# Zoonomia/II.II.I.III

ORDO I.
Increased Sensation.
GENUS III.
With the Production of new Vessels by external Membranes or Glands with Fever.
The diseases of this genus are perhaps all productive of contagious matter; or which becomes so by its exposure to the air, either through the cuticle, or by immediate contact with it; such are the matters of the small-pox and measles. The purulent matter formed on parts covered from the air by thicker membranes or muscles, as in the preceding genus, does not induce fever, and cannot therefore be called contagious; but it acquires this property of producing fever in a few hours, after the abscess has been opened, so as to admit the air to its surface, and may then be said to consist of contagious miasmata. This kind of contagious matter only induces fever, but does not produce other matter with properties similar to its own; and in this respect it differs from the contagious miasmata of small-pox or measles, but resembles those which have their origin in crowded jails; for these produce fever only, which frequently destroys the patient; but do not produce other matters similar to themselves; as appears from none of those, who died of the jail-fever, caught at the famous black assizes at Oxford, at the beginning of this century, having infected their physicians or attendants.
If indeed the matter has continued so long as to become putrid, and thus to have given out air from a part of it, it acquires the power of producing fever; in the same manner as if the ulcer had been opened, and exposed to the common air; instances of which are not unfrequent. And from these circumstances it seems probable, that the matters secreted by the new vessels formed in all kinds of phlegmons, or pustles, are not contagious, till they have acquired something from the atmosphere, or from the gas produced by putrefaction; which will account for some phenomena in the lues venerea, cancer, and of other contagious secretions on the skin without fever, to be mentioned hereafter. See Class II. 1. 4. 14.
The theory of contagion has been perplexed by comparing it with fermenting liquors; but the contagious material is shewn in Section XXXIII. to be produced like other secreted matters by certain animal motions of the terminations of the vessels. Hence a new kind of gland is formed at the terminations of the vessels in the eruptions of the small-pox; the animal motions of which produce from the blood variolous matter; as other glands produce bile or saliva. Now if some of this matter is introduced beneath the cuticle of a healthy person, or enters the circulation, and excites the extremities of the blood-vessels into those kinds of diseased motions, by which it was itself produced, either by irritation or association, these diseased motions of the extremities of the vessels will produce other similar contagious matter. See Sect. XXXIII. 2. 5. and 9. Hence contagion seems to be propagated two ways; one, by the stimulus of contagious matter applied to the part, which by an unknown law of nature excites the stimulated vessels to produce a similar matter; as in venereal ulcers, which thus continue to spread; or as when variolous matter is inserted beneath the cuticle; or when it is supposed to be absorbed, and diffused over the body mixed with the blood, and applied in that manner to the cutaneous glands. The other way, by which contagion seems to be diffused, is by some distant parts sympathizing or imitating the motions of the part first affected; as the stomach and skin in the eruptions of the inoculated small-pox, or in the bite of a mad dog; as treated of in Sect. XXII. 3. 3.
In some of the diseases of this genus the pulse is strong, full, and hard, constituting the sensitive irritated fever, as described in the preceding genus; as in one kind of erysipelas, which requires repeated venesection. In others the arterial action is sometimes moderate, so as to constitute the sensitive fever, as in the inoculated small-pox; where the action of the arteries is neither increased by the sensorial power of irritation, as in the sensitive irritated fever; nor decreased by the defect of that power, as in the sensitive inirritated fever. But in the greatest number of the diseases of this genus the arterial action is greatly diminished in respect to strength, and consequently the frequency of pulsation is proportionally increased, as explained in Sect XXXII. 2. 1. Which is owing to the deficiency of the sensorial power of irritation joined with the increase of that of sensation, and thus constitutes the sensitive inirritated fever; as in Scarlatina with gangrenous tonsils.
From this great debility of the action of the arteries, there appears to be less of the coagulable lymph or mucus secreted on their internal surfaces; whence there is not only a defect of that buff or size upon the blood, which is seen on the surface of that, which is drawn in the sensitive irritated fever; but the blood, as it cools, when it has been drawn into a bason, scarcely coagulates; and is said to be dissolved, and is by some supposed to be in a state of actual putrefaction. See Sect. XXXIII. 1. 3. where the truth of this idea is controverted. But in the fevers of both this genus and the preceding one great heat is produced from the chemical combinations in the secretions of new vessels and fluids, and pain or uneasiness from the distention of the old ones; till towards the termination of the disease sensation ceases, as well as irritation, with the mortification of the affected parts, and the death of the patient.
Dysenteria, as well as tonsillitis and aphtha, are enumerated amongst the diseases of external membranes, because they are exposed either to the atmospheric air, which is breathed, and swallowed with our food and saliva; or they are exposed to the inflammable air; or hydrogen, which is generated in the intestines; both which contribute to produce or promote the contagious quality of these fluids; as mentioned in Class II. 1. 5.
It is not speaking accurate language, if we say, that in the diseases of this genus the fever is contagious; since it is the material produced by the external membranes, which is contagious, after it has been exposed to air; while the fever is the consequence of this contagious matter, and not the cause of it. As appears from the inoculated small-pox, in which the fever does not commence, till after suppuration has taken place in the inoculated arm, and from the diseases of the fifth genus of this order, where contagion exists without fever. See Class II. 1. 5. and II. 1. 3. 18.
SPECIES.
1. Febris sensitiva inirritata. Sensitive inirritated fever. Typhus gravior. Putrid malignant fever. Jail fever. The immediate cause of this disease is the increase of the sensorial power of sensation, joined with the decrease of the sensorial power of irritation; that is, it consists in the febris sensitiva joined with the febris inirritativa of Class I. 2. 1. 1. as the febris sensitiva irritata of the preceding genus consists of the febris sensitiva joined with the febris irritativa of Class I. 1. 1. 1. In both which the word irritata, and inirritata, are designed to express more or less irritation than the natural quantity; and the same when applied to some of the diseases of this genus.
