• f
*'
as
Digitized by the Internet Archive
in 2012 with funding from
LYRASIS Members and Sloan Foundation
http://archive.org/details/workslatewilliOOstar
THE
WORKS
OF THE LATE
w
ILLUM STARK, M. D.
ST/\
t
T I-I E
WORKS
OF THE LATE
W I L L I A M STARK, M. D.
CONSISTING OF
CLINICAL and ANATOMICAL OBSERVATIONS,
WITH
EXPERIMENTS,
DIETETICAL and STATICAL, REVISED and PUBLISHED from his ORIG.INAL MSS.
B Y
JAMES CARMICHAEL SMYTH, M. D. F.R.S.
PHYSICIAN EXTRAORDINARY to his MAJESTY.
LONDON:
Printed for J. JOHNSON, No. 72, St. Paul'* Church-Yard.
M.DCC, LXXXVI I I,
! Q 7 a
CrA-^oxA—
i j I lllill^.l |,ljii*wfi1il*lW^ffM*' ""** I " I "■
T 0>
The Hon. THOMAS FITZMiUJR I CE,
S I R,
A S mankind are commonly defirous of know- ing the perfons to whom they are indebted, it is proper for me to inform them, that if any ufeful knowledge is contained in the following pages, they owe it chiefly to you. You diflinguiihed,, at an early period of life, the talents and abilities of the Author ; you honoured him with your friendship, encouraged him by your protection, and your regard for his memory has preferved his works from oblivion, which, otherwife, would have perifhed with himfelf. You at firfr. committed them to the care of a Gentleman* very capable to have done them juftice, had not bad health and a variety of avocations, prevented him. For myfelf, I can only fay, that I have executed, widi all the zeal and ardour of friendship, a talk which I formerly undertook at the requefr. of the Author, and to the performance of which I felt myfelf urged by thole fentiments which are fo happily expreffed in the energetic
and
( iv )
and manly language of the firft of hiitorians. " Non hoc prascipuam " amicorum munus eft, profequi defunclurn ignavb queftu ; fed qua? " voluerit meminifTe; quae mandaverit exfequi*."
Permit me, Sir, to acknowledge Kkewife, the pleafure which this oecafion affords me, of publickly declaring the great regard and citeem, with which I have the honour to be,
S I R,
Your moft obedient,
And moft humble fervant,
JAMES CARMICHAEL SMYTH.
# Tacit. Annal. lib. ii? cap. Ixxi.
The
PREFACE by the EDITOR.
ALTHOUGH the importance and fcarcity of original Obfervations in Phyfic are well known, yet I am ready to confefs, that neither the merits or originality of the prefent work, nor even my knowledge of the accuracy and candour of the Author, would have been fufficient inducements with me to become the Editor, had I not felt a ftrong defire to comply with the requifition of a friend, now no more, and a wifh to preferve to his memory, the fame he fo juftly deferves, and which he fo dearly earned. It is evident that I was influenced by no pecuniary motive, as any emolument arifing from the fale of the book is deftined to his family; and I could expect but little re- putation from publishing the works of another, compared with the time and trouble which I mull neceffarily devote to it.
As Editor, my chief object has been perfpicuity ; and to effect this, I have taken conflderable liberties both with the arrangement and language of the Author ; adhering, however, with the moil fcru- pulous exactnefs, to facts, and, wherever I could, retaining his own language, which, though fometimes obfcure, is commonly expreilive and manly. I am extremely fenfible that this mixture
of
VIII
PREFACE by the EDITOR;
of compofition mutt affect the unity and fmoothnefs of the flile, but, in works of fcience, it is clearnefs and precifion, more than elegance, that is wanted.
The different parts into which the Clinical and Anatomical Obfervations are diftributed, though equally correct, are by no means equally complete, or equally ufefui. It was, at firft, my intention, to have endeavoured to fupply what appeared to me de» fective, and to have fubjoined a comment to each part, in the manner I formerly did to the one published in the Medical Com- munications, but I foon found that I had neither time or leifure atpreient, for fuch an undertaking. I mall therefore only obferve in general, that from the Clinical and Anatomical Obfervations of our Author, the young may receive much ufefui information, and that even the more experienced may find fomething to iearn.
His Experiments on Diet are the firft, and will probably long remain the only Experiments of the kind. It will pofiibly be objected to them, that they arc not fuiiiciently numerous or va- ried to admit of any conclufions, bat I would advife thole who may ftart fuch objections, to reflect, that all inductions from experi- ence, are, at bell:, only greater or lefs de0rees of probability, and that if one Experiment did not afford fome probability, twenty Experiments could not eftablifh any. Eut Dr. Stark's Experi- ments will be looked upon by all true lovers of fcience, in a much higher point of view. They wili be confidered as the corner-flone or a great building, to be finished at fome after-pe- riod of time, when men fhall be found of equal fortitude, per-
feverance
PREFACE by the EDITOR. ix
Severance and felf-denial with our Author, actuated by a fimilar zeal for the promoting of ufeful knowledge.
Having faid thus much of the Work, it may be expected that I mould fay fomething of the Author himfelf. This I do with a fingular pleafure, as it is tracing back in my remembrance, the image of a friend I efleemed and valued, and to whom I am cer- tain it would have afforded a fingular fatisfaction, had he known that I would have been the publimer of his works, and the hif- torian of his life.
Dr. Stark's father, as I have been told, was a native of Ireland, his mother of Scotland, he himfelf was born at Birmingham. This might be confidered as a whimfical anecdote only, and fcarcely defer ving notice, did we not every day fee the characters and conduct of men influenced by fuch trifling and accidental circumftances, and therefore it may not be unreafonable to fuppofe, that even this had fome effect in expanding the natural liberality of his mind, and freeing it from all thofe little local and con- fined prejudices, which too often difgrace characters otherwife refpectable. But, wherever his cradle was rocked, he was educated at Glafgow, and there, under Drs. Adam Smith, Black, Reid, &c. he firft learnt the rudiments of philofophy, and acquired that mathematical accuracy, that logical precifion, and fceptic doubt, which diflinguifhed his future life.
From Glafgow he repaired to Edinburgh, where he was foon diflinguifhed, and honoured with the friendship of Dr. Culleij, who is not more eminently confpicuous for the fuperiority of his
b own
x PREFACE by tme EDITOR.
own genius, than quick-fighted in difHngui firing,, and liberal in- encouraging it in others.
Having finifhed his fludies at Edinburgh, he came to London in the year 1765, and now devoted himfelf entirely to the ftudy of phyfic -, and, looking upon anatomy as one of the principal pillars of the art, he endeavoured to complete with Dr. Hunter, what he had begun with Dr. Monro, and acquired, under this eminent profeffor, that perfect anatomical knowledge, which appears in all his difTections. He likewife entered himfelf a pupil at St. George's Hofpital -, and, difgufted, as he has often told me, with the inaccuracy or want of candour, of the generality of practical writers, he determined to obtain an acquaintance with difeafes at a better fchool* and under mi abler mailer j and to have, from his own experience, a ftandard, by which he might judge of the experience of others- With what induffry he profecuted this plan, and with what fuccefs his labours were crowned, we may, form fome judgment from the fpecimen now offered to the Public.
Whilfl attending the hofpital, he was alfo employed in making experiments on the blood, and other animal fluids; and like wife in a courfe of experiments on chemical pharmacy, which are frill extant, and give the ilrongefr evidence of his accuracy and dili- gence ; but whether they are of importance enough to be prefented to the public, I have not yet had leifure to afcertain.
In the year 1767, he graduated at Leyden, and published an; Inaugural DhTerta'tion on the Dyfentery. On his return to London he recommenced his ftudies at the hofpital -, and, in June, 1769, began
fail
PREFACE by the EDITOR. si
his Experiments on Diet, to which undertaking he was greatly encou- raged by Sir John Pringle and Dr. Franklin, whofe friendfhip he then enjoyed, and from whom he received many hints, both as to the plan, and, afterwards, in the execution of his defign. Thefe Experiments, or rather the imprudent zeal with which he profecuted them, proved in the end fatal to himfelf; at leaf!, fuch was the general opinion of his friends at the time, but, in my mind,* and I fpeak from an intimate knowledge of his character, other caufes, pa; ticularly chagrin and difappointment, had no fmall mare in bringing about this event. Dr. Stark was much more converfant with books than with men; poffeffing great flrmnefs and dignity of mi xl himfelf, with uncommon fimplicity of manners, he was ill prepared for the cold prudence, the time-ferving meannefs, or the bafe duplicity which he met with in others. He had not yet learned in the great fchool of the world, a leiTon which all young and ingenuous minds receive at firft with indignation, viz. that genius or talents avail nothing, when oppofed to intereft or to faction. Nor had he yet made the obfervation of Figaro, equally applicable to all ages and to ail countries,
Que, le iavoir fafre, vaut mieux que le favoir.
But if Dr- Siark may by fome be reckoned unfortunate, in having been cut off at an early period of life, and before he had ob- tained that eminence and diitinction to which his talents and application entitled him, he was peculiarly fortunate in what is infinitely more valuable. If his life was fhort, it had, at leail, been fpent in the molt agreeable, as well as mod ufeful of all purfuits, the purfuit of knowledge. If he did not accumulate wealth, he preferved his independence. If he did not obtain the vain praife of
b 2 the
Xll
PREFACE by the EDITOR.
the world, he had the fuffrage of the wife and good, the praife that's worth ambition. He enjoyed the high fatisfaclion, laudari a laudatis viris, and a ftill higher fatisfaction, in the confciouf- nefs of having always afted his part with integrity and honour; and, in his laft moments, might have juftly confoled himfelf with the magnanimous reflexion of the immortal Tycho, " non inutilis vixi."
For thofe who wifh to know his perfon, I mall tranfcribe the account he himfelf gives of it, at the beginning of his Experiments on Diet. " The perfon," fays he, " upon whom thefe Experiments are tried, is a healthy man, about twenty-nine years of age, fix feet high, ftoutly made, but not corpulent, of a florid complexion, with red hair."
The character of his mind, which is infinitely more valuable, I mall not pretend to delineate; but thofe who were beft ac- quainted with his merit, will not think, that I apply improperly to him, what was formerly faid by Salluft, of one of the greatefr. and beil of the Roman citizens — " Non divitiis cum divite, neque faclione cum facliofo, fed cum ftrenuo virtu te, cum modefto pudore, cum innocente abftinentia certabat; effe, quam videri, bonus ma- kbat*M
* Bui. Catalin. cap. liv.
TABLE.
ABLE
O F
O N T E N
CLINICAL and ANATOMICAL OBSERVATIONS.
PART I.
Difeafes of the Stomach, Inteftines, and Liver.
CHAP I.
Difeafes of the Stomach illuflrated by Dijfeflion.
Page i . Cancer in the Stomach -_ i
2. Inflam?nation of thefmaller Intejiines, with Effufon of Blood 2
3 . Blacknefs of the Cellular Subftance, a?zd Erofons of the internal
and neighbouring Coats of the larger Intejiines - 4
4. The glandular Follicles of the great Intejiines much enlarged,
and filed with a glutinous Sub/lance 5
5 Striclure
xiv CONTENTS.
Page
5 . Stricture in the Re'Bum, and Erojion of the Glands of the
Ileum ------ _ j
6. Irruption into the Colon of 'Matter , collected near the right
Hypochondrium ------ 8
j. .Numerous Conjlriflions of the Intsjlines 9
8. Hardnefs of the Liver, and Thi/inefs of the Bile - 10
9 . Abfcefs of the Liver - - - - 11
10. Hy da tides in the Liver ----- ibid.
1 1 . Whitiflj Granules, or Tubercles in the Liver - - 12
12. The Common Gall-due'* l J!:ut up by a Gallflone, and the He-
patic-dudl opening into the Duod.num - ibid.
CHAP. II.
A Dtfcription of the Symptoms of Difeafes cf the Stomach, &c. taken from thoje Cafes where the Patients recovered, or where the Author had no Opportunity of examining the Bodies after Death.
1 . Vomiting - -----_j-,
2. Purging ----- - _ I4
3. Cojlivenefs - - - - - - - ir
4. Jaundice »---__*. j6
C H A P. III.
Obfervations on the Effects of Remedies, given in the Cure of
Dfeafes of the Stomach, &c. - - - 17
PART
CONTENTS. xv
PART II.
Difeafes of the Cbeft*
CHAP. I.
Difeafes of the Cheji Migrated by Difeclion,
Page
i » The Canal of the Aorta almojijhut up by the femilunar Valves 1 9
2. Pericardium adhering to the Heart - - 20
3. the Pericardium enlarge 'd, containing eight Ounces of a Flu-
id, and, by fatty Papilla, adhering partially to the Heart 2 1
4. "Ulceration of the Lungs, or Pulminary Confumption 22
Symptoms of the Difeafe - ibid.
Appearances on Difeclion - - 25
Tubercle - - - - 26
Vomica - - - 27
£&?/? c/V^ ^/r Vejfels aud Cellular Sub/lance - 2&
State of the large Blood VeJJels - - #/*/.
'Trachea - - - 29
!T/fo Degrees of morbid Affection - - $/<£.
5. ./£;* Aneurifm of the Pulmonary Artery opening into a Vomica 3 1
6. 7#<r Vefcles of the Lungs filled with extravafated Blood 32
7. Lymph in the Thorax - - - oc
8. Inflammation of the Pleura, and Efu/ion of Blood in the In-
tercoflal Mufcles - - - o£
9. Suppuration of the contiguous Surface of the Diaphragm
and Liver « - « ^7
CHAP,
-* I
XVI
CONTENTS,
CHAP. II.
A Defcription of the Symptoms of Difeqfes of the Chef, taken from thofe Cafes where the Patients recovered, or where the Au- thor had no Opportunity of examining the Bodies after Death
i. Of the different Kinds of Cough Page
Cough without Expectoration, or with Expectoration of
Mucus only - - -. - 38
Cough, with Expecloration of thick Matter - 39
Cough, with Blood fpit up in f mall Quantities - 40
Cough, with Blood f owing from the Mouth by Fits 41 A remarkable Inftance of Recovery from a violent Spitting
of Blood - 42
2. Of difficult Breathing, or Aflhma - 43
An In fiance of difficult Breathing relieved upon foft Tu- mors appearing externally - *■ 44
A Cafe of difficult Breathing immediately relieved, by the fpontaneous Dij charge of Matter from the Side 45
3. Of Pains in the Side - - - 46
CHAP. III.
Obfervations on the Effects of Remedies employed in the Cure of
Difeafes of the Chef - - - 47
PART III.
Difeafes of the Fluids.
CHAP.
CONTENTS.
CHAP. I.
XVII
Page
Difeafes of the Fluids, illuftrated by DiffeBion - 49
1 Extravafation of the Serum, or thinner Part of the Blood ibid.'
2 Extravafation of the red Part of the Blood 50
3 Extravafation of coloured Serum, &.c. - - 52
4 PutrefaBion of the Fluids, &c. - - "53
5 Extravafation and PutrefaBion, united in the fame SubjeB 55
CHAP. II.
A Defcription of the Symptoms of the Difeafes of the Fluids, taken from thofe Cafes where the Patients recovered, or where the Author had no Opportunity of examining the Bodies after Death - 59
1 Swelling of the Belly, with FluBuat ion - - ibid.
2 General external Swelling, retaining the Imprefion of the Finger 60
3 General external Swelling, with Swelling of the Belly - ibid.
4 A fluBuating Swelling on the Loins - - 61
5 Fever, with red, or purple Spots on the Skin - - 6z
CHAP. III.
Obfervations on the EffeBs of Remedies given in the Cure of Dif- eafes of the Fluids - 1 A general Account of thofe EffeBs - 64
c 2 The
xvlii CONTENTS,
Page
2 The Effect of Mercury in an cbjlinate Swelling of the Limbs 64
3 The EJ/'ecl of Barks in a copious Df charge of putrid Saliva 65
PART IV.
Difeafes of the Head, Nerves and Mufcles.
CHAP. I.
Difeafes of the Head, &t\ illuf rated by Diffeclion.
1 Lymph lodged 'between the Dura and Pia Mater - 68
•2 Suppuration of Part of the Dura Mater - - 70
3 The Veins of the Pia Mater apparently enlarged - 72
4 No morbid Appearance in the Brain after an Apoplexy 73
5 Deep red Blotches, and partial Suppuration in fever al Mufcles
of the Body, in confequence of a Wound - - 74
CHAP II.
A Description of the Symptoms of Difeafes of the Head, Nerves, and Mufcles, taken from thofe Cafes where the Patients re- covered, or where the Author had ?io Opportunity of examin- ing the Bodies after Death
1 Lofs ofFee/ing and of Motion - 77
2 Lofs of Mot ion j with Relaxation of the Parts 79
3 Lofs
CONTENTS. xix
Page
3 Lofs of Motion > ivith Contraction of the Farts - - 80
4 Perpetual involuntary Motion - - « 82
CHAP. III.
Obfervations on the Effects of Remedies in Difeafes of the Head, &c. - - - "84
BBMMM
EXPERIMENTS DIETETICAL and STATICAL.
EXPERIMENTS on DIET.
Introduction - - - - 89
Facts relative to Diet - - - 92
Obfervations on Digejlion - - - 94 Abjlract of a Journal kept during a Courfe of Experiments
on Diet - - - - 96
EXPERIMENT I.
Diet of Bread and Water - - - 96
c2 EXPERIMENT
Page.
xx CONTENTS.
EXPERIMENT II.
Diet of Bread and Water, with Sugar - - ioo
EXPERIMENT III.
Diet of Bread and Water, with Oil of Olives - 105
EXPERIMENT IV.
Diet of Bread and Water, with Milk - - 109
EXPERIMENT V. Diet of Bread and Water, with roafled Gcofe - III
EXPERIMENT VI. Diet of Bread and Water, with boiled Beef - - 114.
EXPERIMENT II. repeated. Diet of Bread and Water, with Sugar - - 115
EXPERIMENT VI. repeated. Diet of Bread, with boiled Beef and Water - 117
EXPERIMENT
CONTENTS
xxi
EXPERIMENT VII.
Page
Diet of Br end, with only the lean Part of boiled Beef and
Water - - - - 1 1 8
EXPERIMENT VIII. Diet, Jlewed Lean of Beef with the Gravy, and Water 121
EXPERIMENT IX.
Diet, Jlewed Lean of Beef , with the Gravy, Oil of Fat or
Suet, and Water - - - -122
EXPERIMENT X.
Diet of Flour, Oil of Suet, Water, and Salt - - 124
EXPERIMENT XI. Diet of Flour, Water, and Salt - » - 127
EXPERIMENT X. repeated. Diet of Flour, Beef Suet, Water, and Salt « - J29
EXPERIMENT XII.
Dkt of Flour , frejh Butter, Water, and Salt, - 130
EXPERIMENT
xxii CONTENT S.
EXPERIMENT XIII.
Page
Diet, Yolks of Eggs, Suet, Figs, and Water. - - 131
EXPERIMENT XII. repeated. Diet of Flour, Butter, or Oil of Butter, Water, and Salt 1 3 3
EXPERIMENT XIV.
Diet of Flour, Oil of Marrow, Water, and Salt. - 135
EXPERIMENT XV.
Diet irregular * ~ - - - ** 137
EXPERIMENT XVI.
Diet, Bread with roa/led Fowl, Infifion of Tea, and Sugar 139
EXPERIMENT XVII.
Diet, Bread, flcwed Lean of Beef, with the Gravy, Infufwn
of Tea, with Sugar - - - 141
EXPERIMENT XVIII.
Diet, Bread, the Fat offewed Beef with the Jelly, Water,
and Salt - - - - 144
EXPERIMENT
CONTENTS. xxiii
EXPERIMENT VII. repeated.
Diet, Bread } the Lean oj boiled Beef, Infufon of Tea, with
Sugar, but no Salt - - - - - 147
EXPERIMENT XIX.
Diet, Bread, Fat of boiled Beef, Infujion of Tea, with Sugar 150
EXPERIMENT XX. Diet, Breaa, the Lean of roajied Veal, and Water * 153
EXPERIMENT XXI.
Diet, Bread, Fat of Bacon- ham, Infufon of Tea, with
Sugar - - - - 155
EXPERIMENT XXII.
Diet, Bread, Lean of Bacon-ham, Infujion of Tea, with
Sugar - - - - " lS7
EXPERIMENT XXIII.
Diet, Bread, or Flour, with Honey, and Infufon of Tea,
or ofRofemary - - - - 1 $g
EXPERIMENT XXIV.
Diet, Bread, with Chef dire Cheefe, and Infujion ofRofemary 165
STATICAL
xxiv CONTENTS.
STATICAL EXPERIMENTS.
Statical Experiments, or Ob/ervations made on the Weight of the Body, with a View to determine how far it is af- fected, both in the Day and Night, by the D if charges of Perfpiration and Urine - - - 169
Statical Table - - - - 171
Account of Dr. Stark's laft Illnefs and Death - - 183
Mr. Hewfons Account of the DiJJetlion of the Body 185 Mr. Hunter s Account from Memory, fame Days after-
'Wards « - - m 189
CLINICAL
■ ■ »i ■! nr
CLINICAL and ANATOMICAL
OBSERVATIONS.
PREFACE
TO THE
CLINICAL and ANATOMICAL OBSERVATIONS.
IT is with the greateft: diffidence that the Author of the fol- lowing work, though encouraged by the advice of fome very gooi judges, ventures to prefent it to the Publick, but he flat- ters himfelf, that in this enlightened age, when original obferva- tions on difeafes are fo much, and fo juftly fought after, it will be received, at leaft with indulgence, if not with approba- tion.
The materials were collected at a large hofpital, where he had at all times accefs to the lick, and, confeqnently, the mofl: fa- vourable opportunity of obferving the appearance and progreis of difeafes, and, when they proved fatal, of examining the bodies after death. Pie employed feveral years in thefe refearches, deem- ing it an indifpenfable duty to write a faithful hiftory of each difeafe, from the report of the patient, and never deviating from this rule, but where the lick were incapable of giving a fatis-
d 2 factory
xxviii PREFACE.
factory account of their complaints -, then, and then only, he had recourie to the relation of friends, or of thofe who were prefent. His remarks are the refult of ohfervation and infpection, unbi- ased by any hypothecs or fyflem. He has made but little ufe of the terms of art, from an opinion that they are not always very correctly applied, and being defirous of avoiding all vain parade of learning, or ground of cavil.
The parts into which this work are divided, are thofe into which the materials feemed naturally to break themfelves, and the order is according to their degree of fimplicity and certainty.
