A few typographical errors have been corrected: they are listed at the end of the text.
By ERASMUS DARWIN, M.D. F.R.S.
AUTHOR OF THE BOTANIC GARDEN.
Principio coelum, ac terras, camposque liquentes, Lucentemque globum lunae, titaniaque astra, Spiritus intus alit, totamque infusa per artus Mens agitat molem, et magno se corpore miscet.—VIRG. Aen. vi.
Earth, on whose lap a thousand nations tread, And Ocean, brooding his prolific bed, Night's changeful orb, blue pole, and silvery zones, Where other worlds encircle other suns, One Mind inhabits, one diffusive Soul Wields the large limbs, and mingles with the whole.
London: Printed for. J. Johnson, in St. Paul's Church-Yard. 1796.
Entered at Stationers' Hall.
THE LAWS OF ORGANIC LIFE.
A CATALOGUE OF DISEASES
NATURAL CLASSES ACCORDING TO THEIR PROXIMATE CAUSES,
SUBSEQUENT ORDERS, GENERA, AND SPECIES,
THEIR METHODS OF CURE.
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Haec, ut potero, explicabo; nec tamen, quasi Pythius Apollo, certa ut sint et fixa, quae dixero; sed ut Homunculus unus e multis probabiliora conjectura sequens.—CIC. TUSC. DISP. l. 1. 9.
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All diseases originate in the exuberance, deficiency, or retrograde action, of the faculties of the sensorium, as their proximate cause; and consist in the disordered motions of the fibres of the body, as the proximate effect of the exertions of those disordered faculties.
The sensorium possesses four distinct powers, or faculties, which are occasionally exerted, and produce all the motions of the fibrous parts of the body; these are the faculties of producing fibrous motions in consequence of irritation which is excited by external bodies; in consequence of sensation which is excited by pleasure or pain; in consequence of volition which is excited by desire or aversion; and in consequence of association which is excited by other fibrous motions. We are hence supplied with four natural classes of diseases derived from their proximate causes; which we shall term those of irritation, those of sensation, those of volition, and those of association.
In the subsequent classification of diseases I have not adhered to the methods of any of those, who have preceded me; the principal of whom are the great names of Sauvages and Cullen; but have nevertheless availed myself, as much as I could, of their definitions and distinctions.
The essential characteristic of a disease consists in its proximate cause, as is well observed by Doctor Cullen, in his Nosologia Methodica, T. ii. Prolegom. p. xxix. Similitudo quidem morborum in similitudine causae eorum proximae, qualiscunque sit, revera consistit. I have taken the proximate cause for the classic character. The characters of the orders are taken from the excess, or deficiency, or retrograde action, or other properties of the proximate cause. The genus is generally derived from the proximate effect. And the species generally from the locality of the disease in the system.
Many species in this system are termed genera in the systems of other writers; and the species of those writers are in consequence here termed varieties. Thus in Dr. Cullen's Nosologia the variola or small-pox is termed a genus, and the distinct and confluent kinds are termed species. But as the infection from the distinct kind frequently produces the confluent kind, and that of the confluent kind frequently produces the distinct; it would seem more analogous to botanical arrangement, which these nosologists profess to imitate, to call the distinct and confluent small-pox varieties than species. Because the species of plants in botanical systems propagate others similar to themselves; which does not uniformly occur in such vegetable productions as are termed varieties.
In some other genera of nosologists the species have no analogy to each other, either in respect to their proximate cause, or to their proximate effect, though they may he somewhat similar in less essential properties; thus the thin and saline discharge from the nostrils on going into the cold air of a frosty morning, which is owing to the deficient action of the absorbent vessels of the nostrils, is one species; and the viscid mucus discharged from the secerning vessels of the same membrane, when inflamed, is another species of the same genus, Catarrhus. Which bear no analogy either in respect to their immediate cause or to their immediate effect.
The uses of the method here offered to the public of classing diseases according to their proximate causes are, first, more distinctly to understand their nature by comparing their essential properties. Secondly, to facilitate the knowledge of the methods of cure; since in natural classification of diseases the species of each genus, and indeed the genera of each order, a few perhaps excepted, require the same general medical treatment. And lastly, to discover the nature and the name of any disease previously unknown to the physician; which I am persuaded will be more readily and more certainly done by this natural system, than by the artificial classifications already published.
The common names of diseases are not well adapted to any kind of classification, and least of all to this from their proximate causes. Some of their names in common language are taken from the remote cause, as worms, stone of the bladder; others from the remote effect, as diarrhoea, salivation, hydrocephalus; others from some accidental symptom of the disease, as tooth-ach, head-ach, heart-burn; in which the pain is only a concomitant circumstance of the excess or deficiency of fibrous actions, and not the cause of them. Others again are taken from the deformity occasioned in consequence of the unnatural fibrous motions, which constitute diseases, as tumours, eruptions, extenuations; all these therefore improperly give names to diseases; and some difficulty is thus occasioned to the reader in endeavouring to discover to what class such disorders belong.
Another difficulty attending the names of diseases is, that one name frequently includes more than one disease, either existing at the same time or in succession. Thus the pain of the bowels from worms is caused by the increased action of the membrane from the stimulus of those animals; but the convulsions, which sometimes succeed these pains in children, are caused by the consequent volition, and belong to another class.
To discover under what class any disease should be arranged, we must first investigate the proximate cause; thus the pain of the tooth-ach is not the cause of any diseased motions, but the effect; the tooth-ach therefore does not belong to the class of Sensation. As the pain is caused by increased or decreased action of the membranes of the tooth, and these actions are owing to the increase or decrease of irritation, the disease is to be placed in the class of irritation.
To discover the order it must be inquired, whether the pain be owing to increased or defective motion of the pained membrane; which is known by the concomitant heat or coldness of the part. In tooth-ach without inflammation there is generally a coldness attends the cheek in its vicinity; as may be perceived by the hand of the patient himself, compared with the opposite cheek. Hence odontalgia is found to belong to the order of decreased irritation. The genus and species must be found by inspecting the synopsis of the second order of the class of Irritation. See Class I. 2. 4. 12.
This may be further elucidated by considering the natural operation of parturition; the pain is occasioned by the increased action or distention of the vessels of the uterus, in consequence of the stimulus of the fetus; and is therefore caused by increased irritation; but the action of the abdominal muscles in its exclusion are caused by the pain, and belong to the class of increased sensation. See Class II. 1. 1. 12. Hence the difficulty of determining, under what class of diseases parturition should be arranged, consists in there being two kinds of diseased actions comprehended under one word; which have each their different proximate cause.
In Sect. XXXIX. 8. 4. and in Class II. 1. 1. 1. we have endeavoured to give names to four links of animal causation, which conveniently apply to the classification of diseases; thus in common nictitation, or winking with the eyes without our attention to it, the increased irritation is the proximate cause; the stimulus of the air on the dry cornea is the remote cause; the closing of the eyelid is the proximate effect; and the diffusion of tears over the eye-ball is the remote effect. In some cases two more links of causation may be introduced; one of them may be termed the pre-remote cause; as the warmth or motion of the atmosphere, which causes greater exhalation from the cornea. And the other the post-remote effect; as the renewed pellucidity of the cornea; and thus six links of causation may be expressed in words.
But if amid these remote links of animal causation any of the four powers or faculties of the sensorium be introduced, the reasoning is not just according to the method here proposed; for these powers of the sensorium are always the proximate causes of the contractions of animal fibres; and therefore in true language cannot be termed their remote causes. From this criterion it may always be determined, whether more diseases than one are comprehended under one name; a circumstance which has much impeded the investigation of the causes, and cures of diseases.
Thus the term fever, is generally given to a collection of morbid symptoms; which are indeed so many distinct diseases, that sometimes appear together, and sometimes separately; hence it has no determinate meaning, except it signifies simply a quick pulse, which continues for some hours; in which sense it is here used.
In naming diseases I have endeavoured to avoid the affectation of making new compound Greek words, where others equally expressive could be procured: as a short periphrasis is easier to be understood, and less burthensome to the memory.
In the Methodus Medendi, which is marked by M.M. at the end of many of the species of diseases, the words incitantia, sorbentia, torpentia, &c. refer to the subsequent articles of the Materia Medica, explaining the operations of medicines.
The remote causes of many diseases, their periods, and many circumstances concerning them, are treated of in the preceding volume; the descriptions of many of them, which I have omitted for the sake of brevity, may be seen in the Nosologia Methodica of Sauvages, and in the Synopsis Nosologiae of Dr. Cullen, and in the authors to which they refer.
In this arduous undertaking the author solicits the candour of the critical reader; as he cannot but foresee, that many errors will be discovered, many additional species will require to be inserted; and others to be transplanted, or erased. If he could expend another forty years in the practice of medicine, he makes no doubt, but that he could bring this work nearer perfection, and thence render it more worthy the attention of philosophers.——As it is, he is induced to hope, that some advantages will be derived from it to the science of medicine, and consequent utility to the public, and leaves the completion of his plan to the industry of future generations.
DERBY, Jan. 1, 1796.
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CLASSES OF DISEASES.
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I. DISEASES OF IRRITATION.
II. DISEASES OF SENSATION.
III. DISEASES OF VOLITION.
IV. DISEASES OF ASSOCIATION.
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The Orders and Genera of the First Class of Diseases.
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DISEASES OF IRRITATION.
1. With increased actions of the sanguiferous system. 2. With increased actions of the secerning system. 3. With increased actions of the absorbent system. 4. With increased actions of other cavities and membranes. 5. With increased actions of the organs of sense.
