With the Production of new Vessels by internal Membranes or Glands, without Fever.
Where inflammation is produced in a small part, which has not great natural sensibility, the additional sensation does not produce an increased action of the arterial system; that is, the associated motions which are employed in the circulation of the blood, those for instance of the heart, arteries, glands, capillaries, and their correspondent veins, are not thrown into increased action by so small an addition of the sensorial power of sensation. But when parts, which naturally possess more sensibility, become inflamed, the quantity of the sensorial power of sensation becomes so much increased, as to affect the associated motions belonging to the circulation, occasioning them to proceed with greater frequency; that is, a fever is induced. This is well exemplified in the internal and superficial paronychia, one of which is attended with great pain and fever, and the other with little pain and no fever. See Class II. 1. 2. 19. and II. 1. 4. 5.
From hence it appears, that the sensitive fever is an accidental consequence of the topical phlegmon, or inflammation, and not a cause of it; that it is often injurious, but never salutary; and should therefore always be extinguished, as soon as may be, either by the lancet and cathartics, and diluents, and cold air, when it is of the irritated kind; or by the bark, opium, cool air, and nutrientia, when it is of the inirritated kind.
1. Ophthalmia superficialis. As the membranes, which cover the eye, are excluded from the air about one third part of the twenty-four hours; and are moistened by perpetual nictitation during the other sixteen; they may be considered as internal membranes; and from the analogy of their inflammation to that of other internal membranes, it is arranged under this genus; whilst the tonsillitis is esteemed an inflammation of an external membrane, because currents of air are perpetually passing both day and night over the fauces.
The superficial ophthalmy has generally been esteemed a symptom of scrophula, when it recurs frequently in young persons; but is probably only a concomitant of that disease, as a symptom of general debility; ramifications of new red vessels, and of enlarged old ones, are spread over the white part of the eye; and it is attended with less heat, less pain, and less intolerance of light than the ophthalmia interna, described in Class II. 1. 2. 2. It occurs in those of feeble circulation, especially children of a scrophulous tendency, and seems to arise from a previous torpor of the vessels of the tunica albuginea from their being exposed to cold air; and from this torpor being more liable to occur in habits, which are naturally inirritable; and therefore more readily fall into quiescence by a smaller deduction of the stimulus of heat, than would affect stronger or more irritable habits; the consequence of this torpor is increased action, which produces pain in the eye, and that induces inflammation by the acquisition of the additional sensorial power of sensation.
Ophthalmia lymphatica is a kind of anasarca of the tunica adnata; in this the vessels over the sclerotica, or white part of the eye, rise considerably above the cornea, which they surround, are less red than in the ophthalmia superficialis, and appear to be swelled by an accumulation of lymph rather than of blood; it is probably owing to the temporary obstruction of a branch of the lymphatic system.
M. M. If the pain be great, venesection by leeches on the temple, or cutting the temporal artery, and one purge with three or four grains of calomel should be premised. Then the Peruvian bark twice a day. Opium from a quarter to half a grain twice a day for some weeks. Bathe the eye frequently with cold water alone, or with cold water, to a pint of which is added half an ounce of salt. White vitriol six grains dissolved in one ounce of water; a drop or two to be put between the eyelids twice a day. Take very small electric sparks from the eyes every day for a fortnight. Bathe the whole head with salt and water made warm every night for some months. Send such children to a school near the sea for the convenience of sea-bathing for many months annually; such schools are to be found in or near Liverpool.
When a child is afflicted with an inflamed eye of this kind, he should always sit with his back to the window or candle; but it is generally not necessary to cover it, or if the uneasy sensation of light makes this proper, the cover should stand off from the eye, so as not much to exclude the cool air from it. As covering an eye unnecessarily is liable to make that eye weaker than the other, from its not being sufficiently used, and thence to produce a squinting for ever afterwards.
Nevertheless, when the pain is great, a poultice must be applied to keep the eyes moist, or a piece of oiled silk bound lightly over them. Or thus, boil an egg till it is hard, cut it longitudinally into two hemispheres, take out the yolk, sew the backs of the two hollow hemispheres of the white to a ribbon, and bind them over the eyes every night on going to bed; which, if nicely fitted on, will keep the eyes moist without any disagreeable pressure. See Class I. 1. 3. 14.
