1.Febris sensitiva irritata.Sensitive irritated fever, or inflammatory fever. Phlegmasia. A strong full pulse, with inflammation of the coats of the arteries, constitutes this disease. It originates from some topical inflammation, which, if the fever is not subdued, terminates in suppuration; and differs from irritative fever in respect to the painful sensation which accompanies it. For as pleasurable sensation is the cause of the growth of the new vessels, and distention of the old ones, in the natural enlargement of the body during our infancy; so a painful sensation is the cause of the unnatural production of new vessels, and enlargement of old ones in inflammatory diseases.
When matter is thus formed in any internal viscus, or in the cellular membrane, as in the lungs or liver; so long as this abscess remains without admission of air, this inflammatory fever is liable to continue, receiving only temporary relief by bleeding or emetics, or cathartics; till the patient, after a month, or two, or three, expires. But, if air be admitted to these internal abscesses, this kind of fever is changed into a hectic fever in a single day. It also sometimes happens, that when the abscess remains unopened to the air, if the matter has become putrid, that hectic fever supervenes, with colliquative sweats, or diarrhœa; the matter in both cases is sometimes absorbed, and the sides of the abscess grow together again without an external aperture. See ClassII. 1. 4. 1. and2. Another termination of inflammation is in gangrene, but this belongs to the inflammation of the external skin; as the production of purulent matter belongs to inflammation of the internal or mucous membranes. Thus when the external skin is the seat of inflammation, as in erythema, or erysipelas, and produces sensitive irritated fever, no collection of purulent matter can be formed; but a material oozes out, and lies upon the surface, like that in the confluent small-pox, and the cuticle at length peels off, or gangrene supervenes. It must be noted, that these kinds of inflammation can exist together; and some parts of the cellular membrane may suppurate at the same time that the external skin is affected with erythema, or erysipelas.
M. M. Venesection. Cathartics. Diluents. Cool air. Torpentia. Cold Bath? See Sect. XII. 6.
The increased arterial action in this sensitive irritated fever is not simply owing to the increased irritability of the arterial system, or to the stimulus of the distention of the vessels, but also to the increased acrimony or pungency of the blood; which has now so far changed its nature as to become more fluid, more dense, and to be loaded with coagulable lymph. Hence it becomes necessary not only to lessen the quantity of blood by venesection and by cathartics, but also to dilute its acrimony, or pungency, by the introduction of aqueous and mucilaginous fluids, such as barley water, cream and water, sugar and water, weak broths; to which may be added so much of some vegetable essential oil, as may render them grateful to the stomach, and thus promote their absorption, as by infusing parsley or cellery and turneps in the broth; or by balm, mint, or sage teas.
The following species of this genus only distinguish the situation of the part previously inflamed, and which is the remote cause of the sensitive irritated, or inflammatory fever, which attends it.
2.Ophthalmia interna.Inflammation of the eye is attended with the production of new vessels, which spread over the tunica adjunctiva, and over the cornea; these new vessels are easily seen, as they lie on a white ground, and give ocular demonstration of their production in inflammation. When this inflammation of the cornea suppurates, it is liable to leave little ulcers, which may be seen beneath the surface in the form of little excavations; and as these heal, they are liable to be covered with an opake scar. This scar, in some months or years, is liable to wear away, and become transparent, without the assistance of any polishing powder, as of very finely levigated glass, as some have recommended. But when the cornea is affected through all its thickness, the return of its transparency becomes hopeless. See ClassI. 1. 3. 14.
In violent degrees of ophthalmy the internal parts, as the retina, optic artery, iris, ciliary process, become inflamed, as well as the external ones; hence the least light admitted to the eye occasions intolerable pain. This curious circumstance cannot be owing to the action of light on the inflamed vessels of the cornea; it therefore shews, that the extremity of the optic nerve or retina is also rendered more exquisitely sensible to light, by partaking of the inflammation; and I have been told, that red colours are in these cases sometimes painfully perceived even in perfect darkness. This shews that the retina is excited into motion by the stimulus of light; and that, when it is inflamed, these motions give great pain, like those of other inflamed parts, as the muscles, or membranes. And secondly, that the ideas of colours consist in the motions of the retina; which ideas occasion pain, when the extremity of the moving nerve is inflamed.