1. With decreased actions of the sanguiferous system. 2. With decreased actions of the secerning system. 3. With decreased actions of the absorbent system. 4. With decreased actions of other cavities and membranes. 5. With decreased actions of the organs of sense.
Retrograde Irritative Motions.
1. Of the alimentary canal. 2. Of the absorbent system. 3. Of the sanguiferous system.
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The Orders, Genera, and Species, of the First Class of Diseases.
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DISEASES OF IRRITATION.
With Increased Actions of the Sanguiferous System.
1. Febris irritativa. Irritative fever. 2. Ebrietas. Drunkenness. 3. Haemorrhagia arteriosa. Arterial haemorrhage. 4. Haemoptoe arteriosa. Spitting of arterial blood. 5. Haemorrhagia narium. Bleeding from the nose.
With Increased Actions of the Secerning System.
1. Calor febrilis. Febrile heat. 2. Rubor febrilis. Febrile redness. 3. Sudor calidus. Warm sweat. —— febrilis. Sweat in fevers. —— a labore. —— from exercise. —— ab igne. —— from fire. —— a medicamentis. —— from medicines. 4. Urina uberior colorata. Copious coloured urine. 5. Diarrhoea calida. Warm diarrhoea. —— febrilis. —— from fever. —— crapulosa. —— from indigestion. —— infantum. —— of infants. 6. Salivatio calida. —— salivation. 7. Catarrhus calidus. —— catarrh. 8. Expectoratio calida. —— expectoration. 9. Exsudatio pone aures. Discharge behind the ears. 10. Gonorrhoea calida. Warm gonorrhoea. 11. Fluor albus calidus. —— fluor albus. 12. Haemorrhois alba. White piles. 13. Serum e visicatorio. Discharge from a blister. 14. Perspiratio foetida. Fetid perspiration. 15. Crines novi. New hairs.
With increased Actions of the Absorbent System.
1. Lingua arida. Dry tongue. 2. Fauces aridae. Dry throat. 3. Nares aridi. Dry nostrils. 4. Expectoratio solida. Solid expectoration. 5. Constipatio alvi. Costiveness. 6. Cutis arida. Dry skin. 7. Urina parcior colorata. Diminished coloured urine. 8. Calculus felleus et icterus. Gall-stone and jaundice. 9. —— renis. Stone of the kidney. 10. —— vesicae. Stone of the bladder. 11. —— arthriticus. Gout-stone. 12. Rheumatismus chronicus. Chronic rheumatism. 13. Cicatrix vulnerum. Healing of ulcers. 14. Corneae obfuscatio. Scar on the cornea.
With increased Actions of other Cavities and Membranes.
1. Nictitatio irritativa. Irritative nictitation. 2. Deglutitio irritativa. Irritative deglutition. 3. Respiratio et tussis. Respiration and cough. 4. Exclusio bilis. Exclusion of the bile. 5. Dentitio. Toothing. 6. Priapismus. Priapism. 7. Distensio mamularum. Distention of the nipples. 8. Descensus uteri. Descent of the uterus. 9. Prolapsus ani. Descent of the rectum. 10. Lumbricus. Round worm. 11. Taenia. Tape-worm. 12. Ascarides. Thread-worms. 13. Dracunculus. Guinea-worm. 14. Morpiones. Crab-lice. 15. Pediculi. Lice.
With increased Actions of the Organs of Sense.
1. Visus acrior. Acuter sight. 2. Auditus acrior. —— hearing. 3. Olfactus acrior. —— smell. 4. Gustus acrior. —— taste. 5. Tactus acrior. —— touch. 6. Sensus caloris acrior. —— sense of heat. 7. —— extensionis acrior. —— sense of extension. 8. Titillatio. Tickling. 9. Pruritus. Itching. 10. Dolor urens. Smarting. 11. Consternatio. Surprise.
With decreased Actions of the Sanguiferous System.
1. Febris inirritativa. Inirritative fever. 2. Paresis inirritativa. —— debility. 3. Somnus interruptus. Interrupted sleep. 4. Syncope. Fainting. 5. Haemorrhagia venosa. Venous haemorrhage. 6. Haemorrhois cruenta. Bleeding piles. 7. Haemorrhagia renum. —— from the kidneys. 8. —— hepatis. —— from the liver. 9. Haemoptoe venosa. Spitting of venous blood. 10. Palpitatio cordis. Palpitation of the heart. 11. Menorrhagia. Exuberant menstruation. 12. Dysmenorrhagia. Deficient menstruation. 13. Lochia nimia. Too great lochia. 14. Abortio spontanea. Spontaneous abortion. 15. Scorbutus. Scurvy. 16. Vibices. Extravasations of blood. 17. Petechiae. Purple spots.
With decreased Actions of the Secerning System.
1. Frigus febrile. Coldness in fevers. —— chronicum. —— permanent. 2. Pallor fugitivus. Paleness fugitive. —— permanens. —— permanent. 3. Pus parcius. Diminished pus. 4. Mucus parcior. Diminished mucus. 5. Urina parcior pallida. Pale diminished urine. 6. Torpor hepaticus. Torpor of the liver. 7. Torpor pancreatis. Torpor of the pancreas. 8. Torpor renis. Torpor of the kidney. 9. Punctae mucosae vultus. Mucous spots on the face. 10. Maculae cutis fulvae. Tawny blots on the skin. 11. Canities. Grey hairs. 12. Callus. Callus. 13. Cataracta. Cataract. 14. Innutritio ossium. Innutrition of the bones. 15. Rachitis. Rickets. 16. Spina distortio. Distortion of the spine. 17. Claudicatio coxaria. Lameness of the hip. 18. Spina protuberans. Protuberant spine. 19. Spina bifida. Divided spine. 20. Defectus palati. Defect of the palate.
With decreased Actions of the Absorbent System.
1. Mucus faucium frigidus. Cold mucus from the throat. 2. Sudor frigidus. —— sweat. 3. Catarrhus frigidus. —— catarrh. 4. Expectoratio frigida. —— expectoration. 5. Urina uberior pallida. Copious pale urine. 6. Diarrhoea frigida. Cold diarrhoea. 7. Fluor albus frigidus. —— fluor albus. 8. Gonorrhoea frigida. —— gonorrhoea. 9. Hepatis tumor. Swelling of the liver. 10. Chlorosis. Green sickness. 11. Hydrocele. Dropsy of the vagina testis. 12. Hydrocephalus internus. —— of the brain. 13. Ascites. —— of the belly. 14. Hydrothorax. —— of the chest. 15. Hydrops ovarii. —— of the ovary. 16. Anasarca pulmonum. —— of the lungs. 17. Obesitas. Corpulency. 18. Splenis tumor. Swelling of the spleen. 19. Genu tumor albus. White swelling of the knee. 20. Bronchocele. Swelled throat. 21. Scrophula. King's evil. 22. Schirrus. Schirrus. 23. —— recti. —— of the rectum. 24. —— urethrae. —— of the urethra. 25. —— oesophagi. —— of the throat. 26. Lacteorum inirritabilitas. Inirritability of the lacteals. 27. Lymphaticorum inirritabilitas. Inirritability of the lymphatics.
With decreased Actions of other Cavities and Membranes.
1. Sitis calida. Thirst warm. —— frigida. —— cold. 2. Esuries. Hunger. 3. Nausea sicca. Dry Nausea. 4. Aegritudo ventriculi. Sickness of stomach. 5. Cardialgia. Heart-burn. 6. Arthritis ventriculi. Gout of the stomach. 7. Colica flatulenta. Flatulent colic. 8. Colica saturnina. Colic from lead. 9. Tympanitis. Tympany. 10. Hypochondriasis. Hypochondriacism. 11. Cephalaea frigida. Cold head-ach. 12. Odontalgia. Tooth-ach. 13. Otalgia. Ear-ach. 14. Pleurodyne chronica. Chronical pain of the side. 15. Sciatica frigida. Cold sciatica. 16. Lumbago frigida. —— lumbago. 17. Hysteralgia frigida. —— pain of the uterus. 18. Proctalgia frigida. —— pain of the rectum. 19. Vesicae felleae inirritibilitas Inirritability of the gall-bladder et icterus. and jaundice.
With decreased Actions of the Organs of Sense.
1. Stultitia inirritabilis. Folly from inirritability. 2. Visus imminutus. Impaired vision. 3. Muscae volitantes. Dark moving specks. 4. Strabismus. Squinting. 5. Amaurosis. Palsy of the optic nerve. 6. Auditus imminutus. Impaired hearing. 7. Olfactus imminutus. —— smell. 8. Gustus imminutus. —— taste. 9. Tactus imminutus. —— touch. 10. Stupor. Stupor.
Retrograde Irritative Motions.
Of the Alimentary Canal.
1. Ruminatio. Chewing the cud. 2. Ructus. Eructation. 3. Apepsia. Indigestion, water-qualm. 4. Vomitus. Vomiting. 5. Cholera. Cholera. 6. Ileus. Iliac passion. 7. Globus hystericus. Hysteric strangulation. 8. Vomendi conamen inane. Vain efforts to vomit. 9. Borborigmus. Gurgling of the bowels. 10. Hysteria. Hysteric disease. 11. Hydrophobia. Dread of water.
Of the Absorbent System.
1. Catarrhus lymphaticus. Lymphatic catarrh. 2. Salivatio lymphatica. Lymphatic salivation. 3. Nausea humida. Moist nausea. 4. Diarrhoea lymphatica. Lymphatic flux. 5. Diarrhoea chylifera. Flux of chyle. 6. Diabaetes. Diabetes. 7. Sudor lymphaticus. Lymphatic sweat. 8. Sudor asthmaticus. Asthmatic sweat. 9. Translatio puris. Translation of matter. 10. —— lactis. —— of milk. 11. —— urinae. —— of urine.
