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COlTffTWAV

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CHAMLIN
STUDY OF MEDICINE,

;/

JOHN MASON GOOD, M.D. F.R.S.

XEM. AM. PBIL. 80C. AND F.L.S. OF PHILADJSLFHIA.

IN FOUR VOLUMES.

VOL. IV.

BOSTON :

WELLS AND LILLY— COURT-STREET.

1823.

BOSTON MEDICAL UBRARY

IN HE
FRANCIS k. COUNTWAY

UBRARY OF MEDICINE

CLASS V.

CLASS V.
GENETICA.

DISEASES OF THE SBXCAI. rUNCTION..

ORDER I.

CENOTICA.

APFCCTIBC THE FI.VIOS'. .,

II.

ORGASTICA.

AFTECniia TBC ORGASH.

HI.

CARPOTICA. ^

AFFECTING THE UIFREQNATIO\.

CLASS V.

PHYSIOLOGICAL PROEM.

W^i DOW enter upon the maladiee of that important fuDCtioD bj
which animal life is extended beyond the individual that possestse^
it, and propagated from generation to generation. To this divifdon
of diseases the author has given the classic name of gcnetica, from
fumfuti^ ^^gignor,^' whence genesis {ym^n)^ ^^ origo,'^ ^^ ortus.^'

In almost every preceding system of nosology the diseases of this
IvDCtioD are scattered through every division of the classificat^ny
and are rather to be found by accident, an index, or the aid of the
Bieraoiy, than by any clear methodical clue. Dr. Macbride^s clas-
sificatioD forms the only exception I am acquainted with ; which,
however, iis rather an attempt at what may be accomplished, than
the accomplishment itself His division is into four orders ; gene-
ral, and local as proper to men, and general, and local as proper ta
women ; thus giving us in the ordinal name little or no leading ide«r
of the nature of the diseases which each subdivision is to include^
or any strict line of division between them; for it must be obvious
that many diseases commencing locally very soon become general,,
and affect the entire system, as obstructed menstruation ; while oth-
ers, as abortion, or iporbid pregnancy, may be both general and
local.

Under the present system, therefore, a different arrangetnent fs
ciiosen, and one which will perhaps be found not only more strict
to tbe.limits of the respective orders, but more explanatory of the
leading features, of the various genera or species that are included
wnder theoL These orders are three : the first embracing those
diseases that afiect the sexual fluids ; the second those that aflect tho
orgasm ; and the third those that affect the impregnation. To the
first order is applied the term cekotica {%%tmtuiM) from %»mrti ^^ eva-
cuatio," " exinanitio," to the second orgastica {•^avxtxa) from
f^m " irrito," '' incite," and especially libidinos^ ; and to the
third CA&PoncA {nm^wtMa) from M^xa^, " fructus."

Before we enter upon these divisions, it will perhaps prove ad-
Taotageous to pursue the phm we hnve hitherto followed upon

6 PHYSIOLOGICAL PROEM. [cL. V-

commencing; the preceding classes, and take a brief survey of
the general nature of tlie function before us, under the following
heads:

1. THE MACHINERY BY WHICH IT OPERATES.
11. THE PROCESS BY WHICH IT ACCOMPLISHES ITS ULTIMATE END.
III. THE DIFFICULTIES ACCOMPANYING THIS FROCJESS WHICH STILL RE- .
MAIN TO BE EXPLAINED.

L One of the chief characters by which animals and yegetables
ace distinguished from minerals, is to be found in the mode of their
formation or origin. While minerals are produced fortuitotrsly or
by the casual juxta-position of the different particles that enter into
their make, animals and vegetables can only be produced by gene-
ration, by a system of organs contrived for this express purpose,
and regulated by laws peculiar to itself

Generation is effected in two ways: by the medium of seeds or
eggs, and by that of offsets : and it has been supposed that there
may be a third way, to which we shall advert' hereafter; that of
the union of seminal molecules, furnished equally by the male and
the female, without the intervention of e^s, which constitutes
the leading principle of what has been called the theory ©f epi-
genesis.

Many plants are propagable by offsets, ^nd all plants are suppos-
ed to be so by e^^ or seeds. As we descend in the scale of animal
life, we meet in the lowest class, consisting of the worm tribes, with
examples of both these modes of propagation also. For while a
production by ova is more commonly adhered to, the hydra or po^
lype is well known to multiply by bulbs or knobs thrown forth from
different parts of the body, and the hirudo viridisj or green leech,
by longitudinal sections, which correspond with the slips or suck-
ers of plants.

In these cases we meet with no distinction of sex ; . the sanie in-
dividual being capable ^of continuing its own kind by a power of-
spontaneous generation. In other animals of the worm class we
trace examples of the organs of both sexes united in the same in-
dividual, making a near approach to the class of mbnoicous plants,
or those which bear mal^e and female flowers distinct from each
other but on the same stock, as the cucumber : thus constituting
proper hermaphrodites, evincing a complexity of sexual structure
which is not to be found in any class of animals above that of worms.
Sojnc of the intestinal worms are of this description, as the fasciola
or ffuke, which is at the same time oviparous, the ovaries being
placed laterally.

The helix hortensis^ or g^rdcn-snail, is hermaphrodite, but incapa-
ble of breeding singly. In order to accomplish t^is, it is necessary
that one individual should copulate with another, the male organ of
each uniting with the female, and the female with the male, when
both become impregnated. The manner in which this amour is

eL- v.] PHYSIOLOGICAL PROEM. 7

coadncted is singular and highly carious. Tbej make their ap-
proach by discharging several small darts at each other, which are
of a sharp form, and of a horny substance. The quiver is contain-
ed within a cavity on the right side of the neck, and the darts are
launched with some degree of force, at about the distance of two
inches, till the whole dre exhausted ; when the war of love is over
and its consummation succeeds. The increase is by eggs which are
perfectly round and about the size of small peas.

There are some animals in which a single impregnation is capa-
ble of producing several generations id succession: we have a fami-
liar example of this in the common cock and hen ; for a single co-
pulation is here sufficient to give fecundity to as many eggs as will
constitute a whole brood. But the same curious fact is still more
obvious in various species of insects, and especially in the aphis
(puceron or green-plant louse) through all its division, and the
Daphnia Pulex of Mull^r^and Latreille (the monoculus PuUx of
Linn^us.) In both these a single impregnation' will suffice for at
least six or seven generations ; in both which, likewise, we havQ
another curious deviation from the common laws of propagation,
which is that in the warmer summer months the young are produc-
ed viriparously, and in the cooler autumnal months oviparously.
It is also very extraordinary that, in the aphis, and particularly in
the viviparous broods, the ofispring are many of them winged, and
many of them without wings or. distinction of sex: in this respect
making an approach to the working-bees, and still more nearly to
the working-ants, known, till of late, by the name of neuters.

For the generative process whidh takes place in these two last
kinds we are almost entirely indebted to the nice and persevering
kbours of the elder and the younger Hiiber ; who have decidedly
proved that what have hitherto been called neuters are females
with undeveloped female organs, and therefore non-breeders; but
whose organs, at least in the case of bees, are capable of develope-
roent by a more stimulating or richer honey, with which one of
tliem, selected from the rest, is actually treated for this purpose by
the general consent of the hive on the accidental loss of a queen-
bee, or common bearer of the whole, and in order to supply her
place. It is these aloite that arc armed with stings ; for the males,
or drones, as we commonly call them, are without stingy ; they are
much larger than the non-breeders or workers, of a*darker colour,
and make a great buz in flying. They are always less numerous in
a hive than the workers^ and only serve to insure the impregnation
of the few young queens that may be produced in the course of the
season, and are regularly massacred by the stings of the wodcers in
the beginning of the autumn. The impregnation of the queen-bee
is produced by a process too curious to be passed over. It was con-
jectured by Swammerdam that this was effected by an aura seminalis
thrown forth frem the body of the whole of the drones or males
collectively. By other naturalists it has been said, but erroneously,
to take place from an intermixture of a male milt or sperm with

S PHTSiOtOGlGAt PROBM. [cL. V*

%h% 6|gf or spawD of th« ^deen-bee, a« ia the case of fishes. M.
lluber, however, has saffictently proved that the queen-bee for this
pMrpose forms an actual coition, and this never in the hive, but
darings a tour into the air, wliich she takes for tbfs purpose, a few
days only after her birtli, and in the course of which she Is sore to
meet with some one or other of her numerous seraglio of males.
As soon as copulation has been effected, she returns to the hive,
which is usually in the space of aboot half an hour, and oAen bears
home with her the full proofe of a connexion in the ^$a verendm of
the drone ; who thus wounded and deprived of his virility by the
violence of his embrace, dies almost immediately afterwards. This
single ioipregnation will serve to fecundate ail the eggs the queen
will lay for two years at least ; Huber believes for the whole of her
Mfe ; but he has had repeated proois of the former. She begins to
lay her eggs, fdr the bee is unquestionably oviparous, forty-six
hours after impregnation, and will commonly lay about three thous-
and in two months, or, at the rate of fifty eggs daily. For the first
eleven months she lays none but the eggs of workers ; after which
she commences a second laying which consists of drones^ eggs
alone.

Of the mode of procreation among fishes, inconsequence of their
living in a different element from our own, we know but little. A
few of them, as the sqoalus, or shark gpenus, some of the skates, and
other cartilaginous fishes, have manifest organs of generation, and
^questionably copulate. The male shark, indeed, is furnished with
a peculiar sort of holders for the purpose of maintaining his grasp
upon the female amidst the utmost violence of the waves, a^ his
penis is cartilaginous or homy. The female produces her young
oy eggs, which, in several species of this genus, are hatched in her
own body, so that the young, when cast forth, are viviparous.

The blenny produces its young in the same manner ; in most spe-
cies by spawn or eggs hatched externally, but in one or two vivi-
parously, three or four hundred young being thus brought forth at
a time. The blenny, however, and by far the greater number of
fishes, have no external organ of generation, and appear to have
jDo sexual connexion. The females, in a particular season of the
year, seem merely to throw forth their ova, which we call hard
roe or spawn, in immense multitudes, in some shallow part of the
water in which they reside, where it may be best exposed to the
vivific action of the sun's rays; when the male shortly afterwards
passes over the spawn or hard roe, and discharges upon it his sperm,
which we call soft roe or milt. These substances are contained in
the respective sexes in two bags that unite near the podex, and at
spawning time are very much distended. The spawn and milt thus
discharged intermix ; and, influenced by the vital warmth of the
sun, commence a new action, the result of which is a shoal of young
fishes of a definite species. *

Yet though no actual connexion can be traced among the greater
number of the class of fishes, something like pairing is often dis-

CL. ▼•] rarSlOLOGICAL JPRbfiBl. 9

cernible among many of those that have no visible organs of copu-
lation : for if we watch attentively the motions of such as are kept
In ponds, we shall find the sexes in great tumult, and apparently
straggling together among the grass or rashes at the brink of the
water, about spawning-time ; while the male and female salmon,
after having ascended a fresh stream to a sufficient height and shal-
lowness for the purpose, are well known to Unite in dig^ng a nest
or pit in the sand, of about eighteen inches in depth, into which
the female casts her spawn, and the maie immediately afterward
ejects his milt ; when the nest is covered over with fresh sand by a
joint exertion of their tails.

The salmon, the sturgeon, and m^ny other marine fishes, seek
out a fresh-water stream for this purpose : and their navigations
are often of very considerable length before they can satisfy them-
selves, or obtain a proper gravelly bed. The salmon tribe some-
times make a voyage of several hundred miles, cutting their way
against the most rapid currents, leaping over floodgates, or up cata^
racts of an astonishing height : in their endeavour to surmount which
they often fail, and tumble back into the water ; and, in some places
are, in consequence, caught in baskets placed in the current for this
purpose. •

The power of fecundity in fishes surpasses all calculation, and
appears almost incredible. A single herring, if sufiered to multiply
unmolested, and undiminished for twenty years, would show a pro-
geny greater in bulk than the globe itself This species, as also
the pilchard, and some others of the genus clupea, as a proof of
their great fertility, migrate annually tirom the Arctic regions in
shoals' of such vast extent, that for miles they are seen to darken
the surface of the water.

The mode of procreating among frogs does not much vary irom
that of fishes. Early in the spring the maie is found upon the back
of the female in close Contact with her, but there is no discoverable
communication, although this contact continues for several days ;
nor can we trace in the male any external genital oi^an. After the
animals quit each other, the female seeks out some secure and shal-
low water, in which, like the race of fishes, she deposits her spawn,
which consists of small specks held together in a sort of chain or
string by a whitish glutinous liquor that envelopes them ; and over
this the male passes and deposits his sperm, which soon constitutes
a part of the glutinous matter itself. The result is a fry of minute
tadpoles, whose evolution into the very different form and organi-
zation of frogs, is one of the most striking curiosities of natural his-
tory. In the Surinam toad (rana Ptpo), this process is varied. The
feinale here deposits her eggs or spawn without any attention to or-
der; the male takes up the amorphous mass with his feet and smears it
over her back, driving many of the eggs hereby into a variety of cells
that open upon it ; and afterwards ejecting over them his spermous
fluid. These cells are so many nests in which the eggs are hatched

VOL. IV. 2

iO IHirstOLOOiCAL PiU>EH« [ct. T.

iDto tadpoles, which ^e perfected and burst their imprisoDment ia
about three months.

But a yolufi»e would POt suffi/ce to poiut out all the singularities
eybibited by different animals in the economy of procreation. It
ifi wprth while, however, to notice how variouisly some of the or-
gans of generation are situated in many tribes. In the ft^male lii^el'
hila, or dragon-fly, the vagina is situated on the upper part of the
belly near the breast. In the male spider, the generatiye organ is
&(ed fW the extremity of an antenna, in the fiemale ascaris vermis
whrni, or maw-worm, the young are discharged from a minute
punctifonn aperture a little below the head, whi6h appears, there-
fore, to constitute the ascarine vagina. In the snnil we find this
of^n placed pear the neck, in the immediate vicinity of the spira-
cle which serves ibr its lungs. The taenia sotkan^ or tape-worna,
throws forth its young from the joints* So some plants bear flow-
ers on the petioles or edges of the leaves instead of on the flower-
itelk.

In like manner, while the mammae in the human kind are placed

On the chest, and made a graceful and attractive ornament, in all

^iiadropeds they are placed backward, and concealed by the thighs.

, In the mare, the teats, wluch are twe, are inguinal ; in the horse,

they are singularly placed on the glans penis.

The testes of most animals that possess this organ, and procreate
only once a year, are extremely small during the months in which
they are not excited. Those of the sparrow, in the winter-season,
are scarcely larger than a pin^s head, but in the spring are of the
|ixe of a hazle-nut. In man this oi^an, before birth, or rather dur-
ing the early months of pregnancy, is an abdominal viscus : about
the seventh month it descends gradually through the abdominal ring
into the scrotum, which it reaches in the eighth month. And if
thb descent do not take place anterior to birth, it is accomplished
with difficulty, and is rarely completed till the seventh or eighth
year. Sometimes, indeed, only one testes descends under these
circumstances, and occasionally neither.

Tiiere is a set of barbarians at the back of the Cape of Good
Hope who appear to be very generally monorchid, or possessed of
only a single testis; and Linneus, believing this to be a natural and
tribual defect, has made them a distinct variety of the human spe-
cies. Mr. Barrow has noticed the same singularity : but it is doubt-
ful whether, like the want of a beard among the American savages,
this destitution is not owing to aimrbarous custom of extirpation in
early life. It is generally admitted that the productive power of
man is greatly impaired, if not totally lost, by a retention of both
testes in the abdomen : yet in the crinaccus or hedge-hog genus,
and a few other quadrupeds, they never quit the cavity of the ab-
domen. In the cock, whose penis is dicfaotomous or two-pronged,
they are situated on each side o[ (he back-bone.

It has been made a question amoog |jliysio legists whether the se*
roinal fluid is secreted by the tcbtcs at Ibo moment of the demand^

<^y.] rafaiOLOGiCAL pr^oi. 11

or fraduftUj mi Imp^FMpffiUy io th« iaienrals df copufcitloB^ and
ledlfcd ifi the tesieoltt seflaiMiles as a reeenroif for the feoeratiye
power to draw upon. The latter is a cobmbod opinioo. It it, how-
ever, opposed, aod with rery pt>frerful affumeiils, hj Swammerdam
«ad Mr. Joho Huotef. The aeeretioii foaod \m the vesicoln semlt
Dales is dliferent froai that of the testes in the properties of colofff
and smell ; those of the fonder beiag yellow aod inodorous, tbos^
of the ktter whitish, asd posses^df the odour of the orchis-root, or
the down of chesirats. Oh the dissectioD of those who have natu-
rally or accidettta^T been dealit«te of oae testis, the vesicula of the
ODe side has been lomd filled with the same fluid, and as lai^ely as
that of the other; and consecpieDtly the fluid on the vacant side
Bsost bate been sbppUed by a secretory action of the vesicula il-
self. There are no organs of gfeneratkm that difier so much in
their form and comparative size in diferent animals as these vesi-r
colar bags : in the hedge-hog they are twke as large as in omrfi,
and in many anindals ihty are utterly wanting. They are so in the
dog, which continues for a very long time in a state of copulation,
and in birds, whose copulation is momentary. They are, moreover,
wanting in most animals whose ibod is chiefly derived from an ani-
■mI source, though not in all, as the hedge-hog, to which I have
JQst referred, is an example of the contrary.

Mr. Hunter hence concludes that the vesicul® seminales are not
seminal reservoirs but glatids secreting a peculiar mucus, and that
the bulb of the urethra is, properly speaking, the receptacle in
which the semen is accumulated pfevious to ejection. Of the actu-
al use of these vesicular bags, he confesses himself to be ignorant,
yet imagines that in some way or other they are stdiservient to the
|Mffposes of generatioo, though not according to the common con-
jecture.

The ovaria are to the female what the testes are to the male.
They w^re formerly, indeed, called female testes, and furnish, on
tiie part of the female, what is necessary towards the production of
a progeny. They are, in fact, two spheroidal flattened bodies, in-
closed between the folds of the broad ligaments by which the ute-
rus is fuf ponded. They have no immediate connection with the
oteros; but near them the extremity of a tube, which opens on
either side into that organ, hangs with loose flmbrisB in the cavity
of th^ abdooaen into which it opens at the fimbrial end. This tube
is calM the Fallopian from the name of its discoverer."*^ At the
age of puberty, the ovaria acquire their full growth, and continue
to weigh about a drachm and a half each till menstruation ceases.
Tliey contain a pecuhar fluid resembling the white of eg^, .once
supposed to be secreted by the glandular structure of various small
bodies imbedded in them, which have been denominated corpora
lutea. By some early writers this fluid was contemplated as a ie-
male semen, forming a counterpart to the semen of males ; but it

*■ Fsllop. Obtsrv. Anat. 197.

12 PHTSIOLOGieAL PROEM. [CL. V^

has since been held, and the tenet is well supported by anatomical
facts, to be a secretion of a different kind thrown forth in conse-
quence of the excitement sustained by the sepi^ration of one or
more of the minute vesicles, which seem to issue from them as
their nucleus or matflix, and which are themselves regarded by the
same school as the real ovula of subsequent fbtuses : to which sub-
ject, however, we shall advert presently.

It is singular to contemplate the very powerful influence which
the secretion, or even the preparation for secreting the seminal
fluid, but still more its ejection, produces over the entire system.

On the perfection, and a certain and entonous degree of distention,
of the seminal vessels, apparently producing an absorption of the fluid
when at rest, the spirits, the vigour, and the general health of man de-
pend. Hence antecedently to the full elaboration of the sexual system,
and the secretion of this fluid, the male has scarcely any ^listincti ve
character from the female : the face is fair and beardless, the voice
shrill, and the courage doubtful. And whenever, in subsequent life,
we find this entonous distension relaxed, we find at the same time
languor, debility, and a want of energy both in the corporeal and
mental functions. And where the supply is entirely suppressed or
cut off by accident, disease, or unnatural mutilation, the whole sys-
tem is changed, the voice weakened, the beard checked in it^
growth, and the sternum expanded : so that the male again sinks
down into the female character. These changes occur chiefly where
the testicles are extirpated before manhood ; but they take place
also, though in a less degree, afterwards.

In like manner, during the dischai^e of the seminal fluid in sex-
ual commerce, the most vigorous frames of the stoutest animals be-
come exhausted by the pleasurable shock : and the feeble frames
of many of the insect tribes are incapable of recovering from the
exhaustion, and perish immediately afterwards ; the female alone
surviving to give maturity to the eggs hereby fecundated. The
same effect occurs after the same consummation in planU. The
stoutest tree, if superfructified, is impaired for bearing fruit the
next year ; while the plants of the feeblest structure die as soon as
fructification has taken place. Hence, by preventing fructification,
we are enabled to prolong their duration ; "for by taking away the
styles and stigmas, the filaments and anthers, and especially by
plucking off the entire enrols of our garden-flowers, we are able
of annuals to make biennials, and of biennials triennials.

In many animals, during the season of their amours, the aroma of
the seminal fluid is so strong, and at the same time so extensive in
its influence as to taint the flesh ; and hence the flesh of goats at this *
period is not eatable. Most fishes are extremely emaciated in both
sexes at the same time, and from the same cause, and are equally un-
fit for the table. Stags, in the rutting season, are so exhausted as to
be quite lean and feeble, and to retire into the recesses of the forest
in quest of repose and quiet. They are well known to be totally
inadequate to the chace ; and hence, for the purpose of maintaining

(X. y.] ' FHTSlOLOCnCAL PROEM. 13

a succemoD of sportiiig, they are sometimes castrated, in which
state thej are called heaviers. If the castration be performed
while the horns are shed, these never grow again ; and, if while
the horns are in perfection, they are never shed.

The male and female rein-deer (cervus TarandusS ordinarily cast
their horns every year in November. If the male oe castrated the
horns will not grow aAer he is nine years old ; and the female, in-
stead of dropping her bonis as usual in November, retains them, if
gravid, till she fawns, which is about the middle of May. In this
case the usual stimulus necessary for the operation of exfoliation is
transferred to another part of the system. And for the same reason
we often find that a broken bone in a pregnant woman will secrete
no callus, and, consequently, not unite till after child-birth. In the
former case the roots of the horns are affected by sympathy with
the general sexual system, of which, indeed, they may be said to
form a part, and by their superior size are discriminative of the
male sex. In the human race, the strong deep voice characteristic
of manhood is rarely acquired, if castration be performed in in-
fancy.

There is no animal, perhaps, but shows some sympathic action
of the system at large, or some remote part of it with the genital
organs, when they are in a state of peculiar excitement. The tree-
frog (rana arborea) has, in the breeding season, a peculiar orbicular
pouch attached to its throat ; the fore-thumb of the common male
toad is at the same season affected with warts : and the females of
some of the monkey tribes evince a regular menstruation.

11. The process by which the generative power is able to accom-
plish Its ultimate end, is to the present hour involved in no small
degree of mystery ; and has given rise to three distinct and highly
ingenious hypotheses that have a strong claim upon our attention,
and which we shall proceed to notice in the order in which they
have appeared.

The first and most ancient of these consists in regarding the fetus
in the womb as the joint production of matter afforded in coition by
both sexes, that of the male being secreted by the testes, and that
of the female by the uterus itself or some collateral organ, as the
ovaria, which last, however, is a name of comparatively modem
origin, and derived from a supposed office which was not contem-
plated among the ancients. To this hypothesis has been given the
name of bfiocncsis.

The seed or matter afforded by the female was regarded by Hip-
pocrates, Aristotle, and Galen, as the menstrual blood or secretion,
which they supposed furnished the substance and increment of the
fetus, while the male semen furnished the living principle : £mpe-
docles, Epicurus, and various other physiologists contending, on the
contrary, that the father and mother respectively contributed a se-
minal fluid that equally cooperated in the generation and growth of
the fetus, and stamped it a male or a female, and with features more
flosely resembling the one or the other according as the orgasm of

14 PRTUOLOOICAL PROEM. [cL. T*

tither wu pr^ctmiiiaiit at the time, or accomp— ied with a mere
copious discharge. Id the words of Lucretius, who has etegastijr
compressed the £picureaik doctrioe :

Et maliebre oritur patrlo de semlne seclum ;
Maternoque mares exsistunt corpora cretei.
Semper enim partus duplici do semine constat :
Atque, utri simile est magis id, quodquomque creatur.
Ejus habet plus parte squA, quod ceroere possisi
Sire virum suboles, sive est muliebris origo.**

The distiuction of sex, however, was accounted for In et Cerent
ff^anner by Hippocrates, who supposed that each oi the sexes pos-
sesses a strong and a weak seminal fluid ; and very ungallantlj as-
serted that the male fetus was formed try an intermitture of the ro-
buster fluids of the two sexes, and the ^rnale by that of the more
Imbecile. Lactantius, in quoting the opinion of Aristotle upon this
Subject, adds fancifully enough that the dgfat side of the uterus is
the proper chamber of the male fetus, and the left of the female :
a belief which is still prevalent among the vulgar in many parts of
Great Britain. But he adds that if the male, or stronger, semen
should by mistake enter the left side of the ttteros a male child mav
litill be conceived ; yet, inasmuch as it occupies the female depart-
ment, its voice, its face, and its general complexion will be effemi-
nate. And, on the contrary, if the weaker or female seed shotild
flow into the right side of the uterus, and a female fetus be begot-
ten, the female will exhibit many signs of a masculine charactet^
and be inordinately vigorous and muscular.t

The doctrine of epigenesis under one mofttfication or another,
continued to be the leading, if not the only hypothesis af the day
till the beginning of the sixteenth century, when, in consedoence of
the more accurate examinations and dissections of Sylvius, Vesalius^
Fallopius, and De Graaf, the organs which had hitbefto been re-
garded as female testes, and so denominated, were now declared to
be repositories of minute ova, and at length named ovaria by Steno
in 1667.| We now therefore enter upon the second of the tltree
hypotheses above alluded to, which derives the fetus from rudi-
ments furnished by the mother alone. This hypothesis was origi-
nally advanced by Josephus de Aropiatariis, as flowing from these
anatomical discoveries, but was chiefly brought into notice by Swam-
merdam and Harvey^ who estabii^ed the doctrine of omne ah ovo^
Observing a cluster of about fifteen vesicles in each of the female
ovaria, apparently filled with a minute drop ^f albuminous yellow
serum, and perceiving that they appeared to diminish in number in
some kind of proportion to the number of parturitions a woman had
undergone, it was conceived by these physiologists that such vesi-

• De Rer. Nat. Lib. iv. 1220,

t De opificio Dei. Cap. xii.

% Elero. Myologios Specimen, p. 117.

CI« y.] FHTSIOLOOICAI^ PKOEM. 15

clc8 are inert eggs or ovQ]a, cootaioing miniature etnbryons of thd
form to be afterwards evolved, one of which, by the pleasurable
•hock that darts over the whole body, but iu an especial degree
through this organ, during the act of copulation, is instantly thrown
Into a state of vital activity, detached from the common cluster, and
ID a 8h<Mrt tiai« passes into the uterus through the canal of the Fal-
lopian tube which sj^ontaneously enlarges for the purpose ; where
its mioiatiffe germ is graduallv unfolded and augmented into a sen-
sible fetus, partaking of the form and figure of the parent stock.
Tlie elementary animalcule, it was farther asserted by Harvey, may
be occanoDally impressed with a resemblance in its features to the
fiither from the electric impulse given in the genial act to every
portion of the solids and fluids of the body, and of consequence to
the fluid contained in the ovula themselves : but, reasoning from
the leogth of the vagina in cows and many other animals, and an
occasional dissection of the human subject soon after coition, he
contended that the male semen never did. or indeed could, enter the
uterus, and of course could not add any thing to the embryon in its
evolution.

Leewenhoeck and Hartsoeker, however, upon a more accurate
anatomy of the uterus immediately after copulation, discovered not
only that the projected male semen could enter its cavity, but actu-
ally did thus enter, and in some instances, which fell within their
nodce, had clearly ascended into the Fallopian tubes. And now a
new doctrine was started, and one altogether opposite to the tlieory
of Harvey. Upon the principle of the former, the father had no
immediate connexion with his own child ; he could not bestow upon
it a particle of his own matter, and the whole production was the
operation of the mother. But, in consequence of this later discove-
17, it was contended that the entire formation was the work of the
father, and that the mother, in her turn, had nothing to do with it r
tliat every particle of the propelled fluid was a true and proper se-
minium, containing in itself, like the ovulum of the female upon the
hypothesis of Harvey, a miniature of all the oj^ans and members of
the future fetus, in due time to be gradually evolved and augment-
ed ; and that the uterus, and possibly the ovulum, into which som^
one of these male semina or seminia is almost sure of being protrud-
ed in the act of generation, oflers nothing more than a nest in which
tlie homunculus or rudimental fetus is deposited for warmth and nu-
triment And as the former hypothesis appealed to the natural eco-
nomy of oviparous animals during the period of incubation, that of
worms and tadpoles was appealed to by the latter : and a very con-
siderable degree of life and motion was supposed to be discovered
mod proved by the aid of good magnifying glasses in the simple fluid
of the male semen insomuch that not less than many millions of these,
homunculi, or unborn manikins, were pointed out as capering in a
ifiameter not greater than that of the smallest grain of sand, each
resembling the tadpole in shape. Delappius, indeed, n celebrated
pupil of Leewenhoeck, advanced farther; for he not only saw these

16 PHYSIOLOGICAL PROEM. fcL. t:

homuncular tadpoles, but pretended to trace one of them burstings
through the tunic by which it was swaddled, and exhibiting two
arms, two legs, a human head and heart.

Such was the* dream of the popular philosophy on the subject of
generation indulged in at the period we are now adverting to, and
which continued for upwards of a century. It is truly astonishing
to reflect on the universality with which this opinion was accredited,
and how decisively every anatomist, and indeed every man who pre-
tended to the smallest portion of medical science, was convinced that
his children were no more related, in point of generative power, to
his own wife than they were to his neighbour's. It was in vain
that Verheyen denied the existence of animalcules in the seminal
fluid, and undertook to demonstrate, that the motion supposed to be
traced there, was a mere microscopic delusion : it was in vain to
adduce the fact of an equal proportion of paternal and maternal fea-
tures in almost every family in the world, the undeviating intermix-
ture of features in mules, and other hybrid animals, and the casual
transfer of maternal impressions to the unborn progeny when sud-
denly frightened in the earlier months of pregnancy. The theory,
as it was triumphantly called, of generation ab animalculo maris,
was still confidently maintained ; and the mother, it was contended,
had nothing to do with the formation of her own ofispring, but to
give it a warm nest and nourishment.

At length arose the celebrated and indefatigable Buffon, who was
not inattentive to the facts before him, nor to the absurdities to
which some of them had led. He readily accredited the microsco*
pic motion pointed out by Leeweohoeck in the floating bodies of
male semen, and which Spalanzani has since persuaded himself he
has detected not only in this fluid but in various others of an animal
origin f^ but instead of admitting them to be animalcules, he regards
ed them as primordial monads, molecules organiques^ of a peculiar
activity, existing through all nature, and constituting the nutrient
elements of living matter : and upon this principle he founded not
indeed a new hypothesis, but a new edition of that of epigenesis,
with so much accessary, and in his view of the subject, impor-
tant matter, as very nearly to entitle it to the character of an origi-
nal plan. Like the speculations to which it succeeded, it soon ac-
quired a very high degree of popularity.

AH organized beings, and hence plants as well as animals, accord-
ing to the doctrine of M. de Buffon. contain a vast number 'of these
active molecules in every part of their frames, but especially in
the generative organs of both sexes, and the seed-vessels of plants,
in which they are more numerous than in any other parts. These
organic primordia afford nutrition and growth to the animal and ve-
getable fabrics ; and, as soon as these fabrics are matured, and con-
sequently a smaller proportion of such molecules are requisite, their
surplus is secreted and strained off* for the formation of vegetable

• Opuscolide Fisica, Animale, Vcgitabile, &c. Vol. il. 8vo. Milan. 1776.

CJL v.] PHYSIOLOGICAL PROEM. 17

aod animal seeds. The eidstence of ovula, Id the female ovaria,
impregnated and detached at the time of conception, is by this hy-
pothesis declared to be a chimaera, and their passage into the uterus
asserted to be contrary to all observation and fact. The ovaria are
oDce more regarded as female testes receiving, like those of the
male, the surplus of the organic molecules of the body, and secret-
11^ them, like the latter, for the common purpose of generation.
The seminal liquor thus secerned in the male and female frames
are, in the act of coition, projected simultaneously into the uterus,
and, becoming intimately blended there, produce, by a kind of fer-
mentation, the first filaments of the fetus, which grow and expand
like the filaments of plants. To render such combination of semi-
nal fluids productive, however, it was contended that their quanti-
ties must be duly proportioned, their powers of action definite, and
their solidity, tenacity, or rarefaction symphoneous ; and the fetus,
it was added, would be either male or female, as the seminal fluid
of the man or woman abounded most with oi^ganic molecules, and
would resemble either the father or the mother, according to
the overbalance of the respective elements contributed by each
parent.

ft is obvious, from this brief view of the subject, that Bufibn in
the planning of this hypothesis did nothing more than avail himself
of the anatonucal facts of Vesalius, De Graaf, and Harvey and the
supposed' discoveries of Leewenhoeck, to revive in a new form the
doctrine of the Greek schools, and especially that of Epicurus. The
subject, however, was ofiered to the world in plausible arguments
and captivating eloquence, and had soon the good fortune to meet
with powerful and enlightened supporters in Manpertuis, and Need-
ham, who added some improvements, but of no very great impor-
tance, to several of M. de Buffbn^s tenets ; while Haller and fionet
strove hard to revive the hypothesis of a female generative power
or evolution alone, as first established by Harvey ; or rather to erect
an edifice, somewhat similar to it, out of the crumbling ruins of the
primaiy building; in doing which they appealed to the phenoipena
of die vegetable creation with considerable research, and some de-
gree of success. But this revived hypothesis, notwithstanding, has
never been very generally followed ; and is now almost, if not alto-
gether, retinqi^hed even in Germany.

In like manner, there are several physiologists, who have endea-
voured to improve upon the hypothesis of Buffon, of whom it may
be sufficient to mention Dr. Darwin and Professor Blunfenbach.
Tlie alterations, however, are little more than verbal, and conse-
quently of no great importance, and chiefly relate to the subordi-
nate doctrine of oiganio molecules. For the term organic mole-
cules Darwin prefers that of vital germs, which he assorts into two
kinds, or rather maintams are thus formed by. nature, as being se-
creted or provided by male or female organs, whether animal or
T^etable ; for in* the philosopbv of this writer, the two depait-
mentB tread doaeljr upon each other. In this sabdivifliim of geitfn^

18 PHTSIOLOGICAL PROEM. [CL. V.

however, the term molecnle is still retained, but Uoiited to the fe-
male character or department : the vital germs or particles secret-
ed by the female organs of a bad or flower, or the female organs of
an animal being by Dr Darwin denominated molecules with forma-
tive propensities; while those secreted from the male organs of
either department are C9\\ed fibrils with formative appetencies. To
the fibrils he assigns a higher degree of organization than to the
molecules. Both, however, we are told, have a propension or an
appetency to form or create ; as we are told also that " they reci-
procally stimulate and embrace each other and instantly coalesce ;
and may thus popularly be compared to the double affinities of
chemistry.''

In the view of Professor Blumenbach, matter is cBvided into two
kinds, possessing properties essentially different from each other,
these are organized and unorganized : unorganized matter is^endu-
ed with a creative or formative power throughout every particle ;
and organized matter with a creative or formative effort, a nisus
fartnativus^ or bildungstrieb^^ as he calls it, a principle in many res-
pects similar to that of gravitation,^ but endowing every separate or-
ffan, as soon as it acquires structure, with a vita propria. From the
first, he traces the origin of the world in the simple and inorganic
state of the mineral kingdom ; from the last the rise of Vegetables
and animals.

It Is only necessary to add farther a remark of Mr. John Hunt^'s,
that in plants of all kinds, the seed, properly so called, is produced

Sthe female organization, while the male gives nothing more than
e principle of arrangement; and that the same operation and prin-
ciples take place in many orders of animals.t

In all these attempts to improve upon the older speculations,
there is a great deal that cannot but be. regarded as philosophical
nngm. The physiological experiments that have been toade, and
the anatomical facts that have been discovered, since the days of
Harvey, and particularly during the last half centuty, though they
leave the doctrine of generation still surrounded with many difficul-
ties, have sufficiently established the following positions :

^rst that, in all ordinary cases, the male semen enters into the
uterus at the timie of coition ; and that in those cases in which it
does not or cannot enter immediately, from the extreme length of the
Tag^na. as in some quadrupeds, or from a greater or less dwree of
Impertoration of the vaginal passage, it is conveyed there soon
afterwards in consequence of its proximity of situation.

Secondly, that the uterus itself, worked up at this time to the
Mghest pitch of excitement, secretes also some portion of a pecfuliar
ftodd, the female semen of the Epicurean philosophers^ with which
the male semen combines, and which is probably the basis of the
membranes soon afterwards prepared for the fetus.

* Uber den Eildungstrieb, 8vo. GSttiog. 179J,
't Animal Bcopenif , p. 55.

L

CL. V^ P^XSIOLOGICAL PROEM. 10

TUfd^t that the Fallopian tubes at this period become rigid;
tbeir fimbriae embrace the ovigria ; aoct consequently form a direct
channel of communication between the ovaria and the uterus ; that
w^at ivare formerly supposed to be vesicles are real ovula ; and
that one of them, detached by the momentary shock or excitement,
Inicsts from its nucleus or matrix, enters into one of the open
months of the fimbriae of the Fallopian tube, and, in consequence,
into the tube itseli*, by which it is conveyed to the uterus ; anefiect,
Inmever, which does not seem to take place during the act of
coitiop, since the ovulum is seldom found, even in the Fallopian
tnbe, till some time afterwards : and that, as soon as the ovulum
hn thus escaped, the lips of the wound hereby made in the side of
the ovary are closed by an external cicatrix, and indented with a
amail cavity, which forms what is meant by a corpus luteum.

Fourthly, that the cervix of the uterus is, from this time, closed
in its canal toward the upper part, so as to prevent a close fetation
by the introdoction of fresh male semen ; while the internal surface
c^ this organ becomes lined.with a fine coagulable and plastic lymph,
being probably the fluid secreted at the moment of intercourse,
assuDes a thin membranous form, and has been called tunica
cadnca or decidua, and constitutes the nterine ovum or egg of the
fetm; which important part of the process seems to take place
about a week afier the. time of copolatioa. In the rabbit Mr.
Cmikahaok has found it as early as the fourth day.

Fifthlv, that, for the better protection and nutrition of the fetus,
the wafit of the uterine ovum are multiplied ; and that hence,
while the tonica caduca itself possesses a duplicature, which is
caQed tunica reflexa, there are also two other membranes by which
the deddna is lined, denoBiinated chorion and amnion, both which
are filled with peculiar fluids ; the fluid of the chorion occupying
the mce between itself and the amnion which it surrounds ; and
the fluid of 4he amnion occqpying the whole of the interior which
is distended with it like a bladder.

^xthly, that the mediittn of connexion between the fetus and the
moiher is the umbilical chord and the placenta into which it is
diftribntied ; the former consisting of an artery from each of the
letal iiiacs, and a vein nsnnipg to the fetal liver, twisted spirally
•ad surrounded by a common integument ; and the latter consiitii^
of two parts, an uterine or spongy parenchyma, derived from the
deddna, and a fetal parenchyma cbnstating of a great multitude of
•zqniaitely beautiful knotty flocculi that cover the chorion, and
constitute not only an organ of nutriment, but, as was first ingeniously
si^poaed by Sir Edward Huke, of oxygenation.

Seventhly, that about the third week, or as soon as the uterine
ovum is thus prepared for its reception, we can trace the first ves-
tige of the embryon, oval in its shape and resembling a minute beim
or kidney, swimming in the fluid of the amnion, and suspended by
the umbilical chord which has now shot forih from the placenta.
From this reniform substance the general figure pullulates, the
ttmbs are protruded and the face takes its rise.

20 PHYSIOLOGICAL PROEM. [CL. V*

III. The chief ^fficnltles that have been felt as accompaDying
these positions, and the general doctrine that flows from them are
the following':

First, as to the mode by which the male semen is conveyed to the
ovalam in the Fallopian tube.

Secondly, the occasional existence of corpora Intea in the ovaria
of virgins, or of those who, from misformation, have been incapable
of indulging in sexual commerce.

Thirdly, the occasional detection of a full-sized fbtos in the
uterus without any placenta, umbilical chord, or mark of an umbili-
cus.

The first of these difficulties was earliest started, as we have
already observed, by Dr. Harvey, who contended ^at in die case
of cows, whose vagina is very long, as well as in various other
cases, the semen cannot possibly reach even the uterus ; and that
hence there is no reason to suppose it ever reaches it It was not
then known that impregnation commences in the Fallopian tube,
and that it must also reach thb canal as well ; which, by Harvey
would have been received as an objection still more triumphant.

By what means the ejected semen is conveyed into the uterus
we do not, indeed, very clearly know even to the present hour ;
but that it is so conveyed and even in animals in which the male
organ can by no means come in contact with it, has been proved by
incontrovertible facts. Mr. John Hunter killed a bitch in the act
of copulation, and found that the semen was then existing in the
cavity of the uterus, in his opinion carried there per saltiim. Now
if it reach the uterus there can be no difficulty in conceiving that
it may also reach the Fallopian tubes, which by one end open into
the uterus ; sucked in, perhaps, as supposed by M . Blumenbach, by
the latter organ during the thrilling orgasm of the moment. Lee-
wenhoeck and Hartsoeker, seem, indeed, to have removed the
difficulty altogether, bv having, in some instances, detected the
seminal fluid in the Fallopian tubes themselves. And there seems
great reason to believe that it has, occasionally, entered the ovari-
um, and even produced impregnation in that organ instead of in the
uterus, where an obstruction has been ofiiered to the descent of an
ovulum into the fimbrial openings of the tube, after its detachment :
for we cannot otherwise readily account for the formation of fetuses
in the ovarium ; facts, however, well known to occur, and of which
Mr. Stanley has given a singular instance of late,* and Dr. Granville
a still more extraordinary example, the last fetus at its examination
appearing perfect, and four months old.t

The second difficulty is also capable of a plausible answer, but
not quite so satisfactory as the preceding :

There can be no doubt that the ovarium is directly concerned in
the great business of generation : for it is well known that the

• Med. Trans. Vol. vi. Aft. i^i,
t Pbil. Traiif.lS20.p. 101.

CI« T.] PHY610L0GHCAL PROEM. 21

operattoi of mylag or exdnog tlie OTuies corroipoiKli in £«-
nMdesto thai or cattradon in males. It takes oflf, not only all power
of prodoctioD^ but kll desire. And, in a recent Tolume of the Phi*
losopfaical Transactions, there is the case of a natural defect of this
kind in an adalt woman, who, in like manner, had never evinced
aDj inclination for sexnai onion and had never menstruated : and
who on dissection was found, with the deficiency of ovaria, to have
the uterus only of the size of an infant's, a very narrow pelvis, and
no hair on the pabes.*

It seems, also, perfectly clear that in conception an ovum does
really descend from the ovarium into the uterus within a few days
after sexual intercourse has taken place : in proof of which it will
be sufficient to quote the following curious historical fact from Sir
Everard Uome,t who appears to have traced its path very accurate-
ly : ^^ A servant maid, twenty-one years of age, died of an epileptic
fit seven days after coition, there being circumstances to prove that
she could not have seen her lover after the day here adverted to,
nor for many days before. The sexual organs were submitted to
dissection : the right ovarium had a small torn orifice upon the most
prominent part of its external surface, which led to a cavity filled
with coagulated blood, and surrounded by a yellowish organized
structure: its inner surface was covered with an eiudation of co-
agulable lymph. A minute spherical body, supposed to be an ovum,
was concealed in the cavity of the womb among the long fibres of
coagulable lymph which covered its inner surface, and especially
towards the cervix. Tiiis supposed ovum was submitted to the
microacopical powers of M. Bauer, who has made various drawings
of It, and who detected in it two projecting points which are con-
sidered as the future situations of the heart and brain.*'

What exact period of time the ovum demands to work its way
down the tube into the uterus, has not been very accurately ascer-
tained. That it does not descend at once is admitted on all hands :
and there can be no doubt that in difierent kinds of animals a differ-
ent period is requisite. Mr. Cruikshank, whose experiments were
confined to rabbits, ascertained that in this species the ovum de-
manded for its journey about forty-eight hours. In the case just
alluded to, seven days had elapsed, and consequently a period per-
fectly sufficient seems to have been given for the purpose, and
there can be little doubt that the minute body observed in the cavity
of the uterus was a genuine impregnated ovum that had completed
its travels.

But whence comes it to pass, if the copulative perculsion, feh
through every fibre, is the cause of the detachment of ova or ovula
from the ovaria, that examples should be found of a like detach-
ment, and consequently of a formation of corpora lutea in cases
where no copulation has ever taken place ? Of the fact itself there

• Vol. for the year 1805. p. 22S.
+ PhiU Trans. 1817. p. 252.

2Si PHYSIOLOGICAL PROEM, [CX. Y.

if DO qnefltion. ^^ Upon exanrfpiog^^^ says Sir EYerard.Home^ ^^ the
oiFaria of several women who bad died yirgrins, and io whom the
hymen was too periect to admit of the possibility of impregnation,
there were not only distinct corpora lutea, but also small cavities
roand the edge of the ovarium, evidently left by ova that had passed
out at some former period, «o that thit happens during the Hate of
virgimky*^^* Professor Blumenbach has met with similar examples ;
and they have endeavoured to account for it, first, by supposing
that the females thus circumstanced must have been of a peculiarly
amorous disposition, and at particular times morbidly excited by
a venereal orgasm originating in their own persons alone, without
any intercourse with the male sex. And Bext, that a higb^wrougpht
excitement of this kind may be sufficient to produce such an effect,
and to lead to the first and most important step in the generative
process. All this is highly ingenious, but we seem at present to
want facts to justify us in offering such an explanation. ^^ We cai^
not doubt,^' says Sir Everard Home, ^^ that every time a female
quadruped is in heat, one or more ova pass from the ovarium to
t3ie uterus, whether she receives the male or not^'t And to the
same effect Professor Blumenbacli, who first launched this opinion
in 1718, before the Royal Society ( of Gottengen. ^^ The state of
the ovaria,^' says he, ^^ of women who have died under strong sexual
passion has been found similar to that of rabbits during heat.^' And
in confirm^on of this he adds : ^^ in the body of a young woman,
eighteen y^rs of age, who had been brought up in a convent, and
had every appearance of being a virgin, Valisneri found five or six
Yedcles puAi$ig forward in one ovarium, and the correspondent
Fallopian tube redder and longer than usual, as he had frequently
observed in animals during heat Bonet, he adds,- gives the histofj
of a young lady who died furiously in love with a man of low rank^
and whose ovaria were turgid with vesicles of great size.'' In
lieither of these cases, however, do we meet with ovnla actually
detached, and still less with corpora lutea. Add to which, that noit
only corpora lutea, but detached ovula, and even imperfect fetation,
h^ve at times been found in the ovaries of infants of ten or twelve
years of age, who can scarcely be suspected of any such erethism :
a very curious instance of which we shall have to quote from Dr.
Baillie, under the genus PrGeotia.&

I am aware that the same explanation has been adopted by M.
Cuvier, indeed it is difficult to adopt any other, but direct facts in
support of it are as wanting in him as well as in the authorities just
referred to. There is an indirect fact appealed to, however, by
the last, which is well worth noticing for its curiosity, whatever

• Phil. Trans. 1817. at taprik.
tibid.

± Specifneo Physiologie comparats. Comment. Soc. Reg. Scientle Gdttengent.
Vol. IX. 128.

4 Class V. Ord. ii. Gen. ii. Spec. ii. of the present volume.

Ctm T.] FHTSICnXKHOAL PROEM. S3

degree of bearing it may have upon the present qaestion. AAer
obsenring' that a corpus luteam h not positire evidence of impreg-
natioo, be adds, nor does the existence of a decidua in the utems
coDfltftote better evidence of the same, since it has sometimes hap-
pened that at each period of paiafal menstruation the excitement
fjff the uterine vessels has produced a perfect decidua not to be dis-
tinguished from that belonging to an ovum. The present author
lias never met virith a case of this kind, but of the fact itself there
seems no doubt t Morgagni has given one striking instance of it in
liis daj,* and Mr. Stanley another in our own.t To e^lain the
origin of such a membrane under such circumstances is by no means
dmcnit, as it follows upon the common principle by which other
membranous or membrane-Hke tunics are produced in other hollow
eigans in a state of peculiar irritation, of which some curious ex-
amples have already been offered under diarrhcea tubvi.aris.^ The
peculiar character of the membrane must necessarily be governed
Dj the character of the organ in which it is formed. Upon the
whole, it does not seem to afford much suppori to the aigument in
whose fiivour it is appealed to, and the subject requires turther in-
Testigattion.

Hie ihird difficulty attendant upon the common doctrine of the
day, which supposes the fetus to hold its entire communication with,
and to derive its blood, nutriment, and oxygen from the mother by
means of the placenta and umbilical chord, is founded upon the oc^
casional instances of fetuses of large and even full growth being
found in the womb, and even brought forih at the proper period
wKhout any placenta, or at least of any utility, without any um;
bilical chord, or even the trace of an umbilicus. Admitting the
course jnSt glanced at to be the ordinary provision of Nature, what
is the substitute she employs on these occasions ? the means by
which the bereft fetus is supplied with air and nourishment?

The advocates of the doctrine of epigenesis, as new modelled by
the liands of Bufifon and Darwin, triumphantly appeal to these curi-
ous deviations from the established order of nature, as effecting a'
direct overthrow of the doctrine of evolution by an impregnated
ovum: while the supporters of the latter doctrine have too general-
ly cut the question short by a flat denial of such monstrous aberra
tions.

There is little of the true spirit of philosophy in either conduct
Admitting the existence of such cases, they just as much cripple the
one doctrine as the other, for, granting the explanation which is
usually offered by the former, the ordinary machinery of a placenta
and an umbilical chord, become immediately a work of supereroga-
tion : a bulky and complicated piece of furniture to which no im-
portant use can be assigned, and which the overloaded uterus might
be Will rid of

* De Sed. et Caus. Morb. Ep.
t Med. Trans. Vol. vi. Art, xvi.
% Vol. I. p. 162.

24 PHYSIOLOGICAL PROEM. [cL. \.

But, OD the contrary, to deny the existence of well established
and accumalated facts merely because we cannot bend them to our
own speculation, is still weaker and more reprehensible. The
kan^roo, opossum, and wombat, all breed their young without
either placenta or navel-string*. The embryons are inclosed in one
or more membranes, which are not attached to the coats of the
uterus, and are supplied with nourishment, and apparently with air
from a gelatinous matter by which they are surrounded. Hoffman
gives us the case of a fetus bom in full health and vigour with the
funis sphacelated and divided into two parts.* Vander Wiel gives the
history of a living child exhibited without any umbilicus, as a pub-
lic spectacle ;t and in a foreign collection of literary curiosities is
the case of a hare which was found, on being opened, to contain
three leverets, two of them without a placenta or umbilical vessels :
and the other with both.} Ploucquet has collected a list of several
other instances in his Initia :§ but, perhaps, the most striking ex-
ample on record is one which occurred to the present author in
December 1791, an account of which he gave to the public in
1795.|| The labour was natural, the child, scarcely less than of the
ordinary size, was bom alive, cried feebly once or twice after birth,
and died in about ten minutes. The organization, as well external
as internal, was imperfect in many parts. There was no sexual
character whatever, neither penis nor pudendum, nor any interior
organ of generation : there was no anus or rectum, no funis, no
umbilicus ; the minutest investigation could not discover the least
trace of any. With the use of a little force, a small, shrivelled pla-
centa, or rather the rudiment of a placenta followed soon after the
bjrth of the child, without a funis or umbilical vessels of any kind,
or any other appendage by which it appeared to have been at-
tached to the child. No hemorrhage or even discoloration follow-
ed its removal from the uterus. In a quarter of an hour afterwards
a second living child was protruded into the vagina and delivered
with ease, being a perfect boy attached to its proper placenta by a
proper funis. The author dissected the first of these shortly after
its birth in the presence of two medical friends of distinguished
reputation, Dr. Drake of Hadleigh, and Mr. Anderson of Sudbury,
both of whom are still able to vouch for the correctness of this
statement. On the present occasion, however, it is not necessary
to follow up the amorphous appearances any further, as they are
already before the public, except to state that the stomach which was
natural, was half filled with a liquid resembling that of the amnios.

* Op. de Pinguediue.

t Observ. Cent. post.

\ Commerc. Literar. Norimberg.

fr Initia Bibliothecao, Medico- Pracl. ct Chirurg. Tom. ill. p. 554. 4to. Tubing,
1794.

II Case of Preter-natural Fetation, with observations : read before the Medical
Society of London, Oct. 20, 1794.

CL, y*] PBYaiOUXttCAL PROBM. 25

This aa1](iect has beea brou^t forward, and will be foondi ablj
discQSsad io the earlier Tolumes of the Edinburgh Medical Essays,
by Professor Monro, and Mr. Gibson.* . The latter giving fall credit
to the few histories of the case then before the world, endeaTonrs
very in^nioas^ to account for the nutriment of the fetus by the
liquor aainU, which he conjectures to be the ordinary source df
vapplj and not the placenta. The chief arguments are, that the
embryon is at all times found at an earlier period in the uterus than
the placenta itself; which does not appear to be perfected till two
or three months aher conception ; and consequently that the em-
bryon must, thus far, at least, be supported from some other source
ihan the placenta ; and if thus far, why not through the whole term
of paturition ? That extra-uterine fetuses have no placenta, and yet
obtain the means of growth and evolution from the surrounding
parts. That the liquor amnii is analogous in its appearance to the
albumen of a hen's egg, which forms the proper nourishment of
the young chick : that it is found in the stomach and mouths of vi-
Tiparoos animals when first bom ; and that it diminishes in its vo-
lume in proportion to the growth of the fetus.

To these arguments it was replied by Professor Monro, that we
hawe no satisfactory proof that the liquor amnii is a nutritive fluid
at all, and that in the case of amorphous fetuses produced without
the vestige of a mouth or of any other kind of passage leading to
the stomach, it cannot possibly be of any such use : that if the office of
the placenta be not that of affording food to the embryon, it be-
coBies those who maintain the contrary to determine what other
office can be allotted to it ; and that till this is satisfactorily done,
it is more consistent with reason to doubt the few and unsatisfac-
toiy cases at that time brought forward, than to perplex ourselves
with facts directly contradictory of each other.

For the full scope of the argument the reader must turn to
the Edinburgh Medical Essays themselves, or for a close sunmianr
to the present author^s observations appended to his own case, ft
most be admitted that the instances adverted to in the course of the
dbcosdoo are but few, and most of them stamped with something
misatisfactory. Others, however, might have been advanced even
at that time on authorities that would have settled the matter of
fiict at once, how much soever they might have confounded all ez«
phmation. But after the history just given, and the references to
other cases by which it may be confirmed, this is not necessary on
the pieaent occasion.

It ia singular that the subject of aeration, which forms another
difficulty, in discussing the question, is not dwelt upon on either
side, notwithstanding the ingenious conjecture of Sir li^ward Hulse,
that the placenta i^ht be an organ of respiration as well as of
nutrition, had at this time been before the public for nearly half a

* VoL ». Art. xiu. Vol. u. Art., ix, ic, xi. See also Dr. Fleroiog't 'paper.
Phil. Traos. Vol. XUX. 1775-6. p. 254.
you IV. 4

26 FHIMOlMttGAI. FRMM. [«i»r.

omtwy : and it skowt w how %hm ikm hmk £MHidM
Qnfrequentlj are in obtaining the need of piblic aneat la irhkh
thej are ei^tled from the firat

Theie^ however, are oalj a lew of the pecaHar diificultiee tinft
still accoaipaajr the ttds^ect of feaeratioo, to whateter doctrine wt
attach onrselTOs. Tiiere are otfaera that aire aofe geaeral, hit
epaalij iBexpttcabfo. The whole rangv of extrsHitefflne letaeei la
of tluto character ; often fomod and noaiiihed oad detel^iod with*
oat either placeota or aa anaiea) aaid yet foaeUaMi advaaciagv
OTOD in the reaiolo cavity of the mrmbam^ and perfiMt ii erety inis
fan, to the age of, at leaat, liMnr ftoaitha, d'uhich wo faavo aWaady
oiered an ezasiple. Agrei^ part of the range of aaoi^MMB bMoi
defy eqyally all aaentai sohmon; particoia^ the piMoetlon of
■uNMters withoat heads or hearts, sowe of whoas hare lived for
several days after birth f* of others consistkff of a head ahMsOi
wholly destitnte of a tmnh, and yet possessii^ a fitll devekMmeot)
a spedmen of which was latefy k^ the posswfeit of Dr. Elfes, of
Neoss, oa the Rhine :t and of otheia again, the whole ^ whose abi»
domijial and thoraric viscera has been fooftd transpesed.|

Nor less inexplicable is the gehetative power of tvaasaiittki^ pe>
ctdiarities of talents, of form, or of defecis io a long line of heredi^
tacy descent, and occastonaUy of saspendiog the peouUafity throvgh
a link or two, or an individual or two, ivith an efmareiit caprksioas^
awss, and then of exhibitiog them once tnos^ hs raU vigoar. The
vast infloence whidi tliis recoadiie, hot acllve power pimosmas, ai
well over the mind and the hochr^ cannot^ et att times, eacape the
notice of the most inattentive. Not only ave wi^ heaaty^ and geolas
propagahle in tMs manner, hat didawss, amdnem^ aad defoimity ef
ovenry kind.

Even where accident, or a cause we esenaeidlBeeMi, has predooed
a pretematural conformation or stegukiity in a parttadar ergan, it
is astonisfahig to behold how reacttly it is often copied by the geimi^
ative power, and how tenadoosly it adheres to the mm Mneiige*
A pretenatoral defect in tlie haiid ev foot, has^ in mmiy oases, haea
wo commoii to the sncceeding members of a fam%, as to lay a £»aa#
dation in every age and conn^ for the imikj name, m hi tet of
Varro, Valgius, FkMwas and Pkitos of Reme. fteleocas had the
malic of an anchor on his thigii, and is said to have transmitted il«e
his posterihr : and sQpeRramerary fingem and toes have descended
in a direct line for many generatioiis in variom GOQirtil«s» Henoe
hornless sheep and hornless oxen produce an eqmdly hofatem o&
spring, and the broad-tailed Asiatic sheep yiekh a progeny with a
tail equally monstroas, often of not less than half a hmndtoed pemidi
weight And bence^ too, those enormous prominenees in the hhid-
er parti of one or two of the nations sA the back of the Cape of

* Bm tot ozHiDplci ftnd sutfaorittes tbe antlior^ Ttrtum of Ifotulogj*
t HuMandy Jouraal dec Ptactiieken KeHktnide. Apr. 181S.
% 8tai|iiois Pbil. Trani. 1674.

L

CU ▼.] FHVBiOIjMlCAL PROEM. 27

€l«od Hope, of whkh examples hare been ftinisbed to us in onr
om If land.

How, are we moreover to account for that fearfbl host of diseases,
gout, coosumptioD, scrophnla, leprosj and madness, which, ori^inat-
" _ In the first suffifirer accidentally, are propagated so
and so exlenslrely that it is difficult to meet with a family
\ blood is totally free from all hereditary taint ? By what means
lils preAapoiitioo nay be best resisted it is not easy to determine.
Bat w tiMve en be no qnestimi that intermarriages among the col-
lateral branches of the saae ftonily tend more thdb any thing else
to 6x sDd Mhiply aad aggravate it, there is reason to belie?e that
wakaoB between total etrangers, and, perhaps, inhabitants of diflerent
eeutiies, fyrm the sorest antidote. For admitting that such stran-
gers to each other may be tidnted* on either side with some morbid
pradkpoaitlon peculiar to their respective lineages, each must lose
siiiiibin| of its influence by the miitture of a new soil ; and we
are net without analogies to render it probable that in their mutoal
cneooMter Hk one may even destroy tne other by a specific power.
And, hence, nothiBg can be wiser, on physical as well as on moral
grmdi, than the restraints which dlvfaie and human laws have con-
cnmd in lajiag en marriages between relations : and though there
Is efiis thing ^mhit and extrairi^fant, tliere Is something sound at
the beHam, In the foUewIng remark of the sententious Burton upon
thia sobject:^ And surely,*' says he, » I think it has been ordered
by Qrfa napcclal providience, that, In all ages, there should be,
ence in six hmidred years, a transmig^tion of nations to amend
ani pntiff their Mood, as we alter seed upon our land ; and that
Hiere alioiild be, as it were, an inundation of those northern Goths
and Vandals and many such like people, which came out of that
pentinent ef Scandia and Sarmatia, as some suppose, and over-ran,
as a Mnge, nwat part of Eorope and Afiica, to alter, for our ffood,
enr r uiiipitiions tWt were much defaced with hereditary infirmi-
ttai^ wlddi by o«r lost and intempenmce we had contracted.*^
Bo^Mmk^ommm of a dUbrent and still seirere^ mode of disd-
I nt one time estabUriied In Scotland for the same purpose, but
' J hewerer anocessfal, would make, 1 am afiraid, sad havoc in
ear own day, were it ever to be carried into execution. *^ If any
earn,** snyahe, ^were visited with the falling sickness, madness,

Crt, laproey, er any sodi dai^rous disease, which was likely to
ptefMigated from &ther to son, he was instantly castrated ; if it
wnre n womanshe was debarred all intercourse with men ; and if she
wen Ibond pregnant with such complaint upon her, she and her
I ehtld were buried allve.**t

• Aaatoar of Melftnchoiy, Vol. i. Pan i. Sect ii. p. S9, Cvo.
t 0* V«t«niai Scotorom Moribu», Lib. i

CLASS V.
GENETICA-

ORDER I.
CENOTICA.

HOBBID DOCHAROES ; OR EXCESS, DEnciENCY OR IRREGULARITT OF SUCH
AS ARE NATURAL.

Tom order, the name of which is derived from Galen, and has been
exphdned already, is designed to include a considerable number of
diseases which have hitherto been scattered over every part of a
Boaological classification, bat which are related to each other as be^
kng morbid discharges dependent upon a morbid condition of one or
Biore of the sexual organs. The genera are five, and they may be
flras expressed :

L PAftAMBmA.

MISMEIVSTRUATION

n. tfUOORB»XA.

WHITES.

IlL MUnKWUfflCEA.

QOHORRBCBA.

rV. SRBlfORRHCEA.

SEMINAJi FLUX.

V. OALACTU.

MISLACTATION.

GENUS I.
PARAMENIA.

mOKBD XVACUATlOir OR DEFICIElfCT OF THE CATAMENUL FLUX.

is a Greek term derived from wtum " male'' and M4f ^^ men-
ib.^ The genus is here limited to such diseases as relate to the

30 GENETIGA. [cL. Y.-KOL I*

menstnial flui, or the vesseb from which it issues. This Ami Is
Incorrectly regarded as hlood, hy Culleo, Leake, Richerand, and
other physiologists : for, in truth, it has hardly any common pro-
perty with hlood, except that of heing a liquid of a red colour. It
is cMefly distinguished by its not being coagulable ; and hence,
when coagula are found in it, as in laborious and profuse menstrua*
tion, serum or blood is intermixed with it, aud extruded either from
atonic relaxation or entonic action of the menstrual vessels. ^^ It
is,^' observes Mr. John Hunter, ^^ neither similar to blood taken from
a vein of the same person, nor to that which is extravasated by
accident in any other part of the body ; but is a species of blood,
changed, separated, or thrown off from the common mass by an ac-
tion of the vessels of the uterus similar to that of secretion ; by
which action the blood loses the principle of coagulation, and, I
suppose, life.'^ Mr. Cruikshank supposes H to be thrown from the
mouths of the exhaling arteries of the uterus, enlarged periodically
for this purpose ; and his view of the subject seems to be confirmed
by a singular case of prolapse, both of the uterus and vc^na, given
by Mr. Hill, of Dumfries, in the Edinburgh Medical Commentaries.
In this case, the os tines appeared like a nipple projecting below
the retroverted vagina, which assumed the form of a bag. The
patient, at times, laboured under leucorrhoem : but it was ebsarved
that, when she menstruated, the discharge flowed entirely from the
projecting nipple of the prolapse-; while the leucorrhcea proceeded
from the surrounding bag alone.*

As this distifiction has not been sufficiently attended to either bj
oosologists or physiologists, many of the diseases occurring in the
present arrangement under paramenia, have been placed by otheor
writers under a genus named menorrhagia, which, properly speak-
ing, should import hemorrhage (a morbid flow of blo^d aUme) from
the menstrual vessels. And we have here, there£we, not only a
wrong doctrine, but the formation of an improper fesas; for
menorrhagia or uterine beaorrbage is, correctly ipeakisig, «Dly «
species of the genus HCMOBiiiuau, and will be so HbvbA im tlie
present system, in which it occurs in Class ra. Order iv. This
remark appUes directly to Sauvages ; and quite as much so to
Cullen, who, in his attempt to etrnf^ify, has carried the confusion
even further than Sauvages. Few diseases, perhaps, of the uterus,
or uterine passage, can be more distinct froik each other than
vicarious menstruation, lochial discharge, and sanious ichor ; yet all
these, with several others equally unallied, are arranged by Sau-
vages under the genus menorrhagia, though not one of them belongs
to it While Cullen not only copies nearly the whole of these
maladies with the names Sauvages has assigned them, but adds to
the generic list leucorrhoea or whites, abortion, and the mucous
fluid, secreted in the beginning of labour from the glenduiss
Nabothi at the orifice of the womb, and hence vulgarly denominated
its Mk9»^ or appearance.

• Vol. IT. p. 91.

«E» ir-BT. l] sexual VUNCnON. 31

HenstniatioD wolj be diseased firoin obstnictiOD, severe pain in Ui
•eeredon, excess oi discharge, transfer to some other organ, or
cessation : tb« offering as ttM fire following species, accoai^Mnied
witk ^Kttinct sjrmptoms :

1. FAaAnmu OBsraucrioiiB. obstrvcted MENSTRUATioir.

%, < DiFFlCILIS. LABORIOUS MENSTRUATlOir.

S. ' WnSLWLVA. ^ EXCESSIVE MEflSTRUATIOir.

4. •*-^— — SRROMS. VICARIOUS MXNSTRUATlOir.

h. — — - cauATioins. irregular cessatioh of sbs

MEITSBS.

SPECIES I.

PARAMENIA OBSTRUCTIONIS.

•totntcteH ^Irnitntatfiii*

CATAXBNIAL 8ECRETI01I OBSTRUCTED VX ITS COURSE ; SENSE QW OPPRESSION ;

languor; oTSPEPsr.

Tns species bj many writers called menostatio, appears under the
two ibllowing varieties :-—

io. The secretion obstructed on its

RetentioD of tlie menses. accession or first appearance.

The feet and ancles edematous

at night; the ejes and face in

the morning.

C Siipf>reasio. The secretion obstructed in its

Suppression of the menses. regular periods of recurrence.

Head-ache, dyspnoea, palpitation
of the heart.

la order to explain the first of these varieties, or retention of
THE menses, it is necessary to observe, that when the growth of tlie
animal frdme is completed, or nearly so, the quantity of blood and
aensorial power which have hitherto been employed in providing
for such growth, constitutes an excess, and must produce plethora
by being diffused generally, or congestion by being accumulated
locally. Professor Monro contended for the former effect; Dr.
Cullen, with apparently more reason, for the latter. And this last
ttfm it seems to take for the wisest of purposes ; 1 mean in order
to prepare for a future race by perfecting that system of organs
which is immediately concerned in the process of generation ; and
whidi, during the general growth of the body, has remained dor-
mant and inert, to be developed and perfected alone when tveTj
other part of the frame has made a considerable advance towards

32 OfiNWKU.' [Ch. T.-01U 1.

matarity, and there is, ao to speak, more leitare and materialfl for
80 important a work. We shall hare occasion to touch upon thk
subject more at large when we come to treat of the genns cfiLOitosis :
for the present it will be sufficient to observe, that this accnmnla-
tion of nervous and sanguineous fluid seems first to show itself among
men in the testes and among women in the ovaria, and that from the
ovaria it spreads to ali those organs that are connected with them
either by sympathy or unity of intention, chiefly to the uterus and
the mamm» ; exciting in the uterus a new action and secretion,
which secretion, in order to relieve the organ from the congestion
it is hereby undergoing, is thrown off periodically, and by lunar
intervals in the form of a blood-like discharge, although when
minutely examined, the discharge, as already stated, is found to
consist not of genuine blood, but of a fluid possessing peculiar
properties. These properties we have already enlarged upon, and
have shown in what they differ from those of proper blood : and It
is upon this point that the physiology of Dr. Culien is strikinghr
erroneous, for not only in his First Lines, but long afterwards in ok
Materia Medica, he regards the discharge as pure blood, and, conse-
quently, the economy of menstruation as a periodical hemorrhage.
» I suppose,'^ says he, " that in consequence of the gradual evolution
of the system, at a certain period of life, the vessels of the uterus
are dilated and filled : and that by this congestion these vesseb are
stimulated to a stronger action by which their extremities are
forced open and pour out blood. According to this idea it will appear
that, 1 suppose, the menstrual discharge to be upon the footing of
an actvoe kemorrhagy^ which, by the laws of economy, is disposed to
retom after a certain Interval."^

From the sympathy prevailing between the uterus and most other
organs of the system, we meet not unfrequently with some concomi-
tant afiection in various remote parts ; as an appearance of spots on
the hands or forehead antecedently to the efflux ;t or, which is
more common, a peculiar sensation or emotion in the breasts.^

We cannot explain the reason why this fluid should be thrown off
once a month or by lunar periods, rather than after intervals of
any other duration. But the same remark might have been made
if the periods had been of any other kind : and will equally apply to
the recurrence of intermittent fevers. It is enough that we trace
in this action the marks of design and regularity : and after the
establishment of a habit by a few repetitions, there is no difficulty
in accounting for the intervals being of equal length.

The time in which the secretion, and consequently the discharge,
commences, varies from many circumstances, chiefly, however,
from those of climate, and of peculiarity of constitution. In warm
climates menstruation appears often as early as at eight or nine

• Mat. Med. Vol, ii. p. 587. 4to.

t Salmutb, Cent. iii. Obs. 18.

t Act. Nat. Cur. Vol. in. App. p. 168.

GbLHO^.I.] SEXUAL FUNCnOff. 33

yean of age — for here the general growth of the hody advances
more rapidly than in colder quarters, and the atmosphere is more
stimulant In temperate climates it is usually postponed till the
thirteenth or fourteenth year, and in the arctic regions till the nine-
teenth or twentieth.

In all climates, however, when the constitution has acquired the
age in which it is prepared for the discharge, various causes, ob-
serves Dr. Gulbrand, may accelerate its appearance. Among these
we may mention aoy preternatural degree of heat or fever, or any
other stimulus that quickens the circulation. Mauriceau relates a
case in which it was brought on suddenly by an attack of a tertian
intermittent i and in like manner anger or any other violent emo-
tion of the mind, has been found to produce it as abruptly. The
depressing passions, as fear and severe grief, conduce to the same
end though in a different way : for here Uiere is rather uterine con-
gestion than increased impetus, in consequence of the spastic chill
of the small vessels on the surface, which lessens their diameter.
Inordinate exercise, or a high temperature of the atmosphere, has
in like manner a tendency to hurry on the menstrual tide ; and
hence its appearing so early in tropical regions. Dr. Gulbrand,
Indeed, conceives that even an increase in the elasticity or weight
of the atmosphere is sufficient to produce a like effect, and refers
to a curious fact inifroof of this. In an hospital, to which he was
one of the physicians, he tells us that a very considerable number
of the female patients were suddenly seized with catamenia ; which
was the more remarkable because several of these had, for a con-
siderable time laboured under a suppression of that discharge, and
had been taking emmenagogues to no purpose ; while others had
only been free from their regular returns for a few days. On in-
quiring into the cause, Uie only one which could be ascertained
was a veiy great augmentation in the weight or pressure of the
atmosphere, the mercury in the barometer having attained a height
at which it had never been observed at Copenhagen before : though
he does not state the point it had actually reached.* It is possible
that other general causes may sometimes operate to a like extent ;
and hence this disease is said, by StoU and other writers, to be oc-
casionally epldemict

Still much depends upon the idiosyncrasy : some girls are of a
more rapid growth than others of the same climate ; and in some
there is a peculiar- sexual precocity or prematurity of orgasm that
hurries on the discharge before the general growth of the body
would lead us to expect it, of which Pecklin gi?es an example in a
girl of seven years of age who, in the intervals, laboured under a

leucorrhcea.} And hence chiefly we are able to account for those

• •

* De SaoguiflusCi Uterino, 8vo. Hafn.

t Rat. Med. P. in. p. 48.

Samtnl. Med. WabrDebm. ix. B. p. 401.
X Lib. I. Qbt. 24.
VOL. IV. b

34 GftNETICA. [CL. V--OR, f.

very early and marvellous Ktories of pregnancy in girifl of iaot more
than nine years old, which if not well authenticated, and from dif-
ferent and unconnected quarters, might justify a very high degree
of scepticism.*

The e£9ux continues from two to eight or ten days ; and the
quantity thrown forth varies from four to ten ounces in different
individuals : the monthly return running on till the fortieth or fitltieth
year, and sometimes, as we shall have occasion to observe here-
after, to a much later period of life.

It is not always, however, that a retention of the menses to a
much later date than sixteen, or even twenty years of age consti-
tutes disease : for sometimes it never takes place at all, as where
the ovaries are absent or perhaps imperfect ; or where, instead of
precocity in the genital system, there is a constitutional ^tairdiness
and want of stimulus ; -under which circumstances it appeared for
the 6rst time, according to Holdefreund, in one instance at the age
of seventy.! It is only, therefore, when sjTnptoms take place in-
dicating a disordered state of some part or other of the body, and
which experience teaches us is apt to arise upon a retention of the
menstrual Hux, that we can regard such retention as a disease.

These symptoms, as already stated in the definition of the disor-
der, consist chiefly in a general sense of oppres^on, languor, and
dyspepsy. The languor extends over the wholl system, and affects
the mind as well as the body : and hence, while the appetite is
feeble and capricious, and shows a desire for the most unaccounta-
ble and intiutrient substances, the mind is capricious and variable,
often pleased with trifles, and incapable of fixing on any serious pur-
suit The heat of the system is diffused irregularly and is almost
always below the point of health: there is, consequently, great
general inactivity and particularly in the small veiisels and extreme
parts of the body. The pulse is quick but low, the breathing at-
tended with labour, the sleep disturbed, the face pale, the feet cold,
the nostrils dry, the intestines irregularly confined, and the urine
colourless. There is also, sometimes an irritable and distressing
cough ; and the patient is thouglit to be on the verge of a decline,
or perhaps to be running rapidly through its stages.

A decline, however, does not follow, nor is the disease found
fatal, although it should continue, as it has done not unfrequently,
for many years : for if the proper discharge do not take place, the
constitution will often in some degree accommodate itself to the
morbid circumstances that press upon it, and many of the sjmptoms
will become slighter or altogether disappear. Most commonly,
however, when the patient is supposed to be at the worst, probably
from the increased irritation of the system peculiarly directed to

• Haller, (Gotll. Eman.) Blumenbach. Bibl.^i. p. 558.

Schmid, Art. Helvet. iv. p. 167.

Eph. Nat. Cur. Dec, in. Ad. ii. Obf. 172.-
t Erziiklungen, N. 4.

CE. L-ep. l] sexuaj- function. 35

ibe defaoldng orgaos^ a little mucous or serous discharge, with a
slight show of colour is the harbinger of a beneficial change, and is
sooQ succeeded by the proper discharge itself: though it often hap-
pens that the efflux is at first not very regular either as to time or
quantify : but this is an evil which generally wears away by degrees,
and is dinainished with every recurrent tide.

All the symptoms indicate that retained menstruation is a disease
of debility ; and there can be little doubt that debility is its primary
cause — a want of energy in the secernent vesseb of the uterus that
prevents them from fulfilling their office, till the increase of irrita-
bility from the kicrease of general weakness, at length produces u
sufficient degree of stimulus, and thus momentarily supplies the
place of strength. The system at large suffers evidently from
sympathy.

Yet menostation may take place from a suppression of the menseh
aiter they have become habitual, as well as from their retention
la early life, which constitutes the second variety of the disease.

The causes of this form arc for the most part those of the pre-
ceding, and consist in a torpitude of the extreme or secernent vesr
sels of the uterus produced by anxiety of mind, cold, or suddenly
aappressed perspiration ; falls, especially when accompanied with
terror, or a general inertness and fiaccidity of the system, and more
particularly of the ovaria. Hence the disease may exist equally in
a robust and plethoric habit and in. the midst of want and misery.
Id the last case, however, it is usually a result of weakness alone ;
and on tliis account it is sometimes found as a sequel upon protrac-
ted fevers.

Aa this modification of the disease occurs after a habit has been
established in the constitution, its symptoms differ in some degree
from those we have just contemplated. And as it occurs also both
io a state of entony and atony, the symptohis must likewise difler
according to the state of the constitution at the time. If, however,
the frame be at the time peculiarly weak and delicate, the signs
will not essentially vary from those of the first variety, only that
there will be a greater tendency to head-ache, and palpitation of
the heart

If the habit be plethoric, and, more particularly, if the cause of
suppresaion take place just at the period of menstruation, or during
its efflux, a feverish heat and aridity of the skin usually make their
appearance, the face is flushed and tlie eyes red, the head is op-
pressed and often aches, with distressing pains down the back, occa-r
siooally relieved by a hemorrhage from the nose.

As the principle which should guide us in the mod^ of treating
both these varieties, will also extend to the ensuing species, it will
be most convenient to defer the consideration of it till that species has
passed in review before us. Wo shall then be able to see how far
fL common process may apply, and to contrast the few poiiits iu
which it will be necessary to institute t dificrcncc.

36 GBNBTfCA. [CU T«-K>1U I.

SPECIES II,
PARAMENIA DIFFICILIS.

PATAXCNU ACCOUPAMED WITH OBEAT LOCAL PAHf AND ESPECIALLY IN
THE loins; part of the fluid C0AG12LABLE.

In the preceding species the regular efflax is altogether prevented,
as we have already observed, bj a torpitude of the secerning ves-
sels of the uterus, perhaps of the ovaries also. In the species be-
fore ui there is no actual suppression, but the quantity thrown forth
is for the most part too small, and attended with severe and forcing
pains about the hips and region of the loins, that clearly indicate a
spasmodic constriction of the extreme vessels of the uterus. The
secretion is hence extruded with great difficulty, and is sometimes
perhaps of a morbid character : while from the force of the action
the mouths of some of the vessels give way and a small portion of
genuine blood becomes intermixed with the menstrual discharge,
forming coagula in the midst of an uncoagulating fluid, aad thus
drawing a critical line of distinction between the two.

The spastic action, thus commencing in the minute vessels of
,the uterus, not only spreads externally to the lumbar muscles, but
internally to the adjoining organs of the rectum or bladder, in ma-
ny instances, indeed, to the kidneys ; and hence an obstinate costive-
ness, and suppression of urine are added to the other symptoms,
and increase the periodical misery, the frequent return of which
embitters the life of the patient, and effectually prohibits all hope
of a family ; for if impregnation should take place in the interval,
the expulsory force of the pains is sure to detach the embryon from
its hold, and to destroy the endearing promise which it offers.
These pains generally recur at the regular period, but often antici-
pate it by a day or two, and rarely cease till a week afterwards.
The disease, moreover, is peculiarly obstinate, and in some in-
stances has defied the best exertions of medical science, and has
only yielded to time, and the natural cessation of the discharge.

We have frequently had occasion to observe, and especially un-
der croup, and tubular diarrhoea, that where hollow and mucous or-
gans labour under a certain degree of irritation, a portion of gluten
is often thrown forth with the morbid secretion that takes place on
the surface, and the result is the formation of a new membrane or
membrane-like substance that lines the cavity to a greater or less
extent : the nature of this substance being regulated by the nature
of the organ in which it tak# place. This remark applies particu-
larly to the uterus under the influeiRe of the%ritation we are now

CE. I.HJP, n.] ^ SEl^UAL FUNCTION. 37

n>eaking of; and, coDseqaeotlj, a membrane very mnch redembting
the decidaa, or that naturally elaborated by the uteras on impregna-
tion, has been occasionally formed and discharged in fragments,**^
during the yiolence and forcing pain of laborions menstruation.

Cold, mental emotion, local injury from a fall, and, ^bove all, a
pecnKar irritability of the atems itself, are the common causes.

The core of all the forms of paramenia, we hare thus far no-
ticed, is to be attempted first, by increasing the tone of the system
m general, and next, by exciting the action of the uterine vessels,
where they are mortrfdiy torpid, or relaxing them whefe they are
m pain from spasmodic constriction. Both the last, however, are
snbordinate to the first ; for if we can once get the system into a
state of good general health the balance of action will be restored,
and the organs peculiarly affected will soon fall into the common
train of healthful order.

To give strength and activity to the circulation is generally at-
tempted by tonics : to give local action, by stimulants. Both these
should be employed conjointly in the two forms of the first species.
The astringent tonics, however, are supposed, and apparently with
good reason, to be injurious, and in many instances to extend the
retardation, or diminish the flow where there is any appearance.
Ifyrrh has long been a favourite medicine, but its power does not
appear to be Very considerable in mismenstruation, though it un-
doubtedly acts as a stimulant in phthisis, and has at times, in highly
initable habits, produced hsmoptysis. The metallic tonics are
those on which we can chiefly depend ; and of these the principal
tliat have been employed are iron and copper. The first requires
less care than the second, and has hence been more frequently re-
cmred to as the safer. It has been given under a great variety of
forms, but that of the sulphate, or green vitriol, is one of theliest,
and most readily obtained. It is often tried, in union with myrrti ;
and, where symptoms of dyspepsy exist, and especially acidity in
tlie stomach, the two have been united with the fixed alkali, a com-
bination which makes the celebrated draught so well known by the
name of its inventor, Dr. GriflSths.

Iron is, by some writers, supposed to show an astringent, and by
others, an aperient power. In difierent constitutions it may be said
to operate both ways. " If for example," says Dr. Cullen, " a re-
tention of menses depends upon a weakness of the vessels of the
uterus, chalybeate medicines, by invigorating the force of the ves-
seb may cure the disease, and thereby appear to be aperient : and
on the contrary in a monorrhagia, when the disease depends upon
a laxity of the extreme vessels of the uterus, iron exhibited, by re-
storing the tone of these vessels may show an astringent operation.!

The preparations of copper labour under two disadvantages :
they are essentially more astringent than many of the other metals,

Deninao, MediAl Facts ana Observuiioiis. I. 12.
t Mat. Med, Vol, ii. p. 22, 4io.

38 GBNBTIGA. [CJL T.-OR. I.

and at the same time more aocertain in their effect. They are,
perha|)8, more soluble in the stomach than any other metallic pre-
parations, wherever there is a sufficient proportion of acid for tins-
purpose : but as the quantity of acid in ^is organ is constantly ▼»-
Tjing, their effect must vary also. Dr. Fordyce advises to avoid
cupreous preparations when the intention is to strengthen ; but when*
we attempt to lessen irritability he observes that they are extreme-
ly useful ; and hence, their advantage in epilepsy and plethoric hjrs-
teria. It is, however, a just remark of Dr. Saunders, that all solu*-
tions of metals are sedative and ease pain, or, in other words, take
off irritalMlity, provided the solution be not too strong. The old
tinctura veneris volatilis, consisting of one drachm of filings of cop^-
per infused in twelve drachms of water of ammonia, is one of the
simplest, and best preparations of this metal ; and forms a good sub-
stitute for the cuprum ammoniacum, or c. ammoniatum of the Editi*.
burgh and London Pharmacopoeias. Boerhaave directs us to begin
with three drops as a dose, and gradually to increase it to twenty-
four.

The chalybeate mineral waters have also been used with conside-
rable success, and the more so as with th^e are usually conjoined
the advantages of travelling, change of air, and a new stimulus
given to both the mind and body by novelty of scene, novelty of
company, amusing and animating conversation, and exercise of
various kinds. With these may also be combined, in the intervals
of the menstrual season, and particularly before Uie discharge
has appeared, the use of cold, and especially of sea-bathing Ad
unnecessary apprehension of catching cold by the employment of
this powerful tonic has been entertained by many practitioners : with
proper care I have never known it produce this ^ect; and it
should only be relinquished, where no re-active glow succeeds to the
chill produced by immersion, and the system is hereby proved to
he too debilitated for its use.

The stimulants to be employed under the first species, in conr
junction with a tonic plan, are those that operate generally and
locally. The general stimulants should consist of those that do not
exhaust the excitability or nervous power of the frame, but rather
by the moderation of their effect, and the constancy of their appli-
cation, support and augment it. Exercise, which we have already
recommended, will in this view also be of essential service ; as will
likewise be uniform warmth ; and hence, the warmth of a mild
climate, and a generous diet with a temperate use of wine. Hence
also the benefit of friction and electricity applied directly to the
hypogastric and lumbar regions.*

As the depressing passions produce the disease, the elevating

* Albert!, Diss, de Vi Electrica in Amenorrhoiatfi, souCatameniorum obstructio-
nem. Goett, 1764. ^^

Birch, Considerations of the Efl4pt:y of Electricity in Female Obstructions, &c,
Loud. 1799. • %

G£.l-»«ilJ sexual function. 99

pMdoas hii¥e oAen ksown to operate the best* and speediest cure.
k hoB sometiiDes suddenljf jie^lded to a fit of joy,'*' acid, in one
iDSteoce, ijrom the yiolence of the emotion, to a fit of terror.t We
caa hence eadiy see how it may be indoced by disappointed lo?e
and removed by a return of hope, and a prospect of approaching
happinesB.|

The stimnlants operating locally in this disease are known by
the name of emmenagognes. in the old writers the catalogue of
these is yery numerous. Those tliat are most worthy of notice
consist of the warmer gums and balsams, as guaiacum, assafoetida,
tarpeotiae, and petroleum ; castor, and the more irritating cathartics,
as aloes and black hellebore. The last is, in most cases, too stimulant
i^KMi the whole range of the intestinal canal, though at one time in
h^ fiivour as an emmenagogue. Aloes is a very valuable medi-
cine. Dr. Adair gave it in combination with cantharides ; but in
this form it will often be found to produce a troublesome irritation
oo the rectum . or bladder, rather than a salutary stimulus to the
▼essels of the uterus.

The jnaipenis Sabinaj or common savine, is also a valuable medi-
cine, as being both stimulant and slightly aperient, and operating
aat only locaUy but upon the system at large. It- may be given in
powder, extract, or essential oil : of the powder, the dose varies
from a scrapie to a drachm twice or three times a day : of the
extract from half a scruple to half a drachm ; and of the essential
oil frem two to four drops. Dr. Home thought highly ^f it, and
M. Ueiz has praised it in equal terms.§ The former declares that
by employing the scruple doses three times a-day he succeeded in
^ree out of five cases. But the most favourite emmenagogue in
his hands, was the root of the rubia tinciormk or madder. Of nine*
teen cases, of which be gives an account, fourteen, he tells us,
were cured by it. From half a drachm to a drachm was prescribed
twice or oftener daily. Dr. Home asserts that, in this quantity, if
produces scarcely any sensible operation, never quickens the pulse
Bor lies heavy on the stomach ; yet that it generally restores the
discharge before the twelilh day from the time of its commence-
raent.|| The present author has never tried it; he has been
deterred by the very different, and even contradictory accounts of
its effects upon the constitution which have been given by difierent
writers of \kgh avthority. While Dr. Home found it thus beneficial
in cases of obstructed menstruation, Dr. Parr tells us that it prO"
duced a cure in excessive menstruation, but in the former disease
^fected no change whatever.lF From its tinging the urine of a red

• Medicin.WocbenbUtt, 1783. p. 41S.
t Walther, Thes. Obe.ST.
% Eph. Nat. Cur. D«c. i. Ann. ix. x. Obs. 58.
i Briefe, ii. p. 5. ' ^

* I Clinical Expttdments, Hi||one8, Sl. Svo. 1780.
t Med. Diet. Vol. ii. in verb. p. 524«

40 OENETICA. ' [CL. V.-OR* I*

colour it has been supposed to be a powerfiil diuretic, bat even
this quality it has l>eeD incapable of supportiDg : and yet in
the opinion of Dr. Cullen tliis seems to be its only pretensioD to
the character of an emmenagogue."^ Given freely to brute animalB
Dr. Cullen tells us, that it always disorders them very considerably,
and appears hurttul to the system. Its direct virtues do not there-
fore seem to have been in any degree ascertained ; bat let them be
what they may, it has deservedly fallen into disrepute as a remedy
for any misaffection of the uterus.

The athamanta Meum^ or spignel, which once rivalled the repu-
tation of madder, and has long sunk with it into desuetude, is better
entitled to notice, and ought not to be abandoned. It seems to
have a peculiar influence in stimulating the lower viscera, and
especially the uterus and bladder; and is no indifferent sudorific.
On this last account it was at one time highly in favour also ia
intermittents, and was afterwards employed in hysteria, and humoral
asthma.

This part of the subject must not be quitted without glancing at a
medicine that has lately acquired great popularity in North America,
as an emmenagogue, and is said to have been employed with unques-
tionable success. This is spurred rye, or rye vitiated by heiDg*
infested with the clavus or ergot, a parasitic plant which we liave
already had occasion to notice as producing a powerful effect on
the whole system, and especially on the nervous part of it, and the
abdominal viscera in general. ^ When taken in such a quantity as
to be poisonous, it first excites a sense of tingling or formication,
and fiery heat in the extremities, where the action of the system is
weakest ; to this succeed cardial^, and griping pains in the bowels ;
and then vertigo, an alternation of clonic and entonic spasms in
different parts of the body, and mania, or loss of intellect. If the
quantity be something smaller than this, it excites that pestilent
fever, which the French denominate mal des ardens, and in the
present work is described under the name of festis erythemaiica :t
while in a quantity still smaller it seems to spend itself almost
entirely on the extremities as being the weakest part of the body,
and to produce that species of oANait£NA,which is here denominated
nsHlaginea^ or mildew mortification.];

It is hence a very acrid irritant, and from its peculiar tendency
to stimulate the hypogastric viscera, seems often, in small quanti-
ties, to prove a powerful emmenagogue. For this purpose an ounce
of spurred rye is boiled down in a quart of water to a pint : half of
which is usually taken in the course of the day, both in obstructed
and difficult menstruation, and continued for three or four days.
The symptoms said to be produced are head-ache, increased heat,
and occasional pain in the hypogastrium, succeeded by a free and

• Mat. Med. Vol. il. p. 553. 4to. edit. comp. with p. 38, of the same.

t Vol. II, p. 427. 428. •

% Vol. II. p. 608. *

G& L-6P. IL] sexual FUNCTION. 41

•Mj flow of die menstraal fluid. Advantage has been takeo of
this efiect on another occasion, for the same medicine has been
prescribed in lingering labours, and we are told by Dr. Bigelow,
with the best success, as good forcing pains are hereby very generally
produced speedily.* In this case Dr. Bigelow, instead of a decoc-
tion of spurred rye, prefers giving the crude powder, to the amount
of ten grains to a dose.

We have hitherto regarded the spur in spurred rye, and other
grain, as a clavus or species of ustilago. It was formerly, however,
conceived to be a disease of the grain itself M. DecandoUe has
sfaice described it as a variety of champignon, under the name of
sderotium, from its rendering the grain hard and homy. And M.
Virey in a work reported upon by M. Desfontaines, to the Acade-
my of Sciences of the French Institute in 1817, lias still more lately
endeavoured to revive the obsolete opinion, by contending that it
is a specific disease of the plant under which the grain is render-
ed not properly speaking hard and homy, as is actually the case
when infested with the sclerotium, but rather friable and easily
detached.

There is something highly plausible and ingenious in the plan
that was at one time tried rather extensively, of compressing the
cmral arteries by a tourniquet, and thus gorging the organs that lie
above and are supplied from collateral branches. By compressing
the jugular veins we can easily gorge the head and endanger extra-
Tasi^oo and apoplexy. But it appears upon trial that the tide thus
dammed up in the case before us, is thrown back upon too many or-
gans to produce any very sensible effiect upon the uterus. Indepen-
dently of which the uterus is not like the brain, exactly inclosed in
a booy box that prohibits a general and equable dilatation of its ves-
sels. In six. cases in which Dr. Home made experiment of this re-
medy, he succeeded but once ; and others have been less success-
ful stiU.t

Impeded menstruation is sometimes, however, a disease strict-
ly local, and proceeds from the obstruction of the passage by a
polypous or other tumour or an imperforate hymen. In all these
cases it is obvious that the cure must depend upon a removal of the
local cause.

Emetics have often been recommended ; they rouse the system
generally, but have not often been found useful in retention of the
menses : thoi^h when employed in cases of suppression, and espe-
cially at the regular periods of return, or so as to anticipate such
return by a few days, they frequently prove a valuable adjunct. If
this jperiod be passed by without any salutary efiect, and particular-
ly, i^ at the same time, the system labour under symptoms of op-

* New England Joorn. of Med. aad Surg. Vol. r. No. ii.

TOt. TV.

t ^aniltony £dio.CoiD. Vol. A^rt. 31.
Welj md Fabric, vf. tf. ^

I

4ft GENETICA. [CL T.-<iR. 1.

pression in the head or chest, venesection to the extent of frotti
foar to six ounces of blood will be found a very nsefnl palliatiTe,
and will haye a tendency to keep op that periodical habit of deple-
tion which will probably prove advantageous against the ensuing
lunations. Venesection will also be found useful and often absolute-
ly necessary where the suspension has suddenly taken place during
the flow of the catamenia, from cold, depressing passions, fright, or,
indeed, any other cause.

In treating the second species of paramenia, or dffficntt menstma*
tion, the stimulant part of the process we have thus far recommend*
ed must be sedulously abstained from, but the rest may be follawed
with advantage. Every thing, indeed, that has a tendency to pro-
duce local excitement, and in this respect the conjugal embrace it-
self, where the patient is married, must be systematically abstained
from. The diet must be plain and inirritant, and the bowels be
kept cautiously open with neutral salts or other cooling aperients.
And, to allay the strong spasmodic action on which the severe pains
in the lumbar and hypogastric regions depend, it will be found high-
ly advantageous, a short time before the expected return of men-^
struation, to employ relaxants, and especially local relaxants ; and
of these, one of the best and pleasantest is the hip-bath, which ope-
rates directly upon the diseased quarter, and has a tendency to pro-
duce the desired effect without weakening the system generally.
The ease and comfort of this val^iable contrivance is acknowledged
by almost all who have had recourstg to it. Martini and various
other writers recommend the cold bath in preference to the hot,
and Tissot represents the latter as injurious. But thi^ is to speak
without due discrimination. That the cold-bath has been found of
use in some instances is unquestionable : but only where there has
been such a degree of energy in the constitution as to produce a
reaction correspondent to the antecedent rigoh The direct efiect
of the cold bath is to constringe, and consequently where a spastic
contraction exists already, as is mostly the case from local or con-
stitutional debility, to increase the evil. But where the constitution
is naturally robust, and but little inroad has hitherto been made up-
on its strength, the latent energy of the system is capable of resist-
ing the sudden shudder : an increased action and consequently an
increased dnd glowing heat ensoe; the repelled fluids are fbrted
forward ; the blood flows more briskly ; the mouths of the capillary
vessels give way in every direction ; the muscular fibres lose thelt
rigidity, and the suppressed secrefioris, of whatever kind, recom-
mence. And, hence it is, ^bat cold bathing may sometimes be
serviceable in the disease befot^ us, and warm bathing less use-
ful ; but these cases are rare, and warm bathing is mostly to b^
preferred.

Even the hip-bath, however, though it mitigates the pain, occa-
sionally does nothing more ; there is the same paucity Of discharge,
the same intermixtttre of coagula, and the same tendency to a re-

f3E. U-SP. H*] SEXUAL FUNCTION. 43

ton of the 4ifle«9e. Id such casaS| it has been common to ahstract
fight .or ten onncee of blood from the loins by cupping, antecedent-
^ to the ttse of tbie bath : and this, by diminishing the spastic con-
ftijctiGp, has, at times, diminished in a still greater degree the dis-
tremog pain. But I do not thiojc the hip-bath is in general had re-
coone to early enough to give it all the beneficial effect it may be
Bade to possess. Instea^l of waiting till the periodical pains return,
as is the comnion practice, I have found it more advantageous to
fll^j<apate this jperiod, and to relax the vessels by employing it for
t«ro 4>r th«ee 4»igbts before the pains are expected* And iv^ere in
this and every other way it has failed, pr the patient from great de-
Ucacy of conatiitutioo has appeared too much exhausted by its use,
I Jwre av^ied myself of the same relaxant power in another way,
and, with » like anticipation, have prescribed the use of a broad
folded swathe of flannel wrung out in hot water, to be applied round
tfaeioioa and belly at the time of going to rest, and bound over with
a linen swathe oi equal width, as already recommended in peritoni-
tis, and hepatitis. The whole should be suffered to remain till the
gioming, by which time the warmth of the body will be usually
Iband to have evaporated all the moisture, though the s)un wiU
•tiU be dewy with perspiration from so powerful a sudorific. I have
qfiao ibvmd this plan succeed ^till better than the hip-bath ; and
IttFe never known the patient catch cold, or complain of any chilly
sensation firom the use of the epithem.

SPECIES III.

PARAMENIA SUPERFLUA.

<^ti|ieirflMotw jRf eiuftntatfon.

ftlTAWBgi X9BCI96I^ ^O ACCOMPANIED WITH HCMORRBAaE nOM TfOt
MENSTRUAL VESSELS.

Tops spades alecs ns a disease precisely the reverse ,ef the U^
aat km In 4^ iaoiUty with which the mpuths of the vessels give
iw, tt^n In the quantity of the dischacge. It exhibits the two
fidlowii^ varieties :

H Hednplicata. Excessive from a too frequent re-

KedopUcate menstruation. currence.

C Profma. Excessive from too large a flow at

Profuse menstruation. the proper periods.

Tlie SECOND VAAiBTv, or profuse menstruation, is often technically
dMogidshed by the name of meporrhagia. It is, in effect, tna

44 GENETICA. [CL. T.-eiL I.

menorrhagia rubra of Callen, who makes it a distinct affectioQ from
metrorrhs^a or hemorrhag^a uteri, by confiiiing the latter term to a
significatioQ of hemorrhage from other yessels of the otems than
those coDcemed Id separating and discharglDg the catamenial flux.

We have already observed that we cannot lay down any general
rule to determine the exact quantity of fluid that ought to be thrown
forth at each lunation, some individuals secreting more and others
less ; and the measure varies from four to eight or ten ounces. We
can only, therefore, decide that the quantity is immoderate and
morbid when it exceeds what is usually cKscharged by the individual,
or when it is associated with unquestionable symptoms of debility,
as paleness of the face, feebleness of the pulse, unwonted fatigue on
exercise ; coldness in the extremities, accompanied with an edema-
tous swelling of the ancles towards the night, pain in the back in
an erect posture ; and various dyspeptic affections.

Either of the varieties may be entente or atonic, or, in common
language, active or passive : but in the first there is nsually a
greater degree of local irritability than in the second, so that the
secements are excited, or the extremities of the minute blood*
yessels open upon very slight occasions. As the disease may occur
under these two different states of body, it may proceed, as Dr.
Gulbrand has observed, from an increased impetus in the circulation,
a relaxed state of the solids, or an attenuate state of the fluids :*
to which be might have added uterine congestion.

Increased impetus usually indicates great robustness of consti-
tution, or an entonic habit, and is not unfrequently connected with
uterine gestation ; and the accidental causes are, in many cases,
cold, a violent shock or jar, or an accidental blow. Under this form
the disease commonly yields to venesection, cooling laxatives, and
quiet ^

Sup^'rfluous menstruation from atony, or in other words, a relaxed
state of the solids, and an attenuate state of the fluids, frequently
arises from repeated miscarriages or labours, poverty of diet, and an
jimmoderate indulgence in sexual pleasure. It often proceeds, also,
and especially in the higher ranks, from a life of indolent ease, and
enervating luxury, producing what we have denominated atonic

Slethora, lax yessels easily distended by a current of blood super-
uous in quantity but loose and unelaborate in crasis, and whicn is
reproduced, and perhaps still more abundantly but at the same time
still more loosely, as soon as the excess is attempted to be removed
by bleeding.

Here, therefore, venesection is almost sure to do mischief;
we must restrain every luxurious excess as far as it paay be in our
power, apd we may have authority enough to insure a conipliance,
which is not always the case ; we must employ, at the same time,
the milder tonics with astringents, as kino, catechu, or sulphate of
zinc, and carefully guard a^dnst costiveness by cool vnirritating

I — — f

* Ih Sanguioe Ut«rino. ?▼•• Hava. 177S.

GE. L-er. ul] sexual functiok. 45

lazatiTes. If the discbaif e be irery considerable, astringeDt iojeo
tiODfl of cold water, or which will commooljr be found better, of a
iohition of almn or zinc, or cold water with a third part of new
port wine, should be had recourse to without fail ; or the vagina
HHij be closely plugged up with a sponge, confined with a proper
bandage. Earlj hours are of especial importance, with a due inter-
■mrtvre of moderate exercise, and the use of cold sea-bathing. The
Cheltenham waters, as those also of many other chalybeate springs,
iiaye often proved serviceable, partly from their own medicinal
powers, and partly from the greater purity of air and increase of
exercise with which a temporary residence at a waterii^-place is
etoally accompanied.

It is a common observation, in moral as well as in physical
philosophy that extremes meet in their effects, or produce like
resutts. There is, perhaps, no part of natural history in which this
Is more frequently exemplified than in the sphere of medicine.
In the case of apoplexies and palsies, as well as various other
^aeases, we have had particular occaMon to make this remark;
and in Uie genus immecUiately before us, as well as others closely
connected with it, we have another striking instance of its truth.
^ The proportion of the diseases peculiar to the female sex in the
bospital,^^ says Sir Gilbert Blane, speaking from tables accurately
kept by himself for this purpose, ^ is the same as in private cases ;
from which it would appear that the unfavourable influence of
iadolent habits, excessive delicacy, and sensibility of mind and body
in the upper raqks, compensate for the bad effects of hard labour
pid various privatibns in the lower orders.^'

SPECIES IV.

PARAMENIA ERRORIS.

0fcatfott8 ^rtiittniatfoti.

CATAMENU TRAHSFERRED TO, AND EXCBETEO AT REMOTE ORGANS.

Wb have already observed upon the extensive sympathy which the
sexual organ^ maintain with every other part of the system. With
the exception of the stomach, which is the grand centre of sympa-
thetic action, there is no organ, or set of organs, possessed of any
thing like so wide an influence. And hence, where, from any
• particular circumstance, as sudden fright or cold, the mouths of the
menstrual vessels become spasmodically constricted at the period of
Aenatniation, and the fluid is not thrown forth, almost every organ
ieema ready to offer it a vicarious outlet. We have accounts,
tiierefore, of its having been discliarged, by substitution, from the

46 o^nsTicA. [a«* r.-aiu i^

^ei, tbe ooBtnk) the tockettof the teeth, the can, the Dipfdai, thf
stomach, the rectum, tbe bladder, the navel, and Ihe skio generallTy
m noticed more falljr in tbe volume of Nosology to whAch ^
reader may tarn at his leisure.

In effect* there is scarcely an organ of the body from which it hai
Bot been dif«charg!ed under different circnmstances.* in the Edii^
bai^b Medical Enays is a very singular case of its being tbronEHi
forth from an ulcer in the ancle of a young woman little moire tbt^m
twenty yean of age, and which continued to flow at laontUj
periods, lor two or three days at a timet ^^^ about five yemi:
after which, some fiart of tbe bone having separated in a c9gion$
state, the ulcer assuming a more healthy appearance, and the bjod^r
becoming plumper and stronger, the vkietfious outlet was no longer
needed, and tbe menstrual tide returned to its proper Qhanoel*t

io all these cases there is a considerable degree of uterine Aoif^
tnde^ and commonly of general debility : while the part forming the
temporary outlet is in a state of high irritability or other dieeaaad
action. And hence tbe remedial process should consist in aUayiRg
Uie remote irritation, strengthening the system generally, -aM
gradually stimulating the uterus to a state of i^althy e»cltei»eat by
the means alvendy fecommended.

SPECIES V.

PARAMENIA CESSATIONIS.

Xrrrgutor ensratfoti of tite i^tnma.

CATAMENIAL FLUX IRREGULAR AT THE TERM OF rrS NATURAL CESSATION ;
OCCASIONALLY ACCOMPANIED WITH STMFTOMS OF DROPSY, GLANDULAR
TUMOURS, OR SPURIOUS PREGNANCY.

The set of organs that are most tardily completed and soonest ex-
hausted are those of the sexual system. They arrive latest at per-
fection and are the first to become worn out and decrepit In this
early progress to superannuation the secretory vessels of the uterus
grow torpid, and, by degrees, the catamenial flux ceases. This
cessation, however, has sometimes been protracted to a very late
period, and, in a few rare instances, the menses have continued

•'■'■■ III I ■ I H ■ ■

* Eph. Nat. Cur. passim. Act. Nat. Cur. Act. Med. BeroU
Bertholin. Obs. passim. Cent, passim.
Fwhlm, lib. I. patsim.
Bierling. Thes. Pracu
Seiuiertu% Pract. et ParaUp. Lib. iv.

t Art, by Mr. Jamts Calder, Vol. in. Art. xxix.^ S41.

OB. L-bK t.] SEXUAL FUNCmON. 47

iie«riy^ or tltogetlMr, throtifh the wfade (em of life : we hav« ex-
amplesi of H, noticed in the ▼olatne of Nosology, atserentj, efghtT)
abd even nin^tj yean o( age ; but the nsoal term it between fmr
and fifty, except where women marry late in life, in which c»e,
from the postponement of the generative orgasm, thej will, occo-
ritoimllj, breed beyond their fifdeth year. On approaching the na-
toral term of the cessation of the menses, the sexual organs do not
aiways appear to act in perfect harmony with each otlier, and per-
haps, at times, not eren eveir part of the same organ with every
Other part In proof of the first remark, we seem, occasionally,
to itieet with a lingering excitement in the ovaria, after all ex-
citetDent has ceased In the *uterus : and we have hence a kind of
coneeptiTe stimalation, a physcony of the abdomen, accompanied
with pecollar feelings, and peculiar cravings, which mimic those
of pregnancy, and give the in^vidual room to believe she is really
pregnant^ and the more so in consequence of the cessation of her
lanar discharge, while the uterus takes no part in the process, or
merely that of sympathetic irritation, without any change in size
or structure. '

On the contrary, we ma? chance to find the uterus itself chiefly,
if not solely affected with irregular action at this period : evincing,
sooMtimes a suppression of menstruation for several months, some-
Unes a profuse discharge at the proper period, and sometimes a
SBNdler discharge returning every ten or twelve days, often suc-
ceeded by leucorrhoea. And not unfrequently the system associates
generally in the misaffection, and suffers from oppression, head-
ache, nausea, or universal langpaor.

Ah these are cases that require rather to be carefully watched,
than rigorously practised upon ; and the character of an expectant
nhysiclan, as the French denommate it, is the whole that is called
fer. The prime object should be to quiet irregular local irritation
wherever necessaty, by gentle laxatives, moderate opiates, or other
nal^colics, and to prevent any incidental stimuhis, mental emotion,
or any other cause, from interfering with the natural inertness into
which the sexual system is progressively sinking. Hence the diet
Aould be nutritive but plain ; the exercise moderate ; and costive-
nen prevented bv lenient, but not cold eccoproctics : aloes, though
mosl osoally had recourse to, ftom its pungency, in earlier life, is
olife of the worst medicines we can employ at this period, as the
EpMm Saks, warmed with any pleasant aromatic, is, perhaps, one of
thebiest.

y the eonstitation be vigorous tod plethoric, and particularly if
ftie hffiad feel oppressed and vertiginous, six or seven ounces of
hlood may, at -first, be taken from the arm ; but it is a practice we
should avoid if ponible, from the danger of its being necessarily
leiorted to again, and at length mnniiur into an inconvenient and
deWitatii^ habit

The mamnia ^at constantly associate in the changes of the ute-
ma and coutitute a direct part of the sexual system, are at this

48 GENETICA. [CL. T.-OR. U

ttflde, ako, not tmireqaently Id a state of considerable initatioo ; and
if a cancerous diathesis be larking in the constitution, such irritation
is often found sufficient to excite it into action. And hence, the pe-
riod before us is that in which cancers of the breast most frequently
show themselves.

From the natural paresis into which this important and active
system is hereby thrown, a certain surplus of sensorial power seems
to be let loose upon the system, which operates in Tarious ways.
The ordinary and most favourable mode is that of expending itself
upon the adipose membrane generally, in consequence of which a
larger portion of animal oil is poured forth, and the body becomes
plump and corpulent. The most unfavourable, next to the excite-
ment of a cancerous diathesis into action, is that of irritating some
neighbouring organ, as the spleen, or liver, and thus working up a
distressing parabysma or visceral turgescence; or deranging the
order of Sie stomach, and laying a foundation for dyspepsy.

GENUS II.
LEUCORRH(EA.

MVCOUS OISCHABGE FROM THE VAGUTA, COMMOITLY WITHOUT UrVBCTIOir ;
DISAPFEARINO DURING MENSTRUATION.

The term leucorrhoea from xwuh, ^' white,^' and fw, ^' to flow,^' is
apparently of modem origb ; as it is not to be found in either the
ureek or Roman writers ; and seems first to have been met with in
Bonet or Castellus.

This is the monorrhagia cUki of Dr. Cullen, so denominated be-
cause he conceives the evacuation to flow from the same vessels as
the catamenia ; as also that it is often joined with monorrhagia, or
succeeds to it Its source, however, is yet a point of dispute :*
Stoll,t PiniBus, and various other distinguished writers have ascribed
it, like Cullen, to the uterus. But as it occurs otlen in great
abundance in pregnant women, in girls of seven, eight, and nine
years of age,| and even in infants, it has been supposed by Wedel,§
and most writers of the present day, to flow from the internal sur-

* Rat. Med. P. vii. p. 155.

t Do Notis Viiginitatis. Lib. I. Prob. 3.

% Heister, Wabrneihuiigeiiy B. ii. N. 138.

Hoecbstailer, Obs. Med. Dec. iv. Cas. i. SchoU
) Di98. De Fluoro albo. Jen. 1743.

•E.n.-3P.I.J SEXUAL FUNCTION. ' 49

face of the vagina, or at the utmost, from the vagio^ jointly with
the cervix of the uterus. Morgagoi is, perhaps, most correct, who
conceives, and appears, indeed, to have proved by dissections, that,
io different cases, the morbid secretion issues from both organs ; for ,
be has sometimes found the uterus exhibitiD^ in its internal surface
whitish tubercles, tumid vessels, or some other diseased indication,
and sometimes the vagina, during the prevalence of this malady.*
Io the case narrated by Mr. Hili« o^ Dumfries, and noticed under
the preceding genus. It was evidently confined to the vagina alone.t

From its frequency in Sweden, Riedlin conjectures it to be en-
demic there 4 but this can hardly be allowed, and there are more
obvious causes to which such frequency may be referred.

When first secreted it is bland and whitish, but differs in c<^lour
and quality under different circumstances, and hence affords the three
following species :

1. LEUCORRHCEA COMMUNIS. COMMON WHrTES.

2. NABOTHl. LABOUR-SHOW.

3. SENESCENTIUM. WHITES OF ADVANCED LIFE.

SPECIES I.

LEUCORRHCEA COMMUNIS.

ittmmm 9ltffiiun.

THE DISCHABGE OF A TELLOWISH-WHITE COLOUR, VERGING TO ORE^.

Ten species is the fluor albus of most writers. It is found in girls
antecedently to menstruation, or on any simple local irritation in
the middle of life, and hence also, as just observed, during preg-
nancy. It is said in the Berlin Transactions to be occasionally con-
tagious :§ and I have met with various cases which seem to justify
tlds remark.

It has occurred as the result of suppressed menstruation : as it is
said also to have done'^on a suppressed catarrh ;|| and chillness or sup-
pressed perspiration of the fcet.ir Local irritations moreover are

• De Sed. et Caus. Morb, Ep. xlvii. Art, 12. 14. 16, 17, 18, 19. 27. Ep. Lxvit.
ArU 14.

t Ediob. Med. Comment, iv. p. 91.
X Lin. Med. 1695. p. 164.
k Act. Med. Berol. Dec. L Vol. v. p. 85^
y Act. Erud. Lipa. 1709, p. 376.

Raul in, 8ur les Fleurt blanches, p. 329.
t Acu Nat. Cur. Vol. viii. Obi. 3«.
VOL. IV. 7

50 GENETWA. [CL. V.-OR, I.

frequent causes. And hence one reason of its being an occasional
concoroitant of pregnancy ; as also of its being produced by pes-
saries injudiciously employed, by voluptuous excitements, and un-
clean lincss. It is said at times to exist as a metastasis, and particu-
larly to appear on a sudden failure of milk duriag the period of lac-
tation ; a failure which may be set down to the list of suppressed
discbarges * Jensen gives a singular case of leucorrhcea that al-
ternated with a pituitoufl couglkt

It is usually accompanied with a sense of languor, and a weak-
ness or pain in the back. And if it become chronic, or of long con-
tinuance, the countenance looks pale and unhealthy, the stomach is
troubled with symptoms of indigestion, the skin is dry and feverish,
and the feet edematous.

The discharge, in its mildest form, is slimy, nearly colourless, or
of an opaline hue, and unaccompanied with local irritation. It af-
terwards becomes more opake and muculent, and is accompanied
with a sense of heat, and itching or smarting ; in this stage it is of
a yellowish-white. But as the disease advances in degree it ap-
pears greenish, thinner, more acrid, and highly offensive, and is apt
to excoriate the whole surface of the vagina : while there is oAen
a considerable degree of pain in the uterus itself and even in the
loins.

Among novices there is some difficulty in distinguishing the dis-
charge of whites from that of blenorrhoea, which we shall describe
presently. But though the appearance of the two fluids is often
similar, they may easily be known by their accompanying signs.
In blenorrhoea there is local irritation from the first, and this irrita-
tion extends through a considerable part of the meatus urinarius, so
as to produce a considerable pain in making water; symptoms
which are not found in leucorrhcea. There is also from the first in
the former a swelling of the labia, a more regular though a smaller
secretion, and of a more purulent appearance.

When the (Hsease is violent, or of long continuance, it leads to
g^eat general as well as local debility, so as in some instances to
make sad Inroads on the strength of the constitution. It has some-
times been followed by a prolapse of the uterus or vagina ;| by
abortion or miscarriage, where there is pregnancy ; and by barren-
ness, where no pregnancy has occurred. When it acts on the sys-
tem at large, it has given rise to cutaneous eruptions of various
kinds ;§ and is said to have introduced tabes and hectic fever,||
scirrhus, and cancer.lT

The cure is often difficult : but it is of no small importance to be,

* Astruc, De Morb. Mulier. Lib. i. cap. 10.

t Prod. Act. Havii. p. 160.

:f. Bocrhman, Disfu de Prolapsu et Invertione Uteri. Hal. 1745.

( Klein, Interpr*!8 Clinicus. p. 112.

II Hippoci. Aph. Sect. v.

^ Raulioi Sur les Fleurs blanches. Tom. f. passim.

GE. If.-«P. I.] SEXUAL FUNCTION. 51

from the first fullj acqaainted with the nature of its cause and cha-
racter, for the proper means to be pursued will mainly depend
upon this. Aud hence It will oflten be necessary to examine the or«
gans themselyes, or to entrust the examination to a nurse on whose
judgment we can fully depend.

If the cause be unclean liness, a lodgment of some portion of a
kte menstrual flux, or any other acuating material in the vagina,
nothing more may be necessary than frequent injections of warm
water: or if the vagina itself be much irritated, injections of the
diluted solution of the acetate of lead : which last will often indeed
be found highly serviceable where the dischai^e proceeds from de^
bility and relaxation produced by a severe labour or miscarriage,
formiiig no uncommon causes : as they are also no uncommon ef-
fects.

Other astringent injections have often been tried, as green tea, a
solotioD of alum, or sulphate of zinc, a decoction of pomegranate
bark, or a solution of catechu. All these are sure to be of service
as tending to wash away the discharge, and keep the parts clean ;
and in many cases they will also succeed as astringents : nor is it
always easy to determine which is to be preferred, for in some cases
one answers the purpose best, and in others another.

Sir Kenelm Digby recommended a local application of the fume
of sulphur,* which may be communicated in various ways; and so
far as this has a tendency to change the nature of the jnorbid ao*
tlon, by originating a new excitement, it is worthy of attention ;
but periuips the diluted aqua-regia bath, of which we have spoken
oader spasmodic jaundice,! may prove more advantageous.

The disease, however, is often highly troublesome and obstinate,
and hence it has been necessary to employ constitutional as well as
local means.

The general remedies that have been had recourse to are almost
innumerable. Acids have been taken internally in as concentrated
a state as possible, but rarely with much success. The sulphuric
add has been chiefly depended upon : and, in the form of the eau
de Rabel, wliich is that of digesting one part to three of spirit of
wine, it was at one period supposed to be almost a specific. The
compound, however, has not been able to maintain its reputation,
and has long sunk into disuse.

Emetics have been found more useful, as operating by revulsion
and stimulating the system generally : and oh this ground a sea-
voyage accompanied with sea-sickness has often effected a cure.
Stimulating tiie bowels, and particularly in the commencement of
the disease, and where the general strength has not been much
encroached upon, has for the same reason been frequently found
useful, as transferiing the irritation to a neighbouring organ, and
under a more manageable form. And one of the best stimulants for

* Medic. Experiment, p. 65.

t Medic. ExperimeiU, Vol. i. p. 380.

52 QEICETICA. [CL. T.-OR. U

^bis purpose is sulphate of mag^nesia. Small doses of calomel hare
beea given daily with the same view, but thej have not succeeded
in general. Heister, however, recommended mercury in this dis-
ease even to the extent of salivation ;* yet this is a very doubtful
remedy, and even under the best issue purchases success at a very
dear rate. A spontaneous salivation has sometimes indeed effected
a cure ;t but this is a very different affair, for here the blood is not
broken down into a dilute state, nor the general strength interfered
with. Mr. John Hunter, with a view of changing the nature of the
morbid action in its own field, advised mercurial inunctions in the
vagina itself.

Other stimulants have been recommended that operate more
generally, and have a peculiar tendency to influence the secretion
of mucous membranes, as the terebinthinate preparations, particu-
larly camphor, balsam of copaiva, and turpen^ne itself: and there
is reason to believe that the second, of these has often been useful.
It has sometimes been employed in combination with tincture of
cantharides: but the latter is, in roost Instances, too irritating,
whether made use of alone, or with any other medicine.

As the acids have not succeeded, neither have other astringents
to any great extent. The ai^entina or wild tansy (Potentilla
anserina^ Linn.) was at one time in high favour ; it was particularly
recommended by M. Toumefoot, and, upon his recommendation,
very generally adopted. Alum has been supported by a still greater
pumber of advocates for its use; and kino has, perhaps, been
employed quite as extensively. Dr. Cullen asserts that he has tried
all these alone without success, but that by uniting kino and alum,
as in the pulvis stypticus of the Edinburgh College, he obtained not
only a most powerful astringent, but one that had occasionally
proved serviceable in the present disease. The anserina has justly
sunk into oblivion.

Upon the whole, the best general treatment we can recommend
is a use of the metallic tonics, and especially zinc and iron, in
conjunction with a generous but temperate diet, exercise that
produces no fatigue, pure air, and change of air, cold bathing,
regular and early hours, and especially a course pf the mineral
fvaters of Tunbridge or Cheltenham.

* Wahrnemangeo. Band. ii.

t Eph. Nat. Cur. Dec. in. Ann. ix. x. Obs. 140.

«c iLr-«p. n.] SEXUAL FummoK. $3

SPECIES II.
LEUCORRHCEA NABOTHI.

THE DISCHARGE SLDCT, AND MOSTLY TINGED WITH BLOOD.

Lr this species the flaid is secreted by the glandals Nabothi situate
on the mouth of the uterus, whence tlie specific uame. It is the
kucorrhcea ^Tc^otki of Sausages, and the haemorrhagia M'idfothi of
CuUeo. It is most usually fouad as the harbiuger of labour : and
indicates that the irritation which stimulates the uterus to spas-
modic and expulsory contractions, when the full term of pregnancy
has been completed, or some accident has hurried forward the
process, has now commenced, and that the pains of child-birth may
be expected soon. It is probably nothing more than the usual fluid
secreted by the glands from which it flows, augmented in quantity
in consequence of temporary excitement, and mixed with a small
quantity of blood thrown forth at the same time, and fro'm the same
cause, by the mouths of the exhalants which giyes it, soon after its
first appearance, a sanguineous hue. It is hardly entitled to the
name of a hemorrhage, as given by Dr. Cullen, ^ough blood from
the uterus often succeeds to it, apparently thrown forth by anasto-
mosis, In consequence of the violence of the pains.

In its ordinary occurrence it is only worthy of notice, as a
deviation from the common secretions of health, and is rather to be
hailed than to become a subject of cure or removal. But there is
a state of irritation to which these glands are sometimes subject that
produces the same discharge, and in considerable abundanccL, for
many weeks or months before labour, and which, for the comfort of
the patient, requires a little medical advice and attention.

The irritation may proceed from plethora and distension, or from
a weak or relaxed state of the constitution. If from the former,
venesection and gentle laxatives will prove the best course we can
pursue : if from the latter, a reclined position, easy intestinal
evacuations, and such Sedatives as may sit most pleasantly on the
stomach, and produce least disturbance to the head.

54 QiiiamcA* [oL.ir.-OR t*

SPECIES III.

LEUCORRHCEA SENESCENTIUM.

asbftm tit atttamcf ti %iU.

THE DISCHARGE THUf, ACRWj FREQUBIITLT EJKOBUTUIQ AND FITID.

This is usually, but not always, connected with a morbid state of the
uterus. It commonly shows itself on the cessation of the menses :
«ad is of>en chronic and obstinate.

The more common diseases of the uterus with whioh the discharge
is combined are an incipient cancer, or a polypous fungus. But I
have occasionally met with it unconnected with either, and appo*
rently dependent upon a peculiar and chronic irritability of the
uterus, or rather perhaps of those glands which secrete the fluid
that is poured forth during the act of sexual interccHirte. A lady
about forty years of age, not long ago applied to me, who had for
more than a twelvemonth been labouring under a very distressing
case of this kind. She had been married from an early period of
life, but had never been pregnant. Her general health was good,
her temper easy, her imagination peculiarly warm and vivid, 8he
had no local pain, and bad ceased to menstruate at the age of aboot
thirty-eight. The discharge at the time I first saw her consisted of
at least from a quarter to half-a-pint daily ; — ^thick, slimy, brownish,
and highly ofiensive. Every external and internal remedy that
could be thought of appeared to be of only temporary avail, and
sometimes of no avail whatever, though she certainly derived relkf
from injections of the punica Granatumj with a fourth part port
wine, which for some time checked the discharge, and diminished
the fetor. In the mean time, the general strength was preyed upon,
the loins became full of pain, the appetite Aiiled, and the sleep was
cttsturbed. Accidental circumstances compelled h€lr, even in this
debilitated state, to undertake a voyage to India. During its
progress she suffered severely from sea-sickness ; but the change
hereby produced, or effected by the warmth of the climate^ proved
pecutiariy salutary : for she gradually lost the complaint, and reco-
vered her usual health.

Emetics, change of climate, and the tonic plan already recom-
mended under the first species, seem, hence, to be the best course
we can pursue ia the species before us.

GE. m.] sExuAi. Fomnoir. 55

GENUS III.
BLENORRHCEA.

MUCUUERT DI8CHARGI: mOM THE URETRRl, OR VAGINA ; GENERALLY WITH
LOCAL IRRITATION AND DYSVRT ; NOT DISAPPEARING DURING MENSTRU-
ATION.

Blen ORRHCBA Is a Orcek compound of modern writers, derived from
Cxgpw, *^ mucus,^' and fw^ ^^ to flow.^' Sauvages, and afler bim Cul-
len, have emploved gonorrhoea from yffy ^^ semen,^' and fw^ as a
common term for this and spermorrhcea constituting the ensuing
genus, and consisting in an evacuation of semen. Cullen, indeed,
has extended the term still further in his First Lines, and hence
morbid secretion of mucus, all kinds of venereal contagion, and se-
minal flux, are equally arranged as species of the same generic dis-
ease; and diis too under a word which imports the last alone.
While, to add to the confusion, this very word, in its vulgar sense,
is restrained to venereal contagion, which, in its strict meaning, that
of seminal flux, it signifies just as much as it does abortion or stone
in the bladder. It is high time to make a distinction, and to di-
vide the list of Sauvages into two genera. Blenorrhoea has,
indeed, been already employed of late by various writers to de-
note the first of these genera, and there is no necessity for chang-
ii^ the term.

The genus under Miiller,* is subdivided into numerous spe-
cies : but the three following include the whole that fairly belong
to it:

1. BUnrORRHCBA SIMPLEX. 8IMPLB URETHRAL RUHHINO.

2. LUOOE8. CLAP.

3. -^— — CHRONICA. GLEET.

• Muller, M^ic. WocheoUatt, 1T84. N. 51, pluret'ipecits.

56 GENETICA. [CL. T.-OIU I.

SPECIES I.

BLENORRHCEA SIMPLEX.

aUmpU nrrtliiral mmtitfiig*

nifPLB IfrCREASBD SECREnOH FROM THE MUCOUS OLAITDS OF THE URE-
THRA.

This definition is given in the words of Dr. Fordjce, and is suffi-
ciently clear and expressive. In effect, the efflux proceeds from
mere local irritation, unaccompanied by contagion, or virulence of
any kind, and is chiefly found in persons in whom the affected or-
gan is in a state of debility ; the occasional causes of irritation be-
ing venereal excess, too large an indulgence in spirituous liquors,
cold, topical inflammation, too frequent purging, violent exercise
on horseback, to which various authors add transferred rheumatic
action ;* and occasionally, according to Mr. John Hunter, transfer-
red irritation of the teeth.t

The matter dischai^d is whitish and mild, producing no exco-
riation, pain in micturition, or other disquiet. It is the mild go-
norrhoea of many writers, the gonorrhoea pura of Dr. Cullen ; and
usually yields without difficulty to rest, emollient injections, and
very gentle and cooling purgatives.

SPECIES 11.
BLENORRHCEA LUODES.

MUCULENT DISCRAROE FROM TBS. URETHRA OR VAOOfA, INTERMIXED WTTH
SPECIFIC VIRUS : BURNING PAIN IK MICTURITION : PRODUCED BY IMPURE
COITION ; 0IFBCTI0U8.

Tms is a disorder of far greater mischief and violence than the
preceding, and in contradistinction to it has been very generally de-
nominated 4he virulent or malignant gonorrhoea. It is the gonorr-
hoea tmpura of Cullen.

* De Plalgne, Joiira. de Med. Tom. lxxit.
Richter, Chir. Bibl. B. iv. p. 508.
PoDteau, Oeuvrei Posthumes. i.

t Natural History of the Teeth.

OE. QL-^P. II.] SEXUAL FUNCTION. 57

Tbe ditease was for manj years supposed to be a local effect of
that p4lM>D, which when cofflmunicated to the system, produces sy-
phitis. It is in truth received in the same manner, and by the same
organs — ^its medium of conveyance being that of cohabitation with
as infected person. We are chiefly indebted to Mr. John Hunter
for having pointed out the distinction : and there is now scarcely
an individual who has any doubt upon the subject, though there are
several who conjecture that it has been derived from the syphilitic
▼eoom cliaoged and softened in its virulence by an introduction into
diffsrent constitutions. These conjectures are harmless, but they
have little ground for support That it is a disease specifically dif-
icreot from sypldlis, is clear from the following facts. Its appear-
Mce did not commence till more than a hundred years afler that of
syphilis ; it will continue for months without any syphilitic symp-
toms, which are rarely, indeed, found connected with it ; and where
ioch symptoms liave shown themselves, there has been full evi-
dence of a new and different infection or strong ground for suspi-
cion : the matter of chancre, the pathognomic symptom of syphilis,
wkee iatrodiiced into the urethra has been found not to produce
elap, and tlie matter of clap inserted under the skin, has been p9v-
ed not to produce syphilis : the conunon course of mercury which
is the only specific cure for the latter, is a very inconvenient, and
dilatory way of treatiBg the former; while the local plan by which
tiie former is conquered with great speed and ease, produces no
efiect on the latter.

Some of these Acts were known to physiologists and reasoned
firom even before the time of Mr. John Hunter ; and hence Baglivi
contended tliat virulent gonorrhoea, as it was then called, may be
predeced by other acrimonies than the syphilitic,* while Zeller,
towards the close of the seventeenth century affirmed, that it may
origiDate in either sex witliout contact :t and StoU in the middle
of tiie eighteenth, that it proceeds from various causes of which
syphilitic contagion is one.|

It ia not easy to account for the primary appearance of this or of
any other specific poison : but we see daily that most, perhaps all,
mncoQB membranes, under a state of some peculiar morbid action, .
have a tendency to secrete a virulent and even contagious material
of aome kind or other; the particlea of which are in somer instances
hqihly volatile, and capable of communicating their specific effect
to <»|;nns of a Hke kind ; and of propagating their power by assimu-
latien, after having been dift»ed to some distance through the
atmesphcre, which does not at all times readily dissolve them;
iheof^ agreea]>ly to a general law we have formerly pointed out,
the more readily^ the purer the constitution of the atmosphere.§ We

* De Pibrt Motiee, ftc.

t Ditg. <l« Gofrenrhtta Tiralentft in^utroque wx^y Tubing. 1700.
t JPrttkct. p. 104.

♦ Vol.ii,0b«t.9. p. T6.
vot. rv. S

68 GENETICA. [CL. V.-OR. L

have a maoifest proof of this in the muculent discharge of dysent^pry^
Id caoine catarrh of the muculent affect! od in the nostrils ^ dogs,
which is vulgarly called distemper, and id the glanders, possibly
also in the farcy, of horses. And although that species of catarrh
which we name influenza, is probably a miasm rather dependent
on some intemperament of the atmosphere itself in its origin, than on
the temperament of the individual who suffers from it ; yet this also
becomes a contagion in its progress, and is communicable in conse-
quence of such new property, from individual to individual, after a re-
moval into fresh and very remote atmospheres by travelling :* whilst
nothing can be more highly contagious than the discharge from the
mucous glands of the tunica conjunctiva in purulent ophthaimy,
although possibly the matter of this contagion dissolves rapidly in
the atmosphere, or it is not sufficiently volatile to float in it ; whence
a direct contact is nei^essary for the production of its effect

In like manner, leucorrh«ea, as we have already observed, has
sometimes seemed to be contagious ; for I have occasionally found a
kin4i of blenorrhcea produced in men, accompanied with a slight
pain in the urethra, and some difficulty in making water, upon
co^bitation with women who upon inspection, had no marks what-
ever of luodic blenorrhcea, or clap ; and, in some instances, indeed,
were wives and matrons of unimpeachable character.

The disease before us, hovfpever, has symptoms peculiar to itself^ •
and undoubtedly depends upon a specific virus. The chief of these
symptoms are described in the definition. They are generally
preceded by a troublesome itching in the glans penis, and a general
sense of soreness up the whole course of the urethra: soon after
which the discharge appears, on pressing the glans, in the form of
a whitish pus oozing from its orifice. In a day or two it increases
in quantity, and becomes yellowish ; and, as the inflammation aug-
ments, and the disorder grows more virulent, the yellow is convert-
ed into a greenish hue, and the matter loses its purulent appearance,
and is thinner and more irritant. The burning or scalding pain
that takes place on making water is usually seated about half an inch
within the orifice of the urethra, at which part the passage feels
peculiarly straitened or contracted, whence the urine flows in a
smail^ interrupted stream : the lips of -the urethra are thickened
and inflamed, and a general tension is felt up the course of the penis. >
This last symptom is sometimes extremely violent, and accomfmnied
with involuntary erections ; at which time, as the frenum, in conse-
quence of the inflammation, has lost its freedom of motion, the penis
is incurvated with intolerable pain. It is to this state of the penis,
in which it bears some lesemblance to a hard, twisted cord, that the
French have given the name of chokdee. Under these circom-
stances we often meet with a troublesome phimosis, either of the
strangulating, or incarcerating kind; in consequence of the ii^
creased spread of the inflammation. Sometimes it extends, to one

* See Catarrhva epidtmicuB of this work, Vol. ii. p. 395, 396.

GE. ni.-SP. II.] SEXUAL FUNCTION. 59

or both groins, in which case the glands swell and buboes are often
formed ; sometimes it reaches to the bladder, the surface of which
pours forth a cheesy or wheyey fluid instead of its proper lubricous
secretion, which is communicated to the urine ; and sometimes the
testes participate in the inflammation, become swollen and painful,
and excite a considerable degree of fever.

In women, the chief seat of affection is the vagina ; but as
this is a less sensible part than the urethra, the pain is seldom so
pangent, except when the meatus urinarius and the nytdphae associate
and participate in the inflammation.

The (Msease appears at very different intervals after infection,
according to the irritability of the constitution. The usual time is
about the fourth or fifth day. Qut it has shewn itself within the
first twenty-four hours, and has sometimes continued dormant for a
fortnight Domeier lays down the time from the fourth to the
fourteenth day.'*' Plenciz fixes it after the tenth.! Sometimes by
Hke violence of the irritation the secretion is absorbed as fast as it is
effosed r so that only a very small discharge takes place, while the
oUier sjnnptoms are peculiarly exasperated. To this state of the
dbease some practitioners have applied the very absurd name of
gtmorrkcsa neca.

It was at one time imagined that the puriform fluid which is usu-
iHj poured forth in considerable abundance, proceeds from an ulcer
in the urethra ; but it is now well known, as we have already had
occasion to observe frequently, that it is not necessary for an ulcer
or an abscess to exist for the formation of pus, and the dissection of
persons who have died while labouring under tliis disease, have
sofficiently shown that the secretion is thrown forth from the internal
membrane of the urethra, chiefly at the lacunae, without the least
appearance of ulceration, or even, in most instances, of excoriation.

T%e cure, in the present day, is simple ; for the venereal clap,
like the venereal pox, appears to have lost much of that virulence
and severity of character, by passing from one constitution to another,
wliich it evinced on its first detection. Rest, diluent drinks, and
an antiphlogistic regimen will often effect a cure ah>ne. But it
may be expedited by cooling laxatives, and topical applications.

The remedies employed are of two kinds, and of very opposite
characters ; stimulant, and sedative. Both, also, are used generally
and locally ; with a view of taking off the irritation indirectly by
exciting a new action ; or directly, by rendering the parts affected
torpid to the existing action, and thus allowing it to die away of its own
accord. Many of these medicines, indeed, as well the local as the ■
general^^ere, at one time, supposed to be natural antidotes, and to
core by T specific power : an idea, however, wliich has been long
banished from the minds of most practitioners.

The general sedatives that have hitherto been principally em-

— '■-■■■■ m% k

* Pragmente iiber die Erkenntnis venerischer Krankbeiten. Hanov. 1790.
t Atta, et Obeerraliones, Med. p. 139.

60 GENETICA. [OL. V.-OIU U

ployed ate opiam, coniam, nitre, oilj emnlflloiis, and macllages.
The first has often succeeded, but with considerable and very un*
necessary inconyenience to the constitution : the others are not much
to be depended upon. They may ha?e co-operated with a rigidly
reducent diet, but haye seldom answered alone.

Employed locally, some of them, and particularly opium, hay^
proyed far more beneficial. The best form of this last k that of an
injection rendered somewhat viscid by oil or mucilage, both wliich
haye a greater chance of acting as demulcents, and sheathing, or
inviscating the acrimonious corpuscles in this case, than on the ir-
ritable surface of the lungs in catarrhs, and asthma, when given by
the mouth.

The stiifiulant process has, however, been found to answer so
much more rapidly and more effectually, that it has almost super-
seded the use of sedatives in modem practice.

Formerly this process, also, wto employed generally, and it was
supposed, and, in many cases, sufficiently ascertained, that by strongs
ly irritating some other part the morbid excitement of the urethra
would subside, and the organ have time to recover its natural ac-
tion. And hence the intestines were daily stimulated by cathartics,
as neutral salts, mercury, and colocynth, which last was at one time
regarded as a specific ; or terebinthinates, as camphor, balsam of
copaiba, and turpentine itself. And sometimes the bladder was
treated in the same manner, with diuretics of all kinds, and especi-
ally with cantharides.

This plan is still continued in many parts of the East, and par-
ticularly in Bengal and Java ; where, as we are inforaaed by Mr.
Crawfurd, the common remedy, and one to whioh the dlseaBe, la
those hot regions, yields very easily is that of cubehs, the pi|^
eti&edd of Linneus. This pepper, well pounded, is exhibiled in n
little water, Bye or six times a day, in the quantity of a dessert-
spoonlul, or about three drachms, as well in the easuiag as in tke
present species, during which time all heating alhnents are to be
carefully abstained from. The cure, we are toU, is entirely com-
pleted in two or three days, the ardor urinss first ceasing, iad the
dischargtB again becomes viscid. A slight diarrhoea is sometimes
produced, with a flushing in the face, and a aense of heat in the
pains ^fihe hands, and the soles of the feet, ba few instaaceB,
Mr. Crawfurd tells us, inflamed testicles have supervened, an affec-
tion wliich yields easily to the common treatment.'*^

There is no necessity, however, for subjecting the oonstitutioD
to so fievere a discipline : for the stimulant process, and particular-
ly that of astringent stimulants, when employed locally ^succeeds
ordlnafily in a fbwdays without any trouble. These coont ciuefly
of metallic salts in solution, as the muriate, and sub-mnriate of aaei^
cury, the former in Che proportion of three or four grains to eight
ounces of water : — sulphate of zinc, sulphate of copper, ammoniacal

* Account or the Piper Cubeba, &c. Edinb. Med. and Journ. Ho, &111. p. 33«

OE.IiI.H9UP* U.] SEXUAL FUNCTION* * 61

copperi and sob-acetated solation of lead. The tstnngeot property
of most of these, under due management, instead of being found
mischievous,. gives a check to the morbid secretion, at the' same
time that it acts as a direct tonic and rapidly restores the irritated
mouths of the exhalants to their healthy and proper action ; and
tliis, too, without the inconvenience of a secondary inflammation.
A slight solution of alum alone, indeed, in the proportion of one or
two grains to an ounce of water, has, for this purpose, been often
employed with sufficient efficacy ; though the present author has
reason to prefer the sulphate of zinc, which he has usually combined
with bole armenic in the proportion of one scruple of the former
mid two of the latter to half a pint of water. And he can venture
to say that through a pretty extensive course of practice, for up-
wmrds of thirty years, he has never known this composition to fail ;
and has never perceived it produce any of the inconveniences of
stricture or swelled testicle which were so much but so groundless-
h a^rehended when the stimulating and astringent practice was
first iatroduced.

The addition of the bole mav to some practitioners appear trifl-
ii^, but it adds to the power of the zinc, probably by giving an in*
creased body to the solution without diminishing its stimulant efiect,
which would certainly follow by using oil or mucilage in its stead.
The sulphate of copper is more irritating than that of zinc, and, in
a strong solution, is more likely to produce inflammation ; and it is
on this account chiefly that the author has confined liimself to the
latter. It is in eflect, by an analogous practice, that several modifi-
cations of purulent ophthalmy, and particularly that of infancy, is
most successfully subdued, as we observed when ' treating of this
disease.

It is almost unnecessary to add that the utmost cleanliness by
frequent washing should be maintained from the first appearance of
the &ea«e.

Where the complaint, however, is improperly treated with sti-
mulants, and particularly astringent stimulants, or where it has con-
tinued too long before application for medical assistance, the whole
range of the urethra, or some particular parts of it, are apt to be-
cmne so irritable as to excite spasmodic contractions, which com-
BMmly pass under the name of strictures, without being so in reality ;
and, as we have already observed, this irritation in some cases, ex-
tends to the interior surface of the bladder, and even thickens it.
We have often had occasion to remark that in fibrous structures
and canals the most sensible parts are their extremities ; and this
remark is particularly applicable to blenorrhoea, for the portions of
the urethra which sufier most from irritation are the interior mem-
brane of the glans and the prostrate, particularly the latter, in CQn^
se<inence of its direct connection with the bladder as well as the
urethral canal.

On this account, when a patient once labours under spasmodic
constrictions from the disease before us, whatever other parts these

62 GENETICA. [CL. y.-OR. I.

may exist in, the fntrotlaction of a bougie will be almost sure to
prore that there is also a coostrictioo in the prostrate. Geoerallj
speakiog it will be found to originate here, and to occur in other
ptrts of the canalfrom sympathy. But the case will oflen l>e re-
versed, and while the irritation originates in some other part, or in
the bladder, it is by sympathy with these that the prostrate itself is
affected. Mr. Abemethy has pointed out this double source of spas-
modic constriction in the prostrate, in the clearest manner possible ;*
and the remarks he has offered upon the propriety of employing or
withholding the bougie as an instrument of cure cannot be too
deeply imprinted on every student^s mind : the general principle of
which is to persevere in its use wherever it appears to blunt the
sensibility; and to pass it as high up the urethra as can be accom-
plished with this effect, if possible indeed through the prostrate
into the bladder; but in everj instance to desist where a second or
tliird trial of the instrument gives more pain than the first, or to
content ourselves with passing it as high as can be done without
any such symptoms of increased irritation, and there stopping short :
and only making an occasional trial when we have reason to hope
that the morbid sensibility has still further subsided.

SPECIES III.

BLENORRHCEA CHRONICA.

flflert

6LI1C¥ DISCHARGE FROM THE MUCOUS GLANDS OF THE URETHRA, WrTH^^
OUT SPECIFIC VENOM OR INFECTION : SUGHTLV IRRITATING : CHRONIC.

This species is a frequent sequel upon a clap that has been ill-ma-
naged, or has lasted long, and produced an obstinate local debility.
Bat it exists also independently of clap, and is occasioned by strains,
excess of venery, and other cause? of weakness. The discbarge is,
for the most part, a bland and slimy mucus not accompanied with
inflammation, apparently proceeding from a morbid relaxation of
the mucous glands of the urethra, and at times, like other dis-
charges from debilitated organs, accompanied with and kept up by
irritation and especially irritation produced by a stricture in the
m'ethra properly so called, or a diseased state of the prostrate
gland.

In common causes, the disease yields to the local tonics and as-
tringents recommended under the preceding species, but it is some-

* Surgical Observations on Diseases of the Urethra, p. 194, 8vo. 1810.

GE. in.-SP. lU.] BEXUAL FCJNCTION. 63

times pecaliarlj irritable, and bids defiance to all tbe ingenuity of
the medical art. A Castro gives an instance of its having continued
for eighteen years.*

The stimulants ordinarily employed have consisted of copaiba or
some terebinthinate or resinous balsam in the form of injection ;
tincture of ipecacuanha, as recommended by Schwediauer; infusion
of cantharides, a favourite remedy with Bartholin ; or a blister appli-
ed to the urethra, as advised by Mr. John Hunter and several other
writers.

The bougie may here be used, for the most part more fearlessly
than in the preceding species. Its own i>imple stimulus, if employ-
ed regularly once or twice a-day, has oAen proved sufficient : and
where thh fails it may be rendered more active by being smeared
with turpentine, mercurial ointment, or camphorated liniment; or
armed with nitrate of silver, where there are strictures that require
it Even in this species, however, it is a valuable remark of Mr.
John Hunter, that, before we have recourse to any powerful acuants,
we should well weigh the degree of irritability of the patient's
constitution : for we may otherwise run a risk of exciting a violent
local inflammation, or of extending the irritation to the testes or
the bladder. Should such an issue unfortunately occur, one of the
most salutary Injections we can employ is a solution of tbe extract
of hyoscyamus in water. Even in chordees, which resisted the in-
fluence of opium, Mr. Bell asserts that he has found this medicine '
adyantageous in the quantity of from one to three grains at a time,
and repeated three times a-day or oftener. Or we may have re-
course to a warm hemlock poultice, applied every night, and made
sufficiently large to cover the whole of the perinaeum, testes, and pe-
nis. 1 have known this succeed in taking off an habitual irritation,
and with it effectually suppressing the discharge, on the third appli-
cation, in two instances of more than a twelvemonth's stancting :
and this ailer stimulants of all kinds, and narcotics of many kindi,
and particularly opium, had been tried in succession. The leaves
were here employed in a fresh state. Ni<«bet gives an instance of
core, produced by a fresh infection : but this is not a remedy to be
recommended either medically or morally.

In women this disease is oAen mistaken for leucorrhoea ; wMave
pointed out the distinctive character under the last species. Yet
the mistake is not of essential consequence, as the same treatment
will often effect a cure in both. As the vagina, however, is less ir-
ritable than the urethra, gleet in females is a less frequent and a
less troublesome complaint than in males.

• DeMorb. Mul. p.68.

64 GENETICA. [CL. V.-OR. I.

GENUS IV.

SPERMORRH(EA.

Sonfnal iFluir.

. IRVOLtmTART EB11S8I0N OF SEMINAt FLUID WITHOUT COPULATION.

The generic name is demed from exu^^^ ^^sero^' ^^semiDo;''
whence aspermas, ^^ Yoid of seed,'' gjmDOspermiis, ^^ haTing the
seed naked,'' — a term well known in botaoy ; and hence also nuaie-
roQS other derivatives of the same kind. Gonorrhoea, which is a
direct synonym, woald have been retained as the name for this ge-
nus, but from the confused significatioD in which it has been employ-
ed by Saovages and CuUen ; and from its being usually, though most
inuproperly applied in the present dav to blenorriuea luodt9*
The genus ofiiers two varieties as follow :

1. SPElUffORllHCEA BNTOmCA. ENTOmC SEMINAL FLUX.

2. — — — ATOfaCA. ATONIC SEMINAL FLUX.

SPECIES I.

SPERMORRHCEA ENTONICA.

SntonCr Sbrmfnal JTlup*

UVVOLUNTARY EMISSION OF PROPER SEMEN WrTH ERECTION ; MOSTLY FROM
AN INDULGENCE OF UBIDINOUS IDEAS.

The pual cause is assigned in the definition, and it very strikingly
points out the influence which the mind bears upon the body, and
the necessity of subjecting the passions to the discipline of a chaste
and virtuous deportment ; since, as there is no passion more debas-
ing than that of ^ross lust, there is none more mischievous to the
general health of the body It leads the besotted slave straight
forward to every other sensuality, and, by becoming at length an
established and chronic disease, stupefies the mind, debilitates the
body, and is apt to terminate in hectic fever and tabes.

This affection sometimes originates in the body itself: in a local
and urgent erethism, produced, as Forestes conjectures,* by a su-

* Lib. XXVI. Ob«. II.

6E. HT.HSP. I.] SdSXUAL FUNCtlON* 65

perabondant AecretioD of seminal flaid in a constitution of entonic
health and Tigonr. And, as in the formei; case, the body is to be
cliastised through the mind, in the present the mind is to be chastis-
ed through thie body : particularly by purgatives and venesection, a
low diet and severe exercise. If, however, the patient be single,
« as is commonly the case, the pleasantest tis Well as the. most efiec^
tual remedy is to be sought for in marriage.

SPECIES IL

SPERMORRHCEA ATONICA-

atanfc Aemfnal jTlup

MVOLinrrART EBOSSION of ▲ dilute and nearly PELLUCm SEMlNAi

vluid; wrm libidinous PROPENsmr but wrniouT erection.

Of this species Sauyages gives us two curious examples : one fromi
Deidier, in which the patient was an exemplary monk, who shrunk
with horror at the idea of this involuntary self-pollution, as he re-
garded it : the other a cas^ in his own practice, in which the pa-
tient, a most religious young female, was, as he affirms, driven al-
most to madness under the same erroneous contemplation of the
disease. From his having included a female under this genus, it
should seem that Sauvages inclined to the theory of epigenesis, or
that wliich supposes the male and female to contribute equally a
seminal fltid fti the act of procreation. It is probable that some
local irritation is the usual cause. Professor Deidier himself sus*
pected this in the first of the above cases ; and referred it rather
to a calculus in the bladder, sympathetically affecting the prostate
gland, than to any idiopathic disease of the resicute seminales, or
the testes. The pious monk found himself most relieved by scourg-
ing his 1^;8: a blister applied to the perinaeum would probably have
relieved him still more effectually. The fluid is a thin degenerate
secretion, apparently from the vesiculs seminales, rather than se-
men itself. It is sometimes found intermixed with blood ; and in
tUs case we haye the further irritation of a wound or ruptured ves-
seL The most common cause of this miserable disorder is a pre-
vious life of unrestrained concupiscence : and under this debility^
hereby produced, the morbid discharge is peculiarly apt to flow
upon the mere muscular excitement that takes place on evacuating
the rectum ; and hence follows hard upon a stooL*

• Art. Med. Berol. Dec. i. Vol. iv* p. 70.
Wichmann De Pollutiont, &c. Goett. 1712.
VOL. ly. 9

66 ' CEi^ticA. j^cL. V.-6R. i.

A care sh6nid be attempted by the daily use of a bidet of cold
6ea-watfer, or of early bathing in the sea, and the internal use of
metallic tonics. The bowels should be kept lax, but the warm and
irritating purgatives should be carefully abstained from. Blistering
the perinsum, or making a seton in it has occasionally been found
Serviceable : as has also a local use of electricity. #

GENUS V.
GALACTIA.

MORBID FLOW OR DEFICIENCY OF MILK.

