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MEDICAL
TRAN SACTIONS,
PUBLISHED BY THE
COLLEGE of PHYSICIANS
I N
LONDON.
VOLUME THE SECOND. THE SECOND EDITION.
1?
LONDON:
Printed for J. Dodsley, P. Elm sly, and Leigh and So the by*
MjDCCjLJtXXV I.
sm ££££_
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ADVERTISEMENT,
THE experience of many ages hath more than Efficiently
j
fhewn, that mere abftradt reafonings have tended very little to the pro- moting of natural knowledge. By laying tkefe afide3 and attending carefully to what nature hath either by chance or upon experiment of- fered to our obfervation, a greater progrefs hath been made in this part a 2 of
iv ADVERTISEMENT, of philofophy, ft nee the beginning of the laffc century, than had been till that time from the days of Ariftotle.
This advancement hath been greatly owing to thole learned focie- ties in Europe, who, by collecting papers relating to this branch of knowledge, have preferved many ufe- ful obfervations, which would other- wife have been loft.
As the art of Phyfic hath been much improved by this method of communicating obfervations, the Col- lege of phyftcians in London are de- lirous of furthering a delign fo wor- thy of their attention ; and are ready
to
V
ADVERTISEMENT, to receive any Medical Papers that {hall be prefented to them, in order to publish the raoft ufefui.
Though the principal view of the College be to perfed the hiftory of difeafes, and afcertain the effeds of medicines, yet papers which in any manner relate to medical fubjeds will be received.
Many, who have given their ob- fervations to the world, have pur- pofely feleded fuch as were rare and extraordinary. Now, though thefe may be worth preferving, for almoft all fads teach fomething, yet the preference Ihould not be given to fuch ; as the end of thefe colledions
vi ADVERTISEMENT, is not merely to gratify the curiofity of the reader.
Single cafes, which occur every day in common diftempers, and ac- counts of the ordinary effects or medicines, muff be endlefs. What- ever important additions or excep- tions to the general practice may be contained in thofe cafes, would much better be drawn out by the author himfelf, and prefented without giving along with them a tirefome account of common appearances, with which every one is fuppofed to be well ac- quainted.
It is to be wifhed that writers would not confine themfelves to re- late only their fuccefsful pradice. A
4 Ihy-
ADVERTISEMENT. vii Phyfician of great experience might write a very ufeful paper, if he would have the courage to give an account of fuch methods of cure only as he had found to be ineffe&ual or hurtful.
The College think it proper to declare, that they do not, as a body, mean to vouch for the truth of any relation, or to give authority to any opinion, contained in the papers here publifhed.
a 4.
CON-
I
[ ix 3
CONTENTS.
I. Of the HeSlic Fever : By William
Heberden, M. D. Fellow of the College of Phyficians , and of the Royal Society. p. I
II. Remarks on the Pulfe. By the
fame. p. 1 8
III. An Account of an extraordinary
Ptyalifm , and of its cure : com- municated in a letter from Mr. John Power, Surgeon at Polef- wortlv'/z Warwick (hire, George Baker, M. D. Fellow of the College of Phyftcians , and of the Royal So- ciety. p. 34
IV. 7 he
X
CONTENTS.
IV. Fhe Cafe of a Locked yaw , com-
municated in a letter from Dr. William Carter, at Canterbury, to James Hawley, M. D. Fellow of the College of Phyfcians , and of the Royal Society. p. 39
V. A Cafe of the Hydrophobia. By the late Nicholas Munckley, M. D. Fellow of the College of Phyfcians , and of the Royal Society.
p. 46
VI. Some Account of a Di [order of the Breaf. By William Heber- den, M. D. F. R. S. p. 59
VII. Of the Colica Pi&onum, by
R. Warren, M. D. Fellow of the College of Phyfcians , F. R. S. and
S. A. and Phyfcian in Ordinary
to His Majefy. p. 68
VIII. Fhe Hifory and Cure of a dif- ficulty in Deglutition of lottg con- tinuance, arifng from a fpafmodic
affeSlion
CONTENTS. ji
affeBion of the Oefophagus . Com- municated to the College hy Tho- mas Percival, M* D. F. R. S.
p. 90
IX. On human Calculi ; floewing them to be of very different kinds . By Ambrose Dawson, M. D. Fellow of the College of Phyflciam .
p. 105
X. Of the Difeafes of the Liver.
By William Heberden, M. D.
F. R. S. p. 1 23
XL Cf the Nettle-raff. By the fame. p. 1 73
XIL Canine Madnefs fuccefs fully treated : Communicated to the Col- lege by W. Wright son, Surgeon , in Sedgfield, Durham. p. 192
XIII. A Letter from Dr. Lysqns to Dr. A 0 e e : On Elm Bark. p. 203
XIV. An Account of the noxious
effeBs of fome- Fungi ; By W. Heberden. p. 216
XV. A
Xfl
CONTENTS.
XV. A Cafe of the Hydrophobia, by Mr. Falkener, Surgeon at Southwell, in Nottinghamfhire.
p. 222
XVI. An Account of an improved Method of preparing Magnefa Alba , by Thomas Henry,, Apo- thecary at Mane heller, communi- cated by Richard Warren, M.D. F. R. S. S. A. and Phyfcian in Ordinary to the King. p. 226
XVII. Several extraordinary infiances
of the cure of the dropfy , colleEled and communicated by George Baker, M. D. Fellow of the Col- lege of Phyficians , and of the Royal Society , and Phyfician in Ordinary to Her Majefity . p. 235
XVIII. The cafe of Mr. Thomas Wood, a miller , of Billericay, in the county of EiTex, communicated by the fame. p. 2 $9
2 XIX. Ob-
CONTENTS. siii
XIX. Obfervations on the modern me- thod of by the l
XX. An Account of fome uncommon Cafes : i . Of a violent Scurvy ;
■ — 2. & 3. Qf the Venereal Dif- order ; — 4. Of an obflinate inter- mitting Fever ; — 5. Of a “Tumor on the Brain ; — 6. Of a Hydroce- phalus \ — 7. Of Offif cations in the Mefentery ; — By Donald Monro, M. D. Phyfcian to his Majeftfs Army and to St. George s Hofpi- tal , and Fellow of the College of Phyfecians , and of the Royal So- ciety. P • 325
XXI. An Account of the Succefs of Inoculation for the Small-Pox: , at Jamaica, in a Letter from Mr. John Quier, P raSlitioner of Phyfic in that If and, to Dr. Donald
Monro,
inoculating the f mall-pox, Lme. p. 275
XIV
CONTENTS.
Monro, Phyfician to St. George’s Hof pit at, &*c. London. p. 366 XXII. Farther Obfervatiom on the fioifon of Lead , by George Baker, D. Fellow of the College of Phyficians, and of the Royal So- ciety, and Phyfcian in Ordinary to Her Majefy. p. 419
XXIII. An Account of two infiances of the true Scurvy , feemingly oc- cafionecl by the want of due Nou- rifhment ; being an ExtraB of a Letter addreffed to Dr. Baker, hy Francis Milman, M. B. Fel- low of Exeter College , in Oxford, and one of Dr. Radcltffe’s Era- veiling Phyficians. Communicated by Dr. Baker. p-. 471
XXIV. A Cafe of Hydatids, dif- charged by coughing, related in a letter from John Collet, M. D. Phyfician at Newbury, Berk (Lire, to
CONTENTS. xr
to Dr. Baker. Communicated , to- gether with fome remarks on it , by Dr. Baker. p. 486
XXV. Queries. By Dr. William Heberden. p. 500
M E D l
MEDICAL
TRANSACTION Si
I. Of the HeSiic Fever: By William Heberden, M. D. F. R. S.
Read at the COLLEGE, July 7, 1768.
g H E He<3ic fever, which is otherwife called the fympto- matic, the irregular intermittent, and the fever of fuppurations, is frequent- ly mentioned ; but it is not eafy to meet with it fo chara&erized, as to enable any one clearly to underftand what is meant by thefe names, and readily to diftinguifh this fever from all others. Its appearance is not un- like that of the genuine intermittent, but it is a very different diftemper, Voiu. II, B and
s medical
and requires a different method of cure, and is as dangerous in the event, as the other is ,fafe.' In the true intermittent, the three ftages of cold, and heat, and fweat, are far more diftin&ly marked ; the whole fit is much longer; the period, which it obferves, is more conftant and re- gular, and the intermiffions are more perfedt, than in the Hedtic fever; for in this laid, even in the cleared remiffion, and during a date of the greateft quiet between the fits, there is ufually a feverilh quicknefs percep- tible in the pulfe, which feldom fails to exceed the utmoft limit of a heal- thy one, by at lead: ten beats in a minute. Whoever attends to thefe circumftances, will very feldom mif- take the one for the other ; but it is worth while to be more particular in pointing out the difference.
The chiilnefs of the He&ic fever is fometimes fucceeded by heat, and
fome-*
TRANSACTIONS. g
fometimes immediately by a fweat, without any intermediate ftate of heat ; and the heat will fometimes come on without any remarkable pre- vious chillnefs, and the chillnefs has been obferved to go off without be- ing followed either by heat or fweat. The duration of thefe ftages is fel- dom the fame for three fits together ; and as befides it is not uncommon for one of thefe ftages to be want- ing, the length of the whole fit mult vary much more than in the true m- termittent, but in general it is much fhorter.
The He&ic patient is little or not at all relieved by the coming on of the fweat ; but is often as anxious and reftlefs in the fweat* as in the chillnefs and heat. When the fweat is over, the fever will fometimes con- tinue, and in the middle of the fever the chillnefs will return, which is a moil certain mark of this fever r- al- B 2 moft
4 MEDICAL
moft all others begin with a chill- nefs, but the return of it fo as to laft half an hour or longer, while the fever is ftrong upon the patient, is what I never faw, except only in this fever.
The Hedfic fever will return with great exadtnefs, like a quotidian, or tertian, or quartan, for two or per- haps three fits; but I do not remem- ber ever to have known it keep the fame period for four fits together. The fit will now and then keen off
i.
for ten or twelve days ; and at other times, efpecially when the patient is very ill, it will return fo frequently on the fame day, that the chillneis of a new fit will follow immedi- ately the fweat of a former. It is not unufual to have many threaten- ings of a {hivering return in the fame day. Some degree of drowzinefs is apt to attend the going off of the fit.
The
TRANSACTIONS. 5
The urine in a true intermittent is Well known to be clear in the fits and turbid in the intervals ; but in the He&ic fever there are all forts of irregularities in the appearance of the water. It will be equally clear or equally turbid in both ftages : or even turbid in the fits and clear in the intervals ; and fornetimes it will be, as in a true intermittent, clear during the fever, and thick at the going off.
Hectic patients often complain of pains like thofe of the rheumatifm, which either affedt, by turns, almoft every part of the body, or elfe return conftantly to the fame part ; which is often at a great diftance from the feat of the principal diforder, and, as far as is known, without any peculiar connexion with it. Thefe pains are fo violent in fome patients, as to make no inconfiderable part of their fufferings, and to require a large B 3 quantity
'6 MEDICAL
quantity of opium. As far as I have obferved, they are more common, where the He&ic arifes from fome ulcer open to the external air, as in cancers of the face, breads, anus, &c. Joined with this fever, and arifing probably from one* common caufe, I have been furprized to fee fwellings of the limbs, neck, or trunk of the body, rife up almoft in an inftant, as if the part was all at once grown fatter : thefe fwellings are not pain- ful, hard or difcoloured, and they continue for feveral hours.
1 have feen this fever attack thofe who feemed in tolerable health, in a fudden and violent manner, like a common inflammatory one, and like that, in a very little time, bring them into imminent danger of their lives; after which it has begun to abate and to afford hopes of a perfed recovery: but though the prefent danger might be over, and but little of a fever
remain.
TRANSACTIONS. 7
remain, yet that little has foon fhewed, that it was kept up by Tome great mifchief within, and, proving unconquerable by any remedies, has gradually undermined the health of the patient, and has never ceafed except with his life. But this man- ner of its beginning is extraordinary; it much oftener diffembles its ft rength at firft, and creeps on fo flowly, that the fubje&s of it, though they be not perfectly well, yet for fome months hardly think themfelves ill, com- plaining only of being fooner tired than they ufed to be, and of want of appetite, and of falling away: but, gentle as thefe fymptoms may feem, if the pulfe be quicker than ordinary, fo as to have the artery beat at leaf!: ninety times, and perhaps a hundred and twenty times, in a minute ; there will be the greateft reafon to be ap- prehenftve of the event. There is perhaps no diforder of the body, in B 4, which
I MEDICAL
which the pulfe is of more ufe to guide our judgment, than in the complaint which has been defcribed : and yet even here we muft be upon our guard, and ought not to truft en- tirely to it ; for one in about twenty patients, with all the worft figns of decay from feme incurable caufe, which irrefiftibly goes on to deftroy his life, will fhew not the leaft de- gree of quicknefs, nor any other ir- regularity of the pulfe, to the day of his death.
This fever will be brought on, whenever there is a great collection of matter formed in any part of the body ; but it more particularly at- tends upon the inflammation of a feirrhous gland, and even upon one that is flight, and only juft beginning, the fever growing worfe in proportion as the gland becomes more inflamed, or ulcered, or gangrenous ; and fuch is the lingering nature of thefe gland'
tdar
transactions. 9
ular diforders, that the firft of thefe ftages will continue for many months, and the fecond for fome years.
If this fcirrhous inflammation be external, or in the lungs, or fome of the abdominal vifcera, where the dis- turbance of their fun&ions plainly points out the feat of the diforder, there can be no doubt about the caufe of the fever : but if the part affedted be not obvious to the fenfes, and its precife fundtions be not known, there the Hedtic, which is only part of the train of another difeafe, may be miftaken for the pri- mary or only one.
Lying-in women, on account of the violence done, in their delivery, to the parts concerned, generally die with this fever.
Women of the age of near fifty and upwards are particularly liable to It : for, upon the ceafing of their na- tural difcharge, the glands of the
breafts.
10 MEDICAL breads, ovaries, or womb, too com- monly begin to grow fcirrhous, and proceed to be cancerous : and not only thefe, but the glandular parts of all the abdominal vifcera are difpofed to be affected at this particular time, and to become the feats of incurable diforders.
The injuries done to the ftomach and liver by hard drinking are at- tended with fimilar fymptoms, and terminate in the fame manner.
The flighted: wound by a fine- pointed inftrument is known upon fome occafions to bring on the great- eft difturbances, and the moft alarm- ing fymptoms, and even death itfelf. For not only the wounded part will fwell and be painful, but by turns alrnoft every part of the body, and very difl ant parts have been known to come even to fuppuration. Thefe fymptoms are conftantly accompa- nied with this irregular intermittent,
which
TRANSACTIONS. it which lafts as long as any of them remain.
This anomalous fever is never lefs dangerous, than when it belongs to a kindly fuppu ration, into which all the difeafed parts are melted down, and for which there is a proper out- let.
The fymptoms and danger from fome final 1 pundtures, together with their concomitant fever, moft fre- quently give way in a few days, though in fome perfons they have continued for two or three months, and in others have proved fatal.
The inflammation of internal fcirrhous glands, or of thofe in the breafis, fometimes goes off, and the fever, which depended upon it, ceafes; but it much oftener happens, that it proceeds to cancerous or gangrenous ulcers, and ends only in death.
The fame medicines are not likely always to fuit a fever, which, arifing
from
is MEDICAL
from very different caufes, is attended with fuch a variety of fymptoms. A mixture of al'afcetida and opium has in fome perfons feemed fingular- ly fervicea'ble in this fever, when brought on by a fmali wound. But in mod other cafes, the principal, if not the foie, attention of the phyii- cian mud be employed in relieving the fymptoms, by tempering the heat, by preventing both coftivenefs and purging, by procuring deep, and by checking the fweats : and if, at the fame time, he endeavour to put the body into as good general health as may be, by air, exercife, and a proper courfe of mild diet, he can perhaps do nothing better, than to leave all the reft to nature. And in fome few fortunate patients nature appears to have fuch refources, as fttould hin- der us, even in very bad cafes, from defpairing of their cure. For fome have recovered from this fever at- tended
TRANSACTIONS. i3
tended with every fign of an abdo- minal vifcus incurably difeafed, after all probable methods of relief from art had been tried in vain; and after the flefti and ftrength were fo ex- haufted, as to leave fcarce any hopes from nature. In thefe deplorable cir- cumftances, there has arifer). a fwel- ling not far from the probable feat of the diforder, and yet without any difcoverable communication with it. This fwel)ing has come to an abfcefs, in confequence of which the^pulfe has foon become a natural one, and the appetite, and flefh, and ftrength, have returned with perfect health. What nature has in thefe rare cafes done, I have often endeavoured to imitate, by making iflues or applying blifters near the feat of the difeafe, but I cannot fay with the fame fuc- cefs.
It feems at prefent the opinion of many practitioners, that gangrenes
will
14 Medical
will be flopped, and fuppurations will become more kindly, by the ufe of the bark. It muft, I believe, be owned, that we know no remedy, which we can certainly affirm to be more ferviceable in thefe cafes ; and therefore the ufe of the bark is always either advifed or allowed in the irre- gular fever joined with fuppurations and gangrenes. And though there be no apparent tendency to either-of thefe, yet the great refem blance, which this fever bears to an intermittent, makes the lick, and their friends, importunate to have the bark pre- fcribed, and often inclines the phy^ iician to give it from his own judge- ment. Hence it happens, that the experiment is frequently made ; but I never yet remember to have feen any good done by the bark in this fever unattended with an apparent ulcer t and even in gangrenes it fo often fails, t^hat in fuccefsful cafes, where it has 6 been
TRANSACTIONS. ij
been given, there mull be room for fufpicion, that the fuccefs was owing to another caufe. At the fame time I muft acknowledge, that I never faw any harm from the bark, in thefe, or indeed in any other cafes, except a purging or ficknefs of no confe- quence, where it has happened to difagree with the ftomach, or where it has loaded it by being given too faft,efpecially in dry bolufes wrapped in wafer paper : and I have heard the fame obferved by one, after he had prefcribed it for forty years, more than any other phyiician out of England, and as much as any one in it ; I mean the late Sir Edward Hulfe ; whofe j udgement and fagacity in making a proper ufe of his very great practice is fufficiently known to this audience. The general expe- rience in this country feems to con- firm this character of the bark, its ufe having been increafing among us
for
for many years, fo that for the laft ten years the confumption of the Peruvian bark in England has been more than double of what it was twenty years ago, and above ten times as much as it was in the be- ginning of this century : whence it appears, that the more it is known, the lefs regard is there paid to the fufpicions which were at firft raifed of its having feme ill effe&s. Some pra&itioners to this day, but chiefly foreigners, do not choofe to give it foon, if at all, even in a genuine inter- mittent, imagining, for I know not what reafons, that a fever is an effort of nature to throw off fome offending humours, and if her kind intention be checked by a hafty cure of the fever, that they will fall upon the abdominal vifeera, and create ob- ftru&ions, and dropfies, and death. It appears probable, that thefe ap- prehenfions are owing to thofe cafes,
TRANSACTIONS. 17
in which a HeCtic fever has been miftaken for an intermittent, and treated as fuch, and that the glandu- lar obftruCtions were, in reality, not the effe&s of the bark, but the ori- ginal caufe of the fever.
In lingering illneffes, where all other means have proved ineffectual, a journey to Bath is ufually propofed by the friends, and wifhed for by the Tick: but, be {ides the fatigue, and many inconveniences of a journey to a dying perfon, the Bath waters are peculiarly hurtful in this fever, which they never fail to increafe, and there- by aggravate the fufferings, and haf- ten the death, of the patient.
Vol. II.
C
II. Remarks
iS
MEDICAL
II. Remarks on the Pulfe. By the fame.
Read at the COLLEGE, July, 7, 1768.
