17. _Arthrocele._ Swelling of the joints seems to have its remote cause in the softness of the bones, for they could not swell unless they were previously softened, see Cla.s.s I. 2. 2. 14. The epiphyses, or ends of the bones, being naturally of a looser texture, are most liable to this disease, and perhaps the cartilages and capsular ligaments may also become inflamed and swelled along with the heads of the bones. This malady is liable to distort the fingers and knees, and is usually called gout or rheumatism; the former of which is liable to disable the fingers by chalk-stones, and thence to have somewhat a similar appearance. But the arthrocele, or swelling of the joints, affects people who have not been intemperate in the use of fermented or spirituous liquors; or who have not previously had a regular gout in their feet; and in both these circ.u.mstances differs from the gout. Nor does it accord with the inflammatory rheumatism, as it is not attended with fever, and because the tumors of the joints never entirely subside. The pain or sensibility, which the bones acquire, when they are inflamed, may be owing to the new vessels, which shoot in them in their soft state, as well as to the distention of the old ones.

M. M. Half a grain of opium twice a day, gradually increased to a grain, but not further, for many months. Thirty grains of powder of bark twice a day for many months. Ten grains of bone-ashes, or calcined hartshorn, twice a day, with decoction of madder? Soda phosphorata?

18. _Arthropuosis._ Joint-evil. This differs from the former, as that never suppurates; these ulcers of the joints are generally esteemed to arise from scrophula; but as scrophula is a disease of the lymphatic or absorbent system, and this consists in the suppuration of the membranes, or glands, or cartilages about the joints, there does not seem a sufficient a.n.a.logy to authorize their arrangement under the same name.

The white swelling of the knee, when it suppurates, comes under this species, with variety of other ulcers attended with carious bones.

19. _Caries ossium._ A caries of the bones may be termed a suppuration of them; it differs from the above, as it generally is occasioned by some external injury, as in decaying teeth; or by venereal virus, as in nodes on the tibia; or by other matter derived to the bone in malignant fevers; and is not confined to the ends of them.

The separation of the dead bone from the living is a work of some time. See Sect. x.x.xIII. 3. 1.

ORDO I.

_Increased Sensation._

GENUS V.

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

The ulcers, or eruptions, which are formed on the external skin, or on the mouth or throat, or on the air-cells of the lungs, or on the intestines, all of which are more or less exposed to the contact of the atmospheric air, which we breathe, and which in some proportion we swallow with our food and saliva; or to the contact of the inflammable air, or hydrogen, which is set at liberty by the putrefying aliment in the intestines, or by putrefying matter in large abscesses; all of them produce contagious matter; which, on being inoculated into the skin of another person, will produce fever, or a similar disease.

In some cases even the matter formed beneath the skin becomes in some degree contagious, at least so much so as to produce fever of the hectic or malignant kind, as soon as it has pierced through the skin, and has thus gained access to some kind of air; as the fresh puss of a common abscess; or the putrid pus of an abscess, which has been long confined; or of cancerous ulcers.

From this a.n.a.logy there is reason to suspect, that the matter of all contagious diseases, whether with or without fever, is not infectious till it has acquired something from the air; which, by oxygenating the secreted matter, may probably produce a new acid. And secondly, that in hectic fever a part of the purulent matter is absorbed; or acts on the surface of the ulcer; as variolous matter affects the inoculated part of the arm. And that hectic fever is therefore caused by the matter of an open ulcer; and not by the sensation in the ulcer independent of the aerated pus, which lies on it. Which may account for the venereal matter from buboes not giving the infection, according to the experiments of the late Mr. Hunter, and for some other phenomena of contagion. See Variola discreta, Cla.s.s II. 1. 3. 9.

SPECIES.

1. _Gonorrhoea venerea._ A pus-like contagious material discharged from the urethra after impure cohabitation, with smarting or heat on making water; which begins at the external extremity of the urethra, to which the contagious matter is applied, and where it has access to the air.

M. M. In this state of the venereal disease once venesection, with mild cathartics of senna and manna, with mucilage, as almond emulsion, and gum arabic, taken for two or three weeks, absolve the cure. Is camphor of use to relieve the ardor urinae? Do balsams increase or lessen the heat of urine? Neutral salts certainly increase the smarting in making water, by increasing the acrimony of the urine.