This fever is frequently accompanied with topical inflammation, which is liable, if the arterial strength is not supported, to end in sphacelus; and as mortified parts, such as sloughs of the throat, if they adhere to living parts, soon become putrid from the warmth and moisture of their situation; these fevers have been termed putrid, and have been thought to owe their cause to what is only their consequence. In hot climates this fever is frequently induced by the exhalations of stagnating lakes or marshes, which abound with animal substances; but which in colder countries produce fevers with debility only, as the quartan ague, without inflammation.
The sensitive inirritated, or malignant, fever is also frequently produced by the putrid exhalations and stagnant air in prisons; but perhaps most frequently by contact or near approach of the persons, who have resided in them. These causes of malignant fevers contributed to produce, and to support for a while, the septic and antiseptic theory of them; see Sect. XXXIII. 1. 3. The vibices or bruises, and petechiæ or purples, were believed to be owing to the dissolved state of the blood by its incipient putrefaction; but hydrostatical experiments have been made, which shew the sizy blood of the patient in sensitive irritated or inflammatory fever, with strong pulse, is more fluid, while it is warm, than this uncoagulable blood taken in this sensitive inirritated, or malignant fever; from whence it is inferred, that these petechiæ, and vibices, are owing to the deficient power of absorption in the terminations of the veins, See Class I. 2. 1. 5.
This sensitive inirritated fever, or typhus gravior, is distinguished from the inirritative fever, or typhus mitior, in the early stages of it, by the colour of the skin; which in the latter is paler, with less heat, owing to the less violent action of the capillaries; in this it is higher coloured, and hotter, from the greater energy of the capillary action in the production of new vessels. In the more advanced state petechiæ, and the production of contagious matter from inflamed membranes, as the aphthæ of the mouth, or ulcers of the throat, distinguishes this fever from the former. Delirium, and dilated pupils of the eyes, are more frequent in nervous fevers; and stupor with deafness more frequent attendants on malignant fevers. See Class I. 2. 5. 6.
There is another criterion discernible by the touch of an experienced finger; and that is, the coat of the artery in inflammatory fevers, both those attended with strength of pulsation, and these with weak pulsation, feels harder, or more like a cord; for the coats of the arteries in these fevers are themselves inflamed, and are consequently turgid with blood, and thence are less easily compressed, though their pulsations are nevertheless weak: when the artery is large or full with an inflamed coat, it is called hard; and when small or empty with an inflamed coat, it is called sharp, by many writers.
M. M. The indications of cure consist, 1. In procuring a regurgitation of any offensive material, which may be lodged in the long mouths of the lacteals or lymphatics, or in their tumid glands. 2. To excite the system into necessary action by the repeated exhibition of nutrientia, sorbentia, and incitantia; and to preserve the due evacuation of the bowels. 3. To prevent any unnecessary expenditure of sensorial power. 4. To prevent the formation of ulcers, or to promote the absorption in them, for the purpose of healing them.
1. One ounce of wine of ipecacuanha, or about ten grains of the powder, should be given as an emetic. After a few hours three or four grains of calomel should be given in a little mucilage, or conserve. Where something swallowed into the stomach is the cause of the fever, it is liable to be arrested by the lymphatic glands, as the matter of the small-pox inoculated in the arm is liable to be stopped by the axillary lymphatic gland; in this situation it may continue a day or two, or longer, and may be regurgitated during the operation of an emetic or cathartic into the stomach or bowel, as evidently happens on the exhibition of calomel, as explained in Sect. XXIX. 7. 2. For this reason an emetic and cathartic, with venesection, if indicated by the hardness and fulness of the pulse, will very frequently remove fevers, if exhibited on the first, second, or even third day.
2. Wine and opium, in small doses repeated frequently, but so that not the least degree of intoxication follows, for in that case a greater degree of debility is produced from the expenditure of sensorial power in unnecessary motions. Many weak patients have been thus stimulated to death. See Sect. XII. 7. 8. The Peruvian bark should be given also in repeated doses in such quantity only as may strengthen digestion, not impede it. For these purposes two ounces of wine, or of ale, or cyder, should be given every six hours; and two ounces of decoction of bark, with two drachms of the tincture of bark, and six drops of tincture of opium, should be given also every six hours alternately; that is, each of them four times in twenty-four hours. As much rhubarb as may induce a daily evacuation, should be given to remove the colluvies of indigested materials from the bowels; which might otherwise increase the distress of the patient by the air it gives out in putrefaction, or by producing a diarrhœa by its acrimony; the putridity of the evacuations are in consequence of the total inability of the digestive powers; and their delay in the intestines, to the inactivity of that canal in respect to its peristaltic motions.
The quantities of wine or beer and opium, and bark, above mentioned, may be increased by degrees, if the patient seems refreshed by them; and if the pulse becomes slower on their exhibition; but this with caution, as I have seen irrecoverable mischief done by greater quantities both of opium, wine, and bark, in this kind of fever; in which their use is to strengthen the digestion of the weak patient, rather than to stop the paroxysms of fever; but when they are administered in intermittents, much larger quantities are necessary.
The stimulus of small blisters applied in succession, one every three or four days, when the patient becomes weak, is of great service by strengthening digestion, and by preventing the coldness of the extremities, owing to the sympathy of the skin with the stomach, and of one part of the skin with another.
In respect to nutriment, the patient should be supplied with wine and water, with toasted bread, and sugar or spice in it; or with sago with wine; fresh broth with turnips, cellery, parsley; fruit; new milk. Tea with cream and sugar; bread pudding, with lemon juice and sugar; chicken, fish, or whatever is grateful to the palate of the sick person, in small quantity repeated frequently; with small beer, cyder and water, or wine and water, for drink, which may be acidulated with acid of vitriol in small quantities.