The firil place is given to difeafes of the alimentary canal ; which, as moll within our reach, are probably the bed under- itood, and the moft fuccefsfully treated.
Next to thofe of the alimentary canal, which converts our nou- rimment into chyle ; are placed the difeafes of the heart and lungs, which change the chyle into blood.
The third clafs comprehends the difeafes of the blood itfelf, and of the fluids fecreted from it.
The fourth clafs includes the difeafes of the nervous fyflem, by far the moil difficult to be underflood.
It was the Author's original intention to have added feveral other claffes, particularly one giving an account of common fevers, another on the difeafes of the urinary organs, and a third on the
diflempers
PREFACE. xxix
diftempers peculiar to women, but finding it a more difficult and tedious labour than he at firft apprehended, to abridge diaries of fingle cafes, and to place thofe which are fimilar, in the fame point of view ; he is obliged to defer the execution of this part of his plan to fome future opportunity.
The firfl chapter contains an account of thofe difeafes which proved fatal, with the morbid appearances upon diffe&ion.
The fecond relates the bifiory of fymptotns only >y for when the difeafe did not prove fatal, the morbid flate of the parts could not be defcribed : and, in the prefent imperfect flate of the art, however difcriminating fymptoms may be, they can only lead to a probable conjecture of the condition of the difeafed parts. It would be the perfection, indeed, of medical fcience, could we, from the fymptoms alone, declare with certainty, the changes which have taken place in the body, and thus, in many diforders, have a truly rational foundation for practice. A frequent, care- ful, and impartial comparifon of the fymptoms which have pre- ceded death, with the appearances of the dead body, can alone lead to this defirable perfection.
In the third chapter you have the fuppofed effects of medicines. But in this matter, which is of the utmoft importance, we are liable to great deception, As fymptoms, whether difeafes be left to nature, or treated by art, are always changing, fometimes fa- vourably, fometimes unfavourably, fo that it requires great faga- city, diligent obfervation, and a thorough knowledge of difeafes,
to
xxx PREFACE.
to diftinguim between thofe changes which happen in the natu- ral courfe of a diftemper, and thofe which are the effects of re- medies applied -, yet, unlefs fuch diftinction be made, our opinions with regard to the effects of remedies will be perpetually liable to un- certainty. There is, perhaps, no place fo favourable for obtaining this knowledge as an hofpital -, here we fee a number of fick, who, from their circumftances and fituation, have not had it in their power to prevent their diforders from taking their natural courfe ; here, therefore, it is, that the foundation muff be laid of this moft neceffary and important distinction, whereby numberlefs mis- takes to which this fubject has always been liable, can alone be obviated.
The examples which I have given of difeafes running on in their natural courfe, and terminating favourably, which J call a fpontaneous cure, will not, I hope, be ufelefs or uninfirudtive.
The delicacy which I am bound to obferve, when defcribing the cafes of patients who were under the care, or relating the effects of medicines prcfcribed by othei phyficians, obliges me to mention thofe . medicines only which feemed fucccfsful. I am very fenfible that filence, with refpect to the unfuccefsful cafes, which mould be fairly compared with the fuccefsful, being the pro- per method of conveying truth and conviction to the mind, is a very great defect, but it was here unavoidable. I have, however, endeavoured to fupply this deficiency, by relating, and I believe impartially, the refult of a comparifon made by myfelf. But it will not, I hope, be thought, from my filence refpeding feve- ral remedies whofe effects appeared ambiguous, that I fuppofed
them t0 kc wholly inefficacious.
The
PREFACE. xxxi
The chapters are fubdivided into fections, which, in the firft chapter, confift frequently of one or more cafes, the diffections not having been fufficie'ntly numerous to admit of the fhorter, and more eligible method of compofing from a number, one general hiftory.
In the fecond chapter each article, or fection, is an attempt towards a general hiftory of the difeafe or lymptom.
The third chapter is fometimes divided into fections, accord- ing to the particular remedies, whofe effects are related.
The queries are thofe opinions or doubts, which a comparifon of the fymptoms that preceded, with the appearances after death, fuggefted to the author at the time ; and were deligned to direct the attention of the Reader, to the moft important objects.
The difficulties which attend the execution of fo extenfive an undertaking, comprehending all the diforders which come under the care of a phyfician in a large hofpital, will doubtlefs plead the Author's excufe with the candid, for the many imperfections of this firft fketch, which, at leaft, has this merit, that it is faithfully copied from nature. Of its numberlefs defects no per- fon can be more fenfible than he is himfelf,. but he thinks it better to fubmit it to its fate, rude and imperfect as it is, than to fupply any thing from conjecture, that bane of phyfic and bar to all improvement. Upon the whole, he trufts, that this performance, however defective in itfelf, will anfwer one good purpofe, by point- ing out a large hofpital as an inexhaustible fource of the moft ufeful medical knowledge.
CLINICAL
CLINICAL and ANATOMICAL
OBSERVATIONS.
— g— ■ »— ■■■ i - — ■*■**-
PART I.
Difeafes of the Stomachy Inteftines> and Liver.
CHAP. I.
Difeafes of the Stomach, &c. illujlrated by DiJJecJion.
§ i. Cancer in the Stomach.
A
MAN, aged forty-five, was feized with a paJn ahnut the region of the ftomach, attended with purging. At firfr. he voided flime but afterwards white fibrous fubilances, in fome meafure refembling afcarides, together with thin membranes ; he complained of want of appetite, low fpirits, dimnefs of fight, and giddinefs, which laft was fo confiderable, that he was fometimes in danger of falling down : his pulfe was weak and quick, and his ftrength much impaired, though he continued to walk, about till the day of his death, which happened four months after the commencement of his illnefs. He had then two fainting fits, in the laft of which he was carried to bed, and died quietly a few hours afterwards.
B On
( 2 )
On opening the cavity of the abdomen, the ftomach was found adhering above to the liver, and below to the pancreas. It was diftended with putrid air, which burft forth on feparating the adhefion at the liver. Great part of its upper fide was confumed, and that portion of the liver in contact with the difeafed part of the ftomach, was ulcerated and covered with a putrid reddiih matter. The lower part of the flomach adhering to the pancreas, had fuffered in like manner. The parts by which it adhered, and fome others, were thickened, foft, fpongy, and in general rotten. It contained a large firm clot of blood, weighing almofl a pound, together with fome putrid matter. The pylorus was greatly thickened, but the paffage was free. The duodenum and jejunum were of a dark bluiih colour, but the extremities of the villi of the latter were quite black. The ileum, and large interlines, were, to all appearance, found.
Was it not furprizing that, in the preceding cafe, the patient never complained of ficknefs, nor was troubled with retchings ? Perhaps the flomach was too weak for that exertion.
§ 2. Inflammation of the J mailer Inteftines, with Effufwn of Blood*
A man aged thirty, unknowing of any caufe, was, one evenings fuddenly feized with retching and vomiting, which were frequent day and night ever after, and conftantly and immediately followed the fwallowing any thing, even in the fmalleft quantity. His fkin became yellow on the fourth day, and what he vomited was obferved on the eighth, to be of a coffee-colour. His ftools were fmall, and of a natural appearance, and he had one every day till the tenth. A glyfter being then adminiflered, a purging with blood enfued. Some of the ftools confided of clots of blood, with hardly any mixture of
other
( 3 )
other fubftances : the fkin and eyes were yellow ; his breathing was opprefled ; the expirations terminated in a flight groan, and were about twen ty- five in a minute : his tongue, on both furfaces, was covered with a whitifh flough ; his pulfe was quick and full ? he had conftant ficknefs, and vaft uneafinefs acrofs the flomach and hy- pochondria; the fever encreafed, the tongue and lips became hard and black, and, retaining his fenfes to the laft, he died on the thir- teenth day.
On examining the body, the flomach and large inteftines were, externally, of an afh-colour ; the fmall inteftines, in general, were of a blackifh red ; towards the lower extremity, of a deep red ; and towards the upper extremity, of an olive, or greenish brown colour. A portion of the duodenum, a little below the ductus choledochus ; alfo a portion of the fundus cceci, were of a very dark red colour, blood being effufed between the peritoneal and mufcular coats. Internally, The ftomach, duodenum, and jejunum, were of a dirty brown, or blackifh colour; the ileum was uniformly of a deep red, and, after being wiped, gave, when preiTed, a reddifh taint to a white cloth : the rugs, and fome other parts of the furface of the colon and rectum, were of a light red colour; the parts mofl affected did not, when pulled, appear to be at all weak or tender : the bile was almoft black ; the contents of the ftomach, and duo- denum, were a corTee-coloured fluid : thofe of the jejunum were a foft fubftance, like meconium : thofe of the ileum were a dark red fubftance : thofe of the colon were pure red ; the colour of the liver, on its lower furface, was dark blue ; internally, it was found ; the gall ducts were quite open : the other parts of the abdomen, and thofe of the cheft, were in a found ftate.
B a § 3. Bfocknefs
( 4 )
§ 3- Bkcknefs of the cellular SubJIance, and Erofions of the internal and neighbouring Coats of the larger Intejlines.
A man, aged fifty, was, when in the Eafr.- Indies, feized with a violent bloody flux, accompanied with excefilve pains in the bowels, and almoft conftant {training. The flux, though lefs fevere, con- tinued almoft conftantly tor four years afterwards, and he commonly voided very tough flime. After that period, it gradually diminished, and had entirely flopped about a month before his death ; which, as will afterwards appear, ( § 9. ) was probably owing to a large abfcefs in the liver.
A woman, aged thirty, after being wet, was feized with pains, in her limbs and bowels, and, in a week afterwards, with fo violent a purging, that there was fometimes not a minute, feldom more than ten minutes, and never, me faid, above half an hour, between her ftools : fhe did not void above a fpoonful at a time ; it was of -a natural colour, but frothy and vifcid : the pulfe was very irregular ; and the tongue covered with an olive- coloured fur. After a very confiderable remiflion, the Ji/Ordti returned with the utmofl violence, and carried her off" in about two months from its firfl attack.
In both cafes, the cellular fubftance, between the internal and mufcular coats of the large interlines, was black, but gave no tinge to water. The blacknefs was either in fmall circles, or in fpots, or diffufed over large portions of the cellular fubftance : in the middle of fuch fpot3 as were larger and deeper-coloured than the reft, the internal coat
was
( s )
was broken by a very fmall erofion. We oblerved other erofions^a little larger, penetrating into that membrane ; they appeared fome- times white, but moft commonly black ; others, ftill larger, and which were always white, ran into the mufeular coat : in the parts moil difeafed, more than half the internal coat, great part of the cellular, the tranfverfe and fome of the longitudinal fibres of the mufeular coat, were confumed ;-f externally on the peritoneal coat, faint brownifh fpots were feen oppofite to the deep black internal fpots ^ the fmall inteilines were not to appearance difeafed.
§ 4., The glandular Follicles of the great Intejlmes much enlarged > and Jilled with a glutinous Subjlance,
A woman, aged twenty-feven, was, after an irregular intermittent, feized with fevere purging, accompanied with excruciating pains of the bowels. What the voided, was a thin olive- coloured fluid, with many fmall portions of a clear glutinous fubftance floating in it ; they fomewhat refembled drops of oil : her pulfe beat commonly about 90 in a minute, and was fmall ; her tongue was uncommonly dry. No confiderable remiflion having happened, me died in about fix weeks after the purging began.
A man, aged fifty-fix, fome months after a tedious fever, in which, his ftrength had been greatly impaired, was feized with a purging, which, though fometimes violent, frequently remitted, but never
wholly
* In the inteftines of the man were obferved the circles, fpots, and fmaller erofions : in thofe of the woman, befides thsfe appearances, were obferved the more advanced, changes.
( 6 )
wholly flopped. Pain of the bowels commonly preceded each fit of purging : what he voided, in the beginning, had been often mixed with blood, but afterwards it was mixed with fmall manes of a clear glutinous fubftance, coagulable by heat, or by alcohol, and fome- times it wholly confifhed of that fubftance. Part of the food, efpe- cially liquids, palled through the body unaltered : his pulfe beat about 90 •, his tongue was dry. The diforder was conftant and violent for above a month before his death, which happened in eleven months after the purging began.
In the large interlines of both, portions of the internal coat were railed up into fmall hemifpheres, containing a colourlefs glutinous fubftance, which was rendered white and firm by alcohol, or by heat, but by cold water was foftened, and partly diflblved.* On the internal furface there alio appeared irregular eminencies and depreffions, both, of which were covered by the internal coat : the former were white, both externally and internally ; the latter externally were commonly livid, and fometimes they were in fpots : under the eminencies the cellular fubftance was thicker and more folid -y under the depreffions it was thinner than in the found portions of the inteftines.-f- In the loweft part of the ileum, we obferved eminencies of the fame colour and ftrudture as thofe in the colon. |J There were alfo a few irre- gular erofions of the internal coat in the firft cafe. J In the fecond, we obferved erofions fimilar to thofe defcribed under the next article. The other parts of the fmall inteftines were in a found ftate.
Were
'* Fig. 2, 3. b by c, &c. d, iv. & v. a, &c. b. •v Fig. 3. a a. I Fig. 5. A B. J Fig. 3, (.
( 7 >
Were the hemifpheres, above defcribed, the inteftinal glands, en- larged ? Was the coagulable part of the blood fecreted by them, inftead of common mucus ? Is the voiding of a clear gelatinous fub- ftance, in fmall feparate maffes, the fign of this ftate of the in- teftines ?
§ 5. Strifture in the Reffum, and TLrofion of the Glands of the
Ileum*
A man, aged forty-fix, had almoft recovered of a flux, which had continued about a year, accompanied with gripings, and after each motion, with blood dropping from him, when, twelve days before he died, the paflage of his body was entirely mut up; the belly fwelled, and for fome time was partially pufhed out by portions of the colon. Glyfters and whatever he drank were immediately re- turned, the former with wind. There was much noife in the bowels. The belly becoming at laft uniformly fwelled, he died in the utmoft agony.
The colon was every where diftended, to almoft five inches in diameter, by thin feces and air, which laft, through fome fmall aper- tures in the coats of the intefHne, had burft into the cavity of the abdomen. The ftomach was compreiTed by a flexure of the colon,, which almoft entirely filled the left hypochondrium, and the di- ftenfion of this intefline terminated at a ftricture thereof, a little above the reflexion of the peritoneum over the bladder. At this ftri<fturethe pafTage was almoft wholly fhut up, by a kind of tubercles, fbft, fpongy, and rotten. We obferved fome erofions of the internal coat of the coeeum?J and in the lower part of the ileum y alfo erofions
of
( « )
of what is commonly called Peyer's glands ; * and, near the attach- ment of the mefentery, we difcovered fmall holes of the internal coat,-f- fome of which might, by prefiing upon the veffels near them, be filled with blood. The other parts of the alimentary canal were internally found.
§ 6. Irruption into the Colon of Matter collected mar the right
Hypochondrium.
In a man aged thirty-four, during a bloody flux, accompanied with pain chiefly in the upper part of the belly, a hardnefs was felt, and foon afterwards a tumor appeared near the right hypochon- drium. In about three months the flux flopt; but the tumor in- creafed for two months longer, when it broke ; and, the opening being enlarged with a knife, difcharged about a pint of a thick reddifh matter. At this time the purging returned, and in three weeks he voided matter refembling that difcharged at the wound, where, while forcing at flool, there was often a bubbling noife. Lying on the left fide was foon followed by a motion to flool, and preflure on that fide of the belly forced the matter through the anus. The purging increafing, and the difcharge, though fmall in quantity, continuing from the tumor (which had now almofl quite fubfided), he died in about feven months from the firft attack of the purging, and two months after the breaking of the tumor.
The parietes of the abdomen, the edge of the right lobe of the liver, and the neighbouring part of the tranfverfe arch of the colon, were found adhering to one another, and all of them in fome degree ulcerated. The colon was at that part perforated by fome
very
* Fig- 7- t F'S- 8-
( 9 )
very fmall apertures ; and its internal coat, in many places, chiefly near the apertures, irregularly eroded.
§ 7. Numerous ConJlrlBions of the Intejllnes.
A man, aged nineteen, by trade a brazier, having for nine months been often afflicted with pains, fenfe of twilling of the bowels, and coftivenefs, was feized a fortnight before his death with a violent fever, attended in the beginning with purging, and towards the end with ftupor.
Another man, aged fixty-five, by trade a houfe-painter, was, for the laft five years -of his life, frequently afflicted with violent pains in his bowels, accompanied with coftivenefs : he was oft times nine or ten days without a ftool. About a month before his death, being greatly weakened and wailed with his difordcr, he was feized with a purging, which, though moderate, carried him off.
In both fubjecls, the fmall, as well as the large inteftines, were found alternately contracted anH AAxte-A . the contracted parts in the former v/ere about one quarter of an inch ; in the latter about half an inch in diameter ; they were both externally and internally of a deep red colour, feemingly from the enlarg§ment of the blood vefTels. The widefl portions were nearly four times larger than the narrowed.
§ 8. Hardmfs
10
§ 8. Hardnefs of the Liver, and thinncfs of the Bile,
A man aged thirty, after a fever, became yellow, and continued fo almofl conitantly for four years, his colour being fenfibly deeper every time he caught cold ; but except a flight loofenefs, to which he was now and then fubject, he had no other remarkable complaint till three weeks before his death. He was then feizedwith thirit, fever, great pain in the upper part of his belly, and in both hypochondria j a frequent cough, his breathing fhort and painful, his fkin and eyes of a deep yellow, his tongue clammy, the greater part of it very red, and one edge of it covered with a white ilough j his belly was tenfe and fwollen..
On difleclion the liver appeared large, and of a dirty brown colour : xt was hard and uneven on its farface, which was raifed up into fmali eminencies in clufters. Externally, it was variegated, dark orange and dark green being mutually interpofed. On preling the gall bladder, a thin tranfparent bile, of a deep green colour, was forced into the duodenum -, no ftone, conftriction, or other difeafed appearance, was found in the gall-ckiars or gall-bladder, though both were accurately examined. The omentum was thick and opaque, and turned upwards over the flomach and liver : over the ftomach, it was attached to the diaphragm at its edge ; over the liver, by a broad furface ; but it did not adhere to either of thofe organs : the fmall intcflines adhered by their convolutions to one another, and to the parietes, being covered with a kind of cellular fubftance. In- ternally,, they were in a found ftate..
§ 9. Abfcefs
( » )
§ 9- dbfcefs of the Liver.
A man, who (as already related, § 3,) had been much afflicled with a flux, was, about iix weeks before his death, feized with fits of coldnefs, which came at firft at irregular periods, but afterwards eveiy forenoon. In the beginning, they lafled four or five hours only, and were followed by heat, head-ach, and thirft ; but towards the end they lafled all day, and were followed by burning heat, continuing throughout the night. The ftools were of an afh-colour.
In the right lobe of the liver was an abfcefs, containing about half a pint of matter -, the gall-bladder was large, and full of pale yellow bile.
§ 10. Hydatides in the Liver,
A man, aged twenty-nine, was, three months before his death, feized with pains in the right hypochondrium, foon followed by a fwel- ling of the part, and yellownefs of the fkin, and afterwards by a fwel- ling of the whole belly. A fortnight before he died, he was taken with a purging and vomiting, of dark-coloured matter, accompanied with exceffive gripings. The vomiting ceafed in a few days, the yellownefs of the ikin difappeared, the belly fubfided, the pains abated, and the purging only remaining, he, two days before his death, thought himftlf greatly better.
On dhTe&ion, the abdomen contained feveral pints of a muddy liquor, tinged yellow ; the right lobe of the liver was greatly
C 2 lengthened,
( «3 )
lengthened, its lower furface being puflied out, formed, with the upper one, a continued convexity ; and matter ifiued from fome fmall apertures on its furface. Internally, there were two large cavities, containing about three quarts of a lightifh brown thick fluid, and many round gelatinous tranfparent bags, white or yellow j the gall- bladder, at the bottom of which was a large opening, was included in the anterior of the two cavities ; the gall- ducts were widened, and opened freely into this cavity and into the duodenum. The left lobe of the liver was nearly found. A part of the jejunum was reflected over the omentum and colon, adhering to the liver and to the parietes*
§ ii. TVhitiJlj Granules, or Tubercles in the Liver.
On examining the bodies of two perfons, neither of whom had any fymptom of an affection of the liver, both having laboured under complaints of the chelt, and which, on diffection, appeared the chief feat of difeafe ; the liver, though not considerably enlarged, through- out its whole extent contained fmall whitifh granules, which were not vafcular but fmooth, almoft tranfparent, and fo numerous, that they occupied more than half the fpace naturally filled by this vifcus. The gall bladder was very fmall, and contained little more than a tea-fpoonful of bile.
§ 12. The common Gall-ducJ Jhftt up by a Gall-fane, and the Hcpatic-duc~l opening into the Duodenum.
In the body of a man who died of a fever, without having any fymptom of jaundice, the extremity of the ductus choledochus was
quite
( '3 )
quite (hut up by a large gall-ftone, which protruded into the duo- denum ; the gall-bladder was greatly contracted, empty of gall, and covered all over with a cellular fubflancej the ductus hepaticus ad- hered to the duodenum, and opened into it about an inch below the pylorus : over the gall-bladder, the edge of the liver was a little rounded. This vifcus was in other refpects found.
CHAP. II.
A Defcription of the Symptoms of Difeafes of the Stomachy &c. taken from thoje Cafes where the Patients recovered, or where the Author had no Opportunity of examining the Bodies after Deatb.
§ i . Vomiting.
BLOOD is fometimes thrown up by vomiting, mixed with the food, or with the liquors of the flomach. The ufual fymptoms accom- panying this, are, giddinefs, pain of the head, and, in fome instances, pain in the left hypochondrium, increafed, after eating ; with exquiflte forenefs, when folid food, hot liquors, or hot medicines, are pafBng down into the ftomach , and, in other cafes, weight at the fcrobi- culus cordis, ficknefs after eating, till the food is brought up , dim- nefs of light, difagreeable dreams, and purging of black matter, or of blood. This diforder fometimes follows a blow or a fprain : moil commonly the caufe is unknown. In the firft inilance it terminated favourably,
§ 2. Purging,
( H )
§ 2. Purging.
