Zoonomia Volume Ii Part 26

The most manageable method of using digitalis is by making a saturated tincture of it, by infusing two ounces of the powder of the leaves in a mixture of four ounces of rectified spirit of wine, and four ounces of water. Of this from 30 to 60 drops, or upwards, from a two-ounce phial, are to be taken twice in the morning part of the day, and to be so managed as not to induce violent sickness. If sickness nevertheless comes on, the patient must for a day or two omit the medicine; and then begin it again in reduced doses.

Mr. ----, a young man about twenty, with dark eyes, and large pupils, who had every symptom of pulmonary ulcers, I believed to have been cured by digitalis, and published the case in the Transactions of the College, Vol.

III. But about two years afterwards I heard that he relapsed and died. Mr.

L----, a corpulent man, who had for some weeks laboured under a cough with great expectoration, with quick pulse, and difficulty of breathing, soon recovered by the use of digitalis taken twice a day; and though this case might probably be a peripneumonia notha, or catarrh, it is here related as shewing the power of pulmonary absorption excited by the use of this drug.

Another method of inducing sickness, and pulmonary absorption in consequence, is by sailing on the sea; by which many consumptive patients have been said to have received their cure; which has been erroneously ascribed to sea-air, instead of sea-sickness; whence many have been sent to breathe the sea-air on the coasts, who might have done better in higher situations, where the air probably contains less oxygen gas, which is the heaviest part of it. See a Letter from Dr. T. C. below.

A third method of inducing sickness, and consequent pulmonary absorption, is by the vertigo occasioned by swinging; which has lately been introduced into practice by Dr. Smith, (Essay on Pulmonary Consumption), who observed that by swinging the hectic pulse became slower, which is explained in Cla.s.s IV. 2. 1. 10. The usual way of reciprocating swinging, like the oscillations of a pendulum, produces a degree of vertigo in those, who are unused to it; but to give it greater effect, the patient should be placed in a chair suspended from the ceiling by two parallel cords in contact with each other, the chair should then be forcibly revolved 20 or 40 times one way, and suffered to return spontaneously; which induces a degree of sickness in most adult people, and is well worthy an exact and pertinacious trial, for an hour or two, three or four times a day for a month.

The common means of promoting absorption in ulcers, and of thickening the matter in consequence, by taking the bark and opium internally, or by metallic salts, as of mercury, steel, zinc, and copper, in small quant.i.ties, have been repeatedly used in pulmonary consumption; and may have relieved some of the symptoms. As mercury cures venereal ulcers, and as pulmonary ulcers resemble them in their not having a disposition to heal, and in their tendency to enlarge themselves, there were hopes, from a.n.a.logy, that it might have succeeded. Would a solution of gold in aqua regia be worth trying? When vinegar is applied to the lips, it renders them instantly pale, by promoting the venous absorption; if the whole skin was moistened with warmish vinegar, would this promote venous absorption in the lungs by their sympathy with the skin? The very abstemious diet on milk and vegetables alone is frequently injurious. Flesh-meat once a day, with small wine and water, or small beer, is preferable. Half a grain of opium twice a day, or a grain, I believe to be of great use at the commencement of the disease, as appears from the subsequent case.

Miss ----, a delicate young lady, of a consumptive family, when she was about eighteen, had frequent cough, with quick pulse, a pain of her side, and the general appearances of a beginning consumption. She took about five drops of laudanum twice a day in a saline draught, which was increased gradually to ten. In a few weeks she recovered, was afterwards married, bore three or four children, and then became consumptive and died.

The following case of hereditary consumption is related by a physician of great ability and very extensive practice; and, as it is his own case, abounds with much nice observation and useful knowledge; and, as it has been attended with a favourable event, may give consolation to many, who are in a similar situation; and shews that Sydenham's recommendation of riding as a cure for consumption is not so totally ineffectual, as is now commonly believed.

"J. C. aged 27, with black hair, and a ruddy complexion, was subject to cough from the age of p.u.b.erty, and occasionally to spitting of blood.