ALL, who begin the ftudy of phyfic, mult find in the doc- trine of the pulfe, as collected from medical writers by Bellini and others, a great deal, which they do not un- derhand: and all, I imagine, who have advanced a little in the practice of phyfic, can have very little doubt of its not being understood by the authors themfelves. There can be no pretence, before this audience, for waiting any time in fhewing, that fuch minute difhndtions of the fe- veral puifes exift chiefly in the imagi- nation of the makers, or at lealt that they have little place in the know- ledge and cure of difeafes. Time
indeed
TRANSACTIONS. i9
indeed has fo fully fet them afide* that rnoft of thefe names of puifes are now as unheard of in pra&ice, as if they had never been given : and it may be doubted, whether fome of thofe, which are retained, are perfectly underftood, or applied by all to the fame fenfations, and have in every one’s mind the fame meaning. I have more than once obferved old and eminent pradlition- ers make fuch different judgements of hard and full and weak and (mall puifes, that I was fure they did not call the fame fenfations by the fame names.
It is to be wifhed, therefore, that phyficians, in their dodlrine of puifes and defcriptions of cafes, had attend- ed more to fuch circumftances of the pulfe, in which they could nei- ther miftake nor be milunderftood. Fortunately there is one of this fort, which not only on this account, but C 2 like wife
20
MEDICAL
likewife for its importance, deferves all our attention. What I mean is, the frequency or quicknefs of the pulfe, which, though diftinguifhed by fome writers, I (hall ufe as fyno- nymous terms. This is generally the fame in all parts of the body, and cannot be affe&ed by the con- ftitutional firmnefs or flaccidity, or fmallnefs or largenefs of the artery, or by its lying deeper or more fu- perficially; and is capable of being numbered, and confequently of be- ing mod: perfectly defcribed and com- municated to others.
The degrees of quicknefs of the pulfe, belonging to the feveral ages and diftempers, have been taken no- tice of by few phyficians in their writings; and, as many obfervations are neceffary to fettle this doCtrine, what I have made, and am going to relate, may be of ufe towards con- firming, correcting or enlarging thole,
which
21
TRANSACTIONS.
which have been made by others. When the number of pulfations is mentioned without any time being fpecified, a minute is to be under- ftood.
The pulfe of children under two years old fhould be felt while they are afleep; for their pulfes are great- ly quickened by every new fenfation, and the occafions of thefe are per- petually happening to them while they are awake. The pulfe then of a healthy infant afleep, on the day of its birth, is between 130 and 140 in one minute; and the mean rate for the firft month is 120 ; for dur- ing this time the artery often beats as frequently as it does the firft day, and I have never found it beat flower than 108. During the firft year, the limits may be fixed at 108 and 120. For the fecond year, at 90 and 108. For the third year, at 80 and 108. The fame will very nearly C 3 ferve
22, MEDICAL
ferve for the fourth, fifth, and fixth years. In the feventh year, the pul- fations will be fometimes fo few as 72, though generally more; and in the twelfth year, in healthy children, they will often be not more than 70 ; and therefore, except only that they are much more eafily quickened by ill- nefs or any other caufe, they will dif- fer but little from the healthy pulfe of an adult, the range of which is from a little below 60 to a little above 80. It mull be remembered, that the pulfe becomes more frequent, by ten or twelve in a minute, after a full meal.
If the pulfe either of a child or of an adult be quickened fo as to exceed the utmoft healthy limit by ten in a minute, it is an indication of fome little diforder. But a child is fo ir- ritable, that during the firft year a very flight fever will make the ar- tery beat 140 times, and it will beat
even
TRANSACTIONS. 23
even 160 without danger; and as there begins to be fome difficulty in counting the pulfe when the motion is fo rapid, the third, quicknefs of breathing, averfenefs from their food, and, above all, the want of fleep, enable us better than the pulfe to judge of the degree of fever in in- fants.
A child of two years will die of an inflammatory fever, though the artery beat only 144 times in a mi- nute; and I have feen a child of four years recover from a fever, in which it beat 156 times ; and one of nine, where it beat 152.
If the pulfe of a child be 15 or 20 below the lowed: limit of the natural ftandard, and there be, at the fame time, figns of confiderable ill- nefs, it is a certain indication, that the brain is aftedted, and confequenrly fuch a quiet pulfe, inftead of giving C 4 us
24 MEDICAL
us hope, fhould alarm us with the probability of imminent danger.
In adults ill of an inflammatory fever the danger is generally not very great where the beats are fewer than i go; 120 fhew the beginning of danger, and they feidom exceed this number, unattended with dehriouf- nefs, and where the patient does not die. There are two exceptions to this obfervation: the firft is, that before fome critical fwelling or de- poflt of matter begins to fhew itfelf in fevers, the pulfe will be fo rapid and indiftincf as hardly to admit of being counted ; but I have known it certainly not lefs than 150, and yet the patient has recovered. Acute rheumatiims afford a fecond excep- tion, in which the artery will often beat above 120 times without any fort of danger ; and, in both thefe cafes, we may remark, that the appe- tite
TRANSACTIONS. 25
tite and fenfes, andfleepand ftrength, are put lefs out of their natural Hate, than where the life of the patient is in immediate danger.
Though it be difficult to count above 140 ftrokes in a minute, if they be unequal in time or in ftrength, yet where they have been •'very diftin£t I have been able to count 180.
Asthmatic perfons are often feized with an uncommonly bad fit, arifing probably from fome great in- flammation of the lungs; and here, if the pulfe exceed 320, they very rarely recover.
In an illnefs where the pulfe all at once becomes quiet from being feverifhly quick, while all the other bad figns are aggravated, it is a proof, not of the decreafe of the- dis- order, but of the leflened irritable- nefs of the patient, the difeafe be- ing tranflated to the brain; and a
pally.
26 MEDICAL
pally, apoplexy, or death, is to be apprehended.
In low fevers, and in exhaufted old men, the pulfe will often conti- nue below joo or even 90, and yet the diftemper be attended with want of deep, delirioufnefs, reftlefsnefs, and a parched tongue, and end in death, without any comatofe, or le- thargic appearances.
Scirrhous diforders of any of the vifcera in an inflamed date, cancers, and gangrenous or otherwife ill-con- ditioned large ulcers, ufually occa- lion a gradual lofs of flefh, a heat, third, and a pulfe between 90 and 120 for many months, This date of the body is called a heftic fever ; and fome judgement may be formed of the degree of danger by the fre- quency of the pulfe. But a quick- ened pulfe more certainly denotes danger, than a natural one does fe- curity, where there are ulcers, or
where
TRANSACTIONS.
where diforders of the vifcera are fufpe&ed. I have known perfons die of cancerous ulcers of the anus, tefticles, proftate gland, and of al- moft all the vifcera, without ever {hewing any preternatural quicknefs of the pulfe. It is obfervable in he&ic, as well as in rheumatic pa- tients, that they will eat with a to- lerable appetite for many months, and bear little journies, with fuch a quicknefs of pulfe, as in acute fevers would be joined with an averfenefs from all food, and an inability to keep out of bed.
From thefe remarks it appears, that the pulle, though in many cafes an ufeful index of the hate of the health, yet it is no certain one in all ; and that without a due regard to other figns it may miflead us : a good pulfe (which I have known in comatofe fevers) with delirioufnefs, rapid lofs of appetite and ftrength,
28 MEDICAL fleepleflnefs, quicknefs of breathing, and great thirft, would afford very little hope; and a bad one without any of thefe might be harmlefs.
I remember two young women ill together with others in the fame houfe of the fame infectious fever ; the pulfe of one of which was never above 84, and the pulfe of the other was always extremely quick, and I once counted it, when I thought her dying, 180. Both of them recovered, and the latter quite beyond my ex- pectation; for, except in this inftance, I hardly remember any one recover from fuch a fever, where the pulfe exceeded 120. But the firft of thefe was ftupid, infenfible of the coming away of her water and flools, and perhaps her brain was affeCted co- matoufly, which might make her pulfe fo flow.
The pulfes of women will fome- times exceed what I have mentioned
TRANSACTIONS. 29
as the higheft limit of the healthy ftandard, and fometimes, thougli more rarely, thofe of men ; but the pulfes of men afford more excep- tions in falling fhort of the loweft. There are very few healthy men, _ jvhofe pulfes are more than go ; and I knew one, whofe chief diftemper was the age of fourfcore, in whom for the laft two years of his life I on- ly once counted fo many as 4 2 pul- fations : but they were feldom above 30, and fometimes not more than 26 ; and though he feemed heavy and torpid, yet he could go out in a carriage, and walk about his garden, receive company, and eat with a to- lerable appetite.
I saw another, whofe pulfe, as I was told, was fometimes in the be- ginning of his illnefs not above 1 2 or 16 in a minute j. but in this, and all other inftances where it is below 40, I fufped that the artery 7 beats
§o M fe D I G A L
beats oftener than it can be felt ; becaufe fuch flow pulfes are ufually unequal in their ftrength, and fome of the beats are fo faint as but juft to be perceived ; fo that others pro- bably, ftiii fainter, are too weak to make a fenfible impreffion on the finger.
Some books fpeak of intermitting puifes as dangerous figns, but, I think, without reafon ; for fuch tri- vial caufes will occafion them, that they are not worth regarding in any illnefs, unlefs joined with other bad figns of more moment. They are not uncommon in health, and are perceived by a peculiar feel at the heart by the perfons t'nemfelves every time the pulfe intermits. A woman above fifty years of age, who died of a cancer of the v/omb, had from her youth frequently experienced this fort of intermitting puife ; and that the caufe of this intermiftion might be 6 difcovered
TRANSACTIONS. 31
difcovered, fire was opened after her death, as fhe had defired fhe might be. It was done by a very expe- rienced and able anatomift : but he could difcover not the lead appear- ance of any thing preternatural in the pericardium or heart, or any of the great veflels belonging to it; fo that, for aught which appeared to the contrary, (he might, notwith- ftanding this complaint, have died of old age.
Many perfons will likewife have unequal pulfes without any other fign of ill health. I have met with two, who in their beft health always had pulfes very unequal both in their ftrength and the fpaces between them; upon their growing ill, their pulfes conftan tly became regular ; and it was a never- failing fign of their recovery, when their arteries began again to beat in their ufual irregular manner.
It
32 MEDICAL
It is often fuppofed, that great pain will quicken the pulfe : I am more fure, that mere pain will not always do it, than I am, that it ever will. The violent pain occalioned by a ftone palling from the kidneys to the bladder is often unattended with any quicknefs of the pulfe ; and the exceffive and almoft into- lerable torture produced by a gall ftone palling through the gall duds, never once quickened the pulfe be- yond its natural pace, as far as I have ever obferved, though it be a diforder which occurs fo very fre- quently: and this natural ftate of the pulfe, joined with the vehe- ment pain about the pit of the fto- mach, affords the molt certain diag- noftic of this illnefs. I have feen a man of patience and courage roll- ing upon the floor and crying out through the violence of this pain, which I was hardly able to lull into
a to-
TRANSACTIONS. 33
a tolerable date with nine grains of opium given within twenty - four hours, to which he had never been accuftomed, and yet his pulfe was all the time as perfectly quiet and na- tural, as it could have been in the fweeteft deep of perfect health.
Vol. IL
D
III. An
34
MEDICAL
III. An Account of an extraordinary Ptyalfm , and of its cure : com- municated in a letter from Mr . John Power, Surgeon at Polef- worth, in Warwickfhire, to George Baker, M. D. Fellow of the College of Phyfcians , and of the Royal So- ciety.
Read at the COLLEGE, July 7, 1768.
IN the month of April, 1751, a young lady of this town, about the age of fixteen years, of a delicate habit, but fubjeft to no particular complaints, perceived the beginning of a difeafe, which afterwards proved moil obftinate and loath forne ; viz. an incefiant fpitting. The quantity of this difcharge was different at dif- ferent times, varying from one pint, to two pints and an half, in twenty- four hours. As to its quality, it 2 ■ feemed
TRANSACTIONS.
feemed to be no other than the ordi- nary fecretion of the faiival glands. By fo large and conftant an evacua- tion, her flrength became extremely impaired; and the moft efficacious medicines had proved ufelefs. She had taken large quantities of the peruvian bark, both alone, and combined with preparations of iron : and afterwards the fetid gums, opium, amber, alum, and the Nevil- Holt- water had, in fucceffion, been given her. In the mean time an exadf regimen had been prefcribed : (he had been ordered to ride conftantly, and to confine her- felf to a mucilaginous diet, fuch as veal, calve’s feet, &c. Likewife a gently opening medicine had now and then been interpofed. The dif- eafe ftill continuing unaltered, Hie had afterwards tried the tinElura fa~ turnina ; and had, at the iame time, been encouraged to chew the peru- vian bark, and to fwallow the faliva.
D 2 But
3 6 MEDICAL But all thefe attempts had been vain 5 and after that fhe had taken fome or other of the medicines, above-men- tioned, until the end of September 1753, namely, above two years, it appeared to me unreafonable to ex- pect relief, in fuch a cafe, from any internal medicines whatever.
I now conceived a fufpicion, that fome extraneous body, having acci- dentally found it’s way into the mea- tus auditorius , might poffibly be- the caufe of this extraordinary fecretion, by keeping up a continual irritation on the parotid glands. With this view, I examined her ears, and ex- tracted from them a quantity of fetid wool. How, or when, it came thi- ther, no account could be given.
To this fubftance I could not but attribute the beginning of the fali- vation ; notwithftanding that the dif- eafe did not immediately abate on the removal of the wool; as it ap-
TRANSACTIONS. 37
peared to be no improbable fuppo- fition that the difcharge might be continued by the force of habit, though the original caufe no longer remained.
It feemed therefore expedient to introduce fome other habit, in the place of the increafed fecretion of fa~ liya ; which habit might afterwards be gradually left off. With this in- tention, I prevailed on the patient to chew perpetually a little dry bread, and to fvyallow it with her fpittle. In a few weeks, it became neceffary for her to chew the bread only at cer- tain hours in the day; and thus, af- ter two months, fhe became entirely free from a moll difguftful and tedi- ous diforder.
It is worthy of obfervation, that, at firft, the fwallowing of fo much faliva frequently occafioned a naufea\ ; and that then, for a few hours, fhe was obliged to fpit it out as ufual ;
D 3 and
as
8 MEDICAL
and that, during the greateft part of the time, when {he chewed the bread, {he had a ftool or two, every day? more than common.
Polefwotth, Warwicklhirep Jan. zf 1768.
IV. The
TRANSACTIONS. 39
IV. ‘The, Cafe of a Locked Jaw , com- municated in a letter from, Dr. William Carter, at Canterbury, to James Hawley, M. D. Fellow of the College of Phyfcians^ and of the Royal Society.
R.ead at the COLLEGE5 July 7, 1768,, Dear Sir,
I Take the liberty of fending you what fee ms to me an uncommon cafe. As the old laudable cuftom of writing hiftories of this fort in Latin is; I find, grown obfolete, you will pardon my coming to you in an Englilh drefs.
The History.
On the jyth of May lafi, I was called to a ftrong healthy man, in the 21ft year of his age, who D 4 had
4© MEDICAL
had been confined to his bed for three weeks. What gave rife to his prefent diforder was a wound on the inner gncle of his right leg, which he had received fix weeks before from a joiner’s chiffel. At the time I faw him, his mouth was fo far clofed, as to admit only the moft liquid nou- rifhment, which he conflantly fucked through his teeth : both his legs and jaw, and the whole length of the Spina Dorfi, were quite immovable, being as lliff, and rigid, as thofe of a perfon long dead ; his head was drawn back- ward, and he was frequently ftrong- ly convulfed. The motion indeed of both his arms was but little impaired. From the beginning to the end, his fight, hearing, and memory, conti- nued perfect ; his appetite was good ; and his fenfes, in the day time, en- tire, though fometimes wandering in the night. As to his pulfe, that was regular ; if it deviated at all
TRANSACTIONS. 41
from the pul'fe of a perfon in health, it was rather flow than quick, and fo me what fuller than natural. Such, was the fituation of my patient. A detail of which had been given me before I fet out on my journey, which I undertook with a determined refolution to make ufe of the method, recommended by Dr. Silvefler, in the firft vol. of Medical Obfervations and Enquiries, publiflied in the year 1757. But on my arrival at the houfe, I found great quantities of the Extrac- tum Thebaic um diffolved had been already given him; and that, for the five laft days, he had taken no lefs than 28 grains of that medicine, with 50 grains of mufk, in the fpace of 24 hours, without any fenfible efiedt, except the bringing on a confufed fleep, out of which he frequently awoke in great hurries, attended with a violent pain in the head, which almoft deprived him of his
fenfes.
fenfes. Startled as I was at the great quantity already ufed, I was afraid to extend the dofe, and foon deter- mined to take fotne other method, though at a lofs what method to purfue, as, during a courfe of aim oft 30 years pradiice, nothing of the fame kind had ever fallen under my cognizance before. Refledtjng how- ever within myfelf, that this diforder had always been deemed of the fpaf- modic kind ; and that the good ef- fects, produced by the Extra cium. Thebaic urn, in the cafe related by Dr, Si-vefter, mu ft probably be owing to the relaxing and refolving faculty of that medicine, I was not long in coming to a refolution. According- ly I dire died a blifter, to be- applied between the fhoulders ; the whole length of the fpine, and jaw, to be ancinted with the Oleum Lateritium, and a purge, confifting of the Tinc- tura Sacra, Jalapii, and the Syrupus
de
TRANSACTIONS. 43
de Rhatnno Cathartico, to be given him. This potion was repeated three feveral times afterwards, at the dis- tance of three or four days between each dofe. On the intermediate days, he was ordered the Oleum Succini, the fetid gum, and the Oleum A- mygdalinum. Of the firft he took 30 drops, of the gum 20 grains, and of the laft four ounces in nyc - themeri fpatio. By thefe means and thefe only, thefe convulfions foon ceafed, and he grew daily better and better, till at the end of a fortnight he was able to walk about his room, and in lefs than three weeks became in all refpe&s well, fome fmall weak- nefs in the parts only excepted. The jaw was relieved firft, after that the fpine, and laft of all the legs. A pain and uneafinefs in the places af- fected, neither of which he had felt before, were the forerunners of his approaching amendment.
/ '
What
44 MEDICAL
What feems to rae moft remark- able in this cafe is, that the perfon was able to go abroad, by the help of flicks, in a fortnight after the ac- cident happened ; that no bad fymp- toms came on till after that} at a time too, when the wound was heal- ing, nay, almoft healed. I have ob- ferved before, that an occurrence of this kind was new to me, and not often to be met with, 1 apprehend, by gentlemen of the faculty. If you fhall find any thing in the relation entertaining to you, I fhall be fuffi- ciently recompenfed for this trouble; if any thing contained therein fhall be judged to be of ufe, and benefit to mankind, in times to come, it will make me happy.
The fadts are mod undoubtedly true ; I took minutes of them on the fpot, and have lately had the whole confirmed to me by the mouth of my patient. Do with them there- 6 fore
TRANSACTIONS. $3
fore as you pleafe; communicate them to your medical friends, or in any other manner you fhall judge proper. If any farther fatisfadtion be required, every part fhall be au- thenticated to any one, who {hall pleafe to apply to,
Dear Sir,
Your moft affectionate
Canterbury, July 3, 17M,
humble fervant,
W. Carter.1
w
V. A Cafe
4<S MEDICAL
' >
V. A Cafe of the Hydrophobia. By the late Nicholas Munckley, M. D. Fellow of the College of Phyf clans, and of the Royal Society .
Read at the COLLEGE, July 7, 1768.