Thofe cafes of purging which I had an opportunity of obfervlng at the hofpital, were accompanied with thirft, want of appetite, foul- nefs of the tongue, quicknefs of the pulfe, gripings, noife in the bowels, {training, with pain in the fundament; and fometimes the food pafied unaltered. They may, according to the matter voided, be divided into two fpecies ; the flimy, and the gelatinous : in both of which blood is frequently paffed. In the flimy purging, the {tools are frothy, and confift of a yellowifh or whitim, vifcid, ropy matter -, which, unmixed, is fometimes, with the utmoft {training, forced off {balding hot, -and fometimes panes off almoft involuntarily. This {pedes is often accompanied with darknefs before the eyes, giddinefs, retching, vomiting. In the gelatinous purging, the {tools are either a thin liquid, containing fmall, clear, whitifh gelatinous fub- {tances, or almoft wholly jelly ; and fometimes nothing but wind is voided. In this fpecies, any liquid taken into the body is apt imme- diately to run off with fevere gripings. The duration of either fpe- cies is, moft commonly, a few weeks ; fometimes two or three months : and, in one cafe, the flimy purging continued three years. The event is frequently fatal. The caufes are uncertain.
Is it not probable that, in the firft fpecies, the bowels are in the ftate defcribed (§. 3.) 5 that, in the fecond, they are in the ftate defcribed (§. 4.); and that, when bloed is voided, which happens in either fpecies, it proceeds from the erofion of blood- yeffels, as delcribed (§. 5.) ?
5 3' Cojiivmefs*
( »s )
§ 3. Cojiivenefs..
The almoft conftant attendants on coftivenefs, are head-ach, fick- nefs, vomiting. It is accompanied alfo with flight pricking, or ievere and violent pains ; either in the right fide of the belly, near the fcrobiculus cordis • in the left fide of the belly, near the anus ; or over the whole belly : thefe pains are oft times increafed by flight preffure of the part. "When the diforder is moft violent, it fome- times has exacerbations, in which the bowels, after a fenfe of cold- nefs in them, are, according to the feelings of the patient, twifted, drawn together, and fqueezed to the back ; the teeth gnafh, the body is drawn forward ; whatever is then taken is immediately vomited, and glyfters adminiflered are returned without faeces. As the ftools are, for the moil part, retained till the remedies given have proved effectual, the coftivenefs, in fome violent cafes, has continued a fort- night or a month ; and one patient, a painter, had no ftool for three months. In general, purging medicines, and glyfters, when re- tained, produce very foon the defired effedt. The duration of the- difeaie is various and uncertain, but the mofl obftinate cafes continue fbmetimes two or three years 5 intervals, which now and then happen after a fpontaneous purging, being interpofed. The caufe, even when the diforder is moft violent, is, at times, altogether unknown. Lead, in various forms, and the fumes of quickfilver, frequently occafion it in painters, and other workmen, who, in their feveral trades, make ufe of thofe metals. It fometimes follows a blow on the. belly, or a fprain in lifting a great weight ; and, in this cafe, blood, or matter, is voided with hardened faeces. It did not, in any of the inftances from whence this hiftory is drawn, prove fatal.
Arc
( »6 )
Are the bowels, in fuch cafes, fometimes inflamed ? Were they, in the more violent cafes, nearly in the flate defcribed (§. 7.) ?
§ 4. yaundice.
This difeafe begins with ficknefs and pain at the fcrobiculus cordis, and fometimes with giddinefs, retching, and vomiting of a yellow four ropy phlegm. The urine is of a faffron colour, flaming paper that is dipt in it, and becomes turbid when cold. The tunica fclerotica of the eye and fkin are yellow; the yellownefs is firfl perceptible at the pit of the ilomach ; external objects appear as ufual. This difeafe is frequently accompanied with purging, though fometimes with collivenefs : the flools are commonly in colour like blue clay ; fome- times of a dark earthy, or of a deep yellow colour ; but, fo far as I have feen, never white. In general, there is a bad tafte in the mouth, with a white tongue and a flight fever; frequently, immediately pre- ceding the vomiting, there is a violent pain in the back ; the pains in the belly are increafed by walking; they complain of pain in the right, or left hypochondrium, or in the flank ; and fome- times, though rarely, of pains fhooting from the fhoulder to the breafl, or from the back down the thighs. In fome cafes, the difeafe intermits for feveral weeks or months, but more commonly is con- tinued, though the pains and vomiting attack by fits, lafling either a few hours every morning, or for feveral days. Relief always follows fpontaneous vomiting, or purging. When the difeafe is going off, there is fometimes a violent itching of the fkin.
Does not the relief which follows fpontaneous vomiting and purging, point out the proper method of curing this diforder, by emetics and purgatives ?
CHAP. III.
( *7 )
CHAP. III.
Obfervations on the EffeSi of Remedies, given in the Cure of Difeafes
of the Stomach, &c.
OPIUM alone feldom failed to reflrain purgings for two or three days or a week ; but the difeafe, at the end of thofe periods, returned, and commonly with more violence, than before opium had been taken. But, though this drug alone appeared to be a medicine altogether inadequate to the cure of purging, yet when combined with others, moll excellent medicines were formed, whofe effects were not lefs powerful, and were more lalting.
In the ilimy purging, the moil: efficacious medicine was vitri anti- monii cerati* gr. v. opii circiter gr. i. quotidie. Another powerful medicine was radicis columbae gr. x. opii gr. i. in die. Columba root alone gave only a temporary relief. In the gelatinous purging the mofl efficacious medicine was ipec. gr. i. opii gr. i. quotidie. Vitr. an- tim. cerat. cum opio, given in this fpecies, aggravated the iymp- toms. Other ufeful medicines, in either fpecies, but of inferior efficacy, were opium with rhubarb, with aromatics, with abforbents, or the abforbents alone. When the pains were violent, fomentations gave much relief. In coftivenefs, the bell; remedies were fomentations and the common purgatives. In the painter's colick, oil, or oil with rhubarb, was moll ufeful. In the jaundice, emetics and pur- gatives were ufeful remedies.
r> is
* A medicine in the Edinburgh Pharmacopoeia.
( "3 )
Is not the combination of opium with other drugs, recommended to us by practitioners in all ages, and of all fedls ? Have we not an example of this in the antient compofitions Mithridate, Theriaca, and feveral others, which are flill retained in the modern difpenfa- tories, and in which opium is a principal ingredient ; alfo, in the highly celebrated medicines of Dover, and of Ward, the moil effi- cacious of which are opium joined with ipecacuan, with hellebore, or with mercury.
PART II.
( 19 )
PART II.
Difeajes of the Chefl.
CHAP. I.
Difeafes of the Chef, illujkrated by Diffeclion.
§ i. 'The Canal of the Aorta almofk jlmt up by the fcmilunar
Valves.
A WOMAN, aged twenty-one, who got her bread by hard labour, had, for five years, been fubject to fits of palpitation, which attacked her commonly after an interval of fome months : the laic fit, in which fhe died, lafted five weeks, being more violent and of longer continuance than any of the preceding ones. In this fit, the left hypochondrium and fcrobiculus cordis were much pufhed out at each palpitation ; there was alfo a remarkable throbbing in the courfe of the veflels on each fide of the neck, but from the irregularity of thofe motions, they could not be counted, and the parts themfelves were fo tender, that fhe would hardly allow them to be touched. Her pulfe was weak, quick, and irregular, fometimes fluttering, fometimes intermitting : fhe complained of pain and tightnefs acrofs the cheft ; her breathing was oppreiTed and quick, infpiring commonly forty-five times in a minute ; fhe had a fhort cough, was low, faint, confbntly fick, and, for rnoft part, vomited immediately after fwallowing the fmalleft quantity of any thing, whether liquid or foli'd. At firft, fhe lay on her left fide, or on her back ; afterwards on her back only, having her head and
D 2 moulders
( 2° )
mouldeis raifed up, and at laft with her arms folded over her head. She became anafarcous a month, and yellow two or three days before her death.
On diffection, the lungs were found adhering to the pericardium, and to part of the parietes of the cheft near it : in other places de- tached, every where foft, and, when prefTed, froth iffued out of the noftrils. The femilunar valves of the heart were thickened, and projected towards the axis of the aorta.* The heart was feemingly lengthened, in other refpects found. The large blood- veffels, which were traced and cut up, as far as the head and arm-pits, were alio found. The abdominal vifcera were in a natural ftate.
§ 2. Pericardium adhering to the Heart, &c.
A woman, aged twenty-feven, was, fbme months before death, feized with a frequent dry cough, followed by pain in the left hypo- chondrium, and at the fcrobiculus cordis : her breathing was fhort and quick, her pulfe commonly one hundred in a minute ; fhe com- plained of ficknefs, with conftant and often violent head-ach. A fortnight before her death, me loft the ufe, firft, of the left arm •„ then of all the left fide, and her fpeech faultered..
The pericardium was found adhering every where to the heart, which, was much enlarged, and hardened, but internally found ; the lower, and greater part of the lungs of the left fide, were of a dark red colour, firm, and adhered to the neighbouring parts ; there was a. very ftnall quantity of water in the right cavity of the cheft. The:
ftomack
( « )
ftomach was narrow : the other abdominal vifcera had a natural appearance.
§ 3. The Pericardium enlarged, containing eight Ounces of a Fluid, and, by fatty Papilla?, adhering partially to the Heart.
A girl, aged fourteen, was, three weeks before her death, feized: with great difficulty of breathing, and with pain in the left fider attended fometimes with a fhort cough, which was not at all relieved by repeated ven affection. When in bed (he lay conftantly on the left fide, her cough being excited by any attempt to lye on the right fide, or on her back. She often chofe to fit up; but whether fitting or lying, the b©dy was always much bent forward. The pulfe was full, and very quick.
The pericardium was much enlarged, and being covered towards the upper part with a foft fubftance half an inch thick, concealed all the lungs of the left fide, except a fmall portion of the upper lobe near its edge. It contained eight ounces of a fluid : its internal fur- face, and alfo the external furface of the heart, was covered, in many places, with a layer of a kind of fatty matter, eafily feparable from either furface, and fupporting numerous oblong fatty papilla?. The oppolite papillae on the pericardium, and on the heart, in fome places, adhered to one another. The great veiTels within the pericardium, were covered by a, foft fubftance a quarter of an inch thick. The heart and great veiTels, internally, were found. The lungs adhered, univerfally, though flightly ; were in every part foft, and eafily dilated. by air blown in by the windpipe. There were fbme ounces of a rluid in
eacJx,
( ** )
each cavity of the cheft. The abdominal vifcera, except the right kidney, were quite found.
On examining the body of another woman who died of a con- fumption, but who, a fortnight before her death, had lain alfo, night and day, bent forward on her elbows and knees, the pericardium contained much water.
§ 4. Ulceration of the Lungs, or pulmonary Confumption.
The frequency and fatality of this diforder having afforded me many opportunities of obferving the fymptoms, and of examining the ftate of the body after death, I fhall here, inftead of particular inftances, endeavour to give a general defcription of the fymptoms, and of the appearances on diffection, taken from ten cafes, where the difeafe proved fatal.
Symptoms of the Difeafe.
The fymptoms of the difeafe may be divided into primary and fecondary •> the former being fuch as are peculiar to affections of the cheft, the latter, fuch as are common to thofe, and to fome other
affection s.
Of the firft kind are cough, fpitting, pains of the cheft, difficult breathing, and pofture. Of the fecond kind may be reckoned cold- nefs, heat, fweating, purging, wafting, pains of the limbs, &c.
The cough, which is brought on by expofure to cold, or by drinking any cold liquor whilft hot, or by various other caufes, is
almoft
( 23 )
almoft conftantly the nrft fymptom, and in the beginning often the only one -y though it is, at times, accompanied with flitches, or mooting pains in the cheft, and with expectoration. It generally attacks by fits, which are moil frequent and fevere towards evening, or during the night, preventing fleep.
The (pitting or expectoration, is commonly very thick and vifcid, of an afh- colour, with a flight tinge of green, and contains many air bubbles ; fometimes it is yellowifh, and in fmall round maffes, which probably come from fmall vomica? ; now-and-then, though rarely, it is ftreaked with blood. The quantity expectorated is generally inconsiderable in the beginning, but afterwards increafes to about half a pint, or a pint, in twenty-four hours. In thofe cafes, where (upon diffection) the large vomica? were found almoft empty, the fpitting, towards the end, had been in very fmall quantity.
As the fpitting is, perhaps, the moil certain criterion of vomica, it will be proper to enquire into its peculiar character, that it may be diftinguifhed from pus and mucus : two fubftances which it greatly refembles. All of them, when free from air bubbles, fink in water. Pus is eafily difFufible in it, by gentle agitation, but in a few hours falls to the bottom. Mucus cannot be equally difFufed in water without ftrong agitation, but when difFufed, forms with it a per- manent ropy liquor. The fpitting of confumptive perfons is diffufible in water more eafily than mucus, and like that, at firft forms with it a permanent ropy liquor ; but which, in a few days, depofits a fediment in the fame manner as pus ; the liquor, however, ftill con- tinuing ropy, and refembling mucus and water.
The pains of the cheft are of two forts ; viz. ftitches, which fometimes come on in the beginning ; or a general forenefs
of
( 24 )
of the cheft, which is moll feverely felt after violent fits of coughing.
The breathing (even before the difeafe has arrived at its acme) is. generally two or three times more frequent than that of a perfon In health, and is often accompanied with a fighing noife, and performed with great motion of the chefl ; but it is fomewhat relieved by the expectoration which follows the fits of coughing. Neither in- fpiration, nor expiration, can be continued fo long as by a healthy perfon ; but the former, in confequence of the pain or cough excited by it, is moft. fenfibly fhortened.
With refpect to pofture, the patient commonly lies on his right fide ; but this is not compleatly fixed till the difeafe is far advanced, when he can only lie on his back, with his head and fhoulders high, and fometimes with his knees drawn up.
The coldnefs (which fometimes precedes any figns of an affection of the chefl) comes on by fits, either regularly every day, or every other day, like the paroxyfms of an intermittent fever ; or, as is mofl common, at uncertain periods.
The heat is of two kinds, either a burning heat, with intenfe thirft, continuing all night, which fucceeds the fits of coldnefs ; or a continued heat, increafing towards evening, which, in general, is much more moderate.
The pulfe is always fmall and quick ; commonly there is a lofs of appetite, though, in fome inftances, towards the end of the diforder, the appetite is voracious.
The
( 25 )
The Sweating is alniofl a conftant fymptom, and is at times profuie, breaking forth, chiefly, on the head and breaft ; though more com- monly it is moderate, and follows the evening exacerbation ; and fometimes towards the end, it diminiilies, or ceafes.
i
The purging feldom comes on till near the end of the difeafe, at which time the legs are apt to fwell. When the purging begins all the feverifh fymptoms greatly abate, but are again increafed, if, by any means, it is flopped.
The wafting of the body is more remarkable in this, than in any other difeafe.
Pains in the limbs, or all over the body, are alfo not unfrequent fymptoms ; and the menfes, in women, (who are more liable to this difeafe than men) commonly ceafe jfoon after it is eflabliihed.
The duration of the difeafe is various, from four months to two years ; and it will be found to be nearly in proportion to the age of the patients, which varies from feventeen to thirty-five years.
Appearances on Dtjfeftion.
As the appearances on direction, though extremely uniform, are very different in degree, it may be ufeful to arrange them under the following heads: — Tubercle; Vomica; State of the Air Veficles, and cellular Subftance ; State of the large Blood VeiTels j Trachea ; the Degrees of morbid Affection j and fome other circumftances.—
E Tubercle.
( «6 )
tubercle.
In the cellular fubftance of the lungs are found roundifh firm bodies, (named tubercles) of different fizes, from the fmalleft gra- nule, to about half an inch in diameter; the latter often in clutters.. The tubercles of a fmall fize are always folid, even thofe of a larger are frequently fo ; they are of a whitifh colour, and of a confidence approaching nearly to the hardnefs of cartilage ; when cut through, the furface appears fmooth, mining, and uniform. No veficles, cells, or veffels are to be feen in them, even when examined with a microfcope, after injecting the pulmonary artery and vein. On the cut furface of fome tubercles were obferved fmall holes, as if made by the pricking of a pin ; in others were found one or more fmall cavities, containing a thick white fluid, like pus ; at the bottom alfo of each of thefe cavities, when emptied, feveral fmall holes were frequently to be feen, from which, on prefting the tubercle, matter iffued ; but neither thefe holes, nor the others abovementioned, (fb far at leaft as could be determined) communicated with any veffels. The cavities, in different tubercles, are of different iizes, from the fmalleft per- ceptible, to half an inch, or three quarters of an inch, in diameter; and, when cut through and emptied, have the appearance of fmall white cups, nothing remaining of the fubftance of the tubercle, except a thin covering or capfula. The cavities of lefs than half an inch diameter are always quite (hut up ; thofe which are a little larger have, as conftantly, a round opening made by a branch of the trachea. At this period, there being a free paftage for the matter contained in the tubercle into the trachea, and.a, communication between the cavity- of it and the open air, it is proper to change the name of tubercle to that of vomica.
Vomicae
( *7 )
Vomica.
The fmaller vomicae are commonly entire, the larger are frequently ruptured j the largefl: (which, generally fpeaking, are of an oval fhape,- and about four inches in length) i r^ lined, either partially, or entirely, with a fmooth, thin, tender Hough or membrane ; the fame as the capfula of the fmaller vomicae. The matter contained in them, when the capfula is entire, is whitifh or yellowiih ; when ruptured, reddifh ; in either cafe readily diffufible in water. It is proper, how- ever, to remark, that even in the largefl vomicae, when they are not compleatly ruptured, the matter is feldom red, but yellowiih, afh- coloured, or greeniih jj often foetid.
Into all vomica; (the fmallefl perhaps excepted) there are feveral openings of the bronchia ; alfo openings forming communications between the different vomicae ; the bronchial openings are commonly round and fmooth ; the others, generally irregular and ragged. The larger vomicae, which have numerous bronchial openings, are found to contain fcarcely more matter than is fufficient to befmear their furface ; and what fhews clearly that the matter of vomicae is dif- charged by thefe openings of the afpera arteria, is, that if a deep incifion be made into any difeafed part, of the lungs, and that part gently compreffed, the matter will be {qgd. to ifTue from the cut ex- tremities of the bronchia ; or if any considerable branch of the afpera arteria be laid open, and the lungs preffed in the fame manner, the matter will be ftcn coming into it, from the fmaller ramifications.
The largefl vomicae are generally fltuated towards the back part of either upper lobe, and are commonly concealed ; though fometimes
E 2 on
(28 )
on the furface of that part of the lungs, which is thin and finks into a hollow, there are feveral fmall apertures leading to the vomica ; and fometimes, though rarely, a vomica is a hemifpherical cavity on the outward part of the lungs. Wherever there is a vomica there is always a broad and firm adhefion of that part of the lungs to the parietes, or pleura, fo as to preclude all communication between the cavity of the vomica and that of the cheft ; even tubercles are feldom found without adhefion.
State of the Air Veficlesy and cellular Subjlance.
Thofe parts of the lungs which are contiguous to tubercles are red, fometimes foft, but more frequently firm or hard -, and whilft other parts of the lungs unaffected by difeafe are readily diftended, by blowing into the trachea, thofe portions which are contiguous to tubercles or vomicae, remain deprefTed and impervious to air, either blown into the lungs in this, manner, or forced, by a blow-pipe, into incifions made on the furface. So that the function of the lungs, fo far as refpeds the admiflion of air, feems, in thofe parts, entirely deflroyed.
State of the large Blood VeJJels*
The pulmonary arteries and veins, as they approach the larger vomicae are fuddenly contracted ; a blood veffel, which, at its begin- ning, meafured nearly half an inch in circumference, fometimes (though it had fent off no confiderable branch) could not be cut up farther than an inch ; and when, outwardly, they are of a larger fize, yet, internally, they have a very fmall canal, being almofl filled up by a fibrous fubflance ; and frequently, as they pafs along the fides of vomicae, they are found quite detached, for about an inch of their
courfe,
( 29 )
courfe, from the neighbouring parts. That the blood vefTels are thus obftructed, and that they have little or no communication with the vomicae, is rendered ftill more evident, by blowing into them, or injecting them ; by blowing they are not fenfibly diftended, nor does the air pafs into the vomica?, excepting very rarely, and then only by fome imperceptible holes j and, after injecting the lungs by the pul- monary artery and vein, the parts, lefs affected by difeafe, which before injection were the fofteft, become the hardeft ; and, vice verfa, the moft difeafed parts, before injection the hardeft, are now the fofteft. Upon cutting into the founder parts, numberlefs ramuli may be feen, filled with the wax, but in the difeafed parts there is no fuch ap- pearance ; and upon tracing, by diflection, the injected veffels, thofe which terminate in the founder parts may be traced for a long way to the fmaller ramuli, but thofe which lead to tubercles and vomicae, a very fhort way, and only to their principal branches. The wax was very rarely found to have entered the middling fized vomicae, and never the fmaller or larger ones.
trachea*
The branches of the trachea are never found in any degree con- tracted ; the internal furface of thofe which opened into the large vomicae, was of a deep red, (feemingly from the enlargement of veffels) and the internal furface of the trachea itfelf, was fometimes partially red.
The Degrees of morbid AffeElion.
The degrees of morbid affedion are very different, in different fub- jects, and in different parts of the lungs of the fame fubject. In fome
cafes
( 3° )
cafes there are no vomicae to be found above an inch in diameter ; in others, feveral of two, three or four inches. In the former cafes, the pulmonary arteries and veins are hardly fenfibly contracted. Some- times not above a third or fourth part of the lungs are affected ; at other times, the lungs, of one or both fides, are entirely difeafed. From a rude calculation made on difeafed lungs, the part which re- mained fit for the admiflion of air, may be eftimated, at a medium, to be about one fourth of the whole fubftance of the lungs. When the lungs are only partially affected by difeafe, the difeafed parts are always the higher, and rather the pofterior -, whilft the found parts are the lower, and rather the anterior. When they are wholly difeafed, the higher and poflerior parts, are always much more fo than the reft ; and the lungs of the left fide are more commonly affected than thofe of the right.
The lymphatic glands in the cheft are frequently blackifh, and fometimes contain a fubftance like moiftened chalk. In the abdomen there is not any thing remarkable, excepting, fometimes, flight erofions of the villous coat of the inteftines.
Is a conflant cough, though unaccompanied with any other com- plaint, a fymptom of tubercles in the lungs ? Is it, when attended with fits of coldnefs, and with fpitting, a certain fign of vomica?? Is not the fpitting compofed of matter from the vomicae, and of mucus from the membrane of the trachea ? Does not the contracted ftate of the pulmonary vcffcls, and the thickening of their coats, prevent, in moft cafes, the fatal haemorrhages, which other wife would enfue ? Is there not fame reafon to apprehend, that though a tranfitory relief is fometimes afforded by fmall bleedings, the progrefs of the difeafe is ihercby quickened ?