Of the Sanguiferous System.
1. Capillarium motus retrogressus. Retrograde motion of the capillaries. 2. Palpitatio cordis. Palpitation of the heart. 3. Anhelatio spasmodica. Spasmodic panting.
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DISEASES OF IRRITATION.
With increased Actions of the Sanguiferous System.
The irritability of the whole, or of part, of our system is perpetually changing; these vicissitudes of irritability and of inirritability are believed to depend on the accumulation or exhaustion of the sensorial power, as their proximate cause; and on the difference of the present stimulus, and of that which we had previously been accustomed to, as their remote cause. Thus a smaller degree of heat produces pain and inflammation in our hands, after they have been for a time immersed in snow; which is owing to the accumulation of sensorial power in the moving fibres of the cutaneous vessels during their previous quiescence, when they were benumbed with cold. And we feel ourselves cold in the usual temperature of the atmosphere on coming out of a warm room; which is owing to the exhaustion of sensorial power in the moving fibres of the vessels of the skin by their previous increased activity, into which they were excited by unusual heat.
Hence the cold fits of fever are the occasion of the succeeding hot ones; and the hot fits contribute to occasion in their turn the succeeding cold ones. And though the increase of stimulus, as of heat, exercise, or distention, will produce an increased action of the stimulated fibres; in the same manner as it is produced by the increased irritability which was occasioned by a previous defect of stimulus; yet as the excesses of irritation from the stimulus of external things are more easily avoided than the deficiencies of it; the diseases of this country, except those which are the consequences of drunkenness, or of immoderate exercise, more frequently begin with torpor than with orgasm; that is, with inactivity of some parts, or of the whole of the system, and consequent coldness, than with increased activity, and consequent heat.
If the hot fit be the consequence of the cold one, it may be asked if they are proportionate to each other: it is probable that they are, where no part is destroyed by the cold fit, as in mortification or death. But we have no measure to distinguish this, except the time of their duration; whereas the extent of the torpor over a greater or less part of the system, which occasions the cold fit; or of the exertion which occasions the hot one; as well as the degree of such torpor or exertion, are perhaps more material than the time of their duration. Besides this some muscles are less liable to accumulate sensorial power during their torpor, than others, as the locomotive muscles compared with the capillary arteries; on all which accounts a long cold fit may often be followed by a short hot one.
1. Febris irritativa. Irritative fever. This is the synocha of some writers, it is attended with strong pulse without inflammation; and in this circumstance differs from the febris inirritativa of Class I. 2. 1. 1. which is attended with weak pulse without inflammation. The increased frequency of the pulsation of the heart and arteries constitutes fever; during the cold fit these pulsations are always weak, as the energy of action is then decreased throughout the whole system; and therefore the general arterial strength cannot be determined by the touch, till the cold part of the paroxysm ceases. This determination is sometimes attended with difficulty; as strong and weak are only comparative degrees of the greater or less resistance of the pulsation of the artery to the compression of the finger. But the greater or less frequency of the pulsations affords a collateral evidence in those cases, where the degree of strength is not very distinguishable, which may assist our judgment concerning it. Since a moderately strong pulse, when the patient is in a recumbent posture, and not hurried in mind, seldom exceeds 120 strokes in a minute; whereas a weak one often exceeds 130 in a recumbent posture, and 150 in an erect one, in those fevers, which are termed nervous or putrid. See Sect. XII. 1. 4.
The increased frequency of the pulsation of the heart and arteries, as it is occasioned either by excess or defect of stimulus, or of sensorial power, exists both in the cold and hot fits of fever; but when the cold fit ceases, and the pulse becomes strong and full as well as quick, in consequence of the increased irritability of the heart and arteries, it constitutes the irritative fever, or synocha. It is attended with considerable heat during the paroxysm, and generally terminates in a quarter of a lunation, without any disturbance of the faculties of the mind. See Class IV. 1. 1. 8.
M. M. Venesection. Emetics. Cathartics. Cool the patient in the hot fit, and warm him in the cold one. Rest. Torpentia.
2. Ebrietas. Drunkenness. By the stimulus of wine or opium the whole arterial system, as well as every other part of the moving system, is excited into increased action. All the secretions, and with them the production of sensorial power itself in the brain, seem to be for a time increased, with an additional quantity of heat, and of pleasureable sensation. See Sect. XXI. on this subject. This explains, why at the commencement of the warm paroxysm of some fevers the patient is in greater spirits, or vivacity; because, as in drunkenness, the irritative motions are all increased, and a greater production of sensation is the consequence, which when in a certain degree, is pleasureable, as in the diurnal fever of weak people. Sect. XXXVI. 3. 1.
3. Haemorrhagia arteriosa. Arterial haemorrhage. Bleeding with a quick, strong, and full pulse. The haemorrhages from the lungs, and from the nose, are the most frequent of these; but it sometimes happens, that a small artery but half divided, or the puncture of a leech, will continue to bleed pertinaciously.
M. M. Venesection. Cathartic with calomel. Divide the wounded artery. Bind sponge on the puncture. If coffee or charcoal internally? If air with less oxygen?
4. Haemoptoe arteriosa. Spitting of arterial blood. Blood spit up from the lungs is florid, because it has just been exposed to the influence of the air in its passage through the extremities of the pulmonary artery; it is frothy, from the admixture of air with it in the bronchia. The patients frequently vomit at the same time from the disagreeable titillation of blood about the fauces; and are thence liable to believe, that the blood is rejected from the stomach.
Sometimes an haemoptoe for several successive days returns in gouty persons without danger, and seems to supply the place of the gouty paroxysms. Is not the liver always diseased previous to the haemoptoe, as in several other haemorrhages? See Class I. 2. 1. 9.
M. M. Venesection, a purge, a blister, diluents, torpentia; and afterwards sorbentia, as the bark, the acid of vitriol, and opium. An emetic is said to stop a pulmonary haemorrhage, which it may effect, as sickness decreases the circulation, as is very evident in the great sickness sometimes produced by too large a dose of digitalis purpurea.
Dr. Rush says, a table spoonful or two of common salt is successful in haemoptoe; this may be owing to its stimulating the absorbent systems, both the lymphatic, and the venous. Should the patient respire air with less oxygen? or be made sick by whirling round in a chair suspended by a rope? One immersion in cold water, or a sudden sprinkling all over with cold water, would probably stop a pulmonary haemorrhage. See Sect. XXVII. 1.
5. Haemorrhagia narium. Epistaxis. Bleeding at the nose in elderly subjects most frequently attends those, whose livers are enlarged or inflamed by the too frequent use of fermented liquors.
In boys it occurs perhaps simply from redundancy of blood; and in young girls sometimes precedes the approach of the catamenia; and then it shews a disposition contrary to chlorosis; which arises from a deficiency of red blood.
M. M. It is stopped by plunging the head into cold water, with powdered salt hastily dissolved in it; or sometimes by lint strewed over with wheat flour put up the nostrils; or by a solution of steel in brandy applied to the vessel by means of lint. The cure in other respects as in haemoptoe; when the bleeding recurs at certain periods, after venesection, and evacuation by calomel, and a blister, the bark and steel must be given, as in intermittent fevers. See Section XXVII. 1.
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With increased Actions of the Secerning System.
These are always attended with increase of partial or of general heat; for the secreted fluids are not simply separated from the blood, but are new combinations; as they did not previously exist as such in the blood vessels. But all new combinations give out heat chemically; hence the origin of animal heat, which is always increased in proportion to the secretion of the part affected, or to the general quantity of the secretions. Nevertheless there is reason to believe, that as we have a sense purposely to distinguish the presence of greater or less quantities of heat, as mentioned in Sect. XIV. 6. so we may have certain minute glands for the secretion of this fluid, as the brain is believed to secrete the sensorial power, which would more easily account for the instantaneous production of the blush of shame, and of anger. This subject deserves further investigation.
1. Calor febrilis. The heat in fevers arises from the increase of some secretion, either of the natural fluids, as in irritative fevers; or of new fluids, as in infectious fevers; or of new vessels, as in inflammatory fevers. The pain of heat is a consequence of the increased extension or contraction of the fibres exposed to so great a stimulus. See CLASS I. 1. 5. 6.
2. Rubor febrilis. Febrile redness. When the cold fit of fever terminates, and the pulsations of the heart and arteries become strong as well as quick from the increase of their irritability after their late quiescence, the blood is impelled forwards into the fine extremities of the arteries, and the anastomozing capillaries, quicker than the extremities of the veins can absorb and return it to the heart. Hence the pulse at the wrist becomes full, as well as quick and strong, and the skin glows with arterial blood, and the veins become empty and less visible.
In elderly people the force of the heart and arteries becomes less, while the absorbent power of the veins remains the same; whence the capillary vessels part with the blood, as soon as it is received, and the skin in consequence becomes paler; it is also probable, that in more advanced life some of the finer branches of the arteries coalesce, and become impervious, and thus add to the opacity of the skin.
3. Sudor calidus. Warm sweat may be divided into four varieties, according to their remote causes. First, the perspirable matter is secreted in as great quantity during the hot fit of fever, as towards the end of it, when the sweat is seen upon the skin. But during the hot fit the cutaneous absorbents act also with increased energy, and the exhalation is likewise increased by the greater heat of the skin; and hence it does not appear in drops on the surface, but is in part reabsorbed, and in part dissipated in the atmosphere. But as the mouths of the cutaneous absorbents are exposed to the cool air or bedclothes; whilst those of the capillary glands, which secrete the perspirable matter, are exposed to the warmth of the circulating blood; the former, as soon as the fever-fit begins to decline, lose their increased action first; and hence the absorption of the sweat is diminished, whilst the increased secretion of it continues for some hours afterwards, which occasions it to stand in drops upon the skin.