IN the morning of the nth of July 1760, a gentleman of about 36 years of age being in his {tables, a little favourite dog, which uled to follow him, leaped upon him on a fudden, and without any provoca- tion bit his hand. On his ftriking him, the dog immediately leaped at him again, and bit him in the cheek and in another part of his hand : thegentleman, alarmed at this, called out to have the dog fecured ; on which the people about him knock- ed him down, and killed him. The phyfician of the family was inftantly fent for : he ordered bleeding in the
arm
TRANSACTIONS. 47
arm to the quantity of ten ounces, and what elfe he thought proper 5 and advifed bathing in the fea. This was complied with as foon as poffi- ble, the gentleman fetting out for the fea- fide on the fame afternoon. He flayed there ten days, during which time he bathed conftantly; but, meeting with a perfon who told him that bathing was the only thing from which he could expect any fer- vice, though his medicines were re- gularly fent down to him from town, there is the greateii reafon to believe that he took none of them : and on this account I forbear to mention what was ordered for him. He re- turned to town about the 21ft of July, and continued near a month in his ufual way of life : at this
time, though the accident, which had befallen him, had feemed, during the whole time, to lie heavy upon his mind, his family and friends ob-
ferved
48 MEDICAL
ferved him to be more than ufually melancholy. On the 19th of Au- gull, he found a difficulty of {wal- lowing, like that, as he the day after defcribed it to me, which proceeds from a common fore throat : but I imagine that he was greatly alarmed at it, as he afterwards told a friend of his, that he had the day before, when he foil perceived it, rifen from din- ner that his mother might not ob- ferve it. He continued very uneafy and diflurbed the remainder of that day, and the fucceeding night : at live in the morning, he fent for his apothecary, to whom he owned his fears that what he then felt was ow- ing to the bite which he had for- merly received. In the forenoon he lent for his phyfician, who coming to him about eleven o’clock, and being alarmed at the account which was given him, delired a con ful ra- tion. I was fent for, and when 1
TRANSACTIONS. 49
came, the other phyfician, who had waited at the houfe, informed me in general of what had happened in refped to the patient’s having been bitten j and fent to bathe in the fea ; and added that he would fay no- thing more to me, being defirous that I fhould form my opinion up- on what I fhould myfelf obferve on examining him* On going into the room, I found the patient in bed: he was lying on his left fide, and reding his head, a little lifted up from the pillow, upon one hand. He had in his countenance the ap- pearance of a fixed melancholy; and did not much care to lift up his eyes, on being defired to look at me, or to anfwer to the queftions which were afked him. There was no con- fiderable degree of heat upon the fkin ; his pulfe was low, and not much quicker than is ufual in health; the vefiels of the eyes appeared tur- Vol, II, E gid ;
5<S MEDICAL
gid; and his tongue, which I owri I did not touch, parched and dry, but not white. He did not mention to me the circumftance of his hav- ing been bitten by his dog, and feemed to be folicitous to make me believe that he ailed nothing but a common cold or fore throat. On my appearing to aftent to this, he feemed fomewhat pleafed, and gave me an opportunity of making the trial which I wanted, by telling him that it was neceffary for him to drink plentifully. The moment I had mentioned this, he darted aim oft upright in his bed, and, with a con- fiderable degree of fiercenefs and an- ger in his looks, repeated the word drink ! and in fhort and unfinished fentences, which he fpake with great eagernefs and quicknefs, faid, it was impoflible, he could not, and begged, for God’s fake, that I would not men- tion it. After fome little time, and
when
TRANSACTIONS. 51
when he had returned to his Former pofture and appearance, I made an- other trial by mentioning again the fubjedt of his drinking, as gently as 1 could : but the effedt was exadtly fimilar to that which I have deferr- ed. On returning to the other phy- fician, who, being very old and in- firm, had excufed himfelf from go- ing up flairs again, and acquainting him with what I had obferved, he laid that the fymptom of the Hydro- phobia had come on very fa ft, for that, when I was firft feat for, there was no certain appearance of it. It may not be improper to obferve, that the reafon of thefe particulars being mentioned more minutely than at firft fight may perhaps be thought neceftary, is to mark with the greater exadtnefs this circumftance of the ra- pidity of the fymptom’s coming on. And upon the whole I am certain there could not be an hour between E z the
s% MEDICAL
the time in which the other phy- fician faw him, when, as is evident from what he faid to me on my firft coming, he doubted whether the fymptom was upon him or not, and my finding him in the fituation which 1 have above defcribed. The Hydrophobia did not, however, in- creafe in any confiderable degree that day : for when I faw him again
in the evening, I could not perceive much alteration from what I had oblerved at noon. He had however fwallowed nothing during this time; and the apothecary, who feemed to be particularly attentive to what had palled, told me, that he was very certain he had drank nothing fince the day before, when he got up from the table, as has been already men- tioned. When we met about ten o’clock the next day, we were in- formed that, though he had not flept, he had lain quiet the greater part of
the
TRANSACTIONS. 53
die night ; but that towards morn- ing he had begun to fliew figns of great diftrefs and uneafinefs, which had gradually increafed upon him, till they had arrived to fuch a height as that none of his friends could bear to remain with him. On going into the room, we found him lifting up in his bed, with an attendant on each fide of him: he was in violent agitation of body ; moving himielf about with great vehemence, as he fat in the bed, and toiling his arms from fide to fide. On feeing us, he bared one of his arms, and, finking it with all his force, he cried out to us, with the greateft eagernefs, to or- der him to be let blood. His eyes were redder than the day before ; and there was added to the whole look an appearance of horror and defpair greatly beyond what I had ever feen before, either in madnefs, or in any other kind of delirium.
E 3 He
54 MEDICAL
He had begun to fpit, from the time of his growing difturbed : and this fymptom had greatly increafed upon him. When we favv him, he was al- inoft perpetually fpitting, fometimes to the top of the bed, at other times about the room ; and now and then into the handkerchiefs which his at- tendants had ready for that purpofe. The phlegm which he fpit was of a yellow cad, and at the time we faw him was grown fo tenacious, that he could not without great difficul- ty get it up ; to do which, he at times appeared to labour very hard. And the tenacioufnefs of the phlegm was fuch, that whenever he opened his mouth, we could fee it adhering to the inlide : but there was nothing like a foam about his mouth. The found which he made in endeavour- ing to raife the phlegm, was of a very lingular kind; it was different from common hawking : but this
difference
TRANSACTIONS. 55
difference appeared to be owing to his being much oppreffed by what he wanted to get up, and his ftriving with a very extraordinary degree of vehemence to get rid of it. This found varied alfo at different times, being at fometimes much lharper than at others : and being frequently re- peated, and quick and fudden, as every other motion of his body was, a doubt ftruck me whether a warm and pre- poffeffed imagination might not con- fider this as barking, or yelping, like a dog. This gentleman was perfedtly in his fenfes at this time; knew eve- ry body, and, excepting what I (hall prefently mention with regard to the trial by water, did not appear to me to have any falfe imagination. After having faid this, I fcarce need to add, that there was not the leafl ap- pearance of perfon near him : nor, among the va- riety of motions which he made, was E 4 there
clanger of his biting any
5<S MEDICAL
there any which looked like attempt- ing to fnap or bite at any thing within his reach ; and that they who were conftantly about him had no apprehenfion of his doing this, will appear from what follows. His fhirt collar was unbuttoned, and the fore part of his neck appeared to me re- markably protuberant, and as if the uppermoft cartilages of the wind- pipe had been fwollen and thruft forward : one of the attendants, w^q was a man that had been employed in the care of mad people, held his left hand in one of his own, and with the other gently ftroaked the outhde of his throat ; which Teemed to give him a momentary relief. The perfon was told to be upon bis guard, for that it was not impof- iible but that he might receive a bite ; and that he fhould put on gloves, or cover his hands in fome way or other, if he continued to be
thus
TRANSACTIONS, $7
thus employed. But he refufed to do any thing of this kind; and faid, that he had feen enough of him in the courfe of the night, to be very certain that there was nothing to be feared from him. And the apothe^ eary afterwards informed me, that, feveral times when the phlegm was fo tough and tenacious that the pa- tient cpuld not himfelf fpit it out of his mouth, this perfon put his finger into his mouth, and, with the corner of an handkerchief, drew it out for him. But this, though I have no doubt pf its being true, I did not myfelf fee done.
After we had been for fome time in the room, two bafons were brought in, and being held near him, water was poured feveral times from the one to the other: this occasioned in him the greateft diftrefs and horror imaginable; he feemed as if con- yulfed all over, and, in fhrinking 1 from
58 MEDICAL from the fight, to endeavour to get through the head of the bed, which he hit feveral times with his back and fhoulders with great vehemence. He cried out aloud on the perfon •who was employed in pouring out the water, calling him villain, and exclaiming againlt the cruelty of fuch treatment. And indeed the agony into which the fight feemed to put him was fo very great, that we foon defifted. We left him about eleven o’clock ; and between one and two at noon, death put an end to his ml- iery.
VI. Some
TRANSACTIONS. &
VI. Some Account of a D if order of the Bread. By William Heber-
i3en, M, -D . F. R. S.
Read at the COLLEGE, July 21, 1768*
f" I NHERE is a diforder of the breaft, marked with ftrong and peculiar fymptoms, confiderable for the kind of danger belonging to it, and not extremely rare, of which I do not recoiled: any mention among medical authors. The feat of it, and fenfe of ftrangling and anxiety with which it is attended, may make it , not improperly be called Angina pe&oris.
Those, who are affli&ed with it, are feized, while they are walking, and more particularly when they walk foon after eating, with a pain- ful and moft difagreeable fenfation in the breaft, which feems as if it
would
€0 MEDICAL’
would take their life away, if it were to increafe or to continue s the moment they Hand {till, all this unealinefs vanifhes. In all other re- fpe&s, the patients are, at the begin- ning of this diforder, perfectly well, and in particular have no fhortnefs of Breath, from which it is totally dif- ferent.
After it has continued fome months, it will not ceafe fo inftan- taneoufly upon Handing Hill ; and it will come on, not only when the perfons are walking, but when they are lying down, and oblige them to rife up out of their be is every night for many months together : and in one or two very inveterate cafes it has been brought on by the motion of a horfe, or a carriage, and even by fwaliowing, coughing, going to llool, or fpeaking, or by any diilurbance of mind. I have heard one, and . only one perion, fay, that he had
known
TRANSACTIONS. 6i
known it attack him, while he was up and ftanding ftill or fitting. But moft, whom I have feen, have been perfectly unaffe&ed with riding in any manner, with fpeaking, fwaliow- ing, laughing, fneezing, or vomiting. One has told me, that this co|tiplaint was greateft in winter; another, that it was aggravated by warm wea- ther : in the reft, the feafons were not fufpe&ed of making any differ- ence.
I have obferved fomething like this affe&ion of the breaft in one woman who was paralytic, and have heard one or two young men com- plain of it in a flight degree ; but all the reft, whom 1 have feen, who are at leaft twenty, were men, and al- raoft all above fifty years old, and moft of them with a fhort neck, and inclining to be fat.
When a fit of this fort comes on by walking, its duration is very fhort,
as
62 M E D I G A' L
as it goes off a 1 mo ft immediately up* on flopping. If it come on in the night, it will laft an hour or two; and I have met with one, in whom it once continued for feveral days, during all which time the patient feemed to be in imminent danger of death.
When I firfl: took notice of this diftemper, and could find no fatisfac- tioii from books, I confulted an able phyfician of long experience, who told me that he had known feveral ill of it, and that all of them had died fuddenly. This obfervation I have reafon to think is generally true of fuch patients^ having known fix of thofe, for whom I had been con- fulted, die in this manner ; and more perhaps may have experienced the fame death, which I had no oppor- tunity’’ of knowing. But though the natural tendency of this illnefs be to kill the patients fuddenly, yet unlefs
TRANSACTIONS. 63
jP 1 \
it have a power of preferving a per- fon from all other ails, it will eafily be believed, that fome of thofe, who are afflided with it, may die in a different manner, fince this diforder will laft, as I have known it more than once, near twenty years, and molt ufually attacks only thofe who are above fifty years of age. I have accordingly obferved one, who funk under a lingering illnefs of a different nature.
The os fterni is ufually pointed to as the feat of this malady, but it fee ms fometimes as if it was under the lower part of it, and at other times under the middle or upper part, but always inclining more to the left fide, and fometimes there is joined with it a pain about the mid- dle of the left arm. What the par-* ticular mifchief is, which is referred to thefe different parts of the fter- num, it is not ealy to guefs, and I have
had
®4 MEDICAL
had no opportunity of knowing with certainty. It may be a ftrong cramp, or an ulcer, of poffibly 'botff
The opinion of its being a con- vulfion of the part affected will rea- dily prefen t itfelf to any One, who conliders the fudden mariner of its coming on and going off ; the long intervals of perfect eafe ; the relief afforded by wine and fpirituous cor- dials; the influence, which paffionate affedions of the mind have Over it ; the eafe, which comes from varying the pofture of the head and fhoulders, by ftraitening the vertebras of the thorax, or by bending them a little backwards or forwards; the number of years, which it will continue with- out otherwife difordering the health; its generally bearing fo well the mo- tion of a horfe, or carriage, which circumftance often diftinguifhes fpaf- modic pains from thofe, which a rife from ulcers; and laftly, its coming
on
^TRANSACTIONS. 65
bn in certain patients at night, juft after the firft fleep, at which time the incubus, convulfive afthmas, numb- nefles, epilepfies, hypocondriac lan- guors, and other ills juftly attribut- ed to the difturbed fundions of the nerves, are peculiarly apt either to return or to be aggravated.
The pulfe isj at leaft fometimes, not difturbed by this pain, and con- fequently the heart is not affeded by it ; which I have had an opportu- nity of knowing by feeling the pulfe, during the paroxyfm ; but f have never had it in my power to fee any one opened, who had died of it ; the fudden death of the patients adding fo much to the common difficulties of making fuch an enquiry, that moft of thofe, with whofe cafes I had been acquainted, were buried, before I had heard that they were dead.
But though it be moft probable, that a ftrong fpafm be the true caufe Vol. II. F of
66 MEDICAL
of this diforder, yet there is fome reafon for thinking, that it is fome- times accompanied with an ulcer, and may partly proceed from it : for I have feen two of thefe patients, who often ufed to fpit up blood and purulent matter, one of whom con> llantly afferted, that he felt it come from the feat of the diforder. An- other had a painful fenfation in fwal- lowing, and upon preffing the part, which feemed to be affeCted. From a fourth, who fell down dead with- out any notice, there immediately arofe fuch an offenfive fmell, as made all, who happened to be prefent, judge, that fome foul abfcefs had juft then broken.
Bleeding, vomits, and other eva- cuations, have not appeared to me to do any good. Wine and cordials taken at going to bed will prevent, or weaken, the night fits ; but no- thing does this fo effectually as opi- 3 ates.
TRANSACTIONS. 67
ates. Ten, fifteen, or twenty drops of Tin&ura Thebaica taken at lying down will enable thofe to keep their beds till morning, who had been forced to rife, and fit up two or three hours every night, for many months. Such a quantity ora greater might fafely be continued, as long as it is required : and this relief afford- ed by opium may be added to the arguments, which prove thefe fits to be of a convulfive kind. Time and attention will undoubtedly difcover more helps again It this teizing and dangerous ailment ; but it is not to be expected, that much can have been done towards eftablifhing the method of cure for a difiemper hi- therto fo unnoticed, that it has not yet, as far as 1 know, found a place or a name in the hiftory of difeafes.
63
MEDICAL
VII. Of the Colica Pi&onum, by
R. Warren, M. JO. Fellow of the College of Phyfecians , F. R. S. and
S. A. and Phyfcian in Ordinary to His Majefy.
Read at the COLLEGE, August 4, 1768.
TH E Colica Pi&onum, from whatever caufe it proceeds, begins with a lenfation of weight or pain at the pit of the ftomach, attended with lofs of appetite, yel- lownefs in the countenance, a flight degree of flcknefs, and coftivenefs. The pain gradually increafes, and foon becomes violent and continual : the flcknefs advances nearly in the fame proportion, and, by the fecond day of the difeafe, retchings are fuc- ceeded by frequent vomitings of very acrid dime, and porraceous bile. The matter thrown up from the ftomach
7 feems
£
TRANSACTI ON S. 69
fee ms to the patient to come imme- diately from the part afledted, and the vomiting always flatters him with a momentary relief, but the pain foon returns with as much feverity as be- fore. The pain is molt commonly feated at the pit of the flomach, where it will fometimes remain fixed in one point, from the beginning of the difeafe to the end : it will how- ever very frequently defcend to the region of the navel, and (hoot from thence to each fide with fo much violence, that the patients declare that they feel as if they were cutting in two : from thence it will dart in- to the back and loins, and palling down to the bladder, in the direction of the ureters, will refemble a fit of the ftone ; fometimes it fhoots into the fcrotum, groins, thighs, and legs, or, mounting into the breafts, Ihouiders, or arms, refembles a violent fit of the rheumatifm; always leaving fo great F $ a degree
70 M E D r C A L a degree of forenefs in the external
o
mufcles, that the weight of the bed doaths or the flighted: touch of the finger is painful. It is remarkable that two diftant parts of the body are feldom affedted at the fame time. If the pain is in the fiomach, the lower bowels are generally eafy, the exter- nal mufcles always ; if the external mufcles are in pain, the fiomach and b wels are perfectly free, and the patient is apt to imagine that his diforder is gone off, or converted into another : but he is foon undeceived, and, at the end of two or three hours, feels the pain returning, with all its violence, to its old feat the region of the navel, or the pit of the fio- mach. When the pain is feated near the navel, and the patient complains that he feels as if he was boring through w h an inftrument, the ab- dominal mufcles are fometimes knot- ted, fometimes painfully retraced
TRANSACTIONS. 71
with all the contents of the abdomen towards the fpine. In whatever part of the bowels the pain is feated, there is frequently a very conliderable ful- nefs, and tension of the abdomen. The pain does not, as in fome colics, abate and increafe feveral times in a few minutes, but generally ob- ferves the fame tenor for feveral hours together ; fometimes it has ex- acerbations, and now and then it ad- mits of truces for two or three hours. The fphindter mufcles of the bladder and anus are always affedted ; ’ fome- times the ftrangury and tenefmus are the confequences, at other times a total incapacity of making any water at all, and fo great a contraction of the fphindter -mi that a glyfter can hardly be introduced. The vomitings, un~ lefs relieved by medicines, continue as long as the pain, or, if they ceafe, bitter eradiations and hiccoughs come on in their room. This diforder is
not
?2 MEDICAL not preceded by chillinefs, nor often attended with fever at the beginning; the pulfe at that time, notwithftand- ing the violence of the pain, being generally found as quiet as in health 3 after the fourth or fifth day of the difeafe, the pulfe grows quicker ; but I have commonly thought that this was rather the efieft of medicine than of the diftemper, for when the complaint has been entirely let alone, though there has been very great tenfion of the abdomen without any ilools for five days together, the pulfe has not grown quick, nor has any fign of inflammation come on. The urine is fo various, that nothing at all, that I know of, can be learned from it. Sometimes it is high coloured and remains clear, fo me times it depoflts a lateritious, at others a bright pink fe- diment, and fometimes it is pale with a white woolly fediment. Towards the end of the difeafe there is ge- nerally a pain round the edges of the
feet.
TRANSACTIONS. 73
feet, and at the end of all the toes, which are frequently red and fwolien, and in appearance gouty. Relieving fweats likswife break out, attended fometimes (as I have been informed) with eruptions. About this time the patient feels a griping in the lower bowels (a fenfation very different, and which he is always able to diftinguilh, from that of the colic) with a difpo- fition to go to ftool ; and after large difcharges of various kinds of excre- ment, frequently of hard lumps, in fhape refembling fheeps dung, toge- ther with black and dirty coloured flime, now and then mixed with blood, he is per fed ly relieved. Though the diforder is moderate, and treated in the beft way that we know of, it can feldom be removed in lefs than four, five, or fix days, and it will fome- times require even a longer time; but if it is negleded, ill treated, or is very violent, it will laft weeks, or even
months.
