warm water after every evacuation. For the contagious matter consists in the mucous or purulent discharge from the membrane which lines the intestines; and not from the febrile perspiration, or breath of the patients. For the fever is only the consequence and not the cause of contagion; as appears from Genus the Fifth of this Order, where contagion exists without fever.

19. _Gastritis superficialis._ Superficial inflammation of the stomach. An erysipelatous inflammation of the stomach is mentioned by Dr. Cullen from his own observations; which is distinguished from the inflammatory gastritis by less pain, and fever, and by an erysipelatous redness about the fauces. Does this disease belong to aphtha?

20. _Enteritis superficialis._ Superficial inflammation of the bowels is also mentioned by Dr. Cullen from his own observation under the name of enteritis erythematica; and is said to be attended with less pain and fever, without vomiting, and with diarrhoea. May not this disease be referred to aphtha, or to dysentery?

ORDO I.

_Increased Sensation._

GENUS IV.

_With the Production of new Vessels by internal Membranes or Glands, without Fever._

Where inflammation is produced in a small part, which has not great natural sensibility, the additional sensation does not produce an increased action of the arterial system; that is, the a.s.sociated motions which are employed in the circulation of the blood, those for instance of the heart, arteries, glands, capillaries, and their correspondent veins, are not thrown into increased action by so small an addition of the sensorial power of sensation. But when parts, which naturally possess more sensibility, become inflamed, the quant.i.ty of the sensorial power of sensation becomes so much increased, as to affect the a.s.sociated motions belonging to the circulation, occasioning them to proceed with greater frequency; that is, a fever is induced. This is well exemplified in the internal and superficial paronychia, one of which is attended with great pain and fever, and the other with little pain and no fever. See Cla.s.s II. 1. 2. 19. and II. 1. 4.

5.

From hence it appears, that the sensitive fever is an accidental consequence of the topical phlegmon, or inflammation, and not a cause of it; that it is often injurious, but never salutary; and should therefore always be extinguished, as soon as may be, either by the lancet and cathartics, and diluents, and cold air, when it is of the irritated kind; or by the bark, opium, cool air, and nutrientia, when it is of the inirritated kind.

SPECIES.

1. _Ophthalmia superficialis._ As the membranes, which cover the eye, are excluded from the air about one third part of the twenty-four hours; and are moistened by perpetual nict.i.tation during the other sixteen; they may be considered as internal membranes; and from the a.n.a.logy of their inflammation to that of other internal membranes, it is arranged under this genus; whilst the tonsillitis is esteemed an inflammation of an external membrane, because currents of air are perpetually pa.s.sing both day and night over the fauces.

The superficial ophthalmy has generally been esteemed a symptom of scrophula, when it recurs frequently in young persons; but is probably only a concomitant of that disease, as a symptom of general debility; ramifications of new red vessels, and of enlarged old ones, are spread over the white part of the eye; and it is attended with less heat, less pain, and less intolerance of light than the ophthalmia interna, described in Cla.s.s II. 1. 2. 2. It occurs in those of feeble circulation, especially children of a scrophulous tendency, and seems to arise from a previous torpor of the vessels of the tunica albuginea from their being exposed to cold air; and from this torpor being more liable to occur in habits, which are naturally inirritable; and therefore more readily fall into quiescence by a smaller deduction of the stimulus of heat, than would affect stronger or more irritable habits; the consequence of this torpor is increased action, which produces pain in the eye, and that induces inflammation by the acquisition of the additional sensorial power of sensation.

_Ophthalmia lymphatica_ is a kind of anasarca of the tunica adnata; in this the vessels over the sclerotica, or white part of the eye, rise considerably above the cornea, which they surround, are less red than in the ophthalmia superficialis, and appear to be swelled by an acc.u.mulation of lymph rather than of blood; it is probably owing to the temporary obstruction of a branch of the lymphatic system.

M. M. If the pain be great, venesection by leeches on the temple, or cutting the temporal artery, and one purge with three or four grains of calomel should be premised. Then the Peruvian bark twice a day. Opium from a quarter to half a grain twice a day for some weeks. Bathe the eye frequently with cold water alone, or with cold water, to a pint of which is added half an ounce of salt. White vitriol six grains dissolved in one ounce of water; a drop or two to be put between the eyelids twice a day.

Take very small electric sparks from the eyes every day for a fortnight.

Bathe the whole head with salt and water made warm every night for some months. Send such children to a school near the sea for the convenience of sea-bathing for many months annually; such schools are to be found in or near Liverpool.

When a child is afflicted with an inflamed eye of this kind, he should always sit with his back to the window or candle; but it is generally not necessary to cover it, or if the uneasy sensation of light makes this proper, the cover should stand off from the eye, so as not much to exclude the cool air from it. As covering an eye unnecessarily is liable to make that eye weaker than the other, from its not being sufficiently used, and thence to produce a squinting for ever afterwards.

Nevertheless, when the pain is great, a poultice must be applied to keep the eyes moist, or a piece of oiled silk bound lightly over them. Or thus, boil an egg till it is hard, cut it longitudinally into two hemispheres, take out the yolk, sew the backs of the two hollow hemispheres of the white to a ribbon, and bind them over the eyes every night on going to bed; which, if nicely fitted on, will keep the eyes moist without any disagreeable pressure. See Cla.s.s I. 1. 3. 14.

_Ophthalmia equina._ An inflammation of this kind is liable to affect the eyes of horses; one cause of which is owing to a silly custom of cutting the hair out of horses' ears; by which they are not only liable to take cold at the ear, but gra.s.s seeds are liable to fall into their ears from the high racks in stables; and in both cases the eye becomes inflamed by sympathy. I once directed the temporal artery of a horse to be opened, who had frequent returns of an inflamed eye; and I believed it was of essential service to him; it is probable that the artery was afterwards contracted in the wounded part, and that thence less blood was derived to the eye: the haemorrhage was stopped by two persons alternately keeping their fingers on the orifice, and afterwards by a long bandage of broad tape.