3. All unnecessary motions are to be checked, or prevented. Hence horizontal posture, obscure room, silence, cool air. All the parts of the skin, which feel too hot to the hand, should be exposed to a current of cool air, or bathed with cold water, whether there are eruptions on it or not. Wash the patient twice a day with cold vinegar and water, or cold salt and water, or cold water alone, by means of a sponge. If some parts are too cold, as the extremities, while other parts are too hot, as the face or breast, cover the cold parts with flannel, and cool the hot parts by a current of cool air, or bathing them as above.
4. For the healing of ulcers, if in the mouth, solution of alum in water about 40 grains to an ounce, or of blue vitriol in water, one grain or two to an ounce may be used to touch them with three or four times a day. Of these perhaps a solution of alum is to be preferred, as it instantly takes away the stench from ulcers I suppose by combining with the volatile alcali which attends it. For this purpose a solution of alum of an ounce to a pint of water should be frequently injected by means of a syringe into the mouth. If there are ulcers on the external skin, fine powder of bark seven parts, and cerusia in fine powder one part, should be mixed, and applied dry on the sore, and kept on by lint, and a bandage.
As sloughs in the mouth are frequently produced by the previous dryness of the membranes, which line it, this dryness should be prevented by frequently moistening them, which may be effected by injection with a syringe, or by a moist sponge, or lastly in the following manner. Place a glass of wine and water, or of milk and sugar, on a table by the bedside, a little above the level of the mouth of the patient; then, having previously moistened a long piece of narrow listing, or cloth, or flannel, with the same liquor, leave one end of it in the glass, and introduce the other into the mouth of the patient; which will thus be supplied with a constant oozing of the fluid through the cloth, which acts as a capillary syphon.
The viscid phlegm, which adheres to the tongue, should be coagulated by some austere acid, as by lemon-juice evaporated to half its quantity, or by crab-juice; and then it may be scraped off by a knife, or rubbed off by flannel, or a sage leaf dipped in vinegar, or in salt and water.
2. Erysipelas, St. Anthony's fire, may be divided into three kinds, which differ in their method of cure, the irritated, the inirritated, and the sensitive erysipelas.
Erysipelas irritatum is attended with increase of irritation besides increase of sensation; that is, with strong, hard, and full pulse, which requires frequent venesection, like other inflammations with arterial strength. It is distinguished from the phlegmonic inflammations of the last genus by its situation on the external habit, and by the redness, heat, and tumour not being distinctly circumscribed; so that the eye or finger cannot exactly trace the extent of them.
When the external skin is the seat of inflammation, and produces sensitive irritated fever, no collection of matter is formed, as when a phlegmon is situated in the cellular membrane beneath the skin; but the cuticle rises as beneath a blister-plaster, and becomes ruptured; and a yellow material oozes out, and becomes inspissated, and lies upon its surface; as is seen in this kind of erysipelas, and in the confluent small-pox; or if the new vessels are reabsorbed the cuticle peels off in scales. This difference of the termination of erysipelatous and phlegmonic inflammation seems to be owing in part to the less distensibility of the cuticle than of the cellular membrane, and in part to the ready exhalation of the thinner parts of the secreted fluids through its pores.
This erysipelas is generally preceded by a fever for two or three days before the eruption, which is liable to appear in some places, as it declines in others; and seems frequently to arise from a previous scratch or injury of the skin; and is attended sometimes with inflammation of the cellular membrane beneath the skin; whence a real phlegmon and collection of matter becomes joined to the erysipelas, and either occasions or increases the irritated fever, which attends it.
There is a greater sympathy between the external skin and the meninges of the brain, than between the cellular membrane and those meninges; whence erysipelas is more liable to be preceded or attended, or succeeded, by delirium than internal phlegmons. I except the mumps, or parotitis, described below; which is properly an external gland, as its excretory duct opens into the air. When pain of the head or delirium precedes the cutaneous eruption of the face, there is some reason to believe, that the primary disease is a torpor of the meninges of the brain; and that the succeeding violent action is transferred to the skin of the face by sensitive association; and that a similar sympathy occurs between some internal membranes and the skin over them, when erysipelas appears on other parts of the body. If this circumstance should be supported by further evidence, this disease should be removed into Class IV. along with the rheumatism and gout. See Class IV. 1. 2. 17.
This supposed retropulsion of erysipelas on the brain from the frequent appearance of delirium, has prevented the free use of the lancet early in this disease to the destruction of many; as it has prevented the subduing of the general inflammation, and thus has in the end produced the particular one on the brain. Mr. B——, a delicate gentleman about sixty, had an erysipelas beginning near one ear, and extending by degrees over the whole head, with hard, full, and strong pulse; blood was taken from him four or five times in considerable quantity, with gentle cathartics, with calomel, diluents, and cool air, and he recovered without any signs of delirium, or inflammation of the meninges of the brain. Mr. W——, a strong corpulent man of inferior life, had erysipelas over his whole head, with strong hard pulse: he was not evacuated early in the disease through the timidity of his apothecary, and died delirious. Mrs. F—— had erysipelas on the face, without either strong or weak pulse; that is, with sensitive fever alone, without superabundance or deficiency of irritation; and recovered without any but natural evacuations. From these three cases of erysipelas on the head it appears, that the evacuations by the lancet must be used with courage, where the degree of inflammation requires it; but not where this degree of inflammation is small, nor in the erysipelas attended with inirritation, as described below.
M. M. Venesection repeated according to the degree of inflammation. An emetic. Calomel three grains every other night. Cool air. Diluents, emetic tartar in small doses, as a quarter of a grain every six hours. Tea, weak broth, gruel, lemonade, neutral salts. See Sect. XII. 6.