As the skin becomes cooler, the evaporation of the perspirable matter becomes less, as well as the absorption of it. And hence the dissipation of aqueous fluid from the body, and the consequent thirst, are perhaps greater during the hot fit, than during the subsequent sweat. For the sweats do not occur, according to Dr. Alexander's experiments, till the skin is cooled from 112 to 108 degrees of heat; that is, till the paroxysm begins to decline. From this it appears, that the sweats are not critical to the hot fit, any more than the hot fit can be called critical to the cold one; but simply, that they are the natural consequence of the decline of the hot fit, commencing with the decreased action of the absorbent system, and the decreased evaporation from the skin. And from hence it may be concluded, that a fever-fit is not in general an effort of nature to restore health, as Sydenham considered it, but a necessary consequence of the previous torpor; and that the causes of fevers would be less detrimental, if the fever itself could be prevented from existing; as appears in the cool treatment of the small-pox.
It must be noted that the profuse sweats on the skin are more frequent at the decline of fever-fits than the copious urine, or loose stools, which are mentioned below; as the cutaneous absorbents, being exposed to the cool air, lose their increased action sooner than the urinary or intestinal absorbents; which open into the warm cavities of the bladder and intestines; but which are nevertheless often affected by their sympathy with the cutaneous absorbents. Hence few fevers terminate without a moisture of the skin; whence arose the fatal practice of forcing sweats by the external warmth of air or bedclothes in fevers; for external warmth increases the action of the cutaneous capillaries more than that of the other secerning vessels; because the latter are habituated to 98 degrees of heat, the internal warmth of the body; whereas the cutaneous capillaries being nearer the surface are habitually kept cooler by the contact of the external air. Sweats thus produced by heat in confined rooms are still more detrimental; as the air becomes then not only deprived of a part of its oxygene by frequent respiration, but is loaded with animal effluvia as well as with moisture, till it can receive no more; and in consequence, while the cutaneous secretion stands upon the skin in drops for want of exhalation, the lungs are exposed to an insalubrious atmosphere.
I do not deny, that sweating may be so managed as to be serviceable in preventing the return of the cold paroxysm of fevers; like the warm bath, or any other permanent stimulus, as wine, or opium, or the bark. For this purpose it should be continued till past the time of the expected cold fit, supported by moderate doses of wine-whey, with spirit of hartshorn, and moderate degrees of warmth. Its salutary effect, when thus managed, was probably one cause of its having been so much attended to; and the fetid smell, which when profuse is liable to accompany it, gave occasion to the belief, that the supposed material cause of the disease was thus eliminated from the circulation.
When too great external heat is applied, the system is weakened by excess of action, and the torpor which causes the cold paroxysm recurs sooner and more violently. For though some stimuli, as of opium and alcohol, at the same time that they exhaust the sensorial power by promoting increase of fibrous action, may also increase the production or secretion of it in the brain, yet experience teaches us, that the exhaustion far out-balances the increased production, as is evinced by the general debility, which succeeds intoxication.
In respect to the fetor attending copious continued sweats, it is owing to the animalized part of this fluid being kept in that degree of warmth, which most favours putrefaction, and not suffered to exhale into the atmosphere. Broth, or other animal mucus, kept in similar circumstances, would in the same time acquire a putrid smell; yet has this error frequently produced miliary eruptions, and increased every kind of inflammatory or sensitive fever.
The ease, which the patient experiences during sweating, if it be not produced by much external heat, is similar to that of the warm bath; which by its stimulus applied to the cutaneous vessels, which are generally cooler than the internal parts of the system, excites them into greater action; and pleasureable sensation is the consequence of these increased actions of the vessels of the skin. From considering all these circumstances, it appears that it is not the evacuation by sweats, but the continued stimulus, which causes and supports those sweats, which is serviceable in preventing the returns of fever-fits. And that sweats too long continued, or induced by too great stimulus of warmth, clothes, or medicines, greatly injure the patient by increasing inflammation, or by exhausting the sensorial power. See Class I. 1. 2. 14.
Secondly, The sweats produced by exercise or labour are of the warm kind; as they originate from the increased action of the capillaries of the skin, owing to their being more powerfully stimulated by the greater velocity of the blood, and by a greater quantity of it passing through them in a given time. For the blood during violent exercise is carried forwards by the action of the muscles faster in the arteries, than it can be taken up by the veins; as appears by the redness of the skin. And from the consequent sweats, it is evinced, that the secretory vessels of the skin during exercise pour out the perspirable matter faster, than the mouths of the absorbent vessels can drink it up. Which mouths are not exposed to the increased muscular action, or to the stimulus of the increased velocity and quantity of the blood, but to the cool air.
Thirdly, the increased secretion of perspirable matter occasioned by the stimulus of external heat belongs likewise to this place; as it is caused by the increased motions of the capillary vessels; which thus separate from the blood more perspirable matter, than the mouths of their correspondent absorbent vessels can take up; though these also are stimulated by external heat into more energetic action. If the air be stationary, as in a small room, or bed with closed curtains, the sweat stands in drops on the skin for want of a quicker exhalation proportioned to the quicker secretion.
A fourth variety of warm perspiration is that occasioned by stimulating drugs, of which opium and alcohol are the most powerful; and next to these the spices, volatile alkali, and neutral salts, especially sea salt; that much of the aqueous part of the blood is dissipated by the use of these drugs, is evinced by the great thirst, which occurs a few hours after the use of them. See Art. III. 2. 12. and Art. III. 2. 1.
We may from hence understand, that the increase of this secretion of perspirable matter by artificial means, must be followed by debility and emaciation. When this is done by taking much salt, or salted meat, the sea-scurvy is produced; which consists in the inirritability of the bibulous terminations of the veins arising from the capillaries; see Class I. 2. 1. 14. The scrophula, or inirritability of the lymphatic glands, seems also to be occasionally induced by an excess in eating salt added to food of bad nourishment. See Class I. 2. 3. 21. If an excess of perspiration is induced by warm or stimulant clothing, as by wearing flannel in contact with the skin in the summer months, a perpetual febricula is excited, both by the preventing the access of cool air to the skin, and by perpetually goading it by the numerous and hard points of the ends of the wool; which when applied to the tender skins of young children, frequently produce the red gum, as it is called; and in grown people, either an erysipelas, or a miliary eruption, attended with fever. See Class II. 1. 3. 12.
Shirts made of cotton or calico stimulate the skin too much by the points of the fibres, though less than flannel; whence cotton handkerchiefs make the nose sore by frequent use. The fibres of cotton are, I suppose, ten times shorter than those of flax, and the number of points in consequence twenty times the number; and though the manufacturers singe their calicoes on a red-hot iron cylinder, yet I have more than once seen an erysipelas induced or increased by the stimulus of calico, as well as of flannel.
The increase of perspiration by heat either of clothes, or of fire, contributes much to emaciate the body; as is well known to jockeys, who, when they are a stone or two too heavy for riding, find the quickest way to lessen their weight is by sweating themselves between blankets in a warm room; but this likewise is a practice by no means to be recommended, as it weakens the system by the excess of so general a stimulus, brings on a premature old age, and shortens the span of life; as may be further deduced from the quick maturity, and shortness of the lives, of the inhabitants of Hindostan, and other tropical climates.
M. Buffon made a curious experiment to shew this circumstance. He took a numerous brood of the butterflies of silkworms, some hundreds of which left their eggs on the same day and hour; these he divided into two parcels; and placing one parcel in the south window, and the other in the north window of his house, he observed, that those in the colder situation lived many days longer than those in the warmer one. From these observations it appears, that the wearing of flannel clothing next the skin, which is now so much in fashion, however useful it may be in the winter to those, who have cold extremities, bad digestions, or habitual coughs, must greatly debilitate them, if worn in the warm months, producing fevers, eruptions, and premature old age. See Sect. XXXVII. 5. Class I. 1. 2. 14. Art. III. 2. 1.
4. Urina uberior colorata. Copious coloured urine. Towards the end of fever-fits a large quantity of high coloured urine is voided, the kidneys continuing to act strongly, after the increased action of the absorbents of the bladder is somewhat diminished. If the absorbents continue also to act strongly, the urine is higher coloured, and so loaded as to deposit, when cool, an earthy sediment, erroneously thought to be the material cause of the disease; but is simply owing to the secretion of the kidnies being great from their increased action; and the thinner parts of it being absorbed by the increased action of the lymphatics, which are spread very thick on the neck of the bladder; for the urine, as well as perhaps all the other secreted fluids, is produced from the kidnies in a very dilute state; as appears in those, who from the stimulus of a stone, or other cause, evacuate their urine too frequently; which is then pale from its not having remained in the bladder long enough for the more aqueous part to have been reabsorbed. The general use of this urinary absorption to the animal oeconomy is evinced from the urinary bladders of fish, which would otherwise be unnecessary. High coloured urine in large quantity shews only, that the secreting vessels of the kidnies, and the absorbents of the bladder, have acted with greater energy. When there is much earthy sediment, it shews, that the absorbents have acted proportionally stronger, and have consequently left the urine in a less dilute state. In this urine the transparent sediment or cloud is mucous; the opake sediment is probably coagulable lymph from the blood changed by an animal or chemical process. The floating scum is oil. The angular concretions to the sides of the pot, formed as the urine cools, is microcosmic salt. Does the adhesive blue matter on the sides of the glass, or the blue circle on it at the edge of the upper surface of the urine, consist of Prussian blue?
