Zoonomia/II.II.I.VI

by Erasmus Darwin

ORDO I.

Increased Sensation.

GENUS VI.

With Fever consequent to the Production of new Vessels or Fluids.

SPECIES.

1. Febris sensitiva. Sensitive fever, when unmixed with either irritative or inirritative fever, may be distinguished from either of them by the less comparative diminution of muscular strength; or in other words, from its being attended with less diminution of the sensorial power of irritation. An example of unmixed sensitive fever may generally be taken from the pulmonary consumption; in this disease patients are seen to walk about with ease, and to do all the common offices of life for weeks, and even months, with a pulse of 120 strokes in a minute; while in other fevers, whether irritated or inirritated, with a pulse of this frequency, the patient generally lies upon the bed, and exerts no muscular efforts without difficulty.

The cause of this curious phenomenon is thus to be understood; in the sensitive fever a new sensorial power, viz. that of sensation, is superadded to that of irritation; which in other fevers alone carries on the increased circulation. Whence the power of irritation is not much more exhausted than in health; and those muscular motions, which are produced in consequence of it, as those which are exerted in keeping the body upright in walking, riding, and in the performance of many customary actions, are little impaired. For an account of the irritated sensitive fever, see Class II. 1. 2. 1.; for the inirritated sensitive fever, Class II. 1. 3. 1. IV. 2. 4. 11.

2. Febris a pure clauso. Fever from inclosed matter is generally of the irritated sensitive kind, and continues for many weeks, and even months, after the abscess is formed; but is distinguished from the fever from aerated matter in open ulcers, because there are seldom any night-sweats, or colliquative diarrhœa in this, as in the latter. The pulse is also harder, and requires occasional venesection, and cathartics, to abate the inflammatory fever; which is liable to increase again every three or four days, till at length, unless the matter has an exit, it destroys the patient. In this fever the matter, not having been exposed to the air, has not acquired oxygenation; in which a new acid, or some other noxious property, is produced; which acts like contagion on the constitution inducing fever-fits, called hectic fever, which terminate with sweats or diarrhœa; whereas the matter in the closed abscess is either not absorbed, or does not so affect the circulation as to produce diurnal or hectic fever-fits; but the stimulus of the abscess excites so much sensation as to induce perpetual pyrexia, or inflammatory fever, without such marked remissions. Nevertheless there sometimes is no fever produced, when the matter is lodged in a part of little sensibility, as in the liver; yet a white pus-like sediment in those cases exists I believe generally in the urine, with occasional wandering pains about the region of the liver or chest.

3. Vomica. An abscess in the lungs is sometimes produced after peripneumony, the cough and shortness of breath continue in less degree, with difficulty in lying on the well side, and with sensitive irritated fever, as explained in the preceding article.

The occasional increase of fever, with hard pulse and sizy blood, in these patients, is probably owing to the inflammation of the walls of the vomica; as it is attended with difficulty of breathing, and requires venesection. Mr. B——, a child about seven years old, lived about five weeks in this situation, with a pulse from 150 to 170 in a minute, without sweats, or diarrhœa, or sediment in his water, except mucus occasionally; and took sufficient nourishment during the whole time. The blood taken was always covered with a strong cupped size, and on his death three or four pints of matter were found in one side of the chest; which had probably, but lately, been effused from a vomica. This child was frequently induced to swing, both in a reciprocating and in a rotatory swing, without any apparent absorption of matter; in both these swings he expressed pleasure, and did not appear to be vertiginous.

M. M. Repeated emetics. Digitalis? Perseverance in rotatory swinging. See Class II. 1. 6. 7.

Mr. I. had laboured some months under a vomica after a peripneumony, he was at length taken with a catarrh, which was in some degree endemic in March 1795, which occasioned him to sneeze much, during which a copious hæmorrhage from the lungs occurred, and he spit up at the same time half a pint of very fetid matter, and recovered. Hence errhines may be occasionally used with advantage.

4. Empyema. When the matter from an abscess in the lungs finds its way into the cavity of the chest, it is called an empyema. A servant man, after a violent peripneumony, was seized with symptoms of empyema, and it was determined, after some time, to perform the operation; this was explained to him, and the usual means were employed by his friends to encourage him, "by advising him not to be afraid." By which good advice he conceived so much fear, that he ran away early next morning, and returned in about a week quite well. Did the great fear promote the absorption of the matter, like the sickness occasioned by digitalis? Fear renders the external skin pale; by this continued decrease of the action of the absorbents of the skin might not those of the lungs be excited into greater activity? and thus produce increased pulmonary absorption by reverse sympathy, as it produces pale urine, and even stools, by direct sympathy?