His maternal grandfather died of consumption under thirty years of age, and his mother fell a victim to this disease, with which she had long been threatened, in her 43d year, and immediately after she ceased to have children. In the severe winter of 1783-4, he was much afflicted with cough; and being exposed to intense cold, in the month of February he was seized with peripneumony. The disease was violent and dangerous, and after repeated bleedings as well as blisterings, which he supported with difficulty, in about six weeks he was able to leave his bed. At this time the cough was severe, and the expectoration difficult. A fixed pain remained on the left side, where an issue was inserted; regular hectic came on every day about an hour after noon, and every night heat and restlessness took place, succeeded towards morning by general perspiration.

The patient, having formerly been subject to ague, was struck with the resemblance of the febrile paroxysm, with what he had experienced under that disease, and was willing to flatter himself it might be of the same nature. He therefore took bark in the interval of fever, but with an increase of his cough, and this requiring venesection, the blood was found highly inflammatory. The vast quant.i.ty of blood which he had lost from time to time, produced a disposition to fainting, when he resumed the upright posture, and he was therefore obliged to remain almost constantly in a rec.u.mbent position. Attempting to ride out in a carriage, he was surprised to find that he could sit upright for a considerable time, while in motion, without inconvenience, though, on stopping the carriage, the disposition to fainting returned.

At this time, having prolonged his ride beyond the usual length, he one day got into an uneven road at the usual period of the recurrence of the hectic paroxysms, and that day he missed it altogether. This circ.u.mstance led him to ride out daily in a carriage at the time the febrile accession might be expected, and sometimes by this means it was prevented, sometimes deferred, and almost always mitigated.

This experience determined him to undertake a journey of some length, and Bristol being, as is usual in such cases, recommended, he set out on the 19th of April, and arrived there on the 2d of May. During the greater part of this journey (of 175 miles) his cough was severe, and being obliged to be bled three different times on the road, he was no longer able to sit upright, but at very short intervals, and was obliged to lie at length in the diagonal of a coach. The hectic paroxysms were not interrupted during the journey, but they were irregular and indistinct, and the salutary effects of exercise, or rather of gestation, were impressed on the patient's mind.

At Bristol he stayed a month, but reaped no benefit. The weather was dry and the roads dusty; the water insipid and inert. He attempted to ride on horseback on the downs, but was not able to bear the fatigue for a distance of more than a hundred yards. The necessity of frequent bleedings kept down his strength, and his hectic paroxysms continued, though less severe. At this time, suspecting that his cough was irritated by the west-winds bearing the vapour from the sea, he resolved to try the effects of an inland situation, and set off for Matlock in Derbys.h.i.+re.

During the journey he did not find the improvement he expected, but the nightly perspirations began to diminish; and the extraordinary fatigue he experienced proceeded evidently from his travelling in a post-chaise, where he could not indulge in a rec.u.mbent position. The weather at Bristol had been hot, and the earth arid and dusty. At Matlock, during the month of June 1784, there was almost a perpetual drizzle, the soil was wet, and the air moist and cold. Here, however, the patient's cough began to abate, and at intervals he found an opportunity of riding more or less on horseback. From two or three hundred yards at a time, he got to ride a mile without stopping; and at length he was able to sit on horseback during a ride from Mason's Bath to the village of Matlock along the Derwent, and round on the opposite banks, by the works of Mr. Arkwright, back to the house whence he started, a distance of five miles. On dismounting, however, he was seized with diliquium, and soon after the strength he had recovered was lost by an attack of the haemorrhoids of the most painful kind, and requiring much loss of blood from the parts affected.

On reflection, it appeared that the only benefit received by the patient was during motion, and continued motion could better be obtained in the course of a journey than during his residence at any particular place. This, and other circ.u.mstances of a private but painful nature, determined him to set out from Matlock on a journey to Scotland. The weather was now much improved, and during the journey he recruited his strength. Though as yet he could not sit upright at rest for half an hour together without a disposition to giddiness, dimness of sight, and deliquium, he was able to sit upright under the motion of a post-chaise during a journey of from 40 to 70 miles daily, and his appet.i.te began to improve. Still his cough continued, and his hectic flus.h.i.+ngs, though the chills were much abated and very irregular.

