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<• •
THE FIELD OF DISEASE.
77//.N- hnoV is fhr prnf)tnft/ oj COOPKll MKDJCAL COL[.hO:;,
rpgg SAN FnANClSCO. CAL.
FIELD 0I^''mS'1^X'gte
A BOOK OF
PREVENTIVE MEDICINE
BENJAMIN WARD ^JCIIAllDSON, M.D., LL.D., F.R.S.
FKLXiOW or THE ROYAL COLLEGE OV FBT8ICIAM8, AMD HOMORABT FHY8ICIAK TO THE BOTAL LITXBABT FUND.
IlaniinrM ad deoi nuUd repropiui accedurU quam salutem hominibm dando.''
Cicero.
PHILADELPHIA
HENRY C. LEA'S SON & CO.
1884
^
• • «.• •
•••• • ••••
• • •
• • • •
• • • • •
PNINTINQ AND ■OOKBINOINO COMPANY, NEW YORK.
TO
RICHARD OWEN, CB., D.C.L., F.R.S.,
IN HOMAGE TO (JENIUS,
IN ADMIRATION OP INDUSTllY,
IN REMEMBRANCE OF LONG FRIENDSHIP,
THIS BOOK
IS INSCRIBED.
AMERICAN PUBLISHERS' NOTICE,
The prevention, no less than the cure of disease, is now under- stood to belong to the function of the physician, to whom alone the public can look for protection as well as for rescue. As the author very truly says : " The conception that these afflictions can be prevented is of modem times, and indeed we may say practi- cally of the present century, or even of the later two-thirds of the present century;" and it would seem that the time had now come in which the results of the investigations and experience as to the relations between health and disease should be summed np, not owly for present use but as a starting-point for further acqui- sitions in this supremely important field of knowledge.
Although Dr. Richardson assumes that the present volume is intended prunarily for the public, the publishers have, for tlie reason just stated, no hesitation in laying it before the profession, being advised that it contains much with which every physician should be familiar, while there is no work in the language in which the information here presented can be sought, systemati- cally arranged, and intelligibly presented.
PuLLADELPniA, November, 1883,
PREFACE.
I HAVE written this work for those members of the intelli- gent reading public who, without desiring to trench on the prov- ince of the Physician and Surgeon, or to dabble in the science and art of medical treatment of disease, wish to know the leading facts about the diseases of the human family, their causes and prevention. Any one, therefore, who opens this book with the expectation of finding in it receipts and nostrums will not have that expectation fulfilled, and will discover reference to no remedies except such as are purely preventive in character.
To adapt the book tOkthe general reader I have carefully avoid- ed most of the new names and terms which have recently stolen their way, at a rapid rate, into the literature of medicine. This was a necessity which I do not regret, because the old historical terms with which the people have become familiar are, as a rule, far more cori-ect and classical than the new terms which have iKjen introduced by modem caprice and love of change rather than by learning and judgment.
For the same reason I have kept pretty closely to that classifi- cation of diseases which has descended from the best scholars in medical science and art, and which, through their labors, is best known to the people at large.
For the objects and intentions of the book I respectfully refer tlie reader to the first or introductory chapter, in which all that is desired to be achieved is fully expressed.
25 MANCHEarr::R Square, London, W.
CONTENTS.
Book I. — Diseases. DISEASE AS UNITY WITH VARIETY OF PHENOMENA.
PAOB
The Preventive Scheme of Medicine 19
PART THE FIRST.
GENERAL DISEASES AFFECTING MANKIND.
I. Outlines of General Disease 25
II. CJonditions of Disease 28
m. General Diseases Running a Definite Course 44
IV. General Diseases of Constitutional Type. 59
PART TEE SECOND.
LOCAL DISEASES.
I. The Seats of Local Diseases. A Physiological Outline 71
IL Diseases of the Digestive System 104
III. Diseases of the Heart, Circulatory Apparatus, and Blood 129
IV. Local Diseases of the Breathing or Respiratory System 15H
V. Local Diseases of the Nervous System 167
VI. Diseases of the Organs of the Senses 185
VH. Diseases of the Absorbent and Glandular Systems 202
VHI. Diseases of the Muscular System, Tendons, and Aj^pendagos . 231 IX. Diseases of the Osseous System or Skeleton, including the
Teeth 238
X. Diseases of the Skin and Membranous System 250
XU CONTENTS,
PART THE THIRD. DISEASES FROM NATURAL ACCIDENTS.
CHAP. PAOK
I. Diseases from Natural Accidents 273
II. Diseases from Natural Poisonings and from Accumulations of
Poisonous Excretions Within the Body 280
III. Diseases from Venomous Organic Substances 287
rV. Diseases from Animal and Vegetable Poisons Taken as Food. 293 V. Diseases and Accidents connected i^dth Pregnancy and Child- birth 297
Book II.— Acquired Diseases. DISEASES OF ARTIFICIAL ORIGIN. PHENOMENA AND COURSE. Induced or Acquired Diseases 311
PART THE FIRST
ACQUIRED DISEASES FROM INORGANIC AND ORGANIC POISONS.
I. Acquired Diseases from Inorganic Poisons . 315
n. Acquired Diseases from Inorganic Gases and Vapors 331
III. Acquired Diseases from Organic Poisons 343
PART THE SECOND.
ACQUIRED DISEASES FROM PHYSICAL AGENCIES, MECHAN- ICAL AND GENERAL.
I. Acquired Diseases from Dusts 377
n. Acquired Diseases from Mechanical Pressure on the Lungs. . 390
m. Acquired Diseases from ^lechanieal Concussions and Shocks. 395
rV^ Acquired Diseases from Muscular Overwork and Strain 400
V. Acquired Deformities and Defects of Body 410
VI. Acquired Diseases from Physical Injuries 416
VTL Surgical Operations 425
CONTENTS. Xlll
PART THE THIRD,
ACQUIRED DISEASES FROM MENTAL AGENCIES, MORAL, EMOTIONAL, AND HABITUAL.
CHAP. PAQE
I. Acquired Disease from Mental Agencies 443
II. Acquired Disease from Moral Agencies 448
IIL Acquired Disease from Mental Shock 463
IV. Acquired Disease from Imitation or Moral Contagion 458
V. Acquired Disease from Hysterical Emotion 465
VI. Acquired Disease from lUe Common Emotions or Passions . . 470
VTL Acquired Disease from Habits of Life 480
Book III. — A Practical Summary of the Origins, Causes, and Preventions of Disease.
Origins, Causes, and Preventions of Disease 499
PART THE FIRST
ORIGINS AND CAUSES OF DISEASE.
I, Varieties of Origins and Causes of Disease 505
11. Congenital and Hereditary, or Constitutional Causes of Dis- ease 508
m. Atmospherical, Meteorological, and Climatic Causes of Dis- ease 524
IV. On Weather and Season as Causes of Disease 530
V. Atmospherical, Meteorological, and Climatic Causes Consid- ered in Detail 546
VI. On Parasites in connection with Disease 559
VII. On Parasites as Causes of Disease 500
VIII. Zymosis, or Ferment, as a C'au.se of Disease 588
IX. Industrial and Accidental Causes and Origins of Disease (V21
X. Social and Psychical Origins and Causes of Disease 028
XI. Senile Degenerative Causes of Disease 630
XH Deaths and Chief Causes of Death in England and "NVules in
1880 639
XIV PBEFAOE.
PART THE SECOND. PRACTICAL SUMMARY OF PREVENTIONS OF DISEASE.
CHAP. PAOB
I. Introductory Notes 645
n. Prevention of Hereditary Constitutional Diseases 648
m. Preventions of Atmospherical, Meteorological, and Climatic
Disease 659
IV. Preventions of Parasitical Disease 668
V. Preventions of Zymotic Disease 673
VL Preventions of Accidental and Industrial Diseases 692
VIL Preventions of Social and Psychical Disease 701
Viil. Preventions of Senile Disease 712
BOOK THE FIRST. DISEASES.
DISEl^SE AS XJNITY WITH VARIETY OF PHENOMENA
THE PREVENTIYE SCHEME OF MEDICINE.
In this work we have to study first the nature, secondly tlie causes, and afterwards tlie prevention of those calamities which afflict mankind, and which have received the title of diseases. The conception that these afflictions can be prevented is of mod- em times, and indeed we may say practically of the present cen- tury, or even of the latter two-thirds of the present century. The idea which came down almost to us who now live was that diseases of every kind were a portion of the necessary sufferings of human existence, sufferings which might by some art, or conjuration or divination, be removed, but which could not be avoided or pre- vented. For this reason the so-called curative art, the art of re- lieving or removing diseases, took, naturally, a first place in the course of human progress. This curative art, brilliant in many of its discoveries, useful in many of its applications, and benefi- cent alike in discovery and application, could not, however, be ex- pected forever to remain the be-all and end-all of human effort against disease. It was wonderful while it combated the unknown and the invisible. But in course of natural development of knowledge the unknown and the invisible passed away, in so far as belief in them was concerned, and there was left on the mind, in place of that belief, the fact that not one of the diseases long thought to be supernatural and out of the range of inquiry as to first causes, was supernatural at all. Each was traceable, by the acquirement of correct knowledge, and, when traceable, was largely and effectively preventible by a further extension of the same acquirement.
In this manner has arisen the science and art of preventive medicine. It is not a science, it is not an art separated neces- sarily or properly from so called curative medicine. On tlie con- trary, the study of prevention and cure proceed well together,
so
THE PREVENTIVE SCHEME OF MEDICINE.
and Iti
the;
; perfect i
sanitarian, and lie is tlie most accom- plislied and useful physician, who knows inost both of tlie pre- vention of disease and of the imttn*e and treatuieut of disease; lie wlio know.s, in fact, tlie before and tlie after of eacli striking phe- nomenon of disease tliat is presented for Ins observation.
If I were to speak of the progress that lias been made in the past thirty years, I should he obliged, in candor, to confess that great losses of time and great injuries to advancement have been caused by the circumstance that the unity of the two labors has not been duly recognized. A few entlmsiastic men, devoted al- most exclusively to the grand and new inetauration of medicine in its preventive character, Iiave, if I may so say, made war on the curative system which lias held sncli long, such niulisputed, and such classical sway. They have coneequeiitly often been led to Bpcak and write abont diseases without any accurate knuwledge of the natural In story of disease after its birth, and so have in- flicted Iiarm on the principles of preventive art. To use an ap- propriate simile, they have reasoned on diseases as another school of philosophers might reason on the antecedents of unborn indi- viduals without knowing anything whatever of the natural history, or the natural life, or the natural peculiarity, or the natural ter- mination of the lives of those individuals after they had come into existence.
All this has led to unnecessary and often to entbusiastic and extravagant warfare ; and it h:i3 had the effect of interrupting the order of refortuiition of thought amongst the representatives of the curative school, wlio by inheritance have held the study of disease in their liunds. Tlieso having few treatises of the past, or little wisdom t*f tlie past, descending from great and acknowl- edged masters, to guide them on the subject of the prevention of first or antecedent causes of disease, have held obstinately by their own principles, and have sometimes stoutly resisted what they have conceived to be an ignorant encroacluuent on theii* rightful domain.
1 confess, for my own part, I have had great sympatliy with the curative school, in which I was bred, and with which I remain associated too closely ever to be disconnected from it. At tlie same time the truth ninst now be candidly adnitttcd, that the sys- tem of i-elicving mankind of its misery an<l load of disease can no longer rest alone on wlmt is called curative skill We have en-
THE PREVENTIVE SCHEME OP MEDICINE. 21
tered an era in which the Bteady effort must be, not only to cure disease, but to cui*e cure. The men who have proclaimed the art of prevention, based upon the art of learning the antecedents of the phenomena of disease and the reasons why diseases are devel- oped at all, are right in principle however widely they may some- times have erred in details of facts and in endeavors after practi- cal attainments for the realizations of which they were not ready, and for many a long day will not be ready.
The grand work of this era is to reconcile the two different schools ; to systematize the preventive part of medical science, so far as that is now known ; to bring the preventive part into en- tii-e accord with the remedial ; to let the world at large under- stand the interrelationships which exist between the two parts ; and, by a sympathy of action, based on knowledge, to enable every man and woman to assist in that part which tends towards prevention.
With the objects here expressed I write this present volume. I have nothing to say in it that has any relation to the cure of diseases. I base it nevertheless on the curative side of medical learning. In other words, I strive to trace the diseases from their actual representation, as they exist before us, in their natural progress after their birth, back to their origin, and, as far as I am able, I try to seek the conditions out of which they spring. Thereupon I endeavor, further, to investigate the conditions, to see how far they are removable, and how far they are avoidable.
The success of my effort will turn on the success with which I am able to carry out this analytical and practical design. I may say at once that I know the effort, though it be ever so laborious, cannot be perfect. The wisest of us who look at disease are still like persons watching the progress of a dramatic representation. We see the various characters, we hear them speak, we observe the scenic conditions, we understand the plot and its develop- ment ; but as yet we are not acquainted with the players, we are not behind the scenes nor conversant with the very simple means by which the most startling effects are often produced. It is my wish to get at all the truth, as far as is possible, in the study of the phenomena of the great tragic drama of disease which is ever being enacted before us. I ask no pardon for apparent or real failure wherever it occurs, because I am sure that frequent fail- ure in this stage of human knowledge is inevitable. At the same
i.: :', l-e laboriously
.. ■ -rr* ^:::■.■e by such an
. ..' .•..::iin facts which
. .:.-: .. '. u'cnenilizations
. :.: .L::vr:ij>t the critical
.. :.. .i:; p:»'ne, perchance,
.. . . i- rliereby have tlie
, • '.: :.:.irket of his own
?.:..:i an atlenjpt the
- iture in tlie future,
■ '. [ ?iHvialIy win, — may
v-..'.vIoilge and wisdom
.-.:■•.• •-^ent, and from their
. Li:L\.ied.
BOOK I. PART THE FIRST.
GENERAL DISEASES AFFECTING MANKIND.
f
CHAPTER I.
OUTLTNES OP 9EKEEAL DISEASE.
Let ns before we proceed further glance in a preliminary way
at some of tlie evils wliieli, under a correct system of preveatiTo
medicine^ have to be i*emoved from mankind. Let us, in otlier
.word:?, glance at those pherioinenH of nature which in their variety
aonstitute what is called disease.
Diisease is uirity with a variety of phenomena. Disease if? a departure from a certain assumed standard of liealth eitlier in the individual as a whole living body physically and mentally exist- ing, or of a part of that body ; and, wrthont any error*, I niay say part of that mind. For this reason tlio j>henomena of disease ive, from very early times, been divided into the general and the local. This division has in late days been re affirmed by no less an authority than a Committee of tlie Eoyal College of Physi- cians, which has reported on the ^^^ nonien/^lat are of diseased The C-oUcge defines general dUai^es to bo such " as affect the whole frame rather than any special part of it," and local dueases to be such " as occupy special parts of the body."
Under the head of general diseases the isame authority enu- srates fifty -elgJd forms. Uuder the head of local diseases it e- res thjht humlred ami fort g4hree varieties. Tn these it
a ty-on^^ ot *' other conditions of disease '" which are not
necessarily associated with general or local diseases, and which include premature birth ; okl age ; debility or "uniform ex^haus- tion of all the organs of tlie body %vithout specific disease;" tlie affections arising from the action of the various animal, vegetable, and mineral poisons; aud the affections arising from wounds in- flicted by poisonous animals. In conclusion it also adds on^ hun- dred and fij^yfi^'^' forms of injuries, {a) general, such as burns «id scaldis; {h local, such aa fractures aud other meclianical injn- riei of parU of the body.
26
GENERAL DISEASES AFFECTING MANKIND,
Tlie result of this calculation gives us a grand total of (nie thamand one hundred ami forlt/six variations from liealtli as making tip the conditions and the phenomena of disease to which the human family, at this period of its civihzationj mny be sub- jeeted.
A philofiopliical friend who has no practical kniiwledge of dis- ease, tells me he is surprised to learn that tlie number of diseases is so small. It is in truth very much smaller than above stated. The learned men who witli infinite labor have drawn up this latest record of diseases^ a record historical in its character and singularly practical, were bound, by the nature of tiieir task, to retain much that they might have thr(»wn aside, and whicli they doubtless would have thrown aside had they been classifying dis- eases on any philosophical system that might lead to condeusation. This was not their duty. They were compelled to simplify names and classifications in such a manner and to such an extent as to keep their record in harmony with current knowledge and method of description, and to adapt it, wdthout too rapid transition of thought or practice, to the requirements of medical men every- where, to the million of physic^ tliroughont the world.
And so we may start with the great fact in our minds, a fact we may afterwanJs use for w^hatcver necessary purpose we may be at in illustrating prevention, that tliere are, in detail, before the echolar of the preventive art one thousand one hundred and forty- six diseases affecting mankind which he has to study with a view to their abatement or removal.
In the classification of diseases which the most recent authori- tative effort at classification lias HUpjdied, the diflicnlty of estab- lishing a sound and simple mode of classiUcation is set forth witli all candor. Diseases, say the College reporters, miglit he classi- fied according to their symptoms; their causes, tlieir intimate nature; the tissues or the systems of tlie body that are affected ; or the parts of tlie body as they lie anatomically. ^Vftcr due con- sideration the reporters determined to follow the anatomical plan, and to base their classification upon anatomical consitlerations. Thus, after dividing the fifty-eight general diseases into two classes, a class (a) of thirty-tliree diseases, including all that are infectious and con tag! OUR, and a class (h) of twenty-five diseases, iucludiug the great constitutional maladies, such as gout, cancer, scrofula, they pass afterwards to the classification of one tlionsand and
OUTLINES OF GENERAL DISEASE. 27
eighty-eight local diseases, — diseases having a localized seat in some organ or part rather than in the body altogether, — and thus they complete their laborious and important undertaking.
Taking the work of the Koyal College as a general basis and direction, I would now proceed to place before the reader the descriptive list of the general diseases affecting mankind. Before passing to this task it will, however, be necessary to render famil- iar certain terms, which are in common use amongst the learned for expressing what may be called attendant conditions of disease; conditions which may be present in the course of different dis- eases, and common to them in various stages, but which are not strictly diseases themselves, though much may depend on their presence or their absence.
The facts relating to these condition^ apply to the part of this book which treats of general diseases. They apply also to the part which treats of local diseases. In fact they cover the whole field of disease. We will consider them in a special chapter.
CHAPTER n.
CONDITIONS OF DISEASE.
The conditions of disease referred to in tlie last chapter and now inviting definition and brief exposition may be classified under fifteen heads.
1, Fever.
It is customary to say of persons suffering from varions acute diseases and from some slow or lingering diseases, that they have fever; that the fever runs high ; that tlie fever is reduced ; that the fever is intermittent, and so on.
Under this term fever, the older writers sometimes meant one spec^ial disease, which they defined no further. Afterwards fever began to be considered nndcr two heads, according as it was or was not communicable. Thus there were coniagknm fevers^ or Buch as were communicable by tuueli aiul could be conveyed by something that was crtpable of being carried from the affected to the healthy ; and there were infect louJi fevers, or such as cuuld be contracted by coming into innnediato contact with the poison that was emanating from the affected. Again, there were fevers which were neither contagious nor infectious — simple feviTS ; or which ran a continued course, conUnued fevers. By another change of expression fever was connected with diBeases of particular organs, as witli the brain, hramfeae)\ or witli particular functions or states, by which method of expression we got such terms as ^mlk- fever and chlMAml fnm\ Once more fever w^as cotuiected with anotlier general term, inflannnation, so giving rise to the term m- flammatartf fever ; or it was considered to be the result of some irritation, from which view was derived the expression irriiatvm fever.
In these days we Imve not lost tliese expressions, but we use them, when we are speaking correctly, with more precision. We
CONDITIONS OF DISEASE,
have now learned to take with tlie tliermometer the temperature of tlie human body, and we accept the iiaturul temperature to be 98.4"* Fahrenlieit hi temperate climates, with a range of two- tenths on either side, below for arctic, and above for tropiciil con-* ditiuns. It is the fact ev^en in what may be considered liealth that these ninges may be exteiiLled on either side for bhort periods of time, but practically the figiti'es are sufficiently correct. When therefore tlie tem{)eratiire of the body is sliown by an accurate thermometer to be 98. 4"" Fahrerdteit^ we consider there is a natu* ral temperature. When the temperature is above 98,4^ in any marked degree we say there h fever.
We must not boast that by this defmition we have added inneh to human knowledge, for the most ancient physicians aud iolars gave us a similar, if less precise, statement, and went so £ftra8 to di*icuss whether fever could exist of itself without any |ireocdin|r change in the body, such as inflammation. But we Iiave ijained, by the labors of many hard- workers, by those of the late Dr. Wunderlieh especially, a correctness in the reading and the detection of tlie range of fever that was never before attain- able. From itfi intensity we now measure fever and its dangers -With almost exact detail: so nnieh fever, so much or so little dau^r^ so much probability of recovery, so much probability of death.
By the term fever in these days we mean an elevation of ani- [il temperature varying in degree*, and when the word is used me we mean notliiug else. If the fever is one, two, or three degrees above the natnral, we look upon it as mild in form. If it runs up to four and five degrees above the natural, we say it in- dicates danger ; if it rises over six degrees, tlie danger is immi- nent ; whet^it passes seven, the chance of contimied life is very small ; and, at eight degrees, if the condition continue very long, deatJi is all but certain* At an increment of eleven degrees of heat al*ove the natural, on Fahrenheif s scale, continuance of life is, with tlie rarest of exceptions, impossililc. licfore that stage is readied the minute blood-vessels liave undergone contraction; the moficles of the body, generally, have shown a tendency to spas- modic contraction whicli may pass into tetanus ; and the blood haft« in some instances, commcncctl tt» separate into two parts, or, M It is commonly said, it has commenced to set, oi* coagulate, ierer tlius viewed becomes a condition of disease running
90
GENERAL DISEASES AFFECTHS'G MANKIND,
witli otber conditions wlut'h may, locally, be more apparent, but %vliicli in a general sense cannot be mure iletiriite* It is not a basic condition, for it is a result of something that preceded it, Bnt it determines the after results so decidedly that to retain it as if it were basic, and to speak of irritative fever, inflammatory fever, contagious fever, intermittent fever, beetle fever, tetanoid fever, scarlet fever, spotted fever, malarial fever, and the like, is qnite correct if we only keep in mind the simple tnith that the added words merely express either the origin, or the course, or the phenomena of the febrile state.
A good simile is given to ns of tiiis in the example of a com- mon fire. Fire is not a base ; it is a result ; and yet it determines consequences so decidedly that it very soon becomes the one domi- nant fact. Fire may be sliarp, slow, bright, smouldering, aeei- dental ; it may be a coal fire, a wood fire, a peat fire ; it may be continued, intermittent, subdued, wild ; and l)y all such terms we may distinguish its character. Instead of serving its intended purpose in the house or manufactory. It may be playing the part of a destroyer. Fever is the counterpart of this in tlie house of' life ; it is the animal fire burning beyond what is natural, excited to that burning by sometliing that was, in a basic sense, the prime cause of the condition of disease.
The influences which set up fever in the animal body are many. If sensitive nervous surfaces bo rubbed or irritated so that pain results there is an increase of temperature, Irritative fmer^ a fever probably of short duration and harmless in kind, lasting only so long as the irritation lasts and dependent on the disturbed nervous balance, but still present. If, from local causes, an organ of the body becomes inflamed, there is soon some increase of temperature, or fever, injimnit^itorif ftver^ whicli will vary in intensity with the extent of tlie inflammation, and will probably subside with the inflammation, but will not fail to be present. If some foreign sulistances, minute particles of matter, —fever-poisons, — be irit rod need into the body, they may modify the animal chemistry, so as to increase the animal com- bustion and produce f every contagious or infe<jti<nis fever^ which will last so long as the cause of the disturhauce remains in opera- tion. Such fe%^er may, in some instances, suhside from reduction of the cause, and then break out again as the cause is reproduced, or it may by its violence, eitlier before or after the cause has
Boi^B
ITION8 OF DISEASE,
81
ceased to operate, give rise to a destniction whicli renders death inevitable. If the body he expo&ed to agciitj? which modify the vascular tensi<»n so thtit through the Tessels the blix>d shall pass with undue friction, there may be an increase of fever which tnight be cMedfru-fional fever* Or, if the tension of tlie vessels be suddenly reduced by some agent, say alcohol, or ct>hl, so that tlie heart shall intensely inject the minute vessels with blood* there may again be, from the reaction, an increase of tempera- tt^m^J^ever qf rea^^ion or etmfjestive Jcver* Lastly, if the body be i5abjectx?d to the influence of gome agent which, interfering for a time with the animal chemistry, causes a development of fever, then ceit&es to act, as if it were itself destroyed, but after a time U reproduced and sets up once more the increase of temperature, there is excited what is known as recurrent^ relapsing^ intermit- ienly or he^fic fever.
Th«8 it will be seen that the word fever indicates a condition of the widest significance, w^hile in itself it is not strictly speaking n disease. It is an exalted state of that natural function by which all the flexilulity of life, the chemistry of life, the coni^truetiou of matti.tr into living fonn, tlie destruction and removal of matter in dead form, is regularly carried on. In fever, the body is, in Abort, living out of its compass, and wherever in tltese pages the fever is used, let it be remenihered as meaning fii'e,— over- •etioD, — expenditure beyond the natural capacity of vital process.
iRRrrATIOK.
The term irritation is applied to express a condition in which mme fien8iti%'e surface richly supplied with nerves is subjected to mechanical cr chejuical injury. The effect produced on the sur- face of tlie eye by the introduction of some small foreign body, like a grain of sand between the lids and the eyel*all, is a familiar illustration of irritation. We may say, as a general rule, that the effects of irritation are always confined to membranous surfaces; Si to tho *ikiii or cutaneous membrane ; to the mucous membranes of the eye, the alimentary canal, the bladder and its passages ; to tlie nerouis membranes enveloping the heart, tho lungs, tho intes- tilie«; to tho membranes enveloping the brain and nerves; to the Qembrane which covers the bones, the periustemn; to tlio ner- rom membranous expanses like the retiaa or receptive surface of sbalK
3S
GENERAL DISEASES AFFECTING MANKIND,
When a membrane is irritated, in addition to the pain which IB produced, there is an effect also on the blood-vessels. The ves- eelfi, Beeming to lose control over the current of blood that should be paBsiog through them in measured and self-adjusted quantity, become overcliarged with blood, or, as it is said, congested and dilated. If t!ie part affected be in nervous comnnHiicntion with a secreting gland, the gland is influencedj and pours forth a too abundant secretion. And, finally, in regard to local oflFects, if the irritation be continued, changes take place which are usually in- flammatory in character.
Irritation, as a local condition, is tlierefure attended with many inconveniences and dangers, but the mischief does not always stop at what is local Owing to the intimate intercommu- nications between one part of the body and other parts, by means of nervous fibres, and <>wing to tlie fact that vibrations communi- cated to irritated parts may easily be conveyed along nervous fibres, from the circumference to the nervous centres tltemsclvcs, it constantly liappens that by irritation in one part of the body a disturbance of action communicated to a nervous centre is re fleeted from that centre, through other nervous fibres that are directly or indirectly connected with it, to some remote part wliieli is thereby affected. An illustration of this i?* offered in tlie case of convul- sions from an irritation in the intestinal canah It happens fre- qnently in infancy, and occasionally in later lifcj that a foreign substance in the stomach is a cause of convulsions of a general character. Here the irritation communicated to tlie nerves of the stomach is carried to tlic motor part of the sjiitiul cord, and from thence is reflected along the motor tract of nerves to the muscles which they supply with the stimulus to excite contraction, and with the result of exciting uncontrolled convulsive movements in the muscular organs.
Irritation may therefore produce four distinct phenomena. (a) Pain ; (J) congestion of Idood- vessels, leading towards inflam- mation ; {(j) over-secretion ; and, (//) convulsive muscular move- ment Further, it may produce a general febrile condition, and as a producer of one or more, or all of these changes, it deserves to be remembered and understood whenever it is named in rela- tion to disease.
Agencies producing irritation are called irritants. They may be purely mechanical, like a grain of sand, or chemical, like tlie
I
CONDITIONS OF DISEASE.
; of ammonia or turpentine. Their mode of action is not eo dittriy understood a^ their coarse of action, but it is probablv hy the setting-up of vibration in nerrooa matter, through an ethereal medium or nervous atmoi^here.
Catakrh.
Wlien under irritation there is an excessive flux or discharge &om any secreting or excreting surface of the body, the term catarrh is employed to express tlie fact. This term indicates that tiie natural seci-etion or excretion is being tlirown off in excess. In common cold there is an excessive secretion from the nostrils, and what is called na^al catarrh is presented, AVhen thej*e is discharge of nmcons fluid from the bladder I'esuxil catarrh is said to be present When there is free seci-etion and expectoration of pblegm from the bronchial tubes, without inflamuiatioiu hronchial catarrh is said to be present. The condition is what the word de- aeribes ; it is an outpouring or defluxion.
IxFI.A!irMATION.
Inflammation is one of the most common conditions of dis- ease, and from oldest times the term, like the term fever, has been in common use. The question whether there can he fever without inflammation is, in fact, one of the oldest problems in nedicine, dating even from Erasi&tratus. luflariunation is under- to mean a change in an organ or part, attended with four distinct phenomena, "rubor et tumor, cum calore, et dolore'*: redness and swelling, witli heat and pain. As a pictuix? of phe- nomena nothing more accurate has ever been given. When any part is red and meollen^ with heat and jL>am, it is inflamed. The condition leading to this state is one of preceding irritation, and the phenomena observed are all indications of a derangement be- tween the nerves and blood-vessels. Tiie vessels are dilated with bloody and the surrounding loose tissues swollen; the nerves are painfully compressed ; the whole of the affected part is raised in tempeniture, — ^it niny be above the temperature of the rest of the body ; — and, the injected parts are red*
All portions of the body that are supplied with blood-vessels and nerves are subject to inflammation, so that there is an ini- inensG number of inflammations, as many, in fact, as there are organs, or even of parts of some of the more complicated organs.
34
GENERAL DISEASES AFFKCTIXG MAJTKIND.
To give one example: the eyeball nlone is subject, in its, various parts, to SIX distinct acute itiflaimnatioiis.
IiitlainniatioD, besides being considered in respect to loeal Btnicturea and organs, has also to he considered in regard to cer- tain characters of the condition itself. If the intlammution of a part be connected with Borue particular state ot" condition of body by which its own phenomena are modified, the particidar constitutional state is described, adjectivelj, to express the con- nection that has occurred. In this manner peculiar forms of in- flauiniation arc quoted, of which the following are specially given in the scientific nomenclature.
Ptjivinlc InflmmtKitum. — An inflammation occurring during the existence of the diseased state called pyjflemia ijv pyji?mic fever. In pysemia, which follows often on a wound uv after an operation^ there is a state of the blood inclining it to coagulate w^itJiin the body, and to arrest its circulation in the visceral organs, by the clot which IS formed froni the coagulation. The presence of the obstructing clot causes iiritatioii at id in flam mat ion, which is then c-alled pyEemic inflammation,
Jilu'umalw Tnff<imff(fifion, — Inflammation connected witli the rheumatic condition, and Hometiujes of a ilyiiig character during the attack of disease. The intlamiuation affects different organs oi the l>ody, or one or other of the joints, or the coverings of tlie heart, or the valvular stinictnres of the heart.
GmUy Injlamrfiati&fi* — Inrtammation connected with a gouty condition of body and developed in some local parts during the gouty state, and especially in some particular part, as the great toe* This inrtamijiation, like tlie rheumatic, is often transitory^ in character, and moves from one organ of the body to anothei*, by what the older writers designated, metastasis, or transference of disease.
Sf/philkir //(^]ft/mwi<7//<>w.— Inflammation associated with and taking its inclination from the specific contagious disease laio>vn as syphilis.
Scf'qfidous Infiavinmtwn, — Inflammation connected with tlio general condition and feebleness of body j-ecognized, commonly, as struma, scrofula, or, — once on a time,— king's evil. The in- flammatory state in persons of scrofulous taint is easily excited, is often of a !ow% or *' asthenic'^ type, and is prone to invade the glands of the body, and especially tlie glands of the neck.
C0NDTTI0N8 OF DISEASE.
ss
Qanorrhoml InfiammuUion. — Iiiflauimation connected with the Atagious diBesse, gonon*hcBa,
Inflammation finally gives origin to certain changes in the parU to which it has been confined, wliich changes have i-eeeived also particular names. To three of these, owing to then* fre- ucncj, special reference itnist be made.
Uleeraiion. — AVlien from acnte or slow inflammation a &tnict* ^ «ach as tlie skin or a mncoita nieinbrane of the. body, is Inflly destroyed on the snrface, so that there is left an open sore which will only heal by contraction of its edge^s and formation of ieed points or grari tiles, tite part is said to have nlcenitetl, antl "an nicer is said to have been fc^rmed. If the tendencv of an in* flammatiou is towards this state, ule^ratire infammallon is the t^jnn use<l to define the condition of disease.
SuppunUttni and Abstiess, — If the result of inflammation be the formation in the inflamed part of the white, ct^amydike fluid led "mattcn*^ or *'pvis,-* the terms snppnration and abscess are tscd to explain what has occurred, and tlie inflammation is said to be suppurative. When the formation of matter is circum* ibed and is confined to a small ep:>t, with a tendency to break throngh and escape at some point wliem there is least resistance, the term hyd is ordinarily used to describe tlie change. Wlien the accumulation of matter is large, an abscess is said to have been formed.
Plujitie /^unulatwn, — When in t!ie course of an inflammation there is thn>wn out of the blood-vessels, from the blood, a portion the fibrinous, sizy, or plastic part of the blood, ainl when that astic fluid, in the course of after clxanges, instead of being re- ttbsorlted into the blood, is solidified and causes adjacent parts to held together or condensed, ^;//r*/;V? exmlntion is said to have urred, and the term pktMlc is u^ed to define the inflammatory condition. In the luembranons cavities, such as the pleura! cav- ity of the chest, plastic exudation may bind the pleural surfaces together. In the cavity of the aMomen plastic exudation may form bands around the intestines. In the structure of organs, idi as tlie Inngs^ plastic exudation may infiltrate into the loose mnecting tUsne, and may even become the basis of new growtlis. In all these cases, ami in others of a similar kind, in different parts <rf the body, the inflammation is said to be plastic in its character*
\ GENEP^\L DISEASES AFFECTING MANKIND,
Gangrene^ Mortification.
When an organ or structure ceases to live, either from defi- cieuey in its supply of bloort or from deficiency of its nervous supply, and when, bo changed j it begins to darken and to give off offensive gases, the term gangrene,^ or mQrtijicdtiany is used to ex- press Uie diseased conditioD.
Congestion.
When in an organ or part richly supplied with blood, — such as the lung, the brain, the liver, the kidney, a serous meuibrane, a mucous ineuibraue, or the skin, — the blood, flowing through the organ or part, stagnates and aecutniihites, the organ or part ia then said to be suffering from congestion. The congestion may be active or passive.
EXTRATASATION.
When in an organ or part there is poiired, into its structure, a
quantity of blood which has escaped from the blood-vessels that naturally supply it; and when tlic ljlood,-= in stead of flowing on in due course, yielding to each part the material uecesdary for its sustainraent, atrd taking up the used materials, — is mechanically diffused in the structure of the part, the structure is then said to be subjected to eoctravasatum of blood,
ILorifORRHAOE.
When the blood having escaped from its vessels, flows away from them, hemorrhage is said to have occurred. If the Ijlood is slowly oozing away the hcniorrhage is said to be passive. If the blood flows in a steady stream, or if it spurts out in a jet, tlie hemorrhage ia said to be active.
Dropsy.
When the watery part of the blood exudes too freely into a cavity of the body, — such as the pleural cavity of tiie chest, the pericardial cavity of the lieart, or the perituneal cavity of the ab- domen,—and when the fluid accumulates in such cavities, the term dmpsg is employed to designate the condition. When the watery fluid accumulatee in the celhilar or eounecfcing tissue of the body so as to cause the skin to be raised and tense, and the feet
CONDITIONS OF DISEASE.
87
or other parts to be swollen, the same term, drop^y^ is etill em- ployed to express the eoiidition. The word aaa^mrca is also used to express this last-named dropsy.
FiBKiNous DEPoamoN,
During life the healthy blood eontahis 2.50 in the 1000 parts of a sabstaDce called fibrine. This eubstanee is the plastic part of the blood, and in the blood stream it is in the fluid state. Drawn from the body it coagulates and becomes solid, forming the blood clot. In some conditions of disease this ti brine sepa- rates, witliin the body, during life. It may separate as a coaga- lorn or clot in the heart or blood-vessels, portions of which clot may be carried into the circulation and may close np the smaller vessels. It ma}' separate in the structure of very vascular organs, LWhen such separations occur the term JihnnotLS separation or JtpotfilioH is applied to express the diiseaeed state.
Dilatation ant> Coxtractiok.
When different organs or parts of the body are subjected to in or to irregular work they change in their dimensions^ and ~io these changes different terms are applied. When a hollow structure, — such as the heart, or an artery, or a vein,^ — is dis- tended without being enlarged in its own structure, it is said to he aufforing from dilafaium. When, on the other hand, it is re- duced ill calibre, it is said to be suffering from contraction.
JlYPERTKOl'nV OK ExLAUQEMEKT.
Sometimes it happens that an organ or part is increased in re, throughout its entire substance, beyond what is naturaL A oouimon illustration of this state is shown in the muscles of the >rking, or haramer-ann of the blacksmith. To this condition of ilargement the term hijpertrttpht/ is applied.
Atrophy or Wastikg.
^A» organ or part of the body may undergo jnet the opposite nge from that doscribed under the head hyperti-opli)% It may [>me smaller, from having wasted, under which circmnstances woH aU^ophy is used to express the change that has been laeed- The words, dilatation, contraction, hypertrophy, atrophy, arc
SB GENERAL DISEASES AFFECTOG MANKIND.
of common use in the literature of disease, and their general meaning should be carefully remembered. The terms may l>e applied to any organ. Thus in diseased conditions of the heart, to cite a common example, the heart may be dilated, contracted^ hypertrophied, or atrophied.
Deoenerations of Organs and Parts.
Tlie organs of the budj, the more active especially, — though none are actually exempt, — are apt to undergo actual change of structure, so as to have their minute and elementary struetum trangforiued into new and umiatunil istructure, the function of the, organ being thei^eby deranged. When these changes occur the word degeiieraiion is generally employed to express the change. Tlie degenerations are rather numerous, and they are very im- portant in relation to hfe, Wit!njut being detected or known by tlie person subjected to them, they are often in progress until they have BO far advanced that life is reduced in value, or is e%en sud- denly cut off, in the midst of apparent Iiealth. The principal de- generative clianges are as f*jlluw :—
Fatty and Calcareowt, Atke^ronia, — A change of structure most commonly occurring in the heart and arteries, and consist- ing of a (legencration of the structures into a peculiar fatty and calcareous, or petrif active, condition. To this the term atheroma^ or alhr^roinatonH mndition^ is techm'cally applied. Tlie structures affected are rendered very brittle and are easily rupturetl. Apo- plexy, from the rupture of a vessel, is often due to atheroma.
Ossitication,^ A cliange developed in the arterial vessels, but not specially confined to them, and consisting of a transformation of active or even elastic structiu'e into inactive bony substance. Tins ch^mge may extend to other parts than the bl oud- vessel b» It may affect the membranes and the mnscnlar structures.
Fibroid Degeiierathn. — In certain structures of the body, the Inngs ])arti€ularly, the elastic connective tissue becomes firm, hardened, and fibrous, causing condensation of structure, and, it may be, compression of neighboring tissues. To this cliange the woTiijihvotd d4:(jetuTaiiofi is applied.
Lmlm^mm Amyloid or Wimy Degeneration^ — A change in which the stnieture of important organs, — snch as the liver,— un* dei'goes a transformation into a lardaceous waxy condition. This is called the lardaceom amyloid or waxy condition of disease.
COTTDmONS OF DISEASE.
FiUly and 0/rtnular Degem^ratiom, — S^jmetimes active orgauB, — eacli as the heart and other nuiscles of the body, the brain, liver, or kidney,~iindergo a fatty transformation which renders them liable to tear or rapture, and which greatly impairs their acli%*e power. These degenerations are of two kinds, oim fatty ^ in wliich the elementary parts of the nuiscle or the cells of the m&octcd organs or ceJitres are transformed into fatty element>B; ilia odier fji^arudar^ in which the natural elements arc changed xnu> a granular fatty state, and lose their ordinary functional eapa- etty. These changci* liecouie most importatjt wlien they affect tlie heart, the liver, or the brain and other portions of the ner- %*ons gystem. They invariably lead to faihire of action on the part of these vital organs, and, as affecting the heart, are frequent ranses of sudden suspension of function, of faintnese, and even of death.
Cirrhosis. — Under various influenced, — the iniiuence of alco- holic drinks particularly, — ^in addition to many of the above- named induced changes of structtire^ there is one particular cliange «>f condition to which the liver is especially liable* The cnmietttivc tissue of the organ is hypertrophied and hardened, and lht» ct>nii>ressed secreting cells are charged with a yellow coloring stuff or pigment. To this condition the term cirrhosis is applied.
PijnierUalkm. — X degeneration is occasionally met with in which the minute elementary cells of parts or organs ai*e cliarged with dark pigment. This change has been known to commence *»u one place in the skin attd to extend over the %vhole of its sur- face, producing an actual dark or black skin. Tlie phenomenon ti» extremely i-ai^e.
Siff'rijCff Defj^n^rafions. — The different organs and tissues of
tlie body are ©ometimes affected with special constitutional changes
rhich mark off forms of local disease, alno called degenerative.
!/hangea frotn stjp/uUth diseases^ from tfittwer^ and from colloid^
t,C, gelatinous growth, are of this kind, Scrofidoits degenera-
m\\ — with an<l withfKit the specific condition of true phthisical
' consumptive affections, tuherck, — come under this hetid.
TiTMORs AXt> Cysts.
The organs and parts of the V>ody are liable to become the •oats of growths which ai*e not necessarily malignant or fatal in chamcteri fhoogh they may give rise to inconvenience, and, iiidi-
40
GENERAL DISEASES AFFECTING MANKIND,
rectly, to Berions or fatal obstructions or pressures. Such growthe are called tum^malignant tumors, Aualogouis, in some respects to them, are other growths which coutain fluid or cheesy-like mate- rial within them, and which are called hollow or encysted tumors, or cysts. The growths which are often seen on the exterior of the body, wliich occasionally grow to a large size, and are vulgarly called ** wens," ai*e of this encysted or cystic character.
Calottlus.
In some of the open cavities of the body, as in the gall blad- der, in tlie urinary bladder, and in the intestinal canal, there are fonnefl, in some persons^ hard, separate, loose masses, which, taking somewhat the character of stones or pebhles, are called calcuii — caLnduB^ a pebble. In tlie gall bladder they usually con- sist of a fatty substance, — ^^holcs ferine* In the imnary bladder they consist of earthy bases combined witli an animal acid, or of an insoluble animal acid itself, condensed on a foreign body which acts as a nucleus. In the intestiuo they consist generally of some foreign substance wliich lias been swallowed m large quantities, snch as magnesia, and which, fjiiling to pass along the intestine^ has entered into u concrete or sulid mass.
Malk<u?matton-
Amongst the local diseases affecting particular organs and parts of the body, is included, in scientific nomenclature, what is called rmdft/nmdtfm uf organs, some error of natmal eonstniction by which the proper working of the organic structure is impeded or perverted, A good illustration of tliis is supplied in those who are horn with a defect in the partition wall which separates the right from the left side of the heart hi tho auricular cavities, of the heart. When this malfoniiation occurs, the verums blood on tho right side of tho heart, which, naturally, should all pass over the hmgs to be oxidized, is allowed, before it readies the left side, to pass, in part, directly fnMu the verums into the arterial mle of tho cii-culatioa, and so to circulate over the body aa a blood im- perfectly arterial ized. The hioml in this state is of a dark or venous c<ilor, and the blue conditi«»n of body which is j>resent gives origin to the term cyanmis as descriptive of the condition. This is only one 7nalfopmat}on^ but it is [>erhaps the best that coidd be offered for tho pm^poses of practical illustratlun.
CONDITIONS OF DISEASE,
Pakasitio Conditions.
There is another state of the corporeal organs or stnictiirefi in which the cliange whicli constitutes the eoudition of disease is due to the introihiction of new foiins of animal life which multiply, And hy their presence and multiplication create local, and, from the loi*a], general, derangement of the body. To these manifest iitions of difiea^e the term j^arasitu* is ajijilied. One common itioa of parasitic affection is offered in those wiio are suffer- j^from intestinal worms; another is supplied in those who are suffering from scabies, vulgarly, itch, in wlicmi an insect, the Sar- wjtt^^ scahiel^ burrows under the skin and keeps up a constant rnptiou and iiTitation.
Cachexia,
Literally a bad state of body. The term is used to describe, wititont any particuliir definition of disease, a condition of feeble* 8, a depression of a physical, or, of a physical and mental char- eter. The term is often applied to people of scr'ofulons cijnsti- tation. It is applied also to persons wlio have become reduced health from confinement in close air, from overwork, or from indifferent diet. It is applied again to those who have long been sahject to slow and exhausting diseases. It is sometimes used to define the bloodless condition more correctly expressed as aneetnia.
Coi:4L.iP8K AND Syncope.
The word collapse is a]>plied to a condition in which the pow- ers of life are rapidly sinking, the body prostrate, tiie abdomen shrunken, the limbs helpless, the face contracted, the expression vacant, the mind listless or nnconiscions, tlie external surface cold, and the respiratory muscles and heart failing in their action.
When the bodily and mental i>owers suddenly collapse, faint-
; or syncope is said to have taken place.
Functional Dkranokmknt,
An expression employed to define a class of disorders, as yet
&ry obscure in tbeir nature, in which the organs of the bedy are
[joved t<i man i festal ions of disease wit hunt beintj tlieni selves
actually changed in structure. The affeete<l organs may seem, to
ill appearances and to all present modes of physical investigation,
GENERAL DISEASES AFFECTINa MANKIND.
to be healthy, but may, nevertheless, he perfunniiig their duties in an imperfect or irregular manner. Tiiey often, under tliese circunistiiiice&^ i*egaia their natural powers altogether. When an oi^an itself seemingly perfect and capable of regaining its orderly life and a<.*tion h n rider thin irregular actiun, it is tsaid to be /unc- iionaUy disturbed, and the phenoineaa of disease caused by its aberrations are held to be ^ wnt-^^Ww/ distn-ders, as distinct from p(>siti\^o organic diseases. The distinction is, as a rule, vital in it4» meaning, inasmuch as the most alarming symptoms of a func- tional character may be of lesser nu>meut than a comparatively light series of symptoms springing from actual organic change. The skilful physician is, therefore, ever on the watch to detect tlie ditlci'cnce between svruptotns dependent on functional aber* rations and symptoms depeiulent on organic ciumges. Tlie func- tional disorder* are, generally, of nervous origin, and are depen* dent on a disturbance of the nervous atmosphere or nervous futiction of the organ affected, not on structural disease of the urgan itself. The derangement is as from a storm passing tlirougU the structure and teinporarily modifying its action, not from phys- ical change of the structure.
DEBn.rrr.
Tlie College authorities define the technical application of the term debility as intending to express an •* uniform exhaustion of all the organs of the body without specific disease." The defini- tion is, perhaps, as complete as can be supplied in our present state of knowledge, and many deaths are I'egistered every year in this and other countries as from debility. The term is more commonly used to express the intermediate condition between an attack of acute or exhausting disease and the return tu the natural state. Debility is sometimes defined as astft^nia.
Coma.
Literally a profound or deep sleep. A condition of disease in
which the body lies unconscious, insensible to all external impres- sions, and incapable of being roused from the toqx)r.
Asphyxia.
Suffocation. A condition in wliich the respiration is checked, — m during strangulation^ — and the body is rendered cold and
CONDITIONS OF DISEASE. 43
dark from obstructed aeration of the blood. By asphyxia, coma, asthenia, or syncope, death ordinarily supervenes.
Natural or Senile Decay.
Natural or senile decay is that condition in which the bodily powers pass into helplessness and the mental powers into second childishness and mere oblivion. The condition is one in which the elastic structures of all the organs of the body have lost much of their resilience ; the muscular structures have shrunken ; the cartilages have been transformed into bone ; the bones have be- come condensed ; the skin has shrivelled and become dry ; the liair lias become gray or has fallen off ; the gums have atrophied ; the teeth have fallen out or decayed ; and the cells of the nervous system, locked up, as it were, in the now firm connective tissue, or nerve -cement, ai-e all but dead to motion. In this state death at last takes place as in a sleep, tlie one only natural mode of dis- solution.
CnAPTER IIL
lasatASMS HcyT^mG a DEPimTE coursk
t. THB GREAT PLAGUEa
1st lh« nomeiK'huiii^ of tlia Royal College of Physicians, on %^ UlMi^ vi which^ with few exceptions, I^ as a rii1e« proceed^ the 1. immm^^ diiieHM.^ th^t affect nnuikiud, as apait from the local con- jSliiMii irf clh^a*»t\ are divuleil iiito two grand classes: namely, \%^f.. .!ta*»4^tHi which run a detltuto course, ^nJ take, s^^me of them, li tic or vpn^avling character: and into diseases which am
\kM4 *|uvHdin^, hut ait» of a constitutional and often of an heredi- ' -- "-.*^u\\ I pn.>po*o iu the present chapter to btatethe diseases 4 of thi^i*o da^ea, the epidemics or great plagues. They lov dvtiuiHi* authoritativehs vl& follows \- —
UtiKHii^^tt " which ap|H>ar to involve a morbid condition of the ViH*^l ; which* for the most part, but not all of them, rim a vU^ioou* ^*iiuriM»; am attended with fever, and frequently with vm|*iiMnM iHi tho skin; are more or less readily coTiimunloable tivo» iKHnou U> jHM'ifion ; and possess the singular and important vi|vv|i0y^v of Ri^neraily pwtecting those wiio suffer tiiem from a 1^* ' ' " These diseast^s have each a periml, between tlie
\.i , i"y are fii*iJt contracted and tlie lirst appearance of
%l^|4(^ ar other aymptoni, which is called iiie period of meuba- ^i$^ 8ome of tliese diseases have also what is called a critical il^k .»! vV^/^ xi^Kiti which the patient either begins to succumb or V. <^ to n^iover.
I I >es i>f this class are thirty -seven in number. They
■•^v dly, the great plagues. They are all dependent for
, tncnt on some particular poisonons agent which is
oouiiuunicable from the affected to other susceptible
ISES BUKNI^G A DEFreiTE COURSE. 45
Small-pox, Vaeiola^
An extremely contagious affectionj marked hy an ernption over the body oontaiiiing matter or pus, and called pustules. The sriod of incubation ia twelve days. The crisis is about the jlith day of eruption, but is not very definite.
Varieties.
Distinct'. — Each pustule of the eruption distinct,
Cotijliumt — Pustules very numerous and running together ir the surface of the body.
Scmi-c^nfinent, — Pustules running together in parts.
Ahortivey varicelloid.- — Minor emall-pox. Few pustnles, and fbOie little more than veBiclea, — little bladders, — containing wa- tery fluid.
I\tecAtal* — Called, vulgarly, black or putrid emall-pox, dark blood being effused into the pustules.
Jlemorrhafjie. — Sraalbpox with blood in the pustules, with a tendency to bleeding from the mucous membrane of the intes- tinal canal.
CbnjifJxme, — Tlie disease with the pustules running in clusters like bunches of grapes.
Cow-pox. Vaccina.
A disease induced in the human subject by the process of vac- lition. A modified form of small-pox, in which a cow-pox reeicle on the udder of a cow or heifer is the couimun original source of tJje infecting matter. A disease attended, as a rule^ with no further eruption than the vesicle or pustule at the points where the matter is inoculated ; communicable by inoctilation, but not otherwise ; mild in its course, and yet, generally speaking, protective against small-pox. The period of incubation is from two to tlirec daya. The crisis is about the eighth day.
Chicken-pox. Varicella.
A disease attended, like the smalbpox, with a vesicular erup- fn>ti, which may become pustular. The spots of the eruption iirLially lie far apart* and are confined to the tnmk of the body. In bad forms varicella so closely resembles small-pox as to re* quire skilled medical knowledge to distinguish it. The disease is
46 OEHS^ERAL DISEASES AFFECTING MANKIND.
attended with Bome fever, but is hardly ever fatal, and rarely leaves pits or marks on tlie body. It 16 not prevented by vaccina- tion, and it is not protective against sinalbpox. It is also doubt- ful wlietlier ^malbpox is protective against it. It is not com- nninieable by inoculation. Tlie period of inculmtion is from ten to twelve days. The crisis is abont the fifth day of the eroption.
Measles. Morbilli,
A common and well-known eruptive contagions affection com- mon to the voting, and octnirring in all parts oi tlie world into wliich it may he imported. The disease is attended with a gen- eral red measly eruption and fever, pi-ece^led by symptoms of catarrh or cold in the eyes and nose. Under conditions favoralde for recovery it is not generally fatal, but it becomes very fatal urjder unfavi>rable conditions. Tlie period of incubation is from ten to fourteen days. The crisis,— not very definite, — is about the fourth day of the eruption.
German Measles. Rotheln, Rubeola,
A contagious raild disease, attended with slight fever, sore throat and ineaaly oval-shaped red eruption. Tlie affection, vvliich usually commences with catarrh of the nose and eyes, pre- sents mixed symptoms of measles and of scarlatina. Tlie period ^of iiRnihaiion is from four to six days. The crisis is on the cond or third day of the eruption.
Scarlet Fever, Ferris RrBRA.
A ver}^ contagions and often fatal disease, marked by a nni- versal i*ed rash over the body with high fever, strawbenT tongue, and witli redness and, sometimes, ulceration of the throat. The prmd of incubation is usually considered six to eight days, but may be not more than as uiany houi'*i. The natural crisis is about the fifth day of the eruption, but is often prolonged by ci>n I plications.
SimpU Scarlet Feiyer, — Commonly called Scarlatina, The rash on the body is well marked^ and the throat is very red but is not ulccmttHl.
Ancjhtose Scarlet Ft?t)er. — A more severe type; the throat is
DI8EA£
m A DEFrKITE COURSE.
47
iBWolleu, and ulcerated, with f ormationj soinetimes, of abscess the neck,
Malifjnant Scarlet Femr, — Scarlet fever in Its most rapid and fatal fonn. In this x^ariety the tliroat becomes covei-ed with a dough from quick decomposition of tlie duicous membrane; the eruption on the skin is dark; tlie fever intense; the external glands of the throat are nuicli enlarged ; and, the prostration, sudden and severe, is attended often with e^^uvukive movements uf the Hnihs, with insensibility, coma and death. As a general rule the malignant form of scarlet fever is developed from the onset, and it may bo said, generally, of each variety that, with rare exception:^, each maintains its own character and rims its own eonrse. This is true of epidemics as of individual instances of the disease* At the same timt^ all the varieties arc contagious, and one may be caught from the other, the severe form from the milder form, the milder form from the severe, or the like from the like. Constitutional peculiarity seems to determine the ty|)e which the dlBe£«se will assume.
Suh-Varietws.
houhtfiil Scarhi Fever. liomlia Idiopathica. — A disease deecribed originally in my Clinical Essays^ in whicli a searlatmal eruption occurs with some fever, soreness of the tliroat, and •awberry-like tongtie. The disease is transient in character, (oes not spread, and apparently is not contagious. The period of incubation is probably from one to two days. Tlie crisis is on the second day of the eruption. The disease is not known to be fatal.
Jihewtnatic Scarlet Fever, — A mixed condition of rheumatic ad scarlet fevers,^ — also defined in the Clinieal EssaySj — in rhteh, with the 8ynjpt*Hns either of simple or of angiuose scarlet fever, there is acute rheumatism of the juints* The Bcarlatinal element of tlie disease is contagions. The period of hicubation is the same as of scarlet fever. The crisis is rendered indefinite by the fre<|uent recurrence of rheumatic complications,
DKNotiE. Dandy Fever.
A febrile contagious disease, attended with rheumatic synip*
tarns and with an eniption resembling measles. It occurs in the
iSireit Indies and in some other hot or tropical climates. The
48
GENERAL DISEASES AFFECTING MANKIND.
period of incubation is sliort, probublv not more than three days. The crisis is rendered indefinite by the recurrence of rheumatic eymptonis.
Ckrkbro*sptnal or Tetanoid Fevkr.
Cerebro^spinal fever is Bometimea called malignant purpuric fever; or epidemic cerebro-spinal meningitis. More recently it has been named by Dr. RoBenstcin, and m I venture to tliink most correctly, idanoid fever. It lias beeia known to occur in England. It is marked by a dark eruption, intense fever, deli- rium, and tetanic spasms. It is very fatai The i)erif»ds of in- *Cnbation and of crisis are not deterniiued. It is pi*obably not contagious.
Typhus Fever.
A continued fever attcndod with a dark mottled rasli on the, body, great nervous prostration and delirium, but without any fipecific affection of the bowels. The disease is very contagious, and very fatal. The period of incubation is, in niost cases, from ten to twelve days. The crisis is about the fuorteenth day after the eniption.
Typhoid oe Enterio Fever,
Typhoid or enteric fever, called also gastro-enteric, — owing to the circumstance that in it the stomach and intestines are seats of disease, — is marked by a rose-colored rash on the skiu, high fever, delirium, and much disturbance of the bowels, Until com- paratively modern days typhus and typlioid fevers were con- founded together as one disease, in the same way as measles and ' scarlet fever once were. Typhoid is now known as a distinct af- fection, and is distinguished from typlius l)y the occurrence of special intestinal derangement as well as by tlie eruption. It is not so readily contagious as typhus. The period of incubation ranges from six to fourteen days. The crisis is about the four- teenth day after the eruption. Typhoid, owing to its common connection with bad drainage, has received the vulgar but expres- sive name of " drain or cesspool fever."
Belapsing ob Famine Fei'er,
A fever which breaks out in ill-fed, badly-housed, or rather doeely-housed communities. In some respects it resembles ty-
DISEASES RUNNING A DEFINITE COURSE. 49
pbus, but difiFers in the absence of an eruption and in tbe cirenni- stance tbat tbe onset is direct, i.e.<, witbout preliminary signs, and tbat tbe febrile attacks, usually of sbort tbongb severe duration, pass away leaving tbe person comparatively well. After an in- terval of about seven days tbe attacks recur, tbe relapse taking place, it may be, four and even five times. Tbe disease is less fatal tban typbus fever, but recovery from it is often mucb more prolonged. It is extremely communicable, and attacks tbose wbo are well fed if tbey be exposed to its influence. It is connected witb famine in its origin, but seems also to require impure air for its development. Tbe period of incubation is from five to seven days. Tbe period of crisis is indefinite.
Febeicula.
A minor fever, in wbicb tbe person affected is for tbree or four days feverisb witbout sbowing any signs of eruption on tbe skin or any indications of inflammatory disease, recovery being rapid and complete. Tbe disease can bardly be called communi- cable, tbougb it may be epidemic. Tbe periods of incubation and of crisis are indefinite.
Continued Fever.
Simple fever, witbout eruption, inflammation, or otber specific sign tbat would link it witb any of tbe specifically contagious fe- brile diseases. It differs from simple febricula by its longer con- tinuance. In past days pbysicians included znany of tbe now well-defined fevers under tbe term continued fever, making it almost a general term to describe a fever tbat was of long dura- tion. Tbe periods of incubation and of crisis are undefined.
Yellow Fever.
" A malignant epidemic fever, usually continued, — but some- times assuming a paroxysmal type, — cbaracterized by yellowness of tbe skin, and accompanied, in tbe severest cases, by black vomit, bemorrbage from tbe stomacb, nose and moutb." Tbis is tbe terse description of tbe disease by tbe Royal College. It is peculiar to tropical* climates, and does not spread in a tempera- ture below 72° F. It is extremely fatal, perbaps communicable, and decidedly epidemic. Tbe period of incubation is indefinite, 4
1" crM.'ii of crisis is
1
:-7cr.ded with bubo,
I. ■: other ghiuds, and
■. :vst or pestilentia,
.- ivriod it invaded this
.-'y confined to Eastern
.... ;,-.: oxtreniely fatal. The
., . i-t vorv short, two to eight
-.-Tri:Mr:!:NT Fkvek.
p.^,r,,\vs]ns of severe fever, followed
..:., cMihlition during which the suf-
.- T-^i'NJcii. is comparatively well. The
rurcc ^^ages, called respe(*tively the
■ inflv rise to 105"' V, ; the m\atintj
.wi'.iiT to the profuse loss of water
.. -....ivVii and the temperature brought
.' li'.o body is reduced in temperature
^ .- .i:i!nos to a little below what is nat-
^ .icveloped recur with considerable
..^^ -. :lie same order of time, but in the
.-ior. Thus, in one case the paroxysm
. . ory third day, in another every fourth
r..i> has led to the enumeration of sev-
_. :c ?.: ivcui^s every twenty-four hours while
■ n •: .wurs every forty-eight hours while the
xit *v' ttt occurs every seventy-two liours while
■ s''\k:>. \\w paroxysms are not distinctly periodi-
^ iv.i'.l :ho College includes the periodical neural-
, .„:t».' *f\»w ague.
'., ,. .:Mii ^'•'i'* ^'*^* ^^ ^^ "^*^^*^ prolonged ; it may last for
' Ku.> .»!* •■''*: *^^^ three stages. In the tertian variety the
DISEASES RUNNING A DEFINITE COURSE. 51
fit 18 of shorter duration, ten hours. In the quartan the fit is of shoi-ter duration still, namely, six hours. Ague was once a com- mon disease in England, and even in London. The great Lord Protector, Oliver Cromwell, succumbed to it, and in the time of His Highness and long afterwards the physicians had much practice from it It declined in this country from two causes, from the drainage of fenny and marshy districts, and from the introduction of Jesnit^s bark, — cinchona, — ^for its treatment. The disease seems to be entirely due to some miasmatic marshy poison which, disposed of largely during the paroxysm, re-forms in the body in the course of the interval of remission and reproduces the attack. The period of incubation is from one to fourteen days. The crisis in each fit is defined above. The general crisis is un- determined.
Remittent Fevek.
A fever occurring occasionally in this country, but more fre- quently in warmer climates, in which, with paroxysmal attacks of high fever, as in ague, — but at less regular intervals, — there is a yellowness of the skin something like that which characterizes yellow fever. The disease in temperate climates is sometimes called " bilious remittent," and in tropical climates malignant re- mittent fever. It is rarely fatal in the milder forms of it, and is of local or endemic character, depending upon some malarious cause. It was remarked to me thirty years ago by an old prac- titioner, who in the fen districts had, in his early life, seen much of ague, that on cessation of that disease bilious remittent fever, which had also been common, remained much longer as a local disease. There are no definite periods of incubation nor of crisis.
Simple Cholera.
Cholera, or relaxation of the bowels, with or without vomit- ing. The disease occurs in this and in other countries with a cer- tain degi'ee of seasonal regularity, and is marked by a copious loss of fluid from the intestinal canal, with, in bad cases, cramps in the bowels and limbs and coldness of the body, followed, during recovery, by reactive fever. The affection, which is not conta- gions, occurs at times epidemically, and is not infrequently fatal. From its common appearance in the autumn, it is sometimes called antumnal cholera. It is usually excited by indulgence in
Il»i
- - :. .:>i» MANKIND.
- - . ..-. ;:irij)e frnits, but there
..-' ■ntiiu.tingtlie tendency,
..i.ii :- rn»t as yet ileHned by
. =. ariMH is usually short, not
xriiiL-d period of crisis.
I'i.I-.KA.
■ ; :tis» Asi.itic cliolera, serous
. iM d. ^rupliically, by the Royal
^ .-X. itu-.Mcrerized by vomiting and
. '. v:irer. acconij^anied by cramps,
:>.» :uid cnllapse/' The disease
, .. ^I'd iiver the temperate, and to
L- is apparently comnnniicable,
^" :i: rivt-rs, and, according to the
-IK' late Dr. Snow, the })oison of
..•.'. It is extremely fatal, and at-
■ t.-'.i more frequently than women.
. / -■ t*i»rnu breaking out, that is to
v'l .reading, without pursuing a def-
, . ic»ii.>ation is short, often not exceed-
A • ■>;> is iudeliuite.
•itMllllKKIA.
...'. !v>pocts is allied to croup, but which . :. '\\M it is of contagious character. It % ;» ii usually appears to arise from cold .,1 ends in a specific affection of the . i':hlpipeand air-passages become cov- iMt'u^ exudation, which may separate M the mucous surface. Diphtheria is •! children, but it attacks persons of iir, and it is extremely fatal. There are . ^^,M iiffv suscepti])le than others to its inliu- ,11 »c ■»•' vi'.»ubt that the tendency to it runs in V!'.io'ii:h manifesting itself l)y the most s,. M.- n ''^^' ::ll^»at, it is a general disease* in which , .. •» •> -L-|»a'"i-i'^'^i and coagulation of the fibrinous :> ont'U ivndered rapidly fatal by the sepa- ,. «ia.:ca 01 the tibrine of the blood within the heart.
,'i:ii
i;\.>«
uri'vi*
vn.
n*
DISEASES BUNKING A DEFINITE COURSE. 63
The period of incabation, according to my observation, is from three to six days. The crisis is about the fifth day.
Diphtheritic Pa/ralysis. — Diphtheria is sometimes followed by paralysis of some of the muscles of the body. The palsy affects mostly the muscles used iu swallowing, but it sometimes extends to the muscles of the neck, and even to those of the limbs. I have seen it once extend so as to include the whole of the mus- cles of the right side of the body. It is, I believe, due to a pro- cess of coagulation in the nervous fibres. As a rule persons of fair general health recover from it under conditions favorable for recovery.
Whooping-cough or Pertussis.
A disease beginning as a cold and attended with spasmodic cough coming on in paroxysms and often, by the violence of the cough, causing disease of the lungs. It is attended at first with some febrile disturbance, and in all stages it is communicable. At the onset it is apparently confined to irritation in or near tlie glottis, — the opening into the windpipe. The period of incubation is from four to six days. The crisis is indefinite, but the disease rarely lasts less than five weeks.
Mumps.
An epidemic and probably a communicable disease, affecting the salivary glands. The glands are much swollen and inflamed, and there is a general feverish condition. It is rarely a fatal disease, but is often severely painful. The period of incubation is about fourteen days ; that of crisis about four days.
Influenza.
A suddenly developed and intensely severe cold or catarrh, hence sometimes called "lightning catarrh," attended with an extreme nervous depression and violent cough. It is often epi- demic or spreading, but h uoi proved to be contagious. Some- times it suddenly affects a whole community, and in many epidemic visitations has been extremely fatal. The period of incubation ifl a few hours. The crisis is indefinite.
n^a;Lk?3^ xFTCCnXO MANKIND.
.it. •••4*' .'-j^it* * in3!^*ao£ng as a specific inflammation
•. •..L«-iia» Q*im:n:i.e of the nose and throat, and
. ^ '*ix,iii:^ II Ltr-v^c from a glandered horse. In the
,^..«..u- ui»i.:tfr x'uies f rom the mucous secretion of
*^. -^ *^ •!*» mzMc :he human subject by a wound.
•^ u.-^ - •..i«.»{i;,'*.'ii> :rt.tu one affected person to another.
. ^^ *.'.ijai.:«.'ii Si <hort, from two to four days. The
- .^ ^^. .r, r»^iu :«jur to seven days.
Farcy.
-<!»«* irfwcing man, caused by contagious mate-
.. ,, . ... ^ >!>*?• either under glanders or farcy, to man.
... A ..i:iiiiiiu*c:on of the skin and absorbent vessels
"i. .jxuc* 'i^ 'j^Muetimes accompanied by swellings
V. ».;. uiis •»r farcy buttons. It is communicable
, v.* s.i.!tL<.'U r'ivni the sores. The period of incuba-
u. ..v.-x I'lie crisis is indefinite.
.iw;.».<K. EgriNIA MTTIS.
\.»4 .ass- ular disease produced by communication
1 1 mm A horse suffering from what is called
...ii.*..i.*ih.'ii of the sebaceous or grease glands, — to . ^.v. i. iK'iilNitkm is four days, and of crisis or ..o^ ; • J cas o i t;a c days.
* I \ . . V. v,\.\ !• ri\<nTLE. ClFARBON.
..-..i. c»*ii ^*i disease communicated by the trans-
. .^.s-.. Aiiv^,\{ t'rvMu cattle suffering from malignant
V -■^•.A- v»%i*.«^cuvs as a small bladder or vesicle on
. ..»., i ..<< i^rt-H^riMious inflammation which becomes
\ i%l*,i*oivo. It is exceedingly fatal. The
:k,u*.^'»< UuiliiCKi from ten to twenty hours. The
, ^ .^ ^^ PApdifi/>/i trf wounds in which a slough, — a
pntrcfa^'ti^"^ wrface, — attacks wounds or ulcers
* V -Noni th«n. The Uiaease is usually produced in
DISEASES RUNNING A DEFINITE COURSE. 55
wounds affecting persons in a bad atmosphere. The periods of incubation and of crisis are indefinite.
Sloughing Phagedena.
A more severe form of phagedena, in the progress of which the putrefactive destructive change not only extends on the surface of the body, but goes deep into the tissues, involving the cellular or connective tissue beneath the skin. The periods of incubation and of crisis is indefinite.
HosprrAL Gangrene.
A form of " sloughing phagedena occurring enderaically, i.^., locally, in hospitals." The disease is developed in hospitals charged with impure air. The periods of incubation and of cri- sis are indefinite.
Erysipelas. St. Anthony's Fire.
A specific infiammation of the skin, of a contagious character and tending to spread over the surface of tlie skin. The inflam- mation sometimes springs up spontaneously, affecting the head and face more frequently than other parts of the body. It is apt to occur from wounds and after surgical operations. It may become epidemic. The period of incubation is about four days ; that of crisis is indefinite.
VarieUes.
Simple. — In which the inflammation is entirely superficial or confined to the surface of the skin.
Pfdegmonons. — In which the infiammation extends below the skin into the cellular or connective structure.
Diffuse. — In which the infiammation, extending into tlie cel- lular tissue beneath the skin, diffuses through the cellular tissue.
PY-fiMiA. Suppurative Fever.
An acute febrile affection resulting in formation of purulent matter and of abscess in the viscera and other parts of the body. Pya»mia follows on wounds, surgical operations, and childbirth. Tlie period of incubation is from four to eight days. The crisis is indefinite.
GENERAL DISEASES AFFECTING MANKIN^D.
Puerperal Fevee, Childbed Fe\"eb.
An acute form of contagious fever occumng in women dur- ing or after cliildbirth, usually a few days after childbirth.
Tlte poison of tliis fever may bo cojimuiuitiated bj tho«?« who attend her to the eliildbed woman, and it is so conveyed in many instances. But the disease may probably originate from other poisouo!ia secretions than the eecretion derived from a previous specific case. Thus it may occur from cimtagion of scarlet fever or erysipelas. The periods of incubation and of criids are un- certain.
PuERPER^vL Ephemera. Weed.
A fever, sometimes called milk-fever, usually occnri^ing in women after childbirth. It is probably not contagious, but may be of malarious origin. The secretitm of milk is suppressed^ and fever of a short remittent kind follows. The period of incuba- tion is fi*om three to seven days. The crisis is uncertain.
SVPHILIS.
A contiigious di&ease called sometimes specific disease^ affect- ing bc»th sexes, and jH'odueed iiy the inoculation of a poison know*n as a ""^ venereal ■• poison. The period of incubation is variable, forty days being tlie most common period. The crisis is indefinite.
Pnmnrf/ Sf/phili^. — In which the disease is limited, in effect* to the part inoculated with the poison and to the lynjphatic ves- sels and glands, — glands of the groin, — connected witli it
Sill)- varieties of primary syphilis : —
(1) Where the part inoculated is swollen and hard, and the glands affected are swollen and indnrated ; indurated boil, or bubo.
(2) Wliere the part inoculated is swollen and soft, and the glands s\vollen and suppurating; suppurating boil, or bubo.
(3) Where the part inoculated is a spreading sore; phagedenic 8ore,
(4) "Wliere the part inoculated is sloughing or superficially mortifying ; sloughing sore.
DISEASES RUNNING A DEFINITE COURSE. 57
Secondary ayphUis.—ln which the disease extending beyond the part inoculated affects the system generally, causing soreness of the throat, neuralgic and rheumatic pains in the limbs, copper- colored eruption on the skin, and gieneral cachexia.
Tertian/ sj/philis. — In which the disease, without new inocu- lation, and after apparent i*ecovery from secondary symptoms, recurs in tlie secondary form.
Hereditary syphilis. — In which the disease appears in the child in the constitutional form, from taint communicated by its parent; one or other of its parents having been affected with tlie disease or having inherited it.
Gonorrhoea.
A contagious disease affecting both sexes, and consisting of a suppurative inflammation, yielding a specific poisonous secretion, and sometimes accompanied with swelling in the groin. The disease has an acute and chronic stage, the chronic or prolonged stage being commonly called gleet. The period of incubation varies from thi-ee to nine days. The crisis is indefinite.
Gonoiu-hoeal inflammation, when it is present, is apt to produce three specific inflammations, designated respectively :
Ganorrhwal Ophthalmia^ a specific infiammation of the con- junctiva or mucous covering of the eyeball.
GonorrhijeaZ Iritis^ a specific inflammation of the iris or cur- tain of the eyeball.
GonorrhcBol Hheumatism^ a specific rheumatic fever occurring during the presence of gonorrhoea.
IIydrophobia.
Literally a disease marked by fear of water, Middr^ water, and phobos^ fear. Actually, one of the communicable diseases depend- ing upon a specific poison secreted by certain animals, the dog particularly, while in a state of rabies, fury. Both terms, hydro- phobia and rabies, are unfortunate. As a rule the disease is com- municated by the bite of the rabid animal, the poison being in the saliva of the animal, and the wound made in the person bitten being the receiving surface. The symptoms are those of painful dread on hearing the motion of water and other similar Bounds; frenzied terror; difficulty of swallowing; convulsions
58 OENEBAL DISEASES AFFECTING MANKIND.
proceeding to tetanns ; copious secretions of saliva ; and, death from exhaustion or from spasmodic seizm'e of the muscles of respiration. The period of incubation varies. The symptoms may appear within a few days or even a few hours after the inoc- ulation, but the time is varied from those short intervals to the longer one of weeks and months, and in rare instances of two and even three years. The crisis is from the third to the fourth day after the first appearance of the symptoms.
CHAPTER IV. GENERAL DISEASES OF CONSTITUTIONAL TYPE
The, diseases ennmerated in the nomenclature of disease, under tbe second section or division of General Diseases, are dis- tinguished from those of the first division by their longer per- sistence, tlieir possible recurrence in tlie same person, and their constitutional and hereditary character.
These types of disease are defined in the nomenclature of the Royal College as : —
" Diseases for the most part which are apt to invade diffei'ent parts of the same body simultaneously or in succession. They are sometimes spoken of as constitutional diseases, and they often manifest a tendency to transmission by inheritance."
The diseases may be described in the following order.
Acute Rheumatism.
A specific disease, attended with fever and characterized by inflammation of the fibrous tissues surrounding the joints, but without tendency to the formation of matter. Many joints may be affected in the coui*se of an attack at the same time or in suc- cession.
Acute rheumatism is attended with a free secretion of acid fluid from the skin, the acid being of the kind known as lactic. In my experimental researches I have shown that this acid has the power of producing the symptoms of the disease. Rheu- matic disease of the heart is a conmion result of acute rheumatic fever. The affection is hereditary.
Varieties of Bheumatiam.
Subacute liheumatism. — A less acute form of the disease, but attended usually with some fever and much pain.
OonorrhcBol Rheumatism. — A specific form of acute rheuma-
60 GEKEKAL DISEASES AFFECTINO MANKIND,
tisiii, often very severe, and attended with severe febrile disturb- ance and with pain and swelling in the joints. A disease con- nected with and probably dependent on the epeciiic disease which precedes its occurrence.
Synovial i?Atfum€^wrm.^Kheninatifim of the joints with ac- cumulation of Berons or watery flnid in the synovial sacs or in- vesting riicnibranuus pouches of the joints in which the lubricat- ing synovial fluid is secreted. The disease is attended with much local Bwelling of the joints and pain, but with less inflamiiiation and fever than occurs in acute rlieiinjati&ni.
Muscular liheimiatwm, — A form of rheiunatism affecting the shcathsj or fihroua coverings of muscles, and giving rise to pain, increased greatly by motion, thruughoiit the niiiBcular struetm^s. There are two sub-varieties of mii&cular rheiuiiatisni : —
Lumbago, or rheumatism of the muscles of tlie back.
Stiff neck, or rheumatism of the muscles of the neck.
Chrome liheunuttimn, — Rheuniatism in which the pain is eon- tinned chiefly in joints, and attended with *' stiffness and swelling of the various affected jomts/' and with little or no fever.
Gout. Acute Gout.
*'A specific febrile disorder, characterized by inflammation without suppuration " — in other words, %vithont the formation in the part affected of matter or pus — ^' but with considerable red- ness of the affected joints, chiefly of the hands and feet, ami especially of tlie great toe. The disease is attended with excess of uric acid in the blood."
Varieties of Gout
Chronic OouL — A disease marked by a persistent gouty con- dition, with the joints often permanently enlarged from deposit of the urate of soda.
Gouttj Si/novltin, — Gout attacking the synovial, or lining mem- brane of the joints,
Chronir. L%nma(ie Arfhrih's* — ►"An affection characterized by pain, stiffness, and deformity of one or luore of the joints, as- Bociated with depositiun of new bone around them." This affec- tion is sometimes confounded with pure chronic gouty disease.
DISEASES OF CONSTITUTIONAL TYPE. 61
Cancer. Malignant Disease.
" A deposit or growth that tends to spread indefinitely into the snrrounding structures, and in the course of the lymphatics in the part of the body affected, and to reproduce itself in remote parts of the body."
Varieties of Cancel*.
Schirrus. — Hard cancer. A cancerous swelling, hard at first and then ulcerating. Schirrus often affects the breast in the female.
Medullary. — Soft cancer. A cancerous tumor, frequently of rapid growth. It often becomes fimgoid and easily bleeds.
Epithdial. Cancroid. — Surface cancer. A cancer occurring superficially, and ulcerating over a large surface from the point where it commences.
Melanotic Cancer. Melanosis. — Dark cancer. A cancerous growth with deposition in it of black pigment.
Osteoid. — Cancer commencing in bone, and followed, as a rule, by similar development in other organs of the body.
Villous. — Cancer of mucous membrane covered by villi or fine projecting mucous filaments.
Colloid.
" A new growth, a great part of which is formed of trans- parent gelatinous substance," often attaining a large size. Colloid is doubtfully ranked as malignant.
Tumors. Simple Tumors or Swellings.
The term tumor or simple tumor is applied to a swelling caused by a growth which is not cancerous or malignant. Such growth is sometimes called *^ benign," or non-malignant.
Varieties of Tumors.
Fibrosis tumor. — A circumscribed growth of fibrous tissue, usually firm and of slow development.
FibrO'Cellular. — A circumsci'ibed growth of mixed fibrous and cellular tissue.
Fibro-nudeated. — A growth of fibrous tissue containing elon- gated nuclei.
62
GENERAL DISEASES AFFECTING MANKIND.
Fihro-jd>.t^tu\ — A raj>i<liy-growing nneleated cellular growtlu tlie cells being fusifonti, spindle shaped,
Myeloid. — A gi*owth of red tint, containing many nucleated oelle, and commencing, generally, in the endft of bones.
FaUfj. — Sometimes called Lipoma, — A growth composed of adipose or fatty tissue.
Osseous. — A growtli of bone called eometimes exoHto»is^ and preBenting several sub- varieties, as imry^ or liard and ginooth ; — cancelluk'd or porous ; and diffused or spreading.
Cartilaginous^ sometimes called Mwhomlroma, — A growtli affecting cartilage or cartilaginous structure*
FihrcMXirtilafjinaus, — A growtli composed of fibrous and car- tilaginoua elements,
(rhinduhtr. — A growtli occnrring near to a gland and, to eome extent, resembling a gland in structure. Sometimes called Ad^:- nocele*
Vascular, — A growtli composed largely of blood-vessels, but increasing slowly.
^^<mus* — A vascular growth developing upon or below the skin, and when upon tlie skin assuining a round or strawberry- like character. Diffused over a considerable surface of the skin, a neevus is called, vulgarly, *•■ port-wine mark " or " mother's mark."
Seha^mi^. — A gi*owth containing a fatty suet-llke material^ and often called a wen,
CJtoh}steatQma. — A gi*owth coutaioing a fatty substance re- sembling cholesterine.
3IoUascum. — ^A tirm dermoid growth connected with the hair follicles and resembling somewhat the bodies of molluscs. The growths attain sometimes a large size and have a pedicle or stalk.
Warts, — The hard, rough, vegetativedike structures occurring on the skin.
ChehirL — A hard growtli ou the skin. Is often developed on a cicatrix or healed wound or sore.
Moles. — Irregular raised spots on the skin contahiing black pigment*
Cysts.
Cysts, — often also called wens,— are hollow growths, more or less firm, containing some substance within them. The contained
DISEASES OF CONSTITUTIONAL TYPE. 63
sobstance varies, and so gives rise to modifications of cysts. Se- rous cjsts contain watery or serous fluid. Synovial cysts, situated near joints, contain synovial fluid. Bursm are the little swellings which occur near to joints, as at the back of the wrist. In addi- tion to these there are also mti€02is cysts ; suppurating cysts ; sanguineous cysts, — called by the vulgar blood-warts ; — hemor- rhagic / aneurisTnal / oily ; gelatinous / comjpouThd or prolifer- aus / complex / cretaceous or dermoid / and dentigerous cysts.
Lupus. Noli me Tangeee.
" A spreading tuberculous inflammation of the skin, usually of the face, tending to destructive ulceration." There are two varie- ties:—
Chronic lupus; fixed, or not spreading.
Lupus exoedens / extending or spreading lupus.
Rodent Ulcer.
A gnawing ulcer, or destructive ulceration going very deeply into the tissues without previous hardness, ulceration, or constitu- tional affection. The appearance is as if the tissues had been bitten or nibbled out from the suiface.
Leprosy.
Tlie Elephantiasis of the Greeks. A disease of the skin, con- sisting of dark-red swellings or tubercles, with a rough and raised state of the skin generally. The affection is attended with hoarse- ness of the voice ; with a foetid discharge from the nose ; and with ulcerations on the surface of the body.
Scrofula.
A common constitutional disease, showing itself, generally, in symptoms of physical weakness of the body, with external swell- ings of the glands which often end in suppuration, — formation of matter. In some instances there is a deposit of tuberculous mat- ter in different structures or organs of the body, especially in the lungs and in the mesenteric glands. To this condition or ten- dency of the body, the term scrofulous diathesis has been applied. There are two varieties of scrofula.
Scrofula with tubercle.
Scrofula without tuberde.
64 GENERAL DISEASES AFFECTING MANKIND*
There ai-e also eeveral forms of scrofulous affectioD character- ized by their position in relation to the organs of the body that are attacked by the disease. When tubercular deposit, the result of the scrofulous diathesis or constitution, is on tjie coverings or meninges of the brain, with inflauiniation, tuberculitr inenhvjHls is said to be present ; when on the bag or covering of the heart, iuhtTcular perimrditi^ h tiie name applied; when the deposit is in the lungn, consumjdwn, ca- phtkUiH jndmcmalisj is the disease; when deposit occurs of a udliary or millet-seed character on tlie surfaces of tlie body, aeiit^ mHianj iuhefTukmis is the name adopted ; when the deposit is in the mesenteric glands, — the glands of the mesentery, or fold of membrane which connects the small intestine with the posterior wall of the abdomen, — jneseji- teric dUmse^ or Tahes mesenierica {tahes^ w^asting), is the name of the disease ; when the deposit is on the peritoneum, with inflam- mation, iuherctdar peritanitis is the local affection.
BlCKETS.
A disease briefly and sliarply ^lefined by the College, as — " A constitutional disease of early ch!ldhot)d, manifested by curvature of the shafts of the long bones and enlargement of their cancel- lous extremities/' The disease aiisesfrom a deficiency of earthy matter in the bones.
Cretinism.
A disease equally well epitomized as — "A condition of im- perfect development and deformity of the whole body, especially of the head, occurring in the valleys of certain mountainous dis- tricts, and attended by feebleness or absence of the mental quali- ties and special setises, and often accompanied with goitre."
There are two varieties of cretiiusm*
CompleU cretinism: — "' Cliaracterized by idiocy, deaf dumb- nese, deficiency of general sensibility, and absence of reproductive power/'
Incomplete cretinwm: — Or ** curable cretinism; a degree of cretinism in which the mental faculties, though limited, are capa- ble of development; the head is well formed and erect ; and the special senses, the faculty of speech, and the repmJuctive powers are present/'
DISEASES OF CONSTITUTIONAL TYPE. 65
Diabetes. Diabetes Mellitus.
A disease in which there is excessive discharge of fluid from the kidneys, and in which glucose, or grape sugar, is produced in the body in large quantity, and to which the profuse elimination is due. The urine contains grape-sugar in excess. The exhaus- tion which follows the loss of fluid is often accompanied by other systemic changes, due to the presence of sugar in the other secre- tions and in the blood, and to the modifications of nutrition which thereby are effected. Opacity of the crystalline lens, — diabetic cataract, — is, occasionally, one of these modifications of structure ; shrinkhig o^ the structure of the brain is another; a peculiar type of pneumonia is a third. Diabetes commonly proves fatal. It is primarily due to changes commencing in the nervous system.
Va'riety.
Diabetes Insipidus: — A form of disease resembling diabetes mellitus in one symptom, viz., the excessive excretion of fluid by the kidney. There is, however, no sugar excreted in this variety of the disease. The affection is more frequent amongst members of the male than of the female sex, and it is less fatal, as it is also less common, than diabetes mellitus. The stage of adoles- cence, and a few years afterwards, are the periods in which the disease is most apt to occur. The nature, causes, and seats of this malady are indifferently understood.
Purpura. Land- Scurvy.
A disease in which the surfaces of the body are affected with small purple spots or blotches of effused blood, but without fever. The blood is exceedingly fluid, with a tendency to the separation of its fibrine. There are two varieties of purpiira.
Simple : — In which there is no acute loss or discharge of blood from the body.
JSemarr hoff ic .'--Jn which the mucous surfaces of the body bleed or give out blood.
Scurvy. Sea-Scurvy.
A disease allied to purpura, but attended with a spongy con- dition of the jaws and witli " livid patches under the skin of con- siderable extent, which are generally harder to the touch than 6
00
GEXEKAL DISEASES AFFECTIXG MANKIND.
the snnT)nn<]iTig tisi^nes,'*' The disease is eorunion at &ea in those who h:ive been long kept on salted provisioud and exposed to much hardship. It has been stigmatized ad the "great plagne of tlie ftca/' It 18 sometimes called '*• Bea-ecurvy,'- as purpura is called *' land-sen rvy/*
A disease attended with paleness of the surface of the binly and detieicncy of the red eorpuscles of the blood. A coiniuou disease amongst women and anaongst the ill-fed and badly noiir- islied of both sexes, in crowded and close localities,
CnLOEOtiiiH. Gkeen Sxckxess.
Another form of anemia peculiar to women and attended with paleness, tending to a green tint, of the surface of the body. Tlie disease occurs after puberty, but rarely tifter twenty-five or twenty-six years of age.
BerI'Deki, AcrTE Anaemic Dropsy,
A very serious disease peculiar or endemic to Ceylon^ part of Madnts, the Mauritius, and the coast of Malabar. The disease begins with anivniia or bloodlessneis.s, and tenuinates in general dropsy. It attacks natives and Europeans, but the latter rarely until after nine or ten months' residence in the affected district. It is often very fatal, destroying one in thi'ee or four of those attacked by it. It attacks most severely those who indulge in alcoholic drinks, and meu more than women.
SUMMABY.
The reader, if he shall liave followed tlieso pages carefully, has now a concise, but fairly complete view of the tjejieml diseases wliich in this day atfliet humanity in civilized comnnmities. lie will^ I doubt not, wonder with my friend of whom I Itave before spoken, thiit the diseases should be so limited in number, and he will expect to be prepared for entirely new phases of diseased action when be comes to the next part of this \vork, which treats of local diseases, injuries, and poisonings. In this expectation, however, be will be largely deceived. The list of local affections and injuries will, it is true, be a long one; but it will bo found to be made up, in great part, of repetitions of one or other of the
DISEASES OF CONSTITUTIONAL TYPE. 67
several conditions of disease^ applied, over and over again, to pailienlar organs and structures; of repetitions or references to ceitain of the general diseases which lun a regular course ; and of repetitions of some of the diseases which have been classified as of constitutional type. In a word, essential as it is to become acquainted with the local diseases and injuries, the reader will find the fact remaining that, if by preventive art we could con- trol the comparatively small number of conditions and affections which have been detailed in the last three chaptei-s, we could control the local diseases as well as the general, and could prevent the whole, with the exception, always, of that final process of decay which forms the prelude to natural death from ripe old age.
BOOK I. PART THE SECOND.
LOCAL DISEASES.
CHAPTER I.
THE SEATS OF LOCAL DISEASES. A PHYSIOLOGICAL
OUTLINE.
In the preceding four chapters we have studied the subject of human diseases as divided into those which are general and those which are local, and in the last two of these chapters we have taken a brief analytical review of the general diseases as a whole. To take into similar review the local diseases is our next task. For the purpose of this book it will be convenient to depart a lit- tle from the plan of the Royal College of Physicians in specify- ing the local affections, in order to condense the narrative and bring tlie facts of it into close compass. With this intent I shall place the local diseases under nine heads, corresponding to the systems of organs of the body ; — the digestive, circulatory, respiratory, nervous, sensory, glandular and absorbent, muscular, osseous, and membranous.
Let me, however, in a brief preliminary manner, first describe these systems.
If we could by some sleight of science look physically through a living man and see how all his vital organs work, as we can look into the mechanism of a watch or a timepiece, we should discover in the nine grand systems of working organs, some active in their uses, some passive, but all playing important parts in the duties of maintaining or utilizing life. We should also discover them to be all bound together for a common object, that of bring- ing the various organs and systems of organs into one organic f i-aine or whole ; so that while each system and each organ is to some extent independent of the others, such intimate ties hold them all together, that it is difficult, if not impossible, for one alone to suffer and for the rest to be unaffected.
72
TIJJ:; SEATS OF LOCAL DISEASES.
Tire Digestive System.
In the trunk of the b<*dy, we slionld first observe a tube wliich the ancients very correctly called the jwmw via*^ the first wayp, and vvliich we moderns call tlie digestive, or alimentary tube. The tulH) is truly the lirst way. It is the canal which receives the ulimcnt out of wliicli itself and the whole of the body is biult \\\K It is ihc centre from which the body that is to be proceeds, in crude form it is tnie, but prepared for elaboration. Into tliis lung canah whicli, laid out and measured, would, in the adult, be fuund to bo nut le^^s than thirty-two feet in length, and whiuli is conn posed of many divisions, each playing, as we shall see, its fiwn part la digestive wurk, the food and drink enter. Received here, the drink, if it be eolnble, if it be water or a fluid niiscible with water, is at once taken up by membranous and vascular ab- sorption into the blood. The food, solid or gemi-solid as it enters the month, is ground there or masticated, mixed with saliva which Iielps to fluidify its stai-ehy and fatty parts, and is then swallowed into the stomach. In the stotnach this food is digested and churned until its albuminous or Hesh-formiiig structures arc brought into solution, and this effected, the prepared fluid is passed into the tirst part of the intestine below tlie stomach, the duodenum, where, meeting with the secretions from the liver and panereas,^ — the bile and pancreatic juice,— the starchy and fatty, or lieat'producing, portions of it are enmkitied, liquefied^ and made ready also to be absorbed and further utilized. Thence the prepared untriment, passing into a longer line of intestinal canal, tlie jejunum, and ileum, is further digested, and at last is, directly or indirectly, convcved bv two classes of vessels into the circulating lilood, and through the Idtiod into all other structures, to become for a time the veritable body of the uiauy^bone, mus- cle, sinew, nerve, eye, ear, heart, vessel, membrane, — ^everything there is of body.
Finally, from t!iat long absorbing portion of the alimentary tube sundry parts of the food that have been taken and are not wanted are passed into the large intestines,— the cfifcnni, colon, and rectum, — with gases generated in the process of digestion, and d<^hris of food that could not be digested or apidied to the purposes of life, Tliese are all passed on into tlie larger recepta-
A PHTSTOLOGICAL OUTLTTTE.
de of the intestine to be expelled, aa the ejected results of the digebtiie process.
In observing the parts of tlie digestive system we should note various structures and organs, beginning at tlje lips and extending
the lowest part of the intestinal tube. The eanal ii$ lined with the red mucous membrane which we see at the lips, and which, throughout its entire length, h surrounded by two layers of mus- cnUr fibres, one longitudinal or long, tlie other circular. These are all enclosed, in some parts, in a strong investing sheath, the stomach and intestines being further invested, in great part, with a delicate serous membrane called t\iG pcrifoneum.
The parts <if the alimentary system to lie observed would l»u ; — {a) the inouthy — into which the saliva i:^ poured, — ih^Pmytu^ the fawv'S or back of tlie thn:>at, the jmlaie^ the uvula and totisUs. (4) The J flt4in/nj*^ or dilated pouch at the back of the throat, end- ing iti \e) tlie iTSophiuju^ or gullet, — tlie tube extern ling from the pharynx to tlie stomach. (</) The Momach^ or first true digesting rtHH*[*tacle, in which the albmninous or flesh- forming foods am trauHformed during primary digestion into chyme, which is passed through l\\Q pyhrus^ or exit gate of tlie stomachy into the duode- nmiL {e) The fluodtnumy or first portion uf the small intestine, into which the liver pours its bile and the pancreas its emulsify- ing jnlee, and in which the fatty and starchy portions of the food digi!Sted, — secondarj' digestion, — l>eforo !>eing carried into '^Bie next small intestines. (/') The small mtQ^t\nQ%^ jt^utntm and ilemn^m which digestion is completed, and from which the pre- pared food is absorbed intr* tlie tjlood, partly by the veins, — direct absorption,— and partly l>y the villi or absorbents which line the intet^tinal surface, and whicli convey the fiiiid to the glands of the mesentery, from whence, after elaboration, it may pass into the iharacic diu^t^ and by that clnvnnel find its way into the veins, 1(1 »(i into the circulating blood, itj) Tlio largo intestine, called the oobyn^ for receiving the debris^ the undigested or useless part ;^f food substances, and tlic gases arising from cligestion. The [>lon epringing from a pouch, the cmmm^ situated at the end of the small intestine on the right side, first ascends, and then ex- Ifiodtng across the abd<^miiial cavity from right to left, next da«eendj!s. and at la^t termiimtes on the left side in tlie straiglit intestine. (A) The straight intestine, th^ rectum^ with the outlet of which the canal is terminated, {%) The peritoneum
THK BEATS OF MWAI4 BIBEASES.
or serous monibrane of tlio aLdomiiial cavity, in wlxich tlie 8toiiiat*li, the iiit08tinet?, and other abdominal organs are in gmat part infolded, and which lines also the walls of the ahdominal eavitv.
Within the canal on the mnconxS surface at varion?^ points we shonld discover glands or seereting organs. Gastric glarjda in the stomach, for secreting the gastric juice ; two large external glands, the liver and the pancreas, pouring bile from the liver and pan- creatic jnice from the pancreas, into the lirst part of the small in- testine, or duodeinnn ; and other smaller glands along the mucous surface of the snndl intestines.
Sliall any local disease, functional or structural, visit this sys- tetji of organs, indications of general and local disorder nuist needs ensue. The old fable of tlie belly and the members is re- told. Let the alimentary canal fail in any of its duties; let its salivary juices be inactive; let its stomacliic digestive juires be deficient or inactive ; let its intestinal juices be deficient or inac- tive; and the Iwlance of supply to the <>rganisui will he disturbed. Or let the tube be obstructed, so that food camiot enter the diges- tive apparatus freely; or, entering and being digested, cannot pass on for absorption ; <ir, passing tlie absorbing surface, cannot discharge itself; then, the balance of supply to all parts must be disturlKid, Or let the mechanical ]«art of the digestive system fail; let the mastication lie imjxtrfet't ; let the swallowing be dif- ficult; let the churning movements of the stomacli be enfeebled; lot the transmitting pow'er or motion of the lower parts rf>f the caual he irregular; then the liabince of supply of food to all parts must be disturbed. Once more. Let the alisorbing portion of this system be in any way impeded, and the balance of supply in all parts must be disturl>ed. Lastly, let the digestive system, |>erfect in itself, be overloaded or overcharged, or undercharged, or improperly charged with foi>ds and drirdvs, and the balance of supply to all parts must be disturbed.
If to these facts we attach one more, nanjely, that by nervous connuunication the intestinal canal is bi^*ught into commuiuon with all the nervous centres in which vital acts, automatic and voluntary, have tiieir Beat, w^e discover how the digestive system, as a systeju exposed to local diseases, holds a first place for our consideration. It has been called the primm vi<E, tlie tirst ways ; it might with almost equal truth be called the first ways of dis-
A PHYSIOLOOICAL OUTLINE.
TO
Indeed the most learned have not as yet discovered liow imny diseases take tlieir urigiu there.
The CiBCTLATOEY System,
Keeping our minds still intent on studying the construction of tlie body dnring life, — looking tlirongh the man, — we shoold observe that the fluids prepared by the pnjcess of digestion lind their entrance into another tubidar system by which they are car- ried ronn<l the body in two circnits, one large, including all the Iwxly, the other small, and including only a part. We should see tliat the fluid which leaves tlie alimentary organs, white or milky in color, is, in this next system of tubes, of red, or bluisli red, color, and that it has become a red, tenacious, and coagulable or clotting fluid which flows from a wound in the body directly a wound IS made^ and wldeh is called blood. The new supply of tliifi bk>od, received from the digestive parts, would l>e seen Ixirne along by a series of tubes of a darkish l*lue color, whielu fi\>tn all parts, head, limbs, trunk, are making for one point, like a river which, springing from several sources, is making for a lake into which it will iiually discharge itself. These tubes, as mil anatomist would explain them to us, are called rciW ; and the point tliey ai*e making for, in order to give up their currents, is the pulsating organ on the left sidtj of the bt>dy, lying in the cav- ity of the chest above tlie stomacli, and separated from the cavity holding the stomach by a partly fleshy, partly teiuhnous parti-
rtion, the diaphragm or midriff. The beating or pulsating organ disclosed to us wc should be told to recognise as the fieart. The iie«rt^ we should discover, to lie formed of four hollow stnietures,
^each stnicture expanding and contracting in peifect rh) thmical order. The veins carrying tlieir blood would he observed to |K>nr the bloml into the upper small dark cavity on the right side, called tlie right auricle of the heart. There, being compressed by tlie ooiitraction of that cavity, the blood %vould be seen to be driven into a cavity immediately below it, through a valve, the tricuspid, which placed in the intervening opening M^otild allow it to pa»s downwards, hut wonld not let it pass back again. IJere arrived wo ehould see this lower cavity, called the right ventricle, contract ; the valve, consisting of three segments, rise and close up with a dull sound, so as to let no blood get back into the auri- cle from whence it came; and the blood itself make its way to
THE SEATS OF LOCAL DISEASES.
a large vessel springing out of the lower cavity and then move
towajxls two epongy-lookiii^^ organs, lying al)ove tlie heart, named the hing^. As it passed into this vessel the lilood would be seen to piiBh np before it thi*ee little flaps of valves, shaped like cj-es- cente, — tlie eieinihuiar valves, — and as it filled the vessel the ves* sel would expand fur a iiionient, and afterwards contract, like an india-rubber tube expanding!; and contracting from fluid pumped througli it. The contraction of tlie vessel on its contained blood would diive down, with a shai-p click, tlie three little crescent- Bhaped or eeujihiniir valves; and as by their closure the blood would be prevented getting back into the hearty it would be driven np into the two spongy lungs above. It would enter the lungs dark in c*>lor, bnt, as they moved iti breathing, as they ex- panded, the color of tlie blood would be found to change, and to become of very bright red. Thus changed the blood wonld be detected leaving the hmgs, and by f«*nr suial! vessels guiug back again to the heart, Tlie four vessels would be found directing their cuuri^e to another suudl cavity of tlie heart at tlie top of the organ, a cavity lying un the left side, on a level with that cavity on the right side which took in the blood froui the veins, and which we understood was the right auricle. This secon<l small cavity, also called an auricle, — the left anricle, — wonld be seen to be the receptacle of the blood from the lungs. It would be dia- eovered tilling with red Itlood from tlie lungs as its fellow tilled with dark blood froua the body. It would contract after it had filled, in the same way as its fellow, and at the same njfunent, but in contracting it would drive its charge into auotlier cavity of tlie heart lying beneath it, called the left ventricle. The blood, pass- ing thi'ouirji the opening from the left auricle to the left veutri* cle, would force open a valve,— the mitral, — composed of tw^o cur- tains which would let it enter and fill the left ventricle. Next, the ventricle would be seen to contract, the curtaliKS of its valves to rise, tlieu close with a dnll sound, and the blooil, unable to go back into the auricle, would be observed to ascend towards another large tube, whiclij springing from the ventricle, makes a beautiful arch that stretches three to four inches over the lieart fi*om right to left. The blood moved, by the contraction beneath, towards this vessel, called technical ly the great aorta or great arterial ves- sel, would be discovered, as before, to lift up three little crescent- shai>ed valves,^aortic semiluaar valves, — as it passed into the
A PHYSIOLOGICAL OUTLmE.
bL Under the pressure we Blionld now behold the big elastic "iortic vessel expand, so that its wliole bow or arch is inchided in the expansion. In an instant its expansion would, however, be followed by its coutractiorij tlie little crescent valves w^ould go down with a sliurt shai-p click or sound, and the colnmn of blood, luiahle to get past tlie little valves back into the heart, would he carried in the direction of tiie aorta into the vessels that branch off from the aoita, in its course over the whole of the vascular livstem.
And nowj if we continued to follow that colnmn of blood iIjus ejected fi-oni tlie beating heart through the great arterial vessel, re sliould have to look for it at every portion of the body from bead to foot ; for wherever there is a living part of the body the arterial blood will permeate. The great vessel dividing into smaller vessels, penetrates, it will be noted, every limb and every organ, not excepting the hard skeleton itself. The vessels beat witii the heart and give us tlie pulses wo feel in the wrist, the Bniple, and other portions of tlie body. The enmll vessels sub- livide into smaller stilh and by continuance of subdivision the whole system of vessels passes into one vast hair-like»— capillary, — web of tubes expanding unt in all structures, looking like the ulti- mate branches and foliage of a tree, and foriuing, in fact, the whole organic outline of the corijoreal frame.
1 have elsewhere called this fine net- work of nltimate vessels the minute circulation. It is in fact the organism, as we look at it, spi'ead out la proper form. We see in it the features and out- ues of every structure and organ. It is, as it were, the living mvas on which the organism is constructed. Here the blood yields up its constituent portions to make organs, bone stuff for bone, muscle for muscle, nerve for nerve. Here the animal fire glnwft, the blood from the lungs breatlting into it its vital air. We may, as we look at it, almost see it as a slow but steady Animal fire.
At the same time we are led to observe that tlie blood, carried bto this vital arena, does not rest there. We detect that l>y an infinite ninnber of minute vessels, springing from the vital arena, it returns back, after making its extended circuit, to the heart. It returns now dark in color. It collects in small veins. The veins by tributaries become larger and larger, and so the whole volume of blood, from the great minute circulation, goes back again
TOE SKATS OF LOCAL DISEASES.
through t!ie venous trunks to the right side of the heart from wlience we behold it 8tart, to repeat its round on its greater aud lesser circulations*
In the constmetion of this vital system of organs,^ — as will already he gathered from the above, — is included tire Uood itself ; the heart ur propelling organ; the arteries; the niioute circula- tion ; and the veins. The blood,, arterial and red on the one side uf the t^yiitem, venous and dark on the other, is a fluid liaving a specific weiglit of Hi5r>, compared with water as 1000, It Las an alkaline reaction. In the body it flows along the vessels in a thin liquid state, although a part of it is in the sulid form. It consists of curpnseles or globules, which float in a &aline albuminous fluid, and which are m small that they pass through the minutest ves- sels. The globules are of two kinds, red and white. The red globules, each about tire three- 1 lion sand th of an incl» in diameter and the teu-thonsandtli in thickness, are fonr-lrundred times more abundant than the white. In the lungs they receive oxygen from the air, earlx>nic acid being given oft* as oxygen is taken in. In the extremities of the circulation ttiey give up oxygen, and, as I have elsewiiere shown, assist in condensing the carbonic acid formed during the animal combustion. The fluid in which the corpuscles float, — Liquor sanguinis, — is composed of water, albu- men, fibrine, and saline matter* The proportion of the parts of the blood in the thousand is t — water, seven hundred aud eighty- four parts; l>lood corpuscles, one hundred and thirty; albumen, seventy ; flbrine, two and a half ; fatty fiubstauces, one and a half ; chloride of soditmi, — common Bait, — three ; other inorganic salts, two ; extracts of grape sugar, coloring substances, and organic salts, six. Iron is one of the inorganic constituents of the blood ; it exists in the red blood corpuscles.
Mliile tlio blood is circulating in the body the whole mass seems fluid, the red corpuscles being afloat in the stream, and so mobile as to convey the idea even of their fluidity* But when blood is drawn the fibrine separates and coagulates, or sets, enclos- ing the lOood corpuscles in its setting, and forming that red blood clot by whicli wounded vessels are phigged up and closed. The arterial, red, or out-going blood contains the oxygen ; the venous, dark, or returning blood contains the carbonic acid. The tejni>er' ature of the blood is 99° Fahrenheit. The arterial blood goes forth in jets from the heart ; the blood in the minute vessels flows
A PHTSIOT.OOICAL OrTLFNE.
78
I
throngh a sponge ; the venous blood flows in steady circuit %)wards tiie lieart.
The luartj the central driving organ of the circiilationj we bould find to be^ — if we carried our inquiry fio im\ — made up of "mnscular fibres, in fact, a strung mnsciilar organ. Wc should diw^over that it possesses an iudepeuderit ar-terial nrtd venous eir- cuktion of blood, and that it la fed by the first supply of blood which h, itself, j>ours forth. Wc sliouKl learn tliat it has twoh'no!^ of nervous BUpply, one stimulating it to motion, the other control- ling its motion. On its out&ide, the heart would be disclosed as coated with a strong fibrous membrane whlcli can he stripped off its surface, and tlii& membrane, reflected on and over the heart, would be observed as enclosing tfie organ in a membranous bag, — the pencardluttu — containing a small quantity of serous or Bricardial fluid. Inside the moseuhir organ we should find aother tine strong serous inendjrano Hiiiug the walls and the four •tela of valves of both cavities of the heart, — the emlomrdium.
The iirtrrieH^ if w*e looked into their struettire, would exhibit a smooth internal lining or coat,— epithelial^— j^urronnded by a eoat of elastic fibi^s. Next to the elastic fibres would be detected miihlle coat of circular miiseiilar fibres w^ith some interwoven ilaiatic tissue; and outside all a firm strong coat, made up of con- nective tissue containing some more elastic fibres. Thus an artery is elastic under internal jiressnre or dilatation ; contractile by its ttwn muscular power ; and strung and resistant by its external investment.
If, following up tiie arteries, we paused to consifler next the minute cir^ulatlmj or cttjfillary system^ w*e shoulil come upon a sim- pler but much more extended vascular arrangement. We should fnd a web or net'W(»rk of vessels, springing from divisions of tlie cries, and themselves now of nearly equal dimensions, one- three-thousandth of an incli, througliont. A lining and surround- ing membrane is all that would be found in the finer structure of *L,.,^ ve-ssels : but there would be exposed a free supply of nerves, r the influence of which the small vessels would either con- tract or dilate, as directed by the nervous current, Tlie contents would still be the blood, the corpuscles of w^hich would be seen to pa^j* in single file, through the eapillaries. The inner lining of tiie capillaries, derived or continuous from the arteries, would be traceable into tlie vems.
80
THE SEATS OF LOCAL DISEASES.
The veim rising, as it would appear, from the capillaries and passing on towards the heart, increasing in size as they progress, would be disclosed to us next as a series of tubes closely retetn- bling tlie arteries hut let^s strong in striieture. Internallj we should detect in thetn a similar epithelial cuat or lining; around tliat a lining or coat of cii-cular museular fibres witli some elastic fibres ; and outside all a covering or coat of connective tissue. In addition, the veins would present interiorly a series of small valves, derived from their inner coat, which open upwards and direct the blood onwards in its course to the heart.
Shall any local disease visit this circulating system the result must be some disturbance of the balance of life. Let the blood be changed in physical property ; let the heart overact or fail in its beat ; let the valves of the heart get wrong; let the arteries or veins give way ; let the vital arena of the minute circulatioji be the seat of change, let its minute vessels distend or bi^eak, itd fire glow too fiercely, or its fire die out in w^liole or in pai't ; and the result anust be disturbance of the balance of life.
Tdtk Resptkatory System,
From the circulation and the parts of which it is, as a sys- tem, composed, we would next, naturally, tuni to the respiratory system at which we did ah^eady briefiy glance when our attention was directed to the course of the blood from tlie right tu the left side of the heart. In the respiratory mechanism we should ob- serve the mode in which the blood is changed from tlie dark venous to the red or arterial hue. We should see in the two spongy organs, the lungs^ one on the right, t!ie other on the left Bide of the chest, the vessel which comes into them from the right ventricle of the heart dividing into two large branches, a branch for eacti lung. We should observe, further^ that the vessel belonging to each lung divides again into smaller Ivranches, and that these smaller branches, after numerous diviij^ions and suhdivisionsj become, at length, a vast web of very fine ve>sels, like to the minute circulation of the body at large. We should, in this instance, however, detect a difference, owing to the in- troduction of a new element into the refined circulation of the lung. We should discover that in tlie net-work of the minute vessels of the lung as the vessels pass on in their course to form the comineuccnient of veins, there are interposed mill-
>OICAL OUTLINE.
^1
^
ioiis of little vesicles or bladders, over the outer surfaces of rkich the web of vessels spreads. Wo should find that with
h breath drawn the little vesicles expand, while w^itli each expiration of breath they contract, so that tlie whole mass of the long expands and contracts bj the expansion and contrac- tion of the whole mass of the vesicles. Tracing out tlie meaning of this we should learn tliat the tiny vesicles are the terminal poaehes or cysts of small tubes from which they cluster, some- thing like as grapes cluster from their sterns. Follow^ing the tubes from the vesicles we should trace them becoming larger and firmer, until at last they became large strong tubes lined with mtteons membrane, coated with mucous secretion, and filled with air. Finally we should see tliat the tubes, as they increase, Ive- come firmer still, — constructed now of rings of cartilage, — an<l that at last they emerge, by a single tube, from the right lung and the left, to form one commfjn large tulie which runs up to the tliroat, and opens into the throat by a chink from which the sound issues when the voice is heard. The anatomist would tell us that the tubes springing from the little vesicles are the niinute
liiications of w*hat he calls the bronchial tubes ; tliat the larger %ibes arc the bronchial tubes themselves ; and that the final large tube, ending in the larynx or voice-box, is the traeliea or windpipe* The anatomist would also explain to us that all the parts named as belonging to the lungs, the large blood-vessels, the minute blood-vessels, the air vesicles, the bronchial ramifications, the bronchial tubes, are united together, in each lung, by connective tissue and by abundance of elastic tissue; and that each lung, made up of a great number o£ little lobules, all con- etructed ou the one plan, is finally included in a deHcate, semi- transparent sensitive membrane. This membrane surrounding the wiiole spongy mass, is reflected over the walls of the chest, enclosing the lung in a double bag, — the pleural vfiembrane, or pUurtiy — tlie bag or space of which is tlm pleural camty.
If, now, knowing these general facts of construction, we looked at the intention of so much fine and beautiful mechanism, we should detect that in each act of breathing the chest, by its expansion, draws, like a bellows that is being expanded, a quan- tity of air, from three to four cubic inches by volume, into the Inngs through the windpipe; tliat under this the small air vesicles ftro filled with air ; that during the expansion of the vesicles the
THE SILVTS OF LOCAL DISEASES.
blood, wiiicli courses over them m the ininnte eircnilation of the liiugj changes in color froiri dtirk to red. We shoiihl further de- tect thatj in expiration, or emptying of the chest, the vesicles contract, and give back into the bronchial tubes and into the windpipe, and bo into tlie outer air, tljo game or nearly the same quantity of air as that whisjli they took in during inspi ration.
One change more would demand our attention. T!ie air wliieh tire tiny vesicles I'eceive in the act of drawing in the breath is com mull atmo&pheric air. It i^s a mixture of two gases in iin* equal quantities. Nearly four parts out of five are made up of a gas called nitrogen ; rather more than one part is made up of a gas called oxygen, in which gas suhstances capable of going into flame or of being more slowly consumed by slow combustion, burn^ with evolution of heat. From this atmosplieric air then wc slioiUd see, as it passes over into tlie air vesicles, a certain portiun of oxygen extracted by the blood. The myriads of small disks of red color floating in the blood stream would be rtbserved to seize upon the oxygen till saturated mth it, while the blood woidd give np, in return, into the brouehial tubes, the windpipe, the mouth and nostrils, and the outer air another gas, a mixture of oxygen and carbon, — carbonic acid, — with some returned nitrogen, and with some unused oxygen.
Presuming that we were not acquainted with the nature of this curious process, we might tltiuk that by tliese interchanges of air and blood some heat was produced in the hmg when the dark blood began to glow. The industrious scholars who first noticed these changes thought so, naturally enough. We know better now. The process is all for this primary end, that the blood may be cliarged with oxygen and may carry oxygen into that minute circulation of the body at large which we have already seen to be the vital arena. Tliere tlie oxygen is to be given up; there the animal fire is to burn ; tliere the carbon supplied by the food is to consiime; and there the blood, losing its oxygen, is to exchange it for the newly-formed carbonic acid, and to convey that product of combustion to the lungs, to be cast off by them.
To render the physical mechanism of the lungs more perfect, there is planted,^^ — as the microscope would next reveal to us,— all along the mucous membrane covering the bronchial surface, not -only bronchial glands to afford secretion, but an exquisite ap- paratus called the ciliary. Tide, if we got to view it, would be
A FHYSIOLOGIOAIi OtTTLINm
83
found to conftist of an initnense number of fine prociGsses, — cz/«4ar^ — which pave tlie ttiiicous membrane round the tubes and keep ever iii motion, like the waving motion of corn in the bi*eeze, to- wards the outlets of the tubes. Thus tine particles of offending dust drawn into the depths of the king?, in iiispiration, are wafted back bj the cilia, and brought into the throat by the windpipe, are removed from the lungs by being expectorated or swallowed.
Shall any local disease visit this respiratory system, tlie result must be some distm-bance of the Imdy at large. Let the bnmcJiial ckaimels be obstructed, then the animal tire, unfed by vital air, loust decline in proportion to the obstruction, even to the extent of going out altogether. Let tlie air contain some gas or vapor that modifies the character of the respiratory act or carries new matter into the blood, and tlie whole body must suffer. Let the tninute air vehicles bo charged with fluid, or be congested with blood, or bo dilated, or broken, and the whole iKnly must feel the dtstnrbance. Let the structure of the lungs be the eeat of a new growth, and the whole body must suffer soiriething from the mis- chief. Let the heart fail to send arterial ize<l blood to the minute circtdation, or blood that cannot sustaiu combustion, and the whole body must needs collapse. Tx;t the sensitive pleural mem- brane be injected with blood, or rendei-ed dry and iutianteii so that its surfaces rub one against the other, and pain will follow, from the lowering effects of which all the body will sympathize. Let the surfaces of the pleural membrane be fixed by adhering one to the other, or be compressed by an excess of fluid secreted between I hem, and so much breathing power must be lost, to tho comparative detriment of all the organism. Lastly, let the elas- ticity of the elastic fibre of the lung tissue become itnpaii'ed, and tho vital capacity, as a whole^ must suffer relative impairment.
The Nervous Systems,
Keeping our attention still directed on the construction of the Ihiug man, looking through him still, we should remark that in pirta of liifl organism, on the terminals of his vascular system, there are certain solid organs from which spring an infinite num- 'ber of cords and threads, to traverse tlie body in as many direc- tions 4M the blood-vessek thcmselveis, and to enter freely into the fleahj »tmctnre«, to wliich, at times, they eeem to impart motion. At th<s uppermoBt part of the body, crowning the whole, and
84
TirE SEATS OF LOCAL BISEASE8.
occupjing the cavity which we call the skull, the largest of tlie&e organs, — tits hroinj — will lie before \\^, It fills the cavity of the fikulK It is divided into two parts, one part large in front and above, tlie other email and ocnicealed behind the larger, and both divided by a vertical or perpendicular separation into two sections or halves. From the back of these structures we should also see a cord of the same kind of substance extending along tlie central opening in the long column of bone known as the spinal colnnm, — the sjnnal cord. From these great centres in the cavity of the ekull and in the cavity of the spine, we should next see a series of small white cords, proceeding to their various destinations. The anatomist would tell us that the large mass in the fore part of tlie ekull is known as the eerebruitu or larger brain, and that eai'h half of it is callefl a hemisphere ; that the smaller lower mass, — seven times smaller than the larger,^s known as the certbdlum, or smaller brain, the two halves into which it is also divided being its hemisphei'es ; and that the long cord passing along the spinal canal is the Kjdnal eordy the first part, a little more than an inch, proceeding from the two brains, — fur lie wonld show us that it does proceed from both, — being particularly defined as the medulla oMonffaM. The smaller cordis that come o§ from the brain and from the spinal conl he would designate as nen^cs. He woidd explain to us that all these parts, large brain, small brain, spinal cord, and nerves, form one great system, of which he would speak as the mrehro-jijdnal fnf stein, ; and he would demonstrate that tlie centres of tliis system are not merely covered by bone, but by membranes also, three in number, l^pim the actual sur- face of the brain and spinal cord he would show a fine web of blood-vessels, a nutrient membrane, i\w. pia mater {gooA mother); above that, and coequal with it, a delicate serous membrane, so delicate that he calls it the araehnoidy spider-webdike membrane, yet active enough to secrete a layer of tluid to interpose between the brain and the firm over surmunding parts; while enveloping the whole, he would exhibit to us a strong, hard, fibrous, white membrane, inelastic and smooth, lying between the delicate arach- noid and the inside of the bony cavity, which firm membrane he would call the dfira mater (hard mother). Turaing then to the brain and spinal cord enveloped in the three membranes, — pia mater, arachnoid, and dura mater,— he would describe to us that they are each made up of two kinds of nervous matter, one di&-
I I
I
A PHY8IOLOGI0AL OI7TLINE,
86
tinctly white, the other as distinctly gray. In the braiii he would bid OS observe that the gray matter is all on the outside and gath- ered up into folds, or convolutions, the white in alter being eu* dosed within it ; while in the spinal cord the gi'ay is in the centie and tlie white on the outside* He would &how, too, that the gray matter, very rich in blood supply, is composed of an infinite number of minute cells, held together by a soft nervous connec- tive substance, nerve cement ; and that the w^hite matter, more clearly linear, and made up of fibres sinularly connected, is the apparent origin of the nerves wliich arc passing from the centres to deploy over the body at large. In relation to the nerves he would indicate that some go from the brain to special structures, tlie eye, the nose, the ear, — nerves of special sense ; and that the nerves which issue from tlie spinal eoi'd pass off from it in pairs on each side the cord, lie would trace out thirty-one pairs of spinal nerves, each nerve having two origins or roots, one from a back segment, the other from a front segment of the cord, which i» in fact built up of four columns, tsvo on each side, as if for this apacial pmf»ose of dividing the nerves itito pairs on each side.
Of the nerves themselves he would give us a ready detuonstra- tJon. Ue would show^ us that the nerves going from the brain to the organs of the senses spread out, at their terminations, into a sheet or scj^een, endowed with active cells like a small spread-out brain, at the far end of the connecting nerve. He would show that the nerves wdiich go off from the spinal cord, divided into two roots at their start, soon unite into common or compound nerves, and that these combined nerves, with others fi'om the braiTi not destined to go to the organs of the senses, are distrib- uted either to the fleshy parts or muscles, or to membranes and •kin. Here, in their hifinitely fine terminations, they w^ould be found making a surface or net- work equivalent to the vascular net-work we have already surveyed, and probably equivalent in material quantity to the nervous centres from which they spring.
And now if, turning to the meaning of this elaborate con- tiction, we could mentally realize w^liat was effected by it, the loiinn would indeed be curious. Vfe should see that whenever •iiexlaroal vibrating impression,— a picture to the eye, a sound lalihfrMri a friction on tlie skin^^is luade on a part of the great terminal nervous surface, the vibration is conveyed directly away
ilktt commuaicating centre, telling it, as it were, what haa
86
8EAT8 OF LOCAL DISEASES.
occurred. Or we glioiild see some indication of will made in a centre, and conveyed from thence to the nervous teniiination, bid- ding that to set in motion miiscnlar fibres and creating, for a time niotioti of body or limb. We ebonid notice that all kinds of motor connections from the centre pass throogh the front cohinms of tlje spinal cord ; while all connter ini press ions, from the ex- trejnities of the nerves to the commanding centres, pass throngli the cohvmns that are at the back of the spina! cord. Thus in the cerebro-spinal system we should witness the connections between will and actions of will ; the mode by which the physical impres- sions of the outer world are poured into the inner man to inspire him J while he lives, with the life of the onter world ; and the mode by which he responds to, or reflects back, those inspirations.
But another survey of the nervous microcosm would he neces- sary. The cerebrO'Spinal is one nervous system. There is a second. Our anatomist, ready to instruct us here also, would dis- close for US the centres of this second nervous system, not in tlie bony cavities of the skull and spinal column, but in the trunk of the body itself, in the great cavities where lie the lungis, heart, stomach, and intestinal canal. Behind these organs and running in front of the spinal column, on both sides of it, he would point out a dcnible line of suiall masses of nervous matter, — (/anfjlia. These, he would indicate, extend, on each side, through the neck, np to a point inside the skull a little above the eyehalL Of these masses, the largest not much larger than an almond, he would count for us twenty-eight in each chain. He would demonstrate, springing from these centres, sets of nerves which pass off from each centre in four directions, and often closely couununicate in their course with the nerves of the cerebro-spinal system. He would tell ns, that in addition to this chain of ganglia there are other distinctive ganglia and plexnses of sympathetic nerves con* nected with tlie heart and all the vital organs; and one great gan- glion, the seffiUunar, near to the stomach, which receives branches from the cerebro-spinal system, and which sends off radiating fibres to so many organs,^ stomach, diapliragni, liver, kidneys, and intestines, — that it was calledj by the oldest physicians, the great solar or radiating plexus.
But chiefly would the anatomist interest us by pointing ont the leading course of the sympathetic nerves from their chain of ganglionic centimes, in the direction of the lines of the arterial
A PHYSIOLOGICAL OUTLINE.
87
hlood-veseels. He would expound foreil>ij and do all in hi« power to fix on our nieinories the fact that whei'ever arterial blood-vessels are distributed, whether thej^ go to mugcles, or glands, or nervous uiaseee, or ineiDbraues, or skin, or to their iin^t tenuinations in the vital arena^ they are attended, to their ultimate branches, by a fibre from thiu syfeteui of organic nerves.
We lcx>k, naturally enough, as we witness this demonstration, for an explanation of its meaning. We gather on inquiry that if we could see the niecbanisin, it is this. The nervous masses of tl»e eliatn are the centres of what is known as the sympatlietie, lie, vegetative, or ganglionic system, and they are called, aa ire know, ganglia. In tbem, from tlie bkK)d which supplies them, nervous foi-ee or stinuUus is always being produced. From tlieni the nervous influence is at all times passing, independently of will, automatically that is to say, tlirougU the nervous cords to the arterial tubes and to their terminals. Over these fine blood- ressels, at their extremities, the nervous influence so supplied exerts a perfect eontn:»l as long as the action is steadily main- tained, and by that control the vessels of the minute circulation jir& regulated. Each vessel, fine as it is, being tluis obedient to li€nrDUS direction, is so governed that, under the t^troke of the lioart, it shall admit the right quantity of bluod, and distribute the proper supply to the vital arena witli as much order and rhvthm as the pulsating heart ^hall deliver the supply.
These are some of the phenomena derivable from our survey i»f the nervous systems, The knowledge is a treasury as applied to the diseases of hmnan-kimL iSliali the great ctintres of the i-erehro^spinal system be injured, how can they receive extenial imprejisions, how can they deliver commands in response^ or reflect imck what they have received, in due time and order ? Shall the nerves conveying sensiVJe impressions to a part be interrupted m their work, then the part, cut off from its nervous centre, nnist he rendered senseless. Shall the nerves conveying motion from a centre to a pai*t be interrupted in their fimctiou,tbe part must be rendercHl motionless, — paralyzed. Shall a |>ortion of nerve in the nervous cii^cuit bo excited, or irritated, tho iiTitation, reflected by intercommunicating fibres to many centres, may produce various niovunientfl or sensations which may he quite remote from the original direction, as well as iu it. Shall the expanse of an oi^n of fiense be over-excited, tho effect may tell, perchance, on all
88
THE SEATS OF LOCAL DISEASES.
centres, Sliall an interriiption occur between an organ of sense and its centre, tlie sense will fail in proportion to tl^e interruption. Shall the centresj the masses of gray matter of brain and spinal eord cease to act ; shall the active cells which move in the con- necting substance or nerve cement die out ; or, shall their sur- runnding snbstanee become, as it is apt to becomCj too ^ulid and linn; then all parts supplied from oerebro-spinal tracts thus in- jured will, virtually, live a vegetative life, receive no impression, deliver no impulse nor command.
The most striking piece of learning of all, wonld^ howeverj be gleaned from the study of the automatic nervous regiilatiug pro- cess earrieii out by the second nervous system, the organie, sym- pathetic^ vegetative, or ganglionic nervous chain, the nerves of which follow the arteries throughout tlicir course. Shall this nervous system be subject to disease, functional or actual, then instantly tlie tiile is told. By a sudden blow or mental impulse of surprise or emotion the centres of this system being for a mo- ment overpowered, tlie blush of i-ed blood on the cheeks and over the surface of the body will declare that the control over vessels has been checked as far as the termination of the nervous fibre ; while the glands that may bo involved in the same slmck, and for the same reason left uncontrolled, will weep and pour out their secretions in copious streams. Shall the shock be so extreme as to communicate a vibratiuii from the centres, the nervous fibres will be irritatc^i t^o decisively as to close the arteiial ternanals and shut off the blood stream in the vital arena. Then sudden and death-like pall«>r will seize the t^urface of the Ixvdy ; the brain- cells, uuBupplied, will fail to yield consciousness; a loatl of bl(»od cast on the struggling heart, itself the first organ to be robbed, by the shock, of its arterial supply, the heart will sink in its beat, and all tlie powers prostrate, there will be prinuiry death, syncope or faint, an apparent prelude to that which shall close all access to impres^iion and all impulse of will, death.
Again, sliall tliese organic nervous centres be injured in parts 60 that local supply from them is impeded, then the stiiietures they quicken wnll suffer in proportion to the injury. The vessels will be congested of l>lno<l or surrounded by effused fluid derived from blood which may uiulergo a false organization, and all the natural functions l>ecome deranged.
Lastly, if tlie extremities of the nerves of this organic system
A PHYSIOLOGICAl. OUTLiyE.
80
be affected, as they are etmstantlj', hy varioiis changes, of heat, or eold, or uiecbajiical motions acting upon them, thereby interrupt- ing the current supplied to Uieni from their centres, tlie effect ou tijeir function i& iustantaneoua. The part or organ to which they minister is made red, or pale, is heated or cooled^ as if by the mem lotion of the agent itself that exerted the change. Thus tlie tin held before the fire glows ; the skin held in the cold grows "white; the skin recovering from exixisure to cold grows retl and [*ls hot; the hand covered with .tm-pen tine or mustard reddens ad bums; the eye irritated, the lachryraal gland weeps; the membrane of tlie nostrils excited, is fii*st made dry and then pours forth H secretion, — catarrh ; the lungs taking in first a warm and then suddenly a cold air^ become congested with blood ; the kings inhalnig a gas whicli excites thera, the whole body is rendered red or pale, is convidsed or collapsed. In each and all of these disturbances it is the organic nervous chain or its fibres that have experienced the shock or communicated the results,
Thk Sensoky System*
While yet our nunds were occupied with the task of observing -the construction of the nervous organization we should see con- t^-ted with certain parts of it a special adaptation for bringing it into communication with the motions of the external world. >Vo iiould discover in connection witli it two organs of purely optical "€hanicter, for condensing and focussing light, for receiving a pict- ure on a nervous screen, and for letting that picture pass to the brain* These are the organs of sight* We should see two other orgiins for collecting the atmospheric waves which citnse sound, for receiving the impressions so collected on a nervous expanse, for transmitting the impressions to the brain. These are the Organs of hearing. We should discover, in a third part, a ner- vous surface supplied with a much simpler plan of condensation, for n?ceiving the impulses, in this case perhaps purely me<*.hanical, which odorous particles impart to the ncrvuus sense. This is the ^an of smell. We should discover in another portioti^ at the tip* of the fingers, a small nervous body containing a little gray utter and surmounting a filament of a nerve for receiviug tiio leiNai impressions conveyed by delicjite pressure on an external object. This is the organ of touch. Lastly, in a less perfected Eld csertam form, we should discover a nervous expatibo in a por-
90
THE SEATS OF LOCAL DISEASES.
tion of the tongue and palate, for the reception of inipreseioiiB conveyed by foodu, dritiks, and otlier substances which may enter the nionth. This is the organ of ta&te*
Our ariatouiist would describe to us in respect to these organs that 111 every instance the design is carried out on the same prin- ciple, though tlic details vary considerably in each case. He would show to us that there is, in all instances; (a) a collecting part of the organs for bringing together the vibrations that have to be absorbed; (i) a receiving nervous surface for taking up the im* pression ; (c?) a sj>ecial nerve, originating in the nervous receiving surface and going to the l»rain, for conveying tlic inipression ; (</) a receiving part within the brain itself, by whicli tlie impression is finally brought into the physical domain of thought and con- Bciousness.
Defining these general facts by and from the special organs, the anatomist would sliow to ns that in the organ of vision the condensing part consists of three duly fldju6tc*d lenses: of the cornetfy or concavo-convex lens in frunt of the eye, tixed into the hard sclerotic white coat wluch forms the outer part of tlie ball of the eye; of double convex lens situated further back within the globe of the eye, and called the enjstaUine hns ; and of a third fluid transparent structuroj concave in front, convex beliind, made up of many segments in membranous divisions, and filling the greater part of the glt>be, tlie tufrmtjs hunwr or lens. He would show also that betw^een the first and second of these lenses there is a perforated curtain which, responsive to the stimnlus of light, closes or opens automatically, so as to exclude light oi- admit it freely according to circumstance, the iris, lie wuuld explain that the inner surface of the globe of the eye behind the curtain is clothed with an absorbing dark coat, the choroid * and that on the choroid is spread the nervous expanse, the rvthui^ for receiv* ing the picture or impression of the objects whicli gave or i*eflected the waves of light. He would show ns the nerve, the optic iwrve^ whicli proceeds from the retina of each eye to the brain; he would trace tliat nerve in its coui^se, and point out how on each side at a certain point wi'tliin the skull it meets and conjinns with its fellow from the opposite side, and tlien passes on in separate or amalgamated tracts to the brain to be lost in the matter of the cerebrum. Lastly ho w^ould describe liow the eye is moved in the orbit by six muscleSj and how it is lubricated by a tiuid, secreted
A PHTSIOLOOICAL OUTLIKK*
91
from a gland 1 ving above it in the onter comer of each eye, the ichrrjmal tjland^ the fluid inm\ which, after it has flowed over :ie eyeball, escapes by a minute opening, tlie ktehnjmal duci^ xind, finding a ready passage into the nasal cavity, on each side, is disposed of there by evajxiration.
From the eye, as the organ of sight, our guide would lead ns to Uie organ of hearing, the ear. He would show lis a tube on each ide of the skull, for the colleetion of sound, leading inwards the ^distance of three-quarters of an inch, the tfuatuji audli^rlus cxter- ntu9, lie would show ns a ineujbrane stretched across the bottom of tlie tube, like the head of a drum, the tymjyamim. Beyond this he would lead us into the middle ear, a cavity into which ho would show us an opening from the throat by a tube, culled after it« discoverer, Eustachius, the Eustachian tube. In this cavity he wouM indicate four mimite muscles for the regulation of the tyrn* mum and three snuiU bones, the inall^u^^ hunis^ and stitpes^ the kmmer, anvil, and stirrup,— so named from likenesses to those in- "itruments, — stretching across in a connected line from the inner enrfaee of the tympanum to an opposite surface in which are two arnall openings each covered ivith a membrane, and on one of wliich meml»ranes the foot of tlie stirrup is planted. This middle ^ear, he wotdd tell us, is tlie tympanic cavUtj, tlie opening into it [>ni the throat being intended to keep up a balance of air on both wdes of the tympanum, so that the tympanum may vibrate freely, without pressui*c from within the cavity. Next he would take us into a third and innennost recess of the ear, the part which the Ider anatomists, in their ad mi Hug wonder, called the hihjrhxth^ 'knd which is indeed to this day a labyrinthine mystery. He would point out tons in this internal ear two nervous surfaces; one spread out on membranous tubes filled witii fluid, endoli/mjih, en- closed in three semicircular canals ; the other spread out on a fine membrane laid on a tspiral layer of bone, the coehha or shell. From these nervous expanses, so singularly formed, he would ehow us tlie origin of another nerve of sense, the andito/y nerve, Ue w*uuld trace this nerve for us out of tlie t^nijtoral bone, through opening in its hard, or petrous part, the rneatm auditorius in* ' kniySy into the cavity of the skull; and, he would finally trace the nerve, which lie would tell us is like a nervous trunk of the great «ivmpathetic chain in its consistency and construction, first liy an obviuua tract into the substance of the brain, and after-
92
THE SEATS OF LOCAL DISEASES.
wards, as Bome euppoeej into the organic chain of nerves. This median ism we should perceive is all for condensation and trane- iiiissiou of sound. Under the vibration of the external air the tympanimi vibrates. The vibration of the tynipanmu h Qonnuu- nicated through the ndddle ear and the nienihraneB at the back of it to the nervou8 expanses in tlie labyrinth* TJie nervous ex- paiiiies receive the xibrations, and through the auditory nerve tratismit tliein to the bensoriuni. Membranes, nnieelei^, bones, fluids, nerves, all play their parts in this exquisite [jhysical mech- anism. Tliese parts, again, are fed from hlood passing into them by minute l)]ood-vcssels ; and these blood-vessels are regulated and governed by nervous force.
Passing from the ear to the sense of smell, our anatomist would show to us, within the cavity of tbe nostril, an elaborate surface of nervous membrane laid uut tu i-eueive t!ie ultimate fila- ments of another pair of nerves of special sense, the olfactort/ nerves. lie would trace up these nerves, one on each side, into the cavity of the skulL Here ho would expose for us t\vt> enlarge- ment's of these nerves in their course, the olfactory bulbs, from which the nervous filaments descend to the nostril ; and he would follow the nerves back in their tract until tjtey are lost in the bu1>- etance of the brain.
In tliis mechanism we should see a simpler means for obtain- ing an impression than was presented in the two other senses. If we passed to the organ of touch w^e should find that sinjpler still, for thei*e we should discover an ordinary nerve endowed, at its termination, with a minute ganglionic structui-e for receipt of im- pressions; while in the sense of taste even this niodiiicatiyn is absent, — a common sensitive nerve, spread out on tlie mucous sur* face of the tongue and palate, doing the special work. But in every instance, simple or elaborate, we should find the principle to be the same.
We beconae conscious, at once, as we learn these various parts of the different organs that very slight changes in them are suf- ficient to make varieties of disease. If the collecting surfaces be injured the function of the organ must be perverted or destroyed. If the receiving surface of the organ be damaged or made imper- fect for reception in any way, the function of the organ must be deranged. If the transmitting nerves between tlie receiving sur- face and the brain be interrupted or obstructed, the function of
A PnTSIOLOGICAIi OirTLimB.
93
the organ mnst be disturbed or suspended. If the brain at the jwint of reception be affected, however perfect all the other parts may be up to that point, the impression from the senses must be imperfectly appreciated. Injury to an organ of sense may more- over be indirectly injurious to other organs or parts. One eye is easily affected, sympathetically, from injury to or disease of the other eye. But of all organs the ear h that which excites the widest range of physical sympathy. Derangement in the ear may be communicated, by sympathetic nervous agitation, to all the body. The body may be actually stunned by sound. Every vi- bration of a harsh and shrill nature "goes through the body," as it IB said, with pain and suffering; while pleasant sounds, sounds of beautiful music, thrill every nerve and make the body dance with pleasure and delight.
The Absorbknt and Glanbular System.
The absorbent and glandular system is made up of a series of tubes and of masses of fleshy-looking matter wliich are called gland^j and which are dispersed over various parts of the body. If we continued our plan of looking through the man we shouhl see glands in every cavity of the body, and beneath the skin m many of the external parts, as in the arm-pits, groin, and neck. In the structure of the skin itself we should discover, deep down in it, many thtmsands of small sweat glands.
In this display of structure wo should be first impressed by the fact that tliere are various kinds of glandular systems in the body. We should see one system^ quite distinct in itself, pofl- aewing its own proper vessels or tubes connected with its glande, and charged with a fluid either of a limpid or of milky character. This our anatomical teacher would tell us is the ahsorhcnt or lyin- pfuUi4* ghmdular system. We should discover next a series of glanda connected with the vascular system and seeming to be made up of arterial vessels from which they derive all their fluids, and this system M^e sliouhl be told is the vasetilar glandu- lar syidem, looking still closer at the vascular glands we should see that they are of various kinds. In some we should find an artery enterifjg and a vein coming out of the gland, but no other tube. These are called ductless ghmdj^. In others we ehould seo an artery entering the gland, a small vein coming out of it^ and,
94
BEATS 01
kSES.
in addition to the vein^a new tube which is called a duet. These are dud glmuh.
Analyzing tlio facts further, we should detect that the duct glands do not return all the blood they receive from their arteries hy veins, hut yield by their ducts a new fluid, which, like the fluid that flow8 from the duct of the gland called tlie liver, — tlie bile, — ^may be going forth to be partly taken up again into the blood, — a s^'cretmn : or like the fluid froni the kidney^ — the urine, -^may be entirely an excrementitious fluid going out of the body, an excretiofu
Thus wo should see in the glandular gystem alisorbent glands and vascular glands. Of tlie vascular glands we fclioukl see duct- less glands, and glands with a duct. Of the duct glands we Bhould see some which arc secreting fluids that are about to be applied to the purposes of the economy ; others which are excret- ing fluids that are no longer of use in the economy, but require to be voided.
Tracing out the absorbent glands, we should find thetn to be connected %vith a series of vessels called the lyniphatici or lymph- collecting vessels. In the body these vessels would be seen to rise iudepcndeutly of the vascular system, and after coursing a dis- tance along a limb or part, in the connective tissue beneath the skin, conveying a white lymphy fluid, into a gland ; from whence, by a new tube, the course, perhaps through other gbifids in line, would bo towards the heart. Finally the system of alisorbent tubes froni all parts, gathering together near the heart, would be seen to pour their fluid or hptiph into one of the large veins close to the heart itself, where the lymph minghng with the blood en- ters the circulation by the right auricle.
In the intestinal canal the absorbent vessels would be seen to rise from what are called the villi of the small intestine* Ilem, rising by an immense number of radicles, they w^ouhl be observed to form into tubes, ItitienU^ which convey a milky fluid derived from the digested food, and, running along the folds of the mes- entery, to enter a series of glandular masses called the mesenteric glands, Ehiborated in these glands, and transformed into t-hf/le^a fluid now containing white celle, we should see tliis fluid passing out of the glands by an exit tube, and through other tubes on towards a point a little below the middle half of the spinal col- umn. At this poiut tlie tubes from the mesenteric glands all col-
A PnrSIOLOGICAL OtTTLINE.
95
lecting into a small receptacle* the recejtta/^iilum chyUy become one tube, the thoracic dut% wliicli makes its way, as we slmnld discover, in the line of the spiuaL column, towards the heart, to enter with the other lymphatic currents into the venous system find into the circulation, by the right auricle*
Turning from the absorbent glands to the vascular^ we should be puzzled about the ductless glands. We should find four of tiiese deserving our special notice- One in the front of the neck, called the thyrmd^ the gland that is enlarged in cases of ** full jftock,'^ or "goitre/' Another, very large, in the cavity of the aMomen, the aj^^en^ the gland that is enlarged to form what is called "'Ague cake;"" and two others, one on the upper part of each kidney but separate from it, the suprarenal cajMul^s, Our anatomist would tell us that as the blood courses through these ductless glands it is changed for some important purpose, the precise natui*e of wiiich cluinge he cannot define.
Turning, lastly, to the vascular glands with ducts we should find, in each case, a vascular and tubular system, with a secerning or sepamting cellular ari-angement, and with a rich nervous supply for regulating the amount of secretion or excretion. The salivary glands we should see secreting saliva ; the stomach glands gastric juice; the pancreas pancreatic jmco; the liver bile; the lachry- mal gland excreting tears ; the skin glands sweat ; the kidneys urine I the glands of the mucous surfaces the fluid excretions of the bronchial passages and of the intestinal canah
Shail any derangement take place in these systems of glands Iba effect on the body is, of necessity, marked in various ways and forms of disease. If the absorbent glands fail to act, there is loss of supply to the blood, and therewith exhaustion and w^asting. If they absorb what is foreign to them, there is poisoning by the ab- sorption. If the ductless glands are perverted in action, there is «et up several kinds of obscure, but serious diseases: goitre ; white blood cell disease ; bronzed skin disease, — ^Addison's disease. If the secreting glands either fail or overwork tiiere is direct irregu- larity of their physiological function and power. If the excreting glands fail, there is retention in the body of water and of various ©xcrementitiouB, or, it may be, poisonous product? ; while if they overact, there is catarrh or flux, and exhaustion from that cause. Finally the coudition of the glandular system is of special im- portance, from the circumstance that the secretions derived from
96
TnE SEATS OF LOCAL DISEASES.
tlie secreting glands are apt, nnd themselves poisurioiis^ and in tkis diseases that are communicable. is a vindeiit poison ; the secretion ease sjphiiis is a virulent poison ; dered animal is a virulent poison other glandular fluidsj as we shall
er some conditions, to become manner to be the promoters of Tims the saliva of the rabid dog which produces the specific dis- ; the nasal secretion of a glan- ; and, the same may be said of ultimately discover.
The Musctlae System*
Keeping our minds still on the living man, we should see in hini a set of orirana that, under various impidscs, are excited to movements bj which parts of the body, as the limbs, or the w^hole of the body, may be moved. These the anatomist would tell us are the rnu^chis or mnscolar organs-, the engines of the organism. He would explain that in tiie body there are three classes of mus- cles. One class made up of the ordinary red muscles of tlje limbs and trunk, which w© can order to work when we like,— the volun- tary/ muscles. A second class composed of muscles of similar con- gtruction^ but only partially or indirectly under our will, the heart and the muscles used in breatliing, — the semi'Voluntary muscles. A third class composed of white muscular tibres, delicate in struct- ure, wliieh surround the intestinal tube, tlie stomachy the bladder, and the arterial blood-vessels, which do not act under the direc- tion of the will, but which keep tlxe vegetative life gtnng, inde- pendently of ourselves, our business, or it may be our inclinations, — ^the involuntary muscles. The anatomist would show us that the voluntary and semi -voluntary muscles are composed of bun- dles within bundles of fleshy fibres surrounded by membranous sheaths, which fibres are ultimately made up of disks that lie upon each other in lines or strite. lie would exhibit to us a beautiful net-work of blood-vessels in the muscular structure, and an equally fine distribution of nervous filaments. He would show how when a nerve current, directed by the will from a nervous centre, enters the voluntary muscle, the organ is at once contracted or shortened, producing motion ; and he would define, as the difference betw*een this form of muscle and the involuntary muscular fibres around the visceral organs and the arteries, that the organic muscles have no true muscular striated elements, and that the nervous supply which moves them is not from the will but is rhythmical and automatic. Again, he would show this difference between the
A PHYSIOLOGICAL OUTLINE.
87
folnntary and semi-voluntary musc!es, that althongh both are nearly alike in structural character, the nervous directioiij in the jM3iui- voluntary muscles, as in the involuntary, is mainly rhythmi- eal and automatic.
Shall any change in function occur in thfe muscular action » the derangement in the system at large uinst needs be merited. If a volantary muscle ceases to obey the will, if it contracts with- oat the direction uf the will, then it is mmmhtYl or Ukmhtil ; if it will not contract, but remains quiescent wlien the will luds it move, then it is paralyzed. If the involuntary muscles respond to an unnatural stimulus, so as to become convulsed or tetanic, the parts they surround are coutraeted. By such contractii>n the blood in the arteries may be obstrik*ted or cut off; the intestinal canal may be thrown into the painful spasm called colic; the pu- pil of the eye may be contracted. If tlie involuntary muscular fibres fail to respond to their natural stimulus, if they are relaxed f by the action of some agent, such as alcohol, or extreme cold, or
I physical injury, then the parts they surround may be paralyzed,
^^ and the blood-vessels injected with blocnl until the surfaces they ^B supply are intensely reddened, congested and intlamei
*
TuE OssEors, OR Bony System.
We should observe as we kept up our observations of the liv- ing man tliat all the parts of him which we have had befoi*e ua op to the present time,-— digestive organs, circulatory organs, breathing organs, nervous system, — organs of sense, absorbent vessels, glands, musL'Ies,^ — are placed upon, or are enclosed in, a pasaive system of organs, which, combined into one great system, ig denominated the mseom^ or the skeleton.
The anatomical teaclier, wonderfully at home in this system, will declare it to be the groundwork of the body. He will de- acribe it as divided into the skull, the trunk, and the limbs. He will divide the skull into the liead and face ; the trunk into the spinal column, thorax, and pelvis; the upper limbs into the chivi- de or collar-bone, the scapula or shoulder-blade, the humenis or arm-bone, the ulna and radius or fore-arm, the carpus, metacarpus and phalanges,— finger-bones, — or the hand ; the lower litubs into the feinar or tliigh-bone, the patella or knee-pan, the tihia and fibula or leg-bones, and tlie tarsus, metatarsus and phalanges, — toe*baiiea, — or the foot. He will describe the various kinds of
96
THE SEATS OF LOCAL DISEASES.
jointe. He will enter into the snhject of fitnicture and explain how the hardest bone is really built on a vascular net-work, lie will tear off from the bone a portion of strong membrane, — periosteum^ — will tell us that this membrane is snpplied with nervest by which it is rendered extremely sensitive, and that by it the bony structure is seci-eted* He will also explain that the structure of bone is made up of earthy and animal matters in such proportion as to give solidity, but with sufficient tenacity to prevent brittleness or easy fracture.
Shall tliese bones be subject to injury or local disease^ there will be acute pain, shock, and eonie inability of movement of the body ; ehall there be much exposure of bone to air, tliere will be decomposition ; shall the parts which make up the bone be die* arranged eo that the earthy matter is in excess, the bone will be brittle and will easily break ; shall the organic matter l)e in ex- cess, the bone will bend or give way so as to produce defoi'mity, and will fail to sustain, natiu*ally, the structures it was intended to support.
The Membranous System.
Onr last survey would extend to those surfaces of the tKxIy of the living man which constitute the membranous system. The anatomist would point to the skin as the most obvious of those surfaces. Jle would tell us that this skin surface consists of two layers, one of outer or scarf-skin, made up of dead and flattened cells, and forming a negativ^c protecting cover on which cori'osive substances have little action, tlu^ ejndermw / and of another or deeper layer of true skin, the derrn or derma. In this true skin he would show to \m blood-vessels, nerves, papillae rising up to give the ridges of the skin which are so plainly seen in tlie hand and other parts, and the open tubes of the perspiratory ducts which, passing in spiral or corkscrew-like fashion from glands beneatli, pour out the cutaneous watery excretion called sweat.
Beneath the derma he would also show us another membra^ nous layer, partly belonging to the skin, a layer of connective tissue, in which we should find embedded the sweat-glands, a number of fat glands, and in many parts a mruiberof small follicles or folds, in each of which a bulb of hair is planted, — hairfoUicUs; — and thus he would incidentally teach ug the fact that the hair is an
A PHYSIOLOGICAL OtlTLTIirE*
OS
Eppendage of the skin. The same fact he would afterwartls show ne to hold good in reg^ard to the nails*
We ehould gather from tins demonstration that the bkin is more than a protective elastic covering of the bodj. We sliould find that it is also a vast excreting surface ; that it excretes car- bonic-acid gas and acid fluids, — formic and kctic acids,— that from it an immense quantity of water, taken into or produced in the economy, is disposed of, insensibly, by evaporation ; and that, in truth, the equalization of the temperature of the body is mainly regulated by the excreting action of the cutaneous sheet which ivelops the body.
From the membranous outer enveloping skin our attention would next be directed to that internal membranous lining which, commencing from the skin and seemitig to he, as it really is, a modification and continuation of the skin, is called the red or mu- o<me membrane. As we looked at the face of the man before us we should be informed that where the skin terminalesou the eye- lids the mucous membrane begins^ and that the outer part of the ball of the eye, all of the ball that is visible, is covered with a layer of mucous membrane called, technically, the conjunctma. It would be demon strate<l that the iiiiicr margin of the mucous membrane, continuous from a series of glands situated under the delicate cartilages of the eyelids and receiving water}^ secretion from tJiem, is continuous also with the little duct,^the lachrymal duct,— which runs down from the inner angle or corner of each eye, into the nasal cavity, to convey away the tears. If we turned fram the eye to the ear, we should find tliat at the point entering ibe ear, at the point where the skin end^, the mucous membrane begins^ and that extending into tlie ear it lines the external mea- liie or passage and the outer side of the drum. Here, too, we should tind the membrane supplied with minute glands for pro- ducing secretion.
The most extensive tracts of mucous membrane would he de- fecrilKid to us, however, when we came to look at the tract which commences where the skin terminates in the lines of red mem- brane at the margins of the nostrils and the lips. In those red lines we should be made to recognize the beginning of the great pulmonary or hrmwhlaJ,, and of the int£stinal tracts of mucous membrane. In the nostril the membrane would bo observed to
100
TJIK SKATS OF LOCAL BISKASES.
cover the nasal cavity and to become eontimious with the con- junctiva throtigh the laehrvjual duct. It would also be seen to continue to the hack of the throat. In the mouth the Tiiembran© would he detected ns coverinif all the inner surface to the throat and as extending at the back, on each sidcj along the Eustacln'an tube into the cavity of the internal ear, lining that also. From the tliroat, the niucouB membrane, eontinuoue from the mouth and nose, would he obBcrved as extending in two directions. In one direction it would he seen passing down the chink of the glottis into the windpipe and thence through both Iwngs, lining the bron- chial tubci? throogliout all their course and dipping Into the Btruct- ure of the bronchial follicles, or small glandular folds whieh 3 ield the bronchial secretion, to the bronchial surface. In tJie other direction it wouhl be seen extending down tlie pliar) nx or ex- panded upper part of llie alimentary canal ; along tlio tjesophagua or gullet into the etomach ; from the stomach through the duo- denum, jejunum, ileum, caecum, colon, and rectum ; and so on quite through the canal to terminate by again joining with the surface of the skiiu In this course through the alimentary tract we should learn that the mucous membrane is everywhere iu con- tact with glandular structures, dipping into the ducts of those structures and forming their inner tutndar coating. In the throat this glandular plan wonld be seen to be follicular; in the stomach, — where the gastric juice is [>roduce<i,^ — tubular. In the tirst part of the small intestine the nmeous membrane would be fonnJ dipping in so as to line the tubular ducts and passages from the pancreas and liver ; in the other parts it would be observed lim'ng all the small intestinal mucous glands that open into tho canal and afford a secretion.
Xor would the course of the mucous membrane end with these views of the pulmonary and the alimentary tracts. We should ob- eerve that again from the skin there proceeded a tract of mucous mend>rane along the passages leading to the bladder; through and from the bladder to the small tubes, the ureters^ which convey the urine from the kidney to the bladder ; to the kidneys and 011 through the tubular excretory structure of the kidneys up to the cusps containing the vascular tufts from which the renal fluid is derived.
We should thus, in the end, be led to the conclusiivn that all the parts of the body ai-e enclosed in these two kindred mem-
'"PHrSIOLOOIOAX OUTLINE.
1(H
bmnes, the skin and the mueoiis membrane, and should rcadilj^ keep ia mind their continuous and intimate rehitionebips the one to the other.
There would etill remain for ns to recall this further fact re* lating to the membranous sjgtem, that all the organs of the liody are individually enveloped in nieoil»ranes proper to themselves. The brain and gpinal cord, we should i^eraemberj as being invested with three membranes, \\\q pi a inater^ arachnoid^ slwA dura mater : the bones^ in their outer parts, with jh:rio^^'um^ in their joints with ^i/Timmd uxemhrane : the heart with tho perieardium : the hmgs with tlio jdeura : the liver, stomach, intestines and bladder, m great part, with the peritoneum : the kidneys with a tine capsule or covering of tlieir owii, the renal eajf^^uk'. Tliese membranes would also be found either to be strong and fibrous like the dura mater ; or fibro-serous like the pericardium ; or serous and eingu- l&rly sensitive to pain, like the peritoneom and pleura.
Our observations on the mendiranons surfaces would not be ended until it was demonstrated to us that the whole of the or- gans of the body are knitted together by a thin web of tissue, called the cellular or areohir timto\ which so intimately interposes between each separate struetui^e, that if air be blown into it every of^ti of the body can lie separated by a coating of air from every other organ. This tissue, elastic, interweaving, binding, is seen in all parts except lu the serous bags and in the nmcous canals* II lies between the skin and the muscles ; between the muscles liiemsclves ; surrounding the glamhilar masses ; filling vacant gpHces between organs ; conuecting organs; and in many of the i>ngy organs making up the chief portion of their structure.
Sliall anything interfere with the functions of these nienibra- nouB surfaces, disturbance of the bodily functions must result, and that to an extent often little appreciated. Shall the pores of the skin be bkicked up by dust and dirt, the evaporation from the body will be reduced, and the lungs, liver, and kidneys will at onc*e Iiave thrown upon them some extra or vicarious labor it was not their duty to perform. Shall the skin be clotlied with an impenneable covering so that evaporation be generally checked, the same derangement will be pi^sented in a nu>re marked, nay, even fatal degree. Shall the excretion of free acid by the skin be suspended, there will follow a dyspeptic condition and rheu-
103
THE SEATS OF LOCAL DISEASES,
matic tendency* Shall the ekiii be subjected to great iiTitation or injury, the sympathetic shock and reflected nervous agitation will extend througli the nervous system in the most decisive manner. Shall the follicles of the hair become tilled with purulent or fatty substance, tliere will be a destruction which may be as painful to the sufferer as it is offensive to the observer. One inoie peculi- arity we shall gather in relation to the skin and disease. We shall learn that the skin is the special surface on which many of the specitic characters of the epideiuic and contagious diseases are 80 legibly written that tliese diseases are often named by theu* mode of eruption upon the sldu, and are called eruptive diseases. Lastly, we should Icaru thiit the skin is, for many reasons, the fre- quent temporary residence of various parasitic growtlis, animal and vegetative; that some of these growths destroy the upper or scaif- skiu, laying bare the sensitive uuder-skin ; that others bore beneath the surface and while they arc present keep up a constant irritation.
Shall disease occur in tlie course of the great tracts of mucous membrane, the disturbance excited will be acutely or slowly de- monstrated. Every condition of disease w^iicli we designate by the name of a eatarrli or flux, and which is attended with the dischart^c of phlegu* or mucous fluid, is an affection of a nuicous nieuibratui^. A cold in the eyes, iu the throat, in the bronchial tubes, iu the stomach, in the intestine, in the bladder, is an affec- tion yf mucLJUs membrane. The iutlammatiuns that occur in the same parts and the ulcerations that may succeed, are inflamma- tioud and ulceTations of mucous membrane. The irritations that occur from foreign substances lodged in tlie alimentary canal and whieii when long continued lead to convulsions, as iu the convul- sions so eommoti daring childhood, are primarily irritations of mucous membrane i*eflected from tlie irritateil spot, through the nervous system, to the musciUar organs*
Shall disease occur in tlie fibrous or serous membranes, all of which are sul»ject to irritation^ intlamnmtion, over-secretion, dry- ness, thickening, and even transformation into new structm^e such as bone, the evils resultant must, it w^ill easily be conceived, be serious in the extreme, first to the vital organs enveloped by the membranes, and next to the body at large. The dropsies are accumulations of fluid in the membranous pouches. The inflam- mations that are most acutely painful, pleurisy, peritonitis, are inflammations of the delicate and sensitive serous surfaces.
A PHYSIOLOGICAL OUTLINE. 103
Lastly, if the connective or areolar tissue, that wonderful web which binds together all the organs and parts so intimately, is the seat of disease, the danger may and often does become rapidly universal. Through this web-work gases and fluids diffuse as through a vast sponge. Through the meshes of it poisons can pass, practically, without interruption over all the organic sur- faces. The watery part of the blood accumulating in it produces anasarca, general dropsy, until the pressed skin above indents like dough. Air diffused through it produces the disease called emphysema of the cellular tissue. Pus or matter burrowing through it, produces circumscribed inflammation, — carbuncle, or diffused phlegmonous inflammation, — erysipelas. It is the seat of many tumors and diseased growths, and is perhaps the mother of them all.
And now our general survey concluded, we may pass to the study of the local diseases belonging to the great organic systems which have been made the subject of our observations in the pres- ent chapter.
ciiiVPTER n.
DISEASES OF THE DIQESTIVE SYSTEM,
In studying the local dieeases of mankind we cannot do better than take theni in order as affecting the different Bystems of or- gan ie parts wo havo juBt considered* The local diseases, the reader may be once more reiuindcdj are, for the most part, bnt repetitions of the conditions of disease and of the general dis- eases, locally situated. We commence, therefore, following onr pliysiulogieal outline, with thu diseases of the alimentary or diges- tive system of organs.
The different parts of tlie alimentary pystcm ai'e, as wo have seen, (a) The lips, mouth, tongue, fauces or back of the throat, and palate, with the uvula and tonsils, (i) The pharynx, or dilated pouch at the back of the throat, ending in the o^tsophngus or gul- let, the tube extending from the pharynx to the stomach, {c) The stomach, or first digesting receptacle, in which the albumi- nous or flesh- forming focKls are transformed into chyme, primary digestion, to be passed through the pylorus or exit gate of the stomach, into the duodenum. {([) The duodenum, or tirst portion of small intestine into whicli the liver pours its l>ile and the pan- creas its emulsifying juiee, under which the fatty and starchy portions of the food are digested, ^secondary digestion, — before being carried into the small intestines, {e) Tlie small intestines, jejunum and ileum, in which digestion is completed, and from which the prepared food is absorbed into the bload. {/) The large intestine springing from a pouch, the cfecnm, for I'eceiving the d-ehrh^ undigested or useless part of food substances, and the gases arising during digestion, — the colon. Uj) The straight in- testine, with the outlet of which the canal is terminated. (A) The mucous niemhrane lining the whole of the canal internally. (/) The peritoneum or serous membrane of the abdominal cavity, in
DISEASES OF THE DIGESTIVE SYSTEM.
105
which the intestines and other abdominal organa are in great part ifolded, and which lines also the walls of the cavity* All these parts are seats uf loeal disease.
Diseases of the Lire.
Ulesr of ths Lip. — A small round ulcer by whi^h the mucous membrane is destroyed in a circular manner so cleanly tliat it tlooks as if a portion had been punched out, the cellular tissue be- neath forining the lower part or base. The ulcer is often exceed- ingly painful, and fi-equenily recui^s in those who are liable to it.
Fimure,—k. cleft in tlie mucous tnembrane of the lips mnniing longitudinally, often occurring in the middle of one lip, and most frequently in the lower lip. As a rule the Assure is painful, slow to heal, and apt to recur.
Caiu^er. — Cancer usually of the form called epithelial, occur- ring mostly in the lower lip, and excited in uiany cases in those who are addicted to smoking by irritation ivoin the stem of the [>ipe. The disease not uiifrequeutly affects men, Init eo rarely af- cte women, that in thirty vears of medical observation I have nut seen one instance of it.
Cijtsts. — Small cystic or hollow tumors attached to the mucous j^gnrface of the lips*
Ilartllp, — A malformation in wdiicli the upper lip has not been developed in such w^ay as to unite in the centre previous to birth, so that diere is a deep cleft down the lip. The malforma- lioii is now^ remediable by surgical art*
Diseases of the Mocth and Tongue.
S^mafUU, — A diseased condition of the mouth to wliicfa in- fanta or young children are most subject, in which the mucous menibnitie is more or less covered with whitish flaky-kK>king sfiots or pati-hes,
luAlicular St^mMitia, — A catarrhal inflammatory state of the follicles or little sacs of the mucous surface.
ll/4:L^'atit}t' St4JHLatitU,—X scries of small ulcerations of the mucous surface involving the follicles.
Thrush u YcmenUtr Stomal it is. — Stomatitis in which there is a vesicular eruption of tlirush on the mucous surface.
ParamliAJ Thrush, — Tbrush in which there is present the par- isite called oidium albicans, or thrush fmigus.
106
LOOAL DISEASES.
Oancrum Oris, Canker of the Mouth. — A form of stomatitis in which there is death or mortitication of the mucous membrane. The disease is sometimes called gangrenoiis Btomatitis.
In all the&e loeal fonns of disease thei*© is sume pre-existing general disease and weakness of the body, the eomiiion cause of which is improper feeding, Tliriish most generally precedes death in exhausting diseases, and is^ as a rule^ a fatal symptom.
Absrt'm, — A eireu inscribed accumulation of matter or pus in the structure of tlie cheek, the result of inHannnation.
' G/H, — Growth of a hollow or cystic timior beneath or upon the mucous surface of the cheek.
Jiamda. — A cystic tumor beneath the tongue, sometimes, but not always, connected with destruction of one of the ducts which convey the saliva from the salivary gland into the mouth. It is occasionally attended with a deposit of phosphatic concretion or calculus, derived from the saliva.
Diseases of tue Gums.
Iftffammaiion, — Inflammation of the firm structure which, covered with mucous nienibrane, extends over the alveolar part, — socket part, —of the Jawbone up to the comuiencement of the crowns of the teeth. When the iafiammatiun is caused by a de- cayed tooth, and involves the periosteum of t!ie fang of the tooth, the term fftwi hoil is employed to express the disease.
Ulceration, — A desti^uctiou, by ulceration, of the surface of the gum from irritation or intlammation.
Jltq^ertrnjthij.—Kii excessive growth or thickening of the structure of the gunu
Atrophy. — Wasting of the structure, often called, in advanced life, sliriiiking of the gums.
Ifiduratioju — Hardness of the structure of the gum ; a condi- tion which, occurring in infancy, causes much pain and difficulty in the process of cutting the teeth.
Tttmors. — Growths, malignant or non-maligimnt, attached to or springing from the stnicture of the gum. Tlie cancerous or malignant growths are usually epithelial. The simple or non- malignant are of four kinds, (a) Polypoid. (J) Cartilaginous, (e) Vascular, (d) Fibrous, called sometimes epulis.
Perforation of ths Palate, — The palate, the bony structure forming the roof of the mouth and, in the natural state, covered
DISEASES OF THE DI0:^TIVB SYSTEM.
107
with mucous membrane, i^ said to be cleft or perforated when fiMiii irregidar development before birth the two parts of which it is coTiipoi^d have not come together. The condition is some- times aecompaaied with cleft or harelip.
Diseases of the Tonouk,
hOhsriiie. — Inflammation of the etrncture of the tongne, an dideaee of rare occurrence,
Crhx'ralkm. — An ulceration of the mucous surface of the tongue assuming different forms, (a) Small round ulcers like llicme seen on the lips, or taking the form of a cleft, {h) Wider P»pread, more irregular shaped, deeper idcers, {c) Aphthous ulcers, ulcers acx*oinpanied with aphthae, often of parasitic char- acter,
Alm^fss, — A circmnscribed aceiimulatiun of matter or pus in the structure of the tongue, tlie result of inflammation. A dis- Leaae of comparatively rare occurrence.
Hypertrophy. — A partial or geuei'al enlargement of the tongue, lite organ sometimes assuming a great size from interstitial de^ posit between the muscular fibres of which it is composed.
tbn/f^r. ^Malign ant disease commencing in the tongue, ueii- »Uy in the epithelial form of the malady, but taking, sometimes, the bard or scirrhous type.
Y<i^^ular Tiiniors. — Various forms of tumors, made up mainly af arterial and venous vessels, and attaelied to the tiingiie from its cellular or connective structure.
CtUuliir Injiltrutlon, — A condition I have observed and de- fcribed, in which tlie whole cellular structure of the tongue has become infiltrated with diseased serous fluid as the result of inoe- tdation, through a wound in the tongue, of decompfisirig animal nbstanee taken as food. The tongne is greatly enlarged so as to protrude from the mouth, is of soft spongy consistency, and com* pletely infiltrated with a serous, milky-looking decom|x»6ing fluid.
Partilyma, — ^The tongue often shares witli tlie lips and other parts of the body in paralysis. Tn rare instances it is subjected to paralysis of motion independently of the rest of the body.
Ton^ut} Tie. — A malformatioQ in which, from prolongation iff the little central band called the frsenum, the tongue is tied down to the lower jaw.
108
LOCAL DISEASES.
E^oliaiion of the Mucouff Meinhrane, — Tn soiiie dyspeptics, egpocially iu persons wlio smoke excessively, tlie toDgue is some* times coated with a thick white fur, M'bich peels off^ carrying with it the epithelial snrface and leaving an irritable red surface beneath*
Diseases of titi^ Throat.
The part of the mouth called the fauces, the back of the tliroat, is comiutmly injected, inflamed, and ulcerated iu the course of some acute febrile affections, such as scarlet fever. It is aliio 8ul»jcct to several purely local affeetioixei. The following are the more important :
Sore ThroaL — A diffuse injection of the mucona membrane of the throat, with raised points, accompanied by a sense of sore- ness, licut, and dryness, but without exudation of any membra- nous substance. The affection is a frequent attendant of a com- mon Ciild, — culd and sore throat, — and may be associated with 1^4 >mc decree of temporary deafness and feeling of pressure on the <!run» of the ear. The Eustachian tube, which extends from the throat into the middle ear, Ij* tlien also affected,
lidiued Throat.— X state of the mucous membrane of the fauces in which, with redness and irritation, there is a relaxed condition uf the nnmous membrane, w^ith projecting folds of mcrubnme which are often, at the same time, large and relaxed. Tlu' ctnulition foUc^ws usually upon cold and sore throat, but it may be in tl need by mechanical causes, such as severe hoarse e*ongh, scrcauung, shouting, frequent reading in one harsh tone, and overhtruin in singing. It is induced also, in persons wlio are ausceptible tt) it, by no means ati inconsiderable number, by smok- ing tobacco. It is more frequent in men than in women, and h[Rni{dly in men wdio are engaged in oecupalions in wiuch the voice is employed in one strain. Thus to one chronic form of thipi affcrtion the term "clergyman's throat'^ is applied, because it afflicts muubers of the clergy' who, while in indifferent health, road the services of tlie Church and pi'each too frequently.
l'li*i'ra(rd Throat — A condition in wliieb the mucous mem* brano of the throat is itj parts destroyed so deeply in bad cases, that tlie conneetivo tissue beneath it may be seen* It is the re- nult, as a rule, of inflammation of the mucous membrane or of Hpecilic disease.
DISEASES OF THE BIOESTIVE SYSTEIT.
109
Quirifty. Cynatiche. Cynanehs TormUaris^ — An inflariinia- |tion ending of tan in formaticm of matter in one or both toneits. The disease is usually broiiglit on by eukl, and occurs most fre- quently in the young. It is strongly hereditary.
Tonmllilh, ^&omet\me% called follicular tont^illitis. A euper- ficial inflammation of the tonBils common in childhood, Tlie tonsiU are swollen, but the inflammation is on the mrface, and matter does not form in tlic substance of the tonsil. Tho disease is apt to assume a chronic form in children who are badly fed, or rho are of weakly constitution,
ILjpertrophy, — Enhirgement, or hypertrophy of the tonsils, from repeated or long-continued chronic inflammation. The en- largement may bo bo marked and persistent that the tonsils may liav"e to be removed altogether by operation,
Cynaiu'ht^ MaU^nn>.—Qn\\Q\\ also sloughing sore throat or pu- trid sore throat. A low and dtmgerous form of inflammation of the tonsils, attended with death or putrefaction of the mucous membrane and sloughing of tho toneil itself, there being no at- tendant Bcarlet fever. The disease seems at times to iiave taken An epidemic cliaracter, but has not been shown to be contagious. It is not so common now as it was in past days.
CHfi^er Aff^ctwns.—^VUQ tonsilt^, in diphtheria, may be swollen and covered with diphtheritic false membrane or s(x>ti§ of false roemhrane. The tonsils are occasionally tlie scats of cancer. Filially tlie tonsils are often enlarged ami irritable in persons of erofulotis taint, so that chronic enlargement is, by some, believed to be an indication of that taint, When connected with scrofulous ewellings in other parts of the body, enlargement or abscess of tlie tonsils is called scrofulous disease of the tonsils.
Ehmfjat^l Uvula. — ^An eidarged condition of tiie uvula, with elongation, so that tlie inverted apex of the Btrueturo dest^cnds into the throat and is a cause of irritation, with some difficulty of ewallowlng and occasional sense of choking and cough.
StriHure of the Faw^en, — ^Contraction of the back of the throat, sometimes from accident, as fr4>m thinking of scalding Iwater ; at other times from severe inflammation ; and again from snaligtiant disease.
Tumors of the /^i^?^^.— There are several varieties of tumors iffecting the fauces: — Malignant or cancerous growths; flbro- cellalar and tibro-cystic non -malignant growths ; specific growths ;
110
?AL DISEASES.
the inucoiis eoveritig of the fauces being tlie seat of sypliilitic ulceration in persons wLo are under the taint of that specific disease*
Diseases of the Phakyxx.
PhuryngitU. — Inflammation of the raucous membrane of the pharjTix or expanded part or pouch lying between the fauces and the commeneeinent of the gullet or cefiophagus.
5^^rr.— iriceratioTi of the uiucous surface of the pharynx. There are two varieties: — («) Superficial; the numeration behig on tlie surface only. (5) Perforating ; in which the ulceration extends throngh the mucous inembrane or even through tlie coats of the pharyngeal tube entirely.
Ahmtiis, — A circumscribed accumulation of matter or pus in the structure of the pharynx.
Tumors, — ^Tumors or growths affecting the pharynx ; of wliich there are the same varieties as above named in respect to the fauces.
Other Affections. — The pharjTix is subjected to other forms of
disease. Sloughing of the mucous surface. Dilatation. Adhe-
-aion of the soft palate. Injury by scalding and by corrosive euh~
inces. Sypliilitic ulceration. Impaction of foreign bodies.
Paralysis. Constriction of the pharynx, stricture, is an occasional
disease usually the result of accident.
Diseases of the (Esophagus or Gullet.
CE}sophagit!s. — Inflammation of the mucous membrane of the tube extending from the pharytix to the cardiac end c»f the stom- ach. The inflammation is generally the result of an accidental swallowing of some irritant ; but it may arise from erysipelas of the throat, or from inflammation extending from the throat or the stomach. The disease is of rare occurrence.
Ulceration, — An ulcerated condition, localized in the cepoplia- geal tube and involving the mucous surface. The ulceration is of two kinds : — (a) Superficial; involving the mucoue surface only, (i) Perforating; the ulceration extending more deeply^ so as to cause, in the extreme form of the aff"ection, perforation through all the coats of the tube.
Stricture, — A condition in wliich the gullet is constricted at one or more points, so that foods and drinks ai-e swallowed with
DISEASES OF THE BIGESTITE SYSTEM.
Ill
difficulty, or are prevented from being Bwallowed altogetlier* There are several varieties of Btric-ture of the cefiophagus.
Spasmodic Stricture.^ — Stricture in wUidi the ohstaniction is due to eitnple Bpaem of the oesophageal tuhe. A condition often connected witli hysteria, and, though alarming for a time, recov- erable as a general rule.
Traumatic Stricture. — Stricture in which the constriction has been caused by irritation and inflammation due to an injurj' in- flicted on the oesophageal surface in some part of its course, as by the swallowing of scalding wat^r, or of corrosive substances. A condition in wliich the act of swallowing may be rendered perma- nently diiBcult, but in which the mischief need not, necessarily, become fatal.
Simple Organic Stricture. — A form of the disease in which there is simple thickening of the tuhe at some part, without ten- dency to ulceration.
Malignant Organic Stricture. — The most common form of strictni"e of the gullet. The affection comes on in persons subject to tlie hereditary taint of cancer. It is excited originally* in most instances, by some accidental irritation. The malignant manifes- tation takes at least two distinct forms* It is sometimes of a firm or cartilaginous character; at other times it is of an ulcerative character. It is most common in the upper third of the tube, but may be developed in two or more points at the same time. 1 have aeen it in three. The tetidency is to progress to a fatal issue, either by producing a complete obstruction or by an ulceration extending through the tube, perforation.
Difficulty in swallowing. The term is applied generally to , indicate ditticulty in swallowing from any cause. It is also ap- lied to cxpi-ess difficulty arising from sj^asm or other niei'e tem- porary state by which the act of swallnwiug is impeded* Literally it means swallowing badly, and is rather a definition of a symptom than of any particular disease.
Diseases of the Stomach.
tht$§titis* — Inflammation, acute or chronic, of the lining mem- bme of tlie stomach. There are several varieties of gastritis. Simple Catarrhal InflammatioiL — A temporary and slight in*
\
112
LOCAL DISEASES,
flaniniation of the gastric mncons enrface, attended with pain, thirht^ feoiiie fever, and eometinies bilious vomiting.
Acute Iiiflannnation. — Inflaiuntatiou occurring without au obvioiiis external cause ; attended with pain, sensation of sinking, vomiting and fever, with tendency to sudden collapse*
Traumatic Gastritis, — Acute inflannnation of the mucous sur- face, arising from the swallowing of scalding or corrosive sub- stances*
Gastro-Enteric Inflammation.— Inflammation of the stomach coincident with inflammation in the intestinal eanah A condi* tion occurring during the existence of intestinal or enteric fever, and adding seri^►usly to the dangers of that cumplaint.
Ulom'cUion. — Ulcerative destruction of the mucous membrane of the stomach and of adjacent structm-es. There are five varie- ties of thie ulceration.
Small Defined Gastric Ulcer* — An tdcer of the mucous iiiem- lu'ane of similar character to the simple circular ulcer of the lip, and productive of nuich pain, especially after food.