Such external applications as carry away the heat of the skin may be of service, as cold water, cold flour, snow, ether. Because these applications impede the exertions of the secerning vessels, which are now in too great action; but any applications of the stimulant kind, as solutions of lead, iron, copper, or of alum, used early in the disease, must be injurious; as they stimulate the secerning vessels, as well as the absorbent vessels, into greater action; exactly as occurs when stimulant eye-waters are used too soon in ophthalmy. See Class II. 1. 2. 2. But as the cuticle peels off in this case after the inflammation ceases, it differs from ophthalmy; and stimulant applications are not indicated at all, except where symptoms of gangrene appear. For as a new cuticle is formed under the old one, as under a blister, the serous fluid between them is a defence to the new cuticle, and should dry into a scab by exhalation rather than be reabsorbed. Hence we see how greasy or oily applications, and even how moist ones, are injurious in erysipelas; because they prevent the exhalation of the serous effusion between the old and new cuticle, and thus retard the formation of the latter.
Erysipelas inirritatum differs from the former in its being attended with weak pulse, and other symptoms of sensitive inirritated fever. The feet and legs are particularly liable to this erysipelas, which precedes or attends the sphacelus or mortification of those parts. A great and long coldness first affects the limb, and the erysipelas on the skin seems to occur in consequence of the previous torpor of the interior membranes. As this generally attends old age, it becomes more dangerous in proportion to the age, and also to the habitual intemperance of the patient in respect to the use of fermented or spirituous liquor.
When the former kind, or irritated erysipelas, continues long, the patient becomes so weakened as to be liable to all the symptoms of this inirritated erysipelas; especially where the meninges of the brain are primarily affected. As in that case, after two or three efforts have been made to remove the returning periods of torpor of the meninges to the external skin, those meninges become inflamed themselves, and the patient sinks under the disease; in a manner similar to that in old gouty patients, where the torpor of the liver or stomach is relieved by association of the inflammation of the membranes of the feet, and then of other joints, and lastly the power of association ceasing to act, but the excess of sensation continuing, the liver or stomach remains torpid, or become themselves inflamed, and the patient is destroyed.
M. M. Where there exists a beginning gangrene of the extremities, the Peruvian bark, and wine, and opium, are to be given in large quantities; so as to strengthen the patient, but not to intoxicate, or to impede his digestion of aliment, as mentioned in the first species of this genus. Class II. 1. 2. 1. But where the brain is inflamed or oppressed, which is known either by delirium, with quick pulse; or by stupor, and slow respiration with slow pulse; other means must be applied. Such as, first, a fomentation on the head with warm water, with or without aromatic herbs, or salt in it, should be continued for an hour or two at a time, and frequently repeated. A blister may also be applied on the head, and the fomentation nevertheless occasionally repeated. Internally very gentle stimulants, as camphor one grain or two in infusion of valerian. Wine and water or small beer, weak broth. An enema. Six grains of rhubarb and one of calomel. Afterwards five drops of tincture of opium, which may be repeated every six hours, if it seems of service. Might the head be bathed for a minute with cold water? or with ether? or vinegar?
Erysipelas sensitivum is a third species, differing only in the kind of fever which attends it, which is simply inflammatory, or sensitive, without either excess of irritation, as in the first variety; or the defect of irritation, as in the second variety: all these kinds of erysipelas are liable to return by periods in some people, who have passed the middle of life, as at periods of a lunation, or two lunations, or at the equinoxes. When these periods of erysipelas happen to women, they seem to supply the place of the receding catamenia; when to men, I have sometimes believed them to be associated with a torpor of the liver; as they generally occur in those who have drank vinous spirit excessively, though not approbriously; and that hence they supply the place of periodical piles, or gout, or gutta rosea.
M. M. As the fever requires no management, the disease takes its progress safely, like a moderate paroxysm of the gout; but in this case, as in some of the former, the erysipelas does not appear to be a primary disease, and should perhaps be removed to the Class of Association.
3. Tonsillitis. Inflammation of the tonsils. The uncouth term Cynanche has been used for diseases so dissimilar, that I have divided them into Tonsillitis and Parotitis; and hope to be excused for adding a Greek termination to a Latin word, as one of those languages may justly be considered as a dialect of the other. By tonsillitis the inflammation of the tonsils is principally to be understood; but as all inflammations generally spread further than the part first affected; so, when the summit of the windpipe is also much inflamed, it may be termed tonsillitis trachealis, or croup. See Class I. 1. 3. 4. and II. 1. 2. 4.; and when the summit of the gullet is much inflamed along with the tonsil, it may be called tonsillitis pharyngea, as described in Dr. Cullen's Nosologia, Genus X. p. 92. The inflammation of the tonsils may be divided into three kinds, which require different methods of cure.
Tonsillitis interna. Inflammation of the internal tonsil. When the swelling is so considerable as to produce difficulty of breathing, the size of the tonsil should be diminished by cutting it with a proper lancet, which may either give exit to the matter it contains, or may make it less by discharging a part of the blood. This kind of angina is frequently attended with irritated fever besides the sensitive one, which accompanies all inflammation, and sometimes requires venesection. An emetic should be given early in the disease, as by its inducing the retrograde action of the vessels about the fauces during the nausea it occasions, it may eliminate the very cause of the inflammation; which may have been taken up by the absorbents, and still continue in the mouths of the lymphatics or their glands. The patient should then be induced to swallow some aperient liquid, an infusion of senna, so as to induce three or four evacuations. Gargles of all kinds are rather hurtful, as the action of using them is liable to give pain to the inflamed parts; but the patients find great relief from frequently holding warm water in their mouths, and putting it out again, or by syringing warm water into the mouth, as this acts like a warm bath or fomentation to the inflamed part. Lastly, some mild stimulant, as a weak solution of salt and water, or of white vitriol and water, may be used to wash the fauces with in the decline of the disease, to expedite the absorption of the new vessels, if necessary, as recommended in ophthalmy.
Tonsillitis superficialis. Inflammation of the surface of the tonsils. As the tonsils and parts in their vicinity are covered with a membrane, which, though exposed to currents of air, is nevertheless constantly kept moist by mucus and saliva, and is liable to diseases of its surface like other mucous membranes, as well as to suppuration of the internal substance of the gland; the inflammation of its surface is succeeded by small elevated pustules with matter in them, which soon disappears, and the parts either readily heal, or ulcers covered with sloughs are left on the surface.