M. M. Venesection. Cathartics. Diluents. Torpentia. Frequently moisten the eye with cold water by means of a rag. Cool airy room. Darkness. When the inflammation begins to decline, white vitriol gr. vi. in an ounce of water is more efficacious to moisten the eye than solutions of lead. Tincture of opium diluted. New vessels from the inflamed tunica adnata frequently spread like a fly's wing upon the transparent cornea, which is then called Pterigium. To stop the growth of this, the principal vessels should be cut through with a lancet. When the inflammation begins to decline, after due evacuation any stimulating material put into the eye increases the absorption, which soon removes the new red vessels; which has given rise to a hundred famous eye-waters, and eye-doctors; if these stimulating materials are used too soon, the inflammation is increased by them. See Sect. XXXII. 2. 10.
There is another ophthalmia, which attends weak children, and is generally esteemed a symptom of scrophula, as described in ClassII. 1. 4. 1. and another, which is of venereal origin, mentioned in ClassII. 1. 5. 2. both which may be termed ophthalmia superficialis.
3.Phrenitis.Inflammation of the brain is attended with intolerance of light and sound; which shews, that the extremities of the nerves of those senses are at the same time inflamed; it is also attended with great pain of the head, with watchfulness, and furious delirium. The violent efforts, these patients are said sometimes to exert, are owing to the increased secretion of sensorial power in the brain; as all other inflamed glands have a greater circulation of blood passing through them, and a greater secretion in consequence of their peculiar fluids, as in the hepatitis much more bile is generated.
M. M. Venesection. Cathartics. Torpentia. Foment the head with cold water for hours together. Or with warm water. Cool airy room. Afterwards cupping on the occiput. Leeches to the temples. When the patient is weakened a blister on the head, and after further exhaustion five or six drops of tincture of opium.
4.Peripneumonia.Inflammation of the lungs. The pulse is not always hard, sometimes soft; which is probably owing to a degree of sickness or inaction of the stomach; with dull pain of the chest; respiration constantly difficult, sometimes with erect posture; the face bloated and purplish; cough generally with moist expectoration, often stained with blood.
When the difficulty of respiration is very great, the patient is not able to cough; in this situation, after copious bleeding, the cough is liable to return, and is so far a favourable symptom, as it shews some abatement of the inflammation.
A peripneumony frequently occurs in the chin-cough, and destroys the patient, except immediate recourse be had to the lancet, or to four or five leeches; when blood cannot be otherwise taken.
The peripneumony is very fatal to young children, especially as I believe it is frequently mistaken for a spasmodic asthma, or for the croup, or cynanche trachealis of Cullen. Both which, however, when they occur, require immediate venesection by the lancet or by leeches, as well as the peripneumony.
The croup is an inflammation of the upper part, and the peripneumony of the lower part of the same organ, viz. the trachea or windpipe. See ClassI. 1. 3. 4. But as the inflammation is seldom I suppose confined to the upper part of the trachea only, but exists at the same time in other parts of the lungs, and as no inflammation of the tonsils is generally perceptible, the uncouth name of cynanche trachealis should be changed forperipneumonia trachialis. The method of cure consists in immediate and repeated bleeding. A vomit. A grain of calomel or other mild cathartic. Bathing in subtepid water, and in breathing over the steam of warm water, with or without a little vinegar in it. And lastly, by keeping the child raised high in bed.
Inflammation of the lungs is also liable to occur in the measles, and must be attacked by venesection at any time of the disease; otherwise either a present death, or an incurable consumption, is the consequence.
The peripneumony is frequently combined with inflammation of the pleura, and sometimes with that of the diaphragm; either of these may generally be distinguished, not only by the pain which attends inflammation of these membranes, but by inspecting the naked chest, and observing whether the patient breathes more by elevating the ribs, or by depressing the diaphragm.
A crisis happens in children about the sixth day with much pale urine, which must be waited for after evacuations have been used, as far as can be done with safety; in this situation the warm bath twice a day, and small blisters repeatedly in succession, are of peculiar service.