Ophthalmia equina. An inflammation of this kind is liable to affect the eyes of horses; one cause of which is owing to a silly custom of cutting the hair out of horses' ears; by which they are not only liable to take cold at the ear, but grass seeds are liable to fall into their ears from the high racks in stables; and in both cases the eye becomes inflamed by sympathy. I once directed the temporal artery of a horse to be opened, who had frequent returns of an inflamed eye; and I believed it was of essential service to him; it is probable that the artery was afterwards contracted in the wounded part, and that thence less blood was derived to the eye: the hæmorrhage was stopped by two persons alternately keeping their fingers on the orifice, and afterwards by a long bandage of broad tape.
2. Pterigion. Eye-wing. A spot of inflammation sometimes begins on the inside of the lower eyelid, or on the tunica albuginea, and spreads an intertexture of red vessels from it, as from a center, which extend on the white part of the eye, and have the appearance of the wing of a fly, from whence its name.
M. M. Cut the ramifications of vessels again and again with the point of a lancet close to the center of inflammation.
3. Tarsitis palpebrarum. Inflammation of the edges of the eyelids. This is a disease of the glands, which produce the hairs of the eye-lashes, and is frequently the cause of their falling off. After this inflammation a hard scar-like ridge is left on the edge of the eyelid, which scratches and inflames the eyeball, and becomes a very troublesome disease.
The Turkish ladies are said to colour the edge of the eyelash with crude antimony in very fine powder, which not only gives lustre to the eye, as a diamond set on a black soil, but may prevent extraneous light from being reflected from these edges into the eye, and thus serve the purpose of the black feathers about the eyes of swans, described in Sect. XXXIX. 5. 1. and may also prevent the edges of the eyelids from being inflamed by the frequent stimulus of tears on them. Black lead in fine powder might be better for all these purposes than antimony, and might be put on with a camel's hair brush.
M. M. Mercurial ointment smeared at night on the edges of the eyelids. Burnt alum sixty grains, hog's grease half an ounce, well rubbed into an ointment to be smeared on them in the night. Cold water frequently in the day. See Class II. 1. 1. 8.
4. Hordeolum. Stye. This inflammation begins either on or near the edges of the eyelids, or in the loose skin of them, and is sometimes very slow either in coming to suppuration or in dispersing. The skin beneath the lower eyelid is the most frequent seat of this tumor, which sometimes never suppurates at all, but becomes an incysted tumor: for as this skin is very loose for the purpose of admitting great motion to the eyelid, the absorbent power of the veins seems particularly weak in this part; whence when any person is weakened by fatigue or otherwise, a darker shade of colour is seen beneath the eyes; which is owing to a less energetic action of the absorbent terminations of the veins, whence the currents of dark or venous blood are delayed in them. This dark shade beneath the eyes, when it is permanent, is a symptom of habitual debility, or inirritability of the circulating system. See Class I. 2. 2. 2.
M. M. Smear the tumors with mercurial ointment, moisten them frequently with ether. To promote their suppuration they may be wounded with a lancet, or slit down the middle, or they may be cut out. A caustic leaves a large scar.
5. Paronychia superficialis. Whitlow. An inflammation about the roots of the nail beneath the skin, which suppurates without fever, and sometimes destroys the nail; which is however gradually reproduced. This kind of abscess, though not itself dangerous, has given opportunity for the inoculation of venereal matter in the hands of accoucheurs, and of putrid matter from the dissection of diseased bodies; and has thus been the cause of disease and death. When putrid matter has been thus absorbed from a dead body, a livid line from the finger to the swelled gland in the axilla is said to be visible; which shews the inflammation of the absorbent vessel along its whole course to the lymphatic gland; and death has generally been the consequence.
M. M. In the common paronychia a poultice is generally sufficient. In the absorption of putrid matter rub the whole hand and arm with mercurial ointment three or four times a day, or perpetually. Could the swelled axillary gland be exsected? In the absorption of venereal matter the usual methods of cure in syphilis must be administered, as in Class II. 1. 5. 2.
6. Gutta rosea. The rosy drop on the face is of three kinds. First, the gutta rosea hepatica, or the red pimples on the faces of drunkards, which are probably a kind of crisis, or vicarious inflammation, which succeeds, or prevents, a torpor of the membranes of the liver. This and the succeeding species properly belong to Class IV. 1. 2. 14.