§ 5- *n
( 3' )
§ 5* -^n -dncurifm of the pulmonary Artery opening into a Vomica.
A man, aged twenty- nine, who had led a very irregular and riotous life, was, for ten months before his death, fubject to a flight cough, which came on immediately after his recovery from the meafles^ Notwithstanding his cough, he purfued his ufual courfe of life ; and, three weeks before his death, was taken ill in the night, with a violent bleeding at the mouth and nofe, which continued about a quarter of an hour, and returned four times at different intervals. He was paler weak, faint, low-fpirited, and apprehenfive of death, but breathed eafily and coughed feldom. The night before his death he refted well, and rofe in the morning without any particular complaint ; but, having again laid down in bed, he was, when afleep, feized with a fit of coughing, and blood began to flow (interruptedly), but without any effort from his mouth, though, fometimes, it was brought up by a flight cough, or blown haflily from his nofe. When the bleeding began, he immediately got up, and fat upon the bed, although he could not continue for a moment in the fame pofture, but was con- stantly either bending forwards, or reclining from fide to fide. At laft, in a profufe fweat, he Started upon his legs, and, with amazing quicknefs, threw off his waifteoat : the cough and bleeding imme- diately ceafed ; his pulfe, which before had been very quick, was not now to be felt ; his thiglis trembled, his urine ran from him, and he funk down into the arms of a perfon who was Standing bye, dying without a ligh or a groan, in about ten minutes- from the time the hemorrhage began : the quantity of blood which he loft, was about a quart*
Ifo
( 3* )
In a branch of the left pulmonary artery, which pafTed along a vomica, in the upper and pofierior part of the lungs of the left fide, was an aneurifmal fac, about an inch long, and one third of an inch broad : the coats of the fac refembled thofe of the artery, only thicker ; on one fide of it was a (lit, with coagulated blood adhering to it, both internally and externally ; within the fee, the coagulum was fomewhat whitifh: externally, it was divided into three branches, formed by three ramifications of the afpera arteria, that opened into the vomica ; the other ramifications of the afpera arteria, and even the trunk itfelf, being alfo filled with coagulated blood. There was no blood in the veficles of the lungs, which were, every where, evidently diftended with air, and the air, upon prefTure, readily pafTed from one lobule to another, but could not be forced out at any branch of the trachea, except at the vomica above-mentioned. On opening the chert, the lungs did not fubfide ; they were of a light grey colour, with many fmall afli- -coloured granules, but no adhefion of their furface, no other vomica, tubercle, or hardnefs, in any part of them. There was no blood in any of the cavities of the heart, excepting a few fmall clots between the carneas columns. In the large blood vefTels, which iffue imme- diately from the heart, there were fome very fmall polypi. The fub- clavian vein was empty ; the abdominal vifcera found.
§ 6. The Veficles of the Lungs filled with extravafed Blood.
Three middle-aged men were, all of them, feized, fome months before they died, with pains in the chefl, which, in two of them, were fevere from the beginning : in the third, moderate till within three weeks of his death. They were accompanied with miveiing and vomiting ; the fhivering recurred at intervals, commonly every morning, and was followed by head-ach, heat, and profufe fweating ;
the
( 33 )
the patients commonly lay, and with mofl eafe, on the fide principally affected, excepting in the night, when they were fometimes obliged to fit up. The breathing was about twice as quick as ufual, and the expirations ended with a flight groan. The cough was very frequent, and in one cafe almoft confront. The fever was high in all, and in two in (lances attended with delirium. The pulfe, from ninety to one hundred and twenty in a minute, was full ; and, at laft, beat with a kind of vibration. Pure blood burft forth, or was brought up in confiderable quantity by coughing : in one patient, about three weeks; in another, about one week ; and' in the third (who alone had been repeatedly blooded in the beginning) only two days before his death. Two of tho/e men, one of whom had lived rather fafr, and was fubjeci to a cough in winter, became anafarcous fome weeks before the fatal conclufion of their illnefs.
The air veficles, in fome parts of the lungs, were filled with blood, or with bloody ferum : thofe parts did not collapfe on opening the thorax -, they were firm, and of a very dark, or of a light red colour ; they could not be comprefTed, nor was it pofiible to diflend them with air blown in from the windpipe, or at punctures made on the furface. In fome inftances, however, they did collapfe, and admitted to a certain degree of compreflion or diflention. The lungs them- felves were furrounded by a bloody fluid, the quantity of which varied from a few ounces to feveral pints ; they were frequently attached to the fides by membranous adhefions ; when cut into, a thick blood, or bloody matter, iffued forth at the cut furfaces ; and flices cut off from the difeafed parts, after having for fome time been macerated in water, frill funk in it, in the fame manner as before maceration. The infide of the trachea was pale red.
The parts of the lungs chiefly affected, in the preceding cafes, were, in one cafe, the whole lungs of the left fide, befides a large
F quantity
( 34 )
quantity of fluid in the cavity : in another, the pofterior part of the upper and middle lobes of the left fide j alfo the whole of the lower lobe of the right : in a third, the whole of the lungs in both fides were difeafed, although thofe in the right were moft confiderably fo j in this cafe only, the bloody matter, as mentioned above, iffued at the incifions made in the lungs. There were no other preternatural appearances, excepting in one body, where the liver was hard and granulated.
To afcertain more accurately the ftate of the air and blood- veiTels, the following trials were repeatedly made on two portions of the lungs taken from the fame body -} one of which was apparently found, the other flightly difeafed. On the cut furface of each portion, air was forced in by a blow-pipe j through the largefl branch, we could find of the pulmonary artery, vein, and afpera arteria. Upon blow- ing into the branch of the pulmonary artery, in the difeafed portion,; the minuter ramuli were diftended, and a little air bubbled out at fome vtry minute openings on the cut furface. Upon blowing into the branch of the pulmonary vein, the air veficles were diftended, and air bubbled forth at the largefl bronchial orifice ; and, upon blowing into this lc*ft, the air veficles were diftended, and air efcaped, with fome blood, at the large venal branch. The fame ex- periments being made on the found portion of the lungs, the event was fomewhat different 3 for, upon blowing into the arterial, or venal branch, the ramuli peculiar to each were alone diftended, and a little air efcaped at fome minute openings on the cut furface. Upon blowing into the branch of the trachea, the air veficles were diftended, and no air efcaped. The fame experiment was alfo repeated on the found lungs of another fubject, and with the fame effect.
§ 7. Lymph
r 35 r
§ 7. Lymph in the Thorax,
Three men, two of them middle-aged, the third fixty-five, were afflicted with a cough, attended with a frothy expectoration : two of them had this complaint for fome months ; the third, who had lived rather irregularly for fome years before his death. They were out of breath upon walking only a few yards, and fpeaking was fo trouble- fome to them, that they were unwilling to give any account of their feelings ; their breathing was quick, and the expirations fometimes terminated in a flight groan j they could blow but feebly, and for a fhort time : they were, in general, defirous to fit up -y and, when prevailed on to lie in bed, they were reftlefs ; or, if they continued for any time in one pofture, it was lying on the back with the head high, or on the fide in which (as afterwards appeared) the fluid was contained. The pulfe was very quick and fmall ; two of them had an inconliderable fwelling of the belly and ancles : and thofe two who had the lungs hardened, v/ere hoarfe , the other was not.
A yellowifh tranfparent fluid was found in one or in both cavities of the chefl ; it coagulated by heat, though lefs firmly than the ferum, having a larger proportion of water $ the quantity of this fluid, in each cavity, was nearly a pint ; the lungs were, more or lefs, difeafed in all, with partial adhefions of the higher parts of them to the parietes : in one cafe, there were only fome fmall tubercles in the higher part of the upper lobe ; in the other two cafes, the whole of the upper lobes, and part of the lower, were very hard, could not be diftended by air, and when cut into, emitted a bloody froth. In one cafe, we obferved on the furface of the lungs, fmall bliflers,
F a containing
( 36 )
containing a clear fluid. In two bodies, there was a fmall quantity of water in the abdomen ; and, in one, the liver was granulated, the omentum in folds*
§ 8. Inflammation of the Pleura, and Ejfufion of Blood in the
intercojial Mufcles.
A woman, aged thirty, who for three months had been affTided with fevere purging, had alfo, foon after this crmplaint began, been taken with a cough, at firfl accompanied with fpitting of blood, but afterwards of thick mucus and purulent matter. About a month before her death, when greatly weakened by thefe complaints, me was feized with violent pains, or ftitches, in the left fide, which almoft entirely prevented her breathing : her pulfe, as before, was quick, fmall, and weak : two bliflers having been applied, the pains, in fix days, abated, and afterwards were only felt on coughing; during the violence of the complaint, me lay on the fide affected, but towards the end, her breathing being very fhort and difficult: efpecially in the night, me fat bolltered up in bed.
In the left fide of the thorax, the lungs were of a very dark red. colour, particularly at the upper part, where we found a vomica, and fo/ne tubercles : there were alfo fome adhefions at this part, and at this part only ; the pleura lining the ribs, was fmooth, but its posterior part, particularly where contiguous to the intercoflal mufcles, was of a dark red; the rednefs penetrated the mufcles, and, in fome places, extended to the ferratus major; it feemed partly owing to the enlargement of blood- vefiel's, but principally to an eiiiifion of blood into the cellular fubftance, and which, by prefiure, could be forced from one part to another. In the right fide, the lungs,.
excepting
.»■.
( 37 )
excepting a few tubercles in their upper part, were found, and free from adhefion, nor was there any rednefs of the pleura. In each cavity there was about a pint of yellow ferum, though the quantity was greater in the right than in the left. The interlines adhered ex- ternally to one another, and there was a flight rednefs to be feen on fome parts of their internal furface.
§ 9. Suppuration of the contiguous Surfaces of the Diaphragm
and Liver.
A bkckfmith, aged fifty, having, in the depth of winter, lain feveral nights in a cold houfe upon ftraw, was, two months before his death, feized with pains acrofs the lower part of the chefl, dif- ficulty in breathing, and cough, but without fpitting. The pains fixed in the right hypochondrium, and were, fometimes, felt at the fcrobiculus cordis. In fpeaking, he could only whifper, but was not hoarfe. The cough was performed v/ith very little noife, and re- fembled more a lengthened-out expiration than common coughing. He could fuck in air, or blow it through a quill a long time, and without pain : his pulfe was low j he lay on either fide, or on his back, and often with the body bent forward, his chin refting upon his breaft. Sometimes he was obliged to fit up, efpecially a few days before his death, when he could not utter above two or three words without flopping, and faid, he could hardly breathe, but had then no pain.
In the right hypochondrium, the greater part of the contiguous fur- faces of the diaphragm and liver, were inflamed and covered with pu- rulent matter ; but the inflammation did not penetrate into the fubflance of either organ j there was no other preternatural appearance in the
abdomen ^
\
( 3S )
abdomen j the lungs, and other parts of the cheft, were accuratebf examined, and found to be in every refpect found, excepting a few flight adheiions in the right fide.
G II A P. II.
A Defer iption of the Symptoms of Difeafes of the Chef: taken from thofe Cafes where the Patients recovered, or where the Author had no Opportunity of examini?ig the Bodies after Death.
§ I. Of the different Kinds of Cough. Cougb without Expectoration -t or with Expectoration of Mucus only.
THIS cough is commonly moll fevere at firft going to bed, and is troublefome by fits during the night -, in fome cafes, how- ever, (though rarely) it is worfe in the day-time. It is accompanied with difficulty of breathing, fometimes with hoarfenefs, and often with pains in the chefr. -} but thefe are feldom obferved till the cough has been of fome Handing. The fits ©f coughing frequently ter- minate with an expectoration of frothy mucus, which afFords con- fiderable relief. I have, however, known inftances where that relief has taken place, feveral hours before the fpitting began. But the moft remarkable fymptom attending this cough, and which indeed characterifes it, is, the peculiar kind of fever. After one or two mivcring fits, or after flight fits of coldnefs and of heat alternately, which come on in the morning, or a little after mid-day, (fometimes
on
( 39 )
on alternate days only) the heat begins, and continues all the after- noon, and during the night, and then commonly terminates in profufe fweating. Sometimes there is no coldnefs nor fhivering, but a con- tinued heat, which increafes after mid-day.
The pulfe is always quick, generally about a hundred in a minute, with almdft conflant head-ach, inceffant thirft, lofs of appetite, frequent retching, and fometimes faintnefs. This cough frequently is occafioned .by expofure to cold or moifture. Delicate young women, efpecially when incautious, in thofe particulars, about the menftrual period, are very liable to it. It fometimes terminates favourably, but oftener in phthijis pulmonalis ; and may therefore be reckoned the firft ftage of this difeafe,
Cough, with Expectoration of thick Matter.
This cough attacks alfo by violent fits, commonly in the night, fometimes in the morning. The expectoration (which generally begins fome weeks after the cough) is yellowifh, or greenifh, and is fometimes ilightly {freaked with blood. It is thick, vifcid, and mixed with a little frothy mucus ; at times foetid, and of a dif- a'greeable putrid tafle. Its quantity is often not lefs than two or three pints in twenty-four hours, but it diminifhes towards the end of the difeafe.
The pains accompanying this cough are of two kinds ; viz. acute pains in the fides, which frequently precede the firft attack of the cough, and are often fo violent as to flop it ; or forenefs, in the edges of the hypochondria, in the upper part of the recti abdominis mufcles* or in the loins ; which follows the fits of coughing,
In
( 4° )
In fome cafes there is no pain at any period ; frequently there is fever, though it is feldom preceded by coldnefs and fhivering, nor is it, in general, fo regular as that which accompanies the cough firft defcribed. Sometimes, in the laft ftage, there is no fever, the pulfe being only fixty in a minute. At this period alfo, purging, dropfical fwelling, or profufe fweats take place ; though ibmetimes none of *hefe fymptoms occur during the whole courfe of the difeafe. As die cough abates, the fever, purging, and fwelling abate alfo.
This cough is commonly produced by the fame caufes as the pre- ceding, but fometimes the caufe is unknown. It frequently proves fatal in a few months ; but fometimes the patient is, for a number of years, fubject to fits of it, which continue for feveral months at a time, efpecially during the winter, and, in women, during pregnancy.
Cough, ivitb Blood /pit up in fmall Quantities*
This fpitting of blood commonly happens only in the more fevere fits of coughing ; it is preceded by violent pains of the cheft, and accompanied with great difficulty of breathing, confiderable fever, and iometimes fhiverings. The pains of the chefr. are, at times, increafed by prefTure ; when thefe, and the fpitting of blood, come on without any evident caufe, they are often removed, in a week or two ; but when they attack after expofure to dampnefs or cold, they generally terminate in fpitting of matter, and a fatal phthifis.
When thcfe fymptoms are occafioned by an external injury, the fpitting of blood feldom continues above a week, and all the com- plaints ceafe in about a month ; unlefs when it terminates in dropfy,
which
( 4i )
which is fometimes the cafe. As the {pitting diminifhes, it is more or lefs mixed with a yellowiih matter, and at laft becomes entirely purulent.
In fome patients this complaint becomes habitual ; continuing for many years, and attacking chiefly in the winter, or after any violent exertion.
Cough, with Blood flowing from the Mouth, by Fits.
Frothy blood is brought up by fits of coughing, which are, in fome cafes, extremely flight ; in others, are violent, immediately before the blood begins to flow -y the quantity brought up at once is -about half a pint, or a pint : it is generally pure, but fometimes mixed with matter. The blood, in fome cafes, flows only twice or three times during the paroxyfm j in others, much oftener. The approach of each fit is commonly known by the patient's expecto- rating more eafily than ufual ; and when coming on, the blood is felt riling warm in the breafl.
Thefe paroxyfms of haemoptoe are fometimes preceded by a cough of feveral months continuance, accompanied by an expectoration of matter, or of blood in fmall quantity, or of a mixture of both ; in other cafes they fupervene a hoarfenefs brought on by expofure to cold.
This kind of haemoptoe is accompanied by flight pains of the cheft, (chiefly about the fcrobiculus cordis) with faintnefs, heavinefs and drowfinefs, which fymptoms are greatly increafed before each pa- roxyfm, and are attended with confiderable fever ; the pulfe being
G fometimes
( 42 )
fometimes one hundred and thirty in a minute. Fits of coldnefs, and of fweating, with ficknefs, retching, and purging, are alfo not unfrequent fymptoms of this complaint ; which, for the moll part, terminates fatally, though fometimes in recovery.
A remarkable Injlance of Recovery from a violent /pitting of Blood.
A man, aged twenty-eight, had, for about a week, complained of pain and fwelling at the pit of the ftomach, and under both hypo- chondria ; the pain was greatly encreafed by the flighteft preifure, efpecially on the right fide, by lying on the left, or by a full infpi- ration : it was accompanied with a trifling cough, but with a very high fever, the pulfe being commonly about one hundred and thirty in a minute. In this ftate, he was feized with moft violent fits of coughing, during which he fweated profufely, particularly on the upper parts of his body, and expectorated a confiderable quantity of a thick, brownifh, red, fmooth, or frothy matter. The cough and fpitting having been almoft inceffant for thirty hours (fome hours in the night only excepted), the pain of the right lide, and the dif- ficulty of breathing, decreafed ; the fwelling difappeared, the fever abated, and the pulfe fell to one hundred and eight -y but, in about twelve hours, all thefe fymptoms, except the fwelling, returned with violence, the fits of coughing lafting, with hardly any intermiffion, for three, four, fometimes ten, and once for twenty hours at a time. The matter which he expectorated was often extremely fcetid, became gradually more bloody, and, at laft, in the fits of coughing, he brought up pure blood in confiderable quantity, and which fome- times flowed from his mouth, uninterrupted by the cough ; the pain and fever were always relieved after the fits of coughing and hemorr- hage, and they increafed after thefe ftopt or abated. About the four- teenth
( 43 )
teehth day from the mil violent attack of the cough, he began to fpit, in fmall quantity, a white matter ftreaked with blood. The cough and fever now decreafed very fenfibly, the pulfe fell to one hundred, the pain went entirely off, the breathing became eaiy, and, in a fortnight, lie had gained fo much ftrength as to be able to quit the hofpital. In a fortnight afterwards,., his complaint again returned with as much violence as before, and had nearly the fame duration. Since this time four years have elapfed, during which he has never ' had the fmalleft complaint in the cheft, and now enjoys perfect health and ftrength.
§ 2. Of difficult Breathing, or Aft h ma.
In this complaint the patients commonly breathe, with a wheezing or crackling noife, thirty or forty times in a minute, and ftill oftener after eating, or after the moft moderate exercife. They feel a general uneafinefs in the upper part of the body, which commonly obliges them to fit up ; and likewife a tightnefs or pain acrofs the fcrjobiculus cordis, which prevents them, whether fitting or lying, from ftraight- ening the fpine, and obliges them to keep the body much bent forwards ; and fometimes makes them lie with their knees drawn up. They complain of a fenfe of weight either in one or both fides of the cheft, or at the pit of the ftomach ; when this laft is the cafe, they fometimes lie on their face, and when they turn on their back, have the fenfation of fomething falling from before ; or if they turn to either fide, of fomething falling from the oppofite fide. They often awake in a fright. Their pulfe is about one hundred in a minute. This difeafe is not unfrequently attended by a cough with fpitting, or by dropfical fwellings ; and fometimes by rheumatifm, It continues
G 2 for
( 44 )
for many years, increafing by fits ; and I have not known it, when unaccompanied with other difeafes, prove fatal.
Is it not probable, that in thefe cafes there is a fluid in the cavity of the cheft ? er a luperabundant quantity of fluid in the pericardium ? or 0 t tins membrane (in c«nfequence of inflammation) adheres to. the forepart of the. chefl ?
An inftance of difficult Breathing relieved, upon fift 'Tumors
appearing externally. .
A woman, aged fixty, formerly very healthy, after having been for feveral nights expofed to cold, was feized with great pain and dif- ficulty in breathing, and with a fevere dry cough, from which (lie was feldom free above an hour in the day. In about a month from the beginning of the complaints, a tumor appeared on the left fide near the lower part of the fcapula ; and, a month afterwards, two fmaller tumor's were obferved a little above the mamma of the fame fide : as thefe tumors increafed in fize, her complaints abated, and, in nine months, when the tumor on the back, nowalmoflhemifpherical, was larger than a new-born child's head, and each of thofe on the breaft nearly the fize of an apple. She perceived no difficulty in breathing, unlefs after exercife, and her cough was feldom fevere : ilie had fcarcely any pain in the tumors, which felt foft> as if they contained a fluid, and the fkin which covered them was of the natural colour. When me coughed, the tumors fwelled, became hard, and, as me imagined, were in danger of burfting.
In the preceding cafe, was there not an evident communication between the tumors and the cavity of the cheft ? Is it not probable, .
that i
( 45 )
that matter, formed in the cavity, had made its way through the parietes ? Could thefe tumors have been opened with fafety, or advantage ?
A Cafe of difficult Breathing immediately relieved, by, the fpontaneous D if charge of Matter from the Side.
A woman, aged twenty, received a violent blow with a man's fift on the lower part of the right fcapula ; me fell down inftantly in- fenfible, and remained fo an hour : when £he recovered her fenfes, ihe could hardly breathe, and the part where (lie had been ftruck was fwelVtd and difcoloured. Three days after the accident, fhe began to fpit blood by coughing (fometimes in clots), and fhe continued to do fo for two months, during all which time fhe could not endure any poflure but laying on her face, refting on her elbows and knees. In about ten months, the pains in her chefl, and difficulty of breathing, having nearly left her, her only remaining complaint being fits,* which came on foon after the accident, and to which fhe had been fubject ever fmce, me was feized with chillinefs, fhiverings, cold fweats, fometimes partial, fometimes general, head-ach and giddinefs, her pulfe was about eighty-four, her fkin itched violently, and many fmall itchy pimples, and painful bliflers, - appeared on it. After twelve months, the pain of the right fide again increafed ; in fourteen months it affected greatly her breathing, and fhe could not bear even the gentleft exercife, nor lie on the right fide; in fifteen months, fhe was obliged to fit up conftantly, fupported in bed, and frequently faid, that fomething was collecting in her right fide, although there was no fwelling or difcolouration of the part to be obferved. Towards the end of the fifteenth month, a flight rednefs
appearing
* Probably of the hysterical kind, .