This includes the greater part of those afiections, treated of by
Dioscorides, under the name of spai^anosis, which, however, in his
inrrangement embraced, as we observed under phlbgmone mamma,'*'
many complaints that have little or no connection with each other,
and particularly one of the species of bucnemu, or tumid-leg : so
that, it has be<>n necessary to break up the division and allot to its
difiFeretit members their proper positions.

Galactia is a Greek term, from ^^kXa, " lac," whence ytiXMcrmsf^
'^ lacteus.'^ It occurs in Linn6us and Vogel for the genus now
before us, which by Sauvages and Sagar is written galactirrhoea,
literally *' milk-flux,'^ in a morbid sense of the term. The author
has preferred galactia as more comprehensive than^'galactirrhoea,
so as to allow the idea of a depraved or defective, as well as of a
superabundant secretion of milk : all which are equally entitled to
be comprized under one common head,* as excess, deficiency, or
Other irregularity of arterial action in fever. Hitherto, however,
from an opposite fault to that of Dioscorides, these affections have
been separated from each other by many nosologists, and carried
to different heads, sometimes to different orders, and occasionally to
different classes ; whence the student has had to hunt for them
through every section of the nosological arrangement. It has al-
ready been necessary to make the same remark respecting many of
the species of paramenia: and various other instances wiH occur to
us in the ensuing orders of the class we are now explaining.

The flow of milk may become a source of disease as being out of
season, defective in quantity, vitiated in quality, transferred to ah
improper organ, and as discharged from the proper organ but id

Vol. II. p. 187.

CE. V.-SP. I.] SEXUAL FUNCTION. ^7

the male sex. These difiereoces will furoish the present geni^
With fiFe distiDct species as follow :

1. GALACTU PIUEMATURA. PREMATURE MILK-FLOW.

2. DEFECTIVA. DEFICIENT MILK-FLOW.

3. DEPRAVATA. DEPRAVED MILK-FLOW.

4. ERRATICA. ERRATIC MILK-FLOW.

5. __-, — VIRORVM. MILK- FLOW IN MALES,

SPECIES I,

GALACTIA PRiEMATURA.

IPrrmaturr jwn&^to.

EFFLUX OF MILK DURING PREGNANCY.

The mamms, which maiDtain the closest sjmpathj with the ovaria,
and atenis, aad Id most animals possessing them are placed in their
direct Ticinity, and which in truth are as much entitled to the
character of a sexual organ as any organ of the entire frame, parti-
cipate in the developement of the generative function from the first
stimulus of puherty, It is then that the hreasts assume a glohose
plumpness, and the catamenial fiux commences : when pregnancy
takes place, and the uterus enlarges, the breasts exhibit a corres-
pondent increase of swell; and, when, shortly after child-birth, the
lochial discharge ceases, and the uterus takes rest, the lacteal disi
charge is secreted and poured forth in immediate succession. The
sympathy continues, however, even after this rest has commenced^
for one of the most effectual means of increasing the flow of milk
from the breasts is a slight excitement of the uterus as soon as it
has recovered its tone : and hence the mother of an infapt living
with her husband, and herself in good health, makes ^ far better
nurse and even requires a less stimulant regimen thai^ a stranger.
brought from her own family, and secluded from her husbs^nd'^
visits. Of this, indeed, many of the rudest and most barbarous na-
tions, but who are not always inattentive to the voice of nature,
have the fullest conviction : insomuch that tho Scythians, according
to Herodotus, and the Hottentots in our own day, irritate the v(|t
gina to increase the flow of milk in their cows and mares.

It sometimes happens, however, that this stimulus of sympathy la
carried to excess even during pregnanpy, and that the lactiferous
ducts of the mammae secrete milk from the ultiipate branches of
the arteries Sooner than it is panted. If the quantity thus separat-
ed be small it is of no moment ; but if it be considerable, some de-
gree of debility is usually produced with restlessness and pyrexy

08 OENETICA. [CL. T.-OR. I.

And hence Galen obienres, that a prematore flow of milk indicatet
a weakly child ;* and the collections of medical curiosities contain
Tarions cases, in which it has appeared to be injurious.t Saavages
gives an instance in which a pint and a half was poured forth daily,
as early as the fifth month. Where the constitution is peculiarly
robust, eyen this may for some time be borne with as little mis-
chief as menstruation during pregnancy : but in ordinary cases the
system most be weakened by so excessive and unprofitable a dis-
charge. There is an instance noticed in the volume of Nosologv,
in which a pint and a half was poured forth daily at the fifth
month.

The morbid irritation, however, may generally be taken ofi* by
venesection, and, if this should not succeed, by a few doses of ape-
rient medicines, which have the double advantage of lowering the
liction in the affected organ, and exciting a new and revulsive^ac-
tion in an organ that is usually more manageable.

It has sometimes happened that a like precocity has occurred in
young virgins, and that these also have secreted and discharged
milk from the proper organ. In many cases this has occurred as a
substitute for the catamenial flux which has been retained or sup-
pressed at the time ;% but more generally it has proceeded from en-
tonic plethora, or a morbid erethism of the sexual organs at the
geriod of puberty ;§ and is to be removed by a reducent regimen,
. leeding and purgatives, as just pointed out.

On the other hand we have occasional instances of a supply of
milk, in women considerably advanced in life, and who have long
ceased to bear children, and even to menstruate. l*hus a woman
of sixty-eight, is stated by Dr. Stack, in the Philosophical Transac-
tions, to have given suck to two of her grand-children ;ir and an-
other of eighty, in a Swedish Journal, is said to have performed
the same office.^ In most of these cases the antiquated nurses
have consisted of married women, who had many years before
reared families of their own, and whose lactiferous organs were
therefore more easily reexcited to the renewed action, than if they
had never suckled, the cause has been some peculiar irritation
originating in the radicles of the lactiferous dqcts, or excited by^a
transfer of action from the uterus or ovaria in consequence of a
cessation of the menses.

* Pragm. ez Aphor. Rab. Mois. p. 34.
t Act. Ifat. Cur. V^ol. iv. Obi. 66.

f De la Oorde, Ergo virgo, meostruis deficientibus, lac in maromif habere po-
test. Paris, 1580.

4 Hippocr. Apfa*. Sect. v. k 39.
Vega, Comment, in Hippocr. Aph. ▼. ^ 39.

T Vol. XLi, year 1739. 141.

♦• See alio Phil, Trans, Vol. tx. year 1674.

aS^ ▼.HIP. 11.3 SEXUAL FuircTioNr 99

SPECIES II.
GALACTIA DEFECTIVA.

nrinuTT to suckle upok child-bibth.

Tbis is the agalaxis or agalactatio of preceding nosologists ; and
my proceed from two causes, accompanied with sjmptoms produc-
iii|^ the two fbllowiog varieties :

• Atonica. From want of secretion.

Atonic inability to suckle.

C Oiganica. From imperfect nipple or other

Organic inahili^ to suckle. organic defect.

To every feeling and considerate mother, inability to suckle is a
serious evil : and, generally speaking, it is an evil of as great a mag-
nitude to the mother herself as to the child ; for a free secretion of
milk prevents many present and not a iew eventual mischiefs. The
health of women during suckling is, in most instances, better than
at any period of their lives. Their appetite is excellent, their
sleep sound and refreshing, their spirits free, their temper cheerful.
But to eveiT conscientious mother there is, superadded to all this,
a pleasurable feeling of a still higher and nobler kind : it is a sense
of conscientiously discharging the maternal duty : it is the gratifica-
tion of beholding the lovely babe to whom she has given birth
aaved from the cold caresses of a hireling, to lie in the warm em-
braces of her own bosom : to grow from the sweet fountain which
she furnishes from her own veins, rich, ample, and untainted : tq
swell with the tender thrill that shoots through the heart at every
little draught which is drawn away from her ; to see the cheeks
^mple and the eyes brighten, and the limbs play, and the features
open ; and to trace, in every fresh lineament, a soflened image of
l^rself or one dearer to her than herself. This is the luxury that
awaits the mother, whose unseduced ear still listens to the voice of
Nature, and estimates the endearments of domestic life at a higher
▼aloe than the intoxicating charm of fashionable amusements and
midnight revels. Though transported with the present, her com-
forts do not end with the present : for she has yet to look forward
to a term of life in which, when those who have made a sacrifice
of maternal duty at the altar of pleasure, are wasting with decline,
trembling with pahy, or tormented with the dread of cancer, she
will still enjoy the blessing of unbroken health, and sink as on a
downy pillow into a tranquil old age.

But though these remarks apply to the greater number of those

70 GENBTICA. [OL. T.-OR. I.

who, in the career of fashioD, abstain from the dubr of a mother, it
bj no means applies to all. There are many excellent mothers who
would midergo the severest discipline of pain to accomplish this ob-
ject, but after all are not able. There are some who from the want
of a proper nipple, or perhaps the want or undevelopement of lacti-
ferous ducts, are naturally disqualified for the office : as there are
others whose constitutional debility renders them incapable of se-
creting their milk in sufficient abundance, or with a sufficient elabo-
ration for healthy food. And in all such cases it is expedient,
wherever the means will allow, to seek carefully for the substitute
of a foster-mother.

But let not the natural office be abandoned too soon, and particu-
larly where the child is strong and hearty. If the nipple be at fault
much may be done to remedy it If it be buried in the breast, it
may often be drawn out by exciting a vacuum with the ordinary
glass tube invented for the purpose, if dexterously applied ; or,
which will often succeed better, by the suction of a woman who is
well skilled in the art : or an artificial nipple may be employed if
these do not succeed.

And if the breasts be hard and lumpy, and a considerable degree
of symptomatic fever supervene, the same kind of suction must be
had recourse to twice a-day, while the breasts are kept in a constant
state of relaxation by gentle friction with warm-oil, large cataplasms
of bread and water, and a suspensory bandage of flannel passed un-
der the arms and drawn as tight as may 1^ borne without incon-
venience.

Even where the milk is not very promising, either in respect to
quantity or quality, let not the unhappy mother despair for the first
week or two. As her own strength increases, the strength of the
milk will often be found to increase also : the milk vessels will
yield with more facility, and the symptomatic pain in the back will
subside. Added to which the matrimonial excitement to which I
have alluded in the preceding species, will in due time be called
in to bear its beneficial part ; and the woman who had a hope-
less prospect before her may in due time reap the full harvest of
her labours.

6& V,-SP. Ill,] SEXUAL FUNCTION. 71

SPECIES III.
GALACTIA DEPRAVATA.

EFFLUX OF A DILUTE OR VTlUTEb MILK;

Here also we ^ have two varieties :

• . , ,

• Serosa. Weakened by too large a proportioii

Serous Milk-flow. of seram.

C Cootaminata. Deteriorated by intermixture with

CoDtaminated Milk-flow. some foreign material.

To the FIRST variety we hate alluded under the preceding spe-
cies : for it sometimes happens that milk, when deficient in quanti-
ty, is also of a more dilute quality than it ought to be. But more
frequently, as local irritation is a result or concomitant of debility,
there Is in weakly habits a very lai'ge^flow of a thin, slightly blue,
and almost pellucid milk, containing little sugar, and stillTess cream.
The properties of a sound woinan^s milk we nave already given
under cohsumption, and to save an unnecessary repetition, the rea-
der may turn to the passage, at his leisure, and compare it with the
defective character before us.*

Tonics, and a generous diet, aflbrd In this case the best chance of
success, and ate often employed with full eflect.

Under the second variety the assimilation is Imperfect, and thcS
milk has the taste or smell of beer, or wine, or some other fluid that
has been introduced into the stomach : proving that the digestive
power is weak, and requires correction and invigoration. In other
cases we have examples of black, green, or yellow milk : probably
jfiscoloured by an union With efiused blood.

All violebt exertions, whether of body or mind, and hence vio^
lent passion, as rage and terror, have a peculiar influence in
changing the natural character of milk ; and the depressing pas-
sions frequently drive it away entirely.? It is hence, of no small
moment that a wet nurse be of an easy and even temper, and not
^iisposed to mental disturbance.

* Marasmus Phthisis, Vol. ii. p. 494.

t Starch, Archi?. Air Geburtshelfer. B. in; 13. B. ii. p. 3.

72 GENETICA. [CL. V.-OR. I.

SPECIES IV.

GALACTIA ERRATICA.

ISrratCr JUOiNltfD.

MILK TRANSFERRED TO, AND DISCHARGED OR ACCUMULATED AT SOME
REMOTE ORGANS, OFTEN UNDER A DIFFERENT FORM.

Like the menstrual flax, there is scarcely an organ to which the
flow of milk has not heen transferred mider diflerent circamstances,
or in different constitutions. And hence the author has adverted
in the volume of Nosology to examples of its translation to the
fauces, where it has heen discharged in the form of a ptyalism : to
the general surface.of the mammae, where it has heen evacuated in
the form of sweat : to the navel, where it has assumed an ichorous
appearance : to the kidneys, which have thrown it off in an increas-
ed flow of urine : to the eyes, whence it has been discharged as a
milky epiphora : to the veins, which it has overloaded, so as to de-
mand the use of the lancet : and to the vagina, where it has excited
a copious leucorrhcea. It is also said to be frequently translated to
the thighs, so as to produce the disease we have already described
under the name of bucnemu sparganosis,. but which is clearly un-
connected with the state of the milk or of the breasts.

The causes are chiefly a sudden exposure of the breasts to cold ;
cold-water drunk improvidently when in a state of perspiration,
epirituous potation, and sudden emotion of mind.

The irregular action is best subdued by gentle laxatives, dia-
phoretics, and perfect quiet in a warm bed. Where ardent spirits
have been the cause, the aperients should be more stimulant, and
bleeding will often be necessary.

The blood itself, however, during the time of suckling is oflen
loaded with milk from resorption, and evinces a milky appearance,
as are likewise several of the fluids secreted from the b^ood : and
hence, also one cause of many of the above peculiarities.

GE. T.-SP. T.] SEXUAL PUKCTIO\. 73

SPECIES V.
GALACTIA VIRORUM.

mUi SECRETED IN MALES AND DISCHARGED FROM THE PROPER EMUNC-

TORY.

A MILKY serum, and sometimes geDuine milk iias been found to distil
from the nipples of new-born infants, of both s^xes, and sometimes
from boys of a later age. But various authors, as Scholk, P. Borelli,
and Lauremberg have given cases of genuine milk discharged in
Ue manner by adult males ; occasionally continuing for a long time ;
and, in some instances, enabling them to perform the office of
nurses. In the Commentaries of the St. Petersburg Academy,* a
flow of milk from the breasts of males, is said to be very common
in Russia : and Blumenbach has noticed the same peculiarity in the
males of various other mammals.! Among men, indeed, the dis-
charge appears occasionally to have occurred even in advanced
life ; for Paullini gives the case of a man, who was able to suckle
at the age of sizty.|

Why man should, in every instance, possess the same organiza-
tion as woman for secreting and conveying milk, is among the many
mysteries of physiology that yet remain to be solved. But as there
is little or no sympathy between the mammae in man and any of the
proper organs of generation, as in women, we are at no loss to ac-
count for their general sterility and want of action. Occasionally,
however, the lacteal glands in man, or the minute tubes which
emerge from them are more than ordinarily irritable, and throw
forth some portion of their proper fluid. And if this irritation be
encouraged and si^ported, there is no reason why such persons may
not become wet-nurses as well as females. And hence, Dr. Parr
inquires, with some degree of quaintness, whether this org^ization
is allotted to both sexes, in order that *-^ in cases of necessity men
should be able to supply the office of the woman ?'^ Under these
drcumstances, the discharge, though unquestionably a deviation
from the ordinary law of nature, can scarcely be regarded as a dis-

* Tom. ni. p. 278.
t Haaorersich Mag mu^ 1787.
t Ctni. n. Obt. 98.
Schacker, DiiB. de lacte Vironim et Virginuin.
VOL. 1^. 10

CLASS V.
GENETICA-

ORDER II.

0BGA8TICA.

IXntMtu affettdig tlie Arnaism.

ORGANIC OR CONSTITUTIONAL INFIRMITY, DISORDERING THE POWER, OR
THE DESIRE OF PROCREATING.

The ordinal term oroastioa, is derived firom •fymtt ^^ appeto impa-
tieoter ; proprie de animantibus dicitar, qus turgent iibidine. iSca-
pul. Orgasmos is, heoce, used by most writers for salacity in gene^
ral ; though by LioD^us it is employed in a very different sense,
being restrained to subtultus arteriarwn.
The following are the genera which appertain to this order:

I. CHLOROSIS. green-sickness.

II. PRCEOTIA. OENFTAL PRECOaTY.

III. LAONESIS. ' LUST.

IV. AOENESU. MALE STERILITY.

V. APHORU. FEMALE STBRIUTT. BARRENNESS.

VI. JED0PTOSI8. GENTTAL PROLAPSE.

GENUS I.

CHLOROSIS.
«frem==ACcitnrw-

PALE, CHLORID COMPLEXION ; LANGUOR ; LI8TLESSNE8S ; DEPRAVED APPETITE
AND DI«RSTION : THE SEXUAL SECRETIONS DEPRAVED OR OTBRT, ESPEClAlXf
AT THEIR COMBfENCEBfENT.

Chlorosis is a derivative from x?^ ^^ X^«» " herba virens;"
whence, among the Gr««lL8, ^ifim^fm and xxttfm^n ^^ viror,'^ ^^ pal-

Gf. l]

SEXUAL FUNCTION. 75

lor ;" eTidently applied to the disease, like our own term green-
skknees, from the pale, lurid, and greeoish cast of the skin.

The causes of this disorder are numerous: one of the most
frequent is oaeiiostration, retained or suppressed catamenia ; another
Is excessive menstruatioD ; a third, inahility of obtaining the object
ef desire, in popular terms love-sickness : a fourth is djrspepsj, or
aaj other source of general debility about the age of puberty, by
which the natural developement of the saxual system and the
•Bergy of its secretions is at this time interfered with. Dr. Parr
makes it a question whether love-sickness or an ungrati&ed longing
ibr an object of desire is ever a cause ; but the examples are too
numerous to give countenance to any doubts upon the subject ;*
aad pining, eager, ungratified desire for any object whatever, in a
particular state of constitution, whether for an individual or for a
particular circle of society, for home or for country, is well known
in many cases to break down the general health, and to lay a foun-
dation for chlorosis, as well as many other complaints even of a
severer kind. We have already noticed it 9s producing suppressed
menstmation ; as we have also the opposite state of disappointment
overcome, renewed hope, and a prospect of connubial happiness, as
one of the best and speediest means of cure.

Perhaps retained menses, and dyspepsy at the period of puberty,
are the most common causes ; and hence chlorosis makes so near an
approach to both these complaints, that some nosologists have merg-
ed it altogether in the first, and others in the second. Dr. Cullen
so far as relates to his opinion^ is an example of the former.
Dr. Young, so far as relates to his arrangement^ of the latter.
It is necessary to attend to this limitation : for while Dr. Cullen, in
the later editions of his Synopsis, asserts ^^ nullam chlorosis speciem
▼eram, praBter illam qu» retentionem menstruorum comitatur, ag-
noscere vellem'^ — h^ still continues chlorosis in all the editions of
tliis work as a distinct genus from amenorrhoea, or paramenia
obgtntetumis^ of which upon this view of the subject it should be
oolj a species or variety. In the same manner, Dr. Young, while
be Slakes chlorosis a mere species of dyspepsia in his classification,
observes^ as thpugh dissatisfied with its arrangement, ^^ I have
ibllowed a prevalent opinion, but there are various reasons for
thinking it is quite as naturally connected with amenorrhoea.''

Chlorosis is often, indeed, not only connected with amenorrhoea,
hot a consequence of it. Yet few writers have felt themselves able
to adopt Dr Cullen's views upon the subject, and to believe it in
every instance a modification of this disease. Sauvages asserts that
ttere are daily cases of chlorosis occurring among children from
their cradles; and he has hence, among his chloroses vera, set
down one species under the name of chlorosis infantum. This,
however, is to generalize the term too widely, and to make it

* Panar«L J&trolog. Pentecb. iii. Obs« 14.
Epbem. Nat. Cur. Dec. ii. Auo. IX. Obs. 114.

76 OENETICA. [CL. v.-oiu n*

ioclade all cases marked by indigegdoo, and a chloiid cooDtenaiice.'
Yet I cannot bat concur with those authors who contend that
chlorosis is by no means uncommon among females who have
no interruption of the menstrual flux ; though a derangement of «one
kind or other in quantity, quality, or constituent principles appears
to be always connected with it ; and is for the most part the came
or leading symptom. There is eyen ground for carrying th^ tei?D,
with other authors, stMl further, and applying it to green-sick boys
as well as green-sick girls, for reasons which will be offered in their
proper place.

For the present, it is sufficient to characterize chlorosis as a
dysthesis or cachexy, produced by a diseased condition of the sexoal
functions operating upon the system at large, and hence most cohi-
mon to the age of puberty, in which this function is first called forth
by the complete elaboration of organs that have hitherto been inert
and undeveloped. "A certain state of the genitals,'' says Dr.
Cullen, ^^ and the remark will apply to both sexes equdly, is neces-
sary to gWe tone and tension to the whole system ; and, therefore,
that if ^e stimulus arising from the eenitals be wanting, the whole
system may fall into a torpid and flaccid state, and from thence
chlorosis may arise." •

The genus chlorosis offers the two foUowing species :

1. CHLOROSIS ENTONIGA. EMTOKIC GREEN-SICKNESS.

2. ATONICA. ATONIC GREENrSICKNES3.

SPECIES 1.
CHLOROSIS ENTONICA.
StitDtite tRvtn^&ithnfm'

lUBTT rLETHORIC $ PAIN IN THE HEAD, BACK, OR LOINS ; FREQUKNT
PALFITATIONS AT THE HEART ; FLUSHES IN THE FACE ; PULSE FULL, TENSE,
AND FREQUENT.

Chlorosis has been commonly confined to the second or atonic
species. But the syiAptoms atid mode of treatment of the disease,
as it appears in a vigorous, florid, and full-bosomed country-girl
overflowing with health and hilarity ; and in a delicate, pale-foced,
emaciated town-girl, debilitated by an indulgence in a course of
luxurious indolence from her infancy, seem to jtistify and even
demand a distinction.

In both cases there is a want of energy of mind, great irregularity
|n the mental functions, and oAen a high degree of irritability in the
nervous system, clearly proving a very extensive disturbance of the

GE. L-6P. 1.] SEXUAL FUNCTION. 77

general belaDce. But they differ io the symptooM eDamerated io
the definitioDS) than which no two sets can well be more at Yariance.
Thej differ also in the remote and proximate causes, and conse-
qoentlj io the mode of treatment.

lo the species before us, characterized by a rich and oppilated
habit, with a full and tense pulse, and pressive pains in the head or
Imqb, the ordinary causes are catchingf cold in the feet at the period
of the catamenial discharge, by which the constitutional plethora is
coBsiderably aggravated, and the plethoric excess itself even where
no cold has been received. The pains so common and oflen so
severe in the back and loins, and from sympathy, not unfrequently
in other parts, evince local irritability with entastic spasm in the
organs which form the seat of the disease. There is here a mor-
bid accnmulation of living power : the fabric is satiated or over-
loaded ; and for the very reason that in dyspermia entonica or
super-erection, as we shall have occasion to observe presently, there
is no seminal emission, or as in double-flowering parts there is no
efficient developement of the sexual distinctions, in the present case
there is no efficient secretion of the genital fluids. And as we have
shown in the Physiological Proem to the present order, that the ma-
turity of the system in females as well as in males, depends upon a
developement of the sexnal organization in all its powers, and a cer-
tain degree of resorption of its secreted materials, the general frame,
bow rich soever and even oppressed with juices of other kinds, must
remain incomplete and unripened, and sicken at the time of matu-
rity for want of this appropriate stimulus. And if such an effect
may occur where there is no concomitant source of excitement, we
can easily conceive how much more readily it may take place upon
catching cold in the feet, or on a sudden and violent mental emotion,
or any other cause that may accidentally add to the pressive irrita-
tion of the organs immediately affected, and increase their tendency
to spasmodic action.

Yet there can be no doubt that the species before us, though the
offipring of a redundancy of living power, if neglected, or obstinate,
and of long continuance, may, and often does, by debilitating the
coDsUtotion, terminate in the atonic species we shall presently enter
upon.

Before such a change, however, takes place, and particularly in
the commencement of the disease, we are loudly called upon for
general depletion. Copious, and not unfrequently repeated vene-
sections will be found necessary : cooling, rather than heating and
irritant purgatives should ba interposed ; and where pain about the
lorabar region, or any other local irritation, is very troublesome,
the bip-baU), or a general warm-bath should be used steadily. And
when, by this plan, the sanguiferous entony is subdued, a plain diet,
regular exercise, and sober hours, will easily accomplish the rest.

78 GENETICA. [CL. T.-OR. II.

SPECIES 11.

CHLOROSIS ATONICA.
MUnUt iSitttn^SUthntim.

BABFT debilitated; GREAT lHACTiyiTT AND LOVE OF INDITLGGirCB ; OT»-
FN<EA OR MOVUCO ; LOWER UfiCBS COLD AND RDEUATOUS, C8PCCULLY
AT NIORT; PULSE QUICK AND FEEBLE.

In coDJimctioD with the above specific symptoms, there is, in this
division of the disease, the same want of energy of mind, and fickle-
ness of temper, and corporeal irritability which we have already
noticed in the preceding, and this too in a much greater degree ;
abundantly proving a very extensive disturbance of the generri
balance.

For examples of this species we are to look not into the quiet ao4
sober retreats of rural life, nTarked by simple meals, healthfnl acti-
vity, and early hours ; but to the gay and glittering routine of town
indulgences, and midnight parties, and hot un ventilated atmospheres ;
tlie Imvoe of all which is to be seen in the pale, but bloated counte-
nance, the withering form, emaciated muscles, and departing sym-
metry of those who are the victims of a life of pleasure ; and who,
in consequeiice of their turning night into day, are exhausted, and
drowsy, and spiritless, and perhaps confined to their beds all the
morning ; thus carrying on the inversion of nature, and turning in
like manner, the day into night.

Under a life of this kind, it i$ impossible for a growing girl to
acquire a healthy maturity : and most happy is it for her that the
caprice of fashion, which calls upon her to make this heavy sacri-
3ce of her person for one half of the year, drives her, in most cases,
into the freshening shades and soberer manners of the country for
the other half.

There are other girls, however, who without these pecuUar
sources of exhaustion, have so much constitutional debility and re-
laxation, as to be incapable of bearing the double load of growth
and sexual developement without mamfesting a considerable degree
of sickliness in all their fumctions.

In both these cases, the disease is probably produced by a che-
mical imperfection or want of elaboration in the blood itself, so as
not to keep pace with the expansion and irritability of the sexual
organs ; and consequently so as not to afford them a pabulum suffi-
piently rich and ripe for secretion.

Here, therefore, bleeding and purgatives would only add to the
evil ; and it behoves us even from the first to employ a strengthen-
ing and tonic plan, and to extend it through all the departments of
diet, exercise, and medicine : the whole of which, however, may be

OE. L-SP. Il] sexual FUNCTION. 79

collected from what has already been observed od the genus para-

XEiriA.

The same kind of debility which prevents the foil developement
of the sexual organization and a secretion of the sexual juices in
growing girls, prevails, not unfrequently, in growing boys, and espe-
cially when about the age of puberty the growth is rapid, and out-
runs the general strength of the system. And it is to this state I
alluded when observing a page or two ,back, that the term chlorosis
has occasionally been applied to males as well as to females at this
unsettled period of life. In the volume of Nosology I have remark-
ed that it is frequently so applied in the East, and especially among
Perstan writers, who accordingly express one subdivision of the
dneMe by the name of bimaru/ kodek or morbus puerormn. Bonet
hm Ibliowed the oriental extension of the term, and has given in^
staaeea of its occurring not only in pubescent but even adult males :
Md, in like manner, Sir Qilbert Blane in his table of diseases, under
tke airticle chlorosis, observes that one of his patients affected with
thk complaint ^^ was a male of seventeen, who had all the charac-
ters of this malady except that which is peculiar to the female sex.
He was treated like the others, and recovered under the use of
carboiMited iron and aloes.^'* It is on this account that the defini-
tion of chlorosis will be found, in the present work, to vary in some
degree from M that have preceded it, so as to render its characters
capdbia of embracing the male as well as the female form of the
disease, which unquestionably ought to be included under it : and is
to be attadied by the same remedial plan.

GENUS IL

PROEOTIA.
CBfrnCtal 9terocfts*

PREMATURE DEVELOPEMENT OF SEXUAL ORGANIZATION OR POWER.

The generic term prceoiia or pr(eotes is copied from Theophras-
tns, and derived from w^i^ " pnpmature." It is, however, pecu-
liarly applied to premature semination.

Tlie genus, as embracing both sexes, comprises the two follow-
mg species :

1. PBIBOTIA MASCULINA. MALE PRBCOCrTY.

fL ■ rCMIBINA. FEMALE PRBCOCITV.

'V ■Tun nrrr- i i ■ ■ . ':

• Medico-Chir. Trans. Vol. iv. p. 140.

90 GEMETICA. [CL. V.-OR. 11.

SPECIES 1.

PRCEOTIA MASCULINA.

malt ^recocits.

PAEMATURB DEVELOPEMENT OF SEXUAL ORGANIZATION IN MALES.

Both the mind and body advance in their ordinary career, by slow
and almost imperceptible steps to maturity ; faculty after iaculty,
and function after function puts forth, acquires strength, and be-
comes perfected. But it occasionally happens that this ordinary
course is departed from, and that the whole system as well mental
-as corporeal, or, which is still more frequent, that particular powers
or organs, push forward with incredible rapidity. The admirable
Crichton, as he is commonly called, and others pre-eminently gifted
in the same extensive way, afford instances of the first of these re-
marks : and those who, in early and even in infant life, have shown
a peculiar aptitude for an acquisition of languages, or of music, or
Aiumerical arithmetic, give examples of the last kind.

It is not hence much to be wondered at that a like extraordinary
precocity should sometimes exhibit itself in the developement of
sexual organization and power : and that from a peculiar degree of
local irritation or erethism, the pubes should be found covered with
hair, the testes be formed and capable of secreting a seminal fluid,
and the penis be susceptible of a concupiscent turgescence and erec-
tion.

It is not necessary to dwell upon instances of exemplification,
which may be traced in great numbers in the writings of physiologists
who have been curious upon the subject. Those who are desirous
of doing so, may turn to the Journal des S^avans for 1688, and the
Philosophical Transactions for 1745. In the formerBioset, gives an
instance of this disgusting anticipation in a boy of three years old ;
in the latter, the subject in the case recorded was two years and
eleven months. A similar example at a similar age is well known
to have occurred, only a few years since, in a boy who was exhibit-
ed by his friends for money to medical practitioners in this metro-
polis; and may be found, together with various others, minutely
described in the first volume of the Medico-Cliirurgical Transac-
tions.

With respect to moral, or even medical treatment, nothing can
be worse than this very common practice of a public exposure
whenever the case occurs among the poor, who are so strongly
tempted to make a profit of it The orgasm is fed by a repetition
of examinations, and the polluting tide that exhausts and debases
the body, is at length accompanied, even though it should not be so
at first, with a polluting pleasure, that in a still greater degree ex«

GE. ll.-SP, I.] SEXUAL FUNCTION. 81

haosts and debases the mind. An occasional application of leeches
to the seat of affection, coolings aperients, a cool, loose, and unirri-
tating lower dress, with the daily nse of a bidet of cold water, or
iced water, will form the best plan that can be pursued on such oc-
casions : and, by producing a healthful repression, may enable the
unhappy infant to grow up with gradual vigour to the possession of
a hearty manhood, instead of sinking, as has been sometimes the
case, into a premature and tabid old age at the early period of pu-
berty.

SPECIES 11.
PRCEOTIA FEMININA.

PREIUTURE DEVELOPEMENT OF SEXUAL ORGiNlZATION IS FEMALES.

UivDER the species of obstructed menstruation, we have observed
tliat this secretion which commonly affords a proof that the sex-
ual organization is developed, and its function completed, takes
place at very different periods of life under different circumstances,
chiefly those of climate and peculiarity of constitution': and that
though its ordinary epoch is that of thirteen or fourteen, it has
sometimes, under the influence of a tropical sun^ or a warm and
forward temperament, shown itself as early as eight or nine years of
age*

There is hence no difliculty in conceiving that, under the influ-
ence of the same kind of local erethism we have noticed in the
preceding species, the sexual organization in females may acquire
a similar precocity to that in males. And so complete has been the
developement occasionally, that we have numerous and well authen-
ticated instances of pregnancy itself occurring \i the early age of
nine, on which we shall have to remark more fully in the introduc-
tory observations to the third Order of the present Class, when
treating of morbid impregnation. ^

This foremarch of nature should be timely checked, for it will
otherwise assuredly lead to a very great debility of the system in
general, and is usually found to stint the stature, and induce a pre-
mature old age. '^ And the means of repression may be the same as
those already proposed for male precocity.

The premature developement of organization before us does not
always seem to be connected with any cupidinous orgasm, or at
least it has occurred under circumstances that render it extremely

» Walther, Thes. Obs. 40. >

VOL. IV. 11

ttfl GEN£TICA. [CL. T.-OIU U.

difficult to eotertain any sach idea. One of the most siogalar in*
stances of this kind is a case of extra-uterine fetation comuMUUcated
by Dr. Baillie to the Royal Society, and published in their Trans-
actions for 1789. It consisted of a suetty substance, hair, and the
rudiments of four teeth, found in the ovarium of a child of not n^pre
than twelve or thirteen years of age, with an infantine uterus, and
perfect hymen.^

In this case there can be little doubt that an ovulum by some pe-
culiar irritation had been excited to the rudimental process of an
imperfect conception, and that it had, in consequence, been separat-
ed from its niche, and a corpus luteum taken its place. In the
Physiological Proem to the present Class, we have observed that
such changes are occasionally met with in mature virgins whose
organs have afforded ample proof of freedom from sexual com-
merce, the ordinary mode of. accounting for which, is by supposing
that although they have never cohabited with the male sex, they
have at tiroes felt a very higli' degree of orgasm or inordinate de-
sire, and that such feeling has been a sufficient excitement to pro-
duce such an effect The author has already expressed himself not
satisfied with this explanation ; and the case before us can hardly
be resolved into any such causation.

GENUS IIL

LAGNESIS.

150RD1NATE DESIRE OF SEXUAL COMMERCE, WITH 0RGA5IC TURGESCENCE
AND ERECnON.

Lagnesis is a derivative from ym^/ntt^ '*' libidinosus ;'' ^^ praeceps in
venerem ;^' and, as a genus, is intended to include the satyriasis
and NYMPHOMANIA of Sauvages, and later authors ; which, chiefly, if
* not entirely, differ from each other only as appertaining to the
male or female sex, and in their symptoms do not, like the preced-
ing genus, offer ground for two distinct species. The proper spe-
cies belonging to this genus are the following :

1. LAONE8I8 SALACITAS. SALACrPT.

/ S. .....•.—^ FUROR. LASCIVIOUS MADNESS.

♦ Phil. Trans. Vol. LXXIX. p. 71.

OE. in«-fip. l] sexual function. 83

SPECIES I.
LAGNESIS SALACITAS.

THE APPETENCY CAPABLE OF RESTRAINT ; THE EXCITEMENT CHIEFLY CON-
FINED TO THE 8EXXTAL SYSTEM.

In a state of health and civilized society there are two reasons why
mankind are easily capable of restraining within due bounds the
animal desire that exists in their frame from the period of puberty
till tiie infirmity of age : the one is of a physical and the other of
a moral kind. The natural orgasm of men differs from that of
bmtes in being permanent instead of being periodical, or dependent
upon the return of particular seasons; and on this very accountis
lem Tiolent, more uniform, and kept with comparative fadlitr
within proper limits. Tins is a cause derived from the physical
coosthution of man. But the power of habit and the early inculca-
tion of a principle of abstinence and chastity in civilized life, form
a moral cause of temperance that operates with a still stronger in-
fluence than the preceding, and lays down a barrier, which, though ^
too often stealthily broken into, yet in the main, makes good its
post and serres as a general check upon society.

As man rises in education and moral feeling, he proportionally
rises in the power of self-restraint ; and consequently, as he be-
comes deprived of this wholesome law of discipline, he sinks into
setf4ndalgence and the brutality of savage life. And were it not
that the yeiy permanency of the desire, as we have already ob*
served, torpefies and wears out its goad, the savage, destitute of
moral discipline, would be at all, times as ferocious in his libidinous
career as brutes are in the season of returning heat ; when, stung
with the periodical ardour, and worked up almost to fury, the
whole frame of the animal is actuated with an unbridled force, his
motions are quick and rapid, his eyes glisten, and his nerves seam
to circulate fire. Food is neglected ; fences are broken down ; he
darts wild throi:^h fields and forests, plunges into the deepest rivers^
or Mies the loftiest rocks and mountains, to meet the object that is
ordflfed by nature to quell the pungent impulse by which he is
uiged forward :*

Nonoe vidac ut Uta tremor p«rtentet equorum

Corpora, li untum notas odor attulit auras ?

Ac Deque eoi jam frena virum, neque verbera saera,

k — —

• See Crichton on Mental Derangement, ii. p. 301.

84 GENETICA. [CL. V.-OIL 11.

Non scopuli, rubesque cavs, atque objecta retardant
Flumina, correptos undft torquentia montos.*

The power of restraiot, however, does not operate alike on all
persons even in the same state of society, and under a common
discipline. * Period of life, constitution, and habit, produce a con-
siderable difference in this respect, and lay a foundation for the
four following varieties of morbid salacity :

« Pubertatis. Salacity of youth.

C Senilis. of age.

y Entonica. of full habit.

} Assueta. of a debauched life.

The FIRST VARIETY proceeds not so much from organic turges-
cence, as from local irritability : for it is chiefly found in relaxed and
delicate frames, weakened by ovei^rowth, or a life of indolence and ii>-
dalgence. The action is new, and where, from whatever cause the
irritability is more than ordinary, a degree of ei^citement is pro-
duced which shows itself constitutionally or topically, if in the
former way, hysteria or chorea, or some other nervous affection, is
a very frequent effect: if in the l^ter,a high-wrought and distress-
ing degree of appetency. It is under this state that females are
said to be capable of separating ovula from their ovaries, and to
form corpora lutea without copulative perculsion, in the same manr
ner as the ovaries of quadrupeds that are only capable of breeding
in a certain season of the year, exhibit during their heat, manifest
proofs of excitement and especially of florid redness, when exami-
ned by dissection. I do not think the assertion concerning women
is altogether established : but in the case of young men when en-
tering upon, or emerging from pubescence, and of the relaxed and
deUcate frame just noticed, nothing is more common than involun^
tary erection and seminal emission during sleep, often connected
with a train of amorous ideas excited by the local stimulus, as we
have ikhoeadj observed under paron.ria salax.T

It is posdble that this affection may occasionally be a result of
entony or plethoric vigour as well as of atony or de&cacy of health :
but the last is by ikr the most common cause.

In the first case we have nothing more to do than to reduce the
excess of living power by copious venesections and purgatives,
active labour, or other exercise and a low diet. In the secfitti, it
will be expedient in a very considenible degree to reveiw the
plan. We may, indeed, palliate the topical irritation by the use of
leeches and cooling laxatives ; but in conjunction with this, we
should employ the unirritant tonics as the salts of bismuth, zinc,
and silvet, or the sedative tonics as the mineral acids, most of the
bitters, and the cold bath. By taking off the debility we take off the

• Virg. Gcorg, Lib. iii. 250.
t VqU III. p. 120.

GE. OI.-6P. I.J SEXUAL FimCTION. 83

irritation) and, by taking off the irritation^ we oyerpower the dis*
ease.

The SALACiTT OF AGE is a very afflictive malady, and of^en wears
away the hoary form to the last stage of a tabid decline by the fre-
qoency of the orgastic paroxysms, and the drain of seminal emis-
sions without enjoyment. It is usually a result of some accidental
cause of irritation in the ovaria, the uterus, the testes, or the prostate
gland ; and has sometimes followed upon a stone in the kidneys or
bladder ; and is hence best relieved by removing or palliating the
local irritation by a warm hip-bath, anodyne injections, or cataplasms
of hemlock, or the other umbellate or lurid plants in common use.
Where these do not succeed, our only resource is opium, and the
warmer tonics.

In the first volume of the Transactions of the Medical Society of
London, Mr. Norris has given a very curious nnd striking case of
this variety, produced by a blow received a few months before near
the prostate gland, followed by a small, but nearly indolent tumour
on the part affected. The patient was a married man of sixty-seven,
and during the violence of the erethism occasioned by this local
irritation, which had now continued for two months, was reduced
to a state of the most wretched and squalid emaciation. He could
not restrain the libidinous propensity, though he confined himself to
his wife, with whom he copulated from fifteen to twenty times
nightly, receiving, nevertheless, pain rather than pleasure from
the indulgence The wife, a matronly woman of great modesty,
was hereby rendered extremely ill from local inflammation. By
Mqyporting the system with tonics, and bringing the tumour to suppu-
ration, the man completely recovered.

£iiT0Fric SALAcrrr, or that of a robust and sanguine temperament,
is not always so easily remedied as might at first be supposed. Co-
pious venesections, purgatives, and a reducent diet, and this suc-
ceeded by a regular use of neutral salts, and especially of nitre,
will often, indeed, be found highly beneficial. But the erethism
occasionally becomes chronic, and defies the effects of all medicines
whatever: and, where there is an excess of irritability in the
constitution, and the patient, from a principle of chastity, has
sedulonsJy restrained himself from all immoral indulgences, the
nervous system, and even the mind itself, has sometimes suffered in
a very distressing degree. One or two examples of this we have
already noticed under bcphronia Mania^ or madness ;'i^ and it is
hardly worth while to dwell further upon the subject. The natural
cure is a suitable marriage i^herever this can be accomplished :
but unless the anion be of this character, it will often be attempted ■
in vain. Professor Frank of Vienna, in his >System of Medical Polity,
relates the case of a lady of his acquaintance, of a warm and amorous
constitution, who was unfortunately married to a very debilitated
and impotent man ; and who, although she often betrayed unawares,

* Vol.111, r. 66.

86 GBITETIGA. [CL. V.-*OR. II.

by ber looks and gestures, tbe secret fire tbat consumed ber, jret
from a strong moral principle resisted all criminal gratification.
After a long struggle her health at last gave way : a slow fever
seized her, and released her from her sufferings.

The SALAcnr op a debauched life, or lechery produced and
confinned by habit, can only be cured by a total change of habit :
which is a discipline- that the established debauchee has rarely the
courage to attempt. Exercise, change of place and pursuits, cooling
laxatives, and a less stimulant diet than he will commonly be found
accustomed to, may assist him in (he attempt: but in general tlie
ound is as corrupt as the t>oHy, and the ca^ie is hopeless. He perse*
▼eres, however, at his peril, for with increasing weakness, he will
at length sink into all the miserable train of symptoms which
characterize that species or marasmut^. which is usually expressed
by the name of tabes dorsalis, and wliich we have described al*
Twrfy.*

SPECIES II.
LAGxNESIS FUROR.

APPETE'VCY UNBRIDLED, AlfD BREAKING THE BOUNDS OF MODEST DEMEAKOUR
AND CONVRRjATION : MORBID AGITATION OF BODY AND MIND.

Most of the causes of the preceding species are causes of the present,
though it shows itself less frequently at the age of puberty. It is
in fact very nearly related to the species sav \citas, though the local
irritation is more violent, and the mind parlicipate? more generally
and in a very different manner. Under the first, the patient has a
sufficiency of self-command to conduct himself at all times with
decorum and not to offend the laws and usages of public morals ; and,
if, as is rarely tbe case however, the mind should at length become
affected, it is rather by a transfer of the morbid irritation than an
extension of it, so that patients thus afflicted very generally lose the
renereal erethism, and show no reference to it in the train of their
maniacal ideas, in lascivious madness, on the contrary, this last
symptom continues in its utmost urgency, all self-command is bro-
ken down, the judgment is overpowered, the imagination enkindled
and predominant, and the patient is hurried forward by the concu-
piscent fury like the brute creation in the season of heat, regardless
equally of all company and all moral feeling. As it occurs in males
it is the satyriasis Jurens of Cullen : as it occurs in females it is
the nymphomania yiirt6ttmia of Sauvages.

* Vol. II. p. 488.

a£. UL-fiP. Il] SEIUAL FUNCTION. 87

The pulse is qoick, the breatbia^ sbort, the patient is sleepless,
thirsty, and loathes his food ; the urioe ii evacuated with difficulty,
and there is a continual fever. In women the disease is oAeo
connected with an hysterical temperament, and even commences
with a semblance of melancholy ;* and I once had an instance of it,
from local irritation, shortly after child-birth. The child having
suddenly died, and there being no more demand for a flow of milk,
the fluid was repelled from the breasts with too httle caution, and
the uterine region, from the debility it was yet labouring uoder,
becaone the seat of a transferred irritation. Among females the
disease is strikingly marked by the movements of the body and ihm
salacious appearance of the countenance, and even the language that
proceeds from the lips. There is often, indeed, at flrst some de*
gree of melancholy, with frequent sighings ; but the eyes roll ia
wanton glances, the cheeks are flushed, the bosom heaves, and
every gesture exhibits the lurking desire, and is enkindled by the
distressing flame that bums within.

La some cases it has unquestionably proceeded from the perpetual
friction of an enormous clitoris, making an approach, from its erec-
tion, to what Galen calls a female priapism. Buchner, Schurig,t
and Zacutus Lu8itanus| gives numerous examples of this : and Bar-
tholin has the case of a Venetian woman of pleasure, whose clitoris
was rendered bony by frequent use, and consequently became a
source of constant irritation.

In hot climates this kind of enlargement and elongation is by no
means uncommon, and, as it becomes a source of uncleanliness, as
well as of undue excitement, circumcision or a reduction of the
clitoris to its proper size, has been oAen performed with advantage.
The same operadon has been proposed for the case before us, and,
in some instances, it has succeeded completely. ^^ A young woman,''
says M. Richerand, ^^ was so violently affected with this disease, as
to have recourse to masturbation, which was always accompanied
with profuse emissions ; and which she repeated so frequently as to
reduce herself to the last stage of marasmus. Though sensible of
the danger of her situation, she was not possessed of self-command
enough to resist the orgastic urgency, lier parents took her to
Professor Dubois, who, upon the authority of Levret, proposed an
amputation of the clitoris, which was readily assented to. ' The or-
gan was removed by a single stroke of the bistoury, and all hemor-
rhage prevented by an application of the cautery. The wound
healed easily, and the patient obtained a radical cure of her dis-
tresmng afi'ection.§

Where the cause cannot be easily ascertained we must employ a

* Deljus, Advert. Fascic. i.
Belo], furor uterinus, Melancholicus Eficcius, Paris), 1621.

t Gynaecology p. 2. 17.

X Prax. Admir. Lib. ii. Obs. 91.

k Richerand, Noeograpbie Cbirurgicale, Szc.

88 GENETKJA. [CL. V,-OR. II.

general plan of cnre. If there be plethora or constitutional fulness,
venesection should never be omitted ; and, in most cases, cooling
laxatives, a spare diet, with acid fruits and vegetables, cold bathing,
local and general, will be found useful. Nitre, by attenuating the
crasis of the blood, and diminishing its impetus, has often proved
beneficial ; and to this may be add^d conium, aconite and other nar-
cotics. Camphor, which acts upon another principle, is a favourite
medicine with many, aud is also well worth a trial.

From the infuriate state of the mind in most cases of this malady,
Vogel has arranged both satyriasis and nymphomania as species of
MANIA. But this is incorrect ; the fury of the mind is merely symp-
tomatic. Parr, on the contrary, has ranked, under lagnesis, to
which, with great perversion,, he applies the term hallucinatio,
erotomania or love-sickness, more properly a variety of empathema
desideriif and which, in the present, and most other systems, is,
therefore, regarded as a mental malady.

Love-sickness, however, may sometimes be an occasional or ex-
citing cause, and its symptoms may be united with the complaint,
and even add to the general effect,^f which the History of the
Academy of Sciences affords an instance :* but in itself, it is, as we
have already shown, altogether a disease of a different kind, and
even nature ; and where it becomes blended with concupiscent
fury, it must be from a concurrence of some of the special causes of
the latter, either general or local, which we have just pointed out.

In males the disease has led to quite as much exhaustion as in
females : Bartholin gives an example of a hundred pollutions daily.

G E N U 8 1 V-

AGENESIA.
iHale Strrflftfi.

INABILITY TO BEGET OFFSPRING.

The generic term is a compound from it negative and yi»i^ut«, " to
beget," and will be found to comprehend the three following
species, derived from impotency of power or energy ; an imperfect
emission where the power is adequate ; or an incongruity in the
copulative influences or fluids upon each other.

1. AGENESIA IMPOTENS. MALE WPOTENCY.

2. n DYSSPEHMU. SEMINAL MlS-EMISSION.

3. INCONGRUA. COPULATIVE INCONGRUITY.

* Ann. 1764. p. 26.

. v;-4V. I-] sExiuL fuvonoK.

jUdodc 9^^"^ 1** MiDBtiiMt meet lOA a like gMietatfiFe 4bf
tbiUtj; oGC^Bkoally fr«Di imperfectlj ibmed styled or sUgDua,
sUmens or antbecB ; soinetimes irom a guppreiiioD of farina, ap4
sometimeB from a total destitutioo of seeds : which last defect is
«MBaiiion to Inromelia AnoMu; miisa varadiiiaca^ or Baojan ; artocar-

aimcim or faread-fimit tree j and berberis vtdgorit or common
emgr.

SPECIES I.

AGENESIA IMPOTENS.

mmiFBOTioir on aboution or osnxiUTiyE powEa.

Thb spedes before ns is, perhaps, more generally called by tne
ttoaologfBts anaphrodisia, though this last term has been nsed in
very ^Mftrent senses ; sometimes importing a want of desire, some*
tiines inability, sometimes both ; and sometimes only a particular
kind of inability resulting from atony alone. The third species hai^
nerer, hitherto, so far as the author knows, been introduced into
any nosological arrangement, although the reader will probabljr
find, as he proceeds, sufficient ground for its admission. And eveii
^ first and second, closely as they are connected by nature, have
rarely, if eyer, been introduced before under the same common
dyision, but been regarded as distinct genera belonging to distant
orders or eyen classes, and arranged with diseases that have little
or no relation to them, of which numerous examples are giyen in
the yolume of Nosology.

Impotency in males may proceed from two yefy distinct causes,
lowing themself es in yery Afferent ways, and laying a foundiition
for the following varieties :

# Atonica. Atonic impotency.

C Orgaaica. Organic impotency.

In th« FIRST of these there is a direct imbecility, or want of
tone ; produced chiefly by eicess of indulgenee, long-continued gleet,
or a paralytic affection of the generative organs, it has also been
occasioned by a violent contiuion on the Wins, or a fall on the
nates.*

Under the two last cases a cure is often effected by time, and lo-
cal tonics and stimulants, especially cold-bathing: and the*same

• HUdan. Cent. vi. Obs. r?.
VOL. IV. 12

99 «mmrieA. [eL> T^^noftt a^

|^noG6«s wfil fin^Qentlj socceed ffkere the mukxtrnm hu followed
upoD a chronic gleet : in which we maj alto employ the course of
Remedies which have already been reooaimended for this com-^
]plaint.t

Where die impotency resnlta from a paresis or a paralysis of the
local nerves, or has been broi^^ on by a life of debauchery, the
ease is nearly hopeless. We have heard much of aphrodiidacs, but
there is none on which we can depend in effects of this kind*
Wine, which is the ordinary stimulant in the case before us, will
rarely sooceed even in a single instance, and where it has done so,
it has increased the debility afterwards. It is, in truth, one of the
most common causes of the disease itself

Gantharides have often been employed, but in the present day
they are deservedly distrusted, and flourish rather in proverbs thao
in practice. Their effect, as a local stimulant, shows itself rather
on the bladder and prostrate glapd than on the testes, and as a gene*
ral irritant in increasing the heat and action of the whole system,
in which the testes may, perhaps, sometimes have participated.
^^JThey are,^' says Dr. CuUen, ^^ a stimulant and heating substance,
aV I have had occasion to know them, taken in large quantity a# a^
aphrodisiac, to have excited violent pains in the stomach, and a fe^
verish state over the whole body/'t

Many of the verlicillate plants, as mint and penny-royal, have
been tried in a concentrated state for the same purpose, but with
Afferent, and even opposite effects, p the hands of different prac-
titioners. To the present hour they are supposed by many to sti-
mulate the uterus specifically, while they take off the venereal
appetency in males. Upon sober and impartial trials, however,
they seem to be equally guiltless of both : and may as readily
be relinquished for such purposes as the nests of the Java swal-
low which are purchased at a high price as a powerful incentive,
and ibrm an extensive article of commerce in the East.

The best asphrodisiacs are warm and general tonics, as the sti-
Aiulant bitters, and the metallic salts, especially the preparations of
JLrott.'- pjngseng, is an aromatic bitter, has a just claim to a further
trial than it seems hitherto tp have received. In China it has for
ages been in high esteem, not only as a general restorative and ro-
borant^ but particularly in seminal debilities. Dr. Cullen appears to
have thrown |t not idf practice by tell^g us that he knew ^^ a gentle-
man a little advanced in life, who chewed a quantity of this root
every day for several years, but who acknowledged that he never
found his venereal faculties in the least improved by it.'^ This is
ao doubt true, but the merits of a medicine are not to be decided
by a single esperiaient of so very loose a kind.

Local irritants, in many cases, have undoubtedly been of use, as
blisters, caustics, and setons. Electricity is said to have been still

• Art. Nat. Cur. Vol. v. Obs. 59.
t Mat. Med. Vol. ii.^. 50S,

Oft. ir.*^. 1.] sBxuAt wmmoff. ft

more extensiTtfty 9i^fteMe: and frictioii ^ivMi aaitiUHiiated oil or
tpirlts, or any otber rubefadent is fairly entitled to a trial. Stingy
lag whh nettle-leaves (urtica urtmt) was, at one time, a popular re-
medy, and flagellation of the loins* or nates,t or both, still more so.
The principle is the same, and we hence account for the socces!^
which is said to ha?e attended M theae in partiieniar cases.

In oiCoAiiic ixpoTBNCT, iomiing our second variety, the chance ot
success is generally hopeless. This proceeds from a mlsformation
or misorganization of the parts, either natural or accidental : as an
amputated, injured, or enormous penis, or a defect or destitution of
the testes. Plater introduces brevity or exility of the penis| among
the causes, but these evils are generally overcome by hamt. An
incurvated, retracted, or otherwise distorted form is also mentioned
by many writers, but these seem rather to belong to the ensuing
species. An unaccommodating bulk of the organ seems to have
been no uncomaK)n causie.§ Shenck gives an i^tance of this kind
in which tlie bulk was produced by the monstrosity of a double pe-'
nis;|| and Albinos reUtes a case of divOTce obtained against a hua^
bmd from inability to enter the vagina 06 penem inarmmh»% A si^'
mikr Utigation with divofce is recorded by Pkteri**

SPECIES li.

AGENESIA DYSSPERMIA. •

AemfHal ifltiBmiMUm.

IMPERFICT EHIBSION OF Tmc SClflNAL FLUld.

Tbm is the dyspermatlsmus, or, as it is usually but incorrectly spelt,
dy-spermatiamus. The termination is varied^ not merely on ac«
count of greater brevity and simplicity, but in conformity with the
parallel Greek compounds, polyspermia, gymnospermia, aspermia^'
terms well known to ev^ry botamst, and Uie two former of which
are ekgantfy introduced into the Linn^an vocabulary.

* BSeibom. de Flagrorum usft in re VenorelU

t Riedlin, Linn. Med; 1698. p. 6.

I Obsenr. Libr. !• pp. 349. 250.

4 Scburig. Gjnscolog. p. 326.
Wadel, Pathol. Sect. iH. p. 11.

I Oliwrv. Lib. iv. N. 2. 8.

t Dissert, de Inspectione corporis, forensis, in causis matrimonialibui fallacibttt
•tdubus.Hall. 1740.

•• Obserr. Lib. i. p. 260.

P

d* OBNAmCA. iGL.T.-Oft.ft^*

Imptfi^cUoii or deftct of euifefliMi proceeds from numerous ctea^
•^ accompanied with soaie dlange of symptoBV as apperUdnii^ t9
e«ch| and hence hrylag a foaiWIatioB for the folbwing Tarietiee :

• Entonica. ^ TJhe imperfect emissiofi proceeding'

Eotonic odieiidstioB. ^ , from saper^rection or priapism.

€ EpilepUca. tendered imperfect by the incnrr

Epileptic ndsemisBion. sion i>{ an epileptic spasm pro*

ducQd by sexual excitemeat doiK
ing the intercooiae.
y AttUcipans, The discharge ejected hastily, pre-

Anticipating miyemssiibns. maturely BSki withoat due adjust*

ment.
J Cuoctans. The dischaige unduly retarded from

Retalrding misenussioa. hebetude of the genital oiipans^

^ hence not accompUslied till

the orgasm, on the part of the fe-*

. ^ male, has subsided.

I Refluens. The discharge thrown back into the

Refluent misemiaien. resiculss seminales or the bladdeiSr

before it reaches the extremity of
the penis.

Of the first, or entoii ic variety, examples are by no means un-
tommon. Dr. Cockbum gires an instance in a yoUbg noble Vene-
tian, who, thfugh married to a fine and healthy young lady, had n<y
seminal emission in the act of union notwithstanding there was a
Tigorous erection, whilst he could discharge very freely in bis
dreams.* He was greatly a£9icted, as were also his family, by such
a misfortune ; and as no remedy could be devised at home, the Ve-
netian ambassadors resident at the different courts of Europe were
requested to consult the most eminent physicians in their various

2uarters. The case came in this manner under the notice of Dr.
;ockbum,who, hitting accurately upon the cause of the retention, and
aSscdbing it to. the violence of the erection, or rather to the pletho-
ra of the vessels of the penis, whose distension produced a tempo-
rsity imperforation of the urethra, so that the powers which threfir
out the. semen could not overcome the resistance, an effect which
probably did not occur in dreaming, advised purgative medicines
and a slender diet, which soon produced the desired issue. t

i remember, many years ago, a healthy young couple who con-
tinued without o&pring for seven or eight years after marriage, at
which period the lady, for the first time, became pregnant, and
continued to add to her family every year till she had six or seven
children ; and in professional conversation with the father, he has
clearly made it appear to me that the cause of sterility, during the

* See a sirailar case in Marcel. Dooat. Lib. iv. Cap. 18«
t Edin. Med. Ep. i. p. 270.

W- W^S?. 1I.J SEXUAL FUNCTION. 93

above pcnMt, Was tfie morbid entonj we are now Atsdtissidg. Inline,
yiet^ hy degrees, Jbrofee tbe Tigom* of the encounter, effected at
leagth a'ra&^ owre^ and gdre Mm an ofTspHng he had almost des-*
paiied o£ Mr. J. Honter recommends opium in this case, as the
Mat dUayer of the undne stimulus.

The SECOND TARienr, or misemisiion from the incursion of an
efileptic fit, it is not difficult to account for. Persons who arc
predisposed to eplllsp^, are, fbr the most part, of a highly irrita^
blebmi; and wherever the predisposition eidsts, any accidental
esciteinent, as we have already shown in discussing this affection,*
la aofficieDt to produce a fresh parbicysm : and hence it is seldom
more likely to occur than from the pcrculsion of a sexual em-
brace. Eren death itself has sometimes ensued in consequence of
Hie violence of the venereal paroxysm.

Szaibpies of epHepsy from this cause, as collected in tbe public
aaedicid records, are numerous. Among men, one of the most famous
inataiices is that of tlie celebrated Hunnisb chief Attila.t Morgag-
t&l and Sinbaldiis§ have given examples among women.

Henoe a life of matrimony had better be relinquished by those
wbo are thus afficted*, as well on their own accounts, as on that of
tb^ descendants. And where marriage is actually effected, sexual
commerce ^onM be sedulously abstaUied trom at the periods in
wbicb tbe disease is accustomed to recur, or during the continuance
of those signs by which a pak-oxysm is usually preceded.

The TBuiD and vovrth varieties, or anticipating and retarding
mlBemission, are put together by Ploocquet under &e name of eji^
culatio mteinpestiva^W and are equally entitled to this character f
while the former is, by Schenck, denominated ejaculatio prcemo*
htra.H

The anticipating or premature variety evinces great nervous ir*'
ritability in a delicate or relaxed habi^ ; the plethora of the first or
entonic variety would produce the best and most effectual cure ;
but as this is rarely to be accomplished in a constitution of this
kind, tonics, a plain but nutritious diet, especially light suppers^
and, more especially still, a bidet of cold water before retiring to
bed, form the most effectual means of subduiog this precession oi^
generative power. In some cases, the afflux has been so quick as
to take place even before the vagina has been fairly entered.

The FOURTH or retarding variety forms a perfect contrast to the
preceding. It imports a sluggishness either of constitution or of
local erethism, in consequence of which the seminal flow does not

* Vol. in. SyBpasia, Epilepsia, p. 358»

t BoroHi, Amaltb. Med. Hist, p* 16K

{ De sed. et Caus. Morb. £p. XXTI. Art. 13.

f Geneaathropia, p. 794*

N Init. Bibliotb. Tom. iv. p. 61. 4to. Tubings 1795«

T ObsefT. Lib. iv. Obs. 46.

94 QfilCfiTft^A; [CL. r.-OlL tf^

take p1ac6 till (he oi^asm of tbe fbmale bos stibsided, and fatigue^
perhaps disgust, has succeeded to desire. Here 'too, general tonics
and local stimulants offer the fairest chance of snccesa ; and bo^
sting-nettles* and flagellations,! as in some cases of oi^fanic impo-
tencj, are said to have worked wonders. ,The yarietj is generallj
described under the name of bradyspermatismns.

The REFLUENT VARIETY is .chie^j introdnced upon the anthority
of M. Petit,J whose description has been copied bj Sanyages. " It
consists,'^ he tells us, ^^ in a refloz of the semen into the bladder
or vesiculs seminales, on account of the narrowness of the urethra,
in consequence of which there is no semination during the inter-
Qnion, and the semen is afterwards dischaiged with the urine.

This narrowness is common to those who have suffered from fre-
quent blenorrhoeas, and have hence contracted strictures or scirrhous
indurations in the course of the urethral passage, or have the pas-
sage blocked up with indurated mucus. Deidier g^ves a case not
very unlike, consisting of a patient who laboured under a fistula
opening from the vesicula seminales into the rectum : in conse-
quence of which, though sound in every other respect, whenever
he embraced his wife scarcely any of the semen escaped from the
penis, nearly the whole passing into the intestine, intermixed with
a small quantity of urine ; and hence his marriage was steTile.§

In all these cases the cure of the impotency must depend upon a cure
of the local cause of constriction. The dyspermatismus, urethraliij
nodosus and mucosus of Sauvages and Cullen, who has copied from
him, are all resolvable into this variety, as proceeding from like
causes, and producing a like effect

SPECIES III.
AGENESIA INCONGRUA.
(Eoimtotfiir KncntifiritCtfi.

THE SEMINAL tLVTD INACCORDANT IN ITS CONSTITUENT PRINCIPLES, WlTtf
THE CONSTITUTIONAL OEBfAND OF THE RESPECTIVE FEMALE.

All the species of this genus are closely connected ; yet it is only
the first two that have hitherto been noticed by nosologists ; nor
is there any preceding system that I am aware of, under which

* Eph. J^aL Cur. Dec. ii. Ann. v. App. p. 55.
t Meibom, and Biedlln, loc. citat.
X Memoiret de I'Academie de Chirurgle, i. p. 434.
4 Tom. m. Consult, i.

«E. nr.-6P. iil] sexual fumction. 95

eveo theise4wo have heea introdiiced into the same sabdivision.
In almost every instance, indeed, they have been regarded as dis-
tinct genera belonging to distant orders or even classes, and ar-
ranged with diseases that have little or no relation to them. Thns,
in Sausages iapotentia, by him called anaphrodisia, occurs in the
second order of his sixth class, united with such diseases as ^' loss of
tbiisV^ and ^^ desire of eating;^' while dysspermia, or dyssperma-
tismus is carried forward to the third order of his ninth class. la
Cullen these diseases occur, indeed, in the same class, a very im-
proper one, that of locales, but under different orders of this class;
impotentia being arranged under the second order, with the mor-
bid cravings of the alimentary canal, and some of those of the mind,
as nostalgia ; and dysspermia being placed under the fifth order, en-
titled epischeses or suppressions.

The present species is, for the first time, so far as the author
knows, introduced into a nosological system ; and is derived from
personal obse^ation in full accordance with the scattered remarks
of several othbr writers and practitioners. The principit upon
which the species is founded belongs, strictly, to the general doc-
trine of conception, and has been already explained in the Physio-
logical Proem to the present cli»s. It will hence be sufficient to
throw out a few additional hints for the purpose of bringfing the
principle more immediately home to the disease before us, and
sopporting the propriety (^ its introduction into the general register.

Every one must have noticed occasional instances in which a
husband and wife, apparently in sound health aod vigour of life,
have no increase while together ; either of whom, nevertheless,
upon the death of the other, has become the parent of a numerous
&mily ; and both of whom, in one or two curious instances of
divorce, upon a second marriage, in various instances, indeed, the
latent cause of sterility, whatever it consist in, seems gradually to
diminish, and the pair that for years was childless, is at length
.endowed with a progeny. In all this there seems to be an incon-
gmity, inaccordancy, or want of adaptation in the constituent
prin<»ple8 of the seminal fluid of the male to the sexual organization
of the respective female ; or, upon the hypothesis of the epigenesis,
ffhich we have already illustrated, to the seminal fluid of the
female. Writers, strictly medical, have not often adverted to this
subject, though it is appealed to, and for the most part with appro-
bation, by physiologists of all ages and countries. Sauvages, how-
ever, evidently alludes to and admits such a cause in his definition
of dysspermatismus teronij, which is as follows : ^^ Ejaculatio seminis
aquosloris, adeoque ad genesim inepti, quae species est frequentis-
dmum steriKtatis virilis princlpium.'' He illustrates his definition
by a case which occurred to Haguenot and Chaptal, who attributed
it to the cause in question, and refers for other examples to Etmuller.
CuUen expresses himself doubtfully upon this species, ^' De dyssper-
fnatkmo seroso Sauvagesii,^' says he, ^^ mihi non satis constat."
Yet his own gonorrhoea laxorumj in the present system spermorrhoea

96 GEinCTlCA. [CL. ¥.-^R. If*

oiamcay «od which be exphtus ^^ homor plerraqoe pettocMok
fline pjeois erectioDe, aed cum Ubidioe, in yigiUoite, .ex nrelhra flvk,^^
mak^ 80 Dear an apfiroach to it, that the phystotogitt who admito
the ope cm £od littie difficulty in admittiog &e other. Hie reseoH
blance ia, iadeed, close and stiiking ; in tbe latter disease the todi-
vidual labooriai^ under it, emits involuntarily, and wUhout ooMm,
or eyen erectioo, but with a libidinous sensation, a pellucid fluid,
apparently of a seminal character, affirmed positively bj Sauvages,
from whom CuUea derives his species, and to whom he refers, to
be an ^^ effluxus semiris ;^^ while, in the former, the same dilute and
effete semen, with difficult, and imperfect erection, is poored fortb
during coition.

In Uke manner, Forestus speaks of a proper gononiicoa, or invo^
luntary emission of seminal fluid, produced ex aquotitaU^* from too
watery a cpndition of the secretion : Timsus, c« the same disease
occasioned ex semine acrt,t by a secretion of an acrimonious semen 2
and Homung, of hysterics occasioned in married women who are
^nle from an ^^ immissio /rtgiji seininis :'^t an expression adopted
£rom, or at least employed by, Ballonius,^ and supported by Schurig,|t
and Ab Heer.D

The explanation, however, now offered, takes a more compre*
hensive view of the subject, by supposing that the seminal fluid may
be secreted, not merely in a state of morbid diluteness, but, under
various modifications, even in a state of health, of such a condition
as to render it inadequate to the purposes of generation in female
idiosyncrasies of certain kinds, while it may be perfectly adequate
in those of other kinds. In agricultural language, it supposes that
the respective seed may not be adapted to the respective soil, how-
ever sound in itself. So, Parr tells us, on another occasion that,
^^ In some instances the semen itself seems defective in its essential
qualities."**

Here again, the mode of treatment must be regulated by a close
attention to the nature of the cause, in most cases, whatever will
tend to invigorate the system generally will best tend to cure the
sterility : as a generous diet, elercise, the cold-bath, and particu*
larly the use of the bidet or local cold-bath. With these may be
combined the warm and stimulant resins and balsams, as g^acuDy
turpentine, copaiba ; and the oxydes of iron, jsinc, and silver.

Abstinence by content, for many months, has, however, proved a
,■■■■■»■ ■ ' ' " . — -

• Lib. XXVI. Obs. 18.

t Cas. p. 188,

} Cista. p. 487,

f Opp. I. p. 120.

|| Spermatologia, p. 21.

T Observ. Rar. N. 10.

•• Diss. Art. Anaphrodiria.

GE. IV.-SP. lU,] SEXUAL FUNCTION. 97

more frequent remedy than any other, and especially where the
intercourse has be^n so incessantly repeated as to break down the
staminai strength : and hence the separation produced by a voyage
to India has oAen proved successful.

GENUS V.

APHORIA.
iremiilr &trtflfts« Uatvtnwn^.

INABIUTY TO CONCEIVE OFFSPRING.

Aphoru («^m») " sterilitas" " infecunditas'' from « negative, ft^
" fero," " pario," is the term in common use among the Greek
writers. It is singular that the morbid condition it imports has no
distinct place in any of our most esteemed nosologists. It may
posdbjy be intended under the anaphrodisia of several of them,
thof^ in none of them ban the genus any one species, that expressly
applies to feniale barrenness.
The proper species belonging to it are the following : —

1. APHORIA IMPOTENS. BARRENNESS OF IMPOTENCY.

2- ■ PARAMENICA. BARRENNESS OF BflSMENSTRUATION.

3. ^— ^ mPKRCTTA. BARRENNESS OF IRRESPONDBNCE.

^' — INCONGRUA. BARRENNESS OF INCONGRUITY.

SPECIES I.
APHORIA IMPOTENS.
3totrnitir)9i8 of Hmfottnts.

IMPERFECTION OR ABOLITION OF CONCEp4fr>9 POWER.

Tbb species runs precisely parallel with the same disease in males
already described under agenesu impotensy and consequently offers
us the two following varieties :

It Atonica. Atonic barrenness.

C Organica. Organic barrenness.

In ATONIC BAARfiNNESs there is a direct imbecility or want of tone,
VOL. m 13

98 GGNETICA. [CL. V.-OR. IL

rather than a want of desire : and the ordinary <^vi8es are a life of
intemperance of any kind, and especially of intemperate indulgence
in sexual pleasures, a chronic leucorrhoea, or paralytic affection of
the generative organs. It has also been occasioned by violent con-
tusions in the loins, or the hypogastric region, and by over-eier-
tion in walking.

The plan of treatment is to be the same as already laid down un-
der a ionic sterility or impotency in males, yet it is seldom that any
treatment has afforded success under this variety.

Organic barrenness is produced by some structural hindrance or
defect, whether natural or accidental. And this may be of varioas
kinds : for the vagina may be imperforate, and prohibit not only all
intermission of semen, but an entrance of the penis itself. The
ovaria may be defective, or even altogether wanting, or not duly
developed, or destitute of ovula ; or the fimbri» may be defective,
and incapable of grasping the uterus ; or the Fallopian tube may be
obstructed, or impervious, or wanting ; in all which cases barren-
ness must necessarily ensue. In the case of an impervious vagina,
however, unless there be a total occlusion, conception will some-
times follow : for it has occurred where the passage has been to
narrow as not to admit the penis; and occasionally indeed, when,
with the same impediment, a rigid and unbroken hymen has offered
an additional obstacle, of which the medical records contain abundant
examples. Ruyset gives us a singular case of a hymen found un-
broken at the time of labour.

In all these instances the hymen seems to have been placed high
up in the passage, so as to allow the penis to obtain a curtailed en-
trance, and to produce its shock ; when the occlusion not being
complete, a part of the semen has passed through the aperture, and
effected its ordinary result

These, however, are rare instances : for the impediment before
us is, in common cases, a sufficient bar not only to conception, but to
copulation. The author was lately consulted by a very amiable
young couple in an instance of this kind, to whom the want of a
family was felt as a very grievous affliction. The hymen had a small
aperture, but was tense and firm, and the ordinary force of an em-
brace was not sufficient to break it. He explained the nature of the
operation to be performed, and added that he had no doubt of a suc-
cessful issue. T^^lady was reluctant to submit herself to the
hands of a surgeod^nd hence with equal courage and judgment be-
came her own operator. The impediment was completely remoT-
ed. and she has since had several children.

In a few instances, however, this will not answer, for there is a
natural narrowness or stricture, sometimes found in the vagina,
which cannot be overcome, at leiist without a severer operation
than most women could be induced to submit to ; that I mean of lad-
ing it open through the whole length of the contraction. A sponge
tent,ltowever, graduaUy en^rged, hjas sometines suQcee4ed- Si^ig

Gfi. V.-SP. il} sexual function. 99

fiTes an account of a dueolution of marriage in consequence of an
impediiDent of this kind.*

SPECIES II.

APHORIA PARAMENICA.

Itotrrnnnui of JUfmirttittriuitfotf.

CiTAMEinAL DISCHARGE MORBIDLY RETAINED, SECRETED WITH DIFFICUL-
TY, OR IN PROFUSION.

It is not alwajs necessary to impregnation that a female should
menstraate : for we have already ohservedt that a retention of men-
ses, or rather a want of menstruation^ is not always a disease ; but
only where symptoms occur which indicate a disordered state of
some part or other of the body, and which experience teaches us
is apt to arise in consequence of such retention. In some cases,
there is great turpitude or sluggishness in the growth or develope-
ment, or proper erethism of the ovaries, and menstruation is delay-
ed on this account, and in a few rare instances we have remarked
that it has occurred for the first time after sixty years of age. It
may hence easily happen, and we shall presently have occasion to
show that it oAen has done so, that a woman becomes married who
has never been subject to this periodical flux: and although it
is little to be expected that she should breed till the sexual or-

aare in a condition to elaborate this secretion, yet if such con-
t take place alter marriage, impregnation may instantly suc-
oeed and prohibit or postpone the efiSux which would otherwise
tike place.|

But where there is a manifest retention of the catamenial flux
irDdncipg the general symptoms of disorder which we noticed when
tocrihing this disease, it is rarely that conception takes place,
in consequence of the morbid condition of the organs tliat form
tfsaeat

. For the same reason it seldom occurs wheg^4)ie periodical flow
is accompanied with great and spasmodic pain, is small in quantity,
aod often deteriorated in quality. And if, during any intermediate
ttmi^ collection accidentally commence, the very next paroxysm of
ttrtretdi^ pain puts a total ^nd to all hope by separating the germ

fimn the uterus.

* -

* Gjn«colog. p. 223.

t Vol. IV. Paramenia obstructionii, p. S3.

% Clasi y. Order nu Carpotica, Inuoductory lemarkt.

100 GENETICA. [CL. V.-OR. U.

But there must be a healthy degree of tone and energy' in the
conceptiye organs, as well as of ease and quiet, in order that tliej
should prove fruitful : and hence, wherever the menstrual flux is
more frequently repeated than in its natural course, or is thrown
forth, even at its proper time, in great profusion, and, as is gene-
rally the case intermixed with genuine blood, there is as little
chance of conception as in difficult menstruation. The organs are
too debilitated for the new process j and not unfrequently there is
as little desire as there is elasticity.

Haying thus pointed out the general causes and physiology of
barrenness when a result of mismenstruation, it will be obvious that
the cure must depend upon a cure of the particular kind of morbid
affection that operates at the time and lays a foundation for the dis-
ease, of all which we have already treated under the different spe-
cies of the genus paramenia, and need not repeat what is there laid
down.

SPECIES III.

APHORIA IMPERCITA.

Harrrnnrisd of KrrejsyonDfrticr.

STCRIUTY PRODUCED BY PERSONAL AVERSION OR WANT OP APPETENCY.

It is not perhaps altogether impossible, that impregnation should
take place in the case of a rape, or where there is a great repug-
nancy on the part of the female, for there may be so high 9 tone
of constitutional orgasm as to be beyond the control of the individual
who is thus forced, and not to be repressed even by a virtuous recoil,
and a sense of horror at the time. But this is a possible rather than
an actual case, and though the remark may be sufficient to suspend
a charge of criminality, the infamy can only be completely wiped
away by collateral circumstances.

In ordinary instances, rude, brutal force is never found to succeed
against the consent Hf the violated person. And for the same
reason, wherever there is a personal aversion, a coldness, or reserve,
instead of an appetency and pleasure, an irrespondence in the
feelings of the female to those of the male, we have as little reasoA
to hope for a parturient issue. There must be an orgastic shock,
or perculsion sufficient to shoot off an ovulum from its bed, and to
urge the fine and irritable fimbriae of the Falftpian tube to lay hold
pf the uterus and grasp it tight, by which alone a communication caa
be opened between this last organ and the ovarium, or the seed
teannot rfa^h home to its proper soil, and produce a harvest

GE. V,r-8F. III.] SEXUAL FUNCTION. 101

So obseryes the first didactic poet of ancient Rome, addressing
himself to the Generative Power, in the language not of the voiup-i
tnary but of the physiologist :

— per maria, ac monteis, fluviosque rapareis
FritDdiferasq^ie domos avium, ranipoKque virenteis,
Omnibus incvtiens blandum per pectoia amorem,
Ecficis, ut CUPIDS generatim secla propagent.*

So through the seas, the mountains, and the floods,
The verdant meads, and woodlands filled with song,
SriTRR'*D BT DEBIRE each palpitating tribe
Hastes, at thy shrine, to plant the future race.

The cause is clear, and the effect certain, but it is a disease
immedicable by the healing art, and can only be attacked by a
kind^ assiduous, and winning attention, which, however slighted at
fifvt, will imperceptibly work into the cold and stony heart, as the
drops of rain work into the pavement. It should teach us, howerer,
the folly of forming family connexions and endeavouring to keep up
a family name, where the feelings of affection are not engaged on
both sides.

SPECIES IV.
APHORIA INCONGRUA.
itorrmtir00 oC XtKongntfts.

THE COKCEPTTVE POWER WACCORDANT WITH THE CONSTITUENT PRINCIPLES
OF THE SEBHNAL TIVID RECEIVED ON THE PART OF THE MALE.

This species runs precisely parallel with the third under the
preceding genus aoenesu incongrua^ and the physiological and
therapeutic, remarks there offered will equally apply to the present
place.

* De Rer. Nat. i. 17.

J 02 GENETICA. [CL. Ti-OR. II.

GENUS VL

iEDOPTOSIS.
<&frtiftal 9trobi|i0e.

PROmUSIQN OF ONG OR MORE OF THE OENfTAL OROAITS, OR OF EXCRES-
CENCES ISSUING FROM TREM, INTO THE GENITAL PASSAGE ; IMPAIROfO OR
OBSTRUCTING ITS COURSE.

iEiMtfTosis is a compound term from mim*9^ ^' ingueii,^' pi. ittkm
^ padeDda,'^ whence mi«H ^^ podor,^^ and wrmn ^^ lapsus.'' In iike
■MiDner SauTages and Sagnr use iBdopsophia, applying the term to
the meatos urtearius^ as well as to the uterus. Sauvages, however,
expresses the present disease, but less correctly, by hysteroptosis,
for tys, with strict propriety, can denote only one of the species
fliat fall within its range, namely displacement of the uterus.
The genus embraces the five following species : —

1. fDorrosis uteri. falling down of the womb.

2. — — TAGINf. prolapse OF THE VAGINA.

3. VESICA. PROLAPSE OF THE BLADDER.

4. , COMPUCATA. COMPLICATED GENITAL PROLAPSE.

5. . POLTPOSA. GENITAL EXCRESCENCE.

SPECIES I.
JEDOPTOSIS UTERI.

PROTRUSION OF THE UTERUS INTO THE VAGINA.

This may take place in several vrays, and hence offers the following
vaiieties :

m Simplex. Simple descent of the womb.

C Retroversa. Retroverted womb.

y Inversa. Inverted womb.

In the FIRST VARwnr, or that consisting of a simple descent of the
uterus, the organ retains its proper posture and figure. Different
names are frequently given to different degrees of this variety.

GE. TL-eP, 1.] SEXUAL FUNCTION. 103

if the descent be only to the middle of the vnfinti, it is called
relaxoHo uteri; if to the hibi», procidentia; if lower than the
lalit», proktpeue. The distinction is of trifling importance ; the caesea
are the same hi all, which are those of debility or yioienoe.
The disease is hence most common to women who have had
Bomerons families; but is occasionally met with in viii^DS after
draining, ndng violent eiercise in dancing, or running, and hesce
sometimes in girls of a very early age. Professor Monro girea an
example of its occurring in an infant of not more than three jeara
old, preceded by a regular menstruation, or more probably a dis*
charge of blood, every three weeks or month, from the vagina,
accompanied with considerable pain in the belly, loins, and thighs.
The case was too long neglected as being Supposed of little impor»
taace ; and the uterus, which at first appeared to be a very small
body just peeping out of the vagina, descended lower and lowev^
coDtiBiially increasing in size, till at length it became as big as a
hand-ball, and entirely blocked up the passage of the pudendoflk
At this time the sanguineous discharge had ceased its returns ;
but a considerable secretion of leucorrhsea supervened. The nto-
ros seems at last to have been strangulated, gangrene ensued, and
was 8000 succeeded by death.*

The disease first shows itself by what is called a bearing down of
the womb, which is a slight descent produced by a relaxed state of
its l^^ameatB, and its own weight when in an upright position.
There is, at this time, an nneasy sensation in the loins, as well as in
the inguinal regions, often extending to the labia, and particularly
in walking or standing. There is also an augmented fiow of the
natural mucous secretion in conseq^ience of the local irritatioa,
which by degrees becomes acrimoDious, and excoriataa the sni*
rounding parts, and is accompanied witK an obatiaiate lencorrhoem
The stomach sympathises with the morbid statd of the womb^ the
appetite fails, the bowels become irregular and flatulent, and the
■umal spirits are dejected.

In attempting a cure we must first restore the prolapsed organ to
its proper position, and then retain it there, by a support intreduee^
into the vagma, which should be continued till the ligaments of the
womb have recovered their proper tone. Various pessaries ha/ve
been invented for this purpose, but that made of the caoutchouc «r
elastic gum, with a ligature to withdraw it at option, appears to be
one of the most commodious. Astringent injections, as a solution ef
alum or sulphate of zinc, or even of cold-water, will generally be
found useful ; as will also spunging the body with cold*water, or
using a hip-bath of sea-water. New and rough port-wine, diluted
with an equal quantity of cold-water, has proved one of the most
valuable injections to which the author has ever had recourse.

Dr. Berchelmann in a foreign journal, has recommended a far
bolder and more decisive cure, derived from the rash, but successful

* Edin. Med. Essays, Vol. ill. Art. xvii. p. 283.

104 GENETICA. [CL. V.-OR. IL

practice of a womao upon herself. This courageous suiTerer baring
long laboured under a prolapse of the womb, and tried every method
in ?ain, tired out with the continuance of her complaint, cut into
the depending substance of the womb with a common kitchen-
knife. A considerable hemorrhage ensued ; after which, the ves-
sels collapsing, the organ gradually contracted, and ascended into
its proper site ; and she was radically cured of the disease. Having
boasted of her success, the writer informs us that many other
women in the neighbourhood, afiOicted with the same complaint,
applied for her assistance, and derived a like cure from the same
operation.*

In cases where the prolapse depends upon a loose and relaxed
condition of the uterus, it is highlv probable that this bold practice
may often be found to succeed, but it must be useless where the
relaxation is seated in the ligaments : and the knife, if employed'
at all, should be applied to an extirpation of the entire organ, wMch
has lately taken place with success in various cases.

In the RETRovERTED WOMB, the fundus falls down, and becomes the
lower part, sometimes from a morbid weight and enlai^ement, but
more usually from a neglected distension of the bladder between the
third and fourth month of pregnancy, at which period- the fundus is
just heavy enough to fall forward, whenever the cervix is pressed
upon and elevated by such distension ; though afler this period the
cervix itself is too heavy to be affected by the bladder in this way,
and the -entire uterus too much enlarged to fall down in any way.
The bladder, in this case, must be carefully evacuated, and kept
evacuated by a free use of the catheter, which will give the uterus
an opportunity of righting itself But if this should not take place
in two or three days, the obstetric practitioner should endeavour to
restore the organ to its proper position by introducing the fingers
of one hand into the vagina and two fingers of the other hand into
the rectum.

The WOMB is inverted when at the same time that it is displaced
or has fallen down, it is turned inside out This mischievous con-
dition is most commonly produced by unskilfully and violently-
pulling away the placenta after delivery : and is only to be reme-
died by a restoration of the uterus to its proper state before it
contracts, without which perpetual barrenness must necessarily
ensue, and the patient be subject for life to a difficulty of walking,
leucorrhoea, ulceration, and the chance of a schirrhus or cabcer.

* Acta Philosophico-Medica Soc. Acad. Scient. Princ. Hassiacs 4to. Giesss
Cattorum.

QE. FI.-QP. iLJ SEXUAL FyVCTlON* 1$6

SPECIES 11.
iEDOPTOSIS VAGINiE.

im«mP»PV fiV Tfiffi VjrPBft PIBT (MP THE i^APIVA WFO XW8 WW"

Tw^ like tb^ 4w:«at gtf itbie oterps, in»7, accor4iji|^ tp tb^ xlf^/f i^
of the di^^Hie, be 9, relimtioq, procid^ncf , p rokp^ fi^ CiooplMe
JQFer^QP of tbe qmQ. Under all wMcln mocUficiitioop it b»s #
c<>Daulei7d>Le irete9|ih(wce to a p^uppie of ^tbe anus. It 9ffmfP 4p
the form of a fleshy iiqbstaooe protrpii^ »t ijbe bfftok p«kt of .tb#
Tulra, with an openings ia the centre or on one dde. At first it is
soft, bat by continued exposure and irritatioB, it becomes inflamedi
indnrated, and ulcerated. The urethra is necessarily tuifted out of
its course : and if the catheter be required it should be employed
with its point directed baokwaids and downwards. Its ordinaiy
causes are those of a prolapse of the womb, and it is to be treated
by a like plan ef f^triiifeiitlnioctifns jqiid^^eidt^^ Pregnancy
commonly performs the best cure : and where this fells, Dr. Ber-
chelmann, rrom the success which has accompaoied incision in the
case of prolapsed uteri, has reconmiended searification, which
appears well worthy of trial, though the author has not known it
put into practice.

SPECIES III.

iEDOPTOSIS VESICAS.
9tola|wr or the iHiiinirr*

PROTRUSION OF THE BLADDER INTO THE URINAflT PARAGE.

This species is introduced chiefly upon the authority of Sauvages,
who gi?es us two paodificatipns or varieties of it ; one in wmch
there is a protriision of the inner or nervous membrane, in conse*
quence of its separating from the general substance of the blad-
der, visible in the meatus urinarius, of the size of a hen^s eggy
subdiaphonous and filled with urine ; and the other in which
there is a protrusion of the inner * membrane of the neck of
the bladder into the same passage. He gites a case of the former
variety from Noel, who met with it in a virgin, who was from the

VOL. IV. 14

1<>6 (^IGNBTlGi. [CL. t.-OR. ti.

first peculiarly troubled with a retentioD of urine, accompanied witli
frequent convulsiye ino?ements. She soon fell a sacrifice to it, and
it was on dissection that the nature of the tunic was clearly proved.
M. de Sauyages queries whether op a recurrence of this case it
would be most advisable to make an opening into the protruding
sac, or to extirpate it altogether.

The second variety he tells us is cMeHy found among women who
liave borne many children, or have been injured by blows or other
violence on the lower belly. The protruding cyst produced by an
inversion of the membrane drops down in the urinary passage to
About the length of the tittle finger, and is sufficiently conspicuous
between the labia. Solingen, who met with a case of this kind, re-
turned it by a probe, armed at the upper end with a piece of sponge
moistened with an astringent lotion; and afterwards endeavoured
to retain it in its proper position by a bandage.

SPECIES IV.
iEDOPTOSIS COMPLICATA.

PBOTRUBION OF UFFERBNT ORGANS GOMFUCATEO WITH EACH OTHER.

From the connexion of the uterus and the vagina with the bladder,,
a prolapse of eidier of the two former is often complicated with
that of the latter, giving us the two following varieties :

It Utero-vesicalis. Prolapse of the uterus dragging

Utero-vesical Prolapse. the bladder along with it.

C Vagino-vesicalis. Prolapse of the vagina dra^;ing

Vagino-vesical Prolapse. the bladder along with it

Under either of these conditions the bladder, being deprived of
the etpulsoiT aid of the abdominal muscles, in consequence of its
dropping below their action, is incapable of contracting itself suffi-
ciently to evacuate the water it contains : and hence the patient is
obliged to squeeze it with' her hands or between her thighs.

The causes and mode of treatment have been already described
under the tivo preceding species. The present is the hysteroptosi^
compoiiid of Sauvages.

<UL VI--SP. T.] SEXUAL FUNCTION. |07

SPECIES V.

^DOPTOl^S P01.YP0SA.

<Setifta( ^xtvtnttntt,

rOLTFODS OR OTOBR CARVircULAR EXCRESCENCE UK THE C0IIR8E OF Tfl£
GENITAL AVENUE.

This is the poljpus firm, and polypus vagina of authors : but, strictly
speaking, they are less polypi than polypous concretions, since the
proper polypus is the fleshy excrescence of the nostrils, as already
observed in the first volume.*

The excrescences before us issue both from the uterus and the
vagina, and hence form two distinct modifications as folloi^

M Uteri. Issuing with a slender root mostly

Polypus of the womb. from the fundus of the uterus, and

more or less elongating into the
vagina.
C Vagins. Issuing from the sides of the vagina

Polypus of the vagina. broad and bulbous.

The latter excrescences in an incipient state, and particularly
when loose and flabby, are sometimes dispersed by stimulant and
astringent applications, or a hard compress of sponge or any other
elastic material : and, if this cannot be accomplished, they must be
destroyed by excbion or caustics.. It is rarely that they have a
nedc narrow enough for the application of a ligature.

Polypous excrescences of the womb, are, however, a disease of
much greater severity ; since the stomach suffers, in most cases,
from sympathy, and consequently the general health, producing all
the symptoms we have already noticed under adoptosis uteri : which
last is not unfrequently a result, if the excrescence be of long con-
timumce, and of considerable weight and magnitude.

They are of all sizes, and of various degrees of hardness, from
that of a soft and yieldmg sponge to that of firm and substantial
leather. Thoi^h they commonly grow from the fundus of the
uterus, they have sometimes been found to sprout from its sides,
and even its cervix, shooting down to diflerent depths of the vagina,
and occupying it more or less completely according to their extent.
They are generally round in shape and compact in structure, inter-
sected by membranes, running in diflerent directions. Sometimes,
however, they are oblong, in which case they uspally consist of a
loose irregular texture with numerous interstitial cavities. Dr.
— ■-■■,. I ■ I ■ .11. , I ^ ^

♦ Vol. I. p. 313.

100 OBinsYioA. [et. tr'-etL u.

Baillie has given yariong examples of this diseased prodactiLon in
his tables of Morbid Anatomy.*

They liave been attempted to be removed in different ways, as
by canstics, excision, laceration^ aniKgature. ^ The last, however,
is the only method nnaafompiniiej t^th danger or uncertainty.
Tet even tl4s can rarely b/e had recourse to while the excrescence
continues in the womb ; and hence, the usod method is to defer the
operation till, from its increase of dze and weight, it has descended in-
to the vagina, when the remorai caunot be attetsptad too soon. They
have sometimes dropped off spontaneoosly, the peduncle having
probably decayed or shrivelled away.

• See especially J'ascie, c. ix, Platte rr. 1.

CLASS V.
OENETICA.

ORDER III.
CAHPOTICA.

The ordinal term carfotica, is derived from umfWHj ^^ fructos,^'
wbcnce mmfwrn^i^'t '^ frnitio.''

in the Physiological Proem to the present Class, we ha?e taken
a brief sorrey of the laws and general process of generation so fkr .
as we are acquainted with them. Impregnation constitutes a part,
and the most important part, of this wonderful economy, and, from
the changes that the body undergoes during its action, it can never
be surpri^ng that it should often give rise to various diseases.
These diseases may be arranged under four genera; includiog,
those which occur during the progress of pregnancy : Uiose which
occur durii^ the progress of labour ; conceptions misplaced ; and
qturious attempts at conception ; the whole of which may be thus
expressed :

I. PAlUCVZStS. MORBIO I»REGNANCV.

II. PARODYlCU. MORBID LABOUR.

til. ECCYCSIS. EXTRA-UTERINE FETATION.

I?. neunocTEsis. spurious pregnancy.

In the preceding Physiological Proem, we have shown that, in
order for Impregtiation to take place, it is necessary the semen of
the male should pass from the vagina to the one or other of the
OTtttes by means of the Fallopian tubes which lay hold of the uterus
by their rery fine and sensible fimbriae, or fringed extremittes, with
a soft of sptistic grasp during the high-wrought shock of the em-
1)11106, and thus alone open a path-way for the semen to travel in.

The two ovaries are not merely intended to supply the place of
each other, in the event of one being wanting or defective, but,
Mke the testes in men, they seem to increase the extent of the pro-
dqetive power, and enable a female to bear a larger offspring than
she would do, if she were possessed of* one ovary alone. Mr. John

1 10 GENETICA. [CU T.-OR. HI.

Hunter has pat this to the test hj comparing the Qumber of young
produced by a perfect sow with those of a sow spayed of one ovary,
both of the same farrow, and impregnated by a boar of the same
iarrow also. The spayed sow contlnottd to breed for four years,
during which period she had eight farrows producing a total of
seventy-six young. The perfect sow continued to breed for six
years ; during the first four of which she also had eight farrows pro-
ducing a total of eighty-seven young : and during the two ensuing
years she had five more farrows producing a total of seventy-five
young, in addition to those of the first four years.* So that, if we
may judge from this single experiment, the use of two ovaries, in
equal health and activity, enables an animal to breed both more
numerously, and for a longer period of time, than the possession of
^ne alone.

Among women, however, the extent of fecundation does not seem
to be much intertered with by the defect of a single ovarium, or its
means bf oMnmunlcation with the uterus, according to a paper of
Dr. Granville read before the Royal Society, April 16, 1813, con-
taining the case of a female whose uterus was found after death to
have had but one set of the lateral appendages, and, consequently,
a connexion with but one ovarium, and who, nevertheless, had
Jbeen the mother of eleven children, several of each sex, with twins
on one occasion.

After impregnation has taken place, the membranes produced in
the uterus form a complete septum, and, consequently, a bar to the
ascent of any subsequent flow of semen, so as to prohibit the pos-
sibility of two or more successive impregnations co-existing in any
part of the uterus during the period of a determined gravidity.
Children, indeed, have been born within a few weeks, or even
months, of each other, and hence a colour has been given to the
Bypothesis that they may be conceived at different periods of a com-
mon parturition, and such births have, in consequence, been distin-
guished by the name of s.uperfetations ; but we shall have occasion
Jiereafter, when treating of a plurality of children, to show that
fetuses thus bom in succession, however they may vary in size or
maturity, are real twins, conceived at one and the same tin^e, from
the descent of a plurality of ovula into the uterus, instead of a single
one, and that the diQerence of pize or maturity depends upon some
unknown cause in the dead or puny fetus, which has killed it or
prevented it^ k^epipg pace with the other.

Women ^e in general capable of breeding as soon as they begio
to menstruate, which is the ordinarv proof Siai the organs of con-
ception are fully developed and per^cted : and since this discharge,
as we have remarked m the Proem just referred to, commences
sometimes in very early life, and particularly in hot climates, where
it has occurred in girls of not more than nine years of age, so we
have instances of conception and pregnancy having commenced as

— ' —_ ^.^ .-T

* Animal Economy, p. 157,

CL. V.-OR. in.} SEXUAL FUNCTION. Ill

early. Baron Haller* and professor Schmidt,! concur in examples
of pregnancy at nine years old : and the medical records confirm
these singalar histories hy mimerous instances of a like kind-l

Yet, though menstruation is the ordinary proof that th^ concep-
ti?e powers have acquired a sufficient finish and vigour for their
proper function, menstruation itself is not ahsolutely necessary for
impregnation. As there are circumstances that hurry on this secre-
tion before its ordinary term of appearance, there are others that
delay it, insomuch that some women pass through a long life with-
out menstruating at all, while others only begin aAer reaching an
adnh age, and others again not till the period in which it usually
ceases. Now, it may happen that a woman whose peculiar habit
produces a peculiar retardation of menstruation, may marry before
this secretion takes place for the first time ; and, as we have just
observed that she is able to breed as soon as ever she is able to
menstruate, the former process may anticipate the latter, and post-
pone it till the term of pregnancy has been completed. **' A young^
woman,'' says Sir Everard Home, ^^ was married before she was
seventeen, and, although she had n^ver menstruated, became preg-
nant : four months after her deUvery she became pregnant a second
time, and four months after the second delivery she was a third
time pregnant, but miscarried : after this she menstruated for the
first time, and continued to do so for several periods, and again be-
came pregnant"§

There is much difference of opinion as to the period of pregnancy
lo the human female ; for while other animnb seem to observe great
poDctuallty upon this subject, we meet with so many and sucb
codsiderable varieties in women, that legislators, as well as physi-
C13U18, have i!iot agreed in assigning a common term. Hippocrates
rules it that we should admit th^ possibility of a child being bom
tt ten months, but not later, which is the common term assigned in
the book of the Apocrypha entitled Wisdom of Solomon ;|| while
Haller gives references to women who are said to have gone not
only ten but eleven, twelve, thirteen, and even fourteen months ;
most of which, however, are of a suspicious kind. Twelve months^
neTertfaelesil is a term allowed by many physicians, as what may
take place under peculiar weakness or delicacy of health ;ir and yet
it 18 most probable that in all these the mother is mistaken as t a the

• Vide Blumenbacb, Bibl. I. p. 558.
t Act. Helvet. iv. 162.

t Eph. Nat. Cur. Dec. iii. Ann. ii, Obs. 172.

♦ Phil. Trans. 1817, p. 258.
I Chap. vi'i. 2.

t Buchner, Miscell. 1727, p. 170.
Etiguio, Journ. de Med. Ton. lxi.
Brunbilla, Abhaudl. der Joseph. Acad. Band. i. p. 102.
T^lmout de St, Jouro. de Med. Tom. xxvii.

Ploacquet, Von den pbysichen Erforderntf&en der Erblahigheil der Kliultr^ p.
69. Trcb.

112 GENETICA. [C^ 7,-Qlt. W*

proper time of her conception, and imagiofts berveif to hure
4:ooomenc04 preg^nancy for some weeks or even months beAre it
actually takes place. The state of menstmatiim affords no iiiU
• {NTOof ; for as conception may occur without its appearance, 90 it
may continue for many months or even during tbe whole term of
pi'egnancyi though most commonly in a smaller quantity than ;asii^.
There is a singular case in the Histoire de rAcademie des Science
of a liriog child bom after what is said to hare been thi;«e yjaacs of
pregnancy."^ Few reports of tb|s kind are worth ^ttevdiing to, pr
entitled to any kind of explanation : hat it has sometimes bappeoed^
and probably did so in this last case that a woman conceits hc^Em^lf
to be in a state of pregnancy, and has various symptoms that
simulate it, for a twelvemonth or considerably mare Uian a iwisljvii-
montb, and particularly towards the cessation of the catamflW»
instances of which we shall have occasion to notice under tiie
iburth genus of the present order, entitled rsisvi>ocrwis or s|Kuio^
pregnancy : and if, afler such a simulation continued for a year ^r
two, the woman should fall into a state of real pregnancy, she m^j
persuade herself at the close of the process that she bas .beien
pregnant for the whole of this time.

By ihe code ^apoleon, the legitimacy of a child boi^^ thvee
hundred days alter a diasoiutipn of marriage may be qneatiooed*
In our own country the law is to thifi hour in an unsettled state ;
|i^d much nicety of argument has frequently taken place ; of which
an example was afforded in the famous question of the Baobury
peerage, upon a new raised distinction of access and genorfttive
access. There can be no doubt, however, thata considerable diffiH*-
ence in duration may ensue from the state of the mother^s health :
for as the fetqs receives its nourishment from the mother, there is
^ probability that various deviations from health may retard the
maturity of the fetus. And it is prob2di)ly on this account that
different legislators have assigned different periods of legitimaqy ;
one of the shortest of which is tliat determined upon by the Aoul^
of Leipslc, who have been coa^kdsant enough to decide, that a
child bom 'five months and eight days after the return of the
husband, may be considered as legitimate ; and that a fetos at £me
months is often a perfect and healthy child.

In the ordinary calculation of our own country, the allowed term
does not essentially differ from that in the code Napoleon, for it
extends to nine calendar months or forty weeks : but as there is
often much difficulty in determining the exact day between a^y two
periods of menstruation in which semination has taken effect, it is
usual to count the forty weeks from the middle of the interval
before it ceases ; or, in other words, to give a date of forty-two
weeks from the last appearance of the menses : and at the expira-
tion of this term, within a few days before or after, the labour may
confidently be expected.

f Hist, de I'Academie des Sciences, 1753, p. 206,

OIL l] 8£xu al junction. 113

In the progress of pregnancy the figure of the uteros, as well as
its position, changes considerably. Before the end of the third
month it has a tendency to dip towards the pelvis, at which period
it may be felt to ascend : during the seyenth month it forms a line
with the navel ; in the eighth month it ascends still higher, reach-
log mid-way between this organ and the sternum ; and in the ninth
it almost touches the ensiform cartilage ; at the close of which, as
though overwhelmed by its own bulk, it begins again to descend,
and Portly afterwards, from the irritation produced by the weight
of the child, or, more probably, from the simple law of instinct, it
becomes attacked with a series of spasmodic contractions extending
to the surrounding organs, which constitute the pains of labour,
gradually increase in strength, enlaige the mouth of the organ, and
protrude the child into the world.

In natural pregnancy, a strong hearty woman suffers little consi-
dering the great change which many of the most important organs
of both the thorax and abdomen are sustaining; and in natural
labour, though the returning pains are violent for several hours,
there is little or no danger. But numerous unforeseen circumstances
may arise from the constitution of the mother, the shape of the
pelvis, the figure or position of the child, to produce difficulty,
dai^r, and even death.

In describing the diseases which appertain to the whole of this
period, it is not the author's design to do more than to take a gene-
ral pathological survey, so as to communicate that kind of knowledge
upon the subject which every practitioner of the healing art should
be acquainted with, even though he may not engage in Uie obstetric
branch of his profession. The minuter and more practical parts,
and e^ecially those which relate to the application of instruments
and the mechanical means of assistance, must be sought for in
books and lectures expressly appropriated to this purpose, with
which it is not his intention to interfere^

GENUS I.

PARACYESIS.

^orbfH IPreaiiaiiefi.

THE PROGRESS OF PREONANCY DISTURBED' OR ENDANGERED BY ttit SVPEtl-*
VENTION OF GENERAL OR LOCAL DISORDER.

Tmi: generic term is derived from «r«^, ^^ male,'' and Mvn^tf^ <^ gravi-
ditas." The genus will conveniently embrace the three following
species, according as the general system, or oigans distinct from

VOL. V. 16

1 14 GCNET1CA« [CL. T<-OR. lU*

those immediately coDcenied, are disturbed ; as the sexual organs
themselves are disturbed ; or as the fruit itself is disturbed and ex-
tended prematurely : •

1. PAIUCYESIS IRRITATIVA.

2.
3.

UTCRINA.
ABORTUS.

CONSTITUTIONAL DERANGEMENT OF PREG-
NANCY.
LOCAL DERANGEMENT OF PREGNANCY.
MI8CARRUOE. ABORTION.

SPECIES I.
PARACYESIS IRRITATIVA.
€nmtitutUmul Beransetnmt a( Hreonants*

PREGNANCY EXaTINO DISTRESS OR DISTURBANCE IN OTHER ORGANS OR
FUNCTIONS THAN THOSE PRIMARILY CONCERNED.

tnE new condition of the womb operates upon the whole or diffe-
iereot parts of the system in various ways. We have frequently
had occasion to observe that there is no organ whatever which ex-
ercises a more extensive control over the entire fabric than the
uterus, with the exception of the stomach, and hence many parti
are affected by sympathy during its new action, and particularly the
brain and the whole of the nervous function. But its change of
shape, bulk, and position, operates mechanically on other organs
and frequently produces serious mischief by pressure or irritation ;
these organs are chiefly the stomach itself, the lungs, the intestinal
canal, and the veins of the legs. And hence the evils result-
ing from these causes, may be contemplated under the following
Tarieties :

M Systatica.

C Dyspeptica.
y Dyspnoica.
} Alvina.

i Vaiicosa.

Accompanied with faintings, palpitations,

convulsions, or other direct affections

of the nervous system.
Accompanied with indigestion, sickness,

and head-ache.
Accompanied with difficult breathing and

occasionally a cough.
Accompanied with derangement of the

alvine canal, as costiveness, diarrhoea,

or hemorrhoids.
Accompanied with venous dilatation of

the lower extremities.

That the nervous system should often suffer severely and in va-
rious ways during pregnancy, will not appear singular to those wh*

GE. I.-SP. I.] SfiXUAL FUNCTION. 115

have attended to tbe remarks we have already made concerning the
M^lose chain of sympathy that prevails between the brain and tbe
sexual organs, from the time of the first developement of tbe latter
to their becoming torpid and superannuated on the cessation of the
catamenia. But in delicate habits, in which these nervous affec-
tions chiefly occur, there is another cause, which is even more
powerful than the preceding ; and that is tbe demand of an addition-
al supply of sensorial power in support of the new process, and,
consequently, an additional excitement and exhaustion of the senso-
rium, persevered in without intermission, and increasing from day
to day. This excitement and exhaustion necessarily produce weak-
ness ; and of course an irregularity in the flow, and particularly in
the alternating pauses, of the sensorial current ; hereby predispos-
ing alike to palpitation of the heart, clonic spasms, and convulsions,
according to the law of physiology laid down under the genus c^o-
inis,'^ to which the reader may return at his leisure. Fainting, as
has abo been previously shown under the genus syncope,! is depen-
dent upon the same deficiency of action, rendered more complete,
or more protracted in duration.

PALPrTATioN, in the case before us, is rarely attended with dan-
ger, but is often a most distressing symptom. It returns irregularly
in the course of the day or night, but particularly after a meal, and
very frequently on first lying down in bed. In the capricious state
of the nervous system at this time, its return after meals does not
seem to be so much dependent upon the nature of the food as upon
the state of the stomach at the moment : it has recurred after a light
and plain dinner, and been quiet after a more stimulant dinner ; and
then for a few days has been most severe ^ifier the latter, and least
so after the former ; for a short time the digestion has gone on tran«>
quilly under both, and then again excited palpitation, and perhaps
in an equal degree under both : nor has a total abstinence from so-
lid animal food afforded any relief. The pulsatory action is some-
times confined to the heart, sometimes alternates with the cqeliac
or some other arterial trunk in the abdomen, and sometimes with
the temporal arteries. While writing this sheet, the author is oc-
casionally consulted by a lady now in her sixth month, who has
been most grievously afflicted with this affection from the time of
her beginning to breed, and who will probably be subject to it till
her*confinement. None of the antispasmodics afford much, if any
relief; camphor, in large doses, is found the best palliative ; the
narcotics have all been tried in vain; opium maddenis the head and
throws out a most distressing Ijcbenous rash. The paroxysms usual-
ly continue from two to six or eight hours. CHfaer irritations pro;
duce it, as well as those of the stomach, and especially any sudden
emotion of the mind.

Syncope or fainting occurs during any period of pregnancy, but

III .111.11 I ' I ■

• Vol. III. p. 265.
t Vol. III. p. 337.

116 GBNETICA. [CL. V.-OIU lU.

cbieflj in the stage of the first three months, and especially about
the time of quickening. After this period the general frame ac- ^
quires a habit of accommodation to the change that has taken place,
and is less easily affected. It is ordinarily produced by more than
usual exertion, exposure to heat, or any sudden excitement of the
mind. It is sometimes of short duration, and the patient does not
lose her recollection ; but in other instances it continues for an hour
or upwards. A recumbent position, pungent yolatiles, sprinkling
the face with cold water, and a free exposure to air, with a mode-
rate use of cordials, offer the speediest means of recovery. The
extremities, however, should be kept warm, and the friction of a
warm hand applied to the feet.

One of the worst ailments that ever accompanies the process of
gestation is that of convulsions. They may occur at any period of
this process, and their exciting causes are not always manifest.
The predisposing causes are general weakness or irritability of the
nervous system, a constitutional tendency to epilepsy, or any other
clonic spasm, and entonic plethora. In all these cases there is a
doxible danger ; for we have to dread apoplexy from a rupture of
blood-vessels in the head ; and abortion or premature labour from
an extension of the spasmodic action to the uterus. No time, there-
fore, is to be lost, and the remedial process must be as active as it
is instant.

Bleeding must be had recourse to immediately, as well in the ato-
nic as in the entonic form of the disease. In the first, indeed, it is
of itself an evil, for it will add to the general weakness ; but as
there is already, or, by a repetition of the fit, will unquestionably be,
a considerable determination to the head, and more especially as
the vessels in an atonic and relaxed frame yield easily as weU to
anastomosis as to rupture, it will be a far greater evil to omit it.
The quantity of blood, however, that it may be adviseable to ab-
stract, must be determined by the concomitant symptoms so far as
they relate to the head. Generally speaking, in weakly habits, the
head is only affected s^econdarily, or by sympathy with the irritation
of the uterus, where convulsions make their appearance ; and hence
bleeding, in such cases, is to be employed rather as a prophylactic
than as an antidote : and it may be sufficient to confine ourselves to
the operation of cupping ; at the same time opening the bowels by
a sufficient repetition of some laxative. After this opium must be
chiefly trusted to, if the spasms still continue : and, on their subsi-
dence, or in their interval, the metallic tonics should be introduced
with the warmer bitters.

Where, however, the constitution is robust, and the convulsions
have been preceded, as is often the fact in this case, by a tensive
or even heavy pain in the head, vertigo, illusory corruscations be-
fore the eyes, or illusory sounds in the ears, the encephalon is it-
self the immediate seat of disease, and the bleeding even in the
first instance should be followed up to fainting, or at least till twenty
ounces are drawn away, which it will frequently be necessary to

(HS. L-OT, I.] BEXUAL FUNCTION. 117

repeat within twenty-foqr hours afterwards ; and, if the practition-
er be a skilfol operator, it will be better to abstract the blood from
the jugular Tein, as the good effect will be sooner felt. The
hair shoald be shaved from the head and ice-water or other frigid
lotions be applied, and very frequently renewed. The bowels must
at the same time be purged vigorously, and dilute farinaceous food
constitute the whole of the diet. Opium should be abstained from,
at least till the general strength is reduced to an atonic state, when
if the paroxysms should still return, it may be had recourse to in
conjunction with antimonial powder or some Qther relaxant.

When, in despite of all this treatment, apoplexy has taken place,
and is followed by a palsy of a particular organ, or of an entire
side, it will often be found that the paralytic affection will often con-
tinue through the whole course of the pregnancy, and entirely dis-
appear afterwards.

Sickness, heart-burn, and other symptoms of indigestion are still
more common aff*ections than those of the nervous system we have
first noticed. These are chiefly troublesome in the commencement
of pregnancy, and evidently prove that they proceed not from any
roecliaoical pressure, either direct or indirect, against the coats of
the stomach, but from mere sympathy with the new and irritable
state of the uterus : for, as the novelty of this state wears away
and the stomach becomes accustomed to it, the sickness and other
dyspeptic symptoms subside gradually, and are rarely troublesome
even when in the latter months of pregnancy the uterus^has swollr
en to its utmost extent, from a length of three inches to that of
twelve, and has risen nearly as high as the sternum.

The head-ache, which occurs as a dyspeptic symptom, is of a
very different kind from that we have just noticed, and is rardy re-
lieved by very copious bleedings, though the whole of these symp-
toms are occasionally mitigated by a loss of eight or nine ounces of
blood from the arm, or the applicatiop of leeches to the epigastric
region as recommended by Dr. Sims, and M. Lorentz. Cloths wet-
ted with laudanum and applied to the pit of the stomach have also
been found serviceable in various cases : but the most efficacious
means consist in the employment of gentle laxatives, and a very
light diet, to which may be added the use of the aerated alkaline
waters or saline draughts, in a state of effiervescence.

The fluid discharged from the stomach on these occasions is usu-
ally limpid, thin, and watry ; but w|^ere there is much straining a
little bile is thrown up at the same time. It is rarely that this Idnd
of vomiting produces any serious evil ; though when it has become
very obstinate, as well as very severe, it has sometimes endangered
a miscarriage. The other symptoms of dyspepsy usually cease with
this and are rather disquieting than sources of any degree of alarm.
They may often be palliated by some of the means already recom-
mended under limosis, cardulgu,^ and dvsfefsu.T

^ 91 —

* Vol. I. p. 86.
t Vol. I. p. 105.

118 GENETICA. [CJU V.-OIL ni/

The chief symptoms of dyspnosa that become troublesome daring
pregnancy are occasional fits of spasmodic anhelation. These are
mostly common to those, whose respiratory organs are naturally weak,
or who are predisposed to hysteria. The paroxysms are of short
duration and usually yield with ease to the warmer sedatives and an-
tispasmodics. A dry and troublesome cough, however, is some-
times combined with this state of the chest, that, if violent, endan-
gers abortion, and has occasionally produced it. Bleeding will here
also be adviseable as the first step in the curative process. Eight
^ounces of blood will suffice, but the depletion must be repeated at
distinct intervals if the cough should continue unabated. Gentle
laxatives should succeed to the bleeding and be persevered in as
the bowels may. require. And to these may be added the mucilagi-
nous demulcents already recommended in idiopathic cough, united
with such doses of hyoscyamus, conium, or opium as are found best
to agree with the state of the constitution.* There is little danger,
however, of this cough terminating in consumption however trou-
blesome and obstinate it may be in itself, for it is rarely that two
superadded actions go forward in the constitution at the same time :
and hence, as we already have had "^occasion to observe, when-
ever pregnancy takes place in a patient labouring under phthisis,
the progress of the latter disease is arrested, till the new process
hajs run its course.t

Derahgements of the alvine CAJHJ4. under some modification or
other, accompany most cases of pregnancy, are oAen very distress-
ing, and by their irritation sometimes hasten on labour pains before
jthieir time.

These affections are of two very opposite kinds. In some in-
stances the intestines participate in the irritability of the uterus,
the peristaltic action is morbidly increased, and there is a trouble-
some diarrhoea. In othera the larger intestines appear to be ren-
dered torpid partly by the share of sensorial power which is taken
from them in support of the new action, and partly by the pre^ure
of the expanding uterus on their coats. In both cases piles are a
frequent attendant, but particularly in the last

The diarrhoea varies in different individuals from a looser flow
of proper feces to a muculent secretion, or a dejection of dark co-
loured offensive stools, accompanied with a foul tongue and loss of
appetite. The first modification requires no remedy, and may be
sa^ly left to itself. The second and third import a morbid action
of the excretories of the intestines, and are best relieved by small
and repeated doses of rhubarb with two grains of ipecacuan to
each,| and afterwards by infusions of cascarilla, orange-peel, or any
other light aromatic bitter.

The costiveness must be carefully guarded against by such ape-

• Vol. I. p. 346. 352.

t Vol. 11. p. 505. *

I Burns, Principles of Midwifery, p. 154.

GE.I.-SP.I.] SEXUAL FUNCTION. llO

dents, as are found upon trial to agree best with the bowels. Where
aciditj in the stomach is suspected, magnesia maj be employed,
and will oAen prove sufficient : but were tiiis does not exist, the
senna electuary, Epsom salts, or castor oil, will be found to answer
much better. The piles will usually disappear as soon as the
bowels are restored to a current state : and, if not, they should be
treated according to the plan already laid down under proctica

MABISCA.^ »

Vamcose dilatations of the veins of the lower extremities are a
frequent, though not oflen a very troublesome accompaniment of
pregnancy. They are chiefly found in women whose occupation
obliges them to be much on their feet. Where the affected veins
are first perceived to enlarge, the varicose knots may generally be
prevented by exchanging the accustomed erect position for a re-
cambent one, and using the legs but little. Where the varices are
actually formed, the legs may be supported with a bandage drawn
only with such moderate pressure as to afford sustentation ; for if
carried beyond this we shall only endanger a worse congestion in
some other part not equally guarded against. For the rest th^
reader may turn to exangu vakix, in a preceding part of this
work.t

SPECIES 11.

PARACITESIS UTERINA.

SDcal Brratisemrnt of Hrrgtiatus*

rBCOKAlVCT DISTURBS) Oa ENDANOERRD BT SOME DISEASED AFFECTION 01^

THE VTBllUS.

far tfte progress of this work, we have seen thait on the com-
mencement and through the course of impregnation the periodical
secretion of the uterus is suspended ; that the organ gradually en-
luges from its ordinary size till, in the ninth month, it measures
ten or twelve inches from top to bottom, and that, in the coarse of
this enlargement, it changes its position according to a law that is
never departed from in a state of health.

In a state-^f morbid action, however, or from some accidental in-
jury, the Qterus does not always maintain its proper position, nor
abstain from throwing forth not only its ordinary and natural secret
tioDs, bat other floids of a morbid character ; and hence becomes

• Voh I. p. 233.
t Vol; u. p. fiSS.

120 GENEtlCA. [CL. V.-OR. UI.

subject to several varieties of affection of which it may be sufficient
to notice the following:

« Retroversa. Retroversion of the uterus.

C Leucorrhoica. The uterus secreting, or exciting in tiie

vagina a secretion of, leucorrhcea, so as

to produce debility.
y Catamenica. The catamenia continuing to recur.

I Hemorrhagica. Accompanied with hemorrhage.

A RETROVERSION OF THE UTERUS may he produced in various ways,
though it is seldom found except in pregnancy, and between the
third and fourth month of this state. This organ, notwithstanding
its appendages of broad and round ligaments, is still left pendulous
in the hypogastrium : and hence, if the fundus or broad and upper
part happen, by a scirrhous induration, or pregnancy, or any other
means, to acquire a certain bulk and weight, and if at the same
time the cervix, or lower and narrow part, be pushed on one side
by any accidental force, as that of the bladder when distended, the
broad and upper part will tumble downward, while the narrower
part ascends and takes its place. It is this which constitutes a re-
troverted uterus ; but as it occasionally occurs under other states
than that of pregnancy, we have treated of it already, under the
genus ADOPTosis uteri, where we have stated the mode of treaty
ment to be adopted in the case before us.

Leucorrbgea is a result of the increased action excited in every
part of the uterus, or of the upper part of the vagina which is in-
flamed by continuous sympathy. We have already observed that
the mucous discharge denominated leucorrhoea, or whites, appears
to be secreted from the lower part of the uterus, and the upper
part of the latter oi^n v* and hence any excitement operating on
the fundus of the womb may be easily conceived under a particular
condition of the cervix of the uterus and the vagina, or of the sys-
tem generally, capable of producing this secretion in considerable
abundance.

When treating of leucorrhoea as an idiopathic affection We re-
marked that where the discharge is excessive it produces considera-
ble debility of the system generally, and of the sexual and lumbar
region more particularly : and that when it becomes chronic, ft of-
ten degenerates into an acdmonious condition and occasions great
disquiet by excoriating the cuticle to a considerable extent.

Both these evils are consequent upon its occurrence in pregnan-
cy, and the first has, occasionally, threatened abortion. They are
to be relieved by the remedial process already pointed out under
the genus leucorkhosa in the first order of the present class.t

A continuance of the catamemial discharge at the regular periods,

• Vol. IV. CIms v. Ord. i. Gen. ii.
t Vol. IV. p. 51.

G£. L-^P. II.] SEXUAL FUNCTION. 121

is also, in many cases of delicate habits, a source of great weakness
and discomfort, and sometimes endangers miscarriage or premature
labour : in all which instances it oaght to be checked by a recum-
bent position, and particularly a little before the time in which it
may be expected, and by the other means already enumerated under
TABJMEsu suPERFLUA in the prescut class.* It has sometimes con-
tinued, however, in strong and vigorous habits through the whole
period of pregnancy without any serious mischief;! though, even
here, it has usually been found to produce general debili^, and
many troublesome dyspeptic symptoms.

Hemman) and several other writers give cases of women who
have never menstruated except when in a»state of pregnancy : sucli
is the degree of irritation which the secretories of the uterus, ia
some instances, demand, in order to be roused into a ^ue perform-
ance of their function. So, some persons can only see on a full ex-
posure to a meridian light,§ and others can only hear when the
tympanum is irritated by the noise of a drum or of a carriage,
sufficient to deafen all the world around them.||

Hemorrhage from the uterus is sometimes connected with this
irregular return of the periodical discharge, as we have already
observed it is not unfrequently in an unimpregnated state of the or-
gan. In both cases this is usually a consequence of great general de-
bility, and it is hence the more alarming in any period of parturi-
tiott, as risking the loss of the uterine fruit. In the delicacy of
habit we are now contemplating, bleeding would only add to the
debility or predisponent cause : and we must content ourselves with
the plan already recommended under atonic hemorrhage of the
uterus in a prior class and volume.lF Where the discharge has
been induced by external violence, or a sudden emotion of the mind,
venesection will be the best remedy we can have recourse to, and
afterwards thirty or five and thirty drops of laudanum in a saline
draught with two or three grains of ipecacuan.

i- ^

• VoL IV. p. 44.

t Hai^edorn, Cent. ii. Obs, 94.

X Medicinisch-Cbinirgche Aufaaze. Ber). 1778.

Hopfergartner, iiber inenfchlicbe Entwiklungen. p. 71. Sturlg. 1798.
i Vol. lu. Paropsis noctifuga. p. 138.
I Vol. ni. Paracusis perversa, p. 138.
t Vol. II. Class III. Ord. iv. pp. 469, 470.
VOL. TV, 16

122 QfiNEllGA. [CL. r^f^^fU III.

SPECIES III.
PARACYESIS ABORTUS.

PRElf ATURE EXCLUStOir OF A DEAD FETUS FROM THE UTERUS.

We hftTC Stated io the iotrodactory remarks to the present order
that the usual term of pregDaocy is forty weeks, or nine calendar
months. Within this period, however, the fetus may be morbidly
expelled at any time. If the exclusion take place within six weelu
after conception it is osnally called misca riaoe ; if between six
weeks and six months, abortion ; if during any part of the last three
months before the completion of the natural term, premature la-
bour. Among some writers, however, abortion and miscarriage
are used sjmonymously and both are made to express an exclusion of
the fetus at any time before the commencement of the seventh
month. At seven months the fetus will often live. It has been
bom alive, in a few rare instances, at four months ;* and has as rare-
ly continued alive when bom between five and six months.!

The process of gestation may be checked, however, from ita
earliest period: for many of the causes of abortion, which can
operate afterwards, may operate throughout the entire term, and
hence a miscarriage occurs not unfrequently within three weeks
after impregnation, or before the ovum has descended into the
uterus. In this cdse the pains very much resemble those of difficult
menstruation; and with a considerable discharge of clotted or
coagulated blood the tunica decidua passes away alone, having also
some resemblance to that imperfect form of it which we have
already noticed as being produced in some cases of difficult menstru-
ation, but exhibiting a more completely membranous structure.
And here the ofulum escapes unperceived at some subsequent
period, and is probably decomposed and incapable of being traced.

in subsequent periods of pregnancy abortion consists of two parts
or stages, the separation oi the ovum from the fundus of the womb,
and its expulsion from the mouth. Sometimes these take place
very nearly simultaneously, but sometimes several days or even
weeks intervene ; so that the process of abortion may considerably
vary in its duration, and become exceedingly tedious. In several cases
I have known the ovum remain undischarged for upwards of six
weeks, and, in one case, for three months after its separation, and
consequently after the death of the fetus, comparing its size and
appearance with the ascertained term of gestation.

* A. Reyes, Camput Elyt. Qusst. 90. p. 1164.

-*- Brauset, lur V Edusatlon medicinalt det EnfaDt. i. p. 37.

GE. L-HW. DL] sexual FUNCTION. * 123

• Through the whole of this period tliere is an occasional discharge
from the vagina, and often temporary disquietudes, and even con-
tractile pains in the ntems. But both are of a very different kind
from those which occur antecedently to the separe^on of the ovum.
The first pains are usually sharp and expulsory, with a free <^
charge of clotting arterial blood ; sometimes, indeed, in an alarm*
ing, though rarely a dannferous profusion ; in the last they are dull
and heavy, and the discharfife is smaller in quantity, dark gnd fetid.
We any also judge of the detachment of the ovum, and consequently
the death of the fetus, by the cessation of those sympathetic symp-
toms which have hitherto connected the stomach and the mammie
witib the action of the uterus, as the morning sickness, and the
increasing plumpness of the breasts, which, not unfrequently, are
so stimulated as to secrete already a small quantity of milk. On the
seftaratioa of tiie ovum from tliKS fundus of the uterus all these
disappear ; the stomach may be djrspeptic, but without the usual
sickness, and the breasts become more than ordinarily flaccid.

The 6vum, when at length discharged, comes away very differ-
ently in different cases. Sometimes the whole ovum is expelled at
OM^e; hot more generally it is discharged in detached parts, the
fehH first escaping with the liquor amnii, or descending with its
own proportion of the placenta, the maternal proportion following
sove lionrs, or even days, afterwards. And, where there are twins,
one of the fetuses, nakend or surrounded wifth its membranes, is
usaBll^ expelled a^>ne, and the ether not till an interval of several
hofttS;, or even a day or two ; the dischaige of Mood ceasing, aiHl
the patient appearing to be in a state of recovery : so that it is
<Bffictiit to determine whether or not there are twins in cases of
early abortion. *

The causes of abortion are very numeroos ; and some of them
are rdther to be conjectured, than fnlly ascertained. They maj
depend upon the ovum itself, upon the uterus itself, or upon the
utertis as affected by the nature of the maternal con8tituti<»n, or acci-
dentri lesloBS.

^ The imperfections observable in ova,^' remarks Dr. Denman,
^ tare of different kinds, and found occasionally in every part ; and
there is usually a consent between the fetus and the shell of the
OTOD, i» the placental part and membranes mi^ be called, but not
always; For examples have occurred in which the fetus^ has died
before the termination of the third month, yet the shell, beii^
healthy, has increased to a certain size, has remained till the
expiration of the ninth month and then been expelled, according to
the genius and constitution of the uterus, though frequently it has
been found to have undergone great changes, as, for instance, in
many cases of hydatids."*

^ It is remarkable," says the same author, '^ that women who are
in the habit of miscarrying^ go on in a very promisifig way to a cer-
tain time, and then miscarry, not once, but for a number of times,

* Practice of Midwifery, Edit. S. p. 508. 8vo.

124 * GENETICA. [CL. V.M)1L m.

in spite of all the methods that cao be contrived, and all the methods •
that can be given : so that, besides the force of habit, th^re is
sometimes reason to suspect that the uterus is incapable of distending
bejond such size, before it assumes its disposition to act, and that
it cannot be quieted till it has excluded the ovum. What I am
about to say, will not, I hope, be construed as giving a licence to
irregularity of conduct, which may oAen be justly assigned as the
immediate cause of abortion, or lead to the negligent use of those
means that are likely to prevent it But from the examination of
many ova after their expulsion, it has appeared that their longer
retention could not have produced any advantage, the fetus being
decayed, or having ceased to grow long before it was expeUed.
Or the ovum has been in such a state as to become wholly unfit for
the' purpose it was assigned to answer : so that if we could believe
there was a distinct intelligence existing in erery part of the body,
we should say it was concluded in council that this ovum can never
come to perfection and shall be expelled.^''*'

The causes of abortion of a constitutional or accidental kind are
more obvious. They may be internal and depend upon a relaxed
or debilitated state of the system generally, and consequently of
the uterus as a part of it ; or external, and depend on adventitious
circumstances. Violent pressure, as that of tight stays, by preventing
the uterus from duly enlarging, is an obvious cause, as is also that
of a sudden shock by a fall, or a blow on the abdomen : violent ex-
ertion of every kind is a cause not less obvious, as that of immoderate
exercise in dancing, riding, or even walking ; lifting heavy weights ;
great straining to evacuate the feces, or too frequent evacuations from
a powerful purgative. Violent excitement of the passions, as of
terror, anxiety, sorrow or joy. Violent excitement of the external
senses by objects of disgust — whether of sight, sound, taste, or even
smell ; or whatever else tends to disturb or check the circulation
suddenly, and hereby to produce fainting, will oAen prove a cause of
abortion. And when onc^ this affection has been produced, the
organs with difficulty recover their elasticity, and it is extremely
apt to recur upon the slightest causes. Plater gives us an account of
fourteen miscarriages in succession ;t Werlhoff, of five within two
years ;| and Werloschnig, of not less than eight in a single year.§
Wolfius relates the history of a woman, who, in the whole course
of her life, suffered twenty-two distinct abortions :|| and Schultz,
that o\pother, who, in spite of every remedy, miscarried twen^-
three times, and uniformly in the third month, probably from an
indisposition in the uterus to become distended further, as suggested

* Dentnan, ubi suprt. p. 608.

t Observationes, Lib. ii. p. 467.

% 0pp. III. p. 718.

k De Curatiooibus Verno-autumn, p. 49€.

II Lection. Memorab. p. 418.

GE. L-SP. in.] SEXUAt FUNCTION. 125

in similar cases by Br. Denman in the passage just quoted from
him.

Another, and a Tery frequent cause, is plethora, and this, whether
it be from entony or atony. " The uterus,'^ observes Mr. Bums,
^ being a large vascular organ, is obedient to the laws of vascular
action, whilst the ovum is more influenced by those regulating new
formed parts ; with this difference, however, that new formed parts or
tnmours are united firmly to the part from which they grow by all
kinds of vessels, and generally by fibrous or cellular substance,
whilst the ovum is connected to the uterus only by very tender and
fragile arteries and veins. If, therefore, more blood be sent to the
maternal part of the ovum than it can easily receive, and circulate
and act under, a rupture of the vessels will take place, and an
extravasation and consequent separation be produced: or even
where do rupture is occasioned, the action of the ovum may be so
oppressed ahd disordered as to unfit it for continuing the process
of gestation."*

Now in atonic plethora, or that commonly existing in high and
iashionable life, among those who use little exercise, live luxurious-
ly, and sleep in soft warm beds, although the action that accom-
panies the pressure is feeble compared with what occurs in the op-
posite state, the vessels themselves are feeble also, and their mouths
and tunics are exceedingly apt to give way to even a slight im-
petos : and hence plethora becomes a frequent cause of abortion in
women of a delicate habit and unrestrained indulgence.

Amoi^ the robust and the vigorous, however, its mode of opera-
tion is still more obvious and direct. An increased flow of blood is
here forced urgently on the uterus, which participates irresistibly
m the vehemence of the action ; so that if the vessels do not sud-
denly give way, and hemorrhage instantly occur, the patient feels
a tensive weight in the region of the uterus, and shooting pains
aboQt the pelvis. " This cause," observes Mr. Bums, " is especial-
ly apt to operate in those who are newly married, and who are of
a salacious disposition, as the action of the uterus is thus much in-
creased, and the existence of plethora rendered doubly dangerous.
In these cases, whenever the menses have become obstructed, all
causes tending to increase^the circulation must be avoided, and ohen
a temporary separation from the husband is iodispensable.^t

The general treatment of abortion consists of two intentions, that
of preventing it when it threatens ; and that of safely leading the
patient through it when there is little doubt that it has taken place.

The chief symptoms menacing abortion are transitory pains in
the back or hypogastric region, or a sudden hemorrhage from the
vagina. In all these cases the first step to be taken is a recumbent
podtioo, and when the patient is once placed in this state we should
dehberateiy examine into the nature of the cause. If there be

* PriDciples of Midwifery, 3d Edit. 8vo. p. 191.
t Burns, ut supri, p. 192.

126 QEWETICA. [CL. V.-OR. lU.

symptoms of plethora, or oppression, if an accident, or a sodden
emotion of the mind, or severe exercise, as of dancing, riding, et
even walking, have produced them hy disturbing the eqnitiforium
of the circulating system, blood shonld be immediately taken from
the arm, and all irritation removed from the bowels by a genfle^
laxative or injection. In plethora, indeed, we may go beyond thtsy
and empty the bowels more freely; yet even here our object
should he to reduce without weakening. In every instance, except
where plethora prevails, aAer abstracting blood, the next best
remedy is a full dose of opium consisting of thirty or forty drops
of laudanum, or more if the symptoms be urgent, and repeated
every three or four hours till the object is obtained.* And #here
the system is so feeble or emaciated that bleeding is counterindicat-
ed, we must content ourselves with giving sulphuric acid with
small doses of digitalis, unless, indeed, there be much tendency to
sinking at the stomach, and, in this case, we mnat limit bur practise
to the mineral acid and opium, and gently relieving the bowels.

By this plan the pains originating from incidental causes are oflen
checked, and (he partial separation of the ovum that has commenc-
ed is put a stop to. But the remedial process is thus far merely
begun : the patient, for some weeks, must be peculiar^ attentive
to her diet, which should be light and sparing, and if exercise of
any kind be allowed, it should be that of swinging, or of an easy
carriage. Cold bathing, and especially cold sea-bathing, is of great
importance; and where these cannot conveniently be had, a cold hip
or shower-bath may be employed in their stead ; and if there should
stfil be the slightest issue of blood from the vagina, injections of
cold water, or of a solution of alum, or sulphate of zinc, should be
thrown up the passage two or three times a-day : or an icicle or a
SDOW ball be employed as a pessary.

If the habit be peculiarly vigorous and robust, stimulants and soft*
ness of bedclothes must be carefully avoided, and the downy cooch
be exchanged for a herd mattrass. But if the constitution be delicate
and emaciated, two or three glasses of wine may be allowed daily,
and a course of angustura, columbo, or some other bitter tonic
should be entered upon, in either case, hoi^rever, it is absolutely
necessary that sexual connexion should be abstained from for ten
days or a fortnight

H has of late been very much the custom to confine women of a
very delicate frame, and especially after they h<ive once miscar-
ried, to a recumbent position from the first symptom of conception
tbirough the whole term of gestation. In a few cases this may be a
right and advantageous practice, but in the present day it is em-
ployed far too indiscriminately. Among the causes of abortion we
have just enumerated there are many it can never touch, as where
the ovum itself is at fault, or there is a natural indispositioii in the
uterus to expand beyond a certain diameter. In this last case, if

• Aaskow, Act. Soc. Med. Hafn. Tom. I.

GE. |.-€P. in.] SEXUAL FUNCTION. 127

we could be sore of it, a tepid hlp-batb employed every eye&iog
aboat the time the abortion is eipected would be a far more likely
meaoB of preTenting it : for we should act here as in all other affec-
tions where our object is to relai and take off tension, in which
states we uniformly employ warmth and moisture, commonly, in-
deed, a bread and water poultice. And hence, in the instance
before us, one of the best applications we could have recourse to -
would be a broad swathe of flannel moistened with warm water and
applied round the loins and lower belly every night on going to
bed, surrounded externally with a dry swathe of folded linen. This
should be worn through the whole night, and continued for a fort-
night about the time we have reason to expect a periodical return
of abortion from the cause now alluded to>

I was lately requested to join in consultation with an obstetric
physician upon the state of a young married lady of a highly ner*
vons and irritable frame united with great energy and activity both
of mind and body, who bad hitherto miscarried about the third
month of gestation, by braving all risks, taking walks of many milef
at a stretch, or riding on horseback for half the day at a time. She
was now once more In the family way, and had just commenced thC'
discipline of only quitting her bed for the sofa to which she was
carried, and on which she was ordered to repose with her head
quite flat and in a line with her body, and without moving her arms*
otherwise than to feed herself: and to continue in this motionless
state for the ensuing eight months. Without entering into the io^
mediate cause of her former miscarriages, 1 ventured to express
my doubts whether so sudden and extreme a change would not
rather hurry on than prevent abortion, by accumulating such a
degree of sensorial power as should produce an insupportable dys-
phoria or restlessness, which would peculiarly vent itself on the
oigan of greatest irritation. But 1 recommended that all exertion
of body and mind should be moderated, that the diet should be plain,
the hours regular, that the position should be generally recumbent,
and strictly so for a fortnight about the time in which abortion
might be expected. It was overruled, however, to persevere in
the plan already adopted from the moment, and every sedentary
relief and amusement that could be devised was put in requisition
to support the patient^s spirits. She went on well for a week, but
^ the end of this period became irritable, fatigued, and dispirited ;
and miscarried at about six weeks from conception, instead of ad-
vancing to three months as she had hitherto done.

£ven in the case of a delicate and relaxed frame, and of a mind
that has no objection to confinement, it is well worth consideration
whether the ordinary means of augmenting the general strength
and elasticity by such tonics as are found best to agree with the
system, and such exercises as may be taken without fatigue ; par-
ticularly any of those kinds of motion which the Greeks denominat-
ed sora, as swinging op sailing, riding in a palanquin, or in a car-
riage with a sofa-bed or hammock, which, as we observed on a

128 GENETICA. [CL. V.-OIU UI.

former occnsion,* instead of exhaastlog, tranquillize and prove se-
dative, retard the pulse, produce sleep, and calm the irregularities
of every irritable organ, — may not be far more likely to carry the
patient forward than a life of unchanging indolence, and undisturbed
rest, which cannot fail to add to the general weakness, how much
soever the posture it inculcates may favour the quiet of the uterus
itself.

We have thus far supposed that there is a mere danger of abor-
tion, and that the symptoms are capable of being suppressed. But
if the pains, instead of being local and irregular, should have be-
come regular and contractile before medical assistance is sought
for, or should have extended round the body, and been accompanied
with strong expulsory efforts, and particularly if, in conjunction
with those, there should have been a considerable degree of he-
morrhage, our preventive plan will be in vain, a separation has un-
questionably taken place, and to check the descent of the detached
ovum would be useless if not mischievous. Even though the pains
should have ceased we can give no encouragement, for such a ces-
sation only affords a stronger proof that the effect is concluded.

if the discharge continue but in small quantity, it is best to let it
take its course ; to confine the patient to a bed lightly covered with
clothing, and give her Bve and twenty or thirty drops of laudanum.
Bleeding is often had recourse to with a vitew of effecting a revul-
sion : it is uncalled for, however, and may do mischief by augment-
ing the weakness.

But the practitioner often arrives when the discharge is in great
ahundance and amounts to a flooding ; and the patient is faint and
sinking, and appears ready to expire.

To the inexperienced these symptoms are truly alarming, and,
in a few instances, sudden death appears to have ensued from the
exhaustion that accompanies them. But these are very uncommon
cases, for it rarely happens that the patient does not recover in an
hour or two from the deliquium : and even the syncope itself is
one of the most effectual means of putting a check to the discharge
by the sudden interruption it gives to all vascular action. Cold,
both external and internal, is here of the utmost importance ; the
bed-curtains should be undrawn, the windows thrown open, and a
sheet alone flung over the patient ; while linen wrung out in cold
water, or ice-water should be applied to the lower parts of the body
and renewed as its temperature becomes warm : holding the appli-
cation, however, as soon as the hemorrhage ceases.

Injections should, in this case, be desisted from ; for the formation
of clots of blood around the bleeding vesseb should be encouraged
as much as possible, instead of being washed away. And for this
reason it is now a common practice to plug the vagina as tight as
possible with sponge or folds of iinen, or what is better, a silk

* Marasmus Phthisis, Vol. ii. p. 519.

GE. I.-3P. ni.J SEXUAL FUNCTION. 129

handkerchief, smeared over with oil that they may be introduced
the more easily, and afterwards to confine the plug with a T ban-'
dage. This plan has been long recommended by Dr. HamlUon,
and has been extensively followed with considerable success. Here,
also, Dr. Hamilton prescribes large doses of opium as an auxiliary,
beginning with five grains, and continuing it in doses of three grains
every three* hours, till the hemorrhage has entirely ceased.
Opium, however, is given with most advantage where the flooding
takes place after the expulsion of the ovum ; for if this have not
occurred its advantage may be questioned, since it has a direct ten-
dency to interrupt that muscular contraction without which the
ermn cannot be expelled. And it should be farther observed that
where opium is had recourse to in such large doses as are above
produced, it must not be dropped suddenly, for the most mischievous
conseqaences would ensue ; but must be continued in doses gra-
doailj diminishing till it can at length be omitted with prudence.

If the flooding occur after the sixth or seventh month, and the
debility be extreme, the hand should be introduced into the uterus
as soon as its mouth is sufficiently dilated, and the child turned and
broQght away. And if, before this time, a considerable degree of
irritatioii be kept up in the womb from a retention of the fetus or
any considerable part of the ovum after its separation, one or two
filers sliOQld also be introduced for the purpose of hooking hold of
wImI remains, and bringing it away at once. Such a retention is
* often exceedingly distressing, the dead parts continuing to drop
away in membranous or filmy patches for several weeks intermix-
ed with a bloody ami offensive mucus. And not unfrequently some
danger of a typhous fever is incurred from the corrupt state of the
unexpelled mass. In this case, the strens;th must be supported with
a notritioaa diet, a liberal allowance of wine, and the use of the
warm bitters, with mineral acids. It is also of great importance
that the otems itself be well and frequently washed with stimulant
and antiseptic injections, as a solution of alum or sulphate of zinc,
a decoction of cinchona or pomegranate bark, a solution of myrrh
or benzoin, or, what is l>etter than any of them, negus made with
rough port wine. The injection must not be wasted in the vagina,
bit pais directly into the uterus ; and, on this account, the syringe
must be armed with a pipe made for the purpose and of sufficient
leogth.

The application of cold then, plugging the vag[ina, opium, and
perfect qidet, and, where the pulse is full, venesection, are the
chief remedies to be employed in abortions, or threatenings of
abortion, accompanied with profuse hemorrhage ; and where these
do Bot succeed, and especially after the sixth month, immediate de-
lireiy should be resorted to. The process, however, of applying
cold should not be contiiiued longer than the hemorrhage demands ;
for cold itself, when in extreme, is one of the most powerful
sources of sensorial exhaustion we are acquainted with. And hence,
where the system is coostitutiODally weak, and particularly where

yot. IV. 17

130 GENETICA, [CL. T.-OR. UL

it has been weakened by recarrence of the same discharge it may
be a question well worth weighing whether any thing below a
moderately cool temperature be allowable even on the first attack ?
as also whether the application of warm cloths to the stomach and ex-
tremities might not be of more advantage ? for unless the extremi-
ties of the ruptured vessels possess some degree of power they
cannot possibly contract, and the flow of blood must continue. And
it is in these cases that benefit has sometimes been found by a still
wider departure from the ordinary rules of practice, and the al-
lowance of a little cold neg^s. So that the utmost degree of judg-
ment is necessary on this occasion, not only how far to carry the
established plan, but on peculiar emergencies how far to deviate
from, and even oppose it.

We have said that the hemorrhage which takes place in abor-
tions, however profuse, is rarely accompanied with serious effects.
This, however, must be limited to the first time of their taking
place : for if they recur frequently in the course of a single gesta-
tion, or form a habit of recurrence in subsequent pregnancies, the
blood, from such frequent discharges, loses its proper crasis ; the
strength of the constitution is broken down ; the sensorial fluid is
secreted in less abundance, perhaps in less energy ; and all the func-
tions of the system are of consequence performed with a considera-
ble degree of languor. The increasing sensorial weakness pro-
duces increasing irritability : and hence slighter external impres-
sions occasion severer mischief and the patient becomes subject to
frequent fits of hysteria, and other spasmodic affections. Nor is
this all : for the stomach cannot digest its food, the intestines are
sluggish, the bile is irregularly secreted, the heart acts feebly ; and
the whole of this miserable train of symptoms is apt to terminate
in dropsy.

GENUS II.

PARODYNIA.
J^ortiflir 3laIiour.

THE PROGRESS OF LABOUR DISTURBED OR Ein>ANGERED BY IRREGULARI-
TY OF SYMPTOMS, PRESENTATION OR STRUrTURE.

The generic term is a Greek compound from xm^t^ maid, and mitt
or «)if, iM(, ^^ dolor parturientis.^' All the different species of vivi-
parous animals have a term of uterogestation peculiar to them-
selyes, and to which they adhere with a wonderful precision.
Among women we have already said that this term is forty weeks,
being nine calendar or ten lunar montlis. Occasionally the expnlao-

GE. n.] SEXUAL FUNCTION. l3l

17 process commences a little within this period, and occasionally
extends a little beyond it : but, upon the whole, it is so true to this
eiad time as clearly to show it to be under the influence of some
particular agency, though the nature of such agency has never
been satisfactorily pointed out. Sometimes the weight of the child
has been supposed to force it downwards at this precise period, and
sometimes the uterus has been supposed to contract, from its inabi-
lity of expanding any farther, and hence from an irritable excite-
ment produced by the pressure of the growing fetus. By other phy-
siologists it has been ascribed to the increasing activity of the child,
and Ske uneasiness occasioned by its movements. But it is a suffi-
cient answer to all these hypotheses to remark that a like punctua-
lity is observed whether the child be small or large, alive or dead ;
unless, indeed, the death took place at a premature period of the

Sregnancy : for ^^ No fact,'' says Dr. Denman, ^^ is more incontesta-
ly proved than that a dead child, even though it may have be-
come putrid, is commonly bom after a labour as regular and natural
in every part of the process as a living one :''* and hence we can
only resolve it into the ordinary law of instinct or of nature, like
that which regulates the term of menstruation, or assert still more
intelligibly with Avicenna that, ^^at the appointed time labour
comes on by the command of God.''

In natural labour, which consists in a mdual enlargement of the
mouth of the womb, and the diameter of the vagina, so as to suffer
the child to pass away when urged from above by a repetition of
expulsatoiy contractions of the uterus and all the surrounding mus-
cles, there is little or no danger, however painful or distressing to
the mother. These contractions, or labour-pains, continue with a
greater or less regularity of interval and recurrence from two hours
to twelve, the process rarely terminating sooner than the former
period, or later than the latter: the ordinary term being about six
hours.

But unhappily labours do not always proceed in a natural course ;
for sometimes there is a feebleness or irregularity in the muscular
action that greatly retards their progress; or a derangement of some
remote organ that sympathizes with the actual state of the uterus,
and produces the same effect ; or the mouth of the uterus itself is
peculiarly rigid and unyielding ; or the natural presentation of the
child's head may be exchanged for some other position ; or the ma-
ternal pelvis may be misshapen, and not afford convenient room for
the descent of the child; or there may be a plurality of Children ;
or even after the birth of the child the placenta may not follow with
its ordinary regularity, or an alarming hemorrhage may supersede :
each of which conditions becomes a distinct sp^^cies of disease in
the progress of morbid labour, and the whole of which may be ar-
ranged as follow :

♦ Pract. of Midwifery, 8vo. Edit. 5. p. 256.

132 GENETICA. [CL. V.-OR. HI.

1. PARODYNIA ATOmCA. ATONIC LABOUR.

2. IMPI«A8TICA. UNPUANT LABOUR.

3. 8YBCPATHETICA. COMPLICATED LABOUR.

4. PERVERSA. PRETERNATURAL PRESEIITATIOIZ.

CR06S-BIRTH.
j5, __ AHORPHICA. IMPRACTICABLE LABOUR.

6. PLURALI8. MULTIPUCATE LABOUR.

7. SECUNDARIA. SEQUENTIAL LABOUR.

SPECIES I.
PARODYNIA ATONICA.

LABOUR PROTRACTED BT GENERAL OR LOCAL DEBIUTY, OR HEBETUDE OM

ACTION.

It often happens in various affections of the syttem that a general
law is incapable of being carried into effect with promptness and
punctuality from weakness or indolence of the organs that are
chiefly concerned in its execution. Thus, when vaccine or variolus
fluid is properly inserted under the cuticle, it remains there in ma-
ny cases for several days beyond its proper period, in a dormant
state from inirritability or indolence in the cutaneous absorbents :
and, in the case of small-pox, even where the fluid has been receiv-
ed into the system, whether naturally or by inoculation, and has ex*
cited febrile action, this action is, in many instances, very conside-
rably augmented from a like indolence or irritability of the seceF*
Dents of the skin which do not throw ofi* the morMd matter tiiffi-
cientiy on the surface.

A like want of harmonious action very frequentlv occurs Li
parturition. The full time has expired - the uterus reels uneasyiy
and the uneasiness is communicated to the adjoining organs^ and
there are occasional pains in the back or in the lower heUy, but
either from a weakness, or hebetude, or both, in the uterus itself^
or in the muscles that are to co-operate with it in expelling the
child, the pains are not effective and the labour makes iittle pro-
gress.

It often happens, also, in debilitated habits that while in sobm
part of its progress the labour advances kindly and even rapidly,
the little strength the patient possesses is worn out, and her pains
suddenly cease ; or, what is worse, still continue, but without their
expulsory or effective power, and, consequently, do nothing more
thao tease her, and add to the weakness. This azhaustion wiU

«C IL-SP. I.] SEXUAL FUNCTION. 133

^ometimee occur soon after the commencement of the labour,
or in its first stage, before the os uteri has dilated and while the
water is slowly accumulating over it ; but in this stage it is more
likelj to occur if the membranes should have prematurely given
way, and the water have been already evacuated. Yet it occurs also,
ocoEMionally, towards the close even of the last stage, and when tiie
head of the child has completely cleared itself of the uterus, and is
so broadly resting on the perinaBum that a single effective pain or
two would be sufficient to send it without any assistance into the
world.