5. Diarrhoea calida. Warm diarrhoea. This species may be divided into three varieties deduced from their remote causes, under the names of diarrhoea febrilis, diarrhoea crapulosa, and diarrhoea infantum. The febrile diarrhoea appears at the end of fever-fits, and is erroneously called critical, like the copious urine, and the sweats; whereas it arises from the increased action of those secerning organs, which pour their fluids into the intestinal canal (as the liver, pancreas, and mucous glands), continuing longer than the increased action of the intestinal absorbents. In this diarrhoea there is no appearance of curdled chyle in the stools, as occurs in cholera. I. 3. 1. 5.
The diarrhoea crapulosa, or diarrhoea from indigestion, occurs when too great a quantity of food or liquid has been taken; which not being compleatly digested, stimulates the intestines like any other extraneous acrid material; and thus produces an increase of the secretions into them of mucus, pancreatic juice, and bile. When the contents of the bowels are still more stimulant, as when drastic purges, or very putrescent diet, have been taken, a cholera is induced. See Sect. XXIX. 4.
The diarrhoea infantum, or diarrhoea of infants, is generally owing to too great acidity in their bowels. Milk is found curdled in the stomachs of all animals, old as well as young, and even of carnivorous ones, as of hawks. (Spallanzani.) And it is the gastric juice of the calf, which is employed to curdle milk in the process of making cheese. Milk is the natural food for children, and must curdle in their stomachs previous to digestion; and as this curdling of the milk destroys a part of the acid juices of the stomach, there is no reason for discontinuing the use of it, though it is occasionally ejected in a curdled state. A child of a week old, which had been taken from the breast of its dying mother, and had by some uncommon error been suffered to take no food but water-gruel, became sick and griped in twenty-four hours, and was convulsed on the second day, and died on the third! When all young quadrupeds, as well as children, have this natural food of milk prepared for them, the analogy is so strong in favour of its salubrity, that a person should have powerful testimony indeed of its disagreeing, before he advises the discontinuance of the use of it to young children in health, and much more so in sickness. The farmers lose many of their calves, which are brought up by gruel, or gruel and old milk; and among the poor children of Derby, who are thus fed, hundreds are starved into the scrophula, and either perish, or live in a state of wretched debility.
When young children are brought up without a breast, they should for the first two months have no food but new milk; since the addition of any kind of bread or flour is liable to ferment, and produce too much acidity; as appears by the consequent diarrhoea with green dejections and gripes; the colour is owing to a mixture of acid with the natural quantity of bile, and the pain to its stimulus. And they should never be fed as they lie upon their backs, as in that posture they are necessitated to swallow all that is put into their mouths; but when they are fed, as they are sitting up, or raised up, when they have had enough, they can permit the rest to run out of their mouths. This circumstance is of great importance to the health of those children, who are reared by the spoon, since if too much food is given them, indigestion, and gripes, and diarrhoea, is the consequence; and if too little, they become emaciated; and of this exact quantity their own palates judge the best.
M. M. In this last case of the diarrhoea of children, the food should be new milk, which by curdling destroys part of the acid, which coagulates it. Chalk about four grains every six hours, with one drop of spirit of hartshorn, and half a drop of laudanum. But a blister about the size of a shilling is of the greatest service by restoring the power of digestion. See Article III. 2. 1. in the subsequent Materia Medica.
6. Salivatio calida. Warm salivation. Increased secretion of saliva. This may be effected either by stimulating the mouth of the gland by mercury taken internally; or by stimulating the excretory duct of the gland by pyrethrum, or tobacco; or simply by the movement of the muscles, which lie over the gland, as in masticating any tasteless substance, as a lock of wool, or mastic.
In about the middle of nervous fevers a great spitting of saliva sometimes occurs, which has been thought critical; but as it continues sometimes two or even three weeks without the relief of the patient, it may be concluded to arise from some accidental circumstance, perhaps not unsimilar to the hysteric ptyalisms mentioned in Class I. 3. 2. 2. See Sect. XXIV.
M. M. Cool air, diluents, warm bath, evacuations.
7. Catharrhus calidus. Warm catarrh. Consists in an increased secretion of mucus from the nostrils without inflammation. This disease, which is called a cold in the head, is frequently produced by cold air acting for some time on the membranes, which line the nostrils, as it passes to the lungs in respiration. Whence a torpor of the action of the mucous glands is first introduced, as in I. 2. 3. 3. and an orgasm or increased action succeeds in consequence. Afterwards this orgasm and torpor are liable to alternate with each other for some time like the cold and hot fits of ague, attended with deficient or exuberant secretion of mucus in the nostrils.
At other times it arises from reverse sympathy with some extensive parts of the skin, which have been exposed too long to cold, as of the head, or feet. In consequence of the torpor of these cutaneous capillaries those of the mucous membrane of the nostrils act with greater energy by reverse sympathy; and thence secrete more mucus from the blood. At the same time the absorbents, acting also with greater energy by their reverse sympathy with those of some distant part of the skin, absorb the thinner parts of the mucus more hastily; whence the mucus is both thicker and in greater quantity. Other curious circumstances attend this disease; the membrane becomes at times so thickened by its increased action in secreting the mucus, that the patient cannot breathe through his nostrils. In this situation if he warms his whole skin suddenly by fire or bed-clothes, or by drinking warm tea, the increased action of the membrane ceases by its reverse sympathy with the skin; or by the retraction of the sensorial power to other parts of the system; and the patient can breathe again through the nostrils. The same sometimes occurs for a time on going into the cold air by the deduction of heat from the mucous membrane, and its consequent inactivity or torpor. Similar to this when the face and breast have been very hot and red, previous to the eruption of the small-pox by inoculation, and that even when exposed to cool air, I have observed the feet have been cold; till on covering them with warm flannel, as the feet have become warm, the face has cooled. See Sect. XXXV. 1. 3. Class II. 1. 3. 5. IV. 2. 2. 10. IV. 1. 1. 5.
M. M. Evacuations, abstinence, oil externally on the nose, warm diluent fluids, warm shoes, warm night-cap.
8. Expectoratio calida. Warm expectoration consists of the increased secretion of mucus from the membrane, which lines the bronchiae, or air-cells of the lungs, without inflammation. This increased mucus is ejected by the action of coughing, and is called a cold, and resembles the catarrh of the preceding article; with which it is frequently combined.
M. M. Inhale the steam of warm water, evacuations, warm bath, afterwards opium, sorbentia.
9. Exsudatio pone aures. A discharge behind the ears. This chiefly affects children, and is a morbid secretion; as appears from its fetor; for if it was owing to defect of absorption, it would be saline, and not fetid; if a morbid action has continued a considerable time, it should not be stopped too suddenly; since in that case some other morbid action is liable to succeed in its stead. Thus children are believed to have had cholics, or even convulsions, consequent to the too sudden healing of these morbid effusions behind their ears. The rationale of this is to be explained from a medical fact, which I have frequently observed; and that is, that a blister on the back greatly strengthens the power of digestion, and removes the heart-burn in adults, and green stools in children. The stimulus of the blister produces sensation in the vessels of the skin; with this additional sensorial power these vessels act more strongly; and with these the vessels of the internal membranes of the stomach and bowels act with greater energy from their direct sympathy with them. Now the acrid discharge behind the ears of children produces sensation on that part of the skin, and so far acts as a small blister. When this is suddenly stopped, a debility of the digestive power of the stomach succeeds from the want of this accustomed stimulus, with flatulency, green stools, gripes, and sometimes consequent convulsions. See Class II. 1. 5. 6. and II. 1. 4. 6.
M. M. If the matter be absorbed, and produces swelling of the lymphatics of the neck, it should be cured as soon as possible by dusting the part with white lead, cerussa, in very fine powder; and to prevent any ill consequence an issue should be kept for about a month in the arm; or a purgative medicine should be taken, every other day for three or four times, which should consist of a grain of calomel, and three or four grains of rhubarb, and as much chalk. If there be no appearance of absorption, it is better only to keep the parts clean by washing them with warm water morning and evening; or putting fuller's earth on them; especially till the time of toothing is past. The tinea, or scald head, and a leprous eruption, which often appears behind the ears, are different diseases.
10. Gonorrhea calida. Warm gleet. Increased discharge of mucus from the urethra or prostrate gland without venereal desire, or venereal infection. See Class I. 2. 3. 8.
M. M. Cantharides, balsams, rhubarb, blister in perinaeum, cold bath, injections of metallic salts, flannel shirt, change of the form of the accustomed chair or saddle of the patient.
11. Fluor albus calidus. Warm fluor albus. Increased secretion of mucus in the vagina or uterus without venereal desire or venereal infection. It is distinguished from the fluor albus frigidus by the increased sense of warmth in the part, and by the greater opacity or spissitude of the material discharged; as the thinner parts are reabsorbed by the increased action of the absorbents, along with the saline part, whence no smarting or excoriation attends it.
M. M. Mucilage, as isinglass, hartshorn jelly, gum arabic. Ten grains of rhubarb every night. Callico or flannel shift, opium, balsams. See Class I. 2. 3. 7.
12. Haemorrhois alba. White piles. An increased discharge of mucus from the rectum frequently mistaken for matter; is said to continue a few weeks, and recur like the bleeding piles; and to obey lunar influence. See Class I. 2. 1. 6.
M. M. Abstinence from vinous spirit. Balsam of copaiva. Spice swallowed in large fragments, as ten or fifteen black pepper-corns cut in half, and taken after dinner and supper. Ward's paste, consisting of black pepper and the powdered root of Helenium Enula.