The salutary effects of motion being now more striking than ever, he purchased a horse admirably adapted to a valetudinarian in Dumfriess.h.i.+re, and being now able to sit on horseback for an hour together, he rode out several times a day. He fixed his residence for a few weeks at Moffat, a village at the foot of the mountains whence the Tweed, the Clyde, and the Annan, descend in different directions; a situation inland, dry, and healthy, and elevated about three hundred feet above the surface of the sea. Here his strength recovered daily, and he began to eat animal food, which for several months before he had not tasted. Persevering in exercise on horseback, he gradually increased the length of his rides, according to his strength, from four to twenty miles a day; and returning on horseback to Lancas.h.i.+re by the lakes of c.u.mberland, he arrived at Liverpool on the first of September, having rode the last day of his journey forty miles.

The two inferences of most importance to be drawn from this narrative, are, first, the extraordinary benefit derived from gestation in a carriage, and still more the mixture of gestation and exercise on horseback, in arresting or mitigating the hectic paroxysm; and secondly, that in the florid consumption, as Dr. Beddoes terms it, an elevated and inland air is in certain circ.u.mstances peculiarly salutary; while an atmosphere loaded with the spray of the sea is irritating and noxious. The benefit derived in this case from exercise on horseback, may lead us to doubt whether Sydenham's praise of this remedy be as much exaggerated as it has of late been supposed. Since the publication of Dr. C. Smyth on the effects of swinging in lowering the pulse in the hectic paroxysm, the subject of this narrative has repeated his experiments in a great variety of cases, and has confirmed them. He has also repeatedly seen the hectic paroxysm prevented, or cut short, by external ablution of the naked body with tepid water.

So much was his power of digestion impaired or vitiated by the immense evacuations, and the long continued debility he underwent, that after the cough was removed, and indeed for several years after the period mentioned, he never could eat animal food without heat and flus.h.i.+ng, with frequent pulse and extreme drowsiness. If this drowsiness was encouraged, the fever ran high, and he awoke from disturbed sleep, wearied and depressed. If it was resolutely resisted by gentle exercise, it went off in about an hour, as well as the increased frequency of the pulse. This agitation was however such as to incapacitate him during the afternoon for study of any kind. The same effects did not follow a meal of milk and vegetables, but under this diet his strength did not recruit; whereas after the use of animal food it recovered rapidly, notwithstanding the inconvenience already mentioned. For this inconvenience he at last found a remedy in the use of coffee immediately after dinner, recommended to him by his friend Dr. Percival. At first this remedy operated like a charm, but by frequent use, and indeed by abuse, it no longer possesses its original efficacy.

Dr. Falconer, in his Dissertation on the Influence of the Pa.s.sions and Affections of the Mind on Health and Disease, supposes that the cheerfulness which attends hectic fever, the ever-springing hope, which brightens the gloom of the consumptive patient, increases the diseased actions, and hastens his doom. And hence he is led to enquire, whether the influence of fear might not be subst.i.tuted in such cases to that of hope with advantage to the patient? This question I shall not presume to answer, but it leads me to say something of the state of the mind in the case just related.

The patient, being a physician, was not ignorant of his danger, which, some melancholy circ.u.mstances served to impress on his mind. It has already been mentioned, that his mother and grandfather died of this disease. It may be added, that in the year preceding that on which he himself was attacked, a sister of his was carried off by consumption in her 17th year; that in the same winter in which he fell ill, two other sisters were seized with the same fatal disorder, to which one of them fell a victim during his residence at Bristol, and that the hope of bidding a last adieu to the other was the immediate cause of his journey to Scotland, a hope which, alas! was indulged in vain. The day on which he reached the end of his journey, her remains were committed to the dust! It may be conjectured from these circ.u.mstances, that whatever benefit may be derived from the apprehension of death, must in this case have been obtained. The expectation of this issue was indeed for some time so fixed that it ceased to produce much agitation; in conformity to that general law of our nature, by which almost all men submit with composure to a fate that is foreseen, and that appears inevitable. As however the progress of disease and debility seemed to be arrested, the hope and the love of life revived, and produced, from time to time, the observations and the exertions already mentioned.

Wine and beer were rigorously abstained from during six months of the above history; and all the blood which was taken was even to the last buffy." Feb. 3, 1795.

8. _Febris scrophulosa._ The hectic fever occasioned by ulcers of the lymphatic glands, when exposed to the air, does not differ from that attending pulmonary consumption, being accompanied with night-sweats and occasional diarrhoea.