In the greater number of these cases, to wait with a quiet com-
mand of mind, and soothe the patient^s desponding spirits by a
thoosand little insinuating attentions, and a confident assurance that
she will do well at last, is the best if not the only duty to be per-
formed. A stimulant injection, however, of dissolved soap or mu-
riate of soda will often re-excite the contractions where they flag,
or change the nature of the pains where they are ineffective. After
this it is often useful to give thirty or five and thirty drops of
UndaBum, and to let the patient remain perfectly quiet. It is not
certain in what way the laudanum may act, for it sometimes proves
a local stimulant, and sometimes a general sedative, but in either
wtty it will be serviceable and nearly equally so ; for it will either
fliorten the labour by re-exciting and invigorating the pains, or
increase the general strength by producing sleep and quiet.

If the pulse should be quick and feeble with languor and a sense
of £adntnes8 at the stomach, a little mulled wine or some other
cordial may be allowed. If the mouth of the womb be lax and
dilatable, and the water have accumulated largely and protrude
upon it as in a bag, advuitage is often gained by breaking the
membranes and evacuating the fluid, for a new action is hereby
gfren to the uterus, and while it contracts with mare force it meets
with less resistance, and its mouth is more rapidly expanded. But
unless the labour should have advanced to this stage, the membranes
should never be interfered with ; for their plasticity, and the gradual
increase and pressure of their protruding sac against the edges of
the OS uteri, form the easiest and surest means of enlarg^g it,
whilst the retention of the fluid in this early stage of parturition
l^nicates the inner surface of the womb, and tends to keep ofi^ heat
and Irritation.

For the same reason, if the mouth of the womb be narrow and
have hitherto scarcely given way, the application of the finger can
be of Ao advantage. Every attempt to dilate it must be in vain, and
only produce irritation, and an increased thickening in its ec^es:
but if it have opened to a diameter of two inches, and be at the
same time soft and expansile, advantage should be taken of the
pains to dilate it by the introduction of one or two fingers still fnr-
^r, which should only, however, co-operate with the pains, and be
employed while they are acting ; and by these conjoint means the

134 GCNETICA. [CL. V.-OR in.

head of the child sometimes passes rapidly and completely oat of
(he Qterus into the vasrina, or outer mouth as it is called od these
occasions.

We have said that it is sometimes apt to lodge here in conse-
qnence of the patienOs eihaustion, and an utter cessation of all
pains, or of all that are of any avail. She should again therefore
be suffered to rest, and, if faint, be again recruited with some cor-
dial support Generally speaking, time alone is here wanting, and
the practitioner must consent to wait : and it will be better for
him to retire from his patient and to wait at a little distance. But if
several hours should pass away without any return of expubory
efforts, if there should be frequent or continual pains without any
benefit, if the patient^s strength should sink, her pulse become weak
and frequent, if the mind should show unsteadiness, and there be a
tendency to syncope, and if, at the same time, the head be lying
clear on the perinaeum, the vectis or forceps should be had recourse
to, and the woman be delivered by artificial means. This situation
forms a general warrant : but for the peculiar circumstances in
which such or any other instruments should be employed, the
manner of employing them and the nature of the instruments them-
selves, the reader must consult such books as are expressly written
upon the subject, and should sedulously attend the lectures and
the introductory practice which are so usefully offered to him ii^
this metropolis.

SPECIES IL

PARODYI^IA IMPLASTICA.

tSitjiUiint Satuittt.

LABOUR DELATED OR IIVJURED P-^OM IMPLASTlCmr OR UNKINDLY DILATATIOIT
OF THE SOFT PAKTd.

The tediousness and difficulty of the preceding species of labour
proceed chiefly from atony or hebetude of the system generally, or
of the instrumental organs particularly. But it oflen happens that
the parts dilate and the labour proceeds as slowly from animplaaticity,
or rigid resistance to the expansion and expulsory efforts which
should take place, according to the law of nature, at the fuhiess of
time which we are now supposing to be accomplished, and which
is sometimes productive of other evils than that of protracted sofieiv
ing, offering us indeed the foot following varieties :—

a& ILHSP. II.] SEXUAL FUNCTION. 135

• Rigiditatis. The delay coDfined to a dmple rigidity of

the uterus or outer mouth.

C Prolapsa. Accompaoied with prolapse.

y Haemorrhagica. Accompaoied with hemorrhage.

} Lacerans. Accompanied with laceratioo of the ute-

rus or perinsum.

Rigidity of the ttteru? may extend to the entire organ, or he
limited to the cervix, or os uteri as it is called aAer the cervix has
lost its natural form, and partakes of the sphaeroidal shape of the
fundus. Where the former occurs the practitioner meets with
severe pains in the loins, shooting round to the lower helly and
producing great contractile efforts of the muscles surrounding the
uterus, so as to throw the patient from the violence of her exertions
into a profuse perspiration, and induce the attendants to helieve
that the lahour is advancing with great speed, while the practitioner
himself (mds, on examination, that there is<no progress whatever;
that the uterus itself does not unite in the expulsory force, the fluid
of the amnios does not accumulate over the os uteri, nor the head of
the child hear down upon it.

In other cases, he finds that the general organ of the uterus, does
participate in the common action, and force the head of the
child downward, hut that the mouth of the womb does not dilate or
hecome thinner in consequence hereof; appeanng on the contrary,
in some cases, from a peculiar tenderness and irritation, to grow
thicker and tenser, and more intractable.

And be not unfrequently finds even where both the body and
mouth of the womb are sufficiently pliable and co-operative with the
common intention, and the head of the child has become easily
cleared of this organ, that a like rigidity and impi isticity exist in the
06 externum, and that the child having readily worked its way thus
far, is fast locked from this circumstance, and cannot get any
further.

In all cases of this kind the same means of relaxation should be
resorted to as in an irritable or inflammatory tenseness and rigidity
of other organs. Blood should be freely abstracted, active purga-
tires be given by the mouth, and copious emollient injections be
administered without much aperient virtue, so that they may for
some time remain in the rectum and act as a fomentation. And
here ako it may be advantageous to apply round the loins and
lower belly, a broad swathe of flannel wrung out in hot water, and
to encircle it with an equally broad band of folded linen, in the
manner already recommended in PAiuMEinA difficilis.

Id several cases of rigidity, if no means be adopted to subdue the
teniioD, the protrusive force of the surrounding muscles is some-
times so considerable that, as it cannot expel the child by itself, it
ffoei far to expel the child and the uterus conjointly, the latter
being thrust downward into the outward passage and its mouth
projecting out of ihe vulva, thus constituting a parturient prolapse.

1S6 GENETICA. [CL. V.-OR. lU.

While the uterus is thus forcibly desceDding, the attendant should
supportHt, or the head of the child, with two fingers : if the pro-
lapse be Complete, the utenis should be returned into its proper
place as quickly as possible ; and if this cannot be done, the child
must be turned, and delivery take place as speedily as may be.

Id the violence of this struggle, it sometimes happens moreover,
aed particularly where the water has escaped, that some of the
vessels give way, or the placenta is partly detached, and there is
the additional evil of a profuse hemorrhage to contend with.

If this occur in the commencement of labour, venesection should
generally be had recourse to, the patient be kept cool and quiet,
and take thirty drops of laudanum. If the labour have advanced
and is advancing rapidly, and the hemorrhage not be very consider-
able, we may safely trust to nature to complete the process before
any serious mischief ensues. But if the patient be debilitated, or
much exhausted, or the labour advance slowly, the woman should
be delivered by turning the child, or having recourse to the forceps
according to the progress of the labour, and the position of the
child at the time.

But there is a far worse evil than any of these, which results from
the ibplasticity we are now considering : and that is a rupture or
LACERATION either of the vagina or of the uterus.

The causes of laceration are said to be numerous, and it oflen
occurs suddenly and without any known cause : but if we examine
into their general nature, we shall find that except in the case of
brutal force or want of skill, they are almost always dependent on
a certain degree of implasticity in the part of the lacerated organ
which prevents it from yielding with the uniformity of the other
parts, or, from a peculiar degree of irritability that renders it more
liable to irregular action or spasm : though there can be no question
that in a very few instances the laceration has commenced from a
cut produced by an occasional sharpness of the edge of the ilium.
^^ Those women,'' observes Mr. Burns, ^^ are most liable to rupture
of the uterus who are very irritable, and subject to cramp ; or who
have the pelvis contracted, or its brim very sharp, or who have the
08 uteri very rigid, or any part of the womb indurated. Schulzlus
relates a case where it was produced by schirrhus of the fundus ;
and Friedius one where it was owing to a cameo-cartilaginous state
of the 08 uteri."*

Laceration of the fundus of the womb may take place during any
part of the labour when the pains are violent, and the walls of the
oi^ns do not act in unison in every part; but the mischief more
commonly commences in the cervix, when the head, or the shoul-
ders, or any other part, is passing through, and the whole of its cir-
cumference does not yield equally. Where the accident occurs in
the vagina or perinsum, it must necessarily take place afiter the
l^Ad has descended from the womb, and is pressing upon tlie

* Principles of Midwifery, 8vo. 3d. edit, p, 361.

qe.ii.-6p.1l] sexual function. 137

substance of these organs that, like the lacerating 09 uteri, does not
yield eqnallj in every point

In most cases of an implastic rigidity, whether in the hody of the
uterns itself, or in its cervix, or in the os externom, there is a consi-
derable degree of local irritation, and, in very many of them, of firm
and vigorous action. The parts are not only rigid, but dry, and hot,
and tender, and the pulse is generally full with restlessness, and a
heated skin. And hence venesection is imperatively .called for
from an early period of the labour ; and there are few cases in
which the uterus has not acted aAerwards with more freedom, and
its mouth been rendered lexer, softer, and more compilable. In all
such cases also an emollient injection several times repeated, will
considerably co-operate in taking off the tension, and iucreasiiig the
expansibility. Here opium should be avoided, but general relax-
ants as antimony and ipecacuan, given in the neutral effervescing
draught, may add to the general benefit. The operator must be
abstinent till the parts have yielded and the tension and irritation
subsided, for before this, every application of the fingers will only
increase the morbid tendency.

The only case in which the use of opium is here to be justified,
is where, Hom the violence of the contractile pains, a considerable
and an alarming hemorrhage has ensued, and the state of the os
uteri will not allow of the introduction of the hand for the purpos^
of turning and delivering immediately. In this instance, after vene-
section and a due administration of emollient and aperient injec-
tions, our last dependence must be upon a powerful opiate for the
purpose of allaying the irritation and taking off the pains.

And if the force of the expulsory power thrust diown the uterus
so as to give danger of producing a prolapse, the practitioner must
support the organ during the recurrence of the pains, by introducing
two fingers into the vagina for this purpose, and the patient must be
kept in a recumbent pmition without moving from it ; and must be
instructed to avoid as much as possible every expulsory or bearing-
down exertion, while the pain is upon her. If the uterus have
actually protruded into the vagina, a reduction must be instantly
attempt^ ; and if this cannot be done, no time should be lost in
passing the hand through the cervix, as soon as, without force, it
can be suffikdently dilated for this purpose, and delivering the child
by turning.

Laceratiion generally takes place suddenly, though, in irritable
habits, cramps or other spasmodic affections are often previously
complained of in different parts of the body. Mr. Bums has well
described the symptoms that succeed : ^ When this accident does
happen the woman feels something give way within her, and usually
suffers at that time an increase of pain. The presentation disappears
ttoie or less speedily, unless the head have fully entered the pelvis,
or the uterus contract spasmodically on part of the child, as happen

VOL. IV. 18

13ft ^tOfpTiCA. [cu r.-KHU in.

ed in Bechling^ patient.''^ The pains go off as soon as the chiM
passes through the rent into the abdomen : or if the presentation
be fixed in the pelvis, they become irregular and gradaally decline.
The passage of the child into the abdominal cavity is attended with
a sensation of strotag motion of the belly, and is sometimes prodoc*
tive of convnlsions.^'t

It is not necessary to make a distinction hetween jthe parts in
which tlie laceration takes place : for whether it l>e in the fundus
or cervix of the womb, or in the vagina, except where, as just ob-
served, the position is fixed in the pelvis, the part presented in-
stantly disappears, and the child slips imperceptibly through tht
chasm into the hollow of the abdomen, sometimes with a hemorr-
hage that threatens life instantly, but sometimes with little or even
no hemorrhage whatever.

This accident will not unfrequently occur towards the close of a
labour that promises fair. It is not many years ago, when the pre-
sent author, at that time engaged in this branch of the profession,
was requested with all speed to attend, in consultation, upon a lady
in Wigmore Street, who was then under the hands of a practitioner
of considerable skill and eminence. She had for about eight hours
been in labour of her first child, herself about thirty-eight years of
age, had had natural pains, and been cheered throughout with the
prospect of doing well, and even more rapidly than usual under the
drcumstances of the case. In fact the head had completely cleared
the 08 uteri and was resting on the perinaaum, and the obstetric
practitioner was flattering himself that in a quarter of an hour at
the farthest, he should be released from his confinement, when he
was surprized by a sudden retreat of the child during a pain which
he expected would have afforded her great relief, accompanied
with an alarming flooding : and it was in this emergency the author
ef this work was requested to atteod. On examination, it was ascer-
tained that a large laceration had taken plaoe Sn tfcc uterus com-
mencing at the cervix and apparently on the pas^ng of the shoulders,
hni why any part of it should have torn at this tkne rather thanan^
tecedently there were no means of determining. It ii usual, under
these circumstances, to fbllow up the child with the hand thrat^h
the rupture into the abdomen, and to endeavour to lay hold of the
feet, wd withdraw it by turning. The hemorrhage bad alarmed
the practitioner, and this had not been attempted ; and at the time
of the authorVi arrival, which was about an hour and a half after-
Wards the attempt was too late, for the pulse was rapidly sinking,
the breathing interrupted, and the countenance ghastly, yet the
patient had not totally lost her self^ossession, and being informed
of her situation, begged earnestly to be let akme, and to be sofiered
to die in qniet
Where there is little or no hemorrhage, the life nsnalfy ooati*

.^■•fcifclM*!* mM ■ I II . ■ I HIM I I I MM II** iWi

* Haller, Disput. Tom. iii. p. 477.
t BuniB, ut supra, p. 362.

OE. U.-^. n.] SEXUAL FUNCTION. 139

aoes mDch loBg^er, whether the child he extracted or not ; mostlj
ahoat twenty-foar hours ; though iu some cases considerahlj longer
•tin. Dr. Garthshore attended a patient who lived till the twenty-
■Ixth day^ and the Copenhagen Transactions* contain the case of a
woman, who after being delivered, lingered for three months : and
a few manrellons histories are given in the public collections, of a
natural healing of the uterus while the child continued as a foreign
and extra-fetal substance in the cavity of the abdomen for many
years. Haller has reported a case in which it continued in this
state for nine years ;t and others relate examples of its remaining
for sixteen,! and even twenty-six years,§ or through the entire term
of the mother^s natural life.

The only rational hope of saving both the mother and the child
is by following up the latter through the rupture, and delivering it
by the feet : hut where this cannot be done from the smallness of
the dilatation of the os uteri, or from a violent contraction of the
uterus between the os uteri and the rent, we have nothing to pro-
pose but to leave the event to nature, or to extract the child by the
Cesarean operation. We have just seen that in a few rare instan-
ces the vis medicatrix Natures, or instinctive tendency to health
has succeeded in healing the wound and restoring the patient with
the fetus still inhabiting the belly. But this result is so little to be
expected that an incision into the cavity of the abdomen has not
unfrequently been tried, and in some instances unquestionably with

fQCCe8S.||

SPECIES in.
PARODYNIA SYMPATHETICA.

LABOVR RETJJLDEO OR HARASSED BY STMFATHETIC DBRAirOKKCNT OF
SOalE REMOTE ORGAN OR IlJNCTIOlf.

Wc have often had occasion to observe that, with the exception of
the stomach, there is no organ that holds such numerous ramifica-
tloQS of sympathy with other organs as the womb : and we hence

* Tonu u. p. 326.

t Mem. de Paris. 1773.

t Epb. Nat. Cur. Dec. i. Ann. ui. Obe. 12.

i Id. Dec II. Ann. viii. Obs. 134.

B Progr#f de la Medicine, 1S98. ISmo.

Abhandlung der Rdnid. Schwed. Acad. 1744.

Hist, de TAcad. Eoj J« des SciMCf •, 1714. p. 39. 1716. p. 82.

140 GENETICA. [CL. V.-OR. Ill

find the progress of partarition disturbed, and what would otiiei^
wise be a natural, converted into a morbid labour by the interfet>-
cnce of various other parts of the body or the faculties which ap-
pertain to them. The whole family of varieties which issue from
this source are extremely numerous : but the three following are *
the chief:

• Pathematka. Accompanied with terror or other

mental emotion.
C Syncepalis. Accompanied with fainting.

y Convulava. Accompanied with convulsions.

In the FATHEMATic VARIETY, the joiut emotions which ar^ usually
operative upon a patient^s mind, and especially on the first labour,
are bashfulness on the presence of her medical attendant, and ap-
prehension for her own safety. There is not a practitioner In the
world but must have had numerous instances of a total suspension
of pains on his first making his appearance in the chamber. And
in some cases the pains have been com(>letely driven away for (bur
and twenty hours, or even a longer term.

There is nothing extraordinary in this, for two poweHul morbid
actions are seldom found to proceed in the animal frame simultane-
ously ; and hence pregnancy is well known to put by phthisis, and
ihe ^evert^st pain of a decayed tooth to yield to the dread of having
it extracted, while the patient is on his way to the operator's
Jiouse.

It is hehce of great importance that the bespoken attendttnt
should familiarise himself to his patient before his assistance is re-
quired, and endeavour to obtain her entire confidence : and it is
better, when he is first ushered into her presence, in his profession-
al capacity, that he should say little upon the subject of his visit,
direct the conversation to some other topic of general ipterest, and
then withdraw till he is wanted. And if the idea alone of liis ap-
proach be peculiarly harassing, it is best foi^ him to be in a remote
part of the house in readiness, and not to see his patient, till her
pains have taken so strong a hold as to be beyond the control of the
nncy.

If her apprehensions, however, be very active, and if there be
any particular ground for them it is most reasonable to enter can-
didly on the question, and to afibrd her all the consolation that can
be administered.

Sthcopb in labour proceeds commonly from a peculiar participa-
tion of the stomach in the irritation of the womb, and is lience
often connected with a sense of nausea, or with vomiting. Occa-
sionally it occurs also from the exhaustion produced by the violence
of the pains ; and particularly in relaxed and debilitated habits, in
which case the fainting fits sometimes follow up each other in very
rapid succession, and require very close attention on the^part of the
practitioner and the patient's friends.

The usual remedies should here be had recourse 'to in the first

GB. n.-6P, iil] sexual function. 141

iMtaDce : pungent yolatiles should be applied to the nostrils, the
ptttiest be in a recambebt position, with the curtains nndrawn, and,
vokss tlie season of year prohibit^ with the windows open ; the
lace, and especially the forehead and temples, should be sprinkled
'ifitlieold-water or ether; and the usual yolatiie fetids, aromatica,
and tereblnthinates, as camphor, should be given by the mouth: and
to these. If necessary, and particularly where the pulse is feeble
and fluttering, should be added a glass or two of Madeira, or any
other cordial wine, with twenty drops of laudanum.

If this plan should not answer, and especially if the fainting fits
flfaonld increase in duration and approximation to each other, the
pattent most be delivered by the process of turning as soon as eyer
tlie OS nteri is sufficiently dilated to let 'the hand pass without force.

One of the worst and most alarming of the associated symptoms
in kbonr, is that of convulsions, and these are of^en connected with
fidntiog-fito and alternate with each other. We have already glanc-
ed at them generally under sys^asu convuubio,* but must dwell a
little more at large upon th» present modification.

Convulsions may occur during any period of gestation, but we
ace DOW to consider them as an accompaniment of labour and as
interrupting its progress.^ Their proximate cause is a peculiar ir-
ritation of the nervous system as participating in the irritation of
the womb : and hence it is obvious that the radical and specific cure
it a termination of the labour.

We cannot always trace the link of this peculiar influence of the
woAb opon the nervous system : though, where there is a predispo-
sition to clonic spasm of any kind, we can readily account for its
exciteDient, and may be under less apprehension than where it
occurs without any such tendency. The occasional causes of faint-
ing are the occasional causes of convubions ; and hence they are
apt to follow, and particularly in delicate or debilitated constitu-
tioDS, on the fatigue and exhaustion of violent and protracted pains,
great depression of the animal spirits, and profuse hemorrhage.
SometiDies, however, they occur where none of these are present,
and where the patient is of a strong* plethoric habit of body, and
especially if it be her first time of pregnancy : and are accompanied
wi^, or even preceded by a sense of dizziness and oppression in the
bead, ringing in the ears, or imperfect vinon : the plethora itself
formittg the occasional cause.

The attendant symptoms are peculiarly violent, sometimes re-
smMiog those of hysteria, sometimes those of epilepsy, but more ve-
tiement than in either of these. Nothing can restrain the spastic
force of a woman when in parturient convulsions, whatever be her
natural weakness. The distortion of the countenance is more hide-
oos tlian the most extravagant imagination can conceive : and the
rapidity with which the eyes open and shut, the sudden twirlings
of the mouth, the foam that collects about the lips, the peculiar

P Vol. III. p. 348.

J42 GENETICA. [CL. r.-OR. IIL

liiss that iMoes from them, the stertor, the ioseiudbility, and the
jictitating straggle of the limbs, form a picture of agony that can-
not be beheld without horror.

The exciting cause is the irritable state of the womb ; and, what*
erer be the predisponent or occasional cause, whether a debilitated
and mobile condition of the nervous system, or a robust and entonic
fiihiess of the blood-vessels, it is obvious that such violence of action
cannot take place under any circumstances without endangering a
rupture of the vessels in the head, and consequently all the i^s*
chiefs of apoplexy. It is against this, indeed* that all practitioners,
how much soever they may disagree upon other points, most cor*
dially endeavour to guard, though it rarely happens that effusion
in the brain, and some of its results, do not take place in spite of all
their exertions.

The first step is to open a vein and bleed copiously, from a large
orifice, till the patient faints : and if the operator be expert, the
best vein to make choice of is the jugular : the hair should be im* ^
mediately removed from the head, and 4otion9 of cold water, pound-
ed ice, or the freezing mixture, produced by dissoKing three or
fotir different sorts of neutral salts in water at the !>ame time, be
applied all over it by wo t^d napkins changed for others as soon aa
they acquire the least degree of warmth. At the «(ame time a pur-
gative injection should be thrown up the rectum, and five or six
grains of calomel be given by the mouth with a draught of sulphate
of magnesia in infusion of senna. The paroxysms must, if possible,
be put a stop to, the fatal effects they threaten must be anticipated^
and not a moment is to be lost.

This is the general plan ; and it is to be pursued under all cir-
cumstances, though its extent, and particularly in regard to blood*
letting, must be regulated by the strength and energy of the patient
The local mode of treatment seems to be somewhat less decided.

It may happen that at the attack of the fits, the os uteri is merely
beginning to open, or that it is of the diameter of a crown piece,
but peculiarly ligid and undilatabie. There are practitionen who,
in this case, confine themselves to the depleting plan, and only wait
for the advance of the labour : but, in the state of the uterus we
are now contempl iting, they may have to wait for some hours be-
fore the labour is so far advanced as to render them capable of
affording any manual assistance whatever, while the fits are, per-
haps, recurring every quarter of an hour, and threatening fatal .
mischief to the brain. And in this case 1 cannot but warmly i^

grove of the bolder, or rather the more judicious advice of Dr.
land, who, after a due degree of depletion, recommends a full dose
of opium, for the purpose of alla^^ing the nervous irritation gene-
rally, and part culaily that of the uterus, which is the punctom
saliens of the whole. A few hours rest may set all to rights, if no
ressel have thus far given way in the head : for when the next tide
of pains returns, it will commence under very different circumstan-
ces in consequence of the reducent course of medicine tltat has been

cc lu-'dF. ul] sexual FUnCTlOK. 143

ipiHraed : and it will rarely be found that the whole body of tiie
titeros is not rendered more lax and plastic, and consequently ita
cerrix, and even the os externum, more yielding and dilatable.

Bat this is not the common course which the uterus takes under
these circumstances ; for, in by far the greater nuaiber of cases, the
whole of this organ, the cervix as well as the fundus, is so exhaust*
«d in the general contest, as to be more than ordinarily relaxed and
flaccid, and dilatable with considerable ease : insomuch that if the
moscular power of the system were now concentrated in a common
expulsory e£fort, as in natural labours, the whole process would
terminate in a few minutes. But unfortunately this moscular exer^
tioB, instead of being concentrated, is distracted and erratic, and
wandering over all the muscles and organs of the system, producing
general mischief instead of local benefit : so that whatever paina
there may be they are of far less use than in a state of harmonious
action. This may be easily ascertained by introducing the hand on
a return of the paroxysm, when the uterus will be found to contract^
indeed, but with a tremulous undetermined sort of force, perfectly
different from what it does at any other time

The necessary practice in this case should seem to be obvioea
and without doubt : the medical attendant seems imperatively called
npon to introduce his hand into the os uteri, as soon as it is suffi*
ciently open for him to do so without force, to break the membranes
Vnfi broken already, lay hold of the child's feet, deliver by tuni-
iag^ and thus put an end to the convulsions at once, and, consequent
ly, to the fatal effects which seemed to await the mother as well as
the child.

Such was the practice recommended by Mauriceau, upwards of a
century since : La convulsion, says he, tail souvent perir la mere
et Feniunt, si la femme n^est pas promftement tecourue par Paeeouch4'
nuni^ qai est le meiHenr remtde, qu^on puisse apporter a Tune et
i Tautre.* This recommendation wiis adopted generally, and in
our own country successively by Smeliie, W. Hunter, and Lowder.
And althoQgh, in circumstances of so much danger, it was not and
conld not be always successful, yet it was supposed, and with reason,
to be the means of saving the iile as well of the motiier as of the
cluld, in very numerous instances in which that of one or of both
would otherwise have unquestionably perished. Some forty yean
after the publications of M. Mauriceau's work, Professor Roederer of
Goettingen called this practice in question, and recommended that
tlie patient be lell to the natural course of the labour :t and we are
tnid by Dr. Denman that in our own country Dr. Ross, toward the
dose of last century, ^^ was the first person of late years, who had
covrage to declare his doubt of the propriety of speedy delivery in
«tf cttHs of puerperal convulsions. The observation,'' continues Dr.
Denman, ^on winch these doubts were founded, was mereiy practi-

* Traits dm MaladiM des Femmei grosses. Tom i. 23. 4to. Paris, 17SJ.
t EleiBeiita Aitis Obstetrica. Apb. t79. Go«t. 1709. tvo.

144 GENETICA. [CL. V.-OR. III.

cal, and the event of very many cases has since confirmed the jm^
tice of his observation, both with respect to mothers and children.'^
The sweeping extent of this censure seems to show that the pracr
tice has often been had recoarse to indiscriminately, and without a
correct limitation. And the apparent concurrence of Dr. Denman
in Dr. Rosses opinion, together with the undecided manner in which
he treats of the question in his subsequent pages, has raised up
amongst the most celebrated obstetric physicians of our own day
various advocates for leaving in general to nature the case of labour
'^ accompanied with convulsions, or at least till the natural efforts of

' '^ the mother are found completely to fail ; and in this last case, as
the child's head may be supposed to have cleared the uterus, to
have recourse to the perforator or the forceps, according to the na-
ture of the position.

The chief grounds for this proposed delay, as far as I have been
able to collect them, are, that the introduction of the hand into the
OS internum, in the irritable state of the organ we are now cpntem*
plating, is more calculated to renew the convulsions than to put an
end to them : that a repetition of them after due depletion has been
employed is not so dangerous as is generally apprehended, and con-
sequently that immediate delivery is by no means essential to the
patient's safety : and lastly, that we are not sure of putting ati end
to the convulsions, even after delivery is effected ; since it is well
known that they have occasionally continued, and sometimes have
not commenced till the process of labour has been long com-
pleted.

In reply to this, it may be observed, that if a repetition of the
convulsive fits be not so dangerous as is commonly apprehended, a
practitioner should feel less reluctance in introducing the hand even
though he were sure of exciting a single fit by so doing : and the
more so as this single fit might perhaps be the means of terminating
the whole, and, consequently, would be a risk bought at a cheap rate.
At the same time it should be c^erved that general experience
does not seemtojustiiy the remark that a cautious and scientific use
of the hand, where the mouth of the womb is sufficiently dilated, be-
comes a necessaiy or even a frequent excitement of fresh parox-
ysms ; and the prediction of such an effect is therefore without suf-
ficient foundation. And if there be a considerable chance, as seems
to be admitted, that instrumental assistance will be requisite at lait,
and that tiie forceps, or what, in the probability of the child's being
still alive is ten times worse, the peribrator must be called into ac-
tion, how much more humane is it, as well as scientific, to employ
instrumental aid at first, and thus save the pain and the peril of per-
haps many hours of suffering — and particularly when the soft, and
supple, and plastic instrument of the hand, may supersede the use
of the ruder, and rougher, and less manageable tools of art.
But the most important part of the question is as to the actual de-

* Practice of Midwifery, p. 586. Svo. 3cl. edit. 1816.

GB. 1I.-«P. III.] SEXUAL FUNCTION. . 145

free of danger which is iodoced hj coDVulsioiis ; and to determine
tiiis, notliing more seems oecessary than to put the whole upoo the
Ibotiiig of an impending apoplexy. It is possible that no eftoslon in
the brain may have taken place at the time when the depleting pkn
has been carried into execotion, but if the paroxysms should still re*
cur, surely few men can look at the violence of the struggle which they
induce, at the bloated and distended state of the vessels of the hcB
aod of the temples^ at the force with which the current of blood is
determined to tlie head, at the stertor and comatose state of the pa-
tient during the continuance of the 6t, without feeling the greatest
alarm at every return. And that he does not feel in vain is clear,
because in various instances the insensibility continues af)er the pa-
roxysm is over, accompanies her through the remainder of her la-
bour, and is the harbinger of her death.

Regarding puerperal convulsions then as a case of impenduig
apoplexy produced by an exciting cause which it is often in our
power to remove, it should seem to follow as a necessary and vtr
contestable result, that in this, as in every other case in which the
same disease is threatened, our first and unwearied attempt should
be to remove such cause as far as it may be in our power, and
whenever it is so.

ft is not long since tliat the pretent author^s opinion was request-
ed upon a case of this very kind ; but it was by the connexions of
ihe patient who had already fallen a victim to her sufferingB. She
had been attacked with natural labour-pains and was attended by a
female, who, alarmed by the sudden incursion of a convulsion-fit,
sent immediately for male assistance. The practitioner arrived,
and a consultation was soon held with several others : the os uteri,
is admitted to have been at this time open to the size of a crown-
piece, soA, lubricous, and dilatable. The depleting and refrigerant
plan was, however, confided in alone, and the labour was suffer-
ed to take its course. Expulsory pains followed at intervals, but
the convulsions followed also, and became more frequent and more
aggravated : in about six hours from the time of venesection, the
patient became permanently insensible, and as the child^s head,
completely cleared of the uterus, had now descended into the pel-
vis, it was determined to deliver her by the forceps, which was ap-
plied accordingly ; and in about an hour afterwar<k a dead child was
brought into the world, whose appearance sufficiently proved that it
had not been dead long.

The source of irritation had now ceased, and with it the convul-
sions, but the patient continued comatose still : yet even this effect
went off in seven hours afterwards, and she revived, and gave con-
nderable hopes of recovery. On the second day, however, in con-
sequence of the accession of milk-fever, the convulsions returned,
immediately followed with stertor and insensibility, and on the en-
eoing day she died apoplectic.

To reason irom a single instance, whether successful or unsuc-
cessful, is oAen to reason wrong. Yet it is difficult to avoid con-

YOL^ IV. . j9

^

146 GENBTICA. [cIm Tw^^)!!. lO

jectaring that if immediate deliTerj bad here taken place as sood a»
file Bangaiferoui system had been duly emptied, and when the state of
the utenis was so fayourable for a trial, two lives might have been
spared, both of which were lost imder the course punned. It hr
tme the fits returned widi the miik-ferer, bnt had the brain been
less injured, there would have been far less danger of such return:
The cases of Dr. Smellie and of Dr. Perfect concur in justifying such
a conjecture : and the following passage of Mr. Bums sheoM be
committed to memory by every student, and every pracdtiener.
^ But this is not all,'^ adverting to the necessity of a free depletion,
^^ for the patient is suffering from a disease connected with the state
of the uterus, and the state is got rid of by terminating the labour.
Even when convulsions take place very early in labour, the os ute-
ri is generally opened to a certain degree, and the detraction of
blood which has been resorted to on the first attack of the disease.
Tenders the os uteri usually lax and dilatable. In tUs case, al-
though we have no distinct labour-pains, we must introduce the
hand, and slowly dilate it, and deliver the child. I entirely agree
with those who are against forcibly opening the os uteri : but I
also agree with those who advise the woman to be delivered as
soon as we can possibly do it without violence. There is, I am
convinced, no rule of practice more plain or beneficial. Delivery
does not, indeed, always save the patient, or even prevent the re-
currence of the fits, but it does not thence follow that it ought not
to be adopted."*

SPECIES IV.
PARODYNIA PERVERSA.

LABOUR IMPEDED BY PRETERNATURAL PRESENTATION OF THE FETUS OR ITS

MEMBRANES.

In the ordinary course of gestation the fetus is rolled up into as
small a compass as possible with the breast uppermost, and the
head dependent, the legs incorvated and the arms folded : the pla-
centa rises from softie part of the fundus, and the umbilical cord
hangs at perfect ease in loose folds, or is sometimes turned loosely
round the body : thus forming an ellipse whose longer axis corres-
ponds to the longer axis of the uterus. Why the head rather thair
the breast, or indeed any other part of the fetus should so uniformly

* Principles of Midwifery, p. 359. 3d edit. 8to. 1311.

GC H.-6P. IV.] SEXUAL FUNCTION. 147

comfhute the point of pretentaiion, we know not, excepting that it
li hy far the most commodioos point for delivery ; and we cao
hence only resolve it into one of those striking laws of nature
wfaicfa are ever aiming at accomplishing the best ends by the best
means, and afford an unvarying and unequivocal proof of design
vnited with benevolence and power.

Here, however, as in every other part of the animal economy,
we meet with occasional deviations from the ordinary course of na*
tore, and deviations which are always productive of evil. For it
MMoetimes happens, from incidental causes that are totally conceal-
ed from us, that some other part of the child is lowermost or pre*
9eBts itself instead of the head; or that the placenta rises in an un-
fiiTOorable part of the womb, or that the navel-striog hangs down
below the head and is constantly in danger of being strangled as the
child passes through the sharp bones of the pelvis : and hence we
have the following varieties of morbid conifition offering themselves
to us under the present species :

M Faciei. Presentation of the face.

C Natium. Presentation of the breech.

y Pedis. Presentation of one or both feet.

i Brachialis. Presentation of one or both arms.

f Transversalis. Presentation of the shoulder.

^ Funis prolapsi. Prolapsed navel-stringy

« Placentae. Presentktion of the placenta.

As it is by no means the object of the present work to instruct in
tlie manual or artificial operations of the obstetric art, the author
must limit himself to pointing out the different morbid conditions
in which such operations will be found necessary. Their nature,
mode of accomplishment, and effective instruments are only to be
learnt by works written professedly on this subject, or, which is in-
finitely better, by an attendance on lectures, and such initiatory
practice as the obstetric schools afford. A few general or inciden-
tal remarks are all that the author can undertake to add to the
above table of morbid presentations.

There is no mode of determining what may be the presentation
of a child before the commencement of labour, and even at that
time it is most prudent for a practitioner to speak with some hesi-
tation on the subject till the membranes have actually broken, and
the position is fully decided. For though the real prcsenhition is
often sufficiently ascertainable through the membranes themselves,
and particularly on the natural descent of the head, yet it has oc-
casionally happened that, on the breaking of the membranes, the
bead has receded and the shoulder or some other part taken its
place ; and there are cases In which the opposite and more fortu-
nate change has occurred of a recession of a presenting shoulder
and a descent of the head in its stead.*

Joerg, Hist. Part. p. 90.
Burns, ut supri, p. 292.

148 afiNBTicA. [cL. r«-^>iu IS.

There is hence do fonndatton for those aj^prehendonB which aie
often entertained by pregnant women respecting the mispositioD of
the child drawn from some peculiar symptom or feeling which she
has never been conscious of on former times, as a singfularity in the
shape of the abdomen, a sense of the child^s risii^ suddenly to-
wards the stomach, or a numb or painful uneasiness in one leg more
than in another. These, and hundreds of other anomalous sensa-
tions have occurred in cases where the presentation has at last been
found natural, and the labour has proved highly favourable ; while
on the contrary it is very rarely, when a cross birth is detected,
that it has been particularly apprehended by any precursive tokens
whatever. And the mind of the timid may hence be comforted in
the midst of all the peculiarities on which they are accustomed lo
hang with daily alarm.

It will rarely be found necessary to hare recourse to any mecha-
nical instrument in any of the varieties we have enumerated above ;
and in some of them, as the breech and foot^presentations, the ex*
pulsory powers of nature alone are found sufficient, at least till the
head descends into the pelvis: at which time it will be found ne*
cessary, whenever the arms He over the head, to introduce a finger
or two and gently draw them down.

Where the face presents, or any other part of the head than the
vertex, it was formerly the custom to deliver by turning, bat a
skilful practitioner of the present day is commonly able, by a dex-
trous pressure of one or two fingers against particular parts of the
head, and particularly, if attempted in an early stage of labour, to
give the organ a right direction without introducing the hand.

On the presentation, however, of a shoulder or of one or both arms,
it will be expedient to turn as soon as possible \ or, in other words,
as soon as the mouth of the womb is sufficiently dilated for this pur-
pose. It is singular that, while under the old practice, delivery by
the feet was oilen endeavoured in face-cases, attempts were made
in arm and shoulder-cases to bring down the head and reduce the
labour to a natural course. This it seems has been done, and may
be done, but with so much fatigue and exhaustion to the patient as
to run the risk of incapacitating her for ai^ subsequent efibrts, if
she do not even fail a sacrifice to a flooding as in a case related by
Dr. SmelliCi It is to the successful exertiobs of Par6 and Mauri-
ceau that the better practice of the presf^nt day has obtained a
triumph over all Europe. Yet, in justice to the obstetric practi-
tioners of ancient Greece, it should be observed, that the modern
method is little more than a revival of their own which unaccountably
sunk into disfavour ; for we are told by £tius, that Philomeles dis-
covered the method, at that time in common use, of turning and
delivering children by the feet in . all unnatural presentations.
Where, however, the child is small, or of premature birth, it may
sometimes be taken away without changing the presentation : for
the obstetric writers abound in examples of delivery effected under

«(, Q^Hitp^ I?.] SEXUAL mmenov. 149

•nefa tlKOM>Kpeei by pvBlsg down tike ftm and *r«#ii« ^ ^citd
iBte the regina.* ^ , , . ^

It tenetlnefl happen^ that the shoulder h 9o far adt anced ib4o
Um pelrla before the arriyal of the practitioBer, or from the Te-»
hement force rfthc uterus, that it is impossible to raise or move
Ae chUd by the utmost power of the operator : and the state of the
case seems to leaye the vroman without aay hope of relief. At
this very mooKot, however, and by these very meaos the wise and
benevolent law of instinct or of nature is interposing to the relief
that is despaired of. This wonderful process, though occaaonally
noticed by earlier writers, and foremost of aH perhaps by Schoen-
heider, in the Copenhagen Transactions,? was first folly illustrated
and ezplttned by Dr. Denman, who chstiogmshed it by the name of
a sfOKTJismo€s EvoLvnoK. His explanation is best given in his owfli
woidi : ^* As to the manner in which this evolution takes place, I
presume that after the long continued action of the uterus, the body
of the child is brought into such a compacted state, as to receive
the full force of every returning action. The body in its doubled
state beiog too large to pass through the pelvis, and the uterqs
yitfwjnf men its inferior extremities, which are the only parts
capable of being moved, the latter are forced gradually lower,
mahitig leom, « they are pressed down, for the reception of some
ether part into the eavity of the uterus which they have evacuated,
ttU, the body tnmwg as it were upon its own axis, the breech of
the chUd is expeUed, as in an original presentation of that part :
and consequently is delivered by nature at the time she least ex-
pected it." Dr. J. Hamilton, however, has justly observed that
diis evolvtioa can only take place where the action of the uterus
can produce no exertion on the presenting part, or where that part
» so shaped that it cannot be wedged in the pelvis : and he might
have added where the woman is in full strength and the uterus Is
capable of exercising a strong expulsory power. And hence, it b
a chance that should never be trusted to or suffered to interfere
with the oommon practice of delivering by the feet wherever this
cssk be accomplished.

In all the above cases it is a general rule and one of great im-
portaDce, to suffer the water of the amnios to accumulate towards
the neck of the woasb as largely as possible, and to leave the mem-
branes uohroken as long as may be.

A presentation of the wma is another difficulty often of considera-
ble momcfldt in the progress of labour : for it is obvious that by a
check to the puiaation, either actually taking place or being greatly
endangered in every pain by the violent pressure of the head or of
any otiier part i^^idnst the mouth of the uterus, or afterwards s^iost

» GsrdMr, Med. ComoMnU Vol. v. 307.
Bandelocqae, Sect. 1530.
Btiriie, ut supr^, 303.

t Act. HaTn. Tom. ii. Art. xxiH. ..

150 GfifTBTlCA. [cyU V,--OIL Ittr

tlM tides of tin pelfis, sad omiseqiieiitij aganut tiie ftntli itielf, tlie
life of the child is in imminent lia2»rd, and withont the exercise of
coDsiderahle skill, mar fnevitahly be lost. If it be poMH>le to return
the prolapsed part of the funis roond the head as it is descending,
or to hook it against ^e hand or some other part so as to keep it
clear of pressure, tliis ought to be done by all means. Bat if this
be impossible the child most be tamed, as soon as taming is prac-
ticabie from the dilated slate of the os interaam : or if the head
should have reached the pelvis before the accident takes place,
the labour most be accelerated by the patient's using her utmost
efforts daring every pain ; and, if she be . too much exhausted for
concentrating her strength, it must be quickened by the use of the
Ibrceps. fiut if the pdsation in the chord have already ceased, and
we have Mreby a proof that the child is dead already, the labour is
to be sofiSred to take itsnatoral course.

It sometimes happens, however, that afler the child is turned and
the head does not follow the body so speedily as could be wished
from the patient's being greatly exhausted, — and the same fre-
quently occurs in breech cases, in consequence of the protracted
length of the labour in this presentation,— there is stiil a considerable
danger to the navel string, from its pressure between the child's
head and the pelvis. This should be remedied as much as possible
by giving the funis full play between the pains. But it frequently
occurs, in spite of the utmost caution, that the pulsation is suspend-
ed, and the ichild is born in a state of asphyxy, and apparently life-

The common practice in this case is to tie the navel-string as
quickly as possible, remove the child from the mother to the warmth
of the fire-place, and endeavour to stimulate the lungs into action by
breathing forcil)ly into the mouth while the nostrils are closed.
Friction with a warm hand, and with a conjoint aid of some pungent
volatile is at the same time applied actively to the chest ; and if this
do not succeed the nostrils are attempted to be roused with ammonia,
or the fauces with a tea-spoonfal of brandv and hot water, to excite
sneezing or coughing. Ail this is well ; but there is a great and, I
am afndd, not unfrequently a fatal error in thus separating the
navel string and removing the child from the mother. While it
continues united it has two chances of recovery, that of the action
of the longs and that of the re-action of the umbilical artery. By
removing it from the mother we allow it but one chance, and tliat,
in my opinion, the feeblest. The expansion of the lungs is alto-
gether a new process, and, like other new processes, does not
always take place with great promptness, even where the child is
in full life and vigour, and the umbilical artery in regidar puta-
tion ; for it is sometimes half a minute or double this time befofe
the child begins to cry, which is the first proof of its respiring. But
the flow of the blood throiu(h the umMlical artery is an established
habit, and, like all other habits, has a powerful tendency to recur if
we give it time and favour; and must derive an additional tendency

froB t]i0 flUoMiliw of t)ie poilenor pkcental veaielB wJuch are stiB
pokatiiig and operating with a Tia a teigo. Of the various cases of
asphTzj on hirth whieh 1 ha?e witnessed, by far the greater nnwr
ber have proved fatal when treated in the former way, and success*
ibl when treated in the latter : and the ejq[Uanation here given will
leadilj account for the difference.

The PLACEiTA itself maj, also, form a preternatural presentationi
and^d much to the difficultly, iad the danf^ of labour. W^ have
said that this rises ordinarily from some part of the fundus of the
uterus, though it may originate from its sides, or from some other
quarter, for tliere is no quarter of the womb which may not become
its source. Hence it occasionally takes its rise more or less oyer
the mouth of the womb ; and while this part of the wom^ continues
quiescent, it produces no more inconvenience there thamany where
else. But the moment labour commences, or even, in the latter
months of parturition, when any cause whatever irritates the mouth
of the womb, and in any degree puts it upon the stretch, some of
the placental vessels must necessari^ become ruptured and a he-
morrhage ensue. So long as this is small in quantity, and does not
frequently return, it will be sufficient to enjoin quiet, a recumbent
position, and that the bed be not heated with a profusion of blankets.
But If the hemorrhage be considerable, whether before the full time
of labour, or on its accession or in any part of it, there is no perfect
safety but in delivery, and hereby ^vlng the ruptured vessels an
opportunity of closing their mouths. The difficulty is less than a
young practitioner m%ht at first expect : for he may be sure, from
the hemorrhage itself, that the os uteri is both dilated and dilatable,
lor if this did not give way neither would the vessels which produce
the hemorrhage.

SPECIES V.

PARODYNIA AMORPHICA.

Xmpractfcaiile Sateur.

LABOmt JMPBDSD BY MIS-COXFIOVEATION OW TUG FSTSS, ORy OF TH£ MJt-
TBBVAL rSLVlS.

far iMtural lidwur the size of the head is adapted to the diameter of
the pelvis it has to pass through : in some children, iiideed, the
head is rather larger than in others, or has a difference of shape ;
and wf meet with a like difference in the area of the pelvis : and
Iheie circumstances may proloi^ the labour, though the eipulsory
powers of the mother will ukimately triumph over the resfetance.
fittt it unfertunately happens that the iiead is sometimes so ea-

16f QBMncA. [oL. r.-mft« m.

Urged hy mmittroflltj of «irtiohi«e, iij^lroni mpMs^ or some otfier
^ease, or tliat the ouitenMl peWh is so deformed in its make, that
the child caonot pass through the pas^age^ and detirerj becomes
aUogetber impracticable.

There is, bowerer, aa iDtermediatc state between the natural
size of the peif is with a iiead of a natural ii2e applied to It, and
tiiat of absolute impracticability from the utter inaccordance of the
head to the opeoiflg ; ^^ which, tboogli the most riolent and best
directed pafais of the mother mat not be salient to produce expul-
sioo, this object may be effected by the assistance of instruments co-
operating irith the natural efforts.

What space of peliris is absolutely necessary to enable a ;1Wing
child, at lis iiill time, to pass through it, has not been rery accu-
rately-sattled by (^istetric wfiters, some maintaining that this cannot
take place where the conjugate diameter is less than two inches and
a half, though it may tiU we reach this degree of narrowness ; and
others that it cannot take efieet under three inches. The difference
in the size of the head in different children on their birth, and of
the thickness of the soft parts within the pelvis in different women
may easily aocooet for this Tariation in the rule laid down. It is
clear, however, from the acknowledgment of botili parties, that if
the dimensions of the pelvis be much under three inches, delivery
cannot be accomplished without the loss of the child : and it is also
clear that if the head be ratich enlarged beyond the natural size from
aay cause whatever, it cannot pass even through the ordinary
dimensions, thus giving us the two following sources or Tarieties of
difficult labour from an amt>rphous cause.

m A fetu. The fetus deformed by a preternatural magni*

tude of head, or some other morbid protu-
berance.

C Pelvica. The pelvis contracted in its diameter by natural

deformity, or subsequent disease or injury,

U is by no mftans easy to determine what is the ^actual measure-
ment 6f the hollow of the pelvis to a 11 Hng woman, and particularly
duifog the time of labour: and hence, how useful soever it may be
to be acquainted with what ought to be its precise capacity as taken
undeur oth«r chrcuwataoect, the judgment must chiefly determine as
to the praeticafaility or impracdcablliiy of the passage from a calm
attention to the kidivldtiai case at the tiine, and particularly where
the difficulty proceeds from the Ibrtn of the child rather than from
that of the mother. It^ in weU weighing the circumstances, the
question remain ^uhtAil, the pfltient ahouid be allowed to proceed
with he#' natural exertions ekorie, or suefo only in addition as the
hands may be Me to affond, tUl the strength is considerably
exhausted, and the mind partiripates in the depression of the body.
And if at this time, as will probably be the ease, the head has
descended so low as to be in contaet with the pedaeitm, and an ear
can be folt, it would be imiprodeot Co delay aay hager ussistiDg her
with the vectis or the forceps.

ofi. iiiHHP. t;] sexual FUifcnov. 153

But tbe can wmj not be donblfiil, and the passage bmt be fo mocK
contracted at to render all attempts to accoinplish deliferj bj the
Kaods or the ordinary instrtunenta totally inefiectaal from the first
In this aitnatlon otl^r means miMt be resorted to, or the mother and
the child most both perish^ worn ont by fiUigoe, and perhaps ren-
dered ganfrenons in the points of contact from irritation and inflam-
mation.

The means that present themselyes to the practitioner oo thii

- occasion are the three fdlowing : He may reduce the head of the

child by the crotchet or perforator. He may, in a small degree,

enlarge the diameter of the pehis by dlTidingthe symphysis pubis.

Or, he may make a section tnro^gh the abdomen into the aterns.

The first of these methods is designed to save the mother by a
Tolqntary sacrifice of the child. The two last give a chance to the
child, bat at an. imminent hazard of the mother.

Where the difficulty proceeds from a morbid enlargement of the
child's head, the onestion as to which of these three methods of
treatoMnt shoold be adopted, ooffht not to admit of a moment's
debate. The child is, perhaps, dead already, or, if not, it is not
Ukely that it would long survive the defonn^ it hibours onder, or
live so as to render life a blessiag : and the life of a sound woman
most not be risked, and still less sacrificed, for the chance of saving
an unsound child. The head, therefore, ought to be diminished^
and consequently* the perforator to be had recourse to.

But there are instances of a deformity of the pelvis so considerable
as that the perforator cannot be employed to any advantage : &r
bow much soever the cranium may have been brdien down, there
may not be bieadtb enough to extract the child in any way.
And this will always be the case where the range of the pelvis Is
under an inch and a half from the pulds to the sacrum, or on either
side. Dr. Osbora asserts that he once succeeded in removing a
child by means of the crotchet in a case where die widest sHa of
the pelvis was only an inch and three quartan broad, and not more
than two inches long ;* which is a capacity so narrow aa to throw
soone doubt upon tbe accuracy of the measurement in the minds of
many practitioners,! and certainly so narrow as to form an unparal-
lelled case in the annals of the obstetric art.

In situations, therefore, of this kind, some other plan must be
pursued even to save tbe life of the mother ; and the only plana
that can even be thought of are that of dividing the symphysis of
the pubis, and that of the Cesarean section. .

Towards the latter monthi of pregnancy there seems to be a
disposition in the bones of the pelvis to separate at their symphysis,
insomuch that some pregnant women are sovdble of a motion at
tbe junction of the ^bones, especially at that of the oasa pubi&t

V

• Osborn't Em/I, p. 903.
t Bun's Prioc. ofMidwiiuy, p. 35i:
t I>etiiiiaa. Pract. •f Midwifery,' p# 46. 446.
VOL. iv. 20

154 OENBTIGA. [OL. Y.-OK. IQ*

This has been known to anatomists for some ceataries, and aboat
seventy years ago, for the first time, gave rise to a question whether
advantage might not be taken of tids tendency in cases of pelvic
contractions, to enlarge the space by dividing the ossa pnbis at their
symphysis, and thus obtain the same end as is answered by the
Cesarean section, with a considerate diminution of risk. The
operation seems first of all to have been proposed by M. Louis of
the French Academy of Surgery to Professor Camper of Groningen,
who tried it first on a dead female bodv, and found it would afford
space, and next on a living pig, which, for some days afterwards, was
incapable' eitiier of walking or standing, but in a few weeks per-
fectly recovered. He was then desirous of trying it upon a young
woman conctemned to death at Groningen, but £d not succeed in
his request Not long afterwards, however, it was performed with
complete success by M. Sigault of Paris upon the wife of a soldier
who liad hitherto borne four children, each of whid), from the
mother^s misformation, was obliged to be extracted piece-meal.
The section of the cartilage connecting the ossa pubis enabled the
bones to be separated, according to his account, by a chasm of two
inches and a half; and yielded a free passage to the child in four
minutes and a half. The wife, with her husband and child, a few
weeks afterwards, presented themselves to the members of the
fiiculty assembled in their hall. The patient walked steadily and
was found to be perfectly recovered.* lfe» L« Roy, who was
requested to attend on the occasion, tells us that the same operation
was afterwards performed by two other practitioners on two other
women, and in both cases with an equally happy termination. He
also observes that although, in an unimpregnated state, the bonei
of the pelvis cannot be made to separate upon a division of the
symplnrsis to a space of more than an inch, which would be insuffi-
cient for the purpose proposed, the additional softness and flacciditj
which take place during pregnancy, as well in the bones and car^
tilages as in the muscles, is so considerable, that a separation of two
inches and a half may be easily effected in labour and was effected in
the above cases, while the same bistoury that divided the soft part8»
eauly also divided the <:artilage.t In various other parts of the
Continent, and especially at Moos and in Holland it has been re-
peated with complete emancipation both to the child and mother.
Dr. J. H. Myers, who witnessed it at Paris, speaks of it in the
highest terms of commendation. He says that the length of the
incision does not exceed three inches, and that the whole operation
is over in less than five minutes : while in the Cesarean opera-
tion the wound is necessarily more than nine inches long, the ute-
rus is divided, and the surrounding viscera are uncovered. ^^ 1 have
seen," si^s Dr. Myers, ^^ the operation twice performed in thi

• Med. Comm. Edin. Vol. v. p. 214.

t Reohercbes Htstoriques et Pratiques tur la Section de la SjhipUyse du Pubis
&c. Paris. Sto. 177S.

CE. If.*-6F. v.] SEXUAL FimCTION. 155

capita! witti erety posrilile sncceM. The h»t pattent, wUle 1 am
writiDf , is in the room, coming^ to show herself in justice to her
operator. It is only eighteen days since the operation was perform*
ed, and she is in perfect health, and hy no means injured hy if*

The operation, however, has heen decried, and, in some instan-
ces, lias certainly failed; but there appears to be some doubt
whether, in several of these cases at least, if not in all, it was con-
ducted with a sufficient degree of dexterity and skill : for when we
are told by one operator that, after the division of the symphysis he
could not effect an opening of much more than a finger's breadth,
and by another that the utmost- extent of the hiatus was not more
than an inch and a half, and compare these remarks with th^
following assertion of Dr. Myers upon this very point, it is difficult
to come to any other conclusion. ^^ The moment,'^ says, he, ^^ the
division is made, there is an enlargement of the pelvis, i venture
to say, to any extent desired ; the last I saw was three inches, ac-
curately measured by an instrument called petoimetre contrived by
Mr. Trainel.'^ To which we may add that M. de Lambon perform-
ed the operation twice on the same patient ; in the first instance
without injury to the mother, and in the second with success to both
motlier and child.t

After these decisive facts in its fiivour, to which the reader may add
others from the volume of Nosology, I cannot but conceive that the
prejudice against it, in our own country, has been carried too far.
One experiment alone has been made amongst ourselves, and that
with an unsuccessful issue. But the chief opposition to it seems to
have proceeded from the discountenance of Dr. Denman, added to
certain experiments made in relation to it by Dr. William Hunter,
which do not seem to have been conducted under circumstances
that can fiurly call in question the truth of the preceding state-
ments.

^ Immediately,'' says Dr. Denman, ^^ after the accounts of the
operation were brought into this country, wishing, as a matter of
duty, to understand the ground of the subject, i had a conference
with the late Mr. John Hunter, in which we considered its first
principle, its safety ; and after the most serious consideration it was
agreed thai, if the utility could be proved, there appeared firom the
structure of the parts, or from the injury they were likely to sus-
tain by the mere section of the symphysis, no sufficient objec-
tion against performing it. Of its real utility it was, however, im-
poenible to decide before many experiments had been made on the
DEAD body, to ascertain the degree of enlargement of the capacity
of the pelvis, well-formed or distorted, which would be thereby ob-
tained. Such experiments were soon made : and their result pub-
lished by the late Dr. Huntm^ and these proved on the whole that,
in extreme or great degrees of distortion of the pelvis, the advan-

• Edin. Med. Comment. Vol. vii. p. 453.

t Leakeys Practical Observations on the acute Diseases of Women. 8vo.

156 aunmeji. [cl. r.-oiu in.

ttf* iq he gtkmi VM wiiollj insoffici^ttC to tllow the hetd of s
child to paw wkhoiit toflfleniiig its bulk: and In Moall defreet of dlt-
ftortipo that the operation was onneceaiary, anch caaea adaftittfaig of
relief bj less desperate methods. They protred, moreover^ that ic-
reparaUe injury would be done by attempts to increase the com-
mon advantages gained by the section of Uiesympl^yiis by straining
or tearing asnnder the Uganients which connect the ossaPtnnomlnata
to the sacrum, and to the soft parts contained in the pelvis, partf-
cnlarly to the bladder.^'*

Now it did not require these eicperiments to prore that this ope-
ration, or .almost ai^ othev, would become miachieTOus if unskil-
fully performed, but surely it was something too mnicb to endeavour
to set aside the ^ts and results known to have taken place in very
numerous instances in the ftotiif body, aid to call in question the
veracity of those who made them and those who witnessed them,
by facts and results made merely on thcf dead body, without one
single experiment on the body while aHve and in the peculiar cir*
cumstances under which alone it is admitted that the tacts and re-
pults contended for could posnbly take place.

Upon the whole it is allowed in the passage just quoted, as the
concurrent opinion of Dr. Denman himself Mr. John Hunter, and
apparently Dr. William Hunter, and this too after ^ the mqst seri-
ous consideration,^' — that ^ there appears from the | atoructore of
the parts or from the injury they are likely to sustain, by the
|a»ece section of the sympfayais, no sufficient objection against per-
forming the operation.'^ That it will answer in every degree of
a contmcted pelvis was never asserted by its most sanguine ad-
yocates, but only in cases wliere the constriction was somewhat
too considerable to. allow of the extraction of the child by the
forceps. And lastly, it is after all admitted by Dr. Denman himself,
that where the life of a child is of more than ordinary importance
from public or other coasideratiens, and the mother who is in la-
bour with it possesses a pelvis so deformed and contracted, that
it cannot pass through the passage in its present stete, ^ there
the section of the symphysis of the ossa pubis might be propaaed
and performed, — being less horrid to the woman than the Cesarean
operation, and instead of adding to the danger, givii^ some chance
of preserving the life of the child,''t

It is perfectly clear, however, that, be the advantages of dividing
the symphysis what they may when the pelvis is under certain
states of deformity, it is an operation that can never be of any avail
where the passage is so narrow that the child cannot be brought
away piece-meal even by the use of the perforator. And in such
circumstances the only alternative is to leave the patient to nature,
in the slender and deq>erate hope that the pains may gradually
wear away as the parts become habituated to the irritation, and the
child, as in many cases of extra-uterine fetation, be thrown out in

* Denman^s Practice, iu^ 447.
t Denman, ut supr. 449*

v.] 8EXVAL ranenoK. 157

4eteclwd irtpMBte by an lAiioeM ; or to hme recmme to what lias
beea called tte Gesaraan opaiatloii, and MiTer by makiag a sec-
liaa into die atoms tbro«gb the abdoaeo.

The lore of oftpnog , or a sense of da^, has been so prevalent
in aooM wooMtt as to indioce theoi to sabmit to this severe trial in
cases where the pelvis has by no means been so straitenecj as we
soe new GoatesBf^infr. And these motives not being confined to
any particidar age, the operation is of considerable antiquity, and is
particolarly noticed by the elder Pliny, who tells as that the elder
Sdpio Afiicanus, and the first of the Cesars were brought into the
world in this manner, and adds, that the name of Cesar was hence
derived ^ k ea$o mateis utero."* In recent times, one of the ear-
liest cases In wfaieh it was svbmitted to was that of the wife of a
cattle-geMer at Sjegtn-haasen in (jennany in the beginning of the
sixteenth centary. The child it seems was, from its size, supposed
to be incapable of being expelled in the natural wi^, and the ope-
ration was perf<»ined by the cattle-gelder himself. Bareliin, in his
^^endix to Ronsset, who was a warm supporter of the practice,
and wrs^ i» fiivour of it in 1581, tells us that this woman did
well and bore several children afterwards in the natural way.
There are a lew other instances related of its having been execut-
ed faf li^ hanib, and with equal success; particularly one perform-
ed in Ireland by an uninstrncled midwife whose instrument was a
razor. The case is related by Mr. Duncan Stewart in the Edin-
boifh Medksal £ssays,t who saw the woman a few days after the
q>eratiesu She was well in about a month. Among regular prac-
titioners, however, it has been generally opposed on account of its
very doobtful result, from ^e time of Par^ and GulUemeau, who
warmly resisted ito employment Dr. Hull not long since made a col-
lectien of aU the cases in which the operation had been performed
both at home and abroad, and calculated them at 231, of which 139,
bei^g considerably more than half, had proved successful.! The
Qerman collections, indeed, give various examples of its having
been repealed several times on the same person : and M. Trestan
narrates the extetiordinary ystor^ of one woman who had submit-
ted to it not iewer than seven times.§ One of the latest eiamples
is, 1 believe, the case furnished by Dr. Locker of Zurich, and pub-
fished in a late volume of the Transactions of the Medico-Chirurgi-
cal Society; in which tiie mother and child were both happily
pre9enred.||

Under tMs view of the subject it is sii^pdar to observe the gene-
ral fatality, at least to the mother, with which the Cesarean section

* Hitt. Hat. lib. tii. cap. ix.

t Vol. T, p. 960.

t Trantlarton of M. Bandeloque*8 Memohr, p. 233.

t Journ. de Medicine, Tom. xxilvi. p. 69.

a Vol. IX. p. 11.

188 GtlWiTICA. [CL. V.-OR, in.

has been foHowed In our own coontry. ^^ There are, I think,'' says
Mr. Burns, ^^ histories of twenty cases where this operation has
been performed in Britain : out of these only omc woman lias been
•ayed, but ten children have been preserved.''*

At Edinborgh, Mr. Hamilton remarks,! that it had been perform-
ed ^Ye times at the date of his publication : and that in no instance »
had the patient the good fortune to survive it many days. Of tlie
last case he was an eye-witness, and it was only resorted to after
every other means had proved ineffectnal : the child was saved but
the mother survived only six and twenty hours. This ingenious
writer enters with great pertinence into the question to what cause
so general a failure is to be ascribed. And while he admits that
nervous or uterine irritation from cutting, internal hemorrhag'e, or
an extravasation into the cavity of the abdomen may each have an
Influence ; he is disposed to think that its nnsnccess is principally to
be imputed to the effect which access of air Is well known to have
on viscera exposed and in a state of irritation. Dr. Monro repeat-
edly found that, in making even a large aperture by incision into
the abdomeo' of animals, if the wound be quickly closed the animal
readily recovers : "but that if the viscera be exj>osed for only a few
minutes to the air, severe pains and fatal convulsions ensue. And
hence Mr. Hamilton most warmly exhorts that, in performing the
Cesarean operation, the bowels be denuded as little as possible*, and
the wound be closed with the utmost expedition.

This answer, however, is hardly satisfactory : and I am rather in-
clined to think that the comparative want of success at home, is ow-
ing to the greater reluctance in performing the operation than
seems to be manifested in France and Germany, in consequence of
'which it is rarely determined upon till the woman is too far ex-
hausted, and has an insufficiency of vigour to enable the wounded
parts to assume a healing condition. In most of the cases recorded,
there does not seem to have been any deficiency of skill; and par-
ticularly in that which occurred about five and thirty years since,
and was attended by Mr. John Hunter and Dr. Ford,^ and hence the
unfavourable issue must be resolved into some other cause.

It is happy for the world, and peculiarly so for those who are
possessed of a contracted pelvis, and in many cases withont knowing-
it till they are in labour, that a far safer, and les» painful operation ^
may be had recourse to, where the deformity is known in due time,
1 mean that of a premature delivery. " A great number of instan-
ces have occurred," says'Dr. Denntan, " of women so formed that it
was not possible for thenTto bring forth a living child at the termi-
nation of^nine months who have, in my own practice, been blessed
with living children by the accidental coming on of labour, when
they were only seven months advanced in their pregnancy, or se-

* Princip. ut supr. p. 348.

t Elements of the Practice of Midwifery, 8vo.

J Deunoan, ut stipr. p. 403.

«£• IL-SP. ¥•] SEXUAL VUKCTION. IM

veral weeks before their doe tioie. But the first account of any ar-
tificial method of briDging on premature labour was given to me by
Dr. C. Kelij. He informed me that about the year 1756, there was
a consultation of the most eminent men at that time in London to
consider of the moral rectitude of, and advantages which might be
expected from, this practice ; which met with their general ap-
probation. The first case in which it was deemed necessary and
proper fell under the care of the late Dr. Macaulay, and it termi-
nated successfidly. The patient was the wife of a linen-draper
in the Strand. Dr. Kelly informed me that he himself had practis-
ed it ; and, among other instances, mentioned that he had perform-
ed this operafcioB three times upon the same woman, and twice the
children had been bom hying.

^^ A lady of rank,'' continues the same writer, ^^ who had been
married many years, was soon after her marriage delivered of a
livii^ child in the beginning of the eighth month of her pregnancy.
She had afterwards four children at the full time, all of which were,
after very difficult labours, bom dead. She applied in her next
pregnancy to Dr. Savage, whom I met in consultation. By some ac-
counts she had received she was prepared for this operation, to
which she submitted with great resolution. The membranes were
accordingly mptured, and the waters discharged, early in the
eighth month of her pregnancy. On the following day she had a
rigor, succeeded by beat and other symptoms of fever which very
much alarmed us for the event On the third day, however, the
pains of labour came on, and she was, after a short time, delivered,
to the great comfort and satisfaction of herself and friends, of a
small but perfectly healthy child, which is at this time nearly of the
same size it would have been had it been bom at the full period of
utero-gestation ; and it has lived to the state of manhood. In a sub-'
sequent pregnancy the same method was pursued, but whether the
child was of larger size, or the pelvis was become smaller, whether
there was any mistake in the reckoning, or whether the child fell
into any .untoward position, 1 could not discover, but it was still-
born though the labour did not continue longer than six hours. Yet
in a third trial the child was bom living and healthy, and she reco-
vered without any unusual inconvenience or trouble."*

it is only necessary to add, that the time in wjiich labour-pains
will come on after thus rupturing the membranes and discharging
the waters, is uncertain, and appears to depend much on the irrita-
bility of the uterus. It is sometimes delayed, as in the first trial in
the case just noticed, for three days, but the labour has sometimes/
also, been found to commence within a iew hours.

♦ Episu App. ad Strauss de foptii. Miissipoiit. p. 298.

100 QUfBTICA. [CL. T.-OB. WU

SPECIES VI.

PARODYNIA PLURALIS.

Jlltat(]a(»tr %afmt.

UlBOVR COlfPUCATED BY A PLVRALITT OF IIWillHIFf.

Thb fertility of women seeoM to depend npos Tarioiw drcmnstafr-'
C68, partly, perbapg, the extent or resources of the oyarie, partly
constitutional warmth of orgasm, and partly the adaptation of tWe
male semen to the organization of the reepectiye female. Eisen-
monger gi?es us the history of a woman who produced fi%-oite
children :* and sometimes the fertility seems to pass from genera-
tion to generation, in hoth sexes, though it must he always Uahle
to sor e Tariation from the constitution of the family that is mai^
ried into. 1 have in my own family.at Uie time of writing,, a young-
female serfant whose mother bore twen^three chil^n, and
brought them up with so much success, that at the time of lier
mother's death, she was the youngest of nineteen then living : and
Iter eldest brother lias fourteen chil^hren at present, aH <^ whom I
believe are in heidth.

But while some women produce thus rapidly in single succession,
there are others that are multiparient, and bring forth occasionallj
two or even three at a time, more than one ovum being detached
by the orgastic shock. Three at a time is not common : I have
met with but one instance of it in wliich tlie children were all alire
and likely to live ; and one instance only occurred io Dr. Denmaii'
in the c<mrse of upwards of thirty years practice. Four have oc-
casionall^but very rarely been brouglit forth togefther, and there
are a few wonderful stories of five, but which rest on no weltau-
thenticated testimony. ,

Twins are mostly produced at a common birth, but^ owing to
the incidental death of one of them while the otiier continues alivey
there is sometimes a material difference in the time of their expul-
sion, and consequently, therefore, in their bulk or degree of maturi-
ty, giving us the two following varieties:

m Congruens. Of equal or nearly equal growth.

Congruous twinning. and produced- at a common

birth.

C Incongruens. Of unequal growth, and produc-

Incongruous twinning. ed at different births.

In CONGRUOUS TwnnriNO or ordinary twin cases, in which there^is

'«.-- — ^ ^ ■ ■

* EpUt. App. ad Stratits de fotu. Mussipont. p. 338.

OS. H.«-fiP. vl] sexual function. 161

DO greiit disparity of siae between the two, on the birth of the one,
It can be pretty easily ascertained that another is still in the womb
by applying the hand to theabdtmen; for the limbs, and, if the
child be alive, its movements, may generally be felt very distinctly,
except, indeed, when an ascites is present, and the practitioner
most then have recourse to other tokens.

There are no precise signs by which a woman or her attendant
can determine whether she be pregnant of twins or not. Inequali-
ties in the promineBce of the abdomen, peculiarities of internal sen-
sation or motion, slowness in the progress of a labour, have been
•draoeed as signs ; but they belong as frequently to the uniparient
w to the moltiparient, and hence are not entitled to attention.

The claim to priority of birth in a twin case is dependent, not on
superiority of strength, or any other endowment, but on a closer
proximity to the mouth of the uterus alone, and, consequently, on
a greater convenience of position. Though when, on the birth of
twins, one is found small and emaciated, and the other plump and
strong, we have some ground for apprehending that the vigorous
child has ab8orl>ed the greater part of the nutriment afforded by
die mother, as we find not unfrequently in plants shooting from the
same spot of earth.

The general rules that govern in morbid labour of individual
children, govern equally in morbid labour of twins. The second
child is usually delivered with comparatively few pains and little
incoovenience, as the parts have been sufficiently dilated by the
passage of the first ; and, although there is commonly some interval
between the termination of the one and the commencement of the
other struggle, it is not often that this interval exceeds half an hour
or an hour. It has, indeed, in a few instances extended to whole
days; in one instance to ten,* and in another to seventeen davs.t
Bat Uiese are very Uncommon cases : and as miscliief may possibly
happen to the womb, and to the system at large fro<n a long pro-
tnbctioD of uterine irritation, it is now the practice to deliver the
second child by art, after having waited four or five hours in vain
for a return of ezpulsory exertions.

In nrcoiioRuovs twwnino we meet in different cases with every
possible diversity in perfection of form, and term of expulsion
between the co-offiiprtng. Nor is this ^o be wondered at in either
respect We have already seen that a single fetus may die during
any period of parturition from a variety of causes : and hence we
any readily conjecture that one of the twins may die at any period,
while the other still thrives and remains unaffected. This twin
may remain in the womb, and both be expelled together at the
Ml tioM. But It may happen, also, from the peculiar irritation of
^e uterus generally, or the peculiar position of the dead fetus near
the cervix, that this organ may be so far stimulated by the death,

• Hist, de TAcad. des Sciences, 1751, p. 107.
t i)e Boset in VerbeodeKngeri van Harlem, xit A^ No. 6.
VOL. IV. ' 21

102 GESffiTICA. [CU T.-eiU HI.

and corrapt state of the fetal cone and its membranes, as to expel
it from the body, while the living child receives no injury, and
continues to thrive, and is maturely delivered at its proper time.

In the latter case, where the dead fetus has been discharged in
the second or third montli of pregnancy, the mother, not knowing
herself to have been pregnant with twins, has been erroneously
conceived, on the arrival of the second birth, to have produced a
perfect child within the short term of six or seven montlis.

In the former case, or that in which the dead fetus remains auiet
in the womb through the remaining term of pregnancy and both
are discharged at a common birth, an opinion equally erroneous
was formerly entertained in order to account for the apparent dif^
ference of the two in growth and size : for it was supposed that the
dead and puny, and apparently premature fetus, was conceived
some months subsequently to the perfect and vigorous child, and
hence had not time to reach it in size and perfection : and to this
supposed subsequent conception was given the name of suferfeta-

TION.

We have reason to believe that such a process does occasionally
take place in some quadrupeds whose wombs are so formed as to
allow of it: but -we have already observed in the preliminaiy Proem
to the present Class, as also in the introductory observations to the
present Order, that, in women, from the moment of conception, an
efflorescent membrane is formed which lines the whole cavity of
the uterus, and acts as a septum to the ascent of any subsequent tide
of male semen; not to say further that the os uteri itself is so plug-
ged up by the secretion of a viscid mucus at the time as to prevent
any communication between this organ and the vagina till the period
of pregnancy is completed. And hence the doctrine of superfeta-
tion in women has deservedly sunk into general disrepute.*

The cases of this kind, and formerly ascribed to this cause, are
by no means uncommon. Dr. Maton has given a very decided one
in the Medical Transactions, containing the history of a lady de-
livered .at Palermo of a male child in November 1807, and again^
scarcely three months afterwards, in February 1808, of another
male infant, ^^ completely formed.^t The proportion or powers of
the first child are not sufficiently noticed : but we are told thai
both were bom alive; that the elder died when nine days old
^^ without any apparent cause ;'^ and that the younger died also, but .
after a longer term.

In Hencbel we hare an account of a minute| and a matore fetoa
bom at the same time : and in the Transactions of the Medico-
Chimrgical Society, a similar account by Mr. Chapman with the ex-
ception of the time which varied considerably : the dead and mi-
nute fetus, apparently not more than three or four months old^haT'*

* WakbchaiUd, Diitert. dt Superft^taUoM OeOso pra'tens a Hmab. 1737.

t Vol. IV. Art. xu,

% lltae A^4if ii^iHbt and 0|il(ii|gMk« AumerJMiBtui, B. u.

OE. a.H^. rh\ SEXUAL FUNCTION. 163

ing in this case been born in October 1816, and the twin, a foil-
grown child, not till December, just two months afterwards.^

In this last instance, however, there can be no doubt that the
aborted fetus bad remained quiet in the uterus for some months af-
ter its death before it was expelled ; which in truth is the only
way of reconciling its apparent age and size of not more than three
or four inonths at the time of its expulsion, with the full time or
nine months of the mother, completed only two months afterwards.

Nor is a quiet and undisturbing continuance in the uterus after
the death of the fetus by any means uncommon, whether the off-
sprUig be single or double. We have already given examples of
an interval of ten, and even seventeen days, in the case of twins
bom eqoailv of full size. But where the growth has been discre-
pant, and the dead fetus has remained behind unsuspected, it has
sometimes been several- months before expulsion has taken place.
Rayset gives a case in which it was delayed a twelvemonth, after
the apparent term of its death, and even then discharged without
eormption :t and some of the foreign collections have instances
that more than double this time.]:

The present author was lately engaged in consultation upon the
ease of a lady in Bedford Row, who had miscarried of a fetus under
three months old, which there was every reason to believe died
firar months antecedently ; as at that time the mother had been at*
tacked with a flooding and rigors, had had various subsequent ute*
jibe hemorrhages, and had never been able to quit a recumbent
podtion without producing some return of the bleeding.

SPECIES vn.

FARODYNIA SECUNDARIA.

Amitrtitial Sfltoitr*

DISBASED ACnOir, OR DISTVRBAKCB StTCCIKDnia nELmUlT.

In ordinary child-birth the pains of labour may be said to cease with
the expulsion of the fetus : since thoughjsequential, or after-pains,
as they are ordinarily called, are not uncommon for a day or two,
and are useful in expelling the placenta and its membranes, and a
few large coagula of blood that have formed in the uterus, these

• Vol. IX. p. 195.

t Thetaur. omnium max.

t Nene Samrol. Wahrnekmiuigeo* Band. iv. p. S41.

164 GENETICA. [gL. V.-OE* IU*

Jmt are neither violent nor by any means frequent. It somettmefl
happens, however, that there is almost as moch trouble) and as
much pain, and as much danger after the birth of the child as an-
tecedently, so that the labour itself may be fairly ilaid to be prOr
tracted into this secondary stage, which offers the following va«
rieties of morbid affection :

# Retentiva. Retention of the secundines.
C Dolorosa. Violent aAer-pains.

y Hxmorrhagica. Violent hemorrhage or flooding.

# Lochialis. Profuse lochial discharge.

In about ten minutes or a quarter of an hour afler the birth of
the child the uterus recovers its action, and again exerts itself,
though with less force, and consequently slighter pain, to expel
what is commonly called the af\er-birth, consisting of the placenta
and its membranes ; which in common cases are easily separated
and thrown off from the sides of the organ. The instinctive or re*
medial power of nature is just as competent of itself to do this a»
to expel the child ; but, as unquestionable benefit is £ound from as*
sisting in the expulsion in the latter case, a like degree of benefit
is also found in the former ; and the practitioner by taking hold o^
^e funis, and gently pulling it during the action of a pain, will in
most cases, be sure of expediting the passage of the placenta, with*
out running the least risk of rudely tearing it from the sides of the
uterus, and exciting a hemorrhage.

It will sometimes however be found that the funis, instead of
being fully inserted at its upper extremity into the body of the
placen^m originates alone from a few of its vessels, and that from
an incautious tug it gives way, and is drawn down by itself, leaving
the placenta behind ; and consequently putting it entirely out of
the practitioner's power to render any collateral assistance.

It also happens, not unfrequently, from the general exhaustion of
the system, or the local exhaustion and terpitude of the uterus^ that
no expulsory pains of any kind follow at the ordinary time, or even
for a long period afterwards, and consequently that the placenta is
still lying unseparated in the uterus.

On a trial instituted by Dr W. Hunter, and Dr. Sandys in the
IHiddlesex Hospital, it was found in one case, that the placenta let\
to the action of the uterus alone, was not rejected till twenty-four
hours aAer delivery : and as no ill consequences followed on this
experiment, it became soon afterwards a practice with many in this
metropolis, as it had long before been with still more on the Conti-
nent, to pay no attention to the placenta, and to leave it to take its
course. \ Great miscliief however, has been, in many cases found to
ensue from this kind of quietism : for, where there is great ex-
haustion, a sufhciency of natural exertion does not in numerous in-
stances return for three or four days afterwards, and sometimes even
longer: while the placenta, by remaining in the uterus, keeps up
a febrile irritation and, what is infinitely worse, by being in many
instances partly though not wholly detached, and rendered a dead

GE. II.-SP* VII.] SEXUAL FUNCTION. 165

M well as a foreign Bubstaoce, the detached part pntriBes, and pro-
duces a fetor through the whole atmosphere of tne chamber soffi-
cieat of itself to render the patient sick, and faint, and feyerkh, If
it do not occasion a genuine typhus.

1 was lately requested to attend in consultation upon a case of this
kind. The patient had had a very difficult labour, and aller two
or three days of severe sufiering was delivered by the use of the
crotchet. She was afterwards for a longtime in a state of syncope,
and the placenta was suffered to remain without any attempt to re-
move it She had no expuisory pains for three days, but very
great soreness and some degree of Jace ration in the sod parts, with
such a torpitude of the bladder that the water was obliged to be
drawn off daily. In about eight and forty hours, she had a hot dry
- ikiD, brown furred tongue, with a quick, small pulse, and slight de*
lirium, and occasional shiverings. it was in this state 1 was re«
oaested to see her. The room which was small, was insupportable
from iu stench, notwithstanding all the pains taken to maintain
deanUness, and to cover the fetor by pungeiit odours, i streonoosly
advised that the placenta should be instantly removed, but was an«
swered that gangrene had already begun, the patient would cer-
tainly die, and as certainly sink under the very attempt to bring it
away, so that the operator would fail under the charge of having
killed her. • My reply was, that she would assuredly die if it were
net removed, but I was not so certain that she would if it were ;
that in my judgment the fetor rather proceeded from the placenta
itself than from the ichorous discharge about the vagina, and gave
a token of a very extensive separation, though the patient wanted
power to espel it from her body. And 1 could not avoid adding
that if none of the gentlemen present (we made Ibiu* in all) would
ventnre upon the task 1 wouki take the risk upon myself, though I
had long declined the practice, and give the patient this only chance
of a recovery. This declaration inspirited the rest: the operation
was determined open, the placenta, as 1 suspected, was found nearly
separated throughout, and half advanced into the vagina, and was
reHK>ved without difficulty, ^y the use of cinchona and the miner-
al acids, with a nutritive regimen, the patient gradually recovered,
and is »ow in a state of perfect health.

The modem practice, therefore, of not trusting the placenta to
the mere powers of nature, when those powers are exhausted or-
inoperative, is founded upon a principle of the soundest observa-
tion. Four or Sive hours is the utmost time now usually allowed,
and if it be retained beyond this period, the operator m^erferes,
brings it away by the funis^ if the uterus will hereby become sufficient-
ly stimulated, and it not, or the funis be broken, by cautiously intro-
ducing his hand into the uterus, and peeling the placenta gradually
from .H, walls by the action of his tinge rs.

If the uterus, instead of contracting at all at its fundus, should
contract irregular»\y and transversely so a* to Torm what has been
called an hour-ola 8s contraction, the removal ol the placenta should
take place before t bis time.

166 GENETICA. [CL. V.-OR. IH.

Iq some irritable habits it is sometimes fooDd, on the coDtrarVy
that ArrcR-PAiiis, instead c^f ceasing grRdually, coDtiDue almost with-
out ceasing, and with nearly as great violence as the pains of la-
bour itself; and this for many hours alter the extraction of the pla*
4:enta.

If soch after-pains follow close upon the labour, they- proceed
from a morbid irritation and spasmodic tendency of the uterus
^done ; and the best remedy is an anodyne liniment applied to the
abdomen, with an active dose of laudanum, which last must be re-
peated as soon as the first dose has lost its effect, the bowels in the
mean while being kept regularly open. If such violent pains do
not take place till some hours after the evacuation of the placenta,
or e?en the next day, it is highly probable that some large cake of
coagulated blood has formed in the uterus, and become a source of
irritation. This may oilen be hooked out by a finger or two intro-
duced for such purpose, and the organ be rendered easy : if not, an
opiate will here be as necessary as in the preceding case.

Hemorrhage or flooding after delivery is another evil which the
practitioner in the obstetric art is not unfrequently called upon to
^combat. This is sometimes produced by pulling too forcibly at the
umbilical chord, and separatmg the placenta from the walls of the
uterus before its vessels have sufficiently contracted : but the most
common cause is an exhausted state of the uterine vessels them-
selves, and a consequent inability to contract their mouths ; so that
the blood flows through them without resistance.

The uterus is, at this time, so stored with blood of its own, that
a prodigious rush will often flow from it without producing syncope
or any serious ev.l upon the general system : for it is only tiU it has
lost its own proper supply, and begins to draw upon the corporeal
vessels for a recruit, that any alarming impression is perceived.
Yet from the first moment the attendant should be on his guard, and
should have recourse to the means already laid down under flooding
occurring in the latter months of pregnancy.* From the very open
state in the present case of the mouths of all the uterine vessels
that have anastomosed with the vagina, the flooding is here, how-
ever, upon some occasions, far more profuse and dangerous than at
any other period, so that a woman has sometimes been carried off
in the course of ten minutes, with a sudden faintness, sinking of the
puh)e, and wildness of the eyes that is most heart-rending. And, in
such a situation, as the living powers are failing apace, and must^
be supported at all adventures, while cold and astringent applica-
tions are still applied to the affected region, we must have recourse
to the warmest, the most active, and most diffusible cordials, as Ma-
deira wine or brandy itself in an undiluted state : and it we succeed
in rousing the frame from its deadly apathy, we must drop them by

* Vol. IV. p. 121. Gen. i. Spec. ii. Paracyesis uterinm bemorrhai^ica ; and
cpmpare with Vol. ii, pp. 468. 4S9,

OE. U.--6P. VIL] sexual FUNCTION. 167

d^^rees, or exchange them for food of a rich and nutridTe, but leas
tdmolant description.

When the discbarge of blood from the uterus ceases, it is sue*
ceeded by a fluid of a different appearance which is commonly call*
ed LOCRU (A«;^Mh) a term employed by Dioscorides in the sense of
secundsB, or the materials evacuated by a lying-in woman after the
birth of the child. The nature of this discharge does not seem to
have been very fully explained by pathologists. The numerous
and expanded blood-vessels of the uterus contract gradually, and
particularly in their mouths or outlets ; by wtiich means the fluid
they contain, and which is not entirely evacuated by the vagina, is
tiirown back on the system with so much moderation as to produce
no serious evil, and its stimulus is chiefly directed to the breasts.
As the mouths of these vessels progressively collapse, the finer part
of the blood only, or at least with not more than a small proportion
of the red particles, issues from them, and in smaller abundance, and
hence the discharge appears less in quantity and of a more diluted
redness. By intermixing with the oxygene of the air, which has a
free admission to the sexual organs, this red, as in the case of ve-
nous blood, assumes a purple or Modena hue : and as tliis hue be-
comes blended with the yellowish tinge of the serum, it necessarily
changes to greenish which is the colour of the lochial discharge
before its cessation.

While this discharge issues in a due proportion to the demand
of tlie idiosyncracy, for the quantity differs considerably in diffe-
rent Women, there is little fever or irritation, and we have no ill
consequences to apprehend : but the mouths of these vessels mav be
irritated by various causes, as catching cold, violent emotions of the
mind, the use of too stimulant a diet, or the want of a sympathetic
action in the breasts ; and the result, under different circumstances,
is of a directly opposite kind. If there be no spasm hereby induced
on the months ot the closing vessels, they will throw forth a morbid
superabundance of serous fluid, without running perhaps into a he-
morrhage, or opening sufficiently to discharge red blood, and the
patient will become g^atly exhausted and weakened, have a sense
of a prolapse of the uterus, and be pecul arly dispirited in her
miiid. if, on the contrary, which is more frequently the case, the
moutlis of the uterine vessels become suddenly and spasmodically
closed in consequence of the superinduced irritation, there will be
a total and abrupt suppression of the lochia, a sense of great weight
and pain will be perceived in the uterus and the whole region of
tlie pnbes, a considerable degree of fever will ensue, and die pa-
tient idll be in danger of a puerperal typhus.

These are the evils which result from a disturbance of the ba-
Imce of the lochial discharge. In attempting to remedy them the
exdtii^ cause should, in the first place, be removed as far as this
is capable of being accomplished. After which, in the former case,
tint strength is to be sustained by unirritant tonics, astringents, and
a plain notritive diet : and in the latter, the spasmodic pain, and

168 GBNETICA. [CL. V.-OIL HL

lieat, and other febrile symptoms are to be subdoed by antispaimo*
dies aod relaxaotst, particularly camphor, with small doses of ipec»-
cuao or antimony. The neutral salts have also in this case proved
serviceable, which have the farther advantage of opening and
cooling the bowels. It will likewise be found highly useful to fo«
ment the abdomen with flannels wrung out in hot water, or, which
is ^ better, to bind a flannel swathe wrung out in hot water in the
•use manner round the whole of the abdomen and the back, and to
encircle it with a band of folded linen to prevent it from wetting
the sheets, aod to let it remain on like a cataplasm, till it becooMS
dry by evaporation.

GENUS 111.
ECCYESIS.

IHPEHrECT FETATION IN SOME ORGAN EXTERIOR TO THE UTBRVS*

We have shown in the Physiological Proem to the present clasf,
^t the sexual fluid of the male passes, at the time of the embrace
or sooD afterwards, into the uterus, and from the uterus into the
Fallopian tube, or even the ovarium, where it impregnates ao
OTulom detached from its proper niche by the force of the orgastic
pereuAsion. It^ometimes happens, howeyer, that the Fallopian
ti^es, or the openings from the uterus leading into them are so im-
pacted with fat or some other material, or so straitened in their
diameter that the detached and impregnated orum is incapable of
obtaining a passage into the cavity of the uterus, and is arrested in
its course : in which case it most either remain in the tube itself,
into which it has thus far proceeded, or drop, at the origin of the
fimbrise, into the hollow of the abdomen. And it has also some-
times occurred that the ovulum or vesicle that has been detached
in the ovarium has been incapable of making its way out of the
ovarium itself, and has become impregnated in its original seat
without a possibility of stirring farther.

In all these cases, the progress of impregnation still goes forward
though in an imperfect manner, and with an imperfect develope-
ment of organs, and we are hence, furnished with the three follow-
ing distiiict species of extra-uterine gestation.

1. EGCYBSIS OVAJUA. OVARIAN EXFETATION.

S. ■!■ TUBALI8. TUBAL EXFETATION.

3. ■ . ■ ABDOMINAUS. AiDONIVAL EXFBTATIOK*

oe. iil] sexual function. 169

It is a very remarkable fact, that the uteros still qrmpathises in
every one of these species with the impriioned and impregnated
ovum, in whatever part of the body it may happen to be lodged, pro-
duces ordinarily the same efflorescent membrane or decidua, which
we have already observed it secretes in the commencement of ntero-
gestation for the reception of the ovum upon its arrival in the
uterus, enlarges its capacity and thickens its wails as though the
fetus were really present in its interior ; exhibits the same symp^
toms and excite the same caprices of the stomach as those by which
utero-gestation is usually distinguished : and at the expiration of the
regular period of nine months, and sometimes, as in ordinary preg-
nancy, even before this, is attacked with spasmodic or expulsory
pains, which often continue for some hours and seldom altogether
subside tiil the oiganized and extra-uterine substance loses its living
power, and becomes of the nature of a foreign material to the or^
gans by which it is surrounded. After which menstruation again
returns regularly, as it has hitherto been suspended.

The extra-uterine ovum, in the miean while, endowed in conse-
quence of its impregnation with a principle of life, continues to
grow, whatever be the place of its aberration, in some instances
becomes surrounded with an imperfect kind of placenta, developes
the general structure of its kind, and exliibits an organized com-
pages of bones, membranes, vessels, viscera, and limbs ; the whole
figure being more or less perfect accor^g to circumstances that
lie beyond our power of penetration.

AAer the death of the extra-uterine fetus, the uterus, and conse-
quently the general frame, frequently becomes quiet ; and the bulky
substance, enveloped in a covering of coagulable lymph, remains
for years, or perhaps through the wiiole of life, with no other in-
convenience than that of a heavy weight and tumour in the part in
wMch the dead fetus is lodged. But, in many instances, like any
other intrusive or foreign material, it produces great irritation,
which is succeeded by the ordinary process of ulcerative inflamma-
tion, and an opening is hereby made into the intestines, or the
vagina, or externally through the integuments of the abdomen, and
the indUsoluble parts of the fetus are cuscharged piece-meal ; some-
times the patient sinking during the tedious process under the ex-
haustion of a hectic, but more generally evincing strength enough
to sustain the progressive expulsion, and at length restored to the
enjoyment of former health.

VOL. IV.

170 GfilTETICA. [CLiV^^fUUU

SPECIES I,

ECCYESIS OVARIA.

•tatiau SrCrtatCon.

mrEiiFBCT rcTioiON occmiiiNo in tmc rmbt or UOT'OVJJUVU,

The phyBiol<^ and general pathology have been already given so^
much at large in the paragraphs imniediately preceding that it is
only necessary to observe farther that this forin of extra-uterine
fetation is very common^ as well as very distresdng. Vater relates
a singular case of this kind prodocing a general intumescence of
the abdomen on the right side, the right ovarium being the seat of
the disease, that continued with little variation through a period of
three years and a half with an equa! degree of distress and danger
to the patient :* and other instances are adverted to in the volume
of Nosology.

It is in this oigan more espede^h' that rudimental attempts at
fetal oiganization, the mere sports of nature, are frequently found
produced without impregnation, or any contact with the male sex,
and sometimes in very youog subjects.

One of the most singdar cases of this kind is that communicated
by Dr. Baillie to the Royal Society in the year 1788.t The young
subject of the case was not more than twelve or thirteen years old,
vrith an infantine uterus and perfect hymen: and the fetation con-
sisted of a suetty substaooe, hair, and the rudiments of four teeth.

The same kiod of formative ludibria are found, also, in mature
life in women of the most correct lives, and whose chastity has
never been impeached, of which we liave an instance in a late
volume of the Transactions of the Medico-Chirurgical Society.
The subject, an unmarried female, was about thirty years of age,
at the time of her death, which took place after a long series of
Buffering, accompanied with great pain in the region of the bladder,
and a considerable swelling of the abdomen. On examining the
body, a large tuil of hair of about the size of a ben^s egg was
fou^ inclosed in a tumour of the left ovarium, surrounded with a
fluid of the thickness of cream, in the bladder was traced a similar
tuft of hair surrounded with a like fluid which distended and
plugged up the organ.|

Such rudiments of organised form have been resolved by the
disciples of Buffbn into the peculiar activity of his tnolecuUs organ-
iqaes, concerning which we have already spoken in the Physiological

* Disiert. de Graviditate apparente ex tumore ovarii dexui enormi. Ice.
t Phil. Trans. 1789.
% Vol* IX. p. 427.

eB**mi'-»*u'] WIUAL FOnCTlON, 171

Proett to the preient dass, throi^^ with a more tbwd or^nfttj
propordon in the region or organ in whkh the pretemataral pro-'
doctione haTe been fovrndl to exist : and by stiU later phynologistt*
into a salacions teoaperameat in the indiridnals whd hvre been the
subject of them^ and who are still farther said, as wie have also
rcmaiiced in the saaie Proem, to hare a power when this orgastic
eretfaiun^ is at its ottnost heat as about the period of menstruation)
of irritating and even inflaming the ovaria,and occs»ionally even of
detaching one or more ova and putting them into a like state of
irregular action. And where cases occnr in infants they are ascribed
to the same cause operathig on a constitution diseased by a morbid
precocity.*

The first of these explanation? it is hardly worth while to combat
in the present day, and parti^culariy in the present place, after
faarii^ already illustrated^ in the Proem above referred to, the
feebleness of its first principles. And with respect to the second it
is sufficient to observe that the yery same attempt at fetation are
sometimes made and carried quite as far towards completion, in
organs that cannot be suspected of any salacious sensation, and even
in males as well as in females. Thus, Dr. Huxham gives a case in
which the rudiments of an embryo were found in a tumour seated
near the anus of a cliild ;t and Mr. Yoon^ a still more extraordinary
one, yet a case well known, I suppose, to nearly ull the medical
practitioners of this metropolis from personal inspection, of a large
protuberant cyst, containing a nucleus. of fetal rudimentt found in
the abdomen of a f?kx/e infant about fifteen months old. The child
died after a tedious and painful illness. Tlie bo^ was opened, and
the cyst examined : ^^ The substance it contained,'' says Mr. Young.
U had unequirocally the shape and characters of a human fetus :^
for a particular descriptipn of which the reader must turn to the
account itBelf.|

Upon this subject we can only say that all such abortive attempts
are monstrosities ; and that monstrosities are not confined to tony
particular age as that of fetal life, pr to any particular organ.
They run occasionally through every part of the frame, and every
part of the life, and appear in the form of cysts, and excrescences,
and polypi, and ossifications, and a thousand other morbid deviations
from the ordinary mark of nature, though they are most frequently
found in the first months of impregnation, unquestionably because
the excited organs are, at that period, more capable than at any
other, of being moulded, by accidental circumstances, into anomalous
shapes, and of preserving life under almost every kind of miscon-
struction and deformity.

In extra-uterine fetation of whatever kind, or wherever situated,
^e art of medicine can do but little. If the tumour be free from

* Vol. nr.Prccotia feminina, Ord. i. Geo. ii. Spec. ii. of the preient class, p. 81.
t PhU. Trans; Vol. xlt. 1748. p. 325.
t Medico-Chir. Trans. Vol. i. p. 241.

172 GEVTBTICA. [CU T.-OR. UL

paiD, and the ge&eral system not essentially disturbed by it, nothingf
should be attempted whatever. And if, in a case of initatioo and
ulcerative inflammation, nature herself seem to point out one par-
ticular part for the opening of the abscess rather than another, it
will almost always be far better merely to watch her footsteps, and
assist her intention than to attempt a cure or removal of the cyst in
any other way : for we had long ago an opportunity of observing,
when treating of inflammation generally, that, '^ it is a wise and
benevolent law^ of Providence, and affords an incontrovertible proof
of an instinctive remedial power, that inflammation, wherever
seated, is always more violent on the side of the inflamed point
nearest the surface, and shows a constant tendency to work its way
externally rather than internally;^'* or, in other words, in that
direction in which the most salutary end can be obtained with the
least essential mischief. And, hence, though it may often be found
adviseable to enlarge an opening made externally by the effort of
nature alone, it will generally be injurious to deviate from the spot
thus instinctively marked out, and make' an opening elsewhere.

The cyst has sometimes laid dormant, or without producing much
disturbance, for many years, and then, from some accidental cause,
has become irritated, inflaofied, and produced a large abscess :
the ovarium, in the progreA of the inflammation, forming an adhe-
sion to the integuments of the abdomen, and thus at length breaking
externally ; mostly in the course of the linea alba, often near the
navel, but sometimes towards the groin. In a few instances, how-
ever, the inflammatory action has travelled in some other direction,
and sought some other outlet ; so that the ovarium has formed an
adhesion with the vagina, or the larger intestines, and /dltimately
opened into them, and the bones and other indissoluble parts of the
fetus have been thrown forth in fragments from the vagina or the
anus. Zacutus Lusitanus gives a case in which the bones of an
impregnated ovarium were dischai^ed piece-meal by the anus after
the impregnation had continued for twelve years :t and Bartholin
another of much longer duration, in which the exit was formed in
the hypocbondrium after the fetus bad been imprisoned for not less
than eighteen years.

In a few instances, however, the extra-uterine substance has been
removed by art without waiting for the formation of an abscess,
A successful operation of this kind is related in the Histoire de
PAcademie Royale, after a gestation of twenty-seven months, the
child being extracted by an incision into the abdomen.]; M. Trisen
gives a similar example, attended with a like favourable issue :§
and in the Edinburgh Medical Commentaries we have an account of
the vagina being laid open for the same purpose.||

• Vol. II. p. 161.

t De Praxi admirandd. Lib. ii. Obs. 157.

X HUt. de TAcad. des Sciences, 1714. p. 29. 1716. p. 32;

^ Observ. Chiiurg. Leid. 1743. 4to.

)| Smith, Vol. V. p. 337.

QG. III.H9P4 H.] SEiUAL FUHGTION. 173

SPECIES 11.

ECCYESIS TUBALIS.

CtOM Srfrtatfmi.

mPERFECT FETATION OCOURRWO W THE FALLO^UK TITBE.

DiEBfERBROEK hos obeefTed that this is the most common cause under
which extra-uterine gestation shows itself,* and it is at the same
time the most dangerous. There is in truth less room for disten-
tion here thao in any of the other cavities in which the exiled ovum
may happen to lodge : and hence the oyerstretched tube has occa-
sionally bursted, and the patient has soon fallen a sacrifice to the
irritation and fever produced by so large a rent: while, if this have
not taken place from the mischief done to the tube, it*has follow-
ed nearly as soon from the morbid excitement and inflammation pro-
duced in the abdomen in consequence of the sudden entrance of so
laige a foreign body into its cavity. Dr. Middleton, however, has
described a singular case of a woman who carried a fetus for six-
teen years in one of the Fallopian tubes with so little disturbance
to the general health of the system -that at this period she became
pregnant in the regular way, and appears to have -passed through
her pregnancy with a favourable issue.t The general pathology
and mode of treatment run parallel with those of the preceding
species.

SPECIES III.
ECCYESIS ABDOMINALIS.

DfPERFBCT FETATION OCCURRING IN THE CAVITY OF THE ABDOMEN.

Aw extra-uterine fetus may be deposited in the cavity of the abdo-
men by bursting through the walls of the ovarium or Fallopian tube
after it has been produced there, or by an accidental drop of the
impregnated ovum from the extremity or fringe of the tube in its
way to the uterus. In the two former instances there is danger of
great and fatal inflammation, not less from the rent produced in the

• Opera omnia Anatoraica, p. 135.

+ Phil, Traos. Vol. xlviii. 1744, 1745.

174 ^ OBMBliCAi [cu y»^lti IH^

organ jost qnittad by the fetus, than from the irritation whidi so
la^ a foreign body cannot &il to prodoce on the organs on which
it presses, in the last instance, on the contrary, the substance, on
iti first entrance, is so minnte, and its growth so gradual, that the
contignons organs suffer little or no iititation except from some ac*
cidental excitement, till at length, indeed, the magnitude of the fe-
tus may alone be a suflBdent cause of nltfrfaid action, and lay a foun-
dation for the most serious consequences.

In the introductory remarks to the present genus^ we obsenred,
that, in almost all cases of extra-uterine fetation, the moment the
OFum becomes impregnated the womb regularly sympathises intlie
action, produces a tunica decidua, enlarges, ceases to> menstruate,
miorfo* the entire process of utero-gestation^ and, at the expiration
of nine* months, is attacked with regular labour pcdns. Afler these
haTe continued for seme hours they gradually cease : and, what it
still more remarkable, the ex-fetus, which, till this moment, is en'>>
dewed with life, and continues to grdW, how imperfect soeyer itr
form, dies as though strangled in its. imprisonment ; and by becom-
ing a dead substance, becomes, at the same time, a substonce obr
noxious to the lining organs around it, which have hitherto suffered
little incouTenience horn its proximity ; often excites irritation and
an abscess, and from such abscesr, as we haye already obserred, i^
thrown forth piece-meal.

The following history, which is highly curiotis in itself, forms a
striking illustration of the whole of these remarks. It is pqblished
by Dr. Bell of Dublin, from a fnll knowledge of the entire facts '.
A young woman, aged twenty-one, afler being married fifteen mootha
had the usual signs of pregnancy, and at the expiration of her reck*
oning was attacked with regular labour pains which were very vio-
lent for some days, when they gpradually left her. But the abdomen
still continued to enlarge, while the strength of the patient as gra-
dually failed, and she was reduced to the utmost state of emadation.
Eight or nine months from the cessation of her labour-pains she
discharged a considerable quantity of fluid from a small aperture at
the nayel, along with which were perceived some fleshy fibres and
pieces of bone. It was proposed to follow up this indication of
nature, and make an opening into the abdomen at this very point,
large enough to remove the fetus supposed to be lodged there.
This was accomplished by an incision running two inches above
and the same length below the navel, when the bones of two full
grown fetuses were extracted, for little bende bones at that time
remained. No hemorrhage ensued, and the patient recovered her
health so speedily as to be able to menstruate in about three months,
AAer three months more she was prevailed upon again to cohabit
with her husband, became pregnant, had a natural 1 JM>ur, and bore
several children in succession.*

* History of a case in which two Fetuses that had been carried near twenty-on^
wonths, were successfully extracted from the abdomen by incision, Scc»

te. mrHIP. HI.] SEXUAL rUHOTION. 175

Itt this case it is clear that the seniatioDS of the ateras during the
deTelopement of the twin ex-^toget, were those of mere sympathy ;
as it is also that they ceMed to grow, and became dead and irritat-
ing sabstances .after the common term of nt^ro^estation, or on the
cessation of the labonp-f ains.

This is the usual course, but in some cases the imtation the dead
substance eiuites is Utss violent, and, instead of an ukerajtiTe, an
adhesive inflammation is produced, and coagulable lymph is thrown
forth, which, by the law of nature, is gradually transformed into a
soft and memJiranous material that becomes a sheath or nidus for
the dead fetus, and prevents it from exciting any further irritation.
And in this manner an abdominal ex-^etus has sometimes been borne
for a considerable number of years, or even to the end of life, with-
out any serious mischief. In the volume of Nosology I have refer-
red to various proofs of its having, in this way lain quiet for twenty
two, twenty six, and even forty six years.

Putrefaction, under these circumstances, does not take (^ace, for
the imbedded substance is shut out from the chief auxiliary to putre-
Action, which is air : but a change of some other kind is genenally
found to prevail, though with some diversity, according to the acci-
rdenUl circumstances that accompany it. And hence the fetus, pn
opening the cyst, after the death of the mother, or on its own ex-
traction antecedently, has been found sometimes converted into
ad^odne, or a suetfy or cetaceous material,* making a near approach
to it ; sometimes into a leathery or cartilaginous structure ;t and
sometimes into an osseous or almost stony mass, which has been
^stioguished by the name of osTEoriXoioN or ijthop<edion4

Under these circumstances, also, the bulk and weight of the fe-
tus has considerably varied ; for, the fluids having evaporated, it has
ofien been found light and shrivelled, yet, when loaded with osse-
ous matter, it has been peculiarly heavy. In a structure of some-
what more than ordinary completion Krohn found the weight amount
to four pounds and a half.

For medical treatment there is little scope, and this little has been
already touched upon under the first species.^

• Wagner, Nov. Act. Liter* Maris. Balth. 1699.
t Phi). Tiaas. Vanoiis examples, passim.
% Abhandl. der Josephin. Acad. Band. i.
Eyson, Diss, de FoetS lapidesceete. Groning. 1601.

t FiBt^ extra uteram lustoria. Lond. 1791. Gott. Ann. 1791.

176 OENBTICA. [CL. V.-OR. HI.

GENUS IV.

PSEUDOCYESIS.

SYMPTOMS OP PREGNANCY WITHOUT IMPREGNATION: CHIEFLY OCCURRING
ON THE CtSSATION OF THE CATAMENIA.

In the preceding genus we beheld the uteros excited to action, and
mimicking the progress of pregnancy though without anj preten-
sions to it in consequence of its association with some extra-uterine
impregnation. In the present genus there is no proper impregna-
tion any where, But a mere irritation derived from the lodgement of
some morbid and unorg^anised substance, which excites a train of
feelings, and not unfrequently a change of action, easily recalled
from the force ofhabit. It is on this last account that virgins are
rarely, if ever, liable to this affection. Such at least is the ge-
neral opinion, which appears to be well founded; ^^ And no case,^'
says Mr. Burns, " that I have met with contradicts the suppo-
sition."

This train of feeli^ and change of action seem also, at times, ex-
cited by a peculiar kind of irritability of the uterus itself, even
where there is no substance whatever in its own or any other cavi-
ty that can become a stimulus : and we are hence put into posses-
sion of the two following distinct species :

1. PSEUDOCYESIS MOLARIS. MOLE.

2. r. INANIS. false CONCEPTION.

SPECIES I.
PSEUDOCYESIS MOLARIS.

THE UTERUS IRRITATED BY A COAGULUM OF BLOOD OR OTHER SECRE-
TION LODGED IN rrS CAVmr, often assuming a FIBROUS APPEAR-
ANCE.

A COAGULUM of blood thrown into the womb by a relaxation of the
mouth of the menstrual excements, or remaining there as a sequel
of ipiscarriage or labour, is perhaps the most common cause of this
morbid action and sensation. It was long ago thus explained by Bfr.

GE. IT.-6F. 1.] SEXUAL PDKCTIOK. 177

Hewsoa— ^^ from the blood's being without motion in the ctTity of
the ntenis;'' and conseqoently coi^lating : ^ and hence,'' continues
he, ^ the origin of those large clots wldch sometimes come from
the cayitj : and which, when more condensed by the oozing out of
the serum, and of the red globnles, assome a flesh-Hke appearance,
and hare been called moles."* The concretion, indeeid, has be-
come sometimes so close and indurated as to resemble the consoli-
dation of a stone ; and hence Mr. Bromfield describes a mole expel-
led from the uterus as consisting of a stony man of the size of a
child's head.t And Hancroft has related a similar case.J

living blood, howerer, has a strong tendency at all times, and es-
pecially when aided by rest and the vrarmth of the body, to fkbri-
cate vessels and assume a membranous structure. ^^ I have reason
to believe," says Mr. J. Hunter, ^^ that the coagulum has the power
under necessary circumstances, to form vessels in and of itself: for
although not organic, it is still of a peculiar form, structure or ar-
rangement 1 Uiink 1 have been able to inject what 1 suspected to
be the beginning of a vascular formation in a coagulum when it
could not derive any vessels from the surrounding parts."§ It is
probably on this account that we sometimes find the dischaiged
mass or mole evincing something of a fibrous or membranous ap-
pearance, and mimicking the structure of an organized substance.

Fragments of a placenta, or of its membranes have also some-
times remained unexpelled firom the uterus, and have become
blended with coagula of blood,|| and probably of blood aiming, as
above, at a vascular developement, and hence the mole has been of
a still more complicated character, and has often puzzled practi-
tioners of great jud^ent and experience.

And occasionally hydatids have found the means of forming a ni-
dus in some one of the sulci of the womb, and, by swelling into a
considerable tumour or various clusters of tumours, have very con-
nderably added to the enlargementlT /^

Many writers have described, by the name of moles, the fng'
ments of a fetus, which have long remained in the uterus after its
death, and have sometimes been surrounded with an adsciddous in^
volocrum, or soijle part of its placenta or membranes, but so chang-
ed by some subsequent chemical or animal operation, as to have little
resemblance to their original structure. These, however, are rath-
er miscarriages, or remnants of miscarriages, than moles. They
manifestly bespeak an impregnation and organic growth in the pro-
per organ, but, owing to torpitude or some other diseased condition

* Inqairies, ftc. Part i. p. 27.
t Obfenr. n. p. 156.

f Diss, de Mola, occasione molte ossen iu vetula inventa. Goet. 1746. ,
4 On Blood, &c. p. 92. 4to. Edit. 1794. *
g Ruyfich, Thesaurus, iii. vr.

t Eph. Nat. Cur. Dec. ir. Ann. ii. 157. Ann. yiii« 50. et alibi.
Morgagni, De Sed. et Caus. Mnrb. £p. XLViir. 13, &c.
VOL. IV. 23

, 1 78 GENETICA. [CL. V.-OR. HI*

of the womb, were not expelled at the period of the death of the
fetus. We nave already observed, in treating of miscarrii^e, para-
cTESis ABORTUS, and more particularly still under paractesis flo-
RALis, that such retention, and almost to an unlimited period, is bj
no means uncommon, and hare illustrated the remark by nume-
rous examples.

Simulating pregnancy, from molar concretions, assumes in many
cases so much of the character of genuine impregnation as to be
distinguished with considerable difficulty. In general, however, the
abdominal swelling increases in the spudous kind far more rapidly
than in the real for the first three months ; after which it keeps
nearly at a stand : the tumour, moreover, is considerably more
equable, the breasts are flat and do not participate in the acdon, and
there is no sense of quickening. There is almost always a reten-
tion of the menses.

If we suspect the disease, the state of the uterus should be exa*
mmed, and it will often be in the examiner^s power to ascertain the
fact, and by a skilful introduction of the finger to hook down a part
of the mass through the cervix, and hence, by a little dexterity, to
remove the whole -, but he should be careful not to break the mole
into fragments.

Moles, wholly or in fractions, are thrown out by the action of the
uterus at different periods : often at three months ; more frequently
by something like a regular accession of labour-pains, at nine : but
they occasionally remain much longer : in a case of Riedlin^s, for
three years ;* and in one described by Zuingen for not less than
seventeen.!

SPECIES 11.

PSEUDOCYESIS INANIS.

iFfllse €oncrjitfon.

THE UTERXTS VOID OF INTERNAL SUBSTANCE ; AND IRRITATED BY SOME UN-
KNOWN MORBID ACTION.

There are two periods during the active power of the womb in
which it is peculiarly irritable ; and these are at the commence-
ment, and at the final termination of the catamenial flux. And
hence it-sometimes happens at the last period, from some unknown
excitement, though generally, perhaps, the increased erethism

• Lin. Med. 169S. p. 297.

t Theatrum vits humaDe, p. 331, 357.

GE. nr.-SP. II.J SEXUAL FUNCTION. 179

which, io conseqaence of such irritation, accompanies the conjugal
embrace, that it becomes sensible of feelings and communicates
diem to the stomach, not unlike what it has formerly sustained in
an early stage of impregnation ; and, a catenation of actions haying
thus commenced, every link in the chain that accompanied the
whole range of former pregnancies, is passed through and as ac-
curately imitated as if there were a real foundation for it.

Tliis illusory feeling, however, sometimes dies away gradually
at the end of three montlis, but more usually runs on to the end of
the ninth, when there is occasionally a feeble attempt at labour-
pains, but they come to nothing : and the farce is gradually, and in
a few instances suddenly concluded by a rapid diminution of the ab-
dominal swelling, and a return of the uterus to its proper size.

The distinctiye signs which indicate real from spurious pregnan-
cj under the last species, and which we have already noticed, are
equally applicable to the present, and the practitioner should avail
himself of them.

CLASS VI.

CLASS YI.
ECCRITICA.

DISEASES OP THE EXCEBNEHT FUHCnON.

ORDER I.

MESOTICA.

imcmia the PiKEMcana-
II.
CATOTICA.

A1TBCI1R0 inEMlft tOaMACU.
III.

ACROTICA.

AITECTraO THE EXTEMML SOKHIBi.

CLASS VI.
PHYSIOLOGICAL PROEM.

X HE structure of the solid parts of the body consists of three dis-
tioct substances — a fibrous, a parenchymatous, and a cellular or
web-like. The fibrous is chiefly to be traced in the bony, mus-
cular, and membranous parts; the parenchyma, a term first em-
ployed by Erasistratus, and, as we shall show hereafter, in a very
different sense from that in which it is used at present, in what are
commonly called visceral organs ; and the cellular in both. The
cellular, is in truth as it was first denominated by Bordeu, a mucous
web ;* and, while it serves the purpose of giving support to the
vessels and nerves of the fibrous parts, of separating them from
each other where necessary, and where necessary of connecting
them ; it is the repository or receptacle of the gelatinous material,
which constitutes the general substance of the parenchymatous
parts, and has peculiar qualities superadded to it according to the
nature of the organ which it embodies, and the peculiarity of the
texture which runs through it : — whence the structure of the liver
differs from that of the pancreas the structure of the pancreas from
that of the kidneys : and the structure of the lungs, or of the placen-
ta, from all the rest

All these parts are perpetually wearing out by their own action —
the most firm and solid as well as the most spongy and attenuate.
They are supplied with new materials from the general current of
the blood, and have their waste and recrement carried off by a cor-
respondent process. '

It is obvious that, for this purpose, there must be two distinct
sets or systems of vessels : one by which the due recruit is provided,
and the other by which the refuse or rejected part is removed.
These vessels are, in common language, denominated secretories
and ABSoasEiiTS. They bear the same relation to each other as the
arteries and veins : the action which commences with the former
IB carried forward into the latter : and we may further observe that
while the secretories originate from the arteries, the absorbents

* Recherches sur le Tiwu muqueux otforgane celluUire. Parif, 1767.

184 PHTSIOLOGIOAL PROEM. [cL. VI.

terminate in the veins. Tlie general function sustained by these
two sets or systems of vessels is, in the present work, denominated
EccRiTicAL or EXCERNENT : the health of this function consists in the
balance of power maintained between their respective vessels : and
its diseases in the disturbance of such balance. There may be on-
due secretion with healthy absorption ; undue absorption with
healthy secretion : or there may be undue or morbid absorption and
secretion at the same time.

The refuse matter, however, or that which is no longer fit for
use, is not all wasted : nor in reality any of that which falls within
the province of the absorbents. Nature is a judicious economist,
and divides the eliminated materials into two parts— one consisting
of those fluids which, by an intimate union with the newly formed
chyle, and a fresh subaction in the lungs, may once more be adapted
for the purposes of general circulation ; and the other of those
which no elaboration can revive, and whose longer retention in
the l^ody would be mischievous. It is the province of the absorb-
ent system to take the chai|^e of the whole of the first office ; to
collect the eflete matter ^om every quarter, and to pour it, by
means of innumerable channels that are perpetually uniting, into the
thoracic duct, which forwards it progressively to the heart. The
really waste and intractable matter, instead of disturbing the ac-
tion of the absorbents, is at once thrown out of the general system
by the mouths of the secements themselves, as in the case of insen-
sible perspiration; or, where such a perpetual efflux would t>e in-
convenient, is deposited in separate reservoirs, and sufiered to ac-
cumulate, till the individual has a commodious opportunity of eva-
cuating them, as in the case of the urine and the feces.

Thus far we see into the general economy : but when we come
to examine minutely into the nature of either of these sets of ves-
sels, we find that there is much yet to be learned both as to their
structure, and the means by which they operate. The subject is
of great importance, and may, perhaps, be best considered under
the three following divisions :

I. THE GENERAL NATURE OF THE SECERNENT SYSTEM.
II. THE GENERAL NATURE OF THE ABSORBENT SYSTEM.
III. THE GENERAL EFFECTS PRODUCED BY THE ACTION OF THESE TWO
SYSTEMS ON EACH OTHER.

1. It was at one time the common doctrine among pbysioli^ts,
as well chemical as mechanical, that all the vast variety of animal
productions which are traced in the different secretory organs,
whether wax, or tears, or milk, or bile, or saliva, were formerly
contained in the circulating mass ; and that the only office of these
organs was to separate them respectively from the other materials
that entered into the very complex crasis of the blood ; whence,
indeed, the name of secernents or secretories, which mean nothing
more than separating powers. This action was by the chemists sup-

CU VI.] t>HTSIOLt>GlGAL FROEM. 185

poted to depend on peculiar attractions, or the play of affinities
which was the explanation advanced by some ; or on pecntiar fer-
ments, conveyed by the blood to the secernent organ, or pre-exist-
iog in it, which was the opinion of others. The mechanical phy-
siologists, on the contrary, ascribed the separation to the peculiar
^gnre or diameter of the secretory vessels, which, by their make,
were only fitted to receive particles of a given form, as prisms
where the vessels were triangular, and cubes where they were
square. Such was the explanation of Des Cartes : while Boerhaave,
not essentially wandering from the same view, supposed the more
attenuate secretions to depend upon vessels of a finer bore, and the
more visdid upon those of a larger diameter.

Modem <;hemistry, however, has completely exploded all thesd
and many other hypotheses founded upon the same common princi-
ple, by proving that most of the secerned materials are not formally
existent in the blood, and, consequently, that it is not, strictly speak-
ing, by an act of separation, but of new arrangement or recomposi-
tion that they produced out of its elements. And hence, phydolo-
gists have been led to a critical inquiry into the fabric of the secern-
ing organ, but hitherto without much satisfaction, (n its simplest
state it seeflds, as far as it can be traced, to consist of nottiiog more
than single vessels possessing a capillary orifice, as in the Schneide-
rian membrane. In a soinewbat moi^e compound form we find this
orifice opening into a follicle,' or minute cavity of ad elliptic shape ;
and, in a still more complicated make, we meet with a glandular
apparatus more or less glomerate, consisting of a congeries of se-
cernent vessels, with or without follicles, and occasionally accom-
panied with a basin or reservoir for a safe deposit of the secreted
or elaborated matter against the time of its being wanted, of wliich
the gall-bladder furnishes us with a well-kdown example. But in
none of these instances are we able to cHscover any peculiar effect
produced by this complication of machinery beyond that of affording
the means of accumulation : for large as is the organ of the liver it
is in the penicilli, or the pori biliarii alone that the bile is formed
and completely elaborated : the liver is a vast bundle or combina^
tipn of these^ and hence affords an opportunity for d free fbrm^tioa
of Mle in a collective state, but it has not been ascertained that it
affords any thing more. And although in the gall-bladder we find
this fluid a little varied af\er its deposite, and rendered thicker,
yellower^ and bitterer, the change is nothing more than what must
necessarily follow from absorption, or the removal of a part of the
finer particles of the bile. The conglomerate glands of the mam-
m» offer us the same results, for the milk here secreted is as per-
fect milk in every separate lactiferous tube, as when it flows in an
accumulated form from the nipple. And hence, follicles themselves
may be nothing more than minute reservoirs for the convenient ac-
cumlation of such fluids as are deposited in them till they are re-
quired for use. Mucus and sebum are inspissated by retention, but
they rarely undei^o any other change. We are obliged, therefore,

VOL. ir. 24

186 FHTSIOLOGIGAL PRO£M. [CL. Tl.

to conclude with Sir Ererard Home, that ^^ the organs of tecretioo
are pri&cipally made up of arteries and veins ; hut there is nothing*
io the different modes in which these vessels ramify that can in any
way account for the changes in the blood, out oi which secretions
ailse."*

These organs, however, are largely supplied with twigs of small
nerves^ and it has been an idea long entertained by physiologists
that secretion is chiefly effected through their instrumentality. Sir
Everard Home, in his paper inserted in the volume of the Philoso-
pfaical Transactions iust refered to, has ^^ observed that in fishes
which are capable of secreting the electric fluid the nerves connec-
ted with the electrical organs exceed those that go to all the other
parts of the fish, in the proportion of twenty to one :"t and in con-
firmation of this view of the subject, it may be remarked that there
are no parts of the body more manifestly affected, and f^w so much
so, as the secretory organs, by mental emotion. The whole sur-
face of the skin is sometimes bedewed with drops of sweat and even
of blood by a sudden paroxysm of agony of mind ; grief fills the
eyes with tears : fear is well known to be a powerful stimulant to '
the kidneys, and very generally to the alvine canal ; anger gives
an additional flow, perhaps an additional acrimony, to the bile ; and,
if urged to violence, renders the saliva poisonous, as we have al-
ready observed under the genus lyssa:} and disappointed hope
destroys the digestion, and turns the secreted fluids of the stomach
acid.

All this should seem to prove that the secretory organs are chief-
ly influenced by the sensorial system ; yet Haller has long ago ob-
served that the larger branches of the nerves seldom enter into
them, and seem purposely to avoid them :§ the secernent glands have
little sensibility ; and the secretions of plants, which have no ner-
vous system, are as abundant, and diversified, and as wonderful In
every respect, as those of animals.

The means, therefore, by which the very extensive and impor-
iant economy of secretion are affected, seem hitherto, in a very
considerable degree, to have eluded all investigation. We behold,
nevertheless, the important work proceeding before us, and are in
some degree acquainted with its machinery.

The most simple, and at the same time, perhaps, the most copi-
ous of the fluids, which are in this manner separated fVom the blood,
is that discbai^ed by very minute secernent vessels, supposed to be
termioal or exhalant arteries, which open into all the cavities of
the body, and pour forth a fine, breathing vapour, or halitos, as it
is called, which keeps their surfaces moist, and makes motion easy
— an effluvium which must have been noticed by every one whi»

• Phil. Trans. 1809, p. 387.

t Id. p. 386.

% Vol. HI. p. 232.

b Pbyslolog. Tom* ix. passim.

tSM Vh] PHYSIOLOGICAL PROBM. 18T

bas ever attended the cQtdng up of a bollock in a slaughter-boos^.
We haTe formerlj bad occaidoD to dmenre that arteries terminate
In two ways— in minute veins — and in exhalant vessels. The for^
mer termination can Qflten be followed up by injection? and occa-
sionally traced by the microscope ; but no microscopic experimee^t
bas hitiierto enabled the anatomist to discover the orifices of <he
exhalant branches of arteries. Their' existence, however, is prov-
ed, as Mr. Cruikshank has observed, by their sometimes, and es-
pecially when enlarged in diameter or acted upon by a more than
ordinary vis a tergo, pouring forth blood instead of vapour, of
which we have a striking instance in bloody sweat ; as also in the
menstrual flux, which though not blood itself, proceeds, as Dr. Hun-
ter has sufficiently shown, from the mouths of the exhalant arteries
of the uterus, periodically altered in their diameter and secernent
power.

II. The fluid thus thrown forth to lubricate internal surfaces,
would necessarily accumulate and become inconvenient, if there
were not a correspondent set of vessels perpetually at work to carry
off the surplus. But such a set of vessels is every where distribu-
ted over the entire range of the body, as well within as without, to
answer this express purpose : and they are hence called absorbents ;
and, from the limpidity of their contained fluid, lymphatics.

Their course has been progressively followed up and developeil
from the time of Asellius,* mio, in the year 1622, ^ reaped the
first laurels in this field by his discovery of those vessels on the
mesentery which, from their carrying a milk-white fluid, he de-
nominated lacteals,''t and whose researches were confirmed and
extended by the valual>le works of Pecquet, Rudbeck, JollyffB,
Barthoiine, Glisson, Nuck, and Ruysch, till by the concurrent and
finishing demonstrations of Hoflman and Mekel, and more especially
of our own illustrious countrymen Hewson, the elder Monro, both
the Hunters, and Cruikshank, the whole of this curious and elabo-
rate economy was completely explained and illustrated towards the
close of the preceding century, and the opposition of fiaron Haller
was abandoned.

The vessels of the absorbent system anastomose more frequently
than either the veins or the arteries ; for it is a general law of
nature that the smaller the vessels of every kind, the more freely
they communicate and unite with each other. We can no more
trace their orifices, excepting, indeed, those of the lactcak, than we
can the orifices of the exhalants ; but we can trace their united
branches from an early function, and can follow them up singly, or
in the confederated form of conglobate glands, till, with the excep-
tion of a few that enter the right subclavian vein, they all terminate
in the common trunk of the thoracic duct ; which, as we have for-
merly observed, receives also the* tributary stream of the anasto-

* Epistola ad Haller.

t Hewson, Of ihe Lymphatic System, p. 2.

188 PHY6IOL0QICAL PROEIL [cL. YU

mosing lacteaU or the absorbents which drink up the subacted food
from the alvine canal, whose orifices are capable of being traced —
and pours the whole of this complicated fluid, steadily and slowly
by means of a valve placed for this purpose ^t its opening, into the
subclavian vein of the left side.

By this contrivance there is a prodigious saving of animalized
fluids, which, however they may difler from each other in several
properties, are far more easily reducible to genuine blood, than new
and unassimilated matter obtained from without.

Yet, this is not all : for many of the secretions, whose surplus is
thus thrown back upon the system, essentially contribute to its
greater vigour and perfection. We have a striking example of this
in absorbed semen, which, as observed on a late occasion,* gives
force and firmness to the voice, and changes the downy hair of the
cheeks into a bristly beard : insomuch that those who are castrated
in early life are uniformly deprived of these peculiar features of
manhood. The absorption of the surplus matter secreted by the
ovaria at the same age of puberty produces an equal influence upoo
the mammary glands, and finishes the character of the female sex,
as the preceding absorption completes that of the male. So,
absorption of fat from the colon, where, in the opinion of Sir Eve-
rard Home, it is formed in great abundance, carries on the growth
of the body in youth.t

Absorbents accompany every part of the general frame so closely,
and with so much minuteness of structure, that Mr. Cruikshank has
proved them to exist very numerously in the coats of small arteries
and veins, and suspects them to be attendants on the vasa vasorum,
and equally to enter into their fabric. Wherever they exist they
are peculiarly distinguished by their very numerous valves, with
which they are enriched far more than any other sets of ves-
sels whatever. " A lymphatic valve is a semicircular membrane,
or rather of a parabolic shape, attached to the inside of the lym«
phatic vessels by its circular edge, having its straight edge, corres-
ponding to the diameter, loose or gating in the cavity : in conse-
quence of this contrivance fluids passing in one direction make the
valve lie close to the side of the vessel, and leave the passage free ;
but attempting to pass in the opposite direction, raise the valve from
the side of the v«ssel, and push its loose e^ge towards the centre of the
cavity. But, as this would shut up little more than one half of the
caVity, the valves are disposed in pairs exactly opposite to each
other, by which means the whole cavity is accurately closed."J

The distapce at which the piiirs of valves lie varies exceedingly.
The intervals are often equ^l and noeasure an eighth or a sixteenth
part of an inch. Yet the interval is at times much greater. ^ 1
have seen a lymphatic vessel,'^ says Mr. Cruikshank, ^^ run six inches
■ , ,

* Vol. IV. p. ll.Phys. Proem, suprck. a

t \io!. I. p. 13. of the present work, as also Phil. Trans. 1313, p. 157^
1(. Cruikshank, Anat. of Absorb. Vessels, p. 66. 2d. Edit.

CSm Tl.] PHYSIOLOGICAL PROEBT. 189

withoat a single valye appearing in its cavity. Sometimes the
tnmks are more crowded witli yalves than the branches, and some-
times 1 have seen the reverse of this.''*

In the absorbents, also, we meet with glands ; their form is mostly
oval, one end being turned to the thoracic dact and the other from
it : but we are in the same kind of uncertainty concerning their
ase, and, in some measure, concerning their organization, as in
respect to those of the secernent system. The vessel that conveys
a fluid to one of these glands is called a vasinferens^ and that which
conveys it away a va» efferent. The vasa inferentia, or those that
enter a gland, are sometimes numerous ; they have been detected
as amounting to fifteen or twenty ; aud are sometimes thrice or
oftener as many. They are always, however, more numerous than
the vasa efferentia, or those which carry on the fluid towards the
thoracic duct. The last are consequently, for the most part, of a
larger diameter, and sometimes consist of a single vessel alone. It
is conceived by many physiologists that the conglobate mass which
forms the gland consists of nothing more than convolutions of the
vasa inferentia ; whilst others as strenuously contend that they are
a congeries of celk or acini totally distinct from the absorbent
vessels that enter into them. Whatever their structure may be,
they seem to the present author to be powerfully auxiliary to the
valves by abating the back force they are unquestionably called at
times to encounter from some morbid action, and there is reason to
believe that in this way, like the conglomerate glands of the secer-
nents, they become basins or receptacles.

As in the case of the secernents, we are also unacquainted with
the means by which the absorbents act. This, in both instances, is
said to be a vtt a Urgo^ — a term which gives us little information in
either instance, and is peculiarly difficult of comprehension in the
latter. In their most composite state they possess a very low degree
of sensibility, and are but little supplied with branches from the
larger trunks of nerves.

Abetruse, however, as the process of absorption is to us at present,
we have sufficient proofs of the fact. Of six pints of warm water
iojected into the abdomen of a living dog not more than four ounces
remained at the expiration of six hours. The water accumulated
in dropsy of the brain, and deposited in the ventricles, we have
every reason to believe is often absorbed from the cavities ; for the
symptoms of the disease have been sometimes marke'd, and after
having made their appearance, and been skilfully followed up by
reme&es, have entirely vanished : and the water in dropsy of the
cbe^t, and even at times, in ascites, has been as efiectually removed.

It has been doubted by some physiologists whether there t>e any
absorbent vessels that o|!%n on the surface of the body : yet a mui-
litude of facts seem sufficiently to establish the positive side of this

• Loc. cUat|

190 . PHYSIOLOGICAL PROEM. [cL. TI.

queetioD, though it i8 not floitls of erery kiod that can he canied
from Uie ikio into the ciraiUtingsjftein, and hcDce thehr power is hj
no means universal. Sailors who, when in great thirst, put on shirts
wetted with salt water, find considerahie relief to this distressing
sensation. Dr. Simpson, of St Andrews, relates the case of a ra-
pid decrease of the water in which the legs of a phrenitic patient
were bathed : and De Haen finding that his dropsical patients filled
equally fast whether they were permitted to drink liquids or not,
did not hesitate to assert that they must absorh from the atmoe*
phere. Spirits and many volatile irritants seem to be absorbed more
rapidly than water, and there can be no doubt that warmth and
firiction are two of the means by which the power of absorption is
augmented. ^^ A patient of mine,'' says Mr. Cruikshank, ^ with a
stricture in the oesophagus, received nothing, either solid or liquid,
into the stomach for two months : he was exceedingly thirsty, and
complained of making no water. I ordered him the warm-bath for
an hour, morning apd evening, for a month : his thirst vanished,
and he made waterin the same manner as when he used to drink
by the mouth, >and when the fluid descended readily into the sto-
mach.''* The aliment of nutritive clysters seems, in like manner,
to be oflen received into the system, and it i^ said, though upon
more questionable grounds, that cinchona, in decoction, has also
been absorbed both from the intestines and the skin.

Narcotic fluids rarely enter to any considehible extent and ne-
ver so as to do mischief, respecting which, therefore, the power of
the cutaneous absorbents is very limited : and there are few poison-
ous liquids, wUh the exception of the venereal, that may not be ap-
plied with safety to a sound skin.

This double process of secretion and absorption was supposed by
the ancients to be performed, not by two distinct sets of vessels
expressly formed for the purpose, but by the peculiar constructioD
of the arteries, or of the veins, or of both. These are sometimes
represented as being porous, and hence, as letting loose contained
fluids by transudation, and imbibing extraneous fluids by capillary
attraction. There is, in fact, something extremely plausible ia thk
view of the subject, which, in respect to dead animal matter, is al-
lowed to be true, even in our own day. For, it is well known that
a bladder filled with blood and suspended in the air, from a cause
we shall presently advert to, is readily permeated with oxygena
gas, so as to tl^nsform the deep Modena hue of the surface of the
blood that touches the bladder into a bright scarlet : and thin fluids
injected into the blood-vessels of a dead body transude very gene-
rally ; insomuch that glue dissolved in waiter and thrown into the
coronary veins, will permeate into the cavity of the pericardium,
and by jellying even assume its figure. AM hence it is that bile is
often found, after death, to pass through the tunics of the gall blad-
der and tinge the transverse aorta of the colon, the duodenum or the

• Anat. of the Absorb. Vessel?, p. 108,

CL.TL] PHYSIOLOGICAL PROEM. 19 1

pjlonw with a bfowD) yellow, or green hue, according to its colour
at the time.

The doctrine of porosity or transudation, was hence very gene-
rally supported till the time of Mr. Hewson, by physiologists of the
first reputation. Boyle, hence, speaks, as Mr. Cniikshank has just-
ly obsenred, of the ponuitas afitma/tum, and wonders that this pro-
peHy should have escaped the attention of Lord Bacon. Even Dr.
HoDter and Professor Mekel believed it in respect to certain fluids,
•r certain parts of the body. The experiments of Hewson, J. Hun-
ter, and Crvikshank, hare, however, sufficiently shown that, while
vessels in losing life, lose the property of confining their fluids,
the V possess this property most accurately so long as the principle
of me continues to actuate them.

There is, moreover, another method by which the ancients some-
times accounted for the inhalation and exhalation of fluids, making
a much nearer approach to the modem doctrine, and that is by the
aooths of vessete ; still, however, regarding these vessels as arte«
ries or veins, and particularly the latter. '^ The soft parts of the
body," observes Hippocrates, " attract matter to themselves both
from within, and from without ; a proof that the whole body ex-
hales and inhales.'' Upon which passage Galen has the following
conment : ^ For as the veins, by mouths placed In the skin, throw
out whatever is redundant of vapour or smoke, «o they receive by
the same mouths no small quantity from the surrounding air : and
this is what Hippocrates means when he says that the whole body
exhales and inhades.^'

This hypothesis of the absorption of veins, without the interie-
rettce of lymphatics, has l>een revived within the last eight or ten-
years by M. Magen^, and M. Flandrin, of Paris, who have made'
an appeal to experiments which appear highly plausible, and are'
entitled to a critical examination.

The doctrines hereby attempted to be established are, indeed,
varied in some degree from those of the Greek schools ; and are
more complex. In few words, they may be thus expressed : that
the only general absorbents are the veins ; — that the lacteals mere-
ly absorb the food ; — that the lymphatics have no absorbent power
whatever;— 'and that the villi in the different portions of the intes-
tinal canal are formed in part by venous twigs which absorb alt the
fluids in the intestines, with the exception of the chyle, which last
fs absorbed by the lacteals, and finds its way into the blood through
the thoracic duct ; and that these fluids are <:nrricd to the heart and
lungs directly through the venae ports whose function it is minutely
to subdivide and mix with the blood the fluids thus absorbed, which
subdivision and intermixture is necessary to prevent their pft>ving
detrimental.

M. Mageodie further supposes that the cuticle has no power of
absorption in a sound state, either by veins or lymphatics ; but thaty
if abraded or strongly urged by the pressure of minute substances
that eater into its perspirable pores, the mouths of its minute vcin^
are thus rendered absorbent.

192 PHYSIOLOGICAL PROEM. [cL. tU

He supposes the fbnction of the lymphatics to consist in coovey-
ing the fiDer lyonph of the blood directly to the heart, as the yeins
convey the grosser and parple part ; and'tbat they rise, as the veins,
from terminal arteries.

Proper lymph, in the system of M. Magendie, is that opaline,
rose-colonred, sometimes madder-red, fluid which is obtained by
puncturing the lymphatics or the thoracic duct after a long fast.
it is every where similar to itself; and hence differs from the fluid
of cavities which is perpetually varying. He supposes the mistake
of confounding the. two to proceed from a want of attention to this
fact ^

One of the chief reasons urged for regarding veins as absorbents,
is, that membranes which absorb actively have, in his opinion, no
demonstrable lymphatics, as the arachnoid. But, according to Bi*
chat, such membranes have no more demonstrable veins than lym-
phatics ; veins are seen to creep on them, but never to enter.

The two principal experiments on which M. Magendie seems to
rely in proof that the veins, and not the lymphatics, are absorbents,
are the following : — First, M. Delille and himself separated the
thigh from the body of a dog that had been previously rendered in-
sensible by opium. They lefl the limb attached by nothing but the
crural artery and vein. These vessels were isolated by the most
cautious dissection to an extent of nearly three inches, and their
cellular coat was removed lest it might conceal some lymphatic
vessels. Two grains of the upas tiente were then forcibly thmst
into the dog^s paw. The effect of this poison was quite as imme^
diate and intense as if the thigh had not l>een separated from the
body : it operated before the fourth minute, and the animal was
dead before the tenth, in the second experiment a small barrel of
a quill was introduced into the crural artery and the vessel fixed
upon it by two ligatures. The artery was immediately cut all
round between the two ligatures. The same process took place
with respect to the crural vein. Yet the poison introduced into
the paw produced its effect in the same manner and as speedily. By
compressing the crural vein between the fingers at the moment
the action of the poison began to be developed, this action speedi-
ly ceased : it re-appeared when the vein was leflt free, and once
more ceased if the vein were again compressed.

The experiments are very striking, and, on a cursory view may
be supposed to carry conviction with them : but the confidence of
those who have studiously followed the concurrent experiments,
and the clear and cautious deductions of our distinguished country-
men, Hewson, both the Hunters, and Cruikshank, will not so easily
be shaken.

We have already observed that lymphatic absorbents, in the opi-*
nion of the last of these writers, probably in the opinion of all of
them, enter as fully into the tunics of veins and arteries, and even
into those of the vasa vasorum, as into any other part of the ani"
mal frame : and hence there can be no difficulty in conceiving that

CU VU] PinrflDM)QH^L PROfiM. 193

the poi«Mi empUfM In tiwie etfeaimea^ mlglit o«Mtfipaity the
▼eiM by mesmB of tbeir lymphatics. We abo ebsenred that while
the lymphaties aaattomose, or nm into each other more frequenlfy
than aaij other set of vessels, their valves, which aiecie prsveat a
tetfOfeTSiie eo«rse, and direct the contained flidd towards the tho-
racic diMt, are occasionaUj placed at a oonsiderat^e diatance froBi
each ether, in some instamees not less than six inches, aad that ibA»
kafth of ioterval occurs in the ninnte twigi as well as in the
tronltt. jknd hence, admittif^ that, in the veins that were cot of
iaolrted in M. Ifagandie^ eiparlments, snch a yacnitj of valves in*
cidentaily existed, there is also no difficulty ta conceiving hy what
oeorae the poiaans that imre already entered into their ^mphatics
from without sfaoald, hi conseqoenra of this frcfoency of anastomo^
sis and ikstitntion of valves, he stimidated to a retrograde coorso hy
the violence made ose oi^ and be tlurowB into the current of the
bbod from wittiio, hy the months of those lymphatics that entor
into tlie tmics of the veins ; and particnkariy as the sepmrated ves^
sols wore only IsohUed to a distance of less than three inches, wMie
Uk lya4>hatics are oceasiosmny void of valves to double this dis'

In some cases we have reaaan to believe that the lymphatics that
enter into the Umics of the laeteals, which M. Magendie admits to
he a system of absoihentB altogetiier ^stinet from tiie veins, are
ei|aally deatitnte of valves in certain parti or directions, and com-
mooicate hy anastomoais some portion of tlie ehyle and any snh-
fllanee contained in it to the interior of the adjoimog veins, and
conseqtKtttly to the bloed itoelf : for the experimenti of Sir Everard
Home npeo rfanbarb iatrodoced into tlM stomach of an animal, aftej^
the thoradc doet has been secured by a doable ligature, show thar
this siRwtance and consequently others as well, is capable of trav^ ,
ling from tiie stoasach into the urinary bladder, notwithstan^bg tMs
impediment, in the singular experiments made with prussiate of
potash by Dr. Wollaston and Dr. Mareet, the blood widich wu
drawn from the arm during tiie interval of the introduction of tids
MbatODce into the stomadi, and its detection in the urine, did not,
indeed, on being tested, discover the smallest trace of the {>ras-
^te, though it was so obvious in the fluid of the urinary bladder.
The difficulty of accounting for this is considerable, but may pep-
hafM be eaptainod by the very diffused state of tlie prussiate in ^le
entile mass of the blood, and its greater concentration when se-
cntod hy the kidneys: by wl^h tiie same test which was applied
in vaiof in the former imftance, completely socceeded in the latter.

Thoff<e is, however, aiiother mode of actounting ibr the result of
M. Magendie's experimeali witliout abandooing the well-established
doctnne of absorption by the lymphatic system. It is a remailt:
widch ought never to be lost sight of, that experiments made upon
animals in a state either of great pain or of great debility can give
us, by their lesolt, no foil proof of the line of conduct pmrsued by
nature in a state of health. In the dead animal body the valves of

VOL. IV. 25

194 PHrSlOLOOICAL FRDfildC [CL. Vf-

the lymphatic veaseb very generally lose all etaBtidfy aod power
ef resistance, and tnmsndt flmds in every direction ; whence, in all
probability, that porosity or transudation, which we have already
observed, as manifest, occasionally in the stomach and intestines, and
in various other organs, on the use of anatomical injections. And
hence there can be Uttle doubt, that as an organ makes an approach
to the same state of insensibility and irritability^ by the severe if
Bot fatal wounds inflicted on it in the course of such experiments as
are here alluded to, the valves oi its lymphatic vessels make an ap*
proach also to the same state of flaccidity^ and allow the fluidb^
whose course they should resist, to pass In any direction.

This altered condition of many parts of the lymphatics in the
dead body, was su£Gk:iently shown by Mr. Cr nikshank, iu a course of
numerous experiments made at Dr. Honter^s Museum, in the spring
of i77>3. The organs chiefly injected were the kidney, liver, and
lungd of adult human subjects, in one case, he pushed his injection
from the artery to the pelvis and ureter without any rupture of the
vessels. In another he injected the pelvis and ureter /rom the vetM,
which he thought succeeded better than from the artery. In three
diflereot kidneys he injected from the uterus the tubuli uriniferi
for a considerable length along the mammillge ; and in one case a
number of the veins on the external surface of the kidney were
evidently filled with the injection. In ail these experiments, the
colouring matter of the injection was vermillion. In numerous in-
stances he filled the lympiiatics of the lungs and liver with quick-
silver ; and from the lymphatics of the liver, he was nble, twice in
the adult, and once in the fetus^ to fill the thoracic duct itself.*
Dr. Mekelt had, already shown the same facts by a similar train
experiments, instituted only a year or two before, and the con-
clusion he drew from them is in perfect coincidence with the ex-
planation now offered. Dr. MekeFs experiments consisted in in-
jecting mercury with great care,, but considerable force, into various
lymphatics, and minute secreting cavities ; and he found that a di-
rect communication took place between such cavities and lympha-
tics, and the veins in immediate connexion with them : and hence,
he contended, that the lymphatics and the veins are bo^i of them
absorbents under particular circumstances; the lymphatics acting
ordinarily, and forming the usual channel for carrying off secreted
fluids,' and the veins acting extraordinarily, and supplying the
place of the lymphatics where these are in a state of moAid torpi'
ktde or debility, or the cavity is overloaded, lie traced this com^
munication particularly in the breasts, in the liver^ and in the blad-
der : and be thus accounts for the ready passage which bile finds
into the blood, when the ductus choledochus is obstructed, as in

* Edln. Med. Com. i. p. 430. •

t N<ova Experimenta et ObservAtiones de Abribus venarum et vasoram Ijhn-
pliaticoruA ill ductus, vi8ceraq.ue corporis bufnanj, ejusdemquo stiucturn dti*
lltate.Svo.

If

CL. ¥1.] PHTilOIjOOIGAL MM^M. 193

JMiidice ; and the nnnoiis fluid wUeh is often thrown forth from
the axilla and other organs npon a syppreasion of the natural se^
4:rietioD.

k follows therefore, t^ the experiments of M. Mageodie, al-
lowing them to be precisely narrated, are capable of explanation
without abruptly overthrowing the established doctrines of pre-
ceding physiologisis io the same line of pursuit : and we have stitl
ample reason for beUeving that the economy of secretion and ab-
sorption is effected by two systems of vessels distinct from veins
and arteries, and in a state of health continually holding a balance
with each other.

III. In different periods of life, many of the secretions vary con-
siderably in their sensible properties, or relative quantity. Thus
the Ule of the fetus is sweet, and only acquires a bitter taste after
birth. In infancy perspiration flows more profusely than during
manhood ; and the testes wiiich secrete nothing before the age of
puberty, at this time acquire activity, and again lose their power in
ok) age.

There are also many of the secernent organs that, in case of ne-
cessity, become a subfliitute for each other. Thus the perspirable
matter of the skin when supprest by a sudden chill or any other
eause, is often discharged by the kidneys ; the catamenia by the
Kings ; and the serum accumulated in dropsies by the intestines.

The secretions are moreover very much affected and increased
by any violent commotion of the system generally. In hysteria the
flow of urine is greatly augmented, while the absorption of bile
seems diminished ; and hence the discharge 4S nearly colourless. In
violent agitation of the mind, we have already observed that tl^
juices of the stomach become acid ; and sometimes the seceV %
nents of the skin, and sometimes those of the larger intestines,g
are stimQlated into increased action; whence coUoquative per-'
spiration, looseness, or both. The heat aed commotion of a fe-
ver will sometimes produce the same effect and sometimes a con^
4rary ; the skin being dry, parched, and pricking. And occasion-
ally the dryness has been so considerable as to produce a sudden
separation of the cuticle from the cutis; of which Mr. Gooch
relates a singolar instance in a patient who £ot several years, had
once or twice a year an attack of fever accompanied with a pecu-
liar itcliing of the skin, and particularly of the hands and wrists, that
ended in a total separation of the cuticle from these parts: insomuch
that it could easily be turned -off from the wrist down to the fingers
ends so as to form a kind of cuiicular glove.* The same distin-
guished writer gives as singular an instance of the effects of solar
heat upon the skin of another patient who had no sooner exposed
himself to the direct ravs of the sun, than his skin began to be af-
fected with a sense of tickling, became violently hot, as stiff as
leather, and as red as vermillion.t In this case we have an instance

* Medical and Chirurgical Obsei rations, 8vo.
t Ppi. Citat.

196 varmoMmeAh momr. [cl. n.

of highly excited ftotien in the ciftaMei3is eseeftiento of b6th Idtt^
Mid of the formation of new blood-vefltsek under the cuticle ; lite
more attenuate part of tlie flnid secreted being rapidly carried off,
tmd hence, the cntaneoos integattent coATorted into a coriaceouB
•nbstance.

There are some parts of the body that waste and becottie renown-
ed far more rapidly than otiiers ; the fat than tlie ttnscles ; tlie rantf-
clea than the bones ; and probably tlie bones than the skin ; fbr tite
dye of the madder-root with wliich the bones become coloured when
this root iias for some time formed a part of the daily food of an
animal, is carried off far sooner than the coloured Knes of cbarcoel
powder, ashes, soot, and the juices of Tarious phmfe, when introduc-
ed into the substance of the skin by puncturing or tattooing It, a
practice common among our sailors, and still more so, and carried to
a far greater degree of perfection among the inhabitants of the
South-sea Islands.

It has been said, indeed,* that the disappearance of the madder-
colour from the bones, affords no proof that the phosphate of lime
in which it was seated has itself been carried off at the same timo ;
because the serum of the blood is found to hare a stronger affinity
for madder than the phosphate coloured by it ; and hence will gra-
dually attract and remove ft, when tlie animal is no longer fe6 with
the coloured food. The expertmeot, howerer, upon which this
latter opinion is grounded, has not been hitherto conducted in such
a manner as to be directly appllcabte to the question ; and if it had
been, it would afford no proof that a perpetnal, though, in that case,
a slower change than the madder would exhibit, le not taking pifice
^ Mp the bones : nor are we driyen to the effects of* madder dye upom
^ ^heir solid substance as the only foundation for #this opinion; for
I there is scarcely a bone in the animal system which does not qs-
same a different shape at one period of life compared with that at
pnother period : a remark that peculiarly applies to the flat bones
of the skeleton, and forms the chief cause of that wonderful change
which the lower jaw experiences as the individual advances from
middle hfe to old age, and which often gives a diffsrent character
to the entire face.t

It is from this mysterious power of reproduction appertaining to
every part of the system, that we are so often able to renew the
substance and function of parts that have been wasted by fevers or
atrophy, or abruptly destroyed or lopped off by accident.