74 MEDICAL
months, with now and then a truce for a few days, and terminate at laft in a peculiar fpecies of palfy of the upper extremities; or deafnefs, blind- nefs, delirium, and epileptic fits com- ing on, in death.
This complaint has many fymp- toms in common with a dyfentery ; and if a tenefmus comes on at the beginning, with a difeharge of mucus and blood, as it fometimes, though rarely, happens, it is very difficult to diftinguiffi the one from the other. The dyfenteric pain however differs from that of this colic, in not being for any length of time equally fevere, and in going and comingfevera! times in a few minutes : and a tenefmus is often a confequence, but feldoin at- tends at the beginning, of a dyfentery.
As foon as the complaint is afeer- tained, the patient fhould be ordered to drink half a pint of warm camomile tea, which will prefently be vomited
up
TRANSACTIONS. 75
up again together with Tome of the acrid contents of the ftomach. After the ftomach has been wafhed two or three times in this manner, and feme little relief has been procured thereby, twenty drops of Tinctura Thebaica in an ounce of water, or a grain of opium in a pill, fhould be directed to be taken immediately, and to be re- peated every two or three hours till the pain is abated, or till the patient is laid aileep; if he wakes, fome hours after, complaining of pain and fick- nefs, as he probably will, the camo- mile tea and opium mutt be repeated as before. After twenty-four hours treatment in this manner, the pain will fometimes be conhderably abated, or a Abort truce will come on, and the patient will find himfelf difpofed to eat. This interval fhould be em- ployed in giving fome proper futte- nance, which ought not to be ft ranger than weak chicken broth or panada ;
nor
76 MEDICAL
nor fhould it be much in quantity, for if the ftomach is oppreffed the ficknefs will return the fooner, and all the fy niptoms will be aggravated : but whether any food is taken or no, the colic will return, and the fame method of cure mu ft be pur- fued from day to day not only till the pain is removed, but till the ten- lion of the abdomen is gone, and till the fymptoms appear which Ihew that thedifeafe is near its termination, Thefe are not to be expe&ed till the third, fourth, or fifth day from the be- ginning of the cure, fometimes much later : purging medicines Ihould
now be given; and in this ftate of the difeafe, I have always found the gentleft the moil efficacious, and that ftools may be procured with more eafe, and in lefs time, by two drachms of the cathartic fait diffolved in warm water or infufion of fena, and taken every two hours, than by any draftiq
purge
TRANSACTIONS. 77
purge whatever, Inftead of the cathar- tic fait, I have fometimes given half a drachm of fulphur prcstipit at um in a bolus every four hours, fometimes a drachm of cream of tartar diflolved in water, as often, and now and then the oleum Ricini. An ounce of this oil, with two ounces of water and about half the yolk of an egg, makes a draught that may be taken tolera- bly well, and need not be repeated fo often as the other purgatives : but, according to my experience, it is more apt to be vomited up again than the other medicines, and I believe it is indifferent what cathartic is ufed, pro- vided it is not rough, or painful in its operation : in general, the purging muft be continued till the bowels are emptied, and the patient is free from all uneafinefs in them.
If, after the purging, the pain re- turns to the region of the navel or the pit of the ftomach, purging me- dicines
78 MEDICAL
dicines mu ft be laid afide, and re-
courfe mutt again be had to opium, and at the end of a day, or two, the bowels will difcharge, with relief, as large a quantity of faeces as before : but if the purging is continued not- withftanding the return of the pain, the fymptoms will be aggravated, and the diforder will be protra&ed.
If the pain is not removed by the quantity of laudanum mentioned above, the dofe mutt be increafed till a fufficient one is found. Two grains of opium have been given with fuc- cefs three times in fix hours. But in general, if a moderate dofe by the mouth does not fuffice, a glyfter of four ounces of oil of olives, and forty drons of Tin&ura Thebaica fhould
x
be inje&ed ; which will fometimes prove more effe&ual than twice the quantity by the mouth ; and fhould be repeated, if the pain returns. I have frequently ordered the abdomen
to
TRANSACTIONS. 79
to be fomented with warm water ; to be rubbed with warm oil ; with a liniment made of the expreffed oil of mace, oil of almonds, camphire, and opium ; and fometimes to be covered with a large plafter of Theriaca An- dromachi, and perhaps with fome little benefit ; but no great ft refs is to be laid upon external applications, and the forenefs of the mufcles ren- ders them frequently very inconve- nient. The warm bath takes oft the pain immediately; and while the pa- tient remains in the water, he is per- fectly eafy ; but as foon as he comes out of it, the pain returns with as much violence as before. It feems as if it was neceftary to remove the fpafm for feveral hours together, be- fore the bowels can recover them- felves ; and therefore the warm bath cannot be expected to be of much fervice, unlefs the patient could ftay in it for many hours together.
Though
I
So MEDICAL
Though this complaint is appa« rently well carried off, it will fre- quently return in a few days, if the patient is fuddenly expofed to cold, or loads his ftomach intemperately ; and fometimes I have thought that the difpolition to return has arifen from purging medicines being given too foon, before the fpafms were fuf- ficiently abated by opium.
If, after the colic is removed, the bowels are in good order, and do their duty without any ftimulus at all, no more medicines are required. But coftiveuefs is very apt to fucceed, and as long as it lafts, whether it be months or years, the patient is in danger of a relapfe. In order to remove this, he fbould be directed to take two drachms of the cathartic fait diffolved in half a pint of Pyrmont water every morning, and another half pint of the fame water without any fait at noon j or ten grains of lima-
tura
8 1
TRANSACTIONS, tura martis twice a day, with fifteen grains of Pit. Rufi at night ; or as much cream of tartar, morning and evening, as is fufficient to keep the bowels laxative. When thefe means have failed to remove the coftivenefs, I have known the Bath waters An- gularly ferviceable ; and, even when the bowels have not particularly want- ed their affiftance, they feem to re- cruit the debilitated patient fooner than any other means.
As this complaint has been fup- pofed to go off by a critical difcharge of fweat, fometimes attended with eruptions, and by a copious diarrhoea, fpontaneoufly coming on : phyficians have been induced to take the indi- cations of cure from thence, and, at the beginning of the difeafe, have endeavoured, either to raife fvveats - by cordial and diaphoretic medicines, or to procure (tools by the mod (hi— mulating cathartics they could think Vol, II. G ok
/
Sz MEDICAL
of. By the former method, febrile fymptoms are brought on, which otherwife do not appear at all; by the latter, the pain is much increas- ed, and ftools are Seldom obtained. The perpetual di Spoil don to vomit renders almoft all cathartics for Seve- ral days ineffe&ual, and Simulating glyfters increafe the fcri&ure and fpafm of the bowels : if however ftools are obtained by either, the re- lief, if any, is only temporary ; the coSivenefs remains : the diftemper is protradled, and feldom goes off till Some antifpafmodic means have been ufed. The truth, I believe, is, that this complaint does not terminate by any critical evacuation ; that the Sweats come on becaufe the body is relieved; and the bowels difcharge their contents with eafe, at the end of the complaint, becaufe the fpafm .is removed : it is in vain therefore, before certain fymptoms come on, to 4 endeavour
TRANSACTIONS. 83
endeavour to procure either the one or the other. From an eagernefs to put an end to the complaint, I have more than once directed purging me- dicines too foon, and have always found the colic protracted by them. Opium mu ft be continued in a greater or lefs proportion till the painful fymptoms mentioned above are re- moved : and purging medicines fhould not be given even then, unlefs the pa- tient complains of a griping in the lower bowels (a fenfation very differ- ent from the pain of the colic), which never fails to precede the termination of the diford er : if neither a diarrhoea comes on (which I have feen only twice), nor the griping in the lower bowels, the eafe is nothing more than a fallacious truce, and the pa- tient will foon be in pain again.
Bleeding, unlefs there is a fever, is never of any ufe, and is fometimes very prejudicial. This difeafe fee ms G 2 to
$4 MEDICAL
to be not at all related to inflamma- tion ; nor is there any reafon to ap- prehend a gangrene of the bowels, though the coftivenefs fhould conti- nue many days with a confiderable tenfion of the abdomen.
The temporary relief derived from vomiting is apt to lead a practitioner to prefcribe vomits; and the large quantity of green and difcoloured matter, thrown up by them, per- fuades him that his prefcription was judicious. The peculiar irritation of this colic brings on a large fecretion of this matter, which is veryoffenfive in the ftomach ; and this fecretion, which opium would have abated, is promoted by the increafed irritation from the adion of the vomits : fo that a fucceflion of this porraceous bile may be continually procured by vomits, and a man may flatter him- felf that he is removing the caufe,
when,
TRANSACTIONS. 85
when, in truth, he is only increaftng the diforder.
Vomits neither diminifli the pain nor ftiorten the difeafe; they are often given without any other incon- venience than that of tiring the pa- tient, but fometimes they bring on convuliions and delirium. Half a pint of camomile tea, which may be frequently repeated, generally makes the ftomach difcbarge its contents, and gives as much relief, without any inconvenience at all, as the moil boafted antimonial vomits : it feems to do juft as much as is wanted, it brings up the offenftve matter that is already in the ftomach, without fo- liciting more into it by any new ftimulus. I am not ignorant that this diforder has been removed by vomits, by ftrong cathartics, and by ftimulating glyfters : but this me- thod is fometimes dangerous, and al- G 3 ways
86 MEDICAL
ways more tedious and painful than that defcribed above.
In June 1752, thirty-two perfons in the duke of Newcaftle’s family, then reading at Hanover, were feized with the Coiica Pi<£k>num, after hav- ing ufed, as their common drink, a fmall white wine that had been adul- terated with fome of the calces of lead. As the complaint was not well underftood when it firft appeared, and the ufual confequences of violent pains in the bowels with obftinate cof- tivenefs were apprehended, recourfe was had to bleeding, glyilers, and various kinds of purgatives, by which means every fymptom was increafed.
They were all attacked in the common way ; excepting one, whofe firft feizure was an epileptic fit. As foon as the fit was over, he com- plained of pain in the bowels ; and upon the ceaiing of the pain in the
bowels.
TRANSACTIONS. 87
bowels, his head was affe&ed again; a diforder like St. Vitus’s dance came on, and, in lefs than a fortnight from the fir ft attack, he died epileptic.
Three were feverifh from the be- ginning to the end of the difeafe. The reft- were perfefily free from fe- ver till the fourth or fifth day ; at which time the pain began to abate, and their pulfes became quicker than in health.
Some of them complained that their mouths and throats were made fore by the acrimony of the matter they vomited up. Four fell into fa- livations for feveral hours every day, and faid that their pain was abated during the fpitting.
Many of them had profufe fweats juft before the diforder terminated ; and a few had an eruption of white and red pimples, which were very fiery, and itched exceedingly.
G 4
One
88 MEDICAL
One was delirious, and in that fiate was put into the warm bath, and recovered his fenfes while he was in the water, and at laft got perfectly well.
All of them relapfed within four or five days after they feemed to have been cured.
Many had the diforder thrice, and fome few of them five times. It is very probable that the caufe of the complaint was not difcovered, nor a more wholfome drink provided, tiil fome time after the difeafe appeared ; but the relapfes were fuppofed to have been caufed by hidden exposition to wet and cold, or by intemperate eat-
ing-
The method of cure differed very little from that laid down above, ex- cepting that a glvf'er of oil and brown Sugar was injedted every night, and a fpoonful oS oil of almonds with two drachms of Syrup of lemon
juic§
TRANSACTIONS. 89
juice was directed to be taken every fix hours. Their nourishment was barley broth, barley pudding with currants, and panada.
One of them had a fever e return of the colic two years afterwards : he was cured by the method defcribed above, and has remained well ever fince.
Another relapfed five years after- wards, has had nine returns of the colic fince that time, and is now in the chronical date of the diieafe with the fingers of both hands paralytic. It is remarkable that this perfon has never been free from coftivenefs fince the attack in 1752, except when un- der a courfe of Bath waters.
One died of the colic : five have died fince of othercomplaints. Twen- ty-fix are ftill alive, and only one of them has been rendered paralytic by the diforder.
VIII. the
MEDICAL
50
VIII. The Hiftory and Cure of a dif- ficulty in Deglutition of long con- tinuance^ ariftng from a fpafmodic affection of the OEfophagus. Com- municated to the College by Tho- mas Percival, M. D. F. R. S.
Read at the COLLEGE, August 9, 1769.
MISS L — r, aged thirteen, a fp rightly girl, of a delicate and irritable habit of body, during feveral years, had a difficulty in (wal- lowing; which occafionally left her for a month or two, and then fud- denly returned without any apparent caufe. September 3, 1768, l was defired to vifit her. She had then laboured under her diforder fix or eight months, without any intermif- fion, and was reduced almofl to a fkeleton, though fhe ft ill retained her natural vivacity. When fhe at-
tempted
TRANSACTIONS. 9*
tempted to fwallow folids, they palled down readily as far as the upper ori- fice of the fiomach ; but when ar- rived there, they were inftantly, and with a ftrong convulfive motion, thrown up again. Liquids fipped llowly, and fwallowed leifurely, met with no refiftance j but when haf- tily drunk, or in too large a quan- tity, they were quickly regurgitated. Warm liquors were fwallowed with more eafe than cold ones; and in the evening, the difficulty of deglutition generally abated. She complained of no other pain but an uneafy crav- ing in her flomach; nor was there any external fwelling, or inward fore- nefs, through the whole paffage of the cefophagus. When fhe was in her ninth year the catamenia appear- ed, and had recurred once or twice fince that time, but without any re- gularity. Her belly was coftive, her pulfe was quick and fmall, and her
feet
9 2 MEDICAL
feet were ufually cold. She was nei- ther of a ftrutnous nor fcorbutic ha- bit of body ; nor could her friends give me any fatisfadory account of the origin or caufe of her diforder.
I apprehended her cafe to be fpafmodic, complicated with a flight thickening of the oefophagus about the part affeded, the confequence of a contradion fo long continued. The following medicines were therefore preferibed,
E£. Elixir, myrrhas comp. Tind. valerian, vol. aa. ^iv. M. den- tur guttse viginti in thea. pule-* gii bis die.
I£. Ol. amygdal. §j. Sp. fal. am- raon. cum calce viva ^vj. Cam- phoras oleo folutas ^sj. Ol. fuc- cin. ^ifs. M. f. linimentum, quo bene fricetur fpina dorfi a prima cervicis vertebra ufque ad duo-
decimam
TRANSACTIONS. 95
decimam dorfalem, mane & vef- peri quotidie.
Merc, dulcis fexies fublimat. gr. fs. Mucilag. gum. Arab. 9ij. Sp. nitri dulcis Bij.Vin. antimon, gutt. vj. Aq. fontan. ^fs. Sacchari alb. 9j M. f. hauft. hor. decubi- tus quotidie fumendus, vini an- timonialisdofin fenfim augendo.
j0£. Extract, cort. Peruvian. Mollis, caftor. ruffic. Galban. colat. aa. partes aequales, Camphor® fp. vin. redl.trit. ^j.Ol. fucccini 9j. Balfam. Peruvian, q. f. M. f. em- plaftrum fcrobiculo cordis ap- plicandum, & femel in feptima- na renovandum.
Directions were given that her feet and legs fhould be kept warm by woollen yarn {lockings ; that her drinks fhould be taken milk warm;
that
94 MEDICAL
that her diet fhoulcl confift of broth; mutton, or beef tea, as it is called, panada, vermicelli, fago, rice milk* chocolate, cocoa, falep, &c; that a little wine Should be occafionally allowed; that She Ihould abftain from tea and coffee ; that moderate exercife ihould be daily ufed ; and that a nourishing clyfter, prepared of milk, broth, See. Ihould be injedted every morning and noon; to obviate the loofening effedfc of which, a few red rofe leaves were ordered to be boiled in it, or a little ftarch to be added to it.
September 22, The liniment, ca- lomel draught, and clyfter, had been negle&ed. But the plafter had been applied ; She had taken the drops with regularity, and had carefully ob- ferved the regimen preferibed to her. The difficulty of deglutition was fen- fibly abated, her appetite was mend- ed, and (he had recovered flefh and ftrength.
October
TRANSACTIONS. 95
October i.The mercurial draught had purged her. To prevent this ef- fect, fifteen or twenty drops of elixir paregoricum were added. But a few days afterwards it occafioned a fore- nefs in her gums, and a flight faliva- tion. The ufe of it was therefore difcontinued.
October 2 r. She could now fwal- low folid food without any difficulty. Her appetite was good, her belly re- gular, her pulfe fuller and flower, her flefli and ftrength recruited, and her health in every other refpe<S was perfectly re-eftabli(hed. Idireded her to continue the ufe of her medicines, and to perfevere in her regimen a month or two longer ; and flie has ever fince been entirely free from her diforder.
I shall beg leave to make fome general obfervations on obftrudled de- glutition, without confining myfelf
to
§6 MEDICAL
to the particular confideration of the cafe which has been related.
i. A difficulty in fwallowing may proceed from fuch a variety of caufes, not eafy to be diftinguifhed, and yet each requiring a particular method of cure, that the phyfician’s pradtice in fuch cafes rauft be uncer- tain and perplexed. And what adds confiderably to his embaraffment is, that the effect often co-operates with the original caufe, and confirms the difeafe. Thus a conftridtion of the osfophaguSj arifing from a fpafmodic affedtion, will, if it continue long, produce either an enlargement of the glands, or a thickening of the fub- ftance of the gullet, about the part affedted. On the contrary, if the ftridture proceed from a glandular humour, from fcirrhofities, or fun- gous excrefcences, it will at the fame time be complicated with fome de- gree of fpafm ; of which amon
7 feveral
TRANSACTIONS. 97
feveral infiances that have fallen un- der my obfervation, I {hall mention the following.— —A farmer’s wife, aged fifty, of a ftrumous habit, per- ceived an impediment in her throat to the paflage of folid food, fome months before fhe applied for advice. Her diforder had ihcreafed by de- grees, and (he was then unable to fwallow any thing but liquids. A furgeon examined the gullet with a probe, and found the two glands which are fituated about the fifth vertebra of the back confiderably en- larged. .dither was then a fafhion- able remedy in this part of the coun- try ; and (he was induced, by the fame of its effects, to wifh a trial might be made of it. A dofe properly di- luted was given her; and about half an hour afterwards {he had the power of fwallow ing, without much diffi- culty, a morfel of folid food. But the relief was only temporary. She Vol. II. H relapfed
98 MEDICAL relapfed in an hour or two, and had again recourfe to the fame remedy, which after a few trials loft all its efficacy, and the poor woman having languiffied about fix months, died literally famiffied. From this and other inftances, I ffiould apprehend that the ufe of antifpafmodics would affift the operation of the mercurial courfe, fo judicioufly recommended by Doctor Munckley in the firft vo- lume of the Medical Tranfaftions j and would quicken, as well as render more certain, the cure of this deplo- rable difeafe.
2. In fpafmedic affefiions of the cefophagus , external applications to the fpme are likely to be very fer- viceable, from the contiguity of that tube to the vertebrce. And perhaps nothing would be more effectual in
O
fuch cafes than a blifter, applied either to tire neck or between the fhculders. That epifpaftics are pow- erful
TRANSACTIONS. 99
drful antifpafmodics, experience ha§ fully afcertained; and where thedif- drder is attended with an enlargement of the fubftanCe, or a fulnefs of the glands of the gullet, they would have additional efficacy, by producing a copious difcharge of ferous humours; and by that means unloading the veffels of the part affedted.
Volatile and antifpafmodic lini- ments are alfo highly ufeful, as the cafe above recited fufficiently evinces. It is indeed to be lamented that exter- nal applications of this kind are not more frequently employed in prac- tice; for there is juft reafon to appre- hend that powerful effedts might be expedted from them in various difeafes. In the hooping cough particularly I have obferved conftderable benefit to accrue from the ufe of a liniment, fimilar to the one prefcribed above.