Perforating Gastric Ulcer. — An iileer extending deeply, but often limited and cireumscrihed. It extends sometimes so deeply as to j>erf orate through the whole of the coats of the ston)ach and to cause death by alluwing tlie C€»ntents of the stomach to enter the abdominal or peritoneal cavity.
Traumatic Gastric Ulcer. — An ulcer of the stomach produced by injury to the coats of tl»e stomarh, as by the swal lowing of heated or corrosive fluids, and, in rare cases, by the swallowing of hard solid substiinces.
Alcoholic (lastric Ulceration. — A diffused ulcerated condition in which, from tbe long-continued action of strung alcoholic drinks taken in free quantities, the nmcotis surface liecomes studded with small ulcerated points which often give out blood, and which always give rise to extreme dyspepsia, deficiency of appetite, uneasiness, pain, and failure of digestive power.
MaligT»ant Gastric Ulcer. — Ulceration of tbe mucous surface of tlie stomachy from the development of cancer.
Cancer, — The stomach may be tbe seat of cancerous disease, especially fjf epitbelial or diffuse, and of scirrhus or hard cancer. The cardiac part of the stomach is most frequently the seat of epitheliab the pyloric of scirrhus cancer. The disease, in either case, is, as a rule, developed in those only who are under the
BISEASE8 OP THE DTGE8TWE SYSTEM.
113
; 6£ the conBtitutional malady, and both forms are, up to this tinie^ fatal conditions of disease*
UiBJimterTU'sis, — Literallj vomiting of blood, but a terra used to define loss of blood from the stomach only, Ilfematemcgis may occur from extreme congestion of the vessels of the stomach, bnt it is most frequently a result of rupture of vessels froro nleeration. This loss of blo(xl is often extremely profuse from the stomach during tlie congestion and ulceration produced by the taking of alcoholic drinks.
SlmpU Timwrs.—lChe stomachr may be the seat of growths or tumors of the non-malignant kind ; fibro-celhilarj tibro-cystic, cystic, and gelatinous or colloid. The colloid tumor is by some considered malignant in character.
Parasitic DUease. — Tlie stomach may be the seat of various forms of parasitic disease* It may Im the scat of aplithous para- sitic affection. It may be a pc»int of attachment far cysts contain- ing the larvBB of parasites. It may hold parasitic growths in its
estive and nmcous fluids.
Spontmieous Laccvaiion. — The stomach may be spontaneously torn or lacerated during some act of exertion of the body, or even daring diges>tion of food. The accident is usually preceded by degenerative changes, during which the coats of the organ have become so weakened that they are easily ruptured.
InjurUs of ih^ Stoviach, — The stomach is liable to accidental injuries. External blows over tlie stomacli and affecting it are extremely and suddenly dangerous. Wounds penetrating the stomach are causes of great danger, although there have been re- coveries ivoiw such wounds. Injuries from swallowing foreign •uhstancea of large size and irregular furm, are also occasionallj' produced, though here again it is remarkable how much disturb- ance the stomach will sometimes bear. This is well seen in men who, as a leat^ pass a blade or cane into the gastric cavity.
Ihjsp^fma,
Literally bad or imperfect digestion, A condition in which the food taken into the stomacli is not naturally digested, and in wliich the stomach becomes either overcharged with fofKl, or subjected to foods that undergo fermentation or otber changes which are not according to nature. Pain, distention, oppression, ijifitnrbed bowels, and excitement or depression of mind, are the
114
LOCAL DISEASES.
leading signs of dyspepsia* Dyspepsia when it le elmrp and short is said to be acute ; when it is snbdiied and continnoiis, it is said to be chronic- It may be due to one or other of the diseases of the etoraach itself, or to entire carelessness in U»ading a healthy stomach with foods and dnnks whicli it was never intended to , receive. The last-natned is, by far, the mofet connnon cause of] dyspepsia,
Octstrodynia.
Pain in the stomach, or pain referred to the stomachy occur- ring nsnally after a meal, sometimes periodically and acutely. Tlie periodic form of gastrodjnia is often of neuralgic or gouty character, and may alternato with attacks of tic dr neuralgia in other parts of the body. It is dependent rather on constitutional than local causes, Gastrodynia occurring after food, and not otherwise periodically, is a common symptom of intiigestion.
Pyrosis.
Commonly called water-brash* A sudden rising into the mouth of a thin fluid, brackish in tastCj and now and tlien acid. The eructation often occurs early in the morning, before break- fast, and in many persons is attended by a singular sensation of exliaustion and feebleness. It is induced by alcoholic drinks, by smoking tobacco, by eating sweets, — especially such nauseous sweets as cliocolate cakes,— and by oatmeal porridge. The watery matter thrown up is not always the same. It is in some jtsases a mere watery fluid containing the secretions of the stomach, while in other instances it contains, in addition, forms of organ- ized growths CiiUed sarcincB t^entrietdi, which seem to be con- nected with some peculiar fermentative change excited by food through which the organized particles were first introduced, and in wliich they have continued to be generated.
Degenerative Gasirie JSxhaiistion,
TIio stomach in aged people, and in people who are prema- turely aged, undergoes an enfeeblement both in its secreting power and in its muscular tone. Under this condition the func- tions of the stomach become imperfect and its action at last so indifferent that all desire for food ceases and the body sinks from inanition.
DISEASES OF TIIK DIGESTIVE SYSTEM*
115
Potnlting, though called a disease^ is rather a Bymptom of some derangement tliat excites the stomach to revulsive action tlian a disease ia itself. It may occur imder any of the affections of the stomach which we have seen, as well n^ in other condi- tkm^ each as sea-sickness and sickness frtun fear or mental emo- tion. In the latter case the impression producing the phenome- non 18 primarily made on the nervous system and is reflected to the stomach.
I>ilatation. — The stomach may be gmatly dilated, and the dilatation may remain pci'manent. Thiis is often the case in per- sona who for long periods daily over-indulge in eating. It also occurs in dyspeptic persons in w4iom the stomach is much dis- tended with gases. In some kinds of chest disease* phthisis pn!- monalis, chronic bronchitis, astlmia, in which the stomach per- forms vicarious work by retaining antl ejecting large quantities of gas, distention and dilatation of the stomach is extremely com- mon* The stomach when permanently dilated \^ feeble in ita contraction, and secretes the digestive fluids most imperfectly. Dilatation is a source of persistent indigestion and general de- rangement of the body, and is a more frecpient cause of prema- ;ure vital decay than is usually supposed.
SiriHure. — The stomach is occasionally the geat of stricture, the pyloric end or outlet being tlie part most frequently constrict- ed. The stricture may be spasmodic in character. It may be a simple thickening of the mucous membrane. It is more fre- quently the rest lit of maHgnant disease*
GaHivic FiMttla. — By gastric fistula is meant a permanent Eipening, that is not natural, from tlie stomach to some other part. The stomach in this way has been made, either by acci- dent or by operation, to communicate directly with the outside of the tK)dy thrtmgh the abdominal wall, and by the opening so pro- duced foods and drinks have been introduced into it The pro-
i of stomachic digestion has thus been ohflcrved from stage to By a gastric fistula the stomach has also been known to commnnicate with tlie intestines, and even witli the bladder.
GfUftrlc Hernia. — An accidental affection, in whicli the stom- ch protrudes througli an ojiening in the abdomen, or through an
ing in the mesenteric membrane within the abdominal cavity.
LOCAL DISEASES,
liefiex Disease from Gastric Irritation,
The Btomach, richly supplied with nervoas fibres, derived both from the cerebro-fipiual and the sympathetic nervoas sys- teins, is a frequent centre of reflected irritation to remote organs. This is shown in the convulsions of infancy arising from fitoniach derangement; in that form of epilepsy of the adult called stoni- acli epilepsy ; in palpitation of t!ie heart from distention or op* pression of the stomach; and in vertigo or giddiness and faintness, from the same cause.
Diseases of tue iNTESTmEs,
Enteritis.
Inflamniation of the whole, or of a portion of the mncous tract of the small intestines. In some instances enteritif? is a purely local affection, occurring after exposure to cold and priva- tion. In other instances it is the resnU of injury, or of the pas- sago of irrit4int substances %vit]i fof>d, or of improperly -digested fooiJ, into the intestine. In a third class it is induced by sympa- thetic irritation, as in examples where the neigliboring mesenteric glands are the seats of acute disease. Lastly, it is an accompani- ment of certain forme of general disease, especially of typhoid or enteric fever. It is^ in fact^ so regularly a part of this fever that the word '* enteric'' is as of ten used to express the fever as the word *' typhoid." In typhoid the lower part of the small intes- tine is the most seriously involved, the groups of nmcous glands called Peyer's glands or Peyer^s patches being specially affected, swollen and inflamed, or ulcerated*
In all its forms, acute aud chronic, enteritis is a serious dis- ease. The irritation keeps up a frequent discharge from the bowels, w-hieh is most exhausting. The absorption of food is in- terfered with, and the danger is always contingent that ulceration, proceeding to perforation of the intestine into the peritoneal cav- ity, %vill take place aud will lead to an all but certahi fatal termi- nation.
Enteritis may assume a slow or chronic fonn, in which case the suffering perscm is for a long time subject to pain in the bowels, diarrlnea often attended with loss of blood, and exhaustion, ending in death from obstruction or perforation of the intestine.
DISEASES OF THE DIGESTIVE SYSTEM.
11"
Under tliiB tenn the College authorities define a disease which cousists of mflaitiniatioTi of the nmeoiid itiembraiie litiiug the cse* cum or large pouch in the right lower side of the ahdotiien, the pouch in whieli the email iiittistitie ends, and from wiiieh the colon or large intestine takes its rise. The ciBcum has been called the second stomach, the idea once being tliat in it the tinal pro- cess of intestinal digestion was carrieti out. It is often the recep* lacle of food that has not been digested, and of substances^ snch aa magnesia^ taken as medicine fur long pericKls, M'hich do not admit of being digested, and it is to irritation caused by the pres- ence of such bodies that the inflammation known as typhlitis is nfitially due. The mt>fit remarkable illustration of the disease I have met with was one in which tlie cause of irritation was a large ooiicretion made np of magnesium carbonate, which drug the affected person had in early life been made to take for several months in repeated doses. The disease, acute at first^ l>ecomes dironic, as a rule, and terniinates in various ways. The substance in the cfficnni, as in the instance just referred to, may break np, and ftfter much suffering be ejected by the bowels; or it may create or accunmlation of njatter which may burst into the peri- toneikl ca\^ty, or may even escape through an external opening from the body.
Dysentery.
The term dysentery is most commonly applied to define a t*ere epi*lemical, but not contagious, affection of tropical coun- tries. The disease consists of inflammation, principally of the nutcous surface of the small intestines and of the solitary glands there, followed by ulceration, and, in very bad cases, by perfora- tion or contraction of the intestinal tube. The disease, in the first instance, is marked by choleraic dii^charges from the bowels followed by discharges of blood, the latter being the specific *yrnpiom. In the epidemic form dysentery is often a x^rj fatal
In temperate and cold ch* mates dysentery rarely fM?cnrs, but
rsona who have lived in tropical, and have returned to temper-
!, climatefi, suffer, especially in hot weather, from symptoms
^tA chronic dysentery. Occasionally, too, persons permanently
118
LOCAL BISEASES.
residing in temperate clitnes experience dysenteric symptome^ due to extreme irritation in tbe intestinal canal from tbe presence there of undigested food or other foreign substances.
Chronio Affections of the Intesthie,
Ulceration. — An ulceration, usually from inflammation, of the lining coat of tlio intestine, in points, or over an extended surface. The ulceration conmiences from the niucous coat, and extends more or less deeply towards the external investing mem- branous coat, tbe peritoneum,
Perfomiion. — Xn ulceration or injury extending through the intestinal tube into the abdominal or perittmeal cavity.
Fecal AJmcem and Fwtula, — ^An unnatm-al opening, perma* nent in cbameter until closed by medical art, from the intestine into some part of tbe abdominal cavity, or through to tlie outside of the body. "When the fistula so formed allows the contents of the intestine to escape through it, it is called fecal fistula.
Hemorrhage mid Melama. — Tbe intestinal canal may be the seat of hemorrhage, or loss of blood, from ulceration of the mu- cous coat^ injury, malignant growths, or undue fluidity of blood. Wlien blood is discbarged from tbe bowel of a dark color or black, the term melaena is sometimes employed to express the condition of disease.
Physical Changm (jf InUHine.
Tbe intestine is subject to dihtaiion in the whole or in parts of its length ; to distention from accumulation of gases within it, tifmjHiniti^ ; and to obstruction from vai'ious substances lodged in it tliat have not been digested.
StriHure. — Stricture of the intestine is a constriction of the canal in some particular part* There are several varieties of in- testinal stricture.
Spasmodic. — Stricture from a spasm, form usually temporary in character, due to irritation, and often connected with hysteria.
Inflammatory, — Stricture from inflammation of the mucous coat, followed by deposition and thickening, or by ulceration and contraction.
Mecbauicah — ^iYicUxT^fmm pi'^mure on the intestine by some external growth, or by a baiid of membrane or adhesion surround- ing or enclosing it*
DISEASES OF THE DIGESTIVE SYSTEM.
119
Malignant. — Stricture from tlte Dcciurence of eialignant de- posit, cancer^ in tlie intestinal wall.
JnttissustsqMmu — The involution of a portion of the intestinal nbe into another portion, as if a piece of a thin india-nibber tube pnghecl, in an invohited or folded manner, into the inner of the tube. Intussusception as a cause of obstruction in the canal is usually of fatal character. It is, as a rule, the i-esult of some accidental shock or strain.
Internal Stranffulaiiofi. — ^Internal strangulation of tlie intea* tines occurs when the intestine is so tightly compressed that the cireulation through it is checked and mortification is the threat- ened or actual result. There are two varieties :
Mesenteric. — In this form tlie intestine slips through a small ^opening in the membranous expansion called the mesentery.
Hedoeolic. — la this form the intestine dips through an open- ing in the part of the mesenteiy which hangs like an apron from the transverse part of the colon. In either form the strangula- tion is due to the pressure or tie caused by the opening in the membrane into wliich the fold of bowel has slipped. The disease is usually the result of accident, and is fatal unless tlie detection of its nature be speedily discovered, and the resources of opei'ative art be promptly secured and applied.
Jleniui.
Whenever an organ or part of the body protrudes from the cavitj^ containing it, pushing before it the skin of the body, her- nia is said to have taken place. The term comes from IwrnoSy a branch, and implies a branching out of the protruded structure. Thus protrusion of the cerebrum from the cavity of the skull is ^called ** hernia cerebri/' The word, however^ is most fi-equeutly ipplied to protrusion of the intestines from the abdominal cavity. The intestines are the part most frequently subjected to the acci- ient, a natural sequence fi-om their structure, function, and posi- tion.
Hernias are divided, in the first place, according to their
ll^aract^ra. If the hernia, or ]>rotrusion of intestine through the
*mbdominal wall, can be put back into its cavity by pressure over
the skin at the point of protrusion, it is called a redtieihle hernia.
If it cannot be put back in this way, it is called an irreduelMe her-
nia. If it m prevented from returning by some obstacle within it-
LOCAL DISEASES.
self, it is called an ohstruded hernia. If it lias become eubjeet to inflammatory action, it is called sd injiajned hernia. If it is so constricted at the opening from which it has escaped that the ciiTnilation through it is preventedj it is called a strangulated hernia.
Hernias^ again, are named after the parts which tliej pass through. If the protrusion is tiirougli the midriff or diaphragm, it is said to be dutj^hrcvgmatic ; if tlirough tlie epigastrium, ejpifju^trit^ ; if through the miibilicus or navel, nmhilical * if through the fure part of the abdominal wa!ls^ ventral ; if through the back part, fuml/ar / if in the groin, through tlie abduminal rings, mguinal; if on to the thigh, below the ligament tliat croi?ses oblic|neIy from the crest of the hip to the central pubie \\on^^ ft moral ; if througli the great obdurator liganient in the front of the pelvis, iihdurator ; if tlirough the ischiatic notch at tlie back of the pi?! via, ischiatw*
The most counnon form uf hernia is inffumah The intestine in inguinal hernia slips through the weakest and one of the most dependent parts of tlio abdominal cavity.
There are !?ix varieties of inguinal hernia ; —
The Oblique: in which the course of the protnided intestine 16 obliquely downwards and inwards in the line of the inguinal canal.
The Direct: in which the protrusion is pushed out strongly, forming a direct protrusion fi uiii the cavity.
The Incomplete: in which the protrusion is not completely into tite inguinal canal.
The Scrotal : in which the intestine passes quite along the inguinal canal until it enters the pouch called the scrutuuL
The Congenital : in which the male child is born with the disease. The bowel descending with the testes into the scrotal bag.
The Infantile, a variety of the congenital : in which the bowel is enclosed in two adherent folds of membrane. This is also called enevsted hernia.
Hernia is often prmluced by very slight causes: by a jerk, as in suddenly pulling open a door that sticks; by a fall ; by an at- tem]>t to raise a heavy wciu;ht, or any other act which tends to liring a strain upon the intestines that shall make them bear downwards. It is also favomd by many causes; by over-eating;
DISEASES OF THE DIGESTIVE SYSTEM.
121
by arer«exhaustiiig exertion ; and, by exertion during times when tbe body is enfeebled by disease, Tlie affection is hereditary. It 18 more frequent on the right than on tlie left side of the body ; and it is eo cummoo in civilized coinnmnities that m America during the late war one man in every thirteen men was found to be subject to it. Occasionally from etraugnlation of the intestine bernia proves fatal, but surgical art haa reduced the dangers of death from it to a very low figure.
I/istases qfths Ilerniiil Piniches or Sae8. — Wlien a hernia has existed for a long time it forms for itself a distinct poucli or sac out of the investing peritoneal membrane which the intestine has pushed before it. The sac so formed is, in turn^ subject to local diseases, of whicli the followiug have been described. Inflamma- tion ; fibrinous exudation, witli closure of the sac as a i*esult ; fiuppuration ; dropsy ; movable bodies witliin the sac j tear or lacOT&tiou of the sac.
Tumors (if the Intestines.
The intestinal canal is sometimes the seat of internal tumoi's. Thi^re are several varieties.
Malignant — Cancer in one or other of its forms. Colloid or gelatinous tumor, Koo-tDaUgnant tumors and polypus.
Parmitic Disease^
The intestinal canal is often the seat of parasites, vulgarly called worms. The three common forma of parasite of this part are the U»nm solium^ tape-worm ; the ascarislumbricttiAhs^ lound- worm ; and the nxynria vermietddfu^^ or thread-win-m. Tlic canal may ale>o be the seat of certain rare forms of developed parasites, and of cysts containing larv© of a parasitic nature.
Parasites are always introduced into the cana! from without, with foods or drinks* The rouml-wonn and the thread-wocm are most frequently present in ytjurig persons, the tape-worm in ■dalta. The worms aj*e a source of great irritation so long as they remain, and in childhood are one of the common causes of con* ruUion from reflex ii-ritatiou.
122
LOCAL DL3EASES,
Diarrhwa,
The woi'd diaiThcEa is used to express a looseness or discharge from the canal, in which the actioo of the bowels is much dis- turbed, and the contents eliminated are fluid and profuse. It may be regarded rather as a eyraptoni of disease than as an actual priniary disease ; but custom has made it to he considered as a disease of itself. Diarrhoea is classitied, ordinarily, under the fol- lowing heads.
Simple Diarrhoea. — ^A temporary loss or discharge fi"ora the bowels of fluid secretion wirhout acute pain. Tliis is called chronic catarrh of the bowels when it is long-continued. Diar- rhtBa is often dependent upon cold, and on changes of season; it 18 due to congestion of the mucous sui'face of the intestinal canaly a tendency which in some persons is constitutional.
Irritative DiarrhcEa. — Diarrhoea acconipanied with gtiping and pain, in which the discharge is induced by some foreign substance in the canitlj creating the irritation and exciting the over-secretion.
Choleraic Diarrhcea.^ — A condition of disease in which the dis- cliargo of fluid from the bowels is very profuse, with pain, ex- haust io!i, coldness of tlie body, and, it may be, cramps in the limbs. This form of diarrhtea is the same as the cholera of the autumn season, generally de.scribcd and known as autumnal ehi>lera. It is apt to assume an epidemic form, but it is not con- tagious.
J^irahjHiHofthii Intestines. — Tlie intesfinea in various parts of their course are subject to paralysis, or palsy, either from muscu- lar wasting or from want of nervous supply. Tlie condition is dependeut on some disease pre-existent in the muscular fibre, or in the nervous centres, or in the nerves of the motor parts of the corebi"«»-spinal system. It is attended w^ith deficiency of propul- rive pijwer in the canal, and, as a result, with imperfect action of the bowels.
Colic.
An acute spasmodic affection of the hitestinal canal, without diurrlnca, but often attended with severe cramps of the abdomi- nal mU8cles, extending even to the muscles uf the extremities. Then* may be some fever with colic, but severe cases ocemr m whicli there is no febrile excitement at all.
There are two varieties of colic.
las
iatte
Lead CofiB.--GaGe iaso Ae hadjm
bf it.
met is tarn mhiA ia lof the ilitiMi in laul I imnteri^
oolie, mad 9M flnmftiwMit CitallT
CooMqwIioii k A oQoditiMi of daemm m which the intMtiiiil ^ sad ia which, ms m tesgit, it becomes luided with pmitM or dektia of digeeied food* The kr|:e iutastiDei » eoloo, i» the pftit tmaUj iasctiire and loaded tnoonsiipatioji, die iiglift of the affBClioa heii^ paiQ sad «eaee of weight ia the abdo- iPCtt, deprenrioa of yirits, biiSougaess^ headache or dull pain iathe head, lingiag noises in the ears^ and had appetite. Constipation maT be doe to mechanical obelniction in tbe canal, or to paral vsis. la the Urge majoritT of inetancea it is can^ bj want of eiiercisev iudiilgence in impruper food, or inattention to tlie daUy uatnral tion of the bow^k^ It is more eotnnion in women thati in uien^ Eld more in men who follow in-door and aedentary piir&iiiu tli&n in tboae who are engaged in active ont-door occupations. It tends to leimr more determinately in the aged of both 8exea» and it aeetns to be an hereditary condition in some ^miliea,
I>t«KAi»B3 or TB£ LOWEB BoWKL OR STRAIGHT IwriStfriNK.
Tile last portion of the intestinal canal, a tube about ten inches long, extemling from the end of tlie colon to the extreme outlet of the canaK and C4illed the straight intestine or rectum, is subject I aeveral forms of local disease.
Vloeraiian. — The inncous surface of this part of the hitestinal Dbe 16 subject to ulceration as a result of inHatnuiation, and, in Bxhaui^ting diseaf^es, this is attended with much irritation an*l '^di^ic^harge from the bowels, giving rise also to paroxysms of ir- ritative fever. The ulcerative surface ia usually limited and irregular.
Ab9oesB, — A condition in whtehj subsequent to iiitlanimatiau.
Ii4
UXAL DI&KASES.
ir«% :i^ ifc .m
aeciimidation of matter or pus in lower
Fidula in Ano.
Vn «»fwntfije ■^■■uiiiMUfiiii^ as a rc&iilt of inflammatioa and of
*tL iii cbe muicouB surface of tlie intestiue, low
'^^^Mmlttig itA coatis and exteudmg from the
* «sl^ ibId the 8urroiui4jing cellular tibsue, aud
it QfiBs ihmngli tlie skin near to the natural
l. Througli this tistiila the contents
ift to |MMB) unchecked by tlic volitiun of the
kieliiiB» mKv^ is called technically "fi&tula in
^*iii|fUcalloii of tubercular disease, and particu-
-i!iiia>a of the lungs, puhnonary con^unipti^n.
tupa lErom the accidental lodgement in the lower
zn b* Jy, AS a fish-bone or fruit-stone, Fis-
*r>uyxk& of ahnost all periods of life, and,
^intcnable to fiiii'gieal art. The fistulous
x*^, froiti the bowel to an outlet through
• ^Mtestine, It i^umetimes o|ions into the
. — in other cases into the urethra, —
^«Oi — aod in the female, in some instances, into
i ^wBf i0tBifitmi JiaiuJn. Tlie?e forms of fistula are now
*UlilMlbhl li> medical and surgical art,
MsHwrrhoid^,
su. : tt.^^ viiliear^ called piles, in the lowest part of the
Ukd caiudfttiug of a vascular enlargement, or of
* V tlie inucons membrane, whieli pi-otnide
ich uften extrude from the outlet of tlie
si*4 lilM^ M small or large painful external tunie-
^)||» tkx^ie varieties of hemorrhoids or piles. I Uoik iki^ swelling does not descend so as to appear iiulul internal obstruction, occasionally giving •Mia aro said to be present. * lli^ enlarged tumefactions descend and are ^».vternal piles are said to be preseiit. They '^'liable.
'ther internal or external piles give out -wwliug Uemorrhoida or bleeding piles*
DISEASES OF THE DIGESTIVE SYSTEM.
iSB
Hemorrhoids are cansed by indifferent flow of blood through the hemorrhoidal veins, or veins wliieU return the blood from the lower bowel into the circulation. These veins empty in grcat part into the hepatic portal, or venous portal system of the Hver, and in ahnost every case the heniorrhoidiil affection is duo prima- rily to congestive and temporary inaction of the liver* For this reason the disease is common in persons who lead a sedentary life, and especially in those of sedentary life who indulge in alcoholic uks. As a rule the fii^st attack of piles is develope^l after consti- tion. The affection is often excessively painful, is attended with dejection of mind, and where there is mnch loss of blo^xl, with exhaustion of l*ody. It is amenable to medical Hnd surgical art»
Hemorrh^igt. — Hemorrhage, or bleeding from the lower liowel, is nsnalty caused by an enlargement and congestion of the hemorrhoidal veins^ but it may also occur from ulceration. In all cases it is secondary to some other local affection,
Fimure, — An extremely painful affection, in which the lip or
outlet of the lower bowel is fissured, the mucous membrane Ijeing
dividcnl or cleft transvei-sely down to the circular fibres of tlic
hincter, or muscle which surrounds and closes the outlet. The
fissure may be caused originally hy tear or accidental cut from
le passage of a sharp substance, like a fruit-stone or fish-bone
ing froni the lx>weL It is more frequently the result of deep uh*eration of Uie mucous membrane. It often attacks those who are subject to hemorrhoids, in whom tlie mucous membrane is easily congested. It is a remediable affection,
Prolap9u$, — ^A state of local disease in which the intestinal tube, or its rancoos membrane at the lowest part, is prolapsed or projected from the outlet of the bowels. The condition is most common in children, but may occur in persons of any time of life. The protrusion may be to the extent of three or four inches, and
tin the severest forms may be attended with complete strangula- tion of the extruded part. It is caused in most instances by con- ■tipation, and is generally a recoverable condition, but not always without operation, Btn era
Stricture of the Lower Bowd.
Internal constriction of the bowel, so that the passage is ob- Btructed in part or altogether, is called stricture. oral varieties of this affection.
Ther
■e are eev*
126
LOCAL DISEASES.
Spaemotlic Stricture. — Stricture arising from spasm of the miiseiilar circular fibi*es, and due to im tat ion of a nervous centre. This is sometimes an hysterical phenomenon.
Externid Stricture. — Stricture produced by pressure on tlie tube externallvj aa by a tumor, an abscess, or a band.
Internal Non-malignant Strictui'e.— Stricture in which the mncona membrane is contracted from thickening or deposition beneath it ; or f n:>m ulceration followed by contraction,
JIalignant Stricture* — Stricture in which the constriction 18 caueed by one or other of the varieties of cancer.
In most cases of stricture of tlie lower bowel the disease be- longs to the cancerous or malignant form. It is more frequently ^levuloj>ed in the lower third of the tube than in the other parts.
Tumors, — The lower bowel is the local seat of tutnors which may be simple or malignant, and of the same types as those al- i"eady descril>ed as developing in other parts of the intestinal canal.
Parasitic Di^mse,~The lower bowel is the most common seat of the parasite called thread-worm, Oxijuria vermicularU. It may alst* bo the seat of cystic parasitic growths,
Sj}asm of t/ie S/'him^r, — The circular band of muscular fibres which encircle the low*er bowel at its outlet is sometimes subject to spasm and spasmodic closure : this may be of fiHir kinds,
IlystericaL — Spasm of tbo sphincter, developed as the result of hysterical spasmodic excitement.
Irritative. ^ — Spasm of the sphincter, excited by irritation in the bowel above, or in some remote nervous surface or centre.
Traumatic. — Spasm of the sphincter, the result of some injury inflicted from without.
General. — Spasm of the sphincter occurring as a part of a general spasmoflic condition, as in tetanus.
Tenesmus. — A painful condition of the lower part of the lower bowel, accompanied with straining, desire for action of the bowel, spasm of the sphincter, sense of acidity in tlie throat by which the teeth are ** set on edge,'' and general irritation, witli some irritative fever. The aifection is usually due to irritation within the intestinal canal from the presence of a foreign sub- stance.
Neurahjm. — Painful neuralgic seizure, affecting the lower bowelj and occurringj as a rule, with more or less of periodic
DISEASES OF THE DIGESTITE STSTEIT. 127
regnlaritT. It is eonneeted osiianT with eome odter form of nearalgic pun, and espedaUj with scimtica.
PmrUis, — ^An affection of the lower bowel at its outlet, ocm- fiisting of an intolerable itching, and attended often by a slightly ndsed eropdon, which maj ext^id to the adjoining skin. It is cansed most feequentlj bj congestion of the vesdels of the mnoons membrane from disturbance of the action of the liver, and is ac- companied nsoallj by constipation and other signs of dvqiepsia.
Injuries, — The lower bowel is, lastly, subject to local disease from external wounds and from impaction of foreign bodies within it.
Diseases of the PERrroNEux.
Peritonitis.
The peritoneum, or delicate investing serous membrane of the intestines and abdominal cavity, is subject to various local condi- tions of disease.
Inflammation of the peritoneal membrane is called peritonitis. It is an inflammatory condition of extreme danger, and is usually attended with high febrile excitement and acute pain. There are many forms of this inflammation.
Idiopathic Peritonitis. — In this form the membrane is pri- marily affected, the disease coming on from cold and chill, or from exposure to excessive fatigue.
Puerperal Peritonitis.— Metro-Peritonitis — Inflammation of the membrane occurring in women during or after childbirth, and often a part of puerperal fever.
Suppurative Peritonitis. — Peritonitis with the fonnation of matter or pus within the peritoneal cavity. A fonn of tlie dis- ease which is extremely fatal owing to the intensity of the local changes and the secondary absorption of purulent fluid from the peritoneum into the blood.
Chronic Peritonitis. — Peritonitis continuing in a subdued form for a long time, and maintaining an intermittent febrile state of the system.
Tubercular Peritonitis. — Inflammation of the peritoneal mem- brane induced by deposit of tubercular matter upon or near to the membrane. The disease often assumes an acute form, with much fever. It is very fatal
JUUiesiTO Peritonitis, — A condition in which the surfaces of the in famed membrane ultimately adhere by exuded adhesive ftl diSmut points^ so that tlic intestines become agglu- u>r boond logellier by tlie adhesions.
Dropey ^ the Peritoneum. Asdtei.
A Qonditioe of Iho peritoneum in which the inemhranouB car- i^ tioQiamd ati ejn?e88 of serous fluid. This disease, commonly Cttllod abdoaiinal dropsy* is, as a rule, dependent on some other of^^anic miaehief by whicli obstruction to the return of venous blood to the Heart has been pnxiuced. It is a very common re* «tiJt of Uver dfeimwe luid of organic affections of the heart.
IStman iff the Peritoneum,
" AJlio pertU>iie4il membrane may afford attachment to morbid ^ malignant; cancerous, and malignant eolloid,^ — gela- liay likewise l>e a seat for attachment of cysts con- tajtiiiig }»<arMiUc developments.
/lyyriW ia tM Peritoneum.
Hk^ periloiieiim ia ^-ery liable to injuries of various kinds* It
leie iMMilly ftr^ii ccnitusions of the abdomen; from wounds;
ire luid irritation caused by foreign substances in the
it«>Aiini\^ : und fn>m pn*ssure of the intestines themselves when
s\l into the openings from the abdomen, as in her-
t!* reaulta of all such seeidents led the older phy-
, ,..^ , ..i.in an almost superstitious dread of injury to the
if mi, and altliongh they greatly overrated the danger in
k^»ak Ihuir anxiety, drawn from their experience, was not
.* gouftklerable quality of sound learning and judgment.
CHAPTER m.
DISEASES OF THE HEART, CIRCULATORY APPARATUS,
AND BLOOD.
The local diseases of the heart and cmmlatorj apparatus are placed under various heads, according to the particular part that is affected. The parts include the pericardium, or double fibro- serons bag in which the heart is enveloped, and by which it is re- tained in position, separated from the lungs, and lubricated. The endocardium, or inner lining membrane of the heart The struct- ure of the heart itself. The coronary or special circulatory ap paratos of the heart.
Diseases of the Pebigardium. The pericardium is subject to several varieties of disease.
Pericarditia.
There are two varieties of pericarditis.
Simple pericarditis. — Inflammation of the pericardial mem- brane.
Suppurative pericarditis. — ^Inflammation with formation of pus or matter.
Adheaion.
Adhesions in whole or in part of the outer layer of the peri- cardium to the inner layer which is always adherent to the heart. These adhesions follow inflammation of the membrane, and are most serious impediments to natural motion of the heart after they have occurred. With them are sometimes connected dor posits of bony or calcareous substance, which cause the heart to be more or less encased in unyielding structure. 9
130
LOCAL DISEASES*
Dropsy of the Pericardium.
An accumulation of watery or eerous fluid in the pericardial sac or bag, called vulgarly dropsy of the heart, resulting some- times from iiitlanimation of the meml)raiiesj and eonie times from other causes, such as general dropsy, Di-opsy of the pericardium has also been known to occur as a purely local disease, without any definite signs of pre-existeot disease, and lias prored suddenly fatal by the fluid compression exerted npon the heart. To this and all other affections of tlie pericardium those who are of rheumatic constitution are most liable. Pericardial diBcases are amongst the most serious complications of rheumatic fever and the rheumatic constitution.
Diseases of the Enikjcardium and Valves op the IIeaiit,
EndocardUis.
Inflammation of the endocardium, or inner lining membrane of the heart, occurring on one or both sides of the heart, but most frequently ia the ventricle on the left side.
Valmd-ar Disease,
Diseases of tlie valves of the heart take two varietiee of name^ one having reference to the name of the valves affected, the other to the nature of the disease.
In relation to the valves themselves there are said to be four varieties of disease, viz. :
Aortic disease, — Disease of the semilunar or aortic valves; the valves wliich lie between the aorta, or great out-going artery, and the left vcntricle^or great oat-forcing structure of the heart.
Mitral disease. — ^Disease of the large bicuspid or mitral valve ; the val ve wliich lies between the left auricle and left ventricle of the heart.
Pulmonie valvid^ar disease, — Disease of the small semilunar or puhnonic valves ; the valves which lie between the puhnonary artery, ^-tlie artery proceeding to t!ie lungs from the right ventri- cle of the heart,— and the right vf?ntricle.
Tricuspid disease, — Disease of the tricuspid valve ; the valve which lies between the right auricle and the right ventricle of the heart.
DISEASES OF THE HEABT AND CIKCTtLATION.
131
Of these valvular Bti*netiires the valves on the left side of the beart, — the aortic and mitrfil^—are much more liable to disease tliau are the valves, — pulinotiic and trieut?pid, — of tlie right side* It may be said that valvular diseaso of the right side is conipara- tively rare, a fact I have endeavored to explain in my experimen- tal t-esearches on 'Mhe synthesis of valvular disease,^' by sliowing tliat in most instances the valvnlar disease is due to irritation caused by blood that has undergone an nnnatural chemical change while passing over the Inngs from the right to tlie left side of the heart. Vah nlar diseases ai*e by far the most prevalent in persons of rheumatic constitution, and are the frequent consequences of acute rheumatic fever.
Divided according to the character of the disease the valvular affections of the heart are : —
VegtiatioTis, — In which Btnall growths, resembling fungoid Tegetations, occur on the margins or tine surfaces of the valves,
Thiekenirhg, — In whicii the tibrous tissue of the valvular struct- ore is thickened and coufleused, so that the valves do not act with due facility in opening and closing, for the admission or arrest of the blood current.
yaity and calcareous degeiwrations.—lihe fatty degeneration is called atheroma, the calcareons is called o)«sitication. They con- fitst of clianges in whicli the valvular structures are transformed, in part, into a form of fatty structure, or into bony eubstance, and in which the regulating movements of the valves is extremely imj^eded.
Aneurism, — Disease consisting of enlargement, — dilatation, — of the valves, or t>f enlargement of the vesisels by which the valves are supplied with bluud*
lAP'tndmn, — Accidental tear of the valvular structure, under ipx'at excitement or strain. In very rare instances this accident has occurred where there has been a fairly healthy condition of valve.
DU^iJUUlon of the orijice of ths valves, — A condition in which the opening or orifice of the valves is much dilated, so that tlie curtains of the valves which spring from the orifice become inca- pable of meeting perfectly in the act of closure. This condition i« common in instances in which tlie heart is subjected for many years to severe strain from over- act ion, and where ail its structures are dilated. It is singularly common in persons who drink freely of alcoholic liquors, few of whom, indeed, escape it.
132 LOCAL DISEASES.
In certain of tliese forms of vahailar disease regurgUaiion of blood is not unfrequently detected by tiie physician. The term means that owing to tlie imperfect action of the valves they do not close efficiently, so that the blood which they ought to prevent from retnrning, and which they ought to dh^ect in its conrpe, flows back or regurgitates into the cavity from which it was projected. Regurgitation through the aortic valves is the most frequent form of this derangement
Orgaxic Diseases of the Structttre of the Heart.
The heart, an organ composed of muscular fibre, is subject to diseases of its own true striictui'e, and to diseases arising from nervous or functional disortler. Tlie first of these are the onjanl'C diseases of the heart, and they range as follow ;
MyoearditiSn
Inflammation of the nmscular structure of the heart. A rare form of disease, ending often in fibrous or fatty degeneration of tiie nmsenlar structure. There are three varieties.
Interstitial, occurring during existence of the syphilitic taint or constitution.
Rheumatic, occurring in persons of rheumatic constitution.
Alcoholic, oecnrring in persons addicted to the free use of al- coholic drinks, and ending often in fatty degeneration.
Abscess of ih£ Heart.
Formation of matter or pus in the rauscidar structure of die heart. A very rare aftection.
lltjjmirojyhtj of the Heart,
Ilypertrophy is a condition in which tlie heart is increased in size beyond w4iat is natural, until, instead of weighing nine or ten ounces, it increases to double, or, as I once saw it, to three times that weight. There are three varieties of the disense.
Jiypertrophy simple and general.^ — In wliich the whole of the muscular walls of the heart are enlarged equally, the cavities of the organ remaining of the game size.
Ilypertrophy si tuple and parti ah ^ — In which a part of the wall of the heart, usually uf the left ventricle, which is natm-ally twice
MSEASES OF THE HEART AND OXKCULATION.
aa thick as the right, ig increased in size, the cavity or ventricle remaining of the same eize as in health.
Hypertrophy general, with dilatation. — In which the walls of tlie heart are generally increased in Bize^ the cavities being also dilated or extended beyond their natural c^apacity.
liypertrophy partial, with dilatation. — In which one of the sides of the heart, usually the left, is enlarged, with dilatation of the corresponding ventricle or cavity.
Hypertrophy in its purest forms means simple increase of the mnscuJar structure of the heart ; but it is rarely long imattended with other changes, such as fatty deposit. It ci-eates extreme embarrassment to the circulation of the blood. It is induced by various causes, (a) By obstruction to the circulation, and over- work of the heart in order for it to overcome the difficulty ; (J) by excessive and long-continued pliysical exertion, as practised by runners, rowers, and persistent sharp walkers such as postmen; (e) and above all, by constant stimulation and over-action from flic use of alcoholic drinks. Hypertrophy with dilatation is a fre- quent combination of dis^asCi
Bj acme the affections of the heart are divided, according to the parts implicated, whether on the left or on the right side of the heart. They am so divided in the Cullege record.
Atrophy of the Heart
Atrophy, as its nauie implies, is wasting of the substance of the heart, so that the organ becomes reduced in size. The waste occurs in the mnsinilar structure, and, as a rule, to whicli liowever I have more than once seen an exception, is general in character, including the whole structure. The cavities of the heart usually retain their natural capacity, or they may be increased in capacity rather than diminished. Atrophy occurs during wasting condi- tion of the body, and is commonly attended by structural change or degeneration. I have seen it caused by excessive development of fat around the heart, and I believe tliis to be a moi-e important cause of it than has been supposed up to the present time.
JSxfjess of Fat on the Heart
_ In animals fatted for the market it is found that the heart is
witli fat, which lies in a dense layer close to the muscular
irOy atid which in the sulci or spaces between the auricles
134
LOCAL DISEASES.
and ventricles, and between the ventricles on the exterior of the heart, exiBta as a thick roundish layer that cannot easily be torn away. In Botue instances, in the hninan family, in persons sub- ject to obesity, fat in like manner accumulates on the heart, and forms a firm, heavy, and cmiiherBome surround iog. The effect is to interfere seriously %vith the action of the heart, to create heart- breatlilessness, — cardiac apnoeaj^ou slight exertion of the body, and ultimately to demnge the nutrition and structure of the heart itself.
Dilutalion of the Heart,
Dilatation of the Iieart is a condition in which one or more cavities of the heart are dilated without either hypertrophy or ati*ophy of tlie muscular walla ; or in which the oritiees leading into or out of the cavities of the organ are expanded, dilated, and relaxed* There are two varieties, {a) Of the left side or cavities of the heart, auricle, ventricle, or both, (i) Of the right side, auricle, ventricle, uj' both.
Fatty Degener(ition of tM Hearts
Tatty degeneration of the heart is a change of the physical strnctore of the organ in which the true muscular elenjcnts wliich lie in transverse lines on each other in each musc^ular Wbril, are transformed into or replaced by series of fatty particles which possess no ]>ower of contractile aggregation, and undergo no moditication into motion under nervous or other stimulus. The heart so degenerated is therefore, in proportion to the extent of the change, practically dead. Fatty degeneration is promoted by indolence and luxurious living ; by living in bad air ; and, most easily of all, by the use of alcoholic drmks. It becomes an hei*ed- itary disease,
Fihroid Degeneration of the IleaH.
A degeneration of the muscular structure, of slower develop- ment and course than the fatty cliange, in which muscular ele- ments are replaced, more or less, by tibrous elementary structnre which possesses no irritability, and fails to respond to the nervous stimulus. Together with this state of disorc^anization there is thrown out a plastic fluid, probably a moditied fibrine, which is not developed into natural muscular tissue, but which fills up the
DISEASES OF THE HEAET AND CIRCULATION.
135
I
meshes of the fibrons struetnre, causing a deposit wliich enlarges, hardens, and incapacitates any remaining muscular fibres for their natural action. Fibroid degeneration is connected often, if not alwAve, with some constitutional taint, syphilitic, rlienmatic, or alcoholic. It is less rapidly fatal than the fatty degenerative change.
AneurUni of ike JTeart.
Aneurism of the heart means a condition in which, owing to weakness of the muscular wall, there is a proti*usion of the wall poshing before it the serous covering of the heart, and forming a pouch or sac containing blood* The disease is very rare, and when it occurs is preceded by degenerative changes.
^H Acute Aneurism of the Heart
^m Another form of aneurism defined by the Royal College as ^V applicable to cases " in which blood becomes effused into the sub- ^L^ance of tlie heart owing to inflammatory eofteniug and rupture
■ tim
mm
liiipture of the IIe4irt.
An accident in which the heart under strain bursts, or is rupt- ured in some part, letting out its contained blood into its peri- cardial sac or cavity, •Philip Y. of Spain is said to have died from mpturo of the heart on hearing of the defeat of his army. Some d^ths are occasionally recorded from the same cause in our own time, after excitement from hurry, rage, or other fc»rm of severe »citement. In such examples there has always been some pre-
ing disease of the structure of the heart, such as fatty, fibroid, or anearisniat degeneration. The accident is rare. I once knew mptiire of the heart to occur in a man who was supposed to have died of Asiatic cholera.
Disease of toe Cosonakt Abteeies.
y ................... ply the prime organ of the circulation, the heart itself, with are called the coronary arteries, because they encircle the as it were, with a corona or crown. These arteries are sub* ject to various forms of disease.
DihUUwn, — General dilatation of the vesseh
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LOCAL DISEASES.
Obt^kc^ion. — From narrowing of the vessels or deposit in tliein.
De^efwration,— From fatty or osseous changes of structure.
AfieurUm. — -From aneurisnml enlargement of the artery.
Disease of the coronary arteries leads invarialily to injury of the nutrition of the heart itself, and to degenerative changes iu its structure.
Sudden death sometimes, but very rarely, occurs from quick arrest of the circulation of blood in the coronary circulation.
Cyanosis, or Blite Skik Disease.
The heart is subject to various kinds of malformation, that i to say, in plain languagCi departure from tlie natural construction. The errur of this kiud whicli conceruB us most is that which gives rise, after birth, to the disease cyanosis, so called because the body of the sufferer is blue in tint. The error in the mechanism of tlie heart in this disease i^^ that an opening between the right and left auricles of the heart, called the foramen ovale, and which previous to birth allowed the blood in the right auricle to flow direct into the left auricle without passing first through the lungs, but which ought to close after birth by a finu membrane so as to prevent that direct exit and insure that tlie blood is made to pass over the lungs, does not close. The result of the failure of clos- ure is that after birtli venous blood passes fi-oni the right to the left ride of the heart without undergoi ug due change from respi- ration, Le.y without being duly arterial ized* The person who has cyanosis is of dark bluish color ; is cold over the bijdy ; is of feeble constitution ; and, raroly lives beyond five years, although I have known an instance of the kind in wdiich, nnder extreme care, life was extended to twenty-two years. The intellect, in tills form of disease, if not brilliantj may be clear and sonnd. Death is usually caused by congestion of the lungs, or by develop- ment of tnbercnlous or other disease of tlie breathing organs.
In one instance recorded, by the late Dr. Mayne of Dublin, the deficiency of the heart aliove named, deficiency of closure of the foramen ovale, led to an opposite condition, namelj-, to the passage of a portion of arterialized h\ooA from the left auricle back into the right auricle, and into tlie venous side of the circu- lation ; so that the person affected, a W'Oman, wlio In^ed to be over twenty years old, was always being supplied with supef-
DISEASES OF THE HEAET AND CIRCtTLATIOIf.
137
oxygenated blood. She was the subject of profuee perspirations, aded with gi*eat lasaitude aiKl feebleness ol body, like a feeble >n in a tropical climate* She died suddenly after some slight
exertion.
Fl^NCTTIONAL DitiEASES OF THE HeaRT.
Si/fvoope. — Famti7ig Fit>
A failure of the heart, leading to sudden collapse, coldness and failure of the body, with unconsciousness, called comnionly deliquiuin, swoon, or faint Syncope may occur from nervous fihoek, bodily exhaustion, loss of blnod, or mental emotion. In
Liyneope, as I have shown in a Croon ian Lecture, the size of the beart is for the time redneed, and tlie organ, which still continues beat regidarly, is working at low presriurc, in a state t»f *' pas- sive efficiency," that is to say, in a degree sufficient to sustain its
^own Hfe^ but not to maintain consciousness and the other active (unctions of vitality.
Sjmsm of the UearL Angina Pec(<rns,
A sudden spasm of the chest, involving the heart, attended
with severe pain, coldness uf the budy, and prostratiLiri, and with
much ditiiculty of breathing, Tlie disease occurs in paroxysms,
lid is vulgarly called heait or breast pang. 1 liave proposed to
it cardiac apno^a, heart breathlessness.
Irretjuhirity of the Action of ihs Heart.
Under the intluence of organic disease of the organ, but much more frequently under nervous disturbance, the heajt may un- dergo irregularity of movements. There are several varieties of these irregular movements.
PalintiUion, — Pa!pit;ition is a sudden violent over-action of the heart, during which the natural sounds are indistingnishable, ad the impulse is so stroTi*^ that it may even 1k3 seen through the of the affecteci pereyinh The pulsej in thin state, is ex- aely rapid in movement, and when its movements are trans- ited into Botmd by the sphygmophone, instead f»f being heard as rthree distinct sounds, the sound is as of a wheel in loud and rapid rotatory motion. Palpitation is nsnally attended witli flushing of tlie face, sense of fulness and oppression of the chest, rushing of
138
LOCAL DISEASES.
blood to the head, and want of power, ending in faintnegs or ex* liaustion. It is usually excited by some distant irritation, in the stomach, bowels, or throaty and is often relieved immediately by eructation of flatus.
Acute itTegnlarUif of ths hmrt-heaL — An irregularity in which each beat uf the heart is given in correct order of succes- aiotij the one stroke to the otlier, Ijut in eeriefl of five, teUj or other ninnber of beats, differing in rate from other series. This irregulai'ity occm*3 when the action of the heart is feeble, as in ana*mia, and after loss of blood.
Probjnged irre^fdaritf/ of the heart-heat, — A condition in which the strokes uf the heart may register during one minute a certain number of beats, say seventy, and the next minute a dif- ferent number, say ninety or a Iiundi*ed, ^> that from minute to niimite tlie rate of motion varies. This irregularity is common when there is disease of the brain, and in some acute affections of the brain in children it is a yerj dangerous indication.
IntermiMefU Action of t/ie Heart
Intermittent action of the heart is a condition in which the stroke of the heart is every no%v and tlien lost, so tliat when lis- tening for the sou 11*1 of the stroke in the chest over the heart, or when feeling for it in tlie pulse at the wrist, it is lost, and does nbt occur when it is expected and ought to uecur. If we are listening to tlie healthy hc^art we hear always two distinct sounds, a first sound and a second sound, the second sound being followed by a pause. The first sound, whicli is e4>nnected with tlie act of contraction of the ventricles and with the sending forth of the lilood over tlie hmgs and over the whole body, the systole, — sus- telloy I contnict, — is called technically the systolic sound. It is caused by the closure and tension of the great valves lying be-, tween the auricles and ventricles of the heart, and resembles in sound the wonl hth. The second sound is connected with the time of the reHlling of the heart with bhx>d, when the ventricles are in a state of dilatation^ dhistole.^ — dia^ apart, 8f4:JM^ I send, and is called, technically, the diastolic sound* It is caused by the closure and tension of the little semilunar valves which lie at the base of the pulmonary artery and great aorta, and resembles in Erand the w^ord tfdjK
So there are produced two very distinct sounds, luh^ dOp, and
BISEABl^ OF THE HEART AND CIRCULATION.
139
then follows ^ pause. The first sound, ?wi, is equal in length to tbe dOj) and the jHtust\ the whole occurring within a &econd of time. With tbu lub the heait is contmeting ; with the dii^* it is refilling ; with the, pause it ifl resting, waiting, aa it were, to take breath l>efore it sends forth its charge. That little pause is, in fact, the holiday time or sleeping time of the heart ; the onJj rest the organ has in the three billion of strokes which it niuet make in a life of fourscore years ; hut after all, when it is faii'ly obtained, one-fourth of the wliole period, viz., twenty years of rest. In intennittent pulse this rhythm o£ work is lost. When w« listen for the lub, d&p^pause^ we get it a few times, and then, with a lapse which may almost make the listener start, we miss the long stroke^ and get instead, dup / afterwards in a sort of knnckling over fashion, there follows luh^ diipy dup / andj next lime, in rhythm again, lah^ dCip^ pause. If tlie finger be on the rist while the ear is over the heart, the pulse, at the momeut when the ear loses the /wi, fails to be felt ; the systole or sending forth of blood has been, for that time, witliheld,
Intennittent action of the heart means, therefore, a failure in tie contraction of the heart, by which thi.^ blu-od is sent forth over the body. It does itot^ of necessity, mean any disease in the structure of the heart itself, fur it may be present when the heait is in tbe most healthy state organically ; but it means a functional disturbance owing to irregular supply of nervous stimulus.
My researches, recorded in another essa>', have shown that in- termittent pulse is usually the result of some form of nervous shock, — grief, anger, fear, physical injury, anxiety, and the like. It is almost always pi*esent, at times, in persons who have passed their sixtieth year, but it is often developed much earlier in life, and it may be congenital and be existent from the moment of birth. It is not of itself a fatal condition ; but when tbe lieart is diseased, or when other diseases are present in the hotly, it is a source of evil, addmg much to the danger. It may be considered tttteotially as a sign of organic nervous failure.
Fihrlnons Depmiis in t/ie Heart*
In some forms of diaeaso the cavities of the heart become the centres of fibrinous separations or deposits of fihrine from tbe blood. In some inflammatory diseases, croup, inflammation of Iho lungs, malarial fever, surgical fever, or fever following surgi-
140
LOCAL DISEASES.
cal operations, puerperal fever or fever of eltildbed women, these deposit ioijB am caiises of death, actini^ in a rapidly fatal manner. They ai'e also met with after certain forms of disease from animal and mineral poisons. The separations of fibrine may occur in eitlier of the cavities, the anricles, ur ventricled, on the right or left sides of the heart, hut the right cavities are their most fj-e- qiient seats, and the riglit auricle the most frequent part in which the prcKjess of separation cojmneiices. The tihrinons masses fornied in the heart are often of pure white color, tibrous in text- ure, and 60 extensive as to fill the cavity of the right anricle and pass through the ventricle into tlie pnluionary artery and its branches. The mass is souietimes a solid cylinder, at other times tubular, and now and then a spiral, from blood havhig flowed around it.
Diseases of tite AEXERrES. The larger bliKKi- vessels, arteries, and veins are liable, like tlie lieart itself, tt> various structural changes or diseases. Those of the arteries are classified in the following order,
Inflannnatlon of an arterial strnctiirc, beginning in the inner lining or serous cuat of the vesjseL It is a rare disease, and of difficult detection during life.
FaUt/ ami CalcareouB Arterial Degeneration* Changes taking place in the structure of the arteries, leading to defKisits of fatty or of calcareous material. The lirst of these changes is called atheroma, the sec^ond, ossification. In both in- stances the vessels at the affected part lose their elasticity and theh* contractile j^mwer, and are easily ruptured under extra press- ure from the heart, or from back pressure due to retarded circu- lation in the veins. In this condition rupture of the arteries supplying the brain is a fi^quent cause of apoplexy ; and rupture of the large arteries near the heart is a fretjuent cause of sudden death, from iuternal hemorrhage. The degenerations are not common until after juiddle life.
Narrowing and ObUierathn of the Arteries,
Conditions in which tlie arteries are reduced in calibre or completely closed. The closure is usually due to deposits within
DISEASES OP niE HEART AND CIHC!TLATIOTr.
141
tlie csoats of the vessels, or to pre-existent iiifiammation of the vessels.
Oodiman of the Arteries,
The arteries are sometimes occluded, so tliat they fail to per- mit tlie l>lood coming from the heart to traverse them. Ocdusiou is of two kinds.
(a) From compression. In wliich an artery is subjected to C50mpi*eflsion from pressure exerted upon it by some external sub- stance, such as a tumor or growth ; or from the displacement of an organ ; or from effusion of fltiirl into a closed cavity ; or from the prepuce in the hody\ near to an artery, of some foreign sub- etance which presses upon the artery.
(b) From impaction of coagnia or clots within the arten\ Occlusion of a portion of the ai^terial system is nioch moi-e com- monly caused by impactioUj *.^., by the filling up of a portion of an arterial tube with coagiihi or clot of blood. The clot in these caaes may fill up the vessel at the spot wdiere it, the clot, is formed, that is to say, at the place where the process of coagula- tion has occurred. Or a Braall clot may be formed in one part of the arterial system, or in the heart itself, and may be carried to another part where, owing to tlxe calibre of the vessel being less, it fills up the vessel and creates the obstruction. This latter con- dition is one of the causes of apoplexy, a small clot set free fills op an arterial trunk; or a series of minute clots fill up the mi- nuter branches of the arterial circuit of the brain. Occasionally these detached masses wbirb occlude the arteries are composed of other matter than coagulum of blood. Portions of warty excres- oeoeee detached from the valves of the heart may cause the ob- Btmction^ and a mass comjwsed of fatty substance has als*:^ been met with. The old physicians called the larger depositions of fibrine which occur in the arterial vessels, polypi, mistaking them for polypoid growths.
Dilatation of the Arteries.
Dilatation is an increase in the size of an artery beyond its natural calibre, but ecpially in tlie direction of its course. Dila- tation is common in the large arteries near the heart in persons of advanced life, and is often attended with changes and deposits in the arterial coats. There is also a form of general dilatation
142
LOCAL DISEASES.
of the arterial Bjstem common in hard drinkers and otliers who have subjected the arterial vessels to great pressure of blood. The dilated artery 18 incapacitated, to a large extent, for the work it has to perform in the economy. It has lost its elasticity to a considerable degi'ee, so that its recoil, from the dilating stroke of the heart, is imperfect. The circular organic muscular fibres with which it is endowed are, moreover, deprived of their natural due contractile power,
Aneurmn of the Arteries*
An aneurism of an artery is a dilatatioTi of the arterial vessel, hut with this difference from simple dilatation, that the enlarge- ment is not general in the course of the vessel, but is at one part, and is attended with thinning, or even rupture, at the affected spot of one or more of the arterial coats, which, as we have seen, consist of an investing, an elastic, and a muscular coat, and an inner or serous linitig. Aneurisms are classed under several heads. The following are the most important varieties of an* curism.
{(i) Fnsiform aneurism. In which the dilated part is like a spindle, large in the middle and reduced at botli ends.
(J) Yascular aneurism. In which the diktatiou is round like a hollow ball or sac.
(f) Diffused arterial aneurism. In whicli the sac or surround- ing wall is not; made by tiie dilated artery itself, but by the con- densed surrounding tissues, which have become united or adhe- rent with the broken arterial coats,
(//) Dissecting arterial aneurism. In which there is partial tear or rupture of the intenial tissues of the artery, and effusion of blooj between the coats of the vessel, extending for some dis- tance, and dissecting its way between the coats.
{e) Traumatic arterial aneurism. Aneurism in which the dila- tation has been caused bv a %vound inflicted on the artery.
(f) Aneurism by anastomosis. Anenrism by arterial vessels which are carrying on a new circulation owing to obstruction in the main arterial current through which the blood originally passed.
There are some other varieties of anenrismal disease which are of rarer occurrence, such as arterio-venous aneurism, aneu- risnial varix, varicose aneurism, arid arterial varix ; but those
DISEASES OF THE HEART AND CIItCtlLATrON,
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I
classified above concern iis most as being the iBore decisive and frequent. Aneurism of tlie large vessels, as of the great aorta at its comraencenient or arch, and of the vessels springing from tlie arch, are the more serious and common aneurisms: but aneurism of the pophteal artery, — the artery running through tlie hollow spdoe at the back of the lower limb lietween the thigh and the leg, Ijehind the knee-joint, — is also common. Aneurism is in- duced by acts which c^use great strain on the arterial system, and especially when such acts subject the body to rapid jerks and 8hoc*ks. In the old posting days aneurisms of the aorta were so freqnent, that the term " post-boy's disease" was applied to them. Aneurisms are specially liable to occur in persons who are disposed to degenerative disease of the arterial coats, and it has recently been observed that persons who are born suffering from syphilitic taint, or who have themselves contracted that specific disease, are more liable to aneurism than other persons who are free of such constitutional affection. The question whether an- eiirism is hereditary in character has not been satiftfactorily set- tled. It affects those who have approached the middle term of Jife more fi*equently than it does the yoimg, but I have neverthe- less seen it affecting the young, under fifteen years of age. An aneurism is occasionally healed, spontaneously, by deposits on its inner surface of tibrine from the blood and by gradual oblitera- tion of its sac or pouch by that gratlual process of deposition.
Hiipture of an Art^ri/,
Rupture of an artery means a breakage through the arterial 5ats, without preceding dilatation or aneoristual enlargement. Rupture occurs from two causes; —
(a) From disease in the artery itself by wliich the coats are
ikened and destroyed.
(h) From disease of the structures outside tlie artery and ex- tension of the disease into the vessel, as when an artery is in- volved in an abscess or in an ulceration.
Diseases of the VEms,
The veins, vessels which bring the blood back to the heart ter it has passed from the arteries througli the minute circula- tion, are subject to local changes or diseases, which, on the official ooU^iate record, are put under seven principal heads.
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LOCAL DISEASES.
Inflarnmatioii of the structure of the veina. There are two Tarietie8.
{a) Adhesive inflammation. In which the rein is inflamed, and has deposited in it fibrinous coagula or blood clot
(J) Suppurative inflamoiation. In wliieh purulent matter, pus, is formed at the part inflamed, often with ulceration of the vein, ending in adiiesion and obliteration,
PhUgma^ia Dclens, Wliiie SttfeUin^,
A condition of inflammation of the iliac and femoral veins, veins of the groin and thigh, in which those vessels become ob- stmcted by coagula, and the returning blood, from the lower part of the limb to the heart, is impeded or prevented. The limb tlierenpon becomes swollen, tense, white, and extremely painful, while the whole systetn becomes fe%'erish, distnrljed and pros- trated, Pldegmasia dolens occnrs in women after ehildhirth, and is rarely developed under other circumstances. It is fiometimes rapidly fatal, the cause of it being often due to a detachment of a portion of the coagulated flbrine in the vein and the floating of the clot, thus separated, into the heart, whei*e it becomes the centre of a larger clot and an obstruct ion to the blood in its pas- sage to the Imigs from the right side of the heart
Fihrinous Concretions in the Veins.
Separations of flbrine from the blood in the veins ; sometimes occurring frijm local causes, sometimea from a general condition of the blood in which there is a disposition to the separation and the coagulation of its fibrinous part,
OlMructian in the Veins.
Obstruction to the course of the blood back to the heart by a vein. There are two causes of such cibstniction.
{a) External compression. In which the vein is compressecl by externa] pressure, as from a tight garter or bandage ; or from the growth of a tumor ; or from pressure of fluid contained in a sewus cavity or cyst.
(5) Disease in the vessel itself, by which its canal is filled, or its coats become adherent.
DISEASES OF THE HEART AND CIRCULATION. 145
PhleboUtea.
Small loose masses or concretions, feeling like seeds, in the veins. When they are in the veins immediately beneath the skin they can sometimes be moved by the pressure of the finger.
Varicose Veins.
Veins enlarged and knotted, the enlarged parts being filled with blood ; a condition most frequently met with in the veins of the legs. The affected vein, in these instances, is distended with blood, and the distention may even proceed, though such is rarely the case, to actual rupture or tear. Varicose veins are induced in some persons by remaining long in the upright position and taking little exercise. They are also caused by obstruction to the return of the venous blood to the heart, from liver diseases and heart diseases, in which the free current of returning blood is impeded. The tendency to varicose veins is hereditary.
N^CBVus Vascularis.
A vascidar growth, on the skin, usually consisting of a series of small capillary vessels forming a dark vascular tumor, which in some cases throbs or pulsates. A small nsevus is often vulgarly called a blood wart. A large diffuse nsevus, not raised above the skin, is called a mother's mark or a port-wine stain.
Injuries of Veins. The veins are often subject to injuries from blows, from com- pressions, and from wounds. They may be ruptured or torn without an external wound, and may give up much blood beneath the injured surface. This happens in cases of bad bruise. In some accidents a large vein having been cut or opened, air is drawn into the opening and, being carried to the heart along the vein, is a cause of fatal obstruction to the circulation of the blood through the lungs.
Functional oe Organic Diseases of the Intermediate or Minute Vascular System.
Between the arteries and the veins there exists the wide- spread surface or net-work of communicating blood-vessels, which we already know as the minute circulation. To these vessels the 10
140
LOCAL DISEASES*
term capillary, capillm, liair, was once applied. The term gtill retains its pliiee ; but wc are aeeu&tomed now, in speaking of tiie system of fine veiieels which He between the arteries and the veins, to tlunk of them as eoiuc thing more than fine hair-like tubes for conveying blood. We know now that these tubes are endowed, in a part of their course, with contractile powers, and that their contraction i.sregnkited w^ith natural automatic precision by the nervous stun nl us derived chiefly from the great centres of the organic or sympathetic nervous system, and that through the nen^ous system they are influenced botli by physical and emotional vibrations. Hence tliia minute circulatory system is a centre of balance lying between supply and deniand^^ — supply of blood for feeding and sustaining the tissues of the body, and demand, by the tissues, for the supply. Hence again, this minute circulatory system, subject to nervous disturbance from phYsical and emotional shocks, derived from without the body as well as from within, is exposed to variations of action and to changes which hy their mere occurrence affect in the most sensitive and explicit manner the nutrition and the powers of the body,
A shock of a physical kind, a blow or stun, communicates to the minute circulation, through the nervous centres, an impulse which, for a time, more or less prolonged in proportion to the forc^ of tlie impression, makes the small vessels dilate or con- tract, and so causes tliem to disturb the sirpply of blood which gives color and life to all the parts for which it is destined. In like manner mental shock communicated to this circulation, through the senses and nervous centres, causes dilatation or con- traction, making the surfaces of tlie body, as tlie face, fluslied or blanched, the mental concussion acting, virtually, as if it w^er© a physical blow. In other states this minute circulation is relaxed or pandyzed, from different nervous impressions, and the course of blood tlirough it being tlien uncontrolled, the vessels become distended with blood, the heart vehement in its action, and the secreting and nutritive processes quickened to overflow and waste.
Tlie body " braced up " by exercise in an invigorating air is \n a condition in which the healthy tension of the minute circulation is perfect. The body relaxed, inactive, in heated, unchanged, damp, tropical air, is in a condition in which its powera are greatly thrown away and its vital energies too much expended in
DISEASES OF THE HEART AND CIRCULATION. 147
the mere acts of eliminating and evaporating the excessive pro- ducts of uncontrolled secretion and nutrition.
We are beginning now to discern that much of the nature of ^ diseased action is primarily traceable to influences telling upon the' nervous snpplj of this great though minute system of blood-ves- sels, in which animal heat is generated, animal parts selected out, animal structures built up ; in whidi, in short, all the animal or- ganism is being constructed during life.
The minute circulation is subject to the following changes.
Spasm, or CorUro/ctiony more or less Permanent.
This may be produced by : —
(a) Physical shocks. Blows; stuns; heat-stroke; electrical stroke; nervous concussion; sudden exposure to great and dry heat ; high barometric condition of air.
{h) Mental shocks. Passion ; fear ; sudden starts ; sudden and intense grief.
{c) Substances taken into the body. Some poisons, such as strychnine, brueia, tobacco.
(d) Some conditions of disease. Acute fever ; tetanus ; teta- noid fever ; various obscure changes in the nervous centres ; press- ure on organic nervous centres from flatulency and dyspepsia. •
MdcuDoUon or Paralysis of Minute Ovrcvlation,
This may be produced by : — '
(a) Physical depressions, such as long-continued exposure to cold, or cold and wet ; privation ; impure air ; low barometric condition of air ; excessive fatigue.
(J) Mental depressions, such as long- con tinned grief ; worry ; anxiety ; mental strain ; prolonged as opposed to sudden fear ; minor developments of all the passions ; corroding excitements.
(c) Some diseased conditions. Sucli as exhausting diseases, like consumption and diabetes; organic changes in the nervous centres ; possibly, some poisons of disease, such as cholera poison, and poison of scarlet fever.
{d) Some poisonous agents, such as alcohol, which for fre- quency of effect stands first ; and agents like nitrite of amyl, which for suddenness of action on the minute circulation, in para- lydng it, is the most potent.
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LOCAL DISEASES*
Organic C%ange8 of MinuU Circylation,
That changes of the most important kind for the production
of disease are induced by long-continued or repeated dihtnrbance iu the unnute circulation is a fact which day by day u being uioje and more recognized by the physician. In particular, it is now known that the organic modifications of structure in vital «>rgan8 which follow persistent indulgence in alcoholic drinks ai*e prima- rily due to the continuous relaxing inHuence exerted by those drinks on the nervous function of tlie minute vessels, and thereby on the nutrition of the structures which they supply with daily food in the form of bloixL This is one, and at present one of the best illustrations ; but the w*hole question of the origin uf organic diseases is so intimately eounected with the changes inci- dent to the minute eirculatiou, and i.s now l>eing so carefully con- eidered, that much w^ider views and departures of knowledge in relation to it may be expected during succeeding years.
It has been sufficient for my purjxise in this place to give a mem glance, short, but I hope to the thoughtful reader signifi- cant, of tlie automatic niechauism of the nutritive processes in the living b<xly ; of tlie nervous action that is constantly at work to control that mechanism; of the agencies, physical, mental, nioi^al, by which the cotitrol or rhythm may be modified ; and of the re- sults, immediate or deferred, whicli may follow upon such nuidi- fication. In the course of the after paiis of this Tolume, as in what lias preceded, tlie bearings of the study of this automatic regulation and of the perturbations to whieli it is subjected, will be incidentally but amply represented in still more varied lights.
The Blood in Relation to Disease,
In the whole of the present chapter we have been treating of a system of vessels and tubes constructed for the purpose of con- %^eying blood tlirough the various parts cif the body. It remains for me to add a few sentences on the blood itself in relation to disease, — ^the local diseases, as they might be called, of the blood.
The authorities of the Koyal College in their nomenclature let this subject pass, as they do that included under our last heading, without notice.
To tliose who are not practically learned in medicine sucli an omission as this mu^st seem strange. ** The blood ia the life,"
DISEASES OF THE HEART AND CIRCULATION. 149
"blood disease," "good blood," "bad blood," "pure blood," *' impure blood," " poisoned blood : " these and many other simi- lar tcnns convey the idea that the blood is a very centre of all the diseases of mankind.
But when we come to precise facts, when we condescend to learn the true and fixed local diseases concentrated in the blood, great diflBculties at once appear ; because, after all, the blood, a constantly regenerated fluid, is but the channel through which diseased conditions, lying apart from itself, are temporarily pre- sented. The blood may be the means of conducting or conveying into the tissues agents which may be poisonous, and so it may be itself poisoned from without. The blood may be the means, and is the means, of conveying poisonous products out of the body and of presenting them for oxidation and destruction to air, and so it may be poisoned from within. Both, however, of these states are but passing phases, and the same holds good in respect to all other conditions of disease, with a few exceptions to the contrary so rare they may be allowed to pass without special no- tice. The blood, in brief, is the whole body in transitory solu- tion, and is the representation of the body in that state.
It IS difficult, consequently, to name any permanent local diseases of the blood ; but it is not without service to look at some changes in its constitueu t parts, which may be called its local temporary disorders or diseases.
Increase of Water of Blood.
The blood contains naturally 790 parts per 1,000 of water, and its specific gravity is 1.055. In some forms of disease, such as dropsy, the quantity of water may be largely increased. The blood of a woman who was suffering from ovarian dropsy, I found to have a specific gravity of not more than 1.016. Such blood is incapable of sustaining the natural functions of life.
Decrease of Water of Blood,
In certain exhausting diseases, such as cholera, where mere is a constant drain of watery fluid from the body, the blood may be left so dense from loss of its water that it may cease to be able to flow through the minute vessels.
100
LOCAL DISEASES,
Increase of Ferine in the Blood, — Tfi/jpenno8t9.
The blood nfitiirally contains from two to three parts in the thousand of the plastic coagiilsble colloid called fibrino, which while circulating in the vessek k in the fluid state, but which, when the blood flows out of the body, sets or clota. In some conditions of the body the fibrine undergoes increase in the blood, especially in various fonns of local intianitnations, such as pneu- monia, or ioflamniation of the lungs, croup, and malarial fever* In extreme instances it may increase to the extent of nine parts in the thousand* When an increase of the fibrine of the blood is present the tendency is to its deposition and to the formation of those fibrinous concretions which the ancient physicians called polypi, and whicli we have seen classified amongst the local diseases of the heart and blood-vessels.
Dect'ease of Fthnne in the Blood.— H-ijpinos^is.
In some conditions the fibrine is decreased to one or even % lesser part in the thousand parts of blood. Blood so circum- etanced is often nncoagulable ; it easily flows out of the vessels, and if a small wound be made, a wound from tito bite of a leech, for example, the bleeding may continue to a fatal issue. This state of fluid blood may give rise to an eniption on the body of , dark spots like bruises, and to one form of the disease known as purfmra. Cliildren are sometimes born with tlie blooil in this state of extreme fluidity, and in exceptional instances the affection is hereditary.
Decrease of lied Corptwd*^ of Blood,
The natural blood contains one hundred and twenty-seven parts in the thousand of corpuscular nuitter, made np iu great part of the little circular red disks containing a substance known as hwmagMnny in a thousand parts of which there is four and (me-fifth of the metal irun. The corpuscles may be greatly re- duced in amount without actual danger to life ; but the reduction of them gives rise to paleness of the blood, and, as they are the Ijearers of the oxygen of the external air into the body, such reduction gives rise also to paleness and feebleness of the body, and to defective nutrition. The disease *' anaemia'' is due to a reduction of red corpuscles iu the blood, and the '' auajuiic state,"
DISEASES OF THE HEART AND CIRCULATION. 161
from the same cause, is present in many lingering and wasting diseases. The term ^^pocr hlood " is commonly used to indicate this state.
Injury and De^tmction of Bed Blood Corpuscles.
The red corpuscles of the blood are subject to injuVy, and even to destruction, by various agents acting on the body. By admixt- ure of ammonia and of other alkalies with the circulating blood the corpuscles can be wholly or partly dissolved, made crenate at their margins, and irregular as if indented or notched. By the smoke of tobacco they are modified in a similar form. By alco- hol taken freely into the body they are reduced in size, and lose their true rounded form, becoming long and " truncated." In blood surcharged with soluble saline substances they are reduced in size, shrunken. In blood surcharged with water they are in- creased in size, lose their flattened form and depressed centres, and become of rounded or globular shape. In instances in which the blood is surcharged with carbonic acid, the corpuscles lose their red color, and the mass of the arterial as well as of the venous blood becomes dark in color.
Under all these varying states, the natural function of the blood corpuscle, its power to condense the oxygen of the air which it meets as it circulates through the lungs, and to convey oxygen into the ultimate tissues of the body for supporting the combustion and the nutritive changes, is perverted. Thereupon the healthy state of the body is rendered impossible, and various modifications of organic f uactions ai*e set up, which, if long con- tinned, lead, of necessity, to natm*al perversion of function and proclivity to disease.
Increase of the White Corpusdes of Blood. Leucocythasmia.
Besides the red corpuscles there are, as we know, in the nat- nral blood a number of other corpuscles, far less numerous than the red, which corpuscles are colorless, called therefore the white or colorless corpuscles of the blood. In some forms of disease, especially from changes in certain organs of the body, as the spleen, the white corpuscles increase, and the blood becomes sur- charged with them, the red corpuscles being at the same time relatively decreased. The disease so produced is called " white blood cell disease/' or leucocythsemia, a disease of serious import.
152 LOCAL DISEASES.
It is accompanied with paleness of tlie body, great languor and depression, and impaired nutrition. White blood cell disease is probably hereditary in character, and np to this time has been little amenable to treatment. It was discovered in 1845 by the late Dr. Hughes Bennett of Edinburgh, one of the few illustrionfi in medicine of this age.
Poisoned Conditions of Blood.
The blood, lastly, may be charged with poisonous substances which so interfere with its function that death may be the result These poisons may be derived from without, as when a gaseous or vaporous body, such as nitric acid vapor, or chlorine gas, or ammonia vapor is inhaled ; or they may be derived from rapid changes excited in the body itself by some animal poisons, such as snake poison, with which the body has been inoculated ; or tliey may be derived from substances which are natural to the body formed in excess, such as urea, the natural soluble salt of the urine. In yellow fever ammonia has been formed in such ex- cess in the body as to reduce the blood to a fluid like port wine in consistency, the corpuscles being dissolved altogether, and their coloring matter being diflFused through the whole mass of the blood like a dissolved coloring principle or dye.
CHAPTER IV,
LOCAL DISEASES OF THE BREATHING OR RESPIRATORY
SYSTEM.
Ukdeb the respiratory system is included all the orgaas and ptrts concerned in the act of respiration or breathing ; the nos- trils, larynx, and glottis ; the trachea or windpipe ; the bronchial tnbes; the structure of the lung proper, including the air-vesicles; the pulmonic vascular plexuses ; the nervous filaments; the elastic oonuective tissue ; the covering of the lung or pleural membrane ; and the space between the lung formed by the meeting of the pleara of each lung — the mediastinum. The diseases of this sys- tem represent a numerous class.
Nasal Catarrh. Coryza.
Ifasal catarrh is a discharge of fluid from the nose, called also common cold. It is a well-known aflFection, becoming often epi- demic, lasting usually from three to five days, and, when severe, attended with pain and sense of weight in the head, pain in the hmbs, great depression of the physical powers, and irritability and inactivity of mind. There is usually a few degrees of fever dur- ing the presence of catarrh.
Croup.
A diseased condition of the larynx and trachea, in which the breath is drawn through those parts with difficulty, and with the production of a hard or croupy sound, which may become so in- tense as to be actually ringing and shrill. There are two distinct varieties of croup, the spasmodic and membranous.
Spa^modw croup, — Called sometimes Larymjlsnius Stridalm, A spasm of the glottis or opening througli the larynx into the windpipe and lungs attended with croupy breathing. The dis-
164
LOCAL DISEASES.
eafie is sudden in its onset. It is usually produced by nervous irritation at some part distant from the larnyx, as the stomach, or intestine, or the gains during the process of teething, the irrita- tion being reflected, through the nervous coimnunicHtions, to tlie muscles of the glottis* The spasm will often cease as suddonlj as it came, hot it is apt to recur in those who have once suffei^ed from it. Occasionally it pi^oves fatal by the asphyxia or suffoea- titm it produces ; but, m during suffocation, there is a tendency to relaxation of the muscles, death is not so frequent as it might be expected to be from spasm in fio important a part of the respira- tory tract.
Mertihrano'iia croup, — ^The membranous or infta^mntatory va- riety of croup. A dangerously fatal affection. It begins often with signs of cold and hoarseness, but may be developed without these preliminary warnings* It consists of a suddenly developed iuflammatory condition of the larynx and windpipe, followed quickly by an exudation, upon the lining surface of those struct- ures, of a layer of fibrine or lymph, which inechanically obstructs the passage of air, and which, if the exudation \m large and be not coughed up, causes, in the absence of surgical intervention, death by suffocation. The disease is rare after childliood, affects l>oy6 in greater number than girls, and is not contagious. From the severity of the throat affection it is considered as a local dis- ease: but it is now known that in the croupy condition there is an increase of fibrine in tlie Idood, and a tendency to separation of tibrine in the heart, so that the local manifestation is probablv only a part of some general systemic disturbance,
DiSKASKS OF TllK LaBYNX.
The larynx, the cavity or enlargement at the upper part of the windpipe, and which is marked out in the neck at the prominent part vulgarly called ** Adam's Apple," is subject to several forms of disease, the following being the chief.
Injbimniaium and td<*era.tion of the <?p/^fo^*>.— Inflammation of the valvular structure, which is situated at the top of ti\e larynx, and which falls down in the act of swallowing, to prevent liquids and solid particles from entering the glottis. Inflamma- tory disease of the eiiiglottis or valve may be followed by ulcera- tion or loss of structure, and in some constitutional states, tho
DISEASES OF THE RESPIRATORY SYSTEIT.
165
sypbilitic especially, tlie ulceration may oocur without any pre- vious acute inflaiaiuatory affect iou.
Lat*ywjeal tatatrk^—X catarrh or profuse Beeretiou from the macoQB surface of the larynx. A condition apt to become cbrouic, and to recur in those subject to it, particularly during the winter eea&oiu
Lar^jngiiiM. — Inflammation of the larynx without epecifie Dupourt exudation. An affection not peculiar to any age of life^ ad occurring in the acute and chronic form. It is, as a rule, an extension of inffammatory disease from the throat or from tlie tracheal and bronchial surfaces*
Laryngeal uleei\ — Ulceration of the mucous Uning of the lar- ynx^ extending, it may be, into the cartilages of which tlie larynx i* formed, and ending in necrosis, or death of the curtilages. This ulceration is most fretpiently seen in diseases of constitutional taint, such as syphilis, and puhnonary phthisis. It has conse- qtiently been divided into the syphilitic and phthisical types,
Lanjrujeal aJ/scess, — A circutuscribed formation of matter, or jios, involving the larynx, and usually following inilammatory dis- of the part implicated.
(Eiema of tJie glottic,— K swelling fi'oni exudation of watery serous fluid into the structure of the edges of what is called ""the glottis, the opening beneath the epiglottis leading into the larynx athl trachea* The disease is generally the result of acci- dent, from swallowing or iniialing some hot or irritant substance. It occura occasionally during erysipelas of the head and face, and J once knew it to happen during a severe attack of nettle- rash. It h a very dangerous affection.
GrowthM in tfie larynx. — The development of growtlis within the laryngeal cavity is a cause of local olistruction, happily rare. The growths may be one of three. Warty growth^^ cQUjposed of Btnieture, rather firm, and attached to the inner surface of the cavity by a broad base. PohjfHnd growf/i^f, soft and gelatinous, Attached by a pedicle. Cysts, or lioUow growths, containing, in mw instances, parasitic forma of life.
Parol ysut^ luid apfumia or Ims of voice.— In the larjTix are nituated the muscles which move the vocal cords, the cords which stretch across the glottis from the back to the fore part by tlic vibration of whicli the aounds of the voice are pro- In paralysis of tlie muscles of the glottis the breathing
156
LOCAL DISEASES.
is rendered difficult, and the power of pro<liicing audible voice eoLiLida U lost* The term aphonia h applied to the loss of voice, — ff, not ; jj/u)/i€^ voice. Apliouia is of two kinds, the i^'iiiiulated and the true. The siruiilated form is of hysteric origin, and though it may last for long intervals of time, is temporary in character. Tlie true is due to an actual palsy of tlie laryngeal muecles, is dependent on some important nervoug injury or die- ea&e, and is^ in most instances, a permanent affection.
BfiOKOHlTIS AKD BbONCUIAL DiSEAjBES*
Bronchia} Catarrh,
A cold or catarrh affecting the mueoas membrane of the tra- chea and V>roncliial tubes; eoujmeucing sunietimes in a nasal catarrh, and at other times by itself. It is frequently epidemic, but is not eontagiovij,. It lasts from three to five days in its acute stage, and, when it begins in the eaily part of winter or spring, is apt to pass into a long cl ironic stage. In some persons it be- comes a disease of anmisil ocenrrence, and is attended with very free secretion of phlegm and troublesome congh. The tendency to bronchial catarrli increases with advance of life.
Bronchith.
Inflammation of the mucous tract covering the inner siirfaee of the bronchial tubes. A common affection in this country, and fatal to large numbers of persons. It presents two forms, acute and ch runic.
Aeutd hronehitw arises, in most instances of it, from taking a severe cold, liut it may assmne an epidemic form, and from the first be broncliial. There is with it in the earlier stages, chill, depression, a sense of constriction at the chest, difficult breatliing, and pain. Tliese signs are followed by fever, and continue until relief is obtamed from free secretion of phlegm from tlie con- gested mucous surface. Acute bmnchitis is j>ecu]iarly dangerous to the young, tlie old, and the enfeebled of all ages.
Chronic hnmc/titt^ is in tlie ordinary way a sequence an<l con- tinuance of the acute type of the disease. It may nevertheless be developed without the indications of a very acute attack. It is often recurrent in those who have once suffered from it, and
DISEASES OF THE RESPIRATORY SYSTEM. 157
probably in this kingdom there are more permanent sufFei^ers from chronic bronchitis than from any other disease whatever. It is attended with constant cough, and an expectoration that is often profuse. In the young it may assume a form so severe as to make it imitate phthisis or consumption, and the term hron- chial phthisis has been invented to define that form of disease, recoveries from whicli have, without doubt, often been mistaken, by iguorants and pretenders in physic, for recoveries from actual or tubercular consumption. Chronic bronchitis is very fatal to the aged, and it tends to become more determinate with increas- ing years.
In addition to these ordinary forms of bronchitis there aro other forms in which the disease is induced, as by the inhalation of various vapors, gases, and dusts. It will be shown in a future part, that the affections thus, mechanically, excited run much the same course as when they follow more common causes, and are attended with similar dangers. They are peculiarly fatal to cer- tain of oar industrial populations.
CapiUary bronchitis.
Some authors have recognized, and I think correctly, a va- riety of bronchitis, acute and chronic, of the fine bronchial ramifi- cations or capillaries, by which the bronchial tubes communicate with the air vesicles. To this type of the disease the term capil- lary bronchitis has been applied. It is a disease intermediate between bronchitis and inflammation of the lung, — pneumonia, — and it has also been described as pneumonia, under the name of catarrhal pneumonia. It is, in my experience, always sequential to bronchial catarrh or bronchitis, and therefore I venture to place it under the head of bronchial diseases.
In the bronchial ti-act there may, finally, be developed various foreign growths ; tumors, malignant or cancerous, and non-malig- nant; cysts; and, parasitic developments. Occasionally foreign bodies from without are carried into the bronchial tubes and lodge in them.
Bronchial Structural Changes.
The bronchial tubes are subjected to various other changes, of which the following is a brief summary : —
Ulceration. — A condition in which there is a circumscribed
1C8
LOCAL mSEASES.
destraction of tlie mnoous lining of the bronchial surface ; an iikier.
Cast deposits, — A condition in which a semi-organized deposit of a fibrinons character is laid down on the bronchial mncons sur- faces so as to take the cast or shape of tlie Uibea, 8nch tubular casts are, in some rare instances, coughed up entii^e.
Necrosis of cartilages. — The cartilages of the rings of the windpipe, and even of the large broncliird tubes into which tlie windpipo bifurcates or divides, may uiulergo necrosis or local deatli, under cotistitutional taint. There are two forms of this affection marked by their respective taints, viz., the sifphUUic and xXiQ j)hthtslcaL
Dilatation and contraction of the bronchial tubes. — The bron* chial tubes, under long-con tinned disease, may become generally dilated, or dilated in part^, like the fingei-s of a glove, with con- tracted sections in other parts. The air pafesiug through tubes go changed produces sounds of a blowing, wheezing, or whistling kind, which the person aflFected, as well as t!iose near, may be able to hear. The dilatations which now and then are caused in the larger bronchial tubes, as a result of long-continued laborions breathing, may be virtually cavities in which large accumulations of secretion are held uutH they are removed by coughing and expectomtion.
Asthmatic Disbabes of the Lukos.
In the strict use of the word, asthma is a spasmodic disease^ in which the organic muscular fibres surrounding the bronchial tubes are thwwn into a state of aciUe spasm, so that the entrance of air into the air vesicles, in which the bronchial passages finally ter- minate, is impeded. The spasmodic paroxysms are often sudden and rapids but may be unattended by fever. The breathing dur- ing the attack is very oppressed and difficult ; the suffocation is severe ; the body dark^ often cold, and eufeebled*
Asthma may he excited in those who are subject to it by causes of irritation lying away from the lungs, and one of the most common excitants of it is irritation in the stomach or intes- tines, fi'om improper food or defective digestive power. It accure
DISEASES OF THE RESPIRATORY SYSTEM. 169
in all periods of life, is hereditary in character, and rarely passes altogether away in those wlio are affected by it, although it may be much controlled by care in diet and regimen. Death is not common during the pai'oxysm, the relaxation incident to dying, if I may so express it, having in itself a tendency to cause relaxation of the spasmodically contracted muscular fibres. There are two varieties of asthma.
Pure spasmodic asthma, — As above described.
SymptanuUic asthma, — In which the asthma is an attendant or indication of some other disease, such as heart disease. Thus we hear of cardiac asthma and bronchial asthma.
Hay Asthma.
Bay asthma, placed by the Royal College first in the list of the local diseases of the lungs, is a spasmodic affection occurring in some persons during the hay season, when the odor of fresh hay is present in the fields. There is, commonly, a sense of catarrh or cold in this affection, with some discharge from the nose, and with paroxysms of severe spasmodic cough, brought on much after the same manner as coughing and sneezing are brought on by taking snuff. The disease is supposed to be due to the in- halation of fine particles derived from the flowers of grasses, and which specially affect particular individuals. The powdered par- ticles of ipecacuanha produce a similar condition in some persons. I have observed that from Russian hemp particles are given off which cause a most aggravated form of disease of a similar kind in susceptible subjects. Hay asthma continues as long as the canse remains in action, and it may be prolonged for several days, or even for some weeks, after the cause of it has ceased to exist in the air.
Industrial Aathm^as.
Under the general term asthma, by which is meant diflBcult breathing, — not necessarily from spasm, but from disease caused by the inhalation of dusts which create destruction of function in portions of the lungs, — there are included several kinds of lung disease incident to different callings. We shall see the details of these affections more fully as we proceed, in another part of this work, but the typical asthmas thus refeiTed to may be named, so •8 to make our record so far complete. They are :
160
LOCAL DISEASES.
Grmders^ asthma ; MinevH^ asthma / PoUera^ aslhnia / dressers' asthma ; MiUers' asthma.
Tbese asthmas are all specially conaected with the occupations by whieh thej are defined.
Diseases of the STKrcruRE of the Lung.
Pneum&nta. Injfnnmmtwn of the Lungs.
Inflammation of the longs, inflammation, that is to saj, of the trne structure of the lungs, the air vesicles, vessels, and the surrounding or ujvesting tissues, which together make up the spongy texture of the huig, is called pneumonia. The disease commonly follows a nasal or bronchial catarrh, or bronchitis, but it may assume an epidemic character, and may begin without any preceiling afFeetion. The disease is aecoujpanied with higli fever, diffieiilt lij'eatliing, darkness of the countenance, and, after a time, with cough and expectoration of a rusty-colored fluid, due to the presence of the coloring matter of blood. Pneumonia runs a defi- nite course, and, like some fevers, has its critical days, but it is not contagious. Essentially the disease is one, but various writers upon it speak of it as of different varieties, [a) Eight and left, and double pneumonia, aceoi-diiig as the right or left lung, or both lungs, may be affected. (S) Acute pneumonia ; when the disease is running its acute course, {c) Chronic pneumonia ; when the disease is attended with less fever, and the symptoms are pro- longed, {d) Lohular pneumonia ; when the disease is confined to portions of the lung structure, ie) Diffuse pneumonia, called also interstitial pneumonia, when the inflammation involves large portions of the lung structure* {/) Bronchopneumonia, when the pneumonia is combined with bronchial inflammation, ig) Pleuro-pneumonia, where the disease is eomhined with inflam- mation of the pleural membrane. (A) Secondary pneumonia* when the disease comes on during the existence of other diseases of the body, especially febrile diseases, such as typhoid, typhus, small-pox, measles, erysipelas, and pysemia. In tills secondary form it is frequently the immediate cause of death*
Abscess of the Lung,
A circumscribed accumulation of matter or pus in the struct' ure of the hing, following general inflammation, or produced by
SYSTEM.
IBl
eome local irritation, such as the deposition of tubercle. It is oeeasionallv produced by the presence of some foreign substance that hsL& been lodged in the lung.
Gangrene of the Lung,
Gangrene or mortification of the lung etructure usually occur- ring in the last stages of the worat forms of pneumonia, and in rarer instancies from obstructed circuliitiou. It is ahuost ah^^ays a fat^ disease when it extends over a large surfare even of one Ittng. The affection seems to have been more prev alent in former days than it is at present.
Passive Pulnionary Cangesitan*
Paasive congestion of the lung is a condition in wliich there is stasia or arrest of the circulation of blood from the rigitt to the left side of the heart through the hmg, in the course of the pul- inonic circuit. The lung, in this instance, is engorged with blood in the affected parts. Pulmonary congestion is brouglit on by causes which lead to weakness or palsy of the minute vessels of the pulmonic circulation fiom withdrawal or reduction of nervous timulns ; or by w^eakness of the right side of tlio heart ; or by 'obstruction of the left side. It is induced actively, by sudden ex- posure to cold ; by over-fatigue ; bj the action of some narcotic agents; by long-continued use of alcoholic drinks ; and by suffo- cation. The most common immediate cause is exposui^ to cold in persons whose pulmonic circulation is almady enfeebled or diseased.
Ilwrnoptj/sis. SpUting of Blood.
Le^ea of blood from the lungs is what is comtnonly conveyed ader the t^tm hemoptysis. Literally, the term means spitting blood<« but the sourc^^ of the loss is so frequently from the lungs the phenomenon is as a nilc connected with those organs. Loss of blood from tlie lungs is active or paaeiire. A<iim^ when pure Jood is <Hrcctly und rapidly given out; passim^ when the blood, small quantities, tinges otlier expectorated fluids. It occurs in tlto active fonn, fmm rupture of a vessel, or fj'om great congestion of the Innga. It occurs in the passive form, from partial conges- tion or inflammation of the hmg. It is a common aceompanying iymptom of pulmonary phthisis or consumption in both the early and the late stages of tliat malady. 11
162
LOCAL DISKASES.
P'ldmonary E^^/rwmxsation. or Apoplexy,
An extravasation of bloijd from the vessels of the lung into the spongy stnit'ture* It takes plare either from extreme con- gestion of the blood-vessels, or from rupture of them, Piilmonaiy apoplexy is often attended by passive, and sometimes by active hcemoptysis or spitting of bkiod.
(Edema of the Lmig.
(Edema or dropsy of the lung is a state in which the water part of the blocrd is diffused into the structm^e of tlte lunj (Edema is iisually the result of obstruction to the return of vc nous blood in the blood-vessels which supply the lungs with the blood reqnired for ttieir own sustainmeut, that is to say, the nu- tritive vessels of the lungs proper, as distinct from tlio vessels of the pulmonary artery,
CirrkoBts of the Lung.
A rare disease, in wliieli the tissue of t!ie lung in the whole, or in parts, is cirrhosed or hardened from eondensaticui of the connective tissue. The disease is most commonly met with in per- sons who have indulged freely in alcoholic drinks.
Emphyaema of the Lxmg,
A condition in which the lung structure is inflated with air beyond the natural filling of the elastic air vesicles during the act of inspiration. Literally it is a passive distention of the lung structure with air, and in a minor degree is auak^gous to the dis- tention wliich the butcher produces in the Inugs of a dead animal by blowing into them forcibly in order to inflate them before he susjiends them iu the shambles. There are two varieties of em- physema.
(a) The vesicular, in which the air vesicles tliemselves are dis- tended and dilated.
(ft) The interlobular, in which the air has escaped from the vesicles, owing to accidental rupture of them» and has diffused thi-ough the connective tissuoa and lobular structure of the lungs. It is this form of artificial emphysema the butcher produces in the lunge of the dead animal and io the human subject it is com- niouly the result of accidents leading to great strain, as in the
DISEASES OF THE RESPIRATORY SYSTEM. 163
stndn of congh in whooping-cough and asthma. The most ordi- naiy form of emphysema is that in which the air vesicles are dis- tended and broken the one into tlie other. Men and animals so affected are said vulgarly to be " broken winded," and the term is wonderfully expressive. In aged people, in whom the elastic tis- Bues of the body are much impaired and are wanting in resilience, emphysema is of such common occurrence that the term *' senile emphysema" has been employed to distinguish it as a disease that has resulted from old age.
Atelectasis of Lung,
A term signifying deficient expansion of the lung by breath- ing, and applied to the lungs of a child after birth, when the act of breathing has not been perfected. The lung structure, wanting inflation by air, is condensed, heavy, and sinks in water.
Pulmonary Phthisis. Consumption.
A condition including various phases and characters of dis- ease, in which the lungs are the active seats of the evil. Xu- meroQS terms are used by physicians to indicate the different phases of the particular affection, which, under its constitutional designation, is called consumption or phthisis pulmonaris.
Tubercular Phthisis. True Pulmonary C&nsumption.
True pulmonary consumption is that form of phthisis of the long in which specific tubercular matter is deposited in the struct- ure of the lung in small masses or tubercles, which masses become centres of irritation, inflammation, and suppuration or formation of abscess, ending in destruction of the structure of the lung and in the fonnation of what is called a cavity of the lung. The disease is constitutional, hereditary, and doubtfully contagious. It is most commonly developed in the period of adolescence, and in nine cases out of ten is first lighted up by cold or some nervous depression. Haemoptysis is a frequent early symptom, and there is, usually, an acute stage with fever and a kind of inflammatory condition of the affected part of the lung, tubercular pneumonia.
The upper parts or apices of the lungs are usually the first affected. As the disease progresses, there is constant cough, frequent spitting of blood, and wasting of the body ; three
t«4
trN^AI. DI8RA8IS.
Bjmpioms^ wBich uken Djgeitier tp© Epical of plimi^i^. In kte «lag«9 there ftre recoiTeiit pmraxjsii» of ferer called ^'^ IIccti^\^ and pfof iLBe sweatings. The dlfioa^e is Tery widft-spread in this 00101117, ^^ exceedingly fatal*
Aeuie pneumonic j^hikiM, — A oonditioa in whidi poeninoii^. —inflammation of the etmeture of the Inng^ — ia developed, in ill acitte form, In persons susoeptlble to phthisis.
Chnmie jm^furfumw p/uAifis, — ^A condition in which diit>ti pnenmonia is developed in the eame const! tntiuu&
Acui^ mUiary pfdhms. — A condition in which there is de- Telojjment or deposit in the Inng of a tntjerenlar material of a iniliaiy character, resembling millet seed and widely di£tribiite«j.
Tr*i^ iubenrular phtJiUis. — A condition in which the ordinary form of tnbercnUr gnbsUmco is deposited in the Inng in gmall separate masses, tubereka, which become centres of irritation, inflammation^ and suppuration, followed by destruction of tissue, and carities.
Jndti^rml phthiSM, — A condition in which the mischief in the lung structure, leading to phthisis^ is produced by inhalation of suVwtances to which persons following particular industries are sub- jected. M illstone dufit, coal dust, flax dust, give rise respectively to millstone workers' phthisis, miners' phthisis, flax*dressers' phthisis.
Ah^fholu* phihUis. — The consumption uf drunkards, A defi- nition, first applied by myself, to a form of phthisis peculiar to sonut pi*rftons who indulge freely in alcohoh - As a rule it occurs after middle age.
The various conditions leading to pulmonary" phthisis fill up one of the greatest cliapters in the history of disetise as a whole, and the greatest of all the chapters in the local history of pulmo- nary diseases. Of all the organs of the body the lungs are most oiwn to invasion of disease from causes operating both from within and w^ithout the body ; and as in respect to every one of the iililhisieal rnaladie.s the hereditary law of descent is main- tained, ihe lungs are, t-aking all in all, tlie organs most liable to the acquired as well as to the inherited types of the malady.
Diseases of the Plefra.
The pleura is I lie tliin, elastic, semitransparent membrane which cnn so eii.^ily be stripped from the surface of the lungs. It envelops each lung as in a jseraus bag or sac, which is reflected
DISEASES OF THE BESPIBATOBT SYSTEM. 166
on to the inner walls of the chest, covering them, and which between its two surfaces produces a serous fluid for preventing friction or adhesion.
The pleura is liable to several varieties of local disease.
PleurUia. InjUmrniation.
Inflammation of the pleural membrane in whole or in part is called pleuritis. The inflammation may be acute or chronic. In the acute form it is marked by fever, and by great pain in breath- ing. The membrane is injected, inflamed, and extremely sensi- tive, being brought in the act of breathing to rub on adjacent structures. In the chronic form the symptoms are modified and prolonged, but the pain in breathing remains exquisitely acute when a deep breath is fetched, or when cough is severe. Pleu- risy, acute and chronic, is most apt to occur in persons of rheu- matic and gouty constitution. It may exist as an independent affection, but is more frequently connected by sympathetic or organic influence with some other affection of the lung. It is a f reqnent complication of the other acute diseases of the lungs.
Empyema.
Empyema is an accumulation of purulent fluid or matter in the cavity of the pleura ; that is to say, between the two layers of the pleural membrane. Practically, it is an abscess of the pleural cavity, resulting from inflammation, and from the in- flammatory products thrown out during the inflammation.
AcUiesian^ ThicJcening^ a/nd Ossification of the Pleura.
Adhesion means the uniting together of portions of oppos- ing pleural membrane which, in the natural state, would glide smoothly over each other with perfect freedom. Thickening means an enlargement, from deposit of plastic exudative material on the membranous structure, in patches or over the whole surface. Ossification is a transformation of a part of a pleural surface into hard structure, from calcareous or any deposition.
ITl/drothorax, Dropsy of the Pleura.
Hydrothorax is an accumulation of watery or serous fluid in the cavity of the pleura. It is usually the result of inflammation, but sometimes is due to venous obstruction. The fluid may in-
166
3AL DISEASES.
crease until it fills the cavity, presses on the hing of the affected Bide or on both lungs, and even dkplaces the heart itself.
Pneumotkoraac,
Pneumothorax is a condition in which air !ias entei'ed, and pai*t]y t>ccupiDf|j the cavity of the pleura. The accident some- times tKvurs from rupture of the vesicles of the hmgs together With the pleural covering of the lungs. At other times it is from an injnry to the chest, as from fracture of a rib. In very rare instances it is from gases develoj>ed in the blood.
The pleural membrane may also be the seat of cancer, simple tumor, tubercle, and parasitic growths.
Diseases in the Mediastikum.
The space between the lungs, formed by the two pleural niembranes which cover the lungs, and called the mediastinum, is mmiut lines a ponit in which local disease is manifested, Tlii'ee Bucli forms of manifestation ai*e recorded.
(a) Ahtn^m^ or accumulation of purulent rnatten
{ft) C(tnvei\ or formation of malignant tnmor.
(o) Shnpl^ tumor^ or growth of tumors w hich are ** non-malig- iiftut," uut cancerous.
Other Pulmonary Affections.
The lungs, filially, are liahlo to become the local seats of can- cer ami of jmrasites. They are subject to mecliatucal injuries from without, wounds; to inipactions fi'om inhalation of solid foreign njatcrinls ; and to injmies from inhalation of corroding anil irritating gases or vapors.
Tliis hook is the propertij oj COOPER MEDICAL COLLING::,
SAN FRANCiSCO, CAL. ctud is not fn hf ri''r,i)rrfl fror.i iho
V/idcr an J ^ji-iusxt tr.'.i ^f-rcr.
CHAPTER V. LOCAL DISEASES OF THE NERVOUS SYSTEM.
In the nervous system the parts and organs subject to disease are the brain and its membranes ; the spinal cord and its mem- branes; the nervous cords and their peripheral surfaces; the ganglia and nerves of the sympathetic chain.
The diseases of the nervous system are divisible into those which are functional and those which are organic. In fact, no diseases are so distinctly divisible into the two forms of func- tional and organic as those affecting this system of bodily organs.
It is always most difficult during life for the physician to make an absolutely correct diagnosis, or finding out, of either the acute or chronic diseases of the different parts of the brain and its membranes. The parts lie in close proximity ; the sympathy between them is most intimate ; and, the direct physical exami- nation of them is impossible. It has therefore been necessary to invent a term that shall include in a word any one, or more than one, of the individual inflammatory diseases of the parts enclosed within the skull, and that word is EncephcHMis^ inflammation of the brain or its membranes.
At the same time the different parts, as examination of them in post-mortem inquiries have demonstrated, are the special seats of acute inflammatory diseases and of other resultant or degener- ative changes.
Diseases of the Membranes of the Brain.
The membranous coverings of the brain and spinal cord are subject to both acute and chronic diseases.
Acute Meningitis. Brain Fever.
The old physicians gave the name of brain fever to a condi- tion of disease which we moderns call acute meningitis, or inflam-
168
LOCAL DISEASES.
Ttiation of the membranes of the brain. The dura mater, the firm external fibrous covering of the brain, is the part most fre- quently affected, but the irritation whicli is set up usually extends deeper, to the more deli<iate membranous structures beneath, Uie arachnoid and vascular pia mater. The disease is extremely serious, is attended with a high degree of fever, with extreme pain in the head, and with violent, often furious, delirium. It lasts for many days, and whe»i recovei'ed from often leaves per- manent evidence of faihiro of nervous power. As an uncompli- cated disease it is exceedingly rare.
Mernbranoud Vascular Conffestlau.
The vascular membi-ane of the brain, tlie pia mater, may be the seat of extreme congestion. This is common under alcohol, and is a cause of the excitement which is present in that form of alcoholic poisoning known as delirium tremens» In one instauce in which a man while in this state committed guicide by casting himself under a railway carriage, I saw the brain within four minutes after death, while still the fumes of whiskey were most readily detectable fi*otn it. The pia mater was injected to the extremest degree, lying like a velvety pile over the brain, and within the convolutions. In sucli examples the membrane, after many excitements, becomes firmly attached, in parts, to the sub stance of the brain.
Thsbm'mdar Mmmgitis.
In children and young persons of scrofulous or tuberculous constitution, the membranes of tlie brain are apt to become the seats of tubercular deposit from the blood. The deposition takes place, as a nde, beneath the dura mater, between it and the arachnoid ; but I have seen it also in the upper surface of the membranes, between tlie dura mater and tlic inner lining, or periostennij of the ekulh Purulent matter may form with this exudation. The symptoms of the disease are practically tliose of brain fever, and the malady is usually fatal. It is a more fi*e- qnent form of disease than simple acute meningitis, and it is fol- lowed in some instances by effusion of serous fluid and dropsy of the membranes of the brain, ** Acute hydnHJi^fialm.^^
I
KKKVOU8 SYSTEM.
Chronic Hydroeeph^ns. Wat^^ on tihe Brain*
An accumulation of Beroiis floid in the investing membranes of the brain, between the brain siibstiince and the outer and firm jrering, tlio dura mater. The fluid is secreted by the middle or erous covering, the artiehouid membrane, and accumulates be- neath the arachnoid, in the araclinoid sac or space, and even in the ventricles of the brain. The diseafte may progress with very little disturbance of the bodily functions until the head has at- tained an enormous size, the yielding bones giving way before it. The dii>eas4o occurs in young childj'en of strumous or ecrofulous taint, and hi the end is usually faUL Latterly surgical art has been the means of saving life in some inj^tances of it.
Thl4^henin0 of the Dura Mater ami Deg&nm^athn.
The dura mater is subject to a form of disease in which it be- oomea unduly firm and thickened in structure. In persons who are given to partake freely of alcoholic drinks, this thickening is irerj common. Some years ago, by the kindness of several pi*o- fe^ional friends, I was able to make an iiu|uiry into tiie condition jji tlie brain in that form of disease which has yet to be described
general paralysis. In every instance I found the Jura, mater thickened, firm, and dense, and often adherent to the membranes beneath it at one or more points. The re&iBtauce exerted l>y the lembrane, as thus changed, tends greatly to tlie produetiou of the paralysis, and 1 am of opinion that it is, in some instances, tlie c^use t»f it.
Tlie dura mater is also subject to various degenerative changes. It ii eometimcB affected with calcareous and osseous degeneration, 80 that it i* trauHfoi'njed, in jmrts, into a bony structui-e. tu one instance I observed a projection of bony matter of needle-bliaped character, which passed an inch into the substance of the brain itself, and was probably the cause of epileptic seizures, from which the person in whiun it was found suifered, and in one of which
ures he died.
Deseaskb of the Bbath*
The diseases of the substance of the brain, as distinct from its rocmhranotia investments, are of several kinds. The more im- portant of these are mcluded under the following heads.
T>t
Hfiyusss,
•^' M^ Srm$u Cerehntis.
LonliKftUiiUxya. at tim MilMMWfr of the brain it&elf is of veiy
iiM^iMiii Ite «piml symptoms by which it iimy be
.. oLk«A:iire. It fe nstudly connected with inflamina-
ctfrtng it» or is dependent, as the Collego
11^ utt ivcai injury cu* foreign deposit.
Aktotm ^if t/te Brahi,
r^^l af iathimiMlk>ii aod fornmtion of pnrulent matter
ulartinrfi abace^ or encyBted fonuHticm of matter
^ at in tb# hiiubpliere^ of the brain. The positive
t ftbiBcee^ U very difiiculU and itts oeeurrenoe earn-
4
ttiyiiipfi <2f the Bmin,
' brain is a condition in whirh the vessels are
-r^y and white matter are overcharged witli
iiatvr U jkUo surcharged with blood, and there
iluid RX*reled into the arachnoid space, and into
he brain. Congestion of the brain is due, most
.lenient and over mental work. It is easily pro*
u>e of alcoholic drinks, by paj^&ion, by worry
iy. It is the origin of unieb nervous disease.
it when it is evidenced in the acute form are
There is feverish excitement, and it may be
1 by extreme prostration. In the milder and
iMisi. the symptoms are : a M;tmfi of fulness in the
MlH>i»; fV4«lles6ne68 and desire for change: irritability
-s ; fits of felight fever folic twed by acid per-
I'ltie lajignor. liepeated miiny times cerebral
m*6>t always leads to the production of some persist-
■'>-, if not inmied lately fatal, nervous disease such as
Ui|h<ii$,
*tfi^fifh'^s^nt'4t^ of t/te Brain, Armenia,
v xiiv vvndition to the congestive is known as antemia
111 thiis condition the vessels of the brain are hot
Knid, and the structures of the brain, gray and
ueing vascular and red, are unnaturally bloodless
DISEASES OF THE NERVOUS SYSTEM. 171
and pale. The condition is produced by exhaustion, mental and physical, and by insufficient food and nourishment generally. It may be the result of long-continued and excessive physical work and fatigue. The signs of it are a sense of faintness, ringing sounds in the ears, and somnolency. The somnolency may pass into deep sleep from which the person cannot be roused, coina.
Softening of the Br am, SamoUisTnent,
Several varieties of softening of the substance of the brain have been named by different authorities, and described as, white or atrophic / red ; and, yellow softening. Atrophic softening is defined as a form of disease in which the brain substance under- goes what is called white softening, " the result of imperfect nu- trition arising from deficient supply of blood, and in most in- stances dependent upon mechanical obstruction or degeneration of the cerebral arteries."
Eed softening is a condition in which the brain matter, very soft and cream-like, is of reddish tint or color, the tint being de- rived from the red coloring matter of the blood. Red softening is assumed to have its origin in preceding infiammatory disease of the cerebral substance or in repeated and extreme congestion.
Yellow softening is a condition in which the brain substance is more nearly like cream, its color being of yellow white. This form is not considered to be of inflammatory origin, but rather a fatty degeneration, somewhat analogous to fatty degeneration of the heart, the brain-cells being transformed into fatty structures. The disease is connected, by some authorities, with anaemia of the brain, and is considered to be one of the results of that malady.
All these varieties of softening of the cerebral substance are irremediable, and are attended with failure or irregularity of ner vous, mental, and muscular power.
Condensation of the Brain. Sclerosis,
An opposite condition of the brain to any of the varieties of softening is now known as condensation of the brain sub- stance, or sclerosis. Sclerosis is a condition extremely simi- lar to what has been before us when we were treating of disease of the lung known as fibroid disease. It is in fact a condensa- tion or hardening of the connective tissue of the nervous struct- ure, and the tenn sclerosis, the same in meaning as sclerotic in
r^AAAtVa'kfk tux S
iivjpl*Ht?f
^^ i.»t»r (3omt at the ball of the eye, is therefore ap-
-i^aeii UtiLj be localizeii iu the braiu, ur in the
•r it luo^v ttjLt^nd tliraugh both* It niaj come on in
•' — ^^nm ua ia later life ; and it may be one of the
. aien. When it is present in children they
it^% Wb«ti it attacks the aged it leadB to fail-
:d pDvrers, and to " the second chiJdifih-
H tu ii -^^loix^^fj^ affecli the tuiddle-aged it causes persigtent
tuUw— jMamfym agttam^ — a stale of disease in
:iUtiot eimtrol a persistent agitation or trem-
> \4 a j^rt of the body, or even of the wbole
• Urui^ aiteuded with gmdual loss of muscular
I't^jms la-its often for many years, ending usn-
Mki^ of the muscles of deglutition, or of some
structures which are essential to life, but dur-
II Lva£4^:$ altogether. Thh last fact 1 was able
n suffering with the disorder who was under
oikn?* I also found the agitation pass away
!i chloroform and from methylene bichloride,
lilLi*k '1 'I ^**»-»M 4iiu Alwaya progressive affection towards death*
AjwpUxy,
i bKiw or sudden shock by which a person is
:his country the people speak uf it as *• a
utv«iji of the attack gives a natural meaning
' .' person affected suddenly falls insensible,
:rn becomes feverish, breathes with noise
♦ HlwrU^ivuidy, and is sometimes convulsed. The dis-
-4 under the middle stage of life. The synip-
.. to some sudden pressure made on t!ie brain,
1 ti arre«it of blood through the brain. Usually
i MU priKhices the phenomena. Either a blood-
^ivo^way from diseased structure and blood is
' iv^ cKised cavity of the skull, san^uinmis u^m-
,. V U J re ubstructed by coagula of blood form-
/ veins which allow the blood to return from
. I hero is effusion of watery matter from the
DISEASES OF THE NERVOUS SYSTEM. 173
blood, throngh the vessels, into the closed cavity ; the pressure necessary to cause the phenomena is produced ; and, congestwe or serous wpoplexy is the result.
Of late years we have learned to discriminate another and more limited kind of apoplectic seizure, in which the minute ar- terial vessels of some part of the brain become obstructed from coagulation of the fibrine of the blood in them, or from the con- veyance into them of minute portions of fibrinous coagulated matter. From these causes there is developed a primary shock, not necessarily passing into complete insensibility, followed by some deficiency of power, or partial paralysis, which may be per- manent, but from which there is often a fair recovery.
Sunstroke,
Sunstroke, sometimes called coup de soleily is a form of apo- plexy, attended in its acute representation with all the signs of common congestive apoplectic seizure, and supposed to be due to the direct action of the rays of the sun on the body, during tropi- cal weather. There seem to be two varieties; one acute and purely apoplectic, specially affecting plethoric, full-bodied pereons, who drink freely of stimulants, and who are prone to congestion of the brain ; the other, less acute, in some sense resembling faintness in respect to the symptoms excited, and affecting the prostrated and enfeebled persons. I believe them to be entirely different conditions of disease ; but being brought on by the heat of the sun, acting on different constitutions, they are usually con- sidered as one, and are incorrectly designated by the same term.
Hypertrophy and Atrophy of the Brain.
Hypertrophy means an actual enlargement or overgrowth of brain substance generally. Atrophy means a wasting of brain substance generally. Both are conditions of great significance. As common diseases dependent on physical causes they are rare ; but as conditions produced by mental activity or inactivity, re- spectively, they are, I suspect, common enough. In men of com- pletely developed skeleton, in whom expansion of the skull is no longer possible, an extreme activity of brain leads to condensation of brain substance, and, thereby, to a form of hypertropliy which is easily transferable into degeneration. In persons of inactive brain and of mere automatic life, atrophy, — wasting of brain
174
LOCAL DISEASES.
matter, — attended with 8lnggi8!Hie88 and feebleness of miiid, and faulty nutrition of body, is the more eoniuioa form of brain dis- ease.
Pals}^ of intelleettial speech is the nearest ehort definition of the disease which is known under tbe nn fortunate term, apliasia. In aphakia the voice is clear^ words can be spoken, and all the mnseles mechanically required for gpoeeh are in perfect action; but the affected person, when he tries to express himself, uses words that may have no relation to the object he would flefine by them. Thus, in one example I knew of* the woi-d '* sack " was used for tlie word '"chair" Aphasia is very fre*|uently accom- panied with paralyris of the right side of the hotly, right hemi- plegia, and 18 due to some organic change, softening, or occlusion of blood in tlie nervous centre for articulate speech. Aphasia is very little amenable to treatment when it ib fully established*
Tumors and Deposits on the Brain,
The brain is sometimes the seat of morbid growths, of which there arc several kinds. The more eomiTion are : <//) Malignant i growth or cancer, (b) Fibroid tumor not malignant, (c) Osseous ur bony tumor, {d) Deposit of tubercular matter, {e) Parasitic cysts. The l>rain is furttier subject to changes from specific or syphilitic disease which may cither be inherited or accpiii-ed.
Disease of the Blood-vessels of the Brain, The cerebral arteries are very subject to disease. They may nndergo : {a) Fatty and calcareous degeneration, — ^athei'oma and ossification, — in wiiich condition they sometimes give way and let out blood. (J) Aneurism or dilatation at one point, {c) General dilatation, {d) Closure or impaction from clots of blood or tibrine canned into them from the heart or from coagulation of blood in them. The sinuses or veins of the brain are also subject to oc- clusion from coagulation of fibrine within them.
Diseases of tue Spinai. Cord and its Membkaxes.
The membranes of the spinal cord, — ^dnra mater, arachnoid, and pia mater, — being continuations of the coverings of the brain, are Biibject to the same diseases as were related of them on pp, 169-71, under the head of diseases of membranes of the brain.
DISEASES OF THE NERVOUS SYSTEM. 175
Spinal Congestion and Inflammation. Myelitis.
I notice here two diseases which the "Nomenclature" distin- gaishes rather differently. The conditions 1 indicate relate to congestion of the spinal cord, followed sometimes by inflamma- tion, myelitis, produced by peripheral or surface injury to the body. The researches on the action of cold on the skin in causing these conditions, made originally and coincidentally by Dr. Weir Mitchell of Philadelphia and myself, and since confinned by Al- thaus and other observers, prove that the blood-vessels of the nervous centres and of the spinal cord may be paralyzed and con- gested by the influence of cold and other agents acting on the ex- tremities of the nervous fibres on the surface of the skin. Central spinal derangement may thus follow upon exposure of the surface of the body to cold or injury.
The phenomena of spinal congestion and myelitis are : pain in the limbs and other parts supplied by the tract of nervous matter that is affected ; fever ; loss of power ; paralysis, temporary or permanent in the muscles which receive their nervous stimulus from the affected tract ; and, impaired nutrition in the same af- fected parts.
Spinal Atrophy.
Wasting of the spinal cord in the whole or in parts is called spinal atrophy. Loss of motor or sensational faculty, or of both fac- ulties in the structures supplied with nervous stimulus from the affected parts, is the result of the disease. The atrophy is usually due to deficient supply of blood to the spinal cord, owing to ob- struction in the blood-vessels, or to degeneration of them. The disease was called by the older physicians, Tahea doraalis.
Spinal Hemorrhage and Degenerative Changes of Structure.
The vessels of the spinal cord are subject to similar changes as the vessels of the brain, under which changes they sometimes give way and allow blood to exude from them, a condition to which the name of spinal apoplexy is applied. The structure of the spinal cord, like the brain itself, may undergo, white soften- inffj red softening^ yellow softening, and sclerosis. It may also be tiie seat of malignant and non -malignant tumors, and of parasitic e/Cstic growths.
176 IX)CAL DISEASES.
MalformtxlAoM. Spina Bifida.
The epinal cord is in some newly lioni eliildren the seat of a peculiar malformation called Spina Bifida or IlTdro-racliiteg. From the cord there protrudes, hy an opening tliiough the bony etmcture of the spinal column, a large soft watery tumor or sac which is made np of skin, dura mater of the cord, arachnoid, and serous fluid from the arachnoidal epace. The opening in the spinal column is due to imperfect closure of the two lateral halves of tlie column hefore birth* The fluid geereted l>y tlie arachnoid juemhrane, finding no eflicient resistance, pushes its way throngli the opening. The disease is now, in certain instances, amenable to surgical art.
General Diseases of the Cerebeo-Spinal System,
The cerebro-spinal nerves, issuiiig from the brain and spinal cord and distributed over the body, are subject to diseases similar to the brain and spinal cord tliemselves. Tbey may be subjected to inflammation, or neHritis: and to atroj^hy. They may also be the seat of a tihrous tumor growing on or between their bundles or fasciculij called a nerve tmnor or t^iroma.
Paralysis. Pahtj. StroJce,
The most important series of diseased conditions officially classified as connected with the cerebro-spinal nervous fibres or cords is included mider the head paralysis or palsy, stroke, in which, owing to the failure of nervous stimulus to tbe muscles there is a loss of power of will to move parts under the control of tlie will ; or loss of the will itself to control ; or failure in a part to experience a sensation that would otherwise be received by it and communicated to the sensorium. Vnhy of motion. Palsy of will Palsy of sensation. Xo disease in the list of human mala- dies plays a more important role tlian paralysis. Paralysis is divided technically into many sections :
General I\imli/8is. -—Fiimly^h of the insane* A palsy in which the whole voluntary muscular system sluu'es more or less in the catastrophe.
Hemiplegia, — Half palsy. A palsy in which one lateral lialf or side of the body is stricken so clearly that it is customary to
DISEASES OF THE NERYOtTS SYSTEM-
define the condition by the use of the terras right or fcft; as right lieuiiplcgia : left hemiplegia; according to the eide of the body that is attacked,
Parajdetfia. — Palsy in which the half of the body below tha chest, and including the lower limbs, is stricken by the disease.
JjOC(tmo(or ataxy, — Palsy indicated by ataxy, /.<;>, irregular power of locomotion. The niovenienta of the body are not cor- rectly under the control of the will, and there is inability to walk forward ^^^thout falHiig when the eyes are closed.
Pnyjremive muM^nlur atroj}hy. — A form of palsy due to grad- ual failure and wasting of tlie mnseiilar organs, but coinmencing sometimes with apparent enlargenieot or hypertrophy of the muscles,
Jr^aniilc paralj/sf^,—Vsihy developed during infant life, and occasionally present from the tiuio of birtlu As a rule, this palsy U spinal in character, and is markeJ in special groups of muscles. It comes on with acute symptoms of fever and convulsive seizures, and ends in palsy of a limit, or limbs* The disease is probably allied to that form of paralysis described above under the head of spinal congestion and myelitis, and is dne to some periphenil irri- tation acting on tfie vascular supply uf the spinal cord. The dis- ease sometimes terminates in permanent paralysis.
Local parahjds, — ^Paralysis of some special part or organ of the body. There are two marked forms of this paralysis. The first iBjaeud palsy, in which the nervous supply of the muscles of tljG mouth and lower jaw is induced. The nmscles of one side of the face are paralyzed, so that tlie balance of power bet ween the two sides of the face, l)y which the luitural expression is pre- served, is lost, and the eye on the affected 8ide camiot be closed. The second is known as it?^iUr'*s palsy, and is a form of palsy of tlie hand called also v«/Wivn/?/^^ palsy, — affecting, specially, writers, like conveyancers, who, in their funual, stiff mode of writirig, rest the ann heavily on the paper or parchment, and press the hand lieavily down* The whole nervous supply of the hand becomes, in these persons, impiured ; they begin to direct the pen with difficulty; tlie hand feels benumbed and heavy; there are starts or cramps of the muscles; and, in time, if the affection pro- greftses, there is complete loss of power, so tliat even the grasp of a stick or other ol»ject may be impossiljle. Another form of local paralysis is palsy of the upper eyelidy ptosisy from failure of IS
178
LOCAL DISEASES,
the third nerve, the motor oculL The eyelid, in this instance, drops, and cannot rise in obedience to the will.
DiphtfierUk jmralysis. — ^A form oi paraly&is often veiy ee* vere, following njion the disease diphtheria. The palsy, as stated niider the head, diphtheria, in a previous ehaptei', affeete chiefly the mueclea used in swallowing, muscles of deglutition. It sonie- timea extends to the muscles of the neck, and even the limbs* It ie, as a rale, recoverable, spontaneously, under conditions fa- vorable to recovery.
Lead jparalyms*—VB\^j produced from the absorption of lead, by workers with that metal, and commonly affecting the muscles which raise the w^rist* It is called from this circumstance, '* wrist dmp."
Functional Diseases of the Brain and Spinal Cord.
The diseased conditions above described are assumed to be dependent, always, upon actual change of structure, temporary or permanent, of the lirain, spinal cord, or nervous cords. In addi- tion to these nervous affections, organic in character, are some others which are technically claseilied as ^\fumfio}ml dheaMs of tfte nertHm^ system,^^ I reproduce this definition without being able altogether to subscril)e to it. In the diseases to be named it may be true that organic changes in the nervous centres and cords cannot be so distinctly traceable as in other examples of nervous derangement, but that there is often structural as w^eli as func- tional derangement can hardly be doubted.
Tetanus.
Tetanus, vulgarly called locked jaw, is an extremely agonizing and fatal disease, in whidi all the muscles of the body, during paroxyms of attack, are in a state of firm or tetanic, — i^ino^ I stretch, — spapm or stretch. The spasm is so extreme, in the worst examples of the disease, that the muscles may be torn by the vio- lence. The muscles which close the jaw% and which are very powerful, are, as a rule, rigidly contracted, so that the jaw cannot he opened without the use of great force* Tetanus is of three kinds :
(a) Traumatic^ in w^hich it follows upon the infliction of a wound or injury.
DISEASES OF THE XERVOtTS STSTEM.
179
(i) Idicpathit^^ in which it comes qn seemingly from ex{>osiiro \o cold, or to cold ami wet.
(c) Yenomous^ in which it k produced hy the action of a poi- eon, as by the poison strychnine, wliicli of all known poisons in- duces the severest tetanic disease.
Death from tetanus nsiudly occurs from spasm of the muscles of respiration, but eotnetimefi from spasm of the hearty and more rarely from continued exhaustion, Fntil recently tetanus has been an incurable mahidy, but is now often amenable to treat- ment. Its precise nature has yet to be discovered.
InfatUUe Convtdsiona.
Convulsions occurring during infancy. They usually proceed from some surface or peripheral irritation, such as cutting of the teeth, or irritation of the lK>wel3 from the presence in them of improper or partly digested food.
Epilepsj% vulgarly, but characteristically, known as ** falling sickness,'' is a sudden seizure of insensibility, followed by con- vulsive movements, — fy//, on, lejrn^^ seizure. The attacks occur at various periods of time in thoBC who are subject to them, and are like lui explosion in their suddenness and intensity. They often excited^ in the susceptible, by some trifling external ir- itation, and many epileptics- fee! at the time of the attack an aura or breath, or a sound. The paroxysms are limited in duration, and recovery from them is rapid, and, fur the time, complete. They have occurred in perscais of the highest intellectual power a$ well as in those of tiie lowest. During the fit the face is livid, the features somewhat distorted, the breathing noisy, the limbs for a time convulsed, the eyes turned up, and the uncoil eciousu ess complete. Death rarely takes place during tlie attack, urdess the unconscious sufferer hapixms to fall in such a manner as to be tally injured or suffocated. The disea^^e is !iereditarj% and t!ie vent of it is peculiar to no age after infancy; Ijut true epileptics, though they may not die from the seizure, rarely live to old age. J^/fl^pif'r v^Htfjf), — There is a minor form of epilepsy called liy the French petit mul^ by us epikptk vertigo. In this form the seizure is less pronounced ; the aura is not so distinct ; and, the person affected, though conscious of giddiness, vertigo, — or
180
LOCAL DISEASES.
senBation of turning rounds — and of miieli confusion of tlionght, may not ac?tiitilly lose eoiisciousness, or complete want of self-con- troL Epileptic vertigo is a recoverable form of disease, and by some physicians is called ^"^ epihptifonny^ to distinguish it from true epilepsy.
Gonvuieion cmd Spasm.
Convulsion or epasni are terms nsetj to define uncontrolled ac- tions of the muscles. In conTnision the contraction of the mus- cles alternates with relaxation, and opposing muscles eonti*act one after the other, so that active movements of the linihi!? or other parts, over which the affected mu.^cular organs are distrilnUed, take place. In spasm the muscles are held in a state of perma- nent contraction, one set of muscles, or, it may be, opposing sets of muscles, being in some instances equally affected at the same time. Convulsion is contraction of muscle with altenmte relaxa- tion. Spasm is contraction long continuedj until either the mus- cle or nervous stinuilus is exhausted. Cramp is spasm of an ex- treme kind, prolonged, rigitl, and acutely painful, but usually confined to one part, as the calf of the leg. The voluntary m well as the involuntary nniscles may be affected by spasm.
There are many varieties of spasmodic disease, of which the follo%ving are the more striking :
Lanjngeal i^pamn^ hxrynfjismus sindulus or sjmAmodie croujK — A spasm of the nmscles cvf tlie glottis or opening into tlie windpipe, by which a crowuig or croupy cough is produced, with hard or stridulous hreathing. It is a t!isease often fatal to yoimg chOdrcu, and due tf> some surface irritatiuu reflected to the ner- vous centres which form the muscles of tlie glottis.
IntiMimd t^pasni, — CoUc, — Spasm of the intestines. It is due to irritation from improper food ; or to coUl ; or to tlie action of gome poisons, especially lead ; hence the term "lead colic."
Cht?M spmm, — Angina ptctorh, — A sudden and painful spasm of the muscles of the chest, including tlie heart, and seizing the sufferer with such sudden violence that the term *' breast pang" has been employed to express the paroxysm,
Oiorea, St. YUus' Bafice.
A disease in which the muscles of the voluntary order are in frequent motion without either the direction or the control of
DISEASES OF THE NERVOUS SYSTEM.
181
tlieir MHMpi'- I^ some inslaiiees Biiigle tracts of musolee are
^ affected, m others all tiie large tracts of voluntary muBcnlar fibre. The disease iiiiglit be called a paralysis or palsy of iutellecrual direction of muscles, the nervous stimulus flowing, if I may eo Wpres8 it^ of its own accord into the niasciilar organs without my individual controlling power being exerted over it. The phe- nomena present themselves at all ages, and the affected seeming to move constantly are said to have a dancing disorder, — choros, a dance. Recovery sometimes occurs. The disease is technically divided into two varieties, (a) acute^ ih) chronic.
Ilf/Jiterici.
A functional disorder probably of the great sympathetic or organic nervous system, during the existence of wliich almost every other disease of a nervous kind, — even such a disease as tetanus, — may be eirnulated without practical danger to life. Aa a rule, however, the symptoms are special, consisting of emo* tioual excitement with tendency to sighing, crying, hmghing, with a peculiar sense of suffocation, or ball in the thruat, and often with singular nniseular movements and convulsion. The disorder is most common amongst women, hut is not confined to the female sex altogether. It is rarely fatal, although, I beHeve, I once witnessed a death from hysterical convulsions. Hysteria is inclined to jiass away with increasing yeai'S even in those who during early life are most subject to it.
Catalepsy is a condition of body in which the whole frame lies quite prostmte and helpless, — katti^ down, l^jm*% a seizui'e, — f that a litnb lifted up falls back as if it were i-elaxed and dead, ^ile yet the consciousness of the person affected is retained witliont physical pain. In this state persons have been taken for dead, or have been said to lie in a condition of trance, although the word trance more exactly defines a iMiig liysterical sleep, dur- ing which the consciousness is rephiced by dreams. Catalepsy oocura most commonly, though not oxchisively, in the female sex, and in many instances is connected with one or other forms of liTitcria. The motions of tlie heart continoe, and can usually bo detected by the skilled observer, liespiration is also detectable* Catalepsy sometimes ends fatally.
183
LOCAL DISEASES.
Neuralgia,
Keuralgia is an extremely painful affection of the extremities of the nervous libres, oecorring in some constitutions witli peri- odic regularity, and much iullueuced as to its occurrence by con- ditions of the weather. Tbe pain is sharp and lanciokting dur- ing acute paroxysms, and dull and weariug after the aeuteness of the attack has subsided. The pain is cummotdy felt to be pnl- eating, tlirobbiiig, and often synchrfnious with the arterial puke. Musenlar startiugs near to the affected part are also experienced. There are five recognized varieties of neuralgia: Facial^ or Ttc doloretiu', Keuralgia in tlie face. Brow atjtie^ or Ilemicrimia^ Neuralgia in the head. Sciatica^ or Neuralgia in the sciatic nerve. Phurodynia^ or Neuralgia in tbe pkniral membrane of the lung. Irritahle or stumj)^ Neuralgia in the stump of a limb after amputation.
ITijj>oehondHa^u*
Hv|3ochondriasis is a persistent affection often hereditary, and occurring mure frequently in men tlian in women. During the attack there is, apparently, great depression of mind, w^ithout actual njcntal disease* The patient is atfiictcd writh ideas of fan- cied diseases of the most varied kinds ; ideas of impending mis- eries and dangers ; sensations of swellings and contortions of the body which are or may be purely imaginary; dest-riptions of pains and sufferings which if real would quickly destroy life ; andj altogether, a dread of disease and death wdiich at last linds expi^ession in terms so frequently repeated as to give rise to auto- matic repetition, in the same words, *>f the same sensations, to the real pain of those who are obliged to listen to the narrative. The disorder may he called a bad form of hysteria. The an- cients referred its seat to the region uf the stomacli, hence the term, — /u//io, imder, chrondroSy a cartilage,— mider tlie cartilages of the lower ribs*
Mania,
Mania is an irregidar comlitiun of the mind in w*hich there is false notion of existing facts and things, personal or general, to- gether with excitement, extending from mere warmth or haste of expression to actual freiizy. There are two varieties of mania, the Acid'C and the Cfumic^
PISEA5K3 OF THE NKKVO0S SYSTEK,
183
In the acute form the excitement or frenzy is extreme, and follows closely on tlie delusion or derangement o£ ideas. In the chronic form the delusion or derangement is con firmed, but is more in abeyance, while the excitement is subdued and is at longer intervals of time. Mania assumes various types, according to the bent or turn of mind of tlie affected. Hence there is relig- ious mania, monomania, dypsomauia, and the like.
Melancholia.
Melancholia is a form of mental derangement, marked by ex- treme depression generally, with much lassitude and feebleness of body. The mind is often filled with sad and hopeless thoughts, and with frequent disposition to commit self-destruction as the nearest and shortest method of closing a miserable and intolerable life, llelancholia is by some classed as a monomania, the mhid of the sufferer being, as it were, turned only upon himself, and in that sense it may, correctly, be called monomania. The disease is most commonly developed in grown-up persons, but indications of It are often teniporaiily present in those subject t(j it during cliildhood. It is almost invariably attended with functional dis- lurbanees of the organic nervous system, with dyspepsia, iri*egular motion of the heart, and sleeplessness. It is frequently attended with a peculiar odor or fetor of the breath.
Dementia,
Dementia may bo taken literally as a want of mind, — de^ fi'om^ viens^ the mind. It is a condition in which there is feebleness of intellectual grasp or attention, imbecility of word and act, and general deficiency of mental power. There are two varieties of dementia, the Acute and the Chrome,
Acute dementia is a sudden development of feebleness of the mtellectnal power occurring in i:>ersons hitlierto healthy and pos- sibly actively or over-actively engaged. The chronic form is one in which the symptoms approach very gradually, and pass slowly into what may be called true mental death, as in old age.
Dementia is commonly attended witli failure of the physical powers ; but this, in the early part of the disease^ is not neces- rily correlative.
DIS£JLS£^.
i:i which the mind is, from birth, im-
fitli^ fur tiin; ughtful duties of life, and in which
..»% tiJtMm^ i^ said to be *' half-witted," or wanting in
^ttHtttml cupttdij. The condition nmy be attended
.or&ttflv i^Axl iienith of body in early life, but as a rule
d dermngeiDeiit connected with it, some in-
,^ ^^ M mental feebleness dne to a bad consti-
' -^**'^» ^ $crv»hila. Tiie family of imbeciles is,
V 1, ihe members of it dyin^ of consnmp-
'i-tirt, or of diabetes, or of diseases de-
I *' -: irreat nervous centres. Imbecility
k ..V type, but, as with those who suffer
«it ilw ref»n>ductive faculties of the imbecile are low,
iA'^ 'va^'^vilj* wirvivml k uot largely promoted.
'i 4 \»rn vNUidition in which, vdth Pome constitutional
!»,* tik^iit^ faculties are below the natural Intel*
III iicocessary for the maiutenance of reasonable
■ the head is of reduced Hize, and the capacity
nxi to bi^ insufficient for the manifestfition
'%*vwk The instin(?tive faculties and desires
i%i>l ^MiltolM by the I'easou, or are imperfectly eon>
H<>to mr^ ^mi and dumb, but most of them retain
k Tlmjf are unimpressionable to a hu-ge extent.
v^ fiicflltiefi are commonly either absent or in
iv'ir )xxm are compai*atively short.
CHAPTER VT.
DISEASES OF THE 0EGA2iS OF THE SENSES.
The diseases of the organs of tlie sensea to he described in tlie present chapter ai*e divisible into three groups accordhig to the organs concerned. Diseases of the organs of sight, of hearing, of smell : of the eye, the ear, tiie nose.
DISEASES OF THE EYE.
8eventj*five diseases are official Iv tabulated as affecting the ejes and their appendages. Of these diseases, fourteen are re- ferred to the nmcoiis nii^nibraue which covers the eyeball from the point whei*e the skin terujinates on the upper iid to the same point on tlie lower lid, the conjutictloa. Nine are i-eferred to tlie cara^a^ the convexo-concave lens, which forms the first transpar- ency of the eyeball Two are referred to the ficlerotie coat^ or outer firm white covering or case of the eyohHll. Seven belong to the Irfs or curtain, in tlie centre of wliicii is the opcnini^ called tlie pupil. Seven are connected with the f^horohl or dark coat, and the nervous expanse known as the retina. Two are assigned to the Vitreous fuunor^ the large, cellulai*, and partly fluid lens which tills up the body of the eyeball posteriorly. Fuuj' relate to the crystuUim leiiSy the great refracting njcdiuoi which lies between tlie curtain or iris and the vitrcotis boiuor. Tlirce are clas-*itied as general diseases of the eyeball, and six as*' defects of sight." Four are named as diseases of the hN^hnjmnl appara* iu9 ; eleven, as diseases of the eydid^ y six, as diseases within the 0rbiU.
Duea^eB of tfm Canjunativa — TJie Ophthahnias,
Under the general term ophthalmia the diseases affecting the exlfiriial covering of the eyeball,— the mucous membruue called
188
LOCAL DISEASES.
the conjunctiva, —are arranged iu tlie series of fonrteen varietiee. These are all commonly known m inflauimationa of the ejeball, although it is not usual for them to extend actually into the in- ternal etructuro of the eye, nor even beyond that part of the external structure whieh is directly visible and is bounded by the enveloping eyelids. The varieties of the uphthalniias aie follow : —
PtiMular, — A form in wliich iuflanintatiou of the conjunctival ends in the developujent of purulent matter in pustules. Tho diseage occurs, usually, in the course of other diseasea attended with pustular eruption, such as small-pc^x,
Purtth'nt ojfhihalmia. — Ophthahuia of a contagious charaeterj attended with a pundent discharge which is capable, by contact^ of commuriicatiag the disease from one person to another* The contagious particles may he carried by the atmospheric air, and thus become the means of communication.
PuruUid ophthfdmia iff ififants, — Anotlier form of purulent contagious ophtbabnia occurring in infant life, especially in chil- dren who inliabit badly ventilated rooms and live under condi- tions leading to feebleness of body. Improper or insufficient nourishmeiit is one of t!ie most potent of these conditions.
Sfrumou.'^ or scrofuhm {tphlhahfrni, — An ophthalmia peculiar to those who are of scrofidous taint. It is often persistent in its course, and leads, in bad cases, to impainneut or even actual loss of vision.
Erufithematom ophihxilftiUt. — An oj)litlialmia of an exantlieni- atous or eruptive character, occurring sometimes during the pres- ence of the ordinary exanthematous or eruptive diseases, such as lueflfiles and small -pox.
Goiwrrhiml ojiktJtalmia, — An ophthalmia eomiet^ted with the disease called gonorrhoeaj and pruduced l->y the contact of tho specific discharge from that disease with the conjimctiva. An acute and very troublesome affeetioUj leading occasionally to deep inflammation aucl loss of sight,
Chronw ophth^jilmia. — A slowly progressing ophthalmia, or a con tin mm ce, in a modified form, of one of tlie other of the varie- ties of ophtlialmia iu the slow or chronic condition.
In addition to these diseases the conjunctival membrane is subject to f edema, or dropsy, c/wmoeis / to fatty and other tumara attached to its surface ; to para^iiio disease ; to granular change ;
DISEASES OF THE OKGA]S^3 OF THE SENSES.
187
ta H triangular or wing-like red and fleshy formation called piertjgitim ; and to nhetalllc etaltia deri^^ed from nitrate of silver^ or from lead,
I^iiteme^ of the Camea,
The cornea, the horny, transparent, eancavo-convex lens, which lies immediately beneath the uuicous conjunctival mem- brane^ is subject to the following local affections :
JC^ratUtSy or acute ioflaiiimation of its structure.
Chrome ifUerstitial keratitU, — Inflaniniation of long standing, with interposition of fluid between the layers of whieli the cornea is composed.
KetatUUy wUh sup^mrcUlo/i, — A long, continued inflammation of the cornea, with formation of matter or jniti in the luyers of tlie structure* The appearance protluced by the presence of the pnnUent fluid has caused the terna anyx to be applied to the affection.
Ulcer. — ^A condition, following usually upon inflammation, in which there is active destruction or loss of substance of the cornea.
Leuconia, — An opacity of tlie cornea, due to a cicatrix*
Arcu» Henili^, — A white line running round the cornea at its circumference, in whole or in part, and commonly sCen in the old or prematurely aged. The white structure is composed, chiefly, of fatty substance. At one time the areug Benilig was viewed by practitioners of medicine as an outward and vii^ible sign of fatty degeneration of the heart and other internal organs, and great importance was therefore attached to it ; but later experience has not so fully confirmed this inference as to render it absolute as a
1 of internal disease.
In addition to the above, the coniea is subject to three other Tarieties of disease, namely, conical cornea, in whieli tlie stnictm'o is poshed forward in the form of a conical projection : staphijhnia^ i>T a white pronjinencc of a dead and disorganized cornea : and, parmiiic dhe^tse^ hydatids of the anterior chamber immediately behind the coinea.
IDimases of Hie ScUrotic Coai* The sclerotic or investing coat of tlie eyeball is subject tr* {nflamiimtion, — sderotith^ — and to inflammation connected with
»
l%»
IXK7AL DISEASES,
i^-^^-r^eufnatie BcleroiUU. These affections ai*e oi^trvoMftlv fKittifttl, aud are attended with fever atid iriueh general 4lttMrbii^* ''^^- lKHh\ The sclerotic is also subject to Btaphj'-
u^ iji MX frotn its eiirface, and to iufnurfi attached to it.
IHscmes of tM I/u^,
Six uttt uf the ijieven diseases o£ the iris or enrtaia oi the eje, Mid oil th0 CuUvgv list, are inflammatory in character, and the :'t<t ijt uji^hI to denote them. In tlie simpk^st form of in- loii, tiie woi\l iritis ah»ue is employed. When a wound ii^» of the disease, traumatic iritis is the mode of expres- ^uiutimea the iritis is an accompaniment of other diseases, f^y^^i, ^- .K,...i...t|j^. fever, artliritis, or intiammation of joints, iVHy or scrofula. Then the iritis is said to 1x5 tti«\ Hy^»hiUtie^ fjonorrhwal^ or 8cr(yfnhm. Tho ux* inc^utloil under tliis same head of inflamnia- ; of juihesiun of tlie iris to surrumiding parts; axUiktiuli of ivuiph and protrusion ; permanent contraction ; |kuuui4i»mU dlUtalion ; cl<*smx^ ; and, irregnlarity of the pnpiL
l^UifiiMsea of the CJwnnd and Iitetlfm.
I hi>niid coat of the eye is subject to inflammation, Aifii l\\ i'horoidiii^y Mid to congestion of its vessel^
i y ,* hut these are rarely ^ if ever, distinct forma «.»X iit nj^ tlie choroid coat alune.
ii\thimn»aLion of the retiua^ tlie nervous screen or ^VHt fiHviit of tlie choroid coat.
I ./^-^.-^A disease of the retina, dependent upon various
i^h- .,, I Uo n»ti rial surface, and ending in an inahihty of the
• o\paniH» to receive and transmit impressions from the
rid til tho hntin* Amaurosis may he produced by the
of iho t^ye fi>r a long time to a white, dazzling object,
vv, tiiid *' Auow bHndness " is the most faniiliar example of
.hiiu^ It occurs also from other accidents, as from light-
t fiH^m blows on the head. It has sometimes its
; -. J alive changes of the retina, in inflammatory
tJMllMwmg ovhansting diseases, and in sympathetic irrita-
! illv imluced bv smokin^r tobacco.
-Small specks or spots crossing the field of lUmting, and often taking a slight upward direc-
DISE.1SES OF THE OROAK8 OF THK SEXSES.
189
Ik I
I
, gad then a downward coarse id a long carve. Tlie specks I iiSerent shapes ; aometiraes thej are mere dark poiBta, at ocber timea the; oonsUt of a fierier of dark points lieU together ill linea mad angles like a loose web or net-work* ^Vgaiii %\wj ap- pear as ringSt snd ^^ unfrequentlr aa dkka with a dark centre, reiembling the magnified red corpuscles of the blood m closeljr that they niigUt pass for them. Kings of tliis i^llular shape oc- cur singly, or in line, or in broken network, Mnscaj % ulitantes l^>pear in yet another variety of eliape, namely, in Btraiglit, dark Itnea, arranged in zigzag forms, with tlie dark eilgcs t^liglitly illn- minated* Mnscse are, as a rnle, seen mo&t frequently in the sttn- light, and as if at some yards distance. Tlicy appear greatly exaggerated in a fog, and then t^em to be witliin arm's-length of tlie observer. In extreme instances they are visible by gas and c'li '' ' 'lit. They do not indicate actual organic dibease of the hi: ■- of the eye, but are ^apposed to be from debris of celU
floating in tlie vitreons hmnor.
AlhiniMm, — A condition of disease existing in persons wlio are often culled Albinos, and in wlioui the dark jngnicntary sub- stance of the eyeball at the back of the iris and \n the middle or ebomid coat of the eye is not duly eeci-eted. In alljini^m the eye is seen of a red color within the pupil^ and vision, during day- light, is extremely embarrassing and painfuK The disease is hereditar}% and *^ peculiar to some families of men and to some lower animals.
Diseases of (A^ Crystalline Lens and its Vaj>ftuh\ — OataroiCf.
Tlie word cataract is an unfortunate but long-used term for defining opa^'ity of the crystalline lens of the eyeball. In cataract the lens b«*conics white and opaque at some point of its surface, er in the ca[)sulu wliich envelops the albuminoid substance, — globnline, — of which the tens ib conifmsed. The opacity extends itnttl, at length, the whole of the lens may be involved, and br V rendered complete. The process of development is
u. ow in its progress, except in the case of saccharine or
dial>etic cataract, which maybe developed in a few days. Tho pfOcesB has been called the '" ripening'* of cataract by the sur- geons, who have an operation for the removal, or depression, or destniction of tlie opaque lens, and who are accustomed to wait until the cataractous change is complete or ripened before they
u
190
LOCAL DISEASES,
perform the operation. A few years ago Dr. Weir Mitchell of Philadelphia discovered that cataract conld be artitieially pro- duced hy charging the blood of an inferior annual with fiugar. In continuation of his most important research, I observed tliat the same condition could l>e produced by nearly all erystalloidal substances, salts, which %vould enter tlio blood and increase its specific weight- There are several varieties of cataract : —
Ilard cataraet^ in which the lens has become firm, condensed, and dark. The cataract of the aged.
Soft cataraet^ in which the lens is of hlnish-gray tint, some- times of fractured appearance and swollen or large. The cataract of all ages of life.
Fluid caiarad^ in which the lens is more aqueous than in soft cataract.
Traumatic cataraef^ in which the disease has occuri-ed from an injury to the eyeball.
Diahttic ar glucme cafaraeL — A cataract iJi which the disease is produced by the presence in the hluodj in large quantity, of ghicose or grape sugar.
Congenitul catarmi, — A form of soft cataract in which tlie opacity is developed at birtli.
The tendency to cataract is ]iereditar3\ but the disease does not generally occur until late in life. C'ataract is common to the lower animals, — herbivorous and carnivorous, — as well as to man.
Dueases of the YUreous BmJij.
f^ynchyMw, — The most distinct affection of the vitreous humor is syncbysis, in which tJie membranous cells are broken up, and the humor, unnaturally fluid, is clmrged witli nunute scales. The eyeball is soft, and the iris, or curtain, bangs flaccid. Before vision is lost, bright starlike ©pots, due to the floating scales, are constantly seen. There is no chance, according to our pi'escnt experience, of recovery. The disease may be due to a blow, or to slow inflammation, or to wounds inflicted on the eyeball during operations.
Morhtd dejmsits^—Uhe vitreous liumor is the seat of morbid deposits. Flakes, or (Mjris of its o%vn membranous structure are the commonest deposits.
DISEASES OF THE ORGANS OF THE SENSES. 191
General AFFBcrrioNs of the Eye, and Defects of Sight.
Glaucoma is ati affection in wljicli the globe of the eye be- comes large, dull, and tense, with dihited fixed pupil, greenness of color bejond the pupil, and excavation of the optic disk. The disease, attended with much pain fallowed by loss of vision, exists in two varieties, the acut^ and the chro7\if\ It is rather a common affliction, occnrring more freqnently in men than in women, and not usually commencing before the period of middle life. It lias an hereditary character, afflicting those who are of worn or feeble oanstitntion chiefly. It is frequently connected with a gouty or rheumatic constitutional taint,
Jlydrojihthalmm.
Hydrophthahnia is dropsy of the eyeball from an accumulation of the fluid secreted in the space between the inner surface of the cornea and the crystalline lens, in which space, called the anterior chamber, the iris or curtain floats. In this disease the eye in lai^e, tense, and staring, and the pupil is dilated. The cornea may or may not be rendered opaque, and vision, if not lost, is much impaired. Tlie disease is due to irritation of the lining membrane of the anterior chamber.
Weak Sight, Asthenopia,
Weak or enfeebled sight, thougli a term commonly used, is not easily defined as connected with any special change in the qreball. It may be present from an irritable condition of the retina ; from a fluid state of the blood ; from a want of power to accommodate the eye to distances ; fi*om nervous anxiety about the sight ; or, from the commencement of one or otlier of the diseases of the structures of the eyeball. Most conjmonly, I tliink, the term weak sight is applied to one of t!ie two defects of vision that come next before ns, myopia or presbyopia, before they are fully developed or while they remain undetected.
t Short Sight, Myopia, A condition of vision in which, from the greater convexity or position of the lenses of the eyeball, the natural focus of L ^^^
I I
103
LOCAL BISEA9ES.
vision is not maintained. Tlie rajs of light being focnssed l>efore ' tliey reach the retina, objects have to be brought nearer to the eyes than is natural or convenient, in order tliat thej may be cor- rectly seen. It lias lately been pointed oat by Mi*. Liebreich that this condition may he induced in children by the habit of leaning forward, witli the face almost on tlie paper, in the process of learning to read or write. The disease is of hereditary char- acter.
Long Sight, Preshyopia.
A disorder of vision, in which the conditions are the opposite from those wliidi are preBcni in myopia. The focus of vision is 8o deranged tiiat objects have to be held at a distance incon- veniently away from the eyes in order to be distinguished natu- rally. The disease is common to old age, hence the term pres- byopia. Another term, Af/j)ermatropm^ has been introduced to define true long eight. It is a common cause of asthenopia or imperfect vision,
Cohr Blindness.
A condition in which, from defect of vision, a person cannot distinguish colors correctly, nor tel! one color from another. Dr. B. Joy JefTrics of 13ostun defines the condition as an inability to distinguish one of the basic colors *'of the spectrum, red, green, and violet, from gray. A person may be coltu' blind in any one of tliese colors, retl blindness being most common, green next, and violet least.'' The same author computes that one per- son out of Qv^ry twenty in the conimimity is affected with color blindness. At one time it was assumed that the diseased state leading to color blindness was confined to the retina, but it is now known to be connected also with changes of disease in the optic nerve, or even in the brain itself. It can be produced by nervous shocks, and, strangest, perhaps, of all, it can be induced by some cliendcal substances taken into the body, specially by santonine and by alcohoi The ilisease is hereditary, and up to this time seenvingly incnral>Ie in those who inherit it. The hy- pothesis as to lU nature is that in the retina tliere is a correspond- ing nerve centre for each basic color, retl, green, and violet, and ^ that the color blindness is due to disease affecting these centres.
DISEASES or THE OROAJ^S OF THE SENSES. 198
Astigmatunn.
Tlie term Astigmatism, irregalar refraction, is applied to a defect of sight, by wiiicli the uatm*al acuteness of vision is to some extent lost, owing to different refraction from difiFerent meridians of the eye ; so that " rays of light derived from one point do not again unite into one point." The deviation of sight ia monochromatic, that is to say, an aberration of rays of the same color. The cause of the aberration lies in the cornea or in the crystalline lens. There are two varieties, the regular and the irregular. In the regular variety the cornea is chiefly the seat of the irregularity. In the irregular variety the crystalline lens is the seat of the irregularity. Astigmatism is now very eflSciently remedied, in many cases, by the scientific adaptation of artificial lenses or glasses.
Day and Night Blindness.
Day blindness is a term used to describe a disease in which the person affected can only see when the light is subdued, as at night Night blindness, on the other hand, means a condition in which there is blindness except in full light. The causes of the two conditions are often vaguely defined, but night blindness is known to visit those, chiefly, who have been exposed to intense or tropical light The term Nyctalopia is sometimes used to e^pi-ess the former and Hemeralopiu to express the latter affection.
Diseases of the Lachrymal Apparatus and EvELms.
The lachrymal gland placed at the upper and outer angle of the eyeball is subject to inflammation and to resultant structural changes. But the most common disease connected with the lach- rymal apparatus is obstruction of the lachrymal duct, the duct which runs from the inner corner of the eyeball downwards into the nasal cavity, and which conveys the tears from the eyelids into the cavity of the nose to be dispersed there. The lachrymal duct, when obstructed, fails to allow the watery seci*etion to pass through it, and the tears then flow in continual current over the lids on to the cheek. Acute inflammation of the lachrymal sac, — lacryocystitis / — chronic inflammation of the sac ; and abscess uA fistula are other diseases of the lachrymal system. 18
umjLL
^oAjyvpt tm iitAinimitioa ; lo the gmall or pain-
cnjffc luiu MjOiyiM JH / falling or paUv of tbe
<9«lift imwAft; and, cancer. The evda&hea
^.uniB^ — iriMatia f and loss, — madarotFU.
wmmr thk O&bit,
!^ttabt«mfi^ t«i^ sqtttbCv w ito commonest of the derangenientd
hm orbit Tbe eye is involontarilj drawn
>tbvuii Id one or other side, or obliquely towards
^ timt l&e natural axis of the eye at rest m not
» die direction is inwards, towards the nose, tlie
l^lMllfiveiil, the §tTabi8iiii]8 h cuilled c^onver^nt :
u^ta^ft il^ called divergent Tbe error is dne either
L' of tka muscles by which the eyes are moved
r ^ apastnodic contraotiou of a muR'Ie ; or to
i-«l#aitd relative overaction of tbe opposing
> id in some cases an acquired affection; in
^ .:r from liereditary proclivity. It often af-
o <une person and in the same direction of
L.^iins; ur it may affect only one eye, single
* -'-iTsion of the eyeball; abscess; tamors^^^ _ nant ; — -jjaramtw Cf/sfs ; are other forms of ^ within tbe orbit. The orbital nerves are also 'it with disease.
DISEASES OF THE EAB.
DKAFNE88.
I it pre0ented nnder three conditions : — -actional nervoLiB derangement. „ 4 ,^.,., .^liciency of development, deaf-mutism. 4. IV^i disease of the auditory raechanisTn. |>a(VMv« from functional nervous derange njent may occur llMil M^ awtnig dibease of the ear. Deaf-mutism may give
<
DISEASES OF THE ORGANS OF THE SENSES. 195
no actual indication of disease, though the organ of hearing itself is, probably, always defective and of imperfect development.
Tlie diseases of the ear are catalogued under twenty-one heads. Four are connected with the auricle or outer projecting part of the ear ; six with the external opening or meatus leading from the external orifice of the ear down to the drum ; three with the drum itself ; one with the Eustachian tube, or tube loading from the throat to the middle ear ; three with the cavity of the tym- panum or middle ear ; four with the labyrinth or internal ear.
Diseases of the Auricle.
The outer part of the ear, the auricle, is the occasional seat of ffouti/ and other depositSy which give rise to prominences and to irregularity of the structure ; of vascular swelling, — hcmiaioma ; of nudi^nant and non-maliffnant tumors / and, of malformations. In persons of slight and delicate organization the outer ear is of ten exceedingly small, though it may be* perfectly shaped. In persons of large build and of full-bodied circulation the outer ear is some- times large, the lower lobe pendulous and exceedingly large. As a role, a large lower lobe of the ear indicates a free vascular sup- ply of blood to the brain, and is, to some extent, a sign of epi- lepsy, and of other kindred nervous diseases. The auricle may also be subject to enlargement, — hypertrojphy.
Diseases of the External Meatus^ or Canal leading to the
Drum.
Inflammation. — Inflammation of the mucous membrane lining the tube may be ocwfe, attended with pain, swelling, throbbing, earache, and febrile disturbance ; or chronic, in continuation of an acute attack, with less pain and swelling but with frequent discharge, and, in some instances, with ulceration of the mucous surface.
Abscess. — Formation of pus or matter within the passage, the sequel, usually, of acute inflammation. It is accompanied with much pain, general disturbance, and fever which does not subside until the abscess breaks or is relieved by surgical operation.
Accumulation of wax. — The natural waxy secretion of the ear under some exciting influences is produced in excess, and iocumulates in the meatus. The wax so placed blocks up the
^«. »)ii . :^. ». -iimk cMWB teoiponirjr df
i ^ -^jjMBSam 114. UW «Ur*
-'Wmtumm tstt Tascolar growtli withio
1% bmud base, to the mtiooiia
p« ta gn>w rapidly and to heef
-^imMjg^ with deafness of ilie
..i^ik within the meatus, attached to
*ig wasnr or sebai?eon8 matter en-
^ %k£ cjTht, It is sometimes called
ffiiwiif, — A tomor of a bony character,
..i^^'f the meatus beneath the mucous
.y^ ovji^re it and filling up a part of the
*M:^ taiiturof bone is often very painful,
the hearing. It is most frequently
niitie or gouty tendency.
i_ the seat of simple tumors, cystic
.Ml 11-, iiud foreign substances introduced
-Mm ^ ike Ear or Mernbrmns qf tha
.r ts the membrane whieli stretches across V kiwer part. It is a fibrons web, lined on - Tiieinbrane of the meatus, and on ^ lembrane of tlie cavity of tlie tym* J g| the lining of the Enstachian tube ,^ iHAiijo of the throat into the cavity. The w^ifHl kcal diseases. ' ^Hitely painful affection attended often ctime-s with faintness in the early stage^i .»4M^ AttJ subsequent fever being also severe. \H thickened or liardened and imperfect in ^ inflammation.
uotiou of surface of tlie mucous lining of
i^vti into the true membranous hiyer be-
.*, «#.W?edingly painful, and frequently leaving
ui#«k— cicatrix, — and imperfect hearing after
i.t'vrTftted spot.
DLSEASES OF THE OBaAI
>F THE SENSES.
^
PeTfotattJon, — An exteDsion of ulceration quite tlirongh the drtiin, so as to prmhice an opening from the external meatus into the middle ear. When tlie perfuration is permanent there is a certain defect of hearing, which is, however, at times, lessened by accumulation of wax over the opening, and which can often be greatly ameliorated by the insertion of an artificial drum.
In forniB of disease in which the mucous membrane of the throat ii^ implicated in inflammation, the inflamed condition is apt to fepread from the throat into the Eustachian tube, and so to pro- duce '* throat deafness/' In extreme eases the drum is in this way affected from its irmer surface, and is ulcerated and per- forated or even destroy ed. One disease specially gives origin to thifi serious mischief, namely, scarlet fever* In my experience, which is rather considerable on this point, four out of every six examples of perforation of tiie dnim of the ear have been from acarlet fever.
TMckeninj and condensation, — The drum of the ear is apt, in the later years of life, to undergo a slow process of change by which it loses its resilience and becomes firm in structure, like to the nail of the linger. This condition, in which the vibration of the membrane is rendered imperfect, leads to permanent defect of hearing. The drum may also be subject to deposit of earthy or bony matter, and to collapse.
Diseam of the JEuatactiian Tube.
The Eustachian tube is liable to inflamraation from extension of disease from the tliroat. It is also subject to obstruction and contraction so that air cannot pass freely throogli it into the cav* ity of the tympanum. When this occum tlie vibration of the drum is interfered with, there is pressure within the cavity, ami a sense of fulnei38 and deafness wliich is very oppressive. Great relief to the condition is now often rendered by the operative pro- cedure of passing a probe or hollow tube along the Eustachian canal into the middle ear.
jyUemes of the Tympanum* or MiiMh Ear,
The middle ear, lined with mucous membrane from the Eus- canal, and containing the three little bones, the mallena, incos, and stapes — "hammer, anvil^ and stirrup" — is subject to —
108
5al diseases.
Tnfl>ammatio7v^ tdoeraiion cmd abscess of ifu fnticmis mem- brane.
I^fiammoMoi^ adhssion and fixuli&n^ — anchylosis^ — of tlw^ ossicles or srnaii bonnes.
The small bones ai*e also liable to inflammation of tbeir uiem-' branouB covering or periosteum ; to rheumatic inflammation ; to gouty inilaraniatiou ; and to incapacity of motion. By inflam- matory changes they may l>e deBtroyetl and dip<'harged ; or tliey may become adherent, and lose their adaptahiJity to the refined movements which are retpiired in the adjustments for correct hearing.
I}ise4ise of the inasknd eJh. — The mastoid celU, — ^the cellular departments of bone wliich sniTound and form the walla of the middle ear, — are subject to inflammation, with eflfusion into the cellular structure ; to thickening with condensation ; and some- times, to constriction and redaction of the size of the cavit}' of the tympannni. When the dmm of the ear has been peJ'f^irate^l and destroyed by acute inflatnmation and ulceration, so that the middle ear is open into the meatus, aiul the small bones are de- stroyedj tlie mastoid cellular structure may abo be disintegrated and discharged.
Diseases of the Labyrinth or Internal Ear.
Tlie internal ear, with its vcstibnle, its semicircular canals, itftl cochlea, and exquisitely refined nervy us arrangements, is never" affected by disease witliout becoming the seat of Beriong disturb- ances, extending from it to the nervous system generally. The official nomenclature gives three varieties of disease as connected with this part of the binly, namely,^ —
Organic dineaMj such as woulil result from inflammation of tlie membranous structure; abMccHH^ ^nd adhesion of parts; and, disease fi-om new grotHhn^ simple or malignant, within the cavity.
li'ecrosis^ or deatli of the petrous bone, tlie bone within w^hich the internal ear is formed.
Deafness^ resulting from functional or nervous derangement^ from actual disease, or from deaf -dumbness.
To these there is added malformation of tlie internal ear, which is a cause, in fact, of deaf-dumbness, the fine mechanism' of hearing in this part being undeveloped or impaired in develop ment.
DISEASES OF THE ORGANS OF THE SENSES.
199
Uii;fli;x Nervous Deranokment from Disease of the Ear, aki>
XBPBC14IXT OF THE IktEEKAL EaR AND AtTDITORY KkBVIC.
Tlnmiiis auriuni^ a noiee In tlie ear, variously described as a ringing, a btizzlng, a roaring, a singing or a grinding noise, is now considered to be often of nervoim origin. Tlie obsei'vations of many recent observers indicate that from diseased and disordered oonditions of tlie internal ear, and of the auditory nerve which springs from it, certain important general syinptonisof disease are induced, sneh as " ear vertigo," convulsive starts and movements^ nausea, and varions affections of the alimentary canal. Bearing on this jMjint, Dr. Bucke, of London, Ontiirioj Canada, seems to me to Imve made one of the most important of modern sugges- tions, by showing that the auditory nerve possesses the character* ifetics of an organic nerve, and of being, as it were, a direct inter- communicating line between the outer world aiid the ganglionic nervous centres. Thus the nervous nieclumism at the origin of the auditory nerve, or of the nerve itself, from being subjected to an inflammatory condition or 8et|uel of intlamraation, to direct shock or irritability from shock, or to paralysis from disease or injury, may become the seat of symptoms affecting the whole of the body through the nervous organizations, directly througli the organic, and indirectly, from the organic, througli the cerebro- .l^inal system.
Wbetlier Dr. Buckets observation should turn out to he cor- rect or not, it ia now certain that many symptoms of disease, liitlierlo believed to be of a general nervous eharacter, have their i0at or centre in the organ of hearing ; and again, that the organ of hearing, in its turn, is subject to nervous derangements, and tiiereby, ultimately, to organic clianges whicli are of the most ierions import. Tliusfrom pi-essure on the internal car, and from Diingestion, inflammation, or exudation, within the labyrinth, there produced a variety of vertigo or giddiness, ** lahyntithine ^rt<j^," to whicli the name of *' Mesniers disease,'' after the dis- coverer of it, baa been applied. Lately, Dr. Woakes, with much facility of exposition, has indicated that earache in infants, and important nervous disordei*6 arising from acute disease in the ; may, by s>^npathetic connection, be induced from the irrita* lion from teething and from the exanthematous diseases; that some forms of cougli may, by reflex direction, be dependent on
200
LOCAL DISEASES*
dUeaee within the ear ; and that vertigOj having its primary Beat in the etoamoh and digestive eygteni, is frequently developed through the inter-nervous relationships of the oi*ganic nervous chain and the auditory nervous apparatus.
The recent application of the electric balance by Professor Hughes, and the introductiun of his most skilful instrument, the audiunieter, liave enabled the physician to make various new and important observations relative to disturbances in the internal au- ditory apparatus, Tims I have myself found that in instances of labyrinthine vertigo the degree of vibmtion that niay bring on thei particular symptoms connected with the affection can be ac- curately gauged, aud the extent of the disease that is present estimated. In extreme examples the vibrations within a few de- grees of zero, or point of absolute silence, are sufficient to excite tlio remote phenomena indicative of the local derangement.
DISEASES OF THE NOSE.
The diseases connected with the nasal cavities and olfactory apparatus are arranged, technically, under the following lieads.
lltjpiirtrophy, — ^A disease in wliicli the skin and cellular tis- sue of the nose become large, the skin being vascular and mottled. It is a common result of alcoholic indulgeuce, not itself fatal, but often a sign of similar vascular changes in vital organs,
Warts^ or watery excrescences upon the nose.
Sthaceous cysts. — Cysts attached to the nasal organ and con- taining fatty or tallow-like substance.
Acne rosacea, — A disease affecting the skin causing redness of the point of the nose, enlargement of veins, and an eruption of small tubercles, ending in thickening and minute scars. The affec- tion is usually produced by alcoholic excess,
Ozama, — A singularly painfid affliction, consisting of a persist- ent fetid disiOiarge from the nose, aud lasting often for long peHfxls of time. The disease is usually connected witli death and decomposition of the soft or spongy .bones within the nasal cavity. It is sometimes produced without any apparent cause, as if from sometliing impereeptihly iidialed which excitod ulceration. In many instances ozfena is constitutional in its nature, and inherit'Cd.
Ulceration of the Ihiing memhrtine of the nose,
Hytpertrophy of the Uning nienibram.
DISEASES OF THE ORGANS OF THE SENSES. 201
Diseases of the septum or dwision between the nostrils. — Ab- soess ; perforation ; ulceration ; thickening. Tumors attached to the mucous surface.
Epistaxis, — Loss of blood from the nose.
Polypus. — A large soft growth occurring within the cavity of the nose, and creating great obstruction. There are two varieties of polypus : the gelatinous or fluid polypus ; and the Jibrous^ a firmer variety in regard to structure, and of slower development. Polypus of the nose, of both kinds, sometimes passes back into the pharynx, — the opening at the commencement of the gullet. It is then called, naso-pharyngeal polypus.
Impairment of sense of smM. — An impairment arising from oi^nic disease or functional derangement of the olfactory nerves, the filaments of which are distributed to the mucous membrane of the nasal cavity.
CHAPTER VII
DISEASES OF THE ABSORBENT AND GLANDULAR SYSTEMS.
The glandular system is divisible, for the classification of tlie diseases tiiat nre cunnected with it, into three parts, 1. The lymphatic glandular system, cuUfeisttng of the lyinpliatie glands and the series of lymphatics or absorhent tubes of the body gen- erally, with those of the small intestines, — ^mesenteric ghindular system. 2. The tubular or duct glands, with their ducts or canals, sacs or bladders, and other parts or apj>endagcs. 3. The ductless glaiuls, or glands from which there is no tube or duct to convey away secreted or excreted fluids.
Diseases ok the LvMi'iiATio and Mksi!:nt£RIO Glaxdulab
System*
Diaemes of Lymphatic Glafida,
Infiammation and supjmratmn. — The lymphatic glands are subject to inflauimation which may pass on to suppuration. They sometimes are acutely iutlauied aftei' the iuJliction of poisoned or venomous wounds, and sometimes, but rai'ely, after oi^inary wounds and surgical operations. In strnuious or 8c*rofulous per- Bons the lymphatic glands are lialtle to undta-go sh»w or chronic inflainmatiun ending in formation of matter and in bursting of tlie abscess formed. Glands which siippurat-e in this manner are very slow to heal, and in healing leare^ in many instances, a deep scar, which occurring in the neck is vulgarly called ^*curl."
The glands are SLibject to infiammation during the specific dis- ease called syphilis, and syphilitic inflammation of them is a com- mon result. When, in the same disease, the glands in the groin suppurate, ^^ ayphUltlc huho'^^ is said to have been produced.
In the true plague accoiupauied with the "plague bubo" the
DISEASES OF THE GLANDULAR SYSTEM.
lymphatic glands are specially implicated as local centres of sup- purative changes.
Malignant disease. — The lymphatic glands are often involved in malignant disease, and become themselves seats of cancer. In cancer of the breast the glands of the axilla are often affected, sometimes before and frequently after the operation for remov. ing the affected breast.
Hypertrophy and atrophy, — The lymphatic glands are subject to hypertrophy or enlargement, a condition very common in scrofulous pei'sons, and perhaps almost exclusively confined to them. Indeed, scrofula, as a disease, is by some considered to be strictly an affection of the lymphatic glandular system. The en- largement of the glands may take two forms ; an a^ute form, in which the swelling, rapidly developed, remains for a few weeks, and then subsides ; and a chronic form, in which an acute swell- ing becomes chronic, or in which a gradual enlargement com- mences and steadily continues until the gland attains a large size, is extremely firm and dense, and, showing no tendency to sup- purate, is very difficult to resolve or dispei*8e.
The lymphatic glands may be seats of tubercular disease, and in per8(Hi8 of tuberculous taint are liable not only to be charged with the matter of tuberculous deposit, but to pass through the various changes incident to tubercular degeneration.
The glands are again in some instances subject to atrophy or wasting of their structure. This state is presented in persons who have been subject to great exhaustion and general wasting. The atrophy is in other instances local in character, the gland or glands affected being subjected either to external pressure, or to deprivation of pi'oper nervous stimulus, diminution of the nervous supply which should, naturally, pass to them.
Disease of the Lymphatic Vessels.
Tlie lymphatic vessels, like the glands, may be the seats of inflammation and of subsequent suppuration, and in examples of poisoned wounds the inflammation may extend through the ves- sels, from the point where the poison was absorbed, up to the nearest glands. To this state the term, '^ inflammation of the ab- sorbents," is commonly applied. The lymphatics are further subjected to obstruction from pressure upon them, as from a tu- mor lying in their course, or from disease and obstruction in the
204
LOCAL DISEASESt
glands with which tliey are connected. During such obstnictiou the vessels may burst, — ^*^ bursting of lymjthatimj^ — and the lymph contained in them be exuded into the surrounding struct- ures.
Lyvvphatic Jistul4i is another condition of disease in which a lymphatic duct or tube becomes connected by a fistulous opening with some part out&ide of it througli which it passes.
Lymphatic glands and lymphatic vessels are closely coimected with all the vital organs, the lungs, the heart, the liver, the spleen, the stomach, the intestines. In all these parts tliey are subject to the vai'ioiis eltanges deuotetf above. Tlie hronehUxl f/lartdj^, which He near the point of bifurcation of the windpipe into the bron- chial t\il>es, are so far susceptible to infiamniatiLin, abscess, en- largement, malignaut disejiae, and tubercle, that these diseases are classified in the official nomenclature as specially connected with them.
Di^ases of ifts Me»etUerio Gla^nda atid Tharacic IhtcL
The mesenteric glands, the glands of the small intestines, ly- ing wuthin the layers of the mesentery, are specially named as seats of disease. These glands receive lynrphatic vessels from the structure of the intestines, and also the tiilies which spring from tlie villi of the mucous coat of the small intestine, called the lucteals, because the fluid they contain, derived from the digested food, is of a milky color. The tubes or ducts going out from tiie mesenteric glands tenninate in the pouch, called the receptacu* hnu chyJi, which gives origin to the thoracic duct, the duct or tube tliat ends in the venous circulation. Thus these glands lie, as it were, midway between the digesteil food and the Itlood, and in them tliat change of the food which consists in its transforma* tion into chyle is perfected. They play therefoi^e a nunst impor- tant part in living fimction, add disease of them is extremely seri- ous, since it leads to interference with the process by which food is changed into blood.
The mesenteric glands are subject to the same diseases as the other lynipbatic glands. They may be the seats of inflammation, abscess, enlargement, cancer, and tubercle,
Mesentiric dUease, Taben inesentenea, — The disease to which the glands are most liable is tubercular deposit, a wasting and painful affection to wliich the name of *' tabes mesenterica" has
3LANDULAR SYSl
SOS
BD long applied ; ** tabes," — wasting, gignifj ing the leading symptom of the malady, and ** inesenterica '■ the seat of the dis- ease. In ordinary conversation the term ^' me«§eateric disease ■' ia tised to denote this particular tubercular state of the mesenteric (liuidfi. Mesenteric disease is usiiHlly developed in the young who of tubercular taint, and is attended with fever, pain in the ibdomen, enlargement of the veina over the alKlouien^ swelling, indi flatulency, sometimes dropBv, great disturbance of the bow- f«k, and rapid wasting. It is often but not always fatal.
The t/wra<?io duci^ the duct of the mesenteric glandular system, 18 feubject to ohstruHioji from pressure upon it from tumor^^, and from inflammation of surrounding tissues and organs. The ob- struction is attended with wasting of the body and exhaustion, bnt the detection of it is very difficult during life, and the oecur- i"ence of it is exceedingly rare. I have only known one instiince in the human mibject, and then it was complicated with disease of the liver.
OF THE TtrBUI*AB OR DuCT GlANBS AND XmSIR PaRTS
OB Appenbaoes,
The glands included under this head possess a tubular stract- nre, and have a canal or passage for conveying away the fluid whicii they have secreted or excreted. Some of them, like tlie liver, have a reservoir or bladder for temporarily holding a portion of the fluid w^iich they throw uut. One of them, the kidney, has not only a tube or duct, the ureter, leading into the reservoir or bladder, luit another special tube, the urethra, leading fi^om the bladder to the outlet from the body.
Diseasea of the Saliixpry Glands*
The glands which secrete the skliva, and the ducts of which open within the mouth, are subject to injfnmtnalmn and afmcedB, When mercury has been taken largely tliesc glands are much irri- tated, secrete saliva freely, and are greatly inflamed and enlarged. The tcnu mUvatumy or ptijalUm^ is used to express this state. In the communicable disease called mumps the salivary glands ire enlarged and intlamed. Tlie glands may also be the seats of
»irthii, tiialignant or non-malignant, or may be involved in suoli
^wtlii.
