Zoonomia/II.I.II.II
ORDO II.
Decreased Irritation.
GENUS II.
Decreased Action of the Secerning System.
These are always attended with decrease of partial, or of general heat; for as the heat of animal bodies is the consequence of their various secretions, and is perpetually passing away into the ambient air, or other bodies in contact with them; when these secretions become diminished, or cease, the heat of the part or of the whole is soon diminished, or ceases along with them.
SPECIES.
1. Frigus febrile. Febrile coldness. There is reason to believe, that the beginning of many fever-fits originates in the quiescence of some part of the absorbent system, especially where they have been owing to external cold; but that, where the coldness of the body is not owing to a diminution of external heat, it arises from the inaction of some part of the secerning system. Hence some parts of the body are hot whilst other parts are cold; which I suppose gave occasion to error in Martyn's Experiments; where he says, that the body is as hot in the cold paroxysms of fevers as at other times.
After the sensorial power has been much diminished by great preceding activity of the system, as by long continued external heat, or violent exercise, a sudden exposure to much cold produces a torpor both greater in degree and over a greater portion of the system, by subtracting their accustomed stimulus from parts already much deprived of their irritability. Dr. Franklin in a letter to M. Duberge, the French translator of his works, mentions an instance of four young men, who bathed in a cold spring after a day's harvest work; of whom two died on the spot, a third on the next morning, and the other survived with difficulty. Hence it would appear, that those, who have to travel in intensely cold weather, will sooner perish, who have previously heated themselves much with drams, than those who have only the stimulus of natural food; of which I have heard one well attested instance. See Article VII. 2. 3. Class III. 2. 1. 17.
Frigus chronicum. Permanent coldness. Coldness of the extremities, without fever, with dry pale skin, is a symptom of general debility, owing to the decreased action of the arterial system, and of the capillary vessels; whence the perspirable matter is secreted in less quantity, and in consequence the skin is less warm. This coldness is observable at the extremities of the limbs, ears, and nose, more than in any other parts: as a larger surface is here exposed to the contact of the air, or clothes, and thence the heat is more hastily carried away.
The pain, which accompanies the coldness of the skin, is owing to the deficient exertion of the subcutaneous vessels, and probably to the accumulation of sensorial power in the extremities of their nerves. See Sect. XII. 5. 3. XIV. 6. XXXII. 3. and Class I. 2. 4. 1.
M. M. A blister. Incitantia, nutrientia, sorbentia. Exercise. Clothes. Fire. Joy. Anger.
2. Pallor fugitivus. The fugitive paleness, which accompanies the coldness of the extremities, is owing to a less quantity of blood passing through the capillaries of the skin in a given time; where the absorbent power of the veins is at the same time much diminished, a part of the blood lingers at their junction with the capillary arteries, and a bluish tinge is mixed with the paleness; as is seen in the loose skin under the eye-lids, and is always a mark of temporary debility. See Class II. 1. 4. 4. Where the paleness of the skin is owing to the deficiency of red globules in the blood, it is joined with a yellowish tinge; which is the colour of the serum, with which the blood then abounds, as in chlorosis, and in torpor or paralysis of the liver, and is often mistaken for a superabundance of bile.
A permanent paleness of the skin is owing to the coalescence of the minute arteries, as in old age. See Class I. 2. 2. 9. There is another source of paleness from the increased absorption of the terminations of the veins, as when vinegar is applied to the lips. See Sect. XXVII. 1. and another from the retrograde motions of the capillaries and fine extremities of the arteries. See Class II. 3. 1. 1.
M. M. A blister, nutrientia, incitantia, exercise, oxygene gas.
3. Pus parcius. Diminished pus. Dryness of ulcers. In the cold fits of fever all the secretions are diminished, whether natural or artificial, as their quantity depends on the actions of the glands or capillaries, which then share in the universal inaction of the system. Hence the dryness of issues and blisters in great debility, and before the approach of death, is owing to deficient secretion, and not to increased absorption.
