Chapter VII: Part 7

The pyrosis, or cardialgia-sputatoria, is more frequent and endemic in some countries than others; and, it is alledged, more amongst the poor than affluent, and amongst females than males; and of the former, the single and barren: it rarely occurs in puberty, or in old age. The pain at the stomach and back is often very severe, and with anxiety, until the torrent of watery fluid bursts forth, which, after continuing one or two days, intermits: but relapses are frequent, and the disease is contumacious. The hiccup, or sudden convulsive inspiration, is a complicated affliction of the stomach and diaphragm. Of rumination in the human species, there is scarce an instance in a generation.

The predisposing and occasional _causes_ of the preceding diseases of the stomach are in general, weakness of the muscular coats; diseases of its nerves; small omentum; the digestive menstrua as bile, saliva, mucus, defective or depraved; frequent exspuition and waste of saliva; slow digestion, and food corrupted in the stomach; crudities in the stomach; vitiated chyle; excess of pituita, acidity, bile; relaxed pylorus, large stomach, calculi in the biliary ducts; scirrhus stomach, pancreas, liver, spleen, duodenum; mucus of the stomach abraded; ulcers, cancer, depression of the xiphoid cartilage; frequent emeticks and purgatives; valetudinarian regimen, too much physick, quackery, and care about health; gluttony, epicurism, pampered indulgence of that passion and appetite; frequent surfeits; dram-drinking; malt liquors in excess; the aliment in quantity or quality, or in multiplicity at one meal, injurious; ravenous ingurgitation at meals, and imperfect manducation; fat, rancid, corrupted, salted, and indigestible farinaceous food; tea, tobacco, watery liquids: in infancy, acid milk, sucking to excess, curdled milk in the stomach; superfluous acid generated in the stomach; too violent agitation in the nurse’s arms; passions of the nurse; too tight bandages; saliva swallowed in excess during dentition; too much vegetable diet and milk: to the catalogue of general causes may be added various depressing and cankering passions of mind; cares and troubles; want of sleep, intemperate study, sedentary life, unremitting application to sedentary business; moist cold air, foul air of cities; leaning forward on the stomach, and improper postures of the body; costiveness; suppression of salutary evacuations and cutaneous exanthemata; sanguineous plethora; conference of hereditary infirmity, bad health, old age, chlorosis, worms, gout, rheumatism, intermittent and remittent fevers, and of various other acute and chronic diseases; poisons; extraneous substances swallowed, contusions on the head; external injuries; blows and falls.

_Cholera Morbus_ is much more frequent in tropical and warm climates; and in northern regions in the summer and autumnal seasons; especially in unusually hot summers. The disease is not unfrequent in this island and metropolis; nor is it entirely restricted to the warm season only. The symptoms are sickness and nausea, succeeded by violent vomiting and purging, of a bilious nature, with gripes, tenesmus, tension of the abdomen, anxiety, great prostration of strength, intense thirst, cardialgy, and sometimes muscular spasms in the lower extremities. The vomiting and purging either commence about the same time, or alternate with each other: and throughout its rapid race there is seldom any fever. It is often a salutary effort of nature, by which a superfluity of bile is disembogued; and in cases of ordinary violence, may continue a day or two, and then cease. In more tremendous assaults it sometimes proves fatal in twenty-four hours; portentous omens of which are violent vomiting and purging, sudden prostration of strength, quick weak pulse, hiccup, fainting, cold sweats and extremities. The predisposing and occasional _causes_ are, hot climate and seasons; in warm climates extreme heat and dry weather, succeeded by a fall of rain and coolness of the atmosphere; sudden changes of weather; increased secretion of bile and corrupted bile; surfeits, intemperance, accumulation of feculence in the intestines and liver; excess of food or drink without sufficient exercise; indolence, luxurious living and sedentary life; malt liquors; passions of mind; repulsion of cutaneous eruptions; gout; poisons; worms; symptomatick in intermittent and remittent fevers.

_Dysentery_, bloody flux, spurious remittent. This contagious disease has been before mentioned, under remitting and autumnal fevers. It is called by the sagacious Morton, the Spurious Remittent turned on the intestines; and by Sydenham also, who, perhaps undeservedly, is panegyrized as a superior oracle, the Fever of the Season turned on the bowels. The general symptoms are, frequent stools with severe colick, gripes, and tenesmus, or urgency to exonerate the intestines: these evacuations are slimy, generally with intermixture of blood, and fragments of feces concreted into hard globules, and unusually fetid. It is also accompanied with sickness at the stomach and pain, inappetency, vomiting, flatulence, restlessness, foul tongue, and more or less fever. When fatal, many are destroyed between the seventh and twentieth days; but when moderate, it may be protracted much longer. Relapses are frequent on any irregularity or intemperance. The _causes_, warm climates and seasons, marshy effluvia; cold nights followed by warm days; sudden suppression of perspiration, especially in warm climates; exposure to cold and moist air and rains, and wet cloaths and beds; long continuance of sultry and dry weather; excess and corruption of bile; symptomatick; dysenterick contagion from privies, beds, &c.——_Vid._ REMITTENT FEVERS.

_Diarrhœa_, ventris profluvium; including the different species, the celiaca, lienteria, morbus hepaticus, niger, atrabilis. In the simple diarrhœa, the evacuation by the anus is unnaturally frequent and liquid. In the celiaca, or chylous diarrhœa, the aliments and chyle are ejected: and in the lienteria, like a bucket whirling into a well, food is no sooner taken than discharged. The morbus hepaticus is without pain or tenesmus, with flux of blood and serum, or like ink; in colour and consistence various. Diarrhœa is accompanied with gripes; but not so excruciating as in the dysentery, with inappetency, dry skin, thirst, hectic heat: but no considerable fever; nor is it contagious. In the severity and evacuation there are varieties: and in some cases it is salutary. The _causes_, excess of food and drink, or acrid putrescent aliment; new fermented liquors; vegetable laxative food; feculence in the intestines, stercorous, pituitous; vitiated digestion, with morbid irritability of the intestinal tube; irritability of this muscular canal, and increase of its peristaltic motion; atonia; excess and acrimony of bile, warm climates, broken constitutions, cachexy, chronic dysentery, immoderate flux of humours to the intestinal tube, and exhalation by the arterial extremities of that canal; suppression of perspiration, and of other evacuations; superfluity of serous humours; impediments in the absorption and passages of the chyle; obstruction in the vena portarum; laxity of the pylorus; palsy of the sphincter ani; ulcers of the stomach, repelled gout, and rash; sudden passions of mind; nervous irritation; erosion or rupture of the blood-vessels on the interior surface; obstruction of the spleen; acrid dissolution of the blood; colliquative; worms; symptomatic in fevers; purgatives; poisons. In infancy, acidity, dentition, and saliva swallowed to excess; corrupted milk and chyle, thin laxative vegetable diet; errors of the nurse in diet; gravel in the kidneys.