Secondly, the pimpled face in consequence of drinking cold water, or eating cold turnips, or other insipid food, when much heated with exercise; which probably arises from the sympathy between the skin of the face and the stomach; and may be called the gutta rosea stomatica. Which is distinguished from the former by the habits of the patient in respect to drinking; by the colour of the eruptions being less deep; and by the patient continuing generally to be troubled with some degree of apepsia. See Class I. 3. 1. 3. I knew a lady, who had long been afflicted with pain about the region of the stomach; and, on drinking half a pint of vinegar, as a medicine, she had a breaking out commenced on her face; which remained, and she became free from the pain about the stomach. Was this a stomachic, or an hepatic disease?
Thirdly, there is a red face, which consists of smaller pimples than those above mentioned; and which is less liable to suppurate; and which seems to be hereditary, or at least has no apparent cause like those above mentioned; which may be termed gutta rosea hereditaria, or puncta rosea.
Mrs. S. had a pimpled face, which I believe arose from potation of ale. She applied alum in a poultice to it, and had soon a paralytic stroke, which disabled her on one side, and terminated in her death.
Mrs. L. had a red pimpled face, which seemed to have been derived from her mother, who had probably acquired it by vinous potation; she applied a quack remedy to it, which I believe was a solution of lead, and was seized with epileptic fits, which terminated in palsy, and destroyed her. This shews the danger of using white paint on the face, which is called bismuth, but is in reality white lead or cerussa.
Mr. Y—— had acquired the gutta rosea on his nose, and applied a saturnine solution on it for a few nights, and was then seized with paralysis on one side of his face; which however he gradually recovered, and has since acquired the gutta rosea on other parts of his face.
These fatal effects were probably caused by the disagreeable sensation of an inflamed liver, which used before to be relieved of the sympathetic action and consequent inflammation of the skin of the face, which was now prevented by the stronger stimulus of the application of calx of lead. The manner in which disagreeable sensations induce epilepsy and palsy is treated of in Class III. In some cases where habitual discharges, or eruptions, or ulcers are stopped, a torpor of the system may follow, owing to the want of the accustomed quantity of sensation or irritation. See Class I. 1. 2. 9. and II. 1. 5. 6. In both these situations some other stimulus should be used to supply the place of that which is taken away; which may either be perpetual, as an issue; or periodical, as a cathartic repeated once a fortnight or month.
Miss W. an elegant young lady of about twenty, applied a mercurial lotion to her face, which was covered with very small red points; which seemed to have been not acquired by any known or avoidable means; she was seized with inflammation of her liver, and after repeated bleeding and cathartics recovered, and in a few weeks the eruption appeared as before.
M. M. Five grains of calomel once a month, with a cathartic, five grains of rhubarb and a quarter of a grain of emetic tartar every night for many weeks. With this preparation mercurial plasters, made without turpentine, and applied every night, and taken off every morning, will sometimes succeed, and may be used with safety. But blistering the face all over the eruption, beginning with a part, succeeds better than any other means, as I have more than once experienced.—Something like this is mentioned in the Letters of Lady Mary Wortley Montague, who blistered her face with balsam of Mecca.
Mrs. F. had for many years had a disagreeably looking eruption on her chin, after a cathartic with calomel, she was advised to blister her whole chin; on the healing of the blister a few eruptions again appeared, which ceased on the application of a second blister. She took rhubarb five grains, and emetic tartar a quarter of a grain every night for many weeks.
Miss L. a young lady about eighteen, had tried variety of advice for pimples over the greatest part of her face in vain. She took the above medicines internally, and blistered her face by degrees all over and became quite beautiful. A spot or two now and then appeared, and on this account she frequently slept with parts of her face covered with mercurial plaster, made without turpentine, which was held on by a pasteboard mask, and taken off in the mornings; if any part of the plaster adhered, a little butter or oil destroyed the adhesion.
7. Odontitis. Inflammatory tooth-ach is occasioned by inflammation of the membranes of the tooth, or a caries of the bone itself. The gum sometimes suppurates, otherwise a swelling of the cheek succeeds by association, and thus the violence of the pain in the membranes of the tooth is relieved, and frequently cured; and when this happens the disease properly belongs to Class IV. as it so far resembles the translations of morbid actions in the gout and rheumatism.