M.M. Digitalis?

5. Febris Mesenterica. Fever from matter formed in the mesentery is probably more frequent than is suspected. It commences with pain in the bowels, with irritated sensitive fever; and continues many weeks, and even months, requiring occasional venesection, and mild cathartics; till at length the continuance of the pyrexia, or inflammatory fever, destroys the patient. This is an affection of the lymphatic glands, and properly belongs to scrophula; but as the matter is not exposed to the air, no hectic fever, properly so called, is induced.

6. Febris a pure aerato. Fever from aerated matter. A great collection of matter often continues a long time, and is sometimes totally absorbed, even from venereal buboes, without producing any disorder in the arterial system. At length, if it becomes putrid by its delay, and one part of the matter thus becomes aerated by the air given out by the other part; or if the ulcer has been opened, so that any part of it has been exposed to the air for but one day, a hectic fever is produced. Whence the utility arises of opening large abscesses by setons, as in that case little or no hectic fever is induced; because the matter is squeezed out by the side of the spongy threads of cotton, and little or no air is admitted; or by tapping the abscess with a trocar, as mentioned in ischias, Class II. 1. 2. 18.

In this fever the pulse is about 120 in a minute, and its access is generally in an evening, and sometimes about noon also, with sweats or purging towards morning, or urine with pus-like sediment; and the patients bear this fever better than any other with so quick a pulse; and lastly, when all the matter from a concealed ulcer is absorbed, or when an open ulcer is healed, the hectic fever ceases. Here the absorbed matter is supposed to produce the fever, and the diarrhœa, sweats, or copious muddy urine, to be simply the consequence of increased secretion, and not to consist of the purulent matter, which was supposed to be absorbed from the ulcer. See Sudor calidus, Class I. 1. 2. 3.

The action of the air on ulcers, as we have already shewn, increases the acrimony of the purulent matter, and even converts it into a weaker kind of contagious matter; that is, to a material inducing fever. This was ascribed to the union of the azotic part of the atmosphere with the effused pus in Sect. XXVIII. 2. but by contemplating more numerous facts and analogies, I am now induced to believe, that it is by the union of oxygen with it; first, because oxygen so greedily unites with other animal substances, as the blood, that it will pass through a moist bladder to combine with it, according to the experiment of Dr. Priestley. Secondly, because the poisons of venomous creatures are supposed to be acids of different kinds, and are probably formed by the contact of air after their secretion. And lastly, because the contagious matter from other ulcers, as in itch, or small-pox, are formed on external membranes, and are probably combinations of animal matter and oxygen, producing other new acids; but further experiments must determine this question.

It was thought a subject of consequence by the Æsculapian Society at Edinburgh, to find a criterion which should distinguish pus from mucus, for the purpose of more certainly discovering the presence of ulcers in pulmonary diseases, or in the urinary passages. For this purpose that society offered their first gold medal, which was conferred on the late Mr. Charles Darwin, in the year 1778, for his experiments on this subject. From which he deduces the following conclusions:

"1. Pus and mucus are both soluble in the vitriolic acid, though in very different proportions, pus being much the less soluble.

2. The addition of water to either of these compounds decomposes it; the mucus thus separated, either swims on the mixture, or forms large flocci in it; whereas the pus falls to the bottom, and forms on agitation a uniform turbid mixture.

3. Pus is diffusible through a diluted vitriolic acid, though mucus is not; the same occurs with water, or a solution of sea salt.

4. Nitrous acid dissolves both pus and mucus; water added to the solution of pus produces a precipitate; and the fluid above becomes clear and green; while water and the solution of mucus form a dirty coloured fluid.

5. Alkaline lixivium dissolves (though sometimes with difficulty) mucus, and generally pus.

6. Water precipitates pus from such a solution, but does not mucus.

7. Where alkaline lixivium does not dissolve pus, it still distinguishes it from mucus; as it then prevents its diffusion through water.

8. Coagulable lymph is neither soluble in diluted nor concentrated vitriolic acid.

9. Water produces no change on a solution of serum in alkaline lixivium, until after long standing, and then only a very slight sediment appears.