M. M. The bark. Opium internally. Externally cerussa and bark in fine powder. Bandage. Sea-bathing. See Cla.s.s I. 2. 3. 21. and II. 1. 4. 13.

9. _Febris ischiadica._ A hectic fever from an open ulcer between the muscles of the pelvis, which differs not from the preceding. If the matter in this situation lodges till part of it, I suppose, becomes putrid, and aerates the other part; or till it becomes absorbed from some other circ.u.mstance; a similar hectic fever is produced, with night-sweats, or diarrhoea.

Mrs. ----, after a lying in, had pain on one side of her loins, which extended to the internal part of the thigh on the same side. No fluctuation of matter could be felt; she became hectic with copious night-sweats, and occasional diarrhoea, for four or five weeks; and recovered by, I suppose, the total absorption of the matter, and the reunion of the walls of the abscess. See Cla.s.s II. 1. 2. 18.

10. _Febris Arthropuodica._ Fever from the matter of diseased joints. Does the matter from suppurating bones, which generally has a very putrid smell, produce hectic fever, or typhus? See Cla.s.s II. 1. 4. 16.

11. _Febris a pure contagioso._ Fever from contagious pus. When the contagious matters have been produced on the external habit, and in process of time become absorbed, a fever is produced in consequence of this reabsorption; which differs with the previous irritability or inirritability, as well as with the sensibility of the patient.

12. _Febris variolosa secundaria._ Secondary fever of small-pox. In the distinct small-pox the fever is of the sensitive irritated or inflammatory kind; in the confluent small-pox it is of the sensitive inirritated kind, or typhus gravior. In both of them the swelling of the face, when the matter there begins to be absorbed, and of the hands, when the matter there begins to be absorbed, shew, that it stimulates the capillary vessels or glands, occasioning an increased secretion greater than the absorbents can take up, like the action of the cantharides in a blister; now as the application of a blister on the skin frequently occasions the strangury, which shews, that some part of the cantharides is absorbed; there is reason to conclude, that a part of the matter of small-pox is absorbed, and thus produces the secondary fever. See Cla.s.s II. 1. 3. 9. And not simply by its stimulus on the surface of the ulcers beneath the scabs. The exsudation of a yellow fluid from beneath the confluent eruptions on the face before the height is spoken of in Cla.s.s II. 1. 3. 2.

The material thus absorbed in the secondary fever of small-pox differs from that of open ulcers, as it is only aerated through the elevated cuticle; and secondly, because there is not a constant supply of fresh matter, when that already in the pustules is exhausted, either by absorption, or by evaporation, or by its induration into a scab. Might not the covering the face a.s.siduously and exactly with plasters, as with cerate of calamy, or with minium plaster, by precluding the air from the pustules, prevent their contracting a contagious, or acescent, or fever-producing power? and the secondary fever be thus prevented entirely. If the matter in those pustules on the face in the confluent small-pox were thus prevented from oxygenation, it is highly probable, both from this theory, and from the facts before mentioned, that the matter would not erode the skin beneath them, and by these means no marks or scars would succeed.

13. _Febris carcinomatosa._ Fever from the matter of cancer. In a late publication the pain is said to be relieved, and the fever cured, and the cancer eradicated, by the application of carbonic acid gas, or fixed air.

See Cla.s.s II. 1. 4. 16.

14. _Febris venerea._ From the absorption of the matter from venereal ulcers and suppurating bones. See Syphilis, II. 1. 5. 2.

M. M. Any mercurial calx. Sarsaparilla? Mezereon?

15. _Febris a sanie putrida._ Fever from putrid sanies. When parts of the body are destroyed by external violence, as a bruise, or by mortification, a putrefaction soon succeeds; as they are kept in that degree of warmth and moisture by their adhesion to the living parts of the body, which most forwards that process. Thus the sloughs of mortified parts of the tonsils give fetor to the breath in some fevers; the matter from putrefying teeth, or other suppurating bones, is particularly offensive; and even the scurf, which adheres to the tongue, frequently acquires a bitter taste from its incipient putridity. This material differs from those before mentioned, as its deleterious property depends on a chemical rather than an animal process.