M. M. Opium, wine in very small quantities, Peruvian bark.
4. Mucus parcior. Diminished mucus. Dryness of the mouth and nostrils. This also occurs in the cold fits of intermittents. In these cases I have also found the tongue cold to the touch of the finger, and the breath to the back of one's hand, when opposed to it, which are very inauspicious symptoms, and generally fatal. In fevers with inirritability it is generally esteemed a good symptom, when the nostrils and tongue become moist after having been previously dry; as it shews an increased action of the mucous glands of those membranes, which were before torpid. And the contrary to this is the facies Hippocratica, or countenance so well described by Hippocrates, which is pale, cold, and shrunk; all which are owing to the inactivity of the secerning vessels, the paleness from there being less red blood passing through the capillaries, the coldness of the skin from there being less secretion of perspirable matter, and the shrunk appearance from there being less mucus secreted into the cells of the cellular membrane. See Class IV. 2. 4. 11.
M. M. Blisters. Incitantia.
5. Urina parcior pallida. Paucity of pale urine, as in the cold fits of intermittents; it appears in some nervous fevers throughout the whole disease, and seems to proceed from a palsy of the kidnies; which probably was the cause of the fever, as the fever sometimes ceases, when that symptom is removed: hence the straw-coloured urine in this fever is so far salutary, as it shews the unimpaired action of the kidnies.
M. M. Balsams, essential oil, asparagus, rhubarb, a blister. Cantharides internally.
6. Torpor hepaticus. Paucity of bile from a partial inaction of the liver; hence the bombycinous colour of the skin, grey stools, urine not yellow, indigestion, debility, followed by tympany, dropsy, and death.
This paralysis or inirritability of the liver often destroys those who have been long habituated to much fermented liquor, and have suddenly omitted the use of it. It also destroys plumbers, and house-painters, and in them seems a substitute for the colica saturnina. See Sect. XXX.
M. M. Aloe and calomel, then the bark, and chalybeates. Mercurial ointment rubbed on the region of the liver. Rhubarb, three or four grains, with opium half a grain to a grain twice a day. Equitation, warm bath for half an hour everyday.
7. Torpor Pancreatis. Torpor of the pancreas. I saw what I conjectured to be a tumour of the pancreas with indigestion, and which terminated in the death of the patient. He had been for many years a great consumer of tobacco, insomuch that he chewed that noxious drug all the morning, and smoaked it all the afternoon. As the secretion from the pancreas resembles saliva in its general appearance, and probably in its office of assisting digestion, by preventing the fermentation of the aliment; as would appear by the experiments of Pringle and Macbride; there is reason to suspect, that a sympathy may exist between the salivary and pancreatic glands; and that the perpetual stimulus of the former by tobacco might in process of time injure the latter. See Tobacco, Article III. 2. 2.
8. Torpor renis. Inirritability or paralysis of the kidnies is probably frequently mistaken for gravel in them. Several, who have lived rather intemperately in respect to fermented or spirituous liquors, become suddenly seized about the age of sixty, or later, with a total stoppage of urine; though they have previously had no symptoms of gravel. In these cases there is no water in the bladder; as is known by the introduction of the catheter, of which those made of elastic gum are said to be preferable to metallic ones; or it may generally be known by the shape of the abdomen, either by the eye or hand. Bougies and catheters of elastic gum are sold at No 37, Red Lion-street, Holborn, London.
M. M. Electric shocks, warm bath. Emetics. See calculus renis, Class I. 1. 3. 9. When no gravel has been previously observed, and the patient has been a wine-drinker rather than an ale-drinker, the case is generally owing to inirritability of the tubuli uriniferi, and is frequently fatal. See Class I. 2. 4. 20.
9. Punctæ mucosæ vultûs. Mucous spots on the face. These are owing to the inactivity of the excretory ducts of the mucous glands; the thinner part of this secretion exhales, and the remainder becomes inspissated, and lodges in the duct; the extremity of which becomes black by exposure to the air.