_Colick._ From slight or serious attacks of this torture, few of the community are exempted. We here associate together the inflammatory, spasmodic, saturnine, bilious, flatulent, the infantile colick, and other species. Colick is generally a temporary disease; and with which some, much more than others, are afflicted at intervals. Inflammation of the intestines ileus, volvulus, enteritis; generally sudden assault of excruciating, fixed, and increasing pain, in some degree affecting the whole abdomen, but more pungent about the navel; with nausea, frequent vomiting of food and drink, and sometimes of intestinal feculence; obstinate costiveness, severe gripes, eructation, flatulence: the fever sometimes succeeding, sometimes preceding, the local pain; and of which there are exacerbations and remissions, and various gradations. The pulse at the beginning is not remarkably full nor frequent, from which fatal mistakes and irremediable procrastination, have often ensued in medical practice: the urine is in small quantity, or suppressed. It is much more frequent in the narrow than the wide part of the intestinal tube. In the rectum, constant tenesmus, excretion of mucus; and in the male sex strangury are natural consequences and symptoms. Inflammation or nephritick paroxisms in the kidneys and ureters, with which it has been confounded, are hereafter discriminated.

It is extremely dangerous and precipitate; frequently destroying in a few days, sometimes in one day, and is seldom protracted beyond nine. There is less danger in young than in old persons: abatement of pain, cessation of nausea and vomiting, discharge of flatulence and of feces, softer and freer pulse, are favourable symptoms: unfavourable are, unconquerable costiveness, immoderate vomiting, tumid belly, eructation, hiccup, cold extremities, gangrene; abscess rarely. Inflammation is sometimes the effect, and not the original cause of colick.

Under the spasmodick colick may be classed the colica pictonum, saturnina, plumbeia, and dry belly-ach of the West Indies. The symptoms, writhing pain in the abdomen, about the loins and back; retraction of the navel towards the spine, dysury, ischury, or strangury; costiveness with difficulty removed, and the feces in conglobated lumps, vomiting, anxiety, depression of spirits. In the saturnine the countenance is sometimes of a leaden colour, and there is a saccharine taste on the tongue. This infests various classes of artificers: sometimes terminating in chronic colick, in palsy of the lower extremities, and in convulsions.

Bilious colick is accompanied with severe pain in the stomach and intestines, nausea, sickness, vomiting of bile, costiveness, bitter taste on the tongue, anxiety, dejection of spirits, dysury, often flatulence. Its duration is short, but it is prone to return on any intemperance or irregularity; sometimes it ends in jaundice. Flatulent colick is distinguished by the pain being mobile, without much nausea or vomiting, or hard pulse and thirst, or fever; by considerable unusual distention of the abdomen, and flatulent explosion upwards and downwards; and sometimes efforts to vomit until the flatulence is ejected: respiration is also more or less interrupted.

The infant colick is very frequent, and infinitely more fatal in those years than the London bills represent. Infants scream lamentably, and cannot be appeased; they contract and draw up their legs to the belly, are restless, sometimes costive; but often there is concomitant diarrhœa and green feces, vomiting, flatulent explosion; and sometimes the breath smells sour; in some the urine is suppressed; and many die convulsed.

The predisposing and occasional _causes_ of colick, inflammatory, spasmodick, bilious, and of most other species are, acrid matter of aliment, medicines, poisons; acrid putrid bile; obstruction of the intestinal tube by indurated feculence, hair-balls, cherry-stones, calculi, steatome, volvulus, intusesception, contraction of the intestines in some part; scirrhus, cancer, severe colick, spasm, ruptures; wounds of the intestines; the aliments, pickles, condiments, and luxuries of the table, cooked, prepared, or preserved in lead or copper vessels not well tinned; the lead corroded from clayed vessels used for domestick purposes; wine adulterated with lead; cyder pressed in leaden cisterns; effluvia of lead to which painters and some metallurgies are exposed; excess or acrimony of bile; broken constitutions in tropical climates; acrid chyle; particular food or drink; new fermented liquors; sudden suppression of perspiration; cold wet feet; sudden passions of mind; flatulence and elastic air pent up; muscular and nervous spasms; plethora menstrual, lacteal, hemorrhoidal, scorbutick, rheumatick, arthritick, hysterick, nephritick; calculi in the biliary ducts; epidemick; aneurism of the aorta; turgid gall-bladder; spasm in the abdominal muscles, violent vomiting. In infancy, corrupted meconium, crudity, and sour or adulterated milk; suction to excess; acrid bile; the mother or nurse fasting too long before the infant sucks; corrupted unwholesome milk of nurses; nurses addicted to passion, to dram-drinking; insufficient exercise of the infant; tight rollers round its abdomen; dentition; worms.

_Gall-Stones_, calculi cystici. We have no account of this disease in ancient records. Until the beginning of the present century, it had escaped the vigilance of medical observation. But it is now known, that biliary concretions are, perhaps, not less frequent than those in the urinary organs. Gall-stones infest more the adult, old, and sedentary; and it is alledged, more females than males. The symptoms at first are dubious, and are all to be weighed together in forming a diagnostick. In attempting to descend throughout the gall-ducts, they excite direful pain at the pit of the stomach and hepatick region, darting to the back, with restlessness, anxiety, dyspnœa, jaundice-colour of the eyes, costiveness, and commonly vomiting: the pain is aggravated by coughing or sneezing, and sometimes ascends to the right shoulder and arm; but the pulse and circulation are not accelerated.