16. _Febris puerpera._ Puerperal fever. It appears from some late dissections, which have been published, of those women who have died of the puerperal fever, that matter has been formed in the omentum, and found in the cavity of the abdomen, with some blood or sanies. These parts are supposed to have been injured by the exertions accompanying labour; and as matter in this viscus may have been produced without much pain, this disease is not attended with arterial strength and hard full pulse like the inflammation of the uterus; and as the fever is of the inirritative or typhus kind, there is reason to believe, that the previous exhaustion of the patient during labour may contribute to its production; as well as the absorption of a material not purulent but putrid; which is formed by the delay of extravasated or dead matter produced by the bruises of the omentum, or other viscera, in the efforts of parturition, rather than by purulent matter, the consequence of suppuration. The pulse is generally about 120 when in bed and in the morning; and is increased to 134, or more, when the patient sits up, or in the evening paroxysm. The pulse of all very weak patients increases in frequency when they sit up; because the expenditure of sensorial power necessary to preserve an erect posture deducts so much from their general strength; and hence the pulse becomes weaker, and in consequence quicker. See Sect. XII. 1. 4.

In this fever time must be allowed for the absorption of the matter. Very large and repeated quant.i.ties of the bark, by preventing sufficient food from being taken, as bread, and wine, and water, I have thought has much injured the patient; for the bark is not here given as in intermittent fevers to prevent the paroxysm, but simply to strengthen the patient by increasing the power of digestion. About two ounces of decoction of bark, with four drops of laudanum, and a dram of sweet spirit of vitriol, once in six hours, and a gla.s.s of wine between those times, with panada, or other food, I have thought of most advantage, with a small blister occasionally.

Where not only the stomach but also the bowels are much distended with air, so as to sound on striking them with the fingers, the case is always dangerous, generally hopeless; which is more so in proportion to the quickness of the pulse. Where the bowels are distended two drops of oil of cinnamon should be given in the panada three or four times a day.

17. _Febris a sphacelo._ Fever from mortification. This fever from absorption of putrid matter is of the inirritative or typhus kind. See the preceding article.

M. M. Opium and the bark are frequently given in too great quant.i.ty, so as to induce consequent debility, and to oppress the power of digestion.

ORDO I.

_Increased Sensation._

GENUS VII.

_With increased Action of the Organs of Sense._

SPECIES.

1. _Delirium febrile._ Paraphrosyne. The ideas in delirium consist of those excited by the sensation of pleasure or pain, which precedes them, and the trains of other ideas a.s.sociated with these, and not of those excited by external irritations or by voluntary exertion. Hence the patients do not know the room which they inhabit, or the people who surround them; nor have they any voluntary exertion, where the delirium is complete; so that their efforts in walking about a room or rising from their bed are unsteady, and produced by their catenations with the immediate affections of pleasure or pain. See Section x.x.xIII. 1. 4.

By the above circ.u.mstances it is distinguished from madness, in which the patients well know the persons of their acquaintance, and the place where they are; and perform all the voluntary actions with steadiness and determination. See Sect. x.x.xIV. 2. 2.

Delirium is sometimes less complete, and then a new face and louder voice stimulate the patient to attend to them for a few moments; and then they relapse again into perfect delirium. At other times a delirium affects but one sense, and the person thinks he sees things which do not exist; and is at the same time sensible to the questions which are asked him, and to the taste of the food which is offered to him.

This partial delirium is termed an hallucination of the disordered organ; and may probably arise from the origin of one nerve of sense being more liable to inflammation than the others; that is, an exuberance of the sensorial power of sensation may affect it; which is therefore thrown into action by slighter sensitive catenations, without being obedient to external stimulus, or to the power of volition.

The perpetual flow of ideas in delirium is owing to the same circ.u.mstance, as of those in our dreams; namely, to the defect or paralysis of the voluntary power; as in hemiplagia, when one side of the body is paralytic, and thus expends less of the sensorial power, the limbs on the other side are in constant motion from the exuberance of it. Whence less sensorial power is exhausted in delirium, than at other times, as well as in sleep; and hence in fevers with great debility, it is perhaps, as well as the stupor, rather a favourable circ.u.mstance; and when removed by numerous blisters, the death of the patient often follows the recovery of his understanding. See Cla.s.s I. 2. 5. 6. and I. 2. 5. 10.