This disease is generally attended with only sensitive fever, and therefore is of no danger, and may be distinguished with great certainty from the dangerous inflammation or gangrene of the tonsils at the height of the small-pox, or scarlet fever, by its not being attended with other symptoms of those diseases. One emetic and a gentle cathartic is generally sufficient; and the frequent swallowing of weak broth, or gruel, both without salt in them, relieves the patient, and absolves the cure. When these tumours of the tonsils frequently return I have sometimes suspected them to originate from the absorption of putrid matter from decaying teeth. See Class I. 2. 3. 21. and II. 2. 2. 1.
Tonsillitis inirritata. Inflammation of the tonsils with sensitive inirritated fever is a symptom only of contagious fever, whether attended with scarlet eruption, or with confluent small-pox, or otherwise. The matter of contagion is generally diffused, not dissolved in the air; and as this is breathed over the mucaginous surface of the tonsils, the contagious atoms are liable to be arrested by the tonsil; which therefore becomes the nest of the future disease, like the inflamed circle round the inoculated puncture of the arm in supposititious small-pox. This swelling is liable to suffocate the patient in small-pox, and to become gangrenous in scarlet fever, and some other contagious fevers, which have been received in this manner. The existence of inflammation of the tonsil previous to the scarlet eruption, as the arm inflames in the inoculated small-pox, and suppurates before the variolous eruption, should be a criterion of the scarlet fever being taken in this manner.
M. M. All the means which strengthen the patient, as in the sensitive inirritated fever, Class II. 1. 2. 1. As it is liable to continue a whole lunation or more, great attention should be used to nourish the patient with acidulous and vinous panada, broth with vegetables boiled in it, sugar, cream, beer; all which given frequently will contribute much to moisten, clean, and heal the ulcuscles, or sloughs, of the throat; warm water and wine, or acid of lemon, should be frequently applied to the tonsils by means of a syringe, or by means of a capillary syphon, as described in Class II. 1. 3. 1. A slight solution of blue vitriol, as two grains to an ounce, or a solution of sugar of lead of about six grains to an ounce, may be of service; especially the latter, applied to the edges of the sloughs, drop by drop by means of a small glass tube, or small crow-quill with the end cut off, or by a camel's-hair pencil or sponge; to the end of either of which a drop will conveniently hang by capillary attraction; as solutions of lead evidently impede the progress of erysipelas on the exterior skin, when it is attended with feeble pulse. Yet a solution of alum injected frequently by a syringe is perhaps to be preferred, as it immediately removes the fetor of the breath, which must much injure the patient by its being perpetually received into the lungs by respiration.
4. Parotitis. Mumps, or branks, is a contagious inflammation of the parotis and maxillary glands, and has generally been classed under the word Cynanche or Angina, to which it bears no analogy. It divides itself into two kinds, which differ in the degree of fever which attends them, and in the method of cure.
Parotitis suppurans. The suppurating mumps is to be distinguished by the acuteness of the pain, and the sensitive, irritated, or inflammatory fever, which attends it.
M. M. Venesection. Cathartic with calomel three or four grains repeatedly. Cool air, diluents. This antiphlogistic treatment is to be continued no longer than is necessary to relieve the violence of the pain, as the disease is attended with contagion, and must run through a certain time, like other fevers with contagion.
Parotitis mutabilis. Mutable parotitis. A sensitive fever only, or a sensitive irritated fever, generally attends this kind. And when the tumor of the parotis and maxillary glands subsides, a new swelling occurs in some distant part of the system; as happens to the hands and feet, at the commencement of the secondary fever of the small-pox, when the tumor of the face subsides. This new swelling in the parotitis mutabilis is liable to affect the testes in men, and form a painful tumor, which should be prevented from suppuration by very cautious means, if the violence of the pain threaten such a termination; as by bathing the part with coldish water for a time, venesection, a cathartic; or by a blister on the perinæum, or scrotum, or a poultice.
When women are affected with this complaint, after the swelling of the parotis and maxillary glands subsides, a tumor with pain is liable to affect their breasts; which, however, I have never seen terminate in suppuration.
On the retrocession of the tumor of the testes above described, and I suppose of that of the breasts in women, a delirium of the calm kind is very liable to occur; which in some cases has been the first symptom which has alarmed the friends of the patient; and it has thence been difficult to discover the cause of it without much inquiry; the previous symptoms having been so slight as not to have occasioned any complaints. In this delirium, if the pulse will bear it, venesection should be used, and three or four grains of calomel, with fomentation of the head with warm water for an hour together every three or four hours.
Though this disease generally terminates favourably, considering the numbers attacked by it, when it is epidemic, yet it is dangerous at other times in every part of its progress. Sometimes the parotis or maxillary glands suppurate, producing ulcers which are difficult to cure, and frequently destroy the patient, where there was a previous scrophulous tendency. The testis in men is also liable to suppurate with great pain, long confinement, and much danger; and lastly the affection of the brain is fatal to many.
Mr. W. W. had a swelled throat, which after a few days subsided. He became delirious or stupid, in which state he was dying when I saw him; and his friends ascribed his death to a coup de soleil, which he was said to have received some months before, when he was abroad.
Mr. A. B. had a swelling of the throat, which after a few days subsided. When I saw him he had great stupor, with slow breathing, and partial delirium. On fomenting his head with warm water for an hour these symptoms of stupor were greatly lessened, and his oppressed breathing gradually ceased, and he recovered in one day.
Mr. C. D. I found walking about the house in a calm delirium without stupor; and not without much inquiry of his friends could get the previous history of the disease; which had been attended with parotitis, and swelled testis, previous to the delirium. A few ounces of blood were taken away, a gentle cathartic was directed, and his head fomented with warm water for an hour, with a small blister on the back, and he recovered in two or three days.