206
LOCAL DISEASES.
Salrmry caleidu». — Fmm glands which, like tlie s<alivarv, are fiirnislied with a duct by which their secreted fluids are dis- charged, a format ion or deposit of a liard mass, or calculus, in the duct 18 apt to occur. The calculus produces coubidei'al>lc irritation and obstruction. Salivary calcuhis is a eoQcretiun of this nature in a salivary duct, the deposit being derived from the saliva. The calciihis is largely composed of the same earthy substance as that which is sometimes deposited on the inner surface of the teeth as *' tartar/' These deposits are due, to a certain extent, to unclean- liness in respect to the teeth, but some persouB are, in spite of cleanliness, disposed to suffer from them, Tlie affection is most common in those who are of rheumatic and gouty constitution.
J^iseases of the Pajwreas.
The jmncreas, the large ghmd situated across the alKlomen l^elow and bciiiud the stomach, is subje<.*t to the same series of diseases as the salivary glands. The pancreas resembles a sal- ivary gland in construction, and secretes a fluid which has some of the physiological qualities of the saliva. It is a large gland, six inches in leugtli, and its duct pours its secretion into the part of tlie small intestine called the duodenum. The pancreas is sub- ject to injliumnatwn of its stnu^ture> and to ahi^cess. It is some- times tho seat of mnccr or malignant disease, oijiiroid degenera- tiou^ and of mleidus or stone. The pancreatic duct also may become the scat of calctdus.
The effect of the pancreatic secretion on the food is to emulsify the fatty constituents, and to take an active part in the -secondary digestive pi-ocess. When the pancreas, therefore, is functionally or organically diseased, the digestion is seriously impaired, and in organic disease- of the organ the fatty substances eaten as food may pass through the body unchanged in character.
DlSHAfiES OF TOE Lr-ER.
The large organ or gland called the liver, the largest gland in the body, is situated in the upper part of the abdomen immedi- ately below the midriff or diaphragm. The liver is very suliject to disease, and as its uses in the economy are many and vaiied, its importance, as a seat of disease, can hardly he over-estimated. It u a comujon practice for persons w4io are ailing to attr ibute their
DISEASES OF THE GLA:N^DULAR SYSTEM.
207
"inhering, as if by Rome instinctive process, to the liver and bile, and there is often a great deal of rea&on in the obfiervation. The liver secretes bile, and inueL of the bile so secreted and thrown into tlie alimentary canal is absorbetl there and is burned in the body ; so the liver becomes indirectly a source of supply for ani- mal heat. The bile, if it be not dnly applied, and if it be re- turned into the cii*culation as bile, is a poison to the blood, a eaueo of depression to the spirits, and when in the blood in large quan- tities a c-ause of yellow disc^oloratioii of the skin, — jantidice. In the liver there is a translation of the matter derived from the digested food into a substance called glycogen, mIucIi is easily changed into glucose or grape sugar. If from irregular nervous action tliis process be improperly carried out, glucose may bo formed and given over in excess to the blood. Thus tire liver may become indirectly the origin of glycosuria or saccharine urine, and of the disease called diabetes.
The liver is often the receptacle of poisonous substances taken into the body, such as the metallic poisons, some vegetable poisons, and alcohol. These poisons will remain in the liver long after they have been taken, and some of them, as it would seem from researches I once conducted on the elimination of antimony from the body, are thrown out by the liver into the alimentary canal, to make the round of the circnlation and to be returned to the liver for re-el irainat ion.
The liver again is a frequent centi'e in which parasitic growths are developed, and in certain animals, the sheep for example, it is the special seat of one parasite, the liver fluke, the famcohi Aepatica. The liver, it will be seen from these facts, is a great centre of disease and the seat of many distinct diseases.
Congestion, — The liver is sometimes the seat of vascular con- gestion, during which it is temporarily increased in size, to the dijicomfort of the sufferer, who feels pain whicli is often referred to the right shoulder. With tlds congestion there is always dyi»pepsia and flatulency, derangement of the Ijowels, and not in* frequently piles or hemorrhoids. When the congestion is great, there is usually some yellowness of the conjunctiva or even of the dn, and there i* always a pasty and ameniic look of skin. Con- stion of the liver is most apt to occur in perscms of sedentary habitfi, and especially, in such persons, when they indulge in itimidants and in rich food. It is almost universally attended
208
LOCAL BI8EASES.
with depression of the mind, from whence, doubtless, the ternie ''bilious disposititHi "* and ''bilious feeling-' are derived,
IlepaiitlH^ or inf{*im?natwn and abscess. — The liver is subject to iutlammatioti, which may be simple or pysemic ; that is to sAy, the inflaaiiuatioti imiy originate in the liver itself, or may be one of the conHeqneiicefi of that condition of fever to which the word pyemia is applied* In this climate the last-named is the most frequent form of inflammation and of abscess of the liver, the abscesses being numerous and sbialL In tropical climates, as in India, inflammation pure and simple and abscess of tlie liver, are of common occurrence^ especially in those who indulge in alcohoL
Inflammation of the livery however caused, is attended with high fever, pain, great disturbance in tlie abdominal organs, and jaundice. If abscess follow the inflammation it leads to enlarge- ment of the livor, to irritative and hectic fever, to jaundice, and usually to death by exhaustion. When abscess of the liver is the result of simple inflammation, there is, as a rule, one large abscess, and in rare examples the abscess breaks externally and recovery is the result. I have known one such instance.
Deffeneratwn of the liver,— The liver is subject to several de- generative changes which are classified as — (a) Acute atrophy. (b) Thickening of the capsule, (c) Cirrhosis, (rf) Fatty liver. (e) Fibroid deposit, (/) Lardaceous^ amyloid, or waxy liver.
Acute atrophy or contraction. — A condition in which the liver suddenly shrinks, its cells undergoing a rapid degeneration and becoming charged with oily and gmnular deposits. This disease is attended with extreme distnrlmnce of the other organs in the abdomen, with arrested action of tlie kidney, ending in death l>y sleep, coma. There is sometimes yellowness of the skin or jaun- dice* The affection is rare, and except in pregnant women is almost unknown in tliis country.
Ch^rh4)8is.
Cirrliosis is a condition in which the liver, after first being much enlarged, from repeated attacks of congestion, shrinks and becomes hard and I'ough on its surface, ''hob-nailed/' The dis- ease has been called, from this appearance of the liver, *'!iob-naiJ liver." It has also been called, owing to its almost invariable connection with alcohol as its cause, •''gin-drinker's liver." The diabase is due originally to a change in the membranous structure
DISEASES f>F THE GLANDULAR SYSTEM.
^
ie liver, produced, most frequently, by tlie direct actiou of alcohol ou tlie nienibraiioua structure, and ending in the con- densHtion and destruction of the secreting cells, with thickening of the connective tissue. The liver gradoally con tracts, ceases to eeerete bile, and, becoming an obstruction to the venous circula- tion, prodnees ascites or abdominal dropsy, under which the sufferer generally euccnml»s. Tlie term cirrhosis is taken from the yellow color, which the diBeased liver structure presents. The color is doe to a yellow pigment in the diiseased cells. Cirrhosis of the liver, as a disease, is almost peculiar to the human subject, but in ray experiments with alcohol it was shown that by administration of alcohol it could easily be induced in tho lower animals.
Tluekening of the capsular angering and Jibroid depmlt. — Dis- tinctive conditions of disease of the liver, but less ciuiimon than cirrhosis. By some authorities they arc connected with the vari- ous atages of cirrhosig.
Fatty litter. — The liv^er is subject tt> a |»cculiar fatty degenera- tion in which the cellular structure is charged with fatty cells. The liver then resembles a fatty etnicture; it floats in water and is of yellowish tint* It is also milch enlarged. Fatty liver is often connected with consumption of the hmgs. It may be pro- duced by indulgence in alcohol. It can be eyntheticAlly induced in the lower animals by alcohol, rich feeding, and cessation from natural exercise.
Jjinhu^oiw Ik^er* Afnyhnd disease, Wa^apy Umr.—\u this <!Ondition the liver, fi^om changes in its secretiug cellular structure, undergoes a gradual enlargement and a transfonnation toward what is conveyed in the terms lardaceous, amyloid, or waxy. Tlie affection is perhaps hereditary, and it is mostly, if not in all instance-^ connected with some constitutional taiut, the syphilitic and 6erofuh)us most markedlv. It is slowlv destructive of life, and causes death by some indirect influence on other orgaiiB of the body, or in combination with fatty elianges in otlier organs, imcb as the kidneys or heart.
Tho liver may also be the seat of cancer; of ftyphilitte de- posit f of iiiln'rcuhtr dcj)Oftlt ; oi simple tumor; and of hydatid cy«ts — cysts containing the larvee of the tjienia echinococcus, a variety of cestodo or tape- worm, — whicli may increase until they break and tiischarge their contents extei-nally. In addition to these ^tatct) of disease the great vein of the liver, the venaporta^ 14
210
LOCAL DISEASES.
wliicli returns tho blood from tlie digestive organs to the liver, and from which b!oi>d tlie bile is secreted, is subject to obstriic* tion from inflammation of its coats, atid from dcpisitionof librine within it* Obatructiafi of the t^ena jporta is attended with sup- pression of the bile, constipation, dyspepsia, and in extreme eases with dropsy of the abdunieo,
I>iseases of the GaU-Blmld^r and BUe-Dtici.
The gall-bladder or eac for holding the bile secreted by the liver, and the tube or duct connecting it with the liver, are liable to several forms of disease, viz., itifiammation, ulcer» perforatioti, fistula, obstruction, and calculus or gall-stone. Infmnmation of the bile-duct and gall-bladder is rarely if ever disconnected from disease of the liv^er, and is always a very painful affection. Ulcer is a destruction of surface from the mucous Hniug of the gall- Idadder or tube. I*eif oration is an ulceration extending quite through the coats of the sac into the abdominal cavity. Fistula is an opening, from perforation, not into the abdominal cavity, but tlirough the abdomhud wall to the outside of the body, so that a fistulous opening from' the gall-hladder or its duct is estab- lished, from which bile may be discharged externally. CalculKft of the giiU-h!add4'f\ or goll-slom^ is a hard concretion deposited from the bile within the gall-bladder. This calculus, foi'merly said to be formed of inspissated Idle, consists largely of choles- terine, a waxy substance of crystal line character wliich is derived from bile and which hums lilvc wax. There may be one ealcuhis in the gall-bladder, or more than one. I have seen six in one gall-bladder. The calculus takes different shapes, but very often a triangular or "cocked hat'' shape, from having been moulded into that fcvrm in the neck of the galhhh^ddcr. Calculus in the gall-duct is a cause of the in tensest of human snfPeriugs when it 18 lodged or impacted in that sensitive structure. The pain comes on in paroxysms whicli nothing removes except the esc^npe of the atone into the intestine, or its retuni into the gall-bladder. In very rare instances the stone is discharged by a fistulous open- ing through tlie skin, and in the young it is often passed into the intestine, and discharged by the bowels. In |>erst>ns of miuMle or advanced life gall-stone is often associated with an atheromatous condition of the vessels of the brain, those vessels having under^ gone a fatty change, witli a deposit in their structure of the same
TUSEAffES OF TTTK OLATDirr.AR SYSTEM.
911
I
kind of waxy substance as tliat whieh is contained in the gall- stone.
Jaundice* letents, ,
The old physicians gave the name of janndice to what they considered was a specific disease aceunipanied by universal yel- lowness of the surface of the body, with or without fever, with much depression, and in the worst cases with coina, ending in death. Tliey connected the ditiease with the ciruulatiou of bile tlirough the blood, and we do tlie same in this day, but we differ from them in that we consider janndice to be a symptonx of dis- ease rather than a specilic afEection. Jaundice, in fact, accom- panies many diseases acute and chronic, though it is naturally most intimately conneefed with diseases of the liver and tlie gall* bladder. The t^ymptom may be caused by obstrnction to the course of the bile from closure of the gall-duct ; by over-secretion of bile ; and again from failure of tlie prc*cess by which the bil- ious matter brought by the blood into the systemic circulation is utilized. Thus there is a tnio hepatic or liver origin of jaundice nod a systemic origin. Tlie first is connected with hepatic dis- ease; tlie second with other diseases of a more general cliaracter, such as yellow fever, pyteraic fever, and bilious remittent fever. Jaundice thougli not a dctinite dieease is often a dangerous com- plication of other diseases. It tells us that bile, which in itself is a poisonous product, is circulating in the bluod and is acting as a direct source of danger*
Diseases of tite Kidneys anb Rekal System.
The two glands in the abdominal cavity, called the kidneys, have for their function a purely eliminative intention. The fluid they excrete is the grand outlet for the niti'iigcnous excretes of llie animal body. The flesliy parts of food that are not used, and the u^d-up parts of the muscular system of the body itself pass out of the body through the kidney. In the Cfiurse of its revolu- tion tlie fleshy material has liecome transformed from its colloidal ilafce into a crystalloidal. It has ceased to be flesh, and has be- ne a salt. It has ceased to be insoluble in water, and has be- ne excessively soluble. It has ceased to absorb and hold water, and lias assumed the power of fixing water so as to liecome, as it were, a part of water, flowing away witli it as though it were
LOCAL VWJD
water itself. Tlie nitrogenouB salt which has thus been produced from miisL'iiiar or flesliy substance, and which the kidnev thmwe off, is t-ailed urea. It is a white ervstalline substaiife tasting BoinGthing like niti^e, and poaeeBsing extreme eohibility.
The kidnevB also eliminate water very freely, in order to carry away the iiiirogenous salt and to relieve the body of exeess of water. They excrete Bomo other substances. They excrete an aniniid acid, called uric or Itthic, derived front flesliy matter. They excrete sulphates of sodium, potaBBinm, and calcium, de- rived from food. They excrete phosphates of anmionia, calcinmy and si»dium, derived partly from food direct antl partly from dis- integrated or effete brain and nervous tissue. They excrete some organic ealts and coloring matters derived from the blood, to- gether with mucus from the Ihnng mucous Rurfaces of the kid- ney, the ureter, the bladder, and tlie urethra or external passage. If we measured the proportions of all tltese parts as they exist in the nrine, excreted by the healthy kidneys of an adult person in twenty 'four hours, we sliould fiiul in all forty -eight fluid ounces. If of this fluid we arialyzcfl a thousand grains, we should discover fourteen grains of urea; eight and a half grains of other salts, eulphates, bipliosphates and chlorides; half a grain of unr atad, and tea grains of coluriug material with nincns ; thirty-three grains in all. The remaining nine hundred and sixty-seven grains would consist of water.
Tlie due excretion of all these parts is necessary for healtli^ but the excretion of urea and water is specially important. The saline substance, nrea, if accunailated iu the body, acts as a poi- son, causing the comatose state called ura^mic coma, or sleep. The euppression of excreted water in due quantity by the kidney is a cause of dropsy. Imperfect excretion of uric acid, or of other salts than urea, is a cause of locid diseases sucli as calculus of the bladder or other parts of the renal system, and of gouty deposit in the Joints. On the other hand, excessive excretion from the kidney is a cause of exhaust iiui, and as the kidney is the channel by which many soluble saline substances Hud their esc-ape from the body, its excessive excretive action becomes often a most urgent symptom in disease. The affection known as dia- betes mellitns is a case in point. In this disease the blood is sur- charged with the soluble saline substance called glucose or grape Bugar, and as the sugar dissolved in the renal excretion is eliin-
DISEASES OF THE GLANDULAIl SYSTEM.
213
t
inBted by the kidney, the flow from tlio kidney is frcqneiit and, it may be, many times more abimduut tbim is natural. In paet days it was thought that the cases uf excessive flow of water from the kidney was from disease of that organ itself, Now we know that the excessive flow may be hut a Bymptom, and that the kid- ney may be quite healthy tliough forced to porform an extra amount of work* The di^seases pr(>i>er to which the kidneys arc subject am congestion, inflammation, hypertrophy and atrophy, degeneration, and mechanical disease.
Congoitioiu — ^The kidneys may be congested or Biii^cliarged with blood, the congestion being of two kinds, aeute m\djHtmwe, Acute congestion of the kidney is Buddeti in its develujnuent, ia attended with fever, suppression of secretion, pain, sense of weiglit in the loins, and, in very bad cases, with dropsy, or dropsy and coma. Acute coiigustlLMi is iismilly bniuij^bt on by sudden &nppres£Lion of the action of the skin, as by lying down to sleep on damp ground, or by the action of some poisons, such as bella- donna or alcohoh It also accompanies other forms of tjisease, as 6(.*arlet fever and malarial fevers. Passive congestion is slower d less severe in its manifestation. It is soinetimes a sequel of icute congestion, and it is liable to ix*cur in tliose who have once suffered from it.
ITwmatiirla. — A term applied to the passage of bhK)d from tlie kidney by the urinary canal. It is rather a symptom of con- gestion, or of mechanical injm-y to the kidney, or of some foreign growth in the structure, or of ulceration, than a disease uf itself.
^ej}hrtiU^ iiijiutnmation^ and SHjtpuratlon, — The kidney may be the seat of intlammation and of subsequent suppuration, mip- puraiim jwjihrUls. The affection may be of tlie simple in- tlamnuittrry form, following upon extreme congestion, or upon irritiition from some foreign boily within the organ ; it may also be secondary to other acute affections, as pyai'mia. The secondary form is the most common of the two. Wben tlie inflammation, bowover induced, extends to tlie pelvis of the kidney, — tlie little pouch fnjni which the duct of the kidney called the ureter pro- ceeds,— the term pt/eltlh is used, in the nomenclature, to define tlie condition of dis«mse that has been set up.
AH these inflammatory states of the kidney are of grave tnoment. Tliey are attended, generally, with much fever, snp- pr(»aeioa of secretion, and often with dropsy. When suppuration
214
DISEASES.
takes piaffe the fever assumes the liectic character, aTul pus or matter may be excreted with the tirine.
Ihfpeiirophy and atrophtj. — The kidnej is eometimes much enlarged or hypertrophied. The enlargement may be uniform throughout, and Biniply owing to the increase of the natural etruct- ure as a result of excels of function. Or the enlargement may be dne to effused material into the connective tiesne. Atrophy or wasting of the kidney is a condition a Hiding fi-om two or three causes. It may accompany general wasting from privation or exhausting diseases: it may arise from failnre of nervous supply; or, it may take place from <leprivatiou of hlood to tlie kidney, either through pressure exerted on the organ itself or from ob- struction in the arterial blood-vessels.
Ilyjwrtrophy of the kidney of the simple form is usually at- tended with an increased flow of nrine or diuresis. Atrophy is attended with a decrease of the renal excretion, and wlien from tliis or other cause the decrease is carried to arrest of flow of the exci*etion there is said to be euppressioi^ or Uchuria renalis.
Deijent-ratuyns of the Kidfu^y. JiriglU-s JJUeaae. A Ihum inu ria.
The moBt important, because the most fi^equent, organi diBeases of the kidney are those included under tlie head of Bright*^ disease, so called fruui the circnmstauce that the late distinguished Dj', Richard Bright iirst recognized the affections and made them known. The College authorities define these diseases as ^* several forms of acute aiul clironic disease of tlie kidney, usually associated w^ith albumen in the urine, and fre- quently with dropsy, and with Tarions secondary diseases result- ing from determination of the blood/'
Varieties of Brighi^s Disease.
There are several varieties now I'ccognizcd of Bright's disease, which resolve, however, into two great divisions, the acute and chronic.
Acute Brighfs dlsca^n^ called also acute edburmnuria^ acute dc^qnamative nephrid^^ or acfttt} renal dropaty^ is a disease in which the kidney becomes greatly enlarged and vascular, with its minute convoluted tubes into which the urine is primarily se- ci'eted filled with epithelium. The epithelial scales, in the form
I
DISEASES OF THE GLANDULAR SYSTEM.
21C
of casts of the renal tubes, are voided by the urine, together witli albumen and soinetiine^ with blood . The obstruction to the How of urine mid the interference witlx the function of the kidney ^ive rise to the most serious general ejinptoms. There h fever followed quickly by dropsy, and, in extreme instances, by coma and death. Acute Bright's disease is a rather comiuon complica- tion of scarlet fever, and i& one of the dangers most to be dreaded in that disease. It is also produced by sudden and extreme chills, and by excessive use of alcoliol.
Chrofiic Jiri^Ms disease is either a continuation of the acute affection, or h slowly devek^pcd without the occurrence of active ^ymptom8, It is connected with further and permanent changes in the structure of the kidney, giving rise to three subdivisions of the clironic afrectii>!is called granular, fatty and lardaceous kidney.
Granular kidney, called also contracted granular kidney, chronic des4|uatnative uephritiH, or gouty kidney, is a form of the disease coming on, usually, in persons of middle agc^ and espe- cially in those of gouty habit. It is attentlcd with albumen in the urine. Tlie kidney is granular, firm, rough, hard, and gen- erally contracted, its membranous capsule mlhering closely to it.
Fatty kidney is a condition in which the organ is white and mottled. Tlie secreting cells are granular and contain fatty or oily deposits.
Lanlaceous kidney, known also as amyloid or waxy kidney, is a condition in which tlie organ is, a.s a general rule, enlarged, and presents on its surface a waxy appearance. This change seems to commence in the vascular structure of the organ, in the minute tuft« of arteries that yield the bluud from wliich the urine is iecrcted. The affection is often connected with f attv and amvloid changes in other parts of the body, as the liver, and it iw, like them, associated not unfrequenliy with pulmonary consumption, and, specially, with syphilitic degeneration.
In addition to these degenerative changes the k id ne?y is suIj- ject to dt^xmt of jil^rlfie within its structure. It is sometimes the iieat of catict'i\ of non-rfiaUfjiuint tumors^ of ajsts^ of jmrasUio *UTflnpmeufs^ and of fuiercle.
The mechanical diseases of the kidney are :
Jlydrfm^^phrosU, — *' Dilatation of the pelvis of the organ, or *tf the glandular structure, into one or mofo cyste^ by retained
retiofi,'*
210
LOCAL DISEASES,
Cnlctdim, — Stone in the kidney, xisiiallv m the pc*lvis, or in the tube leading from the kiJnuy to the bladder, the ureter. It is a very painhd affection, causing often faintness and vomiting dm*- ittg the passage of the calculus,
MoiHiUs kidney. — A condition in which tlie kidney is, as it were, dislocated from its natural i>OBition and niitixed.
DiHKAfiES OF THE BlADDEK.
The IJadder, a inemliranous pouch or bag for temporarily holding renal f^ecretioii, is laade up of tliree coats or layers; a eerous layer on its outer sidcj which may ea.^ily be stripped off the dead bladder, and which is derived from the peritoDeum; a middle ninscnlar layer of involuntary mucicular fibres which sur- round lliG organ, and by their contraction empty it; an inner or lining mucous coat, whitdi secretes a thin mucus. The bladder is subjected to many diseases.
CyHtilis. Catarrh iff the hUulthr. Vtmeal catarrh,— 'A con- dition in which the mucous surface of the bladder is in a state of extreme irritation, or is actually intiamed. The disease is acute or chronic. In the acute form it is attended with pain, fever, and frequent discharge from tlie bladder of ordinary secretion, con- taining, after a time, mucus. In the chronic form of the disease the feverish and other acute syniptoms are modified, but the excretion of mucus and the irritation continues.
JJh-cratmn and suppuration, — Under long-continued irritation of tlie mucous surface of the bladder the mucous rnendirane may undergo ulceration at one or more points. This change is at- tended with extreme pain, and often with discharge of blood as well as mucus. "When the discharge of mucus contains pus or matter in large quantities, with febrile disturbance, suppuratiou of the bladder is said to be present. In rare instances the bladder may undergo dowjhtwj or actual deconi position*
Fistula ofihiS hladiler^^Yroiw inllammatory mischief affecting it or its surrounding parts, the bladder may have in it an opening or fistula extending from it into other cavities. Four fistulous open i n gs of this kind m ay occu r f roi n d i sease ; {a) \ Isica-in te- iinal JisUikt^ m which tbo opening is from the bladder into the intestine. (J) J?edO'Vesicaljfstuhi„ where tiie opening is from the bladder into the lower or straight intestine* {*") Uiero-veaical
^^1
i
BI9EA8E9 OF THE GLANDULAR SYSTEM.
217
w-a, where, in the female, the upeninj^ it^ from the bladder into the uterus or womb, {d ) Vt'^ico-vatjlitS JiHtuhu where, in the female, the opening is from the bladder into the vagina,
Htji^virnpluj. — The etmts of tiie bladder are sometimes very mucli enlurged in eiises M'here there is great obBtrnction to the escape uf the urinary gccretion. The muscular coat is tbe part wkicli \% most couunonly hypertrnphied, I have recorded an in- litatioe iu which the walls of the bladder were nearly an inch in thickness from muBcular hy|)ertrophy.
Disttmtion. — The bladder may be distended, the distention causing it to be ?aecuhited or pouched, bulged out in parts, from the giving way of a portion of the coats. It may lie actually ni}>tured. Long reteation of the urine is the commonest cause of these accidents.
Mechanical aecidetits.— The bladder nuiy be subjected to mechanical accidents^ as inversimi^ e.rtrovcriiJon^ uud /icrnkt. It may contain foreign bodies accidentally passsetl into it. The most frequent mechanical mischief that happens to it is the deposit witliin it of calculus or stone.
Caleidus. Stone m t/ie bladder.
b rrc
^H This wclbknowa affection is due to deposit from the urine <if
^^^■bne or other of the m(»re solid coTifitituents* There is not ulwavB ^^^^ direct deposit, for soiULftiiues a foreign substance forms the nucleus of the calculus. Tliere are twelve kinds of calculus of the bladder recognized iji the nomenclature of disease. These gre placed iu tlie following order. 1* Uric acid. 2. Urate of '^ftumoriia. 3, Uric or Xanthic oxide. 4. Oxalate of lime. 5. Cystic oxide, 6. Phosphate of lime. 7. Triple phosphate, phos- phate of ammonia and magnesia, 8. Fusilde, 9, Carbonate of lime. 10. Fihrinons. 11 ♦ Urostealith. 12. Blood calculus.
Tlie uric acid calculus, the triple phosphate, and the oxalate of lime which once was called tl»e nudberry cidcidus liecause of its likeness to a mull)erry-stone, are perliaps the most common linds of calculus of the bladder. The first of the three, uric %cid, is ueuallv oval, fuwn-eolored, hard, and constructed in lay- ers; the second, triple phosphate, is rough, firm, und drab- eolored ; the third, oxalate of lime, is rough, hard, and red, like a iMullicrry-sUme,
Calctdus of tlic bladder is mure common iu men than iu
1
218
LOCAL DISEASES.
TTomeTi, and affects residents of certain part& of the country more tliau those of otlier parts. It depends greatly on Jjubit of body for its foriLiation, and is very niiieli favored by the use of alco- holic drinks, especially of nialted liqnoi^. The affection is at- tended with irritation and pain ; ^i^nso of retained scci-etion withhi the bladder ; and often, when tlie cakndns is lar<^e, with discliarge of mucus in the Becretion* AVhen tbe formatituhs are minute and distinct, the escape *>f small calculi way orcnr, with much pain. Calculus of the bladder is now a remediable affeetiuu under sur- gical skill.
Forfugti f/rowt/is of the bladder, — Tbe bhidder is sonietinies " the seat of simple or non-malit^iant tumors ; of cancer ; and of a tumor called ''villous/- involving tlie mucous membrane.
Mumular affectloiw, — The muscular coat of the bladder may be the seat of disease. We have already seen tliafc it may be liypertroplued. It may also suffer from paralysUy irntabil/ii/, and apamn. When the muscular coat Ib paralyzed tbei-o is what is called rd^^ntloit uf urine, from the want of expulsive power. When tlie nuiseular coat is irritable the urine bus to bo voided too frequently, and there is what is known as incofUinence of lU'ine*
jyiseases of ike PrmtaU Gland.
In the male subject there exists in the front of the neck of the bladder a gland of the size of a Spanish nut, called the pros- tate. Tbe <j^land has not oue coujmoii duct, but has sixteen or eevonteen email ducts, which terminate in the urethra, the pas- sage leading from the neck of the bladder. Tbe gland is the sea^t of several diseases, including; — ififfarnmationy acute and chronic; nice ration ; almreft:* ^' lUrojAfj ^ inmorfit^ non-malignant and can- cerous; cahndus ; ct/st^ ; and, iuhtrcU, Tbe most frequent forms of disease affecting the prostate are c/irontG efdargerthtnt^ whicli may be simple or malignant ; and ealctduH, which occasionally be- comes of large size, and is only removable by surgical skilh
Diseases of the Urethral l\imag€,
Tbe urethra, or tube, leading fi-oni tbe bladder to the outlet from the bodv, is the seat r»f several diseases, especially in tlie male subject. It is subject to indaunnation, urethrlttHy whicii may be simple^ or gonorrhceab It is subject to ulceration^ the result
DISEASES OF THE GLAI^DULAR SYSTEM.
219
Of preceding iTiflatntiiatory diisea&e ; to urinary ahsfXJ^s ^ to c^- travasatkyn of urine ; to jistula ; to iXtUndas^ or stone lodged or impacted iti it, from Avhich it may suffer severe laceration and in- jury ; and to hitjuuiion of other foreign bodies. Tlie most jser- sistent disease of the urethra is, however, sfrirtffn, a resuh, iu the great majority of instances, of specific or gonorrhreal inflamma- tion. In stricture the passage is narrowed, bo that the nriae is passed with diffiridty, and iii wor>?t cases is stoppetl altogether until i*elief is ohtaiued from the siirgtjon. There are four kinds of stricture. Orffamcy where the stricture is caused by organic ^deposit and growth; traumtdu^ where it lias been caused by a *%oimd ; sjHWtufMlie^ where it is the result of spastn of tlie nmseu- Ur fibres surrounding the canal; and Injiummatori/^ where it is the result of existing iuflammatioa within the canal-
^
Diseases of the REriiontTrrivE Glakds and Okgaks,
The reproductive organs include in the male subject the testes ad their parts; the gperniatic curd ; a serous membrane, whicli insists of two layers, investing and reflected, forming a true niembranotis sac, the tunica vaginal i.s; and an external pt>ucli of skifif the scrotum. In the female subject t!iey include the ovaries; the uterus or >vomb ; and the Fallopian tubes.
J}Ueases ttpeeial to tfie Male Subject.
DUeasfS €ff the testes, — Tlie testes are seats of hiflammation, orchitis^ M'hich may be acute or chronic, and which in the acute form is attended with extrenie pain, fever, and often with faint- ness; of intlamniation of the convolutions of the excreting ducts of the gland, the epididymis, epldJtbjtnUh / of abscess / and of Iwniia, These glands may also be the seats of malignant disease ; of simple tumor; of cystic disease; of wasting or ati\>j}hy ; of rurural'^m f* and of the weakness of function knowTi as sjwrtna'
Tlie ttiniea, tHiginalUy or investing serous niembrane of the gland, is subject to inflanunation ; to extravasatiuu of lilood into the timic^ h*i^mnt4}i^le ; and to dropsy or hydrocth^ in which watery or serous fluid accumulates, in large quantity, in the serous Mc, and greatly ditstcnds lx>th it and the scrntiirn. Of hydrocelu there arc three varieties: the confjciittiilj where the dropsy is from
220
LOCAL DISEASES,
birth; tlie infantil^^ where it oc*cnr8 in infancy; and tlie encyst* wheie it comes on in later years. Hydrocele is a disease very amenable to surgical skill
T/ie ttjtennafi*' an-d, composed of an in vesting membrane, of the spermatic artery derived from tlie abdominal aorta, uf retm^n- ing veing, and of the excreting duct of the gland, the vas (ieferena^ in its course from the gland toward the abdominal cavity on each side of the body^ nuiy be the eeat of hydtoceb;^ or dropsy, en- cysted, or diffuse ; and of varu'oe^le^ or enlargement of the veins, with a varicose or knotted condition, and dist^intion of them from eneloRed blood. The cord ii< sometiuies the seat of tnmo»"8, simple or malignant, and of the painful nervons affection known m neuralgia.
The scrotum or cutaneous imneh containing the glands may be subjected Xo doatjhinif ; to swelling or mi<'ma ; to elejthaittlanis * to fWU-mdiUymitd (frowth ; and to canv<t. In the days when youths were matle to as<?end chimneys as svveej>s, ej>ithelial cancer of the sci'otiun was commonly developed in them, and was called €fdmncy-8icecp€i*^B cancer.
DUeases special to the Female Subject*
Duea$e$ of the ovaries, — The two glands of the female, called the ovaries, situated in tlie lower part of the abdomen on each side, and each enclosed in a layer of peritoneum at the back of the broad ligaments of the womb, are tlie seats of several forma of disease. The ovary itself is a very vaseular structure, with a cellular net- work enclosed in three layers of membrane, called the capsule. The inircr of these layers of the capsule is finely vascu- lar; the middle thick and fibrous; the outer, derived from the peritoneuuu thin and serous. In the cellular structure of the ovary are a number of small vesicular hf>dics, called the Oraatiau vesicles or ovisacs, which contain an albuminous tlnid, many gran- ules, and tlie body, wliich becomes impi-egnated in impregnation, called the ovum.
The ovaries am liable to become the seats of injkimmation^ which in tlie acnte form is attended with severe pain and fever; of ahsccss ; of hntorrhagc * of ht/pertrojduj and airttjdiy ; of cancer; of Jibroiis tumor; of ei/sts * of para^Ulc growths; of complex cystic tiim&r^ colloid^ and cystomft'oma ; of /u^rnia; of disloc4jUimi ; and of etwyHted drojmy.
DISEASES OF TTIE GLAXDULAU BYSTEM-
221
ropsy of tfie Ovary, — The most reiDarkablo and most com- Dion disease uf the ovaries is the last-named above, encysted dropsy, cotmnoiily known as ovarian disease, or ovarian dropsj% In this affection one or more ovarian cysts form, and become en- larged and filled with fluid. Tho fluid accmnnlutes ntitil t!ie cyst inay increase to over a foot iji diameter, and may attain a weiglit of many pounds. The fluid in tho cyst ia somotimes quite clear and watery ; in other instances it is tliick and albuniinons ; iu other instances &tillj it is gelatinous ami almost solid. The ten- dency is for the ovarian cyst U> increase until it tills the abdomi- nal ca%^ity, and to destroy life by the pressure it exerts on the breathing, the circukting, and digestive organs. Of bite yeai-s, an operation, invented by Dr. McDonnell of Kentucky, and gi*eatly advanced by Mr. T. Spencer Wells and other eminent surgeons, for the removal of these ovarian tumors, has been attooded with tho most magnificent fiuceeaa, fi-om seventy to ninety per cent, of ca^a which would have ended fatally without tlie aid of the ojier- ation being now recoverable. Xo surgical operation discovered or invented in the present century, or indeed in any century, has be^i BO remiirkable as this operation wliicli is called ovariotomy. DUeastS of thfi Uf^eru^ or Womb. — The uterus or womb is the receptacle in which the ovum is received after impregnation, and is tlie pouch in which tlie body is developed from its emljiyonic fitate into that in which it is presented at its birth* The utema is not connected permanently with the ovaries by a duct» in the game way as the bladder is connected with tlie kidney ; but it is indii-ectly connected by means of two ducts, called the Fallopian tubes, which emerge itxtni it one on each side at the upper angle of tlie fundus or body of tho organ. These little tubes, discov- ered by Gabriel Fallojdns about the year 1550, extend frotn the jjtttcrus laterally on each side, for a length of nearly five inches, t)ng the upper border of tho broad supporting ligament of the "womb. They are made up of a nmcous lining, which is continn- ous from the uterus; of a coat of circular nniseular fibres lying onUi<le the mucous coat; and of a serons outside coat derived from tlie peritoneum. The tubes expand at their free ends in a trumpet-shaped fashion, and terminate in two or tliree fringed or fimbriated projections, which are ordinarily free, but which under «cdtation grasp the ovary, and enable the ovum to escape into the tabe, and pass through the tube into the uterus.
'222
LOCAL DISEASES.
The litems itself is made up of three coats : of a lining of mucous inerabrane, the inner coat ; of a circular and longitudiniil hirer of invuhintiirv ninseles^ the middle coat ; and of an invest- ing serous membrane from the peritoneunij the outer coat. The organ 18 pear-shaped, and in tlie nn impregnated etato in the adult person is about the size of a moderate-sized pear. The upper part of it i^ called the fundus or body ; the gmaller and lower, the cervix or neck ; and the opening of tlie neck, Uie os or mouth. The uterus is the seat of many diii^eases.
Catarrh or Letworrhcea.—TliQ mucous lining of the utenis is snbjeet to catarrli or excessive secretion from its surface, ibo 6e- eretion passing away as a passive white discharge, leucorjhaea.
Jtijlammaiion, — Tlie uterns is subject to iuHaramation, which may be of tlie simple kind, involving chiefly the mucous lining, or may extend mcu*e deeply into the inuscuhir coat, and may be of II special form, called rjranular inflatnmation. The inllaniniation may also end in formation of matter or pus, which when diffuse is called suppurative^ 2Ln\i\v\ien encysted r>r confined is called abscess.
l^^Y ration. — The organ is often the seat uf that d*^strnctiou of surface, called ulceration, brought on either by long-continued irritation, by congestion, or by intlainmatioTk The neck or cervix of the uterus at its os or mouth is the part most commonly affected with ulceration. In rai'e cases the utenis is the seat of the special ulceration called rodent vhrr.
Ahra^Ion. — The mucous surface of tlie uterus may be sub- jected to abrasion J by which the surface is suddenly removed or destroyed at some point. The affection nsiialiy ends in ulceration, and heals after the manner of a healing ulcer.
Mechanical affectio-n^t, — The utenis may l»e the seat of me- chanical diseases or affectiuus, of which the ]>rineipal ones are : — - Utero' vesical Jist id a^ — a tistulous opening from tlie uterus into t!ie bladder ; drlcture of the or iff ee of the ctruLt ; struiftre of the canal of the cervix / ocehmon of the cervix ; ocelusimi of the canal. It is liable to seven displacements — {a) Antrrcrston^ tilting or turn- ing forwards; (b) lid roller Hion^ tilting or turning backwards; (c) Aut^jiexion^ bending forwards; (d) jRetroJicttofiy bending back- wards; {c) Invermon^ or turning inside out of the organ, an ac- cident occasionally connected with childbirth; {f)Prolap&m^ falling or descent of the organ from its natural place ; (^) Hernia or rupture.
BISEASES OF THE OLA^^DULAR SYSTEM,
223
lTt/pertn>phy and atrophy, — Tim uterus may undergo liyper- trophy or euJarg*2ua*nt, cither from actual increase of its muscu- lar fibres, or from deposit in its cellular connecting structure. The cen*ix, or neck, may also become cnlarge<J or elongated. The uterus may undergo atrophy or wasting of its structurcj and 6o become reduced to an extremely ??tnall ti-ize.
Tumom and Gmwtfia of the Uterus—FJbroid Dm^me. — The titems may bo the seat of various growths, malignant and simple. It 18 liable to become aflfeeted witli scirrhtis cancer, itjcdullary cancer, and epithelial cancer. It is the seat, in some cases, of a non*malignant but troublesome cellular or fibrous growth, spring- ing from its inner surface by a neck or pelUcle, called jxdf/jrfis / and of a growth in its own substance, known mjibroid disease or efduryemtnt. In this last-named form of disease, fibroid eidarge- ment, the uterus may beeume of a very largo size and a Fuurce of great discomfort, but the affection is not necessarily fatal, and it fiometimcs, according to my experience, permits those who suffer from it to attain to old age.
Dueases of tfis Appenditges of tfie Uterus, — The Fallopian tnbes may be tlie seats of inilammation, dropsy, stricture, occln- fion, hernia, dislocation, and of foreign growths, simple and can- cerous. The broad ligaments of the uterus, the folds or duplica- tions of the peritoneum by w^hich the organ is supported in its place, are subject to two inflammations,— ^>t'/i^/6' ^>e/v^o;i///^ and pelvic cdlulitiH / to abscess ; to cyst and pelvic hctmatocele ; and to extravasation of blood into the cellular or connecting structure.
The \'agina or membranous tubular sheath, which extends from the os or mouth of the uterus to the external surface of the body, and wdiich is lined with mucous membrane continuously with the uterus, is tlie seat of several diseases, viz., catarrli ; in- flammation ; abscess ; cicatrix or band ; hernia ; cancerous growths, usually epithelial ; and non-malignant growths, includii»g polypus. It is subject to laceration ; and to three kinds of fistula, (a) Vo^nal tistula. (JA Yesico- vaginal, — ^fistula into tlie bladder. (c) Recto- vaginal, — fistula into the lower bowel. By surgical manipulation carried in these days to great pei-fection, nearly all cases of these kinds of fistula are curable, and an untold amount of suffering, common in former times, is saved*
Functional Diseases of the JJUrus — Irregular Menstnmtion. — The uterus, after the age of puberty, fourteen years, and up to
224
^OCAL DISEASES,
tlie a^Q of forty -five to fifty years, is the seat of a period jcaI iiioiithly change, called nietistruatioii, during which it di^chargeti, for a period of three to five days, a fluid called the njeiifitrual, composed of uncoagulated blood, of mucous or epitlielial cells from the iiiueous gurface, and of d^hru of a lueinhrane formed within the uterus, aud which lias, in the imimpregiiated utenii%, to be cast off. I>\iriiig childbearing this menstrual function is bus- jjeudcd, the membrane east off in men^itruatiou being rerpiired aS| a receptive membrane for the ovum when it enters the uterine cavity ; but at other times the function is necessary for the per- fectly healthy condition of the woman during the periods of her life that liave been quoted above.
The phetiouieua of menstruation are sometimes changedj in various ways, from what is natural ; and such derangements aJ'o expressed under the following heads :—
AmenorrluBii. Ahsenl menstruation. — A condition in which the function fails from one of four causes, (a) Original defective formation, (h) Want of development at puberty, (c) iMeehanical obstruction, (d) Teujporary suppression of function.
Scant 1/ menMruation. — A condition in which the function is jierformed, but iu which the amount of fluid thrown off is scanty and uriually de tic lent in color.
Vicarious fnen^trualion, — A condition in which menstruation occurs, as it were, in place of, or vicai'iously for, some other dis- charge or function.
Dymn&norrhoia. Painful menstrtmiion. — A condition in which the act is carried out with great pain, the pain l)eing re- ferred to the lower part of the body, aiul being reflected seveix'ly to the back and loins. This state is often accompanied w^ith faint- ness, nausea, iti ability to take food, mental excitement hysterical in eharacterj and physic-al depression.
Jtcf I ort 'h arj la . Excessive m enstritut ion . — A con d i 1 1 o n in wh i ch the function is attended with great loss of fluid. The loss may be extreme at the natural period, or it may, by frequent recur- rence, be a repetition of smaller losses. Some, therefore, speak of tlio first kind as acute, and of the second as chronic menor- rhagia.
JJeiaorrhnge. — ^A condition in wliich there is direct loss of blood from the uterus, uterine liemorrhagc. This is most com* monlv connected with childbirth, and is one of the serious com*
DISSiffiB' OF THE OLANDCLAG STSTKM.
225
I I
plications of tliat act. But it may occur under otlier circinniitancea, *is in connection with acute or clironic menorrhagia, with a pur- puric or extreinelj fluid state of the blood generally^ witli nicer- ation of the mucous surface of the uterus, or with polypi or other tumors, malignant or uoii-maUgnant, developed in the uterine cavity.
J)ise<i8es of the breast Glands.
The female breast, the gland yielding tlie secretion of milk in the nursing woman, is liahlo to many diseases. It may be euh- jected to diseaAO at times wlien it is taking on the active function of secretion, and at other times when it is yielding no e-ecretion*
Tnfiainmation and its consequrnet's. — The breast 5s sometimes the seat of intlammatioi], which, when secretion is comnienciiig in it, may be acute or chroiuc. The inflaiinuation is attended with much pain and fever, and ends often in the formation of abscess, commonly called fnilk ahftcem^ which, as a ride, eitlier breaks or has to be incised by the surgeon. In healing there is sometimes left a small opening which will not close, and which is called a
EjTcem (ind deficUncy of seerettmi of milk, — In rare instances the secretion of milk is so profuse that the loss is a cause of great debility. To tliis state of disease tlie term Gfdartfjrrhtta is ap- plied. In other cases, and much more frequently, tlie milk is deficient in quantity and in quality. Tikis is called dejki<fncy of juiU', and is one of the most common conditions of disease in or and ill-fed nursing mothers of all comnnniitles.
J}i^ase of the nij^le, — The nipple of the breast is liable to two painful affections, chapjitd iiqyph and nh'eraUd. It is in tMime instances drawn in so closely as to be on a level with the liody of the gland. This is called dc^yressed nipjile.
Hypertrophy and atrophy. — The breast*glaTul may bo sub-
ed to enlargement or hypertrophy, either from excessive growth of the natural parts, or from deposit in the connective
acturo. The gland is std>jccted, more fretjnently, to wasting, ' atrophy, in which it shrinks into very small dimensions, leav- iog the once distended skin in loose folds and wrinkles, marked
li white spots and linos. Excessive action from many and olonged nursings, with irapoverisliment of food, or improper Mipply of food, are the usual causes leading to this atrophy. 15
226
LOCAL DISEASES,
Growths or Tuniom of the BreaM^-^'Xhe female breast is tlie scat of miiuy foreign growths, non-iiialiguarit and malignant. The non-malignant ai*e — (a) Fibrous tumor^ a firm and very painful growth immediately under ilie skin — " painful subeutaneous tu- mor." (?>) Fibro-j)liistid tuijior^ a deeper beated growth^^ more fixed, of Blower development, and less painful, (c) laittj tumor, a growth of fat enclosed in its own membranes, often in lobules, slow of development, rather loose, and not painful, {d) Osse- ous tum<n\ a very hard tumor of calcareous or bony structure, (d) Enchmuirama or cartilaginous tumor, very firm to the touch. {f) Adejioul^ a tumor like the gland itself in structure, and of alow growth ; called also ^' chronic mammary tumor.'' {g) Vascu- lar tumor^ a tumor eonsisting of vascular stmctnrej but uot of rapid development. (A) CystO'Sarcoma,, a tumor made up of cystic growth &, with firm inter-deposited plastic matter ; called also " complex cystic tumor." {i) Simple cystic growths. (/) Parasitic cystic developments.
Cmiccr and tkdloid of the Breast, — The mammary gland, or breast, may be the seat of malignant disease, and is perhaps the organ of the body that ia most subjected to this affection in women. The breast may be attacked by epithelial^ by m^did- l^ry^ or by hard cancer, — sciiThus, Of these the sch^rhus form is most frequently met with, and ordinarily commences as a small swelling in the gland, which at first may feel loose and give little pain, but which grows larger, liarder, and more painful. In time it causes retraction of the nipple ; and, allowed to run its own course, it continues to increase, involving surrounding parts, until tlie skin breaks throngh, and a large ulcerated surface is produced, which shows no tendency to contract or heal. The dis- ease, up to this day, is mortal, for althougli by surgical operation the local growtli can be remo\"ed, there is ordinarily a recurrence of the affection eitiier in the other breast, in the glands under the arm, or in some otlier gland or orgau of the body*
Colloid.— The breast is sometimes the seat of the gelatinous tumor called colloid. The growth may attain a very large size, and develop with great rapidity. It is doubtful wbether it be malignant* From the breast of a patient under my care, the late Sir "William Ferguson removed, in the year 1852, a large colloid, after which event the lady lived over twenty -five years, and died of senile decay.
^
DISEASES OF THE GLANDULAR SYSTEM.
227
Oth^^r qfccfians, — The breast, lastly, is Biibject to a peculiar neuralgia, called raaskKlt/nia ; and to excessive sensitiveness,
The rudimentary mammary gland or breast in the male m Buhject occasionally to disease, I have seen it once the seat of cancer, »eirrhus. It may be the seat of inflammation, hyper- tropliy, simple tumor, and cystic growth* It has been known to secj-ete milk.
Diseases of the DucrrLEsa Glands.
Tiie ductlesii glands that demand our attention are three in number. Tlie thyroid, or tlie gland in the fore part of the neck. The spleen. The suprarenal capsules.
Diseases of the Tky^roid Gland,
ii|^fciiiima//^n.— The thyroid gland may be the seat of inflatn- mation, either acute or chronic in character. The affection is rare as an nncomplieated condition of disease. ■ GoUre. — The disease known as goitre, also known in this conntn^ as "full tliroat '' and *' Derbyshire neck," is a disease of the thyroid gland* It is often present in connection with the condition called cretinism, and in certain districts it is specially frequent, as if from some purely local cause. The College re- porters define it as "enlargement of the thyroid gland, endemic in certain mountainous districts, but not limited to them.'* The onlai^nient is sometimes due to hypertrophy of the natural tis- eties of the gland. In otlier cases it is due to a cystic enlarge- rtient* It often attains a very large size, and in worst examples it interferes with the circulation of the blood through the neck, or even with the passage of food througli the oesophagug,
Ej*opfUhalnu<j goitre or brmic/iocdle, — This term is now used to express "an enlargement with vascular turgescence of the thy- roid gland, accompanied by protnision of tlie eyeballs, antemia, and palpitation.'' It h the most distressing form of gottre, and m aotne nionntainous districts in tropical regions is, comparatively, a freqnent affection. It would seem to be hereditary in character.
Pulsating hronch^oeeh^—Xn enlargement of the thyroid gland aooompanied with arterial pulsation.
The thyroid gland is occasionally the seat of cancer, usually of the scirrhus variety.
228
LOCAL DISEASES,
Diseases of the Spleen.
The spleen, a large vascular organ^ lying in the abdominal cavity^ beneadi the livei*, on the left eide, is a ductless gland, en- closed in an elastic coat, and invested by the peritoneuin. The uses of the spleen are as yet not fully miderstoud. Important duties in the animal economy have been assigned to it, and yet, to my own knowledge, the experimental fact reniahia that an animal can live what appears to be a perfectly liealthy life withont the spleen. The spleen was considered by the older physiologists to be a compensating organ for the blood of the digestive system. When the digestive organs do not require blood, when they are not at work, the spleen, it was imagined, is tlie elastic spongy reservoir for blood ; bnt when the digestive organs are at work then the spleen gives np its blood to them. This mechanical view is not abandoned, though there is now added to it the belief that in the spleen tlie corpn&cles of the blood, called the wltite corpuscles, are produced, and that in it the red corpuscles are dis- integrated or broken up. These latter views are chiefly derived from tlie diseased conditions of the spleen tliat have been discov- ered after death*
The .spleen is the seat of several diseases.
Spf^nitis. — Inflammation of the spleen. ThiB affection is not often difttinnt or uncomplicated in the human suhject. Inflam- matiuu of the spleen iu man is most coiimioiily the result of pyBBmic inflammation, with abscess as a further development of the inflammatory eoudition. In tliis way the spleen may beconje indirectly the scut of inflammatory disease, and is often so alTected during acute diseases of other organs.
I*lhrinouH depomf. — After some general inflammatory condi- tions of tlie body the spleen may bo the seat of extensive dt^posit of fibrine from the bkMxL The deposit may be diffused iu patches, or, as I have once seen, in lines or bai-s, through the structure of tlie glandt The deposit may undergo partial organization.
Congestion. — The spleen is naturally liable to nndergo vascti- lar congestion, being essentially a vascular organ. It is pmbable that we never experience a chill but that an excess of blood is thrown upon the spleen. The congestion is most fully developed in the disease known as intermittent fever or ague, with its parox- ysms of coldness, heat, and perspiration. In this aflFection, when
DISEASES OF THE GLANDULAIi SYSTEM.
it is long conf iniied, the epleen gains an enormous size from re- peated an J prolonged congestions, and is left permanently en- larged, forming what is, expresdvelj but vulgarly, called agtie^ cake.
Ihjperirophy. — The spleen may undergo enlargement from hypertrophy of its natural parts, in which &tate its functional ac- tivity is believed to Im? incmaeed. This condition is so f retjuently eonneeted with the blood disease in which the white corpuscles ire inci*ea&ed, leumeythwrnia^ that this bkiod affection is thought to be due to super-activity of the spleen, with consequent increae^ of tlie white, and, possihly, an unniitural disintegration of the red, corpuscles.
Amyloid disease. — A diseased Btate of the spleen, in which it M\. ' > degeneration into a lardaceous or waxy condition. The
iit_ liun is connected, perliaps in every case, with a similar
{ai*m of change in some other organ or organs of the body, such as the liver or kidney.
IlodgkifCs disease. — A disease first described by the late Dr. Hodgkin, in which tlie spleen is the seat of a white deposit, and in whicli the lymphatic glands of the body are greatly enlarged. The disease, which has been laboriously studied and written on by Dr. Wilks as a distinct organic affection, is attended by gen- eral symptoms of amemia or bloodlessnefie, with a tendency to dropsy or anasarca,
Ot/ujt affeetums, — The spleen may be the seat of cancer, — ^I have once seen it the seat of niedullary cancer, — of Cfjlloid^ of tubercle, and of parasitic growths* It may be, mechanically, torn or ruptured.
Diseaae of the Suprarenal Capsules,
The two ductless glands placed upon tlie kidneys, and called the suprarenal capsules, Jiave long been a puzzle to the physiolo- gist. Their use is yet undiscovered, but, since the days of the late Dr, Addison, they have been brought under close observation froni the fact that he coimected with disease of their structure a leriea of general l>odjly symptoms, which have since been desig- nated after him as '' Ad<lisoirs disease."
JfelasmO' AddmmL — This disease, called commonly " Addi- •OD'S disease," is attended by auii^mia, great debility, occasional ivncopc, and exhaustion. But the most marked feature of the
230
LOCAL DISEABES.
affection is the peculiar color of the skin. Tlie skin assumes a bronzed or smoked appearance, which may iiitensifj until the person affected may scarcely be recognizable from a mulatto. The affection is fatal, and is attended always with some changes of varied character, — atrophic, fibroid » tnbereidar, cancellous, or inflammatory, — in the suprarenal capsules. It is still doubtful whether these changes are the cause of the symptoms of bronzed skin disease or the results of a general condition of disease, in which the suprarenal capsules are ijivariai)ly but secondarily in- volved. Whichever may, ultimately, be foimd to be the fact,— and there is a wide field for research in the investigation of the changes in other organs connected with tlxe disease, — the original and perceptive labors of Addison cannot well be over-estimated.
CHAPTER VIIL
USSA8ES OF THE mrSCV7.AE SFSTEM, TENJ>ON^, AKB
APPENDAGES.
The diseai^es of the muscular system were but little under- stood as structural diseases until the microscope became an instru- ment of research in the Iiands of tlie physician, and even iu the present day the subject has not been studied with tiie successful zeal that has been devoted to other inquiries on the seats and caused of disease. It will be remembered that there are three eeta of muscular organs : the red striped voluntary muscles, t!ic mascles which move the body under the direction of the will ; the red atriped involuntary muscles^ the muscles, like tlie heart, which move without the direction of the will ; and the unstriped white mu&cles which surround the automatically acting organs, and which are purely involuntary in the direct sense of the term. The structural diseases of tlie voluntary and involuntary red striped museidar organs have been best studied, while tliose of the involuntary are open to much further investigation. It must be understood, therefore, that the diseases referred to as affecting the muscular system, relate, with few exceptions, to tlie red or striped muscidar organs.
IH»ea9es of Muscular SirucCure.
Injlnmrnalion amd almjess, — The muscles may be the seat of inflammation, but whether that is connected only with the fibrous or membranous sheaths in whicli the fleshy muscular elements are enveloped, or wlicther it is in the nmscular elements, is nut as yot fully determined. Pure and simple inflammation of muscle is, in fact, very rare as a disease uncotnplicated by rheumatic affec- tion, or by pyeemic fever. Wiien the inrtamination does occur in a muscle it is attended with dull pain, inability to move the muscle, iwelling, and fever. As a result, naatter or pus may form in the muscle^ producing ahscesa.
232
LOCAL rUSKASES*
IIfjj>ertro^)hy» — The natural etructure of a muscle may become enlarged or hypertroplued, a result, as a general rule, of excessive work of the muscle. This is commonly illnstrated iu the enlarge- ment of the muscles of the arm of the hlaeksmith and of the leg of the opera -dancer. It is met with also in I lie heart, as we have ah*eady ^een.
Atrophy, — ^ Atrophy of the muscles is a condiHon common t<i all the extremely exhausting diseases, and is the chief cause of the weakness which characterizes them. In puluionary consump- tion and other diseases of the wasting class, the nniscles Are re- duced until they almost become like cords* In many instances special nniscles, or sets of muscles, are atrophied from want of use, and iu paralysis of the limhs this form of muscular failure is of common occorrence. Atrophy of the heart is sometimes ascj'ibed as a cause of death.
Progresstm imiscular atrojthy. — ^A condition in which the muscular structure begins to w^aste in some part of the hody, the mui^cles of the upper liinb, and in which the was-ting continues^ nntil the whole of the voluntarv system is affected in a similar manner. The disease is sometimes called wasting palsy. Strictlv speak iuiT, it is a nervous disease, and is truly a paralysis depend- ent upun intlannnatory or deg'caerative change in the gray matter of the spinal cord.
Paralysis. — The muscles are subjected to tlie varied forms of paralysis which liave been before us already, under the heads of infantile paralysis, scrivener's palsy, diphtheritic pai-alysis, general paralvsis, paralysis agttans, atid so on. It is not, however, con* sidercd that tliese are diseases of tiie muscular structures; though, froTn their continuance, the muscular system may undergo wast- ing and other organic changes, owing to impaired nutrition. The paralyses are of nervous origin, and are considered as belonging to diseases of the nervous system.
CanviilsiOTiy Spasnu and 7\/^3«7^«.— The muscles may be con- vulsed, or may be tliruwn into spasm or tetamis, in which condi- tions they are the seats of serious functional dism^der, and may, indeed, be physically injured. The conditions, however, are not dependent on the muscles, but are due to primary nervous dc- raugeuient to w!uch the muscular fibre resi>ond3. These affec- tions are therefore also classed under diseases of the nervous sys- teuL
DISEASES OF THE MFhCULAR SYSTEM.
233
Erhnn^wn, — A mii.sele, or set of muscles, may be exhausted, fruni :i blow, or from excessive work or strain, and for a time ay be unable to act freely in response to nervous influence. This tealled exhaiistiou of the umscle.
Foret(/n g Wiethe. — The inui^clea may be the Beat of foi*eign growths. These inchide, simple non-nialignant and erectile non- niah'gnant tumors, colloid tumors, cysts, cystic growths, and cancer. It cannot be said that any of these are common affections of tho muscidar substance.
ParaaUia disease — Triehinoals. — The muscular organs may l>e the seats of parasitic developments, and they are si^eciaHy the M»at8 of the parasite called trichina spiralis, tlie larval state of a nematode worm. The parasite infests the muscidar stmctiire sometimes in large numbers, and remains embedded in the sub- stance in jioints or spots, looking like small cells or beads. When tbe parasites first enter tlie niuscjular substance they create pain, which is often mistaken for miiscidar rlicuinatism. As the larvjB become encysted the acute pain is reduced, and then there is, or may be, a prolonged perio^l of impairment of function, the cause of whicli may not be discovered nnti! after death. The trichino- sig parasite in man is derived from Ids taking as food the mnscular flesh of lower animals affected with the parasitic growth. Ue- eeived into the stomach, the larvie very quickly develop into matu- rity, causing much pain and disturbance in the alimentary system. The female trichinte giving forth their embryos in abundance, the (ntibryos migrate along the connective tissue into the structure of the muscular organs, where they become encysted, as described above,
^Degeneridio7l8 of Muscular Orffans* The muscles, including the heart, are seats of degenerative panges, two of which are specially important, Fatttj tiiyeiheratlotu — The muscular tissue in this form of de- generation is transformed, more or less, into a fatty condition, the truly muscular elements being rephiced by fatty or oily particJea. In this state the muscle fails to respond to the nervouB Btimulus, End though the structure may remain of the same size, or may even increase in bulk, it is incapacitated for active work. The heart is the mustde most frequently affected by this degeneration. Oiuwoiui dt(ji;ndratiofu — A condition in which the muscular
I
S34
7AL DISEASES.
fitructure is converted into calcareous or bony matter. The heait may become — as I have once myself seen it — transformed, in part, into firm bone. Osseous change is attended with little acute pain, ' but with permanent destruction of function of muscle in the part involved in tlie change.
I}iseiuies yroiib if^jx>sits, — The muscles may become the seats of special deposits, tubercular and syphilitic, and it is probable that the involuntary muftciilar fibres are often the seats of syphi* litic deposit, by which their action is greatly impaired, and from which impairment two diseases of the blood-vessels, namely, dila- tation and aneurism, have frequent origin.
The nni^'les are subject to rupture or tear. The rupture may be in the structure itself. It is moi-e commonly in the muscular sheaths. It may be caused by excessive strain or by a blow* on a healthy mnscle. It may occur under ordinary movement in a muscle affected or weakened by disease.
Diseases of Tendons.
The tendinous terminatioiiB of muscles called commonly the sinews are themselves devoid of contraction. They are, as it were, tlie membranous sheaths of the true muscular tissue con- densed into one homogeneous structure at the ends of the muscular bodies. They are comi>osed of fibrous tissue, and are enclosed in an investing web or Bheath. They are the passive parts of muscle, and form the attacliment.s of muscles to bone, by means of which the muscles pull or exert their power to move the bones« j Tlie tendons are the seats uf several diseases.
InJlaiHffialh)ti'—The<:alah^cem,—-^\\o tendons are often tlie Beat of inflammation, as a result of wounds in which they are in- volved. A common form of inflammation of tendon is tliat known in the finger, c-alled thecal alxscess or wklilow^ in which matter forms within the sheath of the tendon, causing a most painful local inflammation accompanied witli irritation and fever. The tendoniri are sometimes involved in rheumatic inflammation.
Spraiiu — When a tendon, or a tendinous expansion, or fascia, is subject to severe stretch, or to tear, or to displacement, a sprain is produced. Sprain is a common injury, and is usually attended with external swelling, pain, and difticulty of movement in the part, lasting for several days. The tendinous expansions or fascial coverings of muscles are occasionally torn across, in places like
DISEASES OF THE MUSCULAR SYSTEM.
235
Secalf of tlio leg; severe injury to motion occurs fi*om such tearing^, together with great pui a, swelling, sometimes ecchymosis or effusion of blood, and usually some after fever. This painful accident is called rupture oftJie temUnoiis fmcia, _ Adhesion, — Tendons, as a result of inflammation, may be-
f come adherent one to the otiier, or to surrounding parts. The effect of tlie adhesion is to produce more or less derangement of
^ motion from the muscles connected with tlie tendon or tendons implicated. Cojitraction of Tendotis. I Tendons are liable to contraction, by which the parts they Ire connected with may be shortened or otherwise distorted. The contractiona are sometimes congenital and sometimes the resnlt of disease or accident after birth. The most common con- trac
I
tractions are tliose
affect iug
the foot and cau^jiui; the various
I
deformities called generally club-foot.
Talipes or Cluh-foot,
There are several kinds of club-foot, talipes, some of whicli have received different names according to the character of the deformity. The principal of tliese are as follow.
TaiijHs varm. — This is the most common form of club-foot, and maybe a congenital affection* The heel is drawn up; the inner side of the foot is drawn up and tho toes are turned in- wards. The sufferer learns to walk, in tliis case, on the outside of the foot.
Talipes valgus,— A condition tlie opposite to the above, in whicli the heel is raised, the outer side of the foot is turned up, and the sufferer walks on tlie inner side of the foot and inner ankle,
Talip'S eqmnu4i, — A eou traction in wiiich tho heel is drawn straight up, so that the sufferer walks on the toes, ur on the toes and a small part of the surface of the foot*
Talijx'^ calcaneus, — A conti'action in which tho toes are drawn up, and tlie sufferer walks on the Iieel bone, — the calcaueum, or 06 calcis.
Tidfj>€^ calcaneo-^vams. — A contraction in w^hieh the toes and inner side of the foot are dra^vn up, so that the patient walks on tlie heel and outer side of the foot.
Tttifpes e^piino-valgus. — A contraction in which the heel and <mter aide of the foot are drawn up, so that the patient walks on
236
LOCAL DISEASES.
the toes and inner Bide of the foot. Thk is called also ^^Jfat-
Cluh-hai\d and contracted fascia of t/ie Hand.
The hand, from contraction of tendons, is subject to defbnni- ties which are not sufficiently dctinite in character to admit of classification like those of tbe foot. The deformity called con- tracted fascia is one in which the palm of the hand is con- tracted, or iti wliich the fingers are contracted on the jmlrn. Tho' contraction may be in the fascia or in the flexor tendons, or in both fascia and tendons. It is mostusnally the rcsnlt of accident, as from strain, or from lifting vciy hot substances such as heated | metal. In some j>er&ons of gonty or gouty I'lieumatic constitution tbe contraftiun may come on in middle life without the action of any apparent exciting cause.
Wry 7ie<*k. — The College authorities classify wry neck as diBcase of the teiulons. It is a cunditiou which is owing to ftl contraction of tbe oblique muscle of tlae neck, the sftrno eleid(A fnaatoid&us^ the muscle which stretclies across on each side from the mastoid ]K>rtion of tlic teinjMinil bone, near to tbe ear, to the jimction of the sternum, or breiibtbuue, witli the mncr end of the clavicle, or collar-bone. The contraction of this muscle^ w^jicli the artist knows so well, causes tJie head to be drawn on to one sboidder, wbile the face looks towards the other shoukler. The sternal end of this muscle is tendinous, and the contraction may bo in the tendoii ; but it may also arise from spasm of the muscle itself. Wry neck is most common in the young %vho are of mixed stnimous atid rheumatic constitution. It usually follows attacks of feverish afFeetions in these. The spasmodic form may be purely liysterical in character, and in one of the worst examples of wry neck I ever knew, which was of this origin, recovery oc- curred instantly from a start or fright, although the contraction had existed iive years*
All tliese distortions from contraction of tendons are now, owing to the excellent labors of Dr. Little, Mr. "William Adams and other surgeons, greatly amenable to surgical skill.
JHaeases of the Ajypendu^eB of the Mimmlar System,
Connected with the muscular sj^stem are small bodies called bursae, Tbese are small pouches or sacs of synovial membrane,
DISEASES OF THE MUSCULAR SYSTEM.
237
I filled with synovial fluid, and placed near to joLiits to prevent tLe
rictiou of parts gliding t!ie one over tlie other. Thus tliere is a
bursa over the wrist-joint, another over the knee-pan, and so on
for other simihir parts. The bnrsffi are subject to diseases^ which
are classified in the following order.
Enlarged bursa frf {Ji£ pateUa* — A condition in which the bursa of the patella, or knee-pan, is enlarged and distended with synovial fluid. The disease is brought on by frequent kneeling on a hard substance, and is so commonly presented by the house- maid, who kneels to scrub floors, that it has obtained tlie Jiarne of r houBcmn urn kn cc .
WriM bursa is another name given to an enlarged bursa at the back of the wrist. It is a common disease among pianoforte players in their early life.
Murmi Ctimor, — An enlargement of a bursa, ending in solid i- ELtion, &o as to form a hard and often painful tumor.
Bursal ahsf3es8,—A condition in wdiich matter, or pus, forms within a bursa. It is the result of inflammation, and is a con- tinuation of an acutje enlargement of the bursal sac. I have known it induced by a blow ignorantly inflicted (»n an enlarged bursa, with the object of dispersing it.
Bunum. — The affection called bunion is an enlargement ur thickening of the bursa over the large or metatarsal ymd of the great toe. It is usually produced by the friction of a badly fitting boot or shoe.
Gamfllon, — A painful Bwelling, resendding a bursa, formed by an enlarged cyst, or a newly developed cyst of synovial mem- brane in the sheath of a tendon, or of a tendinous expanse. The swelling, if it be near to a nerve or a sensitive stinictnre, is very painful. It may attain a large size* At first it is soft, and the presence of fluid untbin it can be detected ; hut after a time it becomes firm and solid. It is commonly produced by undue pressure and friction, or by a violent strain. When it is present
tlie hand, involving tin; sheaths of tbe flexor tendons, anil
cauj^ing one large double swelling in the palm of the hand, and
nother on the wrist above the ligament which runs transversely
cross the wrist, the affection is called in the uomenclaturej " dif-
fused jpalnutr yanglion.^^
CHAPTER IX. mEASM^OF TTfE OSSEOLTS SYSTEM OR SKELETON,
mcLUBma the teeth.
Ti!K bonea on llveir exterior are covered with a strong genBitive niembratiej the periostenni, from which, as tlie researclies of M. Oilier go aUy proved, the bony etructiire is secreted, so thatj perioBtenni being in contact with many xxUil ti&sues, new bone is producible. In the joints the bones are covered with synovial nienibrane, the glistening structure which is seen when a joint 15 laid open and which secretes tlie glairy synovial flnid, by . which the surfaces of the joints are lubricated and saved from friction. Within sonio of the bones, within the shafts of the long bones particularly, there is also a substance made up ofi fatty tissue, called the inednlla or inarix>w, which supports the I jlood- vessels by which the bone is fed, and also> according to a i*ecent view, plays an important part in the formation of the red corpuscles of the blood.
In considering the diseases which have their seat in the skele- ton we have, therefore, to include diseases of tlie bone proper, of the periosteum, of the synovial membrane, and of the tnediilla or marrow.
It is well to recall, in relation to the diseases of bone, that the bony structure is made up of two parts, of an organic, and of aa earthy or inorganic part. The organic matter is the gelatine which can be separated by the process of boiling bones. The earthy is that which is left as powder or ash when a bone is burned. The animal, or organic matter, makes np about tliirty- three per cent, of bone, the earthy sixty-seven per cent* Of the earthy matter fifty-five i>er cent, is composed of calcium phosphate, the remaining twelve per cent, is made np of magnesian phos- phate and calcium carbonate, with a little calcium fluoride. The earthy substance gives strength and solidity to the bone ; the animal matter holds the earthy together, acts as a cement, and
DISEASES OF THE OS8EOUS SYSTEM.
239
gires to bones a certain measTire of resiliency. This is important to keep in mind in relation to disease. If the earthy matter be deficient^ the bone will bend ; if the animal matter be in excess, the bone will too easily fracture ov break. The bonea are con- nected togetlier by etrong fibrous bands or ligament.s, which inter- lace and form elaborate and important structnres, while in many of the joints there are interposing structures of cartilage.
To the skeleton we have to add, as part of it, the teetli, which, placed in what is called the alveolar or socket portion of tlie jaw- bones, are thirty-two In the second or complete set; viz., four incisor; two canine, four bicnspid» and six molar in each jaw; and twenty in the first set or teetli of infancy, milk teeth ; viz.^ four incisors, two canines, and fonr molars in each jaw. These fitructnres have to bo taken into the study of tlie diseases of the oseeous system.
The diseases of the bones and teeth fill, as may be expected, a long list in the local history of disease ; and yet, after all, they are not extremely complicated. In the nomenclature forty die* eases are assigned to the skeleton ; thirty are connected wnth the teeth, and seventeen are connected with tlie process of development of the teeth.
DiBBABES OF BoN^ AND PeRTOSTEUM.
Ostitis. — ^Inflammation of bone ; a disease very rare in its nn- complicated form. When it occurs it is, usually, in the young who are of feeble and strumous constitution. Even in them it is, I believe, always induced by some external influence, such as a cold, an injury, or one of the epidemic diseases. It occurs, as a iiile, in the large long bones, and is attended with much pain, fever, local swelling, and it may be redness of tlio skin over the lected bone. jWiostltis, — Inflammation of the periosteum, or periostitis. This, like inflammation of the bone structure, is rarely seen except in feeble persons of scrofulous taint. It is attended with signs ^milar to those which are noticed in ostitis, but the pain is more Qte. When the inflammation is very diffuse, and matter forms eneath the membrane, <ioute perioateal ahaceas or diffuse perioa- tUis are tlie terms used to express the diseased condition. When again this ends in death of the bone structure, without death of
240
LOCAL DrSKASES.
tbo periostenm, acute Tiecro^iSj—desith of bonej — is said to have taken place.
Nodes. — Persons who have contracted the specific disease syphilid, are subject to a fiubacntc inflammation of the perios- teoma usually in the long bouas, and most fretpientlv in the leg- bone, the tibia, ivom which there is produced a long-shai^ed and painful swelling, called a node. As a general rule, the swelling passes away with tlie i^solution of the constitutional affection.
Carter* — A condition practically of ulceration of bone, in which, after inflammation, the bony substance becomes porous, and, in the acute stage, filled with a reddisli glairy exudation. The bone is dead, and, left to become dry, assumea, literally, a worm-eaten appearance. It is a cause of great irritation and often of ulceration, attended with offensive dificliarge. Caries may be the result of injury of bone, of iutlammation, or of death of the periosteum.
JVeenms, — Necrosis also means a deatli of bone and arises, like caries, from injury or from inflammation. But in necrosis the periosteum, w^hich may remain intact, throws out a plastic fluid, and from that new bone is gradually formed, which jtuniug with sound bone ab(n-e and below causes separation of the dead bone in what is called a sequestrum or residue. The new bone thus formed nuiy fulfil all the purposes of natural bone. The late Professor Laurie of Glasgow was wont, very happily, to de- fine caries as death of bejne, and necrosis as '^ death of bone with r^eneratioTi."
MoUitle^ Ossium. — A condition of di&easo in which the bone softens, and at tiie same time becomes brittle. The bone loses its earthy constituents, and the animal structure of wliich it is com- posed is Softened, it may be almost to a puUaceons state, &o that the bones cattily bend and break. Or the osseous matter may be left porous, so that the bone is extremely brittle, and breaks from very slii^dit causes. The affection is most common in women, and the pelvic bones are the njost frequent scat of it It is not neces- sarily fatal, and it maj' last for many years. I have known it to occur in tlie male subject, though no doubt that is not a common event. It is connected always with some constitutional condition, usually syphilitic or tuberculous in character.
An allied disease to mollities ossium is often met witli in the insanej and wlien it is present very slight injuries cause fractures
DISEASES OF THE OSSEOUS STSTEST.
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of the bones or the ribs. I knew an instance of this kind hi which ten ribs were fonnd to liave been fractin*ed after death. In these ca^s the earthj matter is deficient, I found in a lioue taken, after death, from a man wlio had suffered fnnn tlie affec- tion, that the amount of earthy matter was, actually j under nine per cent. Yet tliat bone, which had been f factured at least twice, had undergone two attempts at repair from effused periosteal lymph and new ossification.
liicket^, — A disease classed by the College as one belonging to the general diseases of constitutional type. liickets is connected with deficiency of eartiiy substance in the bones, and the btines, therefore, unable to support the weight of the body, bend under it and give rise to curvature of limbs and spine, wdiich may, and often do, become permanent deformities. Ttickets is due to con- stitutional taint ; to tlto bringing up of children in bad air ; atiih above all, to the feeding of children on foods deficient in the rthy salts that arc necessary for the natural conatructiun of bone.
SjHmUtneousfra^iurt', — Spontaneous fracture of l>one is fract- ure occurring from some simple accident or natural act of the body* In one of inj medical friends it occurred in a rili^ from coughing. The bune in these cases is usually discasiu! arnl brittle from deficiency of animal structure*
threign gronik^n ofhont\ — The bony e-trncture may bo the seat of several forms of the non-malignant growtlis, with the nature of which wo are now familiar, Tlie growths of simple character as specially connecte<l with bune am Jihrous andjihro- tamorH ; vit/elmd, a reddish tuntor comn^encing usually in the ends of bones ; eatiildJt^jimmii^ called also enchondronui ,• and ^Htsemds^ called exontosis. Of the last named, exostosis, there are three varieties ; tire Ivon/ atostmlsi^ in winch the erdai'gement is hard and smooth like ivory ; the eanceU-ated^ in which the en- largement is porous or cancellated ; and the difnsedy in which the enlargement Is spread over a considerable surface of bone.
The bony structure may also^ as we have seen, be the seat of cancer^ OBteokL This cancer commencing in bone may be of ex- tremely rapid growth.
The bony structure maj-, again, be the seat of cystic develop- ments and of parasitic growths.
llypt^Hnyphii and atrophy,— Th^ whole or part of a bone may bocome generally enlarged, or hypertrophied, from uniform in-
343
LOCAL DISEASES.
crease of its stmchire ; Imt it is more frequently tlie seat of atro- phy or wasting, in which it is generally redneed in size and ren- dered weak and fragile, the extenial tinner surface Leeoiuing thinned and deficient in p^wer o£ resistance. To this etate the termfrat/Ultf/ ov/rafjilUas osmtim has been applied,
Comiitutional changes in hone. — ^Tlie gi^at constitutional taints, syphilis and scrofula, are common causes of disease in bone, and the terms sj^bilitic and scrofulous disease of the osse- ous system are in common nse. As a rule these terms refer to one or other of the forms of disease already named, and as devel- oped in persons who are under the taint of the constitutional aflfectionSj syphilis or scrofula.
Diseases of the Joints.
5ynot?t^M.— Inflammation of the synovial or lining membrane of the Joints is the first disease named on the list of affections of the joints. This inflammation, attended usually with severe pain, and when the joint is a large one, like the knee-joint, attended also with mucli constitutional derangement and fever, is divided into two kinds, the acute and the chronic. The acute form is often the result of injury, which may be very slight in cliaracter; it runs a course of from ten to twelve days, causing much swell- ing, and severe suffering under the slightest movement, in the joint. The chronic form is, as a rule, a contiuualiou of the acute, but it is sometimes assumed w^ithout precedence of acute symp- toms. Clironic iuflanmiation of the synovial membrane may lead to softening and to what is techuically designated *" pulpy degen- emtion" of the synovial membrane.
The inflamtnation of the synovial structure of joints may as* 8ume the rheuuiatic, the scrofulous, and the sypluiitic charactering persons who are constitutionally under tlie influence of tliese taints. Kheumatic and chronic rheumatic inflammation of the synovial membrane is the most common of all the varieties of synovitis.
Vlcemtion, of cartilage, — The cartilages of the joints may, from long-continued inflammation, and some think from irritation without active inflamtjiation, become t!ie seat of ulceration by which the joint is disabled and rendered excessively painful. This ulceration, when it is not the result of itijnry, is commonly connected with rheumatic or scrofulous taint.
DISE^VSES OF THE OSSEOUS SYSTEM.
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Ah8€^M. — ^ Abscess witliin a joint, thoiifrli it rnay occur from injury or from extension of inflaniniation frouj neighboring parts, is exceedingly raj'e in a healthy const itnti*»n* In Bcrofulous per- sons it id more connnon, and in serofnlons children abscess or for- mation of matter within a synovial pouch is by no lueatis uncom- mon. The disease, in them, is called scrofnlons disease of the joint, and is typified in an affection of the hip-juint known as
Ankt/lo8M. — ^The stiffness of joints which follows upon inflsm- niation, ulceration, abscess, or otlier injury, and which leaves the joint firm or inniioviible^ so that it cannot he moved by the per- son to wliom it belongs, nor even by another person without its being broken, is called ankylosis. Ankylosis may give rise to various kinds of deformity according to tlie position in wdiieli the fixture of the joint, from adhesion of its surfaces, has taken place.
Dropsy of the joints. — An accumulation of synovial or watery fluid within a joint is calle<l a dropsy of the joint. It is usually the result of injury, and is attended wit!i slow and large swelling of the joint, and for a time with acute pain. It subsides, usually, from natural absorption of the exudc^d fluid, but in less favorable instances it demands assistance fi*ora surgical art.
DUeiUtMs of tJw eartila^es, — In additicni to the ulceration of cartilage, to which reference has already been made, the carti- lage-s of joints are subject to other ftfrnis of disease ; viz» (a) to dfigt'nerafion^ involving the articular surfaces of tlie bones ; {h) to Beparation from tlieir natural position within joints, so that they become movable, and by movement out of their place give rise to intense suffering, loom eartUcuje / and, {c) to displaceiuent at their artienlating surfaces, dmpUi4^em£nt of articular' eaj'til^^e, by which they cause deformity of the joint, and thereby of the lind> or part with wdiicli they are connected.
liel^ixation of Ufjariients. — The ligaments or etrong but deli- cate fibrous bands which hold tlic joints in position are liable to relaxation under sprain or violence from without, or from swell- ing or tension derived from within the joint, The relaxed liga- ment becomes imable to hold the joint in its proper position, and is then readily dislocated from slight causes. This is w^ell illus- trated in those instances where the shoulder-joint is very easily displaced in consequence of the ligaments having become un- tiMurally relaxed, weak and incapable.
LOCAL DISEASES.
Defm^nltks of the hme-jomt, — The knee is Bnbjoct to two market! deformities^ which are called respectively how-htj or oid- kfwe^ and, knork-knee. In the first of these affections the knees are widely separated from each other, and cannot be brought to- gether, so that the legs are bowed. The deforniitv is CLnunion amongst those who ai-o accustojiied to carry heavy weights from the shoulders, like water and uiilk-bearers who carry the yoke, In these instances it is scunetiincH the case that the thigh-bones and leg-bones are somewhat bent ; but the chief deforniity is in the knee-joint, the lieads of the femur and tibia being depressed on the inner side, so as to throw the limb out of the straight line. lnJinock*knee, on the other hand, the knees come close together on the inner side, so tliat the fetnur on each side bends inwards, and the tibula and filnda leg-bones bend outwards fj-om the knee, the feet standing far apart. Knock-knee is more common in women than in men. The deformity may, 1 think, become liereditary.
Tbe joints are sometimes the seats of tuirwrg w^hich may be either non-malignant or cancerous. The joints are not infre- quently the seats of n^iural^iac pain.
Diseases qf the Spine,
The bony column called the spine is subject to a series of dis- eases whicli, owing to their importance, have Ijcen particularly enumerated. The ligaments and cartilages of tlie spine are sub- ject to ul4^eration ; the bones are subject to fiecrosis^ carles^ and ankyimis. The bones may also be involved in surrounding nh- scess in tlio lumbar or loin region. They may be subject to rlieu* matic affection, to cancer, and to tumors of a simple character.
We have already seen ia the section of the local diseases of the nervous system that the spine is subject to a particular mal- formation called Spina hijida, — IlydnynichitiS,
Spinal Ciiri^atures.
The spine is subject to several varieties of distortions called commonly curvatures* The following four are named in the official catalogue.
Anrjuhtr thformity. Kifphoms,—K deformity in which there is bending of the spine as a result of caries, or of absorptioTi of t!ie bodies of tlie vertebra, — those thick, solid masses of tlie ver-
DISEASES OF THE OSSEOUS SYSTEM,
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al sh'uctui*e wliidi lie upon eacli otlier antl form tliu solid part of the spiaat eoliuim. Tlii^ dufonnity occur.s u^uully m scrofu- loos children or adults, and is one of the worst forms of spinal disease. It is always painful, and from tho pressure which may ensue, it is eonietinies a cause of paUy of parts fi^d with nerves derived from the portion of the spiue involved in the disease.
ZMiterul ctirvatun\ ASkofu/^tis. — The spine is snhjeet to hend- ing or curvature on one or other sidw of tho body, a condition which may be inherited or acquired. It is ofteci acquired in the young by making them stancl for long j>eriods in one position while they are growing; or by the habit of standing on one foot or of bending over to one side. The curvature shows itself first in the process of becoining liigh-shouldcrL'd on one side, and, finalh*, in a complete distortion, if it go on, of curve or bending over, the CAdnnin itself being visibly bowed or bent from the pel- vis^ on which it rests, over to the side to which it has been di- rected* The disease, less severe and less dangerous than angular curvature, is a defect causing weakness of the spine, and occasion- ally much weakness of tiie limbs and body.
Anterior curvature, IjtrdosM. — Under this liead is defined a curvature in which the spine is« bent fiirward or anteriorly, but not at an angle. Anterior curvatm^e is the frequent result of making the young lean forward for b^ng periods when tliey are sitting at work, as at writing. It is sometimes acquired by the habit of stooping, and, in the poor, I liave known it caused by tlie pressure of weiglits cajTied on the head. Mn Liebreich has shown tliat anterior spinal curvature is often concurrent with Bhort-sightedness, the two diseased conditions being produced by the same cause, vix , the bending forward of the body, and the long continuance of that unnatural }w>Bition.
liu^kety curvature, — The deformity of the spine known as rickety curvature is not, necessiirily, of one curve, but sometimes of two or more cnrves. It commonly accompanies rickets of other parts of the body. It affects feeble rachitic children, who have been improperly nourished. It forms, almost invariably, a part of the disease rachitis.
The spinal column is subject to aeural^u^ rheumutle affection tfiis membranes^ and various kinds of mechanical injuries.
246
5AL BISEASES.
DiBEASKS OF TllE JaWS,
The jaws, including in the upper jaw the cavitj called the antrum, &ve subject to fibrous, myeloid, osgeous, cartilaginous, and vascular tumors. They are also subject to hypertrophy, to neero- fliBj to carieg, to cysts, and to cancer. In rare instances they are subject to adhesion by cicatrix.
AhH(*eHH in the Antnum,^-T\\Q antrum, or cavity in the body of each upper jaw-bone, is subject to inllammation, followed by tlie fonnatiou of matter, — abscess of the antrum. This absce may give rise to much enlargement of the bone and of the clieek, and may be incapable of cure until brought under siugieal skill.
Polypus ami Tumors in the Antrmn, — Tlie antrum may be the seat of polypoid growth, and such growth may extend into the cavity of the nose^ giving rise to swelling and great deform- ity of the face, which nothing but surgical operation can j-eaeh as a means of cure. The antrum may be the seat of tmnor, ma- lignant or non-malignant, under the growth of which the cavth* is distended and the bony walls of it thinned and destroyed. It is occasionally the seat of foreign bodies.
Diseases of tue TeivTH.
The diseases affecting the teeth are divided into^(l) Diseases which affect the true dental tissues ; the enamel or crown ; the dentine or internal bone j and the crusta petrosa or ccmentum, the outer bony Btructure of the tooth that lies within the jaw, the fang. (2) Diseases which affect tlie dental pulp, a sensitive structure within the tooth made up of arteries, veins, nerves, and connective substance. (3) Diseases of the periosteum or fibrous structure surrounding the fang, and connecting it with its socket or alveolus. (4) Diseases of the alveolus or socket in which the tooth is inserted. (5) Specific diseases affecting the periosteum of the teeth, the alveolus, or the gum. (6) Irregtdar develop- ment of the teeth ; irregular dentition.
Diseases of' the Structures of the Teeth,
Caries, — ^Caries of the teeth is a slow process of destruction or ulceration witlmut auy attempt at repair. It commences usu- ally in the enamel or cruwn of the toothy but it may commence
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DISEASES OF THE OSSEOUS SYSTEM,
247
'rom inflammation affecting the dentine or supporting bony tubes of the enamel, and may extend from within tlie tuoth outwards. In my Medical History of Diseases of i/is leethj pubhshed in 1860, I deiined caries of tlie teeth as a 6h>w disintegration of the hard structures, mainly of the enamel and dentine, by which a cavity in the tooth t& produced from a process of destruction pro- gressing in the dentine without replacement or development of new tissue. The detinition thus given is suiReiently correct. The disease commeneeSj as a rule, in the enauiel, either from an acci- dent or from defective condition of that structure. From theace the niiscJiief soon passes to the dentitie^ the tubes of which sup- port the enamel, and as that structure dies, from uleeratioHj the enamel gives way. The cavity, called in common language the decayed cavity of the tooth, is thus produced.
Necrosis, — Necrosis means partial or complete death of the fitructnre of the tootli, the death commencing either fiom failure of nutrition from the vascular nervous structure^'^ pulp "~in the cavity of the tooth, ur from the periosteum* The necrosetl tooth becomes dark and dead in the parts affected.
EtodoHis. — Exostosis of a toolii is an enlari^ement of the true bony part of tl\e organ, the cementum of the fang* The enlarge- ment is sometimes general, at other times it takes the form of a tumor or swelling at the extreme point of the faug, where it may make almost a socket joint within the alveolusj prLKlucing a tooth it is very difficult to extract. In exostosis the surrounding mem- brane or |)eriosteum is thickened, and tlie disease is always at- tended with severe pain, the wurst form of toothache.
Ahsorjffion, — Alisorption of the teeth is a gradual removal of structure, owing to impoverishment of nutrition, usually from disease of tlie external nutritive membrane, the periosteum* The absorption is rarely coufitied to the tuutli alone, it is cimimonly oombiued with absorption of the alveolus or socket. As a result the tooth recedes from tlie jaw, aiulj becoming loose, is detached from its position. Absorption is most comujon in persons of ad- vanced life. It occurs, however, occasionally, in the young, when the body is improperly nonrislied, or is suffering under some ex- treme constitutional taint. Partial absorption of the enamel of tlie teeth, causing indentations to the surface, may follow the oe- cnrrencc of some of the eniptiv^e cutaneous diseases of the young. Tlie jagged, sawdike appearance on the cutting edges of the
248
LOCAL DISEASES.
teetli, wliieh is seen in some pers^ons who are conetitutionalljl weak, is, gtrietly speaking, an iiTeguiar furni of absorptioQ of the hard or enamelled Btructui*e.
J}tsea»es of the Denial Ptdp,
The pulp of the tooth is said to he subject to three forms of disease — irrUaimiy injltimmMimi^ and ul€era(Jwi* Theee may, in truth, be coni5id<?red as the course of une diseased I'onditicm proceed- higfroni UTitatRmto iutlainniatkui on to debtrui^tion or uk^enitioiK At the same tiroe, irritation raaj^ stand alone* and may not pro- ceed to inflammation. Irritation of tlie pnlp is rarely, if ever, a disease of itself ; it commonly is fonnceted witli some other form of disease, such as rheumatic affection or injury, or commencing caries, or exostosis. It is always attended, in the acute stages, witli severe pain, and after complete defetnu-tiou, from ulceration, it is followed by death of the internal bony tooth tissue.
Gamjnne of the tooth is a diseaeo specified in tlie nomencla- ture. It is of tlie rarest occurrence, and when present h a rapid decomposition of the tooth, attended with moist softening ami offensive odor. I have seen it once, maike<ily, in a person suffer- ing from scurvy, who was also constitutionally affected with the specific disease, syphilis,
Diseasi'8 of the Ikutul Periosteum,
The dental periosteum or peri-dental niendjrane which envel- ops the bony pai't or fang of the tooth and comiects it with the alveolus^ is subject to a change of texture called tjrannhitkm ; to a change into hardness called calcljicatum ; and to infanmiar turn*
Guiti'lmiK — Tlie disease commonly known as gum -boil is an acute inllammation involving tlie periosteum. The affection, ex- tremely ])aiuful, is i^esolvod at last, in most cases, by the formation and escape of matter, or pus, between the fang of the tooth and tbe alveolus.
C/ironio niicheninf^, — The periosteum after inflammation, acute or chronic, is liahle to undergo chrouic thickening, accom- panied with swelling and hardness of the gnm, and often witli extreniu pain iu the tooth itself, which nothing but extj-actiou permanently removes,
Mfieumatw Injiammation, — In persons of rlieumatic consti-
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DISEASES OF THE OSSEOUS SYSTEM.
24D
tutioii tlie periosteiiiii of tlie tooth is snl>ject to rlieiuiiatic itiflaiu- luation, followeJ by tliiekeniiig of the membrane and eontiimcd irritation. Most of the examples of thickening of the peri-dentul ijiembrane are, according tu luy experience, the rcisult of rheu- matic ujflammatioii.
J^iseases of the Alveolus,
The bony stnieture which enchjses a tooth» and which ia called the alveohis or 6i>cket process, is subject to the sariio classes of (UBeases as the jaw-bones themselvefij of which, in fact, it fonns a part. It ia liable to suffer from ififfur/wutilon, carie^% n^cnma^ exosixtifi^i^ ahsitrjdion^ and ct/Hta. Tlie alveohia is sometimes fi'aet- ured ia tJie operation of extraction of a tooth.
Errors ix Dentition,
In the process of cutting the teeth, and in tlie development of the teeth, — whether the tenjporary or the permanent sets, — there are certain errors or irregidarities whicli are noticed by our i=itan(l- hvA authoiity as forms of disease. These irreguhLriti&sare : (a) An irregularity in the time of eruption uf ilie temponiry or perma- nent teeth, the irregularity consisting, usually, in delay iu the time of erujition : (Aj irrogolarity iu the position of the temporary or permanent teeth, us when one tooth overlaps or displaces an- other : (c) irregularity in the number of the terjii>orary wv perma- nent teeth : {d) irregularity in the form of the teeth of either set; {e) development of unnatural structures iu the enamel, the dentine, or the cementum.
In addition to these iiTegolarities there are also added changes in the jaws and teetli. (a) Unnatural development of the sockets of the teeth in relation to size or fornt : {h) defective growth of the lower jaw: {o mechanical injuries of the sockets and peri- oateutii, includitig fracture and hemorrhage: (</) mechanical in- juries to the teeth themselves, sudi as fracture, dit?locatiou, and, a not uncommon cause of caries, friction from pressure*
CHAPTER X.
DISEASES OF THE SKHT JJO) MEMBEANOUS SYSTEM,
TiiK iTiembranons pjstem includes, as we have already learned : (a) the caveriiig of the body called tlje skin ; {h) tlie lining of tlic external cavities of the bronchial surface, oi the mouth, of the whole length of the arnneiitary canal, and of the bLadder, called the 7fiu*rHis ptemhrane ; (c) tlie meinbraiies whieiL envelop the vital organs, as the brain, the heart, the lungs, tlie intestines, caller] fibrtm^i antl Mtrous rtiemhranL's ; {d) the strong njeinbranes which envelop the bones and line the joints, called jf/t7vV>^/tc// and synovial numhranes ^ {e) the connective or sponged ike web of membrane which connects all tlie organs of the hody together, called connedu^e or areolar inembranc^ or, more commonly, cellu- lar or connective tissue,
Wc have studied the diseases affecting the mucous mem- branes, the i^eroua membranes, t!ie periosteal and the synovial meudiranes, in the descriptions of the diseases of the different or* gans and parts with which thv>se meuibranes are connected- We have ordy, therefore, now to study the diseases of the skin and of the cellular or connective tissue.
D1SEABE8 OF THE Skin.
Tlie older medical authorities have been aeenstomed to divide diseases affecting the skin into nine ordur:^ according to the ex- ternal appearances presented to observation. By this method they descrihetl the following forms of cutaneous disease: —
{a) The Papula? or pimples.
(t) The Squauuie, or scaly diseases.
(r) The Exantheme, flowerdike or eruptive diseases.
((f) The Bulhe, blisters or blebs.
{e) The Pustulte, or pustular diseases, in which pus or matter is thro\^"n out in points.
DISEASES OF THE SKIN.
251
(/*) The Veslciilne, or vesicukr diseases, in which small vesi- cles or water bladders are furnied.
(jr) The Tiiherculae, or tubercular diseaseSj in wLlek hard swell iiig:^ or tubercles are funned.
(A) The Maciik^ or spots^ spotted diseases of the skin.
(i) The Li Iceruus diseases, in which there is break of continuity of the skin with loss of structure.
The authorities of tbe Rojal College avoid this elasgificationj and very properly throw ont of their list tho exantlieniatuns erup- tionS) like those of measles or scarlet fever, wliieh are merely signs of general diseases. I slialh as nsnal, follow tlie College order, without, iiowever, ignoring the classification given above, which, in many respects, is practical, useful, and distinctive.
Under tlie term erjtliema is described redness of the skin of an acnte form. It is couimonly detirjcd as *' a nearly continuous redness of a portion of the &kin, attended with sonje disorder of the constitution^ but not contagions. •• Sir Erasmn? Wilson gives another definition. Ue defines the especial uharaeteristic of ery- thematous affections as "redness without exfoliation or desquama- Ition (scaling), or other secondary change.^- There are six varieties of erythema recorded in the official list. 1. Er^th^nia liBt^e^ redness of a dark cliaracter, surround rng an old ulcer or large vein, or spreading over a limb affected with an- asarca or divjpsy. 2. Enjthemafaga.Y^ the i-edness that suddenly sttffn^s the face and neck of nervous hysterical subjects. 3. KrythevHi marfjinatum^ redness niarginated or edged. 4. Ery- tfu^na papukUum^ mdness very bright and in patches, with many AkI points or pimples, appearitig on the limlis or the breast. The ptpulte or pimples are usually small, and dispersed on the retl ' surface, though dtstinguishable to the touch as well as the sight ; hut sometimes they arc in clnstera, and sometimes they them- L^ selves extend or increase fronj their edges. Tlie affection is com- ^p monly acute and transient, lasting only a few days, but it may become chronic. 5. Enjthotm tuhffretdatimu a variety in which, ^H Instead of mere pimples, small raised swellings or tumors aio ^P present. Persons affected with tubercular disease of tlie lungs are supposed to be most liable to this erythema, wliich generally comes on with some fever and constitutional disturbance. 6. En/-
252
DISEASED.
thema nodosum^ erytliema in raised patches of round or oblong form, oecurriiig on the inner hide of the limbs, and looking Jike a spotted eruption. Tins variety of tlie disease is always at- tended, according to my experience of it, by dyspepsia and slight fever. It often recurs in the same person, and may last a week or ten days.
Intertrigo.
The term intertrigo is applied to define the red cutaneous eruption and soreness, resembling erythema, and by some classi- fied with itj %dueh is brought on by the rubbing of two surfaces of the skin together in tlieir fold*;, Tiie aifection is apt to occur in persons who are very corpnlent, and in fat infants, especially when tbey are not kept wliolesoniely flrv and clean. The redness may pas8 into actual al>rasion of the skin from the frictioMj fo! lowed by watery exudation.
lioseola*
Roseola is a word used to define a rose-colored rash on the skin which is evanescent in character and attended with slight fever. The rash may be in patches or general, and may resemble that of measles or scarlet fever, for both of which it is often mis- taken by the nnskilled. The disease is not accompanied by sore- ness of throat, is not contagious, and only lasts a few days. It connnonly comes on from indigestiun, and in children is often connected with derangetnent of the Btomach from errors in diet, such, for instance, as are incident to cbihlren'a parties. It may be acute or cln^cmic, and it is said to present four varieties : — 1. Hoseola wsttva, summer roseola ; 2. limeohi mdurnnalis^ au- tumnal roseola ; 3. lifmeokt sifmjdonyitkHi^ indicative or symp- tomatic ; 4. limcola amiulutUy annular like, or in form of a ring.
Ill tiearla, JVettk-ra^h .
Tlie disease urticaria, though commonly called a skin disease, is in truth an affection uf a general kind, attended with eruption on the skin as one particular syniptoni. Tlie disease may be acuta or chronic, arul it is prone to recur in certain i>ersMns nnder conditions fav**rable to its development. The eruption on the skin is erj^thematous, with raised surfaces in wheals, or in round wliite points resembling closely the sting of the nettle. The skin
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BISEASES OF THE SKIX.
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Is often raised around the wliite point The cniption h attended with much heat and irritation. When it attucfkbthe pahns of the hands or soles of the feet the burning sensation may he uf the acate&t kind, and, in the worst forms of the affection, excruciat- ing. There is always some constitutional disturbance and dys* pepsia, but there may be no fever, and the malady is certainly not contagious.
Urticaria is stated to appear mider six diiferent varieties : —
1. (/i*iican<i /ehrllwj in which ease it is accoinjianicd with fever.
2, Urticaria evanida^ a short or evanescent form, 3- Urticaria jktrstanSy a lingering or persistent variety. 4. Urticaria ronferta^ in which the points of eruption are clo^e or crowded together, conflnont* 5. Urticaria suhcutanea^ whci*© the skin is much in- flamed and raised from beneath. 6. Urticaria tuhf^rculata^ where the erythematous surface is affected with Buiall hard swellings or tubercles ; a rare form of the disease.
Uitiearia seems to be almost invariably connected with de- rangement of t!ie digestive system. It is often accompanied with much disturbance in the stomach and bowels, and is relieved most readily and dcterminately by purgation. It often follows the taking of certain articles of food or drink, and is therefore iairly considered as due to intestinal irritation in most instances, und t** peculiar action of certain foods on particular constitutions. In persons liable to it I have seen it follow the taking of lobster, nmllet, mussels, pork^ oranges, and whitebait. I have known one death occur during urticaria. It was caused by the mucous membrane of the larynx becoming implicated in the eruption, with suffocation as the result*
The term pellagra is employed to descril:)e a disease of southern Enn>pe which is also known under other names, as the leprosy of the Astnrias and as the elephantiasis of the Astiniari. It U met with in Italy, in Spain, and in sonic parts of France, It com- mences as a slow cutaneous inflammation, not unlike erysipelas, and ends in hardening of the skin and accumulation of scales. The attack commonly comes on in the spring, goes through a dis- tinct series of stages, and dies away in the following winter. It returns in a worse form the next spring, and still worse in the frpriug following. At last the skin is more or less covered with a
254 ^^^^^TotHT DISEASES,
scaly eruption, thick and liard^ resembling leprosy. As tlie local disease beeoriies iiHire pronounced, various nervous gyinptonis ap- pear, ending in paralysis and mental alienation^ The disease attacks all classes of society, bnt chiefly the poor. It is not con- tagious and, ill its early stages, is amenable to treatment
I
Acrothfiiia and Asturkm roae,
AcrodyTiia is a dif^ease marked, as its name implies, by pain in the limbs, with changes Imth in sensibility and motion. It is at- tended with irritation of the eonjonetival membrane of the eyes and of the surface of the skin, the skin becoming sometimes Bcaly and hard as in pellagra. During its course there is much disturbance of the nervous and digestive systems, and it is com- monly of long duration. In almost all severe instances of it it leaves in its train some form of nervous disease.
Adurhin rose is another cutaneous affection of southern Europe. It partakes of the character of an erythema, shading into pellagra, but is of a less formidable type»
The diseases included in the above descriptions would be ]>laced by the older antliorittes as belonging to the order " exan- iliemata/' _^J
The disease prurigo is a cutaneous eruption of papulee or pimples, attended with an intolerable itching, which in very bad cases is so severe and tormeiiting as to cause even disturbance of the mind. In tbe first stages the pimples or papuke, although raised from the surface and rough to the touch, are not changed in color from the natural skin ; but, owing to the irritation and the scratching which is used to relieve it, the skin soon becomes dotted or lined with dark marks from bleeding. The disease is not contagious. It is often of long duration, and is usually con- nected with nervous depression and failure of nervous power
Another pimply or papular eruption on the skin is called lichen. The pimples are raised, cone-like in shape, and red. They spread in large patches, and often extend over a conlider- able snrface of akin. The affected parts are subject to severe
DISEASES OF THE SKIN.
S55
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Itching or pniritns, and sc^le?* are usually thrown off from tliem. The College rei>orters give live varieties of lichen. 1. Lidten aimpl-exj the simple and most transieiii: form. 2. Jjlcfwn pil<zri8j when the pimples iiielnde the roots of the hairs. 3, LkJwn cir- cumscriptus^ where the eruption appears iti large and fairly dis- tinct patches. 4. Lieheti agriuSj a very trouhlesome lichen, ap- pearing usually on the arms, tlie papulae being close togetherj scaly and moist with, it may be, fissures and cracks in the bkin sniface. The disease not unf requently attacks grocers and bakerg, and from the irritation it produces is called ** baker's or grocer's itch." 5. IJr/wn tropiem^ an extensive eruption of liehenj ac* eompanied by much prickly irritation and heat, from which cir- ctimstaneeB it has obtained the nanio of ^'prickly heaV^
Strophylus, Tooth ra^ih. Ji(^d gum.
In infancy, especially during the period of teething, the body of the child is liable to bo affected with a red pimply or papular rash called strophylus. The affcetiau is usually mild in character, and passes away wlieu the irritation of cutting the tooth is over. There are said to be three varieties of strophylus : 1. Stropkylus intertmctus, 2. Strophtjlns canfeHu^s, 3, Strop/tyhis ca?id!di&(t, Tiiey are mere shades of the one eruption, and are all dependent (»n the same cause. The rash is usually slight and transient.
The diseases prurigo, lichen, strophylus are included iti the old dasflification under the order ** papulae.*'
PkyriasU,
The cutaneous affection called pityriasis is commonly defined as a ftcaly eruption, in which the scales are distributed over the tiirf;ice of the skin in irregular patches. TJie scales are often separated and reproduced, but they are dry scales. They do not form crusts* and they are not attended with cracks, sores, or ex- coriations. The College authorities dcffcribe one variety only of the disease, namely,— ^>%r/a«i> mpitts, pityriasis of the scalp, dandnff^ which is often met with in infants, and sometimes in tlie aged.
There are, however, two other important varieties uf the affectii^n which deserve to be noted. 1. Pltyriaf^lH rfdjra^ a form in which the scaly eruption is attended with great redness of the
256
LOCAL DISEASES.
skin, redness of the scales themselves, and separation of the sc in lines or layers which are very eiiaracteristie. This form of the disease is often combined with other severer cutaneous seal v erup- tions, and the subjects of it are usnally sufferers from nervous depression and debility. 2. Pityrumseharna,, a variety in vrhich the scales thrown uff ai*e pure white and Hat, like scales of bone or ivory.
The disease pityriasis may he induced by known agents act- ing on the body. When arsenic is taken internally for a long time in small and frequently repeated medicinal doses, pityriasis may be tlie Yem^\U--jrityn€isi8 arsenieaVis, I have myself re- cently seen a sharp attack of the disease on the hands and arms of persons engaged in work which exposes the skin of those parts to the action of the bichromate of potassa. Antotype w^orkers are exposed to tins last-named accident unless great care be taken in their dealing with the bichromate solntiun which is used in their art* Another form of pityriasis, jntfjrkisk I'ermcolor, is now referred to parasitic affections, as synonymous with Tiiua ViTnicolor,
Psoriasis, Lepra Vul/^arin.
At one time the cutaneous disease known as lepra vulgaris was assumed to be a distinct disease. It is nu%v included, l)y our authority, under the head of psoriasis.
Psoriasis is a scaly eruption wliich may appear in separate rings or patches, each distinct from the other, the extension of each being ftoiu the circunifercuce. Tliis is the ftirm of the disease wtueh was known as lepra vulgaris, to distinguish the con- dition from that which occurs when the patches unite by exten- sion, when the islands of scales — if I may be pernntte<l the simile ' — blend into continents, a condition to which the word psoriasis was always applied. In truth, the natm'e of the eniption is, in both cases^ practically the same. There is first some irritation, then ernj>tion (*f s<.^ale8 which grow dense and white at the centre, and afterw^ards expansion of t!ie eruption from its outer edge, which is red and occasionally slightly raised.
There are five varieties of Psoriasis: — 1. Psoriasis vulgarU^ or lepra vuhjarls^ the forms just described. 2. Psoriasis ^uttata^ in wiiicii the scaly eruption is spread out, like drops, on the skin. 3. Psoriasis diffusay iu w^liich a number of patches unite together
DISEASES OF THE SKIN.
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and lose by their union their original rounded form or outline. 4, Psoriasis gyraia^ a modification of the foregoing, in which the patches, owing to irregular healing, assume an in and ont, or gjy'nitcd appearance. 5. PmrlasU inveUtata^ a varietj^ of the extreniest kind, in which the scaly eruption invades the greater part of the body. The faeOj the pahns of the hands, and the soles of the feet often ei^eape, hut not always. The incrusation of scales in this variety of psoriasis is dense. After a time the ikin chaps and breaks, on which there is soi'eness, with exuda- tion of fluid from the broken surface, intense irritation and itching, and great mental and physical exhaustion, lasting over many weeks or even months, I have never known the disease end fatally, but some authors state that they have. When the scales assume a dark appearance on a leatien-colored surface of the skin, the term ^sariams nigricans is used to expre&* the modification.
IchtAj/osis.
The disease ichthyosis^ Jish-shin disease^ is an affection in whicli the etitancous structure is tliickened and firm, lehthfjosis vera ; or dense and horny, Ichthyosis cornea. It is so commonly an affection existing from birth that some have looked upon it as pnrely constitutional, as neither aliiod to psoriasis nor other scaly eruptions, but as a cutaneous malformation rather than a cutane- ous disease.
Ichthyosis, with the diseases pityriasis and psoriasis, belong to the old order of skin affections, " 64][uam8e.'*
Miliaria,
In the oourso of some acute diseases of the febrile type there *irill sometimes appear on the skin a vesicular rash or eruption, to which the name of miliarial rash or eruption is appHed. The irosicles are usually compared to millet seeds in respect to appear- ance^ and may be spread or interspersed over the whole surface of the body.
There are two varieties : — 1. Jlili^xria sitdamina, where the vesicle's are like drops of perspiration. 2. Miliaria rubra, where the vesicles are injected and inflamed,
17 ^
268
LOCAL DISEASES.
Herpes is a cutaneous disease in which there is a vesicular eruptiou, comparatively transient in character, with the vesicles ranged together in clusters. The skin in the part affected is in- jected and iufiafned, and at first the fluid filling the little vesi- cles is almost transparent* As the vesicle matures its contents thicken, and in the end the eruption passes away in scab-like ficales.
Tliere are four varieties of hei-pes named in the College list : — 1. Htrpes jfhhjctenode^ in which the eruption is variable in re* epect to its place on the surface of the body. 2. Ilerpm circi' natv4fy where the eruption assumes a ring-like shape, 3. Uer^^s iris^ iu which the eruption takes the form of concentric rings. 4. Ilerptu zmter^ commonly called shinaUs^ in which the eruption breaks out in the lower part of the chest, about tiie middle of the body, and, in clusters of a bead-like kind, extends more or less round tlie trunk as a circumscribed zone two or three inches wide. Shingles or herpes zoster is a painful affection, and is at- tended with fever for two or three days, and often with pain which is described as rheumatic in character. It is apt to recur in tlio pers4:m who is subject to it, and it most commonly reeurs in the months of spring. I have no doubt that it is hereditary. The vulgar notion that it proves fatal when the eruption com- pletely encircles the body is without foundation, the disease not being fatal in its course unless it be complicated by some other and more seriuus affection. It seems to have a short period, one to two days, of incubation, and it runs a course of from five to seven days. Neither it nor any other of the lierpetic affections are contagious.
Eczema is a most painful and obstinate vesicular affection of the skin. It is well-defined by AVilson as ^^an injlummation of the akin attended with a hrearh of it^ i^urfai'e,'^- There is redness, swelling, elevation uf tlie cuticle, and a vesicular eruption in a number of minute blisters. After the vesicles break there is a copione exudation of fluid, whicli itself acts like a blistering fluid, and keeps up the irritation. The exuded fluid forms into scabs and crusts, intenuLved it may be with matter or jms, and some- tinics with blood. The pain, biii'ningj and itching are intense,
DISEASES OF THE SKIN.
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^
and when tlie affected surface is cliapped and excoriatedj the een- feitiveness is intolerable*
There ai^ four recognized varieties of eezema:— 1. Eczema ftlmplexy in which the disease is pi'e^nt in its simplest and mild- est form. 2. Eczema ruhvuin^ m ^*hick there is redaess uf feur- face or erythema, erythematous eczema. 3. E'zenia ith-petiifi- iiod^Sj wliei^e tlic eezeinatonfi eruption is coupled with an eruption of snuill pustules called impetigo. 4. E^ema chron!cum^ an eczema in which the disease becomes chronic, with persistent in* tlammation, formation of crusts, and discharge.
Eczema is not contagious. It is hereditary, and is apt to re- cur in a person w!io lias once suffered from it. It nmy or may not be accompanied by systemic signs of disease, and it is usually conn©t*ted with nervous exliaustioii and feebleness. It is now largely under the control of medical art,
liupia.
Rupia is the name assigned to another vesicular cutaneous eruption* The vesicles are spread out in patches from wliich there exudes a fluid which forms a crust or scale, and !ias imder it an ulcerated surface. Tlie points of eruption are usually widely separated, and occur on various parts of the body.
There are three varieties of rupia; — 1. Hupla slmphx^ in wlildi the ernption is of the simplest arifi mildest form. 2. liupia jjramineiis^ in whicli the scale that is formed is raised, in a conical shape, layer upon layer. 3. Ilupia escharotica^ in which there is an extension of irritation, as from a caustic or blis- ter, with an offensive discharge. Rupia is usually due to consti- tutional specific disease, syphilis.
liupia, eczema, herpes, and miliaria belong to the old order *^ vcsiculse " of cutaneous diseases. Two other affections, which have ali*eady heen described in the chapter on diseases running a definite course, namely, varicella or chi(*kcn-jK>x, and vaccina or cow-pox, are often put under this same order.
Pemjphig^us or Pompholyx,
Pemphigus is an eruption of a blister or bleb, breaking out on the cutaneous surface without much, or it may be without any, cryibema or preceding inflammation.
260
Jat. diseases.
Tlie College list names three varieties of Pemphigus:^-!, Pemphitjus acutus^ where the outbreak is sudden and distinct, and in more than one purt at the Bame time. 2. I\'mj.fhigns BoliiaHm^ wliere one Ijlister is developed and pasees away to be eiieceeded hy another or by others. 3. Peinjthltjus chnmlcim^ M^here the disease is long persistent. To these varieties the late Dr. Stokes added a fourth, or epidemic variety ^ to which he gave the name of Pemj}h!(/m ga/Hp'tnoj^^as. Pemphigus in its active form is attended with fever, and in the ilhfed young assumes, sometimes, an epidemic type ; but it does not seem to be conta- gious.
If the blister which denotes pemphigus were to appear on an infiamed ur erythematous surface of skin it would be said t!iat the disease pi-esented was erysipelas, a disease included in the chapter on diseases which run a deliuite course.
Erysipelas and pemphigus were formerly classed as cutaneous affections under the order '' hullie.''
Impetigo is a disease which is characterized by an eruption o£ a pustular ehamctcr. In this respect it resembles smalbpix, but differs, essentially, in that it is not contagious, and cannot even be communicated by inoculation. The pustules are email, and form light continuous scales or mmbs. Tlie disease differs also from Buialhpox in that it is not accompanied by severe fever. Tlie eruption usually appears on the limbs.
There are two varieties of impetigo :^1» Jmjtttvjo t^jmrsa^ in which the points of eniption are distinct and apart. 2. Impetujo confiiie}h% in winch tlie pustules run into each other. The affec- tion appears chiefly in tlic feeble, and is most frequently seen in cliildrcn who have been badly fed.
£cthynm.
Ecthyma, like impetigo, is a pustular eruption very similar to the eruption of benign or mild cases of small-pox, but the spots are widely apart, and are not necessarily attended with fever. The disease is not itself contagious, but it occasionally occurs dur- ing convalescence frum the communicable diseases. The pustules
DISEASES OF THK SKIN.
2Gi
are larger tlian those in iitipetigo. Eetlijma appears most fre- queiitlv in tliu fceblo aiifl iinpoverislieJ.
Tiie diseases impetiiro and erthyma were classified by tbe uldt-r authorities imder the ordtr ^-^ jmstulie.*'
Actu\
The eruption calie^l acne tvtiitiistis of a nnniher of sTiiall pointed and tirm tiiljercles. It is a &low or dironie inliainniatic*ii uf tlie sebacouus follicles of tlie face, and sonietiuies of the l>reast and shoulders. After a time the fc^nxall tnbercles become surrounded with pu8 or matter at their bases, and when they have died away they often leave a scar.
There are said tf» be four varieties of acne : — 1. Aaie j>Hnc(ata^ in which each tubercle is distinct^ and, as it were, marked out, 2* AcTte iaduratii^ in which tlie swelling is indurated or Inu-d, 3. Acne r^osacea, a had form of acne, occurring in persons of ad* vanccd life. It is seated, exclusively, on the no&c, is attended with redness of the surface of the skin of the nose, and causes great disfigurement. The affection mostly afflicts persons who have indulged freely in alcoholic drinks, and connects itself with the enlargement of the blootl-vessels whii-h is so comnuui a result of alcoholic disease. 4. Acttf^ stroj^Aul^jsa^ a form of acne attended with strophuhnis rash* In some cases of acne an acarian parasite, called by Owen the ''Demodex folliculorum/' is present in the affected follicle.
S^^easis. Menta/jra.
Syooeis is an eruption of a tuhercnlar character, affecting the beanlcd part of the face or the hairy scalp, Tlie tubercles are large, »iften tlie size of a pea, hard, smd at first inflamed. After a time they yield pus or matter which, mixing with the hair, tftiises a crust that resembles tlie cut surface of a fig. The dis- ^iase when it is seated on the chin is called sfjamis /tunti, when on tlie ficalp, 9yeottU cajnUklL In some instances of sycosis mcnti the ** Microsporon mcntagrophytes/* and in other instances the pameite " Dcmodex folliculorum," is present. The term meuta- gra waa once applied to a similar disease of the face, which was first observed in the reign of Tiberius, and was found to be con- tagions by kissing and other modes of contact.
262
LOCAL DISEASES.
Elephantiasia.
Elephantiasis la a tenn applied to two very different diseases; one a local affection, confined to the leg, called EUj^hantiaH^is Ant- buviy Elephant lefj^ Barhoilaes leg^ or Ehjyhus ; the other called Elephantiasis Grwcorum or true Uprosij^ a general affection ap* pearing on various parts of the hodvj or even covering tlie whole cutaneous Rurface,
Elephantiasis Arahim is an enlargement of the leg from swell- ing of the cutaneous tissues aud of the cellular tissue beneatli, the result of recuiTcnt inflamniation and serous iufiUration from the blood, Tlie affection becomes chronit'j aud tho liinl> really as-' fitimes, as in a case lately under my own observation, the appear- ance of an elephant's leg aud foot. It is usually a fatal disease from the exhaustion it produces, unless the affected limb can be amputateth It is not contagious*
E hphantiitsi^ Grmeorum nr (rue hprosy is a tuberculous dis- ease of tlic skin, epidemic or endemic^ and contagious. It com- mences with erythematous blotches ou the skin, which soon be- come dark or bronzed and tuherculan The tubercles are red and raised, and the skin, generally, about them is raised and rough- «« encd. There is often hoarseness of tlie voice, fetid discharg9^^| from the nose, and ulceration of skin with the other syniptorns. The disease was well described l>y Celsus, who lived in the reign of tlie liouian Emperor Augustus, in the beginning of tlie Chris- tian era. It is the true leprosy of the ancient world, and, as Wilson points out, was the e]udemic leproF?y wbieh for fifteen centuries had a home in this country. The affection is believed to arise from a specific poison, and to liave a period of incubation. It is attemled in its first stages with fever. It is still present in the East and West Indies, in South America, in China, and in the Islands of the PaciJic*
Eramhaisi^. Yaim*
Framboesia or yaws is a disease of the skin, usually classed tuberculous, met with chiefly in Guinea, amt>ngst persons, negroes especially, who jiave l>een badly fed. The eruption begins, gener- aUy, on tho foreliead in white spots, like an insect bite, and then extends. The spots form matter which becomes incrusted, and beneath the crust an ulcer appears from which a fungous tubercle,
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BISEASE8 OF THE SKIN,
263
rjmg in color from wliite to I'erl, rises. The eruption is apt to duriBg a period often extending to nearly a year. It is not ariljr a fatal disease, and it is doubtfully contagions,
Aleppo Evil.
Under the term Aleppo evil is defined a disease of the skin eominencing as a tnhercle and extending until it forms a crust wliicli falls off or divides, reforms, and at last leaves an ulcerated surface, often of large size. One or more of these spots of erup- tion may he presented. The disease in most cases continues for many months, and leaves, usually, an indelihle scar, or a series of ficarSy behind.
MollvseuTn,
Under this term different aulhors descrihe an eruption of small tumors from the skiti, appearing on various parts of tlie body with- out inflammation, and varying in size from a pea to that of a nut. The tumors may pass away withont irritation or hy ulceration* They may contain a sebaceous matter^ or a semitransparent fluid, or an amorphous substance embedded in cellular structure and blood-vessels. The persons in whom they occur are sufferers from nervous exhaustion, are dyspeptic, and are of feeble circulation. In one remarkable instance under my own care an eruption of these small tumors, each of which resembled a largo ripe white currant, broke out all over the body, lasted several days, and then rapidly disappeared.
Scleroderma and Leitcoderma,
Under the term sclei'oderma is included a rai"e affection of the skin, which consists of a chronic inflammation uf the deep layer of tlie dermis called the coriurn, and attended with hardness without increase of growth. The skin is drawn up or puckered in white lines or creases. When near to joints the hardness of the skin renders motion difficult.
Leurod^'tnta^ sometimes called vkUiffo^ — veal skin, — is an af- fection of white, smooth, shining tubercles, in patches,' on the fiktn of the face, neck, and other parts of the body. The tuber- cles are often rapid in growth and then die away in a few days, leaving white surfaces or seams in patches or lineB.
S64
LOCAL DISEASES.
Acne, sycosis, elephantia&is, fraiiiboesia, Aleppo evilj tnollns- cum, and vitiligo, liave been iisiially classed under the order '* tiibercula."
Stearrhoea,
An excesBive oily secretion from the snbaceous follicles, those of the face epecially. There are two varieties ; — 1. SitaT^rfuta Bimplea\ in which the secretion thrown out is almost colorless oi faintly yellow ; 2* SkarrJajm nigricaii^y in which the eruption and secretion are of dark color.
AVmiimyuB, CanUi^s. Melasma.
Albinismns is a partial or general cliange in the color of the skin^ from an absence of the en tan cons pigment The skin is of a peculiar shade, like milk, and tlie hair on the skin is white* The disease affects the dark races, giving rise to the '^piebald negro," in whom portions of the snrface of the body may asunie a complete whiteness, in large patches.
The term canities defines change of the natural color in the hair to gray or white*
Under the term melasma is inchided the dark eruption seen on tlie limbs of old people. The change is due to an excess of pigmentary substance*
CfilBImn mid Frosi-hiie.
CkilMain is an erytliematons condition produced by cold on the hands and feet of persons of weak circulation. The erythema and congestion may be extended deeply uver a large surface, and often attended witli swelling and much pain*
Frost'iiU is a temporary death of the skin from the action of cold. The affected part, emptied of blood, is hard and in- sensible* During recovery the relaxed vessels are apt to be- come surcharged with blood, on w^hicli there is arrest of cir- cnlatiou and mortification or death of the part The danger of mortification is often mcreased by too rapid an admission of warmth*
DISEASES OF THE SKIX.
PARASmO DISEASES OF THE SfOK.
The list of the Royal College euppliea the nanies of ten dis- eases or affections of tlie skin as dim to parasites or to irritation from parasitic living forms. In respect to certain of these as specific causefl of tlie affections with which thej are nndoiibtedly connected there is difference of opinion. Some would trace the diseases exclusively to the parasites, others would trace the para- sites to the diseases, that is to say, they %vould main tain that the parasite does not cause the disease by its presence, but exists at the affected spots from finding there a favoring locality for its existence.
IXnea Uyiuurans. Ring worm.
An affection in which the scalp is the seat, marked in the first instance by shrivelling of the hair in patches of rounditah or oval yhape, and by falling off of tlie hair. The bare place is often scaly, and tlie roots of the hair are sun*ounded with dry matter. The disease often breaks out in eicliools, and is supposed to be very oont-a^ous* The parasite found in the affected part, in ring- worm, is the "* Trichophyton tonsurans/' a vegetable spore round or oval in shape, transparent and colorless. The spores multiply around the root of the hair. Tlingvi'orm lasts a very variable time, but is always recovereil from, and often with unexpected rapiditj'.
Tinea £>eealmfis. Ahjyevla. Baldness.
A disease of the scalp in which the hair is lost over large sur- faces^ or even over the whole of tlie head. The surface i^ left, not scaly, but white and shining. In old persons baldness seems to be as natural a condition as grayness of hair, but in the yonng and middle-aged it is a distinct disease. The parasite said to be present in some cases of this affection is the ** Microsporon Audouini/^ a vegetable spore.
Itma Fo/vosa. Fav^ts. Porrigo,
Tinea favosa, sometimes called '* foreign ringwonn," is a severe form of disease resemlding in some I'espects the ordinary ring- worm of this counti'y. The hair i^s diseased and sometimes quite
266
Ul diseases.
destroyed. The pam&ite in favns is so abnndantly developed that the spores, massed together, may be visible to the naked eye. The pai-afiite is the '^ Aehorion Sehunleiiiii."
2in€a Versicolor. Piiyriams Versicolor.
An affection of the cutaneous surface, sometimes in chid ed with pityriasis capitis or dandnff, wliich, resembling, in some respects, the scaly disease already descriljcd imder the iicad pity- riasis, is supposed to depend on the presence of a vegetal)le parasite called the "Microsporon furfur,^* a spore of spherical shape, adhering to the epidermis and causing yellow or bro%vnish spots of varying size.
Tinea Poloni^*^, Plique*
4
A disease of the skin affecting the hair of the body in the scalp and elsewhei'e, in which the affected part is the seat of great irrita- tion and is painful to the toncli* There is an exudation from the iH>otfl of tlie hairs which dries into a crnst, niatling the hairs to- gether, and causing a bad odor. The first symptoms may be attended with fever, which, however, soon subsides, and in time the growtli of liair causes the crusts to be thrown uff, w^ith re- covery. The disease is specially seen in Poland, hence the name Tinea Polonica. The parasite present is the vegetable 8poii3 ** Trichupliyton eporuloides."
Mycetoma. Madura Fix>t. Fungus Foot
Madura foot, a disease first observed by Dr. Colebrook at Madurti, in Madras. It is an affection commencing in the skin of the fout in those who go about with the feet uncovered. It is due to the action of a fungus parasite called ** Chionyphc Carter!,'' Dr. XL V. Carter being tlie first authority who clearly reported on the nature of the affection and on the fungus wdiicb produces it. The parasite getting beneath the skin increases rapidly, and actually invades the bones themselves and causes their destruction . It is supfiosed by some observers that there is always some pre- existetit local disease or injury of the foot Mycetoma not uufre* quently ends fatally, from extension of the local affection, and the consequent pain and exhaustion.
^
DISEASES OF THE SKIN,
Scabies. Itch.
267
The disease seabies or itch was classed by the old writers as a pustular disease, and was defined bj them a:^ an eruption of jiu^ tales with imi^h irritation and itching, but with no fever. We now know it to be parasitie in ita character. The face usually escapes from the eruption, but the wrists, the hands, and the Hex- ures between the tingern are almost always affected, together with the Hexures of the joints and other parts of the body. It is a disease essentially of dirt, and is comunmicable by contact of one affected body with another. It is due to the introduction lieneath the epidermis of the female of the parasite ** Acarus sculjiei '' or ** Sarcoptes scabiei.- ' Scabies sometimes assumes the character of an endemic or even epidemic disease. Dr. Arthur Hill Ilassall has indicated that what is called ** Grocer's itch'* is sometimes due to a similar parasite which he has found present iu inferior samples of sugar*
Irritation from External ParaaUes and Stiru^*
rThe akin is liable to irritation from other parasites which infest it on its surface, as from the " Pedienhis capitis," the '' Pulex " or " Chigoe,'' the " Cimex '' or '' Bug;' and tlie *' I^p- tothrix autumnalis '■ or '^ Harvest bug." Tlie irritations from the stings of the wasp, the bee, the gnat, and ijtlicr stinging insects, aa well as from the stings of nettles and other stinging plants, are al«a considered as forms of cutaneous affection, of a temporary ^L character. ^M General Affections of the Skin.
^1^ In addition to the special diseases of the cutaneous surface
^P^^^^ noted, tliere are others of a general kind, the iiritures of
which have been described in previous chapters under the heads
of ulcer, tiunor, fissure, carbuTicle, gangrene or mortification,
atrophy, hypertrophy, malignant disease, and fnnmeulus or boil.
The tumors affecting the skin are the fatty ^ i\\e jibro^ceUular^ the
?i4^, the chcloid^ the a.mdi/lomata^ warts or iwnntca, and
^or cornua. Of the malignant diseases, or cancers, affecting
the skin, tlie ejatheUal is the most frequent form, but i\i^ scirrhjL^
and the melanotic varieties are sometimes developed in it. Of
the boils the most specific is the ** Delhi boil "' uf India.
LOCAL DISEASES.
Tlie ekin i^ subject to injnry and irritation, witli swelling and tliickeiiing of stnieinre, as in tlie case of an inflained Inirsa, aris- ing from pressure and friction. It is subject to sores and ulcer- ations from tlie same causes as in tlie bedsore of those who lie for a long period of time in one position. It is subject to macule or marks : — {a} spots like/VtrW^'*, — tjtftells : {h) the vascular mark ah^eiidy described as ntBvus or mother's mark, of which there are two varieties ; one where the nn^vnis is raised above the skin, the other where it is a stahi called, vulgarly, port-wine mark : and (c) molcj a raised growtli above the skin, colored by dark pig- ment, and sometimes including in it Iiairs which protrude through the vascular mass, ntm'uj^ jnhirls.
The skin, lastly, is subject to contractions from the healing of wounds, ci/yxirice^ : to harden ings or induratious, as on the palms of the hands and soles of tlie feet : to jyrurltU or itching : to ana^t/u\s!a or insensilulity iu parts of its surface : to profuse sweating m parts, ephidroiits : to absence of sweaty — anidrosis : to wasting in Hues, linear atrophy.
Diseases qf the IfaiU^
Tlie uails are Biibject to several kiuils of disease, of which the following are the more important. 1. Infjnnfm naii^ the growing in of the nail into the skin, a condition most common in the easel of tlie great tue nail, 2. Ont/chia, inflanrtuation of the matrix of the nail. 3» Onyehia maligna^ a rare and severe form of onychia. 4. Whithwy an inflammation arising near tlie nail, ending in abscess involving the theca cf the tendon, tAtx*al ab- icess, 5. Atrophy^ or wasting of the nail. 6* pHoriat^is and 0C2emay affections causing umch destruction and dit-tigni-ement of the nails, and usually occurring in persons subject to the same diseases on the skin. I have delineated, from natm*e, in my " Clinical Essays'' a striking illustratiou of the disease psoriasis affecting the nails of a person who was also suffering from lepra, — psoriasis vulgaris. Tlie affection eoramcuccs with a tingling sensation beneath tlie nails, often described as ''pins and needles/' After a few weeks the nails look glazed, as if they had been mneared over with varnish of a yellow tinge. They then begin to show little indentatious, as if they had been pricked over with the point of a pin, and afterwards rul>bed with a dark substance. Finally, thickening occurs beneath the nail, with crumbling of
DISEASES OF THE CELLULAR TISSUE.
fie nail Btructure and destruction, The difteaee is amenable to treat iiieiit. A new nail is generally reproduced iu the proceia of i-ecovery.
Diseases of thk Cellulae Tibsus.
Inflammalion, — The cellular tissue ie often the seat uf intlam- mation and of chatiges, connected with the indauunatury process, ending in the fonnation of purulent matter in a eiir.umscrihed form, ab9ce98. Socli intlanmiati(»n h apt to follow under circuni- stances in which the ekin is woundedj and in whicli the wound extends into the cellular structure. It also occurs fi-oni intenial iDJurieii, and from exteneion of inflammatojy disease into the membranous cellular tissue* In deep-seated boils and abscesses, generally, there is extension of the intlannnatory mischief into the cellular membrane.
JnjiammcUory imiiiraiion^ or hardening of the cellular struct- ure in the newly born, is another diseasse of this struchu'e, of which 1 have narrated several instances iu my essay on *' Diseases of the Fcetns in lltero," In these instances the surface of the body is rendered in parts hard and intlexilrle. Sometimes even the whole surface of the body is involved iu the induration.
Slowjh or Phh^gtnoii is another disease of the cellular tissue consequent on acute inflammation, and extending from the sur-
BS over or under lyhig the cellular layer. In erysipelas the in- ftmmation may extend in this way, and rapidly involve large tracts of the cellular tissue, phLjfjnwHOus ertjatj^el^in.
Ciirhund4^ or Anthrax is another special inflammatory affec- _tion in which tlie cellular tissue is invulved. The inllamniation ^usually limited or circumscribed, and ends in the formation of or matter, which, after great swelling, tension, and redness, bfetkfi thri^ugh the skhi in a nuTuljor of small percolations, utdess it be relieved by operation- The cellular tissue is involved, in like manner, in the disease called malignant pustule.
Obc^lffj^ — The laying up of fat in the cellular tissue beneath the skin and other membranes that are coimeeted with the cellu- lar structure becotnes, when the fat is in great excess, an actual disease called obesitj'. Obesity is fertile of many mischiefs. It mskea the body altogether pendulous, heavy, and cumbersome; it loads the intestines and interferes with their functional activity ; and, when it surrounds the lieart it very seriously impedes the
270
Diseases.
action of that orgaD, No mistake is more commonly made and no mistake h greater than that of accepting the external evidence of a free deposit of fat in the cellular tissue heneath the bkin aa a sign of robust liealth.
EinjrhjHema, — When air or other gas finds its way, as it some- times does, into the eellylar tissue, and diffuses through it, the disease ealled emphysema is produced. Emphysema may occur from a wound in the cellular tissue, as when the end of a broken rib pierces it, and 1 have once seen the whole of tlie cellular tissue beneath the skin injected with air, as it is injected in the carcass of the dead animal when the butcher inserts a knife into it, and distends it hy his breath. EmphyBema may be present in any part where there is cunnective tissue. It is often present in the lungs.
Anasarca. — ^When water exuiles in tlie cellnhir tissue beneath the skin, the form of dropsy called anasarca is produced. In anasarca the surface over the affected part becomes spongy, and *^ pits,^* on pressure, like dough.
Lastly, the cellular tissue is a common seat of simple tuniaris. It may, also, be the seat of heviorrhagic tjfwiarw^ of patd^tic cysts J and of cancerous t/rowths.
i-ii<i'^Lv:.j
This booh is the proper! ij <./ COOPER MEDICAL GO
SAN FRANCISCO. CAL. a7)d is w)f t>, lie vir.or.d ' f, ■(,,;•. {;,< Library R-..,., h,, „ ,,, ^>.,.so.i. o, under auij yrcUxt duUecer.
BOOK I. PART THE THIRD.
DISEASES FROM NATURAL ACCIDENTa
CHAPTER L
DISEASES FROM KATURAL ACCIDENTS.
TffE history of natural disease would not be complete were reference not made to certain accidents to which the human kind is sabjected. These ma j be divided into four clasees. L Acei* dents which are purely mechanicaL 11. Accidents which arise from poisonouB substances developed within the body. IIL Ac* cidents from venomous organic substances, lY, Diseases from animal or vegetable substances, tjdceu lu foods. V, Accidents in the female, connected with pregnancy and labor.
Diseases fhom Mechanical NAXtrRAL Ac^oibents.
Shock.
LroiITNTNO
Primary efef^ijf. — The passage of lightning through the body may produce varied phenomena, from mere temporary shock, to &liock witli insensibilityj and to shock that is fatal either at tlie nioment or sbortly afterwards. These plicooineua may or uuiy not be attended with marks of distortion or external injury. The fatality is in proportion to the intensity of the sixock, and those discliarges which by their intensity kill most readily, may leave least mark of distortion or external injury. In cases where the lightning shock has prodnced iiistantaneous insensibility, followed by recovery, the stricken persons have been, in some cases, alto- gt*.ther unconscious of receipt of injury. It may be inferred, tlicrefore, that instant death by lightning is, as Franklin tsuight, the most painless of all deaths.
The injuries inflicted by the shock are internal and external. In niy libservations on animals killed by electrical ligli tiling shock, I di^scorered that the course of the discharge through tiie body was, preferentially, by the blood, and that coagulation of the blood, general rigitlity of the muscles, and decomposition of the ttisties wei^ the three proofs of death* Id
274
DISEASES FROM NATURAL AOOIBKNTS.
Secondanj eff&!ta of lujktniiig shock,— yi^XiQW the Hgbtni] stroke does not actually kill^ a eeries of secondaiy effects, consti- tuting what may be called actual di&easeSj may bo induced^ and may be named under tlie following heads. Keaetivo fever; apo- plexy; convubious and epilepsy; paralysis; catalepsy; and blindnegs.
Reactive Fever. — Sir Erasmus Wilson once directed my atten- tion to a remarkable illustration of tliis effect of light rung m a woman iixty-one years of age, wdio was saved from instantaneous death by the wires of her crinoline wduch acted as conductors. After the shock, the woman, who had been suffering previously from indigestion, vertigo, and nunibnesB of her limbs, remained insensible for twenty minutes, uttering an occasional groan. When consciousness returned, she stated that she had felt nothing at the time of the accident, although she had several burns on her body, but she complained of nausea and oppression about the chest, wliich were relieved by vomiting. Her skin at this time was cold and clammy from perspiration, and her pulse extremely weak. Subsequently she was attacked with fever, accompanied with delirium, and it was not until the end of ten weeks that she was reported to have recovered her usual strength, the burns being at the same time healed. At this period it was stated that she was quite cheerful, except when left alone, when she was dis- posed to sleep too much, and a feeling of great lassitude an- nounced to her the approacliof a thunder-storm, before its coming was perceived by otiiers. *^ The case," adds Sir Erasmus, '* is one of deep interest in its illustration of the influence of nervous shock, and its phenomena are most suggestive ; — for example, a concussion of the nervous system, the loss of consciousness, the sickness of the stomacli, the oppression of the lungs, the prostra- tion of the heart, the reactionary fever, and last, but not least, the morbid sensitiveness of the nervous system to electrical im- pi-essions, enduring for a time, and probably for life. Is not this the oft' to Id tale of many of our fevers ? "
Apoplexy. ^Flienomena of apoplexy from lightning shock have been observed. Jn the^e instances the countenance is livid, the body affected witli a cold clammy sweat, the breathing op- pressed and stertoi-ous, the puke strong and full, and the powers of sense and voluntary motion suspended. The sluick producing this condition is one of low tension, and is much like the shock
LIGHTNINO SUOOK.
275
I
>m ennetroke. Recovery Jiaa been known to take place on let- ting of blood*
Convulsions and Epilepfiy. — Convulsive actions and epileptic or epileptiform seizureA have been recorded as following upon' ligbtning stroke. The paroxysm ironies on some time after the shock, and it may i*eturn after apparent recovery.
Paralysis. — ^Paralysig has been observed to follow lightning stroke, tl»e paralytic condition being eitlier loe^l or general. In all crises of lightning shock there is some degree of paralj'fiis of sensation and of motion* It has been observed that during recov- ery sensation returns first.
Catalepsy.^ — The moet remarkable phenomena of lightning shock are those of catalepsy. 1 have related an instance in which a man was struck by lightning in Grinstliorpe Park. He was rendered uncon.scious, but recovered and muuaged to reach home and go to bed. He was confined to his bed for several weeks, re- food, and sank into a cataleptic state which sitnulated death closely that he was thought to l>e dead, was laid out by two women* and was tolled for in duo order. lie knew all that was ping on^ but was unable to move until he heard the wonieu talk-
of his death and caught the sound of the passing bell- Under the dread impression that he should certainly be buried alive, he succeeded by a great effort in moving one of his thonibs, winch fortunately attracted attention, lie was then treated as one alive and recovered. During his convalescence lie was annoyed by a strong smell of sulphur which seemed to coiuo from liis whole bfiKly ; a j»henonienon which was also observed by Gaiiltier Clan-
, who experienced it for several days while recovering from lightning shock.
Blindness*— Blindness has been obser%'ed to follow lightning shock, and may be present from tw^o conditions. (1) From a direct change in the structure of the cornea, (2) From nervous «lifK*k, without any visible mark of injury* To these may be a<ldcd temporary blindness from tlie excitation of the light of the lightning tlash without shock.
Etiemal injuries ami marks left after Ughtning stroke.
Bnms. — Bnrns are sometimes left on the body or on the hair after lightning fitroke. The luiniings differ in degree from mere iingeings of the hair or skin to extensive cauterizations. Bums
fw
DISEASES FROM NATURAL ACCIDKXTS.
are moi-e Hkelv to happen where the person is not destroyed bj the t*hock, Tlie reasuii of tliis is tliat the Hash h of low tension, is of the character of a flanie, and is not penetrating.
Jletallic Impressions. — The inipreseions of metallic substances may be left on the bodies of persons struck by lightning. In a case I have reported, a man subjected to lightning shock had left on his body impressions of ornaments which he wore, namely, a cliain, a coin, and a cross. The stain produced was of a dark brown color, and the impre^hion was wfll marked. Tlie nature of the mark is very simple. It is an ecchymosis or bruise through the metallic substance of which it presents a rough outline.
Ecchymo8es.~8implo ecchymuses and livid spots Iiavlng no reference to metallic or other substancea in contact with the skin are sometimes seen on the surface f»f the body after lightuuig stroke. These spots were deeply marked on Professor Reich man, of St. Petersburg^ the first martyr to science wlio lost his life by reL^eiving a shoL'k in the laboratory wliilo drawing electricity fruin the clouds, on the 0th of August, 1733. lie was killed instanta- neously. On his forehead was a red spot, from which issued mme drops of blood without wnund on the skin. On the lieel of the left foot and on the left side of the body were several blue spots resembling leather that had been shrunken hy being burnt.
Arborescent marks, ^ — ^ Marks of an arborescent kind have been noticed on the Ijodies of persons %vho have been struck by light- ning, wIiilIi marks luive, naturally tliougli wrongly, been sup- posed to be representations of the figures of trees. The truth when explained is very simple. The arborescence is not the figure of a tree, but is an anatomical outline of the trunk and branches of the superficial veins of tlie body of the person struck.
Loss uf hair." — In some instances where the nervous centres
41
have been affected by lightning shc^ck, death of the hair has been produced. On June 1st, 1804, at Jlonssy in the Vosges, a mason, aged fifty-ninCj was caught in the rain and took refuge under a tree, where he was struck by lightning, lie became unconscious, and thotight four hours elapsed before he recovered his senses. He then fmmd that be had lost the \ue of his legs, and cotdd not speak, and it was not until after nine days that tlie paralysis ceased. The electric fluid had come into contact with the back of his neck, had passed down his lower extremities and had es- caped, hurling his shoes to a considerable distance. Soon after
EXPOSUKE TO COLD.
277
I
I
rent, tiie hair on tlie head and body of this man ft*]! off entirely, the eyebrows, eyelashes, and beartl being conjpletely re- moved* There were no other external evidences of lightning shock.
Sunstroke — Coup-dk-soleil.
Sunstroke, or conp-de-soleil, has been referred to under local diseased of the nervous system, at page 173, There are two kinds of it; one apoplectic in its nature, aftV-L-ting persons of plethoric habit, and especially tiiose who indulge in stimulants ; the other syncopal in its nature, and affecting the feeble. The tirat is true Bunstruke, ha 1 should detifie it strictly, from what I have seen. The affection is rai*e in this country^ except, in summer, when the heat is intense. It then luippens to persons who go out without being protected {nmi the direct rays of the suil I have seen in* stances of it in adults of botli sexes, and twice in children. The
son affected is seized with a sudden giddiness or vertigo, fol- ded by unconsciousness and want of power in the limbs.
In the apoplectic variety of the disease the face is livid, tlie veitiB swollen, the teui]>eratuTO of the body raided, the heart labor- ing» and the breathing heavy and stertorous; signs which in fatal eases continue until death* When recovery occurs it is often very rapid.
The syncopal variety is, according to my experience, rather an extreme faintness or oppression from heat tlian the effects of a snddeu wave of heat. It is attended with coldness, faintness, clammy perspiration, and often with convulsion or hysteria, the attack lasting for several Jiours, and being followed by some reac- tive fever and a long continued dyspepsia. I have known it to be
leeded by f>artial priralysis of the right side of the body, but it
uch less serious, botli immediately and subsetpiently, than the tpoplectic funn of the malady.
Exposure to Cojld.
attac H tive
Exposure to cold is an accident fatal to life in two ways. Flr«tj by extreme action, as when a person is exposed to glacial cold witliout due protection from it ; and, secondly, when a per- ■oti in an enfeebled condition is exposed to the intluence of mod- jrate cx^Id.
278
DISEASES FROM NATURAL ACCIDENTS.
Under the first of these states, whieh may be called acute ex- poBure, the extremities of tlie body, euuh as the nose and tips of fingers and tues, may be teuiporarily destroyed by the aetion of the cold, tlie parts being rendered entirely bloodless and insensible to pain, frost-bitten. In such eases, if due care be not taken to restore the ciruulation gradually, tfje frozen part is con*pletely de- stroyed and retnoved by mortitieation.
If the whole body suecuiub to the influence of cold the ten* deney is for it to experience a sense of benumbing sleep, under which it falls into deep torpor and gradually dies, apparently witliout pain or sense of dissolution.
Under the second of the states of accident fi^om cold the en- feebled person exposed to it becomes subject to congestion of some internal organ, whicli congestion passes into inflammation, with fever, and the se^juelaj of VkjiIk Tiie lungs are the organs which suffer the most severely, and from this exposure congestive bron- chitis or congestive pneumonia are the furms of disease connnonly manifested. Aged ]>eople, wlio in winter weather retire to rest in bedrooms insufficiently warmed, afford striking examples in all cold seasons of the dangers incident to this insidious action of cold.
Starvation.
The natural accident of starvation is presented nnder three sets of circumstances. 1, From actual deprivation of food, ab- Bolnte famine. 2. From deprivation of certain portions of food which are essential to life, 3. From inability to swallow food, owing to disease or obstruction in the canal leading from tlie month to the stomach.
Starvation may be an acute or a chronic manifestation. "When it is acute, that is to say when food is altogether withheld, there is rapid emaciation of l)ody, fever with failure of muscular power, nausea, fetor of the breath, and, suhsefpiently, a condition in whicli the ability to digest food and even the desire for food passes away. It has been shown by Mr. Coraish, in his observa- tions upon the Indian faTuines, that when the second stage is reached the most skilful feeding rarely succeeds in saving life. The limits to which deprivation of food may he carried, witliout destruction of life, have not been fixed. Much, it would seem, depends upon the circumstance whether water is or is not sup-
STABVATION. 279
plied. If water be withheld, death, probably, is inevitable in from seven to ten days even under favorable circumstances, much sooner if the surrounding air be dry and cold. But the evidence is clear tliat with a free supply of water the body may be sus- tained for a period extending over five weeks. I have myself seen an instance of such maintenance of life without food.
In examples of starvation from insufficient or improper supply of food the phenomena may present two characteristic forms. The disease which has been described at page 48, as relapsing or famine fever, may be the result of the starvation ; or, there may be merely a feverish state and feebleness, ending in general ex- haustion, ulceration of the surfaces of the body, paralysis of parts of the body, and general deterioration from which, at the best, recovery is but imperfect. Starvation from improperly selected foods is often well marked in young children who are fed on a diet which is too exclusively starchy, and does not contain the elements for building up the muscular and osseous systems. Such children become of lax and feeble muscular fibre and rickety in the skeleton, the muscles failing to receive their proper aliment and the earthy matter necessary for the solidification of bone being insufficiently supplied.
CHAPTER IL
DISEASES FROM NATURAL FOISOirmOS AND FROM AC- CUMULATIONS OF POISONOUS ESCRETIONS WITHIN THE BODY,
In the course of some diseases Bymptoms occur which ai-e t>f fiingular importance, and which feeeiu to be due to the presence of poisonous substances which have beeu developed in the living body itself. These poisons may be conBidered as natural products or excretes of the body. Sometimes these excretes are nothing more than the natural products of excretioUj excretes w^hich are regularly made, and do no harm whatever so long as they are duly thrown off, or, as it is said, technically, eliminated. In health they are so eliminated, but under disease of the excreting organ the function of throwing them off is impaii-ed, from which circumstance they may continue to be formed within but do not continue to be cast out of the body. They then accunnilate in tlio blood and in the secretions, and, after a time, from such accumulation, exert all the effects of au active poison.
The above is one form of natural poisoning, hut to it must he added anotlier. It would seem that dmung certain forms of dis- ease new poisons, wdiich are extremely virulent in their action, are produced hy modified clieniical changes. It is probable that poisoning so induced is much more common than is generally 8 apposed.
I shall Itave occasion to touch on this subject again when I come to treat of the causes of disease. In the n*can tiTi\e it was necessary to point out the two divisions of natural poisonings which have now been Bjiecified, and having briefly perfornierl that task I may proceed to present short notices of the phenom- ena of disease incident to both forms of poisonous action from natural som^ces.
DISEASES FKOM NATURAL POISONINGS,
281
1%ilASE8 FROM EeTAINED ExcBBTIOKS.
Coma.
JJrmmia and Uilemio
We liave eeen in the chapter on the *^ Local Diseases of the Glandular System,'^ p* 212, that thu kidneys by thek secretion eliminate, with every thousand graiug uf the secretion, fourteen grains of a substance wlddi i^ called urea. Urea is a very sulu- ble saline substance, a cyanide of tunnioniuui. It is a white crys- talline salt, easily separable from the secretion, and admitting of being made, artificially, out of the body. Like nitre and other Baline substances whicli easily alisurb water, it is, I found, an ex- cellent antiseptic ; but that which is most important to us is the fact that urea, if present in the body in excess, acts after the manner of a narcotic poison. h\ my original researches on this Bubject I found that whenever an ajiinial body was charged with one part per cent, of ui*ea, symptoms of sleep or coma were the reisult, and tliat in proportions above this amount tlie symptoms wei*e, as a rule, invariably fataL Similar ubservatiuns lutve been made by i^thcr inquirers, and niucli discussion has taken place on the tpicstiun whether the effects are due directly tu the urea, or indirectly to another ammoniacal salt^ the carbonate, into which it is easily decfomposed. It is umiecessary here to discuss this point. It is sufficient to state that urea accumulating in the body lends to symptoms of a poisonous character which are always alarming, often fatal, uud called urBeniia or uiijemic coma.
The conditions of disease which givii rise to nriemia are con- nected with organic changes taking place in the structure of the kidney. In scarlet fever tlie miimte uriniferous tubes cast off their epithelial lining profusely and become blocked up by it, whereupon the secreliug pf>wer of the organ is irupf^ired atid, urea ceasing to be freely eliminated, accumulates in the blood and gives rise to the symptoms of uni?niic coma, marked bv prostra- tion of the body, dilatation of the pupil, vonnting, darkness of the skin, convulsions, deep sleep, and insensibility— coma. In flcarlet fever ursemic coma is a common cause of fatal ity.
In acute cougestion of the kidneys, produced by exposure to wet and cold, desi-ribed at pp* 212-13, the function of those or- gana may again be suppressed, with the result of causing urtemic coma, and w^ith the same risks as happen when scarlet fever is till* i^vr'iting cause.
DI?
>ISONINGS,
In those forma of disease of the kidney described as ** Bright'fl Dis aee/' page 214, ura^niic syinptotiis are apt to be developed, and ill the tdirouic furiii of these maladies, in aged persons, iiree- niic coma is always to be dreaded. The symptoma of ten come on with an irresistible desire to sleep at almost any time or place. With this tliere may \m deficiency of iscnsntiun in the limbs, occa- sional confusion of mind, feebleness, liritlessness, and ammoniacal fetor of the breath* Persons so affected are readily influenced by cold or anything that checks the free action of the skin, and they often die with symptoms which, in former times, wei"e called apoplectic. They are seized with drowfriness, vomiting, convul- sion j and insensibility, under whicli tbey succumb. Such per- sons, when in a comparatively healthy state, are easily influenced by some meclicines, such as opiiini^ and, above all, mercury. They fall readily into ura^mic disease under slight exposure to these dek^terioiis iriHuences. It will be seen from these data how large a part the excreted substance nrea may play in the role of disease.
Asi'uvxiA, Cyanosukia.
Otber illustrations of phenomena of disease from deficient elimination uf a natural excretion are shown in instances where the product of respiration, called commonly carbonic acid, is not duly eliminated by the lunge.
Certain uf these phenuinena are most strikingly seen during conditions which lead to what is known as asphyxia. If, under any cii'cumstances^ the respiration be interferred with, so that a due quantity of air is not taken into tiie lung, or a due escaj^e of air does not take place from the lung, as occurs through suffoca-. tion from hanging, drowning, iininersiun in a mephitlc atmos- phere, and the like, there is accumulation of the caj*bonic acid in the blood and eyinptoms of danger and death from that causa. These symptomB aj-e darkness of the face and surface of the body generally, coldness, eonvnlston, and insensibiiily. They are the acute symptouis of suppressed respiratory exci^etiou.
In some instances the suppression of the respiratory excretion may be slower in character, and njay give rise to symptoms very painful to bear and to witness, but not necessarily fatal, imme- diately. These states are u^iually brought alxnit from some defect in the mechanisms of the circulation and of the i-espiration. lu
DISEASES FROM NATURAL P0IS0NING8. 283
the newly boni it occasionally happens that there is an imperfect expansion of the air vesicles of iliu iuogg, eo that a portion of the lung structure is not bronght into play. Thereupon there is diminkshed inspiration^ which, if it do not prevent, from tlie first, the manifestation uf lifOj leads to difiicnlty of respiration, cold- ness of surface, and impaired nutrition, with the eonunon risik of early death from respiratory falhirc. To thia form of disease the term aUt'ectasis has been applied.
In other instances the i^pcuing from the right to the left side of the heart, the foramen ovale, wliich naturally closes after birth, remains open, and the hlotid frotii the right auricle of the heart, which ought to go altogether into the right ventricle, est^apes, in part, aa venous blood into the left auricle, and ui this state, un- charged witli oxygen, circulates through the body. Under these circumstances the hody is rendered dark iii ciJor civer all its sur- face, cold and enfeebled, a diseased condition which has already been under our ohaervation at page 136, where it is defined under the head rytmo^lH*
In persons w^ho are subject to epasm of the mimite bronchial tubes, persons who are often called aisthniatic, the same dangers from imi>erfect elimination of the expiratory excretion often occur, and death from asphyxia would be easily induced but for the ciix'uuistance that the prostration produced by the seizure leads to i-elaxation of the constricted tubes, and so permits the air once more to enter tlie temporarily occluded lung.
I do not doubt that there are many other conditions in wluch a deficient excretion of the re^spiratory products leads to disease, and even to deatli, by natural process of poisonings and I know that mucli remains here to be explored and explained. Under the title ** Asphyxia commencing in the BIockV I have described in anotiicr place various conditions in which this kind of poison- ing may occur. It is enough for me in the present place to state the few well-defined illustrations which have been supplied mider tkis head of Asphyxia and Cyanosuria.
BiLioua Toxaemia.
When tlie secretion of bile is soppreBsed from organic disease Bting the liver or gall-bladder, so that there is not a proper ^•ecretion of bile, or when a proper secretion finds an imperfect
DISEASES FEOM NATURAL POISONINGS^
escape into the alimentary canal, the constituents of the bile are carried into the circulation and excite gyiyptoiiis of biliuns poison* ing, janndice, coinulsiun, coma. We have already studied some of these sytnptoios in treating of diseases of the liver, undei* the head *SJaandiee,-* pages 211-12, and to these we need not again refer.
There are, however, certain minor symptoms due to the sup- pression of l>iHons Becretion which deserve to be noticetl under tliis liead. These are commonly called symptoms of biliousness, or sufferings from bile, and consist of headache, nausea, depres- sion of spirits, constipation, hissitude, and inalvility to apply tlie mind or the 1>ody to their respective labors. I believe it not nn- frcfpicntly happens that more serious symptoms than theae result from suppressed liver secretion, but I have named those which are most common*
Diseases from New Poisons de'\^eloped ix the Body.
I said in the opening sentences of this chapter that in various conditions of disease new products may be formed in tlie body, ]>rodnct8 which are not the natural excretion is, but whirh are pro- duced from umiatural decompositions progressing within the organism during some forms of disease. In my lieports to the Critisb Asstxriiition for tlie Advancement of Science I liave pointed out that the suljstance amylene, an organic product whidi can be easily constructed in vit^il chemical changes, produces plienumena identical witb those of somnambulism and with some of the phenoujona of hysteria.
I have pointed out, in the same Reports, that another organic product, called mercaptan, sulphur alcohol, causes, when inhaled, symptoms of profoundest inelanch uly, and that, in the process of being eliminated by the breath, it gives to the breath an odor which is identical with the o<lor evolved in the breaths of many patients wiio are suffering from the disease called meluncholia. From these observations 1 liave ventured to suggest that various forms of mental affection and of nervous affection, depend, for their development, on tiro presence, in tlie body, of organic cliemictil compoundt^, formed and distilled tlirough an unnatiu*al chcmiciil process carried on in the body itself,
I have endeavored to develop this subject somewhat further
DISEASES FROM NATURAL POISONINGS.
285
by mj researches on tlie action of lactic acid on animal bodies, I have ghown by experiment that this acid, diffused throiigli the body by the bkKKl, acts as a direct irritant upon the lining in em- brand of the heart, tlte endocardium^ and all the fibro-serons meinbraneg of the Uxly, so that a synthesis uf heart disease and rheumatism can be established by its means. Lactic acid h the most cc»pinns product tlirown out in the disease called rheumatic fever, and as many uf the phenomena resulting from t!tat disease :take the same form and character as those prodncihle hy lactic acid, I infer, from the best evidence attainable, that this acid, the product of a fermentative ciiange going on in the body during acute rheumatism, ijj the cause of the secondaiy structural affec- tions wlaich so fretpiently follow acute rheumatism.
It has been for some time past observed, by sevcj'al able physicians, that persons who are suffering from the affection known as diabetes give off a peculiar odor from their breath, an odor which to some is like that of vinegar, to others of sour beer, to others a mixture of ether and cldoroforni, to others of acetic ether. I should compare it myself to the odor of grains as it is detected in a brewery. When this odor is observed in the breath of diabetic patients it frcipiently happens that they l*econie sleepy, cold, and unconscious, with the result of coma and death. At one time it was supposed that these phenomena were ura^mic, and were due to the presence of urea in the blootl ; but the ibseiiee of convulsion and of sorue other symptoms destroy tliia lypothesis, or at all events sliake it. It is now believed that the fivniptonis owe tlieir origin to the decomposition of the diabetic ksttgar which is in the body, and to the production from that de- [composition of a volatile etliercal fluid calle<l acetone, a fluid I which has been discovered in the blood and secretions of these affected persons, who are said therefore to be suffering from the disease " acetonipmia/^ From the action of acetone upon animal bodies I infer that the theory of acetona?mia is founded on good evidence.
Lastly, under this liead of poisoning from natural products of idbeaee, I have to name the phenomena produced by the secondary ibaorption of poisonotis material from abraded and nlcerating sur- faces during tbe presence of acute feln-ilc and contagious affec- tions. The secondary absorption of diseased secretion from the throat in diphtheria and malignant scarlet fever, and the second-
L9ES FROM NATURAL POISONINGS.
ary absorption of poisonous matter from woimds, are all illastra* tion8 ia point* The matter absorbed, entering the bo«Jy and cir- culating through the blood, sets up new conditions of disease, wliich lead to various changes occurring within tJie blood itself, to separations of fil>rine, to breaking up of tiie red coriiu&oles, and to various other changei* of the most serious character. Some- times in these decompositiona Ammonia is produced. Dn Blair observed that sufficient quantities of ammonia are produced in yellow fever, to cause a degree of fluidity of tlie blL»«jd, whieli i^e- duced that fluid to the thinness of water, so that it resembled a dark wine rather than blood, refused to enter into combination with oxygen, and became altogether incapable of sustaining life. 8uch observations as have been noticed under tJiis short head lead to a study of another new point, namely, the possibility of the formation of organic alkaloids in the body during some conditions oE disease. Scientific discovery has not, however, advanced so far as to enable me, at this moment, to do more than allude to one of the newest and most important studies in modern medical research.
CHAPTER m.
DISEASES FROM VENOMOUS ORQAmC SUBSTANCES.
TiTR College aiitliorides classify^ in tlieir li8t> diseases arising from the body being subjected to certain aiiiiiml and vegetable poisong* Under this head they iuelude: {a) Poisoning by venom- DOS animals, namely, simkes, scorpions, and stinging insects, (i) Poisonings by animals having infectious diseases, namely, glan- lers, farcy, eqninia mitis, malignant pustule, hydrophobia, rabies ad cow-pox, affections, all of which have been described in our chapter on diseases running a definite course, pagea 44-58, (c) Poisonings by inoculation of dead or diseased animal matter, (rf) Poisonings by animal or vegetable substances, used as foods.
DisKASKs ritoM Venomous Animals.
The Tenomous animals called Biiakes, which by their poison affect man, are tiest known as the viper, the cobra di capello, and the rattlesnake.
The peculiar secretion which is produced by these animals, and which is communicated in w*hat is called their bite, is not poisonous unless it be injected into the body subcutaneously, or by a wound* TJiis was proved by the famous experiment of the distinguisljed Dr. Mead, who himself swallowed some of the poi- son of the viper without suffering any bad effect.
When, however, the poison is intrcKiuced into the skin or mu* coua membrane by a bite, puncture, or injection, the phenomena of disease are rapidly set up. After t!ie bite of the tnper tliere is usually acute pain at the bitten part, often immediately and always within the honr. The pain rapidly extends and swell- ing and inflammation follow. Soon afterwards the general syrap- toma set in* The stomach is disturbed, the iicart intermits or grows feeble j there is faintuess, voniiting, dyspnoea, and complete
288
DISEASES FROM VENOMOUS SUBSTANCES.
prostration. In extreme cases tlie collapse ends fatally witliin k few hours. There is as yet no known antidote for tliis disease.
Tlie poison of the cobra, like that ot the viper, is only effective when it is introduced by bite or incision. The action is, in the most deadly poisunings, not unlike that of the viper poison, but the depression is usually more immediately general and complete. In other and less virulent instances the symptoms are prolonged, time is given for the development of ]oi.'al clianges, niimely, death of the cellular tissue at the bitten part and surrounding inflam- luation. The bloud also may be rendered extremely fluid ; there may be vomiting, convulsion, and gradual stupor preceding the fatal collapse. The precise mode of action of the poison is still not understood. The poison seems to be easily destroyed in the digestive system and rendered harmless there, and I diseovei-ed that its powers as a poison are rendered abortive by ex|K>sure of it to sunlight. At the same time it may be retained in an active state for many years, if it be dried and carefully pres^erved in the dark. Its action seems to be immediately directed to the nervous system. According to my observation the poison that most closely resembles it in operation is nicotine.
The symptoms produced b>^ the jwison of the raUh^snahe ap- pear to be still more rapid in development, aiid in certain in- stances have been followed by a sudden collapse almost as deci- sive as that which follows a lOow on the stomach. The mode of action of all tliese poisons is probably the same.
The mortality from the poisonous snakes is exceedingly large* In the Madras Fremiti ency of India alone there are sometimes as many as two tliousand deatlis per annum by puake-bite. Various antidotes have been snggested and tried for the poisons of the colu^a and rattlesnake as well as for that of the viper, but, tmfor- tunately as yet, witli negative results.
Disease from Stings of Insects^
The affections from the stings of insects such as the wasp and the bee, are usually only local in cliaracter, but are now and then very painful and troublesome if not dangerous. I have seen the sthig of the wasp produce a local inflammation, followed by ery- sipelas, and prove dangerous though not fatal. The local symp- toms induced are due to the fluid secretion conveyed by the sting,
DISEASES FROM VENOMOUS SUBSTANCES. 289
and the effect has been ftiij>posed bj souio u* (ii^iienci un a zymu6i6 ui* ferment. 1 aiii iiicliried myself to look upon it eb resulting from the action of an organic acid.
DlSKASl^ FROM THE JeLLY-FISU OB MeDUSA.
The jelly-fish produces a peculiar secretion which, coming in contact with tlie ekin, seta up an acute erythema, attended gome-
Ltimcs with an irriuil>le vesieuhir eruption. The eniption is ac-
^companied by a burning and tiugling, and may la&t for several hour&. In one instance, which came under iny own cognizance,
|a bather in the sea, wliere a considerable number of jelly-fishes wei-e floating, became so entangled in the nieshe» of a group of them that ^* he was gtung over almost all tlic sui-face of liis body." He suffered from an acute eruption which did not disappear for sixteen hnnrs, and which was attended* with two degrees of fever. In another instance, wliifb also came under my own cognizance, a bather while swimming on liis back, with open niouth, was
^•tung in tlio thi*oat, and was affected with so severe an iufiamma- Uon as t^^ cause considerable anxiety for several hours. The poi- son of the jelly-fish is, I believe, an organic acid poison.
Dli^ARB ITEOM iNOOULArrON OF DkAD AnIMAL MaTTER. POST- MORTEM POISONLNQ.
Coder the head of disease fixnn venomous subetances we may include examples of diseased phenomena arising from inoculation of the living body with fluid or semifluid material derived from bodies that are dead. The most striking examples of this affec- tion are witnessed in what are called post-mortem wounds* A physician or surgeon is performing a post-mortem operation, or a
^student or professor is making a dissection of the dead bodj\ lie accidentally wounds himself with a needle or knife which he hag in use, and thereby inflicts a poisoned wound. If he can im- mediately suck out the poison or dosti'oy the part by caustic he miiy escapo. If he is not so fortunate lie is subjected, in a few hours, to pain in the wounde<l spot, with redness round about it, Jiiflammation nmning along tlie lymphatics, swelling o( tlie lym- jlbatic glands and fever, ending, not unfi'equently, in prostration
^arid death. In less fi»rmitlable cases tlie acute symptoms are brought to a crisis by the fornlation of an abscess or abscesses in- 19
290
DISEASES FROIC VENOMOUS SUBSTANCES.
volviiig the lymphatic glands, as tlie glands of the armpit if the hand haa beeu the part tlmt has received the puiiH>n» In buch ex- amples tUo formation of tlie abscesa may lead to bubsideuce of the muie dangerooa symptoms and slow i^covery may be the result.
Tiie distiase thus induced is, I tldiik, less frequent in tliese days than it was formerly, owing pi-obably to greater care and cleanliness. I have seen four instances of it in my career, three of which terminated fatally. The nature of the poisonous mat* ter or infection is little understood, but it seems to he a poison having a compai-atively short duration in the dead subject. It does not seem to he formed immediately after death, and it ap- pears to be destroyed very soon after the dead structure begins to underg<3 put!*e fact ion. The late distinguished anatomist, Dn Amadce Deville, who had seen many examples of the aflfectiun, told me that he liad on no occasion witnessed the poisoning from a tiubject that had actually undergone decomposition.
Cases of poisoning somewhat similar to these are sometimes due to the eating uf food which in a partially decompospid state cornea into contact with an abraded surface or a woun<l in the month. I have elsewhere described an accident of this kind which affords a good typical example. A man partCMjk of some jugged hare theflesliof whicli had become liigh previous to cook- ing. Beneath the tongue of the man tliere was an abraded nlcer- ated spot caused hy friction from the stump of a broken tooth. A portitin of the animal food lodged in this goi*e, and within twenty -four hours the symptoms of acute poisoning, local and general, had set in. The tongue became enormously swollen, there was intense fever and rapid prostration. The offending matter was sought for and removed, but without avail. The patient gradually sncenmbed.
I have on two or three occasions witnessed symptoms of dis- ease in persons who have partaken of decomposing or, as it is vulgarly called, **liigh*' foot], although no wound was inflicted. The phenomena are those of iodigestion, nausea, fetid breath and prostration : they continue nntil the poisonous material which has been swallowed is eliminated from the body.
Accidents somewhat similar to the above are occasionally met witli hy surgeons and veterinary surgeons when they are profes- sionally engaged in dressing the w^ounds or sores of living ani- mals. The accident may occur in very rare instances without the
DISEASES FROM VENOMOUS SUBSTANCES,
291
infliction of a wound on the person who becomes infected, that is to ^y, by absorption through tiie skin. I have known one ex- ample of this kind wliere the poison from a epeeiiic wound eanie Bunply into contact with the reddened sarfnce of an inflamed fin- ger. Mure frequently a fresh wound is the centre of the infec- tion, and the poison h ilnu directly inocuJated, A surgeon of my acqnaintance was once^ unfortunately, inoculated fatally from a point of bone in the limb of a patient upon whom he was per- forming an operation.
The symptoms induced in these instances of poisoning vary jiocording to the disease affecting the per go n fi^oni whom the poiaon is taken. If the poison is that of specitic disease, — sypli- ilia* — the person inoculated suffers from that disease should the poison take effect. In this manner it sometimes happens that the disease in question is communicated in vaccination by the use of impure lymph, that is to say, lymplv taken from the arm of a subject who is at the time a sufferer fi-oni the specific affection.
In other instances the accidental inoculation of the morbific It tatter excites erythema in the part immediately around the wound that has been inflicted, whicli erythema may spread, and Esauming the character of erysipelas may pass into an attack of erysipelatous inflammatjon.
In these forms of poisoning by inoculation the period of incu- bation varies ac^ordir^g to the nature of the poison that has been introduced, Tlie deveh^puient of symptoms from the specific poifion of syphilis is slow, the incubation being forty days. The action of the p^:ns*»^ uf erysipelas is rapid, the incubation being from a few hours to four days at the latest The action of the poison derived from a post-mortem wound is still more rapid, commencing generally within a few houiis after the infliction of the injury.
Disease fbom Wool, Wool-sorter^s Disease,
In the pi'ocess of sorting wools, especially that kind of wool called Van mohair, the workers are subjected to a peculiar and often fatal disease which arises from something which they in- hale or absorb. Tlie disease runs a fairly definite course, the period of incubation being about four da)'s. The first symptoms tro those of headache and pain in the chest with chilliness. These
CHAPTER IV.
DISEASES FROM ANIMAL AKD VEGETABLE POISONS TAKEN AS FOOD.
Disease from Poisonous Fish,
Ix tropical climates the perch, the giirnardj the goby, the sar- dine, and the two varieties uf gluhe fishes, the diadon or two* toothed and the tetradon or four- toothed, are all, at particular deaeoQS, causes of disease when they are taken as food. The poisonous siibetanee is developed in their digestive organs, in the spawn^ and in the liver of the fiahes ; it is most potent in those fishes whic'li have arrived at maturity of growth.
The Spattish colonists give the name of Siguatera to the symp- toms of acnte disease whieli result from the eating of pnisoTioiis fishes in hot eli mates* The phenomena of disease that are pre- sented are of tv^o kinds — gastro-enteric and nervous. The gastro- enteric form of disease begins with a severe attack of indigestion, followed by gi'eat pain in the stomach, and by all the indications of gastro-enteric irritation, viz. : nansea, vomiting, first of food then of mneous fluid, diarrlnea, coldness of the body, depression of the pulse, and cramps. The nervous type of the disease is marked by sudden muscidar prostration : the face of the sufferer I>6eomes flushed and then pale ; the pupils are contracted ; the lips are swollen and blue ; the pulse is weak, quick, and intermit- tent; and, very soon, there is general convulsion with inability to exert any volitional power. Death quickly occurs unless skilled help be at hand.
Both these forms of the siguatera are dangerous to life. Re- covery from the gastro-enteric form is rapid when it commences, but the nervous type of the malady causes, for several days, ex- tieme debility and irregular action of the heart. The poison,
294
DISEASES FKOM POISOXOUS
whatever may be its nature and cumposition, excites, it is clear, a
most effective irritation of the jxieuino-gastrie nerves, an irritation as tnily energetic as that wliicli might be excited by &nbmitting the nerves to the influence of a series of electrical dischargee.
Mussel Paisoning.
Some very serinns forms of disease have been produced by taking mussels as food* There are certjihi persons who seem specially liable to irritation of tlie stomach even from taking a small quantity of mussels. There are others who suffer from nettlerash from the same cause. These facts are so general that the inference lias been drawn that at certain seasons the mussel produces an irritant poison. In exceptional cases poisoning from mussels has l>eeu extremely sev^ere and even fatal, the symptoms resembling those which have been dei?<.»ribed above as constituting the disease siguatera, with other peculiar nervous symptoms. The indications are those of nausea and vomiting, followed by con* striction of tlie month and throat, difficulty of speech, numbness of the limbs, muscular exhaubtion, coldness of the body, and death with faintness and torpor. Notwithstanding the violence of the symptoms, the appearances after death liave been rarely of ftutScient importance to explain any fatal jihenoniena. The real jiature of the poison remains up to this day unknown. Atone time it was supposed to be a salt of copper with which the mus- sels thumselves were charged, but analysis, in fatal cases, ha*> failed to establish this view. The probabilities are that the poison is of an organic kind, and is produced by the mussel itself at particular seasons.
The oyster has been accredited wnth producing disease under some circumstancCvSj and I have myself known one example of oyster poisoning ; but the occurrence i& e\tj*emely rare. The Bymptoms are those of nausea and irritation of the Btomach.
In the books of a recent past day treating on disease from foods, references are made to ]ioisonous effects produced by the taking of sausages, pork, milk, and other animal sul>stances. The symptoms cited refer, in nearly every case, to irritation affecting the alimentary canal, and various speculations are offered to ac- count for the plietjomcna that have been observed. In these days much light has been thrown on that part of the subject which re* lates to disease from sausages, pork, and bacon, owing to the dis-
SUBSTANCES USED AS FOOD.
295
covery in Btich foods of trieliina? 8iid other parasitic fortns of life. It is probable that in nearly all the instances of the kind recorded by the older writers the irritations described were dne to para- eitie introdtictions. We know now also that in ilk may be the Imarer of various organic poisons, snch as the poisons of typboid fc^er, cholera, and probably diphtheria.
PoiBONiKO BY Vegetable SirB8TANCEs.
TnBtanecA still occur in whicli peculiar forms of disease are produced by accidental feeding on vegetable substances wliich are poi^nous. Fortunately these accidents are much less frequent than they were in former times ; but, the College authorities still refer to the disea.se known as ergotism produced from taking ergot of rye ; to disease from ix>isonous fimgi and mould}' bread ; and, to disease from certain poisonous grains or seeds, especially of the everlasting pea, — iut/it/ntM jtu/rmt^. I need to dwell only on two of these, namely, on ergotism and disease f mm the poison- ous fungi.
Di^me from ErgoU Ergot mm.
Ergotism is an affection of a very distinct character, produced by eating the spur which forms on rye and other grasses, ergot, 9ecale conmtwriu This spur is a growth affecting fc^everal kinds of grain, especially rye, and the disease which it produces has, consequently, Imen most comiiionly observed in countries where the poor have fed on rye bread.
Ergotism, the disease caused by the ergut, takes two forms; one called conmilHive^ the other (jantjrenouH ergotism.
Convulsive ergotism is marked by vertigo, yellowness of the ekin* tldrst, pain.^ in the liiiilm and chest, cramps and convulsions, insensibility and deatlj, with, in some examples, an eruption of dark gpot« on the body. In districts where the rye has been largely used the disease has assumed the epidemic forui-
Frorn the analogy which exists lictween the symptoms above destTibed and those which characterize the severe affection re- (*ently recognized as cerebro-Kpiual meningitis or tetanoid fever, I have snggested tliat this latter disease is prolmbly due to taking a diseased grain analogous in character to ergot* This view has received contirmatiou fru!u the observations of the late Dr. Day of Stafford and of Dr. Baker of Michigan.
296
BTBEASES FROM POISONOUS SUBSTANCES.
Gangrenous ergotism is a tlisease of much slower development and longer duration tliat tLe convulsive variety. It comnieucea with debility and sense of tingling over the surface of tlie skin. The limbs then become cold, pale, and so benumbed tliat they are insensible to pain from extenml impressions* After a time pain conies on independently in them and is followed by death of the extreme parts, so that the fingers and toes completely die off by a dry gangrene* These last symptoms have given rise to the nauie gangrenous ergotism.