Can the discharge from the urethra be soon stopped by saturnine injections, or mercurial ones, or with solution of blue vitriol, at first very dilute, and gradually made stronger? And at the same time lest the syphilis, or general disease, should supervene, the patient might take a quarter of a grain of corrosive sublimate of mercury twice a day, as directed below?

2. _Syphilis._ Venereal disease. The contagion shews itself in ulcers on the part first inoculated, as chancres; ulcers on the tonsils succeed, with eruption on the skin, especially about the roots of the hair; afterwards on other parts of the skin, terminating in dry scabs; and lastly, with pain and swelling of the bones.

The corona veneris, or crown of Venus, consists of the eruptions at the roots of the hair appearing most round the forehead; which is occasioned by this part being more exposed to the air; which we observed, at the beginning of this genus, either produces or increases the virulence of contagious matter. But it is difficult to conceive from this history, why the throat should be first affected; as it cannot be supposed, that the disease is so often taken by the saliva, like the small-pox, though this may sometimes occur, perhaps very often. The connection between the genitals in men and the throat, is treated of in Cla.s.s IV. 1. 2. 7.

Hydrophobia.

M. M. A quarter of a grain of corrosive sublimate of mercury, taken thrice a day for five or six weeks, made into a pill with breadcrumbs, or dissolved in a spoonful of brandy and water, is a very efficacious and almost certain cure. When it does not succeed, it is owing either to the drug being bad, or to its having precipitated from the brandy, or from its being spoiled in the pill by long keeping. Opium contributes much to expedite the cure both of the simple gonorrhoea, and of venereal ulcers, by increasing absorption both from the mucous membrane, and from the surface of ulcers.

3. _Lepra._ Leprosy. Leprosy of the Greeks. The skin is rough with white branny scales, which are full of c.h.i.n.ks; often moist beneath, and itching.

The scales on the head or arms of some drinking people are a disease of this kind. The perspirable matter designed for the purpose of lubricating the external skin is secreted in this disease in a too viscid state, owing to the inflammation of the subcutaneous vessels; and, as the absorbents act too strongly at the same time, a viscid mucus is left adhering to the surface of the skin.

In the leprosy of the Jews, described in the thirteenth and fourteenth chapters of Leviticus, the depression of the sore beneath the surface of the skin, and the hairs in it becoming white, seem to have been the princ.i.p.al circ.u.mstances, which the priest was directed to attend to for the purpose of ascertaining the disease.

M. M. Essence of antimony from 20 drops to 100 twice or thrice a day, with half a pint of decoction of elm-bark; or tincture of cantharides from 20 to 60 drops four times a day; or sublimate of mercury, with much diluting fluid. Acid of vitriol? Perhaps the cure chiefly depends on much dilution with water, from two to four pints a day, in which elm-bark, or pine-buds, or juniper-tops, may be boiled. Bath or Buxton water drank in large quant.i.ties. Warm bath. Oil-skin bound on the part to confine the perspirable matter. Ointment of tar and suet; or poultice for two or three days, and then cerate with lapis calaminaris. Diet of raisins and bread.

Abstinence from wine, beer, and all spirits.

4. _Elephantiasis._ Leprosy of the Arabs. A contagious disease; the skin is thickened, wrinkled, rough, unctuous, dest.i.tute of hair, without any sensation of touch in the extremities of the limbs; the face deformed with tubercles; the voice hoa.r.s.e, and with a nasal tone. Cullen.

5. _Framboesia._ Yaws is said to be contagious and hereditary. It princ.i.p.ally affects the negroes in the West Indies. Edinb. Essays, Vol. VI.

6. _Psora._ Itch. A contagious prurient eruption. There are two kinds of itch, that which appears between the fingers, and under the joints of the knees and elbows; and that which seldom is seen in these places, but all over the other parts of the body. The latter is seldom thought to be the itch, as it does not easily infect even a bedfellow, and resists the usual means of cure by brimstone.