M. M. They may be pressed out by the finger-nails. Warm water. Ether frequently applied. Blister on the part?
10. Maculæ cutis fulvæ. Morphew or freckles. Tawny blotches on the skin of the face and arms of elderly people, and frequently on their legs after slight erysipelas. The freckles on the face of younger people, who have red hair, seem to be a similar production, and seem all to be caused by the coalescence of the minute arteries or capillaries of the part. In a scar after a wound the integument is only opake; but in these blotches, which are called morphew and freckles, the small vessels seem to have become inactive with some of the serum of the blood stagnating in them, from whence their colour. See Class III. 1. 2. 12.
M. M. Warm bathing. A blister on the part?
11. Canities. Grey hair. In the injection of the vessels of animals for the purposes of anatomical preparations, the colour of the injected fluid will not pass into many very minute vessels; which nevertheless uncoloured water, or spirits, or quicksilver will permeate. The same occurs in the filtration of some coloured fluids through paper, or very fine sand, where the colouring matter is not perfectly dissolved, but only diffused through the liquid. This has led some to imagine, that the cause of the whiteness of the hair in elderly people may arise from the diminution, or greater tenuity, of the glandular vessels, which secrete the mucus, which hardens into hair; and that the same difference of the tenuity of the secerning vessels may possibly make the difference of colour of the silk from different silk-worms, which is of all shades from yellow to white.
But as the secreted fluids are not the consequence of mechanical filtration, but of animal selection; we must look out for another cause, which must be found in the decreasing activity of the glands, as we advance in life; and which affects many of our other secretions as well as that of the mucus, which forms the hair. Hence grey hairs are produced on the faces of horses by whatever injures the glands at their roots, as by corrosive blisters; and frequently on the human subject by external injuries on the head; and sometimes by fevers. And as the grey colour of hair consists in its want of transparency, like water converted into snow; there is reason to suppose, that a defect of secreted moisture simply may be the cause of this kind of opacity, as explained in Cataracta, Class I. 2. 2. 13.
M. M. Whatever prevents the inirritability and insensibility of the system, that is, whatever prevents the approach of old age, will so far counteract the production of grey hairs, which is a symptom of it. For this purpose in people, who are not corpulent, and perhaps in those who are so, the warm bath twice or thrice a week is particularly serviceable. See Sect. XXXIX. 5. 1. on the colours of animals, and Class I. 1. 2. 15.
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12. Callus. The callous skin on the hands and feet of laborious people is owing to the extreme vessels coalescing from the perpetual pressure they are exposed to.
As we advance in life, the finer arteries lose their power of action, and their sides grow together; hence the paleness of the skins of elderly people, and the loss of that bloom, which is owing to the numerous fine arteries, and the transparency of the skin, that encloses them.
M. M. Warm bath. Paring the thick skin with a knife. Smoothing it with a pumice stone. Cover the part with oiled silk to prevent the evaporation of the perspirable matter, and thus to keep it moist.
13. Cataracta is an opacity of the crystalline lens of the eye. It is a disease of light-coloured eyes, as the gutta serena is of dark ones. On cutting off with scissars the cornea of a calf's eye, and holding it in the palm of one's hand, so as to gain a proper light, the artery, which supplies nutriment to the crystalline humour, is easily and beautifully seen; as it rises from the centre of the optic nerve through the vitreous humour to the crystalline. It is this point, where the artery enters the eye through the cineritious part of the optic nerve, (which is in part near the middle of the nerve,) which is without sensibility to light; as is shewn by fixing three papers, each of them about half an inch in diameter, against a wall about a foot distant from each other, about the height of the eye; and then looking at the middle one, with one eye, and retreating till you lose sight of one of the external papers. Now as the animal grows older, the artery becomes less visible, and perhaps carries only a transparent fluid, and at length in some subjects I suppose ceases to be pervious; then it follows, that the crystalline lens, losing some fluid, and gaining none, becomes dry, and in consequence opake; for the same reason, that wet or oiled paper is more transparent than when it is dry, as explained in Class I. 1. 4. 1. The want of moisture in the cornea of old people, when the exhalation becomes greater than the supply, is the cause of its want of transparency; and which like the crystalline gains rather a milky opacity. The same analogy may be used to explain the whiteness of the hair of old people, which loses its pellucidity along with its moisture. See Class I. 2. 2. 11.