In the expulsion of these calculi, there are usually reiterated paroxisms, or exacerbations and remissions of pain. The continuance of the paroxisms is from a few hours to days, weeks, or even months; but the latter is rare; during which period either no stone is discharged, or one or many stones are successively protruded. Their immediate expulsion is accompanied with a sensation, as of something bursting in that part, or of a fluid rushing into the intestines; and often some tenderness is there left behind. The calculi vary in shape, colour, consistence, size, and number; from a pea to a walnut, and from one to dozens and scores. It is generally a tedious and chronic disease, and may continue many years; often thro’ life. It is seldom immediately dangerous, unless, as in nephritis, inflammation is kindled, or during pregnancy. When chronic and inveterate, it may terminate in jaundice, cachexy, dropsy. The symptoms of calculi in the gall-bladder are obscure; such as weight, uneasiness, dull heavy pain at intervals, sometimes temporary jaundice, cachexy, and diseases of the stomach. The _causes_, hereditary, viscid, tenacious bile, sedentary life, depressing passions, spirituous liquors; often ambiguous.

Whether any calculous concretions are formed in the pancreatick duct, is yet unexplored by authors. The pancreatick fluid is nearly similar to the saliva, which separates a tartarous sediment on the teeth.

_Jaundice_, icterus, morbus regius. Some of the eastern nations have naturally this complexion. The mortality by jaundice is not inconsiderable, amounting in the London bills, in the last thirty years of the preceding century, to 2169; and in the present century is doubled. The symptoms, heaviness and aversion to motion, itching and dryness of the skin, yellowness of the tunica-conjunctiva of the eyes, and also of the skin; the urine of a saffron-colour, and tinging linen; objects appear yellow; there is thirst, bitter taste in the tongue, bitter and yellow saliva, inappetency, indigestion, costiveness, and frequently pale-coloured feces. Sometimes, though very rarely, jaundice is local and not general. Jaundice may be critical, symptomatick, idiopathick, periodick, chronick. From gall-stones it is generally periodical; and such are prone to relapses. The prognosticks are more favourable with natural sweats; in recent than in chronic; in youth than in old age; in robust than in weak persons; in yellow than mulatto tinge; and when not complicated with other dangerous diseases, especially dropsy. Its duration and termination is various; from a few days to weeks, and months.

The predisposing and occasional _causes_ are, sand, mucus, or inspissated bile in the biliary ducts, especially the ductus communis; tumors compressing the biliary ducts, or their concretion; scirrhous duodenum; spasmodic, and flatulent colick obstructing the intestinal orifice of the biliary ducts; violent passions of mind; strong emeticks or purgatives; sudden refrigeration of the body; hepatic obstruction and inflammation; languid circulation through the vena porta, sedentary life; warm climates and broken constitutions; excess of bile and re-absorption; cachexy; depraved state of the blood; symptomatick in some intermittent and remittent fevers, pregnancy, scurvy, obstructed spleen; venomous bites and stings. In infants, excess of bile and meconium, or distention of the duodenum obstructing the biliary excretory.

_Worms._ In assigning an adequate share of mortality to worms, the London bills, probably, are defective. During the last thirty years of the preceding century, they are rated at only fourteen hundred; and continue decreasing throughout the present century. Perhaps a portion of verminous mortality is confounded with colick and gripes, or with hectic emaciation. Worms infest most in infancy and childhood; but seldom until after ablactation; and then, probably, more of the children of the necessitous than of the affluent. The principal species of human worms are the rotunda, or lumbricalis, the tænia or lata, the cucurbitina, and the ascarides: these are again, but with superfluous subtility, subdivided by nosologists. The rotunda or lumbricalis, has most resemblance to an earth-worm; it is forked at both ends, but paler: in length various, from inches to feet: and often many are entangled together in clusters. The tænia has some resemblance to tape, consisting of numerous joints, or coherent links, about an inch or more distant, and often many yards in length: this is most frequent in the adult age. The ascarides are extremely numerous, active, and minute, like fine needles, or the cuttings of white thread; and generally burrow in the lower extremity of the intestinal tube of children: the former species wallow through all parts of the alimentary canal.

Verminous symptoms are numerous, various, and all extremely ambiguous, unless worms are discharged with the feces: feculence in the stomach and intestines may occasion all the other symptoms: such as pale countenance; fugaceous flushing of the face and cheeks, and circumscribed spots of redness; itching of the nose; swelling of the upper lip and nose, and lower eye-lids; dilatation of the pupil; grinding of the teeth; fetid breath, and eructation; flow of saliva; irregular, impaired, or voracious appetite, nausea, vomiting, colick, gripes and sudden screams from the violence of pain; tumid and enlarged belly; costiveness, or diarrhœa and fetid stools; the urine sometimes like milk; sudden startings in sleep, frightful dreams; palpitation of the heart; dry hectic cough, atrophy; various nervous symptoms, epilepsy, tetanus, convulsions. The ascarides excite irritation about the anus, tenesmus, and dysury. These intestinal insects are often most tormenting when the stomach and intestines are empty. Sometimes they excite a symptomatick and slow fever, with hot skin, quick pulse, thirst; and the children are then confined to bed. But without fever, children pursue their usual amusements. The _causes_, improper diet for these years, as cheese, farinaceous, legumens, fruits, saccharine, putrid diet or unwholesome aliment, hereditary weak constitution, moist air: the ova of the insects swallowed with the air, food, or drink.

_Hemorrhoides_, piles. Is a frequent and very universal disease in both sexes, and most so during the adult stages and decline of life; and by which the lives of many are incommoded and harassed. They are distinguished into the blind and open, the external and internal; and are temporary, periodical, and chronic. The blind piles denote small imperforated lumps and tumors about the margin of the anus. Sometimes the tumours and hemorrhage from the anus ensue without any previous disease of the body; but generally some antecedent or accompanying disorder is felt; such as vertigo, headach, pain of the back and loins, oppression in the breast, colick, dysury, some fever and heat. The approaching hemorrhage is with sense of fulness, heat, itching, and pain about the anus, with tenesmus, costiveness, and conglobated feces; and sometimes is preceded by a serous discharge, or this sometimes is substituted for red blood. The quantity of sanguineous extravasation is various in different persons, and in the same person at different periods: from the internal vessels of the rectum it is more profuse than from the external; and is generally during, or after the fecal discharge: in other cases it is without fecal efforts, and then in larger debilitating streams, but rarely immediately fatal. These tumors, or sanguinous torrents, are almost always periodical, and at various intervals. They are often salutary, if moderate, especially if bad health preceded; and also as preservatives. In the decline of life, when the hemorrhoidal flux has been frequent, but suddenly ceases, they are in danger of apoplexy or palsy. On the other hand, in excess, it may exhaust the body, injure the health, and terminate in dropsy or consumption. Or sometimes hemorrhoidal tumours inflame, suppurate, and form fistulas in ano.