If the itch be cured too hastily by rubbing mercurial or a.r.s.enical preparations over the whole body, or on too great a part of it, many bad symptoms are produced; as weakness of digestion, with pale bloated countenance, and tendency to dropsy. I have twice seen St. Vitus's dance occur from the use of a mercurial girdle; and once a swelled liver. I have also seen a swelled spleen and swelled legs from the external use of a.r.s.enic in the cure of the itch. And very numerous and large phlegmons commonly succeed the too hasty cure of it by other means.

There does not appear a strict a.n.a.logy between the hasty cure of the itch, and the retrocession of the pustles in the secondary fever of the small-pox; because in that the absorption of the matter is evinced by the swelling of the face and hands, as the pustles recede, as explained in Cla.s.s II. 1. 3. 9. Variola discreta. And a fever is produced by this absorption; neither of which happen, when the pustles of the itch are destroyed by mercury or a.r.s.enic.

Nor can these inconveniences, which occur on the too hasty cure of the itch, be explained by those which follow the cure of some kinds of gutta rosea, Cla.s.s II. 1. 4. 6. as in those the eruptions on the face were an a.s.sociated disease with inflammation of the liver or stomach, which they were accustomed to relieve; whereas the itch is not known to have had any previous catenation with other diseases.

In the itch there exists not only great irritation in the production of the pustles, but great sensation is caused by their acrimony afterwards; insomuch that the pain of itching, without the interrupted smarting occasioned by scratching, would be intolerable. This great excitement of the two sensorial powers of irritation and sensation is so great, when the pustles are diffused over the whole surface of the body, that a torpor succeeds the sudden ceasing of it; which affects those parts of the system, which were most catenated with the new motions of the skin, as the stomach, whence indigestion and flatulency; or which are generally most liable to fall into torpor, as the numerous glands, which form the liver. Whence the diseases consequent to the hasty cure of the itch are diseases of debility, as tumid viscera, oedematous swellings, and St. Vitus's dance, which is a debility of a.s.sociation. In the same manner indigestion, with green evacuations, are said to follow an injudicious application of cerussa to stop too hastily the exsudation behind the ears of children, Cla.s.s I. 1. 2.

9. And dropsies are liable to succeed the cure of old ulcers of the legs, which have long stimulated the system.

M. M. The size of a large pea, of an ointment consisting of one part of white precipitate of mercury to six parts of hogs' lard well triturated together, to be rubbed on a part of the body every night, and washed off with soap and water next morning, till every part is cleared; with lac sulphuris twenty grains to be taken every morning inwardly. Warm saline bath, with white vitriol in it. Flowers of sulphur mixed with thick gruel, with hogs fat. With either of which the body may be smeared all over.

7. _Psora ebriorum._ Elderly people, who have been much addicted to spirituous drinks, as beer, wine, or alcohol, are liable to an eruption all over their bodies; which is attended with very afflicting itching, and which they probably propagate from one part of their bodies to another with their own nails by scratching themselves. I saw fatal effects in one such patient, by a too extensive use of a solution of lead; the eruption disappeared, he became dropsical, and died; I suppose from the too suddenly ceasing of the great stimulus caused by the eruptions over the whole skin, as in the preceding article.

M. M. The patient should gradually accustom himself to half his usual quant.i.ty of vinous potation. The warm bath, with one pound of salt to every three gallons. Mercurial ointments on small parts of the skin at a time. A grain of opium at night instead of the usual potation of wine or beer.

8. _Herpes._ Herpes consists of gregarious spreading excoriations, which are succeeded by branny scales or scabs. In this disease there appears to be a deficient absorption of the subcutaneous mucus, as well as inflammation and increased secretion of it. For the fluid not only excoriates the parts in its vicinity by its acrimony, but is very saline to the taste, as some of these patients have a.s.sured me; I believe this kind of eruption, as well as the tinea, and perhaps all other cutaneous eruption, is liable to be inoculated in other parts of the body by the finger-nails of the patients in scratching themselves.

It is liable to affect the hands, and to return at distant periods; and is probably a secondary disease, as well as the zona ignea, or shingles, described below.

M. M. Poultice the eruption with bread and milk, or raw carrots grated, for two or three whole days, to dilute or receive the discharged fluid, and abate the inflammation; then cover the parts with fresh cerate mixed with lapis calaminaris. On the parts not excoriated mercurial ointment, made of one part of white calx of mercury and six of hogs' fat. Internally, after venesection, gentle repeated cathartics. Lastly, the bark. Acid of vitriol.