( 46 )
Uppearin^ in one part of the fide, a poultice was applied, and, -in a few days, matter burft forth, to the quantity, as fhe informed me, of two quarts ; her difficulty of breathing was inflantly relieved. Several months after this, me had fevere pains, or flitches, in her fide near to the wound, which was between the fixth and feventh rib ; but thefe were removed by the application of a blifter, and the appearance of many large boils. She has, ever fince this time, though now four years after the accident, enjoyed perfect health.
§ 3- Of Pa?ns in the Side.
Thefe- pains are fometimes fo acute, and fo much increafed by infpiration, that the patient dares hardly attempt to breathe. Pie cannot bear the flighteft prefTure on the part affected, nor, while the pain continues violent, lie upon that fide ; but commonly lies on his back, with his head very high. His pulfe is fmall, and about one hundred in a minute ; with third, and fometimes head-ach. After the abatement of the pain, there is often a flight cough, without expectoration ; and a degree of breathlefsnefs, after exercife. The patient fometimes recovers perfectly in a few days, but fometimes the complaint lafts from one to three weeks. Thefe pains, in fome cafes, attack by fits, and then they are of longer duration ; or they accompany hyflerical fymptoms, but are then feldom fixed. The caufe of them is frequently unknown ; they fometimes come on from expofure to cold, and fometimes are occafioned by external violence.
CHAP. III.
( 47 )
CHAP. III.
Obfervattons on the Ejfeff of Remedies employed in the Cure of
Difeafes of the Cheft.
IN difeafes of the cheft I have hardly ever obferved any certain good effect from internal medicines. Vinegar of fquills, has, on fome occafions, feemed to give relief to patients affected with cough and difficult breathing ; and oily medicines, or fpermaceti, appeared almoft certainly to allay, for a fhort time, violent coughing. But the remedies which have ftill greater and more lafting effects, are bleeding, blifters, and other local difcharges ; alfo fomentations. Bleeding is the appropriated remedy for a cough, and, except in the laft ftage of confumption, feldom fails to afford very coniiderable relief, which fometimes is felt immediately after the operation, at other times not till the next day, or even the third day j and upon fome occafions, not till after repeated bleeding. This remedy is alfo of fervice in cafes of difficult breathing, and in pains of the fide ; although, for the latter complaint, the appropriated remedy is a blifter, which almoft conftantly gives relief either immediately, or the day following.
Blifters are likewife of confiderable efficacy in cafes of difficult breathing, or hoarfenefs, and fometimes of cough. Setons or iffues are ufeful in pains of the cheft -, and fomentations are of fervice in pains occafioned by external injury. From the early application of thefe remedies, pains of the fide frequently, and dry coughs, fome- times, terminate favourably ; but if they are delayed for a week or a
fortnight,
( 43 )
fortnight, the difeafe does not yield to them, but feems to keep on in its natural courfe.
In cafes of cough with expectoration, and of difficult breathing, or afthma, thefe remedies feem to afford only a very tranfitory relief, and to contribute but little towards retarding the progrefs of the difeafe. Thofe diforders, therefore, which are the moft common, and the moil fatal of any, are unfortunately leaft under the power of phyfic. I have known good air of fervice in fuch cafes, after bleeding had failed to afford, even a temporary relief.
PART IIL
( 49 )
P ART HI.
Difeafes of the Fluids,*
CHAP. I.
Difeafes of the Fluids, illufl rated by DiJJ'etfion.
% I. Extravafation of the Serum, or thinner Part of the Blood.
A WOMAN, aged twenty-three, who had never menflruared, and, for many years, had been in a bad ftate of health, but without any particular complaint, became anafarcous about fix weeks before her death. She had no cough, nor was her breathing labo- rious, although fiie frequently fat up in bed, and fpeaking was trou« blefome to her : fhe only complained of the fwelling of her* body, and of weaknefs of her eyes. She died quietly, and rather unexpect- edly, in the night,
A tranfparent yellow fluid was found in mcft parts of the cellular membrane, a fimilar fluid in the abdomen, and a more than ufual quantity of fluid in the pericardium, which adhered by a broad furfice to the ribs and pleura of the left fide: the lungs of this fide, on firft opening the thorax, were not vifible, but after feparating ^he pericardium from the ribs, and drawing it forwards, they were {sen.
H firmly
* I chofe this title, not from any idea that the difeafes defcribed under it were •difeafes of the fluids only, and that the folids were not likewife affected ; but becaufe the changes which took place in the fluids were evident to the fenfes, whilft thofe of the folids were not.
o
Li: RY
( 50 )
firmly adhering to the poflerior part. They were intirely red, not more than three inches broad, thin in proportion, not divided into lobes, not veficular, every where hard, and, at each extremity, nearly of a tendinous confidence, and adhering fo firmly to the ribs,, that they could not be feparated from them by pulling : the lungs, in the right fide adhered likewife to the parietes, in other refpech were found, as were the abdominal vifcera.
As anafarcous fvvellings fo frequently accompany difeafes of the: lungs, is it not probable, that they have fome dependance on the ftate of this organ ?
§ 2. Extravafation of the red Part of the Blood.
A woman, aged fifty, who, a fortnight before, had been feized with- a fever, of which fhe could give no diftincl: account, complained (the fever ftill continuing) of pains all over her, and red fpots ap- peared on her arms, breafl, and legs : fiie was cofKve, her tongue parched, and covered with a black cruft, or Hough ; her pulfe, fmall, but not very quick ; fhe was at times delirious, and often quite fenlible. The colour of the fpots becoming gradually darker, and her pulfe finking, fhe died about the nineteenth day of her illnefs.
Forty hours after her death, we examined the body, when, befides red and purple fpots, of about a quarter of an inch diameter, which were very general on the furface, particularly of the ex- tremities ; there were alfo fome blue blotches. The purple fpots,, viewed with a microfcope, appeared of an uniform colour, whilffc the red fpots, which were broader, feemed a congeries of minute fpecks and ramifications. The cuticle, feparated from the fkin by boiling
water t
( 5' )
•\vater; was found not in the leafl affected by the fpots, which appeared more diftinct after its removal : they were confined entirely to the fkin, though only viiible on its external furface ; and they difappeared altogether, when, after removing the cuticle, the fkin was macerated in water. Sometimes, immediately under the fpots, there were fmall effufions of blood in the cellular membrane ; and, under the blotches, both this membrane and the fat were en- tirely red ; but the mufcles never were affected. After having very carefully and fuccefsfully injected one of the arms, no extravafation of the injecting fluid could be perceived, either on the fkin, or in the cellular membrane ; nor could we fee any extravafation or en- largement of vefTels on a piece of the fkin, which had feveral fpots, when injected and dried. The vifcera of the thorax and abdomen were found : in the cavities of the heart and large blood-vefiels, were found fmall but not firm polypi. A bit of the black emit, or Hough, taken from the tongue and macerated for fome days in water, tinged it red : what remained was a white mucus, readily diffufible in water, and fomewhat refembling moiftened bread.
As there was no extravafation to be difcovered after a very minute injection, is it not probable that the extravafation of the colouring part of the blood, in the preceding cafe, was more owing to the Hate of the blood than to that of the blood- vefTels?
§ 3. Extravafation of coloured Serum, &c*
A man, aged twenty-four, was fuddenly feized with fhivering, which, after returning two or three times, was followed by the fymptoms of fever ; he complained chiefly of heat, flept much in the day ; in the night was often delirious : his pulfe was quick and fmall,
H 2 his
( 52 )
h.s tongue dry, but not foul -y he had two or three ilools a day, and I his urine let fall a copious cream-coloured fediment, refoluble by heat. On the feventeenth day, he felt a pain in the lower part of his thigh, which, on the twentieth, was greatly increafed, and extended down the outfide of the leg ; the parts affe&ed were red, and fomewhat fwelled : his tongue was parched, and his pulfe fuller than before. On the twenty-fourth, the limb had become in part livid, the leg and foot were greatly fwelled and painful -, his countenance was pale, his tongue black, his pulfe fluttering : and, on the twenty-fifth^ the day of his death, the cuticle was raifed in bliflers, the leg having exactly the fame appearance as it had . two days after, when the body was examined.
The lower part of the right thigh was, on the outfide, red, or livid, and covered with fmall bliflers, containing a red liquor; the lower part of the leg and foot, of the fame fide, were very much .. fwelled, ' and, on the outfide, which was of the fame colour with the thigh, there was a great blifler, from which, before death, two ounces of a tranfparent red fluid, without fmell, were taken. On the right arm, was a flight livid fpot. In the veins of the pia mater, , we found blood and air alternately interpofed. The fluid in the lateral : ventricles, was reddifh, and coagulated Hightly by heat. The liquor taken from the leg being immediately mixed, in different proportions, with water, gave it a red tint, the mixture remaining tranfparent ; but, next morning, there was either a white cloud formed, a fur adhering, or a fediment depoflted : the fame liquor unmixed with water, fuffered no change 'till the fourth day, when it alfo let fall a fimilar fediment ; but it flill, and for feveral days afterwards, re- mained tranfparent : it was coagulated by heat almofl as firmly as the ferum, a fmall quantity of an aqueous fluid remaining.
Did
( 53 )
Did not the firm coagulation, by heat, of the extravafated fluids /hew that it was chiefly ferum ? Did not the admixture of the red part of the blood with this fluid, and with the lymph of the lateral ventricles, fhew a tendency to putrefaction ?* although, as there was no difagreeable fmell, this could hardly be faid to have taken place. Was not the air interpofed between the portions of blood in the veins of the pia mater, a further evidence of this tendency ? for I have, on other occafions, remarked, that large veffels which paffed near an internal putrid ulcer, contained, in like manner, portions of blood,, and of air,, alternately.
§ 4. Putrefaction of the- Fluids,
A woman, aged twenty, was feized with fhiverings,. followed by fever ; fhe became dull, heavy, flupid, and fometimes delirious : me had a violent purging, her tongue and eyes were parched, her pulfe quick and fmall, and there were petechias on the right arm ; fhe was quite neglected 'till the tenth day of her illnefs -y fhe died on the eleventh, and, immediately after death, a change of colour took place in the body. .
This difcolcuration was principally on the right dde,. from the breaffc to the middle of the thigh, and from the linea alba to the fpine; the upper and lower parts, and belly, were green, the back liyid, and the pudenda quite black : at incifions made on any of thofe parts, a confiderable quantity of a muddy liquor, nearly of the fame colour with the part, run out : it was fo intolerably fcetid, that a man had almofl fainted from fmelling to it; the parts from which it flowed were tender, and eafily pulled afunder. In the pudenda, the blacknefs penetrated to the cellular fubftance
and.
( 54 )
-and fat, but it did not extend inwardly beyond the nymphas, and backwards not quite to the anus ; the green colour of the abdomen penetrated through the integuments, the fat, and the oblique mufcles j but the recti, tranfverfe mufcles, and peritoneum, were free from it. The livid colour of the back penetrated almofl to the bones, near which the mufcular fibres appeared found ; there were a few red fpecks on the arm and bread of the right fide ; nothing preternatural appeared in the cavity of the abdomen, except one black fpot on the fundus uteri.
After having vifited this woman, I became for a minute, blind, ftupid, and confufed, but I fuffered no inconvenience either during the diiTection, or afterwards. One drachm of the putrid liquor re- ceived at the incifions, was, an hour afterwards, along with three drachms of water, injected into the crural vein of a healthy bitch, who was giving fuck : in a minute me vomited ; in an hour all her limbs trembled, and in an hour and a half fhe feemed in the greatefr. uneafinefs, whilft her puppy, who had given over fucking, was making a noife : me frequently vomited during the day, and in the night j next day, when called to, Hie moved flowly and feebly, and could hardly keep her eyes open ; her hair flood on end, and me refuled taking food 'till the evening, from which time flie gradually recovered.
Twelve hours after death, I examined the body of a young man who died of a fever refembling the preceding. The fkin of the left bread was brown, and the pectoral mufcle had loft its colour and was rotten ; the liver, likewife, was in fo tender a ftate, that a very fmall force was requifite to pufh the finger into any part of it. The other abdominal vifcera appeared found.
Soon
( 5S )
Soon after examining this body, I felt an acute pain at the end of the finger which I had pufhed into the liver j it inflamed : a fmall piece of it near the nail became black and mortified, and, after a few days, was thrown off by fuppuration.
Are dullnefs, ftupor, and lownefs of pulfe, the criteria of this fever, or of a tendency to it ? Is infection more readily communicated from the living than from the dead body ? May an external part of a healthy body be affected without injuring the reft of the fyftem ? If the putrid matter has been mixed with the blood, will a putrid fever always follow ? Is there a connection between this and the petechial fever ? From the external parts being principally affected, is it net- probable that the air has fome influence in promoting the putrefaction ? Would not the external application of antifeptics have an effect in retarding this procefs I
§ 5 . Extravafation and PutrefaBion, united in the fame SubjeSf,
A woman, aged fifty, who, though addicted to the ufe of fpirituous liquors, was healthy till four years before her death,, when fhe was feized with pains of the cheft, cough, and difficulty of breathing, which going off in a few months, me continued well for three years : her complaints then returned, and, for two months, were accompanied with a very copious difcharge of thin faliva ; foon after the flopping of which, fhe became generally oedema tous. During a few months In the fummer, the fymptoms were moderate,, but, four months before her death, they were more violent than ever ; her breath being very fhort, obliged her to fit up almoft con- stantly -, for, when lying, fhe was in danger of being fuffocated ; fhe could utter but a few words without flopping j her cough was very troublefome, and, in the fits of it, her face, which was at all times
bleated.
( 5« ')
bloated, became purple ; me often performed all the motions of coughing, without uttering any found ; me was thirfly, her tongue dry and whitifh ; her pulfe about one hundred -, her urine de- pofited a copious fediment, like powdered bark, the liquor above refembling diluted claret. The fwelling was univerfal, but the lower extremities were fo much diflended, that they could hardly be moved. The belly being alfo greatly diflended, fhe was tapped, and feveral gallons of a greenifh liquor, by this means, were evacuated. After the operation, (he was, for feveral days, much relieved ; but, on the fixth, having had a violent fit of fhivering, fhe died fuddenly.
In the month of February, thirty-four hours after her death, I examined the body. It was generally fwelled, with red fpecks and purple fpots on feveral parts of the furface j the latter, about one third of an inch in diameter, penetrating quite through the fkin, were owing to extravafated blood. The face was of a deep purple; on the breaft were long, ramifying, red vibices ; a portion of the cuticle, on the infide of the thigh, was raifed in a blifter, containing a thin, reddifh fluid, and, for a confiderable way round the blifter, was eafily feparable from the true fkin : in the abdomen, were feveral quarts of a reddifh muddy fluid, in fome degree coagulable ; the contents of this cavity were found ; the liquor pericardii was reddifh ; the lungs every where adhered, by a cellular fubflance, to the neigh- bouring parts, and, though there was no particular hardnefs, or tubercle, to be feen, they were not quite fo foft as in a found ftate -9 air blown in at the windpipe efcaped, and diflended the cellular fub- flance on their furface ; the fame thing happened, when, in a portion of the lungs cut off, air was blown in at a branch of the windpipe, or pulmonary vein : when the pulmonary artery was blown into, its fmaller branches were alone diflended ; a black fubflance accompanied
the
y
( 57 )
he vefTels in their courfe, and appeared, upon a tranfverfe fection, like a black circle furrounding them.
Was the want of found in coughing owing to the air, in the time of that action, efcaping from the veficles into the cellular fubftance ? Is this, therefore, a fign of ruptured velicles ? Did the copious dis- charge of faliva, in the beginning, mew a feparation of the thinner fluids j which, upon the flopping of that difcharge, were depofited in the cellular membrane, and in the abdominal cavity ? Did the purple colour of the countenance, the fpots and vibices, mew that the red part of the blood was broken down, and entered vefTels which, in a found ftate, it could not do ? Did the colour of the urine, of the liquor in the blifler, abdomen, and pericardium, ihew a folution of the red part of the blood in the thinner fluids ? Do the fluids in cavities fometimes acquire a red tint, either a few days before, or a few days after death ? Was the difeafed ftate of the fluids, in the preceding cafe, to be imputed to the affection of the lungs, to the ufe of fpirituous liquors, or to both ?
In differing the body lad mentioned, having broken the ribs that the lungs might be more fully feen, the pointed fplinters of them punctured the cuticle on feveral of my fingers, efpecially of the left hand. On returning home, about an hour after, I was feized with miverings, wearinefs, and pains all over my body : towards evening I had a violent head-ach, and fome degree of fever; but next morning awoke perfectly well. The wounds did not heal up, but became red, fwelled, and, though not very painful, for feveral months gradually increafed. Having the fame day, imme- diate^ after examining this body, examined the body of a man who had had a veneral complaint, it was fuppofed that from the latter, the injury might perhaps have been received : I, therefore, made trial
I of
( 53 )
of a variety of mercurial applications, after each of which the tumors became larger, redder, and more painful ; they were then burnt down by lunar cauflic, but always grew up again, and, at laft, had the appearance of warts, with their bafes fwelled and red. In lefs than a twelvemonth after the accident, there appeared on the back of the left hand, where there had been no wound, a fmall, moveable, round tumor, refembling a lymphatic gland, which gradually in- creafed ; the lkin became livid, and there were fometimes flight mooting pains in the part. Soon after the appearance of this tumor, the glands in the left armpit fwelled, and became, in fome degree, painful -y the glands of the fame fide, under the lower jaw, alfo fwelled, and feveral fmall fores broke out upon the tongue and inlide of the mouth ; foon afterwards the glands alfo of the right armpit fwelled. Being at a lofs how to flop the progrefs of fo uncommon an affection, I began to take mercurial medicines, in comiderable quantity, which I had feveral times employed before, though fparingly : at laft, I underwent a falivation by unction ; but never obferved, during this courfc, nor for a confiderable time after it, the fmallefl favourable change upon the tumors on the hands, the fwelled glands in the armpits, or the fores in the mouth ; I, therefore, fubmitted to have the tumors removed by the knife, feveral of which growing up again, were repeatedly cut off. The fores, while healing up, never had a good appearance, but were floughy, and fometimes very painful. In about a fortnight, after the laft remaining tumor had been cut off for the fecond time, and about two years after the wounds had been inflicted, the fwelhng of the glands fubiided, the fores in the mouth healed up, and have not (though it is now almofc three years) in any degree returned.
CHAP. II.
( 59 )
CHAP. II.
A Defcription of the Symptoms of the Difeafes of the Fluids, taken from thofe Cafes where the Patients recovered, or where the Author had no Opportunity of examining the Body after Death.
§ i. Swelling of the Belly, with Fluctuation,
THIS fwclling fometimes occurs alone, but raoft commonly it is attended with external, or cedematous fwellings. Women are chiefly fubject to it from obftrucftion in their menfes, or during preg- nancy, in which cafe it continues after delivery. It happens to psrfons of either fex after a cold, cough, or fever, and fometimes without any difeafe preceding it. It is accompanied with difficult breathing, cough, thirrr., a diminution in the quantity of urine, and, at times, with fever. The patients, in general, have a faded, or fallow complexion, though fometimes they retain a ruddy and healthy appearance. I have known this complaint continue five years, with- out caufing any confiderable uneafinefs ; but when the fwelling has reached its utmoft extent, the condition of the patient is truly miferable : obliged to lean forward, the belly fupported by pillows, tormented with violent pain in the bowels, and with bile forced up into the mouth almofl every minute. This difeafe is frequently relieved, or carried off, at leaft for a time, by fpontaneous purging ; fometimes by fpontaneous fweating. When it returns, as it fome- times does, feveral times in a year, it terminates fatally.
Might not fudorifics be tried in thofe cafes where purgatives have filled ?
I 2 § 2. General
( 60 )
$ 2. General external Swelling, retaining the Imprejfion of the
Finger*
This fwelling is more remarkable in the lower, than in the upper parts of the body, and is frequently more confiderable in the right than in the left fide ; the parts affected, are, fometimes, though rarely, tender and painful to the touch. This complaint is fometimes unpre- ceded by any other, or it follows after ficknefs and indigeftion, fudden fuppremon of the menfes ; and frequently after a cough, or fome other affection of the cheft. It is commonly accompanied by difficult breathing, thirft, and paucity of high-coloured urine, be- coming turbid when cold. Perfons of very different ages, from twelve to fixty-two, are fubject to this difeafe : fome have the countenance bloated, others have a fpontaneous and very confiderable bleeding at the nofe -f in either cafe, and not otherwife, the difeafe terminates fatally.
§ 3. General external Swelling, wltb Swelling of the Belly.
The union, or combination, of thefe complaints, is to be met with mod commonly in perfons naturally of a weak or unhealthy conftit .on, the external fwelling almoft constantly precedes the fwelling of the belly ; they follow from the fame caufes, as when fingle or alone. I have known them happen, and to a high degree, in a fortnight, after a bruife on the cheft. They are accompanied by the fame fymptoms as § 1. and § 2. often with faintnefs and lownefs ; fometimes with vomiting of blood, or purple fpots on
the
( 6i )
the fkin, both fatal fymptoms. They fometimes terminate favourably by a fpontaneous purging, increafed difcharge of urine, or a flow of thin fluid from the falivary glands.
Is not either fpecies of dropfy commonly a fecondary difeafe ?
Is it not evident, from the bleeding at the nofe, vomiting of blood, and purple fpots, that the red part of the blood is broken down, or the blood- veflels weakened ?
Should not the view of the phyfician be directed rather to the amendment of the fluids and folids, than to the evacuation of the former ?
Is it likely that this amendment may be attained by animal food and Peruvian bark ? r
When the evacuation of the fluid is necefTary, and when purgatives, diuretics, and fudorifics have failed, might we not imitate nature, and excite a falivation ?
§ 4. A fluctuating Swelling on the Loins.
A man, aged thirty-two, having been thrown down on his face, the narrow wheel of a loaded cart went directly acrofs his loins from left to right ; he was carried home, neither wounded nor in pain ; and, though benumbed in the loins, he walked in the evening. For fome days he complained of pain in his bowels, and had no ftool. The day after the accident, we obferved a fluid collected under the integument of the loins. In a fortnight, the integuments were greatly
fwelled,
( 62 )
f welled, and an evident fluctuation was felt on ftriking the tumor. In a month, the fluid having fpontaneouily decreafed, did not fill the cavity which it had formed, and by change of pofture, or upon prerTure, it moved from place to place, the patient himfelf being fenfible of its motion, as he had been before of its fluctuation. The cavity, at this time, extended from the os coccygis, feven inches upwards ; and from the left great trochanter to within a few inches of the fame tuberofity on the right fide. In two months, the fluid had almofr. wholly difappeared, and the integuments having become firm, adhered to the parts underneath. In a few weeks more, he was free from complaint.