The predisposing and occasional _causes_ hereditary; plethora, dense blood, luxurious living, indolence and stimulating diet; intemperance, especially in spirituous liquors; dried indigestible diet; suppression of the menses, and their final cessation, and of other critical evacuations; obstructions of the liver, spleen, of the mesenteric and hemorrhoidal veins; reiterated and severe colick; abrasion of the intestinal mucus; acrid purges; acrimony of the blood; costiveness, and hardened feces; worms; sitting too long on the necessary, and over-warm steams, or stoves; long sitting, riding, and compression of the hemorrhoidal veins; diseases of the vagina, womb, and neck of the bladder; prolapsus ani; pregnancy; rupture of the extremities of the iliac arteries; effusion of blood into the cellular texture of the intestines, near its extremity.

_Vomiting of Blood_, hematomosis, vomitus cruentus, is a very rare disease. It is said to be more frequent in females than males; and is an adult malady. The symptoms, weight, straitness, and anxiety at the region of the stomach; nausea, cardialgy, efforts to vomit, and discharge of blood without coughing: the colour depends upon the time it has lain in the stomach, and is with various intermixtures of food, bile, pituita: there is also great prostration of strength, and proneness to faint. The quantity of this extravasation is various, from ounces to pounds; and frequently some portion descends by the anus. It is extremely dangerous, either immediately, or in its consequences. If with fever and great force in the discharge, it may destroy in a few paroxisms; or if chronic, may end in dropsy, consumption, or diseases of the stomach and intestines. Slight eruptions have relieved chronic maladies of the liver and spleen, hypochondriasm, hystericks, and intermittents. From obstructed menses it is much less alarming. The _causes_, obstructions of the liver, spleen, menses, hemorrhoids; scirrhus of the stomach and liver, or spleen; suppression of habitual discharges or evacuations, or old ulcers; dregs of intermittent fevers; scorbutick; acrids and poisons swallowed, and violent efforts to vomit; worms; violent passions; external injuries.

_Poisons._ By poisons conveyed through the mouth or wounds, very few of the community are destroyed. The ancient Asiaticks, Greeks, and Romans, were infected with the silly infatuation and apprehension of constantly swallowing poison in their aliment. This was not an epidemical error of the rabble, but had spread amongst their emperors and philosophers: hence the pompous and absurd compositions of mithridate, theriac, and other poisonous antidotes. None of the two hundred genera of the quadruped creation, nor of birds, are poisonous; and very few of the fish, or of the numerous insects and reptiles. Out of the many thousand genera of the vegetable creation, the poisonous are comparatively trifling: such are the napelli, apocyna, strammonium, solanum, laurus, aconitum, manchinel, cicuta, opium, and a few others; some of which, however, are powerful remedies. Of the mineral, the metals and semi-metals, arsenick excepted, the preparations of lead, copper, and mercury, are also amongst the potent remedies.

Of poisons, some corrode or burn, others are septic; and by far the greatest number attack the vital principle, by either violent irritation or torpidity: some have a more deadly malignity than others, and are more speedily destructive. Most of the vegetable poisons excite narcotic, stupifying, vertiginous, lethargic, convulsive, and emetic symptoms, affecting the brain, external senses, heart, and stomach. The minerals, as arsenick and corrosive sublimate, excite symptoms of inflammation in the stomach, in the most violent degree; and both copper and lead of spasmodic colick also. From their readier solution in the stomach, the vegetable poisons, except by the symptoms, can rarely be subjected to ocular detection; but by certain chymical analysis, when in any considerable quantity, the mineral may be discovered. Arsenick has a milky whiteness, is gritty and insipid; part of it swims in water, like a pale film, the greatest part sinking to the bottom undissolved: thrown on a red-hot iron plate, it does not flame, but rises in thick white fumes, which have an offensive smell of garlick, and cover cold iron held over them with thick flowers: arsenick inclosed between two plates of copper, then put into the fire and made red-hot, changes copper white. Copper is soluble in all acids, and assumes a blue colour when corroded by any acid or saline substance. Preparations of lead have a peculiar sweet taste; and wine adulterated with lead is detected by any alkali, which renders the mixture turbid, and precipitates the metal. These observations are a part of medical jurisprudence; and we shall hereafter touch upon it, under Female Abortion, and External Violence, especially injuries of the head.

_Hydrophobia._ This disease may be classed with the mental, or with poisons, and spasmodic affections of the superior part of the alimentary canal. There are very few instances of this disease in Britain: it is, notwithstanding, one of the modern hobgoblins, in which we rival the folly of the ancients respecting alimentary poisons. It should first be indisputably ascertained whether the dog, or other animal, was mad or not: we have a thousand false alarms, forgeries, and falsehoods in this respect. Dogs, especially puppies, are subject to periodical short fits, in which they run about as if mad, barking incessantly, and with a querulous angry voice. The symptoms of a mad dog, as described by authors, are, he suddenly becomes mopish, peevish, and morose; has an aversion to food and drink; an unusual look about his eyes; he runs about disorderly, forgets his master; his voice changes to a shrill bark; he suffers no one to approach, or to handle him, but bites at those who attempt it; he deserts his own habitation, running with his head and tail drooping; the tongue hangs out of his mouth, covered with foam and slaver; other dogs fly from him with horror; he attempts to bite all who fall in his way; he flies from water and rivers, and at length falls down exhausted, and dies on the third or fourth day after the first appearance of the disease. It is also agreed, that canine madness is more general in hot climates, and in the hottest summers of northern. But unfortunately hitherto, in most cases, probably nineteen out of twenty, the mania of dogs has not been incontrovertibly decided; as in cases even at the commencement, when it is very dubious, dogs are very improperly and impolitickly destroyed, instead of being confined in a place of security, to observe whether the poison is fermenting in them. Hence, probably, much ideal terror and horror; and boasted, though impotent, virtues of many vulgar nostrums, panaceas, and antidotes.