Bolus Armeniae, or testacia. Antimonials. Decoction of interior bark of elm.

9. _Zona ignea._ Shingles. This eruption has been thought a species of herpes by some writers, and by others a species of erysipelas. Yellow or livid vesicles appear, producing a corrosive ichor, which is sometimes attended with a degree of fever. It is said to infest sometimes the thorax and ribs, but its most general situation is on the small of the back, over one kidney, extending forward over the course of one of the ureters.

There is reason to suspect, that this also is a secondary or sympathetic disease, as well as the preceding one; but future observations are required, before it can be removed to the fourth cla.s.s, or diseases of a.s.sociation. In three patients I have been induced to believe, that the eruption on the loins was a translation of inflammation from the external membrane of the kidney to the skin. They had, for a day or two before the appearance of the eruption, complained of a dull pain on the region of one kidney, but without vomiting; by which it was distinguished from nephritis interna, or gravel; and without pain down the outside of the thigh, by which it was distinguished from sciatica. In other situations the shingles may sympathize with other internal membranes, as in a case published by Dr.

Russel (De Tabe Glandulari), where the retrocession of the shingles was succeeded by a serious dyspnaea.

M. M. Venesection, if the pulse is strong. Calomel three or four grains, very mild repeated cathartics. Poultice for a few days, then cerate of lapis calaminaris, as in herpes. A grain of emetic tartar dissolved in a pint of water, and taken so as to empty the stomach and intestines, is said much to hasten the cure; compresses soaked in a saturnine solution are recommended externally on the eruption; and cerate where there are ulcerations. Desanet's Surgical Journal, Vol. II. p. 378. If this be a vicarious disease, it should continue half a lunation; lest, on its ceasing, the bad habits of motion of the primary disease should not have been so perfectly dissevered, but that they may recur.

10. _Annulus repens._ Ring-worm. A prurient eruption formed in a circle, affecting children, and would seem to be the work of insects, according to the theory of Linnaeus, who ascribes the itch and dysentery to microscopic animalcula. These animalcula are probably the effect, and not the cause, of these eruptions; as they are to be seen in all putrescent animal fluids.

The annular propagation of the ring-worm, and its continuing to enlarge its periphery, is well accounted for by the acrimony of the ichor or saline fluid eroding the skin in its vicinity.

M. M. Cover the eruption daily with ink. With white mercurial ointment, as described above in herpes. With solution of white vitriol ten grains to an ounce. These metallic calces stimulate the absorbents into stronger action, whence the fluid has its saline part reabsorbed, and that before it has access to the air, which probably adds to its acrimony by oxygenating it, and thus, producing a new acid.

11. _Tinea._ Scald head. This contagious eruption affects the roots of the hair, and is generally most virulent around the edges of the hair on the back part of the head; as the corona veneris appears most on the edges of the hair on the forepart of the head; for in these parts the eruption about the roots of the hair is most exposed to the external air, by which its acrimony or noxious quality is increased.

The absorption of the matter thus oxygenated swells the lymphatics of the neck by its stimulus, occasioning many little hard lumps beneath the seat of the eruption; when this happens, the sooner it is cured the better, lest the larger lymphatics of the neck should become affected.

M. M. The art of curing these eruptions consists, first, in abating the inflammation, and consequent secretion of a noxious material. Secondly, to prevent its access to the air, which so much increases its acrimony. And thirdly, to promote the absorption of it, before it has been exposed to the air; for these purposes venesection once, and gentle cathartics, which promote absorption by emptying the blood-vessels. Next poultices and fomentations, with warm water, abate inflammation by diluting the saline acrimony of the secreted fluid, and abating the painful sensation.

Afterwards cerate joined with some metallic calx, as of zinc or lead, or solution of lead, mercury, or copper, or iron, which may stimulate the absorbent system into stronger action.

Cover the shaved head with tar and suet, and a bladder; this, by keeping the air from the secreted fluid, much contributes to its mildness, and the stimulus of the tar increases its absorption. See the three preceding species of this genus.