Zoonomia Volume I Part 26

The decoction of foxglove was given as in the preceding cases, which operated chiefly by purging, and seemed to relieve his breath for a day or two; but also seemed to contribute to weaken him.--He became after some weeks universally dropsical, and died comatous.

6. A young lady of delicate const.i.tution, with light eyes and hair, and who had perhaps lived too abstemiously both in respect to the quant.i.ty and quality of what she eat and drank, was seized with great difficulty of breathing, so as to threaten immediate death. Her extremities were quite cold, and her breath felt cold to the back of one's hand. She had no sweat, nor could be down for a single moment; and had previously, and at present, complained of great weakness and pain and numbness of both her arms; had no swelling of her legs, no thirst, water in due quant.i.ty and colour. Her sister, about a year before, was afflicted with similar symptoms, was repeatedly blooded, and died universally dropsical.

A grain of opium was given immediately, and repeated every six hours with evident and amazing advantage; afterwards a blister, with chalybeates, bitters, and essential oils, were exhibited, but nothing had such eminent effect in relieving the difficulty of breathing and coldness of her extremities as opium, by the use of which in a few weeks she perfectly regained her health, and has suffered no relapse.

_Ascites._

7. A young lady of delicate const.i.tution having been exposed to great fear, cold, and fatigue, by the overturn of a chaise in the night, began with pain and tumour in the right hypochondrium: in a few months a fluctuation was felt throughout the whole abdomen, more distinctly perceptible indeed about the region of the stomach; since the integuments of the lower part of the abdomen generally become thickened in this disease by a degree of anasarca. Her legs were not swelled, no thirst, water in due quant.i.ty and colour.--She took the foxglove so as to induce sickness and stools, but without abating the swelling, and was obliged at length to submit to the operation of tapping.

8. A man about sixty-seven, who had long been accustomed to spirituous potation, had some time laboured under ascites; his legs somewhat swelled; his breath easy in all att.i.tudes; no appet.i.te; great thirst; urine in exceedingly small quant.i.ty, very deep coloured, and turbid; pulse equal. He took the foxglove in such quant.i.ty as vomited him, and induced sickness for two days; but procured no flow of urine, or diminution of his swelling; but was thought to leave him considerably weaker.

9. A corpulent man, accustomed to large potation of fermented liquors, had vehement cough, difficult breathing, anasarca of his legs, thighs, and hands, and considerable tumour, with evident fluctuation of his abdomen; his pulse was equal; his urine in small quant.i.ty, of deep colour, and turbid. These swellings had been twice considerably abated by drastic cathartics. He took three ounces of a decoction of foxglove (made by boiling one ounce of the fresh leaves in a pint of water) every three hours, for two whole days; it then began to vomit and purge him violently, and promoted a great flow of urine; he was by these evacuations completely emptied in twelve hours. After two or three months all these symptoms returned, and were again relieved by the use of the foxglove; and thus in the s.p.a.ce of about three years he was about ten times evacuated, and continued all that time his usual potations: excepting at first, the medicine operated only by urine, and did not appear considerably to weaken him--The last time he took it, it had no effect; and a few weeks afterwards he vomited a great quant.i.ty of blood, and expired.

QUERIES.

1. As the first six of these patients had a due discharge of urine, and of the natural colour, was not the feat of the disease confined to some part of the thorax, and the swelling of the legs rather a symptom of the obstructed circulation of the blood, than of a paralysis of the cellular lymphatics of those parts?

2. When the original disease is a general anasarca, do not the cutaneous lymphatics always become paralytic at the same time with the cellular ones, by their greater sympathy with each other? and hence the paucity of urine, and the great thirst, distinguish this kind of dropsy?

3. In the anasarca of the lungs, when the disease is not very great, though the patients have considerable difficulty of breathing at their first lying down, yet after a minute or two their breath becomes easy again; and the same occurs at their first rising. Is not this owing to the time necessary for the fluid in the cells of the lungs to change its place, so as the least to incommode respiration in the new att.i.tude?

4. In the dropsy of the pericardium does not the patient bear the horizontal or perpendicular att.i.tude with equal ease? Does this circ.u.mstance distinguish the dropsy of the pericardium from that of the lungs and of the thorax?

5. Do the universal sweats distinguish the dropsy of the pericardium, or of the thorax? and those, which cover the upper parts of the body only, the anasarca of the lungs?

6. When in the dropsy of the thorax, the patient endeavours to lie down, does not the extravasated fluid compress the upper parts of the bronchia, and totally preclude the access of air to every part of the lungs; whilst in the perpendicular att.i.tude the inferior parts of the lungs only are compressed? Does not something similar to this occur in the anasarca of the lungs, when the disease is very great, and thus prevent those patients also from lying down?

