Chapter X: Part II (9)

I have known two instances, and have heard of others, where the natural small-pox began fourteen days after the contagion had been received; one of these instances was of a countryman, who went to a market town many miles from his home, where he saw a person in the small-pox, and on returning the fever commenced that day fortnight: the other was of a child, whom the ignorant mother carried to another child ill of the small-pox, on purpose to communicate the disease to it; and the variolous fever began on the fourteenth day from that time. So that in both these cases fever commenced in half a lunation after the contagion was received. In the inoculated small-pox the fever generally commences on the seventh day, or after a quarter of a lunation; and on this circumstance probably depends the greater mildness of the latter. The reason of which is difficult to comprehend; but supposing the facts to be generally as above related, the slower progress of the contagion indicates a greater inirritability of the system, and in consequence a tendency to malignant rather than to inflammatory fever. This difference of the time between the reception of the infection and the fever in the natural and artificial small-pox may nevertheless depend on its being inserted into a different series of vessels; or to some unknown effect of lunar periods. It is a subject of great curiosity, and deserves further investigation.

When the inoculated small-pox is given under all the most favourable circumstances I believe less than one in a thousand miscarry, which may be ascribed to some unavoidable accident, such as the patient having previously received the infection, or being about to be ill of some other disease. Those which have lately miscarried under inoculation, as far as has come to my knowledge, have been chiefly children at the breast; for in these the habit of living in the air has been confirmed by so short a time, that it is much easier destroyed, than when these habits of life have been established by more frequent repetition. See Sect. XVII. 3. Thus it appears from the bills of mortality kept in the great cities of London, Paris, and Vienna, that out of every thousand children above three hundred and fifty die under two years old. (Kirkpatrick on Inoculation.) Whence a strong reason against our hazarding inoculation before that age is passed, especially in crowded towns; except where the vicinity of the natural contagion renders it necessary, or the convenience of inoculating a whole family at a time; as it then becomes better to venture the less favourable circumstances of the age of the patient, or the chance of the pain from toothing, than to risk the infection in the natural way.

The most favourable method consists in, first, for a week before inoculation, restraining the patients from all kinds of fermented or spirituous liquor, and from animal food; and by giving them from one grain to three or four of calomel every other day for three times. But if the patients be in any the least danger of taking the natural infection, the inoculation had better be immediately performed, and this abstinence then began; and two or three gentle purges with calomel should be given, one immediately, and on alternate days. These cathartics should not induce more than two or three stools. I have seen two instances of a confluent small-pox in inoculation following a violent purging induced by too large a dose of calomel.

Secondly, the matter used for inoculation should be in a small quantity, and warm, and fluid. Hence it is best when it can be recently taken from a patient in the disease; or otherwise it may be diluted with part of a drop of warm water, since its fluidity is likely to occasion its immediate absorption; and the wound should be made as small and superficial as possible, as otherwise ulcers have been supposed sometimes to ensue with subaxillary abscesses. Add to this, that the making two punctures either on the same, or one on each arm, secures the success of the operation in respect to communicating the infection.

Thirdly, at the time of the fever or eruption the application of cool air to those parts of the skin, which are too warm, or appear red, or are covered with what is termed a rash, should be used freely, as well as during the whole disease. And at the same time, if the feet or hands are colder than natural, these should be covered with flannel. See Class IV. 2. 2. 10.

10. _Rubeola irritata, morbilli._ The measles commence with sneezing, red eyes, dry hoarse cough, and is attended with sensitive irritated fever. On the fourth day, or a little later, small thick eruptions appear, scarcely eminent above the skin, and, after three days, changing into very small branny scales.

As the contagious material of the small-pox may be supposed to be diffused in the air like a fine dry powder, and mixing with the saliva in the mouth to infect the tonsils in its passage to the stomach; so the contagious material of the measles may be supposed to be more completely dissolved in the air, and thus to impart its poison to the membrane of the nostrils, which covers the sense of smell; whence a catarrh with sneezing ushers in the fever; the termination of the nasal duct of the lacrymal sac is subject to the same stimulus and inflammation, and affects by sympathy the lacrymal glands, occasioning a great flow of tears. See Sect. XVI. 8. And the redness of the eye and eyelids is produced in consequence of the tears being in so great quantity, that the saline part of them is not entirely reabsorbed. See Sect. XXIV. 2. 8.

The contagion of the measles, if it be taken a sufficient time before inoculation, so that the eruption may commence before the variolous fever comes on, stops the progress of the small-pox in the inoculated wound, and delays it till the measle-fever has finished its career. See Sect. XXXIII. 2. 9.

The measles are usually attended with inflammatory fever with strong pulse, and bear the lancet in every stage of the disease. In the early periods of it, venesection renders the fever and cough less; and, if any symptoms of peripneumony occur, is repeatedly necessary; and at the decline of the disease, if a cough be left after the eruption has ceased, and the subsequent branny scales are falling off, venesection should be immediately used; which prevents the danger of consumption. At this time also change of air is of material consequence, and often removes the cough like a charm, as mentioned in a similar situation at the end of the chin-cough.

