ORDO I.
Increased Irritation.
GENUS III.
With increased Actions of the Absorbent System.
These are not attended with so great increase of heat as in the former genus, because the fluids probably undergo less chemical change in the glands of the absorbent system; nor are the glands of the absorbent vessels so numerous or so extensive as those of the secerning ones. Yet that some heat is produced by the increased action of the absorbents appears from the greater general warmth of the skin and extremities of feeble patients after the exhibition of the peruvian bark, and other medicines of the article Sorbentia.
SPECIES.
1. Lingua arida. Dry tongue occurs in those fevers, where the expired air is warmer than natural; and happens to all those, who sleep with their mouths open; the currents of air in respiration increasing the evaporation. There is also a dryness in the mouth from the increased action of the absorbent vessels, when a sloe or a crab-apple are masticated; and after the perforation has been much increased by eating salt or spice, or after other copious secretions; as after drunkenness, cathartics, or fever fits, the mucus of the mouth becomes viscid, and in small quantity, from the increased absorption, adhering to the tongue like a white slough. In the diabætes, where the thirst is very great, this slough adheres more pertinaciously, and becomes black or brown, being coloured after a few days by our aliment or drink. The inspissated mucus on the tongue of those, who sleep with their mouths open, is sometimes reddened as if mixed with blood, and sometimes a little blood follows the expuition of it from the fauces owing to its great adhesion. When this mucus adheres long to the papillæ of the tongue, the saliva, which it contains in its interstices, like a sponge, is liable to become putrid, and to acquire a bitter taste, like other putrid animal substances; which is generally mistaken for an indication of the presence of bile.
M. M. Warm subacid liquids. See Class I. 2. 5. 8.
2. Fauces aridæ. Dry throat. The expuition of a frothy mucus with great and perpetual hawking occurs in hydrophobia, and is very distressing to the patient; which may be owing to the increased irritability or sensibility of the upper part of the œsophagus, which will not permit any fluid to rest on it.
It affects some people after intoxication, when the lungs remain slightly inflamed, and by the greater heat of the air in expiration the mucus becomes too hastily evaporated, and is expectorated with difficulty in the state of white froth.
I knew a person, who for twenty years always waked with his tongue and throat quite dry; so that he was necessitated to take a spoonful of water, as soon as he awoke; otherwise a little blood always followed the forcible expuition of the indurated mucus from his fauces. See Class II. 1. 3. 17.
M. M. Steel-springs fixed to the night-cap so as to suspend the lower jaw and keep it closed; or springs of elastic gum. Or a pot of water suspended over the bed, with a piece of list, or woollen cloth, depending from it, and held in the mouth; which will act like a syphon, and slowly supply moisture, or barley water should be frequently syringed into the mouth of the patient.
3. Nares aridi. Dry nostrils with the mucus hardening upon their internal surface, so as to cover them with a kind of skin or scale, owing to the increased action of the absorbents of this membrane; or to the too great dryness of the air, which passes into the lungs; or too great heat of it in its expiration.
When air is so dry as to lose its transparency; as when a tremulous motion of it can be seen over corn fields in a hot summer's day; or when a dry mist, or want of transparency of the air, is visible in very hot weather; the sense of smell is at the same time imperfect from the dryness of the membrane, beneath which it is spread.
4. Expectoratio solida. Solid expectoration. The mucus of the lungs becomes hardened by the increased absorption, so that it adheres and forms a kind of lining in the air-cells, and is sometimes spit up in the form of branching vessels, which are called polypi of the lungs. See Transact. of the College, London. There is a rattling or weezing of the breath, but it is not at first attended with inflammation.
The Cynanche trachealis, or Croup, of Dr. Cullen, or Angina polyposa of Michaelis, if they differ from the peripneumony of infants, seem to belong to this genus. When the difficulty of respiration is great, venesection is immediately necessary, and then an emetic, and a blister. And the child should be kept nearly upright in bed as much as may be. See Tonsillitis, Class II. 1. 3. 3.
M. M. Diluents, emetics, essence of antimony, fœtid gums, onions, warm bath for half an hour every day for a month. Inhaling the steam of water, with or without volatile alcali. Soap.