10. Corrosive sublimate coagulates mucus, but does not pus.

From the above experiments it appears, that strong vitriolic acid and water, diluted vitriolic acid, and caustic alkaline lixivium and water will serve to distinguish pus from mucus; that the vitriolic acid can separate it from coagulable lymph, and alkaline lixivium from serum.

And hence, when a person has any expectorated material, the composition of which he wishes to ascertain, let him dissolve it in vitriolic acid, and in caustic alkaline lixivium; and then add pure water to both solutions: and if there is a fair precipitation in each, he may be assured that some pus is present. If in neither a precipitation occurs, it is a certain test, that the material is entirely mucus. If the material cannot be made to dissolve in alkaline lixivium by time and trituration, we have also reason to believe that it is pus." Experiments on Pus and Mucus. Cadell. London.

7. Phthisis pulmonalis. In pulmonary consumption the fever is generally supposed to be the consequence of the stimulus of absorbed matter circulating in the blood-vessels, and not simply of its stimulus on their extremities in the surface of the ulcers; as mentioned in Class II. 1. 5. and Class II. 1. 3. 9. The ulcers are probably sometimes occasioned by the putrid acrimony of effused blood remaining in the air-cells of the lungs after an hæmoptoe. See Class I. 2. 1. 9. The remote cause of consumption is ingeniously ascribed by Dr. Beddoes to the hyper-oxygenation of the blood, as mentioned Section XXVIII. 2.

As the patients liable to consumption are of the inirritable temperament, as appears by the large pupils of their eyes; there is reason to believe, that the hæmoptoe is immediately occasioned by the deficient absorption of the blood at the extremities of the bronchial vein; and that one difficulty of healing the ulcers is occasioned by the deficient absorption of the fluids effused into them. See Sect. XXX. 1. and 2.

The difficulty of healing pulmonary ulcers may be owing, as its remote cause, to the incessant motion of all the parts of the lungs; whence no scab, or indurated mucus, can be formed so as to adhere on them. Whence these naked ulcers are perpetually exposed to the action of the air on their surfaces, converting their mild purulent matter into a contagious ichor; which not only prevents them from healing, but by its action on their circumferences, like the matter of itch or tinea, contributes to spread them wider. See the preceding article, and Sect. XXXIII. 2. 7. where the pulmonary phthisis is supposed to be infectious.

This acidifying principle is found in all the metallic calces, as in lapis calaminaris, which is a calciform ore of zinc; and in cerussa, which is a calx of lead; two materials which are powerful in healing excoriations, and ulcers, in a short time by their external application. How then does it happen, that the oxygen in the atmosphere should prevent pulmonary ulcers from healing, and even induce them to spread wider; and yet in its combination with metals, it should facilitate their healing? The healing of ulcers consists in promoting the absorption of the fluids effused into them, as treated of in Section XXXIII. 3. 2. Oxygen in combination with metals, when applied in certain quantity, produces this effect by its stimulus; and the metallic oxydes not being decomposed by their contact with animal matter, no new acid, or contagious material, is produced. So that the combined oxygen, when applied to an ulcer, simply I suppose promotes absorption in it, like the application of other materials of the articles sorbentia or incitantia, if applied externally; as opium, bark, alum. But in the pulmonary ulcers, which cannot protect themselves from the air by forming a scab, the uncombined oxygen of the atmosphere unites with the purulent matter, converting it into a contagious ichor; which by infection, not by erosion, enlarges the ulcers, as in the itch or tinea; which might hence, according to Dr. Beddoes's ingenious theory of consumption, be induced to heal, if exposed to an atmosphere deprived of a part of its oxygen. This I hope future experiments will confirm, and that the pneumatic medicine will alleviate the evils of mankind in many other, as well as in this most fatal malady.

M. M. First, the respiration of air lowered by an additional quantity of azote, or mixed with some proportion of hydrogen, or of carbonic acid air, may be tried; as described in a late publication of Dr. Beddoes on the medicinal use of factitious airs. Johnson, London. Or lastly, by breathing a mixture of one tenth part of hydro-carbonate mixed with common air, according to the discovery of Mr. Watt, which has a double advantage in these cases, of diluting the oxygen of the atmospheric air, and inducing sickness, which increases pulmonary absorption, as mentioned below. An atmosphere diluted with fixed air (carbonic acid) might be readily procured by setting tubs of new wort, or fermenting beer, in the parlour and lodging-room of the patient. For it is not acids floating in the air, but the oxygen or acidifying principle, which injures or enlarges pulmonary ulcers by combining with the purulent matter.