In the progress of this* general economy, every organ and part of
the body secretes for itself the nutrin^ent it requires, from the com-
mon pabulum of the blood which is conveyed to it, or from secre-
tions which have already been obtained from the blood, and deposit-
ed in surrounding cavities, as fat, gelatin, and lymph. And it is

^ Bernouilli, Diss, de Nutritione, Groning. 1669. 4to.
t Gibson, Manchester Memoirs, Vol, I. 533.

a* n.] PHmoMaicAL fnam* 197

pfohiMbig tet the Mvend orgttiis ofsecraddDy Mk« tbe «9«,41m ««r,
•ad the other ditttoci oi^mM ef teese, are peovMerly effected by pe-
««liitf Bitmelaiits a»d escited to somt diveriiiy of Mmsetion.

In GreraHuiy, this idee hes been pursued so feres in some hy^^
theses, aed perticolarij that of M. Hubuer,* to lay a foundatioe for
1kB doctriae of a sisth eeaee, to which as we observed on a former
occasioD^t has been fivea the name of mlhiigefiihl or gtmimgtfiikLi
^ self-^eelh^,'' or ^^ getteral-feelieg.'' The sensations bowerer,
we are at preseat aliudkif to, are set so much general cii those of
the whole self, as particular or limited to ibe organs in which Ihey
(ffigiBate ; aad seem rather to be a result of different modifioatioas
of the fluid that causes the comrnon sense of touch, than produced
by dietiBct sensorial secretions. In oiost parts of the system these
■ledificatioDs are so inconsiderable as to elude our notiee, but in
others we have the fullest proof of such an effect ; for we see the
stooMich evincing a sense of hunger, the fauces of thirst, the genital
enfaas of venerml <»rga8m. And in like manner we find the blad-
der stittMilated by cantbarides, and the intestinal canal by pui^-
tives ; and we may hence conjeclure that every other part o^ the
spteoi, where any khid of secretion is going forwards^ is endowed
with a Mke peculiarity ol' irritability sod sensibility, though not suf-
ficiently keen le attract our attention.

It H hence we meet with that surprising variety of secretions
which are furnished not only by different, but even by tbe same
SBunal in dUbreut parts of the body. Hence sugar is secreted by
the stomach, and sometimes by the kidneys ; sulphur by tbe braia ;
was by the ears; Hme by the salivary glands, tbe secretodesofthe
henea, and, lo a state of disease, by the lungs, tlie kidneys, the arte-
rtes, and the eibalants of tbe c^n : milk hy the breasts ; semen by
the testes ; the menatrual fluid by tbe uterus ; urine by the kidneys ;
bile by the Uver; muriate of soda by the seeements of almost ever)'
organ ; and sweat from every part of the surface.

Hence some animals, as tbe bee, secrete honey ; others, as tbe
coccus t/fctt, a lai^e store of wax ; others, as the viper and scor-
pion, gum which is the vehicle of their poison : others thread, as
the spider and some species of slug ; and nmoy silk, as the silk-worm
and the pinna, or nacre; whence Reamur denominates the pinna
the sea-silk-worm : it is common to some of the Italian coasts, and
its silky beard or byssus is worked at Palermo into very beautiful
silk stu£&. There are great numbers of worms, insects, and fishes
that secrete a very pare, and some of them a very strong phospho-
rescent light, so as, in some regions, to enkindle the sea, and in
others the sky, into a bright blaze at night Many animals secrete
air; man hiijDself seems to do so under certain circumstances, but
fishes of various kinds more largely, as those furnished with air-

* Comment, de CsncsUiesi, 4794.
t Vol. Ill, Physiol. Proem, p. 12.

198 FHTSIOLOGICAL PROEM. [cL. TI.

bladders which thej fill or exhaost at pleasure, and the sepia or
cuttle-fish, with namerous other sea-worms ; and by this power ther
raise or sink themseiyes as they have occasion. The cnttle-fidk
secretes also a natural ink, which it evacuates when pursued by aa
enemy, and thus converts it into an instrument of defence ; for by
blackening the water all around it obtains a sudicient concealment
and easily effects its escape. Other animals, and these also chiefly
fishes, secrete a very large portion of electric matter, so as to
conrert their bodies into a powerful battery. The torpedo-ray was
well known by the Romans to possess this extraordinary power :
and the gymnotos eUctricus (electric eel,) has since been discovered
to possess it in a much larger proportion. The genus tetradon In
one species secretes an electric fluid, in another an irritating fluid
that stings the hand that touches it, and in a third a poisonous
matter dmused through the whole of its flesh.

From the same cause we meet with as great and innumerable a
rariety of secretions among plants, as camphors, gums, balsams,
resins : and, as in animals, we often meet with very diflierent secre-
tions, in very different parts of the same plant. Thus the mmosa
niloHca secerns from its roots a fluid as offensive as that of assafoe-
tida I in the sap of its step an astringent acid ; its glands give^ forth
gum arable ; and its flower an odour of a very grateful fragrance.

.This subject is highly interesting, and might be extended to
volumes, but we are already digressing too far. There is no part
of the body in which the process of secretion is not going forward:
we trace it, and Consequently the fabric which gave rise to it, in
^e parenchyma or intermediate substance of organs, in their inter-
nal surfeces and outlets, and on the external surface of the entire
frame : thus forming three divisions Of prominent distinction, both
in respect to locality and to the diseases which relate to them.
It is on these divisions, that the orders of the present daas are
founded.

CLASS VL
ECCRITICA.

ORDER I.

MESOTICA.

mmuntn afferifng tlie ^vtnthwm.

fKkWm IN TRC ^UAHTITY OR QUALITY 09 THE INTERMRDfATE OR COIC'-

irccnirG substance of organs; without inflammation, fever, or

OTHER DERANQBMENT OF THE GENERAL HEALTH.

The classic term eccritica is a derivative from mz^tw^ ^ secemo,^^
*• exhaiirio,'' ** to secern or strain off," " to drain or exhaust," and
is preferred by the author to any other derivative which jk^hiv, its
primitive, affords, as equally applicable to the two systems of vessels
fbrnt enter into the general and important economy illustrated in the
preceding Proem. The ordinal term mesotica is derived from
M^fy " me<ttu8 ;" for which *parenchymatica might have been sub-
stituted, but that 'there are two objections to the use of the latter t
te first is that wm^» is here employed in a different sense from its
general signification in the system before us,^ which is that of
** male,^' or '^ perperam," — instead of per or penitus^ its real mean*
ing in parenchyma ; and, consequently, the double signification
would trench upon that simplicity and uniformity which it is the
^rect object of the present nomenclature to maintain. The second
objection is, that the term parenchyma (jira^tyx^f**) i^ formed upon
a false hypothesis invented hy Erasistratus, who first employed the
term, and held that the common mass or interior substance of a
viscus is produced by concreted blood, strained off through the
pores of the blood-vessels which enter into its general structure or
membranes.
The order embraces the five following genera i —

I. POLYSARCIA. CORPULENCY.

If. emphyma. tumour.

III. PAROSTU. MIS-OSSIFICATION.

IV. cyrtosis. contor;j[ion of the bones.
V. osthexia. osthesy.

200 £CCRIT)CA. [Ct. TI.-OIL I.

GENtFS I.
POLYSARCIA.

FIRM AND UNWIELDY BULKINESS OF THE B0D7 OR ITB MEMBERS, VROH
AK ENLARGEMENT OF NATURAL PARTB.

•

PoLTSARciA from wX9«rm^»H^ ^^carnosus," '^caroe alxindaDs,'' im*
ports bQlkiness from any morbid increase of natural parts, whether
fleshy or. adipose : and the present genos is co-extenoive with this
latitude of interpretation. In mescal history, however, we know
of no morbid increase of this kind except from an accunnilation ef
fat : and hence the genus is at present Ufliltad to a tiogle specif
as follows :

1. ADIPOSA. OBESITY.

SPECIES I.
POLYSARCIA ADIPOSA.

BULKINESS FROM A SUPERABUNDANT ACCUMULATION OF FAT.

This species admits of two varieties. For it may be

K Generalis. Extending over the body and limb&

General obesity.

C Splanchnica. ConfiDed to the organs or inte^u-

Splanchnic obesity. ments of the trunk.

In man and other animals fet is collected in the follicles of the
cellular membrane, accumulated in the groin, axilla, omentum,
around the kidneys^ and the blood-vessels. It is likewise secreted
on the surface of the skin, which it protects from acrid substances,
and where it sometimes concreted, often from want of cleanliness,
or being intermixed with hardened mucus, in the shape of minute
worms, forming the varus punctatus^ or maggot-pimple, of the third
Order of the present Class. When the perspiration becomes pro-
fuse in consequence of bard walking or other exercise, a certain
portion of animal oil is dissolved in this fluid which makes the chief.

i}B.1.-5P.I.] EXCERNENT FUNCTION. 201

perhmps the only difference between the matter of perspiration and
that of sweat Fat is, hence, accamalated by diminished perspira-
tion ; as it is also by the nature of the aliments fed on, and from
idiosyncrasy. It is the basis of steatomatoas tumours, and contains
the sebacic aidd which acts readily on many metals as lead, copper,
and iron.

In many fishes, as the salmon and herring, it is diffused over the
whole body, as though the body were steeped in it. in other genera
of fishes, as the ray, it is found in the liver alone. In some few, as
the whale, it appears in the form of flakes, and is called blubber,
which sometimes amounts to the enormous quantity of three tons
In an indiTidiial.

Fat is a bad conductor of heat ; and hence, one of its uses is that
of keeping the body warm ; on which account those who are in-
canberod with fat perspire with but a small quantity of exercise,
and are almost always too hot. We may hence also see why the
war»th of the body is retained by oiling the surface, or wearing
<^led skin over it Fat is also of considerable use in lubricating
the solids, and facilitating their movements ; in preventing exces-
aive sensibility; while by equally distending the skin, it contri-
butes, when not in excess, to the beauty of the person. In cases of
extreme hunger, or of abstinence from food, fat is re-absorbed and
carried to the blood-vessels; and from an experiment of Dr. Stark,*
it appears to be more capable of supplying the waste of the body
than any sort of ordinary food. And hence, there is much proba-
bility in the conjecture of Lyonet that insects, destitute of blood,
derive their chief nourishment from the fat in which they abound.f

With the exception, however, of the earth of the bones, it is the
least animalized of all the substances that enter into the composition
of the animal frame. Chemically examined pure fat contains no
azote, which is the peculiar characteristic of animalization ; it has
also little oxygene, consisting chiefly, indeed, of hydrogene and
carbooe. ^^ 1 do not consider,^' says Mr. John Hunter, ^^ either the
&t or the earth of bones, as a part of the animal : they are not
aoimal matter : they have no action within themselves : they have
not the principle of life.^^ It is of late formation in the fetus :
scarcely any trace of its existence is discoverable before the fifth
nooth from conception.

The mode of its production is still a matter of controversy. By
some it has been supposed to be secreted by peculiar glands, by
oCbers merely to transude from exhalant arteries of a peculiar kind.
Sir Ererard Home has lately started another hypothesis, which is
at least highly' ingenious and plausibly supported. He has attemp-
ted to prove that the fat of animals is produced in the lai^er inr
testines, (especially the colon,) out of the recrement of the food and

* Howioii, II. p. 151.

i Tr. Aomt. de Im chenille qui rouge le boiit de Mule, pp. 42S. 4S3, et teq.
X On Blood, p. 440.
vor- IV. tS

202 BCCRITICA. [Ct, Y1»*«<W« I.

the bile, and afterwards coDveyed into the system goQemllj by
chaDDels yet undiscovered to contribate towards the coisniop growth
of the system, especially in early life.* And sooie arguments in
favour of this opinion may be drawn from the nature of that tpedle«
of ENTERouTHus, to which in the present system is gfyeo the name
of scy balum, and from the observations with which it has been UIii»«
trated.t

In general obesity, or the variety of adipose polysarcia irnine-
diately before us, the bulk of the body has sometimes been eaoiw
mous. It has amounted to five hundred, and nearly six hundred pounds
in many instances. Bright, of Maldon, weighed seven hundred and
twenty-eight pounds; Lambert of Leicester, seven hundred and
thirty-nine pounds a little before his death, which was in the for-
4eth year of his age. The German journals give us examples ef
men who weighed eight hundred pounds. Yet the Philosophical
Transactions furnish perhaps a still more extraordinary example of
this disease in a girl that weighed two hundred and fif^r-slx pomida
though only four years old4

Where a powerful adipose diathesis prevails, fkt is often predno*
ed whatever be the food fed upon. Ale and porter drank to exce9l^
are, perhaps, the most ordinary means ; Akermann gives prooA of.
the same effect from spirits :§ and in the EpheiQera of Natural
Curiosities is the case of an individual who generated fat flMler,
and in lai^er quantities, upon bread than upon a meat diet.|| Indo-
lence and an indulgence in sleep seem necessi^ry, however, in everj
instance.

In these cases the animal oil is sometimes secreted and deposited
in the cellular membrane almost as rapidly as water in anasarca : on
which account obesity has by some writers been called, and eor>
rectly enough, a dropsy of fat. It is in fact under particular circum-
stances the soonest formed and deposited, and the soonest ahsoi^^ed
of all the animal secretions. For its formation, however, ease oT
body and mind are indispensable, and perhaps a slight increase in
the flow of sensorial power beyond the common standard, or what
has hitherto been the standard of the individual. It is on this ac*
count those are apt to become fat who suddenly relinquish a habit
of hard exercise either of body or mind for a life of quiet enjej*
ment, provided the change be not sufficient to interfere with the
general health. And for the same reason, as we have alrea<fy ob-
served, animals which are castrated, and females that do not breed,
or who have just ceased to breed, grow fat and corpulent witk equal
ease ; the sensorial power intended for the use of the sexual organs,
and to be expended at h particular outlet, being hereby thrown

• Phil. Trans, for 1813. p. 15$. «nd 1816. p. 301.

t Vol. I. p. 191.

% N. 186.

« Baldinger N. Mag. B. vi. p. 489.

II Dec. III. Ann. vii. vni. p. 138.

G& L-4F. l] EXCERNENT FUNCTION. 203

ImmIc «pOD the syitem fenerally, and transferred to the adipose se-
ceraeDts. And hence, also, the cause of that increase of bulk which
moU persont eiperieoce aboat the middle of lif<p, when the muscles
luiTli^t attained their utmost firmness, the stature it5s full height, and
the sexual economy its perfection, there is a less demand for the
ordtoiuy supply of sensorial power than has hitherto been made
and the surplus is expended in broadening and rounding the general
frame by filling, up the cells of the adipose membrane with animal
oil. instead of elongating it.

For all this, however, there must be an ease of body dnd mind
Approaching to cheerfulness ; on which account plumpness, and
.cheerlhlness, or good humour, are commonly associated in our ideas:
fyr palo and anxietv^ that wear away the corporeal substance gene-
rallv, mabe their first inroad on the animal oil, and empty the cells
af liie adipase membrane before they produce any manifest effect
an the arascular fibres, or, as tliese are collectiTely termed, the
flask i upon which subject we hare already touched in discussing
•evei^il of the ^>ecies of the genus BiAiusif us.*

Uaace the ftit beeomes absorbed or carried off, as it is secerned
aid deposited more readily than any other animal substance. By
•waatiQjg, horse-riding, and a spare diet, a Newmarket jockey has
aot aofreqaentlj reduced himself a stone and a half in a week or
tao days :t and a plump widow has, by weeping, become a skeleton
in a moBth or two.

▲ moderate increase in the secretion of animal oil rather adds to
tha (a^ity of motion, and Improves the beauty of the person. But
if It DMCh exceed this, the play of these different organs upon each
other k impeded, the pulse is oppressed, the breathing laborious,
there is an accumulation of blood in the head, a general tendency
to drowsiaest^ and a perpetual danger of apoplexy.

la iTLAUcmrtc OBtsirr, the encumbered viscera are more or less
buied ia beds of fat, and usually accompanied with scirrhous affbc-
tioDt ; aiaking an approach to some species or other of parabysica, as
deacfibed ia the fint Class and second Order of the present system.]:
We have observed that general obesity may be regarded as a dropsy
of animal oil instead of a dropsy of water. And, t as the latter dis-
ease is sometimes universal and runs through the whole of the cel-
Mar sabstance, and at others local, and confined to particular cavi-
tiasy the former also exhibits bojth these modifications ; and in the
rariety before as, is confined to individual organs.

It most generally overloads the omentum, and gives that project-
iag rotundity to the abdomen which is vulgarly distinguished by the
name of roT-aeLLV, and is well described by Prince Henry in his

• Vol. II. p. 494.

t Code of Health, bj Sir John Staclair, &c.

t Vol. I. p. 273.

204 ECCRITICA. [CL. TL^OR* h

address to Fcrktafi; as '^ a huge hill of flesh,'''*' — ^^ a globe of aiafol
contineDt8."t

Animal oil is more apt to accumulate la the abdominal viscerm
than on the surface, and hence while these organs always partici-
pate in a general obesity, it is not to be wondered at that they
should sometimes be loaded alone. As it has been stated that free-
dom from pain is necessary to its accumulation, it may, perhaps, be
a matter of surprise that schirrosities should be a concomitant Bat
this morbid condition takes place so slowly as to produce little or
no local disquiet; while the small degree of increased irritabili^
that accompanies their formation, for a reason already assigned^
tends rather to promote the morbid deposit than to prevent.it

In attempting a cure of the general disease, the first step is im
avoid all the common and more obvious causes as much as possible^
Hence, as a life of indolence and indulgence in eating and drinking
is highly contributory to obesity, the remedial treatment should
consist in the use of severe, regular, and habitual exercise, a hard
bed, little sleep, and dry and scanty food, derived from vegetables
alone, except where, from a singularity of constitution, farinaceooB
food is found to be a chief source of obesity. And where these are
insufficient, we may have recourse to frequent venesection and such
medicines as freely evacuate the fluids whether by the bowels or
the skin. And, for the same reason, sialogogues, as chewed tobac-
C04 and mercury, have occasionally been used with succe88.§

uenerally speaking, however, the diet and regimen just recom-
mended with a spare allowance of water will be sufficient to bring
down the highest degree of adipose corpulency. Of this we have
a striking example in the history of Mr. Wood, the noted miller of
Billericay in Emcx. Bom of intemperate parents, he was accus-
tomed to indulge himself in excessive eating, drinking, and indolence,
till, in the forty-fourth year of his age, he became unwieldy from
his bulk, was almost suffi>cated, laboured under very ill healtii from
indigestion, and was subject to fits of gout and epilep9y. Fortunately a
friend pointed out to him the Life of Comaro : and he instantly de-
termined to take Comaro for his model, and if necessary to surpass his
abridgments. With neat prudence, however, he made his change
from a highly superfluous to a very spare diet gradually : first dimi-
nishing his ale to a pint a day, and using a much smaller portion of
animal food ; till, at length, finding the plan work wonders as well
in his renewed vigour of mind as of body, he limited himself to a
diet of simple pud&dg made of sea-biscuit, flour, and skimmed milk,
of which he allowed himself a pound and a half about four or five
o'clock in the morning for his breakfast, and the same quantity at

• Henry iv. Part 1. Act. n.

t Id. Part n. Act n.

% Borelli, Cent. 11. Obs. 11.

} Bartholin. Act. Hafh. I. Obs. 74.

Bonet, 8epulobr. Lib. Ii. Sect. ii. Obs. 36. Appz.

GJB. I.-0P. I.} EXCERNENT FUKCTION. 205

noon for his Amer. Besides this he took nothings either of solids
or floids, for he had at length brought himself to abstain, even from
water ; and found himself easier withont it. He went to bed about
c%ht or nine o^clock, rarely slept for more than five or six hours, and
bence rose nsnaliy at one or two in the morning, and employed him-
self in laborious exercise of some kind or other, till the time of his
break&st. And by this regimen he reduced himself to the condition
1^ a middle sized man of firm flesh, well coloured complexion and
sound health.* A like plan, or rather something approaching it,
the present aothor once recommended to Mr. Lunbert of Leices-
ter on being consulted concerning the state of his health. But
either he had not courage enough to enter upon it, or did not chuse
to reHmfuisb the profit obtained by making a show of himself in
this metropolis. He made his choice, but it was a fatal one, for he
foil a sacrifice to it in less than three years afterwards.

The local disease is for the most part for less manageable : but it
kas sometimes yielded to a steady perseverance in the above plan,
In collection with active purgatives, and the application of mercu-
rial diitaient to the vicinity of the organ affected ; or a free use of
calomel in the form of pilb.

GENUS 11.

EMPHYMA.
ITumimr.

ULOMK&ATION IN THB SUBSTARCB OF OROAKS FROM THE BRODVCTIOll Off
KSW AU> ADSCmTIOUS MATTER: SENSATION DUIX, GROWTH SLOGOtfH.

Phtka, in the present system, is limited ,to cutaneous tumours
accompanied with inflammation, as already explained in Class m.
Order u.t Emphyma imports, in contradistinction to phyma, a
tumour o^ginating below the integuments, and unaccompanied with
inflammation, at least in itb commencement: while ecphyma in
Order m. of the present Class, imports, in contradistinction to both,
mere superficial extuberances, confined to the integuments alone.
The term glamtraiion^ or ^^ heaping into a balV^ in the generic
definition, is preforred to the more common terms protuberance or
extuberanee^ because some tumours or emphymata lie so deeply
seated* below the integuments as to produce no prominence what-
ever, and are only discoverable by the touch.
-- ' — — .^

• Med. Trans. Vol. ii. Art. xvii.

t Vol. n. p. 190.

206

ECCRITIGA.

[CL. VIi-HOR< I.

The 8peci«8 of Mb Order, and mach of their geiftral cfanniotar
and arrangeaieDt, are takeo with a few rariationi from Mr. Aber-
nethy^ Taluable Tract on Tomours.

1 he subject^ indeed) thouffb of a mixed description, is commoiilj
regarded as appertaining rather to the province of sargerj than of
medicine, from the tendency which most tumours seated on or near
the surface have to open extemaHy, or to call for some manual
operation. In a g;enerai system of the healing art^ howei^er, it is
necessary to notice them, though it is not the authors intention to
dwell upon them at length ; hot rather to refer tlie reader, from the
few hints he is about to pursue, to Mr. Abemethy^s woric, at tlie
best comment upon them which he can consult.

The species embraced by the genos phtma are the followhig :

1. EMFRTIIA Sl&COMA.
g. — _- ENCYSnS.
3. ■ EXOSTOSIS.

SARCOMATOUS TUMOUR.
ENCYSTED TUMOUR. WEK.
BONY TUMOUR.

SPECIES I.

EMPHYMA SARCOMA.

TUMOUR immoveable; FLESHY AND FIRM TO THE TOUCH.

The yarieties of this species, modified in respect to structure and
situation, are rery numerous. The following, distinguished by the
former quality, are chiefly worthy of notice :

• Camosum.
Fleshy tumour.

C Adiposum.
Adipose tumour.

y Pancreaticum.
Pancreatic tumour.

Vascular throughout : texture simple :
when bulky mapped on the surface
with arborescent veins. Found orer
the body and limbs generally.

Suetty throughout : inclosed in a thia
capsule of condensed cellular sub-
stance : connected by minute vesaels*
Found chiefly in the fore and back
part of the trunk.

Tumour in irregular masses ; connect-
ed by a loose fibrous substance, like
the irregular masses of the pancreas.
Found occasionally in the cellular
substance, but more usually in con-
voluted glands : chiefly in the female
breast.

COS* &-»•!.]

Cyttoie toBOiir.
D<Brbj8hire-neck.

EXCERNENT FUNCTION.

207

t Sdnrhofoin.
Schrbont toinoar.

^ BlMBmariQiii.
Mammary tumoar.

n Tqbercnlosiim.
Tuberculous tumour.

Tumour cellulose or cystose : cells
oval, curraot-flized or grape-dzed,
coDtaifiiug a serous fluid ; sometimes
caseous. Found generally, but most-
ly, ID the thyroid g4and, testis, and
ovarium.

Hard, rigid, vascular, infkrctlon ef
glandular follicles ; indolent, insen-
tient, glabrous ; sometimes shrink-
ing and becoming more indurated.
Found in glandular structures, chiefly
those of the secernent system.

Tumour of the colour, and assuming
the texture of the mammary gland :
dense and whitish : sometimes softer
and brownish: often producing, on
extirpation, a malignant ulcer with
indurated edges. Found in various
parts of the body and limbs.

Formed of firm, round, and clustering
tubercles ; pea-sized or bean-sized ;
yellowish or brownish-red ; when
large, disposed to ulcerate, and pro-
duce a painful, malignant, and often
fatal sore. Found chiefly in the lym-
phatic glands of the neck : often
simultaneously in other glands an^
organs.

Of a pulpy consistence and brain-like
appearance ; whiti^ ; sometimes
reddish-brown ; when large, apt to
ulcerate, and produce a sloughii^,
bleeding, and highly dangerous,
sore. Found in different parts ;
chiefly in the testes : at times pro-
pagating itself along the absorbent
vessels to adjoining oi^ns.

All these grow occasionally to an enormous size, particularly the
sarcomatous, the adipose, and the scirrhous. They are all pro-
duced by some increased action or irritation in the part in which
they occur, the cause of which it is rarely in our power to ascer-
tain. In general, they commence slowly and imperceptibly, and
are seldom accoapaoied with much pain whatever be the ex-
tent of their growth. They are all more or less organized through
the whole of their structure, by which they are particularly distin-
guished from those of the next species : and it is highly probable
that most of the irritating causes which produce any one, produce
all the rest, the modification depending on the dinerence of site.

1 Hedullare.

Medullary tumour.

208 fiocRmcA. [cL. TI.-OE. r.

habit, idiofyncraqT) or local misaffection. Id their formatioD, how-
ever, there seems to be a (greater tendeDCj to iDflaimnation, and es-
pecially adhesive iaflaminatioD m the fleshy tumour, or proper sar-
coma, than in aoy of the rest ; and, from the more perfect elabora-
tion of its fabric, there is no other form that maintains itself so
firmly, or is removed, excepting by excision, with so much difficul-
ty. The ong^n of the adipose may, in some degree, be understood
from the remark we have olTered under the last genus, and particu-
larly under its second variety.

The scirrhous tumour, when irritated, has a general tendency to
run into a cancerous ulcer : for which it is not always easy to ac-
count, excepting where there happens to be an hereditary taint in
the blood : for neither the tumour nor its ordinary result, as we ob-
served when treating of carcinus, is by any means confined to a
glandular or to any particular structure, though the secernent glands
constitute its most common seat. In Mr. Abemethy^s Treatise, the
place of the scirrhous tumour, however, is occupied by another to
which he gives the name of carcinoma, which, in the present sys-
tem, is regarded as a modification of the scirrhus, degenerated, and
ulcerated mostly by a cancerous diathesis ; and in such case apper-
taining to CARCINUS, already described in the fourth order of the
third class;* or where no such' diathesis is present, belonging to
the same class and order under the genus and spiles vix)vs vitir
OMfin.t

The scirrhous tumour is, in fact, the most important of the
whole tribe, not only as leading, under peculiar circumstances, and
ID particular habits, to the most fatal result, but as being more com-
mon to every organ than any other variety whatever; and, in a few
instances, common to almost every organ collectively or at the same
time.J

. The other varieties are looser and more spongy, and contain far
less of living power : in consequence of which they are more easi-
ly disposed to ulcerate, and, when in this condition, oAen spread
and become sordid and malignant from debility alone.

We have said that the tumours of this species will sometimes
grow to a vast and preposterous bulk. Thb is particularly the case
with the first variety or fleshy sarcoma, and more especially when it
seats itself in the scrotum forming the sarcocele, or hernia carnosa of
authors. Negroes are particularly subject to this affection, and in
one instance the tumour weighed fifty pound8.§ It is said that
among them the disease is more common to the right testicle than
to the left. StoU, however, has asserted directly the contrary so
far as relates to Europeans, and his remarks are supported by the
observations of Pfeffinger and Friedius. He has moreover general-

♦ Vol. II. p. 534.
t Vol. II. p. 616.

% Henggen, Museum der Heilkunde, Band. ii. p. 111.

* Schotte, Phil. Trans. Vol. Lxxiii, 1783.

GIU U.-SP. I.] £XCERN£NT FUNCTION. 209

ised his awertioii by contendiog that the left oyary of women as well
as the left testicle of men is more subject to diseases of all kinds
than the right.*

The adipose tumour is also frequently of a very large magnitude.
Mr. Abernethy eives an instance of one on the thigh that weighed
fiAeen pounds aUer extirpation,! and M. Leske of another of the
weight of nineteen pounds dissected from the face.]; In the Jour-
nal de Medicine, is an account of a third, that weighed not less than
forty-two pounds.§

The bulk of the scirrhous tumour, however, and especially when
seated on the breast, has often equalled and sometimes exceeded the
largest of these. M. Leske,,indeed, gives a case, in which a tu-
mour of this kind was amputated from the breast, of the enormous
weight of sixty -four pounds, that had been increasing for years, and
was at last so oppressive as to endanger the patient^a life.||

The most unsightly, however, of the whole is the sarcoma cellu-
losum^ when it fixes in the thyroid gland in which situation it is often
called Botium, Bronchocele, or Goitre ; and, in our own vernacular
language, derbyshire-neck, from a vulgar idea, of considerable anti-
quity, that the inhabitants of this county are more subject to it
than those of other districts. The cells are here very numerous,
the fluid often viscid, and sometimes gelatinous ; so that, when the
tumour bursts, as it occasionally does, spontaneously, the contained
fluid is apt to drain away very slowly, and has ulcerated with a
large sloughy surface without having half evacuated its contents.

Most of these may be frequently repressed or resolved if disco-
vered and attended to on their origin. The fleshy, which always
commences with some degree of inflammatory action, should be vi-
gorously attacked with leeches, repeated as often as may be neces-
sary, and afterwards with astringents or alterants, as the dilute solu-
tion of the superacetate of leatl, for the former purpose, and the
mercurial emplaster for the latter. An issue or seton in the vicinity
will also frequently assist by producing a transfer of action. If this
plan do not succeed the tumour should be extirpated by the knife
without loss of time, or allowing it to acquire any considerable
bulk.

The scirrhous tumour is usually indicative of weak, instead of
entonic, action in the organ in which it makes its appearance, in
consequence of which the lymphatics absorb only the more attenu-
ate part of the secerned fluids, and leave the grosser which thick-
en and harden in the parenchyma. There is little irritation at first,
but as the distension and obduration increase, the part becomes
stimulated, and, as we have already observed, in a scrophuious can-

• Nov. Act. Physico-Med. Acad, Nat, Cur, Tom. iv. Norim,
t On Tumours, p. 31. 8vo. 1814.
f AuterlesMM AbbandluDgen, &c. Leipzig, 1774, 8vo.
i Tom, XX. p, 551.
H Op. citat.
VOt. Pr. 27

210 ECCRITICA. [CL. VI,-OR. U

cerous diathesis is apt to Call the latent semiDium into action, when
the hardened tumoar degenerates into a foul ulcer. In an eartjr
stage the J have yielded to local irritants, which have a tendency to
excite an increased action, and of a new kind, and hence the ad-
vantage of mercurial applications, or emplasters of the gum-resins :
and particularly the emplaster of ammoniac with quicksilver which
unites the two, and is an admirable preparation. Where, indeed,
the irritation is already considerahle the more direct of these sti-
mulants must be abstained from, and the inirritants and narcotics
may be had recourse to with more advantage, as the preparations
of lead, acids of almost every kind, and cataplasms of hemlock,
henbane, bella donna, or potatoe-leanes. But here also the best
and most e£fectual relief is to be had in extirpation, and the actual
cautery as employed by M. Maunoir* will often be found more effec-
tual and even produce less pain than the knife.

Many of these varieties of tumours on their first appearance, may
be repelled by stimulant applications in conjunction with a stea<^
pressure wherever this can be applied ; for, with the exception of
the first, there is little tendency to inflammation in any of them, and,
in the greater number, a decided weakness of the living power.
They are often, indeed, connected with constitutional debility, and
hence appear simultaneously in di£ferent parts of the body. Ex-
tirpation in this case is useless ; at least till the general irame is .
Invigorated by a tonic regimen and course of medicines. And even
then from the peculiar seat or size of the tumour it will not al-
ways be found adviseable.

This is particularly true in that variety of the cystous sarcoma
which is denominated bronchocele, corraE, or derbyshikb-xeck;
and wliich usually proceeds from an enlargement of the thyroid
gland. It is mostly found in females, and in its commencement the
patient and her friends always turn a deaf ear to the use of the
knife, under a hope that it may yield to a course of external and
internal medicine : nor is the tumour, indeed, at all times suffi-
ciently defined from the first for any effective ase of cbirurgical
means, h originates without pain or any discoloration of the skin,
and presents a general prominence on the fore part of the neck,
that rises so gradually as to be at first almost without an outline.
As the prominence increases it becomes harder and somewhat ir^
regular, commonly with a partial feeling of fluctuation, though. In
some instances, the tumour appears to be firm throughout The
skin grows yellowish, and the oppressed veins of the neck become
varicose ; the respiration is sometimes rendered difficult, and from
the same cause the patient is troubled with bead-aches. The ex-
pediency of removing the tumour is, at this time, highly questiona-
ble, and every day increases the difficulty from the growing diame-
ter of its arteries and their proximity to the carotids.

* See Vol. u. p. 617.

GE. IL^-SP. I.] EXCERNEKT FUNCTION. 211

Tlie interaal tohstaoce and strocture of this tumoar dMfera ez-
ceediDf Iv ID diierent cases. It 1^ sometimes been foond steato-
Vfttous throoghout bat more iteDerally, as we have already ob-
serred, coosists of a fluid rarjing in viscidity, and in the number of
cells, or capsales in which it is locked up. It commonly first shows
itself in giris who have reached the age of puberty, though it fre-
quently commences at a later period ; and is an ordinary symptom
of cretinism, as we shall notice when treating of th it disease in the
conrse of the present order.

Here also we iiave deficient Hying power in the organ affected,
and very fifene rally in the entire constitution : for it usually appears
in i^rls of relaxed and flaccid fibres, in many cases partly debilita-
ted by growth, and partly by a larger flow of catamenia than the
general tone of the system can sustain without yielcKng. On this ac-
count we may see why cretinism should be a cause.

Stimulants and tonics have hence been found generally useful, as
hare aho repeated and long continued friction with the hand over
flie area of tne tumour, alone or in conjunction with ammonhical or
terebinthinate irritants, chiefly solutions of camphor in spirits. For
a reason that does not seem hitherto to have been sufficiently ex-
plained, fa) this kind of tumour, as in those of scrophula, the most
Successful stimulants are the alkalies : and of these the ammoniacal
were at one time believed to be far more so than any of the rest ;
and hence the patient was limited altogether to a course of burnt
sponge cff burnt hartshorn, and at one time to burnt toads. There
does not seem, however, to be any particular reason for this pre-
dilection, and hence In the present day the subcarbonate of ammo-
nia, or the carbonate of soda hare been pretty generally allowed
to supply the place of all the other preparations of this kind, as the
most convenient form in which the alkali can be giren. It is also
recommended to be applied externally, in the form of sea-water, or
the bibulous sea-plants, as already described in the treatment of
scrophula :* tk% whole of the remedial process for which may be
adopted as the fittest line of conduct on the present occasion : both
diseases being chiefly seated in the glandular )>arts of the animal
frame, and accompanied with great indolence in the lymphatic
system.

The tumour has sometimes been cured spontaneously, an in-
stance of which occurred not long ago to the present author, in a
young lady who had for six or seven years been successively under
the care of all the most skilful physicians and surgeons of tliis me-
tropolis, and who had nevertheless the mortification of findii^ the
protuberance grow much larger, and more unsightly in spite of
victions, and Misters, and setons, and mercury in every form, and
the alkalies, and hemlock an^ hyosciamus, employed jointly or al«
temately, and in almost every proportion through the whole of this
period. The distended skin at length gave way in various places

• Vol. u. p. 580.

212 ECCRITICA. [CL. VI.-OK. 1'

and h tfain fluid ittaed from the ^ramina. This natural discharge
was encouraged, and the sac by degrees exhausting itself, the tu-
mour as gradually diminished, and at length completely disappeared.

SPECIES II.

EMPHYMA ENCYSTIS.
Sncsistetir Sumour* Wtn.

TUMOUR MOVEABLE ; PULPY ; OFTEN ELASTIC TO THE TOUCH.

A VERY small change in the power or mode of action of a secernent
vessel will often produce a very considerable change in the nature
of the fluid which it secretes. Of this we have a clear proof in the
thin and acrid lymph poured forth from the mucous membrane of
the nostrils in a catarrh, and the bland and viscid discharge which
lubricates this cavity in a state of health ; limpid and mucilaginous
at flrst, but gradually hardening into a horny substance. So the
lungs, which, when sound secrete a mild, when in a morbid condi-
tion throiv out a tenacious, phlegm, a watry, or whey-like sanies^
or a muculent pus. And we may hence easily account fo^ the great
diversity of materials found in the species of tumour before ns^
which is peculiarly distinguished by being surrounded with a pro-
per cyst, and hence rendered moveable to the touch.

To follow up the subdivision through the whole of the varieties
it offers would be almost endless. The following are chiefly worthy
of notice : •

ft Steatoma.
Steatome.
Adipose Wen.

C Atheroma.
Atherome.
Mealy W^n.

^ Melliceds.
Honied Wen.

^ Ganglion.
Ganglion.

Encysted extuberance, containing a fatty or
suetty substance, apparently secreted from
the internal surface of the cyst. Found over
most parts of the body, and varying in size
from that of a kidney bean to that of a pump^
kin.
Encysted extuberance containing a mealy or
curd-like substance,'Soraetimes intermixed with
harder corpuscles : apparently secreted as the
last. Found of different sizes over most parts
of the bpdy.
Encysted extuberance containing a honey-like
fluid. Found of different sizes over most parts
of the body.
Encysted extuberance containing a colourless
^uid : the extuberation fixed upon a tendon.

QE. II.'^-SP. It. J EXCERNENT FUNCTION. 213

I Testudo. fiocyated extuberance contaioiog a floid reodilj

Horn J Wen, hardeniog into bora or nail : and especial! j

when protruded externally upon an ulceration
of the surrounding integuments.

Most of these are supposed by Sir Astley Cooper to be nothing
more at first than obstructed and enlarged cutaneous foltirles : the
sebaceous matter accumulating in the hollow of the follicle, which
is lined with cuticle, and expanding it oAen to a considerable extent
by pressure, in consequence of the mouth of the follicle becoming
plugged up or entirely closed. Where it is plugged up the
obstructed mouth is generally visible by a black dot, which is
carbonized sebacious matter. This being picked off or otherwise
'removed, a probe may often be easily forced down into the cavity
and the whole of the confined material be squeezed out by pressing
the sides of the tumour, even when of some inches in diameter, and
this with little pain and no indammation.'*' Such Sir Astley regards
as the general history of common encysted tumour seated on the
surface. Bui they will necessarily vary in their structure and
contents from a multiplicity of adventitious circumstances, and
perhaps also from idiosyncrasy.

The steatorae grows to a larger size than any of the rest. Rho-
dius gives a case m which it weighed sixty pounds :t and it has
been dissected of the weight of twenty six pounds from the sca-
pula.J

The ganglion is introduced into the present list from the parity
of its nature ; and in so doing the author has only followed the
example of Mr. Sharp. ' ^^ i'he ganglion of the tendon,^^ says he^
^^ is an encysted tumour of the meliceris kind ; but its fluid is
generally like the white of an egg. When it is small, it sometimes
di^>er8e8 of itself. Pressure and sodden blows do also remove it, but
, for the most part it continues unless it can be extirpated.^^§ It is
mostly produced by hard labour, or straining a tendon ; and hence
is peculiarly common to the wrists of washing-women. In many
instances, however, its exciting cause is unknown: and in some
cases it appears to be connected with the constitution. It is singular
that it should sometimes disappear, as it seems to do, during pregnan-
cy, and return afterwards. Plater records a case of tliis Idnd in the
ham, and Bartholine, in the Copenhagen Transactions, another on
the wrist.

The homy cyst is described by Vogel, under the name of testudo,
here adopted. Mr. Abernethy has glanced at it in his treatise, and
Sir Everard Home has more fully described nnd illustrated it In
his cases of homy excrescences on the human body, inserted in the

* Surgical Essays. By A. Cooper and B.Travers. Part. ll. 1819.
t Observ. Med. Cent. ill. Patav. 1657. 8vo.
X Fabr. Hildau. Cent. ill. Obs. 63.
S Surgery, chup. xxt. p. 12B.

214 KGCRITICA. [CL. TI.-aiL I.

Pbilosopliical TraosactioBS : a subject, however, which we shall
have occasion to return to when treating of lefidosis icthtusis, in
the third order of the present class.

I have stated that the ganglion is sometimes connected with the
habit or constitation, and the remark may be applied to terenl
of the other varieties. They have hence been found scattered
over the whole body ;* and in one instance appear to have beea
connate and hereditary.! Id these cases they will sometimes yield
to a general treatment or a change of regimen. Richter gives
examples of the cure of the steatome, one of the most (fifficalt to be
(^erated upon by internal means, by emetics ;| and Kaltschmid, by
a diet of great abstinence ;§ by which plan we have already observed
tiiat adipose corpulency is commonly capable of being removed, and
hence not unreasonably advised when there is a tendency to the
formation of adipose tumours.

Electricity, and particularly that of the voltaic trough, seems to
have been serviceable in removing many tumours belonging to tills
and the last species; and having omitted it in its proper place we
may here observe that Dr. £ason of Dublin has given an instance,
in which a hard scirrhous tumour was removed from the breast of
a woman who was struck to the floor, and for sometime deprived of
the use of her limbs by a stroke of lightning. It was observed to l>e
much softer almost immediately af\er the accident, and in a short
time totally disappeared, though it had for a long time resisted the
power of every application that could be thought of ||

For the rest the writers on practical surgery must be consulted,
and especially Mr. Sharp^s excellent Treatise, and Mr. Abernethy's
y?OTk already referred to.

SPECIES IIL

EMPHYMA EXOSTOSIS.

Hotifi ITitmotir*

TUMOUR INELASTIC, OFTEN IMMOVEABLE ; HARD AND BONT TO THE TOUCH.

These consist of calculous or bony matter ; and are sometiaes

* ODonnely Lond. Med. Journ, vi. p. 33.

t Vogel, Briefen ao Haller. i. Hundest.

X Chir. Bibl. Band. y.

i Pr. de Steatomau fame curato.

Comp. Girard, LMpioIo^e : ou Traits des Tumeiuri connues sar le nom des
Loupes. Paris 1776.

n Edin. Med. Comm. iv. p. 84.

6E« IL-SP. HL] EXCERNfiNT FUKCTION. 215

seated immoyeably on a bone, sometimes immo^eaUy on Ihe
periosteum, sometimes pendulouslj in a joint, sometimes either
moveabij or immoveably in some fleshy part of the bodj, thus
constituting the four foilowing varieties :

m Oitea. ImmoTeable; protuberant; seated

Osteous Tumour. on the substance of a bone.

C Periostea. Immoveable: protuberant; from a

Node. bony enlargement of the perios-

teum.
y Pendula. Bony tumour hai^;ing pendulous in-

Pendulous Exostosis. to a joint.

} Exotica. Bony tumour moveable or immove*

Exotk Exostosis. able, seated in some fleshy part

of the body.

Lime is one of the substances most easily secreted in tiie body of
alt animals. How far it may be formed in the body we shall liave
occasion to notice under the genus osthbxu, forming the fifth of
(he present order. We behold it at an early period of fetal life,
and, in old age when every other secretion has diminished or
^ied altogether, we are perpetually meeting with examples of a
morbid augmebtation of this in the coats of the blood-vessels, the
bladder, the brain, and various other org^ans, afflicting the closiiq^
Years of life with a variety of troublesome, and not unfrequently
highly painful disorders.

The FIRST VARIETY is found in most of the bones of the body, but
chiefly perhaps in the bones of the cranium : where they are some-
times excrescent, and composed of bony spicula resembling crystal-
lizations: sometimes exquisitely hard and glabrous, analogous to
ivory ;* no doubt from their being composed of phosphate in a great-
er measure than carbonate of lime.

According to their structure, Sir Astley Cooper has subdivided
these tumours into cartilaginous and fungous; and according to
their seat, into periosteal, when they commence between the ex-
ternal surface of the bone, and the internal surface of the perios-
teum; and medullary, when they commence in the medullary mem-
brane and cancellated fabric of the bone.t

This periosteal subdivision includes the second variety of the
present species : which is chiefly found as a symptom in lues, and
is commonly described under the name of nodes. In some instances
it has occurred as a sequel of acute rheumatism. And in both cases
its treatment must depend upon the nature of the disease to which
it appertains, and must form a part of the general plan, as we have
already observed when discussing these maladies.

Tlie THIRD and fourth variett are chiefly derived from Mr. Aber-

* Baillie, Morb. Aoau Fascie. x. PI. i. Fig. 1. 2.
t Surgical Essays, Treatise on Exostosis.

216 ECCRITICA. [CL. VI.-OR. I.

nethj^a classification. The difference of their form and mode of
union with the adjoining parts, depends chiefly upon the difference
of their seat. " A woman,'' says Mr. Ahemetby, "was admitted in
St Bartholomew's Hospital with a hard tumour in the ham. It was
about four inches in length and three in breadth. She had al«o a
tumour in the front of the thigh a little above the patella, of lesser
size and hardness. The tumour on the ham by its pressure on the
nerves and vessels had greatly benumbed the sensibility and ob-
structed the circulation of the leg so that it was very edematous.
As it appeared impossible to remove this tumour, and as its origin
and connexions were unknown, araputntion was resolved on. On
examining the amputated limb, the tumour in the ham could only
be divided by a saw : several slices were taken out of it by this
means and appeared to consist of coagulable and vascular substance,
in the interstices of which a great deal of bony matter was deposit-
ed. The remainder of the tumour was macerated and dried, and
it appeared to be formed of an irregular and compact deposition of
the earth of bone. The tumour on the front of the thigh was of
the same nature with that in the ham : but containing so little lime
that it could be cut with a knife. The thigh-bone was not at all
diseased."*

Of the general nature of the exotic variety we shall have to treat
under osthexia infarciens, of which perhaps it is only a modifica-
tion.

These in all instances are cases for surgical rather than medical
treatment, and are seldom to be cured e^ce^t by extirpation, and,
when this cannot be done, and the tumour is seated on a limb, by
amputation.

GENUS IIL
PAROSTIA.

BONES UNTEMPERED TS THEIR SUBSTANCE, AND INCAPABLE OF AFFORDING
THEIR PROPER SUPPORT.

Parostia is a compound from «*«(«, ^^ perperam" and mtio, ^^ os oa-
sis." The genus is new, but sufficiently called for. It included
two species connected by the common character of an inaccordant
secretion of some one of the constituent principles of the bony ma-

* Surgical Observations, Classification of Tumours, p. 102.

GE. 1II.-SP. I.] EXCERNENT FUNCTION. 217

terial, in consequence of which the substance is rendered top brit-
tle, and apt to break on slight concussions, or other movements, or
too soft, and equally apt to bend. These species are as follows :

1. FAROSTIA FRAGILIS. FRACIUTY OF THE BONES.

2. ■ FLEXILI8. FLEXIBILITY OF THE BONES.

SPECIES T.
PAROSTIA FRAGILIS. ^

:^rasflftfi of the Htmtn.

SUBSTANCE OF THE BONES BRITTLE AND APT TO BREAK ON SLIGHT EXER-
TIONS WITH LITTLE OR NO PAIN.

BovE, shell, cartilage and membrane, in their nascent state are all
the same substance, and originate from the coagulable lymph of the
blood, which produces both gelatine and albumen, probably as be-
ing possessed of a smaller or larger proportion of oxygene. Mem^
brane is gelatine with a small proportion of albumen to give it a
certain degree of firmness : cartilage is membrane with a larger
proportion of albumen to-g^ve it a still greater degree of firmness ;
and shell and bone are cartilage, hardened and rendered solid by
the insertion of lime into their interior : in the case of shell, the
lime being intermixed with a small proportion of phosphoric, and a
much larger proportion of carbonic acid ; and in the case of bone,
with a small proportion of carbonic, and a much lai^er of phos*
phoric acid. It is hence obvious that if the earthy and the animal
parts do not bear a proper relation to each other, the bone must be
improperly tempered, and unadapted to its office : that if the earthy
or calcareous part be deficient, its substance roust be soft and yield-
ing ; and that if the animal part be deficient, or the calcareous part
in excess, it must lose its cohesive polver, become brittle, and apt
to break.

It is the second of these morbid states that forms the proximate
cause of the species before us, as the first forms the cause of the
ensuing species.

Parostu FRAGILIS is the fragilitas omtcm, or fragile vitreum of au-
thors, and is most frequently found as an attendant upon advanced
age. It is, also, occasionally to be met with as a symptom in lues,
struma, porphyra, and general intemperance ; and has been known
as a sequel of small-pox. In most of these diseases the blood be-
comes attenuate, and the coagulable lymph loses much of its visci-
dity. In old age the diameter of the bloodvessels becomes con-
tracted, all the secretions are separated less freely, and particularly

VOL. IV. 28

218 ECCRITICA. [CL. VI.-OIU L

that of animal oil ; and the grossest of them, and hence, particularly
the earthy corpuscles, are less freely ahsorhed, and consequently
accumulate. We are, therefore, at no loss to account for the in-
creased hardness and fragility of the hones under these circumstan-
ces ; nor for their tendency to hreak upon slight and sudden move-
ments. The author was onte present at a church in which a lady
nearly seventy^ years old, in good general health, hroke hoth the
thigh hones in merely kneeting down ; and on heing taken hold of
to be carried away,, bad an os humeri also broken without any vio-
lence, and with little pain. It was in the winter season, and ^be
cold might have added to the constitutional rigidity. From the ge-
neral inirritability of the system no fever of importance ensued, and,
under the influence of a warm bed, and a diluent but somewhat
cordial regimen, the bones united in a few weeks. Mr. Gooch
relates a similar case of fracture occasioned by a violent fit of
coughing.*

The common cause seems to consist in a general inirritability of
the system, and a torpitude of the absorbent powers, which, by car-
rying off only the finer and more attenuate particles, and su&ring
the grosser and particularly the earthy to accumulate, overcharge
the bones with this material.

Hence the best remedy is to be found in a plan of warm tonica
that may supply the system with something of the stimulus it stands
In need of, and in a free use of acids whether mineral or vegetadide,
that by their tendency to dissolve calcareous earths, may at least
diminish its introduction into the chyliferous vessels in the procAss
of digestion, if they do not reach the assimilating vessels of the bones
and lessen the separation or elaboration at the extremity of the nu-
tritive chain.

Of the mineral acids the sulphuric will generally be found pre-
ferable; it seldom gripes or nauseates, and almost always promotes
the action of the stomach when weak or indolent. It is hence, also,
an excellent tonic, and may be persevered in longer than any of the
rest The muriatic agrees in most cases with the stomach, but not
with the bowels, which always become more relaxed during its
use than where the other adds are employed. It is on this ao-
comit, however, peculiarly adapted to cases of habitual constipation.
The nitric acid, in a few idiosjrncrasies, has proved a very power-
ful tonic, as well as solvent of animal earth ; but in many cases it
disagrees with the stomach, and produces flatcdency, eructation, and
other symptoms of indigesdon. Where these cannot be employed,
we must have recourse to the vegetable acids, and especially the
citric, or tartaric, the last either in its pure form or in that of
creme of tartar. Lemons and oranges may also be taken c<^ioasly,
and the carbonic acid, combined with water by means of Nooth's
apparatus.

* ObMnratMot, Ice. Appondiz.

QE. III.HSP. U.] EXCERNfiNT FUNCTION. 219

SPECIES II.

PAROSTIA FLEXILIS.

SroSXAXCfi OF THE BONE SOFT AMD APT TO BEND AND BECOME CROOK-
ED ON SUGHT EXERTIONS WITH UTTLE OR NO PAIN.

Ton k the moUities omum of authors, formerly ^denomiQated spina
vmUo§tL, from its being first noticed on the spine, and a<H:omp«-
Died with protuberances which were supposed to proceed mm
inflation.

Its physiology has been given under the preceding species, with
which it is connected in the relation of contrast. As fragility of
the bones proceeds from an excess of osseous earth, JUxibiliiy
proceeds from a dbfidency of one or more of the elements which
constitute it. This deficiency may proceed from two causes, each
producing some peculiarity of symptoms, which we shall presently
illustrate by examples. For first, there may be too small a secre-
tioD or elidK>ration of calcareous phosphate to allow a sufficient
compactness to the bones ; and secondly, there may be an adequate
separation of the calcareous earth but a deficiency of the phospho-
ric acid which, we have already observed, is necessary to give it
fixation; in consequence of which it is often carried back in a
loose state into the circulation, and discharged as a recrement by the
kidn^ra or some other emunctory.

The disease is sometimes idiopatidc, and occurs sometimes as a
q^mptom of porphyra, diabetes, mid some forms of colic In direct
opposition to the precediag species, moreover, it is commonly
fomid in the earlier rather t£ui in the later periods of life, and lias
been observed, in infimcy. It has occasionally been detected in
qaadmpeds, and of the stoutest kinds, as the ox and the lion. It
& sometimes general, and sometimes confined to particular bones.

Tlie cause is coDsmonly obscure : it appears frequently to consist
in a morbid state of the digesti?e organs, but is seated, perhaps, as
often at die other extremity of the great chain of the nutritive
powers, in the assimilating or secernent vessels, where it must ne-
cessarily elude all detection. In the museum of Professor Proskas-
ka of Vienna, is a preparation of an adult who died of this disease,
in which all the vertebra are glued into one mass, the sacrum be-
ing scarcely distinguishable, and the ribs bent inward, and mariied
by the impression of the arms, which the patient was in the habit
of pressing forcibly against his sides. The whole skeleton Is ex-
tremely light This last fact is always the case from the absence

220 ECCRITICA. [CL. VI.-OR. I.

of so large a portion of animal earth. An analysis, by Dr. Bostock,
of the vertebrae of an adult female who died of the species before
us, indicated that the earthy matter was only one eighth part of
ijxe weight of the bone, instead of amounting to more than half^
which Dr. Bostock estimates to be its proper proportion in a state
of health.*

A singular case of this disease is given by Dr. Hosty, of Pa-
ris, in the Philosophical Transactions.! The patient, a married
woman, between thirty and forty years of age, was attacked by it
gradually, after several lyings-in and two falls on the side, which
gave her great pain over all her body but fractured no bone. The
first decided symptom was an incurvation of one of the fingers, ac-
companied with a very considerable discharge of bony or calcareous
earth by the urine which was loaded with it, and gave a copious
deposite. The incurvation by degrees extended to all the limbs, so
that the feet were at length bent upwards nearly to the head, but
without muscular contraction or fracture. The calcareous matter
at length ceased to flow towards the bladder, and seems to have
been transferred to the salivary glands, from which was discharged a
flux of dark discoloured spittle. All the functions of the body were
in a state of great disorder ; she had, at times, a very considerable
degree of fever, which was, at one period, accompanied with head-
ache, delirium, and subsultus tendinum. She died in about a twelve-
month from the commencenfent of the disease : and all the bones,
on being examined, were, found soft, and supple, though some of
them, as the ribs, were still in some degree friable. The scalpel,
with very little force, ran through the hardest of them. Nothing
extraordinary was found in the thoracic or abdominal viscera, but
the right hemisphere of the brain appeared to be one third larger
than the left.

In this case, the disease evidently commenced in the bones them-
selves, and seems to have proceeded from a want of phosphoric
acid to give compactness to the calcareous earth ; for that there
was a sufficiency of this earth is clear, from its being found loose in
the fluids, and thrown out as a recrement by the urine and saliva till
the whole was removed, and nothing of the bones remained but
their cartilaginous or membranous fabric. In a similar case related,
in a work of considerable value, by Mr. Thompson, this tendency to
the dischai^e of the absorbed and loose earth of the softened bones
at the emunctories of the body was still more considerable. The
urine, we are told, for the first two years of the patient's illness,
deposited generally a whitish sediment, which, upon evaporation,
became like mortar ; and, on one or two occasions, he voided a few
jagged calculi. After this period the calcareous discharge ceased,
the bones having no more earth in their composition, as was soffi-

♦ Transactions of the Mcdico-Chirurg. Soc. Vol. iv. p. 42.
t Vol. XLViii. vear 1753.

OE.m.-:SP. II.] EXCERNENT FUNCTION. 221

ctently ascertained on the patient^s death, which, however, did not
occur till nine years from the commencement of the malady.*

In some cases, there seems to be but little deficiency of phos-
*phoric acid, while there is an evident want of earthy matter:
for we meet with no calcareous dischar^ by any of the emunctories,
while the union which taken place between whatever portion of the
earth is conveyed to the bones, and the phosphoric acid which is
secreted at the same time, renders them in some degree friable
though weak, and hence as liable to fracture on slight exertions as
in the preceding species.

A case of this kind is at this moment under the joint care of the
author and Mr. Howship. The patient is a lady, hitherto in good
health, of about eight and twenty : both the thigh-bones were
broken without any violence about a twelvemoth ago, and all the
other bones showed a strong tendency to softness and compressibility.
There was great general debility in all the functions, with a feeble
and qtlickened pulse. By perfect quiet, a recumbent posture Qn a
hard and level couch, and the steady use of a tonic regimen and
diet, she is now evidently recovering. Her general health is
improved, the extremities of both bones appear to be united and
buried in an irregular mass of callus that has clustered around them :
and it is probable that in a few months she may be able to be
removed by an easy conveyance id the sea-coast

A somewhat similar case, but of greater severity, communicated
by Sir John Pringle to the Royal Society, is contained in its forty-
eighth volume.! The patient was an unmarried female servant of
good character. A parostic diathesis seems, from some cause or
other, to have existed, and to have been brought into action by a
tedious and troublesome chlorosis. One of the legs first gave way
and snapped as she was walking from the bed to her chair, and soon
afterwards both the thigh bones from a little exertion. From this
time her gene*ral health suffered, her habit became cachectic, and
there being an increasing inability to a supply of compact calca-
reous earth, all the bones became soft and pliable, and bent in every
direction without breaking, while those which were broken never
united. Her head, however, throughout was scarcely affected, and
her mental faculties continued clear to the last. She Hied in less
than nine months from the commencement of the disease : and on
examining her body all the bones were capable of being cot through
without turning the edge of the knife.

In one or two of the preceding cases mercury was employed, and
carried to the extent of producing salivation, yet without any benefit
whatever, it is not easy, indeed, to conceive what benefit could be
expected fipom such a plan. The deficiency of one or all the
coDstitueDts of perfect and healthy earth of bones, is evidently

• Medical Observations and Inquiries bv a Society of Physicians in London,
VoL V. 8vo.

t Phil. Trans, year 1753.

222 ECCRITICA. [CL. ▼I.-OIL L

dependent upon local or general debility, thongfa we cannot alvrays
discover the cause of this debility, nor the peculiar circnnstancaa
connected with it which gire rise to this rather than any odier
effect of diminished energy. .And hence, the only line of treatment
we can engage in with any hope of success is that of perfect qniet,
and a recumbent posture to prevent distortion and fracture, a plain
but nutritiTe and somewhat generous diet, and a course of tonic
medicines. In the case of the lady just adverted to, and who Is now
in a train of recovery, the medicines chiefly employed were various
preparations of cinchona and iron, chiefly the piluln ferricompoalts,
with an allowance of ale instead of wine with her dinner.

GENUS IV.

CYRTOSIS.

€ontortCon oC tixt Urntn.

HEAD BULKY, ESPECIALLY ARTERIOaLY : STATURE SHORT, AND 1NCURVAT£3> ;
FLESH FLABBY, FALE AND WRINKLED.

The term cyrtosib is derived from the Greek k^th^ ^^ curvus,
incurvus, gibbosus,^^ and, among the ancients, particularly imported
recurvation of the spine, or posterior crookedness, as lordosis
(A«^«^if ,) imported procurvation of the head and shoulders or ante-
rior crookedness. It has, in recent times, more generally been
written cyrtonosos, literally '^ morbus incurvus :'' but the term mtik,
or morbus, is pleonastic in a system of nosology, and hence, cy&tosb
is preferable.

The genus is intended to include two specific diseases which have
a close connexion in many of their most prominent symptoms, and
e^cially in the sponginess and incurvation of the bones, and in the
withered appearance of the flesh, insomuch that the second is, by
some, regarded as only a modification of the first ; but wliich, how-
ever, are peculiarly distinguished from each other by the different
state of the mental powers. — These are : —

1. CYRTOSn RHACHIA. RICKETS.

2, m CRETUVISNUS. CRciinliuf.

0& iv.-sp. l] excernent function. 223

SPECIES I.
CYRTOSIS RHACHIA.

CaUlXY IFFECnilO TRB LIMBS AND BODY: SFUIfi caoOKSD ; AlBS Dfi-
FBXBSED^ ARTICVLAE EPIPHYSIS BWI.HinF.P AHD 8P0K0T ; BBLLY TUMID;
MBBTAI. FACUITIBB CIJBAB9 OFTBR PKEMATURB.

Thbbs is some doubt aboot the origin of b^. the veroaciilar names.
Cretinism on its first disc<^ery was, by mmkj writers, supposed to
be produced by an habitual use of water impregnated with chalk or
eretoj in tlie low Swiss Yalleys where it was earliest traced : and it
is commonly supposed tlut the specific name is deriied firom tliis
opinion.

The English word riektU^ is usudly written in technical language,
rbachitis ; a name first giren to it by Glisson, and said to be derlT-
ed froB fmxH {rkackii^) the spine, in consequence of the distortion
and curvature of this orgau, occasioned by its being no longer able
to bear the weight of the bead and upper extremities. As this
malady, however, was first observed in England, and particularly
in the western counties^ and was pravinciaUy denominated rick^^
before it attracted the attention ot medical writers ; it is more pro*
babie that rickets is derived from the Saxon ricg or rick ^^ a heap
or hump,^' and particularly as applied to the back^ which also it
denotes in a second sense ; so that rUked or ricket is literally, in its
foil import, ^^ hump-backed.^' It is from this root we derive hay^
rtdb, ^^ a heap of hay,'' and not, as Dr. Johnson has given it, from
^ reek," to smoke. Rachitis might, however, be a word su£kient-
ly good for the present purpose, were it not for its termination ;
ms, in the OMdical technology c^ modem times, implying visceral
inflammation, and being Umited, by a sort of common consent, to
the numerous species of disease arranged in the present method
under the genus empegbma, Class ni. Ord. n. which we have con-
sidered already ;* and on this account it is that, in the species be-
fore us, rachitis is exchanged for rhachia.

If this disease were known to the Greeks, we should expect to
find it, not indeed under the specific term rhachia, but the generic
term cyrtoais; for while neither rhachia nor rbachitis is to be trac-
ed among the Greek writers in the sense of diseased action, the
latter is common to them in the signification already ascribed to it

There is much reason for believing, however, that both rickets
and cretinism are comparatively of modem date : and it is a singu-
lar circumstance that both these species should have been tot

•Vol. IE. p. 2W.

224 ECCRITICA. [CL. VI.-OR. I.

noticed, and apparently have made their first appearance coetane-
oosly. The earliest account we hare of rickets is that published
by Glisson as it occurred in Ekigfland in the middle of the seven-
teenth century ; the first account of cretinism is that of Plater who
met with it about the same time in Carinthia and the Valais. The
disease is also common in Navarre, and in many of the vallies of
the Pyrennees, particularly that of Luchen ; and it has been observ- '
ed by Sir Geoi^e Staupton as far off as Chinese Tartary, in a part
of the country much resembling Switzerland and Savoy in its Alpine
appearance. There are some writers, however, who have endeav-
oured to trace both species of this genus up to the Greeks and Ro-
mans. Thus Zeviani contends that rickets, if not cretinism, is to
be discovered in the ^jpan names of Vari, and Volgi, as also in
several passages ridicumig deformity, ip Thersites, the supposed
.£sop of Greece, as well as in other authors ;* but all such remarks
are too general ; he cannot produce a single passage from the medi-
cal writers of antiquity, clearly characterizing the peculiar defor-
mities before us. De Haen has attempted to trace the same disease
in the works of Hippocrates, but has failed ; and hence it is gene-
rally admitted in the present day, and has been so from the time of
Glisson himself, supported by the concurrent opinions of* Bate,
Regemorter, Van Swieten, and Trinka, that both rickets and cre-
tinism are of the recent date we have just assigned to them. •

The enlargement of the thyroid gland called goitre, or broncho-
cele, is the most striking feature in the unsightly aspect of a cretin ;
but this, as Dr. Reeve has observed, i« not a constant attendant ; nor
is there any necessary connexion between goitre and cretinism, not-
withstanding the assertions and ingenious reasoning of Fodere.
Ctetiuism is frequently observed without any affection of the thy-
roid gland, and this gland, on the contrary, is often very much en-
larged withoutthc slightest degree of that affection of the intellec-
tual faculties by which cretinism is particularly marked.! *

Cretinism, in many of its symptom**, though not in all, may be
regarded as a most severe and complicated modification of rickets ;
and the pathology of both is closely connected with that of atrophy,
as we endeavoured to explain it in its proper place.}:

In order that the various parts of the body should thrive and
enlai^e in the infancy of life, it is necessary not only that there be
a due supply of nutritious food, but that the entire chain of the
nutritive organs, from the digestive to the assimilating powers,
should be in a state of sound health, and capable of fulfilling their
respective fonctions. In several of the varieties of atrophy this is
not the case. In one or two of them we have reason to believe
that the digestive process is imperfect, and that the disease is
chiefly seated in the chylific viscera. In others that proper nutri-

* Delia cura di Bambini, attacati della Rhacbitide. Cap. ri. p. 15.
t Storr, Alpenreise Vorbereiiung, p. 55,
t Vol. II. p. 475. Marasmus atrophia.

CE. IT*-6P« I.] ExcBRinanr rvNcnoN. 225

nefit, Ikoogh My kitiodaced Into the blood, Is not duly etabordted
from it ind con? erted into the structure of the different parts whose
waste it is to sofiplj ; and, Gonseqveiitlj, ^at the disease is cfaieflj
seated id the assimiJatiDg powers. And, in treating of atrophj, we
observed that the one extremify of the nntritiye chain so closelj
harmonizes with the otlier, that let the disease commence at which
end soever it may, the opposite is affected by sympathy. We also
Dbserved that tlie different divisions of secements are not all equal-
ly under the influeoce of a morbid torpitude ; shice occasionally
those tliat secrete the ai^mal oil cease to act long before any of the
rest ; whence emaciation occurs, and in many ^stances continues
for some time, as a solitary symptom : and the individual falls away
IB plumpness without beii^T sensible of any other failing.

In rickets the nutritive organs are disturbed generally through
the whole length of. the chain ; but the chief failure is in a d^e
aopply of boihy earth or the pliosphorie acid that should combine
with it The evident Intention of this kind of supply is to enable
the bones to expand and acquire maturity while growing, and to
uphold their strength and firmness afterwards. And so long as they
obtain a. sufficient supply and the waste earth of the bones is pro-
ponionably carried off by the absorbents, so long this part of the
animal economy continues perfect : but, with the exception of the
hi or anii^al oil, there is, perhaps, no secre^on that is so Mable to
have its proper bahince disturbed whether by excess or deficiency,
by a morbid conditloD of the digestive or of the assimilating powers,
as that of bony or calcareous earth.

A deficient forfhation then, or elaboration, of bony earth consti-
taCes the proximate cause of both rickets and cretinism. The re-
mote or exciting cause it is not always in our power to ascertain :
jet in numerous, perhaps in most instances, we are capable of trac-
ing them to a want of pure air, and a warm and diy atmosphere,
notritious food, regular exercise, cleanliness, and the concomitant
evils attendant upmi a state of poverty ; and hence, it is chieflv in
the hovels of the poor, the destitute, and the proff^te, that both
diseases are met with ; while the severity of Ihe symptoms is very
generally in proportion to the extent or mnltiplica^km of these con-
current causes.

But there are other diseases that result from the evils we are
BOW contemplating as well as rickets or cretinism, such as a^^phy,
ecTOphula, scurvy, and typhous fevers : and hence, there must be
some predisponent pause operating in the present instance, and
calHog rickets into action rather than any one of the rest Sueh cause
we do not seem always able to trace, but there is reason to beheve
that it is sometimes dependent upon an hereditary taint of an idA^-
pathic nature, sometimes upon a scrophulous or venereal deprava-
tion in the constitution of the father or the mother. Such, also, is
the opinion of Dr. Cullen. " This disease,'' says he, " may be just-
ly considered as proceeding from parents : for it often appears in a
great number of 4he same family ; and my observation leads me to

roL. IV. 29

226 ECGRITfCA. ' [CL, TL-«IU h

judge (hat it origioates more frequently from mothers thao from
father^. So far as I can refer the disease of the children to the
state of the parents^ it has appeared to me most commonly to arise
from some weakness, and pretty frequently from a scrophulons hahit
in the mother.^' — ^^ 1 must remark, however,'' continues Dr. CuUea,
^^ that in many cases I have not been able to discern the conditioa
of the parents to which 1 could refer it"*

Rickets seldom appears earlier than the ninth month of infancy,
and Dot of\en later than the second year, being preceded, accordii^
to Dr. Strack, by a paleness and swelling of the coontenaoce, and a
yellow, sulphur hue in that part of the cheeks which should natur-
ally be red.t In some instances it seems to have originated later ;
ill every stage, indeed, of a child's growth, till the bones have ac-
quired their full size and firmness 4 and it is said to have oc<mrred
even af\er this. But in these late appearances we are generally
capable of tracing the disease to some local injury, which acts as
an exciting cause, and, for the most part, unites it with parostia
Jkxilis.

Rhachia, in its ordinary course, commences imperceptibly and
advances slowly : the body becomes gradually emaciated, the flesh
flaccid, and the cheeks wan or sallow, with a slight degree of tume-
faction. As the flesh diminishes in bulk, the bead is found to in-
crease, the sutures gape, and the forehead grows prominent The
spine bends and ts incapable of supporting the weight it has to car-
ry : the ribs and sternum partake of the distortion, the former lose
their convexity, and the latter projects into a ridge.

The same deficiency of bony earth runs through the entire ske-
leton, and aflects not only those parts that are composed chiefly of
lime and phosphoric acid, as the flat bones and the middle of the
long bones, but the extreme knobs or epiphyses, in which lime is
combined as largely with carbonic as with phosphoric acid. And
hence, the joints are loose and spongy, and in swelling keep pace
with the head. In many instances the lime appears to be elabo-
rated but without its correspondent acids, and consequently, with-
out compactness) and to no purpose : for we can occasionally trace
it loose in the urine, in which it forms a calcareous depoaite, as
though carried off" from the blood as a recrement

All the assimilating powers participate in the debility in a great-
er or less degree : the process of dentition is slow and imperfect,
and, while the cellular membrane is without animal oil, the muscu-
lar fibres are tabid, without energy, and almost inirritable. It does
not seem, however, that the secretion of sensorial power is so much
interfered with as the other secretions of the system. Some part,
indeed, of what should be sent over the frame at large, appears to

• Pracl. of Phyg. Vol. iv. Book ii. Cb. iv. ♦ MDCcxxii.
t Act. PhiloBophico-Medico Soc, Acad. Princ. Hassle, &c. 4tD. Giesse. CaUuv-
ruin,
t Thomasioy Journ. de Mad. Tom* XLiii. p. 323«

€«• IT.-SP. !•] EXCEBNENT PimCTION* 227

be concentrated in the sensprinm : so that its equipoise is disturbed,
trat the general arerage Is not perhaps much diminished. And we
are hence able to account for the curious and interesting fact that
while the body is generally failing, the mind in many instances ad-
Tances in its faculties, insomuch that a very slight recapitulation
of the names of those who hare been pre-eminently giAed with
mental talents in every age and nation, and liave immortalized them-
selres as poets, philosophers, and even leaders in the field, will put
before the eye of those who have not much attended to this sub-
ject, a far greater proportion of the hump-backed, and the ricketty,
than they may hitherto have had any conception of. We had occa-
sion to make a like remark when treating of scrophula, and the
same fact occurs almost as strikingly in hectic fever. The progress
of the mind does not necessarily depend upon the general progress
of the body: in the ordinary course of things the one runs parallel
with the otiier ; but, in the great field of pathology, where this
course is departed from, we are perpetually called to behold proofs
that these powers are bv no means one and indivisible, and that,
even before the hour of death, the spirit gives token of an advance
towards perfection, while the body in its general crasis is imbecile,
or, perhaps, sinking gradually into ruins.

At the commencement of rickets there is rarely any degree of
lever, but, as the disease advances, irritability, ns in scrophula, suc-
ceeds to inirritability, and a hectic is produced. Or it may happen
tiiat the sensorium at last participates in a greater degree with the
disease of the rest of the frame, and the mind itself becomes en-
feebled, and torpid, or fatuous.

In the treatment of rickets, the eye should be directed to the
two fbllowiBg intentions : that of strengthening the system general-
ly : and that of facilitating a supply of phosphate of lime to the or-
gans that form the chief seat of dnease.

For the former purpose, a pure, dry, and temperate atmosphere,
a wholesome and somewhat generous diet, regular exercise, of
such kind as can l>e indulged in with the least inconvenience, clean-
iiness, and cold-bathing are of essential importance, and have often
worked a cure alone. And it is possibly owing to a more general
conviction of the advantage of such a reffimen in the present en-
l^htened age, that rickets is a complaint far less common now than
it was a century or even half a century ago.

A tonic plan of medicines, however, ought to be interposed, and
will effectually co-operate with a tonic regimen. As in infancy we
can eBiploy those remedies only which are neither very bulky nor
▼ery disgustful, we should, for the purpose immediately before us,
make choice of the metallic salts. Mr. Boyle is said to have em-
ployed, long ago, with very great success, some kind of ens veneris ;
and various preparations of copper have since been made use of,
and been highly extolled for their virtues in the present disease,
especially by Benevoli, and Biichner. Dr. Cullen, however, is per-
suaded that the ens veneris of Boyle was a preparation not of cop-

25K ficcRiTicA. [cc* TL-oiu r*

per, but of iron, in fact iheJUresmartiaUs <tiihe old dUpenrntoriefl,
am) there k no doubt that this conjecture is rig:ht. From the ge-
neral irritability of the system, iron, indeed, seems to be more ad-
riseable on the present occasion than any other metal. And it»
stimulant property is a recommendation to its use, rather than a
dissuasive.

If the appetite fail, which is not common, and the stomach evince
acidity and other dyspeptic symptomf, an occasional emetic will be
highly serviceable. The bowels must be kept open with rhubarb,
or neutral salts ; and, if the abdomen be tumid, or there be any
other symptoms of an affection of the mesenteric glands, mercmry
in small doses may be advantageously had recourse to, and combined
with the tonic plan.

The means of carrying into eiecution tlie second intentioD, or
that ot producing a direct supply 6f osseous matter, is accompanied
with more difficulty, nor is it certain that we are in possession of
any remedy whatever by which this can be accomplished, though it
has often been attempted

Bone may be regarded as a cancellated fabric of gluten whose
cells are filled up with the earth of lime and a cembination of car-
bonic and phosphoric acid, of which the former bears the larger
proporti<m* In all cases of rhachia, there seems to be a deficiency
of these acids, but particularly of the phosphoric, and, in ma^y
cases, a deficiency of the earth as well as of the acids.

Acids, however, of every kind, when in excess, have a tendency
to dissolve calcareous earth instead of concreihig it into a solid
mass : and hence one of the most effectual means of preventing that
tendency to the separation or production of a morbid superabond*
ance ot calcareous earth in oernfiziA and lithia, is a firee use of
acids as a solvent.

A hint has been taken from this effect, and, as the ^ease before
us is of an opposite kind, and evinces a deficiency of lime, and es-
pecially of phosphate of lime, instead of an excess it has been io-
geniuusly proposed to pursue an opposite practice, and to bave re-
course to a free use of alkalies and alkalescent earths, especially
lime united with phosphoric acid, with a view of obtaining the de-
ficient materials. Baron Haller and De Haen employed, for this
purpose, prepared oyster-shells ; but these consist of lime with car-
bonic acid, and do not, therefore, offer a proper supply for tiie
basis of bones. M. Bonhomme has of late improved upon this prac-
tice by substituting the phosphate of lime, or the powder of bones
for its carbonate, and uniting it in equal parts with phosphate of
soda ! of which compound the dose is a scruple for an infant given
twice a day. And he recommends that the body should also be
bathed moroing and night with an alkaline solution, consisting of
half an ounce of common potass in a pound of spring water. Abil-
gaard lias carried the alkaline plan still farther, and baa employed

Gt. 1T<-6P. l] excernent vunction. 229

the fixed alkali ioternaUjr.* And, as acidity ofthe itomach iniii-
Aots seeoiB to be one cause of the disease, and a priocipal cause, as
coojectured by Cappelt aod Zeyiani,} where the digestioo is evir
dently at fault, we may, in such cireuoistances, reasonably expect
be^ent from alkaline preparations or magnesia.

How far any preparation of lime introduced into the stomach
may be able to find its way without decomposition through the
sanguiferous system to the assimilating vessels, and be secerned iai
the parts afiected, has not been exactly determined. Vauquelin
made various experiments upon fowls, to decide the question^ and
M. Bonhomme has since attempted otiiers. To themselves these
experiments appeared sa^factory ; but they are open to some ob-
jections which have not been entirely removed. Yet we see every
day, in a thousand instances, with what facility substances, of almost
e? ery kiod, introduced into the stomach, are diffused with little
other change than that of minute division over every part of the
system. iSnetics do not act till they reach the drcelatlng system:
the colouring matter of the madder-root is conveyed to and tinges
the most solid bones': prussiate of potash, turpentine and various
other balsams enter without change into the bladder. It is heoce
that rape-seed communicates an intolerable taste to hares that feed
upon it, and that the flesh of sheep feeding upon wormwood ao*
quires the bitter flavour of this plant. So, the buck-thorn gives a
eathartic property to the flesh of thrushes that have swallowed it,
and scammony to goat's milk. Partridges that have feasted harm-
lessly on hellebore, often occasion sickness when employed as food ;
and when oxen have grazed in a pasture abounding with alliaceous
plants the beef they produce possesses the same taste and smell.
And hence, phosphate of lime may, in like manner, be conveyed
from the stomach to the secements of the bones, and reach them
without chemical decomposition.

As rhachia is peculiarly distinguished by a great inirritability
and want of action, rubefacients and other cutaneous stimulants
have often been employed, and proved serviceable, as well from
the friction that accompanies their use as their own acuating pow-
er. These have sometimes been so far heightened as purposely to
excite some degree of fever, with a view of carrying on the dis-
ease by this means, as dyspei)sy, cephalasa, and chronic rheumatism
have often been carried ofi" by a smart attack of a tertian intermit-
tent We are told that a practice of this kind prevails very gene-
rally in the Western Isles, and is productive of great success. The
heating oil of the skate-fish is rubbed every evening first upon the
wrists and ancles of the patient, which raises, a fever of several
hours' duration : and when the inunction upon these parts has lost

* Collect. Soc. Med. Havn. i. Art. i.

t Vertuch einen ToUerstaudigeo AbbandluDg iibci die Eogliscbe kraokbeit, icc.

% Delia cura di Bambini} attacati della Rbachitide. Cap. ii/p. 80.

230 ECCRITICA. [CL. Tl.-OR. h

its effect, it is then applied, in like manner, to the knees and el-
bows ; and afterwards, in like ^kanner, to the spine ; so that a cer-
tain degree of pjrexj may be daily maintained And when fric-
tion, on all these organs, is found to fail, as fail it will by degrees,
a flalnnel shirt dipped in the oil is finally had recourse to, and worn
on the body, which produces a higher degree of fever than has yet
existed ; and continues to be worn, afler fresh iliinations, till a cure
is obtained, which is said to be pretty certain, and usually in a
short time.

Many ingenious devices have been executed by surgical instru-
ment makers for giving support to the limbs that seem mostly to
suffer, and for removing the weight of the body from one part to
another. In infancy, however, all these are of little avail, and
where the disease pervades the entire skeleton, they will al-
ways do as much mischief as good, by aiding one part at the ex-
pense of another. The best mechanical instruments are a hard in-
compressible couch, and a level floor on which the infant may lie
at full length, and stretch his limbs as he pleases. The couch
should be made light and moveable, so that he may be carried upon
it in the open air for exercise. Moderate warmth is of great service,
but a downy bed that gives way to the pressure of the body and
sinks into unequal hollows cannot fail to increase the incurvation.

SPECIES II.

CYRTOSIS CRETINISMUS.

€rrtCtifiim*

CHIEFLY ATFECTINO THE HEAD AND NECK; COUNTENANCE VACANT AND
STUPID ; MENTAL FACULTIES FEEBLE OR IDIOTIC : SENSIBILrFY OBTUSE :
MOSTLY WITH ENLARGEMENT OF THE THYROID GLAND.

Cretinism makes a veiy close approach to rickets in its general
symptoms. It differs principally in the tendency to the peculiar
enlargement of the thyroid gland, which, in France, is denominated
goitre, and with us, Derbyshire-neck, and in the mental imbecility
which accompanies it from the first.

'In treating of rhachitis we observed, that, while all the func-
tions of the general frame are here in a state of great debility^
with the exception of the mental, these last exhibited, in many in-
stances, a precocity and a vigour rarely found in firm health. And
we endeavoured to account for it by supposing that the flow of sen-
sorial fluid instead of being in deficiency, like all the other secre-
tions, is only disturbed in its balance ; and that much of the pro-

QE. iy.-raP. U.] EXCERNENT , FUNCtlON. 23 1

portioQ of this, which ehould be distribated among the motory fibres
of the frame, and prevent that inirritability and muscular inertness
bj which rickets t^ so peculiarly distinguished, is transferred, under
a different modilScHtion, to the sensorium, and gives to the , mental
&colties a more than ordinary degree of quickness.

In cretinism the organ of the brain seems to follow the fate of
the rest of the body, and, in many cases, even to take the lead, so
that the chief imbecility is to be found in this region. For the
peculiar symptom of goitre it is not so eas^ to account We know
so little of the purpose, and eyen of the fabric of this gland, as to
be incapable of assigning its use in the animal economy, and hence,
it is not much to be wondered at that its peculiar tendency to asso-
ciate, in the present disease, with the morbid condition of the bones
and of the intellect, should not hitherto have been ascertained.
It does not always, however, accompany the other symptoms, though
it is, for the most part, an associate.

We have already observed that cretinism was first distinctly
noticed and described by Plater about the middle of the seventeenth
century, as occurring among the poor in Carlnthia and the Valais ;
and that it was afterwards found in a still severer degree in other
▼allies of Switzerland and the Alps generally ; as it has since been
detected in very distant regions where the country exhibits a simi-
larity of features, as among a miserable race called Caggets, inha-
biting the hollows of the Pyrennees, whose district and history have
been given us by M. Raymond, and as far off as Chinese Tartary,
where it is represented as existing by Sir George Staunton.

On the first discovery of cretinism it was ascribed by some to the
use of snow-water, and by others to the use of water impregnated
with calcareous earth : both which opinions are entirely without
foundation. The first is sufficiently disproved by observing that
persons bom in places contiguous to the glaciers, and who drink no
other water than what fiows from the melting of ice and snow, are
not subject to the disorder ; and, contrary wise, that the disorder is
observed in places where snow is unknown. The second is contra-
dicted by the fact that the common waters of Switzerland, instead
of being impregnated with calcareous matter, excel those of most
other countries in Europe in purity and flavour. ^' There is not,"
observes Dr. Reeve, '^ a village, nor a valley, but what is enlivened
by rivulets, or streams gushing from the rocks. The water usually
drunk at La Batia and Martigny is from the river Dranse, which
flows from the glacier of St Bernard, and falls into the Rhone ;
it b remarkably free from earthy matter, and well tasted. At
Berne the water is extremely pure, yet, as Haller remarks, swell-
ings of the throat are not uncommon in both sexes, though cretinism
is rare.

As comfortable and genial warmth form one of the best auxiliaries
in attempting the cure of both cretinism and rickets, there can be
no doubt that the chill of snow-water, if taken as such, must consi-
derably add to the general debility of the system when labouriBg

332 EccRincA. [cl. tl^-or. i«

under either of these diseases, though there seems no reason for
supposing that it would originate either. It is not difficult to explain
why water impregnated with calcareous earth should have heen
regarded as a cause : for in cretinism, as in rhachia, the calcareous
earth designed hy nature for huilding up the hones, is often sepa-
rated and floats loose in various fluids of the hody for want of a
sufficiency of phosphoric acid to convert it into a phosphate of lime,
and give it solidity. And as it is, in consequence hereof, pretty
freely discharged hy the urine, it seems to have given rise to the
opinion that such calcareous earth was introduced into the system
with the common heverage of the lakes or rivers, and produced the
morhid symptoms.

M. de Saussure has assigned a far more prohahle, and unquestion-
ahly the real cause of the disease fh referring us to a few other
physical features of the Alpine districts in which it makes its appear^
ance chiefly. The valiies, he tells us, are surrounded by very high
mountains^ sheltered from currents of fresh air, and exposed to the
direct, and, what is worse, the reflected rays of the sun. They are
marshy, and the atmosphere is hence humid, close, and oppressive.
And when to these chorographical causes we add the domestic ones,
which are also well known to prevail very generally among the
poor of these regions, such as meagre, innutritious food, indolence
and uncleanliness, with a predisposition to the disease from an here-
^tary taint of many generations, we can sufficiently account for the
prevalence of cretinism in such places, and for the most humiliating
characters it is ever found to assume.

The general symptoms of cretinism are those of rhachia ; but the
disease shows itself earlier, often at birth, and not unfrequently
before this period, apparently commencing with the procreation of
the fetus, and aflbrdiog the most evident proofs of ancestral conta-
mination. The child, if not deformed and cachectic at birth, soon
becomes so ; the body is stinted in its growth, and the organs in their
developement ; the abdomen swells, the skin is wrinkled, thci mus-
cles are loose and flabby, the throat is covered with a monstrous
prominence, the complexion wan, and the countenance vacant and
stupid. The cranium bulges out to an enormous size, and particu-
larly towards the occiput, for it is sometimes depressed on the
crown, and at the temples ; insomuch that to a front view the head,
in some cases, appears even diminutive. The blunted sensibility
of these wretched beings renders them indifferent to the action of
cold and heat, and even to blows or wounds. ^^ They are, gene-
rally," observes M. I^el, " both deaf and dumb. The strongest
and most pungent odours scarcely affect them. I know a Cretin
who devours raw onions and even charcoal with great avidity.
A striking proof of the coarseness and imperfect developement of
the organ of taste. Their organs of sight and feeling are equally
limited in their operation. Of moral affections they seem wholly
destitute ; discovering no signs of gratithde for kindness shown
to them, nor any attachment to their nearest relations.''

€E. IV.-SP. 1l] EXCERNENT FUNCTION. 23^

The medical treatment, if medicine can ever be of any avail,
should be conducted upon the principles and consist of the process
laid down under the preceding species.

GE-NU8 V.
OSTHEXIA.

m

^rr rARTs more or less hcdurated bt a supirRntors secretion and

DEPOSITE OF OSSIFIC MATTER.

OsTHEXiA is derived from •rrmint^ " osseous or bony," and itif,
** habitus or habit," — " ossilk diathesis Or idiosyncrasy." This
morbid affection, though repeatedly alluded to and described bj
miscellaneous writers, has seldom been attended to in nosological
arrangements. It does not occur in Dr. CuUen's Classification:
but he alludes to it in his " Catalogue of omitted Diseases" as one
of those which he thinks ought not to have been omitted.

We have bad various occasions for remarking that as the calca-
reous earth, which gives compactness and solidity to the skeleton of
the animal frame, becomes waste, and is consequently absorbed and
carried off, it is necessary that there should be an equal and regular
supply of the same material. This is partly obtained from the
lime which enters, in some proportion or other, into almost every
kind of nutriment on which we feed : but it seems to be obtained
also, and perhaps in a larger proportion, by some chemical elabora-
tion out of the constituent principles of the blood itself: for a healthy
animal of any kind appears to supply itself with the requisite
quantity of bony earth whatever be the nature of its food, and though
the soil on which it is grown contains no lime whatever, as is the
case in several of the Polynesian islands, and throughout the whole
of New South Wales, on the hither side of the Blue Mountains. *

In several of the preceding genera we have seen that this
material is produced or secreted in deficiency : in the species
appertaining to the present genus, it is, on the contrary, produced
or secreted in excess : and deposited, sometimes in single organs for
which it is not naturally intended, and sometimes throughout the
system at large, occasionally in the parenchyma or general substance
of organs, and occasionally in the membranes or tunics by which
they are covered and protected, or in the vessels by which they are
furnished with their proper stores.

yfe see much of this irregularity in old age the cause of which
we have already endeavoured to explain. The cxcement vessels

VOL. IV. 30

234 ECCRITICA. [CL. VI.-OR. r.

of both sets, abeorbents and secretoriei, partake of the commoa
debility and torpitnde of this adyanced period. There is hence, in
all probability, a smaller quantity of lime, as of every other secerned
material, formed at this period than in the earlier and more vigo-
' rous stages : but however small the quantity, it is carried off, on
account of the groisness of its corpuscles, less freely by the debilitated
absorbents than the finer and more attenuate fluids, and is hence apt
to stagnate first in the bones themselves, which, as we have already
observed, are hereby rendered unduly impacted and brittle, and
next in the lymphatics of every part of the system, and especially
those that enter into the tunics of the sanguiferous vessels, which
are hereby often rendered rigid or even ossific.

This b a natural consequenoe of the debility of advancing^
yean. Bat we not uofireqneatly meet with a like effect in the
eariier stages of life, and in persons of the fullest and most vigorous
health, in which case there can be no question that the lime thus
profusely and erratically deposited is produced and secreted iix
excess, and consequently by a state of action the very reverse of
that we have thus far contemplated.

The mischief thus originating,— as it appears in the parenchyma^
and in the membranes or vessels of organs, and thus lays a
foundation for twQ very distinct trains of symptomsi) — may be coct^
teniplated under the two following species :

1. OSTHEXIA IVFAllClEIfS. , PARCNCmrMATOirS OSTHEXT.

2. IMFLKXA. VASCULAR OSTHEXT.

SPECIES I.
OSTHEXIA INFARCIENS-

OSSIFIC MATTER DEPOSITED IN NODULES OR AMORPHOUS MASSES, IN THE PA-
RENCHYMA OF ORGANS.

The most common organs in which calculous concretions are found,
are the kidneys and the bladder ; but, as in these they form detached
and unconnected balb, and are intimately united with local symptoms
or a morbid state of these organs and constitute only one of various
kinds of concretions, it will be most convenient to consider them
when treating of the particular diseases to which they give rise, or
of which they are prominent symptoms.

The orgnn in whose interior fabric the present concretions are
most usually found, seems to be the pineal gland ; of which almost
all the medical and physiological journals, as well domestic as

OE. y.-SP. I.] EXCERNENT FUNCTION. 235

foreign, give nameroTis examples, as do likewise Diemerliroek,
De Graaf, Schrader, and other monographists. Id tkis gland they
have also heeD found in other animals than man, chiefly those of the
deer kind.

Such deposits are also freqnently found in various other parts of
the substance of the bUEun ; in the lungs ;*in the substance of the heart,
in one instance weighing two oimces ;t in the thymus gland ;t in the
thyroid ;§ in the parotid ;|| the soblingual, and most other glands ;ir
in the deltoid and most oth^r muscles : nor is there an organ in
which it has not been traced on different occasions. Paullfni
records one instance of an ossified penis, and in the Ephemera of
Natural Curiosities, we meet with another.**

The general pathology We hnye already given : the symptoms
and effects vary to infinity. Most of the above cases seem to have
occurred after the mericUan of life ; and in many instances to have
been connected with atonic gout, which, by adding to the debility
of advancing age, adds to its tendency to fbrm such deposits.

SPECIES IL

OSTHEXIA IMPLEXA. • .

OOSIFIC MATTER DEPOSTTED IR CONCENTRIC LAYERS IN TBB TUNICS OF yES-
SBLS OR MEMBRANES, RENDERING THEM RIom AND VNIMPRESSIBLE.

All the vessels and membranes as well as ttie more massy or com-
plicated organs of the body, are subject to d^posites of phosphate or
carbonate of lime, from the causes already pointed out : some of
which are those of weak and others of entonic action : the former
operating upon the debilitated and the aged, the latter upon the
young and vigorous, who lahour under a peculiar diathesis or pre-
disposition to the formation of hony earth. The chief modifications
appertaining to this species may be contemplated under the follow-
ing varieties :

* Bailliey Moib, Anat. Fasc ii. PI. 6.
t Burnet, Thotaur. Med. Pract. iii. 254.
( Act. Med. Berol. Tom. i. Dec. iii. 28«
I Coatali, De Lapid. &c.
g Plater, Observ. Lib. iii. 707.

t Haller, Pr. de induratis corp. hum. partibus Goett. 1753.
Praneer, Diss, de induratione corp. in specie ossium. Leips. 17()5.

♦• Dec, II. Ann. ? .

236 ECCRITICA. [CL. VI.-OFU U

M Arterialis. OssificatioD of the aorta or other

Arterial osthexy. large arteries.

€ Membranacea. Ossification of membranous or cod-

Membranous osthexy. ' necting parts.

y Compiicata. Ossification of different parts sim-

Complicated osthexy. ultaneously.

Where the deposite takes place in the aorta, it is rarely confined
to this artery alone, but spreads to some parts of the heart, and,
perhaps, of the pulmonary, or some other iai^e artery as welL
Dr. Baillie gives an instance in which a considerable portion of the
right ventricle and right auricle of the heart were affected at the
same time ;* and Morgag^i another in which the ossification extend-
ed to the valves, and this too without having produced in the patient
either palpitation or dyspnoea.! So wonderfully is the instinctive
or remedial power of nature capable, in various instances, of ac-
pommodating the general system to morbid changes.

We have other examples of the trunk of the aorta being wholly
08sified,| and in one case so^ rigidly, both in its ascending and
descending branches, as to compel the sufferer to maintain an erect
position.§

The most troublesome of the membranous ossifications are those
of the pleura, of which an example is given by Dr Baillie in hia
Moitiid Anatomy :|| though tl)e trachea affords at times severe and
even fatal examples of this affection,! in consequence of the stric-
ture which is hereby occasionally produced. Mr. Chester gives a
singular case of a spread of this disease over the thoracic duct, the
jileum, and other abdominal viscera.

Yet, in the structure of the arteries, ossigcation is found more
frequently than in any other organ, with the exception of the pineal
gland : the cause of which seems to have been first glanced at by
jbr. Hunter, and was afterwards followed up with much patient in-
vestigation and accuracy of research by Mr. Cruikshank. The for-
mer used to send round at his lectures a preparation of the patella,
in which ke demonstrated that the ossification of that bone began in
the arteries running through the centre of the cartilage which, in
young subjects, supplies the place of a bony patella. Mr. Cruik-
shank on prosecuting the subject, discovered that all other bones os-
sify jn the same manner, and made preparations in proof of this
faci ; distinctly showing that the ossification of bones is not only be-
gun, but carried on and completed by the ossification of their ar-
teries : and, consequently, that arteries have a natural tendency

• Morb. Anat. Fasc. v. PI. 2.

t De Sed. et Cans. Ep. xxiii. 11.

f Buckner, Miscel. 1727, p. 305.

k Guattani, De Aneurism, &c,

II Fascic. n. PI. i.

t Kirkring, Spccileg. Anal. Obs. 27.

GE. V.H5P. n.] EXCERNENT FUNCTION. 337

to become ossific above that of- all other parts of the system
whatever.

One of the most extensive appearances of this habit acting mor-
bidly on the tunics of vessels, is related by Dr. Heberden* in 'the
Medical Transactions, in the case of a very old man who at last
died suddenly, as well indeed he might, since almost the only viscus
that was found, on examination, to be in a healthy state was the
liver. The internal carotid and basilary arteries with many of their
primary branches were ossified. Through the substance of the
lungs, which firmly adhered to their walls, were scattered small
calculous tumours. In the heart the valves of the left auriculo-
ventricular opening were partially ossified, those of the aorta com-
pletely so, and small depositions of bony matter were found in the
tendinous portions of the cameae columns. The coronary artery
was ossified through its whole extent. The descending thoracic
and abdominal aorta, with all their primary branches, were convert-
ed into cylinders of bone, as were the external and internal iliacs.
It is not necessary to pursue the description into the morbid ap-
pearances of almost every other organ : and 1 shall only observe
farther that though the substance of the brain was healthy^the ven-
tricles contained about eight ounces of water. And yet with all this
extent of diseased structure, the patient appeared almost to the last
to be of a sound constitution and free from the usual infirmities of
advanced age, with the exception of an habitual deafness ; and at-
tained upwards of fourscore years of age before he died.

Where this diathesis prevails very decidedJy, it sometimes con-
verts not merely the vessels but the whole of the tendons and the
muscles into rigid bones, and renders the entire frame as stiff and
immovable as the trunk of a tree. There is a striking illustration
of this remark in a case communicated to the Royal Society by Dr.
Henry of Enniskillen.t The patient was a day labourer who had
enjoyed good health till the time of his being attacked with this dis-
ease. It commenced with a pain and swelling in the right wrist,
which gradually assumed a bony hardness, and extended up the
course of the muscles as high as the elbow, the whole of which
were converted into a bony hardness, and were of double their natu-
ral size. The left wrist and arm followed the fate of the right: and
the line of ossification next shot down to the extremities of the fin-
l^ers on both sides, and afterwards up to the shoulders, so that the
joints were completely ancylosed, and the roan was pinioned. At
the time of communicating this history, the same ossific mischief
had attacked the right ancle with a like degree of pain, swelling,
and bony induration up the course of the muscles : in which state
the man was discharged from the hospital as incurable, after sali-
vation had been tried to no purpose.

Salivation has, indeed, often been tried, probably from its suc-

• Med. Trans. Vol. v. Art. xiii.
t Phil. Trans. Vol. Li. year 1759.

238 EOGRITICA. [CL. n.-oiL I

€689 ia removing yenereal nodes, bat it does not seem to have been
of much more avail in any instance than in the present.

We have pointed out (wo opposite causes^ or rather states of bo-
dj, in which a tendency to ossification chiefly shows itself. One is
^t ol general debility, and the other of an entonic action in the
assimilating organs which are chiefly concerned in the fabricatioa
•r separation of lime : and in laying down any plan for relief, it
seems necessary to attend to this distinction. Where debility be-
comes a predisponent of morbid ossification, it is mostly a result or
concomitant of old age, a scrophulous diathesis or atonic gout : and
in all these cases warmth, a generous diet, and tonic coarse of medi-
cines will form the most reasonble curative plan that can be pursu-
ed ; and that which will tend most effectually to stimulate the ab-
sorbents, and prevent that retardation of bony earth in the lympha-
tics and vasa vasorum, on which we have already shown the disease
to depend in this modification of it

On the contrary, where it occurs in the middle and vigour of liie,
and we have reason to believe in the existence of too much action
in vessels which we cannot very accurately follow up, a reducent
plan wil) be far more likely to prove successful. We should bleed
and move the bowels freely, and restrain the patient to a low diet
with a copious allowance of diluent drinks.

And in both cases with a view of dissolving, as far as we are
able, the calcareous matter that may morbidly exist in the systeiB
already, or be on the point of entering into it, we should prescribe
a free use of the mineral or vegetable acids, as ahready recemmeod-
itd under parostu fragilit.

CLASS VI.
ECCRITICA^

ORDER IL
C A TOXICA.

BCseausen affecting Kntrrnal Aureacr^.

nUVntT OF THB FLUIDS, OR EMUNCTORItS THAT OFEV INTO THE INTER-
NAL SURFACES OF ORGANS.

Catotica U derived from um^^ ^^ infra,'^ whence utvrmnft and umt0'
mm$$^ ^^ inferior,^' snd ^^ iniiinaB.^' The order ioclades four genera
as foUowB, some of which will be foand of extensive range:

I. HTDROPS. DROPSY.

II. EMFHYSEMA. INFLATION. WIND-DROPSY.

III. FARURU. MISMICTURITION.

IV. UTHIA. URINARY CALCULUS.

GENUS I.

HYDROPS.
Bropss*

PALE, INDOLENT, AND INELASTIC DISTENSION OF THE BODY, OR FTS MEM-
BERS, FROM ACCUMULATION OF A WATRY FLUID IN NATURAL CAVniES.

Hydrops is a Greek term {Hf^) importing an accnmnlation of
water : and in nosology there is no genus of diseases that has been
more awkwardly handled. The term hydrops does not occur in
Sauvages, Linnens, or Sagar, and only once in Vogel in the com-

240 F.CCRITICA. [CL. VI.-OR. II,

pound hydrops scroti. Linn6us connects anasarca and ascites, its
chief species, w5th tympanites, poly^arcia, or corpulency and gra-
viditas or preQ:nancy, into one ordinal division, which he names
TUMiDosi, and of which these constitute distinct genera. Sagar ar-
ranges ail the same under the ordinal division cachexle. Vogel pur-
sues the same plan ivith the omission of graviditas or pregnancy,
which he does not chuse to regard as a cachexy Sauvages em-
ploys the term hydropesy but only in connexion with partiales^ ia
order to restrain it to local dropsies : so that with him ascites is a
hydrops, but anasarca is not a hydrops, and does not even belong to
the same order ; it is an intutncscentia^ under which, as in the ar-
rangement of Linneus, it is united with corpulency, and pregnancy ;
while hydrops thoracis is an anhelatio, and occurs in a distinct place
and volume.

Dr. Cullen has certainly, and very considerably, improved upon
his predecessors in this range of diseases. After Sauvages he takes
intumescentij: for the name of his order; but divides it into the four
sections of adiposae, flatuoss, aquosae vel hydropes, and solidas ;
while under the third section (the aquosae vel hydropes) hejntro-
duccs all the family of dropsies, whether general or local, instead
of sending them with those who preceded him, to different quar-
ters. It would, however, have been a much greater improvement,
and have added to the simplicity he aimed at, to have employed
hydrops as a generic, instead of hydropes as a tribual or family
term. It is to Bocrhaave we are indebted for the first use of hy-
drops as employed in the present method ; and he has been follow-
ed by Dr. Macbride and Dr. Young with a just appretiation of Ills
correctness.

The species of this genus, which extend over the body generally
or almost all the different parts of it, are the following:

1. HYDROPS CELLULARIS.

2. CApms,

3. 8PIN£.

4. THORAaS.

6. ABDOMINIS.

€. OVARH.

7. TUBALig.

8. — — - UTERI.

9. ' "SCROTI.

CELLULAR DROPSY.
DROPSY OF THE HEAD.
SPINE.

CHEST.

BELLY.

OVARV.

FALLOPUN TUBE.

WOMB.

SCROTUM.

Before we enter upon a distinct view of the history and treat-
ment of these several species, it may be convenient to give a glance
at the general pathological principles which apply to the whole.

All dropsies proceed from -similar causes, which, as they are
general or local, produce a general or iDcal disease. The common
predisponent cause is debility. The remote causes are very nu-
merous, and most of them apply to every form under which the dis-
ease makes its appearance ; for the accumulation of watry fluid

0E.1.} BXCERHEKT FUNCTION. 241

wMch.eoDsdtiites the most prominent symptom of the malady, may
be produced by a profuse halitus from the terminal arteries occa-
sioning too large a supply of that fine lubricating fluid which, as we
have obserred in the Physiological Proem to the present Class,
flows from the surface of all internal organs and enables them to
play with ease and without attrition upon each other ; it may be
produced by a torpid or inactive condition of the correspondent
absorbents occasioning too small a removal of this fluid, when it has
answered its purpose and is become waste matter ; or it may be
produced by each of these diseased conditions of both sets of ves-
sels, operating at the same time ; and it is to this double deviation
irom healthy action that Dr. Cullen applies the name of an hydropic
diathesis.

Want of action on the^artof the absorbents is, in every instance,
the result of debility. Profuse exhalation on the part of the secem-
ents or terminal arteries, in most cases, proceeds from a like cause,
for it takes place from a relaxed state of these vesseb, which open
their mouths too widely, and suffer the serum or other aqueous fluid
to escape wit^too much freedom.

Dropsy is, A most instances, therefore, a disease of debility ; and,
if we minutely attend to the histories of those who are suffering
from this disease, we shall generally find that they have .for some
time antecedently, been labouring under debility either general or
local : that they are weakened by protracted fevers ) or la^iguishing
under the effects of an unkindly lying-in ; that they have unstrung
their frames by a long exposure to a cold and moist atmosphere ; or
liave worn themselves, out by hard labour; or, which is still worse^
by hard eating and drinking ; or that they are suffering frt>m habi-
tual dyspepsy or some other malady of the stomach or chylopoetic
oigans, especially the liver, which destroys or deranges the diges^
tive process, and hepce lays a fonndation for atrophv. And, for the
same reason, innutritious or indigestible food is a frequent cause of
some species of this disease i'*' as is alsa great loss of blood from
anv organ, and especially when such discharge becomes periodic
cal.

Where the digestive organs are in a very morbid state dropsy
may take place as a result of general debility ; but it more common-
ly occurs from that peculiar sympathy which prevails so strikingly
between the two ends of the extensive chain of the nutritive, or, ixi
other words, the digestive and assimilating powers, which we had
occasion to explain when treating of marasmus :t the inertness and
relaxation of the excement vessels being, in this case, produced by
the torpitude of the chylopoetic viscera ; and the usual forms of
^psy being those of the cellular membrane or of the abdomen.
Hence a single indulgence in large draughts of cold drinks, and
especially of cold water when the system is generally heated and

* Obererzgeburgiscbes Journ. iv. St.
i Vol. U. p. 475. 482.
tot. IV. 31

242 t»3CRlTlCA. [CL. VL-OR. n.

esbainted htm occftstomdly proved snAcient to produce dropsy in
one of these forms ; of which we have a striklDg eicarople So the
srmy of Charles V. doHog its etpedition against Tunis, the greater
part of it, as we are told by De Haeo, haying fallen into this disease
In consequence of having freely quenched their thirst with cold
water in the midst of great fetigue and perspiration**

A like sympathy not nnfrequently takes place between seToral
other organs and tiie months of the excements : as the skin and the
uterus : the former as loaded with an extension of the same terml-
aai vessels, and the latter as maintaining an infloence over almost
every part of the frame. It was partly perhaps from sympatlnr
with the skin, and as participating in the chill and consequent col^
lapse of its capillaries produced by the coldness of the be? erage,
that the excement system became affected in the extensive dropsy
jwt alluded to in the army of Charles V. And we frequently per-
ceive a similar effect on a sudden suppression or repulsion of cutanea
ous eruptions, the mouths of <be exceraent vessels opening into
intemal cavities partaking of the torpitude of the cutaneous capil-
laries. The sympathetic influence exercised ovelithe same vea-
aels by a morbid state of the uterus is not less -nanifest : for in
chlorosis the al^domen becomes tumid, and the lower limbs edema-
tous ; and, on the cessation of the catamenia, cellular or abdomin^
dropsy are by no means uncommon.

Such are the general causes of cellular dropsy as well proximate
as predispooent. But there are a few other causes which it is ne-
cessary to enumerate as acting occasionally, though the effects pro-
duced by some of them can hardly be called dropsy in the proper
and idiopatldc sense of the term.

In the first place, the absorbents are supposed by some patholo-
gists, as M. Mezlert and Dr. Darwin, to be at times affected with a
retrograde action, and^hence to pour forth into various cavities of
the body a considerable mass of fluid instead of imbibing and car-
rying it off. Next, the exbalants of an organ, though themselves
in a state of health, may throw forth an undue proportion of fluid In
consequence of some sti^nulus applied to them. The most common
stimulus to which they are exposed is distention and that by a re-
tardation of the blood in the veins, and^a consequent accumulation
in the arteries. This retardation or interrupdon of the flow of
venouS' blood may arise from diseases of the rieht ventricle of the
heart or its valves ; from various affections of the lungs or their
surrounding mescles ; from an upright posture continued without
intermission for many days and nights, as is of>en the casein month-
ly nurses ; from a gravid uterus, whence the edematous ancles of
pregnant women ; from scirrhous or other obstructions in the liver
or spleen ; from polypous concretions in the veins, aneurisms in the

• Rat. Med. Part v. 38. 90.
t Von d€T Wa^sersucht.

«e.^} ^EXGERiTHinr vmrcnoN. S43

■Jteficti, w stortoipgtoqB ot atlwt fa«nl tonumri ki tlie ttelnitf of
tile larger arterial tmoht.

ik tome cases iaflamsiatiov soeceedr to dlsteotioo, aaci the ^iifr-
tity of floM pound lerth is still more consMerftblev It is from tM$
^uble soorce of stimidai, disteatioii and ioflammatery action, that
the ▼entrielea c^ the httdn become filled ia meniegic cephalitis, aiKl
1^ cavify of tile perkardiam occadooalij io carlkis.

Thirdly, the a<]pittoua fluid of a cathy may be undaly atigmcsotedi
and coDseqaently dropsy ensue^ from-a ropture of the thoracic dac^
er of a large branch of the lacteal vesseis. These, however^ are
net coaunon causes; the lymphsitics of the kidneys may, perhaps^
moot freqoenlly hare produced the ^sease when mpiared by ecei>>
deal or idSlopathic affection ia the case o( renal ischaiy ; daring
which the watry parts of the Mood that s4M>nld pass off by the km^
M^s hare been tkroum back kito the system, and lodged io some
cafity. And itis ppobiAle that whe» dropsy foUoiara apon long* ex^
pasttve to a cold daaip atmospheroy it is pradecedy in some instasv-
ces^ in the same manaef ; the fluid that should pass off by the ex^
faalants of the skin, bat which oaaaot kv consequence of having lost
their power ; being, m like mamMr thrown back into the bbod
and transiarcad to and aocamnlated in improper channels.

Fourthly, the skin is said, at times, to be in a condition Io absorb
raoistare too freely from the atmosphere ;* the stomach is said, as
ift the case of difsosm awtv, to d^ma&d too large a q^mntlty of li«>
4|aids to qoeoch its insatiable thirst ;t and the blood is said te be in
a state of preternatural tenuity from saline acrimony ;| and each of
these conditions it is affirmed has occasionally proved a source of
dropsy. The first of these unquestionably occurs at times during
dropsy, and all of them may have operated as causes : but pretematur
ral tenuity of blood, adequate to and producing such an effect is
very uncommon from any cause ; and the remedial power of nar
tare is at no loss for meains to carry off a superabundance of fluidity
introduced by any means into the system, provided the excement
fimction itself be not diseased.

From this diversity of causes we may reasonably expect that the
^^prtcal fluid discharged upon tapping should exfaibft different
properties, not only in different organs, but in different cases in the
same oi^;an. And hence, it is sometimes found nearly as thin as
aratec, kkcapabie of coagulating when exposed to heat> which only
renders it turbid ; while, at other times, it flows in a ropy state^
and accords, upon exposure Io heat, with the natural seram of the
blood. A similar discrepancy is discoverable in its colour or some

• £rattut, Disp. iv. p. 306.

Do Ha«% Rat. Med. P* iv. p. 125. leq.
t BiicbDer, Miteell. 1730. p. 8SS.

Moadschien, p. \2»
% Galen, De Lympb. Caus. Lib. iii. cap. 8.

Van Swicten ad Sect, 1229.

244 BOGRino^. [cL. yiv-oiL n*

ptlier coodiliOD ; for it has sometiiDes been fomid black and fetid,^
bloody, sanious, milky,! gr^een4 yellowiBb, or peculiarly acfid.^
In some instances it bas resembled tbe glairy ichor of sores in a
languid constitution or degenerated habit ; and according to Goa*
thani and Steidele it has at times appeared oily.j) It has been oc-
casionally so urinous or ammoniacal as to turn syrup of red poppies
green :ir and, according to Dr. M^Lacklan, has sometimes contained
so much soda as by the addition of sulphuric acid to produce Glau-
ber's salt** with little or no trouble.

From the nature of the fluid itself, therefore, we hare a clear
proof that the causes of dropsy must be different in different cases.
In augmented secretion, impeded absorption, or the rupture of a
lymphatic vessel, the accumulated fluid should contain nothing more
than the ordioary constituents of the halitus that naturally moistens
the cavity into which it is discharged. A relaxed state of the ex-
balants may admit particles of greater bulk, and even red blood:
in which case the fluid may differ both in viscidity and colour.
While, on the other hand, morbid collections of water must proceed
from a cause of a very different nature ; probably from the exfaalant
arteries being themselves so altered by disease as to change the
properties of the fluid which passes through them : or the general
mass of blood being so attenuate or otherwise vitiated as to affect
the secretion. In the last case, dropsy is not a primary disease, bat
the consequence of some other, generally perhi^ of a morbid liver^
(Spleen, or iungs.tt ...

SPECIES I.
HYDROPS CELLULARIS.
CCrllttlar Srovfffi.

(;OLD AAD DIFFUSIVE INTUMESCENCE OF THE SKIN, FITTING BENEATH TffS.
PRESSURE OF THE FINGE|IS*

This species includes three varieties, as it is general to the ceU

* Galeauj, in Com. Qoood. Tom, vi.*

t Willia, PhanDBcetitico Rationalia.
Med. Com. of Edin|). Vol. y.

% Riickor, Coram. Lib. Nor. 1736.

i Du Veroeyi Morooirt c)e Paris, 1701. p. 1S3.

H Guau De Aneurismatibus. Sceid. Chirurg. Baobacbt. B* i.

t De Haen, Rat. Med. P. xi. p^. 314.
** Med. Comm. Editib. ix. ii.
" tt Hewion DeKript. of the Lymp|i. ^yit. Cfa. zii .

«B. hr-^t. 1.] EXGERmONT FUNCTION. SS45

lulur membrane, limited to the limbs, or aocompftnied with a com-
bination of Tery pecnliar symptom^, and especially severe, and in
most cases iatai, dyspnoea:

• Generalis. Extending through the cellular mem-

General Dropsy. brane of the whole body.

C Artuum. Limited to the cellular membrane of

' Edema. the limbs, chiefly of the feet and

ancles ; and mostly appearing in the

evening.
y Dyspnoica. Edematous swelling of the feet, stiff-

Dyspnetic Dropsy. ness and numbness of the joints ;

the swelling rapidly ascending to

the belly, with severe and mostly

fatal dispnoea.

it is under the first of these varieties that cellukr dropsy usually
appears as an idiopathic affection. . Where the intumescence is
'confined to the limbs, it is usually a symptom or result of some
other affection, as chlorosis, suppressed catamenia or any other
Imbitfial discharge ; a disordered state of the haMt produced by a
cessation of the catamenial flux; repelled eruptions ; or the weak-
ness incident upon protracted fevers, or any other exhausting ma-
hdy.

The third variety is introduced upon the authority of Mr. W.
Hunter, and talcen from his E^say, published at Bengal in 1804.
The disease apjieared with great frequency among the Lascars in
tiie Company ^s service in 1801. Its attack was sudden and its
1>rogress so rapid that it frequently destroyed the patient in two
days. FronS the description it does not seem to have Ineen connected
with a scorbutic diathesis : and Mr. Hunter ascribed it to the
concurrent causes of breathing an impure atmosphere, suppressed
perspiration, want of exercise, and a previous life of intemperance.
All or any of these may have been auxiliaries, but the exciting cause
does not seem to have been detected.

The second and third varieties, however, may be regarded as the
opening and concluding stages of cellular dropsy : for before the
disease becomes general it ordinarily shows itself in the lower limbs,
and in iU closing scene the respiration is peculiarly difficult and
forms one of its most distressing symptoms.

General or local debility is its predisposing cause, ordinarily
brought on by hlird labour, intemperance, innutritions food, fevers
of various kinds, exhausting discharges, or some morbid enlarge-
ment of the visceral or thoracic organs that impedes the circulation
of the blood, and produces congestion and distension.

The disease is hence common to all ages though most frequently
found in advanced life ; the edema of the feet and ancles, with
which symptoms it opens, appears at first only in the evening, and
)rields to the recumbent position of the night. By degrees it
becomes more permanent and ascends higher, till not only the thighs

24$ BoemncA. [ct.iTv-aK..ii;

and hifM, b«t the bo^ At Uirge is afiactedl^ tlM ftfie «i«( ^^4idi asi
surcharged and bloated, and t^ compleuofty ioBlead of the vMf
hue of healthy is sallow and waxy. A geoenil inaddvl^ pervBdoi
all the oimos, aod cooseqaently a)l their respective ftmctioDS. The
poise is slow, oflen oppressed, and always inelastic : the bowefo are
costive, the urine for the most part small in cjoantity, and coosai-
(^uently of a deeper hue than usual : the respiration is troublesome
and wheezy, and accompanied with a cough that brinn up a little
dilute mucus which affords no relief to the sense of weight and
oppression. The appetite fails, the muscles become weak and
flaccid, and the general frame emaciated. Exertion of every kind
is a fatigue, and the mind, partaking of the hebetude of the bodj^
engages in study with reluctance, anid is overpowered with drowai^
ness and stupor.

An unquenchable thirst is a common symptom ; and where this is
the case the general irritation that is connected with it semetiitea
excites a perpetual feverishness that adds greatly te the geiMMDttl
debility. In some parts the skin gives way mece oeadily then- 1m
others, and the confined fluid accumulates in ba^s. At other tiOMM
the cuticle cracks, or its pores become an outlet fer the escape gf
the fluid, which trickles down in a perpetual oooe. The dtflisHlly
of breathing increases partly from the overloaded state of the lumtii
and partly from the growing weakness of the muscles of respiratiea :
the pulse becomes feebler and more irregular, slight clook spasms
occasionally ensue, an<) death puts a termination to the seiiss of
sufiering. Tet the progress is slow, and the disease sewetiaies
continues for many years.

In attempting a cure of cellular dropsy, and indeed of drepsy hi
general, for it will be convenient to concentrate the tifeatment, v^e
should first direct our attention to the nature of its cause wilb«e
Tie w of palliating or removing it We are next te onlead the ^stem
of the weight that oppresses it And lastly to re-establish the baaut
in health smd vigour.

Simple edema, or swelling of the extremities is oflen, as we have
already observed, a symptom or result of some other eeeipWttt, as
chlorosis or pregnancv, or some other cause of dktenwbsB. ha the
two last cases it may be palliated by bleeding, a recuoibeiit pesitiefl^
and other means adapted to take ofi" the pressure. In chk>9S6ls k
can only be relieved by a cure of the primary afiectioo^ Im Uke
manner, general dropsy may be) dependent upon a hdbit of intieni-
perance, or a sedentary life, or innutritious food, ov ail obstinate' fit
of jaundice ; and till these are corrected no medlcinai phm fiw
evacuating the accumulated water can be of any avail. For, if we
could even succeed in carrying it off, it would agasa coUect, so long
as the occasional cause continues to operate.

The occasional cause, however, may no longer exist, as where H
has been produced by a fever or an exantbem that has at leDgtfa
peased though it has left the constitution an entire wreck> Or it
may exist and be itself incurable, as where it proceeds (mt a

GB. I.-H3P. I. J EXCERNBNT FimCTION. 24?

idrriioat indiiratioii or some other obBtraction of one of the larger
▼lacexa of the thorax or abdomen : ^od in this case our object should
he to TMiioive with all speed the mischievous effects, and palliate
the organic cause, as far as we are able, according to its peculiar
nature, so tinrt it may be less operative hereaAer.

A removal of the accumulated fluid from the cellular membrane
generaUy has been attempted by internal and external means, aa
hydragogues of various Idnds, and scarification or other cutaneous
drakift.

Thfi H7DEAG0GUES OT expellents of water, embrace medicines of
aU kinds that act powerfully on any of the extretories, though the
tena has sometimes been limited to those that operate on the
exeretorlea of the intestines alone. And it becomes us therefore
to contemplate them under the character of purgatives, emetics,
dbphoretioa, and diuretics.

The iHirgatives that have been had recourse to are of two kinds,
those of general use, and those that have been supposed to act
with some specific or peculiar virtue in the removal of the dropsical

Among the first we may rank calomel, colocynth, gamboge,
scaaunofiy, jalap, and several other species of convolvulus, as the
greater white bind-weed (convolvulus Septum^ Linn.) : the turbetb
plant (c. Turpetkum^ Linn.) : and the brassica marina^ as it is called
tt the di^ensatories (c. SoldandUt^ Unn.). These may be employ-
ed as drastic purgatives almost indkcriminately, and tbeir compara'
tive meal will depend upon their comparative effect, for one wiU
sAen be found to agree best with one constitution and another with
aaother. We need not liere except calomel, unless indeed, where
girven for the purpose of resolving visceral infarctions ; since in any
•tber case it can only be onployed in reference to its influence up<»r
the eaKretories generaHy, aad particularly those of the intestinal

The purgatives that have been supposed to operate with a
specifie effi^in dropsies are almost innumerable. We must content
ourselves with taking a glance at the following, grana Tiglia, or
bastard ricinus ; elaterium : elder, and dwarf elder ; black hellebore ;
stMga; and chrystals of tartar.

The caoToir TigUmn^ or bastard ricinus, affording the grana
Tiglia of the pharmacopeeias, is an acrid and powerfti] drastic in
att its pwrtft, root, seeds, and expressed oil. The oil is of the same
character as the oil of castor, but a severer and more acrimonious
piHge; insomuch, indeed, that a single drop prepared from the dry
seeds is often a sufficient dose ; while a larger quantity proves
Cathartic when rubbed on the navel. In India the seeds themselves
have long been given as a hydragogue ; two being sufficient for a
robuster constitution, one for a weaklier ; and four proving some-
times fatal.

From the uncertainty and violence of the action of this plant,
the BUTERnm or inspissated juice of the wild cucumber, is a fat

248 ECCRITICA. [CL. VI.-OK. IT*'

preferable medicine. Elaterimn, however, has heen objected to av
unduly stimulant ; and both Hofiinan and Lister observe that its ef-
fect in increasing the pulse is perceivable even in the extremities-
of the fingers. It is on this account that it seems chiefly to have
been neglected by Dr. Cullen ; who admits that he never tried it bj
itself, or otherwise than in the porportion of a grain or two in com-
position with other purgatives. And it is hence, also, that attempts
have been made to obtain a milder cathartic from the roots of the
plant by infusion in wine or water,* than from the dried fecula of
^ the juice, which is the part ordinarily employed. Admitting the
stimulant power here objected to, it would only become still more
serviceable in cold and indolent cases from local or general atony ;
but even in irritable habits in cellular dropsy, I have found it high-
ly serviceable in a simple and uncombined state, produced, as it
ultimately appeared, and especially in one instance, from a tMcken-
ing of the walls of the heart, in a young lady of only thirteen years
of age. It is best administered in doses of from half a grain or a
grain to two g^ns, repeated every two or three hours for five
or six times in succession according to the extent of its actioD.r
Evacuation by the alvine canal is the most efiectual of any ; nor
can we depend upon any other evacuation unless this is combined
with it.

The elder tree, and dwarf elder (Sambucus nigra^ and s. Elmhu)
have been in high estimation as hydragogues by many practitioners*
Every part of both the plants has been used ; but the liber or inner
bark of the first, and the rob or inspissated juice of the berries of
the last, have been chiefly confided in. Dr. Boerhaave asserts that
the expressed juice of the former given from a drachm to half an
ounce at a dose, is the most valuable of all the medicines of tliis
class, where the viscera are Bound ; and that it so powerfully dis->
solves the crasis of the difiereni fluids, and excites such abundant
discharges that the patient is ready to faint from sudden inanition.
Dr. Sydenham confirms this statement, asserts that it operates both
upwards and downwards, and in no less degree by urine, and adds,
that in his hands it has proved successful in a multitude of hydropic
cases.t Dr. firocklesby preferred the interior bark of the dwarf
elder,! as Sydenham and fioerhaave did that of the black, or com-
mon elder. Dr. Cullen seems to have been prejudiced against both,
though he admits that he never tried either, notwithstanding that
he had oflen thought of doing so :§ and it is chiefly, perhaps, from
his unfavourable opinion of their virtues, that they may seem in
our own day to have sunk into an almost total disuse. Chesneao
employed indiflerehtly the seeds, and their expressed oil, the root
\ . .

• Bonlduc, HUt. de PAcad. Royal de Sciences de Paris.

t 0pp. p. 627, 768.

% (Ecotioni. and Med. Observ. p. 278.

4 Mat. Med. Vol. i. p. 534.

GE. 1.-SP. l] excernent function. 249

and the inspissated jnice of the root : though he preferred the s.
Sbuhu to the s. nigra,*

The melampodium or black hellebore, was at one time a favour-
ite cathartic in dropsies, and has the testimony of high anthorities
for having very generally proved efficacious and salutary. The
ancients found the plant which they employed under this name so
severe in its purgative qualities, that they were obliged to use it
with great caution ; but we have reason to believe that the black
hellebore of the present day is a different production, as it is mild-^
er in its effects than the hellebore of Dioscorides, and different in
some of its external characters. Its root was the part selected, and
the fibres of the rools, or their cortical part rather than the inter-
naL These were employed either in a watery infusion or extract.
Mondscheint preferred on all occasions, the latter; Quarin used
either indifferently.| Bacher invented a pill which was once in
very high reputation, and sold under his own name all over Europe,
for the cure of dropsy, in which an extract of this root, obtained,
in the first instance, by spirit, formed the chief ingredient ; the
others being preparations of myrrh and cardans benedictus. These
pills were said to produce a copious evacuation both by stool and
urine ; and by this combined effect to carry off the disease. They
have however had their day, and are cone by, apparently with too
little consideration upon the subject : for the experiments of Daig-
Bftu and De Home, and especially the successful trials in the French
miitary Hospitals, as related by M. Ricbard§ to say nothing of Dr.
Bacher himself, do not seem to have excited sufficient attention.
h oar own country, since the days of Dr. Mead, the black helle-
bore has been limited to the list of emmenagogues, and even in this
view is rarely employed at present Whether this plant prove pur-
gative, as has been asserted, when applied to the body externally
hi the form of fomentations or cataplasms like the croton I have ne-
ver tried. Ferrara, employed as hydragogues, the black and wliite
hellebore indiscriminately.

The seneka or senega (polygala Senega^ Linn.) was another me*
dieine much in use about a century ago, and reputed to be of very
greiit importance in dropsy, from its combined action upon the kid-
ney^ and intestines, and, indeed, all the excretories. It reached
Europe from America, where it had been immemorially employed
by the Senegal Indians, from whom it derives its specific name, as
an antidote against the bite of the rattle-snake. The root of the
plant is the part chiefly, if not entirely, trusted to, and this is given
in powder, decoction, or infusion M. Bouvart found it highly ser-
viceable as a hydragogue, but observes that, notwithstanding this

* Lib. III. Cap. i'li. Obs. 8.
t VoD der Wassersucbt, &c.
X AnfmadrertioDes, &c. ^.

i Recueil des Observations de Medicine des Hospiiaux Militaires, Sic, Tom. 11.
4to. Paris.

VOL. IV. 32

250 ECCRinCA* [OL. ▼1.M>R. lb

effect, it does not of itself carry off tbe induratioili or enlflrgemettt
of infarcted viscera, and ought to be combined with other means.
It was verj generally employed by Dr., afterwards Sir Francis Mil-
Hian, m the Middlesex Hospital, and has again found a place in tbe
Materia Medica of the London College. There are unquestionablft
instances of its efficacy in the removal of dropsy when it has been
carried so &r as to operate both by the bowels and the kidneys. It
has, however, often failed ; and, as Dr. Cullen observes, is a nause*
OQs medicine which the stomach does not ea^ly bear in a quantity
reqonite for success.

A far more agreeable, if not a more effectual medicine in the
case of dropsy, is the super-tartrate of potass, in vernacular laa*
guage the cream or crystals of tartar. In small quantities and very
largely diluted with water, or some &rinaceous fluid, it quencher
the thirst most pleasantly, and, at tbe same time, in most casea^
proves powerfully diuretic But it b as a purgative we are to con-
template it at present : and to give it this effect it must be taken in
a much larger quantity, never less than an ounce at a dose, and often
considerably above thb weight Thus administered it proves
powerfully cathartic, and excites the action of the absorbents kk
every part of the system far more effectually than is done by the
influence of any entirely neutral salts. ^^ 1 need hardly say,'' oh*
serves Dr. Cullen, ^ that upon this ojperation of exciting the absor*
bents, is chiefly founded the late frequent use of the ciystals of
tartar in the cure of dropsy.''^ Dr. Cullen, in this passage, s^pn-
rently alludes to tbe practice of his friend Dr. Home, who was pe*
culiarly friendly to its use, and in his Clinical Experiments relates
twenty cases in which he tried it, and completed a radical cure ki
fourteen of tliem, no relapse occurring notwithstanding the frequen*
cy of such regressions. The practice, however, is of much earlier
date than Dr. Cullen seems to imagine ; for Hildanus represents tiie
physicians of his day as at length flying to it as their sheet anchor,
and deriving from it no common benefit! On the Continent it has
geneipdiy, but very unnecessarily, been united with other and more
active materials, as jalap, gamboge, or some of the neutral salts^
chiefly vitrioiated tartar, or common sea-salt ; the latter in the pro*
portion of from three to eight drachms of each daily, largely mint-
ed with some common drink.^

Anotlier powerful source of evacuation that has often been bad
recoune to for the cure of dropsy, is emetics : and, though, little in
use in the present day they have weighty testimcmies in their fn-
Tour among eariier physicians. Their mode of action has a resem-
blance to £at of the drastic puigatiyes ; for, by exciting the stoa->
ach to a greater degree of secretion, they excite the system gene*
rally ; and, in fact, far more extensively and more powerfully than

-■~ I- ■_■ . . _r>i -r — ■ 1— I—

• Mat. Med. u. 513. 4to. EdiU

t Cent. lY. Obi. 42.

i MediciiiKhes Wocbenblatt, 17S1. N. 40.

4UB.L-«B.l.] EXCERNENT FUNCTION. 251

' can be accomplished bj mere purgatives, in tome degree from the
greater laboar exerted in Jth^ act of vomitiiig, but chiefly from the
closer sympathy which the stomach exercises over every other paart
of the system than the alvine canal, or, perhaps, any other organ,
can pretend to. hi cases of great debility, however, it must be ob-
vious that such exertion would be too considerable and wouUl only add
to the general weakness ; and it is on tiiis account chiefly that the prac^
lice has be«o of late years very much discontinued in our own country.
It is in consequence of thia extensive sympathy of the stomach widi
every part of the system that emetics have often proved peculiarly
eervKeable in various local dropsies, especially that of the scrotum
when lindted to the vaginal sheath, and that of the ovarium, when dis-
covered in an early sti^e. And from this cause, in combination with
powerful muscular pressure, they have often acted with prompt
and peculiar efficacy on ascites or dropsy of the abdomen : while
Withering, Percival, and many of the foreign journals* abound with
cases of the cure of ascites by a spontaneous vomiting.

Diaphoretics have also been resorted to as very actively promot-
ing the evacuation of morbid flirids ; and many instances are relat-
ed by Bartholet,! Quajin| and others, of the complete success of
perspiration when spontaneously excited. Tissot tells us that it
was by this means Count Ostermann was cured, a very copious
sweat having suddenly burst forth ft^m his ieet, which continued
fer a long time without intermission.

In the Medical Transactions there is a very interesting case of
an equal cure effected by the same means, in a letter from Mr.
Mud|B^e to Sir George Baker. The form of the disease was, indeed,
an ascites, but it will be more convenient to notice it here, while
discussing the treatment of dropsy generally than reserve it for the
place to which it more immediately belongs. The patient, a fe-
male of about forty years old, had laboured under the disease for
twenty years : the abdomen was so extremely hard as well as en-
larged, that it was doubtful whether the complaint was not a para- .
bysma eomplicatum^ or physcony of various abdoaainal organs, and
tapping was not thought adviseable. She was extremely emaciat-
ed: had a quick, small pulse, and insatiable thint; voided little
urine, breathed with difficulty, and could not lie down in her bed
for fear of suffocation. For an accidental rheumatism in her limbs
^e had four doses of Dover's powder prescribed for her, of two
scruples in each dose, one dose of which she was to take every
night The first dose relieved the pain in her iimbs, but did nothii^
more. An hour or two after taking the second dose on the ensuing
night she began to void urine in large quantities, which she conti^
nued to do through the whole night, and as ftmt as she dischaiged

* SammluDg Medicinitchen WahrDemuiigeo. B. vui. p. SSO*
N. SammluDg, Sc€. B. viu. p. 114*
Schulx. Schwed. Abhundlungen, B. xxi. p. 192.

t Apud. Bonet. Poljalth. iv. 47.
% AnimadTersioneS) kc.

252 ECCRITICA. [CL. Vl.-OR, 11.

the water her helly softened and sunk. The third dose completed
the evacuation ; and " thus," observes Mr. Mudge, " was this formi-
dable ascites, which had subsisted near twenty years, by a fortiv
nate accident carried off in eight and forty hours." The cure, too,
was radical : for the constitution fully recovered itself, and the par
tient was restored to permanent health.

We may observe from this case that the viscera are not neces-
sarily injured by being surrounded or even pressed upon by a very
large accumulation of water for almost any length of time. It
should be noticed, also, in connexion with this remark^ that the
patient before us was not much more than in the middle of life,
even at the date of her core : at which period we have more reason
to hope for a retention of constitutional health in the midst of a
chronic and severe local disease, than at a later age. And there can
be no question that sudorifics will be found more generally success-
ful in establishing a harmony of action between the surface and the
kidneys, and produce less relaxation of the system at this than at a
more advanced term of life.

But except where there is such a concurrence of favourable
points sudorifics can be but little relied upon in the treatment of
dropsy, and are rather of use as auxiliaries than as radical remedies.
They are also open to the same objection as emetics : they are apt,
as Buchner has well observed, to do mischief by relaxing and debi^
litating ;* and instances are not wanting in whiQh they have yery
seriously augmented the evil.t

Diuretics are a far more valuable class of medicines, and there
are few of them that operate by the kidneys alone ; the intestines,
the lungs, and oftentimes the whole surface of the body, internal as
well as external, usually participating in their action.

Of diuretics, the most powerful, if not the most useful, is foxglove.
It was in high estimation with Dr. Withering, and Dr. Darwin
regards it almost as a specific in dropsies of every kind ; though he
admits that it does not succeed so certainly in evacuating the fluid
from the abdomen, as from the thorax and limbs. The preparation
usually employed by the latter was a decoction of the fresh green
leaves, which, as the plant is a biennial, may be procured at all
seasons of the year. Of these he boiled four ounces in two pints of
water till only one point remained ; and added two ounces of vinous
spirit after the decoction was strained off. Half an ounce of this
decoction constituted an ordinary dose, which was g^ven early in
the morning and repeated every hour from three to eight or nine
doses, or till sickness or some other disagreeable sensation was
induced. In the hands of Sir George Baker, even when used in the
form recommended by Dr. Darwin, its success was, occasionally,
yery doubtful ; while in some cases it was highly injurious without

• Diss, de diversa Hydropi Medeodi Metbodo. Hal. 1766.
t Pifo, de Morb. ex serosa Coil. Obe, i.

QE.L**fiP.I.] EXCERNENT FUNCTION. 253

the slightest benefit whaterer.* Eren where it acts yery power-
iullj as a diuretiC) and* carries off Ave or six quarts of water a day,
it often excites such incessaot oausea, sioking, giddiness, and dim-
ness of sight, and such a retardation and intermission of the pulse,
that the increased evacuation by no means compensates for the
increased debility. And by a repetition it is often found to lose
evee its diuretic effects.

In the powder made into pills it seems to operate with an equal
uncertainty. It has sometimes produced a radical cure without any
superinduced mischief: but in other cases it has been almost or
altogether inert. Sir George Baker giyes an instance of tiiis inert-
Dess both in the decoction abd in pills. In a trial with the former
the dose was six drachms every hour for ^ve successive hours
during two days, through the whole of which it had not the least
efficacy, not even exciting nausea. In a trial with the latter, three
pills, containing a grain of the powder in each, were given twice a
day for several days in succession. They gave no relief whatever ;
nor produced any other effect than giddiness and dimness of sight

It is not wonderful, therefore, that the fortune of fox-glove should
have been various : that at one time it should have been esteemed
a powerful remedy, and at another time been rejected as a plant
toUt subitantiA ve%eno$a. Its roots have been tried as well as its
leaves; and apparently with effects as variable but less active.
It seems to have been first introduced into the London Pharmacopceia
in 1721 — folia, flores, semen; was discarded in the ensuing edition
of 1746, and has since been restored in its folia alone : having
encountered a like alternation of favour and proscription in the
Edinburgh College. It is greatly to be wished that some mode or
management could be contrived, by which its power of promoting
absorption might be exerted without the usual accompaniment of its
depressive effects. When recommended so strenuously by such
characters as Dr. Darwin, and more particularly Dr. Withering,
from a large number of successful eases, it is a medicine which
ought not lightly to be rejected from practice, and should rather
stimulate our industry to a. separation of its medicinal from its
mischievous qualities. Upon the whole, the singular fact first
notieed by Dr. Withering seems to be sufficiently established that in
all its forms it a less injurious to weakly and delicate habits than to
those of firmer and tenser fibres.t

The most useful of the diuretic class of medicines is the siliquose
and alliaceous tribes; particularly the latter, comprising leeks,
onions, garlic, and especially the squill. The last is always a
valuable and important article, and Sydenham asserts that he has
cured dropsies by this alone. It has the great advantage of acting
generally on the secernent system, and consequently of stimulating
the excretories of the alvine canal as well as those of the kidneys.

• Medical Transactions, Vol, iii. Art. xvii,
t Essay on Digitalis, p. 189.

254 CCCRITICA. [CL. TI.-4MU U.

It sometimes, indeed, proves a powerfbl purgative by itself; but Is
always an able associate with any of the cathartics jost eDomerated.
It may he given in any form, yet tts disgusting taste points out that
of pills as the least incommodious.

When intended to act by the kidneys alone, Dr. Cullen advises
that it should be combined with a nentral salt ; or, if a mercarial
adjunct be preferred, with a solution of corrosive sublimate, which
•eems to urge its course to the kidneys quicker and more completely
than any other preparation of mercury.* It may, also, be observed
that the dried squill answers better as a diuretic than the fresh ;
the latter as being more acrimonious, usually stimulating the stomach
into an increased excitement, which throws it off by stool or
vomiting, too soon for it to enter into the circulating system.

The colchicum autwntiaU^ or meadow-saffron, ranks next, perhaps,
in point of power as a diuretic, and is much entitled to attention.
It is to the enterprising spirit of Dr. Stoerck that we are chiefly
indebted for a knowledge of the virtues of thb plant, whose
experiments were made principally on his own person. The fresh
roots, which is the part he preferred, are highly acrid and stimu-
lating ; a single grain wrapped in a crumb of bread and taken into
the stomach, excites a burning heat and pain both in the stomach
smd bowels, stranguary, tenesmus, thirst, and total loss of appetite.
And even while cutting the roots, the acrid vapour 4hat escapes,
irritates the nostrils and fauces; and the substance held in the
fingers, or applied to the tip of the tongue, so completely exhausts
the sensorial power, that a numbness or torpitude is produced in
either organ, and continues for a long time afterwards. According
to Stoerck's experiments this acrimony is best corrected by infusion
in vinegar; to which he afterwards added twice the quantity of
honey .t In the form of an acetum, and of the strength he proposed,
it is given as a preparation in the extant London Pharmacopoeia,
while most of the other colleges have preferred his oxymel.
Stoerck used it under both forms, but, perhaps, the best preparation
is the wine, as recommended by Sir Everard Home in cases of gout,
depurated from all sediment, as already noticed under the latter
disease. Stoerck began with a drachm of this twice a-day and
gradually increased it to an ounce or upwards. Hautesierk asserts
that it is less efficacious than the oxymel of squills.^

The other diuretics, in common use, are of less importance ;
though many of them may be found serviceable auxiliaries as they
may easily enter into the dietetic regimen. These are the sal diuret^
cus, or acetate of potash, which very slightly answers to its name,
unless given in a quantity sufficient to act at the same time as aa
aperient ; nitrous ether ; juniper berries, broom-leaves, and which
is far better, broom-ashes ; or either of the fixed alkalies ; and th0

• Mat. Med. Vol. n. Part n. Ch. xxi.

t Libellus de Radice Colchice autumnali. Vindob. 1763. 8to.

t Recueil. ii.

<2B. I^-6F. I.] EXCERNENT FUNCTION. 259

freen lettuce, lactuca Tirosa, strooglj recommeDded by Dr* CoUip
of Vienna, b«|t as far as it has been tried in this country far beyond
its merits. Dr. Collin, however, asserts that oat of twenty-foor
dropsical patients he cured by this medicine ail but one.

To this class of remedies we hare yiet to add dandelion (Leonto-
doB taraxaomn^ Linn.) and tobacco. The former of these was at
one iime supposed to act so powerfully and specifically on the kid-
nies as to obtidn the name of Uctuninga : and is said by some writers
to have effected a cure in ascites after every other medicine had
£uled. It is truly wonderful to see how very little of this virtue it re-
tains in'the present day, so as to be scarcely worthy of attention : while
with respect to tobacco, notwithstanding the strenuous recommen-
dation of Dr. Fowler, it is liable to many of the objections already
started against fox-glove.

The gratiola officinalis or he^e-hyssop, was once extendrefy
employ^, both in a recent state of its leaves and in their extract,
and like many other simples, it appears to have been injudiciously
banished from the Materia Medica. In both forms it is a powerful
dfiuretic, and often a sudorific ; and in the quantity of half a drachm
of the dry herb, or a drachm of infusion,- whether in wine or W^ter,
it becomes an active emetic and purgative. It is said to have been
peculiarly useful in dropsies consequent upon parabysma, or infarc-
tion of the abdominal viscera; and in such cases seems still entitled
to our attention. As a strong bitter, it may, like the lactuca anroto,
which is also a strong bitter, possess some degree of tonic power,
in connexion with its diuretic tendency. The bitter, however, is
of a diaagreeable and nauseating kind, which it is not easy to cor-
rect

The EXTERNAL MEANS of evacuatiug the fluid of tellular dropsy are
blisters, setons, or issues, punctures, and scarification. The last is
as modi leas troublesome as it is usually most effectual It is, how-
ever, commonly postponed to too late a period, under' an idea that
sloughing wounds may be produced by the operation, difficult of
core, and tending to gangrene. In blistering tliis has often happen-
ed, but in scarifying the fear is unfoundec^ while any degree of
Titai energy remains: and it should never be forgotten that the
longer this simple operation is delayed, the more the dai^r, what-
ever it may be, is increased. 1 have never experienced the slight-
est inconvenience from the practice ; and have rarely tried it with-
out tome advantage ; seldom indeed without very great benefit. The
woend should be limited to a small crucial incision, resembling the
letter T on the outside of each knee, as the most dependent organ, a
little below the joint. The cut thus shaped, and very slightly pene-
trating into the cellular membrane will not e^ily close, and conse-
quently the discharge will continue without interruption. In a young
lady about twelve years of age, whom the author lately attended, appa-
rently labouring under an affection of the liver, but whose enormous
bulk of body as well as of limbs, prevented all accuracy of examina-
tioo, a common jack-towel applied to each leg after the incisioii was

256 ECCRITICA. [CL. Vf.-OR. ll^

made) wascompletelj wetted through and obliged to be changed every
three or four hours, for as many days. She was also purged with
small and frequently repeated doses of elaterium : and the quantity
of 6uid hereby drawn oif at the same time by the intestines is scarce^
ly credible. The whole system was evacuated in aboot a week ;
and the entire figure re-acquired as much elegance of shape and
elasticity, as before the attack. She was of a lively disposition and
fond of dancing; in which exercise she engaged with as much
enei^y and vivacity as ever. Nearly a twelvemonth afterwards the
disease returned : but the same means were not successfuL The
breathing was now affected, and there was great palpitation of the
heart ; so frequent and distressing indeed as to render her incapable
of sleeping for a moment unless in an upright position. The pa-
tient in a few weeks fell a victim to the disorder ; and on examining
the body, the liver and lungs were found perfectly sound : but the
heart was enlarged to nearly double its natural size, and particular--
ly on the right side.

During the progress of hydropic accumulation there is great dry-
ness of the tongue, and, as already observed, an almost intolerable
thirst And the question has often been agitated, whether under
these circumstances the patient^s strong desire to drink should be
gratified. In a state of health it is well known, that whatever be
the quantity of fluid thrown into the blood it remains there but a short
time, and passes off by the kidneys, so that the balance is easily re-
stored : and hence it is obvious that one of the most powerful, as
well as one of the simplest diuretics in such a state, is a large por^
tion of diluent drink. But dropsy is a state very far removed from
that of health ; and in many cases a state in which there is a pecu-
liar irritability in the secements of a particular cavity, or of the
cellular membrane generally, which detracts the aqueous fluid of >
the blood from its other constituents and pours it forth into the
cavity of the morbid organ. And hence it has been very generally
concluded, that the greater the quantity of fluid taken into the sys-
tem, the greater will be the dropsical accumulation : and conse-
quently that a rigid abstinence from drinking is of imperative ne-
cessity.

Sir Francis Milman, however, has very satisfactorily shown, that
if this discipline be rigidly enforced a much greater mischief will
follow than by perhaps the utmost latitude of indulgence. For, in
the first place, whatever solid food is given, unless a due proportion
of diluent drink be allowed, it will remain in an hydropic patient,
a hard, dry, and indigested mass in the stomachf and only add a
second disease to a first. And next, without diluting fluids, the
power of the most active diuretics will remain dormant : or rather
they will irritate and excite pyrexy instead of taking their proper
course to the kidneys. And, once more, as the thirst and general
irritation and pyrectic symptoms increase, the surface of the body,
harsh, heated, and acrid, will imbibe a much larger quantity of fluid
from the atmosphere than the {>atient is asking for his stomach ; for it

Qt, I.-SP. I.] EXCERNENT PUNCTIOJ^. 25*?

has been sufficiently proved, that, under the most resolute determi-*
nation not to drink, a hundred pounds of fluid have in this manner
been absorbed by the inhalants of the skin, and introduced into the
system in a few days, and the patient has become bulkier to such
an extent in spite of bis abstinence.

Even in a state of health or. where no dropsy exists we are in all
probability perpetually absorbing moisture by the lymphatics of the
skin. Professor Home found himself heavier in the morning than
he was just before he went to bed in the preceding evening, though
he had been perspiring all night, and had received nothing either by
the mouth or in any other sensible way. " That the surface of the
skin," says Mr. Cruikshank, " absorbs fluids that come in contact
with it, I have not the least doubt. A patient of mine, with a stric-
ture in the oesophagus, received nothing either solid or liquid into
the stomach for two months : he was exceedingly thirsty, and com-
plained of making no water. 1 ordered him the warm-bath for an
hour morning and evening, for a month : his thirst vanished, and he
made water in the same manner as when he used to drink by the
mouth, and when the fluid descended readily into the stomach.'"*

Under these circumstances, therefore, our first object should be
to determine by measurement whether the quantity of fluid dis-
cbai^ed by the bladder holds a fair balance with that which is re-
ceived by the mouth : and if we find this to be a fact, and so long as
it continues to be a fact, we may fearlessly indulge the patient in
drinking whatever diluents he may please, and to whatever extent.
In some cases, indeed, water alone, when drunk in large abundance,
has proved a most powerful diuretic, and has carried ofi" the dis-'
ease without any other assistance, of which a striking instance oc-
curs in Panarolus ;t and hence Pouteau;^ occasionally advised it in
the place of all other aliment whatever : as does also Sir George
Baker, in a valuable article upon this subject in the Medical Tran-
sactions,§ in which he forcibly illustrates the advantage of a free
use of diluent drinks, by various cases transmitted to him, in which
it operated a radical cure, not only without the assistance of any
other remedy, but, in one or two instances, after every medicine
that could be thought of had been tried to no purpose.

But the fluid discharged from the kidneys may not be equal, nor
indeed bear any proportion to what is introduced by the mouth, and
we may thus have a manifest proof that a considerable quantity of
the latter is drained ofi" into the morbid cavity. Still we must not
entirely interdict the use of ordinary diluents, nor suff*er Ihe pa-
tient to be tormented with a continued and feverish thirst. If sim^
pie diluent drinks will not pass to the kidneys of themselves, it will
then be our duty to combine them with some of the saline or aci •

• Anat. of Absorb. Vessels, p. 106. 4to. 1790,
t Pentec. ii. Obs. 24.

J Oeuvres Posthumes i.

♦ y6\» II. Art, xvii.

VOL. IV. 2d

258 ECCRITICA. [CL. VI.-OR. H.

dulons 4iuretics we have already noticed, which have a peculiar
tendency to this organ ; and we shall generally find, that in this
state of union they will accompany the diuretic ingredients, and
take the desired course. Of these, one of the most effectual, as
well as the most pleasant, is creme of tartar ; and hence this o«ght
to form a part of the ordinary beverage in all extensive dropsies,
and especially the cellular and abdominal. Any of the vegetable
acids however may be employed for the same purpose : as may also
rennet-whey, and butter-milk, and the more acid their taste the bet-
ter will they answer their end. A decoction of sorrel-leaves makes
also a pleasant diet drink for an hydropic patient ; as does likewise
an aqueous infusion of sage leaves with lemon-juice: both sweeten-
ed to the taste. Small stale table-beer, and weak cyder, or cyder
intermixed with water, may in like manner be allowed, with little
regard to measure. And it was by the one or other of these that
most of the cures just referred to, as related by Sir George Baker,
were effected. In one instance the cyder was new, yel it proved
equally salutary under the heaviest prognostics. The patient was
in his fiftieth year ; his legs and thighs had increased to such a
magnitude that the cuticle cracked in various places ; he was ex-
tremely emaciated, and so enfeebled as not to be able to quit his
bed, or return to it without assistance. His thirst was extreme, bis
desire lor new cyder inextinguishable, and his tase being regarded
as desperate it was allowed him mixed with water. He drank it
most greedily, seldom in a less quantity than five or six quarts a-
day ; and by this indulgence discharged sixteen or eighteen quarts
of urine every twenty-Tour hours till the water was totally drained
off; and he obtained a radical cure without any other means what-
ever. Even ardent spirits, if largely diluted, and joined with a por-
tion of vegetable acid, have been found to stimulate the kidneys ;
and in the opinion of Dr. CuUen may make a part of the ordinary
drink.* An<l it is chiefly owing to the tendency which the neutral
salts have to the kidneys, as their proper emunctory, and the sym-
pathy which the secements of these organs maintain with those of
all others, that the cure of dropsy has sometimes been effected by
large draughts of sea-water alone ; though sometimes this has also
acted upon the bowels, and produced the same salutary result, by
exciting a very copious diarrhoea, of which a striking example is
given by Zacutus Lusitanus.t

It should never, however, be forgotten, that dropsy is a disease
of debility, and that the plan of evacuating will rarely of itself effect
a cure ; and never, perhaps, except in recent cases, and where little
inroad has been made upon the constitution. In all other cases it
should be regarded as a preparatory step alone ; a mere palliative ;
and an evil in itself; though an evil of a less kind to surmount an
evil of a greater. And it is for want of due attention to this fact,

• Mat. Med. ii. 549.