At other times the tooth dies without caries, especially in people about sixty years of age, or before; and then it stimulates its involving membrane, like any other extraneous substance. The membrane then becomes inflamed and thickened, occasioning some pain, and the tooth rises upwards above the rest, and is gradually pushed out whole and undecayed; on its rising up a pus-like mucus is seen discharged from the gum, which surrounds it; and the gum seems to have left the tooth, as the fangs or roots of it are in part naked.
M. M. Where the tooth is sound it can only be saved by evacuations by venesection, and a cathartic; and after its operation two grains of opium, a blister may also be used behind the ear, and ether applied to the cheek externally. In slighter cases two grains of opium with or without as much camphor may be held in the mouth, and suffered to dissolve near the affected tooth, and be gradually swallowed. See Class I. 2. 4. 12. Odontalgia may be distinguished from otitis by the application of cold water to the affected tooth; for as the pain of common tooth-ach is owing to torpor, whatever decreases stimulus adds to the torpor and consequent pain; whereas the pain of an inflamed tooth being ceased by the increased action of the membranes of it is in some measure alleviated by the application of cold.
8. Otitis. Inflammation and consequent suppuration of some membranes of the internal ear frequently occur in children, who sleep in cold rooms, or near a cold wall, without a night-cap. If the bones are affected, they come out in a long process of time, and the child remains deaf of that ear. But in this case there is generally a fever attends this inflammation; and it then belongs to another genus.
M. M. A warmer night-cap. Warmish water should be gently syringed into the ear to keep it clean twice a day; and if it does not heal in a week, a little spirit of wine should be added; first about a fourth part, and it should be gradually increased to half rectified spirit and half water: if it continues long to discharge matter with a very putrid smell, the bones are injured, and will in time find their exit, during which time the ear should be kept clean by filling it with a weaker mixture of spirit of wine and water; or a solution of alum in water; which may be poured into the ear, as the head is inclined, and shook out again by turning the head, two or three times morning and evening. See Class II. 1. 4. 10.
9. Fistula lacrymalis. The lacrymal sack, with its puncta lacrymalia and nasal duct, are liable to be destroyed by suppuration without fever; the tears then run over the eyelids, and inflame the edges of them, and the cheeks, by their perpetual moisture, and saline acrimony.
M. M. By a nice surgical operation a new aperture is to be made from the internal corner of the eye into the nostril, and a silver tube introduced, which supplies the defect by admitting the tears to pass again into the nostril. See Melanges de Chirurgie par M. Pouteau; who thinks he has improved this operation.
10. Fistula in ano. A mucous discharge from the anus, called by some white piles, or matter from a suppurated pile, has been mistaken for the matter from a concealed fistula. A bit of cotton wool applied to the fundament to receive the matter, and renewed twice a day for a week or two, should always be used before examination with the probe. The probe of an unskilful empyric sometimes does more harm in the loose cellular membrane of these parts than the original ulcer, by making a fistula he did not find. The cure of a fistula in ano of those, who have been much addicted to drinking spirituous liquor, or who have a tendency to pulmonary consumption, is frequently of dangerous consequence, and is succeeded by ulcers of the lungs, and death.
M. M. Ward's paste, or 20 black pepper-corns taken after each meal twice a day; the pepper-corns should be cut each into two or three pieces. The late Dr. Monro of Edinburgh asserted in his lectures, that he had known a fistula in ano cured by injecting first a mixture of rectified spirit of wine and water; and by gradually increasing the strength of it, till the patient could bear rectified spirit alone; by the daily use of which at length the sides of the fistula became callous, and ceased to discharge, though the cavity was left. A French surgeon has lately affirmed, that a wire of lead put in at the external opening of the ulcer, and brought through the rectum, and twisted together, will gradually wear itself through the gut, and thus effect a cure without much pain. The ends of the leaden wire must be twisted more and more as it becomes loose. Or, lastly, it must be laid open by the knife.
11. Fistula urethræ. Where a stricture of the urethra exists, from whatever cause, the patient, in forcing the stream of urine through the structure, distends the urethra behind it; which after a time is liable to burst, and to become perforated; and some of the urine is pushed into the cellular membrane, occasioning fistulas, which sometimes have large surfaces producing much matter, which is pressed out at the time of making water, and has been mistaken for a catarrh of the bladder; these fistulas sometimes acquire an external opening in the perinæum, and part of the urine is discharged that way.
