Zoonomia Volume Ii Part 21

Mr. F. F. came from London in the same manner in the coach. He was mildly delirious with considerable stupor, and moderate pulse, and could give no account of himself. He continued in a kind of cataleptic stupor, so that he would remain for hours in any posture he was placed, either in his chair, or in bed; and did not attempt to speak for about a fortnight; and then gradually recovered. These two last cases are not related as being certainly owing to parot.i.tis, but as they might probably have that origin.

The parot.i.tis suppurans, or mumps with irritated fever, is at times epidemic among cats, and may be called _parot.i.tis felina_; as I have reason to believe from the swellings under the jaws, which frequently suppurate, and are very fatal to those animals. In the village of Haywood, in Staffords.h.i.+re, I remember a whole breed of Persian cats, with long white hair, was destroyed by this malady, along with almost all the common cats of the neighbourhood; and as the parot.i.tis or mumps had not long before prevailed amongst human beings in that part of the country, I recollect being inclined to believe, that the cats received the infection from mankind; though in all other contagious diseases, except the rabies canina can be so called, no different genera of animals naturally communicate infection to each other; and I am informed, that vain efforts have been made to communicate the small-pox and measles to some quadrupeds by inoculation. A disease of the head and neck destroyed almost all the cats in Westphalia. Savage, Nosol. Cla.s.s X. Art. 30. 8.

5. _Catarrhus sensitivus_ consists of an inflammation of the membrane, which lines the nostrils and fauces. It is attended with sensitive fever alone, and is cured by the steam of warm water externally, and by diluents internally, with moderate venesection and gentle cathartics. This may be termed catarrhus sensitivus, to distinguish it from the catarrhus contagiosus, and is in common language called a violent cold in the head; it differs from the catarrhus calidus, or warm catarrh, of Cla.s.s I. 1. 2.

7. in the production of new vessels, or inflammation of the membrane, and the consequent more purulent appearance of the discharge.

Raucedo catarrhalis, or catarrhal hoa.r.s.eness, is a frequent symptom of this disease, and is occasioned by the pain or soreness which attends the thickened and inflamed membranes of the larynx; which prevents the muscles of vocallity from sufficiently contracting the aperture of it. It ceases with the inflammation, or may be relieved by the steam of warm water alone, or of water and vinegar, or of water and ether. See Paralytic Hoa.r.s.eness, Cla.s.s III. 2. 1. 4.

6. _Catarrhus contagiosus._ This malady attacks so many at the same time, and spreads gradually over so great an extent of country, that there can be no doubt but that it is disseminated by the atmosphere. In the year 1782 the sun was for many weeks obscured by a dry fog, and appeared red as through a common mist. The material, which thus rendered the air muddy, probably caused the epidemic catarrh, which prevailed in that year, and which began far in the north, and extended itself over all Europe. See Botanic Garden, Vol. II. note on Chunda, and Vol. I. Canto IV, line 294, note; and was supposed to have been thrown out of a volcano, which much displaced the country of Iceland.

In many instances there was reason to believe, that this disease became contagious, as well as epidemic; that is, that one person might receive it from another, as well as by the general unsalutary influence of the atmosphere. This is difficult to comprehend, but may be conceived by considering the increase of contagious matter in the small-pox. In that disease one particle of contagious matter stimulates the skin of the arm in inoculation into morbid action so as to produce a thousand particles similar to itself; the same thing occurs in catarrh, a few deleterious atoms stimulate the mucous membrane of the nostrils into morbid actions, which produce a thousand other particles similar to themselves. These contagious particles diffused in the air must have consisted of animal matter, otherwise how could an animal body by being stimulated by them produce similar particles? Could they then have had a volcanic origin, or must they not rather have been blown from putrid marshes full of animal matter? But the greatest part of the solid earth has been made from animal and vegetable recrements, which may be dispersed by volcanos.--Future discoveries must answer these questions.

As the sensitive fever attending these epidemic catarrhs is seldom either much irritated or inirritated, venesection is not always either clearly indicated or forbid; but as those who have died of these catarrhs have generally had inflamed livers, with consequent suppuration in them, venesection is adviseable, wherever the cough and fever are greater than common, so as to render the use of the lancet in the least dubious. And in some cases a second bleeding was necessary, and a mild cathartic or two with four grains of calomel; with mucilaginous subacid diluents; and warm steam occasionally to alleviate the cough, finished the cure.