3. When conftridtions of thd a?foph(igust arifing from fpafm, have H 2 been
ICO
MEDICAL
been of long continuance, and do not yield to medicine ; ele&ricity fur- nishes us with no improbable means of relief. The publick indeed have been much difappointed in the medi- cal effects of electricity. But this hath-
j
in part proceeded from the misappli- cation of fo powerful a remedy. It appears to me, and I am confirmed in this opinion by the obfervation of a very eminent phyfician, that the electric Shock bids fair to do far more good in difeafes from rigidity, than in thofe from laxity. Amongft ma- ny other proofs of this, may be ad- duced the cure of a univerfal Tetanus , the hiftory of which is published by Doftor Watfon, in one of the late volumes of the Philofophical Trans- actions.
4. Stimulating vapours convey- ed into the pharynx have a tendency to remove fpafms, even when feated deep in the cejfophagus. A few years
ago
10 1
T R ANSA C T I O N S. ago an elderly gentlewoman, after eating peafe, felt an uneafy fen- fation as if one of them (luck low down in her throat,, and fuddenly found herfelf deprived of the power of deglutition. Notwithftanding the ufe of a variety of remedies, her in- ability to fwallow continued five or fix days. She was directed to fumi- gate her throat with afa foetid a dif- folved in a ftrong infufion of the aro- matic herbs: and drawing in the va- pours very forcibly, the fpafm was inftantly refolved; nor has fire ever fince fuffered the leaft return of it.
5. When this dreadful difeafe is ib confirmed as to be deemed incu- rable, the patient’s life may be pro- longed by the daily injection of nu- tritive clyfters, and by bathing his feet, hands, and arms, and occafion- ally his whole body, in new milk, broth, decodtions of falep, fago, or vermicelli, &c. The abforption by H 3 the
102 MEDICAL
the lymphatics of the fkin is very confiderable. It has been found by experiment that the hand, after being well chafed, will imbibe in a quarter of an hour near an ounce and a half of warm water. And allowing that the furface of the hand is to that of the body as one to fixty, the abforption of the whole in the fame fpace of time would amount to up- wards of feven pounds. — The co- pious difcharge of urine in the dia- betes, fo much exceeding in quantity the patient’s drink, confirms infome meafure this calculation. And the curious fadt related by Dr. Chalmers, at the fame time that it affords a fur- ther proof of the great abforption by the pores of the ikin, points out to us the valuable purpofes to which it may be applied in the diforder under confederation. A negro man, who had eaten or drunk but little be- fore he was gibbeted in March 1759,
at
TRANSACTIONS. 103
at Charles Town in South Carolina , and had nothing given him after^ wards, regularly voided every morn- ing a large quantity of urine, but difcharged no more till about the fame hour next day. The dews of the evening, imbibed by the body, fupplied in this cafe a fuperabundance of fluids in the night, and a fufficient quantity to fupport perfpiration in the day. Had thefe fluids been of a nutritious quality, it is not impro- bable that, even under fuch circum- ftances, the poor negro might have been kept alive for a conflderable length of time.
Prosper Alpinus relates that the Egyptian women, in order to become fat, ufe every day a tepid bath; and whilft they continue in it, receive nourifhing clyfters, and a variety of the richefl: foods. By this means the females of that country, particu- larly the Hebrew women who re fide H 4 there,
104 MEDICAL
there, are for the mod part immo- derately corpulent. Illarum plurima perinde ac fues cernuntur pinguijfima burnt recumbentes , maximeque He- braa, quibus ifiud vitii aids f ami Ha- rms oHfervatur.
I have not enlarged upon the ne- cetuty of conveying aliment into the body by clyfters, in obftru&ions of the cefophagus , becaufe this muft be obvious to every practitioner. The other method of nutrition, if not lefs known, is certainly lefs attended to, and in general is altogether negle&ed. -—It may perhaps be thought an omiffion, that no notice has been taken of the adminiftration of me- dicines under the form of clyfters^ in thefe deplorable cafes. But I ap- prehend, however ufeful they might be in many refpefts, they would ip general too much interfere with the nourifhment of the patient.
Manchefler, July 6, 1769.
IX, On
TRANSACTIONS. 105
IX- On human Calculi ; fhewing them to be of very different kinds. By Ambrose Dawson, M. D. Fellow of the College of P by f dans.
Read at the COLLEGE, August, 15, 1769=
I Mean not to throw difficulties or difcouragerpents in the way of thofe, who are in fearch of a folvent of the human calculus; but rather to recommend a trial of va- rious folvents, as I am convinced the human calculi are very different in their compolition.
A bare infpeftion may juffify this opinion ; but experiments will evince the truth of it much more. For if trials be made on many cal- culi, it will be found, that fome Calculi will be diffolved by an alka- line menftruum, and but little af- feffed by an acid one ; and that others will be diffolved, or rather
deflrojed.
xo6 MEDICAL
deftroyed, by an acid menftruum, and yet able to refill an alkaline fol- vent.
I confined my experiments chief- ly to fuch folvents, as have obtained an internal ufe in pra&ice : moye particularly to the cauftic lixivium, and the fpirit of the fea fait.
The lixivium, I ufed, was pre- pared with fait of tartar ^i, ftone or oyfter fhell lime ^iifs. or giii. if not quite frelh, new river water boiled and filtered through fine filtering paper ^xxiv. And this preparation, I beg leave to call the cauftic lixi- vium, or C.
The experiments I made, though pleafing in the purfuit, may be dull in the relation : however, of feme of them, I fhall endeavour to give a brief account.
About gr. vii. of finall gravel Hones, palled with the urine by dif- ferent perfons, were put into C ^fs ;
they
»
i f.
TRANSACTIONS. 107
they were of various colours, yellow, brown, and reddifh. The Hones from different perfons were put in at dif- ferent times ; and until thofe of one perfon were diffolved, I did not put in thofe of another. The lafi, after 20 hours, being but little changed, the phial was placed within the warmth of a fire ; and in about 8 hours the folution was completed, and the menfiruum probably fatu- rated.
A gravel Hone weighing gr. iv. paffed by a boy, was diffolved in C §fs. — Gravel Hones from the fame boy, weighing gr. ii, were infufed in Malvern water; but except a few adhering bubbles, which foon dis- appeared, no impreflion was made on them. I dropt fp. of fea fait ^ii on fome of the ftones taken out of the Malvern water, but not a bubble was feen. A frefh Hone from the fame boy was dropt into the acid fpirit,
and
ioZ MEDICAL
and a very few bubbles appeared 5 but, after fame days, no other alter- ation was d,i (covered.
A fragment weighing gr. iv. of a fmall brown compa£t laminated (lone, was on the fifth day complete- ly diffolved in G §fs.-— A fragment of the fame (lone put into new river water boiled, &c, and fp. of fea fait gtt. xxx, feemed on the fifth day un- altered ; gtt. xxx. of the acid fpirit were added; and after four days the fragment appeared unaltered; and on examination was hard.
A fragment weighing gr. v. of a fmall bluifh laminated (lone was on the 5th day completely diffolved in C. §fs.— - A fragment weighing gr. v. of the fame (tone was infufed in N. R. W. &c. §i. and fp. of fea fait gtt. lx. It yielded a few bubbles, loft its polifh, and the furface became rather brown ; but no other material effect appeared.
1 C §fs?
TRANSACTIONS. 109
C §fs. was poured on gr. x. of a large brown laminated done. A few bubbles appeared, a film was feparat- ed from the outward granulated coat, and the menftruum became lemon- coloured the firft day. The third day, the colour was heightened, the frag- ment diminifhed, and fplitting in many dire&ions. A few days after, the fragment exhibited the appear- ance of mofaic work on all fides, and was whiter, yet ftill kept its form. C was decanted, and the remaining fragment when dried fcarce weighed gr. iii, on which I poured frelh C gfs; and the next day but one, the fragment was totally diffolved ; and the menftruum only of a ftraw-co- lour.
I repeated this experiment ; and alfo made one with a fragment of the fame ftone, and a lixivium ob- tained from cauftic. commun. fortius jii, and N. R. W. &c, Jxiv. The
foiutions
i to MEDICAL
folutions fucceeded ; and in the couifd of them, I remarked many orange- coloured films, which were much di- miniftied by the menftruum. Other alkaline folvents had great effedt on this calculus, and others; but I pre- fer the cauftic lixivium above de- fcribed ; when well prepared, it will mix with ftrong fp. of vitriol with- out effervefcence or ebullition.
On a fragment weighing gr. iv. of the abovementioned ftone I pour- ed fp. of fea fait ^ij. A few bub- bles appeared. The fragment, on the fourth day, difcovered no change. Malvern water only gave a pink-co- lour to part of a fragment of the fame ftone.
In experiments made with human calculi, which will diflolve in the cauftic lixivium, generally, fmall bub- bles reft on the furface of the ftones, the furface becomes darker coloured, brown films are raifed and caft off,
then
TRANSACTIONS. hi
then the ftones begin to appear whiter, and the menftruum at the bottom of the phial of a lemon- colour.
As the folution advances, the men- ftruum acquires a deeper colour: and when it becomes perfectly bright, and no more of the calculus remains than a few films, or a fmall flocky fediment, I prefume to call it a com- plete folution.
I will juft obferve, that if a fo- lution of gravel ftones in the cauftic lixivium be expofed to the air, the calculous particles will commonly concrete, and may be recovered ; though they will be much fooner recovered by the addition of the acid fpirit : the calculous particles of larger ftones are not much dif- pofed to concrete by the free accefs of air; but, on the addition of the acid fpirit, they form falling clouds, and foon after a fediment. Thefe fe- 2 diments
*12 MEDICAL
diments, after they have been walked, will readily diffolve again in the cauftic lixivium.
Solutions of calculi frefh made, or well preferved from the air, are not apt to effervefce with the acid fpirit.
These may be deemed fufficient examples and proofs, that there are human calculi, which will difiolve in an alkaline, and refill an acid menftruum*
I shall now offer fbme experi- ments on calculi that demand an acid menllruum.
Fragments of a large ftone broken into fcales, the fcales refembling red tartar on the outfide but white with- in, I believe of the mulberry kind, were infufed many days in various alkaline folvents. Except that fome bubbles were produced, thefe folvents had little or no effedt on the frag- ments; nor had Malvern water.
Undiluted
TRANSACTIONS. 113
Undiluted fpirit of fea fait had great power over the fragments of this done; it occafloned an effervef- cence with noife, and tore them to pieces ; diluted with water, it de- flroyed them, but more {lowly. Per- mit me to give fome particulars of one of the experiments.
On gr. xv. of the fragments I poured N. R. W. boiled, &c. ^i. and added or fpirit of fea fait gtt. xxx ; large bubbles appeared, and part of the fragments floated, and was tofied about, and fmaller bubbles continued to arife. On the third day the frag- ments were reduced to large {kins, fome floating, fome funk, and to a fandy-looking fediment. The fourth day the {kins had for the mofl: part fubfided; and now gtt. xxx. of fpi- rit of fea fait were added, without any renewed motion or bubbles. 'Four days after, the fediment con- flfted of large brown {kins or films, Vol. II. I a light
II4 MEDICAL
a light whitilh fubftance, and fome tough portions, which I found in the filtering paper, after 1 had paflf- ed the menftruum through it. The whole that remained in the filtering paper, when dried, weighed about
gr- »•
An old tradefman was many years ago fearched by an eminent furgeon, who faid he found a large ftone in the bladder. Hard ragged white frag- ments were often expelled by urine.
On a fragment lately palled weigh- ing not gr. IT. I poured C />ii. Seeing little effed, I poured on it more C. After fome days, no impreffion to the eye was made on the fragment.
On about gr. ii. of very final! fragments, refembling fpar, from the fame perfon, I poured N. R. W. boil- ed, &c. ^ii. and added gtt. x. of fpi- rit of fea fait. Some portions foon floated. The next day the fragments were reduced, for the molt part, to
floating
TRANSACTIONS. iij
floating: films or exuvia;. I now add- ed gtt. x. of fpirit of fea fait ; and the day following they were flill more reduced.
Fragments of a latrge whitilh ftone, fandy yet hard, were infufed above three weeks in various alka- line folvents. They were diminished fome more, fome lefs, from one fifth to one half. I collected, and walked the remains, on gn xv. of which grofsly bruifed I poured N. R. W. boiled, &c. gfs. and then added fpi- rit of fea fait perhaps /pfs ; a vio- lent ebullition enfued, and raifed a froth, that pu fhed out of the mouth of the phial, and carried part of the calculous matter along with it* The remainder, though reduced to a finer powder, could not be faid to be dif- jfolved. — A fragment fteeped many days in N. R. boiled, &c.- did not appear to have loft any weight.
1 14
Judging
ii 6 MEDICAL
Judging this calculus to be of that kind which would yield to the acid fpirit, a mixture of N. R. W. boiled, &c. §i. and of fpirit of fea fait gtt. xxx. was poured on gr. xv. of fragments. Large bubbles arofe; fome of the fragments floated, and were much agitated, and bubbles continue to rife. The third day the fragments were much reduced in their flze, and lay at the bottom of the phial, except a few fmall portions, which ftill floated ; there was alfo a mealy-looking fediment. The next day, fome fragments, though more diminifhed, kept their form. I now added gtt. xxx. of fpirit of fea fait ; neither bubbles nor motion fucceed- ed.
About the eighth day of the ex- periment the whole was thrown into filtering paper; and the remains, when dried, weighed about gr. iii.
I REPEATED
TRANSACTIONS. 117
I repeated this experiment with two fragments weighing gr. xv. N. R. W. boiled, &c. ^i. but made ufe only of gtt. xxx. of the fpirit of fea fait. In about eight days the frag- ments were quite diffolved or deftroy- ed, only a brown, filmy, and a little of a fandy- looking, fediment remain- ing.
Though alkaline folvents affe£ted this calculus, yet the acid one a&ed upon it much more powerfully.
As only gr. ii. were found after fil- tering in one of the experiments made on this clafs of human calculi, what became of the other thirteen grains ? I thought an obvious and proper queftion. To try if I could recover them from the filtered liquor, I pour- ed into it the cauftic lixivium, which produced only a few blue clouds, that foon difappeared. I then pour- ed into it a folution of alkaline fait, which caufed an ebullition, with I 3 clouds
nS MEDICAL
clouds falling to the bottom of the phial, which vanished without a fe- diment. I poured in more of the alkaline folution (which produced a frefh ebullition), fucceeded by clouds at the bottom, which vanifhed on fhaking the phial. — Into a mixture of N. R. W. boiled, See. and fpirit of fea fair, I dropped an alkaline fo- lution; an ebullition followed, but no clouds.
U pon the whole I concluded, though too haftily, that very little of the thirteen grains was diffolved and fufpended in the filtered men- flruum, and that they confifted chiefly of fixed air, which was rendered elaftic and loft in the operation ; and fuf- pe&ed that the calculus, from which Dr. Hales obtained fo much elaftic air by diftillation, was of the fame nature with this calculus : however, fome trials by evaporation convinced me, that a great part of the thirteen
5 grains
TRANSACTIONS. 119 grains was really diffolved and fuf- pended in the menftruum.
The above experiments afford plain inftances of human calculi which ftrongly refill an alkaline fol- vent, and yet are by an acid folvent fufficiently diffolved or deftroyed to pafs off in the urine.
Before we undertake the cure of the Hone by a folvent, furely an at- tempt fhould be made to difcover the nature of the flone with which the patient is affli&ed.
An attention to the fragments, fcales, or films it may call off, and alfo to the contents and fediment of the urine, with trials made upon them, may lead to a difcovery, whether an alkaline or an acid menftruum is the proper folvent. To ufe either im- properly, will be ’harrafling, if not hurtful : though there may be fuch kind of calculi, as may demand the alternate ufe of alkaline and acid I 4 folvents :
I
120 MEDICAL
fol vents : nay there may be found
calculi of oppofite kinds in the fame fubject : there may be ftones alfo
generated in the fame fubjeci, fome of which will difl'olve in one of thefe folvents, and fome in neither; as, from careful and fufficient trials, I judged to be the cafe with a patient of my own. And this is not the only in- flance from which I have reafon to fear that there are calculi which will too powerfully refill the force of both the abovementioned folvents, efpe- cially vvhilff their laminae remain whole and entire ; for on fragments of a calculus (pond. Divfs.) the fpirit of fea fait manifefled no power at all ; and the cauftic lixivium after nine aftufions was unequal to the deftrudion of the laminae : it ex- cited bubbles, feparated a few films, and became a little yellow : the firft impreffion was made on that part which immediately covered the nu-
cleus
121
TRANSACTIONS.
cleus (the nucleus was not made the fubjedl of this experiment), and by- degrees the interfaces of the lamina;, or all the meditullium, if I may fo exprefs it, feemed diffolved; yet the laminae would not yield, but in a great meafure preferved their figure and fubftance.
To difcover fol vents of fuch cal- culi, is a talk indeed ! a talk I fhall with pleafure purfue ; and hope that others better qualified, and better pro- vided with materials for fuch refearches, will be fo humane, as to do likewile, not defpairing but that united efforts will in time prevail.
Could the proper folvcnts of the various kinds of human calculi be difcovered, I cannot but hope, that fuch mechanical heads, and dextrous hands, might be found, as, a Hilled by fagacious inventive minds, and found judgements, would introduce the folvents into the bladder with to- lerable
122 MEDICAL
krable eafe, and with the dehred fuc- cefs ; efpecially in the cafes of fuch patients, as are under favourable aif- poiidons and circumftances of mind and body. The fol vents might at the fame time be taken conftandy, or oc- calionally, as the phyiician fhould di- rect. For an attempt of this kind, we have the countenance of the hu- mane and ingenious Dr. Hales, who has left us a defcription of a double catheter, with fome obfervations on the ufe of it.
TRANSACTIONS. 123
%. Of the Difeafes of the Liver. By William Heberden, M, D.
F. R. S.
Read at the COLLEGE, August 15, 1769.
IN the following account of the difeafes of the liver, I do not propofe to give a complete hiRory of them, by compiling medical writers .on this fubjeS ; but to afnR others, jf I can, in this defign, by contribut- ing fuch materials only, as have been furnifhed, or fuggeRed, by my own experience. In the difeafes of the liver, I mean to comprehend thofe of the gall and gall-dudts.
The obRruftion of the gall-duffs from gall- Rones is the moR common, but the leaR dangerous, of all liver complaints ; for it admits more re- lief from art, and is often furmount- ed by the unaffifled efforts of nature.
The
124 MEDICAL
The bile, from caules not hitherto clearly underftood, frequently thick- ens into grumous lumps, which gra- dually harden into an almoft ftony fubftance. It feems probable, that thefe gall-ftones, as they are ufually called, are generally formed in the gall bladder. This, I think, or the du&us choledochus communis, is the place, in which they are moft fre- quently found ; and often, when the liver is fo perfedtly found, as proba- bly to have had no fhare in producing them. At leatt, it muff be owned, that the gall-hones acquire their chief bulk in the gall-bladder, though it fhould be judged that the nucleus comes hither from the liver.
The contents of the gall-bladder are naturally poured through the duc- tus cyfticus and choledochus com- munis into the duodenum. Together with the bilis cyftica, the gall-hones readily pafs, it they are very fmall ;
and.
TRANSACTIONS. 125
and, if they are large, they fometimes lie quiet in the gall-bladder, without being at all perceived, and iometimes make frequent efforts to get into, and pafs, the gall-duds: in the beginning of which, or in any part of them, if they happen to be flopped, they of courfe obftrud all or mold of the gall, that fhould flow into the intef- tines ; which therefore is forced back into the liver, and thence into the blood, tinging the ferum, and confe- quently the flcin and eyes, of a yellow hue, and deepening the natural colour of the urine, fo as to make it of a very dark yellow, or brown.