_Rubeola inirritata._ Measles with inirritated fever, or with weak pulse, has been spoken of by some writers. See London Med. Observ. Vol. IV. Art. XI. It has also been said to have been attended with sore throat. Edinb. Essays, Vol. V. Art. II. Could the scarlet fever have been mistaken for the measles? or might one of them have succeeded the other, as in the measles and small-pox mentioned in Sect. XXXIII. 2. 9.?

From what has been said, it is probable that inoculation might disarm the measles as much as the small-pox, by preventing the catarrh, and frequent pulmonary inflammation, which attends this disease; both of which are probably the consequence of the immediate application of the contagious miasmata to these membranes. Some attempts have been made, but a difficulty seems to arise in giving the disease; the blood, I conjecture, would not infect, nor the tears; perhaps the mucous discharge from the nostrils might succeed; or a drop of warm water put on the eruptions, and scraped off again with the edge of a lancet; or if the branny scales were collected, and moistened with a little warm water? Further experiments on this subject would be worthy the public attention.

11. _Scarlatina mitis._ The scarlet fever exists with all degrees of virulence, from a flea-bite to the plague. The infectious material of this disease, like that of the small-pox, I suppose to be diffused, not dissolved, in the air; on which account I suspect, that it requires a much nearer approach to the sick, for a well person to receive the infection, than in the measles; the contagion of which I believe to be more volatile, or diffusible in the atmosphere. But as the contagious miasmata of small-pox and scarlet fever are supposed to be more fixed, they may remain for a longer time in clothes or furniture; as a thread dipped in variolous matter has given the disease by inoculation after having been exposed many days to the air, and after having been kept many months in a phial. This also accounts for the slow or sporadic progress of the scarlet fever, as it infects others at but a very small distance from the sick; and does not produce a quantity of pus-like matter, like the small-pox, which can adhere to the clothes of the attendants, and when dried is liable to be shook off in the form of powder, and thus propagate the infection.

This contagious powder of the small-pox, and of the scarlet fever, becomes mixed with saliva in the mouth, and is thus carried to the tonsils, the mucus of which arrests some particles of this deleterious material; while other parts of it are carried into the stomach, and are probably decomposed by the power of digestion; as seems to happen to the venom of the viper, when taken into the stomach. Our perception of bad tastes in our mouths, at the same time that we perceive disagreeable odours to our nostrils, when we inhale very bad air, occasions us to spit out our saliva; and thus, in some instances, to preserve ourselves from infection. This has been supposed to originate from the sympathy between the organs of taste and smell; but any one who goes into a sick room close shut up, or into a crowded assembly-room, or tea-room, which is not sufficiently ventilated, may easily mix the bad air with the saliva on his tongue so as to taste it; as I have myself frequently attended to.

Hence it appears that these heavy infectious matters are more liable to mix with the saliva, and inflame the tonsils, and that either before or at the commencement of the fever; and this is what generally happens in the scarlet fever, always I suppose in the malignant kind, and very frequently in the mild kind. But as this infection may be taken by other means, as by the skin, it also happens in the most mild kind, that there is no inflammation of the tonsils at all; in the same manner as there is generally no inflammation of the tonsils in the inoculated small-pox.

In the mild scarlatina on the fourth day of the fever the face swells a little, at the same time a florid redness appears on various parts of the skin, in large blotches, at length coalescing, and after three days changing into branny scales.

M. M. Cool air. Fruit. Lemonade. Milk and water.

_Scarlatina maligna._ The malignant scarlet fever begins with inflamed tonsils; which are succeeded by dark drab coloured sloughs three or five lines in diameter, flat, or beneath the surrounding surface; and which conceal beneath them spreading gangrenous ulcers. The swellings of the tonsils are sensible to the eye and touch externally, and have an elastic rather than an oedematous feel, like parts in the vicinity of gangrenes. The pulse is very quick and weak, with delirium, and the patient generally dies in a few days; or if he recovers, it is by slow degrees, and attended with anasarca.

M. M. A vomit once. Wine. Beer. Cyder. Opium. Bark; in small repeated doses. Small successive blisters, if the extremities are cooler than natural. Cool air on the hot parts of the skin, the cool extremities being at the same time covered. Iced lemonade. Broth. Custards. Milk. Jellies. Bread pudding. Chicken. Touch the ulcers with a dry sponge to absorb the contagious matter, and then with a sponge filled with vinegar, with or without sugar of lead dissolved in it, about six grains to an ounce; or with a very little blue vitriol dissolved in it, as a grain to an ounce; but nothing so instantaneously corrects the putrid smell of ulcers as a solution of alum; about half an ounce to a pint of water, which should be a little warmish, and injected into the fauces gently by means of a syringe. These should be repeated frequently in a day, if it can be done easily, and without fatigue to the child. A little powder of bark taken frequently into the mouth, as a grain or two, that it may mix with the saliva, and thus frequently stimulate the dying tonsils. Could a warm bath made of decoction of bark, or a cold fomentation with it, be of service? Could oxygene gas mixed with common air stimulate the languid system? Small electric shocks through the tonsils every hour? ether frequently applied externally to the swelled tonsils?