The catarrhus contagiosus is a frequent disease amongst horses and dogs; it seems first to be disseminated amongst these animals by miasmata diffused in the atmosphere, because so many of them receive it at the same time; and afterwards to be communicable from one horse or dog to another by contagion, as above described. These epidemic or contagious catarrhs more frequently occur amongst dogs and horses than amongst men; which is probably owing to the greater extension and sensibility of the mucous membrane, which covers the organ of smell, and is diffused over their wide nostrils, and their large maxillary and frontal cavities. And to this circ.u.mstance may be ascribed the greater fatality of it to these animals.

In respect to horses, I suspect the fever at the beginning to be of the sensitive, irritated, or inflammatory kind, because there is so great a discharge of purulent mucus; and that therefore they will bear once bleeding early in the disease; and also one mild purgative, consisting of about half an ounce of aloe, and as much white hard soap, mixed together.

They should be turned out to gra.s.s both day and night for the benefit of pure air, unless the weather be too cold (and in that case they should be kept in an open airy stable, without being tied), that they may hang down their heads to facilitate the discharge of the mucus from their nostrils.

Gra.s.s should be offered them, or other fresh vegetables, as carrots and potatoes, with mashes of malt, or of oats, and with plenty of fresh warm or cold water frequently in a day. When symptoms of debility appear, which may be known by the coldness of the ears or other extremities, or when sloughs can be seen on the membrane which lines the nostrils, a drink consisting of a pint of ale with half an ounce of tincture of opium in it, given every six hours, is likely to be of great utility.

In dogs I believe the catarrh is generally joined with symptoms of debility early in the disease. These animals should be permitted to go about in the open air, and should have constant access to fresh water. The use of being as much as may be in the air is evident, because all the air which they breathe pa.s.ses twice over the putrid sloughs of the mortified parts of the membrane which lines the nostrils, and the maxillary and frontal cavities; that is, both during inspiration and expiration; and must therefore be loaded with contagious particles. Fresh new milk, and fresh broth, should be given them very frequently, and they should be suffered to go amongst the gra.s.s, which they sometimes eat for the purpose of an emetic; and if possible should have access to a running stream of water. As the contagious mucus of the nostrils, both of these animals and of horses, generally drops into the water they attempt to drink. Bits of raw flesh, if the dog will eat them, are preferred to cooked meat; and from five to ten drops of tincture of opium may be given with advantage, when symptoms of debility are evident, according to the size of the dog, every six hours. If sloughs can be seen in the nostrils, they should be moistened twice a day, both in horses and dogs, with a solution of sugar of lead, or of alum, by means of a sponge fixed on a bit of whale bone, or by a syringe. The lotion may be made by dissolving half an ounce of sugar of lead in a pint of water.

Ancient philosophers seem to have believed, that the contagious miasmata in their warm climates affected horses and dogs previous to mankind. If those contagious particles were supposed to be diffused amongst the heavy inflammable air, or carbonated hydrogen, of putrid marshes, as these animals hold their heads down lower to the ground, they may be supposed to have received them sooner than men. And though men and quadrupeds might receive a disease from the same source of marsh-putrefaction, they might not afterwards be able to infect each other, though they might infect other animals of the same genus; as the new contagious matter generated in their own bodies might not be precisely similar to that received; as happened in the jail-fever at Oxford, where those who took the contagion and died, did not infect others.

On mules and dogs the infection first began, And, last, the vengeful arrows fix'd on man.

POPE'S Homer's Iliad, I.

7. _Peripneumonia superficialis._ The superficial or spurious peripneumony consists in an inflammation of the membrane, which lines the bronchia, and bears the same a.n.a.logy to the true peripneumony, as the inflammations of other membranes do to that of the parenchyma, or substantial parts of the viscus, which they surround. It affects elderly people, and frequently occasions their death; and exists at the end of the true peripneumony, or along with it; when the lancet has not been used sufficiently to cure by reabsorbing the inflamed parts, or what is termed by resolution.

M. M. Diluents, mucilage, antimonials, warmish air constantly changed, venesection once, perhaps twice, if the pulse will bear it. Oily volatile draughts. Balsams? Neutral salts increase the tendency to cough. Blisters in succession about the chest. Warm bath. Mild purgatives. Very weak chicken broth without salt in it. Boiled onions. One grain of calomel every night for a week. From five drops to ten of tincture of opium at six every night, when the patient becomes weak. Digitalis? See Cla.s.s II. 1. 6. 7.