The ufual fymptoms of the gall- duds thus obftruded, are lofs of ap- petite, a fenfe of fulnefs in the fto- mach, ficknefs, vomiting, languor, inadivity, fleeplefinefs, and, if the obftrudion be continued for a few days, a very great wafting of the
flefh. Thefe complaints are remark-
£
a able
1
126 MEDICAL
able in the obftru&ed gall-du£ts, but' they likewife belong to many other difeafes. The moft diftinguifliing flgns of this malady, are a yeliownefs of the eyes, fkin, and urine, and a want of this colour in the ftools. Nor is this diforder much lefs cer- rainly denoted in fome patients, be-* fore the yeliownefs appears, by an exquilite pain about the pit of the ftomach, the pulfe being at the fame time as flow as a natural one : and by an attention to thefe two circum- ftances it is not difficult to foretell the outward yeliownefs in many cafes fome days before it appears,, The flownefs of the pulfe will almofl al- ways diftinguiffi this pain from one, which belongs to an inflammation of the bowels ; and, wherever, toge- ther with this pain, the artery beats in the natural manner, the phy- fician will have the great fatisfa&ion of being able to afiure the patient,
that-
TRANSACTIONS. 127
that his pains can be relieved, and that they are not of a dangerous na- ture.
But this pain, which fometi tries is hardly fupportable in the jaundice by perfons of the greateft patience and courage, rifes in others only to a flight uneafinefs about the region of the liver, or is not felt at all. This perhaps may be owing to the dif- ferent parts of the gall -duds, in which the ftone happens to lodge. There is great reafon to believe, that the liver itfelf has little or no fenfe of feeling ; and it is probable, that not more belongs to the gall-duds. But every day’s experience acquaints us, how exquifttely this fenfe be- longs to the inteftines. It may there- fore be, that little or no pain is felt, while the ftone is forcing it’s way through the gall-duds, till it come to the end ; but in ft retching that part which is inferted into the duo- denum.
123 MEDICAL
v
denum, the inteftine is by a large or angular done diftended, or irritated to a degree, which may account for all the torture, that ever attends a jaundice. This pain feldom lafts with- out intermifiion above two or three days ; but f remember its continuing, in one perfon, near a month, with- out any intervals of eafe, except what were procured by opium. Wherever this pain is felt at all, it not only comes before the yellownefs, but is fometimes more, fometimes lefs, fome- times entirely difappears, and then rages afrefh throughout the whole fit of the jaundice.
There fometimes appears reafon to fufpedt a ftone in the dufts of the liver, from the prefence of all the other fymptoms, though there be no yellownefs in the eyes or ikin ; which fufpicion has been verified by the voiding of a gall-ftone with the re- lief of all thefe fymptoms ; or, after
frequent
TRANSACTIONS. tag frequent returns of them without any difcoiouring of the eyes and fkin, by having one of thefe fits end at laft in a jaundice : whether it be, that in thefe cafes, the ftone is of fuch a form as not perfectly to fill up the aperture, or that the violent efforts of vomiting force fome bile, without diflodging the ftone, between it and the fides of the du£L
And as a gall* ftone may fome- times be fufpeCted without any marks of it in the eyes or (kin, fo this yellownefs is faid to be found with- out any gall-ftone, or preternatu- ral confiftence of the bile. It has been fuppofed that an infarction of the duodenum may be great enough to hinder the efflux of the bile ; but this may be queftioned, if we reflect, that the duodenum has feldom any folid contents in it, and that it it fhould be fo plugged up by them, or compreffed by the diftenfion of Vol. II. K the
the other inteftines, as to hinder the palling of the bile, it would for the fame reafon be incapable of admit- ting any thing into it from the fto- mach, which is a fuppofition hardly countenanced by experience.
Sydenham mentions the jaundice, as no uncommon fymptom in hyfteric cafes, where there is no diforder of the gall or gall- duds. No reafon- able deference to this accurate ob- ferver can make any one much doubt of his having been here miftaken, becaufe nothing like this has occur- red to very many other praditioners, as they have allured me, though hy- fteric complaints be fo very frequent : and it requires but a very moderate underftanding to fee, after it has been pointed out, what could not have been difcovered but by one of fupe- rior fagacity.
A perfect jaundice is faid by phylicians of unqueftionable autho- rity
TRANSACTIONS. i3t
rity to be an attendant upon fome fevers, and particularly upon the yellow fever of the Weft Indies : it is alfo faid to be produced by the bite of a viper ; and in thefe cafes is judged to be owing to a convulfive ftrhfture of the duodenum: of all which I am no judge, as I have never feen thefe diforders. There is in many exhaufted and cachedtic perfons a fkin almoft of the colour of a lemon, in which the bile is not concerned ; but then they have not yellow eyes, and dark urine, and afh-coloured ftools, which I have never yet happened to fee without the ftrongeft reafon to fuf- pedt the gall-dudts obftrudted by bili- ous concretions, or fcirrhi.
It has long been a prevailing opi- nion, that every objedt appears yel- low to the eyes of a perfon in the jaundice :
“ Lurida praterea fiunt quacunque tuentur
“ Arquati — ”
K 3
IS
i3t MEDICAL
is the aflertion of Lucretius, lib. iv« ver. 333. and the fame has been allowed by fome phyficians. Now though the tunica conjunctiva be tinged by this ail, yet, as the milk in the bread: preferves it’s whitenefs, it is not probable, that the much finer humours of the eye, through which the light is tranfmitted to the optic nerve, fhould ever be infedted; nor if they could, would it thence fol- low, that all objedts would appear yellow : accordingly all the jaundiced patients, whom I ever afked, have unanimoufly denied the truth of this pretended fadt, for which it is not likely that there ever was any juft foundation.
The bignefs of the gall-ftone, and (which principally depends upon it) the duration ot the jaundice, is ex- tremely various and uncertain. In fome patients the jaundice will difi. appear in two or three days ; in
others
TRANSACTIONS. 133
others I have feen it continue near a twelvemonth, before the gall-ftone could pafs into the inteftine, or fall back into the gall bladder : nor will this long obftrudion of the natural courfe of the bile have any lafting ill effeds, or hinder the patient from being foon reinitiated in perfect health after the removal of the obftrudion. I have known the jaundice return fre- quently for more than twenty years in fome perfons, who have had good health in the intervals of the fits.
There is no limit to the pofiible fize of gall-ftones, except the capa- city of the gall bladder ; and they are found of all intermediate mag- nitudes between this and the minuteft duft. When the gall-ftone becomes too large to enter the dud, it is pro- bable, that it’s lying in the cyftis may be attended with fome, though I know not what, inconvenience ; but it is often, we are fure, a very K 3 flight
i34 MEDICAL
flight one ; for many have been opened after their death, in whom a very large done, or many fmall ones have been found, without their ever having had in their life-time any complaint, which could certainly be imputed to this caufe. A gall-ftone weighing two drachms was found in the gall bladder ol the late Lord Bath, though he had never com- plained of the jaundice, nor of any diforder which I could attribute to this caufe.
I attended a woman, who for five years laboured feveral weeks every year under all the ufual fymptoms of the jaundice in the higheft de- gree. In the fixth year, fhe voided a gall-ftone like a fmall olive in fhape and fize; fince which time fhe has enjoyed good health for many years without any returns of the jaundice, or the appearance ol a diforder which could be imputed to her once having
had
TRANSACTIONS. i3i
had it. The paffing of fuch large ftones fhews what great efforts na- ture is capable of making towards freeing itfelf from fuch an incum- brance. The natural fize of the gall du£t hardly excedes that of a goofe quill ; and a force may be exerted which will diftend this narrow paf- fage fo, as to let a done pafs, the fmalleft circumferenceof which equals two inches : I fpeak only of what I myfelf have feen, others give us ac- counts of the paffing of much larger. In the gall-du£t of one woman, whom I had attended, there was found after death a gall-ftone as big as a fmall hen’s egg.
I have had an opportunity of ex- aminingthegall-duflsof fome, whom I had frequently feen in fits of the jaundice, and I found them much diftended beyond their natural dia- meter throughout their whole length, but very unequally. The fame ap- K 4 pearances
136 MEDICAL
pearances are very common in the ureters of thofe, who have had many ftones pafs from the kidneys to the bladder. The liver of thefe perfons, though they had for many years fuf- fered frequent fits of the jaundice, was perfectly found.
It is frequently recommended to the attendants upon i£teric patients to examine their {tools in order to find the gall-ftones, and there can be no reafon to hinder them from doing it ; but the other figns of this diforder are fo certain, that the find- ing of a gall-ftone will add very little to the evidence for the nature of the diforder, and will be of no ufe to the cure. For whether a gall {tone be found or not, the method of cure muft be continued as long as the fymptoms remain, by which alone the phyfician muft be directed. Let there be ever fo many gall-ftones found, if the patient be not relieved.
TRANSACTIONS. 137
it muft be fuppofed that more re- main ; and confequently the fame me- dicines muft be continued : and on the other hand, though there be none found, if all the complaints ceafe, the probability is, that the ftone has fallen back into the cyftis, and therefore lit- tle or nothing more is to be done;
Some gall-ftones, which I have weighed, have been heavier than wa- ter, and others have been to water as 9 to 10. They melted alfo by heat, and were inflammable. I have examined only a few in this man- ner; and poffibly there may be a great difference between thefe and others, in the texture, and materials of which they are compofed : moil of what I have feen were df a dark brown colour, but fomehave been al- moft white externally, though brown within.
A very troublefome itching, but without .any eruption, is often ob-
ferved
i38 MEDICAL
ferved in the jaundice: this is fup- pofed to be owing to the irritation of the fkin from the acrimony of the bile mixed with the blood : but it is not eafy to fay, why this or any other caufe fhould make this com- plaint fo exceedingly diftrefsful to fome, whilft it is not at all felt by others.
In a fimple jaundice, without any apparent diforder of the liver, or other vifcera, a hiccup will now and then join itfelf to the other fymptoms, but without denoting any preient or fu- ture mifchief.
It might naturally be expedted, that the want of irritation from the bile fhould make i&eric perfons cof- tive ; but in fact they are often dif- pofed to have a purging, certainly neither of thefe dates is peculiar to their diftemper : and ' the fpontane- ous diarrhoea, or the readinefs with 4 which
T R A NS ACTIONS. 139
which a coffivenefs is removed, may help to diftinguiffi it from the ileus.
In other diforders of the bowels it is a very alarming fymptom, to have the patients fubjedt to fits of fhivering: but very ftrong ones now and then happen in the jaundice, and laft an hour, and return every day for two or three times, without being followed by any other com- plaint. It is difficult to guefs fatif- fadtorily at the caufe of this ; but whatever it be, 1 have fufpedted that this fymptom happens at the time of the ftone’s paffing into the intef- tines. However, neither fuppuration, nor gangrene, nor any other mifchief, needs be apprehended from , this {hi- vering.
It is not conftant in this malady, but it is far from being uncommon, to have all folid food tafte bitter, and fometimes, though more rarely, the fame is true of liquids. I knew
one
$4o MEDICAL
one to whom all liquids and folldi tafted bitter, except oyfters.
The milk of idteric women, who fuckle children, is not tainted with the bile, either in its colour or tafte. I remember to have feen a woman, who with a very deep jaundice had been for fix weeks fuckling a child, who fucked with eagernefs, and was healthy and robuft.
Infants and children of all ages are fubjedt to the jaundice; but they have it in a flight manner, and foon recover from it, and it does not, as far as I have obferved, do them any hurt. Men and women feem equal- ]y liable to this malady ; in a con- tinued fucceflion of a hundred pa- tients I counted 52 males and 48 fe- males.
Those, who have once had this diftemper, are very liable to returns of it, not only becaufe other gall-ftones are likely to be generated by the
fame
TRANSACTIONS. j4t
lame caufes which formed the firft, but like wife becaufe a fit of the jaun- dice is frequently terminated not by the pafling of the ftone into the duo- denum, but by it’s falling back into the cyftis; at it’s pafling out of which it occafions a frefh fit, and many may thus be caufed by the fame ftone.
A jaundice, caufed merely by an obftrudion of the gall duds by a ftone, is ufually void of all danger; but where the obftrudion is made by fcirrhus, either of the gall duds, or of that part of the duodenum through which they pafs, it is moft likely not only to be dangerous, but incurable.
I h ave indeed known two perfons die, for whofe death there was no other evident caufe, than an obftruc- tion from gall-ftones; as I judged from the fymptoms, and becaufe this diftemper had frequently appeared in x them
14* MEDICAL
them before, and had readily gone off. I fufpedted, that one of thefe died apople&ic : and perhaps the liver or inteftines of the other were difeafed, though I might hope and judge otherwife from the quietnefs of the pulfe, which fometimes is ob- fervable in the molt dangerous dis- orders of the bowels. If we con- fider, that the jaundice will fome- times continue for feveral months, and is no prefervative from other fatal illneffes, it may now and then hap- pen, that one of thefe may come on during a fit of the jaundice, to which laft the mifchief may be unjuftly im- puted.
People of the middling or lower rank often go about with a deep jaundice upon them for many weeks, and are not hindered by it from do- ing all the common bufinefs of life, where no great exertion of ftrength is required.
Very
TRANSACTIONS. 143
Very different is the danger in difeafes which properly belong to the liver itfelf. This vifcus feems in feme inftances to have been feized with a fudden and violent inflam- mation, joined with a fever and the figns of immediate danger : which are either followed by a fpeedy death, or by a lingering one after an un- kindly fuppuration, which, though more llowly, yet is fcarce lefs cer- tainly fatal. Such an inflammation, perhaps, more ufually begins in fome of the parts to which the liver is contiguous, and is communicated to it from them. But what I have con- jectured to be this diftemper of the liver has rarely occurred to me in comparifon of that which begins here, as in other glandular parts, with a fmall fcirrhus, which gradually fpreads itfelf over its whole fub fiance, and, I imagine, juft in the fame man- ner
144 MEDICAL
ner as it happens in the breafts of women.
These fcirrhi by fits inflame, whence a fever is raifed, and the health in many refpe&s much difcom- pofed. This fever retreats on the abatement of the inflammation, and the patient is encouraged to hope for a recovery ; but his hopes are ufually vain, the intervals between thefe in- flammations becoming fhorter, the appetite, flelh, and ftrength, decreaf- ing, with a little cough and hiccup, which fometimes without, and often with adropfy, bring on death; towards which the progrefs in different pa- tients is fo unequal, as either to take up feveral years, or to be finifhed in a few months.
The liver having but a very dull (if any) fenfe of feeling, if the in- flammation be confined to the inte- rior parts, it will hardly be attended
with
i
TRANSACTIONS. 145
with any pain; which, as I fufped, is never perceived, but when an ulcer or inflammation of the furface of the liver catches the diaphragm, intef. tines, or parietes of the abdomen : In this ftate of the liver the patients choofe to lie on their right fide.
A pain of the right fhoulder .is common in liver-cafes ; but on what circumftances it depends, no obferva- tions have yet afcertained to me* nor whether it belonged to a mere oh-
O
flrudion of the gall-duds, or only to fcirrhous inflammations of this part, which laft I rather fufped.
M- ^
In the advanced date of thefe fcir- rhi, the blood will gufh out in great quantities from the nofe, the gums, the ftomach, the navel, and with the dools ; which is probably to be at- tributed to the obdrudion which it meets with in the fcirrhous liver.
The word of thefe cafes, of which 1 have fatisfied myfelf by feein Vol. If. L th
CD OQ
i4 6 MEDICAL
the bodies opened, will fometimes, throughout their whole courfe, fhew nofigns of a jaundice; thatis, though the complexion may be of a leaden colour, yet the fkin and eyes and urine will be free from the jaundice-tinc- ture, and the ftools will not be afh- coloured. The reafon of which may be this : the matter of the bile before it’s fecretion from the blood, is no more to be difcovered there by any of its fenlible qualities, than any of the other fluids, which may be fe- creted by their proper glands. But when once the feparation of thefe liquors has been made, it is impofli- ble to remix them with the blood in fuch a manner, as that they fhall not be difcovered by the fenfes. If an animal could live without a liver, and this was to be cut out of the body, the blood of this animal would no more abound with bile, than that of caftrated animals does with feed.
If
TRANSACTIONS. 147
If the urine, after its fecretion, meet with any cbftrubtion, which hinders it’s evacuation, and forces it back in- to the blood, all the humours will be tainted with it, fo that the urinous tafte will be always prefent to the patient: this will happen, as I have known, when a pint of water has been made in the day, becaufe this was not the whole of what had been fecreted. But in dropfical perfons, no tafte or fmell of urine is perceiv- able in the humours of the body, becaufe none has been fecreted, and afterwards forced back into the blood, though they often do not’ make half a pint in twenty- four hours.
Let us therefore fuppofe one half of the liver fo hardened with fcirrhi, as to be ufelefs ; no bile could then be feparated bv this morbid part, and it would be juft the fame, as if it had been cut out; confequently there would, upon this account, be no ex- L 2 traord inary
1 48 MEDICAL
traordinary appearance of bile, either in the blood, or in any of the hu- mours : but if the fcirrhous part of the liver happen to be fo fituated, as to comprefs and obftrudt any of the pori biliarii, through which the bile, fecreted in the found part, fhould pafs into the common gall-dudf, then, the paffage of this bile being intercepted, it will be forced back in- to the blood, as in a Ample jaundice, infecting that and all the humours, thence derived, with it’s bitternefs and golden colour: and this reafon has been confirmed by the appearances on opening the body of one, who died of a fcirrhous liver. The pre fence there- fore of a jaundice, with a hedtic fever, will afford a very convincing proof of a difeafed liver; but the ablence of it, will by no means fhew that it is not difeafed.
An indurated liver is often very evidently diftinguifhable by applying
the
TRANSACTIONS. 149
the hand to the region of it : and this affords another certain fign of it’s difeafed date. And thefe are the only peculiar figns, that this vifcus is the feat of any malady ; for the quick pulfe, hiccup, ficknefs, and averfenefs from food, equally belong to the dif- tempers of the liver, and of many other vifcera. 1 doubt indeed, whether it be of any great moment to be able to decide with precifenefs, whether the ail be here, or in the pancreas, or fpleen : for I know of no remedy pe- culiarly or fpecifically appropriated to this Irate of the liver ; and there is not much more to be done in it, than what the common cure of the he&ic fever requires, whether the fever arife from this, or from any other caufe.
It is probable, if a final 1 part only of the liver be fcirrhous, that it may, by a cool regimen, and by all! fl- ing the general health, be kept for many years from fpreading, as it L 3 feme-
i5o MEDICAL
fometimes happens in the breafts of women: but, as in thefe, fb I ima- gine, in the liver, when once fuch a mifchief is begun, it moft ufually goes on increafing, and is fo much more dangerous than a fcirrhous brxaft, as it’s fundions are more neceflary to life, and as it is more likely, by being obftruded, to occaflon a dangerous breach of the lymphatics and blood veffels.
Where frequent inflammations, with a conflderable degree of fever, cannot be prevented, there the flefh and ftrength more rapidly decreafe ; and if the inflammation be great enough to occafion a fuppuration, the only chance of a recovery is from the breaking of the abfcefs in fuch a manner, as that the matter may be carried off by the hepatic du<fl ; or when the inflammation of the liver has made it adhere to the parietes of the abdomen, in which a
tumour
TRANSACTIONS. 151
tumour forms, and is opened orburffs externally. I have known one or two recover in fuch circumftances, but more who have funk. In fome, a great abfcefs of the liver has ap- peared to have made it’s way preaser- naturallyinto the ftomach or bowels; and immediately, upon the burfling of it into thefe parts, the patients void, by vomiting, and purging, a moft of- fenfive matter, filling a whole houfe with it’s noifome fmell, and die in a few hours.