PoUofiing frofn, FungL
It still occasionally happens that accidental poisoning occurs from taking poisonous fungi, — those especially which are mis- taken for the common mnshroom, agaricu8 campestris, Christi- son defines that most fungi which have a warty cap wnth frag- ments of membrane adhering to their upper surface are poisonous; that all which grow in tufts or clusters from the trunks or stumps of trees are dangerous; and, that tlie sure tests of a poisonous fungus are an astringent styptic taste and a disagreeable pungent odor. The poisonous principle seems to reside in the juice of the fungus, and has narcotic and irritant properties.
The symptoms produced by the poisonous fungi varj% but, taken as a whole, are definable as narcotic and irritating, the irritation bein^r seated in the alitnentarv C4inal and leadinc^ to gi-eat disturbance of the stomach and bowels. Sometimes the narcotic symptoms are dominant, iu others the irritative. In an example under my own observation, where the fungus called toadstool was catcti by four children in mistake for musliroom, three suffered eiitii-ely from intestinal irritation, and one from the narcotic effect, which lasted until the offending substance was re- moved by purgation artificially induced. During the time when the fungus is prothicing its effects the body is c«>hl and faint, while in the reaction which follows there is fever which lasts for several hours. The acute symptoms of poisoning occur, as a rule, wit! I in one or two hours after the fungus has been taken, but exceptions have been known in which several hours have elapsed before the development of the phenomena.
CHAPTEB V.
niSEASES AND ACCWENTS CONNECTED WITH PREO- NANCY AND CHILDBniTlL
During the pregnant state the feiiiale of Iniman kind is liable to soflFer ivowi various local affeetiooB wliicfi are considered special to her condition at that time. Some of these affectiuns are most diatressin*^, but happily it is rare tlmt the worst of them become fatal. In this brief chapter I will condense what needs to be eaid under different head.^ according to the parts or systems of the body that are particularly affected.
Disorders of the Digestive Ststem-
One of the earliest derangements of pregtianey is a depraved mnd eapricioits appetite. The ordinary sense of taste is often much perverted ; there is particular distaste for certain articles of food, and particular desire for others, such as shell-ii8!i, cream, aDd various other delicacies not specially cared for under ordinary circumstances. Tliis perverted taste and desire will often last for two or three months. Occasionally, with or without perversion of taste, there is a free and excessive secretion of saliva — mlha-
JTauma atid Ymniting^ are other common dyspeptic affections in the earlier periods of pregnancy, and in certain instances they continue until the late months, giving rise to extreme misery and exhanstion^ and remaining unchecked by any and every attempt At relief* The nausea or vomiting communly conies on period- ically, and most frequently in the early morning, lasting for many bourd each day.
Ilearthum^ or cardialgla, is also a dyspeptic phenomenon in prejB^nancy, and when it is frequent it becomes very oppressive. It is commonly accouipanied by eructation of acid fluid from the stomach into the moutli,— yyrc^m or water-brash.
298
DISEASES Al^D ACCIDENTS CONNECTED WITH
LUeMinal cramp^ or coltc^ is another affection of the pregnant state, whieli causes severe siiffering if it take place in the later stages when tlie uterus Itas attained a large size.
DetaTujement in the acttmi of th^. boimls is by no means infre- quent during pre-gnancj. In some persons the derangement is from CfnisHpatiofi^ in others it is from relaa^Mfon^ or diarrA^a. Together with tliese derangements of the howels tliere may he disoi'der of th« liver, with Jaufuiice as a temporary accompani- ment.
DiSOEDERR OF TIIK OmOULATORV SvSTKM*
Tlie circulatory system is apt to become painfully afiFected during tiie pregnant state. An obstniction io the flow of blood hack to tho heart by the large veins, an obstruction caue.ed by the pressure of the enlarged nterus or woml>, may give origin to en- largement of the veins in the lower parts of the body. Tims may arise large or var lease veins of the lower Hmbs, and heinorrhoul^^ or piles.
From the same pressure and obstruction to the return of ve- nous blood there may he effusion of serum into the peritoneal cavity, — ascites / a serous effusion into the cellular tissues of the lower limbs, — adema* From irritation connected with the uterus in various stages of pregnancy, and from reflex nervous action, the heart is sometimes disturbed m its movements and rendered irregular ; or, the rapid action of tlie lieart, known as palpifa- timiy may be induced ; or, the motion of the heart may he brought temporarily to partial aiTest, and syncope or faintness be the re- sult.
DreORDEES of ^ntE RESPmATORY OR BREATHmO Sv8Ti:M*
Three disorders of the respiratory or breatlnng system are noted in the College lists as specially connected with the pregnant sUte. The iirst is I/f/spmmy or dilBcult brcathiug, an affection most commonly developed in the later stages, wlien the eidarged womb pressing upwards upon the diaphragm interferes with the movements of that great muscle of respiration, and encroaches on the cavity of the chest itself. Tliis oppressioti of breathing, thougli not in itself dangerous, except in the rarest instauces, is distressing, and frequeutly remains until the end of the condition
PHEONANCY AND ClULDBIHTH. 296
from which it springs. Tlie second difficulty named is called ot*- tfmptimi^ and i.^, ia fact, a dyspriosa, or difficult bi-eathiiig, during which respiration can only be carried on, effectivelj, when the l>ody is sitting up ur Ptatiding. On lying down the chest cannot he duly tilled with air. This derangement is nc^t, as a iiile, de- j>endent on pregnancy alone. It is usual for the per&on in %vhom it occurs to be at t!ic wuno time affected with &ome actual de- rangement of tlie breathing organs thcniHclves, such as aetliina or chronic bnmcliial disease. The third disorder named is deserihcd Bimply as cough, and refers to a frequent or it may be a constantly Incurring cough, excited by reflex nervous action frotrj uterine irritation. The c<»ogh is most commonly developed during tho early part of pregnancy, and often goes away, entirely, in the lat^r months.
DifeiORDKRS OF THE NeRVOUS SySTEM,
Tlio nervous system is most apt to be subject to disorder during the period of pregnancy. The following are the derange- ments officially defined as the most important.
Nenralgiac paitis, of a veiy acute kind, are of rather common occuri'ence. They often start suddenly* without any previona warning, excite excruciating pain, and then pass away in a mo- ment) with as little apparent reason for ceasing as for coming on,
Tliere are three varieties of these neuralgias of pregnancy, each one named after the part affected. 1. Oihntalyta^ a sadden and severe neuralgia in a tooth, presenthig itself as a toothache of the intensest character. The tooth or teeth in pain ntay lie quite free from organic disease. 2. CephdUih/la^ a similar intense pain affecting the head, and producing M'hat is described as violent and intolerable headache. 3. Mastothjuia, an extreme nenialgic pain Affecting the breast ; perhaps the most intense of all, but liappily the least frequent. To these forms of neuralgia miglit also prop- erly be added facial neuralgia, — tic dohmreux ^ stomach neural- gis, — gastrodynia ; and neuralgia of the sciatic nerve, — scicUica. I have known these last-named derangement!=^ happen as fre* qoenUy during the pi-egnant condition ati the three speciidly no-
300
DISEASES kUTD ACCIBENTS CONKECTED WITH
ticed, although they are not so severe, and are, therefore, not
distinctively classified.
Chorea and Convulsions.
The affection which we have already bad before ns nnder the name of chorea, or St. Vitus' dance, is sometimes present during pregnancy, as if dependent on the peculiar condiHou of the pa- tient. When it is calle<l fortli tbe sufferer is, I tbink^ always pre- disposed to it, or to some allied nervous disease. The chorea, in the majority of instances in w^hich it is present, is marked in the earlier stages and subsides in the later, but I have known it to continue quite to the end, and only cease after childbirtlu In this form of cliorea tliere is no necessity for tfie existence of any or- ganic disease as its cause. It may be entirely dependent on uter- ine irritation in a predisposed subject
Convulsive seizures may take place during pregnancy, and may be hysterical in character, or true. The hysterical convulsion is commonest in tlie earliest portion of the period, and though alarming to those who look on is, in reality, attended with little danger, and 'is not likely to be of permanent nature. The true convulsion is commonest in the later stages of pregnancy, is often due to the uterine pressure and temporary congestii)U of the spinal cord, and may be of serious ijnport. Fortunately the convulsive derangement ceases, with few exceptional instances to the con- trary, at childbirth.
HVPOCHONDEIASIS AND MaXIA.
The pregnant woman may he subject to that singnlar depres- sion of mind and nKu4>id sense of fear and fancy, which we have had before us in a preceding chapter under tbe head hf/poehofidri' asis. The affection is exceediugly uncommon in women at any time, and is not very common in the pregnant woman. I have seen but one illustration of it in practice. When it does occur the sufferers are, constitutionally, of a nervous temperament, hyster- ical and desponding, and the symptom which lasts during almost all the period is not always removed by the act of childbirth. It should be looked upon rather as a constitutional than a special condition*
Mania is a loss uncommon disorder of pregnancy. It assumes
PREGNANCY AND CHILDBIRTH.
301
I chamcter of an acute madness wlimi it is developed. It is developed ill any portion of the pej-iod, though niost ut't^ii in the second or thiixl month; it may be of short duration, but it is apt to be recurrent. It is, 1 think, only Been in those in whom the prueUvity to mental derangement is strongly marked.
DlSOKDEKS OF TIIK Gl-AXDULAB SySTEM,
It has been stated that salivation or overaetion of tlie salivary glandii is an occasional symptom during pregnancy. Other glands are sometimes affected, the kidneys being those most likely to be ijjipliciited. This may easily bo assumed when tlie position of the kidneys in relation to tiio increasing pressure produced by the en- larged uterus is considered.
ASruminuria from the pressure of the womb on the kidneys, and the congestion incident to the pressure, is a functional de- rangement of moment when it is present. The symptonis are tliose which have been described under the head of acute Bright^s disease at page 214. They are, fortunately in tlie large run of cases^ only temporally in character, and they disappear when the act of childbirth has passed oven
Dtj8u/'i(u or difficulty of void hi g the renal secretion ; ineonti' mmwe^ or difficulty of retaining it ; and reUntiony ai-e otlier tem- porary ileraugementa incident to tiie pregnant condition, which, though very painful to boar, are rarely prejudicial to life.
Dekanoekents (jf tue Utejune System.
During pregnancy the organs most concerned, the uterus and its Beighboring parts, arc apt to be subject to derangcmeut beyond the changes natural to their function in the ]*rocess of child-hear- ing. The uterus during this state may be affected by inflam- mation, victritls^ giving rise to uterine irritation, to fever, to sym- pathetic pain in the stomach, and to hysteria. It may l>e liable to dist'harge of watery fluid, //y^/rf/r/'A/ie^/ to r/uumatt^m / to aCQte nervous pain unattended with inflammatiou, hysicral^ia * to epnrious ])aiTis like those of labor* to severe stpfMm or ^ramjt ^ to discharge of fluid colored with hlooiX^ Hart^uineons d'tfif'hanje ^ to actual loss of blood, kemorf*hafje ; and, to the three kinds of di^pLa^ment: (a) prolapsus; (h) hernia; (e) retroversion, which have been explained in a preceding page.
302
DISEASES AND ACCIDENTS CONNECTED WITH
Affections coxNErrEB with Delivery or Partckition.
The delivery of tbe child may be contrary to natural course fioni tiiree causes; 1. From delivery before the completiou of tlie developtiieTit of the chikl to tlie extent of enabling it to exist as an indepetident life; abortion. 2. From delivery after the time when an independent life could be sustained, but before there is eoiiipleto developtiient for natural birtli ; premature hirth, 3. From development out of the uterus itself, us in the FaUopian tube ; extra-^uterlrie gestation,
When tlie period of devdopmeiit has attained its natural dura- tion and the growth of the cliild is complete, m that it is ready to be born, there may be affections connected with its birth, from uterine or other causes, which are briefly classified as foF lows:
Atony J or want of power in the muscular walls of the uterus for due expnbive effm't.
(her-distcidiim t if the ut^^rus, (a) From excess of the liquor atniiii or fluid surrounding the child, (b) From pi-esence of twina or triplets.
J/er/unifcnl fihstntdion to the action of the uterus from a variety of causes, [a) Frotn occlusion or closure partly or wiioUy of the month or neck of the wunib or of the passage below, (J) From riiridity, narrow ncsj*^ cicatrix, cysdc growtli, cancerous growth, prohipt^us of the bladder, distention of the lower bowel, or, prolapsus of the boweL (c) From tumor; uterine, ovarian, pelvic, or externah {d) From polypus, {e) From fracture of the pelvis or bony basin which supports the abdominal organs, {f) From exostosis or botiy tliickening of the pelvis, (y) From dis* torted, or contracted, or diminutive pelvis. (A) From dislocation of the lower or lumbar vertebrae into the pelvis. (/) From fixid- ity or anchylosis of the terminal bone of the spinal column, the coccyx. (J) From extreme anteversion of tlie womb with pendu- lous abdomen, {kj From peculiarities of the child, namely, exces- sive size, malpcjsition, nuilformation, or enlargement from disease. (/) From nnuKiial thickness and resistance of the membrane>> wdiich envelop the chihh (m) From imnsnal shortness of the umbilical cord, the vascular cord wliich connects the body of the child with the placenta or af ter-birdi*
PRKGNANCr AND CHILDBIRTH.
303
Hemorrhage, or loss of Wood during labor, is one of the seri- ous accidents which sometimes occur, and which occasionally prove fatal during chikiljirtli. In thc^se days, however, so exact has obstetric practice becunic in tlie Lands of scientific practi- tionei*s» that fatal loss of blood or hemorrliiige during parturition 15 comparatively rare. In no department, in short, has medical science come nearer to exactitnde of rnle, and with more snceess from exactitude, than in tliis department of the trcatnient of the parturient woman.
Uterine hemorrhage during delivery is said to be of the three following kinds :
1. Unav<nd<ihle h&nwrtfuiget or j}la^^e?iiaprePina,hxnx} tlie pla- oenta presenting itself for birth before the child. The plat;cnta is the interconnecting organ between the uiother and the child ; and, as the mother supplies it with blood, as the child derives its supply of blood exclusively from it and retm-ns its blood to it by the umbilical cord, and as it is a net -work of blood -vckscIb, it Is almost imiMi^ssible that it can be expelled first without the acci- dent of loss of Wood. Hence tins hemorrhage is styled unavoid- able. Fortunately here medieal art, again, comes in, and by changing artilicially the mode of delivery, brings down the child first and averts the danger. The operator skilfully converts the accidental into the natural eonditiou, and secures the safe de- livery.
2. Acrif/ental /ler/ifyrrhags^ in which tlie placenta is acciden- tally detached, is a second form of loss of Ijlood which may occur during childbirtli. This danger, like the last named, is now usu- ally averted by the skill of the obstetrician.
3. Tfitotnhu^ of the neck of the womb, or of tlie parts, or ibia, beneath is said to be another c^iuse of hemorrhage. The
lonii thrombus is a very absurd one, but it means really in this instance a swelling attendc^^ wifh much disteiition of the blood- Teioels, or cflfnsion of lilood into the soft tissues, followed by actual loss or escape of blood during delivery. It is a rare acci- tnt, and is not generally fatal when it does take place.
S04
DISKAS£S AND ACCIDENTS CONNECTED WITH
Mbchanical Inj^ctries.
Mechanical injuries to the mother occurring iliin'rig cliildbirth are eoinewhiit coiauu/n and may be very severe, leading to long- standing and troublesome affections* Thebc injnries consist of riiptiire<3 or lacerations of parts involved in the act of parturition, and are classed under four divii^ions; (a) Rupture or laceration of tlie uterus or womb, (5) Laceration of the vagina or canal leading from the womb to the outlet. (<:•) Rupture of the nri* nary bladder. (^7) Laceration of tlie j^crineum or stretch of skin and mu8cle between the outlet from the uterine passage to the outlet from the lower bowel
The gravity of the injuries Uius inflicted is very different in character. Rupture of the uterus or womb is an accitJent of ex- ceedingly rare occurretu^'e, and happily &o, becau.ne it in ulmoat of necessity a fatal accident. The same may be Baid of rupture of the urinary bladder. Rupture of tlie vaginal canal, also rare, is a serious but not necessarily a fat^d accident. Ku}>ture of the perineum is the moat frequent accident, and at one time was followed in many cases by extreme after suffering, which lasted throughout life. The tear or laceration produced remaining un- healed, a source of sujjport was lost, and the deficient sustaiimient caused a persistent iuJliction* Kow, by opciative skill, brought to a degree of perfection which leaves little to be desired, the ruptured parts are made to reuidte and assume their original and natural function, AuK^ngst women of savage tribes, who are un- aided during childbirth, the accident of laceration of thepermeum is commoti, and so serious as to be a cause of premature exbaus* tion and decline. The uterus may also be invtrU^d, turned inside otJtj from childbirth, an accident which, though foruxidable to read of, is less dreaded by the accomplished accoucheur than many otliers that have been inferred to and that teem of less importance.
AocroKNTS WITH THE Fl^ACENTA OR AfTEB-BTRTH.
Delivery of the placenta or after-birth is sometimes a cause of
* difficulty and of danger during childbirth. In the natural way
the placonta is thrown off entii*e, by one or more contractions of
the uterus, a few minutes after the birth of the childj upon which
PliEGNANCY AND CHILDBIKTU,
805
the tit^riis, fully contracted and feeling like a crieket ball tlirougli the walk of the abduoieu, remains in a rpieRcent state, whereby the act of childbirth may be said to be completed. Under less natural circiinui^tances the placenta may be a cause of trouble from what is technically called its jxteiithn. Retention of the placenta 18 induced by one of three eanees : (1) It may fail to be thrown off owing to atony, or want of expulsive power of the ntenis. (2) It may be retained by an irregular contraction, or, ae it is often designated, "honr-glass conti'action *' of the womb, the organ being contracted in its ^yenti^e, Boniething like an honr*glas8, and holding the placenta firmly in the contracted part or enclosing it in the space above. (3) It may bo detained by preternatural ad- hesion to the uterine wall, and may be so adherent that consider- able force has to be used in removing it from its attachment. All these difficulties are in our day met by the skill of the ob- stetrician, whu removes the placenta without subjecting the child- bed woman to danger from it^ long detention.
Affections Following CmLBBiRTn.
There are several affections following childbirth which deserve to be briefly stated* The most immediate of these is loss of blood, called technically prnt-partum hemorrkmjej and which u often conM»quent on one ur other of the causes wliich have been noticed in connection with childbed hemorrhage itself. There is a fever of a tenijKjrary kind, which sometimes follows the reaction of la- bor and is called putt'peral ephemera. This has alrea*]y been de- scribed as the affection termed milk fever or weed, at page 56, amongst diseases that run a definite course. Under the same head is &Uo ii\cluded the serious affection following childbirth called \pt$erperal or childbed femtj a distinctly contagious malady. To i these have to be added, as occasional affections, inflammation of the peritoneum, tnetro-peritonUIs and puerperal peritonitis ; the formation of abscess in the iliac or pelvic regions, ilieLC or pelvio €A90€9$ ; slf?u'jhin</ oi tlieneck of the womb or neighboring struct- ures; tlie various kinds of Jistuluj which have been described already ; intfumfuatian of the hrea^t^ and breast abscess.
Two other affections following on cliildbirth are of a kind in which the nervous system is. involvedj namely, puerperal convul- \ iioiifi and puerperal mania.
306 DISEASE8 A^TD ACCIDENT8 CONNECTED* WITH
Puerperal Convulsions, Eclampsia.
Puerperal convulsions have a distinction and importance as in- dicating a special form of nervous disturbance. Tlie convulsive seizures may commence during the period of labor, but more com- monly they follow delivery, They may contiime in repeated par- oxysms for several hours, and be attended by inseusibiUty, the end, unfortunately, being in \m\x\y instances fatal. I believe, from my own observation ttf the plienomena and of the causes that lead to them, tliat there are at least two varieties of eclampsia : one, in which the convulsive moments are reflex, and result from irrita- tion in the parts locally concerned in childbirth; the otherj in which the seiznt-es are due to the accumtdation in the body of some poisonous exci*ete, probably urea, which ought to have been thrown ofif by natural excretion, but wliich has been retained, owing to tlie pressure of the gravid womb on the excreting renal glands. The nature, however, of eclampsia remains yet to be learned with precision, as docs also the gra%*e question of its suc- cessful management for the purpose of prevention or cure.
Puerperal Jfaniu.
Puer]>eral mania may be connected with parturition or with the yielding of milk, lactation. The attack is of a mental kind, and is often at first very severe, amounting to violent frenzy, with ftberratiou, under which deeds of violence of the worst kind may be perpetrated. The severity of the acute symptoms is somedines resolved by sudden and complete return to n)enta1 health ; but^ more commonly, the acute stage is succeeded by one of melancholy and depression wliich lasts for many weeks or even months. In most iii;?tances of puerperal mania the hereditary proclivity to mental disease is distinctly marked. One of my medical con- freres, who during a professional life of fifty years had been en- gaged actively in attendances at childbirth, once reported to me that he had never known an instance of the disease in which the proclivity was not traceable.
Still and Peematitre Birth.
The College authorities place under the head of ** conditions not necessarily associated with general or local diseases," still and premature birth. These accidents, occurring naturally, are due
PBEGNANOY AND CHILDBIRTH. 307
to a series of causes rather than to any one particular cause. They ireaometiinefl doe to accidents which befall the mother, sncb as frights, falls, and other physical shocks, enfeebled health, anxiety, insufficient rest, impoverishment, and the like. They are some- times due to intra-nterine changes, such as degeneration of the placenta and accidents to the umbilical cord. Again, they may be due to diseases originating in the offspring itself, diseases which extend to more than fifty in number, including many of those which affect persons in full life, not excepting cancer itself, of which there is more than one recorded example.
Once more, the event of still-birth may happen from disease which Uie offspring shares with the mother, such as communicable disease like small-pox or fever, or disease from absorption of min- eral poisons like lead, or vegetable poisons like ergot or opium. In such cases it sometimes happens that the child dies while the mother recovers. The still-birth event may also be the result of accident, or of diflSculty occurring in the act of childbirth.
But on the whole the gi'eat cause of still and premature birth is constitutional in its nature, and is specially due to that taint of constitution which I have had to describe as specific disease, syphi- lis. This cause may affect the offspring through either of its par- ents or through both. It leads to impaired nervous life in the offspring and thereby to impaired nutrition, and it leads commonly to dcgeDei*ative changes of the placenta or intercommunicating vascular link between the mother and the child. Thus directly and indirectly it is of fatal significance.
BOOK THE SECOND. ACQUIRED DISEASES.
DISEASES OF ABTIFICIAL ORIGIN. PHENOMENA AND
COUKSE
INDUCED OR ACQUIRED DISEASES.
In the previous book, treating on the history and phenomena of what> in the present state vf our knowledge, may fairly be called natural diseases, I have classified the diseases according to the parts of the body in which they ai"e manifested. This plan seemed to me to be lugieal, because in the natm*al diseases the phenomena presented are distinctive, while the cauees are often obscure, and admit only of being diseuesed after the phenomena to which tliey give rise are correctly known. The causes are not sach as we ourselves knowingly produce, or primarily understand ; they are tliei'efore only discoverable by tracing them back through their effects, and under the most careful tracing they still remain^ to a large extent, unknown.
The diseases to be disenssod in this second book, are diseases artiiScially produced, aiid, if I may so express it, are of human de- vice* They are induced or acquired. The causes of them are in our own hands. We produce them, and the phenomena flow from iuch production* It would not be logical, therefore, to put for- ward the phenomena barely, and afterwards tu treat of tlie causes* It is the natural course to classify the causes, all of whieh are known, in the simplest possible manner, and to display the results springing from them in direct line.
Tliis procedm-o is the more necessary because, as will be seen by the history that is to follow, the diseased states which date ^'' tn hmiian origins, are less localized in character than are those 'wuch are of natural development. Thus out uf one cause of ar- tifieiat origin tliree or four, or even more, distinctive forme of disease may arise, so that a classification depetident upon the phenomena, apart from cause, would lead to endless complication and to repetition of the same cause for various diseases.
It may l>e that in course of time, as knowledge expands and gi*^ncrali2ation becomes somider, the natural diseases will be viewed in this same light, and that nmnbers of natural diseases^
CHAPTER L
ACQUIHED 31SEASKS FROM INORGANIC POISONS,
The inoi"ganic poisons which produce diseases in man are of two classes, the solid, which are more or less soluble, and the vaporous or gaseous.
Disease from Arsexic.
The salts of the metal arsenic, so much used in the arti^i, are insea of at least twu kinds uf disease : one direct! v affecting per- sons who are working in arsenic, as in the making of artiiicial flowers, ornamental papers, cards, paper- hangings, dresses of ladles^ and candle^: the other affecting those who occupy rooms, from the walls or othei* parts of which particles of arsenical poi- eon are being diffused into the air. The fir^t may be called the acnte, the second the sub-acute or chronic type of arsenical disease. Acute arsenical dkease.—The acute type of arsenical disease has been described as a form of phthisis pulmonalis, or consump- tion of the lungs, caused, it was believed, by the dii*eet absorption of arsenical dust. When the disease occurred it was thought that • the absorption nnist have taken place through the pulmonary sur- face, but the death, st^me yeurs since, of a girl who was engaged in making artificial flowers led to a modified view. On that occa- sion Dr, Ilassall showed that the local action of the poison on the skin is directly injurious. The green powder, diffused through the work-room, settles on the head, face, neck, and hands. The luwds, Dr, Haaaall stated, become stained of a green color, wliich no washing will remove. At lens^th ugly-looking sores appear on various parts of the body, inehuling chiefly the exposed parts, and there is constant soreness of and nmning from the eyes. The t and throat are sore, and there is cough. Finally, from the Mtion extending from the throat along the alimentary canal, there is irritation and pain of the stomach, diarrhueaj and absorp-
316
DISEASES FROM INORGANIC POISONS.
tion of tlie poi&on, attended with all the symptoms of acute ai^sen- ical poisoning.
Dr, Ilassall pointed out, further, that ball dresees colored widi areenical pigment are a source of danger to the wearers of the dres&es as well as to the manufacturers of them, and I also col- lected some cases of disease, induced hj the absorption of arsenic, amongst wearers of artificial flowers colored with arsenical pig- meiits as well as among artificial fiower-makers. My experience is to the effect that aUhough absorption may be by tlie skin the danger is most frequently developed through the lungs and throat, the arsenical substance teing apparently absi^rbed by the mucous surfaces, Tlie more serious disease to M'hieh the workers are sub- jected is commouly called consuniptiooj but it is not a consump- tion uf the ordinary kind, although it is attended with wasting and sometimes ends fatally. It is accoinpaTvied by that remission of fever and flush of the face, to which the name of hectic iscom- moidy applied, but it is rarely accotupanied by spitting of blood, and it often proceeds a long time without any cough, except the throat cough which springs from irritation at the back of the throat. There is also, as l>r, Ilassall describes, irritation of the luenilirane of the nose and of the eyes, neither of which symp- toms are necessarily connected wnth constmiption. In the end, the guffei'er, if i^moved from the work in time, may make a fair re- covery, which would not be the case if attacked with true tuber- cular consumptioTL
In some parts of the paper-staining process, the dust of arsen> ical coloring compounds is thrown oil. This dust, dissolved in the mucous seiu-etions uf the mouth and tliroat, is Bwallowed into the stomacli, and sets up tlie irritative symptoms of elow arsenical poisoning, viz., pain in the stomachy redness and soreness of the throat, and irritability of the skin. I have seen one instance of this kind, where the symptoms amounted to a modified form of gastro-enteritis. In the mildest of these irritative states of the mucous membrane there is created a persistent dyspepsia, so long as the excitant is at work*
Arsenical salts are employed for the preservation of some or- ganic suhstances, as, for instance, for the preservation of the skins of animals, and, under some circumstances, where the preserving process is not carrie<l out with proper skill, minute particles of the salts are thrown off, Hoat iu tiie air^ and so become inhaled.
BISEASES FROM INOKGAlfl^IO POISONS
317
I hflve twic^e seen ejTnp turns of arsenical irritation pi-oduced in tliis manlier in a person wlio liad the dusting and cleaning of staffed animalB, in a dose and badly-ventilated nmsenni.
Suhaeutc arsemeal diitease. — Some painful affeetions hare been traced to long but less severe exposure to arsenical gases or ar- eenieal particles. The sjinptoms tiius excited are of a class analo- gous to those above described but in a modified form. They are iivniptonis of chronic catarrh or cold aflfecting the mucous mem- l>rane of the eyes and of the whole bronchial puhiionary tracts the nostrils, the throat, and the bronchial surface. It has been assumed that the skin may also 1x3 affected with eruption of a 8f|namous or scaly character from the same cause, and some ob* eervers have traced out a series of nervous affections more or lese severe, and often obscure.
About twenty years ago a dispute arose in the world of science on the question whetlier arsenic could he distributed through the air, in mirtute particles, from walls covered with arseuical pa|>ers^ and so l>ecome poisonous. On this important point an experi- mental inquiry of a very conclusive character was conducted by Professor Abel. h\ the experiments wliich Abel carried out, a I irge tube was filled with slips of arsenical paper-hangings and the tnbo was placed in a room, the temperatm^e of which waa raised to 90^ Falir. Tltmngli tUh tube air was constantly drawn hj moans of an aspirator, and was collected in test st^hitions. Tlte experiments were exceedingly varied^ the paper holding tlie arsenic Vjcing in some cases roughened and in other ca^es treated with paste in a state of decomposition. The air was made to pass over the arsenical surface for periods of nine days. The result of all these experiments was that not a trace of nrR?nic could lie detected! in the solutions; neither were any particles of arsenic mechanically carried over.
In a funher experiment six hundred grains of finely pow- dered Scheele's Green were uniformly dispersed through a quan- tity of cotton wool sufficient to fill, compactly, a tall jar of a gftilon capacity. A tube, charged with cotton wool and connected with a test apparatus, was passed to the bottom of the jar, atid air was drawn through the apparatus eoutinuoiiBly for one week, tlie jar being placed in a temperature of 90° during a portion of the lime. Not a trace of arsenic was found to be volatilized at the eoneJusion of this experiment.
318
BISEASES FROM TNOttOATnC POISONS.
For many years these experimental facts led to tlie conclnsion*
that ai*ftenieal particles can only be diffused iu the air when the fiurfuee eoiitaiiiing tiie arsenic is very rough, so tliat the arsenical colors are loosely attached. At the earne time, a great deal of evidence was colle*!ted by different observ^er^, indicating that symptom B of arsenical poisoning were produced in persons wlio were exposed to arsenical surfaces of a smooth kind^ and even after such surfaces had been submitted to varnislu These obser- rations led Dr. Hambergof Stockholm to suspect that the arsenic might escape in the gaseous form, that is to say, in the form of arsenide of liydrogen. To learn if this was tlie fact, he drew tlje air of a room that was papered with a light-green colored paper through retined test solutions. Tlie color of the paper had undergone a gradual alteration: one part of the arsenious acid liad l>een oxidized to arsenic atnd, while another part had been reduced and liad been combined with hydrogen, whic!i being vola- tile was passing off as a gas, and which he detected in his experi- ments.
We may gather, then, in considering the action of arsenic upon those who are exposed to it, the probable fact that those exposed inhale, during the exposure, the gaseous arsenic, or, speaking more correctly, arsenic in the gaseous state, in conil>ination with hydro- gen. This explanation accounts for many of the facts that have been observed, the? arsenical gas lieing poisonouw in such minute proportions, that even to work with it in the laboratoiy requires considerable care on the part of tlio worker.
M. Delpech points out various details of facts relating to the effects produced by the inhalation of arsenic derived from the dead bodies of aniuials that have been preserved by arsenical pixjpa rations. He finds that dead animals which have been pre- served with Becceur's arsenical soap, and afterwards collected in large nmubers in a Museum, charge the dust of the room w^ith arsenic in such proportions that it can actually be removed from the air an(J T>rove<i bv aualvsis. He too believes that surfaces covered with Scheele's Green may yield arsenical gases, devel- oped by the reaction of the ar&enious acid upon the organic com- pounds with which it comes in contact, and that these gases, mingling with the air, infest it and make it a source of danger- He adds, in relation to the practical bearing of the subject, many iatU demonstrating that people wlio live habitually in rooms in
DISEASES FROM IKOEGANIC POISONS.
319
wliich large numbers of dead birds and mammals are preserved by ai-senic, are subject to symptoms of arsenical poisoning.
In the instances of disease from inhalation of 'arsenic which have come under my own observation, the evidence of the action of tiie arsenic was definite enougli. But the extreme organic nervous aymptoms of convulsion and partial paralysis which have been iw^nietimes described as common to poisoning from slow inhalation of arsenic, have not come so clearly under my own observation,
Dr* Leonard Sedgwick has noticed symptoms of arsenical irri- tation occurring in members of a family who occupied a room decorated with blue paper, in the preparation of which arsenic bad been used.
Disease fbom Cadmtitm.
In the year 1817 Stromeyer discovered the metal known as cadmium in oxide of zinc, and it has since been obtained from calamine and other conjpouuds of zinc* It exists as a native com- poniul, as the sulphide, in wiiiit is called Oi-eenoekite, in Renfrew- shire, and some of the compounds of it, the green sub-oxide ©special ly, and the sulphide or cadmium yellow, are used in the arts as pigments. Some of the salts of cadmium have been ap- plicil to medicinal purposes, and are found to have an emetic action, hut their use is comparatively limited.
The wliite carbonate of cadmium is said to be used in the form of A fine powder for the purpose of cleaning or burnishing plate, and from the absorption of this powder symptoms of a verj' aerious character have occurred. Dr, So vet published tlie fii*fit account of these phenomena. He records three cases of accidents from the use of cadmium in the manner described. The svntp* toms observed, brought on from the absorption of the powder used in cleaning plate, were w^ell marked, and were of a choleraic character. They consisted of giddiness, followed by difficulty of breathing, and afterwards by vomiting and diarrh<.i?a. There was l^reat exhaustion, and severe cramps in the legs, liecovery took place lu every case.
XhSEASES
FROM L.EAD.
I^ad aa a source of disease affects those who are engaged in ^painters work, pottery works, lead works. It also sometimes af- iteta through water that has been cai-ried through leaden pipes.
320
DISEASES FROM INORGANIC POISONS*
Tlie diseases induced by lead are of two kinds, aeute and often transient ; slow and entirely disabling, or fat^. The first or tran- sient fonu consists of ejmptomg of intestinal spasm, colic aa it is commonly called ; the second of paral^fds. I have seen, but this is of rare CKscnrrence, an intermediate disease, in wliieh the inter- nal spasm, succeeded by fever and by tbe extrication of an ex- treme fetor from the breath, has ended in a paralysis from which the 6ick man has recovered without other symptoms. Occasion- ally the spasm of the intestines* colic* ends in death ; but, as ft! rule, there is perfect and often rapid j-ecovery from this symptom.
The paralysis from lead is sometimes deterniinately serictus from the first, and is so distinctive that the term '* saturnine , paralysis ■' has been applied to it. It is in some respects like thai! form of paralysis from alcohol which has Ijeen compared with the general paralysis affecting the insane. It differs from this and from other paralytic affections in many i-espects^ notably in the following particulars —
(1) It attacks most frequently the muscles of the upper limbs. This is so commonly the ease that Tanquerel affirmed he had only seen tlie lower limbs involved in one case out of one hundred and two. His experience is exceptional. I sliould place the occur- rence of general paralysis, involving the lower limbs, after paraly* sis of the arms and hands, at one in eleven. Still it is the broad) fact that the muscles of the hands and arms are those in w^hieh the failure of power apj^ears first, and that the failure in a large majority of instances is confined to these parts.
(2) In this paralysis the extensor muscles, the muscles hj| which we extend the limbs, are first and most seriously affected ; hence tlie origin of the condition kno%*n as " drop wrist '' f mm lead, in which tho extensor nmseles lose the power to lift the weight of the hand. Later in the course of t!ie disease^ the same deficiency extends to the muscles that raise the limb altogether. The luss of fiower which is induced is due, in the first instance, to failure of nervous etimuhis from those nervous centres which direct and excite the muscles of the upper limbs of the body to motion. There is no doubt that all the muscles of tlie limbs ar^ paralyzed ; but, as relatively, the group of extensor muscles is less powerful as it is less massive than the group of flexors, the ex- tensors are those in which the enfeeblement is first discovei'ed and continues longest
DlbEASES tUOU IKOKOAyiO 1»0lS0K9.
321
Man J investigations have been made to determine the mode in which the lead poison acts in causing the paralytic state; but in this dimction little that is definite has been revealed. In what form of clieinical combination witii the tissues the metal lead is fixed has not been detenmiied ; all that is known is that the metal is distributed largely through the body in the cases tinder notice. It ha* been found in tlie liver, the blood, tlie nervous substance, and tlie muscles of tl»o»e who have died from it ; but how it is combined in those parts is not ascertained. The nearest approach i^iowardg an explanation is, tbat as a salt of lead it acts on the "•Ibuminoufl parts of die tissues^ coagnlating them, and becoming itself combined with the solidified structure. In this way the activity of nervous action would readily be cut. off; but why par- ticular parts of tbe nervous syi^teni should sneni to l>e involved in preference to other parts is difficult to answer. After a period id inaction from lead paralysis, the muscles waste, they become of fa^^ color and shrunken. From this state they never recover, and when the heart, which as we know is a muscle, is involved, tiie sinking into death is inevitable. Lead paralysis becomes here<iitary.
While the patient is suffering from the influence of this simple but potent poison, other parts of his bifdy, besides the muscles and nervous centres, undergo organic changes. Along the gums a deep dark blue line extends, which si>ecially indicates the action f>f the metal* The line is narrow and may pi-esent different nhadei^ of color, varying from a light leaden hue to a dark blue or purple. The darkened surface is very sensitive, and if pricked gives out dark fluid blood. The structure affected is ratber firmer than is natural, and shows signs of shrinking. The line is pro- duced by lead in combination with a compound of sulplmr, and El!iiidicates that the system at large is under the influence of lead poison. The visceral organs, the liver, the kidneys, the lungs^ show a reduceil nutrition and shrinking of their tissues.
It is assumed that lead enters the body in various ways, ac- cording to the mode in wliicli it is presented. By those who are working with the oxide of the metal it may be iidialed as fine dust By those who are working with it in the form of paint, painters^ and by thoBe who use it in solution, potters, it is supposed to enter by absorption through the skin. When it is taken thrnugh water il 19 ab6orbed by tlie stomach. From what I have gathered from 21
322
DISEASES FROM INORGANIC POISONS,
workers in lead in all departments, I am inclined to the opinion that a]>&urption bj the stomach is the most common eource of danger.
The potters find tliat sohitions of lead may be applied freely over the external surface of the body without producing effects of a deleterious kind, and I have had convincing evidence of this from men who have worked in ^jhitions of lead for years and have never shown a sign of leatl-poisoning. The evidence, on the whole, is strong, if not conclusive, tliat in most cases of lead-poi- soning the poison is swallowed by the moutli. Tlie workman or workwoman, becoming careless after a time, takes np bread or other articles of food with hands soiled with lead. Thus a little^ lead is taken daily, and in time the mischief is done.
It is one of the pex^uliarities of this agent of disease, lead, that it is, what is designated, a cumulative poison. Some injurious agents am 60 soluble they are readily carried out of the body when once they have l>een received into it> They accompany the excretions, and at brief intervals make their escape. Other foreign and in- jurious substances are of organic cliai-acter ; these are decomposed or broken up in the chemical processes that go on within the body, and soare eliminated. But lead, an inorganic and sparingly solu- ble substance, is thrown off witli great difficulty* Its chief mode of exit is by the excretion from the kidney. For a time this mode of elimination is sufficient to prevent the general poisonous effects' of the lead from becoming active; but at length the action of the poison upon the kidney is to cause chronic inflammation in it, nephrosis, as it is called, with destruction of the delicate mechan- ism of the organ and ijuperfeet function. Then, the mode of es- cape cut off, the poison commences to accumulate in the system and disease is established.
Disease from MERtTiTRY.
In past days persons were often medicinally subjected to mer- cury until they were affected with swelling of the sali%'ary glands, profuse salivation, and extreme depression. Under this condition the teeth are also affected, there is intlammation of the connecting membrane l>et ween the teeth and the alveolus, swelling of tho gimiB and great pain, followed by loosening of the teeth in their sockets, and absorption Ijoth of the tooth structure and of the
BI8EA8ES FKOM IXORGAIJIC POI80K8.
323
:)las. The teeth are left loosened and became necrosed or
kiUed.
These calamities Lave practically ceased, but others from mer- cury fitill occur. Salts of mercur}" are einplojed iti preserving furs aud skins, and from tliese the poisonous particles of the iiietallic compound are given off. In this manner packers of furs are af * fected, sometimes very seriously. A man, thirty^wo years of age^ so affected, was admitted into Guy "a Hospital in Deceiuber, 1S03, under Dr. Owen Hees. He had been engaged four years in pack- ing the skins of animals tJiat Lad been prepared with an acid eo- lution of mercury aud then dried. Until the skins were perfectly dry he had nothing to do with tLeui, His duty was to pack tLem afterwards. He was salivated for three months, recovered, and remained in good health until twelve uioutLs before Le was ad- mitted into tLe hospital. At that time his hand became unsteady, and he could not shave himself; a little later he lost power in his limbs when standing or moving, and afterwards began to have twitxjhingsand tremors when in bed. Soon he was unable to walk without assistance, and a day or two after admission into the hospital Le was seized witli dtjlirium. Ue became paralyzed and uuconst-ious, and died within fifteen days from the time of liis admission. The mercury was detected in the organs of this man.
The workers at mercurial mines are still tiuhject to the danger of mercurial finnes, especially when they are engaged in the out* mde works^ preparing and subliming mercury.
Tlie disease excited by the fimies varies according to the mode in which they are ialuiled. The most f rec|uent symptoms are sali- vation and ulceration of the month. In some instances the stom- tli is fii*8t affected; tliere is pain in the stomach, constriction, Sleeplessness, and cough. Thei?e signs are followed by those of fialivation ; and in some exampleg, first observed by M. Ferrand, there is a red rash on the Ixuly, like tJie rash of scarlet fever, which lastd for several days, and leaves rheumatic pains in the limhs.
In yet another class of cases the symptoms are more purely nervous, and are those of neuralgia, accompanied or followed by mnscnlar tremor, called, significantly, mercurial tremor. The whole muscular eystcm is, in fact, thrown into constant feeble c»Dtr»ctions and relaxations, over which tlie patient can exert no
In the cxtremest forma of disease from mercurial ijdialation,
324 DISEASES rmm I^oKGA^uc roiso>*s.
the teeth bccoTne carious, and eveti the bones are affected. Some idea uf these varied forms of disea&e may be obtuiiied from the facts tlmt have been collected at Idria in Austria, Here there are the second best niercm-ial mines in Enrope, and over five hundred men are employed at them. Tlie works for smelting and purify- ing are al>out a mile from the mine.^, luit the men change about eo that all ai*e equally engaged at the various parts of the works. In one year Th\ Hermann found that of five hmidred and sixteen men thu8 employed, one hundred and twenty-two were attacked froni the mercm-y, with the following forms of disease: Twenty- seven had netiralgia; fourteen rlieumatiem ; mx tremors; sixteen salivation ; and two cariehi. Herman n states that in tlie valley of Idria all tlie people, and even the domestic anhnak, are liable to be attacked with mercurial disease in one or other of its phases*
Disease fkom Potassa BicnKOMATE.
Of late years, since bichromate of potassa has been nsed so largely in the arts, certain reniarkable affections have been ob- served as occurring from it» They have Ijcen presented under two conditions, namely, during the manufacture of the salt itself, and during the nse of it, in the form of solutionj in water*
Jiichromaie Uheration,
The first observer who specially detected disease arising from the bicliiximate, was a French p>hytsician, I>r* Becourt. By an acci- dent Bccourt met witli a man who was engaged in a manufactory of biclirouiate of potassa, and who was suffering from a pecidiar kind of idceration in the fac*e- The case was studied by Becourt in consultation with the distinguished hygieuist, Chevalier* and they both came to tlie conclusion that the bicliromate of po- tassa was probably the cause of the disease. They failed to obtaiJi from the man, however, any such j^articnlars as they could con* sider satisfactory ; they therefore k.>i*ked in other directions for more knowledge. After a time they obtained fmm the director of a nranufactory at Graville the information that many of the workers in the manufactory were subject to a peculiar fi>nn of ulceration.
In transforming neutral chromate of potassa, by means of cliromic acid, into bicbromatej the vapor arising carries with it
DISEASES FROM INORGANIC POISONS,
335
an infinity of pulverized iiio]e<]ul68 of the prcKjuct which epreacl tlirongli the workfiitop. A cloud of particles is easily visilile in a ray of BUnligliL The particles, if itispii-ed abundantly, give to the palate a bitter and disagi'eeable taste; but, as saliva h profusely pnjdiiced, the ebromate is thrown oft and has not tuae to inflict injnry.
If, instead of breatliing by the month, which for long periods of time seems impossible, the particles are drawn in by the nose, great irritation of the delicate membrane lining tlie nose is pro- dnced, there is a violent sensiitiun uf pricking, euffnsion of tears, and iri'esistihle sneezing. There follows upon this ulceration of the septum <»f the nose, — ^the partition that divides tlie nostrils, — and ultimately the septinn is destroyed alt^igether and lost. Upon this the symptoms cease, and the workmen, as a nde, continue fiteaiiily at their employment withuut further suffering.
Chevalier and Beeourt are of opinion that this process of ul* eeration of the nose is not j>rodnced in those men w*ho take simff*
The same observers noticed tliat if the skin of the bcMJy be nnbroken, it may be exposed to a strong and even to a heated so- lution of tlie bicliroinate, or may remain for many h<mrs in actual contact witli the salt itself witliout any bad effect. Bui if the skin be torn, or abraded^ or cut, and the salt be left in contact with the wound, the caustic action is so intense that eev^ere inflammation follows with decomposition of the living tissue. The caustic action is so gi*eat it does not cease until it has penetrated to a bone. The pain of the ulceration is excessively severe. They also observed that when a moist surface of the body is exixised in creases or fulds to this salt, a peculiar irritability and itx?liingis set up* This is unattended by ulceration if the part be not abraded by rubbing, but. under abrasion, a troublesome and very painfid ttlceration occurs.
M. Clouet, a manufacturer of bichromate of potassa at Plavre, Itfls added to the above factr^ others Avbicb are of great impoilance in their practical bearing. He shows that the inferior animals suf- fer frora the effects of the bichromate as severely as man. Horsee emph>ye<l in the mannfat^tory, and whicli walk over the bicliro- mate sfdt^ are attacked in the feet ; the lioof falls off, and the ulceration extends to the npper part of the leg. In one instance of this kind, ivcordcd by Chevalier and Breourt, a liorso was at- tacked in one of its hind feet, and was quite disabled. The nicer
396
DISEASES FROM IKOROANIO FOISOITS.
ation extended through the liinbs and through nearly Iialf the body of the animal, and death occurred within a month of the couimeneement of the malady. Both legs on the aifeeted side were entirely ulcerated* It was as if the decomposition, when it had commenced, went on indefinitely as a veritable metamorphosis of the 8kin and liesh altogether, analaguiis to a fermentative action. Dogs and cats and rats were discovered, in the manufactory, suf* fering in a similar manner.
Bichromate of potassa taken internally by the mouth is a pur- ' gative, and in large doses of front fifteen to twenty grains is poi- sonous. It causes severe colic and purging, but no vomiting. If* Clonet, to whom we are so much indebted for ijiformation on this subject, and who first made observations respecting the in- ternal action of the bichromate, states that in one manufactory some workmen inflicted the fuolisli and practical joke of putting bichromate of potaasa into a ban-el of cider belonging to certain of their fellow- work men. The cider was rendered of a dark color, but, notwithstanding, the workmen drank of it, and were all af- fected witli severe colic and diarrhcea, from which, happily, they recovered.
Bichromate PUyHaiii*
I have been miable to trace ulceration from the bichromate in England. But amongst English operatives I have recently ob- served a series of facts iJhistrative of the action of a watery solu- tion of the bichromate on the skin. In that part of the autotype process in which a solution of bichromate, containing from thrc^e to five per cent, of tlie salt, is employed, some of the workers with the solution are affected by an irritation wliich extends over tlioso parts of the hands and arms that are exposed to the irritant. There is at first a redness, erythema, over the parts affected, which is followed by a considerable amount of irritation, with raised spots, ending in a reddish, scaly exfoliation of the upper skin, rery much like wiiat wo have already studied under the head of pityriasis rubra. The eruption passes away in a few weeks after the hands and arms are no longer exposed to the solution, and the disease never extends deeply nuless there be a sore or wound of the skin. Some workmen suffer much more severely than others, and are much longer before they make a recovery. A few eseapej altogether, and that even though their skin be of delicate texture.
DISEASES FROM INORGANIO F0IS0K3.
327
Disease from Potassittm CYAimjEL
Serions symptoms are Bometimea produced fmm the absorp- tion of cyanide of potassium by those wlio are en^^agcd at work wbere solutions of this subHtancc ai'o employed. The danger af- fects those, specially, who are engaged in photography. It seems to arise from direct absorption of the poison by the skin, but only when the skin is wounded, abraded, or cliapped. My attention was first c-alled to this subject by a photographer, who consulted lue for a series of syinptonis with which I was not familiar, and which could not ho accounted fur by any evidence leading to the
1 suspicion of organic nervous disease. The symptoms only came on when he was at his work, but they lasted for some hours after he had left his work. I suspected they might be due to the in- haling of the vapors which am present in the working-room of the photographer ; but this theory was exeliuicd by tlie fact that lie had worked for many years in the same place without being
i Affected^ and that none of tlie workmen who were in the room with him were similarly affected.
These circumstances led me to look out for hjcal absorption by tlie skin. I found that the hands of the man were severely
[ehapped, and that they had been so on every occasion when tlie phenomena recurred ; for the phenomena wei-e repeated many times before their cau:>e was disco vered< I was now on tlie right track^ and by directing him to give up that part of the employ- ment which involved exposure of his chapped hands to the solu- tion, tlie patient experienced a cpiick cessation of his symptoms, and recovered from them without any recurrence.
The symptoms are exceedingly characteristic ; they begin with vertigo. A sense of giddiness is gradually developed, with a sen- Mtion aa if all objects were passing in a circle, and then as if the body of the affect t^d person were turning round. At times there ifi a further sensation of falling, as tliough, of necessity, the body
(magt pitch forward, and as if the lower limbs w^ere unable to sup- port the weight of the body. These symptoms may last for B^_uue hour«, and if tliey are not exceedingly severe they will sul>side when the work of the day is over, and will not i-ecur until the re- Buuipti<m of labor on the following day. They may be entirely misunderstood^ and indeed often are misunderstood. In their lighter manifestations they are attributed to biliousness, or to in-
DISEASES FROM INORGANIC POISONS.
jgestion. When they become more sevei^e another symptom is
Padded ; the giddiness or vertigo is attended witli nausea and famt-
ness, BO that it is iniposgible to go on with the work. But even
from this more extreme condition recovery is rapid after exposnit*
to tlie cause ceases*
Under still further exposure the body becomes cold, and an extreme sliivering takes place, which is succeeded by a pn»8ti*ation that altogether hicapaci tales from work, and is connected with a fieriea uf new nervous phenomena of serious moment. The first of these nervous signs is double vision ; the patient, that is t^ say, in looking at a single tibject sees it as if it were two objects, or as if both eyes were separately discerning the one thing.
Finally, tliere are nniscular tremors which are alt^igether be- yond the cnntrol of the will* Tiie tremors do not amount to spasms of the museles, bnt they are sufficiently active to cause in- voluntary movements of the limbs, and they are attended with occasional starts and twitchiugs. Tlie temperature of the body h lowered, tlie appetite is greatly reduced, the secretions are con- finedj the face is pale, the action of tlie heart is quick, weak^ and irregular, and the sense of exhanstion urgent- The mind through- out is unaffected, hut ihero is, perhaps, an unnatural tendency to sleep.
The poison being soluble finds its way out of tlie eystem witli mwlerate rapidity, and thprcui>on all the severer symptoms are removed, but some remain for several weeks. The streTjgth re- turns but slowly ; dyspepsia continues as a very troublesome symp- tom ; antemia is a marked condition ; and, the lilood, which ha8 been rendered very fluid, escrapes too freely from wounded surfaces*
Some examples of poisoning by the local absorption of cyanide of potassium have been reeunled, in which symptoms still mom alarm ing than any 1 have seen have followed upon the accident One remarkable case of this kind is given by Dr. Davanne. A gentiemim who lm*l stained his hand with iwtrate of silver en- deavored to remove tlie stain by rubbing it very freely with cya- nide of potassium. In this process he slid under the nail of one of his fingers a small portion of the cyanide salt. At first he did not notif-e what had happened, but in a little time he felt a severe pain in the part, which after a few minutes was followed by an intense vertigo, so that all objects appeared to be moving around him. To relieve himself^ promptly, he conceived the idea of
DISEASES FROM IXORGAKIC POISONS. 329
washing the part freely with vinegar. The vertigo now increased, was accompanied by sUiverings, extreme pallor, complete loss of sight, and entire prostration ; even the power of speech was lost, but the intelligence was, throughout, preserved. The limbs were YeTy cold, and as the sight returned the phenomena of double vision were manifested. These alanning symptoms were not altogether removed within a period of ten hours, but I'ecovery ultimately took place.
DiSKASE FROM SaLTS OF SiLVEB.
When some of the salts of silver, the nitrate especially, are brought into contact with the skin, with moisture, they produce a dark stain, which, ordinarily, is only of temporary duration. If the salt be taken internally in small quantities, and for a consid- erable time, tlie whole of the surface of the skin becomes dark in color. The discoloration or stain is fairly distributed over the surface, but is most marked in those parts of the body which are exposed to light, as the face and hands, in which parts I have known the stain to be as deep as the complexion of a mulatto. The discoloration gradually lessens in the course of years, and it may be somewhat reduced by medical art, but I have never known it pass away entirely.
Disease from Zing.
Men engaged in bronze founding are subject to serious symp- toms from inhaling the fumes of oxide of zinc. The fumes rise to the mouth of the workman and settle on tlie lips, causing some- times a whitish efflorescence. After long exposure to these fumes choleraic attacks are induced, with shiverings and severe cramps in the muscles of the legs. Vomiting is induced, and the food taken undergoes a peculiar fermentation, causing water-brash. Zinc-plating and the manufacture of " corrugated zinc " are also attended with most pernicious results to health.
Disease from Sodium Chloride, — Common Salt.
Seafaring men, and others who have lived for a long time on salted foods, are subjected to an induced disease called commonly "sea scurvy," but which is more correctly defined as "saline
330 DISEASES FROM INORGANIC POISONS.
piirpnra,"^ inasnmcli ae it depends on the action of the salt which 13 taken with the food. The physical change induced consists of a modification in the state of the blood. Tlie specitic weight of the blood is imdiily increased, the plastic constituents of the blood are held in too extreme a state of solubility, and the coj-puscles are reduced in size and made irregular at their edges. The effect of these changes is to render the blood so flidd that it pours out of a wound or into the soft tissues with unnjitural readiness. From such parts as the gums the blood exudes freely. It infil- trates into the skin, causing dark vascular blutclies, purpuric spots, and, sometimes from a wounded surface, or even a weakened vas- cidar surface, it flows so freely that danger of deatli from the loss of it becomes imminent. In addition to these changes there follow indirect modifications in other organs, owing to t!ie readiness with which, in its unnatursd saline condition, the blood atti-acts and condenses water. The nervous centres suffer in consequence, and extreme prostration is the result.
Disease from Coppes.
Tlte salts of copper are sometimes productive of disease, tlie acetate being the most commonly offending substance. Food re- tained in copper vessels lias become poisoned, and peas, beanSp and other green vegetable products boiled in contact with copper, for the purpose of increasing or preserving the green color, have also been i-endered poisonous. The symptoms are choleraic in character, and attended witli severe irritation of the stomach and bowels. When the dose taken lias been large, coUapse and fatal exhaustion have supervened ; or, the acute symptoms having sub- sided, long-continued irritation and even ulceration o£ the mucous tract of the intestinal canal have set in, followed by slow and im* perfect recovery.
CHAPTER n.
ACQUIRED DISEASES FROM INORQAmC GASES AND
VAFORS,
Bv a gas is meant a siibetance which is ordinarily known tons in the gaseons form of matter^ like the air wc breathe. A gas is incondensible into a liquid or Bolid under the ordinary atuiosptieric pressure, at conitnou teuiperatures.
By a vapor is meant a more readily condensible aeriform fluid which has taken that form from a hquid or solid, mider the influence of heat^ and is diffused iu the air. It is usual to epeak of a vapor as being derived from the volatilization of gome volatil- izable body like water-vapor,— steam, — from heated water.
Sometimes gases or va|M)r8, given off from various substance*^, are called fume?. The vapors given off from heated resin, from phosphorus which is being oxidised, from mineral acids, such as the nitric or hydrochiorio, are commonly called fumes, I prefer to apeak of them as gases or vapors.
Gases and vajx»rs when inhaled pass, like tlie air, into the windpipe and Imigs. Diffused with the air, they may reach the blood which has been sent from the right side of tlie lieart to the lung'4, and absorl>ed by it may enter the blood-stream and condense in it. They have, therefore, a general as well as a local action.
Disease i^oM Ammonia Gas.
In many industrial occupations ammonia gas is liberated in free quantities. In the process of felt hat-making shellac is dis- solved in a weak solution of ammonia. The felt is then steeped in the solution, and tlie ammonia, volatilized by heat, charges the atmospliei*e with its vapor. In other occupations ammonia is libenited in the decomjKJsition of ammoniacal salts. In a tliird das-i am muni a is given off from decomjJObing organic com pounds. In all cases the workers are exposed to the ammoniacal ^s.
WWOM INOBGANIO
of opinioi] exists on the qnestion of
^ii miicted by the inhalation of aniniouia. Some
•M . .^nvwl at the conclusion that the gas inflicts no
4Ui oi opiniufi that the injury is mueh less than
sappofltd. When, however, the inhalation
<^^ QOttlnuiedi certain physical effects result
:t«idiif«Kl iBJiirioii& The blood is rendered an-
-Aioi^ of this Uood are clianged in form and
H\\ uitt iiiiitiiiiw of the blcKxI is reduced, and the
-k *vitirtl hmr ihm-lr been described^ is developed.
I (iviv uv HtfiM^ MiKit|Mt»itts ill which decomposing organic i*e-
T'^Mkm wAwUA yield to tlte air of the place whei'e . I <4rrieit oa «e emaiontacai sulpliiir odor which is
4 mhidk #Tini Umts tlie clotlies and person of ' hanfii eugiged io the latK>r of making cat- l>Mit wbi> are engaged in dressing skins i>: attd tboee M*ho act as bone-sorters and <>ijt<t Io Ihfifie odors. A woman who waa ^m ^kmm oertipations, and who came to a pub- ^i^lUi^k I vuft physician, for medical advice, was W tolerated in the waiting room with >, jui«l she had to come in after all the (mm the fellmonger's yard and frtun > 1$ detectable even at long distances ^ r a^mned, at first thought, tliat the . , V hours avery day such an atmos- '^r tKmi £«>me marked disease. I am hound sup|x*rt of this suspicion is all but to discover any definite symptom M callings as the result of the labor, ^^;^ii^tical faets that illustrate an unusual
iHMiVMi tmoH Cabboh BistiLPHmE.
^^
vyrv iliwigreeable volatile fluid, known origi- >ut|vliur, then as sulphuret of carbon, and iv^ liiM come int^ great use in various in- . «>tti|JoYed for taking grease out of wool : iJKmlkm uf parafflue; for extraction of ail
OASES AND VAPORS, 883
5m oil-cakes when pressure is of no further use ; fnr draining the sawJutit ii^ed in retining oil by filtration ; for extracting grease from bones or kitchen refuse ; and for extracting aroinatic essences and perfumes from plants. But the most important use of carbon bi^uljjhide is, j^erhaps, in the nianufaetiire nf caontflione articles, toy-balloons, and water-prootings. In making toy-balkK)ns the bi- 6n]i)lude is u^etl to diseolve the caontehouc and bring it into f^uch a state of softness as will allow it to yield to the blast of air from the bellinvs. In water-proofing, it is used for the varnishing with india-rubl>er. The peculiarity of the bisulphide of carbon is, that on its volatilization the substance liiss^jlved in it is deposited, while it, itself, diffuses in vapor through the air.
The action of tins vapor on the workmen was originally de- scribed by M. Delpech to the Academy of iledicine of Paris, on January 15th, lS5t>, The effects ai'e [xjeuliarly severe. They con- fiist, firsts of acnte symptoms of anaesthesia, with intoxication, which afterwards become cl ironic. The head is imich affected at all times, and partial insanity is not infre(|uent. The taste is vitiated ; the Kight and hearing am troubled ; the digestion is perverted so that the appetite is increased, even to gluttony, and there is persistent nausea. The breath itig organs, tlie organs of the circulation, and all the secreting organs are demnged, and such enfeeblement results that the workers, so long as they continue at tlieir work, are simply wretched.
Jfo name can be found for this particular disease in the old clasfiification of diseases. It i^, in fact, a malady, sni f/fntriM, from which the victim of it suffers so long as he labors, Tiie symptoms inehide derangement of mind as well as body. The disease ap- proaches most nearly to the general paralysis of the insane, and we may chissify it as i^rSnil j>aralt/^U,
Under an improved hygienic system, including better ventila- tion of the factories in wdiich the bisulpliide of carbon is used in the arts, the resultant dangers from its use, above described, have been greatly reduced during the last few years. They are not, however, as yet entirely removed.
Disease feom Carbonic Okjde-Gas.
CarV>onic oxide is the product of the imperfect combustion of 4Wbon in oxygen. It is pr*xluced in large quantities whenever •cfctrcoal or coke is burned in common air, as is so often done in
m ioidiifitrial oecapatione. Tbe
I found bv direct experi-
of this gas* pi-odticed, by
STinptoine, namely, giddiness,
t of tbe heart, tremulous and con-
, mnd naui^ea* I also discovejed,
m iStS^ th« cturions fact that prolonged
. xsi wulB qiuuilitie6, giTes rise, tempo-
:i«i«ftas dmbetas,
Mmt»«xpueed to carbonic oxide, certain of
» aflBBii are frei^uently induced when the
^adni itt m dosed room. I have found tin-
friMU Uiis canse, and tlie influence of
makers and all others who are
vj^'er dHt baae» of incandescent cote. After a
>^i» bMonMy to some extent, aecugtomed to the
M^t^mm ttol tborefore mitigated, though they
Thm duel qnnptouis complained of may be
- _«j mxdwBitigo. The sufferer tells you he is
^ouidi. and thai hi^ hand becomes unsteady at
^lia-wwk for a time, enters into a better at-
■nd returns to his work again to feel the
cmm of a brazier who worked in a small
. cbUitig-dish at all times on his bench
irotts^ the symptoms weit? at first those
en 6^> vomiting, flushing of the face,
.'iiutitig round, and faintness. He be-
' — ^ symptoms after a time^ but lost
£ help feeling giddy, do what he
rs* Things seetned to be moving
*^ady. An improved system ol
:ii^ pmducts of respi ration, pat
tfered for a considerable time
i'/^ frame suffei^ from carbonic
rs. In cold weather they are led
J cote beneath the frame, and
, :iie object being to keep theii*
<^ of thcii* work, which requires
at In this way the women
GASES Ain> VAPORS.
335
are made to breathe an atmosphere charged with carbonic oxide, from which they suffer severely, at first with acute, afterwards with clironic symptoms- The acute symptoms are headache^ gid- diness« naosea, f aiutnees, fliishino^ of the face, and irre^ilar action of the heart. The chronic symptoms are, failure of appetite* fetor of breath, a nervous, hysterical coadition, and ansemia, with great depression of mascular power.
It has not aa vet been ascertained whetlier the disease diabetee haa actually been excited in those who work in an atmosphere containing carbonic oxide, but it lias lieen observed, in corrobora- tion of the experimental evidence I before mentioned, that some men exposed, by accident, to the gas were rendered diabetic for a perird after their iH?covery from the narcotic effect and from the other immediately dangerous conditions into which they had been east. Carbonic oxide forms a part of all coal gas, existing in the purest coal gas in considerable proportions — 7.85 per cent. It thus becomes diffnsed, in small quantities, from the burners into the air of badl y-vx'ntilated rooms and shops in which gas is largely employed for lighting and warming, I believe that in this man- ner carbonic oxide is a common cause of nervous derangement and dyspepsia.
Carbonic oxide is the chief cause of the headache^ nausea, and giddiness which are experienced whenever coal gas is directly es- caping into rooms where it is introduced for lighting or heating purposes. Carbonic oxide also escapes, sometimes, from badly C5onstructed furnaces and poisons the air. An instance of this, described by the late Dr. John Davy, took place in a church at Ambleside, and caused serious illness to large numbers of the congregation.
Disease fbom Chlorine Gas,
Workers engaged in the manufacture of chloride of lime are exposed to dilorine, one of the moat fatal and dangerous of gases. At the works where chloride of lime is made chlorine is con- Teyed into chambers or rooms closely vaulted in. The chambers are lighted by strong panes of glass which, firmly inserted in the wall, are just suflScient to allow the yellow color of the chlorine in the chamber to be seen. Within the vaults are shelves on which lime is laid before the chlorine is admitted. Then^ the vault
336
DISEASES FROM INOBGANIO
l)eing closed, the clilorine is allowed to enter and remain in con- tact with the lime to form chloride of lime.
When the cliange is complete the doors of the vanlt ar opened, and the workmen enter to remove the chloride. They wrap I'onnd their niouthB large ehawls or towels Baturated with watei' hefore ihey enter, and they come out, f ret|uently, t*) l)reathe fresh air. The water in the towels absorbs much of the chlorine, and direct risk is in this manner saved, but they rarely escape eome risk, atul often come out with gi*eat oppression of breathing and irritative cough. They suffer also from irritation of the con- junctival membrane of the eye, caused by the gai^ and they use this irritation as a test of the endurability of the atmosphere within the chamber. If the eyes do not become irritable they feel safe in continuing at the oecnpation.
It seems clear that after a time the workers tolerate the inha- lation of chlorine to a considerable extent and, from this cause, suffer nmch less than would at tirst sight be expected, Xeverthe- less, in all I have examined, — and I once had the opportunity of carrying out an extended examination, — I found no clilorine workers who were free from affection of the lung. They all pre- sented signs of bronchial affection, with anaemia, and they aU complained of occasional paroxysms of spasmodic breathing. The healthiest one amongst them was pale, with purple congested lips, indications of frequently distressed breathing and perma- dently impaired respiration.
D1SKA.BK FBOM Copper Smokk Vapors,
The action of copper smoke vapor, on those >vho are expos to it, is to produce asthmatic seizures in the older operatives in additi<>n to a bronchial irritation which it excites in the younger. The snmke is extremely destructive to vegetation. Its inllucnce on vegetation may, indeed, be summed up in one won!, — corrosive.
Although the f tunes are called copper smoke, the amount of copper in them is minute. One half per cent, only, exists in the deposit in the interior of furnace chimneys, and so little is dif- fused in the air that none can be detected a few yaitls fi'om the works, except when the smoke is extremely dense.
The late Dr. T. Williams, F.Il.S., of Swansea, from whose analyses we receive tlie above and the best facte, states that the
GASES AND TAPORS.
337
prodacts of tlie smelting operation are divisible into two parts, the gaseous and non-eondensible, tlie solid and condeiiisible f iimea.
The fames Miiicli condense in the culverts contain oxide of iron, oxide of lime, and traces of antinionj and other metalsj with a proportion of about 44 per cent* of pure copper ; 5 per cent, of arsenious acid ; 10 to 15 per cent, of Bulpbur ; 15 to 20 per cent, of sulphuric and sulphurous acids in combination ; 14 to 19 per cent, of water.
The smoke which escapes into the air frotn the cliinmejs con- tains coal smoke in abundance, witli traces of ar&enic and of sul- phurous and sulphuric acids, Williams reekuued that 829,790 cubic feet of sulphurous acid were sent into the Swansea district every week from the copper smelting works adjacent. This acid can he de- tected in the atmosphere twenty miles from the works. Sulphune acid ie also diffused with suJpliurous. For every fifteen parts of sulphurous acid in the smoke there exists one of sulphuric acid in combination* l^pon these acids is chargeable the destruction of the vegetation of the district*
Tlie ciittle feeding in the hicality are afFected with a disease termed by the Welsh farmers '' Effydrdod." This disease is joi inflammation of the periosteum or membranous covering of Wne. The bone becomes thickened in the neighborhood of the johits. There is inflammation of the joints witli effusion of fluid into them. The Imnes are prone to fracture. The teeth stMnetimes fall out and sometimes decay. Willi.nms, whoso description is here again followed, attributes the symptoms solely to the sulpliur- UU8 and sulphuric acids. These acids, brought down by therain, render the grass sour, and the eating of the grasa by the cattle eaiises the pecnliar malady.
Disease from Vapor of Hvdrochlobic Acid,
In 0ome chemical factories the vapor of hydrochloric acid pro* duces injurious efl^ects, and, to a certain extent, the action of the vapor 16 felt by men who use this acid for soldering and other mechanical purposes. The symptoms produced are dryness of the mucons membrane of the nose, mouth, and throat, with suffo- cative cough, and sometimes spasmodic difficulty of breathing. In some workmen considerable irritation of the nmeous membrane of the nostrils is induced by this vapor.
22
|
^H 336 BlrKA.iK.-i ^^^1 |
|
|
^H being closed, the clilorine i ^^^| |
|
|
^H tact with the lime to f |
^^^H |
|
^H When the ehangt |
^ i»> _ - mo oeenpa* ^M |
|
^H opened^ and the wurki |
rnen - i-^iged in the ^M |
|
^H MTap round tlieir n |
for two ^M |
|
^H water before they ^ |
matter^ ^M |
|
^H £resh air* The water |
in tl vapor of the H |
|
^^m and direct ri««k m v^ |
i by the work- ^H |
|
^^m 6omo risk, and t>ft' |
-,-. ^^ redness of tlic ^M |
|
^H and irritative i |
• ^ at the back of the ^M |
|
^H janctival niem |
«is A sense of giddiness. ^M |
|
^H this irritation |
Mmrrt^ laboratory the ^M |
|
^H within tlie cUn^ |
^^m ^ery eerions effects, ^^H |
|
^H feel safe in e4.»r |
^vtfKWT once suffered &e- ^^^| |
|
^H It seem- |
^^ 4r iiffictilt breathing and ^^H |
|
^^1 lution of ^ |
txiriu 1^'33« Mi^- Steward, u ^| |
|
^H :»nffermiuH |
: ^ Institution, together ^| |
|
^H less^ in all 1 ^m. |
^^^g^iidfrom this cause. A ^M |
|
^H carrying ont |
^^j yftr* and the two men in- ^M |
|
^H workers v^hu \s |
^ ^ite time felt pain ; bnt botli ^M |
|
^H rented |
^ it dboat thirty hours after the ^| |
|
^H eomph |
^^H |
|
^B Theheaiti |
^^H |
|
^B lipi$. |
^ riKiernoRus. ^^H |
|
^-p^cfsre of phosphorous, or lucifer, ^| |
|
|
.^-: fortythi-ee years ago, created a ^| |
|
|
^^B |
^^ 1^ inhalation of the phosphorous ^| jigufciiir This disease, an extremely ^| |
|
^^^^ to |
^^^imt of tlie worker, causing necrosis ^^k |
|
^H |
ii «s» ■'^ detected until the year 1845, ^| ^^^ in the pnblic hospitals at Vienna. ^| ^j^j^^ for the first liglit tliat was shed ^^ |
|
^■^ Til |
|
|
mmtis^' Tlie mischiefs, when they etc- ^| |
|
|
r^ ^*the use of white photiphonis, the ^| *^*'^~^J',nfii-* In the match manufacture ^H "^^ ig-l^were inhaled at every step in the ^| |
|
|
^^^ de> |
|
|
■ |
|
|
^^L^ iv» |
jgg rf Ae mixture, through the dipping, ^| ^'^^^l,!^ While tlie disease was extant I ^| |
|
' ^v-gt«»tion of it in respect to its develop- ^| |
GASES AND VAPORS.
339
L\ aiHi rt-ported the facts in one of my leMures on
History of Diseases of tlie Tt.etli,-- delivered in li^58,
[ittblLihed in 1860* The facts, briefly described from tltat
that the symptom first complained of was pain, deep
^ teeth, and having, usimlly, one tooth for his centre.
m*ii« not a toothache, nor was it strictly contined to the particular
litit. extended steadily and persistently along the lower jaw,
raa* imich intensified wlien the jaw was gently i>ereii8sed or
ntnick. In time the disease became concentrated in the jaw ; a
iVF inflammatory process occurred and a tliickening of the bone,
ading in death of the bony structui-e, w^ith attempts, in parts, at
?nerat5on. In short, what is called a true necrosis was devel-
pcd. In tlie w'orst cases, where the patient was not relieved by
|»ei^tire measnres, hectic supervened, with copious night-sweats,
extreme pain, and even death from exlianstion. It was remark*
able that no hones except those of the jaw were affected, even in
||l$e worst cases, so that the disease was purely local, and, indeed,
raa disconnected from the other symptoms of phosphorous poi--
ioning. I inferred that the malady was due to a volatile acid of
phosphorus, whicli was abt?orbed by the sali\% and affected the
jawbone whenever tlie teeth became unsound and the alveolus, or
edge of the jawbone, became exposed. Tliis view accounted for
Lttiany of the anomalies, namely, tliat the lower jawbone alone was
'affected, that the enamel of the teeth escaped injury, and that
workers whose teeth generally were sound escaped tlie injury
Itogether.
When the phosphorus disease once commenced, it continued
in progress over periods of one, two, or even three years. It was
in some cases so local i;^ed in its extent that only the teeth came
^out ; in others it extended through the whole of the bone. I com-
ired it, in 1858, to a chemical destruction of the bone, w^ith in-
immation from the irritation produced by the foreign pt^odncts
'of docoraposition. I see no reason to modify that defitiition.
In treating of the phoepliorus disease, I liavc spoken of it in past tense. I have done so because, fortunately, tlie affection is now all but extinct. The discovery made by Lnndstrum, of Sweden, that red or amorphous phosphorus could he applied for Uie productiofi of matches, led to a complete revolution in the ^match making business, and to the introduction of what h called le safety match. By this plan the red amorphous and pracU*
340
DISEASES FROM IT^OKQANIO
innocuous phosphorus was placed on the box, and the combustible substance put on the match was made of materials that were per- fectly harnilesB to health.
Disease from Yapor of Resin.
Some very simple, and as it would seem itmocuous, occupations are attended with bad results from trilling causes. For Jixing the tufts of hair of brushes, such as shaving brushes, a solution is made by mixing melted resin with boiled linseed oil. The workman dips the toft into this solution, and while leaning over it inhales the fumes of resin. Great distress of breathing and irritation are produced by this process. The cough is suffocative, and becomes in time chronic with perBistent irritation. Many workmen have to leave the business from these causes, and those who do not actually retire from the occupation are often obliged to rest from itj on account of the cheat affectionsj for long intervals of time.
Disease from SirLPHUBOUS Acid Gas,
Sulphurous acid, the gas produced by the burning of sulphur, is used for bleaching purposes, and especially for bleaching straw for bonnets. The plaited straw is brought in lengths to the bleacher. It is first soaked in an alkaline solution of potash or ammoniaj and afterwards is exposed to oxalic acid. It is sub- sequently washed in soapsuds, and, lastly, is bleached by being subjected in a closed chamber to the fumes of burning sulphur. Into the bleaching ehaml>er the workman enters to turn and cliange the straw. The air is irrespirable, but by learning to hold the breath for one or two minutes, tlic operati>r becomes skilful in avoiding a dangerous inhalation of the gas. He rarely escapes altogether from the effects of tJie gas, and he still feels the effect while the straw is being retnoved and dried.
The more active symptoms induced by Bulphnrons acid arc those of suffocative cougli, which is of short duration upon with- drawal from the gas, and iloes not seem to lead to any serious bronchia! mischief. But after fi-equent and prolonged exposure to the effects of the gas, die system is influenced through the blood. The blood is rendered unduly fluid, tlie diseased con- dition knowuj technically, as ansemia is developed, and bilious-
4
OASES AND VAPORS.
341
Bess, aniounting even to Jaundice, is, occasionally, an added dis- order.
In coiinection with the effects of sulphurous acid, I have found fliiotlier class of workers who suffer from it in conj unction with effects from another c^iuse of injury. The class I refer to l^are the "fellowship porters/' I discovered in these men, who are employed in lauding merchandise, com and fish especially, that the workers amongst tlie corn are affected not only hy the dust, which is a soui'ce of much irritation, but also hy the escape of vapor of sulphurous acid which exhales from grain that haft been hleached by the acid, Oats coming from Ireland are often bleached in tliis way, and smell strongly of the gas. The admixt- ure of gas and dust is exceedingly irritating to the lungs, and is a cause of broncliial coughs and spasmodic asthma. The connec- tion of dust with the gas must, iu this instance, be taken into consideration as adding very much to the distress, and» probably, &s accounting for the bmnchial cough and asthmatic seizure.
Disease from SuLPHUEEnrED Hydrogex.
In some of the cltcmieal manufactories, and, occasionally, in lal>oratories, the operatives are exposed, at times, to the action of fiulj>huretted hydrogen gas, which is evolved in certain processes of chemit;al dei^om posit ion. Workmen in sewers and cesspools are also exposed to the influence of tliis gas, which is there evolved f roiti the organic decomposing matter.
The gas is an active poison, and death is an occasional result fmni inhaling it. Diffused in breathing air in the proportion of L714 per cent, it is immediately fatal ; and in the proportion of 0/205 per cent, it produces instmsibility, witli feebleness of respi- ration and muscular treujors. Even when diffused in the minute proportion of 0.056 per cent, it causes, when inhaled, distresBed breathing, nausea, giddiness, rrtpid pulse, heat of the surface of tlie body followed by coldness, and after symptoms like those of low continued fever.
These primary effects of the gas, thougli severe when first ex- perienced, pass away after a tijne, owing to the toleranee for it which seems generally to be set up. Hence in tlie alkali districts^ where the gjts is conetantly being evolved in most objectionable qimntities from the alkali lieaps, and where it quickly discolors
342 DISEASES FROM INORGANIC OASES AND VAPORS.
f i*e&h animal substances exposed to the air, it appears to affect but little the health of the persons who live in the districts. I de- voted some weeks to inquiry on this partit^ular point in the alkali districts, and though at first I suffered severely myself, and was absolutely unable to live in some atmospheres in which the gas was present, I found that tliose who were accustonied to tlieui breathed them with impunity, and I failed to trace either amongst the young, middle-aged, or old any special form of disease to which I could give a name as dependent upon the action of the gas upon the organism. A similar inquiry, having the same ob- ject, amongst persons engaged in the sewers led to siuiilar nega- tive i-esults, although I reeeived confirmation of a fact, noticed by other writers, of an occasional accident of actual poisoning from the respiration of an overwhelming dose.
CHAPTER III. ACqUIREB DISEASES FROM ORGAmC POISONS.
DlSEASEB FEOM AbSINTUE,
The substance made and sold under the name of absiutlie is a mixture composeil of 50 per cent, of alcohol ; 0.35 per cent, of oil of wormwood, oil of tlie arfefnisia ahsluihium ; 2^ per cent, of other essential oUs^ usually of cloves ; 1 J of sugar ; and, 45,65 of water.
To give a color to absinthe, tlie juice of spinach, which con- tains a coloring principle, chlorophyll, is added in ginall quantity, by which the liquid is rendered of yellowish green ; but the color ]g not always cared for, and I have seen a specimen of almost amber tint from the absence of green coloring stuff.
The phenomena produced by absinthe in persons who indulge in it are those of alcoholic intoxication, combined with nervous derangement, and a s|>eeitic epilepsy produced by the oil of wonu- wood. There is first intense dyspepsia, with dryness of the nioutli and throat, followed, if the Itabit be continued, witli destruction of all desire for food, until the appetite has been tempted by the "bitter." This marks the first stage of the disease. In tune the nervous system becomes disturbed, and muscular movements cease to l>e i>erformed correctly under the direction of tlie will, such irregularity being attended with vertigo and giddiness. This marks a second stage. Later stitl there is insensibility and epi- lepsy, with recurrent epileptic seizures up to death.
DiSEAflES FROM AlCOUOL.
All the members of the alcohol family, when they are taken into the body in sutFicient quantity to produce an effect, excito dtacase, But, the member of the family in this respect is the common ethylic alcohol which enters into the composition of our
DISEASES FROM ORGANIC POISONS,
ordinary beverages, called spirituouB, bucU as ales, wines, gin, rum, whiskey, brandy, and the like. The number of diseases produced by alcohol liave been variously estimated by different writers. The distinguished Dr. Benjamin Hush i*eckoned twelve diseases from this cause, most of which '* are of mortal natui'e/' Dr. McNifih reckoned twenty^two diseases from this cause, in- cluding, liowever, certain minor effects, such as foul breath, red- ness of the eyes, tremors, and palpitation, which should rather, perhaps^ be considered symptoms of diseases than diseases them- selves. The affections I have myself noticed and reeonled may be classiiied under the following heads,
D^j»pejmiu fr077i Alcohol.
The dyspepsia from alcohol is one of the first indications of its baneful action. The tongue is coated with a M'hite fur, tlie appetite is capricious, the skin is often very hot and then very cold, the action of the bowels is irregular, sometimes attended with constipation, at other times with relaxation. The renal se- cretion varies, being at one time copious and pale, at another time scanty, loaded with a pink, dense deposit, and often coated with a fatty-like iridescent film or pellicle. The sleep is irregular, at times too iieavy, at other times absent during natural hours of sleep. The mind is irritable, and the desire for tlie alcohol grows upon the affected person until tlie poison seems to be an absolute necessity of life.
jyiseases of the JSkin from, AlcokoL
In those who are frequently under the influence of alcohol the external surface of the body is often affected. The skin becomes
easily red and injected, assuming the appearance of enjthenm. The condition shows a relaxed state of the blood-vessels, caused by the action of the alcoholic poison.
The disease of the skiu whicli we have already discussed under the name of a4.me rmaeea is very frequently produced by long- continued action of alcohol in persons in the decline of life. This disease shows itself, as it will be remembered, in the vessels and cutaneous surface of the nose.
DISEASES FBOH ORGANIC POISONS.
840
fif lAtf M^i/rt and Blood /rom Alcohol.
The Leart and other organs of the circulation are affected by alcohol functionally and organically. Whenever a distinct effect is made on the system by alcohol the fact is indicated at once in the motions of the heart. The action of the heart ia quickened for a considerable time, and then becomes enfeebled mitil another qnantit}" of the poison is taken to revive it, a revival which soon becomes a pernicious habit of desire. Persons habituated to alco* J liol, thei*efore, all but invariably present an irregular state of the ' circulation, one moment a jaded, another an excited, circuJation. In time this becomes the ordinary condition, supplemented by in- termittent action of the heart aud by a persistent functional de- rangement which extends through the whole vascular system.
A long-continued functional disorder from alcohol leads almost invariably to organic changes of the heart and circulation. The heart, from frequent over-action, becomes dilated, and its valves relaxed and flabby. The membranous structures whicli envelop and line the organ are changed in quality, are thickeneil, rendered cartilaginous and even calcareous or bony. Then tlie valves, which are made up of folds of membrane, lose their suppleness and valvular disease is established* The (?oats of the great blood* ^ ve^el leading from the heart, the aorta, share often in the same ■ ciianges of structure, so tliat the vessel loses its elasticity and its power to feed the heart with blood by its recoil. In like manner the refined arteries which forui the terminals of the arterial sys- tem undergo degeneration, and the recoil of the arterial system generally i» reduced.
The muscular structure of the heart, owing to degenerative changes in its tissue, fails also under tl*e iulluence of alcohol. The elements of the muscular fibre are replaced by fatty cells, or if not so replaced are transformed into a mmlified muscular text- ure by which the }iowcr of contractiou is greatly reduced. It fol- lowg^ from these facts that the circulation, in all who indulge in alcohoU is subjected to many extreme dangers. Even the func- tional deraugements are not without danger unless all parts and organs of the l>ody are in the most perfect balance and health. During organic derangement the danger is at all times great ; •danger of sudden failure of the heart itself, of rupture of the blood-vessels, of effusion of blood into vital organs like the brain^
346
DISEASES FROM OKOANIC POISONS.
with productiou of apoplexy, or of effusion into other organs^ each as the lungs or kidney, with interfei^eoce of their func- tion. Lastly, there is the danger, always present, of the heart and its subordinate parts failing in power from pi*ematare old age.
The blood is iojiiriouely influenced by alcohoL The presence of alcohol in the blood interferes with the due oxidation* The blood corpuscles are easily made to undergo changes by which they become irregular in diape, triiucated, or shrunken and notched or crenated at their edges. The plastic part of tlie blood is subjected to two niodilications by alcoliol. When the blood is feebly diluted with the poison the phistie part is rendered exceed- ingly fluid, so that the blood flows too easily from the vessels and injects tlie surf aces of the body, giving to the outer surfaces, like the skin, a mottled appearance, which in cold weather, when the vessels are greatly relaxed, extends even to a general bhie- ness or h?aden color. Wlien the blood is strongly charged with alcohol, the plastic part of it, instead of being rendered thin, may undergo coagulatiuu, and by such coagulation may impede the course of the blood in its circulation through the finer vessels or even through the heart itself.
Gout and IlhemfmiimK usually considered as diseases of the blood, but much more probably allied to nervous derangement in regaitl ti> their primary origin, ai-e both influenced greatly, tlKuigh not produced, exelusi%'cly, by alcohol. Gout often owes, without donbt, its origin to indulgence in rich and luscious alcoholic drinks, the drink known as port wine being the most potent of- fender. Such drinks favor rheumatism as well as gout. Their action is compound. They contain saccharine and fermentable principles which unite with the alcohol in favoring these specifle affections.
Dhe^ses of tAs Lunys from AhvhoL
From the paralyzing influence of alcohol on the vessels of the minute circulation, the lungs, as will easily be inferred, soon begin to share in the accidents and degenerations which folluw upon the disturbance of blood produced by alcoholic indulgence. The pul- monary vessels are easily relaxed by alcohol, and as they of all parts of the body are most exposed to chaTiges of heat and cold, they are easily liable to congestion when, paralyzed by alcohol,
FKOM ORGANIC POISONS*
847
they are snbjected to a sudden fall of temperature. Tire sudden coijgestions of the lungs wliieh so tref\\wntly occur in persons who indulge iu alcohol dimng severe winter seasons are i*eadil7 ac- counted for from tliis cause, and the long list of deatlis which tlien characterizes our mortality tables tells, Ux} forcibly, the story of alcoholic devastation.
I obf^erved many years ago that there was a peculiar form uf c<insunjption connected with indulgence in alcohol to which I gave the name of alcoholic phthisis, or tfis conmtmjdion of drunkards. The disease occurs usually in persons over twenty -eight and under tifty-five yeai-sof age* These need not be charged with hereditaiy consumptive taint, though they may transmit the taint they have ac^iuired. They are often considered as very healthy persons, who can endure anything, sit up late at night, and perform any amount of business. They may never have been dnuik, l>ut they are hard drinkers, and they bear drink with a tolerance that is surprising to lookers on. Of a sudden they break np wnth lung disease, they get pain in tho side and pleurisy, followed by cx>ugli, vomiting of blood, rapid fibroid degeneration of tho lung, loss of flesh| and speedy death*
Dimas€4i of the Nervam System from Akvhol,
The nervous system shares largely in all derangements of the body produced by alcoiiol, and, in fact, it never escapes some in- jury. The nervous system suffers from various fimctional aflfec- tioNS under alcoholic excitement and depression. It fails to i*eeeive correct impressions, it fails to send out correct commands, it fails to rest* Ilenee it is sometimes extra sensitive to vibrations set up within the body itself, and hears ninnmiring, ringing, or humming sounds, or sees shadows and spots and glintings which are not natural to it ; or, blunted by excess, is oblivious of impressions to which it ought to bo acutely alive.
One striking functional derangement of the nervous system under alcohol is that which is called insamnia or sleeplessness. The action of the alcohol is to keep the vessels of the brain re- laxed, and no alcoholic sufferer is therefore a trnly natural sleeper. He either lies restless with tho brain imdergoing an unnatural activity, sleeping but for a moment and then waking again, or liking an excessive dose of the poison he produces a congestion' the brain and a torpor which is not sleepj but rather a moditied
348
DISEASES FROM ORGANIC POISONS.
apoplectic condition interrupted by startings and deep snoringB, inid endin*^ in a collapsed insensibility;
In both njen at)d women, bnt in women especially, alcohol leads to an bysterical condition, ak-ofiolk hysteria. This diseafio iij attended wkli great sensitiveness and irritability, noises and ringing sounds in tlie bead, appearance of specks and spots before tlie eyes, flatulency with senee of fulness in the throat, emotional excitement from slight causes, and varied uncertain action of tlie inind, ustmlly accompanied by reckless or feeble indecision of character.
Under the contiimed influence of alcohol the nervous centres nndergc^ degeneration, and then diseases of the most serious kind are the subi^eqnent and necessary phenomena* Epihjmi/ from alcohol is thus sometimes manifested, the disease assuming its most decided form and intensity, and proving, as a rule, fatal. Ajmjyh'xy is a second result from the same causcj and probably is a much more frequent result of alcohoHc indulgence than is com- monly supposed, Tlie accident of rupture of a blood-vessel on the brain is doubly liable to happen in the diseased. from alcohol; firstly, because of the weakened state of the vessels, and, secondly, because of the j>ressure to which the vessels ai*© subjected during periods of excitcmeut from the poison.
But the most detenninate nervous injury resulting from the use of alcobol is Paralf/m^, Wben a persou takes alcohol for the liret time to complete drunken nesSj he passes, tliiongh stages of moderate excitement, of exti*eme excitement, and of depression, into a state of temporary paralysis both of mind and body. Hie nervous system is overjxnvei'ed bv the ak*oliol. In like manner when men indulge for years in alcohol they pass through a series of long stages. At first the poison is to them a source of excite- ment ; then of excitement w^ith depression ; next of depression altogether; and, fiujiily, if tbey continue to indulge in it, of paralysis, Tlius much of the genei'al paralysis met with in our asyhmiB is traceable to alcohol as the cause.
The action of the poison is upon the nervous matter and upon the membranes which cover tlie great centres of the brain and spinal cord* The mendiranes lose their power as chiilyzing struct- ures, and the nervous matter itself is made to undergo degen- erative changes, from whieli follow the failnres of voluntary, and in the end, of involuntary, power, leading to paralytic seiisure and
DISEASES FROM ORGAKIC POISONS.
348
paralyeis. Alcoholic paralysb develops itself in two forms. In some instances it is local, affecting one limb or one side of the body, and not iin mediately interfering with the mental powei-s. In other instances it commences with a lung btago of muscular feebleness, passes into mental alienation, and finally into a loss nf all volitional power. The muscles I'etain some irritHbitity, but the will fails to control them,— general paralysis.
Di-psomanUi, Mania a potu,
A distinct form of disease, produced by the poisonous aetion of alculiul, is that of craving for tlie poison nutil the craving becomes a form of mania* In persons affected in this manner, dipsomaniacs, there is a veritable disease marked by an insatiable desire for alcohol, by the ordinary phyeieal symptoms which attend over-indulgence, by the development of the most depmved animal tastes, and by such extreme derangement of moral faculty that falsehood becomes one of the most striking of the phenotnena by which the dieeaee is characterized. Dipsomania assumes two forms. One, the intermittent, where the craving propensity comes on at intervals of time ; the other, the continuous, in which the craving never actually ceases. Recovery from both forms is pos- sible, during the early stages, under entire abstinence from the cause ; but, as entire abstinence is not carried out, in the great run of cases, tlie connnon end is towards nervous degeneration and mental and pliysical death.
Delirium Tremens.
The disease known as delirium tremens is that most intimately connected in the public mind with aleoho! as the producing agent. It is an acute delirium bmnght on by direct excess of alcohol. Tlie delirium pi*esent8 various phases. Sometimes it is violent, passionate, ecstatic ; at other times low, muttering, and wandering. It is mai'kcd by dread apprehensions and imaginings of the pres- ence of evil spirits, and especially of the devil, the conjured up visions offering to the sufferer all the characters of realities. With this mental excitement there are altemations of fever and cold- ness, of thirst and craving for drink, of maniacal raving, and of heavy prostrate coma. Through all there is one marked symptom, from which the disease takes part of its name, tremo}\ an uncon- trolled action of the muscles, increased by any external irritation*
350
DISEASES FROM ORGANIC POISONS.
This tremor intensifies as the temperature of the body declines, as it does in many cases, even to an extent of from three to four de* greee below tlie natural standard. The disease continues so long as the poison is supplied, and is so often fatal that it yields a cal* culable mortality registered from week to week in tire returns of mortality. After recovery from delirium tremens the body is left enfeebled and the tissues pi*one to degenerative changes. My ex- periments have shown that the admixture of the heavier alcohols, like the atnylie, fusel oil, with the ordinary alcuholic drinks, is a powerful adjimct in the production of delirium tremens.
SUrility and inheriied feMene^ from Alcohol.
Many observers have remarked tlmt pei'sous who indulge freely and for hMi»jj periods in alcohol are subject to the nervous failure called sterility, and ilcNish observes tJiat children horn of parents who are enfeebled by alcohol are apt^ from tlie general defect of vital power in tlie parental system, to be puny and emaciated, and nu»re than ordinarily liable to inherit the diseases of those from whom they spring. I entirely endorse this view as consonant, in ©verj' particular, with my own experience.
Inaanity from Ah^oh^l,
It U admitted, with very few exceptions of opinion, that a cer- tain |H»reeutage <*f insanity is produced by alcohol, but the exact amount is nut satisfaetorily ascertained owing to the complication ariiAtng fnm\ the study of the direct as well as the indirect effects of the |u>ist>n. Profess^or Edgar Shepiherd states that forty per ciuit. \>f the patients admitted into Colney Hatch Asylum w^ei*© hi\ni^ht there from tlie direct or indirect effects of alcftliol. The r iomM-s in fjuiacy attribute only fourteen per cent, from
t i i\ ( H\wv (*l)servers would make it still less than the Com-
uit«aiuiier^ and still otljcrs would make it greater than that which Or, Shephcrtl has recorded. It is perhaps safest on the whole t^ aocH^pt the statement by the Commissioners in Lunacy as founded oil th*> broadest basis of observation. The mental alienations con- iHH^Iod with alcohol as ttieir cause are, melancholia and various cImummi oi Hcttte mania,
dtdancfudia is a common mental disease of those who indulge freely^ for a** l>r. McNisli says, though drunkards over their cups aru tho happiest of mankind, yet in their solitary hours tliey are
DISEASES FROM ORGANIC POISONS.
351
the most wretched. Gnawing care lieiglitened by remorse preys upon their conscience. The weapon they employ to drive away care is tnrned upon themselves; and every titne it ie used, it he- comes less capable of gearing the fiend of niehincholy, and more effectual in wounding him tliat uses it*
JfomH'ulal ffiania induced by alcohol is, iinfoj'tnnately, of too common occurrence to need description* Suiciflal mania from the same agency is still more common. In my own experience I have seen six examples of suicide bronglit on by the poisonous action of alcohol.
Diseases of Olmuhil^iT Orgai\s from Al'Cohol*
Two of the glands of the body, tlie liver and kidneys, are pe- culiarly liable to disease from alcohol. They are the two glandu- lar organs most concerned in the process of elimination of the poison, and are always, until they am structurally damaged, actively engaged in removing it from tlie body. For this reason they, like the heart, are extremely liable to undergo stroetural disease.
The organic disease of the liver called cirrhosis, which has already been described in the previous book, page 208, is so spetn- Kcally an alcoholic malady that it has been called '* gin-driuker's liver." It affords one of the most striking illustrations in the whole range of pathology of a structural disease induced by a known external cause,
Tlie various diseased conditions of tlie kidney known under the title of Bright's diseaFc, also described iii the preceding book, pages 214-16, are coumionly due to the action of the alcoholic poi- son, They may, truly, be induced by otlier causes than alcohol, M by scarlet fever, smalbpox, and possibly typhoid ; but experi- ence has shown that the large majority of cases of t!ie kind is from alcohol.
ihlcultis^ or €tone of the hkidde}\ described at page 217, is in- timately related to excessive use of aleoltolic drinks. Indulgence in malt liquors is a common cause of this affection.
Sunwnary of Diseases from Alcofud.
There are, it will be seen from these last pages, no less than twenty diseases acquired by humankind from tbi.s one poisonous agent alone, and I might have added, if I had entered on specu-
352
DISEASES FROM ORGANIC POISONS,
hitive ground, certain other affections, such as cataract and amau- rosis, as due, in some cases, to the same destructive agent. I might also have dwelt on premature decay and old age from alcohol, the course of which will easily be inferred by the intelli- gent reader.
A substance which leads to so much disease leads also of necessity to a great mortality, from a variety of causes^ physicjil and menta.L I do not think it is an exaggeration to say, as an illustration of this fact of injury and mortality, that in the United Kiugdoni over a hundred deaths by violence occur per week from alcoholic excitement, and a thousand deaths per week from the diseases which directly and indirectly follow from indulgence in the use of alcohol.
Disease from Cannabis Indica, llAsrHisii, on Bako.
The active principle of Indian hemp, called hasehisli or bang, induces veiy detiiiito and peculiar plienomena of disease in those who indulge in it. It is a substance extensively used in Eastern coimtries as a luxury, and occasionally it is resorted to in Europe and even in England* It is an extract prepared from the Indian hemp, and is taken nsnally in the solid form, but eometimes as a tincture.
Like other narcotics, hascliish creates an intense craving for itself. The symptoms which follow upon indulgcTice in it are tlrowstness and intoxicant dreaming, with visions of the most ec- static duiracter, during whicli time and space seem to be expanded into infinite proportions, and all the events of a lifetime concen- trated into a passing moment.
Persons who become confirmed in the habitual indulgence of hascliish seem at last to suffer organically, the mind becoming ex* eit4ihk\ witli mental aberration followed by feebleness of intellect fis the sequence. During the acute period of action, as I observed in a person who insisted on indulging in the narcotic, there is a glight febrile condition, flusliing of the face, dilated pupils, rapid speech, considerable mental excitement followed by hysterical somnolency, sobbing and plaintive utterances, but without any evid^jue^ of physical paiu«
DISEASES FROM ORGANIC POISONS.
Diseases from Chloral.
The saline siibstante known as eliloral hydrate was introduced as a narcotic in 1809 by Dr, Liebreieh, of Berlin. The first in- troduction of it into tliis country was by a Keport of inirje made at the British Association for the Advancement of Science at the Exeter Meeting in 1S61>. In that Report I pointed out that as the hydrate acts by causing a decomposition of the blood, as it nndei^oes decomposition itself, and seizing the natural alkali of the blood adds to t!ie UixkI a new salt, sodium furmatej it re- mained to be seen whether untoward results would not follow upon its frequent use. This suggestion was soon shown to he true, and in a very few months a disease, to wlufh I gave the natne of cfdo7*ali^8ni^ was added to the catalogue of diseases. In 1S71, in a Report made to the British Association at Edinburgh^ I showed that as tliei^e were dipsomaniacs and opium -caters, so there were then lai'ge classes of persons who liad becunic habitual consumers of ehloi*al. Since tliat dav chloralisni has lari^elv in- creased as a form of disease* The symptoms are well marked. The craving for the narcotic is extreme, and sleep is rarely ob- tained without its aid. The digestion suffers, the appetite be- comes bad, and the secretions unhealthy. After a time the circu- lation folh*ws in dci^angement^ the pulse is at one time \ery full and bounding, at another time feehle and irresolute. The ac- tion of tl|e heart is irregular, irritable, and intermittent. Fol- lowing upon these indications the nervuus functions beenme de- ranged, the mind beeomes enfeebled, the temper capjiciuus, the resolution irregular. The limbs are rendered unstefidy, the face u easily flushed, and the eyes are reddened under slight excite- ment.
Under longer-continued use or abuse of chloral the blood b^ igins to suffer. Owing to the action of the now salt with whiL-li it \» charged the blood is rendered unduly fluid, and phenomena like those of scurvy are proiluced. I have twice seen bleeding from the gums brought about in this manner by chloral; and I have several times seen dark blotclies on the skin, — purpurit! hlutches. 1, as well as other observers, have also seen an eruption on the skin which, assuming in the first place the character of ptyriasis, lias passed into ecxema* To this stage of the disease I have given the name nf chhral j)urjmra or scurvy. 28
354 DISEASES FROM ORGANIC POISONS.
In a few other instances I have seen jaundice as the result of chronic indulgence in cliloral hydrate a8 a narcotic.
Disease from Culoroforic
I have seen a few examples of disease brought about by the habitual use of chlorofonn, and have known one death from this canse. The phenomena are usually induced in those who have commenced to take chloroform for the I'elief of pain or spasm. The craving for the agent is soon a \erj marked ejmptom, and the bad resulta of its action steadily appear. The digestive oi^ans suffer, the appetite becomes imperfect, and tlie secretions irregular. The circulation follows in disorder, tlie heart becom* ing irritable, palpitating, feeble, and intermittent. The nervous system is speedily deranged, the memory is rendered treacherous, the mind depressed, and tlie sleep all bat impossible without the narcotic. Jaundice is another symptom occasionaJly incident to this form of induced disease.
Chloroform administered by the surgeon sometimes destroys life, I have estimated the fatality produced by it in this way as at the rate of one death to 2500 ad minist rations.
Disease from Etiiek,
The light fluid substance called ether, or more correctly ethylie ether, and whicli is used by tlie surgeon, by inhalation, for the production of general anesthesia, and iu the form of spray for local amesthesia, is sometimes a cause of hiduced disease, I have known symptoms of disease to follow tlie habitual inhalation of ether, and though tliey are transient in character they ai*e serious so long as they are present. They consist of fulness of the head, stupor, unsteadiness of gait, and a sense uf falling forward. During recovery there is a tendency to hysterical laughing and sobbing, with extreme sensitiveness to sounds, symptoms which remain for some hours after the inhalation has ceased, and which arc attended with dys]>epsia.
In and alx>ut Draper's Tohti in the north of Ireland a practice has been in existence for nearly foii;y years of drinking ether in- stead of alcohol. The craving for the agent is very great, and those who are habituated to it often take several ounces of ether
DISEASES from: ORGANIC POISONS.
355
per day* Direct intoxication is tlie common and ftpeedy result of this procediirt}, lint tho insensibility does not last long, and is fol- lowed by far less distreBsing syiiiptoms than those wliich .^^iiceeed upon intoxication from alcohol. The evidence of organic disease frvnn ether drinking is not very decisively marked, bnt the dys- peptic and other symptoms noted above^ as following inhalation, are generally present if the indulgence be carried to a great ex- tent Occabionally death succeeds npon taking a large dose of ether, Dn Morewood of Draper's Town has witnessed fonr such fatal results, and has seen many cases in which the symptoms pro- duced were all but fatal in degree.
BlSKABE FROJf NrTROCS OxiDE*
The gfts known under the name of nitrous oxide, and which is used as an amesthetic, chiefly for the extraction of teeth, is some- times a cause of induced disease. Sir Humphrey Davy, wito first introduced nitrous oxido as an anaastlietic, so habituated himself to the inhalation of tho gas that lio could not, he tells us, look at a gashtilder or watch a person breathing %vithout feeling the desire to inhale. The Rvmptoms the gas induces are those of sleep, ac- companied with dreams more or loss ecstatic in character. Con- eidering how largely this gas is used it is remarkable what a small nnmlier of injnrions effects are caused by it. Sir Humphrey Davy does not seem to liave been physically injui'ed by it althougli ho iahalod it so many times, and, as we see, modem experience of its use rnns in confirmation of the same fact,
I have twice, however, seen results from it that assumed an alarming character. In one instance continued headache, vertigo, and nausea f*>llowed its administration, with very slow recovery. In another instance tho phenomena induced were far more severe* The headache and vertigo lapsed into a fielzure reseml>!ing epi- lepsy in character, recovery from which was followed by hysterical unconsciousness, febrile excitement, extreme dyspepsia, antl recnr- rent convulsive movements* The affection thus excited lasted, in ita acute form, for several weeks, and ended in a slow recovery.
In very rare examples nitrous oxido has proved immediately fatal 'during iidialation ; but it must be admitted that this ex- treme accident has occurred less frequently from it than from any other anajsthetic.
MMII.Sra FBOX OROAXIC POISONS*
DiSXASS FBOM OpIOf.
^.^ , * ms of induced disease nnder two
uues ialialed as opium sinokc. It is K .xt»a in ikn suiiil form, or in the form o£ tinctui'e.
' abit very extensively practised in East*
^ ed to be on the increase, as a pi*actice,
Lon deem^ to be somewhat divided in regard
' sve myself directly observed
, ^ ^ ve uf most serious miechief,
«' dunl ut^:9iue. Thtt habit, when once it is commenced, ?s devotee, in the end, to a pitiable ily iruictivity. The symptoms in- w and I'cstless di^eaming. After a I, the circulation is iiTegular, the ^■' ^n indifferent, and the seci^etions i^, in the end, premature and >i viiai powvr. 11^ ar drittldiif hmds to a series of phenomena of <liir^i> > «r# fu^ wdferm and long pei-sistent. Tlie acute
4««MI4 <irv tb^Mi« oi ilwige uid wandering dreams, occurring Jili^ii dMfk and followed, after waking, by diilness, v^WllI tn iImi IummIi and mental depression. In the con- iMlw %\m menial depression continues, in an in- s aii^ t**^ nioi-e had to the cause of it. In
vt^m0 ^ -. L'd on a new food the desire for
what iitay be called an insatiable instinctive ^'i of opium the digestive organs soon , ,,,L' appetite is impaired, the secretion of l>o\^-eIs are constipated, and there is a per- id of emptiness in the abdominal . . . ,..c bad digestion and assimilation the .Uirinkis the circulation becomes feeble, the .* ^uiek and irritable, and the tongue dry, red, ' * ^ In the end the centres of the nervoua >. and paralysis of some jxirtion of the i44V tlw* U>wer limbs fail first, then the muscles of ^••k^^ K^lv* hune and bent like the body of an old i^ij'^Nhr pillule of senile degeneration. Death from fl^j|^iT« of digestive power, closes the scene.
DISEASES FKOH ORGANIC POISONS.
357
A modern form of indnced disease from opium u lij using it in solution as morphia for injection nnder the skiu,— siibciitaneous injection of morpliia, Tho narcotic poludon is taken up in a small ejringe and iiijected throiigli a tine needle into the celhilar tii&sue. The practice eommonly commences for tlio relief of pain, particu- larly the pain of neuralgia, a niinimam medicinal dose of the drug heing originally used. The dose is gradually increased wiien the practice is persisted in, and in some examples a great mimber of grains of morphia are injected during the day, I have seen the skin so punctured from this operation that it was somewhat difli- ciilt for the sufferer to find a new place in which to insert the needle. At first nausea and even vomiting occur soon after the injection, and when these syToptoms snhside they are succeeded by defective digestion, irrihibility or slowness i}i the circulatioTi, reduced secretion, torpor of the nervous system, insatiate craving for the drng, muncular prostratit>n attended witli hysterical excite- ment, and general inertia, iiianitit»n and failure of power. In the end there is usually a gradual paralysis commencing in the lower limbs and extending throughout the mnscular system, together with wasting degeueratioii uf muscular tissue and death.
Disease from Tobacco,
The dust arising fmm tobacco leaf, during the process of making cigars, is most injurious. While the leaf is being rolled up, unless the ventilation of tlie work-room is exceedingly perfect, the dust from broken leaves and sif tings is inhaled, and proves most irritating. In the course of drying, the dust and vapor from the drying-roum act in cond>i nation, and lead not oidy to oppres- sion of breathing but to irritation of the throat, and, in the yomig, to giddiness and nausea. One workman told me that he never got over a bronchial irritation produced by this dust until he left his work at night, then the effect subsided*
The dust produced in the various processes of snuff- making is still more injurious. The tobacco leaf, finely cut up, is mixed witJi lime-water, salt, sometimes even floor-dust sweepings, and, iii yellow snuff, with red lead. These Ingredients, placed in a bin and heated twice or tliree tiutes, to give sharpness to the snuff, ai*e frerjuently turned over in order to facilitate the process of drying. While this ttmiing is in progress, there arises a dust
mSMABES FEOM ORGANIC POISOKS.
wilb m stookeft which €o affecU the younger workmen Uiat tliey IwviMrtff fiiiitt mud vomit, untii^ by u^ie, they are mndered tolerant of ihft pojsonocid mauerd Uiey iiihale*
in tl»e further procefis o£ tiuUhiug the snuff, after it has been gt>a:ul Jk»u! thJeJ, there is what i& called sifting "the shortdi" pjvj'^Htorv u» aiidUig the ** liquors^" viz., salt and water to make wvi^ht, and soeata to give perfume. The sifting charges the air with du^f ' ' irious as tlie enioke, and which pi'oduces
«0vifro «^,^ , ^'*^ung» retching, faintue^e, and great
irrtUti^m ^ tho brouclual pad3iigte& The rooms in w^hich these iftvrk)^ aa*) carriiHl on an) too often close and un ventilated, atul ^hi^rvhyt th0 trritatiiiii of the throat, tlie cough, and tlie nansea are much inondadied. Sifting tha " shorts^' 13 more hurtful than roll- U«i cigar^ The eoni«olation of the workman is that he be- v^^iwo aoeikstumcnl to the }K>idou if he only keepg to the work, and at ItfettI gl^ta ovi^r tho syuiptoms.
1m m» Imr mt^ the acuteuesi^ of the symptoms is concerned tl^e
w "^ ■ i^tnerally ettnvct, but it is not to be presumed that
t *itv»j»«t at this {Kiiiit. The syfetein of the workman
X4n«iii tiii^^raut ill sumo meaacu^ but the tolerance is only par-
i'bi\«nio uialadiecH wliich are of serious and even fatal ini-
porti an^ iiivhu*iHl by ctmtinue*! application. Those workmen who
MV i)iii|KM>«Kl to pulmouary consumption suffer readily from that
4illliii^ vv' ' otbiorai of boKer ih institution, lese serious, but
ilttt iMiri^« I igementa are manifested, the most common of
V atv a }Mc»i>i^teut dyt»]>epsia and that pale and bloodless con-
'10 technical term anft'nua is applied.
, iiAon liymptum is a rapid and irreguUr action of
ti IVpttatioti of the heart, and intermittent action in
►V M I ^ r Jin hesitates in its beat, are marked phenomena. I
;: , V nuWi\l» aay tliat in these workmen the action of tlie
al iu full power, and never perfeiitly regular so
u^ following their employment. In cases where the
» are most intense^ the muscles of ttie body share in
ivwi and disturbance* Tlie hands become tremulous,
<ba unsteady. In two examples I have seen the
* *^ncnceii and an extremely painful spasm pro-
/At, followed by faintness, as if the sufferer
b
UH> ^t4gan4 of the senses are impaired from .these occu-
DISEASES FROM OKGANIO POISONS.
m»
pations. There is deafness and an imperfection of vision, which renders light painful to the eye* It is also unfortunate tliat these oocnpations lead often to the liahit of smoking or chewing tobacco, and when either hahit occurs the evil c^juserjuences are greatly increased. I helieve few workmen escape altogether the dangers I have named, and not many are able to carry on their buBiness beyond their fortieth year.
Tobacco Smoking.
Ever since the habit of smoking tobacco has been iuti-oduced into civilized communities its bad induenoe upon the health has been acknowledged by all who have cared to locjk the subject plainly in the face. Even the advocates of smoking am often constrained to admit that the habit causes wiiat they call tempo- rary or functional symptoms which, to say the least, are unplead- ant. It certainly produces functional derangements in most cases ; in many cases it does a great deal more.
Tobacw smoke is a compound substance. It contains water in a state of vapjr ; free carlx)n diflfused in tine particles, soot ; ammonius in a state of vapor; carbonic oxide; carbonic acid; an organic product coming over in vapor and condensible into an oily eubfitance called nicotine ; anempyreumaticammoniacal substance; and a rcsiuous bitter substance. Of these substances the most dangerous are the carbonic oxide and the nicotine. These are present^ no doubt, in exti'emely small proportions^ Init even in these small proportions they are active poisons. The carbonic oxide tends to produce drowsiness, irregular action of heart, con- vuUive snatches *»f the muscles, and nausea or vomiting. Nico- tine tends to produce tremor, palpitation of the heart, and par- alysis. Some of the other agents named above are not aUc^gether innocuous. The ammonias bite tlie tongue after long smoking, makhig the tongue and throat dry ; they cause free secretion of sdiva,and they produce a solvent action on the blood and the red blood corpuscles. The volatile empyreumatic substance causes a ficnse of oppression, and gives an unpleasant odor to the breath. The hitter extract is nauseous to yoimg smokers, and produces dbtnrbance of the stomach.
DISEASES FROM OEOAITIC POISONS*
Dermigefiimii of tlie Digestive St/^tem.
Most of the gi*eat systems of the ho<ly suffer f mm the effects of tobacoo smoke, but of all feVBtcms the digefttive is the one most affected. The tongue of the contirmed smoker is rarely clean, the appetite rarely perfect The umcons iiiemhrane of the mouth, tongue, and throat is often much irritated, the salivary glands are excited to profuse secretion, and the tonsils are often rendered large and irritable. The miicuus membrane of the sti^mach is ir- ritatcil and secretes its digestive fluids Irregularly, with frequent e.xcn*tit>n of acrid fluid wliich causes hoartbum, eructation, and pMieral debility. The muscular fibres of the stomach are also inrtuenced, losing their tone and activity. The food, therefore, in a contirmed smoker seldom pas^^es thri>iigh complete digestion, and constipation and irregular action of the bowels are the conse- quences. On the wh*vle dyspepsia may be said to be the malady of the confiruied smoker, and the terms *' smoker's sore throat," **Kmoker*s tongue/" *' smoker's salivation,"' are too familiar. When tlie Hhioker is not cleanly in Ids habits a Jeposit of an earthy khwl takes place, on the teeth » from tlie saliva, — milkmry calculus.
(•auccr of the lips or tongue has not nufrequently been con- net*ted with smoking, and the cancer of the lip at the point where the pi|H^ presses has often been observed as the sj>ot from which opitheliul cancer takes its rise, I have no doubt that the irritation pmduced by the stem of the pipe does excite epitheh'al cancer in perfioiiM prodisposeil to tliat affection, but I do not think there is sufficient eviilence to show that tobacco smoke itself is an exciting cau»u of cancer.
Deraitffemsfit of the Circtilaiory System,
Tobae(x> smoke does not, I believe, produce organic disease of the lu^'art *>r other parts of the circulatory system, but it i-euders like bl*KKl umiatnrally tluid, it injures the red blood corpuscles, and ilgivatly disturbs the action of the heart and of the arteries. It Ci' ji|»itation of the heart, irregular motioii, intermitteney^
iki vtivmt* iuptaucesj cardiac breath lessness, attended by acute
puiii or upasm through the choBt. It causes constriction of the bUkHbve«i»i«ls of the minute circulation, paleness of the face, and ananuia*
DISEASES FROM ORGANIC POISONS.
361
DeiHingemetU of the He^ratary St/stem.
The action of tLe smoke of tobacco on the iniicous lining of the bronchial passages is to prochice Hiiicli irritation, attended often with cough and expectoration. At the same time, considering how lai^ a surface in the huigs is ininiediately exposed to the vapor, it is remarkable that the irritation should be so limited as it really is. I have uf ten been obliged to proljibit smokers who suffer from bronchial irritation the indulgence of the pipe» but I could not say that I have ever known organic disease of tlie lungs to spring from emuking. I have entered largely in another place into the ques- tion whetlier pnhnouary consumption and bronchitis are directly caused by tlie action of tobacco, and I think I have conclusively shown that they are not* At the same time I am convinced that when either of these diseases is present smoking adds to the mis- chief. This is partictdarly true in regard to consumption, for smoking iTiterferes witli the due oxidation of blood and jtromotes iudigestion, both of whieli derangements are favorable to the de- velopment of the inherited affection.
Derangements of tlie Nervous System,
The opponents of tobacco unite in the expression of opinion that tobacco smoke seriously affects the nervous function, and even produces nervous diseaset?, such as apuplex}* and piindyt^is. In one remarkable and exceptional instance I witnessed in a man fatal symptoms whicli had been induced purely from excessive smoking. In this instance death came on from a paralysis, involving, I may say, the whole nervous system, for all the motor powers, vohmtary and invohmtary, together with the mental powers, collapsed. As a rule, however, tobacco smoke does not produce structural or organic nervous change, althongh it keepg the nervous system in a continual state of irriialulity and debility. It also creates giddi* ness and unsteadiness in some persons,^vertigo ; atnl, without any doubt, it dulls while it seems to soothe tlie mental facidties. It canses also irritability of temper and a eravhig for itself which amounts too often to a kind of mental disorder. Through the sympathetic nervous systetn tobacco acts oti the glandular system, exciting over-secretion followed by an impaired secreting power. I do not accredit the hypothesis that tobacco smoking is a cause of insanity.
DISEASES FROM OBOANIC P0I80XS.
Derangeme^its of the Sengorif Systems.
There can be tio doubt tbat Binoking produces seriouB func- tional derarigejneiit of the geiise^. It markedly impairs the senses of taste and Buiell, and probably renders less accurate the ^ixse of touch. lUit the sendee nioet seriously influenced by it are those of hearing and eight.
The specific effect of euiokiog on the sense of lie^iring is indi- cated bv a confusion of sounds, with a difficulty in appreciating rounds that ar© very soft or unusually loud. This causes the affected person to ask qneetions with respect to articulate sounds I which by others are distinctly heaitl. When tliis symptuni is pre* sented it is usually followed by that of a sudden sharp ringing in the ears, wliich may be excited, at one time, by a slight external noise, and, at other times, without any noise at all. These symp- toms are often long continued in smokers, but liappily pass aw*ay, as a general rule, when the habit is discontinued.
On the sense of sight tohaceo smoking produces, indisputably, phenomena of a serious character* In moderate smokers the sight is often peqilcxcib Letters become confused in reading, Inminons specks float before the eyes, deep-seated pain is felt in the eyes, and the vision is, at times, attended with irritaliility, as if the sight could not be linnly fixed on au object. In inveterate stnokersthe pupils ai*e unnaturally dilated, and when the light is very strong the visitin is imperfect.
The best evidence that the tobacco is acting injuriously on the sense of sight is supplied when there is a long retenti<»n of images on the sensorium after the eye is withdrawn fn»m them. This I when long continued indicates that the retina or Dcrvous screen | is becoming affected, and the Bvuiptoiits whidi follow are gener- ally indicative of steady impairment of visioti under all conditions. In time there is produced a disease which is called ** tobacco amaurosis," one of the most determinate forms of blindness when completely estabHslie*i. In this instance the habit of tobacco smoking produces a distinct organic or structural disease, |
Effects of Smoking on the Young.
From what is written above it will be seen that tobacco plays
an important part in the roU of induced diseases. I have spoken so far of its effects on adults only. In the young those effects are
DISEASES FROM OKaAXIO POISONS.
363
N
infinitely more serious* In them smoking checks nutrition, bodily development, and mental development, to eueli an extent that if a GonimuDity of youths of both sexes were trained to early smoking, and if marriage were (•oniiued to them^ an inferior race of men and women, compared with what U now existing, would, of neces- wty, be born. To the ci^dit of our women this experiment is not being carried out.
E^'vcts of Toha€€0 taken as Smiff^.
Indtilgenoe in tobacco in tlie form of emiff has now consider- ably decreased, hut the habit, when it is carried out, is, decisively, productive of injurious effects. Many of the results attributable to smoking are produced by snuff, especially those wldch are ex- erted on tlie threat and on the digestive and nervous systems. Profuse snuff-takors are, as a rule, always dyspeptic, for the par- ticles of the snuff pass down into the back of the throat and are flwallowed, so that tlie direct action of the jM:uR<>n on the stomach is brought about. I have seen confiriried indigestion, injected throat, irritative cough, and vertigo, with other nervous plienom- ena, induced by the inhalation of tobacco as snuff, and 1 have on<^ known further poig«;>nous results from the action of lead with wliich the snuff was adulterated.
I
Disease from Tea.
The common beverage tea is often a cause of serious derange- ment of health, if not of actual disease. The symptoms of dis- turbance occur wlien even the best kind of tea is taken in excess, and almost inevitably from the mixture called "green" tea when that is taken even in moderate quantity.
It is common to speak of tea as a stimulant, and it is quite oorreet so t4> speak of it when the term is properly uuderstuod. Tea first quickens and then rcxluces the circulation, which is the action of a stimulant. But tea does more than this; it contains taimiu, and is therefoi'e styptic or astringent in its action, from which circumstance it is apt, in many persons, to produce consti- pation and interference with tbe function of tile liver. Tn some persons this astringent effect of tea is very had. It gives rise to acontmued indigestion, and to wliat is called biliousness.
The most important agent^ howx'ver, in tea is the organic
36i
DISEASES FROM ORGANIC POISONS*
alkaloid fMine, Tliis alkaloid exercises a special influence on the nervous system which when carried to a considerable extent is, temporarily at least, if not permanently, injurious. At first the alkaloid seems to tjxcite the nervous system, to produce a pleasant sensation, and to keep the mind agreeably enlivened and active. The cGFect h followed by depi'ession, sinking sensation at the stomach, flatulency, unsteadiness with feebleness of muscular power, and, not tnifrequently, a lowness of spirits anumuting ahno&t to hy[K>choridriacal despondency.
In tliose who live in the midst of poverty* and who, having insufficient food, meet tiie craving for natural food by taking largo quantities of tea, a strong craving for it is engendered which leads to the taking of tea at almost every meal, greatly to the injury of the health. Poor women in the factory and cotton districts become actual sufferers from this cause. Thev are ren- dei*ed anaemic, nervous, hysterical, and physically feeble. In better classes of society similar if not such severe injury is effected by tea in tliose mIio indulge in it many times a day, and eB]>e- cially in those who indulge in what is called afternoon tea, a repast, if it may be so styled, partaken of late in the day, and, probably, when tlie stomach is nearly empty of food. The after- noon tea, or drum, causes dyspepsia, flatulency, nervous depres- sion, and low spirits, for relieving which not a few peisons have recourse to alcoholic stimulation, a procedure simply calculated to give temporary relief and to increase and confirm the mischiefs that have been inflicted.
Tea taken late in tlie evening, except immediately after a moderate meal, iutei feres with the sleep of most persons by caus- ing indigestion, with flatulency, and sense of oppression. Some are kept awake entirely by the action of the tea on the nervous system ; others get off to sleep, but are troubled with <1 reams, restlessness, and muscular startings. In a few, incubus or night- mare is a painful symptom induced by tea.
As persons advance iu life the had efl^ecta of tea sometimes pass away or ai'e gi^eatly modified, so that it can be tolerated by them as well as enjoyed ; liut in t!(e young during the earliest periods of youth it is, I might really say, unexceptionally injuri* ous. It leads to nervous exliaustion and to mental nervousness, so that the simplest natural pheriomenon, a dark cloud, a deep shadow, or a sudden sound, excites anxiety and feai*.
DISEASES FROH ORGANIC POISONS.
366
I
The most characteristic effects of tea are inHtaiieeil in *' tea- ters/' persons who hy profession are engaged to det^rntine the (jimlities of teas by the proce&s of tasting different Bpecimeus of strong teas. I have several times been consulted by gentlemen who have been thus occupied on account of the syniptouis from which they were suffering. They complain of deficiency of secre* lion of the saliva, of distaste for food, of deficient appetite, of nausea, of nervous depression with muscular tremors and feeble- nesa, of constipation, flatulency, and almost entire inability to sleep. On giving up the practice of tasting, the symptoms, as a laile, ilisappear in a few days.
I am not aware that actual organic disease ever takes place from the use of tea, and it would therefore be more correct to Bpeak of the phenomena it induces as phenomena of functional lerangement rather than of actual disease.
Disease from Coffek.
Coffee in no way rivals tea as a cause of derangement or dis- eaiie, but, like tea, it contains an alkaloid whicli in action some- what reseuibles theine. The alkaloid is called eaffcifu\ and the effccte it produces ai-e upon the nervous system, on which it is said to be a stimulant. Coffee is less astringent than tea, and indeed cm most persons it exerts no astringent effect at all, but that rather of a relaxant after the immediate nervous stimulation has passed away. For this reason coffee induces, lu some indivithials, diuretic phenomena, and in others relaxation ui the bowels* In some both conditions. Indulged in too freely it usually produces dyspepsia and flatulency, and taken late at niglit is, like tea, too often pro- vocative of sleeplessness, ending in disturbed dreams, muscular fttartings, and nightmare. Coffee is usually pronouncedly in- jarioua to the young ; in persons of advanced life a tolerance to its action is often established.
I must repeat in relation to coffee what I hare said alx>ut tea, namely, that thei*e is no evidence aa to its ever being a cause of actual organic change. Its effects may be described as entirely functional, and as being more correctly defined under the head of derangement than of disease. The derangement is much increased by the addition of chicory.
366
DISKASES FROM ORGANIC FOISON8.
D18EA6E FROM C0CCULU8 Ikdicus, Levant Nct.
The fruit known under the name of Cocriihis Indicus, or Le- ^ vant mit, is used as a poison for killing tigh add hinle. Tiie kernel is tlie part employed for tins purpose, and the active principle is a crystalline substance called pwrotorine.
The phenomena produced by cocculus indieus are those of vertigo^ delirium, and insenBibility, with deep stertorous bi^ath- ing, convulsive motion, and epasm. On firint taking the poi&on it causes vomithig and purgation, with coneidcrahle pains and cramps. Also during recovery from the narcotic effects there is pui-ging, cramp, and coldness, followed by reactive fever. I quote these phenonicna from the one exceptional iuf^tance in which I could feel giire tliat cocculus indieus was the cause of the symp* toms ; for although I have been called to two other cases in which it was supposed to he the cause of acute disease, I am of opinion that in them an impure alcohol, an alcohol containing fusel oil, was the poisonous agent j
Owing to tlie large quantity of cocculus indieus that is im- ported into this country, and the difficulty of accounting for it« use, it has been assumed to have been employed for the adultera- tion of beers, and especially for those beers which go to India. I do not think there is any satisfactory evidence in support of this hypothesis* 1 was instructed at one time to mske a special in- quiry for the detection of cocculus indieus in beers sold in Lon- douj and in some that were reputed to be prepared for Indian exportation ; but I found no trace of the substance, altliough I searched for it in a very largo number of specimens. Amongst my medical brethren I liavo never met with one who could give me any satisfactory proof that he knew tlie symptoms except by what he had read of them in the few recorded examples supplied in works on Medical Jurisprudence.
Disease from Aj^tltne.
Since the manufacture of aniline dyes has become a great com- mercial pursuit, serions injuries have occurred to the workmen employed in the manufacture of them. The first decisive case o| injury from this substance which attracted marked attention corred in a lad sixteen years of age, who was brought into the
DISEASES FROM OKGANIC POISONS.
387
London Hospital^ from eorae aniline works in which ho was en* gaged, on the S>th of June^ 18f>l. The lad had been found in a state of insensibility in the interior of a vat used for the manu- facture of aniline. He was pale and cold ; but that which attracted most attention was tlie extreme bkieness of \m lips* The Jad i-e- covered, but on the following day he etill remained blue, and his breath smelt strongly of aniline.
Three yearg later, l>n Kreuser, of Stuttgart, reported a set of new facts respecting the influence of aniline on the industrials employed in its manufacture. He showed that the vapor, when it does not act to the extent of producing insensibility, causes vio- lent dry spasmodic cough, lie also noticed for tlie first time that the vapor produced ulceration of the skin in the lower extremities, with much pain and swelling. The ulcers rapidly healed when the workmen were removed horn the influence of the vapor.
I*atery Messrs. Knaggs and Mackenzie in this country, and M. Chevalier in France, discovei\;d that a peculiar and extreme neu- ralgia is indnced by the vapor of aniline. The neuralgic attacks begin witli an intense nervous pain in the head, and a giddiness increasing almost to faintness*
Two French investigators, Tardieu and Roussin, have made
ome important researches on the physiological action of tlie i-e<l
^und yellow dyes, by which they have determined that when living
animals are subjected to tliese substances, a fatty change takes
plaoe in the minute structure of tlie vascular organs. The liver,
I specially, is made to undergo fatty degeneration and the tissues
'♦re dyed with the color. From the dye-stuff extracted from the
aoimal organs the experimentalists dyed a skein of silk.
We have no evidence, as yet, that the phenomena of fatty change have ever occurred in the human subject, although it is fairly to be inferred that a long exposure to the vapor would lead to tliis result.
Aniline Erytf^ma.
iPnie introduction of wearing apparel, socks, stockings, and aela, made, by new processes of dyeing, to assume a rich red yellow color, has led to a local disease of the skin, aniline ery- bema, attended in rare cases with constitutional symptoms. The lisease is, primarily, due to the dye-stuffs. The chief poisonous dyes are the red and yellow coralline, substances derived from
368
DISEASES FROM ORGANIC POISOK^,
tUat series of cLemieal bodies wliicli have been obtained of late years fi-om coal tar, and commonly known as the aniline series.
The euloring principle is extremely active as a local poison. It induces on the skin a reddish, slightly raised ernjition of mi- nute round pimples which stud the reddened enrface, and which, if the irritatiun be severe and long-continued, pass into vesicles discharging a thin watery ichor, and prixlacing a siiperticial sore. The disease is readily curable if the cause of it be removed, and, as a general rule, it is purely local in character. I have, however, once seen it pass beyond the local stage. A young gentleman consulted ine for M'hat he considered was a rapidly developed at- tack of erysipelas on tlie chest and back, lie was covered with an intensely red rash, and was affected with symptoms of nausea, faintness, and depression of pnlse, of a singular and severe kind. I traced both the local eruption and the general malady to the agency of aniline dye contained in one of those red woollen chest and back " comforters ^' which are commonly worn in cold weather. On reraoviiig the ** comforter" the symptoms ceased and recoveiy was speedily effected.
Sir Erasmus Wilson gives the name of clei^iatUh amUna to a local affection produced by aniline dyes, which may be accepted as a severer form of that which I have called aniline erythema. Respecting tlie effects of these dyes upon the skin, Wilson says that they have been observed l)otli in the hands and the feet from the use of gloves and stockings colored with the pigments. The feet ai*e most frequently the victims, the dyes, in some instances, being transferred to the skin, while in others tlie patterns of the stocking are represented on tlie skin by tracings and figures of inHammatory redness. The inflammation caused by the pigments may be set up in the course of a few hours and may present t!ie eliaracters of an aggravated eezemaj attended witli considerable effusion beneath the scarf skin, raising it up into blebs which sometimes occupy the whole of the surface of the sole of the foot. Occasionally, according to this authority, the inflammatory rash is transferred to tlie hands, even w*hen those members have not been in contact with the poison, and a general irritation of the entire skin is set up by propagated irritation.
Happily the insolubility of the dye*stuff in water and in the watery secretion of the skin prevents its ready absorption into the body ; for if it were easily absorbed it would so often prove fatal
DISEASES FROM ORGANIC POISONS,
3C9
iinSiigBt the workers engaged in manufacturing it and amongst those who wear cloth nig colored with it» that it would be a source of Yjublic danger. We have seen a little above tliat, according to the experiments of Tardien and Houssin, fatty degeneration of the liver was eafiily induced in the lower animal 3 by the dye, and tliat the other tissues were colored by it. They further observed that the coloration specially affected the lungs, and it may there- fore be fairly assumed that two, at least, of the vital urgiuis must suffer if the aniline obtained admission into the blood and circu- lated with the blood through t!ie body.
Up to this time I have not personally witnessed any serious cbaDges of the kind, but while this part of my work was in pro- gress I obsenxd that an inquest was held on a person who was ftseuraed to have died from absorption of aniline dye by a wound in the skin.
Disease from NrrRo-BENzoLE.
The oily liquid called nitro-benzole is a source of danger to persons employed in chemical works, and has, more than once, proved a fatal danger. Long exposure to the vapor of this sub- stance produces nervousness and torpor, and when the vapor is inhaled in a concentrate form, the drowsiness, after from thi-ee to four hours, passes into stupor and intoxication^ and soon after into coma or a]K>plectic sleep. The mind remains tolerably clear until tlie stupor suddenly comes on, and then the insensibility is complete. The body falls precisely as in apoplexy, and death en- sues in about five hours.
Dp* Letheby, who of all observers has most carefully inrpiired into the action of nitro-benzole, is of opinion that the j>oison is reduced in the body into aniline by giving up its oxygen, but that on tlie surface of the body the opposite condition is in progress, by which the salts of aniline are oxydized, and are converted into mauve or magenta purple. I have learned of another mischief incident to the manufacture of nitro-benzole. In making it, by acting on benzine with nitric acid, vapor of hypo-fiitrle acid is freely evolved* TJiia vapor produces great bronchial irritation, nausea or vomiting, and colic. Chevalier has reported on these ^lets, and has added some others which in England have not been f>oticed B*j ilistinctly. He says tliat the process of washing the' nitixj-benzine is more painful than the making of it, and that th©_
STO
DISEASES FROM ORGANIC POISONS.
rapor of benzine itself induces intense headache, a faet I can fully
cuiiiirni.
Disease from PAHAFFrxi!:*
We are indebted to Dr. Alexander Ogston for the first obeer- vations that have been made on disease f ix»ni paraffine. The work- men engaged in the manufacture of enide paraffine have the skin of tiieir hands, of their feet and legs, and of other portions of their bodies, brought daily, for many hours at a time, into con- tact with the paraiBne eliale and with the oily matters mixed np with it.
Two distinct classes of symptoms characterize this disease, one acute, the other chronic. In the aente form the parts of the skin exposed to the crnde paraffine are covered m ith a rash of bright red nodnles which lie close together, and are largest and most nnmerons on the wrists and where the dress fits tightly. The palms of the hands and soles of the feet are not affected, but the back of the hands and upper eurface of the feet suffer severely.
Similar nodules arise, though to a lesser extent, on the face, neck, and other parts of the body to which the oily matters find I access. In the acute form of the disease the size of each bright red nodule is about eqnal to a grain of barley ; it is hard to the touch, tender on pressure, and roimded in shape. Dr. Ogston discovers that each nodule consists of a single hair follicle with the parts immediately surrounding it ; the whole in a state of active inflammation. The hair emerges from the %'eiT summit of tlie nodule, and the orifice of the hair folHcle, much enlarged, is easily visible to the naked eye as an aperture of a magnitude simi- lar to that of a pin-hole in a card. The dilatation extends to the deeper part of the follicle, which forms the kernel of the inflamed knot. The redness and hardness of the nodule after a time dis- appear, leaving the hair follicle enlarged and its moutli gaping so as to show retained masses of epithelial scales.
^^ In all paraffine workers/' Dr. Ogston j emarks, " openness and enlargement of the hair follicles continue to some extent, and the black dots on the skin of their hands and face strike the eye of the observer at once. Men with dark complexions and strong hair are specially deformed in this way, while those of fair complexions
DISEASEfi FROM^ OKGANIC POISONS.
371
anil of light or reddish hair escape comparatively unaffected* The chronic form of the disease exhibits the following characteristics. Tlie Itacks of the feet and t<x?s, the backs of the hands and the backs uf tlic fingers, between but not over the joints, present a honey-combed aj>pcarance of the skin. The skin i^ elevated, thick- ened, and inelastic, so as to prevent and render diificnlt and pain* fill the flexion of the lingers and hand. The raL^ed honey-coiiibed patches are of natural color, and arc not lnllann.»d, Init consist of deeply-grouped arrays of hair follicles with, a hard deep skin between and around them ; the folUt»les packed with dry, brittle accumulations of epithelial scales, &o extensive as to be easily visi- ble throtigh the follicle, the latter being large enough to admit the itremity of an ordinary probe. The hairs themselves have lisappeared from these patclies, having probably become atropbic from the pressure of the epidermic masses, wbile craeksand bleed- ing fissures traverse the indurated parts, and in rare instances a follicular abscess gives variety to the picture."
When the malady becomes confirmed the general health of the suflferer is greatly affected ; the complexion becomes pale, the skin becomes loaded, the hotly wastes, and the constant irritation and pain of the skin produce sleepless nights* Dr. Ogston accounts for the production of the disease in a very clear and satisfactory way.
"The oily matters in the shale called blae oil, wdien separated^ both penetrating and irritating to the skin ; coming continu- ally in contact w^ith tlie epidermis, they soak into the hair follicles, where they create an irritation soon leading to hardening and in- creased shedding of epithelial scales. This shedding of the scales is not counterbalanced by increased expulsion, owing doubtless to the large quantities cast off, and to tlie natural fatty and lubricat* log substances being dissolved out and removed by the blae oil. Tims the brittle epidermic nj asses or scales plug the follicles and increase the irritation. Parts of the kind supplied with sweat glands and no hair follicles,— palms of the hande» soles of the feet, and knuckles of the fingers and toes, — escape tlie irritation. r After a time the hairs and the most exposed parts w^aste and fall Out, but the retention of the epithelial masses keeps up the process in the follicles and the hardening of the surrounding skin."
tm
8o«.
la mmm irtjri liit aatiao of orttde parHBiiit oc tiieikin, k tiiej iliebodj. Iiitiieiddi die cliiauiejr viifc liis Iittfe 0Wfep4wrj« S£i4 voQtltiy — sad be£iat« the da diiiiljr heUti el the mwf^ m tfacgr bow « ttieee «ei oCleD e&dted oa tlie bodjr of tfae voiiEer in eost \ euimr nnd erea fatml Ameasm^ whidi faesn die omaieof aootn Tb^ diMeie k prodocsed bj tlw loial lelicm of Mid m extmae initinriii it is eo cevtoie that desih oeeais from it* | The ditetee in riig— cmbs oommeneei m sd iadttratioD or hsrdai^ j tag prodneed br tlie oootact of the soot with the £kin in pertf irhem tlie ikto m eofolded. This is followed bj ulcendoo, ud | dbe nleer ii ftodiffieialt to heel and so often extends, mvolnng mom i iiASoef tlijit it part&keiy %& I IisTe said, of the cjiaincter of a Bia%- jianl ulcer or caooer. I bare mjeelf ^een bat one tme example of tbia diaeaae^ and I learn that now it \& rarelj known amongst thoeei M'lio work in noot^ The workmen are candid enongh to admit thai by att^nitiori to deanlineta^ et-en in a moderate degree, tbev escape ^froin irijiiry. To be merelj begrimed with soot does not suffice to produce actUfiJ ulceration ; it ifl neceaaarj for the soot to remain on the body f»r ftonie time in acciiranlated quantity for it to pro* doe© miKchief. Then it caufc^eg abrafiion and sorenesg, and upcm i that the ulceration follows* There is an imprefision amongst the workers in »Mif»t that the finality of the Boot ntakes a marked differ- oncrc in the t/ffeet« of it a^ an irritant to tlie skin. Soot derived from the tiunting of wood is believed to l>e more injorioos than coal iviot, and w^ot from Bwiftly-burning and slaty coal is held to bo more injnriouH timn that from good, solid, dow-bnming coal that leaveit little anh*
DineASE FROM Vapor of Titepenttne.
Wo aro indebtDd to M. Marchal de Calvi for the first intima* tion t!uit (ho vapor of turpentine produces a specific eflFect on those who aro cnga^^ed in ]iiy'ntiog in oi! and lead colors. Lefore his time it wa« conmdered tliat tlie lead in the paint was the cause of the disuHisu. Do Calvi proved that when the lead is fixed, the
DISEASES FROM OKOANTO POISONS,
373
emanations from the painted snrface, wbieli consLsfc purely of tur- pentine, are exceGJingly poiBoiioiis. He furtlier pointed out that some workmen are specially affected througli idiosyncrasy ; in oilier ardi?, that certain workiaeu are specially affected, but that all are ible to suffer, lly own observations, made at various times since Calvi'g announcement to the Academy of Sciences in Paris, on De- cember 9, 1855, have fully confirmed his observations.
I Lave found marked symptoms in workmen using turpentine, eepeciallj when they are engaged in the process of *' flatting." The syuiptonis are those of prostration, coldness, constipation,
i giddiness, headache, which lasts for many liours, impakment of api>etite, and anaemia, Tliese disorders are produced from the u^e of tuqicntino varnishes as well as from paints. Some wurkinen escape the action ahuust ultogetlier; otliersare so susceptible that they will rather pay more favored men to perfunu the work than do it themselves. H The mode of action of tui*pentine on the body is not yet fully V understiiKjd. Turjieutine rapidly inhaled as a vapor ]>ruiluces sleep^ like ehloroforni, and it has been used on an emergency as a eiib- stitnte for chluroform in order to bring on anLesthesia. A key to its action was given some years ago by I)r, L. (J. Roche, who, in ■ commenting upon the researches of Marchal de Calvi, relates an interesting fact told to him by the illustrioug ehemifcit Thenard. It is that Thenard, liaving analyzed the atmospheric air of a cel- lar which had becouie poisonously charged with the vapor of tur- |>entine, found that all the oxygen had been removed, tmd that nitrogen alone remained, Hent'e Koche assumes that tur]>entine produces its bad effects by depriving the au* of oxygen, I believe this theory to be sountl, but it docs not explain all the facts, A more i^ccnt research by Dr. Licrnsh has proved, by direct experi- njent, tliat turpentine vapor causes paralysis of the vessels of the minute circtdation, with congestion of the brain and of the other large vasctular organs.
Diseases from Mixed Vatobs akd Gabeb,
Workmen ex|K>sed to confined air in which oa-ganic vapors are evolved, are apt to suffer from disease. The workmen in wine docks are lialile to this danger, a fact wliich T pointed out in my ** Journal of Public llealth," for 1855, after an inspection U
374
LBES FROM OEOANIC POISONS.
London Wine Docks, I had been informed that serious un- heal tliiiie^s prevailed amongst tlie dock men there, independently of the diinkhig luibits which their uecupution is liable to induce. My hispection showed that there was good ground for the sus- picion of dfingur. I found the air cluso, and so charged with carbonic acid that in some recessea the liglits bnnied dindy, while the whole atmosphei^e was tainted with vapor of alcoholic spirit From the facts Btated there can be no doubt that the men em- ployed Buffered severely from the effects of their occupation, that they contracted asthmatic coughs, lost appetite, became emaciated, and saw the end of life prematurely. On an average, ten years of constant service in the wine-vaults were more than siitficient to impair the health materially, and often completely. In one re- markable instance, however, a man worked twenty-seven years in the vaults without injury, but this was altogether an exceptional case.
BOOK IL PART THE SECOND.
ACiQmBED DISEASES FROM I^YSICAL AGENCIES, MECHANICAL AND GENERAL
CHAPTER I. ACQUIRED DISEASES FROM DUSTS.
The first class of physical agencies by which diseases of the body are acquired may be included under the term " dusts." In this term we comprise those particles of solid matter which are mechanically suspended in the air, which settle on the body, which sometimes aflFect the eyes, and which are inhaled in breathing.
It is through the breathing organs, the lungs, that these dusts are most productive of injury; and it is among tlie industrial classes of the community that the injury produced is most fre- quent.
Dusts mechanically drawn into the lungs may induce true organic mischiefs, some of which, as we shall see, are of fatal character, although as a rule they are purely local in respect to their primary action on the body.
The dusts that inflict injury are of varied quality. They are also of varied effect in regard to the specific evils which they pro- duce. We shall most conveniently study them as divided into different groups, according to their physical characters, as fol- lows :
(a) Cutting dusts, formed of minute hard, crystallized parti- cles which have sharp, cutting, and pointed edges. These dusts are composed of iron, steel, stone, sand, glass, dried silicates of earthen-ware, lime, pearl.
(J) Irritant dusts, derived from woods ; from ivory ; from textile fabrics, such as fiuffs of wool, silk, cotton, fiax, or hemp ; from hair ; from clay. Soluble saline dusts, derived from soluble crystalline substances.
{c) Obstructive and irritating dusts, composed of carbon, of fine particles of coal dust, of soot, of rouge, and of fiour.
m ^-'^ tr>ju, stone, steel,
mL mKBfldiate and most
divided, are iiisulu-
^ ^mg- usaaiXj cut througl
1^1^ imm tm wliich the pro«
.^^1^ 'lusts. Tlioy aie also
.iiiT*- such dusts inflict is
y of their fatal mis-
I tlie sand- or glass»J
- ^j»- c:illedj teehnically,^
.ti tbe ordinary gymptunis
..^MiJgr^ tlie same, except that
- f«ft& i» an inorj^anic particle,
.i«ptiii»of the natural affection.
i»^i©i^ of steel on the lungs is
rindera of Sheffield ; and
of the masons of Edin-
?4afice in which a hewer of
y$^ w^& free from pulmonary
^ .M^ Glass Dtists.
Jimm^ of the lungs produced by ^ nel with, have been amoQg>t «.^|«per making- Great improve- ^f« been iiiti-oduced of late iiita' It? danger from it was imminent. ,^gHl^ihr-powdered .sand and glass, was ^^^ were employed to distribute the ^MC<. Tlie work was lights and tliej ,iii m* competent for its performance.] ,^V» was under my observation fi-omj «^ iftCktj] his death, I traced the symp- 1 ,oal- The youth was quite w^ell until iflKl on tlie first day he coughed ee* •rvJuced by the dn^L When he re- , coughed, and complained of sevei-e
]>mSASS3 FBOM DrSTS.
an»
p&in in kk adm md AbsL He ooathnied^ iiev«ftiifiUifi% to toil on in hia fatad wosk, b«l ia a hw dmrs wms striekeo down willi mil iImi tymptomt of icute poimoiuuj consoniptiaa* In tlie course of doee weAm the qrmptotns luid become ea eerere that life wmi rendeffed impoadblei and within the month death took place. The fijmptoois were eo dofidv allied to those of oominon piilmo- waij toommptii&nj it would hare been impoesible to distingubh tbem from tlie ordinary disease but for the knowledge obtaiued aft to their can^. The erpeetoration gare evidence, under the miefoaeope, of the predence of tlie foreign irritating snbstance ; and^ after the death of the sufferer^ the diseased lungs throughout tibim minute vedcolar structures gave the same evidence, as tlic? expectoration liad, of the presence of the foreign [uirtieles. The mifichief was nearly eqnallj distributed over each lung*
I afterwards met with two other sluiilar instances of fatal in< jury from die cause named. Of late, I have, I am happy to say, mei with no repetitions of this experience,
DiBeaBefram SUd Ihtd.
In the work of the needle*pointers improvements have taken place of late years. Mr* E. Bartleet of Redditch, who has lai^ numbers of needle-pointers under his observation, reports to me, tinder date of December 14th, 1875, respecting them, **that their occupation may now be considered very nearly, perhaps, taking all things into account, quite as healthy as the other branches of the trade. The work is now chiefly done by machinery, the work* men having merely to keep the stone, over which the ncctUe wii-es are passed, in proper ortler and sliape by frequently applying a piece of iron-stone to, and to see that the said wii-es are kept in proper order for travelling over the stone. A fan of considerable power is used to draw the dust away from the work man j so tliat it is his own fault if he inhales the dust Careless men no doubt Htill suffer to a small extent, when not closely looked up by their employer or a foreman, Tlieso pointing machines have been in use about ten years, but the fans have been in use mom than twenty years, and since their introduction it has been tlie fault of the men if they liave suffered to any extent. Prior U\ the introduction of the fans the men seldom were able to continue work after about thirty years of age/-
This, so far, is satisfactory ; but needle manufacturers sti'
BUSTS.
i ami tw^eoty-tbree to one hundred
occupations ; while tool- Urn at ihe rate of out? hundred
t looms whei'e earthen-ware is
r»lWr Ihe dust of a silicious ruate-
. produces aii action of two kinds.
t-^ter part of the inanuf actni-e,
if 4a^ ai!ts rather as an obstructive
hnr pmDd of the pmcess, when the
f and the dust tirnier, tiner, and
Mt k eCiBcied, for now tlie dust partakes
^fiM 8i]id| and the mischiefs induced
immi m the stone-cutters. One linndred
B-wanN potters, die in pro|K)rtion
^siVimtY other occupations. Bronchitis,
kMV tfkd diseased most eonjniou amongst
uji^m I^md DmL
cutting substance, and pearl- They are x^v\ nnmerons as a class i ako live in Birmingham and some asoaliy work in their own rooms, irKZonim odious, and stifling, bo that • uifeJ^ whick they labor are evils su|>eradded
>%AMdl id^ d&itribated, mechanically, through the
t^n il. cooftparatively a lii^ht dust, is readily
-. >i«jjpK^HM\ and, without creating much irrita-
hi* iMttgSf is carried into t!ie minuter rami-
^mi^ where, mixing with the secretion,
^ i^jF^^isence.
I the manner described does not,
i of an injurious kind. Modem
■>^^fc4«^ A.tv**.^» itnd most Bingular disease in -
.4g^lg FKhii the inhalation of fine , particles
..^fwid a pecidiar inflammatory disease
BI8SA6ES FHOM DUSTS.
381
of the bones, to W&te'k the name of *^ osteitis '' has been given. This disease, first described by Englisch^ as attacking mother-of- j>earl turners, lias since been studied by Gussetibauer, Klauser, llert, and llerkel with much ability and originulity of investiga- tion.
The di&ease only attacks youths, before the skeleton is fully developed. It is characterized by sudden pain, which is neither increased by pressure nor motion, A swelling, first from theperi- t^steura, or covering of the bone, aud afterwards from the bone itself^ commences at tlio ends of the bones at what are called tlie epiphyses. The soft elastic 8wellingis sometimes fluctuating ; its development is accompanied by fever ; it enlarges in tliedii'ection of tlie length of the bone, and, in time, it lieeomeR harder, but rarely suppurates. As a rule tlie swellitig subsides Itut it often attacks several points of the skeleton at the same time, and it has H tendency to return. Tlie bones that have been observed as af- fected, in seven cases under the observation of Gussenbaner, in youths from fourteen to sixteen years, are the radius of the aim, tlie uhia, the lower jaw-bone, and tlie thigh-bone. In one instance several bf>nes were attacked successively iu the same subject, viz., the left iustep and the elbow, the left shoulder-blade, the left armdjones, the cuhuids, and the right astragalus or heel bone,
Gussenbauer, to whuiu I am indebted for these descriptions, is of opinion that the malady is pro<Iuced in the following nianncr. The pearl dust enters the lungs, penetrates the cellular structure of those organs and their lymphatic vessels and glands. Decom- posed under the influence of the carbonic acid of the venous blood, the calcareous carbonates of the dust are dissolved, but its insoluble organic matter, wliich is a Ruhstance called conchyolino, <liscovered by M. Freniy, remains, penetrates the vessels, aud is carried by the current of the arterial blood info the minute circu- lation. In the minute vessels of tlie bone at t!io epiphyses the mibstance tinds resistance and depisits there, causing tlie swelling and otlier symptoms which have been described, and which con- tinue until the foreign body is resolved and removed. Such is the mo<Llern ingenious theory of the origin and nature of the bone disease peculiar to the pearl-turner.
From the circnmstance that the joints are the parts aflected, and tluit the symiitoma are those of pain, heat, redness, and swell- ing, the aifection was conceived to be due, previous to the time
:i82
DISEASES FROM DUSTS.
when the modem light was thrown upon it, to rheumatic or gouty teDtlency, though wliy such affection shoult] attach specially to pearl-cuttera was inexplicable. The mystery is now explained, and the ex]>lanation may possibly have a wider reading than at present appears,
Gnssenbaner and Klauser have made an analysis of the three different layers of which the pearl-sheli is composed. The most internal layer is the one used by mother-of-pearl turners. It contains of organic matter insoluble in water 5.57 ; of organic matter .suluble in water 0.11; of water OAl \ of carbonate of lime 93*555 ; and of alkaline salts 0.295.
DiSRABB FROM TRRrTANT DuSTS,
Some dnsts are exceedingly irritating to the bronchial pai and to the minute vesicuhir structure of the lung without bein] actually cutting dusts. They are removed, in part, with the se- cretions, by the action of the beautiful ciliary apparatus wdiich lines the mucous surface, and which wafting back the small par- ticles of dust towards tlie throat, saves tlie hiogs from injurVj until, in fact, its own motion is impaired, or until it is overcome or destroyed by the actual weight of irritating material which is imposed nptm it.
The dusta which may be included as irritant dusts am mechan- ically suspended iti the air. They are common in work-rooms of persons engaged in a considerable number of industrial occupa- tions, and are the causes of a large amount of suffering.
DUease fi^n Wood and Imry Dmts.
The dusts of some kinds of wood, to which turners of wood and cutters of wood are exposed, are causes of much irritation of the lungs, and of bronchial cough. The dust of wood is fine and penetrating, and when derived from colored wood imparts its own color to the bronchial seci*etion. I have seen severe phenomena of disease induced in mahogany carvel's, and in tiiose who turn ornanients for couches and other articles of furniture. The work gives rise to a great quantity of wood dust, whicli is freely in* lialed. In turning, the artiaan has tu keep up a l>lowing process with the lips in order to blow away the small portions of wood which he removes with the tool Thia process is wearying, but
DISEASES FROM BUSTS,
383
uieHiief complaint made by tlie worker is of the dnst he draws
^*^ck in inhahaion. The mihchief h greutlj increased in tlie
*'tK>ms wliere the ventilation is inij^ertecL Congh, usually at-
^^ttded wit] I copious secretion from the bronchial tubes, is set up,
'loa I liave moi-e than once known the accompanying expectora-
tiou from this cause to be ^i free as to induce symptonis of wast*
'^^rtiij exhaustion alhed to phthii?i8 puhnonalis, and constituting
w/Lit has been called bronchia! plitliUis. As a rule, however,
ti/os<a who Buffer from this form i»f ilisca§e get well when they are
reiuo-ved tmm tlieir occupation and are placed under favorable
circvi. instances for recovery.
T'hese same obsen^ations extend to the phenomena observed »s '^■^osulting from ivory dust, but I do not think I have ever seen m ivury turners or carvers Bymptoms equally severe with those tliiii: are presented hy the artisans in wood,
DUeizaefram Hair DuhU
Dr. Cholnieley has observed a peculiar lironchial irritation btDnght on in the carrying out of a couiparatively new industry, liauiely, that of hair-briifthiiig by machinery. The fine particles (»f hair carried off by the hnish in \K^ rapid revolutions give an atmosphere of dnst wliich is extremely irritating, and which is carried into the face of the operator. Dr. Cholraeley has known three hair-dressers who have been obliged to leave their oceiipa- tion, owing tu the injuries that liave been inflicted upon them from this cause. The wig-makers and liair-dressera ai'e, as I have myself observed, subjected to a similar danger. The unheal thi- ne^ uf all the occupations is sliu wn by the rate of mortality in those who follow them. From the age of twenty-five onwards, the mortality of hair- dressers is one hundred and twenty-seven to one hundred uf pereons following seventy otlier occupations.
DUt'ose from Cotton^ FI<i^r^ and Hemp DuH,
The fine particles derived from cotton, flax, and hemp are irritating dusts, and, as w*e shall see, are different in their action from the dusts of wool and silk. Tlie cotton flue produces bron- chial irritation, but the worst injury results from tlie duet of hemp during the process of dressing it. The quantity of dust lost in hemp-di'essing may be inferred from tlie fact that for every one Imodred and twelve pounds weight of hemp employed
382
DISEASES FROH DUSTS.
when the modern light was thrown tipori it, tu rhcninatic or gouty tendent'v, thongli why such affection Bhould attach specially to pearl-cutters was inexplicable. The mystery is now explained, and the explanation may possibly have a wider reading than at present appears.
Gusftenbaiier and Klauser have made an analysis of the three different layers of %vhich the pear'l-Bhell is coTuposed. The most internal layer is the one used by mother-of-pearl turners. It contains of organic matter insohible in water 5,57 ; of organic i natter soluble in water 0.11 ; of w*ater 0.47 ; of carbonate of Ihne 93.555 ; and of alkaline salts 0.295,
Disease from iBRrrANT Dusts.
Some dusts are exceedingly irritating to the bronchial passages and to the minute vesicular structure of the lung without being actually cutting dusts. Tliey are removed, in part, with the se- cretions, by the action of the beautiful ciliary apparatus which lines the mucous surface, and which wafting back the small par- ticles of dui?t towards the throat, saves the hmgs from injury^ until, in fact, its own motion is impaired, oi' until it is overcome or destroyed by the actual weight of irritating nmterial which is imposed npon it.
The dusts which may be inclnded as irritant dusts are mechan- ically suspended in tlie air. Tjiey are common in work-rooms of persons engaged in a considerable number of industrial occupa- tions, and are the causes of a large amount of suffering.
Disease Jrom Wood and Ivory Dusts,
The dusts of some kinds of wood, to which turners of wood and cutters of wood arc exposed, are causes of tnuch irritation of the lungs, and of bronchial cough. The dust of wood is fine and penetrating, and wlien derived frcmi colored wood imparts its own color to the l>ronchial secretion. I have seen severe phenomena of disease induced in mahogany carvers, and in those who turn ornaments for couclies and other articles of furniture. The work gives ri^e to a great quantity of wood dust, which is freely in- haled* In turning, the artisan has to keep up a blowing process with the lips in order to blow away the small portions of wood which he removes with the tool. This process is wearying, but
i«f &•
HI iVQiy I
flM agcimJhMl fhftiiM At m
■Ml to die i I do Bot timk I luiTc erer i eqodlj sevwo with ti i in wxKid.
bjrtiiej
IHm&mJwmm Bait JhmL
Dr. Ghofandej- Ium obwocd ai peeoliar bmnehial imtalmi brw^t on in tbe eamrii^ out of m eompArmltrelj new indttstiyi nsmel V, thM of hair-bmsMng bj roarfiinerr* The fine pmtielee o{ luur carriel off br the bru^ ia it^ rapiJ re%*alarfciii8 give an atmoBpliere of dust wbtdi is extremely irritating, and wbkh m ewried into the &ce of the operator. Dr. Cliolmeley hs^ known tkree Itair-dreaeri wbo bmre been obliged to leave their occiipa* tion, owing to the injaries that have been inflicted upon them from ihh caa$e. The wig-makers and hair-dressers are« as Ihav^ my^If observed, snbjected to a similar danger. The unhealUii* tiesft of all tl>e ocenpations is shown by the rate of mortality in tho&e who follow them. From the age of twenty-five onward*^ the mortality of hair-dressers i^ one hundred and twenty -seven to one hundred of persons following seventy other occnpationa.
IH9tme from ChUoit, Flax^ and Hemp Jh$«$.
The fine particles derived from cotton^ flax, and hemp an> irritating dusts, and, as we shall see, are different in their action frum the dusts of wool and silk. The cotton fine prLKlnces hi-on- chial irritation, but the worst injury results frcnn the dust of hemp during the process of dressing it. The quantity of dust* lofit in hemp-dressing may be inferred from the fact thut for <?very one hundred and twelve pounds weight of hemp employed
388 DISEASE? Fno]tf: di^st^.
suffering from the same kind of bronchial irritation obtains from the dust of wouJ, According to my observation, this only occurs when colored isilk is used hy the trimmer, and it 18 tlicrefore pi^esilile tliat the dye-stnff used for the coloring may be the actual source of the mischiel
My attention was first attracted ti> thh point by the eircum- fitance of a youtig woman being brought to me who was Bupposeci to be suffering from hnptnoptysi^, or epitting of lilood. She was, in fact, expectorating freely something that seemed to bo, at first gightj deeply tinged with blood. At the same time she exhibited no symptoms of disease which indicated consumption (ir other se- rions affection of the Inngs, and was so lieakhy, generally, that except for a slight cough, it might liave been ae^sunied against her that she waa simulating the very serious malady from whicli it was presmocd t^lio was Kiiffcring. I took the precaution to exam- ine the colored Bocretioa microscopically* and detected in it the fibre of silk, colored with red Bubstance. On irjfpiiry upon thi.s, I found that the yonng woman was engaged in a tiimming manu- factory, in whicli red silk was being, at that time, largely used, and that Bhe derived the re<l particles frum the dust or flue wliich Bhe inhaled. Other women in the same business were, I discovered, simihii'ly affected, bnt suffered only from irritative congh when they were using red or other colored silks. "White silks did not cause irritation, from whii'h fact I dj'aw the inference tluit the dye-stuff rather than the material is the irritatit.
The niortality from workers in wool, cotton, and silk is, never- .fheless^ rather high, luimely, one lum^lrecl and nine to one hundred as the mean of the b>eveuty otiier occnpatiuus. The mortality of the drajier who is exposed in )iis shop to the dusts of these sub- stances is also high, namely, one hundred and eight. The mor- tality of those wlio work in cottoii and fiax is more remarkable j it stands at one hundred and fifteen as cumpared with one hun- dred H3 the mean or standard-
Disease fmm Copperas I}u8L
Fine particles of some of the soluble salts of iron, especially copperas or sulphate of iron, are sometimes inhaled. One salt, copperas or sulpluito of iron, which is used in fur dyeing for mak- ing the skins black, is in this way injurious. After the skims have been treated with a solution of the salt they are dried and beaten
PISEAi^ES FROM DUSTS.
387
with a bat, and thoroughly Ijriished. The copperas dust diffused freelj through the air is an excessive tetnporarj irritant to the lungs, bnt tlie solubility of it seenia to rednce its power as a pi-o- muter of permanent disease in the lung tissue* Its action on the broneiiial surface is therefore less destructive than that of many other irritating substances. Owing to its solubility, and to its cor- rosive action on bony substances, copperas dupt is, however, de- HtructivG to the teeth, which are alninst invarirdily affected by it. The teeth are rendered brittle, and generally carious. The grind- ing down oi the coh»r Btuffs from the hirge crystals into the state of fine powder leads tu siioihir bad results*
Diseases from OasTRuoriNo and Ikkitattng Deists.
There are other dusts, as I have stated in the beginning of the chapter, which, being drawn into the lungs, are indeed causes of irritation, bnt are injurious rather from the obstruction they pro- <luce than froui the irritant effect. These dusts firtd their way into the structure of the lung and become embedded in it, render- ing the tissue, in soTue inetanees, of the same color, and I had ahnost said of the same character, as themselves, and coinmuni- cr.tirg similar characteristics to the expectorated secretion.
Dtaeme JVmn Carbon DusL
The inhalation of carlxm in the form of fine powder is a com- mon evil attached to industrial labor. The coal-inifiorg, the coal- heavers, and men w1h» are exposed to some other occupations, sncji. M walking-stick making, suffer from this dust. In the miner the lungs may become actiiully charged with the dust, so as to pi'esent, in "v^ivy extreme examples, the appearance of a carbon Ized lung, bnt the carbon, as a nde, is to be considered as less destructive than steel dust, powdered glass, or stone.
The effects of carbon dust are characteristically seen in those who are engaged in charring and 8hading walking-sticks. The stick having been charred over a coke fire, the shading is conducted l»y removing the charred part by means of a fine rasp and sand- paper* An atmosphere of fine particles of dried carbon is pro- duced, and the irritative action on tlie lungs is often severe. In the first stages the cough is attended with much suffering, but in time the cough loosens, and if the workman can be I'elieved of the
388
DISEASES FKOK DUSTS.
irritant with the secretion, the acute evinptoms give way to a chronic cuiiglx. One of these workers, who was greatly reduced by the disease excited in this manner, told ine very simply and clearly the facts in a sentence which I repeat. '^ It h all right,'* he said T referring to the charcoal dust, "it is all right when wo can cough it up. If a man gets into that way he can stand his work for many yeai'S, but eventually the cough always masters us, and we break down."
I}isease frmn Dust of Itouge.
In some occupations where the burnishing of metallic snbetanee is carried on, iinich irritatiiiii and gome ohstrnrtion is produced in the bjYmchial tubes by inhalation of the dust derived from the soft impalpable powder with whieli the polishing is effected. The jK>vvder of rouge is commoidy used for this purpose. The powder is placed on a circtdar Lruaii, winch is made to turn in a latlie, and as the brush rapidly revolves, an atmosphere of dust it? thrown in the face of tlie worker. The inhalation causes a slight bronchial irritation, and the expectoration of a phlegm which is often tinged of a rouge color ; but the difBcnlty that is most complained of by the workmen, is a peculiar oppressiveness and obstrnetion of breathing, which, when it is once experienced, lasts for a long time, and is the cause of an all but [persistent chronic cough.
JMsease frmn Sidphur I>mL
In the great vine-producing district of the lleranlt sulphur is employed to destroy the minute fungus called tlie oidium. The oidiimi is injurious to the vine, upon the stems and leaves of which it tixes, and, in order to destroy the parasite, sulphur is dispersed over the leaves of the vine, either with a fine sieve or with bellows which are made to blow it over. The effect of this process is to induce in the work-people who are employed in the task an oph- thalmia or inflammation of the eyes. The pain, redness, and swell- ing of the eyes is most distinct and distressing in the middle of the day, when the heat and solar radiation is most intense. Women and children are the severest sufferers. We are indebted to M. Bouieson, of Montpelierj for the lirst description of this in- duced disease.
DISEASES FBOM DUSTS. 389
Disease from Flour Dust.
Flour dust is another of the obstructive as well as irritative dusts, and men who work in flour-mills afiFord, I think, the most striking illustrations of obstruction of breathing from the inhala- tion of minute particles of solid matter. The particles of flour produce, comparatively, little irritation, but they are carried readily from the larger bronchial tracts into the minute ramifica- tions of the bronchial surface, and render the breathing irregular through parts of the lung. Thus an unequal pressure of the in- spired air is brought about ; an undue pressure is exercised upon some portion of the lung substance, ending in rupture or break of the minute vesicular structure, and therewith in the develop- ment of that disease of the lung which is, technically, called emphysema.
CHAPTER n.
ACQUmEB DISEASES FROM MECHANICAL PRESSURE OF
THE LUNGS,
Caisson Disease.
In many Industrial pursuits the lungs are subjected to extreme pre**iiuro or struin by which they are brought into a state of or- ganic disL'iiw.'. Glaiss^iiowors afford a eoaimou illustration of this cIat»B of iiijuiy. In theu' occupation, while blowing glass during i\w iluw it Ls in thv niolteu state, their lungs, which are for the HiorniTit the hlower^, are subjected to extreme strain. The deep inflation of the hmg pi*oduces, after a time, extensile dilatation of the mumte nlv tubes. The dilatation passes into pennaneut enlargement, and in workuicn of nut very advanced years is fol* lowed by ruptui'e of the air vesicles, emphysema. WHien this Hcoident ofcnrs two sets of evils are established. The first is ^thurlnuHs of breatli, because a portion of the lung is disahled, and rhe air in it is not duly expelled by the natural elastic contraction; iu plain words, the lung is not efficiently tilled and emptied* In the second place there is a deficient oxidation of the blood : a large volume of air taken into the lungs is not made available for rcHpiratory purposes.
Under the inHnence of these two changes tbo persoT\ MdiO is affectt^d liy them suffers from shortrjess uf breath, paleness, ctdd- ner^Hof the surface of the body, dyspepsia attended with consid- erable rtatnlency, deljility, ami eoniparatively early disablement, l*crM>ns so afl'eeted am alno exceedingly lialde to danger from ftceidontal bronchial eoniplications, such as bronchitis from cold or exposure to some otlier exhausting or deljilitating cause.
< Jtlter chisHcs of men than glass-blowers suffer in like manner from pressure upon the pulmonary structure. I notice an»ong these, parfit'nhirly, the workmen called paviors, who while en- »'iiged in liiying stones use the heavy maul or iostrument called
LUNG DISEASES FROM MECHANICAL PRESSttRE.
391
the rammer, whieh they lift up about half a fuot from the ground, auti then let fall upon the paved ^vii-fuee. From a curiuub Imhit tltefie men as they let the rainjiier descend jerk out the air from tlieir chests ^'ith a noisy efifort, and then draw iu a very deep breath. By tliis abtsurd process they produee dryness of the thraat, hoarsenessi a muse of exliaustion in the muscles of the chest, and a feeling of emjTtiness within tlie chest. After a few years the coiientunt njechmiical strain leads to dilatation of the bronchial tubes, rupture of the air vessels, and empliyseuia. Tha lives uf these rnen are n finally j)reearions and sliurt.
Playing u|H:m musical wind instruments is eometimes a cause of disease of the lungs, owin^ to the pressure which is maintained during hmg retention of the l>reath after deep inflation^ It has been stated that players on wind instruments are less susceptible to sevei-e forms of chest disease than are other persons. 1 can find no precise data to support this view, although it may be that those who are disposed to consumption uf the lungs are henetited by any act which, in moderation, eatises regular and deep iuspira* tion. When I first commenced professional life* there \vas a physician living in London who made considerable reputation by the inventi<.»n of what was commonly called a wliistle or blow- tnbe, through which consumptive persons wei-e taught to breathe deeply several times a day. It would seem tliat some good was really effected by this plan, and it is told of Cuvier, the great naturalif^t, that he, being threatened with consumption in his youth, was greatly benefited from reading aloud every day, b}' which the lungs were freely exercised and filletl witli air.
I think I have seen, for the same reason, some benefit from playing very moderately on a wind instrnment. On the other hand, when such playing becomes a professed occupation, and the player is for many hours a day subject to over-distention of the hnig, the delicate pulmonary structure is very soon apt to lose its elasticity and to becorne emphysematuus. Bassoon, trondione, horn, and tnu7i]>et players are specially liable to these iujuries, althougli the liability is not equally distributed amongst them. An intelligent bandmaster once explained to me why some suffer soon and others esca]>e. It depends, he said, on the question ^vhether the phiyer has or has not learned the art of retaining a large volume of air iu the month and throat, and of charging the diiiteuded partfi from the nostrils while still playing. iSouio learn
392 LUNG DISEASES FROM MECHAKICAL PRESSURE.
this art so well it l»eri>mes witli tliem an n neon scions act, and their Iung8 are gearcely at all inHuenced. Others make a distended hmg the reservoir, and, in fact, hold their bi^eath all the time tliej are playing* It is these players wlio break down.
From holding the bi'eath very closely in playing a wind instru- ment, tlie cii*culatioii through the hinga is sometimes impeded, and pressure of blood is thereby thrown on the right fiide of the heart. An amateur flute-player, who^e history came under my observation, euflFered from a very singular accident in this way. From the tension of lioldiuic his breath tlie rii^ht side of liig lieart was engorged, and the membrane whicli closes the fommen ovale or ftPtal opening between the two auricles gave way. lie became, thereupon, of dark color all over the body, eoldj and sul>ject to that form of disease desct^bed at page 136 as cyanosis, or blue skin disease.
In other instances the obstruction to the flow of blood on the right side of the hoai*t during the process of playing })re vents the due retuj'n of blotid by the veins from the head, and leads to pressure of blooil upon the braiu with vertigo and nausea, I kuew this to occur, iu tlie case of ati amateur clarionet-player, to such an extent that he was ol>lrgeJ to give up the practice. In youths w*ho have been trained to band exercise one or otlier of the above- named symptoms is not mifrequently met with, and is an indica- tion that the coiifetitutional peculiarities are against the prosecu- tion of tlie art.
Aiiotlier cuiious disease from pressure is called '* Caisson,'' or ** Coffer-dam,- ' disease. It belongs to an industry tliat is practi- cally of modern iiitroductiou, and is brought alanit by the process of gubjeciiiig the body to great atmospheJ'ic pressure and after- wards suddenly relieving it from the pi-essm*e.
In laying piles of bridges and in some other similar works it is necessary to place the workmen iu ei^closed spaces beneath the level of the water, and to exclude the entrance of water by forcing air into the spaces in which the woi-k is carried on. Tliese en- closed spaces, or rather the tubes wdiich form the enclosures', arc called "caissons,'' or citfiFer-dauis. In tliem the compressed at- mosphere in which the workmen labor is contine<L and to the diseased conditioTis which result in the men the term '* Caisson tlisease " is applied.
The ordinary pressure of the atmosphere on man is fifteen
LUNG DISEASED FROM MECHANICAL PRESSURE.
393
pounds to the square inch of siu'faee of the body. Under that pressure all the foiictions of life are iiatm^ally carried on. In the caisson the air is pimiped in with such foi-ce that an addition of two. tliix»e, and even four atnioeplieres may be maintained, under which additional pressure the workmen have to folhiw their avo- cation. If a workman can work ten hours under the ordinary pre^sui'e of one atmosphere, he can work five hours, or half the time, under two atmo8plieres, three hours and twenty minutes, or a tliird of the time, under three atmospheres, and two hours and a half, or a fonrtli of the time, under four atmospheres.
It was soon detected that when work was prosecuted under these pressures, some peculiar physiological changes wei'e pro- duced in the workers. It was ohj^rveJ that the blood in their veins became of the same red color as that in the arteries, that the breathing was quickened, tliat tJie action of the skin was profuse, and tliat when the men returned from their work to tlie ordinary atmospheric pressure they were subject to pains in their limbs, and to giddiness, with other syniptonjs of nervous disturbance.
The caisson disease has recently been most carefully studied hy Dr, Andrew II, Smith of New York. Dr. Smith, whom I have the pleasure to know, has had an unexampled experience of the disease afforded to him while attending numbers of caisson laliorers at a great work which bus recently been carried out near to New York. The disease, he says, depends upon increased at- mospheric pressure, but is ahvays developed (ffier the pressure is removed. It is chnracterize*] by extieme pain in one or more of tlie extremities, iiud sumetimes in the trunk of the body, and this pain may or may n^jt be associated with pain in the stomach and vomiting. In some cases the pain is accompanied l>y jiandysis, more or less complete* Tlie paralysis may be general or local, but is most fi-enuently confined to the h>wer half of the body. Ilead- adie and vertigo are sometimes present. The above symptoms are connected, at least in tlic fatal cases, witli (congestion of the brain and spinal cord, often resnlring in effusion of serum or of hlood, with congestion of one or more of tlie abdominal organs. When sutBcient time elapses before death the»"C may even be soft- miing of the brain in parts of that organ.
The one essential cause of the caisson disease, according to Dr* Smith, is the transition to the natural atmosjdieric pressure after a prolonged sojourn in a highly -condensed atmosphei*©. Without
394
LtTNG DISEASES FROM MECHANICAL PBESSURE.
this change the disease is never developed, and in some workere it is never developed at all, so that a special prediBpofiition to it geems necessary.
The Btudy of the caiseon disease has led Dr. Smith to the opinion tliat it affords a key to the singular tlioiigh verj coniinon predisposition to pains in the litnhs on the approach of a storm. These pains are generally condidered to be of a neuralgiac eharae* ter, and to depend upon the dampness of the atmusphere. But, as the caisson disease aflfords examples of precisely the same pains, immensely inteni&ified in degree, and resulting from the diminu- tion of an atmospheric pressuj-o to which the body had adapted itself, irrespective of any qnestion of Innnidity, analogy suggests that the so-called neuralgiac cases are simply exaggerations of a predispusition identical in kind with the one nuder discussion, and produced, not hy the intluence of nuusture, but by the low baronie- tric condition of the atmoHphere which precedes a storm. It is tnio that tlie cliange in the pressure is insignificant when compared with that which pnxlnces the caisson disciise, but it is supple- mented liy the longer duration of the higher pressure to which the subject has been previously exposed.
