Chapter II: Part II (1)

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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CLASS I.

DISEASES OF IRRITATION.

ORDO I.

_Increased Irritation._

GENERA.

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.

ORDO II.

_Decreased Irritation._

GENERA.

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.

ORDO III.

_Retrograde Irritative Motions._

GENERA.

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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CLASS I.

DISEASES OF IRRITATION.

ORDO I.

_Increased Irritation._

GENUS I.

_With Increased Actions of the Sanguiferous System._

SPECIES.

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.

GENUS II.

_With Increased Actions of the Secerning System._

SPECIES.

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.

GENUS III.

_With increased Actions of the Absorbent System._

SPECIES.

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.

GENUS IV.

_With increased Actions of other Cavities and Membranes._

SPECIES.

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.

GENUS V.

_With increased Actions of the Organs of Sense._

SPECIES.

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.

ORDO II.

_Decreased Irritation._

GENUS I.

_With decreased Actions of the Sanguiferous System._

SPECIES.

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.

GENUS II.

_With decreased Actions of the Secerning System._

SPECIES.

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.

GENUS III.

_With decreased Actions of the Absorbent System._

SPECIES.

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.

GENUS IV.

_With decreased Actions of other Cavities and Membranes._

SPECIES.

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.

GENUS V.

_With decreased Actions of the Organs of Sense._

SPECIES.

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.

ORDO III.

_Retrograde Irritative Motions._

GENUS I.

_Of the Alimentary Canal._

SPECIES.

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.

GENUS II.

_Of the Absorbent System._

SPECIES.

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.

GENUS III.

_Of the Sanguiferous System._

SPECIES.

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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CLASS I.

DISEASES OF IRRITATION.

ORDO I.

_Increased Irritation._

GENUS I.

_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.

SPECIES.

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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ORDO I.

_Increased Irritation._

GENUS II.

_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.

SPECIES.

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.

* * * * *

ORDO I.

_Increased Irritation._

GENUS III.

_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.

SPECIES.

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.