A sudden inflammation of any of the parts contiguous to the liver, by which it would foon be affected, or poffibly of the liver itfelf, may be occafioned by any of the caufes to which pleurifies and fimilar difor- ders are owing,* The more chronical difeafes of the liver, which begin with fmall fcirrhi, arife fometimes from the fame ill habit of body which occafions fcirrhi in other glandular L 4 parts.
i52 MEDICAL
parts, or from a blow : but the molt common caufe is an intemperate ufe of fpirituous liquors, which fpecifically hurt the liver, far more than thev do the ftomach, to which they are im- mediately applied, or than they do any other of the bowels. The ex- perience of mankind has been fo un- fortunate, as to find out this fpecific poifon for the liver, but has not yet found out a fpecific remedy : for of all the pretended medicines appropri- ated to the liver, it may be doubted, whether one deferves the name ; and until the evidence of their virtues is more clearly eftablifhed, it will be moft advifeable to fave the patient from the great tedioufnefs of a courfe of them, and to aim only at moderating the fymptoms, abating the hedfic fe- ver, and ftrengthening the ftomach.
Men are more commonly aftedted
j
with fcirrhous livers than women, be- came they are more given to intem- perate
TRANSACTIONS. 153
perate drinking', which is the princi- pal caufe of this diforder.
Bath waters are in no cafes more ufeful, than in remedying many • of the injuries done to the conftitution by drunkennefs: but where the liver is become fcirrhous, and a hedtic fever fhews thefe fcirrhi to be in an inflamed ftate, there the Bath waters will aggravate all the fymptoms, and contribute no otherwife to end the difeafe, than by battening the pa- tient’s death.
Besides the diftempers belonging to the liver, which have been men- tioned, the bile is by ibme judged to be the caufe of many difeafes, with- out any confiderabie affection of the liver itfelf, or any obftrudtion of the gall-ducts ; and much danger is ap- prehended from it, where it’s qualities are vitiated, or where it exceeds it’s natural quantity, and is plentifully voided by vomiting and purging.
Now
134 MEDICAL
Now in many other glands their peculiar fecretions may be made in a very abundant manner without much hurt to the health. This is evident from the great, yet harmlefs, flow ot faliva and urine obfervable in hypo- chondriac and hyfteric patients. So likewife from the feveral glands, which empty their contents into the bowels, there often happens an in- undation, which only occafions an innocent loofenefs. And an excefs of fweating will arife from fuch trivial caufes, and have fuch flight effedts, that it is hardly poflible to guefs at them. The fame is perhaps true of every fecretion.
The bile was antiently judged to be an excrementitious and ufelefs, if not an hurtful, humour ; but the moderns are agreed, that it is a fecre- tion of very great importance to the well-being of the animal: and from the nature of it, there appears no
evident
TRANSACTIONS. 155
evident reafon, why this, as well as other fecretions, mav not exceed it’s natural limits, without any confider- able detriment. 1
It is not likely that the health of the body depends on a very precile quantity of bile; We are fure, that little or none may be furnilhed to the bowels for feveral days, without any great mifchief; and probably there is an allowance for as great a latitude, on the fide of excefs, withperfed fafe- ty to the body.
The healthieft perfon may, by failing in a fhip, almoft inftantly have the prim® viae deluged with porrace- ous bile, and yet, from the moment of his landing, feel no other diforder, than that of the fatigue in bringing it up. Nor is it credible, that fome flight appearance of, what is called bile, in the urine or eyes, can be worth our attention in fevers, when almoft all the humours of the body
156 MEDICAL
may be ftrongly tainted with it, as we fee in a jaundice, without any dangerous alteration of the health, and without occafioning any fever at all. The quantity alfo of the bile may be exceedingly altered without any other confequences, than difor- dering the ftomach. W e every day
have inftances of it’s becoming fo cor- rolively acid by the juices, according to Haller, which it meets with in the ftomach, as to make the throat fore, and to fet the teeth on edge, without any dangerous difturbance of the ge- neral health : and very little ft refs can be laid upon its colour, which is fo eafily changed, that bile after ftand- ingr a few hours will of itfelf often
O
turn from yellow to green.
In putrid fevers fuppofed to arife from the bile, the contrary quality of putridity in this humour is fufpeded from theory, but is hardly warranted by experience. Vomiting'indeed, in
J i O
TRANSACTIONS. 157
the beginning of moft fevers, has from the time of Hippocrates down to the prefent age been experienced to be an ufeful method of cure ; but it is very doubtful whether the quantity of bile evacuated by it, or of any other hu- mours of the ftomach and pancreas, or the fihock itfeif, contribute moft to it’s good effedt ; for it is juft as ufeful, when the bile vomited up is neither considerable for its quantity or qua- lity. “ Ssepe miratus fum,” fays Sy- denham, “ dum forte materiam vo- “ rnitu rejedtam aliquando curiofe “ contemplabar, eamque neque mole “ valde fpedlabilem, nee pravis qua- “ litatibus infignem, qui factum fu- “ erit, ut asgri tantum levaniinis inde <£ fenferint.”
I can fay nothing from my own experience of the diftempers which derive their origin from redundant or corrupted Bile ; and therefore fhould have been ftlent on this head, if f 3 had
*$* MEDICAL
had not hoped* that the few partied* lars, which I have mentioned, might be worth being attended to by thofe, Vvho would examine the current doc- trine of bilious diforders 5 nor is it of little importance in practice to form a right judgement about this dodrine ; for where the bile is judged to be the caufe of a diforder, there other me- dicines are laid aiide, and repeated purgings are directed, in delicate and weak, conftitutions, in hypochondriac and hyfteric affections, in low fevers, in perfons exhauited with chronical illneffes, and in other cafes, in which* upon all other accounts, this evacu- ation would be highly improper.
In the cure of thofe vvhofe gall- duds are obftruded with biliary con- cretions, the firft thing to be attended to, is the pain ; which is often fo exceffive, that nothing elfe ought to be attempted, before this is relieved. Bleeding is here of no ufe, and fhould 1 therefore
TRANSACTIONS. 15*
therefore be foreborn, as a needlefs wafle of ftrength. This pain can only be affuaged by giving and re- peating opium, or it’s preparations, as often as the continuance of the pain requires them. And becaufe this pain is very apt to return, the patient fhould always be advifed to keep by him, as long as the diftemper lafts, pills of pure opium, each weighing one grain, (or what is equivalent to them) that no time may be loft in quieting a fenfation which it is fo difficult to endure. One of thefe pills may be taken as foon as the pain comes on; and it may be repeated once, or twice, in the fpace of two hours, if the pain require it ; and I have often found it both fafe and ne- ceflary to give much more.
Vomiting is commonly the next fymptom which demands the phyft- cian’s affiftance. This fee ms to be an effort of nature, to diftodge the
ftones ;
i 60
MEDICAL
ftones : bat it may be a queftion, whether it be fuch an effort, as ought to be encouraged, or checked ; for though on the one hand this violent concuffion may force the ftone back into the cyftis, or forward into the duodenum, and fo effed either a tem- porary relief, or a perfect cure, yet it may be feared, if the ftone be fo fixed in the dud as not eafily to be moved, that the adion of vomiting will la- cerate the membranous dud, and be the caufe of future mifchief, as well as of prefent pain. Now whether this fear be juft, or groundlefs, can only be determined by experience ; and by what 1 have obferved of ideric cafes, it has appeared to me, that a vomit excited, while the pain was intenfe, has rather quieted, than aggravated' it, and has never brought it on. But if we be fee u re of it’s do- ing no harm, there is fo good a chance of it’s being beneficial, that, whether
the
TRANSACTIONS. 161
the patient have a vomiting, or not, it is a judicious practice to order an emetic, either at firft, or as foon as the intenfenefs of the pain has been alle- viated, and occafionally to repeat it. To excite a vomiting in this malady, is much more eafy, than to flop it; and therefore it is always proper, and fometimes neceflary, to order an opiate to be taken after a moderate number of ftrains have been pro- cured, or if the ficknefs continue longer than ufua).
Similar good eftedts may with rea- fon be expedted from purging medi- cines, by their increafing the natural motion of the inteftines, and folicit- ing a greater flow of bile, as well as of all the other humours which are pour- ed into them. Mercurial purges have been preferred by fome pradiitioners ; but there appears nothing, in the known powers of mercury, peculiarly ufeful in diflodging a biliary concre- Vol. II. M tion ;
i6z MEDICAL
tion ; and the preference fhould be given to thofe purges, which a£t with the moil eafe, and may be continued with the greateft l'afety. Such are the fea-water, the water of many purging fprings, as alfo many of the neutral falts, diffolved either in water, or, if it can be borne, in a weak in- fufion of fome bitter vegetable fub- jftance. Thefe, as we know by abun- dant experience, may be taken for feveral months, either every day, or every other day, without palling the appetite, orexhauftingthe ftrength or fpirits. I knew a weakly perfon, who, for a ftrumous inflammation of the eyes, was gently purged with fea- water three times a week for a twelve- month, and rather gained, than loft fled), during this courfe. But in fome cafes there may be reafon for uflng other purgatives ; and I have known a few grains of rhubarb, or one or two drachms of the tin&ure of fena
or
TRANSACTIONS. 163
or rhubarb taken with advantage in a (mail draught of fome moderately bit- ter infufion. The jaundice of infants and young children loon yields to a few purging medicines.
If it happen, that the jaundice is of itfelf attended with a purging, there may be nothing further necef- fary, than by gentle means to prevent it’s being exceffive, and at the fame time to ftrengthen the ftomach by proper bitters.
The itching is many times fo ex- tremely troublefome, as to require opium ; without the help of which it would be impoffible to procure any eafe, or deep.
Besides thefe medicines, which have appeared to me the moft bene- ficial of any which I have feen u!ed, there is a clafs of bodies which have been trufted to, from a belief that they have a power of diffolving gall— Hones. Of this kind are the alkaline M 2 falts,
164 MEDICAL
falts, lime-water, foap-leys, and va- rious foaps : all which I have tried by fteeping gall-ftones in foap-leys, and lime-water, and in the folutions of foap, and of the falts ; and it is no wonder, that the others did nothing towards diflolving the hones, when the moft powerful of them all, the ftrongeft foap-leys, could only fetch out a flight green tin&ure from a gall- ftone, but neither feemed to lefien its bulk, nor to alter its fhape, in feveral months ; and there is very little like- lihood of their being able to do more in the body than out of it. Gall- ftones were likewife infufed in every' one of the acid fpirits, without being diflolved in any.
But if we had ever fuch powerful folvents of gall-ftones, it might be doubted whether they could do any fervice in the obftrudions which thefe occaflon ; for whilft they remain in the duds, or cyft, the folvents can- 7 not
TRANSACTIONS. 165
not reach them ; and when they are come out into the inteftines, they want no medicines, but will of courfe be voided by ftool.
It would be very delirable to find out a remedy, which would medicate the bile fo, as to make it unapt to coagulate, or enable it to refolve the concretions already formed; and fuch there may be found hereafter, but, though this has been pretended of feveral, I have no reafon to think it true of any ; and as we do not yet know any which may be fafely taken, which can diffolve gall-ftones, it is not likely that we know any thing which will make the bile diflolve them.
I attended a perfon, who for a ftone in the bladder of urine had been in a courfe of fwallowing an ounce of foap every day for feven years. His diftemper and advanced age having made him retire from all M 3. the
1 66 MEDICAL
the bufinefs of life, and he being na- turally conftant in what he under- took, I imagine there could be but very few days, and I do not know that there were any, on which this medicine was omitted. His body was opened after his death, and, notwith- ftanding fuch an extraordinary quan- tity of loap had been taken, a great number of hones were found in the gall bladder, which (hewed no fign of having been a&ed upon by any folvent.
The only ufeof foap and alkaline falts in a jaundice, as far as we can reafon upon their probable virtues, is, to make amends for the deficiency of the bile, which they referable, in digeiting the food, and cleanfing the bowels. But too much ftrefs rauft not be laid upon this reafoning, for I have known large quantities of an acid, fuch as lemon-juice, taken by fome icteric patients, with fo much
apparent
TRANSACTIONS. 167
apparent benefit, as to have gained the credit of the cure.
A very judicious phyfician aflured me, that he had feen extremely good effe&s in an inveterate jaundice from a fcrupleof volatile alkaline fait given three or four times a day ; and he feemed to be convinced, that, befides the virtues juft mentioned, it had fome peculiar or fpecific ones in the cure of this difeafe.
Specifics for it are to be met with in great abundance among medical writers : many of which manifeftly owe their reputation to inconclufive reafoning, or to fanciful criteria * of
* a Tincam pifcem, admotum corpori, i£lero “ mederi, omnemque bilera in corpore effufam ad te feattrahere, refer untConradus Gefnerus&Kent- “ mannusd’ Sennert. de Chemicor. cum Arifto- telic. & Galenic, confenf. ac diftenf. Cap. xvm. This is mentioned by Sennertus as an in- fiance of real cures, which he allows, by fecret at- traction, and the power of amulets. It has hap- pened to the tench, as it has to all the precious ftones, and to many other parts of the materia
M 4 the
168 MEDICAL
the virtues of medicines ; others are unfupported by well-attefted expe- rience; and I have no reafon, from what I have obferved, to think the teftimonies in favour of any of them deferve to be examined or men- tioned.
The waters of Bath have fome credit of being ferviceable in a jaun- dice. But it mutt be obferved, that idteric patients generally recover, wherever they are, and it may be doubted, whether they recover the fooner for the ufe of thefe waters. However, there can be no medical reafon, for difiuading any one, in a fimple jaundice, from going to Bath ; becaufe the waters are perfectly fafe,
medica, that from being ufed at firfl only as an amulet or external charm, it has paffcd, by a mif* take, in the manner of it’s ufe, from the outfide to the infide of the body; and hence the tench itfelf, or tench* broth, has been reputed a food endowed with a fpecihc virtue in the cure of the jaun- dice*
and
TRANSACTIONS. 169
and the proper medicines may be taken there, as well as anywhere elfe; while the vacancy from care in fuch public places, together with the change of air, and water, and objects, may be of fome ufe to the general health, and thereby facilitate the cure of this, as they often do of many other, chronical diforders.
The ancient phyficians have left it upon record (as Boerhaave judges by comparing Hippocrates and Galen, Swieten, Comm. § 923. 4.), that a profufe bleeding of the right noftril critically terminates diforders of the liver. I remember to have feen one ic- teric woman, out of whofe right nof- tril the blood fuddenly gufhed with fuch violence, as to alarm the family, and make them fend for the neareft furgeon, who could not entirely hop jt for fome hours. The woman had then been ill feven weeks, and foon after recovered. But the bleeding of
the
170 MEDICAL
the nofe, in affections of the liver, is not constantly through the right noftril, for I have known the blood come alfo from the left ; and it is molt probable, that this bleeding is owing to the fame caufe which makes profufe haemorrhages from all places fo common in a feirrhous liver ; and, il fo, it muft be looked upon as an ufelefs, or hurtful fymp- tom, which can have no merit in the cure, though this fhould happen foon after. But whatever may be thought of a fpontaneous efflux of blood, I do not know, that any one has ever at- tempted, with fuccefs, to imitate it, by ufing artificial means to make the nofe bleed in any diforders of this vifcus.
Before I conclude this paper, it may be of fome ufe to obferve, that biliary concretions are probably one caufe, am id ft various others, of (that common eft of all complaints) an un-
eafinefs
TRANSACTIONS. 171
eafinefs or pain, as it is called, of the fiomach; to which it is ufually re- ferred, whether the pain be feated there, or in feme of the neighbouring parts : and the fame may be faid of a chronical naufea, and fenfe of fuinefs. This I have been induced to believe, from finding, that, in near twenty perfons, a fuppofed pain of the fto- mach, which has frequently afflicted them for months, or years, has at laft been joined by a jaundice. 1 will not pretend to determine, whether this may be attributed to fmall grumes of bile, which are perpetually forming, and irritating, as they pafs, the entrance into the duodenum ; or whether it muft be attributed to a Hone in the cyilis fellea ; which, though it be often unattended, as hath been before remarked, with any pain or uneafinefs, yet, like the ftone in the bladder of urine, may, in cer- tain fituatiens, occafion very difagree-
able
i72 MEDICAL
able fenfations in the parts againft which it prefles.
Whatever be the way, in which thefe caufes a<3:, it will often be ufe- ful to have them in our thoughts, where a pain, or loathing, or fenfe of fulnefs in the itomach is complained of, and other circumftances make fuch caufes not unlikely : for in this cafe, gentle vomits, and a courfe of purging waters, would prove themoft effectual cure, by altering the pofition of the ftone, or by facilitating the expulfion of the grumous matter, and by preventing the formation of it, while the gall was made to flow more plentifully into the inteftines.
XI. Of
TRANSACTIONS. 173,
XI. Of the Nettle-rafh.
By the fame.
Read at the COLLEGE, August 15, 1769.
f I "''HE Nettle-rafh is a diftemper _§_ of the lkin, which being at- tended with no danger, is mentioned but feldom, and flightly in books ; though it be often fo extremely trou- blefome, that phyftcians might juftly have thought it important enough to have told us more of what they bad learned, from their experience, rela- tive to its nature and cure.
It has it’s Englilh name from re- fern bling, in it’s appearance, the effect of flinging- nettles upon the lkin. Sydenham, in his chapter on the Ery- fipelas, reckons it a fpecies of that difeafe ; and Sennertus, and others, defcribe it under the name of Eflera, fuppoflng it to be the fame diftemper
with
i74 MEDICAL with that which' is fo called by the Arabian phyficians. Whether their fuppofition be right or wrong is of no great moment; but as it is ufe- ful that this diiorder fhould have a name, and as this is juft as good as any other, I (hall follow their au- thority in fpeaking of it under this appellation. The little elevations upon the Ikin in the Nettle-rafti often appear inftantaneoufly, efpeci- allv if the ficin be rubbed or fcratch- ed, and feldom ftay many hours in the fame place, and fometimes not many minutes. There is no part of the body exempt from them. Where many of them rife together and con- tinue an hour or two, there the parts afFe&ed are often considerably fwelied; which particularly happens in the face/arms, and hands. Thefe eruptions will continue to infeft the fkin, fometimes in one place, and lome- tiines in another, for one or two hours 6 at
TRANSACTION S. 175
at a time, two or three times every day, or perhaps for the greateft part of the twenty-four hours. In fome perfons they laft only a few days ; in others many months, I have known feveral complain of them for two years, with very fhort intervals, and fome for feven or even ten years.
Males and females are equally liable to the Effera, and I have ob- ferved it in all ages from childhood to decrepit old age. Conftitutions taint- ed with flrumous, or harrafled with rheumatic andhyfteric complaints, or broken down with intemperance, pal lies, and age, have all been, as far as I could judge, equally fitted for this diforder ; but not more fo than the fcundeft ftate of health, in the vigour of life, to which all other com- plaints were unknown.
If fome of the fufferers by this eruption have found themfelves well, whilft it appeared, and infefied with
pains
176 MEDICAL
pains of the head and ftomach, and languors, upon its difappearing; others have complained of as much languor, and equal pains of the ftomach, during the time of it’s appearance : but far the greateft number experience no other evil from it, befides the intole- rable anguifh arifing from the itching, which will fometimes make them fall away, by breaking their reft, and is often fo tormenting, as to make them almoft weary of their lives.
The external ufe of Cantharides has been known to occafion this ail in feveral perfons, and in fome the internal ufe of the wild valerian root ; but all, who are affli&ed with it, find the itching and little eminencies hardly ever fail to be brought on by any degree of fcratching or rubbing the {kin. The feafons of the year have no conftant effedf, either in alle- viating, or exafperating this diforder ; and the fame may be faid of cold and
heat.
TRANSACTIONS. 177
heat, and particularly to the heat of a bed, which appears to make fome much better, and others much worfe. Sea-bathing has feemed to occafion it in fome, and to relieve it in others, but is perhaps in reality innocent and ufelefs in all, as it certainly has been in feveral, as well as warm-bathing, though continued for an unufual length of time. Mercurial and ful- phureous ointments have been found ineffectual in curing it ; and the powder, infufions and decoCtions of white Hellebore root, in ointments, and lotions, have only for afhort time changed the itching into fmarting. Oil, vinegar, and fpirit of wine ap- plied to the fkin, will fometimes mi- tigate the itching, and afford a little prefent relief.