Can this matter be distinguished from mucus of the bladder by the criterion delivered in Class II. 1. 6. 6?
M. M. The perpetual use of bougies, either of catgut or of caoutchouc. The latter may be had at No. 37, Red-lion street, Holborn, London. The former are easily made, by moistening the catgut, and keeping it stretched till dry, and then rounding one end with a pen-knife. The use of a warm bath every day for near an hour, at the heat of 94 or 96 degrees, for two or three months, I knew to be uncommonly successful in one case; the extensive fistulas completely healing. The patient should introduce a bougie always before he makes water, and endeavour to make it as slowly as possible. See Class I. 2. 3. 24.
12. Hepatitis chronica. Chronical inflammation of the liver. A collection of matter in the liver has frequently been found on dissection, which was not suspected in the living subject. Though there may have been no certain signs of such a collection of matter, owing to the insensibility of the internal parts of this viscus; which has thus neither been attended with pain, nor induced any fever; yet there may be in some cases reason to suspect the existence of such an abscess; either from a sense of fulness in the right hypochondre, or from transient pains sometimes felt there, or from pain on pressure, or from lying on the left side, and sometimes from a degree of sensitive fever attending it.
Dr. Saunders suspects the acute hepatitis to exist in the inflammation of the hepatic artery, and the chronical one in that of the vena portarum. Treatise on the Liver. Robinson. London.
13. Scrophula suppurans. Suppurating scrophula. The indolent tumors of the lymphatic glands are liable, after a long time, to regain their sensibility; and then, owing to their former torpor, an increased action of the vessels, beyond what is natural, with inflammation, is the consequence of their new life, and suppuration succeeds. This cure of scrophula generally happens about puberty, when a new energy pervades the whole system, and unfolds the glands and organs of reproduction.
M. M. See Class I. 2. 3. 21. Where scrophulous ulcers about the neck are difficult to heal, Dr. Beddoes was informed, in Ireland, that an empyric had had some success by inflaming them by an application of wood sorrel, oxalis acetosella, the leaves of which are bruised in a mortar, and applied on the ulcers for two or three days, and then some more lenient application is used.
A poor boy, about twelve years old, had a large scrophulous ulcer on one side of the chest beneath the clavicle, and another under his jaw; he was directed, about three weeks ago, to procure a pound of dry oak-bark from the tanners, and to reduce it to fine powder, and to add to it one ounce of white lead in fine powder, and to cover the ulcers daily with it, keeping it on by brown paper and a bandage. He came to me a few minutes ago, to shew me that both the ulcers are quite healed. The constant application of linen rags, moistened with a solution of an ounce of sugar of lead in a pint of water, I think I have seen equally efficacious.
14. Scorbutus suppurans. In the sea-scurvy there exists an inactivity of venous absorption, whence vibices and petechiæ, and sometimes ulcers. As the column of blood pressing on the of origins of the veins of the lower extremities, when the body is erect, opposes the ascent of the blood in them, they are more frequently liable to become enlarged, and to produce varixes, or vibices, or, lastly, ulcers about the legs, than on the upper parts of the body. The exposure to cold is believed to be another cause of ulcers on the extremities; as happens to many of the poor in winter at Lisbon, who sleep in the open air, without stockings, on the steps of their churches or palaces. See Class I. 2. 1. 15.
M. M. A bandage spread with plaster to cover the whole limb tight. Rags dipped in a solution of sugar of lead. A warm flannel stocking or roller. White lead and oak bark, both in fine powder. Horizontal rest.
15. Scirrhus suppurans. When a scirrhus affects any gland of no great extent or sensibility, it is, after a long period of time, liable to suppurate without inducing fever, like the indolent tumors of the conglobate or lymphatic glands above mentioned; whence collections of matter are often found after death both in men and other animals; as in the liver of swine, which have been fed with the grounds of fermented mixtures in the distilleries. Another termination of scirrhus is in cancer, as described below. See Class I. 2. 3. 22.
16. Carcinoma. Cancer. When a schirrous tumor regains its sensibility by nature, or by any accidental hurt, new vessels shoot amongst the yet insensible parts of it, and a new secretion takes place of a very injurious material. This cancerous matter is absorbed, and induces swelling of the neighbouring lymphatic glands; which also become schirrous, and afterwards cancerous.