Another easy method of adding carbonic acid gas to the air of a room, would be by means of an apparatus invented by Mr. Watt, and sold by Bolton and Watt at Birmingham, as described in Dr. Beddoes' Treatise on Pneumatic Medicine. Johnson, London. It consists of an iron pot, with an arm projecting, and a method of letting water drop by slow degrees on chalk, which is to be put into the iron pot, and exposed to a moderate degree of heat over a common fire. By occasionally adding more and more chalk, carbonic acid gas might be carried through a tin pipe from the arm of the iron pot to any part of the room near the patient, or from an adjoining room. In the same manner a diffusion of solution of flowers of zinc might be produced and breathed by the patient, and would be likely much to contribute to the healing of pulmonary ulcers; as observed by Mr. Watt. See the treatise above mentioned.

Breathing over the vapour of caustic volatile alkali might easily be managed for many hours in a day; which might neutralize the acid poison formed on pulmonary ulcers by the contact of oxygen, and thus prevent its deleterious quality, as other acids become less caustic, when they are formed into neutral salts with alkalis. The volatile salt should be put into a tin canister, with two pipes like horns from the top of it, one to suck the air from, and the other to admit it.

Secondly, the external ulcers in scrophulous habits are pale and flabby, and naturally disinclined to heal, the deposition of fluids in them being greater than the absorption; these ulcers have their appearance immediately changed by the external application of metallic calxes, and the medicines of the article Sorbentia, such as cerussa and the bark in fine powder, see Class I. 2. 3. 21. and are generally healed in a short time by these means. Induced by these observations, I wished to try the external application of such powders to ulcers in the lungs, and constructed a box with a circulating brush in it, as described in the annexed plate; into this box two ounces of fine powder of Peruvian bark were put, and two drams of cerussa in fine powder; on whirling the central brush, part of this was raised into a cloud of powder, and the patient, applying his mouth to one of the tin pipes rising out of the box, inhaled this powder twice a day into his lungs. I observed it did not produce any cough or uneasiness. This patient was in the last stage of consumption, and was soon tired of the experiment, nor have I had such patients as I wished for the repetition of it. Perhaps a fine powder of manganese, or of the flowers of zinc, or of lapis calaminaris, might be thus applied to ulcers of the lungs with greater advantage? Perhaps air impregnated with flowers of zinc in their most comminuted state, might be a better way of applying this powder to the lungs, as discovered by Mr. Watt. See Dr. Beddoes on Pneumatic Medicine. Johnson.

Thirdly, as the healing of an ulcer consists in producing a tendency to absorption on its surface greater than the deposition on it; see Sect. XXXIII. 3. 2. other modes of increasing pulmonary absorption, which are perhaps more manageable than the preceding ones, may be had recourse to; such as by producing frequent nausea or sickness. See Sect. XXIX. 5. 1. and Art. IV. 2. The great and sudden absorption of fluid from the lungs in the anasarca pulmonum by the sickness induced by the exhibition of digitalis, astonishes those who have not before attended to it, by emptying the swelled limbs, and removing the difficulty of breathing in a few hours.

The most manageable method of using digitalis is by making a saturated tincture of it, by infusing two ounces of the powder of the leaves in a mixture of four ounces of rectified spirit of wine, and four ounces of water. Of this from 30 to 60 drops, or upwards, from a two-ounce phial, are to be taken twice in the morning part of the day, and to be so managed as not to induce violent sickness. If sickness nevertheless comes on, the patient must for a day or two omit the medicine; and then begin it again in reduced doses.

Mr. ——, a young man about twenty, with dark eyes, and large pupils, who had every symptom of pulmonary ulcers, I believed to have been cured by digitalis, and published the case in the Transactions of the College, Vol. III. But about two years afterwards I heard that he relapsed and died. Mr. L——, a corpulent man, who had for some weeks laboured under a cough with great expectoration, with quick pulse, and difficulty of breathing, soon recovered by the use of digitalis taken twice a day; and though this case might probably be a peripneumonia notha, or catarrh, it is here related as shewing the power of pulmonary absorption excited by the use of this drug.