1 Prax. Hist. Lib. vin. Obs. 53.

GE. I.-SP. !•] EXCERNENT FUNCTION. 259

that the plan of evacuating, and particularly by drastic purgatives,
has by many practitioners been carried to a dangerous and even a
fatal extreme. Every purgative that does not diminish the general
bulk, adds to the genei^ disease by increasing the debility : and if
upon a very (ew trials the plan be not found to answer this salutary
purpose it cannot too soon be desisted from.

The radical cure must, after all, depend upon inv^rating the
constitution, or the organs particularly affected : for even a total
removal of the water affords nothing more thaA a palliative and pre-
sent relief.

Such an intention may often, indeed, be combined with that of
evacuating the fluid ; and hence Mondschein with great reason ad-
vises us to employ bitters with diuretics,* as Martins does with
purgatives.t

Bitters, indeed, where the debility does not depend upon visce-
ral obstructions, form one of the most efficacious tonics we can ena-
ploy. They are peculiarly adapted to that general loss of elastici-
ty in the whole system and that laxity of the exhalents which consti-
tutes the hydropic diathesis. " It has been alleged," says Dr. Cul-
len, *' that bitters sometimes act as diuretics. And as the matter of
them appears to be often carried to the kidneys, and to change the
state of the urine, so it is possible that in some cases they may in-
crease the secretion : but in many trials we have never found their
operation in this way to be manifest, or at least to be any ways con-
siderable. In one situation, howeverr, it may have appeared to be
so. When in dropsy bitters moderate that exhalation into the ca-
vities which forms the disease,^there must necessarily be a greater
proportion of serum carried to the kidneys : and thereby bitters
may, without increasing the action of the kidneys, seem to increase
the secretion of urine."J

To bitters have been added the warmer balsamics and aromatics,
and by many physicians the metallic oxydes ; chiefly the different
preparations of copper ; though Willis, Boerhaaye, Bonet, and Dig-
by, have occasionally preferred those of silver. Iron has generally
been abstained from as too heating, though recommended by
Grieve,§ Richard,|| and Rhumelius.TT

Where the disease is evidently dependent upon some visceral ob-
struction, mercury offers a fairer chance of success than any other
metal ; and in this case has often been pushed to salivation with the
most salutary result. Du Verney employed it to this extent in an
ascitic patient, whom at the same time he tapped ; and by this dou-

* Mtndscheiii, p. 82.

t Martius, Obs. 54.

X Mat. Med. ii. p. 58.

^ Med. Com. Edinb. ix. ii. 75.

II Journ. de Med. xxix. 140.

T Medic. Spagyr. tripart. p. 168.

26« BCCRITICA. [CL. VI.-OR. U.

ble plan effected a cure ; allowing a regimeD of wine and stimulant
zneais during the process.* And Rahn assures us, that in one case,
the disease, though it several times recurred, was in every instance
put to flight by a ptyalism excited by mercurial inunction.! But
where the system is in a state of great general debility, such a so-
lution of the fluids will only add to the weakness and increase the
disease. Small doses of calomel steadily persisted in will be here
our safest course, with a nutritious and generous diet of flesh-meat
two or even three times a day ; sheli-flsh ; eggs ; spice, and the
acrid vegetables, as celery, water-cresses, raw red cabbage shred
fine, and eaten as sailad.

I have dwelt the longer on this species because the general ob-
servations whicb it suggests, as well in respect to its causes and
history as to its mode of treatment, apply in a very considerable de-
gree to all the rest ; concerning which we shall now have little
more to do than to enumerate them and point out their distinctive
characters.

SPECIES II.

HYDROPS CAPITIS.
Srcqiiss oC the ^tan. abater Cti the ^ealr.

GOEMATOVS INTUMESCENCE OF THE HEAD : THE SUTURES OF THE SCUIX

GAPING.

This disease has been strangely confounded by nosologists and prac-
tical writers with that inflammation of the brain which apparently
commences in its substance or lower part, and, producing eflusion
into the ventricles, distends them, and thus unites the symptoms of
fever and great irritability with those of heaviness, and at length
of stupor. The accumulation of fluid is here only an eflect, and
follows upon inflammation of the brain as in any other part, and is
only to be removed by removing the inflammation. U is ordinarily
denominated, however, acute or internal hydrocephalus ; but Dr.
Culien has correctly distinguished it from proper hydrocephalus or
dropsy of the head by placing it in a difl*erent part of his classifica-
tion, and assigning it a different name. In his view it is an apo-
plexy, and he has hence called it apoplexia hydrocephalica, in the
present work it occurs under the name of cephalitis profunda^ and
in treating of it as a cephalitis the author has submitted his reasons
for not regarding it as an apoplectic aflection.

• iMeni. dc Paris, 1703, p. 174.
+ Medic. Briefwechsel, B, i, 365,

as. I.H5P. II.] EXCERNENT FUNCTION. 261

The disease before ns is common to children. A few singular
cases are, indeed, recorded of its commencing in adult age,* and
producing an enlai^ement of the scull by a morbid separation of
the sutnres, but these are very rare. That it does, however, occur
without such separation and enlargement, and that too occasionally
in every period of life, has been proved by a multitude of exami-
nations after death, that have shown the ventricles of the brain dis-
tended with fluid, and producing a considerable pressure upon the
brain. Yet where no such enlai^ement of the scull takes place, we
may sometimes strongly suspect the disease from the symptoms, but
cannot during the life of a patient speak with certainty upon the
subject.

Dropsy of the head, like that of every other organ, is a disease
of debility, and as we have already observed in the introductory re-
marks to the present genus, may proceed from a relaxed condition
of the secements of the brain, a torpitude of its absorbents, or
from both. The causes of this morbid state we are rarely able to
ascertain : yet in some families there setms to be a peculiar pre-
disposition to it, since it occurs in many of the children bom in
succession : and it may sometimes be connected with a schrophu-
loas diathesis.

The immediate seat of the dropsy varies considerably : for some-
times the fluid accumulates between the bones of the cranium and
the dura mater ; sometimes between the dura mater or the other
membranes and the brain, and sometimes in the ventricles or con-
volutions of the organ. With the deficiency of tone there is also
not unfrequently some deficiency of structure or substance : and it
is in consequence of this that the fluid when morbidly secreted or
collected in one part, spreads without resistance to another. A de-
ficiency of structure or substance is sometimes found in the brain
Itself and sometimes in the cranium. If it occur in the former a
path may be immediately opened for the morbid fluid, accumulated
in the ventricles or in any other interior part, to reach the mem-
branes and distend the scull : and if in the latter, it may even pass
beyond the scull, and separate and distend the integuments. I have
seen instances of large perforations produced in diflereut parts of
the bones by a morbid absorption of the bony earth, as though the
trephine had been repeatedly applied, and this too in adult age :
and in some instances there has been a total absence of the calvaria.!
Generally speaking, there is some deficiency of bony earth, as
though it were impossible for this secretion to keep pace with the
enlargement of the cranium : and hence the boAes of the cranium
have occasionally been so thin as to be pellucid and transmit the
light of a candle, of^ which Van Swieten gives an instance,^ from

• Hildan. Cent. ill. Obs. 17. 19.

t Act. Helvct. I. 1.

% Comment, in Hydrop. Sect. 1217.

262 ECCRITICA, [CL. VI.-OIU II.

Betbeder;* or have had their place supptied by a membraDe co-
vering the entire range of the sinciput, an example of which will
be found in Vesalius.t

The dropsical fluid is also said by many writers of high authority
to originate in some cases between the integuments and the bone,
and to be contined to this quarter : and hence, the disease has been
divided into external and internal dropsy of the head. It is possi-
ble, indeed, as Van Swieten has justly observed, that since water*'
may be collected in the cellular membrane of the whole body, such
an accumulation may take place in the integuments of the Jiead.^
But the pretended cases are so rare that Van Swieten himself^ Pe-
tit,§ and many other writers of high credit, have doubted whether
such a form of the disease has ever actually occurred. Yet, should
it occasionally take place, there can, I think, be no question that it
ought rather to be regarded as a variety of anasarca or cellular
dropsy, than hydrocephalus or dropsy of the head, properly so call-
ed. Celsus has been quoted upon the occasion as confirming the
existence of this external modification, and applying to it the name
of hydrochephalus : but this is to misund'^rstand him egreg^ously.
In the passage referred to he is speaking of internal diseases of the
head alone, of cephalasa, and other aches produced by wine, or
indigestion, by cold, or heat or the r«iys of the sun, sometimes ac-
companied with fever, and sometimes without ; sometimes affect-
ing the whole of its interior, and sometimes only a part : — " modo
IN TOTo CAPiTE, modo IN PARTE." And he then adds, " praeter^hsc
etiamnum invenitur genus, quod potest longum esse : ubi humor
cutem inflat, eaque Itumescit, et, prementi digito, cedit : ti^§tu^tiX§9
Graeci appellant."|| It is manifest, therefore, that the hydrocepha-
lus here noticed, like the other diseases with which it is associated,
is an internal affection of the head : and this idea is still farther
confirmed by the treatment which he shortly afterwards proceeds
to prescribe for it.

It is hence highly probable that the cases which have been called
external dropsies of the head, have consisted of internal acoumula-
tions spreading to and distending the integuments through channels
that were not ascertained, and on this account not supposed, to
exist.

Were the distinctions of external and internal dropsy of the head
necessary to be preserved, it would be far more accurate to limit
the former to those modes of the disease in which the water is con-
fined between the calvaria and the membranes, and the latter to
those in which it originates in the cavities of the brain : but as we

• Histoire de THydrocephale de Bcgle, p. 35.
t De Corp. human. fabiicSl* Lib. i. cap. 8,
X Coronient. loc. citat. 1718*
( Academ. des Sciences, Mem. p. 121.
B Dc Medicln. Lib. iv. cap. xi.

Gft. I.-SP, n.] EXCERNENT FUNCTION. 283

can rarely, if ever, determine the limits of the collectiin hy the
symptoms, it is a distinction which cannot be supported, and would
oAen lead us into error.

Hydrops capitis frequently commences in the fetus, and some-
times renders the head so large as to retard the labour, and greatly
harass the delivery. Blanchard gives a case in which four pounds
of water were evacuated from the head of a fetus after its birth.
At other times it doe$ not show itself till some months, or even two
or three years, after birth. In most cases the whole head enlarges
gradually by a gradual separation of the sutures ; but in a few cases
tiie first symptom has been a small, elastic tumour on the upper
part of the head, produced by an inequality of the dura mater, and
its yielding more readily at the part that presents, than in any other
quarter. This tumour sometimes grows to a size as large as the
head itself It is seldom, however, that the walls of the tumour
burst ; for the uniform pressure to which they are exposed, has a
tendency to thicken and harden them. And hence, as the resist-
ance increases, the sutures give way generally, and the tumour
frequently disappears and is lost in the general swell.

The brain often exhibits, as we have already observed, some
misformation or defect, which of itself may constitute a remote
cause : but the proximate cause is a debility of the local secernents,
absorbents, or both, if the debility be confined to these, or the
defect in structure do not interfere with the proper developement
of the mental or corporeal powers of the sensorium, the infant may
live and even thrive in every other part, while the water continues
to accumulate and the head to become more monstrous, and even
insupportable from its own weight : for, provided the pressure ap-
plied be very gradual, and unaccompanied with inflammation, the
brain, like the stomach and intestines in dropsy of the belly, may
be drowned in water for even twenty or thirty years without serious
mischief. Michaelis relates the case of a patient twenty-nine years
old, whose appetite and memory were good, and the pupils of the
eyes natural, though the disease had continued from birth.* And
in treating of vascular osthexy I had occasion to notice, from Dr.
Heberden, the history of a patient who, with about eight ounces of
water in the ventricles of the brain, as appeared on opening him,
— and which there was good reason for believing had existed there
for many years, — and with scarcely an organ free from disease in
his whole body, with the exception of the brain itself, which was
found healthy in its substance, was enabled to attain the good old
age of upwards of fourscore years with an apparently sound consti-
tution, and free trom all the usual infirmities of advancing year^,
saving the inconvenience of an habitual deafness.

But the torpitude or imbecility of the excernent vessels may ex-
tend to the other parts of the brain, and to parts that are immediate-
ly connected with the mental faculties ; or the defects of structure

• Medical Communicalions, \'oI. i. Art. xxv.

2C4 ECCRITICA. [CL, TL-OR. lU

that are so often combinec) with dropsy of the head may extend to
the same : and in such cases the hearing, sight, or speech may be
adected : there may be loss of memory or stupidity, vertigo, epi-
lepsy, or convulsion fits. The brain has sometimes been found in
a spongy or fungous state ;* or otherwise disoi^anized :t and some-
times tense and slender with nerves like mucus.| The fluid, more-
over, may accumulate with rapidity, instead of slowly, as soon as
the exciting cause, whatever it may be, is in operation, and the
suddenness of the pressure may impede the action of the sanguifer-
ous vessels ; and we shall then perceive symptoms of compression,
as a heavy pain in the head, stupor, occasional vomiting, quick
pulse, and other febrile concomitants, a perpetual flow of tears from
the eyes, or of mucus from the nostriU. And hence it is that dropsy
of the head is so frequently a symptom or a sequel of inflammation
of the brain, and particularly of parenchymatic inflammation.

Yet even here we have, sometimes, striking and most singular
proofs, that the remedial power of nature is interfering either to
obtain a cure, or to render the disease compatible with life, and
with the general faculties of the sensorium. There is an interest-
ing illustration of this remark in a case, related by Dr. Donald
Monro, in the Medical Transactions. It is that of a child which at
the age of a year and a half, was brought into St. George's Hospital
with a head much enlarged from the disease before us. She was
feverish and had a slight stupor. The complaint was peculiarly
obstinate, and resisted the use of purges, blisters, issues, bandages,
and other remedies. The enlargement proceeded and became
chronic, though the fever and stupor gradually diminished and at
length ceased ; yet the head continued to enlarge and kept an equal
proportion with the child^s growth : so that when in her eighth
year, it measured two feet four inches round, which is nearly a foot
more than it ought to have done, and the forehead alone was half
the entire length of the face, or four inches out of eight, which is
double the proportion it ought to have held, — ^yet the child was at
this time as lively and sensible as most children of her age, and had
a strong and peculiarly retentive memory. It was long before she
could walk, on account of the vast weight of head she had to carry,
and the difficulty of preserving a balance ; but at length she learned
to walk also with tolerable ease.§

In the following case the eflbrts of the remedial power were less
successful : but it is peculiarly Worthy of notice, as much from the
lateness of the age in which the disease commenced, and the sutures
were separated, as from the natural struggle there seems to have
been to obtain a triumph over it. It is related by Dr. Baillie, in
another volume of the same valuable work. The patient was a

• Conrady Diss, tie Hydrocephalo. ArgeDt. 1778.

t Bonct, Sepulchr. Lib. i. Sect. xvi. Obs. 9.

% Biittner Beschreibung dcs inncrn Wasserkopfs, &c. Konigs. 1773.

\ Medical Transactions, Vol. ii. p. 359»

GE. L-8P. II.] EXCERNENT FUNCTION. 265

boy, not less thao seveii years of age when he first bee aine aflecfed.
The pupils, from an early stage, were considerably dilafed and the
pulse was somewhat irregular ; he complained of pa in towards the
bock of bis head, and was often in a state of stupor. His under-
standing, however, was clear, and his sight very little impaired
almost to the last. He had twice intervals of great promise, for a
few weeks, with considerable abatement of all the symptoms, and
aB appearance of doing well, fiut in both instances he relapsed,
and at the distance of ten months from the commencement, fell
under daily attacks of convulsion fits. It is remarkable that, though
his intellect continued unimpaired, the frontal and parietal bones,
from the force of the accumulated fluid in every direction, were
separated from each other, to a distance of from half to three quar-
ters of an inch, notwithstanding that they had been firmly united at
dieir respective sutures before the commencement of the disease.
Nearly a pint of water was found in the ventricles upon examina-
tion.

We have observed, that in many cases the bones of the scull be-
come peculiarly thin and pellucid, or are altogether deprived of
their calcareous earth, and reduced to cartilages. But where the
instinctive or remedial power of nature, which is always labouring
to restore morbid parts to a state of health, or to enable them in
their altered condition to fulfil their proper functions, has succeed-
ed io rendering the diseased brain still capable of exercising some
of its faculties, a supply of phosphate of lime, is, in various instan-
ces, also provided for the bony membrane ; which not only re-as-
sumes its ordinary firmness, but has sometimes exhibited a density
far beyond the usual proportion and commensurate with the magni-
tude of the scull ; while the cervical vertebrae have been equally
strengthened for the purpose of bearing so enormous a load. Hil-
daous gives a case of this kind in a youth eighteen years old, who,
had laboured under a dropsy of the head from his third year. The
scull was of an immense magnitude ^immens<B magnitudinis) as well
as peculiarly hard and solid. The patient spoke distinctly, but his
mind was not equal to his articulation, and he suffered greatly from
violent epileptic attacks.* ^' If sculls of this kind,-' says the Ba-
ron Van Swieten, " should be disinhumed in their burial-ground by
posterity, there would certainly not be wanting persons who would
ascribe them to some gigantic family. If, indeed, the calvaria
should be dug ap entire the error may be corrected, by observing
the size of the upper jaw-bones, which would be found of the ordi-
nary proportion : but if the bones should be separated and single,
there could be no appeal to this distinctive mark.j

The disease is always dangerous from the difficulty of determin-
ing its extent and what degree of cerebral disorganization may ac-
coispaoy it. Where, however, it is limited to a weak condition of the
■ * . ,.■■■.

* Observ. Chirurg; Cent. iii. Obs. xrx. p. 199.
t Comment. Tom. iv. Sect. 1217. p. 123.

VOL. rv. 34

266 ECCRITICA. [CL. VI.-OR. lU

excerneDts of the brain it is oflen remediable and admits of a, radi-
cal cure. But where on the contrary, no favourable impression can b<*
made upon it, the general frame partakes by degrees of the debility,
the vital powers flag, the limbs become emaciated^ and death ensaes at
an uncertain period : or the patient survived, a miserable spectacle to
the world and burden to himself; rarely reaching old age, but some-
times enduring life for twenty or even thirty years* before he is
released from his sufferings. On opening the bead twelve or fif-
teen pints of fluid have often been evacuated ; and occasionally not
less than twenty-four or twenty-five pints,! which have the singu-
lar property of not jellying even on exposure to heat}.

The water has sometimes been found lodged in a cyst, and in a
few instances the cerebrum itself has formed a sack for containing
it. Morgagni asserts that the disease is more common to eirls than
to boys.§ 1 do not know that the remark has been confirmed by
any collateral authority.

The cure, as in the preceding speoies, must be attempted by
evacualiog the water by internal or external means, and by giving
tone to the debilitated organs.

Drastic purges can rarely, in this form of the disease, be carried
to such an extent as ;to be of essential service, on account of
the early period of lif^ in which it commonly shows itself. For
the same reason diaphoretics have not been generally recommend-
ed, or often found' serviceable when ventured upon. Diuretics
have been more frequently had recourse to ; and particularly the
digitalis. Dr. Withering was favourable to its use, but it has com-
monly, as in other forms of dropsy, proved more injurious than be-
neficial.

The best internal medicine is calomel, in small doses, in union^
with some carminative for the purpose of keeping up the actioa
of the stomach, a healthy state of which is of great importance.
The calomel, however, should be employed rather as a stimulant
or tonic, so as to excite the mouths of the torpid vessels to a return
of healthy action, than as a purgative or with a view of producing^
salivation; except indeed, where symptoms of inflammation are
present, in which case it cannot be given too freely, as already ob-
served under parenchymatic cephalitis.1[ Where the disease has
been unaccompanied with inflammaiory symptoms, but nevertheless
has been attended with a feverish irritation, and great heaviness,
as well as considerable enlargement of the head, the author has
found half a grain of calomel, given three times a-day, in the maii-

* Van Swieten, Comment, loc. citat.

t Bonet, Sepulcbr. Lib. i. Sect. xvi. Obs. 1.

£ph. Nat. Cur. Dec. iii. Ann. i. Obs. 10.

If Hewson, on Lymph. Sysl. Part ii. p. 193.

♦ Dc Sed. et Caus. Mor. Ep. xii. Art. 6.
II Vol. II. p. 224.

GE. l.-SP. II.] 'eXCERNENT FUNCTION. 267

tier above pHposed, and continued three times a day for a month,
of essential service : and particularly in a case that occurred to
bitn, many years ago, of a little boy who was four years old when
the disease first appeared ; which, however, had made its attack so
in^diousty as to escape the observation of the parents till the in-
creased bulk of the head attracted their notice, which was soon af-
terwards succeeded by the symptoms just adverted to. The com-
plaint had increased, the symptoms were mpre aggravated, and the
scull, within six months, had become as large as that of an adult,
when th<s mercurial process was commenced, accompanied with a
free fbmentatibn of the head with the solution of the' acetate of am-
motiid, and aik occasional use of purgatives. In ten days there was
an evident improvement : the child was less languid, and feverish,
and ' showed less desire to rest his head perpetually on a chair.
The scull no longer augmented ; the mental faculties which began
to discover hebetude regained vigour, and the patient, now in his
twentieth year, is an under-graduate in one of our universities, ex-
IdMtittl^ a developement of talents that has already obtained for
bitn various prizes, and gives a promise of considerable success
herfeaftiir. The bulk of his head is at this moment very little
fair^er thAn it was at sit years of age : a curious fact in pathology,
thotigh by no tneans uncommon : since where the disease forms
^ace enough for a perfect growth of the brain, the calvaria ceases
to expand, and the head becomes once more proportioned to the
rM of the body.

The external means employed for diminishing the contained
fluid have consisted in local stimulants, as different preparations
of ^mmoiiia, blisters, and cauteries, and puncturing the integu-
ments.

Al> local stimulants have a chance of being useful where the dis-
ease is seated near the surface, or between the membranes and the
cranium, for they tend to excite the absorbents to an increased de-
^ee of tone and action, and consequently to a diminution of the

Seneral tiiass. But they do not seem to have much effect when the
uid issues from the convolutions or ventricles of the brain. Blis-
tering the whole of the sinciput has unquestionably been found ser-
viceable, and is perhaps the iibost effectual external stimulant we
can ethploy.

The water has also been evacuated in many instances, with full
success by a lancet : and, where the sutures gape very wide, and
the integuments are considerably distended, this remedy ought al-
ways to be tried. The brain, however, like every other organ,
when it has been long accustomed to the stimulus of pressure, can-
not suddenly lose such a stimulus without a total loss of energy ;
and hence, as it is necessary in many cases of dropsy of the belly,
to stop as soon as we have drawn off a certain portion of water,
in order to avoid faintness, it is found equally necessary to evacu-
ate the water from the brain with caution and by separate stipes ;
for where the whole has been discharged at once, the sensorial ex-

268 ECCRITICA. [CL. Vl--piU i\.

haustion has been so complete as to produce deliquiAb and sadden
death. Hence six or eight ounces are as much as it may be pru-
dent to let loose at a time in an infant of three or foar years of
age ; when the orifice should be covered with a piece of adhesive
piaster, and an interval of a day or two be allowed. The opera-
tion, indeed, is very far from succeeding in every instance : lor in
some cases there is so much internal disease or even disorganiza-
tion, that success is not to be obtained by any means. And next, a
fresh tide of water wiFl not unfrequently accumulate, and the head
become as much distended as before. Still however, the attempt
should be made, and even repeated and repeated again if a fresh
flow of fluid should demand it: for the dAsease has occasionally
been f^l^und to yield to a second or third evacuation, where it has
triumphed over the first.

Dr. Vose of Liverpool, has published an instructive case of this
kind in the ninth volume of the Medico-Chirurgical Transactions.
The patient was seven months old, and the head between two and
three times its natural size when the operation was first performed.
On this occasion a couching needle was made use of, and the ori-
fice was closed when three ounces and five drachms of fluid were
evacuated : about an equal quantity was conjectured to dribble from
the orifice after the operation, at which time the infant became ex-
tremely faint, and the integuments of the head had shrivelled into
the shape of a pendulous bag. He revived, however, with the aid
of a little cordial medicine ; and, the water accumulating afresh,
a second operation was performed by a history about six weeks af-
ter, when eight ounces of fluid were drawn off" with little constito-
tional disturbance ; which was succeeded only nine days later by a
third operation, that yielded, by the introduction of a groved cKrec-
tor, tvi^elve ounces, without any interference with the general health
whatever. A copious and vicarious discharge of serum from the
rectum took place shortly after this third puncture of the integu-
ments, which was succeeded by some degree of deliquium ; but
from this also, the patient soon recovered ; the head gradually di-
minished in size, and a complete cure was at length effiected.

Formey,* Pitschel,! and several other writers, have recommend-
ed compression, with a view of stlthulating the torpid mouths of the
absorbents to a resumption of their proper action. But no com-
pression can be made on these, whatever they may consist in (for
absorbents have not hitherto been detected in the brain,) without
compressing at the same time, parts that are injured by pressure
already. Advantage, however, may be taken of the recommenda-
tion after the brain has been evacuated ; and a proper compress
about the shrivelled head, may be of as much use in preventing
deliquium, and perhaps, by its excitement, in stimulating the tor-

* Ad. Riverii, Observ. Medic. Cent. v.
t Anat. and Chir. Anmerk. Dresd. 1784.

GE. I.«-6P. II.] EXCERNENT FUNCTION. 269

pid Teasels to a return of their proper fanctioa, as it is well known
to be of when applied around the abdomen afler the nse of the
trocar.

SPECIES III.
HYDROPS SPIN^.

«0FT rLUCTUATINQ EXTVBERANCE ON THE SPINE ; GAPING VEl\TEBRE.

This is the spina bifida of authors, so calkd from the double chan-
nel which is oflen produced by it through a considerable length of
the vertebral column: a. natural channel for the spinal marrow, and
a morbid channel running in a parallel line, and equally descending
from the brain, and filled with the fluid which constitutes the dis-
ease.

It is soBietimes local, but in tnost instances is connected with a
morbid state of the brain, and directly communicates with it. In
this last form it may be regarded as a compound dropsy of this or-
gan, the accumulating water working its way down towards the fo-
ramen ovale in consequence of its dependent position, or a deficien-
cy in the substance of the brain in this quarter, instead of up to-
wards the fontanel. In both cases the surrounding dura mater gives
way, and, in the last, forms a sinus, which, as it descends, winds it-
self through any accidental opening that may exist in or between
the bones of the vertebrae, and distends the superincumbent integu-
ments into the same kind of tumour that we have already noticed as
sometimes existing on the crown of the head, when the fluid is
pressed in an upper direction.

Dropsy of the spine is mostly congenital, and consequently a dis-
ease of ^etal life ; in many instances, however, the tumour does not
show itself till some weeks, or even months after the birth of the
child. The degree of danger roust depend upon the structural de-
fect, or other mischief that exists in the brain or the substance of
the spinal marrow. It has sometimes appeared as a local affection
jp adult age, and has admitted of a cure ; but, from its usually oc-
curring in the earliest and feeblest stage of life, and oflen before the •
sentorinm is fully developed, so as, indeed to prevent its develope-
ment in a perfect form, it is rarely remediable. We observed in
the last species that the bones of the cranium are often found im-
perfect ; and it is hence not to be wondered at that the bones of the
vertebrae should exhibit a like imperfection in the present, and al-
low a protrusion externally. Fieliz gives a case in which the whole

270 ECCRITICA. [CL, vi.-ok. «•

bf the spinous processes were deficient, ^tad the diropsj extiebded
throogh the entire length of the spinte.*

The integuments are here thinuer and more disposed to burst
than in the head, and hence, if the tumour be left to its natural
course, it commonly continues to enlarge till it bursts ; while, if it
be opened, the child, in most cases, dies from exhaustion and deli-
quium, as in dropsy of the head, provided the water be evacuated
entirely ; and if it be discharged gradually, an inflammation of the
spinal marrow is apt to ensue, which proves as fatal. Hence there
is much reason in the advice of Mr. Warner merely to support the
tumour, but not to touch it otherwise, and, in the mean while, to
see how far we can give the remedial power of nature an opportu-
nity of exerting itself bv invigorating the frame generally. Some-
thing, however, beyond support may be safely ventured upon, for a
gentle compression may be tried with propriety, and if found to do
DO mischief, it should Wgradually increased. If the disease extend
to the ventricles it will probably be of little use, but if it bis local,
it may ultimately prove successful.

This form of dropsy is mostly fatal ; but there are a few cases on
record of a successiul termination upon the employment of difierent
methods. Thus, Heister, who in bis day also recommended^ com-
pression^ gives an example of Its having radically yielded to this
pifiti, in anion with spirituous liniments ;t and Fantoni,| and Heil-
niann,§ describe, each of them, an instance of a perfect cure upon
opening ;ind evacuating the cavity, in all which instances, how-
ever, it seems probable that there was no such communication with
the brain, or that the brain, or spinal marrow, was less afifected
than they ordinarily appear to be.

A few lingular cases have occurred of young persons protracting
a miserable existence under this disease to the age of adolescence.
MarLiril mentions a youth who lived till eleven years old ; and Arcrel
notices others who survived till seventeen,|| but with paralytic
sphincters of the anus and bladder.

• In Richter, Chir. Bibl. Band.ix. p. 185.
t Wahrnebmuug. B. ii,

% In Paccbioni Animadvers. cit.

Morgagni De Sed. et Caus.
( Prodrom. Act. Havn. p. 136.
II Schwed. Abhandl. B. x. p. 291. seq.

GE. k-SP. lY.] EXCE^INENT FimCTION. 3^1

SPECIES IV.

HYDROPS THORACIS.

SENdE OF OPPRESSION IN THE CHEST; DTSPNOCA ON EmUHSB) OR OC-

cumbitvre; litid countenance; urine red and spare; pulse mr

regular; EDEMATOUS EXTREMITIES; PALPITATION, AND STARTIN08
DURING SLEEP.

This is the hjdrothorax of authors ; and the secreted fluid, in direct
oppositioQ to that of hydrocephalus, commonlj, perhaps always,
jellies upon exposure to heat.

Sauvages, who has made this disease a genus, gives a considera-
ble number of species under it, derived from the particular part oe
cayity of the tl^orax which is occupied, or the peculiar nature of
the effusion ; as hydrops mediastini, pleurae, pericardii, hydatido*
sus ; to which he might have added putmonalis, as the water is,
perhaps, sometimes effused into the cellular texture of the lungs.
But as these can never, with any degree of certainty, be distia*
guished from each other till afler death, and as such distinctioo
could make no essential difference in the mode of treatment^ it is
unnecessary to notice them, and is scarcely consistent with an ar-
rangement founded upon symptoms alone. Those who are desir**
ous of examining into the curious, and often contradictory signs by
which these several forms of pectoral dropsy have been attempted
to be discriminated by various writers, may turn with advantage to
Sir L. Maclean^s work upon the subject, where he will find them
selected with much patient study, and accompanied with many judi*
cious remarks.'*' In the present place it may be sufficient to oh*
serve that the disease is, in fact, sometimes limited to any one of
those parts, and sometimes extends to several of them : and that
when it occurs as a consequence of cellular dropsy, it is in a great-
er or less degree common to the whole.

The complaint originates with little or no observation and con-
tinues its course imperceptibly ; there is at length found to be some
difficulty of breathing, particularly on exertion or motion of any kind,
or when the body is in a recumbent position, usually accompanied
with a dry and troublesome cough, and an edema of the ancles to-
wards the evening. Then follow, in quick succession, the symp-
toms enumerated in the definition, several of which I have drawn
directly from my friend Sir L. Maclean^s very accurate arrange-
ment of them. The difficulty of breathing becomes, at length, pe-

* Inquiry into the Nature, Causes, and Cure of Hydrothorax. p« 52, 70. Sto.

272 ECCRITICA. [CL. VI.-OR. IL

culiarlj distressing, and the patient can obtain no rest but in an
erect posture ; while even in this condition he oflen starts suddenly
in his sleep, calls vehemently for the windows to be opened, and
feels in danger of suffocation. His eyes stare about in great anxie-
ty, the livid hue of his cheeks is intermixed with a deadly paleness,
Ids pulse b weak and irregular, and as soon as the constrictive spasm
of the chest is over, he relapses into a state of drowsiness and insen-
sibility. By applying the hand to the sides and using a slight de-
gree of perci»sion, we shall sometimes be able to trace a slight
degree of fluctuation. v

The disease, contrary to the preceding species is mostly to be
ibund in advanced life, and its duration chiefly depends upon the
strength and habit of the patient at the time of its incursion.- it is
hence, in some cases, of long continuance, while in others the pa-
tient is suddenly cut off, during one of the violent spasms, which
^ at length attack him as well awake as in the midst of sleep.

The causes are those of dropsy in general, upon which we have
already enlarged, acting more immediately upon the organs of the
chest, and inducing some organic affection of the heart, lungs, or the
larger arteries. We also frequently find, upon dissection, that the
disease has been produced, or considerably augmented by a number
of hydatids (taenia kydatis^ Linn.) some of which appear to be
floating loosely in the effused fluid, and others to adhere to particular
parts of the internal surface of the pleura, constituting the hydro-
^ Ihorax hydatidosus of Sauvages. They consist of spherical vesicles
containing a watery fluid, whose circular membrane is possessed of
a living power and a peculiar organization that enables them to
attach themselves to the internal surface of a cavity, and to suck
up the more attenuate and limpid humours from the neighbouring
parts.

The only decisive symptom in this disease is the fluctuation of
water in the chest, whenever it can be ascertained ; for several of
the other signs are often wanting, or, in a separate state, are to be
found in other complaints of the chest as well as in dropsy, more
particularly in asthma and empyema. And hence, in determining
the presence of this disorder we are to look for them conjointly,
and not to depend upon any one when alone. Even when asso-
ciated, we ara sometimes in obscurity : and the difiicultj' of indi-
cating the disease by any set of symptoms has been sufiiciently
pointed out by De Haen ;* while Lentin,t StoerckJ and Rufus§ have
given instances of its existence without any symptoms whatever :
and Morgagni with few or none.|| Bonet observes that dyspnoeall

* Rat. Med. P. v. p. 97.

t In Blumenbach Biblioth. iii.

X Ann. Med. ii. p. 266.

k Ad River. Observ. Med.

II Dc Scd. et Caus. Morb. Ep. xvi. Art. 2. 4. 6. 8. 11.

•T Ep. cit. Art. 28. 30.

CU& L-SP4 IV.] EXCERNENT FUNCTION. 273

is not an indication common to all cases,* and Morgagni, that start-'
ings daring sleep or on wakings do not always accompany the disease,
and may certi^inly exist without it. Hoffmann and Baglivi have
given, as an additional symptom, intumescence and torpitude of the
leA hand and arm ; but even this affection, or the more ordinary
one of laborious respiration, has existed without water in the chest.
De Rueff relates a singular case in a man who was attacked with
most of the symptoms jointly, at the age of about sixty, and was
supposed to be in the last stage of this disease. He;, recovered by
an ordinary course of medicine, and died at the age of tighty with
his chest perfectly sound to the last.t

The general principles to be attended to in the mode of treatment,
are the same as have already been laid down under hydrops cellularis :
for, as already observed, the causes are similar, and only varied by
an accidental deposition of the morbid fluid in the chest, in conse-
quence of a peculiar debility in the thoracic viscera, or of some
organic misaffi^ction. The squill is here a more valuable medicine
than in most other species ; as, independently of its diuretic virtue,
it affords great relief to the dry and teasing cough, and In some
degree, perhaps, to the pressure of the fluid itself, by exciting the
ezcretories of the lungs to an increased discharge of mucus.
Digitalis, as in other species of the same genus, is a doubtful
remedy ; its diuretic effects are considerable, but, however cautiously
administered, it too oflen sinks the pulse, and diminishes the vital
energy generally ; and is particularly distressing from its producing
nausea, and endangering deliquium ; results which ought more
especially to be guarded against in dropsy of the chest, as it is, in
most cases, not merely a disease of debility but of enfeebled age.
Sir L. Maclean is a firm friend to its use in almost every case :
but even he is obUged to admit that the state of the pulse, the
stomach, the bowels, and the sensorial function, should be atten-
tively observed by every one who prescribes it. And under the
following provision, which he immediately lays down, there can be
no difficulty in consenting to employ it. ^^ If these be carefully
watched, and the medicine vnthdrawn as soon as any of them are
materially affected^ I hesitate not to affirm that no serious inconve-
nience will ever ensue from it, and that it may be administered
with as much safety as any of the more active medicines in daily
use.^J

Blisters are, in many cases, of considerable avail ; they act more
directly, and therefore more rapidly and effectually than in most
other modes of dropsy, and should be among the flrst remedies we
have recourse to.

The strong symptoms of congestion under which the heart seems,
in some instances, to labour, has, occasionally induced practitioner^

• Sf pulchr. Lib. ii. Sect. i. Obs. 72. 84.
t Kov. Act. Acad. Nat. Cur. Tom. iv. 4to. Norimb.
f Inquiry into tho Nature, &;c. of Hydcotborax, p. 171.
VOL. IT. 36

274 JEJCCWTICA. [CL. VL-OIU IL

to try the effect of venesection : and there are cases in which it hai
tmqueslionably been A)und serviceable : as that more especially
related by Dr. Home, in which he employed it seven times in the
coarse of eighteen days, and hereby produced a cnre.* I am
induced fo think, however, thdt in this instance the dfopsy was an
effect of the obstruction under which the heart labonre,d, rather than
that the obstruction was an effect of the dropsy. And in all
instances of this kind joo practice can be more prodent But where
the dropsy is primary and idiopathic, all such obstructions will b^
more safely and even more effectually relieved by a quick and
drastic purge than by venesection.

Opium is a medicine that seems peculiarly adapted to many of the
symptoms : but by itself it ^cceeds very rarely, heating the skin
and exciting stupor rather than refreshing sleep. When mixed,
however, with the squill pill, or with small doses of ipecacuan, and,
if the bowels be confined, with two or three grains of calomel, it
often succeeds in charming the spasmodic strode of the night and
obtaining for the patient a few hours of pleasant oblivion.

Besides blisters as external revel lents, setons and caustics have
sometimes been made use of, and especially in the arms or legs.
Baglivi preferred the cautery and applied it to the latter ;t Zacutus
Lusitanus to both, and employed it in connexion with diuretics and
tonics.|

Tapping is another external mean of evacuating the water.
The practice is of ancient date, and is described by most of the
Greek writers. To avoid the effect of a dangerous deliquium from
a sudden remeval of the pressure, Hippocrates allowed, in many
instances, thirteen days before the fluid was entirely drawn off.
And to prevent the inconvenience resulting from a collapse of the
integuments, and the necessity of a fresh opening or the retention of
a canula in the orifice through the whole of this period, he advised
that a small perforation should be made in one of the ribs, and that
the trocar should enter through this foramen.§

There are two very powerful objections, however, to the use of
the trocar. The first is common to most dropsies, and consists in
its offering, in most instances, nothing more than a palliative.
The second is peculiar to the present species, and consists in the
uncertainty of drawing off any water whatever, from the obscurity
or complicated nature of the complaint, upon which we have touched
already. If the fluid be lodged in the pericardium, the duplicature
of the mediastinum, or the cellular texture of the lungs, it is obvious
that the operation must be to no purpose. And yet, with the rare
exception of a palpable fluctuation in the chest, we have no set of
symptoms that will certainly discriminate these different forms of

* Clinical Experiments, p. 34$.
t 0pp. p. 103.

% Prax. Admir. Lib. i. Obs. 112.
k Ilt^t t^m wnAm, Lib. liii. p. S44.

OE. !•«-«. IT.] EXCEIINENT FUKCTION. 275

the disease. It must be also equally in vain if the fluid be confiDed
in a cjrst, as has occasiooally proved a fact, unless the operator should
have the good fortune to pierce the cyst by accident. And, in a
few instances, again, the fluid, wl>ich has at all times a striking
tendency to become inspissated, has been found so viscid as not to
flow : of which Saviard has given us a striking example.*

A considerable pause is necessary, therefore, before tapping is
decided upon : nor ought it ever to be employed till the ordinary
Interna] means have been tried to no purpose. But where these
Junre been tried and withput (ivail; and more especially where
we have reason to ascribe the disease to local debility or some local
obstruction rather than to a general decline of the constitution ;
and more aapeciaUy still, where we have the satisikction of ascer*
taining a fluctxMliQn, or of noticing, a« has sometimes occurred, that
the ribs bulge out on the a&cted side, the operation may be
▼eBftuMid upon, and wHl oAen be found serviceable. The ordinary
place for introducing the instrument is between the fourtl^ and fiflii
<)f the £ilse ribs, alM>ut four fingers^ breadth from the soine. Bu
Veniey, however, recommends between the second and third of the
OUse nhe : and, in diSereot cases, there may be reason for even a
greater latitude than tliis.

On the Continent the operation of tapping is far more frequently
tried than in our own country : and the German Miscellanies are full
of cases of a successful event. In the volume of Nosology I have
given an account of many of these ; in several of which the quantity
of water evacuated appears to have been very considerable. Thus
in one instance, a hundred and fiHy pounds were discharged at a
single time : in others between four and five hundred pounds by
different tappings within the year : and in a single example nearly
seven thousand pints, in eighty operations, during a period ^f
twenty five years through which the patient laboured under this
complaint ; having hereby prolonged a miserable existence, which
doabtleas would have terminated without it much earlier, but
fHiich, perhaps, was hardly worth prolonging at such an expense.
In the Beriin Medical Transaction there is a case of a cure effected
by an accidental wound made into the thorax by which the whole
of the water escaped at once.t

la a few rare instances we have reason to believe that the disease
has ceased spontaneously, ju^ing from the trifling remedies that
were employed at the time : as, for example, the specific of eighteen
ounces of dandelion-juice taken daily, which, according to Haute-
sierk, succeeded radically in one patient, or the use of small doses of
squilk alone, wlikh, in the hands of Tissot, was equally fortunate In
another.

* R«ctieU «lX>bflervatione8 Cbirurgiques, Sic, Va.m, 1784.
t Act. Med. Bero]. Vol. x. Dec. x. p. 44.

876. BCCRITICA. [CL. YL-OIU U.

SPECIES V.

HYDROPS ABDOMINIS.

Brniiss of tfce ileUfi.

TENSE, REAVT, AND EQUABLE INTUMESCENCE OF THE WHOLE BELLT ; Dlft-
TINCTLT FLUCTUATING TO THE HAND UPON A SLIGHT STROKE BEIN«
GIVEN TO THE OPPOSITE SIDE.

This is the ascites of Dosoloeists. It is sometiines a result of gene-
ral debility operating chieflj on ttie exhalants that open on the
internal surface of the sack of the peritonaeum and the abdominal
muscles: sometimes occasioned by local debility or some other
disease of one or more of the abdominal organs considerably in-
farcted and enlarged, and sometimes a metastasis or secondary
disease produced by repelled gout, exanthems or other cutaneous
eruptions : examples of all which are to be found in Morgagni,*
and offer the three following varieties, which may not unfrequently
be applied to the preceding species :

m Atonica. Preceded by general debility

AtoniQ dropsy of the belly. of the constitution.

C Parabysmica. Preceded by or accompanied

Parabysmic dropsy of the with oppilation pr indurated

belly. enlargement of one or more

of the abdominal viscera.

f Metastatica. From repelled gout, exanthems

' Metastatic dropsy of the or other cutaneous eruptions,
belly.

In the FIRST VARIETY, the fluid is found in the cavity of the abdo-
men, or between the peritonaeum and the abdominal muscles. It is
produced by any of the .causes of general debility, operating on an
hydropic diathesis ; and is frequently a result of scurvy, or various
fevers.

In the SECOND variety, the organ most commonly affected is the
liver, which is occasionally loaded with hydatids, and has sometimes
weighed twelve pounds. The gallrbladder is often proportionally
enlarged and turgid, and has occasionally been found with an oblite-
rated meatus, full of a coffee-like fluid, and together with its contents
has weighed Upwards pf ten pounds. The apcumuUtion has also
sometinies been discovered in the omentum,! or sides of the intes-
tines.| In this second variety the disease is often denominated an

* De Sed. et Caus. Morb. Ep. xxxvui. Art. 49.
t De Haeo. Rat. Med. P. iv. p. 95.

Senberlicb, Pr. de Hydrope omenti saccato. Fr. 1752.

:( Frank, in Cominentatioo.. Goetting, vii. 74.

GE. L-SP. v.] EXCERNENT FUNCTION. S77

encjiited dropsy ; a term, however, which will quite as well applj
to dropsies of the o?aria, the Fallopian tube, and even the ntenis
and scrotum, as to that of the liver.

Id the thikd variety the fluid is commonly deposited in the cavity
of the abdomen ; aod is far more easily removed than in either of
the others ; oAen yielding, indeed, to a few drastic purges alone :
except where, as sometimes happens in metastatic dropsy from
repelled gout, the constitution has been broken down by a long
succession of previous paroxysms.

Under the veil off dropsy, pregnancy has oAen been purposely
disguised ; and, sometimes, on the contrary, where pregnancy has
been nrdently wished for and has actually taken place, it has been
mistaken for a case of ascites : while, in a few instances, both
have co-existed : Mauricean, indeed, mentions a case of preg-
nancy recurring a second time along with dropsy:* and in an
hydropic diathesis there is a general tendency to the kitter whenever
the former makes its appearance ; for the exhalants of the abdomen
are easily thrown into a morbid condition, and the pressure of the
uterus, as it enlai^es, weakens and torpefies their action. If dropsy
occur at a period of life when the catamenia are on the point of
naturally taking their leave, and where the patient has been mar-
ried for many years without ever having been impregnated, it is
not always easy, from the collateral signs, to distinguish between
the two. A lady under these circumstances was a few years ago
attended for several months by three or four of the most celebrated
physicians of this metropolis, one of whom was a practitioner in
midwifery, and concurred with the rest in affirming that her disease
was an encysted dropsy of the abdomen. She was in consequence
put under a very active series of different evacuants; a fresh plan
being had recourse to as soon as a preceding had failed ; and was
successively purged, blistered, salivated, treated with powerful
diuretics, and the warm-bath, but equally to no purpose >for the
swelling still increased and became tirmer ; the face and general
form were emaciated, the breathing was laborious, the dischai^e of
unne small, and .the appetite intractable; till at length these
threatening symptoms were followed by a succession of sudden and
excruciating pains, that by the domestics, who were not prepared
for their appearance, were supposed to be the forerunners of a
speedy dissolution, but which fortunately terminated before the
arrival of a single medical attendant, in giving birth to an infant
that, like its mother, had wonderfully withstood the whole of the
preceding medical warfare without injury.

in all common cases, the best means we can take to guard against
deception, are to inquire into the state of the menses, of the mam-
mae, and of the swelling itself. If the menses continue regular, if
the mammsB appear flat or shrivelled with a contracted and light-

* Traits dos Maladies des Femmes grosses, ii. p. £9. 204.

27B ficc&iTftCA. [cu.vu-<xa.n.

coloared areola; and if the intimeficeBce floctnate to a tap of the
fingera, there can be no doubi of its being a case of dropsy : but i£^
OD the contrary, the mamnuB appear plump and globolar with a
broad and deep-coloured areola ; if we can learn, whidi, in cases
where pregnancy is wished to be concealed, we often cannot do,
diat the catamenia have for some time been obstructed; and if the
iwelling appear onilbrmly hard and solid, and more especially
if it be seated chiefly just above the symphysis of the pubes, or,
provided it be higher, if it be round, and circumscribed, — though
we may occasionally err, there can be little or no doubt, in most
instances, of the existence of pregnancy. The most difficult of all
cases is that in which dropsy and pregnancy take place stimulta-
neoualy. It is a most distressing combination for the patient; and
can only be treated with palliatives till the time of child-birth.

The ordinary causes of dropsy of the abdomen are thoae of cel-
lular dropsy, of which we have treated at considerable length al-
ready, and to which the reader may therefore refer himself: the
only difference being, as in dropsy of the chest, that the excements
of these cavities, are, from particular circumstances, more <q>en at
the time to the influence of whatever may happen to be the caose
than the excements of tiie cellular membrane, or of any other part
of the system. From the extent, however, of the abdominal regipn,
and the connexion of its cavity with so many large and important
riscera, and especially with the liver, we can be at no loss in ac-
counting for a*more frequent appestrance of dropsy under this species
than under any other.

The general symptoms, moreover, are those of cellular dropsy.
The appetite flags, there is the same aversion to motion and slug-
gishness when engaged in it, the same intolerable thirst, dryness of
the sJdn, and diminution of all the natural discharges. The pecu-
liar symptoms, as distinct from cellular dropsy, are the gradual
swelling of the belly, and, as a consequence of this, a dry, irritable
cough and difficulty of respiration.

It is oflen as difficult to determine whether the water foe seated
in the cavity of the abdomen or in the liver, omentum, or any
other cyst, as in making a like distinction in dropsy of the cheat.
But, generally speaking, if we have previously had reason to sus-
pect a diseased condition of any of these organs, if the abdominal
swelling be local or unequal, and the constitution do not seem to
enter readily into the morbid action, and the remaining functions
retain a healthy vigour, we may suspect the dropsy to be of the
encysted form. While, on the contrary, if the animal frame evince
general weakness, if the limbs be edematous, the appetite fail, and
the secretions be concurrently small and restricted, there is good
reason for believing that the fluid is effused into the cavity of the
peritonaeum.

The treatment of ascites, as to its general principles and plan,
must be the same as that already laid down for anasarca or cellular
dropsy : but here, instead of evacuating the water by scarification,

GB* I.-8P. T.J EXCERNENT FUNCTION. 279

we CRD often yerj adyaDtageouslj, and more easily than in any of
the preceding species, draw it off at once by tapping. Where, in-
deed, the dropsy 'is of the encysted kind, oar efforts will often prove
in rain ; for we may either miss the proper viscus, or the flaid
lodged in the separate vesicles of a vast aggregation of hydatids,
amonnting sometimes to seven, eight, or nine thousand at a time,*
cannot be set free. Bnt where it lies in the peritoneal sac alone,
or on the ootside of this sac alone, we can often afford very great
relief by tiiis simple process, and sometimes an effectual cure. H
ought, therefore, oy no means to be delayed as it often is till the
debility firom being local has become general, nor can the operation
be too soon performed after a fluctuation is distinctly felt, and the
swelling from its bulk has become troublesome to the breathing,
and interferes with the night's rest Nor should we be deterred if
the first evacuation do not fully succeed. On the contrary, if the
general strength seem to augment for some time after the opera^
tion, the appetite to improve, and the usual symptoms of the disease
to diminish, we may take courage from our nrst success, and augur
still more favourably from a second or even a third attempt if it
should be necessary. Various cases have fallen to the lot of the
author in which a radical cure has only been completed in this man*
ner : nor are instances wanting in which the patient has only reco'
yered after the twelfth time of operating. Hautesierk gives an
instance of cure after sixty tappings within two years and a half, in
conjunction with a steady use of aperients and tonics :t and Martin,
in the Swedish Transactions, relates another instance of an infant
of four years old restored after a second use of the trocar, in con-
junction with a like course of medicines.

Internal evacuants therefore, as far as the strength will allow,
and tonic restoratives generally, should be called to our aid through
the entire process of cure, as already recommended under hydrops
cel/u^arif. The thirst, which is often unconquerable, and the most
distressing of all the symptoms, may be allayed, as we have already
pointed out, by a free use of subacid drinks, the desire for which
is by no means to be repressed, as the absorbents of the skin are al-
ways stimulated by the irritation of an ungratified desire to imbibe
far more fluid from the atmosphere than any indulgence in drink-
ing can amount to : as ordinary food, the alliaceous plants which
give an agreeable excitement to the stomach, and at the same time
quicken the action of the kidneys, will be found highly useful : and
asparagus, which in an inferior degree answers the last of these
purposes, may make a pleasant change in its season.

After all it must be confessed that tapping, is often employed
without radical success, for the disease, under all its modifications,
is too often incurable. Yet even in the worst of cases it has its ad-
vantage as a palliative ; and it is no small consolation to be able to
\-- ___

• Comroerc. Nor. 1731. J>, 271,
t Rccucil, II.

280 ECCRITICA. [CL. VL-OiU 11^

procure temporary ease and comfort ia the long progress of a
chroDic but fatal disease.

The quantity evacuated by the operation of tapping has, in some
instances, been enormous. It has oAen amounted to eight gallon*
at a time, and Dr. Stoerck gircs an instance of twelve gallons and
a half.* Guattani relates a case in which thirty pints of an oily
fluid were, in like manner, evacuated by a single paracentesis.
This disease was produced by an aneurismal affection,! and it shows
great irregularity of action in the absorbent system : for while the
absorbents of the perltonsal sac were in the utmost degree dull
and torfjid, those of the surface were in a like degree irritable, and
drunk up all the animal oil from the cellular membrane, as well as
all the moisture they came in contact with from the atmosphere.
The operation has frequently been repeated forty or fifty times
upon the same patient ; and sometimes much oflener. In the Edin-
burgh Medical Communications is a case in which it occurred ninety-
eight times within three years.J And in a foreign Journal of re-
pute is another case in which the operation was repeated a hun-
dred and forty-three times, though the total quantity evacuated is
not given.§ Dr. Scott of Harwich performed the operation twenty-
four times in only fifteen months, and drew off a hundred and six-
teen gallons in the whole.||

Occasionally, both abdominal and cellular dropsy have been car-
ried off by a spontaneous flow of water from some organ or other.
In the latter species most frequently by a natural fontanel in some
one of the extremities, as the hand, foot, or scrotum.lT In the for-
mer by a spontaneous rupture of the protuberant umbilicus, of
which the instances in the medical records are very numerous :**
And hence many operators, taking a hint from this spontaneous
mode of cure, have preferred maldng an incision into the umbili-
cus with a lancet to the use of the trocar. Pauilini relates a sin-
gular mode of operation, and which, though it completely succeed-
ed, is not likely to be had recourse to very often. The patient^
not submitting to the use of the trocar, had the good fortune to be
gored in the belly by a bull ; the opening proved effectual and he
recovered.!!

There are also a few instances of a subsidence of the accumula-

s.

• Ann. Med. i. p. 149.

t De Aneurismatibus.

X Vol. IV. p. 378.

4 N\ Sarninl. Med. Wabrnemtingen, B. iii. p. 94.

P Edinb. Med. Comment. Vol. Yi. p. 441.

T Reidlin, Linn. Med. 1696. p. 258.

Scbenck, Lib. lu. Sect. ii. Obs. 136. ex HoUerio. Obs. 140. 14V
** Desporte?, Hist, de Malad. de St. Domirrrques ii, 122.

Scbenck, Lib. iii. Sect. ii. Obs. 1 17.

Forettus, Lib. xix. Obs. .^3.

It Cent. II. Obg. 10.

Cffi. 1.-6F, v.] BXCERNENT FUNCTION. 28 1

tioD upon a spoDtaneous efflux* of some other kind ; especially of
blood, aod cbieflj from the hemorrhoidal vessels.^

SPECIES VI.

HYDROPS OVARII.
Mtnmt of the ebiirs«

HEAVY iHTUBfESCENCE OF THE ILUC REGION ON ONE OE BOTH dIDES ^
GRADUAJXY SPREADING OVER tBE BELLY ; WfTH OBSCURE FLUCTUA-
TION.

There is the same difficulty in distinguishing this disease from preg-
nancy as in dropsy of the belly : and, conseijuently, the same mis-
takes have occasionally been made. There is also quite as mnch
difficulty in distinguishing it from the parabysmic variety of abdomi-
nal dtopsy, especially when the liver is the organ enlarged and filled
with hydatids. Tet in this last case, the confusion is of less conse-
quence as the general mode of treatment will not essentially vary
Pregnancy, when it first alters the shape, produces an enlargement
immediately over the pubes, which progressively ascends, and when
it reaches the umbilicus assumes a definite boundary. In the atonic
or common variety of abdominal dropsy, the swelling of the belly
is general and undefined from the first. And in dropsy of the ova-
ry or ovaries, it commences laterally, on one or both sides, accord-
ing as one or both ovaries are affected. And it is hence of the ut-
most importance to attend to the patient^s own statement of the ori-
gin of the disease and the progressive increase of the swelling. It
is generally moveable when the patient is laid on her back ; and as
the orifice of the uterus moves also with the motion of the tumour,
by passing the finger up the vagina, we may thus obtain another
^sdnctive symptom. Where there are several cysts in the ovary,
we may perceive irregularities in the external tumour resembling,
to the touch, those of schirrhus.

This disease is sometimes found in pregnant women, but far more
commonly in the unimpregnated and the barren. It is also met
with in the young and those who regularly menstruate, as ^ell as in
those whose term of menstruation has just ceased: The accumu"
lation of fluid is often here also very considerable. Morand drew
off four hundred and twenty-seven pints, within len months ;t and
Martineau four hundred and ninety-five within a year ; and from

* Saviard, Obsenr. Cbir. Engalenus, p. 150.
t Mem. de TAcad. de Chir. ii. 448.
VOL. »v. 3#

282 EccRincA. [cl. ti.-or. u.

the same patient lix thousand six hondred and tbirty-one pints by
eighty punctures within twenty-five years.*

The disease commences, and indeed oflen continues for years,
without much affection of the general health ; yet it is insidious,
and the constitution at length suffers and fails a prey to it

Internal medicines have been rarely found efficacious, and when
tried must consist of those already noticed in the treatment of cel-
lular dropsy. Tapping affords the same ease as in abdominal dropsy,
and the operation is to be performed in the same manner. I liad
lately a lady under my care for six or seven years, who required
the operation to be performed at first every six montlis, afterwards
, every three months, and at length every month or six weeks. She .
rose from it extremely refreshed, and in good spirits ; and often on
the same evening joined a party of friends, and was sometimes
present at a musical entertainment. In about six years, however,
her health completely gave way, and she sunk under the disease.

So little, however, is the general health interfered with for the
first year or two, that the patient occasionally becomes pregnant,
while the accumulation continues to increase, and often produces a
living offspring. Sir L. Maclean, has given an interesiing case of
this kind, in which there was not only aq extensive dropsy, but an
abscess of the ovary, and a discharge of pus as well as of water on
tapping which was performed &Ye times during a single pregnancy.
The patient passed easily through her labour, but died within five
months afterwards upon a bursting of the abscess into the peritonseal
sac. On examining the body, two pints of ^^ a thick, brown, well
digested pus were found to have escaped into the cavity of the ab-
dbmen, and three pints more in the ovarian sack. The opening
was large enough to admit of three fingers ; and the external sur-
face of both the large and small' intestines was found inffamed,
and verging in some places on gangrene.'' This my learned friend
ascribes to the influence of the pus that had escaped and was in
contact with them :t but as this is said to have been ^^ well digested
pus," the inflammation is, 1 think, more probably to be attributed
to sympathy with the lacerated ovarium in its actual state of irrita-
tion from so large a rent, and so much larger an inflamed surface in
its interior.

The fluid is in this species als<>, sometimes lodged in a cyst, oc-
casionally in many cysts, or perfoaps hydatids, and there is great
difficulty in ascertaining its exact situation, and consequently in
puncturing it. A distinguished and skilful friend of the author^s
not long since made an attempt on a lady, who had been affected
with the disease for some years ,* yet unfortunately not a drop of
serum ensued, but instead of it a pint of blood. The swelling of
the abdomen has since increased to an enormous size ; internal me-
dicines have proved of little avail, and she has not consented to

♦ Phil. Trans. 17R4. p. 471.

t Enquiry inlo the Nature, &c. of Hydrotborax. Appx. p. 1. Svo. 1810.

QE. I.-SP. VI.J EXCERNfiNT FUNCTION. ' 283

ttiother trial of the trocar. It was probably from an equal want of
success that Tozzetti long since declared the operation to be of no
avail ;* and that Morgagni denounced it not only as useless but mis-
ebMTOus.t A more radical mode has been proposed, but so far as I
know only proposed, that of extirpating^ the ovarium ; which, how-
erer, for yarious reasons is| not likely to be brought into practice ;
De Haen regards such an operation as doubtful,§ and Morgagoi as-
serts it to be impossible.ll Dr. Perceval relates a case of cure pro
doced by yomiting.ir Port-wine has been injected ai\er evacuating
the water, but a general inflammation is apt to succeed, and some-
times death.*^

. SPECIES VII.-
HYDROPS TUBALIS.
Stops ftf the :^aU0p{an Cuir.

HEAVY ELONGATED INTUMESCENCE OF THE lUAC REGION, SPREADING TRANS-
VERSELY ; WITH OBSCURE FLUCTUATION.

Tms species is not common. Dr. Baillie, however, among others,
has particularly noticed and described it in his morbid anatomy, in
a case referred to in the volume of Nosology. Its mode of treat-
ment is that of dropsy of the ovary. Tapping may be attempted,
but as the water lies frequently in the hydatid-vesicles or distinct
sacs, success is doubtful.

Tlie quantity collected is for the most part larger than in the
ovarium. Munnik mentions a case in which the distended tube
contained a hundred and ten pints of fluid ;tt Harder one in which
the fluid measured a hundred and forty pints ;];{ and Cypriani an-
other that afforded a hundred and fi% pints at a single tapping.§§

* Ottcrraiioni, ftc.

t De 8ed. et Caus. Morb. Ep. xxxviii. Art. 68, 69.

t N. Act. Nat. Cur. VoL ▼. Obi. 49.

t Rat. Med. P. iv. c. iii. i 3.

I De Sed. et Caus. Morb. Ep. xxxvui. Art. 69, 70.

T Ep. II. p. 156.

— Denman, lotroduct. to the Pract. of Midwifeiy. Cb. iu« Sect, xii,

ft Apud Manget.

%X Apiar. Obt. 87, 88.

H Epistola bistoriam exhibens foetus huroani ex Tuba excisi. Leid. 1700*

2S4 JBGCRITICA. [CL. VI.-OR- II.

Weiss describes a case of complicated drop^ dhtending both the
ovariuiD aod tke Fallopian tabe.*

The causes, and progress as well as general mode of treatment
are those of dropsy of tiie oTary. Its chief distinctiTe symptom is
the elongated line which the swelling assomes and the direction it
takes towards the iliac region on the on6 dde or on the other.

SPECIES Vill.
HYDROPS UTERI^
Bto]i0fi o( the 89omt.

HEAVY, CIRCUMSCRIBED PROTUBERANCE IN THE HYPOGASTRIUM, WTTH 0B»
• SCURE fluctuation; progressively enlarging, without ISCHURY,

OR pregnancy; mouth of the womb thin and yielding to the
touch.

Sauvages makes not less than seven species of this disease, which
tie calls hydrometra, and which with him occurs as a genus. Th^
distinctions, however, are of too little account to call for such sub-
division ; and one or two of the species is doubtful : particularly
4he hydrometra, gravidarum, or dropsy of the womb during preg-
nancy. Dr. Cullen regards it as altogether unfounded, and hence
makes the symptom of eitra graviditatem a pathognomic character
of the complaint. '

The disease is rarely to be met with in the cavity of the uterus,
and when this is the case the orifice is perfectly closed. It is much
more frequently to be found in a particular cyst, or the walls of an
hydatid, or a cluster of hydatids, or between the tunics of the or-
gan. Carron ascribes it in various cases to a debility of the uterus
produced by a chronic leucorrhoea.t Other writers to the stimulus
of pent-up, coagulated blood, sometimes assuming an encysted struc-
ture.{ It is for tlie most part the result of a scirrhous or some
other morbid change in the organ, producing debility and occa-
Viionally fever. A membranous or cellular dropsy is the variety
most commonly assumed, in which the uterus is sometimes distended
to an enormous size, and the abdomen seems to b^ laborious under
an anasarca.

The water when in the cavity of the uterus, may oflen be eva-
cuated by a canula introduced into the mouth of the organ; and if
this should be prevented by a scirrhus, cicatrix, or tubercle lying
over its mouth, a rupture of the sac in which the fluid is lodged

* Abbandl. einer ungewobnlichen Kraokheit, &c. Rastadt. 1785,

t In Blegnj, Zodiac, 1781.

f Act. Nat. Cur. Vol. vii, Obf. 61.

«B. 1.-6P. VIIL] EXCGltKENT PUNCTION. ^5

may somedmes be produced by a riolent shock of electricity passed
throi^h the hypogastric region, hard exercise or.emetics.
/ A radden fall -has often had the same effect. TozEetti relates a
case of cellular dropsy of the womib which extended down the
thigh and leg on one side ; and disappeared by a spontaneous dis-
charge of the water from the cuticie of the leg affected.*

The utems has also been said to be sometimes affected with
dropsy in consequence of a conveyance of the water accumulated
in the cavity of the abdomen in dropsy of the belly, into the uterine
cavity by means of the fringy termination of the Fallopian tubes.
Of this cause, however, there does not appear to be any satisfac-
tory proof. " Yet I must confess," says Dr. Denman, " 1 have seen
«ome cases of water collected, and repeatedly discharged from the
uterus in the state of child-bed, which I was unable to explain on
any other principle.^t

The internal treatment is that of the preceding species.

SPECIES IX.
HYDROPS SCROTI.
Srotnsfi 0f the Aerotum.

«OFT TRANSPARENT, PYRIFORM,. INTUMESCENCE OP THE SCROTUM; PRO-
GRESSIVELY ENLARGING, WITHOUT FAIN.

Thi« is the hydrocele of Heister, and other writers : and offers the
two following varieties :

41 Vaginalis. The fluid contained in the tunica

Vaginal dropsy of the vaginalis or surrounding sheath

scrotum. of the testis.

i Cellularis. The fluid contained in the cellular

Cellular dropsy of the membrane of the scrotum.

scrotum.

•

The ordinary causes of the first variety are organic atony, and
organic violence as a contusion, and perhaps repelled buboes.
Van der Harr asserts that it occurs more frequently on the left
than on the right side ;}; and Jonston that it is never found on the
latter.§ Delattre described a case of congenital affection.||

• Owervaiioiii, Mediche, Firein. 1752.

t IntroducU to the Pract.ol" Midwifery, Ch. iii. Sect. ix.
f Waarneeminge.

♦ IV. 72.

H Journ. de Med. Tom. ixxii.

286 EccwncA. [cu vl-oiu u.

The second Ttiiety takes easily the pressure of the finger, and is
mostly an accompaniment of general cellular dropsy, or a prelude
to it. If it be an idl<^thic affection it may be remo?ed by scarifi-
cation.

The vaginal dropsy of the scrotum is the proper disease and is
elastic to the touch. Tt sometimes takes place with great rapidity,
and sometimes very slowly. The tunic is, in some cases, extreme-
ly distended, and the whole scrotum rendered transparent, so that a
candle may be seen through its contents.

On the Malabar coast, Koempfer asserts, that the disease is ende-
mic ;* and the scrotum has been sometimes found to weigh sixty
pounds.t

In recent cases, emetics have appeared peculiarly senriceable :
and astringents and stimulants may be tried in the form of cataplasms
or fomentations ; as vinegar, with or without a solution of muriate
of ammonia, or neutralized with volatile alkali. Though where
there is much pain leeches should be previously applied. If thu
do not succeed the sac must be opened, and the fluid be evacuated
by a lancet or the trochar. But the water soon re-accumulates, and
the same palliative must usually be had recourse to three or four
times a year. Van Swieten mentions the case of a dignified eccle-
siastic who was obliged to have the operation performed every
three months for twenty years in succession.| And I had lately a
patient who submitted to it as often, for many years of the latter
part of Ms life, though he did not live so long as Van Swieten's
patient.

The only radical cure we are acquainted with is that of obliterat-
ing the cavity, by exciting an inflammation in the vaginal and
albugineous tunics, or in the latter alone. By the first of these
operations the two tunics adhere together, and, the cavity being
destroyed, there can be no subsequent accumulation. Thus inflam-
mation may be excited by a seton, a caustic, the introduction of an
irritating fluid by means of a syringe, as brandy, diluted spirits of
wine, or a solution of corrosive sublimate ; or by incision. This
was the ordinary plan pursued till of late years, and the particular
modes of carrying it into effect were equally countenanced by sur-
geons of reputation.

For the latter and simpler process, or that which consists in con-
fining the inflammation to the t|pica albuginea, we have been
chiefly indebted of late years to*Mr. Ranisden, and Mr. Kinder
Wood. The last, after evacuating the fluid, draws forward with a
small hook " that portion of the tunica vaginalis presenting at the
external opening, and cuts it away with a pair of scissors, imme-
diately closing the external opening with adhesive plaster. By
which means a moderate inflammation of the membrane will be

* AniOBnitat. Exotic.

t Memoires de Paris. 1711. p. 30.

% Comment, ad i 252.

OE.L-6P.IX*] EXCERNENT FUNCTION, 287

insured, and I am led to hope,^^ says the ingenious writer, ^^that
the success will be frequent ^^* In effect Mr. Wood gives various
instances of complete success. Tlie piece snipped pff is very small,
and very little inconvenience is suffered. The inflammation under
this mode of operating is so inconsiderable as to be confined to the
tunica vaginalis alone, and consequently the cavity between the
two tunics is not obliterated as is obvious by the testis being still
able to tM to a considerable extent within the scrotum. Tlds
plan, therefore, is best adapted for dropsies of recent standing, and
where the sac is not much thickened and indurated. In old and
olkiurate cases it will mostly be found necessary to carry the in-
flammation so far as to obliterate the cavity.

Mr. Wood does not seem to be aware that Mr. John Douglas em-
ployed a similar remedy as a radical cure in the cellular dropsy of
the scrotum, and recommended it in his Treatise on Hydrocele,
published in this metropolis in 1755. Celsus appears also to have
glanced at the same in both kinds of dropsy .t

In a case on which the author was consulted some few years ago,
th^ patient, a gentleman far advanced in life, and who had been re-
gularly tapped about once in three months for hve or six years
antecedently, found a considerable hemorrhage ensue shortly after
the last operation, but which yielded on immersing the scrotum into
water chilled to the freezing point The hemorrhage, however^
returned within two days, and the scrotum was again as much dis-
tended, though manifestly with blood, as before the trochar had
been applied. It was clear that a pretty large artery had been ac*
cidentally wounded, or that the internal parts were in a very mor-
bid condition. To ascertain the real fact, and put a stop to the dis-
charge, the scrotal and vaginal tunics were immediately laid opett ,
from the top to the bottom, and a pretty strong pressure made
between the testicle and the sides of the latter tunic with folds of
lint which effectually restrained the hemorrhage, without the ne-*
cessity of pausing to take up any vessel. On examining the organ
more closely on the ensuing day, a foul and spongy ulcer was
detected on the tunica albuginea, from which the hemorrhage had
proceeded : by a course of warm digestive dressing, however, bo(b
the wound and the ulcer healed, aiid a radical cure of the dropsy
was completely accomplished.!

The clitoris has sometimes been found affected with the second
or cellular variety, and acquired a considerable size. The earliest
writer who seems to have noticed this sort of dropsy is Aetius ;§
and it has since been described or adverted to by Van Swieten,))

• Traiw. of the Mcdico-Chir. Soc. Vol. ix. 49,
t De Medicin. Lib. vii. cap. 21.

X See, for a case somewhat similar, Edin. Met!, E»s. ii. Art. xiv, by Mr.
Janiiesoo.

♦ Tetrab. iv. Serm. ii. c. 22. Serm. iv. c. 100.
y Comment ad ^ 1227.

288 EGCRITICA. [CL. VL-OR. II*

Saviard,* Menoary,! aod various others under the aame of hydro^
cele muliebris or fastninina.

GENUS IL

EMPHYSEMA.
Xtiftattoif* ^Xfitca^tinpusi.

EtAdTtC AND SONOROUS DISTENTION OF THE BODY OR ITS MEMBERS, FROlf
AtR ACCUMULATED IN NATURAL CAYfriES, IN WHICH FT IS NOT COMMONLY-
PRESENT.

The term ebcphysema is derived from i^ or ip and fvr«« '^inflo^'
^ flatu distendo.'' It has often been mnjUe a question by what means
the air is obtained in various cavities, in which it is K)und in great
abundance ; for we cannot always trace its introduction from without,
nor ascribe it to a putrefactive process. Fantoni found air seated
between the tunics of the gall-bladder, and Hildanus in the muscles^
" In one instance,** observes Mr. J. Hunter, " I have discovered air
in an abscess which could not have been received from the external
air; nor could it have arisen from putrefaction."^ The case is
singular and well entitled to attention, but too long to be copied.
From this and various other circumstanced, Mr. Hunter conceived
the opinion that air is of\en secreted by animal organs, or separated
from the juices conveyed to them : and he appeals, in confirmation
of this opinion, to the experiments of Dr. lugenhouz upon vege-
tables. I have not had an opportunity of reading these experiments,
but that such a sort of secretion exists in plants must be obvious to
every one who carefully examines the inflated legume of the differ-
ent species of bladder-senna, (colutea,) and the capsules of several
other shrubs quite as common in our gardens, and which can only
become inflated by a separation or secretion of air fVom the
surrounding vessels. Yet an appeal to a variety of curious facts in
the economy of numerous animals will perhaps answer the purpose
much better, as leading us more directly to the point. The sepia
officinalis^ or cuttle-fish, and the argonauta J^Tautilus^ the ordinary
parasitic inhabitant of which — for we do not know the animal that
rears the shell, — has a very near resemblance to the cuttle-fish, and
iis suspected by Rafinesquc, and since determined by Cranch, is a
species of ocythoe,§ introduce air at option into the numerous cells

• Nouvcau Recueil, Szc,
t Journ. de Med. 1790.
X Anim. Econ. p. 207.
« Phil. Tran?. 1817, p. 29i?.

6E.il] * EXCERNENT FUNCTiON.

of Uw back-bMA, and Umm rtader tbemielvefl spedfiMRy ligbter
whene?er they wish to ascend from the depths of the sea to the
surface ; aod, Id like maoDer, exhaust the back-bone of its air, and
thus render themselves specifically heavier whenever they wish to
descend. All fishes possessing a sound or air-bladder arc equally
capable of supplying this oi^an with air, first for the purpose of
balancing themselves, and next apparently for that of raising them-
selves towards the surface. In all these cases the air, thus intro-
duced and accumulated appears to be a direct secretion : at least
we cannot otherwise account for its presence, as we can easily do in
the bones of birds whose cells are filled with air ; for we can here
trace an immediate communication with the air-cells of the lungs.

Mr. Bauer has lately shown that a gas is constantly shooting forth
in small bubbles from the roots of plants into the slimy papulae by
which tdey are surrounded ; and that it is by this mean that the
slimy matter becomes elongated, is rendered vascular, and converted
into hair or down. Mr. Brande has also shown that gas, meaning
hereby carbonic acid gas, exists in a considerable quantity in the
blood while circulating in the arteries and veins, and is very largely
poured forth from blood placed, while warm, under the receiver of
an air-pump, so as to give an appearance uf effervescence. He
calculates that two cubic inches are extricated from every ounce of
blood thus experimented upon, the venous and arterial blood contain-
ing an equal proportion. And Sir Everard Home, has hence inge-
niously conjectured that it is by the escajpe of bubbles of this gas
through the serum, in cases of coagulated blood, that new vessels are
formed, as also that granulations are produced in pus ; from which
it appears that the same gas escapes with equal freedom.

These results of Mr. Brande, upon the same subject, are In per-
fect accordance with the well known experiments of Dr. Hales and
Baron Haller, which of late years appear to have been too much
neglected, if not discredited. The former asserts that in distilling
blood, a thirty-third part of the whole proved to be air : and the
latter confirms the assertion ; ^^ utique,^ says he, ^^ fere trigesima
tertia pars totius sanguinis verus est aer.^' From all which we may
reasonably conjecture that the body of air found in many cases, of
perhaps all the species of emphysema, is produced, like other fluids
found in the different cavities of the animal frame, by a process of
secretion. These species are three, and are as follow :

1. EMPHTSEHA CELLULARE. CELLULAR INFLATION.

2. ABDOMINIS. TYMPANY.

3. '■ tJTERI. INFLATION OF THE WOMB.

Tliere are probably many others— bat these are the only ones
which have been hitherto distinctly pointed out
TOL. ir. 37

290 ECCEITICA. [CL. TI.MIiU U*

SPECIES I.
EMPHYSEMA CELLULARE.

TENSE, GLABROUS, DIFFUSIVE INTUBCCSCEHCE OV TBC SKIN) CRACKUN6
BENRATH THE PRESSURE OF THE FHiaBR.

This is the poeumatosis of SauTages and CuUen, aiid coBsists in a
distension of the cellular membrane by air instead of by water, as in
hydrops cellularu or anasarca. The distension is sometimes limited
to particular parts of the body, and sometimes extends orer the
entire frame.

From the remarks we ha?e just offered on the probable separation
or secretion of air from the blood, tltis disease may originate from
various causes, and exhibit itself under rarious modifications : bat
the two following are the only extensive forms under which it has
liitherto been traced :

a A Tulnere thoracis. From a wound in the cheat|

Traumatic Emphysema. with sense of suffocation.

C A veneno. From fish-poison Or other ve-

I Empoisoned Emphysema. nom ; with extensive signs

of gangrene and putrescencj.

For the first of rtKSz VARiBrrnas tiiere is no great difficulty ia
accounting. If a wound so far penetrate the chest as to enter any
part of the lungs, and divide some of the larger branches of tba
bronchiae, the inspired air, instead of being confined to its proper
channels, will rush immediately into the chest and fill op its whole
cavitv ; as it will aho into the cellular membrane of the farogs, firom
which it will find a passage into the celhilar membrane of tha
entire body, and produce an universal inflation.

This last effect is highly troublesome and dtstressing : but the
first is productive of the utmost alarm. The lungs compressed on
every side by the extravasated air, are incapable of expansion : and
there is consequently an instantaneous danger of suifbcatioD. The
patient labours for breath with all his might, and laboan to hot
little purpose ; his cheeks are livid, his senses soon become *tu»e-
fied, and, without speedy relief, death must inevitably ensue. The
distress is moreover sometimes aggravated bv the exciteoMnt of a
cough, IB the fits of wiiiciH if ai^ coasiderahle blood-vaaial JHtre
been burst, blood is •expectorated along vith tha rejected mnoaii.

Mr. Kelly, in the Edinburgh Medical Commentaries, haa givaa a
very singular case of this affection from another cause, wMch we
will presently explain. The patient almost fiAy-seven years of age,

Cffi. «*-«. I.] EXCERNCST 1U1M3T10N. 291

bai long laboured oaJer a chronic cotigh and difficuhj of breathiBg.
Tbe empbjfvema begm te «j^ear on tbe second day after a most
Tioleot fit «f coughing, laborious vespiratiMi and pain in the side.
It «ooB coTered tbe whole rigbt side to the scrotom which was
Bbio nncb inflated, producing a crackling sound upon pressure ; and,
gradoaily widening its coarse, by tbe fourth day it extended over
^e whole body. -It was at first concei?ed that air Imd entered from
without into the cellular membraae by means of some wound in the
^de ; but no such injury or any other channel of eommunication
co«M be discovered. The symptoms, however, were so presdng
-fltet It was at length determined, under the advice of Dr. Munro, to
afibrd an escape for the air, by an opening into the cavity of the
chest. The pleura was in consequence tapped ; when upon with-
drawing the perforator, such a blast of wind issued through the ca-
Dula, as to blow out a lighted candle three or four times succes-
sively. The patient immediate became easy, and free from op-
pression, and his pulse fell from above a hundred strokes in a mi-
nute to ninety. Punctures were at the same time made into the
cellular membrane, in different parts of the body, and from these
also tbe imprisoned air puffed out upon pressure but not other-
wise. The patient recerered gradually, and in about three weeks
ate and slept as well as be had done at any time for thirty years
before. For nearly a twelvemonth he continued to enjoy a good
state of health ; but about the dose of this period was again attacked
with a cough, a pain in ^ chest, and a dificolty of breathing ; a
l»ectic fever followed, and be ^ed in about six weeks. On opening
tbe thorax^ Mr. Kelly tells us, that be found the lungs ^^ in a very
fvlfid diseased state, wftb some tubercles on tbe external surface
of tbe right lobe ; there was extensive adhesion to the pfiBura, par-
Mcolarly at the place where the pain had been felt most keenly be-
fore the perforation; and,, on making an incision into the right lobe,
an abscess was discovered which contained about four ounces of
fetid pumlent matter.^'* We are hence, 1 think, led to conjecture
ttiat tbe emphysema was in this case produced by the bursting of a
former abscess in the right lobe of the lungs, accompanied with a
rapture of one or moce of tiie bronchial vessels, in consequence of
which the same efiect followed as if a wound had been inflicted
from without

Where it is necessary to evacuate the air from the cavity of the
xbeet, kf an artifidial opeaing, the operator cannot do better than
feiiow the example of Mr, Hewson who employed a scalpel, and in-
troduced it into the fore-part of the thorax, either on the right or left
aide ; bat be^eea tbo iiiib and sixth ribs in the former case, be-
caose beve the integumeiUs are tUn ; and between the seventh and
€ic^b, or tbe eigbth and tenth in the latter, for the purpose of
avoidiag the pericaidiiuii.

The inflatioa which follows so suddenly and so extensively in the

* Edinb. Med. Comment. Vol. n. p. 427.

292 BGciUTicA. [gl. T1.*^B* u.

sscoifD VARnrrr, or upon the introductioa of fish-pokon, or fliat of
several species of the mushroom or numerous other edible venoms
into the stomach, it is not so easy to account for. In most of the
cases there is so violent and general a disturbance of every functioD,
as to produce extreme and instantaneous debility ; all the precwr-
sors of putrescency are present, and speedy dissolution is threaten-
ed. Every part of the body is swollen and inflated, particular^ the
stomach and intestines, the vapour of which, when examined after
death, is found to consist of a fetid and putrid gas : a blackish and
greenish froth is discharged from the mouth; clonic or tetanic
spasms play wildly over all the muscles ; the chest labours with suf-
focation, the brain is stupefied, and broad, livid or gangrenous spots
spread over the body ; and on dissection are found still more freely,
and of larger diameter on the surface of most of the thoracic and
visceral oigans.

If then, in a state of undisturbed organization, many parts of the
body have a power of secreting or separating air from the blood,
as we have endeavoured to show in the introductory remarks to the
present genus, how much more readily may we suppose such a se-
paration to take place in proportion as the oi^ns approach that
precise state in which the gases of the blood extricate themselves
spontaneously from its other constituents. And it may be added
that this explanation is confirmed by our perceiving that the most
effectual , remedies against all such inflations are the most powerful
antiseptics we can employ : as acids, alcohol, and the aromatics.

In few words, we never cease to find a free extrication of air
whenever the body or any part of it is running rapidly into a state
of putrefaction : and hence another cause of cellular emphyseoM,
fmd a caifee that is perpetually occurring to us in gangrene.

SPECIES II.
EMPHYSEMA ABDOMINIS.

TENSE, LIGHT, AND EQUABLE INTUMESCENCE OP THE BELLT ; DISTINCTLV
RESONANT TO A STROKE OF THE HAND.

This disease is the tympanites of authors, so called from the drum-
like sound which is given on striking the belly with the hand.

There have been man^ occasions of obseiVing that the Greek
termination itis or ites^ is, ior the sake of simplicity and perspicuitr,
confined, in the present system, to the different species of a single
genus of diseases, that of empresma, of which we have treated al-

6E» IIw-«P. IL] EXCERNEIiT FUNCTION. 293

ready :* and hence, as well as for other reasons suffidentij obvions,
the specific term before us has been selected in its stead.

Tympanites, however, is by most writers applied principally to
an enormous collection or evolntion of air In some part or other of
the alykie canal, constituting the tympanites intestinaiu of Sanyages :
and it is to this disease alone that Dr. Cullen confines his attention,
wlien treatii^ of the subject in his First Lines. This flatnlent dis-
tention he ascribes to an atony of the muscular fibres of the intes-
tines, accompanied with a spasmodic constriction in parts of the
canal ; by which means the passage of tlie air, is, in some places,
Intermpted. In this view of the case, however, tympany, instead
of being entitled to the rank of a distinct genus, is nothing more
than a symptom or sequel of some other enteric affection, as dyspep-
sy, colic, worms, or hysteria : and hence the remedies applicable to
these are what Dr. Cuilen recommends for tympanites — namely,
aToiding flatulent food, laxatives, and tonics.

Mr. John Hunter seems to have conceived that a tympany of the
stomach or intestines may exist as an idiopathic complaint ^^ I am
inclined,^' says he, ^ to believe that the stomach has a power of
forming air and letting it loose from the blood by a kind of secretion.
We cannot, however, bring any absolute proof of this taking place
in the stomach, as it may in all cases be referred to a defect in
digestion; but we have instances of its being found in other
cavities where no secondary cause can be assigned.^'! He alludes
chiefly to an extrication of air in the uterus, which we sliall have
occasion to notice in our next species.

In concurrence with these remarks it may, also, be observed, that
some persons are said to have a power of producing ventricular
disten^ons voluntarily, which it is difficult to account for except by
a voluntary power of secreting air for this purpose, or forcing it
down the cesophagus, which will be still less readily allowed. Mor-
gagoif and other writers have hence treated of this form of the
disease as well as of that in which the flatus is lodged in the
peritonsal sac : while others have contended that this is the only
form, and that a peritonaeal tympany has no real existence. §

If an idiopatliic tympany of the stomach should ever be decidedly as-
certained, its cure must be attempted by the remedies for flatus of any
other kind : but at present the only disease we can fairly contemplate
as entitled to the name of tympanites, or emphysema abdominis^
notwithstanding the incredulity of some practitioners, is that in
which the resonant swelling of the belly is produced by air collected
in the sac of the peritonseum. It is unquestionably a rare disease,
though we must contend, in the language of Dr. Cullen, that, ^^ fronx

* Vol. II. Cl. III. Ord. II. Geii. vu. p. 212.
t On the Animal Econom. p. 206. 4to. 1792.
{ De Sed. et Caus. Morb. Ep. xxxviii. Art. 23.

Collect. Soc* Med. Havn, ii. p. 73.
i Litre, Mem. de TAcad. des Sciences, 1713. p. 235,

294 BccRmcA. [cu n^-cnu il

atrenl iaMeMam it is ui^eslloMMe tkAtavdi a <
times truly, •ocurred :^^ nor can we mi|ifMte tndi aecwate and ^
tiauB patholagiBts as H^ter,'*' Lieataad^t and Bell4 wbo hare
lespeetiveiy girea examples of it, to barre baenanccetsiTelj decehr*
ed upon the aabjeot Admittio; it lie prodoced by aecretlati, its
ocoasioiial causes are still very diMcare. It bas be«B said to follow
iqpoa jaoadice, aod morbid afiections of other abdoniBid Tiacera^
vpoQ debility produoed by fever ; apoo bysteiia, TiolaaA passiaiia or
otber emotions of the miad; and probably all tbese may baTe
operated in different cases.

The ordinary natural care seems to consist in an escape of tin
air from the mnMlicas by an outlet produced by an abscess or
ukeratiott of this protuberant organ, or a sadden and foartmate mp-
tare of its iateguments. Morgagai and sereral latet wiiterB§ gire
us well authenticated cases of an occarranoe of die first of tlwae,
and Stoerck of both.|| We are tlras led by nature herself to try the
effects of tapping, or making an artificial opening into the carity of
the abdomen in the case oi wind-dropsy, as well as in that of water-
drop^ : and here, from the protruded state cff tbe umbilicus, the
lancet may conveniently be introduced at this point. The belly
should, at the time of the operation, be well swathed with a bread
girth, which may foe tightened at option, and should be kept as t^h(
as the patient can bear it, as well for the purpose of general support
as f(w that of expeibog the air within, and preventing the entrance
of air from without.

Van Swieten dissuaded his pupils firom tbis operation ;ir and
Cembalusier,^ and a few others iutve since asserted that it does not
answer. But inmost of these cases we have reason to believe Chat
the seat of ttie disease was mistaken, and that the fiaMency existed
in the intestinal canal rather than in the peritonwai sac.

Antecedently, however, to Ibe operation of the paracentesis, we
may try the effect of sending abocks of the electric aura throngh
tiie abdomen. Cold fomentations, moreover, or even pounded toe
may be applied externally, and gelid drinks, reduced nearly to the
freezing point, be swaHowed copiously at the same time. This pHm
ia said to have answered occasioaally.tt And it is obvious that a
tonic regimen, with free exercise, and particularly equitation,
and, whore It can be bad recourse to, sea4>athlttg, should be enter-
ed upon as soon as the tympany is dispersed

• Walirnehininigen. i. Art. 15.

+ Hi9t. Anat, v. p. 438.

± On Ulcers and Tumours. Vol. il.

^ I

( Gulsard, Practique de Chirurgic. Tom. I. p. 134.

II Ann. Med. ii. p. 190, 193, 194.

T Ad Sect. 1251.

•• PneumatopathoL p. 503.

Duswau, Journ. de Med. 1779.

ft Thedeq, N. Bemerkungen und Erfabrungen, n. p. 251.

QE. IM^'^m, U.} EXCERKEliT FWCTION. MS

Then is a nngakr ease of flatoteul Jiikianioa inserted in- tke
Edinburgh Medical Essays, by Professor Monro, which is called a ty»-
paoy, but does nod seem to hirre been exierior to the intestiDa] canal ;
and hence, if a tyinp«ny at all, most havB been prodDced bjr m
secretion of air into the stomach or bowela, as conjectured by Mr*
J« Hunter. The patient was a yocrog woman aged twentjr^two*
The inflation continued for at ieaiit three moBtha, the belly being^
sometimes so extreme^ dutended as to endanger its bunthag, mSt
sometimes considerably detumefied, at which last period a ranetf
ef une4)aal and protuberant balls were lelt all over the abdomen,
ao^ seemed to indicate- so many intestinal constiictioni. The
patient^ appetite continued good, she was very costive, and meok
struated onW at intervals of several monthsi She was at length
attacked widb borborygmi, and a day or two afterwards had such
explosioas of wind mm mm nmm^ that none of the other jpatientB would
remain in the same rooin, and hardly on the ^ame floor with her.
From this time she recovered gradually.*

SPECIES III.

EMPHYSEMA UTERI.

ucwr, TBiisu, onunjMaoaiBBn FfceruBCRiiveB uc the mrroojiaTRiuii ; on*

SCURBLV SOtfOROUS ; WtKD OOGiSMNrMXT DISCHAROia> THB090R TUB
MOVTH or THR VTBRVS.

Tnn is the physometra of Sauvag^s and later nosologlsts. Lfte tiie
last species, it is by no means a ft^quent complaint, and not easy to be
aecounted for exc^t upon the principle of a secretion of air : and
hence the existence of this species as well as of the last has been denied
by seyeral writers who do not happen to have met with exampleaof
it The description given of it is somewhat obscure in most of the
pathologists, but there seems, upon the whole, sufficient reasoa
R>r admitting it into the Kst of morbid affections. ^^ it ha» been
said,^' observes Dr. Denrnan, ^^that wmd may be collected and
retained in the cavity of the uterus till it is distended in such a
manner 8B to resemble pregnancy, and to produce its usual ^mp-
loma ; and that by a sudden eruption of the wind, the tumefaction
of the abdomen has been removed, and the patient immediately re-
duced to her proper size. Of this complaint I have never seen an
example : but many cases have occurred to me of temporary explo-

• Idia. Med. Ewayt, Vol. i. Art. itxxi.

296 ECCRITICA. [CL. yi.-OR. IL

sioQ9 of wind from the uterus which there was no power of restrain-

The uterus is one of those oi^ns referred to under our last spe-
cies, as supposed by Mr. John Hunter to have a power of secret-
ing or separating air from the blood : and, as he has examined the
subject with critical attention in direct reference to the present
complaint, his remarks are particularly entitled to our attention. ^^ I
have been informed,^' says he, ^^ of persons who have had air jn
the uterus or vagina without having been sensible of it but by its
escaping from them without their being able to prevent it : and
who, from this circumstance, have been kept in constant alarm lest
it should make a noise in its passage, having no power to retard it,
as when it is contained in the rectum. The fact being so extraordi-
nary made me somewhat incredulous ; but rendered me more in-
quisitive in the hope of being enabled to ascertain and account for
it : and those of whom I have been led to inquire, have always
made the natural distinction between air passing from the vagina
and by the anus : that from the anus they feel and can retain, bat
that in the vagina they cannot ; nor are they aware of it till it pass-
es. A woman, whom I attended with Sir John Pringle, informed
us of this fact, but mentioned it only as a disagreeable thing. I
wais anxious to determine if there were any communication be-
tween the vagina and rectum, and was allowed to examine, but dis-
covered nothing uncommon in the structure of these parts. She
died some time afler ; and being permitted to open the body I found
no disease either in the vagina or the uterus. Since that time I
have had opportunities of inquiring of a number of women concern-
ing this circumstance, and by three or four have been informed of
the same fact, with all the circumstances above mentioned.''t

The only difficulty in the case is the means by which air can
thus become accumulated in the cavity of the uterus ; for admitting
this fact, of which there can no longer, I should think, be any doubt,
we can easily conceive a distention to the utmost power of the or-
gan in consequence of an obstruction of the mouth of the womb
from spasm, a coagulum of blood, or any other viscid material
And hence, in all the cases of this disease which have descended to us,
we find such a closure described as existing whenever the organ
has been examined. Thus, in the instance related by Eisenmen-
ger,| we are told that the uterus was completely impervious ; and
a like account is given of a similar instance recorded in the Ephe-
mera of Natural Curiosities. Palfin§ gives a case in which the ob-
struction proceeded from an hydatid cyst that had fixed at the mouth
of the uterus, and Fernelius{| another in which the obstruction,

. * Introduction to the Practice of Midwifery, Chap. lU. Sect. x.

I Animal Economy, p. 406. 4to. 1792.

f Collect. His^oria foetus Mussi-pontani, &c.

i Description des parties de la femine qui servant k la generation. Leid.
1708.

II Palholog. Lib. IV, Cap. xv.

cas, ii«-8r# in.] excernent function. 297

and consequently the inflation, returned periodically. Dr. pen-
man intimates that this affection is sometimes accompanied with
spasmodic pains, resembling those of labour : and the same remark
will apply to dropsy of the womb which so much resembles it.
The fact is that the uterus, when once enlarged by whatever.means,
and stimulated, has a natural tendency to run into a series of expul-
sory exertions in order to free itself from its burthen, and to ex-
cite all the surrounding muscles into the same train of action ; and
hence, natural labour, fidse conception, uterine dropsy and inflation
produce the same effect, though, perhaps, in different degrees.

Emphysemas, like dropsies, are,1n all cases, disorders of debility :
and hence the mode of treatment in the disease before us is obvi^
oos. As an occasional discbarge of wind from the ragina affords
temporary ease, we should take a hint from this effect : and endea-
vour, first, to evacuate the confined air entirely, by a canula in-
troduced into the os tineas ; and secondly, to invigorate the weaken-
ed organ by the use of some tonic injection, as a solution of catechu,
alum, white vitriol, or diluted port wine*

GENUS IIL

PARURIA.
SfUlBmittuxitim.

^ MOEBO) SECRETION OR DISCHARGE OF URINE.

The term paruria is a Greek derivation from wm^ perperaro, and
mifmj ^^ mingo.'^ The genus is intended to include the ischuria,
djrsoria, pyuria,, enuresis, diabetes^ and several other divisions and
subdivisioiis of authors, which, like the different species of the pre-
cedinjp: genus, lie scattered, in most of the nosologies through wide-
ly di&rent parts of the general arrangement. Thus, in Cullen,
diabetes occurs in the second class of bis system ; enuresis in the
fourth order of his fourth class ; and ischuria, and dysuria, in the
fifth order of th$ same class. All these, however, form a natural
group ; an^ several of them have characters scarcely diversified
enough for distinct species, instead of forming distinct genera.
Dysuria might have been employed instead of farubia, as a generic
term for the whole ; but as it has been usually Uroited to the third
^ecies in the present arrangement, it has been thought better to
propose a new term than to run the risk of confusion by retaining
the old term in a new sense.

The species that justly belong to the present genus appear to be
the following :

VOL. IV. 38

298 ECCRITICA. [cfc, Vt^-OR. U.

i. PARURU IN0P8. toEStmmOir OF VMirE.

2. RETENTIONS. STOtPACaB 0» mMXm.

3. STILLATITU. aTRANOURT.

4. MELLITA. SACCHARINE ^fhlNS.

B. iNCONTnlERS. iNCONTlNl^fCE OP ^A^Kk

6. — iNcoctA. vNAd8niti^'t«& rnmrn.

7. — ERRATtCA. ERRATIC VRfNE.

From tids groop of iimilj diMtte* w« iftaj p^re^iTe that the
urine fssdmetiiBes derafijB^ed ia its goaptiy v<om>pH«wn in its^pialttjci
and Bometf mes in its outlet : and that in its qnality it is deranged in
two ways^ by being ttiade a medinn for foreign materiak, and by
being imperfectly elaborated. The meat important prmdple whicii
it seems to carry off from the constitntio& is the urea or that of the
nvic acid : and it has been ingwsionaly r«imariLed by M. B^rard^ in
fats Atlatysis of Animal Substances, «« That, as this is thtt most az^
tised of all the animal principles, the aeeretion of untie appears to
have for its object a separation of tlie eaccem of azote ibma the
blood, as respiration separates from it the excess of carbone.^'

SPECIES L

PARURIA INOPS.

URINE UN8ECRETED BY THE mONEVS : NO DfiSmB TO tOXB WATER, NOR
SENSE OF FULNESS IN ANY PART OF THE URINARY TRACK.

A DEFICIENT secretion of urine is often a result of renal hsflamaN^
tion, in which case, however, there is necessarily a coosidecabiih
degree of pain and tenderness in the lumbar region. Bmt the pre*
sent species occurs occasionally as ati idiopatMc affection, soms*
times followed rapidly by great danger to the general fabric, some*
times assuming a chronic form, and nmnhig on for a coBsiderahla
period of time without danger, and sometimes extsting as a oonoti-
tutional affection coeval with the birth of the iodividual.

Dr. Parr relates a case that occurred in his own praotiice in whiah
no urine was apparently secreted for six weeka^* and Haller gives
a similar case that lasted twenty-two weeks.t in the Phik)sophiad
TraDsactions| we meet with various instances of a similar d«fiOMift*>
cy ; among the most singular of which is ^e case o^ a y^ooth of

* Diet, in verb. Ischuria,
t Bibl. Med. Fr. ii. p. 200.
:f Vol. XXVIII. year 1783.

HE^ m--SP. 1.] EXCERNKKT FUNCTION. 209

-B6veote«ii yeaisof age deiciibedbv Dr. Bicbi^rdsoii, who had never
4mKi& vFfit^r firom his birth, uqv had felt the least uneasiness on this
KQ^o^Mif being beatth^, vigorous, and active.

liet it not be tvppofed, however, that so important a recrement
m the urine is ftan h^e its constituent principles remain behind,
^04 k)9d the blood without danger. The outlet at which these are
4i9paistod nod dwchaiged is not always manifest, and hence they
VQinetiines ihPP^^^ not to be separated and dischar^^d at all ; though
if the stale of the patient be critically exanuned into by an accurate
pathologist, the vieiurious channel will general^ be detected, nnd
meat of the cases that mnBt at present range imder the species be-
fore «s, would be tfansferred te that. of paruria erratic^.

The two most common emuactorles that supply the place of the
kidneys are the ^kkk and the bowels. In Dr. Farr's case, he states
that there was no vieariooB evacuation, ejicept a profuse sweat for
a day or two, and he adds that there was no suspicion of imposture,
as the patent was in a hospital and constantly watched. But wc
have no aceonnt of the state of the bowels. In Dr. Richardsonls
case of a natural destitution of imoe, the patient is admitted to have
laboured wider an habitual diarrhoea, though with little uneasioess,
and the discharge of the urinary elements is very correctly ascribed
(o the intestinal flux.

The efiiects that result from a retention of the urinary elements
in the system, are a loss of energy and a growing torpitude in eve-
ry function, proving that the sensorium is directly debilitated, and
rendered incapable of secreting its proper fluid. It is, hence, to be
expected that the brain should evince torpitude in a -greater de-
gree than any other organ, and become oppressed and comatose, as
though in a state of apq^^texy. Nor is it difficult to account for
these effects, since they naturally follow from having the blood sur-
€hs^r§^ with that excess oi aaote which, as we have just observed,
it appears to be the office of the urine to carry off. The destruc-
tive power of azotic gas to animal life is known to every one, as
is also its further power of increasing the coagulability of the
blood.

I do not knotw, however, that the great and pressing danger of
havii^ the constitxient principles of the urine thrown back into the
blood, have been distinctly pointed out by any physician before the
appearance ^^ Henry Halford's valuable article in a late volume
of the Medioil Transactions which contains the following interest-
ing case : " A very corpulent robust farmer, of about fifty-five yeara
of age, was seised with a rigor which induced him to send for his
arpe&eoaiy. He had not made water, it appeared, for twenty-four
hours ; b«t there was no pain, no sense of weight in the loins, no
dtotenlion in any part of the abdomen, and therefore no alarm was
tnlmi till the fellowing morning when it was thought proper to as-
cofftain whether there was any water in the bladder^ by the intro-
duction of the catheter; and none was found. I was theii called,
and another inquiry was made, some few hours afterwards, by one

300 KCCRITIGA. {Ct. TL-M. U.

of the most experienced sorgreons in London, wliefter the hladdet
contained any urine or not, when it appeared cleariy thiit there wti
none. The patient sat np in bed and conyeraed as osnal, complaiih
ing of some nansea, but of notliing material in his own view ; and I
remember that his friends expressed tlieir snrprise tlmt so moch
importance should be attached to so little apparent ilhiess. The
patient^s pnlse was somewhat slower than nsnal, and sometimes he
was heavy and oppressed. I ventured to state that if we shoald
not succeed in making the kidneys act, the patient wonld soon be-
come comatose and would probably die the following night; for
this was the course of the malady in every other instance which I
had seen. It happened so ; he died in thirty hours after this, in a
etate of stupefaction."*

To this short history, Sir Henry has added the following remarks
which are of too much importance to be omitted. ^ All the pa-
tients who have fallen under my care were fat corpulent men be-
tween fifty and sixty years of age : and in three of them there was
observed a strong urinous smell in the perspiration twenty-foor
hours before death ;" evidently proving that in these cades the in-
stinctive or remedial power of nature, aided by the constitutional
vigour of the respective patients, was endeavouring to convert the
exhalants of the skin into a substitute for the palsied kidneys, bat
was not able completely to succeed.

in attempting a cure of parurla inopa we ought, in the first in-
stance, whatever be its cause, to take a hint from the light of na-
ture which is thus thrown upon us : and, as the excretories of the
skin and of the kidneys are so perpetually assisting each other in al-
most every way, excite the former by active diaphoretics «to take
upon themselves for a lime the oflfice of the latter, and carry off the
urea that should be discharged by the kidneys.

We should next endeavour to restore the kidneys to their natural
action by gentle stimulants or diuretics, as the alliaceous and sili-
quose plants, especially horse-radish and mustard, the aromatic re-
sins and balsams, especially those of turpentine, copaiba, and the
essential oil of juniper. Digitalis is of little avail, and in idiopathic
diseases of the kidneys does not often exhibit a diuretic effect If
given at all it should be in conjunction with tincture of lytta, or the
spirit of nitric ether.

Stimulants may, at the same time, be applied externally as the
hot-bath, or strokes of the electric or voltaic fluid pasted through
the loins ; to which may succeed rubefacients and blisters.

In the mean while the akine canal should be gently excited by
neutral salts ; and juniper-tea, broom-tea, or imperial, may alter-
nately form the common drink. The juice of the birch-tree (be-
tula alba) will often, however, prove a better diuretic than an^ of
these, it is easily obtained by wounding the trunk, and wh«i mah
is a sweetish and limpid fluid, in its concrete state affording a brown*

* Med. Trans. Vol. vi. p. 410.

0&. m.-6P. f.] ExcEmn&NT function. 301

Ish umnDa. It has Ae advantage of being 6)^% aperfontas wdl
m powerfully diuretic. From its stimolatiiig the iDtestines it waa
at one time supposed to be a good yermifage, and to hare yarions
other properties of which, in the present day, we know notliing:
whence it has nnjnstly ftHen into discredit eyen for properties to
which it has a fair ciidm.

SPECIES IL

PARURIA RETENTIONIS.

Jktatit»0e tC eirftir.

VRINE TOTALLY OBSTRUCTED IN rTS FLOW: WTTH A SENSE OF WEIOHT
OR UNEASINESS IN SOME PART OF THE URINARY TRACK.

This is the ischuria of many writers, and thongh, like the preced-
ing species, it is equally without a flow of urine, it differs yery
widely from it in other circumstances. In paruria %nop$ the excre-
tories of the kidneys are inactive, and, consequently, no urine is
produced. In the species before us the secements possess an ade-
quate power, but the secretion is obstructed in its passage. And, as
it may be obstructed in diflerent organs and in numerous ways in
each organ, we have the following yarieties :

m Renalis. Pain and sense of weight in the region of

Renal stoppage of the kidneys, without any swelling in the

urine. hypogastrium.

C Ureterica. With pain or sense of weight in the region

Ureteric stoppage of the ureters,
of uiine.

y Ve^calis. With protuberance in the hypogastrium ;

Vesical stoppage frequent desire to make water ; and

of urine. pain at the neck of the bladder.

2 Urethralis. With protuberance in the hypogastrium ;

Urethral stoppage frequent denre to make water ; and a

of urine. sense of obstruction in the urethra, re-
sisting the iiUroduction of a catheter.

OBtnufcnoN of uains may take place in the kidneys from a va-
riety of cavses, as spasm, cd.lculus concretions, inflammation or ab-
scess ; and th« tumour or swelling which occurs in any of these
states, floay be so coBsiderable as to prevent the fluid from flowing
into the pelvis of the kidneys as it becomes secreted by the tubules,
or out of the pelvis when it has collected there.

The kidneys, however, lie so deep, and from their minuteness

808 AocmncA. [cju tl-or. u.

•re se complfttrij tetied in tke loins tbnl the -Int^mtcceQce whjck
ymducns the abstraction it often imperceptible to the eje, or e^en
lo the tench. At tioiea, however, the organ becomes wgoderfuU^
angmented as the process of inflammaUon proceeds. CabroUns
gives OB t^ history of a purulent kidney that weighed fourteen
pounds.* And where the enlargement is accompanied with Inj^
little inflammation, proceeds g^dually, and does not enter into a
suppurative state, the organ not unfrequently becomes much more
enormous, and has sometimes been found to weigh from thirty*five
to forty pounds.!

In this condition there is no difficulty in conceiving a total ot>-
struction to the flow of the urine even when elaborated in sufficient
abundance. But the kidney, on the contrary, ^metimes wastes
away, instead of enlarges, and this so much as to become a shri-
velled sack, and not exceed a drachm in weight ; and as the sintis
of the kidney contracts with its body, the organ at its extreme point
is iemetimes found imperforate : and hence how small soever may
be the quantity of fluid which in this morbid condition may be se-
parated from the blood, none whatever can pass into the ureter ;
and if both the kidneys concur in the same emaciation, this aleo
must form as efiectuaf a cause of the disease before us as any other.

When the stopfaoe or uiun e exists in the uaETSRs, the causes may
be as numerous and nearly of the same kind as when the kidneys
are at fault : for here also we occasionally meet with calculus con-
cretions, inflammation, and spasm : to which we may add grumoi»
blood, viscid mucus, and a closed orifice in consequence of ulcer-
atioD.

Vesicil retention of urine is produced by inflammation, pres-
sure upon the neck of the bladder, irritation, or paresis. Pressure
on the neck of the bladder may be occasioned by distention of the
rectum from scybala, or other enteroiithic concretions, flatus, in-
flammation, or piles ; or by distention of the vagina from inflam^
mation, or a lodgement of the menstrual flux in consequence of
an imperforate hymen. Irritation may be excited by a calculus, or
too long a voluntary retention of urine, as often happens on our
being so closely impacted in large assemblies or public courts, or so
powerfully arrested by the interest or eloquence of a subject db-
cussed in such places, that we cannot consent to retire so soon as
we ought : whence the sphincter of the bladder Arom being volun-
tarily, becomes at length spasmodically, constricted, and the urine
cannot escape. It sometin^ happens under the last circumstance
that, from the pressure of the urine against the sides of the blad-
der, the absorbents are stimulated to an incre^ised degree of action,
and a considerable portion of the surplus is thus carried back into
the vessels, and perhaps thrown ofi* by persjiiration, so that we are
able to remain for a very long term of time after the bladder has
become painful from over-distention.

• Cabrol. Observ. p. 28.

t Commerc. Liter. Nor. 1731. p. 32. 1737. p. 326.

iSS. QL-AP. IL] EXCERNENT FUNCTION. 303

Atony or paralysis of the blad^r by which its pr6pulsiTe power
m destroyed) is a freqveat came ; whence, as Sa?iard has observed^
it Is-^fteD met with la paraplegia :* and, as Moraod remarks, on in*
juries tp ^tt spioe.t And hence, I have occasionally found It an at*
t«ndant upon severe and long protracted attacks of lumbar rheauia*
tisn4 ^ most practitioners have probably done on injuries to the
kkbtp, acetea^ urethra, prostate gland,^ or^ penis. It is said more*
over, to be a result of repelled eruptions of various kinds, chiefly
of scabies§ and scaHed head ;|| but it has not occurred to me from
Umb^ cawes : though I have not witnessed it io infancy from the
ioitstioo of teething where dentition has been attended with diffi-
cutty.

la URBTHiuL KETtjurnn OF uRiNfe, the causes do not essentially
vary from those already noticed ; such as iDflammation, the lo%e»
mmai, of a calculus ; viscid mucus ; and grumous blood. To which
are to be added the ligature of a strangulating phimosis ; irritation
ireiBL a blennorrhoea or clap ; strictures ; an ulceration of the ure-
thra produeing an openiag into the scrotum, or renderii^ the canal
altogether imperforate.

Tbere is always danger from a retention of urine when it has
continued so long as to distend and prove painful to the bladder :
and the danger U of two kinds, first, that ot an inflammation of tbe
dfetrested organ, and next, that of resorption, and arefluence of
the orea, and other constituent parts of the urine, as noticed under
the preceding species. ,

Tlie retention, however, has occasionally continued for a consi-
derable period without mischief. It has lasted from a week to a
fortnight.^ Marcellus Donatus gives a case of six months stand-
ing ;*** and Paullini another of habitual retention.tt But in all these
an observant practitioner will perceive the tnvo following accom*
ponlaients : nrstly, a constitutional or superinduced hebetude of -
the moscular coat of the bladder so as to indispose it to inflamma-
tion ; and secondly, a resorption of tbe urinary fluid, and its evactr-*
atioa by some vicarious channel, as already remarked under paruria
tMpt* We hare there stated that the two most commonly substi*
taled outlets are tlie excretories of the bowels and of the skin.
Dr. Percival grres an instance of the latter in which the perspira-
ble matter was so much supersaturated with the ammoniacal salt of

* Obterv. Cbiruri^iies.
t Vermicbte Scbrifteo, B. u.

% Se0 alto Sdowden, in the Loiidon Medical Journal,
f Morgagniy de Sed. et Caus. Morb. Ep« xu. Art. 4.
I Not. Act. Nat. Cur. Vol. v. Art. 68.
T Eph. Nat. Cur. paMtm.
Cornar. Obs. N. 21.

•• Lib. IV. cap. 27, 28.
tt Cent. II. Obs. 26.

304 ECCaiTICA. [CL. Tk-OB. K^

the refluent urine, as to crystallJbEe on tke surface of the hody, and
this to such an extent that the skin was covered all over with a
white saline powder.* Sometimes it has heen thrown oat from* the
stomach intermixed with blood, in the form of a hsmatemesis ;t and
sometimes from the nostrils with the same intermixtare in the form
of an epistaxis-l And where the absorbents of the bladder have
been too torpid for action, it has regur|^tated throii^ * the ureters
into the pelvis of the kidneys, and been resumed by the absorbent»
of these oi^ans instead of by those of the former.§

The quantity retained, and afterwards dischaxged, or foiled in the
bladder on dissection, has often been very considerable. It has oc-
casionally amounted to eight or nine pints : and there is a case
given by M. Viide in the Journal de Medicine^ in which it equalled
sixteen pints.

In all the varieties thus pointed out the mode of managesient
must be regulated by the cause as lar as we are able to ascertain it.

If we have reason to believe the suppression is strictly renal
from the symptoms just adverted to, and particularly firom ascer-
taining that there is no water in the bladder or ureters, in most cases,
whether it proceeds from inflammation or stone, we shall do right
to employ relaxants, and mild aperients : and, where the pain i»
violent, venesection succeeded by anodynes. But it sometimes hap-
pens that the obstruction is produced by a paral^smic enlaiveraent
or coacervation of the substance of the kidney without in&mma-
tion. If this should occur in both kidneys at Uie same time, which
is rarely the case, we have little chance of success by any plan that
can be laid down. If it be confined to one, the sound kidney will
often become a substitute for the diseased, and perform double du-
ty ; and we may here attempt a resolution of the enlaigement by
minute doses of mercury continued for some weeks, unless saliva-
tion should ensue, and render it necessary to intermit our prac-
tice. A mercurial plaster with ammoniacum should also be worn-
constantly over the region of the affected organ.

The same plan must be pursued if we have reason to suspect the
obstruction is confined to the ureters. The passage of a calculus
is the chief cause of this variety of retained urine : and, indepen-
dently of the sense of pain and weight in the region of the ureters
which an impacted calculus produces, we have commonly also »
feeling of numbness in either leg, and a retraction of one of the
testicles in men, as the calculus in its passage presses upon the
nerves which descend from the spermatic vessels. Opium and relax-
ants are here the chief, if not the only, means we can rationally em-
ploy ; though the ononis spicata^ or rest-barrow of our fields, is said,
both in the form of powder, and of decoction, to be useful in this and

• Edhi. Med. Coram. Vol. v. 437.

t Act. Nat. Cur. in. Obs. 6.

X Eph. Nat. Cur. Dec. ii. Ann. iv. Obs. 63.

i Petit, Traill, &c, GSuvres Fosthumes. Tom. in. p. 2.

€iE. ilI,-SP. II.] EXCERNENT FUNCTION. 305

farioDs other diseases of the bladder accompanied with severe
pain t- on which account it holds a place in the Materia M^dica of
Bei^QS. The asplenium Ceterach and athamanta Oreoselinvm^ or
mountain-parsley were formerly in vogue for the same purpose, but
seem to be of feeble efficacy. The seeds of the athamanta cre-
tensit or wild-carrot, had a wider and better founded fame, both as
a diuretic and lithontriptic. Dr. Cullen employed them for the lat-
ter purpose but without success. The suppression is seldom total ;
for the opposite ureter is rarely so much affected by sympathy as
to be spasmodically contracted, and equally to oppose the flow of '
the urine.

The most common variety of this disease is that of vesical retention,
or a retention of the water in the bladder. This is usually produced
by inflammation or spasm by which the sphincter of the bladder be-
comes contracted, and rigidly closed. Inflammation is to be re-
lieved by the ordinary means ; and, in addition to these, by anodyne
clysters, and fomentations, a warm-bath, warm liniments, and blis-
ters to the perinaeum. Spasm is excited by various causes : a stone
in the bladder will do it, an ulcer about the neck of the bladder
will do it, as will also too long a voluntary retention of urine^
Spasm is for the most part to be treated, and will in most cases be
subdued, by the method just proposed for inflammation ; to which
we may add camphor and opium by the mouth, and bladders of
warm water applied to the pubes and perinseuro^ or, which is bet-
ter, the warm-bath itself. Camphor has the double advantage of
being a sedative as well as an active diuretic ; but combined with
opium we obtain a much more powerful medicine than either af-
fords when employed singly. If the retention proceed from Spa-
nish flies camphor alone will often answer : though in this case it
is far better to combine with it mucilaginous diluents, as gum-arabic
dissolved in barley water. Several of the terebintliinate oils have
also been employed with great advantage, as the oil of juniper;
the balsamum carpathicum, as it was called by C. Ab Hortis who
first introduced it into practice, and recoa^mended it for a mul-
titude of other complaints as well ; concerning which there was at
one time a great secret, but which is, in fact, nothing more than an
essential oil very tarefuUy distilled from the fresh cones of the
trees which yield the common turpentine ; and the balsamum hun-
garicum which is an exudation from the tops of the pinus silvestris,
and proves sudorific as well as diuretic. Another remedy, of early
origin, and which has preserved its reputation to our own day, is
the dandelion, the leontodon Taraxacvm^ of Linneus. It was at
one time regarded as a panacea, and prescribed for almost every
dbease by which the system is invaded, as gout, jaundice, hypo-
chondrias, dropsy, consumption, parabysmas of every species, as
well as gravel and other diseases of the bladder : and 'was equally
employed in its roots, stalks, and leaves. It is now chiefly used as
a deol»truent; but it possesses unquestionably diuretic powers, and
hence, indeed, its vulgar name of piss-a-bed.

VOL. IV. 39.

30& £CCRITICA. [CL. YK-OIU II.

If the joint use of these meaoa shonld fail, the water most be
evacuated by the introduction of a bou^e or catheter, though the
irritation is sometimes increased by the use of these lostriimeDts ;
and the spasm or the thickening at .the prostate or about the neck
of the bladder is so considerable, as to prevent an introduction of
even the smallest of them. In this case, if the inflammation in-
crease, and the distress be alarming, nothing remains but to punc-
ture the bladder, either above the pubes, in the perineum, laterally,
or posteriorly through the rectum, for the operation has been per-
formed in ail these ways and each has had its advocates.

The URETHRAL retention, as already pointed out, arises also froca
inflammation, which is to be treated in the ordinary way ; or from
a calculus or a stricture ; both which are best removed by the ap-
plication of a bougie. In the last case the bougie, if it pass with-
out much pain, should be continued daily, and progressively en-
larged in its size. It has oflen been employed with a tip of lunar
or alkaline caustic : and in many instances with perfect success :
but very great caution is requisite in the use of a caustic boogie ;
and even in the hands of the most skilful it has sometimes proved
highly mischievous. When a simple bougie is employed, Ferrand*
advises that, if the water do not flow immediately, it should be re-
introduced and left in the urethra ; and I have myself advised such
a retention of the bougie catheter through an entire night with con-
siderable advantage ; for the water which would not flow at first
has gradually trickled, and given some relief to the oyer distended
bladder, which has hereby progressively recovered its tone and
propulsive power ; so that the water before morning has been pro-
pelled in a stream. But this is a plan only to be pursued where
the organ has too little instead of too much irritability, and conse-
quently where there is no danger of inflammation.

SPECIES III.
PARURIA STILLATITIA.

PAINFUL AND STILLATITIOUS EMISSION OF URINE.

This is the dysuria of Sauvages and later writers. In the preceding
species there is an entire stoppage of the urine ; in the present it
flows, but with pain and by drops. Several of the causes are those
of paruria retentianii ; but others are peculiar to the species itself;

* Blegny Zod. Anu. 1681.

«E. ni.-9P. IH*] EXCERNENT FUNCTION. 307

and, as they are accompanied with some diveraity in the symptoms,
they lay a foondation for the following varieties :

# Spasmodica. Spasmodic strangury.

C Ardens. Scalding strangury.

y Callosa* Callous strangury.

) Mucosa. Mucous strangury,

t Helmlnthica. Vermiculous strangury.

^ Polyposa. Polypose strangury.

The rinsT VAtutrrv is characterised by a spasmodic constriction
<>f the sphincter, or some other part of the urinary canal, catena-
ting with spasmodic action in some adjoining part. The spasmo-
dic actions of which this variety is a concomitant are chiefly those
of hysteria, colic, and spasm in the kidneys. It is hence a secon-
dary affection, and the cure must depend on curing the diseases
which have occasioned it. Opium and the digitalis will often af-
ford Speedy relief when given in combination.

In the SECOND variety there is also a spasmodic constriction, but
of a different kind, and making it more of a primary affection ;
whence SauVages and others have distinguished it by the name of
djsnria primaria. It is excited by an external or internal use of
various stimulants as acrid foods, or cantharides taken internally ;
and is accompanied with a sense of scalding as the urine is dis-
charged.

This is also a frequent result of blisters : and to avoid it in this
case the patient should be always advised to drink freely of warm
diluents in a mucilaginous form. Gum-arabic, marsh-mallows root,
the jelly of the orchis or salep, infusion of quince-seed, lint-seed, or
decoction of oatmeal or barley may be employed with equal advan-
tage ; for they do not essentially differ, and the only preference is
to be given to that which affords the largest proportion of mucilage.

Formerly the winter-cherry (physalis Mkekengi^ Linn.) was in
much repute, and was supposed to produce speedy relief.* it is
unquestionably sedative and diuretic, and possesses these properties
without heating or irritating: and seems to be worthy of farther
trial. As a sedative, indeed, Hoffman employed it in haemoptysis ;
and as a diuretic it has been still more generally made use of in
dropsy. About five or six cherries or an ounce of the juice forms
a dose ; the pericarp is bitter, yet the fruit within possesses but little
of this property, and has an acidulous and not unpleasant tsiste.

Camphor has also been employed with great advantage for the
same purpose^ and acts on the same double principle of being n
diuretic and a sedative. It is often found to act in the same manner
when applied externally, and even when intermixed with the blister
plaster itself, as though in some constitutions it possesses a specific
inflnence over the bladder : upon which subject Dr. Perceval has
penned the following note in his Commentary to the volume of

• Manardus, Epist, Libr, xiii. N. 12.

308 • ECCRITICA. [CL. VI.-OR. tt.

Nosology; ^Md three instances blisters sprinkled wiUi camphor
were repeatedly applied without strangary, and as uniformly, when
the camphor was omitted with the concurrence of that symptom.
I will not say that in all constitutions, camphor will obmte stran-
gury ; nor in all constitutions will cantharides without camphor
produce it."

It will commonly be found useful, and sometimes absolutely neces-
sary, in this variety, from whatever cause produced, to employ
neutral aperients : and with them the means just recommended in
cases of cantharides will rarely fail to succeed in most other cases.
If not, the practitioner should have recourse to a decisive dose of
opium.

Strangury is also occasioned by a callous thickenino of the meo^
brane of the 'urethra producing a permanent stricture. Some inte-
resting examples of this may be seen in Dr. Baiille^s Plates of
Morbid Anatomy.*

We have already had occasion to observe that the most common
situation of a stricture is in its bulb or the prostate 'gland that lies
immediately above,t though it may take place in any other part
A stricture of this kind ^^ consists,'^ says Dr. Baillie, ^^ of an approxi-
mation for a short extent, of the sides of the cans^l to each other.
Sometime^ there is a mere line of approximation, and not uncom-p
moniy the sides of the urethra approach to each other from some
considerable length, as, for instance, nearly an inch. The surface
of the urethra at the stricture is.oAen sound, but not unfrequently it
is more or less thickened.^' It is this thickening which produces
the variety of strangury before us. The sides of the urethra have
sometimes approximated so nearly by its increase that the stricture
will only allow a bristle to pass through it : and hence ulcers are
occasionally formed in the prostate gland, and fistulas in the perinae-
um ; and the cavity of the prostate is enlarged from distension, in
consequence of the accumulation of urine behind the ulcer ; of all
which Dr. Baillie has also given examples.

When the prostate, «r urethra, is highly irritable, palliation only
can be resorted to ; but where the thickening is recent and there jls
little irritation, a skilful use of a bougie will sometimes afford
temporary relief; after which, by gradually employing those of
larger diameter, the stricture will often give way and the canal
widen so as to allow the water to flow with considerable comfort.
i have at this moment a patient under my care, who was so grievously
afflicted with this variety of strangury about six years ago, from two
distinct strictures, as never to msdke water otherwise than by drops :
the smallest cat-gut bougie could with difficulty be made to pass
through the thickened parts ; and he was entirely debarred from
going into company. By gradually accustoming himself to bougie^
pf increasing diameter he can now bear the introduction of a

t Fascic. VIII. PI. IV. v:

* Vol. IV. Blenorrhaa. luodcs, p. 58.

^E.1U.-«P..UI.] EXCERNENT FUNCTION. 309

jonoderately dzed oae with ease ; the water flows freely, thoof h in
a small stream, and he is able to go into company and to travel
without inconvenience. He still finds it necessary, however, that
the bou^e should occasionally be continued, and it is introduced into
the urethra every week or fortnight.

In the variety which we have called mjcous strangury, the urine
is intermixed with a secretion of acrimonious mucus, of a whitish or
greei^ish hue, which is frequently a sequel of gout^ lues, or blenor-
Thoea. It is often, however, produced by cold, and in this last case
forms the catarrhus vetictt of various authors : so denominated from
its being conceived that the bladder and urethra are affected in the
same manner as the nostrils in a coryza. The constriction therefore
depends upon an excoriated or irritable state of the urethra, or neck
of the bladder. And hence the warm-bath, or sitting in a bidet of
warm-water, is often of considerable service. Warm and diluent
injections have also frequently been found, as well as diluent Imd
demulcent drinks, of great advantage. If this variety continue
long it is apt to produce an obstinate and very narrow stricture, of
which ulceration and fistulas in perinaeo are frequent results.

Strangury is also sometimes accompanied with a discharqe of
WORMS of a peculiar kind,, and proceeds from the irritation they
excite. Of this we have various instances in the Ephemerides of
Natural Curiosities,* in some of which the worms were found in
the bladder after death, and in others discharged by the urethra
during life. They are described as of different forms in diflerent
cases, sometimes resembling the iarvcs of insects : sometimes dis-
tinctly cucurbitinous, of the fnsciola, fluke, or gourd- kind. Dr.
Barry of Dublin has given us the case of a solitary worm discharged
by the urethra of a man aged fifty, ^^ above an inch in length, of the
thickness of the smallest sort of eel, and not unlike it in shape,
ending in a sharp-pop ted tail.^^ It was dead, but did not seem to
have been dead long. The patient had for several years been in
the habit of discharging urine mixed with blood, but unaccompanied
with pain either in the bladder or urethra. During the whole of
this time he bad been feverish; and gradually lost his appetite,
found his strength decay, and had become turbid and hectic ; from
all which he speedily recovered as soon as this cause of irritation
was removed.!

We have also an example of a like vermicule, highly gregarloot,
and of much longer dimensions in an interesting paper of Mr.
Lawrence, inserted in the second volume of the Medico-Chirurgical
Transactions. The patient was a female aged twenty-four, and had
« long laboured under a severe irritation of the bladder, wliich was
scribed to a calculus. She at length discliai^ed three or four
worms of a non-descrlpt kind, and continued to discharge more,

* Dec. I. Ann. ix. x. ObA. 113. Dec. ii. Aou. i. Obs. 104. Ann. vi. Obs. 31.
Dec. III. Ann. l. Obs. 82. Ann. ii. Obs. 203.

t Edia. Med. Ess. Vol. v. Part ii. Art. l^xii. p. 280.

310 ECCRITICA. [CL. VI.-OR* IL

especially wfaed their removal was aided by injecdons into the
bladder, or the catheter had remained id th6 orethra for the Dig bt
The eracaatioD of these animals continued for at least a twelve-
month. Twentj-two were once passed at a time ; and the whole
number could not be less than from eight hundred to a thousand.
A smaller kind was also occasionally evacoated. The larger were
usually four to six inches in length ; one of them measured eight.
For the most part they were discharged dead.

The subject is obscure, but it may be observed that the ova of
worms, and even worms themselves, are occasionally found in many
animal fluids, and have been especially detected in the blood-vessels,
where they have been hatched into grubs or vermicules, for the
most part of an undecided character ; though some, observed in the
mesenteric arteries of asses, have been referred to the genus stron*
gylus.'*^ Dr. Barry supposes his isolated worm to have travelled ia
the form of an ovum as far as to the extremity of an exhaling artery
opening into the bladder ; to have found, in this place, a proper
nidus and nourishment for the purpose of being hatched into a larve
or grub, and of growing to tbe size it had assumed when tbrowa
out of the urethra ; and, in consequence of this progressive growth
and the proportional dilatation of the resselin which it was lodged,
he accounts for the discbarge of blood without pain. If a worm
reach the bladder alive and full of eggs, we have no difficulty la
accounting for a succession of progenies.

Strangury is also sometimes produced in consequence of the
bladder or urethra, or both, being obstructed by the formation of a
FOLYFOus EXCRESCENCE wMch hus occaslonally shot down to tbe exter-
nal extremity.

Dr. Baillie^s Morbid Anatomy furnishes several examples of this
variety ; which, in most cases, is only to be radically cured by an
extirpation of the substance which produces tbe obstruction,? wher-
ever it can be laid hold of. When small, however, and in the form
of caruncles, these excrescences have sometimes separated spontan*
eously, and been thrown out by the urethra with very great relief
to the suiferer, and have been followed by a perfect core.J

Upon this variety my venerable friend Dr. Perceval has added
the following not^ in bis manuscript Commentary on the Nosology,
from which the present work has been so often enriched : ^' It might
not be amiss to insist on a case which sometimes deceives young prac-
titioners : ischnria cum stranguria. A copious draining of urine took
place for several days in a patient with a swelled belly. Death supers
vening, the bladder was found distended to an enormous bulk, and
the parietes of the abdomen wasted. Two excrescences near the
neck of the bladder internally had almost closed its outlet, and
interfered with the action of the sphincter."

• Hodgson on the Discaecs of Arterie?,
t Fascie. ix. Plate iii.
% Fabric. Hildau. Cent. iv. Obs. Liii.
Alt, Nat, Cur, Vol. i. Obs. xiii.

GE. UI.-*«F. IV.] EXCERNENT FUNCTION. 311

SPECIES IV.

PARURIA MELLITA.

Aatriiarfiir asn'tir

UlUlfB DISCHARGED FREELY) FOR THE MOST PART PROFUSELY ; OF A YIO*^
LET SMELL A|ID SWEET TAffTE ; WITH GREAT THIRST, AND GENERAL DE-
BILITY.

This is the diabetes, diabetes Anglicus, or diabetes inellitns of au-
thors ; from isJinrnt^ importing ^« a siphon,^ or rather from imitum^
*^ transeo.^' Dial etcs among the Greek and Roman, aiid, indeed, among
modem physicians till the time of Willis, imported simply a flux of
urine, either crude or aqueous^ for no distinction was made between
the two, and both were named indifferently diabetes, dipsacus from
the accompanying thirst, urinary diarrhoea, urinal dropsy, and
hyderus (Am^,) or water-flux.* The writers among the ancients
who seem chiefly to haye noticed it are Galen, Aretxus, and Tral-
liaD ; and the reader who is desirous of knowing what they say,
and is not in possession of the original authors, may turn to Dr.
Latham's Treatise upon the diseasef who has translated the whole
with Tery gpreat clearness and fidelity. The form of diabetes, to
which we are now directing our attention, Galen describes aft
haying a resemblance to lientery, from the rapidity with which
the solids and fluids of the body seem to be conyerted into a crude
and liquid mass, and hurried forward to the kidneys ; and to canine
appetite, from the yoracity and thirst which are its peculiar symp-^
toms. He supposes a high degree of appetency or irritation to
exist in the substance of the kidneys, in consequence of which it
attracts the matter of urine with great yehemence from the yena
caya ; and an equal degree of atony and relaxation to exii^t in its
orifices or pores, so that the same matter flows off unchanged as
soon as it reaches them.|

This general yiew of the subject was adopted with a few additions
by AretsBus, and without any by Trallian ; and seems to haye
descended with little yariation, as we have just obseryed, till the
time of Willis, who first called the attention of practitioners to the
curious and important fact that the urine of diabetic patients, seemed
in many cases,, to contain a saccharine principle. These cases,
howeyer, were not, at that time, duly distinguished, and hence, in
Saayages, who was well acquainted with Willis's discoyery, diabetes

• Galen, de Crisibus, Lib. i. Cap. xii.
t Facts and Opiiions concerning Diabetes, 8vo. 1811.

% Dc Loc. AflVct. Lib. vi. Cap. lii. iv., roinpared vrtXh De Crisibus, I^ib. i.
Cap. xii.

312 EccRiTicA. [cL. VI--OR. u;

sigoifies equally an immoderate flux of uriDe from hysteria, gout,
fever, spirituous potation, as well as urine combined with saccha-
rine matter : though the only relation which the last has to the
rest is that of its being usually secreted in a preternatural quantity :
but as even this last quality, though mostly, is not always, the case,
it should be distinguished by some other name than that of diabetes,
and form a distinct division : or, if the name of diabetes be applied
to it, it should be given to it exclusively. Dr. Young, whQ retains
the name in the latter sense, and employs it as that of a genus^ JQ^tly
allows but one species to the genus, the diabetes mellUus of Cullen,
and describes the diabetes insipidus imder the genus and species of
hyperuresis aquasus. There is great doubt whether this last ever
exists as an idiopathic affection. Cullen himself, indeed, candidly
expresses the uncertainty of his mind upon the subject : ^^ Almost
all the cases of diabetes of late times,'' he observes, ^^ exhibit saccha-
rine urine, ita ut dubium sit, an alia diabetis idiopathic^ et perma-
nentis species revera detur.'' If such be found it will probably be
nothing more than a variety of the next species in the present
arrangement, paruria incontinens :* while the honeyed diabetes or
saccharine urine ought to be studied as a distinct affection.

The pathology of this disease is still involved in a considerable
degree of obscurity : for though anatomy has pointed out a few
morbid changes that exist more or less extensively in the urinary
or digestive organs, and chemistry has sufficiently explained to us
the morbid character of the discharge, they have thrown less light
upon its origin than could be wished for, and have hitherto led to
no satisfactory opinion upon the subject. Even the seat of the
disorder is, to the present hour, a point of controversy ; and as its
seat, together with the nature of its cause, can only be collected
from its symptoms, we wUl first lay down its general history and
afterwards glance at a few of the leading hypotheses which have
been started in respect to its pathology.

Saccharine or honeyed paruria is rarely, though sometimes,!
found in early life, but is oAen a sequel to a life of intemperance,
on which account it is occasionally connected with a morbid state
of the liver. It makes its approach insidiously, and often arises to
a considerable degree and exists for some weeks without being
particularly attended to. If the urinary symptoms take the lead it
is without the • patient's noticing them, for the first morbid change
he is sensible of is in the stomach. At this time, to adopt the
description of Dr. Latham, ^' It is attended, for the most part with
a very voracious appetite, and with an insatiable thirst; with a
dry harsh skin, and clammy, not parched, but sometimes reddish
tongue ; and with a frequent excreation of very white saliva, not
inspissated, but yet scarcely fluid. As the disease proceeds it is
accompanied often with a hay-like scent or odour issuing from the

• Spec. V.

t Latham's Facts and Opinions, p. 176.

OE. m^^-flp; nr*] ExcEitNEifT PuircnoN. 313

body, wMi a chiiUBr sort of hditm exhaling firom the langs, and
with a state of mind duMoas and forgetfiil : the patient heing dis-
satisfied, fretfal, and distrosting, erer anxious indeed for relief, bat
wareriog and unsteady in the means advised for the purpose of
proeorkig it'^

In the mean time the kidneys discharge a fluid usually Tory
limpid and large in quantity, though sometimes slightly tinged
wltbgrtei^ like a diluted mixture of honey and water, and possessing
a saceharine taste more or less powerftil. The pulse varies in di^
ferent Miriduals, but, for the most part, is quicker than In health ;
and not unfrequently Hiere is a sense of weight or even a<^ute pain
in the leins occasiotialiy spreading to the hypochondria, a symptom
which Aretaus notices as one of the earliest that appears ; the unr
easiness extending still lower till, as the same writer remarks, a
sympathetic smarting is felt at the extremity of the penis whenever
the patient makes water. .

llie flesh wastes rapidly; and, as the emaciation advances,
^ cramps," sayi Dr. Latham, ^ or spasms of the extremities some-
times supervene, tlie pulse is more quick and feeble, atid the saliva
more glutinous." And when the strength is almost exhausted in a
stiU more advanced stage of the disease, the lower extremities of-
ten become edematous, and the skin cold and damp : the diabetic
discharge is then finequeotly much diminished, and is sometimeii
even found to become more urinouji for a few hours before death
closes the distresshsg scene."

A pulmonic atfsction occasionally accompanies or precedes the
attack ; Dr. Bardsiey, indeed, affirms that he does not recollect a
case that was entirely free from ^is ^mptom. And It is probablv
on this account, as also from the feverish state of the pulse, which
by some writers has been supposed to partake of a hectic character,
that by M.M. Nicolas and Gueudeville the disease has been deno-
minated Phthuurie 9uer(e.\ The state of the bowels is extremely
variable, though there is commonly a troublesome costiveness;
sometimes, indeed, so much so, that the feces are peculiariy hard-
ened and scyboloqs : which is well described by a patient of Dr.
Latham's, in a letter of consultation ; «^The heat of my body," says
he, ^ I suppose arises from a most determined costiveness that I
cannot find means to conquer, and which occasions me great pain
and misery, frequently feeling an inclination without the ability of
discharging: and when, ai\er much difficulty^ the excrement is
ejected, it has almost the solidity of lead."t in a few instances the
disease seems to be connected with femily predispositioo. Mr.
Storer has noticed a case of this kind in his communication with

* Facto and Opinions conceniiog Diabetes, &c. p. !•

t lUcbercbes et fxp^ricnces MMicale* et Chimiqiies sur la Diab^to incite;
ou la Pbtbisie tucr^. 8vo. Paris, 1S03.
X Facto and Opinions, &c. p. 135.
tot. IV. 40

314 ECCRITICA. [CL. V1.-0R. U.

Dr. Rollo ; and M. Isenflamm has given the history of seven chil-
dren of the same parents who fell victims to it in saccession.*

The real nature of the flaid evacuated has l>een very saffideotly
determined both in our own country and on the Continent by ciiem-
iflts of the first authority, who have concurrently ascertained that,
whilst it is destitute of ite proper animal salts, it is loaded with the
new ingredient of saccharine matter.

Dr. Dobson from a pound of urine collected an ounce of sac-
charine substance; and Mr. Cmikshank, from thirty six ounces
Troy, obtained, in like manner, by evaporation, not less than three
ounces and a quarter : which, from the quantity discharged hy the
patient, would have amounted to not less than twenty-nine ouncea
every twenty-four hours. Chevreul has shown that by concentrat-
ing this morbid urine and setting it aside we may obtinn a deposit
of sugar in a crystallized state.

The absence of animal salts has been ascertained not less satis-
factorily. M. M. Nicolas and Gueudeville showed, by a series of
experiments in 1802, that the saccharine urine contoins no area,
nor uric or benzoic acid ; that the phosphoric salts exist in a verj
small proportion : and that in consequence of its sugar it will enter
into the vinous and acetous fermentation, and yield an alcohol of a
disagreeable odour.t The same results have since been obtained
by M. M. Dupuytren and Thenard by experiments still more satis-
factory. They also found an albuminous substance in the urine
which is always discharged in a sensible form when the disease be-
gins to take a favourable change, and is the constant harbinger of a
return of the proper animal salts ; for af^er having appeared for a
little while it gradually diminishes and yields its place to the nrea
and uric acid. In an excellent paper of Dr. Henry's inserted in the
Transactions of the Medico-Chirui^cal Society,! ^^ appears to
have arrived at many of the same conclusions though by a some-
what different process.

Dissection has also been had recourse to for collateral informa-
tion on this complicated malady : but its researches have been less
successful than those of the chemists. The only oi^n in whioh
any morbid structure has been clearly ascertained is the kidneyk
Mr. Cruikshank affirms generally that the arteries of the kidneys
are, on these occasions, preternaturally enlai^ed, particularly those
of the cryptae or minute glands which secrete the urine."§ And
this state of inflammation or morbid activity is confirmed by Dr.
Baillie in his ^ Account of a case of diabetes, with an examinatioa
of the appearances afler death,'|| in which he tells us that '^ The

• Versuct einiger practicher Anmerkungen iiber die Eingeweidc, &c. Erlans
1784.

t R^cberches et Experiences, ut supra ciiat,

f Transact. olMedico-Chirurg. Soc. Vol. x.

i On the Lacteals and Lymphatics, p. 69.

II Transactions of a Society for the Improvement of Medical and Chirurgical
Knowledge, &c.

•OE. 1II.-8P* IT.J EXCERNENT FtJNCTION. 315

Teins upon the sor&ce were much fuller of blood than usual, put-
ting on an arborescent appearance. . When the substance of both
Iddbeys was cut into it was observed to be every where much more
crowded with blood-vessels than in a natural state, so as, in some
parts, to approach to the appearance of inflammation. Both kid-
neys had the same degree of firmness to the touch as when healthy :
but I think, were hardly so firm as kidneys usually are, the vessels
of which are so much filled with blood. It is difficult to speak
very accurately about nice differences in degrees of sensation unr
less they can be brought into immediate comparison. A very small
quantity of a whitish fluid, a good deal resembling pus, was squeezed
out from one or two infundibula in both kidneys, but there was no
appearance of ulceration in either.''

These premises, taken conjointly or separately, according to the
light in which they may be viewed by different persons, open an
abundaiit field for speculation concerning the nature of the malady :
and hence, an infinity of hypotheses have been offered of which the
following are the chief:

I. The disease is dependent upon a morbid action of the stomach,
or some of the chylifacient viscera, which necessarily, therefore,
constitute its seat.

II. The disease is dependent upon a dyscrasy or intempera-
ment of the blood, produced by a morbid action of the assimilat-
ing powers.

III. The flisease is dependent upon a retrograde motion of the lac-
teals, and is consequently seated in the lacteal vessels.

IV. The disease is dependent upon a morbid condition of the
kidneys, and seated in these organs.

1. The first of these hypotheses, though not the most ancient,
has been by far the most commonly received, and is, perhaps, the
most prevalent in the present day. It is derived from observing the
increased action which exists in the stomach, and probably also in
the coUatitious viscera, in conjunction with the untempered fluid
which is discharged by the kidneys, whose morbid crasis is referred
to these org^s. But even here there has been much difficulty in
determining which of the digestive viscera is principally .at fault.
Dr. Mead having remarked that the disease is frequently to he
traced amongst those who have lived in temperately, and particular-
ly who have indulged in an excess of spirits and other fermented
liquors, ascribed it to the liver, and the idea was very generally re-
ceived in his day. Dr. RoUo has since, and certainly with more
plausibility, fixed the seat of the disease in the stomach, and confin-
ed it to this org^n : conceiving it to consist ^^ in an Increased action
and secretion with a vitiation of the gastric fluid, and probably too
active a state of the lacteal absorbents : — while the kidneys, and
other parts of the system, as the hea<J and skin, are only affected
secondarily.''

According to this hypothesis the blood is formed imperfectly

316 BOGiuxNu. [col. ▼I.'-KA. u*

from the first, and the morbid chaage of aaimd ftaUs for Mgu- kthe
work of the stomach or its aaxlHarj oigaiis, whkh *re uninediAtBT
}y infiueDced by it. It is a strong if not a fetal objeetioD to thi4
Tiew of the subject, that the blood before it reicbM the kidoeya^ is
fonod, upon the most accurate ezperinientB to which it has hitkert*
been submitted, ^^ to contain the salts of the blood, bat no trac*
whatever of sugar." The experiments I allude to are tliose of
Dr. WoUaston, and Dr. Marcet, detailed in the Philosophical Tra»T
sactions.* Prior experiments had, indeed, been BMide under the
superintendance of Dr. Rollo, which induced thos^ engaged in them
to conjecture that some small portion of d^gar might exist in the
blood; but these trials led to no de^te cdncloBion^'attd dui not
satisfy the experimenters themselves. The results of Wollastun
have since been confirmed by other experiments of Nicholas, Bofg,
Thenard, and Bostock.

II. The second hypothesis, or that which r^ards the diaeaae as
dependent upon a dyscrasy or intemperament of the blood, prodnc?
ed by a morbid action of the assimilating powers, is of parallel dale
with the preceding, and has had the successive support of many of
the ablest and most distinguished pathologists from its origin to our
own day. It was first started by Dr. Willis and immediately fol-
lowed upon his discovery of the saccharine property of diabetic
urine, who thus expresses his opinion of the seat and nature of the
disease in his treatise upon this malady : — ^^ Diabetes is rather an
immediate afiection of the blood than of the kidneys, and thence de«
rives its origin ; for the mass of the blood becomes, so to speak,
melted down, and is too copiously dissolved into a state of 8ero8it)r :
which is sufficiently manifest from the prodigious increase of the
quantity of urine which cannot arise from any other cause than
from this solution and waste of blood.'' He admits, however, that
the orifices of the kidneys are at this time peculiarly relaxed and
patulous, in consequence of which the untempered fluid passes off
with a greater ease and rapidity.

This hypothesis of Willis was readily embraced by his distin*
guished contemporary Sydenham, who fortified himself in the same
by observing, that those who have long laboured under an intermit-
tent, and have been unskilfully treated, and esq[»ecially old persona,
sometimes fall into a diabetes, from a crude or debilitated conditioii
of the blood. And hence, he tells us in his letter to Dr. Brady, Re*
gius Professor of Physic in the University of Cambridge, that ^^ the
curative indication must be completely directed towc^rds invigorat-
ing and strengthening the blood, as well as restrainiiig the preter-
natural flux of urine."

Thus advanced and adrocated by two of the brightest Imninaries
that have ever enlightened the medical world, it cannot be a mat-
ter of surprize that this opinion should have been extensively
adopted. In truth it was espoused on the continent as well as at

1 ■ — - ■ ■

• Vol. CI. 1811. p. 96.

fiffi. tIbHir. IT.] EXCEmfCMT PUMCnON. 817

Wbm, and, iB 17S4, fav* Urth Jo Bl. Place's abte diaMrMion At
CRftttdgfeD :* asd cctttkiaed to bo Ibe preveilliig oftnioB till tbe ap-
pearanco of Df * RoUd's work, to wMch w6 hare just adverted ; aod
•▼ea sIdco the appctrance of Mi work, it has bees stiH warmlj
attd ably Aaiatidaed bf Dr. Latham, who^ white he pays all the
hdinage to Dr. Rollout hboan and al^lHies to which they are eoti-
tied, aad scmpfiknwly adopts the general prindples of his praotiGe,
opposes his-doctriae of a morbid condition of the stomach,! which,
aa well aa the kkhiejs,! be believes to be perfectly sound in its ac-
tiOD« ^« I most take leave,'' says Dr. Latham, ^^ to difler in opioiOB
most materially from Dt, Rello, who seems to consider this most
enormous appetite as such an evil in diabetes, as to endeavour, by
every possible memM, to repress it, having founded his theory
priooipaJly upon the idea ttmt on this action of the stomach depends
the evolution of sugar with the whole train of consequent symp-
^ toms : whereas, I consider tlie appetite, however great it may be,
aad which I would never check by medicines, as a natural sensation,
calling into Its fall exercise (hat organ through wl^cfa the constant
itaste of tiM body must he Erectly supplied, and without which the
pkitient must soon inevitably perish : and I look upon the more mo-
denite appetite which takes place usually in a few days aAer a strict
eenforn^ty to animal diet, as the surest sign of convalescence, Inas-
nM»h as I hold it in proof that the blood being thereby rendered
firmer in its crasis, tiiere is less disposition in it to be decomposed,
ami, consequently, Tas is the Act) that there must soon be a dimi-
niehed diseiiarge or nutritious matter from the kidneys.

An opinion promulgaked and maintained in succession by author!*
Has so high, and names so deservedly dear to the ucAUlio iat,
ought not to be Ughtly called in question : but it is as difficult to
recondie the present nation as the preceding with the existence 0{
the ordtnaiy salts and the non-existence of sugar in the blood of
diabetk patients. Dr. Latham, however, has argued tbe point with
great and elaborate ingenuity, and has endeavoured to show, by a
train of reasoning which is worthy of attention, (hat the 9ugar, in
reepect to its elements, may exist in the blood, though tbe sul^tance
itself be not discoverable in it, being ^^so weakly and loosely oxyge-
nated as to be again readily evolved by the secretory action of the
kidaeys, not from any ihult in the kidneys themselves, but from the
regular «id natural exercise of their function, in separating from
tbe knperfect blood such matters as are not properly combined
with it»&

IJI. A bold and plausible efibrt was made, between forty imd fiAy
yens ago, to get rid of the stumbHag-^biock of the absence of sugar

* Dhu de Verd Dlftbcrtls caussd in defectu ofisimilntionis quierenda. Goett.
t Facts stii Obeervatton?, ftc. p. 3S0.

; id.i»*iio.

f Ut fapta, p. 97.