7. As a princ.i.p.al branch of the fourth cervical nerve of the left side, after having joined a branch of the third and of the second cervical nerves, descending between the subclavian vein and artery, is received in a groove formed for it in the pericardium, and is obliged to make a considerable turn outwards to go over the prominent part of it, where the point of the heart is lodged, in its course to the diaphragm; and as the other phrenic nerve of the right side has a straight course to the diaphragm; and as many other considerable branches of this fourth pair of cervical nerves are spread on the arms; does not a pain in the left arm distinguish a disease of the pericardium, as in the angina pectoris, or in the dropsy of the pericardium? and does not a pain or weakness in both arms distinguish the dropsy of the thorax?

8. Do not the dropsies of the thorax and pericardium frequently exist together, and thus add to the uncertainty and fatality of the disease?

9. Might not the foxglove be serviceable in hydrocephalus internus, in hydrocele, and in white swellings of the joints?

VI. _Of cold Sweats._

There have been histories given of chronical immoderate sweatings, which bear some a.n.a.logy to the diabetes. Dr. Willis mentions a lady then living, whose sweats where for many years so profuse, that all her bed-clothes were not only moistened, but deluged with them every night; and that many ounces, and sometimes pints, of this sweat, were received in vessels properly placed, as it trickled down her body. He adds, that she had great thirst, had taken many medicines, and submitted to various rules of life, and changes of climate, but still continued to have these immoderate sweats. Pharmac. ration. de sudore anglico.

Dr. Willis has also observed, that the sudor anglica.n.u.s which appeared in England, in 1483, and continued till 1551, was in some respects similar to the diabetes; and as Dr. Caius, who saw this disease, mentions the viscidity, as well as the quant.i.ty of these sweats, and adds, that the extremities were often cold, when the internal parts were burnt up with heat and thirst, with great and speedy emaciation and debility: there is great reason to believe, that the fluids were absorbed from the cells of the body by the cellular and cystic branches of the lymphatics, and poured on the skin by the retrograde motions of the cutaneous ones.

Sydenham has recorded, in the stationary fever of the year 1685, the viscid sweats flowing from the head, which were probably from the same source as those in the sweating plague above mentioned.

It is very common in dropsies of the chest or lungs to have the difficulty of breathing relieved by copious sweats, flowing from the head and neck.

Mr. P. about 50 years of age, had for many weeks been afflicted with anasarca of his legs and thighs, attended with difficulty of breathing; and had repeatedly been relieved by squill, other bitters, and chalybeates.--One night the difficulty of breathing became so great, that it was thought he must have expired; but so copious a sweat came out of his head and neck, that in a few hours some pints, by estimation, were wiped off from those parts, and his breath was for a time relieved. This dyspnoea and these sweats recurred at intervals, and after some weeks he ceased to exist. The skin of his head and neck felt cold to the hand, and appeared pale at the time these sweats flowed so abundantly; which is a proof, that they were produced by an inverted motion of the absorbents of those parts: for sweats, which are the consequence of an increased action of the sanguiferous system, are always attended with a warmth of the skin, greater than is natural, and a more florid colour; as the sweats from exercise, or those that succeed the cold fits of agues. Can any one explain how these partial sweats should relieve the difficulty of breathing in anasarca, but by supposing that the pulmonary branch of absorbents drank up the fluid in the cavity of the thorax, or in the cells of the lungs, and threw it on the skin, by the retrograde motions of the cutaneous branch? for, if we could suppose, that the increased action of the cutaneous glands or capillaries poured upon the skin this fluid, previously absorbed from the lungs; why is not the whole surface of the body covered with sweat? why is not the skin warm? Add to this, that the sweats above mentioned were clammy or glutinous, which the condensed perspirable matter is not; whence it would seem to have been a different fluid from that of common perspiration.

Dr. Dobson, of Liverpool, has given a very ingenious explanation of the acid sweats, which he observed in a diabetic patient--he thinks part of the chyle is secreted by the skin, and afterwards undergoes an acetous fermentation.--Can the chyle get thither, but by an inverted motion of the cutaneous lymphatics? in the same manner as it is carried to the bladder, by the inverted motions of the urinary lymphatics. Medic. Observat. and Enq. London, vol. v.

Are not the cold sweats in some fainting fits, and in dying people, owing to an inverted motion of the cutaneous lymphatics? for in these there can be no increased arterial or glandular action.