In the human species, Hydrophobia, phrenitis latrans, rabies canina, aquæ fugax, is described, for I never saw an instance of it, in the following progressive train of symptoms; some days or weeks after the bite and wound, heaviness, lassitude, disturbed sleep, frightful dreams, restlessness, melancholy, pain in the wounded part; exacerbation during the phases and changes of the moon; aversion to food and drink, pain in the throat, difficulty or impracticability of swallowing, fluids especially; and horror, or even convulsions, at the sight of any fluid; in some, delirium; in others, the senses perfect. There are some instances of recovery in the stages of hydrophobia. The diseases from other venomous bites and stings are transferred to the future class of external accidents.

_P. S._ In the preceding group of diseases may be included two, which I had no opportunity to introduce sooner: these are costiveness, and nasal hemorrhage. Costiveness, it is true, is frequently symptomatic in many diseases, but is also idiopathic; and the suppression of this excretory during several days, occasions vertigo, headach, disturbed sleep, inappetency, indigestion, flatulence, colick, &c. The _causes_, obstruction or constriction of the intestinal tube; faults in its muscular fibres, diminution of irritability by age or disease; defect of mucus, bile, especially cystic bile, its inertness; costive food and drink, and medicines; too little drink; excessive discharge, by perspiration or urine; indolence, and hard feces. Nasal hemorrhage predominates principally in the adolescent age, and towards puberty and manhood, and more amongst the male sex: the hemorrhage is generally periodical at irregular intervals, usually from one nostril, and slight, or in torrents: and there are instances on record of many quarts of blood being discharged within a few days. After puberty it commonly abates, and some years later ceases. The hemorrhage is very seldom immediately fatal; and more dangerous diseases have followed its rash suppression. The causes will be comprehended from those of hemorrhages in general.

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_Diseases of the Urinary Organs._ We shall begin with the diseases of the first urinary strainer, the kidneys, descending progressively through the conduits and reservoir, the ureters, bladder, and urethra. During the last 30 years of the preceding century, those marked in the mortal catalogue of London as cut of the stone, gravel, and strangury, are only 1796; and at present the mortality is more inconsiderable; and perhaps, in some degree, maybe accounted for by modern improvements in the cure of the venereal disease, and in the operation of lithotomy; for as to lithontripticks, we are as yet as ignorant as of the philosopher’s stone. From Dr. Dobson’s Treatise it appears, that out of 192,394 sick of various diseases, medical and surgical, in different county hospitals, throughout England, 430 of these underwent the operation of lithotomy. Some countries more than others, are obnoxious to calculous concretions; which have been variously imputed to air, food, drink, and water. Gravel and sand in the urinary organs is a frequent complaint, to which infancy and childhood are by no means such martyrs as adults, those especially in the decline of life: but from the shortness and width of the female urethra, they are preserved freer from calculi in the bladder than the male sex. Diseases of the urinary organs have been often described by authors under three general heads; Ischury, Dysury, and Strangury. Ischuria means a total suppression of urine; and from the seat of the disease is called renalis, uretoria, vesicalis: Dysury is only a slighter degree of the former: Strangury, a constant irritation to urine, in small quantity, and often with tenesmus.

_Inflammation and Calculi of the Kidneys_, nephritis, nephralgia: and generally confined to one kidney. The symptoms, shivering, fever, acute pains and heat in the lumbar region, following the tract of the ureters, and various in severity, from calculi excruciating; frequent efforts to micturition; the urine in small quantity, red, bloody, hot, often intermixed with sand, sometimes totally suppressed; with colick, flatulence, bilious vomiting, costiveness. When the disease is severe, and from calculi, there is stupor of the leg of the same side, and pains in the groin and male testicle, and often retraction of the latter. There is also difficulty and pain in walking or erecting the body; but the rheumatick lumbago, with which it may be confounded, has no concomitant fever, nor disorder of the stomach; and has more intense pain on bending or erecting the body. It is always dangerous and precipitate, especially when the urine is suppressed, terminating within seven, or, the utmost, fourteen days, by discussion, suppuration, gangrene, scirrhus: discussion indicated by a copious flow of urine and sweats.

But the most frequent malady about the fountain of the urinary secretion, is from calculi in the ureters. The kidneys have few nerves, and therefore not very acute sensation. Calculi or gravel in the strainers of the kidneys, seldom excite much uneasiness until they are forced into the ureters by the current of urine, by exercise, exertions of the body, agitations of a coach, passions of mind, stimulating diet and drink: then they excite atrocious pain, like a stake driven into the back, which is exasperated by certain postures, by every motion of the body, and by a full stomach; together with all the other symptoms common to inflammation, except the fever; to which, however, and to inflammation calculi, often give birth. At the beginning the urine is limpid; afterwards it becomes turbid and fabulous. This is a chronic periodical disease, with intermissions and nephritic exacerbations at uncertain intervals. It is distinguishable from intestinal colick by the pain fixed in the loins, the urinary obstruction, stupor of the leg, and retraction of the testicle.

_Inflammation and also Calculus of the Bladder._ Of cystitis, the symptoms are acute burning pain in the region of the bladder and perineum, and extending to the loins; tumour, tension, and hardness of the abdomen from the distended bladder, which may be felt between the pubis and navel; and sometimes is turgid to an enormous magnitude; perpetual painful efforts to urine and stool, and the urine either suppressed, or in small quantity; a finger introduced into the anus, or into the female vagina, feels the vesical tumour; or if the inflammation particularly fixes upon the neck of the bladder, the surgical catheter cannot, without immense difficulty, be introduced; and with all these symptoms, symptomatick fever, quick, hard, phlogistic pulse. It is very rapid and dangerous: total suppression within a very few days excites burning fever, lethargy, delirium, convulsions, gangrene: or even after recovery from a violent disease, incontinence of urine may remain for a considerable time.