M. M. Small electric shocks through the eye. A quarter of a grain of corrosive sublimate of mercury dissolved in brandy, or taken in a pill, twice a day for six weeks. Couching by depression, or by extraction. The former of these operations is much to be preferred to the latter, though the latter is at this time so fashionable, that a surgeon is almost compelled to use it, lest he should not be thought an expert operator. For depressing the cataract is attended with no pain, no danger, no confinement, and may be as readily repeated, if the crystalline should rise again to the centre of the eye. The extraction of the cataract is attended with considerable pain, with long confinement, generally with fever, always with inflammation, and frequently with irreparable injury to the iris, and consequent danger to the whole eye. Yet has this operation of extraction been trumpeted into universal fashion for no other reason but because it is difficult to perform, and therefore keeps the business in the hands of a few empyrics, who receive larger rewards, regardless of the hazard, which is encountered by the flattered patient.
A friend of mine returned yesterday from London after an absence of many weeks; he had a cataract in a proper state for the operation, and in spite of my earnest exhortation to the contrary, was prevailed upon to have it extracted rather than depressed. He was confined to his bed three weeks after the operation, and is now returned with the iris adhering on one side so as to make an oblong aperture; and which is nearly, if not totally, without contraction, and thus greatly impedes the little vision, which he possesses. Whereas I saw some patients couched by depression many years ago by a then celebrated empyric, Chevalier Taylor, who were not confined above a day or two, that the eye might gradually be accustomed to light, and who saw as well as by extraction, perhaps better, without either pain, or inflammation, or any hazard of losing the eye.
As the inflammation of the iris is probably owing to forcing the crystalline through the aperture of it in the operation of extracting it, could it not be done more safely by making the opening behind the iris and ciliary process into the vitreous humour? but the operation would still be more painful, more dangerous, and not more useful than that by depressing it.
14. Innutritio ossium. Innutrition of the bones. Not only the blood effused in vibices and petechiæ, or from bruises, as well as the blood and new vessels in inflamed parts, are reabsorbed by the increased action of the lymphatics; but the harder materials, which constitute the fangs of the first set of teeth, and the ends of exfoliating bones, and sometimes the matter of chalk-stones in the gout, the coagulable lymph, which is deposited on the lungs, or on the muscles after inflammation of those parts, and which frequently produces difficulty of breathing, and the pains of chronic rheumatism, and lastly the earthy part of the living bones are dissolved and absorbed by the increased actions of this system of vessels. See Sect. XXXIII. 3. 1.
The earthy part of bones in this disease of the innutrition of them seems to suffer a solution, and reabsorption; while the secerning vessels do not supply a sufficient quantity of calcareous earth and phosphoric acid, which constitute the substance of bones. As calcareous earth abounds every where, is the want of phosphoric acid the remote cause? One cause of this malady is given in the Philosophic Transactions, where the patient had been accustomed to drink large quantities of vinegar. Two cases are described by Mr. Gouch. In one case, which I saw, a considerable quantity of calcareous earth, and afterwards of bone-ashes, and of decoction of madder, and also of sublimate of mercury, were given without effect. All the bones became soft, many of them broke, and the patient seemed to die from the want of being able to distend her chest owing to the softness of the ribs.
M. M. Salt of urine, called sal microcosmicum, phosphorated soda. Calcined hartshorn. Bone-ashes. Hard or petrifying water, as that of Matlock, or such as is found in all limestone or marly countries. The calcareous earth in these waters might possibly be carried to the bones, as madder is known to colour them. Warm bath. Volatile or fixed alcali as a lotion on the spine, or essential oils.