8. _Pertussis._ Tussis convulsiva. Chin-cough resembles peripneumonia superficialis in its consisting in an inflammation of the membrane which lines the air-vessels of the lungs; but differs in the circ.u.mstance of its being contagious; and is on that account of very long duration; as the whole of the lungs are probably not infected at the same time, but the contagious inflammation continues gradually to creep on the membrane. It may in this respect be compared to the ulcers in the pulmonary consumption; but it differs in this, that in chin-cough some branches of the bronchia heal, as others become inflamed.

This complaint is not usually cla.s.sed amongst febrile disorders, but a sensitive fever may generally be perceived to attend it during some part of the day, especially in weak patients. And a peripneumony very frequently supervenes, and destroys great numbers of children, except the lancet or four or six leeches be immediately and repeatedly used. When the child has permanent difficulty of breathing, which continues between the coughing fits: unless blood be taken from it, it dies in two, three, or four days of the inflammation of the lungs. During this permanent difficulty of breathing the hooping-cough abates, or quite ceases, and returns again after once or twice bleeding; which is then a good symptom, as the child now possessing the power to cough shews the difficulty of breathing to be abated. I dwell longer upon this, because many lose their lives from the difficulty there is in bleeding young children; where the apothecary is old or clumsy, or is not furnished with a very sharp and fine-pointed lancet.

In this distressing situation the application of four leeches to one of the child's legs, the wounds made by which should continue to bleed an hour or two, is a succedaneum; and saves the patient, if repeated once or twice according to the difficulty of the respiration.

The chin-cough seems to resemble the gonorrhoea venerea in several circ.u.mstances. They are both received by infection, are both diseases of the mucous membrane, are both generally cured in four or six weeks without medicine. If ulcers in the cellular membrane under the mucous membrane occur, they are of a phagedenic kind, and destroy the patient in both diseases, if no medicine be administered.

Hence the cure should be similar in both these diseases; first general evacuations and diluents, then, after a week or two, I have believed the following pills of great advantage. The dose for a child of about three years old was one sixth part of a grain of calomel, one sixth part of a grain of opium, and two grains of rhubarb, to be taken twice a day.

The opium promotes absorption from the mucous membrane, and hence contributes to heal it. The mercury prevents ulcers from being formed under the mucous membrane, or cures them, as in the lues venerea; and the rhubarb is necessary to keep the bowels open.

M. M. Antimonial vomits frequently repeated. Mild cathartics. Cool air.

Tincture of cantharides, or repeated blisters; afterwards opiates in small doses, and the bark. Warm bath frequently used. The steam of warm water with a little vinegar in it may be inhaled twice a day. Could the breathing of carbonic acid gas mixed with atmospheric air be of service? Copious venesection, when a difficulty of breathing continues between the fits of coughing; otherwise the cough and the expectoration cease, and the patient is destroyed. Ulcers of the lungs sometimes supervene, and the phthisis pulmonalis in a few weeks terminates in death. Where the cough continues after some weeks without much of the hooping, and a sensitive fever daily supervenes, so as to resemble hectic fever from ulcers of the lungs; change of air for a week or fortnight acts as a charm, and restores the patient beyond the hopes of the physician.

Young children should lie with their heads and shoulders raised; and should be constantly watched day and night; that when the cough occurs, they may be held up easily, so as to stand upon their feet bending a little forwards; or nicely supported in that posture which they seem to put themselves into. A bow of whalebone, about the size of the bow of a key, is very useful to extract the phlegm out of the mouths of infants at the time of their coughing; as an handkerchief, if applied at the time of their quick inspirations after long holding their breath, is dangerous, and may suffocate the patient in an instant, as I believe has sometimes happened.

9. _Variola discreta._ The small-pox is well divided by Sydenham into distinct and confluent. The former consists of distinct pustules, which appear on the fourth day of the fever, are circ.u.mscribed and turgid; the fever ceasing when the eruption is complete. Head-ach, pain in the loins, vomiting frequently, and convulsive fits sometimes, precede the eruption.