5. Constipatio alvi. Costiveness from increased action of the intestinal absorbents. The feces are hardened in lumps called scybala; which are sometimes obliged to be extracted from the rectum with a kind of marrow spoon. This is said to have happened from the patient having taken much rust of iron. The mucus is also hardened so as to line the intestines, and to come away in skins, rolled up as they pass along, so as to resemble worms, for which they are frequently mistaken; and sometimes it is evacuated in still larger pieces, so as to counterfeit the form of the intestines, and has been mistaken for a portion of them. Balls of this kind, nearly as heavy as marble, and considerably hard, from two inches to five in diameter, are frequently found in the bowels of horses. Similar balls found in goats have been called Bezoar.
M. M. Cathartics, Diluents, fruit, oil, soap, sulphur, warm bath. Sprinkling with cold water, cool clothing. See Class I. 2. 4. 18.
6. Cutis arida. Dry skin. This dry skin is not attended with coldness as in the beginning of fever-fits. Where this cutaneous absorption is great, and the secreted material upon it viscid, as on the hairy scalp, the skin becomes covered with hardened mucus; which adheres so as not to be easily removed, as the scurf on the head; but is not attended with inflammation like the Tinea, or Lepra. The moisture, which appears on the skin beneath resinous or oily plasters, or which is seen to adhere to such plasters, is owing to their preventing the exhalation of the perspirable matter, and not to their increasing the production of it, as some have idly imagined.
M. M. Warm bathing, oil externally, oil-skin gloves, resinous plasters. Wax.
7. Urina parca colorata. Diminished urine, which is high coloured, and deposits an earthy sediment, when cold, is owing to the great action of the urinary absorbents. See Class I. 1. 2. 4. In some dropsies the cutaneous absorbents are paralytic, as well as those opening into the cellular membrane; and hence, no moisture being acquired from the atmosphere, or from the cellular membrane, great thirst is excited; and great absorption from all parts, where the absorbents are still capable of action. Hence the urine is in very small quantity, and of deep colour, with copious sediment; and the kidneys are erroneously blamed for not doing their office; stimulant diuretic medicines are given in vain; and very frequently the unhappy patient is restrained from quenching his thirst, and dies a martyr to false theory.
M. M. Diluent liquids, and warm bathing, are the natural cure of this symptom; but it generally attends those dropsies, which are seldom curable; as they are owing to a paralysis both of the cutaneous and cellular lymphatics.
8. Calculus felleus. Gall-stone. From the too hasty absorption of the thinner parts of the bile, the remainder is left too viscid, and crystallizes into lumps; which, if too large to pass, obstruct the ductus choledochus, producing pain at the pit of the stomach, and jaundice. When the indurated bile is not harder than a boiled pea, it may pass through the bile-duct with difficulty by changing its form; and thus gives those pains, which have been called spasms of the stomach; and yet these viscid lumps of bile may afterwards dissolve, and not be visible among the feces.
In two instances I have seen from thirty to fifty gall-stones voided after taking an oil vomit as below. They were about the size of peas, and distinguishable when dry by their being inflammable like bad wax, when put into the flame of a candle. For other causes of jaundice, see Class I. 2. 4. 19.
M. M. Diluents, daily warm bathing. Ether mixed with yolk of egg and water. Unboiled acrid vegetables, as lettice, cabbage, mustard, and cresses. When in violent pain, four ounces of oil of olives, or of almonds, should be swallowed; and as much more in a quarter of an hour, whether it stays or not. The patient should lie on the circumference of a large barrel, first on one side, and then on the other. Electric shocks through the gall-duct. Factitious Selter's water made by dissolving one dram of Sal Soda in a pint of water; to half a pint of which made luke-warm add ten drops of marine acid; to be drank as soon as mixed, twice a day for some months. Opium must be used to quiet the pain, if the oil does not succeed, as two grains, and another grain in half an hour if necessary. See Class IV. 2. 2. 4.