Of calculus, or stone in the bladder, the symptoms are all dubious, without sounding the bladder with the surgical instrument. It is a chronic disease, slow in accumulation; and is frequently endured many years, without having recourse to lithotomy. The symptoms vary in severity, and recur in exacerbations at uncertain intervals; such are frequent irritation to urine, and difficulty in the evacuation; strangury, tenesmus, pain, and titillation of the glans of the penis, and the urethra, especially after making water; itching of the genitals; sometimes bloody urine after riding, or exercise. If the stone is large, there is a sensation of weight in the region of the pubis and perineum; sudden stoppage of the urine during micturition; sometimes necessity of kneeling, and of a prone posture in endeavouring to evacuate the bladder. A finger introduced into the anus, will sometimes feel the stone; but the sound is the only certain criterion. The size, shape, and number of stones are various: often only one, but sometimes several are extracted by lithotomy. Internal incrustations, and also scirrhus of the bladder, or even internal hemorrhoides, have imposed on medical judgment as cystic calculi.

Inflammation and obstruction of the urethra cannot be thoroughly investigated, without a description of the venereal disease, to which we have not yet arrived; but which there could be no impropriety to introduce amongst this group.

The predisposing and occasional _causes_ of urinary suppression, obstruction, and strangury, whether originating in the kidneys, ureters, bladder, or urethra, are inflammation of the kidney or ureter, calculi or sand in the kidneys or ureters; acrid diureticks; spirituous liquors; plethora, spasm, poisons, severe riding, violent heat and muscular exercise; strains of the lumbar and dorsal muscles; long continued posture in a bent position or supine on the back; inactive sedentary life; wounds, contusions, abscess; defecation and crisis of other diseases by the kidneys; scirrhous, incysted, dropsical, paralytick kidney; gout; inflammation of the bladder or its sphincter, stone in the bladder; the urine too long retained in the bladder, by which it becomes violently stretched, and paralytic; hernia of the bladder; obstructions in the neck of the bladder, or in the urethra; varicous blood vessels; the prostrate glands or seminal vesicles scirrhous, or enlarged; inflammation, caruncles, and stricture in the urethra; the corpus cavernosum thickened; contiguous diseases of the anus, vagina, and womb; hardened feces, hemorrhoides, wounds of the rectum, fistula; ulcers of the womb, obstructed menses, or their retention in the vagina; pregnancy; ulcers and worms in the kidneys, bladder, or urethra, and excretion of acrid pus or membranes, by urine; grumous, extravasated blood in the bladder and urethra; inspissated semen after coition; excess of venery; too acute sensibility of the urethra, defect of mucus; acrid urine; tartarous and astringent wine or drink, food, or medicines; stimulating food and drink; frequent ebriety; terrestrious water; sudden refrigeration of the body; contusion; old age; plethora; lunar, venereal, rheumatick, arthritick, hysterick, scorbutick, dropsy, violent colick, retraction and shrinking of the penis.

_Incontinence of Urine, and also Diabetes._ Of incontinence, or eneuresis, authors make three species; one involuntary, without sense or effort; the second involuntary, but with a knowledge of its excretion; the third involuntary, during sleep. The Diabetes was unnoticed in the London bills until the present century; and perhaps its trifling depredations were thrown amongst consumptions. It denotes a chronic discharge of urine beyond the natural quantity, and sometimes exceeding in weight all the fluids and solids taken by aliment: it is generally clear and colourless, but sometimes white and chylous, or unctuous, or, like honey dissolved in water, a yellowish green, and tastes sweet like honey: there is unquenchable thirst, intense heat, flow hectic and emaciation, pain in the loins; increased flow of saliva, voraciousness, or inappetency. It often invades by slow and imperceptible steps, and without any other disorder, until, by long continuance, emaciation is visible, with debility and obscure fever. It is sometimes periodical, and in hystericks symptomatic.

The predisposing and occasional _causes_ of incontinence of urine are, palsy of the sphincter of the bladder, from either too great dilatation and accumulation of urine, or from violent efforts in parturition; debility, old age, excess of venery; fistula, abscess, ulcers, lithotomy, stone, spasm, gout, apoplexy, palsy, external injuries. Also, copious, watery, acrid urine: the bladder irritable from inflammation, ulcers, excoriation, defect of mucus; spasm, relaxation of the sphincter; weakness of the sphincter ani, and accelerator muscles; pregnancy, laborious parturition; compression and irritation of the bladder; habit.—Of diabetes, aqueous tenuity, and also acrimony of the blood; weakness, laxity of the kidneys and renal vessels; the crassamentum of the blood not cohering with the serum; faults in the assimilation of the nutriment, and sanguification; excess of watery drink and ebriety; diureticks; sudden refrigeration of the body, and suppression of perspiration; unusual determination of blood and serum to the kidneys; excess of venery; increase of cutaneous absorption; obstructions of the abdominal viscera; spasm; nervous; habit: often unknown.

_Ulcers in the Kidneys and Bladder, and Bloody Urine._ Of ulcers in the kidneys, thick fetid urine, sometimes with mouldered fragments of the kidneys; heat and weight in the loins; hectic emaciation, stupor of the leg, and some other symptoms of nephritis. It is tedious and dangerous. Of ulcer in the bladder, pain in the pelvis and perineum, exasperated at intervals; heat, strangury, dysury; the urine fetid with intermixtures of pus, mucus, and blood; sometimes the rectum also is eroded. Of bloody urine, or hematuria from the kidneys, ureters, bladder, seminal vesicles, or urethra. From the kidneys the hemorrhage is sometimes profuse, and the blood of various colours, according to its solution and stagnation in the bladder; and sometimes coagulated, takes the mould of the urethra: the urine tinges linen dipped into it of a red colour, and the blood is coagulable by heat. There are instances of its periodical flow, like the menses. The predisposing and occasional causes of urinary hemorrhage are the general causes of hemorrhages; calculi in the kidneys or bladder; falls, blows on the loins; violent exertion of the lumbar muscles, riding, exercise; venery; plethora; obstructed evacuations, hemorrhoids, menses; hemorrhoids of the bladder and varicous veins; acrid diureticks; ulcers, symptomatick in scurvy; putrid small pox, and malignant fever.