Another method of inducing sickness, and pulmonary absorption in consequence, is by sailing on the sea; by which many consumptive patients have been said to have received their cure; which has been erroneously ascribed to sea-air, instead of sea-sickness; whence many have been sent to breathe the sea-air on the coasts, who might have done better in higher situations, where the air probably contains less oxygen gas, which is the heaviest part of it. See a Letter from Dr. T. C. below.

A third method of inducing sickness, and consequent pulmonary absorption, is by the vertigo occasioned by swinging; which has lately been introduced into practice by Dr. Smith, (Essay on Pulmonary Consumption), who observed that by swinging the hectic pulse became slower, which is explained in Class IV. 2. 1. 10. The usual way of reciprocating swinging, like the oscillations of a pendulum, produces a degree of vertigo in those, who are unused to it; but to give it greater effect, the patient should be placed in a chair suspended from the ceiling by two parallel cords in contact with each other, the chair should then be forcibly revolved 20 or 40 times one way, and suffered to return spontaneously; which induces a degree of sickness in most adult people, and is well worthy an exact and pertinacious trial, for an hour or two, three or four times a day for a month.

The common means of promoting absorption in ulcers, and of thickening the matter in consequence, by taking the bark and opium internally, or by metallic salts, as of mercury, steel, zinc, and copper, in small quantities, have been repeatedly used in pulmonary consumption; and may have relieved some of the symptoms. As mercury cures venereal ulcers, and as pulmonary ulcers resemble them in their not having a disposition to heal, and in their tendency to enlarge themselves, there were hopes, from analogy, that it might have succeeded. Would a solution of gold in aqua regia be worth trying? When vinegar is applied to the lips, it renders them instantly pale, by promoting the venous absorption; if the whole skin was moistened with warmish vinegar, would this promote venous absorption in the lungs by their sympathy with the skin? The very abstemious diet on milk and vegetables alone is frequently injurious. Flesh-meat once a day, with small wine and water, or small beer, is preferable. Half a grain of opium twice a day, or a grain, I believe to be of great use at the commencement of the disease, as appears from the subsequent case.

Miss ——, a delicate young lady, of a consumptive family, when she was about eighteen, had frequent cough, with quick pulse, a pain of her side, and the general appearances of a beginning consumption. She took about five drops of laudanum twice a day in a saline draught, which was increased gradually to ten. In a few weeks she recovered, was afterwards married, bore three or four children, and then became consumptive and died.

The following case of hereditary consumption is related by a physician of great ability and very extensive practice; and, as it is his own case, abounds with much nice observation and useful knowledge; and, as it has been attended with a favourable event, may give consolation to many, who are in a similar situation; and shews that Sydenham's recommendation of riding as a cure for consumption is not so totally ineffectual, as is now commonly believed.

"J. C. aged 27, with black hair, and a ruddy complexion, was subject to cough from the age of puberty, and occasionally to spitting of blood. His maternal grandfather died of consumption under thirty years of age, and his mother fell a victim to this disease, with which she had long been threatened, in her 43d year, and immediately after she ceased to have children. In the severe winter of 1783-4, he was much afflicted with cough; and being exposed to intense cold, in the month of February he was seized with peripneumony. The disease was violent and dangerous, and after repeated bleedings as well as blisterings, which he supported with difficulty, in about six weeks he was able to leave his bed. At this time the cough was severe, and the expectoration difficult. A fixed pain remained on the left side, where an issue was inserted; regular hectic came on every day about an hour after noon, and every night heat and restlessness took place, succeeded towards morning by general perspiration.

The patient, having formerly been subject to ague, was struck with the resemblance of the febrile paroxysm, with what he had experienced under that disease, and was willing to flatter himself it might be of the same nature. He therefore took bark in the interval of fever, but with an increase of his cough, and this requiring venesection, the blood was found highly inflammatory. The vast quantity of blood which he had lost from time to time, produced a disposition to fainting, when he resumed the upright posture, and he was therefore obliged to remain almost constantly in a recumbent position. Attempting to ride out in a carriage, he was surprised to find that he could sit upright for a considerable time, while in motion, without inconvenience, though, on stopping the carriage, the disposition to fainting returned.

At this time, having prolonged his ride beyond the usual length, he one day got into an uneven road at the usual period of the recurrence of the hectic paroxysms, and that day he missed it altogether. This circumstance led him to ride out daily in a carriage at the time the febrile accession might be expected, and sometimes by this means it was prevented, sometimes deferred, and almost always mitigated.