The distinct small-pox is attended with sensitive fever only, when very mild, as in most inoculated patients; or with sensitive irritated fever, when the disease is greater: the danger in this kind of small-pox is owing either to the tumor and soreness of the throat about the height, or eighth day of the eruption; or to the violence of the secondary fever. For, first, as the natural disease is generally taken by particles of the dust of the contagious matter dried and floating in the air, these are liable to be arrested by the mucus about the throat and tonsils in their pa.s.sage to the lungs, or to the stomach, when they are previously mixed with saliva in the mouth. Hence the throat inflames like the arm in inoculated patients; and this increasing, as the disease advances, destroys the patient about the height.

Secondly, all those upon the face and head come out about the same time, namely, about one day before those on the hands, and two before those in the trunk; and thence, when the head is very full, a danger arises from the secondary fever, which is a purulent, not a variolous fever; for as the matter from all these of the face and head is reabsorbed at the same time, the patient is destroyed by the violence of this purulent fever; which in the distinct small-pox can only be abated by venesection and cathartics; but in the confluent small-pox requires cordials and opiates, as it is attended with arterial debility. See Sect. x.x.xV. 1. and x.x.xIII. 2. 10.

When the pustules on the face recede, the face swells; and when those of the hands recede, the hands swell; and the same of the feet in succession.

These swellings seem to be owing to the absorption of variolous matter, which by its stimulus excites the cutaneous vessels to secrete more lymph, or serum, or mucus, exactly as happens by the stimulus of a blister. Now, as a blister sometimes produces strangury many hours after it has risen; it is plain, that a part of the cantharides is absorbed, and carried to the neck of the bladder; whether it enters the circulation, or is carried thither by retrograde movements of the urinary branch of lymphatics; and by parity of reasoning the variolous matter is absorbed, and swells the face and hands by its stimulus.

_Variola confluens._ The confluent small-pox consists of numerous pustules, which appear on the third day of the fever, flow together, are irregularly circ.u.mscribed, flaccid, and little elevated; the fever continuing after the eruption is complete; convulsions do not precede this kind of small-pox, and are so far to be esteemed a favourable symptom.

The confluent small-pox is attended with sensitive inirritated fever, or inflammation with arterial debility; whence the danger of this disease is owing to the general tendency to gangrene, with petechiae, or purple spots, and haemorrhages; besides the two sources of danger from the tumor of the throat about the height, or eleventh day of the eruption, and the purulent fever after that time; which are generally much more to be dreaded in this than in the distinct small-pox described above.

M. M. The method of treatment must vary with the degree and kind of fever.

Venesection may be used in the distinct small-pox early in the disease, according to the strength or hardness of the pulse; and perhaps on the first day of the confluent small-pox, and even of the plague, before the sensorial power is exhausted by the violence of the arterial action? Cold air, and even was.h.i.+ng or bathing in cold water, is a powerful means in perhaps all eruptive diseases attended with fever; as the quant.i.ty of eruption depends on the quant.i.ty of the fever, and the activity of the cutaneous vessels; which may be judged of by the heat produced on the skin; and which latter is immediately abated by exposure to external cold.

Mercurial purges, as three grains of calomel repeated every day during the eruptive fever, so as to induce three or four stools, contribute to abate inflammation; and is believed by some to have a specific effect on the variolous, as it is supposed to have on the venereal contagion.

It has been said, that opening the pock and taking out the matter has not abated the secondary fever; but as I had conceived, that the pits, or marks left after the small-pox, were owing to the acrimony of the matter beneath the hard scabs, which not being able to exhale eroded the skin, and produced ulcers, I directed the faces of two patients in the confluent small-pox to be covered with cerate early in the disease, which was daily renewed; and I was induced to think, that they had much less of the secondary fever, and were so little marked, that one of them, who was a young lady, almost entirely preserved her beauty. Perhaps mercurial plasters, or cerates, made without turpentine in them, might have been more efficacious, in preventing the marks, and especially if applied early in the disease, even on the first day of the eruption, and renewed daily. For it appears from the experiments of Van Woensel, that calomel or sublimate corrosive, triturated with variolous matter, incapacitates it from giving the disease by inoculation. Calomel or sublimate given as an alterative for ten days before inoculation, and till the eruptive fever commences, is said with certainty to render the disease mild by the same author. Exper. on Mercury by Van Woensel, translated by Dr. Fowle, Salisbury.