N. B. Fomentations had been employed.
§ 5. Fever, with red, or purple Spots on the Skin.
This difeafe commonly begins with a fit of mivering, which fome- time3 returns, and is always followed by fever. The patients, in general, take to their beds in the beginning, although they fometimes go about for three or four, or even nine days, uncertain of the nature of their complaint. The fpots appear, at different times, from the fifth to the tenth day, and are either very fmall, of a deep red or purple colour ; or larger, about one quarter of an inch in diameter, and of a paler red : both kinds frequently appear in the fame perfon ; the former chiefly on the extremities, the latter all over the body. The breathing is laborious, and fometimes accompanied with a fnorting noife. The eyes are red ; the tongue and lips parched, or chopped, and covered with a black, tough, femi-tranfparent cruft ; which, by maceration in water, becomes at firft gelatinous, and afterwards of the confluence of fyrup. Sometimes blood is effufed on the tongue,
and
( H )
and hardens on its furface. The pulfe feldom exceeds one hundred in a minute, fometimes flower ; it is low, and ftrikes the finger fo "radually, that it feems rather to prefs upon than ftrike it : it fre- quently intermits. The patients complain of pain, or of noife in the head, and of general uneafinefs ; they are dull, and fo drowfy, that . they can hardly keep their eyes open ; they are fometimes fenfible, but more commonly delirious, efpecially in the night, when, unlefs prevented, thay frequently get out of bed, but are not outrageous, and are eafily prevailed on to return again to bed. The liquor difcharged by blifters, though of a dark brown colour, is free from fmell. The ftools are fometimes of the fame colour, and the urine deposits a ipongy, fometimes reddifh fediment, in fmall quantity, there is feldom any tendency to fweating, but very often to purging, the fick having commonly four or five ftools in twenty-four hours ; end it is difficult to determine, whether this evacuation be hurtful, or ferviceable. An abatement, or relief of the fymptoms, commonly happens on the fourteenth day, feldom fooner ; frequently not till about the twentieth. For feveral days after the abatement of the fever, the patients are often troubled with a dry cough, and fome- times become deaf. Of ten patients whom I faw in this fever, two died : the firft, who had a mod violent purging, died on the fixth ; and the lecond, who was coftive, died on the twenty-fecond day. This fever appeared, in fome inftances, to have been communicated by infection.
Did the fpots, the blood effufed and concreted on the tongue ; the colour of the liquor of the blifters ; that of the ftools, and the fediment of the urine ; mew that the red part of the blood was broken down ?
CHAP. III.
( 64 )
CHAP. III.
Obfervations on the Effects of Remedies given in the Cure of
Difeafes of the Fluids.
§ i . A general Account of thofe Effects.
IN the fpotted fevers, inftances of recovery were moft frequent after the ufe of bark, of cordials, and of blifters. The fwelling of the belly, or of the external parts, in general, fubfided, though com- monly only for a time, from the ufe of the more powerful purgatives ; viz. jalap, elaterium, and dried fquills, given either feparately or combined. Alfo during the ufe of diuretics, as nitre, the fal diu- reticus, infufion of horferadim, and tincture of cantharides. The fwelling of the belly con flan tly returned after tapping, and fometimes the patients died very foon after this operation. The puncturing the legs was likewife attended with danger, and, in one cafe, the limbs inflamed, became black, and the patient died in three weeks. As evacuations then are mofl commonly ineffectual, and even dangerous, a medicine is greatly wanted which would produce fuch a change in the parts, as after abforption to prevent the further extravafation of the fluid. The two following Angular inftances of the happy effects produced by mercury and bark, may poffibly fugged fome ufeful hints on this important fubject.
§ 2. The Effect of Mercury in an objlinate Swelling of the Limbs.
A young woman having, on the day her menfes began to flow, taken imprudently, whilft hot, a draught of cold water, the difcharge
immediately
( 6j )
immediately flopped ; her legs inflamed and fwelled ; and me was feized with fhiverings> followed by fever and pains all over her body -t after two or three weeks, the fits of fhivering, fucceeded by fever, frequently returned again, and at thofe times the inflammation of the legs increafed. In about a year, the whole of the lower extremities had attained an enormous fize ; but the fwelling was not now at- tended with inflammation ; on the contrary, the limbs were cold and hard : it differed alfo from the oedema, as it did not retain the im- preffion of the finger ; nor was fenfibly increafed towards evening. In every other refpecl, excepting a diminution of the catamenia, the patient feemed to be in perfect, health. Notwithftanding the ufe of various medicines, and the application of cauftics and blifters, which laft, by the bye, occafioned no difcharge, her limbs remained in the ftate above defcribed for almofl two years and a half ; fhe then began to rub on her legs the mild mercurial ointment, gradually encreafing the quantity to half a drachm, afterwards to one drachm every night -3 fhe lived low, and the limbs were kept in a horizontal poflure. In three weeks, the fwelling having fubfided, the legs were foft and flaccid ; and, in three months, the fkin was fo loofe, that it feemed probable, that what had formerly diflended it, was nowmoflly abforbed. Her mouth was but little affe&ed ; her bowels not in the leaft : fhe fweated much, and made water in confiderable quantity.
§ 3. The Effeff of Bark in a copious Difcharge of putrid Sa/iza,
A woman, aged thirty-eight, after feveral irregular fits of coldnefs, fucceeded by heat and fweating, was feized with a fwelling of her cheeks, which externally were tenfe and mining, and internally were covered with a firm white cruft, or flough, above half an inch thick, and which was totally infenfible when cut through with a knife ; the
K palate
( 66 )
palate and gums were alfo covered with a fimilar flougk ; the tongue was almoft unmoveable, fo that her fpeech was feldom intelligible, and the teeth could not be brought in contact, owing to this cruft projecting between them : there was, day and night, a continual difcharge from the mouth of a vifcid, ropy fluid, frequently bloody, and fo abominably foetid, that it was difagreeable to come within feveral yards of her 5 the quantity difcharged was about four pints in twenty-four hours. The fluid fpontaneoufly feparated into two parts : the one a thinner j the other a more vifcid and heavier ; the former not at all, the other only partially coagulable by heat ; the patient could fwallow only the thinneit liquids, and even thefe with difficulty: {he had no appetite, but had ddly four or five loofe ftools : her pulfe was very fmall, between one hundred and fix, and one hundred and twenty. To this miferable condition fne had gradually arrived ; when, on the twelfth day of her illnefs, flie began to ufe the bark in the following manner :
R. deco£L corticis pcruv. unciani unara. Tin<St. cjufdem, drachmas duas. Quarta quaque hora fumendas.
In four days the difcharge was thinner, and lefs ofrenfive ; fhe had lefs difficulty in fwallowing, had fome appetite -, her pulfe was flower, her purging had flopped, and the cruA began to fall off from the angles of the mouth ; continuing to recover, me, in a few days more, began to have pain in her cheeks, which before were in- fenfible ; afterwards in her tongue ; and, laftly, in her gums and teeth •> the agony of which was fometimes lb great as to prevent her fleeping. When the cruft had fallen off from the gums, they ap- peared puihed out in the form of papillae. On the twelfth day, after fhe began to take the bark, her face, outwardly, had almoft. its natural appearance ; the cruft had fallen off entirely from the cheeks,
palate,
( 67 )
palate, and gums, the papillas of which had alfo fubfided, and there was but little of it now remaining at the root of the tongue : fhe could bring her teeth clofe together, could move the tongue a little, and fpeak more difKnclly. The difcharge, now far lefs copious and lefs foetid than formerly, did not flow conftantly, but, being col- lected in the mouth, was fpit out ; fhe had hardly any pain, could fwallow folid food, was colli ve, and her pulfe between eighty and ninety. In a few days more the difcharge flopped entirely, and, in a few weeks, fhe had no complaint but fliffnefs in the parts, which prevented her from opening her mouth, or putting out her tongue freely 3 and fome months afterwards, being perfectly well, fhe went into the countrjr»
X 2 PART IV.
i <>* )"
PART IV.
Dijeafes of the Head; Nerves, and Mufcles.
CHAP. I.
Difeafes of the Head, &c. illufiratcd by DiffeBion.
§ i . Lymph lodged between the Dura and Pia Mater.
A STOUT man, aged twenty-three, was fuddenly feized with a fever, accompanied almon: conftantly with violent delirium. When brought to the hofpital, he walked about nearly as a perfon in health, and anfwered fome queftions fenfibly ; but the anfwers he gave to others, and a certain wildnefs in his look, difcovered the dangerous ftate he was in. As he could not otherways be kept in bed, he was bound with broad ftraps of leather ; his face and eyes were red, his pulfe neither quick nor full ; he always faid he was very well, that his giddinefs had gone off, and complained of his confinement. Every night, and frequently during the day, he was noify and ungovernable, tearing whatever came within his reach. On the night but one preceding his death, he broke the ftraps, got out of bed, and it was with difficulty that three men could again lay him down. Pie then fweated profufely, his pulfe funk, his f:.ce became pale, his voice changed to a doleful cry ; and, in a few hours afterwards, on the morning of the ninth day, he expired.
A woman,
( 69 )
A woman, aged fixty, was feized with a fever, accompanied alfe with violent delirium : when afked how fhe did, me commonly anfwered fhe was very well, excepting towards the end, when fhe complained of her head ; fhe was noify in the evening, and during the night, and it was with difficulty that fhe could then be kept in bed. Her pulfe was quick, and fometimes intermitting ; her eyes red, her lips black : at laft, her face having been frequently diftorted, and her arms fometimes convulfed, fhe died on the thirteenth day.
A flout man, aged thirty-two, after feveral fits of fhivering, was feized with a fever, accompanied with violent delirium, though lefs conflant than in the . preceding cafes: he was fometimes fenfible during the day, and complained greatly of his head ; he was out- rageous on particular nights only ; his eyes were red, and his pulfe quick. He died on the eighteenth day.
In the three preceding cafes, after the fcull had been fawed through, on cutting the dura mater* and inclining the head, a thin colourlefs liquor, not coagulable by heat, run out, to the quantity of about two ounces, in the firfr. cafe ; of about an ounce and a half in the fecond; and of about half an ounce in the third. After the upper part of the fcull had been feparated from the dura mater, on railing this membrane, a fmall quantity of lymph was obferved lying between it and the pia mater ; and, after the brain had been removed, the medulla oblongata and fpinal marrow appeared fur- rounded with lymph. In the firft cafe, there were no other preter- natural
; We were 3cd to perform this part of the difle&ion with caution, having formerly found lymph in the encephalon of a man, who before death had fimilar fvmptoms, but v/hofe head was not opened fo carefully as to enable us to give an exad defcription cf it.
( 7° )
natural appearances in any part of the encephalon ; in the fecond and third cafe, there was a fmall quantity of lymph effufed between the convolutions of the brain, under the pia mater ; and, in the fecond cafe, there was rather more than the common quantity of lymph in the lateral ventricles.
Are outrageoufnefs, and inTenfibility to pain, characterifKcs of this fpecies of fever in its highefl degree ? From the violence of thofe fymptoms being nearly in proportion to the quantity of lymph effufed, is it not probable that they are occaiioned by the preflure of that liquor upon the brain ?
§ 2. Suppuration of Part: of the Dura Mater J*
A woman, aged thirty-four, ftooping to avoid a beam of wood which a man carried on his ihoulder in the ftreet, was ftruck by it in the upper and fore part of her head fo violently, that fhe fell backwards : lhe, however, got up again immediately, and, after wiping off fome blood which came from the wounded part, walked feveral miles : fhe alfo next day walked feveral miles, but complained that the cold ftruck like a knife through her head. On the fourth day, fhe came to the hofpital, when a tumor, which had rifen about the wound, was laid open, and a fracture fearched for, but none was found. Though fenfible, fhe fometimes ftarted and looked oddly. In the evening a delirium came on, and fhe was noify a great part of this, and for many fucceeding nights. During the day alfo fhe was frequently infenfible and delirious, efpecially on the tenth and the three following days ; fhe often complained of exquifite pain in her forehead, which fhe would Hot fuffer to be touched ; fhe alfo complained of weight and op-
preflion* * ftg. xu
( 7> )
predion, and always cried out at the dreiling or enlarging of the wound : her face was often diflorted, and her limbs convulfed ; fometimes (he trembled, and frequently ftarted when fpoken to : the pulfe was feventy, and pretty regular. On the fourteenth day the delirium had greatly abated -, fhe became almoft conftantly fenfible of her pains, and was apprehenfive of danger ; on hearing the leaft noife me ftarted, and faid it was like thunder in her ears : the pulfe was between lixty and feventy. On the morning of the feventeenth, fhe had a fit of fhivering, which returned afterwards, four or five times, at irregular periods : it was followed by fever and fweating : the pulfe, during the fever, varied from one hundred, to one hundred and thirty, according to the violence of the fit, and the fiiortnefs of the interval between it and the time of examining the wound. About the twenty- firft the delirium went off entirely; fhe was dull, drowfy, kept her eyes fhut, and feldom fpoke j fhe afterwards became gradually weak, apt to faint when fitting up to have her wound dreffed : the pulfe funk ; and, on the twenty-eighth day, after receiving the blow, fhe expired.
The contiguous furfaces of the difeafed part, both of the dura mater and of the cranium, were each of them moiflened with a little purulent matter -3 but the bones were fmooth, and, in every refpecl:, found. The internal furface of the dura mater, oppofite to the difeafed part ; the falx, and the two lower fides of the longitudinal finus, appeared quite found, but the internal furface of the upper fide of that finus, was of a light flraw colour, fmooth, and, when held oppofite to the light, did not feem thickened. All the other parts of the membranes of the brain, and of the cerebellum, were carefully exa* Hiined, but we met with no other preternatural appearance.
Where
( 7* )
Where the reflexion of the dura mater forms the falx, is there any cellular fubftance in which pus may be formed and collected ? Does matter collected there, make its way more readily through the ex- ternal lamina of that membrane to the bone, than through its internal lamina to the brain ? In the preceding cafe, was there no matter formed till about the feventeenth day, at which time the delirium went off, and the fhiverings began, which were foon followed by drow- finefs ? If fatal confequences arife from a few drops of matter in the head, what have we to apprehend from a larger quantity of this, or, probably, of any other fluid, collected there.
§ 3. The Veins of the Pia Mater apparently enlarged.
A man, aged twenty-three, after having been drunk and riotous in the ftreets for two nights, was feized with pains, particularly in his head, attended with fever : he fweated in the beginning. On the fourth, and fome following nights, he was delirious, though not unmanageable : during the day he was fenfible, until the feventh, after which he appeared quite ftupid, and his eyes, both day and nighty were open and fixed -, his body at firft coftive, was now loofe, and his ftools and urine came away involuntarily ; he fweated pro- fufely, and died quietly on the eleventh day.
In fawing the fcull rather haftily, the veins of the pia mater, which terminate in the longitudinal finus had been, as we afterwards found, cut through, and about two ounces of blood had run out ; yet thofe veins, when the cranium and dura mater were raifed, appeared ftill diftended with blood, and greatly enlarged. The other parts of the encephalon were examined, but nothing preternatural was feen. The lungs and heart were in a found ftate.
§ 4- M
( 73 )
§ 4- -ZVb morbid Appearance in the Brain after an Apoplexy,
A flout healthy man, aged thirty-one, who in the morning went out perfectly well, in the courfe of the day complained of giddinefs and head-ach. In the evening, when walking with fome com- panions, he flopped fuddenly, faying, that his head-ach and giddinefs were fo great he could not go on. He immediately leant to a fide, was violently convulfed, and, though his friends ran to his affiflance, fell to the ground' fpeechlefs and infenfible. Twenty- four hours after the attack, he lay on his back, breathed high, with a fnorting noife ; his face was turned to the right, his mouth and nofe drawn a little to the fame fide, and froth ifTued from his mouth ; his eyes were fhut, whilfl tears ran from them j his pulfe was quick and very high ; his fkin hot, and moiflened with fvveat ; and the mufcles of the arms quite relaxed. After thirty-fix hours, there was little alteration in the fymptoms, only that the eyes were now open, though fixed, and not affected by the near approach of objects ; pulfe alfo was lower, and his fkin was neither fo hot, nor fo moifl as at firft. After forty hours, the ala? nafi were during infpiration drawn almofl clofe to the feptum ; and, indeed, the trunk of the body ieemed drawn up at the fame time : the right fide of the face was now frequently diftorted ; the right arm fometimes convulfed : the heat of the body diminished ; the pulfe was no longer to be felt, and, m forty-five hours, he expired.
The membranes, fubflance, and ventricles of the brain, cere- bellum, and medulla oblongata, were all carefully examined, but nothing preternatural was obferved. Upon inverting the trunk of the body, about an ounce, or more, of a bloody fluid, ran out from the
L fpinal
( 74 )
/pinal canal. The fpinal marrow, owing to fome neglect, was not examined. The vifcera of the thorax, and of the abdomen, appeared perfectly found. The ftomach contained a yellow fluid.
§ 5. Deep red Blotches, and partial Suppuration in federal Mufcles of the Body, in Confluence of a Wound.
A man, aged forty-five, fell from a height of about eight feet, and ftruck his left leg againft the point of a pick-ax. He walked a good deal after the accident, and the wound, for feveral days, was quite neglected. On the eighth day, he firit felt pain in his throat, and, in the evening, fwallowed with difficulty. On tJie eleventh day, the lower jaw was fixed fo clofe to the upper, as to prevent him taking folid food. On the thirteenth day, when he was brought to the hofpital, he could endure no poflure but that of lying prone, refting upon his knees and elbows, raifed up by pillows. When- ever he attempted to change that pofture, and very often at other times, he was violently convulfed, and fometimes thrown out of bed. In the more moderate fits of convulfion, the courfe of which could be obferved, he firft flarted fuddenly from the prone pofture to his knees j the bedy was then drawn forward, the head backward, and the lips flrongly preffed together ; though he was, at all times, careful to infert the points of his fingers between them, over which, in breathing, the air ruihed with a hifling noife. During thefe fits, which continued fome minutes, the recti abdominis, flerno-maftoidei, and other mufcles on the fore part of the neck ; thofe within the arch of the lower jaw, and the mafTeters, were hard to the touch. He told us, that the fit began with a catching below the navel, that he had, at all times, exquifile pain in that part, and alfo in the fore
part
< 75 )
part of the neck, and near the jaw, and that he mould be ftifled, unlefs he kept his lips afunder, by inferting his fingers between them. The lower jaw was always immoveably fixed fo clofe to the upper, that the point of the finger could not be puflied between the teeth, and any interval between them was more owing to the lower jaw being drawn back than to its being deprerled : the fweat flood in drops upon his face and his body ; his pulfe was fmall, and between eighty and ninety : though he had the flrongefl defire to drink, yet the great difficulty he found in fwallowing, made him moil reluctantly put the cup to his head, and frequently withdrew it j and, when he had fucked in a little, he only fwallowed a fmall part of it -y the reft was fquirted out immediately, and the lips and mufcles of diglutition were ftrongly convulfed. In the evening of the fourteenth day, his face was pale, his body covered with cold fweat j his pulfe inter- mitted i and when his convulfion fits came on, he could not raife his hand to keep his lips afunder, which was done by an affirmant : the lower jaw was confiderably relaxed. In the morning of the fifteenth day, at three o'clock, he fpoke fenfibly : at four he was fuddenly convulfed ; and, though lying on his belly in bed, was thrown on his back upon the floor, and died inflantly. Four hours after- wards, the body being ftill quite warm, the lower jaw was immove- ably fixed to the upper.
On the outfide of the tendo achillis of the left leg, there was a wound, which paffing before that tendon, penetrated as far as the fkin on the oppofite fide behind the internal maleolus. The cavity of the wound, which contained pus, and two bits of woollen ftocking, was about the fize of a pigeon's egg. The pofterior tibial nerve, in paffing along it, was covered by a thin cellular fubftance, which, in the wound and feveral inches above it, was of a bright red ; but the nerve cut acrofs appeared found. The mufcles which formed the
L 2 fides
( 7« )
fides of the wound, were partially fuppurated, and, for a confiderablc way up the leg, of a deep red. The cellular fubftance and tendinous aponeuroiis on the outfide of the leg were, as high as the knee, of a deep red; the latter unequally fo, being in fome places almoft black. In the upper angle of the wound, a nervous filament was loft. The flefliy part of thefterno-maftoid, fterno-hyoid, firft fcalenus, co- racohyoid, longus colli, of the right fide, were, in fome places, of a deep red, as if from blood effufed ; and the longus colli, but no other correfponding mufcle of the left fide, was affected in a fimilar manner : the lower extremities of both ftylo-hyoids, and of both hyo- gloili, were of the deep red colour ; the other mufcles employed in diglutition, alfo the tongue, palatum, molle, pharynx, part of the oefophagus, and larynx, upon examination, appeared found. There were feveral red fpots on the external furface of the tendinous aponeu- roiis covering the abdomen, and on many parts of both recti abdominis, there was the fame deep red colour, which penetrated quite through the fubftance of each mufcle ; the pofterior fur- face of each being ftill more generally of that colour, and, in many places, particularly below the navel^ the fibres were confumed, for about an inch of their length, by ulcers containing a reddifh matter; the pofterior parts of the (heaths of thofe mufcles, were, in fome places, oppofite to the ulcerations in the mufcles, of a light red. The maffeters, the temporals, the mufcles which pull the head back, and the vifcera of both great cavities, appeared quite ibund.
CHAP. II.
( 77 )
CHAP. II.
A Defcription of the Symptoms ofDifeafes of the Head, Nerves and Mufcles, taken from thoje Cafes where the Patients recovered, or %v here the Author had no Opportunity of examining the Bodies after Death.
§ i . Lofs of Feeling and of Motion.