The innutrition of the bones is often first to be perceived by the difficulty of breathing and palpitation of the heart on walking a little faster than usual, which I suppose is owing to the softness of the ends of the ribs adjoining to the sternum; on which account they do not perfectly distend the chest, when they are raised by the pectoral and intercostal muscles with greater force than usual. After this the spine becomes curved both by the softness of its vertebræ, and for the purpose of making room for the disturbed heart. See Species 16 of this genus.
As these patients are pale and weak, there would seem to be a deficiency of oxygene in their blood, and in consequence a deficiency of phosphoric acid; which is probably produced by oxygene in the act of respiration.
Mr. Bonhome in the Chemical Annals, August, 1793, supposes the rickets to arise from the prevalence of vegetable or acetous acid, which is known to soften bones out of the body. Mr. Dettaen seems to have espoused a similar opinion, and both of them in consequence give alcalies and testacea. If this theory was just, the soft bones of such patients should shew evident marks of such acidity after death; which I believe has not been observed. Nor is it analogous to other animal facts, that nutritious fluids secreted by the finest vessels of the body should be so little animalized, as to retain acetous or vegetable acidity.
The success attending the following case in so short a time as a fortnight I ascribed principally to the use of the warm bath; in which the patient continued for full half an hour every night, in the degree of heat, which was most grateful to her sensation, which might be I suppose about 94. Miss ——, about ten years of age, and very tall and thin, has laboured under palpitation of her heart, and difficult breathing on the least exercise, with occasional violent dry cough, for a year or more, with dry lips, little appetite either for food or drink, and dry skin, with cold extremities. She has at times been occasionally worse, and been relieved in some degree by the bark. She began to bend forwards, and to lift up her shoulders. The former seemed owing to a beginning curvature of the spine, the latter was probably caused to facilitate her difficult respiration.
M. M. She used the warm bath, as above related; which by its warmth might increase the irritability of the smallest series of vessels, and by supplying more moisture to the blood might probably tend to carry further the materials, which form calcareous or bony particles, or to convey them in more dilute solution. She took twice a day twenty grains of extract of bark, twenty grains of soda phosphorata, and ten grams of chalk, and ten of calcined hartshorn mixed into a powder with ten drops of laudanum; with flesh food both to dinner and supper; and port wine and water instead of the small beer, she had been accustomed to; she lay on a sofa frequently in a day, and occasionally used a neck-swing.
15. Rachitis. Rickets. The head is large, protuberant chiefly on the forepart. The smaller joints are swelled; the ribs depressed; the belly tumid, with other parts emaciated. This disease from the innutrition or softness of the bones arose about two centuries ago; seems to have been half a century in an increasing or spreading state; continued about half a century at its height, or greatest diffusion; and is now nearly vanished: which gives reason to hope, that the small-pox, measles, and venereal disease, which are all of modern production, and have already become milder, may in process of time vanish from the earth, and perhaps be succeeded by new ones! See the preceding species.
16. Spinæ distortio. Distortion of the spine is another disease originating from the innutrition or softness of the bones. I once saw a child about six years old with palpitation of heart, and quickness of respiration, which began to have a curvature of the spine; I then doubted, whether the palpitation and quick respiration were the cause or consequence of the curvature of the spine; suspecting either that nature had bent the spine outwards to give room to the enlarged heart; or that the malformation of the chest had compressed and impeded the movements of the heart. But a few weeks ago on attending a young lady about ten years old, whose spine had lately began to be distorted, with very great difficulty and quickness of respiration, and alarming palpitation of the heart, I convinced myself, that the palpitation and difficult respiration were the effect of the change of the cavity of the chest from the distortion of the spine; and that the whole was therefore a disease of the innutrition or softness of the bones.
For on directing her to lie down much in the day, and to take the bark, the distortion became less, and the palpitation and quick respiration became less at the same time. After this observation a neck-swing was directed, and she took the bark, madder, and bone-ashes; and she continues to amend both in her shape and health.