_Variola inoculata._ The world is much indebted to the great discoverer of the good effects of inoculation, whose name is unknown; and our own country to Lady Wortley Montague for its introduction into this part of Europe. By inserting the variolous contagion into the arm, it is not received by the tonsils, as generally happens, I suppose, in the natural small-pox; whence there is no dangerous swelling of the throat, and as the pustules are generally few and distinct, there is seldom any secondary fever; whence those two sources of danger are precluded; hence when the throat in inoculated small-pox is much inflamed and swelled, there is reason to believe, that the disease had been previously taken by the tonsils in the natural way.--Which also, I suppose, has generally happened, where the confluent kind of small-pox has occurred on inoculation.

I have known two instances, and have heard of others, where the natural small-pox began fourteen days after the contagion had been received; one of these instances was of a countryman, who went to a market town many miles from his home, where he saw a person in the small-pox, and on returning the fever commenced that day fortnight: the other was of a child, whom the ignorant mother carried to another child ill of the small-pox, on purpose to communicate the disease to it; and the variolous fever began on the fourteenth day from that time. So that in both these cases fever commenced in half a lunation after the contagion was received. In the inoculated small-pox the fever generally commences on the seventh day, or after a quarter of a lunation; and on this circ.u.mstance probably depends the greater mildness of the latter. The reason of which is difficult to comprehend; but supposing the facts to be generally as above related, the slower progress of the contagion indicates a greater inirritability of the system, and in consequence a tendency to malignant rather than to inflammatory fever. This difference of the time between the reception of the infection and the fever in the natural and artificial small-pox may nevertheless depend on its being inserted into a different series of vessels; or to some unknown effect of lunar periods. It is a subject of great curiosity, and deserves further investigation.

When the inoculated small-pox is given under all the most favourable circ.u.mstances I believe less than one in a thousand miscarry, which may be ascribed to some unavoidable accident, such as the patient having previously received the infection, or being about to be ill of some other disease. Those which have lately miscarried under inoculation, as far as has come to my knowledge, have been chiefly children at the breast; for in these the habit of living in the air has been confirmed by so short a time, that it is much easier destroyed, than when these habits of life have been established by more frequent repet.i.tion. See Sect. XVII. 3. Thus it appears from the bills of mortality kept in the great cities of London, Paris, and Vienna, that out of every thousand children above three hundred and fifty die under two years old. (Kirkpatrick on Inoculation.) Whence a strong reason against our hazarding inoculation before that age is pa.s.sed, especially in crowded towns; except where the vicinity of the natural contagion renders it necessary, or the convenience of inoculating a whole family at a time; as it then becomes better to venture the less favourable circ.u.mstances of the age of the patient, or the chance of the pain from toothing, than to risk the infection in the natural way.

The most favourable method consists in, first, for a week before inoculation, restraining the patients from all kinds of fermented or spirituous liquor, and from animal food; and by giving them from one grain to three or four of calomel every other day for three times. But if the patients be in any the least danger of taking the natural infection, the inoculation had better be immediately performed, and this abstinence then began; and two or three gentle purges with calomel should be given, one immediately, and on alternate days. These cathartics should not induce more than two or three stools. I have seen two instances of a confluent small-pox in inoculation following a violent purging induced by too large a dose of calomel.

Secondly, the matter used for inoculation should be in a small quant.i.ty, and warm, and fluid. Hence it is best when it can be recently taken from a patient in the disease; or otherwise it may be diluted with part of a drop of warm water, since its fluidity is likely to occasion its immediate absorption; and the wound should be made as small and superficial as possible, as otherwise ulcers have been supposed sometimes to ensue with subaxillary abscesses. Add to this, that the making two punctures either on the same, or one on each arm, secures the success of the operation in respect to communicating the infection.

Thirdly, at the time of the fever or eruption the application of cool air to those parts of the skin, which are too warm, or appear red, or are covered with what is termed a rash, should be used freely, as well as during the whole disease. And at the same time, if the feet or hands are colder than natural, these should be covered with flannel. See Cla.s.s IV. 2.

2. 10.

10. _Rubeola irritata, morbilli._ The measles commence with sneezing, red eyes, dry hoa.r.s.e cough, and is attended with sensitive irritated fever. On the fourth day, or a little later, small thick eruptions appear, scarcely eminent above the skin, and, after three days, changing into very small branny scales.