318 EccRiTicA. [<x. yi.-<m. tu

from the blood bj showing that provided it were once formed hj
the digestire organs, there is no necessity for its trarelting in tlifo
direction. Thb hypothesis was brought forward by that yery
acute and ingenious physiologist, Mr. Charles Darwin, in an essay
presented to the .£»calapian Society of Edinburgh in 1778, tliat
obtained for him an unanimoas grant of the prhse-medal for the
Tear : an honour dearly earned, as almost immediately afterwards,
he fell a mar^ to his indefatigable pursuits, while on the verge of
graduating. In this essay he endeavoured to account for theidisease
of saccharine urine by a retrograde motion of the lymphatics of tlie
kidneys. Having endeavoured to establish the general principle of
a retrograde lymphatic action, he proceeds to remark, that all the
branches of the lymphatic system have a certain sympathy with
each other, insomuch that when one branch is stimulated into any
unusual motion, some other branch has its motions either increased,
or decreased, or inverted, at the same time : thus, when a man
drinks a moderate quantity of vinous spirit, the whole system
acts with more energy by concert with the stomach and intestines,
as is seen from the glow on the skin, and the increase of strength
and activity : but when, says he, a greater quantity of tlds inebri-
ating material is drunk, at the same time that the lacteals are quick-
ened in their power of absorbing it, the urinary branches of the
absorbents which are connected with the lacteals by many anasto-
moses, have their motions inverted, and a large quantity of pale,
unanimaiized urine is hereby discharged. Where, continues Mr.
Darwin, this ingui^tation of too much vinous spirit occurs often,
the urinary branches of absorbents at length gain a haUt of invert-
ing their motions whenever the lacteals are much stioMilated : and
the i^hole or a great part of the chyle, is thus carried to the blad-
der without entering the circulation, and the body becbmes ema-
ciated : while the urine is necessarily sweet and of the colour of
whey. And on this account Mr. Darwin proposed to denominate
the species before us a chyliferous diabetes.

This hypothesis, for, ingenious as it is, it has never been entitled
to a higher character, became at one time also very popular, and
was supported by the talents of the celebrated author of Zoonomia,
the father of its ingenious inventor. A few singular facts which
have occurred since the decease of both these writers, seem at
first sight to give it a little colourable support : such as the rapid
passage of certain substances from the stomach to the bladder appa-
rently, according to the experiments of Dr. WoUaston and Dr. Mar-
cet, without their taking the course of the circulation ; and M. Ma-
gendie's experiments upon the lymphatic system, and tlie doctrine
he has founded upon them. These, however, the author lias ex-
amined with some attention in the Physiological Proem to the pre-
sent Class, and has endeavoured to reconcile them with the ascer-
tained and admitted structure and laws of the animal frame : so that
they can add but little to the speculation before us. And in truth,
how much soever it may have bee^i caught up hastily by men pf

©E. nii-SP. ivfj EXCERNENT FUNCJTION. 319

warm hnagioatioD, or those who are fond of noTeliy, the soberer
physiologists have never been made convertB to it. ^^ In the diabe-
tes," says Mr. Cmikshank, ^^ it has been supposed that the chyle flows
retrograde from the thoracic doct into the lymphatics of the kidney,
from them into the cryptaB, so into the tnboli ariniferi, thence into
the infbndibula, peWis, ureter, and so into the bladder. This opinion
is mere snppositioo, depending on no experiments. And, besides
that all such opinions should be rejected, why should the chyle flow
retrograde into the lymphatics of tiie kidney and not in the lacteals
themselves ? and why are not the feces fraught with a similar fluid
as weir as the urine ? The arteries of the kidneys are, on these oc-
casions pretematurally enlarged, particularly those of the crypts
or minute glands which secrete the urine. And it is infinitely more
probable that the fluid of the diabetes arises from some remarkable
change in the vessels usually secreting the urine, than from any
imaginary retr<^rade motion of the chyle through the lymphatics
of the kidneys."* Even Dr. Wollaston prefers a state of doubt coii>
ceming the course pursued by the above-mentioned substances to
an adoption of this conjecture, notwithstanding the ready solution
it offers to his experiments. ^^ With respect," says he, ^' to Dr.
Darwin's conception of a retrograde action of the absorbents, it is
so strongly opposed by the known structure of that system of ves-
sels, that 1 believe few persons will admit it to be in any degree
probable."?

IV. We come now to the fourth hypothesis to which the disease
before us has given rise, and which places it in the kidneys. These
form, indeed, the most ostensible seat, and hence, as we have al-
ready seen, they were the first suspected, and were supposed by
the Greek writers to be in a state of great rel'axation and debility,
and hence also of great irritability. To this irritability was ascrib-
ed their morbid activity, and the accumulation of blood with which
they were overloaded : while their weakened and relaxed condition
allowed the serous or more liquid parts of the blood to pass off
tlirough the patulous mouths of the excretories without restraint or
change, and, consequently, in a crude and inelaborated form like
the food in a lientery.

Such was the explanation of Galen : and of all the hypotheses
before us there is no one that seems to be so fully confirmed, as
well by the symptoms of the disease during its progress, as by the
appearances it offers upon dissection. The anatomists have hence
generally adopted this opinion, which is to be found in Bonet,|
Ruy8ch§ and Cruikshank ;|| and in proof that it has of late been
gaining additional ground among physicians and medical f^actiticm-

* On the Lacteals and Lymphatics, p. 69.
t Phil. TraDS. ut supra. 1811. p. 106.
X Sepulcbr. Lib. in. Sect, xxr'u Obs. 1.
i Observ. Anat. Chir. N. 13.
y On the Lacteals and Lymphatics^ p. 69.*

320 EccRincA. loL ri-^fu n,

en !b general, as well on the Contliiefit as in our own country, it
may be safficient to refer to the writings of Richter, the worics of
.M. M. Nicholas and Gneqdeville, and M. M. Dnpuytren and The*
nard, already qooted from, and the commnnications of Mr. Watt,
Dr. Henry, and, still more lately, of Dr. Satterlcy ; several of
whom? however, conceive the stomach or some other chylifactive
orguk Ur be affected at the same time secondarily or sympatheti-
cally.

By far the greater number of these writers regard the irritation
of the kidneys as connected with inflammation : though several of
them ascribe it to a spasm. They seem to reason ^om the pain
foimd occasionally in the region of the loins, and the limpidity and
enormous quantity of the fluid that is discharged, which in their
opinion is analogous to that evacuated in hysteria or hypochondri-
as; such was the opinion of Camerarius upwards of a century ago,^
and of Richter and Gueudeville in our own day : '*la phthisurie,^'
says the last, for under this name he describes saccharine urine,
^^ est une consomption entretenue per une deviation srASMODi^rB et
continuelle des sues nutritifs non animalism, sur Torgane urinaire.*^

There seems after all but little to support this doctrine, and yet '
it was adopted by CuUen, and that so completely as to induce him
to arrange diabetes in his Class Neuroses, and Order Spaspoi, imme-
diately l^fore hysteria, and hydrophobia. His reason for doing so
is contained in the following passage in his First Lines : " As hard-
ly any secretion can be increased without an increased action of
the vessels concerned in it, and as some instances of this disease
are attended with affections manifestly spasmodic, I have had no
doubt of arranging the diabetes under the order of spasmi.''} A
tnore unsatisfactory reason has, perhaps, never been offered, nor
does the author himself seem satisfied with it, for we find him,
shortly afterwards, not indeed, like M. Gueudeville, uniting it with
another cause to give it potency, but abandoning it for this auxiliary
cause which seems to be adopted exclusively: for he adds within a
few aphorisms, ^^ I think it probable that, «fi most cases^ the proxi-
mate cause is some fault in the assimilatory powers, or those em-
ployed in converting alimentary matter into the proper animal
fluids."§

But admitting the kidneys to be in a morbid and highly irritable
state, which is the oldest, and apparently the best supported doe-
trine upon the subject, and that this state is connected with an ki»
flammatory action of a pecuhar kind, what necessity is there for
supposing an idiopathic affection of any other part, whether the«
stomach or the nerves, the chylifaclent or the assimilatiog pow«t»Y
And why may not every other derangement that marks the progieii

* Diss, de Diabete Hypochondriacorum periodico, Tub. 1696.
t Recbercbes et Ezperieoces Medtcales, Sic. 8vo. Pans, 1803.
J Practv of Pbys. Aph. mdiv.
i Pract. Pbyt. Apb. MDXii.

GE- IlL-SP. IV.] EXCERNENT FUNCTION. 321

•
of the disease be regarded as consequent apon the renal mischief?
I ask the question with all the deference that is due to the distin-
guished authorities that have passed in review before us, the value
of whose writings, and the extent of whose talents no man is more
sensible of than myself: but 1 ask it also, after having studiously at-
tended to the nature of these derangements both in theory and in
all the practice which has fallen to my own lot, and with a strong
disposition to believe that the whole can be traced and resolved into
this single and original source, and consequently that diabetes is a
far less complicated disease than has hitherto been imagined.

That an inordinate excitement of the kidneys is capable of aug-
menting the urinary secretion, whatever be the cause of such ex-
citement, is obvious to every one who has attended to the stimulant
effects of spirits drunk to excess, hysteria, and several other irregu-
lar actions of the nervous system, and the whole tribe of diuretics.

In all these cases, however, the excitement is only secondary,
and follows upon a previous affection h( some other organ or part
of the system. But in the disease before us, we are contemplating
a primary excitement, a morbid action originating and seated in the
kidneys themselves. And surely when we reflect upon the pro-
digious quantity of serum the excretories of the cellular membrane
are capable of separating and caiTying off from the blood in cellular
dropsy, and those of the more limited range of the pleura or the
peritoneum in dropsy of the chest or of the belly, there can be no
difficulty in conceiving that the emunctory of the kidneys, whose
function, when in health consists in eliminating a very large portion
of the more attenuate parts of the blood, should, when in a state of
morbid and increased action, be capable of secreting quite as pro-
digious an excess of fluid as is found secreted in any kind of dropsy
whatever. And hence, from a morbid irritation pf the kidneys
alone, we may, I think, satisfactorily account for the largest quantity
of water that is ever discharged in the disease before us, and see
with what peculiar force it was denominated by the Greeks hyderus
(Ji^H^) or water-flux, as also hydrops matella^ or urinal dropsy.

This analc^ will be still more obvious from our following up
the common forms of dropsy to their ordinary consequences, and
comparing them with the consequences of diabetes. As the watery
parts of the blood in cellular or abdominal dropsy are drawn off
with great rapidity and profusion to a single organ, every other
organ becomes necessarily desiccated and exhausted ; the skin is
harsh and dry, the muscles lean and rigid, the blood-vessels collap-
sed, the bowels costive, and the adipose cells emptied of their oil.
Every part of the system is faint, and languishes for a supply, and
hence that intolerable thirst which oppresses the fauces and sto-
mach, and urges them by an increased action to satisfy the general
demand. TMs is a necessary effect of so profuse a depletion, be
the cause what it may : and we have reason, therefore, to augur a
priori that such an effect must follow in this form of the Greek
HTDEaus or water-flux. That it doe$ follow we have already seen ;

VOL. IV. 41

322 ECCRITICA. [CL. VI.-OR, If.

and we are hence led almost insensiblj to adopt, in it§ fullest hti-
tude, the correct doctrine of Dr. Latham, that " the increased ap-
petite in this last disease, however g^eat it may be, is a natural sen-
sation, calling into its full exercise that organ through which the
constant waste of the body must be directly supplied, and without
which the patient must soon inevitably perish."*

From a morbid excitement then, a weak and irritable inflamma-
tion, if I may be allowed the expression, of the kidneys alone, we
are able to account, not only for all the local symptoms of an enor-
mous flux of water, lumbar, or hypochondriac pains, and occasionally
fullness, and the post-obit appearances of distended or " pretematu-
rally enlarged arteries," as observed by Mr. Cruikshank, " blood-
vessels more crowded than in a natural state, so as in some parts to
approach to the appearance of inflammation," as observed by Dr.
Baillie, " ossified arteries," as observed by Mr. Gooch, and " a
glutinous infraction of the parenchyma of the kidneys," as observed
in other cases by Plenciz ;t but also for all the constitutional symp-
toms of a dry, harsh, and heated skin, general emaciation, and sense
of exhaustion, depression of animal spirits, great thirst and voraci-
ous appetite. In dropsy, indeed, the appetite is not uniformly
voracious, nor is it always so in diabetes : but that inanition of al-
most every kind has a tendency to produce this system, where the
tone of the stomach is not interfered with or has re-established itself,
is manifest from its occurring so commonly afler severe fatigue,
long fasting, protracted fevers, or any other exhausting stale of
body. And hence the very existence of the symptoiri in cSabetes is
a direct proof that the action of the stomach, instead of being nK>r-
bid, is perfectly sound though inordinately excited.

But the grand question, it may, perhaps, be said, still remains
untouched. How are we to account for that crudie, fused, or dis-
solved state of the blood, which appears so conspicuously in diabe-
tes, and which reduces it from an animalized to a vegetable crasis ?
Now upon this point, let us fairly put to ourselves this previous
question : Does such a state of the blood appear at all ? and is it in
fact reduced or changed in any respect from its animalized charac
ter antecedently to its arrival at the morbid organ of the kidiieys T
So far as we have been able to obtain information fronl chemibal
experiments, the blood of a diabetic patient continues in fbll pos-
session of its animalized qualities, and evibces no approach towards
those of vegetablfe fluids : and so far as' we can judge from its being
drawn from the arm during life, instead of evincing a thin, dissolv-
ed, and colourless state, it discovers that very condition which w^
should anticipate as a natural consequence of a very copiotis abstrac-
tion of its serous or more liquid, principles. For we are told)
without a dissentiebt voice, by those who have ^Wn blood flr^^U^
and repeatedly during the disease, that it ha^ the general appear-

* Practical Treatise, &c. 1. p. 417.
t Acta^et Observatibne^ Med. p. 153.

GC »I.-SP. IV.] EXCERNENT FUNCTION. 323

ance of treacle ; thicjcer than natural from the drain of its finer
parts, and darker from a closer approximation of its red corpuscles,
little capable of coagulability from its loss of coagulable lymph, and
heoce pot 0jDparating by rest into a proper serum ^nd crassament.
And we are told farther that wherever venesection has been ser
viceable, and the renal flux has diminished, the latter instantly as-
sumes a greater disposition to coagulate, and loses the darkness of
its hue.

The grand reasojo, after all, for supposing that this change from
an animaHzed to a vegetable, or rather from an uric to an oxalic
character, takes place in ike blood itself, is from the difficulty of
conceiving how iX can take place in the' kidneys : the difficulty of
explaining how an organ whose common function is to secern aJka-
4ies, and an acid strictly animal, should be brought to secern an acid
d^ectly vegetable. But, in the first place, is the difficulty one
which is diminished by transferring this won<]erful change of action
to the assimilating powers, or to the stomach, or to any other or-
gan ? For let us lay the fault where we will, we are still involved
in the dilemma of supposing, that an animal structure whose healthy
function consists in the formation of ammonia, has its action so per-
verted by the disease before us, as to produce sugar in its stead.
And hence, by enlisting the assimilating powers into service upon
ihe present occasion, we only gain two levers instead of one. We
place the globe upon the elephant instead of upon the tortoise, but
we have still to inquire what it is that supports the latter.

Thefe are, however, if I mistake not, various pathological and
physiological facts perpetually occurring before our eyes, which if
properly applied, may at least reconcile us to this supposed anoma-
ly, if they do not explain its nature : a very few of which I will
briefly advert to.

We see a tendency in most animal organs to produce sugfir un-
der particular circumstances, whatever be the character of the^
ordinary secretion ; and this both in cases of health, where we have
no ground ' for supposing an imperfectly animalized fluid ; and in
jcaflfes of disease where such a change may perhaps be contended for
and supported : and we see this also, and equally, under an animal
and under a vegetable diet ; in some instances, indeed, most so
where the former predominates. No one, if he did npt know the
Act, would predict that the breast of a healthy woman, which forms
no sjigar at any other time, would become a saccharine fountain
immediately after child-birth; and still less so that an animal diet,
or a mixed diet of animal and vegetable food, would produce a lar-
ger abundance than a vegetable diet alone : and least of all, that
Iwoman^s milk produced by animal food would yield more sugar in
a given quantity than ass'^s, goafs, sheep s, or cow^s ; and Jiess case-
ous matter than any of these quadrupeds* though this last is the

* Experlmens des M. M. Stipriaan, LinsciuB, et De Bondu in Mem. do la So-
ciety de Med. & Paris. 178$.

324 ECCRITICA. [CL. VI.-OR. II.

only matter of a strictly animalized quality wbich milk of any kind
contains.

This, however, is a natural process. Yet under the action of a
morhid influence sugar is often produced in other u>rgans, while
what should he sugar in the mamm» is changed to some other sub-
stance. Under the genus Ptyallsmus, we haye obsenred, that the
saliva is «omc times so impregnated with a saccharine principle as
to acquire the name of p. mellitus :* it is indeed by some authors
represented as having the sweetness of honey. Pus, under vari-
ous circumstances, evinces a sweetish taste, and hence the occasicMi-
al sweetness of the sputum in consumptive patients. So in fevers
of various kinds, as we have already had several occasions to ob-
serve, and particularly in hectic fever, the sweat throws forth a
vapour strongly impregnated with acetous acid. Even the cera-
men sometimes both smells and tastes sweet ; a fact noticed by Hip-
pocrates, who at the same time remarks that it is a fatal symptom.

As an animal product it might be reasonable to expect that the
gastric juice would be alkaline, and it is so in some animals : yet
those who have paid but little attention to animal chemistry will
be surprised to learn that while it is for the most part neutral in
animals that feed jointly on flesh and vegetables, it is alkaline in
ruminating and graminivorous animals, or those that feed on grass,
and acid in carnivorous animals, as the falcon, hawk, and heron.
Upon which points the experiments of Brugnatelli,t coincide with
those of Carminati and Macquart.

It is unnecessary to pursue these illustrations any further. Can-
didly reflected upon they cannot fail, I think, to diminish in a conside-
rable degree, the repugnance which the mind at first feels in admit-
ting a secretion of sugar by an organ, whose common function is so
inaccordant with such a production : and consequently they co-ope-
rate in leading us to the conclusion which it has been the design of
these remarl^ to arrive at, that paruria mellita^ or diabetes, is a
disease seated in the kidneys alone, and dependent upon a peculiar
irritability or inflammation of the renal organ. '

Of the predisposing or occasional causes of this disease, however,
we are still involved in considerable darkness ; with the exception
that whatever debilitates the system seems at times to become a
predisponent, and only requires some peculiar local excitement to
give birth to the disease, without which it is in vain to expect that
it should take place. Hence it occurs to us, in some instances, as a
consequence of old age, in others of a constitution broken down by
intemperance or other illicit gratifications; in others again of a
diseased livei', or diseased lungs,{ of atonic gout, or suppressed
eruptions : and particularly of chronic carbuncles, or ill-conditioned

• Vol. I. p. B5.

t Saggio d'uii Analisi Chemica di Succi gastrici.
Vide Crell, Beitrag. zu dem Chero. Annal. 1787.

f See Case in Latham's Tracts, &c. p. 142, as also the remarks already quoted
from Dr. Bardsley.

GE. m.-SP. IV.] EXCERNENT FUNCTION. 325

sores approaching to their nature, and showing like themselves a
considerable degree of constitutional debility.

I am greatly obliged to Dr. Latham for calling my attention tothitf
last fact while drawing up the present history of the disease, and
for referring me in support of his own opinion upoiil*this subject to
the following passage m Cheselden : " There is sometimes a large
kind of boil or carbuncle in this membrane^ which first makes a
large slough and a number of small holes through the skin which
iu time mortifies and casts off, but the longer the slough is suffered
to remain the more it discharges, and the more advantage to the
patient : at the latter end of which case the matter has a bloody
tincture, and a bilious smell, exactly like what comes from ulcers in
the liver ; and both these cases are attended with sweet urine as in

DUBETES.'**

In concurrence with this remark of Cheselden, Dr. Latham in-
forms me in a letter as follows : ^' I have a patient at this moment,
whose diabetes was first observed after a long confinement from
carbuncle : he is upwards of seventy, and is moreover afflicted with
a mucous discharge from the internal coats of the bladder." Not
dissimilar to which, is the following case, which is well worthy of
notice, and occurs among the earliest, in Dr. Latham's treatise on
this disease. " About the year 1789 there was a most remarkable
case of diabetes in St. Bartholomew's hospital, under the imme-
diate care of the late greatly to be lamented Dr. David Pitcaim.
The patient's history ot himself was this : that a rat had bitten him
between the finger and thumb, that his arm had swelled violently,
and that boils and abscesses had formed, not only in that arm but in
other parts of the body : that his health, from that time had decay-
ed, and emaciation followed. His urine had then the true diabetic
character both in quantity and quality : the saccharine part was in
very great proportion, constantly oozing through the common earth-
em pot over the glazing, and affording an infinity of pure saccha-
rine crystals, adhering like hoar-frost to the outside of the utensil,
and which were collected by myself and by every medical pupil
daily, in great abundance. "t

How far the grand agent in this change of renal action, admit-
ting the disease to be seated in the kidneys, is to be ascribed to a
change in the quality or intensity of the nervous power transmitted
to it, or, as the chemists call it, in the state of the animal electrici-
ty of the organ, to which power Dr. Wollaston has referred the
production and distinction of all the secretions, I am not prepared to
say : but the subject ought not to be concluded without noticing this
conjecture, which at the same lime imports, on the part of those
who hold it, an admission of the general principle of the disease
"^hich I have endeavoured to support. " Since," says Dr. Wollas-
ton, ^^ we have become acquainted with the surprising chemical

* Anatomy, 8vo. p. 139.

t Facts and Opioions, p. 134.

326 EeCRITICA. [CL. VI.-OR. u.

effi^cts of the lowest states of electricity, I have beep inclined to
hope that we might from that source derive some explanation of
foc^ phaeoomena. But though I have referred secretion in general
^ the agency of the electric power with which the nerves appear
pf l?e indued, and am thereby reconciled to the secretion of acid urine
frofik blood that is known to be alkaline^ which, before that time,
^emed highly paradoxical, and although the transfer of the prus-
^ate pf potash, of sugar, or of other substances ipay equally be ef-
^cted by the same power as acting cause, still the channel through
which they are conveyed remains to be discovered by direct ef pe
rin?uent."*

Whilst such is the diversity of opinions which have been held
concerning the pathology of honeyed paruria it cannot be a matter
of much surprise that the proposed plans of treatment ahouid also
exhp>it a very great discrepancy.

On a first glance, indeed, and without keeping the grounds of these
^tj^nct opinions in view, nothing can be more discordant or chaotic
tfaap the remedial process proposed by different individuals. To-
nics, cardiacs, astringents, and the fullest indulgence of the vora-
cioqs appetite in meals of animal food, with a total prohibition of
yegjetable nutriment on the one side, and emetics, diaphoretics,
a^ venesections to deliquium, and again and again repeated, on
the other : while opium in large doses takes a middle stand, as
t)MM;^h equally oHering a truce to the patient and the practitioner.

Itls i^asy, hojwever, to redeem the therapeusia of the present
d^y |n)m ijoj^ charge of inconsistency and confusion, to which at
first flight it may possibly lie open- Different views of the disease
hare \ed to different i^Uenti^ns : but so long as these intentions have
bee^p clearly adhered to, how much soever they may vary in their
];espje^ctive icoursies, they are fr;ee from the imputation of absurdity.
T^e^e inteijitions h^ve been chiefly the following :

I. 7<> invigorate the debilitated organs whether local or gene-
rail and to give firmness and coagulability to the Mood.

This was the object of all the Greek physicians, and it reg^ated
the practice to a very late period in the history of the d^ease.
'* 'Khe vital intention,'' says Dr. Willis, " is performed by an incras-
^atMig and moderately cooling diet ; by refreshing cordials, and by
fj:i>f^ .?nd seasonable hypnotics." Hence agglutinants of all kin&
we^^ called into use, as tragacanth, gum arabic, and the albumen of
4^ggs ; ^3^ these were united with astringents as rhubarb, cinnamon,
fipj iime-water, with or without an anodyne draught at evening as
WtfhX }>B thought prudent. Sydenham carried the tonic and cardiac
ps^t of this pilan considfBrably further than WilUs : for while the lat-
^^r clbi,efl|y limited lus patients to milk or a farinaceous diet, the for-
p)^ ^owed them an animal diet, with a vinous beverage. ^^ Let
i)^ patient," says he, ^^ eat food of easy digestion, such as veal, mut-

* Phil. Trans. 1811. p. 105,

CHB. ni.-Sr. IT.] EXCERNEKT FUNCTION. 327

ton. and the like, and abstain from all sorts of fruit and garden-ettrff,
and at all his meals drink Spanish wine.''

This plan continued in force with little variation, eicept as ia
the proportionate allowance of animal and vegetable food, till With-
in the last thirty years. The chief tonic medicines being the Warni
gums, or resins, astringents and bitters. Alum and alum-whey ap-
pear to have been in particular estimation with most practitioners.
They were especially recommended by Dr. Dover and Dr. Brock-
lesby in our own country, and by Dr. Herz* on the Continent. Dr.
Brisbane, and Dr Oostendyk,! on the contrary assert, that in theii'
bahds they were of no use whatever. Sir Clifton Wintringham ap-
plied arlum dissolved in vinegar, as a lotion, to the loins. The othei^
astringents that have been chiefly, had recourse to are lime-watei^,
lis noticed already, chalybeate waters, kino and catechu in tincture,
powder, and decoction; none of which, however, seem to have
been eminently serviceable. While cantharides as a local astrin-
gent h^ been exposed to a very extensive range of experiment
both at home and abroad. Dr. Morgan gave it in the tincture, Dr.
Her2 in the form of powder, and both esteemed it salutary. Dr.
Brisbane tried it in the first of these ways, giving from twenty td
tiilrty drops, twice a-day : but appears to have been as dissatisfi-
ed with cantharides as with alum, and declares that all astringentt
are htirtful, as Amatus Lusitanus]: asserted long before, that they
ire of no use.

U. A second intention of pathologists in the present disease ha^

b^en that of addinjj^ to the deficient animal salts, and resisting the

si^t^etibn of sugar, by confiiiing the patient to a course of diet and

,nAeddnes calculated t^ yield the former, and to counteract the

' latter.

This intention may have been indirectly acted upon by soilae
part of the process we have just noticed, and particularly by the
dietetic plan of Sydenham : but it is to Dr. Rollo that the medical
nvorld is immediately indebted for its full illustration, and the mean^
of carry ingf it directly into effect, which consists in enforcing upod
the patient an entire abstinence from every species of vegetaole
matter, and consequently liitaiting him to a diet of animal food
ilone : some form of hepatized ammonia being employed as an auxi-
Hftry in th\e mean time. Narcotics, as under the preceding inten-
tion, are alsb occasionally prescribed'by Dr Rollo : and, in accord-
diice with bis doctrine that the stomach is the chitf seat of morbid
action, and that the thirst and voracity are indications of such
fiction, the ^d of an emetic is occasionally called in to allay the
high-wrought excitement

Frbm this last part of Dr, Hollo's curative method Dr. Latbam
app^¥S to dis^eiftt upon the groimd, and in the present author's opi-

• Sell Keuc Beitrftge. I. 124.

•f Stmni^l. aaserl. Abfiandt. fiir Pract. aerzt^. B. 1. 179.

t Cenr; r. Cur. 33.

328 ECCRITICA. [CL. VL-OR. U.

nion a correct ground, that the increased action of the stomach pro-
ceeds from a sound instead of from a morbid appetency : but to the
injunction of an exclusive use of animal food, and a total abstinence
from fermented and fermentable liquors, he accedes, with a full
conviction of its importance, and without permitting the smallest
deviation. And as Dr. RoUo, with a view of completing the inten-
tion of supplying the readiest means for a recruit of the deficient
animal salts, prescribed hepatised ammonia as an auxiliary. Dr.
Latham, for the same purpose, prescribes phosphoric acid, having
observed in various cases of the disease an evident deficiency in the
supply of phosphate of lime ; whence, indeed, the destruction that
is occasionally met with of the fangs of the teeth t(^ether with
their alveolar processes.

Some severe remarks, which I am at a loss to account for, have
occasionally been thrown out upon this last recommendation since
the publication of Dr. Latham^s very candid and ingenuous work.
The idea is in perfect accordance with his own view of the gene-
ral nature of the disease : and, in every view of it, is more Ukely
to be of service than Dr. RoUo^s hepatized ammonia, or, perhaps,
than alkalies of any kind. For while, like the last, it has been sug-
gested upon the principle of supplying to the kidneys the deficient
materials upon which they are to work, it has a claim to attention
as a very valuable tonic and astringent, even by those who may
abjure this principle as incorrect, and particularly by the advocates
for the mineral acids. I ought not indeed, while upon this subject,
to conceal the following paragraph of a letter in direct allusion to
it, addressed to me by Dr. Latham, so lately as May 26 of the cur-
rent year, in which he communicates with much candour, his pre-
sent opinion upon the general line of practice he thus undertook to
recommend to the public, little less than twelve years ago. ^^ The
experience,'' says he, ^' which 1 have had in diabetes since the pub-
lication of my observations on that disease, does not excite, in any
degree, a wish to alter the opinions which I had then formed con-
cerning it : and I am more and more convinced that although my
theory may be wrong, the practice has been successful. As to the
theory about the phosphoric acid, I cannot help jinking that there
is more in it than I ever suspected : be that however as it may, 1
urge my patients to persevere in its use, and am certain that it may
do something more than produce a mitigation of the thirst, which
circumstance of itself would be sufficient to maintain it as a remedy
even if it went no further in effecting a cure."

in. Some of the indications of the disease, however, have given
rise to a much bolder intention. We have already seen that, from
a few of its symptoms, and the appearances discoverable on dissec-
tion, there is reason to apprehend an irritable and inflammatory
state of the kidneys ; and it has hence been attempted to cut short
the complaint, and, so to speak, to strangle this condition at its
birth, by copious and repeated bleedings. Le Fevre appears to
have adopted and acted upon this principle almost as early as the

L

G£U liL-^F. ly.] CXCERMBNT FUNCTION. 329

beginoiiig of the preceding ceDiary ;* but be does not seem to ha?A
obtained any considerable number of converts to bis opinion ; and it
is to Dr. Watt of Glasgow that we are principally indebted for
whatever advantages may have resulted from this mode of practice
in our own day ; and particularly for trusting to it mainly or exclu-
siyely, and carrying it to a very formidable extent. The plan pur-
sued by Dr. Watt, has since been pursued by Dr. Satterley, and the
success obtained by the former has apparently been more than
equalled by the latter, in the course of various trials, of which a
very interesting account is detailed in a late volume of the Medical
TraasactioDS.t These trials embrace four distinct cases, the first
of which is given most at length. The patient was thirty-two
years of age : and had been in a state of progressive debility for
nearly six months, brought on in the first instance, as was appre-
hended, by his having drunk copiously of cold water when over-
heated. He fell under Dr. Satterley's care in consequence of being
taken to the Middlesex Hospital ; the symptoms were strongly
marked, and the disease unequivocal : the pulse was quick, small,
and hard. Fourteen ounces of blood were taken from the arm on
the day afler his admission, which was Feb. 19, 1808 : he was put
upon a meat diet, with an allowance of drink sufficient to allay,
though not to satiate, his distressing thirst. The abstraction of blood
appearing to afford relief, eighteen ounces more were taken irom
him the next day, the 20th ; twenty ounces more on the 23d ; the
same quantity on the 2dth ; and eighteen ounces successively on the
28th, on March the 3d, and March 1 Ith : making a total of a hun-
dred and twenty-six ounces in twenty days. On the day and night
of admission, he had evacuated sixteen quarts of urine ; aAer the
first use of the lancet, the quantity was reduced to eleven quarts in
twenty-four hours ; after the second, to six quarts ; after the third it
▼ailed from five to seven quarts ; after the fourth, it stood at six ;
after the fifth, it varied from five to six ; after the sixth, it sunk
below five ; and at the time of the seventh, was calculated at three,
and had sometimes been not more than two : at which time his mor-
bid thirst had entirely left him, he was in tolerably ffood health,
and increased in strength and size. In consequence of some pneu-
monic symptoms, he was afterwards blooded once or twice, and de-
tained in the hospital for a long period of time, though the term is
not stated. He was, however, at length discharged cured, and was
found several years afterwards to have kept free from any return
of the complaint

The regimen and accompanying course of medicines are not very
accurately stated. He seems to have been limited to a diet of ani-
mal food ; to have used alternately as a part of his beverage, alum*
whey, and lime-water ; to have taJien occasionally calomel, and cas-
tor-oil, and for a part, if not the whole period, a grain of calomel

* Opera, p. 134. Verunt. 1737. 4to.
t Vo), V. Art. I.
VOL. IV. 42

930 ECCRITICA. [ex. TL-OR. II.

and a dose of compooikl powder of ipecacuan every night, the qiMA-
tities of which are not given. But it was the deple&ig plan thai
was altogether depended upon, and no verj minute attention was
paid to any thing else.

The two next cases admitted of easier cure under the same
treatment. The patients were both males. The fourth case breidcs
off incompletely, for, in consequence of a removal of the patienli
the termination was not known.

In each of these there was the local symptom of gpreat pain in the
loins, which in the first is described as having been ^* always severe
but at times excessively acute.'' Here also the testicles were
occasionally retracted ; and in one of two female cases there was a
distressing itching in the pudendum: so that there is reason to
conclude that these instances were accompanied with a more than
ordinary degree of irritability or inflammation. ^^ This,'' says Dr.
Satterley, ^^ is the extent of my experience respecting bleeding in
diabetes : an experience that fully warrants my asserting the sa^tj^
and I think the efficacy, of the practice, in some $p9cUs of tliJ»
complaint."

IV. It has, however, been thought possible by other practitionen,
to subdue the irritation whether loc^l or general, and which is oAen
strikingly conspicuous, by powerful narcotics repeated in quick
succession; and thus to obtain a cure without that increase of
deblKty which, in many cases, must necessarily ensue upon an active
plan of depletion — and this has constituted a fourth intention.

Anodynes, though of no great potency, were occasionally admi-
nistered by Willis and Sydenham ; and their benefit was expressly
insisted upon by Buckwald.* The ordinary form has been that oif
Dover's powder, thus aiming at a diaphoretic as well as a sedative
effect: and in this form it has sometimes been found successfnl,

Particularly in a case published by Dr, M^Cormick in the £dinbui]gh
[edical Commentaries :t but 1 am not aware that narcotics alone
have been relied upon, or their effects completely ascertained
before the late experiments of Dr. P. Warren, an interesting state-
ment of which he. has communicated in the same work that con-
tains Dr. Satterley's practice in venesection.| These experioEieotB
embrace the progress of two cases that occurred under Dr. Warren'a
care in St. George's Hospital. In the first he directed his attention,
like Dr. M^Cormick, to opium, in conjunction with some relaxant ;
and hence made choice of the compound powder of ipecacuan.
So far as the present cases go, however, they prove very saHafac-
torily that whatever benefit is derivable from the use of this
valuable medicine, depends fkr more upon its sedative than ita
sudorific power. Dr. Warren, indeed, seems rather to have found
the latter a clog upon his exertions, as he could not carry the opiuoa

* Dissert, de Diabetis curRtione, &c.
t Vol. IX. Art. II. p. 56.
X Vide supra.

•£• ilI.*-SP. IV.] EXCEKNENT FUWCTION. 331

fiur enough to prodace a permaDent effect on accoimt of the namea
or TonttiDg occasioned by the ipecacnan, from which symptoms no
benefit whatever appeared to be derived. Id his first case, thero^
fore, he soon trusted himself to opium alone, and persevered in the
MflM practice through the second.

These patients also were in the prime or middle of life : the one
aged twentj-two, the other thirtj-eight : and both had been declin-
ing for some months antecedently to their applying to St. George^s
Hospital for relief The first seems to have been worn down by
the latlgae of journeying, and was considerably disordered, before
the atti^ of diabetes, in his stomach and bowels. When received
into the hospital, however, with this last complaint upon him, he
imd a considerable pain in his back and loins. Of the origin of the
veeond ease no account is g^ven. To ascertain whether an animal
diet would succeed by itself, or whether it be of any collateral
advantage, the patients were sometimes restricted to animal food
alone, to opium alone, and to opium with a mixed diet of animal
and vegetable food. It appears to me from the tables that the
animal regimen was of advantage, but certainly not alone capable
of effecdog a cure, for in every instance the quantity of urine
increased and became sweeter, whatever the diet employed, as soon
as tlie opium was diminished. Dr. Warren, however, is inclined to
tliink that it was of no avail whatever ; and, consequently, the second
Mtient had no restriction upon his food, whether animal or vegetable.
The quantity of opium given was considerable. When Dover's
powder was employed it was gradually increased from a scruple to
a drachm twice a-day. And when opium was employed alone, or
with kino, with which it was for a short time mixed, but without
any perceptible advantage, it was augmented from four grains to
•Ix grains and a half twice a-day in one patient : and to five grains
Ibor times a-day in the other. It is singular that the opium seldom
produced constipation. Few other medicines were employed.*

The disease in both cases was as decided as in the preceding
treated by venesection : but the flow of urine was much less, the
aaazimum in the one patient being only fifVeen, and in the other onl v
ai^t pints in the twenty-four hours : and the cure occupied a much
lo^er period of time ; running on to nearly four months in the first
inttonce, and to more than six in the second.

Tlie sum of the whole appears to be, that paruria meUita attacks
persons of very different ages, constitutions, and habits, and hence,
te dUferant cases, demands a different mode of treatment : and that
the morHd action is seated in the kidneys ; with the irritable, and,
often, iaiammatory, state of which all the parts of the system more
or less sympatliize. It appears that under a diet of animal food
strictly adhered to, the tendency to an excessive secretion, and
particalarly to a secretion of saccharine matter, is much less than
! any other kind of regimen, though, from iiUosyncrasy or some

• Med, Traniact. Vol. iv. Art. xvi. ^. 1S8.

332 ECCRITICA. [CL. VI.-OR. 11.

other cause, tbls rule occasionally admits of exceptions. It appears

also that the irritation is in some instances capable of being allajed,

and at length completely subdued by a perseverance in copious

doses of opium, probably by an exhaustion of the general exoita^

bili^ ; and in others by a free use of the lancet, leading more

rapidly to a like effect. The skin, through the progress of this

complaint, does not seem to catenate in the action of the kidneys so

much as in many others, except in a few individuals ; and hence

diaphoretics are rarely of advantage. As the irriiaMlity of the

affected organ is connected with debility and relaxation, tonics are

frequently found serviceable, and particularly the astringents ; those

mostly so, that are conveyed to the kidneys with the least degree of

decomposition. And hence the advantage that has been so often

found to result from an use of lime-water, alum-whey, and many of

the mineral springs. The mineral acids are, on this account, a

medicine of very great importance, and in some instances hare been

found to effect a cure alone ; of which Mr. Earnest has given a

striking proof in a professional journal of reputation.* Their

sedative virtue is nearly equal, to their tonic, and they surpass

every other remedy in their power of quenching tlie (^stressing

symptom of intolerable thirst. Cinchona and various other bitters

have been tried, but have rarely proved successful. Some benefit

has occasionally been derived from irritants applied to the loins, and

especiiilly from caustics ; but these have also failed.

How advantageous soever the plan of sanguineous depletion may
be founfl occasionally, it is clear that it cannot be had recourse to
generally, for the present disease, is, for the moat part, though by
no means always, a result of advanced years and of a debititated
constitution. Under such circumstances, indeed, it has uniformly
occurred to the present writer, in the few instances he has been
called upon to superintend it, in which, while the thirst was intense,
fhe appetite by no means kept pace with it, and was sometimes found
to fail completely. Where, on the contrary, the constitution does
not seem seriously affected, and the soundness and, indeed, vigour of
the stomach and collatitiOus viscera are sufficiently proved by the
perpetual desire of food to supply the waste that is taking place, a
free use of the lancet may probably be allowed as offering what may
be called a royal road to the object of our wishes : but the practice
should, I think, be limited to this state of the animal frame ; since,
while this favourable condition of the digestive organs remain9,
whatever be the prostration of strength induced by the hmcel, it
will soon be recovered from.

By what means an animal diet effects the beneficial change that
00 generally follows iVom its use, has never, that 1 know of, been
distinctly pointed out : but there is a fact of a very singular Idnd
that has lately been discovered in animal chemistry wliich is, I'
think, capable of throwing a considerable light upon the subject

* (ledical Joufnal, Vol. xili.

GE. OL-^SP. IT.] EXCERNENT FUNCTION. 333

Id hMtAy utfne, the predominaDt principle is that of uric acid, in
diabetic, that of saccharine or oxalic. The uric acid, indeed, eidsts
so largely in sound urine as to be always in excess, as we shall haye
occasion to observe under uthia or uRiiiART calculus. It is not
ooly a strictly animal acid, but till of late years was supposed to ex-
ist in no other urine than that of man ; though it has since been
found, but in a smaller proportion, in the urine of various other
animahi. Whatever then has a tendency to reverse the pature of
the add secretion in the disease before us, to produce uric instead
of oxalic acid, and in this respect to restore to the urine its natural
pfteciple, must go tar towards a cure of the disease, as well by
takii^ off from the kidneys a source of irritation, and hereby di-
minidiing the quantity of the secretion, as by contributing to the
soundness of the urine itself Now the physiological fact I refer
to is, that animal food has a direct tendency to induce this effect : for
Dr. WoUaston has satisfactorily ascertained that a greater quantity
of uric acid is produced in the dung of birds in proportion as they
feed on animal food : and he has hence ingeniously suggested, that
where there is an opposite tendency in the system to that we are
DOW cootemplatiDg, a tendency to the secretion of an excess of uric
add, as in the formation of uric calculi and gouty concretions, this
evil may possibly be obviated by a yegetable diet.

SPECIES V.
PARURIA INCONTINENS.
XncontCKence ot Wixint-

FRXQUENT OR PERPETUAL DISCHARGE OF URINE, WITH DIFFICULTY OF

RETALNINO IT.

This is the enuresis of most of the nosologists, and admits of four
varieties from diversity of cause and mode of, treatment, with oflen
a slight diversity in some of the symptoms.

• A^ris. From a peculiar acrimony in the

Acrimonious incontinence fluid secreted.
of urine.

C Iriitata. From a peculiar irritation in some

Irritatiye incootiDeDce of part of the urinary channel.

7 Atottica. From atony of the sphincter oi

At«Hiic incontinence of the bladder.
urine.

) Aquosa. From superabundant secretion :

flux of aqueous urine. the fluid limpid and dilute.

334 ECCRlTiCA. [cSm TL-OIL II.

Id the ratsr ▼Aimmr, .p]:oceecKDg from a pectiliar acrhnoDy «f
the secreted fluid, the cause and effect are mostly temporary ; ai
400 large a portion of spirits combined with certain essential oils as
that of the jnniper-berry. Diluents and cooling laxatives offer the
best cure.

In the SECOND variety, the • irritation nsnally proceeds from sand
or gravel, or some foreign substance, as hairs, accidentally Intro-
jdnced into the urethra. We have some accounts, however, of a
^discharge of liairs, in such quantities that it is not possible to ascribe
the affection to an accidental cause ; and we should rather, per-
iiaps, resolve them into a preternatural growth of hair in the blad-
der itself, an idea the more tenkble as we shall have to observe, in
d«e time, that calculi of the bladder have occasionally ' been dis-
charged or found after death surmounted with down. In this
case the disease may be regarded as a species of trichosis,
imder which name it is described by Goelicke,* as it is under that
of trichiasis by Scultetus.t But at present we are in want of de-
cisive information upon the subject. If the last view be correct,
filling the bladder with injections of lime-water or any other depi-
latory liquid of as much acrimony as the bladder will bear without
injuring its internal and mucous surface, will be the best mode of
cure.

Frequently, 'however, the irritation is that of simple debility:
and hence, tonics and stimulants, as the terebinthinates or even the
tincture of cantharides, may be employed internally with success,
while externally we prescribe blisters to the perinaBum, or the cold
water of a bidet. Pressure is also of great service in many instaii-
ces. In the sixth volume of the Medico-Chirurgical Transactions,
Mr. Hyslop gives a case of nine years^ standing, in which a cure
was eflfected in three days by binding a bougie tightly to the urethra
through its course by means of adhesive plaster. And Mr. Bums

Sves another case, in the same volume, in which great benefit was
rived from a similar plan ; which is also in many instances equally
adapted to the next variety.

In incontinence of urine from an atony of the sphincter of the
bladder, the same means may be had recourse to, though with leas
hope of success.

Stoll recommends the use of an acetum armoracium, which, from
combining a stimulant with a tonic and astringent power, may pos-
sibly be found serviceable, and is certainly worthy of trial-l Small
shocks of electricity passed from the pubes to the perinsum seem
also to have succeeded in a few cases.

As the perpetual dribbling of the urine in this, and even the
preceding variety, is always troublesome, and often produces ex-
coriation, the patient will find it very convenient to be provided
with a light urinary receptacle. This, for males, may consist of a

• Dissert. d« Trichosi. Frankf. 17i4,

t Trichiasis admiranda, sen Morbus Pilaris^ ke, Norib. 1^8.

% Prelect, p. 287,

GE. H1.-9F. V. J EXCERNfiNT FUNCTION. SSS*

mall big.of oiled-silk worn as a glove for the penis, with m small
piece of sponge placed in it as an absorbent. The simplest contri-
vance for females is a larger piece of soil sponge loosely attached
to the pudendum.

The FOURTH Variety, or flux of aqueous orine, is often a nervouf
affection, as in hysteria, or hypochondrias ; but it more generally
proceeds from a relaxation of the mouths of the cryptae or- tubuli
uriniferi, which in consequence suffer a much larger quantity of
fluid, and with too little elaboration, to pass through them tliaa
they should do.

In treating of paruria melliia^ we observed that antecedentlv to
the discovery of the singular secretion of sugar in the genuine form
of this disease, the term diabetes, by which it was commonly ex-
pressed, imported any , extraordinary or profuse flow of urine,
whether watry or saccl^rine : whence the term was made to em-
Wace at least two affections of the kidneyi of very different kinds :
as a simple relaxation of the mouths of the urinary tubules from
debility ; and vehement excitement and a morbid change of action ;
the former expressed by diabetes innpidtu, and the latter by d«
mellitut. The variety we are now contemplating constitutes the
first of these ; as the secood runs parallel with the preceding spe*
cies. It is the urina aquosa* of Galen which was also by himself,
as well as the Greek writers in general, blended with the uiina
mellita^ from their not having been acquainted with the difference of
their constituent principles, and of the state of the kidneys in the
one case and in the other ; and hence both were equally described
by them under the names of hyderos or water-flux, and hydrops
matellaB or minal-dropsy.

As this variety, like the preceding, is dependent on a debilitated
state of the organ, it should be attacked with the same remedies,
and particularly with astringent tonics and stimulants both local and
general. Blisters applied to the loins will be found often useful, aa
may also tincture of cantharides in doses of from twenty drops to
half a drachm or even a drachm. The warm and resinous balsama
will moreover frequently afford aid, as turpentine and balsam of
copaiva, or the essential oil of juniper.

The quantity discharged under this variety of the disease haa
occasionally been enormous : amounting to from thirty to forty pints
a-day and sometimes more, for one, two or even three months with-
out intermission ; a variety of examples of which are offered in the
volume of Nosology. Fonseca mentions a case of two hundred
pinu evacuated daily, but for what term of time is uncertain,!

* De Crisibusy Lib. i. Gap, xu.

t De NaUine Artisque Miraculis, p. S38.

336 ECCRITICA. [CL. VI.-OR. U.

SPECIES VI.
PARURIA INCOCTA.

VEINE IllFREONATED WITH FLUIDS TAKEN 0ITO THE fiTOMACH, AUD EX-
CRETED WITHOUT CHANGE.

The Greek pathologists evidently allude to this morbid state of
the urinary organs in comparing some varieties of their diabetes,
or urinary diarrhoea, to a lientery or IsMritas intutinorum^ mder
which last the food >is described by them as evacuated in a crude
and undigested state, with very little alteration from the condition
in which it was mtrodticed into the stomach.

The experiments of Sir Everard Home, and those of Dr. WoUas-
ton, and Dr. Marcet, both contained in the Philosophical Traosae^
tions for the year 1811, show that rhubarb and prussiate of potash,
may pass from the stomach into the bladder, without undergoing
any decomposition ; and, in these cases, apparently without taking
the course of the blood-vessels. By what other path it is possible
for them to have travelled is to this moment a subject of mere con-
jecture, upon which, however, the author has offered a few hints
in the Physiological Proem to the present class. Oil of almonds
has frequently reached the bladder with -an equal destitution of
change and has been discharged in the form of oil by the urethra :*
and oil of turpentine and juniper pass off in the same manner daily.
Actuarius mentions a discharge of urine of a blue colour, in a boy
who had taken a bitter pill designed for another patient, but does
not state the materials. Urine containing a sediment resembling
Prussian blue was discharged copiously by a patient in a low fever
about three days before his deaUi : it afterwards became greenish,
and possessed a strong ammoniacal smell. Another case is related
by the same author of a discharge of blue urine in a woman of
sixty without mischief. We do not know, however, that eithe^^of
these two last cases was connected with any thing introduced into
the stomach, and the blue or dark-coloured matter consisted proba-
bly of extravasated venous blood, intermixed with the yellow or
other tinge of the urine.

Copious diluents, mucilaginous or farinaceous, will at all times
afford the best means of deterging the kidneys of any such unteflip-
ered materiab as those we are now contemplating ; and if tlie co-
lour should appear to proceed from a rupture of blood-veaseb In

* BachotoDi, CommeDt. Bonon. Tom. ix. Part, i.

OE. in.-sp. til] excernent tvvcnos. 337

Uie same or^ns, the affectioo will become a variety of bsmaturia^
and should be treated accordinglj.*

SPECIES VII.

PARURIA ERRATICA.
Srratfc SbrCxe.

URINE DISCHARGED AT SOBIE FOREIGN OITTLET.

Under the preceding species, we have seen that certain substances
introduced into the stomach, will fmd their way unchanged to the
kidneys. The present species presents to us a singularity of differ-
ent and almost opposite kind, by showing us that the urine itself
in a certain condition of the organ that secretes it, or of the sys-
tem generally, may travel from the kidneys to other regions in a
form equally unchanged. We know nothing of the means by which,
all this is accomplished, but we can sometimes avail ourselves of
the fact itself^ by employing a variety of medicines, which, in con-
sequence of their being able, in this manner, to arrive at a definite
organ without being decomposed in the general current of the
blood, are supposed to have a specific influence upon such quarter,
and have often been denominated specifics for such an effect ; as
cantharides io respect to the bladder, demulcents in respect to the
lungs, and cinchona in respect to the irritable fibre.

This disease lias often been described under the name of uropla-
nia, which is nothing more than a Greek compound for *' erratic
urine'' as it is here denominated, but it has seldom been introduced
into nosological arrangements. The cases, however, are so numer-
ous and distinct, in writers of good authority, that it ought not to
be rejected. In most instances it is not a vicarious discharge ; or,
in other words, a secretion of a different kind compensating for a
destitution of urine, but a discharge of an urinous fluid apparently
absorbed after its secretion by the kidneys« and conveyed to the
outlet from which it issues by a path or under a protection that
has hitherto never been explained. We sometimes meet with it
while there is a free secretion of urine by the kidneys, and a free
passage by the bladder and urethra, in which case alone it can be
called a disease. On other occasions we find it, as already observed
under fahuria iihops^ performing a remedial part, and travelling in
the new direction to carry off recrementory matter that cannot be

• Sco Vol. II. p. 460. .
VOL. IV. 43

33tl fiCCRtnCA. [CL. TU-OR. !!•

dfochlo'ged'at its proper ootlet, nor retained in the blood without
mischief.

It has in different persons been evacuated by the salivarj glamh^
the skin, at the navel, and by a fistulous opening into the perinsum.

The volume of Nosology gives a reference to cases and autho-
rities illustrating each of these forms of discharge : and others are
probably to be met with iti other writings.

GENUS IV.

LITfflA.

■ORBID SeCRSTION OR ACCUMULATION OF CfALCULOtJS MATTER IR 1RTB«.-

SAL CAVmES.

firraiA is a Oreek term from A/Ik whence xt^mm *^ calculo laboro.'^
ft has oflen been written lithiasis, which is here exchanged for
Hthia, since torn, m the present arrangement, is limited, as a ter-
mination, to words indicating diseases affecting the skin or cuticle,
and that for reasons which wilt be explained presently.

The name of II thus or lithiasis, as used by Aretasus and Amrelia-
'rtus, and that of calculus or sabulum, as employed by Celsus and
Fliny, sufficiently evince the elementary principles of which the
Greeks and Romans conceived urinary calculi to consist. The mis-
take is not to be wondered at when we reflect, that it is not till
about thirty years ago that these principles were detected with any
degree of accuracy ; and that we are indebted to the minute and
elaborate experiments of Foiircroy and Vauguelin for an analysiB
that till their time, though successively pursued by Hales, Boyle,
Boerhaave, and Slare, had been left in a very unsatisfactory state ;
and which even since this period has required the further correc-
tions of WoHaston, Marcct, Cruikshank, Berzelius, Brande, and vari-
ous other animal chemists to produce all the success we could desire.
So generally was the belief that the calculi of the bladder were
ibrmed'in the same manner and consisted of the same materials as
the stones oC the mineral kingdom, that Dr. Shirley published a
learned book as late as 1671, which is now become extremely
scarce, entitled *^ Of the causes of stones in the greater world in
order to find out the causes and cure of the stones in man."

The urinary secreiion in a state of health is one of the most com-
pound fluids of the animal system : and consists of various acids, and
alkalies, the former, howevev^ bearing a preponderancy, with a
eertain proportion of cjilcareous earth, and other materials which

«c.«r..] ExouumFF function. 5S9

AU not iM)e«Mry to 4wb\1 npcp at ^^eMot. The acid fint dis-
ctmtmA in lit wa? the photphorlc, which was traced by Brandt and
i^Bnekal, wfaeoce tha eKpefiaients of fio^ from wiuch he obtain-
ed phocphoms. The important discovery of uric acid was reserv-
ed 4br Scheele, wlio detected it in 1776: as he did ako bencoic
•cid, ebleiy confined to the urine of cbildpen. Proost has since
fNTOfed that it cootaias also .carbonic acid, and a peculiar resin liJce
that of bile; and other acids, In smaller proportion, have more 4ate-
fy "been ascertained by Thenard and BeraeMus. Heece tiiexakart-
oos earth that it separated by the kidneys, as we tere liad ooea-
sion to observe that it is also by most other organs of the body in a
•tate of health or of disease, is prodactiTe of nuneroos eesipaands,
as cariionate of lime, phospliate of time, oxalate of lioie : togetlwr
with compounds stilt more complicated by an intermiKtare of the
Mme with the urinary alkalies. But as, in a state of health, the
nrine is always found to contain calcareous earth under some form
or other, in a morbid state it is also found to contain magnesian
earth more or less united with the other materials, both acid and
alkaline. In many cases moreover, the natural acids, or the natural
alkalies are secreted in excess, in others in deficiency. And from
all these circumstances it is easy to conceive that a very great
rarlety of concretions, or calculi may at times take place either in
the kidneys or in the bladder. How far these varieties extend, has,
perhaps, not fully been determined to the present day, but the num-
ber which has been detected and analyzed Is now very considerable
and has been increasing erer since Dr. Wollaston's valuable essaj
on this subject, which appeared in the Philosophical Transactions
for the year 1797, and laid a iboadation for the ammgenent.
Among those which iMve been subse^oentlj ascertained^ a few, and
especially the cystic oxyde, have been discovered by himself; and
the whole are thus enumerated by Dr. Marcet in a still later pro-
duction of highly distinguished merit* 1. LUhie calculus, composed
chiefly ij^ litiSc or uric acid. 2. iW<Ar6one calculus, consisting chief-
ly of phosphate of lime. 3. AmmoniaethmMgnetian fkotphai^ or cal-
colas, In which thtt triple salt obviously prevails. 4. Ftaible calco-
los, consisting of a miuture of the two former. 5. Mulberry calculusi
or oxalate of lime. 6. CysHc calculus, contiating of the substance
called by Dr. Wollaston cystic oxyde. 7. AUemating calculus, or a
concretion composed of two or more different species arranged hi
alternate layers. 8. Compmmd calculus, the ingredients of which are
so intimately mixed as not to be separable without chemical aoaly-
bIs. 9. Cakulus irom the otiottele gUind^ of a peculiar kind, aad cour
Bisting, according to Dr. Wollaston, ^ of phosphate of lime not dis-
tinctly stratified, and tinged by the secretion of the prostate gland.''
The two not hitherto described are. 10. JCanthic oxyd, making an
approach to the cystic calculus, but giving, which that does not, a

♦ Essay on the Che^^ica] History nnd Mettlcal Treatment of Calculous piir
orders.

840 Bconncu. [cutl-kmux.

briffat lemon resUhnun on evaporatiiig its nkrlo flolndon. Aai
11. Fibrinous calculus, so called from its posseasiDg propertleaaxact-
Ij similar to those of the fihrina of the blood, and no doubt formed
1^ a deposit from this fluid.

Of these a few only are commonly found in the kidneys, though
most of those which are found in the kidneys are found also in &
bladder, and in reality constitute the pommon nuclei of the caltu-
lous concretions of this last organ ; the augmentation resulting from
other constituent principles of the urine, gradually separating,
and encrustii^ them as they lie in the blad<i&r in an undiaturb^
state.

The symptoms, moreover, of renal and vesical calondi differ aa
widely as their component parts, and hence pwit out the neceasi^
of subdividing the genus into the two following species:

1. LITHU RENILIS.

RBKAL CAIiCULUS.

SPECIES I.

ViSIOAL CALCVUm

LITHIA REJNALIS.
Unrnl Calodiui.

pinr IN THE Lotus, snooTuro down towards the testes or TmoBB,

INCREASED ON EXERCtSS; tTRnfE OFTEN DBPOSrTINQ A SABVLOtTB 8ED|-
BfENT.

The calculous matter of the kidneys sometimes passes off in minute
and imperceptible gt^dns with the urine, which are only noticed by
their concreting or crystallizing about the sides of die vessel that
receives it; and sometimes collects and forms very troublesome
spherules or nodules in the substance or pelvis of the kidneys : tlius
offering the two following varieties :

• Arenosa. Pain slight, and imfrequent : free

^Jrinary sand. discharge of sabulous g^nmules.

C Calculosa. Pain mostiy severe and constant :

Urinary graveL sabulous discharge small and

seldom or never : calculus vaxr-
ing in size, often large and ob-
structing the pelvis or ureter of
the kidney.

Urinanr sand, or the sabulous matter deposited on the sides or
bottom of a receiving vessel, is of two liinds, whitk and red : and i(

GB. I¥k-€IP* I*] EXCERinCBrr 'TONCnON* 341

is of gTMt hapoitiiice to dkHofoiah ike one fnm the other as they
proc^d fr(MD Tery diffevent causes^ and require a different, and, in-
deed, opposite node of treaitBient Mr. Brande has pnbiished an
excellent treatise upon this subject in liis (Quarterly Joamal ; and in
tlie remarks about to be offered upon this species, I shall ayail my-
self in no small de^pree of the benefit of his labours in connexion
with those of Dr. Marcet to which I haye already referred.

The urine, in a healthy state, is always an acid secretion, and it
is the excess of its add that holds the earthy salts in solution. I^
jfrom any cause, it be deprived of this excess, or, in other words,
the secretion of its acid be morbidly diminished, the earthy parts
wre no longer held in solutioo, and a tendency to form a wbtte sand
or cAULOuoovs i»posiTB immediately commences. And that this is
the real source of its production is manifest from the inmple expe-
riment of mixing a little alkali with recently voided urine ; for the
alkali has no sooner exercised its affinity for the add than the urine
tltfows down a white powder. And hence a like deposite will
not unirequently take place upon using magnesia too freely.

A knowledge of the cause of this modification of urinary sand
pats us at once into an easy mode of curing it, a mode however
which was first pointed out to the world by Dr. Wollaston. It con-
dsts in introducing into the system some other acid as a substitute
A>r that which is wanting to the kidneys. All the acids seem to
answer this purpose, but as the sulphuric usually sits easier on the
stomach than any other of the mineral acids it is entitled to a pre-
ference ; and the more so on account of its superior tonic powers,
and consequently its better adaptation to the cbylifactive organs, a
deUlity which is no uofrequent cause of the complaint The
vegeXMe acids, nevertheless, may be interposed with the sulphu-
ric, or, where the stomach is very delicate, entirely supersede their
iBO. Of these the citric is the pleasantest and can be persevered
in for the longest period of time, especially in the case of children*
The tartaric, however, and especially in the form of creme of tar-
tar, has the advantage of gently operating upon the bowels which
is always a beneficial effect. Carbonic acid whether taken in the
form of effervesdng saline draughts, or simply dissolved in water
by means of Nootb's apparatus will also be tound a useful and plea-
sant auxiliary. The general diet should be of the same description,
and be as largely as possible intermixed with salads, acida, fruits,
and espedally oranges. Malt liquor should be abstained from ; and,
if the habit of the patient require that he should continue the use
of wine. Champagne or claret should be preferred to Madeira or
port.

It is poanble, however that this modification may be a result of
too large a secretion of calcareous earth, instead of too small a se-
cretion of acid ; yet the effect being the same the same mode of
treatment will be adviseable.

But the acid may be in excess instead of in deficiency, or, which
is nearly the same thing, the natural secretion, of calcareous earth

342 SGCRmoA. [cl. vuhqiu n.

may itself be ctefidcfit wkHe tlie acid ratete to
and in this case the add itself has a teDdeacj io fium m depoaite hj
crjstalUzingf into mhrate aod red spieolo^ — aad hesce the mo^fica-
tion of RED SAVo that is so frequemlj found coatkig the aidea aad
bottom of chamber^utoosils.

This, like the preceding, is aometimes v^ded in a coocrate or
crystallized state, or the urine may be voided clear, and die depe-
site not take place till some houfs afterwards. The last ta erdhia-
rily the result of some temporary cause, and is of no importance a»
it disappears with the cause that produces it The first is of mere
serious consideration as it indicates a lithic diathesis tliat maj lead
to a formation of large and mischievons caiovti, and is a pre^ cei^
tain harbinger of the variety we shall have lo notice nodar the
name of gravel.

As acids form the best preventiTe and cure in tlie precedtag
case, alkalies present an equal, or nearly equal remedy in die pre-
sent, with the exception that the tendency to prodece mioacv red
sand is more likely to ran into a habit, and is hence leas easily ex-
drpated, than that to produce wiiite.

It has, in fact, been long known that concrete eric acid la sokiHa
in the caustic lixed alkalies, and these were, in conseqneece hern-
of, the earliest forms of alkali adverted to for this deposit. Bet it
has since been ascertained that the alkaline carbonates and eub-cer-
bonates are equally effectual. And, as the lafler are £ir leas epc to
disagree with the stomach than the former, they have very gea^
rally taken their place. Of the alkalies and alkaline carbonataa
soda has commonly been found to answer the purpose best, it is,
indeed, chiefly effectual in its pure state, but it i» most convenieet
to use it in a milder form ; and of all the forms it offiars that of ao*
da-water is the pleasantest, and may be persevered in for die long^
est period of time. Nevertheless thefe are some coDsdtnUons in
which potash and its carbonate prove mere effejDtual than soda, a
remark for which we are indebted to Sir Gilt»ert Blaae, who, oo
this account, has occasionally given it the preference, aed for the
sake of rendering it more palatable has sometimes partly saturated
it with lemon-juice or citric acid ; and where there has been severe
or protracted pain, producing considerable irritation^ has united it
with opium.* A drachm of the carbonate of either of the 6xed al»
kalies will form a moderate dose for an adult, and may be repeated
two or three times a-day, taken during the effervesceoce produced
by the addition of half an ounce of lemon-juice to the menstruum,
which may consist of two ounces of water aweeteeed with honey.

Ammonia and its sub-carbonate have been had recourse to, aa^
with great advantage, where, symptoms of indigestion liave been
brought on by the fixed alkalies ; and particularly in cases in whieli
red gravel is connected with gout, and the two <tiseases show a dis-
position to alternate.

• Transactions of a Society for improving Mf dical and Chirurgical Knowl€(1ge,
Vol. in. p. 358.

<%u rr.-sr. i.] excerkent function. 343

lAigpS^sia is atoo of considerable tme, as has been lately shown by
Mf. Brande in two excetteat papers upon thisr subject, published in
the Philosophical Transactions * Taken in free and frequent doses
it ha0 6Aen succeeded in checkinc^ the tendency to a formation of
sM&d and gravel, and has kept many individuals iiiree from this com*
jrtaint for Very long periods of time who have been constitutionally
predisposed to it. Nevertheless it is not calculated to supersede the
ns^ of tiie alkalies, but may be employed as a convenient adjunct,
or supply their place for a time, when the patient has become tirefd
of using them.

Tbere is some doubt as to the manner in which the acid? em-
ployed to a correct secretion of white sand, and the alltaiies that of
red, ftilfil their object: whether indirectly by a peculiar action on
the chylifacient organs so as to render the fresh supply of nutriment
oiore easily disposed to yield an acid in the one case, and less easi-
fy in the other ; or directly by passing unchanged along the current
of the blood and arriving at the kidneys in their proper forms.
Tliere is a diificotty in attending both these views ; but as uric acid,
though soluble in the caustic alkalies, is found not to be soluble in
tbeir carbonates and sub-carbonates, the benefit of alkaline medi-
cines does not seem referable to their solvent powers. And hence
It is, on the whole, more probable that both adds and alkalies pro-
dace an indirect influence on the kidneys, as we have already had
occasion to observe that 'animal food does in saccharine urine, by a
peculiar influence on the chylifacient viscera, or the nutritive ma-
terials during their subaction.

There is also another class of medicines which have long stoo^
the test, and been proved to possess a truly remedial power in all
urinary concretions of the kind before us — 1 mean astringents. So
considerable is their eflicacy that De Heucher ascribes to them an
eitpulsory power, in his treimse entitled ^^ Calculus per astringentia
pellendus.'^ Their real mode of action has probably been pointed
out by Dr. Cullen in a passage in which he has anticipated much of
the reasoning of the present day concerning the benefit of alkalies,
and has hereby given an additional proof of the strength of his judg-
ment Speaking of the leaves of the uva ursi, he says, that this medi-
cine, ^^ Not only from the experiments of the late De liaen, but also
from my own, I have found to be oAen powerful in relieving the
symptoms of calculus. This plant is manifestly a powerful astringent :
and in what manner this and other astringents arc useful in the
cases m(>ntioned may be diflicult to explain : but 1 shall ofl'er a con-
jecture upon the subject. Their powerful attraction of acid we
have mentioned above, and that theircby they may be useful in cal-
culous cases is rendered probable by this, that the medicines which
of late have been found the most powerful in relieving the symptoms
of calcoliis are a variety of alkalies, which are known to do this

• Phil. Trans. Year 1010, p. 136 ; 1513, \'u ^\'3.

IJ44 ECCRITKA. [CL. VL-OR, II-

without their acting at all id dissoWing the stone.'^* The Tirtne
as a stomachic toolc ought also to be taken into consideration as
well as their absorbent power.

The 8KC0ND variety of the lithic concretion we are now contem-
plating, and which, from its tendency to form larger masses is usual-
ly denominated gravel, is of far greater importance than the pre-
ceding, from the actual pain that is suffered in most cases, and the
danger there always exists of the conversion of such nodules into
calculi of the bladder.

Of the eleven classes of urinary calculi enumerated by Dr.\ Mar-
cet, there are rarely more than three that are found paaaing through
the natural passages of the kidneys, though others are traced occa-
sionally as imbedded in the pelvis or substance of the kidneys.
These three are the uric, oxalic, and cystic : and of these the two
last are very rare productions in comparison with the first. ^^ Out
of fifly-eight cases of kidney calculi,'^ says Mr. Brande, ^^ fifty-one
were uric, six oxalic, and one cystic.'^ The phosphates seem never
to concrete so as to form calculi in the kidneys, for which it seems
difiicult to assign a reason.

The uric cakuli as voided immediately from the kidneys, are of
a yellowish or reddish-brown colour, somewhat hard, and soluble in
caustic potash. They exhale the smell of burnt horn before the
blow-pipe, and, when heated with nitric acid, produce the peculiar
red compound which Dr. Prout has called rosacic acid. The oxalic
calculi vary considerably in appearance. They are generally of a
grayish-brown colour, and made up of numerous small cohering
spherules, and have sometimes a polished surface and resemble
, hempseeds. They are easily recognised by their insolubility in di-
lute muriatic acid : and by swelling up under the blow-pipe, and
burning into a white ash consisting of pure lime. The cystic cal-
culi have a yellowish colour, and a crystallized appearance ; they
are soluble in dilute muriatic acid, and in diluted solution of potash.
Dr. Wollaston has remarked that when heated in the flame of a spi-
rit-lamp, or by the blow-pipe, they exhale a peculiar fetid smell
by which they may readily be characterized.!

The usual symptoms by which this variety is marked are those
of pressure and irritation : as a fixed pain in the region of the afiect-
ed kidney, with a numbness of the thigh on the same side, the pain
alternating with a sense of weight. The pain is sometimes very
acute and accompanied with nausea and deliquium, proving that
the calculus has entered the ureter, and is working its way down
into the bladder, ader which the pain ceases till it reaches the ure-
thra, or, by remaining in the bladder, it becomes encrusted with
other materials, and forms a vesicular calculus. Durii^ the whole
of the passage firom the kidneys the urine is usually high-coloured,
and deposits a reddish or reddish-brown sedlmeat, occasionally not

* Mat. Med. Part. ii.Chap. i. p. 13.
t Braivle. Joirnnl. ^-r-. Vol. vtn. P.(?r.

afi. IV.-SP. I.] EXCERNENT FUNCTION. 34:3

UDlike the gfroonds ofcofiee, aad evidently giving proof of the lace^,
ration of blood-vesseld by the angnlar points of the calculus., It is ai
Tery singular fact, and has been properly notiqed by Dr. Heberden^
that during the most violent pain at any time endured from this
cause there is rarely an acceleration of the pulse : in the same man-
ner as the torture sustained by the passage of a gall-stone through
the gall-ducts produces as little effect upon it. If, however, th^
flow of the urine be obstructed by the calculus, as sometimes hap-
pens, the ordinary constitutional symptoms take place which cha-
racterize that affection, as a general sense of uneasiness, heat,
thirst, a quickened pulse, and other pyrectic concomitants : sick-
ness at the stomach, costiveness, sleepless nights, and at length
coma, intermitting pulse, convulsions, and death : and all this
even where the pain or weight in the loin^ is not pecuiiariy dis-
tressing.

We have often had occasion to observe that where a morbid
change takes place in an organ very gradually it may proceed to
almost any extent without any acute suffering on the part of the pa-
tient, and sometimes without any suffering whatever. The same
fact not unfrequently occurs in the disease before us, of wliich a re-
markable instance is related by Dr. Marcet, in a patient who died
of fi dropsy in the chest, without having made any complaint of the
state of his urinary organs, though one of his kidneys was foi^nd, on
dissection, to be distended b^ a large collection of calculi.

The proximate cause of the formation of uric calculi we have
already shown to be an excess of uric acid ; that of the oxalic and
cystic is not quite so obvious, — a point however, of less importance
from the infrequency of their occurrence. The predisposing and
occasional causes of all of them are too often involved in obscurity.
In many persons there is an hereditary tendency to this complaint ;
general indolence or a sedentary life becomes a predisponent in
others ; too lai^e an indulgence in fermented liquors, and the luxu-
ries of the table generally, forms a predisponent in a third class ;
but the chief cause of this kind we are acquainted with is a want of
constitutional vigour, and especially in the digestive organs ; and
hence the periods of life in which this disease occurs most frequent-
ly are from infancy to the age of puberty, and in declining years :
while it is rarely found during the busy and restless term of mature
Tirility.

The process of treatment must, for the most part, be derived
from these causes. As a preventive of that modification of calculus
which is by far the most frequent, we have already advised the use
of alkalies and alkaline carbonates. Where the digestive org^ans
are weak the diet should be light but generous ; warm and bitter
tonics will always be found serviceable ; the bowels should never be
suffered to become costive, and should occasionally be stimulated
by brisk purgatives, which tend equally to remove acidities from
the stomach, and to stimulate the kidneys to a more healthy action.

VOL. IV. 44 "

346 ECCRITICA. [CL. YL-oa. 11.

Indoleoce and a tcdatire life most give way to exercise^ and espe-
cially equitation, which is by far the best kind of exercise for the
present purpose, and whatever will tend to promote an increased
determination towards the surface, and a frequent §^ow on the skin
will proTe a valuable auxiliary : for the skin itself becomes, in this
affection, though rarely in paruria tntllitaj an outlet for the dis-
charge of a redundancy of acid, as may be observed by the simple
experiment of tyeing a pi^e of paper stained with litmus about the
neck ; which even in a state of common health, will oflen be chain-
ed to a red colour by the acid thrown off in the ordinary coarse of
perspiration.

Of the mischievous effects of a luxurious diet, and the advantage
of abstinence M. Magendie has given a very striking example in
the case of a merchant of one of the Hanseatic towns who was
habitually afflicted with the complaint before us. ^^ In the year
1814 this gentleman," he tells us, ^^ was possessed of a considerable
fortune, lived in an appropriate style^ and kept a very good table, of
which he himself made no very sparing use. He was at this time
troubled with the gravel. Some political measure unexpectedly
took place which caused him the loss of his whole fortune, and
obliged him to take refuge in England, where he passed nearly a
year in a state bordering upon extreme distress, which obliged Mm
to submit to numberless privations ; but his gravel disappeared. By
degrees he succeeded in re-establishing his affisiirs ; he resuned h^
old habits, and the gravel very shortly began to return. A second
reverse occasioned him once more the loss of all he had acquired.
He went to France almost without the means of subsistence, when
his diet being in proportion to his exhausted resources, the gravel
again a second time vanished. Again his industry restored him to
comfortable circumstances ; again he indulged in the pleasures of
the table, and had to pay the tax of his old complaint."*

It may at first sight appear a singular fact, but the remarks jost
offered will tend to explain it, that mariners are rarely subject to
stone or gravel. Mr. Hutchison has published a valuable article
upon this subiect in one of the volumes of the Medico-Chirurgical
Transactions^ from which it appears that out of ninety-six thousand
six hundred and ninety-seven patients admitted in the course of
sixteen years into the three grand coast hospitals of Plymouth,
Haslar, and Deal, not more than eight had laboured under either
species of lithia. Whence it appears that the occupation, diet,
.ictivity and regimen of a maritime life are the best preservatives
against all such affections : such as an animal aliment largely combined
with the alkaline stimulus of muriate of soda ; a farinaceous, for the
most bart, instead of any other vegetable diet ; great exercise, and
that free exhalation from the skin at night which is so well known

* Kccherclies Physiologiques ct Medirales sur Ics Causes, les Symptomet et la
Traitment de la Gravellc. 8vo. Paiis, 1818.
t Trans, of the Medico-Chirurg. Soc, Vol. ix.

fSUIV.-BF. l] EXCERmENT rUKCTION. - 347

U> take place amoog sailors in the royal oavy, ]h consequence of
tbeir beinj^ con^elled to sleep closely together. And, as the disease
ai^fiettrs to be equally nocosunon in tropical climates, we have here
an easy explanation of the cause of its infrequency. In our own
country it appears from the tables of the Norwich hospital to be
more frequent in Norfolk than in any other county of the sumo
. population.

It only remains to be observed that during the paroxysm of pain
produced by the passage of a calculus through the ureter, our chief
object should be to allay the irritation and mitigate ihe distress,
^he warm-bath is here a very valuable remedy, friction on the ^
loins with rubefacient irritants combined with narcotics often afford
relief: but the present author has found most benefit from a flannel-
swathe wrung out in hot water and folded about the loins ; being
suffered to reniain there for hours, wrapped round, to confine the
moisture, with an- outer swathe of calico or linen. If these do not
answer, opium, and in free does, nuist be had recourse to.

SPECIES IL
LITHIA VESICALIS.
Atone in tin m&vntv.

rREqUElfT DESIRE OF MAKUfO WATER, WITH A DIFFICULTY OF DISCHARGE ;
PENIS RIGID, WrTH ACUTE PAIIf AT THE CLANS : SONOROUS RESISTANCE TO
THE SOUND WHEN SEARCHING THE BLADDER.

The substances, vulgarly called stones in the bladder, are, for the
most part, of a very composite structure. They originate from a
nucleus which may consist of any morbid or foreign material that
can accidentally obtain an entrance and a lodgment in the bladder;
the body of the calculus being formed out of such constituent parts
ef the urine as are most easily detached and attracted : which gra-
dually encrust around it, and concrete into a mass for the most part
far too large to pass through the urethra.

The most common of these nuclei is a kidney-calculus itself, and
consequently a crystallized spherule or nodule of uric acid ; and,
where the acid is habitually in excess, the coating of the vesicular
calculus may consist of this alone or chiefly : but, from the great
variety of materials, as earths, alkalies, and other acids besides uric,
and sometimes blood and mucus, which enter into the composition
of the urine at this time, it is not often that a calculus of the bladder
is a crystallization of uric acid alone.

In the introductory remarks upon the present genos we observed
that the different kinds of cakuU discovered in the human bladder

348 fiCCRlTtCA. [C^ TI.-OR. B.

had been trefttetl of by Dr. WoUaston, as iar as they were then
known, in a verj masterly essay opon this subject, pablished in the
Philosophical Transactions for the year 1797 : he has suice ennmera-
ted them as follows .

1. Uric acid calculus.

2. Fusible, triple, or ammonio-magnesian phosphate.

3. Bone-earth calculus, or phosphate of lime.

4. Mulberry calculus, or oxalate of lime.

5. Cystic oxyde.

The cystic oxyde is not contained in the article above referred to,
as hot haying been discovered at the time : but it has since been
detected by the same excellent chemist, and named as above.

We have also observed that various other calculus masses have
still more lately been ascertained by the analyses of other experi-
menters, and that the whole number, as arranged by Dr. Marcet,
amounts, in the present day, to eleven or twelve. Their names
we have already given, nor is it worth while, in a work devoted to
practical medicine, to notice them any further, as they are rarely
to be met with in comparison with the five arranged above, and
-when met with will not call for any essential difference in the mode
of treatment

in effect, they have been found equally different in composition,
form, size and colour ; from the weight of half a drachm to that of
several pounds ; purple, jasper-hued, red, brown, crystalline, cine-
ritious, versicoloured : in one or two instances covered with down,*
apparently produced from the surface of the bladder, from which,
as we have already had to observe, hairs are occasionally dis-
charged with the urine.t They have also been found solid, perfo-
rated, hollow, compact, crumbling, glabrous, rough, and spinous,!
and, in a few instances, combined with iron.§ ^

They seem sometimes to form very rapidly; and, where the
patient has already discharged one or two, and the urethra has in
consequence become more than ordinarily dilated, they occasionally
pass off in great numbers in a short space of time. We have hence,
in different professional journals and transactions, accounts of a
hundred and twenty voided in the course of three days;|| two
thousand in the course of two years ;ir and three hundred of a pretty
large size within the same term.** The largest discharged in this
manner, which has ever occurred to me in reading, weighed five

* Blegily, Zodiac. Ann. iv. Febr. Obs. 4.
t Gen. 111. Spec. ▼. part, in cont.
X Bartholin. Act. Hafn. Tom. ii.Obs. 85.
f Act. Erudlt. Leips. 1627. p. 332.

Dotnus, Ep. ad Waldfchroidt. p. 253.
II Eph. Nat. Cur. Dec. ni. Ann. v. yi# p. 99.
T Gnindlicher Bericbt, von Blatteratein.
^* Hildan. Fabric. Cent. i. Obs. 89.

«£• iy.-*flr. U«] EXCERNEtiT FUNCTION. 349

ounces. Dr. Hmkam describes one instance of soch a fact ;* and
another is giyen in a distingaislied foreign miscellany .f Bj females
tbej haye often been discharged of the weight of two omices and a
half; and my excellent friend Dr. Yellowly mentions a calcalus of
Deariy three ounces and a half ;| in one case we are toU) of a stone
thus evacuated that weighed twelve ounces.§

The general character of the uric calculus has been given already.
Its texture when formed in the bladder is commonly laminated;
and, when cut into halves, a distinct nucleus of uric acid is almost
always perceptible. Its exterior is generally smoother than that of
other calculi, except the calculus of bone-earth, or phosphate of
lime.jl

The appearance of the second or fusible calculus is generally
white, and often resembles chalk in its texture. Strongly heated
before the blow-pipe this substance evolves ammonia, and readily
fuses ; whence the name assigned to it. It oAen breaks into layers,
and exhibits a glittering appearance when broken.

The third division, consisting of the bonc-earth calculus, or
phosphate of lime unmixed with any other substance, has a pale
brown, smooth surface ; and when sawn through is found of a
laminated texture, and easily separates into concentric crusts.
This calcalus is peculiarly difficnlt* of fusion.

The fourth division embracing the mulberry calculus, or oxalate
of lime, is of a rough and tuberculated exterior, and of a deep red-
dish-brown or mulberry colour, probably produced by a mixture of
blood that has escaped from some lacerated vessel, whence the name
assigned to it The nucleus is generally oxalic, and of renal origin ;
but it is sometimes uric. It is also frequently enveloped by the
fusible calculus.

The fiAh, or cystic calculus has a crystalline appearance but of
a peculiar greasy lustre, and is somewhat tough when cut Its
colour is a pale fawn bordering upon straw-yellow. It is very
rarely to be met with.

Such are the calculi which are principally found in the bladder ;
and we may readily conceive with what facility they are formed
there, when an accidental tendency is given to their formation by a
lodgement of any thing that may serve as a nucleus, by noticing the
deposites of phosphates of lime and other materials that are perpe-
tually encrusting every substance over which a current of urine Is
frequently passing ; as the public drains in our streets, wliich are
daily exhibiting them in regular crystals.

The ordinarv causes of renal calculi are necessarily those of
vesical calculi, but any local injury or infirmity, which prevents the

• Huxh. Vol. in. p. 42.

t Sammlung. Med. Wahrnemung. Band. viii. p. 258.
% Trans, of the Medico-Cbir. Soc. Vol. vi.

* Eph. Nnt. Cur. Dec. ii. Ann. t. Obs. 71.
fl Brande^s Jovrna!, Vol. viu. p. 207.

350 • ECCRITICA. [OL. VI.-OR. W.

urine from pawing off freely from the bladder, accelerates their
formation and enlargement, not only by the confinement it causes
but by the decomposition which rest soon produces, in which case
It becomes amrooniacal, and a larger portion of the phosphates will
be precipitated. And hence, an obstruction in the urethra of any
kind, but particularly a diseased prostate becomes a frequent auxi-
liary, and sometimes even a primary cause of the formation of a
fltone without any mischief in the kidneys, or any disordered secre-
tion of urine.* " The bladder," says Sir Everard Home, ." never
being completely emptied, the dregs of the urine, if I may be
allowed the expression, being never evacuated, a calculus formed
on a nucleus of the ammoniaco-magnesian phosphate and mucus is
produced, when it would not have been produced under other cir-
cumstances. This species of stone, or a stone upon such a nucleus,
can only be produced where the bladder is unable to empty itself.
It may therefore be arranged among the consequences of the enlarge-
ment of the middle lobe of the prostate gland."t

It does not appear from the experiments or observations of Dr.
^ Marcet, that a difference in the waters of different places is much,
if at all, concerned in the production of calculous disorders : nor
have we any satisfactory evidence of their being more prevalent in
cider than in other countries, niotwithstanding the general opinion
that they are so. But we are yet in want of sufficient data upon
this subject to speak with much decision.

As the disease of stone in the bladder is very generally a sequel
of calculi in the kidneys, the symptoms indicative of the preceding
species form, in most instances, the first symptoms of the present.
Yet occasionally, from causes we have just pointed out, the concre-
tion commences in the bladder, and the symptoms of an affected
kidney are not experienced. One of the first signs of a stone in the
bladder is an uneasy sensation at the point of the urethra occurring
In conjunction with a discharge of urine that deposites red or wliite
sand, or after having occasionally voided small calculi or fragments
of a larger. This pain is sympathetic, and proceeds from the
irritation of the prostate or the neck of the bladder, agreeably to a
law of nature we have oAen found it necessary to recur to, which
ordains that the extremities of nerves which enter into the fabric of
an org^n, and particularly of mucous canals, should possess a keener
reciprocity of feeling than any intermediate part, and consequently
participate with more acuteness in aby diseased action. This un-
easy, sensation at the point of the urethra, Is at first only perceived
on using any violent or jolting exercise ; or in a frequent desire to
make water, which is oAen voided by drops or in small quantities,
or, if in a stream, the current stops suddenly while the patient is
still conscious that the bladder is not fully emptied, and has still an
inclination to evacuate more, but without a power of doing so.

• Brande*8 Journal, &c. Vol, vxii. p. 210.

t On the Diseases oftbe Prostate Gland, Vol. i. p. 40,

GE. IV.-SI*. II.] EXCERNENT FUKCnON. ^ 351

As the Stone increases in size there is also a doll pain about the neck
of the bladder, the rectum partakes of the irritation, and produces a
troublesome tenesmus, or frequent desire to go to stool. Where the
pain is triding the urine is often limpid, as the saline or earthy
materials from their confinement in the bladder arrange themselves
around the growing calculus, and enlarge it by a new coating ; but
where the irritation is considerable, there is often a mucous sedi-
ment in the water, and sometimes a discolouration from blood.
The region of uneasiness extends its boundary, the stomach partici-
pates in the disquiet, sleepless nights ensue, with pyrexy, anxiety,
and dejection of spirits : all which symptoms are increased by exer-
cise of every kind and particularly by equitation. Several of these
signs may indicate a primary disease of the prostate or neck of the
bladder, but the occasional discharge of calculous fragments or
deposite of urine loaded with uric acid or phosphate of lime, are
sufficiently pathognomic. It is usual, however, in all such cases, to
examine the bladder by a sound, which commonly puts the question
beyond all dispute : though if the calculus be lodged in a peculiar
sac or the fasciculi of the bladder, or lurk behind some morbid
enlargement of the prostate gland, the sound may not detect it, and
the experimenter may deceive himself and the patient in respect
to the nature of the disease.

The treatment of this disease offers two indications, a palliative
and a radical.

The palliative may be applied to relieve the actual symptoms,
and to prevent a further enlargement of the calculus.

The symptoms vary greatly in diflbrent cases: partly, indeed,
from the size of the calculus itself, but quite as much from the con-
stitutional irritability of the bladder and the particular quarter of
it in which it is seated. In a few persons, the bladder has possessed
so little morbid excitemetit that stones of considerable magnitude
have been found in this organ after death without having produced-
any very serious inconvenience during life. If the calculu:^ be im-
mediately seated on the neck of the bladder it is, however, almost
impossible for the most impassive not to suffer severely at times.
But the stone has sometimes found a fortunate lodgement between
the muscular fascicles of the bladder, wh^re it has become imbedded
as in a pouch, and a train of morbid symptoms, which have antece-
dently shown themselves, have gradually disappeared in proportion
as this change has been affected.

Mr. Nourse showed to the Royal Society the bladder of a man in
which not less than six sacs or bags were in this manner produced
by a protrusion of the internal coal of the bladder through the mus-
cular, and which contained altogether nine stones.* The stones
are sometimes fixed so firmly that it is impossible to separate them
by the forceps in performing the operation of lithotomy, witliout
tearing the bladder or cutting one side of the sac; which last rae-

♦ Mem. 4(52. Seel. 3.

L

'352 ^ ECCRITICA. [dL. VI.-OR. lU

thod M. Garangeot iDfomis us he once tried with success. lo seve-
ral other cases, however, that he has described, the vessels of the
bladder had spread luxuriantly over the stone, and apparently gro^n
into it ; and the extraction was followed by a mortal hemorrhage.*
GenerdUy speaking, calculi, when seated in pouches of this Idnd,
continue without much disturbance for years, and sometimes for the
whole of a man^s natural life, of which Dr. Marcet has given various
striking examples in his treatise.

Art cannot scoop out such convenient receptacles, bat it may do
something to allay the irritability of the bladder when severely ex-
cited, and in this manner palliate the distressing pain that is often
endured. This may frequently be accomplished by the warm-baUi ;
by rubefacients impregnated with opium applied to the region of
th6 pubes, and in the course of the perinasum; by cooling aperients
and a steady use of sedatives, and particularly of conium. If these
do not answer we must have recourse to opium, which will oftea
succeed best, and with least inconvenience to the constitution if in-
troduced into the anus in the form of a suppository.

Our * next intention should be to prevent, as far as possible, aQ
augmentation of the calculus already existing in the bladder.

In order to accomplish this, it will be necessary tp inform our-
selves of its chemical constituents, for otherwise any method we
may propose will probably do harm. From the remarks already
made, it is obvious that the chief constituent principles of the cal-
culi in the bladder, like those in the kidneys, are uric acid and
bone-earth, or phosphate of lime. If the former predominate the
urine will oAen throw down a precipitate or incrustation of red sand,
if the latter, of white sand : and in the former case, as there Is an
excess of uric acid, pur remedial forces must be derived from the
alkalies and alkaline preparations to which we have already advert-
ed under the preceding species : in the latter case, as there is, in
all probability, a deficiency of acid, we must have recourse to an
opposite mode of treatment, and employ the mineral and vegetable
acids, with a diet chiefly composed of vegetables as recommended
above under renal calculus.

But the calculus may consist c^f both, for it may exhibit, and oAen
does, a nucleus of crystallized uric acid with laminae of phosphate
of lime, magnesia, or some other substance : or, by carrying either
of the above processes to an extreme, we may convert one morbid
action into another. For if, by the use of alkalies, we diminish too
nmch tliu secrelJon of uric acirl, v;e may U*[ Imi^e the calcareous
i'unh, which, ia a healthy profiorliun, it always liolik in solution,
und hereby iticrease the vesicitl c:iiciihis by 9up[i lying il wilh tills
njHiedai; Vhilc, on the contrary, Uy an tindua use of acid* where
these are required to a cerLain extent, we may obtain n secretion
of uric acid in a morbid excc.^, iind augment the jslorte in the bbd-
^r by a crystalli^mtlaa of an oppoiile kind. Hence a very coosl-

* r^lem. dc TAcn^. dc Cijlfwr^ Ton;,

€e. iV.-6P. II.] EXCERNENT FUNCTION. * 353

derable degree of ^11 aod caation is reqisdsite in the mode of treat-
meat, mdtlie character o# the urroe^ioi^d be watched perpetaally.
Nor, where the caknliis is of a stili more composite kind, can
eidier of dieae ptas he attended with all the sacces thej seem to
eiHore, so that the aiq^mentmtioD will sometimes be foimd to pro-
ceed Id spite of the b^t directed efforts.

.From the success that has attended tiie nse of the colchicum
auimimuk in isanj cases of foot, and the tendency there is in many «
caeet of tliis ^sease to A>rm calcali in the joints, Mn Brande has
ingvnionsly thrown out tlie idea of trying^ the w'nixte of the colchi-
cum in ti» disease before us^ and hints that he has received from
one quarter a very littering account of its success, though not sufi&-
cieotly precise for publication. If the reasoning pursued in examin-
ing the powers and effects of the coiclucum in that part of the
present itork which is allotted to tl>e history of gout be correct,
we can have little li^>e of any permanent advantage from its use
in respect to the litfaic concretions before us. It has there appear-
ed that the colchicum does not act as a preventive, but as an anti-
dote, during the peevaleoce of a paroxysm. Nor does it act in
this last way in all paioxysms, bat chiefly, if not solely, in those
of tlie regular form of gout, in which the general state of the con-
stitution is sound and tigoroofe, while in atonic gout, it seems from '
the vioience of its effects, not unfrequently to add to the evil.
Tet it is in tliis last modification of gout that calcnii are only found
to concrete in the joints : the deposite rarely, if ever, taking place,
till the constitution has been seriously shaken by a series of at-
tacks, eiddencing, as in the case of similar depositea in the coats of
the vessels and the parend^yma of various organs in old people, a
general torpilude and debility of the excement system. Upon
wMch subject the reader may turn to tiie genus osthexia* in a pre-
ceding Order of the present Class. ,

Tliere is something perhaps more plausible io the remedial regi-
tben proposed by M. Magendie, who, on reflecting that azote is an
essential constituent of urea and uric acid, advises that the patient
he confined to food that possesses no sensible portion of azote, as
sugar, gum, oil-olive, butter, and a vegetable diet generally :t thus
treating it with a dietetic course direcUy the reverse of whut is now
generally proposed for paruria, welliia, or-.diabetes.

From the whole that has been advanced not only under ti>e pre-
sent genus, but also under much of the preceding, it is obvious that
the soundness of the uiine keeps pace, in a considerable degree,
with the soundness of the stomach and its auxiliary organs, and is
dependent upon them : aod hence in calculous concretions of every
kind.it is of the utmost importance that the chyiify^cmtit viscera,
and the whole course of the intestinal canal, should be kept in as
healthy a state as possible.

• Supra, p. 233,

t Rechercbes Physiologiques et Medicates, &c. ut tupra.-
VQL. IV. 45

354 * ECCRITICA. [CL. VI^-OR. U.

Astringents and bitters offer to us the best remedies for this p«r-
pose. From the supposed absorbent power of the former, Dr.
Calien, as we haye already seen, ascribes to them much of the pe-
culiar benefit resulting from the use of alkalies and magoesiA, in*
dependent Ij of their decided virtue as a tonic: nor ought we, while
upon this subject, to overlook the adraniage which, in calculi of ude
acid at least, the same distinguished writer asserts that he derived
,from the use of soap, which lie ascribes entirely to its correcting
acidity in the stomach ;* thus acting the same part as magnesia,
and in many cases with greater potency.

If snch be the difficulty of preventing a calculus already formed
in the bladder from enlai^ng, we may readily see how lu>peie6S
must be every attempt at dissolving the matter that has already be*
come crystallized or concreted. Calculi of uric acid will dissolve
in caustic alkalies, but in no alkalies of less power : nor can those
of tbe phosphates be acted upon by acids of any kind, except in a
state far too concentrated for medical use. ^^ These considera-
tions,^^ says Mr Brande, '^ independently of more urgent reasons,
show the futility of attempting the solotion of a stone of the bladder
by the injection of acid and alkaline solutions, in respect to the
alkalies, if sufficiently strong to act upon the uric crust of the cal-
culus, they would certainly injure the coats of the bladder : they
would also become inactive by combination with the acids of the
urine, and they would form a dangerous precipitate from the sane
cause. The acids, even when very largely diluted, and cjualified
with opium, always etcite great irritation. They cannot, ther^
fore, be applied strong enough to dissolve any appretiabie portion
of the stone, and the uric nucleus always remains as an ultimale
obstacle to success.'^t The greatest impediment of all, however,
consists in the difficulty of ascertaining the nature of the surface of
the stone that is to be acted upon, and the diversity of substances
of which its various laminaB very frequently consist : insomuch that
had we glasses that could give us an insight into the bladder and
unfold to us the nature of the first layer, and could we even re-
move this superficial crust by a solvent of one kind, we should be
perpetually meeting with other crusts that would require other li-
thontriptics ; while the very means we employ to dissolve them,
by decomposing the principles of the urine, would build up fresh
layers faster than we could hope to destroy those that have already
concreted.

in truth if we examine the most famous iithontriptics that have
had their day, we shall find that by far the greater number of them
were calculated to deceive either their own inventors, or the pub-
lic, by a palliative rather than a solvent power. Some of tbem
were oleaginous or mucilaginous ; others, that contained a consi-
derable portion of alkali, contained also some narcotic preparation:

* Mai. Med. Part ii. Chap. x. p. 402.
t Journal, Vol. vxii. p. 216.

GE. IT.-^STP* H.J EXCERNEMT JUNCTION. 355

while a third 9ort seem to have acted by a diloent power alone, ia
eoDse^ueiica of beiog taken into the stomach or injected into the
bladder in a ?ery large quantitj ; and by these means all had a
tendency to appease the irritation. Even Mrs. Stephens^s rude and
operose preparations which exercised so much of the analytical
skill of Dr. Hales, and Dr. Hartley, and Dr. Lobb, and' Dr. Jurin,
and many other celebrated characters of their day, were combined
with opinm when the patient was in pain, and with aperients when
be was costiTe ; and through their entire use, with an abstinence
from port wines and other fermented liquors, salt meats, and heat-
log condiments, and with rest and a recUned position instead of ex-
ercise ; and with these auxiliaries there is no great difficulty in
Mqipoaing she might oilen succeed in allaying a painful fit of stone
or irritation of the bladder, whatevejr may be the talismanic virtue
of her egg^shelk, and pounded snails, and best Alicant soap, and
cresses, and burdock, and parsley, and fennel, and hips, and haws,
and the twenty or thirty other materials that held a seat in the ge-
neral council.*

How far filling the bladder with sedative or demulcent injections
may succeed in diminishing irritation and alleviating pain, has not
perhaps been sufficiently tried : but from the supposed success of
many of the old Uthontriptics employed in this way, and whose vir-
tue can be ascribed to no other cause, it is a practice worth adven-
torii^ upon in the present age of physiological experiments. When,
however, there is much disease of the prostate or bulb of the
urethra, the attempt should be desisted from, but wherever the
flound can enter without much pain, we need not be afraid of in-
creasing the irritation* This operation is of very ancient date, and
of equally extensive range, as appears from a brief account, pub-
lished in a professional journal of considerable merit, of the manner
in which it is performed in the present era, and has been from time
Immemorial in the dominions of Muscat, beyond the mountains <^
Sohair in Arabia. The instrument employed is a catheter of gold
made long enough to pass directly into the bladder, so as to avoid
injuring any part of the urethra with such solvent as might be had
recourse to. The usual form it appears, and I notice it for the
purpose of confirming the remark I have made upon the nature of
such Uthontriptics as have been most in vogue in every age, con-
sisted of a weak ley of alkali or alkaline ashes, united with a cer-
tain proportion of mutton suet and opium.t And when we are
lively told that this preparation never fails to dissohe the stone,
we are at no loss to settle the account upon this subject, and can
trace the real cause of whatever degree of ease may have been
derived from such an injection, and can allow that eten the alkali
itself, if not in too concentrated a state, may have been of occa-
sional advantage.

• See a full account of them iu Edin. Med. Essnys, Vol. v. Part ii. Ait. lxix.
t Edin. Med. Comm. Vol. ill. p. 334.

356 EeCRITICA. \cu T1*-0IU IJf

WheD, howerer, all these means of relief fail, and the general
health is worn out bj a long saccession of pain and anxiety, no-
thing remains but the operation of extraction. The shortness and
expansibility of the urethra in women which allows, as we hare
already seen, a passage for calcnli of a considerable calibre to pass
naturally, has suggested an idea of the possibility of introducii^ a
stone forceps into the female bladder so as to supply the place of
lithotomy. The first hint of this kind that has occurred to me, is
to be found in the Gallicinium Medico-practicnm of Gockel, publish*
ed at Ulm in 1700. It was afterwards taken up, perhaps ong^nally
started, by Mr. Bromfield, wiio ingeniously advised that the urethra
should, for this purpose, be dilated by forcing water through the
gut of a fowl introduced into the urethra as an expansile cannku
Mr. Thomas has since, by the use of a sponge-tent gradually en-
larged for the purpose, succeeded in introducing his finger into the
bladder, and bringing away an ivory ear-pick which had been in-
cautiously used as a catheter, and had slipped into the cavity of this
organ.*

This, however, is a method that can never be applied to males,
nor even successfully to females, except where the calculus is com-
paratively of small dimensions, or the meatus is so far dilated by
the passage of former calculi as to render it unnecessary. In all
other cases lithotomy offers the only means of removing the indis-
soluble stone from the bladder ; and for the various modes in which
this IS performed, the reader must consult the writers on practical
surgery.

Calculi thus extracted have been found of all weights and bulks.
A stone from a quarter of a pound to half a pound may, perhaps, be
regarded as the ordinary average : but they have sometimes grown
to a much larger size, and have still been safely extracted. The
largest for which lithotomy seems at any time to have been per-
formed in this country, weighed forty-four ounces, and was sixteen
inches in length. The operation was performed by Mr. Cline, but
the stone could not be brought away, and the patient died a few
days after.t In a foreign journal of high reputation, we hare an
account of a calculus found in the bladder after death, that weighed
ibur pound and a half or seventy-two ounces, and seems to have
filled nearly the whole of its cavity .|

1 -T

• Traasactions of the Medico-Chir. Soc. Vol. i, p. 124/*'

t Phil. Trans, year 1«09.

% BretH, Samnilung. Band, ii* 1724. 434. 11.

CLASS VI.
ECCRITICA.

ORDER III.

A OROTIC A.

BtsraBTS affmfng the S^rrnal S^ntfaer.

JP&AVmr OF THE FLUIDS OR CMUNCT0RIE8 THAT OPEIT ON THE EXTER-
NAL surface; WITHOUT FEVER, OR OTHER INTERNAL AFFECTION, AS
A. NECESSARY ACCOMFANUIENT.

AcROTiGA is a Greek term, from m^, '^ sammus,^^ whence mk^mik-
«f«(, ^^ sammitas,^^ ^ cacumeo.^' The excretories of the skin form a
most important outlet of the system, and although the fluid they se-
crete is, in a state of health, less complicated than that of the kid-
neys, under a variety of circumstances it becomes more so. It is
to this quarter that all the deleterious or poisonous ferments pro-
duced by eruptive fevers are directed by the remedial power of
nature, as that in which they can be thrown off with least evil to
the constitution. By the close sympathy which the surface of the
ik>dy holds with the stomach, the heart, the lungs, and the kidneys,
its excretories are almost perpetually varying in their acti<m, and
still more so from their direct exposure to the changeable state of
the atmosphere : in consequence of which they are one moment
chilled, torpid, and collapsed, and perhaps the next violently excit-
ed and irritated : now dry and contracted, now relaxed and stream-
ing with moisture ; now secreting their natural fluid alone, and now
charged with acrimonies of every kind, acid, alkaline, and saburral :
and sometimes with a load of gluten or calcareous earth that har-
dens into horn or shell.

But the mouths of the cutaneous exhalants are in their own na-
ture peculiarly delicate and tender; and hence the necessity of their
heiug covered by the epithelium of a fine cuticle, which defends
them in a considerable degree from the rudeness of external im-

358 ECCRITICA. {CU YL-OR. III.

pressioDS or irritaDts with which the air is impregrnated. This de-
fence, however, thej freqaeDtty lose ; often from eiteraal violence,
and often also from the acrimony or roi^hoess of the materials that
are thus transmitted to them, and which excoriate as effectually as
firiction, a keen frosty north-east wind, or the direct rays of a tropi-
cal snn. And at times the absorbents of the skin are torpid or weak
in their action*; and the finer parts only of the fluids that are se-
cerned are imbibed and carried off^ while the grosser parts remain
and accumulate in the cutaneous follicles, and become acrimonious
from decomposition. And hence a great variety of superficial erup-
tions, papulous, pustulous, and ichorous, sqnammose, or furftira-
ceous. And not unfrequently there is a constitutional irritability of
the skin which not only renders it peculiarly liable to be excited
by small causes in every part, but to sympathize in the morbid ac-
tion through its whole extent in whatever part it may commence :
and hence the spread of eruptions to a greater or less extent, some-
times, indeed, over the entire surface.

From these sources of affection a variety of complaints must ne-
cessarily take their rise, none of them perhaps fatal to life, but ma-
ny of them peculiarly troublesome and obstinate. They may be
arranged under the following genera :

I. EFBIDROSIS. MORBID SWEAT.

II. EXANTHESIS. CUTANEOUS BLUSH.

III. EXORMIA. FAPULOUS-SKIN.

IV. LEFI008IS. SCALE-SKIN.
V. ECFHLTSIS. BLAINS.

VI. ECPYESn. SCALL. TETTER.

VII. MAUS. CUTANEOUS TERMINATION.

VIII. ECPHTMA. CUTANEOUS EXCRESCENCE.

IX. TRICHOSIS. MORBID HAIR.

X. EFICHROSIS. MACULAR SKIN.

Most of these genera contain numerous species, many of which,
though by no means all, form a part of Dr. Willan's arrangement,
and have been described by himself or my late excellent friend Dr.
Bateman, of whose labours I shall a^ail myself as far as they may
answer the present purpose.

CE.I.] EXCERNENT FUNCTION. 359

GENUS I.

EPHIDROSIS.
iWorbfli Sbtoeat

PftETERHATUIUL SECRETIOir OF CUTANEOUS PERSPIRATION.

EpBiDRoas (tfii^tf) is a Greek term for ^' sador.'^ The matter of
sweat and that of insensible perspiration are nearly the same ; the
former con^ting of the latter with a small intermixture of animal
oil. It is afomed bj some writers that there are persons who
never perspire. This demands ample proof; for experience teaches
us that all warm-blooded animals either perspire by the skin, or
bare some vicarious evacuation that supplies its place, as in the
case of the dog kind, in wliich an increased discharge of saliva
seems to answer the purpose ; though in violent agony, I have
known a Newfoundland dog thrown into a sweat that has drenched
the whole of his thick and wavy hair. In cold-blooded animals We
sometimes find partial secretions, as in the lizards, the exudation
from some of which, particularly the lacerta Geitja of the Cape of
Good Hope, is highly acrid ; and as it touches the hands and feet of
men occasionally produces dangerous gangrenes. Generally speak-
ing, however, cold-blooded animals secrete but a small quantity of
fluid from the surface, and consequently suffer but little exhaustion
or diminution of weight, and can live long without nourishment :
and it is hence probable that, among mankind, those who throw off
but a small quantity of halitus may exist upon a very spare supply
of food ; which may afford a solution to many of the wonderful
stories of fasting persons, most of whom seem to have passed seden-
tary and inactive lives, recorded in the scientific journals of differ-
ent countries, a subject we have already discussed :* for the matter
of insensible perspiration is calculated, upon an average, as being
daily equal in weight to half the food introduced into the stomach
in the course of the day. Thus if a man of good health and middle
age, weighing about 146 pounds avoirdupois, eat and drink at the
rate of fiAy-six ounces in twenty -four hours, he will commonly be
found to lose about twenty-eight ounces within the same period by
insensible perspiration : sixteen ounces during the two thirds of this
period allotted to wakefulness, «nd twelve ounces during the re-
maining third allotted to sleep.

It sometimes happens that this evacuation is secreted in excess,
and becomes sensible, so as to render the whole, or various parts of
the body, and especially the palms of the hands covered with moi«-

♦ Vol. I. Class T. Ord. i, Llmosis expcrs, p. "C.

36ft ECCRITICA. [OU VI.-01L HI*

tUTe, without any mlsaffection of the system. It is to (his species
tlmt the term ephidrosis has beeD usually applied and limited bj
nosologists. Sauvages, however, has employed it in a wider signifi-
cation, so as to include various other species, and perhaps correct-
ly; tliough Culten inclines to regard all but the first as merely
symptomatic of some other complaint.

The following appear to be those wliich are cliiefly entitled to a
i^cific rank :

1. EPH1DEO018 PR0FU91. PROrVSE 8WC4T.-

9. ■ CftHENTA. BLOOnY SWEAT.

3. PARTIALIS. PARTIAL SWEAT.

4. DISCOLOR. COLOVRKD SWEAT.

6. > OLSNS. 8eniT£t> SWEAT.

5. ARER08A. SAirOT fWEAT.

SPECIES I.

EPHIDROSIS PROFUSA.

VroCttse ab^tuu

CUTAREOUS PERSPIRATION SECRETED PROFUSELY.

This is commonly a result of relaxed fibres : the mouths of the co-
taneoQS exhalants being too loose and patulous, and the perspirable
floid flowing forth copiously and rapidly upon yery slight exertions,
sometimes without any exertion at a41; as we have already seen the
urine flows in paruria aquosa and the serum in various species of
dropsy.

There is here, generally speaking, less solution of animal oil than
in perspiration produced by exercise or Imrd labour :* but from the
drain thot is perpetually taking place, no animal oil accumulates,
aad the frame is usually slender. Corpulent persons also perspire
much, bnt this is altogether from a different cause, being that of the
weight they have to carry, and the labour with which breathing
and every other function is performed in consequence of the gene-
ral apppossion of the system. Here also an extenuatioD of the
frame would soon follow, but that from the peculiar diathesis which
so readily predisposes to the formation of fat the supply is always
equal to, and for the most part continues to exceed the waste, unless
a more than ordinary course of exertion be engaged in.

In persons of relaxed fibres, but whose general health is sound, I
have frequently perceived that there is no particularly liability to

* Biicbner, Diss, de Sudoro tolliqeativo. Hal. 17S7.

Ofi. I.-SP. l] feXCl^Rl^NT FtJNCTION. 361

calch cold, notwithstanding this tendency to perspiration, and have
very often seen it suddenly checked without any evil : such is the
wonderful effect of an estahlished habit. But the moment the gene-
rat health suffers, or the system becomes seriously weakened by its
continuance^ the sweat is apt to become colliquative^ and to termi-
nate in a tabes or decline.*

Tulpius gives a case of its continuing for seven years.t Astrin-
gents of all kinds have been tried, but with variable effects. Dr.
Percival relied chiefly on bark; De Haen employed the white
agaric,! and in the Journal de Medicine,§ the same medicine is re-
commended under the name of fungus laricis^ it is the boletus ktridi
of the present day. It was given in the form of troches and pills.
Cold sea-bathing, and the mineral acids, with temperate exercise,
light animal food, and the use of a hair mattrass instead of a down
bed at night, have proved successful on many occasions, and form
the best plan we can adopt.

SPECIES H.

EPHIDROSIS CRUENTA.

CUTANIOVS PIRSPUUTION INTERMIXED MTITH BLOOD.

This species has not been very commonly described by nosologists ;
but the cases of idiopathic affection are so numerous and so clearly
marked by other writers that it ought not to be passed over.||

We have noticed a sympathetic and vicarious affection of tbiB kind
under the genus msmehstruation,! and have there observed that the
cutaneous ekhalants, in such instances, become enlarged in their
diameter, and suffer red blood or a fluid of the appearance of red
blood to pass through them* In cases of extreme debility from-
other causes, as in the last and fatal stage of atobic fevers, or in sea
or land scurvy** blood has been known to flow from the cutaneous
exhalants in like manner, evidently from weakness, and a relaxation
of their extremities, in connexion perhaps with a thinner or more

• See Vol. II. p* 474.

t Lib. III. Cap. 42.

t Rat. Med. P. xii. Cap. vi. ♦ 6.

I Tom. XLVii.

II Pioucq. IniU vii. 316.
t Vol, III. p. 45.

•• N. Act. Nat. Cur. Vol. iv. Obs. 41 .
Bresi. Samml. 1726. i. p. 183.
VOL. IV. 46

362 BcauTicA^ [cl. tl-or, in.

diflsoWed sUte of the blood itself. None of these, however^ are
idiopathic affections. When the discharge shows itself as a primik
rj disease, the cause has generallj been some violent commotion of
the nervoos system forcing the red particles into the cntaneoos ex-
cretories, rather tlian a simple influx from a relaxed state of their
fibres. And hence it has taken place occasionally during coition ;*
sometimes during vehement terror ; and not unfrequently during the
agony of hanging or the torture.t It is said also to have occurred
in some instances in new-bom infants^ probably from the additiea-
al force given to the circulation, in consequence of a full inflation
of the lungs accompanied with violent arying.

SPECIES III.

EPHIDROSIS PARTIALIS.

mfMUil Atarit

CUTANEOUS PERSPmATIOir UHrTED TO ▲ VJJCnCVJsAH FAKT OR 0R0A«.

There are some persons who rarely perspire, others who perspire
far more freely from one organ than another as the head, or the
feet, or the body. Such abnonpities rather predispose to morbid
affections, than are morbid affections themselves. Sauvages in il-
lustration of the present species, quotes a case from Hartmann, of a
woman who was never capable of being thrown into a sweat either
by nature or art in any part of her body except when she was preg^
nant, at which time she perspired on the left side alode.§ Schmidt
has noticed a like anomaiy.||

In this last case it is probable that the kidneys became a substi-
tute for the action of the cutaneous exhalants, as we see they do on
various occasions, as when their mouths be<Dome collapsed from the
chilly spasm that shoots over them on plunging into a cold bath, or
in a fit of hysterics.

The sweat thus discharged from a partial outlet, is frequently
fetid, as under the fifth species of the present genus ; and wliere it
is constitutional, it is oilen repelled with great danger to some more
important organ.

* Paulini, Cent. iii. Obs. 46.

£ph. Nat. Dec. ii. Ann. vi. Appx. pp. 4. 45. 55,
t Bartholious, Epist. I. p. 718.
X Epb. Nat. Cur. Dec. u. Ann. x. Obs. 65..
k Hartmanni, De Sudore unius lateris, 4to.. 1749'.
II Collect. Acad.. Vol. lu. p. 577.

«& I.-SP. IT.] EXCERNENT FUNCTION. 363

SPECIES IV. '
EPHIDROSIS DISCOLOR.

CUTANEOUS PERSPIRATION POSSESSING A DEPRAVED TINGE.

Sweat is often tinged with a deeper jellow than is natural to it from
a resorption of hlle into the hlood-yessels : and, as we have already
«een, it is sometimes intermixed with hlood from violence, or a re-
laxed state of the cutaneous exhalants. And where these, or causes
like these, co-operate, we can readily account for the various co-
lours it has sometimes exhibited as green, black, blue, saffron, or
ruby : examples of all which are referred to in the volume of No-
sology. We see, indeed, the whole of these hues produced daily
under the cuticle from the extravasation of blood, according as the
effused fluid is more or less impregnated with the colouring matter
of the blood, and the fiper and more limpid parts are first absorbed
and carried off. It is possible also that in some of the cases refer-
red to, the stain may have been produced by inhaling a vapour im-
pregnated with metallic corpuscles or some other pigment ; and
especially when working in metallui^ical trades or quicksilver
inkies.

SPECIES V.

EPHIDROSIS OLENS.

AcrntrH Afneat

CUTANEOUS PERSPIRATION POSSESSING A DEPRAVED SBfELL.

The varieties that have been chiefly noticed are those of a sulphu-
reous scent ; of a sour scent ; jof a rank or fetid scent ; of a violet,*
and of a muskv scent.t The rank or fetid scent is sometimes par-
tial ; being only evacuated from particular organs as the feet and
axilla. De Monteaux, however, has found the same thrown off gene-
rally :( and as a symptom in atonic fevers it must have been witnessed

* PauUint, Cent. I. Obs. 21. •

Epb. Nat. Cur. D«c. ii. Ann. v. Apps. p. 9.
t I^. Dec. ni, Ann. ix. x. Obs. 96.
t Maladies de Femmes, Ton. n.

304 ECCIUTICA. [CL. VhrOfU III,

b}' most pracdtioDers, as also in several sordid cataneoos eruptions.
Id fevers, moreover, we frequeatlj meet with a secretion of soar
perspiration, which, in a few instances, has had the pungency of
vinegar. When sach smells accompany diseases they nsaaUy cease
on the cessation of the disease which gives rise to them. Where
they are habltaal they often depend npon a morbid state of the sto^
mach, or of the cataneoos exeretories ; and will often yield to a
coarse of aperients or alterants, a frequent use of the warm, and,
when the constitution will allow, of the cold-bath, and such exercise
as shall call forth a copious discharge of perspirable matter, and free
the cutaneous follicles or orifices of whatever olid materials may
lurk there.

Many of these, however, are often dependent upon the diet or
manner of life. Thus the food of garlic yields a perspiration pos-
sessing a garlic smell : that of peas a leguminous smell, which is the
cause of this peculiar odour among the inhabitants of Greenland ;
and acids a smell of acidity. Among glass-blowers, from the large
quantity of sea-salt that enters into the materials of their manufac-
ture, the sweat is sometimes so highly impregnated that the salt
they employ and imbibe by the skin and lungs, has been seen to
collect in crystals upon their faces. A musky scent is not often
thrown forth from the human body, but it is perhaps the most com-
mon of all odours that escape from the skin of other animals. We
discover it in many of the ape kind, and especially the simia Jacchus ;
still more profusely in the opossum, and occasionally in b^dge^hogs,
hares, serpents, and crocodiles. The odour of civet is the produc-
tion of the civet-cat alone ; the viverra Zibetha^ and viverra CtDetta
of Linneus, though we meet with faint traces of it ii^ some varieties
of the domestic cat Among insects, however, such odours are con-
siderably more common, and by far the greater number of them are
of an agreeable kind, and of very high excellency ; for the musk
scent of the cerambix mo#cAato, the apis/ro^ratu, and the tipuiamat-
chifera^ is much more delicate than that of the musk quadrupeds :
while the cerambix suaveolen$^ and several species of the ichneumon
yield the sweetest perfume of the rose ; and the petiolated sphe;
a balsao^ic ether highly fragrant, but peculiar to itself

Ofi. LH9P* VI.] EXCERNENT FUNCTION. 365

SPECIES VI.
EPHIDROSIS ARENOSA.

qm'AiiEOirs pebapiration conVairiho a discharob of sahdt or other

GRANULAR MOLECULES.

As the odorous particles of both animal and vegetable food are
sometiaies absorbed bj the lacteals and impregnate the matter of
perspiration, so at times are the more solid particles of the mate-
rials employed in handicraft trades absorbed bj the longs, and
equally thrown forth upon the surface. This, as observed un-
der the last species, is particularly the case with glass-blowers,
upon whose forehead and arms salt is often seen to collect and
crystallize in gpreat abundance, from the quantity of this material
which they employ in the manufaoture of glass, and its diffusion
through the heated atmosphere of the workshop in minute and im-
perceptible particles.

But a reddish sandy material is occasionally found to concrete on
the surface of the body under other circumstances and which can-
not be chained to any material volatilized in the course of business.
Bartholin, Schurig,* *Mollenbroek,t and various other writers have
given instances of this kind of crystallization, which seems to con-
sist in an excess of free uric acid, translated from the kidneys to the
skin by an idiopathic sympathy, and forming red sand on the surface,
as it probably would otherwise have done in the bladder or the
urinal. It is possible, indeed, that a man may hereby escape from
tfae fabrication of an urinary calculus, or stone in the bladder : and
were such a transfer at all times in our power, we should gladly
avail ourselves of it in many cases of a lithic diathesis, and employ
ijt as a preventif e of urinary concretions. When the sand is trou-
blesome from the quantity collected the alkaline and other medi-
cines recommended under l|thia renalisX will easily remove it§

* Lithulog. p» 235.
t De VasiSjiCap. siii.
% Hist. Anat. Cent. i. 34.
rSupra.p.346.

3i6 sccRmcA. [c^ tl-^r. m.

GENUS IL

EXANTHESIS.
etttaneaus Wnxk.

IDfPLB, CUTANEOUS, ROSE-COLOURED EFFLORESCENCE, IN CIRCUII8CRlBn»
PLOTS, WITH LITTLE OR NO ELEVATION.

ExANTHESis is R Greek compound from 4 ^ extra^' and af$^ ^^ floreo,'*
8iq>erficial or cataneoos efflorescence, in contradistinctioD to enan-
THESIS in Class ur. Order iv« rash-fever or ^' efflorescence springing
from within.''

This genns affords hut one known species, the specific name for
which is taken from Dr. Willan :

1. EXANTHfeSM ROSEOLA. ROSE-RASH.

SPECIES h
EXANTHESIS ROSfiOLA.

Efflorescence in blushing patches, gradually deepening to a rose*

COLOUR, mostly CIRCULAR, OR OVAL ; OFTEN ALTERNATELY FADING AND

reviving; soiCBTiMES wrrn a colourless umbo; chiefly on the

CREEKS, neck, OR ARMS.

Roseola was sometimes employed hy the older writers, thongh in a
very loose sense, to signify scarlet-fever, measles, and one or two
other exanthems that were often confounded : hnt as it is now no
longer used for these it may stand well enoagh as a name for the
present species, which Fuller has described as a flushing all over
;the body like fine crimson, which is void of danger, and ^^ rather a
ludicrous spectacle than an ill symptom.'^

As a symptom this rash is frequently met with in various mala*
dies. Thus in the dentition of infancy it appears on the cheeks ;
in the inoculated cow-pox, around the vesicle ; in dyspepsy, and
various fevers, in different parts of the body, constituting varieties,
several of which by Dr. Willan are named, according to the disease

* Exanthematolof la, p. Its.
Batenian^s Synops^ 95.

GE. II.-9P. I.] EXCERNENT FUNCTION. 367

ihey accompany^ Roseola iDfantilis, R. Faiiolosa, R. yaocina, and R. mi*
liaris : bat which, as mere symptoms of other disorders, are to be
sought for in the diseases of which they occasionally form a part

In the spring and autamn it often- appears to be idiopathic espe*
dally in irritable constitutions. The occasional causes are fatigue^
sudden alterations of heat and cold, or the drinking of very cold
water after violent exercise. Dr. Willan mentions one instance of
its occurring after sleeping in a damp bed. It has sometimes
been mistaken for an eruption of the measles, and still oilener for
that of a mild rosalia or scarlet-feve^ of which last error the same .
author gives an example in a child that was extensively affected
with it, about Midsummer, for several years in succession, and
whose attendlmt physician informed the parents that the scarlet fe-
ver had recurred in their child, seven times ; and hence one reason
why the same name was formerly applied to all these.

The attack is sometimes preceded during the heat of summer,
by a slight febrile indisposition. It appears first on the face and
neck, and, in the course of a day or two, is distributed over the rest of
the body. The eruption spreads in small patches of various figures
but usually larger than those of measles, often as large as a
shilling, at first of a brightish red, but soon settling into the deeper
hue of the damask rose. It sometimes assumes an annular form, and
appears over the body in rose<oloured rings with central areas or
umbos of the usual colour of the skin : the ringt being at first small,
but gradually dilating to the diameter of half an inch.

This rash is troublesome, but of Uttle importance otherwise. In
the medical treatment of it the state of the stomach and bowels
should be particularly inquired into, and, for the most part, will
be found to require correction. Acidulated drinks, with occasional
and gentle laxatives generally remove the disease, unless it be con«
nected with any constitutional or visceral a£fection, when it some->
times proves very obstinate, and can only be cured by curing the
primary malady.

GENUS HI.

EXORMIA-

SMALL ACmUNATEn BLXVATI01I8 OF THE CUTf CUE ; KOT CONTAINING A

wvawy Non thiodig to suppuration; commonly tcrminatino ik

SCURF.

For the acuminated elevation of the cuticle, which the Latins call
pspnla, the Greeks had two synonymods terms ecthyma, (mlv^)

368 BcciimcA. [cl. vt-oK. m>

and exormia {t^^^ftm.) The first was used most frequently in thid
sense ; but as this has by some unaccountable means been employed
very generally to import a very different eruption, a crop of larg;^
pustulous, rather than of small solid pimples, forming a species of
BCPYESis, or the sixth genus of the present order, 1 have chosen
the second term for the present purpose.

The common terminating diminutive (u/a or ilia) is jprobably de-
rived from the Greek Aah (ule or ile,) " materia,'* " materies^' —
of the matter^ me^ or nature of; " thus papula or papilla," of the
matter or nature of pappus ; *Mupula,'' of the matter or nature of
the lupus ; ^^ pustula,'^ of the matter or nature of pus ; and so of
many others.

Papula and pustula, which by Sauvages are degraded into mere
symptoms of diseases, and not allowed to constitute diseases of thenl-
selves, are raised to the rank of genera by Celsus, Linn^us, and Sa-
gar, and, under a plural form (papulae and pustulse,) to that of or-
ders by Willan. In the present system exormia and ecphlysis, in-
tended to supply their place, are employed as generic terms, and
run parallel with those papuls and pustuiae of Willan, which are
not essentially connected with internal disease ; and are only made
use of instead of papula and pustula, first as being more immediate-
ly Greek, and next, in order to prevent confusion from the variety
of senses assigned to the latter terms by different writers. Exormia
and ecphlysis, therefore, as distinct genera under the present ar-
rangement, import eruptions of pimples and pustuleis in their sim-
plest state, affecting the cuticle, or at the utmost the superficial in-
tegument alone, and consequently without fever, or other internal
complaint as a necessary or essential symptom ; although some part
or other of the system may occasionally catenate or sympathize
with the efflorescence. It is difficult, indeed, to draw a line of se-
paration, and perhaps impossible to draw it exactly, between efflo^
rescences strictly cutaneous and strictly constitutional, from the nu-
merous examples we meet with of the one description combining
with or passing into the other. But a like difficulty belongs to eve-
ry other branch of physiology in the widest sense of the term, as
well as to nosology ; and all we can do in any division of the sci-
ence, is to lay down the boundary with as much nicety and caution
as possible, and to correct it, as corrections may afterwards be call-
ed for.

The species which belong to this genus, or which, in other words,
are characterised by a papulous skin not necessarily connected with
an internal affection are the following :

1. EXORMIA STROPHUtrS. GUM-RASH.

2. — UCHEN. UCHERODS RASH.

3. PRURIGO. PRURlClIfOUS RASP.

4. MILIUM. MTLIET-RASH.

^E. IU.--SP* !•] EXCERNENT FUNCIION. 369

SPECIES I.

EXORMIA STROPHULUS-

ERUPTION OF RED PIMPLES IN BARLT INFAIICT, CHIEFLY ABOUT THE FACE,
NECK, AND ARMS, SURROUNDED BY A REDDISH HALO ; OR INTERRUPTED
BY IRREGULAR PLOTS OF CUTANEOUS BLUSH.

Dr. Willan has obserred, that the colloquial name of Red-gum,
applied to the common form of this disease, is a corrnption of Red-
gown, under which the disease was known in former times, and bv
which it still continues to be called in various districts ; as though
supposed, from its variegated plots of red upon a pale ground to
resemble a piece of red printed linen. In effect it is written Red-
gown in most of the old dictionaries : in Littleton^s as late as 1684,
and I believe to the present day. The varieties in Willan are the
following, whose descriptions are large and somewhat loose. We
may extract from them, however, the subjoined distinctions of
character:

m IntertiDctus. Pimples bright red ; distinct ; inter^

Red-gum. mixed with stigmata, and red patch-

es; sometimes spreading over the
body.
C Albidus. Pimples minute, hard, whitish; sur-

White-gum. rounded by a reddish halo.

y Confertus. Pimples red, of different sizes, crowd-

Tooth-rash. ing or in clusters ; the laiger sur-

rounded by a red halo ; occasionally
succeeded by a red crop.
9 Volaticus. Pimples deep-red, in circular patches.

Wild-fire-rash. or clusters ; clusters sometimes soli-

tary on each arm or cheek ; more
generally flying from part to part,
i Candidus. Pimples large, glabrous, shining ; of a

Pallid gum-rash. lighter hue than the skin : without

halo or blush.

Ctenerally speaking none of these varieties are of serious imjpor-
tance ; and all of them being consistent with a healthy state of all
the functions of the body, they require but little attention from
medical practidoners. Several of them are occasionally cennected
with acidity or some other morbid symptom of the stomach and
bowels, and, hence, particular attention should be paid to the prinns
visB. The system, alsO| suffers generally, in many cases, if the

voit. IV. 47

3T0 BGCRITICA. [tJL. VI.-OR. UU

efflorescence be suddeolj driven inwards by exposure to currents of
cold air or by the use of cold-bathing. Both these, therefore, should
be avoided while the efflorescence cobtinues; and if such an acci-
d^t should occur, the infant should be immediately plunged into a
warm-bath, which commoiily succeeds in reprddiicihg the erupdon,
when the constitutional ilhiess ceases.* In every variety, indeed,
the nurse should be directed to keep the child's skin clean, and to
promote an equable perspiration by daily ablutions vrith tepid water,
which are useful in most cutaneous disorders ; and will be found hi
other respects of material importance to the health of children.

In the tooth-rash, strophulus cot^erius^ there is no difficut^ In
tracing the ordinary cause. Yet this also, has often been ascribed
to a state of indigestion or some feverish complaint in the mother or
nurse. " I have, however,*' says Dr. Willan, " frequently seen the
eruption, where no such cause for it was evident. It may with
more propriety be ranked among the numerous symptoms of irrita-
tion arising from the inflamed and painful state of the gums in denti-
tion, since it always occurs during that process, and disappears soon
after the first teeth have cut through the gums." It may, however,
like the red-gum, s, intertinctusj be occasionally connected with a
weak and irritable state of the bowels : though the tender and deli-
cate state of the skin, and the strong determination of li>l0oi to the
surface, which evidently takes place in early infancy, and is the
common proximate cause of the red-gum, is probably the common
remote cause of the tooth-rasn.

The tooth-rash is the severest form in which strophulus shows
itself. Instead of being confined to the face and breast, it oftentimes
spreads widely over the body, though it appears chiefly, in a diffused
state, on the fbre«arm. Dr. WilUn notices a very obstinate «nd
painful modification of this disorder which sometimes takes place on
the lower extremities. ^ The papulae spread from the CMvea of
the legs to the thighs, nates, loins, and round the body, as high as
the navel ; being very numerous and close together, they produce
a continuous redness over all the parts above mentioned. The
cuticle presently becomes shrivelled, cracks in various places, and
finally separates from the skin in large pieces.'' It has some
resemblance to the intertrigo, which however may be distinguished
by having an uniform red, shining surface without papule, and being
limited to the nates and thighs.

In like manner^ those children are most liable to the scrooh«lus
vohticus or wild-fire rash, who have a fair and irritable skin, though
this also occasionally catenates with a morbid state of the stomi^
and bowels. It appears sometimes as early as between the tli&rd
and sixth month, but more frequestly later.

This last is the erythema voUticum of Sauva|^a, the ssatiM Tola>>
fticus of many earlier writers : whence the French atme of fe«
vohige. All these terms, have however, been oft«n used in a very

* Bronzet, sur I'EdacatSon des Enfttnt, p. 187. '

OC UL-^^P. L] EXCERNBNT VUNCTION. 371

Bq ami lieQce, ako applied to one or tnro species of

torrigo, aod especiallj porrigo cnuimcea or crusta lactea«* And
ence, Dr. Armstrong ba» described this last disease as a strophulus
pr tooth-rash.t

The strophalns albidus^ and strophulus candidus^ are the two
slightest varieties of this species of indispositions. The first is
chiefly liniited to the face, neck, and breast, and oAen continues in
the form of nmnerous, hard, whitish specks for a long time, which
on the removal of their tops do not discharge any fluid, though it is
probable they wejre originally forpied by a deposition of fluid, whic^
afterwards concreted und/er thje cuticle. The pimples in the ^cro-
phnlos candi4ii8 ar/e lai^er and difiused over a jvider space ; often
dlstrttmted over the lom3, shoulders and upper part of the arms ;
though it is rarely that they descend lower. Several of the varie-
ties occasionally co-exist and run into each other particularly the
iirst two.J

SPECIES II.

EXORMIA LICHEN.

ILfcfieinoiiK lUiirii.

tiaumoN DIFFUSE ; pimples red j ' troublesome sense of tinouno or

PRiqUNG.

LicHEir ()<ujffif -h) is a term common to the Greek phytologist^ as
well as the Greets pathologists. By the former it is applied to that
extensive genus of the algse, or rather to many of its species, which
stfll retains the name of lichen in the Linnean system : and it is
conjectured by Pliny that the physicians applied the same name to
the species of disease before us from the resemblance it produce^
on the surface of the ,body to many of the spotty and minutely
tulMrcalar lichens, which are found wild upon stones, walls, and the
bade of trees or shrubs. Gorraeus, however, gives two other origins
of the term ; one, of wjiich he does not approve, from the eruption
being supposed to be cured by its being licked with the human
tongue ; and the other, to which he inclines, from its creeping in a
lainbent or tongue-like form^ over different parts of the body.
Tlie derivation in both these c^oes being xux^ ^^ lambo,'' ^' lingo.'^
It if a far more troublesome rash than the preceding ; from the
severest modifications of which, however, it chiefly differs by the

* Attruc, De Morb. Infant, p. 44.

t On the Di9eaMS of Children, p. 34.

I Underwood, on the Diseases of Childrein Vol. r. passim.

372 ECCfUTICA. [gL. TL-OIU HI.

into)erri>le tingling or pricking which accompanies, and pecollarly
characterises it The following are its chief varieties :

m Simplex.
Simple Lichen.

C Pilaris.
Hair-Lichen.

f Circumscriptns*
Clostering Lichen.

} Ufidns.
LiTidUchen.

• Tropicus.
Sammer*rash.
Prickly-heat

(Ferns.
Wild Lichen.

f Crticosns.
Nettle-Lichen.

General irritation; sometimes a
few febrile symptoms at the
commencement ; tingling ag-
gravated during the night ; pirn
pies scattered over the body;
which fade and desqnammate in
about a week.

Pimples limited to the roots of
the hair; desquammate after
ten days ; often alternating with
complunts of the head or sto-
mach.

Pimples in clusters or patches of
irregular forms, appearing in
succession over the trunk and
limbs : sometiniea coalescing :
and occasionally reviving in
successive crops, and perse-
vering for six or eight weeks.

Pimples dark-red or livid ; chiefly
scattered over the extremities ;
desquammation at uncertain pe-
riods, succeeded by fresh crops,
often persevering for several
months.

Pimples bright red, size of a small
pin's head; heat, itching, and
needle-like pricking ; some-^
times suddenly disappearing,
and producing sickness or other
internal afiiection; relieved by
the return of a fresh crop.

Pimples in clusters or patches,
surrounded by a red halo ; the
cuticle growing gradually harsh,
thickened, and chappy : often
preceded by general irritation.

Pimples very minute, slightiy ele^
vated, reddish : intolerably itch-
ing, especially at night ; irr^u-
larly subsiding, and reappear-
ing; chieflyspotting the limbs;
occasionally spread^ over the
body with gnat-bite-shaped
wheals: from the violence of
the irritation, at times accooh

GE. ni.-SP. n.] EXCERNENT FUNCTION. 373

panied with vesicles or blisters,
and sacceeded by ao extensiye
exfoliation of the cuticle.

Under this species, as under the last, we may observe that all
the varieties are in their purest state simple affections of the skin,
though occasionally, probably from pecoliarity of habit, or some ac-
cidental disorder of the digestive function, connected with the state
of the constitution or of the stomach or bowels. Dr. Willan, indeed,
makes it a part of his specific character, that lichen is ^^ connected
with internal disorder r but his description is at variance with his
definition ; for with respect to the first variety, or simple lichen,
be expressly asserts,* that it ^^ sometimes appears suddenly without
any manifest disorder of the constitution ;'' while in regard to the
tropical lichen or prickly heat, one of the severest modifications
under which the disease appears, he states, and with apparent ap-
probation, from Winterbottom, Hillary, Clark, and Cleghom, that
it is considered as salutary ; that even, '^ a vivid eruption of the
prickly heat is a proof that the person affected with it is in a good
state of health ;'" — that ^' its appearance on the skin of persons in
a state of convalescence from fevers, &c. is always a favourable
sign, indicating' the return of health and vigour ;''| Uiat '^ it seldom
causes any sickness or disorder except the troublesome itching and
pricking:'^! that it is not attended with any febrile commotion whilst
it continues out;^'§ and that <^ it is looked upon as a sign of health,
and, indeed, while it continues fresh on the skin, no inconvenience
arises from it except a frequent itching.^'|| And, in like manner^
Dr. Heberden observes that some patients have found themselves
well on the appearance of the eruption, but troubled with pains of
the head and stomach during the time of its spread ; but by far the
greater number experieiipe no other evil from it besides the in-
tolerable anguish produced by the itching, which sometimes makes
them fall away by breaking their rest, and is often so tormenting
as to make them almost weary of their lives. Most of these re-
marks apply equally to the urticose variety, one of its severest forms,
as I shall have occasion to observe presently.

The smPLB ucuea shows itself nrst of all by an appearance of
distinct red papols about the cheeks and chin or on the arms, with
bat little inmimmation round their base : in the course of three or
ibor days the eruption spreads diffusely over the neck, body, and
lower extremities, attended with an unpleasant sensation of tingling
which is sometimes aggravated during the night In about a week
the colour of the eruption fieules, and the cuticle separates in scurf.

* WUlan, p. 39.

t Id. p. 35, from Wioterbottom.

% Id. p. 69, frem Hillary.

4 Id. p. 61, from Clark.

II Id. p. 63, from Cleghom.

374 ECCRinCA. [CL. YL-OR* 111.

jUI the sorfrce (^ the body, indeed, remains scurfy for a long^ time,
h«t particnkrlj the flexnres of the joints. The duration of the
complaint raii^ ; and hence, in difierent cases, a term of from
fourteen to thirty days intervenes between the eruption and a reno-
ration of the cuticle. ^^ The eruption sometimes appears suddenly
without any manifest disorder of the constitution:^'* and some-
times there is- a febrile state ' or rather a state df iriltation at the
beginning of the disorder though ^^ seldom considerable enough to
confine the patient to the house^^t — and which is relieved by the
appearance of the eruption. It has occasionally been mistaken for
neades or scarlatina : but its progress, and, indeed, the general
nature of its symptoms from the first are sufficiently marked to d^
Aguish it firom either of these.

The causes are not distinctly pointed out by any of the writers, j
and it is singular that they should have been passed by both by I
IVVllian nod Bateman. So rar as I have seen, this and all the va- f
lieties depend upon a peculiar irritability of the skin as its remote
cause, and some accidental stimulus as its exciting cause. The ir-
ritabiiity of the skin is sometimes constitutional, in which case the
paftent is subject to frequent returns of the complaint ; but it has
occasionally been induced by various internal and external sourcer ,
of irritation : as a diet too luxurious or too meagre; the debilit> -
occasioned by a protracted chronic disease, or an exacerbated stat ' e
of the mind ; an improper use of mercury, or of other preparation «
that have d^agreed either with the stomach, or the chyjlfacieiiv-
viscera. Under any of which circumstances, a slight occasiona'*.
cause is sufficient for the purpose, as exposure to the burning ra^^s
of a summer sun, a sudden chill on the surface, cold water dronx
during great heat or perspiration ; a dose of opium or any othe r
narcoctic, or substance that disagrees with the stomach or the
idiosyncrasy. Dr. Heberden has suggested another cause, as per*
haps operating in various cases, and inquires whether it may not
be produced by some irritant floating in the atmosphere of so fine
a structure as to be invisible to the naked eye, as the down of va-
douB i^ants or insects ; and he particularly alludes to the delicate
liairs of the dolichos pruriens or cowhage as occasioning the dis-
ease in the West Indies, from their attacking the skin in diis man-
ner imperceptibly. But since general ablutions afford little or no
relief, and all medicated lotions are even more ineffectual ; and as
we can often trace it to other causes in our own country, and are
at no loss for a different cause in the West Indies, the present can '
hardly be allowed to be the ordinary cause, though it may become
an occasional excitement.

The remedial process should consist in keeping the bowels cool
and free by neutral salts ; a mixed diet of vegetables, ripe fruits,

* Wnian, ut supra, p. 39.
+ Id. p. 37.

OE. ni.-SP. U.] EXCERNENT FUNCTION/ 375

especially of the acescent kind, as oranges and lemons, and fresh
•Diaial food; with an abstinence from fermented liquors, a light and
cool dress, an open exposure to pure air, and an occasional use of
the tepid^bath. The mineral acids have sometime proved senric^
able, but not always ; and the red or black hydrargynis snlphuraliiB,
has been thought useful by many. Where the system is evident^
in an impoverished state from previous sickness, innutritive food,
or any mesenteric affection, bark, the mineral acids, or the metallic
tonics a£ford a reasonable hope of relief, and especially such prepa*
rations of iron as may sit easy on the stomach.

Hie HAIR ucHEN, and clusteaino uchen differ from the preceding
in little, more than a difference of station or of form. Their causes
or mode of treatment run parallel, and it is not needful to enlarge
tn them farther.

The UYiD UCHEN is evidently connected with a weak and debili-
tated habit, its papulsB are often interspersed with petecchias,
sometimes, indeed, with purple patches or vibices, and manifest a
state of constitution bordering on that of scurvy or porphyra. Here
the diet regimen and medical treatment should be altogether tonic
and cordial, and may be taken from the plan already proposed for
this last malady.'*'

The TRoncAL lichen, or vrickly beat, is a disease of high anti-
wuity and is equally described by the Greek and Arabian writen.
The latter denominate it cshera, which is the plural of sheri, lite-
ifally papula^ and hence the papvl£, or papulous disordbr, by wij
i^f eoiphasis. And this term, softened or corrupted into essera, hu
^ea adopted and employed as the name of the disease by many
European writers of great reputation, as Bartholin, Hilkry, and
PlolKquet. The term, however, has sometimes been used both in
Ate East atod among Europeans in a looser sense, so jus occasionally,
but flftost improperly, to embrace urticaria, and some other febrile
rashes as well.

The symptoms of the disease I shall give in the words of my ya-
lued fneod Dr. James Johnson, whose excellemt work on the hiflth
enceof Tropicd Climates, I lament that I was not in possession of
so early in the progress of the present undertaldng as I could wish
to haFe been. Dr. Johnson delineates the disease as he has Mi it,
and as, in recollection, he seems almost to IImI It Mill, and hence his
description flows

Warm from the heart and faithful to its fires.

u From mosquittoes,^^ says he, '^ cocknroacbes, ants, and the tmrne-
rous other tribes of depredators on our personal property, w^e havA
some defence by n^ht, and, in general, a recite by day ; but this
unwelcome guest assails us at aU, and particularly the most unaea-
sonahle hours. Many a time have I been forced to spring irom ta-
ble amd abandon the repast, which I had scarcely touched, to writhe

* Vol. II. p. 6S2.

376 BccRmcA. [cl. vi-oR. ui.

about !b tbe open air, for a quarter of an hour: ccd often have I
Tetumed to the char|[^e, with no better anccess, against my ignoble
opponent 1 The night affords no asylom. For some weeks after
•rriying in India, i seldom could obtain more than an hoards sleep
at one time, before I was compelled to quit my conch, withnosmaH
precipitation, and if there were any water at hand, to sluice it
oyer me, for the purpose of allaying the inexpressible irritation f
But this was prcxinctiTe of temporary relief only ; and what was
worse, a more violent paroxysm frequently succeeded.

^^ The sensations arising from prickly heat are perfectly inde-
scribable ; being compounded of pricking, itching, tinglkig, and ma-
ny other feelings, for which I have no appropriate appellation.

^^ It is usually, but not invariably accompanied by an eruption of
vivid red pimples, not larger in general, than a pin^s head, which
spread over the breast, arms, thighs, neck, and occasionally along
the forehead, close to the hair. This eruption often disappears, in
a great measure, when we are sitting quiet, and the skin is cool ;
but no sooner do we use any exercise that brings out a perspiration^
or swallow any warm, or stimulating fluid, such as tea, soup, or
wine, than the pimples become elevated, so as to be distinctly seen,
and but too sensibly felt !

^' Prickly heat, being merely a symptom, not a cause of good ,
health, its disappearance has been erroneously accused of produc-^ .
ing much mischief; hence the eariy writers on tropical diseasei; ^
harping on the old string of '^ humoral pathology,.'' speak very 8e| .
riously of the danger o( repelling^ and the advantage of ^^ encouragk
ing the eruption, by taking small warm liquors, as tea, coffees, wini^
whey, broth, and nourishing meats.^' j

^^ Indeed, 1 never saw it even repelled by the cold bath; and i|i
my own case, as well as in many others, it rather seemed to aggT;«-
vate the eruption and disagreeable sensations, especially during the
glow which succeeded the immersion. It certainly disappears SfMf-
denly sometimes on the accession of other diseases, but I never had
reason to suppose, that its disappearance occasioned them, i have
tried lime juice, hair powder, and a variety of external applications^,
with little or no benefit. In short, tbe only means which I ever
saw productive of any good effect in mitigating its violence, till the
constitution got assimilated to the climate, were — light clothing--
temperance in eating and drinking — avoiding all exercise in the heat
of the day— open bowels — and last, not least, a determined resolu*
tion to resist with stoical apathy its first attacks."

The wild lichen, or lichbn ferus, is particularly noticed by Cel-
sus under the name of agria, as applied to it by the Greeks from the
violence with which it rages. It occurs in him after a brief de-
scription of a variety of papula of a milder kind, which Willan sup-
poses, and with some reason, to be the clustering. ^^ Altera autem
est, quam ^Ay^mr Graeci appellant : in qua similiter quidem, sed ma-
gis cutis exasperatur, exulceraturque, ac vehementius et roditor, ct
rubet, et interdum inter pilos remittit. Quae minus rotunda est, diffi-

ks. in.-6P. 11.] EXCERNENT FUNCTION. 377

cilius sanescit : nisi^sublata est, in impetiginem vertitur.'^* This
rarietj, however, in its general range, its vehemence, and protract-
ed daration, approaches nearer to the nettle-lichen than to any otb-
er : yet the pimples are larger, more clustered, and more apt to
run into a pustular inflammation, so as often to produce cutaneous
exulcerations and black scabs ; and hence the remark of Celsus that
it is disposed to terminate in an impetigo, or, as others have it, in
psora or lepra.

The URTicosE or nettle-lichen is, perhaps, the most distressing
form of all the varieties, if we except the tropical : and like the tro-
pical, notwithstanding its' violence, it is often totally independent of
any constitutional affection. I can distinctly say from various cases
that have occurred to me, that even where the patient has been
worked up to such a degree of madness as to force him against his
own will into a perpetual scratching, which greatly exasperates it,
still the constitution has remained unaffected, the pulse regular^ the
appetite good, and the head clear. In most of the cases, the author
alludes to, however, there' iii^as an established or idiopathic irritability
of the system, and especially of the skin ; and in one or two of them
it was unfortunate that opium, under every form and in every
quantity always increased the irritability ; while no other narcotic
was of any avail. I freely confess that I have been more perplexed
with this obstinate and intractable variety, which has, in some cases,
irregularly subsided for a few days or weeks, and then re-appeared
with more violence than ever, than I have been with almost any
other complaint that has ever occurred to me. A tepid bath and es-
^cially of sea-water has sometimes been serviceable, but I have often
found even this fail ; and have uniformly observed the bath mis-
chievous when made hot ; for the skin will Aot bear stimulation.

From the alterant apozems of sarsaparilla, elm-bark, juniper-tops,
dnd snake-ro6t, no benefit has accrued; and as little from sulphur,
sulphurated quicknsilver, nitre, the mineral acids, and the mineral
dxydes and salts. I once tried the arsenic solution, but the stomach
would not bear it. Sea-bathing, however, in connexion with sea-air,
has rarely failed ; and I am hence in the habit of prescribing it to a
delicate young lady tvho has been several times most grievously
afflicted with this distressing malady, as soon as it re-appears ; as
well from the known inefficacy of every other remedy, a long list
of which she has tried with great resolution, as from the benefit
#hich this has almost uniformly produced.

I have said that the wild lichen in its severity and duration offers
a near resemblance to this. The former, however, is more apt to
run into a pustular inflammation, though in the nettle-lichen we
sometimes find a fev^ of the vesicles filled with a straw-coloured
fluid, but which are not permanent There is also a greater
tendency to some constitutional affection in the wild than in the
nettle modification, and particularly to a sickness or some other

•' De Medicina, Lib, v. Cap. xitvm.
VOL. IV. 48

378 EccRmcA. [cl. vr,r-<m. iii.

disorder of (he stomach upon repulsion by cold* Under the nettle-
lichen the patient seldom finds the stomach or any other organ give
way, and will endure exposure to a sharp current of air tirith a foB
Peeling of refreshment, without any danger of subsequent niischief.

There is a singular modification of this disease described in a
letter from Dr. Monsey, of Chelsea College, to Dr. Heberden, in
which the cause was exposure of the skin to a bright sun in the
open air. The patient was a man thirty years of age, of a thini
spare, habit ; and his skin, as soon as the solar rays fell upon it,
became instantly almost as thick as leather, and as red as termilion^
with an intolerable itching: the whole of which abated about a
quarter of an hour after he went into the shade. Dr. Monsey addE
that this was not owing to the heat of the sun, for the sun in winter
affected him full as much, if not more, and the heat of the fire had
not such an effect. He was, in consequence, thrown into a state of
'' confinement for near ten years. It may not be amiss," continues Dr.
Monsey, "to mention one particular, which is, that one hot dinr
having a mind to try if he were at all benefited by his immersions^
(he seems to have used a salt-bath under cover for many weeks)
" he undressed himself and went into the sea in the middle of the
day : but he paid very dearly for the experiment, the heat diffusing
itself so violently over his whole body by the time he had put on
bis clothes, that his eye-sight began to fail, and he was compelled
to lie down upon the ground to save himself from falling. The
moment he lay down the faintness went off; upon this he got up,
but instantly found himself in the former condition : he, therefore^
lay down^ and immediately recovered. He continued alternately
getting up and lying down till the disorder began to be exhausted,
which was in about half an hour, and so gradually went off. He
had frequently been obliged to use the same practice at other timeF,
when he was attacked with this disorder."

That this case is to be regarded as a peculiar form of the present
species, the extraordinary irritation and intolerable itching of the
skin seem to vouch for sufiiciently. It discovers, however, a cuta-
neous excitement of an idiopathic and most singular kind: and,
keeping this idea in mind, it is not difficult to account for the ten-
dency to deliquium related in the latter part of the account. The
patient, it seems, could endure cold bathing under cover or in the
shade, and was not rendered faint by the re-active glow that ensued
upon his quitting the water; but when to this re-active glow was
united, in consequence of his bathing in the open air and in the
middle of the day, the pungent heat of the sun, he was incapable
of enduring both, till, by a certain length of exposure to this con-
joint stimulus, the cutaneous nerves became torpid, which it seems
they did in about half an hour ; when the affection we are told
" gradually went off."

A daily exposure to the same exhausting power would^ in all
probability, soon have rendered the torpitude habitual, or at least
havo reduced the cutaneous sensibility to its proper balance, which,

e^. Ulf-SP. U.} EXCERNENT FUNCTION. 37^

?Aer all, fprros the real cure id tbe West Indies, and in most of the
•^qtrooic cases of oqr own country. This, however, does not seem
to have been thought of: but, after having tried a long hst of
different merles of medicines in hospital and in private practice to no
purpose, the patient was at length fortunate enough, when under
♦he care of Dr. 5(onsej, to be put, as a forlorn hope, upon a brisk
course of calomel, of which he took &ye grains every night with a
purge of rhubarb or cathartic extract the ensuing morning for nearly
a fortnight in succession ; and having thus transferred the morbid
Irritability of the skui to the intestinal canal, the disease leA him.