After the termination of peripneumony a collection of coagulable lymph is frequently left in the cavity of the chest unabsorbed; or a common anasarca of the lungs occurs from the present inaction of the absorbent vessels, which had previously been excited too violently. This difficulty of breathing is cured or relieved by the exhibition of digitalis. See Art.IV. 2. 8.
M. M. The lancet is the anchor of hope in this disease; which must be repeated four or five times, or as often as the fever and difficulty of breathing increase, which is generally in the evening; antimonials, diluents, repeated small blisters about the chest, mucilage, pediluvium, warm bath. Is a decoction of seneka-root of use? Do not neutral salts increase the tendency to cough by their stimulus, as they increase the heat of urine in gonorrhœa? Children in every kind of difficult breathing, from whatever cause, should be kept as upright in bed as may be, and continually watched; since, if they slip down, they are liable to be immediately suffocated. After the patient is greatly debilitated, so that no further evacuation can be admitted, and the difficult breathing and cough continue, I have given four or five drops of tincture of opium, that is, about a quarter of a grain of solid opium, with great advantage, and I believe in several cases I have saved the patient. A greater quantity of opium in this state of debility cannot be used without hazarding the life of the person. This small quantity of an opiate should be given about six in the evening, or before the access of the evening paroxysm, and repeated three or four nights, or longer.
There is a peripneumony with weak pulse, which may be termedperipneumonia inirritata, as described in Sect. XXVII. 2. which belongs to this place. See also Superficial Peripneumony, ClassII. 1. 3. 7.
5.Pleuritis.Pleurisy. Inflammation of the pleura, with hard pulse, pain chiefly of the side, pungent, particularly increased during inspiration; lying on either side uneasy, the cough very painful, dry at the beginning, afterwards moist, often bloody.
One cause of pleurisy is probably a previous adhesion of the lungs to a part of the pleura, which envelops them. This in many cases has been produced in infancy, by suffering children to lie too long on one side. Or by placing them uniformly on one side of a fire, or window, to which they will be liable always to bend themselves.
When matter is produced during peripneumony or pleurisy in one side of the chest, so long as it is a concealed vomica, the fever continues, if the disease be great, for many weeks, and even months; and requires occasional venesection, till the patient sinks under the inflammatory or sensitive irritated fever. But if air be admitted, by a part of the abscess opening itself a way into the air-vessels of the lungs, a hectic fever, with colliquitive sweats or diarrhœa, supervenes, and frequently destroys the patient; or the abscess heals the lungs adhering to the pleura.
M. M. The lancet must be used copiously, and repeated as often as the pain and difficult respiration increase. A blister on the pained part. Antimonial preparations. Diluents. Cool air. Do neutral salts increase the tendency to cough? Pediluvium or semicupium frequently repeated.
6.Diaphragmitis.Inflammation of the diaphragm. Pain round the lower ribs as if girt with a cord. Difficult respiration performed only by elevating the ribs and in an erect posture. The corners of the mouth frequently retracted into a disagreeable smile, called risus Sardonicus.
Those animals, which are furnished with clavicles, or collar-bones, not only use their foremost feet as hands, as men, monkies, cats, mice, squirrels, &c. but elevate their ribs in respiration as well as depress the diaphragm for the purpose of enlarging the cavity of the chest. Hence an inflammation of the diaphragm is sudden death to those animals, as horses and dogs, which can only breaths by depressing the diaphragm; and is I suppose the cause of the sudden death of horses that are over-worked; whereas, in the human animal, when the diaphragm is inflamed, so as to render its motions impossible from the pain they occasion, respiration can be carried on, though in a less perfect manner, by the intercostal muscles in the elevation of the ribs. In pleurisy the ribs are kept motionless, and the respiration is performed by the diaphragm, as may be readily seen on inspecting the naked chest, and which is generally a bad symptom; in the diaphragmitis the ribs are alternately elevated, and depressed, but the lower part of the belly is not seen to move.
M. M. As in pleurisy and peripneumony. When the patient becomes delirious, and smiles disagreeably by intervals, and is become so weak, that evacuations by the lancet could be used no further, and I have almost despaired of my patient, I have found in two or three instances, that about five or six drops of tinct. thebaic, given an hour before the evening exacerbation, has had the happiest effect, and cured the patient in this case, as well as in common peripneumony; it must be repeated two or three evenings, see ClassII. 1. 2. 4. as the exacerbation of the fever and difficult respiration and delirium generally increase towards night.