9. Calculus renis. Stone of the kidney. The pain in the loins and along the course of the ureter from a stone is attended with retraction of the testicle in men, and numbness on the inside of the thigh in women. It is distinguished from the lumbago or sciatica, as these latter are seldom attended with vomiting, and have pain on the outside of the thigh, sometimes quite down to the ankle or heel. See Herpes and Nephritis.
Where the absorption of the thinner parts of the secretion takes place too hastily in the kidnies, the hardened mucus, and consequent calculous concretions, sometimes totally stop up the tubuli uriniferi; and no urine is secreted. Of this many die, who have drank much vinous spirit, and some of them recover by voiding a quantity of white mucus, like chalk and water; and others by voiding a great quantity of sand, or small calculi. This hardened mucus frequently becomes the nucleus of a stone in the bladder. The salts of the urine, called microcosmic salt, are often mistaken for gravel, but are distinguishable both by their angles of crystallization, their adhesion to the sides or bottom of the pot, and by their not being formed till the urine cools. Whereas the particles of gravel are generally without angles, and always drop to the bottom of the vessel, immediately as the water is voided.
Though the proximate cause of the formation of the calculous concretions of the kidneys, and of chalk-stones in the gout, and of the insoluble concretions of coagulable lymph, which are found on membranes, which have been inflamed in peripneumony, or rheumatism, consists in the too great action of the absorbent vessels of those parts; yet the remote cause in these cases is probably owing to the inflammation of the membranes; which at that time are believed to secrete a material more liable to coagulate or concrete, than they would otherwise produce by increased action alone without the production of new vessels, which constitutes inflammation. As defined in Class II. 1. 2.
The fluids secreted from the mucous membranes of animals are of various kinds and consistencies. Hair, silk, scales, horns, fingernails, are owing to natural processes. Gall-stones, stones found in the intestines of horses, scurf of the skin in leprosy, stones of the kidnies and bladder, the callus from the inflamed periosteum, which unites broken bones, the calcareous cement, which repairs the injured shells of snails, the calcareous crust on the eggs of birds, the annually renewed shells of crabs, are all instances of productions from mucous membranes, afterwards indurated by absorption of their thinner parts.
All these concretions contain phosphoric acid, mucus, and calcareous earth in different proportions; and are probably so far analogous in respect to their component parts as well as their mode of formation. Some calcareous earth has been discovered after putrefaction in the coagulable lymph of animals. Fordyce's Elements of Practice. A little calcareous earth was detected by Scheel or Bergman in the calculus of the bladder with much phosphoric acid, and a great quantity of phosphoric acid is shewn to exist in oyster-shells by their becoming luminous on exposing them a while to the sun's light after calcination; as in the experiments of Wilson. Botanic Garden, P. 1. Canto 1. l. 182, note. The exchange of which phosphoric acid for carbonic acid, or fixed air, converts shells into limestone, producing mountains of marble, or calcareous strata.
Now as the hard lumps of calcareous matter, termed crabs' eyes, which are found in the stomachs of those animals previous to the annual renewal of their shells, are redissolved, probably by their gastric acid, and again deposited for that purpose; may it not be concluded, that the stone of the bladder might be dissolved by the gastric juice of fish of prey, as of crabs, or pike; or of voracious young birds, as young rooks or hawks, or even of calves? Could not these experiments be tried by collecting the gastric juice by putting bits of sponge down the throats of young crows, and retracting them by a string in the manner of Spallanzani? or putting pieces of calculus down the throat of a living crow, or pike, and observing if they become digested? and lastly could not gastric juice, if it should appear to be a solvent, be injected and born in the bladder without injury by means of catheters of elastic resin, or caoutchouc?
M. M. Diluents. Cool dress. Frequent change of posture. Frequent horizontal rest in the day. Bathe the loins every morning with a sponge and cold water. Aerated alcaline water internally. Abstinence from all fermented or spirituous liquors. Whatever increases perspiration injures these patients, as it dissipates the aqueous particles, which ought to dilute the urine. When the constitution begins to produce gravel, it may I believe be certainly prevented by a total abstinence from fermented or spirituous liquors; by drinking much aqueous fluids; as toast and water, tea, milk and water, lemonade; and lastly by thin clothing, and sleeping on a hardish bed, that the patient may not lie too long on one side. See Class IV. 2. 2. 2. There is reason to believe, that the daily use of opium contributes to produce gravel in the kidnies by increasing absorption, when they are inflamed; in the same manner as is done by fermented or spirituous liquor. See Class I. 3. 2. 11.