SPECIES III.
EXORMIA PRURIGO.

iCRVFTfOR diffuse: pimples nearly of the colour of the cuticle;

WHEN ABRADED BT SCRATCHING OOZINO A FLUID THAT CONCRETES INTO
MINUTE BLACK SCABS ; INTOLERABLE rrCHING, INCREASED BT SUDDEN EX-
POSURE TO HEAT.

iN^he symptoms of a papular eruption, and an intolerable itching,
this species bears an approach towards the preceding : but it differs
from it essentially in the colour of the papulae, and in the nature of
the itching, which is often far more simple ; and, when combined
with a sense of stinging, gives a? feeling peculiar to itself, like that .of
a nest of ants creeping over the body and stinging at the same time.
It offers the three following varieties, the last of which chiefly
differs from the second in being more inveterate : —

p Mitis. Pimples soft and smooth : itching

Mild Prurigo, at times subsiding ; chiefly com-

mon to the young and in spring
time.
C Formicans. Pimples varying from lai^r to

Emmet-prurigo. more obscure than in the last ;

itching incessant, and accom-
panied with a sense of pricking
or stinging, or of the creeping
of ants over the body ; duration
from two months to two or three
years, with occasional but short
' intermissions: chiefly common
to a^lts.

380 ECCRITICA. [cL.TI.-OR.rar

y Senilis. Pimples mostly larger than in

Inveterate prurigo. either of the above, sometimes

indistinct, giving the snrface.a
shining and granulated appear-
ance ; itching incessant : com-
mon to advanced years, and
nearly inveterate.

In all the varieties the itching diflFers in its extent : being some-
times limited to a part only of the body, and sometimes ppreading
over the entire frame.* Courmette relates a case in which it alter-
nated from side to side :t and in many instances it appears periodi-
cally. Hence, in Willan we have not only an account of the tliree
preceding varieties, but of several others, which chiefly, if not
entirely, differ from them in being limited to particular parts ; as
prurigo podicis, p. praBputii, p. urethralis, p. pubis, p. pudendi
muliebris.

A common cause of this species in all its varieties, though by no
means the only cause, is want of proper cleanliness of the skin and
of apparel ; and hence it is found most frequently in the hovels of
the poor, the squalid, and the miserable. Yet as it is not always
found under these circumstances even where there is the grossest
uncleanlines'S, some other cause jointly operating in such situations,
some idiopathic condition of the skin by which the sordes thus col-
lected and obstructing the mouths of the cutaneous exhalants be-
comes an active irritant, must be admitted. One of these conditions
appears to be a skin peculiarly delicate and sensible, which is most-
ly to be found in early life ; and another, a skin peculiarly dry and
scurfy, which is a common condition of old age ; on which account
repelled perspiration is correctly set down as a cause by Riedlin.
Even in the cleanliest habits, these peculiarities of the skin of^en
become causes of themselves, and of a more intractable kind than
mere sordes, as they are far more difficult of removal. A diet of
fish alone has sometimes excited such a habit : and an habitual ad-
diction to spirituous drinks, whether wine, ale, or alcohol, produces
also, in many persons, a like sensibility of the surface, and lays a
foundation for the disease in its most obstinate form.

Wher« the rash continues lons^ and becomes pertinacious, the
papulae form minate exulcerationS, degenerating, in the first varies
ty, into a species of contagious itch, and in the second, into a run-
ning seal I ; which last, in the third or inveterate variety, sometimes
forms nests for various parasitic insects,^ and especially for several
species of the acarus and pediculus, to which Dr. Willan adds the
pulex. In treating of intestinal animalcules, we had occasion to
observe that " (hey appear, from the luxuriance of their haunts and

i *

♦ Sitjnus, T;, 34, Loeschcr.
t JouriK Med. Tom. Lxxxv.

:( Soramor, Diss, de affectibus pruriginosis Senum.

• liOcscher, Diss, de pruritu senili totius corporis. Witeb. 1728.

/JE. HLH3P. HI.] EXCERNENT FUNCTION. 381

repasts, to be, Id various instances, peculiarly enlarged and altered
from the structure thej exhibit out of the body ; whence a difficul-
ty in determining, in many cases, the exact external species to which
a larve, worm, or animalcule found within the body may belong.'^*
This remark applies with peculiar force to the parasites detected
in the diseases before us, some of which grow to such an enormous
size, and with such altered characters from rioting on so plentiful a
supply of juices, that it is by, no means easy to recognize them.
Dr. Willan describes an insect of this kind found in great abundance
on the body of a patient suffering under the inveterate prurigo,
which he at first took for a pediculus, though from the nimbleness
of its motions, as well as from other characters, he at length ascer-
. >lained it to be a pulex, not described by Linn^us : more probably,
from the causes just stated, so altered in its form, as not to be easi-
ly referred to the species to which it really belongs.

Thorough and regular ablution and cleanliness are here, there-
fore, peculiarly necessary, and these will often succeed alone, espe-
cially in the first variety. If they should not, sulphur and the sul-
phureous waters, as that of Harrowgate, taken internally and ap-
plied to the skin itself, have sometimes been found serviceable.
Fossile alkali combined with sulphur and taken internally with in-
fusion of sassafras or juniper tops is peculiarly recommended by
Dr. Willan. If the constitution have suffered from a meagre diet,
or be otherwise exhausted, general tonics and a nutritive food must
necessarily form a part of the plan.

In many cases, however, of the second variety, and in still more
of the third, this pertinacious and distressing complaint bids defi-
ance to all the forms of medicine, or the ingenuity of man : and I
cannot adduce a stronger illustration of this remark than by refer-
ring to an attack which it has lately made on one of the brightest
ornaments of medical science in our own day, whose friendship
allows me to give the present reference to himself. It is now con-
fiiderably more than a year and a half since he was first visited with
this formlcative but colourless rash which affected the entire sur-
face, but chiefly the legs : and he has since tried every mean that
the resources of his own mind or the skill of his medical friends
could suggest, yet for the most part without any thing beyond a
palliative or temporary relief The tepid bath produced more
harm than good, though several times repeated : Harrowgate water
internally and externally had recourse to has been of as little avail :
acids and alkalies, separate or conjoined, in whatever way made
use of, have failed equally : nor have purgatives or diaphoretics or
any of the alterative diet drinks, or the alterative metallic prepara-
tions answered better. The coldest spring water employed as a
bath or lotion, and free doses of opium as a sedative, are the only
medicines from which he has at any time derived any decided re-
lief, and these have constantly afforded it for a short time. In the

• Vol. I. Helminthia crratica. p. 208.

3j|a jiipcwnpA. [cL. vi.-9n. w,

mifldte ^f the col4^9t m^bts of last winter, and tb^ ^fU co^er Qigbtn
<^f t^^ lyiQter before, be was repeatedly obliged to rise aad liave
IKtcoor^e to spoog^^ with cold water, often w|:^eo on the point of
firee^^iogv The opiam be has tak^en never effected real sleep, nof
^ibjited tb(e coo^laint but generally threw him into a quiet kind of
^ ifyBTy whicb produced all the rf9fre8bment of sleep : and to ob-
tain this happy aphelxia or abstraction of mind he has been com-
pelled to use the opium in large doses, often to an extent of t^n
ffrain^ e?ery twenty-four hours, for ivef ks togetl^er, and rarely in
less quantity than five or six grains a day and night fof many monthii
In succession. The change operated on the general habit by this
peculiar sensibility of the skin is not a little singular ; ifor first, ia
the vf^lAst of the distraction produced by so perpetual a b^^ra^ssmeDt,
iuod the pecessary restlessness of nights, neither his animal spirits
nor liis appetite have in any degree flagged, but, upop the whole,
l^ither increased in energy, and Us pulse has held true to its pro-
per standard. And next, though opium was wont to disagree witli
)iim in various ways antecedently, it has proved a cordial to him
trough the whole of this tedious affection without a single unkind-
ly concomitant, and has never rendered his bowels constipated.
From the long continued excess of action there was at length an
evident deficiency in the restorative power of the skin : for two ex-
coriations arising from the eruption, degenerated into sloughing
ulcers. At the present period, forming a distance of nineteen or
twenty months from the first attack, he is apparently getting well ;
the akm which has been so long in a state of excitement is losing
Its morbid sensibility, and becoming torpid : he has rarely occasion
to have recourse to cold ablutions, but dares not trust himself
through the day without a dose of opium^ as an exhilarant, thoi^b
ithe quantity is considerably reduced. He has also, for many months,
been taking the bark and soda as a general tonic. Perhaps the
most instructive part of this case is the great advantage and ^fety
of the external application of cold water, as a refrigerant and toRie
in cutaneous eruptions accompanied with intolerable heat and irri-
tation. And it is possible that half the wells, which in times of
superstition were dedicated to some favourite saint, and still retain
bis proper name, derive their virtue from this quality rather than
irom any chemical ingredient they contain, which has often as little
to do with ^e cure as the special interposition of the preternatural
patron.

ee. ]n.-«(ip. IV.] excsaitent function. 383

SPECIES IV.
EXORMIA MILIUM.

fDfPLES VERT MINUTE; TUBERCULAR; CONTIHED TO THE FACE; DO*

TUfcr; milk-white; hard; glabrous; resembling millet-seeds.

This species is taken from Plenck who denominates it grntam sive
milium. It is a very common form of simple pimple or exormia,
and must liave been seen repeatedly by every one, though, with the
exception of Plenck, I do not know that it has hitherto been de-
scribed by any nosol<^sts. It has a near resemblance to the white-
gum of children, as described by Dr. Underwood, the strophalos
allndiBS of Willan, and the present system. But the pimples in the
milium are totally unattended with any kind of inflammatory halo
or surrounding redness: and are wholly insensible. They are
sometimes solitary, but more frequently gregarious. It is a blemish
of small importance and rarely requires medical interposition : but
as it proceeds from a torpid state of the cutaneous excretories, or
rather of their moatlis or extremities which are balled up by hard-
ened mucus, stimulant and tonic applications have often been found
serviceable, as lotions of brandy, spirit of wine, or tincture of
myrrh, or a solution of sulphate of zinc with a little brandy added
to it.

When this species becomes inflamed it lays a foundation for a
varus or stone-pock, which we have already described^under the
order of inflammations in the third class of the present system.''^

GENUS IV.

LEPIDOSIS.

efflorescence of scales over different parts of the body, often
thickening into crusts.

Lepidosis is a derivative from Amtk ->•«, " squamma." The Greek
is preferred to the Latin term, in concurrence with the general

• Vol. 11. p. 196.

384 ECCRITICA. [CL. VL-OR. lU/

•
rule adopted in the present system in regard to the names of the
classes, orders, and genera. The genus includes those diseases,
which consist in an exfoliation of the cuticle in scales or crusts of
different thickness, and with a more or less defined outline, in ma-
ny cases owing to a morhid state or secretion of the rete mucosum
or adipose layer of the part immediately heneath, which is some-
times top dry, or deficient in quantity ; sometimes perhaps absent
altogether ; sometimes charged with a material that changes its
natural colour ; and sometimes loaded with an enormous abundance
of a glutinous fluid, occasionally combined with calcareous earth.
In the severer cases the true skin participates in the change.

As this colorific substance, forming the intermediate of the three
lamellae that constitute the cutaneous integument, is only a little
lighter in hue than the true skin among Europeans, it is not often
that we have an opportunity in this part of the world of noticing
the changes effected upon it by different diseases : but as among ne-
groes it contains the black pigment by which they are distinguished,
such changes are very obvious and frequent : for the individual is
sometimes hereby, as we shall see presently, rendered pye-balled,
or spotted black and white, and there are instances in which the
whole of this substance, or rather of its colouring part, being car-
ried off by a fever, a black man has suddenly been transformed into
a white.

Changes of this kind often occur without any separation of the
cuticle from the cutis, but if the fever be violent such separation
takes place over the entire body, and thcf cuticle is thrown off in
the shape of scurf, or scales, or a continuous sheath. And some-
times the desquammation from a hand has been so perfect that the
sheath has formed an entire glove. The same effect has followed
occasionally from other causes than fever, as on an improper use of
arsenic* or other mineral poisons, on being bitten by a viper,T and
sometimes on a severe fright. { There are various instances itf
which the nails have been exfoliated with the cuticle,§ and others
in which the hair has followed the same course. Sometimes, in-
deed, a habit of recurrence has been established and the whole has
been thrown off and renewed at regular periods,|| in one instance
once a month.!

In the genus before us the exfoliations are of a more limited
kind, and in some instances very minute and comparatively insigni-
ficant. In the severer forms, however, the true skin participates
in the morbid action, and the result is far more troublesome.

* De Haen, Rat. Med. Part. x. Cap. ii.

t Eph. Nat. Cuf. Dec. i. Ann, iv. v. Obs. 38.

X Act. Nat. Cur. Vol. vii. Obs. 43.

i Epti. Nat. Cur. Dec. iii. Ann. ii. Obs. 124.

y Oooch, Phi). Trans. 1769.

IT Eph. Nat, Cur. Dec. iii. Ann. i. Obs. 134.

OB* IV.-SP. I.] EXCERNENT FUNCTION. 38&
The species it presents to us are the following :

1. LEPIDOSIS FHTRIASIS. DAin)IUFF.

2. 1- LEPRIASfS. LEPROSY.

«a _ „ ^ i DRY SCALL.

3. ^— — PSORIASIS. < ^

^ ^ SCALY T£TTER.

4t *■ ICTHYIA8I8. FISH-SKIN.

SPECIES I.

LEPWX)SIS PITYRIASIS.
BanVrCff.

PATCHES OF FIlfE BRANNY SCALES, EXFOLUTING WITHOUT CimCULA^

TENDERNESS.

This species is the slightest of the whole : its yarieties are as fol'
low:

• Capitis. ^les minute and delicate : con-

Dandriff of the head. fined to the head ; easily sepa-

rable. Chiefly common to in-
fancy and advaticed years.
C Rubra. Scaliness common to the body ge-

Red dandriff. nerally ; preceded by redness^

roughness, and scurfiness of the
suriace.
y Versicolor. Scaliness in diffuse maps of irre-

Motley dandriff. gular outline, and diverse co-

lours, chiefly brown and yellow ;
for the most part confined to
the trunk.

Pityriasis is a t^rm common to the Greek Physicians, who con-
cur in describing it, to adopt the words of Paulus of £gina, as ^^ the
separation of slight furfura matters (wtrp^mim amftmrmi), from the
surface of the head, or other parts of the body, without ulceration.^'
The same character is given by the Arabian wnters, and especially
by Avicenna and Ali Abbas. But several writers, both Greek and
Arabian, who have thus described it generally^ limit its extent to
the head, which is the ordinary seat of the porrigo or scabby scall,
characterized by ulceration, and a purulent discharge, c6vered by
minute scabs ; and hence in some writers, pityriasis has been con-
founded with porrigo ; or, in other words, the dry and branny scale
with the pustular scab ; which, however, there is no difficulty in
accounting for, since the first variety, whose seat is also in the head,
has a tendency, if neglected, and the minute and scurfy scales grow

VOL. iv. 49

386 ECCRITICA. [ct. VL-OR. III.

thicker and broader, and crastaceons, to degenerate into porrigiDond
pustules.

The FIRST VARIETY, or dandriff of the head, when it attacks ior
fants, exhibits minute scales, and when it appears in advanced age^
scales of larger diameter. It shows itself at the upper edge of the
forehead and temples as a slight whitish scurf, set in the {^fk o^ ^
horse-shoe ; on other parts of the head there are also cuticular ex*
foliations, somewhat larger, flat and semipellucid. Sometimes,
however, they cover nearly the whole of the hairy scalp, imbricate
in position, or with an overlap, as in tiling.

Little attention is necessary to this complaint beyond that of clean-
liness, and frequent ablution ; where, however, the hairy scalp is
attacked it is better to shave the head, when the scales may be re-
moved by a careful use of soap and warm water, or by an alkaline
lotion. This is the more expedient because the scales in thissitua-
tion are often intermixed with sordes, and pustules containing aa
acrimonious lymph are formed under the incrustations ; aad in this
way pityriasis, as we have already observed, may, and occasionally
does, degenerate into porrigo.

The SECOND VARIETY, or red dandriff, sometimes affects the gene-
ral health in a perceptible degree from the suppression which takes
place in the perspiration, and the consequent dryness, stifibess, and
soreness of the skin ; and the general itching which hence ensues,
is oflen productive of much restlessness and languor. This, which
is the severest modification of the disease, appears chiefly at an
advanced period of life, though it is not limited to old age. A tepid
bath of sea-water is, perhaps, the most useful application, as servin^^
to soflen the skin, and produce a gentle dlapnoe. With this external
remedy Dr. Willan advises we should unite the compound decoction
of sarsaparilla, and antimonials, which operate towards a like ef-
fect. The tinctura hellebori nigri in small doses has also some-
times been found useful ; and, where the irritability of the skin is
not very great. Dr. Bateman was in the habit of using a gently re-
stringent lotion or ointment, consisting of the superacetate of lead
with a certain proportion of borax or alum.

The variegated or motley dahdriff, pityriasis versicolor, often
branches out over the arms, back, breast, or abdomen, but rarely in
the face, like many foliaceeus lichens growing on the bark of trees ;
and sometimes, where the discolouration is not continuous, suggests
the idea of a map of continents, islands, and peninsulas, distributed
over the skin.

We have a more distinct proof of a morbid condition of the rete
mucosum, or adipose colorific layer of the skin in this than in any
other afiection belonging to the entire genus. The morMd action^
indeed, seems confined to this quarter and consists in the secretion
of a tarnished pigment, though possibly, in some instances, it may
be only discoloured by a mixture with a small portion of extra?a-
Sated blood. And, were it not for the furfuraceous scalea whicii
tietfirjpiine its real nature, this afiection would belong to the genus

GB. rr.-6P. lJ excernemt function. 387

jEPicHHosD of die preseDt order. There is no elevatioD ; and the
ftandng rarely exteods orer the whole body. Dr. Willan telh us
that it seldom appears OTer the stemam or aloog the spine of the
back. 1 had lately a patient, howefer, in a gentleman about forty
jrears old^ who was suddenly attacked with a discolouration and bran-
ny efflorescence of this kind, which extended directly across the
spine OTer the loins, and very nearly girded the body. It continu-
ed upon him for about three years without any constitutional indis-
positioD, or eren local disquietude, except a slight occasional itch-
iofi^ tmd then we»t away as suddenly as it made Its appearance.
The hue was a fawn-colour : and, as the patient was anxious to lose
it, he tried acids, alkalies, and other detergents of various kinds,
but without any effect wbateven This variety of dandriff gene-
rally continues for many months, and not unfrequently, as in the
present case, for several years. Being altogether harmless, it re-
quires no medical treatment.

The pityriasis nigra of Willan, ref<;frred to by Bateman, but only
glanced at by either of them, so far as I have seen it, is rather a
mollification of the genus cfichrosis, and species Poecilia, under
which it will be ivoticed. It is a cuticular discoloration, but with-
out cuticular exfoliation.

SPECIES II.
LEPROSIS LEPRIASIS.

Tfl0 genus constitutes the vitiligo of Celsus. The term lepriasis
is a derivative from Xawug ^^ scaber, vel asper, ex squammulis dece-
dentibuB ;'' with a termmatioB appropriated by a sort of common
consent, to the sqoammose tribe of diseases.* Lepra, which is the
SMre common term, is derived from the same root : but lepriasis is

E referred to lepra as a more general term, and hence better calcu-
ited to comprise the different varieties of this species so generally
described or referred to by the Greek and Oriental writers, but
whose descriptions, not very definite when first written, at least
with a few exceptions, have been rendered altogether indefinite and
incongruous in modem times, from a misunderstanding or confusion
of the names under jvhich the descriptions are given.

The embarrassment which Dr. Bateman felt upon this subject,
when writing on the genus elephantiasis, and which has been no-
ticed already,! he was equally sensible of when he came to lepra,

♦ See the Author's volume of Nosology. Prelim. Diss. p. 51.*
t Vol. n. p. 567.

388 ECCIUTICA. [CL. VI.-OR. III.

and the researches of Dr. Willan gave him little or no asdstance.
I could not then find time to render him the aid he stood in need oi,
}mt I have since directed my attention to the sahject, and will now
give the reader its resolts as briefly as possible.

In the admirable and exact description of the cataneons efflores-
cences and desqnammations, to which the Hebrew tribes were sub-
ject on their quitting Egypt and which they seem to hare derived
from the Egyptians, drawn op by Moses, and forming a part of the
Le?itical law,'*' there are three that distinctly belong to Uie present
species, all of them distinguished by the name of berat (prvn)
or ^^ BRioHT SPOT ;'' one called boak (pHS) which also imports bright-
ness, bat in a subordinate degree, being ^' % dull-white berus,^ not
contagious, or, in other words, not rendering a person andean,
or making it necessary for him to be confined; and two called
TSORAT (i^jnx) " Tenom or malignity :'' the one a berat lebena or
f( bright-white berat,"t and -the other a berat cecha^ "dark or doaky
berat,"! spreading in the skin; both of which are contagious, or, in
other words, render the person affected with it unclean, and exclude
him frpm society.6

The Arabic and Greek writers have in fact taken notice of and
described all these, but with so much confusion of terms and symp-
toms, from causes I will presently point out, that without thos tam-
ing back to the primary source it is difficult to unravel them or
opderstand what they mean.

The boak, or slighter and uncontaminating berat, is still denomi-
nated by the same name among the Arabians, boak, and is the Anr^
AAf^ or " dull-white leprosy" of the Greeks : while the bright-
white and dusky berats of the Hebrews, which the latter distingoialH
ed on account of their malignity by the name o( PliPf^ (irorat,) me
still called among the Arabians by the Hebrew generic term wim a

very slight alteration ; for the berat lebma (TO3^ T^'Vfl) or briglit-
white l^rat of the Hebrew tongue, is the beras bejas of the Arabic,
and the berat cecha (rtTH^ JTVfl) or dusky berat, its beras aneS:
the former of these two -constituting the Xnr^ Aunm or " bright-
white" leprosy of the Greeks, and the latter their Mar^ fuXmg
*' dusky or nigrescent leprosy."

So nir the whole seems to run in perfect harmony : but as many
of the Arabians, in process of time, used boak and beras indiscrimi-
nately, the different species of the disease as well as their qoaliUes
became immediately confounded, and we are told sometimes that
leprosy is, and at other times that it is not unclean or contagious.
And what increased the confusion }s, that the Arabians employed

• Lcvit. Cap. xin,

i Id. Cap. xiii. 38, S9.
^ t W. V. 3.

♦ W. V. 6. 8.

V

GE. IV.-QP. n.] EXCERNENT FUNCTION. " 389

also another term of stilf wider import than either of these heing
Iraba or konha, which imported scaly eruptions of every kind, run-
Bing not merely parallel with the entire genus lefidosv before ns,
bat something beyond, so as to include the humid as well as the dry
fM»ll ; and consequently diseases of very different qualities and de-
grees of malignancy, contagious and uncontagious, cuticular and
vdceratiYe. It is a term peculiarly common to the writings of Avi-
cenna and Serapion. And as kouba, or with the article alkouba
was also frequently applied to all the species of beras or leprosy,
the real characters of the latter were rendered doubly doubtful and
intricate. And hence a very obvious source of confusion upon this
subject originating among the Arabians.

But while the Arabian writers borrowed two terms appropriated
to the disease before us from the Hebrew tongue, beras and boak, and
employed both of them in a loose and indefinite manner, the Greeks
themselves borrowed one and employed it still more indeterminate-
ly : for from the Hebrew /^JH!^ (tsorat) they obtained their ^m^
(psora) — as our own language 1^ since the word sore. Tsorat, as
we have already seen, is restrained by the Hebrew legislator to
the two forms of beras or leprosy which were contagious or ren-
dered a man unclean : and as the Greeks introduced this term into
their own tongue it would have been better to have restrained it to
the same import, and to have used psora as the translation of tsorat.
But the Greeks had the word lepra already by them, as, signifi-
cative of the same disease gentrally^ or a synonym of berat or beras ;
and hence instead of psora they employed lepra which is the
word made use of in the Greek, as well as in the Latin versions.
As lepra, however, is a generic term and runs parallel with berat,
so as to include the boak or uncontaminating, as well as the conta-
minating forms of the disease, the clearness, if not the entire sense,
of the Hebrew is greatly diminished in the Greek version. When
we are told by Moses^ in the language of the Hebrew bible, that the

griest shall examine the berat, or bright spot, accurately, and if it
ave the specific marks, it is a tsorat, (which the berat is not ne-
^^essarily,) we readily understand what he means. But when he
tells us in the language of the Greek bible, that the priest shall look
at the berat or mAov)^ (which is itself necessarily a lepra) and if
it ioLwe the specific marks it is a lepra, the meaning, to say the
least of it, is obscure and doubtful. It is probable, however, that
psora, when first introduced into the Greek tongue, imported the
very same idea as in the Hebrew : but it soon gave way to the older
term of lepra, and having thus lost its primitive and restricted sig-
nification, it seems to have wandered in search of a meaning, and
had at different times, and by different persons, various meanings
attributed to it ; being sometimes used to express scaly eruptions
generally, sometimes the scales of leprm ; but at last and with a
pretty common assent the far slighter efflorescence of scaly tetters
or scalls, denominated in the Levitical code saphat (JVTSD) : and

390 ECCRITICA. [CL. yi.-o]L m.

by the Latins scabies or impetigo sicca : coostitutiiif the notoAms^ or
ensuii^ species of the present classificatioQ. So that whilst In He-
brew^ or under its primitive sense^ tsorat or psora denoted the most
malignant form of lepidosis, in Greek or under its secondary sense,
it denoted one of the mildest forms of the same. And hence, an-
other source of confusion upon the subject before ns originatii^
among the Greek writers, as the preceding originated among the
Arabian.

And when to these two sources of perplexity we add that the
Chreek term lepra was, from a cause I have formerly explained,
employed equally to express elephantiasis, we shall easily be able to
account for the indefinite and incoherent descriptions of all these
diseases which are given by many of the Greek and Arabian writers,
and the inaccuracy with which the symptoms of one specific disease
are run into another. Actuarius endeavoured to throw something
of order into the midst of tliis confusion by contemplating ail these
maladies, in conjunction with lichen, as different forms of a common
genus, and dividing them into four separate species : ^^ A less vio-
lent disease,^' says he, ^^ than elepSantiasis is lepra ; lepra is, how-
ever, more violent than psora, and psora than the lichenes. But
lepra penetrates deep, forms circular eruptions and certain funguses
or deQquescences of flesh {rimt rvmjjfi^ ra^«i) and throws off scales
from which also it derives its name : while psora is more superficial,
assumes indeterminate shapes, and only casts off furfuraceous cor-
puscles. A roughness and itching of the skin is common to both.^'*
And to the same effect Paulus of .£gina.

The real fact is, that the two last are nearly connected in nature,
and in the present work follow in immediate succession, while both
are widely remote from the first ; and though it is possible they
have occasionally terminated in it, are by no means naturally con-
nected with it, or form a necessary harbinger.

Lepra or lepriasis in Celsus occurs under the name of vitiligo, and
like the berat of the Hebrew legislator, is made to include three
modifications ; the ordinary forms of rt, indeed, that have descended
to us, though delineated with much error and incongruity. The
description of Cebus is drawn up with peculiar accuracy and con-
cinnity, and makes the nearest approach to that of Moses of any I
am acquainted with : and by uniting them and combining a few well
ascertained symptoms-, from other authors, we shall be able to obtain
a pretty clear insight into the genuine characters of these modifica-
tions, freed from the extraneous concomitants that have so often be-
wildered us.

* Actuar. De Mcth. Medend. ii. 11.
And compare Paul JE>g\n, iv. 2.
Serapion. Breviar. Tr. v. Cap. iv.
Avicenn. Lib. f. Hi. 1.

GE. 1V.-SP..II.] EXCERNENT FUNCTION. 391

« Albida. Scales glabrous, dull-white, circular and
Boak (pni). Hebr. definite ; preceded by reddish, and
Boak. Arab. glossy elevations of the skin; sur-
Alphos. (*Ax^h) Auct. rounded by a dry, red, and slightly
Gr. Cels. elevated border : scattered ; some-
Common or dull-white times confluent ; irregularly exfoliat-
leprosy. ing and reproduced : rarely found
on the face : not contagious.
C Nigricans. Scales glabrous, dusky or livid, without
Berat cecha ; Hebr. central depression, patches increas-

SHD Jl'VfU) ^^ ^^ ^^^^ » scattered, or confluent.

ras asved, Arab. Contagious.
Melas (MiAm) Auct.

Gr. CeU.
Dusky or black leprosy,

y Candida. Scales on an elevated base glossy-white,

Berat lebena. Hebr. with a deep central depression ; en-

(TOU^ JIVU) circled with a red border ; patches

Beras bejas. Arab. increasing in size : hairs on the

Leuce (AsmnS Auct. patches white or, hoary ; diffused

Gr. Cels. ^^®^ ^® body. Contagious.
Br%bt-white leprosy.

All these, at least in their origin, are strictly cutaneous afiec-
tions : though we shall presently have to observe that the last two
when thev become inveterate, sometimes seem to afiect the habit ;
and it is hence possible that the first may do so in a long course of
time if neglected.

It is on this account that the boak, common or dull-white lepeo-
sy has been regarded as in every instance a constitutional malady
by many writers of recent times ; but it was not so regarded either
by the best Greek and Arabian physicians, who also duly distin-
guished it from elephantiasis and other complaints with which it
has been confounded by later writers ; nor is it so regarded by Dr.
Willan, who ascribes it chiefly to cold, moisture, and the accumula-
tion of sordes on the skin, especially in persons of a slow pulse,
languid circulation, and a harsh, dry, and impermeable cuticle : or
whose diet is meagre and precarious. It is hence found chiefly in
this metropolis among bakers and bricklayers^ labourers : coal-hea-
vers, dust-men, laboratory-men, and others who work among dry,
powdery substances, and are rarely sufficiently attentive to cleanli-
iiess of person.

la the common, and, perhaps, in all the varieties, the scaly patch-
es commence vrhere the bone is nearest to the surface, as along the
skin about the elbow, and upon the ulna in the fore-arm, on the
scalp, 'and along the spine, os ilium, and shoulder-blades. They
rarely appear on the calf of the leg, on the fleshy part of the arms,
or within the flexures of the joints. Both sides of the body are
dually afiected at the same time and in the same manner ; but, con-

392 EccRmcA. [cl. vl-or. in,.

trarj to the erysipelatous erythema and some other maladies of the
skin, the parts first affected do not ran through their action and heal
as other parts become diseased, but continue with little alteration,
till, from medical application or the natural vigour of the constitu-
tion, returning health commences ; when all the patches assumie a
like favourable appearance at the same time, those nearest the ex-
tremities, and where the disease, perhaps, first showed itself going
off somewhat later than the rest The scaly incrastations sometimes
extend to the scalp, and a little encroach on the forehead and tem-
ples ; but it is very rarely that they spread to the cheeks, chlny
nose, or eyebrows. The eraption is seldom attended with pain or
uneasiness of any kind, except a slight degree of itching when the
patient is warm in bed, or of tingling on a sudden change of tempe-
rature in the atmosphere.

We have said that this variety is strictly a cutaneous eraption, and
rarely, if ever, affects the constitution. It is in consequence regard-
ed as of but little importance in the Levitical code, which coDtem^
plates it as not penetrating below the skin of the flesh, and not de-
manding a separation from society. ^^ If a man or a woma%'' says
the Jewish law, ^' have in the skin of their JUsh a berat, a white be-
rat, then the priest (who after the manner of the E^rptians united
the character of a physician with his own,> shall look ; and, behold,
if the berat in the skin of the flesh be dull, it is a boak growing in
the skin : he is clean.^"^ Not essentially different Ceklto, ^' the viti-
ligo, though it briqgs no danger, is, nevertheless, offensive, and
springs from a bad habit of body. The dull-white and the duskj
forms in many persons spring up and disappear at uncertain pe-
riods. The bright-white when it has once made its attack, does
riot so easily quit its hold. The cure of the two former is not diffi-
cult : the last scarcely ever heals."t

We may hence distinctly affirm that the variety of the dull-white
or common leprosy, is not contagious : and had it been so amoi^
the Jews, Moses would have condemned the patient to a quarantine
, under this form, as well as under the two ensuing. Dr. Willan, in-
deed, yielding to the general opinion upon this subject, derived
from a proper want of discriminating one form of the disease from
another, inclines to believe that it may occasionally become in time
so interwoven with the habit as to be propagable, but still rejects
thi idea of its being contagious. In reality, although in most coun-
tries where leprosy is a common malady, places of separate resi-
dence are usually allotted to those who are affected with it under
whatever modification it may appear, this has rather been from an
erroneous interppetation of the Jewish law, and an ignorance of the
exceptions that are introduced into it The lepers of Haha, a pro-
vince in the Barbary states, though banished from the towns, are
seen in parties of ten or twenty together, infesting the roads, and

• Levit. Cap. xiii. 38, 39.

+ De Medicin^; Lib. v. Cap. xxviir. Sect. 19,

GE* ly.-SP. 11.] EXCERNENT FUNCTION. 393

approach travellers to beg charity. In Morocco they are confined
to a separate quarter, or banished to the outside of the walls.
They are, according to Mr. Jackson, but little disfigured by the dis-
ease, except in the loss of the eyebrows, which the females endea-
vour to supply by the use of lead-ore ; while they give an addi-
tional colour to their complexion by the assistance of al akken or
rouge.

In like manner, Niebuhr asserts that one of the species of
leprosy to which the Arabs are subject, is by thtm still called Boak j
but that it is neither contagious nor fatal. Upon which remark his
annotator M. Forskal adds, " the Arabs call a sort of leprosy in
which various spots are scattered over the body Behaq ; which is
without doubt the same as is named pHl (bohak or behaq) in Ley.
xiii. They believe it to be so far from contagious that one may lie
with the person affected without danger.— On May 16, 1163," says
he, "I. saw at Mokha a Jew who. had the leprosy bohak. The
spots are of unequal size : they do not appear glossy ; they are but
little raised above the skin, and do not change the colour of the hair :
the spots are of a dull-white inclining to red."*

The NIGRESCENT LEPROSY ; forming the second variety, is impro-
perly called blacky though it was so named by the Greeks. The
colour, as repeatedly described by the Jewish legislator, is rather

obscure, darkling, or dusky. The term is HflD (cecha) whence the
Latin csecus: and it immediately innports obfuscous, or overcast
with shade or smoke. The character in Celsus is in perfect accord-
ance with this, as he explains to us that ^fAa«, or niger, in its appli-
cation to this variety imports " umbrae similis," '^ shade-like," or
*' shadowed." The hue is tolerably represented in Dr. Willan's
plate, but better in Dr. Bateman's in which it has been retouched.
The natural colour of the hair, which in Egypt and Palestine Is
black, is not changed, as we are repeatedly told in the Hebrew code,
nor is there any depression in the dusky spot ; while the patches,
instead of keeping stationary to their first size, are perpetually
enlarging their boundary. The patient labouring under this form
was pronounced unclean by the Hebrew priest or physician, and
thereby sentenced to a separation from his family and friends:
and hence there is no doubt of its having proved contagious.
Though a much severer malady than the common leprosy, it is far
less so than the leuce or third variety : and on this account is
described more briefly in the Hebrew canon. In our own quarter
of the world the exfoliated surface in the nigrescent or dusky
leprosy remains longer without new scales, discharges lymph, often
intermixed with blood, and is very sore. When it covers the scalp
it is particularly troublesome. With us it is chiefly found among
soldiers, sailors, sculler-men, stage-coachmen, brewers^ labourers,
and others, whose occupations are attended with much fatigue, and

* Reisebcschreibung nacb Arabien und andcrn-unliegenden Lnndtrn. Band. J*
Koponhag. 4to. 1774.

VOL. IV. 60

394 ECCRITICA. [CL. VI.-OR. ID.

expose them to cold and damp, and to a precarious or improper
mode of diet. For the same reason, women habituated to poor living^
and constant hard labour, are also liable to this form of the disease.

In consequence of the increased eicitement and irdtabilltj of the
Bkin in the hot and sandy regions of Egypt and Palestine, there is,
however, a far greater predisposition to leprosy of all kinds, than in
the cooler temperature of Europe. And hence, under the next
variety, we shall have occasion to observe, from the Levitical
account, that all of tnem were apt to follow upon various cracks or
blotches, indanunations or even contusions of the skin.

The BRIGHT-WHITE LEPROSY, Is by far the most serious and obstinate
of all the forms which the disease assumes. The pathognomic
characters dwelt upon by the Hebrew legislator in deciding it are,
^'a glossy*white and spreading scale upon an elevated base, the
elevation depressed in the middle but without a change of colour,
the black hair on the patches which is the natural colour of the
hair in Palestine, participating in the whiteness, and the patches
themselves perpetually widening their outline.'' Several of these
characters taken separately belong to other lesions or blemishes of
tbe skin as well, and therefore none of them were to be taken
alone : and it was only when tbe whole of them concurred, that the
Jewish priest, in his capacity of physician, was to pronounce tbe
disease, a tsorat (/IjrCt) or malignant leprosy. We have said that
in lepriasis, the rete mucosum, or colorific adipose layer of tbe skin,
is peculiarly aflfected, and we have here a still more distinct proof
of this assertion in the change of the hair, the colour of wMch Is
derived from this material. This change is produced by the barter
of a black for a white colouring material, probably a phosphate of
lime, which gives also the bright glossy colour, not hoary or dull, to
tbe scaly patches; and which in ichthyiasls, forming the fourth
species of the present genus, we shall find is occasionally deposited
on the surface in prodigious abundance.

Common as this form of leprosy was among the Hebrews, diiring^
and subsequent to their residence in Egypt, we have no reason to
believe it was a family complaint, or even known amongst them
antecedently : and there is hence little doubt, notwithstanding the
confident assertions of Manetho to the contrary, that they received
the infection from the Egyptians instead of communicating it to
them. Their subjugated and distressed state, however, and the
peculiar nature of their employment, must have rendered them very
liable to this as well as to various other blemishes and misaffections
of the skin : in the production of which there are no causes more
active or powerful than a depressed state of body and mind, hard
hibour under a burning sun, the body constantly covered with the
excoriating dust of brick-fields and an impoverished diet ; to ail of
which the Israelites were exposed whilst under the Egyptian
bondage.

It appears also, from the Mosaic account, that in consequence of
these hardships, there was, even aAer they had left Egypt, a general

GE. IV.-SP,

11.]

EXCERNENT FUNCTION.

395

JiredispoaitioD to the tsorat or contagious forms of leprosy, so that
t often occurred as a consequence of various other cutaneous affec-
tions ; sometimes appearing as a berat Ubena (j^XP jy\ni ) or
bright-white leprosy, and sometimes as a berat eecha {JUn^ J1*V1^)
du^y leprosy, according to the pecuKar habit or idiosyncrasy.
The cutaneous blemishes or blains which had a tendency to termi-
nate in leprosy, and which were consequently watched with a
suspicious eye from the first, are stated by Moses to have been the
following :

1. Saat (rtW) *

2. Saphat (JVTBD).!

3. Netelc (pW)-!

4. Berat («T>3).§
6. Boak (pni).||

6. Nega (V13\l[

7. Shechin (prw) **

8. Mecutash QdH n»D).tt

Herpes, or tetter, •©An, Sept. an
irritated cicatrix.

Psoriasis, or dry scall. — Dry sa-
hafata. Arab.

Porcigo, or humid scall. Por-
rigo. Lat. vers. Jun. et Tre-
mel. Moist sahafata. Arab.

Leuce, bright-white scale: the
critical sign of contagious le-
prosy.

Alphos, dull-white scale : the
critical sign of uncontagious
leprosy.

Ictus, blow or bruise : i*^, Sept.

Furunculus, or boil, as in Job,
ii. 7.

Anthrax, or carbuncle : literally
^^ a fi^ry inflammation.'^

On the appearance of any one of these affections upon a person
he was immediately brought before the priest for examination.
If the priest perceived that in connection with such blemish there
were the distinctive signs of a tsorat or contagious leprosy, as a
bright glossy and squammous surface, with a depression in the mid-
dle, and white hairs, the person was immediately declared unclean
and is supposed to have been sent out of the camp to a lazaretto
^provided for the purpose. If the priest had any doubt upon the

• Lcvit. cap. xlii. 2, 10, 19, 43.

t Id. V. 2, 6, 7, «.

t Id. V. 30, 31.

4 Id. V. 2, et s»pe alibi.

II Id. V. 39.

IT Id. V. 29. 42.
♦• Id. V. 18.
tt Jd. V. 2^

396 ECCRITICA. [CL. n.-OR. II.

subject, the person was put under domestic confinement for seven
days, when he was examined a second time ; and if in the course of
the preceding week the eruption had subsided and discovered no
tendency to the above distinctive characters, he was discharged at
once. But if the eruption were stationary, and the result still
doubtful, he was put under confinement for seven days more : at
the expiration of which, on a third examination, the nature of the
disease always sufficiently disclosed itself; and he was either sen-
tenced to a permanent separation from the community, or pronounc-
ed clean, and set at liberty.

These doubtful cases, as we have just noticed, sometimes super-
induced the bright-white, and sometimes the dusky leprosy, appa-
rently according to the particular constitution of the skin, or of the
habit generally. And we are further told that there were two
ways in which the disease, and particularly the severest or bright-
white form of it, terminated ; — a favourable and an unfavourable.
If it spread over the entire frame without producing any ulcera-
tion, it lost its contagious power by degrees ; or, in other wordai,
run through its course and exhausted itself. In which case, there
being no longer any fear of further evil either to the individu-
al himself or to the community, the patient was declared clean by
the priest, while the dry scales were yet upon him, and restored
to society.* If, on the contrary, the patches should ulcerate, and

quick or fungous flesh (^H ^tt^3),t spring up in them, the priest
was at once to pronounce it an inveterate leprosy ;| a tempora-
ry confinement was declared to be totally unnecessary, and he was
regarded as unclean for life. The accuracy with which this second
termination is described, is fqlly confirmed by the passage quoted
already, but for another purpose from Actuarius, and it is curious
to observe how closely they coincide. " The lepra," says the lat-
ter, speaking of it in its worst form, " penetrates deep, forms circular
eruptions and certain funguses or deliquescences of flesh." But we
meet with nothing in the Mosaic account that approximates it to ele-
phantiasis : nothing of a thick, rugose, livid tuberculate, and, particu-
larly, an insensible skin ; nothing of fierce and staring eyes, hoarse, and
nasal voise, or of a general falling off'of the hair. And hence we have
additional proof that these maladies were distinct, and unconnected.
This malignant state of the disease, however, is still generally called
after the Greek misnomer elephantiasis : and the two maladies in con-
sequence hereof are to this hour confounded in the Greek islands,
and even as far north as Iceland, the ultima Tkule to which the lite-
rature of the Greeks has travelled :*but we have sufficient proof in
all these cases, from some of the best travellers of the present day,
that the disease thus described is not the tubercular or thick-legged
elephantiasis, but the above malignant form of genuine leprosy.
Thus, Mr. Jowett, in his very mteresting " Christian Researches

• Levit. cap. xiii. v, 12, 13.
t Id. V. 10, 14, 15.
t IH. V, 11.

GE. IV.-SP. n.] EXCERNENT PlU^CTIOK. 397

in the Mediterranean," in describing the beautiful, but now, from
its political reverses, roost pitiable island of Hai?ali or Kydonia,
nearScio, "» little farther on is the hospital for lepers: it was
founded bj a leper. Elephantiasis is no uncommon disorder in
these parts ; its effects are very offensive. I saw poor men and wo-
men with their fingers or legs literally wearing or wasting away ;"*
— forming a character directly opposite to what occurs in proper
elephantiasis; where the limbs, though they continue to crack, con-
tinue to thicken enormously, even to the moment of separation.
Dr. Henderson, on the contrary, while describing the real elephan-
tiasis in Iceland, calls it the Jewish leprosy, and offers a sort of
apology for Moses that he " has not noticed the very striking anes-
thesia, or insensibility of the skin,''! which, continues he, " is an
inseparable attendant of the genuine elephantiasis." The direct
answer is that Moses delineates a different disorder and one in which
no such symptoms exist.

As leprosy, except in its less common and contagious modifications,
has always been accounted a blemish rather than a serious disease in
the East, the art of medicine has rarely, in that quarter, been
gravely directed towards it, save in the use of the oxyde of arsenic,
which is by far the most eflScacibus of every remedy that has
hitherto been tried in any quarter. I have already had occasion to
notice the preparation and proportion of this mineral, employed from
time immemorial, in treating ofelephantiasis, for which disease, also,
it is in common use : and the reader may turn to the passage at his
leisure. But^ with the exception of arsenic, the remedies proposed
by the Asiatics are trifling and little worthy of notice.

In Europe the mode of treatment has, indeed, been far more
complicated, but 1 am afraid not much more skilful or successful :
consisting, till of late years, of preparations quite as insignificant as
any that occur in the Arabian writers, and often highly injurious by
their stimulating property. Of the insignificant the simplicity of
modern practice has banished by far the greater number : and it is
now, perhaps, hardly known to the general, or even to the medical
botanist, that meadow scabious^ and several other species of the same
genus were so denominated from their being supposed, when em-
ployed as a wash in the form of decoction, to possess an almost
specific virtue against leprosy, itch, and almost every other kind of
foul and scabious eruption.

Warm bathing, simple or medicated ; and this frequently repeated,
is advantageous to all th^ varieties ; for it tends to remove the
scales, soften the skin, and excite perspiration. In the nigrescent
leprosy, which proceeds chiefly from poor diet in connexion with
sordes, the bath should be of pure fresh water, and the remainder

* Christian Researches in the Mediterranean, p. 65. 8vo. 1822,
t Iceland ; or, the Journal of a Residence in that Island,

398 ECGRITICA. [CL. TI.-OR. lU.

of the care will generally, io such case, depend upon a hetter regi-
men, and general tonics. In the other varieties, when they occur
among ourselves, the sulphureous waters of Ijfarrowgate, Crofl, and
Moffat, whether applied externally or internally, seem frequently to
prove more efiBcacious. As external applications, most benefit
appears to be derived from the tar-ointment, as employed by Dr*
Willis, and a dilute solution of sublimate, or the unguentum hy-
drargyri nitrati, as recommended by Dr. Willan. These medicines
should be applied to the skin, and the former of them be well rub-
bed in upon the parts affected every night, and carefully washed off
the next morning with warm water, or a slight alkaline lotion.

As internal medicines the most useful seem to have been the sola-
Dum Dulcamara^ and ledum palustre^ in decoction or infusion. Dr.
Crichton strongly recommends the former, and speaks in high terms
of its success. I have not been so fortunate in the trials I have
given it. The ledum in Sweden,* and, indeed, over most parts of
the north of Europe, as high up as Kamschatka, has long maintained
a very popular character, and the form of using it is thus given by
Odhelsus in the Stockholm Transactions for 1774. Infuse four
ounces of the ledum in a quart of hot water ; strain off when cold ;
the dose from half a pint to a quart dally.

The bark of the ulmus catnpestris or elm-tree, has also been
warmly recommended by various writers, for this, as well as nume-
rous other cutaneous eruptions; and, in connexion with more active
medicines, appears to have been of some use, but it is feeble in its
effect when trusted to alone. Its form is that of a decoction, two
ounces to a quart of water: the dose half a pint morning and
evening.!

The oenanthe crocata^ or hemlock drop-wort, is another plant that
^has been recommended in obstinate and habitual cases of this kind ;
and there are unquestionable examples of it having produced a
beneficial effect Dr. Pulteney has especially noticed its success
in a letter to Sir William Watson. The herb, however, is one of
the most violent poisons we possess in our fields, and when mistaken
for wild cellery, water-parsnip, or various other herbs, iftte fre- ^
quently proved fatal a few hours after being swallowed, exciting
convulsions, giddiness, bck-jaw, violent heat in the throat and
stomach, and sometimes sickness, and purging: and where the
patient has been fortunate enough to recover, it has of^en been with
a loss of his nails 'and hair. Goats, however, eat it with impunity,
though it is injurious to most other quadrupeds. As a medicine, it
is given in the form of an infusion of the leaves : though sometimes
the juice of the roots has taken the place of the leaves. Three
tea-spoonfuls of the juice is an ordinary dose, which is repeated
every morning.

* Ltnnstis, Diss, de Ledo palustri. Upsal, 1775.
Abhandl. der Konigl, Schwed. Academic der Wissenchaffen. Band, xi*!* p-
194.

t Medical Transactions, Vol. ii. p. 203.

Ct. IV.-SP. 11.] EXCERNENT FUNCTION. 399

But by far the most active and salutary medicine for every form
of leprosy, in Europe as well as f^ Asia, is arsenic. I have already
adverted to its common use in the latter quarter, and at home, in
the form of the College solution, it has often been found to succeed,
when every other medicine has been abandoned in despair. The
ordinary dose is five minims twice or even three times a-day, in-
creased as the stomach will allow. 4

SPECIES III.

LEPIDOSIS PSORIASIS.

9rs Sbcall.

PATCHES OF ROUGH, AMORPHOUS SCALES ; CONTINUOUS, OR OF INDETERAU-
NATE OUTLINE ; SKIN OFTEN CHAPPY.

Psoriasis is a derivation of ^'^^a, ^^ scabies, asperitas,'' with a termi-
nal ir«(, as in the preceding species. The primary term ^tt^^ or
psora, was used in very different senses among the Greek writers
from a cause I have already explained under lepriasis, where it has
been shown that the real radical is the Hebrew term JT^ (tsora),
*' to smite malignantly, or with a disease," whence ttjf^'^ tsorat),
imports the leprosy in a malignant or contagions form, but not in an
uncontagious. The lexicographers not hitting upon the proper origin
of-^tt^ have supposed it to be derived from ^utt (psao), which means,
however, unfortunately "tergo, detergo," "to cleanse, purify, or
deterge," — instead of " to pollute :" but as one way of cleansing is
by scraping, and, as persons labouring under psora scrape or scratch
the skin on account of its itching, the difficulty is supposed to be
hereby solved, and psora is allowed to import derivatively, what,
upon this explanation, it opposes radically.

The actual origin of the term, however, is of little importance.
It was mostly employed by the Greek writers, and has been very
generally so in modem times to import a dry scall or scale, for the
terms are univocal, the Saxon sceala or scala being the origin of the
former, and denoting the latter, of a rotigh surface and in indeter-
minate outline, as expressed in the specific definition.

Psoriasis, as thus interpreted, is the dry Sahafati of the Arabian
writers, the r\J^^D Saphat of the Levitical code, as already ex-
plained; the Arabic being derived from the Hebrew root. It
embraces the following varieties :

• Guttata. Drop-like, but with irregular

Guttated dry scall. margin. In children contagious.

400 ECCRITICA. [CL.VI.-0R. IU»

C Gyrata. Scaly patches in serpentine or

Gyrated dry acall. tortuous stripes. Found chiefly

on tiie back, sometimes on the
face.
y Diffusa. Patches diffuse, with a ragged.

Spreading dry scall. chopped, irritable surface : sense

of burning and itching when
* warm: skin gradually thicken-

ed and furrowed, with a pow-
dery scurf in the fissures. Ex-
tends over the face and scalp.
3 Inveterata. Patches continuous over the whole

Inveterate dry scall. surface ; readily falling off and

reproducible with painful, dif-
fuse excoriations. Extend to
the nails and toes, which be-
come convex and thickened.
Found chiefly in old persons,
ff Localis. Stationary and limited to particu-

Local dry scall. lar organs.

In the FIRST or guttated variety, the patches very seldom ex-
tend to the size of a sixpence ; and are distinguished from those of
leprosy by having neither an elevated margin nor an elliptic or
circular form, oflen spreading angularly, and sometimes running in-
to small serpentine processes. The eruption commences in the
spring mostly on the limbs, and appears afterwards distributed over
the body, sometimes over the face. It subsides by degrees towards
the autumn, and sometimes reappears on the spring ensuing.

In children, probably from the greater sensibility of their skin,
this variety of scall spreads often with great rapidity, and is scat-
tered over the entire body in two or three days.

The SECOND or gyrated variety runs in a migratory course, and
apes the shape of earth-worms or leeches when incurvated, with
slender vermiform appendages. Not unfrequently the two ends
meet, and give the scall an annulated figure like a ring-worm, par-
ticularly about the upper part of the shoulders or on the neck, in
which case they are sometimes confounded with shingles or some
other modification of herpes.

The spreading scall commences commonly on the face or tem-
ples, as the first of the preceding does on the extremities, and the
second on the back. It is sometimes confined to a single patch, which
nevertheless, is occasionally to be seen in some other part, as the
wrist, the elbow-joint, breast, or calf of the leg. It is often obsti-
nate and of long duration, and has been known to continue for a
series of years: in which cases, however, there is usually an ag-
gravation or extension of it at the vernal periods. It is at times
preceded by some constitutional affection ; and at times seems to
produce the same. When limited to the back of the hand this, like

<HE. IV.-SP, III.] EXCERNENT FUNCTION, 401

dome other forms of lepidosis, is vulgarly called the Bakers Itch.
On the hands and arms, and sometimes on the face and neck, it is
peculiarly troublesome to washer-women ; probably from the irri-
tation of the soap they are continually making use of.

The inveteracy of the fourth variety seems principally to spring
from the general torpitude and want of power in the class of
persons whom it chiefly attacks, which is those who are in the de^
cline of life. It is accompanied with painful excoriations, in many
instances occasioned by the pressure of some parts of the clothing
against the sores, or by the attrition of contiguous surfaces, as of
the nates, groins, thighs, and scrotum. At an advanced period of
the disease, the cuticle is often still more extensively destroyed ;
and the extremities, the back and nates have been seen excoriteited
at the same time, with a very profuse discharge of thin lymph from
the surface : aAer which the discharge itself thickens, from an ab-
sorption of the finer parts, and forms a dry, harsh, and almost horny
cuticle, which progressively separates in large pieces. At first,
this variety intermits in the summer, but at length becomes per-
manent and intractable.

The LOCAL VARIETY is fouud chiefly on the lips, eye-lids, pre-
puce, scrotum, and inside of the hands. It is peculiarly common to
shoemakers, and artificers in metallic trades, as braziers, tinmen,
and silversmiths; probably from filth and the irritation of the sub-
stances they make use of

The DRY scALL, uudor one or other of the above forms, is one
of the most frequent cutaneous diseases in this kingdom, and the first
variety, guttated or drop-scall, psoriasis guttata, is sometimes con-
tagious in irritable skins, and especially among children. Several
of these modifications are also found, occasionally, as symptoms or
sequels of lues, particulaaly the first three; but are in every in-
stance distinguishable by the livid or chocolate hue of the scales.

As cutaneous sovdes, in connexion with a peculiarity in the con-
stitution of the akin, and especially in connexion with a meagre
diet, indolence, and want of exercise, appears to be the general
caase of this as well as of many other, perhaps most other, simple
eataneous eruptions, the first principles of a curative intention must
consist in washing and softening the skin by warm bathing, regu-
larly persevered in ; and in improving the diet, and exciting to a
Mfe of more activity. Beyond this the common treatment of pso-
riasis should be with little exception, that of lepriasis : and hence
the sulphureous waters of Harrowgate, Croft, Sharpmore, Brough-
toD, Wrigglesworth, and other places, used both externally and in-
ternally, will succeed better than common spring or river-water.
Chalybeate medicines, and particularly chalybeate waters, have
been powerfully recommended by Dr. Willis and many others : but,
excepting where the disease is combined with a languid circulation,
as in the inveterate form, and demands excitement, these do not
appear to be of any certain eflicacy. Bleeding and the repetition
of purgatives are of no avail though a common practice with many,

VOL% IV. 51

402 ECCRITICA. [CL. Vt.-OR, lU.

and founded also on the authority of Dr. Willis. " Strong mercu-
rial preparations," observes Dr. Willan, " are of no advantage, but
eventually rather aggravate the complaint." Nor do the fresh
juices of the alterant plants, scurvy-grass, succory, fumitory, or
sharp-pointed dock, appear to be of any material benefit.

A gentle purgative should open the course of medical treatment ;
to which should succeed an internal use of the fixed alkalies with
precipitated sulphur, and decoctions of elm-root, sarsaparilla, sasar
fras, mezereon, or dulcamara ; and where the skin is very dry aa
antiiinonial at night, or five grains of Plummer^s pill, the compound
submuriate mercurial pill of the London College. Yet here, as in
the preceding species, the most effectual remedy, in obstinate cases,
is the arsenic solution, with an abstinence from fruits, acids, and
fermented liquors : under which plan in conjunction with the above
regimen, most of the ordinary cases will be found to disappear ia
about three weeks or a month.

SPECIES IV-
LEPIDOSIS ICTHYIASIS.

THICK, iNDURAtED IfTCRUSTATTON ENCASING THE SKIN TO A GREATER 01^

LESS extent; scauness imperfect.

The specific term is derived from tx^vt " piscis" with the terminal-
adjunct of the preceding species. The word is commonly written,
but less correctly ichthyosis, since as 1 have already observed the
suffix iasis is by general consent applied to all species appertaining
to the genus or tribe of diseases before us.

In treating of the genns parostia* as well as in various other
places, 1 have had occasion to observe that the calcareous earth
which the assimilating powers of the animal frame elaborate from
the materials of the- food or of the blood, for the use of the bones,
to give them increased size and solidity in adolescence, and to
maintain their firmness in mature life, is, in many cases, secreted
irregularly ; sometimes in excess, sometimes in deficiency, and some-
times imperfectly, or without a due proportion of phosphoric acid,
and other constituents : while, on the other hand, in the advance
of old age, although the secretion may not be much disturbed as to
its quantity or quality, in the process of carrying off the waste mat-
ter the finer parts alone are removed in consequence of the debili-
ty of the absorbents, and the bones become brittle and easily
broken.

* Vol. IV. p. 216.

iCE. ir.-SP. IT.] EXCERNENT FUNCTION. 403

In the genos uthia we have seen that one of the outlets for the
^discharge of the waste calcareous earth is the kidnies : and that
when these are supplied with an excess of earth, or a quantity
beyond what the uric acid will hold in solution, it is apt to suhside^
accumulate, and concrete, and consequently to form calculi.

We have also seen under faboria erratica as well as under lfthia
that the excretories of the skin become at times an outlet of the
fSame kind for the removal of calcareous earth, whence the calcare-
ous deposits in gout and the calcareous scurf which is often accumu-
lating on the head of those who perspire much.

In the disease before us the cutaneous excretories throw forth
such an excess of this earthy material that it of^en encases the entire
body like a shell ; and the cutis, the rete mucosum, and the cuticle
being equally impregnated with it, the order of the tegumental
laminsB is destroyed, and the whole forms a common mass of bony
or homy corium, generally scaly or imbricate, according as the cal-
careous earth is deposited with a larger or smaller proportion of
gluten, in many instances of enormous thickness, and sometimes
giving rise to sprouts or branches of a ven grotesque appearance :
thus offering to us numerous varieties, of which the following are
the chief:

M Simplex. The incrustation forming a harsh

Simple Fish-skin. papulated or warty rind ; hue

dusky ; subjacent muscles flexi-
ble. Sometimes covering the
whole body except the head and
face, palms of the hands, and
soles of the feet.

C Cornea. The incrustation forming a rigid,

Homy Fi8li-«kifi. horny, imbricated rind ; hue

brown or yellow ; subjacent mus-
<:les inflexible. Sometimes co-
vering the entire body includ-
ing the face and tongue.

y Coraigera. The incrustation accompanied with

Comigerous Fish-skin. bora-like, incurvated sprout-

ings ; sometimes periodically
shed and reproduced.

This indurated incmstaiion commences with a change in the
papillae of the cutis ; which are elongated and enlarged into roundish
cones or tubercles, often void of sensation. Some of the scaly
papiilffi have a short, narrow neck, and broad irregular lops. Some-
times the scales are flat and laige, and imbricate or placed like
tiling, or the scales on the back of fishes, one overlapping another.
They also differ considerably in colour in different instances, and
are blackish, brown, or white. The skin, to a very considerable
jextenti has sometimes been found thickened into a stout, tougl^

404 ECCRITICA. [CL. VL-OR. IHU

leather. In a singular enlargement of the lower extremity produc-
ed by a puerperal sparganosis Mr. Chevalier found the thickness of
the corium in some parts near a quarter of an inch ; which, on being
cut into, presented the same grained appearance that is observable
in a section of the hides of the larger quadrupeds. Below the
coriaceous skin the adipose membrane exhibited an equal increase
of substance, and in front of the tibia was not less than an inch and
a half thick. Mr. Machin gives a very extraordinary case of icthy-
iasis of the same kind, originating, indeed, from a different and un-
known cause, which covered the whole body with the exception of
the. head and face, the palms of the hands, and the soles of the feet
The entire skin formed a dusky, ragged, thick case, which d&d not
bleed when cut into or scarified, was callous and insensible, and was
shed annually like the crust of a lobster, about autumn, at which
time it asually acquired the thickness of three-fourths of an inch, and
was thrust off by the sprouting of a new skin beneath.* This man
married, and had a family of six children, all of whom possessed the
same ragged covering as himself The father was twice salivated
for the complaint, and threw off the casing each time, as did one of
the children during the small-pox ; but the disease soon returned on
both of them. In the Transactions of the Medico-Chirurgical Socie-
ty there is a case in which the face alone was exempted from the
fish-scale covering.t

There is a remarkable passage in the Lettres Edifiantes et
Curieuses, of the Jesuits which intimates that this disease is by no
means uncommon among the inhabitants of Paraguay, the words,
which have been quoted by M. Buffon and Dr. Willan, are as fol-
lows : " 11 regno parmi eux une maladie extraordinaire : c'est une
espece de L^pre, qui leiir couvre tout de corps, et y forme une
crodte semblable a des ecailles de poisson : cette incommodite ne
leur cause aucune douleur, ni meme aucun autre derangement dans
la 8ant6."t There is perhaps no part of the world where we
should sooner expect to meet with this, and indeed various other
species of squammosc or leprous affections of the skin, considering
the sultry heat of the atmosphere, the rankoess of the perspiration
that issues from the bodies of the natives, apd their deficiency in
personal cleanliness ; yet 1 do not know that the same account has
been given by any other travellers, and have looked in vain over
Estalla and Dobrizhoffer: nor does this particular incrustation of
the skin seem to be preyalent in other inland countries exposed to
the same excitements, though most of them exhibit squammosc db-
orders of the surl'ace of some kind or other.

In our own country it often shows itself locally and is restricted
to a single limb, as an arm, leg, or soles of the feetf and it has

•Phil. Trans. No. 424.

t Trans. Medico-Chir. Soc. Vol. ix. p. 52.

I Recueil de Lettres, kc, xxv^ p. 123.

«B. IV.-6P. rV.] EXCERNENT FUNCTION. 405

sometimeB fiited on a cheek, an interestiog figure of which is given
iQ Dr. Bateman^s Delineations. *

Examples of the cornigerous vaiiety, or •that in which the incrus-
tation is accompanied with a sprouting of horns or horn-shaped pro-
jections are by no means uncommon. Sir Everard Home has given
two cases in the Philosophical Transactions that occurred within
liis own knowledge. The patients were women, about the middle
of life, or rather later : one had four horns, and the other a single
horn. Each of them grew from a cyst which formed gradually,
and at last opened spontaneously and discharged " a thick gritty
fluid.''* The foreign journals ar? full of similar accounts, In some
of which the horns are of considerable length, mostly growing upon
the head, though in a few instances on the back.t In the British
Museum is shown us, as a curiosity, a horn of this kind eleven inches
long, and two and a half in circumference at the base. It is said to
have issued from a wen that formed in the head of a woman, and to
have reached its full length in four years.

When these are single they rather perhaps belong to the genus
ECPHTMA, and particularly the species verruca and clavus ; but they
are very frequently connected with a dry inrfuraceous or scaly skin,
often oozing a calcareous material. A very singular example of this
complex modification occurred a few years ago in a Leicester-
shire heifer which was publicly exhibited, and of which the au-
thor presented a descripdon and a drawing to the Royal Society.
The whole of the skin was covered with a thick, dry, chalky scurf,
often producing an itching ; and whenever the skin was scratched,
a calcareous fluid oozed from it that soon hardened, and put forth
corneous, recurvating excrescences, frequently divaricating, and as-
suming sometimes a leafy, sometimes a horn-shaped appearance.
The back was covered with them ; over the forehead and below the
dew-lap they hung in some hundreds ; many as large as natural horns,
and rattling together whenever the animal moved. The heifer
was otherwise in good health, and secreted the same chalky fluid
whatever food it was fed upon.

Medicine has hitherto bei^ found of but little avail under any
form of this afiection. Dr. Willan advises to immerse the incrusted
part in water, and to pick ofl" the scales with the finger-nails, while
thus soaked. Dr. Bateman recommends that the bath should be
of sulphureous waters, and the scales rubbed ofl" with a flannel or
rough cloth. But both admit that their methods produce only a
partial cure ; that the skin does not recover its proper texture, and
that the eruption will probably recur. Dr. Bateman further recom-
mends, as having been actually serviceable, pills made of pitch
hwlened by flour or any other farinaceous substance, which makes

• Phil. Trans. Vol. Lxxxi. 95.
t Eph. Nat. Cur, Dec, i. Ann. i. Obs, 30.
Se« also Hist, de la Societp Royale do la Medicine, 1776, p. 316.

406 BcciuncA. \cu yl-oiu iu.

the cuticle crack and fall off, as he tells us, without the aid of exteroal
means, and leaves* a sound skin underneath. Where there is an
evident excess of calcareous earth the most efficacious remedy ii
probably to be found in a free use of acids, and especiallj the
mineral adds, as in white urinary sand,* to wldch this disease bean
a near resemblance. The arsenic solution, however, is worth
trying) but i iiave no documents of its effects.

GENUS V.

ECPHLYSIS.

ORBICULAR EXEVATIONS OF THE CUTICLE CONTAINING A WATERY FLUID.

EcpHLTSis, (" £»^Xtf0-if, from w^Xo^tf, " ebullio," " efferveo," " to
boil or bubble up or ovei,^') imports ^^ vesicular eruption confined
in its action to the surface ;'' as emphltsis, which we have long since
described,? is '^vesicular eruption essentially connected with in-
ternal and febrile affection.'' The term is intended to include all
those utricles, or minute bladders of the cuticle containing a watery
fluid, and not necessarily connected with internal disease, whether
buUa or vesicula^ between which Dr. Willan has made but little
difference in his definitions, except in respect to size ; and which
were equally denominated by the Greek physicians phlyctaeoaB, a
term derived from thei^same source. And hence the species that
fiiirly appertain to this genus, appear to be the following :

1. ECPHLYSIS FOMPHOLYX WATER-BLEBS.

J. — ^— HERPES. TETTER.

3. RHYFCA. SORDID BLAIN.

4. ECZEMA. HEAT-ERUPTION.

^ Supra«p. 340.
+ Vol. u. p. 386.

«R V.-SP. l] EXCERNENT FimCTION# 407

SPECIES I.
ECPHLYSIS POMPhSlYX.

ERUmOirOF BLEB8, CONTAimNO A REDDISR, TRANSPAREITT FLUID ; MOSTLY
DISTINCT ; BREAKING AND HEALING WITHOUT SCALE OR CRUST.

PoMPHOLTX or pomphos, was used amongst the Greek writers In the
sapie sense as pemphix, of which we have treated already,* and
equally imported a bladdery tumour of the skin, distended with a
fluid: the Latins denominated it bulla, of which our own term
WATER-BLEB Is au apt and exact representative. PEBfpnix in the
modem use of the term, is necessarily accompanied with fever, and
hence under the present arrangement is an emphlysis as poMPHOLYXy
being without fever or other constitutional affection necessarily con-
nected with it, is an ecphlvsis. The latter is hence denominated
Peoophigus apyretos by Plenck, and Pemphigus sine pyrexift by
Sauvages. it has, however, been properly separated from pemphi-
gus by Dr. Willan, who has arranged it as it stands in the present
work. It offers the four following varieties :

• Benignus. Blebs pea-sized, or filbert-sized;

Mild water-blebs. appearing successively on various

parts of the body; bursting in
/ three or four days, and healii^

readily.

e Diutinus. Blebs- gradually growing from smalt

Lingering water-blebs. vesicles to the size of walnuts ;.

yellowish : often spreading in suc-
cession oyer the whole body, and
interior of the mouth ; occasion-
ally reproduced, and forming an
excoriated surface with ulcera-
tion. Often preceded by languor,
or other general indisposition for
several weeks. Duration from
two to four or five days.

y Quotidianus. Blebs with a dark red base, appear-

Quotidian water-blebs. ing at night and disappearing in

the morning, or appearing in the
morning and disappearing at night.
Found chiefiy on the bands and
legs.

* Vol. II. 402. ttopblysis Pem^igus.

408 EccRiTicA. [cl; VI.-OR. nt*

3 Solitarius. Bleb solitary; but reprodnctiYe ia

Solitary water*bleb. an adjoining part ; very large, and

containing a tea-cup-fall of lymph.
# Preceded by tingling: often ac-

companied with languor.

The third, or quotidian rariety, is here introduced upon the
authority of Sauvages, for it does not occur in Willan, who seems to
have overlooked it : and hence it is not noticed by Bateman.
Sauvages, from the time of its more usual appearance, caJJs it
epinyctis ; but as Vandermonde has given a case of an opposite Jdnd,
in which the bulla showed itself daily and subsided nightly, this
name will not properly apply.

Under whatever form, however, the pompholyx appears, its
causes seem to be debility and irritability either general or confined
to the cutaneous exhalants. The benign variety has hence been
found in infancy during teething and bowel complaints, and occa-
sionally immediately after vaccination. The quotidian has evidently
succeeded to great anxiety, fatijpue, watching, and low diet. It
appears also chiefly in persons of advanced age, or who have been
unduly addicted to spirituous liquors. It is by far the most severe
of all the forms of the disease, as being painful as well as tedi6us.
The other varieties are to be referred to like causes.

In early or middle life, Peruvian bark given freely, with aor
improved diet, where necessary, has formed the most successful
remedy. In old age, softening the skin, and gently exciting the
cutaneous exhalants, has been equally useful : but while the bark is
less serviceable in old age, warm bathing has proved rather inju-
rious in earlier life.

SPECIES II.

ECPHLYSIS HERPES.

Better*

ERUPTION OF VESICLES IN SMALL, DISTINCT CLUSTERS ; WrTH A RED ^ARGIN ;
AT FIRST PELLUCm, AFTERWARDS OPAKE ; ACCOMPANIED WITH ITCmNG
OR TINGLING ; CONCRETINO INTO SCABS : DURATION FROM FOURTEEN Ta
TWENTY-ONE DAYS.

Herpes from i^vw, ^ serpo,'' ^^ repo,^' has been used in very different
senses by different writers : being sometimes restricted to one or
two of the modifications of the present classification, and by others
extended so widely as to include bothike precedii^ and the ensu-
ing genus — or, in other words, cutane^ eruptions, dry, vesicular,

eft. V.«*8F. n^} ' fiXCERKfilSm FtfKcllON. 4tiSI

and pistiikrt and in this latitadlttariaD sense of the term ^t is
•nployed hj Mr B. Bell, who fives us a herpea lariaaaus^ and
postulosns) as well as a herpes imliaris aod exedeos.

In the present arranfeinent the term is limited to minute and ^
closteriD^ cutaneous vesicuiar eruptiom alone, which forms a clear
and distinctif e indication. The fluid contained in the vesicles is
An* the most part hisrbly acrimonious and excoriating ; and hence
tile terms ht^H and im^oq (darsis and dartus) ^ excoriatio and exco-
lifltQs,^' hare been applied to it; from which the FVench have
derived their popular name for it of dartre, which, by an easy
ovntiptlon, has been changed in our own tongue into tetter.

The following are the varieties which seem fahrly to belonfg to it :

m Miliaris. Vesicles millet-sized; pelhieid; clusters

Hillary tetter. commencing at an indeterminate part

of the surface, and progres^ely st^ w«

od over the body ; succeeded by fresh

crops.

C Exedens: Vesicles hard ; of the sixe and origin of

ErosiYe tetterj the last ; clusters thronged ; fluid densOi

yellow or reddish ; hot^ acrid, corrod-
ing the subjacent skin, and spreading
in serpentine trails.
y Zoster. Vesicles pearl-8i2ed; the chntert spread-

Slungles. ing round the body tike a girdle ; at

times eonfluent. Occasionally pteced^

ed by general irritatftMi or otiier ««i-

atitutlomd afectton.

S Circinalus. Vesicles with a reddi^ base, mMng in

Ring-worm. rings, the area of the rings slightly

diacAioofied ; often followed by fresh
crops. c

• Iris. Vesicles unitiBg in small rings, surround-

Rain-bdw-worm. ed by four concentric rings of different

hues; vesicular and prominent Usual-
ly found about th^ hands or instep*

The FIRST, or milury variety, is the herpes miliaris of Hippo-
crates and Hoffman, the h. phlyctcnodes of Bateman. The cause or
the peculiar irritability of the skin that excites this affection is very
obscure. The lymph containjed in the vesicles is sometimes
brownish, and for the space of two or three days, other cluster^
successively arise near the former. The eruption commences in any
part of the body. The inclosed lymph sometimes becomes milky or
opake in the course often or twelve days, from an absorption of its
finer parts ; and about the fourth day the inflammation around the
Vesicles assumes a duller red hue, while the minute utricles break
and dis<^harge their fluid, or dry into scales, which fall off, and leavcf
a considerable degree of inflammation below, that still continues to
exude fresh matter, which also forms into dakes, arid (alls off lito^

vol.. PT' 52

410 ECCIUTICA. [CU

that which preceded. The itchii^ it alw^rs werj

and the matter discharged from the yesicleB is so tough wid

that every thing applied in the way of dreMiog adUMBes /veiy

closely, aod is removed with great troohie and imaatiDeM.

To the SECOND, or erosive vARivry, the Greeks gwve ike BMie «f
i^mt wifftmt^ or herpes esthiomenos, of whkh the Latn faerpei
exedens is a mere traaslatioa. Tlie herpes estiiioneDot^ hoimwiaff
has hitherto heen much misunderstood, and bees heM «i>a,Ar
severer character ^an it reailj possesses, in contequeace olV-«B
error that has long since crept into the text of Cekiis, «k1 hetn
propagated in the common editions, in which he is made toaagr thM
the Hvid and fetid ulcer which the Greeks^alled d^^tm^th •< >»ffiitlnmii
degenerates into a herpes esthiomenos, or exedens, ^^ eating herpes ^
as though the herpes exedens formed the worst and most gnagrtlnwm
stage of this ulcer In the volume of Nosology I have McanriBful
this passage critically, and have shown that for herpes esthioOMttOS
we ought to read ^ayimm^ ^ the ulcer called phag§dmim^^^ as it. is
properly given in the corrected text of the vanorum edition^ whieli
settles the dispute at once, and clears Celsus from the timoMij
which has been ascribed to him of converting a eutaoeess wetMbs
affection into a deep spreading ulcer of a cancerous cinracter.
Celsus, therefore, in reality BMikes no mention whatever of the
herpes exedens or esthiomenos ; and it is to other wiiten we mvt
turn for its character. Galen has described it very accusalehr c «ad
in the vohime of Nosology 1 have copied and translated Oaka'a
descripHoii, as it occurs in different parts of his^ritlnga. The-dafi*
nition given of it above, is entirely taken from his repretentaliaB.
The ulcerative ring*worm oif Dr. fiateman Is, perhaps, a iMdlfica-
tion of this variety : it is of tedious ai^ difficult cure, bat is Uaited
to hot climates.

Where iMs variety is connected^ as it is sometimes found to be,
with the stateof the constitution, and particularly of the stottMh^
and the patches are accompanied with a sensation of actual banana
or scalding, so as to resemble a more papulated form of meaalos,
like the measles of this modification they are denominated aifhwia
some parts of Scotland.

The THiRo TARiETY, HERPES ZOSTER, IS the soua Ignoa dT naay
writers, both which terms imply a beit or girdle, and are etidoaHy
given to the eruption from its ordinary seat and course as sunraaad-
ing the body. The Latin word for these is cingiijiiia, and from da-
gulum our own shingles has been derived in a cornet way. «

A sliffht constitutional affection sometimes precedes the appear-
ance of this form, as sickness and head-ache, but by no meana nae*
rally : for in most instances the first symptoms are those irf* teat,
itching, aod tingling in some part of the tnmk, which, wheia eta^
mined, is found to be studded with small red patches of an irrenlidr
shape, at a little distance from each other, upon each of wluch nik-
merous minute elevations are seen clustering together. Theoe,
when aecotately inspected, are found to be distinctly yeikalary

40ir "VC^HiK U.] BXCEENHIT FUNCTION. 411

imibm eowie if twont^^bur howra tbey ediarge to the sice of small
fmah^ ate p«ffe«tlj tnowparent, sod filled witk a limpid fluid.
^!1ie dwtert are of raiiofis dkmetet, fty>m one to two, or eyen
teec mdietf and are sorroieBded by a narrow red mnrgfin, in cM-
fomace ef tte etteniion of the inflamed base a little bejond
t eengMgated vesidee. During three or four days other clusters
fUmmB te aHae in soeoeasioD^ and with conniJerable regularity,
thal'ia nearly in a ilne with the first, extending always towards the

re at one eatremity, and towards the sternum or linea alba at
otliCT; most commealy passing round the waist like half a sash,
bat eooMtinies, like a sword-belt, across the shoulder. As the
•yatdiai whlek first appeared subside, the vesicles become partially
ceollaent, and assoaie a lirid or blackish hue, and terminate in thin
dark aeabs, the walls of the utricles being thickened by the ezaic-
'latiaa ef the gnosser parts of the contained fluid. The scabs fall
'^ about the tweHlh or ieurteenth day, when the exposed suriaoe
of the skia appears red and tender ; and, where the ulceration and
^Manhaige hare been considerable, is pitted with numerous cica-
tricca. The complaint is generally of little importance, but is some-
Hoiaa aceaaspanied, especially on the decline of the eruption, with
an Mmae d«Bp-seated pain in the chest, which is not easily allayed
hf meilciDe. By some authors, as HoffiaMu and Platner, it is said
te b# eceasioDally malig^nt and dangerous, and Lianguis alludes to
Isro c««i in noUemen that terminated fatally.* The disorder, how-
averi) seems in these instances to haye been of a diffisreat kind from
aldnglaB, aad to htt9€ depended upon a morMd state of the consti-
tattoa.
TUi afieetion is fonnd most frequently in the summer and au-
■ tmrn^ sshaa the skia is most irritaUe from uicreased action, and in
pereoBS of a particular diathesis disposed to herpes, rather tluin to
any otiwr form of scaly eruption. Under these circumstances sli^t
^Mitiag causes will produce it, as exposure to cold after vioknt
•xardse with great heat; cold cncurbitateous yegetables, or
aHiar sahstances that disagree with the stomach; inebriety; or
«!•■ a sadden paroxysm of passion or other strong mental emotion,
ef which Schwarz tells us that he had seen not less than three
oanct it if more common to early tiian to later life, being found
pfftadpaUy between twelye and twenty-fiye years of age. It has
aowttoias appeared critical in bowel-complaints, or pulmonic afiiec-
ltoflB«| It does not seem to be contagious, thoi^ asserted to be so
hy some writwns. ^^ In the course of my attendance,'' says Dr. Bate^
aMa^ ^ at the Public Dispensary during eleyen years, between thir-
ty aad ibity cases of shingles have occurred, none of which were
teaced to a contagions origin, or occasioned the disease iqf other in*
dlvidMb.''
g> > * 1^1* .,.—■■■■ ■■>■,, — ■■ .

« E^it. Med. p. 110.
t DiM. d«Zonl serplgfoosa. Hal. 1745.
'% Bat^mtin on Cutaneous Ptsesfles, p. 2J7. Sto. tf!3,

412 EccRmcA. [ci. r&-#iu m.

The Rnre-woRM is a still slighter variety of iMipta tinn dilB|iM,
boA with respect to disqaieting ^mptoms^ and range of tto^iseMHn
Here the vesicles are restricted to the clrcomfereBee of tiM herpe-
tic patch, thus forming an annular outline ; the oeotral area, him
ever, in some degree participating in the inianimation, beoooMf'
roughish and of a dull red colour, and throws off an exfeiittBOD . jtf
the vesicles decline, leaving a red and tender sarfoee beatalti
The process is completed in about a week: but m freah cro^.ei
herpetic circles freely spring up in the nei^bourfaood^ or in uiiDt
other part of the body ; and, as such crops are occasionally repeirt-
ed many times in succession, the course of the disease is not na^
frequently protracted through a long period, and migratea over ihm
entire surface from face to foot Yet no other incanv^oieiioe at*
tends it than a disquieting itching and tingling in the patches* It it
found most frequently in children, and though deemed contagioas^
affords no real ground for such an opinion. It has, Indeed bees
traced in some instances, in several children of the same school or
family at the same time ; but perhaps only where the same ooc»-
sional cause, whatever that may be, has been operatiiig upon aM of
them : while in most instances, the examples have coadB/t&k \a m»'
gle patients who have not been debarred commtmicatioD or evea
sleeping with their school-fellows, or other branches of a fuaily.

The RAiN-Bow WORM or tetter is of rare occurrence, and wa* by
Pr. Willan at first mistaken for an ezanthem, in conseqoenee-vf ^k
having only seen it in its earliest stage : on which acoooBl ia the
first edition of his Table of Classification he esSled it a wwlnA/om
rash. The error has been corrected by Dr. Bateman, to whMb wm
are indebted for the first accurate description of it its used seat
is on the back of the hands, or the palms and fingera, seoMtknet'oft
the instep. The patches are very small, and at their fall nmrd»
not exceed that of a sixpence. Its first appearhDce is that of an
efflorescence, but by degrees the concentric and iridescent riogt
)[>ecome distinctly formed and vesiculated, and even the area |n»-
takes of the vesication and becomes an umbo. The utricles an
distended in about nine days, they continue stationary for two ilays
more, and then gradually decline, and disappear a week afterwards
The central vesicle is of a yellowish*white colour ; the inoer-
most ring of a dark or brownish-red ; the second of nearly theoesr
tral tint ; the third, which is narrower than the rest, is dark-ted;
the fourth, or outermost, which does not appear till the sevenths
eighth, or ninth day, is of a light-red hue, and is gradually lost in
the ordinary colour of the skin.

This variety has only been seen in young persons, and is uncon-
nected with any constitutional affection. Its exciting cause ia not
known : though it has occasionally followed a severe catarrhal af-
fection, accompanied with hoarseness. It has abo occasionaUy re-
curred several times in the same person, always occupying the same
parts and going through i}s course in the same peripds of time.

«B*Vl*8llII.} EXCERIIEIfT FUNCTION. 41 S

Tke LOctAi. RBM-woRii is aceompanied with a coosiderable soDse
of iMat asd Hchiog or dngliiig irritaUon io the region in which it
orfigiaata& That of the lip renders the adjoining parts hard, and
tamAy aad painful, and especially the angle of the month; tha
fem 10 usnallj semicircular; and though the herpes does not
apread to anj considerable distance, it is sometimes found at tha
tame time within the mouth, forming imperfect rings on the tonsik
smI DTnla, and producing an herpetic sore throat. It usually ap
Mart, howerer, aa a symptom or sequel of some disease of the ah*
oominal Tiacera, and sometimes proves critical to them, it termi-
nates, as in other cases, in ten or fifteen days in dark thick scabs^
wUch ftHna oyer a red and tender new cuticle.

The local ring-worm of the prepuce is apt to be mistaken at first
for a cliancre, and still more so, if, under the influence of this mi^
take, it be treated with irritants, fot the base will then become
ninch more thickened and inflamed, and the natural course of the
▼esicles will be interrupted. If the eruption be \^(i alone, it will
prore itself in about twenty-four hours by the enlargement and dis-
tinct form of the vesicles, and their assuming an annular line. They
die away after having run their course, as in the other varieties.
The exciting cause of this is not known. It has been ascribed,
however, by Mr. Pearson, to a previous use of mercury. Like
aavenil <Mf the other modifications it has a tendency to recur, after it
kaa once shown itself.

No internal use of medicine is necessary in the treatment of any
ef the varieties of herpes, except where the constitution becomes
•fleeted from the irritation ; and in such case, a gentle purgative or
two sheold be administered at first, and a plan of tonics be laid
4own afterwards, tlie diet being simple and plain.

Estemal applications are almost of as little avail, for the erup-
tion muflt have time to run through its course, and if this be inter-
rupted we shall certainly prolong the period, and add to the irrita-
tkm. Stimulating ointments and lotions were in use formerly but
they hav/e now been judiciously laid aside as only tending to ex-
acerbate the affection. Where from the viscosity of the discharged
fluid the vesicles are apt to adhere to the clothes or whatever
covering they come in contact with, they may be covered with a
layer of cetaceous cerate on lint : but a layer of lint alone will be
moat useful in the local variety of the prepuce, as even oleaginous
applications are apt to irritate the disease when in that quarter.

414 BcciwncA. [cLi

SPECIES m.
ECPHLYSIS BHYPIA.
Sbotm main

ERUPTION OP BROAD, FLATTISH, DISTINCT VESICLES ; BASE SLIGHTLT UK
FLAMED : FLUID SANIOUS ; SCABS THIN AND SUFEKFICIAL '. EASILY BUB-
BED OFF AND REPRODUCED.

For a distinct arrangement of this species in medical classification,
we are altogether indebted tp Dr. Bateman, who has denominated
it rupia^ from fwf^ " sordes,** a* indicative of the ill-smell and sor-
did condition of the diseased parts : and in his Delineations has
given two very excellent and instructive coloured plates of its ap-
pearance under different moditications. '?««■««, however, with its
aspirate and the ordinary power of the v should be rendered in
Latin characters rhypia, as now given, and only altered for the sake
of greater correctness.
The species offers three varieties as follow :

• Simplex. Scab flat ; livid or bladdfih ; ahtpt,

Simple sordid blain. circular.

C Prominens. Scab elevated, conical, and blaok-

Limpet-shelled blain. ish ; shape, limpet-shelled.

y Escharotica. Sanious discharge erodve, pro-
Erosive blain. ducing gangrenous eschars.

The vesicles under this species never become confluent : their
progress is slow, and leads to an ill-conditioned discharge wkkh
concretes into thin, superficial, and chocolate-coloured scabs, ttf
the distinctive characters noticed above. When the ulcers under
the scab, in the two first varieties, heal, they still leave the sur-
face of a livid or blackish colour, as if from a pigment in the rele
xnocosum. The second variety assumes the direct form and sweU
of a small limpet-shell with its open part downwards, but its colour
is much darker.*

All the modes of this eruption are connected with a debilitatedt
and hence frequently with a cachectic state of the system, and tke
first is sometimes accompanied with symptoms resembttng those
produced by a morbific poison. They occasionally make a near
approach to the ecthymatat but difier in the form, shape, and stxe
of the vesicle, and in the colour and consistence of the cODtdned

* Bateman, ut supra, p. 237.

t See the ensuing Oenus Species ill. Ecpycsis, Ecthyma.

§M^ u eomMag of flattened oraddy bkiot, and fomiiig larger ead
lAore ctaudar 8c&.

The eseharotic Tariety affects only infants and young children
wlMn redBced by bad diet and nnrsing, or some severe ^sease, as
the amall-poi. Tlie Tesicles are generally found on the loii^
thighs, and other extremities, and appear to contain a corrosiTe
aaia«s: some of which frequently terminate in gangrenous eschars,
wlikh leaTO deep indentations.

The dkease is only to be combated by supporting the system,
and restoring it to a state of vigour by means of good, light, nutri-
tiOQB diet, and the use of alterative and tonic medicines, as Uie
conqpound pili of the snbmuriate of mercury, bark, columbo, tuad
sarsaparilla.

SPECIES IV.
ECPHYSIS ECZEMA.

4UlVmON OF M15UT£, ACUMINATED VESICLES, DISTINCT, BUT CLOflKLT
CROWDING ON EACH OTHER ; PELLUCID OR MILKY ; WITH TaOVBLESOMft
ITCHING OR TINOUNO ; TERMINATING IN THIN SCALES OR SCABS ; OCCA-
SIONALLY SURROUNDED BY A BLUSHING HALO.

EczciiA from ml^jut^ ^^ efferveo'^ is the hidroa of Sauvages and Vo-
gel: it is commoa to all countries in the snmmer, and has been
described in all ages. Its proximate cause is irritation in conse-
^nence of exposure to the direct rays of the sun, or to air hei^d
t^ a high temperature, or violent exercise. Hence it chiefly af-
fects those parts that are most exposed to this influence, as the
fece, neck, and fore anna in women, but particularly the back of
the hands and fingers, the latter being sometimes so tumefied that
the nogs cannot be drawn off. The blushing halo by which they
ve surrounded is popularly called a htaUspot In men of a saD*
guine temperament, and who use violent exercise in hot weather,
these Tesicles are intermixed in various places with minute pus-
tules possessiiig a hard, circular base, the pbylzacium of Willan, or
with hard and painful tubercles, which appear in succession, and
tise to the size of small boils, and suppurate very slowly, though
without a central core. The vesicles are apt to be confoimded with
two other eruptions of rery different kinds, miliaria, while it spreads
widely over the body, and scabies, when fixed chiefly about the
Wrists, the ball of the thumbs, and the fingers. It is, however,
Attinfoishable from the former by being unaccompanied with ierer

or any other comtiiutional derangeneot ; jbjuJl (torn th*i lattor hf-

the pelluciditj and ncuminatioo of the vesicles, . the clotaiMMS Mdr
UDiformity of their dtstributioD, aod the absence of 9atW9vtiMog tft-
flgmmatioo,. or subsequent ulceratioo. The seoaatioa flMrsoveE) to*,
which it gives rise, is that of a smarting or tiogliog rather Ihao
o( itching.

The eruption is irregularly successive, and has oo detemniMte .
period of decline, which very nnuch depends upon the irritability
of the skin itself. Generally, however, it runs its course in two or
three weeks, and subsiileB alowly and almost imperceptibly. But
wbttre the skin is highly irritable it will sometimes ceotluie tili
tk« weather grows cool in the aatamo, and eoBseqaently for two or
eyen three months. ^

Medicine external or internal seems to accomplish but fittle.
The redaction of a cold bath, in most cases, increases the irritatioa:
and hence a tepid bath is most serviceaUe. Astringent lotions add
equally to the irritability, as do unguents of all kinds. Wasbiqf the
parts with mild or Windsor soap and tepid water, I have found most
effectual — wl^en, in a few days, the skin will bear a soap of a coar--
ser kind with still more advantage, l^ere the initabilil^ of the
skin is connected with that of the general frame, the mineral acids,
and other astringent tonics, have proved decidedly beneficial.

The eczema impetiginodes of Dr. Bate man is an eczema set down
on an impetiginous habit of the skin, and is hence a mixed com-
plaint. His eczema rubrum or mercuriale has already been describ-
ed as an erythema.'*'

GENUS VL

ECPYESIS.
l^umOr &call.

ERUPTION OF SMALL PUSTULES DISTINCT OR e0NFLU£NT ; HA|lD£NIMa WtO'
CRUST ULAR PLATES.

EcPTESis is a Greek term from mwv^y ^^ suppuro.'' It is bera used
in contradistinction to empyesis already employed! to import deep-
seated suppurations ; and couse(|ueutly is intended to describe pus-
tular eruptions simply cutaneous, or not necessarily comected with
internal affection as opposed to those which result from an interaal
cause. The genus, therefore embraces the pestnlas of Dr. WiUatt)

* X«y thema vesiculare. VoL ii. p. 310.
t VoL II. p. 411. Class UL Ord« ii.

a. tt] EXCER^JEltT P0*CnON. 417

which he has correctly defined ^^ elevations of *the cuticle with ad
iBflamed hase containing^ pus.''

The old English term for ecpj^sis or pustiila in this sense of the
word, is seall, from the Saxoo scala or sceala^ not essentially different
from the medical sense of scale. The scall was of two kinds, dry
and moist: both which are clearly referred to in the Levitical
law that governed in the matter of plague. The former is there
denominated A*!SD (saphat,) as we hive already observed whea
treating of lepra, and the latter, or the eruption before us pTXi
(netek.)* The Arabians, like our own ancestors, denominated both
these by a common name Tsahafata) from (sahaf,) squammss, or
rather from the iiebrew JinSD (saphat): distinguishing the one
from the other, like our ancestors also, by the adjuncts dry and hu-
tnid : so that th)b sahafata of the Arabians is a direct synonym of
the old English or Saxon scale. Id oui^ established version the He-
brew pn (netek,) which imports the eruption before us or kuniid
acaii, 18 by mistake rendered dry scall, which as remarked above is k
rn&D (saphat.) The expletive dry does not occur in the original,
• add that pj^ (netek,) denotes hutnid scall rather than dry scall, is
clear from the explanation contained in the bible-context, in which
it is represented as a scall seated on the hair or beard, and affecting
its strength and colour, (brming so thick a crust or scab that its re-
moval by shaving cannot be accomplished, or ought not to be at-
tempted. It is distinctly, therefore, a porrigo or scabby scall, and
is thus actually rendered in the Latin version of Tremellius and Ju-
nius, forming one of the species of the present genus ; and seems to
be one of the two modifications of it, which, in our own language,
are denominated honeycomb-scall, and scalled-headi e^MPO^, by
which netek is rendered in the Septuagint, is literally crial, a very
significant term in common use to express the peculiar nature of the
scab that hardens on the porriginous sore. Tett^t, a corruptioa
from the French dartre, or the Greek Xi^rwc, has of late years been
used sydonymously with scall, and has almost supplanted it : but the
proper meaning of dartre, or tetter, is herpes, to which, in this
work, it is confined, an excoriating eruption of a vesicular or icho-
rous kind.

The species that belong to this genus are the following : —

1. ECFYESIS IMPETIGO. RUNNING SCALL.

2. FORRIGO. SCABBY SCALL.

3. — i— ECTHYMA. PAPULOVS SCALL.

4. SCABIES. rrcH.

All these specific terms have been very loosely employed, and in
very different significations by most writers. They are here limit-
ed to the definite senses assigned them by Dr. Willan ; and, with the

• T^viticus x>ii. 30, 31.
VOL. IV. 53

416 BCdtmcA. [cu Ti— oiu m»

exception of ecthyma, by Celsos, whom WiUan hat Allowed. Ec-
thyma doefl not occur in Celtus, though it is foond io Galeii, hat in
a sense somewhat different from its use in modem tioMS, as wiU be
ftirther noticed hereafter.

SPECIES I.

ECPYESIS IMPETIGO.
Umitittfg Skcnll

PUSTULES CLUSTERING, YELLOW, ITCHING; TERMINATING IN ▲ YELLOW
SCALY CRUST, INTERSEdlED WITH CRACKS.

The specific term is a derivative from impeto " to infcst,^^ and the
following are the varieties the species offers us :

m Sparsa.

Scattered humid ScalL

C Herpetica.
Herpetic Scall.

y Erythematica.
Erythematic ScalL

i Laminosa.
Laminated Seal!

ff Exedens.

Erosive Scall.
^ Localis.

Local hwnid Scall.

Clusters loose; irregularly scat-
tered; chiefly over the extre-
mities ; oflen succeeded by fresh
crops.

Clusters circular, crowded vnth
pustules, intermixed with vesi-
cles; often with exterior con-
centric rings surrounding the in-
terioi^ area as it heals ; itching
accompanied with heat and
smarting. Chiefly in the hands
and wrists.

Pustules scattered; preceded hy
erythematic blush and intumes-
cence ; often by febrile or other
constitutional affection. Chie^
in the face, neck and chest.

Pustules confluent ; chiefly in the
extremities ; the aggregate scabs
forming a thick, rough, and
rigid casing around the affect-
ed limb, so as to impede its
motion; a thin ichor exsuding
from the numerous cracks.

The purulent discharge corroding
the skin and cellular membrane.

Confined to a particular part ; most-
ly the hands or fingers ; and pro-
duced by external stimulants, as
sugar or lime.

M. TIi^HIK 1*3 EXCEWfBHT FUNCTION. . 419

The (Meraneee are sofScfently citar from tkese ilefinMom. The
fint variety «r scattbred homid 9call has sometimes beeo confocind^
edi frith vartetier of roRHioo and scames, constitiitiDfif tiro 9Qbe»-
qaent species of the present geoos. it difiers from pmrifro, how*
ever, in haviocr the purulent discharfre succeeded br an ichorous
humour soon after the eruption has shown itself, and in the posses-
fioo of a tliimier and less extensive scab. It differs from scabies in
its more copious exsudation of ichor, when the latter is secreted, in
the magnitude and slower profsrrpss of the utricles, and in the sensa«
tion of heat and smarting, mther than of itching which accompanies
ft And differs from both in being uncontagious.

Tlie znTrmxATK pomi coaimences with the ordinary signs of an
erysipelas, as a redness and puffy swelling of the upper part of the
face with an edema of tlie eye-lids; and the irritation is sometimet
ftcconvpanied with some degree of pyrexy for two or three days.
But a critical eye will easily perceive that instead of the smooth
poHsh of the erysipelas there is a slight inequality on the surface
as if it were obscurely populated, and in a day or two the disease
will show its true cliaracter by the formation of numerous psydraci*
ons pustules over the inflamed and humid skin, instead of the large
irregular buUsB of the erysipelas. 'J he pustules are formed with a
tense of heat, smarting and itching, and, as they break, they dis*
charge a hot and acrid fluid, which adds to the irritation and ex-
coriation of the surface. In tliis painful condition the face or other
part, remains for ten days or a fortnight when the discharge begins
to diminish, and to concrete into thin yellowish scabs. Fresh pus-
tules, however, arise in the neighbourhood, and the disease runs on
from one to two or three month^, according to the irritability of the
akin and its tendency to be affected by continuous sympathy. It has
sometimes perambulated the entire surface from head to foot : dur-
ing the whole of which course the constitution is scarcely disturb-
ed, or in any way affected.

The LAMUfATEo HVMiD scALL is sometimes conjoined in the lower

limbs with cellular dropsy, and produces severe ulceration : and its

, casing or incrustation occasionally extei/ds to the fingers and toeS|

and destroys the nails, being succeeded by nails of an imperfect

fabrication, thick, notched, and irregular.

The EROSIVE FORM is rare, and highly intractable. It commences
on the side of the chest or trunk of tke body, and gradually t\ tends
itself. The pustules are here intermixed with vesicles, the 1 uid is
peculiarly acrid and erosive, and the skin and cellular texture nro
slowly, but deeply and extensively destroyed, with very greai pain
and irritation : insomuch that the disease is said by some, though
with little foundation, to be of a cancerous nature.

The LOCAL FORM i9 chiefly produced by the use of irritant ma-
terials, constantly applied to the parts affected, which are chielly
the hands, as sugar among the labourers in grocery warctioutics:, nnd
lime among bricklayers. Whence this variety has bet ti vulgfariy
<^aUed Grour^s Itch^ or Bricklaijer^s Itch. According to the pecuhar

420 • BCCRmcA. [cfc. Ti*-o«. m.

character of the skin the eruption is sometimes vesiciilar, and he-
lengs to the preceding genua, heing a modification of eczema ; hot
more generally pustulous, and appertains to the genus hefore us.
In nei&er instance does it seem to be contagious.

Most of the causes enumerated under LEPiuASis, and many of tlie
species of ecplhtsis operate in the present species, as general de-
bility or relaxation with a skin peculiarly irritable ; poor diet; filth;
fatigue ; and local stimulants. And hence, where the constitution
seems to catenate with the disease, the same general remedies have
been found successful ; as the alkalies, sulphur taken freely, Plum-
mer^s pill, the alterative decoctions or infusions of dulcamara, ledum
palnstre, juniper-tops, sarsaparilla, and mezereon ; ti^ether with a
frequent use of warm bathing for the purpose of purifying and -sof^
tening the skin. In connexion with these we should have recourse
to such external applications as may best tend to diminish the ir-
ritability of the cutaneous vessels and give tone to their action.
The most useful of these are the metallic oxydes, with the excep-
tion of those of lead which are rarely useful, at least if employed
alone : and are oflen found injurious. About ten grains of sublimate
dissolved in a pint of distilled water, with a small proportion of
muriated ammonia, will frequently prove- a valuable remedy. Or
the oxyde of zinc may be applied in the form of an ointment, which
I have of^en found serviceahle prepared in the manner already
noticed under the species prurigo. Lime-water is also recommend-
ed by many writers, and has proved useful as a stimulant astrin-
gent ; as have also solutions of alum, and sulphate of zinc, and sol-
phuret of potash ; the old liver of sulphur, but I have found them
less useful than the zinc ointment

The acrid oil contained in the shell of the cashew-nut has often
been employed with great advantage in some of these varieties and
especially where the disease is decidedly local, and a local change
of action is the grand desideratum, In many cases, however, the
skin i^ too irritable for stimulants of any kind, and will only bear
wai:m water, or a decoction of mallows, poppy-heads, or digitalis ;
^er which the excoriated'surface may be illined with cream or an
emulsion of almonds. In general, nevertheless, astringent stimulants
agree far better with this affection than with herpes. The burning
and maddening pain in the erosive scall can rarely be alleviated but
by opium. The iiarrowgate waters are generally recommended|
and in many instances have certainly been found useful.

. in«-HnP» B> J EXCERKBVT ' FVHCTIOll.

«H

m Crustacea.
Milky bcall.

( Galeata.
Scailed-head,

SPECIES II.
ECPYESIS PORRIGO.

PV9TCLBB muW COLOURED ; CONCRFTIIIO INTO SCAJLES OR YELLOW SCABS,

This is the porrigo of Celsus and Willan, from porrigo ^^ to spread
about ;^ and the tinea of Sauvages and most of the nosology. It
offers the following varieties :

Pustules comnQencittg on the cheeks or
forehead in patches ; scabs often coo-
flaent, covering the whole face with
a continiions incrustation. Found
chiefly in infants during the period
of lactation.
Pustules commencing on the scalp in
distinct, often distant patches ; gradu-
ally spreading till the whole head
is covered as with a helmet ; cuticle
below the scabs, red, shining, jdotted
.with papillous apertures, oo;ung fresh
matter ; roots of the hair destroy ed«
Contagious. Found chiefly in chil-
dren during dentition.

Pustules common to the head, trunk,
and extremities ; pea-sized ; flattened
at the top ; in clusters, oflen uniting ;
discharge fetid ; scabs honey-combed,
the cells filled with fluid. Found
both in early and adult ag^.

Pustules minute in small patches, most-
ly commencing on the scalp ; patch-
es terminating in dry, delving scabs
resembling lupine seeds ; the inter-
stices often covered with a thin, whi-
tish, exfoliating incrustation. Found
chiefly in early life.

Pustules very nqinute, with little fluid ;
seated on the scalp : terminating
in scurfy scales. Found chiefly in
adults.

Clusters of very minute pustules seat-
ed on the scalp in circular plots of
baldness with a brown or reddish,

y Favosa.

Hooej-comb 8cal|

) Lupinosa.
Lupine scall.

I Furfuracea.
Furfuraceous scall.

Z Circinata.
Hing-worm scalL-

and somewhat forforaceons baK.
Found cl^eflj in children.

The FIRST VARIETY U the cmsta kictfa of nnmeroos authors, the
tinea lactea of Saava^s, so called from the milky or rather the
creamy appearance and consistency of the discbai^e, whence the
French name of croute de lait, and onr own of milky-scall. It Is
almost exclusively a disease of infancy, at which period the skin
bf the head is peculiarly tender and delicate. It commences ordinaii-
'Ijr on the forehead and cheeks in an eruption of numerous, mmate
and yellowish white pustules, which are crowded together upon
tL red surface, and break and discl^arje a viscid fluid that concretes
into thin yellowish scabs. As the pnstular patches spread the dis^
charge is renewed, and continues to be thrown forth from bene'atli
the scabs increasing their thickness and extent till the forehead, and
Sometimes the cheeks and entire face become covered as with a
cap ; the eye-lids and nose alone remaining free from the incrustation.
The quantity of the discharge varies considerably, so that in some
instances the scabs are nearly dry. As they fall off and cease to
be renewed, a red and tender cuticle is exposed to view, like that
in impetigo, but without a tendency to crack into fissures. Smaller
patches are occasionally formed about the neck and breast, and even
on the extremities, and the disease runs on for several weeks,
Sometimes several months : during which the constitution suffers
but little except from a troublesome itching which sometimes inter-
feres with the rest, and destroys the digestion. And, where the
last takes place, a foundation is immediately laid for general
debility, anci especially for torpitude and enlargement of the mesen-
teric glands. In many instances the eruption returns at irregular
intervals, after having appeared to take its leave ; apparently re-
produced by cutting additional teeth, or some other irritation. Dr.
Strack affirms that, when the disease is about to terminate, the
urine acquires the smell of that voided by cats ; and that, where
there is no tendency to this change of odour, the disease is gene-
rally of long continuance. It is singular that notwithstanding the
extensive disfigurement and sometimes depth of the ulcerations, no
permanent scar or deformitv is hereby produced.

The SECOxVD VAUiETi', or 9cxllkv hhad originates generally in the
scalp, and consists of pustules somewhat larger, and loaded with a
still more viscid material than the first. The pustules are circular
in form with a flattish, and irregular edge. They sometimes com-
mence on the cheeks, but where the face is affected the ordinary
course is from the scalp towards the cheeks by the line of the ears.
They are usually accompanied with a considerable degree of itch-
ing, and harass children from six months to four or five years of
age. The disease is rarely found in adults. From the quantity of
the discharge the hair is matted together, the scabs become con-
siderably thickened, the ulceration spreads into the integuments,
and the indurated patches seem, in some^ cases, to be fixed upon a

«& VI.-6F. IL] ' EXCERNnVT FimCTIOK. 42S

qoRflfinlre of offeosiTe fluid. The lymphatic system, if not in a
state of debility before the appearance of the eruption, soon be-
comes affected and exhibits marks of irritation, but whether frooi
general debility or absorbed acrimony it is difhcult to say. The
glands on the side of the neck enlarge and harden, exhibiting at
fir^ a chain Y>f small tumours lying loose under the skin ; after
wluch some of them inflame, the integuments become discoloured^
and a slow and painful suppuration ensues. The ears unite in thm
inflammatioii, and from behind them, or even from their interior a
considerable quantity of the'same yiscous and fetid fluid is poured
forth. In some cases the submaxillary and parotid glands catenate
in the inflammatory action. Th^ fluid is peculiarly acrimonious,
aad consequently whatever part of the body it* lights upon acci-
dentally becomes affected by its influence. Hence the arms and
breasts of nurses evince frequently the same complaint, and other
domestics receive the disease by contagion. Its duration is uncer-
tain, but it is more manageable thnn the preceding species : and i£
not maintained by the irritation of teething or any other excite-
ment, it may be conquered in a few weeks.

The HONEY-COMB scALL, or third variety, differs very little from
the preceding except in the seat of the patches and in an increased
size and thickness of the scab, which is often cellular or honey-
combed. And as pustules of this form have been called favi, from
their resemblance to honey-combs, this variety of the disease from
tlie time of Ali Abbas lo the present has been distinguished by the
name of tinea iavosa, scabies favosa, or porrigo favosa. By Dn
Bateman it is united with the preceding variety. The colour of
the scab is yellowish or greenish, and semi-transparent, its surface
highly irregular, and indented, and its consistency softish. The
ptistules are found on the Cace, trunk, and extremities. The irri-
tation they produce excites the little sufferer to be perpetually
picking and scratching them about the edges, by which means the
skin is kept sore and the ulceration extended. This is particularly
tbe case about the heels and roots of the toes, the extremities of
which last are sometimes ulcerated, while the pustules even creep
under the nails. The odour from this and the preceding variety ia
not only most rank and offensive to the ismell, but occasionally in-
flames the eyes of nurses and others who are ofiicially surrounded
1^ its vapour. ,

The LUPUiE VABiETY, is peculiarly characterised by the driness of
its scabs, which are formed upon small clusters of iniBute pustules,
the finer part of whose fluid is rapidly absorbed, so that the part
remaining concretes, and shows in the central indentations of i^
surface a white scaly powder. The size of the scab is that of a
sixpence : it is found in the head, and in other parts, but, when iu
olkier parts than the head, it is often much smaller in diameter, and
sometimes does not exceed two lines. It is liable to increase if
neglected, and is usually tedious and of long duration.

The FDRycKACEOi»'_#i' BRANNY SCAX.L makcs a still neater approach

43A EccRmcA. [cl. VI.-0R. idu

to the tribe of lepido^tis, and is oAen mistakeo for a pityriasis, tr
leprinstfl, particularly where- it appears in the scalp, which is its
mo^t common seat. It commences, however, if its course be
watchf'd, wUh an eruption of minute pustules, which nevertheless
po:48e8$ a very small quantity of fluid, so that the whole is soon
absorbed, and the excoriation or ulceration is but slight. It is apt
to be renewed, is attended with a considerable degree of itching,
and some soreness of the scalp, the hair partially falls off, becomes
tliio, less strong in its texture, and somewhat lighter in its colour:
none of which symptoms occur in any species of the true scaly erup-
tion. The glands of the neck moreover are occasionally swelled
and painful.

The RiNo-woRM scALL has been known and described under dif-
ferent names, from the Greek writers to our own day. It consist*
of clusters of very minute ' pustules forming circular plots of a
brown or reddish hue. There is sometimes only a single plot ^
and the pustules are so small as to elude all notice unless yery
closely examined, though a papular roughness is obvious to ever)i
one. The exudation is small, yet if neglected it concretes into
thin scabs, sometimes irregularly tipped with green, while the
plots expand in diameter, and become confluent. The hair is ist-
jored from the first attack ; appearing thinner and lighter in c^our,
and breaking ofl* short ; in progress of time the roots are affected
and the plots are quite bald, and, as they spread into each other,
the baldness extends over the whole head, and nothing remains but
« narrow border of hair forming the outline of the scalp. It is
chiefly confined to children, and since the multiplication of large
boarding-schools and manufactories, in which last they are employ-
ed with too little attention to their health, it has been strikingly
common in our own country : and from its contagious property haft
been propagated with great rapidity. It sometimes spreads from
the head over the forehead and neck.

Porrigo, therefore, is a disease which appears under difierenl
DK>difications of ulceration, from sores of some depth oozing a thici:
fetid pns, and covered with a broad, scaly scab, to eruptions sa
minute as to require the aid of a glass, being covered with floe
furfuraceous exfoliations, and discharging a thin purulent ichofi
manifested rather by its cflects than its presence.

The predisposing cause is in every instance irritability of tlie
cutaneous exhalants ; and as we find this irritability much greater
in infancy than in mature life, the different varieties of porrigo are
chiefly confined to this season. The exciting causes are filth, or
want of cleanliness, bad nursing, innutritions diet, want of pure air,
and whatever else has a tendency to weaken the system generally-,
and irritate the skin locally. And we may hence see why some of
the varieties are found occasionally as sequels on lues, or on those
who have debilitated their constitutions by high living, and espe-
cially by an immoderate use of spirits.

»

QB. yi.-SP. n.] EXCERNENT FUNCTION. 423

It is hence obyious that many, perhaps all these varieties may,
in some instances, be connected with the general state of the sys-
tem ; and in such cases the restorative diet-drinks and alteraitive
tonics, enumerated under the genus ecpblysis will often be equally
advantageous here. Sulphur and the vegetable alkalies have also
been found serviceable, but especially small doses of calomel, or
the black or red oxyd of mercury. And if there be much general
irritation it will be adviseable to unite these with the conium or
byoscyamus. The pansy or heart's ease (viola tricolor) was in high
▼ogue for cutaneous eruptions, generally and particularly for those
before us daring the sixteenth and seventeeth centuries. It fell,
Imwever, into disrepute, but was revived by Dr. Strack, towards
the close of the eighteenth century, in consequence of his prize dis-
sertation delivered at Ley den, in 1779, in which he speaks warmly
of its success in all the diseases belonging to the present and the
ensuing genus.**^ In employing this herb Dr. Strack directs that a
handful of the fresh, or half a drachm of the dried leaves, be boiled
in half a pint of milk to be strained for use, and form a single dose,
which is to be repeated morning and evening. He asserts that
during the first eight days th)e eruption usually increases consi-
derably, and that the patient's urine acquires the cat-like smell we
have already alluded to : but that, where the medicine has been
taken a fortnight, the scab or scurf begins to fall off in large scales,
leaving the slun clear. The remedy is to be persisted in til! the
skin has resumed its natural appearance, and the urine its natural ^
odour. Dr. Strack also recommends, as an internal remedy, which
we should little have expected, a decoction of the leaves of the
tnssilago Farfara or coltsfoot, which 1 should scarcely have noticed
were it not that this medicine was also esteemed useful by Dr.
Cellen, as we had formerly occasion to observe, in sores dependent
upon a scrophulous habit, many of which he tells us he has seen
healed under its employment both in extract and decoction.t As
to the viola tricolor^ Baldinger, who seems also to have tried it,
andhipon a pretty large scale, asserts that it is of ijiferior value to
suh>hur,t and Selle, that if given in small doses it is useless, and if
in larger that it does more harm than good.§

There is some difficulty in determining upon the external appli-
cations. Generally speaking, the skin under all the modifications of
this species bear astringent and even stimulant remedies well, and
yield without obstinacy to' their use : but in a few instances we ,
meet wiUi the contrary, and aggravate the pustules, and extend their

* D« Crusta Lacte& InfantOm. Francf. 1779.
See alto Commeo. Lips. Vol. xxvii. p. 170.
Maicard. Besehreibung tod Pyrmont. Mezger. Vcrtnicbte Scriften, B, ii.

^ t Mat. Med. Part. ii. Chap, xviii.

% Neues Magas'm for practische Aerzte ix.p. 117.

f Medicioa Cliiiica. 1. 185^

VOL. IV, * 54

426 EccRiTicA. \cjif yh^=s^. m.

range bj the slightest irritants. The most irrita|)le vniedfis fre
the honej-comb, where it occurs ^t the eiLtremities of the joints, «f
about the toes and heel and behind the ears, and the furAi^aceou.
The last, however, will usually bear ^ lotion of ipild soap and
water, and afterwards equal parts of ^tarch and calamine reduced to
a very fine powder, and dusted over the patches. The honey-
combed scall often requires sedative fomentations and c^plasms at
first, but will afterwards allow an application of the z|pc ointmeot^
or even that of the nitric oxyde of mercury diluted with an eqi»)
part of calamine cerate. Dr. Willan v^f^ attached to the coculos
Indicus in cases of this sort, which he prescribed in the proportion
of two drachn^s of the powdered berry to ^ ounce of lard. In
common, however, we may employ a bolder practice and use
pretty actively alkaline or acid lotions, or solutions q{ zioc^ or
warm resinous ointments of pitch or gum elemi. All that is wan^
ing is the excitement of a new and healthier action, which tbt
cutaneous vesseb for the most part receive with 'bqt little trouble ;
and this, with a punctilious attention to cleanliofss^, is in most c^sfst
sufficient to ensure a cure.

With the suljphur ointment, or, which is better, sulphur and
cream, I have often succeeded in curing very virulent attack^ of the
porrigo /avo5a that have covered the whole Qf the fs^ce, and matted
'the beard into a most disgusting spectacle.

In tjie external treatment of porfigo galeata, or sc^ed-bead, one
of the most efiectual applications is a i^odiQ^atiQi^ of Panyer's
unguenturo ad scabiem, for in its or^jnal form it is both too irritant
and too astringent as well as very unscientifically compoqnded.
I was first induced to try this preparation fron^ the recommendfttiop
of my excellent and learned friend Dr. Parr; it has since bisen
recommended by Professor Ijamilton, and more lately by Dr.
Bateman. Each has altered its composition iq s^ slight degree, and
the following form^ which is more simple than ^qy of the rest, m
that which 1 have been in the habit of employing ^ith great success
for many years. To a powder (consisting of two drachqis of calomel
and an ounce Cf exsiccated alum and cer^sse, add six drachms of
Venice turpentine and an ouppe and a half of spermaceti cerate.
The hair is first to be cut off ^ close ai| mav be, for ((having is often
impossible; t]ie scalp is then tp he slowly and carefully wi^i^ed
with soap and water, and, where (here is y^ry little irritatip(h i^ith
soft soap as being more stimulant, iq preference tfi hard; the
washing to be repeated night and morning, and the scalp to be well
dried afterwards. The ointment is to be applied after the washing
every night, and is to be well rubbed all over the head. It may be
washed ofi" in the morning ; and, when the scalp is made dry, instead
of applying it through the day, the head m^ be thoroughly pawder-
ed with nicely levigated starch contained in a fipe linen or cambric
bag. The scabs and incrustations will hereby become desiccated,
and often brittle, for the ointment alone will di^u^sh, wid at lenffth
utterly suppress the morbid secretion. And in this state tbej

M. tl^Htf^ tf.} EXCERIVBKT PtmCTION. 427

Atdirtd b^ gently pfc1t«4 bt cotnbed (yff, one after atnotfaer as ihey
gfrow loose sfnd becoMtf detached at the edges.

Id the IftEft fririetT the riiig-worto porrigo, of dilopecia porriginosa
6£ Satlvdgfe^^ th'oOgh the appetfnMCe i9 for leis di^asting, and unac-
coili|i^nfed itifh SifieM 6f^ity kind, the btribs of the hair seem tfi6re
^effected that! ia any of the preceding. And hence this, which Js one
of the ^dost odttiroon modifications of the disease, and, as we hare
already obseried, ha^ been peculiarly frequent of late yeats, has
been n>and one of the most obstinate. It has ordinarily made i^
appearance among children at school, but is not confined either to
schools or to childhood ; for I hare at this moment a medical friend
under my care, troubled with the same complaint, whose age is
about forty.

The disease appears to be seated under the cuticle in the mouths
of the secements of the rete mucosum, which secrete a material of
a different colour from #hat is natural and healthy, and hence give
a brown or reddish hue to the entire patch. This material affords
no nutriment to the bulbs of the hair, and seems sometimes to be
acrimonious : whence the hair, like the rete mucosum itself, changes
its colour ; and, with the change of colour, becomes thinner and
weaker, and breaks off short at the base of the cuticle, sometimes at
the roots below.

The acrimony of the secretion occasionally produces a morbid
sensibility in the mTuule yetoels of the part affected, so that the
patient can hardly bear the patch to be pressed upon or the comb
to pass over it ; yet thia itf not a common effect, for irritants may
i0ually be employed from the first

Wh^re this morbid senitffbHity exists we must endeavour to shorten
its stage, for it will at length pass off naturally, by tepid and
iedative foAientations, as of po^py-heads, or digitalis : and afterwards
have recourse to depilatoriesy vi^ithout which we can do nothing, for
we cannot btherwise pentetrate to a sufficient depth ; and hence the
more active they are the more radical wilt be their effects. Dif-
ferent preparations of mercury have for this purpose been chiefly
employed, and mostly a solution of sublimate. The other metallic
acids have been tartar emetic, sulphate of zinc, sulphate of iron,
arugo or the green otyde of copper, and even arsenic: while

Sractitioners of a more timid character have confined themselves to
le pitch-plastei*, balsam of sulphur, or decoctions of tobacco^
hemlock, or tlie viola iri-color.

In slight case's most of these applications will be found sufficient
but, in severe and obstinate cases, none of them. And hence, in
every case, I have for many years (ionfined myself to a solution of
the nitrate of silver in the proportion of from six to ten grains to
an ounce of distilled water, according to the age of the patient, or
the irritability of his cuticle ; and with this application I have never
failed, it destroys the hair to its ro<yts, gives tone to the morbid
vessels, and changes their action. It often excities a slight vesica-
tion or soreness on the surface, and it is in most instances necessary
to push it to this point

428 EGCRiTioA. [ciM nt-om. ttu

Wh^re porrigo is of long standing, and has become chronic, the
initatioo must 1^ lessened graduall j, and a steadj use of alterants Is
absolutely necessary ; especially in the varieties accompanied with
a considerable discharge, for nmny wnters of authority, as Pelargos,*
Sennert,t Stoll,| and Morgagui,§ haye given examples of epilepsy,
apoplexy, and even death itself following upon a sudden retro>
cession of the eruption. In the Berlin Medical Transactions there
is a case or two of amaurosis produced by a metastasis of tliis
disease.ll

SPECIES 111.
ECPYESIS ECTHYMA.

PV8T0LES LARGE ; DISTINCT ; DISTANT ; SPARINGLY SCATTERED ; SEATED
ON A HARD, ELEVATED RED BASE ; TERMINATING IN THICK, HARD,
GREENISH, OR DARK-fOLOURED SCABS.

Ecthyma from tK0vu9^ ^^ to rage, or break forth with fury,'^ was used
by the Greek writers synonymously with exormia, in the sense of
papula : to which effect Galen ^' apertum est ab mipuf, quod .est
f|#^««99 id est erumpere, derivatum esse u$vf*a^h ici est papuub, no-
men in iis quae sponte extuberant in cute."! 1 have observed, how-
ever, under exormia,** forming Genus m. of the present Order,
that ecthyma has of late years been limited by the nosologists, and
especially by Willan, Young, and Bateman, to the species before us,
probably on account of its more papulated form, and there seems
no reason for deviating from arrangement.
The following are its chief varieties :

« Vulgare. Base bright-red ; eruption complet-

Common papulous scall. ed with a single crop. Duration

about fourteen days.
C Infantile. Base bright-red j eruption recurrent

Infantile papulous scall. in several successive crops, each

more extensive than the preced-

* Medicinische Jahrgaoge. i. P. 1. p. SO.
t Paral. ad L. V. Med. Pract. 4. 2.
% Praelcct. p. 48.

^ Dtt Sed. et Caus. Morb. Ep. Iv. Art 3.
II Dec. I. Vol. VII. p. 7. II. Vol. vi, p. 28.
Y Id Hippocr. Lib. iii. Sect. 61.
•• Supr4, p. 367.

Cffi. Tl—ffl*. m.] EXCERNENT FUNCTION. 429

ing. Found chiefly in weddjr
intents during the period of lac-
tation. Duration two or three
months.
y Luridum. Base dark-red ; elevated ; pustulea

Lurid papulous scall. larger, and more freely scatter-

ed, discharging a bloody or curd-
ly sanies. — Found chiefly in ad-
vanced age. Duration several
weeks, sometimes months.

This last is the melasma of Linneus, Vogel, and Plenck. They
are all diseases of debility, local or general ; and hence, whether they
occur in infancy, adult life, or age, are to be cured by general tonics,
pure air, and exercise, tepid bathing, and preparations gently stimqlat-
ing applied externally in the form of lotions, ointments, or powders.
None of them are contagious, and in this as well as in their ap-
proaching more nearly to a papulous or broad pimply character,
especially that of the small-pox, they difier essentially from the
preceding. Nutritious food alone, with pure air and regular exer-
cise, are often sufficient for a cure. But as this species is manifest-
ly dependent upon a debilitated or cachectic state of the constitu-
tion, it is often connected with those other symptoms wliich apper-
tain to such a condition, as a tumid belly, diarrhoea, and general
emaciation in infants ; and dyspepsy and scirrhous parabysmata, or
enlargements of the abdominal viscera, in adults. Dr. Bateman has
given a very excellent coloured print of what he calls a cachectic,
or fourth variety, in his Delineations, in which the scabby pustules
are thickly scattered over the limbs, mimicking very closely in size
and number an ordinary appearance of discrete small-pox at the
time of its scabbing. It is, however, distinctly a symptomatic affec-
tion, or rather a sequel, of some long or chronic disease of an ex-
hausting nature, and always disappears in the train of its cure.

SPECIES IV.

ECPYESIS SCABIES.

»cft.

ERUPTION OP MINUTE PIMPLES, PUSTULAB, VESICULAR, PAPULAR, INTER-
^ MIXED OR ALTERNATING ; INTOLERABLE ITCHING ; TERMINATING IN SCABS.
roUND CHIEFLY BETWEEN THE FINGERS OR IN THE FLEXURES OF THE
joints; CONTAGIOUS.

This disease is peculiarly complex; but the specific characters now

430 ECCRITICA. [OL. TI,-OIU ID.

given embrace the tnodlficationft which constitute its chief varieties,
and which are as follow :

m Pdpularis. Eruption of miliary, aggregate pim-

Rank itch. pies ; with a papular, slightly in-

named base, and vesicular apex ;
pustules scantily interspersed ; tips,
when abraded by scratching, cover-
ed with a minute, globular brown
scab.

Eruption of lai^r and more perfect
▼esicles, filled with a trao^rent
fluid, with an uninflamed \mt ; i»
teTmix«d with pusttiie*; a€ times
coalescing and forming wsMsj
blotches.

Eruption of distinct, prominent yeUoW
pustules, with a sUghtly infiamed
base; occasionally coalescing, and
fomfing irregular blotches^ with a
hard, dry, tenacious scab.

Eruptioft complicated of postqiar, ve^
sicular, and papular pimple^ co»ex<i-
isting; spreading widely over 6»e
body ; occasionnfly invvfing the
face ; sonietimes confiuent and
blotchy.

Eruption chiefly of rank, numerous
pustules witib a hard, iniamed
base, renderkig the skin rough, and
brownish ; itching extreme ; abradon
nniimited from excessire scratcfafaig*.
Produced by handling mangy ani-
mals.

That all these affections are not distinct species of a common ge-
nus, but mere varieties of a single species, is manifest from the fact
that in different individuals, or under different conditions of the skin,
every variety, even the mangy itch itself, will produce every other
variety, while all of them in some instances co-exist, and are de-
stroyed by the same means. The above English names for the first
three are those in common or vulgar use, and it would be difficult
to find names more appropriate. The pocky itch is so denominated
from the resemblance of the pustules to minute small-pox, and not
from any supposed connexion with syphilis. It gives the largest
pimples of all the modifications, as well as the most purulent, but it
has never the hard base of either the small-pox or the ecthyma or
papulous scall we have just noticed, nor has it the hard raised bor-
der or round imbedded scab of the last, and hence is easily distin-
guished from both. The two former varieties aire far mope readi^^

C Vesicularis.
Watry Itch,

y Purulenta
Pocky itch.

> Complicata.
Complicated itch.

• Ecotlca.
Mangy itch.

oc vi.*-sp. nr.J excernekt function. 431

coDfounded with some yarieties of prurigo and of lielteD, and espe-
cially io coDsequence of the hiack dots on the tips of the papul»,
and the long red lines common to all as produced hy scratching.
But they are disdngniihed by the greater simplicity of the itching ^
sensation, wliich, however intolerable, is not combined with ting-
ling or formication ; and by their being highly contagious wliich the
others are not. Yet from their general resemblance, all these hare,
by many writers, been confoundeci, and by others who were fully
sensible of their distinction, been incorrecty described under scabies
or psora as a common name.

As a primary disease, itch is, io every instance, the result of per*
sonal uDcleaiiliaess, and an accumulation of sordes upon the skin,
though the most cleanly are capable of receiving it by contact : and
it always appears most readily where close air, meagre diet, and
little exercise are companions of personal filth ; for here, as we
have already had frequent occasions of observing, the skin is more
irFitable, and more easily acted upon by any morbid cause.
Like many other animal secretions the fluid hereby generated is
contagious ; and, on close intercourse, but not otherwise, and chiefly
in the warmth of a common bed, or of a bed that has been slept in
before by a person affected with the disease, is capable of com-
muoication. Where the cutaneous irritation hereby produced is
Ifonerai to the surface, and has been suffered to remain without
check, or with little attention, for a long time, a sudden suppression
of the irritation by a speedy cure, like the sudden suppression of a
long standing ulcer or issue, is often attended with some severe in-
ternal affection ; in one instance, indeed, related by Wantner, it was
succeeded by mania. And in camps, and prisons, where the consti-
totion has been debilitated by confined air, and innutritions diet,
the eruption has sometimes been known to assume a malignant cha-
racter ; of which Ballinger gives us an example, the whole surface
of the body, in the instances to which he refers, having exhibited a
sordid tesselation of crusts, excoriations, and broad livid spots, with
an indurated base accompanied with fever at night and severe
head-ache.

Whenever an organ is weakened in its action it is extremely apt
to become a nidus for worms or insects of some kind or other to bur-
row in. Hence the numerous varieties of helminthia or invermi-
nation in debility of the stomach or other digestive organs ; and
hence the lodgement, as we have already observed, of the grubs of
a minute insect, probably a species of pulex, in one or two of the
trarieties of prurigo ; and hence again in gangrenous ulcers, and es-
pecially in warm climates, the appearance almost every morning of
innumerable grubs or maggots, of which we have frequent exam-
ples in the wounds inflicted on the backs of the negro-slaves in the
West Indies by severe flogging. A similar deposite of eggs, appa-
rently of the genus acarus or tick, is sometimes found m itch pus-
tules, or in the immediate vicinity of them. And hence itch

432 EccRrncA. [cl* yji-or. uL

has, by Wichroann and maDy other writers of great iDteUigeDce,
been ascribed solely to this cause :* while others who have sought
for the appearance of the grub hereby produced, but in vain, have
peremptorily denied the existence of such a fact in any case.t The
statement now given constitutes, however, the actual history, and
readily reconciles these condicting opinions. Such insects are not
always to be traced, but they may be seen occasional^: and
wherever they appear they are not a cause but a consequence of
the disease.

There are few complaints that have been treated with so many
remedies, and none with so many pretended specifics. Sulphur,
zinc, acids of all kinds, bay-berries, white hellebore, arsenic, alum^
muriate and other preparations of quicksilver, alkali, tobacco, and
tar, have all been used externally in the form of lotions or oist^
ments ; and sulphur and sulphuric acid have been given iotemally,
and been strongly recommended both in Germany and in our own
country for their success. Sulphuric acid was first used in the
Prussian army in 1756, by Dr. Colthenius, chief physician; after
which Professor Schroeder of Gottingen, employed it very freely
and asserted that he never failed herewith to cure the itch in fear-
teen days at farthest.];

Dr. Linckius, in the Nova Acta Naturs Curiosorum, gives ao
account of an epidemic itch which raged very generally around
Nuremberg about the middle of the last century, and r^isted all
the usual means of sulphur, lead, turpentine, arsenic, mercury, hv^
man and animal urine, chalybeate waters, lime-water, and drutic
purgatives, and only yielded to diuretics urged to such an extent as
to irritate the urethra with a considerable degree of pain. The
medicine he employed was a sub-nitrate of pot-ash, obtained by de-
flagrating common nitre with charcoal. The first hint of this
practice he received from a treatise of Mauchart. The urine
hereby excreted was very fetid, and threw down a copious sedi-
ment.9

It is very possible that all of these have been successful under
peculiar degrees and modifications of the complaint. For the itch
is not difficult to cure, and seems only to require an applica*
tion that will excite a new and more healthy action in the cutane-
ous vessels. The simplest and most certain cure is to be obtained
by the sulphur ointment, of which that of the London CoUege
gives as good and as simple a form as any. On the Continent they
usually combine with the sulphur an equal quantity of powdered

* Wtchmann, Aetiologie der Kraze. Hanov. 1700. Rochard, Journ. de Med.
Tom. XLi. p. 26.

t Sager, Baldioger, N. Maga. B. xi. p. 484.

Hartmann, Diss. QuiBsUones super Wicbmanni JEtiologid, Scabiei. Fr. 17S9*
f See Dr. Helonich's Dissertatio de Olei Vitriolis usi^, &c. Hal. 1762*
k Tberapeia Scabiei epidemics per DiureuD, &c* Nov. Act. Kat. Car. Tom.

IV.

OE. V1.-SP. IV,] EXCERTIENT FUNCTION. 433

bay-berries, and of sulphate of zinc, which is mixed up into an
ointment with linseed or olive oil. This form was first proposed
by Jatser, and under the name of unguentum Jasseriauum has main-
tained an unrivalled character for the last half century.* The of-
fensive smell of the sulphur, whether in the simple ointment or
Jasser^s compound preparation, is very much diminished by adding
to the materials a few drops of the essence of burgamot and as
much rose-water as the powders will absorb before they are mixed
with the animal or vegetable oil.

These are the safest and most effectual applications, and should
be employed wherever practicable. But where there is an imprac-
ticability the most elegant mode of treatment is to be obtained by a
mercurial lotion made by dissolving a drachm of muriated quick-
silver in half a pint of water, and adding two drachms of crude
sal ammoniac, and half an ounce of nitre. The hands are to be
washed with this solution night and morning, and a little of it is to
be applied with a clean sponge to the pustules in other parts.

About eight and forty hours steady use of this lotion or the sul-
phar ointment, will generally be found sufficient to effect a cure ;
after which the person should be well cleansed and rinsed with
warm water : and it will tend much to expedite and ensure the cure
if the body be in like manner exposed to a warm-bath before the
curative process is entered upon, as much of the contagious matter
and impacted sordes will hereby be removed, and the ointment or
lotion will have a chance of taking a greater effect. Where the
constitution has been influenced, aperient and alterative medicines
ivill also be necessary, and ought not to be neglected.

In India a pleasant and easy cure is said to be effected by wear-
ing linen that has been dipped in juice expressed from the agreea-
ble fruit of the bilimbi tree (averhoa Bilifnhi. Linn.,) which has
also the reputation of being an antidote in many other cutaneous
disorders : but I cannot speak of its effects from any personal know-
ledge.

How far scabies may, under any circumstances, cease naturally I
cannot say : we are informed, however, by Bennet, that a case
which had resisted all remedies was cured by a phthisical expec-
toration which continued for a month.t

• Schmucher, Vermischte-chirurgiscbe Scriften. Baud. ill. p. 183. Frank. 1783.
6vo.

t Young, On Consumptive Disuses, p. 171.

VOL. IV. 55

434 ECCRITICA. [<X. TI.-OR. HI.

GENUS VIL

MALIS.
GumnemiK S^rrmfnatton*

THE CUTICLE OR 8K1N INFESTED WITH ANDIALCULES.

Malis aod maliasmus (^««A4«, fmJamefUf) are Greek nouns importing:
cutaneous vermination. In the present system the genus is deaigiH
ed to include both the mails and phthiriasis of Sauvages and seven]
other writers which are very unnecessarily divided. Common as
this disease is to man, it is still more so to animals of perhaps
every other class and description, from the monkey to the fish-
tribes, and from these to the lowest worms. All of them are infest-
ed with parasitic and minute living creatures on their skins, shells,
or scales, which afford them an asylum, and for the most part supply
them with nutriment. Yet the same afiection is still more common
to plants ; which are not only infested with parasitic plants but witk
parasitic animals as well. The volume of Nosology contains rnanj
curious examples of this kind which the reader may turn to at his
leisure.

These external parasites, whether animal or vegetable, by our oldl
botanical writers, were significantly called dodders^ from a term
which has lately, but improperly been restrained to a particular
tribe or genus of plants to which Linneus has given the name €/£
cuscnsa^ a parasite found very extensively on the nettles and the
wild thyme of our own wastes : but which formerly was applied to
external parasitic plants of all kinds; and hence Dryden in his
Fables speaks of doddered oaks^ and in his Eneid of doddered
laurels :

Near the hearth a laurel grew
Doddered with age, whose boughs encompass round
The household gods, and shade the holy ground.

Dodders are, therefore, parasites generally, and as strictly apply
to those which constitute the present genus as to any that iniest
the vegetable world.

Generally speaking, vermination is a proof of weakness, whether
in animals or. in plants ; and hence the weaker the plant or the
animal the more subject are they to be attacked, and the more
readily to be infested.

A few instances may possibly be adduced of plants and animals in
perfect health being thus haunted, but they do not oppose the gene-
ral rule. The remote cause of this disease, however, is most com-
monly filth ; for filth debilitates the cutaneous vessels in every in-

OE. Vll.-fflP. !•] EXCERNENT FUNCTION.

43d

stance by obstructing the pores of the exhalants and confining thi!
persfarable matter till it becomes acrimonious.

The animalcules that infest mankind are the following : wiuch
will constitute so many species :

1. MALIS PEDICULI.

2. ruLicis.

3. ACARI.

4. FlLAfOJE.

5. CBSTRI.

6. OOKDII.

LOUSINESS.

FLEA-arrE.
TicK-BrrE.

GUINEA-WORM.

GADFLY-BITE.

HAIR-WOBN.

SPECIES I.

MALIS PEDICULi.

CfTTICLE INFESTED WITH UCE, DEPOSITINO THEIR NITS OR EGGS AT THE
ROOTS OF THE HAIR : TROUBLESOME ITCHING.

The insects of this name that trouble our own race are the two fol-
lowing :

-m Pediculi hnmani.
Common louse.

C Pediculi pubis.
Crab-louse.

Infestment of the ewnnum hu$e^ chiefly
inhabiting the head of uncleanly chil-
dren, where it produces a greasy
scurf or other filth ; and sometimes
exulceration and porrigo : occasion-
ally migrates over the body.

Infestment of the morpio or crab^lauMe ;
found chiefly on the groins and eye-
brows of uncleanly men : itching ex-
treme, without ulceration.

The COMMON PEDicuLUS, is two well known to render any particu-
lar description necessary. Leewenhoeck, who cautiously watched
them, by way of experiment, on his own person, affirms that the
male is furnished at the extremity of the abdomen with a sting, and
that it is this sting which produces the usual irritation, the suction
of the proboscis hardly seeming to produce any irksome sensation
on the skin of the hand The male is readily distinguished from
the female by having the tail or tip of the abdomen rounded, which
in the female is forked or bifid. The animal is produced from a
small oval eggy vulgarly called a nit, which is agglutinated by its
smaller end to the hair on which it is deposited. From this egg

436 ECCRITICA. [CL. VI.-01U IB.

proceeds the insect complete in all its parts, and Offering only from
the parent animal in its size. To determine the time of pregnancy
and proportion of increase this indefatigable physiologist took two
females and placed them in a black silk stocking which he wore
day and night that they might have the full benefit of feeding npon
him. He' found that in six days each laid fi(ty eggs without ex-
hausting its store, and that in twenty-four days the young were
capable of laying eggs themselves : and, carrying on the calculation,
he estimates that the two females conjointly might produce eighteen
thousand in two months.

The largest animals of this kind were discovered by Linneus to
the warm caverns of Falhum in Sweden. It has been observed,
however, by many entomologists that those which conceal them-
selves in clothes, forming the pediculus vestimentorum, are, in
some respects, a different animal from the lice of the hair, or p.*
capitis. Dr. Willan remarks that the latter lay single nits on the hairs
of the head, and do not spontaneously quit the scalp or its natural
covering. The former are large, nat, and whitish, and seldom
appear on the head, but reside on the trunk of the body, on the
limbs, and on the clothes. Their nits are conglomerate and uaoally
deposited in the folds of linen or in other articles of dress.

The pEDi6uLis PUBIS is distinguished by the cheliform structure of
its legs, whence its name of crab-louse ; its antennas consist of Bve
articulations. Its excrement stains the linen and appears like dilot-
ed blood. It is a frequent cause of local prurigo; for these
animals burrow in the skin, and, being almost unknown among
decent persons, may remain a long time unsuspected, since even an
examination for the purpose will scarcely detect them. They are
chiefly discoverable by their nits which may be seen attached to
the basis of the hairs, the insects themselves appearing only like
discolourations of the skin.

All these are bred among the inhabitants of sordid dwellings, jails,
and workhouses, or who are habitually uncleanly. Monkeys, the
Hottentots, and some tribes of negroes are said to eat them. The
cutaneous secretion is sometimes so changed by disease, that it
becomes offensive to them, and they quit the person who is labour-
ing under it ; various infectious fevers seem to produce this resnlt.
It is affirmed by some writers that the pediculus capitis or
humanus, has been found useful in epilepsies, diseases of the head,
and in scrophula, and that the worst consequences have arisen from
drying the little ulcerations they produce. In Russia and other
parts of the Continent, where this kind of uncleanliness is, perhaps,
less attended to than in our own country, all this may have occurred ;
for we have already had occasion to observe, that any cutaneous
irritation, whether from scabies, porrigo, or any another excitement,
maintained till it has become habitual should be suppressed gradu-
ally, or we shall endanger a transfer of the morbid action to a part
of far more importance. Upon the whole, however, such remarks
»re only apologies for filth and indolence, as we are in no want o£

QE. VII.-SP. l] EXCERNENT FUNCTION. 437

much more effectual cutaneous irritants, where such means are called
for, than can be obtained from so disgusting a source.

The most fatal poisons to ail these vermin are the mercurial
oxvdes, staphisacre, menispermum, rue, opium, angelica, and laurel ;
saffiron, pepper, sedum, lycopodium, pinguicula, tobacco, and the
seeds of veratrum. Cleanliness itself, however, is a sufficient anti-
dote, and a sure prophylactic. The pediculus pubis is best destroy-
ed by calomel mixed with starch powder, and applied by a down
puff.

SPECIES II.
MALIS PULICIS.

CUTICLE IKVESTED WITH FLEAS; OFTEN PENETRATING THE CUTIS WITH
THEIR BRISTLY PROBOSaS, AND EXCmNO PUNGENT PAIN ; EGGS DEPOSITED
ON OR UNDER THE CUTICLE.

This species offers us the two folllowing y^rieties :

M Pediculi irritantis. Infestment of the common JUa^

Common flea. with a proboscis shorter than

the body; eggs deposited on
the roots of the hair, and on
flannel.

t Fedicali penetrantis. Infestment of the chigoe or chig^e^

Chiggre. a West Indian flea, with a pro-

boscis as long as the body ; of-
ten penetrating deeply into the
skin, and lodging its eggs under
the cuticle, particularly of the
feet ; producing malignant, oc-
casionally fatal ulcers.

The COMMON FLEA iufests not mankind only, but quadrupeds and
birds of all kinds. It is probable that it has many varieties, but
these have not been ascertained by entomologists. Contrary to the
economy of the pediculus, the flea undergoes all the changes of the
metamorphosing tribes of insects, being produced from an egg^
which gives rise to a minute verrolcle or larve, that is transformed
into a chrysalis, and finishes in a wmged animal. The eggs, in the
summer months, take six days before they are hatched, the larve
the same period before it becomes a chrysalis, the chrysalis twelve
days before it assumes its perfect form : so that the entire process
is completed in a little more than three weeks in the summer

438

ECCRITICA.

[CL. VI

UL

thoagh a longer period of time is consnmed in the colder months.
It obtains its noarishment from the jnices of the animal it InfestB,
by driving its sharp proboscis under the cuticle

The CHGOE or chiggre is thus excellently described by Cateaby.
'( It 19 a very small flea found only in warm climates. It is a very
troublesome insect, especially to negroes and others that go bare-
foot and are slovenly. They penetrate the skin, under which they
lay a bunch or bag of eggs, which swell to the bignesB of a small
pea or tare, and give great pain till taken out : to perform which
great care is required for fear of breaking the bag which endangers
mortification and the loss of a leg, and sometimes life itself. This
insect, in its natural size, is not above a fourth part so big as the
common flea. The egg is so small as to be scarcely discerned by
the naked eye."

As these animalcules are fostered like the pedicolns by filth wot
laziness, they are best destroyed by vigilance and cleanliness : and
in the mean time most of the poisons recommended in the former
case will prove effectual in the latter.

SPECIES III.
MALIS ACARL

CUTICLE INFESTED WITH THE TICK ; rTCHING HARASSING, OFTEN WITH SMART-
ING PAIN.

The tick insect offers us the following varieties :

m Acari domestici.
Domestic tick.

C Acari Scablei.
Itch-tick.

y Acari autumnalis.
Harvest bug.

^*- Observed on the head in consi-
derable numbers." This is not
a common variety, but Dr.
Young has an example, and I
have introduced the variety up-
on his authority and in his words.

Infestment of the itck-tick ; bur-
rowing under the cuticle in or
near the pustules or vesicles of
the scabs in those affected.

Infestment of the harvesi-bugj less
in size than the common mite ;
inflicting its bite in the autumn,
and firmly adhering to the skin ;
itching Intolerable, succeeded
by glossy wheals.

OE. VIL-^P. m.] EXCERNENT FUNCTION. 439

The acarus is a Tery nomerous genus of very minute insects, in-
cluding, besides those enumerated above, a multitude of other spe-
cies well known to every one, as a. Ricinus or^ dog-tick, a. Siro or
mite, a. dysenterioi' or dysentery tick, of which we have spoken al-
ready.*

The first in the above varieties is probably the a. Leucurus of
Linnftus, with a testaceous exterior found frequently in the neigh-
bourhood of gang^nous sores, and dead bodies. The second a.
9eabieii or exulcerans^ for though enumerated as two by Linneus,
they are the same animal, is white with reddish legs. It burrows,
not in, but near the eiulcerations of the itch, as already observed
under scabies, as also in the neighbourhood of other exulceralions,
and adds considerably to their irritation. The harvest-bug is a
globular ovate-red insect, with an abdomen bristly behind. From
the glossly wheals which its bite produces it has sometimes been
called WHEAi«-woaM.

The wounds inflicted by vermin of this kind are to be avoided
by avoiding their haunts ; or a tepid bath when we have been ex-
posed to them. Where the punctures have taken place they are
easiest relieved by a lotion composed of equal parts of the aroma-
tic spirit of ammonia and water, which I have oAen found also
highly serviceable in the bite of an animal that does not, indeed,
harbour in the cuticle or on the skin, though he is as troublesome
by his sudden and predacious sallies, I mean the gnat and the mus-
queto-fly.

SPECIES IV.
MALIS FILARIiE. •

SKIN INFESTED WTTH THE GUINEA-WORM ; WINDING AND TURNING UNDER
THE CUTICLE, FOR THE MOST PART, OF THE NAKED FEET OF WEST IN-
DIAN SLAVES ; SEVERE ITCHING, OFTEN SUCCEEDED BY INFLAMMATION
AND FEVER.

This worm is found chiefly in both the Indies, most frequently in
the morning dew ; oAen twelve feet long, not thicker than a horse-
hair. It should be drawn out with great caution, by means of a
piece of silk tied round its head ; for if, by being too much strained,
the animal break, the part remaining under the skin will grow with
redoubled vigour, and oAen occasion a fatal inflammation.

• Vol. II. p. 307.

44© ECCRITICA. [CL. TI.-01U UI*

This animal is the irk Medini of Ayicenna, and the AraMans,
literally, vermis Medinen^^ but which has, by some means or other,
been by most writers corruptly translated nervus^ or vena Medi-
nensis.

The Guinea-worm was well known to the Greek writers, who,
according to Pliny, denominated it i^tuuvrim^ (dracontia,) whence
the name of dracunculus which is frequently applied to it. Aetios
and Agatharcides have both given an account of this worm, as has
also Paulus of iEgina.

The inflammation produced by this animal commences with an
itching in the part affected, without acute pain. The part swells
and inflames^ and at length resembles a furuncnlus or boil, in hard-
ness, and when on the point of breaking, in vehement pain. Soon
after the tumour has burst, the head of the worm n^iay be seen

{leeping from the bottom of the sore, when it is to b^ caattonsly
aid hold of as already described. Sir James McGregor informs oi
that the native practitioners are far more expert in extractit^ it
than Europeans : and that after a nice feel with their fingers for
the body of the worm they make an incision, as nearly as they can
judge, throngh its middle, and by nicely tyeing a piece of sUk to
each end, curl out both at the same time. Mr. Hatcheson gives an
account of his having extracted one that measured three yards and
a half in length.'*'

SPECIES V.
xMALIS (ESTRI.
eHi^n »Ctr.

SKIN INFESTED WITH THE LARVE8 OF THE GAD-FLY ; CHIEFLY BURROWIfiG
IN THE SCHNEIOERIAN MEMBRANE OF THfc. NOSTRILS.

This complaint is more common to quadrupeds than to mankind ;
especially to sheep, horses, and black cattle ; the insect depositing
its eggs in different parts of the bodies of these animals, and hence
producing painful tumours, occasionally succeeded by death, from
the violence of the indammation. We sometimes, however, and in
the West indies not unfrequently, find the egg^ of this insect de-
posited in the interior membrane of the human nostrils ; acciden-
tally inhaled with the air, or lodged by a sudden ascent of the in-
sect itself Mr. Kilgour of Jamaica, gives a striking example of
this, though he does not indicate the insect. The patient was re-

•* Edin. Med. Essays, Vol. v. Pan ii. p. 309.

0E. VU.-SP. v.] EXCERNENT FUNCTION. 441

doced almost to a state of madness before the appearance of a single
larre ascertained the real nature of the disease. The cure was
effected by an injection of tobacco decoction. Two hundred were
discharged in ten days.* *

SPECIES Vi.
MALIS GORDIL

SKIN INFESTED WFtA THE HAIR-WORM $ CHIEFLY INSINUATING ITSELV UN-
BBB THE CUTICLE OF THE BACK^ OR UUBS OF INFANTS ; PROPUCINO
FRIOONO PAINS, EMACIATION, AT TIMES CONVULSIONS.

This is the morbus pilaris of Horst, the malis a crinonibus of Et-
maller and Sauvages.

The nature of the disease is still involved in some uncertainty,
the fibrils thrown forth from the surface of the skin accompanied
with the symptoms above described, are by some authors supposed
to be a morbid production of real hairs ; but fhe greater number,
and amoi^ the rest Ambrose Pare, ascribe to them a distinct living
principle.

The disease is uncommon : but upon the whole it seems to be
often produced by a species of the gordius or hair-worms ; some of
whi6h are well known to infest other animals in like manner ; and
.especially the cyprinus aUmmus or bleak, which, at the time,
appears to be in gpreat agony.

HoffiBan tells us that the children of Misnia are much infested
vrith worms of this kind, which he describes as resembling black
hairs lodged under the skin : and whidi, by a perpetual irdtation,
so emaciate them that they become little more than living skeletons.
When the skin is warm they appear, but while cold they keep
buried under its cover.