THE total lofs of feelingand of motion in different parts of thebody mofr. frequently happens during a fit of apoplexy, or general in- feniibility; fometimes it occurs before fuch fit, and fometimes there is a gradual diminution of feeling with feeblenefs, terminating in complete numbnefs and lofs of motion, without any fit either preceding or ac- companying it; the fenfes, memory, and fpeech remaining entire, or to a certain degree impaired. The parts affected are oft con- tracted fo that the fingers are bent into the hands, and if at any time they are extended by force, which cannot always be done, they re- turn immediately to their former fituation ; the leg, alfo, of the fide affected is drawn back towards the thigh, and the foot towards the back of the leg; the paralytic mufcles are at times fuddenly convulled, which occafions conliderable pain, and they frequently tremble or fhake, and are generally cold. Sometimes the whole body is affected by this dilbrder, although the one fide more than the other; fometimes the lower half of thebody, or only the lower extremities; or the feet and hands only, but mofl commonly the whole of one fide, the other remaining unaffected. The ftools, and, at times, the urine, are retained in the beginning, but towards the end, efpecially in bad cafes, both of them run off involuntarily. The pulfe is quick and
fmall,
( 78 )
fmall, fometimes having a kind of vibration, or a very feeble heat is interpofed between two common pulfations, and there are inftances, even in favourable cafes, where the pulfe cannot be felt. Amend- ment, or recovery, is commonly preceded by a painful fenfation of pricking or mooting in the part, after which, in a little time, the feeling and power of motion return, though in a flight degree ; after- wards, upon thofe pains going off, the parts recover perfectly their feeling and power of motion, and laflly their ftrength.
The recovery of the patient is alfo fometimes preceded by an erup- tion of very painful fpots, raifed a little above the fldn. The fenfe of feeling and motion commonly return firft in thofe parts which are nearefr. the brain, proceeding gradually downwards from one member to another; but I have known recovery take place in a reverfe order. The difeafe continues from one to three months, though, commonly, much longer; fometimes it proves fatal in five or fix months from the firft attack. Sometimes between the paroxyfms the patient is for a year or two fubject to giddinefs, trembling, &c. The caufe of this difeafe is often unknown. Sometimes it happens during a fever, and often fupervenes flight injuries of the head, when, without any fracture of the fkull, they have been followed by infenfi- bility, either immediately or a day or two after the accident, and in all thofe cafes, the fide of the body affected is oppofite to the fide of the head where the injury has been received.
Do not the pains which commonly precede recovery, point out the ufe of irritating and painful applications to the part ?
Does not the eruption of painful fpots indicate,in a particular manner, the utility of blifters ?
§ 2. The
( 79 )
§ 2. Lofs of Motion with Relaxation of the Parts,
All or only fome of the limbs fuddenly lofe the power of motion, but without any remarkable diminution of feeling; this fometimes happens without pain ; at other times it is accompanied or preceded by very violent pain. When unattended with pain the caufe is com- monly unknown, and, if the feeling is unimpaired, the patient, with- out any disagreeable fenfation, recovers a little ftrength at firft, and, finally, the perfect ufe of his limbs.
The cafes attended or preceded by violent pains, moft fre- quently occur amongft people who are employed in the feveral trades in which lead or quickfilver are ufed, fuch as glaziers, plumbers, colour- makers and gilders; there is this difference however, that thofe perfons who have been expofed to the fumes of quickfrlver, have, befides the other fymptoms, almofl perpetual tremors of the limbs.
In thofe cafes attended with pain I have alfo obferved, that the fu- perior extremities are more frequently affected than the inferior, and that the mufcles of the hands are remarkably wafted. The dry belly-ach, formerly defcribed, commonly, and efpecially in painters who make ufe of turpentine, precedes or accompanies any affections of the limbs.
The patient, even when he quits his bufinefs, recovers his health but flowly j firft. acquiring the power of bending, afterwards of ex- tending the limbs ; but there are few inftances of a complete recovery till after many months, or even years, and a return of the complaint
is
( 8o )
is the almofl certain confequence of returning to their former man- ner of life. The moil; effectual prefervatives are keeping clean, and avoiding, as much as poflible, all immediate contact with the metal, its calx or fumes.
§ 3. Lofs of Motion with Contraction of the Parts.*
A woman, aged thirty-one, fell down fuddenly whilft walking. She retained her fenfes, but had violent pains and contractions in the mufcles of both arms, which were fo ftrongly bent that all efforts to extend them were ineffectual, and the attempting it only caufed more exquifite pain ; but though the upper extremities were fo greatly, the lower were little affected, and flie only complained of a flight pain in one ancle. After ten hours there was no change in her iituation ; after twenty the pains had fomewhat abated, and fhe could move her arms a little. After thirty hours the pains had entirely ceafed, and fhe could move all her joints eafily. In a few days more me recovered the f trength of her arms, and in a week, except that fhe was fome- what low-fpirited, had no farther complaint.
A woman, aged twenty-feven, was for feveral years fubject, commonly in cold weather, to fits of coldnefs and of pain in the ex- ternal parts of the head, face and neck, and in the mufcles within the arch of the lower jaw ; during thefe fits fhe could not bear the flightefl preffure on the parts affected, and the lower jaw was im- moveably fixed, at firfl, almoft clofe to the upper one, but after- wards, as the pains diminifhed, it relaxed fo far as to admit the point
of
* Under this head I have given three cafes, the examples not being fufficiently numerous to enable me to draw up any general hiflory of the complaint.
( Si )
of the finger between the teeth. In about a month or fix weeks the pains ceafed, and fhe perfectly recovered the ufe of the jaw.
A woman, aged twenty-one, whofe hiftory I have in part for- merly related*, three weeks after receiving the blow on her chert, was feifed with a fit, which returned fometimes every day, though more commonly after an interval of a week, a fortnight, or even a month. When fhe perceived the approach of the fit, which was pre- ceded by partial mufcular contractions, what me called twitchings or catchings, fhe laid herfelf on her back in bed, her limbs were im- mediately ftretched out, her fingers and toes ftrongly drawn in, and her head fo much drawn backwards that her face was turned directly to the head of the bed ; in this ftate fhe remained ftruggling for a confi- derable time, her body bent upwards, whilff. the crown of her head was forcibly prefTed againft the bed, her neck and breafl were alfo fwelled, and her belly was repeatedly raifed forwards ; at this time the mufcles every where felt rigid ; fometimes the bead, from the pofture above defcribed, was drawn flowly forwards alfo, from fide to fide. The eyes were fixed, and not affected by the neareft approach of objects. She frothed at the mouth and frequently bit her tongue, (which was pufhed out) from the convulfive contractions of the muf- cles of the lower jaw. Sometimes fhe would fing, or make a noife like the barking of a dog, at other times fhe uttered the mo/f. dole- ful cries, after which the mufcles were always foft, the limbs re-' laxed, and her hands opened ; in this fituation fhe ufed to remain from one to eight hours, and after each fit complained of exceflive wearinefs and pains all over her body. Sometimes her fits were much flighter, fome of her limbs only being contracted -, and, though fhe loll her fight, retaining her other fenfes. During the intervals of the
M fits,
* Vide page 45.
( 32 )
fits, me was troubled with twitchings and tremblings, either of her whole body, of one fide, or of a particular limb only, and thefe were always greatly increafed from any fright or flurry. She frequently gnafhed her teeth, and fometimes with fo much violence when me was drinking, as to break the cup. She alfo complained of head- ach, giddinefs, dimnefs of fight, lownefs of fpirits, coldnefs of her lower extremities, and, fometimes, had coldfweats ; her pulfe was be- tween eighty and ninety. Her fits remained violent near fourteen months, but became more moderate after the burfting forth of mat- ter from her fide, and did not afterwards affecl: her fenfes, and in four months after this event took place, they, as well as the concomi- tant fymptoms, difappeared entirely, and have not fince, now near four years, in any degree returned.
§ 4. Perpetual involwitary Motion.
Mbit commonly after a fright, fometimes after convulfions, h/f- terical or fainting fits, and fometimes nothing remarkable having pre- ceded, the patients are feized with a perpetual involuntary motion, but without pain, either of all the limbs and fpine, or of both arms, though unequally, or of the arm and leg of one fide, or of one arm only, or of the belly and breaft, which laft motion is much quicker than that of refpiration. Thefe motions are fometimes fo violent that, when general, the patients cannot lie in bed, and when one arm only is affected, its motion will throw them down, if while walking they happen to be off their guard ; by the perpetual rubbing the cuti- cle is fometimes abraded from the infides of the fingers. Thefe mo- tions fometimes encrcafe in violence in the evening, and on al- ternate days, and, when going off intermit in the forenoon. The
patients
( H )
patients fometimes laugh or cry, are troubled with a hiccough, or imack with the tongue and lips ; the tongue is often pufhed out very far, and the lower jaw is in perpetual motion; if they happen, as is fome- times the cafe, to flumber for a little, the parts, during fleep, are at reft. Sometimes they complain of pain in the throat, breaft and neck. The fpeech is commonly affected, but the fenfes are entire. Both ftools and urine are retained longer than is natural. The pulfe is fmall and fometimes quick. By a fuperior external force the motion of a limb may be flopt for a little, commonly without any inconvenience to the patient ; but in one cafe, when the arm was held, the patient funk quietly into a fit, as if (he had been afleep, the other limbs retaining the pofture they happened to be in when the fit began, and when, on letting go the arm, the motions of it returned, the feeling and the power of motion in the other limbs returned alfo ; fometimes the motions of the arms, of their own accord, alternately ceafed and returned, and the fame confequences followed. The pulfe did not vary in the different ftates. In the fame patient the left arm was, without any inconvenience, always at reft when fhe lay down, and always in motion when (he fat upright or ftood, the right arm was not affected by change of pofture, till her recovery was advanced, and then it was influenced by it in the fame manner as the left arm. had formerly been.
The fubjects of this diforder are women and children. The dura- tion is commonly not longer than one or two months ; but fometimes the motions of particular limbs continue for feveral years^ and in one cafe, where they had been violent, the limb inflamed. Patients are apt to fuffer a relapfe, efpecially when the difeafe originated in a fright.
M 2 Does
f 84 )
Does the relief which i& afforded during fleep, direct us to the uft- of opiates ?
C HA P. HL
Obfervations on the Effects of Remedies in Difeafes of the Head,8tc
THE fenfe of feeling and thepower of motion were commonly encreafed after the application of blifters to the nape of the neck, or to the arms, when thefe were the parts affected, and to the os facrum, when the lower limbs were affected. Liniment, fapon: rubbed on the parts appeared to have a fimilar effect— After re- ceiving once in three or four days about a dozen of flight mocks of electricity, the fenfe of feeling was in a few hours, and the power of motion in a few days encreafed — After going into a warm bath the pulfe rofe, and the ftrength of the limbs was encreafed a little; Painters ■, whofe wrifts were weak, found fome benefit after having repeatedly held their hands and the lower parts of their arms in the warm moift grains of malt. After hot medicines, fuch as fal. C. C. vol. muftard-feed, horfe-raddifh-root, gum gauiacum, faffron, and fome other fudorifics, a glowing was felt in the affected parts, and was followed by fweating, and, in fome cafes, when bliflers alfo had been applied, the fenfe of feeling and power of motion were perfectly reftored. After Peruvian bark and fteel medicines, tremors and weaknefs of the limbs were diminiflied. In regard to the perpetual involuntary motions, the moft remarkable relief, or rather almofl per- fect recovery, happened to a woman, who, having a fecond time had
this
( »5 )
this diforder conftantly in her arms for three years, took mufk a little longer than a fortnight, to the quantity firfl of one drachm, and afterwards to that of one drachm and an half each day ; me fweated a little during the courfe, and was giddy from the encreafed dofe. Opiates and fetid gums, with fait of hartfhorn, feemed alfo to have in thefe cafes very good effects..
As the difeafes hitherto defcribed are principally fuch as arife from tjie affections of particular organs, I have been fuller in giving ana- tomical defcriptions than may perhaps be necefTary hereafter. And therefore at the doling of this part of my undertaking, I reckon it incumbent upon me to fay fomething of the advantages, which, may- be derived from the dilTectionof morbid bodies..
And here it firfl occurs, that it mufl furely give a Phyiician great fatisfaction and pleafure to find, by the appearances, that he has understood a. diforder and treated it properly ; but this being, a kind of delicate luxury in fcience, relifhed only by the moil liberal minds, and therefore a fuperfluity, we mufl next enquire, whether this modern method of arriving at knowledge, may not be attended with fome more folid advantages, advantages really conducive to the health and happinefs of mankind.
Though there are many difeafes which have not hitherto been in any degree illuftrated by diffe&ions, yet the great light which has been thrown upon others, by the accidental directions of ana- tomifts, ignorant for the mod part of the complaints which preceded death, or who learned them only by hearfay, and after the diffections had been performed, is a Sufficient earnefl of the great encreafe in the knowledge of difeafes which might be made, were Phyficians, who have known the complaints, to examine more
minutely
{ U )
minutely and attentively than they commonly do, the bodies of the dead. A perfon who has carefully performed, or even attended to the difleclion of one cafe, will afterward:- <ook upon fimilar cafes with a more piercing eye than before j •••• iymptoms fuggeft to the mind the ideas of certain changes in trie body, fo, on the other hand, the obfervation of certain change . i\\ the body fuggefts the ideas of certain fymptoms connected with them, which, though ne- ceflary to a full knowledge of the difeaL., would otherwife efcape the notice of the Phyfician.
Directions have alfo led to feveral ufeful and neceflary methods of treating difeafes, which were formerly unknown, and have, likewife, iliewn the inutility and impropriety of many common methods of practice. They tend more than any thing whatever to fhew the infignificancy and the futility of many highly and long applauded remedies, and thus the mind being fet at liberty from a flaviih implicit faith in their efficacy, its powers may be directed to more worthy objects.
If, therefore, by directions, in the performing of which, dif- eafes were frequently only a fecondary object, fo great a progrefs has been made in the knowledge, and in the treatment of them, let thofe who wifh to promote the great intereft of mankind, avoid joining themfelves to the lazy tribe of defpondents, who affert that Phyfick cannot be improved, and who, on that pre- tence, give way to their innate love of indolence and floth. Let the generous few rather hope, nay, let them be affured, that by their united and continued efforts, the knowledge of difeafes may be very highly and effentially promoted.
E X P E R I-
MM*
EXPERIMENTS
0 N
VARIOUS SUBJECTS.
EXPERIMENTS,
DIETETIC A L and STATICAL.
EXPERIMENTS
O N
DIET.
INTRODUCTION.
ALTHOUGH air is more immediately neceffary to life than food, the knowledge of the latter feems of more importance ; it admits certainly of greater variety, and a choice is more frequently in our power. A very fpare and fimple diet has commonly been recommended as mod conducive to health, but it would be more beneficial to mankind if we could mew them that a pleafant and va- ried diet was equally confident with health as the very Ariel: regimen of Cornaro, or the Miller of EfTex. Thefe and other abftemious people, who, having experienced the greateft, extremities of bad health, were driven to temperance as their laft refource, may run out in praifes of a fimple diet, but the probability is, that nothing but the dread of former fufferings, could have given them refolution to perfevere in-fo fcricl: a courfe of abflinence; which, perfons who are in
N health,
( 9o )
health, and have no fuch apprehenfion, could not be induced to un- dertake, or, if they did, would not long continue.
In all cafes great allowance murr. be made for the weaknefs of hu- man nature ; the delires and appetites of mankind muft, to a certain degree, be gratified, and the man, that wifhes to be moil ufeful, will imitate the indulgent parent who, whilft he endeavours to pro- mote the true interefts of his children, allows them the full enjoyment of all thofe innocent pleafures which they take delight in. If pof- iibly it could be pointed out to mankind that fome articles ufed as food were hurtful, whilft others were in their nature innocent, and that the latter were numerous, various and pleafant, they might, per- haps, from a regard to their health, be induced to forego thofe which were hurtful, and confine themfelves to thofe which were innocent. To eftablifh fuch a distinction as this, from experiment and obfervation, is the chief objecT: of my enquiry : and I confefs it will afford me a fingular pleafure if I can prove, by experiment, that a pleafant and va- ried diet is equally conducive to health, with a more ftridr. and fimple one ; at the fame time I fhall endeavour to keep my mind un- biased in my fearch after truth, and, if a fimple diet feems the moil healthy, I fhall not hefitate to declare it.
But before entering upon the prefent, or any other inveftigation, it may not be improper to attend to a difKnclion, made by my Lord Bacon, between ufeful and curious knowledge ; the latter, indeed, or Experimenta lucifera, he recommends, as nearly of equal importance with the former, or Experimenta fructifera, though to me they appear widely different. The only teft of the utility of knowledge is, its promoting the happinefs of mankind ; which,
though
( 9i )
though the Experimenta lucifera may do at fome future period, the Experimenta fructifera, as having directly and immediately this effect, are furely to be preferred ; and, therefore, though I admit that all knowledge is delireable, from the pleafure it af- fords, yet, confidering the fhortnefs of human life, and the very narrow limits of human abilities, and confidering alfo that there are many things Hill unknown which might be of advantage to fociety, it may be doubted whether every perfon be not in ftrict duty bound to direct his whole attention to the cultivation of ufeful knowledge.
In the courfe of the prefent enquiry, I have fometimes doubted whether an accurate attention to the difcharges of the body be not more a matter of cunolity than of ufe ; and, if our attention mould not be chiefly directed to obferve the different effects of food on the body ; whether, for inftance, it agrees or difagrees with the flo- mach, is more or lefs nourishing, has the quality of invigorating, or of occalioning lazinefs and inactivity, if it enlivens or deadens the fa- culties, and if J.t creates or allays the feveral appetites and de- fires.
If after what I have faid, I mall be thought to have indulged my- felf with attending too accurately to the difcharges of the body, it muft be partly imputed to my defire to avoid the appearance of enter- taining a doubt, that what fome of the firft names in Phyfic have thought deferving their attention were things of little moment.
N 2 Dr.
( 92 )
Dr. Stark, before he began his Experiments on Diet, had col- lected fome faffs on the fubjeff, and had made fome obfervations relative to digejlion, which I have introduced in this place, ima- gining that they would not be unacceptable to the public.
Faffs relative to Diet.
Dr. B. Franklin, of Philadelphia, informed me, that he himfelf, when a journeyman Printer, lived a fortnight on bread and water, at the rate of iolfr of bread per week, and that he found himfelf flout and hearty with this diet.
He likewife told me, that he knew a Gentleman, who, having been taken by the Barbary Corfairs, was employed to work in the quarries, and that the only food allowed him was barley, a certain quantity of which was put into his pockets every morning; water he found at the place of labour ; his practice was, to eat a little now and then, whilfr. at work, and, having remained many years in fla- very, he had acquired fo far the habit of eating frequently and little at a time, that when he returned home his only food was ginger- bread-nuts, which he carried in his pocket, and of which he eat from time to time.
By Sir John Pringle I was told, that the inhabitants of Zephalo- nia, during fome parts of the year, live wholly on currants. He
alfo
( 93 )
i alfo faid, that he knew a Lady, now ninety years of age, who eat
only the pure fat of meat.
I learned from Dr. Mackenzie, that many of the poor people near Invernefs, never took any kind of animal food, not even eggs, cheefe, butter or milk.
Mr. Hewfon informed me, that Mr. Orred, a Surgeon at Chefter, knew a fhip's crew, who being detained at Sea after all their provi- fions were confumed, lived, one part of them on tobacco, the other on fugar : and that the latter generally died of the fcurvy, whilfl the former remained free from this difeafe, or foon recovered.
Dr. Cirelli fays, that the Neapolitan Phyficians frequently allow their patients, in fevers, nothing but water for forty days together.
Mr. Slingfby has lived many years on bread, milk and vegetables, without animal food or wine : he has excellent fpirits, is very vi- gorous, and has been free from the gout ever fince he began this re- gimen.
Dr. Knight has lived alfo many years on a diet flric~tly vegetable, excepting eggs in puddings, milk with his tea and chocolate, and butter — He finds wine necerlary to him — Since he lived in this manner he has been free from the gout.
Obferuations
( 9 + )
Obfervatwis on Dig'flion.
A woman, who was in the practice of dram- drinking, after taking an emetic, vomited many pieces of fat, fome pieces of griftle, and only one very fmall bit of the lean of veal, which me had eat twenty- four hours before. She brought up, likewife, a bit of apple, and fome pieces of the fkins of roafled apples which me had eat twenty hours before. Alio part of a brown cruit of bread which me had eat about three hours before.
A young man, ill of a fever, having taken an emetic, vomited fome fat broth, with bits of bread, which he had eat three hours before.
A young man, who had been flightly indifpofed about a week, after taking an emetic, brought up fome mutton, which he had eat three hours before, and nearly in the fame (late in which he eat it.
A girl, in a fever, vomited fpontaneoufly, and brought off her flomach fome fifli, which me had eat three hours before.
A man, with purging, head-ach, &c. brought off his flomach, by an emetic, fome very difagreeable bitter fluff, but without any appearance of bread and butter, of which he had eaten very heartily about fevcn hours before.
A girl, fubject to fits, after taking an emetic, vomited fome oyflers, which me had eat three hours before, but there was no appearance of veal, which (lie had eat twenty-feven hours before.
A girl,
( 95 ) A girl, fubjedl: to pains in her ftomach, after taking an eme- tic, vomited many pieces of the fkin, but fcarcely any of the lean of roafted veal, which me had eaten fix hours before.
A woman, with a tertian fever, head-ach, &c. after taking an emetic, brought up fome mutton, very little altered. She had not eat it long before.
Mrs. I — m informed me, that her fon, a little boy, and her daugh- ter, a delicate girl, vomited, one morning, fome beef, which they had eat at dinner, between three and four o'clock the preceding day.
ABSTRACT
( 96 )
ABSTRACT of a JOURNAL kept during a Courft '
of Experiments on Diet.
N. B. The weight of the folic? food and ftools, is marked in Troy weight, that of the body in Avoirdupois ; the quantity of liquids was determined by wine meafurs — The weight of my body, dreffcd in my ufual clothes, at the begin- ning of thefe Experiments was, 12ft. 31b. or 1 7 1 lb . Avoirdupois.
EXPERIMENT
I.