As this disease is attended with the greatest degree of debility, and as stimulant medicines, if given in quantity, so as to produce more than natural warmth, contribute to expend the already too much exhausted sensorial power; it appears, that there is nothing so necessary to be nicely attended to, as to prevent any unnecessary motions of the system; this is best accomplished by the application of cold to those parts of the skin, which are in the least too hot. And secondly, that the exhibition of the bark in such quantity, as not to oppress the stomach and injure digestion, is next to be attended to, as not being liable to increase the actions of the system beyond their natural quantity; and that opium and wine should be given with the greatest caution, in very small repeated quantity, and so managed as to prevent, if possible, the cold fits of fever; which probably occur twice in 25 hours, obeying the lunations like the tides, as mentioned in Sect. XXXII. 6. that is, I suppose, the cold periods, and consequent exacerbations of fever, in this malignant scarlatina, occur twice in a lunar day; which is about ten minutes less than 25 hours; so that if the commencement of one cold fit be marked, the commencement of the next may be expected, if not disturbed by the exhibition of wine or opium, or the application of blisters, to occur in about twelve hours and a half from the commencement of the former; or if not prevented by large doses of the bark.

No one could do an act more beneficial to society, or glorious to himself, than by teaching mankind how to inoculate this fatal disease; and thus to deprive it of its malignity. Matter might be taken from the ulcers in the throat, which would probably convey the contagion. Or warm water might be put on the eruption, and scraped off again by the edge of a lancet. These experiments could be attended with no danger, and should be tried for the public benefit, and the honour of medical science.

12. _Miliaria._ Miliary fever. An eruption produced by the warmth, and more particularly by the stimulus of the points of the wool in flannel or blankets applied to the skin, has been frequently observed; which, by cool dress, and bed-clothes without flannel, has soon ceased. See Class I. 1. 2. 3. This, which maybe called _miliaria sudatoria_, has been confounded with other miliary fevers, and has made the existence of the latter doubted. Two kinds of eruptions I have seen formerly attended with fever, but did not sufficiently mark their progress, which I conceived to be miliary eruptions, one with arterial strength, or with sensitive irritated fever, and the other with arterial debility, or with sensitive inirritated fever.

In the former of these, or _miliaria irritata_, the eruptions were distinct and larger than the small-pox, and the fever was not subdued without two or three venesections, and repeated cathartics with calomel.

The latter, or _miliaria inirritata_, was attended with great arterial debility; and during the course of the fever pellucid points appeared within the skin, particularly on the soft parts of the fingers. And, in one patient, whom I esteemed near her end, I well recollect to have observed round pellucid globules, like what are often seen on vines in hot-houses, no larger than the smallest pins' heads, adhere to her neck and bosom; which were hard to the touch, but were easily rubbed off. These diseases, if they are allied, do not differ more than the kinds of small-pox; but require many further observations.

The eruption so often seen on children in the cradle, and called by the nurses red-gum, and which is attended with some degree of fever, I suspect to be produced by too great warmth, and the contact of flannel next their tender skins, like the miliaria sudatoria; and like that requires cool air, cool clothes, and linen next their skin.

13. _Pestis._ The plague, like other diseases of this class, seems to be sometimes mild, and sometimes malignant; according to the testimony of different writers. It is said to be attended with inflammation, with the greatest arterial debility, and to be very contagious, attended at an uncertain time of the fever with buboes and carbuncles. Some authors affirm, that the contagion of the plague may be repeatedly received, so as to produce the disease; but as this is contrary to the general analogy of all contagious diseases, which are attended with fever, and which cure themselves spontaneously; there is reason to suspect, that where it has been supposed to have been repeatedly received, that some other fever with arterial debility has been mistaken for it, as has probably universally been the case, when the small-pox has been said to have been twice experienced.

M. M. Venesection has been recommended by some writers on the first day, where the inflammation was supposed to be attended with sufficient arterial strength, which might perhaps sometimes happen, as the bubo seems to be a suppuration; but the carbuncle, or anthrax, is a gangrene of the part, and shews the greatest debility of circulation. Whence all the means before enumerated in this genus of diseases to support the powers of life are to be administered. Currents of cold air, cold water, ice, externally on the hot parts of the skin.

The methods of preventing the spreading of this disease have been much canvassed, and seem to consist in preventing all congregations of the people, as in churches, or play-houses; and to remove the sick into tents on some airy common by the side of a river, and supply them with fresh food, both animal and vegetable, with beer and wine in proper quantities, and to encourage those who can, daily to wash both their clothes and themselves.

The _pestis vaccina_, or disease amongst the cows, which afflicted this island about half a century ago, seems to have been a contagious fever with great arterial debility; as in some of them in the latter stage of the disease, an emphysema could often be felt in some parts, which evinced a considerable progress of gangrene beneath the skin. In the sensitive inirritated fevers of these animals, I suppose about sixty grains of opium, with two ounces of extract of oak-bark, every six hours, would supply them with an efficacious medicine; to which might be added thirty grains of vitriol of iron, if any tendency to bloody urine should appear, to which this animal is liable. The method of preventing the infection from spreading, if it should ever again gain access to this island, would be immediately to obtain an order from government to prevent any cattle from being removed, which were found within five miles of the place supposed to be infected, for a few days; till the certainty of the existence of the pestilence could be ascertained, by a committee of medical people. As soon as this was ascertained, all the cattle within five miles of the place should be immediately slaughtered, and consumed within the circumscribed district; and their hides put into lime-water before proper inspectors.