A similar disease is said by M. Bassignet to have been peculiar,
in 1776, to the town of Seyne and its neighbourhood, and to have
made its attack upon almost all the new-bom children. In Seyne it
was at that time called c^es, a corruption of cedd^s, a provincial
term for a bristle. It appeared from the first twelve hours till the
end of the first month after birth, rarely later than the last period.
The symptoms were a violent itching, and general erethism so as
to prevent sleep ; hoarseness, a diminution of the voice, and an
inability of sucking. Friction with the hand over the body proved

* Higtory of a case in which worms in the nose were removed, &c. 8vo. 1782.
VOL. w. 66

442 ECCRITICA- [cu Ti.Hm. UIU

a certaiD core, and brought forth a kind of dark rough fihuMoff
resembling hair, often not more than the twelfUi of an inch in
length, in some cases furnished with a minute bulb at the extremitj.*
A decoction of the cocculus Indicus is serviceable in this and ia
most of the preceding species : but perhaps the most determinate
cure for the whole, is to be found in the civadilla, supposed, to be a
species of the yeratrum, which I have already recommended in
many cases. No insect or vermin of any kind is cajpable of resisting
or living under the pungent and acrid aroma oi its seeds when
reduced to powder, which it is only necessary to sprinkle over the
linen or bed-clothes that are thus infested. The powder, indeed, Is
a powerful errhine ; and when tasted affects the tongue with tbe
pungency of needles and eicites a severe and protracted ptyalism.
On account of this acrid and penetrating power it ought not te be
nsed where the surface of the body is exulce rated. In porrigo, or
scabby scall, it has even proved fatal : and hence it is omitted in
Resenstein^s third edition of his woik ^^ On the Diseases of Children,^
though recommended in the two preceding.

GENUS VIIL

• ECPHYMA.
entuntonn IBjxvtnttntt.

SUPBRFICUt, PERMANENT, INDOLENT EXTUBERANCE { KOSTLY CfRCUXSCEIBED.

CcPHYBCA is a Greek term from »f v« <^ educo, egero," in contra*
distinction both to phyma ^^ an inflammatory tumour,^' and tmphfma
^^ a tumour without inflammation originating below the integuments.^
Extuberances similar to those belonging to this genus are freouentij
found in the rinds of fruits, as apples and oranges, and form a
peculiar character in some species of melon ; none of whidi are
produced by insects, nor are we acquainted with the immediate
cause.
The species of this genus are the four following :

1. ECPHVMA CARCNCULA. CARUNCLE.

2. VERRUCA. WART.

^. CLAVUS. CORN. '

4. ■ CALLUS. CALLUS.

* Hilt, de la Society Royale, kc, Ann. 1776.

<lfi. fm«HIP^ I.] GXCERKSNT FUKCTION, 443

SPECIES L *^

ECPHYMA CARUNCULA.
€a[niticlr.

90W7i VLESHT, OFTEV PEVOVLOITS, EXCBESCBirCBB OF THE COIOIOV INTEAV'

MfiRT.

t I

This species i$ fooDcl over the sorface generally and oocasiooally,
as a sequel of lues, about the arms and sexnal organs.

From its shape or position it often obtains a particular name, as
Jicui, when fiff or raisin-shaped; encanihis^ when seated on the
cantfaus or angle of the eye.

^ese excrescences on their first formation seem to be prodoc^
tions of the cuticle alone ; but by gradually thickening and a fresh
Tascularity they come at length to be connected with the skin itself,
and, in some instances, even to proceed to the depth of the subja-
cent muscles. They are of trery different degrees of hardness :
being in some instances not much firmer than the parts with which
they are connected : whilst in others they are found to acquire the
obduracy of a rigid scirrhus. Their colour also is very trarieus :
in some cases they are of a pale white, and in others of different
shades of red. In some instances they are single and in others
gregarious. In many cases they are not larger than ordinary warts,
but in others they are much broader and thicker.

Where tlkey are neither painful nor unsightly there can be no
reason for attacking them, but in other cases they should be remotred.
Those of a soft consistency may be often destroyed by rubbing them
freaoently with a piece of crude sal ammoniac, or trashing them
with a strong solution of that salt. Sa?in poirder is a still more
effictual esc£tfotic. Pressure alone will also sometimes succeed
when it can be fiiirly applied. But if none of these answer, recoursa
Buisl be liad to lunar caqstic or the scalpel.

444 ECCRTTICA. [CL. ▼I.-OIU IjU

SPECIES II.
' ECPHYMA VERRUCA,
nratt

yniM, HIRD, ACRID, INSENSIBLE EXTUBERANCB OF THE COMHON INTEGU-
MENT: FOUND CHIEFLY ON THE HANDS.

Warts are small sprcomata that offer the followiDg Tarieties :

^ Simplex, Simple and distinct : sessile or pendle.

Simple Wart
C Lobosa. Foil of lobes and fissures.

Lobed WarU
y Coo (111 ens. In coalescing clusters. ^

Conflueot Wart.

All these ris^, like the caruncle, from the cuticle at first, and
gradually become connected with the cutis bj being supplied with
minute arteries that rarely extend far into its substance, as the sur-
face, when of any bulk, is hard, ragged, and insensible. The ex-
treme sensibility of the base of a wart renders its connexion with a
subcutaneous nerve highly probable.

It is destroyed by ligature, the knife, escharotics, or powerful
astringents. Many of our common pungent plants are employed by
the Tulgar for the same purpose, and in yarious instances answer
sufficiently. One of the most frequent is the celendine or chelido-
nium majusj whose yellow acrid juice is applied to the excrescence
daily or 'occasionally till it disappears. The pyroligneous acid how-
etrer obtained, answers the same purpose, as does the meloe prweara-
heut^the liquor potasse or ammonis, mineral acids,muriated ammonia.
In Sweden they are destroyed by the gryllus verrueivarus, or wart-
eating grasshopper, with green wings spotted with brown. The
common people catch it for this purpose ; and it is said to operate
by biting off the excrescence, and discharging a corrosive liquor on
the wound. They often disappear spontaneously and hence lay a
foundation for being charmed away.

0B» ynxL^-m. in.] excernent function. 445

SPECIES III.
ECPHYMA CLAVUS.

KoumnsH, HORHy, cvtaheous bxtuberance with a comuL rucleos,

8E1I8IBIX IT ITS BASE: FOUND CHIEFLY OR THE TOES FROM THE
FRESSURB OF TIGHT SHOES.

Corns originate in the same manner as camncles and warts. They
are sometimes spontaneous, and gregarious, spreading o?er the
whole head and hodj : and sometimes rise to a considerable height,
and assume a homj appearance. In the last case the tubercle
makes a near approach to some of the species of the genus lepido-
818, especially 1. Ictkyituii cornea, and comigera. In the ninth to*-
lume of the Transactions of Natural Curiosities, is a case of an an-
nual fiUl by a spontaneous suppqratioq.

The cure consists in cutting or paring the excrescence down
nearly to its roots ; and then applying some warm resinous, or other
ttimulating preparation, qs the juice of squills, house-leek, or purfri
lane, or the compound Galbanum or amojioniac emplaster,

SPECIES IV.
ECPHYMA CALLUS,

CALLOUS EXTUBBRANT 'imCRENIRG OF THE CUTICLE; INBEN8IBLB TO THE

TOUCH.

Tms species is found chiefly on the palms of the hands and soles of
the ftet as a consequence of hard labour. Among those who ac*
custom themselves to long journeys over the bum^ sands of Egypt
8ome liaTe had their feet as indurated with a tliick callus as an ox's
hoo^ so as to bear shoeing with iron ; and in Siam such persons
hive been known to walk with their naked feet on* red-hot iron
bars.

This species is produced also by a frequent exposure of the
hands or feet to hot water, or to mineral adds. The cuticle of the
feet has been rendered so thick and insensible by the use of sul-
phuric add as to endure fire without pain. This add is hence

446 EccKTncA. [cl. tl^or. m.

commonlj employed by professed fire-walkers, and fire-eaters, &e
interior of the month being hardened and seared in the same way
as the soles of the feet.

In the Medical Museum is a singular case of this complaint as it
occurred yi a young man, the cuticle of whose hands was so tliick-
ened and indurated as to render them of no use. He was by trade
a dyer ; and the disease was gradually brought on by cleaning brass
wire, with a fluid consisting of sulphuric acid, tartar, and alum.
His fingers were so rigid from the callosity of the cuticle, that oa t
forcible endeavour to straighten them, blood started from erery
pore. As the disease was chiefly ascribed to the use of the acid,
the patient was ordered to apply to his hands an emollient liniment
consisting of equal parts of olive-oil and aqua-kali. After two days,
one half the alkali was omitted, and the yolk of two eggs added.
By means of this application, the hardened cuticle b^an to peel
on ; and a new flexible one to appear beneath ; he acquired the
use of his fingers by degrees, and in about tfv o months the cure was
perfected.

GENUS IX.

TRICHOSIS.

MORBID tfEOANIZATION OR DEFICnBNCT OF HAIR.

Trighosis (r^tj^ffn) ^^ pilare malum,'' is a term of Actuarius, and
other Greelc writers from $^ ^^ pilos.'' trichiasis is the more com-
iBon appellation ; but it has often been used in a somewhat difier-
«il and Hiore liinited sense. The terms atbrix and distiis, whidi
express two of the species under this genus, are evidently from the
tame root.

Hair nay be regarded as a vegetation from the surface of the
body ; it rises from a bulbous root of an oval form wUcb fixes in
the cnticlo or rele mucosum, and seems sometimea to siMai into
the cotis. The separate baics are spiral and hollow, fitfuialMd
witli vessela, and knotted at certain distances like some aorta of
grass, aad in aome cases send out branches at their knotik Tbetf
roots or bulba are found over the whole surface of the body, th^m^
Ibay only vegetate in particular parts, for wlucb it Is not easy to
angn a reason. The hairs in the stems of the roots are aoarkb-
ftd by the gluten at its base, and as this is m^^e copious or mora
flirfd the stem is more succulent : when in a SBUill«r (|«antity of

OB. IX.] EXGERNENT FUNCTION. 44*2^

iBore dense, the hair is dry, crisp, and soon falls off: when not oar*
ried to the extremities, the stems or hairs become brittle, or split.
The rete mucosam fnmishes the hair with its coloar : and as this
ooloor, together with the nutritiye mocas of the hair, diminishes,
and is at length altogether suppressed in old age, we see one rea-
son why the hair becomes gray, and perishes.

As hairs, at least in a state of health, haye no more neryes than
the filaments of vegetables, it is probable that the circulation is
carried on in thenx in the same manner as in plants. By combing
we free the fluid from those obstructions which must necessarily
be produced by their being bent in all directions : and hereby pro-
mote a circulation through the bulb, and relieve the bead from
accumulations : for though the vessels of the bulb are smull they
are numerous.* And we are hence enabled to account for the re-
lief and refreshment which is often felt by a patient after the op-
eration of combing. Longhair has been in all ages esteemed an
ornament There is no question, however, that it requires more
nutriment for its support than short hair ; and some physiologists
have gone so far as to doubt whether it may not h€reby be ia-
jorious to the general health, as productive of debility. But there
seems no real ground for such a belief, as a healthy system, like
the roots or trunk of a healthy tree, will always be able without
inconvenience to furnish sustenance enough for its branchy foliage.
Dr. Parr, however, affirms, that suddenly cutting off long hair has
to his knowledge been injurious and attended with every appear-
ance of plethora : while very thick hair may ocj^asionally weaken
by the undue warmth and perspiration it occasions.

According to the experiments of Vauquelin, read to the Institute in
1808, human hair is not soluble in boiling water, but, when exposed
to a greater temperature in Pappin^s digester, it dissolves readily.
From a solution of black hair, a black matter was deposited, which
proved to be an oil of the consistence of bitumen, together with iron
and sulphur. And as the hair of some persons has a smell approaciiing
to that of sulphur, and especially those who have red hair, we are no
longer at a loss to account for this. The same excellent chemist
found tliat alcohol extracts from black hair a whitish, and a grayish-
green oil, the last of which separates as the alkohol evaporates.
It is probable, therefore, that the black matter is gummy or al-
Imminoos ; the white we are told resembles cetaceum in appearance
though it diflen in chemical affinity. Red hair affords the wldte
matter, and instead of the grayish-green oil, an oil as red as blood.
White hair contains phosphate of magnesia, affording us another

{>roof of the greater facility with which calcareous matter is either
brmed or left loose in old age than in any other period of life ;t
and its oil is nearly colourless. When hair becomes suddenly white

• Parr. Med. Diet. Art. Pilui.
t Vol. IV. p. 215.

448 EccRincA. [ci. vl-or. in*

from terror, Vauquelin thinki it may be owing to a sodden extrkft-
tion of some acid, as the oxjmuriatic acid is found to whiten Made
hair; bat it is suggested by Parr, that this may more probably be
owing to an absorption of the oil of the hair by its salphnr, as in
the operation of whitening woollen cloths.

These remarks will assist us in comprehending something of
tilt nature of the following species of diseases which are indnied
in the genus before us :

1. TRICHOSIS 8ET08A. BRISTLY HAIR.

2. PLICA. MATTED HAIR.

3. ■ HIRSUTIES. EXTRANEOUS HAIR.

4. DlSTRfX. FORKY HAIR.

5. POLIOSIS. GRAY-HAIR.

. 5. ATHRIX. BALDNESS.

7. AREA. AHEATED HAIR.

8. DECOLOR. DISCOLOURED HAUU

SPECIES I.
TRICHOSIS SETOSA.

HAIRS OF THE BODY THICK, RIGID, AND BRISTLY.

This is the hystriacis or porcupine hair of Plenck. It is in facJt a
stiff corpulency of hair produced by a gross or exuberant nutriment,
and has been sometimes limited to the head, sometimes to other
Qiwans, and sometimes common to the body. The remarks already
oltered will sufficiently account for its production.

In the fifth volume of the Philosophical Transactions, we hare
an extraordinary example of hair of this kind being thrown off and
renewed every autumn, like the horns of the deer, and various
other quadrupeds. The aflfecUon was also hereditary, for five
sons exhibited the same morbid ^te of the hair.*

• See also Saraml. Med. Wahmemung.'Band. iv. p. 249.

a£. IX^SP. 11.} EXCERNENT FUNCTION. 449

SPECIES II.
TRICHOSIS PLICA-
^atteDf Hair.

fUlRS TASCULARLY THICKENED; INEXTRICABLY HARLED AND MATTED BY
THE SECRETION OF A GLUTINOHS FLUID FROM THEIR ROOTS.

This disease affords a sufficient proof by itself, if other proofs were
wanting, of the vaseularity of the hairs. Vauquelin ascribes it to
a saperfluoQS excretion of the fluid that nourishes them, but there
must be something more than this : there must be also an intuAies-
cence or dilatation of the vascular tunic of the hairs, since their
capacity is always augmented, and in some cases so much so as to
permit the ascent of red blood; in consequence of which they
bleed when divided by the scissors.

Most authors ascribte it to uncle anliness, which is no doubt the
ordinary exciting cause, though there seem to be others of equal
efficiency, it is also very generally affirmed to be contagious, and
1 had hence added this character to the disease in the volume of
Nosology. But, as Dr. Kerckhofis strenuously maintains the con-
trary after a very minute attention to the complaint in Poland itself,
and more especially afler having in vain endeavoured to inoculate
first himself, and then two children, from the matter issuing from
the bulbs of hair pulled for this purpose from a boy who was suf-
fering from it in the most loathsome manner, I have here with-
drawn the symptom.

Dr. Kerckhofis reduces plica to a much simpler principle than
it has hitherto been described under, and strips it of many of the '
inost formidable features by which it has been characterised ; par-
ticularly its connexioti with hectic fever or any idiopathic affection
of the brain.* He regards it as a mere result of the custom com-
mon among the lowest classes of the Polonese, of letting the hair
grow to an immense length, of never combing, or in any other way
cleaning it, and of constantly covering the head with a thick wool-
len bonnet or leathern cap. And hence, says he, while the rich
are in general exempt from the disease, it is commonly to be met
with among the poor alone, who wallow in filth and misery, and
particularly among the Jews, who are proverbially negligent of
their persons. He contends, in consequence, that it is no more
endemic to Poland than to any other country ; and that nothing more
is necessary to effect a cure than general cleanliness, and excision
of the matted hair.

• Observations Medicales, Par Jos. Rom. Louis KprckholTs, Medicine de TAr-
mee, &c. Sec Med. Trans. Vol. vi. Art. iii.

VOL. IV. 57

450 ECCRITICA. [CL. VL-OR. UI.

The first person he saw lahoaring under this disease, and he
gives the case as a general specimen, was a hoy from fifteen to
eighteen years old, in a miserahly poor village in the neighhoor-
hood of Posen : most ofiensively filthy, lying in a dark hole, and
stinking (puant) beside the beasts. He had black hair, very long, very
coarse and braided into thick plaits of a twelvemonth^s standing. His
head was covered with grease, his brain was greatly affected, and
he was complaining of terrible head-aches. The medical practi-
tioner that attended bim opposed a removal of the hair from a vul-
gar belief that the common outlet of morbid humours being thus
cut oiOr, such humours would flow rapidly to the brain and produce
apoplexy or some other cerebral affection. At length he consent-
ed that after a brisk purge the process of cutting the hair should
commence, but only to be proceeded in by degrees. The length
of two fingers was therefore first removed ; and this producing no
mischief, it was again shortened to the same extent two days after-
wards : and in this manner the whole was cut off in about twen^
days. After this the patient was allowed to comb his head a little
and wash it with milk ; a few bitters and other tonics were pre-
scribed for him, and he was very shortly restored to perfect health.

Admitting Dr. Kerckhofis^ explanation of this disease to be cor-
rect, it is somewhat singular that the same explanation has never
hitherto been given by the most intelligent and most celebrated
Polish, or even German physicians ; as it is also that the disease
should be unknown in other countries where the hair is, in like
manner, suffered to grow without cutting, and where as little atten-
tion is paid to cleanliness.

Hence Sinapius,* and numerous other writers deny uncleanliness
to be the only, or even the ordinarj^ cause. They contend for a
predisposition in the habit, and affirm that under such predisposi-
tion any local accident, and a variety of affections in remote organs,
may become exciting causes. In the Ephemera of Natural Curi-
osities is a case in which it seems to have been produced by a^
wound in the head.f Vehr relates another in which it followed, to-
gether with jaundice, upon a suppression of catamenia for three
months.| It is also occasionally a sequel of several of the varie-
ties of psoriasis.

Cutting off the hair, however, though generally supposed to exas-
perate the disease, or to lead to some secondary evil, does not ap-
pear to produce these effects ; and hence Vicat recommends the
use of the scissors whenever the hairs bleed.§ It is far better with Dr.
Kerckhoffs to use them beforehand.

Though the disease has been usually confined to the hair of the

• Paradoxa Med.

t Dec. II. Ann. ii. Obs. 1.

X Diss. Icterus fuscus cum PJict Polonka, &c. Fr. 1708.

i Memeire sur la Plique Polonoiic Lausanne, 1775.

QE. IX.-SP. U.] EXCERNENT FUNCTION. 451

9C<ilp, it has occasionally appeared ia other quarters, as in the beard,
the cuticle, and even the pudendum : authorities for which are quot-
ed in the Yolume of Nosology.

From the gceat afflux of fluids, and even of blood to the head,
during this disease, it is often accompanied with hemicrania, or
some other cephalalgic affection.

• • SPECIES III.
TRICHOSIS HIRSUTIES.
Strtranroitis ^aiv.

OROWTH OF HAIR IN EXTRANEOUS PARTS, OR SUPERFLUOUS GROWTH IN

PARTS COMMON.

The most frequent example of this misaffection is that of bearded
women. In a few instances the female beard has even been brist-
ly, thus uniting the present with a preceding species. Hippocrates
ascribed hirsuties under this form to a deficient menstruation,'*^
whence it is occasionally met with in young women. This cause
is admitted generally in modern practice ; but one of the most strik-
ing cases in a young woman, that has ever occurred to the present
author, was accompanied with an habitual paramenia superfiua^
under which the patient at length sunk at about forty years of wge.

In like manner a beard has sometimes been found on boys,t and
in a few instances on infants.|

Hair has often also sprouted forth from orgaqs whence it does
not grow naturally ; which, however, in most instances, can be ac-
counted for without any great difficulty by bearing in mind a re-
mark offered in the opening of the present genus, I mean that
" the roots or bulbs of hairs are found over the entire surface of
the body, though they only vegetate in particular parts." Yet
Amatus Lusitanus has given us an example to which this expla-
nation will not apply, for in this the exotic hairs grew on the
tongue,§ as the feathers of the toucan grow naturally. Criniti and
Bose found the heart covered in the same manner.||

• Epidem. Lib, vi. Sect. 7,

Schtirig, Parthenologia, p. 185. Dresd. 1729. 4to.
t PauUini, Cent. iii. Obs. 64.
t Eph. Nat. Cur. Dec. ii. Ann. iv. Obs. 163. Ap. 203.

♦ Cent. VI. Cur. 65.

II Fr. H'jst. de Anitomt^nis Messenii hitsuto corde, Paris, 1525.
Pr. Sistens bistoriam cordis villosi, Leips. 1771.

452 ECCRITICA. [CL. VI.-OR. Ul.

Of organized animal substances hair, however, seems to be ori-
ginated more easily than any other : and this too without having, at
least in many cases, any apparent bulb or root to shoot from. We
had lately occasion when treating of paruria stillatitu, to notice
their discharge from the bladder as constituting one of the causes of
this complaint. So in malis gordii* they have been apparently
solicited by friction, from different parts of the body of an infant
with seeming relief to his distress. And under the genus ecctesis,!
numerous examples have been given of their formation in various
internal organs, his on this account the hak and beard are said
by writers of graver authority occasionally to grow for some time
after the death of every other part of the body ; of which examples
may be found in Heister,]; and Gamerarius.§

SPECIES IV.

TRICHOSIS DISTRIX.

iForitg Haft*

hairs of the scalp weak, slender, and SPLrmNG AT THEIR ElfTRE-

MITIES.

This is a common affection, and depends upon a deficiency in the
supply of proper nutriment from the bulb or root of the hair, in
consequence of which the upper part of the tube becomes arid and
brittle, and splits into minute filaments, as already explained in the
introductory remarks to the present genus. Its cure is to be ac-
complished by cutting the hair short, and stimulating the roots by
irritant pomatums,, unguents, or oils.

• Vol. IV. p. 441.
t Vol. IV. p. 168.

X Heist. Coropend. Anat.

* Camerar. Memorab. Cent. vi. p. 47.

GE. IX.-SF. v.] EXCERNENT FUNCTION. 453

SPECIES V.
TRICHOSIS POLIOSIS.

HAIRS PREMATUREXY GRAY OR HOARY.

The specific term pouosis is a Greek derivative from t«a«(, " can-
didus," " canus,"— " white or hoary "

The general principle of this diseased appearance has been ex-
plained in the introductory remarks to the present genus. The
colour of the hair is derived from the rete mucosum, which secretes
a very compound material for this purpose, a part of the occasional
ingredients of which are iron, sulphur, lime, a grayish-green, and a
blood-red oil. In the silvery white or glossy hair of young persons,
the nutritive matter is, perhaps, the rete mucosum in its purest and
most uncoloured state. Gray hair is produced in two ways. In one
there is no colouring material whatever, except apparently a small
portion of the sulphur; and in this case the hair is «lirectly hoary,
or of a yellowish or rusty white. In other circumstances the rete
mucosum or nutriment of the hair, from causes already explained
under the genus pa^ostia, is loaded with calcareous matter, but
deficient in its proper oil; and hence the hair is somewhat whiter,
but of a dead hue, harsher, and coarser, very brittle, and apt to fall
off from the roots.

White hair, probably produced by the former of these means, has
been found occasionally in every stage of life ; and Shenck gives a
case in which it appeared on birth.'*' It has sometimes been trans-
mitted hereditarily :t and, in one or two instances, seems to have
taken place from terror,]; the spasm of the capillaries of the skin
extending to the bulbs of the hair, which no longer communicated
a supply of the ordinary pigment. It has for the same reason fol-
lowed upon an obstinate cephalaea,§ and is said to have occurred
after death ||

* Lib. I. Obs. 3. tx Stuckio.

t Eph. Nat. Cur. Dec. ii. Ann. I. Obs. 69.

X Camerar. Memor. Cent. ii. N. 14. Doute, Ergo Canities k timore, Paris, 1657.

k Journ. des S^avans, 1684.

H Eph. Nat. Cur. Dec. ii. Ann. I. Obs. 69.

454 ECCRITICA* [CL. VI.-OR. III.

SPECIES VI.
TRICHOSIS ATJtIRIX.

DCCAT AND FALL OF THE HAIR.

The geDeral principle of this defect has heen so fully detailed under
the preceding species, aod in the introductory remarks to the pre-
sent genus, that it is not necessary to add any thing further.

This affection of the hair is the alopecia of Sauvages and other
modem nosologists, hut not that of Cekus and Galen, which is a
variety of the next species. Alopecia is a Greek term derived
from atXiMni ^^ vulpes,'' a fox^ this animal heing supposed to lose its
hair and become bald sooner than any other quadruped. The Ara-
bian writers named it from the same source davs-saleb^ literally
" morbus vulpis." The species admits of the following varieties :

« Simplex. Hairs of the scalp of a natural hue ;

Bald-head. gradually dying at the bulbs, or

loosened by a relaxation of the cu-
taneous texture.
C Calvities. Hairs grey or hoary : baldness chief-

Bald-crown. ly on the crown of the head ; and

confined to the head. Mostly com-
mon to advanced age.
y Barbie. Decay and fall of the beard.

Bald-beard.

The first variety is the defiuvium capillorum of Sennert. What-
ever tends to give an established relaxation and want of tone to the
cutaneous vessels becomes a cause of this affection : and it is hence
a frequent sequel upon fevers of various kinds. It is also found as
a symptom in tabes, phthisis, porrigo, and impetigo.

General tonics and cold bathing form the most promising treat-
ment where it is an idiopathic affection : and where it is a seconda-
ry complaint it must follow the fortune of the disorder that gives
rise to it.

The second variety proceeds from a cause precisely opposite to
the preceding. Here the cutaneous secernents, instead of heing too •
loose and relaxed are too dry and rigid : there is little nutriment
afforded to the roots or bulbs of the hair, whence they become arid
and brittle, particularly at the extreme point of the head or crown,
and are perpetually breaking off at their origin. The cause of the
whiteness or hoariness of the hair has been explained under the
preceding species. Other causes than that of old age are noticed

«E. IX.-SP. VI.] EXCERNENT FUNCTION. 455

by pathologists, and have do doubt a foundation ; as terror, which
has sometimes operated very rapidly, insolation or exposure of the
head to the rays of the son, unlimited sexual indulgence,* cephaliea,
and worms.!

This affection is far more common to males than to females ; it is
asserted by many writers that it never occurs in eunuchs,| and by
Schenck that it never takes place in any persons before the use of
sexual copulation ; and hence ought not to exist in bachelors ; and,
provided the remark be well founded, on which I cannot speak
from my own knowledge, might be employed as a test of their con-
tinence.

The most promising remedies are to be sought for in an external
application of warm animal oils, and oily aromatic essences, as la-
vender-water.

Baldness of the beard is not a common defect : but examples of
it are referred to in the volume of Nosology.

SPECIES VII.

TRICHOSIS AREA.

SlreateDf Hafr.

PATCHES OF BALDNESS WITHOUT DECAY OR CHANGE OF COLOUR IN THE
SURROUNDUVQ. HAIR ; EXPOSED PLOTS OF THE SCALP GLABROUS, WHTTE
AND SHINING ; SOMETIMES SPREADING AND COALESCING, RENDERING THE
BALDNESS EXTENSIVE.

This species is taken entirely from Celsos, who gives two varieties
of it almost in the following words :

m Diffluens. Bald plots of an indeterminate

Diffluent areated hair. figure ; existing in the beard

as well as in the scalp : ob-
stinate of cure. Common to
all ages.
C Serpens. Baldness commencing at the oc-

Serpentine areated hair. ciput, and winding in a line

not exceeding two fingers^
breadth, to each ear, some-

• Gilibert. Adversus Pract. Prin,

Merlet. Diss. Ergo & Salacitate Calvities. Paris, 1662.
+ Paulini Lanx Sat. Dec. iv. Obs. 9.
X De Moor, Diss, in Hipp. App. vi, 21. L. B. 1736.

Schenck. L. i. Obs. 10.

456 ECCRITICA. [CL. VL-«R. lU.

times to the forehead : oAea
terminating spontaoeoosly.
Chiefly limited to children.

The first variety forms the true alopecia of the Greeks, of which
I have spoken already, and is so denominated by Celsus, Galen, and
other Greek and Roman writers. The second is called by them
ophiasis from 9^t( a serpent^ in consequence of the serpentine direc-
tion in which the disease trails round the head.

Dr. Bateman has described this species under the name of porri-
go decalvans^ while he admits that the surface of the scalp offers oo
porriginous or other eruption whatever, hut " within these are« is
smooth, shining, and remarkably white." " It is probable, howev-
er, he adds, though not ascertained^ that there may be an eruption of
minute achores about the roots of the hair, in the first instance,
which are not permanent, and do not discharge any fluid." It most
be obvious to every one that this fall of the hair has no connexion
whatever with porrigo ; depending upon a partial operation of the
causes that we have already noticed as giving rise to the two pre-
ceding species of poliosis and athrix.

A frequent shaving of the entire scalp, with affusion of cold wa-
ter, and the use of stimulant liniments, as a solution of two drachms
of the oil of mace in three or four ounces of alcohol, will some-
times be found to produce a fresh crop of hair : though, in most
instances, all applications are equally unavailable.

SPECIES VIII.

TRICHOSIS DECOLOR.

illC0colimrrD( %aCr.

HAIR OP THE HEAD OF A PRETURNATURAL HUE.

As the hair receives its tint from the pigment communicated to the
bulbs by the rete mucosum, whatever varies the character or colour
of this material, will vary also the colour of the hair. Some of
the causes of such variation we shall have to notice under the en-
suing genus ; but there are others which are not so easily explain-
ed. From the rete mucosum, we have already seen that the hair
obtains iron aqd sulphur, as also the blood-red oil which is procured
by digestion from the red hair, which forms a third constituent,
since it does not seem from the experiments of Vauquelin, that
this is a result of the iron. The grayish-green oil which this ex-
cellent chemist has been also able to extract from black and other

G£. IX.-SP. VUI.] EXCERNENT FUNCTION. 457

dark kinds of hair is another distinct principle : and, from an ex-
cess or deficiency, or a peculiar combination of the colorific con-
stituents, we are able to account for some of the extraordinary hnes
which the hair is occasionally found to exhibit, though others seem
to elude |11 explanation. The chief varieties they display are the
following :

m Caerulea. Of a blue colour.*

C Denigrata. Changed from another colour to

a black.t

y Viridis. Of a green colour. Of which

we have had very numerous
examples.^

i Variegata. Spotted, like the hair of a leo-

pard.§ Of this the examples
ar.e more common than of any
of the preceding varieties.

Many of these singular hues are said to have followed upon some
natural colour of the hair : and, in some instances, suddenly. This
Is particularly the case with the second variety ; or that in which
the hair has abruptly become black, which seertis to have occurred
as a result of fever, of exsiccation, and of terror. Schurig gives a
case in which the beard, as well as the hair, was transformed from
a white to a black. ||

We have observed, under the fifth species, that one of the causes
of white or rather hoary hair, is a dry shrivelled or obstructed
state of its bulbs by which the colorific matter is no longer commu-
nicated. And it is possible, that as both terror and fevers, and ma-
ny other violent commotions, have sometimes proved a cure for
palsy, they may occasionally produce a like sudden effect upon the
minute vessels of the bulbs of the hair, remove their obstruction,
or arm them with new power, and thus re-enable them to throw up
into the tubes of the colourless hair the proper pigment.

• Paulinj, Cent. i. Obs. 93.

t Paulini, Cent. iii. Obs. 59.

% Bartholin. Hist. Anat. Paulin. Cent. I. Obs. 93.

^ Eph. Nat. Cur. Dec. ill. Ann. Obs. 184.

II Schurig. Spermatos.

vot. IV. 58

468 ECCRITICA. [cIm vi*-c«. ih-

GENUS X.
EPICHROSIS.
JUiitttliir Skin.

SIMPLE DISCOLOURATION OF THE SURFACE.

Efichrosis (iff-'xc^^O ^^ ^ ^^^^ common to the Greek iigriters, and
employed to express a coloured or spotted surface of anj kind.
The genus is new, but it seems called for. Like the last it consisto
of blemishes, many of which cannot always either be cored or
even palliated ; but, as all these are morbid affections, the nosolo-
gical system that suffers them to pass without notice is imperfect
5f any of them, however, are not of serious consequence.
The following are the species that belong to it :

2.
3.
4.
5.
6.
7.

LEUCASHUS.

VEAL-SKIN.

SPILUS.

HOLE.

LENTICULA.

FRECKLES.

EPHELIS.

SUN-BURN.

AVRIOO.

ORANGE-SKIN.

POECILIA.

PTE-BALLED SKIN.

ALPH08IS.

ALBINO-SKIN.

SPECIES I.

EPICHROSIS LEUCASMU&

WnUSkin.

WHITE, GLABROUS, SHINING, PERMANENT SPOTS, PRECEDED BT WHTTE TRAl^
SITORT ELEVATIONS OR TUBERCLES OF THE SAME SIZE ; OFTEN COALES-
CING AND CREEPING IN A SERPENTINE DIRECTION ; THE SUPER-INCUMBENT
HAIRS FALLNO OFF AND NEVER RESPROUTING.

This is the vitiligo, or veal-skin of Willan, so called from the veal-
like appearance which these spots produce on the general colour of
the surface. It is common to the different parts of the body, but
chiefly found about the face, neck, and ears. The term leucasmus
(amomi^^,) importing whiteness, is merely employed instead of
vitiligo to avoid confusion as Dr. Willan has used vitiligo m a sense
different from that of Celsus, or of any one who preceded Mm.

aE.X.-6P..n.] EXCERNENT FUNCTION. 459

The size of these spots vary considerably, from that of a large
pin^s head to that of a shilling or half-a-crown. The blank and
morbid whiteness remains through life, and seem to show that the
patches are no longer possessed of red blood-yessels, and that the
white hue of the rete macosum alone is yisible in thek respective
areas, exhibiting a pure white, only differing from thatof death in
being glossy from the action of a living principle.

SPECIES IL
EPICHROSIS SPILUS.

BlU>Wlf| PERMANEKT, CIRCULAR PATCH; SOLITARY; SOMETIMES SUOHTLY
ELEVATED, AND CRESTED WITH A TUFT OF HAIR.

The specific term, from wxtUt ^^ macula,^' has been long in use.
The blemish is common but unimportant.

We have had much of late to observe concerning the rete maco-
sum, and in the ensuing species shall have again to refer to this
material. We have already remarked that it is a substance f^ch
forms the second or middle of three laminas that constitute the
external integument. It is improperly called either rete or mucoswn^
for it is neither a net-work, nor a mucous material, being in effect
nothing more than an adipose secretion of a peculiar kind, which,
when black, has a considerable resemblance to the grease that is
interposed between the axles and wheels of our carriages.

It is the common pigment or colouring principle of the skin,
and hence differs very considerably in hue, as is sufficiently obvious
in the respective individuals of the same country, but still more so
in those of remote regions ; giving a white or fair hue to the
inhabitants of the south side of the Caucausus and their probable
descendants the great body of Europeans, a black to the negroes of
Africa, an olive hue to the Mongo-Tartar race, a brown to the
islanders of Australasia, and a red to the native tribes of North
America.

In temperate climates, and in its purest state, it is a clear glossy
white, and when reddened :mder a delicate cuticle, by the minute
and innumerable arteries that are distributed over the surface
oi the body, it gives that rich but dainty tone of colour which
constitutes beauty of complexion.

It sometimes happens, however, that persons who are perfectly
fiiir in their general complexion, from an equal diffusion of this
substance in its utmost purity, have a few small spots of a lighter or
deeper brown in the face, Umbs, or body, from an occasional dash

460 ECCRITICA. [CU.V1.--0R. HI.

of brown in the rete mucosam) produced by causes which it is
impossible to unravel : and which, as we shall show presently, in
other persons expends over the entire surface, and is consequently
intermixed with the whole of the secretion : and it is this occa-
sional dash^at constitutes a spilus or mole. In treating of tricrosis
we observed that chemical analysis has proved that the hair, and
consequently the rete mucosum which supplies it with pigment, is
possessed of a certain portion of iron : and it is possible that a
concentration of this mineral substance in the coloured part may
constitute the colorific material. Be this as it may, we perceive,
wherever these coloured spots exist, there is a greater tendency to
increased action than elsewhere ; and hence, we oAen find a slight
elevation, and increased closeness of structure, and not unfrequently
an enlargement of the natural down into a tuft of hairs.

If this reasoning be correct, alkaline l<5tions, (and all soaps are of
this character though not sufficiently strong for the present purpose,)
should form the best cosmetics. But the spots are rarely removea-
ble by any means, and the less they are tampered with the better.

These differ essentially from nsvi or genuine mother-marks,
inasmuch as the latter are produced by a distention of the minute
blood-vessels of the skin, so that those which should contain only
colourless blood, admit the red particles, and hereby exhibit stains
of different shapes and ranges, and of different shades of crimson or
purple, according to the quantity of red blood that is hereby suffered
toil^ter, or the nature of the vessels that are distended.

SPECIES III.

EPICHROSIS LENTICULA.

iFrerftlrs.

CUTICLE STIGMATISED WITH YELLOWISH-BROWN DOTS, RESEMBUKG MHfUTe
LENTIL seeds; gregarious; OFTEN TRANSITORY.

Lenticula is more generally written in modem times lentigo ; it is
here given as it occurs in Celsus. The root is the Latin term lent
^ lentil-seed. The Greek word for which is ^cMt» ; and this, with-
out a diminutive termination, was also^pplied to the same blemish,
when the spots were of a larger size.

Its causes are various : most commonly it is produced by an ex-
posure to the rays of the sun : but it frequently arises without any
such exposure, and is sometimes transmitted hereditarily.

The mode by which the colorific rays of the sun operate in the
production of this effect we shall explain under ephelis or sun-bum,
forming the next species. Where the remote cause is coDStitutional

GE, X.-SP, in.] EXCERNENT FUNCTION. 461

it is probably a result of tbe same colorific material as that to which
we have jast referred spilas or mole, existing in tbe rete mucosum,
and operating more diffusively, though in muchAmaller patches.
How it comes to pass that this middle layer of the exterior integu-
ment should at any time be thus interruptedly charged with a co-
loured pigment so as to form the freckled appearance which con-
stitutes the present cuticular blemish, it is not easy to say, but that
it has a remarkable tendency to do so is obvious, not only from the
present and preceding species, but still more so from the very strik*
ing and singular patch-work which constitutes epichrosis pcecilia or
the sixth species of the genus before us : where we shall be again
under the necessity of touching upon the subject.

Freckles most frequently are found on persons of fair complex-
ions and red hair ; and, as we have already observed, that this hue
of the hair is produced by a peculiar pigment derived from the
rete mucosum, which gives rise to a blood-red oil that ascends into
the hair-tubes, we have an additional reason for ascribing the brown,
or reddish-brown freckles of the skin to a superabundance of the
same pigment in the same adipose layer.

Freckles are often transitory. They occur in many instances iu
great abundance in pregnant women, and disappear after lying-in,
sometimes, indeed, in the latter months of pregnancy. Riedlin
affirms, but upon what authority 1 know not, that they are a fore-
sign of a female ofispriog.*

Cosmetics are of less avail in this than in the ensuing species, but
those we shall have there occasion to notice may be tried under the
species before us.

SPECIES IV.
EPICHROSIS EPHELIS.

CUTICLE TAWNY BV EXPOSURE TO THE SUN : OFTEN SPOTTED WITH DARK
FRECKLES, CONFLUENT OR CORYMBOSE ; DISAPPEARING IN THE WINTER.

Ephelis (i^«x«,) is a term of Celsus as well as the name appropriat-
ed to the preceding species : and its real meaning is " sun-bum"
or " sun-spot" — " vitium faciei solis ustione." In Celsus however,
the term is used in a much wider sense, and applied to blemishes
which have no connexion with sun-burning. It is here restrained
to its proper signification.

The sun in hot climates, or very hot summer seasons, has a ten-
dency to affect the colour of the skin in a twofold manner. First
by a direct affinity of its colorific rays, or those of light, with the
oxygene of the animal surface, and particularly with that of the rete
mucosum, in consequence of which a considerable part of the oxy-

* Lin, Med. 1695, p. 393.

9
462 ECCRITICA. [CL. TI.-OR. HI.

gene is detached and flies ofi^ and the carbone and hydrogene, with
which it was united, being freed from its constraint, enter into a
new combination^and form a more or less perfect charcoal, accord-
ing to the proportion in which they combine. And, secondly, by
the indirect influence with which the colorific rays of the sun, or .
those of heat, produce upon the liver and excite it to a more aboii-
dant secretion of bile, possessing a deeper hue, and wliich is more
copiously resorbed iuto the system. That a certain proportion of
bile is resorbed at all times is clear from the colour of the urine
and the stain which the perspirable fluid gives to clean linen : and
that this proportion is greater in hot summers than in cold winters,
and particularly in intertropical climates, is well known to every
one who has attended to the subject

These then are the ordinary causes of that efiusive brown stain
of the skin, which we denominate sun-bum. But whether the
deeper spots or freckles, which so often accompany a sun-burnt skin
be owing to an equal action of either of these causes, and particu-
larly of the first, upon the rete mucosum, or to an extiication of
any colouring matter, as of iron, for example, existing in the rete
mucosum itself, and unequally distributed, is beyond our power to
determine. Either cause is sufiicient to produce such an eflect,
though perhaps the real cause is the latter : and we have already
seen that, in the distribution of this adipose layer over the surface,
and its connexion with the cuticle and the cutis, there is a frequent
obstruction to a free flow of whatever colouring material may exist
in it, which is in consequence accumulated in spots or patches in-
stead of being equably difiused.

As sun-burn is chiefly occasioned by an inordinate separation of
oxygene from the other constituent principles of the rete mucosum
with which it was united, the most rational cosmetics, in this case,
are those which have a tendency to bleach the skin, by containii^
a considerable proportion of some vegetable or mineral acid. Horn-
berg's cosmetic, which has long been in vogue on the Continent, is
a dilute solution of oxymuriate of mercury with a mixture of ox-
gall. Hartmann's which has also been in high estimation, consists
of 1 simple distillation of arum-root in water. This forms a very
pungent lotion, and its object is to dilute or wash out the brown
pigment by exciting an increased flow of perspirable fluid towards
the surface, and to carry oS a part of it by an increased action of
the cutaneous absorbents. Spirit of lavender or any of the essential
oils dissolved in alcohol may be employed for the same purpose :
and some have used a diluted eau de luce which is also useful as an
alkaline irritant. In Schroeder's Pharmacopoeia there is a prepara-
tion for the same purpose which we should little expect, and the
virtues of which are not very likely to be tried in the present day :
it is entitled aqua stercoris human! : but in former times dung of all
kinds was a standard article in almost every Materia Medica, and
there are few diseases for which it was not recommended by some
practitioners ; occasionally, indeed internally as well as extemallj.'
The general intention was that of obtaining a very pungent rola-

GE. X^^P. v.] EXCERNENT FUNCTION. 463

tile alkali; bat this we are able to do at present by far less offeii-
sive means.

When the hands are deeply discoloured they may often be
bleached by exposing them to the fumes of sulphur.

In drupaceous fruits, and especially those of a fine cuticle, as
apples, we sometimes meet with spots and miscolourations of the
same character as moles, freckles, and sun bum ; the causes of which
we do not always know, though we can sometimes trace them to
small punctures in the cutis by birds and insects.

SPECIES V.

EPICHROSIS AURIGO.

#r8ngr^SItCn*

CUTICtE 8AFFR0N-COI.OURED, WrTHOUT APPARENT AFFECTION OF TBE UYE&,

OR rrs appendages; colour diffused oyer the entire surface:

TRANSIENT : CHIEFLY IN NEW-BORN INFANTS. %

This orange hue of infants, and which is occasionally to be met with
in later periods appears, as Dr. Cullen obserres, to depend either on
Me, not as in the usual manner excreted, but receited into the
blood-vessels and effused under the cuticle, or on a peculiar yellow*
ness of the serum of the blood distinct from any connexion with
bile.* Sauvages has rightly distinguished between this disease, as
a mere cutaneous affection, and proper jaundice. In him it occum
under the name of ephelis luiea^ an improper name, however, a9
the affection is not an ephelis or sun-bum ; while the jaundice of
infancy he calls aurigo neophytorum^ which ought rather to be icte-
rus neophytorum.

It may in general be remarked that while the sclerotic tunic of
the eyes as well as the skin is tinged with yelWw in the genuine
jaundice of infants, the former retains its proper whiteness in aurigo.
Whence the serum derives the yellow hue it so strikingly evinces
on some occasions, except from the bile, it is difficult to determine.
That a certain proportion of bile exists constantly in the blood in a
healthy state is manifest, as we have already observed from the
colour of the urine, and the tinge given to linen by the matter of
insensible perspiration : and that tMs proportion varies in different
climates, and different seasons of the year, without producing genu-
ine jaundice, we have observed also. And hence, infants under
particular circumstances, may be subject to a like increase with a
like absence of icteritious symptoms. But what those circumstance9
are, do not seem to be clearly known. We see nevertheless that
whatever rouses the system generally, and the excretories peculiar-

* Syoops. Nosol. Med. Gen. xci. 5.

404 ECCRITICA. [CL. VI,-OR. III.

ly, readily takes off the saffron dye: and hence it often yields to a
few brisk purges, and still more rapidly to an emetic.

SPECIES Vf.
EPICHROSIS PCECILIA.

CUTICLE MARBLED GENERALLY, WITH ALTERNATE PLOTS OR PATCHES OF
BLACK AND WHITE.

PcEciLiA {ircMtXm) is a term of Isocrates, from 5rd«MA«j, " versicolor'^
" pictus diversis coloribus ;" whence F(zcile the porch or picture-
gallen^ of the Stoics at Athens. The species is new to nosological
classification ; but the morbid affection has been long known to
physiologists, and ought to have had a niche in the catalogue of
diseases before now.

This affection is chiefly found among negroes from an irregular
secretion or distribution of the pigment which gives the black hue
to the rete mucosum. In Albinoes, as we shall have occasion to
observe presently, this pigment is entirely withheld, and the matter
of the rete mucosum seems to be otherwise affected ; in the species
before us it is only irregularly or interruptedly distributed.

What the cause of this interrupted distribution consists in we
know not ; but in several of the preceding species of the present
genus, and particularly in moles and freckles, we perceive a striking
tendency to such an effect; and if we turn our attention to the
animal and vegetable world around us, we shall observe it springing
before us in a thousand different ways, and giving rise to an infinite
diversity of the nicest and most elegant cutaneous tapestry. It is in
truth, as the author has already remarked in the volume of Nosolo-
gy, to the partial secretion or distribution of this natural pigment
that we are indebted for all the variegated and beautiful hues
evinced by different kinds of animals and plants. It is this which
gives us the fine red or violet that tinges the nose and hind-quarters
of some baboons, and the exquisite silver that whitens the belly of
the dolphin, and other cetaceous fishes. In the toes and tarsal
membrane of ravens and turkeys, it is frequently black : in common
hens and peacocks, gray : blue in the titmouse, green in the water
hen, yellow in the eagle, orange in the stork, and red in some spe-
cies of the scolopax. It affords that sprightly intermixture of co-
lours which besprinkle the skin of the frog and salamander. Bat it
is for the gay and glittering scales of fishes, the splendid metallic
shells of beetles, the gaudy eye-spots that bedrop the wings of the
butter-fly, and the infinitely diversified hues of the flower-garden
that nature reserves the utmost force of this ever-varying pigment,
and sports with it in her happiest caprices.

In some cases, a diversified colour of the skin appeal^ to be he-
reditary among mankind. Blumenbach gives an example of a

«£. X.-SP. VI.] EXCERNENT FUNCTION. 465

Tartar-tribe, whose skin was generally spotted like the leopard's.*
iDdividuals thus motley coloured are commonly called pye-balled
negroes, or are said to have pye-balled skins.

The Medico-Physical Society of New York, has lately published
a case communicated by Or. Emery Bissel, in which a man of the
Brotherton tribe of Indians, ninety years of age, had been gradually
becoming white for the last thirty years of his life The first ap-
pearance of this change was a small white patch near the pit of the
stomach, soon after an attack of acute rheumatism ; which was
shortly accompanied with other white spots in the vicinity that
enlarged and at length intermixed. And the spread of the white
hue continuing to range over the whole body, the original colour
was only visible, at the time of writing, on the forehead, and fore-
part of the face and neck, with a few small patches on the arm. The
skin, as it became white, was of a fine clear tint, and had nothing of
. the dull earthy appearance, or the livid hue observed in albinoes.
Whence it should seem that not merely the black or dark-coloured
pigment had been absorbed and carried off, but that a fair, whitish,
and glossy rete mucosum, like that secreted under the cuticle in
white men, had taken Its place.f

This extraordinary change, however, is sometimes produced far
more rapidly : for in the American States a black man has in a few
instances bad the whole of the colouring pigment carried off in the
course of a severe fever, and has risen from his bed completely
transformed into a white man. Bijchner, on the contrary, relates
the case of a white man who, on recovery from a like disorder, had
his face tinged with a black hue, doubtless from a morbid secretion
of a pigment the skin had never before elaborated.

A course of nitrate of silver, continued internally for some weeks,
has oAen produced a deep tawny and uniform discolouration of the
^in approaching to a black, being deepest in the parts most ex-
posed to the light. Fourcroy, Butini, Reimarus, and many other
■writers, have given cases of this change ; and Dr. Roget has lately
published another instance in the Transactions of the Medico-
Chirurgical Society.

Pienck asserts that he once saw a man with a green face, the right
side of his bo(^ black, and the left yellow, produced by a previous
disease : and Dr. Bate man informs us, ^^ that, subsequent to the pe-
riod of his publication. Dr. Willan had observed a variety of pity-
riases in children bom in India and brought to this country, which
commenced in a partially papulated state of the skin, and terminate
ed in a black discolouration with slightly furfuraceous exfoliations.
It sometimes affected half a limb, as the arm or leg ; sometimes
the fingers or toes."J

• Dc Generis Hum. varietaie nutiv^.
f Joiirn. of Science and Aits, "Ni?. Xii. p. 379.
:|: Cutaneous Diseases, p. 48.
VOL. IV. 59

466 ECCRITICA. [CL. VI.-OR. HI.

SPECIES VII.
EPICHROSIS ALPHOSIS.

CUTICLE DULL WHITE : PUPILS ROSY : SIGHT WEAK, AND 8TRORO£8T 15 TBK

SHADE.

This species occurs not among negroes only, as conunonlj sup<
posed, but among the inhabitants of Europe a» weli, and affordb off
the two following varieties :

t$ iBthiopica. Hair white and woollj : irids whiter

Negro albino. Found among negroes.

C Europea. Hair flaxen and silky. Found amoo^

European albino. Europeans and other white na^

tions.

The first of these varieties is by far- the most striking, on accoimt
of the greater change in the colour of the skin, and the peeuUar
contrast it forms with the general cast of the negro^featuTea.

The name of albino was first employed by the Fortugueae, and
applied to such Moors as were bom white, or rather who coolkiiie^
so from the time of birth, for the children of negroes baye little
discolouration on birth, nor for several weeks afterwards, and wrb^^
on account of this morbid hue, were regarded as Bionsten: i^
the term has since passed into our own and most other langQaget.
of the world. In these persons, however, there were other pecQr
liarities observed besides the hue of the skin, for their hair, in a)l
its natural quarters, was equally white, the iris of the eyes white,
and the pupil rose-coloured. This whiteness of the suriiBice^ hoiv*
ever, is not the clear and glossy tint of the uncoloured parts of tlw^
European f»ame in a healthy state, but of a dead or palUd ctat,
something like that of leprous scales. The eyes, in coi^eq^nce
of the deficiency of their natural pigment, are so weak that the in-
dividuals can hardly see any object in the day, or bear the r^js of
the sun ; though under the milder light of the moon, they see with
great accuracy, and run through the deepest shades of their ^reite
with as much ease and activity as other persons do in the brutes!
daylight. They are also said to be less robust than other men;
and to sleep through the day and go abroad at night : both wUct^
last facts are easily accounted for, for the weakness of their tigfct,
and the discomfort of the sun-beams, to their eyeg.

It was at one time a subject of inquiry whether tfaeae pcMMOS
were a distinct variety of the human race, or merely instances of
an occasional aberration from the ordinary laws that goTem the
human fabric : and the former opinion derived some support from
its being found that male and female albinoes, who not onfreqoently
intermarried, being rejected by the rest of the world, produced an
etibpiing with the same imperfections as their own.

«. t.-8^. vil] excernent function. 467

Tte ^iestion, however, has long been sufficiently set at rest,
since itfblno children have been found produced in most parts of
tftie #6rld, and from parents of all tribes and colours, black and
ofive-bti^d, and red and ta^n^ : and, since the subject has been
iaote closely attended to, from white parents or inhabitants of Eu-
r4p^, as firell as black or copper-coloured Africans.

It is the appearance of the characteristic albino-signs in £u-
ropeafi children, that constitutes the second of the two varieties
beforfe OS. These signs are h dull or unglossy white diffused over
the body, with white or flaxen hair, white irids and red pupils.
The disease is rare, but we have had at least eleven examples
Ascribed by different authorities to the present time. T^o by de
SsQssure, four by Buzzi, one by Helvetius, one by Maupertius,'
lund thr^e by Dr. Traill. It is singular that all these are males;
ahd ittiil more so that the female offspring of the same families w^re,
without tA exception, destitute of the albino degeneracy.^ The
three described by Dr. f raill were part of a family of six, the
^oghters of #hich were in every respect unaffected. How far this
^border is in Europe capable of being produced hereditarily as
libroad Is not known; nor, indeed, does there. yet appear to have
b*en an opportunity of forming an intermarriage between a male
^d A female of this kind, as not a single female has yet been dis-
covered possessii^ the imperfective formation.

The same delicacy of constitution that distinguishes the foreign
4it ti^gro albino, distinguishes the European, of which we may
ii^rm an estimate from Dr. TrailPs account of one of the three ue
httre ahready alluded to. ^^ The oldest of these albinoes,^' says
lie, "is nine years of age, of a del cate constitution, slender, but
#efl formed both in person and in features : his appetite has aU
#ays been bad; he frequently complains of a dull pam in his fore-
head : his skin is exceedingly fair; his hair flaxen and sod; his
cheeks have very little of the rose in them. The iris and pupil
of hiB eyes are of a bright-red colour, reflecting in some situations
an opaline tinge. He cannot endure the strong light of the sun.
When desired to look up, his eye-lids are in constant motion, and
ke is incapable of fixing his eyes steadily on any object as is ob-
served in those labouring under some kinds of slight ophthalmia,
but in him is unaccompanied by tears. His mother says that his
tears never flow in the coldest weather, but when vexed they are
shed abundantly. He goes to school, but generally retires to the
darkest part of it to read his lesson. — His disposition is very gentle ;
he is not deficient in intellect. His whole appearance is so re-
markable that some years ago a person attempted to steal him, and
would have succeeded in dragging him away, had not his cries
brought him assistance.^'*

The disease consists altogether in a defective ' secretion of the
rete mucoeum, which is not only without the colouring constituent

Nicholson's Journ. Nan. Phil. Feb. 1808.

468 ECCRITICA. [CL. VL-OR. lU.

principles that natarally belong to it, and particularly its power of
aflfording a black pigment, but seems to be also untempered or im-
perfectly elaborated in other respects, judging from the dullness or
deadness of the white hue it gives to the surface of the body« in-
stead of the life and glossiness it diffuses in a state of perfect
health. That this cutaneous layer is not altogether wanting is
clear, since in such case the red vascularity of the cutis would be
conspicuous through the delicate transparent c.uticle, in albinoes
peculiarly delicate, and tinge the surface with a red instead of a
white colour.

It is to this imperfection in the secretion or elaboration of the
rete mucosum that the delicacy or feebleness of the general frame
is in all probability to be ascribed, though we may be at some loss
in determining how such an effect is produced by such a cause.
That the flaxen hue of the hair, and the whiteness of the irids is
derived from the same source, admits, however, of no doubt, and
the opinion long ago expressed by Professor Blumenbach,* that the
.red colour of the pupils in the two adult albinoes, whom he had
examined at Chamouni, was equally owing to the want of the usual
black pigment, has since been confirmed by M. Buzzi of Milan, who
has had an opportunity of dissecting an albino, and has proved that
the pigmentum nigrum of the choroid coat, and also that portion of
it which lies behind the iris, and is called uvea, were totally want-
ing.!

We have observed, under the preceding species, that other
animals are as richly supplied with a rete mucosum as mankind,
and that they are indebted to it for their respective cplours : and,
as there can be no reason why they may not at times endure a like
deficiency, we have reason to expect a priori that they may occa-
sionally exhibit proofs of the same complaint. In accordance with
this reasoning, M. Bulmenbach has traced this affection in many
tribes, and especially in white dogs, owls, and rabbits : and Dr.
Traill has lately observed a case of the same disease in a young
sparrow which he accidentally shot. This seems to have been a
perfect albino, with red eyes, pale reddish beak and neck, snow-
white plumage, of a satin gloss on the head, neck, wing-coverts,
and back. The nest from which it issued contained another young
sparrow of the common colour ; and when the albino bird quitted
the nest, which it was seen to do a few days before it was shot, it
was instantly attacked by &i\y or sixty common swallows, and obliged
to take refuge in a tree 4

♦ Med. Bibl. ii. 537.

t Dissertazione storico-anatoroica sopra una varieti particolare de asmini
bianchi, fee. Milan, 1784.

Le Cat, Trait6 de la Couleur de la peau humaine.
"l Edin. Phil. Journ. No. iv, p. 3S0.

[469]

GENERAL INDEX.

The Numerals indicate the Volume ; the Figures the Page.

The Classes and Orders are distinguished by Small Capiuls ; and the Genera by

Italics.

Abortion, It. 122

Abscess, bow distinguished from Apo-
stem, ii. 163

of the breast, ii. 187
Absence of mind, iii. 108
Abstraction of mind, iii. ill
Absorbent system, physiology of, iv.
187

whether veins are absorb-
ents, iT. 191

general effects frem the
union of this and the secernent sys-
tem, iv. 195
Absorption in cataract, iii. 151
Acari malis, iv. 438
Acarus dysenteric, ii. 304
cutaneous, iv. 438
Acid bath, i. 257

formic, in indigestion, i. 116
uric, produced more copiously
from animal than vegetable food, iv.
333

oxalic, predominant principle in
diabetic urine, iv. 332
Aciduro %bietis, i. 348
Acoroides resinifera of New Holland,

i. 113
ACKOTICA, iv. 357
Acrotism, iii. 260
Acrostismue, iii. ib.
•^dopiotUy iv. 102

vagina, iv. 105
< vesice, iv. ib.
uteri, iv. 102 -^

complicata, iv. 106
polyposa, 107
JESTHBTICA, iii. 133
J&stus volaticus, iv. 370
Athusa Cynapium, or fool's parsley, i.

141
After-pains in labour, iv. 165

Agallochum, or lign-aloes, i. 113
Agtnttta^ iv. 88 •

impotens, iv. 89
dys-spermia, iv. 91
incongrua, iv. 94
Agria, iv. 376
Agrypnta, iii. 308

excitata, iii. ib.
pertssa, iii. 310
Ague, ii. 65

quotidian, ii. 68
tertian, ii. 70
quartan, ii. 71
irregular, ii. 72
complicated, ii. 73
has raged in high grounds^ while
low have escaped, ii. 77
treatment of, ii. 78
Ague-cake, i. 279

Air, average of inspired, in a minute,
i. 301

expired, i. 301. 304
whether secreted by organs, iv. 286
Albi no-ski 0, iv. 466
Algor, iii. 187
Alimentary canal, i. 2

comparative length
of, i. 4

DI8BA8B8 OF, i. 9
Alkekengi, or winter-cherry, iv. 307
Alopecia, iv. 427. 456
Alphabets, why they di^r in ditteteat
languages, i. 335

mostly derived from the
Phenician, i. ib.

Devunagari, and some
others not, i. 336
Alpbos, iv. 391, 392
Alphosis, iv. 466
Alusia, iii. 93

elatio, iii. 94
hypochondrias, iii. 99
Alysmus, iii. 314

470

GENERAL INDEX.

AlyMum, iii. 252
Amiurons, iii. 154

varieties, iii. ib.
Ambition, ungovernable, iii, 63
Ammoniaco-niagneBian phosphate of the

bladder, iv. 339
Amnesia, iii. 124. 126
Anal hemorrhage, ii. 466. 468
Anaphrodisia, iv. 89
Anas cygnui, I. 294

olor, i. ib.
ApM«ro», iv. 245

serosa, ii. 319
Anemone pratensis, iii. 146
Anduiy ii. 65

quotidianuR, ii. 68
tertianus, ii. 70
quartanus, ii. 71
erraticos, ii. T2
complicatus, ii. 73
treatment oi^ ii. 78
Aneurissiii, ii. 592

Varieties, ii. 598
Anger, ungovernable, iii. 84
Angelica, i. 215, 216
Angina polypciM^ ii. 284
Anhelationy I; 362
Animals, lower orders, propagable both

by offsets and seeds, iv. 6
Ani*n tion f^ufipt'nHpd, iii. 367
Anthraeta, ii. 424

pestis, ii. 426
rubula, ii. 445
Anthrax, ii. 193
Antigua fever, c6m|>ared with Bulam,

ii. 103
Antimony, glass of, cerated, ii. 310
AMipiUkia^ antipathy, iii. 315
sensiliff, iii. ib.
insefisilis, iii. J 16
Anxiety, migoveni b). , iii. 88

roipoiral, iii. 312
Aphis humuli, i. 197
Aphtha, li. 390

Aph.-odisiacs, of little avail, iv. 90
Aphonia^ i. 318

elingutum, i. 319
atonica, i. 322
surdorum, i. 324
AphoHOj iv. 97.

impotens, iv. 97
pararaeuica, iv. 99
impercita, iv. 100
incoiigraa, iv. 101
Aphis, iv. 7
Jtph^xiOf iii. 107

socors, iii. 106
intenta, iii. Ill
otiosa. Hi. 112
AppttiU^ morbid, i. 71
canine, i. 72
depraved, i. 80

Apochjrsis, iii. 148
Apottema, aposteme, ii. 163

bow diffisrs from abecess, ii.
164

commune, ii. 164
psoaticum, ii. 175
hepatis, ii. 176
Empyema, ii. 178
Vomica, ii. 181
Apoplexia, apoplexy, Hi. iH

entonic, iii. 402, 403
atonic, iii. 404
sanguine, iii. 401
serous, iii.^ ib.
Aqua regia bath, i. 257
obscura, iii. 149
Serena, iii. ib.
Arctium Lappa, ii. 590
%rdor, iii. 187
Area, iv, 455
Areca oleracea, i. 3. 211. 217

Malabar Nut, i. 106
Arnica, i. 157

montmna, iii. 432
Arqua, iii. 149

Arsenic, in intermittsnts, ii. 86
in rheunatism, ii. 335
in consumption, ii. 510
in career, ii. 544
in nerve-ache, iii. 195
in rabies, iii. 251
in chorea, iii. 296
in epilepsy, iii. 364
in lepro^, iv. 399
Artemisia santonica, i. 215
Arteries and veins, ii. 7
Aithrocarc, ii. 620
Arthona^ ii. 324

acdtei, it, 326
chronirn, ii, 332
Podaf a, ii. 335
Hydarthrus, ii. 358
Arthritis, ii. 324
Articular inflammation, ii. 325
A urn in hemic ania, iii. 328
Ascaris lumbHroides, i. 200
vermicularis, iv. 10
Asriepias, gigaiitea, ii. 572
Asritt'S, iv. 276
Aspnlathus canariensis, i. 93
Asphyxia, iii. 367

varieties of^ iii. 368
how related to acrotismus,
• iii. 260
Asphyxy, iii. 367

Aftpleniuinceteradb, as a diuretic, iv.905
Asthmoy i. 370

siccum, I. 375
humidom, i. 378
nervous, i. 375
Athamanta oreotelintmi, as a diuretic,
iv. 305

OSMIEiUl. IMOBZ.

i^\

Athamanta Meum, iv. 40

creteamt, iv. 305
Atheroma, W, 219
Atmosphere coataminated with febrile

matter, sometimea afiects birds, ii.

48
Atriplex fcBtida, iii. 349
Atrophia, atrophy, ii. 475
Aura epileptica, iii. 360
podagrica, ii. 348
Aurigo, ir. 463
Auruin fulminans, ii. 378
Avarice, ungovernable, iii. 88
Azote necessary to animal nulriment,

I. 3

B.

Bacher*s pills, it. 949
Baker's itch, iv. 401
Baldness, iv. 448.454
Balfour, his hypothesis of sol-luoar in-
fluence, ii. 56
BalHsrous, iii. 297
Balsamure carpatbicum, iv. 305

hungaricum, |v. ib.
Banana, i. 3
Barbadoes-leg, ii. 320
Barbiers, iii. 303
Barli, Peruvian, history of, ii. $1
Barrenness, iv. 97

of impotency, iv. ib.
of mis-menstruation, iv. 99
ofirrespoorience, iv. 100
of incongruity, iv. 101
Basurd-poz, ii. 563
Beating, sense of, in the ears, iii. 169
Bee, economy o£, iv. 7
Beet, I. 3
Beetle, larves ef, intestinal, i. 204

grubs intestinal, i. ib.
Bella donna in cauract, iii. 153
amaurosis, iii. 155
Belly-ache, i. 120

dropsy of, iv. 276
Benat-aUil (Arab.) ii. 385
Beras (leprosy,) iv. 388. 391. 395
Berat ^leprosy,) iv. 388. 391
Beriberia, Beribery, iii. 303

origin of the name, iii. ib.
Bex, i. 342

buroida, i. 344
sicca, 349
convulsiva^ 354
Bezoaj, ) . ,^
Bezoardus, \ *• ^^

spurious, i. 187
Bichat, bis hypothesis concerning the

mind, iii. 28
BUdungstrieb, iv. 18
Bile, use o^ i. 244
Bilious remitliriit ievers* ii. 91. 93. 104.

Bimariy kodek (Pec*.) iv. 79
Birds, singing, vocal aveQue, t^ 2914.

imitative, i. 295
Bismuth, oxyde of, in Indigestion, i. 110
Black disease, i. 362

leprosy, ii. 570

vainii, i. 266.--ii« lOi

water, i. 84
Bladder, prolapse of, iv. 102

vermicules discharged hom^ iv.

stone in, iv. Mr
inflammation o^ ii. 260
Bladder-bougies, i. 238
Bladdery fever, Ii. 402.^v. 800
Blain$, i^, 406. 414
Blear-eye, ii, f|8
Blebs, water, iv. 407
Blenorrhaoj iv. 55

simplioz, iv. 56
luodes, iv. ib.
chronica, iv. 6ft
Blood, hpw a4ected by inspiration, i.
300

modena hue ol bow- ptoducctk
i. 301

scarlet hue, low. prodocedb i.
ib. 305

intrinsic properties ol^ ii. 21
moving powers o^ ii. 11
sulphur of, ii. 22
iron of, ii. ib. 23
colouring matter of, ii. 23
red particles of^ ii. 24
transmiu mental aad coqporeal
taints to subsequent geoeratloas, II. 26
why suppoead to be alive, ia. ib.
Bloody flux, it 300
Blow-fly, larves of, intestinal, i 207
Blue-boy, ii. 602
Blushing, cause of, tf . 8
Bltuh injlammaioty^ ii. 200
Boak (common leprosy,) Hf. 388. 391.

393
Boerhaave, his doctrine of Siviers, ii. 30
Boil, ii. 192
Boletus laricis, iv. 361
Bombus, iii. 169
Bone*^ contortion ofthe^ iv. fiS
Bonus Henricus, i. 237
Borborygmus, i. 89
Botium, iv. 209
Botts intestinal, i. 203
Bowels, inflammation of, ii. 256
Brain-fever, ii. 215. 219
Brain, InflamaMition o^ ii. 214

nature ofy ramificatioat and sub-
stitutes, iii. 6

of man compared with animals^
iii. 10

generally admitted to bt a gland,
iii. 21

472

GENERAL INDEX.

Bread-fruit tree, i. 3

Bread-nut, i. ib.

Breast-pang, suffocative, i. 393
acute, i. 394
chronic, i. 400

Breeze or gadfly larves, i. 204

Breslaw remittent fever, ii. 110

Bright spot leprous of the Hebrews,
what, iv. 388

Broken-wind, i. 370

Bronchial polypus, ii, 237

Bronchitis, ii. 233

Bronchocele, iv. 209

Bronchus, ii. 290

Brosimum alicastrum, i. 3

Brown, his doctrine of fevers, ii. 30

Brown-study, tii. 108. 112

Bubo, ii. 188

Bubukle, ii. 197

Buccal pouch in moidLeys and other ani-
mals, i. 4

Buenemiay ii. 316

sparganotis, ii. 317
tropica, ii. 320

Bulam fever, ii. 99

its relation to the Antigua fever
and others, ii. 103

Bulge-water tree, i. 211

Burdock, ii. 590

Bursa Fabric it in birds, i. 5

Cabbage- tree, i. 3. 211.

Cachbxikb, ii. 450

Caddy-fly larves, intestinal, i. 207

Cadmia of Gaubius, iii. 295

Cajeput-tree, i. 57

Calcareous earth, formed or secreted by

all animals, i. 164
Calculus renal, iv. 340

vesical, iv. 340. 347

intestinal, i. 188
N urinary, iv. 338

its various kinds, iv. 339. 348
Caligo, iii. 146
Callus, iv. 445

Calor mordicans in typhus, ii. 129
Calvities, iv. 454

Camphor, its sedative power against the
irritation of the bladder by canthari-
des, iv. 307
Cancer, ii 533

common, ii. 534

whether contagious, ii. 536

ascribed to vermicles, ii. 537

in various parts, ii. 539
Cannabis fiativa, i. 256
Capsicum, in indigestion, i. 113
Carbuncle, ii. 193

e8car,ii. 194

Carbuncle';berry, ii. ib.
Carbunded face, iL 197
Carcinus, ii. 633

Vulgaris, li. 534
Cardamine pratensis, ii. 245. 351

the sisymbrium of Diosco-
rides, iii. 351
Cardiogmus, ii. 593
Carditis, ii. 248
Caries, ii. 612

of the spine, ii. 614
Carminatives, i. 91
Carnevaletto delle donne, of Baglivi,

iii. 290
Carpotica, iv. 169
Caruncula, caruncle, iv. 443
CaruSf iii. 366

Asphyxia, iii. 367
Ecstasis, iii. 382
Catalepsia, iii. 385
Lethargus, iii. 390
Apoplexia, iii. 394
Paralysis, iii. 414
Caryophyllata, i. 237
Casmunar, in indigestion, i. 113
Cataeausitf ii. 576

ebriosa, ii. 577
Catalepsia, catalepsy, iii. 385
Catamenia, origin and progress, iv. 32^
Cataphora, iii. 391
Cataract, iii. 148
Catarracta, iii. 148

varieties. Hi. 149
Catarrh, ii. 299
Calarrhusy ii. ib.

communis, ii. 291
epidemicus, ii. 293
caninuB, ii. 296
vesicae, iv. 309
Catechu, i. 238
Catoche, what, iii. 388
Catochus, what, iii. 384. 388

how connected with tetanof^
iii. 221
Catotica, iv. 238
Cattu schiragaam, vermifuge, i. 219
Caum/, ii. 117

its varieties, ii. 121
Causus, or burning remittent, ii. 10ft
Cellular substance of organs, iv. 183
CsifOTiCA, iv. 29
CephaloM, iii. 318

gravaus, iii. ib«
intensa, iii. 320
Hemicrania, iii. 323
pulsatilis, iii. 324
nauseosa, iii. 325
Cephalitis, ii. 214

meningica, ii. 219
profunda, ii. 222
Cerchnus, i. 317
Cesarean operation in labour, iv. 156

OENIRAL INDEX.

473

CevadUU, i. 211

Cbaropbyllum sylvestre, i. S37

Chalaiis, ii. 686

Chamomile) in indtgettioD, L 115

Chancres, ii. 549

Charcoal-powder, its use in indigestion,

i. 109
Chenopodium antheluMnticum, i. 215.

▼ulvaria, iii. 349
Cberry^laurel, i. 256
CbervU, i. 237
Chest, dropsy of, it. 271
Chicken-pox, ii. 400
ChUd-bed fever, ii. 146
ChUblain, ii. 210
Chiggoe, Chlggre, iv. 437
Chivalry, iii. 94
Chlorine, iii. 253
Chlomity iv. 74

atonica^iv. 78
entonica, Iv. 76
Chocolate, butter of, i. 237. 353
Choke-damp, iii. 368. 376
XMMft i. 167
Xojui, i. 167
Ch^erth i. 167

biliosa, i. 168
« flatulenta, i. 171
spaimodica, i. 172
epidemic, i» 171
Ch9U)HthWy i. 268

quiescens, i. 270
means, i. 271
Chorea, iii. 289
Chronic rheumatism, ii. 332
Chyle, its nature, i. 6

bow produced, i. 150
diyliftiction, process of^ i. 9
Chyme, i. 102

Cbynlfaction, process of, i. 6
Cicuta virosa, i. 141
Cinchona, history of^ ii. 81
CnrBTicA, iii. 202
Circumligatura, iL 189
Clap, iv. 56
CLASS I. PmoXM i. 1

Order i. 1. 17
Ou>. ii. i. 243
n. Proxm i. 291
Ord. i. i. 300
Ord. ii. t 342
lU. Prosm Ii. 5

Ord. i. ii. 27
ii. ii. 154
iiL ii. 363
iv. u. 450

IV. Proxm iii. 5.

Ord. i. IIL 41
ii.iii. 133
iiLiU. 202
iv. Kt 307

V. Proxm iv. 5

VOL. IV. 60

CLASS V. Ord. i. iv. 30 .
iL iv. 74
iiL iv. 109
VL Proxm iv. 183

Ord. L iv. 199
ii. iv. 239
iii. iv. 357
Clavus, iv. 445
Climacteric disease, iL 480
Climacterics, Greek what, ii. 480
Cloaca in birds, i. 5
Clonic Spatmy iii. 265
Clrnius, Iii. 265

pathology of, iii. 265
Singultus, iii. 268
Sternutatio, iii. 270
PalpiUtio, iii. 272
Nictitatio, iii. 281
Subsultus, iii. 283
Pandiculatio, iii. 284
Clutterbuck, his doctrine of fever, iL 90
Cobalt in consumption, ii. 510
Cofiee, itt use in asthma, i. 481

sick head-ache, Iii. 330
Colchicum autumnale, bow far a speci-
fic in gout, iL 356

useful in
dropsy, iv. 254
Cold, genefal feeling of what, iiL 187

in the bead, ii. 224
COKLIACA. i. 17
Colic, U 120

ofPoitou,i. 127
Colieoyi. 120

cibaria, L 135
constipate, i. 144
constricta, i. 145 .
flatulenta, i. 142
CoUatitious organs of digestion, i. 5
Colon, valve of, i. 4
Coltsfoot in scrophula, ii. 532
Coma vigil, iii. 392
Comatose spasm, see Spasm.
Com6«cMt6ik^ of tbe.body, IL 576
Concoction, ancient doctrine of^ IL 31
Concretion, intestinal, L 185
Conessi bark, ii. 315
Congestion, marks of, in typhus, ii. 133
Constipation, L 148
Consumption, ii. 494

varieties, iL 495
how far affected by agues,
ii. 525
Contagion, what, ii. 43

Impure atmosphere nocesia*
ry to its spread, 11. 51
laws of ii. 52

and miasm, identity of, U.
286
CefUoriiontfihebofus^iv^ 222
Convulsio, convulsion, iii. 345
variititf oL iiL 346

474

GENERAL INDEX.

CoDvuIsio, puerperal, iv. 138
Copaiva, balsam of« i. 164. 237
Coprostasis, i. 147

constipata, i. 148
obstipata^ i. 151
Corns, iv. 445
Cornea opake, iii. 146
Corpora lutea, what, iv. 11
CorpuUncy, iv, 200
CorysOi i. 309

entonica, i. 310
atonica, i. 312

how related to catarrh, ii. 290
Costivenest, u 147
Couching the eje, iii. 151
Cough, i, 342

of old age, i. 344
hooping or convulsive, i. 354
Country-sickness, iii. 86
Cowhage, i. 214
Cow-pox, ii. 394

its varieties, ii. 396
whether produced by grease
in the horse's heel, ii, 399
Crab-louse, iv. 436
Crack-brained wit, iii. 94. 96
Cramp, iii. 211
Crampus, iii. ib.
Craziness, iii. 42
Credulity, iii. 124. 128
Crepitus, i. 89
Cretinism, iv. 231

its relation with rickets, iv.
223
Crimping of cod-fish, iii. 23
Crinones, iv. 441
Crisis, febrile dl)ctrine of, ii. 54
of Hippocrates, ii. 55
referred to the heavenly bodies,
ii. 56
Cross-birth, iv. 146
Crotophium, iii. 260
Crotophus, iii. ib.
Croton Tiglium as a hydragogoe, iv.

247
Croup, ii. 233

acute, ii. ib.
chronic, ii. 237
Crusta lactea, iv. 422
Cubebs, iv. 60

Cucumber-suppositories, i. 238
Cullen, his doctrine of fever, if. 30
Cutaneous vermination, iv. 434
Cyania, ii. 601
Cycas circinalis, i. 3
ChfrtonSy iv. 222

Rhachia, iv. 223
Cretinismus, iv. 230
Cystic oxyde or calculus, of the bladder,

iv. 339
Cystitis, ii. 269

D.

Dal fil (Arab.), ii. 320. 568
Dance of St. Vitus, or St. Goy, iii. 289
Dandelion, i. 256
iv. 305
Dandriff, iv. 385
Dans saleb (Arab.) iv. 454
Dartus darsis, iv. 409
Darwin, E. his doctrine of fevers, ii. 90
Day-mare, i. 391
sight, iiL 137
Deaf-dumbness, i. 324

speech maintained and
how, i. 325
Decay of nature, ii. 480
Decline, ii. 487
Defluxion, ii. 290. 335
Delirium ferox, ii. 219
mite, ii. 219
Delivery premature, its advantages at
times, iv. 158

origin of the practice, iv. 159
Demulcents, their nature and tow they

act, i. 352
Dentition, economy of, i. 19
Dentrifices, i. 36
Depression in cataract, iii. 151
Derbyshire-neck, iv. 207. 209, 210
Despair, iii. 89
Despondency, iii. 89
Destitution of urine, iv. 298
Devonshire colic, i. 127
Diabetes, iv. 311

aquosus, iv. 312
insipidus, iv. 312. 335
mellitus, iv. 311, 312
different hypotheses to ac-
count for its symptoms, iv. 315
Diabetes, sugar secreted by various or-
gans as well in a state of health as of
sickness, iv. 324
Diarrhaoyi. 152

fusa, i. 153
biliosa, i. 154
mucosa, i. 156
chylosa, i. 157
. Lienteria, i. 159
serosa, i. 160
tubuiaris, L 162
gypsata, i. 164
urinary, iv. 311
Diary fever, ii. 58
Dictamuus albus, i. 215
Digitalis, how far useful in phthisis, ii.
519

in dropsy, iv. 253. 273
Digestion, process of, i. 6

hypotheses concerning, i. 8
DiGESTiYB FvTHcnoir, i. 1
Orgajtb, i. 1

QENEHAL INDEX.

475

DiniUi^ iiu 330
Diplopift) iii, 144
IMptacus, !▼. 811
Dtptotity i. 67

avensy L 69
ezpers, i. 70
Dirt-eaters of West Indies, i. 82
Distemper of dogs, ii. 296
Division of the symphysis of the ossa
pubis in impracticable labour, iv. 153
J>tsnne««, iii. 330
Dodders, iv. 434
Dolichos pruriens, i. 214
Doronicum Pardalianches, i. 157
Dotage, iii. 130, 131
Dracunculus, iv. 440
Drivelling, i, 57
Drop serene, iii. 154
Dropsjfy iv, 238

cellular, iv. 244
of the head, iv. 260
spine, iv. 269
chest, iv. 271
belly, iv. 277
ovary, iv. 281
fallopian tube, iv. 283
womb, iv. 284
scrotum, iv. 285
bead (acute) ii. 215. 217
urinal, iv. 311
Drowning, death from, iii. 371
Dry gangrene, ii* 610
Dumas, his hypothesis concerning the

mind, iii. 28
Dumbness, k 318

elingual, 319
Z^yten/eria, a. 300

how far connected with
fever, ii. 301

or contagion, ii. 302
simplex, ii. 303
pyrectica, ii. 307
Dysenteric fever, iL 307
I^rsenUry, ii. 300
Dyspepsia, L 100

phthysis, i. 104
Djfwphagia^x, 58

atonica, i. 62
constricta, i. 59
globosa, i. 63
uvulosa, i. 64
linguosa, i, 65

I>yq9AofMa, i. 326

susurrans, i. 327

puberum, i. 329

immodulata, i. 331
Zhf^phoriOi iii. 312

simplex, iii. 313

anxietas, iiL 314
DytpnmOf i. 962

chronica, i. 364

DyspnoM^ exacerbans, i. 368
Dys-spermia, iv. 91

varieties, iv. 92
Dtsthetica, ii. 450

Ear-ache, ii. 224

Earthbone calculus of the bladder, iv.

339
Ecchymoma lymphatica, ii. 317
EccRiTiCA, iv. 199
Eccyent, iv. 168

ovaria, iv. 170
tubalis, iv. 173
abdoroinalis, 173
EcphlysiSf iv. 406

Pompholyx, iv. 407
Herpes, iv. 408
Rhypia, iv. 414
Eczema, hr. 415
EephroniOy iii, 42

Melancholia, iii. 56
Mania, iii. 64
Eephymoj iv. 442

Caruncula, iv. 443
Verruca, iv. 444
Clavus, iv. 445
Callus, iv. 445
Eepyuit, iv. 416

Impetigo, iv. 418
Porrigo, iv. 420
Ecthyma, iv. 428
Scabies, iv. 429
Ecstasis, Ecstacy, iii. 382
Ecthyma, iv. 428
Ectropium, ii. 288
Eczema, iv, 415
Edematous inflammation, ii. 203
Effluvium, human, ii. 42. 51

marsh, ii. 42
Elatio, iii. 94
Elephantia, ii. 567, 568
Elqfhantiatit, ii. 566.— iv. 390.' 396
Arabica, ii. 570
Italica, ii. 573
Asturiensis, ii. 575
Elephant legy ii, 320

how differs from elephan-
tiasis of the Greeks, ii. 320
EUphant-tkiny ii. 566
Elephas, ii. 566. 568
Elf-sidenne, i. 388
Ellis, his hypothesis of respiration, i.

381.— iL 12
Emaciation, ii. 472
Emansio mensium, iv. 31
Empassioned excitement, iii. 79
deprettiorif iii. 85
EmptUhema^ iii. 77
' entonicuro, iii. 79

476

OJUICRAL INNX.

Et^palhemaf entoiiicuni) latktis, phi*
lautis, superbie glorie famis, ira-
cundie, lejotjrpia, iii. 79
atonicum, iii. 85

varieties, iii. ib.
inane, iii. 92
Ewfhlytui^ ii. 386

Miliaria, ii. 386
Aphtha, ii. 390
Vaccinia, ii. 394
Varicella, ii. 400
Pemphigus, ii. 40S
ErjTsipelAs, ii« 406
EmphynMi iv. 205

Sareoma, iv. 206
EncjTStis, iv. 212
Eiostoais, iv. 214
Emphy9€mny iv. 288

ceUulare, iv« 290
abdominis, iv« 292
uteri, iv. 295
EmpretmOi ii. 212

Cephalitis, ii. 214
Otitis, ii. 224
Parotitis, ii. 225
Paristhmitis, ii. 22T
Laryngitis, ii. 231
Bronchitis, ii. 233
Pneumonitis, ii. 237
Pleuritis, ii. 245
Carditis, ii. 248
Peritonitis, ii. 249
Gastritis, ii. 252
Enteritis, ii. 256
Hepatitis, ii. 260
Splenitis, ii. 267
Nephritis, ii. 286
Cystitis, ii. 269
Hysteritis, ii. 270
Orchitis, ii. 272
Emproslhotonos, iii. 221
JEn^yetiSy ii. 411

Variola, ii. 411
Emrods, i. 233
Encmfkew^ ii. .366

Rosalia, ii. 366
Rubeola, ii. 379
Urticaria, ii. 384
Encanthis, iv. 443
EncysU^ iv. 212
EneeiOf ii. 116^

Cauma, ii. 117
Typhus, ii. 123
Synochus, ii. 145
EigUsh Bselaachoiy, iiu 102

mercury, i, 237
EfUanOy ii. 207

Priapismus iiL 207
lioxia, ii. 208
articularis, iii. 210
Systremma, iii. 211
'^riiyiVfiyiii. 213

Enianoy Tetanus, iii. 229
Lyssa, iU. 228
acrotismus, iii« 260
Ebttsrica, i. 17
Enteritis, ii. 256

adhesiva, ii. 256
erytbematica, ii. 259
EnttroHthWf i. 274

Besoardus, i. 276
Calculus, i. 278
Scybalum, i. 283 •
Enuresis, iv. 333
Eparutut/ii, 91

mitis, ii. ib.
malignusyii. 93
Hectica,ii. 112
Causus, ii. 102
asthenicus, ii. 110
flavus, ii. 98
Ephelis, iv. 461
Ephemeray ii. 58

miiis, ii. 59
acuta, ii. 61
sudatoria, ii. 62
EphialUSyL 388

vigilantium, i. 391
nocturnus, i. 392
EfhidroiiS; iv. 359

profusai iv. 360
cruenta, iv. 361
partialis, if. 362
discolor, iv. 363
olens, iv. 363
arenosa, iv. 365
Epian, ii. 446
Epiehrosuy iv. 458

Leucasmus, iv. 458
Spilus, iv. 459
Lenticula, iv. 460
EpbeUs, iv. 461
Aurigo, iv. 463
Poecilia, iv. 464
Alphoais, Iv. 466
Epigenesis, theory of, i^ 13
Epilepsia, Epilepsy, iii. 356

varieties o^ iii. 357
Epinyctis, iv. 408
Epistazis (nasal hsmorihage,) u. 460

468 ^

Ergot, iv. 40

Erosion of the skia, U. 211
Eructatio, Eructation, i. 89
EacrPTivE fsvbrs, ii. 363
Erysipelas, ii. 406 ^

oedematosuBi, ii. 409
gangraMsum, ii. 409
pestilent, ii. 438
Erysipelatous inflammation, it 804
EfytkemOf ii. 200

oederoatosum, ii. 203
erysipelatosum, ii. 204
gangranofom, ii* 206

-OBNERAL fNDEX.

477

Erjfih§ma, vesiculare, u. 207
Pernio, ii. 210
lutertrigo, ii. 211
why ulcerative rather than
phlegmonous, ii. 202

mercuriale, ii. 210
volaticum, iv. 370
Essera, or Eshera, iv. 375
jSsopbagus, L 4.
EstiiiomenoB, iv. 410
Everted eye-lid, ii. 289
Evolution spontaneous in labour, iv, 150
ExangiOj ii. 592

Aneurisma, ii» 592
VariX) ii. 598
Cjania, ii. 601
EXAVTHSMATICA, 11. 363
EXASTBXM, ii. 363

rash, Ii. 366
ichorous^ ii. 386
pustulous, ii. 411
carbuncular, ii. 424
ExAjrTHXSM, iv. 366

Roseola, iv. 366
Ezcernent system, physiology of, iv. 183
Excitability of Brown, what, ii. 39
Exr.GBcaria Agallochum, 1. 113
Excrescence^ eutaneout, iv. 442
Excrescence genital, iv. 102
Ex/ettUionj iv. 168

ovarian, iv. 170
tubal, iv. 173
abdominal, iv. 173
EXORKIA, iv. 367

Strophulus, iv. 369
Lichen, iv« 371
Prurigo, iv. 379
Milium, iv. 383
how distinguished from Ec-
thyma, iv. 367 ^
Exostosis, iv. 214
Expectorants, i. 346

in what way they act, i.
346
Extra-uterine Fetation, iv. 168. See

^fetation
Eye-lids, twinkling of the, iii. 281

F.

Fainting, iii. 339

£rom various odours, iii. 339
Fainting-fit, iii. 341
FalUng-sicknest, iii. 356
Falling down of the womb, iv. 102
False inspiration, iii. 94. 96
Palte tonceptumy iv. 178
Fanaticism, iii. 94. 98
Fasciola, i. 202. 210. iv. 6
Fasting long, or chronic, i. 77

woman of Tetbury, i. 79

Fat, formed from bile, i. 13.— iv. 201
Fatuity, iii. 123

imbecility, iii. 124

irrationality, iii. 130
Febrifuges possess some property not

yet ascertained, ii. 89
Febris lenta nervosa, ii. 127

dyseoterica, or nova, of Syden-
ham, ii, 302

rubr i of Ueberden, ii. 367
Felon, ii. 199
Fern, male, i. 217
Fetation extra-uterine, iv. 168. See

Exfetation
Fetus has been born alive at four
months, iv. 122

may live at seven, iv. 122
Feu volage, iv. 370
Fevers, ii. 27

difficulty of defining, ii. 27

genera in the present work, ii,
28

proeguminal cause, what, ii.20

procatarctic, ii. 29

exciting cause, ii. 29

proximate, ii. 29

remote, ii. 42

chief hypotheses oi^ i'. SO

by what agents excited or in-
fluenced, ii. 46

atory, ii. 58

sweating, ii. 62

intermittent^ ii. 65

remittenty ii. 91

yellow, ii. 98

Bulam, ii. 99

paludal, ii: 99

seasoning, ii. 99

jungle, ii. 99

ardent, ii. 108

fntinuedy ii. 116

inflammatory, ii. 117

imputrid continent, ii. 117
continued, ii. 117

sanguineous continued, ii. 117

hysterical, ii. 127

nervous, ii. 127

putrid, malignant, jail, caap^
hospital, iL 129

syftochal, ii. 145

puerperal, or child-bed, Ii. 148

peritoneal, ii. 148

E&if^TiVB, ii. 363 '

miliary, ii. 386

bladdery, ii. 402
Fibrinous calculus of the bladder, iv. 340
Fibre, nervous, iii. 8. 21

irritable, iii. 20
Fibrous substance of organs, iv, 183
Ficus, iv. 443
Fidgets, iii. 313
Fi^vre matellotte, ii. 99

478

GENERAL INDEX.

Filari'a, iv. 439

Filix mas, i. 217

Fish-skin, iv. 402

Flavours, how influenced at different

times, and under different circum-

stances, iii. 180
Flatulency, i. 89
Flatus, i. ib.
Flea-bite, iy. 437

Flesh-fly, larves of, intestinal, i. 207
Flexibility of the bones, iv. 219
Flooding, iv. 128. 164
Fluids, sexual diseases affecting the,

iv.29
Fluke-worm, i. 202. — ^iv. 6.

iound in the liver, i. 275
Fluttering of the heart, iii. 272
Flux, i. 152

bloody, ii. 300
of aqueous urine, iv. 333
Food, small quantity often demanded,

L 78

water sufficient food for some ani-
mals, i. 78

air sufficient, i. 71
Fool's parsley, i. 141
Folly, iii. 130
Forgetfulness, iii. 124, 125

singular examples of, iii.

127
Fragile vitreum, iv. 217
Fragilitas ossium, iv. 217
Fragility of the bones, iv. 217
FramboBsia, ii. 445
Fraxinella, i. 215
Freckles, iv. 460
Fret, ii. 211

Frogs, singular procreation of, iv. 9
Frost-bite, ii. 210. 607
Fundament, falling down of, > . ^^
prolapse of, J »• ^^^
Fungi, a common cause of surfeit, i.

141

springing up nightly in gangre-

DOBS limbs, i. 199
Fungus hematodes, ii. 618
Furunculus, ii. 192
Fusible calculus of the bladder, iy. 339

G.

Gadfly larves, i. 204.— iv. 440
Galaelia, iv. 66

praematura, iv. 67

defectiva, iv. 69

depravata, iv. 71

erratica, iv. 72

virorum, iv. 73
Gallantry romantic, iii. 94
Gall-bladder, wanting in many animals,
i. 245

Le Gallois, his experiments, iii. 24
Qall-stone, i. 268

passing of, i. 271
Ganglion, iv. 212

Ganglions of the brain, what, iii. 12
Gangrttna, ii. 603

sphacelus, ii. 604
ustilaginea, ii. 608
necrosis, ii. 610
caries, ii. 612
Gangrenous inflammation, ii. 206
Garden-lettuce, ii. 242
Gassf s, inhalation of, i. 385
Gastric juice, discovery of, i. 9
quantity of^ i. 9
quality of, i. 9
other powers, i. 9, 10
Gastritis, ii. 252

adhflBsiva, ii. 256
erythematica, ii. 259
Generative function, iv. 5

machinery of the,
iv. 6

process of, iv. 6
diflferent hypothe-
ses of, iv. 15

difficulties accom-
panying the subject of generation, ir.
18.20
Genbtica, iv. 29
Geoffro>a, i. 211
Geum urbanum, i. 160
Ginseng, whether an aphrodisiac, iv. 90
Glanders in horses, ii 297. — iv. 58
Glaucedo, iii. 147
Glaucosis, iii. 147
Gleet, iv. 62
Glottis, i. 291

air how rendered sonorous In,
i. 292

capable of supplying the
tongue's place, i. 296
Gluttony, i. 72
Goggle-eye, iii. 160
Goggles, iii. 160
Goitre, iv. 209
Gonorrhoea, iv. 55
Gordius, intestinal, i. 205
cuticular, iv. 441
Gout, ii, 335

origin of term, ii. 335
its varieties, 337
how far refrigerants may be em-
ployed, ii. 344, 345. 347
reputed specifics, 352
compression and percussion, ii.
357
Granulation, ii. 169
Grass-hopper, wart-eating, iv. 444
Gratiola officinalis, iv. 255
Gravedo of Celsus, ii. 291
Gray hair, iv. 448. 453

GENERAL INDEX.

479

Great-pox, u. 549

Greeu-stcknera, iv. 74

Grief ungovernable, Hi. 89

Grocer's Itch, iv. 419^

Grog-blossoms, ii. 198

Groundsel, its use in sicltness of the

stomach, i. 99. 280
Gryllus verrucivorus, its power in de-
stroying warts, iv. 444
Guinea-worm, iv. 439
Gum, yellow, of New Holland, i. 113

of infants, i. 261
Gum-boU, ii. 184
Gums, excrescent, i. 47

scurvy of, i. 47
Gutta seu Junctarum dolor, ii. 335
obscura, iii. 149
lerena, iii. 149
Gymnastic medicine, ii. 520.— iii. 297

H.

HiBMATiCA, ii. 27
Haemoptysis, ii. 462. 468
Hamatemeris, ii. 464. 468
Hamaturia, ii. 464. 468
Hamorrhagioj ii. 456

entontca, ii. 457
atonica, ii. 467
Hair-worm, intestinal, i. 205

cutaneous, iv. 441
Hair, morbid^ iv. 446

matted or plaited, iv. 449
gray, iv. 453
bristly, iv. 448
Hallucination, iii. 93
Hifnging, death from, iii. 371
Hardness of hearing, iii. 165
Hare-brained passion, iii. 92
Harmattan, ii. 45
Harvest-bug, iv. 438
Head, dropsy of, iv. 260
Sead-aehey iii. 318

stupid, iii. ib,
chronic, iii. 320
sick, iii. 325
throbbing, iii. 324
spasmodic, iii. 325
Hearing, how far it exists in different

animals, iii. 15
Hearings ihoHndy iii. 162
acute, iiL 164
hardness o^ iii. 165
Iterverse, iii. 166
double, iii. 168
illusory, iii. 168
varieties of, iii. 269
Heart, arganization of, ii. 6

how far it may leap for joy, ii. 7
fluttering of, iii. 272
throbbing of, iii. 272

Heart burn, i. 83

ache ungovernable, ii. 89
Heat, general feeling of, how produced,

iii. 187
Heat-eruption, iv. 415, 416
Hectic fever, ii. 1 12
Hectica, ii, 112
Hedge-hyssop, iv, 255
Helix hortensis, iv. 6
Hellebore, how far a specific in gout,
ii. 356

black, as a hydragogue, iv.
249
Hemeralopia, iii. 135
Hemicrania, iii. 323
Hdminthia, i. 195

alvi, i. 200
erratica, i. 205
podicis, i. 203
Hemiplegia, iii. 418
Hemorrhage, ii. 456

entonic or active, ii. 457
^ varieties ofentonic,ii. 457

atonic, ii. 467
varieties, ii. 468
Hemorrhoids, i. 233
Hemp seeds, in jaundice, 1. 256
Hen-blindness, iii. 139
Hepatitis, ii. 260

acuta, ii. 260
chronica, ii. 265
Herb bennet, i. 160
Hermaphrodites, iv. 6
Hernia humoralis, ii. 272

carnosa, iv. 208
Herpes, iv. 408.
Hesitation in speech, i. 332
Hiccough, iii. 268
Hirsuties, iv. 451
Hirudo viridis, iv. 6
Hirudo sanguisuga, intestinal, i. 208
Hives, ii. 400

Hoffmann, his doctrine of fevers, ii. 30
Holy fire, ii. 209
Home-sickness, iii. 86
Honey-dew, what, i. 197
Hooping-cough, i. 354
Hordeolum, ii. 191
Horns, never grow after castration, iv.

13
Horse hair-worm, intestinal, i. 205
Horse-leech, intestinal, i. 208
Hour-glass contraction of the womb,

iv. 165
Human Understanding, Locke's Essay
on, examined and eulogized, iii. 33
analysis of, iii. 34
Humoralopacity ofthe eye, iii. 147
Hunger, sensation of, how accounted

f<ir, i. 67
Hydarthrus, ii. 358
Hyderus (diabetes,) iv. 311. 335

480

GENBllAL INDEX«

Hydra, iv. 6

Hydrargyria, i. 51. — ^ii. 210
Hydrocele, iv. 285 %

Hydrometra, iv. 284
Hydrophobia, iii. 228

without rabies, iiL 229
Hydrops, iv. 239

cellularis, iv. 244
capitis, iv. 260
epinn, iv. 269
thoracis, iv. 271
abdomiois, iv. 276
ovarii, iv. 281
tubalis, iv. 283
uteri, iv. 284
scroti, iv. 285
inatells, iv. 335
Hyoid bone, i. 291
Hypochondrias, iii. 99

its varieties, iii. 106
Hypochondrism, iii. 99

its varieties, iii. 101
Hypochyma, iii. 149
Hypochysis, iii.Bl49
Hysteria, iii. 352

fosminina, iii. 352
masculina, iii. 353
Hysterics, iii. 352
Hysteritis, ii. 270

simplex, ii. 270
puerperarum, ii. 271

I&J.

Jaundieet yellow, i. 244
biliary, i. 247
gall-stone, i. 251
spasmodic, i. 251
of infants, i. 261
black, i. 262, 263
green, i. 262, 263
Iceland liver-wort, ii. 517
Iclerwy i. 244

choloBiis, i. 247
chololithicus, i. 251
spasmodicus, i. 251
hepatic us, i. 259
' infontum, i. 261
Icthyiasis, Icthyosis, iv. 402
Illeas, what, iii. 34

of sensation, iii. 34
reflection, iii. 35
objective and subjective, iii. 35
complex, iii. 35
association of^ iii. 37
Idiotism, iii. 13f, 131
Ignis saeer of Celsus, ii. 208
Jealousy, ungovernable, iii. 84
Jimmerat (Arab.) ii. 436
Ueac passion, i. 121
Ileus, i. 121

Illusion, iii. 93
Imbecility, mental, iiL 124
Impetigo, iv. 418
Impostume in the head, ii« 114
Impotency, male, iv. 89

barrenness 4)f, iv4 97

iMFREOlfATIOir, DiBCASXS AVFKCT^
IVG THB, IV. 109

physiology of, it. 109
Inability to beget offspring, iv. 88

to eoneeive offspring* iv. 97
species of^ iv. 88
Incarnation, ii. 169
Incongruity, copulative, iv. 94
Inconstancy, iii. 129
Incontinence of urine, iv. 333
Incubus, i. 388
Indian-pink, i. 219
Indigestion,!. 100

Inflammation, general, of Fordyce, U.
119

edematous, ii. 203
erysipelatous, it. 204
gangrenous, ii. 20i
vesicular, ii. 207 *
of the brain, ii. 214
throat, ii. StT
kidneys, ii. 968
larynx, Ii. 231
lungs, ii. 239
pleura, ii. 245
heait, ii. 248
stomach, ii. tSt
bowels, ii. 256
liver, u. 26«
spleen, ii. 267
Madder, ii. 969
womb, ii. 270
testicles, ii. 279
eye*, ii. 273
iris, ii. 278
articular, ii. 324
Inflammations, iL 153

pathology of, ii. 154
proximate cause of^ ii.
154

remote causes o(y ii. 158
healthy, ii. 158
unhealthy, ii. 158
adhesive, ii. 159
ulcerative, ii. 159
always tend to the mit-
face, ii. 161

resolution of, What, ii.
162

suppurative, ii. 159. 165
process of,
ii. 166
Inflammatory fever, ii. 117

its varieties, ii. 121
blush, ii. 200
Inflation, iv. 288

GSNERAL INDEX*

481

Inflation, cellular, iv. 290
tympanic, iv. 292
of the womb, iv. 295

Influenza, ii. 293

its order of recurrence, ii. 299

Intanifyy iii. 42

pathology of, iii. 44

Insanity, proximate cause, iii. S2

whether more common to Eng-

. land than other countries, iii. 54

whether an increasing mala-
dy, iii. 55

Inoculation for cow-pox, ii. 396
small-pox, ii. 421
far plaigue, ii. 432

Insensibility of touch, iii. 189

complicated with
insensibility of other senses, iii. 189

Inspiration, false, iii, 94

Instinct, what, ii. 26

IhTKLLECT, diseases AVFECTI5G

THE, iii. 41
Intellectual principle, iii. 25
Intermarriages between near relations,
wisdom of restraints divine and hu-
man upon, iv. 26
Intermittent Feeer^ ii. 65

quotidian, ii. 68
tertian, H. 70
Irregular, ii. 72
complicated, ii. 73
treatment of, ii. 77
Intestines, organ of; i. 4
lotroeusception, i. 123
Invermination, i. 195
lonthut, ii. 195

Varus, ii. 196.
corymbifer, ii, 197
Joy, ungovernable, iii. 80
Iris, inflammation of, ii. 278

fherpes,) iv. 412
Irk Medtni (Guinea- worm,) iv. 439
Irrationality, iii. 130
Ischuria, iv. 301
Itch, iv. 429

baker's, iv. 401
complicated, iv. 430
grocer's iv. 419
pocky, iv.430
rank, iv. ib.
watery) iv. ib.
mangy, iv. ib.
Itch-tick, IV. 438
Judam TArab.), ii. 568
Juzam (Arab.), ii. ib.

K.

Kibe, ii. 210 .

Kidneys, inflammation oi^ ii. 268
Kin-cough, or kind-cough, i. 354
TOL. IV. 61

King's evil, ii. 527

Knife-eaters, i. 82

KOIA1A, i. 17

Kouba or kuba (Arab^, iv. 389

Krummholzohl, vermifuge, i. 211

213

Labour, morbid, iv. 130
atonic, iv. 132
unpUant, iv. 134

varieties of, iv. 135
complicated, iv. 139
perverse, iv. 146

varieties of^ iv. 147
impracticable, iv. 151
multiplicate, iv. 160
sequential, iv. 163
premature, iv. 122
show, iv. 53
Lacerta aquatica, intestinal, i. 208
Lachrymose ophtbalmy, ii. 275
Lacteals, organ of^ i. 6
Lagnesis, iv. 82

Salactitas, iv. 83
Furor, iv. 86
Lallatio, i. 338
Lambdacismus, i. ib.
Land-scurvy, ii* 581
Lappa, ii. 690
Laryngic suffocation, i. 360
Laryngitis, ii. 231
L<lf^fngysmtu, i. 360

stridulus, i. 360
Larynx, i. 291

of birds, i. 293

stridulous constriction o^ i. 360
Lascivious madness, iv. 86
Laughing, how produced, i. 300
Lauro-eerasus, see Prunus
Lawrence, his hypothesis concerning

life and a living principle, iii. 30
Lax, i. 152
Lead, subacetate of in hemorrhages, ii.

470
Leech, intestinal, i. 205
Leg, tumid puerperal, ii. 317

of West Indies, ii. 32t
Leipopsychia, iii. 337
Lenticula, iv. 460
Lentor of the blood, what, ii. 32
Leodonton Taraxacum, i. 256
iv.305
Leontiasis, ii. 569
Lepidosis, iv. 383

Pityriasis, iv. 385
Lepriasis, iv. 387
Psoriasis, iv. 399
Icthyiasis, iv. 402
Lepriasis, iv. 387
Leprosy, iv. ib*

482

GENERAL INDEX*

Leprosy, Astunao, ii. 575

black, ii. 570

dull- white, iv. 341

dusky, iv. 391
Leprosy, nigrescent, iv. 391. 393

bright- white, iv. 391. 394

varieties of, iii. 391
Leucasmus, iv. 458
Leuce, iv. 391
Leueorrhcta, iv. 48

coraraunis, iv. 49
Nabothi, iv/ 53
seaescentium, iv. 54
LibeUula or dragon-fly, singular posi-
tion of sexual organs, iv. 10
^Lichen (in botany"^ caninus, iii. 248
terrestris cinereus, iii. 24f
in pathology, iv. 371
Lientery, i. 159

Life, various hypotheses concerning, iii.
27

weariness of, iii. 103.
Lign-aloes in indigestion^ i. 113
Lvnoiisy i. 71

avens, i. 72
Cardialgia, i. 83
Dyspepsia, i. 100
Emesis, i. 94
expers, i. 76
Flatus, i. 89
Pica, i. 80
Lippitude, ii. 288
lippitudo, ii. 288
Lisping, i. 340
hiihiOy iv. 338

renalis, iv. 340
vcsicalis, iv. 347
Lithiasis, iv. 338
Lithic calculus, iv. 339
Lithontriptics, iv. 354

Stephens^s, iv. 355
Lithopoedion, iv. 175
Lithotomy, iv. 356 ,
Lithus, iv. 338
Liver, organ of, i. 5.

how affected by summer heat, i.
155

use of, i. 244

found in most animals of every
rank, i. 244

inflaaMnation o^ ii. 260
Living principle, various hypotheses

concerning, iii. 28
Loathing, i. 96
Lobelia syphilitica, ii. 557
Lochial discharge profuse, iv. 164. 167
Locked jaw, iii. 233

varieties, iii. 215
Locke, tribute to his Essay on Human
Understanding, iii. 33

Lodgement of matter in the diest^ ix>

178
-Long-sight, iii. 140
Looseness, i. 152

Lopezia Mexicana, or lopez-root, i. 160
Love, ungovernable, iii. 86
Love -sickness, iii. ib.
Lousiness, iv. 485
Loxia, iii. 208
Lowness of spirits, ill. 99

its varieties, Iii, 101
Ludibria fauni, i. 392
Lues, ii..547

Syphilis, ii. 549

syphilodes, ii. 563

history of, ii. 549

Ostia^s said to be insusceptive
of, ii. 556
Lullaby-speech, i. 338
Lumbage, ii. 326. 331
Lumbricus cucurbitinus, i« 209
Luna fixata, iii. 295
Longs, structure ef, i. 297
Lupus, ii. 620
Lust, iv. 82
Lyssa, iii. 228

canina, iii. 235. 238

felina, Ui. 235, 236

M.

MacMlar^kin, iv« 458
Madness, iii. 64

varieties, iii. 64
lascivious, iv. 86
Mad wort, iii. 252

Magendie, hie hypothesis concerning
the living principle, iii. 28

of the ahMrkeat
system, iv, 191 .

his azotic regimen oi^ in cnl*
cuius, iv. 353
Maggots, intestinal, i. 207
Magnesia,

its use in indigestionf i. 108
Malabar nut, i. 106
Malaria of the Cam]ingna| ij, 90
Mai de la Rosa, ii. 367. 576
Mai de Siam, ii. 99
del Sole, ii. 574
Maliasmus, iv. 434
MfUis, iv. ib.

pediculi, iv. 435
pulicis, iv. 487
acari, iv. 43t
filiaris, iv. 439
gordii, iv. 441
oestri, iv. 440
Malleatio, iii. 292

(Malum pilare, iv. 446
Mama-pian, ii. 443

OENERAL INDEX*

483

Mandacation, i* 5
Mange, iv.
Mania, iii. 64

varieties, iii. 64

the illusion often unconnected
with the cause of the disease, iiL 69
Mania, most easily cured when pro-
duced by accidental causes, iii. 70

heat and cold in the cure ap-
plied at the same time, iii. 74

attendance on religioua serrices,
how far advisable, iii. 74

moral treatment of, iii. 74
Manie sans del ire, iii. 92
Mttroi/nuSy ii. 472

Atrophia, ii. 475
climactericns, ii. 480
Tabes, ii. 487
Phthisis, ii. 494
Marcus, his doctrines of fever, ii. 90
Mare's milk as a vermifuge, i. 219
Marsh effluvium, ii. 42

principles, ii. 46
laws ef, ii. 52
Masques & louchette, iii. 160
Materialism, hypotheses in support of,

iii. 28
Matter, lodgement of in the chest, it.
178

of the world, its essence not
known, iii. 26

whether extension be a distinct
property, iii. 26

whether solidity, iii. ib.
Maw-worm, i. 203
Meal-bark, i. 3
Measles, ii. 379

black, ii. 379
Medicine gymnastic, ii. 520
pneumatic, ii. 521
Megrim, iii. 323
MtUtnOy i. 262

cholcea, i. 263
cruenta, i, 266
Melaleuca Leucodendron, i. 57
Melampodium, iv. 249
Melansma, iii. 367
Melancholia, iii. 56

its varieties, iii. 56
Melancholy, iii* ib.

how distinguished patho-
gnomically from mania, iii. 58

why mistaken at times for
hypochondrism, iii. 58

exciting caoset, iii. 59
tendency to violence and
abusive language accounted for, iii. 62
Melas, iv, 391
Melasma, iv. 429
Melliceris, iv. 212

Memory, retention of, bow ditert from
quickness, iii. 126

Memory, failure of, iiL 126
Menorrhagia, iv. 43
Menstruation obstructed, iv. 3!

by retention,
iv. 31

by suppres-
sion, iv. 35

laborious, iv. 36
superfluous, iv. 43
vicarious, iv. 45
irregular cessation of, iv.
46
Mental extravagance, iii. 94
Mephytic suffocatioD, iii. 376
Merganser, i. 294
Mergus, i. ib.
McBOTtOA, iv. 199
Metamorphopsia, iii. 144
Miasm, febrile, what, ii« 43 ,
laws of, ii. 52
powers of in typhus, ii. 124
identity with contagion, ii. 296
Mildew mortification, ii. 608
Miliary fever, ii. 386
Milium, iv. 383
Milk, artificial, ii. 516
Milks, analysis of in difiereot animalf,

ii. 516
Milk-teeth, i. 21
Milk-flow, premature, iv. 67
deficient, iv. 69
depraved, iv. 71
erratic, iv. 72
in males, iv. 73
MiUepes, i. 255
Millet-rash, iv. 383

Mind, its nature but little known, iii.
25

whether in its essence material
or immatepal, iii. 25

real character deducible from
natural and revealed evidence, but
its essence not known, iii. 27

by what means it maintains an
intercourse with the surrounding
world, iii. 31

various hypotheses examined, iii.

32

33

the difficulty felt by Locke, iii.

its faculties to itself what organs
are to the body, iii. 37

feelings of, iii. 38

subject to diseases as well at
the body, iii. 38
Misanthropy, iii. 103
Miscarriage, iv. 122
Misemission, seminal, iv. 91
Misenundation, i. 334
Miihctaiumy iv. 66
MitmemtrucUion, iv. 29
MismenMtrwUimiy barrenneBi ofj iv. 99

484

GENERAL INDEX*

MiMmUturUitmy iv. 297

See Paruria
Muossifieation, iv. 216

fragile, iv. 217
flexile, iv. 219
Mole uterine, iv. 176

cutaneous, iv, 459
MoUities ossium, iv. 219
Monorchids, whether natural, iv. 10
Morbus niger, i. 262

comitialts, iii. 356
piFaris, iv. 441
puerorum, iv. 79
MoriOy iii. 123

imbecillis, iii. 124
demens, iii. 130
Mordekie, Mordechie (Arab.), i. 174
Morpio, iv.

Mort de chien (cholera,) i. 174
Mortificatfon, ii. 604
Moss, Iceland, i. 353
Mountain-parsley as a diuretic, iv. 305
Mouth-watering, i 51
Mulberry calculus of '^tbe bladder, iv.

339
Mumps, ii. 225
Mungo radix, iii. 246
Musca, larves of, intestinal, i. 207
carnaria, i. 207
vomitoria, i 207
MVSCLBS, DI8KASB8 AFFECTISG THB,
iU. 202

fibres off iii. 7
in masft, iii. 202
voluntary and involuntary,
iii. 204

See muscular fibres
Muscular fibres, what and how pro-
duced, iii. 7

contraction, laws of, iii. 203
See Muscles
Musk in rabies, iii. 249

artificial, how prepared, i* 357
Myrrh in hectic fever, ii. 116

N.

Nausea, L 96

Necrosis, ii. 610

Necrosis Ui>tilaginea, Li. 608

NefKropF, pye -balled or spotted, iv, 464,

4»io
Nephritis, ii. 269
Nerium anti'^ysentericum, ii. 315
J^erte-arhcy iii. 192

of the face, iii. 193

foot, iii. 192. 198
breast, iii, 192. 200
% Nerves, number and general character,
iii, 8

Nerves, whether solid chords or hoUow

cylinders, iii. 18
Nervous function, its extent and im-
portance, iii. 5

fluid, iii. 21

both sensific and motory,
iii. 22
Netek (Hebrew) Scall, iv.395
Nettle-lichen, iv. 372. 377

rash, ii. 384
ffeuralgioy iii. 192

faciei, iii. 193

mistaken for tooth-
ache, i. 38

pedis, iii. 192. 198
mammas, iii. 192. 200
Neurotica, iii. 41
Nictitatio, iii. 281
Night-mare, i. 302
Night pollution, iii. 114
Night-sight, iii. 135
Nirles, iv.

Nisus forroativus, what, iv. 18
Noli me tangere, ii. 619
Numbness, iii. 189
Nutmeg, hypnotic quality of, i. 92

iii. 311
Nuz vomica, i. 88, 1 14

in iotermittents, ii, 87
dysentery, ii. 313
palsy, iii. 432
Nictalopia, iii. 135. 137
Nymphsea Nelumbo, ii. 559
Nymphomania furibunda, iv. 86. 88

Obesity, iv. 200

general, iv. ib.

splanchnic, iv. 203
Oblivion, iii. 125
Obstipation, i. 151
Ocular spectres, iii. 144
OdofUiOy i. 17

dentitionis, i. 18

dolorosa, i. 27

stuporis, i. 39

deformis, i, 41

edentula, i, 43

incrustans, t. 45

excrescensy i. 47
Glstrus, (larves of, or) bots, intestinal,
i. 203

cuticular, iv, 440
Oil, train, in chronic rheumatism, iL

334
Oleum templinum. i. 213

jecoris aselli, ii. 334
Olives, singular mode of rearing, i. 7,
Omentum, organ of, i. 13

J

GENERAL INDEX*

485

Oneirof^ynia, iii. 114

Ononis spicata, as a diuretic, iv. 304

Opacity humoral, iii. 147

Ophiasis, iv. 456

Ophiorrhiza Mungos, iii. 246

OpkUiolmiaj ii. 273

Taraxis, ii. 275
iridis, ii. 278
purulenta, ii. 280
glutinosa, ii. 287
chronica, ii. 429
metastatica, ii. 283
epidemica, ii. 280
gonorrhoica, ii. 284
catarrhalis, ii, ib.
intermittens, ii. 284
Lippitudo, ii. 288

Ophthaimy, ii. 273

lachrymose, ii. 275
purulent, iL 280
of infants, ii. 284
Egyptian, ii. 280
epidemic, ii. 280
glutinous, ii. 287

Opisthonia, iii. 211

Opisthotonus, iii. 211. 221

Orange-skin, iv. 463

Orban, his practice of using acids in
consumption, ii. 513

Orchitis, ii.

Organic molecules, what, iv. 16

OrQASM, DISRASB8 AFFSCTIfie THE,

iv. 74

Orgabtica, iv. ib.

Ormskirk medicine, iii. 251

Ornithorbyochus paradoxus, or platy-
pus, i. 5

Orthopnea, i. 363

Osmandia regalis. i. 217

Osteopoedion, iv. 175

Osthunoj Oithexy, iv. 233
infarciens, iv, 234
implexa, iv. 235
varieties, iv. 236

Otaheite, vowel-softness of many pas-
sages in this and other savage tongues,
i. 339

Ova^ human, iv. 14
Ovariajkuman, iv. ib.

Painter's cbolic, i. 127
Palpitatio, iii. 272

cordis, iii. ib.
arteriosa, iii. 275
compiicata, iii. 278
Palpitation, iii. 272

in the epigastric region, iii.
277
Palsy, iii, 414

Palsy, varieties, iii. 417
shaking, iii. 297
Pandiculatio, Pandiculation, iii. 284
Papula, iv, 367
Papulous skin, iv. ib,
ParahytmOy i. 273

hepaticum, i. 274
complicatum, i. 288
intestinale, i. 285
mesentericum, i. 282
omentale, i. 287
pancreaticum, i. 281
splenicum, i. 279
Paracentesis in dropsy of the chefit, of

early origin, iv. 274
Paraeutii^ iii. 162

acris, iii. 164
obtusa, iii. 165
perversa, iii. 166
duplicata, iii. 168
illusoria, iii. ib.

varieties, iii. 169
Surditas, iii. 169
Paraeytsis, iv. 113

irritativa, iv. 114
uterina, iv. 119
Abortus, iv. 122
ParageusiSj iii. 178

acuta, iii. 181
obtusa, iii. 180. 182
expers, iii. ib. 183
Paralysis, iii. 414

varieties of, iii. 4174
whether likely to be benefit-
ed by tertian ague, iii. 435
Paramenia^ iv. 29

obstructionis, iv. 31
difficilis, iv. 36
superflua, iv. 43
erroris, iv. 45
cessatoois, iv. 46
Paraphimosis, ii. 189
Paraplegia, iii. 417. 422
Parapriiy iii. 183

acris, iii. 184
expers, iiL 189
illusoria, iii. 190
Parenchyma of organs, iv. 183

PAREIICHTMA, DISEASES AFVECTIITO
THE, iv. 199

Paristbmitis, ii. 227

varieties, ii. 227

ParodytUOy iv. 130

atonica, iv, 132
implastica, iv. 134
sympathetica, iv. 139
perversa, iv. 146
amorphica, iv. 151
pluralis, iv. 160
secundaria, iv. 163

Par<miriay iii. 114

ambulans, iii. 115, 116

4S6

eENEHAL IHDSX.

PanmiriOy loqueos, iii. 115. 118

salax, Hi. 115. 119
Paronychia, ii* 199
Paropsisy iii. 134

lucifo^a, ni. 135
noctifuga, iii« 137
longinqua, iiL 140
propinqua, iii. 14}
lateralis, iii. 142
iilufloria, iii. 143
Galigo, iii. 148
Glaucosis, iii. 147
Catarracm, iir. 148
Synizesis, iii. 152

Amaurosis, iii. 154
Staphyloma, iii. 158
Strabismus, Hi* 169
Pmroimitf iii. 172

acris, iii. ib.
obtosa, iti. 176
expers, iii. 177
ParvrtiOy iv. 216

fragiHs, \w. 217
flezilis, ir. 219
Parotid phlegmon, ii. 18€
Parotitis, ii. 225
PatVriOy iv. 297

inops, iv. 298
retentioms, iv. 991
stillatitia, ir. 386
meHita, iv. 311
incontinens, iv. 333
incocta, ir. 396
erratica, iv. 397
Passio bovina, iv.
Poition unfoiemabk^ iii. 77
Passions of the mind, as liable to dis-
ease, as its intellectual faculties, iii.
77
Pearl-ash, in indigestion, 1 110

?:te ( - «»

Pemphigus, ii. 402

Peripneumonia, ii. 239

Peripneumony, ii. 239

- varieties, iL 239

Peritoneal fever, ii. 148

Peritoneum, inflammation of, ii. 249

pBritomtis, ii. 249

propria, ii. 250
omentalls, ii. 251
mesenterica, ii. 251

Pernio, ii. 210

Pestis, ii. 426

varieties, ii. 426

Phacia, iv. 460

Phalena pinguinalis, larves of, intesti-
nal, i. 207

Phasianus, mot-mot, i. 294

Pheasant, mot-mot, i. 294

Philautia, iii. 82

Phimosis, ii. 189 •

Phimotic phlegmon, ii. 189
Phlegmasia, ii. 153
Phlegmatia, dolens, ii. 317
P/UtgrnofUt Phlegmon, ii. 182
Pamlis, ii. 184
communis, iL 189
auris, ii. KM
parotides, ii. 185
manrns, ii. 187
Bubo, ii. 188
phimotica, iL 189
Phlogistica, li. 153
PRIiOOOTVCA^ if. 153
PblyctttssB, it. 209
Phfyntf H. 199
Phohioa, i. 9t^
Phosphorus in typhut, il. 143

gout, ii. 350
FUKKStCAf H'u 41
Phrensy, il. 219^
Phryganeagrandis, larteroi^ intestinal^

i. 207
Phthiriasis, iv. 484
PhihisiB, ii. 494

varieties, ii. 495
dyspeptic, ii. ib.
Phymoy ii. 190

Hordeolum, ii. 191
Furuncuhfs, it. 192
Sycosis, ii. 192
Anthrax, il. 193
Pfaysalis Alkekengi, or wtnter-dmryV

iv. 807
Physometra, iv. 295
Pian, ii. 445
Piles, i. 239

Pin of the eye, iiL 146. 155
Pin-eye, iii. 146. 156
Placenta, retention of| rr. 164 '
Plague, ij. 426

varieties, ii. 426
of Athens, iL 427. 429.
of London, ii. 429
of Morocco^ ii. 481
of Brititfi army in Cgypt^ H.
433

inoculation for, ii. 432
exposure to, iliiiiiirnhei|^|miw
er, ii. 440 ▼

influenced by state of the At-
mosphere, ii. 441
Platalea Leucorodia (spoon-bill,) i. 294
PUthmrOj ii. 451

entonica or sanguine, fi. 453
atonica or 'Serous^ ii. 454
Pleuralgia, i. 401

acuta, i. 402
chronica, iv. 409
Pleurisy, ii. 245

spuriouS) ii. 331
Pleuritis, ii. 245

vera, ii« 245

ciimauL iNi>£x.

487

Pleuiitis, medUftiMi) ii. 347

4UpbraiSmataca, u» 247
PleurosthotoDus, iii. 221
Plica, iv. 449
PMunatic nediciDev ii. £21

PVS17MATICA, i. 309
PneunttMiB, iv. 290
Pneuroonica, i. 342
Pneumooitis, iL 239

vtim, ii, 239
maligna, ii 243
notba, ii. 244
Podagra, li« 335

its varieties, ii. SS7
Poecilia, iv. 4fi4
Poison of Tipef as an antilyssic, iiL

259
Poliosis, It. 4S3

Polyglottus, mocking-bird, i, 295
Pofyputy i. 313

elasticus, i. 3M
coriaceus, i. ib»
uteri, iv. 107
Tagine, iv* ib.
Po^reiOy iv. 200

adipota, it. tb«
Pompholyz, Ponphaa, hr. 407
Pontine marshes, insalubrity of, ii. 90
Porpbjra, ii. £78

simplex, ii. 680
hemorrhagica, ii. 581
nautica, ii. 5S5
Porrigo, iv. 421, 422
Portland powder, ii. 352
Pose, ii. 33S
Power, nervous, iii. 21

MoeiAc and motific,
iii. 22

motific,* or irritation
of a lower description than sensifie
iii. 23
Pox, ii. 549

bastard, ii. 563
JVecoetijy, genital, iv. 79
Pregnanty^ nmrini, iv. 1 13

from coMdtuCioBaJ
derangement, iv. 114

from local derange-
ment, iv. 119

from miscarriage,
ii. 122

pcopar period of,
iv. Ill

utmost extant al-
lowed, iv. 112
Premature delivery, its advaotagea at

times, iv. 156
Priapus, iii. 207

Pricking, general laaliag of, iii. 188
Prickly-heat, iv:. 372. 375
Pride angovemable^ iii. 82
ProetUa^ i. 810

Proetieih simplex, i. 220

spasmodica, i. 221
callosa, i. !^7
Exania, i. 240
Marisca, i. 233
Tenesmus, i. 232
PraotiM^ iv. 79

fceminina, iv. 81
masculina, iv. 80
Prolapse, geniiai, iv. 102

of the bladder, iv. 105
vagina, iv. 105
womb, iv. 102
Protuberant eye, iii. 158
Prunus Lauro-cerasus, i. 394

in fevers, ii. 87
Prurigo, iv. 379
Pruritus, iii. 186
Prussic acid, i. 278
PsellistnuSy i. 332

Bambalia, i. 332
Blasitas, i. 334
PieudoeyesUy iv. 176

molaris, iv. 176
inanit, iv. 178
Psoas abscess, ii. 175
Psora, iv. 389. 399
Psoriasis, iv* 399
Psorophthalmia, ii. 287
Pfya&my i. 49
P^foiumutf i. ib.

acutus, u 50
chronicus, L 57
iners, i. 57
Pubis symphysis ossa, divMoa of, in

Impracticable labour, iv. 153
Puerperal fever, ii« 148

epidemic, ii. 149
contagions, ii. 149
mania, iii. 65
convulsions, Ui.346
Pulex f Daphnia,) iv. 7

(Monocttlusi) iv. ib.
Pulex, iv.

Pulsatilla nigricans iii. 146
Pulse, doctrine, of, iL 16
Pulse, why diftrant in different agei^
ii. 9 '

standard in adult life, ii. 16
ralkncy, ii. 17
advanced life, ii. 17
difieient kinds af^ ii. 19
of Solano, H. 20
' ofBordeu, iL20
Pulseleasneis, iii. 260
Pulvis, antilyssus, iii. 249

Oobbti, iii. 251
Pupil, cl6aed, iii. 113
double, iii. 153
five^ibld, iii. ib.
Purpura (Miliaria,) ii. 386
Purulent ophthalmy, ii. 280

488

GENERAL INDEX*

Pus, a secretion, ii. 167, 168
Hewson's view, ii. 167
Hunter's, ii. 168. 171
use of; ii. 170. 173

Push, ii. 183

Pye-balled skin,, iv. 464

Ptrectica, ii. 27

Q.

Quartan ague, ii. 71
double, 73
treble, ib.
duplicate, 74
triplicate, ib.

^uas, Russian, ii. 591

Quinsy, ii. 227

varieties, ii. ib.
nervous, i. 63

R.

Rabid blood, as an antiljssic, iii. 252
Rabies, iii. 228

canine, iii. 235. 238
feline, iii. 235, 236
Rainbow worm, iv. 412
Raphania, iii. 300
Raptus nervorum, iii. 211
Mt^ exanthenif ii. 366
rose, iv. ib.

gum, iv. 369 ,

lichenous, iv. 371
pallid, iv. 371
pruriginous, it. ^79
millet, iv. 383
rainbow, iv.
tooth, iv. 369, 370
wild-fire, iv, ib. ib.
Rattling in tht throaty i. 316
Rectum, stricture of, spasmodic, i. 221

callous, i. 227
Red-gum, iv. 369
RemiUtnt fever, ii. 91

mild, ii. 91
malignant, ii. 93
autumnal, ii. 94
yellow, ii. 98
burning, ii. 108
asthentic, ii. 110
of Breslaw, ii. ib.
Renal calculus, iv. 340
Respiration, effect of, on the blood, i.
300

Ellis's hypothesis, i. 301
quantity of air expired and
inspired in, i. 304
Rest-harrow as a diuretic, iv. ib.
Restlessness, iii. 312
Retching, i. 96

Retension of the menses, iv. 31

secundines, iv. 164
Revery, iii. 107

of mind, iii. 108
abstraction of mind, iii. 107.
Ill

brown-study, iii. 107. 112
Rachialsia, i. 127
Rhachitis, iv. 223

origin of the name, iv. ib.
Rheuma, how used formerly, ii. 335
Rheumatism, acute, ii. 326

whether co-exists with
gout, ii. 325

articular, iii. 326
lumbar, U. 330
of the kip-joint, ii. ib.
pleura, ii. 331
chronic, ii. 332
Rhonchus, i. 316

stertor, i. ib.
Cerchnus, i. 317
Rhus vernix, i. 358.— iii. 432
toxicodendrum, iii. 432
Rh3rpia, iv. 414
Richerand, bis hypothesis conctrning a

living principle, iii. 28
Rickets, iv. 223
Ringing in the ears, iii. 169
Ring-worm, iv. 409. 412

scall, iv. 421. 424
Rosalia, ii. 366
Rose-rash, iv. ib.
Rose-wood, i. 93
Roseola, iv. 366
Rosy-drop, ii. 197
Rot in sheep, cause of, i. 210
Rotacismus, i. 338
Rubeola, ii. 366
Rubia tinctorum, iv. 39
Rubula, ii. 445
Rubus Chamsraorus, ii. 590
Rumbling of the bowels, i. 89
Rumination, instances of in man^ L 94
Running at ikt note^ u 309
Rye, spurred, iv. 40

8.

Saat (Hebr.), iv, 395
Sahafata (Arab.) Scall, iv. 399
Salacitas, 7 . ,3
Salacity, $ '^- ''^
Saliva, analysis of, i. 49
Salivation, i. 50
Salmon, fecundity of, iv. 9
Sambucus Ebulus, iv. 248

nigra, iv. 248
Sancti Viti chorea, iii. 289
Sand, urinary, iv. 340

white, iv. 341

GENERAL INDEX.

Sftnd, urinary red, iv. 342
Banguiferous system, machinery of, ii. 5
moving powers of,
ii. 11

fluids of, iii. 21
Santonica, i. 215

Saphat (Hebr.) Scall, iv. 389. 395. 399
Sarcocele, iv. 208
Satyriasis furens, iv. 86
Scabies, iv. 429, 430
Scabiosa Indica, i. 211
ScALS-SKiir, iv. 384
Sea]], dry, iv. 399
humid, iv. 416
scabby, iv. 421
milky, iv. 422
honey-comb, iv. 423
Scalledhead, iv. ^2
Scandiz cerefolium, i. 237
Scarabeus, (beetle-grubs) intestina},

i.S03
Scarlatina, ii. 366
Scarlet-fiBver, ii. ib.

with sore throat, ii. 368.
371
Scelotyrbe, iii. 290. 297
Scenteid odours issuing from the bodies

of animals, iv. 364
Sciatica, ti. 331
Scotodinus, iii. 334
Scotoma, iii. 334. 336
Scott's acid bath, in jaundice, i. 257

lues, ii. 558
SenphuUff iL 525
Scurvy^ ii. 578

land, ii. 581
petecchial, ii. 580
sea, ii. 585
Scybalum, i. 191
Sea-bear, i. 3
cal^ i.3

sickness, how produced, L 99

worms, feed harmlessly on copper-

bottoBMa ships, i. 139

Seasoning fever of hot climates, ii. 100

Secale comutum, or spurred rye, i. 141

SscsRvxvT Stitkm, dubasxs of,

Iv. 184
SeeretioDf, furnished by diffisrent ani-
mals, and often the same animal in
diiEmnt parts, iv. 197
sugar
sulphur
lime
mUk

Secretion8,&c.

unne

bile

honey

wax

silk

phosphorefcent light

mil

vaurr.

62

197

489

. electricity )

furnished by plants > 198
equally diversified, }
Secundines, retention of^ iv. 164
Self-conceit, ungovernable, iii. 82
Seminal fluid, how secreted, iv. 10

powerful influence of, on
the animal economy, iv. 12
flux, iv. 64

entonic, iv. 64
atonir., iv. 65
misemission, iv. 91
Senega, iv. 249
Seneka-root, i. 384

SKVSATION, DiBBASES APPECTIJfO
THS, iii. 133

Sensation and motion, principle of, iii.
19

whether a com-
mon power, or from distinct sources,
iiL22

Senses, external, in diflferent animals,
iii. 13

whether any animal possesses
more than five, iii. 17

SSNSO&IAL POWERS, DISEASES AP-
PKCTIITG JOIITTLT, ii. 307

Sentimentalism, iii. 94

Serpigo, iv

Seta equina, intestinal, i. 205

Seville Orange Tree, iii. 295

Sex and features, how accounted for,
iv. 14. 17

Sexual fluids, diseases affecting, iv. 29

Shaking palsy, iii. 297

Shark, procreation of, iv. 8

Shingles, iv. 409, 410

Short-breath, i. 364

Sibbens, or Sivens, ii. 564

Sick head-ache, iii. 325

Sickness of the stomach, i. 94

Sighing, how produced, i. 300

Sight, in different animals, ii.

Sight, marbidj iii. 134
night, iii. 135
day, iii. 137
long, iii. 140

of age, iii. 141
short, iii. 141
skew, iii. 142
false, iii. 143

Silliness, iii. 130

Silver, nitrate of, in epilepsy, iii. 365
power of producing a dark co-
lour on the skin, iii. 365

Simarouba, ii. 315

Sincine-birds, vocal avenue of, i. 294
buU-finch, i. 294
nightingale, i. ib.
thrush, i. 294
tunefid manakiny i'
294

490

OSNBEAL im>SX.

Singing-birds, vocal mockiog'^ird, L S95
Singultus, ill. 368
Sisymbrium, iii. 351
Skin paptUouty iv* S67
Slaughter-houses, exhalation of, in con-
sumption, ii. 622
Slavering, i. 57
SkepUstnetSy iii. 308
SUep-disturbancty iii. 114

sleep-walking, iii.116
sleep-talking, iii. 115.
117

night-pollution, iii.
115
Smail-poz, ii. 411

varieties, ii. 41V
SmUj morHdy iu. 172
acrid, iii. ib.

eex, age, and other qualities dis-
coverable Dj it, iii. 174
obtuse, iii. 176
want of, iii. 177
illusory, whence, iii. 333
how far it exists in different ani-
mals, iii. 14
Snaffles, ii. 296
Snail, procreation of, iv. 10
Sneezing, 'iii. 270
Snivelling, i. 311

Snuff-taking, why injurious, i. 106
Snuffles, ii. 296
Snaffling, i. Sll
Soap, i. 256
Soins, ii. 591
Sol-lunar influence, Balfoui*s hypothec

sis of, ii. 56
Solid parts of organic of what compos-
ed, iv. 183
Solvents, biliary, i. 273
Somnambulism, iii. 116
Sore-throat, ii. 227

ulcerated or maltgnaat, ii.
228
Soreness, general feeling of, iii. 184
Sounds, vocal, i. 337

guttural, i. 340
nasal, i. 33a
lingual, i. ib.
dental, i. 340
labial, i. 337. 339
imaginary in tiie ears, iii. 169
Sparganosis, ii. 317
Spasm, doctrine of, as applicable to

fevers, ii. 33
Spatmy consirietive, iii. 207

its species, iii. 107
ckmief iii* 265

Its species, iii. 267
syn^oniey iii. 287

its species, iii. ib*
ccmaiosef iiU342

it! species^ iii. 342

Spawn, or hard roe, wbat^ir. $

Speech, how prodiiced, i. 292
inability of, i. 318
may be produced without a
tongue, U 319

Speechlessness, i. 318

Sperm, or aoft roe, what, iv. S

Spwrnorrhaoy iv. 64

Spider discharged from tho anu8| i. 801

Spigelia, i. 211. 219

Spignel, iv. 40

Spilosis, iv.459

Spilus, iv.459

Spina ventosa, what, ii. 614

Spine, dropsy of, ir. 260

Spirit of animation, of Oarwio, ii. 39

Spitting of blood, ii 463

SpuLircHHicA, i. 243

Spleen, office not knovn, i. 13

not fouBd botow tbo «la«f of
fishes, i. 13
iu. 103

Splenalgia, ii. 267

Splenitis, ii. ib.

Spoon-bill, i. 294

Spurred-rye, i. 141
iv.40

Sporzheim, his bypoUievf vpon liiO na-
ture of the mind, iii. 20

Squalus, procreation o^ iv. 8

Squinting, iii. 160

varietios, iii, 161

St. Anthony's fire, ii. 406
varieties, ii. 407

St Quy, Dance de, iii. 289

St. Vitus's Dance, iii. 89

Stahl, his doctrine of kiYOis, ii. 30

Stammering, i. 332

Staphyloma, iii. 158

varieties, iiL ib«

Stays, tight, their mischievoyi «fiKts, i.
404

femal4^ iv. 97
mmtaigm, u 393 _

MibulMtiu«^ i*394
chromca* 1*400
Stemutatio, ii'i. 270
Steitor, i. 816
Stiff^MBty muaculmr, iii* 210

its ^«ri«t»9% ui.
210
SUtch, i. 402
Stomach, organ of, i. 4

omnivorous ppwer of, i. 3.
self-digesting p«wer oi^ i. 11.
seat of univoif^ sympathy,
i.l4

inflammatioA al^ ii. 252
Stone in tba bladder, iv. 347
Stone-po^ ii*106
Stoppage of urine) iv. 901

OCNBRAL IinMBX.

4M

BtraUimaii in. 160
Stramonium, iU. t48
Strangury, iv. 306

ipatmodi€, iv. 907

scalding, !▼. ib.

callousy !▼• 906

Tertticulout, iv. 309

polypous, iT. 310

mucous, iy. 309
Stricture of the rectum, spasmodic, i.

3S1
Stropholiit, if. 969
Stfumm, ii. $2$

vulgaris, ii; 527
Studium inane, iii. 112
Stupidity, iii. 124

Sturgeon, mede of procreatioii, iv« 9
Stuttering, i. 832
Sty, ii. 191
Subsultus, iii. 289
Sudor anglicus, ii« 62
Suffocatio stridula, ii. 299
8uifi>cation from asphyxy, iiu 368

irott hang^lg or drowning,
iii. 368

mephytic. iU, 376

dectrica^ iii. 879

from severe cold, iii. 380
Suffiisio, iii. 149

sdntUltns, iii* 143
reticularis, iii. 143
Sugar in sacchdne urine, the proportion,

iv. 314
Summer-rashf iv. 872. 375
Sun-burn, iv. 461
Superannuation, til. ISO, 181
Superfetation, it. 162
Suppression tit the menses, iv. 85
Suppurative iDiammation^ ii« 165
Surditas, iii. 169

SVRFACXS, DTTS&KAI., MIBAtXS AH*

VKCTIHO, iv. 239
SVRVAOB, BXTUtirAL, MlBAtttf AT*

FKomro THX, iv, 357
Surfeit, i. 135

Suspended animation, iii. 967
Susumii, Ui. 169
Stotaif morbid, iv, 359

profuse^ iv. 960
Moody, iv. 861
partiid, iv. 362
colovred, iv. 863
soeoled, iv. ib.
sandy, it. 865
Swan, dumb, i« 284

musical, i. 9M
Sureatlng-fiiveff, ii.62

whether Englishmen
only sah)ect to it, ii. 64
Sweet-spittle, i. 55. 59
Swimming of the hetd, iii. 886
SwiM-poB, U. 400

Swooning, iii. 837

varieties, iii.- 839
Sycosis, ii. 192

Sympathies and antipathies, how form-
ed in the mind, iii. 37
SyneUmus, iii. 267

Tremor, iii. 287
Chorea, iii. 269
Ballismus, iii. 297
Raphania, iii. 300
Beriberia, iii. 303
Syncope^ iii. 336

simplex, iii. 337

varieties, iii. 339
recurrens, iii. 341
Synisesis, iii. 152
Synocha, ii. 118
Synochal fever, H. 145
Synochus, ii. 145

its varieties, ii. 146
Syrigmus, iii. 169
Sjftpatia, iii. 942

Convulsio, iii. 345
Hysteria, iii. 352
Epilepsia, iiL 356
Stitatica, iii. 307
Systremma, iii. 211

Tabes, ii. 487

varieties, ii. 487
dorsalls, ii. 490
Tabor or Talbor, his early use of the

bark in agues, ii. 84
Tsdium vitsB, iii, 108
Toenia Solium, i. 200
vulgaris, i. ib.
generation oi^ iv. 10
Tarantismus, iii. 290
Tar, fumigation with, ii. 521
Tar-water, useful in indigiestion, i. 109
Taraxacum, i. 256

iv. 305
Taraxis, ii. 275

Taste, how far it exists in different ani-
mals, iii. 14. 178
TuUj tnorbidf iii. 178

acute, iii. 181
obtuse, iAu 180. 182
want of, iii. 180. 183
iUasory, wlienoe, iii. 338
Teats in the mare, inguinal, iv* 10
Teeth, tartar of^i. 45

transplantation of, i. 43
whether an extraneous body, i.
32

whether injured by sugar, i. 84
pretended, reproduced by jug-
glers, i. 27

carious, i« 30

4TO

(a&HtEMAL fKDlSX*

Teeth, deformity of, i. 41
Teething, i. 18

in adults, i. 25
in old age, i. ib.
Tenderness, general external feeUiig of,

bow produced, iii. 184
Teneritudo, iii. 184
Tenesmus, i. 232
Tertian ague, it. 70
double, i
triple, > ii. 73
duplicate, )
Testes, diminish in the winter in many
animals, iv. 10

where seated in the cock, iv. ib.
Testudo, iv. 213
Tetanus, ill. 221

anticus, Iii. 221
dorsalis, iii. 221, 222
lateralis, iii. 221
erectus, iii. 221. 223
Tetter, iv. 408
Therioma, iv. 410
Thirsty morbid, i. 67

immoderate, i. 69
sensation of, ho>v accounted for,
i.67
Thirstlessness, i. 70
Throbbing of the arteries, iii. 275

heart, iii. 272
Thrush, ii. 390

its varieties, ii. 390
Tic, meaning of the term, iii. 194. 213

douloureux, iii. 193
TiclL-bite, iv. 438

Tiglium seeds as a hydragogue, iv. 247
Tinea, iv. 422. 423
Toads, suckling in cancer, ii. 645
Tongue, speech not necessarily depen-
dent upon it, i. 542
Tonquin powder, iii. 251
Tooth, derangement of, i. 17

wise, i. 25
Tooth-ache, i. 27
Tooth-edge, i. 39
Toothlessness, i. 43
ThrpOTy iii. 366
Thueh, morbid, iii. 183

acute sense of, iii. 184
insensibility of, iii. 189
illusoi-y, iii. 190
Trance, iii. 385
Transudation in dead animal matter,

iv. 190
Trembling, iii. 287
Tremor, iii. 287
Trichechus Dudong, i. 3
Trichoma, iv.
Trichocepbalus, i. 200
TVichoiis, iv. 446

setosa, iv. 448 .

Plica, iv. 449 f

TrichtniMy Hirsutii^ iv. 451
distrix, iv. 462
Poliosis^ iv. 453
athrix, iv. 454
Area, iv. 455
decolor, iv. 456
Tripudatio, iii. 297
Trismus (entasia) iii. 213
varieties, iii. 215
mazillaris, ifi. 193
dolorificus, iii. 193
Triton palustris, intestinal, i. 206
Tsorat of the Jews, what, iv. SSt, fS^

394. 399
Tubba, ii. 447
TubereUj ii. 190
Tumid-leg, puerperal, ii. 317

of West-Indies, ii. 390
Tumour, iv. 205

sarcomatous, iv. 206
fleshy, iv, lb.
adipose, iv. ib.
pancreatic, iv. ib.
cellulose, iv. 207
cystose, Iv. ib.
scirrhous, iv. 207, 208
mammary, iv. 207
tuberculous, iv. ib.
medullary, iv. ib.
encysted, iv.212
steatoniatous, iv. ib.
atheromatous, iv. ib.
honied, iv. ib.
ganglionic, iv. ib.
homy, iv. 213
bony, iv. 214
osteons, iv. 215
periosteous, iv. ib.
pendulous, iv. ib.
exotic, iv. ib.
Tta^eMence viteetaiy i. 273
Tussis, i. 342

Twinkling of the eye-lids, iii. 281
Twinning, congruous, iv. 160

incongruous, iv. 161
Twins, iv. 160

Twiichings of the tendons, iiL 283
Tympanites, iv. 292
Tympany, iv. ib.

whether ever an idiopathic
affection, iv. 293
Typhomania, ii. 219. — ^iii. 392
Typhus, how far approximates yaUow
fever, ii. 50. 124

described, ii. 123
causes, ii. 124

how becomes contagious, ii.
124

extent and intensity of conta-
gion, ii. 126

raUd, ii. 127

malignant or putrid, ii. 128

OINEEAL INDEX*

493

Typhus, fpecific properties of its mi-
asm, ii. 124. 132

septic power, distinct from its
debilitatii^ ii. 132

copious bleeding, how far ad*
visable, ii« 134

U &V.

Vaccinia, ii. 394

its varieties, ii. 395
Vagina, prolapse of, iv. 102
Vapours, iii. 101
Variola, ii. 411
Variz, ii. 598
Varus, ii. 196

Vegetation promoted by animal dejec-
tions, i. 8
Veins and arteries, ii. 7
Vena Bledinenses, iv. 440
Venereal disease, ii. 547
Ventriloquism, what, t S95
Vermifuges, 211
Vermis Medinensis, iv. 440
Vermination, cutaneous, iv. 434
Vertigo, Ui. 331

origin of, iii. 332
Venuca, iv. 444
Vesiculs seroinales, iv. 11

diflfor in difierent animals, iv,
11
Vesicular inflammation, ii. 207
fever, ii. 402
its varieties, ii. ib.
Viper, poison o^ as an antilyssic, iii.

259
VU insita, iii. 20
nervea, iii. ib.
It tergo, hypothesis of, ii. 13
Viscus quemns, iii. 351
Vitiligo, iv, 387
i;Zcer,tt*615

depraved, ii. €16
callous, ii. ib.
fungous, ii. ib,
- cancerous, ii. ib.
sinuous, ii. 618
carious, ii. 620
Ukui, ii. 615

incarnans, ii. 615
vitiocum, ii. 616
sinuosuffl, ii. 617
toberculosum, ii. 619
cariosum, iL 620
Vocal avenue, i. 291
Voice, how produced, i. 292
imitative, seat of, i. 295
whispering, i. 327
of puberty, i. 329
rough, i. 331
harsh, i, ib.

Voice, nasal, i. ib,

squeaking, i. ib.
whizzing, i. ib.
guttural, i. ib.
' palatine, or through the nose, i.

331

immelodious, i. ib.
Vomica, ii, 181

occult, ii. ib.
open, ii. ib.
Vomiting and purging, i. 167
of blood, ii. 464
i.96
Vomito prieto, ii. 99
Vomituritio, i. 96
Vomitus, L ib.
Voracity, i. 72
Uric calculus, iv. 344
Urinal dropsy, iv. 311. 335
Urinary calculus, iv. 338
Urinary sand, iv. 340

gravel, iv. 340. 344
Urine, earths, salts, and other princi<t
pies of, iv. 339
bloody, ii. 464
destitution o^ iv. 298
stoppage o(y iv. 301
saccharine, iv. 3il
honeyed, iv. ib.
incontinence o^ iv, 333
unassirailated, iv. 336
erratic, iv. 337
Uroplanta, iv. 337
Urticaria, ii. 384
Uteri procidentia, iv. 103
prolapsus, iv. ib.
relaxatio, iv. ib.
Uterine hemorrhage, ii. 465. 468

W.

Wakefuhaess, iii. 308

irritative, iii. 308
chronic, iii, 310
Walrus, i. 3
Wart, iv. 444
Water in the head, iv. 260
Water-blebs, iv. 407
Water-flux, iv. 311
Water-brash, L 84
Water-pox, ii. 400
Water-hemlock, i. 141
Web of the eye, iii. 146
Weeping, how produced, L 300
Wen, iv. 212

adipose, iv. ib.

honied, iv. ib.

homy, iv. 213
Wheal-worm, iv. 439
Whelk, ii. 195
White-gum, iv. 369. 371

4»4

COnElAL iRum*

White-sweUhig) iL SS^
Whites, iy. 48
WhiUow, ii. 199
Whizzing in the emra, iii. 19B
Wild carrot, as a diuretk, ir. 995
Wind-cholera, i. 171
cholic, i. 142
dropsy, iv. 288
Winkinci iiL281
Winter-cherry, iv* 307
Wity how ft may exist without judg-
ment, and hence in insanhy, iii* 57
crack-brained, iiL 94* 96
Witlessness, iii. 130
Womb, inflammation o^ ii. 270 .
falling-down of, iy* 102
retroyerted, iy. 104
Worm-grass, u 219
Worm, goose-fdot^ i.215
Wormwood, i. 114

Worms, intestinal, their abiBty to resist
digestion, i. 11

yarioui species, i.
195

long round, 1. 200
thread,!. 200,
201

tape, L 201
bread tape, L 202

WonUi bitetthialt mairi L 109
erratic, u 205

hepatic, i. 275

yesical, iy. 309
Wertt-«eed| i. 211
Wry-neck, hi. 298

Xanthic ozyde of the bladder^ It. 398.

Tarn, i* 3.
Yawning, iii. 286
Yaws, iU. 445

Yellow feyer, how far approaches ty-
phus, ii. 50

descriptkm •<; ii. 90

Zaruthal^ ii. 543
Zona, iy. 410

ignea« it* lb.
Zoster, iy. 409, 410

END OF vol; IV.

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