Mr. D. D. came down from London in the coach alone, so that no previous history could be obtained. He was walking about the house in a calm delirium, but could give no sensible answers to any thing which was proposed to him. His pulse was weak and quick. Cordials, a blister, the bark, were in vain exhibited, and he died in two or three days.
Mr. F. F. came from London in the same manner in the coach. He was mildly delirious with considerable stupor, and moderate pulse, and could give no account of himself. He continued in a kind of cataleptic stupor, so that he would remain for hours in any posture he was placed, either in his chair, or in bed; and did not attempt to speak for about a fortnight; and then gradually recovered. These two last cases are not related as being certainly owing to parotitis, but as they might probably have that origin.
The parotitis suppurans, or mumps with irritated fever, is at times epidemic among cats, and may be called parotitis felina; as I have reason to believe from the swellings under the jaws, which frequently suppurate, and are very fatal to those animals. In the village of Haywood, in Staffordshire, I remember a whole breed of Persian cats, with long white hair, was destroyed by this malady, along with almost all the common cats of the neighbourhood; and as the parotitis or mumps had not long before prevailed amongst human beings in that part of the country, I recollect being inclined to believe, that the cats received the infection from mankind; though in all other contagious diseases, except the rabies canina can be so called, no different genera of animals naturally communicate infection to each other; and I am informed, that vain efforts have been made to communicate the small-pox and measles to some quadrupeds by inoculation. A disease of the head and neck destroyed almost all the cats in Westphalia. Savage, Nosol. Class X. Art. 30. 8.
5. Catarrhus sensitivus consists of an inflammation of the membrane, which lines the nostrils and fauces. It is attended with sensitive fever alone, and is cured by the steam of warm water externally, and by diluents internally, with moderate venesection and gentle cathartics. This may be termed catarrhus sensitivus, to distinguish it from the catarrhus contagiosus, and is in common language called a violent cold in the head; it differs from the catarrhus calidus, or warm catarrh, of Class I. 1. 2. 7. in the production of new vessels, or inflammation of the membrane, and the consequent more purulent appearance of the discharge.
Raucedo catarrhalis, or catarrhal hoarseness, is a frequent symptom of this disease, and is occasioned by the pain or soreness which attends the thickened and inflamed membranes of the larynx; which prevents the muscles of vocallity from sufficiently contracting the aperture of it. It ceases with the inflammation, or may be relieved by the steam of warm water alone, or of water and vinegar, or of water and ether. See Paralytic Hoarseness, Class III. 2. 1. 4.
6. Catarrhus contagiosus. This malady attacks so many at the same time, and spreads gradually over so great an extent of country, that there can be no doubt but that it is disseminated by the atmosphere. In the year 1782 the sun was for many weeks obscured by a dry fog, and appeared red as through a common mist. The material, which thus rendered the air muddy, probably caused the epidemic catarrh, which prevailed in that year, and which began far in the north, and extended itself over all Europe. See Botanic Garden, Vol. II. note on Chunda, and Vol. I. Canto IV, line 294, note; and was supposed to have been thrown out of a volcano, which much displaced the country of Iceland.
In many instances there was reason to believe, that this disease became contagious, as well as epidemic; that is, that one person might receive it from another, as well as by the general unsalutary influence of the atmosphere. This is difficult to comprehend, but may be conceived by considering the increase of contagious matter in the small-pox. In that disease one particle of contagious matter stimulates the skin of the arm in inoculation into morbid action so as to produce a thousand particles similar to itself; the same thing occurs in catarrh, a few deleterious atoms stimulate the mucous membrane of the nostrils into morbid actions, which produce a thousand other particles similar to themselves. These contagious particles diffused in the air must have consisted of animal matter, otherwise how could an animal body by being stimulated by them produce similar particles? Could they then have had a volcanic origin, or must they not rather have been blown from putrid marshes full of animal matter? But the greatest part of the solid earth has been made from animal and vegetable recrements, which may be dispersed by volcanos.—Future discoveries must answer these questions.
As the sensitive fever attending these epidemic catarrhs is seldom either much irritated or inirritated, venesection is not always either clearly indicated or forbid; but as those who have died of these catarrhs have generally had inflamed livers, with consequent suppuration in them, venesection is adviseable, wherever the cough and fever are greater than common, so as to render the use of the lancet in the least dubious. And in some cases a second bleeding was necessary, and a mild cathartic or two with four grains of calomel; with mucilaginous subacid diluents; and warm steam occasionally to alleviate the cough, finished the cure.
The catarrhus contagiosus is a frequent disease amongst horses and dogs; it seems first to be disseminated amongst these animals by miasmata diffused in the atmosphere, because so many of them receive it at the same time; and afterwards to be communicable from one horse or dog to another by contagion, as above described. These epidemic or contagious catarrhs more frequently occur amongst dogs and horses than amongst men; which is probably owing to the greater extension and sensibility of the mucous membrane, which covers the organ of smell, and is diffused over their wide nostrils, and their large maxillary and frontal cavities. And to this circumstance may be ascribed the greater fatality of it to these animals.
In respect to horses, I suspect the fever at the beginning to be of the sensitive, irritated, or inflammatory kind, because there is so great a discharge of purulent mucus; and that therefore they will bear once bleeding early in the disease; and also one mild purgative, consisting of about half an ounce of aloe, and as much white hard soap, mixed together. They should be turned out to grass both day and night for the benefit of pure air, unless the weather be too cold (and in that case they should be kept in an open airy stable, without being tied), that they may hang down their heads to facilitate the discharge of the mucus from their nostrils. Grass should be offered them, or other fresh vegetables, as carrots and potatoes, with mashes of malt, or of oats, and with plenty of fresh warm or cold water frequently in a day. When symptoms of debility appear, which may be known by the coldness of the ears or other extremities, or when sloughs can be seen on the membrane which lines the nostrils, a drink consisting of a pint of ale with half an ounce of tincture of opium in it, given every six hours, is likely to be of great utility.