CHAPTER m.
ACQUIRED DISEASES FROM MECHANICAL CONCUSSIONS AND SHOCKS.
The effect of repeated concuB&ions upon tlie bodj is to produce a varied series of di^ea&ed tvmclitituxs affecting various organs of the body. Iron plute workers, owing to the constant noifie to which they are enbjected, especial Jy during the proeeiBS of rivet- ing, {^utfer mnrh from tlie vibration. They are deafened by it, and hi some instances are rendered pt-rnianently deaf* In other ioBtances the circulation throngli the brain is disturbed, so tliat giddiness and nansca follow as i-esults. These phenomena are produced in certain of the uorkiueu much more readily than in others, and occasionally incapacitate them in the very outset of their career. Some exj)erience a temporary annoyance which^ cfter a time, they get over, the ear becoming less sensitive to the din. In a third class of caries the first oppression is tolerated^and tlie ear becomes accustomed to the vibration but slowly loses its natural cupacity, so that deafness, more or less complete, is gradu- [ally established.
Anotlier effect of repeated concussion in these workers, and in others who use the baminer in rapid E-niart stroket?, is a vibration along tlie nervous cords passing fi'Lim the hand to the brain. The concussion gives rise to a thrill which amounls in time to pain and nnnibness, ending In failure of readiness to hold or grasp the hammer. When this symptom is established it, usually, coutinnes, and often renders the workman unable to follow his occupation*
The series of vibrations produced in railway travelling are not imfreqnently severe in their results. In this mode of travelling there are several kinds of vibrations which tell upon the traveller, Tliere is the shrill whistle at tlie railway station, which affects, thr(ni|/h the organ of hearing, the whole of the nervous system. There is the vibration produced by the rolling of the carriages and
396
DISEASES FROM CONCUSSIONS AND SHOCKS.
the collisions of one carriage with another in stopping; and, there is the constant vibration wiiich is felt from the mere motion of the carriai^e as it hdIIs alon*^.
By all railway travellers these syroptonis are more or less ex- perienced at first, but after a time, when travelling is very fre- quently ix^peated, they seem to pass away, sla if the eenbes and sensibilities were deadened to them from use. It may be tliat in certain constitntions the bad effects are actually nentralized by babit, bnt it is more common that they are only concealed. In maijy persons, such as commercial travellers, gnai-ds, drivers, and stokers of tlie engines, wlio ai-e the persons moj'e partienlai'ly con- cerned, there is experienced after a time^ if they are to suffer from the vibration, a sensation of thrill which extends along the spine, and wliich is nncinnfortable if not actual ly painful. When this sensation is borne for several motiths or years, which is often the ease, the digestive functions begin to fail, dizziness witli fmquent headaelies supervene, followed, in the more determinate examples of disease, by want of pL»wer and by numbness in the lower limbs, witli uncertainty of position aiid of prcssni*e when the ft»ot is bronght to the ground. If the symptoms be noticed in time and promptly met they generally subside under rest and judicious treatment, but I liave known thuni pass into complete failm*e of muscular power with prematui^e break up of life.
Voung cliildren are often severely affected by the viViratory ehriekitjg and tnumlt at the railway station.
More determinate and sudden concussions and shocks are in- flicted on raOway travellers b}^ the severe collisions, which now and then occur. Under such concussions, though thei*e may be no trace of actual physical injury, the nervous systems I'eceive, some- times, a shock so severe that it is never recovered front, or, if it be recovered from, only after a long interval of time. In some in- stances the ganglionic nervous systetn is the part that receives the sliock, when the stomach and other digestive organs specially suffer. A sorter of letters in a mail van felt that the train was off the rails, and the van going at gre^t speed down a decline. He seized a mpe that was hanging from tlie eenti-e of the van, hung by it, saved the direct shock which came, and showed no sign of bruise or blow. But he '* spun round," as he expressed it, " like a top,'- and when he found his legs again was suffering an intolerable pain in his stomach and bowels, with violent attempts at vomiting. He came
DISEASES FROM CONCUSSIONS AND SHOCKS; 397
nnder my care almost immediately afterwards, and thongh the pain subsided, the effects of the shock to the 'organic nervous sys- tem remained persistent. He lost all digestive power, snflFered from continued intermittency of the heart, became emaciated, and finally succumbed. In other instances of shock the spinal cord is the part impressed, and want of power or actual failare, paralysis, of some of the gi'oups of muscles supplied by the cord succeeds, although no visible physical injury has been inflicted. I have known an instance of this kind in which paralysis of the lower limbs lasted for ten years, and may possibly have continued longer, for the affected person, although I have lost sight of him, may be still alive.
In a third class of cases of concussion the brain is the organ tliat sustains the shock in one or other of its parts, upon which various kinds of cerebral symptoms follow, such as giddiness, nausea, noises in the head, irregular muscular movements amount- ing sometimes to epileptic seizure, or failure of nervous power. One common impression made upon the brain from these concus- sions is that of sense of repetition of the concussion followed by great excitement. In such cases various exciting causes will light up the panic. A little noise when falling asleep will be all suflS- cient. The hearing of a crash or fall, the rattle of a train, or car- riage, will be all suflScieut. In the worst illustration of the kind the mere news or recital of an accident will light up the record of the impression with all its excitements and dreads, and will be followed with after excessive depression and local or general failure of nervous power.
The phenomena of sea-sickness may no doubt be placed under this same head in relation to cause. The effect of the motion of the vessel is to produce a series of shocks both to the ganglionic, or organic, as well as to the cerebro-spinal system. In some per- sons the organic nervous system is chiefly affected. They are easily made to vomit, and suffer as severely for the time as the patient of whom I spoke above who suspended himself by the cord in the railway carriage. They are slow to recover from the sickness ; they lose appetite, and remain prostrate for many weeks, perhaps as long as the voyage lasts, and I have known at least one instance in which tlie sickness was never entirely recov- ered from during a comparatively long life. In other persons the shock tells most upon the brain and spinal cord. They are less
F
398
DISEASES FROM CONCUSSIONS AND SHOCKS.
troubled with vomiting, but are oppressed with headache, giddi- ness, and inability to stand upright or move with steadiness. After thej have completed the voyage thsse persons suffer still from unsteadiness in walking, feehng, as they express it, the movements of tlie vessel. On going to sleep they are for a time conscious of the isame phenomenon, and are uvvakenetl by it^ as if exj)6riencing the pitclung of the vessel. A repeated series of con- cussions have, as it were, affected the brain so as to leave an im- pression of a waved ike motion which does not subside until after a considerable length of time.
Tliere are other kin<ls of concussion which detcnninately affect the heart and tlie circulatory system, as well as the nervous organism. The cai'penter, who, by the way, enjoys a moderately healthy life, his vate oi mortality being as ninety *one to the mean of a li mid red of the other occupations, is subject to a concussion of a special kind from planing wood. This concussion extends through the chest, and causes a peculiar condition in the large artery, the sob-clavian, which rims under the collar-bone, so that if the stethoscope be placed over the artery, the pulsation of it is giire to be accouipauied by a murmur of a harsh cliaracter. In course of time the effect of this concussion is felt also by the heart. The action of the heart becomes disturbed, irregular, and enfeebled, A sitnilar state of things is induced in the wood -saw- yer, in whom ii^deed the jerk connected with the act of sawmg is brought to bear more distinctly and rapidly upon the heart.
Persons who have to ride much on horseback, and soldiers, such as artillerymen who ride on the gun-carriages, are subject, in like manner, to concussion, which is fe!t nut only by the heart, but by the great bh>od- vessel which ascends from the heart, the ascending aorta. I have already explained at page 143 that in the old posting days aneurism of the aorta was so common among post-boys from this cause, that it was called '* post-boy's disease.'^
The mode in whicli this concussion tells upon the heart is ob- vious enough. The whole column of blood fmm the riglit ven- tricle has first to ascend through the aorta. It is pi*evented find- ing its way back into the ventricle by the semhmar valves which lie across the oritice of the vessel ; but in riding, with each bump upon the saddle, as it is called, the ascending column of blood is brought slightly back, by the concussion, upon the valves. This causes undue pressure upon the valves and undue pressure, from
DISEASES FROM CONCUSSIONS AND SHOCKS. 399
within, upon the artery itself. The artery thus becomes gradually dilated, loses its elasticity, and is made the seat of the aneurismal affection. For these reason* almost all men who ride hard and long suffer from enlargement and failure of the aorta, if not from aneurism.
The effects of concussion may be so severe, in exceptional in- stances, as to cause a fatal accident in the way above described. The late Mr. Bloxam, of Duke Street, for many years my col- league, consulted me once in a case of this kind which led to an inquest. A plumber fell from a height, while doing some repairs to a window, and dropped direct upon his feet. He died shortly afterwards. We found that the cause of death was a small tear or rupture of the aorta, just above the aortic valves. The valves being closed at the moment of shock, the blood came down upon them, like the water hammer in the water pipe when the water comes down on the closed tap, and the vessel gave way.
Porters who carry heavy burdens, and waiters who carry weights up and down long flights of stairs, are exposed to the same dangers ; and, in a more gradual but hardly less certain way, our steady and useful friends the postmen are similarly debited with disease from concussion.
en AFTER IT.
ACQUIRED DISEASES FROM MUSCULAR OVERWORK AND
STRAIN,
MrsciTLAE exercise carried out systematically and reasonably is
an essential part of a healthy life. The imiscles left inactive are exceedingly apt to imciergo ilegenerative change, and to prodnce, in comparatively early life, a feeldene&s of body which is fatal to the full enjoyment of the term cif life that is natn rally allotted to ns. Eut, nsefiil as it is, tnn&ciilar exercise may he carried to the extent of pnxiucing disease and of materially shortening the period of existence*
When ninscidar exertion Ls carried beyond %vhat is reasonable, two unnatural conditions, one locals the other general, follow. The local urmatural chatigo instituted belongs to the innsele or muscles snbje(^ted to the excessive work. We see this in the cnlargeuieut of particular nmscles, as in the enlargement of the muscles in the arm of the blacksmith and in the leg of the dancer. We sa}" that the nmscles in tliis state arc liypertrophied, and al- thongli tliey may be more conipetcnt, for a time, to perform the particular act for which they ai-e employed, they are, in fact, ont of harmony with the rest of tbe body, and are, therefore, in the strict sense of the word, diseased. Later on the local condition in tlie mnscle or muscles thus overworked may change from a state of undue strength to one of deficiency of power. The mnscular fihre may undergo degeneration, and be charged with new ele- ments which have not the contractile property; or, it may un- dergo wasting of structure and loss of w^orking capacity from that cause.
The general mischief which arises from over-muscular exer- tion is the mc,»st serious wlien it affects or influences the involun- tary mtiscnlur organs on which life depends; the muscles and parts engaged in the circulation of the blood; tlie muscles of
BtfiSASES FROM MUSCULAH OVERWORK.
401
respiration ; and the organs of digestioiu When once one of these fails, the faihire of the body altogether is inevitablep
Sometimes the effect of muscular overwork tells primarily upon the body through the stomach* A person who is altogether in fair liealtli becomes conscious of the fact after he has per- formed a certain amount of muscular labor w^hicli he aiay con- sider as not greatly in excess of his capacity, that lie has a painfol sinking and faihire in the stomach which nothing but complete rest can rectify. Afterwards he is dyspi^ptic, and for some daya loses his natural aptitude for taking and digesting food.
In another person the faihire commences in the respiration. There is experienced after fatigue froni mnscular exertion some M'ant of lircathing power, a sense of weariness in breathing, a weight and oppression, or a tightness of the chest with a little cough and not nncommonly an ache, extending from the breast- bone through the chest, with a slight spasm. Nothing relieves this condition but rest, rest whicli may, perhaps, be required for several days.
In a third class of persons, and by far the Largest class, the first signs of general failure are indicated through the cii*culation. The hearty it w^ill be reinenibered, is itself a muscle. It is the (^*ntral mover of the bodily life, and the physical life altogether rests upon it, if I may so express myself, as upon an inverted cone. Its work ever going on involuntarily night and day, cannot be disordered without comnnmicating some derangement to the whole organism. The effect of this is, that the heart soon begins to tindorgo modification of structure under prolonged over-exer- tion. At first its nutrition is increased ; then it beeomes over- active and over-powerf uh and in time holds a relationship to the Wnly at large which is out of proportion, in respect of balance of j>ower, with the rest of the body.
Presuming tliat tlie excessive exercise to whieli the heart is subjected is carried out early in life, while there is yet elasticity of the other vital organs, the body may adapt itself to the in- creased pressure and motion, and so, in the early period of com- pleted life, the balance may he restored and a healthy balatice secured. If it be asked, why should not this healthy balance iioaiu ? the answer is plain. It will not remain because the elas- ity i^ not persistent. As the body becomes developed and ita riicturca firm, the resistance to the stroke of the heart iuci^eases^ 26
40S
DISEASES FROM MUSCTTLAR OVERWORK.
aiid the heart begina to bear a load which oppresses it beyond the work that is put upon it Moreover, as its own nutrition become-8 less active, its own elasticity is impaired. Thus it, in turn, gives way before the resistance. It becomes relatively feeble, and with its feebleness all the rest of the organism necessarily sympathizes.
In one of my studies I calculated up what may be considered the complete niuuericid value of the stn:)kes of the heart of a per- son who has live<:l to fourscure yeai*s. The numerical value of beats or strokes raay be fairly taken at about three billions, which will have been delivered at the rate of rather mure than one hun- dred thousand per day. The heart which accomplished the three billions of beats in the eighty yearn is estimated, in this ealcula- tion, as performing a fairly natural life, and wo will suppose that, according to the construction of the organism to which it be- longed, it carried out its fidly-allotteil ta>k. It worked eighty yeai-s and made the three billions of strokes, which was its limit of work done, in tlie time named. If it had been the heart of a postmaUj its woi-k would have been increased a good fourth during the period of increased activity, and we may deduct from the time when its increased activity commenced a fourtli of tlie value of the life. If then overwork commenced at twenty years of age, a fourth part of the remaining years due might fairly be deducted, bringing the duration of the life that should have been eighty years to t^ixty-five years.
I do not give this as more than an approximate calculation, but it is not far from the truths and the day will come when calculations will be made sufficiently absolute to supply correct vakiations for estimating the value of life in persons following all laborious muscuhir occupations.
In the eases where excessive muscular fatigue induces constitu- tional failure, leading to premature death through the circulation, the heart becomes erdarged in the first stage; the blood-vessels become utiduly taxed in tlie second stage; the elasticity of the blood-vessels declines and resistance increases in the thii*d stage; the heart becomes enfeebled in the fourth stage, degenerated in the fifth, and incompetent for its functions in the sixth. In a seventh and final stage, one of premature old age and decay, some of the other vital organs, hmgs, liver, kidney, or brain^ foUow their leader in failure of function, and death closes the scene*
In certain instances it happens that the lieart itself is the miis-
DISEASES FROK MUSCrLAH OTERWOEK*
40:^
' organ first affected by tlie exercise. Under the exertion tlie organ may suddenly fidl alttjgetlier, lo&ing its iiervonB power, and becoming intermittent or arregidar in its aetion. I have known this aceident tooecnr in tlie most varied ages of life; in yontli, in full age, in mature, and in advanced age. Or the lieart may nn- dei^^ fmm the first, an enlargement, may work with a force that is out of proportion to every tln'ng that i? required of it, and may Ueeorne a centre of disturbance to all the otlier systems of the body. This is by no mcaTis an uncommon result of excessive muscular effort and strain, and, indeed, I may state tliat amongst the many j)ersons wlio liave come before me suffering fiT^m over- physical endurance in its early stages them have been very few in whom the lieart was not Uyo largo and t<H> powerftd. In later stages the enlarged and over-taxed lieart is apt to undergo degen- eration, to lose its contractile elements, and to become a centre of derangement to the body generallj^ from failure rather than from excess of dnty.
Disease from ATrrtErric Strain*
Athletic exercises, while they are in themselvrS exocedingly nsefuh when practised in moderation, are often causes of danger to health* E%'en in those eases where the training inchides the development of the whole of the body an extreme course of train- ing may pjXKluce a strain or an nltimate degeneration which is most detritnentaL We see such danger in the ca&es of men who at gi'eat 8elf*sacritice are, artitieially, bronght up to what is called perfection of work and endurance, as well as in men who are trained to perform particular feats, eueh as prize-figlitiug, rowing, nmning, foc^tdndl, and the like. Tiiere is a time in the life of those who nm trained when it is considered that all parts of the body are equally developed, equally strong, equally active. I have no douht that for a period during mature adolescence this point may be gained, but it is not lasting. There is no one human body so perfect, in conformation and in hereditary value of life through all parts of the body, as to be able to s^us^tain equality of perfection for any length of time. There is no human pursuit so unvarying in its character as to demand an equal quan- tity of work from all organs of the body. Thus in a 6ht>rt time, after what is called complete training has been attained, there ia
404
DISEASES FEOM MUSCULAR OVERWORK*
derangement in tlie body. One part fails while the other romaina in fnll power^ which means, virtually, diseai^e, for one organ does not halaiioe with the other. The kite Mr. Jolin Fernandez Clarke iiliistrated this point most aiiniirably in an essay on tlie fatal ill- ness of lleenan, tlie American prize-fighter. In Ileenan system- atized over- training destroyed the harmony of organic action. Ilecnan retained an imperfect general nniscular power, an exces- sive circulating and breathing power with deficient assimilation. As a consequence the circulation itself became embarrassed, and the man broke np.
In athleticism tliere is still another danger. It would appear that when once the nmscular organs have been brought to what is known as a higli state of trainings and Lave been maintained at this pitch for many months, they have been made to go through a stage of life which has told too determinately, as a ta.v, on their allotted life. In other words, they become prematurely old, have undergone changes as if from age, and thereupon have lost power. A knowledge of this fact is very old; it dates from the time when the athletic exercises of ancient Rome were transformed into causes of physical deterioration and of vital decay.
Some muscular exercises are at once injurious from the cir- curastauce that they calljiarts uf the muscular system irregularly into play* liowing is one of these exercises when it is carried out as a systenuitic labor. In rowing the lower limbs of the body are steadily fixeti, while the trunk of the body is moved backwards and forwards with every ahermite position, and with great mus- cular exertion* The effect of this is to subject the thoracic and abdominal organs to s|jecjal pressni-es. The blood-vessels of these parts are brought to their extreme limits of capacity forlaljor, and tlie heart has tlirown upon it an amount of work which is dispro* portionate and beyond its power, if that be forced over a certain limited degree* Thus professed i-owers frequently become affected with one or other of the diseases of the heart or circulation, called hypertrophy, dilatation, aneurismal enlargement^ degeneration.
Running and walking against time also bring about their evila* In these exercises, carrierl to an extreme degree, the strain upon the lungs and heart is intense ; and concussion, to which so much reference was made in the last chapter, is added to the strain. The heart in persons who carry out this athletic struggle becomes rapidly affected ; it attains a large size at lu*stj and is then reu-
DISEASES FROM MUSCULAR OVERWORK. 405
dered irregular in its action, if not intermittent. Sometimes it is made intermittent with the first effort in running. One of the worst illustrations of this last accident is at present under my ob- servation. The subject of it is a young man, twenty-three yeai*s of age, who was brought to what he very correctly termed " a dead stop " in his first gi*eat race, twelve months ago, and who, notwithstanding a marked improvement under absolute rest since, can never be expected to regain complete soundness of his circu- lation.
Occasionally during the exercise of ninning the breathing fails suddenly instead of the heart. Every runner knows that before he can steadily keep up his pace he must "get his wind," as he expresses it. When he starts to run his heart begins to beat in excess of his breathing, and his breathing consequently seems to be short or lost. By-and-by the heart reaches the height of its velocity, while the breathing muscles are brought up to their full pitch, so that there is established, by this means, an equal action between the two sets of vital organs, and, their balance restored, they go on together until they are exhausted, or until the limbs they supply with oxygenated blood are exhausted. Sometimes when the " wind has been got " the limbs fail first ; but the wind is not always got ; for when the rimner has naturally a weak chest, weak muscles of respiration, or feeble lungs, the strain upon these organs is more than they can endure. Thereupon one of three accidents may happen. The diaphragm and other breathing mus- cles may become partly paralyzed by the effort ; or some of the air vesicles of the lungs may give way under the pressure, pro- ducing emphysema ; or some of the vessels of the lungs may give way, producing hsemoptysis, vomiting of blood. I have known all these diseased conditions induced by the athletic effort of run- ning against time.
The game of foot-ball is another exercise which, violently car- ried out, leads to many dangers from muscular overwork and strain. It leads, perhaps, more than any other game to direct physical accidents from kicks, falls, and concussions; but apart from these accidents it combines with the dangers incident to run- ning another danger which is very great, that of sudden cessation from active running in order to make the effort of kicking the ball. At the moment when the balance of the circulation nnd respiration is being, or is, established, there comes this sudden
m
BI9EASE3 FROM M08CULAR OVERWORK,
check, by which a tremencloua strain is thrown immediately upon the heart, iiiiJer wbieh that organ ijs> fur a moment, checked alto- gether in itfi beat. The worst forms of heart disease I have ever seen in the young, as produced by athleticism, have epnmg from this exercise. I had one boy under my care in whom the heart was brought by this cause to so large a size that as he lay in bed the bedclothes could be seen to vibrate from the impulses of the -ilieart. He had to retain the recumbent position for a pt?riod of ro years before the balance of tlxe circulation was fully restored.
BiSKASE FROM McJSCULAB BtBAIE tS MaTURE LiFE.
Men who are engaged in arduoua professions and businesses,
Land who during their first stages of manhood are occupied in laking a living, often find themselves easily fatigued and wearied with the labors of tlie day.^ If they have been following a seden- tary pm^suit, their muscular organs, nndergL»ing a slow waste and renovation, become the seats of effete and inactive material, and are wearied by very slight exertions. Some men in this position, l>eing deficient in mental energy, and having practically lost the recollection of active exercise, nurse the weakness under which they are suffering, and let themselves fall into incapacity from actual dcireneration of tissue. Other men of more resolute will plunge into exercise as a remedy, and finding at first great benefit therefrom, and discovering an ability for exercise which they im* pued WHS altogether lost in their case, begin to cultivate efforts of a pliysieul kind which nw practically athletic in character, and wliich even in their younger days might not have been altogether judicious.
By this course the mature man entering into active physical work is apt to subject himself to disease. I'p to a certain point he is doing the wisest thing possible; he may partly renew his youth by moderate exertion, but wiieii he begins to lay a serious tax upon liis remaining strength he almost inevitably comes to grief* This, in fact, is his natural fate under such ciixnim stances. lie has passed the tifuc of life for making up, rapidly, his wasting tissues. He has arrived at the time of life when tlie elastic struct- ures of his body have lost much of their elasticity. He has ar- rived at a time of life when, all parts of the body being duly fortnod, the facility for adaptation, under emergency, is impossi-
DISEASES FKOM MUSOULAK OVERWOP.K,
4m
bie. He lias arrived at a time of life at which it is all but certain that there is some irregularity in the systemic work of the organ- ism. Everything, therefore, in the way of physical exertion ought to be like the work of liis mind, active truly, hut with careful measure of activity and without strain.
Kot understanding these truths, the mature man will take to various exercises, iu which he will often compete with young men, and feel a special pride in being their equal or superior com- j>etitor. He will join a vohmteer corps, and go through drill and march after a hard day's work ; he will take to the hunting field ; he will hecoiiie a yachtsman or a boatsman ; he will exercise hiin- *>elf with long morning walks ; or, worst freak of all, he will take to inouDtain climbing, and make that severe effort one of the com- jKJtitive objects of liis life.
Li the pursuit of these efforts, which will be seen to be all somowhat akin, the risks are numerous. The heart very soon be- gujs to suffer. It does not grow larger and stronger now, as it would have done in youth ; it grows wxntried and enfeebled after short efforts. The blood-vessels do not expand and contract as they did, but expand with imperfect contraction, gradually dilate, and sometimes suddenly give way. The lungs are rendered em* pliysematous under comparatively low pressure. The secreting organs, less ready and accoijimodating in function, are easily dis- turbed and made to act out of order. When the exhaustion is very great the digestion is enfeeliled, and does not recuperate nipidly. Most important of all, the nervous system is more limit- ed in respect to its sustaining poM^er tliau it was in early life, and is given to fail locally, that is, in parts of the body, as well ek generally.
There need be tio wonder if amongst so njany causes of mis- _ chief active results in tlie way of disease occur, under extreme Kerci^, in persons exp<»sed to such risks. In one the failure [•mmences in the heart, and is sudden, the acti<»n of tlie urgau kVung rendered irregular or intermittent. In another tlie failure I* in tlie blood-vessels, the largo arteries near the heart becoming dilate*!, or the inimite arteries, the arterioles of some distant or- gan, like the brain, becoming iiipturcd, with secondary results from the injury to the organ in which the accident has taken place. In a third person the Inngs am made the seat of mischief; the bmnchial tubes are dilated or the minute vesicles are niptui'ed
408
M
FROM MUSCULAR OVERWOl
over a surface tooi-e or less extensive, Iii a fourth the liver or kidney becotiies disturlied in function. In a fifth tlie stomach is affc'cted and digestion rendered imperfect. In a g^ixth the nervouis system is implieatedj the brain fails to perform its active duties, BO that mental weariness and somnolency are symptoms of fre- quent occurrence ; or some special part *»f tliC body or limb loses its nervous power, and h said to l>e palsied or jiaralyzed.
In these brief notices I simply eninnerate the more seriouti phenomena I have witnessed as results of muscular overwork and etraiu under the conditions specified.
In addition to the accidents named above is one other of a purely meclianical kind, which not unfrequenlly happens to per- sons of matm-e life who are undergoing seveix^ muscular work» Tliis is sudden rupture or tear of the fascia covering the muscles* particuhij'ly the muscles of the leg, an accident described on page 234 under the head '* sprain/ •
Diseases from Muscplar Strain inbuced by Inditstriai*
Occupations.
Many members of our industrial classes, navvies, hrickmakers^ bargemen, miners, coab beavers, porters, hodmen, dockdaboi-ers, carmen, and blacksmiths, owing to the nature of their occupations, are subjecteil to excessive muscular strain. Amongst these men the diseases incident to their occupation are more commonly con- nected with the heart than with any other organ* When they l>egin tlaiir work in eafly life, as is their coEumon fate, the heart is at iirst enlarged arjd extremely strong. The enlai-gement renders them for a time capable of excessive exertion, but in the end this only leads to preniature failure of the other organs of the body, and to that early break up wliicli is so frequent amongst these classes of the industrial community.
Wheu tliere is predisposition to cliest affection in the workers, or when any special causes operating upon the hmgs combine with thi»se acting upon the heart, the failure may commence in the limgs ; it often commeuces in lungs and heart simultaneously.
There is one renuiining effect of excessive muscular exertion of a long-contirmed character whicli is local in its nature, and which must not be omitted in tliis place. I allude to paralysis of the hand produced by long-cou tinned action of the muscles, an
DISEASES FROM MUSCULAR OVERWORK. 409
affection described at page 177, tinder the head of local paralysis, as ''scrivener's palsy." A similar kind of local paralysis, affect- ing the left hand, sometimes befalls the player on the violoncello, owing to the repeated and prolonged pressure exerted by the fingers on the strings of the instrument. One of our most dis- tinguished violoncellists was for several months under my care with this form of paralysis previous to his death. The disease does Hot, as a rule, appear until there are signs of general failure of constitutional power.
Disease from Long-Continued Pressure.
Continued pressure from strained positions of the body may be productive of temporary or permanent symptoms of disease, even when the work which leads to it is comparatively light and actually sedentary. I have observed that writers who sit closely at the desk acquire, not unf requently, the habit of leaning heavily forward upon the desk, so that the lower part of the breastbone is compressed. The compression may produce an actual defonn- ity if it be caused early in life, and the effect of it is to interfere with digestion and to produce a sense of weakness which is, at times, very depressing. The fact of the pressure being made is almost always indicated by the mark or wear of the clothes which cover the part of the body that is pressed upon. The sedentary worker may therefore always know by this sign that it is time he learned to assume a loss injurious position during hours of work.
Another strained position adopted by persons following seden- tary pui-suits is that of leaning heavily on the chair a little over towards one side of the body. This causes pressure upon the sciatic nerve on the side leaned upon, the result of which may be a sensation of numbness and want of muscular power in the limb below. I have known persons suffering from this cause taken with the fear that they were affected by paralysis.
CHAPTER V,
ACQUIRED BEFORMITIES AND DEFECTS OF THE BODK
The body is subjected to varions deformities and defects in- duced in different ways and connected with different organs or parte. Some of these deformities or defects are of triding, others of the most serious moment. In certain instances the skeleton is tlie seat of the defonnitj, and, in the majority of instances of pernuHient deform ity, the skeleton is involved. In other cases the muscular system is the part affected. In a third class the ex- ternal membranous covering of the body, the skin, is the structure impHfated.
In the chapters on the local affections of the different systems of tho Ijody wo liave aheaJy had before us Oiaay of these deformi- ties and defects. At pages iJ4:4-245 tlie various deformities eddied curvature of the spine are described* At page 24^ defornjities connected with tlie teeth arfe detailed* At pages 235-237 differ- ent kinds of iluformitics connected witli musdes and teridone, pausing chib foot^ club hand, wry neck, and the like aredescnhed. At paf^e VM the defornuty of the eye called strabismns or stjuint IS explained, and at 208 some affections of the skin, wliich may be called defects or deformities, are brought under notice.
1 need not do more than refer as above to these conditions of disease, and as tliey include the greater part of the common de- formities arid defects, I have little else to add to tbiscliapter than a description of one or two deformities induced by practices of fashion and folly.
AcQiTiuED Deformities of toe Chest.
In women tlie chest is too often subjected to deformity from the i>ractice of compression either by tlie tight baud round the w^aist or tlie tigbtly-laced corset. Tlie tight band produces that peculiar wasp-like deformity and ugliness which is commonly
ACQUIRED DEFORMITIES AND DEFECTS OF THE BODY* 411
called the liour-glass waist. By systematic and increasing pressure of tlie band the floating ribs are brought eloeer together, and the space between the thorax and the cavity of the abdomen is reduced, often to an extraordinary degree below what is natural to it. The tightly-fitting corset includes a larger surface in its operation. It produces narrowing of tlie same region of the body as the band, though perhaps not so sharply, but it also includes a consideralile portion of the chest, so that the size of that cavity is greatly reduced, to the serious limitation of the breathing space. The miscliiefs resulting from these mechanically acquired deformities have been described over and over again by various writers, and I Iiave more than once stated them before ; but as they are most serious, and are still extant, I make no apology for i*estating tiieui.
The effect of the pressure is equally injurious to the organs of digestion, i-eRpiration, and circidation. T!ie liver and stomach are compressed, the digestive functions are impeded, and a distaste for solid food, with a difficulty to digest food, and with symptoms uf pain and flatulency after eathig, are tire common proofs of the injury that is being inflicted. The great breathinic nmscle, the diaphragm^ which separates the chest from the abdomen, and which, by its descent in contraction, causes the chest to fill with air, is impeded in its motionn^ add is therefore unable to sustain a free rt^spi ration. The large veins from the lower part of the body, which pdur their blood into the right side of the heart, are compressed, and in the worst instances the liL^art itself and t5ie lunga themselves are actually subjected to rct^traiot.
By these means the organs of the circulation, not less than the organs of respiration and digestion, are disturbed, to the detri- ment of the wht»le of the body, which depends on these organs for its supplies uf nervous and muscidar force, and for its nutri- tion in every part. To the syiuptoms of indigestion are added breath lessness on slight exertion or excitement, coldness of the exti-emities, weakness of muscles, constipation, headache, and other evils not less severe.
The effects of mecbaiiica! pressure of the kind describod are not confined to the mere periotU of time at whicli the pressure is applit?d. They extend to after life, and when long continued, produce an imperfect build of the eliest and of the trunk of tlie l>ody which is never lost. Women thus deform ed^ when it
412
ACQUIRED DEFORMITIES AI
tlieir turn to become mothers, pay a penalty of eiiffering which would have been epared them if their bodies had developed into tbe hiudtJiy and beaiitiftd form devised by the hand of Nature.
The evils arising from coitipreai^ion of the chest and body in early life are not exclusively restricted to the female sex. School- boys and youths constantly practise the habit of binding up their clothes round tlieir bodies, by means of a belt tightened firmly above the hip.% instead of wearing; the brace over the shoulder. 8ome boys and youths are aUo tanglit the plan of putting on an extra belt for ** holding in the breath," before tJiey run or leap. In the pursuit of certain active businesses in which weights have to be carried, this same system of wearing a tight belt is atioptcd and practised by working men, until the artificial and ingenious support, as it is assumed to be, becomes, like the corset of the woman, a veritable injuiy.
To the belt the same objection applies as to tbe tight band and corset. It implies the free motion of the abdominal organs ; it impedes tlje freedom of the respiration ; it interferes with the circulation in the young athletics wlio wear it while they are run- ning, rowing, climbing, wrestling ; it tends to bring on hernia, rupture.
AcQcmjiiJ DKFOEMrrrEs of th?: SpmE.
The spine is subjected to deformities from various acts by which it is made to maintain a bent position for long periods of tirjie eacli day. This bending iB, in s^inie instances, connected with oeeupation. It is enforced in thoBe who have to carry weights upon the head, such as market-garden men and women, itinerant fisbmougers, men and women in gonie factories, and the like. It is unforced in men who have to carry heavy weiglits on their backs, such as luggage -porters, coal-heavers, millers, and hodmen. It is enforced in persons who arc engaged in work re- quiring a stooping posture, as in the sawyer, the wiieelwright., and especially the men wlio are employed at rivetting in cramped positions and in limited space* It is not infrequently induced in persons who are engaged for long liours at the desk, in writing and making calculations or drawings.
The spinal column under these unnatural positions loses its beautiful series of curves, and assunics one long fixed curve, the
DEFECTS OF THE BODY. 413
concavity of which is anterior, the convexity posterior, to the body. The great organs of the chest and abdomen are not neces- sarily compressed by this deformity, but much muscular power, requisite for the full expansion and contraction of the chest in breathing, is lost. The gait also is considerably modified, and the capability of the lower limbs to maintain the ei*ect position is de- creased. Connected with the induced deformity there is, usually, general debility, and a loss not only of bodily elasticity but of nervous activity. The body, generally, is weakened, and is, as it looks to be, prematurely old.
Acquired Deforioties of the Lower Limbs.
The lower limbs are subject to deformities arising from dif- ferent sets of causes, some of which act upon the osseous or bony, otliers on the muscular, others on the circulatory system. The deformities connected with the bones of the lower limbs include those which arise from rickets, as described at page 241 ; con- traction of the limb from abscess in the hip joint ; dropsy of the knee joint; bow-leg, out-knee, and knock-knee affections de- scribed at page 244. Deformities of the muscles of the lower limbs include the varieties of talipes or club-foot, enlargement of the bursa of the patella, housemaid's-knee ; bunion ; and, rupture of muscular fascia ; affections all explained in the chapter on the muscular system, pages 231-237.
These deformities are results of various mechanical influences telling upon the limbs, and combined, as a general fact, with con- stitutional defects and weaknesses.
Acquired Deformities of the Feet.
Other forms of tight pressure upon the body are open to serious, if not to equal, objection. The wearing of shoes which compress and distort the feet is a singularly injurious custom. The pointed shoe or boot is the most signal instance of a mis- chievous instrument designed for the torture of the foot. By this shoe the great toe is forced out of its proper line towards the other toes, giving a reverse curve, from what is natural, to the terminal part of the inner side of the foot, while all the other toes are compressed together towards the great toe, the whole pro- ducing a wedge-like form of foot which is altogether apart from
414
ACQriRKD DEFORMITIES AND
the naturaL Siieli a foot has lost its exparuse of tread ; such a foot lias lost its elastic resistance ; such a foot has lost the strength of its areli, to a verj considerable degree ; 8uch a foot^ by the irregular and iinnsual pressure on certain points of its surface, Ims become hai-d at those points, and k easily affected with eorns and bunions. Lastly^ bueh a foot becomes badly nour- ished, and the pressure exerted upon it interferes witJi its cumu- lation and nutrition. It ceases to he a mendier upon wliich the body can sustain itself witli grace and wUIi easiness u( niovemenr, even in early life; while in old age it becomes a foot which is ab- soltitely unsafe, and which causes much of that irregular holibling tread wbicli often renders so peculiar the gait of persons who have passed their meridian •
It very uften happens, that these mistakes in regard to the boot and shoe are for a time itjcreascd by the plan of raising tlie heel and letting it reat on a block of a pointed gliape, '* the peg top." Anything more barbarous can scarcely be conceived. By this means the body, which should naturally be balanced on a most beautiful arch, is placed on an inclined plane, and is only prevented from falling forwards by tlie action of the nuiscles which counterbalance the mechanical error. But all this is at the expense of lost muscular effort along the whole line of the mu*- cnlar tracks, from the lieels actually to the back of the head ; a loss of force which is absolutely useless, and, as I have knt»wn in several cases, exhausting and paiiifnL In addition lo these evils arising from the pointed heeled boot, there ai-e yet two more. In the first place, the elastic spring of the arch of the foot being broken, the vibration produced by its contact with the earth, at every step, causes a concussion which extends along the whole of the spinal cohnnn, and is sonietiuies very acutely felt. In the second place, the expanse of the fc^ut being limited, the seizure of the eartli by the foot is incomplete both in standing and in walk- ing, so that it becomes a new art to learn how to stand erect or to walk with safety.
The mention of these deformities of the feet would hardly be complete without referring to that systematic deformity of the foot which is practised on the female population of China to this day, and which is brought about by bandaging or compressing tlie foot, in earliest life, so as to prevent growth. The foot of the Chinese woman, crippled by this process, is simply atrophied ; it
DEFECTS OF THE BODY. 415
retains, generally, its original shape, but it is really still the foot of a little child.
Acquired DEFORMmES on the Sitrface of the Body,
Some pressures made on the surface of the body lead to de- formities or defects which, though superficial only and limited, are not without their importance. The constriction on the leg pro- duced by the garter is frequently made permanent. The pressure of the gai-ter causes a line of depression round the limb, by which tlie course of the blood through the veins of the foot and leg into the body is impeded. This is one cause of varicose veins, some- times an original cause, and always a serious impediment to re- covery when, from any other reason, the enlarged or varicose vein is already present. The ligature or band called the garter is bad in any way, but is far worse when it is worn below than above the knee, for above the knee the two tendons, commonly called hamstrings, receive a great portion of the pressure, and act as bridges to the vessels which pass beneath.
In infants, during their first weeks of life, the cutaneous sur- face of the body is often rendered exceeding iriitable by the pro- cess of tight swathing to which the little body is subjected. I have known sores to bo produced by reason of this absurd prac- tice, and a great deal of the discomfort or positive suffering which young children undei'go in their first days spring from the chafing and pressure so inflicted. I have known the bad results , of the swathing process extend even further. I have seen the body rendered temporarily misshapen from the same cause. The practice of swathing young children tightly is a mistake altogether, although it has probably been a custom from the earliest periods of history.
CHAPTER VL
ACqUlRED DISEASES FROM PHYSICAL INJURIES.
A LABGE number of serious and often complicated affections liappoii to the body from common accidental causes, by wliicli I mean causes brought about by sometbing which man himself does^ t>r is doing, or has done,
Varions names are given to distinguish the nature of these accidents when they occur* If the bndy has received a blow in any part by which the surface is braised but not broken, a coii- t union is said to liave been inflicted. If the surface is actually divided or broken, the term wound is applied. If a tendon or musdo ia displaced or injured, so that movement is interfered with, Hprain is tlie word employed to express what has taken phice, If a bone is hmken./raeture is tlie term applied. If a luine i» displaced at a joint, a disheatwn is said to have occurred. If a foi-t^ign substance is carried into any part of the body and it^- mains tliem it is said to be imjxietian. If from a wound an open- ing is f<>rmcd contmimicating with some otlier part or organ, a ^fisUilij is iicclared to Imve been funned. If an internal organ like ih© bowel or the lieart is torn as by a blow» ruj>tuy*6 is tlie expres- sion by which the result of the accident is defined. Should there l>e ivrotrutiion of a part of an orjs^an from the cavity which con- tains it the word hernia explains the fact. Should the skin or nuKHUts membrano be rubbed from the parts beneath the term ikh9\%i^Um is applied. Should the same surfsices be injured by fii^ hff^nyi a»X5 said to have been inflicted; should they be injured by Lifted water uralds,
The*e aii^ the more general terms made use of in relation to cvmiiion accidents, but they are often moditied in order to express •tMiio additional effect, Thns a wound is simjfh if it be merely a clean cut ; }>er/otaiing if it go in deeply as into a cavity ; lacerai^ if it U> j*gged ; contused if it be connected with bruising or croabt
DISEASES FROM PHYSICAL IXJITRIES.
417
Fractures and dislocations of bones are simple when unattended with surronnding injury. But, when the fractured or dislocated bone is exposed at tlie broken part or its ends make their way into some adjacent organ, then the fractures or dislocations are i^aid to be compound.
Injuries inflicted on the body receive also special names ac- cording to the manner in which they are produced. AVhen they iiccur without foresight or intention they are called, simplVj ctcci- dental ; when they are produced for purposes of punishment, as by the infliction of the cAt, they are called judicial; when they are inflicted by one person on another, they are called honiyHdal; when they are inflicted by a person on himself, or herself, they are called self-inflicted or sulvidnl ; when they occur in conflict of armies or navies they ai^e called injuries or it^omuh of ioMle, and are more mimitely defined as gunshot woutidsf sword tmunds^ bayofui woundsy and the like.
Physical Local Injitries*
Pliysical injuries affecting the body are once mom defined according to the part or region of the body in which they occur. The ofl^cial record defines them in tliis manner as injuries incident to tlie liead, the face, the eye, the nock, the chest, the back, the pelvis, tlie upper extremities, tlie lower exti-emities, the absorbent Aystem. It adda to these, injujies not clast^itied ; namely, niptnre of muscle, rupture of tendon, and foreign suhstanees in the eel hi- lar tissue. I present from the ofticial record the following smn- inary of these local injuries.
Injuries of th£ Head- and Face.
The head is liable to contusion ; to scalp wound in which the [le is not exposed ; to scalp wound in which the bone is exjx>sed ; concussion, or stun, in which the brain is involved, and some degree of unconsciousness caused. The head is also subject to fracture of the skull in the upper part or vault. 8ue!i fracture may be simple without depression, or simple with depression ; or the fracture may be compound without depression, or compound with depression. The skull may also be fractured at its base, the pan on wliich the brain rests ; or it may be wounded as from gun- iihot, or other mode of perforation. 27
418
DISEASES FROM PHYSICAL INJURIES.
The brain may be subjected to I<x*al injury; it may protrnde tlirough nn opening in the skull, lieniia cerebri; it nmy be lace- rated, with or without fracture ; it may receive injury of its blixxi- vessels; it may have foreign bodies lodged in it; it may receive injury affecting the nerves wliieh have their origin from it. Some of the most gnigiilar facts in tlie liistorv of disease have been recorded in respect to tlie lodgment of foreign bodies in the sub* stance of the brain* The late Dr. Day of Stafford has written an account of a man in who&e brain a piece of a gun lock was lodge<l for many weeks, during a part «>f which time the man walked the distance between London and Stafford without seeming to be jio- culiarly affectcil, although lie afterwards die<i from extension of disease through the brain. In other iuBtances the brain has Iteen exposed through an opening in the gkull, and has remaine*! cov- ered with such thin cutaneous membrane that the pulsations of it^ vessels could be felt. 1 have i^eeoi^ed an instanoe of this kind in a man who lived in fair health for manv year?., and who ultimately died of an affection in which the brain was not involved.
The face is subject to contusion, wounds, and injuries of it« blood- vessels. It is also subject to impaction of foi^ign bodies in its soft parts, and in organs or parts connected with it, as the ear, the nose, and the liony cavity in the cheek called the antrum* The bones of the face, including the lower jaw, are subject to fmctures which may be simple or compound. The lower jaw is subject to dislocation, an accident which is easily remedie<l by the surgeon* but wiiieh is very apt to i^cur, from comparatively slight causes, when it has once happened.
rnjuri^s of the Eye,
The eye is subject to simple contusion, commonly called black eye; to contusion with rupture to the external or sclerotic coat, ruptured globe ; to contusion with displacement or dislocation of the crystalline lens ; and to contusion witli hemorrhage, or bleed- ing, into the globe. The eye is subject to impaction of foreign bodies in it or in its cavity. It is subject to wounds of its various parts; of the eyelid, the conjunctiva, or covering of the mucous membrane, tlic sclerotic coat, the cornea, the crystalline lens, the vitreous humor, and the iris or curtain. The eyelids and eye may be injured by chemical vapors i^r fluids ; by burns and scalds. The globe of the eye may be dislocated, or displaced, or totally disor-
DISEASES FROM PHYSICAL INJURIES. 419
ganized by injury. Lastly, the parts within the orbit, including the glands, the muscles, the l>ones, and the optic nerve itself, may be wounded or injured.
Injuriea of the Neck.
The neck is subject to contusion of the skin and soft parts be- neath ; to fracture of the hyoid bone at the upper part of the lai^ ynx, and to dislocation of that bone ; to fracture of the cartilages of the larynx ; and, to rupture of the trachea or windpipe. It may su£Ferfrom wounds on the surface, — superficial ; deep wounds, as in cut throat ; gunshot wounds ; and, wounds from the mouth. Its vessels, arteries, and veins, including the carotid arteries and the jugular veins, are liable to injury. Its internal structures, the phar- ynx, oesoph^us, larynx, and trachea are exposed to injtkries from bums, scalds, and the action of corrosive substances. The same internal parts ai*e sometimes injured by foreign bodies lodged or impacted in them.
Injuries of the Chest.
The external surface of the chest is subject to contusion and to superficial wounds, incised or lacerated. The bony structures of the chest, the ribs including their cartilages, are liable to fract- ure with or without injury to the lungs which they enclose. The sternum or breastbone is subject to fracture.
The parietes or walls of the chest may be the seat of wounds of various kinds ; namely, simple wound, when the chest cavity is not penetrated ; perforating, when the chest cavity is penetrated ; penetrating, when the pleura or limg is wounded; mediastinal, when the central cavity between the two lungs, called the medias- tinum, is penetrated ; pericardial and cardiac, when the pericar- dium or covering of the heart or the heart itself is injured ; and Tsscnlsr, whmi some of the vessels in the cavity of the chest are included in the wound.
To these injuries of the chest are added rupture of the heart, or of the lung, with or without fracture of the bony surrounding framework.
Injuries of the Back.
Under the head of injuries of the back injuries aflFecting the whole spinal r^ion are included, and are placed in the following order : —
420
DISEASES FROM PHYSICAL IXJIRIES.
(a) Contusion, involviTjcr the skin, and more or less of the eoft parts beneath, and constituting RJinethnes very extensive bruises.
(b) Wounds, which may be simple and guperticial ; or deep and penetrating; and, in either ca>e, incited or lacerate*!.
(c) Sprains, or injuries of the fascia, niiscliiefs induced by strain of the ranscles of the back or of the fasciie or nienibranous sheaths covering the niiisclce. The very painful injury called commonly crick, or rick in tiie back, or strain, foUuwed by swell- ing and effusion, with inability to raise the body, and now and then with febrile excitement, is an accident of this tmture.
(d) Fracture or dislocation of tlie spine, occurring in any of the regions of the spinal column, spinah fkirsal, or lumbar, and indicated technically according to the region, as spinal, dorsal, or lumbar fVactui-efj or disloeatiuns. Such fractures or dislocations may be unattended or attended witli injury to the spinal cord wliich is included in the spinal canal, the fact of injury to the cord being detected, as a general rule, by the |»henomenon of paralysis which follows upun the infliction of the injury, and which extends to the parts supplied with nerves below tlie seat of the iujury.
{e) Injury of the cord without known fracture, in wliich there are signs of nervous injury or shock without evidence of fracture or dislocation of any part of the spifud cohnniL These injuricr^ are often of the most {lerplexing cliaracter, and are classilied by some under the terms spmal 8hocl\ They come freqiiently under notice in cpses of railway accident, and arc causes of much learned debate as to tlieir nattire and importance.
Injuries of the Ahdmnen,
The ext-ernal surface of the abdomen is liable to contusion, which may be attended witli rupture of the muscles beneath the surface, or even with rupture of the viscera inchided in the cavity of the abdomen, viz., the stomacli, intestines, bladder, and, in the; female, the uterus.
The abdomen is also subject to wounds of its parietes or walls, which may be supei-fieial and incised, or lacerated, or penetrating into the cavity. When the wound penetrates into the cavity there may be protrusion of uninjured visceral organs, or of wounded or injured organs; or, the organs may be injured without protrusion. There may also be injury of the viscera without wound of the,
DISEASES FROM PHYSICAL INJURIES.
421
I
parietes or walla of the uljilomon. Again, there may be iujury of tlie blocMl-ve66els within the abdomen, with or without wound uf ihe parietes.
Foreign bodiee may be lodged in the peritcmeal cavity of the abdomen, or in the cavities of tlie viscera, as in tlie atonifidi or intestiue. Sucli foreign bodies may find their way into the cavi- ties by external wound&, or they may be taken in by the mooth. Foreign sub^t^nces carried into the body by a wound l*ave occa- sionally been lodged, permanently, in the cavity, and becoming fiuri*ounded l>y organized material, have ceased to be causes of irritation. Foreigii liodie^ swallowed have been known to make their way through the structures gurrounding tlieni, and to escape by an external opening or fintnla. I luive a patient still living from whom u (jhun-stone once escaped in this way by means of a fiiitulous ubsee&s through the abdoinitial walL
Another iiijiny affecting the abdomen coneists of au opening which eonununicatcB with tlie stomach or intestine, and consti- tutea au artificial orifice lcadir»g into the visceral cavity* A Ca- Eidian-Indian, called Alexis St, Mai-tin, who died quite recently, lurdcd a renmrkablo illustratioM of this kind of injury. A great many years ago ^VJexis waa wounded in the Ktotnach, from with- out, and an opening was estahli^slied from the outside of his body into his stomach, by wluch opening Dr. lieauniont was enabled to observe the course of the digestive process duriug life.
In cases of obtrusion of the* bowels the surgeon sometimes makes a fistidons opening, and leaves it as a pernnment artificial channel for relief.
Connected with tlie injury to the abdomen may be included injuries affecting the bladder, and the other organs and parts lying within the pelvis or basin which forms the floor of the abdominal cavity.
Injuries of the Ujiper Linibn or ExtremUtes.
The upper limbs or extremities, including the collar-bone, shoulder-blade, liumenis, ulna, radios, carpus, metacarpus, and phalanges^ witii their coverings of ligaments, muscles, tendons, membranes, blood-vessels, nerves, cellular tissue, and skin, are liable to a variety of injuries.
The skin and meudirauous partes arc subject to contusions and womjds, to injuries of vesi^ls and impaction of foreign bodies in
■I
mre subject to sprain or
of tlieir epiplivse^
life are separated from the
bffiding of boued; and« to
W fibnple or compound.
rf iftii ^iff^ extremity may occur in
ttt lk» «sipali <ir fihonlder-blade ; in
&i tbi» miiMr or iiliia of the fure^arm ;
>^afi til« ^Mywk. mm^mmpms^ or phalanges. When,
^ i^ nfift m yinpgr niiioti of bone, m hat i^^ ealled
majr ocvur in tlie joint
, tienio-darictilar dislocation :
%«Mo Ukr cvOlic^fctfiMi and tlie acromion pix>cead of
4p4li|Jhi^i4iyMIK.<HPMBliMllkm^ : in tlie^honlder-
ik lk& dSft&W-i^^^ ftkti* jiiiil between tbt* wrist and the lit;: ami ^ Am philangeal joints.
^ ^b» umoaiiiiate bone of the pelvis,
^1^ tibia and fibula or leg-bonus^ the
*Uc«$ tir heebbone, the antragahig or
ifwms^ aitd phalanges, are subject to
^^ngs %4 thost? parts, namely, the
-..ds iiK»«ibranc^, blofxl- vessels, nerves,
«^^ att»^^ subject to nntnerous injuries.
V V liable to eontusione and wounds,
imj^ction of foreign bodies. The
> > mbjoet to wpruin and rnptnre. The
ivi> I* »*il*jeet tt» nipturo. The epiphyses
tICi yutj^^ ^ ^Muration.
^X>( ^&yte tvt fractures or di^loeations, which may
!]\e femur or leg-bone may be fract-
, U mar be fractured thrt^mgh its cervix or
I tuitnK^iMitly occurring, from elight causei?^
v>l «||p\ <»itber within the capsule of the joint,
d-ap&ule* The large prominence, or
^uiter part of the femur h liable to
U> f nictured in various parts of its
■c ^te«H^|)4in is a bone aubjeefcil to fracture.
DISEASES FROM PHYSICAL INJURIES. 428
from severe strain witli ooncossion, and is always very difficult to reunite, the fracture being usually across the bone from side to side. The tibia and fibula, leg-bones, are liable to be fractured either together or singly. The lai^ leg-bone, or tibia, is most frequently fractured in the lower part. The smaller bone of the leg, or fibula, is sometimes fractured alone, at a little distance above the ankle-joint, from comparatively slight causes, as from blows or kicks on the outer side of the ankle, and from twisting of the foot during falls. This fracture of the fibula is called " Pott's fracture," after the distinguished surgeon who first de- scribed it.
The bones of tho feet may undergo fracture, simple or com- pound. Fi*actures of the bones of the lower limbs may, under untoward circumstances for reunion, remain ununited, and give rise to false joint.
The dislocations, simple or compound, occurring in the lower limbs are, dislocation of the hip, of the patella or knee-pan, of the fibula or smaller leg-bone, of the foot at the ankle, of the foot at tho joint of the heel-bone and astragalus, of the astragalus, of the heel-bone, of the tarsal bones, and of the metatarsal bones and phalanges.
liifjuries of tJui Ahsarhent System,
The absorbent or glandular system is exposed to various inju- ries. Foreign bodies may be lodged in the glandular structures ; concretions or calculi may be formed in the glands. The lym- phatic vessels may be compressed, contused, or wounded. In some forms of poisoned wound the lymphatic vessels are largely in- volved in the accident and become the seats of acute inflamma- tion, which is marked out in distinct lines describing the course of the lymphatic canals; this condition is called, in common language, inflammation of the absorbents from a wound.
Unclassified InjuHes. Burns and Scalds.
Tluptures of muscles and ruptures of tendons are called, offi- cially, imclassified injuries. They have been before us in treating of the diseases and injuries affecting the muscular system.
Under this head of unclassified injuries may be included the lodgment of foreign substances in the cellular tissue of the body.
Under this dame head may also be included the injuries in-
424
DISEASES FROM PHYSICAL INJURIES.
duced by burne and scalds, accidents, affecting chiefly tlie outer or cutaneous surface of the body, ofteu ending fatally, and inflicting the most appalling injuries upon certain classes of the industrial populations. When I was collecting the facts for a medical his- tory of Wolverhaujpton, 1 found that cases of hum were intro- duced at the hospital thei^e at the rate of three per week from the month of October until May* The burns were about equally diviiled amongst the sexes and amongst children and adults.
Burns and scalds affecting large surfaces of the body often kill directly from the shock they produce, Iii other instances life is prolonged, to terminate at last in death caused either by exhaus- tion and pain or by decomposition of structure and secondary absorption of decomposed matter. In a third class of eases life is pix*served, but the bunied surface is left covered with liard cica- trices or with contractions of the skin w Inch, of all deformities, are amongst the most difficult to remove.
Since the introduction of electricity into the Arts severe burns and even fatal shocks are now sometimes sustained by those who are brought into contact with ihc conducting wires of the electric current.
CHAPTER VU.
SURGICAL OPERATIONS.
StrttoicAL operations, although thej can scarcely be cougidered
as induced dijsea^s, because they are performed under necessity, vield nevertheless a certain mortality, and must not therefore be pastied over without mention* The snceess or failure ending iu death fi-om surgical operations roBts upon many cireumstaucee. The skill of the Burgeon naturally plays a very iiuportaut part, \"arioii8 tletailn in the performance of an operation, some of which raay seem at first sight almost trivial, play a part equally important. The age of the patient often determines the result, the rule being that the cliances of recovery from au important oper- ation are lessened in proportion as the age of the pei-sou is ad- vanced, although to this rule tliere are often striking exceptions. The constitution and condition of the patient arc other factors iutluencing results. Persons who have led luxurious lives suc- cumb more cattily than the abstinent and the hardy to snrgieal operations; while those who have iudulgeil largely in alcoholic drinks, and iu whom the kidneys and other glaudnlar organs are affected from that cause, become the dread of the opemtor. Lastly,— as I have shown in au essay on the suliject, — various meteorological or atmospherical conditions of au unfavorable kind tend to increase the mortality inciiJeut to surgical procedure.
In a certain sense, therefore, we are forced to look upon sur- gical interference, conducted with the liest and muKt skilful art, as an induced injury to the body, although induced, of course, to correct injuries or diseases of still graver import* In this sense a hricf bistt^ry of the more important fiperatiuus, referred to in the official recoixl, is deserving of a pbice iu tliese pages. We raay
Liiere follow tl»e plan adopted in the part I'elating to tucal diseases;
I and the various kinds of operation as they affect the various grand eysteinic portions of the body.
426
SUBGICAL OPERA TIU>s.
QpBRATIOKB ON SrSTEMIC Dl^78IONS OF TOK BoDY.
Operations on Parts emineeted witA the Jjlfje^tim Syeism*
A large unniber of operations liave to be performed on parts couTiected with the digestive canal. Removal of portions of the lip for cancerous disease; removal of salivary calcnius, of epulis^ and other growths connected with tlie gonis ; laneingof the gurns for giua-hoil ; extraction of tlie teeth ; removal of the whole or portion of the tongue for malignant disease of that organ ; oper- ation on the roof of the nioutli fur closing the opening calletl cleft palate ; lancing of the tonsils for abscess in them ; removal of the tonsils by excision : these ai^ some of the nioi-e important oper- ations performnd on the parts of the alimentary canal called the mouth and throat.
The cesoplkagus, or gullet, is sometimes ^mbjected to surgical procedui^e. In eases whei*e tlie tBsophageat tube is the seat of obstruction or of stricture, attempts have to bo made to dilate the tube in order that food may be passed into tlie stomach through the dilated opening, or through a tube passed beyond the obstruc- tion. In some exti-enie cases the operation called *rsopha//otmnj/, or the making a direct opening into the u^sophagus for the pur- pose of introducing foixl into the stomach, lias been resorted to.
The stomach, in extreme cases, may liave to be 6ul)jected to the operation of ^/iwtrotonit/^ that i;?, the <»peration of opening it for the pm*po8e of introducing food ; and, desperate as the oper- ation is, it has been perforujod with success. Among tlie re- niarkablc instances on record in which this operation has been, if I may so say, accidentally performed, is that of Alexis St. Martin, who, as stated alwve, lived with an artificial opening frt>m the out- side of the body into the stomach. The abdomen has, occasion- ally, to be subjected to the operation of tapping, paramntt!^U^ m order to draw off dropsical fluid which has accumulated in the peritoneal cavity.
Section of the abdominal cavity, with the object of making an exploration of the canal in cases of ubstruction or tumor, has often been resorted to, and of late years, since the operation of ovariotomy has been so perfected, this formitiable proce<lure has been carried out with greater boldness, skill, and success than was ever for a moment considered possible in past times. For the
SURGICAL OPERATIONS. 427
purpose of removing obstruction and for allowing the contents of the abdomen to find an outlet, the operation called colotomy^ or the opening of the lai*ger bowel, has been introduced. The operation is carried out either from the groin or inguinal region, or from the back or lumbar i-egion, and is called respectively in- guinal or lumbar colotomy. It is a surgical procedure which is often eminently successful in its results.
Operations for hernia, the nature of which afFection is de- scribed at pages 119-21, have very frequently to be resorted to. Li these operations the skin and soft parts are divided down to the seat of the stricture of the intestine, after which the constrict- ing ring is divided so as to enable the intestine or other protrud- ing portion to be pushed back into the abdominal cavity. In certain instances the sac or peritoneal covering of the bowel is returned with the other parts without being opened ; in other in- stances the sac has to be opened. There is also an operation called theoperation for the radical cure of rupture or of hernia, by which the attempt is made to close, permanently, the open ring through which the bowel is wont to protrude from the abdominal cavity.
Operations have to be performed on the lower bowel for con- striction or stricture of it ; for relief of permanent spasm of the circular band of muscular fibres called the sphincter ; for laying open a fistula; for relieving painful cleft or fissure; for re- moval of hemorrhoids; and, occasionally, for arrest of hemor- rhage or loss of blood from the bowel. Removal of tumors and of foreign substances from the same part is a surgical procedure which is sometimes necessary, as is also the attempt to dilate the intestine by artificial means when there is serious obstruction in the passage of the intestinal canal.
Operations on Parts connected with the Circulaiory System.
Many sui^cal operations have to be performed on different portions of the circulatory system. Bleeding arteries have to be subjected to the ligature, tied ; or, a main artery has for a time to be subjected to compression in order to prevent bleeding ; or, a small artery, as in a tooth, has to be put under firm compression at the bleeding point ; or, where an artery cannot be tied it may be necessary to apply the actual cautery or hot iron to suppress the bleeding. Different modifications in the method of stopping the bleeding from arteries have been introduced of late years ; these
428
SXTBOICAL OPERATIONS,
methods include the twisting or torsimi of the Ueeding vessel ; or the introduction of a needle transversely beneath the vessel, as the stem of a flower is lield in the coat by a piu, avuprmsure. Bleeding, when it takes place from a nnmber of vessels in a cavity* such as the nose, i^ cotnmonly arretted by what is called tlio plug, which consists, in most cases, of cottoii wool or other soft sub- stance charged with some styptic solution and pressed firmly into the bleeding part.
The disease vi the Ijlood-veseels, called aneurism, descrilKnl in pages 142-3, is often treated by means of surgical operation, and h usually so treated when the aneurism is sufficiently external to come within reach of surgical ait. Compression of the artery which feeds the aneurism ^ by which the anenrisuial tumor is for a long time deprived of the entrance of blood, is one of tl»ese op- erations; tying the artery above the aneurism is another method ; laying open tlie aneurLsni and tying the vessel immediately above it is a third but now almost exploded plan. Compressing the aneurism when it is in the flexure of a joint by bending the joint and keeping it bent for a long time, is a fourth procedure which has been very successful in the ease of popliteal aneurism, or that aneurism whicii occurs in the popliteal sjmce at the l»ack of the knee joint. Inducing coagulation of the blood in tiie aneurismal poucli or sac is a tifth method, the introduction of a styptic solu- tion or of a galvanic cautery into the pouch being tlie means em- ployed for the purpose. Of these many methotls that of tying the vessel at some part between the heart and the aneurism is, when it can be effected, the most approved ; and many of the larger arteries of the body, — the brachials, tlie subclavianSp the carotids, the iliacs, aud the feniorals,— have been subjected to the ligature with success.
The veins have to be operated ujion in some forms of disease. Bleeding from a vein has to be prevented by compression on the vein below the bleeding part, so as to check the current of blood I'eturning by the vein to the heart. Enlarged or varicose veins have to be operated on in certain cases, either by compression, subcutaneous incision, or ligature. The enlargement of vein called varicx>cele is sometimos subjected to operation by the process of obliterating the main venous trunk wliich supplies the plexus or congeries of small veins, or the dilated large vein which forms the vascular swelling.
8UBGI0AL OPERATIONS.
420
Other vaBcnlar enlargements, especially that known as nfeviis, de&cribed at page 145 as a vascular growth on the skin, consbting of a serie.^ of small capillary vessels, have to be treated by snrgieal means. Tying these vascnhir tninors ia one method ; treating them by means of puncture with a hot needle point is another ; ex- posing them to the action of canstics is a third method ; enbjecthig them to the action of etliy late of giodinni \a a fonrtb nietliod, intro- duced by myself, and one wliieh is now rather largely employed.
Ol^eratwns on Pari^ connecUd vitA the JieRjnratory System.
It IS necessary in some instances where there is obstrnction to the breatliing in the larynx or the trachea, to perform the opera- tion of opening one oE those parts in order to allow the sufferer to breathe from below the seat of the obstruction. This opera- tion, often most brilliant in its results, was described by an ancient surgeon, named Antylhis, with a precision that leaves little to be desired. In certain eases it is found advisable to make the opening into the main air passage leading intrv the lung through the larynx ; when the operation is called hinjnfjotcmuj. In otlier instances it is found advisable to perform the operation lower down, tliat is to gay, tlirongh tho trachea ; this is called tnu^heotomij, Laryngotomy and tracheotomy are resorted to most commonly for obst ructions produced by croup, diphtheria, and intlammation of the mucous membrane. They are sometimes resorted to to relieve l>reathing when some foreign substance has got into the windpipe, or for the removal of foreign snlistances.
The chest has sometimes to lie subjected to the operation of tapping, in order to let out fluids contained in it. When dropsy occurs in the pleural cavity of the chest, tapping may have to be performed for the purpose of drawing *>tf the fluid whieh oppresses the hmg. The same operation may have to be perfonnod when pus or purulent matter has accumulated in tlie cavity of the pleura. In like manner the bag or pericardium surrounding tl^e heart may, in rare canes, liavo to be tapped to relieve tlie pi^essm^e arising from excessive pericardial secretion.
Operations on Parts connected "urtth the JVervowt System and Ovfjans of the Senses,
It has l)een considered necessary, occasionally, in cases of ac* cmnniation of tiuid in the cavities of the brain, to carry out the op-
430
SURGICAL OPERATIONS.
eration of iapj^mg.^Htra^irn^^ms, in order to i-clieve tlie pi'essnr©. The sanic operation has been resorted to in the epiuai cord ff»r the disease desc5ribed at page 176 as spiua bitida.
It has been thought nece&sary in &ome casea of sevei-e nervous paio, persistent neuralgia, and in some cases of severe spat^m, te- tanus, to perform the operation of dividhig a nerve, — neurotomy. It has been thought necessary also in sotne cases, although tlic measure is more d<»ubtful, to perform the operation of stretching a nervous cord. But, taking it all in all, surgical interference on nervous stnicturee is rarely resorted to*
Operations on certaiji of the organs of the senses are of com- mon occurrence. On the eye and its api>endages between twenty and thirty operations are performed. Entropium, or in version of the eyelid, and ectrupinui, or ever^ion, are reu»edied by operation. Ingrowing eyelash, trichiasis, is in like manner remedied. Growths attaclied to the eyelids have to he removed by the knife or other su rgi cal procedu re.
When the eye is subject to squint, strabismus, a skilful opera- tion is carried out by which the sliortened muscle, within the orbit, wliic'h pulls the eye out of place, is divided near the point of its memliranous attachment to the eyeball. When the lachiy- ma! flnct, which leads from the eye into the c^ivity of the nose, is ol)stnicted, it is i*ei>pened by o]>eration.
Various operations arc pcrfurtned upon tlie eyeball itself. An artifiL'isiI pupil may have to be made. A portion of the iris, or curtain, nuiy have to bo i^moved by what is called the operation of irhlt'ctomy. For cjitaraet and other diseased conditions of the cry^tafline lens many procedures are adopted The lens may be broken up, it may be depressed or pnnhed ont of the axis of vision, it may be extracted.
Foreign bodies may require to be abstracted front tlie ere. The globe of the eye may require to bo tapped to relieve acca- mulation of tlnid.
Lastly, it may be necessary to carry out what is called esrcision of the eyeball, in which operation tlie excite ion may be partial, or total* When total, it may or may not include the other structures contained in tlie orbit.
The organ of hearing is eubjeeted to certain operations. Polypus growths, or concretions of wax, or foreign substanoea
SURGICAL OPERATIONS.
may have to be removed from tlie external canal wliicli leads from tlie outer surface of the body to tlie tyniparmm. Portioug of dead bone may have to be extracted from the game canal. Tim drum may require tu be tapped or perforated. An artiticial drum may have to be introduced. The tube leading from the t]i]*oat into the middle ear, the Eustachian tube, Bometimes requn^es to be probed or injected to remove obstruction.
Operaiimis on Patis comwticd ttith the Glandular SrjHfem.
A considerable number of surgical operations are called for in connection witii the trlauduhir system. The salivary ghiuds in tlie mouth which eecrete the saliva have sometimeft to be relieved of calculus iyv !iard concretion. The liver, in case of abscess of it, may have to be tapped. The gall Ijladder ha* been opened, in order to relieve it of gall stones.
The kidney on one side of the body, in some instances of dis- ease of it, bus been relieved of calculus by operation, and several times the whole organ has been successfully i-emoved. The blad- der, which is the jkjucIi or reservoir of the kidney, is subjecrted to operationti of varions kinds. It has sometimes to be tapped ; but the operations ou it that arc nnist common are those for the re* moval of stone or calcuhis. By one series of these operations, lUlwt<>nty^ the calculns is removed entire, tlie Tuetliod for removal being ia) the high operation, supra-pubic ; (J) the lateral ; (<■) the bilateral ; (//) the median ; (c) the recto- perineah In another series of operations, called lithofrlttj^ the calculus is removed by an instrument wliich, pashcd into the bladder by the usual pas- age, IB made to seize the stone and hi-eak it into small fragments,
that it can he washed ont from the cavity. These operatiotis Ire now brou*;ht to a stiito of great perfection.
The prostate gland in the male subject may have to be oper- ated upon for the removal of calcnhis*
In the female subject the glandular organ called the ovary in
examples of dropsy of tliat structure has to be tapped under some
Loonditions; Init, the most important operation connected witli
I disease of tliis organ, described at page 221, is that of (yvarioimny
or removal of the dii?eased ovary altogether.
The breast may be sidiject to incision in order to aHow tlie es- ^cape of matter from it when it is suffering from abscess. It may have to be tapped to remove fluids from cysts. It may have to
439
SimOICAL OPEttATIONS*
be nrmoTed altogether for cancellous or malignant disease affect- tug It
Certain of the dnctless glands are operated npon under special eircimistaiices. Tlie ghitid in tlie neck called the thyroid, which by its enlargement produces the disease known as goitre, is some- tifoe^ tapped in order to be relieved from flnid contained in cj^sts tii its structure. The gland has been subjected to injection and to the needle cautery for destruction of parts of it. It has been partly and wholly excised*
The lai^ ductlese gland in the abdomen called the spleen hnu^ been renio%*ed for disease affecting it, and, on more than one oi<«eiiaion^ with successfnl results.
.Op&nUiom on Paris cofmaded with th<^ 3fiisoul<ir System.
A muscle U sometimes partly or wliolly divided, but the most imiH>rtant series of operations connected with the nni^ular system art* tlui«Be of divisions of tendons of muscles, by the process called h^%n4omy. These divisions of tendons are subcutaneous opera- liou$ ; that is to say, the tendon is divided by means of a very Hne knift* which is introduced beneath it by a small opening thrv^ugli cho sikiiK Great success in the relief of deformities of (Ih> body Um attended these skilfnl and useful operations.
Ojmr%Uio9ui on Parts connected with tfte Osseous or Bony
Sj/stem,
Tht^ joint?* ciinnected with the osseous system or skeleton are iuvolvtHl in nuvny surgical procedures. Dislocations of joints have lo bt> ix»duiHHl so as to bring the disjointed parts back to their iirigUial puiiitions. Stiff and deformed joints have to be extended and URkViHl in order that they may regain some part of their luiturtil motion* A joint, snch as the knee or elbow joint, may haw 10 b© inrimK and, under certain conditions, these large joint* may have to be excised or removed completely. Loose Iktxlivm within u joint may also have to be removed.
yDnoimay riHinire to be excised altogether or in part, in con- i^qnenoe of iliAeaw nf their structure or of injury to them. Tlie b\k^ie« of the »kull may have to be perforated with a circular cut* ting saw t*r ti^eidiine, in order to relieve pressure within the skull : • ' of depressed bone of the sknll may require to be lifted
u^ . 1 the purpose of relieving pressure. A fmctnred long
Sin&GIOAL OPS&ATIOHS.
433
bone iStmi ham not proper! j reunited k iometiBifit opeimted upon in order to indnee reanion. A long booe tiuil has been frMrtored and has tmited in a nselees or deformed manner maj have to be re&aetm^ and reset.
Becentlj tlie art of dividing bane^ enbcntaneaiiidjf has been intiwinoed into surgery, and deformities connected with large kmg bones have been rectified bj division of llie bone throogh a imall opening sofficient onlv for the introduction of a delicately* entting saw, Mr. William Adams bas divided the neck of the femor or thigh-bone soooesfifuUjr by thk operation.
Operations ai» tAe Skin and Suhfoctni SUmctures*
Nnmerons operations are performed on the skin and on the passages of mucon^ membrane which dip into it. Tumors of dif- ferent eliaracters }iave to be removed from beneatii the skin nnnatoral clefts and divisions tlirough it and tlie mucons mem- brane connected with it, as in harelips have to be incised and brongbt together with a stitch or snture; fifitnlous openings throngh it into enbjacent parts have to be incised. Cicatrices, or scars, as those arising from bums^ may require to be scored or divided* Webbed and contracted fingers or toes may have to be scored or divided. Loose growths may have to be removed 6t>m the skin* Ulcerated sm'faces may require caustics or other surgical treatment
ZTndamified OperatiouR.
There remain still a number of unclassified operations which reqnire brief notice.
Amptdaiions^ or removal of large portions of the body occur in sttigical practice, and are classed under different heads. When nn amputation is retpured immediately after an accident^ it is called a priin/inj amputatitm ; when it follows a preceding one, it is calle<l a secomlarfj am potation ; when it is done to remove
Dug'Standing disease, or deformity, it is said to be an ampuiu ' turn for flm'osti or ddrformity. When an amputation includes a larger part of the body, as the shoulder-joint, tlio arm, the foi*e- ann, the liand, the hip-joint, the thigh, the knee-joint, the leg^ the ankle-joint, the foot, the breast, it is Baid to be a major amputation. \Vlien it includes the smaller joints, such as tlie fingers and toes, it is said to be a minor amputation. These
434
SPECIAL DISEASES FBOIC
distinctions of major and liiinor are the same, whether tiie am- putation bo prunary or gecondaiy, or for accident, disease, or defor*Miity*
Tran;gf}mon is an operation by which blood is transmitted from the vessels of one animal into tliose of another, or by wliicir other fluids tlian blood are passed into the circulation. Transfn- sion (ȣ blood J usually from the veins <jf the person supplying to those of the person receiving it, lias l>een attempted with vary- ing successes for over two hundred years, in eases of fever, an<l in cases of hemorrhage or loss of blood. Transfusion of saline suln- tiong into the veins has been practised with remarkable results, but little eorrcBponding success, on persons suffering from cholera. In 1852 I proposed to substitute injection of saline fluids in ciiob era by tlie peritoneum instead of by the veins, but with i*csults whicli were not innch more promising.
Artlftrial rt:»pirati07i is a prtmedure for sustaining the failing natural respiration, or for re-starting the respiration after it has entirely ceased. In the cases of persons who have been drowned, or who have succumbed to narcotie vapors or to other inflnoncea that interrupt the breathing, artiticial re^spiration is employed*
The operation is exti'emely valuable, and is tlie means of saving many lives from the most inimiiient peril of death. It is usually performed through tlic mouth or nostril. In exceptional cases it is performed through an opening in the windpipe.
Cimarean section^ so called Ijocanse the mother of Julius Cflesar was said to have been subjected to it at his birth, is an operation performed dni-ing childbirtli, wlien the birth cannot take plaee in the natnnd way. It consists in making an incision through the abdomen into the uterus or womb of the mother, and of deliver- ing the child with the after-birth through tlie artificial opening. The operation has been many times performed with successful issue, the lives both of the mother and child being sometimes eaved.
Bpeoux Diseases from Sfeoicai. Operations.
The special diseases or conditions of disease which follow upon surgical operations are not extensive as a class, bnt are, unfortunately, of serious nioment when they arise,
ShocL—T\x^ most immediate of the bad resulta from a surgi-
SURQICAL OPEUATIONS.
435
»
¥
cal operation is what is called Biirgieal slio^k ; that is to say, the fihoek or blow to tiie nervous system which ensues immediately upon the operatioih Cieh*ris jmribtis the danger of rfiock is pro- portionate to the extent of the operation, that is to say, to the extent of living surface that is affected by tJie operation. To tliis rule, however, there are many exceptions. Some parts of the body when operated upon are more susceptible than others, bo that ojx»ratio!i3 performed on isiieli parts are attended with more risk than operations, on other parts^ involving more interference. Thus operation ft on the jointft, like the knee*joint, are sometimes attended with extreme shuck. Again, eunstitutioual peculiarity motlifies shock. Some pei*8on8 of sanguine, others of lymphatic or easy temperament, pass through great operations without seeming to be affected at all, while others of nervous and bilioui^ temperament succumb from comparatively minor operations. As a rule, the young bear the shock better than the old, hut the young themselves present exceptional differences. Children who are, what is called, chubby and fat are much more likely to die from surgical oj>erations than wiry and muscular children.
Lastly, climatic influences modify shock, the tendency to which is certainly increased by cold damp weather, in which tliera is a steady decline or fall of the barometer
The symptoms of shock are those generally of collapse, ending, under extreme conditions, in fatal collapse. When the mischief is less extreme tliere is recovery, but nsnally with reaction at- tended with severe fever and the accompanying dangers of the febrile state.
Ilemorrhage, — Hemorrhage, or loss of blood, is a second acci- dent of disease incident to surgical procedure. IIemon'has:e may be primary or secondary ; that is to say, it may occur during the operation, primary, or after it, secondary. Occurring in the first of these instances, it causes, on exceedingly rare occasions, sudden death from syncope. Oceiirritig in the second of these instances, it ia a source of great anxiety to the snrgcon, is sometimes inune- diately fatal, and is almost always checked with more difficulty than when it is of primary origin. In checking it, it may he neoeesary to re-open a closed wound, when it gives rise, usually, to extra trouble and danger beyond the mere matter of loss of
bloody the progress of the healing fered with and retarded.
of the wound being nmch inter-
mm GE^TBHAL AK^ESTHESIA.
S^Mfitmi ^fimt, — Surgical ferer, called sometimes pTromia, CHWliaMM^ mppormlive ferer, is another affection following upon mipiMl i»p«t9tiiio^ and when assnuiing the epidemic form, a$ it ia wtMi I budlv constructed hospitals, u a 80urce of the sever-
oii tr»M« *!m9 surgeon, and a catiae, often, of excessive mor-
liiUly. **««• rtms a rapid oonrse, the period of its incuba-
lifui ur totting iu being short, and indeed limited frequently to a ^ ^ ' 'unUtoci; while the whole course of a tvpieal case of I 'jiul iwbiiing on to death maybe iuchuled in two or
f^llupii^ ill^T«. Tli^rt id higlt fe^er in these ca^s, tendency to rapid ' t' wound, formation of pus with distribution over the body by the blocnl, and very ofte?i ;tion of fibrine on the right side of the heart Illation from that cause* When the primary < V, >., ^..,4 fever are over, the danger of eecoudary )A lA uttU imminent. Tlie distribution of purulent elc- •y ^tncK ik^xnidary abscesses are pi\>duced in the lungs oripMw of Xh^ b^nly, may caui^e accompanying irritation ii^limtk^^ iM" aewte rheumatic affection,
(jt — Tlie inflammatory and contagious disease called ' ^ ' ^loscribed at p. 55^ is an(>tber of the
- .jtience of surgical ujwnitioii, and is <>• uf bilal ftigniticance. In liadly constructed hospitals or t iUhmImImi bMftfei out oocasiotially in the spreading or epi- ibUttc Cmi^ ^km ftk^Ab^H Injing attacked in the parts of the body %\^ W^i iMbj«)cttH) to oiieration, or it may be other parts, ^*f \\w fai\> or heath
^ 1i^ coiuUiion of disease described at p, 41 as
uk^ itlAte of exhaustion and feebleness, leading to
^^u^ %st vital power, may, in Imd constitutions, be the
L*ii. -^»*^-^*^l opei-atiou, or even of an operation not
rtanco*
khIic disease called teiunm^ vulgarly lock-jaw, '^V4 i^n* nervous affections, may follow, in the aame J^ U^u ^xM^Mlf ibo efforts of surgical art to prolong life.
• lilQilA ttt Uklat[<in to Diskase a^nd Moktalit\*.
. Uia l^iwitHtont art of ans^stliesia for removal of sens!* ^^i^.u ^U. <iMi)tip4l]t W^tmtions has been reintroduced into medicine.
GENERAL ANyESTHESIA*
437
certain diseases and fatal accidents liave no doubt also been intro- duced. But the evi] caused in tliis manner has been compara- tively trifling compared with the advantages and freedom from 8u6Fering tliat have been attained. It is now tbirty-seven years feiuce tbe di.scovery was made, in America, that persons alM>nt to be fiiibinitted to surgical operation could be put to sleep by the vapor of sulphuric ether, and bo made to remain unconscious to suffer- ing during a period of tbe longest surgical procedure. Since then hundreds of tliousanda of perst^ns have been rendered insensible hy means of ether or of some other anaesthetic, and I do not think it would be possible to show that so few as one thousand fatal accidents have occurred to mar the splendor of tbe discovery. I Imve been an attentive observer during tbe whole of the period of nna?8thesia and a special investigator of the process, and am there- fore justified in expressing a conviction that by comparison of the go<id and tbe evil, no disco%'ery could have Iveen more serviceable to mankind than that of aniestliesia. At the same time I wonld not attempt to conceal certain disadvantages connected with it, and which I now proceed to mentiun. ♦
The first ameatheHc introduced was really nitrous oxide gas, commonly called laughing-gas, but that was soon superseded by an agent suggested from it, namely, snlphuric ether, or more cor- rectly, etiiylic etiien After a while a substance called chloric ether took the place of sidphurie. Chloric ether was a mixture of a chemical substance called chlorofonn, and this, in turn, led to t!ie application of chloroform pure and simple. Chloroform, after being introduced, retained its place for many years, but as its administration was attended by a considerable number of fatal emilts, i^esearch was instituted to obtain an erjually convenient, ind at the same time safer, agent. By such j^eseareh I was led to introduce the bichloride of methylene, commonly called methy- ene, as an anaesthetic. By such research other experimental ists rere led to recur to nitrous oxide in the pm-e form, for short operations, as for the extraction of teeth, and to introduce other anesthetics. There have been four anaisthetics in use for general anaas- fhesift, which remain still in use. Their relative values may be llaiHy placed as follows. For short operations there is nit torn ^orUlr^ wliich is extremely effective and lias led to a very small mortality, the smallest of any agent of its class. It is, however^
438
GENERAL AN.^ISTUESIA.
not aljsoliitely free from duuger; it hm led to certain symptoms of disease which are de»ci'ibed at page 355, and it has a few times destroyed life*
Next in regard to safety etandjs »ulj^/iurw e^7u'/\ Tliis ageut, which in action very much resembles nitrous oxide, has been a cause of a limited number of deaths. It sometimes produces the symptoms of disease I'ef erred ta at page 354*
Next to sulphuric ether in ix^gard to safety comes methylene hichhrlile^ a substance which for rapidity of action as well as for steadiness of action resembles chloroform, and indeed is more expeditions in its effects. There have been several deaths imdcr iiiethylene; but a few of these ought ti> be deducted, owing to the circumstance thatehlorofonn instead of methylene was actually the agent employed, the methylene nut having been pro|>erly prepared*
Chlui'ofonn of ail these agents is that which lias proved most fatal. As I have stated at page 354» the fatality produced by it may be estimated at about 1 in 2,500 administrations. Chloro- form produces during administration four degrees or stages. In the first stage consciousness is nut lost, but thei'e is often great re- sistance and a desire for pure air. In the secontl stage conscious- ness is lost, but the operation cannot be performed because the patient is restless, often convulsed and even rigid, or screaming, or affected with vomiting. In the third stage, that of complete luicouseiousness, the surgeon carries out his duties without the in- ilictiiMi of any pain. In tlie fourth stage there is extreme uncon- sciousness, witli complete rehixation of all the muscles of the body. This stage is only induced when it itt necessary to oveix^ome every degree of muscular resistance.
It is in the second of tlicso stages that the largest mortality from chlorofortu occurs. I am of opinion that at least fifty per cent, of the deaths happen during the second stage, while about thirty to thirty-three take place in the third and fourth stages. A small number, reachiug perhaps five to six per cent., happen during the first stage, even after one or two inhalations, and are probably due to fear, being the equivalents of the deaths from fear, prior to operation, winch were recognized in the days before ana3sthesia was introduced. A remainder of from eight to ten per cent, of deaths from chloroform takes place during recoveiT from chloroform, or as the result of the bhock of the operation combined with HUiVsthcbia.
GENERAL ANESTHESIA. 439
The other anaesthetics named induce similar stages, and deatiis from them occur in much the same relationship in so far as stage is concerned.
It is an exceedingly difficult matter to account, in manj in- stances, for death under anaesthetics. There seems to exist at all times in the population a certain number of persons who are, if I may so expi-ess it, predisposed to succumb under the influence of narcotic vapor. In certain of these the reason of the tendency is clear enough after death, for they are found to have fatty degen- eration of the heart, of the brain, of tlie kidney, or some degener- ation of the blood-vessels. But in other instances no such changes as these ai*e discoverable, and although the physician is sometimes able to say in respect to some who are about to undergo operation, that general ansesthesia is imprudent or unsafe, there is a greater number in whom it is unsafe, although they present no reliable grounds for such prediction.
Speaking generally, persons who are hard drinkers ; persons who are suffering from decided indications of fatty degeneration of the heart ; pei*sons who have signs of obstructed circulation, sucli as large and varicose veins, or dropsical swellings of the feet ; persons who have had apoplectic threatenings or seizures ; persons who have evident symptoms of Bright's disease of kidney ; per- sons who have intermittency of the pulse ; and persons who are exceedingly emotional and nervous, are bad subjects for general anaesthesia.
A great many more anaesthetics than those I have named have been employed for short periods and in what may be called an experimental way, and various admixtures of anaesthetics, such as other and chloroform, ether and methylene, ether chloroform and alcohol, have been similarly used. But, the general tendency of practice is towards demand for a single anaesthetic which shall act without variability.
A perfectly safe and convenient general anaesthetic remains still to be discovered.
BOOK II PART THE THIRD.
ACQUIRED DISEASES FROM MENTAL AGENCIES, MORAL, EMOTIONAL, AND HABITUAL.
CHAPTER I. ACQUIRED DISEASE FROM MENTAL AGENCIES.
Amongst the induced or acquired conditions of disease, or diseases incident to human kind, are those wliich spring from mental influences, and which are due to something done through the mind of the aflFected person himself, or by some one or some- thing outside himself. By virtue of his higher mental organiza- tion, man differs from the inferior animals in relation to the classes of disease which are now under our consideration. The difference 18 one which is not altogether in his favor, and which is very dis- tinctive in respect to him. He shares with the animal world generally in regard to the influence of the animal appetites on his physical nature. Ho shares with many of the higher classes of animals in regard to the influences of fear, rage, jealousy, and those faculties of mind which we call the passions. But he is subjected to other influences which are exclusively his own, and which belong to his peculiar moral, intellectual, and habit-forming characteristics.
Man, consequently, derives, through mental agencies, a num- ber of diseases, physical and mental, which cannot strictly be said to belong at all to the lower forms of animal life. More than this, in respect to some of the very influences which affect them equally with him, under certain circumstances, he has what they have not, a special gift of foreknowledge, which causes him to be affected by the anticipation of what is to happen, or what may happen, and which anticipation may be to him as severe as the actual occurrence of what is expected.
We have then, in dealing with man, to consider a number of induced symptoms or diseases which, brought about purely by mental influences, are also brought about by such subtle influences that it is very difficult to trace the effects up to their cause. The difficulty is rendered greater by the circumstance that physical
444
DISEASE FROK MENTAL AGENCIES.
eonditions of an unfavorable kind often combine with tbe mental to aggravate the result, or sometimes pr'ecede and lay, as it were, the fomidatiuna for the evils Miiich are lighted up hy mental fihock or mental disturljaiiue. In utlier words, the person affected with some physical disability, following it may be npon some pre- ceding disease or diseased condition which seems to have been recovered from, h disposed to i*ecurrence of the physical malady under the action of depressing or exhausting strains which tell upon the body through the mind.
I pointed out tliis fact many years ago in my work entitled, "Discourses on Practical Physic/' I showed there that tlie class of cases where nervous shi^ck or strain excites latent or intensified actual symptoms, includes many varieties of disease, such as pso- riasis and otlier chronic eruptions on the skin, cancer, epilepsy, and insanity. lu such cases I argued there is some preceding condition, hereditary or acquireil, which by causing primary injury to the nervous structnres leads to a chmnic exiiaustton that h oasilv intensified bv the slis^htest mental shock. Thus cancer frequently shows the first signs of its presence upon the occur- rence of some great mental anxiety. Thus ernjitions on the skin will follow from exposure to excessive mental exertion. Thus iusanity, which probably is never the result of simple mental overstrain, but is marked by mental inactivity as its forerunner, becomes pronounced when some mental shock or strain calls it forth.
Within these last months Dr, Crothers, wdio has the superin- tendence of a home for inebriates in the United States, has illus- trated this same point with great effect in respect to what he calls the influence of psychical traumatism, or, in other woi-ds, mental wound J on persons who have become total abstainers froni alco- holic drinks. Dr, Crothers ex{>laius that such persons may be perfectly safe under the protection of total abstinence so long as they are free from the danger of mental depression or blow; but when they come under sncli source of depression, so intense is its effect upon them, that, losing all moral control, they fall l>ack upon alcoholic stimulants, and, phiuging into inebriety, become its hopeless victims, incurable by any measure short of forcible and entire deprivation from alcolioL
In brief, all states of impaired nervous system, wliether tliey be hereditaiy in their nature or acquired by the accident of
DISEASE FHOK MENTAL AGENCIES.
445
physical disease, assist materially in the development of further physical disease from mental shock or strain. It inay be that in every case of mental shock there isi some aiieh predispoeing ten- dency, ina.srnueh as no living heing exists, !ip to tlie pres^ent time, who can he declared free of all physical defect, latent or active.
It is remarkahle liow very little the question of the origin of physical diseases from mental shock or influence lias hctju studied* Even physicians have let this qnestion largely stand aside, as if content with the contemplation of the grosser and more nKiterial evidences of the origins oi disease* To consider how a person eliould he injured by taking some deleterious substance into his system throngh his breatli. Ins stoinach, his skin, his blood, were a truly scientific and rational pursuit ; but to consider what shall enter by tlie senses or windows of the mind, and so invisibly entering he potent for evil or for good, that were too I'efined and indefinite a pursuit. To observe that a person fainted from loss of blood was naturally to iuquira into the reasons of the phenom- enon, and, step by step, to trace it out in all its mecliauical and physical meanings. To observe, however, that a person fainted on receiving S'^nie disastrous news was not suggestive of inquiry, because the phenomenon was due to something which seemed not
admit of inquiry, hut to define tliat wliicli was inexplicable Ind inevitable. At the same time, the characters of the resultant phenomena were seen to l>e much the eame, and, as it were, to liave some common origin.
I propose in the next few chapters included in the present part of tills work to treat bi'iefly on the connection of mental agency with the production of pliysical disease, and I undertake the task under the solemn conviction that the need for the study was never so decided as at the present hour, because the need for it increases with the intellectual development of the race. An uncultivated all but animal human race, possessing the appetites as its leading characteristic, and Iiaving few other qualities higher than emotions resting on the appetites, may be so near to the ani- mal world that litHe more than the physical agencies which affect it call for observation. In a higlier development and civilization the positions of mind and body ai*e moditied. Impressions telling u|w>n the body tlirough the mind become more potent, rapid, and pcrtiistent. Tlie mind begins to rule. Upon tliis the body, now more snbservieut to the mind, grows upmore susceptible to men-
446
DISEASE FROM MENTAL AnT.NCIE5?.
tal influences, and tlie disea&es developed in it piirtakiiig of its fiiisceptibilities are brought out mure decidedly tlirougli its im- pressionability.
I am quite sure that witbin the range of my own pergonal observation as an investigator of disease, t!iat is to say, within the range of tbirty*fivo years, I liave seen a marked difference in what I may call the individuality of disease, ae a result of pro- gressive intellectual life. 1 aui sui'e tliat what we need to call the strong physical or sthenic forms of disease, are less in nutu- ber and loss intense in character than they were some yeai's ago. I am equally sure that modified, if not new, forms of pliysical disease, developed through the mind, are nmcb more common than they were, and that in many respects disease generally is assuming a new phase, typical of the national life in its present stage of transition.
In makirjg thin statement on the natural history of disease I am offering nothing that ought to be considered alarming in its nature. As a whi»le, disease, in its groeser forms, is being re- duced, mortality is lessening, and life is becoming of longer dura- tion. These are cheering facts, and are facts indicating that the perfection of health and life is compatible, as it is perhaps only attainable, by tlie perfection of civilization. I therefore allude to the change with hope as the passwoi^.
In addition, I have no idea of any evil arising from mental work when that is carried on witli evenness, order, and general- ization. Tlie brain is the most enduring of organs. It is the organ that admits of most change; it is the organ tliat requires most change ; it is the organ that is the most perfect repository of animal foi^ce^ and is the most ready dispenser of it ; it is the organ that can rest in jaded parts and work in parts tliat are not jaded at one and the same time. So brain work, which means mental work, may bo hard work without being dangerous, may be conducive to health of life and length of days ; and, by devel- opment of the nervous organisms, during generation upon gen- eration, may give to mankind an increase in health and the possession of a longer natural h'fe ; may indeed, by continuous evolution, lead to an un thought of birtli of human existence.
Thii^ for the possible future. For the moment I must ask attention to physical disease from mental shock or strain ; to disease springing immediately if not absolutely fmm eomething
DISKASE FROM MENTAL AGENCIES. 447
which takes place through the agency of the mind. We may follow up this study in thi'ee directions.
1. — In relation to those influences which we call moral, Mhieh are usually imitative, and which are contractable by imitation.
2. — In i-elation to those influences which spring out of the passions or emotions, and which are either the quick responses or reflexes of some external action passing through the mind, instantly, from without ; or, which, coming originally from M-ith- out, have been laid up or stored in the mental recesses.
3. — ^In relation to those influences which depend on repeti- tions of mental directions, tendencies, or feelings, and which by repetition become second natures, habits, or habitudes.
CHAPTER II.
ACQUIRED DISEASE FROM MORAL AGENCIES.
TfTE cksB of affections which admit of being considered as arising purely from moral agencies are either direct! j" imitative in respect to origin, or hereditary, or a corahination of imitation and liereditary proclivity* Probably in a great majority uf in- stances the hereditary proclivity is the basis, whilo the imitative actJOTi, by which tlie phenomena of disease are rendered mani- fest and often permanent, is only called forth because the ten- dency or aptitude towards the iniitatiun ie strongly devek»ped. Iniitatioii of plienomena of dit^age is not indeed materially dif- ferent, e\cei>t in results, from that power of imitation which makes sonic |>er8^>n8 excel in the various arts and exerciser of skill in which it is commonly said they ai-e bom to excel.
To a certain extent every person is imitative, and many of tJiO commonest acts of life are the results of imitation. No two ]M3r- eons live together for many years without asj^uniiug some charac- torit^tic« common to both, tlie weaker acquiring, as a rule, the characteristics of the stronger* Features themselves are modified by imitation, aTid so it is a matter of every -day observation that married couples l>ecome so nnich alike that they might be mis- taken for hi'other and sister, in which oliservation we detect how iutiuuitely the hereditary and the acipiired faculties of our nature blend the one with tlio other.
It is not sm-priHing then that persons of feeble* nervous organ- ization should come, incidentally, nuder the spell of imitation in relation to disease, and that we should have presented to us in nature, anxongst the representatives of human kind, a series of diseases depending for tlieir development on moral agencies.
Escpiirol, who seems to have been amongst the first to recog- nize clearly and to define these diseased conditions or diseases, treats of them as diseases of sympathy, whUe the learned Prosper
dis>:ase from mokal agencies.
449
Deapine of Marseilles of our day, treats of them as due to moral coatagioo.
lu umny points of view the Iiypothefiis of contagion^ taking the word in its general nen^e, is nut only correct but exceedingly expi*esaive. The diseases iuduced by moral coniagtun are analo- gous to some extent to those which are traceable tu physical con* tagion. Suuietinies they take a spreading or epiJeniie character, after the manner of tlie oidinary spreading or contagious afEeo- tions more commonly known as catching affections or pestilences, ill wliich case they may widen into great epideniic outbi^eaks. Sometimes they assume what is called a sporadic form, that is to say, they am confined to a limited number of persons living in a limite<i district. Sometimes ttiey take what is called the idiopathic form, that is to say, they appear only in particular individuals.
WTien the diseases dependent on mora! influences have as- sumed their widest extension, it lias beeii observed that, like the conuaoner epidemics, they have exhibited their periods of origin, intensity, and decline. The analogies go further. A common con- tagious disease is often traceable to an imported case, or to what may have been designated, a case of bpontaneous origin. In tlie moral epidemics the same modes of development ai'e discoverable. During a common epidemic one prevailing disease may seem dominant. The like has been observed during moral epidemics. In common epidemics all persons are not equally susceptible to the influence of the contagiun ; s^iime are extretnely susceptible, others are insusceptible. The same obtains in relation to the diseases of moral origin, whether tliey are of epidemic, Bporadic, or idiopathic character.
Again, physical contagious diseases, such diseases as small- po3C, scarlet fever, and the like, present their greatest activities at particular seasons of the year, and that with such i*egidarity as to enable the periods of intensity of these diseases to be marked out aud classified. Souiethi ug sinular has been observed in respect to tlie diseases of moral origin* Thus the Kev. W. Ai'chibald, in a de^Tiption of a peculiar imitative convulsive disease of moral type* which appeared in the Shetland Islands, showed that the affection was only presented during the season of summer.
It oci^'asionany hapi>ens durinir times when an ordinary con- lagious disease is present that the disease, say it be cholera,
460
DISEASE FROM MORAL AGENCIES.
ftppeare to excite a similar form of disease, simply by the moral influence which it exorcisee. Under these cireumstaucee physi- cians theniaelves may be placed in the greatest difficulty in deter- mining whether a suffering person is affected by the actual malady, or only by a moral or simulated attack ; the chief point of diagnosis being that the simulated disease is usually of shorter duration, and rarely fatal. Here the mental and physical oon- ditious blend.
The analogy between the physical and the moral diseases is further supported by the circumstances that a moral epidemic fiometimos succeeds, and, as it were, supersedes a physical, Thia j fact is so marked that it forms, as we shall see, a conspicnoufi feature in tlie histories of some great physical and moral epi- demics. Lastly, bf>th classes of disease, moral and physical, are most readily suppressed by the plan of separating the diseased from the healthy.
The analugics above presented are sufficiently striking, but it is fair to indicate that there are also differences lietween the two classes of phenomena. In the firt?t place, moral contagion appeal's generally to he easily detectable, the time when the imitation took place and all che that relates to the mode of transmission being recognized or recoguizablu. IHiysical contagion, on the other hand, though it may be essentially physical and material in its nature, may neither be detectalile nor definable by present facilities of obeervation. In the second jdace, the diseases of moral origin are not indei>endent in character, they are truly simulated, or sinnilative affections assuming the form of some other well-known disease which is, or may be considered, of purely physical character. This fact will be brought out by the liistory of certain of the moral or imitative diseases which have to be described.
Classes of Disease from Moral Agencies,
Diseases developed through the nervous system are thosul most distinctly brought out through the agency of moral causes. Tlie effect of shoek from mental dietnrbauce is one amongst the most marked of the diseased conditions so induced, A mental shock from bad news snddenly communicated* from intense grief, from intense disappointment, and in very sensitive natures from
DISEASE FROM MORAL AGEKCIES.
^1
some sight or floiind, and specially from sound, ia all-eufflcient to create an effect in the nervous system so similar to that which is produced by eomtoon pbyfical accidents as to be indistinguishable by effect, TJius in ordinary conversation we are wont to speak of persons being stunned by the news they have heard ; or of persons being rendered bloodless and faint on receipt of over- whelming intelligetice ; or, of persons being palsied by the effect of some painful or alariniiig impression that has been made upon them through the mind.
Thna wo have at once three physical phenomena of disease through the nervous system pi'esented to observation as posfiiWy dne to mental agency, and these diseases of major import; con- cussion, syncope, palsy. The list does not end here, for it some- times hapi^ens that diseases of a du-onie kind ai-e indirectly pro- duced from a mental blow, of which diseases diabetes sometimes offers a strikii»g example.
Again, the subtle train of physical diseases through mental agencies may be induced, without any sliock, tlirough mere mat- ter of imitation, the affected person, predisposed, perchance, to the affection afterwards developed, showing the first signs of the malady on being simply in personal contact with some one suf- fering from the affection. In these cases the form of disease indicated is coimnonly a muscular excitement brought out by tlie nervous disturbance, and is for a long time continuous if not permanent.
Once more, in certain unhealthy conditions of the body, where the arterial tone is feeble and the balance between the iieart and its recoil is uncertain, and where, also, accompanying this gtate or leading up to it the nervous ether is deranged or iiiodified, very sHght external physical causes, causes which are not felt by healthy persons, are sufficient to set up in susceptible persons one or other of along series of symptoms, which may simulate any of the true physical diseases.
In these inetances the causes at work may act through any of the senses — the smell, the taste, the touch, the seeing, the hear- ing. We say, there is exalted sensibility in the persons affected. Tlie definition is quite corret^t. We eay, for want of a better tarm, that tlie }:K*rsons affected are hysterical or hysterically dis- posed. It woidd be more correct to say tliat they are for the time living under a different constitution or state of body from tliat
452
DI8EA8E FROM MORAL AGENCIES*
which is iiatnral. They are, in a word, in a special Btate of ner- vous teusioD, 60 tliat every vibratioa in tbeitieelves, so that every vibration outside themselves, whether arising from motion of parts of the body, or from mental fluctuations, or from variations in external temperature, or otlier external causes, may be sufficient to develop temporary phenomena of disease, exhibited through the nervous and muscular systems.
It not nufrequently happens that in the persons of this hys- terical nature, the causes which lead to concussion, syncope, and paralysis come into play witli unusual effect ; so that the hysteri- cal are specially predisposed to be stunned, to be rendei-ed faint, to be paralyzed, by influences wliich do not affect tbeii' stronger and less susceptible companions. They are, too, moi-e easily af- fected by the observation of peculiar or distressing actions, and are thereby rendered mure liable to diseases induced by imitation.
CHAPTER in.
ACqUIJiEB DISEASE FROM MENTAL SHOCK.
The eflfeets of mental shock telling upon the different organs of the body through the nervous organization lead eoiiietirnes, as I liave hinted above, to direct concussion or stun. Tbe gtnn raa^^' extend to wliat is called stroke or apoplexy, and is one of the fatal fomis of apoplexy in some instances wliere it happena to those who, by pre-existing organic disease, have become disposed to apoplectic seizure. In the majority of instances it is nothing more than a temporary shock or blow, from which, after a time, recovery takes place and all is well. In other inetaneee, recovery from any immediate danger is secured, but the shock which has been given conveys a sufficient impression to derange, more or permanently, the mental and physical life. A man or a roman under ibeso circumstances is said to have broken down, or to have lost self-control, or energy, or lieart. These terms, which ire as ejtpressive as they are true, have been used from tlie tirst ^days of literary art in the works descriptive of tiie history of man, his mental attributes, his faihires in attempted successes, and hia successes themselves.
iNEDRrETY FROM MeNTAL ShOCK.
Persons breaking down, as here described, show the failure in
varions ways. Some, losing moral control over themselves, resort
|ta artificial methods for sustainment, flying generally to snch
rigents as alcohol for support. These form the class whom Dr.
Crothers defines as dipsomaniacs from mental wound.
One man, says this author, in a communication which he has en so good as to send me, **one man gives a history of over- work under conditions of great mental excitement, from wliich he bh&B never recovm*ed his former vigor. Years after he becomea
454
DISEASE FKOM MENTAL SHOCK,
an inebriate, but he never traces the connection between the for- mer overwork and the inebriety, A carefui inquirj will ghow many hints along this interval, — which may be years, — ^that refer directly to this event, showing tliat inebriety is but the result of degenerationt? which began there. In another case, a man suffers from some profound grief and sorrow, whicli at the time breaks up his Ileal th, and for a long time after la felt in general debilitA* and weakness. Years go by, and suddenly he drinks to intoxica- tion, and is an inebriate at once. No good reason can be given for drinking, and possibly no stage of moderate use of spiiits pre- cedes the inebriety. To himself and friends a degree of ill-health has been recognized from the time of his great grief, and to the pliysician who can study closely this interval, there will be found nutrient perversions, neuralgias, eccentricities, and nameless indi- cations of a coming storm.
" A very large class of cases has in the past suffered from some form of disease, from wiiich tbe sufferers have recovered with an entailment of debility, and a want of sotnething that cannot be defined. Tliey are fully conscious of diminished power, of cliange of vigor and force. It may be they du not sleep naturally, and do not get the usual rest; or they do not recover quickly when exhausted, cannot digest food tiioroughly, have dyspepsia f mm slight causes. They are more sensitive than before, emotional and excitable with every event that is irritating.
"In one case a man has a severe pneumonia, with a ttxlious long convalescence. After recovery a change of disposition and character is noticed, and a year or so later he begins to drink spirits, and soon becomes an inebriate* In another case, a man recovers from t}T)hoid fever, and for a long time exhibits some marked alterations of habits and clmracter, then suddenly or gradually he becomes an inebriate. Tliere can be no doubt that inebriety originated in the traumatism, or wound, following the diseases in these cases. Some special exciting cause favored its development, or possibly the injury done to the nerve centres would only manifest itself in this way. The first causes are traumatic, following the diseases or lesions wliich take place, partiddarly notable in the complex range of psychical symptoms tiiat are seen. The integrity of the organism and function has been impaired, and from this point disease and diseased ten* dencies are developed.
DISEASE FBOM MENTAL SHOCK,
455
" These cases are found in every community. Of course the affected do uot all become inebriates, but, like a large cIobs of eceeutrics, they are on tlie border line, or inner circle shading into inebriety or insanity, A large number of persons engaged in the late civil war, who suffered hardship and nial-nulritiun, became inebriates, years after, following the psychical and phys* ical trauuiatisni received at that time* The effects of commercial diBasters, of bankruptcfeis, aud panics in Wall Street, can be seen in inebriate or insane asylums* In the asylimi for inebriates, at Binghamton, New York, at one time were eighteen cases whose inebriety could be clearly traced to a great money panic in Wall Street known as the * Black Friday.^ Many of these cases were purely from psychical traumatism, otiiers were ali*eady in the dark circle close to inebriety, and needed but a slight cause to precipitate them over. Political faihires are also fertile fields for the growth of inebriety, and the action of psychical influences. Annually a large class after the close of a campaign find them- selves literally inebriates, and if they have money go to water cures, inebriate asylums, or to tlie far West and begiu life again. The inebriety is often of the paroxysmal or dipsomaniacal type, with free intervals of sobriety, that give renewed energy to the delusive hope that recovery will follow the bidding of the will.
**Cla8»esof moderate or occasional drinkers are always more soBoeptible to tliese influences than abstainers. This was marked in an instance where three men, two moderate drinkers and on© abstainer, par-tners in l>usiiiess, with equal capital, lost their all in one night, Tlie abstainer recovet'ed and resumed again ; the moderate drinkers both drank to excess after, and died iuehriateB. It may be stated, as a rule, that moderate drinkers suffer more frequently from psychical shocka of every form, and are more likely to become inebriates from such causes. The inebriety tliat follows directly or indirectly from psj^chical traurnatisra, differe in natural progress and history from other cases. The physical degenerations are more pmnounced,, the heart and liver take on organic disease quickly, and the mental symptoms are prominent. In some cases the course of the disease is parox- ijBmal, and the mental degenerations are suspicious of what is called moral insanity.'*
466
DISEASE FROM MENTAL SHOCK,
Exhaustion fbom Mental Shock*
In the feeble mental shock, both in the acute and in tlie after Btages of its action, tells, tlirougli the nervous system, upon the
lieart. At first it leads to faintiiess, which may be complete, and which, in rare instances, id complete to fatality. Short of this extreme event, the faintness, when it lias passed away, may re- cur, or, not recurring of itself, may leave a weakness which tends to produce a repetition of the phenomenon on repetition of severe or even of slight shock. Often the iii*8t effect produced, though it may not recur with the same intensity, is followed by a de- rangement in the action of the heart whicli lasts, probably, throughout life, and which is a source of persistent embarrass- ment and enfeeblement. That peculiar condition of the circula- tion descril)eti on pages 13S-9, under the head of intermittent action of the heart, is, of all others, tlie deranged condition most closely connected with mental shock.
In another class of persons the mental shock tells first through the brain, it may be, in the form of stun, or in the form of faint- ness or syncope. It is then followed quickly, and as if in continu- ation of the original blow, by local failure of power In some one limb or through the whole of the half of the body* Tlie physical diseases thus implanted are the same as those which have l)een described at pages 170-77 under the head of paralysis, palsy, stroke*
In other instances persons deeply stricken with mental ex- haustion, fall into despondency, lose all taste for life, and, seizing a moment of courai^e for the desperate act, put thetnselves out of life with their own hands. These form the class called by Despine, " suicides determines par le desespoir/*
DtABKTES.
Mental blow or shock is further capable of inducing chronic changes in the nervous system, leading to the development of at least one special disease, namely, diabetes, the definition of which is given at. page t>5. I notice diabetes as originating from men- tal shock once more because it affonis so remarkable an inns' tration. The disease is one which is ordinarily known as being attended with a profuse discharge of renal secretion, such di&-
DISEASE FBOM MENTAL SHOCK. 457
charge oonstitnting, in fact, the marked demonstration of the dis- ease. For ages past it has been known that mental distm-banees determinatelj inflnence this secretion, rendering it sometimes co- pious and pale, and at other times causing it to be charged with deposits of pale pinkish color. Now we know that diabetes, in which a lai^e amount of grape-sugar is imported into the secre- tion, may be induced by mental as well as physical shocks affect- ing, primarily, the brain. The production of the disease through the mental shock may be actually startling, as in the following instance, which came imder my own cognizance. A healthy boy, eleven years of age, was sent by his father, a cai-penter by trade, to a wood-yard, to give an order for some timber. In the yard there was chained up a large and savage dog. The child, not aware of this, passed down the yard, and before seeing danger was suddenly set on by the furious animal. He got out of reach of the chained brute, but was so paralyzed by fear he could not for some seconds stii* away. He now became faint, was carried home in a state of extreme prostration, and from that hour was stricken of diabetes, from which malady, in three months, he died.
Diabetes is an affection which can be artificially or syntheti- cally produced by physical injuries of the cerebral organ. I have shown that it may even be caused, temporarily, by a disturbance in the circulation of the brain, and that men engaged in the art of coloring a ceiling produce, by the act of holding back the head for a long time, a derangement of the cerebral circulation suf- ficient, in some cases, to lead to the affection during the time they are at work.
The effect of mental shock, in causing diabetes, will possibly lead to other systemic diseases being traced to a similar cause, and to the connections that exist between physical and psychical influences affecting mankind.
CHAPTER IV.
ACQUIRED DISEASE FROM IMITATION OR MORAL CONTAGION.
At various periods in the history of the worid there have been presented diseases of the most singidar kind dependent upon imitation or moral contagion.
Such diseafles have assumed an epidemic form, as convulsive affections bearing the various names of Dctfunn^ manm y Tarant- ism j' SlJoIuis Dant^e ^ SL Vltrn's Dant*e ; TigretieT ; Symjxt- thy ; Convulsionum or Secourism ; Leajping Affuc ; and, Jlys- terla. In other instances the inntative disease has taken the form of paralysis, or of some other serious pliysical malady such as pulmonary consumption* In a third set of cases it has taken the form of suicide.
Dancing Makia,
The motional type of the imitative diseases has been known
from an early period in the history of medicine, but the grandest manifestations which liave been recorded of it, in its various phases, broke out, in the fourteenth century, soon after the sub- sidence of the great typhus phkgne or Black Death. The moral effects of that plague itself had been very severe. The mental shock sustained by all nations during the prevalence of the Black Plague is, says the learned liistoriau Ilecker, without parallel, and beyond description. " ilany fell victims to fear, and the most stout-hearted lost their confidence. The pious closed their accounts with the world, eternity presented itself to their view, and their only remaining desire was for a participation in the cousolatious of religion, because to them Death %vas disarmed of his sting. Repentance seized the transgressor, and an awful sense of contrition seized Christians of every community." But this zeal afterwards took another turn, I may say, many turns, and in
DISEAS33 FROM MORAL CONTAGION.
4m
1374 there commenced in German j the astounding epidemic of St, John's Dance, called goinetinies the dancing mania of Germany and the XetJierlands, In this year, the same lii-storian, Hecker, tells us, there appeared at Aix-la-Chapelle assemblages of men and women whu had come out of Germany, and wlio, imited by one common delusiuii, CAhihited the following strange spectacle. ^'They furrned circles hand in hand, and appearing to have lost all control over their senses, eontinncd dancing, regardless of Uie by-standers, for hours together in wild deliriunij unlil at length they fell to the groumi in a state of exhaustion. They then coujplained of extreme oppression, and groaned as if in tlie agonies of deatli, until they wei-e swathed in clotlia bound tightly round their waists, upon which they again recovered, and re- mained free from complaint until the next attack/* The swath- ing was resorted to on account of the tympany or distention of the body, which followed the spasmodic ravings ; but sometimes the by-stanJcrs relieved the patients in a ruder manner, namely, by trampling on the affected parts. '"While dancing, the dancers neither saw nor heard, being insensihle to external impressions, but were haunted by visions* When the disease was completely developed, the attack commenced with epileptic convulsions. Those affected fell to the ground senseless, panting, laboring for breath. They foamed at the mouth» and suddenly springing up, jan their dance witli strange coiitortious*''
The disease, appearing at Aix-la*Chapelle in July, 1374, ex- tended through the Netherlands, and through Belgium, to Co- logne, where more than five hundred were attacked ; and to Metz, where eleven hundred suffered.
It is supposed that as the first dancers in Aixda-Chapelle ap- peared in July, with St. John's name in their mouths, that the rild revels of St. John's day gave rise to t]»e plague.
About forty-four years later another dancing plague, called St. Vitus's dance, broke out at Strasburg, and extended largely. The sufferers in this case weix) conducted to the Chapels of St, Vitus, near Zahern and Rotestein, wliere, by the ministrations of tlie priests, they were said to be cured* Tiie minds of the suffer- ers, according to Hecker, were probably soothed by the nan^ation of a legend respecting St* Vitus, tliat before his death by the headsman, in the reign of Diocletian, he prayed that he might protect from the dancing mania all who should solemnize the day
460
DISEASE FROM MORAL CONTAGION.
of liis commemoration, and fast upon the eve of it, and that a voice fmni heaven was heard saying, "Vitns, thy prayer is accepted."
Tarantism.
Later on, towards the close of the fifteenth century, there broke out in Italy a motional disease, which took tlie peculiar name of Tarantism, because it was believed to be caused by the bite of the Ihnifiiula, a ground spider common in Apulia. Perotti> who describes tliis plague, states that those who were bitten, — ^I am quoting Perotti, from Ilecker, — generally fell into a state of meb ancholy, and appeared to be stupefied, and scarcely in posse^jsion of tlieir senses. The condition was in many cases united with a great sensibility to intisie, nnder which tliey sprang np, shonted, and danced until tliey sank on the ground exltausted and almost lifeless. Others, on the contrary, wept and pined in the greatest misery and anxiety* Others died in a paroxysm of laughing or weeping. In time tarantism spread, and was attended with more extraordinary phenomena, some of the suffei-ers taking the most vehement dislike to colors ; others an ardent longing for the sea. In time the sight of sufferers who were supposed to have been bitten produced tarantism. Old men of ninety threw aside their crutches, and at the sound of the music joined in the most ex- travagant dances. Even the deaf, it is said, did not escape. All drank profusely of wine, and took little food. Loss of voice, occasional blindness, sleeplessness, vertigo, complete insanity, and frequent weeping without any ostensible cause, were, remarks llecker, the usual symptoms. The disease continued until the middle of the sixteenth century.
A similar form of disease, to which the name of Tigretter has been given, was observed in the early part of the present century in Abyssinia, by an Englishman named Nathaniel Peai'ce. This mania resembled closely the dance of St. John, and took its name from Tigre, the country where it was most prevalent. Pearce noticed that the disease was more frequent amongst women than amongst men, although both sexes suffered. Hecker su^e«ta that as in Abyssinia, where Christianity has maintained itself in its primeval simplicity, St. John is worshipped, so there may have been a connection, aa to cause, between the two histories of the malady.
nSKASX FBOM MORAI. COKTAaiOir.
SrKPATHmC COSTTIJBKK!?.
Under the teno SympaiAy varioos kinds of dtsease of the tiwylionil tjpe hatre been observed. In 17S7 a giri woriang al a eoUmi mtm&etoinr «t Uodden Bridge in Tjuactrfiire put a mcmae into the bosam of anoclier girl, who was imuiediatelv thruwn into a fit, with Tioient eoiiTuliaoii& wkicb lasted for rwentv>four hoiu^ Xext dair three more girls were eeised ; oa the f aUoving daj six ; on the next following dav eleven. One man was also attacked who liad been modi fistigiied with holding the girls^ and three itiore girls were attacked at a factory fire miles distant, being ** infected entirel jr from report.^' The symptoms were inxiely, stiangttlation» and eonTnlsions so violent as to last from a cjaarter of an homr to twienty-four honrs^ and to require several poreons to preTont the patients from tearing their hair and daslting their lieads against the floor and walls. Bj the jadicioas moral treat* meut of Dr. St. Clair the epidemic was stayed.
Soitiethitig similar in the way of disease broke ont in the Charity Hospital, Berlin, in 1801. And, in 1813^14, in a Metho- <*' - ' I ^1 at Rednitli, four thousand people from tlie surrounding were said to liave become affected with a cori'^esponding con^'ulsive malady« Another outbreak was recorded by Mr« Ilib^ bert in 1822 as occnrriug in the Sbetland Islands. The par* oxysms usually prevailed during tlie warm months of summer and were repeated for some years, until the parish minister annred his flock that no treatment was more effectual than immersion In cold water, and that as his kirk was close to a fresh- water lake, he woiUd have attendance at hand to insure the proper means of cure. Tlie threat acted like a charm.
The history of the convnlsionaires in France, which com- m^noed in 1731, and under the names of Convulsitinism and Seeourism continued into the beginning of the present eentury, partook of all these forms of motional disease so closely that it would be but repetition to recount the phenomena. The ^amo remark applies to an affection in certain parts of Scotland, called by Sir •!, Sinclair I^xiping ague^ and to varioii** outbreaks of Cfmrea Samii Fi/5* which have broken ont in America and in this country.
Of late years no extended and dofinito onthreak of convulsive or motional disease has been specially recorded, but the phe-
463
DISEASE FROM MORAL COKTAGION.
nomena of moral contagion have not passed away. They somo- times appear, even now, on a large scale, and we meet with them occurring in what may be called the idiopathic form veiy fre* ijuently.
I have myself put on record two inetances in winch eugcep- tible children readily acquired chorea from imitation. 1 have also recorded an instance in which the muscnlar affection called 6trabismu8 or squint was acquired by imitation.
OruEK Diseases from Imttatiok.
Pulmonary eonsumjjfwn. In addition to diseases of the motional type arising from moral contagion, there are others which take a less vehement but hardly less anxious character. Symptoms of consumption may tlms be simulated, and I have known the history of an instance of this kind. A young woman who had been for some weuks in close communion with a patient suffering from pulmonary consumption, commenced gradually to imitate the movements of breathing and the cough of the con- sumptive sufferer. Gradually other symptoms were acquired, including the most perfect representation of the voice of the real patient The paroxysms of cough increased, and the syinptoms altogether soomcd so real, there was, on the part of the friends of tlie unconsciously imitative girl, no doubt as to her ultimate fate. The stethoscope and other objective means for deteetion of disease yielded, however, no evidence of the actual existence of the graver malady. After two years of suffering from these symptoms she suddenly recovered.
Paralysis, In other instances the simuhited disease may take ' the form of paralysis in susceptible subjects, A patient who was ] long mider my cai^e heard the details of an attack of paralysis, occurring to one of her friends, described witli great minuteness- From that hour she lost, day by day, tlio power of her lower limbs and, later still, the voluntary conmumd over the whole of the lower half of her body. For many weeks this condition was present, the patient remaining soiielpless that she could not, even in bed, raise her lower limbs, much less move on them. The cxtremest and the most varied opinions prevailed amongst the medical men, who from tijue to time visited her, as to the precise nature of her illness. At last, during a great crisis in her family
mSKASE^ FKOM HORAL COXTAGIOX
rCifde^ wben one of the rircfo was eiqpeeted to die^ » aiddai
from mn adjoinii^ room fooaed Uer apparentl ? imA mem*
ben iittD tifa Sbe roee bom her bed nnftsdMedp wmlked rapidly
isio the room where the other prndeut wsd ijing, and hom that
aiomefit rvoovered the entire use ot the preTioofilj, and aa thej
hopeleadj, pakied limba. The new mental eonditioo
I aroiiaed eooitilnted tfaeeimu
PerwUlmi flmiactiJbr wniroelion. Peratstent cootraction of
tnnacie or of a series of muscles is another diseaee whidi maj
the body throQgli imitation^ an instance of which is well
in the f oUowii^ history. A young girl, who was Itv-
\ in India, witnessed some natire feats and shows at a religioaa
ral* Amongst other sights that she 6aw was that of a natiTeiy
liooe lower Umbs were drawn np to his body and were there per-
aanently fixed. The girl was morbidly impressed by this sights
' and next morning was f oond in bed unable to rise, becan^ one of
her own lower limbs was drawn up closely and rigidly to her body.
This iuiitatire condition remained for many months, and neitlier
by persnasion nor by force could the patient be got to straighten
, oat the limb. She was subuiitted to the action of ehlorof orm»
when her volitionaf power was entirely overcome by the in-
Inence of the narcotic vapor and the whole of the muscles were
"rendered flaccid, the contracted limb could be brought down,
lint so soon as the narcotic effect passed away, eo soon as the will
iined its dominion, so soon as the muscles regained llieir stim-
Itia, so soon was the limb drawn again into its distorted and rigid
ftition.
Tlie young la<iy, with the limb in tliis contracted state, was ultimately, to England, whei^e she remained for many I without cliange. One day, while her attention was entirely Ibsorbed in a game of chess, her leg was gently stniightentxl with- out the slightest opposition on her pait ; and the moment she was conscious of the fact she underto<:»k to walk upstaii's. To the wonder of all her friends she aeconiplished the feat without !■ ritur or difficulty, and from that time onwards has i*emained ua:UTecteil, Interrogated afteAvards as to the reason why her limb was distorted in the manner described, she expressed her entire inability to assign any reason. She was of opitiifui that al- thouijh she never willed the contraction, nor by any act of will maintained the resistance, yet that the idea of it was never off
4»i
DIS£A8S FfiOM MOBAL CONTAGION.
ter Mind, daring her waking liours, tmtil the moment when she j WIS d^iroted to tlie simple object of winning the game of ch^e. Tbeci it aeemed to her tliat, in the excitement, ghc had altogether fbrgocteo the contnction, ns well as tlie varied forcible attempts that lud been made lo ovenx>me it, everj one of wliich, she was eonvineed, aenred onlj to aggravate the evil. When she diseov- ^ thai the limb liad beea brought down the fact afforded her
Suicide.
Sukride now and then appears as a phenomenon of disease, b%tm inijlaikiti* This fact has l>een speciallv dwelt upon by Des- ' fh^ who has reM>rdtHl mauj instances in which persons under the itiflueuee of imitation have performed thtj suicidal act in one IMrtkular wav* For example* A soldier during the first Empire haiijCi»d himself in his sentry box. iilmost immediately after- war\b a numWr of other soldiers did the sanje, the contagion re- maining; imtil the sentry Ih^xcs in the garrison w^ere all destroyed, after wliich there was no repetition. The iron cage on the Monu- MMKit in the City of I-t>niliin and on the Duke of York's Column am evMetiees of the same imitative contagion in this country, the Ci^pa having betni erected in order to prevent the frequent recur- iwee df abuicide by leaping from the summits of Uie columns to the «0iarth beneath.
It will be inferred that the act of suicide under contagious in* tueui'e is only carried out by pei'sons whose minds ai"e previously dUturUsl or dcrangtHi, and the inference is practically correct, TW penKUis wen\ no doubt^ prepared mentally for Buieide^ or, as ^# ilK^iftld «ay in relation to an oi'dinary infectious malady, they ^MM in A state rendering them susceptible to the commission of iiiriilii? This fact does not^ however^ change the imitative as}>eet ^(|# %}itestion, since the morbid susceptibility became evoked by libl lipilWr rf iniit4ition and led to the prac*tical result of snicide.
li lyi2i ht«0n assumed by some tliat homicide as well as suicide ^gj^ ually, the imitative contagious character, but I have
^1 to dit»ix>vor any sufficient number of facts to justify k't' t»f this hypothesis.
CHAPTER V. ACQUIRED DISEASE PROM HYSTERICAL EMOTION.
In the earlier part of this volume, pages 87-89, we traced ont how the arterial blood supply to all paints of the body is under the influence of the sympathetic nervous system, and how readily an impression made thi*ough the senses tells through that system upon tlie body. We have now to consider a class of cases in which certain phenomena of disease are developed, largely, from external causes acting through this nervous organization.
In some persons the excitability of the emotional nervous sys- tem is so great, that the merest disturbance of the nervous tension produces some indications or phenomena of disease. Persons so placed are said to be hysterical, and are given to manifest a long and peculiar train of diseases.
There are other persons who, without being hysterical, are easily influenced through the senses, and are rendered liable to be even dangerously afi^ected through what are called the emo- tions or passions, especially the passions of anger, fear, and grief.
In the present chapter we have briefly to consider the types or forms of phenomenal disease, called the hysterical.
Under the one term hysteria so many affections simulating diseases of the true organic type have been recognized, it were almost to go over the whole of the list again to enumerate them. Some authors, indeed, would accept many of the affections placed in the last chapter as being purely of hysterical nature and would consider them of hysterical origin. The general characteristics of the disease hysteria are given briefly on p. 181, and a very few additions here will suffice.
Hysteria is almost entirely a disorder of the female sex, al- though it is sometimes met with in the male. It is most fi-e- quently developed in the years of life extending from the com- mencement of adolescence up to thirty. Its commonest symptoms 30
404
her iniii'i. was dfVo! Tlieii ii .- forgot In. that li:i.i aniviiii-i- ered th.i' no Mirp'.
from ii. pint*, V. tho int" parti*-', lianp- • wanl- iiiaiiii! after V
llllMlI
aro i'^ rag<- rein<'
t\w i- \
ai>t:
Wf
\vr: siii of tl.=
• 1 with
■ THirely
. withoiiT.
..;^!l*.»>i.S is
- . i to pain,
!i liystiM-ia.
•AMiral<ria, <>r
iTu-y. On the
-V ti> ])ain, /. <.
■// U/Hf-sf/hSf'tf,
• •, or the wlioli'
• r«>tliie(Ml in ?<>in<»
i-i mesmerism par-
-: range phemonena
. '...- in liyjmotie and
: resent head.
.ies are apt to mani-
. are distingui>hahle
• e«.-uliarit y of their oe-
• -isteney with which the
< -:•; an ilhistration of this
: tiisease, in the case* of a
ith was silly and fo(»li>lu
•:■ inter.-i)aees of the liours,
liour ha<l ela])sed, as if he
• .. -'--nate the right nnmher of
-. .ill'] no business or emjjloy
i\e him omit this task, lie,
.vTo aloud by making a noise at
. X ; and as often as Ik* lieard ti.e
^ " 0 eried, one, two, three, rejK'at-
>.i:ions. Ilenee, says AVillis, it
.inimal spirits, hy daily imita-
ed up hy such a motion, accord-
.i: length were able to di^tinguish
DISEASE FROM HYSTERICAL EMOTION.
467
„ the same periods of tlieir own accord, notliing directing, as if the llding spaces of time had been measured out by the wheels of a clock/' The above is an extreme case of automatic disease, and is perhaps the most singular on record, as coming from a master who was one of the most faithful observers in the whole world of science. But phenomena approacliiug to it are not wanting amongst tlie liysterical and hypocliondriacal classes of modern communities. Some so circumstanced are impelled to walk a given distance each day in order to touch some particular object, or perfonn some particular trivial act. Others repeat in an auto- matic manner a sericc of words, ejaculations, or sentences. Others again, especially amongst the hypochondriacal, give indications, in an automatically recurrent manner, of some particular suffer- ing or pain, which they accumpaiiy with a special ubservation re- lating to the same, but w^hicli on int|niry may turn out to have no real meaning. A f nrtlicr class of the purely hysterical type suffer from automatic i^ecurrent paroxysuis of pain like neuralgia, tooth- ache, rheumatism ; or again, of paroxysms of cough, difficulty of »wallow^ing, blushing, — ercthema fngax, — or palpitation of the
'heart. In these the singularity of the phenomenon, whichever it may be, is that it is not traceable to any definable organic origin. The most common rules connected with phenomena of disease are open to exception, and so in the hysterical there may be in- ternal irritations which keep up the hysteria. In these instances a true physical is combined with an emotional affection, and the results are of a serious character. I have more than once known symptoms, comnuuily called hysterical, terminate fatally under these circumstances. I have known, for example, what seemed to be purely an hysterical cough CH>ntinue so persistently as to produce death from exhaustion. I knew death take place once from the severity of hysterical convulsion. I knew an instance in which what seemed to he hysterical constriction of the gullet, or oesopliagns, ended fatally, and in which the after-examination showed that there was no organic constriction.
Persons hvsterieally disposed are liable to changes in the hhxKl, and particularly to that change wdiich has been described at page 150, ansemia. Under this condition of blood, accom- pauied as it generally is with loss of vascular tone, the affected suffer from numerous physical perversions, such as tlushes, chills, coldness of the extremities, perspirations, irregular actions of the
466
DISEASE FHo
are those of emotional » laughing, crying, convul^i,t. of fauitncss or insenj?ibilif y. one or other of these syn > pliygical characters of *- these special character! ^ti rendereil exceedingly dStVi-
Excessive sen ' ' hysterical hijperu Thus the nioBt striking of tootliaehe, are other hand, we ^ to common sensatif affecting a part of ti of the body.
The insensihih'tv Btigceptible indiv takes of the hy that have often mesmeric states 1
Persons affli' fest various ft»i from mere li cnrrence, an«i automatic act
The illn^t automat i>fru youth wIl*' yet knew, ev and as ofter had been a the hour 1 about an; at the br every sti Bound in
All
» of ir-
a brisk
rbations
lorquivei",
\ Bi the eyelids
w$ mu8cle&y or
^^ — sihtion to taete
iiimT by observers
^ojsair eliaracteristiee
^ rtjtirely lost, or it
j^- ikmsidered the most
^^^ fkfeetionable things
^ examples distaste for
iih appetite appeal's
fij ftfting, wliicli I and
^ diaracter^ and occa-
, cooqibte range over the
_ the title hysteria. It is,
.r inMrical constitution and
r i^ *f8iploins of every disease
vfaidi have been i*eferred
tinteve noted many other special
, epilepsy, mania, and
^ jMiiiii w 11 difignise \ bat as, in so
plrtocimena^ the labor is un-
happert tion l> ing t<
^ ^ \^^Aiki tawing on the hysterical state
r^^^ r"*' ■■ ibBiwI sopematnral manifestations <■" ^ •fi^ *^ Migriflii); iiffected ai'e of all persons
I?^"
DISEASE FROM HYSTERICAL EHOTION. 469
tliose who are impressed most strongly with the idea of the super- nataral. They see, hear, feel, smell, and taste what others, less susceptible, fail to distinguish, and so are led naturally to distort trivial phenomena into startling events and appearances. They make, in simple truth, a world of their own ; people it, describe it, and invent tliereby a new world which, like their disease, is but a reflection of what is real.
4f9IT EMOTFONB OR
^* nnd re-act itpon our
. btrifces us tli rough
1, the bloodj and pro-
, ami Tibrations, of quickened
^gQM^ We know that under sudden
ti» hairt palpitates or trepidates,
« pfttffntift of mind is lost, and faint-
r^^yrcwinpletoL We know that under
^HfM ^ sficrction are apt to occur ;
Jium MBM^ derangement of the bowels,
.^Mi^ sniudier from free perspiration.
4iimmm of ainger there are two sets of
^sk dMn fiice ifi lluslied and congested,
^r^w^^issi or even faintness ; and so we
. » Vi rage or white with rage. We
^ painful affections follow ; loss of
' ^»vrer^ of mental serenity*
*- r>H bat the physician is aware that
aoiMts corroding passions referred to
. ...-- urn established which may kill after a
*-j^ affect the life unfavorably during
»i fitciire may be prolonged.
i>?.k>ns there Is much that is common.
iisd all strike, if I may so express
and affect the same parts. But
intense in their aetiou than othen?.
^ .,, ,...,- =cst of the passions, hatred is the
, jjitfw whI after that grief. Anger is acute and
^K aoQlei but longer aud corroding ; fear is
DISEASE FROM THE PA88I0N8,
471
acute and depreesiug, but less teuse than anger ; grief is more pro* longed, though it may be less rapid in its onset.
Uniler the severe influence of any of these passions several distinct forms of disease are produced. The most obvious are those whicb follow.
Emotional iNTEKMrrTENCY ok thk IIkart.
The affection of tlie heart described at pp, 1*38-9 as intermit- tency, is a comlition of disease which is specially induced by the influence of emotion or passion. This is so strictly the fact, tliat <mt of an nnusnally large observation of instances of sueli inter- mittency 1 have not met with one instance in which the phe- nomenon was not traceable to an emotional cause. In many kOaaes the effect followed immediately upon the emotion. A member of my own profession admitted to me that an original irrital>ility of temper was permitted by want of due control to pass almost into persistent or elironic anger, S4> that every trifle was a canse of unwarrantable irritation. Sometimes his anger was so vehement that all about him were alarmed for him more than for themselves. In the midst of one of these oiitbi"eaks he suddenly felt as if Ids ** heart were lost" He reeled under the impression, felt nauseated and faint ; then recovering, he put his hand to bis wrist to discover an intermittent action of bis heart as the cause of Jji^ faintness. He never recovered the Fliock, and altliough he livetl ten years the intermitteucy remained, often to siieh an e^ctent that he was conscious of it without tracing it out by tlie pulse, ^* I am broken-hearted," he would say, and that was the simple fact.
In another example of the same affection fear was the cause of it* A gentleman was returniTjg home from a long voyage in perfect health, w^hen the vessel he was in was struck by a larger one, and being hopelessly injured, began to sink. With the sen- sation of the sinking of the ship he felt that his heart, previously acting vehemently, stopped in its beat. He remembered no more» except a confused noise and a return to comparative quiet when he found himself on the deck of another vessel. After lie had gained suftieient calmness he discovered that his heart was intermitting four or five times every minute. The intermittenee continued until the end of the voyage and very much interrupted
■k** .'1 •t^'arae en-
.::'![ ieirree,
— -1^ :::e present
ACQUIRED / .
We are stli' physical natuiv-. the emotiuiLs - duces some ] function or <.| ;. fear the face. i. ■ the limbs br'^i.. ness or syncc}- lesser agitati- that one per^^" another from We know that . phenomena ;-- another in wl,, speak of a ]»>*<
know that iimi
appetite, of ^l• All these
under the ar^
some permaii'
short course, ;.
its future, ho. In the ai't ,
I mean by tli ^
myself, in ti
some of the ;
Anger, I tli
next, then f •
short; hatn
..-ur*-. uni I have
■ :i::iii ^ho lost
•.-s<»£it jrief pro-
r.- ie:irt ceased
- "ne irrief sub-
.... r.u : ^:is reduced
.rHj.:-.n&% but she has
.ii ire .»r other source
c'.iou of the heart,
.*«iaueac manner, and
* kudicional worry or
->.vp^
^ -^-..A
.•* leiTt. another symptom KMi is occasionally pre- «r!:$sicion of coldness or _ 5*ihL which sensation is 7«> ^w'U ^ ^t the skin presents •^ •r^m.'ed when the surface ■^ icier spray. The numb- __ ifHKciiesia in the part, that ^^.raied painlessly at the part. iMtf -rL often remain for a long «^i4i time the sensibility ap- Wlien recovery recommences _ idJ sensibility are completely i» vkich I give the name of local ^ 10 my observation, of emotional s<l^ 1^ cDonected with intermittent pulse. '*** * # ijgod through the afiPected parts, proba- j^ minute Uood-vessels there, under a
DISEASE FBOH THE PAS8I0K8. 473
Emotional Paupitation.
The nnnatai'al action of the heart, called jHxlpUcUianj is a temporary disease often induced by emotional excitement The condition of the heart when it palpitates is, in some respects, the 8ame as that which liappens during intermittent action, tliat is to say, certain of the sounds are lost with tlie strokes. Sometimes the second sound only is heai*d ; sometimes the first is followed by two second sounds without a pause. The motion of the heart is also extremely rapid, so that the pulse can scarcely be counted, and when the motion of the pulse is listened to through the sphygmophone, the sound heard is almost continuous and rotary.
The emotions which most easily bring on palpitations are those of anger and fear. When anger is the excitant tlie palpi- tation is exceedingly violent, causing a sensation of choking and of fulness in the head, followed frequently by vertigo and un- steadiness, with feebleness of the limbs. When the palpitation arises from fear it is, commonly, much shorter in its duration, and terminates moi-e quickly in faintness and exhaustion.
Epigast/ric or Stomach Palpitation.
There is another kind of tremulous action excited easily by the emotions, and especially by the emotions of fear and anxiety, wliich is called a palpitation, but which is not, really, a palpita- tion of the heart. Some of the old writers call this ^^ epigastric palpitation," and the term is exceedingly appropriate. The pal- pitation is experienced as a fluttering or severe tremulous throb- bing just above the stomach, and is attended with a sense of feebleness or sinking in the stomach, and it may be with nausea. At one time I thought this symptom, which I had often heard described by the sick, must needs be, after all, a palpitation of the heart. I was corrected in this view by an eminent man of science, who assured me, as a sufferer from the affection, that when the palpitation was in or near the stomach his heart beat and pulse beat were perfectly correct. To prove this he came to me during a paroxysm, at a time when he had unbearable palpi-- tation. " You can see it," he said, " through my clothes, but it is distinct from an intermittent action of my heart, and from the action of my heart and pulse at the wrist, as you will find." Tlis observation was accurate; his heart was beating seventy-four
DISEASE FROM THE PASSIONS,
476
whole of the body. 1 have known a few ingtances in whicli the erythema was cootined to one side of the body, appearing only on the right or left side of ttie cheek, nock, breast, or limb. As A rule, the affection is not of great importance, and in itself it ia of no gerious munient. It does, huwever, in rare examples, stand cNit m a sign of acriona nervous derangement. It is of more im- portance when it attacks one side of the budy only than when it is equally distributed over the Baiue surfaces on both sides of the body.
Emotional UNSTEADrxEss of thk CuiouLATioN.
tJnatoadiness of the cii-calation, without actual intermittency, |ft condition of disease that is very often connected w^ith emo- nal excitenients. Tlie heart m such eases is said to be irrita- hle, and it is very readily made irregular in its boat, at one time <|mck, at another time slow, during, perhaps, short intervals. When the action is quick and irritable the mind is in much the CUtto state, the body is feverish, and the umscles fidgety and rest- |le6a. After this first stage passes aw^ay, and it usually passes ijaickly, the heart is left enfeebled, as though it had suffered an organic shock ; the mind is dejjressecl, the surface of the body is febUled, the muscles are languid, and the brain, too tired to sleep, It fretful and exhausted. lu these states of hotiy the digestion is always imperfect and the secretiouB irregular. The emotions 1 wfaidi bring on these irregtdar f imctions of tlie heart are those chiefly of anxiety connected with anticipation. They are essen- tially the emotions of tlie speculator and the gambler, but they are aometimes also tliose of the political partisan and even of the retigioua enthusiast. 1 have seen tbeui performing the part dc- icribed as producers of diseased action under all tliese phases, iod they lead not uncommonly to actual derangement of the ital equilibrium.
But of all the passions for exciting this unsteadiness of circu-
I ladon hatred is the most determinate. Hatred acts mucli like
' hupiv in the effects it pruduces, except that the effects are less
•uddenly developed, while tliey are much more closely concealed.
ITiey rarely indeed come under the cognizance of the physician
unmixed with other phenomena, or until distinct physical cbaogea
|»© resulted from them. The emotion keeps up suppressed
witli morose determiiiatiou aud with a rustless a<2tivity of
4TO
]>IBSABE FROK THE PASSIONS.
mind which lead tlie sufferer to neglect the neceeeities of his own existence* His circulation is always disturbed, he is feverish, ex- citable, and, in turns, feeble. As the very accomplislmient of the deBii*eB he may have afiford no palliation, he at last either sinksn into chronic despondency and irritability, which ends slowly in fixed n»elancholy, or he passes quickly into acute and helpless mental derangement, from which recovery is of rare occurrence.
Emotiokai. generai* Synoope.
A blow or shock delivered througli the emotions is not uncom- monly followed by syncope or fainting. In a past day emotional syncope or swoon would seem to have been of much moi*© com- mon occurrence than in this day. The swoon which once waa historical, and which seemed on the part of the fairer section of the creation to be an essential feature in every emotional scene, was not, we must suppose, extremely serious, seeing that the re- covery was always rapid and satisfactory. Like the vertiginous attack called the '* vajM>rs,'' whicii appears to have been so preva- lent at one time in court and mansion, the emotional syncope of a later era, following the course of an absurd and feeble fashion, became contagious by imitation. In our time such manifestation of the phenomenon is exceptional, but syncope from strong emo- tional causes is still often witnessed amongst persons of both sexes who are of excitable and nervous c* institution. Fear and the anxiety connected with the shock of sudden news are the two emotional states which lead to the faintness or deliquium. The syncope may be quite sudden, as though the begirt had stopped immediately in its beat ; but it is more usually preceded by a pal- pitation \iTt;h fulness in the tJiroat, coldness of tlie surface of the body, giddiness and muscular failure. Fn*ni the faintness the body falls, and the heart, relieved by the recumbent position, usually regains its power, upon %vhieli there is recovery.
This is the most favorable view of the course of syncope from emotion. There is a more serious side. In the community there is always a population in whom the balance of the circulation is so delicate, and in whom the heart is so enfeebled, that syncope from emotional causes is at all times a grave and sometimes a fatal catastrophe* A large number of sudden deaths is due to syncope induced through emotional impressions.
DISEJiSE FROM TllE FAS8IOK8*
477
Emotional Paralysis axd AroPLKxy.
In stAtes of tbe nen'ous system, where from the progress of organic nervous diseaeo the danger of nervous seizure is imnii- nent, the effects of emotional excitement sometimes tell witli great effect upon tlie body, throiigli the nervous system. Sliglit emotional attacks frequent ly repeated, or constant emotions like those resulting from anxiety, or sudden attacks like those result- ing from fear or rage, ai'e all sutHcient to bring out, slowly or rapidly, according to their intensity, the nervous affection or stroke, which may Ije a stroke of palsy^ or an apoplectic stroke.
The stroke of paralysis is most commonly induced by a series of emotional attacks dependent upon anxiety, and ending, per- haps, in sometlnng that is moi*e tlian usually oppressive. In cer- tain instancoB the paralysis is at first temporary in its character, and is rather of the hysterical than of the true kind, so that recovery takes ]>lace. In otlier instances the paralysis is local, attacking temporarily the eyelid, — ptosis,— or affecting one side of the mouth, or one or other of the limbs. In pronounced in- duces it is decisive, affecting, probably, one half of the body, ad exhibiting all the phenomena, described at page 176, of pa- ralysis.
Apoplexy induced by emotion, in persons prediBposed to the affection, is sudden in its development, and is developed, in point of fact, as if it had been produced by a direct physical blow. As fear is the passion leading nioet frequently to syncope, so anger is the passion leatling most distinctly to apoplectic seizure. In tlio glow of die passion of anger the brain is surcharged with blood and the attack is immediate. Or, when the rage has passed the congestion of reaction leads to engorgement of the vessels of the brain with the same result, an ari-est of the circulation in the brain and a stroke of insensibility. The number of persona who die from apoplexy under emotional excitement is very con- siderable.
Emotional Delusion and Melancholy,
Under emotional excitement persons of a Busceptible tempera- ment become in certain cases charged with peculiar delusions, which never, perhaps, thoroughly pftss away^ but which may be
47B
DISEASE FROM THE PASSIONS-
SO iiiteneifled as to produce t43iidencie8 decisively insane* A sud- den terror is the commonest cause of this condition of diisease. A gentleman who was long under my care afforded a striking illustration of this faet* As a boy he Lad a supreme dread uf water, and his fatlier for that reason, and with the best inten- tions, determined that he should be tanght to swim* Jle was taken hy his tutor, in whom he had the fullest confidence, to tlie side of a river, and when he was undressed he suddenly found himself cast, by his instructor, into the stream* There w*as no danger of drowning, for the tutor was at once in the water to hold him up and bring him to land ; but the immediate effect on the boy was faintness from fear, followed quickly by vomiting, and severe nervous symptoms. lie had constant dread that some one was about to re]^>eat the infliction ; he dreamed of the event by night, lie dwelt upon it by day. As he grew older he became suspicious of all around hhn, and at last, under a most absurd delusion that he was the victim of a conspiracy, bis mind gave way, and he died insane*
Melancholic symptoms, accompanied with indications of or- ganic nervous feebleness, are apt to become developed from pro- longed grief, especially when the person influenced by the passion of grief has approached or passed the meridian of life. A con- stant desire for rest, for seclusion, for avoidance of cares of the world mark this form of disease. It is not disease leading, ne- cessarily, to rapid failure of further physical or mental power, for the mind and body are subdued &a equally thei-© is no galling irritability, no wearing depression from the influence of other passions. The worst that happens, ultimately, in these instances is the gradual but piismature encroachment of dementia previous to death, if the life he prolonged to its natnral term.
Melancholy from emotion sometimes follows from an excite- ment of another form; namely, that which is engendered from various kinds uf religious emotioTial states. In some natures tlie influence of religious excitement leads primarily to an ecstasy and enthusiasm under which the vascular system is greatly excited, and, through it, the nervous. The excitement, if it be not sub- dued or chsistcncd, drops, after a time, into a settled melancholy, attended, occasionally, with an extreme hardness and even moros ness of mind. In other natures the effect of religious excitement is directly towards gloom and melancholy, with brooding doubt*
DISEASE FROM THE PASSIONS,
479
respecting certain particular beliefs, or regarding certain texts or assages of Bcripture. The saddest forms of nielancboly are now 'and then traceable to this origin. I have known three cases in which self -accusation of sin, which it was l>elieved eouhJ never be forgiven, has led the self-accused to commit suicide under the conviction, logical in its waj, that as no 8tifFt?rijig could be worse than the continuance of life, death might ijossibly be a solution of all tlie trouble.
Bj political excitements, and by these particularly, when they lead to strife and war, various loetital aberrations, ranging from maniacal passion to melancholy, arc acquired. This fact was illustrated witli much force by Dr. Stokes of the Mount Hope Institution of Baltimore after the last great American struggle. One victim of the political war mania is cursed, — so runs the deseription,^with fear until lie fails to sleep ; another sinks into gloom, believing all his estates are confiscated ; a third imagines himself taking part in some bloody fray; a fourth, tlie subject of delusions through the gensa of heanng, no sooner sleeps than he wakes up, roused by what he considers to be awful sounds afar off, but approaching near.
AocmENTAL DiSEABEa FHOM EMO^nON.
Certain accidental diseases are developed occasionally under the influence of the passions. I once saw that enlargement of the thyroid gland, described at page 227 under the term *' goitres- developed under a sudden impidse of grief, during which the suf- fering pei'sou continued for many days to keep up a sobbing cry. In another instance I witnessed the piienomcnnn of htemoptysis, or spitting of blood, induced by rage. In a third instance, under the influence of t!ie passioti of rage, actual blindness, lasting for jme hours, and attended with severe tlirobbing and pain in the ^eballs and head, followed the passionate impulse.
CHAPTER VIL ACQUIEED DISEASE FROM EABfTS OF LIFR
Apart frotii all the influences acting upon the body through tlie tnind, to which the attention of the reader lias been drawn in the last few chapters, there are some others which reqnire to be studied, and which are corniuonly known as individual hahitis or habitudees. Some habits of an injurious kind, alcohol drinking and tobacco smoking for example, liave already been discussed, and need not be referred to again. Tliose that I'emain are habits of irregular I'est and sleep ; of worry in relation to business, oc?cu- pation, or pleasure; of excessive mental strain from overwork or over desire ; sedentary habits ; and habits of moral faihire.
From all tliese habits, carried to excess, some changes, physi- cal or mental J or both, amounting often to actual disease of body, of mind, or of both, are to be detected amongst various classes of our communities. The diseases thus acquireii are seated specially in the digestive, the ciiTulatory, and the nervous systems ; but the nervous systems suffer most, and are, usually, first affected.
Diseases of the DioEamvE System from HABrr*
Persons who ai^ closely engaged in pursuits of a sedentary kind are very liable to suffer from inaction of the digestive organs, and from what they designate inactivity of the liver, a term general enough but not wanting in correctness. The sed- entary habit leads to slow secretion of bile, slow circulation tlirough the liver and tlie otljcr parts of the digestive system, and therewith to indigestion, and, as a general rule, to constipa- tion. The obstruction of the circulation through the liver haa often the further effect of inducing hctnorrhoids. Persons suf- fering in this manner from tlte sedentary life gain, in addition to the dyspepsia, a tendency to become fat and unwieldy. They are
DISEASE FROM HABITS OF LIFE.
481
mucli depressed in spiritB, disinclined for exercise, and are easily affected by alternations of cold and lieat» They ai*e vitally redneed in power, and are prone to suffer from degeneration of the tis- sues. They generally become prematurely old.
Diseases of tiie CiRcmxATioK from IlABrr.
IHaemm of the JImrt,
Those who are engaged in hazardous and speculative pursuits, and who get into the habit of irregular business life, and particu- larly into the habit of laying out plans and devices which shall be sure to win, are ahnost always checked, comparatively early in their careers, by disturbances eoiainencing in the circulation. Their earlier symptoms are, commonly, those of irregular action of the heart, followed by results pertaining to failure of that organ. Exposed under these circumstances to a variety of ex- haustmg intiuences, their mind becomes intensely irritable, loses ita ready quickness, or goes off its balance ahogether. Such per- sons frequently succumb to some sub-acute inflammatory disease* They take cold, suffer from congestion of the limgs or kidneys, and, imable to bear the shock, sink rapidly under it.
Diseases of tlis Blaod-veseds.
The long-continued habit of standing while at work is provo- cative of some diseases of the blood-vessels which may become of serious import. Varicose veuis in the lower limbs are significant changes connected with the habit of stiinding for a long time at work. In persons engaged in trade, and who stand for many hours behind the counter; in persons engaged at the desk for long hours in a standing position ; and, in others similarly cir- camstanced as regards mode of work, this enlargement or van- cosity of vein is very liable to occur.
In like manner the hemorrhoidal veins, to which reference
more than once been made, are apt to becouie congested from long standing, by which means the disease called hemorrhoids is a very common consequence.
Tlie evils resulting from maintaining the erect position for long intervals, in combination with limited exercise, extend also 31
482
DISEASE FEOM HABITS OF LIFE.
beyond the procliiction of the local conditions of diseafie just naiiiGcl, — -varicose veins and hemorrhoids.
By the erect position the couree of the blood through tlie great abdominal veins to the heart is much impeded, and as tlie larger veins are destitute of valves^ the back weight of blood, to use a einiple tej-m, soon becomes considerably telling iu its effect. It checks the course of the arterial current indirectly ; it checks the course of the intermediate or capillary current directly ; and thus leads to congestion of the vascular organs in the abdomen, as tlie liver, the spleen, the kidney^ and often the mucous mem- brane of the intestinal canal itself. From this uiechanieal ob- struct ioji what is called sluggish action of the internal organs is exceedingly frefjueut amongst those persons who are engaged in occupations which keep them on their feet for long periods of time.
The mischief is specially serious in women who are employed for long haul's in shops, and who are not allowed the privilege of a seat. In them the internal congestion to which I have above referred extends to the uterine organs, and is a source, ahnost of necessity, of great i>ain on many occasions, followed by organic changes^ in some instances, in which the commencements of actual disease are made. If the reader will turn back to the sec- tion entitled, " Diseases Special to the Female Subject/' pp. 220- 224, it will be seen that several forms of disease are likely to be induced, or, if not induced, intensified, in the female by tlie habit w^iieh is now under consideration. The various diseases of the uterine system ; catarrh, inflammation, ulceration, and abrasion ; the various mechanical affections ; the various diseases of the appendages of the uterus ; and, all the diflferout functional dis- eases will, without failure, be mifavorably intlueneed by the habit of standing fur long hours in a limited or constrained position.
D18KA.8ES OF TirE Nervous System feom HAurr.
Physical Nervous failure.
In the professional classes unfavorable habits of life lead to various degrees of nervous failure* The professional classes dif- fer from others in many points. They differ from original brain- workers in that they rarely study intensely at original designs, and they differ from the speculator in that they have little en-
DISEASE from: HABITS OF LIFE.
48S
thnriaiiB. Learned in matters of fact and principle, they put their knowledge into practice on behalf of others, and, recog- nlziog the faults, failings, and miseries of humanity, thej know no gurpriises. They learn with the preacher that all things are alike to all, and for many active yeai-a of life they are trained, hy their habit*?, to pass through labors and difficulties which seem to others insurmountable. There comes, however, at last a time even witli some of these when the nervous system shows symp- toms of premature failure, and when success seems to bring cares which appear harder to bear than failure itself* They weary of continual routine, they weary of praise, and they lose the pride which was once attached to responsibility*
As in the members of tins clasps the brain is constantl}" being exei'cised without enthusiasm, and as tlie body is often exercised without sufficient rest, they rarely suffer from excitement of brain, while they easily suffer, after middle life, from those physical ailments which follow as secondary to the overworked nervous gystera. Tlieir habits lead, that is to say, to physical nervous failures. Dial»etes is common in tbese classes. Paralysis of the limbs, with little disturbance of the mental faculties, is another common type of disease amongst tbetn. Affection of the kid- neys, degeneration of the structure of those organs, is a third typical condition ; and disorganization of the structure of the heart is another and by no means rare occurrenoe.
Insomnia or Sleejjlessness.
The habit of keeping irregular hours of sleep, and of taking too little sleep, leads to serious forms of disease, and indeed I know of no Iiabit which helps more surely to shorten life than that of fighting against natural periods of rest. I have seen the effects of this habit in members of my own profession ; in niein- bers of t!ie dramatic profession, who too often set up a new world of their own when the j-est of tlic world is in sleep ; in poli- ticians ; in scholars, who habitually incline to work through the night; and, in many more who are obliged by their occupation to watch wliile others sleep* In all these classes I have seen nothing but universal evil from the habit, imposed or gelf-im- pose<l, «»f broken rest.
In this observation I do not want rigidly to maintain that sleep must necessarily be taken at certain particular liours. I
484
DtSKASS FROM HABITS OF LITE.
believe it to be best to take it at certain Iiouj^^ including the first hours of the night, but I am now describing tlie effects following the habit of sleeplessne^ in season and out of season, and the in^tunia which is generated by such habit.
In persons of vigoRnis constitution the habit of dibregarding proper deep^ and the insomnia which springs from it, may go on for M^reral years without any apparent bad effect. In time, how- e%'er, it h certain to produce its natural consequences^ Tlie first indications of danger are irritability of mind and feverish excite- ment^ followed by depression, pallor^ and deficiency of appetite* Th(is»e aiv suceeetiotl by His of unconst*ionsness, in which the af- fected person jx^itively sleeps^ and, it may be, sleeps soundly, without himself knowing the fact. In this way lie gets rest, wliieh fur a little while may give a certain measuitj of relief; but i*oon the nervous failure inci*east^s, and one of two results succeeds. He eitVicr falls into a sleep which becomes a coma, and termi- nate«i in doiithi or he continues sleepless, milcss artificially made to sleep by narcotics, and witli progressing failing powers sinks into j>aralysis, to succumb from that affection.
In exc^eptional cases the insomniac makes a fair recovery. Undt»r rt^ulattHl nuxlo of life, and especially under the regula- tiiUi which loads the sufferer to go to bed at nnutjually early hours, »uch a« eight or nine o'clock, whether he can sleep or not at first, tho insouuiiu or Hlceplessness is often cured without any artificial aiiL It i«» however, apt to return after mental strain or worry, auil indeed may he expected always to return if the strain or worry bo novere or prolonged.
Dt^mtttdla and Menial Nervoit>6 Failure,
*rhi^re exist auiHrt*rst us men who acquire the habit of work- ing ut Mime purticuhir mental occupation to such an excess that they ^Umtriiy thereby, in a very brief periotl of time, their mental liervtms life, ami fall into what is technically called dementia- Tiie habit which leads to this condition is not usually that of Uiore overW'ork, but is one of restless occupation accompanied with inooft^ant worry, trouble, and excitement, often with deti* oiency of itjst; or, a too al>8orbing singleness of tliought on one topic ; or» ttH» heated an entliusiasm ; or, an unnatural fustering of *lHKn4lative inquiries.
Th^ aigns which indicate the advance of dementia from euch
DISEASE FROM HABITS OF LIFE,
485
overwork are miicli the same in all men, however different tlieir spheres of action may be. The first sign is a fielf-conBtnoiieness of want of full vigcr^ not only of mind, but of body. Tliis 8ymp- toir», as a common rule, is altogether disregarded, or is felt to be a conteniiitible but Iroiiblesorne fact wbieb it were folly even to recognize. It is succeeded by restlessness of mind and more than ordinary craving fur work, with disturbed sleep, and, by no means rai'ely, with involuntary movements of the mneeles of the btdy at tlie lime of lying down, or during efforts to seek repose* With these symptoms are blended a peculiar an<l acute sensitiveness to external impressions and influences, and to the ideas of influences which are not dii'ectly visible* Lines, figures, colors, ocular spectres of various kinds and new^ to the senses, start np in the fiehl of vision ; sounds, ringing or dull, boomingj or sharp and stailling, or harsh and grating, molest the ear; wdiile ordinary sights and sounds are disturbed, the agreealile being overrated, the disagreeable condemned without reason or measure.
In the order of events, in a progressive case, these signs of overwork are confined, it may be, for months or years, to the knowledge of the man himself. Friends see in him merely a inan overwhebned with anxieties, and, as they commonly say, "too anxious,"' and therefore too hasty. The man himself recog- nizes the excitability of his life witli some dreatl at first ; but he soon becomes familiarized w'ith bis condition, and with the objec- tive evidence of phenomena w^iich, according to cc^mmon experi- ence, ought not to be present. lie accepts unnatural creations as natural, feels himself accustomed to them, and may find in them the subject of an easy and vacant contemplation. The hypothesis of ghostly manifestations and the by]K>thesis of ecstatic vision find often a common origin in tliis stage.
The next most characteristic prognostication of progressive disease is a sensation on the part of the patient of necessity, dnr- ing any mental effort, fui* frequent rest and sleep ; symptoms such as are described so faithfully by Johnson in reference to the end of the poet Collins, The course of these cases is usually clear. t is a steady course towards a general palsy of nnnd and body, id is not uiihke the decline of mental activity in the age of second chihlisbness. When this condition exists, at however early a stage, the slightest shock tells on the nervous structures, and trangforms suddenly the threatening malady into the extreme
i
486
DISEASE FROM HABITS OF LIFE,
reality. Sudden nmseular paralysis is the raast common sequence of filiuck under this eonditiou ; it is in most cases, at first, a local paralysis ; but it may at once become general in respect to all the uiiiscular system which is under the control of the centres of volition.
It has been observed in some cases where the habit of excee- fiive mental work has been carried to an extreme that chronic eruptions of tlie skin make their appearance. Tliat this is true 1 think there is little cause for doubt. I have seen, for example, the diseases psonams and pitt/ria^f^ n/bra break out in an aente form under the conditions stated, as well as some other eruptions of a specific kind. It must, however, be understood that in such examples the predisposition to the diseases named already existed, and that the mental exliaustion was supplemented by depressing inlluences of a physical character.
Nervous Exhaustion in Early Life from Ilahii of Mental Strain.
There are some diseases of a nervous character, indicated by great nervous exhaustion or failure, which are due to certain
habits to which tlie young are subjected, or which the young contract by imitation, and which call for particular notice in this chapter*
These nervous diseases are amongst the most important of all. because every affection of the nervous organism contracted during the period destined for active physical growth and development of the body is of necessity detri mental to the future of life, and is certain to interrupt the completion of perfect life*
The habit of enforced mental training, or *' culture," as it is often called, now prevailing to the most dangerous extent, is one of the causes of nervous failure and incapacity threatening the future generations of women and men.
The endeavor to fill the minds of the young with an excess of knowledge, carricil to a habit of a forced character, produces, apart frotu its failure as a true ediieationa! result, distinct physi* cal mischiefs, in forms of bad health or disease, which are, nstuilly, very significant* In cliildren who have a marked pre- disposition to tubercular affection, the effect of habitual overwork of the brain is to favor the occurrence of inflammatory tubercu- lar disease and tubercular deposit in or upon the braio. In chU-
DISEASE FKOM KABIT9 OF LIFE.
487
dren who are not specifically disposed to tubercle, but who are of nervous temperament, the oppression on the brain tends to con- gestioo of that organ, and to the production of attacks of convul- sion, it may be, of an epilcptii; character. In letst^ seriuuB ciises the overwork causes weakness and exhaustion both of mind and body, with dyspepsia, carelessness for active exercise, imperfect sleep, reduced growth, limited expansion of the chesty and aniBmia. When, in short, the brain is habitually overworked in the growing child, however well the child may be fed and clothed and cared for, there will be overwaste of nervoits power in pro- portion to the overwork, ending, natnrally, in the formation of a bad physical body.
In the more advanced young the habit of excessive mental culture is supplemented most injuriously by the further habit of preparation for stiff examinations, and of trying to go through the ordeal of examination. These efforts lead to intense emotional anxiety and to many of the conseC|Uences already described as re- sulting from that injury. I liave recently had befoi*e me a youth who, under pressure of examination, has been affected with in- termittency of the heart to such a degree and in a manner so permanent, that he may be eonsidei-ed as disabled for life.
In young women subjected to the same strain, from the habit of preparation for the same kind of ordeal, the mischiefs inflicted are still more decisive. Such victims to a false system are often made unfit for further pursuit of useful knowledge, and are men- tally as well as physically enfeebled. They of all are least pre- pared for the active responsibilities of after life, and if they marry they run the special risk of giving birth to children who will share with them in the many failures and feeblenesses which they have been made to acquire in the fatal trial of mental against physical power.
In both sexes the habit of mental strain hiads to broken and irregular hours of rest, to insomnia more or less severe, and to the restilts which follow, in order of natural progress, from tlie sleep- less etate. The effect is not, commonly, a success during the time the strain is being put on. Afterwards, a!l is loss. The failure of general health carries with it comparative failure in every effort of life, with a resultant unhappiuess which intensifies the original error, and to trouble addi:^ trouble.
488
mSEASE FROM HABITS OF LIFE.
Nervous Failure from Mahit of Shth.
Another form of nervous faiJnre from babit occurs from tlie opposite of mental strain, narnelj, idleness, or, to use a more ex- presfiive phrase, sloth. There are seveml clashes of what are called idlers* I have elsewhere divided these classes into three, a division which on further reflection I still think holds good. One inchides the class of idlers who are idle by actual hereditary taint of feebleness. Another takes in those who have been indus- trious, mentally and bodily, for many years of life, but who, becoming surfeited with work and being satisfied with the results of their labor by tlie competency they have obtained, retire, as they say, and seek for rest in an enforced repose of life, A third is made up of those most unfortunate pets and pests of society who in the family and friendly circles are considered too weak, or too good, or too superior to be subjected to any work of a useful kind, and who are thus trained to conceive that tliey confer a privilege when, iu allowing others to wait upon them, tliey are not too exacting in their demands.
The first of these representative classes^ and they are truly representative, are born, as a rule, of idle and luxurious parents, or of parents who, in early life, have worn themselves out in the struggle for life, or in the effort to attain some distinction or suc- cess. Such born are deficient in organic construction. Then* centres of will are incompetent for the performance of duties which, by the majority of mankind, are considered the common- est duties. They lie midway between the actually imbecile and the feeble industrious. With their mental inactivity they com- monly present some physical inliruiity. Tliey are often scrofu- lous ; they have feeljle muscles, effeminate voice, and tliin or anffimic blood ; some are lank of limb, sunken of face, and spare of body J othei's, even early in life, grow very fat, so as to become a burden to themselves. They are all slow to learn and retain only for a short time that which they have learned. They are singularly helpless with their hands, their wrists drop as if their extensors were paralyzed, and they usually have small and aber- rant eyes. As children, these unfortunates, unless they are well protected, lead wretched existences : at school they are the butts of their strnnger companions, and the torments of their teachers, who fail eL|uaIly by persuasions, rewards, blows, to make them
3IXSS48E FROM HABITS OP LIFE.
489
active or learned. Happily for themselves they are less sensitive than their fellows ; and, almost happUy for themselves, they are usually short-lived* Possessing no cerebral resistance, they rap- idly sink from acute disease, from accident, or even fi'om moder- ate physical efforts into which they may, in emergency, be per- emptorily foreeth
The nominal diseases under which members of this class suffer and from which they die are chiefly those of a nervous type, diseases like epilepsy, chorea, and paralysis ; hut they also are prone to suffer more than others from tlie inflammatory affeo- tions, from the zymotic diseases, from physical accidents, and from mental depmssion. Many of them inherit rhemnatic and gooty proclivities, under which they easily succumb when those affections take acute form. They are all incapable cjf bearmg any mental or physical strain, and fail rapidly when subjected to privation or Iiartisbip* They represent, in a word, in the most signal manner that order of society which is said to he of '' bad constitution*"
The sufferers from idleness of the second class, those I mean who have earned what they call repose from actual work by their preceding industry, suffer also from nervous failure rather than from otlier form of disease* These become depressed in spirit, feel that life is a bui-den, try to fill up their leisure with some new occupation with which their minds are not familiar, and with which their hands never become familiar if a manual labor he the one selected. Trying a unniber of things all round, and failing to obtain that which they want, a few^ wisely, go back to their old work, while others fall into hypochondriacal ennui, which may be, and sometimes is, so intense that life becomes too intol- erable to be borne, in which condition what certain writers have called "justifiable suicide" is tlie final resnlt.
Others of this class of nisting idlers kill time by rushing into dissipation. They detenuine to enjoy life at all costs, take excess of food or excess of drink, or both, acquire, thereby, a feeble heart, an inactive liver, and a deranged vascular mechanism alto- gether. In this condition they fall, with the greatest readiness, from any depressing canse or shock, often dying suddenly from syncope, apoplexy, or paralytic stroke.
The idlers of the third class, those who become idle by ac- qniruig the habit, and who are encouraged in it by the indulgence
DISEASE FROM HABITS OF LIFE.
or apathy of friends, Miffer through life a feebleness from inertia rather than acute disease of any kind. Thev rarely show what are called acuta sjniptoms when they are subject to diseases which in other persons assume the acute form, while they often struggle, as it were, throtigh these diseases with a pertinacity that is aston- ishing to the hy-standers who ai^e acquainted with their natural inactivity and apparent feebleness. At the same tiiue^ they know nothing of that true happiness which springs from activity of life. The men are apt to become dissolute from drink, and to acquire that abject helplessness which ends in dipsomania or gen- eral paralysis. The wuinen grow up hysterical, feelde, timid. If they marry they l)econie the helpless mothers of helpless chil- dren, and intolerable anxieties to their husbands and fi'iends. Left to their fate, they sink into slatternly misery, lose their good looks, and, like the eipiaHy idle men^ fall at last into complete oervoQS failure and premature old age. These, too, like the men, are apt to indulge in intemperate habits, upon which they becorae ready victims to alcoholic degenerations of bodily structure- Finally, amongst all these classes of men and women who suffer fi*oni sloth or iilleness, there is a tendency under the most favor- able conditions and best advice for tliem to sink into mental fail- ure and despondency, in which state, unfortunately, if they become the mothers or fathers of children, the children inherit the fail- ing; and, the faults of one generation, be they hereditary or bo they acquired, pass to another.
Nervous Z>erangemeiit and Degeneration from Habit qf
Lummoua Feeding. \
The nervous system is liable to undergo degenerative, and especially fatty degenerative changes from the effects of habits in which idle and luxurious modes of life arc combined with exces- sive indulgence in rich foods, as if life were intended to be nothing more than a gluttonous feast. Amongst all classes of our communities there is too great a desire for excess of food, and too great a tax put upon t!ie digestive organs for digestive work*
TJnder excess of food there are several varieties of injury in- flicted upon the body, Some of these injuries are local rather than general, and are confined to the digestive surfaces and the skin. In the year 1854 a peculiar form of disease broke out
DISEASE FROM HABITS OF LIFE.
491
I
»
amongst the convicts of tlie convict establishment of Freeman tie in Western Australia, owing to the effects of an excessive dietary. The reason assigned by tlie authorities for this plan was that a Ijody uf men wei*e more easily managed when well clad, well lodged, and enpplied with more food than wonld eatisfy their animal cravings. Treated on this plan they could be more readily punished by the withdrawal of their hixtiries. The ex- periment went on until it was stopped by the report made, on the question of t!ie results, by Dr. Rennie. The total weight of food allowed per day to each man reached the weight of fifty-nine ounces of solid substance, with sixty-seven ounces of fluid, and this, to men who were not at the time exposed to severe labor, and who were living in a genial climate. The fr»od supplied was of mixed kind, consisting of animal f<XKi, bread, potatoes, tea, sonp, rice, barley, and oatmeal. Of 1554 persons thus fed tlie vast majority snffered from one of three classes of disease — (a) diseases of the digestive organs ; (i) inflannnatory affections of the eyes; (c) cutaneous eruptions. The most marked train of symptoms was dyspeptic in characten The dyspepsia was char- acterized by great uneasiness in tho stomach, cough, difficulty in swallowing, and constipation. Under i*eduction of diet the in- duced diseases were, easily, made to pass away.
I was once consulted in a series of cases nearly identical with the above. The snfferers were the servants of a great house where the utmost extravagance prevailed, and wliere the depend- ents sat down regularly to four meals a day, at each of which ani- mal food was taken at pleasure. A mini her of cases of extreme dyspepsia occurred and recurred, and were attributed, even by myself at first, to every cause except the correct one. At length the truth dawned upon me, and a rectification in the system of dietary very soon brought about a complete removal of the in- duced diaease. There is, in fact, as Dr. Andrew Combe ably illustrated, so strict a limit to the powers of the natural secreting and excreting organs, that under an excesd of overwork these organs cease to act in great part, and upon this variotis derange- ments, amongst which dyspepaia is the most prominent, inevita* bly stand forth*
There may, therefore, be induced disease from actual quantity of food taken, though that itself be of the simplest and, it may be, of the pure&t kind in its way. But more than this liee
483
DISEASE FROM HABITS OF LIFE.
beliincl. There may be induced disease from the richness and variety of foods consumed on a single occasion, or on a series of occasions following qniekly tlie one upon tiie other Many of the acute attacks of dyspepsia whicli succeed bautjiictings are due, in pai*t, to tiiis cause, although, no doubt, additional evil also comes fi*oru the vviues and strong drinks which are not foods, but which form, nevertheless, a part of the entertaiuuTent. There are hosts of people who are never free from dyspepsia owing to the prac- tice of daily hanquethig, of makiug the diuner-table the feast of each day, and of tasting in that delight what they think to be the grand pleasure of life. Such persons almost always die prema- 1 turely of some disease of the digestive organs, or of the secreting' glands, which parts they literally wear out long before the rest of the body has reached its decline.
Lastly, persons wlio are given to luxurious feeding are subject to degenerations of the nervous centres and of other organs, under which they beeonie universally diseased, affected in every vital part, so that tliey fall under the mei'est accident of acute physical or mental disturbance. They take too much of every kind of food ; of tlie colloidal or fleslibuilding foods ; of the fatty, starchy, saccharine, or heat -giving foods ; of the nuneral or bone- forming foods; of the liquid or watery foods. The excess of the flesh -forming substances causes the heart and other working mus- cles to increase in size, while tlie kidneys are taxed to the ex- tremest degree in disposing of the products of deeomposition which have to be eliminated bj* them. The excess of fat -forming substance leads to deposition of fatty substance all through the body, and to fatty degenerations or changes, varying in degree from simple obesity to muscular inactivity and to fatty muscular deterioration, in %v]iich last change the heart, perhaps, partakes more readily than any other of the nuiscular organs. The excess of mineral food thro\vs more work on the kidney and other! excreting surfaces, by whicli so much of that fooil as cannot bdj applied for building up the harder tissues of the body has toj be eliminated.
In the degenerative changes which follow upon the reception of excess of food into the body tlie nervous system shares acutely from the first* The demands made upon it for active work are severest of the severe throughout the whole of the period of dis- organization, and it is therefore soon incompetent to meet a sud-
DISEASE FROM HABira OP LIEK
493
den emergenej, or to Biistain the mind and body when, often, tliey need its fullest sustainuieot. There occur also, in the course of these events, changes of degeneration in the nervons matter, fatty changes especially, under which the nervous functions are impaired, the premature age of the affected body is quickly and decidedly pi*unoiiucudj and the value of life is reduced to the low- est possihiti degree con&istent witii living action. Then comes the end, wlien, under some extra, but to tlie healtliy body trifling, strain, the life altogether ceases.