Delicate young ladies are very liable to become awry at many boarding schools. This is occasioned principally by their being obliged too long to preserve an erect attitude, by sitting on forms many hours together. To prevent this the school-seats should have either backs, on which they may occasionally rest themselves; or desks before them, on which they may occasionally lean. This is a thing of greater consequence than may appear to those, who have not attended to it.
When the least tendency to become awry is observed, they should be advised to lie down on a bed or sofa for an hour in the middle of the day for many months; which generally prevents the increase of this deformity by taking off for a time the pressure on the spine of the back, and it at the same time tends to make them grow taller. Young persons, when nicely measured, are found to be half an inch higher in a morning than at night; as is well known to those, who inlist very young men for soldiers. This is owing to the cartilages between the bones of the back becoming compressed by the weight of the head and shoulders on them during the day. It is the same pressure which produces curvatures and distortions of the spine in growing children, where the bones are softer than usual; and which may thus be relieved by an horizontal posture for an hour in the middle of the day, or by being frequently allowed to lean on a chair, or to play on the ground on a carpet.
Young ladies should also be directed, where two sleep in a bed, to change every night, or every week, their sides of the bed; which will prevent their tendency to sleep always on the same side; which is not only liable to produce crookedness, but also to occasion diseases by the internal parts being so long kept in uniform contact as to grow together. For the same reason they should not be allowed to sit always on the same side of the fire or window, because they will then be inclined too frequently to bend themselves to one side.
Another great cause of injury to the shape of young ladies is from the pressure of stays, or other tight bandages, which at the same time cause other diseases by changing the form or situation of the internal parts. If a hard part of the stays, even a knot of the thread, with which they are sewed together, is pressed hard upon one side more than the other, the child bends from the side most painful, and thus occasions a curvature of the spine. To counteract this effect such stays, as have fewest hard parts, and especially such as can be daily or weekly turned, are preferable to others.
Where frequent lying down on a sofa in the day-time, and swinging frequently for a short time by the hands or head, with loose dress, do not relieve a beginning distortion of the back; recourse may be had to a chair with stuffed moveable arms for the purpose of suspending the weight of the body by cushions under the arm-pits, like resting on crutches, or like the leading strings of infants. From the top of the back of the same chair a curved steel bar may also project to suspend the body occasionally, or in part by the head, like the swing above mentioned. The use of this chair is more efficacious in straightening the spine, than simply lying down horizontally; as it not only takes off the pressure of the head and shoulders from the spine, but at the same time the inferior parts of the body contribute to draw the spine straight by their weight; or lastly, recourse may be had to a spinal machine first described in the Memoires of the academy of surgery in Paris, Vol. III. p. 600, by M. Le Vacher, and since made by Mr. Jones, at No 6, North-street, Tottenham-court Road, London, which suspends the head, and places the weight of it on the hips. This machine is capable of improvement by joints in the bar at the back of it, to permit the body to bend forwards without diminishing the extension of the spine.
The objections of this machine of M. Vacher, which is made by Mr. Jones, are first, that it is worn in the day-time, and has a very unsightly appearance. Mr. Jones has endeavoured to remedy this, by taking away the curved bar over the head, and substituting in its place a forked bar, rising up behind each ear, with webs fastened to it, which pass under the chin and occiput. But this is not an improvement, but a deterioration of M. Vacher's machine, as it prevents the head from turning with facility to either side. Another objection is, that its being worn, when the muscles of the back are in action, it is rather calculated to prevent the curvature of the spine from becoming greater, than to extend the spine, and diminish its curvature.
For this latter purpose I have made a steel bow, as described in the annexed plate, which receives the head longitudinally from the forehead to the occiput; having a fork furnished with a web to sustain the chin, and another to sustain the occiput. The summit of the bow is fixed by a swivel to the board going behind the head of the bed above the pillow. The bed is to be inclined from the head to the feet about twelve or sixteen inches. Hence the patient would be constantly sliding down during sleep, unless supported by this bow, with webbed forks, covered also with fur, placed beneath the chin, and beneath the occiput. There are also proper webs lined with fur for the hands to take hold off occasionally, and also to go under the arms. By these means I should hope great advantage from gradually extending the spine during the inactivity of the muscles of the back; and that it may be done without disturbing the sleep of the patient, and if this should happen, the bow is made to open by a joint at the summit of it, so as to be instantly disengaged from the neck by the hand of the wearer. This bow I have not yet had opportunity to make use of, but it may be had from Mr. Harrison, whitesmith, Bridge-gate, Derby.