13. Serum e vesicatorio. Discharge from a blister. The excretory ducts of glands terminate in membranes, and are endued with great irritability, and many of them with sensibility; the latter perhaps in consequence of their facility of being excitable into great action; instances of this are the terminations of the gall-duct in the duodenum, and of the salivary and lachrymal glands in the mouth and eye; which produce a greater secretion of their adapted fluids, when the ends of their excretory ducts are stimulated.
The external skin consists of the excretory ducts of the capillaries, with the mouths of the absorbents; when these are stimulated by the application of cantharides, or by a slice of the fresh root of bryonia alba bound on it, the capillary glands pour an increased quantity of fluid upon the skin by their increased action; and the absorbent vessels imbibe a greater quantity of the more fluid and saline part of it; whence a thick mucous or serous fluid is deposited between the skin and cuticle.
14. Perspiratio foetida. Fetid perspiration. The uses of the perspirable matter are to keep the skin soft and pliant, for the purposes of its easier flexibility during the activity of our limbs in locomotion, and for the preservation of the accuracy of the sense of touch, which is diffused under the whole surface of it to guard us against the injuries of external bodies; in the same manner as the secretion of tears is designed to preserve the cornea of the eye moist, and in consequence transparent; yet has this cutaneous mucus been believed by many to be an excrement; and I know not how many fanciful theories have been built on its supposed obstruction. Such as the origin of catarrhs, coughs, inflammations, erysypelas, and herpes.
To all these it may be sufficient to answer, that the antient Grecians oiled themselves all over; that some nations have painted themselves all over, as the Picts of this island; that the Hottentots smear themselves all over with grease. And lastly, that many of our own heads at this day are covered with the flour of wheat and the fat of hogs, according to the tyranny of a filthy and wasteful fashion, and all this without inconvenience. To this must be added the strict analogy between the use of the perspirable matter and the mucous fluids, which are poured for similar purposes upon all the internal membranes of the body; and besides its being in its natural state inodorous; which is not so with the other excretions of feces, or of urine.
In some constitutions the perspirable matter of the lungs acquires a disagreeable odour; in others the axilla, and in others the feet, emit disgustful effluvia; like the secretions of those glands, which have been called odoriferae; as those, which contain the castor in the beaver, and those within the rectum of dogs, the mucus of which has been supposed to guard them against the great costiveness, which they are liable to in hot summers; and which has been thought to occasion canine madness, but which, like their white excrement, is more probably owing to the deficient secretion of bile. Whether these odoriferous particles attend the perspirable matter in consequence of the increased action of the capillary glands, and can properly be called excrementitous; that is, whether any thing is eliminated, which could be hurtful if retained; or whether they may only contain some of the essential oil of the animal; like the smell, which adheres to one's hand on stroking the hides of some dogs; or like the effluvia, which is left upon the ground, from the feet of men and other creatures; and is perceptible by the nicer organs of the dogs, which hunt them, may admit of doubt.
M. M. Wash the parts twice a day with soap and water; with lime water; cover the feet with oiled silk socks, which must be washed night and morning. Cover them with charcoal recently made red hot, and beaten into fine powder and sifted, as soon as cold, and kept well corked in a bottle, to be warned off and renewed twice a day. Internally rhubarb grains vi. or viii. every night, so as to procure a stool or two extraordinary every day, and thus by increasing one evacuation to decrease another. Cool dress, diluting liquids?
15. Crines novi. New hairs. The black points on the faces of some people consist of mucus, which is become viscid, and which adheres in the excretory ducts of the glands of the skin; as described in Class I. 2. 2. 9. and which may be pressed out by the fingers, and resembles little worms. Similar to this would seem the fabrication of silk, and of cobweb by the silk worm and spider; which is a secreted matter pressed through holes, which are the excretory ducts of glands. And it is probable, that the production of hair on many parts of the body, and at different periods of life, may be effected by a similar process; and more especially as every hair may be considered as a slender flexible horn, and is an appendage of the skin. See Sect. XXXIX. 3. 2. Now as there is a sensitive sympathy between the glands, which secrete the semen, and the throat, as appears in the mumps; see Hydrophobia, Class IV. 1. 2. 7. and Parotitis, Class IV. 1. 2. 19. The growth of the beard at puberty seems to be caused by the greater action of the cutaneous glands about the chin and pubes in consequence of their sympathy with those of the testes. But this does not occur to the female sex at their time of puberty, because the sensitive sympathy in them seems to exist between the submaxillary glands, and the pectoral ones; which secrete the milk, and afford pleasure both by that secretion, and by the erection of the mamulae, or nipples; and by delivering the milk into the mouth of the child; this sensitive sympathy of the pectoral and submaxillary glands in women is also observable in the Parotitis, or mumps, as above referred to.
When hairs grow on the face or arms so as to be disagreeable, they may be thus readily removed without pain or any ill consequence. Warm the ends of a pair of nippers or forceps, and stick on them a little rosin, or burgundy pitch; by these means each single hair may be taken fast hold of; and if it be then plucked off slowly, it gives pain; but if plucked off suddenly, it gives no pain at all; because the vis inertiae of the part of the skin, to which it adheres, is not overcome; and it is not in consequence separated from the cellular membrane under it. Some of the hairs may return, which are thus plucked off, or others may be induced to grow near them; but in a little time they may be thus safely destroyed; which is much to be preferred to the methods said to be used in Turkey to eradicate hair; such as a mixture of orpiment and quick lime; or of liver of sulphur in solution; which injure the skin, if they are not very nicely managed; and the hair is liable to grow again as after shaving; or to become white, if the roots of it have been much inflamed by the causticity of the application. See Class I. 2. 2. 11. on grey hairs.
* * * * *
With increased Actions of the Absorbent System.
These are not attended with so great increase of heat as in the former genus, because the fluids probably undergo less chemical change in the glands of the absorbent system; nor are the glands of the absorbent vessels so numerous or so extensive as those of the secerning ones. Yet that some heat is produced by the increased action of the absorbents appears from the greater general warmth of the skin and extremities of feeble patients after the exhibition of the peruvian bark, and other medicines of the article Sorbentia.
1. Lingua arida. Dry tongue occurs in those fevers, where the expired air is warmer than natural; and happens to all those, who sleep with their mouths open; the currents of air in respiration increasing the evaporation. There is also a dryness in the mouth from the increased action of the absorbent vessels, when a sloe or a crab-apple are masticated; and after the perforation has been much increased by eating salt or spice, or after other copious secretions; as after drunkenness, cathartics, or fever fits, the mucus of the mouth becomes viscid, and in small quantity, from the increased absorption, adhering to the tongue like a white slough. In the diabaetes, where the thirst is very great, this slough adheres more pertinaciously, and becomes black or brown, being coloured after a few days by our aliment or drink. The inspissated mucus on the tongue of those, who sleep with their mouths open, is sometimes reddened as if mixed with blood, and sometimes a little blood follows the expuition of it from the fauces owing to its great adhesion. When this mucus adheres long to the papillae of the tongue, the saliva, which it contains in its interstices, like a sponge, is liable to become putrid, and to acquire a bitter taste, like other putrid animal substances; which is generally mistaken for an indication of the presence of bile.
M. M. Warm subacid liquids. See Class I. 2. 5. 8.
2. Fauces aridae. Dry throat. The expuition of a frothy mucus with great and perpetual hawking occurs in hydrophobia, and is very distressing to the patient; which may be owing to the increased irritability or sensibility of the upper part of the oesophagus, which will not permit any fluid to rest on it.
It affects some people after intoxication, when the lungs remain slightly inflamed, and by the greater heat of the air in expiration the mucus becomes too hastily evaporated, and is expectorated with difficulty in the state of white froth.
I knew a person, who for twenty years always waked with his tongue and throat quite dry; so that he was necessitated to take a spoonful of water, as soon as he awoke; otherwise a little blood always followed the forcible expuition of the indurated mucus from his fauces. See Class II. 1. 3. 17.
M. M. Steel-springs fixed to the night-cap so as to suspend the lower jaw and keep it closed; or springs of elastic gum. Or a pot of water suspended over the bed, with a piece of list, or woollen cloth, depending from it, and held in the mouth; which will act like a syphon, and slowly supply moisture, or barley water should be frequently syringed into the mouth of the patient.
3. Nares aridi. Dry nostrils with the mucus hardening upon their internal surface, so as to cover them with a kind of skin or scale, owing to the increased action of the absorbents of this membrane; or to the too great dryness of the air, which passes into the lungs; or too great heat of it in its expiration.
When air is so dry as to lose its transparency; as when a tremulous motion of it can be seen over corn fields in a hot summer's day; or when a dry mist, or want of transparency of the air, is visible in very hot weather; the sense of smell is at the same time imperfect from the dryness of the membrane, beneath which it is spread.
4. Expectoratio solida. Solid expectoration. The mucus of the lungs becomes hardened by the increased absorption, so that it adheres and forms a kind of lining in the air-cells, and is sometimes spit up in the form of branching vessels, which are called polypi of the lungs. See Transact. of the College, London. There is a rattling or weezing of the breath, but it is not at first attended with inflammation.
The Cynanche trachealis, or Croup, of Dr. Cullen, or Angina polyposa of Michaelis, if they differ from the peripneumony of infants, seem to belong to this genus. When the difficulty of respiration is great, venesection is immediately necessary, and then an emetic, and a blister. And the child should be kept nearly upright in bed as much as may be. See Tonsillitis, Class II. 1. 3. 3.
M. M. Diluents, emetics, essence of antimony, foetid gums, onions, warm bath for half an hour every day for a month. Inhaling the steam of water, with or without volatile alcali. Soap.