Under 6orne special conditions of body even moderate indul- gence in the use of food is directly injurious, Mr. RobertiJU of Manchester first pointed out, and his wide experience has been confirmed, that many of the accidents of disease, particularly those affecting the nervous system, which occur to women during and after childbirth, are most common in women who are over-
^fed, and are almost unknot n amongst those who are moderately or even scantily fed. Certain it is, in brief, that the luxurious class of feeders are infinitely more exposed to danger from every variety of nervous shock than the moderate and abstemious, and that abstinence, unless carried to positive privation, is safety itself 88 compared with its counterpart. fti1
^ N
Neroous Ex/iausiion ffvm Secret Imniaral IlahU,
It would bo shirking truth for the purpose of avoiding a pain- fal and unpleasant subject were no mention to be made of a ner- vous disease incident to a habit wliich is often acquired by the young of both sexes. In this affection nervous excitement, in- duced by irritation of the sexual organs, sets up a most lamenta- ble condition of disease of mind as well as of body. The affection is the result of a moral contagious secret vice which, infecting the young before tliey have knowledge of the evil or reason to control themselves, leads them into a train of symptonis which are as specific as they are pitiable* The first bad effects of the liabit in question are the tendency it excites to repetition of itself, and the mad persistency with which that repetition is carried out. In course of time the natural life becomes changed, and the mani- festation of what are, ordinarily, called nervous symptoms is de- clared. The sufferer is rendered irritable, indecisive; is unable to carry out usual tasks or *hities with energy and ability; is afraid to face the most common events in life ; avoids strangers,
494
DISEASE FROM HABITS OF LIFE.
or acquaintances, or, it may be, friotiils ; shows startiiigs and ap- prehensions un the commonest alarms ; and, has a desh-e for a eolitude which too frequently leads to further indulgence in the cause of all the evil. These states of body and mind are evi- denced by objective as well as subjeetive symptoms* The suf- ferer^ who looks pale and anseinic, is affected with loss of apj>etite and imperfect digestion, and is often haunted with tlie most intense mental depression and melancholy. There is a sense of constant irritability in the organs subjected to irritation^ and in very bad eases affecting the male sex, physical changes of wasting in them, with involuntary excretion. In such extreme examples the body, generally, w^astes, wltile the brain and other nervous centres lose their perfect controlling power- The mind, under these untoward states of body, is soon brought into deep de- pression and melancholy, during which the illness, bail as it may be, is much more dreaded than it need to be. The impression fixed on the mind, hi many of tliese cases, is, that recovery is impossible, and that the course of life must be a continuous and hopeless misery.
During this forlorn frame of mind the patients to whom i*efer- ence is here made are wont to consult the lowest and most igno- rant of those false pretenders to medical knowledge and skill wdio lie in wait to prey upon them, and who, by exaggerating the dan- ger, make the return to health exceedingly more prolonged. The Bufferers are truly to be pitied, because in fact there are very few instances of the disease in which recovery cannot be insured, under firm and temperate advice, by the conveyance of confi- dence that convalescence is ceitain if the habit be given up, and by the simple and scientific methods of treatment which every properly qualitied practitioner of uiediciue, one as well as another, has at command.
In the ordinary course of events the recovery from the effects of this disease is practically insured so soon as the habit is given lip, and the mind ceases to brood ou the itieas of the disastrous consequences with which it has been stored* Time, however, is always required for natural cure, and a period extending over Bome months, at least, should always be named as necessary for the completion of recovery.
While holding out those facts as explanatory of the profes- sional experience counnou to all reliable professors of medical
DISEASE FROM HABITS OF LIFE. 405
art, it ODght not to be concealed that, exceptionally, some serious results are apt to ensue beyond what have been stated. I have known, and other physicians have known, instances in which epileptic seizures have resulted from the disease, or in which a violent and helpless mania, attended with almost automatic repe- tition of the habit, have followed upon it.
The same kind of experience does not fail to detect that, in women, hysteria of an intense and protracted character is another sequence ; and that, both in the male and female sex, any latent tendencies to tubercular affection of the lung, the brain, or other susceptible organ ai-e unfavorably influenced or advanced by the affection. But even in these exceptional examples recovery from the effects of the habit, and from certain local derangements which may have been also acquired by it, are frequently secured if the patient is consistent, hopeful, and enduring.
The most dejected sufferer from the disease may, therefore, always have hope of recovery, and in ninety-nine cases out of a hundred will realize that hope fully if the cause of the symp- toms be scrupulously avoided, and if those who trade upon the suffering be shunned with equal resolution.
BOOK THE THIRD.
A PBACTIOAL StTHHART OF THE ORIGINS, CAUSES, AND PREVENTIONS OP DISEASE.
ORIGINS, CAUSES, AND PRETENTIONS OF DISEASE.
Is the two preceding books we have Btndied the phenomena of disease, natural or acqnired. We come now to the considera- tions of origins and causes. Why do the phenomena of disease exist, and how are they to be prevented ? These are the ques- tions that ]ie before us at this moment.
ORioms AND Causes. DEFiKrrroNS.
The first qoestion is one of exceeding difficulty, except when, as in the course of the acquired diseases, and a few of the natural ^ we see the cause lying plainly before us. In the large iriajority of diseases the original cause is either concealed, or is so compli- cated with other causes we are unable to trace it out as a distinct agency.
For example, when we speak of hereditary causes of disease, we are usually obliged to connect tliese with some otiier influence which is at w6rk to produce the outbi-eak. When we speak of atmospherical causes we are constantly obliged to connect these with some other agency, hereditary, acquired, or accidental. When we speak of conlagion as a cause we are often forced to connect this with something else, such as hereditary, atmospher- ical peculiarity, or the mental or physical condition of the affected at the time when the affection was induced. Kay, when we have even to discuss the origin of acquired disease^ though we may know the way in which they have been acquired^ it is not nnfre- quently necessary to connect them with some pre-existent condi- tion or state by which the ialluence or cause calling them into existence was favorably assisted in its work.
FrotD these varying circumstances the term, "origins,'^ or ** causes,'- as applied to disease, is often qualified by the addition
I MX» mrEsmoss aw msEASE.
ihtA Am wmm Aatfy dttms^ it Tims, if a L «ff Vijhr iwcnBtt vUik i^Mk ^ promote the develop- #f «a V e^f^m &eaB «a the spplieaUioii or action of some ^^pMH^lfe pR^cxiittBi aosfitiott k tlie jprwfiigwmy causey {•tteagpBitviackcdMlfedinnedirectljmtoietiati is the m§tammL Fot Mtttmam^ m fetmia who hms jM mSeted horn tttm vHoaiSaOD wiD tike, m mo^ cues, either of if fiopcrij espoeed to the smfttl-pox or vaccine Tie eowittioii wliidi fmrored the production of the EtatioQ is bere the predispoeing, while the small* p(Ni m ^mffemm risma k iba exdtisg caiiee of the affection.
ll mm0^mim Iflppem that towards the development of a di&^ mm lib9f» ia yst aaotlier factor. Tlie person may be predisposed i; he maT be exposed to the exciting cause of the and vet he may not take the affection unless goine aiuiosfherical or other rfiyottiy ooodition adds its iuflnenee.
K^ lo a»lar unto further detail^ there are, then, as will \ye sen^'v 4r !«A||^ thiw Amm of eauses of disea^ : the pretlisposingf ti 4uf^ and tht ttdtittf^ I sliall not attempt to detine or
i^buwm ih«sa iu aiij ajatematic form, hince hy giich course I «)iiMiKl W M into a oontroTersial rather than a practical line. ti^h uab^ Iha vorda origin and eatise in their general sense^ I ihatl rijltr, iaeSdentany^ to the positions which they ai-e supposed lo Ukis oa vikch occasion, as the description proceeds.
biviu lh«s0 general Uetinitions we might now commence at <Mfice to ttvat of the varions classes of canees, in detail ; but befoi-e dv * worth while to add a few sentences relating to the
hi i^eaites which require to be 8tudied in a systematic
uuiiiior iu cvnuectiou with the subject of origins and causes.
VUvaM IN Kklation to Number of Diseases,
it WM w^tv to review eirery disease and diseased condition
Aclx buM tc*cn introduced into this volume, we should have to
iak^ ui Itaud more than a thousand distinct facts of disease, and
k ih(d causes of each fact* This would be an unending
* U\ discussion of endless hypothesis, and yielding on
kvomplishcd, a not very pi'ofitable history. It will
th^^jvfoiv, to confine our observations to the causes and
'ki^iT*.^ ^>i iho more common diseaseSj those diseases which
OAtrSES AND PREVENTIONS OF DISEASE.
COl
I
f
yield the ordinary mortalities, and which, fiuccessfully combated, would leave little to be done in the way either of prevention or cure*
By this plan the number of diseases, — tlie canses of which have to be sought,— is reduced to al ittle below a hundred, even if a few diseases which do not add to the mortality tables be in- eluded. We include, for example, ia this maimer, all die disease** that are tabulated from week to week io tlie liegistrar-Generars Iteport under their different heads. We include the zvuiotic dis- wses ; the parasitic ; the coufetitutional, such as rlieumatie fever, gout, cancer, eonsumptiun ; those connected with some default of vital power, eueh as premature birth and old age j tlie local dis- easea of the different systems of the body, digestive, circukUng, breathing, nervous, sensory, glandular, niUBcuhr, osseous, and niein- branous. We include, in like manner, the violent deaths, by ac- cident, homicide, and suicide. Lastly, we include what the Registrar-Genera! puts under the head of " other causes ; • ' and, if we count up the whole, we discover tliat between ninety and a hundred definable di^^eases make up the list*
W^hen f foni causes of disease we turn to preventions, the plan of limiting the mnuber of di&eases referred to immediately above tells with equal force. If we could discover means for removing the causes of these more common and fatal diseases; in other words, if we could discover the means of preventing these dis- eases, the whole field of disease would be so reduced there would be little left to be done except to maintain, systematically, the methods of prevention in all their integrity.
There is no doubt that a large amount of success in the way of prevention could be carried out by a few simple, determinate, and continued efforts to rernove certain of the wursi uffending igins and causes, and the two subjects come therefore, appro- priately, for study in one book, prevention being the natural sup- plement to the study of causation.
We shall see, indeed, as we proceed, that so closely do these two lines of study run together that the possession of the knowl- edge of one, — the knowledge of cause, — leads, almost invariably, to the possession of knowledge for prevention, that is to say, to knowledge whicli will lead to the removal of the cause. The fact leads me to divide this book into two parts, in one of which I dwell on the origins and causes of diseases, first, generally, and
CArsKS ATn> PEETzynoxs of disease
m oetadl ; while m die otiier I ^cat apoa removals of , preretitioiis or prevenfove i
' Cactses Xattkal asd Acquired.
Before proceeding fortUer with the pemfial of this third book, the reader will do well to turn back to the two previous books and to csompare the one with the other. It wOl then be seen that a great many of the diseases which are inchided in the second book, and which, as is there stated, are induced or acquired by those who suffer from them, are cloeelj allied in character to, if thej are not identical with, inanv of the affections which spring from pure natural causes^ and take, from their similarities, the same names. The difference, indeed, between the two depends, in most eases, on the circurastanee, tliat whereas in the natural forms of disease the canse is undiscovered or obscure, in the acquired dis- ease tlie cause is entii^ly known.
As uur learning on tlie question of natural causes advances, all tlie facts pertaining to self-indnced or ac^piii'ed causes become of great valne in explanation : for as the same phenomena mnst, al- most of necessity, be dependent upon what is practically the same cause, the study of the effects of known canses passes into experi- mental observation from experiments accidentally and repeatedly presented, when the mind is directed to the study of original com* parison and research*
BOOK in. PART THE FIRST.
OBIQINS AND CAUSES OF DISEASE.
I
CHAPTEE L vauieties of origins and causes of biseask
With the understandiog rendered in the preceding introduc- tion, I divide the origius and caugea of diseases into the seven following classes : —
I. CJOKGENTTAL, IIeRKDITARY, AND CONSTITUTIONAL OrIOINS A2n>
Causes.
Under this head is inclnded those infloences, chieflj predispos- ing, which lead to dii^ease by descent ; influenees, that is to say, which descend from parent to offspring. Diseases connected with ench tendencies, and seeming to descend as stated, ai*e called /wredUari/ di&eases or comtUuticmal diseases, and under some circumstances (liatheiie diseases, tliat is to say, diseases dependent upon a peculiar disposition of hody, or mind, or both.
II, AraospiTERicAL OR Mcteorological Origins and Causes.
Under this head is included those conditions of the atmosphere which serve as causes, predisposing or exciting, of different kinds of disease. The atmospheric caiittca include a large range. Amongst them may be named varieties of season, and of heat and cold ; variations of atmospheric pressure ; differences of moist- ure in the air \ w^inds ; differences of electrical condition. Some- times these atmospherical variations in relation to disease are 6j>oken of as mctcaniogUxd causes of disease.
TIL PARAsmcAL ORiams and CAtrsKS.
Under tlie head of parasitical origins and cansos are included vaHoos mimite Kving forms derived from the animal or vegetable world, which, entering into the internal organs of the body, in- dace disease there by their presence, and often by their increase ;
506
VARIETIES OF CAUSES OF DISEASE-
or which affect the external surface of the body either super- fieiallj, or in the deeper layers of the skin. The numher of these parasitic organisms is considerable, as will be remembered when the frequent references to them in the two previous books ai'e recalled.
IV, Zymotic Orioiks and Causes.
Under this head is embraced those agents material and probably organic which, acting as exciting causes, induce disease by coming into contact with persons sufeceptible to their influence. The diseases excited by these subtle agents are called, generally, zymotic diseases, or, sometimes, diseases from fermentation, or sy- moais^ which means the same thing. Most of the zymotic diseases, but perhaps not all, arc coutagiousj infectiuiis, cominunicable,
V. ArtTTDKNTAL OrIOIKS AND CArSES.
By accidental origins or causes of disease are meant all those physical agencies which tell directly upon the body to produce mechanical or physical disturbances. These, which are commonly exciting causes, are divisible into two kinds, the natural and the artijickd. Lightning stroke is a good illustration of the natural ; electric sliock cf the artiticial variety. Amongst these ciiuses must Ije i)lacGd all tliose connected witli the industrial pm-suits wbicli lead to disease by physical or mechanical impressioo.
YI. Social and Psychical Oeigins akd Causes. Habits as
Causes.
Under psychical origins or causes we may include those impres- sions made upon the organ of the mind wiiich lead to disturbed and unnatural mental conditions. We may take in also under this head those internal derangements which tend to the produc* tion of physical agents that tell upon the nervous organism, with the effect of causing abnormal action. We may further take in^ under this same head, the influences towards disease induced by injmious habits and habitudes.
YJl, Senile Degenerative Origins and Cafbbs.
Under this last head of origins and causes we take in those final changes in the vital organs of the body whichj under a
VARIETIES OF CAUSES OP DISEASE. 507
natural process of premature or mature decay or degeneration, lead to organic death, and therewith to extinction of life gen- erally.
These senile changes may be of two kinds, {a) Universal change, when all the vital organs degenerate together, — mature decay. (6) Local change, that is to say, degenerative change oc- curring in one or more organs, but not in all, and leading to death through failure of a part, only, of the organism.
CHAPTER TI.
CONGENITAL AND BEREDITABY, OR CONSTITUTIONAL CAUSES OFBISEASK
Diseases coming down to man from birth may have for their
cause wine peenliarity in tlje condition of the parents. Or, they may indieata tlmt t!ie parents have been placed in conditions favorable to t!ie development uf disease. Or, they may show that some accident !ias happened to the person born, previous to birth.
We usually speak of the cau^s leading to such forms of dis- ease as of two kinds, namely, the congenital, or those with which the affected person is actually born, and tbe hereditary, or those* which develop^ as a rule, some time after birth.
The division is nut very accurate, because many hereditary diseases which, as a general fact, do not appear until after a time, more or less long, from birth, may be present at the time of birth. The division, however, is sufficiently practical to admit of being retained* It is often qualified and sometimes blended, by the use of the word constitutional, wlxich word covers both congenital and hereditaiy defects or proclivities.
The CoNOEKiTAi, Class of Causes*
(hngeiiiial Malformatioim,
Under the head of congenital causes we include what are de- signated malformations, that is to say, bad or unperfectly formed conditions eitlier of the body altogether or of its parts or organs* The malformations represent in most cases an incomplete develop- ment or growth of parts. Sometimes this is so marked that life is impossible after l>irth. In oilier cases the malformation, lees distinctive, permits life to he continued, but interferes throughont the whole of its course with the activity of its living powers. The extent to which the minor malformations act as hidirect causes of
CONSTITUTIONAL 0AU3B3 OF DISEASE.
f)09
I I
I I
disease is not, I think, suflScieiitly comprehended or taken into account, for there are very few persons indeed who are free from incomplete development or growth in some parts of the body.
Malforniation may take other forms. It may consist of an ex- ^msive development of some part or organ ; or of an incomplete elosnre of the lateral halves of parts wliich ought to be conjoined ; or of closure of lateral 1 waives which ought to remain open ; or of transpositions of different viscera or structures of the bodj\
All the grand systems which, combined, make np the animal system generally are liable to be subjected to derangement or dis- ease from malformation as a cause. In the digestive system, the CBftophagiis, the stomach, or other portions of the intestinal tract may be constricted, imperviaus, or deficient. In the circulating Byetera tlie heart may be iinperfectly developed as a wliole or in its various parts. The foramen ovale or opening which befoi^e birth exists between the right and left auricles may remain open after birth. The great vessels springing from the heart may be misplaced. The valves of the heart may be irregular or insuffi- ciently developed. Tlic pericardium or outer covering of the heart may be wanting. In the respiratory- system one or both lungs may be deficient in developmeuL A portion of Inng may be so changed, strnctu rally, that it never comes into fid! play. The trachea may be imperfect, constricted partly or altogetlier. The larynx my be imperfect, its vocal coi-ds indiffei*ently developed, or its cartilages deficient, reduced in size, irregular.
The nervous system may be the seat of various malformatious, and is perhaps the evstem wliich is the most seriously affected of all. Hence the origins of numerous failures which are called gen- eral failures from disease. Various parts of the brain may be iu- completely developed, or one part may be more develojfc^d, eom- paratively, than another. The spinal cord may be incomplete in the whole or in parts. The nervous cords issuing from the brain and Bpinal cord may be deficient in development, or may have an incomplete connection with their respective centres. Any of the organ.^ of the sensory system or the parts of these organs may lie insufficiently or irregularly developed.
The organs wliich form the glandular system suffer in like manner from malformation. The liver may be imperfectly formed or its bile-ducts may be contracted or impervious, or its gall-bhid- der imperfect. The kidneys may be deficient iu growth, or per-
filO
CONGENITAL, nEREDITARY, OB
verted in growth, globiilated. The iireters may be contracted. In a word, these perversions of development may occur in any of the glandular organs, and may lead to perversion of function.
Tlie nuiscidar system is subjected to an extensive range of irregular developments which act in producing various phenom- ena of disease, A muscle may be shortened in its development ; it may be deficient ia power when compared with the antagonistic muscle which it has to work against ; it may be preternatiirally large; or, its tendons may be disphiced, or contracted, or imper- fect. The deformities of the hand and foot^ described on pp. 235-236^ are often due to such nxnlformations.
Lastly, the bony and menitjranous systems am liable to various malformed constructions which lead to varieties of disease. It fiometinies liappens that the lateral halves of the bony system that should come together fail to do so. This is the case in the dis* ease known as spina bifida, described at p. 176, in whiuh the mem- branes of the spinal cord protrude through a cleft in the spinal column. In the membranous system a similar absence of union is observed in instances of harelip and cleft palate, the irregu- larity of membranous and bony development being coincident.
It will be seen from this brief survey how very important a part even minor malformations may play as causes of disease. It may be accepted, that very slight malforraatione interfere with the functional activity of the portit>n of the body affected by them. In fact, many of the particular failures of special organs or parts of particular persons, and many deaths from disease of special organs of particular persons are determined by the mal- formation or imperfect development with which the organ was affected from the first of its life.
Congenital Dera^igmnents as Caiissi*
Apart from malformations there are certain derangements in- cidental to the intra-uterinc life which act afterwards as causes of disease. I made this subject a matter of special study in my " Fothergillian Essay" on the diseases of the child before birth, and described these perversions or derangements in a synopsis of which I may here give another synopsis.
I found that by simple pet*version of the nutritive pr there might be induced the following structural changes ;
CO:N^STITnTIONAL CAUSES OP DISEA9B.
Cll
1 , Iljpertropliy, or enlargement of vital muscular organs, sucli ae tike heart and bladder
2, Atrophy, or wa&tiiig of vital structures, which may be gen- eral, that is to say, affei'ting the whole body ; or local, affecting particular organs, such as the heart, Hver^ or kidney*
3, Complete arrest of nntrition, general or local, attended in some cases with complete decomposition of an organ.
4, Intlaiiimationa, incUiding inflammation of the mombranes of the body ; of ibo skin ; the inucons membrane of the lungs and of the intestinal tract; of the serous membranes, pleural, pericar- dial, peritoneal Or, intlammation affecting the structures of or- gans, the Inngw, the kidney and other glands, the brain, The j'esuUs of these intlammatory changes seem to be the same when the disease precedes as when it appeara 6nbset|uent to birth, the formation of matter, the process of ulceration and tlie other secondary changes being the same.
5, Exudations, sometimes of blood itself, into various parts or organs, and specially into the substance of the brain or the sub- stance of the tniigs; or exudations of some parts of the blood, as the senim, into the different cavities. These exudations lead to all tiie known varieties of dropsy and accumulations of fluids.
*). Comuiunieable diseases, including syphilis, soiall-pox, vac- cinia, measles, scarlet fever and typhus, all running appai'ently tlieir own peculiar course, and leaving their distinctive results.
7. Transformations, malignant, tubercular, and rickety ; in- cluding different kinds of malignant tumor or cancer affecting various organs ; deposits of tubercle ; and, softened and brittle conditions of the l)oues.
8, Parasitic developments, occurring in the form of hyda- tids affecting the kidney, or entozoa affecting the alimentary canal.
9, Inorganic products, or deposits, present in the cavities of the body, as in the form of calculus of the bladder; or on the fikin in the form of colorai, reddisli, hai-d deposit or firm scaly crust, — ichthyons,
10. Mechanical alterations and injuries affecting {a) the vas- cular system in form of aneurism ; {h) the skin in form of wound ; (c) the lK>n©8 in form of fracture and fixation of joint^,^ — mu^ky-
IK Derangements of the muscular system, including con vnl-
512
CONGENITAL, irEKKDlTAUT, OR
sive movemente and a form of persistent coDtraction of muscles, rendering the body geDemlly rigid.
12. Accidental separation of parts, or amputationi; of the fin- gers or limbs, induced by pressure or by strangulation of parte from plastic exudation or other accidental constricting gi elance.
From this epitome, brief as it is, of the eubject now in hand, the reader will learn how serious a part is performed by the de- rangements which occur antecedent to birth, and how efifectively Buch derangements may become causes of disease after birth. It is true tliat in the greater number of the instances cited in the above twelve headings there was sufficient disease to render life impossible from the first. They call onr attention, however, to certain other instances in which tliere has been no acute progress towards death, but in which a sntficient degree of mischief hss been inflicted to leave a permanent impression on the whole of the life of the affected individual.
The HfiBEDrrJJiT Class of Oauses.
The hereditary class of eanses, as distinct from the congenital, have nsnally, as we have seen, this peculiarity, that the inherited disease is not necessarily present, and indeed is not often preseB imtil after, it may be many years after, birth. The distingnifit ing mark of the hereditary cause is that it lies, as it were, dor- mant, ready to show its effects if aide<l by an external co-opera- ting cause.
Constitutional taint may therefore show its influence in i% dii*ections, namely, in the tendency to, and m the development < disease. The taint may be of such a kind that the disease it 1 vors w411 not actually occur until some active external agency k brought to excite it. Or, the taint may lead to the developmen of the ditieaae without any such extra and exciting influence.
Thus the hereditary affection, although born with the birtl is often not dieplayed nntil a long time afterwards. But, some times it is displayed at the moment of birth.
At the thresiiold of this subject a question arises which is< immense momezit; I mean the question how the many tamtSj which are undoubtedly lieroditarv, eonnnence. It is difficult enough to discover Iiow they, as causes of disease, pass on fr^^
COK8TITUTI0NAL 0ATT8ES OF DISEASE,
513
one person to another in parental line. It is infinitely more diffi- cult to trace tite origin of the taints themselves. Tl»at they must all have had an origin from without seems to be certain, ami our
■ most modern experience goes to show that the ontside origina- m lion of them is &till in progi'cssion, for we have seen that in cases m^oi lead poisoning iq the n^ale an impression may be made that is llraDsmissible to the cliildren of the affected. This is, pcrhapa,
the most definite observation that has been re(*orded ; l>yt it is almost equally clear that pers^ms who have acqniix^d phthisic piil- monalis by working in dnsts^ have also acquired the power of transmitting the same disease to their oflFspring,
The results of all the inquiries which 1 have been able to in- stitute have led me to the eondusion that in cases of hereditary Kdieeaee the impression which has been made upon the affected
■ person, and whicli is transmitted to the offspring, is inflicted
■ primarily on the nervous centres. This view is contrary to the common belief whiclj fixes the taint in the blood, and which is expressed in sndi every *day terms as ^' bad blood, good blood, im- pure blood, ancestral blood, family blood, diseases which run in the blood," and similar terms, terms which are applied aa fitjely
I to mental as to physical proclivities. The view which assigns the seat of the taint to the nervous matter rather than to the circulating blood is most in accord with modern observation. The blood is a fluid undergoing constant change, and could not be a seat of any permanent taint. The nervous structure, on the other hand, is, comparatively, subjected to little change, and is, as we know, the scat uf transmitted men- tal tendencies. Moreover, we have learned by direct experiment that physical nervous injuries inflicted on parents are transmitted to offspring- Epilepsy induced by nervous injury has been trans-
■ niitted in hereditary course. In what manner the primary injury passes from the parent to the offspring, and that in the paternal as well as the maternal line, is not known ; hut the fact is certain. There is also one otlier fact which beais up<m the subject with great force. It is observable that the injuries to nci-vons matter which are capable of producing hereditary diseases muet be inflicted either on a nervous centre or on a trunk of a nerve. Injuries inflicted on the extremities of neiTes do not seem to be followed by changes that are permanent and transmissible. For ages past the Jews by the
514
CONGENITAL, HEREDITARY, OR
act of circnmcision Ijave inflicted a peripheral wonnd or itijury on ail their male children, but they have ne%^er implanted thei*eby a transmitted change. It is not until the motion of a part dii*ected by central nervous control, or the nutrition of a part directed by central nervous control, or the motion and tlie nutrition are per* verted by a central injury, that the inherited mifichief is egtab* lished.
HxBXDrrABT Special Taints,
The number of hereditary taints of disease are so large that the n)ind is inclined, almost, to accept that every definable disease is hereditary with more or less of directness and intensity. The following are the most generally accepted of the liereditary taints of disease, called, commonly, constitutional peculiarities, or di- atheses.
Tlie Syphilitw TahU,
Tiie taint of the disease known as syphilis, described at pp. 66-7 of this volume, is transmissilile by heredity, and is the cause in the descendants of tliose affected by it of the constitu- tional effects nf the disease* This is one of the most patent facts in the wliole field of medicine. The effects of the taint inav be inanifested at birth ; they may be developed months after birtli. They may be developed in infancy or early life, if they are called forth ; some shock or illness, slight as vaccination itself, inducing them in the fullest degree* They may appear as late as the thne of adolescence or later. The phenomena produced by the taint and depending upon it for their cause are, in a considerable num- ber of instances, the phenomena of the disease itself, pure and simple, in what is known as the chronic form, the equivalent to the tertiary form in a person primarily affected. But in other and in a very large nnnjber of instances the pure and simple out- lines of the affection are lost, and other affections, or conditions of disease, take, nmmnaUif^ their place.
There is the widest diftei'cnce of opinion amongst even the most laborious and learned of the Faculty of Medicine respecting the extent to which the action of the taint of syphilis, as the her- editary cause of various diseases known nnder other names, ex- tends. Unquestionably the extension is very wide, and I fear tliat those who have given to it the fullest range have been nearest to the truth.
CONSTITUTIONAL CAUSES OF DISEASE.
515
I
I
I
All the great ey stems of the body seem to be included in the miscJiiefs that may be transmitted by tins hereditary cause of disease* Feebleness of digeatioti and various kinds of dyspepsia, are ooranion as signs of transmitted syphilitic; acliun. The dis- titrbaiice of the alimentary system and diarrhoea, which are so fatal in some young children, in spite of carefur feeding and ourBing, are often due, prin^arily, to this cause. The heart and organs of the eifculatioo are eeriously clianged by this taint in regard both to their orgaide development, tlieir construction, and their func- tion. The heart is rendered feeble in its action, and the vessels are prone to take on degenerative changes. The breathing organs are distinctly susceyitible to injury from this hereditary cause, and one specific form of pulmonary phthisis, ^ — ^yjjhilitic j>hthuu^ — Las been attributed to it.
The nervous system is perliape of all others the most impressed by this transmitted iiafluenee. Epilepsy ; chorea, or St. Vitas' dance ; other forms uf convulsive disease ; and» paralyses of various kinds liave been traced, by Dr. Hughlings Jackson, to inherited etructural tendencies springing from syphilis. I have, for my part, l)econie so familiar, in practice, with the fact of tlie con- nection of inherited syphilis with tlie wide field of nervous dis- ease, that I never see a case of the kind now without making an inquiry as to the hereditary )i isto ry* The sensory organs, the organs of eight and hearing particularly, are subjected to disease from tlie same taint. Many of tlie most ordinary born faihiresof eight and hearing are also derived frouj an im^>erfect devek^pnient, resting on an imperfect nutrition, the syphilitic constitution being the foundation of the imperfection.
The four other great systems of the body, — the glandular, the muscular, tlie osseous, and the membranous, — come in like man- ner under this nudicions taint. The bony structures are often, most significantly, the ]»arts so affected. Mr. Jonathan Jlutchin- son, whose admirable lalxirs on lieredity in disease cannot be overpraise^!, has described, from tlio teeth, an absolute test of syphilitic taint. This consists of a marked diversion from the natural shape of t!ie two central incisor teeth of the permanent set of the upper jaw, Tliese two teetli in their natural state are dusel-shaped and broader at their cutting edges tiian at their in- sertions into the gum. But in persons of syphilitic taint they
narrower at their cutting edges than at their insertions int
616
CONGENITAL, HEREDITARY, OE
the gitrn, and they are usually notched. When ench teeth are present other signs of feebleness of the bones, or of defoimitjj are couinionly present also, the cause being the same.
Disease of the tnembranouB surfaces of the body from the taint of syphilis is almost as common as disease of the nervous structure, and indeed the two conditions are so closely connected, it is, on many occasions, difBctilt to distinguish which has pi'ece- dence, the meuibranous aflfection seeming to be closely connected with nervous failure. All the membranous surfaces are suscepti- ble to injury from the taint, but the ekin is the most frequent seat of mischief. The skin, under this influence, hecoiues easily affected with psoriasis,^ — lepra vulgarie, — with nipia, alopecia, eczema, and, perhaps, pityriasis.
It will be seen from the above how intense a taint is this first of the hereditary causes of dij^eases on our list ; and I have but glanced at the snliject. It is of common observation amongst us medical men that the symptouis implanted on the constitutional diseai^o are so varied and so extensive we do not really know how far they extend. Dr. llugldings Jackson says on this point, most correctly, that it k only by studying a longer ''base line" that we can discover how widely different symptoms arise out of the one degraded bodily state which t!ie c^ffsfiring of syphilitic parents present. ** Whilst," he adds, **t!ie eldest child of a family may sliow external signs of syphilis, such as Bebuh>U8 cornea, scars about the lumith, or loss of the uvula, the rest of the family may be undamaged externally, and yet be ready to suffer in more obseiu"e ways from a smaller share in their sad common inherit- ance. It would seem, in acquired syphilis at leasts that the Bymptoms are directly dno to a fault beginning in a common tis- sue, the connective, and the wide distribution of this tissue shows how^ we may have very different symptoms from its failure in organs or parts of high or of low function,"
This is admirably spoken, and carries with it all that I have ^ apace to say on syphilis as a cause of disease, except one more obBervation; namely, t!iat the cause acts, unliappily, through more than a single generation. I regret to add, that I have seen it operating certainty through three, and, possibly, tli rough four geueratioos. On tlie person primarily affected, the effects, in tlie opinion of Professor Gross, never die out. With this I more tlian agree, for I am inclined to stipplement that view by saying that
CONSTITUTIONAL CAUSES OF DISEASE.
617
the effects in the members of the first succeeding generation never die out.
The Scrofulous mid Tubereuloiis TairU.
The condition of disease called scrofula, or struma, is con- nected with a taint of a definite kind. There are, as will be seen on p. 63, two varieties of t^cruf iila ; viz,, scrofula with tubercle, and scrofula without tubercle. In both cases the taint is pres- ent^ aiid those bora with it are the victiujs of scrofulous or tuber- cular disease. Whether there are two distinct taints, or whether there is but one taint, which tends to produce differing phenom- ena of disease under the differing c ire lira eta? ices to which the per- son who is subjet!t to the intluence of the taint may be exposed, is a question of the extreuiej^t difficulty to answer.
1 liave made many careful analyses of facts bearing on the point, but am still unsettled in my mind as to the solution of the diflieiUty. 1 have seen many beeonio consumptive who have never shown syiuptonisof scrofnla in the way of scrofulous tumor or glanduhir enlargeiueut of any kind, their pai*ents or close re- lations being of consu!n{)tive tendency* I have seen scrofulous persons escape tubercular consumption.
But, again, I Itave seen in a scrofulous family, derived from scrofulous parents, certain meuibcrs affected by scrofula, others by consuniptton ; and, I have often seen those who were scrofulous become consumptive.
Thus the evidence is peculiarly complex, LE not contradictory. The only conclusion w^e can draw from it is that the taint, in pass- ing hereditarily from one person to anotlier, may, under varying states of an external kind which act upon it, undergo changes whi(.'h modify its ultimate effect.
There is a view now gaining ground to the effect tliat the scrofulous taint is a variuty of the sypidhtic. This view is strongly enforced by my frieud, Professor Gross. '*The word scrofula,'' he says, "for centuries past in such common use, has, it is well known, a special import witli respect to the deformed condition of the neck, assimilating it to that of a swine. At the present day the affections included under this denomination amount to upwards of twenty, Aniong the more common are clironic en- largements of the lymphatic glands, various eruptions and ulcera- tions of the skin, embracing the milder forms of lupus, cbronic
CONGENITAL, HEREDITARY, OR
QBfiecialty psoas and Inmbar, Potts' disease of the &piiie« Mdn»phllialmia^ clironic toiisUlitis, caries atid necrosis, ozcuna, strn- moiiid mftammation of the ejres, strumous hip-joint disease and wliit^ swelling, malignant onychia, otorrhtea, rickets, arachnitis, )l^f4ni00p>halus, penipliigus, sycosis, keratitis, and tlie notched and imjgofaur condition of the teeth of infants and children, so ably
by Mr. Ilutchinson."
facts lead this learned author to aseume that *' scrofula )ly, if not nnifoniily, merely a transformatiun, a degen- vimliom or a remote effect of the syphilitic vims. Through how iMiqr geti^rmtions scrofula may retain it8 specific powers, we bave« k« Ihi^ka^ no means of determining : hut chil<li*en of coosump- Iiv9 parents are almost invariably scrofulous, and the taint thus jMMpWWIwrtrd runs through sev^eral generations, uprooting not un- fr»c)iii|illj entire families. On the other hand, it sometimes *kii^ a ijwiieration, and reappears in the next succeeding one, just n likenesses sometimes do. Still it is scrofula." To these
»\K * ' * 4K>uhl myself give entire assent.
The hoixxlitary taint of pulmonai-y consumption is so intensely luarkinlt that out of three thousand instances of the disea&e which havA* Xh^ix In^foix) me for treatment, in general and pulilic prac- liiv-^ I havo not found it absent in so many as ten per cent, when all c<(MK>3t presenting any real doubt were excluded.
MtUiymmt or Cancer Taint
AU Uie varieties of malignant disease or cancer defined on p. i€*^ lYuei^ted with the eonstitutional taint, Tliis is, I believe,
'* t ivstpoct to one variety as to another. In every inquiry
which 1 have been able to make, in public practice, in private |U'ik'liiX\ and in whsit I may call insurance pracjtice, — I mean the •i>)iVti\Mi of livi*8 for insurancCj — I have never met with one ex* aiu^^M ill the disease, cancer, in a person sufi^ering from it without iliding Binne pre -example of the same affection in one or other ^^ntW^r of ihu family. The disease occasionally skips a gener- MlWt Init ll in nearly always to be found as hereditary.
Thi^ malignant taint appears, according to our present fenowl- o4)|0 of it^ to bo «pet'ific. One variety is not, however, always l^rodiK'tHl by tn\nsmitted taint of the same variety. Tliave known «<'irrhii9i, or hard cancer, in the parent, followed by the game in ih«» uaxl generation ; but 1 have as often known scirrhus in on©
OOirSTITUTIONAL CAtJSES OF DISEASE. 619
generation followed by epithelial, or by ineduUaryj cancer in another, and vice versa. It is probable, therefore, that the virus or taint is the same, but tlmt it is capable of some loodificatfoii, under whicli it leads to a different variety of tlie disease in dif- ferent subjects.
What the nature of the cancer taint iswc cannot Bay. What the fetnicturc is in whicli the taiut i^ inipre&ged or implanted we cannot say, I have ventui^d to think, from various studies of lie question, which I luust not enter on here, that the nervous system is the primary seat of the impressed evil. This, however, is mainly speculutive, and must be accepted as nothing more. The taint, whatever it may be^ does not give evidence of its pres- ence, except in rare examples, until after adolescence, and it often waits for some exciting injury or ©hock to call it into action.
Hheumaiic mid Gouty Taints.
The rheumatic and gouty diseases have an unquestionable basis in morbid impression or taint, derived from parentage. These affections, at the same time, must be considered as differ- ing iu two particulars from eomo that have been named before ; tirstly, that they more fre(|uently than the others seem to spring up without pre-existing taint ; and, secondly, that the impression or taint whicli they transmit is less persistent, I believe tlmt, in two generations, these diseases lose their taint, altltough the taint is often ygvj severe in the second generation affected from the primary source. I knew one instance in which a woman, who had no traceable rheumatic history, became affected with rheumatic fever from living and sleeping in a damp, newly-built house, and who afterwards gave birth to seven children, every one of whom inherited her acquired disease. In like manner I have seen gout transmitted, by heredity, from a parent who, as far as evidence of his past family history could be trusted, had himself acquired the affection by his own luxurious mode of life.
How tlie tendency to these diseases is passed on wo have as ^et no clue. Whether something material and active is passed "on from one generation to another ; or whetlier it is a purely physical impression, or vibration, which is transmitted, we cannot pretend to say. For tlio moment we must accept the fact of the transmission and wait for its explanation.
HKRKPITARY, OR
Jfmrw0U9 Impremonal TaitU^.,
So nMAjr iMrrtHM itnprefifiional taints, iadjeated by aberration W USnm of fanctioa of die nervous gysteui, are passed from one yatatim to anotker, it would almost be to go through the hi^- ttlffy vf all the nerroits diseases to record tliem. I will name ifcflii wUdi are most striking.
I^itopsjr is one of the transmitted affections, though whether ^ sIkMM hm ooAsidered^ when so transmitted, as a distinct disease or M iht BjmpkQm of another disease^ like syphilis, remains an Chores admits of being placed under the same The various forms of palsy or paralysis are often itiitiiirtii'il witk an imiucing tendency or taint ; and it is probable liutk iPopisy ' ^ ome into the same position. All the emo- ItolMllllid m\ ;uii£ements and diseases are, or may be, con-
iMHitsd wtth tlie inherited tendency or taint. Hysteria is often so nWMiitttit : melancholia is often so connected; In^ochondriasis
ofl^^n m c<Mi»©cled. Insanity and that development of mental ctillrd idiotcy are, as a general rule, dependent on a UA. Ti* *t«'iE i» the matter of insanity is as definite as the ^ll^^tf ^f ca:ict r, scri>f ula, or syphilis ; it may skip more than one IfUMmUom ami tben appear in as distinct a form as it presented li lk# ^iiiy iattuH' representative of it. A fonn of purpura de- ymttm II|m»i deficient nervous control over tlie niinute cireula- WM ^ SiiMther pibai»e of nervous failure clearly connected witli VwftJKilWUQr siiftOti>tibiUty or taint^ and exercising an influence pass-
l <hr)H||h lwi\ if not more, generations.
AU^Mlc TaitiL
hk^^lfyrtrr^ a^Njuireil by those who indulge in alcoholic ^flul^i^ «iii^ U(» a teudcucy or taint which umy pass from one gen- tyigjlll^ 1^ ngiiollier. I think it is possible that more has been IIMllll g{ ibW iidierited evil than the facts wich bear upon it, mynllitk .^.n* * J and studied, justify. I am quite sure from ilbMMi that there is an inherited alcoholic intempei^
|y i bAV^ unfortunately, been obliged to witness it too
. . .,. ...V doubt alnnit it. At the same time there ai'u > in which we may be deceived in observation ; |i .it^k in those affected tliat might have been directly
iA^>^u4ivM ^*j ui^r^ ikuitatiou; and there ai-e so many intemperate
CONSTITUTIONAL CAUSES OF DISKASE.
621
pie wlio attach tlieir own follj and weakness and vice to the ciu^se of inheritance, it is impossible to be too circuuispect in ar- riviiig at a conclusion.
Of all the taints derived from parentage or anceatry the alco- holic is probably the least fierjnanent. Unless tlie habit it engen- ders he kept up, 1 believe that tlie worst taint is removable in two generations. It is often removable in one, and I doubt whether a strong taint may not be kept under control in a second generation^ when the circumstances for self-restraint are favorable*
Zifmotic Taint,
W© have seen that one disease, essentially a contagions dis- ease, syphilis, is often developed by the commnnicHtion of a taint in the hereditary line» It is a soimd inference from tlii^fact that other contagious diseases may be connected with a similar favoring Lagency. The evidence is not so clear in respect to the general run contagious maladies, as it is to sj^philis, that they are heredi- %rj ; and yet it is fairly demonstrative to this effect. Typhoid and diphtheria are, I consider, well proved instances of diseases which have an hereditary history. Scarlet fever, by a negative proof, shows a similar position, for I have known a family the members of wliich, though exposed to the poison of scarlet fever in the fullest degree, have shown an insusceptibility to suffer from it. Small-pox has, in all probability, a strong tendency to pass by inheritance, and at one time, when inueulatton for it was gen- eral, it nuist have been an almost universal inheritance of the direst kind.
Mi^ed Taints of Disease.
In studying the constitutional or hereditary causes of diseftaea
we have finally to consider the fact of mixed types of such causes*
It happens in certain families that the hereditary taint is so
rfitrongly developed in one direction that the single taint over*
shadows or covers all the rest In other instances a taint derived
iroin one branch or side of a family is commingled with a taint
derived from a different branch or side of the same family.
There is then established what I have deB^^^ribed as the intarmar-
L^iage of disease, a subject the importance of which impresses me
^more and more deeply as my pj'ofessiunal life ail varices.
The woi-st couibinatioos uf types are those where the taints
622
CONGENITAL, ITEKEDITARY, OB
of extremely fatal diseases are represented. The combination of
the tiimt of cancer with that of consumption is a striking case in point. Under suck combination one form of taint will be mani* fested in some members of a degenerated family ; the other form in other inenibers ; while certain of them may present what seems to be a mixed type of tainted organization* Thus I have seen following an intermarriage of disease of the kind named, cancer in one member of the tainted family, tubercular disease of the lungs in another, and that form of doubtful cancerous disease, called lujru>8^ prubably a mixture or cross between cancer and scrofula, iu a third.
Combinations of rheumatic and gouty taints witli consumptive lead to anotlier class of intermediate diseases in which the bony f i"amework of the body is easily implicated. That peculiar dis- ease of tlie hip- joint described at page 243 as morhuH coitw^ is, I think, clue to the admixture of the rhemnatic with the scrofulous taiut^ Hydrocephalus is probably anotlier ilUistration of the same combination. The diseases of bone called rickets and mol- . lities ossium, descriljed at pages 241-2^ are due, I believe, to a combination of the scrofulous and syphilitic taints.
jRctcial HerediOes.
With tlie^whole of th^s question of hereditary transmission of disease is blended the much wider question of race and disease. The value of life in differ^jd; racfi^ is vesy different. In this country tbe Semitic race presents a vitality which is much moie favorable than that belongitjg to either the Saxon or the Keltic races. This is the fact through all tlie^l(:es of life. It is also true that tlie different races exhibit special immimities and spe- cial proclivities to disease. Tlie Saxon people show an unusual tendency to RTofula and consumption, and to diseases allied to these in character. The Keltic people are, aceoixling to my observation, more liable than either of the other races to acute affections of the brain and nervous system. The Jewish or Se- mitic people are subject to one hereditary disease, cancer, quite as determinately, I believe, as the Saxon and Keltic, and ihey are also subject to melancholia ; but they are less subject to the acute nervous diseases, to suicide, to the tubercular class of noala- dies, and to the contagious or infectious group of fatal affectiona^
CONSTITUTIONAL CAUSES OP DISEASE. 623
From epidemics the Jews have often escaped, as if they possessed a charmed life.
These tendencies for and against particular diseases and classes of diseases are no doubt hereditary. How far tliey are due, in the first instance, to habit and mode of life ; how far they de- pend upon some particular power or faculty impressed primitively on the race, it is perhaps impossible to explain and, perhaps, dan- gerous to submit to speculation. I shall therefore only venture to express that acquired and transmitted qualities, and specific ex- isting social peculiarities, are sufficient agencies for the produc- tion of all the known variations of disease belonging to particular races.
CHAPTER m,
ATMOSPHERICAL, METEOROLOGICAL, AUTO CLIMATIC CAUSES OF DISEASE.
It is one of the commonest as well as one of the oldest ob- servations, tliat some diseases affecting the bodies of men and ani-j mals are due to atmospherical conditions, and to climatic changes. We attribute, iisiiaU y, the contraction of colds or catan'hs to pe- culiarities in the wind or weather, and it has been customary to connect the great epidemics with atmospheric peculiarities.
The older physicians seeni to have attributed all pestilential diseases to the atmospliere. Sydenham considered tliat emails ^ pox itself arose from some luiknown particles of the atmosphere nnconnected with coutagiou, and this view was largely maintained until the early part of the present century. Dr. John Adams, in his essay entitled '* An Inquiry into the Laws of Epidemics/* was, I believe, the first tu distinctly refute this impression, and to put the matter in its tnieUght Witliout disputing that atmospheric changes may be causes of disease, Adams laid down a rule, which w^as exceedingly precise and correct, namely, that "nothing can be called a contagion unless the person affected by it can induce a similar disease in otliers without regard to season, climate, or any local circumstauces--'
This was an important enunciation, because it separated the ideas of the air itself as a cause of disease from the air as a mere carrier or bearer of contagion.
We start then in this chapter with the fact clear in our mind£> that the diseases tnily of atmospherical origin are not diseaees ' dependent upon contagious matter borne by the atmosphere, because the puiest and best atmosphere, as Adams says, may he such bearer. We have to consider the atmosphere itself as a cause of disease.
It is neces&ary at the same time to understand that while at-
CLIMATIC CAUSES OF DISEASE.
625
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mosplieric changes may not be the immediate cause of diseases of the contagious t^^, they may very coneiderably influence the effects of tlie tnie causes of tlioge diseases^ and this specially in regard to the mortality induced by the diseases. Here we are brought into contact with what we may call the secondary action of the atmosphere in respect to caiisatioo. It is also necessary to bear in mind that the border line between the class of diseases springing directly from atmospherical causes and the class spring- ing from contagion is often very refined, and that it is poi^sible that some diseases which are induced by atmospherical variations may pass into the diseases whicli are communicable by contagion. Common cold, or catarrh, is one of these diseases on the border line. That conmion cold is sometimes communicable from one person to another is an hypothesis based on repeated observation ; and tJiat from common colds other diseases, more distinctly con- tagious, such as influenza, may arise, is a theory resting on a good basis of fact.
It might be advisable for the sake of a rigidly systematic de* Bcription to divide the subject now before us into two parts ; the tirst dealing with the direct and positive effects of atntosphcrical variation in producing disease; the second treating on the indirect or secondary effects of the atmosphere in modifying the intensity, course, and results of affections produced, primarily, by anotlier agent. On the whole it will be best, and least confusing, to avoid such division, and briefly to present wliat can be said respecting atmospheric causes of disease in their secondary as well as their primary character.
For the proper arrangement of tliis study it will lie necessary for me to consider the general effects of season in reUilir^n to disease and mortality. Afterwards I shall have to take up certain details relating to atmospheric temperature and moisture, atmospheric pressure, electrical conditions of the air, the influence of particular winds, and some climatic variations in reference to disease and its ten-estrial distribution.
Befoi*e, however, I touch on these topics two preliminary Btatements of facts deserve attention. The tirst relates to what may be called the physiological changes effected on healthy people at different seasons. The second bears upon some |>eculiar pbysi- eal conditions of the air itself, and of life under such conditions.
ATMOSPHERICAL, METEOROLOGICAL, AND
Infliience of Seasons on Healthy Persons,
The facts bearing upon the inflneuce of seasonal changes on persons in health to whieli I would first refer, were recorded bj the late Mr, Milner of Waketield.
From bis position as surgeon to the convict establishment at Wakefield, Mr. Milner was enabled to weigh every prisoner at given periods, to compare the gain and loss throngbont the year, and to estimate such gain and such loss, by individual agamst in- dividual, and by diet against weight. Tbe prisoners upon whom the (->bser vat ions were made had been sent to Wakefield to un- dergo the first portion of their punisliuient. They were kept in separate cells for a period of nine months; they were all males | between the ages of fifteen and sixty, and diey were all in good liealth wben they arrived. Tlieir cells having an equal capacity and the same means of ventilation, they were served with the same quantity and character of air, and the mean temperatui-e of tbe cells was in Qx^iy case 61^. Tbe men were all fed on tbe same kinds of food^ they were all di-essed in the same attire, and they were made to take the same umovmt of exercise. They were weighed on admission, and again at tbe latter end uf every calen- dar month during their stay. Tbe number of men weighed ex- ceeded 4j000 ; tbe period occupied in observation was ten years; the average number of prisoners weighed monthly was 372 ; and the total number of individual weighings was 44jOW.
With tbe first months of the year, Milner found that tbe body undergoes an average loss of weight in January, February, and Marcli^ the proportion of loss being 0.14 in January, 0.24 in Feb* ruary, and 0.1t5 in March. During the months of April, May, June, July, and August, there is gain in the following propor- tions: for April, 0,03; for May, 0,01; for June, 0,52; for July, 0,08 ; for AuguBt, 0,70. In September, October, and Decx*mber, there is a loss in proportion of 0.21 for September, 0.10 for Oc* tober, and 0.03 for December. November presents an exception to the months that precede and follow it, there being an average gain of 0,004 ; so tbat^ at first sight, November would seem to be an exception, in a very slight degree, in the losing series of montlis that precede and follow it. But Mr, Milner points out that this apparent exception was caused in tbe prisoners by the arrival of large numbers of men each year, and by the fact that the men
ClilMATIO CAUSES OF DISEASE.
527
usually gain weight for a short tirue after tliej ai*e received; so that this break iti the series results from the infliieiiee of the stage of iinprisoiimcut On the whuk\ there iti an average loss hegin- ning in December, and increasing rapidly up to March, In April there is an abrupt gain, whicli extends irregularly until August. In September there is a rapid loss, which continues leas rapidly through Octolier.
From these facts Mr. Mihier drew the following important inferences; 1. The body beuonies heavier during the sunimer months, and the gain varies in an increasing ratio* 2* The body l>ecoraes lighter dnrlng the winter months, and the loss varies in an increasing ratio. 3. Tlie elianges from gain to loss, and tlie reverse, are abnipt, and take place about the end of Marcli and the beginning of September,
Influence of the Air under Peculiar Phjsioal CondUiotis,
The second point to which I would draw attention has refer- ence to some changes which take place io the air itself^and which affect life independently of what are commonly called changes of weather or season. At the meeting of the British Association for the Advancement of. Science, licld at Oxford in 1860, I narrated a series of researches which liad been carried on then for ten years, in order to determine the effects of oxygen on animal life, and which had led me to discover the following facts :
(1) That if the life of warm-blooded animals is supported on pnro oxygen at the temperature of 75" Fabr., the gas produces a quickened combustion of the body, hjpercausis^ or increased burning*
(2) That in order for this condition to ha maintained, it is necessary tliat the oxygen should Ije freshly made, and steadily supplied in current.
(3) That if this be not done, the oxygen soon begins to fail to support proper vital action, however carefully tlie products of res- piration are removed ; the animals inhaling it become drowsy and fall into gentle but complete sleep which ends in death if the in- halation be continued.
(4) That this rule applies to all warm-blooded animals, but that cold bloods, like frogs, are unaffected.
From these observations I drew the following conclusion : Oxygen when breathed over and over again, although freed
5?8
ATMnSPllKinCAL, METEOROLOGICALj AJfD
entirely ivmn carhotiic acid, or other known product of res- piration, loses its power of supporting the life of warm*bhK>ded animals ; the process of life ceasing^ not from the introdnc- tion of a pc»ifton, Init as by a negation or a withdrawal of some principle extant in the primitive oxygen which is essential to life.
In a later series of researclies T ffiund tiiat in this negative condition of oxygen^ the decomposition of dead animal substances is very mudi accelerated.
To air thus clianged or deteriorated I gave the name of de- vUalkcd aivy and I l>elieve it to apply to conditions in which the air is deteriorated l>y the presence of organic matter, as in close rooms, crowded cities, and sometimes even in open situations in particular laealities noted for closeness and oppression of the utmosphere*
Still fin^ther, on the same line of investigation, I found that by submitting the negative or devitalized oxygen to the electric spark it resumed its activity, and I was thus led, in conjunction with the late Dr, Thomas Wood, to test the action of electrified oxygen, or ozone, on ain'mal life. In these experiments a different series c»f rcsnlts were brought out. We found that the air of tlie labomtory in which we worked pi'odueed decisive effects upon ourselves, namely, headache of an intense kind, a disagreeable pricking seusMtion of the nostrils, a severe catarrh attended with copions discharge from the nose, and ultimately quickened and difficult respiriitiou* These syitiptoms were so definite we felt it necessary eacli time before we began to produce ozone in large quantities, to diffuse the vapor of ammonia through the air to neutralize the action.
Before tlie conclusion of our research, whicli ended in 1S64, we discovered that in wann-blooded animals the effects of ozone were the same as upon ourselves, and that the continued inhala- tion of ozone by them led to congestion of the lungs, rapid coagu- lation of tlie iilood, and deatli in a luicf period, often in the conrse of an hour, if warmth, which greatly accelerated the action, were added. At a temperature of 40"^ to 45^ Falir. a warm-blooded animal would live, without being seriously affected, for many hours in air charged as fully as it coidd be w^ith ozone ; while at 70° Fahr. the action commenced immediately, and led to fatal results within the hour.
OLIMATIO CAUSES OF DISEASE. 629
We learn from these data that there are two differing condi- tions of oxygen, one active, the other negative ; and as either of these conditions may, according to Schonbien, be' present at dif- ferent times in the atmosphere, the effects incident to their pres- ence require to be borne in mind in the chapters which immedi- ately follow. 84
CHAPTER I\\
OK WEATHER AND SEASON AS CAUSES OF DISEASE.
THEdistiniijuislied Arhntlinot was of opinion that every seasoc lias its special dUeases, a view wliirli he supported most ably, aad'l which, as tlie faet^ about to be etated will bUow, is aiiBtained in a rcDiarkable dogi-ee by modem investigation.
The prevalence of diseases as a whole, and of the mortality arising from them, is well-iiiarked in varioiia periods of the year. In 1S53 1 made a eai"cful aiiulvsis of the facts bearing on this 8ub- jeet, and obtained very important restdts. The analysis referred only to the diseases of certain parts of England, and was derived from mortality tables, viz,, "those piibiished by the liegistrar- General ; but from its wide basis, its resnlts gave a fair picture of the special season diseases of England,
The analysis included deductions made from not fewer than 130,318 deaths, occurring during years extending from 1838 to 1853, and arising from the followirjgdist^ase^: smalbpox, measles, eearlet fever, whooping eongh, croup, diarrhoea, dysentery, cholera, influenza, ague, remittent fever, ty|>hus, erysipelas, quin&y, bron- chitis, jaundice, and carbuncle. The districts of death were Lon- don, Devon, and Coniwall
Out of 139,318 cases thus chronicled, as occurring from tlie above-named diseases, and estimating the gross mortality acx'ord- ing to the season, witliont mference to particular years, the per- centage of mortality in the different quarters ran as follows : In January, February, and March, 25 per cent.. ; in April, May, and June, 2L per cent. ; in July, Axigust, and Septeudjer, 24 per cent ; in October, November, and December, 28 per cent.
Having learned thus much, I set about ascertaining, on tlie same large scale, whetlier the fatal diseases were in any way special to the seasons. The answer to the inquiry w^as to this effect :
AS CAUSES OF DISEASE.
531
Whooping-cough, croup, small-pox, and bronchitis were most oommon in the first quarter.
8mall-poz
'Vrhooping-cough
Ooup
ZBronchitis
|
IstQuar. |
2d Qaar. |
SdQuar. |
|
27,352 32,704 27,523 36,793 |
24,551 27,825 25,100 20,301 |
22,824 17,116 19,919 10,327 |
4th Qoar.
25,272 22,354 27,456 32,570
Pneumonia, I believe, might very properly have been added here. In the second quarter quinsy only stood ahead. Thus :
|
l8t Qnar. |
2d Qnar. |
SdQoar. |
4th Quar. |
|
|
Qnin^lV , - . . |
21,762 |
30,596 |
21,231 |
26,410 |
In the third quarter diarrhoea, dysentery, and jaundice took the lead.
|
IstQuar. |
2d Qnar. |
SdQoar. |
4th Quar. |
|
|
Diarrhoea |
10,196 15,638 24,877 |
10,717 13,541 24,030 |
58,519 42,460 26,967 |
20,567 |
|
Dvsenterv |
28,340 |
|||
|
Jaundice •. . . |
24,109 |
|||
In this third quarter, Asiatic cholera, when epidemic, assumes a greater mortality and prevalence than at any other season.
In the fourth quarter influenza, ague, remittent fever, typhus, scarlet fever, measles, erysipelas, and carbuncle took the lead.
Influenza 23,539
Ague 22,857
Remittent Fever 23,077
Typhus 25,741
Scarlet Fever 20,809
Measles 19,864
Erysipelas 1 25,144
Carbuncle 26,771
Ist Qoar.
2d Quar.
12,171
24,285 26,315 24,825 18,978 21,466 23,444 19,685
SdQaar.
4,502 20,000 23,481 22,912 26,234 26,234 22,337 24,409
4th Qnar.
59,784 32,851 27,125 26,521 33,976 32,434 29,174 29,133
In a pathological as well as a statistical point of view, these results are most interesting ; for they prove, in a great measure, that diseases, analogous in their general characters, group them- selves singularly together at special periods. Thus we see that,
633
WEATHER AND SEASON
in the antnmii quarter, there ai-e grouped together those diseases wluch have for une of their essential syiuptoms an exudation from the intestinal sorface, or from that large ahdoininal organ, the liver. In the tirst quarter, the diseases of the respimtory system — eroQp, M'hooping-eough, and bronchitis — stand forth promi- iienti}', wliile in the fourth quarter, a large family of diseases of tJie febrile or inflammatory order take the first position.
It is not by mere accident that these divisions occur; they ai"ol the effects of fixed, though nearly unkuo\\Ti, physical or chemical ' laws.
It is wortliy of special remark that the fourth quarter of the year is that in wliieh the number of diseases causing a prondnent mortality is, as a general rule, greatest, and that next to it is the quarter commencing with the new year. As tlie cold of winter more decidedly sets in we hegiti to see developed, almost of neces- sity, an increase of deaths from judmonary diseases, and of low fever amongst the poor, if provisions become high in price and i insufficient in quantity or quality.
In public practice, it is ahnost always to be observed that diar- rhtea is a common symptom amongst the poor dming intensely cold weather. In this form it does not, howev*er, prove very fatal : and hence it stands I<:)W at that time in the mortalitv re- tm-ns. It seems to occur simply from inteiTial congestion, arising from long exposure of the external surface to the cold.
Tlie views above expressed were published in my paper ou " Season in Relation to Disease" in the "Journal of Public Health ■' for Deeeml>er, 1855, ]»ages 3*56-9. They have been generally sustained by other writers.
Kcecntly tlie learned offleiids of the Scottish Meteorological Society, lIi-. Buchan and Dr. Mitchell, have, in the most elabo- rate and laborious manner, iUust rated this subject by an analysis of mortality returns of London from 1845 to 1874, a period of I thirty years ; aiul those of New York from IS 71 to 1877.
The work of these authors is so important 1 feel it necessary to offer a summary of the facts which they have supplied.
I should premise by stating that tlie results of their examina- tion of tlio data before them is expressed tbronghout by a curve on a mean line. I give one illuslratiun, frum tijeir calculation of the mortality of whooping-cough, as a representative of all the others.
AS CAUSES OF DISEASE.
533
CURVE OF MORTALITY FROM WHO OP 1^0- CO UGH FOR ALL
AGES AND BOTH SEXES.
Derived from CalculcUions of 34 Years.
|
Jan. |
Feb. |
Mar. |
April. |
May. |
Jnne. |
July. |
Aug. |
Sept |
Oct. |
Nor. |
Dea |
|
|
50 p.re«it. |
D 1 1 |
1 1 1 |
J,JJ>}>>^ |
1 I 1 |
1 1 1 |
1 11 |
1 1 1 |
1 1 1 |
1 1 1 |
1 1 1 |
lie |
|
|
Mmb |
_ |
■V |
"^***- |
^5i. |
> |
|||||||
|
line |
— |
^S |
^^^ |
X- |
||||||||
|
ptrcMt |
3 1 1 |
Ml |
t i 1 |
i i 1 |
1 1 1 |
ii 1 |
1 1 1 |
i i 1 |
rrr |
1 i 1 |
1 il |
IIC |
A glance at the above will show that the height of the ciu've above the line, and the depth of it below the line indicate the periods of maximum and minimum mortalities from the respec- tive diseases.
The facts thus collected are summarized in the subjoined extracts, in which I have only departed from the authors' plan in the matter of the arrangement of the diseases, in order to maintain the system of arrangement which has been carried on throughout this volume.
AbSTKACT ON THE INFLUENCE OF WeATHER ON MoRTALnT FROM
Different Diseases and at Different Ages in London AND AT New York. By Alexander Buchan, F.II.S.E., and Arthur Mitchell, M.D., LL.D., F.R.S.E. [From the ".Journals of the Scottish MeteoFological Society," 1875-8.]
PERIODS OF MORTALITY IN VARIOUS CONDITIONS OF
DISEASE.
Irritation. Teething, London. — Maximum. — January to middle of June and end of July ; ab- solute, March, April. Minimum. — Middle of June to end of December, wifh excep- tion of last week in July ; absolute, October, November.
Dropsi/, London. — ^Maximum. — November to April ; absolute, February, March. Minimum.— June to October ; absolute, July, August.
Atrophy. London. — Maximum. — July to September ; absolute, August.
Minimum. — October to end of June ; absolute. May, June. OuTYe is allied to that for tabes mesenterica and bowel dis- ease.
034
WEATHER AWD SEASON
London* — Maximum. ^ — Beginning of Dei^ember to beginning of Mar ; absolute, March, April. Hininiiim.— June to beginning of D^ember ; absolute, Au- gust and September.
Senile Becat^ ; Old Age. £c»7ui(/n.— Maximum. — Close of November to end of April : absolute,
Januarj, Minimum.— May to close of November ; absolute, July to
October. Very rapid rise in this curve in November.
PERIODS OF MORTALITY IN DISEASES RUNNING A DEFINITIS COimSE IN BOTH SEXES AND AliL AGES.
LoHPON Ajn> New Yobk.
London, — Maximum. — Last week of jMaj*
Minimum. —Last week of September. Above the avemge from ClirLstmas to end of June. New FbrJt, — Max i mum . — May.
Mill i mum . — September.
Abovta the average from January to July,
Metuks. London. — Maximum. — Larger, November, December, January ; smaller, Mtvy and June. Minimum. — Larger, August, September, October; snaaller, F*^bniarv, March, New For^*.— Maxim u 111. —Larger, July; smaOer, Feliruaiy, Minimum,— Ijarger, September; smaller, April
Soarki Amr.
£ond«m*^ Maximum. — September to end of year, Miriiuiimi.— Febniary to end of July, Highe.st death-rate tkrougb October and November. New Ff>r A"*— IVIaxi mum. — December to June ; absolute, April,
Minimimi. — July to November ; absolute, September.
Tophus* London* — Maximum.— January to l>eginniiig of May,
Minimum.— Middle of May to end of September. Except hot season of July and beginning of August typhus is below average from middle of May to end of September,
r
AS CAUSES OF DISEASE. 635
Tf^hoid Fever,
Ijondon, — ^Maximum. — October and November.
Minimiun. — ^Middle of May to end of June. Falls below average last week of February ; begins to rise gradually in July. ^^^«^^^ York, — Maiimnm. — August to November ; absolute, September. Minimum. —-Nearly equal over other months of the year.
Remittent Fever,
Lmdon, — Maximum. — Larger, April to June ; smaller, middle of De- cember. Minimum. — September.
Diarrhcea,
London, — ^Maximum. — Middle of July to beginning of August. Minimum. — Absolute, March and April. Maximum commences slowly in June ; after August decreases (at a slower rate than it rose) imtil December. JVew York, — ^Maximum. — July and August.
Minimum. — ^December, January, February, and March. Death-rate begins to increase in April, two months * earlier than in London.
Simple Cholera,
London. — Maximum. — July and August. Minimum. — March and April.
Malignant Cholera.
Zoncion. —Maximum. — September.
Minimum. — April and May.
Mortality begins to rise in June, rises rapidly in July, main- tains high and steady position in August, runs up to abso- lute maximum in September, and then rapidly falls.
Diphtheria,
London. — Maximum. — September to end of the year.
Minimum. — Middle of March to beginning of September. Deaths remain above the average from September to the beginning of March. New York. — Maximum. — December. Minimum. —August.
Deaths above average from October to February; below it during the rest of the year.
AS CAUSES OF DISEASE. £37
PERIODS OF MORTALITr IN GENERAL DISEASES OF CON- STITUTIONAL TYPE, BOTH SEXES AND ALL AGES.
Rheumatism,
London, — Maximnm. — ^End of November and beginning of December. Minimum. — ^August and beginning of September. The large November December maximum is prolonged, but in a diminished form, to the spring months.
Gout,
LancUm, — Maximum. — ^Middle of March to end of April.
Mimmnm. — Beginning of Jnne to end of year ; absolute, Sep- tember. A large increase takes place in last week in year. Another in middle of March ushering in annual maximum.
Ckmcer and Cancrum Oris,
London. — Maximum. — ^None. Minimum. — None.
Scro/tda.
London, — Maximum. — Larger, middle of April to first week of Augpist ; smaller, in October. Minimum. — January, Febroaiy, September, November, De- cember.
Mesenteric Disease and Scro/ida,
London, — ^Maximum. — Middle of July to middle of September.
Minimum. — End of December to beginning of February. The mortality follows curve of temperature very closely. Ifeuj York. — ^Maximum. — July, August, and September.
Minimum. — ^December to early part of June ; absolute, De- comber and January.
Dicibetes, London, — ^Maximum. — ^None.
Minimum , — ^None.
Purpura and Scurvy,
X(mdSt>9i.— Maximum. — ^March to July.
Minimum.— December to beginning of January.
538
WEATHER AND SEASOX
PERIODS OF MORTALITY OF LOCAL DISEASES IN BOTH SEXES AND ALL AGES.
Diseases op tbs Diosbuvb SismiL
Thrush.
London, — ^Maximum. — l^si week in JiUv to third in Angnst,
Minimum, ^For the rest of the year ; absolute in April and
May. l!he curve is identical in chief features with that of bowel
oompkiut^.
Cyn anche — Qu insy ; TonsUUiis*
London, — ^Maximum. — Middle of October to end of March; abflohiie« end of December and beginning of January. Minimum, — August and beginning of October. Mmimujn period i^ attended with a fall during February.
Qasiritu,
London, — Maximum. — None. Minimum . — None.
Enteritig,
London, — Maximum. — End of JTime to beginuiDg of October ; absolute, first week in Augiasit. Minium m.— January, Februaiy, March, April, May, Novam' ber, December.
Dysentery*
London. — ^Maximum. — June to November; abaolute *"**^"nin, fleeond
week in September. Minimum, — April and May. From November to Jttne death-rate under the average,
IntussiiScepHttJU
London, — Maximum. — March, August, December, and first half of January. Minimum. — September to November, and again in Februaiy. Features very imperfectly marked.
Hernia. *
London. — Maximum. — End of December, and be|riujiing of January, Minimum.— End of May and beginning of June, Below avezage from May to middle of November*
AS CAUSES OF DISEASE.
Diseases of the Heabt and CibcuiiAtion.
Periccntlitis,
Lowffon.— Maximum.— Middle of October to middle of May ; absolute, November. Minimum. — Middle of June to middle of September. Curve resembles that for rheumatism. «
Hectrt Disease OeneraUy,
Zrowcton.— Maximum.— November to March; absolute, December and January. Minimum.— Middle of April to middle of November ; abso- lute, middle of August to middle of September. Neic Fcw-A:.— Maximum. — November to May, with fall in February ; abso- lute, December and January. Minimum.— Middle of June to middle of October. Curves for London and New York correspond closely.
BeSPIBATOBT OBGANa
Croup,
London, — Maximum.— Middle of November to end of April; absolute,
February and March. Minimum. — Middle of May to end of September ; absolute,
middle of June to middle of August. Absolute maximum is in early spring ; absolute minimum in
middle of summer. New York, — Maximum.— From October to April ; absolute, November and
December. Minimum. — May to September ; absolute, July and August. The curves for London and New York essentially agree.
Laryngitis.
London, — Maximum. — Beginning of December to end of May ; abso- lute, last three weeks of March. Minimum. — June to November; absolute, second week in
September. Sharp fall in January in maximum.
Bronchitis,
XoncCon.— Maximum.— November to March ; absolute, second week in
January. Minimum. — ^April to October ; absolate, August. Above the average from November to April ; below from May
to October.
540 WEATHER AND SEASON
Nmp Tork, — Maximum.— Xc*vember to March ; absolute, raitidle of March. Miuittium. — June to midiUe of November; absolute, tii«t
week in August. The number of deaths from bronchitis in New York is only
one-twentieth of the whole deaths, while in London it in
one-eighth of the whole.
Asthma,
London. — Maximum. — From November to April; absolute, second we in Januarr. Jliuimum. — The beginning of May to end of October; abso- lute, Augnst.
Pneumonia.
Lmdm^—l
-Maximum,— Novem1>er to April ; absolute, December- Minium um. — BeginBing of May to end of October; absolute,
August. The curve generally same as lor bronchitis, but absolute maximum earlier.
New ForA.— Maximum.— Beginning of November to middle of May; ab- solute maximum, March. Minimum. ^Middle of May to beginning of November; ab- solute, July and August. . '
Phthisis.
Lmtdon, — Maximum. — January to midcUe of June, and middle of No-
veml>er to middle of December ; absolute, middle of Mardi. Minimum.— Middle of July to middle of November ; alisolute,
fourth week of September. The deatliH from this disease are nearly one-eighth of all the
dcatlvi that octMir, N<$w ForAr. ^Maximum. ^Middle of December to middle of May ; absolnteb
March. Minim unr^ — Middle of May to middle of December ; abstolute,
June. The deaths from this dinease in New York are greater than in
London, viz., one-seventh of the whole.
Pkitristf,
lam^hi^* — Maximum. — ^Middle of November lo second week of Jnne;
absolute, December and Jaimary.
Minimum. — Beginning of July to end of October ; absolute, July and August,
The curve is suliject to numerous fluctuations, and resembles curve for rheumatism and periearditia rather than bronchi- tis, pneumonia, or asthma.
AS CAUSES OF DISEASE. 541
Lung Disease OeneraUy,
Zonditm.— Maximum.— From beginning of November to end of May ; absolute, December and January.
Minimum. — June to November ; absolute, July and August.
This group includes all diseases of the lungs not already spe- cified.
Diseases of thb Nebvous Sysiebc
C^halUis.
London, — Maximum. — From beginning of Febmaiy to end of July ; ab- solute, beginning of April. Minimum. — From beginning of September to January ; abso- lute, September, October, and November. Curve fluctuates considerably. New York, — Maximum. — Beginning of February to end of August ; abso- lute, July. Minimum. — Beginning of September to beginning of Febru- ary; absolute, November.
Hjfdroc^hodus.
London, — ^Maximum. — From second week in February to beginning of August ; absolute ; March and April.
Minimum. — Second week in August to beginning of Febru- ary ; absolute, last week in October.
Mortality shows secondary increase in July as a constant feature. New ForA:.— Maximum.— January to beginning of August ; absolute, April and July.
Minimum. — Second week in August to first in January ; abso- lute, October, November.
Apoplexy,
London, — Maximum. — Middle of November to middle of April ; abso- lute, December, January. Minimum. — Middle of April to middle of November, with a rise in the last week in Jime ; absolute, third week of July to beginning of September. New York, — ^Maximum. — Beginning of December to end of May; absolute, March. Minimum. — Beginning of June to end of November ; absolute, July, August, September.
542
WEATHBB AIO) SEASON
London. ^Maxinmm. —Middle of November to end of April ; absolute,
end of JaDtiary* Minimum. — Begiiming of May to middle of November; ftb-
solate, thinl n eek in September. DifTers from apoplexv in liaving mATtimnpi fatalitj in mid*
winter.
Epilepsy,
Lcr/iciriH.-^MaiimTim. — Last week of December to third week of April ; absolute, third week of March to fii'st week of April. Minimum.— Middle of July to first week of September ; ab- solutet last week in Angoat.
ConritUions*
Xovulpn. — Maximum. — December to end of April; absolute, FebruMPy'
and Mai'ch. Minimum. —Beginning of Mfty to middle of November, ^I'itli
a small secondaty maximum in July : absolute minimum in
Septem be r— Oct ober . il9 York. — Maximum. — June, July, and August ; absolute, July.
Minimum.— EDd of September to end of Deceml^er; abso-
lute, November, Decern Ijer. Blight maximum in Julj in London is much exaggerated in
New York curve.
Inttanity,
Loudon, — Maximum. — December, January, June^ March, April ; abao-
lute, December and Januaij. Minimum. — Beginning of July to November ; absolute, Sei>-
teniber, October. The curve is veiy irregular.
All Nervota BiseaseA,
London. — Maximum. — Beginning of December to cloae of April ; abso- lute, l^liiroh, A|inl.
Minimum.— Middle of May to close of November; absolute, September, October. N4iw York. — Maximum. — February to end of May slifrht, and close of June, July to middle of August ; iibsolitte, July.
Minimum, ^Middle of August to middle of January; abso- lute, November,
Curve differs in New York from London owing to great max- imum in Julv froui sunstroke.
AS CAUSES OF DISEASE. 643
Brain Diseases,
London. — Maximnin. — From beginning of December to end of April,
with slight increase in July ; absolute, March. Minimum. — ^From end of July to end of November ; absolute,
September, October. Chirve almost identical with that for epilepsy. Includes all
brain affections, except convulsions, epilepsy, paralysis,
apoplexy, cephalitis, insanity.
DiBEASBS OF THE AbSOBBENT AND GlANDULAB StBTEM.
Hepatilis. London, — ^Maximum. — Beginning of May to end of September; abso- lute, August. Minimum. — October to end of April; absolute, December, January.
Jatmdice, London.— "hLmmnm, — March slight, June with a fall in July, through July, August, September ; absolute, August. Minimum. — ^November to June, with slight rises above the average in February, March, April ; absolute, December, January, February. Curve much resembles that of Hepatitis.
Brighfs Disease of Kidney, /^Q?Kton.— -Maximum.— October to May; absolute, Febmaiy, March, with a dip in December. Minimum. — Middle of May to end of September ; absolute, Augnist, September.
Kidney Disease (General),
London, — Maximum. — End of November to end of April; absolute, December, January, and April. Minimum. — Middle of May to September; absolute, June, August.
DiSEAHBS OF THE MeMBBANOUS SySTEIC.
Skin Disease,
London. — Maximum. — October to middle of January ; absolute, Novem- ber.
Minimum. — End of May to beginning of September ; absolute, June.
This curve comprehends all skin diseases except phlegmon and ulcer.
544
WEATHER AUTD SEASOK
Smuflv FBcm Natubaii AounjgsfiHL
ObiWtrlik. (Mother.) Jfliidbii.— Mayi mnm. — Second week of October to end of March ; lute, December, Januanr. Minimum. —May, June, ^^J* August; absolnte, Jane to
I^remaiure Birth. Ltmdkm* — MBximnm.— J^annary^ Febmary* May, Jii]j« August, December. MiEumTuu. — During remaining months. Oarve shows little Tanation from the AYerage through the year.
Pritatian^
Londim, — Maximum, — I>ecember to middle of ApriL
Minimum. — Middle of April to end of November. Curve allied to that of diseaae of i^spiratoiy organs.
Wani o/Breasi Miiku London, — Maximum. — July, August, and September; absolute, July, August. Minimum- — October to end of June ; absolute, May* This curve is allied to that from diseases of abdomiiial organs. <
Alcoholic IHaeatea and Ddirium TWmens. London^ — Maxi mu m . —Beginning of May to end of September ; abso- lute, July. Minimum.— Beginning of October to l>egLnning of May, with rise to the average in October, and ftligbtly above the aver- age in first week of new year ; absolute, January, Februaiy, March, December. The cMTve for deliriimi tremens stands alone, resembles no other cur\'e, and ia steady.
Suicide^
I^ywfow.— Maximum.— Latter part of March to latter jmrt of August ; absolute, end of June.
Minimum. ^End of August to March ; absolute, beginning of Febniary. New York. — ^Maximum. — Beginning of April to end of September ; abso- lute. May.
Minimum.— Beginning of October to beginning of April; absolute, February,
Both curves have the niaximum period in spring and earjy summer.
AS CAUSES OF DISEASE. 545
From the details of important facts above recorded we gather information of the most useful and practical kind. There is probably nowhere in medical science such an epitome of disease as that recorded in Messrs. Buchan and Mitchell's papers. From the researches of these distinguished men we can indeed forecast, iu these islands, the course of many diseases with a precision that may to a large degree be called exact.
35
This hook is thepropeiii/ oj COOPER MEDICAL COLLEGS,
SAN FRANOISCO. CAL.
and is vot tn he remorrd frw.i th(>. Library Jfnon, />y ,,,,,^ p^n-son or under au\j yrcttxt Wuctcvcr.
CHAPTER V.
ATMOSPHERICAL, METEOROLOOWAL, AND CLIMATIC CAUSES CONSIDERED IN DETAIL.
Fhom the array of facte which have passed under our obfierva- tion we have been able to arrive at certain general eonclusione,
which are of extreme practical value* It will be instructive now to inquire whether the facts relating tc» disease can be aoeoonted for ae connected with parfieular atniosplierieal conditions. In other words, are the phenomena of disease dependent npon partic- tilar atmospherical vai-iations, or upou particular eombinadon^ of them ?
Atmospheric Temfebatore and Damp.
The influence of temperatui'e on disease has ever been a fer- tile Bubject of obaervatiun by skilled inquirers. Dr. William Farr, however, was the first to treat uixjn it with precision, and to bring the effects of variation of temperatui'e on life into what may be called a calculable form. In one of his early tables he described that after twenty years of age the danger of dying from a fall of temperature ig doubled every nine years.
Thus, out of the same members living, if one die at thirty years, two will die at thirty-nine, four at forty-eight, eight at fifty- seven, sixteen at sixty-six, thirty-two at seventy-five, and sixty- four at eighty-four, from the same wave of cold.
The wave of cold cannot, however, of itself be taken ae the cause of all that depends upon climatic influence, and Messrs. Euchau and Mitchell, recogiaizing tliis fact, have commented on temperature and moisture, together, in relation to disease. They divide the London year into six periods, each one of which has a] climate peculiar to itself. The periods are as follow :
The p'rj<6 jjcriod, extending from the fourth week of October to the thud week of December, is marked by danipnesa and cold.
ATMOSPHERICAL AXD CLIMATIC CAUSES.
547
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The second period, extending fro!n tho fourth week of Decem- ber to the third week of Febrimryj is marked by cold.
The third period, extending from the fourth week of Feb- ruary to the second week of April, is marked by drynms and
The fourth period, extending from the third week of April to the fourth week of June, is marked by drynms and icarinth.
The fifth period, extending from the close of June to the fourth week of August, is marked by heat.
The sitth period^ extending fixim the first week of September to the third week of Octoberj is marked by dampness and wamith.
Diu'ing the ^V^^ of these jH:riod^^ marked by dampne^B and eddy seventeen diseases show a rapid increase of murtalityj and twenty-five a mortality greatly above the average. Ten di&easea, namely, measles, diphtheria, typhoid fever, childbed fever, rheu- matism, pericarrlitis, aneurism, pneumonia, skin disease, and cyanosis, present an absolute maximum. Fourteen diseases, half of which are connected witli the nervous system, show an in- crease of mortality. Twelve show a mortality considerably below the average, three of these being scrofula, cephalitis, and jaun- dice, and nine bowel complaints, or diseases connected w^ith the nervous system.
In the seemid period^ characterized by cold^ six diseases begin to show an increased mortality, whiKiping-cough showing a rapid increase. Forty present a luort^dity considerably in excess. Sev- entoet), namely, small-pox, quinsy, typhus, delirium tremens, paralysis^ insanity, convulsions, heart disease, broncliitis, pleurisy, asthma, other lung disuases, hernia, kidney disease, ulcer, child- birth, and old age, present the annual maxiniura. Seven diseases begin to decrease, live showing a rapid decrease. Twelve fall much below tlie average ; five, namely, purpura an<l scurvy, de- lirium tremens, tabes mesenterica, hepatitis and suicide, reaching the minimum. Diseases of the respiratory organs show the greatest mortality during this period*
In the third period^ characterized by ihyness anfl cold^ three diseases sliow an increase of mortality, and three of them a rapid increase* Thirty-four yield a mortality greatly in tlie excess. Fifteen, namely ci"oup, wlioiipiug-C4>ugb, privation, dropsy, mor- tification, consumption, hydrocephalus, apoplexy, chorea, epUepsy,
548
ATM08PHEB10AL AXD CLIMATIC
conmlgions, brain disease, larvngitis, Bright's disease, and teeth- ing, yielding a tuaximum. Twelve liegin to decline; four pre-^ent a rapid decline ; eleven fall below the average, one of thein, scar- let fever, deeliniug to the annual mininium. Diseases connected with the nervous system show the highest death-i-ate in this l^eriod, and no complaint of which the nervous system is believed to be the seat lias its miniinum at this season.
In t\\Q fourth period J characterized hj drifnem and wm^nifR' nine diseases begin to increase in their mortality ; nine show a rapid increase- Fifteen rise above the average, nine of which, namely, ague, remittent fever, gout, purpura and scurvy, scrofula, cephalitis, intussusception, jt>int disease, and suicide, attain or re- tain their annual maximum. Nineteen begin to decline from the maximum ; nine show a rapid decline. Eighteen are below the average, eleven of them, namely, diphtheria, tj^phoid, dysentery, diarrhoea, cholera, want of breast-milk, thnish, enteritis, ulcer, atrophy and debility, reaching their annual mininmm. This is tlie healthiest of all the periods ; the diseases of the respiratory and lu^rvous systems rapidly diminish, and bowel complaints are at the lowest until just upon the close of the pericK.!.
In the ^ftfi periody characterized by luuit^ fum* diseases begin to increase in their mortality, ten showing a rapid increase. Six- teen are above the average, diarrhoea, summer cholera, want of breast milk, delirium tremens, thrush, tabes mesenterica, gastritis, enteritis, j amid ice, and atrophy and debility, attaining their an- nual maximum. Ten diseases begin to decline^ nine showing a rapid decline. Thirty-one are below the avei'age, twenty of which, namely, croup, erysipelas, childbed fever, rheumatism, dropsy, mortification, apoplexy, epilepsy, pericarditis, Iieart dis- ease, laryngitis, bronchitis, pleurisy, pneumonia, asthma, other hmg disease, Bright's disease, kidney disease, skin disease, aiul cyanosis, attain or maintain their annual minimum* The marked diseases of this period are bowel complaints. Delirium tremens has also its maximum in this period.
In the shth period^ characterized by dampriesa and wannth^ twenty -one diseases begin to increase in their mortality, nine showing a rapid increase. Xine run above the average, three of these, namely, scarlet fever, dysentery, and cholera, attaining or maintaining their annual maximum. Six begin to decline from the maximum ; seven show a rapid decline. Twenty-seven are
CAUSES OF DISEASE,
540
greatly under the average, fifteen of these, namely, Btnalhpox, quinsy^ whooping-cough, typhus, remittent fever, gout, consuinp- tioD, hydrocephiihis, paralyeis, insanity, convulsions, brain disease, hernia, teething, aiul okl agt^*, attaining or reujainiiig at their annual minimum. Scarlet fever is the only disease which reat'hes its maximum death-rate during tliis period, viz., in October. The period altogether is very lioalthy.
A further analysis of these researches indicates that heat and not cold is tlie great destroyer of the infant life of London, wliile coki and not heat is the gi"eat destroyer of the aged.
We find an explanation of the effects of cold by estimating the force of viral ity at different ages. We may assume that the body reaches lu maximum of development at the age of thirty. At this period, if it be quite healthy, it generates by its own chemical processes so much force as eliall enable it, within given bounds, to work its own machinery, to call foith at will a limited measure of extra force, and to supply a fluctuating loss that may be convoyed from it by contact with the surrounding air^ and by other substances that it may touch, and that are colder than itf^elf. The body yields, therefore, applied force, reserved force, and waste force ; and these, under ordinary circumstances, are suflicieut to maintain the perfect organism in effective life. So much active force gives the body thej>ower to perforin so inuch labor; so much reserved force supplies it with the power to perform a measure of extra labor to meet emergencies; so much waste force enables it to resist the external vicissitudes without trencbing oo tlie supply which is ever wanted to keep tlie heart pulsating, the chest heaving, the glands secreting, the digestive apparatus digest- ing, and the brain receiving or thinking.
Let this distribution of force be disturbed, and straightway the life-power is reduced. If we use the active force too long, we become exhausted, and call upon the reserve; and if we still continue the process we fail at last, unless sleep forces itself upon U8, and brmgs, with the rest it insures, renewal of power. If we are robbed of the waste force quicker than we can supply it again, exhaustion is produced ; insufficient nervous control over the vas* cnlar canals succeeds, and therewith that congestive condition of the lungs and other vascular organs, under which death is so easy when exhaustion is severe.
That the exhaustion should be more rapid m the man who
650
ATMOSPHERICAL AND CLIMATIC
lias reached hh prime is but natiiraL In his past he has been a growing, developing body, and in the eoui'se of developnieut he has used up an excess of force coiiunensiirate with the deiuands of hie growth. When he stops in development, and stands on ai fair level with the external forces opposed to him, then his own force, for a short time balanced, soon becomes second in command. He feels cold more tenderly ; if his i^st bo broken, his demand for artiticial heat is urgent; if he lose or miss food, he fails rapidly; and, returning to our facts on the influence of external' temperature on mortality, these many sources of failure are the reasons wliy a fall in the thermometer sweeps away our popula- tion so decisively according to its age*
The influence of temperature is very decisive in regard to certain acute diseases. Thus, as Boudin shows, yellow fever de- mands a temperature of 68*^ Fahr. in order that it should take the epidemic form ; while epidemic plague ceases in Egypt when the temperature approaches 82'^ Fahr. Phtliisis pulmoualis, so fatal in Great Britain, diminishes as the climate becomes warmer^ as in the West Indies, Ceylon, and Mauritius, It also diminishes as the climate becomes colder, as in Canada and Nova Scotia.
Atmospueric Pressure.
Tlie effects on healtli of clianges of weather preceding rain have long been known, and since the discovery of the atmos- pheric pressure, and of the instrument called the barometer, with which that pressure is measured, the idea that there is a close connection between a fall of the barometer and certain painful affections, like neunilgiae and rheumatic pains, has become gen- eral. In our day tins subject has been remarkably illustrated, ott , one side of it, by the observations which have been scientifically made job the effects of pressure upon men who are obliged to work in compressed air, and w^ho suffer from the affection de- scribed at p. 392-4 as caisson, or coffet'-dam disease. The suljjeet has also been studied on the other side by observations on the effects of reduced pressure upon persons who are ascending moun- tains, or upon those w^ho are rising, in a balloon, into a higher and rarefied atmosphere.
The influence of atniospheric pressure, which I have briefly described in the pages above referred to, is variable according to
CAUSES OF DISEASE.
551
the snsoeptibilities of the persona who are subjected to it. In fact, there is nothing which shows more couspieiiously the differ- ence of hnman BU8eeptihiIitie8 to external influences thau the pressure of air, Dn Aodi-ew Smith, in his record of the phe- nomena he noticed in the caisson of the Kant Kiver Bridge at New York, found that a large proportion of the men here the excessive pressure,— reaching at last to thirty-six additional poundg to the square inch,— without the slightest ill effect; whilst in others some severe symptoms resnlted from a very short ex- posure to slight pressure. In one instance a student of engineer- ing, after a brief stay under an additional pressure not exceeding I fifteen pounds, was seized on coming into the air under ordinary ■ pressure, with temporary paralysis* The difference, Dr* Smith thinks, lies in the difference of efficiency of the vaso-motor system, or perhaps in the structure of the blood-vessels themselves, so that in one ease, the vessels rcsujne at once their natural condition when the pressiu'© is removed, wliilo in the otlier case the ahuor- mal distribution of tlie blood persists in certain parts of the vas- cnlar surface. " Wliatever,*^ he argues, ^* the predisposing condi- tion may be in this latter class of cases, we have only to assume its existence in an exaggerated degree to bring the subject within the range of ordinary biirometrical changes. If one man can bear a change of ninety inches, and come out of it to the ordinary pressm'e without feeling it, while another is paralyzed by a change from thirty inches of pressure to the ordinary, it is not incredible that a third may have aching limbs as a result ol being subjected to a fall of two inches of pressure."
This is the reasoning suggested by Dr. Smith, and from these inferences, as well as from many others wliicli he has drawn from hfe unrivalled field of research, he explains why some cicatrices, — Bears, ^such as those following gunshot wounds, are specially prone to be subjected to neuralgiac pains during change of weather. He also explains why, on bright days, when the air is light, and the barometer is high,— when, that is to say, the greater atmospheric pressure on the surface of the body drives the blood Into the interior of the body, and especially into the organs in doeed caTitiee, ench as tlie brain,^the mind is active, and the muscles vigorous ; while on damp, foggy days, mental effort is irk- some, the limine drag, the appetite is small, and the whole tone of the system lowered.
652
ATMOSPHERICAL AND CLIMATIC
The changes are more distinctive still in those who are prone to disease, and in whom the veseels ai-e already enfeebled or changed in structui'e* Tliere can be no doubt that the effects of redaced pressure tell with intense force on large populations who are already enfeebled,
I have dwelt on variation of the atmospheric pressure as a cause of disease, on account uf its great practical meaning. It embraces so much. Whether the variation from higli to low pressure ever acts as a primary cause of disease it is impossible to define, but that it acts as an exciting eauee, of the most serious character, on perfions predisposed to disease there can be no doubt whatever. A sudden rediietiun uf the atmospheric pressure, which means a fall in the baromet^r^ is attended with risk of pi-essure of blood, leading to pressure on nervous fibre and production of jjain ; to internal congestion ; to fever ; to apoplexy : while an increased pi^essure, which means a rise in the bai-ometer, is at- tended with greater risk of injury from physical or mental sliock.
The eflFect of tlio variation extends in yet another direction, I have pointed out in an essay on ^' Meteorology in Relation to Sur- gical Practice/' that the atmospherical pressare plays an important part in the results of surgical procedures, and that with a falling barometer tlie chances of success are reduced.
Thus the time hfavarable for operation, —
(a) When the barometer is steadily rising.
(J) When the barometer is steadily high.
(c) When the wet-bulb thermometer shows a reading of five degrees lower than the dry-bnlb.
(rf) When, with a high barometer and a difference of five de- grees in the two thermometers, there is a mean temperature st or above 55° Falir.
The time is mifavorahU for operation, —
(a) When the barometer is steadily falling.
(J) When the barometer is steadily low*
(<?) When the wet- bulb tlicrmometer approaches the drv-lnilb within two or three degrees.
{d) When, with a low barometrical pressure and approach to unity of reading of the two thermometers, there is a mean tern- perature above 45° and under 55° Fahr,
On the same point Dr. Addenill Ilewson has publislied in the Penn sylvan ian Hospital reports a register of 259 operations with
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CAUSES OF DISEASE. 553
the accompanying meteorological conditions, and the results con- nected with the operations. These results, as stated by Dr. Hew- son, stand as follows : —
** On the occasion of the 259 openitlons, the barometer was ascending in 102, descending in 123, and stationary in 34*
Fifty-four of the whole number were fatal ; 11 of thorn were operated on when the barometer was ascending, 35 when it was descending, and 8 when it was stationary.
Of the successful cases, 91 were operated on with an ascend- ing barometer, SS with it descending, and 20 with it stationary.
'* From which it would secjii/' says Dr* llewson, '" that we got a mortality, when the operation was performed with the baix^tneter ascending, of not quite 11 {10,7) per cent. ; of over 20 (20.0) per cent, with it stationary ; and over 28 (28.4) per cent* with it descending. Of the fatal cases, tlie average length of time which the patient survived the oj»eratit>n was only seven days wdien the barometer was ascending, and thirteen when it was descending ; and of the cases which died within three days over 75 per cent, were when the barometer was ascending/'
Electrical OoxniTioNs of the Atr,
From the experimental data recorded in the last chapter Imt one, it may readily be inferred tliat varying electrical conditions <»f the atmosphere lead to important states of body and to disease The common experience tells us Jiiat many persohs of an impres- sionable nature ai^puiuf idly iiffe(?ted hy electrical storms, and are indeed able to predict such storms. The subject invites a long essay, but it also calls for more research than has yet been made in regard to it.
One of the best series of observations I have ever read was 3t to me by my friend iln llingeston of Brigliton. "If Itched attcntivel}^ thu clouds,'- says my friend, '^ will be seen to approach and i^ecede from each other in a manner similar to bodies charged witli positive and negative electricity. They may be observed also to rotate on an axis of their own, this rotation being from left to right. When these clouds are seen the wind ia as a rule from tlie west. The moiiality is low, but illness of a curable and transient nature is frequent. Virulent epidemics do not prevail* The influenza a.d. 1729 passed over Europe from
554
ATMOSPHERICAL AND CLIMATIC
S.E. to N* W. with a inoigt, clou'Jy, foggy season ; and the epott**^ " fever of x,d, 1847 passed fmni K. to W, over the nortli of Europe^ across Great Britaiti aiid Ireland, till it finally reached America."
During the passage of white-headed cnmuli the electrometer 18 veiy active ; in mists the electricity is negative, feeble, or nil. During " thundery weather," as it is called, head affections and l>owel complaints are noticed. There is a peculiar symptom, analogous to that which arises in cases of injury to the spine, viz., the colon being greatly surcharged wnth wind : it is an evidence of direct exhaustion of the nervous contres.
The large white-headed eumuli that collect in clear bright days are rotary stomis of hail, rain, or thunder, gyrating from left to riglit. Several of these gyratory stonns keep niarchini; onward in alteniate spaces, marshalled in a vast circular arraynj and rolling mund a eireuniference of bright translucent calm.
On the appnjach of one of these masses of vapor, the mercnry of the barometer and thermometer first falls, and then rises with great rapidity. The accompanying and residual state of the at- mospiiere is congenial to health. Cases of debility experience ft| favorable reaction, the air we breathe at these moments being antagonistic of disease.
With the breakiug np aiul dissolving of these large cumuli there is electric action, and most likely explosion, just as the vapor is being condensed into water.
The entire atmospliere changes. Everything is dull and gray. In the damp weather dyspepsia chiefly j>revails — the acid indiges- tion of gouty habits, the scrofulous, indolent^ and pitiable host of *^never-wells,'-
Rheumatism, which some have supposed to arise from a sud- den loss of electricity, occurs in damp weather, when the amount of animal electricity is the smallest, and the most readily parted with.
During the prevalence of cholera the cirrus cloud is rare ; but the cirro-strati, whicli occupy a lower stratum of the atmosphere, are frequent at noon, and accompany tlie sun for three or four hours in his meridian height. A calm prevails. Indolent cirro- cumuli lodge over the hills. The distance is dira, and a sticky vapor, charged with small black flies, pervades everything. The barometer stands obstinately at 30, and the wind is from the N.W.
CAUSES OP DISEASE.
635
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or S.E. Daring the cholera of 1854 the wind was from the S.E. to N,W., and m it was in 1833 and 1H49.
Some observers Imve reniarked that the declination of the needle is very great during the prevalence of the Asiatic ciiolera^ and tliat it also correspoods with certain changes in the vegetable kingdom, as, for instance, the potato rot.
We have some facts to show cause why we slionld connect dis- ease with the greater or less amount of electricity, signiticd by the electrometer. It would seem that, in the non-electric states of the air, diseases of a low type prevail. Thus, in the Registrar- Generars return for the week ending 14th July, 1855, we find it stated, '* weak positive electricity throughout the week,'* and the mortality return of the same date shows that the chief deaths were from snialJ-poxj whooping-cough, scarlatina, diarrhceaj and typhus. On the contrary, in the week ending 8th September, electricity is "positive," and mortality ''not high for the season/'
On the 13th and 14th Se]>tember^ 1854, wlien cholera was at ita maximum, it is reported of electricity, " none was sliown."
Again, for week ending 22d September, 1S55, mortality *' shows a decrease of about one hundred in eacli of the three previous weeks, and indicates a satisfactory state of the public lieallh;"' while the electricity was ** positive," strongly positive, *' and active throughout the day."
If we consider that every living creature is as much an elec- trical machine as eaeli cloud; tliat the earth itself is the largest and most powerful electrical machine of all ; that all things are always exciianging their electricities with each other; and that lightning destroys myriads of insects, as well as some animals and human beings, at a single flash, it is past contradiction that elec- tricity most be a grand actor in every form of life, whether of health or disease.
The violence of the w^inds, if not their directions, seem to be electro*magnetic. And the partial rarefaction of the air by heat, and its condensation by cold, hitherto employed for explaining the force and current of the winds, are, moi^t likely, otdy striking parts of terrestrial electro-magnetism. Moreover, tlie sensorial effects of the electric tiuid ai*e proof paratnonnt of its pathological energy. We have, therefore, tvery possible reason for regarding the kind of clouds as indications of the kind of atmosphere in re- lation to disease ; and the various forms assumed by the vapors
«B ATMOSPHERICAX AND CLIMATtO
oonden^mg or dif^solving in tlie air may be considered, not only as picturesque beauties in the land&oape, but al&o a* criteria for judg- ing of some of the moet patent efFect.s resulting from the opera- tion of an experiment, silently and delicately perfonned, upon the fanetions and sensatione of animated beings. These eigiis only require reducing to some familiar cJiaracterSy in order to render them practically eerviceable; and then, when once recognized, they might be read off at a glance, and bn.mght into daily use a^ easily as the dial-plate of the electric wire, or the minnte-hand our watch, in counting the pnlse at a patient's wrist.
In 1854 the late Dr. Moffat joined me in contributing an e§say on meteorological changes and disease, in which he formed the hypothesis that there were certain pericnls during which ozone was present in tlie air, and that during such periods, called by my colleague, ozone periods, diseases affecting the respiratory organs were peculiarly prevalent. Dr. Moffat continued his observations until the close of his useful life, and was led to trace a connection between periods of phuj^phorescence and the acute forms of dis- ease* A review of his laborious work leads me to the conckibion. that it remains incomplete.
Ox THE Inflctknce of Partioulak Winds anb on Gekeeal
Climatic Differences.
That certain winds are provocative of certain symptoms of disease, and that they intensify cei-tain Bymptoms in those who are suffering fiom disease, is a ]>art of universal, as well as of medical, knowledge. Thus the southwest wind is known to be unfavorable to acute inflammatory conditions; the north and northeast winds to neuralgic and rheumatic conditions ; w*bile the drying, cutting, deiircssing east wind is fatal to those in wliom the stoi"e of vital energy is very low. But here we are wanting m sound method for determining the precise part played by the winds as causes of disease. It is not obvious that the winds de- termine the origin of any disease ; and w^hether they intensifv any by a special action of their own, independently of heat, cold. moisture, electrical tension, and other such active influences, rey mains to be discovered.
It has been surmised that during some great perturbations of nature, changes may take place in the chemical constitution of the
CAUSES OF DISEASE.
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atmosphere, and that these changes nmj account for plienomeua of disease. The passage of au* over certain soils has been con- sidered 8iiiSt*ient to disturb its nstlural chemical state, and to ren- der it directly noxious to human life. In the Grotto del Cane, and in some other rare posit ions* the air is sufBcientlj adniixed with a poisonous gas (carbonic anhydride) to it^ndcr it dangerous to breathe; but beyond these exceptional and well-known in- stances, we have no proof whatever of any such uiodirication of the chemical constitution of the atmosphere as would provoke a special disorder, although we have seen that tlie oxygcTi of tlie atniospherie sea may be changed in physical quality, with injuri- ous effect oa life.
To all our present experience the cond>ination, or moro cor* tectly, the mechanical admixture of the gases that make up the atmosphere, — tlie oxygen and nitrogen, — remain always steadily balanced and fitted to support the vita! processes. The dangers which sprhig from vitiation of atmospheric air, from undue re- moval of oxygen, from introduction of carbonic acid or otiier poi- sonous gas or vapor, are, tlierefore, artificial dangers, invented and promoted by our own hands, and due, consequently, to the con- trollable errors of social life.
On the general siilqect of winds nud geograpbical distribution of disease we are mucli indebted to the researcties of Mn AJfi'cd Haviland, who has devoted many years of splendid labor to tliis investigation. IJis inquiries extend particularly to four chisses of diaease; namely, rheumatism; its concomitants, heart disease and dropsy; cancer in females ; ajul, pulmonary pbtliisis.
Respecting heart disease and dropsy, which Mr. Ilaviland insiders are almost entirely dependent on rheumatiBui. he infers, w-TJuit wherever the sea air has uninterrupted access, as over a flat country, np broad vales or valleys, and elevated countiy, we find a low mortality from heart disease and dropsy. And that, on the contrary^ in places Mdiere tl^e tidal wave has no access, where the rivera run at right angles to its course, or to that of the prevailing winds, there is the highest mortality from the same causes of death.
Respecting cancer, Mr. Haviland infers,— 1, That tho hardest and most elevated rocks, or the most absorbent, like the oolite and chalk, are the sites where the least mortality from cancer is found.
588
ATMOSPITERICAIi CAUSES OF DISEASE.
2. That along the river-courses which flood their banks, sea- fionallyi are to be found tiie districts in whicli the highest mortal- ity fruoj cancer takes place.
8, That wherever, from the nature of the rocks forming the watershed, the floods are much discoloi'ed by alhivium, and where, from the flatness of the country, the floods are retained and not easily drained off, tliere we And the greatest mortality from cancer among females.
Iles[>ecting puhuonary phthisis or consumption Mr. Ilaviland ' infers, that districts with slieltered positions yield a low rate of mortality from the disease* That districts with a general aspect favorable to tlio nuilign influence of the east wind yield a high death-rate. That damp clay soil is coincident with a high mor- tality ; and, that elevated ridges of non-ferniginous and infertile carboniferous limestone and coal formation, and elevated, hard, unfertile, and iu>n-ferruginous Silurian formations, form districts of extensive high mortality from the disease. That elevated parts exposed to westerly, north-westerly, easterly, and south-easterly witids are characterized by high mortality. That a sheltered position, a wann, fertile, well-drained, ferruginous soil are coinci- dent, as a rnk% throughout England and Wales, witli low mortal- ity f r*iui phthisis.
Touching this last question I may add that the influence of a seafaring life as a preventative of jjlithisis has been matter of im- portant observation. In 185** I^iudin showed that while the deaths from consumption in the British army were, in the Line, 8.9 in LOGO men, and in the Gnards, 12.5 in 1,000 men, in the British navy from 1830 to 1856 inclusive, the deaths from phthisis wei^e 1.76 in 1,000 men*
I I
CHAPTEK VL
On Pakasites in Connec-tion with Disease.
A CERTAIN imraber of diseases have for their caoBe the intro- diictiou into the body of what are called parasites.
These parasitic forms of life are of two or, as some would opine^ of three kinds* Certain of them are of distinct animal character ; others are as distinctly of vegetable character ; others, it is assumed, lie between the animal and vegetable kingdoms.
Of late years the subject of the origin of disease from para- sitic forms of life, taken into the body by means of food or air, or received upon the outer surface of the Ixidy, has attracted an unusual degree of attention, an attention, indeed, whicli has led to neglect of other branches of learning relating to tlie study of causes uf disease in their entirety, and thereby to retrogression of knowledge.
The real knowledge which has been accjoired in respect to the action of parasitic forms of life in producing disease is very clearly of three distinct values. Some part of it is quite certain, and is of the greatest value. Another part of it is theoretical, and is waiting for more proof in order to become vahiable» Another part is entirely hypothetical, and is in variL*iis ways so exaggerated and childish as to be valueless, if not misehievons.
The Koyal College of Physicians, to whiclx I have so often referred as my authority fi>r classitic^tion of disease, places tlie ** Human Parasites " in three subdivisions under the following names :
Ehtozoa, Of which there are three classes :
/. OocLELidTSTHA. Enffli»h si/nonym. Hollow worms. Definition : Wonofl with an abdommal cavity.
B. Sterelmintha* BngHsh synonym^ Solid wormfi.
C. AoGiDiEHTAij PABAfiFTES. Lefifiitimt : Internal ]mrtisit«Sj Iiaviog the
habilBt but not referable to the class, of entozoa.
660 PARASITES IN CONNECTION WITH DISEASE.
II* EcTOZOA. In which are inchided the varions acari, or lice, whieli infest the outer surface of the body.
Ill- Entopiitta and Epiphyta, In which are included the algie, fungi, and mycrodennSj that have been foaud on the surfaces or in the cavities of the body*
Studied in relation to diseases of the different systems of the body in the manner followed out in Uiis voiuxuej Parasites may be classified as follows;—
PAKASriES AFFECTING THE DIGESTIVE SYSTEM AND INTESTINAIi CANAL,
ESTOOOA.
Clou A. OaMmimiha.
Asciiris lumbrieoideB. (linuaMii^O ITabitui : InieMiim. Ascaris mjatax, fRudolplii. ) Habitat : IntestineR. Trichocephalus dispan (RmlolpUi.) Habitat : JnieB^es* Solerostoma duodenale. (Cobbold.) Syn, Anchylostomnm duodenale.
Habitat: Duodenum. Oxytuia vermieularis. (Bremser.) English i^/nonynh Thread-worm.
Habitat: Rectum.
Class B, Sterebnintha, .poihnoceplmlns latus. (Bremser.) Habitat: Inteatmes, Sothrioceplmhis cordatns, (Leuckart, ) Habitat : Intestines. TcBnia solium. (Liimieua,) Habitat : lniesime». Tamia mediooanellAta. (KuclienmeiKter,) Habitat: Intestines. Tienia acanthotriafi. (Weinlaad,) Habitat : Int-estines. TteniA flavopimcta. (Weinlond.) Habitat : Intestines. Taenia nana. (Siebold.) /foWia/.* Intestines, Teema lophosoma. (Cobbold,) Hahit^M : IntestindS. Taenia elliptica. (Batscli.) Habitat: Intestines.
Oysticercus of the Taenia margin ata. Si/nonifm^ Cyaticercns tennieoUiB, Difltoma craasum. (Buak.) Habitat : Duodminm,^ Distoma lanceolatum. (Mehlis.) /?a6»7a^ ; Hepatic dnot ; in testinea*
Class C. Aecidenial. • (Estma bominis. (Saj.) English symmymt Jj&rvsk of the giyd-Hj, Habi*
tat: Intestines, Antbomyia canicularis. (A Farre.) /fa^«/a/ .* Intestines.
Entophtta akd Epiphyta. Leplothrix: buecalia. (WedL Bo bin.) English synon^m^ Alga of the mouth.
PARASITES m CONjrECTIOjr WITH DISEASE.
561
Oidiam albicaDs. (link.) Enf^lish mfnonifm^l^hrriHh fim.g\i&. Habitat: Mouth in cases of tlinisb, and certain mncoufl and cntaneous snr- faces.
Sarcina vontriciili. (Goodsir.) ifnto^; Stomach.
Tornla cerevisi«?. {Turi>in,) *%Hm*^yw, CryptococciM cerevisia?. (KQtz- ing.) EngtM st/nonipjt, YeasUplBJut Ilnbitat : Stomacli ; bladder,
PABASITES AFFECrmG THE BL00i>.
Entozoa-
Class B, Sterelmintha,
Hexathjridiiim venamm. (Trentler.) Habitat: Y^x^oMEhlooA, ^f iiaria sangainis liomiiji8. (Hanson.) //afci^/f; Venous blood. Hstonm Htematobia. (BilharzJ /Aj6iV«/ : Venous blood.
PABASITES APFECTme THE LUNGS.
Entozoa.
CUus A* Cwldmintha, I bronchialis. (Cobbold.) //n^t^ .* Broncbial tabes*
PABASITES AFFECTING THE OBGANS OF SENSE, Ektozoa.
Class A, Cwteiminthcu Filari oculi (Kordmann.) Synonym^ Filaria lentifl. (Diesiog.) Habfi- tat : Eye,
Class B. Sterehnintha. DiBtoma ophthaimobmm. (Piosmg.) Habitat: "Eje^
PABASITES AFFECTINa GLANBR Entozoa.
Class A. Cwlelmintha, SnstrcnigjlTis gigas. (DiesingJ Habitai : Kidnej i intestines.
Class B, Sterelmintha, Tetmstoma reuale. (Delia Chiaje.) Habitat: Tribes of the kidneir. Faaciola hepatica. (Linnteus.) Habitat : lAver, Hexatbyridium pingiiicola. (Trentler,) Habitat: Orary,
Class C Accidental Parasites. Pentftstoma dentieulatnm. (Siebold.) HabUat : Ldver ; small intestiBes. Pe&tasioma cotistrictum. Habitat : Liver. 86
663
PARASITES IN CONNECTION WITH DISEASE.
PAKASITES AFFECTING THE MUSCULAR SYSTEM.
Entozoa.
Oass A. Cctietmintha. Trichina spiTalis. (Owen,) Hctbiiai : Mnscles.
PAEASITES AFFECTING THE SKIN AND CELLULAR MEMBRANE.
Si/non^m^ BracimculTis
Medmeo HabUai: SkiD and snbontane
aims A.
Filftria Medinensis. (Gmelin.)
English synonym^ Guinea-worm. tiBsnes.
Clwis B, Sierelmintha,
Cysticercus of tha Toenia solium. Stpiom/m, Cyaticercua tclon cellulosie. Echinococcus homiiiis, or Hydatid of the Taauia ecliinococoiis* (Siebold.)
ECTOZOA.
Phtliirins inguinalis. (Leach.) 3i^luh synonffm^ Crab-louse.
Pediculus capitis. (Nitzsch.) English synfynifm, Head-lonse.
Pedi cuius palpebrainim. ( Le Jeune iu Gmllc^ineau.) Eyebrow-lotiae,
Pedicnlus vestimenti. (Nitxach.) English synonym^ Body-lotise.
PediculLs tabescentinm. (Burmeister*)
Sarcoptes scabiei (Latreiile.) Synonym ^ Acamn. English $ynonyiHf
Itch-inaect. Demodei follicnlorem. (Owen.) Pulex 1)6136 trans, (GmelLn.) English synonym^ Chigoe. HabUeU: fikilkl
and cellular tissue. Cliionyplie Carteri. DefhiUion: A cotton fnngHB oecnrring in the <
called Mycetoma. Habitat : Deei> tissues, and bones of the bfllld9|
and feet. AchorioQ ScliiiDleiuii. (Remak.) Habitnt: Tinea favosa. Puccinia fmi. (ArdstenJ //fi&i7*7/.- Tiuea favosa. Achorion Lebertii. (Robiu.) Synonym^ Trichophyton tonanmna.
(Malmftten.) Ihtbitat : Tinea tonstirans. Microsporon Audouini. (Gruby ) /7aAi/f?^' Tinea decalvana. Trichophyton «i)oniloides. (Von Walther.) Uahitnt : Tinea Polonica. Microsporon furfur. (EichjstMt,) /7<fi/>i7^i^ ; Tine^ versicolor. Microsporon mentaj^rophytes. (Gruby.) Habitat: Follicles of hair in
Sycosis or Mentagra.
EnTOPHYTA and EriPHTTA.
In addition to the parasites cluBsified in the official tiosology under this division as algne, there must now be named some whieJu
PARASITES IN OONITECTIOIT WITH DISEASE.
563
I
since the nosology was published, have received great attention from scientific observers.
A family of the order Sehizoinycetes, the individnals of %vhieh consist of splierical, oblong, or cylindrical cells, sometimes twisted, and whicli inciiease by transverse division, and live separately or in cell groups. Drs. Power and Sedgwick in their admirable "Medical Lexicon-* divide them, after Cohn, into four tribes.
*^ Sphwrobm*teri(t^ in whicli the cells are spherical.
*^ Mkroha^ierm^ in which the cells are short and cylindrical.
^'^ Desimjhacterta^ m which the cells are filamentous.
** Sjnrobact^ria^ in which the cells are tortuous or screw- shaped/'
"A gcnns of the family Vibriones, according to Devaine, fili- fonn, straight or bent, more or less distinctly articulated, in con* sequence of an imperfect spontaneous divisionj and always mo* tionless. Other members of the Bacteridia have been included as globular. The filiform are described by Cohn as JiaclUm^ the glol Hilar as Mk*rococ€u^s,'- The Bacteridia which are most important to name here are, —
BiH^cridfum anihracw or Ba*:iUm wnthracu. The bacillus found in malignant pustide.
Bacteridium fermsnti. The bacillus described as occurring in the leaven of wheat or barley.
I
I
Baderium.
According to Cohn, Bacterium is the single genus of the tribe Microbacteria of tlie family Bacteriaceoi. The term most fre- quently applied to members of this family is ** Bacteria,^^
Bacteria ai*e desei-ibed by Power and Sedgwick as short, cylin- drical, or elliptical cells, hangirjg in pairs whilst undergtiing trans- verse division. Under favorable nutrient conditions, and with good supply of oxygen, they move, freely, at times. Tliey form no chains or threads, but they propagate in a connecting gelati- nous mass, zootjlwa^ in regard to whicli they are distinguished from the sphaBrobacteria by the firmness of the intermediate substance.
061
pahabites in connection with disease*
and by the ab^nce of any finely granulated appearance. The
most important to name in this place are, — -
Baetertuvi carbmieulure^ said to be found in tiie blood of men and animab who liave died with carbuncle* Defined as *' motion* less, flat, straight, highly refraetile, withont inflexion when sliort, and with one or two inflexions when long."
^^ Ba^^rium cat^nuUi (chain-like), a doobtful species, sup- posed to have been found in tj-phoid fever.
''^ Bacierium cuneatmn (wedge-shaped), said to exist in putre- fying blood, and in the intestines of horses and dogs dying of putrefactive diseases.
" Bucterium Urmo^ described as two to five times as long as' broad, about .0015 mm. in length ; often two-jointed, with a vacillating movement, produced by a terminal flagellmn. Found wherever putrefaction of either animal or vegetable matter is going on, and believed, by many, to be the active agent in that process. When putrefaction ceases they cease to be found.**
Bctcilliis,
Meaning a little stick. (Power and Sedgwick.) " A genus of the tribe Desmobacteria of the family Bacteriacese. Distinguished from the other genus of the same tribe. Vibrio, by the straight- ness of the rods,
** Bacillus anih racis. Homogeneous and un j oin ted when fresh, and developing spores. It is found in the blood and diseased structures in the spleuic fever of animals, and in malignant pustule.
•^^ BaoiUm Ujrra. A form of uncertain existence, supposed to be the cause of leprosy.
" Ba<:iUus malariu. A form discovered by Krebs and Tom- masi-Crudeli in the air and soil of malarious districts, especially in the Pontine llartibes, and believed by them to be the cause of intermittents. It consists of small, naiTOW, longish cylindrical spores, about half a niiero-millimetre long, and rods of about the same bread tli, and seven micro-mi 11 imeti^es in length. In the body of animals tlie spores develop into long tilaments, which sub- sequently undergo transverse segmentation, so as to form a chain, in tliC .segments of which new spores grow. They develop most freely in the spleen and the mediiUa of the bones."
PARASITES IN CONNECTION WITH DISEASE. 666
Spirillum.
In addition to the divisions named above must be added the Spu'illum, a parasite of the class algse, and coming also under the head Bacteria. SpiriUum is ranged by Dr. Vandyke Carter amongst " Bacteria (SchizophytsB), forming (like Bacillus) a mem- ber of the Nematogenous subsection, in which the component cells are arranged in rows, and come into a small group character- ized by colorless, screw-shaped threads embracing three genera : — Vibrio^ in which the filaments are short and slightly undulating ; Spirillumy in which they are short, spiral, and stiff ; and Spiro- cIuBUy in which they are long, spiral, and flexible.''
Bacillus Tuberculosis. A Bacillus supposed to be found in the sputa or expectoration of persons suffering from some forms of consumption, and in the walls and contents of tubercular cavities. The parasites, rendered visible by a process of double coloration, and usually demonstrated colored with methyline blue, are seen as minute rods about the third of a diameter of a blood corpuscle in length, and about one- sixth of their own length in breadth. In some of them spores are said to be evidenced, but in the specimens I have seen none were manifest.
^p^
cnAPTER vn.
On FA&A8IT£a AB CauSES OF DiSEASE.
Tub ntder who has Btudied caref n]]y the hi&torj of disease in tlM» part of tliid work devoted to the description of local digeai^eB of tttttmral oriiritu ^vill easily have cunneote^I Dianj of the parasites dMOribod ill the lai»t chapter with the diseases in which they have bMU fi»uud, and will to a considerable escteut have learned the j^ait they j^Imv as factors of disease.
It will, however, be advisable to consider this subject a little further oil, in order to understand how far the presence of a para* «itt? growtli may be taken as a first or second cause of the phe- iHUiidua of dit^tise in the eases of disease in which the growth is dii^wereti
In tlii» review it will, I think, be most convenient to follow out tho \''hm by a reference to tlie parasites under tlie thix^c
gfiM us in which they are described at the opening of the
kal cliapter, namely, aa :
Aiilft^iMt, or Worms,
Kii^Hty or Acari,
A*Hi%>i^yta and JCj>ijtht/t<ij or Algm, or Fungi,
FKOM THE EnTOZOA.
Tltfil^ lUre three kinds of the Entozoa, or worms, which affect Aii Unly aa )>arasite8.
1. The Nctnatinkv or round w^orms. 9, The Ce»tiKk\ or tape worms. a. TUt? TivnialiHloj or lluke worms.
Nematode Disease.
TW Kctcuatodo or n^nud worms include tbo Trichina spimlii^; the Aaoaria lambriooides or common round intestinal worm ; the
PARASITES AS CAU3£S OF DISEASE.
667
I
Oxyuris vermiciilaria or thread worm ; tLe Dracunciilus mediueu- 518 or Guinea worm ; aud tlie Filaria saoguiauB liommiB.
The tricliiiioas fle&h-worm disease, — Tricliiniasis, — has as- 6Hnied in sonie countries tiie cliaracter of an epidemic^ but in England we liave learned its history, cUielly, from isolated ex- amples of it. In order that tlie disease may be induced the trinhinoii& parasite nuist enter the body bv the alimentary canal. The human subject derives tlie hirval tricliirue frooi the muscuhir flesh of some animal on whicli he has fed* The parasite aa it exists in this flesh is iii the larval f tate,— the state intermediate between the eggs and the perfectly developed growth, ^ — and in this ex)ndition it remains so long as it is embedded in tlie flesh* Beoeived into the stomach of a man, or of any other animal, it develops into maturity in a few day. Tlie female trichinte give forth their embryos in abundance, and the embryos at once make their migrations through the cellular connecting network whicli holds all tiio active and nmscidar organs of the body in close con- nection.
In this country, disease from the presence of trichina? hi the tissues is very raj*e, and few English physicians have bad opportu- nities of. studying it. I have seen one portion only of a trichiuous muscle derived from man, and in that case the existence of the parasite was not detected prioi* to death. On the continent there have been epidemics of Tricliiniasis, attended, in extreme in- stances, with intense symptoms.
\V1ien the tricbinous disease occui^ it is marked in its moi^it developed form by three stages, (a) A stage of intestinal irrita- tion, gastro-enteric,— ^corresponding with the period of full devel- opment of the tricbinfe, and the evolution of embryos within the canab (A) A stage of moderate fever, attended with pains in the muscles like those of liieumatism, and accompanied, in some few examples, with a red rash, and boils, — corresponding with the time when the embryos find their entrance into the muscles and am becoming encysted there, (e) A prolonged or chronic stage uf impaired muscular movement with emaciation, — correspond- ing with the after-period wlien tho larvje are entirely encysted in the muscle and are fixed in position. This last stage is not Iways well mai'ked.
food. There is no eatis-
beconies active when it
subjected to perfect cook*
water. TliU degree of heat^
pletely the life of the em-
liftve beeii those in which the
wf&ehetif eooked infested flesh*
i tetuu^iouslife ; they exist ready
date even when tlie flesh in
into decutiipopition. The
t carrier of the triehinotid
^r^^-^ Disease,
i4 which are well known, pro-
I x^ huniaii subject. The large
p-\rv^idcN is one of theee common
Jjle size, resembling in its
It is devf«l(jped and retained
freqnently, extreme irritation,
^ se sleep in children, and to tlxat
J occnrs when a body foreign to
^ dt eontaet with them.
H»«ni as the thread or wiiti worm,
parasite which infests the lower
Mil mdiildren is a frequent Bonrce
1
induces do not usually pa&s beyond those of IcK'al irritation^ but occasionally there is extension of irritation, with phenomena of reflex muscnlar spasm .
The history of the migration of tlie Ascaris hunbricoides and Af?caris vermicularis, is not so clearly detined as we could wish ; but it is certain tliat by some article of fuud ov drink the larvae of tliese parasites enter the alimentary canal, after which entrance they develop tliere. It has been assumed that the introduction is throngh impure watei*, or by vegetable substances and frmts which carry water contahiiiig the larvte.
Another nematode, the A&caris mystax, has been discovered by Cobbold to be uccasiomilly pret>ent in the alimentary canal of tlie human subject. The same yiatient and original observer, M'hose great work on the Entozaa does snt^li lionor to the English school of medicine, has also shown that the Strongylus bron- chialis, a nematode allied closely to Strongyhis micrunig, — the thread worm found often in abundance in the windpipe of the calf, — has Ijeen discovered iu mam These parasites, when tliey ane developed in the body, are also caiTied by food.
Gahica-^wmnji Disease,
Dr. Spencer Cobl>old opens his chapter on the Guinea worm — the Dracimculus or Filaria medinen-sis — with the opinion tJiat the *' fiery serpents" which afSicted '"the children of Israel during their stay in the neighborhood of the Red Sea," were neither more nor less than specimens of this human parasite.
The parasite is found witiiin certain tropical limits in Asia and ^Vfrica ; and is described by Cobbold as tlie adult fenude con- dition of a nematode parasite, which is parasitic only during the final stages of its life period, after it has taken up its resident'e in the subcutaneous and iutermuscnlar cellular tissues of man, dogs, and Iiorses.
The parasite takes literally the form of a scipeut or worm when full grown, having a head with spirnies, an nnifonii cylin- drical b^jdy, and a termination called conmionly a tail. It is viviparous, and repro*liices abundantly. It exists naturally in water, and, as Cobbold explains, " gains access to the hnnuin body without reference to age, sex, race, or country, the oidy necessary condition being that the skin be exix>sed to water in tiiose locali- ties where the Dracimculi iioui'ish."
570
PARASITE8 AS CAUSES OF DISEASE.
The parasite enters tlie body direct from the onter anrfaoe, not by the mouth, but by the surface of the skin^ and prubably by tho 6weat-pores, Getting into the celliihir tissue it attains a great length, and has to be extracted by gently winding it out on ati ivory rod or a qnilK The lower limbs are the parts tifliially affected, and sometimes great irritation is produced by the parasite. After prolonged nionsouns the disease, according to Cobbold, is not nn- frequently severely endemic ; the parasite growing with consider- alile rapidity within the tissue of the hearer of it, and giving rife to a fonaidiible cntozootic affection to whit-li the name of dratwi- tia^is is applied*
Filarial Diaeage,
Another form of disease from worms of tlie filarial kind, is prodnced by the Flhiria Sanfjuinw Ilominis^ and is one of the uiost curious of the affections of the human family that has ever been revealed by minute R*ientifie reseai'di.
We are indebted to Dr, Patrick Manson for so much that has been made out on this subject that we may look upon him as the discoverer of the leading facts.
In the filarial disease tlie filarial embryos are found in the blood of the person affected by them, but only at certain times in the tweuty-fuur hours. The entrance of the end)ryos into the blood liegins some hours before the usual time for going to sleep and ends a few hours before the time for waking. In the blood this minute embryo is of snake-like appearance, having, as Man- eon describes it, a perfectly stnictni-eless body, enclosed in a deli- cate and, for the mo^t part, closely applied tube, within which it shortens and extends itself, giving rise, from tlie collapse of the tube when the body is retracted at either end, to the appearance of a lash at tlie head aiid tail.
The end^ryos may escape from the l>ody by the excretions, and have been detected in tears and urine. It is necessarj^ hideed that the embryo should escape from tlie host wliich received the parent worm, in order that it may nndergo further development* For tliis reason a man infested by these emlirvos is saved from death. In the dog, and in man infested with filarial embryos, Manson has calculated tliat thei^ may be at one momeMt two millions of the embryos. If tliese were to begin to develop into the fulhgrown filarial worm, their volume, lung before they had attained one-
PARASITES AS OATOES OF DISEASE.
671
hundi-edth part of the matnro filaria, would occupy a space many times gi'eater tlian that of the hody of the animal in which they exist Tliey escape, therefore, from the original host.
How they escape from the person or auiiiial in which they ai'e found, and increase and re-infest tlie higher animals, is one of the most remarkable histories in the range of natural science. Where the tronblesome animal called the moHqulto exists there may the filarial disease exist, with the mosqiiitu as tlie fecund ator and car- rier. The man infested with the etrihryo filaria, if bitten by the mosquito at the time when the embryos are in his blood, gives up to the mosquito some of the embryog with his blood. In the digestive apparatus of the mosquito the embryo passes thi'ough three metamorphoses into full development of the filarial worm. About tlie fourth or fifth day, after feeding, most mosquitoes die. Dying ill water the tihiria escape into it, and man using that water comes in contact, accidentally, W4th the jiarasite. The para- site may penetrate his skin, hut more frequently he swallows it witli the water he drinks. It finds its way through his system to its final resting-place, wherever that may be, fecundates there, and fi*om thenee yields its embryos to the blood and tissues, to appear, cease to appear, aiui reappear periodically*
The perfectly -de vehtped parasite, as it is removed from the mosquito, is described hy Dr, Hanson as armed witli a boring ap paratUB, toothed or saw-like, with which it cuts its w^ay into the ti^ues of the higher animal or host, and out of the body of the mosquito or nurse, — the intermediate host. It is endowed with marvellous power and activity. It rushes about, forcing obstacles aeide, moving indifferently at either end, and appears quite at home, and in no w^ay inconvenienced by the wsiter in which it has been immersed. The formidable animal, thus fully eijuipped for independent life, is quite ready to quit its nurse, and if man be- comes its host is equally ready to take every advantage of its posj* tion, and charge him with period icalJy- appearing embryos in liis blood.
The periodicity of the appearance of the embrj^os in the blood is Btill a puzzle. Un Hyers, who has studied the phenomenon, has ventured the opinion that the parent worm from wlience the embryos come reprodnees a swarm daily, and that the product dies every day, leaving the blood free until a new swarm is given forth. To this view, in many respects very natural and reason
JlB causes of disease.
-. incl retains an opinion, which he origiJ : VU5, after remaining in the blood*sti'eam^ ■niwr of hours, retke to eoine other parte of the other set of ve^sele. He holds that in all ca^ got talc the Ivmpliatic vesseK and that when' by tiie accident of a rupture or tear, finds like the urine, the parasite is always With regard to the periodicity* Dr. Ste- ii m vidw^ wliieh was first advanced hy Dr. Mmeiy, that tlie said periodicity is dne to lii vUcli leads to tlie recurrence of sleeping On the idiole I conceive that Myei's' hyputliesis is, m^^ ttlhioai^ it is far from concluaive.
4^ Filarial IHse^zae.
|L» occurrence of Filaria in the body are
kttt il b even more strange still to know
mm^ icittUy be present in the body, and may
u iuitw^b into the bloody without giving rise
; of disease. When symptoms of a
A ^ «ffito fimn them they are those of lymphatic
^m^^ K*i Aa skin called elepliantoid disease, —
KW^ifl^ill wlueh this is brought about is believed
k ^ ^Im U> whdWI li0 designates the miscarriage of the
itiiUtl^ l^v^ft forth the progeny. Naturally, this
. oBOg or embryos living, and they, from
L^i^ s^ «A inck ia dijuneter, travel with as much
♦ fi'Ottcto* thmnitlves. They pass through the
«ii llfct Ijmiriiitie yessels, reach the tltoracic
• It ijleniill ^ v«QOUs blood readily. But some-
v«iV mdl M ih# deatli of the parent^ the ova are
sm ««aibti^;rM» WMsd in them are set at liberty.
^"^mtttitt^ b«tw«cn yf^ and ^, they cannot
I to reacli the bkK>d, As a result
i|> id* lytiiphatie veaaels, cause enlarge-
^fic obstruction^, that dis- ^ iUtoid,
is as singular in its way as
K\] at ]>p. 38(U1 in the pre-
,uuu of the success of careful
PARASITES AS CAUSES OF DISEASE.
573
and painstaking inquiry in the imravclling of the phenomena of disease, and of modern facilities for physical research,
L
^^^b Cebtode Disease.
W The Cestode or tape-worms iiiclucle the Tr^nia or ordinary
■ tape-worms, and the Cysticerci or bladder-shaped worms, — ^Hyda- tids.
■ Tlie phenomena of disease induced hv the Cestode^ or tape- worms, are all related to foods, and the relationship is giiigiilarly exhibit ive of the success of scientific experimental research in ita
(application to medical and sanitary seience. Tape-^von/i Disease. The tape-worm is tlie cestode with which the community is most familiar; but it is, in fact, one only of several piiases of a distinct parasitic growth. It does not enter the body as tape- worm, but is derived from a larval form which is present, usnally in the encysted state, in the fleshy or visceral parts of animals that are consumed as food.
The commonest tape- worm in the human subject is i\ioTmim solium^ a flat, ribbon-like worm, divided into numerous segments, and reaching sometimes a length of many feet. The longest I have seen extended to sixty feet, but some observers have spoken of a length far exceeding even that. This worm is derived fi^om the liydatid known technically as the C^«ticiTcus cdluloHw. The embryo of the C^ysticercus, swallowed accidentally by an animal which is to become human food, the pig for example, enters the alimentary canal, pierces tlio mucous surface, migrates alung the cellular or connective tissue, and becomes embedded in the inter- muscular spaces. In this position the embryo undergoes develop- ment into Cystieercus celluloei^, and so, infesting the flesii of the animal^ gives rise to that diseased condition of food commonly known as measly pork.
The measly food is the source of the tape-worm. By booklets with wliich it is armed, the living Cystieercus connects itself with the wall of the bowel of him who swallows it, and sprouting, as it were, from the attachment it has made, becomes the many- Begmented, long, flat tape- worm,
PAEAdlT£3 AS CAUSES OB*^ DISEASE,
Hydatid jymase.
^ k iaotber side to the qneetion of indncM diseases from Th© imperfect cestoda worms from which the tape- WMBS ve fforidoped^ are, in their turn, the causes of diseases vUeii wore cbaracterized by the old writers as hydatid diseases, iBfd w&ieli aaiocigftl the people are still known by that general HBMu Thm kydaiid disease originates from the tape- worm, and m WMnpb illiialraiion of the fact is derived from the history of ymoUio djicace in the inferior animals. The dog is commonly ^Aitadl vikh the ta[>e-worm called tlie Tamia ammrus. Tlie Ami^ b infected with an encysted hydatid, the C(mmru8 cere- JPnATti^ whidk ttSeetd its bi-ain« and gives ri^e to the disease calk IIhi *«lngjpf*rs** or '^sturdy/' If a sheep be fed with taenia from' a dujt th<> cftMinnid will be produoeil in the brain of the sheep ; •IMi if % il<7g be fed witli ca^nnrns from a sheep the tape-worm will ocemr in the intesline of the dog. Experimental jt*searches \tAS^ since |^r\>ved thai the two forma of disease can be thos, McJ|NrociIIy, itidttced.
TW iUMstimtion extends to the human Bubjeet A little tape- WWVI wlliekii found iu the dog, and is called tlie Tmnia erhino' %SKXwi^ yWldii a larval form whidi is cystic, — the bladder-worm, or l^rdiitiiii i4 t ^ ^inococci^s Ilominu, In its embryonic state
Ihill y«*iiiiiti . u^into the intesthiHl canal by food or water,
yettiHiit«# llie tissnec^ and becomes in time encysted in one or V(tm^ Ike vital oi^is. The liver is the oi*gan most frequently llUflfcrt, but no organ is actually free from invasion. Tlie em- Wy^ i3tt 4w tvur«e beoomes developed into an easily recognizable iuauftl {i>riu etielciied in its cyst It has a head with a double J SHVWU %A bookk't*, a Ixxly containing calcareons particles, andi four «iAckw>
XIHMItyll uh^t pi\H:i8c articles of food or drink embryo of the
ivhlnit^xiocw is ititrvHiuccd is not yet completely known ; but the
'Mlal i^vkWnce of introduction by alimentary substances
^ gM4M«Mli«livew
Syn^ftoms of Cestode Dlseam,
fhg^ pkmuoau'na of disease caused by the cestodes are many
•4iHt importaiiL The tape- worm is a source of constant irritation,
kiiowMgo of Its existence in the body often causes mnch
PAHASITES AS CAUSES OF DISEASE.
576
I
The most dangerous fonns of disease from parasites are those which follow the insertion and development of the true hydatid, the echioococcua, in the tissues and vitid organs. The echiiiococ- cus, as if it had a roving commission, plants it^ielf in t!ie most various and important viscera. The brain, the spinal cord, the eyeball, the lungs, the liver, the inteetinal glands, tlie kidney, the urinary bladder, the muscles, and even the caveiTioiis portions of bone itself, are homes in which it may live.
In consultation with the late Dr. Herbert Barker of Bedford, I once saw a man who threw off the cehinococcus by the renal secretion, and we traced in this instance the mode of entrance of the larvae of the ttenia.
The man had for years subsisted almost altogether on fresh pork, in so far as animal food was concerned, and twice weekly had feasted on pig's fry, a dish made up of the intestinal part of the swine. On some one of these many feasts lie had, by acci- dent, partaken of a fry containing an embryonic parasite which the swine had picked up while feeding, and which had come from the tape -worm of a dog,
Trem-aioiU or I^luks-worm Disease,
Disease from the Trematode or flnke-wornis is rare in man. In sheep, the liver fluke, Fasriida hejmiicay is, as is too well known, a cause of most serious and extensive disease, and the same para.site Iiasj in a few instances, — not ten probably alto- gether,— been found in the human Ijody, By some ha]>py acci- dent or necessity man has, up to this time of his history, missed the food that conveys this fatal enemy ; an accident the more to be wondered at when it is known, as Cobbohl truly says, tliat the liver of a single sheep may, at any given time, harbor several hundred specimens of the iluke, and that every mature specimen may contiiin many thousand minute eggs.
The fluke knowni as the Dhf^itna Ilmmatolna^ or Bil'harziu Bc&matohia — from the name of Dr. Bilhartz, its discoverer in raan — is sometimes a cause of fatal disease in Egypt, Mauritius, and the Cape of Good Hope. The adult male wf^rm is nearly lialf an inch long, and is broad ; the female is longer but nar- rower than the male* The worm ivas first found in the portal veins of the infested subject, and the blood seems to be tlie seat in which it is located. Its ova make their way into the excreta*
FiBiwrw AS CAirsss of disease.
Hi a^ tiie Ud&ejr, mud may be voided by the nrine* They riw Id gmt coDgeetioa of the affected organs, to irritatioD, B vonl ewes to exinmuatioii of blood. The mucous mem* lof theGoloQ has been fotind charged witli vegetative looking . ! fiUed with e^gB of this parasite. The para&He or its ova pmbftfalj fiodd its war iato the body by means of drinking water,
DnKASsa from tsb Ectozoa.
The di9ea«es caused by the Ectozoa, parasites affecting the Mr mrfiftoe of the body^ are of three classes. One class la due to Ibi presence of pediculi or lice ; a second to the acariis or itch IMBiet ; a third to fungoid or vegetable parasitic growths.
Some authors divide these parasitic diseases into —
1. Diseases dependent on animal parasites : —
(n) Phthiiiasis. Diseases from lice.
(>) Scabies. Disease from aearns scabei or itch insect.
S. Diseases dependent on vegetable parasites : — (fl) Fa%nis^ or scald head.
(^) Tttiea tonsurans, inclnding herpes tonsurans, sycosis, herpes liaatiis^ and Tinea Polonica. (c> Pityriasis versicolor. (d) Alopecua. (#) Mycetoma, or cotton fnngus diseasa
PAiktriasts*
The parasites producing tlie diseased conditions included lUKlir Ihe prt^siuit sub-section, ai*e of three kinds,^ — i\m pedu'tdu citi^iiiit^ %\k^ jp^titvu/i^ jmhi\ and ihe jHidtcuJls corporis. The first ia l)w» insec't which is found on the hair of the head ; the second on the hair of the pnl>es ; and the third on the body. The first is smaller than the other two ; the second, crab-shaped, is usually adhereul to the root or base of the hair ; the third is large, and moves rapidly, causing mneh irritation. The first never leaves] the bead; the ejcoinid is alwaj's found where there is hair, but not on the head ; the third never invades tlie liairy parts at all. These parasites give rise to prurigo, — itching,^ — and sometimes, as 1 a cvkuseqimic^ of irritation, they prodnce, indirectly^ an eczema, Tht?y am proniottd by undeaulincss of person^ and are transmis-
PAnASITES AS CAUSES OF DISEASK.
577
I
I
I
He, directly or by their eggs, from one person to auotlier, 801110 pei*8on8 of unheal thy constitution are affected by theen witli fij^jecial facility*
The parasite called Aearus seahei or itch insect is one of the most definite of causes of parasitic disease. The insect burrows under the skin, and produces intense itching and irritation. The body is tirst iufcsted by tlie female acarus, whicli pierces the skin to the lower layers of the epidermis aud there makes its home. As it deposits its eggs it burrows still deeper, and in tliirteen tu fourteen days the new acarus is hatched aud set free, Tiiis nnues to the surface of the skin. The male insects reuiain on the sur- face, but the feuiales after iuipregnation burrow into the ekiu, Uke the mothers from wblc^h they came, aud thus the disease continues to be extended. The feuiale acarus having once bur- ix)wed under tlie skin does not return to the surface.
The effect of the insect on the skin is to produce a painful eruption, which is often pustular at places wdiere the skin is pierced* The irritation leads to much iteliiiig, and the frit/tion used to relieve this symptom is a cause of further irritation. When freshly separated from one of tlie infested spots, the fe* male acarus is large enough to be seen without the aid of a mag- nifier, and is easily seen by the lielp of a (VHlringtou lens. It lias a roundisli body; a head armed with mouth, but not provided with eyes; and eight legs. The mule insect is much smaller than the female. Some years ago Dr. II assail discovered an acarus in some varieties of coar.se sugar, and inferred, I have no doul)t cor- rectly, that the disease called grocer's itch is caused by the hand of the grocer coming into cout;ict with the impregnated female insect from the sugar. In a case of this kind I found au acarus on the person affected, but failed to find any insect in the speei- inen of sugar from which the patient believed he had become affected.
The disease, scabies, is mechanically conmiuuicabie, and is rarely met with except amongst very uncleanly people ; but it may, by accident, be contracted by cleanly peo}ile, TIjo flexures of joints, aud the spaces between the fingers at the points where t!ie fingers meet, are the parts most easily infested.
By very simple means the acarus seahei can be killed, and the disease it produces removed, qi\ as iB commonly said, cured* »7
578
PARASITES AS CAUSES OF DISEASE,
Diseases frmn the Vegetable ParasUm.
DUecme confurhd with Achorion Sehotdeinu. — The Aeborion Scljunleitiii is intimately connected with the disease Datued Faviis, described at p. 205. The parasite \% a f iingoiis growth, cinnsijitiiig of sporules of about y^^^ of an inch in diameter, containing, eonietinies, gmniiles; and of pointed tubes, of about ^^ of an inch in diameter.
Diseases conrwded with TriefiQphyt^n tonsurans and sporu- hidesy and wth Microsjtat*on nwn/a^frftphf/t^s, — ^The para^itef! here named are connected with, if tJiey Ihi nut the canse of, TineA tonsurans,— ring-worru of the head; Hycosis; Herpes eircin- natns; and, Tinea Polonica, diseases described at pp. 261-20(1 The }»arasite8 ai*e composed of very mimite spores and spomlc^, strung together hut unaecotnpanied by tubes.
IHsiOH*' (xoin€c(€d with MicrmjM>r(m furfur, — The Micro sporr»n fui'fur is a vegetable sporule <»r spore of rounded shape, and with short branching tubes. Tlie spures run in clusters, ami adhere firmly to the epidermis or scarf skin. Tlie parasite is the c-ause of or is connected with the diseaf^e called Tinea, or Pity- riasis versicolor. It produces yellow or hmwti K[)<»ts uti tlie sur- face of the affected skin.
Disease connected ttith the JI iceoj^jMjron A W<>?i/;<i.— The af- fection called alopecia areata — ^baldness — is attributed by some writers to the vegetable parasite, Mierosporon Andouini, which is made np of minute spores and fine tubes or filaments. The spores are sometimes met with in the hair itself, prodncing in the hair- tube a swollen or bulbous appearance which is very char* acteristic.
Disease connected with Chiontfphe Cmrieri. — Cottmk Fungtis Disease*
The parasite called Cliinnyphe Carteri is a cryptogam, which getting beneath the skin invades even tlie bones of persons whouj it infests, and gives rise to the diseases called Mycetoma, Madui'a foot, and Fungus foot, described at p, 260. T!ie three disea similar in character^ are attended with apparently different pari*'! sites, due probably to different stages of development of one original form. The parasite exists in roimd firm masses of moiUd- like character.
PARASITES AS CAUSES OF DISEASE.
579
I
I
I
III describing some of the aSvSiinied vegetable parasitic affec- tions, 1 have lieaded tlie paragraphs introdia'ing thcni so as to oonnect the parasites with the diseases in wliich tUey have been found ratJier than to put them forward as primary causes of tlie diseases^ This is necessary, for the opinions of the best ohsc*r- vers are still divided as to whether the parasites are causes, coincidences, or effects. I do not tliink, for my part, that they are ever first causes. They would not exist, I mearij unless tlie diseased conditions which favor their life had nut been made for them. Viewed in this light, they become symptoms or con- eequences, or, at most, aggravations of disease rather than causes of it
BiSKASES FHOM THE ENTOPnTTA ASU El'tPHYTA, IKCLUDnfO
Alq^ l^'uxor, AND Myckodkrms.
Difteam connected with LejUothrh^ Jiurmlis. — Leptothrix isaii alga affecting the month. It has been discovered in concretions on the teetli, and on the tonsils. It is not a known cause of any serious local disease.
Disease connected imih Old him AlhieanA and Tor id a, — The filaments and spores of Oidinm Alhtcans arc always found in tlio eruptions of thrusli in children, and are always atteniled with an acid secretion of the nioutli, a fact which leads Dr, Leonanl Sedgwick to consider the parasite as a cause of fermentative change in the mouth.
This minute parasitic vegetable growth has been assigned as a cati.se of other diseases. M. <J'(»lljn reported to the Academy of Medicine^ in the year 1H64, that three i>ersons who were cutting vines, by an acci<lent cut theinselvcs, ami were poisoned by the oidium. They all suffered after a few days from loss of appetite, shivering, and fever. Their wounds, wduch originally were slight, became gangrenous, and their limhs swollen. In all of them there was ** mwjaet " of the mouth, which consisted of a cryptogamous product called the *' oidium " of the mouth.
That the parasitic cryptogamic oidium albicans may, by in- oculation, become a cause of disease in the human subject, was an hypothesis already advanced in May, 1858, by Professor T^ycock,
late distingnialied professor of medicine in the ITniversity of Edinburgh, on his discovering the Oidium in a pellicle or false membrane that had formed in the throat in a case of diphtheria*
Sli FAKASmS AS CAUSES OP DISEASE.
H kift tern inferred thiil disease maj be taken from tlie nC ^ Hmut oomatnjpg a «aiiLar parasitic fitngus — ^' Oi/iium art- mmiimgiam,^ Tbts fiingiia w»d ilia*overed by the late Dr. Holi^rt P^Mifcis Thamygp in a specimen of 1)read made fi-om an infenor kifed of floor wUeh aasily lieoomes acid when exposed to moisture, mU vUeh omitB ibe weJI-known ^our smell, even after it lias fenttt IvtM^ into bfead, if it be for a sliort time exposed to moist ^.
Tb# tfpona of the Torula (krevmm or yeast plant have been JtliWiwiJi m llw teenytioQa of tlie body, and were at one time I^Hlttd ¥» bs QOOMeted with choleraic disease. The hypothecs ^aa Bdl been fingfednod,
Dimmmfroft^ Saireina Vmirieidi,
Tl#p«rt»ii» c&lkil Sareina, and Mhieh is made np of a series dFl>0(k Md lug!i»tlMir in sqnare-shaped masses, has been found in Ite incitlk'^ng of tlftH 8lonuu!h, in some excretions, atid in the fluid irf (te ti^lrtein of the braui. It is most commonly fonud in the twJC^tkwil 0>f th<r gfnniTirh, finl hence the common name Snmnn Y^lniHI& WImh praeent tltere it develops with great rapidity^ Mil kiV^I^ tik|^ M iMQisant irritation which causes vomiting of a MOtlfajr 9cwr CmftWling fluid. In one instance of this kind, lilMo^ iPti ttndir hit own care^ the irritation lasteil for months ?*t^iH iMi iW fitmtmm of the parasite* and as the digestion of IInmI Htm 4ftliiM^ dloppad death itself became imminent. At tlmt ttriiii iImi f^r«iplOHii suddenly ceased, and recovery was completed
iSigypoftUklMialiMMl dttectetl in the fluid vomited in p^TOsisor iMW4^boh»K Md Iko Into Dr. Tilbury Fox believed that he had iJIwntTiTr^ ^ |*tTTr*** cm tlie skin. Its precise mode of intro- dtifiltDik t&U> tti4^ K^dy is not as yet imderstood.
K-^^tm-vn^ ff^ (\mneciio*% ttith Bacteria and BaciUL
\\ \\\f^ ^i^MSo ^f Iho last chapter a list is given of the various v.xl K^ Uw leniis bacteria and bacilli, and of the diseases Vk :^>.»M%^) to »prinij frt^nn tlicse parasitic organisms,
i^ni btteilHan pamsites are now found to be present^ bii i%n<i*enU in the secretions of many conta»rions dis-
^ ^\f ^>me other diseases which are not ordinarily
vx.*»i-.,.iv*vM i.\s«#i^^tMilk Tho reader may, thei'cfore, turn to the
PARASITES AS CAUSES OF DISEASE.
581
I
I
chapter on diseases which run a definite course, and attach a par- asitic growth tu many of tliem, as well as to phthisis, ague, and leprosy. I do Dot propose here to enter into the controversies which have arisen in relation to the pret^ence of these organisuis in the diseases named, or in regard to their position as causes or effects, because I must refer to that snljject later on when treating on the causes of zynioHc affections. Eut I add one remarkable instance of a disease attended with a bacterial parasite in the blood, as a good typical illustration.
Spirillum in Famitie Fever,
In the relapsing or famine fever of India, Dr. Vandyke Carter has discovered that tlie vegetable unieelhdar parasite described as s[iirilhnn is found in the Ijluod of the affected persons.
Respecting this fever it is admitted by Dr. Carter that no precise information was procurable as to tlie origin of the epi- deniic disease, in the Bujubay Presidency, from winch his obser* vations were made. But as, in the country districts, the fever seemed to appear simultaneously with famine, ho alludes to ihe possibility of an iiulupendent origin of the disease. Supposing that the blood spirillum in some way represents the blood poison, it becomes conceivable, he thiuksj that in certain impaired states of the frame, ^ — the result of starvation and bad hygiene, — it might originate by a spontaneous variation of tlie spiro-bacterium of the saliva. Or the organism might be derived from the spiro-ba*^- terium of impure water, which in a simiku' impaired state of tliu body finds an effect ivo entrance otherwise debarred to it under lioalthy states. Possibly, he adds, germs of the spirilhmi are commonly present^ but remain inert from absence of a nlihis in the normal blood, but which find a suitable soil for some stage or degree of their development in an impoverished blood. Such germs produced dminj^ previous illnesses might lon^ lie dormant in the earth or a biiilditig, e. g. as '' lasting spores*' until a return of the conditiona adapted to their growth ; this woidd account for the seemini^ly in(lc|)eTuleTit origin of some fresh epidemics.
The whole of the evndence brought forward by this laborious investigator tends to show that in the epi<lemio he witnessed the parasite spirillum was present, as a rule, in the blood of tlie affected. At the same time he affords no proof that this was the pritnal cause of the fever, while he proves, incontestablyj thr""
f
26i
PAJtABITES AS CArSES OF DISEASE*
mA primki cftttsa is eBBenliallr related to porertr and famine. In m wohj, a certain diaeaeed conditiou of the blood and tig&ue most be present for either fever or spirillum to be jnaiiifefetedi| The preciee part plaj^ed br tbe pan&ite in the dieeaee bas }et to be demonstrated, together with the fact of its pmsenee in all epi- demie Yisitatioiis of the same affection.
Beeently Professor Ponfick of Breslau has described a disease wUeh is contracted by man from the ox. The ox is attacke<L BOmetin)e8, with a tumor affecting the jaw, usually the lower jaw, tnm which the infection is assumed to Ije diretrtly or indirectly eQilve3red lo the human subject. In the diseased person fistnlous * j^ occur in the skin of the neck and back, ending witli snp- i :. a and phlc^^on, or with pneumonia, pleurisy, or perito- nitis* The discharges from the openings contain yellow millet- like aeeds of fatty character i^esembling what is present in the ox. The millet-like seed consists of a number of small elementary bodies of Mycelium or fungus which Bollinger had found in tJie ox, and called actinoniyces. The disease in the ox is called Ac- tinomycosis ; in man Adinotn^cos!^ hofuinu*
Oh ik0 JParamiic Origin of PhihUU Pulmonalia or VoTutuinjptlmi
of the Lumfs.
^Ve have already seen that a bacillus may be found in the expectoration and in the contents and walls of cavities of tlie Inng^ of persons who are suffering from phtlusis. This observa- tion was tinst made by Profet^or Koeli, ami fiom his experiments on the communicability of symptoms of phthisis to inferior animals it has beon inferi*ed that the bacillus is the cause of this di^ase. The subject has excitetJ the keenest interest in the med- ical w*orid. Fitira the contmversy which lias been elicited, and which I hrivo followed with the closest attention, I gather that in the enthusiasm of the controversy, conclusions have been arrived at which are far too comprehensive to be even near the expected realixation of truth.
In oixler to prove the origin of phthisis from the bacillus of tubercle it has been all at once assumed that j>hthisis is one dis- eaBe. Constitutional tubercular phthisis; alcoholic phthisis, which need not be constitntional ; syphilitic phthisis, and Gxery otlier
4HteA
SITES AS CAUSES OF DISEASE.
583
variety, have been tlirown into one* This is entirely opj>osed to the facts of experience relating to the history of the disease.
To eiipport tlie speeidatioii still fiirtlier it 16 insifited on that the di.*5ease is always eonmiunieated from one person to anotliei' hy contagion. This view is of course cj^sential to the hypottiesis. But there h no evidence that the disease ia ever carried by con- tagion» I was for fourteen years physician to a hoRpital for dis- eases of the chest, and in the large piihlic experience tliere gained, together wi|h that obtained in private practice, I have treated over three thousand eases of the disease. In that large field of observation, extending over thirty years, I have noted no ques- tion more carefnlly than that which relates to contagioUj and 1 cannot recall a single instance in which I conld trace, in a clear and satisfactory manner, that the affection was comninoicated from one j>ej*S4:>n to another.
I have known persons who were susceptible to the disease exj>08ed to what would have been the extreniest peril if tliere had been contagion, hut have never known contagion to result under such cii-eunistances. I have known three members of the same family die of phtliisis, the tirst affected being in closest com- panioubhip with tlie others, without any eoinniunication of the
Esase at the time. Yet years afterwards those same persons, ^on the mere accident of taking cold, have contracted the disease. I never knew a nurse, a doctor, or any other attendant on the con- sumptive take tlie affection from contagion, nor anything that at all resembled such relafionsliip.
The supporters of the bacillus hj-pothesis, in their anxiety to make it true, ignore the overwhelming evidence of hereditary tendency to phthisis. If all were susceptilile to the disease all would take it, and the fact of taking by infection or contagion would be obvious to every observant mind. But, in trntli, few if any suffer from the eonnuonest form of consumption, tliat which attacks the young, except they are born with the pri:M?Iivity to it. In the cases I have seen over ninety per cent* were hereditarily disposed to ttie malady and l)ecanie stricken with it, as an all but universal rule, while living with other persons, and under the same conditions as other peisons who wei*e not affected with it.
Once more, in order to give credit to the hypothesis, the pe- culiar condition of body of tlioso who suffer is practically set aside as of no moment. It is well kuowu tliat they wiio are disposed
or HSULSE.
■1^ ^mv], imm comnioiilj b nar - . Milk mpimtioii ; a delicate^ ~ - rmtm. We, indeed, wlia from 0mm.tmm u once the feopl^ wba aro wmt limj a» in dnger, indt iieontagioiL
I of tlio diaeafie fit in with t)ie
ioggesled that a snsceptible
^ ^ long a^ be* or ii\ie does not
«:Ais whidi (ixcstcs the disease.
^ fkmommM cf Urn comuieoeenieiit
* ^mm thai iIm fsavunon ej^citatit of
^1^ jr eoauDoa odd, oaoitmeted, osn-
^■flia Iram iiiuwm^k, frocn anxiety,
^-.^ safiueooa I nm aamJT reed]
^a» di«a«e was nut ft%Ma a cold ;
mr tiinev viio has latcJr passed
..^ jHa expnioocd to me wlien we were
^«i»4f icnte tnborenlom bn>ught on
dat there was no observation iu
as tliat of the development
a, frt»m taking wliat in
^ifi a cold.
i^^hoi'ause tlier do not chime rv, is. I venture to submit, out "rt been performed is in any xpmiiient from experience, : -i^ in another way. In in which plithisical dis- .tion, I induced similar -]ihere containing vapor : dii-ectJy on the ner\*oiis .^laevift nzMier tlie nervous control, ^gpia'ta the pulmonary structure; ^IwgH of an hypothesis, wljo giaTi is the cause of phthisis Hb-ig jast as rational as tlio germ
^liiili imm practically with the niidusiij is that having refer-
PAHASITES AS CAUSES OF DISEASE.
685
enca to the faet of the injurious influence uf close air on those wlio are predisposed to the disease. I have shown over and over again how easily phthisis is developed in predifipoged persons who sleep in a confined and imveiitilated room, and I have cpioted the hititory of the hairack hie of uiir lioiisehold troops some years ago, and of the ravages of consuinptioii in them when they were housed in confined and close air.
Such facts at iirst seem, truly, to give some countenance to the parasitie hypothesis, and if they stood alone tliey would he forcilile if not demonstrative. As it i&, they can only he taken in eombinadon with the other facta above stated, upon which they ai*e found to tally so completely with the constitutional and neuro- pathological tlieory of origin that they need no other explanation. The coutincd and devitalized air acting as a depressing influence on vita! action favors predisposition, and enables tiny disturbing cause to set up the first series of nutritive changes in the lung from which the rest proceed.
On the whole, tlien, all that it seems to mc can be honestly admitted in i-espect to the parasitic nature of plithisis pulmonalis, is, that in certain instances of it, perhaps in many instances of it, a vegetable parasite is found in the affected structure, and in tlie expectoration. Cut even this requires still further proof.
SCMMAST.
The summary of what is reliably known respecting parasites aa causes of disease may be placed as follows :
1. The embryos of certain parasites enter the body by the alimentary canal, remain in the canal and develop there, causing mucli h:»cat irritation. Example; — Lumbricus, Taenia, Ascaria.
2. The embryos of some other parasites enter by tlie canal, develop there, pierce the tissues, and by their presence produce irritation and various subsequent changes of disease in the tissues and organs with whicb they are brought into contact. Example : — Trichina Spiralis.
3. There is one parasite affecting the blood, the embryos of which appear and disappear from the blood with periodical regu- larity. Example : — Eilaria Sanguinis.
4. There are some parasites which pierce the skin and pro^
AS CAVSSS OF D1S£ASB.
bf lodgneal m tike w Guinea in<in.
Exmtnple : — ^FOmria
& Tbere are pandtai wkidb mSeet tbe outer nufiea
potofe sad prodi
ScabeL
K. Thetie are i
which ^t
i of tlie ddn* £x-
tlie dan or iti
appendages ami pn>ir tbere, aggraTaltiig the sjmplDittd of •
but prcpbaUr not {mMlodng dioeaoe oi
Acfaorum ScbunletJ
Example:
There are regetaUe ]
, which would he placed
iwii
lists aaef the nature of A%Rt. They aiB the aim} and mm tcmnd m the blood, in the eecretiocta^ and i the ftmctares vf the bodj in tmrnefoos diiiMMe6» aa in tjpboid, Aiwdip lelapeiiig ferer, ^ gonorrhflBa^ ngoe, lepFoej^ maltg*
fimA pnstnlei pjnemia, fl ^ ^ dmonalts^ and other diseaeea,
To these parasites, oolorieea and mtkellnlar, the name Baderii haa been applied. Tber are arranged br Cohi^ as already ehoim from Power and Sedgwick a description^ as Sphs^robacteiia, globe- like, including lOcroeoecoB and Sarciua : Mierobacteria, rod-like; Desninliacteriii, larger rod-like ; Filobacteria, thread-like, ineltKl- iiig Vilirio mid Bacilltis; and Spiro bacteria, epiral-diapedi in- cluding tlie Spunllum.
The mast important of these Biniple colorless otganisnia, in the view of tliosc who attacli primarr Tncaning to them as causes of disease, are the Spha*robacteria, which give the inicroeoecas that has been observed in some of the eon famous diseases and in fiilk'Worm disease; the Desmo- and Filobacteria ^' ''' the bacilli, which, as wehaveeeen^ are fouiiJ in anthrax^ i , and
malarial fever ; and the Spirobacteria which yields the Spirillora^ discovered by Carter, in tv fever. There triay also be
added as belonging to the ^ _ • parasites, the fnngns whicli
is met with in mycetoma, Madura foot, or fungus foot disease.
To this summary I have the privilege of adding the following brief notes, on the question of the probable derivation of the vegetable pai*a8ites, frc»m the pen of a microscopical observer, Dr. Braxton Hicks, who of all iiieti ha^ beeu most minute and impa^ tial in investigation :
"(^1 The vegetable parasites on the human body am mostly of the yun(/uSy rarely of the a/^fp, tribe,
"(i) Both have many modes of growth or different phases of
PARASITES AS CAUSES OF DISEASR
687
I
I
I
r
existence, so that when we come upon one mode, we have but slight kiiowletlge of tlie total of the plant.
'* (c) Bacteria, for exuinple, is only one phaso. If it is uf ftingns origin then also we must look in other direi^tions for the other phases.
"(c^ If J for instance, one looked in other partH of the body for that Bupposcd to be the cause of phthisis we should expect to be disappointed ; in otiier parts one wonld expect to tind some other phase — e,g, mycelium,
** (t^) Speeiniens exhibited from lung strnctnre in plithisis seem fioinetimes to be clearly a form of ' Hinary segment iitiun ' of some fungus. The fungus might in that situation go on multijilying in that form till some general ehange of the condition of the system or lung occurred ; then it might alter its m^de and continue in the altered state until another change occurred.
*'(/") It may be inferred that these parasites arc fungi rather than alga?, because algai like light. The lung cavities are suitable to fungi, and low states of healtli favor fungus growths.
*' (^) Hence it is exceedingly difficult to say whether, supposing the lung cavities to be tilled wit!i these segnientating cells, they are the cause of phthisis or the accidental condition.
** (A) The same remarks apply to all diseases of iJRcterial origin, — ^I mean tiJl observation and experiments have proved that thf introduction of a specitic Bacteria reproduces the growth and Hceampanying disease,"
In this review of the parasitic origin of disease, I have kept elosely to the diseases of the human subject, and have avoided pefereneo, except in the most incidental maimer, to those Innnan diseases which am supposed to bo of zymotic origin, atid wliieb an* believed by many to be excited by parasites acting as fer- ments. To the last-natned topic attention will be dh'ected in the chapter which iimnediately follows.
CHAPTER rm.
ZYMOSIS OR FERMENT AS A CAUSE OF BTSEASK
I ENTER HI this chapter oij one of the most debatable subjects in the whole range uf medical ecieiiee ; 1 mean the pan played bj tlie process of zjunueis or ferinentatiou in the production of disease.
The idea of fermentation as a canseof disease is very old* At varions times it has been held up as the origin of all diseases which run a definite course, aud which seem to be communicable froiu one person to another. At other times it has subsided as an hypotliesis almost altogether. When, in fact, the theory of di^ ease being dependent on changes in the secretions or humors and in the blood from which the secretions come, — a theory designated the humoral juif/iolofji/y — has been prevalent, then the zymotic liypothesis lias prevailed. AVlien the theory of diseases being (Ino to nervous impressions and to abermtions in nervous func- tions,— a theory designated the ncuro-paiholog^ij^ — has been in the ascendant, then the zymotic hypothesis has all but passed away.
The works of Thomas Willif^, of Yau rielmunt, of Becher, of 8tabl, did much during tlie two last centuries to snpport the hnmorat pathology. The labors of Ilaitley and Erasmus Darwin in the last ceuturv, and of Bieliat at the close of that century, with those of Charles Bell, Walker, Gall and Spurziieim, Pro- cbaska, and Marsliall Hall in the pi'esent, did as nnicli to support the nenro-palliology. These two tlieories have been specially reflected iu theorizing studies on tbe origins of disease. After Willij^'s great book on fermentation all tbe contagious diseases were thought to be of zymotic origin, and the hypothesis will be found recoixled, for a long period of time, as if it were proven. If the reader will turn to a book published so lately as 1835, Sir Richard Phillips's *' Million of FactSj'* he will find the woi-d con- tagion thus commented on at p. 123.
ZYMOTIC CAUSES OF DISEASE.
SBB
" Contagion is one of tlioFe generic words whidi, like attrac- tion, bewitching, euctioii, iiiidead and obstruet inquiry. The dif- ferences about it among the faculty are intellectual phenomena. Is not contagion, says Dr, D wight, sut'h a fermentation of an ani- mal body as generates animalculsej and, hence, the danger of eon- tact ; and is not exemption, after affection, evidence that the arms in that eubject have been exhausted ? Do we nr»t snlj^^ist 'on such germs, and i^ not the class of contagious diseases evidence that they have overcome the iisnal economy of the subject ? The separation of aninudcula; in our microscopic experiments prove the nniversality and indestructibility of their seeds or germs.**
In the present day the tendency is again all towards the hu- moral pathology, and so strong has this tendency set in that the hypothesis of disease from fermentative changes is once more in ftdl tide. In the force of this current of opinion it is, in fact, very difficult to steer safely. It carries tlioso who are npon it away from all old landmarks and soundings^ Nervous phenomena are ignored altogether, and tlio nervous system itself is almost for- gotten. Hereditary proclivities to disease are treated as of little motnent, or are discredited. In a word, notliing is required lu account for the symptoms of any disease except a germ to excite some kind of fermentation indicated by symptoms which, in reality or in imagination, may be due to a pixxiess resembling fer- mentation.
The exti'eme advocates of tlie zymotic interpretation of dis- ease hardly see, and hardly, it is plain, care to see, to what results tlieir unchecked course is carrying them. If they wish to be au- thors of an instanration founded on demonstration, they must go to the complete proof that the continuance of life iteelf is by a germ derived from without by every animal that propagates its Bpecies. It must not merely be so many germs so many diseases, but also 80 many germs so many animals ; and the germs of ani- mals, not loss than of diseases, must be floating in the air, — in- visible, but there.
I shall endeavor in this chapter to avoid the extreme views which I have here described* I shall try to put the facts we have, lip to this time, in hand in tlieir fair and legitimate position, and having done this, I shall leave the matter to the judgment of the reader.
In following out the plan thus declared it will be best for me
090
ZYMOTIC CAUSES OF DISEASE.
to present an outline of the subject in so far as there is a concur- rence of opinion amongst i*eatioiiing scholars, and amongst those who have studied the natural history of disease rather than nat- ural history pure and simple. Thus placed, the following may be accepted aa common subjects of agreement.
I.
Among the many diseases afiF^ting mankind there is a limited imnilier which may, from certain points of analogy, he placed in the zymotic group, and be commonly called zymotic affections. These diseases are as follows :
Plague,
Ciiolera.
Mahgnant pustule*
Scarlet fever.
Diphtheria.
Infiuenza.
Pertussis.
Puerperal fever.
Pyiemia.
Carhnnele*
Glandeni.
Erysipelas.
Farcy.
Grease.
Dengue.
Oonorrhcea.
Belapsing or Famine lever.
Variola— Bmall- pox.
Vaccinia — Cow-pox.
Varicella — Chickeu-por .
Measles.
Bothelu.
Tjiihus.
Typhoid
Jfalarial fever
ByiiUilis.
Hydrophobifii
To the above list some others may bo added, resrarding the na- t fire of which there would not be the same nnaniujity of opinion* These are : —
Catarrh. Quinsy*
Croup.
Hospital gaDgreue*
Sloughing phagedieuft.
Phagediena.
Remittent fever. Intermittent fever, Cholei-ftic diarrhoea. Dysentery. Cerebro-spiufll fever. Rhoomatio fever*
n.
The diseases of the first of these gronps, abont which there la fair unanimity, arc marked by certain stages which have already been described (pp» 44-58). To us now, as bearing on canse.
ZYMOTIC CAUSES OF DISEASE.
591
the fii*st stage is tlie one tliat is of most importance. ThU Btiige is called the stage of ifwubation, and is that which iriter^^enes lietween the reception of the promoting agt^nt and the first nxaiii- festations or syrnptonis of its action.
To Dr. Squire we aro specially indehted for tlie correct IcBOwledgo we now possess on the periods of incuhation, and in the suhjoined passages I offer, practically, his description. The i:>eriods of incuhation ai-e jihiced under live heads, according to tlie iminber of clays demanded for incuhation hy cacli particular form of ilisease. The dij^oases aro thus arranged into tliose of sliortest, of short, of medium, of long, and of longest iDcnbation.
Shortest €L Diseases of Shortest Period of Incubation — 1 to 4 days. — Malignant cholera. Maligimut piishile, Pla^ie. Catarrh, Disaeotion wound dis-
Shori. 6. Biaeasefl of Short Periods — 2 to 6 daja. — Scarlet fever* Diphtheria. Dengae. Eiyaipehis, Yellow fever. Pyaemia. Influenza. Pertuasia. Glanders. Farcy. Grease. Croup. Puerperal fever.
Mtidimn.
c. Diseases of MetUum Periods— 5 to 8 days. — Be lapsing fever. Gonor- rhcea. Vaecinia. Inoculated small -pox.
Lofiff,
d. IHseaaes of Long Periods— 10 to 15 dajs. — Natural amall-pox. Ta- fioella. Measles. Botheln. Tyjihus, Typhoid, MumpB. Malarial fever.
e. DiaeaBes of Longest Periods — 40 days or more. — Syidiilis. Hydro- pbobift.
Accepting these aa the truest expression of knowledge up to the present time, we have still much to learn. We exclude in the list several diseases whicli pmhahly have some stage of iDCuhation, and we are obliged to grant exceptions in respect to those that admit of being classed together.
The diseases of the first group are fairly steady in respect to incubation, but a question may be raised by some as whether catarrh, either superficial or deep, — cellular, — should be classed^ amoDget the zymotic diseases.
^Mii
CAUSES OP PISEA8B.
»«f Ibeaeocmd ar third group, exceptions may
the disease may^ iu particular r^ses, liuve a
lia U assigned iu the classificatiou. Such
br admitted, and a case of scarlet fever, quoted^
bMRi fcr this diacase^ occagionally, a ver^^ brief
ftiMrsal lomgeat
I diird and fourth groups will be accepted fever, as I knew it in 1847, had a iitai i^m dara of iocubation, but bt/ tnocul^Ulon it
"^ittf^ ^rpbSia will be accepted as having the long
Ja.in§; bat hydrophobia is t!ie iiioet difficult
•. li iBfl^ have a few dajs of incubation only ; it
raae^ even jeani
UL
Wiicb areesapaUe of exciting the zytnotie diseases,
"j^ t^ periods of incubation, are organic sub*
^ ^r dead. In the doubt whicJi 8till i^enming
rf tfaeae agents, they may be called oi^nic
IV.
^vm^ndly agauoKed that tlie jmrtkle is special for
4*^ To tbe perlicles^ therefore, the term sped-
lieir aetloo may be applied. In otlier words,
t diice two diseases. Some exceptions may,
liti ndec There is some evitlence in favor
, ilie perliita o£ aearlet fever may produce child-
i%ii^isivw^
'niiel elwrrers that the particular organic
jioauee may be received into the body by
oaii abiorb them. Tliey may be received
kj ^ Iheair in breathing, — inhalation ; by
lirftMk^AAl abaofption. At the same time each
^w ^ Mnie 6ui*face. Some which act
d*> not aet if taken intfj the stomach a^
4. Special disease-producing particle will
ZYMOTIC CAUSES OF DISEASE. 693
effect action through more than one surface, it is found to be most prompt in action when it is introduced into the body by inoculation. Thus the period of incubation in the disease small- pox is shortened when the poisonous particle which causes it is inoculated into the susceptible body.
VI.
In order for the specific disease-producing particle to exert its action, it must have a susceptible subject on which to operate. A community or a person is, therefore, defined as susceptible or in- susceptible to the poisonous or zymotic influence. As a rule also to which, nevertheless, there are many exceptions, persons who have once been affected by a specific zymotic particle are, for a time, insusceptible to a second action of the same. Such persons are said to be protected, or under immunity, from the disease. The protection, however, does not last necessarily all through life. Many persons who are protected through a course of years, be- come again susceptible, and though, as a rule, these are subjected to a milder attack than would occur if they contracted the disease for the first time, they are not always so fortunate, for it occasion- ally happens that a second attack is as severe as the first, and that such an attack ends fatallv.
It is pretty generally agreed upon that there are some peculiar conditions of the body during which tiiere is extra susceptibility to the action of the infecting particles of disease. Thus women during childbirth are specially susceptible to erysipelas and to scarlet fever.
vn.
In some instances the attack of a mild form of disease acts as a preventative to, or protection against, a severer foi-m of a similar disease. Thus the mild form of scarlet fever, called commonly scarlatina, is probably a protection against the severer forms of scarlet fever; more distinctly still the mild form of small-pox, called cow-pox, is a protection to the severer disease small-pox.
vin.
The specific causes of the zymotic diseases, the specific infect- ing organic particles, travel, under certain conditions, from one 38
j-.e>, tvplioul, ervsi{>elaj L 'It-ra. Tlie organic mate : r-.'bahly, those which pre
•i< *si -:ri-iiicing particles it seem
J- ;■ >;il*iitance bhould come iiit<
^ -..-f.jLV, or with the blood. Th<
:>:rar]oii in point, the infecting
• :L;>:antial if not demonstrative
:.~:;:ic> of certain diseases maj
'. may produce disease by being
• !, L-Iinlora, and, some think, diph-
•t contracted by this method of
. are of solid character, seem to ■ :»rricle3 of clotliing or to other . jirried bv this means.
-.-^ ix^ssess under favoring eircum- \; -.^riods of time, when they are
::ey are locked up by cold. The . . . iionls illustration of this trath.
:ie duid or dried form for many ■% >iirff xo moisture for a long time, or . .i>t:ion of the infecting particlo
ZYMOTIC CAUSES OF DISEASE. 596
Susceptibility to the action of the virus of any of the zymotic diseases is always the primary factor ; and in the susceptible the presence of a minute particle of infection may be as potent as a more concentrated portion. In other words, the extent to which the infected body is influenced depends more on its own condition or state than on the amount of infecting matter to which it has been subjected. Thus a mere point of small-pox virus will pro- duce the disease in a susceptible person, while the amount many times multiplied would not affect one who was insusceptible. In this respect the organic virus differs entirely from an inorganic poison, which, as a rule, injures in proportion to the quantity in which it is received into the body, irrespective of susceptibility or in8usceptibilit3%
It is naturally inferred from these facts that the zymotic virus, when taken into the body of those who are susceptible to its action, either undergoes multiplication by living growth, during the period of incubation, or, by its presence, transforms something else within the body into its own virulent nature and character.
XL
It seems to be a true reading of the natural phenomena of the diseases called zymotic, that those diseases of the class which have a short period of incubation have a prolonged period of conva- lescence, and remain for a long time as sources of further com- munication of disease from the affected ; while the diseases which show a long incubation give a quicker convalescence and a more rapid freedom from danger, as sources of communication.
XII.
It is generally admitted that external surrounding conditions modify the course, intensity, and I'esnlt of the diseases of the zymotic class. Each disease, for instance, seems to have its favor- able season for development, and many have assumed that what is called an atmospherical epidemic influence is essential for the origin and spread of all the epidemic affections. The more reason- able and now more commonly accepted view is that these affec- tions will spread in a susceptible community under all conditionSi
504
Otlii^r- are yy first :i:
tllOSf ■
ophtli:. rials V dii'-c t
esscn:' dirt'ct affcc'ti- substa'
Tl:- cliara travel swall' tlieria com II I
Ti have t siibsta.
Ti fitaiUM dried virus • Tlie N monti: a cert, in Will dccoi]!
E the vi the s:i
It'Ml!*:.. :. ^ W
-. .1- I.".. :?:■:. fi'i-
— V._ :..arve TM>
■ . • -rr:r«>iiiizc ti.o .. •*••!• !:ir? wlu' have •■.:m ..f tlio i.i:r<ase> • Mss fro!!! wi.at is :L-i:t: fiviii practical
-. rir DiSKASK.