In dogs I believe the catarrh is generally joined with symptoms of debility early in the disease. These animals should be permitted to go about in the open air, and should have constant access to fresh water. The use of being as much as may be in the air is evident, because all the air which they breathe passes twice over the putrid sloughs of the mortified parts of the membrane which lines the nostrils, and the maxillary and frontal cavities; that is, both during inspiration and expiration; and must therefore be loaded with contagious particles. Fresh new milk, and fresh broth, should be given them very frequently, and they should be suffered to go amongst the grass, which they sometimes eat for the purpose of an emetic; and if possible should have access to a running stream of water. As the contagious mucus of the nostrils, both of these animals and of horses, generally drops into the water they attempt to drink. Bits of raw flesh, if the dog will eat them, are preferred to cooked meat; and from five to ten drops of tincture of opium may be given with advantage, when symptoms of debility are evident, according to the size of the dog, every six hours. If sloughs can be seen in the nostrils, they should be moistened twice a day, both in horses and dogs, with a solution of sugar of lead, or of alum, by means of a sponge fixed on a bit of whale bone, or by a syringe. The lotion may be made by dissolving half an ounce of sugar of lead in a pint of water.
Ancient philosophers seem to have believed, that the contagious miasmata in their warm climates affected horses and dogs previous to mankind. If those contagious particles were supposed to be diffused amongst the heavy inflammable air, or carbonated hydrogen, of putrid marshes, as these animals hold their heads down lower to the ground, they may be supposed to have received them sooner than men. And though men and quadrupeds might receive a disease from the same source of marsh-putrefaction, they might not afterwards be able to infect each other, though they might infect other animals of the same genus; as the new contagious matter generated in their own bodies might not be precisely similar to that received; as happened in the jail-fever at Oxford, where those who took the contagion and died, did not infect others.
On mules and dogs the infection first began, And, last, the vengeful arrows fix'd on man. Pope's Homer's Iliad, I.
7. Peripneumonia superficialis. The superficial or spurious peripneumony consists in an inflammation of the membrane, which lines the bronchia, and bears the same analogy to the true peripneumony, as the inflammations of other membranes do to that of the parenchyma, or substantial parts of the viscus, which they surround. It affects elderly people, and frequently occasions their death; and exists at the end of the true peripneumony, or along with it; when the lancet has not been used sufficiently to cure by reabsorbing the inflamed parts, or what is termed by resolution.
M. M. Diluents, mucilage, antimonials, warmish air constantly changed, venesection once, perhaps twice, if the pulse will bear it. Oily volatile draughts. Balsams? Neutral salts increase the tendency to cough. Blisters in succession about the chest. Warm bath. Mild purgatives. Very weak chicken broth without salt in it. Boiled onions. One grain of calomel every night for a week. From five drops to ten of tincture of opium at six every night, when the patient becomes weak. Digitalis? See Class II. 1. 6. 7.
8. Pertussis. Tussis convulsiva. Chin-cough resembles peripneumonia superficialis in its consisting in an inflammation of the membrane which lines the air-vessels of the lungs; but differs in the circumstance of its being contagious; and is on that account of very long duration; as the whole of the lungs are probably not infected at the same time, but the contagious inflammation continues gradually to creep on the membrane. It may in this respect be compared to the ulcers in the pulmonary consumption; but it differs in this, that in chin-cough some branches of the bronchia heal, as others become inflamed.
This complaint is not usually classed amongst febrile disorders, but a sensitive fever may generally be perceived to attend it during some part of the day, especially in weak patients. And a peripneumony very frequently supervenes, and destroys great numbers of children, except the lancet or four or six leeches be immediately and repeatedly used. When the child has permanent difficulty of breathing, which continues between the coughing fits: unless blood be taken from it, it dies in two, three, or four days of the inflammation of the lungs. During this permanent difficulty of breathing the hooping-cough abates, or quite ceases, and returns again after once or twice bleeding; which is then a good symptom, as the child now possessing the power to cough shews the difficulty of breathing to be abated. I dwell longer upon this, because many lose their lives from the difficulty there is in bleeding young children; where the apothecary is old or clumsy, or is not furnished with a very sharp and fine-pointed lancet. In this distressing situation the application of four leeches to one of the child's legs, the wounds made by which should continue to bleed an hour or two, is a succedaneum; and saves the patient, if repeated once or twice according to the difficulty of the respiration.
The chin-cough seems to resemble the gonorrhœa venerea in several circumstances. They are both received by infection, are both diseases of the mucous membrane, are both generally cured in four or six weeks without medicine. If ulcers in the cellular membrane under the mucous membrane occur, they are of a phagedenic kind, and destroy the patient in both diseases, if no medicine be administered.
Hence the cure should be similar in both these diseases; first general evacuations and diluents, then, after a week or two, I have believed the following pills of great advantage. The dose for a child of about three years old was one sixth part of a grain of calomel, one sixth part of a grain of opium, and two grains of rhubarb, to be taken twice a day.
The opium promotes absorption from the mucous membrane, and hence contributes to heal it. The mercury prevents ulcers from being formed under the mucous membrane, or cures them, as in the lues venerea; and the rhubarb is necessary to keep the bowels open.
M. M. Antimonial vomits frequently repeated. Mild cathartics. Cool air. Tincture of cantharides, or repeated blisters; afterwards opiates in small doses, and the bark. Warm bath frequently used. The steam of warm water with a little vinegar in it may be inhaled twice a day. Could the breathing of carbonic acid gas mixed with atmospheric air be of service? Copious venesection, when a difficulty of breathing continues between the fits of coughing; otherwise the cough and the expectoration cease, and the patient is destroyed. Ulcers of the lungs sometimes supervene, and the phthisis pulmonalis in a few weeks terminates in death. Where the cough continues after some weeks without much of the hooping, and a sensitive fever daily supervenes, so as to resemble hectic fever from ulcers of the lungs; change of air for a week or fortnight acts as a charm, and restores the patient beyond the hopes of the physician.