It will be from hence easily perceived, that all other methods of confining or directing the growth of young people should be used with great skill; such as back-boards, or bandages, or stocks for the feet; and that their application should not be continued too long at a time, lest worse consequences should ensue, than the deformity they were designed to remove. To this may be added, that the stiff erect attitude taught by some modern dancing masters does not contribute to the grace of person, but rather militates against it; as is well seen in one of the prints in Hogarth's Analysis of Beauty; and is exemplifyed by the easy grace of some of the ancient statues, as of the Venus de Medici, and the Antinous, and in the works of some modern artists, as in a beautiful print of Hebe feeding an Eagle, painted by Hamilton, and engraved by Eginton, and many of the figures of Angelica Kauffman.
Where the bone of one of the vertebræ of the back has been swelled on both sides of it, so as to become protuberant, issues near the swelled part have been found of great service, as mentioned in Species 18 of this genus. This has induced me to propose in curvatures of the spine, to put an issue on the outside of the curve, where it could be certainly ascertained, as the bones on the convex side of the curve must be enlarged; in one case I thought this of service, and recommend the further trial of it.
In the tendency to curvature of the spine, whatever strengthens the general constitution is of service; as the use of the cold bath in the summer months. This however requires some restriction both in respect to the degree of coldness of the bath, the time of continuing in it, and the season of the year. Common springs, which are of forty-eight degrees of heat, are too cold for tender constitutions, whether of children or adults, and frequently do them great and irreparable injury. The coldness of river water in the summer months, which is about sixty-eight degrees, or that of Matlock, which is about sixty-eight, or of Buxton, which is eighty-two, are much to be preferred. The time of continuing in the bath should be but a minute or two, or not so long as to occasion a trembling of the limbs from cold. In respect to the season of the year, delicate children should certainly only bathe in the summer months; as the going frequently into the cold air in winter will answer all the purposes of the cold bath.
17. Claudicatio coxaria. Lameness of the hip. A nodding of the thigh-bone is said to be produced in feeble children by the softness of the neck or upper part of that bone beneath the cartilage; which is naturally bent, and in this disease bends more downwards, or nods, by the pressure of the body; and thus renders one leg apparently shorter than the other. In other cases the end of the bone is protruded out of its socket, by inflammation or enlargement of the cartilages or ligaments of the joint, so that it rests on some part of the edge of the acetabulum, which in time becomes filled up. When the legs are straight, as in standing erect, there is no verticillary motion in the knee-joint; all the motion then in turning out the toes further than nature designed, must be obtained by straining in some degree this head of the thigh-bone, or the acetabulum, or cavity, in which it moves. This has induced me to believe, that this misfortune of the nodding of the head by the bone, or partial dislocation of it, by which one leg becomes shorter than the other, is sometimes occasioned by making very young children stand in what are called stocks; that is with their heels together, and their toes quite out. Whence the socket of the thigh-bone becomes inflamed and painful, or the neck of the bone is bent downward and outwards.
In this case there is no expectation of recovering the straightness of the end of the bone; but these patients are liable to another misfortune, that is, to acquire afterwards a distortion of the spine; for as one leg is shorter than the other, they sink on that side, and in consequence bend the upper part of their bodies, as their shoulders, the contrary way, to balance themselves; and then again the neck is bent back again towards the lame side, to preserve the head perpendicular; and thus the figure becomes quite distorted like the letter S, owing originally to the deficiency of the length of one limb. The only way to prevent this curvature of the spine is for the child to wear a high-heeled shoe or patten on the lame foot, so as to support that side on the same level with the other, and thus to prevent a greater deformity.