:;e theories or hypotii-
• rnientatioru — within
.. ..Ki jx)ints relating to
. : I advanceil in IS61
■::at zyuiosi?, instead
. :i tnith. a natural act
^»f no reason whatever
\>: take into our bodies
.ui'^n. Thei-e is a Mih-
.7* ts* or in the tibrinous
^- \ derived thi\)nirh ics-
• irural zymosis. The
..- i^rtxhiction of animal
• w' decomposition, viz.,
:■: caW perfected animal
^ i«:^ 5^^ called, are, as a cla.s>,
■-.^•.ral state of life, which
.^. * .^: all natural disease.
.- virus entering from i.ii
.'.cVTsni is, then, rather to
^t.'\. rymosis of the healthy
^^.iH;*! ryniosis or fermentation ^,^1. » adil a matter of infei-euce
ZYMOTIC CAUSES OF DISEASE. 697
rather than of demonstration. At the same time the inference is without doubt exceedingly fair and reasonable. It is not demon- strable as applied to every so-called zymotic disease, because the results of zymosis are not present in every such disease. One result of zymosis is production of heat, and it is admitted that most of the zymotic diseases are attended with increase of heat. But some are not so attended. Malignant cholera, for example, is accompanied by a decrease of temperature even to extreme coldness until the stage of reaction from collapse has set in. Cholera, therefore, might be excepted as a zymotic aflFection.
Ordinary zymosis is attended with production of organic acids other than carbonic, such as lactic, acetic, formic. But in many of the zymotic diseases, indeed in the majority, these secondary products have not been detectable. Other results of zymosis out of the body are those of putrefactive change ; but every phy- sician knows that in the vast number of so-called zymotic diseases pnti-efaction does not occur until after death, and that it does occur whatever be the mode of death, zymotic or other.
Such evidences as tliese qualify greatly the absolute specula- tion of the zymotic origin of what are classified zymotic maladies, and would go far to upset the speculation altogether, were there not some other and counterbalancing testimonies of its truth, which are of the following character.
There is one particular disease, acute rheumatic fever, which carries out the zymotic hypothesis in the most striking manner. In that disease— which, by the way, some exclude from the zy- motic class altogether — there is not only increase of temperature, but an acid product, lactic acid, identical with that which is ob- tainable by one form of fermentation — fermentation of milk. Still more, this aflFection is sometimes lighted up by another zymotic disease, notably by scarlet fever. Eheumatic fever fails, however, to represent a zymotic disease when it is in its pure and simple form, because it does not yield an organic product which will, by transmission, excite the same disease in another person. But scarlet fever does yield such a product, and therefore rheu- Viotic scarlet fever offers all the conditions of a true fermentation in a complex yet specific disease.
Again, some other affections, like small-pox, and like yellow fever in certain of its forms, and like typhus in certain of its forms, are capable of yielding the phenomena of putrefactive fer-
/508
ZTMOTIC CATJ8ES OF DISEASE,
nieutation, and this may perhapci be extended to malignant pa^ tiile.
On the whole, therefore, we may accept the zymotic h^ sis of the cause of the diseases now under consideration as the best, and most prohable.
In explanation uf tlie zymotic theoiy in relation to mode of origin, that is to say, in relation to tlie mode in wliieli the healthy zymosis of the liody is modified, or a new zymosis set up in the lx>dy« there are tliree hypotheses.
To these I would assign the following names ; —
1. The paramth hypotfi^Sy wiiich traces the phenomena of zymosis to tlie introduction into the l>ody of a parasite uf the vegetable kind, like Bacteria, Bacillus, or Spirillum.
2* The mtal (jerni hypotfuyms of Dr. Lionel Beale, which traces the zymosis to a diseased living germ produced in the body inself.
3. The nerroiui /ipt/ot/it^th^ which I have ventured to origi- nate, and which traces the zymotic affectituKs to diseased secretions produced under nurvous derangement in the body itself.
The Vboetablk Pakasitio Hypothesis,
Tlie strongest evidence in favor of the origin of zymotic dis- eases from living parasitic ceils or germs is derived from anal(^'; and, indeed, we may say that the hypothesis rests, considerably, upon analogy. What that analogy is has been admirably stated by Dr. John Dougall of Glasgow, and as he is an opponent of the hypothesis, I select his description, as l>eing free from bias in its favor. '* Zymotic poison/- he says, ^' in noway resembles any other toxic substance, excepting that it is a 'a deadly poison,* It differs, on the other hand, from all other such bodies, in respect tliat it cannot be confined iu stoppered bottles, measured in min- ims, nor weighed in grains ; and, in particular, it differs in this important point, tliat, while the actions of other poisons are con- fined to the individual affectetl, it renders tlie person it poi&on«j poisonous.
" For example, one may attend closely on a patient suUering from a fatal dose of opium or strychnia without danger of beeonJ- ini; narcotized or tetanized by the opium or strychnia which the patient has swallowed. Bnt one who has not suffered the special form of zymotic poisoning with which a person is affected could
ZYMOTIC CAUSES OF DISEASE.
699
I
I )
not attend liim with itnpiinity, because he iniglit poison his attendant, his nurse, or doctor, nay, even bis friendfi or neiglibors in tlie same Jiou^^e, with tlie identical virutj by which he himself is poisoned. This body is, for the time being, an alembic in which a special virus is elaborating and multiplying enormonsly by an apparent dcBtnietive distilhitioa of the blood and secretions, §0 tliat the tissues may literally be soaked and tlie body enveloped in an atmosphere of vinilent infcetioiK The blood, saliva, breath, sweat, nrine, feces, and epidermis may all be saturated with it,
**This puison is named from the Gret'k word ^vfJt^n* or leaven, and a person under its inHuence is held to bo in a condition of zymosis or fermentation. It was so denotninated because, when it enters the hlcMKl of an individual susceptibJe to its influ* enee, it gives rise to phenomena very analogous to those caused by the addition of yeast to a substance capable of fermentative cliange. Supposing, for example^ there is added to an aqueous solution of honey, or of grape or other sweet fruit juice, a single cell of the yeast plant, tanda ceremsliB. This i^peck of matter is about the size of a human red blood corpuscle, and heriee only visible under the microscope. Supposing, further, that this solu- tion is kept at a temperature of about 70^ Fahr, tlien in a few fiours, or at most a day or two, from the single yeast cell millions are produced, so as to make the liquid ttirbid, and form a frothy scam at the top, and a sediment at the bottom. During these ckauges tlie temperature of the Huid is increased, and (*arbonic anhydride largely evolved, until latterly the heat begins to re- turn to tlie normal, and the evohition of gas to cease, when tJie sohition is found to have lost its sweet taste, and to be cbangcfl into a mixture of alcohol and water incapable of further fermen- tation.
** Now for the analogy Ijetween this process and that of zy- motic poisoning. Supposing I were to wx»t the point of a needle with lymph from the l»ody of a small-pox patient, and push it under the skin of a person wdio bad neither been vaccinated nor suffered from smalbpox ; then, a thousand chances to one, that in a few days, the recipient of the lymph feels out of sorts, has nausea, vomiting, headache, thirst, back-aebe, a high pulse, and hot skin. In about three days afterwards a papular eruption ap- pears on his body, which soon changes into small blebs or vesicles. These vesicles may be few or many, separate or confluent, but
m
ZYMOTIC CAUSES OF DiaEASE.
the clear and apparently homogeneous fluid which they contain lias the identical epeciHc infective nature as that with which the needle was wetted, the minute portion on the needle having now innltiplied to an enormous extent in the blood of tlie person inoculated.
** I need scarcely say that the symptoms enumerated are those of small-pox, and that the lymph introduced into the blood by the needle is zynioiic poison.
** The putting of the yeast cell into the Bweet solution, and of tlie minute portion of small-pox lymph into the human body, ai-e botli ea^s^es of pure infection, and the zymotic phenomena evoked thereby are almost perfectly analogous.
^' For, observe — Ist. That the eaccliarine solution was BUg- ceptible to the action of tlie yeast, and the huuum blood to that of the Ivmph. 2d, Tho extremelv minute txirtioukr of vea&t an^l of lymph eniplr^yed. 8d. The rise of temperature in both case^: the sweet if^olntion becoming aljuormally warm ; the small-pox patient highly fevered, 4tlj. Thti great multiplication of veast in the sweet solution, and of small-pox lymph in the blood. 5th, The yea*^t frf»tliing to the surface of the fluid, and the Buiall-pox entption forming lymph bubbles or vesicles on tlie skin* 6tb. Both are infectious; a cell of the new yeast would cause fermen- tation in a suFiceptible fluid ; a siieek of the new lymph would cause tlie small'pox in a susceptible person. 7tli. The sweet sola* tioTi is no longer capable of fermentation, owing to the chemical change it has undergone in fermenting ; the small pox is no longer susceptible to smalbpox, also from some chenucal change produced in the body by that poison. Sth. The sweet solution will ferment, as it were, spontaneously, that is, without putting yeast cells into it intentionally, because such cells are constantly flonting al>ont, and fall on its surface ; so a jierson inav lake small-pox spontaneously, by iiihaling air containing that epeciiic poison. These are both eases of pure infection, though in neither is the infecting agent visible/*
Following up this exposition in practice, the advocates of the hypothesis now under consideration contend that all the c^ontagions diseases which run a regular course^ and which, being passed thi-ougli, leave the person who has been invaded safe from a fnrther attack, depend on a veiretaVde organism. Dr. Thndichnrn, with iiis usual facility of iixiug what lie says on the mind, in-
ZYMOTIC CAUSE8 OF DISEASE.
601
cUides the whole hypothesis of contagions disease above defined under the name of *' veytUihk jKiraMltsjiL'^
If thid hypothesis couhi be earned out with the unauiiiiity of simplicity which its promoters wish for it, it would indeed he a happy sohition to the whole of the diffieulty, Eacli vetretahle parasite possesses^ they think, the ]>ower of exciting in tlje body into which it is introduced a fenneiitation^ upoTi which special symptoms of disease are manifested. So the particular disease is made. But the vegetable parasite is itself a living contagion, and finding its proper pal»nlum, is reiirodiieed, to he cast off by various 8cci*etions and to set up fm'ther and simihir disease in all i>erson» sQSceptihle to its influence.
To sum up. The liypothesis supposes : ^ First, that there are as many vegetable parasites capable of ting up the special diseases as there arc zymotic diseases.
Secondly, that in every susceptible person there are as many pabuhnns for the stippoit uf the various vegetable parasites capa- ble cjf producing a specitic zymosis as tliere are zymotic diseases*
Thirrily, tJio hypothesis endeavors to explain tlie reason of im- uinnity from secontl attacks. It suggests that the pabnlnm on w^hich the vegetable geivrn was reprndueed in the body having be- come exhausted, tlie disease ceases if the patient lives, and that the protection is due to tlie fact that the pabulum necessary is not, as a rule, formed in the same body a second time.
■ The autlior of tlio vital germ liypothesis, one of the most
illuistrious of the original thinkers and workci's of this day, Dn Lionel Beaie, supports his views in the following manner.
lie argues that in the body during life there are two condi- tions of matter: one living, the other dead. The living matter he calls hloplusm^ the dead uvaXtev formed jacUertaL Every tissue, ititercellular substance, and matter resulting from changes hi tlie cells are formed from luoplasm.
He shows that iruisses of bioplasm after rcacliing a certain size, usually less tlian one-thousandth of an inch in diameter, imdergo division, and that as soon as any mass of bioplasm has attained a eertaifi definite size it divides, that portions move away and at length detach themselves from it» If the bioplasm were to con-
I
TuK Vital Gkkm Hypothesis*
eos
ZYMOTIC CAUSES OF DISEABE.
tinue to grow, the distance to be traversed bj the nutrient matter, or pabuhiin, before the inmost parts were reached would 6ooii_ become so great that these woiiid be practically beyond reach, and could not be nourished or subjected to the constant action of currents of fluid* Death would begin in the central part of such a masr?, and wtmld Boon involve particle after particle, as its ravages extended outwards, until the whole of the living mass was deady — a nioBt improbable order of events.
Respecting bioplasm^ or living matter, the distinguii^hed au- thor nays that it is clear, colorless, structureless, soft, and when growiTig quickly almost Jitflnent. It is enclosed in a capside of equally colorless formed material, which, however, is linn and sometimes even hard. When this simple organism h nourished, nutrient pabulum dissolved in water permeates the capsule of formed material, and comes into contact with the bioplasm witliin. The notj-liviiig matter then undergoes changes most wonderful, in tlie course of which it acquires the same properties and powers as the bioplasm, already existing, possesses. Thus under favor- able circumstances the particle grows and separator; int<» two or moi*e parts, which move away, and thmugh which the process h continued.
These are vital actions differing absolutely from any actions known to occur in any kind of non-living matter whatever. They cannot be imitated, and no actions kih>wii can be fairly said to exhibit any true analogy with them. Tliese vital phenomena do not characterize the formed material, for the production of this is eoitieidcnt with the death of tlie bii^plasm. As the fonned material is prod need bioplasm ceases to li%"e, and no kind of formed material can g^rfrw and transform matter and direct its forces as living matter is known to do.
Of bacterium y Beale shows tliat its living matter is, prtjbably, the lowest, simplest form of bioplasm in nature. He has figui-ed some bacteria less than tlie one ten-tliuusandth of an inch in diameter, while the germs fi-om which the little particles spring are far more minute. It would be ditHcult to say where bacteria germs do not exist. In air, in water, in the soil, adhering to tiny particles of every kind ; in every region of the earth, from the pules to the equator, they arc tu l>e found. At all periotisof the year they retain their vitality. Extreme dryness does not desti'oy them, and they withstand a temperature far below freezing point.
ZYMOTIC CAUSES OF DISEASK.
603
lliider adverse circumstances they reinain dormant, and are not destiwed by a dcgi^ee of heat which is fatal, probably, to every other living organism.
In the siibatance of the tis&ues, in tlie cells of ahnost all plantB, and in the interstices and lissnes L»f many animals, bac- teria germs exist, and no part of the body of man and of the higher animals m entirely destitute of particles which, under favorable cireuniHtanceti, develop into bacteria. Upon the skin and upon the surface of mucous menibitines they exist in profu- sion, and they abound in the month and in the follicles and glnnds. Changes in the process of digestion are soon followed by the mul- tiplication of bacteria in every part of the alimentaiy canal^ and within a few hours countless milliuns may ho developed. They multiply in the secretions, under certain circumstances, almost aa i^ou as these are formed, and the germs exist even in healthy blood. In the very substance of some cells he has seen thenj, and in many cases, in which little granules have been discenjed in oonnection with bioplasts, there is reason to believe that some of them are really bacteria germs, passive as long as the higher life IS maintained in its integrity, but ready to grow and multiply the instant a clianti^e favorable to them anil a<lver8e to us shall occur.
As the germs of tjacteria are found in healthy tissues and or- ganisms, and grow and develop into bacteria when disintegration and decay occur, we need uot be surpi'ised at their existence in disease. Bacteria prey npon morbid i^tructures, and upon the substances resulting from the death of morbid bioplasm. They are found in great numbers among pus corpuscles which have ceased to live, and they grow and mtiltiply with great i-apidlty in fluids wliicli contain disease germs as soon as these begin to lose their specific powers and to mjdergo decomposition. In the tis- 8ae.s and fluids of the body altered by fevers they are abundant, and exist, as is well known, in many instances during life* In tlie evacuations of clioiera, and not only of cholera, they ai-e very numerous, and in tlie columnar epithelium of tho small intestine many have been found. In all parts of the bodies, in the fluids and amongst the solid tissues of animals destroyed by cattle plague, bacteria are present in varying number,
Turniiig from tins physiological definition of biopiasm or liv- ing matter, Jioale is led to look upon tho changes and degradation
604
ZYMOTIC CAUSES OF DISEASE.
of bioplasm as causes of disease* Increased growtli, owing to an increased access of nutrient pabulum, is the iirst change tliat oc* curs iu iuflammation^ and is eesential to tlie iDrdammatory process. From every form of bioplasm iu tlie body pus or matter may in all probability be produced by descent from some form of nomial bioplasm of the body. The pus coiT>uscle is bioplasm which has been so produced. TJiojilasni always tends to grow. It must grow if it be supplied with nutriment ; but it has within itself no jx)wer of regjilating ur controlling its own growth.
Touching upon the origin of contagious disease, the author dwells on the loss uf formative power, which occurs as the mte of growth and iiinUi plication of bioplasm increase. Every particle of bioplasm which might have taken part in tissue formation will, if it grows and multiplies too fast, not only lose its power of forming tissue, but the particles that may be produced from it, by descent, never regain the wonderful capacity that has been lost* liut although formative power is lost, new powers or properties may be, ne\'erthcless, acquired. These are remarkable for destruc- tion, never for construction. Some forms of pus acquire during their production tlie niost wonderful capacity for rapidly growing and nxuUiplying, as well as for living and i"esisting the intlueiice of external conditions. The little offsets or particles that are de- tached from tlicui may rise in the air, live for a time in water or milk, or other Huids containing organic matter, adhere to a sponge or probe or other substance, or be carried in the living state on the foot of a fly or some other insect, and thus be transported to an organ ii^ui at a distance from the one which was the seat of their production. The minute germs, being in contact with ma- terial adapted for their nourislunent, lapidly grow and uudtiply in their new situatitm. Such forms of virus liave been produced ah initio^ fostered and propagated to the destruction of hnndj*ed8 of human 1 icings.
Thus, according to Beale, the phenomena connected with con- tagious animal virus are due to a minute particle of living bio- plasm produced, by descent, from the natural bioplasm of tlie body. ** This y>article of deteriorated bioplasm, whicli in souje cases may be Hien^ is a ' diseai?ed germ/ and of these *contagium' consists." The contagious bioplasm results from natural bioplasm, the life of which has been carried on, for some time, under un* usual conditions.
ZYMOTIC CAUSES OF BTSKASE,
6or»
An ordinary form of diseased bi<»plasrii, pus, often originates in the bioplas^oi of epitlieliuii* and in that of connective tissne, and certain forms of pus have specific virulent properties^ aro^ in fact, animal poisons which may be inoculated. The antliorot the
t living genu hjpotiiesis does not, liowever, entertnin the opinion that all contagions diseased germs spring fmm the bioplasm of epithelium or connective tissue. Some may como from white
»Mood corpuscle?. Ihit he consiilers that the contagions particles concerned in propHgating many of tlie most serious specific fevers have been derived from the living matter of man's body, and that they are not germs of fungi or bacteria of any kind whatever. Indeed in certain instances they may be seen in far greater nndti* tudes in the tissues of the diseased organism tlian bacteria, wlucli latter, as is well known, are found often CTinngh in countless multitudes in cases in which tlicre is no epecitic di&5ease of any kind.
In these few pages I liave, I hope, condensed in a clear forni the living germ hypothesis of Beale* It differs, it will l>e seen, from the previous h3'p>othesie, tliat while it traces the changes of phenomena which mark the zymotic disease to a living oarticle or germ as the primary c:tnse of those cltanges, it derives liie par- ticle from an affected body itself, in the first instance, and traces the continuance of the disease-pj-odncing i>article from ench body instead of from the parasitic vegetable world.
Tire Nervous ob Neuro Hyj^oTnKsis.
When, at the commencement of tlie Begistmr-Generars He- ports, Dr. William Farr fornuihirized the list of diseases belont;- ing to the zymotic class, the view started by Liebig of tlie cause of zj^mosis or fermentation was the accepted view, Liel>ig sug- gested that in organic natUTO there were certain Inxlies which are capable of undergoing fermentation, and other bodies which, by their presence, are capable of exciting fermentation. The suh* Stances which can ferment are of amylaceous or saccharine nature, and tlie substances which excite fermentation are of alhmnirious or nitrogenous nature. Thus, in the illustratSon which was given a few pages hack, from J)\\ Dougall, the sweet solution, which was referre<l tt> as undergoing fermentation on the addition to it of yeasty was said to ferment in consequence of contact with the
606
XYMOTIC CAUSES OF DISEASE.
yeaet, whidi h a nitrogenoiie eubstance. The torula\ or livmp things in the yeast, were, it was known, there, and tlie fact of ilie increaeed growth of the torulae during the process of fennentation was also kiiowrL But it was eonsideix^d tliat the living thing was merely an attendant thing, ami that the inereii^ed growth of the living thing was resultant, not causative, coineident, not essentiiih It was thei*eupon a^'^umed, very naturally, that changes either re- semhling fennentation, or really fermentative, might take plnoej without any connection at all with living germs or living partiele%§ whenever nitrogenons matter iu decomposition came into oontaci with fluids susceptible of fermentation.
Wlien the In^othesis uf ^^ymosis in relation to disease came under consideration, this view of Liebig, as to the cause of ordi- nary fermentation I was taken as explanatory of tlie general pro-j oess in tlie affections designated zymotic. The material whickl passed fnan the infected persons, the contagium, was assumed to be a vims or poison of a nitrogenous character pc»8sessing the pmperty, when it was absorbed by a person who was susceptible to itsintlueuce, of promoting a sj>ecitic fermentation and a specific disease in that siisceptilile person^ with more of the spoeitic virus itself. Til us each disease i*roduced its own spec r tic ferment.
As a student of this physical reading of zymosis, I conductc between the years 185*] and 18G3 a long series of experimental inquiries as to the propagation of disease-, from one animal to an- other animal, by the inoculation of the secretions of an affected anhnal into a heaUhy. I lighted iu this manner upon many curi- ous facts.
I found that disease could be transmitted from animal to ani- mal by inoculation of various secretions, and, in addition, I leaniecl that the secretion became more and more actively virulent as it became derivable from new stocks of infected animals, i.t.^ the vh-us increased in intensity of action by passing through and af- fecting an animal body.
Again, I found that the virus or infecting secretion would net only act as a virus by being directly inoculated into tlie body of tlie susceptible animal, but that it could be transformed into an alkaloidal substance, when it would still continue to produce llic specific effects. Some fluid drawn from a wound in a patient under the care of Mr. Spencer Wellsj— fluid which during surgi* cal fever liad been excreted into the peritoneal cavity, — afforded
ZYMOTIC CAUSES OF DISEASE.
mi
a vims ^vlnch I i*educed to tlio alkaloidal state m the form of a crrstalliiie alkaloidal ^alt. A &oliition of thia Bait gave rise, when it was inocnhited into a susceptible animal, to the most difttint^t form of disease of specilic febrile character, and the BecretiL>ns of the infected auin}al reproduced, hv inoeulatiou, the same type of disease in cither suRceptible animaU. In the end I came to the conclusion that any secretion of llie living body might bo charged witli a poisonoua gnbfitance which wns capable of acting as a con- taginm. To this hypc^thetical substance I gave the name of scj>- tinej and 1 called the diseases induced by a septine, avptinouft diseABes.
As the inqniries which led np to the experiments with septine progressed, I was led to form a view as to the nature of the i>oi- sonous base and as to its mode of origin. As I have already said, it seemed to me to be an alkaloid, or chemical substance, resembling, in physiciil properties^ morphine, strychnine, and other bodies of that class, derived, not like them from vegetable but fiom animal organic matter. The difficulty in assuring this lay in finding a reason for the various effects of the septinoue material. If it were a conHnr»ri i»ase like that which I suspected 1 liad found, why should it not always produce the snuie fonn of septinons dis- ease ? Why sliuuld it, on the other hand, produce, as virus does, many kinds of disease, each having a certain general likeness to the othei's, but each at the same time different in many important details, as different, for example, as small-pox is from scarlet fever, or measles from hydrophobia.
The difficulty, in this way suggested, led me to i-efleet on the
i^^nnection which might exist between the bases of the different
iecretions of tlie anintal body and the matter I had called septine.
Each seei-etion yields some organic proiluct ; the gastric secretion
pepsine, the salivary secretion ptyaliue, and so on ; and each
[jretion plays a ditTerent paH in fnnction, althoiigb the organic
es of them all may jiresent a general similitude of construction.
Thereupon I was led to tlie conception that the secretions of
the animal body are the sources of the zymotic diseases, and that
^le various diseases are, in fact, all of glandular origin; that in
B17 case of disease tlie virus producing it is nothing mom and
"nothing less tlian a modified form of one or otiier secretion, and
that as regards the organic poisons themselves and their physical
properties^ the great type of them all is represented by the poison
K nor bw» f^
poison btm 4*
.alialmia p«M»*
is a f roe
It is not thtftb
i»«, , ,. ,*\ hut it is tint '-i'
;><* in coniAct with i «?•*
ai ihat point, wbcriO*
; «f |uiii<i mNi diifiiMlpl IIam fe m ttmxige in the secreCieB^
Jh» fiMicom ^HMN*a lliik tilf)k%» «ii«n vecsrettou pours out, isi^
i m |w^Jtew4^ wnA iW %n<witfit |?<^<« o» until, in the end, ^
Wp^jr «f ili^ mutwajl imq^ iMioiM «AMt^ by Rb8orpti0O d
As a gMmi) n^ llie ti«i«ii«ii Wr ftimidic^ I believe, all ^ i titti Am hmmm M^ iititii ri%>iiK ihM i^ to 8»\% ot <r ijr fliiijit ind l«<»nntf {x^t^foiicins witiiout pi< mfectkA. TliU k%i beeii re>«iharkiiKly bixviigUt oiit in the case oi pueiperal pei«m, wlMfO m cteroliK^ii fo>in the liand of tlie ac- ora^eor Im prodMod the pwrp«r»l fevcj. In tbe oa$e of peri- tonitk, or infl&mmalioii ol Uie pwitoneum, tbei"© is a fiecreiioti
ZYMOTIC CAUSES OF DISEASE. 609
which may be carried on the hand of a healthy person and pro- duce the disease. Typhus may be produced by the overcrowding of persons in a room, through the vaporization of organic matter at a low temperature. Thus we may have springing up de novo an organic poison which afterwards, on being introduced into one particular body, becomes increased by the secretions of that body.
Tlie organic virus so formed may be transmitted in each of
. three ways. It may travel as dry solid matter, wafted or carried
iu the air. It may be borne by linen that has been tainted with
the secretions of patients and then dried. It may travel in water
or in water suspended in the form of vapor.
The mode of the entrance of organic vims into the body, although contact is always i^equired, varies with its different kinds. The virus of measles, scarlet fever, and typhus is, I believe, al- ways inhaled. The virus of small-pox, diphtheria, glanders, erysipelas, and hospital fever, may act either by being inhaled or inoculated. The virus of ophthalmia requires direct contact. The vinis of cholera, yellow fever, and typhoid fever seems always to be swallowed ; each may be called, specifically, a poison of sew- age, travelling, usually, in the fluid form ; eacli may, nevertheless, travel for short distances as fine dust, or in water in the form of vapor.
The thought that the virus of the various spreading diseases is a secretion, and nothing more, came naturally out of my researches. I realized, as it seemed to me, that all these spreading and com- municable diseases spring out of the living body itself. Tliat they are as distinctly the offspring of living animals as real prog- eny are, and that to look to outside sources for them, to look to vegetative growth for them, for example, or seedling, is merely to ignore the basic facts which lie obviously before us for lesson and learning. As well suppose that procreation of animals is due to an external vegetable product or other product dissevered alto- gether in its origin from the animal, as that the virus which cre- ates disease of a communicable kind is in such manner dissevered, as to its origin.
Another thought which occurred to me in the course of my labors, and which I expressed in the earliest records of them, has relation to the force by which the poisons of the various diseases are developed and thrown off. It is well known that the produc- tion of the poisons in a living body, infected by one of them, is
610
ZTMOTIC CAtJSIS or BIdSASS.
limiteil in respect to dnration of time of production even wlieo tlie body lives and recovei"s* This fact seemed to nie to prcwe to demonstration that the poison itself Is produced by the aff^4xl body, and h determined, in it^ pi*od action, by some nAtoral fone- don of tlie body or of some part of it*
On tlie basis of my hypothesis that the vims in eveiy a modified secretion, this view of the force of prodtietion the secretion is easily accepted as in accordance witli natuiid la The force of production h the fotxre of secretion, and so long the secretion continues changed in character, so King it is thrown off as a poisonous secretion ; but so soon as the modification of secretion which rendered it poi&onous is stopped, so soon the se- ci-etion, flowing onward as l>efore, is rendered innocuous^ that is to say, no longer poisonous. If this were not the case, there is no reason, as far as I can see, wliy, in every instance of infection, the infected person should not die. Endow the potson itself witJi independent forces of life and of reproduction, give to it a distinct reproductive life of its own, and why should it ever cease to reproduce ? Why should it not, in every case, continue to in* creaso within the infected Iwidy, indefinitely, nntil it kills the body, and why should any one ever recover I
But consider the poison as a part of the animal body itself, a substance to \m eliminated from the lx>dy by natural methorls, then the process of removal of the poisonoujs condition comes into the natural order of events, and recovery is a natural piCM3e8s, unless some unusual conditions occur to interrupt the natural course.
We see in a common nasal catarrh the outline of this p Tliere is first a dryness of the secreting surface, with reflex ner- vous irritation and innch nervous depression, and disturbance thereupon, in tlie circulation of the blood. After a time there is a copious socretion from the nostrils, which continues nntil the disturbed nervous balance is brought back to steady natural ac- tion. Attltis time the overtlow of secretion is checked, and notli- ing more is left than the local effects of hainiened secretion, or scale, due to desquamation arising from the excessive previous action.
In outline this is really the natural course of every zymotic disease, with the exception that the secretion of a catarrh is not definiteiy proved to be a contagious secretion. I believe it may
ZYMOTIC CAUSES OF DISEASE. 611
be so, and sometimes is so ; but I need not press the point. The illustration is adduced merely to chow that the course of the dis- ease is from within outwards, and that it is checked in its course by restoration of internal natural function. If catarrh were pro- duced by some external vital agency, reproductive in character, lighting upon the nasal tract ; if it were due to the colonization of the nasal tract by an army of foreign invaders which settled there, and began and continued to replenish and multiply, when would the catarrh cease ? It would, as far as I can see, continue, nntil, by destruction of parts and continued abstraction of secre- tion and extension of mischief over a wider tract of surface, it killed inevitably.
A catarrh, according to my view, is typical of all the diseases which run a given course, and are called spreading diseases. It springs up constantly from external atmospheric variations ; it runs a given course ; it subsides. It is often epidemic, and it would be a true contagious epidemic if the matter secreted from the nasal cavity and the conjunctiva were not so innocuous. As I have hinted already, I believe it may be contagious. I am quite sure that many times in my life I have taken catarrh by coming near to a person who was affected by it, but whether this conta- gion is sympathetic or toxic, I am not able to define. On these intimate relations I shall have more to say on a futui*e page.
In continuance of observation I have noted that the number of the distinctly communicable diseases is closely related to the number of secretions. The poison of hydrophobia is from the sal- ivary secretion; of diphtheria from the mucous glands of the throat ; of scarlet fever, I believe, from the lymphatic glandular secretion ; of glanders from the mucous secretion of the nasal sur- face ; of typhoid from the mucous glands of the intestinal surface. In some instances the blood itself is infected, and the corpuscular matter becomes the seat of the catalytic change.
On the ground that the virus is always from a secretion I have been led to the conclusion that under certain influences affecting glandular action the virus may be made to originate directly through nervous impression without the necessary intervention of an infecting particle. In many epidemics it is common to see a number of examples of the prevailing disease the origin of which is traceable only to fear or anxiety. We call these nervous cases, and we try to define them as such and as distinct from cases due
013
ZYMOTIC OAtJSES OF DISEAS15.
to oontagiou of a direct kind. But the symptoms are tlie B&me as those M*bicli follow actual contagion, and in epidemics of cholera they take e%en a fatal character. M}* view explains, fully, the reason of this. It indicates that an exti^emc nervous impression acts on the glatjdular nervous supply, paralyzes the glandiilar function, and thereupon produces the same phenom- ena as is produced, in other instances, by the action of a s^pecific poison.
The hypothesis in this manner accounts for Hhe origin of an epidemic disease from an impression made on the nervous sygtem without the direct contact of poisonous matter^ as well as for tlte after-propagation of the disease by distributiun of poisonous par- ticles when they are communicated from an infected tjo a heahhy person. It accounts equally well for the production of di^ase and of a poisonous glanduhir product under conditions of starva- tion and cold, by wliicli tlie nervous tone ia reduced. Again, it accounts for the production of disease and of a virulent glandular secretion under special atmosplierical conditions, in winch the activity of the atmospheric oxygen is reduced in sustaining power.
It has occurred to me furtlier, as a result of the study of the action of the poisonous particles, that wlien they are brought into contact with the secreting surface, their action towards the body at large is, in the fii'st instance, directly on the nervous fibie. They act in^ the first instance as irritants on the peripheral ner- vous surface, and their effect may, I believe, extend particle by particle, as by diffusion, through the whole length of the ner- vous cord to the nervous centre. I have no doubt tliis is what slowly takes pluce in hydrophobia. I believe this is what takes place in diphtheria when paralysis is the sequel of the acuta syniptoms of the malady. I believe the same mode of progrefr^^B sion of the poisonous influence is what happens after inoculatioirH witli matter of snialbpox ; that the severe nervous STOiptomB which mark the nuset of that disease are due to the extensive in- jury inflicted on the nervous organization; and, that the diffusion of the eruption over so wide a surface of the skin and mucous membrane is the reflex on the peripheral nervous surface from the nervous centres,
It is worthy of special notice in connection with this part of my subject, that in the cymtnunical)le diseases attended with an eruption on the skin or nervous surface, the eruption, as a rule,
ZTMOTIO CATT8K3 OF DISEASE.
613
I I I
I
Jces a circular form. If it be a point of vascular blueh, a ^^petecliial spot, it in a rounded spot ; if it be a pustule it is rounded ; if it be a more diffu&ed rasli it couHuences in ceutres which are rouuded points. Thi^i appearance is an indication of nervous injury. The rounded surface is the radius of injiuy done to the nervous supply of tliat part. It is a paralysis of the centre of nervous distribution over the affected part.
My researches on the inliuence of extreme cold on nervous function are strikingly illustrative of this. They suggest that the nervous impresftions sent from the centres to a ffcripheral Buiface spread out when tliey reach the peripheral surface, such as the surface of the skin, like circling waves; as water spreads out in circles on a pool when a stone is made to impinge on it. The time required for this change is, I conccivcj tltc peritKl of incu- bation in ;syniotic diseases.
Some other recent investigations on tlie mode of action of the poisons of the communicable diseases have led mo to suspect the source of the symptom which is so cunimon to most of them, and which is known as the attondunt feven The fever is of three kinds : primary, reactive, and remittent. The primary fever is that which precedes and attends the eruption of an eruptive dis- eaee^ The reactive fever is tliat wliicli succeeds the extreme col- lapse of an acutely-exhaustive disease, and is like that which follows exposure to extreme cold. The remittent fever is that which succeeds npon an acute form of disease, and indicates that there has l>et*ti either secondary absoq^tion of matter from an abraded surface in contact witti poisonous substance, or that some fibrinous or pustidar matter lias formed within t!ie body^ and become a new and permanent centre of infection.
The first of these forms of fever is, I believe, due to the impression on the nervous centres by the poison, in the manner I have described aliove.
The second, the reactive fever, is, 1 believe, due to the same action as that which locally may be inducted by extreme cold, viz,, by an influx of blood into vessels that have been paralyzed, and by a rapid radiation of heat from extensive surface of blood.
The third form of fever, the remittent, has an origin, I believe, apecificaily its own. I have founcl that pustular matter and all secretions containing fibrinous or eellnhir structure Iiave the prop- erty^ by their presence, of liberating oxygen from solution, Thia
614
ZYMOTIC CAUSES OF DISEASE,
extends, as I bave found, to blot^d chiirged with oxygen, a led to the infereuce that wLeu there is an jib&t»rptiun of 6ucli matter into the eircnlatiun it causes an undue liberation of oxy- gen, with a quicker conibugtioii, or fever^ which lasts nntil the exciting matter is itself deistrujed and eliminated, and which does not recui' until there is re-absorption of more of tlie exciting agent. In this phyeiologieal mode 1 &hoiild explain all the phe- nomena of the I'emittent attack ; the culd stage incident to the ab- sorption of tlie exciting matter ; the hot stage incident to the period wlien, by its presence, tlie exciting matter is setting f i^e excess of oxygen ; the sweating stage when, by rapid elimination thruiigh the sweat glandsj the equilibrium of temperature, is restoi-ed.
The study of the nervous hypotliesis of the communicable die- eases lias suggested to me another thouglit, which observation of the diseases fully confirms, namely, that these diseases, like all which have tlieir root in nervous derangement, present a distinct lieredity. The ittipressioii of disease made on a nervons centre is transmitted* There can be no doubt as to transmissiua of teu- dency to particular communicable diseasee. Any physician in full practice can find any amount of evidence on tbis fact by sii natural inquiry. Typhoid fever is clearly a disease poss<> .. hereditary transmissible (juality. Diphtlieria is the same* Scar* let fever is the same, and sin all-pox I should suspect was once, almost universally, so characterized. These facts alone, one uf them alone, is sufficient to stamp tbe origin of tbe communicable diseases as f lom tlie animal hmiy itself. It is certainly one of the best of proofs of the tnith of the h}^>othesis of tlie nervous origin of the poisons.
It will be seen by tliose who kmk with sufficient patience, that the mode of connection of the diseases in hereditai-y line is tlie same as that which conneets hereditary ty{>es of every kind, physical type, mental type, all else that binds many individuali- ties into one family.
Lastly, the study of this hypothesis of the communicable die- eaaes enables me to olfer the most rational explanation of the phenoiiieuon of non-recurrence of tlie diseases after tliey have once attacked a person susceptible to them. It is well under- QUyod that, as a mle, a person who has been affected by a com- itumicable disease is not affected a second time. To this rule there ai^e many exceptions, but on the whole it holds good. On
my hypothesis tlie reason of the pheiionienoti is simple enough. They who are susceptihle are honi with a nervous iyipreseiini tending to the pi'oduction of a diBeased secretion easily cliangeil into a poisonous secretion under tlie direct action of contact with poisonous matter, or even under the irilluence of a cent nil nervuu^ depression whereby the glandular function is deranged. But when such a pergt>n has pas**ed thrtMigli the ordeal, the tendency, for a time at least, disappears, owing to the complete nioditication of glandular function that has been induced, to the free elimina- tion that has been estal>lished, and, prohal>ly, tn the chaUj^e In the nervous matter iteelf that has resulted from organic moditieatiun. Hence the organism becomes insusi.'eptible for a time, and if tl»e tendency be nut intense that time may mean the whole of the life. Indeed as life advances and nervous susceptibilities, derived directly from ancestry, lapse into individual self sustained] sus- ceptibilities, these tendencies to disease subside as a general fact, and lose their activity if not their existence.
It is not therefore a new pabulum that is fiirmed tu insuie a reiH?tition of infection, but the removal of the capacity to pi*odnce a new virus which will act on existing ordinary pabuhnu.
Lastly, this hypothesis connects togctiier in natural order the relationships of the physii-al to the moral contagious diseases, the -border land between which is often all i)ut uodefinable.
In bf>th justauces of cojumunicatiuu of contagion, the first impression of the contagion is o!i a pei'ipheral nervous point or surface. For the uu>ral contagious phenomena, the peripheral expanse of an organ of sense is the receiving point. For the physical contagious phenomena, a poirit in the peripheral nervous expanse of skin, t»f mucous !nombrane, or of serous membrane, is ilie receiving point, Tlie diseases vvhicli spring from contagion i4lre all, therefore, primarily, nervous in their mode of develop- Hjent in the bodies of the affected.
The physical contagions ai*e either absorbed through nervous matter, or they excite, by contact, a change which extends along the nervous matter, the period of incubation being the jierifKl during w^iiich the contagion is extending its influence to the nervous centres, so as to excite central disturbance. In sotno instances the first effect of such contagion is indicated in a few hours, as in cholera ; in other instances the effect is delayed for many w^oeks, as in tJio case of hydrophobia.
ZYMOTIC CAUaU OF DIBEA8E.
T]ie active organs vf tlie body first and gpecifically aftcLiea bji the piivgical contagionB are the glands. When tlie contagion ial moraU Aud extends from irregularity of umscular motion to f imc- tiuual change of organs, tlie action, caused by the nervuiis dis- turbance^ h also on the glands. It is a nervous reflex of some glandular affection tliat has been observed by the sufferer. It is like the weeping which Rtnie |*ersons exhibit at the sigljt of weep- ing, though they themselves may be unaffected by tlie primary cause of sorrow.
Moral contagion is the meii5 continuance of motion from one person to another; a direct impression made thrt»ugh the senses into the internal nervous centres. It is lilce the motion whidi can be excited in a compass needle by bringing a magnet witliiu the sphere of couununicable action* It acts at sensible distances* Physical contagion is the movement of a point of affected matter into contact with a surface of the body tlirough which tlie nervous organism can be reached. It acts at insensible distances.
The diseases arising from moral and physical contagions are so closely related, that one may lapse directly into the other. Both assume sporadic and epidemic forms. Practically, tliej are of the same origin, and are convertible phenomena.
Summary of the Hypotheses.
The reader has now before him the tliree hypotheses of the origin and cause of the so-called zymotic diseases.
The first assumes for the cause a vegetable parasite whicli exists outside the body and which carried ijito it sets np a fe^ mentation, if thei'e be pabulum in the body to undergo tlie pro- cess of fermentation, and is itself reproduced so long as there il any pabulum for its suf?tainment.
The second assumes that the cause is a living germ, which belongs to the body it.sclf, but which has undergone change of deterioration, in whieli condition it reproduces, from a favoring pabulum, its like in large quantity, and thus excites disease.
The third assumes tiiat the virus which excites the disease is a nioditied secretion which has tlie power of communicating, by an interference with nervous function, its own properties to a healthy secretion, and which contiuiies in action until natural nervous function is restored.
ZTMOTIO CAUSES OF DISEASE.
617
I I
I I
By all tliese liypotheses tlie same results are reached in one particular. They all assume tliat the aflected or diseased hody produces or reproduces eoinething which is organic and materia^ and whicli passing over from the diseaised to the heakliy hut &\\^ ceptihle person, i^ eapahle of exciting tlie same disease in the susceptible. To which view the nervous hypothesis adds that the phenomena of the dij^ease may also he excited de mwi}, that is to gay, without the contact of iufec'tion, hy tlie following niodes. — (a) Change of a secretion from simple nervous disturhance. — (ft) Change of secretion excited hy atmospheric conditions^ — so-caUed epi<lemic influence, — {c) Change excited by irregular and imper- fect sustainment of the body. This hypothesis also connects the ordinary or pliysical with the moral contagious affections.
In favor of the first or parasitic hypotliesis there is the matter of analog^'. It cannot he denied that the illustration with which I prefaced that hypothesis, in which the fermentatioo of saccharine solution hy yeast was comj>ared with the action of stualhpox viruH on a snsceptible living body, is striking, as an illustration. There is, admittedly, an analogy. Here, however, analogy, always a ilcmhtful argument mdcss it be supported m every detail, is altogetlier nn reliable. Even in regard to small- pox it does not hold its ground, because in the virus of smallpox a vegetative growth Pimilar to that which is detected in yeast is not detectable, and cannot be, what is called, cultm*ed; so that at the very outset the analogy breaks down.
When we extend the analogy from one disease to the diseases of the whole of the zymotic group, the failure is even more con- spicuous. If it were true, a particular parasitic gi-owth should be detectable in every diseai^e, which is not the fact. If it were true, upecitic forms of fermentation yielding specific products of fer- I'ttlieDtation, should be met with in every case, which is not the fact. If it were true that living germs possessing an independent gi-owth and vitality enter the animal body, tluit every <lisea8e of a communicable kind is due to its own external living gei*m, and that the germs continue to mnUiply and increase I»y an indepen- jnt action of their own ; if this were inileed true, why do the rins after a certain time cease to miiltii)ly and allow the sick person to recover? Why do they not go on multiplying until the person is infected in every part and fatally stricken ? Wio would get well from a disease due to living self-propagating con-
618
2TMOTIC CArSES OF I>I5£ABE«
tagioTis? Again^ who, if the hypothesis were true, would ' fertilisation J A general fertilizing diffuBion of self-propagatii matter, in niinnte invifeible fonn, entering the budv as the air may enter, eoultl hardly be expected to select a small minority of u population, and if it did so at the lirst, wliy should it do so wlien it had i^eized uptm many centreei in which it ccmld increiise? But tho history of all the cotnninnieable dl^aaes ehowa that each epidemic afft*cts individiiak iudividnally at different periods iij llld oonree of the epidemic, according, as a rule, tu exposnm tu the infected^ and that the period of the disease i^ limited by a development and a course rendered in certain periods of time.
If, again, the pai-asitic liypc»thcsis were true, the question of heredity in respect to tendency to particular diseases could have no place, A gertiL of disease extraneous altogether to the tnxly until it canic accidentally into contact with it, can have no connection witli hei*edit}' as a first cause of disease. As a secondary canse »nch a germ may truly find a part ; I mean, that when a dis- ease i^ once excited, a floating vegetable germ in the atmospheiu may find, in the diseased IxhJv, a home in which it can multiply, |)ahuhim on wliich it can live, and a fuiietiuii which may rather he useful than otherwise to the affect^i^d, by playing, as Profeefi^>r Owen has put it, a scavenger's part. But this is not tJ^e proline- tion of disease ; it is merely an illustration of one of Creorge Herl>ert's happiest proverbs, singularly applicable here, ** Flies an huskst about U^an horses,'^
Of Dr. Beale's hypothesis, the living germ hypothefiis^ I would speak with the greatest possible respect, and in regard to its application in ikio direction, the pnxluction of pus, or purulent matter, in the living body, it is the most i-ational, aa it seems tu me, of all the views that have ever been proponuded. At the same time 1 cannot apply it to the whole series of spreading and communicable diseases, witli their varying periods of iiicubatioDf their varying phenomena, tlieir varying nnxles of termination- I think it sometimes forms a part uf the history of every one of these diseases, mo<3ifying them in tlieir com*se, or determining their end. But I cannot see it as primary.
On the whole I abide by the last hypothesis, or that which attributes the so-called zymotic diseases to a change in thenattirfll zymosis, induced by an impression made upon the nervous sys- tem. I believe that this view explains fully why the fij'st symp-
ZTMOTIO CAUSES OF DISEASE. 619
totns of all the diseases point to nervous derangement; why there are varying periods of incubation ; why there are hereditary tendencies for and against the particular diseases ; why a certain meaaure of protection is afforded by an attack of one of these diseases ; why a pui-ely mental or nervous act excites these affec- tions ; and why tliere is so close a correspondence, running even with season, between physical and moral outbreaks of spreading and contagious affections.
Lastly, I maintain the hypothesis of nervous origin because of the pi*actical usefulness of it in relation to prevention of dis- ease. If the view were true, that the air around us is charged with invisible germs which come from whence we know not, which have unlimited power to fertilize, which need never cease to fei-tilize and nmltiply, what hope is there for the skill of man to overcome these hiddden foes ? Why on some occasion may not a plague spread over the whole world, and destroy life uni- versally ?
The nervous hypothesis presents an altogether different aspect. It says to living men and women, it is you who are the producei-s of the communicable diseases, or if it be not you yourselves it is one of your lower earthmates in creation, some domestic animal that shares with you the power of producing a poisonous secretion and of giving an hereditary stamp of production to such poison- ous product. It looks on the man or animal affected with a contagious disease as one precisely, for the time, in the position of the cobra or other animal that is naturally secreting a poison ; and, recognizing this fact, it suggests at once that the danger is all but limited to the person affected.
Isolate that person from the rest of mankind, take care that his secretions, volatile, fluid, or solid, do not come in contact with the secretions of susceptible healthy persons, and the danger is over. With the recovery of that person, that is to say, with restoration in him of a natural secretive process, the poison is destroyed ; or should he, unfortunately, die, then with the failure of his power to produce further secretion the danger is over, ex- cept some of the poison forrned before the death be actually carried away from the dead body. In a word, if the hypothesis be true, we sanitarians have complete mastery over the diffusion of the poisons of all the communicable diseases. We have but to keep steadily in view that the producing and reproducing power
620 ZYMOTIO CAUSES OF DISEASE.
is in the affected body itself, and we can then limit the action to the propagating power of that body, — its power, I mean, of secret- ing and diffusing secretion,— even with our present knowledge, all but completely.
Beyond this, if the hypothesis be true, we must expect, as we reduce the communicable diseases of one generation to reduce the tendency to them in the next generation, so that in time the he- redity to particular spreading disease shall be thoroughly wiped out
CHAPTER IX.
INDUSTRIAL AND ACCIDENTAL CAUSES AND ORIGINS OF
DISEASE
In the last chapter I brought to a close the study of the prin- cipal causes of the natural diseases affecting mankind. The causes of the diseases which are induced by our own acts and deeds were exposed as the diseases were, one by one, described in the cliapters of the Second Book on Acquired Diseases. I need, therefore, do little more in this present chapter than condense the chief of these acquired causes, as they affect the industrial popu- lations, into the following classified forms.
Industrial Caubbs.
Pabts Affected.
Cigar-making
Lace frame-making
Pottery
Painting and lead-working
Far-dyeing
Bronze-founding
Paper-staining
Tinning and brazing
Needlework
Tailoring
Clerk's work
Draper's work
Vine-dressing
Pottery working Painting and lead working Aniline dye-making Chemical manufacturing Working in bisulphide of
carbon Working in bisulphide of
mercury Brazing Fur-jpacking Enpme-driving Railway service Goffer-dam working Cigar-making
Digestive System.
The Brain and Nervous System.
Diseases Induced.
Dyspepsia.
Qastro-enterio irritation.
Nausea and vomiting.
Pyrosis (water brash).
Muguet.
Choleraio Diarrhoea.
Colic.
Constipation.
Vertigo.
Cerebral exhaustion and paralysis.
Cerebral congestion.
Apoplectic coma.
Neuralgia.
Mercurial BheumatiBm and Neuralgia.
Dementia.
|
^ 622 INDUSTRIAL AND ACCIDENTAL CAUSES ^^M |
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^^^H IkdUBTRIAI* CiLUSES. |
DtBBABBB IkDPCKU |
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^^^H Cigar-mtLkinic^ |
r |
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^^^H Lace frame-making |
Palpitation and irregnljit,,^ |
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^^^H Bleat^liing |
action of the heait. |
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^^^H Hat'DmkijQg |
||
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^^^H Fiir-dyeing |
Intermittent action of th*^^^ |
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^^^B Aniline d^re-mftking |
heart. |
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^^^B Needlework |
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^^^1 Tailoring |
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^^^H Draper's work |
heart. ^H |
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^^^H Dock labrjrer'B work |
^^^1 |
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^^^H Drayman's work |
Yalvnlar dinease. ^^| |
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^^^H Potter's work |
Blood and Cir- |
^B^M |
|
^^^H pQBtnmu'H work |
culatoiy System/ |
Degeneration of the fltn^^S| |
|
^^^H Oroom'H work |
ture of the heart ■ |
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^^^H Bone -boiling |
■ |
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^^^H Blacksmith's work |
Aneurism. M |
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^^^H Farrier's work |
^^H |
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^^^H Boatman's work |
Cyanoaia. ^^H |
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^^^H Lauudry work |
^^B |
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^^^H Clerk'^ work |
Extreme fluidity of the ■ |
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^^^H Coal-heayiug |
blood. ^^H |
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^^^H Butebering |
^^H |
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^^H Waiting |
Aneemia. ^^H |
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^^^H^ Porter's work |
■ |
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^^^^^^ Pottery working |
H |
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^^^H Millstone and stone-entting ^^^H Pearl -cutting ^^^H Bandpaper-m ailing ^^^H Needle and knife-grinding |
Phthisis pulmonalis or ^^M pulmonary con^ ^^H sutDption. ^^H |
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^^^H Hemp and ttax-dret^ing and |
^^1 |
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^^^H spinning |
Bronchitis, acute and ^^B |
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^^^H Rag-working |
i^lirnnii^ .^1 |
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^^^H MiiJing and floiur-working |
l,JJ.£UI.Ut^ ^^M |
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^^^H Wooii and ivory turning and |
^^M |
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^^^H earring ^^^H Oigar and tobacco nmnufac- |
Bronchial phthisis. ^^B |
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^^^H tnre ^^^H Walking-Rtiek-making |
The Respiratory Hvatem. |
Bronchial irritation. ■ |
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^^^H Hair-dressing |
► ^ T C7 t/i;* -U.J. « |
^^B |
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^^^H Bmsh making ^^^H Fellowsbip porter's work |
Emphysema, ^^H |
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^^^H Burnishing |
^^H |
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^^^H Faper-gtaiBing and artificial ^^^H flower-making |
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^^^1 |
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^^^H IVIining |
^^^1 |
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^^^H Trimming-making |
Spoamodic and Flax ^^1 |
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^^^H Alkali-Tuaking |
Asthma. ^^H |
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^^^H Tailoring |
^^H |
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^^^H Dokper'B work |
^^^1 |
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^^^H Clerk's work |
Chest spasm. ^^M |
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^^^H Paving |
1 |
AKD ORIGINS OF DISEASE.
623
XiCDUBrFmAii C^usis.
Pabts Atfected.
DtBKAflBi I^TDUCED.
Dock laborer's "work Oar|)eiit«Fiiig and cabinet- making Waiting Butchering Needlework.
The Respiratory
System
(Oontinned).
Phthisis.
Asthma.
Emphyaemfl.
BroiH^hml irritation.
Bronchial phthi^^is.
Bronchitis, acute and
chronic.
Vine-dressing
Working in bisulphide of
carbon Working in CJyanide of jx)-
tassium
Working in mercury Working in lead
The Sensory System.
The Glandular System.
Ophthalmia.
Double vision.
Impairment of vision.
Amaurosis.
Deafness.
Irritation of ita! ivory glands and salivation. Nephrosis. Chronic in- flammation of Kidney. Paralysis.
Pottery making
Ptuntiog aiiil lead working
Pur-packiai?
Oj gar making
WorktDg in mercury
Working in bisulphide of
carbon Bronze founding
The Muscular System.
Mercurial tremor.
Cramp.
Spasm.
Atrophy.
Inflammation of bone.
Pearl working Fur-djreing Working in mercury Working in phosphorus Domestic service Coal-heaving Porter's work
The Osseous System.
Necrosis.
Deformities of limbs.
White swelling.
Caries of the teeth.
Aniline dye-making Working in mercury Working in bichromate of
iwtassa Working in arseiiic Working in crude paraffine Working in soot
Skin and Mem- branous System.
Aniline discoloration.
Ulceration and exfoli- ation.
Follicular inflammation. Soot ulcer.
634
ITroUSTKIAX AND ACCIDEITrAL CAF8ES
Meiaiwnships of Oocupafion to J>mme,
In Btndytng tlie relationships of occupation to disease, I may j observe that many occupations attended with disease and with 4* high mortality should not necessarily be conBidered as unhealthy from the mere influence of the industry itself. The bnsinessee, of the printer, the draper, the needle-woman, the tailor, the clerk, are illustrations of industries which in themselves are harmless, but whidi are connected with a very indiffei*ent vitality. The biitclier^ has not more hours of work than the caqienter, blacksmith, ehoo-^ maker, or baker, yet his vitality is below theirs.
The business of dock laborers would not seem to be moi^ injuri- ous than tliat of tsaw^^ers, yet they are much less healthy and lia%*e a higher death-rate.
Tliese differences are not traceable to the occupation itself in any of the instances iiainedj, but to the conditions under which tlie work is carried on. These conditions are, in the main, exposure to impure air, to alternations of temperature, often great and sudden, and to exposure to damp.
The needle-wonian and tlie tailor are perhaps the fairest repre- sentatives of those who suffer from close and impure air. Packed together in small rooms, impei-fectly heated, or over-heated, and imperfectly ventilated, frequently, in fact, not ventilated at all except through the crannies of window and dooj* and the occa* siunal open door, these people soon become snbjecte<l to the poi- sonous influence <if tlieir own exhalations. Being at the same time overworked, l>adly fed, and unbefriended by any glimpse of change of scene and life, they rapidly fall victims to tlie most fatal of diseases, t!ie disease consumption being the most common of alb They live from day to day in that form of devitalijced atmosphere wliich I have described in a preceding page. By day this is the atmosphere of tlieir workrooms, by night it is the atmosphere of their small miserable bedrooms, and between tlie bedroom an<l workroom where is the life f
If the class of workers named and others kindred to them do not suffer from consumption, if, in eaj'ly life, they gtniggle past that peril, tliey still know nothing of health in the happy sense of the word- The wotnen are depressed in mind and body, an©* mic, bloodless, emaciated, always dyspeptic, and incapable of meeting the maternal duties in such a manner as to be just to
AKD OEIGINS OF DISEASE.
625
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I I
I
themselves or to their offspring- The men are pale, emaciated, restlesj?, aiui imliappy, so that even the songs tbey try to sing, and the convei-satioii they endeavor to carry on in order to relieve the mental gliwm, &0011 become mere antoniatic monotonies, li^rlited up with fitful outburats of petulance or passioD, or deepened darkly bv seizures of eilence and intense melancholy.
The plain truth is that the workers are placed nnder %vhat may not improperly be called experimctital conditions for the development of disease. In tliem the disease of nervous feeble- ness is ver}" easily lighted np if they become subjected to any change that leads to congestion of the hmgs. They are exeeeib ingly siisceptiblo to atmospheric variations. They ai^ tenderly susceptible to cokL They keep their rooms close in order to keep them warm, an*! the slightest exposure to quick and severe cold eubjects sucli susceptihle tilings to a fatal shock which, though it be not immediately fatal, is the beginning of fatality. The suf- ferers " take cold/' tlio cold is renewed in vicissitude of seasotij especially of the Bpring season, and with the frequent repetition cough becomes established and disease usually of the consumptive type is develojH!d.
In an instituiion for diseases of the chest, to which for many year? I acted as physician, this mode of development of consump- tion was told mc over and over again, a stereotyped story* Con- stantly victiitis of the disease were not even aware that it bad c'omnienceiJ, alrliough it had already passed into a stage beyond the art of the physician for the hope of cure.
Clerks and printers are to some extent subjected to the same dangers from impure air as the classes above-named, and both printers and clerks are too often subject to overwork. Printers also ai^e apt to he afiFected by late hours at work, and especially by working in gaslight.
In a less degree than the altove-named workers drapers may be enumerated as sufferers fi-om con line me nt for long hotirs in close and impure air. The goods with which the draper's shop U filled ai-e specially disjxjseil to catch and retain dust, and also to retain every organic en tanation that is capable of taking a hold on textile fabrics. The draper suffers greatly from chest affec- tion aa a result of living under these conditions. In iny work on '* Health and Life," I liave pointed out these facts in reference to drapers, and for the sake of a strikiDg illustration have instituted
INDUSTRIAL AND ACCID:EKTAL CAtTSES
a coraparifion between the draper and the grocer as indicating how much more favorably tlie grocer is placed hi respect to the value of his Jife. I have shown tliat 108 drapers die to 76 gro- fsere^ and have pointed out how the difference dependa upon the comparatively out-door Hfe of the grocer, though he too ib a shop* man, in contrast with the effects of the pent-up life of the draper.
Exposure to great heat is a source of risk incident to some industrial callings, such as those of the stoker, glass-blower, and laundress. If, however, there be a free ventilation in the work- place and such lightness of clothing as permits free perspiration the danger is not great. Laundresses suffer most from the great lieat, for in their case the heated air is often laden with moistnrev and the stoves i?i which the irons are heated produce a very dele* terious atmosplierc.
Exposure to damp is another cause of serious derangement of health and impaired vitality amongst some members of the indns* trial claafi. Harbor and dock laborers are marked illustrations of this type. They, exposed not only to sevei'e labor but constantly to wei and inclement weather, generally die very rapidly, their mortality being 121 compared with a mean standard of 100» During exhaustion they become exceedingly susceptible to colds and affections of the chest which are destructive in cliaracter. They do not suffer so much, however, from consumption proper as fi'om broncliitis, and from a wasting bronchial affection which, at one time, M^as often confounded with true consumption, but which is very distinct from true consimiption, and to which, in modem times, the name of brottehial jfhthms has been applied.
It is well worthy of remark in this place, because the facts that have been before ua in the last chapter render the illustm* tion very complete, that affections of the chest brought on by exposures to unfavorable external conditions vary, with much regularity, accordhig to the circumstances of exposure. '\Vhen the exposure is to confined air within-doors the chest disease in — diiced or favored is, as a rule, tubercular consumption- When. the exposure is to inclemency and vicissitudeii out of doors th^ tendency is towards bronchial affection, which, tliough less spe- cifically fatal to the young, is commonly fatal at a comparatively early period of the middle stage of life, Tlie dock-laborers, and others who like them are subjected to the influence of damp, wet, and sudden variatione of temperature, are, moreover, common]/
AND ORIOniS or DISEASE.
627
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I
the victims of aootlier form of disease, viz,, rheumatism and the attendant plijsical evils which are developed upon it, heurt die- esse and drupsy. Many of these suffer from acute rheumatic fe- ver, wliich rai^ly leaves a perfectly sound heart.
Otliers^ without the acute attack, undergo recurrent minor attacks which, in time, leave them more or less crippled in limb and general Iv disabled in tlie heart. The deranged action of the heart inci^ases the ditHculty of breathing and sets up symptoms usually called asthmatic, w^ith much aggravation at eveiy bron- chial attack. Sometimes dropsy, from the embarrassed state of tlie circulation, proves a fatal sequel to the embarrassment.
Butchers, like dock -laborers, are raucli exposed to the influ- ence of wet, damp, the variations of temperature, and other sim- ilar inconveniences. Tim slaugliter-liouses in which they carry on their occupation are cold, draught;', damp. The flncir is usually of brick, and during the operations of the trade is per- gistently sluiced with water. The business of slaugliteriiig is most deprcssing to luind and body. I have seen the strongest built men in the prime of life most painfully affected by it, and I have never met with one wlio could he said to have become per- fectly inured to it. They all get rapidly weary of their work, and the work, independently of the slaughtering process, is fatiguing to an extreme degree. Every step in dressing an animal is car- ried out with great rapidity^ so that tlie operator is made very hot from the work, w bile at the same time he is using water fi*eely, and is in constant contact with the moist tissues of the dead animal. A man placed under these favorable conditions for the development of c*jld and rheumatism can scarcely escape, and in point of fact very few do escape. I am not far wrong in aaying that no butcher can be found, in our large towns, who, after eight or ten years' daily work at the slaugbter-bnuse, is free from the effects of bronchitis, rheumatism, or heart disease, heart disease being the most prevailing malady of the class. The mor- tality of the butcher is, as a necessity, far above the average ; 111 butchers die to a mean of 100 of those who follow 69 other occu- pations.
CIIAPTER X.
SOCIAL Am) PSYCHICAL OBIGmS AND CAUSES OF BISEASR
Wk have traced out in detail in the history of the acquired diseaBes, most of the eau&es which are at work to produce Uiose diseases. It j^nmin** for lue now to siiinmarize a few, and the^ the most prominent, of origins and caiii?ies of a social or moral character. Such causes sonietimes act independently. At otljcr times thej act in combination with J?et6 of causes differing from themselves, They thus become directly active, indirectly active, or connectively active.
Alcoholic Inteniperanoe as a Cause,
Amongst the social causes of disease I place alcoholic intem- perance first, because it not only directly affects but indirectly leads to some additional evil^ to pauperisTo, to worry, to crime, to violence, and to the lust which gives rise to speeitic disease.
I made a formal estimate, when 1 was preparing the Cantnr lectures on alcoluih nf the mortality caused by alcohol in Eng- land and Wales, basing the calculations on the mortality returns of the Registrar-General. The result could not possibly be so accurate as was desirable, because the returns rarely state that alcohol is an actual cause of deatti. They give the diseases which we know are often incident to tlie use of alcohol, and fit>ra the facts so rendered we infer what should fairly be attrilmted to it On this method^ after making what seemed to me to be tlie fairest ded net ions, I was forced to the conclusion that alcohol leJ, in til is country, to about one-fourteenth of the whole adidt mor- tality.
Recently the Harveian Society of London, a distinguished medical body, has made a most valuable effort, through a special committee, to arrive at the number of deaths produced by alcohol
SOCIAL AND PSYCHICAL ORIGINS OF DISEASE. 629
in the metropolis. The committee collected from medical men in practice in London the certificates of ten thousand cases of death amongst adults. The facts connected with these deaths were very carefully analyzed.
The 10,000 cases, as returned, were broadly divided into three classes : — " (A), Deaths in no wise due to alcohol. (B), Deaths accelerated, or partly caused, by its abuse. (C), Deaths wholly due to it. And their respective numbers were : A, 8,598 ; B, 1,005 ; and C, 397, which gives 1,402 deaths, as nearly as pos- sible 14 per cent., in the causation of which alcohol appears to have played some part. If this part were, in all cases, a leading one, it would correspond to an annual adult mortality of about 5,870 from alcohol in London, or 38,971 for England and Wales, assuming for the moment that the metropolitan figures would apply to the whole country."
Tlie returns, however, required to be weighed as well as counted, and the committee consequently took every circum- stanco connected with them into due deliberation. Of the deaths in the lists B and C, the latter (C) were, with a few partial exceptions, entirely composed of genuine instances of death not only supervening on, but caused by, alcoholic excess, and may be tlioroughly relied upon. The former (B) was a heterogeneous group of deaths, in the causation of which the share attributable to alcohol ranged from the almost exclusive to the scarcely appre- ciable, the fact remaining that they were all deaths of persons known, or reasonably suspected, to be addicted to drink, in which the practitioner in attendance, or the coroner who investigated the death, or the registrar or pathologist of the hospital where it occurred, considered whether, on sufficient or insufficient grounds, that death was accelerated by, or was partially due to, alcohol.
On the whole, the returns seemed to show that, in London, a percentage of adult deaths, which may be variously estimated at from little more than 1.5 to 4, is directly due to alcohol ; while a further proportion of 10 per cent, of those who die have in- jured their health in a greater or less degree by alcoholic excess.
These in brief were the general conclusions arrived at by the members of the committee. In a further part of their labors, however, they studied the particular diseases which make up the mortality caused by alcohol. They summarize as follows: —
" We find, therefore, upon the whole, reason to think thati in
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BOGIAL AND PSYCHICAL
the metropolis, tlie mortality among any oongiderable group of in- temperate persons will differ from tliat generally prevailing among adulCiS in the following important particulars, viz*, a fourfold in- ei*ea&e in the deaths from diseaiies of the liver and chylopoietic viscera ; a twofold increase in the deaths from disease of tlie kid- ney, a decrease of half m much again in thuse from heart disease, a marked increase in those from pneumonia and pleurisy, a con- siderable increase and an earlier occurrence of those from disease of the central nervous system ; a marked decrease in those from broncliitis, asthma, emphysema, and congestion of lungs, a de- crease nearly as great in those from phthisis, and a later occurrence^ or at least termination, of the disease ; a very large decrease in those from old age, with an increase in tliose referred to atrophy, debility^ etc, and the addition of a considerable group refciTed in general terms to alcoholism or chronic alcoholism, or resulting from accidents.''
1 need add little to these conclusions, in so far as mortality from one cause of disease is concerned. That they do not repre- sent many lesser evils done by alcohol, in the pmduction of diseases of body and mind, evils which are not fatal, our previous chapters in Book 11, will suiBciently te8tif3\ But they give a fair abstract of important series of facts. It will be seen by I'e- f erring to the Eeport that the organs of the digestive system suffer most severely from alcohol ; that the organs of the circula- tory and respiratory systems tf^^m, comparatively, to suffer less; that the brain and nervous system suffer very severely ; and tlutt the glandular organs, the liver and kidney especially, are subject to extreme danger train alcohol
These inferences are, I believe, strictly correct with the ex- ception of those which refer to the effects of aleohol on the cir- culatory and respiratory organs of the body. 1 am convinced, both from experience of symptoms, and irom pathological inquiry, that these organs suffer from alcohol as sevei-ely as the otheiu
Dietary mid VooJc4?ry m Causes.
Bad dietary and bad cooking are active causes of disease in, perhaps, all classes of the community, but especially amongst the poorer. In the induBtrial classes tlie greatest diffei*ences previ hi this respect. Amongst the stocking-weavers of the Midland 1 counties we see, as a rule, tlie most; striking evidence of defi-
ORIGINS OF DISEASE,
631
cieney of food ; and tke eameexteods?, though perhaps in a minor degi^ee, to the majority of the iiidu8trial callings. Together with deficiency there is oooibuied the most serious erroi'S as to qual- ity of food, the tendency, for the sake of economy, being towards a too exclusive Bturch dietary, and to the omission, in great part, of nitmgenons food. Tims the muscles and other nitrogenous structures are imperfectly developed, a thin emaciated state of body IS maintained, and a parched and feverish state of the sy^ tern is engendered, ^'aturally these conditions lead to dyspepsia, and from the dyspepsia, in tliose who are disjiosed to the disease, the phthisical tubercular malady readily commences.
Lastly, on tliis point, in cases were the food is fairly good in quality as it first comes to liand, it is so destroyed by the various processes of cooking and preparation t!iat half its pro|>ortioa8 as digestible, wholesome, and sustaining nourishment, are sacrificed-
It is not until these facts are actually wituessedj it is not until tlie cold, uncomfortable, indifferently prepared artisan meal is seen, that the miscliiefs arising fi^om it can be appreciated. The mischiefs extend through all ranks of the induatrials with inoit* or les^ of intensity, and througli all periods of life from childhood to old age. We can scarcely wonder tluit alcohol should be so frequently substituted as a false replacement of a dietary that is I generally objectionable.
While tliese errors in dietary are the rule amongst the indus- trial classes, some exceptional errors of an opposite kind are met with in certain localities* Tims, to take one example which I have noted. Amongst some colliery operatives I have not only known provisions abundant but luxuries holding a prominent place. In the early part of the week, when they have their wages in hand, these industrials '^ play,*' as they call it, and live in sumptuous style. They select the choicest viands that can l>e obtained, and will have whatever is in reason. Ducks, geese, lamb, game, aspar- agus, everything that money can \my they purchase, so long as there is money in the locker. Not uufrequently they keep up this feast for three or four days in the week, and then they fall to work again and live on anything they can get, faring as badly as they before fared sumptuously, the ordinary staple of animal sustenance being pork.
The diet of a population leads, almost, to the introduction of racial peculiarites, and uo estimate of vitality resulting from
mB SOCIAL Airo pstciucal
labor U of strict valoe until tbe die! U kiMHrst ; for^ io trnihtl Iftbor lA die oonveD^iuii of the force ounUined in food into motion and work ; but with the niiUious, the naiund intention of food ie hardJr undentood ; thejr eat as aniinals eat^ horn the itupulse «>C to^ncL
In tlie infant popcdatiofi bad feeding is a cause of int nitj«chief. More than half the di^^isee of the digestive whidi iKxnir in infancT are due to injproj>er foo<l and fee«ling.
Ainung&t the adult rich the errt^ra of over and Inxtirioud feed- ing are common canoes of organic deterioration.
Tbe digestive eystein i^a first injuriondjr influenced by errors in dietary, but many other of the % ital fty&teuis, inehiding, q)e* cially^ the eircnlatory, the nervous, the glandiilan tlie niii£cular» and the inemhrauoi^, am injured by these errors in respect to supply uf fuml for the sustenance «>f the IxWy.
Moral Surroundings as CauseB.
Amongst the industrial clasees there is another set of i at work wliicli lead both to mental and physical derangement of health. I refer to tlie moral influences affecting tlie industjial ' classes. Tbe !iece&.^ity of having to work in masses in the same buildings and at the same monutonous, ever-re])eating labor, in w^hicli the muscles are moving with automatic regularity^ and the brain is left unemployed except to brood over i*ejd or im- aginary injuries, affects life to the core, and exerts a laMing and itijiirious effect on the vital value of the manufacturing classes.
The agricultural laliorer may work hard» fare badly, be housed shamefully^ but he luis advantages. lie is engageii out of doors in the f resli air ; he has all the beauties of tlie external nature to delitfht and refresh him. His work is varied. Tliers is the spring-tide sea&i>ri, with its sheep-wasliing and shearing; the summer with its hay-time ; the autumn with its harvest ; the other months of ploughing and sowing ; — a constant roimdelay of work, with varied change for the mind as well as the body.
The artisan has no such reliefs* Ho passes day by day, month by month, year by year, tlinxigh tlie same monotonoutJ labor, until at last his mind i-ecognizes but one scene; liis hand& fall but to one automatic i-outine. To the end of his cai'eer he sees no change, nor chance of l>eing made independent by his skill and his industry. He, therefore, is naturally apt to become
ORIGINS OF DISEASE. 633
fretful, amcione, imtable, tlie victim of smonlderiug passions, which wear out his heart, and lessen his nervous resistance to the many external shocks to which he is daily subjected. Moreover, the limitation of his means leads to limitation in the necessary comforts of his home. He who is in these straits is rather to be pitied than blamed, if in false measure of the deed he seeks ignorantly still more sorrow in alcoholic indulgence.
When we add these difficulties up, the struggle against penury and actual want, the confined dwelling-ix)om, the badly- ventilated, over-stocked bedroom, the indifferent couch, the lim- ited sleep, the ever-returning toil, and the rarity of wholesome relaxation, eitlier of mind or body ; when, I say, we add up these difficulties, we have before us evidence of vital strain which prac- tically is resisted longer than, at first sight, we could imagine to be compatible with human endurance. The late Dr. George M. Beard, of New York, in an admirable essay bearing on this subject, thus felicitously condenses the conditions I have glanced at.
" Almost all muscle-workers," he says most trutlif uUy, " are born to live and die poor. To live on the slippery path that lies between extreme poverty on one side and the gulf of starvation on the other ; to take constant thought of to-morrow, without any good result of such thought ; to feel each anxious hour that the dreary tread-mill by wliieh we secure the means of sustenance for a hungry household, may, without warning, be closed by any number of forces over which one has no control ; to double and triple all the horrors of want and pain by anticipation and rumi- nation,— such is the life of the muscle-working classes of modem civilized society ; and when we add to this the cankering annoy- ance to the workman that arises from the envying of the for- tunate brain -worker who lives in ease before his eyes, we marvel not that he dies young, but rather that he lives at all."
The nervous system is the chief suffering system from bad moral surroundings.
TJnclewnliness as a Cause.
Uncleanliness is one of the commonest causes of disease. It extends in its bad action from the acquired diseases to tliose dis- eases which are called natural. Uncleanliness in respect to food favors many of the diseases which are manifested in the diges-
634
SOCIAL AND PSYCHICAL
tive 6T6tem, and especiallj of those afifections wbich are of a parasitic nature. Animal and vegetable food whicli is charged with parasitic life is uncleau food, and, as we have seen* is a cause of some of the most troublesome as well m of eome of the most dangerous affections. Water containing organic or inor- ganic impurities is uncleanly, and is a cause of many di^a affecting the alimentary system* Thus water as the bearer of of^l ganic virus is, indirectly, the uncleanly cause of the disease called typhoid fever, and, as tlio bearer of tlie inorganic poison, called lead, it is the indii'ect cause of lead colic. Some affections of the nervous system are induced by uncleanliness in feeding. Tims those who work in lead, and do not take cxire to cleanse tbeir bands, are, as we have seen, subjected to paralysis from abs<>r|v tion of lead. Tlie same fact applies to uncleanliness in itigard to other agents wliich are absorbed by the skin in uncleanly occu- pations and which affect the nervous centres.
Air rendered uncleanly is a cause of numerous diaeases af- fecting the blood and tlic circulatory and respiratory systems. \Ve have seen this fact illustrated in a variety of ways in the preceding pages. All the diseases produced by impure vapors and by dusts are due to this form of uncleanliness, as well as the affections attributable to a deteriorated or devitalized atmos* pliere.
The cutaneous or external membranous surface of tlie body is of all i>arts most subject to stiffer from uneleanlineas of person. Many of the pamsitic diseases, scabies particularly, are deter- mined by uncleanly habits though they be not tlirectly generated. Sores upon the skin and abrasions in folds of the skin are the common results of accumulation of dust and dirt on the surface. We have seen how in disease from paraffin and soot (pp. 370- 72) tlie skin suffers in this manner. ITncleanliness of the skin leads also to general ill health of body. When the skin acts im- perfectly from being oppressed with a covering which closes up the perspiratory ducts and prevents free evaporation of water fix»m the body, there is an excess of transpiratory fimctiou, vicarious function, thrown upon the lungs. When there is excess of work, vicarious work, thrown upon the lungs, the liver soon begins to suffer, and the digestion becomes, tliereupon, deranged. With this there is aceamulation of gas or flatus in the stomach and intestines and greatly impaired digestive activity. Hence persons
OKIGINS OF DISEASE. 635
wlio are not given to ablution of the body are always troubled witli flatulency and indifferent dige&tion.
In addition to the above-named causes, I might add those which have passed before us as worry, unnatural physical exer- tion, and moral contagion, all causes which tell, primarily, upon the nervous systems, and afterwards upon those organs which de- pend upon the nervous centi'es for their vital power.
CHAPTER XL
SENILE DEGENERATIVE CAUSES OF DISEASE.
To all these various classes of disease, divided, so far, in i*e- spect to origin, into eix groups, ^lln^t be added those cliaiige« which am specially incident to old age, and which ai-e said to in- dicate the progress of senile decrepitude and decaj.
Each period of life is marked out as belonging to one or other of four distinct stages of progi'ess. There is a first period extend- ing from infancy to complete adolescence, through a range say of thirty years. There is a second period extending from thirty to forty-five years, which embraces a time that reaches from com- pleted adolescence up to completed manhood. There is a thini period extending from forty-five years to about sixty-five, whicli includes a tittie when the body has attained what may be called full lifehood, and retains it without much shade of change if the conditions necessary for natural life are fairly observed. Lastly, there is a period prolonged from sixty-five to ninety or even a hundi*ed years, in wliich the body is passing from completed life- hood into natural decline.
Tiie first two of these stages seem to be fixed and ordained by strict rules amongst members of the human family. The two last-named jUM'iods are tjot my fixed, but either of them may be reduced or extended. Some men and women have passed into their declining stage so soon as they have reached perfected life- IkkkI, and flie without siiowing any third or retaining stage at all. Others retain fair jierfeetion of lifeliood even xip to the seven- tieth year, and decline ao slowly that their fourth stage may be extended many years beyond the ordinary duration : these seem, positively, to live a new life, to experience a rejuvenescence under which they may attain to even a hnudred years.
Through all these stages there is a certain line of trne physi- cal change. In the fii*st stage all the organs and parts undei^
SENILE DEGENERATIVE CAUSES OF DISEASE.
mi
Wie enlargonient and (levelopment whidi eonstitutea wlmt is callcxl growtb, in this stage the elastic tissue of tlie elastic mohile organs is brought up to its full ratige of tension, to as much as it can bear with equality of resistance and with evenness of action. In the second stage the elasticity is maintained, but is not im- posed upon by further force of growth, wlule all the organs, brought now to their fulness of deveioprnent, are consolidated and fashioned into working order. In tlio tliird stage the perfected organism, thongh no banger naturally expanding or growing, and no longer possessed of its previous elasticity, is enabled, neverthe- less, to endure a certain long and defined phase of work and movement It docs not truly repair so readily as it did; does not bear elioeks, mechanical or mental, so well as it did ; but still it works f>n, a goo<l Rtea<ly, hardy organism, and in some powers of a mental kind is bt^tter endowed than at any previous period of its existence. In the last stage the physical decadence of tlie organism is the notable fact. In this stage the once elastic fabric has ceased to bo elastic, and affords little resistance or resiliency. The once elastic arterial tubes which recoiled after each stroke of the heart, and by eounter'Stmko helped on the circnlatiou of the blood, gradually fail. The resell ient lungs whicli, by their elastic fibres, responded to the impulse of the respiratory muscles, gradually fail, so that the emptying of the lungs of their con- tained air is imperfect, and breathing is shortened. Then within the tissues of the relaxed organs new products ceasing, under an impaired nutrition, to be formed, tlie organs slinnk. Tlicn tlie blood, circulating more languidly, and diminished, is reduced in volume and in vital waniitb. Then the brain and nervous struct- ures undergo the physical change called sclerosis. Then, at last, all organs and parts passing gently into inertia, the extinction of life from tlie periphery or circumference of the lM3<ly towards its centres, loads to complete arrest of motion, or, as it is said* death. It is in this last stage that the phenomena of the natural dis- ease by wluch life is terminated is developed. Tlie disease is sometimes located in one organ^ sometifnes in another, and by the organ most affected the nK>de of death 19 commonly recorded. Really, however, when at the full period of life one vital organ fails, 80 dependent are all the vita! organs on each other, they all soon begin to fail with their fellow, and follow it into its deathly decrepitude. From observation founded on this fact came the
038
SEKILK DEGKNERATITE CAUSES OF DISEASE.
wise eaying of one of the shrewdest of philosophers, that old men are '' like ruined towers/' They hold up, wonderfully, so long as they hold np together and as one ; but touched at a .single part they fall in mass.
Beeanse their \^tal activitv is leas than it was ia earlier times of life^ old |>er6on8 are less liable to be affected by some of the sicnte diseases that are inddent to tlie early days of vital power. Thus thc?y are saved from Tarious causes of danger. For the same re^*ison, however, they are more exposed to danger when they are attacked lanth maladies of an acute character, and sink easily from even slight attacks uf acute disease.
The period of the year in whicli the aged most frequently succumb extends from the close of November to the end of April The period of highest mortality or absolute maximum is Januai These are the periods marked by cold and dryness and cold
The period when the mortality from old ago or senile decay is the least extends from May to November; tlie time of lowest mortality or absolute minimum being from July to October.
So soon as the month of November is on the advance mortahty from senile decay begins rapidly to rise, an indication that the wave of cold, now setting in, is telling upon the reduced vital powers.
The organs of tlio body which are most fi^equently points of failure are the lungs, a fact which has led some authorities to conceive that in every case of natural decline the primary failure is from the respiratory surface. A dogmatic statement to such effect is, I think, too absolute. But it must be conceded that as no surface of the body is so directly afFected by cold air as the breathing surface of tlie limge, this is the surface which in a larj majority of cases is primarily affected. Hence the number aged people who, during tiic season of cold, and of cold and danip^ sink from broncliitis, acute or chronic, pulmonary congestion^ asthma, spasmodic breathing, and otiier affections of tlie chest.
It often happens owing to this weakness of respiration tliat aged people going from a warm room, in winter time, to sleep in a bedroom where a fire is not retained during the whole of the night, are subjected to acute congestion of the lungs as the result of the rapid fall of the temperature of the air they breathe. I have known in my experience several instances in wliich this sud- den change has been sufficient to cause dissolution during the act of sleep.
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CHAPTEE Xn.
DEATHS AND CHIEF CAUSES OF DEATH IN ENGLAND AND WALES IN THE YEAR 1880.
In order to bring to a full conclusion the part of this work relating to causes of disease, I add, on the suggestion of my dis- tinguished friend, Mr. Edwin Chadwick, C.B., a table construct- ed for me, by Mr. Mundy, of the Registrar-General's Office, of . the causes of the mortality of England and Wales in the year 1880.
The table thus presented is, in the main, a copy of a similar one constructed by Mr. Chadwick, from the returns of 1847, an abstract of which table is also added for the purpose of comparing the relative mortalities of two equal periods separated by the span of thirty-three years. On comparing the two years we see that the proportion of deaths from different classes of disease has slightly varied. The zymotic diseases, relatively to total deaths, have decreased in 1880 in the proportion of 3.17 per cent. ; con- sumption has decreased in the proportion of 3.55 per cent. ; dis- eases of the digestive organs in the proportion of 1.08 per cent. On the other hand, diseases of the respiratory organs, irrespective of consumption, have increased 6.64 per cent. ; diseases of the brain, nervous system, and senses, 1.58 per cent. Other causes remain nearly the same.
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BOOK III. PART THE SECOND.
A PRACTICAL SUMMABT OF PBEYENTIONS OF DISEASE.
CHAPTER I.
mrnoDucTORY notes.
It was etated in tlie introductory portion of this thii'd book, tliat, althangh there were, noininaOj, over a thousand diseases affecting human kind, the nnniher of dieeasee wfiieh called for special notice might be reduced, practically, to a little over one hundred.
If we could prevent, therefore, from ninety to a Itnndred of tlie diseases which make up our mortalities, we should compasd the prevention of almost tlie whole field of disease, since we should incidentally learn how to pi-event or remove most of the minor diseases, which do not kill, by the same effects of preven- tion.
Conmiencing the study of prevention we may then limit onr observations to the comparatively few diseases which are most prevalent and most fatal.
In dealing with this limited inimber of diseases, in respect to the means necessary for their prevention, we may again reduce tliem to groups according to their causes, because we sltall discover, if we simply turn back to the pages of the history of disease, that preventive measures group themselves into natural position by tiie side of causes. Thus, to take one example, almost all the class of diseases grouped under the head of zymotic demand similar principles of treatment in relation to their pre* veution.
The chapters which are to follow will consist of a series of practical summaries relative to preventive measures. In these chapters I shall consider the question of prevention as connected with the varieties of origins and causes of disease, with the object of indicating how those origins and causes maj' best be averted or stopped altogether.
There are three grand agencies to be taken into account in
646
nrTKOBUCTORY KOTES.
the numeration of all measnres of pre^^ention, I may call tliese the personal^ the municipal or hcal^ and the central or fjovrrn- mental agencies. By the personal 1 i*efer to the influence; which every individual or person may bring to bear for the prevention of disease in himself, or in thuse who immediately belong to him. By the municipal or local I mean those agencies for prevention which are brought into action through the instrumentality of local or municipal boards in tlieir localities. By the central I mean those agencies which spring from the central government, and which are iji tended to apply to the country altogetlier, to local government, and equally to personal responsibility and authority.
Of tliese three agencies the first is, according to my view, by far the most important. It is so important that if, as an agency, it could be made perfect, all else would sink into mere nominal position, or would, at most, consist of formal administrative la- bor. As, however, it is impossible to secure such personal per- fection, the two other agencies are, perforce, demanded, and of these two the local is in my opinion pre-eminent.
The local government of the place is the health of the place, ^ Each place must be ruled into health by those who know, and know best, the wants, the necessities, the feelings, and the fail- ings of each individual centre. To try to make all the separate centres and towns of our land perfect in salubrity by directions and instructions from a central government control is to give up permanent local reform in this direction altogether. There are in a locality sufficient obstacles in overcoming mere local tra- ditions and sympathies to render liopelessly impossible urgent re- form pressed frotn a distant quarter where tliere is no local knowledL?e of sympathies and no sympathy with them.
For the !c»cal work there must be tlie local power ; power which the local authority shall be proud to exercise witli knowledge and wisdom; power which shall be in its way competitive, and which sliall have the effect of stimulating competition until Iiealth, like leaven, has leavened the whole of the national life.
At the same time in every country there should, no doubt, be a supplementary governmental or central board. A central board of reference ; a board competent to speak with authoritative ad- vice in general questions j a board that could arbitrate between conflicting opinions and would be open to be consulted on dis-
INTRODUCTORY KOTES. 647
puted points ; a board which, by its per%onnel^ would command the respect of the nation, and confer scientific dignity on the nation in the presence of other nations ; and, a board to wliich other nations organizing a national health advancement could refer. Such a central board in England, at the seat of govern- ment, would be invaluable. Here, however, its duties should end. It should rule, not govern, be at once tlie greatest and the least of the sanitary authorities. It should be a centre exhibiting to the nation and to the world the widest, to the particular locality the narrowest, range of action.
Sometimes, in treating on details of prevention, we shall find that all these agencies are required to be brought into operation in order to secure prevention. At other times one only or two may be required ; but in every case the first or personal agency will be demanded. I shall, consequently, in each succeeding chapter take the personal consideration first, and the local and central, when they come into requisition, in the second and third place respectively.
CHAPTER n.
PREVE^mOX OF HEREDITAEr COIISTITUTIONAL DISEASES,
Personal Rexes for Prevention.
The prevention of descent of disease by hereditarr taint can only be systematically secured from its origin by sucli measures as shall arrest or check the intermarriage of disease. By most persons it is supposed that this mode of prevention is neceaa&r only for persons of the same kindred. The theory is time and** untrue* It is quite true when it applies to the marriage of per- fiODS of the same family, such as cousins, if the members of that same family are affected with decisive taints of disease, for then the taint is intensified by such marriage should progeny be the result. On the other hand, if tlie members of a family be per- fectly healthy, and free of taint of disease, marriage taking place among the members of that famil}^ within the legalized limits, instead of being attended witli bad results in regard to progeny may be attended with tlie best results. In other words, mei^i consanguinity is not the determining cause of descent of disease,] and parents who have charge of those who are marriageable* opi marriageable people themselves, need not consider consanguinity an objection unless it carries with it constitutional defect. In allj cases reasonable people should give no countenance to marriageiT where thei"e is definite indication of constitutional affection on both sides, even tliough the constitutional affection shall not be-i the same on each side ; since some crosses of disease are quite ati serious as the double hereditary infliction of the same disease. A reference to the chapter on hei^ditary causes will make this matter sufficiently clear.
PBEVEI«TION OF HKREBITABY DISEASES,
649
Hule^ for an Esi^fiectcmt Mother,,
In all cases, whether tendency to hereditary taint be great or Bmall,^ — it is never, perhaps, actually absc^nt, — special care ought to be taken with women who are about to become mothers. There is no part of the preventive art which calls for more care tlian tills. There is no practice tliat is more eeriouely neglected. Amongst the poor we often eee women laboring at the hardest ta&kg, subjected to the most painful annoyances^ anxieties, and troubles, up to the very moment when the pahis of hibor ai'e con dug on. Amongst the wealthy and well-to-do we see women pursuing occupations and often wearying pleasures, giving way to caprices, or exposing themselves to fatigncs, or being subjected ta trouble and sorrow, np to the same jieriod. This is all as wrong as can be, and when the fact 1% i-ecalled tliat during all tlie period previfuis to its birth the unborn child is dei>endent for its life-blood on its mother, the commonest sense not less than the commonest humanity eomi>rehends liow everything that tends to reduce the vitalit}^ of the mother tends also to reduce the vitality of tlie offspring, and to render it the nioi^ Hable to suffer from the efiFects of hereditary or transmitted taints of disease.
For my part I do nf>t know which suffer most, the poor women or tlie rich women, during these most crilical and im- portant periods of their lives; but, on the whole, I fear tlie wealthy ai-e the worst affected, and that indulgence is more in- jurious than poverty.
Amongst Ijoth classes certain simple rules should invariably be followed. The diet on which the expectant mother subsists should be of the simplest ami h?ast stimulathtg chtinieter. Animal food in the way of flesh should not be taken more than twice per day, and always in moderation. Alcoholic drinks and tea should be strictly avoided, the drink diet being made to con- sist of milk, milk and water, cocoa, and similar nutritious and nnstimnlating fluids.
Next to these attentions in respect to diet matters of exercise and rest should be carefully considered. Daily out-ch>or exercise, to the extent of not j>roduciFig extreme fatigue, is essential, lint this should be alternated with the most careful attention to rest Every night beti sliould be sought at an early liour, and never less than nine houis for sleep should he taken. The bedroom
650
PREVENTION OF HEREDITARY
should be well ventilated and of equable tempt_T:iuirr, u temper- ature of 60^ Falin being a good staudard. Tbe bed-dotliing should be warm but Itglit, and tJie bod should be exclusirelv occupied by the woman herself,
III daily life all scenes leadin^r to excitement of mind, emotion, passion, especially passion of fear or anger, should, to the fullest possible extent, be avoided. Influences telling through the mother on the child during tlie stages of development inflict, I atn quite eontident^ upon the developing child nervous uiipi^essions wliicU are never eradicated.
The clothing of the expectant mother requires special care, since, under the present system, it is the worst that by any mor- tal ingenuity could be devised. The clothing should be loose, light, warm, and borne entirely from the shoulders ; anytlnng like tight bands or corsets round the body are eqmdly injuriou* to mother and to child.
Lastly^ the expectant mother should, of all persons, be pro- tected from exposure to iufectious disease, because, us we aii? now well aware, such disease may bo directly communicated to the unborn.
I have reduced these rules to the fewest possible and to the most elementary form, so as to render them plain and easy to every class. They are very simple ; they are entirely natural ; and, being followed, ^vould largely prevent the many d;iiitrers incident to hereditary proclivity,
liuUs for Infancy,
The infant, so soon as it is bom, should be warmly wrapped np and kept warm. Warmth is essential to its life. It shouU be washed as soon as posdlde with warm water and soft flannel*
After the first washing, the infant should have a warm batli twice a day, one in the morning and one in tlie evening. The w^ater should be pleasantly warm to the hand — not hot, but luke- warm. The body should be washed, while in the bath, with n piece of soft flannel, which should be changed for a new piece every week at least. Tlie w^ashing should be conducted gentlj and rapidly, a little plain' soap being used. After the washitigil the body should be w^ell dried with a warm soft cloth or towel Tlie washing should be continued every day, with careful dryiu and gentle friction.
CONSTITUTIONAL DISEASES.
651
From the fin^tj the dress of the child should fit loosely and easily- Tiglitueiss of tlie dress anywhere is very bad* Tight swathing of the bcniy and limbs by many bands of cloth or flannel, — ewathing-bands, — le the worst thing that can be done. It checkfl free breathing and circulation of the blood, chafes the skin, pinches, and cxinses want of comfort and rest.
The clothing shonld be light and warm, and it ebonld cover all the body J except the head, face, and hands. Liglit Pid't flannel, having a smootli surface, should be put next the skin. The feet shonld be clothed in warm woollen socks and shoes. The clothing should always be kept as clean as can be, so that it never has a bad smell nor shows patches nor spots of dirt. The body linen of the chihl should not l)e washed with soda.
So suun as the infant is washed and dressed, it should be pnt to the mother's breast. The mother and cJuld both get good from this plan. If the mother has little milk, the act of putting the child to the breast will tend to cnu&e a flow of milk ; and, if the infant gets milk direct from its motlier, it will not j'eqtiire opening Tuedicine. The infant will live best, and ought to live solely, on breast milk for six months ; nine months will nut be too long.
If the mother fail to supply milk from her own breast, and if there be no wet nurse, the child slionld be fed witli cow's milk diluted with water. One part of pure cow's milk and two parts of water is the best mixture, to which a little sugar, oneteaspoon- fnl to a quarter of a pint, may be added. As soon as ever it is pofifiible, tlie infant should have its natural breast milk ; and should that not be quite siifficient in quantity it should be supple- mented with cow's milk, dilnted with water as above.
It is wrong to give up breast milk because the Bupp(y fi-oni that source is not enough. The milk given in addition to breast milk should be warmed before it is given as food. As the child gets older, the <piautity of cow's milk may be increased and the water lessened. At two months, the cow's milk may be increased to two-thirds, water one-third. At six months, thecow^s milk may be used w^ithout water.
After six months, the infant may begin to be weaned ; but there is no cause for hnny, and if the child is at the breast for nine months it will take no harm. At nine months it should be weaned.
652
PREVENTION OF HEREDITARY
Weaning should be carried out gradually, and the milk fo ehould l:>e replaced by Boinething similar. The liest substituted are whole meal, wheaten porridge, and oatmeal porridge, inth £i-esh mOk. Until the first set of teeth is complete, no other kinds of food are required. The practice of giving infants bits of ani- mal food, animal soups, or puddings is most injurious.
Intoxicating drinks of all kinds are most poisonous to infants. Any terms less strong than this, as applied to the drinks, would be imder the truth. No such drinks should ever be given, either with or as food. Tea and coffee should never be given to children.
After the child has cut all its first teeth it may begin to take light solid food. Good bread, small portions of well-cooked ani- mal food, light custard puddings, and fresh fruits, ai-e the beet foods in early life. Under a prudent system, animal flesh may be dispensed with, as well as intoxicating drinks. Oatmeal and wheaten porridge with milk are still the best staple foods.
The feeding of children as of infants should be at regular intervals. They should be fed about every three hours in the course of the day.
Care should be taken that the infant does not suck its thumb or any solid substance. This practice is bad in two ways. Of a certainty, it causes pain in the stoniaeh, and d istnrbance of the bowels. It a1 so gi ves rise to after deformity of the mouth, i\ early all grown-up persons who have tlieir upper front teeth too prom- inent and angnlar, with a deep hollow in the roof of the moutb, have caused that deformity by sucking the thumb when they were infants, and the defoniiity is hereditary.
The infant should from the first be taught to sleep in its own little bed or cot. In its first days it should be aUowed to sleep when it likes, and indeed it may pass three parts of it^ life in sleep. It should be trained to go to sleep at regular hours nt night. Its l>ed should be veiy soft, so that the little body finds rest on every part.
The infant should be put into a warm bed, and be kept warm dnring sleep* It should not be excluded from the air, but should sleep in a pui*e warm atmosphere, and be well covered with liglit warm bed-clothes. The air of the room should always feel com- fortably warm. If a thermometer be used, it should indicate aot less than G0° and not more than 65"' Falir.
CONSTITUTIONAI, DISEASES.
653
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All artificial plans and prftctices of causing eleep are bad. Tlie infant eliould go direct to its rest. Walking about with it, rock- ing it, jogging it, am bad habits. One© taught those habits, it fioon fails to go to sleep without thein, and they create much dis- turbance of sleep, with dreams and Rtartiugs, wltich lead to fever- isliness and fretting the next day* Soothing sirups, laudanum, poppies, and all sleeping drugs are most injurious as means for producing sleep, and slioidd only be need nuder competent medi- cal advice. They ought to be excluded from the houses of all persons who call themselves respectable, except when wanted, tinder medical direction.
The sleep of infancy should never be disturbed by noises and sudden surprises. It is most Iturtf ul to take up an infant from its quiet repose to show it to strangers, or to amuse it in gas-, caudle-, or kmp-light. It is desirable that the sleeping- room or nursery should not only be warm, but cjuiet, spacious, and well aired. Anything that causes a bad smell should not remain in the room for a moment. The room should never be darkened. The cot may be shaded from direct light, or tlie light may be shaded fi-om the little sleeper by a curtain; but the sunlight, when it is present, should always be let into tlie room. Sunlight cheers, exposes dirt, and purifies the air.
The infant should be taken out into the air every day, except when the weather is wot or very cold. It does the infant no barm for it to sleep wdieu it is out of doors, if it be well wrappeil up. The exercise »mt of doors should be long before m'ght, and at times when the weather is most agreeable, not too hot and not too cold. In wdnter, the infant should go out twice a day if it be possible, once as a matter of course. In summer, it may live out of (jfK>r8 in the best parts of the day. When out of dooi's, the infant should be well pi*utected from the cold in w^inter and from the heat in summer. In winter as well as in summer light-colored clothing is best for it. In the summer, its head should S|>tvcially be shielded from the direct rays of the sun.
The infant life should be one of quiet all the day and all the night long. An infant ought never to be exposed to sudden noises and starts. An infant should never l>e taken into great crowds or tnnmlts, nor into public noisy meetings and amusements. Many of the painful impressions which are felt in after life, and which cannot be traced to any direct origin, are iullicted in the
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PREVENTION OF HEREDITARY
pcrirxl of infancy, when the mind receives but does not remember the fact of receiving the impressions.
Infants sliould not be shouted at nor scolded, nor in anr way frightened. They suffer intensely from sudden alarms and fears, and may become nervous for life by such injuries, A baby should never be sti'uck nor subjected to any punishment of tliBt kind* It should always be made as happy as it can be. Then it is likely to grow up disposed to be blessed with a eheei-ful dis- position, which will make it happy in itself and a source of happi-j ness to all around it.
The infant should never be lifted up by its arms, or made to j stand just on its toes while partly lifted. It should on no aecouut ' be placed too early on its feet to stand or to walk. By placing it on its feet too early the child is apt to get bow-legged, and some- times weak or deformed in the back. As a rule the child itself learns, naturally, to acquire the art of standing and walking, and it should be left to itself so to learn.
Those who are nursing the young from their o\*ii breast, should be kept as free as is possible from anxiety and care* and should be encouraged to be all day cheerful and happy. The impressiorts they make on the child are often lifedong.
Nursing women and mothers should be well but not richly fed. They should have four liglit meals a day, abundance of milk, fresh fruit, and, in fact, generous food* They may take tea and coffee in moderate quantity, but every stimulant of an alcoholic kind, such as ales, stouts, wines, and spirits, should be avoided. Stimu- lants injure the nurse, the mother, the infant. They can be easiljy substituted by milk, malt ine, uatmoal-porndge, and other harmk and truly sustaining foods.
Every mother, who is not actually in bad healthj should nurse ' her own child. This is a dutj^ not to the child merely, but to tin mother. It is health to both.
Rul€3 for CMWiood,
The first rule for ehxldliood relates to the feeding. This should be at once simple and efficient. The meals should V»e at regular hours and at periods of three or, at most, four times a day. Animal food, with the exception of milk, should not l)e taken more than twice per day, aud judicious preference should
CONSTITUTIONAL DISEASES.
665
always be given to carefully selected vegetable foods and fjnitSt The liking of eliildren for fruits is a natural desire, and with care to see that the frtiits are clean, ripe, but not over-ripe, and fresh, this liking should be encouraged. The child should he taught to ceaee to eat so soon as it feels satisfied. The foods chosen for it should include tliose wliieb provide for all the animal wants ; colloidal fvkods, for building up the active structures of the hodj; mineral foods, for building up the passive structures or bones; hydro-carbon fo(»ds, for supporting the animal warmth ; and water, for supplying the natural fluid foud by which all the other foods are carried and distributed.
AH stimulating beverages, alcoholic drinks in every form, should be strictly avoided. Tea and coffee should also be with- held.
The dress in cliildhood should be warm, light, loose, and should be made to assimilate as nearly as possible, in shape and form, for lioth sexes. All dresses which compress the growing body ; all dresses which muffle up some portioua of the body closely and
■ leave other parts, such as the legs, arms, and breasts, uncovered, are a mistake. Tlic cinthiug should 1h2 so adapted as never to be
_ an encumbrance to the movements f>f tlie limbs or to the move- ments of the respiration. It should he carefully adapted to the
K»ns, on the rules to he des(:*ribed in the next chapter* *""' In childliood there should be free exercise both of body and mind, sufficient exercise \^Hthout enforeement of it. Every simple bodily exercise which brings into play the muscles of the limbs, wliicli causes the lungs healthily to expand, which encourages free circulation, which entices natural appetite, which keeps all the natural functions io order, and which keeps the mind happy and cheerful, is excellent* Whatever goes beyond this in the way of physical exercise, whatever leads to physical strain, is injurious and provocative of constitutional disease.
All mental strain iu childhood is exceedingly mischievous in effect. The mind should be left free to grow with the body, and lesscms should lie permitted rather tlian enforced* l^cssons com- umnicating knowledge shouhl be of tlie simplest and most practi- cal kind, after the manner of the Froehel or Kindergarten system, in which tlie mind is educated through all the senses and with pleasurable emotions. In a word, nothing tends more to prevent the development of constitutional disease than the natural and
666
PREVEIfTION OF HEREDITAKT
healthy development of the nervous BjBtem, without strain or worry.
The repose of childhood by sleep requires to be carefully tended, Durlncj the whole period of cluldhood^ which we may consider to extend to the fifteenth year, ten hours of sleep should be encouraged. Each child should sleep in his or hei* own lied ; this is a vital point The bedroom should be well ventilated, pure, light, cheerful, and of equable temperature, GO"^ Fahr. The beddiog should he clastic, so that the l)ody reclines altogether and not on parts of its surface. Tlie bed-coverings should be light, porous, warm, and spotlessly clean. Perfect quiet in the bedroom is essential for the healthy sleep of childhood, since every tuinecessary disturbanoe of sleep is against nature.
Children should be very carefully tauglit to carry out all natu- ral habits with regularity and cleanliness. They should be par- ticuliii'lv instructed to attend to the action of the bowels at one partictihir tinie each day. They should als*> be taught tlie habit- ual practice, common amongst the Jewish people, of ablution afterwards. They should further be brought into the regular habit of the niorning bath, so that they may feel that the day has not l>een prc*perly conamenced until the bath has been taken.
Connected with niorning and evening habits tliey should be instructed at night to turn their clothes inside out, and lay then in systematic order so that they may be aired during the night^l and turned and cleaned previous to dressing on the foUowing inorniiig.
The mind during childhood should be kept free from all men- tal iHipi-essions of fear and disquietude. Stories of ghosts and such-like absurdities should be kept always from the young. The cliild sliould also be held fi*ee from excitements springingj from details of crime or tragedy of any kind.
Lastly, children should be scnipulously protected from ex- posure to tlie contagious diseases, physical or morah Their time of life is that in which such contagions act with greatest effect, and immbers of the after physical evils t^ which they may be lia- ble are called into action by the results of these contagitms infln- ences. The vulgar idea, which some persons hold, that children ought to be submitted to contagious diseases because they must, almost of necessity, pass once through the ordeal, is most repro- hensible.
COKSTITUTIOJ^AL DISEASES*
657
R%ile8 for Adf^^emim,
AM the rules which have been stated as applicable todiiltlhood are, in the luiiin, equally applicable to tito period of adolescenee. Some of these, however, require to be particularly etiforced, wliile one or two i-equire to be added. The diet &hould be as simple and regular as in childhood, and the avoidance of all Btimiilants shoultl be carried out with equal rceohition. It is unfortunately in tliis period of life that the habit of resorting to alcoholic bev- erages is most frequently acquired, heneo the reason why this habit should be specially guarded agaiust. If it be not guarded againat, the stimulant, in no sense whatever a necessity, soon begitm to Ije considered as sncli, and leads to a sy stein of false dependence upon it which becomes one of the most dangerously disposing causes of constitutional affeetion.
In this same period of life another habit is apt to be acquired which should never bo acquired. I refer to smoldng. Of the bad effects of this habit I liave treated at pp. 359-363, The first symptoms induced whilst acquiring thin halnt ooglit of thein- selves to lie sufficient indiaition^ to all wise a<lolescentSj of the evils which spring from it.
Tlie same rules which are applicable to pliysica! and mental strain in childhood are applicable at this period. Physical over- strain, mental ovei^strain, the all but certain producers of consti- tutional mischiefs, should specially be prevented. Every thought- ful person who wishes well for the future of his kindred should oppose with the most resolute determination tlie conq>etitive freaks and insanities which arc now the fasliion of the hour. With their utmost energy tltouglitful persons slionld ojipose tlie current cmmming system of so-called education, and tiie extor- tionate examinational aberration which brings the cramming VBtem into existence. The result <if extreme mental pressiu'e I already bearing fruit. It is not raising the culture of the na- tion in any sense. It is unfitting manhood and womanhood for good, steady, anti progressive work, and it is keeping alive, ac- tively alive, the eotistitutional proclivities to nervous and mental disease. It is particularly mischievons to young women who are to become the mothers of a future generation.
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PREVENTION OF HEKEDITARY DISEASES*
Ihde»far Mature Life,
For the prevention of derdopment of liereditaTT diseases in
pereonB of mature age, an adhesion to many of the rules ali-eadj given are as necessary as in earlier life, while eouie few other.^ ar-e demanded,
Continned temperance in respect to alcohol is essential, in addition to which other kinds of temperance ar-e called for. Self- pofieession and mastery over the paaaiona or emotions is, with a mature man or woman, one of the choicest eafegnarde against the inroad of constitutional disease. Freedom from ordinary passion of anger protects both the nervous and vascular systems. Freedom from extreme competitive gtrife and the worry def>eud* ent upon it protects largely from two of the constitutional dis- eases to which many persons are predisposedj— tnbercidar disease and cancer. Freedom from restless worry, excitement, and gpccn- lation protects in the most signal manner from those pi-emature degenerations of lieart, brain, and glandular organs such as the kidneys, wliich lead to organic death, in so many instances, dur- ing the middle age of man.
The reader will observe for liimself I hat the rules for preven- tion against hereditary and constitutional evUs ai-e all personal rules, and are 6iich as generally belong to the fii*st, second^ and third stages of life. In later stages active proclivities to consti- tutional affection become much modified, and such distinct he- reditary affections as cancer often niu a eknv and comparatively painless course. No new niles for prevention under these cir- cumstances call for description.
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CILiPTER m.
PREVENTIONS OF ATMOSPHERICAL, METEOROLOGICAL, AND CLIMATIC DISEA.^E.
PEHiH>NAL KrLKS FOB PREVENTIONS,
Hided Jar the Vanovs Seasons.
TitE firfit personal rule for preventing diseases from seasonal infliient*c€ eliould he based on the facta colleeted lij Mr. Milner, and epitomized at pp. 626-7. It elionld be remenjLercd tliut the body beeuiiies heavier during the einijnier months, lighter during the winter inontlis, and that tlie changes fruni gain to loss are abnipt, the gain beginning about the end of Maix^lj, and the loss in September.
The practice Bpringing from this knowledge ehonld bear on fbo(h. Tlie proportions of all foods should increase somewhat, in SeptendK3r, and be maintained so aa to meet waste up to March. The kiiul of focKl that reipiii'es to be most increased is that wliicli siifitains the animal warmth* Starcliy foods^ snch as potatoes and rice ; fatty foods, eiich as bnttcr, and animal fata and oils ; and saecliarine foods, such as cunnnon sngars, jams, and honey, may be increased in quantity* On the other hand, with the turn of the month of March such foods may be de- creased, and may be taken in nnicli more moderate quantities during the succeeding months up to September.
Owing to the cii-cumstance that during the beat of snmmer there is very free perspiration and extreme loss of water from the body, there is often great loss of water weight, and tlie body seems to lose both in substance and weight, Tlie fact leads many to consider that becanee of the apparent wasting, excess of food, and of rich food, i6 called for. This is an entire mistake. Jn
FRKrEKTTONS OF ATMOSl»H15HICAli
wamitli the body requires less food, though it may require a little more watery drink. In wiirnith ridi foods are not digested and aesiiniliited, and a great dual of the dyspepsia and bowel derange- ment in the euniiner season arises from over-feeding, in igno- ranee of these facts.
Attention to dothing should also be connected with theee general changes of season. As Septeml)er advances, additional clotlniig shonhl be assumed, and elundd be fully maintained until the Bcason of waste* It is go^id practice to continue the w^arm clothing well into the period of return of the gaining season, and indeed not to make any important change until April has passedJF^ away. The warmth obtained by clothes should not be attendedffi::^ by great weight of clothes. The warm winter clotliing should b< porous and light ; tiie knitted Shetland woollen clothing is the h^W example that can be given of what is required. During the gum- mer months the light elothing should also be of porous texture.
During the wasting months tlie bcHlilj/ eaeercise should be lesi^ severe than in the gaining months, and excessive strains or suddeta demands on the bodily powers should be particularly avuide< This same rule extends to nietiial exercises. Both nilee ai^ o* special importance in regard to the young, and equally in regar to those who have passed the meridian of life.
During the wasting period longer hours of d^ep and re^ ar required than in tlie warmer months w^hen tlie disposition of th € body is to gain in weight AIJ through the winter season half mjs much sleep again is necessary compared with what is wanted in summer. Other things being equal, six hours of sleep on mid- sumuier night are e*pial to nine on midwinter night Prolongerj hours of sleep in summer are prejudicial ; short hours of sleep in winter are prejudicial. These rides are peculiarly applicable to the young and to the old.
Tlie temperature of tlie hatA should be regarded in re^spect to seaaon, if any variation be desii^ed. As a general thing, it is good practice to find an agreeable temperature for the body and to keep to tliat all the year round. But those who like to have a cold bath for a portion of the year should limit that portion to the seasons when the body is naturally gaining weight, tlie cold bath being very hazardous during the months when the process of waste is in progress. A stmng* man in the prime of life may bear it for some years and feel a pleasure in the reaction ; but
AND CLIMATIC DISEASES-
661
r I
I I I I
I
even he la easily eliilleJ bv it when hh nervous system h de- pressed, and he is never wise in holding rigidly to tlie practice* To the young, tlie old, and the feeble, and to the iiienibei's of the female eex at all ages, the practice is an uiii^afe one. From May to September the cc»l<l hath may be perm issi hie, but as Boon as the wasting period begins the temperature of the bath water rfiould be raised, so as not to produce a chill when entering it.
Hides for Special Seasonal Changes,
Let it be remembered that there are six special periods eliar- acterized by jspecial eouditiong of atmospheric tenl^:^erature and moistmti; namely, a first period of damjynem and cvld ; a second of cold; a third of dnjnem and void ; a fourth of drt/nvm and imrfnth ; a fifth of heitt ; a sixth of datnjmem and warmth. Let it also be remembered tliat eacli of these penods is marked by particular diseases.
The above rnle applies to London in so far as accurate inves- tigation has up to this time been pursued. Ihit probal>Jy in most civilized parts of the world a siuiilar division is equally traceable.
In the period of dampness and cold, extending in tliis countiy from t lie last week in October to the third week in December, the best preventive rnles consist in keeping, as far as possiblcj in a dry and warm atmosphere \ in excludhig moisture from the house, especiallv from the bedroom ; and in avoiding bodily con- tact with dump clothes and bedding. In tliis period the body should lie kept warmly and lightly clothed, and the feet should be well shod. What is calleil waterproi»f clothing is, however, best avoided, except in the form of a very loose cape. A good umbrella is nmch safer and better than a waterproof. The diet gbould be sufficient hut unstimnlating.
In the period of cold, extending fr(»m the end of December to the tliird week of February, a perioU in whieli throat aTid chest diseases begin to be easily developed, and in which diseases of the respiratory organs show tlie greatest mortality, the chief rule id to keep up thti animal temperature by go(.Kj food, and complete avoidance of depressing alcoholic drinks, to conserve animal warmth l»y warm clothing, and to c*onscrve nervous power by tak- ing a full allowance of sleep. These three rules should be rigor-
909 PREVEWTIONS OP ATMOSPHEBICAI.
ov^]y observed by the strongest men if they mean to retain their iti-engtb, and by the weaker if they mean to retain their life.
In tlie third period, that of dryn^s and cold, extendinjr from the Jafit week of February to the second week of April, the de- pression of body is gi-eater than at any other time. The condition of dryness and of cold is most exhausting in it^lf, and caps, if I may so say, the two preceding periods of exhaustion. It U the nervous system now that suffers, and diaeases dependent on nervous depression are dominant. The practical rule in this season is to maintain the animal warmth ; to avoid night air; to avoid excess of every kind ; to avoid gi*eat trials of strength, physic-al and mental; to live well; and, to take abandant rest. The lessons of school-child ren ought to be considerably reduced during this season*
In the f ourtli period, that of dryness and warmth, extending from the third week of April to the fourth week of June, life is beginning to return, and the healthiest 8eas*>n of the year is pi-e- sented. The practical rules now are gradually to ligliten the clothings to reduce the houi-s of sleep, to reduce food, and reason- ably to increase work, mentally and bodily. At this time the best work of the year ought to be carried out, in private as well as in public life.
In the fifth period, that of heat, extending from the end of Jmie to the end of August, affections of the alimentary canaK bowel complaints, and some affections of the Iicad have to he guarded against. The clothing should be light and jx>ih:»us, the hours of sleep reduced to a moderate minimum, and the hours of exhaustive labor of mind and body fairly limited.
The most important rule at this season relates to diet The diet should be moderate in quantity, should be well cooked, should be mainly a cold diet, and shouhl always be composed of fresh food. The greatest care should be taken that the water used as drink shojidd bo fresh and pure. Acid and effervescing drinks are inadvisable, and all alcoholic beverages are most pernicious from being the mobt conmic»n promotei's of liver and intestinal disorder. Indulgence in fruit is permissible, so long as it is mod* erate, when the fruits ai'e quite fresh and are neither under nor over ripe.
AKD CLIMATIC DISEASES.
663
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I
A furtlier important rule in this season is to protect the bead fmm the direct rays of the eun. In sending out infants and children the strictest attention should be paid to this precaution.
In the period of dampness and warmth, extending through September and tlii*ee parts of October, a healthy gea&onal time ia presented. In this &ea&on the simple rules of practice are to avoid damp, and to puj'sue so regular a diet that tlie danger of in- testinal difiturbance» still present, may be avoided* This is a period in which good bodily and luentul work ctin be carried out with facility. It is an exeeOent periud for travel and for recrea- tion out of doors.
i?wfc^ Irrespective of Seasons, Proteciion from Damj\
In all seasons it is essential to insure protection from damp* Damp beds have alwa3"s l>een considered dangeronSj and linou that has not been put to the fire to air and take oflF damp is usually avoided. A great deal mure tlian these measures, which in their way are excellent, calls for attention. The damp huuse is tlie source of greatest danger. AH precautions sljould bo taken to keep atmospheric damp from the house. The stone or brick work of the building should not be porous, so as to hold moisture; the walls of rooms should not be covered with material that will absorb and hold moisture ; the haseiuent should bo perfectly dry, so that from it damp and impm'e air do not rise into the rooms above. Profverly, the basement of every house ought to be raised from the earth underneath by an arch, so that air can llow be- neath it. Cellarage under a house should be well ventilated and kept dry. The roofs and gutters of the house should be made water and damp proof in their relations to the interior of the building. As a certain rule, when moisture streaks the walls and banisters of a house, and looking-glasses are easily dimmed by moisture, the house is unfit for Iiabitation.
The soil on which a house is built modifies, naturally, the facility for saving the house from the bad effects of atmospheric moisture. The choice for selection of site slionld be a porous or gravelly soil, through which the water can percolate rapidly and make free escape. This may be considered the most perfect site. Houses constructed on clay or impervious soils are unfortunately placed in this respect, but tlie dangers can be largely prevented
I
664
PREVEjrnoirs of atmospherical
by thorough drainage and by raising the dwellings from the earth. Sites of impervious stony Btructnre are bad. Tiiese sites are most difficult to drain, and from the surface of them, with each rise of teniperatiire, the evaporation uf water is exceedingly rapid. Tbus in cold seasons they arc cold and damp, in warm seasons they are warm and damp.
The w*orst &it4? of all is perhaps the undrained^ soft, spongy! BOil on which so many new houses are heedlessly constructed- These houses are never truly dry. It is as if tliey were built on sponge, and Mr. Chadwick, in denouncing snch constructions as causes of many of the diseases which lead to the highest mortali- ties, understates, I believe, ratlier tlian overstates the fatal evil.
The plan of securing the most complete subsoil drainage for every human habitation is therefore necessary as a precaution against tlie dangers of atmospheric damp.
Trees in and about habitations are good and bad. They are goofi when they are so placed as to purify the air by the breathing . functinn uf their leaves ; when they protect from harsh winds like the cast and northeast winds; and when they afford pro- tection in liot weather from the sun. They are injurious when they surround a place so completely tliat they shut out the air, prevent escape of moisture, and interfei'e with the entrance of light The dead leaves of trees ai-e alst» a source of danger around a house in the damp and cold season of the year.
Tree«j consequently, should be so placed in respect to a resi- dence as not to interfere with air, evaporation of moisture^ Ught, or atmospheric purity.
As much sunlight as can be obtained sliould be allowed to en- ter into every ruMin of tlie dwelling at all hours of the day, and the light should only be snlMiued when it is paii»fully strong or oppressive. Snnlight pm^ifies, and is a potent agent fur destroy- ing the action of the organic poisone which iluat in the air. Let a beam of sunlight traver*>e a i-oom from an oj^eniug in a shutter, and if tliC course of the beam is not filled or made bright with a cloud uf sf)Ocks of dust, the air is comparatively clean. If^ oti the other hand, the l)eam is loaded with floating particles, tlie air is unclean and unfit fi»r healthy respiratii^u, for those particles en* ter the lungs at every bj-eatli, interfere with respirationj and are j
AND CLIMATIC DISEASES.
665
obetructive of circulation. Such particles iriiiy carry with them the organic iiiatter8 which con&tilute the virus of tlie contagious diseases.
The electric light might ofteu be used with advantage for testing tlie purity of the air o£ a house, a hospital warJ^ or other places where people hve.
Fixsktissa of Air,
The air admitted into a dwellhig-hougo shoiikl always be ae pure and as fresh as it can he. Air that is hreuthcd over and over again is devitalized, and in such air there is nut only risk uf accumulation of the products of combustion, fumes of gm^ and odoi^ of decomposing organic substances, but the air itself is de- prived of its full power to vitalize* As a rule, whatever is pro- ducing an unpleasant or oppressive BUiclI, however faint, in a liouse or in a room, is doing harm to the air uf that house or that i*oom, and should be at once removed. Dead flowers, preserved or stuffed animals, remains of food, should never be kept iu rooms the air uf w*hich is used for the purposes of life, Bed- i-ooms should of all rooms be free of such impuriries ; they should be as free as they can be even of furniture that is unne- cefisary, and should never be the respo&itories of soiled or lof toff clothes, or other similar sources of uueleanliness. They cannot be too efficiently ventilated,
Preventiofis in Jidatian to Climate.
Places that are damp are always bad as localities for human habitations. There is no e^xception to this rule. Some diseasea ai-e closely connected with dampness of climate, puhnrnmry con- sumption especially ; hence the residence uf cunsumptive persons in close and wet valleys is most injurious to thenj. The same fact applies to those who suffer from the disease rheumatism, and, indirectly, from heart-disease confie(|uent upon the rheumatic affection.
The climate that is on the whole best suited to man is one of ooniparative dryness and warmth. The climate of May and June in this country is tlierefore the most favorable, and it is a goo<l thing to remember so simple a lesson derived from the calcula- tions of scientific inquirers.
Tu those in England who can afford to take a change of cli-
PREVENTIONS OF ATMOSPHERICAL
mate, and feel that tliey require such change, it is excellent prac* tice for them to observe which of the six climates uf England, the damp and cold, the cold, tlie dry and cold, tlie dry and warm, the hot, and the damp and warm, is most injiiriouaor most bene- tieial. Tliey can, in this way, lind out what seasons of tlie year require to be avoided, and by reference to technical information as to foreign climates, can discover which climate i& the one to be songht for by w^ay of change. There is in the rnited Kingdom iti^elf a great variety of climate^ and by care in selection many pei*sonB might find what they want here, who now, witli an im- perfect knowledge, go, after what they think tliey want, to other countries, where many of the conditions of healtli ai-o less favor- able than those obtainable at home.
The question of residence in a valley or on a height, or on the sea-level, is one of much moment. Taking it all round, I believe
that the sea-level in an open space is the best It is assumed by some that certain races can bear vai*iations fi'om the sea-level, above it and below it, better than other races, and the Jewish race has l>een cited as peculiarly favored in this respect. The evidence in proof of this is insufficient, while it is very strong in favor of the advantage of the sea-level surface. Much of the ben- efit t>f a scavoyage, in many cases of diseai?e, depends on the equality of atmospheric pressure, as well as on the purity of tlie atniusphere.
With most persons residence at an elevation of a hundred feet or so above the level of the sea gives a sensation of lightness and activity, and is, no doubt, much preferable tv residence below the sea-level.
Occasional change from the crowded city or town to the sea- fiide is, to the vast majority of people, on© of the gi^eate^t of benefits. By such change the blixxJ is newly aerated, and the lungs, to use a familiar expression, are cleared of tlie dust and debris of the populous place. I am of opinion that three or four short visirs to the sea-side in the year are productive of far more good than one prolonged visit extending over the same time.
AND CLIXATIO DISEASES.
607
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Local anb Central Preventions of Atmosphehical Causes of Disease.
Local sanitary autLorities ought to do a great deal for the atDiospliei'ed of towns by attending to the pi'oper planting of trees m open places, the introiluction of parks and squares, and the immediate removal of all sources of atmospheric imparity, Tliey ought to provide also proper Bhelters for t!ie ptotection of those who are, by necessity, engaged in ptihlic out -door work, sneli as cabmen. Tliey ought to provide gymnasia and winter gardens for the poor, and especially for the children of the poor. They ought tc» protect from tlie dangers of lightning shoek by erecting lightning-conductors on all public buildings. But their first and greatest care should relate to the subsoil drainage of the h>cality which is under their direction. Everything is literally and prac- rieally mere surface work until all the area covered with iiouses is rendei-ed dry and efficient for caiTying away moisture.
The Central Government has duties to perform in specially
enforcing subsoil drainage, and in giving the Iwal authorities powers to enforce the use of none but proper materials in the con- struction of human dwellings.
The Central Government has still anotlier duty before it, that, namely, of legislating more scientifically and detenuinately for tlie suppression of noxious exlialations and vapors in large man- ufacturing centres and industries. There is nothing wliatever to prevent every industry from being carrit^d on without causing any impurity of air, except the one ditficulty of deficient resolution. Science has at connnand every means of suppressing noxioue vapors and of making industry more profitable when the expenses incident to the reformation have been met. It is tiie duty of the Government to employ science to discover the methods of refor- mation, and to supply standards by whicli the authorities can in- sist that all work sl*all be carried on by such standards, until the air of every affected town in the kingdom is freed of atmospheric impurities.
CHAPTER IV
TONS OF PARASITICAL DISEASE,
£jM^^« prevention of all the parasitical causes of disease tlier ttiMUblticUiixl, a method which is as effective as it is simpk and lliat ts to be deaii ; for the diseofies induced by pai-asiti^ growtlis of all kinds, with one or two partial exceptions, are due ' to ttQcIeaJiUue&s.
For the prevention of thoee diseases from parasites which enter the body by the alimentary catial, and which give origin to hyda- lULi| lA|>e-woritu and trichinosis, cleanliness in ]'es[^ct to foo<I is ll»4tiiderutum.
For tlie prevention of diseases, like scabies, fi'om those par- a»ite«» which affei^t the surface of the l^ody, systematie general ablution is the means i-eqnired.
For the prevention of cutaneous diseases from vegetable para- tiiti^ like the diseases ring-worm and scnld-head, protection from ivntaipous intluence« sustainment of tlie geiicriil liealth by correct di^t and rjy«#/kf, are^ in addition to cleanliness, the measures de- luaudi^d.
In eiirrying out these preventive measures personal and local uutliihrtlativu tictioo are both required*
Pkrsonal Em-Ks for Prevention.
l\*r^oHHl rUmnliness js called for in respect to the cleanliness that should U? t\*llowed in the preparation of foc^d In every household. FockU are the grand means for the introduction of parasites, and^ buteher*s meat and pork-butcher's meat are the commonest roe-an&f
All s|^eciniens of animal food which present &igns of being ^ •{Hvtted or speckled should be rejected. If in the flesh small ixnuuK^l wintc spots be observed, the moat shtndd he rejei^ted. If comiei'ted with a portion of ilesh there be minute bladder-like
PREVENTIONS OF PARASITICAL DISEASE*
m9
©tmctnres attaelied, the Btibstance ebould he rejected. If tbe meat, especially pork, present what is called a meatfly appearance, or, as it is eornetiiiies coiomonly described, ^* a pepj>er and salted look/* in lines or sections, it should he rejected. If it presenta the appearance of anything living in its structure it should be rejected.
The greatest care phould he taken that all foods, whether ani- mal or vegetable, he thoroughly clean before they go through tlie pi*oces8 of cooking if they are going to bo eaten cooked ; ttill greater care ehonfd be taken with those articles of food of a vege- table kind, such as celery, radishes, onions, and the various kinds of fruits, wduch arc goijig to he eaten uncooked. With children unclean fruits are a constant cause of disease, pailicularly of that parasitic disease caused by the ascaris vermieukirhy or thread- woruK 1 believe, also, that the large round worm asvaris lum- hriandes is often introduced by fruit.
When the intestinal parts of an i mala are being used as food, aa in the case of tripe, too nuich care cannot be taken in regai-d to cleanliness. Such foods are very doubtful altogetlier, but if they are to be ntilized it should be with more than oi'dinary pre- ventive care. The same rule applies to the liver, a structure wliicli 10 an easy channel, as food, for the propagation of disease among those who subsist upon it.
In regard to every kind of animal or vegetable food that may be a means of conveying parasitic forms into tlie body, there is another rule which should be universally adopted, and that is, to have »w'h foml ihoi'oiifjhlif and comj)hieltj eookttL No animal food ought to be eaten that has not been sul>jected to the tem- perature of boiling water, that is to say, 212^ Fuhr. It should be subjected to this temperature through the whole of its struct- ure, whether it be boiled or roasted. It is probable that all tlie parasitic organic forms are destroyed at this temperature of 212% and the actual fact of complete boiling is preventive of itself. But masting when effectually carried out is a still better pre- ventive.
Preserved meat, even when the preservation from deeompo* sition is perfect, is not a sufficient protection against the intro- duction of parasites, and indeed the parasite of the disease irieh* ino^U has l:>een more frequently distributed through presented hams and such kinds of food than by any other means. Pre-
;h venison^ ia ^ br ihoee who wtaH
of the catsDeous eiiffae
lis ecmbies, two rules art
b l» |M«reDt contact of the health;
is to maintain jierfect cleanlines
» the prerention of all the liviii|
tiio earboe of the body, or whiel
which spring from the Ion
and £cald-head, three mlefi
terats^ are required. The fiisi
^i dkn bealthy witli the affected, a mlc
*iini«d oat in nurseries and school^
^»T ^iHo» ^i Ifao affections appear. The second
^im jgsoenl haalth of tlie young in whom
mmmmanf and who become more than ordi-
i( itlMiii, horn ejq)osure to doge and bad air,
mental or physical, the vital f»ower8
rh^ tliini rttJo is to maintain perfect cleanli*
BxrusB FOB pBE^TanroK.
n
hmm al ooaunaad powers which should en- anihiwity with that of personal care foL
PREYENTIONS OF PARASITICAL DISEASE,
671
Thie is a praetical fact wliicli has been known to the Jewish people for ages past, and lias liocn acted upon by tlietii with the nttnost benefit to the health of their community*
In the Jewish conimiinity there is a certain miniber of men set apart to act as inspectors of animal food. They attend at the slaiighter-lionses, and after an animal is slain and dressed they submit it to inspection ; then, nnless they put upon it their sign that it is free of disease^ which certainly excludes all parasitic dis- ease, it 18 not permitted to enter a Jewish family. It enters into the families out of the Jewish community^ so that we, M'ho are not Jews, actually accept into our bodies food which the Jews have rejected as diseased food.
It may he true that the Jewish inspectors are not skilled pathologists; it may ho that they sometimes make mistakes, con- demning as mifit for food what is only seemingly unfit ; but when they err it is on the safe side, and to what extent they reject food which other members of the community accept is shown by com- paring a statement of the number of animals slaughtered for the Jewish community in t!ie London diatncts, with the numbers that were free from disease and diseased* The facts, collected by Mr. II. Harris, Secretary to the Jewish Ecclesiastical Board, have beea supplied to rae by Mr. D. Talterman,
Animals inspected in London by the Jewish inspectors yielded the following retunis : —
In 1878 (55 weeks).
Total Ojem Free from disease IHseaaed Total Calves Free from diseaso Diseafted Total Sheep Free from diseaBe Diseaaed.
In 1879 (50 weeks).
Total Oxen Free from difleaae Diseaaed . Total Calves 1^ from disease
7,885 2,545
28.687 18,019
9S,987
12,856
9,581
2»663
672
FBEVETfTIOXS OP PAllASITICAL DISEASE.
In 1879 (50 weeks).
Total Sheep
Free from disease
Diseased
26.476 1US26
In 1880 (July 1 to December 25, 25 weeks)*
Total Oxmi , . . . . fJ,//e
Free from di»eafie , * . . 6|97B
Biseased* . . . , . 6,143
Total Calees . . . . , /,P«^
Free from disease .... 1,330
Diseased. ..... 634
Total Sheep . . . . ^ ta,7lS
Free from diseafie . « . . 14,206
Diseftsed. . « . * . 5^535
These figui^s, wliich refer to animals slftnghtered at Deptford and Wliitecliapel alone, are of themselves sufficient tosliow that a considerable amount of diseased animal food is sold to, and con* eumed by, the Brilit>li conuiiunity outside the JewL&h pale. The returns include aidmals rejected for pleiiro-pueuraonia and some other diseases of the lung. But I have found, by convei^ation with the Jewish inspectors, that in a very large number of in* stances the obvious and commonly known forms of parasitic disease, in animals killed for human fooil, are those which they detect, and for whieli they exclude such food from the market
Tlie rule, thcix^fore, I suggest is one founded on the Jewish system. The rule is that so long as the consumption of animal food continues the local authorities should provide a well-trained inspector, whose diitv it should be to see that every animal car- cass entering the market for human food is free of disease.
The labors of such an official sliould, I think, extend also, in a properly constituted pljice, to tlie public fruit and vegetable markets, so that no articles of food should be exposed thei"e for sale except when properly cleansed from parasitic forms of life and other evidences of uii cleanliness.
To pi-event the occurrence of parasitic diseases affecting tlj^J skin, It is incumbent on each local authority to supply to tbe people, by means of public baths, every possible facility forcleAtts liness by ablntion. fn t<nvns tins is recognized partially. In village^" it is unrecognized practically. It ought to be recognized universallj'
CHAPTER Y.
PREVENTIONS OF ZYMOTIC DISEASES,
At first sight it would appear to be an incredible task to sup- press the great class of diseases which come under the head of di^ases of zymotic origiu ; and jet it is true that thes^e diseases are, of all those of natural origin, the most distinctly preventable^ For this reason they are sometimes specially called the jpreventa- Ue affections.
In applying tlie preventable measures necessary for this task we may, fortunately, lay aside all reference to the controverted points relating to the nature and origin of the affections. We have only to remember and keep iu mind three admitted facts: (1) That the diseases are comnuinieable from an affected person to an unaffected who is susceptible. (2) That the virns or infect- ing matter, whetlier it l>e living or dead, \s particular ^ and trans- tnissible for short distances, from tlie affected to the unaffected, by the air, by water or watery fluidsj and by attachment to solid substances, as clothing or materials of the house. (3) That a per- son ha^^ng been subjected once to these diseases is, as a general rule, protected for a certain time from their recnrrence.
In the work of preventing the zymotic diseases all the agen* cies under command are recpiired. There must be personal en- deavor, there must be local authoritative endeavor, there must be central authoritative endeavor all acting in harmony together.
I.
Pkbsonal Eitles for Prevention.
B liemaval of Contagious Maternal. Jlome Drainage.
V The first personal rule for prevention is to take every precan-
V tion not to let susceptible people, and especially the susceptible young, be exposed to the contagion of the zymotic diseases. Thus
674
PREVENTIONS OF ZYMOTIC DISEASES.
in all schools where the young congregate, a8 well as in familii if a zymotic affection attacks one meiuber, the others should removed from the affected and placed, as safely as possible, aw from the danger, ^
The next important rule is that every house should 1>e m ^^ ranged as not to be in any way favorable to the retention or c^^ tribution of contagions materia!* This implies, as a basic pri:i:^^ pie in domestic sanitation, the taking care that every tiling th^^ ^ generated in the house, and that is of an exci*etive, offensive, ^ttd injurious nature, shall be prevented accumulating in the dwelljjj^ Whether it bo dust, refuse, remnant of food, or sewage, it ia n^, cessary that it be removed as it is produced*
The foundation of this prirtciple is laid in tlie drainage otthe house. Unless a bouse be so drained that it is absolutely eat off from the sewer into whicli its contents are discharged, it iBiiuta healthy house. Unless a house be so drained that the emptvitig of its sewage is an immediate process, so imraediato that as the Bewage is poured forth it finds its way from the house direct into the sewer, the house is not a healthy house.
This rule also hnplies that it is essential that all pipe^ leading into or from a house slionld be within ready reacli, and should always l>e open to vjqw m their course. The main soil-pipe slionld at all times, where it is possible, be on tlie outside of a house ; it should be open at the upper part, and, under proper arrangement, it should also be open at tlie lower part* But, if it be impossible to have a pipe outside the house and readily accessible then?> if the pipe must be inside the building, so much the more important is it that it should be in sight throughout its course, and so acces- sible that at any moment it can I>e reached. To enclose a soil- pipe in a wall in such a manner that it can only be exaiidned after days of work and a vast amount of costly destructive mischief, h the worst plan that can be adopted. Clear tliroughout its entire course, the pipe should also be open to t!ie air at the top, and in the lower part or basement of the house should be made to enter a space, which in its turn is open to the air, so that tlie collection and retention of gases is impossible anywhere, and any pressure of gas is equally impossible.
Tills nile, again, implies that care must be taken, in respect t4> the drainage of the house, that the contents discharged from the sewer be carried away in the escape-pipe from the house in the
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most perfect and rapid maniten All intercepting catch-pits, al! and every thing that can by the merest accident hold and retain the sewage, must be completely rejected.
Equal care must be taken tliat the soil-pipe from the houeo into the ^ewer diall not itself beeouie like a sewer, from being too large to be completely flushed, Aa a rnlej a pipe fonr inches in diameter h of sufficient si^e to convey away ail the contents of an ordinary house, of a house, for exanipk-, that can comfortably ac- coniniodat© ten persons. For a house used only as a dwelling- house a sLx-inch pipe is Huflicient for a family of lai-ger size, tlie rule being, aB/^ri*sjKirihm^ that the smaller the tube the more com- plete and certain is the flushing and cleansing. The pipe prop- erly selectetl in res|>ect to its size should be lai<l in such a manner that it is of>en at botli ends. It slioidd start from the open space into whieli tlie descending pipe from the house pours its contents ; and, outside tlie house, before it enters tbc sewer, it sliould liave an ascend in I,' liranch for communication with the open air. When tlie«e precautious arc used there can be no accumulation of sewer gas and no pressure of gas between the descending house-pipe and the sewer.
Lastly, this ride implies the necessity for the precaution of making the pipes wiiich convey the eew^age from the house per- fect, in and thi-oiighout their course, so that thei^e shall be no leakage by the way. Tlie sew^er pipe should be as perfect in this i-espect as the coal-gas pipe. Up to the present time that result has not been achieved, though we are now making close approaches towards it. 1 leave it as a matter yet unsettled, even amongst the most eminent practical sanitarians, what material is best for the soil-pipe, — earthenware, iron, glass. My impression is, that iixm, or glass of sufficient strength and well jointed, would be by far the best material. It would be impermeable and lasting, and glasfi would show the facts of obstniction and acenmulation wher- ever they might occur. The tube running from the descending pipe into the sewer ought always, when it is practicable, to be carried outside the dwelling, and in entering into the sewer from the house, it ought to be securely trapped lictween the opening immediately outside the house and the sewer.
A house drained on these principles is as entirely cut oflf fn.mi the sewer and from sewer emanations as if it were set on a mountain-side and were drained into the open air at a distance
676
PBEVENTIONS OF ZTMOTIO 0I8EASES.
f i-om it So ought every house to be drained* It is criminal tc
let disease eater any house by that liitherto grand staircase for^, disease, —the passage from the sewer,
Imlation of the Sick, The Sick-room.
When disease of a zymotic character has broken out in house, and the sick person lias to remain iu the house, he sJioa be separated from all the rest and placed in a room specially pe pared for his reception. The room selected should be at tlie of the house, and free from all unnecessary articles of fumiti*^_ curtains, and hangings. The walls and ceiling should be ci^- fully brushed down, the floor dry scrubbed with sawdust, ^j^( the dust products burned. A fire should be kept burning at ^^| tioies in the room whilst the patient remains in it. Even i warm days the ventilation secured by a fi-ee and unobstnict* chinmcy -draught is of untold vahie. Cupboards within the roo -^n should be emptied and used as little as possible.
Air, without draught, should be freely admitted, togeth^a^r with duyliglit whenever that is attainable. The old*fashione^^^ practice of keeping up darkness in the sick-room, except in sp^ ■^^ cial diseases, such as those affecting the eyes or the brain, ison^^® to be condemned. Tlie face of the sick person may be shielde---' ^ from all glare, but his room should be exposed to the purifvin--s^ influence of the clear light of day* The admission of light ^-4 particularly essential iu the eas^e of infectious diseases, becau&-^ light is a destroyer of the virus of disease.
The temperature should bo kept up equably at a mean of 60** Fahr,
The bed should be protected from di-aughta. It is best placed, as a rule, between the door and the fireplace, except in cases of stnall-pox, when it should bo in the centre of tlie apart- ment, with the head directed towards the window, by whicli means the sufferer is screened from direct light.
It is wise to exclude from the sick-room all vessels containing water, and to bring them freshly into tlie apartment, each time, when required for ablution or for drinking. The presence of a Bteamy vapor in the sick-chamber is always productive of evil ; and is only permissible in cases of bronchial affections and other diseases affecting the organs of respiration.
No food should be allowed to I'emain in the room, and it is
PREVENTIONS OF ZYMOTIC DISEASES.
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wifle to insist that the nurse or attendant shall take her meals in a separate apartioeiit.
The attendants upon the sick should be as few as possible, and dressed, euitablj, in garments nmde of light colored washing material. Dark and sombre dresses have a depressing efifect, and are to be avoided. A patient, particularly in the convalescent stages, progresses most favorably in an atmosphere of clieerfub iiess, A little alteration in the arrangement of tlte room, the admission of freshly -cut flowers, the placing or clianging of a picture, or any similar improvement likely to give pleasure to the mvalid, are incentives to happiness of mindj and are specially agreeable when the senses are awakening from depression to their original activities.
Jiemovai of the Infected Sick*
A question is often raised as to tlie time w^hen a pei-son re-
eoverhjg from infectious disease should be removed from his room. On this subject Dr. Sqnii'e has given some admirable reeonimendationsj wliich I may thus epitomize*
The diseases of the zymotic class which are tabulated at p. 591 as having a short stage of incubation, liave a prolonged eonvalea- cenee, and remain long as sources of contamination. These, therefore, are safest when kept at home and in tlieir own room until convalescence is complete. Scarlet fever is a good illnstra- tioo of tills practice.
Those diseases in tlio same table wdiich show a long period of incubation give, as a rule, a quicker convalescence and a more rapid freedom from danger as sources of contamination. These, therefore, may be removed more quickly, and with less danger to themselves and others. Measles is an illustration of this prac- tice.
The above ndes are not without their value in regard to the separation of the sick from the healthy at the commencement of ^ the outbreak of a contagious affection. In the case of the dis- [ of short incubation included under the two first groups of the table of p. 591, it is gocxl practice to remove the healthy from the affected immediately. It is also safe practice to remove in the diseases named i!i the third series. To remove in the fourth or long incubation class is less important, and if the sick person ba6 to be removed far away it may be very prejudicial.
PREVENnOlCS OF ZYMOTIC DISEASES.
H
PurificaUon of mi Infeded Hoom,
After a sick-room has been occupied by an infected person, _ Blioukl be purified as follows: —
Let everything that can be done be done within the room self.
Mak^ a large fire, close the door very completely, and o] the windows wideiy^ or even take out the sashes altogether, a^ cleanse theui and their framework tlioroughly.
Put on the fire everything that admits of being inetani^ destroyed.
Pack up carefully arid closely every article of clothing ^ bedding that is to be conveyed away for disinfection by heat light iron trunk, such as is coniraoidy enjployed for travellings Tby Bea, is the best for packing up infected garments. If the clot:.Ii. ing is to be cleansed by washing it should be dipped into oo^Jd water, and careful ly wrung out and packed while damp in t Xm above-named air-tight trunk. By this means the spread uf inf^^sc- tion during transit to the laundress is prevented. The laundr^s^sa should be instructed to plunge the clothes hito hnlimj water, atr:^*^ after boiling them for iiftecn minutes to cover them clo&cly untrri'-^^ cold. The garments may then bo washed in the 'ordinary way
Cleanse the walla and ceiling of the infected rcmni ; strip o^^ the wall-paper, and treat with two coats of distemper. Bnis^ the floor aud wood- work free from dust, and burn the dnst. Tlie^ wash the floor thoroughly all over with a solution of oxychlorines^^ one part to forty of water, finishing with clean water.
To make all sui-e, diffuse iodine vapor or snlphnrons aci<3 gas through the apartment. The room may then be consideret/ effectually disinfected.
n.
Local AuTBORrrA-nvE Ritles for Prevention.
It should be the business of every local central authority to apply the same preventive measures for the protection of the community at large as the householder applies to his small com- munity^
PHEVEiniONS OF ZYMOTIC DISEASES.
070
liemm^al of Cantoffious Material. ToW'n I^raindge,
The first rule 13 to drain tborouglUy* Every single house ought to be cut off from its sewer. Every town ought to be cut off from its sewage.
For perfection of drainage and sewerage, the separate system, that is, the removal of the sewage and ail water used for domestic purposes by a distinct series of drains and sewers, and ^11 storm water by anotlier and distinct system, is essentiaL Between sewage and storm water tliere should be no posnible connection. At whatever preliminary cost, the sewage should be exhausted from the town with a known quantity of water admitted for domestic purposes at)d none other*
If natural advantages lie ready for this exhaustion, let them he used. If, however, there Ije no such natural advantages, they should he thoroughly provided hy an artificial exhaust method by which the sewage can be lifted so clean away, that, as it is re- moved, all foul air from every house can be carried away also, and every closet and every drain be iiushed with air as well as water, in one unchanging outK>f-the-town direction* With well- arranged small sewer pipes and with steam power for exliaust power when that is called for, there probal% is noplace that can- not be cleansed of its dead and dangerous matter minute by minute every minute of the year. With complete arrangements, thus carried out, thei^e is no need for special sewer* ventilation for any house or building. Each house is cleansed at all times, and every opening from it, connected with the main system, is a point where flushing commences. Every^ house, in a word, is a house that is always being purified of all the impurity it engenders that can pass away by a sewer.
When this result is obtained, a town is as near to safety as it can possibly bo from a whole class of zymotic diseases ; and, other things being equal, there has been effected in it nearly half the reform that is required for making sure of the natural death-rate of a model conmiuniry.
When, by the separate system, sewage is mixed with a limited quantity of water, there are four modes of i-emoving it from the town,
1. — By utilizing it on a farm.
2. — By pouring it into a stream or the aea.
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PEEVENTI0N9 OF ZYMOTIC DISEASES.
8. — Hy utilizing it witli dry earth.
4. — By collection and removal in floating tanks,
Kespecting these plans : —
The sewage farm plan is excellent when the conditions are favorable, that is to say, when the farm is large enough to utilise all the sewage, and is sufficiently reiaovej fi-oni a living commu- nity not to cause impurity of the air of that eomniiinitr.
The plan of pouring the sewage into open streams and rivers is very bad. The sewage pollutes the stroam and the fertilizing products are lost In sea-coast towns it is better to pour into the eea, and this is sometimes necessary, though it entails loss of pro- duct.
The dry earth plan, where it can be carried out, is excellent, and for small towns and villages and agricultural districts is per- haps the most natural and the safest that could be devised.
The collecting tank plan is a design for meeting all the diffi- culties connected with the above-named systems,
I suggest that for a town placed near a river or canal, the said river or canal should still be the means of transit, but that it should not be polhitcd as a stream. To obviate the pollution I would have receiving floatmg tanks on the canal or river, in or connected with a steam barge provided with a pump for I'aisinj the town sewage into the receiving tanks and for steaming awa; with the fertUizing material to depots in the course of tlie river, where the material could be applied directly, or after preparation, to the purposes of agriculture.
In sea-side towns the plan could be carried out by sending the floating tanks, by sea, to barren coasts, w*here now no land is culti- vated. Here the meadow and corniield could rise up, and add not only food for the grosser appetites of the people, but finer scenery to the laudseape.
In many instances in t!ie inland districts of this country the empty coal-barge, going back from the great centres of life to bo refilled with common fire-food, could, by a simple change in con- struction, be made applicable for carrying or towing the tank containing the fertilizing food-making material for the human fire.
In places where there is no cana! and no river for their convex ance, the sewage tanks might, if rendered perfectly air-tight, l»e removed by night railway train to any destination where their
PREVENTIONS OF ZYMOTIC DISEASES.
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contents could hd applied to agricultural purposes. By this plan tlie whole of the fertilizing sewage of tbo couutry could be put to itd natm-al and economical ubc.
lierno'val of Uoum Jiefuse,
The regular removal of the refuse from houses in towns and the destruction of it is another duty which is almost everywhere urgently demanded. The dust-hin in which the refuse of the honse is allowed to accumulate for several days is a jiersistent nuisance and danger in most populous communities. Each day each house ought to bo cleared of its dust and its organic refuse, and that refuse buried, in agricultiu*al districts in the earth, on coast districts in the sea.
In inland districts in places of large population the refuse sliould Ite transported by railway to its destination. In no place should it reuuiin a centre of nuisance and danger as a huge ash- pit.
Puhlk Water Supply.
Another duty connected with the local authority consists in supplying its community with a perfectly pure water, a water de- rived from au independent source, entirely disconnected from every kind of sewage contamination, and in such abundance that each person sliali have sufficient — 30 gallons — per day foi- Iiis or her personal wants. The water should possess the following qualities : —
{a) It should be free from all impurities, organic and inorganic.
(ft) The supply to every house should be constant.
(c) There should be no partial dependence for it on wells. Wells for individual residences, used or not used according to individual taste or caprice, should certainly all be closed, except iu cases where the distance of a residence from a central supply
I is too great to enable the central supply to he utilized. {(l) The supply should be constant from the main or reservoir to the house, and always laid on, so that there is no cistern stor- a^ of water iu any house. ^P Supervisum of Milk Supplies,
After the water supply, which in past days has been a fre- quent source of commnnicatitui of the zymotic diseases, the nv^^ supply of the place should be niost carefully supervised, i
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Nrt.W Sick
^ricken with the zymotic c? should have within its •C tbt place he large a series of ^iBl for the reception of the mekiijn neb as well as poor. ktrol of the local central au- to receive not more than :► tliftt spread of infection V r ot'ciu". In crowded places ^4j. be placed on the same level 4^M he conBtnicted of iron, so Y ^ fire brush and all organic
I :t« entirely sufe from be- :x. comtnuuity, should be in
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the midst of the commmiity. Firsts because it is bad practice to remove the sick long distances ; and, Bccondly, because every per- son in whose house a case of infectious disease breaks out should be induced, by example, not to have the sufferer taken away a long distance, but removed close at hand to a proper place pixH vidod with every means for the moat scientific treatment while isolated from the rest of the community.
Under this plan every piivate houise would cease to he a centre of infectious disease ; evGvy person accidentally attacked would be removed out of harm's way ; and every person so removed would be placed under the best eircumstunces to secure recovery. Amongst tiie poor children fiuffering from contagious disease, the raei'e matters of equable temperature aud proper feeding in such hospitals woidd alone suffice to reduce the mortality fi'om the in- fectious maladies fully one half what it now is.
In connection with this department for the management of the infectious sick^ the local authority should liave a meteoro- logical observatory in order to detect the relation of seasons and of all known atmospherical variations to disease. It should keep ctirve charts of current diseases after the metliod introduced by Messrs, llitehell aud Buchan, of the Scottish Meteorological So- ciety. It should instruct its sanitary inspectors to sustain the strictest police observation as to the development trf infectious disease in different centres of the commnnity; and whenever a csentre was foimd to l>e steadily yielding a number of cases ex- »lbeeding a certain standard, it should remodel that centi^, and if Rbsi:*lutely neccssarj^ should carry out to the letter the old Mosaic system of pulling the infected part down and reconstructing it in a condition fur health. It should have tlie most accurate reg- istration of dijseases at all times, throughout all the boundaries under its jurisdiction.
Under this system evejy parish would bear its own burden and
ept its own responsibility for the retention and management of e infectious cases occurring within its own boundaries. It would liave all the special centres of infection in each of its districts thoroughly maj>ped out, and would know, on a calculation of cases occurring in quinriuennial periods, what is the permanent accom- modatiun required for its infectious sick.
Tlie general supervision of this work should be in the hands of the Medical Officer of Ileal th.
684
PREVENTIONS OF ZYMOTIC DISEASES,
The nm Bing, also under the supervision of the Medical Offic of Health, should be carried out by trained nurses, who might be educated to their work in the I'^niou Infirmaries. The medical attendance should be eondueted hy a special staff of duly qualified medical men, acting under the Medical OflScer of Health, and re- sponsible to the local authority.
III.
CE2!rrRAL AtrrBORrrATivE Rules tor ^ketentios.
When all tliat can be done by personal effort is done, and when personal effort is backed by local adniiriistrative authoritV| , little remains for a central government to perform. And, as central government is comparatively powerless in a fi'ee country, imless it be acting in accordance with the will of the people, it j has but little to do with matters in which the people are ready act for themselves. On the subject of the prevention of zymotic diseases there are, however, a few rnles required which can onljg be carried out by the central authority.
Jieffuiratton of Disease.
The registration of births and deaths which has been going on since 1S38 has proved the most valuable record extant of tbe nature, course, and progress of tbe zymotic diseases. That ouglit now to be suppleinented by a registration of those diseases, so that we may not only see what those diseases pay over to death, but what Ileal til pays over to them, I suggested this work of registration to the Government nearly a quarter of a century ago. I also organized a voluntary plan of sueli registration, and with over fifty stations, extending in different points of the country] from St. Mary's, Seilly, to the Shetland Islands, carried on the plan for some years. The details were placed by me before Sir Benjamin Ilall wlien he was Pi*esident of the Board of llealtli, and obtained his strong approval. But the project lapsed, and although it has been carried out in some particidar localities, under local authority, it remains yet to be brought into a general scheme in the United Kingdom and to be affiliated with the pres- ent work of the Registrar-Gen eraL
Through the registrars of births and deaths these returns of
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PREVENTIONS OP ZYMOTIC DISEASES. 685
disease sboiild now be collected. A law is required rendering it necessary for every honseliolder to make a return of the conta- gious disease which is present in his Louse- The return should ^ regularly to Somerset House, and should be enibodiedj sys- tematically, in a weekly statement.
Collateral returns relating to the meteorology of districts in which the diseases occur, and of epidemic diseases of cattle, domestic animals atid plants, should also be collected. From such returns, coupled with complete geological survey of the dis- tricts, w^e ebouldj in a few years, possess a perfect natural history of the spreading diseaaes. We should know precisely their modes of origiu, their course, and their relations one to another, as well as their mortalities, from whicli facts we should soon learn how to prevent them altogether.
Compulsort/ Preveniimt^ Yaecinaiion*
Tlie compulsory enforcement of meaf?ures for preventing dis- ease on what are called prophylactic princijvlea is a subject which lias led to the active administration of the Government in regard to one particular disease, Small-pow The Government enforces vaccination as a prophylactic measure against small -pox. Some years ago that measure was made compulsory by Parliament, with the assent of the greater part of tlie nation that had paid atten- tion to the question involved. Of late years a very powerful opposition to vaccination has been Btarted, and active measures have been taken by many energetic and eonseientiouB men to bring about a repeal of tlio compulsory act. It is important to place this question in a true and impartial light.
There is no doubt from the evidence at command that the disease Cow-pox, which is induced by vaccination, prevents those who have suffered froiti it from contracting the more severe disease small-pcx. Again, there can be no doubt that cow-pox itself, pure and simple, that is, uncomplicated by any accident, is a harmless disease, while smalbpox is one of the most serious. As a matter of exchange, therefom, of one disease for another, presum ing that one or other must be had, cow-pox has everything in its favor*
Again, admitting that cow-pox is attended by certain accidents, by the introduction into the body of erysipelas, syphilis, and some other diseases, if the choice of two evils be an absolute nece* the balance is all on the side of vaccination*
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686
PRETENTIONS OF ZYUOTIC DISEASES*
The next point tlien which we have to discnsB is whether email- pox most exist if cow-pox be not conipiilsorilj enforced ?
To iiuderstand this question we must consider on what grouai vacciuatloa stood when it was first introduced.
Vaccination was brought in by Jenner in order to supersede i process called inoculation for smaU-pox, a process by wliich Bmall— ^ pox was systematically propagated from one person to another b\^- operation. This began in the early part of the last century, anr^ became so general it may have been considered all but universal. A few years before the close of the century a census was taken of Brighton and of some other towns, as pixjparatory to a genera/ inoculation of the pec pie. In this way every village and everjr town^ we may almost say every honse^ became a centre of small- pox, because wherever the disease was propa^ted by iuoculaliori it was also propagated by infection. It was at this period, when the country was saturated with the contagions disease^ that Jenner came forward with his antidote, and it is not in any way surprising that by his substitution of a comparatively harmless inoculation for a terribly fatal one, he changeil the state of tilings al together, and created a triumphant success for himself which no one could dispute.
That which remains to be determined is, whether by this suc- cess he merely corrected an egregious blunder in assumed prophy- lactic practice, or whether he went further, and introduced a plan for preventing the natural disease, iiTespective of the mischiefs produced by inoculation*
The truth lies probably between the two extremes. The most determined opponent of vaccination must acknowledge, if he will be fair, that Jenner, in substituting vaccinia for variola, cow- pox for small-pox, substituted a protective disease against small- pox wliich in itself was harmless, and which had this indescribable advantage, that the protective disease, unlike small-pox, was not of an infectious or contagious character, except when it was pro- moted for a distinct object by a specitic operation.
The effect of this introduction was, naturally enough, stupen- dous. If inoculation had been given up, small-pox would have continued in the most wide-spread manner, because the disease was everywhere, and every dwelling was so infected with it that nothing short of insusceptibility to the affection by the process of contractuig it could be considered as protective, while eveiy per-
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PEEVENTI0N9 OF ZYMOTIC DISEASES.
es7
rlio took tlie disease became another instrument for iffi prop- agation. In a word, the wliole population was obliged tu Lave small-pox, and I remember myself being shown by a relative of mine, who entered tJie practice of medicine before vaceination was accepted, a large village where every resident in it had, wilh- out a single exception, been througli the sniall-pox. Vaccination swept this away. It afforded a pixitection ; it did not afford an infections disease. It cheeked the universal evil ; it gave time for the general disinfection of the country from small-pox poison. Its good effect %vag so immense that all secondary evils incitlent to it were naturally overlooked.
So much for the original value of vaccination. It has played a most iniportjmt part, and has, in all probability, by giving time for general removal of small-pox pi>ifion from tlie homes of the people, bronglit the suppression of smalbpox within the range of sanitary raea.^ures alone, without necessitating, for many years longer, the enforcement of vaccination.
The opponents of vaccination wish it to be accepted that that time has now come. They direct onr attention to Jurin's and Ket- tleship's remarkable computations about the mortality of small-pox before the introduction of inoculation, and they urge that the mortality from small-pox of persons who take the disease after vaccination is not greater than that of persons who, in the old times, died from the original sinall-p<»x, namely, — 18 per cent,
Wiiat Jurin said was tlie following: —
{a) That of all children that are born in England at the time he wrote, 1722, there will at some time die of small-pox one in
(5) That of persons of all ages taken ill of the natural small- pox, there will die of that distemper one in Jive or n^^ or two in d^mrij or jnst over 18 per eent.
(c) That of persons of all ages inoculated for small- pox, with- out regard to the healthiness or unhealthiness of the subject, aa was practised in New England, there will die one in sixty,
{(t) That of persons inoculated with the same caution in the choice of subjects as has been used in England, there will die of the inoculated one in ninety-one, ^^ In these notes we Fee why inoculation became popular. It ieemed to produce amongst the inoculated a great reduction of mortality, and if it had not at the same time produced an infective
PBEVEICTIOTTS OP ZYMOTIC DISEASE*
disease, wliich raised the general mortality from the infection, it would have Leen a blessing of no mean kind. As it was, it was a disaster which vaeeination signally corrected.
In this day we have got over that disaster so far, tliftt if throngliont our towns we had proper hospital accommodation for the reception of all email -pox cases so soon as they occur, and ineanB for the complete destruction of the virus which each case repro- duces in such ahundance, we could soon stamp out small-poi altogether by ordinary sauitary measures without vaccination. These measures must, however, be perfect, because if vaccination were withdrawn the whole of the new generation would grow np susceptible to small-pox^ and, the vims being diffused in such an unprotected popuhition, a universal epidemic could easily be spread over the whole land.
From these observations, which I have penned without the slightest bias on either side, the intelligent reader will, I trust, become enabled to form a correct judgment of what the Govern- ment of the country ought to do in respect to legislation on vao-^ cination.
The effects of vaccination are summarized by the Medical Officer of Health for the Privy Council, Dn Buchanan, F.TLS,, in liie kte Report to the President of the Local Government , Board for the year 1881,
In 1881, among 55,000 chihlron wlio had not been vacci- nated, there were 782 deaths from small-pox ; among 801,000 children who had been vaccinated, there were 825 deaths from small-pox in London.
If the Lt>ndon children under ten who were un vaccinated had had the protectioti of vaccination, not 782, but 9, would have died of small-pox during the year.
If the 861,000 vaccinated children had died at the rate of the 55j000 un vaccinated, 12,125 deaths would have occiu-red from smalLpox during the year instead of the 125 that did occur among the London population under ten years of age.
If it be urged, as it has been, that the vaccinated children owed their escape fiom smallpox not to vaccination, but to the circumstance that they belonged to the richer and better- lodged section of tlie community, the hypothesis is negatived by the facts»
The children vaccinated at the public expense number about
PREVEJiTlOyS OF ZYMOTIC DISEASES,
68J>
430,000, Tills is nioro tlian half the cliild popviktion, and be* lungs tu iLe |KJoi'er popiiliitioii. Jf the rate of death aniinig the iinvaccinated children had prevailed also amongst this poui*er sec- tion of the vacciuate<l, then anifmg tbe^ocliildreri vareitiuted at the puhlic expense tlieie wuitld liave heeu over 0,000 deaths from smalhpox in 1881* In reality the outside niiniber of deaths was
^3^1 and indeed this poorer liidf of tlio vaeeinated eoniuinnity had i^lenB mortality than the richer. These facts speak for tlieni- selves, and are a clear set-off again^^t 12 deaths registered in Lon- don in 18S1 as from cow-pox and disease occurring after vac- cination.
For my own part, with all the facts tliat are in my possession hefore nie; witb a knowledge that without protection tlie sniH-ep- tihility to small-pox is as distinct as ever ; with a knowledge that the virus of smali-pox is sdll present in many thousand* *if cen- tres; with a knowledge that amongst an unprotected conimnnity small-pox might easily ravage the wliolc of a nation ; with a knowledge that vaccination, not with standing all its drawbacks, is a protective wMthont being an infective disease ; and, with a knowledge that sanitary mtmsures are not sufficiently advanced to admit of the withdrawal of the protection of vaccination, it is I feel out of reason to request the Government to break np the great organization for vaccination which it has estabHshed, I have been vaccinated myself three timcs^and luivu had those who have been under my control vaccinated and re- vaccinated, a prac- tice which is, I lielieve, all hut universal amongst the inemhers of the profession to wluch I belong, a profession wliicli ought to be best acquainted witli its own interests if with none other.
It rests with politicians rather than with llie njen of science to determine whetlier it is good practice to make vaccination com- pulsory, and speaking on the political side I do not think it is. At present thij compulsory method is doing the greatest injury to vaccination by making it so unpopular that people will not listen
' to reason on the merits of the process; in time it will bring dis- credit on the process altogether, as a useless and tyrannical measure.
In conclusion, it seems to me to be tlie duty of the Govem-
* mcnt to retain the existing organization, and to make vaccination as healthy aufl perfect as pogiftilde ; hut to witlidraw all penaltie
^or enforcement, and to stop at once the unseemly trials fo
^ 44
^L
800 PREVTENTIONS OF ZYMOTIC DISEASEB.
enforcement^ which raise an emotional diegnst or dislike, witho in the elightest degi*ee satiBfjing the reasoning natai'e of C
people.
Other suggested Prophylactic Inoculations,
In iniitAtion of vaccination, it has of lata years been prop
to attempt to prevent other of the spreading diseases than sic^ . pox by means of counter*inociilatioii, on tlie homoeopathic J^^^J^' ciple of keeping off a sevem by bringing fortn a similar 1^,,^ ■ milder disease. Tliore are soiiiewho would persuade our Gov^^jj.jj_ ment to let tliis experiinent bo tried on our flocks and herds^ a.:ijcf who would introduce a series of spick and span new diseases, on w-he chance that certain old diseases, which are perfectly under ^,^^11- itary control, may be conjured out instead of being kept o mjL This would not be a sound governmental proceeding. Alresa^y the hypothesists who are the head and front of this experimeii. ^ crusade are quaiTcUing amongst themselves as to the validity of their own experimental data. They have not proved to tlie s-^t- isf action of each otiier that they have discovered the art of p:^^ venting susceptibility by iriocnlation; and, worse than all, tl» ^/ have not proved tiiat the artificial protective diseases which ilm^J think they can induce are not, when once induced, infectious a nd cormiiunicable independently of mere artiticial and controUab^e propagation.
Contagious Diseases Acts.
The legislature of this country has attempted, through the Contagious Diseases Acts, to suppress, l>y legal measures, the spread of certain diseases which convey tlie worst description of contagion and wliiuh confer the most destructive lieredity. I have studied with the utmost care what has been said on both sides of this important question, and have come to the following conclusions: —
{a) That the Acts where they have been applied have tended to the reduction of one of the woi-st forms of human disease.
{h) Tliat, as the advocates of the Acts claim for them, they have conferred advantages otiier than hygienic. That they have;—
** Diminished prostitution in subjected districts.
" Almost entirely suppressed juvenile prostitution.
PREVENTIONS OF ZYMOTIC DISEASES. 691
" Rescued fallen women from the frightful state of filth and disease in which they had previously lived, and placed them under conditions in which they, for the first time, become amenable to humanizing and reforming influences.
" Contributed to promote public order and decency in the dis- tricts in which they are in force.''
Waier Supply and Drai/ncige.
In the prevention of diseases of the zymotic class it is impor- tant,- perhaps essential, that the Government of the country should take into its own hands the management of the water supply, and should carry out for the whole country those provisions for such supply, as have been referred to under the head of Local Author- itative Action.
The existing laws relative to the drainage of towns and the purification of watercourses, require entire revision, and cannot too early come before the Legislative Chambers of our own and other countries for that purpose.
CHAPTER VI,
PREVENTIONS OF ACCIDENTAL AND INDUSTRIAL DISEASES.
Peesonal Rules for Preve^ttion.
In the prevention of dieea&es arising from accidental injnries, witli special reference to those injuries occurring from industrial labor^ the personal element of prevention is naturally the tirst be considered. In this confiideration must, however, be Inelnd not only the workers themselves, but those for whom the work ia executed. Employer and employed are equally concerned in this labor of pi*evention.
It must be at once admitted that many employers of labor have found the greatest difficulty in introducing preventive raeas- urea, owing to tlie opposition raised by the persona themselves for whose benefit the measures were invented. This may be, and is, ubstrnctive. It need not be deterrent.
All those diseases which are indnced by the altsorption of inor- ganic poisons through the skin or mucous membrane of the mouth, and which are described at pp. 315-330, can only be prevented by extreme cleanliness, and by taking care that the injurious gnb- gtanccj whether it be arsenic, lead, pi^tassa bi-chromate, cyanide salt, or copper, does not remain in contact with the absorbing surfaces. In the working of arsenical preparations this vigilance should be incessant. In re^^ard to the bi-chromate disease, it seems to me that the simple precaution of covering the handa and arms with an impermeable glove or gauntlet is a sufficient prevention,
Prevention of Lead Poisoning.
In lead-working, whether in white lead works or pottery work, extreme care on the part of the workers that they do not take up
PBEVENTIOKS OF INBUBTRIAL DISEASES,
693
their food witli liaTids soiled with lead, is of itself a very consider- able protectioiL In respect to lead*workiiig some recent inventions have rednced, greatly, the danger incidental to the mannfactiii'e of white lead. During the nieeting of the Sanitary Institute at Newcastle, I liad there the advantage of heing shown over some large works and of wutneseing the proeefis of the manufacture of white lead, from first to last.
In these works a numher of improvements are introduced, by which exposure of the skin to the solntion containing lead and exposnre to inhalation during the process of drying are admirably prevented. In the establishment one workman, who had been engaged for many years and never suffered at all, expi-essed to me that, by strict attention, tliere need be no suffering. In a second establishment of the same kind I found another workman w1k» had eeeaped in a similar manner, and who held a similar opinion as to the efficacy of cleanly attention. He* too, tiionght tliat in- temperate habits, by leading to recklessness, and by rendering the body more susceptible to the injury, w^ere, in a secondary point of view, exceedingly productive of the mischief.
A good research is required that wonld help to the discovery of some process by which the use of lead may be dispensed with in the glazing of pottery, and some innocuous substance be put, for this purpose, in its place. Half a century ago the Society of Arts was actively interested on this subject, and awarded, in the session 1822-23, its large gold medal to Mn J. Meigh, of Shel- ton, Staffordshire, for a glaze for vessels of common reel earthen- ware, not prejudicial to the health of those w^ho make use of them. Since then, however, but small progress has been made compared witJi wdiat might have been effected from ingenious and persistent experimental imiuiry. Meigh^s process is descrilied as follows :
**The rock called red marl is usually in the form of beds, of A soft, C'.iarse, slaty structure, and red color, forming the chief part of the conmion soil in many extensive districts in this island, to the north and west of a line running obliquely fix>m Dnrlmm to P^x- ©tcr* This marl is easily ground in water to an impalpable pow- der, which remains suspended for a considerable titne in the fluid. A mixture of this kind is prepared, and the ware, pi-e- viously well dried, but not burnt, is immersed it The superticial pores of the clay are thus filled with fine particles of the marl, and a fit surface is prepared on which to lay the glazhig. Being
pREvi:imoirs of it^dustrial diseases.
again carefully dried the ware is ready for the glaze, which is 1 composed ; — Take one part Cornifih granite, cotisi&ting diiefly of felspar, one part glass, one part black manganese, tJie whole well ground together, and diffused in water* to the consistence of cream. Dip the ware in this mixture, and, when tliorouglily dry, place it in the kiln, and fire it in the usual way. The result will be a solid black glaze, very permanentt and not containing any ingredients noxious to health* If an opaque white glaze is re- quired, omit tlie manganofle."
Mr. Meigh also employed common marl and the red marl aa ingredienta of the body of the ware, with excellent effect, without increasing its expense ; he used for this purpose four parts of common marl, one part of red marl, and one part of brick clay. Vessels made of the above mixture were in the possession of tJie Society. The color of the body is a reddish cream brown ; it is harder, more compact, and less porous than the common red ware; and its general adoption with the above-mentioned glaze, might contribute, in a considerable degree, to the health of tlie lower classes, by whom alone the common red warn is used for vesselft of cooking.
Experiment on an extensive scale is wanted still, to settle the question whether the above-named method, or any other similar, can be rendei*ed serviceable for taking the place of lead in the glazing process.
Encouragement should always he given to tlie introdnetion of paints for house-painting which are fi'ee of lead*
I
Prmentimis of Injuries from Gases and Vapors,
To prevent the diseases arising from the inhalation of gases
and vapors, the grand desideratum is to allow the freest possible ventilation. When that is possible the danger is limited. There are, however, some gases and vapors to which, in my opinion, it is wrong that any person should be subjected at all. Bi-sulphide of carbon vapor is one of these deadly agencies. Chlorine is another. The present plan of letting the workmen go into the chloride of lime chamber while there is free chlorine pi'esent is altogether unnecessary and altogether improper. It would be the simplest thing to cx)nstnict a chlorine chamber, in which by means of a large volute^ the lime could be changed into chloride.
i
PBEVENTION8 OF INDUSTRIAL DISEASES.
695
and tli6 product, chloride of lime, swept out without any pei-son being exjK»*ied to the clilorinc gas.
in tlie course of the last few years many irriprovenieuta have been carried out in different factories where danger in previoae times Mas iimniuent. At Amiens, SI. Kuhhuanu devote^l much attention to the process of fixing chemical vapors given off in various pmcesses of elieniical manufacture, lie invented a mill in which the vapors are carried into neutralizing solutions, being distributed in fine division almost liice spray. In sotue aniline works in France the distinguished Citevalier successfully exerted his ingenuity in construetiug a special room for the manufacture of aniline, so arranged that exposui-o to the va[Jor is practically an imposBibility, and is indeed placed out of the range of the workman though he be even careless in the performance of Ins work.
With a similar worthy object of applying scientific skill to Uie protection of the working man in the factory, M. Galibert has invented an air reservoir, made for economy's sake of a goat* skin, by the use of which a man may carry with him on his back a good supply of pure air, and, by a little practice of breathing through a valved mouthpiece, may work in a deadly poisououe atmospheiii without rit^k.
For the pi*evention of danger from exposum to poisonous va- pors or gases tlicre is now invented an apparatus by means of wliich a workman can actually remain for long periods of time in a room charged with a fatal atmosphere. The apparatus is tliat invented by Mr. Flcuss, and ocmsi&ts of a bi^eatliing^mask con- nected with a supply of condensed pure oxygen, and with a ehainl)er through which the expii*ed air is cleared of the poisonous products of i*espii*ation. The person supplied witli this apparatus makes an atmospliere for hiniseif independently of that which is outside of him. lie can live under water, and he can live, afi I liave shown^ in the most dangerous gases without experiencing any Iiarm. The apparatus ought to be extensively used in vari- ous manufactures where dangerous gases are being given off,
Pf*ev€nfwn& of Injuries from Dusts,
For preventing disease from the inlialation of dusts the prime consideration is to introduce perfect means of ventilation, so tliat the particles of dust, whether organjoy inorganiC} or metallic, may be carried away.
698
PBEVENTIONS OF INDUSTRIAL DISEASES.
In manufactories, such as needle manufactories, where fitecl dust is carried into the air, this metbud of ventilation, ^itli the air always in motion and directed in such manner as to carry the particles of dust outside, answers exceedingly well. 1 found the same to obtain in certain of the flax manufactories in Ireland, which I visited not long since.
In factories where steel grinding goes on to a large extent^ the magnetic plate for drawing down the particles of steel to itself is very useful. It has never been poptilar amongst the workmen, but it is exceedingly scientiticj siujple, and efficient
At first sight it would seem a very easy task to invent a mask whicli sliall exclndu the ]>artide8 of dust, and yet admit, fi'eely. the atmospheric air. But when w^e come to the practical ait of construction, the task is not so easy as it looks. We may succeed in keeping out the dust readily enough, but fail in letting in the air with sufficient freedom. We may succeed in excluding the dust and letting in the air, but fail in letting out the expired air with snfficieut freedom. We may succeed in keeping out dust, and in letting air both in and out, and yet fail in removing the water that is expired with the breath. Any one of these failures is sufficient to spoil a mask intended for ready, prolonged, and easy application.
Messrs. Krohiie & Seseman, the enrgical instmment maketiB, of Duke Street, Manchester Square, have introduced a Swiae ori*nasal mask, made of vulcanite, in w^hich the air h drawn through a layer or thin pad of cotton- wool w^hich can easily be changed. The instrument is simple, and at first it seems easy to w^ork. But in a little time the cotton-wool is sattirated with water from the breath, au<l tlie breathing becomes ditficult, even in pure air. In air charged with dust the cotton pad is choked with tiie mixture of moisture and dust.
A second respirator introduced by the same firm, is made of layers of crape spread over a light wire franjework. It is easily put on and ofl", and it lets air freely in and out. It has two faults —it allows water to accumulite in its meslies, and it filters badly. It answers fairly for very coarse dusts, but the finer sorts^ such as flour, draw through it almost as easily as if nothing were in the way.
A third contrivance has been invented which is much more elaborate. In this a filter, made of porous woollen-material, is
previ:ntions of industrial diseases.
697
I
I
I
I
enclosed in a perforated metal box wliiclj ie worn on the breast, suspended by a cord that passes ronnd tlie neck. The hreatlung- titbe is held in the month, and the inspiration is matle bv the tabe through the filter* The expiration is through an indepen- dent valved opening, the valve being very light and eatsy of movement. Tliis apparatus has two advantages; its filter does not become damp fi*om the condenesatiou of water by the breath, and its filtrating surface is large and free* The ol>jeetion8 to it are, tliat all the air has to be drawn throngh it by the mouth, an nnnatural effort which cannot be persistently sustained for long perioils of time ; and that, witii the utmost care in breatliing by the months care brought by habit to second nature, some dust will find its way into the lungs by the nostrils. The success of the apparatus is, therefore, not certain. The apparatus is also costly, and though it is neat, ingenious, and a leaily good filter, it could not, I think, be expected to come into general use.