14. _Pemphigus_ is a contagious disease attended with bladdery eruptions appearing on the second or third day, as large as filberts, which, remain many days, and then effuse a thin ichor. It seems to be either of a mild kind with sensitive fever only, of which I have seen two instances, or with irritated, or with inirritated fever, as appears from the observations of M. Salabert. See Medical Comment, by Dr. Duncan, Decad. II. Vol. VI.

15. _Varicella._ Chicken-pox is accompanied with sensitive fever, pustules break out after a mild fever like the small-pox, seldom suppurate, and generally terminate in scales without scars. I once saw a lady, who miscarryed during this disease, though all her children had it as slightly as usual. It sometimes leaves scars or marks on the skin. This disease has been mistaken for the small-pox, and inoculated for it; and then the small-pox has been supposed to happen twice to the same person. See Trans. of the College London. It is probable that the pemphigus and urticaria, as well as this disease, have formerly been diseases of more danger; which the habit of innumerable generations may have rendered mild, and will in process of time annihilate. In the same manner as the small-pox, venereal disease, and rickets, seem to become milder or less in quantity every half century. While at the same time it is not improbable, that other new diseases may arise, and for a season thin mankind!

16. _Urticaria._ Nettle-rash begins with mild sensitive fever, which is sometimes scarcely perceptible. Hence this eruption has been thought of two sorts, one with and the other without fever. On the second day red spots, like parts stung with nettles, are seen; which almost vanish during the day, and recur in the evening with the fever, succeeded in a few days by very minute scales. See Trans. of the College, London.

17. _Aphtha._ Thrush. It has been doubted, whether aphtha or thrush, which consists of ulcers in the mouth, should be enumerated amongst febrile diseases; and whether these ulcers are always symptomatic, or the consequence rather than the cause of the fevers which attend them. The tongue becomes rather swelled; its colour and that of the fauces purplish; sloughs or ulcers appear first on the throat and edges of the tongue, and at length over the whole mouth. These sloughs are whitish, sometimes distinct, often coalescing, and remain an uncertain time. Cullen. I shall concisely mention four cases of aphtha, but do not pretend to determine whether they were all of them symptomatic or original diseases.

_Aphtha sensitiva._ A lady during pregnancy was frequently seized with ulcers on her tongue and cheeks, or other parts of the mouth, without much apparent fever; which continued two or three weeks, and returned almost every month. The thrush in the mouths of young children seems to be a similar disease. These ulcers resemble those produced in the sea-scurvy, and have probably for their cause an increased action of the secerning system from increased sensation, with a decreased action of the absorbent system from decreased irritation. See Class I. 2. 1. 15.

M. M. Solutions of alum, of blue vitriol. Powder of bark taken frequently into the mouth in very small quantity. See Class II. 1. 3. 1.

_Aphtha irritata._ Inflammatory aphtha. A case of this kind is related under the title of suppurative rheumatism. Class IV. 1. 2. 16.

_Aphtha inirritata._ Sloughs or ulcers of the mouth, attended with sensitive fever with great arterial debility. They seem to spread downwards from the throat into the stomach, and probably through the whole intestinal canal, beginning their course with cardialgia, and terminating it with tenesmus; and might perhaps be called an erysipelas of this mucous membrane.

M. M. Cool air. A small blister on the back. Bark. Wine. Opium in small repeated quantities. Soap neutralizes the gastric acid without effervescence, and thus relieves the pain of cardialgia, where the stomach is affected. Milk also destroys a part of this acid. Infusion of sage leaves two ounces, almond soap from five grains to ten, with sugar and cream, is generally both agreeable and useful to these patients. See I. 2. 4. 5.

Where the stomach may be supposed to be excoriated by poisons containing acid, as sublimate of mercury or arsenic; or if it be otherwise inflamed, or very sensible to the stimulus of the gastric acid; or where it abounds with acid of any kind, as in cardialgia; the exhibition of soap is perhaps a preferable manner of giving alcali than any other, as it decomposes in the stomach without effervescence; while the caustic alcali is too acrid to be administered in such cases, and the mild alcali produces carbonic gas. If a drop of acid of vitriol be put on cap paper, it will be long before it destroys the paper; but if a drop of mild alcali be added, a sudden effervescence arises, and the paper is instantly destroyed by the escape of the fixed air; in the same manner as lumps of solid lime are broken into powder by the escape of the steam produced from the water, which is poured on them. This shews why a succession of acid and of alcaline caustics sooner destroys a part, than either of them applied separately.

18. _Dysenteria._ Bloody-flux is attended with sensitive fever generally with arterial debility; with frequent mucous or bloody stools; which contain contagious matter produced by the membranes of the intestines; the alimentary excrement being nevertheless retained; with griping pains and tenesmus.

M. M. Emetics. Antimonials. Peruvian bark. Opium and calomel of each a grain every night. Bolus armeniae. Earth of alum. Chalk. Calcined hartshorn. Mucilage. Bee's wax mixt with yolk of egg. Cerated glass of antimony. Warm bath. Flannel clothing next to the skin. Large clysters with opium. With ipecacuanha, with smoke of tobacco? Two dysenteric patients in the same ward of the infirmary at Edinburgh quarrelled, and whipped each other with horsewhips a long time, and were both much better after it, owing perhaps to the exertion of so much of the sensorial power of volition; which, like real insanity, added excitement to the whole system.