Diet of Bread and Water.
|
t2 i .5 . State of the at- |
Daily allowance |
Daily lofs of |
Number and to- |
Weight of my |
|
|
2 \o1 mofphere during v £" the period. |
of food |
weight. |
tal weight of (tools. |
body at the end of the period. |
|
|
Ik |
Bread 20 oz. |
5 oz. 5 dr. |
5 ftools, weigh- |
11 ft. i2lb.8oz. |
|
|
0 |
Water 4 lb. |
ing 7 oz. 5 dr. |
|||
|
#1 w It 1 B |
■» |
V |
|||
|
£ |
|||||
|
Thermometer Bread, 30 oz. 6 oz. 10 dr. |
7 ftools, weigh- |
nft. 1 0 lb. 8 oz. |
|||
|
D 3 •5 ' — ' |
from 60 to 70. |
Water, 2 lb. |
ing iooz. 5 dr. |
||
|
8"S |
Weather com- |
||||
|
monly ferene, |
|||||
|
W* r^j |
fometimes |
||||
|
13 «J O -C |
cloudy, feldom |
||||
|
u 0 Ph ** 13 C §& u O |
rain. |
Third
( 97 )
|
State of the at- |
Daily allowance |
Daily lofs of |
Number and to- |
Weight of my |
|
|
V >^ |
mofphere during |
of food. |
weight. |
tal weight of |
body at the end |
|
*— > |
the period. |
ftools. |
of the period. |
||
|
bZ: |
|||||
|
o o |
Thermometer |
Bread, 30 02. |
6 oz. 10 dr. |
1 {tool, weigh- |
lift. 7 lb. 8 oz. |
|
T3 ^ |
from 6010-73. |
Water, 2 lb. |
ing 20Z. 5 dr. |
||
|
O ~ |
Often ferene, |
||||
|
4J "^ |
fometimes |
1 |
|||
|
cloudy. |
|||||
|
15 |
|||||
|
.c |
|||||
|
OS |
Daily gain in |
||||
|
i^ |
weight. |
||||
|
iv |
|||||
|
Thermometer |
Bread, 38 oz. |
3 oz. 6 dr. |
3 ftools, weigh- |
11 ft. 9 oz. 8 dr. |
|
|
■e^ |
from 63 to 66. |
Watery lb. 8 oz. |
ing 2 lb. 1 oz. |
||
|
o N |
Commonly |
3 dr. |
|||
|
&! |
cloudy, fome- |
||||
|
■e ° |
times rain, fome- |
||||
|
3 |
times ferene. |
||||
|
O |
R E M A R K S.
To determine how long the food is ufually retained in the body, I repeatedly fwallowed muftard or carraway-feeds and ob- ferved, that when coflive, .they did not pais with the firfl, but with the fecond and third ftool ; and, commonly, after thirty-fix or forty- eight hours i when open in the body, they came away with the firft ftool, the next morning.
Before I began regularly this Courfe of Experiments, I had, for feveral weeks been, now and then, making trial of it ; fometimes, inflead of water, I took, in the morning, a weak infufion of tea,.
O iaffafras,
( 9S )
affafras, or of fome herb, but without milk or fugar. My ftools were of a fmooth confiflence and flimy furface, like clay.
Although upon the allowance of twenty ounces of bread, I was hearty, in good fpirits, and had fome defires, yet I found it ne- cefTary to encreafe it, not only as I fell away, but becaufe I was often very hungry.
On the allowance of thirty ounces, I fometimes, immediately after eating, had a little wind upwards, and fometimes, though rarely, a little downwards. My ftools were gradually fofter. I ftill fell away very vifibly; had hardly any defires, though hearty in other refpects. Sometimes I felt a flight fickiihnefs and want of appetite, which went off after eating a bit of brer.d.
Imagining that the ficknefs might be owing to my taking an over proportion of liquid, I endeavoured, during the third period, to af- certain how much liquid was abfolutely necefTary to the quantity of bread I eat, and found, that though I could eafily eat my common meal often ounces, without any liquid, and was not at all thirrty, even for fome time after, yet in two or three hours, an intolerable third came on, which could not be allayed by lefs than ten ounces of liquid.
I likewife found that when I drank lefs than two pints a day I was thirlty in the evening, and had a flight pain in -my fto- mach. formerly I ufed to make eleven or twelve ounces of urine at a time, but now five or fix ounces brought on the incli- nation, and my water was high coloured During the third period I was one day irregular, having ate about four ounces of meat, and drank two or three glaiTes of wine. At the conclufion of it,
I was
( 99 )
I was perfectly hearty, my head clear, often hungry, but never had any deiires.
When I eat thirty-eight ounces of bread (the allowance during
the fourth period) at five or fix times, my appetite was not more
than fatisfied, but if I made fewer meals I found my appetite fatiated.
I fometimes varied my daily quantity of bread, by taking from the allowance of one day and adding to that of the day fol- lowing, but I found that the moft I could eat in one day was forty-fix ounces, and that the greater! quantity I could eat at one time, without uneafinefs, was twenty ounces ; that the fenfation of hunger began four hours after eating this quantity, when I could eat twenty ounces more. I once forced myfelf, to eat, at one meal, in an hour and ten minutes, thirty ounces of bread, I brought up fome wind off my ftomach whilft I was eating it, had afterwards much noife in my bowels, and in a few hours a bolar (tool, weighing one pound ; I continued uneafy during the whole of the evening, but was quite well and hungry next morning. During this laft period I fometimes had deiires (Venus bis) but never before, fince I began this Courfe of Experiments.
By Experiment, I determined, the quantity of faliva fecreted in half an hour, to be whilft the parts were at reft, four drachms, whilft eating, five ounces four drachms.
O 2 EXPERIMENT
choolO.!J>
( 100 )
EXPERIMENT II.
»
D/ttf of Bread and Water with Sugar.
|
o |
State of the at- mofphere during the period. |
Daily allowance of food |
Daily gain of weight. |
Number and to- tal weight of ftools. |
Weight of my body at the end of the period. |
|
Firft period, from t July, to the 3do |
Thermometer from 62 to 66. Weather com- monly cloudy. |
Bread 34 02. Sugar 4 oz. Water 3^ lb. |
2 oz. |
Purging. |
11 ft. iolb. 8oz. |
|
13 |
|||||
|
£ 3 s< |
Thermometer from 64 to 74. Weather com- monly ferene. |
Bread, 30 oz. Sugar 8 oz. Water, 3^ lb. |
Weight of the body ftationary. |
2 ftools, weigh- ing iooz. 4 dr. |
11 ft. 10 lb. 8oz. |
|
1 « ° u u t/5 |
- |
||||
|
o "S w: -. 3" |
Daily lofs of weight |
||||
|
5< , - ■ -** |
Thermometer ' from 63 to 66. We.ither ferene, fometimesrain. |
Diet irregular. |
lib. |
Purging. |
lift. 61b. |
|
"3 "w 3 |
1 |
Fourth
( ioi )
|
2~~ |
|
||||
|
*• |
State of the at- |
Daily allowance |
Daily gain of |
Number and to- |
Weight of my |
|
mofphere during |
of food. |
weight. |
tal weight of |
body at the end |
|
|
the period. |
ftools. |
of the period. |
|||
|
i< |
|||||
|
Thermometer |
Bread 26 oz. |
Nearly 3 oz, |
Purging. |
lift. 7lb. |
|
|
T3 '*-' |
from 6 1 to 63. |
Water 2 lb. 5 oz. |
|||
|
o o\ |
Serene weather, |
||||
|
Pi.r |
fometimes rain. |
||||
|
-C ~ |
|||||
|
" o 3 ~ O 5* |
|||||
|
Thermometer |
Diet irregular. |
Weight of the |
1 loofe ftool. |
lift. 71b. |
|
|
from 59 to 61. |
body ftationary. |
||||
|
-5 5° |
Weather ferene, |
||||
|
fometimes rain. |
|||||
|
.2 ? |
. |
||||
|
£2 |
I |
||||
|
£ |
REMARKS.
Sugar feemed to increafe the flow of faliva into the mouth, for with fugar I could eat more bread at a time, than I could pofiibly do without this addition.
In the afternoon of the firft day after ufing fugar I palled a good deal of fetid wind downwards, and early next morning had a liquid ftool. I had afterwards three loofe ftools, weighing one pound five ounces ; weak defires, (Venus femel) during the firft period.
After I began to ufe fugar with my bread, I found that a finaller quantity of liquid prevented thirft than when I eat bread
alone.
( J°2 )
alone. With my prefent diet, of thirty ounces of bread, and eight ounces of fugar, two pints of liquid a day are fufficient to allay my thirft ; whereas, when I ate thirty-eight ounces of bread, without fugar, I found that three pints and a half of liquid were abfolutely neceffary.
I commonly ate eight ounces of fugar at a meal, without any in- convenience, and became hungry three hours after it • my appetite was not at all cloyed with the fugar. I palled hardly any wind either way, and never had any delires.
On the ioth I ate, at three different times, before one o'clock, twenty ounces of fugar, and, though I ate the laft of it with re- luctance, and was fickifh after it, yet it did not fatisfy my appetite. At two o'clock I became very hungry, and at three began to eat bread with great pleafure, and ate twenty ounces of it, drinking two pints and a half of water, which I found fuflicient to allay my thirft.
On the i ith I ate twenty-four ounces of bread, and fixteen ounces of fugar, but the laft part of it with great abhorrence. I now per- ceived fmall ulcers on the infide of my cheeks, particularly near a bad tooth, in the lower jaw, of the right fide ; the gums of the upper jaw, of the fame fide, were fwelled and red, and bled when preiTed with the finger, the right noftril was alfo internally red or purple, and very painful. I had one thin flooL
On the 1 2th I ate thirty ounces of bread, with ten of fugar, had little appetite for fupper, and after it a thin flool.
The
( io3 )
On the 13th, having been extremely ill, during the night, with pains in my bowels and fvveating ; at day-break, I had a large thin ftocl, and two liquid ftools afterwards, but paffed no wind, nor was troubled with any in my bowels. I had no appetite for breakfaft, could not tafte fugar, dined on a few ounces of meat, with about twelve ounces of bread, and drank two or three glades of wine.
On the 14th I perceived feveral fmall purple flreaks on my right moulder, but the fores in the infide of my mouth, and my gums were better, and my noftril lefs painful.
On the 15th the affection of my gums, though lefs in degree, had become more general, having fpread to the left fide, their femilunar edges were of a deep red, and feveral drops of blood iffued from my right noftril.
N.B. Until the 18th I had, every day, t'hree or four liquid ftools, containing fome clear gelatinous fubftance, and felt but little pain or wind in my bowels — on the 18th and 19th I had one ftool each day.
On the 1 8th, fome part of the gums of both jaws, and on both fides, were red and fwelled, but none of them of that purple co- lour, nor fo apt to bleed as fome days ago, the fores in my mouth were healing, and the ftreaks on my moulder alrnofl: gone. I never had the fmallefl defires.
From the 19th to the 24th, my food wa* thirty ounces of bread with three pints of water every day, excepting on the 2 2d, when
I dined
( 104 )
I dined heartily on meat and fruit, and drank fome wine. Venus femel.
N.B. On the 21ft I made an experiment with two drachms of •faeces, of a pilular confidence, which I had voided, after having lived about a week on bread and water ; they were warned four or five times in about fix ounces of water, which was thereby rendered milky ; but after ftanding ten or twelve days, and depofiting a fe- diment, it became again almoft tranfparent ; the refiduum, faved on the filtring paper, weighed one fcruple and half a grain, was of a darkifh green colour, and perfectly inodorous— Bread, treated in a fimilar manner, occafioned no milkinefs, and the water, inftead •f becoming putrid, was converted into a weak vinous liquor
EXPERIMENT
( io5 )
EXPERIMENT III.
Diet of Bread and Water with Oil of Olives.
|
-*■ |
State of the at- |
Daily allowance |
Daily gain or |
Number and to- |
Weight of my |
|
mofphere during |
of food |
lofs of weight. |
tal weight of |
body at the end |
|
|
-5 m |
the period. |
ftools. |
of the period. |
||
|
o <*• |
Thermometer |
Bread 30 oz. |
Gained nearly |
2 ftools, weighing |
1 1 ft. 9 lb. |
|
^4-« |
from 59 to 62. |
Oilof01ives24oz |
5 oz. 3 dr. |
1 lb. 4 oz. 6 dr. |
|
|
Weather ferene, |
Water 3 lb. |
||||
|
fometimes rainy. |
|||||
|
• is *^ |
|||||
|
O u ° u |
Thermometer |
Bread, 30 oz. |
Loft nearly 9 oz. |
1 ftool, weigh- |
11 ft. 5 lb. 8 oz. |
|
from 63 or 64. |
Water, 3 lb. |
3 dr. |
ing 40Z. 4 dr. |
||
|
Weather ferene |
|||||
|
°£2 |
or cloudy. |
||||
|
«^3 15 |
|||||
|
u 4-. |
|||||
|
Oh O |
|||||
|
"1 3 M U 3 |
|||||
|
OT < |
|||||
|
O |
Thermometer |
Diet irregular. |
0 |
Purging. |
11ft. 131b. 8oz. |
|
from 57 to 661 |
|||||
|
Weather com- |
|||||
|
monly rainy. |
|||||
|
2 'S |
|||||
|
'5 •? o-.~ |
' |
||||
|
H . |
|||||
REMARK^
( io6 )
REMARKS.
Two ounces of oil, taken at one meal, was fo large a quantity as to be difagreeable ; three ounces in the day occafioned fome uneafinefs in my bowels ; and four ounces griped me very much — I had now and then fome wind upwards, and fometimes, after being a little griped, paffed fome downwards ; my appetite was fufficiently fatis- fied -, I was iometimes a little tliirfly, and frequently had denies in the night.
On the 23d of Auguft, a large double tooth, which had been very troublefome to me, during the time, and even after the fugar diet, was extracted from the lower jaw ; the day following I had great pain in the part from whence the tooth was taken, and the gum appeared fomewhat black.*
The fecond night I had no fleep from the exceflive pain, and an abominably putrid flough was formed. The gums in the neighbour- hood of the fore fwelled more than ever'and became in part livid, with a fetid white fluff round their edges, whilft the gums immediately over the fore were black and infenfible. My appetite was keen, not- withflanding this complaint in my mouth, and was not fatisfied until the 5 th of September, when I loft it entirely, and became dull, I never had any wind in my ftomach, and feldom in my bowels. J^o defires. I commonly kept fome powder of bark on the fore, and warned it frequently with diluted vinegar.
On
( i<>7 )
On the 5 th of September the Hough was fmoother, not. fo fetid or difigreeable, but the affection of the gums was more general, and fome of them a little eroded,
On the 6th I had a loofe ftool in the morning, little or no ap- petite.
On the 7th, ftill no appetite, I had five loofe ftools, with griping and wind, and the ftools partly confided of a kind of gelatinous matter. On going to bed in the evening I was feized with coldnefs and fhivering, had fourteen watery ftools in the night, with great pain and wind in my bowels, &c.
On the 8th I was fo weak and low that I almofr. fainted m walking acrofs my room ; had four or live loofe ftools in the courfe of the day, was fick, and my tongue foul. Having taken fifteen grains of ipeca- cuanha, I vomited, firft a clear liquor, of the colour of Burgundy, afterwards a brown and extremely bitter liquor. In the evening I obferved that the flough on the fore, and fome parts of the gums had become black, whilft the gums of the upper jaw, oppoiite the fore, were fwelled, fo as almofl to reach the extremity of the eye- tooth ; and I fpat, in confiderable quantity, a very difagreeable, fetid, yellowim fluid. I took half an ounce of the extract of the bark, and had three ftools, but they were not fo thin as before.
On the 9th, although I was much better, my pulfe was ftill very low, and I was apt to faint whenever I got out of bed; fome black floughs were feparated from the gums, which now put on a more favourable appearance. The eminences or papillae, which to me are natural on the inlide of my legs and thighs, were red or
P 2 purple,
( io8 )
purple, and the difcolouration of the fkin fpread beyond the emi- nencies -, there were alfo a few light brown fpots on feveral parts of my lower extremities. I took an ounce and an half of the extract of bark, with fome mulled Port wine, which had no very fenfible effect -y but I found myfelf greatly revived by a bafon of mutton broth, which was almoft the firfl food I had taken fince the 5th ; I had two foft ftools. I continued to take the bark for a few days longer, and lived freely on animal food, milk and wine, until the 1 8th 5 when I felt myfelf quite recovered,
EXPERIMENT
( "9 )
EXPERIMENT IV.
Diet of Bread and Water, with Milk.
|
i o f"5 • ■5 ■" a 0. g QJ O CO "O -a O N 'H N |
State of the at- mofphere during the period. Thermometer from 57 to 62. Weather ferene, |
Daily allowance of food. Bread, 30 oz. Water, 3 lb. Milk, 4 lb. |
Daily gain of weight. 2 oz. |
Number and to- tal weight of ftools. 4 ftools, weigh- ing 3 lb. 10 oz. |
Weight of my body at the end of the period. 12ft. |
|
-a N • •5 s si -a c O j- u *S Oh n 5 *-' 3 0 u -O |
Thermometer from 55 to 57. Weather cloudy or ferene. |
Bread, 30 oz. Water, 3 lb. Milk, 4 lb. |
2 oz. |
2 ftools, weigh- ing 1 lb. 4 dr. |
12 ft. 8 oz. 1 |
|
n a; jl 2co 1 0 -c - 0 •& C 0\ U N -a j= >-i *-> 12 0 P ~ |
Thermometer from 5 5 to 59. Weather rainy, or ferene. |
Bread 30 oz. Water 3 lb. |
Daily lofs of weight. 10 oz, j dr. |
2 ftools, weigh- 5 oz. 4 dr. |
1 ift. 12 lb. 8 cz. |
|
u 0 p N |
' ermometer $4. or 5?. Weather ferene, I] , or rain. |
Diet irregular. |
12 ft. |
||
( no )
REMARKS.
By the 18 th of September the fore in that part of the gums from which the bad tooth had been extracted, was perfectly healed ; and the gums, though ftill a little fwelled, were daily getting better. My flools were commonly foft, and of a buff colour ; I was fometimes a good deal griped, (Venus bis.)
From the 22d to the 26th my ftools were very hard, forced off with great difficulty and pain, and were covered with blood ; I was quite flout and hearty, and had, fometimes, defires.
On the 29th although the gums were not to appearance worfe, yet I frequently fucked blood from them, and my finger, after touching them, had an offenfive fmell ; what I fpit was yellow- ifh and fetid. I had obferved none of thefe fymptoms before, iince my fevere illnefs.
From the 29th of September to the 2d of October, I lived rather highly, on animal food, and, from being coftive, I became loofe in my body. The bleeding of the gums was lefs perceptible, and they had now no offenfive fmell. (Venus femel.j
EXPERIMENT
( III )
EXPERIMENT V.
Diet t Bread and Water ; with roajied Goofe.
|
o *T3 |
State of the at- |
Daily allowance |
Daily lofs of |
Number and to- |
Weight of my |
|
N £ |
mofphere during |
of food. |
Weight. |
tal weight of |
body at the end |
|
4-» © |
the period. |
ftools. |
of the period. |
||
|
S« |
• |
||||
|
Is |
Thermometer |
Bread, 30 oz. |
40Z. |
1 ftool, weighing |
nft. 13 oz. |
|
from 47 to 52. |
Roafted Goofe, |
9 oz. 6 dr. |
|||
|
T3 J5 |
Weather cloudy |
6oz. |
■ |
||
|
U 1) |
or rain. |
Water, 3 lb. |
|||
|
CkJ= |
|||||
|
■5 »° |
Daily gain in |
||||
|
weight. |
|||||
|
o |
|||||
|
SO |
|||||
|
•> o |
Thermometer |
Bread, 30 oz. |
3 oz. |
Loofe ftools. |
11 ft. 131b. »2 oz. |
|
"O r- o •£ |
_ — |
Roafted Goofe, |
|||
|
Weather com- |
6oz. |
||||
|
CL, |
monly ferene. |
Water 3 lb. |
|||
|
\ |
|||||
|
<JZ |
|||||
|
JG |
|||||
|
o t- |
Daily lofs of |
||||
|
U .a J3 O |
weight. |
||||
|
= « |
|||||
|
i2 |
|||||
|
Thermometer |
Bread, 30 oz. |
3 oz. |
Loofe ftools. |
lift. 131b. |
|
|
about 50. |
Roafted Goofe, |
||||
|
.2 ■*" |
Weather ferene. |
6oz. |
|||
|
-Ho |
Water 3 lb. |
■» |
|||
|
„c |
|||||
|
p |
• |
Firft
112
|
"~ |
■ * ■ ' "■ ■ |
—» » - — ■■■-■ — |
|||
|
"*J |
|||||
|
State of the at- |
Daily allowance |
Daily lofs of |
Number and to- |
Weight of my |
|
|
— : ,0 |
mofphere during |
of food. |
weight. |
tal weight of |
body at the end |
|
■" c •g <5 |
the period. |
flools. |
of the period. |
||
|
PO |
|||||
|
- o |
Thermometer |
Irregular. |
3 oz. |
12ft. lib. 40Z. |
|
|
•o J: |
about jo. |
Loofe ftools. |
|||
|
Weather ferene. |
|||||
|
3 ° |
|||||
|
k |
|||||
|
-C |
Daily gain of |
||||
|
On . |
weight. |
||||
|
~ o |
|||||
|
s2 |
|||||
|
Thermometer $6. |
Bread, 30 oz. |
2 loofe ftocls. |
12ft. i lb. 8 oz. |
||
|
Weather cloudy. |
Roafted Goofe, |
||||
|
■tt « |
8oz. |
||||
|
1 I |
Water 3 lb. |
||||
|
CLJ3 |
|||||
|
— |
|||||
|
ten |
|||||
REMARKS.
I had fucked blood from my gums till the 3d of October, but none afterwards ; the fvvelling of the gums of the upper jaw had fubfided, and they feemed to be quite well, whilft thofe of the lower jaw were daily mending ; in every refpect I was hearty and vigorous botli in body and mind. (Venus ter.)
On the 7th, I had a head-ach, and little appetite for food. One loofe ftool.
On the 8 th, had two loofe flools ; my gums were rather worfe, and I brought away a little blood by fucking them.
Between
( w )
Between the ioth and 14th had two liquid flools ; my gums quite well. (Venus bis.)
From the 14th to the 19th, lived freely on animal food.
From the 19th to the 21ft, was fometimes a little thirfty, and my appetite was rather more than fatisfied -} violent deiires ; paffed a good deal of wind downwards. (Venus bis.)
EXPERIMENT
( "4 )
EXPERIMENT VI.
Diet of Bread and Water, with boiled Beef . M
|
t'irit period, from the 21ft to the 24th of Odober. |
State of the at- niofphere daring the period. Thermometer from 47 to 54. Weather ferene or cloudy. |
Daily allowance of food. Bread, 30 oz. Boiled Beef, 6 oz. Water, 3 lb. |
Weight of my body ftationary. |
Number and to- tal weight of ftools. 1 ftool, weigh- ing 4 oz. 5 dr. |
Weight of my body at the end of the period. 1 2 ft. 1 lb; 8 oz. |
|
"Second period, from the 24th to the 28th of Oftober. |
Bread, 30 oz. Boiled Beef, 40Z. Water, 3 lb. |
1 |
|||
|
|