This experience determined him to undertake a journey of some length, and Bristol being, as is usual in such cases, recommended, he set out on the 19th of April, and arrived there on the 2d of May. During the greater part of this journey (of 175 miles) his cough was severe, and being obliged to be bled three different times on the road, he was no longer able to sit upright, but at very short intervals, and was obliged to lie at length in the diagonal of a coach. The hectic paroxysms were not interrupted during the journey, but they were irregular and indistinct, and the salutary effects of exercise, or rather of gestation, were impressed on the patient's mind.

At Bristol he stayed a month, but reaped no benefit. The weather was dry and the roads dusty; the water insipid and inert. He attempted to ride on horseback on the downs, but was not able to bear the fatigue for a distance of more than a hundred yards. The necessity of frequent bleedings kept down his strength, and his hectic paroxysms continued, though less severe. At this time, suspecting that his cough was irritated by the west-winds bearing the vapour from the sea, he resolved to try the effects of an inland situation, and set off for Matlock in Derbyshire.

During the journey he did not find the improvement he expected, but the nightly perspirations began to diminish; and the extraordinary fatigue he experienced proceeded evidently from his travelling in a post-chaise, where he could not indulge in a recumbent position. The weather at Bristol had been hot, and the earth arid and dusty. At Matlock, during the month of June 1784, there was almost a perpetual drizzle, the soil was wet, and the air moist and cold. Here, however, the patient's cough began to abate, and at intervals he found an opportunity of riding more or less on horseback. From two or three hundred yards at a time, he got to ride a mile without stopping; and at length he was able to sit on horseback during a ride from Mason's Bath to the village of Matlock along the Derwent, and round on the opposite banks, by the works of Mr. Arkwright, back to the house whence he started, a distance of five miles. On dismounting, however, he was seized with diliquium, and soon after the strength he had recovered was lost by an attack of the hæmorrhoids of the most painful kind, and requiring much loss of blood from the parts affected.

On reflection, it appeared that the only benefit received by the patient was during motion, and continued motion could better be obtained in the course of a journey than during his residence at any particular place. This, and other circumstances of a private but painful nature, determined him to set out from Matlock on a journey to Scotland. The weather was now much improved, and during the journey he recruited his strength. Though as yet he could not sit upright at rest for half an hour together without a disposition to giddiness, dimness of sight, and deliquium, he was able to sit upright under the motion of a post-chaise during a journey of from 40 to 70 miles daily, and his appetite began to improve. Still his cough continued, and his hectic flushings, though the chills were much abated and very irregular.

The salutary effects of motion being now more striking than ever, he purchased a horse admirably adapted to a valetudinarian in Dumfriesshire, and being now able to sit on horseback for an hour together, he rode out several times a day. He fixed his residence for a few weeks at Moffat, a village at the foot of the mountains whence the Tweed, the Clyde, and the Annan, descend in different directions; a situation inland, dry, and healthy, and elevated about three hundred feet above the surface of the sea. Here his strength recovered daily, and he began to eat animal food, which for several months before he had not tasted. Persevering in exercise on horseback, he gradually increased the length of his rides, according to his strength, from four to twenty miles a day; and returning on horseback to Lancashire by the lakes of Cumberland, he arrived at Liverpool on the first of September, having rode the last day of his journey forty miles.

The two inferences of most importance to be drawn from this narrative, are, first, the extraordinary benefit derived from gestation in a carriage, and still more the mixture of gestation and exercise on horseback, in arresting or mitigating the hectic paroxysm; and secondly, that in the florid consumption, as Dr. Beddoes terms it, an elevated and inland air is in certain circumstances peculiarly salutary; while an atmosphere loaded with the spray of the sea is irritating and noxious. The benefit derived in this case from exercise on horseback, may lead us to doubt whether Sydenham's praise of this remedy be as much exaggerated as it has of late been supposed. Since the publication of Dr. C. Smyth on the effects of swinging in lowering the pulse in the hectic paroxysm, the subject of this narrative has repeated his experiments in a great variety of cases, and has confirmed them. He has also repeatedly seen the hectic paroxysm prevented, or cut short, by external ablution of the naked body with tepid water.