Young children should lie with their heads and shoulders raised; and should be constantly watched day and night; that when the cough occurs, they may be held up easily, so as to stand upon their feet bending a little forwards; or nicely supported in that posture which they seem to put themselves into. A bow of whalebone, about the size of the bow of a key, is very useful to extract the phlegm out of the mouths of infants at the time of their coughing; as an handkerchief, if applied at the time of their quick inspirations after long holding their breath, is dangerous, and may suffocate the patient in an instant, as I believe has sometimes happened.
9. Variola discreta. The small-pox is well divided by Sydenham into distinct and confluent. The former consists of distinct pustules, which appear on the fourth day of the fever, are circumscribed and turgid; the fever ceasing when the eruption is complete. Head-ach, pain in the loins, vomiting frequently, and convulsive fits sometimes, precede the eruption.
The distinct small-pox is attended with sensitive fever only, when very mild, as in most inoculated patients; or with sensitive irritated fever, when the disease is greater: the danger in this kind of small-pox is owing either to the tumor and soreness of the throat about the height, or eighth day of the eruption; or to the violence of the secondary fever. For, first, as the natural disease is generally taken by particles of the dust of the contagious matter dried and floating in the air, these are liable to be arrested by the mucus about the throat and tonsils in their passage to the lungs, or to the stomach, when they are previously mixed with saliva in the mouth. Hence the throat inflames like the arm in inoculated patients; and this increasing, as the disease advances, destroys the patient about the height.
Secondly, all those upon the face and head come out about the same time, namely, about one day before those on the hands, and two before those in the trunk; and thence, when the head is very full, a danger arises from the secondary fever, which is a purulent, not a variolous fever; for as the matter from all these of the face and head is reabsorbed at the same time, the patient is destroyed by the violence of this purulent fever; which in the distinct small-pox can only be abated by venesection and cathartics; but in the confluent small-pox requires cordials and opiates, as it is attended with arterial debility. See Sect. XXXV. 1. and XXXIII. 2. 10.
When the pustules on the face recede, the face swells; and when those of the hands recede, the hands swell; and the same of the feet in succession. These swellings seem to be owing to the absorption of variolous matter, which by its stimulus excites the cutaneous vessels to secrete more lymph, or serum, or mucus, exactly as happens by the stimulus of a blister. Now, as a blister sometimes produces strangury many hours after it has risen; it is plain, that a part of the cantharides is absorbed, and carried to the neck of the bladder; whether it enters the circulation, or is carried thither by retrograde movements of the urinary branch of lymphatics; and by parity of reasoning the variolous matter is absorbed, and swells the face and hands by its stimulus.
Variola confluens. The confluent small-pox consists of numerous pustules, which appear on the third day of the fever, flow together, are irregularly circumscribed, flaccid, and little elevated; the fever continuing after the eruption is complete; convulsions do not precede this kind of small-pox, and are so far to be esteemed a favourable symptom.
The confluent small-pox is attended with sensitive inirritated fever, or inflammation with arterial debility; whence the danger of this disease is owing to the general tendency to gangrene, with petechiæ, or purple spots, and hæmorrhages; besides the two sources of danger from the tumor of the throat about the height, or eleventh day of the eruption, and the purulent fever after that time; which are generally much more to be dreaded in this than in the distinct small-pox described above.
M. M. The method of treatment must vary with the degree and kind of fever. Venesection may be used in the distinct small-pox early in the disease, according to the strength or hardness of the pulse; and perhaps on the first day of the confluent small-pox, and even of the plague, before the sensorial power is exhausted by the violence of the arterial action? Cold air, and even washing or bathing in cold water, is a powerful means in perhaps all eruptive diseases attended with fever; as the quantity of eruption depends on the quantity of the fever, and the activity of the cutaneous vessels; which may be judged of by the heat produced on the skin; and which latter is immediately abated by exposure to external cold. Mercurial purges, as three grains of calomel repeated every day during the eruptive fever, so as to induce three or four stools, contribute to abate inflammation; and is believed by some to have a specific effect on the variolous, as it is supposed to have on the venereal contagion.
It has been said, that opening the pock and taking out the matter has not abated the secondary fever; but as I had conceived, that the pits, or marks left after the small-pox, were owing to the acrimony of the matter beneath the hard scabs, which not being able to exhale eroded the skin, and produced ulcers, I directed the faces of two patients in the confluent small-pox to be covered with cerate early in the disease, which was daily renewed; and I was induced to think, that they had much less of the secondary fever, and were so little marked, that one of them, who was a young lady, almost entirely preserved her beauty. Perhaps mercurial plasters, or cerates, made without turpentine in them, might have been more efficacious, in preventing the marks, and especially if applied early in the disease, even on the first day of the eruption, and renewed daily. For it appears from the experiments of Van Woensel, that calomel or sublimate corrosive, triturated with variolous matter, incapacitates it from giving the disease by inoculation. Calomel or sublimate given as an alterative for ten days before inoculation, and till the eruptive fever commences, is said with certainty to render the disease mild by the same author. Exper. on Mercury by Van Woensel, translated by Dr. Fowle, Salisbury.
Variola inoculata. The world is much indebted to the great discoverer of the good effects of inoculation, whose name is unknown; and our own country to Lady Wortley Montague for its introduction into this part of Europe. By inserting the variolous contagion into the arm, it is not received by the tonsils, as generally happens, I suppose, in the natural small-pox; whence there is no dangerous swelling of the throat, and as the pustules are generally few and distinct, there is seldom any secondary fever; whence those two sources of danger are precluded; hence when the throat in inoculated small-pox is much inflamed and swelled, there is reason to believe, that the disease had been previously taken by the tonsils in the natural way.—Which also, I suppose, has generally happened, where the confluent kind of small-pox has occurred on inoculation.
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 œdematous 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.
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.
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.
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 armeniæ. 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 fæces 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 diarrhœa. May not this disease be referred to aphtha, or to dysentery?