I have this day seen a young lady about twelve, who does not limp or waddle in walking; but nevertheless, when she stands or sits, she sinks down towards her right side, and turns out that toe more than the other. Hence, both as she sits and stands, she bends her body to the right; whence her head would hang a little over her right shoulder; but to replace this perpendicularly, she lifts up her left shoulder and contracts the muscles on that side of the neck; which are therefore become thicker and stronger by their continued action; but there is not yet any very perceptible distortion of the spine.
As her right toe is turned outward rather more than natural, this shews the disease to be in the hip-joint; because, when the limb is stretched out, the toe cannot turn horizontally in the least without moving the end of the thigh-bone; although when the knee is bent, the toe can be turned through one third or half of a circle by the rotation of the tibia and fibula of the leg round each other. Hence if children are set in stocks with their heels touching each other as they sit, and are then made to rise up, till they stand erect, the socket or head of the thigh-bone becomes injured, especially in those children, whose bones are soft; and a shortness of that limb succeeds either by the bending of the neck of the thigh-bone, or by its getting out of the acetabulum; and a consequent rising of one shoulder, and a curvature of the spine is produced from so distant a cause.
M. M. An elastic cushion made of curled hair should be placed under the affected hip, whenever she sits; or should be fitted to the part by means of drawers, so that she cannot avoid sitting on it. A neck-swing, and lying down in the day, should be occasionally used to prevent or remove any curvature of the spine. The rest as in Species 13 and 15 of this genus.
18. Spina protuberans. Protuberant spine. One of the bones of the spine swells, and rises above the rest. This is not an uncommon disease, and belongs to the innutrition of the bones, as the bone must become soft before it swells; which softness is owing to defect of the secretion of phosphorated calcareous earth. The swelling of the bone compresses a part of the brain, called the spinal marrow, within the cavity of the back-bones; and in consequence the lower limbs become paralytic, attended sometimes with difficulty of emptying the bladder and rectum.
M. M. Issues put on each side of the prominent bone are of great effect, I suppose, by their stimulus; which excites into action more of the sensorial powers of irritation and sensation, and thus gives greater activity to the vascular system in their vicinity. The methods recommended in distortion of the spine are also to be attended to.
19. Spina bifida. Divided spine, called also Hydrorachitis, as well as the Hydrocephalus externus, are probably owing in part to a defect of ossification of the spine and cranium; and that the collection of fluid beneath them may originate from the general debility of the system; which affects both the secerning, and absorbent vessels.
A curious circumstance, which is affirmed to attend the spina bifida, is, that on compressing the tumor with the hand gently, the whole brain becomes affected, and the patient falls asleep. I suppose the same must happen on compressing the hydrocephalus externus? See Sect. XVIII. 20.
20. Ossis palati defectus. A defect of the bone of the palate, which frequently accompanies a division of the upper lip, occurs before nativity; and is owing to the deficient action of the secerning system, from whence the extremities are not completed. From a similar cause I have seen the point of the tongue deficient, and one joint of the two least fingers, and of the two least toes, in the same infant; who was otherwise a fine girl. See Sect. XXXIX. 4. 4.
The operation for the hare-lip is described by many surgical writers; but there is a person in London, who makes very ingenious artificial palates; which prevents that defect of speech, which attends this malformation. This factitious palate consists of a thin plate of silver of the shape and form of the roof of the mouth; from the front edge to the back edge of this silver plate four or five holes are made in a straight line large enough for a needle to pass through them; on the back of it is then sewed a piece of sponge; which when expanded with moisture is nearly as large as the silver plate. This sponge is slipped through the division of the bone of the palate, so as to lie above it, while the silver plate covers the aperture beneath, and is suspended by the expanding sponge. This is removed every night and washed, and returned into its place in the morning; on this account it is convenient to have five or six of them, for the sake of cleanliness. I have been more particular in describing this invention, as I do not know the name, or place of residence, of the maker.