Is the difficulty of breathing, arising from anasarca of the lungs, relieved by sweats from the head and neck; whilst that difficulty of breathing, which arises from a dropsy of the thorax, or pericardium, is never attended with these sweats of the head? and thence can these diseases be distinguished from each other? Do the periodic returns of nocturnal asthma rise from a temporary dropsy of the lungs, collected during their more torpid state in sound deep, and then re-absorbed by the vehement efforts of the disordered organs of respiration, and carried off by the copious sweats about the head and neck?

More extensive and accurate dissections of the lymphatic system are wanting to enable us to unravel these knots of science.

VII. _Translations of Matter, of Chyle, of Milk, of Urine. Operation of purging Drugs applied externally._

1. The translations of matter from one part of the body to another, can only receive an explanation from the doctrine of the occasional retrograde motions of some branches of the lymphatic system: for how can matter, absorbed and mixed with the whole ma.s.s of blood, be so hastily collected again in any one part? and is it not an immutable law, in animal bodies, that each gland can secrete no other, but its own proper fluid? which is, in part, fabricated in the very gland by an animal process, which it there undergoes: of these purulent translations innumerable and very remarkable instances are recorded.

2. The chyle, which is seen among the materials thrown up by violent vomiting, or in purging stools, can only come thither by its having been poured into the bowels by the inverted motions of the lacteals: for our aliment is not converted into chyle in the stomach or intestines by a chemical process, but is made in the very mouths of the lacteals; or in the mesenteric glands; in the same manner as other secreted fluids are made by an animal process in their adapted glands.

Here a curious phaenomenon in the exhibition of mercury is worth explaining:--If a moderate dose of calomel, as six or ten grains, be swallowed, and within one or two days a cathartic is given, a salivation is prevented: but after three or four days, a salivation having come on, repeated purges every day, for a week or two, are required to eliminate the mercury from the const.i.tution. For this acrid metallic preparation, being absorbed by the mouth of the lacteals, continues, for a time arrested by the mesenteric glands, (as the variolous or venereal poisons swell the subaxillar or inguinal glands): which, during the operation of a cathartic, is returned into the intestines by the inverted action of the lacteals, and thus carried out of the system.

Hence we understand the use of vomits or purges, to those who have swallowed either contagious or poisonous materials, even though exhibited a day or even two days after such accidents; namely, that by the retrograde motions of the lacteals and lymphatics, the material still arrested in the mesenteric, or other glands, may be eliminated from the body.

3. Many instances of milk and chyle found in ulcers are given by Haller, El. Physiol. t. vii. p. 12, 23, which admit of no other explanation than by supposing, that the chyle, imbibed by one branch of the absorbent system, was carried to the ulcer, by the inverted motions of another branch of the same system.

4. Mrs. P. on the second day after delivery, was seized with a violent purging, in which, though opiates, mucilages, the bark, and testacea were profusely used, continued many days, till at length she recovered. During the time of this purging, no milk could be drawn from her b.r.e.a.s.t.s; but the stools appeared like the curd of milk broken into small pieces. In this case, was not the milk taken up from the follicles of the pectoral glands, and thrown on the intestines, by a retrogression of the intestinal absorbents? for how can we for a moment suspect that the mucous glands of the intestines could separate pure milk from the blood? Doctor Smelly has observed, that loose stools, mixed with milk, which is curdled in the intestines, frequently relieves the turgescency of the b.r.e.a.s.t.s of those who studiously repel their milk. Cases in Midwifery, 43, No. 2. 1.

5. J.F. Meckel observed in a patient, whose urine was in small quant.i.ty and high coloured, that a copious sweat under the arm-pits, of a perfectly urinous smell, stained the linen; which ceased again when the usual quant.i.ty of urine was discharged by the urethra. Here we must believe from a.n.a.logy, that the urine was first secreted in the kidneys, then re-absorbed by the increased action of the urinary lymphatics, and lastly carried to the axillae by the retrograde motions of the lymphatic branches of those parts. As in the jaundice it is necessary, that the bile should first be secreted by the liver, and re-absorbed into the circulation, to produce the yellowness of the skin; as was formerly demonstrated by the late Dr. Munro, (Edin. Medical Essays) and if in this patient the urine had been re-absorbed into the ma.s.s of blood, as the bile in the jaundice, why was it not detected in other parts of the body, as well as in the arm-pits?

6. Cathartic and vermifuge medicines applied externally to the abdomen, seem to be taken up by the cutaneous branch of lymphatics, and poured on the intestines by the retrograde motions of the lacteals, without having pa.s.sed the circulation.