The prevention of this contagion must consist principally in ventilation and cleanliness; hence the patients should be removed into cottages distant from each other, or into tents; and their faeces buried as soon as may be; or conveyed into a running stream; and themselves should be washed with cold or warm water after every evacuation. For the contagious matter consists in the mucous or purulent discharge from the membrane which lines the intestines; and not from the febrile perspiration, or breath of the patients. For the fever is only the consequence and not the cause of contagion; as appears from Genus the Fifth of this Order, where contagion exists without fever.

19. _Gastritis superficialis._ Superficial inflammation of the stomach. An erysipelatous inflammation of the stomach is mentioned by Dr. Cullen from his own observations; which is distinguished from the inflammatory gastritis by less pain, and fever, and by an erysipelatous redness about the fauces. Does this disease belong to aphtha?

20. _Enteritis superficialis._ Superficial inflammation of the bowels is also mentioned by Dr. Cullen from his own observation under the name of enteritis erythematica; and is said to be attended with less pain and fever, without vomiting, and with diarrhoea. May not this disease be referred to aphtha, or to dysentery?

* * * * *

ORDO I.

_Increased Sensation._

GENUS IV.

_With the Production of new Vessels by internal Membranes or Glands, without Fever._

Where inflammation is produced in a small part, which has not great natural sensibility, the additional sensation does not produce an increased action of the arterial system; that is, the associated motions which are employed in the circulation of the blood, those for instance of the heart, arteries, glands, capillaries, and their correspondent veins, are not thrown into increased action by so small an addition of the sensorial power of sensation. But when parts, which naturally possess more sensibility, become inflamed, the quantity of the sensorial power of sensation becomes so much increased, as to affect the associated motions belonging to the circulation, occasioning them to proceed with greater frequency; that is, a fever is induced. This is well exemplified in the internal and superficial paronychia, one of which is attended with great pain and fever, and the other with little pain and no fever. See Class II. 1. 2. 19. and II. 1. 4. 5.

From hence it appears, that the sensitive fever is an accidental consequence of the topical phlegmon, or inflammation, and not a cause of it; that it is often injurious, but never salutary; and should therefore always be extinguished, as soon as may be, either by the lancet and cathartics, and diluents, and cold air, when it is of the irritated kind; or by the bark, opium, cool air, and nutrientia, when it is of the inirritated kind.

SPECIES.

1. _Ophthalmia superficialis._ As the membranes, which cover the eye, are excluded from the air about one third part of the twenty-four hours; and are moistened by perpetual nictitation during the other sixteen; they may be considered as internal membranes; and from the analogy of their inflammation to that of other internal membranes, it is arranged under this genus; whilst the tonsillitis is esteemed an inflammation of an external membrane, because currents of air are perpetually passing both day and night over the fauces.

The superficial ophthalmy has generally been esteemed a symptom of scrophula, when it recurs frequently in young persons; but is probably only a concomitant of that disease, as a symptom of general debility; ramifications of new red vessels, and of enlarged old ones, are spread over the white part of the eye; and it is attended with less heat, less pain, and less intolerance of light than the ophthalmia interna, described in Class II. 1. 2. 2. It occurs in those of feeble circulation, especially children of a scrophulous tendency, and seems to arise from a previous torpor of the vessels of the tunica albuginea from their being exposed to cold air; and from this torpor being more liable to occur in habits, which are naturally inirritable; and therefore more readily fall into quiescence by a smaller deduction of the stimulus of heat, than would affect stronger or more irritable habits; the consequence of this torpor is increased action, which produces pain in the eye, and that induces inflammation by the acquisition of the additional sensorial power of sensation.

_Ophthalmia lymphatica_ is a kind of anasarca of the tunica adnata; in this the vessels over the sclerotica, or white part of the eye, rise considerably above the cornea, which they surround, are less red than in the ophthalmia superficialis, and appear to be swelled by an accumulation of lymph rather than of blood; it is probably owing to the temporary obstruction of a branch of the lymphatic system.

M. M. If the pain be great, venesection by leeches on the temple, or cutting the temporal artery, and one purge with three or four grains of calomel should be premised. Then the Peruvian bark twice a day. Opium from a quarter to half a grain twice a day for some weeks. Bathe the eye frequently with cold water alone, or with cold water, to a pint of which is added half an ounce of salt. White vitriol six grains dissolved in one ounce of water; a drop or two to be put between the eyelids twice a day. Take very small electric sparks from the eyes every day for a fortnight. Bathe the whole head with salt and water made warm every night for some months. Send such children to a school near the sea for the convenience of sea-bathing for many months annually; such schools are to be found in or near Liverpool.

When a child is afflicted with an inflamed eye of this kind, he should always sit with his back to the window or candle; but it is generally not necessary to cover it, or if the uneasy sensation of light makes this proper, the cover should stand off from the eye, so as not much to exclude the cool air from it. As covering an eye unnecessarily is liable to make that eye weaker than the other, from its not being sufficiently used, and thence to produce a squinting for ever afterwards.

Nevertheless, when the pain is great, a poultice must be applied to keep the eyes moist, or a piece of oiled silk bound lightly over them. Or thus, boil an egg till it is hard, cut it longitudinally into two hemispheres, take out the yolk, sew the backs of the two hollow hemispheres of the white to a ribbon, and bind them over the eyes every night on going to bed; which, if nicely fitted on, will keep the eyes moist without any disagreeable pressure. See Class I. 1. 3. 14.