The stimulus of this small quantity of opium on a patient previously so much debilitated, acts by increasing the exertion of the absorbent vessels, in the same manner as a solution of opium, or any other stimulant, put on an inflamed eye after the vessels are previously emptied by evacuations, stimulates the absorbent system, so as to cause the remaining new vessels to be immediately reabsorbed. Which same stimulants would have increased the inflammation, if they had been applied before the evacuations. See ClassII. 1. 2. 2. Sect. XXXIII. 3. 1. When the sanguiferous system is full of blood, the absorbents cannot act so powerfully, as the progress of their contents is opposed by the previous fulness of the blood-vessels; whence stimulants in that case increase the action of the secerning system more than of the absorbent one; but after copious evacuation this resistance to the progress of the absorbed fluids is removed; and when stimulants are then applied, they increase the action of the absorbent system more than that of the secerning one. Hence opium given in the commencement of inflammatory diseases destroys the patient; and cures them, if given in very small doses at the end of inflammatory diseases.
7.Carditis.Inflammation of the heart is attended with unequal intermitting pulse, palpitation, pain in the middle of the sternum, and constant vomiting. It cannot certainly be distinguished from peripneumony, and is perhaps always combined with it.
8.Peritonitis.Inflammation of the peritonæum is known by pain all over the abdomen, which is increased on erecting the body. It has probably most frequently a rheumatic origin. See ClassII. 1. 2. 17.
9.Mesenteritis.Inflammation of the mesentery is attended with pains like colic, and with curdled or chyle-like stools. It is a very frequent and dangerous disease, as the production of matter more readily takes place in it than in any other viscus. The consequence of which, after a hard labour, is probably the puerperal fever, and in scrophulous habits a fatal purulent fever, or hopeless consumption.
M. M. Venesection. Warm bath. Emollient clysters.
10.Gastritis.In inflammation of the stomach the pulse is generally soft, probably occasioned by the sickness which attends it. The pain and heat of the stomach is increased by whatever is swallowed, with immediate rejection of it. Hiccough.
This disease may be occasioned by acrid or indigestible matters taken into the stomach, which may chemically or mechanically injure its interior coat. There is however a slighter species of inflammation of this viscus, and perhaps of all others, which is unattended by much fever; and which is sometimes induced by drinking cold water, or eating cold insipid food, as raw turnips, when the person has been much heated and fatigued by exercise. For when the sensorial power has been diminished by great exertion, and the stomach has become less irritable by having been previously stimulated by much heat, it sooner becomes quiescent by the application of cold. In consequence of this slight inflammation of the stomach an eruption of the face frequently ensues by the sensitive association of this viscus with the skin, which is called a surfeit. See ClassIV. 1. 2. 13. andII. 1. 4. 6. andII. 1. 3. 19.
M. M. Venesection. Warm bath. Blister. Anodyne clysters. Almond soap. See ClassII. 1. 3. 17.
11.Enteritis.Inflammation of the bowels is often attended with soft pulse, probably owing to the concomitant sickness; which prevents sometimes the early use of the lancet, to the destruction of the patient. At other times it is attended with strong and full pulse like other inflammations of internal membranes. Can the seat of the disease being higher or lower in the intestinal canal, that is, above or below the valve of the colon, produce this difference of pulse by the greater sympathy of one part of the bowels with the stomach than another? In enteritis with strong pulse the pain is great about the navel, with vomiting, and the greatest difficulty in procuring a stool. In the other, the pain and fever is less, without vomiting, and with diarrhœa. Whence it appears, that the enteritis with hard quick pulse differs from Ileus, described in ClassI. 3. 1. 6. only in the existence of fever in the former and not the latter, the other symptoms generally corresponding; and, secondly, that the enteritis with softer quick pulse, differs from the cholera described in ClassI. 3. 1. 5. only in the existence of fever in the former, and not the latter, the other symptoms being in general similar. See ClassII. 1. 3. 20.