When the kidnies are so obstructed with gravel, that no urine passes into the bladder; which is known by the external appearance of the lower part of the abdomen, which, when the bladder is full, seems as if contracted by a cord between the navel and the bladder; and by the tension on the region of the bladder distinguishable by the touch; or by the introduction of the catheter; the following methods of cure are frequently successful. Venesection to six or eight ounces, ten grains of calomel, and an infusion of senna with salts and oil, every three hours, till stools are procured. Then an emetic. After the patient has been thus evacuated, a blister on the loins should be used; and from ten to twenty electric shocks should be passed through the kidnies, as large as can be easily borne, once or twice a day. Along with this method the warm bath should be used for an hour once or twice a day. After repeated evacuations a clyster, consisting of two drams of turpentine dissolved by yolk of egg, and sixty drops of tincture of opium, should be used at night, and repeated, with cathartic medicines interposed, every night, or alternate nights. Aerated solution of alcali should be taken internally, and balsam of copaiva, three or four times a day. Some of these patients recover after having made no water for nine or ten days.
If a stone sticks in the ureter with incessant vomiting, ten grains of calomel must be given in small pills as above; and some hours afterwards infusion of senna and salts and oil, if it can be made to stay on the stomach. And after the purge has operated four or five times, an opiate is to be given, if the pain continues, consisting of two grains of opium. If this does not succeed, ten or twenty electric shocks through the kidney should be tried, and the purgative repeated, and afterwards the opiate. The patient should be frequently put into the warm bath for an hour at a time. Eighty or an hundred drops of laudanum given in a glyster, with two drams of turpentine, is to be preferred to the two grains given by the stomach as above, when the pain and vomiting are very urgent.
10. Calculus vesicæ. Stone of the bladder. The nucleus, or kernel, of these concretions is always formed in the kidney, as above described; and passing down the ureter into the bladder, is there perpetually increased by the mucus and salts secreted from the arterial system, or by the mucus of the bladder, disposed in concentric strata. The stones found in the bowels of horses are also formed on a nucleus, and consist of concentric spheres; as appears in sawing them through the middle. But as these are formed by the indurated mucus of the intestines alone without the urinary salts, it is probable a difference would be found on their analysis.
As the stones of the bladder are of various degrees of hardness, and probably differ from each other in the proportions at least of their component parts; when a patient, who labours under this afflicting disease, voids any small bits of gravel; these should be kept in warm solutions of caustic alcali, or of mild alcali well aerated; and if they dissolve in these solutions, it would afford greater hopes, that that which remains in the bladder, might be affected by these medicines taken by the stomach, or injected into the bladder.
To prevent the increase of a stone in the bladder much diluent drink should be taken; as half a pint of water warmed to about eighty degrees, three or four times a day: which will not only prevent the growth of it, by preventing any microcosmic salts from being precipitated from the urine, and by keeping the mucus suspended in it; but will also diminish the stone already formed, by softening, and washing away its surface. To this must be added cool dress, and cool bed-clothes, as directed above in the calculus renis.
When the stone is pushed against or into the neck of the bladder, great pain is produced; this may sometimes be relieved by the introduction of a bougie to push the stone back into the fundus of the bladder. Sometimes by change of posture, or by an opiate either taken into the stomach, or by a clyster.
A dram of sal soda, or of salt of tartar, dissolved in a pint of water, and well saturated with carbonic acid (fixed air), by means of Dr. Nooth's glass-apparatus, and drank every day, or twice a day, is the most efficacious internal medicine yet discovered, which can be easily taken without any general injury to the constitution. An aerated alcaline water of this kind is sold under the name of factitious Seltzer water, by J. Schweppe, at No 8, King's-street, Holborn, London; which I am told is better prepared than can be easily done in the usual glass-vessels, probably by employing a greater pressure in wooden ones.