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_Dropsy._ During the last thirty years of the preceding century, Dropsy and Tympany amount to 23,366. In the present century, dropsy makes about one twentieth share in the London funerals. It has been alledged, that more women die of this internal deluge than men; and, according to Sydenham, more of the former at the final menstrual ebb, than at any other period. But, so far as my reading extends, neither the age, sex, mortality absolute or comparative, have to this day been decided from facts or numbers; but rather principally in the mode of tradition, and aphorisms of individual oracles. I therefore, through my learned friend, Dr. Sims, procured the registers of diseases in the Aldersgate Dispensary of London, which is accessible to all ages and diseases, and to both sexes: the result of this scrutiny is as follows:—Out of 70,000, during seventeen years, from 1770 to 1788, the dropsical amounted to rather more than one twentieth part of the whole maladies; that is, to 1,188: of which number, I find there were of males, 439; females, 749; cured, 674; relieved, 56; discharged or not accounted for, 275; dead, 186. Of these their sundry ages were, from birth to the 10th year, 106; from 10 to 20, 53; from 20 to 30, 112; from 30 to 40, 249; from 40 to 50, 321; from 50 to 60, 209; from 60 to 70, 110; from 70 to 80, 23; from 80 to 90, 9. Total, 1,188. These include every genus and species of dropsy, the hydrocephalus and hydrocele; neither of which were numerous: and the former principally fatal to children under ten years of age. Anasarca was the most frequent genus; and next to that, Ascites. Besides, all cases of anasarca and œdematous legs were ranged in this dropsical group; nor was it possible to form an estimate of the genera separately, as the word Hydrops was often indefinitely used.

From these data we may draw the following conclusions: That dropsy is more inimical to the female than to the male sex: but at the same time it must be recollected, that in London, and other cities, the women are considerably more numerous; which somewhat detracts from the comparative excess in them of dropsical mortality. For reasons, which medical men of experience will anticipate, we may add to the dropsical dead list some of the relieved, discharged, and not accounted for. It appears, therefore, that, under skilful medical treatment, rather more than one half of dropsies, promiscuously, were cured; that about one third or fourth died; that dropsical ravages are principally amongst adults; for notwithstanding that one half of the community are under twenty years of age, yet but a small portion of these are dropsical. It is chiefly against adults, and those in the decline of life, that dropsy prowls with slow and sullen destruction; and is, as 8 to 1, more fatal after twenty, than before that period. We may here also observe, that, by retrospection to a former proposition, a sort of medical geometry and trigonometry, a gross estimate may be formed from the deaths, of the number of dropsical in a community.

_Dropsy in the Brain_ and Spine, hydrocephalus, and spina bifida, is most frequent in infancy and childhood; but is often very difficult to detect, and the symptoms at the beginning are dubious. The most usual symptoms are loss of appetite, strength, spirits, flesh; fixed pain in the head and eye-brows, drowsiness or restlessness, heaviness, stupidity; pale countenance and tongue; obscure or double vision, dilated pupil, insensibility of the retina, even when exposed to the darting rays of the sun, or of a candle; the hand often applied to the head; irregular pulse; vomiting. It is commonly slow in increase; from months to a year, or more. It is seldom cured; and the fatal termination frequently palsy and convulsions. The external hydrocephalus, or local anasarca, is soft and elastic to the touch, and the enlargement visible. The spinal dropsy is sometimes complicated with hydrocephalus; in it a tumour turgid with fluid, the size of a chesnut, or larger, is protruded from the opening in the lumbar vertebræ of infants.

_Dropsy of the Thorax_, hydrops pectoris, and pericardii: in one or both sacs of the pleura, or in the pericardium; or in the pulmonic cellular texture. This is much less frequent than the abdominal; and is often very difficult in the early stages to be detected, as the same, or nearly similar symptoms, occur in some other diseases of the breast: such are difficult and laborious respiration, especially on any exercise or motion, or in a horizontal posture, and gradually increasing; frequent cough, at first dry, but after some time, with mucous expectoration; weight and oppression in the breast; disturbed sleep, and sudden startings, with anxiety and dyspnœa; necessity of an erect posture; palpitation of the heart, and irregular pulse: there is also commonly scantiness of urine, œdematous tumour of the feet and ancles; a pasty paleness of the face; and sometimes a fluctuation of water in the thorax is perceptible to the patient.

Sometimes it is circumscribed and local; at other times, it begins by anasarca, and is complicated with universal dropsy of the other cavities, or with asthma; sometimes it consists of hydatides. It is distinguishable from the empyema, and from the polypus and aneurism of the large vessels, by the symptoms peculiar to each. After some fevers, thoracic dropsy has formed with surprizing rapidity in one or two days. The fatal event is often preceded by spitting of blood, anxiety, and accelerated respiration. In the dropsy of the capsula of the heart, the pericardium, there is difficulty of respiration, and of laying on the left side; quick, weak, intermittent pulse, palpitation of the heart, syncope, dry cough; anasarcous ancles, scantiness of urine: and sometimes a sensation of fluctuation during the motion of the heart. In dropsy of the mediastinum, the symptoms are conjectural.

_Abdominal Dropsy_, including the ascites, the dropsy of the ovaria, fallopian tubes, and womb. The ascites, or exudation between the peritoneum, intestines, and viscera, is much more frequent than the hydrothorax. The symptoms are enlargement and prominence of the belly; sense of fluctuation to the fingers and ears on striking it with one hand, and applying the other to the opposite side; the urine scanty, turbid, and high-coloured; costiveness; the thirst at the beginning is inconsiderable, but generally becomes irksome and insatiable; the skin dry; the body sluggish, and increased in weight: the countenance becomes squalid, sallow, and unwholesome; the upper part of the body and arms emaciated, and, sooner or later, the ancles œdematous. Where there is a large accumulation of water the diaphragm is impeded, with difficulty of respiration and dry cough, particularly in a horizontal posture. The serous transudation is the general form of ascites; but sometimes it is of a gelatinous consistence, and more of coagulable lymph from the blood, and the fluctuation not perceptible: in other cases it is inclosed in numerous morbid cysts, called hydatides; which cannot be known to a certainty until after the experiment of tapping. It may, however, be suspected, where there is no general cachexy, dropsy, thirst, or scantiness of urine; where the appetite and sleep are natural, and the tumour has begun in one part of the abdomen.