Inflammation of the bowels sometimes is owing to extraneous indigestible substances, as plum-stones, especially of the damasin, which has sharp ends. Sometimes to an introsusception of one part of the intestine into another, and very frequently to a strangulated hernia or rupture. In respect to the first, I knew an instance where a damasin stone, after a long period of time, found its way out of the body near the groin. I knew another child, who vomited some damasin stones, which had lain for near twenty hours, and given great pain about the navel, by the exhibition of an emetic given in repeated doses for about an hour. The swallowing of plum-stones in large quantities, and even of cherry-stones, is annually fatal to many children. In respect to the introsusception and hernia, see Ileus, ClassI. 3. 1. 6.
M. M. Repeated venesection. Calomel from ten to twenty grains given in small pills as in Ileus; these means used early in the disease generally succeed. After these evacuations a blister contributes to stop the vomiting. Warm bath. Crude mercury. Aloes one grain-pill every hour will frequently stay in the stomach. Glauber's salt dissolved in pepper-mint water given by repeated spoonfuls.
When the patient is much reduced, opium in very small doses may be given, as a quarter of a grain, as recommended in pleurisy. If the pain suddenly ceases, and the patient continues to vomit up whatever is given him, it is generally fatal; as it indicates, that a mortification of the bowel is already formed. Some authors have advised to join cathartic medicines with an opiate in inflammation of the bowels, as recommended in colica saturnina. This may succeed in slighter cases, but is a dangerous practice in general; since, if the obstruction be not removed by the evacuation, the stimulus of the opium is liable to increase the action of the vessels, and produce mortification of the bowel, as I think I have seen more than once.
12.Hepatitis.Inflammation of the liver is attended with strong quick pulse; tension and pain of the right side; often pungent as in pleurisy, oftner dull. A pain is said to affect the clavicle, and top of the right shoulder; with difficulty in lying on the left side; difficult respiration; dry cough; vomiting; hiccough.
There is another hepatitis mentioned by authors, in which the fever, and other symptoms, are wanting, or are less violent; as described in ClassII. 1. 4. 12. and which is probably sometimes relieved by eruptions of the face; as in those who are habituated to the intemperate use of fermented liquors.
M. M. Hepatic inflammation is very liable to terminate in suppuration, and the patient is destroyed by the continuance of a fever with sizy blood, but without night-sweats, or diarrhœa, as in other unopened abscesses. Whence copious and repeated venesection is required early in the disease, with repeated doses of calomel, and cathartics. Warm bath. Towards the end of the disease small doses of opium before the evening paroxysms, and lastly the Peruvian bark, and chalybeate wine, at first in small doses, as 20 drops twice a day, and afterwards, if necessary, in larger. See Art.IV. 2. 6.
Mrs. C. a lady in the last month of her pregnancy, was seized with violent hepatitis, with symptoms both of peripneumony and of pleurisy, for it seldom happens in violent inflammations, that one viscus alone is affected; she wanted then about a fortnight of her delivery, and after frequent venesection, with gentle cathartics, with fomentation or warm bath, she recovered and was safely delivered, and both herself and child did well. Rheumatic and eruptive fevers are more liable to induce abortion.
13.Splenitis.Inflammation of the spleen commences with tension, heat, and tumour of the left side, and with pain, which is increased by pressure. A case is described in ClassI. 2. 3. 18. where a tumid spleen, attended with fever, terminated in schirrus of that viscus.
14.Nephritis.Inflammation of the kidney seems to be of two kinds; each of them attended with different symptoms, and different modes of termination. One of them I suppose to be an inflammation of the external membrane of the kidney, arising from general causes of inflammation, and accompanied with pain in the loins without vomiting; and the other to consist in an inflammation of the interior parts of the kidney, occasioned by the stimulus of gravel in the pelvis of it, which is attended with perpetual vomiting, with pain along the course of the ureter, and retraction of the testis on that side, or numbness of the thigh.
The former of these kinds of nephritis is distinguished from lumbago by its situation being more exactly on the region of the kidney, and by its not being extended beyond that part; after three or four days I believe this inflammation is liable to change place; and that a herpes or erysipelas, called zona, or shingles, breaks out about the loins in its stead; at other times it is cured by a cathartic with calomel, with or without previous venesection.