Lythotomy is the last recourse. Will the gastric juice of animals dissolve calculi? Will fermenting vegetable juices, as sweet-wort, or sugar and water in the act of fermentation with yest, dissolve any kind of animal concretions?
11. Calculus arthriticus. Gout-stones are formed on inflamed membranes, like those of the kidnies above described, by the too hasty absorption of the thinner and saline parts of the mucus. Similar concretions have been produced in the lungs, and even in the pericardium; and it is probable, that the ossification, as it is called, of the minute arteries, which is said to attend old age, and to precede some mortifications of the extremities, may be a process of this kind.
As gout-stones lie near the surface, it is probable, that ether, frequently applied in their early state, might render them so liquid as to permit their reabsorption; which the stimulus of the ether might at the same time encourage.
12. Rheumatismus chronicus. Chronic rheumatism. After the acute rheumatism some inspissated mucus, or material similar to chalk-stones of the gout, which was secreted on the inflamed membrane, is probably left, owing to the too hasty absorption of the thinner and saline part of it; and by lying on the fascia, which covers some of the muscles, pains them, when they move and rub against it, like any extraneous material.
The pain of the shoulder, which attends inflammations of the upper membrane of the liver, and the pains of the arms, which attend asthma dolorificum, or dropsy of the pericardium, are distinguished from the chronic rheumatism, as in the latter the pain only occurs on moving the affected muscles.
M. M. Warm bath, cold bath, bandage of emplastrum de minio put on tight, so as to compress the part. Cover the part with flannel. With oiled silk. Rub it with common oil frequently. With ether. A blister. A warmer climate. Venesection. A grain of calomel and a grain of opium for ten successive nights. The Peruvian bark.
13. Cicatrix vulnerum. The scar after wounds. In the healing of ulcers the matter is first thickened by increasing the absorption in them; and then lessened, till all the matter is absorbed, which is brought by the arteries, instead of being deposed in the ulcer.
M. M. This is promoted by bandage, by the sorbentia externally, as powder of bark, white lead; solution of sugar of lead. And by the sorbentia internally after evacuations. See Sect. XXXIII. 3. 2.
In those ulcers, which are made by the contact of external fire, the violent action of the fibres, which occasions the pain, is liable to continue, after the external heat is withdrawn. This should be relieved by external cold, as of snow, salt and water recently mixed, ether, or spirits of wine suffered to evaporate on the part.
The cicatrix of an ulcer generally proceeds from the edges of it; but in large ones frequently from the middle, or commences in several places at the same time; which probably contributes to the unevenness of large scars.
14. Corneæ obfuscatio. Opacity of the cornea. There are few people, who have passed the middle of life, who have not at some time suffered some slight scratches or injuries of the cornea, which by not healing with a perfectly smooth surface, occasion some refractions of light, which may be conveniently seen in the following manner: fill a tea-saucer with cream and tea, or with milk, and holding it to your lips, as if going to drink it, the imperfections of the cornea will appear like lines or blotches on the surface of the fluid, with a less white appearance than that surface. Those blemishes of the eye are distinguished from the muscæ volitantes described in Class I. 2. 5. 3. by their being invariably seen at any time, when you look for them.
Ulcers may frequently be seen on the cornea after ophthalmy, like little pits or indentations beneath the surface of it: in this case no external application should be used, lest the scar should be left uneven; but the cure should be confined to the internal use of thirty grains of bark twice a day, and from five to ten drops of laudanum at night, with five grains of rhubarb, if necessary.
After ulcers of the cornea, which have been large, the inequalities and opacity of the cicatrix obscures the sight; in this case could not a small piece of the cornea be cut out by a kind of trephine about the size of a thick bristle, or a small crow-quill, and would it not heal with a transparent scar? This experiment is worth trying, and might be done by a piece of hollow steel wire with a sharp edge, through which might be introduced a pointed steel screw; the screw to be introduced through the opake cornea to hold it up, and press it against the cutting edge of the hollow wire or cylinder; if the scar should heal without losing its transparency, many blind people might be made to see tolerably well by this slight and not painful operation. An experiment I wish strongly to recommend to some ingenious surgeon or oculist.