So much was his power of digestion impaired or vitiated by the immense evacuations, and the long continued debility he underwent, that after the cough was removed, and indeed for several years after the period mentioned, he never could eat animal food without heat and flushing, with frequent pulse and extreme drowsiness. If this drowsiness was encouraged, the fever ran high, and he awoke from disturbed sleep, wearied and depressed. If it was resolutely resisted by gentle exercise, it went off in about an hour, as well as the increased frequency of the pulse. This agitation was however such as to incapacitate him during the afternoon for study of any kind. The same effects did not follow a meal of milk and vegetables, but under this diet his strength did not recruit; whereas after the use of animal food it recovered rapidly, notwithstanding the inconvenience already mentioned. For this inconvenience he at last found a remedy in the use of coffee immediately after dinner, recommended to him by his friend Dr. Percival. At first this remedy operated like a charm, but by frequent use, and indeed by abuse, it no longer possesses its original efficacy.

Dr. Falconer, in his Dissertation on the Influence of the Passions and Affections of the Mind on Health and Disease, supposes that the cheerfulness which attends hectic fever, the ever-springing hope, which brightens the gloom of the consumptive patient, increases the diseased actions, and hastens his doom. And hence he is led to enquire, whether the influence of fear might not be substituted in such cases to that of hope with advantage to the patient? This question I shall not presume to answer, but it leads me to say something of the state of the mind in the case just related.

The patient, being a physician, was not ignorant of his danger, which, some melancholy circumstances served to impress on his mind. It has already been mentioned, that his mother and grandfather died of this disease. It may be added, that in the year preceding that on which he himself was attacked, a sister of his was carried off by consumption in her 17th year; that in the same winter in which he fell ill, two other sisters were seized with the same fatal disorder, to which one of them fell a victim during his residence at Bristol, and that the hope of bidding a last adieu to the other was the immediate cause of his journey to Scotland, a hope which, alas! was indulged in vain. The day on which he reached the end of his journey, her remains were committed to the dust! It may be conjectured from these circumstances, that whatever benefit may be derived from the apprehension of death, must in this case have been obtained. The expectation of this issue was indeed for some time so fixed that it ceased to produce much agitation; in conformity to that general law of our nature, by which almost all men submit with composure to a fate that is foreseen, and that appears inevitable. As however the progress of disease and debility seemed to be arrested, the hope and the love of life revived, and produced, from time to time, the observations and the exertions already mentioned.

Wine and beer were rigorously abstained from during six months of the above history; and all the blood which was taken was even to the last buffy." Feb. 3, 1795.

8. Febris scrophulosa. The hectic fever occasioned by ulcers of the lymphatic glands, when exposed to the air, does not differ from that attending pulmonary consumption, being accompanied with night-sweats and occasional diarrhœa.

M. M. The bark. Opium internally. Externally cerussa and bark in fine powder. Bandage. Sea-bathing. See Class I. 2. 3. 21. and II. 1. 4. 13.

9. Febris ischiadica. A hectic fever from an open ulcer between the muscles of the pelvis, which differs not from the preceding. If the matter in this situation lodges till part of it, I suppose, becomes putrid, and aerates the other part; or till it becomes absorbed from some other circumstance; a similar hectic fever is produced, with night-sweats, or diarrhœa.

Mrs. ——, after a lying in, had pain on one side of her loins, which extended to the internal part of the thigh on the same side. No fluctuation of matter could be felt; she became hectic with copious night-sweats, and occasional diarrhœa, for four or five weeks; and recovered by, I suppose, the total absorption of the matter, and the reunion of the walls of the abscess. See Class II. 1. 2. 18.

10. Febris Arthropuodica. Fever from the matter of diseased joints. Does the matter from suppurating bones, which generally has a very putrid smell, produce hectic fever, or typhus? See Class II. 1. 4. 16.

11. Febris a pure contagioso. Fever from contagious pus. When the contagious matters have been produced on the external habit, and in process of time become absorbed, a fever is produced in consequence of this reabsorption; which differs with the previous irritability or inirritability, as well as with the sensibility of the patient.

12. Febris variolosa secundaria. Secondary fever of small-pox. In the distinct small-pox the fever is of the sensitive irritated or inflammatory kind; in the confluent small-pox it is of the sensitive inirritated kind, or typhus gravior. In both of them the swelling of the face, when the matter there begins to be absorbed, and of the hands, when the matter there begins to be absorbed, shew, that it stimulates the capillary vessels or glands, occasioning an increased secretion greater than the absorbents can take up, like the action of the cantharides in a blister; now as the application of a blister on the skin frequently occasions the strangury, which shews, that some part of the cantharides is absorbed; there is reason to conclude, that a part of the matter of small-pox is absorbed, and thus produces the secondary fever. See Class II. 1. 3. 9. And not simply by its stimulus on the surface of the ulcers beneath the scabs. The exsudation of a yellow fluid from beneath the confluent eruptions on the face before the height is spoken of in Class II. 1. 3. 2.