_Ophthalmia equina._ An inflammation of this kind is liable to affect the eyes of horses; one cause of which is owing to a silly custom of cutting the hair out of horses' ears; by which they are not only liable to take cold at the ear, but grass seeds are liable to fall into their ears from the high racks in stables; and in both cases the eye becomes inflamed by sympathy. I once directed the temporal artery of a horse to be opened, who had frequent returns of an inflamed eye; and I believed it was of essential service to him; it is probable that the artery was afterwards contracted in the wounded part, and that thence less blood was derived to the eye: the haemorrhage was stopped by two persons alternately keeping their fingers on the orifice, and afterwards by a long bandage of broad tape.

2. _Pterigion._ Eye-wing. A spot of inflammation sometimes begins on the inside of the lower eyelid, or on the tunica albuginea, and spreads an intertexture of red vessels from it, as from a center, which extend on the white part of the eye, and have the appearance of the wing of a fly, from whence its name.

M. M. Cut the ramifications of vessels again and again with the point of a lancet close to the center of inflammation.

3. _Tarsitis palpebrarum._ Inflammation of the edges of the eyelids. This is a disease of the glands, which produce the hairs of the eye-lashes, and is frequently the cause of their falling off. After this inflammation a hard scar-like ridge is left on the edge of the eyelid, which scratches and inflames the eyeball, and becomes a very troublesome disease.

The Turkish ladies are said to colour the edge of the eyelash with crude antimony in very fine powder, which not only gives lustre to the eye, as a diamond set on a black soil, but may prevent extraneous light from being reflected from these edges into the eye, and thus serve the purpose of the black feathers about the eyes of swans, described in Sect. XXXIX. 5. 1. and may also prevent the edges of the eyelids from being inflamed by the frequent stimulus of tears on them. Black lead in fine powder might be better for all these purposes than antimony, and might be put on with a camel's hair brush.

M. M. Mercurial ointment smeared at night on the edges of the eyelids. Burnt alum sixty grains, hog's grease half an ounce, well rubbed into an ointment to be smeared on them in the night. Cold water frequently in the day. See Class II. 1. 1. 8.

4. _Hordeolum._ Stye. This inflammation begins either on or near the edges of the eyelids, or in the loose skin of them, and is sometimes very slow either in coming to suppuration or in dispersing. The skin beneath the lower eyelid is the most frequent seat of this tumor, which sometimes never suppurates at all, but becomes an incysted tumor: for as this skin is very loose for the purpose of admitting great motion to the eyelid, the absorbent power of the veins seems particularly weak in this part; whence when any person is weakened by fatigue or otherwise, a darker shade of colour is seen beneath the eyes; which is owing to a less energetic action of the absorbent terminations of the veins, whence the currents of dark or venous blood are delayed in them. This dark shade beneath the eyes, when it is permanent, is a symptom of habitual debility, or inirritability of the circulating system. See Class I. 2. 2. 2.

M. M. Smear the tumors with mercurial ointment, moisten them frequently with ether. To promote their suppuration they may be wounded with a lancet, or slit down the middle, or they may be cut out. A caustic leaves a large scar.

5. _Paronychia superficialis._ Whitlow. An inflammation about the roots of the nail beneath the skin, which suppurates without fever, and sometimes destroys the nail; which is however gradually reproduced. This kind of abscess, though not itself dangerous, has given opportunity for the inoculation of venereal matter in the hands of accoucheurs, and of putrid matter from the dissection of diseased bodies; and has thus been the cause of disease and death. When putrid matter has been thus absorbed from a dead body, a livid line from the finger to the swelled gland in the axilla is said to be visible; which shews the inflammation of the absorbent vessel along its whole course to the lymphatic gland; and death has generally been the consequence.

M. M. In the common paronychia a poultice is generally sufficient. In the absorption of putrid matter rub the whole hand and arm with mercurial ointment three or four times a day, or perpetually. Could the swelled axillary gland be exsected? In the absorption of venereal matter the usual methods of cure in syphilis must be administered, as in Class II. 1. 5. 2.

6. _Gutta rosea._ The rosy drop on the face is of three kinds. First, the _gutta rosea hepatica_, or the red pimples on the faces of drunkards, which are probably a kind of crisis, or vicarious inflammation, which succeeds, or prevents, a torpor of the membranes of the liver. This and the succeeding species properly belong to Class IV. 1. 2. 14.

Secondly, the pimpled face in consequence of drinking cold water, or eating cold turnips, or other insipid food, when much heated with exercise; which probably arises from the sympathy between the skin of the face and the stomach; and may be called the _gutta rosea stomatica_. Which is distinguished from the former by the habits of the patient in respect to drinking; by the colour of the eruptions being less deep; and by the patient continuing generally to be troubled with some degree of apepsia. See Class I. 3. 1. 3. I knew a lady, who had long been afflicted with pain about the region of the stomach; and, on drinking half a pint of vinegar, as a medicine, she had a breaking out commenced on her face; which remained, and she became free from the pain about the stomach. Was this a stomachic, or an hepatic disease?