5. Constipatio alvi. Costiveness from increased action of the intestinal absorbents. The feces are hardened in lumps called scybala; which are sometimes obliged to be extracted from the rectum with a kind of marrow spoon. This is said to have happened from the patient having taken much rust of iron. The mucus is also hardened so as to line the intestines, and to come away in skins, rolled up as they pass along, so as to resemble worms, for which they are frequently mistaken; and sometimes it is evacuated in still larger pieces, so as to counterfeit the form of the intestines, and has been mistaken for a portion of them. Balls of this kind, nearly as heavy as marble, and considerably hard, from two inches to five in diameter, are frequently found in the bowels of horses. Similar balls found in goats have been called Bezoar.
M. M. Cathartics, Diluents, fruit, oil, soap, sulphur, warm bath. Sprinkling with cold water, cool clothing. See Class I. 2. 4. 18.
6. Cutis arida. Dry skin. This dry skin is not attended with coldness as in the beginning of fever-fits. Where this cutaneous absorption is great, and the secreted material upon it viscid, as on the hairy scalp, the skin becomes covered with hardened mucus; which adheres so as not to be easily removed, as the scurf on the head; but is not attended with inflammation like the Tinea, or Lepra. The moisture, which appears on the skin beneath resinous or oily plasters, or which is seen to adhere to such plasters, is owing to their preventing the exhalation of the perspirable matter, and not to their increasing the production of it, as some have idly imagined.
M. M. Warm bathing, oil externally, oil-skin gloves, resinous plasters. Wax.
7. Urina parca colorata. Diminished urine, which is high coloured, and deposits an earthy sediment, when cold, is owing to the great action of the urinary absorbents. See Class I. 1. 2. 4. In some dropsies the cutaneous absorbents are paralytic, as well as those opening into the cellular membrane; and hence, no moisture being acquired from the atmosphere, or from the cellular membrane, great thirst is excited; and great absorption from all parts, where the absorbents are still capable of action. Hence the urine is in very small quantity, and of deep colour, with copious sediment; and the kidneys are erroneously blamed for not doing their office; stimulant diuretic medicines are given in vain; and very frequently the unhappy patient is restrained from quenching his thirst, and dies a martyr to false theory.
M. M. Diluent liquids, and warm bathing, are the natural cure of this symptom; but it generally attends those dropsies, which are seldom curable; as they are owing to a paralysis both of the cutaneous and cellular lymphatics.
8. Calculus felleus. Gall-stone. From the too hasty absorption of the thinner parts of the bile, the remainder is left too viscid, and crystallizes into lumps; which, if too large to pass, obstruct the ductus choledochus, producing pain at the pit of the stomach, and jaundice. When the indurated bile is not harder than a boiled pea, it may pass through the bile-duct with difficulty by changing its form; and thus gives those pains, which have been called spasms of the stomach; and yet these viscid lumps of bile may afterwards dissolve, and not be visible among the feces.
In two instances I have seen from thirty to fifty gall-stones voided after taking an oil vomit as below. They were about the size of peas, and distinguishable when dry by their being inflammable like bad wax, when put into the flame of a candle. For other causes of jaundice, see Class I. 2. 4. 19.
M. M. Diluents, daily warm bathing. Ether mixed with yolk of egg and water. Unboiled acrid vegetables, as lettice, cabbage, mustard, and cresses. When in violent pain, four ounces of oil of olives, or of almonds, should be swallowed; and as much more in a quarter of an hour, whether it stays or not. The patient should lie on the circumference of a large barrel, first on one side, and then on the other. Electric shocks through the gall-duct. Factitious Selter's water made by dissolving one dram of Sal Soda in a pint of water; to half a pint of which made luke-warm add ten drops of marine acid; to be drank as soon as mixed, twice a day for some months. Opium must be used to quiet the pain, if the oil does not succeed, as two grains, and another grain in half an hour if necessary. See Class IV. 2. 2. 4.
9. Calculus renis. Stone of the kidney. The pain in the loins and along the course of the ureter from a stone is attended with retraction of the testicle in men, and numbness on the inside of the thigh in women. It is distinguished from the lumbago or sciatica, as these latter are seldom attended with vomiting, and have pain on the outside of the thigh, sometimes quite down to the ankle or heel. See Herpes and Nephritis.
Where the absorption of the thinner parts of the secretion takes place too hastily in the kidnies, the hardened mucus, and consequent calculous concretions, sometimes totally stop up the tubuli uriniferi; and no urine is secreted. Of this many die, who have drank much vinous spirit, and some of them recover by voiding a quantity of white mucus, like chalk and water; and others by voiding a great quantity of sand, or small calculi. This hardened mucus frequently becomes the nucleus of a stone in the bladder. The salts of the urine, called microcosmic salt, are often mistaken for gravel, but are distinguishable both by their angles of crystallization, their adhesion to the sides or bottom of the pot, and by their not being formed till the urine cools. Whereas the particles of gravel are generally without angles, and always drop to the bottom of the vessel, immediately as the water is voided.
Though the proximate cause of the formation of the calculous concretions of the kidneys, and of chalk-stones in the gout, and of the insoluble concretions of coagulable lymph, which are found on membranes, which have been inflamed in peripneumony, or rheumatism, consists in the too great action of the absorbent vessels of those parts; yet the remote cause in these cases is probably owing to the inflammation of the membranes; which at that time are believed to secrete a material more liable to coagulate or concrete, than they would otherwise produce by increased action alone without the production of new vessels, which constitutes inflammation. As defined in Class II. 1. 2.
The fluids secreted from the mucous membranes of animals are of various kinds and consistencies. Hair, silk, scales, horns, fingernails, are owing to natural processes. Gall-stones, stones found in the intestines of horses, scurf of the skin in leprosy, stones of the kidnies and bladder, the callus from the inflamed periosteum, which unites broken bones, the calcareous cement, which repairs the injured shells of snails, the calcareous crust on the eggs of birds, the annually renewed shells of crabs, are all instances of productions from mucous membranes, afterwards indurated by absorption of their thinner parts.
All these concretions contain phosphoric acid, mucus, and calcareous earth in different proportions; and are probably so far analogous in respect to their component parts as well as their mode of formation. Some calcareous earth has been discovered after putrefaction in the coagulable lymph of animals. Fordyce's Elements of Practice. A little calcareous earth was detected by Scheel or Bergman in the calculus of the bladder with much phosphoric acid, and a great quantity of phosphoric acid is shewn to exist in oyster-shells by their becoming luminous on exposing them a while to the sun's light after calcination; as in the experiments of Wilson. Botanic Garden, P. 1. Canto 1. l. 182, note. The exchange of which phosphoric acid for carbonic acid, or fixed air, converts shells into limestone, producing mountains of marble, or calcareous strata.
Now as the hard lumps of calcareous matter, termed crabs' eyes, which are found in the stomachs of those animals previous to the annual renewal of their shells, are redissolved, probably by their gastric acid, and again deposited for that purpose; may it not be concluded, that the stone of the bladder might be dissolved by the gastric juice of fish of prey, as of crabs, or pike; or of voracious young birds, as young rooks or hawks, or even of calves? Could not these experiments be tried by collecting the gastric juice by putting bits of sponge down the throats of young crows, and retracting them by a string in the manner of Spallanzani? or putting pieces of calculus down the throat of a living crow, or pike, and observing if they become digested? and lastly could not gastric juice, if it should appear to be a solvent, be injected and born in the bladder without injury by means of catheters of elastic resin, or caoutchouc?
M. M. Diluents. Cool dress. Frequent change of posture. Frequent horizontal rest in the day. Bathe the loins every morning with a sponge and cold water. Aerated alcaline water internally. Abstinence from all fermented or spirituous liquors. Whatever increases perspiration injures these patients, as it dissipates the aqueous particles, which ought to dilute the urine. When the constitution begins to produce gravel, it may I believe be certainly prevented by a total abstinence from fermented or spirituous liquors; by drinking much aqueous fluids; as toast and water, tea, milk and water, lemonade; and lastly by thin clothing, and sleeping on a hardish bed, that the patient may not lie too long on one side. See Class IV. 2. 2. 2. There is reason to believe, that the daily use of opium contributes to produce gravel in the kidnies by increasing absorption, when they are inflamed; in the same manner as is done by fermented or spirituous liquor. See Class I. 3. 2. 11.
When the kidnies are so obstructed with gravel, that no urine passes into the bladder; which is known by the external appearance of the lower part of the abdomen, which, when the bladder is full, seems as if contracted by a cord between the navel and the bladder; and by the tension on the region of the bladder distinguishable by the touch; or by the introduction of the catheter; the following methods of cure are frequently successful. Venesection to six or eight ounces, ten grains of calomel, and an infusion of senna with salts and oil, every three hours, till stools are procured. Then an emetic. After the patient has been thus evacuated, a blister on the loins should be used; and from ten to twenty electric shocks should be passed through the kidnies, as large as can be easily borne, once or twice a day. Along with this method the warm bath should be used for an hour once or twice a day. After repeated evacuations a clyster, consisting of two drams of turpentine dissolved by yolk of egg, and sixty drops of tincture of opium, should be used at night, and repeated, with cathartic medicines interposed, every night, or alternate nights. Aerated solution of alcali should be taken internally, and balsam of copaiva, three or four times a day. Some of these patients recover after having made no water for nine or ten days.