The other kind of nephritis, or inflammation of the interior part of the kidney, generally arises from the pain occasioned by the stimulus of a stone entering the ureter from the pelvis of the kidney; and, which ceases when the stone is protruded forwards into the bladder; or when it is returned into the pelvis of the kidney by the retrograde action of the ureter. The kidney is nevertheless inflamed more frequently, though in a less degree, from other causes; especially from the intemperate ingurgitation of ale, or other fermented or spirituous liquors. This less degree of inflammation is the cause of gravel, as that before mentioned is the effect of it. The mucus secreted to lubricate the internal surface of the uriniferous tubes of the kidney becomes secreted in greater quantity, when these vessels are inflamed; and, as the correspondent absorbent vessels act more energetically at the same time, the absorption of its more fluid parts is more powerfully effected; on both these accounts the mucus becomes both changed in quality and more indurated. And in this manner stones are produced on almost every mucous membrane of the body; as in the lungs, bowels, and even in the pericordium, as some writers have affirmed. See ClassI. 1. 3. 9.
M. M. Venesection. Ten grains of calomel given in small pills, then infusion of sena with oil. Warm bath. Then opium a grain and half. See ClassI. 1. 3. 9. for a further account of the method of cure.
15.Cystitis.Inflammation of the bladder is attended with tumor and pain of the lower part of the belly; with difficult and painful micturition; and tenesmus. It generally is produced by the existence of a large stone in the bladder, when in a great degree; or is produced by common causes, when in a slighter degree.
The stone in the bladder is generally formed in the kidney, and passing down the ureter into the bladder becomes there gradually increased in size; and this most frequently by the apposition of concentric spheres, as may be seen by sawing some of the harder calculi through the middle, and polishing one surface. These new concretions superinduced on the nucleus, which descended from the kidney, as described in ClassI. 1. 3. 9. and in the preceding article of this genus, is not owing to the microcosmic salt, which is often seen to adhere to the sides of chamber-pots, as this is soluble in warm water, but to the mucus of the bladder, as it rolls along the internal surface of it. Now when the bladder is slightly inflamed, this mucus of its internal surface is secreted in greater quantity, and is more indurated by the absorption of its more liquid part at the instant of secretion, as explained in ClassI. 1. 3. 9. andII. 1. 2. 14. and thus the stimulus and pain of a stone in the bladder contributes to its enlargement by inflaming the interior coat of it.
M. M. Venesection. Warm bath. Diluents. Anodyne clysters. See ClassI. 1. 3. 9.
16.Hysteritis.Inflammation of the womb is accompanied with heat, tension, tumor, and pain of the lower belly. The os uteri painful to the touch. Vomiting. This disease is generally produced by improper management in the delivery of pregnant women. I knew an unfortunate case, where the placenta was left till the next day; and then an unskilful accoucheur introduced his hand, and forcibly tore it away; the consequence was a most violent inflammatory fever, with hard throbbing pulse, great pain, very sizy blood, and the death of the patient. Some accoucheurs have had a practice of introducing their hand into the uterus immediately after the birth of the child, to take away the placenta; which they said was to save time. Many women I believe have been victims to this unnatural practice.
Others have received injury, where inflammation has been beginning, by the universal practice of giving a large dose of opium immediately on delivery, without any indication of its propriety; which, though a proper and useful medicine, where the patient is too feeble, when given in a small dose, as 10 drops of tincture of opium, or half a grain of solid opium, must do a proportionate injury, when it is given improperly; and as delivery is a natural process, it is certainly more wise to give no medicines, except there be some morbid symptom, which requires it; and which has only been introduced into custom by the ill-employed activity of the Priests or Priestesses ofLucina; like the concomitant nonsense of cramming rue or rheubarb into the mouth of the unfortunate young stranger, who is thus soon made to experience the evils of life. See ClassII. 1. 1. 12. andI. 1. 2. 5. Just so some over-wise beldames force young ducks and turkeys, as soon as they are hatched, to swallow a peppercorn.
M. M. Venesection repeatedly; diluents; fomentation; the patient should be frequently raised up in bed for a short time, to give opportunity of discharge to the putrid lochia; mucilaginous clysters. See Febris Puerpera.