Thirdly, there is a red face, which consists of smaller pimples than those above mentioned; and which is less liable to suppurate; and which seems to be hereditary, or at least has no apparent cause like those above mentioned; which may be termed _gutta rosea hereditaria_, or puncta rosea.

Mrs. S. had a pimpled face, which I believe arose from potation of ale. She applied alum in a poultice to it, and had soon a paralytic stroke, which disabled her on one side, and terminated in her death.

Mrs. L. had a red pimpled face, which seemed to have been derived from her mother, who had probably acquired it by vinous potation; she applied a quack remedy to it, which I believe was a solution of lead, and was seized with epileptic fits, which terminated in palsy, and destroyed her. This shews the danger of using white paint on the face, which is called bismuth, but is in reality white lead or cerussa.

Mr. Y---- had acquired the gutta rosea on his nose, and applied a saturnine solution on it for a few nights, and was then seized with paralysis on one side of his face; which however he gradually recovered, and has since acquired the gutta rosea on other parts of his face.

These fatal effects were probably caused by the disagreeable sensation of an inflamed liver, which used before to be relieved of the sympathetic action and consequent inflammation of the skin of the face, which was now prevented by the stronger stimulus of the application of calx of lead. The manner in which disagreeable sensations induce epilepsy and palsy is treated of in Class III. In some cases where habitual discharges, or eruptions, or ulcers are stopped, a torpor of the system may follow, owing to the want of the accustomed quantity of sensation or irritation. See Class I. 1. 2. 9. and II. 1. 5. 6. In both these situations some other stimulus should be used to supply the place of that which is taken away; which may either be perpetual, as an issue; or periodical, as a cathartic repeated once a fortnight or month.

Miss W. an elegant young lady of about twenty, applied a mercurial lotion to her face, which was covered with very small red points; which seemed to have been not acquired by any known or avoidable means; she was seized with inflammation of her liver, and after repeated bleeding and cathartics recovered, and in a few weeks the eruption appeared as before.

M. M. Five grains of calomel once a month, with a cathartic, five grains of rhubarb and a quarter of a grain of emetic tartar every night for many weeks. With this preparation mercurial plasters, made without turpentine, and applied every night, and taken off every morning, will sometimes succeed, and may be used with safety. But blistering the face all over the eruption, beginning with a part, succeeds better than any other means, as I have more than once experienced.--Something like this is mentioned in the Letters of Lady Mary Wortley Montague, who blistered her face with balsam of Mecca.

Mrs. F. had for many years had a disagreeably looking eruption on her chin, after a cathartic with calomel, she was advised to blister her whole chin; on the healing of the blister a few eruptions again appeared, which ceased on the application of a second blister. She took rhubarb five grains, and emetic tartar a quarter of a grain every night for many weeks.

Miss L. a young lady about eighteen, had tried variety of advice for pimples over the greatest part of her face in vain. She took the above medicines internally, and blistered her face by degrees all over and became quite beautiful. A spot or two now and then appeared, and on this account she frequently slept with parts of her face covered with mercurial plaster, made without turpentine, which was held on by a pasteboard mask, and taken off in the mornings; if any part of the plaster adhered, a little butter or oil destroyed the adhesion.

7. _Odontitis._ Inflammatory tooth-ach is occasioned by inflammation of the membranes of the tooth, or a caries of the bone itself. The gum sometimes suppurates, otherwise a swelling of the cheek succeeds by association, and thus the violence of the pain in the membranes of the tooth is relieved, and frequently cured; and when this happens the disease properly belongs to Class IV. as it so far resembles the translations of morbid actions in the gout and rheumatism.

At other times the tooth dies without caries, especially in people about sixty years of age, or before; and then it stimulates its involving membrane, like any other extraneous substance. The membrane then becomes inflamed and thickened, occasioning some pain, and the tooth rises upwards above the rest, and is gradually pushed out whole and undecayed; on its rising up a pus-like mucus is seen discharged from the gum, which surrounds it; and the gum seems to have left the tooth, as the fangs or roots of it are in part naked.

M. M. Where the tooth is sound it can only be saved by evacuations by venesection, and a cathartic; and after its operation two grains of opium, a blister may also be used behind the ear, and ether applied to the cheek externally. In slighter cases two grains of opium with or without as much camphor may be held in the mouth, and suffered to dissolve near the affected tooth, and be gradually swallowed. See Class I. 2. 4. 12. Odontalgia may be distinguished from otitis by the application of cold water to the affected tooth; for as the pain of common tooth-ach is owing to torpor, whatever decreases stimulus adds to the torpor and consequent pain; whereas the pain of an inflamed tooth being ceased by the increased action of the membranes of it is in some measure alleviated by the application of cold.

8. _Otitis._ Inflammation and consequent suppuration of some membranes of the internal ear frequently occur in children, who sleep in cold rooms, or near a cold wall, without a night-cap. If the bones are affected, they come out in a long process of time, and the child remains deaf of that ear. But in this case there is generally a fever attends this inflammation; and it then belongs to another genus.

M. M. A warmer night-cap. Warmish water should be gently syringed into the ear to keep it clean twice a day; and if it does not heal in a week, a little spirit of wine should be added; first about a fourth part, and it should be gradually increased to half rectified spirit and half water: if it continues long to discharge matter with a very putrid smell, the bones are injured, and will in time find their exit, during which time the ear should be kept clean by filling it with a weaker mixture of spirit of wine and water; or a solution of alum in water; which may be poured into the ear, as the head is inclined, and shook out again by turning the head, two or three times morning and evening. See Class II. 1. 4. 10.

