Zoonomia/II.I.II.III

ORDO II.

Decreased Irritation.

GENUS III.

The Decreased Action of the Absorbent System.

Some decrease of heat attends these diseases, though in a less degree than those of the last genus, because the absorbent system of glands do not generate so much heat in their healthy state of action as the secerning system of glands, as explained in Class I. 1. 3.

SPECIES.

1. Mucus faucium frigidus. Cold mucus from the throat. Much mucus, of rather a saline taste, and less inspissated than usual, is evacuated from the fauces by hawking, owing to the deficient absorption of the thinner parts of it. This becomes a habit in some elderly people, who are continually spitting it out of their mouths; and has probably been brought on by taking snuff, or smoking tobacco; which by frequently stimulating the fauces have at length rendered the absorbent vessels less excitable by the natural stimulus of the saline part of the secretion, which ought to be reabsorbed, as soon as secreted.

M. M. A few grains of powder of bark frequently put into the mouth, and gradually diffused over the fauces. A gargle of barley water.

2. Sudor frigidus. The cold dampness of the hands of some people is caused by the deficient absorption of perspirable matter; the clammy or viscid feel of it is owing to the mucous part being left upon the skin. The coldness is produced both by the decreased action of the absorbent system, and by the evaporation of a greater quantity of the perspirable matter into the air, which ought to have been absorbed.

M. M. Wash the hands in lime water, or with a small quantity of volatile alcali in water.

3. Catarrhus frigidus. The thin discharge from the nostrils in cold weather. The absorbent vessels become torpid by the diminution of external heat, sooner than the secerning ones, which are longer kept warm by the circulating blood, from which they select the fluid they secrete; whereas the absorbent vessels of the nostrils drink up their fluids, namely the thin and saline part of the mucus, after it has been cooled by the atmosphere. Hence the absorbents ceasing to act, and the secerning vessels continuing some time longer to pour out the mucus, a copious thin discharge is produced, which trickles down the nostrils in cold weather. This discharge is so acrid as to inflame the upper lip; which is owing to the neutral salts, with which it abounds, not being reabsorbed; so the tears in the fistula lacrymalis inflame the cheek. See Class I. 1. 2. 7.

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 quantity 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 quantity 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 constitutions, whose extremities are generally cold and pale. The great quantity of limpid water in hysteric cases, and in diabætes, belongs to Class 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. Diarrhœa 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 quantity, and almost unchanged by the powers of digestion, and is then called lientery.

The mucus of the rectum 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 constitutions, where this discharge is pellucid and thin, it must proceed from want of absorption of the mucous membrane of the vagina, 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 Class I. 1. 2. 11. attends menstruation, or is a discharge instead of it, and thus resembles the venereal orgasm 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 isinglass 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 vagina. Cold bath.

8. Gonorrhœa 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 Class 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 portæ. 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 quantity. From the obstruction of the passage 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 quantity 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 Class 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 quantity of the bile. A blister on the region of the liver. Sorbentia, as worm-seed, santonicum. 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 quantity 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 quantity of red globules of blood, caused by the deficient quantity 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 quantity, 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 vagina 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 scrotum, 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 accumulated 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 scorbutic. 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 scrotum, 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 testicle, 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 vagina 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 quantity, 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 principally 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 Class 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 Class 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 passed 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, Class I. 2. 5. 4. When one eye is affected, does the disease exist in the ventricule of that side?


 * Take here Addition II

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 quantity 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 quantity, 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 œsophagus 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 accumulated lymph, the air could not gain admittance to the other parts, and the animal must immediately perish.

If the pericardium is the principal 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 Class 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 asserts? 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 class 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 peritonæum, 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 peritonæum, 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 circumstance has generally been ascribed to a dropsy at the same time existing in the pericardium, but is more probably owing to the difficult passage 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.

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 analogous cause; that is, to the deficient absorption of fat compared to the quantity secreted into the cells which contain it. See Class II. 1. 1. 4.

The method of getting free from too much fat without any injury to the constitution, 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 buttons. This is to compress the bowels and increase their absorption, and it thus removes one principal 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 quantities, 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 constitute the spleen. See Class 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 passes through the morasses 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 quantity 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 asserted 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-shells, and scarlet cloth burnt together in a close crucible, which was tried with success, as he assured 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 constitute 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. XXXIX. 4. 5.

These indolent tumours may be brought to suppurate sometimes by passing 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 accumulation of sensorial power; and thence either facilitate their dispersion, or occasion them to suppurate. See Class 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 coarse bread in it. See diarrhœa of infants, Class 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 Class 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 mass, till from some accidental violence it gains sensibility, and produces cancer, or suppurates. Of this kind are the schirrous glands of the breasts, 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 rectum 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 rectum. A schirrus frequently affects a canal, and by contracting its diameter becomes a painful and deplorable disease. The canals thus obstructed are the rectum, the urethra, the throat, the gall-ducts, and probably the excretory ducts of the lymphatics, and of other glands.

The schirrus of the rectum 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 Class I. 2. 1. 6.

24. Schirrus urethræ. Schirrus of the urethra. The passage becomes contracted by the thickened membrane, and the urine is forced through with great difficulty, and is thence liable to distend the canal 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 perinæum, and the urine is in part discharged that way, the disease can not be mistaken. Otherwise from the quantity 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 Class II. 1. 4. 11.

25. Schirrus œsophagi. A schirrus of the throat contracts the passage 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 Class 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 ass, 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 passing 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 [[../II.IV.II.IV#11|Class 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 Class 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 quantity of water in this kind of dropsy.