This cancerous matter does not seem to acquire its malignant or contagious quality, till the cancer becomes an open ulcer; and the matter secreted in it is thus exposed to the air. Then it evidently becomes contagious, because it not only produces hectic fever, like common matter in ulcers open to the air; but it also, as it becomes absorbed, swells the lymphatic glands in its vicinity; as those of the axilla, when the open cancer is on the breast. See Class II. 1. 3.
Hence exsection before the cancer is open is generally a cure; but after the matter has been exposed to the air, it is seldom of service; as the neighbouring lymphatic glands are already infected. I have observed some of these patients after the operation to have had diseased livers, which might either have previously existed, or have been produced by the fear or anxiety attending the operation.
Erosion with arsenic, after the cancer is become an open ulcer, has generally no better effect than exsection, but has been successful before ulceration. The best manner of using arsenic, is by mixing one grain with a dram of lapis calaminaris, and strewing on the cancer some of the powder every day, till the whole is destroyed.
Cancers on the face are said to arise from the periosteum, and that unless this be destroyed by the knife, or by caustics, the cancer certainly recurs. After the cancer becomes an open ulcer of some extent, a purulent fever supervenes, as from other open ulcers, and gradually destroys the patient. See Class II. 1. 6. 13.
Two very interesting cases have been lately published by Dr. Ewart, of Bath, in which carbonic acid gas, or fixed air, was kept constantly in contact with the open cancerous ulcers of the breast; which then healed like other common ulcers. This is rather to be ascribed to the exclusion of oxygen, than to any specific virtue in the carbonic acid. As in common ulcers the matter does not induce hectic fever, till it has been exposed to the air, and then probably united with oxygen.
The manner of applying the fixed air, is by including the cancer in one half or hemisphere of a large bladder; the edges are made to adhere to the skin by adhesive plaster, or perhaps a mixture of one part of honey with about twenty parts of carpenter's glue might better suit some tender skins. The bladder is then kept constantly filled with carbonic acid gas, by means of a pipe in the neck of it; and the matter let out at a small aperture beneath.
17. Arthrocele. Swelling of the joints seems to have its remote cause in the softness of the bones, for they could not swell unless they were previously softened, see Class I. 2. 2. 14. The epiphyses, or ends of the bones, being naturally of a looser texture, are most liable to this disease, and perhaps the cartilages and capsular ligaments may also become inflamed and swelled along with the heads of the bones. This malady is liable to distort the fingers and knees, and is usually called gout or rheumatism; the former of which is liable to disable the fingers by chalk-stones, and thence to have somewhat a similar appearance. But the arthrocele, or swelling of the joints, affects people who have not been intemperate in the use of fermented or spirituous liquors; or who have not previously had a regular gout in their feet; and in both these circumstances differs from the gout. Nor does it accord with the inflammatory rheumatism, as it is not attended with fever, and because the tumors of the joints never entirely subside. The pain or sensibility, which the bones acquire, when they are inflamed, may be owing to the new vessels, which shoot in them in their soft state, as well as to the distention of the old ones.
M. M. Half a grain of opium twice a day, gradually increased to a grain, but not further, for many months. Thirty grains of powder of bark twice a day for many months. Ten grains of bone-ashes, or calcined hartshorn, twice a day, with decoction of madder? Soda phosphorata?
18. Arthropuosis. Joint-evil. This differs from the former, as that never suppurates; these ulcers of the joints are generally esteemed to arise from scrophula; but as scrophula is a disease of the lymphatic or absorbent system, and this consists in the suppuration of the membranes, or glands, or cartilages about the joints, there does not seem a sufficient analogy to authorize their arrangement under the same name.
The white swelling of the knee, when it suppurates, comes under this species, with variety of other ulcers attended with carious bones.
19. Caries ossium. A caries of the bones may be termed a suppuration of them; it differs from the above, as it generally is occasioned by some external injury, as in decaying teeth; or by venereal virus, as in nodes on the tibia; or by other matter derived to the bone in malignant fevers; and is not confined to the ends of them.
The separation of the dead bone from the living is a work of some time. See Sect. XXXIII. 3. 1.