Some survive many years under ascites, and after reiterated evacuations by tapping; on the whole, often amounting to several hogsheads of water. In others, there are instances of accumulation so extraordinary, sudden, and profuse, as to render it necessary to be drawn off repeatedly in the short interval of a few weeks. It occurs either singly, or as a part of universal dropsy. Ascites encysted; from broken constitutions; unsound viscera; the consequence of other diseases; chronic; with decay of appetite; with urine considerably disproportioned to the drink, are all species unfavourable, some desperate. But in the most deplorable stages, patients entertain some hopes of recovery.

Dropsy of the Ovaria, fallopian tubes, and womb, are female, and not unfrequent maladies. It is rarely that both ovaria are affected. The disease begins with a soft tumour at one side of the abdomen, generally increasing by slow gradations, and at length sometimes to an enormous size and weight, so as to distend the whole abdomen: it is accompanied with several ascitic symptoms, and with pain about the pubis and loins; but the fluctuation is imperceptible, or obscure; and the extravasation is often encysted and gelatinous. That in the fallopian tubes requires no particular description after the preceding, which it so nearly resembles. Both are often incurable. Dropsy of the womb is a very rare disease: it has been described as occurring either in the pregnant or unimpregnated state; and in the latter case, as contained within the cavity of the womb, or between the fetal membranes and the womb; or within the layers of the membranes. I cannot find an author to satisfy my doubts respecting the accurate diagnostick of this disease; and therefore shall not copy what I distrust.

_Dropsy of the Cellular Membrane_, externally, in the cellular texture under the skin; the species anasarca, leucophlegmatia, œdema. It generally appears first in the lower extremities, and there too only in the evening, disappearing by a horizontal posture in the night: at length, it reaches up, progressively, to the legs, thighs, trunk, and scrotum; and in some instances, to the face, particularly in the mornings. The intumescence of the skin is pale and soft, and, on pressure of the finger, indents; but is soon again filled up with water. As it increases to a universal anasarca, there is difficulty of breathing, particularly after exercise, scanty urine, thirst, decay of strength, slow hectic diminution of the natural heat, and more or less insensibility of the skin, which is dry. Sometimes the legs and thighs only are enlarged and distended to a monstrous magnitude; their skin bursts, ulcerates, or is irritated to erysipelatous inflammation. It is either complicated with ascites or hydrothorax, or beginning as œdema, and increasing to anasarca, it oozes through all the external cellular texture; and having inundated all the out-works, proceeds in drowning the vital organs.

_Dropsy of the Scrotum_, hydrocele. This is a local disease, confined to the male sex; and to which all ages are subject. There are two principal species; that between the vaginal coat and testicle, and that in the spermatic chord; and either collected in cysts, or dispersed through all the cellular membranes inclosing the spermatick vessels. In general, hydrocele is confined to one testicle, at the beginning is not painful, and neither diminishes nor disappears: it has usually a conical pyriform appearance, the large end downwards: sometimes it is very hard and incompressible; and when the membranes are much thickened, it is not transparent: there is slow gradual accumulation of the fluid from below: it is incapable of reduction, or return into the abdomen through the rings: it is not affected by posture, cough, or sneezing of the patient: there is neither nausea, vomiting, quick pulse, nor is the fecal discharge interrupted. If the quantity of water is considerable, the testicle cannot be felt, at least not distinguished. In most cases the spermatick vessels may be felt at their exit, through the abdominal rings; but sometimes the hydrocele tumour reaches up to the rings, and renders such cases puzzling to discriminate, as the spermatick chord is then concealed. Again, hydrocele of the spermatick chord has been mistaken for rupture, from its ascension to the rings: this species feels like a distended bladder.

Hydrocele has not only been mistaken for rupture, but also for scirrhous testicle, and venereal induration. Indurated and scirrhous testicle is rounder, harder, painful, and the spermatic chord distinguishable at the rings: it has, however, frequently a quantity of extravasated and surrounding fluid. Besides, scrotal hydrocele and hernia, hydrocele and scirrhous testicle, hydrocele and encysted dropsy of the spermatic chord, have been seen combined. Some hydroceles are several years collecting: others are very suddenly formed, especially from extravasated blood, external injuries, violent muscular exertions; these likewise have been mistaken for ruptures. Hydroceles vary in the quantity of fluid and magnitude, containing from ounces to several quarts; some are enormous in size, reaching half-way down to the knees, and occasioning great load, and pain in the back. The colour of the extravasated fluid is also various; clear, limpid, pale, straw, yellow, grumous, dark, bloody. Many, from choice or necessity, are contented to drag on life, not chusing to risk what is termed the radical operation and cure; but merely by frequent repetitions of the scrotal puncture or palliative remedy. Sometimes the skin and cellular membrane of the scrotum, in inveterate hydrocele, is prodigiously thickened.

The predisposing and occasional _causes_ of Dropsies, comprehending all the preceding genera, are in consequence of various acute and chronic distempers; broken constitutions, cachexy; intermittent, remittent, and scarlet fevers; repelled erysipelas; rickets; jaundice; biliary obstructions; suppression or repulsion of habitual or wholesome evacuations, as menses, hemorrhoides; general debility from various causes; atony of the sanguinous vessels, and of the exhalents, and transudation of serum through them; excessive evacuations by hemorrhage, diarrhœa, perspiration, or other excretories; sudden and large draughts of cold water when the body is much heated, especially if not discharged by urine or sweat; excess of fluids, of spirituous liquors; languid circulation; sedentary life; watery trades; moist air; suppressed perspiration, and watery excretions; tenuity or impurity of the blood; tenacious adhesion and agglutination of the coagulable lymph; increase of serous fluid in the blood; diseases and also ruptures of the lacteals and lymphaticks, and of the kidneys, ureters, and bladder; defect of lymphatic absorption; obstructed and scirrhous viscera, mesentery and lungs; asthma, polypi, ossified arteries, excessive fatness, and other causes intercepting the circulation of the blood: diseases of the stomach and digestive organs, and those of sanguification; laxity of the external subcutaneous cellular membrane; debility of the muscular solids and fibres, and of the tela cellulosa; hereditary; hydatides; violent muscular exertions, external injuries.