The material thus absorbed in the secondary fever of small-pox differs from that of open ulcers, as it is only aerated through the elevated cuticle; and secondly, because there is not a constant supply of fresh matter, when that already in the pustules is exhausted, either by absorption, or by evaporation, or by its induration into a scab. Might not the covering the face assiduously and exactly with plasters, as with cerate of calamy, or with minium plaster, by precluding the air from the pustules, prevent their contracting a contagious, or acescent, or fever-producing power? and the secondary fever be thus prevented entirely. If the matter in those pustules on the face in the confluent small-pox were thus prevented from oxygenation, it is highly probable, both from this theory, and from the facts before mentioned, that the matter would not erode the skin beneath them, and by these means no marks or scars would succeed.

13. Febris carcinomatosa. Fever from the matter of cancer. In a late publication the pain is said to be relieved, and the fever cured, and the cancer eradicated, by the application of carbonic acid gas, or fixed air. See Class II. 1. 4. 16.

14. Febris venerea. From the absorption of the matter from venereal ulcers and suppurating bones. See Syphilis, II. 1. 5. 2.

M. M. Any mercurial calx. Sarsaparilla? Mezereon?

15. Febris a sanie putrida. Fever from putrid sanies. When parts of the body are destroyed by external violence, as a bruise, or by mortification, a putrefaction soon succeeds; as they are kept in that degree of warmth and moisture by their adhesion to the living parts of the body, which most forwards that process. Thus the sloughs of mortified parts of the tonsils give fetor to the breath in some fevers; the matter from putrefying teeth, or other suppurating bones, is particularly offensive; and even the scurf, which adheres to the tongue, frequently acquires a bitter taste from its incipient putridity. This material differs from those before mentioned, as its deleterious property depends on a chemical rather than an animal process.

16. Febris puerpera. Puerperal fever. It appears from some late dissections, which have been published, of those women who have died of the puerperal fever, that matter has been formed in the omentum, and found in the cavity of the abdomen, with some blood or sanies. These parts are supposed to have been injured by the exertions accompanying labour; and as matter in this viscus may have been produced without much pain, this disease is not attended with arterial strength and hard full pulse like the inflammation of the uterus; and as the fever is of the inirritative or typhus kind, there is reason to believe, that the previous exhaustion of the patient during labour may contribute to its production; as well as the absorption of a material not purulent but putrid; which is formed by the delay of extravasated or dead matter produced by the bruises of the omentum, or other viscera, in the efforts of parturition, rather than by purulent matter, the consequence of suppuration. The pulse is generally about 120 when in bed and in the morning; and is increased to 134, or more, when the patient sits up, or in the evening paroxysm. The pulse of all very weak patients increases in frequency when they sit up; because the expenditure of sensorial power necessary to preserve an erect posture deducts so much from their general strength; and hence the pulse becomes weaker, and in consequence quicker. See Sect. XII. 1. 4.

In this fever time must be allowed for the absorption of the matter. Very large and repeated quantities of the bark, by preventing sufficient food from being taken, as bread, and wine, and water, I have thought has much injured the patient; for the bark is not here given as in intermittent fevers to prevent the paroxysm, but simply to strengthen the patient by increasing the power of digestion. About two ounces of decoction of bark, with four drops of laudanum, and a dram of sweet spirit of vitriol, once in six hours, and a glass of wine between those times, with panada, or other food, I have thought of most advantage, with a small blister occasionally.

Where not only the stomach but also the bowels are much distended with air, so as to sound on striking them with the fingers, the case is always dangerous, generally hopeless; which is more so in proportion to the quickness of the pulse. Where the bowels are distended two drops of oil of cinnamon should be given in the panada three or four times a day.

Take here Addition VIII

17. Febris a sphacelo. Fever from mortification. This fever from absorption of putrid matter is of the inirritative or typhus kind. See the preceding article.

M. M. Opium and the bark are frequently given in too great quantity, so as to induce consequent debility, and to oppress the power of digestion.