For when the drastic purges are taken by the mouth, they excite the lacteals of the intestines into retrograde motions, as appears from the chyle, which is found coagulated among the faeces, as was shewn above, (sect. 2 and 4.) And as the cutaneous lymphatics are joined with the lacteals of the intestines, by frequent anastomoses; it would be more extraordinary, when a strong purging drug, absorbed by the skin, is carried to the anastomosing branches of the lacteals unchanged, if it should not excite them into retrograde action as efficaciously, as if it was taken by the mouth, and mixed with the food of the stomach.

VIII. _Circ.u.mstances by which the Fluids, that are effused by the retrograde Motions of the absorbent Vessels, are distinguished._

1. We frequently observe an unusual quant.i.ty of mucus or other fluids in some diseases, although the action of the glands, by which those fluids are separated from the blood, is not unusually increased; but when the power of absorption alone is diminished. Thus the catarrhal humour from the nostrils of some, who ride in frosty weather; and the tears, which run down the cheeks of those, who have an obstruction of the puncta lacrymalia; and the ichor of those phagedenic ulcers, which are not attended with inflammation, are all instances of this circ.u.mstance.

These fluids however are easily distinguished from others by their abounding in ammoniacal or muriatic salts; whence they inflame the circ.u.mjacent skin: thus in the catarrh the upper lip becomes red and swelled from the acrimony of the mucus, and patients complain of the saltness of its taste. The eyes and cheeks are red with the corrosive tears, and the ichor of some herpetic eruptions erodes far and wide the contiguous parts, and is pungently salt to the taste, as some patients have informed me.

Whilst, on the contrary, those fluids, which are effused by the retrograde action of the lymphatics, are for the most part mild and innocent; as water, chyle, and the natural mucus: or they take their properties from the materials previously absorbed, as in the coloured or vinous urine, or that scented with asparagus, described before.

2. Whenever the secretion of any fluid is increased, there is at the same time an increased heat in the part; for the secreted fluid, as the bile, did not previously exist in the ma.s.s of blood, but a new combination is produced in the gland. Now as solutions are attended with cold, so combinations are attended with heat; and it is probable the sum of the heat given out by all the secreted fluids of animal bodies may be the cause of their general heat above that of the atmosphere.

Hence the fluids derived from increased secretions are readily distinguished from those originating from the retrograde motions of the lymphatics: thus an increase of heat either in the diseased parts, or diffused over the whole body, is perceptible, when copious bilious stools are consequent to an inflamed liver; or a copious mucous salivation from the inflammatory angina.

3. When any secreted fluid is produced in an unusual quant.i.ty, and at the same time the power of absorption is increased in equal proportion, not only the heat of the gland becomes more intense, but the secreted fluid becomes thicker and milder, its thinner and saline parts being re-absorbed: and these are distinguishable both by their greater consistence, and by their heat, from the fluids, which are effused by the retrograde motions of the lymphatics; as is observable towards the termination of gonorrhoea, catarrh, chincough, and in those ulcers, which are said to abound with laudable pus.

4. When chyle is observed in stools, or among the materials ejected by vomit, we may be confident it must have been brought thither by the retrograde motions of the lacteals; for chyle does not previously exist amid the contents of the intestines, but is made in the very mouths of the lacteals, as was before explained.

5. When chyle, milk, or other extraneous fluids are found in the urinary bladder, or in any other excretory receptacle of a gland; no one can for a moment believe, that these have been collected from the ma.s.s of blood by a morbid secretion, as it contradicts all a.n.a.logy.

---- Aurea durae Mala ferant quercus? Narcisco floreat alnus?

Pinguia corticibus sudent electra myricae?--VIRGIL.

IX. _Retrograde Motions of Vegetable juices._

There are besides some motions of the sap in vegetables, which bear a.n.a.logy to our present subject; and as the vegetable tribes are by many philosophers held to be inferior animals, it may be a matter of curiosity at least to observe, that their absorbent vessels seem evidently, at times, to be capable of a retrograde motion. Mr. Perault cut off a forked branch of a tree, with the leaves on; and inverting one of the forks into a vessel of water, observed, that the leaves on the other branch continued green much longer than those of a similar branch, cut off from the same tree; which shews, that the water from the vessel was carried up one part of the forked branch, by the retrograde motion of its vessels, and supplied nutriment some time to the other part of the branch, which was out of the water. And the celebrated Dr. Hales found, by numerous very accurate experiments, that the sap of trees rose upwards during the warmer hours of the day, and in part descended again during the cooler ones. Vegetable Statics.

It is well known that the branches of willows, and of many other trees, will either take root in the earth or engraft on other trees, so as to have their natural direction inverted, and yet flourish with vigour.