The appearance of this eruption was before faid to referable the fling of a nettle, but, together with fuch little rifings in the fkin, there are
Vol. II. N fometimes '
178 MEDICAL
fometimes long wheals, as if the paft had been ftruck with a whip. What- ever be the fhape of thefe eminencies, they always appear fohd, without having any cavity or head containing either water or any other liquor: and this affords an ufeful mark by which this cutaneous affe&ion is diftinguifh- able from the itch. For it often hap- pens, that the infufferable itching at- tending this eruption provokes the pa- tient to fcratch the parts fo violently, as io rub off a fmall part of the cuticle on the top of thefe little tumours : a little fcab fucceeds, and when the fwelling is gone down, there is left an appearance hardly to be diftin- guifhed from the itch, but by the circumftance juft now mentioned. It has been this exaft refemblance, which has occafioned the application of fulphureous and mercurial oint- ments in many perfons whom I have feen, without producing
3
TRANSACTIONS. il9
good or bad effect. The Effera far- ther differs from the itch in not be- ing infectious; for though! have once fufpedted that a hufband had catched it from his wife, yet my fufpicion was probably not well founded in this inftance, becaufe in many others I have known that this complaint fhewed no figns of being communi- cable by contagion.
The Nettle-rafti equally affedting the human body in fuch a variety of circumftances, and having fuch flight eft'eCts upon it, might incline us to look out for fome external mechani- cal caufe, which acted no longer than while it was applied, nor made a deeper impreflion upon the health than what might be expedted from fuch a fuperficial application, and by which every human body would be affedted almoft in the fame manner, juft as we fee it happen in cuts and burns. Moft perfons fuffer alike from N 2 thofe
180 MEDICAL
thofe exquifitely fmall pun&ures made in the fkin by the fine hairs of the flinging nettle. Couhage, or as it is corruptly called, cow-itch, is a fort of phafeolus or french-bean, the pod of which is covered over with a kind of down or hair, and the effect of it upon the Ikin is much the fame with that of nettles ; and almoft any hairs cut equally fhort, and fprinkled .upon the fkin, whenever they hap- pened to flick in it, would make the part itch, or fmart, in a very uneafy manner; and after the finer ones have been ftrewed over the Ikin, it is often a confiderable time before it can be perfectly cleared from them.
Reaumur, in the fecond tome and fourth memoir of his very ingenious, as well as exa& hiftory of infe&s, defcribes a fpecies of caterpillars, to which 'belongs a very fine fort of hairs almoft invifible to the naked eye, which are eafily detached, and fre- . 4 quently
TRANSACTIONS. i8t
quently float in the air round their neft, though it have not been at all difturbed. The touch of thefe hairs has a fimilar effect with the phafeo- lus zurratenfis or couhage; that is, they occafion intolerable itching, with little bumps and rednefs, arifing fometimes to a flight inflammation. Thefe, he found, would continue for four or five days, if the animal, or the nefts, had been much handled ; and though they had not been touch- ed at all, yet by only walking near their nefts the fame effects would be brought on, but for a ftiorter time. Thefe hairs affe£t the fkin in this manner by flicking in it, as he could perceive with a glafs of great mag- nifying power, for with one of a fmall power they were not vifible. The uneafy fenfations caufed by thefe fine wounds not only, as he fays, laft feveral days, but move from one part of the body to the other, fo that they N 3 will
i8s MEDICAL will ceafe upon one wrift, and imme- diately infeft the other; from the wrift they will go to the fingers, or the face, or even to the parts of the body which are covered. He fup- poies, that the motions of the body, when much of this fine down lies near or upon the fkin, may drive it from one part to another, or change what was lying there inoffenfively, to a pofition fit to make it penetrate into the fkin. Neither cold water, nor oil, norfpirit of wine, with which the parts affe&ed were bathed, had any effedt in removing the itching. He thinks the raoft efficacious reme- dy, which he tried forthis complaint, was to rub the parts ftrongly with parftey, which inftantly leffened the fenfations, and after two or three hours entirely freed him from them. It is well known that many fpecies of caterpillars by only walking over the hands will produce fomething
like
TRANSACTIONS. 183
like this effefl: on the parts which they touch, and undoubtedly from the fame caufe.
Is it, we may afk, impoffible, that the Eflera fhould arife from fome fuch caufes, as thofe juft mentioned, which we rnifs by looking too deeply for them in the blood and other hu- mours? Such may have been it’s ori- gin in fome inftances, where the com- plaint has lafted only for a few days. But where this affection has conti- nued for fome years, in perfons who change their linen every day, and who bathe frequently all the time, it can hardly be afcribed to fuch an external caufe, I have faid, that it has feveral times been produced by blifters ; and though it have continued many weeks after a blifter was removed, yet it might be fufpedted that this arofe from the fine fpicula of the canthari- des flicking all this tune about the fkin j it being cuftomary to ftrew N 4 much
i 84 MEDICAL
much of the dry powder of the cantharides over the blifter-plafter, whence it may readily be carried to other parts of the body. But where fhall we find any external mechanical caufe to account for the fame effe&s following the internal ufe of the wild valerian root ? In this and probably in molt other inftances the caufes of the Eflera appear to be of the fame kind with thofe, which in the eaters of mufcles, and ffirimps, and honey, and the kernels of fruits, often pro- duce fymptoms not very unlike thofe which belong to this diforder.
Whatever be it’s caufe, I never faw reafon to fuppofe it had occafi- oned any fuch vicioufnefs of the hu- mours, as greatly to require, or to be much the better for, internal-alterative remedies. And if the itching could be certainly and expeditioufly allayed by any more efficacious waffi or oint- ment than thofe I have mentioned.
we
TRANSACTIONS. 185
we might perhaps fpare ourfelves the pains of looking out for any other method of cure.
I shall conclude this defcription of the Eflera with the hiftory of a diforder, which feems to be a fpecies of it, communicated to me in a letter from the ingenious Dr. Monfey, phy- lician of Chelfea College, which on account of its long duration, and of the uncommorinefs and violence of it’s fymptoms, and of the fuccefsful manner in which it was treated, de- ferves to be related at large.
Chelfea College, 15 May, 1770.
<c Dear Sir,
About the year 1752, W. A. aged near 30, of a thin, fpare habit, was feized with a diforder attended with fymptoms of a very uncommon kind. Whenever he went into the air, efpe- cially if the fun fhined bright, he was
feized
s 86 MEDICAL
feized with a tickling of his flefh on thofe parts expofed to the fun ; this tickling, by his continuing in the air, increafed to a violent itching attend- ed with great heat and pain : the Ikin would be as red, nearly, as Ver- million, and thicken like leather; and this remained till he got out of the air, and then in ten, fifteen, or twenty minutes abated. This happened only when the fun was above the horizon; at other times, he was what he called quite well. But it was not owing to the heat of the fun, for the fun in winter affe£ted him full as much, if not more ; and the heat of' the fire had not any fuch effed. This threw him into a neceffary confinement for near ten years. He tried feveral hof- pitals without any apparent fuccefs. Several of the faculty were fo hu- mane, as to do what they could for him, but without the leaf!: abatement of his complaints. It was at laft
agreed
TRANSACTIONS. x8;
agreed to, by feveral phyficians, that he fhould try dipping in fait water, which he did at Yarmouth, for 13 weeks, without any vilible amend- ment. It might be thought too tedious a detail to give all the parti- culars of his management of himfelf there; but it may not be amifs juft to mention one particular, which is, that one hot day, having a mind to try if he was at all benefited by his immer- fions, he undrefied himfelf and went into the fea, in the middle of the day; but he paid very dearly for the ex- periment, the heat diffufing itfelf fo violently over his whole body, by the time he had put on his cloaths, that his eye-fight began to fail, and he was compelled to lie down upon the ground to fave himfelf from falling. The moment he lay down the faint- nefs went off; upon this he got up, but inftantly found himfelf in the former condition; he therefore lay
down
1 88 MEDICAL
down again, and immediately reco- vered. He continued alternately get- ting up and lying down, till the dis- order began to be exhaufted (which was in about half an hour), and fo gradually went off. He had fre- quently been obliged to ufe the fame pradice at other times, when he was attacked with this diforder.
Chance threw him in my way, and after fo many trials, by Several phyficians and Surgeons, tono purpofe; I had very little hope of doing him any Service, nor can I recollect what means I firft made ufe of : I know this, they were but lew, and not fuccefsful. I firlt enquired of him, if he. could in the lead guefs at the caufe or caufes of his complaint : he told me, that being very poor, he and a comrade lived all one winter upon bullock’s liver and porter. How far this method might go in bringing on his diforder I leave to the refearches
of
TRANSACTIONS. 189
of others ; I have only this to lay, that his comrade fuffered in the fame manner, but in a lefs degree, and got well. My learned friend, Dr. Baker, very humanely gave him his beft alii fiance, and as well as I remember, we agreed to try him with Dover’s powder and a deco&ion of guaiacum, for three weeks ; but this proved in- effectual. I then recommended him to one of the phylicians of Guy’s or St. Thomas’s hofpital, who, I think, gave him many nitrous medicines, for two months, without any relief. He then returned to me, and I not know- ing what to do in fo anomalous a dilorder, in which I had no guide, determined at laft to give him mer- cury, and he accordingly took five grains of calomel for three nights to- gether, and a purge the next morning of infuf. fen. rhubarb, or extrait, cathart. In this courfe he went on for near a fortnight, at the end of
which
i9 o MEDICAL which he found himfelf very fenfibly relieved. His amendment encouraged him to proceed, and I believe, once a little too boldly, for he fell into a little fpitting, for four or five days; how- ever, that went off foon ; and by this method, in lefs than fix weeks, he was entirely cured, and could walk in the fun in the hotteft time of the day, without being at all affe&ed. When I faw him laft, which is now about a year ago, he remained well ; and if he had been otherwife, I fup- pofe I fhould have feen or heard from him. I fhall trouble you with but one thing more, which is this, that fonie confiderable time after his being cured, he found fome intima- tions of a return of his diforder-; up- on which, without applying to me, he took a dofe of calomel, which, he told me, rnoft certainly relieved him next day, and this conftantly as often as he took it, which was not very
often,
TRANSACTIONS. 191
often, and he had had no occafion to take it at all for fome time before I law him laft.
I am, &c.
M. Monsey.”
.XIL Canine
MEDICAL
192
XII. Canine Madnefs fuccefsfully treated : Communicated to the Col- lege by W. Wrightson, Surgeon , in Sedgefield, Durham.
Read at the COLLEGE, August 15, 1770.
ON Friday December 29, 1769,1 was called upon, at two o’clock in the morning, to vifit Michael Gardener, a boy fifteen years old, fervant to Mr. Thomas Agar, of Shotton, in the parifh of Sedgefield, and county of Durham, near four miles diftant from my own houfe: when I got there, I found him tied down with cords to a wooden bench. On enquiry I was told, that the pre- ceding Sunday he had been bit in the leg by his mailer’s dog, which was hanged with all the fymptoms of madnefs upon him the Tuefday following; that on Wednefday in the
evening
TRANSACTIONS. 193
evening he complained of ficknefs. Which was attended with vomiting ; that in the night he had flept well. Was well the next morning, and eat his dinner with an appetite ; but foon after was feized with drowfinefs, and having flept near an hour, ftarted up fuddenly, looked exceedingly wild, and ran out of doors in a furious frantic manner; that he was imme- diately purfued, and brought in again, when he feemed fomewhat more com- pofed ; but that, before the family had prefence of mind to fecure him, the madnefs returned with greater violence, fo that he caught hold of the fire, and the hot bars, without any feeming fenfe of pain ; that at other times, when the fits were upon him, which would continue five or fix minutes, he had attempted to tear and bite himfelf, as well as every perfonand thing, that fell in his way; that fometimes he made a ftrange
Vol. II. O noife,
*
194 MEDICAL noife, not unlike the barking of a dog; was all along fen Able of the approach of the fits, and gave notice of it to the bye-fianders. Upon the whole it appeared, that the attacks had become more frequent, and had gained more and more ftrength; and from what I now faw, the account they gave did by no means feem to be exaggerated. Though the fpafms were not upon him, yet he was under inexprefiible languor, anxiety, and opprefiicn : complained much of an uneafinefs in his throat, with a riling in his breaft, and fenfe of fuffocationj was in the created: dread of a return of the fit ; perfectly fenfible ; his pulfe low, but regular; and there was no appearance of inflammation, fe* verifh heat, or thirft.
I firfl; of all offered him water to drink, of which he got down a little with much difficulty, and ftruggling; foon after he began to be apprehen-
five
TRANSACTIONS. 195
five of an immediate return of the fit, when I again offered him water; but he was not able to fwallow a drop, and the fight of it was vifibly painful to him: this trial was repeat- ed two or three times with the fame effect. Examining his leg, all l could perceive was a very fmall, fuperficial, dry fcab, with a faint red fireak> iffuing from it to a little diftance. I immediately recollected an account of a fimilar cafe, fuccefsfully treated by Dr. Nugent of Bath, publithed in the year 1 753 ; which having read fome time ago, and formed fo favour- able an opinion of his manner of treating the diftemper, and reafoning upon the fubjeCt, that I then deter- mined with myfelf to purfue that method, if ever an occafion fhould offer : I therefore, in the firft place, took away from the arm twelve ounces of blood, which had no bad appear- ance; and the threatening fpafmodic O 2 fym-
196 MEDICAL
fymptoms rather abating, I was able in a little time to give the patient thirty drops of tin&ura Thebaica in a fpoonful of water. Not long after this, a fit returned, in which he was under his former convulfions : he then very forcibly, and with a motion of his head inconceivably quick and fudden, attempted to feize, and bite his own hands ; but, from what I could col left from the people about him, this attack was weaker, and of much lefs duration, than the former ones had been, owing, as I fuppofed, to the power of the opiate. At my return home, I fent the patient fome pills, with one grain and a half of pure opium in each, directing one to be given every three hours, begin- ning with the firft three hours after the dofe of the tin&ure, which he had already taken. I likewife fent fome bolufes, with fifteen grains of mufk, ten grains of native, and ten grains 6 of
I
TRANSACTIONS. 197
of fa&itious cinnabar in each ; one of thefe to be given every fix hours, beginning with the fir ft one hour after the fecond dofe of the opiate ; and a drachm of camphor being dif- folved in two ounces of tin&ura The- baica, a piece of thin flannel moift- ened with this liquor was applied to his throat three or four times a day.
Visiting my patient again in the evening, I found he had had no more than four or five fits fince the morn- ing, and thofe were become gradually weaker. He ftill complained much of his throat, and a difficulty in fvval- Jowing; but more or lefs according to the tendency to the fpafmodic fymptoms. He had almoft continual convulfive catch ings in his arms and hands, his former languor and anxie- ty, with many returns of ficknefs and retching. In the night he flept to- lerably. On Saturday the catchings (fill continued, but were lefs frequent, O 3 and
19S MEDICAL
and not fo violent ; the fwallowing was now more free ; the languor, ficknefs, and retching, confiderably abated. Looking again at his leg, I found that therednefs, which I atfirft perceived, had quite difappeared ; and I underftood that he had never com- plained of any uneafinefs in that part. In the night he llept well, and on Sunday morning was free from all fpafmodic fymptoms, except fomc difficulty in fwallowing. He now was fo far recovered as to bear removing on horfebackto the place where I live. As he had had no ftool from the time I firft vifited him, an oily clyfter was given, which had it’s proper effedt. Till this morning the pills and bolufes were regularly adminif- tered as at firft direSed; but as the worft fymptoms had difappeared, and his ftomach now rejeded the bolufes, I thought it might be fufficient to i con-
TRANSACTIONS. 199
continue the opiate night and morn- ing only, and omit the bolufes.
I had all along qbferved, that the mention ofa dog gave himuneadnefs; and this day one accidentally coming into his room, while I was with him, he fhewed fuch dgns of dread and apprehenfion, that, I believe, if the dog had not been removed, a return of the convulfions would have en- fued. This night, and not before, he fweated moderately the greateft part of it. Although the diforder had been greatly fubdued before, yet this fweat feemed critical, and very effectual in perfecting the recovery. On Monday he was weak, and lan- guid; but in the night dept well, and fweated as before. He was much in the fame date on Tuefday, only fweated lefs than the two preceding nights. During the whole diforder, his urine was turbid, not high-co- loured, and made in fmall quantities.
O 4 As
too MEDICAL
As the want of appetite, with fre^ quent retchings, which had attended him from the firft, did not yield like the other fymptoms, but hill con- tinued; on Wednefday morning the medicines were left off, as I could not help attributing thefe remaining complaints chiefly to the opiates, From that time his appetite mended ; the retchings abating, foon ceafed, and by degrees the patient recovered his former health and flrength; nor have I ever fince perceived him in the leafl: affe&ed by the changes of the moon, He is now in fervice with a farmer, my neighbour, and as able as ever to go about his country bufinefs.
Having finiflied the narrative, I beg leave to add a remark or two, which feem naturally to arife from this cafe. As far as I could obferve, the opiates had the greateft fbare in the cure, as the violence of the fymptoms was confiderably abated before any of
TRANSACTIONS. 201
the mufk-bolufes were adminiftered. It may be apprehended, that opiates may not have the fame happy effedfc on all conftitutions ; as it is found in practice, that they agree much better with fome habits, than with others: but further experience will be able to determine whether a certain dofe may be found, which, applied in time, will anfwer in every habit to take off the irritation, and quiet the fpafms ; for it is upon the early removal of them, that the cure feems chiefly to depend, fince the blood appears to be no way concerned in the firif ffage of this difeafe. After the fpafms are once fubdued, if a fweat does not fucceed, as in this cafe, it may per- haps be thought neceflary to excite one by other fudorifics ; as fweat feems to be the molt natural excre- tion here for the offending virus.
It is much to be wifhed, that as fp on as the firft fymptoms of this
alarm-
i©a MEDICAL
alarming diforder appear, afliftanee fhould be immediately called in. In the cafe related, only twelve or four- teen hours had elapfed from the firft attack of the convulftons,and the hy- drophobia was yet in it’s infancy ; but poffibly, if as much more time had been loft, the difeafe, as it was hourly jncreafing, would have acquired fuch ftrength, that a general inflammation would have come on, and all attempts to relieve the patient would have been to no purpofe.
Sadgcfield, March * WrIGHTSOW
XIII. A
TRANSACTIONS. 2o| XIII. A Letter to Dr. Adeej
p.ead at the COLLEGE, October, 31, 177©.
SIR,
THE College of Phyficians hav- ing, in the firft volume of the Medical Tranfa&ions, expreffed their deftre of receiving Inch obfervations as may tend towards perfecting the hiilory of difeafes, or ascertaining the effedts of medicines ; I beg leave by your means to communicate to them the effects of a decodtion of the inner bark of thecommonElmin cutaneous difeafes. This I fir ft took notice of at St. Thomas’s Hofpital, and from a number of cafes I there obfcrved, have feledted the following ; in which the effedts of this medicine appeared moft confpicuous, very few others being joined with it.
Ann
S04 MEDICAL
Ann Mooney was admitted, Sep- tember the 4th, 1755. She had been fubjecl to itching eruptions on her arms and thighs for feveral years. They appeared in autumn, continued in large patches all the winter, and difappeared in the fpring. In this ftate fhe came to the hofpital, and Was put upon the Elm-deco&ion, taking half a pint twice a day with nitre diffolved in it. O&ober the 2d, fhe eruption was manifeftly diminilh- ed. October 21 ft, the patient’s fkin was quite fmooth, and fhe was dif- charged cured, having taken the de- coction the whole time of her conti- nuance in the