If a stone sticks in the ureter with incessant vomiting, ten grains of calomel must be given in small pills as above; and some hours afterwards infusion of senna and salts and oil, if it can be made to stay on the stomach. And after the purge has operated four or five times, an opiate is to be given, if the pain continues, consisting of two grains of opium. If this does not succeed, ten or twenty electric shocks through the kidney should be tried, and the purgative repeated, and afterwards the opiate. The patient should be frequently put into the warm bath for an hour at a time. Eighty or an hundred drops of laudanum given in a glyster, with two drams of turpentine, is to be preferred to the two grains given by the stomach as above, when the pain and vomiting are very urgent.
10. Calculus vesicae. Stone of the bladder. The nucleus, or kernel, of these concretions is always formed in the kidney, as above described; and passing down the ureter into the bladder, is there perpetually increased by the mucus and salts secreted from the arterial system, or by the mucus of the bladder, disposed in concentric strata. The stones found in the bowels of horses are also formed on a nucleus, and consist of concentric spheres; as appears in sawing them through the middle. But as these are formed by the indurated mucus of the intestines alone without the urinary salts, it is probable a difference would be found on their analysis.
As the stones of the bladder are of various degrees of hardness, and probably differ from each other in the proportions at least of their component parts; when a patient, who labours under this afflicting disease, voids any small bits of gravel; these should be kept in warm solutions of caustic alcali, or of mild alcali well aerated; and if they dissolve in these solutions, it would afford greater hopes, that that which remains in the bladder, might be affected by these medicines taken by the stomach, or injected into the bladder.
To prevent the increase of a stone in the bladder much diluent drink should be taken; as half a pint of water warmed to about eighty degrees, three or four times a day: which will not only prevent the growth of it, by preventing any microcosmic salts from being precipitated from the urine, and by keeping the mucus suspended in it; but will also diminish the stone already formed, by softening, and washing away its surface. To this must be added cool dress, and cool bed-clothes, as directed above in the calculus renis.
When the stone is pushed against or into the neck of the bladder, great pain is produced; this may sometimes be relieved by the introduction of a bougie to push the stone back into the fundus of the bladder. Sometimes by change of posture, or by an opiate either taken into the stomach, or by a clyster.
A dram of sal soda, or of salt of tartar, dissolved in a pint of water, and well saturated with carbonic acid (fixed air), by means of Dr. Nooth's glass-apparatus, and drank every day, or twice a day, is the most efficacious internal medicine yet discovered, which can be easily taken without any general injury to the constitution. An aerated alcaline water of this kind is sold under the name of factitious Seltzer water, by J. Schweppe, at N^o 8, King's-street, Holborn, London; which I am told is better prepared than can be easily done in the usual glass-vessels, probably by employing a greater pressure in wooden ones.
Lythotomy is the last recourse. Will the gastric juice of animals dissolve calculi? Will fermenting vegetable juices, as sweet-wort, or sugar and water in the act of fermentation with yest, dissolve any kind of animal concretions?
11. Calculus arthriticus. Gout-stones are formed on inflamed membranes, like those of the kidnies above described, by the too hasty absorption of the thinner and saline parts of the mucus. Similar concretions have been produced in the lungs, and even in the pericardium; and it is probable, that the ossification, as it is called, of the minute arteries, which is said to attend old age, and to precede some mortifications of the extremities, may be a process of this kind.
As gout-stones lie near the surface, it is probable, that ether, frequently applied in their early state, might render them so liquid as to permit their reabsorption; which the stimulus of the ether might at the same time encourage.
12. Rheumatismus chronicus. Chronic rheumatism. After the acute rheumatism some inspissated mucus, or material similar to chalk-stones of the gout, which was secreted on the inflamed membrane, is probably left, owing to the too hasty absorption of the thinner and saline part of it; and by lying on the fascia, which covers some of the muscles, pains them, when they move and rub against it, like any extraneous material.
The pain of the shoulder, which attends inflammations of the upper membrane of the liver, and the pains of the arms, which attend asthma dolorificum, or dropsy of the pericardium, are distinguished from the chronic rheumatism, as in the latter the pain only occurs on moving the affected muscles.
M. M. Warm bath, cold bath, bandage of emplastrum de minio put on tight, so as to compress the part. Cover the part with flannel. With oiled silk. Rub it with common oil frequently. With ether. A blister. A warmer climate. Venesection. A grain of calomel and a grain of opium for ten successive nights. The Peruvian bark.
13. Cicatrix vulnerum. The scar after wounds. In the healing of ulcers the matter is first thickened by increasing the absorption in them; and then lessened, till all the matter is absorbed, which is brought by the arteries, instead of being deposed in the ulcer.
M. M. This is promoted by bandage, by the sorbentia externally, as powder of bark, white lead; solution of sugar of lead. And by the sorbentia internally after evacuations. See Sect. XXXIII. 3. 2.
In those ulcers, which are made by the contact of external fire, the violent action of the fibres, which occasions the pain, is liable to continue, after the external heat is withdrawn. This should be relieved by external cold, as of snow, salt and water recently mixed, ether, or spirits of wine suffered to evaporate on the part.
The cicatrix of an ulcer generally proceeds from the edges of it; but in large ones frequently from the middle, or commences in several places at the same time; which probably contributes to the unevenness of large scars.
14. Corneae obfuscatio. Opacity of the cornea. There are few people, who have passed the middle of life, who have not at some time suffered some slight scratches or injuries of the cornea, which by not healing with a perfectly smooth surface, occasion some refractions of light, which may be conveniently seen in the following manner: fill a tea-saucer with cream and tea, or with milk, and holding it to your lips, as if going to drink it, the imperfections of the cornea will appear like lines or blotches on the surface of the fluid, with a less white appearance than that surface. Those blemishes of the eye are distinguished from the muscae volitantes described in Class I. 2. 5. 3. by their being invariably seen at any time, when you look for them.
Ulcers may frequently be seen on the cornea after ophthalmy, like little pits or indentations beneath the surface of it: in this case no external application should be used, lest the scar should be left uneven; but the cure should be confined to the internal use of thirty grains of bark twice a day, and from five to ten drops of laudanum at night, with five grains of rhubarb, if necessary.
After ulcers of the cornea, which have been large, the inequalities and opacity of the cicatrix obscures the sight; in this case could not a small piece of the cornea be cut out by a kind of trephine about the size of a thick bristle, or a small crow-quill, and would it not heal with a transparent scar? This experiment is worth trying, and might be done by a piece of hollow steel wire with a sharp edge, through which might be introduced a pointed steel screw; the screw to be introduced through the opake cornea to hold it up, and press it against the cutting edge of the hollow wire or cylinder; if the scar should heal without losing its transparency, many blind people might be made to see tolerably well by this slight and not painful operation. An experiment I wish strongly to recommend to some ingenious surgeon or oculist.
* * * * *
With increased Actions of other Cavities and Membranes.
1. Nictitatio irritativa. Winking of the eyes is performed every minute without our attention, for the purpose of cleaning and moistening the eye-ball; as further spoken of in Class II. 1. 1. 8. When the cornea becomes too dry, it becomes at the same time less transparent; which is owing to the pores of it being then too large, so that the particles of light are refracted by the edges of each pore, instead of passing through it; in the same manner as light is refracted by passing near the edge of a knife. When these pores are filled with water, the cornea becomes again transparent. This want of transparency of the cornea is visible sometimes in dying people, owing to their inirritability, and consequent neglect of nictitation.
The increase of transparency by filling the pores with fluid is seen by soaking white paper in oil; which from an opake body becomes very transparent, and accounts for a curious atmospheric phenomenon; when there exists a dry mist in a morning so as to render distant objects less distinct, it is a sign of a dry day; when distant objects are seen very distinct, it is a sign of rain. See Botan. Garden, Part I. add. note xxv. The particles of air are probably larger than those of water, as water will pass through leather and paper, which will confine air; hence when the atmosphere is much deprived of moisture, the pores of the dry air are so large, that the rays of light are refracted by their edges instead of passing through them. But when as much moisture is added as can be perfectly dissolved, the air becomes transparent; and opake again, when a part of this moisture collects into small spherules previous to its precipitation. This also accounts for the want of transparency of the air, which is seen in tremulous motions over corn-fields on hot summer-days, or over brick-kilns, after the flame is extinguished, while the furnace still remains hot.
2. Deglutitio irritativa. The deglutition of our saliva is performed frequently without our attention, and is then an irritative action in consequence of the stimulus of it in the mouth. Or perhaps sometimes for the purpose of diffusing a part of it over the dry membranes of the fauces and pharinx; in the same manner as tears are diffused over the cornea of the eye by the act of nictitation to clean or moisten it.
3. Respiratio et Tussis irritativae. In the acts of respiration and of coughing there is an increased motion of the air-cells of the lungs owing to some stimulating cause, as described above in Class I. 1. 2. 8. and I. 1. 3. 4. and which are frequently performed without our attention or consciousness, and are then irritative actions; and thus differ from those described in Class II. 1. 1. 2. and 5. To these increased actions of the air-cells are superadded those of the intercostal muscles and diaphragm by irritative association. When any unnatural stimulus acts so violently on the organs of respiration as to induce pain, the sensorial power of sensation becomes added to that of irritation, and inflammation of the membranes of them is a general consequence.
4. Exclusio bilis. The exclusion of the bile from the gall-bladder, and its derivation into the duodenum, is an irritative action in consequence of the stimulus of the aliment on the extremity of the biliary duct, which terminates in the intestine. The increased secretion of tears is occasioned in a similar manner by any stimulating material in the eyes; which affects the excretory ducts of the lacrymal glands. A pain of the external membrane of the eye sometimes attends any unusual stimulus of it, then the sensorial power of sensation becomes added to that of irritation, and a superficial inflammation is induced.