9. _Fistula lacrymalis._ The lacrymal sack, with its puncta lacrymalia and nasal duct, are liable to be destroyed by suppuration without fever; the tears then run over the eyelids, and inflame the edges of them, and the cheeks, by their perpetual moisture, and saline acrimony.

M. M. By a nice surgical operation a new aperture is to be made from the internal corner of the eye into the nostril, and a silver tube introduced, which supplies the defect by admitting the tears to pass again into the nostril. See Melanges de Chirurgie par M. Pouteau; who thinks he has improved this operation.

10. _Fistula in ano._ A mucous discharge from the anus, called by some white piles, or matter from a suppurated pile, has been mistaken for the matter from a concealed fistula. A bit of cotton wool applied to the fundament to receive the matter, and renewed twice a day for a week or two, should always be used before examination with the probe. The probe of an unskilful empyric sometimes does more harm in the loose cellular membrane of these parts than the original ulcer, by making a fistula he did not find. The cure of a fistula in ano of those, who have been much addicted to drinking spirituous liquor, or who have a tendency to pulmonary consumption, is frequently of dangerous consequence, and is succeeded by ulcers of the lungs, and death.

M. M. Ward's paste, or 20 black pepper-corns taken after each meal twice a day; the pepper-corns should be cut each into two or three pieces. The late Dr. Monro of Edinburgh asserted in his lectures, that he had known a fistula in ano cured by injecting first a mixture of rectified spirit of wine and water; and by gradually increasing the strength of it, till the patient could bear rectified spirit alone; by the daily use of which at length the sides of the fistula became callous, and ceased to discharge, though the cavity was left. A French surgeon has lately affirmed, that a wire of lead put in at the external opening of the ulcer, and brought through the rectum, and twisted together, will gradually wear itself through the gut, and thus effect a cure without much pain. The ends of the leaden wire must be twisted more and more as it becomes loose. Or, lastly, it must be laid open by the knife.

11. _Fistula urethrae._ Where a stricture of the urethra exists, from whatever cause, the patient, in forcing the stream of urine through the structure, distends the urethra behind it; which after a time is liable to burst, and to become perforated; and some of the urine is pushed into the cellular membrane, occasioning fistulas, which sometimes have large surfaces producing much matter, which is pressed out at the time of making water, and has been mistaken for a catarrh of the bladder; these fistulas sometimes acquire an external opening in the perinaeum, and part of the urine is discharged that way.

Can this matter be distinguished from mucus of the bladder by the criterion delivered in Class II. 1. 6. 6?

M. M. The perpetual use of bougies, either of catgut or of caoutchouc. The latter may be had at No. 37, Red-lion street, Holborn, London. The former are easily made, by moistening the catgut, and keeping it stretched till dry, and then rounding one end with a pen-knife. The use of a warm bath every day for near an hour, at the heat of 94 or 96 degrees, for two or three months, I knew to be uncommonly successful in one case; the extensive fistulas completely healing. The patient should introduce a bougie always before he makes water, and endeavour to make it as slowly as possible. See Class I. 2. 3. 24.

12. _Hepatitis chronica._ Chronical inflammation of the liver. A collection of matter in the liver has frequently been found on dissection, which was not suspected in the living subject. Though there may have been no certain signs of such a collection of matter, owing to the insensibility of the internal parts of this viscus; which has thus neither been attended with pain, nor induced any fever; yet there may be in some cases reason to suspect the existence of such an abscess; either from a sense of fulness in the right hypochondre, or from transient pains sometimes felt there, or from pain on pressure, or from lying on the left side, and sometimes from a degree of sensitive fever attending it.

Dr. Saunders suspects the acute hepatitis to exist in the inflammation of the hepatic artery, and the chronical one in that of the vena portarum. Treatise on the Liver. Robinson. London.

13. _Scrophula suppurans._ Suppurating scrophula. The indolent tumors of the lymphatic glands are liable, after a long time, to regain their sensibility; and then, owing to their former torpor, an increased action of the vessels, beyond what is natural, with inflammation, is the consequence of their new life, and suppuration succeeds. This cure of scrophula generally happens about puberty, when a new energy pervades the whole system, and unfolds the glands and organs of reproduction.

M. M. See Class I. 2. 3. 21. Where scrophulous ulcers about the neck are difficult to heal, Dr. Beddoes was informed, in Ireland, that an empyric had had some success by inflaming them by an application of wood sorrel, oxalis acetosella, the leaves of which are bruised in a mortar, and applied on the ulcers for two or three days, and then some more lenient application is used.

A poor boy, about twelve years old, had a large scrophulous ulcer on one side of the chest beneath the clavicle, and another under his jaw; he was directed, about three weeks ago, to procure a pound of dry oak-bark from the tanners, and to reduce it to fine powder, and to add to it one ounce of white lead in fine powder, and to cover the ulcers daily with it, keeping it on by brown paper and a bandage. He came to me a few minutes ago, to shew me that both the ulcers are quite healed. The constant application of linen rags, moistened with a solution of an ounce of sugar of lead in a pint of water, I think I have seen equally efficacious.