As the contagious material of the small-pox may be supposed to be diffused in the air like a fine dry powder, and mixing with the saliva in the mouth to infect the tonsils in its pa.s.sage to the stomach; so the contagious material of the measles may be supposed to be more completely dissolved in the air, and thus to impart its poison to the membrane of the nostrils, which covers the sense of smell; whence a catarrh with sneezing ushers in the fever; the termination of the nasal duct of the lacrymal sac is subject to the same stimulus and inflammation, and affects by sympathy the lacrymal glands, occasioning a great flow of tears. See Sect. XVI. 8. And the redness of the eye and eyelids is produced in consequence of the tears being in so great quant.i.ty, that the saline part of them is not entirely reabsorbed. See Sect. XXIV. 2. 8.

The contagion of the measles, if it be taken a sufficient time before inoculation, so that the eruption may commence before the variolous fever comes on, stops the progress of the small-pox in the inoculated wound, and delays it till the measle-fever has finished its career. See Sect. x.x.xIII.

2. 9.

The measles are usually attended with inflammatory fever with strong pulse, and bear the lancet in every stage of the disease. In the early periods of it, venesection renders the fever and cough less; and, if any symptoms of peripneumony occur, is repeatedly necessary; and at the decline of the disease, if a cough be left after the eruption has ceased, and the subsequent branny scales are falling off, venesection should be immediately used; which prevents the danger of consumption. At this time also change of air is of material consequence, and often removes the cough like a charm, as mentioned in a similar situation at the end of the chin-cough.

_Rubeola inirritata._ Measles with inirritated fever, or with weak pulse, has been spoken of by some writers. See London Med. Observ. Vol. IV. Art.

XI. It has also been said to have been attended with sore throat. Edinb.

Essays, Vol. V. Art. II. Could the scarlet fever have been mistaken for the measles? or might one of them have succeeded the other, as in the measles and small-pox mentioned in Sect. x.x.xIII. 2. 9.?

From what has been said, it is probable that inoculation might disarm the measles as much as the small-pox, by preventing the catarrh, and frequent pulmonary inflammation, which attends this disease; both of which are probably the consequence of the immediate application of the contagious miasmata to these membranes. Some attempts have been made, but a difficulty seems to arise in giving the disease; the blood, I conjecture, would not infect, nor the tears; perhaps the mucous discharge from the nostrils might succeed; or a drop of warm water put on the eruptions, and sc.r.a.ped off again with the edge of a lancet; or if the branny scales were collected, and moistened with a little warm water? Further experiments on this subject would be worthy the public attention.

11. _Scarlatina mitis._ The scarlet fever exists with all degrees of virulence, from a flea-bite to the plague. The infectious material of this disease, like that of the small-pox, I suppose to be diffused, not dissolved, in the air; on which account I suspect, that it requires a much nearer approach to the sick, for a well person to receive the infection, than in the measles; the contagion of which I believe to be more volatile, or diffusible in the atmosphere. But as the contagious miasmata of small-pox and scarlet fever are supposed to be more fixed, they may remain for a longer time in clothes or furniture; as a thread dipped in variolous matter has given the disease by inoculation after having been exposed many days to the air, and after having been kept many months in a phial. This also accounts for the slow or sporadic progress of the scarlet fever, as it infects others at but a very small distance from the sick; and does not produce a quant.i.ty of pus-like matter, like the small-pox, which can adhere to the clothes of the attendants, and when dried is liable to be shook off in the form of powder, and thus propagate the infection.

This contagious powder of the small-pox, and of the scarlet fever, becomes mixed with saliva in the mouth, and is thus carried to the tonsils, the mucus of which arrests some particles of this deleterious material; while other parts of it are carried into the stomach, and are probably decomposed by the power of digestion; as seems to happen to the venom of the viper, when taken into the stomach. Our perception of bad tastes in our mouths, at the same time that we perceive disagreeable odours to our nostrils, when we inhale very bad air, occasions us to spit out our saliva; and thus, in some instances, to preserve ourselves from infection. This has been supposed to originate from the sympathy between the organs of taste and smell; but any one who goes into a sick room close shut up, or into a crowded a.s.sembly-room, or tea-room, which is not sufficiently ventilated, may easily mix the bad air with the saliva on his tongue so as to taste it; as I have myself frequently attended to.