17.Lumbago sensitiva.Sensitive lumbago. When the extensive membranes, or ligaments, which cover the muscles of the back are torpid, as in the cold paroxysm of ague, they are attended with pain in consequence of the inaction of the vessels, which compose them. When this inaction continues without a consequent renewal or increase of activity, the disease becomes chronical, and forms the lumbago frigida, or irritativa, described in ClassI. 2. 4. 16. But when this cold fit or torpor of these membranes, or ligaments or muscles of the back, is succeeded by a hot fit, and consequent inflammation, a violent inflammatory fever, with great pain, occurs, preventing the erect posture of the body; and the affected part is liable to suppurate, in which case a very dangerous ulcer is formed, and a part of one of the vertebrae is generally found carious, and the patient sinks after a long time under the hectic fever occasioned by the aerated or oxygenated matter.
This disease bears no greater analogy to rheumatism than the inflammation of the pleura, or any other membranous inflammation; and has therefore unjustly been arranged under that name. It is distinguished from nephritis, as it is seldom attended with vomiting, I suppose never, except the ureter happens to be inflamed at the same time.
The pain sometimes extends on the outside of the thigh from the hip to the ankle, heel, or toes, and is then called sciatica; and has been thought to consist in an inflammation of the theca, or covering of the sciatic nerve, as the pain sometimes so exactly attends the principal branches of that nerve. See ClassI. 2. 4. 15.16.
M. M. Venesection repeatedly; calomel; gentle cathartics; diluents; warm bath; poultice on the back, consisting of camomile flowers, turpentine, soap, and opium; a burgundy-pitch plaster. A debility of the inferior limbs from the torpor of the muscles, which had previously been too much excited, frequently occurs at the end of this disease; in this case electricity, and issues on each side of the lumber vertebræ, are recommended. See ClassI. 2. 4. 16.
18.Ischias.The ischias consists of inflammatory fever, with great pain about the pelvis, the os coccigis, and the heads of the thigh-bones, preventing the patient from walking or standing erect, with increase of pain on going to stool. This malady, as well as the preceding, has been ascribed to rheumatism; with which it seems to bear no greater analogy, than the inflammations of any other membranes.
The patients are left feeble, and sometimes lame after this disease; which is also sometimes accompanied with great flow of urine, owing to the defective absorption of its aqueous parts; and with consequent thirst occasioned by the want of so much fluid being returned into the circulation; a lodgment of fæces in the rectum sometimes occurs after this complaint from the lessened sensibility of it. See ClassI. 2. 4. 15.
M. M. Venesection; gentle cathartics; diluents; fomentation; poultice with camomile flowers, turpentine, soap, and opium; afterwards the bark. See ClassI. 1. 3. 5.
When this inflammation terminates in suppuration the matter generally can be felt to fluctuate in the groin, or near the top of the thigh. In this circumstance, my friend Mr. Bent, Surgeon near Newcastle in Staffordshire, proposes to tap the abscess by means of a trocar, and thus as often as necessary to discharge the matter without admitting the air. Might a weak injection of wine and water, as in the hydrocele, be used with great caution to inflame the walls of the abscess, and cause them to unite? See ClassII. 1. 6. 9.
19.Paronychia interna.Inflammation beneath the finger-nail. The pain occasioned by the inflammatory action and tumor of parts bound down between the nail on one side and the bone on the other, neither of which will yield, is said to occasion so much pain as to produce immediate delirium, and even death, except the parts are divided by a deep incision; which must pass quite through the periosteum, as the inflammation is said generally to exist beneath it. This disease is thus resembled by the process of toothing in young children; where an extraneous body lodged beneath the periosteum induces pain and fever, and sometimes delirium, and requires to be set at liberty, by the lancet.
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 ClassII. 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 ClassII. 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 ClassII. 1. 5. andII. 1. 3. 18.
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 ClassI. 2. 1. 1. as the febris sensitiva irritata of the preceding genus consists of the febris sensitiva joined with the febris irritativa of ClassI. 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 ClassI. 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 ClassI. 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 irritatumis 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 ClassIV. 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 ClassII. 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 inirritatumdiffers 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. ClassII. 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 sensitivumis 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 ClassI. 1. 3. 4. andII. 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 ClassI. 2. 3. 21. andII. 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, ClassII. 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 ClassII. 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.