I have myself made many experiments in order to construct a perfect mask for tlie filtration of dusts, and after testing various kinds of filtering substances, I have come to the concluBion that fine feathers are the best. Tliey are very light, they separate perfectly, they admit air in any quantity, white excluding dust, and they alisorb less water than perhaps any porous flexible sub- stance. They have the further advantage of beitig cheaply pro- cured, and of being easily made into filters.
I ti'ied to imitate with them tlie ciliary process of filtration by a wheel of feathers placed in a mask, which should draw to an opening during inspiration, and expand like a fan during expi- ration. T>y this movement, I thouglit tlie feathers would filter during inspiration, and would be cleared of their dust during ex- piration. The plan succeeds well for a short time, but, as the balance of tlie wheel nmet be finely set, it soon gets out of gear, an accident fatal to success. I planned next to fix the feathers transversely within a breathing'tube, giving them a direction so that in inspiration they would be drawn across the tube to filter, but in expiration would be given out against the side of the tube. This plan was imperfect, because the feathers could not he freed of tlieir accumulated dust by the act of expiratiim.
Lastly, I tried to make a mask by rolling t!ie feathers round the inside of a breathing-tube, and so arranging them that in in- spiration they would rise up and filter, while in expiration they
698 PREVENTIONS OP INDUSTRIAL DISEASBS*
would be carried down tlie tube like a valve. In Uiis Inst plan, lightness, dryness, good filtration, and self -clean sing of dust are insured, and I do not think any better ur simpler plan has been constructed* In order to adapt the filtering tube to tlie face of the worker it is placed in a mask whicli can be put on and taken off as easily as if it were a pair of spectacles* The filter- ing tube ia so placed as to catch all the inspired air, and by means of two side expiratory valves nearly all the moistiiro of the breatli is set free. But, light as the mask is, it is not approved of by those who wear it It causes, it is said, closeness of air, and it looks unsightly.
Mn Baker invented some years ago a crape mask for workers. It answered, but was not popular.
IL
I/ocAL AmroHiTATivK Pbevknttonb,
But little can be done by local authoritative action forprever^^^ ing the indiit?trial tiiseases. One suggestion is, I think, wort^^^, of being expressed in this place.
Public WorX>rooms,
The suggestion is, to build in all our great industrial Itii^ public work-rooms for the use of those industnals who ai*e now obliged to work at home in tlicir Itttle stifling rooms, which are at once living- rooms, bedrooms, and workshops. The new work- rooms ought to be distinct blocks, and arranged so that every pe^ son should be able to liavo his own oliice or workshop at a moder- ate cost per week* Each block of such rooms should be placed under proper superintendence, that intruders be not admitted, and each room should be applied to no other purpose except the work for which it was let, and should be occupied by no more peraoua than could work in it with perfect safety to health.
If these public work-rooms were established, the benetits re*' suiting from them would be incalculable. The workman would pursue his avocation freed from those domestic cares and trouble? which surround him in his household. His wife and family would be left to live fi-eed from the constant plague and worry of business and labor, while the simplest industrial worker would
PREVENTIONS OF INDUSTRIAL DISEASES.
have the same advantages as the professional man, who in the office can transact business relieved from all the annoyances which, of necessity, attended tlie processes of working for bread and living within the same four walls.
The industrial classes would profit by this reform, and every class of the community would also profit by it, in some if not an equal degree. As things now are the private work-rooms are foci of the spreading diseases. In these rooms, where lie the vic- tims of scarlet fever and other contagious diseases, clotUes are made which are to cover the bodies of the wealthier classes and to carry those particles of diseases which flourish wherever they are introduced, when those who are susceptible to their influence are exposed to them.
ni.
Central AurnoRrrATivE Preventions.
The whole subject of Central Legislative action in regard to industrial diseases requires to be recast. The English were the first people to endeavor to do away with some of the evils con- nected with industrial pursuits, and in 1802 the firat Legislative Act concerning the labor of children was passed, an Act from which all similar legislation relating to industrial occupations has taken origin. The time has come for revision of what has been done.
Revision of Factory Labor.
The Legislature might with advantage enlarge the powers of the certifying surgeon in the factories, to enable him to be of service beyond the mere duty of certifying as to age. In the Fac- tory Act age is treated as though it were another term for strength, which we all know is a fallacious idea, and what is really wanted is, the correction of so great an error. To the health and the life of the operative, it is essential that the authority of the surgeon should be extended, and that strength as well as age should be brought into consideration. It is essential, I mean, that a surgeon when he sees a child put to a work which it has not the strength to carry out, should be able to say, " This shall not be ; this child must be set to another and easier task." In further ex- ercise of useful duties, it seems important that the powers of the
RETENTIO:
factory surgeon should extend to the correction of other sources of danger, to the supervision of tlie health of the adult opera- tives, and to the direction of the sanitary condition of the fac- tory.
There are some other directions in wliich it wonld be wise to extend the powers of the factory surgeon. He ought to be en- abled to carry out his duties in workshops as well as in fact4>rie&. I think his power ought to extend further even than this; that it ought to reach into those places called work*rooms in private Itouses. In small shops and work-rooms more injury is inflicted than in the factory, and to let the young remain unprotected frou! the most dangerous forms of labor, on the mere pretence tliat they do not work in a place legalized as a factory, is a legislative fail- ure of the sadtle^t character*
To the application of remedies for each one of these errors w^ might surely, without hesitation, demand the service of the lature.
A legislative reform is required in regard to the regulation of age at which half-time work should commence. The teachings o^ science are clear, that no child of either sex should l>e put to worlc at too early an age. Twelve years is the earliest age at whicli any labor should be commenced. Even then the kind of labor ouglit not to be indiscriminately left to the choice of the employ- ers ; it ought to be placed under the wise direction of educated medical men who know what can and what cannot be bonie by the laborer,
This hoolc is the pro-peri tj of COOPER MEDICAL COLLEGE.
SAN FRANCISCO. CAL.
and is not to he rvraorrd from the Library Ron,,i hif a>,^/ perso7i or ttndtr amj yrciext a^iutcrer.
CHAPTER VII. PBEVENTIOI^ OF SOCIAL AND PSYCHICAL DISEASES.
1.
Rules for Personal Preventions.
The personal rules which require to be carried out in order to Iceep in check the social and psychical causes of disease embrace all those various attentions to domestic, individual, and scholastic life which tend to make existence truly agreeable, chaste, cleanly, and free from care.
Wa/rming and Ventilation,
In addition to the attention which should be paid to the drain- age of the house, a point already considered, in addition to the raising of the house a little distance from the ground and the con- struction of it with materials which will not absorb and retain water, the house should be so planned in all its parts as to equal- ize the temperature of the various rooms as far as possible. Pointed roofs are opposed to this arrangement by presenting too large a surface for cold and evaporation, the chamber or attic immediately beneath such a roof being always seriously affected by external extremes of moisture and temperature.
The ventilation of each apartment or floor should be indepen- dent and derived from the outside air, not drawn from the base- ment by a staircase shaft. The circulation of air should include warming, so that the heat from every fire in the house may be used as a ventilator and a warmer.
The difficulties to be overcome in ventilation and warming are still very great. Many plans have been tried and found wanting ; some for ventilation simply, others for warming simply, and others again for combining the two. It cannot but be conceded
702
PREVENTIONS OF SOCIAL DISEASES,
that those plans succeed best which accomplisU the one by the aid of the other.
It must be remerabored that the amount of air required by each adult person is 3,000 cnhic feet i>er hour. Children need al- most as much, owing to the moi*e rapid breathing and the qaiekcr chemical changes which tlieir growth an J development demand.
Such a couauinption of air would require the contents of a ixrom ten feet square to be changed three times every hour.
Space is not everything in ventilation. Some ]K?rson8 think that because rooms are large and lofty, the matter of changing the air juay be more or less left to take care of itself. This is a mis- taken view, for the height of an aparttrient may be a real disad- vantage, the upper part becoming a gjvecies of reservoir for impure air which cannot escape and which, as it becomes cooler, sinks and diffuses into the con^uu»n air below.
It follows that there shotild be an abundant supply of fr air, and also means of exit for the used air. The rate of mov ment in the air admitted should never exceed 5 feet per second. If it do, drauglit.s are felt, aiul we know by experience tlie serious evils which foHow in their train.
The cldtnney-shaft, protected by an Arnott's or simiiar valve, is the best exit fur the air of a room.
Pnre Air^ Lighi^ Wixten
A leading principle in the construction of the healthy house hi to put into it, for building purposes and for furnishing purix^ses, ^ as little as possible of all substances that hold and retain those specific particles of disease which, being set free, spread by dif- fusion, and excite their specific diseases. Thus, in all construc- tions porous materials are bad; absorbing materials are bad; materials such as thatch and straw for roofings are bad. In fur- nisliing, woollen and fluffy materials are bad ; heavy curtains to beds and windows are bad ; carpets which cover the whole of a room are bad. In a word, all materials tlmt catch dust, keep dusty, hide dust and, on being shaken, yield clouds of dust, are bad.
Light should be freely admitted into all parts, cupboards and closets as well as sitting- and bed-rooms, for sunlight is in itself a potent purifier. One great evil of tlie gloomy cloister like style of building is that the darkness hides lurking dust.
PREVENTIONS OF SOCIAL DISEASES. 703
All water for drinking purposes should be filtered. Cisterns are at present a' necessity, and should therefore be kept as pure as possible by periodical cleansings.
Summary of Healthy Essentials for the Hox^se.
(a) Separation of the house from direct contact with the earth.
(J) Complete separation from the sewer or cesspool.
(<?) Freedom from collections of damp and dust.
{d) Separation, by air communication, between floor and floor.
(e) Unobstructed and instant drainage.
(/) Equalization of temperature.
{ff) Independent ventilation of rooms, with utilization of every fireplace for warming and ventilation.
(A) Free admission of light.
(i) Perfect filtration and cooling of water.
Summary of Healthy Essentials for the Bedroom.
1. The bedroom, as the apartment in which a third portion of life is or ought to be passed, should be the room most carefully provided for, in relation to sanitary requirements.
2. A bedroom should always be cheerfully furnished. The furniture should be light and incapable of holding dust. The walls should be distempered, of a light bluish-gray or sea-green color. A southern aspect for the window is best.
3. Each sleeper ought to be supplied with 1,500 cubic feet, at least, of breathing space.
A. Air supplied for bedrooms ought to be drawn immedi- ately from the outside, and should never be permitted to enter from inside passages, or be carried upwards from the basement. The "costless" ventilation plan, of Mr. P. H. Bird, is an excel- lent one for accomplishing this end ; better still, is a fire-stove, which warms and delivers pure warm air freely and systematically into the room.
6. Free exit should be made for the air by the chimney-shaft.
6. An equable temperature of 60° Fahr. should be maintained in the apartment during its occupation.
7. Daylight should, when it is present, at all times be freely admitted into the bedroom. It should be shielded from the
704'
PREVENTIONS OF SOCIAL DISEASES.
eyes of the sleeper, but permitted to ** flood " the room generally
unimpeded by dark blinds or heavy curtains.
8. 2\11 extraneous artielea of furniture should be dispensed with. Lumbering pieces of furniture reduce the air space of the j apartment and retain dust.
9. Every sleeper should have a separate bed.
Premiitloihs of Psyvhkal DUtufbanees.
For tlie prevention of the great class of psychical causes of disease the leading |>oiat8 to be recalled are,^ — An education of the young which will not produce overstrain of mental or phys- ical power : the cultivation of habits of temperance, cleanliness, and purity of miufl as well as of body : the formation of fixed and regular habits, and especially of the habit of going early to rest and of ririing early in the day : the encouragement of all mental and physical games and exercises wliicli lead to variety of accom- plishments without any undue pressure or exclusivs development of organic structures or mental faculties.
Local AuTHomTATivE Peeventtons.
Oofisiiiuimu of Local Aui/iorUies*
It is a good practice in the formation of local boards for sanitary purposes to elect from all classes of the community, which are eligible for election, the persons whose duty it is to carry out the details of administration.
It would be exceedingly wise also to let women become eligible for seats on local sanitary boards ; for w^omen are by nature sani- tarians; they see the lights of health and the shadows of disease much more acutely and keenly than men do. They are quick at suggesting sound and wholesome reforms, and tlicy know infi- nitely more about the domestic life atjd the liiime than men know. When they are well informed and interested in sanitation they are allies of the first order ; while, when tliey are not informed and are not interested in reforms they are opponents which no man and no board can withstand.
Some general system requires to be introduced for regulating the numbers that shall constitute a local sanitary council in each
PSEVEKTIONS OF SOCIAL DISEASES. 706
locality. At present the system, if that may be called a system which has nothing systematic in it, is altogether irregular. In some places there are too many, in other places tliere are too few, local health legislators. In the largest places there ought to be one local representative of health to three. thousand of the population, as a minimum of representation.
Again, in respect to the selection of sanitary boards more care than now exists should be taken to select members to serve in answer to local demands within the district itself. I mean by this that each person elected should have under his particular knowledge and interest his or her particular district, the require- ments of which should be at all times before the mind. The dis- trict would in this manner be under the most perfect observation, and the Medical Officer of Health would at all times have the most valuable help at his command.
The Medical Officer of Health.
In every local district the Medical Officer of Health should have the true place that belongs to him in all that relates to official action bearing upon health. He should hold to the sani- tary department just the same position as the Recorder docs to the legal. He ought not merely to be the adviser of his 1x>Ard, he ought, by virtue of his office, to be the chief and chairman of the sanitary department. He ought to be elected for a definite period ; he ought to be upheld in eveiy useful health reform he brings forward ; he ought to l)e encouraged to inaugurate reforms ; he ought to be placed in such an independent position that he can inaugurate any reform and correct any evil without bein^ subjected to the risk and personal anxiety of dismissal for g^xxl service. He ought, in a word, to l>e able to put down diseatse of which he is the medical judge as freely, as unsparingly, as fear- lessly, as the legal judge or magistrate puts down crime. L'ntil this is tlie nile medical officers of health will remain 9^ mere clerks and chroniclers of disease ; suggesters of placebo<> in sanita- tion ; scapegoats of sanitary blunderers ; gentlemen of education engaged by money for perf unctorj' service.
Vtiliz^itif/n of Soft Water.
In a town properly drainr^J the fttonn or rain water onght tr. Ix:* caught as it flows from roofn of hoiiiiefi and other buildings, and,
706
PREVENTIONS OF SOCIAL DI9EAS1S.
in a more systeraatic manner than has ever yet been done, puri- fied, filtered, and stored for domestic use. In an improred man- ner tlie old-faehioned system of collecting storm water eliould be adopted, liy common consent and common arrangement, by the whole of a town. There is now invented a very cfFectii*© soft- water collector and filter, and the obtaining of good iron cisterne for storage is not mnch trouble and not mnch expense. Tlie water filtered and 6tore<j nnder the direction of the local anthority conld be supplied at diflferent parts of a town by sale at a fniall cost per gallon : it might be laid on to honses that I'equired it, at a comparatively trifling expense, and be supplied by meter.
It would be good practice for local authorities to supply their localities with water artificially softened.
A water to be quite free from injury to health shonid n have more than 8° to 9° of hardness, and when it exceeds that itai should, by the lime-softening process, bo brought down to thg^ proper standard. In Canterbury the authorities have carried oui^q this process^ and nothing could be more satisfactory Uian the rte^^ suit
Water Supply at Uniform Temperature.
The idea of keeping a town supplied at all seasons with wat< having an uniform temperatui^e is a modern development capable' of wide extension. We are indebted for it to Mr. Balilwm Latliain, and, in my opinion, the debt is considerable. Mr. Latham urges that in summer-time the water stored in houses^ or even in outside reservoirs, becomes heated, and by that means i» a ready cause of decomposition of organic matter, and a cause, indirectly, of the intestinal disturbance which is often present in liot sultry weather. To prevent this accident Mr. Latham has invented an mgenious plan, by which he brinies the water into every house by a tube which has been driven into the earth to a point where there is a persistent low temperatui-e. In the sum- mer season, the water drawn into a house furnished with this tube is what is called cold, and, what is of importance, it remains of equal temperature and dnnks like fresh spring water. Latlianrs would probably be too expensive a process to introduce into every house, although the simple and rapid manner by which the tube is driven into the ground is a model of ingenuity. But the plan might be applied to towns* by tlie local authorities.
\
PREVENTIONS OF SOCIAL DISEASES. 707
JDrmking Fountams and Public Lavdtoriea.
Drinking fountains, artistic in construction, should give out pure water to man, to beasts of burden, to cattle, and to our best of friends tlie dog, who, suffering from want of it, is apt, unwit- tingly, to be affected with disease of madness, and to become in thut state one of man's most dangerous enemies.
Public lavatories are a demand as great as drinking fountains, with which in many instances they might be conveniently asso- ciated, a lavatory for men on one side of the fountain, and for women on the other. In such lavatories there ought to be every convenience for ablution, and a dressing-room. There might also be, as has been suggested by the promoters of the Chdlet Com- pany, a space allowed in which travellers could for a small fee leave, temporarily, a travelling-bag or pai-cel.
The Manufdcture of Bread,
One of the oldest arts in the world is, perchance, the art of making bread, and yet this is, of all arts, the one least advanced as a pure and cleanly process, healthful alike to those who make and those who take. The more we examine the condition of bakeries in town and country, the more, as sanitarians, we wonder that human beings can be found, at any price, to undergo the penalty of being enslaved often half the night underground, ex- posed to varying temperatures and foul gases, and engaged in a labor that is as laborious as it is unwholesome. The more also we wonder that sensible people should be content to eat of bread made under such conditions, and worked as dough by the naked limbs of the unhealthy workers. For all sakes the bakeries in every town call for incessant supervision, for perfect sanitary con- struction, and for the introduction of the pure and simple process of manufacture by machinery.
Formation of Pvhlic Ahattoira.
The claims of morality and of humanity as well a^ of health demand in every locality that the private slatighter-houses should be replaced by the public abattoir, with its sufficient and cleanly lairSp its proper killing-places and rooms for dressing the carcasses, its lavatories for the workmen, and its cold storage-rooms for the reception and wholesome preservation of carcasses and joints.
708
PRKVEMTIOS Vi SOCIAL DISEASES,
Each ahaiif>ir glioDld be under the inspection of the officer, wlio^l after the Jewish fashion, should inqaire into the condition of tlie \ flddh of aaimab used for hamma soitenanoe.
Common Zad^inff-Aoum^, — ScAoak.
The common lodging-hoaees required for itinerant wajfarerft I should have all the healthy necessities for temperance, cleaiilinee^ and i ' ■ i^rasent in the l>6st lodgings* Lnxttried are nut called for, J L^a are; and for the pooi^est, neceesitiee, at least*
should be at hand. I know that imcuUivated moral i&ts of some schooK anxious ever to make man out to be a greater sinner thnn h© really i&, are too apt to throw all the burden of the &ius of a community on the most unfortunate meml>ers of it^ and to feel Of | even express that, for them, anything is good enough. The ail- ment is as false as cnioK and, like all wrong, rebounds^ For these unfortunates left to their own unhappy fate are the plague-spots of communities, and repay neglect by transmission of misery.
In the schools where the young are congi^egated, tliere shouKl be special and regular inspection in order to see that theao places do not become centres of infection. Rules of the plainest kiiul should l»e supplieii to tlie schtjohnasters and school mistressesi instructing them hov¥ to detect infectious and other diseases pro- duced within or imported into the school.
Hecrm^ian Grounds. — Public Roads. — MomegUads.
Beyond the social and political necessities for the care of the prior^ the local authority should make certain particular provisions for the maintenance of their health. For the young it should in- sure good playgrounds and parks forr^^creativelife^so that reci-ea* tion may, in its strictest sense, be not a word but a reality. Far the poor more advanced in life the local authorities ought to pro- vide artistic and refined amusements in the form of out-door musio, museums, and picture galleries.
For health's sake, there shonld be better care than is now gen erally pursued in the preservation of roads, Koads should he made not only smooth, but planned in eueh a way that water does itot accumulate upon them. In towns they shonld be rapidly and systematically cleared of manure and other organic debris with which they liecome polluted.
In country districts, the farm -yards and homesteads call for
PREVENTIONS OF SOCIAL DISEASES. 709
better supervision than has yet been applied to them. The farm- yard with its decomposing litter, in which pigs and other animals wallow, witli its manure-heaps, with its stagnant outside ponds and often unwholesome out-houses, is a direct and indirect source of disease which ought not to be longer permitted by any local au« thority.
In towns not less care ought to be taken to prevent the un- sleanliness and risk which occur in the mews and other places where li ing animals are kept
m.
Central AuTHORrrATivK Preventions.
Central authoritative direction on legislation is now demanded in so many ways, that nothing less than a special inquiry into the existing state of the laws relating to health, and leading to unifi- cation of law and simplification of law, can ever meet the many social changes that are absolutely required. Everything is piece- meal in present sanitary legislation in all its bearings on social life. I can but touch, therefore, on such existing wants as have been brought before me in the most persistent way under the teachings of every-day practical inquiry. Amongst distinctive legislative requirements the following seem the most urgent.
Water S'wppty. — Buildmg. — Air Purification. — SymUure.
The supply of water to all the towns and villages of the king- dom ought to be under the direction of the central government, either directly or indirectly, through the control it can exercise on local authorities, so that all private companies and monopolies may be removed. All those parts of existing Sanitary Acts which re- fer to the drainage of towns, to the direction of sewers and the purification of watercourses, should be recast and rendered definite.
The central authority should empower the local to insist that owners of property construct all residences and other species of building of proper material, and on correct principles for health.
The central authority should direct the local to provide in every place for the lighting of towns, and purification of the air from smoke and other products of combustion which are injurious to health.
710
PREVENTIONS OF SOCIAL DIBXAilB.
The central authority ehonld direct tlie local to provide proper mortuaries^ eo tliat the dead in the crowded living ma}' be re- moved to a fitting temporary place of rest, with all that miuisters to tho respect due to death. It should also direct that the ancient and most iisefiU officer, the Coroner, should have a court-house, where, with the solenmity befitting the vocation, he and his awom men should perform their important duties.
And still in England, if we would have every town healthy, ilt^j is necessary to continue to improve the places of sepulture, Oui^ cenjeteries for about half a century have been sufficient for th* ^ purposes for which they are intended. They are becoming lo^ crowded now, and some of tlienj so crowded as to offend the eenfie^a* A revision of law is immediately demanded in tliis direction, tz^ which, what is known as earth to earth burial should bo providi^^ji^/ for in every cemetery, and by which, under proper legal restrfc- tion, cremation slioidd be permitted whenever it may be dedre</. Cremation is becoming an actual necessity,
Suj^pressimi of Alcoholic Ev^Ua.
Lastly, for social healtli three great legislative reforms are re- quired in relation to the &ale of alcohol and the treatment of the worst sufferei's from that agents The first of these reforms is the establishment of local option, combined, I think, ultimately, with increased taxation on all alcoholic drinks. The second is so to improve the temporary Act whicli permits the establishment of homes for dipsomaniacs that confirmed ineluiates can l>e received in them with less trouble and difficulty than is now ex]»erienced. The third is to provide probationary homes for the dipsomaniac criminal classes, where, on the plan suggested by the Rev. C. llorsley, these classes can be retained for continued reformation under entire abstinence from strong drink, after they have finished the term of their sentence in the prison.
A Ministry of Health,
For the complete cariying out of the Central Health Depart- ment of this country, in all its details, one further inform is required, and that is a Ministry of Health, which shall, in the various departments connected wath it under the control and direction of a Minister of Health, collate all the registrable facts
PBEVSNTIOKS OF SOCIAL DISEASES. 711
bearing on disease and mortality ; all the facts relating to meteor- ology and climate ; all the details relating to the laws connected with local self-government; and, everything which publicly is incladed ander the head of State Medical Jmdsprudence. Snch a Ministry would not only be of the greatest advantage to the country, but, thoroughly organized and eflBciently served, would be sure to win the confidence and respect of other countries, and would serve as a model for countries less advanced than our own in tlie science and art of sanitation.
CHAPTER YIIL PREVENTIONS OF SENILE DISEASE
The niles for the pre veil tion of senile disease are all personal.
They should begin in juuth. It should be a rule amongst grown-up persona never to enbject cliildi*en to mental shocks and unnecessary griefs. When in the surrounding of the child life some grave calamity has occurred, it is best to make the event as light as is possible to the child, and certainly to avoid thrilling it with sights and details which stir it to the utmost, and, in the end, only leave upon the Toind and heart incurable wounds and oppres- fiions. Children should not bo taken to funerals, nor to sights that cause a sense of fear and dread combined witli great grief, nor to sights which call forth pam or agony in man or in tlie lower animals.
To avoid pi-ematnre old age in nmtui^e life the following are important points to remember.
Grief anticipates age. Dwelling on the inevitable past, form- ing vain hypotheses as to what might have been if this or that had or had not been, acquiring a craze for recounting what his occurred,— these acts do more harm to future health and effort tbwi 1 many things connected with real calamity. Occupation and now^ pursuits are the best preventives for mental shock and bereave- ment.
Hate anticipates age. Date keeps the heart always at full tension. It gives rise to oppression of the brain and senses. It confuses the whole man. It robs the stomach of nervous power, andj digestion being injured, the failure of life begins at once. Those, therefore, who are born with this passion^ and a good many* I fear, are, should give it up.
Jealousy anticipates age. The facial expression of jealousy is old age in however young a face it may be cast. Jealousy preys upon and kills the heart. So, jealous men are not only unhappy
J
PREVENTIONS OF SENILE DISEASE. T^IS
but broken-hearted, and live short lives. I have never known a man of jealous nature live anything like a long life or a useful. The prevention for jealousy is diversion of mind towards useful and unselfish work.
Dnchastity anticipates age. Everything that interferes with chastity favors vital deterioration, while the grosser departures from chastity, leading to specific and hereditary disease, are cer- tain causes of organic degeneration and premature old age. Thus chastity is preventive of senile decay.
Intemperance anticipates age. The more the social causes of mental and physical organic diseases are investigated, the more closely the origin of degenerative organic changes leading to pre- mature deterioration and decay are questioned, the more clearly does it come out that intemperance, often not suspected by the ]ierson himself who is implicated in it, so subtle is its infiuence, is at the root of the evil. Born a total abstainer, no man, no woman, should break the rule of abstinence ; having broken it, all, who are wise, should return to it and adhere to it.
When old age has really commenced, its march towards final decay is best delayed by attention to those rules of conservation by which life is sustained with the least faction and the least waste.
The prime rules for this purpose are : —
To subsist on light but nutritious diet, with milk as the stand- ard food, but varied according to season.
To take food, in moderate quantity, four times in the day, in- cluding a light meal before going to bed.
To clothe warmly but lightly, so that the body may, in all seasons, maintain its equal temperature.
To keep the body in fair exercise, and the mind active and cheerful.
To maintain an interest in what is going on in the world, and to take part in reasonable labors and pleasures as though old age were not present.
To take plenty of sleep during sleeping hours. To spend nine hours in bed at the least, and to take care, during cold weather, that the temperature of the bedroom is maintained at 60* Fahr.
To avoid passion, excitement, luxury.
INDEX.
Abatioibs, pnblio, as necessities, 707 Abdomen, the injuries of, 420 Abel, Professor, experiments in ar- senical poisoning, 317 Abscess, formation of, 35
in antrum of the jaw, 246
of the brain, 170
of the ear, 195
of the eye, 194
of the heart, 132
in joints, 243
laryngeal, 155
of lower bowel, 123
of the lung, 160
in the mediastinum, 166
in mouth, 106
in pharynx, 110
in tongue, 107 Absinthe, diseases from, 343 Absorbent system, the, 93
injuries of the, 423 ^ Acarus scabiei,*' the parasite, 267 Accidental diseases, horn, emotion,
479 Accidental origins of diseases, 506,
621 Accidents, mechanical, 273
lightning, 273
sunstroke, 277
from exposure to cold, 277
starvation, 278 Accidents, natural, diseases from, 273 Accumulation of wax in the ear, 195 " Achorion Schdnleinii," the, a skin '
parasite, 266 Acne, varieties of, 261
causes of, 261 Acne rosacea, 200 Acquired disease, from habits, 480 Acrodynia, 254
" Actinomyces," the parasite, 582 Acute miliary phthisis, 164 Acute pneumonic phthisis, 164
Adams, Dr. John, on epidemios, 524 << Addison's disease," 229 Adhesion, of the heart, 129
of tendons, 235 Adolescence, the periods of, 656
evils of mental strain during, 657 Afterbirth, retention of the, 305 Ague, varieties of, 50
decline of, in England, 51
analysis of deaths from, 531 Air, influence of, under peculiar physical conditions, 527
importance of purity of, in houses, 665 Albinism, 189 Albinismus; 264 Albuminuria, 214
during pregnancy, 301 Alcoholic diseases, 343
calculus, 851
delirium tremens, 349
dipsomania, 341
dyspepsia, 344
of the glandular organs, 351
of the heart, 345
homicidal mania, 351
insanity, 350
of the lungs, 346
melancholia, 350
of the nervous system, 347
of the skin, 344
sterility, 350
periods of mortality from, 544 Alcoholic drinks, a cause of acne, 261 Alcoholic evils, on the suppression
of, 710 Alcoholic intemperance, 627
estimated proportion of deaths from, in London, 628 Alcoholic phthisis, 164 Alcoholic taint, 520 AlepiK) evil, 263 Algic, diseases from, 579
|
^H ^^^^^ INDEX. ^^^^^^^^^H |
|
|
^^M Alopecia, 265 |
Arteritis, 141 H |
|
^^H Alilmus, on spinal congestion, 175 |
Asphasia, 174 ^M |
|
^H Alveolus, diseases of the, 249 |
Asphyxia, or suffocation, 42, 282 ^M |
|
^^H Amaurosis, 188 |
Asthenopia, or weak sight, 191 ^H |
|
^^B from industiial canseid, 623 |
Asthma, 158 ^M |
|
^^B Ammonia gas, 381 |
hay» 159 ^M industrial, 159 ^^^M |
|
^^H Amputatioue, 4:^1 |
|
|
^^H Anjyldid disease^ of tbe spleen, 229 |
pure spasmodic, 159 ^^^^H |
|
^^H An Juquin/ into tfie Laws of I^n- |
spasmodic, 158 ^^^M |
|
^^B deimcjs, Dr. John Adams, refen'ed |
symptoniic, 159 ^H |
|
^H to, 524 |
periods of mortality from, 640, ^^ |
|
^^1 Anaemia, 66, 622 |
622 1 |
|
^^H of the brain^ 170 |
industrial causes of, 622 ^J |
|
^H Anesthesia. 436 % |
Astigmatism, 193 ^^1 |
|
^^H value of, in operations, 437 |
Asturian rose, 254 ^^^B |
|
^^H An^atbeties, chloroform, 438 |
Atelectasis, 163 ^^^M |
|
^^^^^ mjthylene bi-chloride, 438 |
Atheroma, 38 ^^^^^ |
|
^^^^K nitrous oxide, 437 |
Athleticism, instance of heart di^ 1 |
|
^^^^V sulpbunc etber, 438 |
ease from, 406 J |
|
^ Anasarca, or droi)8y, 36 |
Athletic strain, 403 ^M |
|
^^H of tha cellnlar tissue, 270 |
instance of over-training, 401 ^H |
|
^^H Anebjloais, congenital, 511 |
Atrootiphere, Loudon, Buchan, sn4^H |
|
^^H Aneurism, of the heart, 135 |
Mitcheirs division of, 546 ^M |
|
^H of tbe arteries, 142, 022 |
analysis of diseases in c(mD«e- |
|
^^H Aniline discoloration, 623 |
tion with, 546-548 |
|
^^H Aniline dveB, disease from, 366 |
Atmospheric pressuj'e, 550 |
|
^^H Anihno erythema, 367 |
Dr. Andrew Smith's ohseni- |
|
^^H instance of, 36§ |
tions on, 551 |
|
^^B Angina ^>eetoris, IHO |
effects of, 552 |
|
^^H AnkylosiH, of tbe joints, 243 |
AtmoRpherieal origins of diseM*^^ |
|
^^H Apoiilectic coma, from industrial |
505, 524, 546 |
|
^^H causes, 621 |
Atrophy, or wasting, 37 ^_ |
|
^^H Apoplexy, 162 |
of the brain, 173 ^H |
|
^^^^^ of the brain, 172 |
of bone, 241 ^^^M |
|
^^^^K from lightning shock, 274 |
of the gums, 106 ^^^^H |
|
^^^^r emotional, 477 |
of tbe heart, 133 ^^^M |
|
^ peritids of mortality from, 541 |
of the liver, 208 ^^^M |
|
^^H Archibald, ReT. W., on convulsive |
muscubir, 282 ^^^^H |
|
^^H dtsease in the Shetland Islands, |
spina], 175, 177 ^^H |
|
^M 449 |
congeuitaK 511 fl^^l |
|
^^H Arena senilis, in tbe eornea, 187 |
periods of mortality fix)m, Sff^^H |
|
^^H Araolar tissue, the, 101 |
from industrial oAuaes, 623 ^^M |
|
^^H Arsenical poisoning, 315 |
Auricle of the ear, diseases of, 105 ^H |
|
^H Dr. Uassall on, 316 |
Automatic hysteria, imstance of, 466^H |
|
^^^^^ Professor Abel's experiments in, ^^^^B Dr. Hamberg's experiments, 318 |
^1 |
|
Back, the injuries of, 419 ^^M |
|
|
^^^H M. Delpeeb on, 318 |
** Bacteria,'' tbe parasites, 580 ^H |
|
^^^^V Dr. Leonard Sedgwick's obser- |
Baker, Dr. (Michigan )i on causefl <i^H |
|
^^V yations on, 310 |
tetanoid fever, 295 ^H |
|
^^^^^ Arteries, the, 140 |
Baldness, a ])arasitic disease, 265 ^^M |
|
^^^^H aneurism of, 142 |
Bang, disease from, 352 ^^M |
|
^^^H arteritis, 140 |
Barker^ Dr. Herbert (Bedford), 575^H |
|
^^^^^H dilatation, HI |
Batb, tbe, rulen for, 660 ^M |
|
^^^^^H fatty degeneration, 140 |
Beale, Br. Liouel. 598 ^1 |
|
^^^^H narrowing of, 140 |
on tbe vital germ hvpotbefiifl|^H |
|
^^^^^B oceluHion of, 141 |
601, 618 ^M |
|
^^^^H rupture^ 143 |
Beard, Dr. George (New ¥ork), cm |
INDEX.
717
the life of the indostrial olasses, 633 B^coort, Dr., researches on bichro- mate ulceration, 324 Beri-beri, 66
Bichromate pityriasis, 326 Bichromate ulceration, 324 M. Clouet on, 325 in lower animals, 325 Bioplasm, Dr. Lionel Beale on, 601 Black death, the, Hecker^s account
of, 458 Bladder, the, diseases of, 216 calculus, 217 cystitis, 216 ulceration, 216 distention, 217 fistula, 216
musculur affections, 218
of the prostate gland, 218
stone in, 217
of the urethral passage, 218 Blindness, color, 192
day and night, 193
from lightning, 275 Blood, weight of, 78
composition, 78
temperature of, 78
in relation to disease, 148
corpuscles of, 150
causes of change in, 151
fibrine in, 150
poisoned conditions of, 152
specific gravity of, 149
alcoholic diseases of, 345
parasites affecting, 561
extreme fluidity of, 622 Blood-spitting, hsemoptysis, 161 Blood-vessels, of the brain, 174
diseases of, from habits, 481 Bone, the diseases of, 239
caries, 240
constitutional changes in, 242
foreign growths of, 241
hypertrophy, 241
mollities ossium, 240
necrosis, 248
nodes, 240
ostitis, 239
periostitis, 239
rickets, 241
spontaneous fracture, 241 Bony or osseous, the, system, 97 Bowel, the lower or straight, dis- eases of, 123 Brain, the, 84
diseases of, 169
■^ -^
Brain, abscess of, 170 ansemia, 170 asphasia, 174 apoplexy, 172 .^ ' '"':i r^
atrophy of, 173 .f- ^^ . . >
blooidlessness of, 170 ^ cS < ^- of blood- vessels of, 17j|w o ^ "^^ cerebritis, 170 ?: ^ >
condensation of, 171 ^ ^ o ,^ congestion of, 170 S r^ il2 ^^ deposits on, 174 '^ ^^ O ^ . hypertrophy of , 173 .53 Q < > inflammation, 170 ^^ W c: *^ paralysis agitans, 172o S ^ C ramollisment, 171 rO ^^ 2: ^ • sclerosis, 171 co ?^ m ^
shaking palsy, 172 :5 g ^
softening of, 171 ^ o "^
sunstroke, 173 q ^ -
tumors on, 174 ^^ 51.
periods of mortality from dis- ^
eases of, 543, 621 necessity of work and change for, 446
Brain, membrane diseases : — acute meningitis, 167 chronic hydrocephalus, 169 thickening of the dura mater,
169 tubercular meningitis, 168 vascular congestion, 168
Bread, manufacture of, 707
Breast diseases, 225
<<Bright's disease,'' 214 varieties of, 214 periods of mortality from, 543
Bronchial diseases, 156 acute bronchitis, 156 capillary, 157 catarrh, 156 chronic bronchitis, 156 structural changes, 157 phthisis and irritation, 622, 623
Bronchitis, 156
analysis of deaths from, 531 periods of mortality from, 539, 622, 623
Bronchocele, 227
Brow ague, 182
Buchan, Alexander, on influence of weather and season, 533
Buchanan, Dr. G., report on vacci- nation, 688
Bucke, Dr., on nervous disease of the ear, 199
** Bug," the, or "cimex," 267
** Bag, the harvest," leptothrix, 267
Building, 709
|
^^H 718 ^^^f ■ |
|
|
^^^H BuQion, 237 |
Cellular infiltration, of mnooaB mexsa- |
|
^^^H Bums, from liglitiiiiig, instanoea of. |
braiie of tongue, 107 |
|
^^m 275, 423 |
Cellular tissue, the, 101 |
|
^^^H Btu-eal aflections, 237 |
the diseases of, 269 |
|
Celsns, mentioned in oonnectionir—- jth leprosj. 262 Cepholitia, periods of mortalitj fp^r-tn, |
|
|
^^^H CkosEsiAi definition of, 41, 436 |
|
|
^^^H Cadmium. eflTeeU of, 319 |
541 |
|
^^^H Cfleaatmn section* 434 |
Cerebral exhaustion and congei^ri^f} |
|
^^H «' Caisson disease/' 390 |
from industrial causes, 621 |
|
^^^1 Dr. ^Vndrew Huiitb on, 398 |
Cerebritis, 170 |
|
^^^H C&leuiud, character and locality of, |
Cerebro-spijiol system, the, gei^^^^^J |
|
^^m 40 |
dlHeoses of, 176 ^^^| |
|
^^^^^_ in the kidney, 216 |
Cestode, the, or tape-worm, 573 ^ |
|
^^^^K in the bladder. 217 |
syniptomn of, 574 |
|
^^^^^V from alcohol, 351 |
Chest, defomiities, 410 |
|
^^^V Cancer, 61 |
physical injtirieH, 419 |
|
^^^^^^ varieties, 61 |
Chest spasm, 180, 622 |
|
^^^^h of the breast, 226 |
Chicken-pox, varicelia, 45 |
|
^^^H lip, 105 |
** Chigoe,'^ the, or '• pulex." 267 |
|
^^^^^^H in the mediaBtinnm, 166 |
Chilblain, 2ti4 |
|
^^^^^^H in the Btomuchf 112 |
Childbed fever, 56 |
|
^^^^^H in tongue) |
Child-birth, diseases connected witL, |
|
^^^^^^H hereditary taint of^ 518 |
297 |
|
^^^^^^H among Jews, 522 |
hemoiThiige, 303 |
|
^^^^^H periodH of moitality from, 537 |
meehanictd injuries, during, 80i |
|
^^^^^^ Havihmd's observations on» 567 |
parturition, 302 |
|
^^^B Concnmi i)riR, 106 |
placeuta or after-birth, 304 |
|
^^^B Canities, 2i'A |
premature birth, 306 |
|
^^^m Canker, in month, 106 |
puei-perol conrukions, 306 |
|
^^^H CanuaViiM Indiea, 352 |
still >irth, 306 |
|
^^^B Capillary BVHtem, the. 79 |
periods of mortality from, 544 |
|
^^^B Ckrbon biNii]|ihide, 332 |
Children, general rules' for, 654 |
|
^^H M, Delpeeh on, 333 |
evils of excitement in, 656 |
|
^^^H Carbon dustK, disease from, 387 |
**Chionvphe Carteri,'* a akin Dara- |
|
^^^H Carbonii* oxide-ga.H, 333 |
site, 266 |
|
^^^^B coHe of poisoning from, 335 |
Chlorul, diseases from, 35:i |
|
^^^H Carbnnele, analjsia of deaths from, |
l>r. Kicljardson*s imports on, 363 |
|
^^M |
Chlorine gas, m^ |
|
^^^H Caries, or bone iileemtion, 240 |
Chloroform, diseases from, 354 |
|
^^^H Fiof, Lfliine*8 delinition of, 240 |
estimated fatality from, 438 |
|
^^H of the t^^eth, 245, 623 |
Cldornnis, 66 |
|
^^H Carter, Dr. H. Y.» on ** fungus foot,'' |
Cholera, malignant or Asiatio, 52 |
|
^^m 266 |
simple, 51 |
|
^^^^H Carter, Dr. Yondyke, on spirillum in j |
periods of mortality from, 635 |
|
^^^H fever, 581 |
Choleraic dian-ha^a, 621 |
|
^^^H Cartilages, diseases of, 243 |
CholD:ielev, Dr., on dise4ise from hair* |
|
^^^H Catalepsy, IBl |
duat, 383 |
|
^^^H inatances of, from lightning |
Chorea, aeute and chronic, 180 |
|
^^H shook, 275 |
during pregnimcv, 3t)0 |
|
^^H Cataract, 1H9 |
Chorea Bancti Viti, instancen cl, from |
|
^^^H varieties of, 190 |
imitation, 462 |
|
^^H Catarrh, classes, 83 |
Chronic ophthalmia, 186 |
|
^^^L naaol, 153 |
Chronic pneumonic jdithisift, 164 |
|
^^^^^^ laryngeal, 155 |
Chronic thickening, of the t^eth, 24A^^| |
|
^^^^^^f bnjiidiial, 156 |
'* Cimex," or - bug." 267 ^^M |
|
1^ C«UB©8, of dises^e, 500 |
Circulatory system, the, 75 ^^H |
|
^^^^^^ h^editory. 512 |
during pregnancy, 298 ^^H |
INDEX.
719
Oinmlatory system, the, operations connected with, ^7 emotional unsteadiness of, 475 diseases of, from habits, 481, 622
Circumcision, 514
Ciirhosis, 39
of the liver, 208 of the Inng, 162
Clarke, John Femandess, on muscu- lar over-training, 404
Climatic causes of disease, 524, 546
Club-hand, 236
Club-foot, 235
Cobbold, Dr. Spencer, on guinea- worm disease, 569
Cocculus Indicus, 866
Coffee, disease from, 365
'* Cofferdam " disease, 392
Cohn, Professor, classification of the parasites entophjta and epiphjta,
Cold, exposure to, fatal effects of,
277 Colebrook, Dr., his discovery of the
disease '' madura foot," 266 Colic, 122, 180
idiopathic, 123
lead, 123, 621 Collapse, the signs of, 41 Collins, the poet, an instance of
mental nervous failure, 485 Colloid, 61
of the breast, 226 Colorblindness, 192 Coma, 42
Combe, Dr. Andrew, on over-feed- ing and dyspepsia, 491 Communicable diseases, congenital,
510 Concussion, diseases from, 395
fatal case from, 399 Condensation, of the brain, 171 Congenital origins and causes of dis- ease, 505, 508
malformations, 508
derangements and synopsis of, 510 Congestion, 36
of the brain, 170
of the kidnevs, 213
of the liver, 207
of the lungs, 161
spinal, 175
of the spleen, 228 Constipation, 123, 621 Consumption, 163
true pulmonary, 163
of the lungs, 582
Contagious Diseases Acts, 690 Contraction and dilatation, 37 Convicts, disease among, from ex- cess of food, 491 Convulsions, 180
infantile, 179
muscular, 232
from lightning shock, 275
during pregnancy, 300
periods of mortality from, 542 Convulsions, sympathetic, instances
of, 461 Convulsive disease, in the Shetland
Islands, 449 Cooking, causes of disease from bad,
630 Cornish, Mr., remarks on Indian
famines, 278 Coronary arteries, disease of, 135 Coryza, nasal catarrh, 153 Copper, poison from, 330 Copper smoke vapor, 336 Copperas dust, disease from, 376 Corpuscles, changes in, 151 Cotton, flax, and hemp dust, disease
from, 384 Cotton fungus disease, 578 Coup-de-soleil, 277 Cow-pox, vaccina^ 41 Cramp, 180
from industrial causes, 623 Cremation, 710 Cretinism, 64 Crinoline, as a lightning-conductor,
instance of, 274 Crothers, Dr., on mental disease of
inebriates, 444, 453 Croup, 153
membranous, 154
spasmodic, 153, 180
analysis of deaths from, 531
periods of mortality from, 539 Crystalline lens, the, diseases of, 189 Cyanosis, 136, 622 C^anosuria, 282 C^nanche maligna, 109 Cystitis, 216 C^sts, 39, 63
in lip, 105
in mouth, 105
in nose, 200 Cysts, parasitic, in the eye, 194
Damp, rules for protection from, 663 Dancing mania, 458 Davanne, Dr., case of poison by cyanide of potassium under, 328
|
^^V iiH) ^H |
|
|
^^^B Davy, Sir Humphry, on mtrous |
Dental periostenm, diseases of, 2ia fl |
|
^^M oxide. 355 |
Dental pulp, diseases of, 248 ■ |
|
^^^1 D&xy, Dr, John, ou carbonic oxide, |
Dentition, iiTegidaritiea in, 249 M |
|
^H 835 |
Deposita, on the bmin, 174 ^^H |
|
^^^H I>Bj and night blindness, 193 |
Derangementa, congenital^ canses d^^| |
|
^^^1 Day, Dr. (Staflford), obfi^rvationa on |
disease, 510 ^^ |
|
^^^1 tetanoid fever, 2^3 |
" Derbyshire neck," 22T |
|
^^^H Deafness, varieties of, 194 |
Deapine, Prosper, on aympalhetK:;^ |
|
^^^H from functional derangement, |
disease, 449 |
|
^H |
on suicide, 464 |
|
^^^^ from industrial causes, 623 |
Diabetes, 65 |
|
^^^^^_ Death- rate, table of, lor the Tear |
caused by mental shock, 456 |
|
^^^B 1880, 641 |
fatal instance of, through fngfc:^^^ |
|
^^^^^M comparative Bommary of the |
487 |
|
^^V years 1847 and 1880^ 642 |
from nervous failure, 483, 537^ |
|
^^^H Debility, technical ilefinition of, 42 |
Diabetes iiisipiduw, 65 |
|
^^^B De C^lvi, M. Marchal, on diseaae |
Diarrhcea, 122 ^M |
|
^^^B from turpentine vapor, 372 |
classes, 122 ^M |
|
^^^H Deformities, acquired, 410 |
analysis of deaths from, 531 fl |
|
^^H oftheche<411 |
periods of mortality from, 53S fl |
|
^^^H of the Rpiue, 412 |
Diet, causes of di»eaae from, &30 ^^M |
|
^^^H of the lower limbs, 413 |
Digestive system, the, 72, 104 ^^M |
|
^^^H Defonnity of knee-joint, 244 |
the seveml parts of, 1(M |
|
^^^B anf^ilar, of the spine, 245 |
disorders of, during pregnaner, |
|
^^^^H of the feet, 414 |
297 |
|
^^^^^B of limbs from industrial cattaes, |
operations connected with, 426 |
|
^^^^ |
diseai^es of, from habita, 480 |
|
^^^B Degeneration, the term, 38 |
parasites of, 569 |
|
^^^^^_ cii-rhosis, 39 |
industrial causes of disease in. |
|
^^^^^H fatty and calcareons, atheroma- |
621 |
|
^^^^H tous, 38 |
Dilatation and contraction, 37. 115 |
|
^^^^^H fatty and granular, 39 |
of the bean, 134 ^M |
|
^^^^H fibroid, |
of the arteries, 141 ^H |
|
^^^^^H lardaceous amyloid, or waxy, 38 |
Diphtheria, 52 fl |
|
^^^^^H ofisiiicatiou, 38 |
periods of mortality from, 530^ M |
|
^^^^^H pigmentation, 39 |
614 ^m |
|
^^^^H apeciac. |
Diphtheric paralysis, 53 ^^m |
|
^^^^^^B of the kidneys, 214 |
Dipsomania, 349 fl |
|
^^^^f of the liver, 208 |
Disease, accidental origins of, 506 1 |
|
^^^^^ mnscular, 2:j3 |
«4W'ial and physical origins, 506 1 |
|
^^^1 Degenerative gastric exhanation, 114 |
habits as causes of, 506 ■ |
|
^^^B Degeuei-ative origins of disease, 507 |
degenerative origins of, 506 1 |
|
^^M '* Dcllii bull/ the, 267 |
Disease, hereditary constitutional, 1 |
|
^^^H Delirium tronienB, 349 |
prevention of, t>47 ^^M |
|
^^^H peno<lft of morUility frorn^ 544 |
X>ersonal mle^ for, 647 ^^M |
|
^^^B Delpech, M<, on ai-senic T>oiboning, |
Diseases, inherited ideas of. 19 ^^H |
|
^H |
progress of recent stndy of, 20 fl |
|
^^^H on cAilion bisulphide, 333 |
curative and preventive art in, 1 |
|
^^^B Delusion, emotiimnl, 477 |
21 1 |
|
^^^^^^ fatal instance of, 478 |
general and local, defined, 26 ^M |
|
^^^^^^ inatanee^ given by Dr. Stokea |
calciilated varieties of, 25 ^H |
|
^^^^r (Baltimore), 479* |
cla^iiic^tion of, 26 ^H |
|
^ Deville, Dr. Aroad^e, remarks on |
origins and caUHeft. 499 fl |
|
^^^B animal poisoning, 290 |
causes in relation to number of. I |
|
^^H Dementia, 183, 484 |
500 1 |
|
^^^B from industrial causes, 621 |
natural and acquired causes, 602 I |
|
^^^B ' ' Demodex f oUiculorum, " in caaea of |
congeniial and hereditaiy ori- fl |
|
^^■^ acne^ 261 gins, 505 fl |
INDEX.
721
Diseases, atmospherical origins, 505
parasitical origins of, 505
zymotic causes of, 506
from weather and seasons, anal- ysis of, 530 Disease, the author's plan for regis- tration of, 684
compulisoiy prevention of, 685 Distention, of the bladder, 217 Dougall, Dr. John (Glasgow), on
zymotic poison, 598 Drainage, house, importance of, 673
town, 679, 690 Dress, escape from lightning shock by wearing crinoline, 274
during pregnancy, 650
of infants, 651
of children, 655
seasonal rules for, 660 Drinking fountains, necessity of, 707 Dropsy, 86
anasarca, 87
acute ansemic, 66
of the joints, 243
of the ovary, 221
percentage of successful opera- tions in, 221
of the pericardium, 130
of the peritoneum, 128
periods of mortality from, 535 Dusts, disease from, 377
irritant, 382
obstructing, 387
poisoning, prevention of, 696 D wight. Dr., on contagion, 589 Dysentery, analysis of deaths from, 531
periods of mortality from, 538 Dyspepsia, 113
alcoholic, 344
industrial causes of, 621 Dysphagia, 111 Dysuria, in pregnancy, 301
Ear, the, 91
diseases of, 194
of the auricle, 195
deafness, 194
of the drum, 196, 196
the Eustachian tube, 197
external meatus, 195
the labyrinth, 198
reflex nervous derangement of, 199
tympanum, 197 Earthenware dust, disease from, 380 Eclampsia, 306
Ecthyma, 260 Ectozoa, 559
diseases from, 576 Eczema, 258
varieties, 259 Electrical conditions of the air, 553
Mr. Hingeston, observations on, 553 I Elephantiasis Arabum, 262 ; Elephantis Grsecorum, or true lep- I rosy, 262 I Elongated uvula, 109 Emotion, accidental diseases from,
instances of, 479 Emotional diseases : —
apoplexy, 477
delusion, and instance of, 477
general syncope, 476
local syncope, 472
melancholy, 477
palpitation of the heart, 473
paiulysis, 477
unsteadiness of the circulation, 475
vascular flush, 474 Emphysema, of the lung, 102
in the cellular tissue, 270 Endocarditis, 130 Enteritis, periods of mortalitv from,
538 Entophyta, 560
diseases from, 579 Entozoa, 559
diseases from, 566 Epidemics, currents of, 449 Epigastric palpitation, 473 Epilepsy, 179
hysterical, 468
hereditary, 513
periods of mortality from, 542 Epileptic vertigo, 179 Epiphyta, diseases from, 579 Epistaxis, 201 Ergotism, forms of, 295 Eiysipelas, 55
varieties, 55
after oi>eration, 436
analysis of deaths from, 531
periods of mortality from, 5S6 Erythema, 251
Sir Erasmus Wilson's definition of, 251
varieties, 251 " Erythema fugax," 474 Esquirol, on diseases of Sympathy,
448 Ether, disease from, 354
fatal cases from, 355
|
^^^^^tS^^^^^^^^^^i^mx^^^^^^^^^^^^^H |
|
|
^^^H EnstachiaD ixxbe^ ol the ear, diEease |
Ferment, as cause of disettg^ 168 ^^H |
|
^^m |
Fever, clasaificatioD of, 28 ^^^H |
|
^^H Evil, Ali^ppo, 203 |
tem[ieratiire denoting^ 29 ^^H |
|
^^^H Ei^Authemaioitit ophthalmia, 1^ |
degiees of, 29 ^^1 |
|
^^^H Exercise, bodilT, in ronnection with |
causes, 30 ■ |
|
^^^H climatic changes, 651) |
Fever, cerebro-erpinal, or tetanoid, -«- M |
|
^^^B mental, in connecticm with cli- |
child)>ed, m ^H |
|
^^^1 matic changea, 660 |
continued, 49 ^^H |
|
^^^H Exhaustion, gastric^ lU |
dandy, denffiie^ 47 ^^H |
|
^^^H mtiscnlar, 233 |
febncnla, 49 ^^M |
|
^^^1 Exophthalmic goitre, 227 |
intermittent, 50 ($tre Ague) ^^M |
|
^^^H ExostosiR, of the car boDcs, 196 |
milk, 56 ■ |
|
^^H of the teeth, 247 |
plague (specific), 50 ^^M |
|
^^^H ExtravaBatioD, 36 |
puerperal, 5(i ^^H |
|
^^^H palmonary, 162 |
relapsing, nr fujniiie, 48 ^^H |
|
^^H Eje, the, ^Ji\ 185 |
remittentf 51 ^^H |
|
^^^H Eje, discaseB of : — |
mippurative, 55 ^^H |
|
^^^H^ abscess, 194 |
typhoid, or enteric, 48 ^^H |
|
^^^^^^ asthenopia, or weak sight, IQl |
typhm^, 48 ^^H |
|
^^^^^K aatigniatiAin, 193 |
yellow, 49 ^^^| |
|
^^^^H cataract, 189 |
FeveV, scarlet, 46 ^^H |
|
^^^^^H of the choroid attii retina, 168 |
anginose, 46 V |
|
^^^^^^H color blindness, 192 |
doubtful, rtmtiia idiapathiet^^ 47 U |
|
^^^^^H of the conjunctiva. 185 |
malignant, 47 ■ |
|
^^^^^H of the coi-nea, 187 |
rheumatiL% 47 f |
|
^^^^^H of the cr^'statline lenB, 189 |
simple, r^r acarlatina, 47 ' |
|
^^^^^H day and night blindness, 193 |
Fever, reactive, after lightisixig |
|
^^^^^H heniemlopia, 103 |
shock, 274 |
|
Sir Erasmus Wil5ion on case c^^ |
|
|
^^^^^^H hydrojitlmlmia, 191 |
274 |
|
^^^^H |
Fevers, analysis of deaths from, 5.^^ |
|
^^^^^H lachrymal duct, obatmction of |
perioda of mortalitv fi'om, 5$*^» |
|
^^^^H |
530, 536 ' _ |
|
^^^^^^H myopia, or short sight, 191 |
Fibrine, increase and deorease of. i^ -^ |
|
^^^^^H Dycatalopia, |
the blood, 15(1 |
|
^^^^^H ophthalmias, varieties of, 186 |
Fibrinous deposition, 37 |
|
^^^^^^H presbyopia, or Inng sight, 192 |
Fibrinous deposit, in the heart, 13& |
|
^^^^^H pam^itic cyata, 194 |
in the veins, 144 |
|
^^^^^H proptoHis, 194 ^^^^^^H of the sclerotic coat, 187 |
of the spleen, 228 ^^1 |
|
Fibroid degeneration, 38 ^^^| |
|
|
^^^^^^H strabismus, or sqnint, 194 |
of the heart, 134 ^^1 |
|
^^^^^H |
Filarial disease, 570 ^^1 |
|
^^^^^^H of the vitreonj) bodv, 190 |
Dr. Patrick Manson on, 570 |
|
^^^^H weak sight. |
Di-s. Mackenzie and Gi-anvill^ |
|
^^^^^H pliysieal in juries of, 418 |
on, 572 |
|
symptoms of, 572 |
|
|
Fifih poiRon, 293 |
|
|
^^^H Factobt labor, reviaion of, 699 |
Fissure, in lip, 105 |
|
^^H ** FaUopian tubes," the, 221 . |
of the lower bowel, 125 |
|
^^^H Farcy, 54 |
Fistula, 124 |
|
^^^H Fat, excess of, ou the heart, 133 |
of the bladder, 216 |
|
^^^H Fatty and calcareous dcgeneratiou, |
Flax-dreasers' asthma, 160 |
|
^^H |
Flax-dressing, disease from, 3^ |
|
^^^H and granular, 89 |
Dr. Purdon (Belfast), report 0% |
|
^^^H Fatty degeneration, of the heart, 134 |
384 |
|
^^^H of the arteries, 140 |
Fleuss, Mr., invention for protection |
|
^^^H Farua or ** foreign ring-worm," 42 |
againat gases, 695 |
|
^^^H Feet, deformities of, 413 |
Flour-dust, disease fmm, 88d • |
INDEX.
723
Flnke-wonn, 575
FloHh, emotional vascular, 474
Follicular inflammation, industrial
causes of, 623 Food, nervous derangement from ex- cess of, 490 instfioice of, 491 for infants, 652 seasonal proportions of, 659 necessaiy care in selection of,
668 cooking of, 669
animal, Jewish inspection of, 671 Foreigpi growths, of bone, 241 FramboBsia, 262 Fro8t-bit«, 264 Functional derangement, the term
defined, 41 Functional diseases, of the heart,
137 Fungi, poisoning from, 296 instance of, 296 diseases from, 579 Fungus foot, 266
GaucBLaddbb, diseases of, 210
Ganglion, 237
Gangrene, or mortification, 36
nospital, 55
of the lung, 161
of the teeth, 248 Gases, prevention of injuries from,
694, 696 Gastric exhaustion, 114 Gastric fistula, 121 Gastritis, 111
periods of mortality from, 538 Gastrodjnia, 114 Gastro-enteric irritation, 621 German measles, 46 €k>ut, hereditary taints of, 519 Glanders, 54 Glands, the ductless, 227
parasites affecting, 561 Glandular organs, diseases of, from
alcohol, 351 Glandular system, the, 93, 202, 623 Glandular diseases : —
of the bladder, 216 and stone in, 217
of the breast glands, 225
Bright*s disease, 214 and varieties of, 214
oakmlnSf 217
cirrhosis, 208
of the duct glands, 205
of the ductless glands, 227
Glandular diseases: —
female diseases, 220
the gall bladder, 210
jaundice, 211
of kidneys, 211
liver, 206
of the lymphatic glands, 202
of the lymphatic vessels, 203
male diseases, 21^
of mesenteric glands, 204
of the pancreas, 206
the prostate gland, 218
reproductive organs, 219
salivary glands, 205
of the spleen, 228
of the supra-renal capsules, 229
of the thyroid gland, 227 Glandular system, the, during preg- nancy, 301
operations connected with, 431 Glaucoma, of the eye, 191 Glossitis, 107
Goitre, or ** Derbyshiiie neck,*' 227 Gbnorrfacea, 57 Gonbrrhceal inflammation, 35 Gonorrhoeal ophthalmia, 18& Gk)ut, acute, 60
chronic^ 60
chronic rheumatic, 60
synovial, 60
periods of mortality from, 537 Gk)uty inflammation, 34 Granville, Dr. Mortimer, on filaria,
572 Grease, equinia miiiSy 54 Green sickness, 66 Grinders* asthma, 160 Gross, Professor, on syphilis, 516
on scrofula, 517 Guinea-worm disease, 569
Dr. Spencer Cobbold on, 569 Qtdlet, diseases of, 110 Gum-boil, 248 Gums, the, 106 Gums, diseases of : — .
atrophy, 106
hypertrophy, 106
induration, 106
inflammation, 106
perforation of palate, 106
tumors, 106
ulceration, 106
Habif, immoral, nervous exhaustion
from, 493 Habits, diseases from, 480
of circulation, 480
|
^^^^^ ^^^^^^^^^1 |
||
|
Habits, of digestive srstero, 480 Heart diseases :— ^^^^^^^^^^B |
||
|
of Dervooe system, 482 | degenemtinn, fattr. 134 ^^^H |
||
|
^^^^^^^^^^H|_^i |
Habits, afr caoses of disease, 506 |
degeoemtioxi, 01>roid, IB% ^^^M |
|
Ha>>ilarul, Mr. Alfred, ubstivationn |
dilatation, 1.33 ^^B |
|
|
on .'. -M ...hieal distcibutiaD of |
^r...^^..T fr^t^ 133 ^^m |
|
|
dis. |
ly, 132 ^H |
|
|
Hi.i. . , 113 |
n „ i.H. 132 ^ |
|
|
]? -1% blood'fipitting. 161 |
niptnro, i:i5 |
|
|
kv .-e, 36 |
Heart diseases, of the i^encardiiim. |
|
|
of tiie lower bowel, 125 |
12S1 |
|
|
spinal, 175 |
adhesion, 129 |
|
|
dnrlQR childbirth, 302, 803 |
drojTsy of, 130 lierif^rilitis, 129 |
|
|
^^^^^^^B the utenLH, 224, 435 |
||
|
^^^^^^^^^P Hemorrhoid^, 124 |
Heart diseases, valvular, \-arietieBc£ |
|
|
varieties, 124 |
130 |
|
|
Hair, instance of entire loss of, after |
Hecker, his account of the blaek |
|
|
liglitning' shock, 276 |
death, and daucttig manintit^ 455*, |
|
|
Hair-dust disease, Dr, Cholinelej |
4^ |
|
|
on, 383 |
Heenan, the prize-fighter, an in- |
|
|
Hamberf^, Dr., experimenta in ar- |
Ktnnce of over-traimng, 404 |
|
|
senic iMii^ouiug, 318 Hinnjituiia, 213 ■ |
||
|
Hare lip, 105 |
Hemiph^^iim 176 ■ |
|
|
*• Harvest bug," the, 207 |
Hepatitis, 208 ■ |
|
|
HafleliiEhp Indian hemp extiBct^ dia- |
periods of mortality from, 543 H |
|
|
eaae from, 352 |
Hereditary origins of 'disease, 503. H |
|
|
Hasiiall, Dr. Arthur Hill, on " gro^ 508. 512 ■ |
||
|
cei-s* itch," 267 ; on arBeuie pobon- |
Hereilitari^ causes of disease, 512 ■ |
|
|
ing, 315, 577 |
origin of, in the nervou?* ceutTtt_™ |
|
|
Hay asthma, 150 |
hH |
|
|
Head, physical injuries of, 417 |
special taints, 514 ^^^| |
|
|
Health, a' Ministrv of, neceasarr, 710 |
Hermann, Dr., rejxirt on mercurial^H |
|
|
Heart, tlie, 70, 129 |
jjoisoning in Iiiria, 324 H |
|
|
Heart, diseu^e^ of :— |
Hernia, IIU ■ |
|
|
of tbe endocardium and valves, |
the several forms of, 111> H |
|
|
im |
periods of mtiiiality from, 538 H |
|
|
eiulocarditis, 130 |
Hernial pouches or sacs^ tlij^^^iscs of, H |
|
|
of the coronary arteries, 135 |
■ |
|
|
cvanosis, IM |
Herpes, 258 ■ |
|
|
alcoholic disease of, 3i5 |
varieties of, 258 ^M |
|
|
disease from athleticism, in- |
Hewson, Dr. AddenHl. oliserratto&s H |
|
|
Btanee of, 40*3 |
on meteorological causes of dis- H |
|
|
emotional internjittency of, 471 |
ease, 552 H |
|
|
and instance of, 471 |
Hibbert, Mr, instance of sympa- H |
|
|
palpitation of, 473 |
t lie tic convttbion recorded by, 461 H |
|
|
dtiseiiBe of, frcrm habits, 481 |
Hingeston, Mr. (Brighton), on dec- H |
|
|
periods of mortalitv from, 539, |
trieal conditions of the air» 553 H |
|
|
622 |
•* Hodgkin^s disease,** 229 ^^M |
|
|
Heart diseases, functional, 137 |
HomcsteodK, 708 ^^^H |
|
|
fibrinous depositj* in, 139 |
Hospital gaugi-ene, 55 ^^^| |
|
|
intermittent ai-tion, 138 |
Hos])italH, for infectious cascvi, cf g-^^B |
|
|
irregular action, 137 |
gestiouH as to, 682 ^M |
|
|
Bpasm, 137 |
House refuse, removid of, 681 ^M |
|
|
synrope, 137 |
House ventilation, 701, 703 H |
|
|
Heart diseases, organic, 132 |
»* HouaenmidV knet?/* 237 H |
|
|
abscess, 132 |
Huddles, Professor, value of his »a* H |
|
|
acute aneurism, 135 |
diometer in ear diseane, l^ti S |
|
|
^^^^^^^^^H 135 |
Hatcliinson, Mr. Jonathan, on sypli- J |
|
|
^^H^f |
atrophy, 133 ' |
ihtic taint in the teeth, 616 ^^^| |
INDEX.
725
Hydatid disease, 574 Hydi'ocephalus, periods of mortality
from, 541 Hydrochloric acid, 337 Hydronephrosis, 215 Hydrophobia, 57
periods of mortality from, 536 Hydrophthahnia, of the eyeball, 191 Hypei-inosis, 150 Hypertrophy, or enlargement, 87
of the bladder, 217
of bone, 241
of the brain, 173
of the breasts, 225
congenital, 511
of the gums, 106
of the heart, 132
of the kidneys, 214
of the lymphatic glands, 203
muscular, 233
of the nose, 200
of the spleen, 229
of the throat, 109
of the tongue, 107
of the uterus, 223 Hypochondriasis, 182
in pregnancy, 300 Hysteiia, symptoms of, 465
forms of, 468
supernatural beliefs under, 469 Hysterical ansesthesia, 466 Hysteiical automatism, instance of,
466 Hysterical convulsion, fatal case of,
467 Hysterical emotion, disease from,
465 Hysterical hypersBsthesia, 466
ICHTHYOSIB, 257
congenital, 511 Icterus, 211
Idiotc:r> 1^ Imbecility, 184 Imitative diseases, 458
convulsionism, 461
dancing mania, 458
hysteria, 458
leaping ague, 461
muscular contraction, 463
paralysis, 462
pulmonary consumption, 462
St. John's dance, 459
St. Vitus's dance, 459
secourism, 461
suicide, 164
sympathy, 461
Imitative diseases, tarantism, 460
tegretier, 460 Immoral habit, nervous exhaustion
from, 493 Impetigo, 260
Induration, of the gums, 106 Industrial asthma, 159 Industrial causes of disease, classi- fication of, 621 Industrial origins of disease, 624 Industiial phthisis, 164 Inebriety, following mental shock, 453
instances of, caused by panics, 455
classes subject to, 455 Infancy, rules during, 649 Infants, errors in' feeding, 632
directions for feeding, 652
the nursery, 653 Infected rooms, cleansing of, 678 Inflammation, symptoms of, 33
changes caused by, 34 Inflammation : —
bone, 239
of the brain, 170
of the breasts, 225
of the cellular tissue, 269
congenital, 511
of the ear, 195
of the eai* drum, 196
of the epiglottis, 154
of the gr^ms, 106
gouty, 34
p^onon'hoeal, 35
industrial causes of, 623
of the lungs, 160
of the lymphatic glands, 202
muscular, 231, 234
pyremic, 34
rheumatic, 24
rheumatic, of the teeth, 249
scrofulous, 35
spinal, 175
of the spleen, 228
svphilitic, 35
thyroid gland, 227
of the tympanum, 198
of the uterus, 222
of the veins, 143 Influenza, 53
analysis of deaths from, 531 I periods of mortality from, 536 ! Inoculation, venomous,* 289
instances of, 290, 684, 689 I Insanity, from alcohol, 350
Prof. Shepherd's report on, 351 ' periods of mortality from, 542
|
^^V 736 IHDEX. ^H |
|
|
^^H Insect atings, 289 |
Jackbon, Dr, Hughlings^ on syphi^-J |
|
^^^H Insomnia, or sleeplessness, 48B |
Utie tendencies, 515, 516 ^^M |
|
^^^H Intermiiteut action, of the heart, 138 |
Jaundice, 211 ^^M |
|
^^^H IntertTigo, 252 |
analysis of deaths from, 531 |
|
^^^H Intestinal spasm, I^ |
periods of mortality from, 543 |
|
^^^H Intestines, 116 |
Jaws, the, diseases of, 246 |
|
^^^B chronic affections of, 118 |
abscess, in the antrum of, 246 |
|
^^^^^^H physical changes of, 118 |
tumor, in the antrum of, 246 |
|
^^^^^^H diseases of :— abscess, of the |
Jeffries, Dr. B. Joy, definition o£ |
|
^^^^^H lower bowel, 123 |
color blindness,* 191 |
|
^^^H |
Jelly-fish, Btiug of, 289 |
|
^^^^^^H constipation, 123 |
Jenner, Dr., introduction of vaeci. |
|
^^^^^H dian hcea, vaiietiea of^ 122 |
nation by, 686 |
|
^^^^^H dysentery, 117 |
Jews, absence of epidemics amoOfc,.,^ |
|
^^^^^H enteritis of, 116 |
522 j^M |
|
^^^^^H fiasnre, 125 |
Joints, the diseases of, 242 :~ ^H |
|
^^^^H fistula, 118 |
abscess, 242 ^^H |
|
^^^^^1 of the lower bowel, 124 |
ankylosis, 243 ^H |
|
^^^^^^H fecal abHcess, 118 |
ulcemtion of cartiloi^es, 242, 24^^H |
|
^^^^^K hemorrhage, 118. 125 |
deformities of knee-joint^ 244 ^^M |
|
^^^^^H hemon-hoids, 124 |
dropsy of, 243 |
|
^^^^^H and varieties, 124 |
relaxation of ligaments, 243 |
|
^^^^^^H hernia. |
spinal curvature, 244 |
|
^^^^^^H and varietie4^, |
synovitis, 242 |
|
^^^^^H injurieK to the lower bowel, 127 |
|
|
^^^^^^H internal stranpilation, 119 |
|
|
^^^^^^H intUKAnseeption, IVJ |
Kbltic races, diseases affecting, 522 |
|
^^^^^H |
Keratitis, of the cornea, 187 |
|
^^^^^H nenral^u, 12fi |
chiHinic, 187 |
|
^^^^^^B paralysis of, 122 |
with 6upi>nration, 187 |
|
^^^^^^H jmi-aaitie dineo^e^ 121 |
Kidneys, the diseases of, 211 |
|
^^^^^H and of the lower bowel, 126 |
Bright'sdisei^e, varieties of, 2U |
|
^^^^^H x*^>'f<^^^^^^^'^i^< 1^^ |
chronic inflammation of, 214 |
|
^^^^^^H 125 |
congestion of, 213 |
|
^^^^^H pruritis, |
hfematnria, 213 |
|
^^^^^H Bpasm of the sphincter, 126 |
hypertrophy, 214 |
|
^^^^^H and varieties, 126 |
nephritis, 213 |
|
^^^^H Btrictnre, |
periods of mortality from, 548 |
|
^^^^^H andTarieties of, 118 |
Knee-joint, deformities*' of, 244 |
|
^^^^^^H of the lower l>owel, 12B |
Krenser, Dr, (Stuttgoii), refiort on |
|
^^^^^^H tenesmus, 126 |
aniline, 367 |
|
^^^^^H |
Kuhlniann, M., experiments to |
|
^^^^^^H and in the lowel bowel, 126 |
chemical vapors, 695 |
|
^^^^B typhlitis. |
Kyphosis, spine defonnity, 244 |
|
^^^^^H 118 |
|
|
^^^^^^" and of the lower bowel, 123 |
|
|
^^^■^ I ntussuseeption, of the inteatines, 119 |
LArHBTMATj dnct, obstruction of, 193 |
|
^^^H }>enocU of moiiality from, 5;i8 |
Laceration, of the stomach, 1 13 |
|
^^^H IHs, the diKcases of, 188 |
Land scurw, 65 |
|
^^^P Irritants, mechanical and chemical, |
Lardaceous' amyloid, or waxy degen- |
|
^HT |
eration, 38 |
|
^^■^^ Initation, definition of the term, 31 ! |
Lmngitis, Inflammation of the |
|
^^^^^^L distinct results of, 32 |
larynx, 38 |
|
^^^^^V ekin, from parasites, 265 ' |
periods of mortality from, 539 |
|
^ periods of mortality from, 533 |
Laiynx, the, 154 |
|
^^K Itch, 267 |
growths in, 155 ^i |
|
^^^K < *' grocerB*/' 267 |
inflammation of, 154 ^^H |
|
"""] |
'^TX.
727
! Ill M/i)io, 'Myj
■■..l!i*-;l, 1S7
. :-:i-- llMlll, lM)Ct
■.. ■: /,\ lun.siK, (505 . l» ... «'X]M'iiiiu*iit8 on tnr-
■ '. Ujiul', 'M'-i
' ■ . ! '. vr fixation of, 243
..: ■ iiii-. sluM'k, 27.*{ ,i i-i.xv t'rniii, 274
i'i!!iilin»ss after, 275
.Mtiilrpsy from, 275
I'liiviilsioiis from, 275
ilrath of Trofeaaor Beicbman from, 276
ill stance of enoape from, by wear- in*^ ciiiioliiiey 274
external injarios from, 275
Franklin and, 273
instance of entire loss of hair from, 276
imralvHis from, 275
reactive fever, 274 Tiinib, deformities of, 413, 623 Lip, cancer of, 105
cysts, 105
tissure, 105
liare, 105
ulcer of, 105 Liver, tbe, 206
diseases of : — atropby, 208
cirrhosis, 208
congestion of, 207
degeneration of, 208
fatty degeneration of, 209
hepatitis, or inflammation of, 208
lardaceons liver, 209 Local syncope, emotional, 472 Locked jaw, tetanus, 178 Locomotor ataxy, 177
■ i'lv-r-houses, 708
■ i .-IS, 11 spinal curvature, 245
I. I-:- <\'Ah\, V.i'2 I . i!;.l'rit-.»i»l disease, 568 I.iii'.i: .st nu-tiire, the, disease of: — ir.u
absfess of, 160
u]K)j)lexy, 162
utelttctosis of, 163
einliosis, 162
en)i>liy8ema, 162
pm^reue, 161
luenioptysis, 161
inflammation of, 160
uidoma, or droj^sy of, 162
pneumonia, 160
l)ulmonary congestion, 161
pulmonary extravasation, 162
spitting of blood, 161 Lungs, the, 80
asthmatic diseases of, 158
alcoholic diseases of, 346
action of wind instruments on, 391
parasites affecting, 561
consumption of, 582
periods of mortality from disease of, 541 Lupus, 63
chronic, 63 I excedcns, 63 Lymphatic fistula, 204 I Lymphatic vessels, diseases of, 203
Mackenzie, Dr. Stephen, on filaria, 572
Madura foot, skin disease, peculiar to Madura, 266, 578
Malformation, of organs, 40 spinal, 176
Malfonuations, congenital, 508
Malignant disease, of the lymphatic glands, 203
Malignant jmstule, charbon, 54
Mania, acute and' chronic, 182 during pregnancy, 300 a form of hysteria, 4(58
Manson, Dr. Patrick, on filarial dis- ease, 570
Mature life, rules for, 658
McDonnell, Dr., his suecesst^s in operating on ovarian tumors, 221
Mead, Dr., experiments on viper poison, 287
Measles, analvsis of deaths h
5;n
XK'riods of mortality from, 6
|
^^M 728 ^ INDEX, ^H |
|
|
^^H MeaaleB, morbim, 46 |
*♦ Microsporon furfur," a idtin pank- |
|
^^^B German, rdtMin, rubeola, 46 |
site, 265 |
|
^^^H Mediai^ical affections, of the uteruA, |
** Microsporon mentagraphTtes,** 26S. |
|
^^m |
Miliaria, 257 |
|
^^^B Mediastinum, the, diBoases in, 1(16 |
Milk, want of, periods of mortali^^ |
|
^^^^^ aba^t^ss, 166 |
fri>m, 544 |
|
^^^^^H caneeiv 166 |
Milk fcyer, 56 |
|
^^^^^V 8Uii]>l6 tumor, 166 |
Milk secretion, 225 |
|
^^^V Merlieul ollicer of health, necesBoij |
Milk Ntqiply, su|)ervision of, 681 ^^B |
|
^^^H power of. 705 |
Milleit^' astlima, 160 ^H |
|
^^^H Meigh, Mr. J., inventor of the |
Milner, Mr. (WakeHeld), obser^i^^H |
|
^^^1 eai-thenware glaze, 693 |
tions on influence of beusonii, 52^^^H |
|
^^^B Melancholia, 183 |
Miners* asthma, 160 B |
|
^^^B from alcohol, 350 |
MtchelJ, Dr. Arthur, abstract of | |
|
^^^B Melancholy, emotional, 478 |
weather and season influe-Dce hr, 1 |
|
^^H MeliiHma, 265 |
533 1 |
|
^^^H ** Mel&sma Addiaoui,** Addison's dis- |
Mitchell, Dr. Weir, researches oo 1 |
|
^^^B* case, 229 |
spinal congestion. 175 1 |
|
^^^H Menil>i-ano, the mneons, 09 |
Mofiatt, Dr*, observations on met«<^^^B |
|
^^^1 MemVimnoUH BYsteni. the, 98 |
ro logical changes and disease, 51}6^^| |
|
^^^H diftea.«iitH of 250 |
MolUties rwisiuni, bone softening. t24d^^B |
|
^^H {see Skin Diseases), 623 |
Molluscum, 263 ■ |
|
^^^H Menstniation, vaiieticB of, 223, 224 |
Moral agencies, disease frona^ 448, 1 |
|
^^^H Mentagra, 261 |
450 1 |
|
^^^H Mental agencies, diseofie from, 443 |
Moral snrroundingTS, as ciiiise of dia-^^J |
|
^^^H lark of stud J in, 445 |
ease, 632 ^H |
|
^^^B Mental diHease, of inebriates. Dr. |
Dr. George M. Beanl on, 683 ^^B |
|
^^m Crotlu'i^ (U. 8.) on, 444 |
MorViitl depositfi, in the vitreous B boily of the eye, 190 ^J |
|
^^^^^^ Mental shock, rebults of, 450 |
|
|
^^^^^^K acquired diRea.so from, 453 |
MorewcKid, Dr., on ether poisoniiig^^^B |
|
^^^^^^f exliaustion from, 456 |
355 ^^1 |
|
^ Mental sh-ain, nervous exhaustion |
Morphia, injection of, 357 ^^B |
|
^^H from, 486 |
Morti6cation, or gangrene, 36 ^^H |
|
^^^H Mental training, dangers of, 486 |
l^eriods of mortality from^ 534 ^^| |
|
^^^H Mental work, adyantages of, 446 |
Mouth and tongue. 105* ^^| |
|
^^^B |)hyKical dinease from, 446 |
diseases of ;— aViscess, 106 ^^M |
|
^^^B Mercurial tremor, industrial causes |
canker, c*incf*wn om, 106 ^^H |
|
^^m |
cyst, 106 ^H |
|
^^^B ^lercnrj poison, fatal case fi^om, 323 |
ranulu, K)6 ^^B |
|
^^^B Dr. Hermann's report on the |
stomatitin, 105 ^^H |
|
^^^H mines of Idi-ia, 824 |
stomatitis foiliculiir, 105 ^^H |
|
^^^H Mesenteric dii^eane, periods of mor- |
KtomatitiH tdcemtiye, 105 ^^B |
|
^^H tality from, 537 |
stomatitis yesieular, 105 ^^H |
|
^^^B Mesenteric glands, the, diseases of, |
thmsh, 105 ^H |
|
^^B 204 |
Mnguet, from industrial caoses, 021 ■ |
|
^^B ** Mesnier's di^eaise,'' 199 |
Mumps, 53 ^^B |
|
^^^B Meteorological causes of disease, 524, |
IVltiscie ^'olitantes, 188 ^^H |
|
^^^L 546 |
l^lucous membrane, the, 99 ^^H |
|
^^^^^K Dr. Addenill Hewson*s reports |
MuHcnlar conti^action, persistent, im-^ B |
|
^^^H |
itative cafte of, W] M |
|
^ Dr. Moffatt on. 556 |
Muscular system, the, 96. 023 ^H |
|
^^^H Mete(mAo(fif in rehUion to Surgical |
tli scales of, 231 ^^M |
|
^^^B Practihe, author's researches cm. |
contmction of tendons, 235 ^^B |
|
^H 552 |
chib-hand, 236 ^H |
|
^^^B Methylene bichloride, in operations, |
club-foot, 23«» ^^ |
|
^^m |
dt-^eneration of the organs, 233 B |
|
^^^B " Microsporon Audouini," a skin |
structure of the, 231 ^^J |
|
^^^B parasite, 265 |
t&lipes, 235 ^H |
INDEX.
729
Mascnlar s^tem, the, tendons of, 284 operations on, 432 parasites affecting, 562 overwork and strain of, 400 of the appendages of, 236
Muscular strain, disease from, in mature life, 406
Mussel poison, 294
Mycetoma, 266
Mycroderms, diseases from, 579
MyeUtis, 175
Myers, Dr., on filarial disease, 571
Myocarditis, 132
Myopia, or short sight, 191
N^VUS VASOUIiABIB, 145
Nails, the, diseases of, 268
Natural decay, 48
Nausea, from industrial causes, 621
Neck, injuries of, 419
Necrosis, of the ear, 198, 240
of the teeth, 247
Prof. Laurie's definition of, 240
from industrial causes, 628 Nematode, or round worm, diseases
from, 566 Nephritis, 218
Nephrosis, industrial causes of, 623 Nerves, the, 84
Nervous derangement, from over- feeding, 490
instance of, among convicts, 490 Nervous diseases, periods of mortality
from, 542 Nervous exhaustion, from mental strain, 486
from secret habit, 493 Nervous failure, mental, 484
physical, 482
from sloth, 488 Nervous or neuro hypothesis, 605 Nervous system, the, 83
alcoholic diseases of, 347
diseases of, 167, 621
operations connected with, 429 Nervous impressional taints, 520 Nettle rash, 252 Neuralgia, during pregnancy, 299
from industrial causes, 621
of the lower bowel, 126
varieties of, 182 Nipple disease, 225 Nitric acid vapor, 338
deaths from, 338 Nitro-benzole, disease from, 369 Nitrous oxide, 355
use of, in operations, 437
Nodes, 240
"Nomenclature of disease," report of Committee of the Boyal College of Physiciims on, 25 Nose, the, 200
diseases of : — acne rosacea, 200
epistaxis, 201
hypertrophy, 200
impairment of sense of smell, 35
ozcena, 200
polypus, 201
sebaceous cysts, 200
septum of, 201
ulceration of the membrane, 200
warts of, 200 Xursery, the, directions for, 653
OBSTBUcnoN, in the veins, 144 Occlusion, of the ai-teries, 140 Occupation, in relation to disease,
624 (Edema, of the glottis, 155
of the lung, 162 CEsophagitis, 110 CEsophagus, or gullet, the, 110
strictures of, 110
ulceration of, 110 Ogston, Dr., observations on disease
from paraffin, 370 Oidium albicans, cases of poisoning from, 580
Prof. Laycock on, 579 Old age, rules for, 713 Operations, surgical, 425 Operations, on the circulatory sys- tem, 427
connected with digestive system, 426
glandular system, 431
muscular system, 432
nervous system, 429
osseous system, 432
respiratory system, 429
skin, 433
cachexia following, 436
eiysipelas from, 436
hemorrhage from, 435
shock from, 434 Ophthalmia, chronic, 186
exanthematous, 186
gonorrhoeal, 186
purulent, 186
of infants, 186
pustular, 186
stiiimous, or scrofulous, 186
from industrial causes, 628 Opium, disease from, 856
|
1 |
730 INDEX. 1 |
|
|
^H |
1 Organic chang^e, in the TBflctUar |
Fartarition, &£Fections codhmIi^^I |
|
^^^^1 |
K fijHUim, 148 |
with. 302 I |
|
^^^1 |
H ID labyrinth of the ear, 11*8 |
Pasdona, the, diaeaae irDm, 470 1 |
|
^^^^ |
Organic disea^sea, of the heart, 132 |
Pearce, Nathaniel, on the disease 1 |
|
^^^H |
Origins of disease, 5t»U |
tegretier, 460 J |
|
^^^H |
Osseous, the, or bony sy8tem, 97, 623 |
Pearl dnst, disease from, 380 ^J |
|
^^^H^ |
diseases of, 288 |
foreign authorities on, 381 ^^^ |
|
^^^1 |
^H of bone and periosfceiim, 239 |
•* Pediculus capitis," the^ 2(J7 ^H |
|
^^^^1 |
B jaws, 24<3 |
Pellagra, districts subject to, 253 ^M |
|
^^^1 |
H of the jointi), 242 |
Pemphigus, varieties of, 259 ^^ |
|
^^^^1 |
^H epiQal oiirvainre, 244 |
Perforation, of the ear dnim, 197 1 |
|
^^^1 |
^H of tUe s]>iue. 244 |
Pericarditis, 129 1 |
|
^^^1 |
H the t«eth, 24G |
j>eriod8 of mortality from, 53D 1 |
|
^^^1 |
^r operations on, 432 |
Periosteum, the, M. * Oilier 'a i^ ^1 |
|
^^^^f |
Osftitieation, 38 |
searches in, 238 ^^B |
|
^^^H |
Ostitis, or bone in fiammation, 239 |
Periostitis, 239 ^H |
|
^^^H |
Ovarian dropsy, 221 |
Peritoneum, the, 127 ^^M |
|
^^^H |
Ovai-ies. the, diseases of, 220 |
dropsy of, 128 ^H |
|
^^^H |
Oyster poisoning, case of, 294 |
injuries to, 128 V |
|
H |
Oztena, 200 |
peritonitis, and rarietiee, 127 J tumonB of, 128 ^^1 Peritonitia, 127 ^H |
|
^^^H |
Pat. ATE, perforation of, 106 |
forms of, 127 ^^M |
|
^^^1 |
Palpitation of the heart. 137 |
Phagedtena, 54 ^^M |
|
^^^H |
emotional, of llie heart, 473 |
slouching, 55 ^^M |
|
^^^1 |
of the stonmelj, inntauce of, 473 |
PhaiyngitiH, 11(» ^^1 |
|
^^^H |
Paky, shaking, 172 |
Phar^Tix, the, 110 ^^H |
|
^^^H |
Pals'v. 17tJ |
abscess in, 110 ^^| |
|
^^^H |
*** writer's," 177 |
pharyngitis, 110 ^^M |
|
^^^H |
Pancreivs, the, diseases of, 206 |
tumoi-s, 110 ^^B |
|
^^^H |
PamlHn, di^ejiHe Srmn^ 37U |
ulcer of, 1 10 ^^B |
|
^^^H |
Paralysis ajtritans, 172 |
Phillips's, Sir Richard, MiUkm <f 1 |
|
^^^^ft |
ParaJysis, emotional, 477 |
Facts, referred to, 688 1 |
|
^^^1 |
H of the intestines, 122 |
Phlebitis, of the veins, 144 | |
|
^^^1 |
^1 after Hghtuiog *ihock, 275 |
Phlebolites, 145 ^J |
|
^^^1 |
^B mnsenliir, 232 |
Phlegmasia dolens, 144 ^^1 |
|
^^^^1 |
^m from nervoiin failure, 483 |
Phosphorus, disease from, 338 ^^M |
|
^^^^ |
■ spinal, 170, 177 |
Phn^iriufiis, 576 ^^m |
|
^^^1 |
^P of the tongue, 107 |
Phthisis, 164 ^H |
|
^^^^1 |
in the vaaenlar system, 147 |
acute miliary, 164 ^^M |
|
^^^B |
ParalvHis, rocoveiy ' fri>m, through |
acute pneumonic, 164 ^^M |
|
^^^^1 |
H flight, 462 |
alcoholic, 164 |
|
^^^1 |
^1 ]>eriod9 of mortality from, 542 |
chronic pneumonic, 164 |
|
^^^^1 |
^ industrial caa843tj of, 621 |
indnstrial, and varieties of, 164 |
|
^^^H |
Paraplegia, 177 |
pulmonary, 163 |
|
^^^H |
Parasites, as eanses of disease, 56U |
tubercular, 163 |
|
^^H |
elassilieation of, 5»UV5<j5 |
periods of mortality from, 540, |
|
^^^H |
in conueetion ^ith disease, 559 |
550 |
|
^^^H |
vegetable, 57H, 586 |
death-rate from, in the British |
|
^^^H |
ParftHitic conditions, causes of, 41 |
ai^ray and navy, 558, 622 |
|
^^^H |
Parasitic cysts, of the eye, lfJ4 |
from industrial causes, tJ22 |
|
^^^B |
Famsitic disease, of the in testines, 12 1 |
Phthisis jmlmoiialis, parasitic origin |
|
^^^^1 |
K of the lower bowel, 126 |
of. 682 |
|
^^^1 |
^M miiscuhir, 233 |
from cold, 584 |
|
^^^1 |
H of the skin, 265 |
Phvsical disease, from mental strain, |
|
^^^^1 |
^ of tlm stomach, 113 |
446 |
|
^^^P |
Parasitical disease, origins of, 505 |
Phvsical injuries, acquired diseaaea 1 |
|
H |
prevention of, 668 i |
from, 416 1 |
|
: i |
I |
J |
INDEX.
731
Physical nervous failure, 482 Physicians, Boyal College of, report of committee of, on the nomencla- ture of disease, 25 Pigmentation, 39 Pityriasis, 255
subjects liable to, 256 Pityriasis versicolor, 266 Placenta, or afterbirth, the, 804 Plastic inflammation, 35 Pleura, the, diseases of, 164
adhesion, 165
dropsy of, 165
empyema, 165
hydiothorax, 165
inflammation, 165
ossification of, 165
pleuritis, 165
pneumothorax, 166
thickening, 165 Pleurisy, periods of mortality from,
540 Pleurodynia, 182
Plique, skin disease, peculiar to Po- land, 266 Pneumonia, of the lung structure, 160
periods of mortality from, 540 Poison, of the blood, 152 Poisoning, from fish, 293
vegetable, 295
from fungi, 296
lead, prevention of, 692
from gases and vapors, 694 Poisonings, natural, 280
developed in the body, 284
from inoculation, 289
post-mortem, 289 Poisons, inorganic, 315
ammonia gas, 331
arsenic, 315
bichromate of potassa, 824
cadmium. 319
carbon bisulphide, 332
carbonic oxide gas, 333
chlorine gas, 335
copper, 330
copper smoke vapoi*s, 336
cyanide of potassium, 327
hydrochloric acid, 337
lead, 319
mercury, 322
nitric acid vapor, 338
phosphorus, 338
resin vapor, 340
salts of silver, 329
sodium chloride, 329
sulphuretted hydrogen, 341
Poisons, inorganic, sulphurous acid 340
zinc, 329 Poisons, organic, 343
absinthe, 343
alcohol, 343
aniline, 366
cannabis indica, 352
chloral, 353
chloroform, 354
cocculus indicus, 366
coffee, 365
ether, 354
mixed vapors, 873
nitro-benzole, 369
nitrous oxide, 355
opium, 356
paraffin, 370
soot, 372
tea, 363
tobacco, 357
tobacco smoking, 359
turpentine vapor, 372 Polypus, of the ear, 196
of antrum of the jaw, 246
of the nose, 201 Pompholyx, 259 Pomfick, Professor (Breslau), on the
parasite actinomyces, 582 " Post-boys' " disease, 143, 398 Potassium cyanide, diseases from,
327 Potters' asthma, 160 Power, Dr., 563 Pox, small, varieties of, 45
chicken, 45
cow, 45 Pregnancy, diseases during, 297
of the circulatory system, 298
of the digestive system, 297
of the glandular system, 301
hypochondriasis, 300 •
of the nervous system, 299
of the respiratory system, 298
of the uterine system, 301 Preg^nancy, mles during, 649 Premature birth, 306
periods of mortality from, 544 Presbyopia, long sight, 192 Privation, periods of mortality from,
544 Prolapsus, of the lower bowel, 125 Proptosis, of the eye, 194 Prostate gland, diseases of, 218 Prurigo, 254
Pniritis, of the lower bowel, 127 Psoriasis, 256
varieties of, 256
|
n |
732 ^S^^^ INDEX ^^^^^^^^^M |
|
|
PsTchical cflnseft ot diswise, 50fi |
Reproductive glands iiiil^^^^^^^| |
|
|
FsVchical origins of distn^He, 628 |
mei'lianiciLl aiTectionsof the q^^^| |
|
|
Pnerptiml con\'ulsion«, 3iK5 |
222 ^^B |
|
|
Pueii>era] epht^mera, 56 |
menstruation, 223 ■ |
|
|
Puei-peml fever, 56 |
and the several forma of, 224 S |
|
|
periods of mortality from, 536 |
of the ovaries, 2*20 ■ |
|
|
iifl |
Pnerperal mauia, 306 |
of the spermatic cord^ 220 ^ |
|
*' PiUex/' the. or ** chigoe/' 267 |
of the testes. 219 fl |
|
|
PuiuiraiaiT coDKefttiou, 161 |
tiunors of the uterus, 223 H |
|
|
l^iilmLinary cousniuijtion, case of, |
ulceration, 222 H |
|
|
ii^^^l |
from imitation, 4«>2 |
of the uterus or womb, 221 H |
|
Pulmonary extravasation, 162 |
the vagina, diseases of, 223 H |
|
|
Pulmonary phthisis, ll>i |
Resin ^upor, 340 H |
|
|
PnrdoD, l5n (Belfast), report on flax- |
Respiratx^iy system, the* 80, 153 H |
|
|
dre8«in^5 disease, 384 |
dieeases of :-— asthma, 158 H |
|
|
Puri>iiru» ti5 |
bronchitis, 156 ^M |
|
|
hemorrhagic, 05 |
crouj), 153 ^^B |
|
|
aimpl*?, 05 |
of the larynx, 154 ^^H |
|
|
^^^^^^^^^^^M penoils of luortjilitT trom^ 537 |
lung ijtructuiQ, 160 ^^H |
|
|
^^^^^^^^^^1 Ptmilent ophthalmia, 1H6 |
of the mediastinum, 166 ^^H |
|
|
^^^^^^^^^1 |
nasal catarrh, 153 ^M |
|
|
Pnatula ophthalmia, 180 |
pleura, 164 ^M |
|
|
Pytomia, 55 |
pulmonary affections, 166 ^M |
|
|
Pya?mie inflammation, 34 |
pulinonaiy phthisis, 163 H |
|
|
Pyrosis, 114, 621 |
Respiiatory system, the, dunn^| prt^gmmcy, 298 ^M |
|
|
Quinsy, 109 |
opemtions connecled iiith, 42$lH 622 H Retinitis, or inBammation of tlifl retina, 188 ^M |
|
|
analysia of deaths from, 531 periods of mortality from, 538 |
||
|
Rheumatic inflammation, 31 ^M |
||
|
Kacial heredities, 522 |
Rheumatic taints, heredilury, 519 ^M |
|
|
Rag dnst, diaoase from, 385 i |
Rheumatism* acute, 59 H |
|
|
Raflway travelliuj?, *?ffe<Tt>i of, 395 |
clironic, 60 ^^^B |
|
|
Ram<illii5nient, or softening of the |
gonorrhceaL. 59 ^^^M |
|
|
brain, 171 |
muscuhir, 60 ^^^H |
|
|
Ranula, in mouth, KMi |
Bub-acute, 59 ^^^B |
|
|
Recreation j^^^rutmds, 708 |
syno\nal, 60 H |
|
|
Red fauih *^i^ |
jxmods of mortality from, 537 S |
|
|
ReRiatration of disease, author's plan |
Rheumatism, mercurial, industriat M |
|
|
for, 684 |
caut^H of. <;21 j^^H |
|
|
Retchman, Profeasor, death of, Aug. |
Rickets, 64, 241 ^^M |
|
|
6, 1753/ 276 |
Ringworm, 265 ^^^H |
|
|
Relaxed thi-oat, 109 |
'* ' foreign." 265 ^^H |
|
|
Remittent fever, analysis of deaths |
Rornla* public, care of, 708 ^^^B |
|
|
from. 531 |
Rolierton, Mr. (Manchester), cm foooH |
|
|
Rennie, Dr., report on disease of |
excess^ 493 ^M |
|
|
convicts at Freemautle, 4V>1 |
Rodent ulcer, 63 ■ |
|
|
Repro*liietive glands and organs, the, |
lioneok, varieties of, 252 H |
|
|
diseases of, 219 |
Rouge dust, dise4&se from, 388 H |
|
|
abrasion of the uterus, 222 |
Rowing, effect of, ou the muacnkrH |
|
|
apjiendages of the uterus, 223 |
system, 404 ^M |
|
|
of breast glands, 225 |
Royal College of Physicians, rppor^^f |
|
|
catarrh or leuoorrhcea, 222 |
of Committee, on Domenclatuiv af ^^ |
|
|
dropsy of tlie ovarv, 221 |
disease, 25 H |
|
|
hemorrhapfe of the" uterus. 224 |
Running, effects of, 404 H |
|
|
hypertroiiiiy of the uterus, 223 |
Hupia, varieties of, 250 ^M |
|
|
indainmation, 222 ^ |
Rupture, of the heart, 13$ ^^H |
INDEX.
733
Baptnre, of an arieiy, 143 during childbirth, 3(U
Sabcina, the parasite, 580
Dr. Tilbury Fox, on, 580 St. Anthony*s tii*e, 55 St. Clair, Dr., treatment of cases of
sympathetic convnlsion, 461 St. John*s dance, Becker's account
of, 459 St Vitus' dance, 180
outbreak of, at Strasburg, 459 Salivary calculus, 206 Salivary glands, the, 205
irritation of, ' from industrial causes, 623 Salts of silver, disease from, 329 Sand and glass dust, fatal case of in- halation of, 378 Sanitaiy authorities, local, sugges- tions as to, 667 "Sarcoptes scabiei,** the, a skin
parasite, 41, 267 Saxon races, tendency to scrofula in,
522 Scabies, or itch, 267
epidemic character of, 267 ; 578 Scalds, 423 Scarlet fever, **Febris rubra," 46
analysis of deaths from, 581, 614 Schools, inspection of, 708 Sciatica, 182 Scleroderma, 263 Sclerosis, of the brain, 171 Sclerotic coat, of the eye, disease of,
187 Scrofula, 63
hereditary, 517
in Saxon races, 522
periods of mortality from, 537 Scrofulous inflammation, 34 Scrofulous ophthalmia, 186 Scrotum, the, 220 Scurvy, 65
land, 65
sea, 65
periods of mortality from, 537 Sea-sickness, after effects of, 397 Seanon in Relation to Disease, 532 Seasonal changes, rules for, 661-663 i Seasons, influence of, on healthy | persons, 526
as causes of disease, 530
preventive rules for, 659 Sebaceous cvsts, of the no«e, 200 Sedgpsrick, l)r. Leonard, on arsenic poisoning, 319 ; 563, 579
Semitic races, hereditary cancer
among, 522 Senile, or natural decay, 43
periods of mortality from, 534 Senile degeneration, 636 Senile degenerative origins of dis- ease, 506 Senile diseases, prevention of, 712 Sense organs, diseases of, 185
parasites affecting, 561 Sensory system, the, 89
industrial causes of disease in, 623 Septum of the nose, diseases of, 201 Sepulture, rules for, 709 Sewage, removal of, 679
suggestions as to, 679 Shaking palsy, 172 Shepherd, Vtot Edgar, report on
alcoholic insanity, 350 Shetland Islands, convulsive disease
in, 449 Shingles, or Herpes zoster, 258 Short sight, 191 Sick, the, treatment of, 676
removal of, 677 Sight, weak, 191
short and long, 191 Siguatera, fish poison disease, 293 Slun diseases : —
acne, 261
acrod^ia, 254
albinismus, 264
alcoholic diseases, 344
Aleppo evil, 263
alopecia, 265
Asturian rose, 254
baldness, 265
canities, 264
of the cellular tissue, 239
chilblain, 264
ecthyma, 260
eczema, 258
elephantiasis, 262
erythema, 251
Sir Erasmus Wilson^s definition of, 251
varieties of, 251
favus, 265
framboesia, 262
frost-bite, 204
fungus foot, 266
general affections, 267
herpes, 258
ichthyosis, 257
impetip^o, 260
intertrigo, 252
itch, 267
|
^^H f^kin diseases :— |
Small-pox, distinct, 45 ^^| |
|
^^^^^^ lopm vxil^aria, 256 |
hemorrhagic, 45 ^^M |
|
^^^^^L leitcoderma, 263 |
|)eiechial, 45 ^H |
|
^^^H lieBen, 254 |
semi-con 6uejit« 45 ^H |
|
^^^^H Madnra foot, 266 |
variola, peiiod of inculmliatii |
|
^^^^^^H melAatua, 2()4 |
and criRis, 45 |
|
^^^^^B mentHiin'a, |
analyws of dt^ahn fn>m, 531 |
|
^^^^^B miliaria, 257 |
periods of mortality from, 534 |
|
^^^^^H moUnJiciim, 263 |
and vaccination, <>85 |
|
^^^^^B iriTcetotua, 2GQ |
Smell, impairment of sense of, 201 |
|
^^^^m nettlo-rash, 252 |
Smith, Br. Andrew (New York), on |
|
^^^^^B parasiteB, irrilation tvom, 267 |
the ** caisson disease," 3t>3 |
|
^^^^^^B p^llaji^i^a, 253 |
obsen-ations on atmospheric |
|
^^^^^B pemplii^is, 259 |
preswun?, 551 |
|
^^^^^^B pitvriafiis^ 255 |
Snake poisonings, 287 ^_ Social causes of disease, 628 ^^B Social oi-iginii of disease, 506 ^B |
|
^^^^^B pityriasis verdcolor^ 266 |
|
|
^^^^^B |
|
|
^^^^^B pompholjx, 259 ^^^^^H pomgo, 265 |
Sodiuni chlonde, diseases from, 330 |
|
Softening of the brain, 171 |
|
|
^^^^^B prurigo^ 254 |
SomnambuliBm, a form of liystena, |
|
^^^^^B peoiiaMis, 256 |
4*>8 |
|
^^^^H red glim, 255 |
Soot, disease fmm, 372 |
|
^^^^^B ringwonn, 205 |
Soot ulcer, industrial causes of, 623 |
|
^^^^^B |
Sore throat, 109 |
|
^^^^^B rapia, |
Sovet, Dr*, on the use of cadmium, |
|
^^^^^B scabies, 2()7 |
819 |
|
^^^^^B sok^iOilfTmB, 263 |
Spasm, 180 |
|
^^^^^B 8t«!arrlHi3a, 264 |
of the chest, 180 ^ |
|
^^^^^^1 stings, 267 |
of the hearts 137 ^H |
|
^^^^^V stropbvliiH, 255 |
iTltestinal, IHO ^H |
|
^^^^^H |
laryngeiiU 180 ^H |
|
^^^^^ft * tmen d«3C4iIvanA, 265 |
muscular, 232 ^M |
|
^^^^^B tinea favo^, 2t)5 |
of the Ri>hincter, 126 1 |
|
^^^^^^H tinea poloniea, 266 |
in the vascular system, 147 ^^B |
|
^^^^^^H tinea tonsurans, 2Ci5 |
mdustrial causes of, 623 ^^M |
|
^^^^^H tinea versicolor, 206 |
Spaomodic asthma, 158 ^H |
|
^^^^^B tooth-i-osli, 255 |
Specific degenemtioD, S9 ^H |
|
^^^^^^P urticaria, 252 |
Spermatic cord, the, 220 ^^M |
|
^^^^^B ^W8, |
Spina bifida, 170 ^H |
|
^^^^V periodH of mortality from, 543 |
Spinal cotMi, the, 84 ^^M |
|
^ Hkin, old elaasafication of diseaiies of. |
diseases of, 174 ^^M |
|
^^B |
atrophy of, 175 ^^M |
|
^^H operatiotui on, 433 |
congestion, 175 ^^ |
|
^^H parasites affecting, 562 |
functional diseases of, 178 M |
|
^^H Skin and membranous system, diB< |
hemorrhage of, 175 ^^B |
|
^^m eases of, 250 |
inflammation, 175 ^^B |
|
^^H industrial causes of dia€aa6 in, |
malformations of, 176 ^^M |
|
^^m |
myelitis, 175 ^^B |
|
^^^B 8k oil OH in, spinal enrratui'e, 245 |
S}una bi6da, 170 ^^H |
|
^^H Bleep, seasonal rules for, 660 |
Spinal curs'tttures, 244 ^H |
|
^^H Bleeplessness, stages of, 484 |
Spinal diseases, general, 176 :— ^H |
|
^^H Slotb, forms of nervous failure from, |
atrophy, muscular, 177 ^H |
|
^H 488 |
hemiplegia, 176 ^^M |
|
^^H evils of, 490 |
locomotor ati^j, 177 ^H |
|
^^H Sloughing phagedena, 55 |
, |*araplegia, 177 ^H |
|
^^H Bnmlliiox, abortive, 45 |
Spinal ivai-aljsis :■ — ^^M |
|
^^^^^^ coudueut^ 45 |
diphtheritic, 178 ^H |
|
^^^^^L coiymliose, 45 |
geueml, 176 ^^B |
INDEX.
735
Spinal paralysis :—
infantile, 177
Ipad, 178
local, 177 Spine, diseases of, 244
deformities of, 412 Spirillum, the parasite, present in
fever, 681 Spleen, the, diseases of, 228
varieties, 228 Splenitis, or inflammation of the
spleen, 228 Spontaneous fracture, of bone, 241 Squire, Dr., on incubation of zy- motic discuses, 591
on removal in infectious cases, 677 Starvation, causes of, 278 Stearrhoea, 264 Steel dust, disease from, 879 Sterility, from alcoholic indulgence,
350 Still-birth, 306 Stokes, Dr. (Baltimore), 260
on emotional delusions, 479 Stomach, the. 111
diseases of :— cancer in, 112
dilatation, 115
dyspepsia, 113
gastric exhaustion, 114
gastric fistula, 115
gastric hernia, 115
gastric irritation, 116
gastritis. 111
varieties of. 111
gastrodynia, 114
Effimatemesis of, 113
injuries to, 113
parasitic disease of, 113
pyrosis, 114
spontaneous laceration of, 113
stricture of, 115
tumors in, 113
ulceration of, 112
vomiting, 115 Stomach palpitation, 473 Stomatitis, 105 Stone, in the bladder, 217 Strabismus, or squint, 194 Strangulation, of the intestines, 119 Stricture, 115
of the fauces, 109
of the intestines, 118
of the lower bowel, 125
(5f the oesophagus, 110 Strophylus, 255
Strumous or scrofulous ophthalmia, 186
Suicide, from imitation, 464
periods of mortality from, 544 Sulphur dust, disease from, 588 Sulphuretted hydrogen, 341 Sulphuric ether, in operations, 438 Sulphurous acid gas, 340 Sunlight, as a test of atmospheric
purity, 664 Sunstroke, 173, 276 Suppuration, cause of, 35 Suppurative fever, 55 Suppurative inflammation, 35 Surgical fever, 436
Swathing of infants, evils of, 415 Sycosis, 261
Sydenham, on small-pox, 524 Sympathetic convulsion, instance of, at Hodden Bridge, 461
instances at Berlin, Bedruth, and in Shetland Islands, 461 Synchysis, of the vitreous body of
the eye, 190 Syncope, 41, 137
general, 476
local, 472 Synovitis, inflammation of the joints,
242 Syphilis,' 56
varieties of, 56
hereditary, 514
membranous taint from, 516 Syphilitic inflammation, 34
Talipes, or club-foot, varieties of,
235 Tape-worm, 513 Tarantism, 460
described by Hecker, 460 Tea, disease from, 363 "Tea-tasters," effects of their em- ployment, 365 Teeth, the, diseases of, 246 :—
absorption, 247
of the alveolus, 249
caries, 246
chronic thickening, 248
of the dental periosteum of the, 248
of the pulp of, 248
exostosis, 247
gangrene, 248
gum-boil, 248
necrosis, 247
rheumatic inflammation, 248
syphilitic taint in, 515 Teething, periods of mortality from, 533
|
^^^^ 786 IKBEX. ^^^^^^^^^^^B |
|
|
^^H Teprretiar, a dftticing dif^Ase, 460 |
Tooth-rash, 255 ^^^^^B |
|
^^m TendoDB, 2;^ |
Toxiemia, bilious, 283 ^H |
|
^^H coutractiou of, 2:^ |
Trance, a form of hy>' 1 |
|
^^^H Tonenmus, or buobiu of lower bowel, |
Transformations, con^ iO J |
|
^H |
TnuisfuMion, 434 ^M |
|
^^H Testes, tlie, diseases ofi 219 |
Trematode, or fluke*worm, 575 ^^ |
|
^^H Tetanua, or Itieied jaw, varieties of, |
Trichiniaaifl, 567 |
|
^H |
Trichinosis, muBcnlar, 233 |
|
^^H Textile fabrics, disiifLse from diiat of, |
** Trichophyton aporuloide^," & bkm |
|
^H 385 |
pai-asite, 266 |
|
^^m Tliooal abs^^oss, 234 |
Tubercular iihthisis, 163, 164 |
|
^^^B Thick eiiiug of tho ear dntm, 197 |
Tuberculous taint, hereditary, 517 |
|
^^m Tlii-ead-worm. 54>8 |
Tumor, in the mediastinum, 166 ^^ |
|
^^H^ Throat, the. diseiiRns of :— |
of the peritoneum, 128 ^H |
|
^^^^^^ c^Dartche iiiali^^na, 109 |
in the pharyn\, 110 ^H |
|
^^^^^H eloDgutf'd uvula, 14 19 |
in the stomach, 113 ^H |
|
^^^^^B hy])ertrophT of, 109 |
of the uterus, 219 ^H |
|
^^^^^H qiiiuKY, lfft9* |
Tumora, 39, 61 ^H |
|
^^^^H relaxed, 1U9 |
rarioties of, 61 ^^M |
|
^^^^H aore, 109 |
on the brain, 174 ^^M |
|
^^^^^B strictnre of the fauces, 109 |
of the breasts, 226 ^H |
|
^^^^H |
of the ear, liH5 1 |
|
^^^^^P tuiuors of the fauces, 109 |
in the eye, 194 J |
|
^^^f ulcerated, 108 |
of the fauces, 109 ^m |
|
^H TkniBh, 105 |
in the gums, KHj ^^H |
|
^^H periods of inoHality from, 638 |
vaactUar, in the tongue, 107 ^| |
|
^^H Thyroid Rland, 227 |
of the intestines, 121 1 |
|
^^m Tie dolorenx, 182 |
of the lower bowel, 126 1 |
|
^^H Tiuea decalvaus, 265 |
Tunica vaginalis, the, 219 J |
|
^^m Tinea favosa, 265 |
Turjientine vapor, disenjte from, ^73 ^J |
|
^^H Tinea }.>oloDica, 206 |
Tympanum, diseases of, 197 ^H |
|
^^^H Tiuea toD8ui*anft, 205 |
Tyidioid fever, 614 ^^ |
|
^^^1 Tiuea versicolor, 266 |
Typhus, analysis of deaths from, 531 ] |
|
^^H Tiuniti^ auiiuui, 199 |
^^J |
|
^^H Dr. Bucke ou, 199 |
^^^ |
|
^^^B Tobacco, diseaBo from, 357, 358 |
UiXTEB, of the cornea, 187 ^H |
|
^^^H Tobacco Buiokiug, 359 |
laryngeal, 155 ^H |
|
^^^1 digestive aud other sTstexna nn* |
in the pharynx, 110 ^H |
|
^H del*. 360-363 |
roilent, 63 ^H |
|
^^^^^^ Tongue, diseasos of :■ — |
Ulcer of the lip, 105 ^H |
|
^^^^^K abscess, 107 |
Ulcer, soot, industrial cmues of, 023 1 |
|
^^^^^B ooneer. |
Ulcerated throat, 108 J |
|
^^^^^B cellular iufiltintion, 107 |
Ulceration. .35 ^H |
|
^^^^^H exfoliation of the mucous mem* |
of the bladder, 216 ^H |
|
^^^^1 |
of cai^tilage of joints, 242 ^H |
|
^^^^^B glosaitif^, 107 |
of drum of the «'ar, 196 ^^fl |
|
^^^^^H hy]»erti'(>phv, 107 |
of the gums, 106 ^^B |
|
^^^^H paralvnis, 107 |
industrial causes of, 623 ^H |
|
^^^H |
of lower boweh 123 ^^ |
|
^^^^^H ulceration, 107 |
of the nose, 200 |
|
^^^^^^ VBHcular tumors, 107 |
of the cesophagns, or gullet^ 110^^ |
|
^^^B Tongue and m^uth, diseases of : — 105 |
of the stomach, 1 12 ^H |
|
^^^^^ abscess, ILHi |
of the tongue, 107 ^H |
|
^^^^h canker, 106 |
of the uterus, 222 ^H |
|
^^^^B cyst, 106 |
Ulcerative intlammation, 35 ^^M |
|
^^^^H ranuJa. |
Uncleaiilines8| as a cause of disra^t^^H |
|
^^^^^V stomatitis, 103 |
633 ^H |
|
^ TonsiUitis, 100 |
Unemia^ and m-sBmio coma, 281 ^H |
INDEX.
737
Urethral passage, the, diseases of, 218
Urticaria, varieties of, 252
Uterine system, the, during preg- nancy, 301
Uterus, or womb, diseases of, 221
Yaooination, in relation to small-pox, 685
introdnction of, by Jenner, 686
opposition to, 687
I^. Buchanan's report on, 688 Vagina, the, the seyeral diseases of,
223 Valvular disease, of the heart, 130,
622 "Vapors," 476 Varicose veins, 145
from habit of standing, 481 Vascular system, 145
diseases of:— organic changes of, 148
relaxation, or paralysis of, 147
spasm, or contraction of, 147 Vegetable parasites, diseases from,
578 Veins, the, diseases of : — 80, 143
fibrinous concretions in, 144
injuries of, 145
nsevus vascularis, 145
obstruction in, 144
phlebitis, 144
phlebolites, 145
phlegmasia dolens, 144
varicose, 145
white swelling, 144 "Venereal" poison, 56 Venomous diseases, 287
from animals, 287
failure of remedies in, 288
from insects, 288
from the jelly-fish, 289 Ventilation, of houses, 701 Vertigo, industrial causes of, 621 Vomiting, 115
Wabts, on the nose, 200
Water, increase and decrease of, in
the blood, 149 Water, soft, utilization of, 705 Water supply, public, 681, 691, 706,
709
47
Watson, Sir Thomas, opinion on de- velopment of phthisis, 584 Weak sight, 191 Weather, abstract of influence of, by
Buchan and Mitchell, 533 Weather, as cause of disease, 530 Weed, 56 Wells, Sir T. Spencer, operations on
ovarian tumors, 221, 606 "Wens," character of, 40 White swelling, 144
industrial causes of, 623 Whitlow, 234 Whooping-cough, 53
analysis of deaths from, 531 periods of mortality from, 536 Williams, Dr. T. (Swansea), analysis
of copper smoke vapor by, 337 Willis, Thomas, case of automatic
hysteria quoted by, 466, 588 Wilson, Sir Erasmus, his definition of erythema, 251 on leprosy, 262 on aniline, 368 Winds, influence of, 556
Mr. Haviland's researches as to, 557 Woakes, Dr., on nervous diseases of
the ear, 199 Womb, diseases of, 221 Wood and ivory dust, disease from,
381 Wool-sorters* disease, 291 Work-rooms, suggestions concern- ing, 698 Writer's palsy, 177 Wry-neck, 236
instance of cure of, by fright, 236
Taws, a skin disease of Guinea, 262
ZiNO, poison from, 329
Zymosis, as a cause of disease, 588
author's researches on, 606 Zymotic diseases, 590-596
periods of incubation of, 591
theories on, 596 *
hypothesis on, 598 Zymotic disease, prevention of, 673 Zymotic poison. Dr. John Dougoll
on, 598 Zymotic taint, 521
HENRY C. LEA'S SON &> CO.'S
(LATE HEHRY C« LEA)
CLASSIFIED CATALOGUE
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PROSPECTUS FOR 1G84.
A NEW WEEKLY MEDICAL JOURNAL.
^
SUBSCRIPTION RATES,
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National Weekly Perloclieal, of iroin 28 to 32 Quarto Fa^es, c-oiitaiiiiiii;^ more Kesidliij^;: Matter tlian auy other Weekly Meilieal JuiirtiaL in America*
^P In annuunclng the forty -second year of publication of The Medical New^
^w urge can Uw^k bsick wilh Htiti»fuction on wliiU bus nlrendy been acwjinpliKhc
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2 Henry C. Lba's Son & Co.'s Publications — The Medical Xews,
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The News, stlwnys endeavoring to enhance its mtefulni^, has pleasure in announdngle the profe-Hsion that ammgements liave been perfected for tlie pubUcaiioo during tlieoonh ing year of a highly valuable series of pnietical articles l»y eoiinent men on the moreiiD* portant diswises met with by every practitioner in his daily duties. The following gellll^ men have kindly promised to aid in carrying out this plan, und the eminence of tiid7 Djunefl Ik a guarantee of the value of the i>apors to lie contribuleti by them.
i
0. HAYES AfiNKW, Philftddphiii. HAinUSON ALLEN, Philadelphia.
1. E, ATKINSON. BAttimore. HOBErrs BABTHuLOVV, Philftdelphi*. 8. M. REM 188, Now Orleaas.
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RICHARD Mt^BHERRY, Bfiltimom THUMAtJ M. .MARKOE, »» Yofk- 8. WEIR MITCHELL, Phlljul^lplda. THOMAS G. MORTON, Phil4.t<?lptiifl. L. S. MiMURTRY, DauviHe, Ky, WILLIAM F. NORRLS PhiUidd|ihia. WILLIAM OSLER, 3IoiJtreal. FEaSEXPEN N, OTIS, New Y<irk. ALONZO B. PALMER. Ann Arbor, Mleh. ROSWELL PARK. ButTftlo.- THEOPUILUS PARVIN, PhilaiMpIik. WILLIAM PEPPER, PhHodHphiii. F. PEYRE PORCHER, Charle^toa. THADDEUS A. REAMY, CIiicina«a. J. C, REEVE, Dayton, O. LEWIS A- SAYRE, New York, FRj^NCtS J. saEPHEKD, *Iot»tre»L STEPHEN SMITU. Now York. J. LEWIS SMITH, New York, LEWIS A. STI3IS0N, New York. ROBERT W. TAYLOR, New York, WILLIAM THOMSON, Phirndelphla. L. MlLANE TIFFANY, BalUnn^w*. JAMES TYSON, Phil*^clphin. ELY VAN DE WARKER,8ynicii»ft,N.f." J, COLLINS WARUEN, Bcwioru ROBERT F. WEIR. N«w Yorlc. JAMES T. WHITTAKER, Cliw^inuiaL EDWARD WIGGLES WORTH, Bo^toiw E, WILLIAMS, Cineintintl.
DAVID W, YANDELL, LoutovUle.
Original artichvs from foreign^ authorities juny also be expected^ the tirst of wttl will appear in the issue of Ja4Jiiary oth, 1S84» un Digital Exploration of thk BLAPtiE*' IN OneciniK Vesical Di^seases, with rra rbsvlts, by Sir IIkkry Thompson, of Linulnii, SurgiM>n Extraor^linary to the King of the Belgians, etc., with 7 origimil iHiifitniiiona.
In tyixjgruphicai iippearance^ The News of 1884 will show an advance even the*iflHues of 1882-3.% and nothing will be left undone to economize the lime and pn^mi the comfort of its reailers. It appears in a dqiible'€t>bimned quarto form, printed by latest improved Hoe speed presses, on handsome paper, ftrom a clear, easily r^od 8])ecta1ly ciiHt for its use.
The Medical News employs all the approved methoils of modern joumoliam with the imentitinof rendering itself indispensable to Ibe pntfession; and, in the nntiapattcm au unprece<lented circulation, its 8ul>8criptiun hiuj hcen placed ut the exceedingly low of $5 per annum, in advance. At this price it nmks m the diesipeat modicuJ |»erjuirK in this coQiitry, and when taken in connection with The American Journal at Xl> DOLLARS per annuin^ ilia conMei^vX^ Mfi«t\.fei\ v\vAV'a.\siT^^et ^m-ovsi^v i*^ uvwtArial of bighetit claiB *w offered iVwm Gaii\)« oXiVaASuwi ^^afiw\l«^, ^^iv-ax. ^.^ssas^Vv^i&K^^^e^sfc.
^0|
mi»tj
Henrt^
IGAI
THE AMERICAN JOURNAL of the MEDICAL SCIENCES,
IEditod by I. MINIS HAY8, A. M., M. B., 1m [Hibljshed Qiiarterlj't on tlit^ first days of Janiiao, April, <luly atid October* each Kuiiibc^r e*oiitjiiiiiii^ over Tliree Hundred L Octavo Pa^es, fully 1 1 hi. nt rated.
eon F Th
N' the ] 80 k
Fminded in 1820, The Amkhican Jouhkal daset* whh l&SS iu aixty-fuurtb
nsccinive yenr of fuitbful and honorable i*ervice to the pmfeaBion* Being llie onljr i^Klical in tbe English lungimge capable of pn?B<*nting cliibtir.ite tirlicles — the form in
hicb the most important discoveries have always been iioramrminited to the profe^aiun — ■
HE AwEBiCAK JoiTRKAti cannol full to 1*0 of the utiutit^ vabie to pbysicians wh«i would keep tbemselvea au courant with tbe nietlical tbonjfbt of the day. It may jnytly claim that it niimljere lunong its contributors till tlie mo«tt di*$tingntshed meml^ena of tbe profea^ion, that its history h identified with the ud^initx's nf medical knowledge, and thai its circu* tutAon is co-extensive witli tbe use oftlie Englijsli language.
During 1884 The JotiBNAL will continue to proHent thode features which hsive Jong proved m alirac-tive to its reiuierB.
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Following thene crimes the Quarterly Summary of Improvements and Dis- coveries in the Medical Sciences, whicb^ being a clusai(ie<l and arranged oondenfcitton of important articles appearing in the rbief medi«il journals of the W(»rld, furnishes a compact digest of medical progreaa abroad ;ind at home.
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4 Hbhrt C. Lba's Son & Co.'s Publications — Dictionaries.
nUNGLTSON, ItOBLEW M. D.,
Ijate fVv>/ry!5or tif Ituttitutt^ of Maiictnf m the Jrjfrrt'nnn Mr>l<ciil GJi^.^fc uf ph u'-ad^JphkL
MEDICAL LEXICON; A Dictionary of Medical Science: CVmtnimr^g
« <ym>t«e cxplaiuilitm of the various Subjects and lenns of A ' '" f;.»f
o^y, llvjciene, ThempeutU's, I'ruirmncoln^y, Pharmacy^ Hur^j' ris-
prudenci? mid Dcriiitttry, Notice* of dimsiie and of Mineral \V,,l i?, Kaipirinil and Dietetic Prt?pa ration!*^ with the Acf.*entiiution and 1
iind (he J^Venth and other Synonymess, so a* to Cfjii.Klitute ti Vrvu ji
Metru^il Tjexic<in. A new edition, thoroughly revi4k*d» and very lu^rejitly ind
aujjuient<Ki, By Richard J. I>UNGLi?mN, M.O. In one very hirge anil i»- yal ortavo vohinie of \Vi*J pipes. C!oih, |G,50; leather, niised bands, |?,50 ; vtiry iiiiiid»yine half Riit^sin^ niisietl humlii, $S.
The object of the aiithnp, fr«»ni the otitset, has not heen to make the work n ni^relcii- con or dictiuniiry of ttvniiST hut to nlloni under euch wonJ u ixmdensetl view <^»f it** raritiiu meili'-'nl rtdjiti<fns, and thus Ut render the work an ejntorne of the exij^tini: ' i nf
medic^il Krieni'e, Startinjt^ with this view, the immense dcnuind which hsis « (he
work lins entihled him, in re]»e4ite<l rfivisiunSj to uiignunt itH romp'f* •" -^^
until ni lenf(th it has attained the |x>sition oi n rewii^uized and j^tan r
tlie lao^tui^e is s^Kiken. Special pains have been t^ken in llie jn^ , , ii
edition to nmintain this enviable reputation. The mid it ions to the vmubutary are more numerous than in any previooa revision, un<l partitnilar attention ha^been l»e»towed on the aceentiiftiion, which will be found marked on every word. The tyiK>|L!^niphi«il arnmgt*fxi^iil lias been irreally improved, ren<lering reference much more eoi^y, and every «ire has liecn taken with the nieiiianical execution. Tlie vuUixnc now contains the nuitter of at leMt four ordinary ortavoa.
A huok of whicrli c?viftry AmerkAn oajflit to he f work hrmh pr»"»n»1. Whon tlio liMirne*! nmtfmr of tli« work , mid needw piiH«eil Awuy, prnbrilily JiU of us jt-MneJ fust llio it*Mi\i bIwtiiM not nmintiiiTi it't pluice in tho Advnitcjhf^ Pf*ipnf^i5 wftoMti toi'iiis) il doliiie!*. Kmtiiiifiti'lv, Vt. lK\o\m\d y IhmKlliiun.lmvlnkj; Aa*i'<l*'d lot^futhor in Viv reiviMon "^f Hf^v«Mai tHliUmiw of iho work, and lmm>K lw'»»n» iliert'r>r<\ 1r;\in«H| fn iho nif»tUi>ils »nd imbii'*d witli tlti' »«|*iril«)f tlict bcKilc, liiv* Ijoon lhhlf« to nlit it ftfi n wru'li of tliLi kind .^tliruild he «di(C'^ — tn t*nrry itt>n Mteailily, witlu>iit jar or inters ruiftJMn, nlitfin the f^vth^vea of thottfjriit it han trav- ^Mrd duiirifir lU lifc^tlnie, Tm ^how thoi rnAgrnltiKle of the t-t^^k whieh l>r. Dnngtison liftx n.ssutm'<i and €iirrifd tfimiixh, it ts only iieceeii«Ai'y to t^tAKi t}>Al- tnore Mmn six tliouftAnd pew Hiifijm'tii tiavo b«<»n k.ftrHtid IN tl}6 prej^ent edition. — Phiiadeipfua MalKtU Timtif, Jnin. 3, 1874.
Ahnut the fir«t hnok pnrpha^^fld by tho medical ntiidimt ii% t](o ^ftv|^r*n^ Uintjormiy, The lexieuii explanatory of (eohiiieal tp^iin^ kh dimply a tinf fpta
f iM^rnl^ A" rni^diclin?^ 11 in tv* iniicii a ui»cewMity aIno ^ III*? ft(W'n>*(ng pliyHkiiun, To mo<%t the want* of HtiHU'iitK ]iad moipt |>liyMi«Man» thi' du tiotmiy rnuf^t hi* rorifU«a»*eci whlh* ooni|»ri«heiiiNiv<*, uiid |a-a4>tif")il Whil*? pei>tilrArioiii<. It wrj* br<rriU**e l>MiiK)i>^»'s ( Jfi**t thci^f Indlmittons timi it tM^i'umc at nrifi? the f dlctl'tnuiy of K»'n*H-i\l itnt' wlvfipver medloin** wa* Bttidh'd m tfu^ KjiK:M*»h lanK^ai!*^- 'h ao former rc>vt4tou Imvc the nlteinCiritKH lOtd additioaM lH'i>n »ft Kh'At. T\w (*ld«*f torms lwv« boon M't in blftck Iett4>r, wtilh^ the ileilvjUiv*?n r-llow in snmll caps; «nttintn)i£cmrinr uhitdi great ly liw'ilitiit<*tt n^foreocv. — CinetttHtitt LttHctt timi Cfimr^ Jan. |o, 1x74.
Aa A fttandnrd work of reference Pungliaon's
nu-nd it V
WS*te of llie jMi:innii' 'MM n :»!, ;
espetriftll V art^ in ncit-d of a m And rcilii)jl«? iiifjirinnlKni on And t«rni« v^ ■ ' *' - - pnr!*uinptlM cannot hi* •
Wfori' u* fiii«_> --HI.-,, - iMi.'i
ntil of Pftarumrftf l-'eh. 1874.
PArt!i"ii'nr rnrf bn^ b<»^n di?rntfdl fn rlTlrnlJnB
.6^
Iter
< rt« in
and
Utte
<M\*d
Meduiiii ^i'l'.'in-*'. It
work piihltHfit*d fur tli
Xi\in» iid'>'i ni'itkoii n(xi
A fi*rm IVir ri/ady Afocs-**
„ ^ , .... I SMf^l U r.M'illv It*. All*
iniinibrp A3 It ia pntClicai,— ^ufAer a «l/ttitm/ fi^Ofm^ Feb. l*fT4 A
lionx It
well .1- -• ,,ru!
oJttnii
meat iif pnucskr ii'.icuvi^b «uui oi ^cu^uuiiiC lore^— Lotnion Lnntrt^ May |;<, liKT^'i.
DiinKbifon'e tiirtiotuwy Is lnenlrtdnl>ly vnlnAblt, and tnrii.Npen<«nbtti li» cvt-ry prnctlilont^r of in^li- rine, pimrmoinAt and dontiAt. — Wtmtrrn Lanret, Mrtroh, l«74.
It has tiie rare merit tbAtitrrertrtlnly liA«aortTd In the FltiKltsh langnatee f«»r ac<< nia^y ajad4M.lCfil<}C rofercneea. — LotuiitH Mtdical UoietU,
JIOBLYW, lilCHARD 2>., 3L D.
A Dictionary of the Terms Used in Medicine and the Collateral ScienceB^ Hevisedt with nnmerotis additiong^ by l3A.\o HAVi*, XL D., latu editor of The American Journal of the Meilical t^cicnces. In one hirge royal 12mo. vuliune of 5^ double-coliunued pagey. Cloth, |il, 50; leather, $2.00.
Tt \n tb9 be^( bot)k of deflnltioas wo have, and ought alwije to be upon the studcarA tiible— ^StncUaii J|«tfii^rW and Sitrqtcat JuurnaL
HO D WELL, G. F., F. R, A. S., F. C. 8.,
LrrtiUir on XnfurnI Si^iftfrr nf Clifton OiHtift\ Etitfhind.
A Dictionary of Science; Com prising Ant rnnomy^ Cliemt'?try, l>ynnmic»,1 tricity, llent, llydroilynami*-^, Hydrostatits, Lignt^ Mni^uclisrn, Mechanics, Meleftn>l rnetmuitics, Siaind and SlMtits. Contributed by J, T, Botlomlev, M. A,, KC^8., William Crookes, F.K.S., F:f\S., Fr««*c^nrk *;othrie, B.A., Ph, U, H. A. PnKtor, B.A., F.U.A.S, G. F. Il4Mlvvi^tl, VjiUlor, C\\av\os TuuA'vw'ym, V.H.S., FXlS.^ antl Iiichun.1 Worntdl, M.A^ B.i^c. Prccedotl Uy an lissay tin \Ave WX^Uitv *.%l \.V\^ V\\^«vwj\ V^^rvst^ifc*^ Wvi^^ ^uiuadidouic ■"nvo volume of 702 pages, milt 1^ VVYuaXTaXAom* vi\vA\\,^S*i.
IlKNRr C. Lea's Son & Co.'s Pcblications — Conipeads, Anat. 5 HARTSHORNE, HENR Y, A. 31., Jf. J).,
LnUhi Professor of Hjitjicnc in the Univergitt/ of Pennjti/tvania,
A Consfpectus of the Medical Sciences ; Containing Handbooks on Anatomy, Physiology', ClieDiistn', Materia Mtniica, Practice of Medicine, Surgery and Obstetrics. 6e«md edition, thoronj^hly revised and j^^eatly improved. In one birge royal 12ma volume of 1028 pagen, with 477 illnHtnitions. Cloth, |>4.25; leather, $5.00.
The work is int^ndefi iw an ai<i t<» the meHirnl . its diw share of attention. We can connelve «ich stiKlcnt, ami lu** siirh a|>|>varM to fulfil a<hniiahly its I a work to be useful, not only to sttulents, but to o)>jt*ct hy its fxc'cllent arrangrmt'Mt, the full com- | practitioners as well. It reflects credit upon the
f)ifati«»!rof fai'ts, the perspicuity arnl terseness of imiustry and energy of its ahle editor. — Bonton aUKiii^ge, and the clear anil insinietive illustra- .l/iWu-a/ an«i .S'iirf/t>a/ ./o'/r/iu/, Sept. a, 1»<74. iiouH.^Animr.nn JunrnnI of J'harninru,.Ui\y, IH74. I We can sav, with the strictest truth, that it is the The object of this manual is to afford a convcn- 1 best w<irk o^the kind with which we areacquaint- ient work of reference to students during the hrici ' v(L It embodies in a condensed form all rci'ent inoinent»« at their command while in attendance ' contributions to practical medicine, and is ihere- up<^n medical lectures. It is a favorable si^n that , foro useful to every busy practitioner throuKhout
it h;v% lK»en found necessary, in a short — ' ' — **— '—='-— ' 1...:— i.i.. .. i 1 *.
time, to issue a new and carefully revlstn The illustrations are very numerous an ally clear, and each part seems to have received i J.JMri«i/. 'April, 1875.
STUDENTS' SERIESOFMANUA LS.
A Series of Fifteen Manuals, for the use of Students and Practitioners of Medicine and Surgery. Tliey will be written by eminent Teachers or Examiners, and will be issue<l in pocket-size r2mo. volumes of 300-540 i)a^es, richly illustrated and at a low price. The following volumes may now be announced: Klein's Elements of HitUoioffy, Pepper's Surf/ical Pathology^ Treves* Suryical Applied An^Uomyj Ralfe*s (flinical ChemiHtry, and Clarke and Lockwood's Dinnector^ Manual^ (Jmi ready); Power's Human Physiology, (Ready shortly); Robertson's Physical Physioloyif^ IJruce's Materia Medica and Theror peuties, Bellamy's Operative Suryery, and Bellas Comparative Physiology and Anatomy^ (In OQtive preparation for ctirly pultlication.) P\)r separate notices see index on last page.
ITETLL, JOHN, M.D., and SMITH, F. G., M. !>.,
Late Surgeon to the Penna. IIt>sp\taL Prof, of the Institutes of Med. in the Umv. of Penna,
An Analytical Compendium of the Various Branches of Medical Science, for the use and examination of Students. A new edition, revised and improved. In one very large royal 12mo. volume of 974 pages, with 374 woodcuts. Cloth, |4; strongly bound in leather, raised bands, $4.75.
it h;v% lK»en found necessary, in a short upace of our country, besiiles bem^ admirably adapted to , ' ^ ed edition, i the use of students of medicine. The bi>ok is
The illustrations are very numerous and unusu- ' faithfully and ably executed. — Charleston MediaU
LUDLOW, J. L., 3T. I).,
Omsultinfj Phf/sicinn to the Philadelphia Hospital ^ etc.
A Manual of Examinations upon Anatomy, Physiology, Surgery, Practice of Medicine, ()b.stetrics. Materia Me<lica, Chemistry, Pharmacy an<l Therapeutii«. Tt) which is added a Medical Formulary. Third edition, thorouglily revised, and greatly extended and enhirged. In one handsome royal 12mo. volume of 816 large pages, with 370 illus- tratioiLS. Cloth, $3.25 ; leather, $3.75.
The arrangement of this volume in the form of question and answer renders it espe- cially suitable for the office examination of students, and for those pre^ring for graduation.
WILSON, JEItA S3I VS^F. 11. S.
A System of Human Anatomy, (leneral and Si>ecial. Edited by W. H. GoRREciiT, M. D., Professor of General and Surgical Anatomy in the Mediiral College of Ohio. In one large and handsome (K'tavo volume of 616 pages, with 397 illustmtions. Cloth, $4.00 ; leather, $5.00.
SMITH, II. II., M.I>., and HORXElt, WM. E.,3I.I>.,
Emeritus /Vo/. of Sunjcry in the Univ. of Pennn., etc. Late Prof, of Anat. in the Univ. of Penna,
An Anatomical Atlas, Illustmtive of tlie Structure of the Human Body. In one large imperial octavo volume of 200 |>agt»s, with 634 beautiful figures. Cloth, $4.50.
CLELAND, JO HN,'3LJ)., F. R. 's.,
ProfeHAor of Anatomy and Ph}isiitluij}i tn Queen" s Coflcffe, Gahcat/.
A Directory for the Dissection of the Human Body. In one 12mo.
volume of 178 pages. Cloth, $1.25.
BELLAMY, EnWARIh I\ It. C. S.,
Stniitr Atiistnnt'.Snrffion to the Chnrintf-O'oxs Jlimpituf, London.
The Student's Guide to Surgical Anatomy : Being a Descrijnion of the most Important Surgiail Regions of tlie Iluman Body, and intended as an IntnMluction to Oi>erative Surgery. In one 12mo. volume of 300 piigCH, with 50 illustrations. Clotli, $2.25.
HARTSHORNE'S HANDBOOK OF ANATOMY I HOKNEH'S SPECIAL ANATOMY AND ITISTOL- ANU PHY.SIOI«OOY. Seoond edition, revlned. I OGY. KiKhtli edition, extt^nnively revised and In one royal l2mo, ro/iime of 310 WBlli. wiUi UD \ mo\V\lV««V. \tv Vnio oeVMct nvA\\\cia« ^V Nas^SV \m|2^^
Henry (J. Lea's Sox & Co.'s Publications — Aiiatoinjr.
ALLEK, HAJiBISOX, M. D.,
PrqfasMur of Ph^/mologit in tk€ Unirer«i(*i of Ptnnti/tcnma.
A System of Human Anatomy, Including Its Medical and Surgical Helations. For tlie iifi* of rmetiiioiiei> untl t^tudcnts of Medicine. With mj Inlitv duclorv iluiptor on lliHtoiogT. By E* O. SiiAKi^rEARE, M-l>., 0plithGdmo]<i>gi6| lu iht I'JiiliMJelnluii HosjjilJiK In one large »nd tiandsonie qimrtu volume of alxml TiKl dtmlle- coluTniii'J piiges, with ^SO ilhi8trtilioiia on 109 Hthcfgraphk" plat**, manj of ^hkh are in colors^ and tdjout 15U cnpravingts in the text. In tjix 8e«iions, each in n jvtrtfolio, t^tjon J. HlKroLCKiY iJu4^t Jitudy] Section 11. lU^>nj? axd JoiX'Tts (Jmt litady), Sivlion JIL Wit84^i.E& AND FAiM-Kii: (JnM lieud}/}. Section IV. AuTERiKri, Veixb ant* LYMi'fiATtcs^ {JuM B^f^tdy). Section \\ Nervoi.'8 System {Jmf fUady). Seciion Vf. OnuASi or Sen^i:, of l>KiESTiuN AXB GKNiToUiirN ARY Uboa?j^ (in /Ve«»). Price IKT Srrlkjfl^ $.'i,5<). For mle fey stib»cription ow/v. Apjtfy to the Publinhrrv.
Extract from Introduction^
It Is the design of this lKX)k to present ihe fads of human nnatomy m t)ie mi#nt)er suited to the requiremenlf* of the student and the practitioner of metiidne. The autbor' belie ven that Hurh a lKK)k is needed^ iiiagmneh at? no treatise, as far as he know*^ rcntiiirukin addition to ttie text descriptive of the suhjcct, n hrstenviitic presentntion of such :ii»:ii43micil facts as Clin be applied lo [>r3tt'!ict!.
A look whit'Ii will lie at oiice ncciiniie in t^tiitement and coneiso in terms; which willte an aeceptal>le ejtpresHion of the present state of the ^^ience of anatomy ] which vi^^' nothing ihitl tun be made jipplicahle to tlie naedical art, and which will thug < : of iiurgi*til importance^ while oniltting nothing of vuhie lo clinical medicine, — w< i lo have tin exciiwc for existence tn u cxiunlry where most surgeons are general pracliucfDo^ und w here there are few general practitioners who have no interest in surgery.
Among other mullcn*, the book will he found to contain an elaborate destTiption of the tii^nes; an necoTint of the nc»nnal development of the Itody; a section on tiie natore kbA varieties of monstrosities; a section on the methr^l of eondiicti: _ [niotr
tions; and a wtlion on the stiuly of the suj>erticies of the I-m* i ibi
position of the deeper stnicture^. The-** will apfiear in their ..^ . >. ^^»*«.v | *...?> ilulj iubordinated to the aeftign of presenting a text essentinlly anatomical.
A tiook like this fj^ rh ideal rarely rcjUlied. It to Tl«r^ r.i.,i..«^s!nn Kt [it^vin.' tS,at U Is euirH M Ii^aailDo of wealth ia fhe iDformatlonlt eiTt««, It | on! bat that tt will h«
dttfen' from all precedin)^ anatomic*** in its .scopo, of n ^^Er^UmMtAutl
and i^, we lM?lieve, a va.et improvement iipoa tliera an all T he chief novelty a' "onl the I K'ok, and rcftlly one cif tbo greatest need> in anntiimy^ is the ex- tension of the text to cover not only unatomicjU de^c^iptloDl», but the u*ies« of annUjniy in 2<tndyin^ diftciipe. Thii«igi done l>y ^tAtJng the narrowrr topo(jrjiphiejil relation^*, and nlho the wider ciitji' \c%\ relfttiotiJ^, of the more remote pnrt*, tjy giving
a hfief afcrmnt of the lifseH of the vatioui* orKaufi, ..,
and by quotinj? ea^es whirii ilfuHtmte the '"ffK-al- | author.— AM'. MeA. Jtmr.a ii»tion tjf dli*fa!*ed notion." The flnlcfr are beau- U is to be considered a study < liful Bpecimenj- of work by one wh-j lojig amec | in it* widest i^en^f^— a evsteniar won a de«i*rved reputation ah an artist,— 'At SJtd*- , ^uch ftnat*»mlcal fucu i^ f*n ^
The appearanee of the book mark» an epoch In medic-al literature. It is the tirf*t ImnorlAnt work oa hantan ftnatomi^* that hai* api^areci in Anierieaj and, more than this, it?* .•'oope i*» new and original. It ip intended to tw? both descriptive and topogi-apti- foal, Rrientific and prurtiral, m that while fatipfy- ing the anatomist it will be of value to the practis- ing phyi»iclan. The illugtratioij<i of the bcnie* are Terv fine. The namtj> of the part;", muscular at> tachmentJ?, ete, are prirted eittjer ou the fiaure or clone beiside, so thai they are ea.sily recoarnited. Dr. A llen'ii treatment of (oe^ jotntals ndiiiirallctaind
It iuv* Uilirn ers to b^ nbh produced in A- much to ore a-« the f .»reSgti wvi I descriitioiis ai^ . .. , np Ui date. The wi>rk, amount of research, and
pra^-'tiee of medielna aa well a author U eonciNe, aceorat* an* I
an
around ih tra veiled over by one ^ larwith iL The iliuNt rations an care, and are ("imply f-ur^rb. Ir Bible, except in a general way, exeellenee of the work of the am Section— that devotfd to t^' - Bone* and J id lit "i, Theif i
the ilJustrallonfii made fo>rii the author* r< dijsf*ec- j apj:diofttion of amdoniical [ tionfe deserve the liighest praij^e. They are well ton- wni'<- ' f 'i" Ttiedit;al clin ceived and well ex*^cuted, hnndMoaie artistically j oj* r-n. In ft
and eiear anarnniieany. As the author pointn oat, ^ tifi 1 tde work
nuch 9 work as he has undertaken is necessarily [ pri-^ . ^ '^ '' ' -
ency«'lM|^iiiMJle» and the ref<ull sliows tlmt he ha*» tag wiii' brought to it a ntind well lireparod for the ta^^k t>y | are po v
ex ten .sive readings eritieoJ Judgrneniand literarv i i» a work . <.- ,..,v .-. ^ ,
llbility. We ciui ooidlally recommend the work I kind innnyianguago,— J/fxi^m^ Jir-auru, >; err. 1^1
CLABKE^W. B.t F.JIX).87& LOCK WOOD,C. If., F.R.C.L
D^motutrnfon Iff Anatomy at St, liarihokmn^v^t, Ilotpital Medical School, London,
The Diaseetor'fl ManuaL In one pocket-size I2mo. volume of 3UG ficucas wSl 49 ilhjhtraiiniih. Liiiip cloth, reti edgesj !fl.50, Ju»t rrady. See SOtcUrttM ^erim Mavrnil*, jntge 5.
TREVES, JFJiEDERICK, F. R, C. 8.,
Applied Anatomy . Iti om vw!«^*iW\wiViTOo. NoVwa^i lA '^^ vvs^v^^^ircftB.^^
^^^^^resttY C* Lka^s^MHTOo.
'S PUBLICAf
hartsiiorxe, hexry, a. m., m. i>.,
Lntfhf fVrtf*#j«*ir of Htffjiene in the Univrrttti/ of Ptnmsfiilrania.
A Conspectus of the Medical Sciences; Omtuinin^ HarniUx>k«on Anftlomv, [*hysi<»loj^', Cheiiiiiitn', Mutenu Me*iii'si, I*rmtiee i)f MetlkHne^ Surgery and OlisU'trics. "" ^^'on<l e<)ilinnj thon»iij>!ily ix'vi»otl aiuI v?**v*»tly imiin>veiL In one large roynl 12m(v olumtMif 1028 pii^eii, Willi' 477 illuMnittntis. CliKh, Ji4.25; le««Ker, f.x«)0,
The work '- '•■' '•"' •'- i.i i.- n,.. i i .--.»>-- -i.-r,, of fti[r*^rii^*ri. \v- — -. '^. i^,. u-tfti
rttiil<<nl, mv i '• Uiwrijl, not on; : iq
lilii».'( t»y u - m* w«'ll. It ri*f). i u^
■Til- -" -^ ' •' ,ii,(„
ent ^ lit
i: is
|"'i inr II I'L^i r :ii J' Ml'" \ii<: v*-i_v ii ' i in '' r ' ?i t"* iir'i uii'.i^ii:' i:iii i pi 1 1 1 n^ iiri'i n"i , ;ciU
Illy clc»ir, ajui ejich piu I jseem^ Ut hnve rtvct^lveil i JaartmL April, i^~
^BTV DENTS' SERIBS OJF MAKtfALS.
A Series of Fifteen MiinnalH» for the tise of Stiuk-nts jmd Fnictitionors of McHlidne Siifj,'erv. Tliey will he wriU<?ti l»y cniiiK'nt Tenoliers or Examiners, nml will b© sue'l in jH>ckel-isiAe I'inn). volimies of r>0ri-54t^ lui^ces^ rir'lily illn^LratLHl uinl uX t\ low pric^. The fol lowing volumci* muy now be imnoiuKea! Kt-fiis' ^ EU^iicntx ■' //^./r m I*f:i*i'J!:u*3 S»mr*rri/ PntJtt^lo^/t/, Trkvki' Surtfiml Ajipiit^i An^ttomyf Ralke's ' < //, «nd
lJL\riKE anl Lcm_KWoud'9 D*Wc^/ir/ J/u»im/, {./»w«.* rtvu/y) ; Powi :'f^*'^^>^[fyt
{Htmtif xkortlif); Robebtson*S Physical Phjsiohffy, Buuce's Mafrrut ^Uft/i^a aW ^Vra- euft'cjr, Bkllamy's Operatit^ «5ar</«n'y, and Bells Comparaiivt Phyxiolo^y ami Aittitoinyf \In oG^itft prepanUhn/or mrl^ pitblicaiion.) For sep:inite notit'es me index un Imt piige.
^ITETLL, JOJLy, 3I.W., ami 83tITii, F. G., M. !>.,
Latt Surffcon to the Penna. HmpituL FroJ, of the jMtitutejt of Med. in the Vnii\ of Penfto,
An Analytical Compendium of the Various Branches of Medical
Science, for the use and ex:iiriiiKiti»kn of Students, A new eilition, rtiviMnl ur»d iaipn»ve*l, III one very large royul 12mo* volume of 1)74 piiges^ with i574 woodcute. Cloth, $4 ; atrongly bouiul in leather, raised bands, JH>75.
ZUDLOW, J. i., 31. J>.,
^^ Omiu(tiu»t PhU9kifift to the IViiUvMpMa ffotpUal^ etc*
^B A Manual of Examinations upon Anntoniy* Physiolo^, Surgery, Prnctice of ^^Dkfedicine, (JbHlctrit5«, MuLtfria MedifHi (lieuiiHtry, Phariiiiicy and Thempeiitit's. Tp wldeh ^■fo aildt*<l Jt Metlicul Formtdary. Tliirti eilitiun, ihoroughly reviwd, and gre^Uly extended ^^mnd otdarge«l In one hundsfmie n\val 12mo. vuUinie of 810 large pages, with ii70 illuu- ^Klmtions. Cloth, ^3.2o ; leather, ^4lJ5,
^f The armngement of this volume in the ftirm of question and niiHwer renders it enpo* cially suitable for the ojtke exaintusitionof atndcnUs and for ibuse pre^i&ringfargraduaUuii,
WILSON, Eli A SSI US^E. J?. S.
A System of Human Anatomy, General and Simial. Editetl by W. H. ronuiociiT, M. D«, Pnife^snr of General and Surgical Anatomy in the Mediail Cidlege of lito. In one large and hamW>ine (K'tavo volume of 616 jiagesy with 397 illiistratioDS. loth, $4,00; leather, I-ICHJ.
S3IITir, H. H.f 3L />., and IIOBNER, WM. E., 31. D.,
BmttUiit l*rnf, of Sur<frrff m the Univ. of PtHnfL, ete. J^ite Prof, af Annt, in the Unn\ of Penna.
An Anatomical Atlas, llluBtnitive of the Structure of the Human Body. In on© rge im|»erLai octavo volume of 200 [lages, witli 034 Iveautifnl figures. Clotli» $4.50,
CLELAND, JO HN, M7l>.rF. It. S.^
Profejutor fif Annttuntf find Pht/Minfofjtf m Qnrcn'i Chfkfjr^ (Jntwny*
A Directory for the Dissection of the Human Body. Ln one 12jiio»
^olume of 178 pages. Cloth, $L2o.
''BELLA3rY, En WARD, F, It. C. &,
Sentur A/^iHtftHt'iyHr(ffon to the Chftrhuf^Cyom Honpttal^ Luimlon,
^■^ The Student's Guide to SuTRieal Anatomy* Bem«: a Description of ^' ^^kl«i*it Important Surgit'nl lk>^ionH <tf the Iluman Body, and intenrled an an Itilroduclir ^HDj>enitive Surgery. In one 12mo, volume of 300 pagen, with 'M) illustrations. Cloth, |
I
I
8
lARPStrnRXE'S H\Nrm<TOK OK AN.Vin^lY AM' PHVSInfvUGV, Hccoml c^lUJoii, rnvinotL 1(1 iinr nnytit I:; mo. vol ante ot ^Ito pAges, with 'Mi WOudcutM. Clotti,fLTd.
HOUXt:USHi|»Krr\L AVATOMY AND »!!$ nitHlifieil, In two ootavo votutiv««ul ^9a^A \
DALTON, JOHN C, 31. 2>.,
Profamor of Phi^AU)lo<fy in the Cudftia of PhtfititianM and Surffeont^ Xew For/t, eir,
A Treatise on Himian Physiology. Designt*! fur the une of Students i
Prnotitioners of Motiicint\ St'vonth etlitioni thoroiiKlily r ' ' rn I rewritten. In cm^l ven' hiindht mie nt'tii vo volume of 722 pages, with 2r>2 hvnwx i i ngs on wood, CUkIj, J
$5.CKJ; lejilher, ^<3.00; very handfeorac half KuMsiu, raiiied 1 ..;.*., , , . JL
previcms on**, Kntl wtll t«t»d la kfrep ih^ pmf«'n)oiil
phv^iOlMKloaf kooM^tedge, — 3tkh*i)an Mtdteai Ke^\ April, imi.
Thf rmerits of PinfPHHor Dnlton's t<?xl'lKX)kj lila
nt'- i-^ nvo rii'i ft otiftp»c»r
oty^ r nnd the general
CCM I , ,' rtly known, TJiwy
hftve it^utii^ Jus U At^iMK>K ihiJt fine triomt fflntiltivr to American sludeiits.— J/(*/, AV<*t'r./, M«rch ^, Ih»2, r«rtaiitiy uo pliy»iolop;ical work lia^* CfvtT i.^MieU frotn the prei«B tlmt preHtintc^l itMBiibject'iimtlcr iu ft eki«ri?r :ind more um-ftcrUo light. Almosi ev»»ry piAi^i^ L)ejvr>i cvitkrire of tlie exhrtu^tive rcvlMon tiuU hii>i trtkenitlme. Th« mnU'rJKl is plfii^ed in a more comjtfiicl f5>niu yet ir« delightful (♦hiirm i* re- iUrincd, ivnd no jiuhjetjit i» tfin>wii tnU) oh^carity., AiCygethcr thif^ edition i;< fAt in ivdikunce of nny
A^i:.
mt?tiil til us, Lc'f nmdo tf fully np I
Odco AH 1
todo.— t
^ iM»k1
FOSTER, MICHAEL, M. !>., ^. B. *.,
Pru/c4aur of Phf/muUjfiy in Crtmbritl^je r^*Mtcr*ifVi Entjlftml.
Text-Book of Physiology, Set-oml Americjin from the tliini EiiglUh < Edited^ witli exTeniine notes Jin<l ndditions, hy ErnVAUD T, Hnu'HKRT, M. I)., Ult| Ik'inonstnitur of ExperuiienUil Ther.ipetitics in the University of Pennsylvaniu. In otK IxandHonie royal V2mo. volume of yilD pages, with 259 illusi. Lloth, |*S.2o; leather, |a.74.J
A mntty crmipacl Rnd «e|pn(:iftp work on phyf.io|- i prf f> ' ♦' * " - O^ has never lieen piihljvlit^d, urid welnlieve our- ' Om •Olve* uol to b<' rtii*^ink('n In Ji»-s<Pttl«)f5 ihat it hiu* now tteen jniriHlunmi in(i> every niediful codeine In whieh the Flniurll^ti hingunKt'' is tijH.Uen, This Work eonformn tu tliehitefit jei*i'A*f lie?*ltil'>jr*Htli>^y and cttfTipanUi* ' ■(■'-"' • ■■ i f i .>, ii,t(, fonsni* enitinn l\\v Iai^ ifj;lc«l ehem*
\»tVY ntuj the I <n*t{ Ferricr
lin»l others-. T..- w ..- r., m d jh i»ueli a!»
to rfUdel' tlje whole »*idijeet lueid Atid Wtjil ctin- nceUfd in Its ifiiriou}* pai(>.— C^Jcm^o M^hcnl Jour-
t>r, Bifiehnel Fcwter'n yfnntmt of Pkt/itf(flf*(ty has betsn tmnshited into the rrermi^n^ with n prefftce, by Pi'ofcbsor KQIine. Kdhiie pijints out in hi»
and phvHioianH a Irioot* wtnei* truM'oly r»r ief*'i-enee, Iml whieh, lively HfyU\ inrlt«» the leader • iilMav«« tiHi'tuI, e*perirtlly M'h* t, el tiding? nunxMofifr mailf'rM In n
cUHMion tn wi'i"^- -■••I
striii't viltli 11' author huN p; tion of jt in|. meiH, ♦'inee
11 not 10 l»y it*
p}iy*ii*>JoKV, a I
U^Xt-lMI ^
POWER, HENRY, M. B., F. R. C, S.,
Kfiimihtr in Phif»ivty(ft/f Riij^at College o/ Surtieons of Ei}^{an<L
Human Physiology. »S/i^ir% See Studcnfs' Series of Manuals, page 5. MOBEETSONf J. MeGMEGOIf, mTa., M. B.,
Muirhrad firttiarijitrnfor of Phi/Miolnijyt, University uf Glasqow. Physical Physiology. InacHtrprepamlionr. See StwUnU* Series of Manual^, {
BELL, F. JEFFREY, m7a7,
PfifiMor of Cv^Hpffrutae Amttoiutf nt Kw<f'a, fhffrgr^ London^
Comparative Physiology and Anatomy. In active prcparatian f^r publication. HitG StudeM Series of 3Iunuah, ptig^ ^, *
CARPENTER, WM. B., M, D., F. R. 8., F. G. 5., F. L,
ReffiHtrfir Co the UmcerMifjj of London^ fie.
Principles of Human Physiology. Edited by Hekry Powek, M. B., F. E. C. S., Examiner in Natund SderueH, University ^A f >xfonL A new Arncrit-an frtun ll eighth revise*! and enlargetl edition, witJi titdesi and additions hv Fhantib O, S.Mmt, M. late Friifewsor of llie InMitiitea of Medirine in the University ia^ Penusjivanin. In i very hirge and liandsome octavo vohime Qi ]U8:i piiges, with two platea and 373 illi tratitms*. Cloth. |?.5.oO ; leather, $6.50; half Russia, $7,
The editors have, wUh tJitMr udditjoins to th© cmly ttork on phyMitjU^gy in onr hingtniK<^ that, in iUr- fnlln,*! M''n^e of (h» wonl, is the pi-odiietion of A plOh)^«>|iher u« well nn a phyHlohigi^^i^ hroii^^ht it lip fidiy Ift the Htaudanl ol oiu knoM ledge of its Buhje<>t Ht the prei*enl day. The a>hlltionc« by tho Amerlean editor give io the work a*« it iw n noni*td* trablo vitlue beyond that of Mio Ja»t 'Englii^ii^tJi-
tlon, We hare been agr<»en^»1y *«firprf8*»d to I the Vfdnine ^oeo|lnplete in oikntrd »-• ll>e "tioifa^ nnil rMni'Lionw of the nervooH >>y>i«'fti in nM \\* t tion^ — a t^idiiteri tfiat ia iminy reH|»»»rt^ inj " the mcKHt ditfieult t.f all, in tin? wholi^ phyi^foloK\% np'in which topioluce a rMlln faetory tiVAllwur the eliis»j to whlelj (fi« ( fore ti-v)>tdoag»,— J^u/ A*TT.*»«d AtenU />!«,, Apr^^
CAnPKNTKU'SPRVZF. ^9K\ OT^'YUV^Vjav^KSU \ LEHM ANN'S MANIUL OF CH^v u * i T>iit^ jE Aa»c- \V i I h t\ pi V Cae e t^v \i.Y. Cot*ti\v, >V .\> . , vvrs A \ wxvt^ (wvA. ft?V\svV>\A> ,N^^ X , v v l2ino, volume oinSpasoB. ao%\i,Wic6u\*. \ trtAicmfc. v:A(A\.,?a..a».
HBjfRT C. Lka'8 Sow & Co.'s PrBucATioss
9
ATTFIELD, JOliy, Ph, Z>.,
/Vo/r^iJfvr of Procltcat Otrmmtrf/ la the rhnrjim^ruht^tt Sorti'ti/ of Orent Britain^ etc
Ctiemistry, General, Medical and Pharmaceutical; Indnding theChem^ t«try nf the U. S. Fliurmacnp<hn;L A Manual of the General Prin^'iples of the Science^ and tfieir Apiiliciitirtn to Metiielne mid Pharnincy. A new Anieritim, fmm the tenth EnglisJi editiMiii speciallv revised by the AntKor. In one himd*une myiU rimo, volume ^f 72i pages, vrith 87 ill'u^triitions. ' Cloth, $2,oO ; leiither, |:t.OO. JwU ready. From the Author's Preface to the Tenth Edition.
Thb* mannid is intcnleJ as u sY!*teai itii; ex lament of the gtjneral truths of chembtiy* but i» written niuinly for the pntiils, uHaiHtuiit^ und |»rin>.ipuis ongiiK^d in medicine ana phjiniiaev. It will be* found e<|iuuly u^fid as a readm^-Uik or as a text-lKK>k, while its <H^iiij>rt'hensive Index, tHmtuimng cii^ht thouswind refureiirfs, will tit the worlt fm* after- oinf>idtatinn in the ntur^o of husinesb or nr<»fe>«ionEd prnfiire. Introdiirtory pa^e^ ure devoted to a few leading pro{K?rticr4 of tlie element* The eonsi<lenition in detail of the relutions of the elementary and n)m|xnmd nvlicids follows, Kyiilhetital and amdyt- icid beurinj^s Ix-'in;^ polnte*.! out, ami attention frextuently direet**<l to eimnm^tini? Of nnderlyiniT truths or fifeneral prineiples. The ehemiHtry of »idwtuneeH natiir.iUy nts»x>eitited in vejrebibles and animals is next eonsidere L Pnu'tical toxieolr»«^', and the ehemical ai well iLH microtj^vipind ehanu^eni of morliiil nrinw, urinary se<(iinients an«l eidt'idi, are theo I », The conil.jiUn;? w.H^'tions form a hdH>ratory-;^nide to the rhemiral and phy^ieal of qmintitative imalyHiri. The work now inrlndes the whole of the eheinistry of U,_ recently published Unite<i StatCH* Pharnitu-ii[ueiji, and nearly all the cliemiMtry of the British and Indian Pharniacojxtda^
BLOXAM, CHARLES i.,
iSnffAMir of Chetnutry in Ktng't Q^Uge^ London.
ChemiBtry, Inorganic and Organic. New Amerienn from the fifth Lon- don edititmt llioroughly reviseti nnd nujdi improved. In one very handw^me octavo ^brtduine of 727 paj^et*, with 1192 iUustrutionK Clothe $3.7o; leather, ^4.75, Jit^t r<viJi/, ^H This work indesi^ed to pive a elear and simple di^eription of the ekmicntM and their ^Bprineimil eotn}Hamds, Uith inorj^anic and orfxanic, and jiIko of the uhemieul principle* In- ^^^nivcd in the most imiK(rt4int bmnrhei* of mannfueture. it will thus ^orve n§ a txinvenient ^Hlext-ltook for the Htiideni ot general or me<Ucal ehemistry, and aH a work of reference for ^BUu«c en;^jftMl in ihe arl^s and man n fact ure.s. The author ban ninied to remler the torrai- ^^Tiolorjy and m:ithernatii's of ehemislry as simple el^ pfHsible, and to inereaso the vividness of tlie tt'Xt liy the iian-iduetitm of ex|K!rinienm witli illuntratiuna of apparatus. The table of content-* l\n» been arran^fed to nerve the purivi!^* of an abstract, l>y which the stialent ay examine him.Helf npm each paragniph of the Uiok, and the Index ineludes cross- ferencei? to the moat imiK>rtnnt fomiuhia. The American edition Inw l>cen parsed throtigh the pre>w Habje<i to the di west fw-mtiny, vkith the re>*idl of eliminating mimcrouM errors which (K'cur in the Knglit^h sheets*. Though lliL* eilitiou euntaiiw as mnch nuitter as its rcdec*e5!8or, the puhlishers are pleasod to have been able lo make a redudion even from lie fonner htw pritx*.
^^1
m
lilCMSEN, IRA, M. !>., Ph. I).,
y^i^^A■^'l/■ <>/ CfittfiUtnt in the Jtthn^ tfitfikim Uniftrsitfi^ Bnttimore,
Principles of Theoretical Chemistry, with Bpeeial reference to the tVmstito- jon of C heoucal Compounds. Second and revisetl edition. In one handi^tme myal 12ni>o. i^lum# t»f 240 pagtes. C'loth, $lJo. Jml rmdy,
I From the Author's Preface to the Second Edition.
^^ The l»f*fik liufl l^een tln»ru\i^hly revise^!, and much of it has l^ecn entirely rewritten. ^BThe principal <"han^;eti will he found in the chapters on valem-e and miiHliiution. Theae ^^Niave been materially ohan^eli an I, I believe, much improve^l, A short chapter on the ^Bphy^icul methods for determining the constitution of chemicjd mnnM^undw hui* been added,
^ rOWXES, GEORGJ^Trfi. D.
IAMinuilof Elementary Chemistry: Theoretical and Pmrtiml. lleviAed <tnd <'!orrecte*l by Hi-:Nitv Watpt^, H. A., KK. S,, fciitorof A DitTroXAUv uv litEMrsTuv, -ttc, A new Americrvn from the twelfth and eninri(ed (jonlon ©illtion I
Kdile*l bv KoHKRT
IBuiDtira, .M, IX In r)no large royal 12mo. voUime of 1031 paj^cs, with 177 ilfuAtratiom Ij&n wood and a c dorer! plate. Cloth, ^2.7.i ; leather^ $:V2\
Thi^ b'('»k oi»ori>* PliV'ic-, incl<iihii((
with a irortti-*** on Chrmi^-'ul fU'Ht, Lkht, Matf:ni»TjHni un-l
hy Hi« t^rr.it inlvnn 'i* \n the sok'nu' of Ctminls^try
or Irtto y*>nr», tfiriohftptur on t*
ofCJiMriii 'jU Philosophy hiUi '
HUM n'tk 'lk4»<J lU IWkiitUi «»4lilliuu. — 04*4/ ir-J..
Wohler's Outlines of Organic Chemistry, Eiiitod by Flrrja I fey Ira UKMisEN, M. IK, Ph. D. In one 12mo. volume of 550 \»i\^'^. CXftlCtv,^
BOFFMAKN, F., A.M., Fh.D., & FOWEIt, F.B., FluJkf
ptt'>he Afii^f^it to the State of iVdU Vt^k, Prof, 0/ Anaf. Cht^i. in PhkL CuiJ. of rfcamoei.
A Manual of Chemical Analysis, as flpplied to the Exiimination ^^f MediciTrnt
ChemittiLs and their Preparations. Being a Guide for the Determi nation of their Hentity and Quality, and for the Detection of Impurities and Adiiltenitions. For the iisc « PhjLrniML'lmth, Phywciiins, Dnips^idts and Manufacturing Chcmis^ and Pharm:w^uti<iit nnd Metliral Students. Thinl e<iitirm, entirely rewritten and rauch enlarged. In **ne very handsome octiivo volume of 621 [lagcs^ with 179 ilhistrutiona. Cloth, $4«2o. ^f"^^ 'r.^h*,
Wi«i congratnlnto the author on the Appoarnnce cjL-ily qndr»rAtAn<i th«m and prarf of the third wiiiJon of Ihiea work, ptiblL-ihivi for the first Hm*> in thii* country iU»o, It i» ailmirAble and the inrtrmati-m It undertAkos Ut *njpply it* l*ctih extem^ivv iiad tni?' I worthy. The e^?]erlion ^f pro- oemeie for dvC4'nninin|E; thfl parity of the Aub^^iUn- oca of which ii treats in exof Meat und ttie doscritK tloD of them I'ingalftrly f'xpli*'it. M«irvovf»r, it tft exi*eptionnlly free from typof^riipliioiit errorw. We havff no heahailon in nr-fornrm^nding it t<i those who are erienjf^i'd eifhf r in Th«» masuji^urMure or the testing or r ' ' ,' fAjndon Pharmor
etxifimi J" 18«3.
Viewed ; J nim«» iv« well M
ta the niHlin^T ii» wmrMi tnrv Ii iv ' initHl
are
Ilk wMirMi trirv Ii i'."
oat^ the work will tx^ found ii<«coiii br d»«**ini?d. The doficrir'tJoiii* >■: fult wUliout beini^ reduudunt, f«o tJiut
ftt)c«ejssfully; at the #»amf tim*» tt - piven with f*iieh rain cteeome weAri^ome aIi^ dent. A work i;^ thu>- l>t)ok of re f« re fire f >r 1 to impart nuoh inf»rn cftw may be useful or 1 itp ob^eetfl. — Amerimn ./.mr-'tat ut , Thjs work has un<ipr)i!;one a v* change ulnoo the first t^dition a ill iU present form it in a mark' on the earlier editifiOK The a^i' tujnKralutjitfd on the manner in sy retnotlelled the work ; in it* pr- Piirc to prove a valnahlft aid m pharmnneatJcal chembtry.— Lun- Ih-uffqvit, June 15, ttMCi,
In one t2mo.
WATTS, HENRY, It. A., F. J{. S.
Author o/".-l iHcttnnarff nf Chrmijtfr}/,*' rir.
A Manual of Physical and Inorganic Chemistry,
of 500 pages with 150 ilhii<lnition& In preis.
CLOWES, FRANK, D. Sc., Ltyndan,
Stmitjr SeiM€€- Master at the High >Sckof:tf, ^'tlcca^ttl(^umier'Li/m€, «f«.
An Elementary Treatise on Practical Chemistry and r
Inorganic Analysis. Sjwci;illv adjipte<i for use in the La bo nit ones ^ Coileges and by lleginners. Seconfl American from the third and revisetl En-xi i In one very handwonie royal 1-mo. vrdume of 372 |>a^es, with 47 iUiistnitions, (.'l«i Thecblof ohjpptof ilieantliorof tlje preHentworU renders it unlalelliplhl*? u^ Mh» rnniv WKJ* to furnish onp wliich was fliirtioit^ialv eleraen- I unle.'is sapplemented by v
md
lary in the deHi'Hption of ajifiaratuf^es e?iiemioalK, in<id<?« of experimentation, *>f,i'- r-n m- t^ ** reduce ti> A minimiun the amount' nired
from a I't'ivtber,'" ]tt»agM I fact
tfons from the t<*a'^lior, Tl- of l*r. t-lowej*. examined v.. above elaims, im foand to be a mi* on either elemenlary workn. A f*t
that one of the mot^t ?*ern> • the | fatly readi^ thin text will iK*areeJy
utility of many of the timaller toxt^boukH i» the loo I ance of a tutor ia fjllowinjj; out iiuv of (h«> cl*
great eonciAeaef^a of the language employed, which | pe^meata described.— f'o. .Ved Manthly^ Aps Itft
RAL FE, CJIA RLES II., M. D., F.l^. €, P.,
Amijtt<ini Phtfuirian at the London Hmpital.
Clinical Chemistry. In one j>ocket-«i7.e 12mo. volume of 314 pajo^eH, with 16 ill UHlrat inns. Limp « Inth, red e^lges, $1.oO. See Studenfs* Sertrjt of Mnmtah^ iittrc x
T)>i« little t<*:tM»ni>U opens with a nhort and able 1 dealt with. The fhnrt eph- • ndi-
ilceteh of the eoni^tiiaentst of (he anhrittl body, and tiuns of the blood Im also ti; 1 M%
of the chemical roar'tioas of \i». chief orifanic and little CUmraf Chrnnatrp will " «ta*
inorpcMnie. componeatK Then fittNiWN a (^htipter 1 dentr<, lut it eon(alai< maeh valutttih^ufonnuii-tn ta j on the blond, ehyl& and lymph, in wht<'h the a ertiekU Cftm^aas.—BritUk ditdttfU Jtmrmti ^u^tm*^ chemi(*try of tlie^se tluidf* is* ably and eueees'sifully | ber 24, 1883.
CLASSEN, ALEXANDER,
ProfcAmr in the Rmjal Ptilpiechnic School^ AiJC-tA-Chapefii.
Elementary Quantitative Analysis, Translated, with notes and Additions^ WJ Etxiar F.HMiTii, Ph. D,, Assistant PrtjfesHor of ChomiMry in the Towne Scientific SchoiJ, ] Univensity of Penn.'*ylvania. In one handsome rovul l2mo. volume of 324 |wges, with 36] illufitnitiona. Cloth,' $2.0(>.
It ii4 proliaHty the bent manual of an olementary I and then advAneing tothe analy^^kieof miti<Ernit»«D4lJ naiare extant^ insomuch a^ ita ntethodm are the I such products an are met with la aiiplied cheinla^ t>eat. It teacher by examtilen, commencing with 1 try. it is an todisipe usable book for atiideat* la ■iogle determinatioaHf followed by tK»paratiou9, cheinUtry.— Boston jQumtU of Chcm%*try, Oct. UTt^
GREENE, WILLIAM H., M. 1)7,
Drmofviirator of CThemustrif in the M^icnl Depftrtmcnt 0/ th€ Univ^rUty ^f JPeniuyNil'ivi.
A Manual of Medical Chemistry. For tlie tise of Students. Based »ipm Bowl raan^s MecJicnI Cherntstn'. In one 12nio. volume of 310 pages, with 74 illus. Cloth, f 1.7&.f
It la a conei.ae manual of three hnndred r' • ^ition of compouii 1 1
gfTiagan exrcdlpni i*unimary of the best nu ; The derectioti
ofaaalyEinKtheWijnid.s and HoTid»4of thebody, i^nt fnhiewi^ f»r (^
fortho cslinialion of their normmV ooTk^Ulvit^ut? wa^i .t»>nt"r ira^nilioQer.— /?<>»/«» JL or tVr-^^rN ..JuEie, aocj
MANrAL OF qUXUTXTl\l£. K^K\.\%\ft,\W4Qtv^v\\X.V B7 Robert Galloway, F.C.S, Ytom \ho m\»XA\\V\\\xiXT»X\w*.
C. Lra's Son k Oo.'s PtmLicATiO!!
i.f Mat. Med. 11
FARRISH, EI>WARD,
Late Prof€A»f>r nf the Thenry and Pntffifenf Pharmacy in the Philadttjihia Cbttryt of rharmaep.
A Treatise on Pharmacy : desip^mvl au* a Text-book for the Slinienf^ »ml as m
Suidc for iho Ph>'»ician ami Fharninceutist. With miinv FornniUffi and Prcscriptiotw.
i Fiflli edition, tliorougliW revised, by Tiioma^i S. WlKfiAND, Ph.G. In cue hundBoiite
[oftflvo volume of lOll'i papes, with 250 ill list nitionB. rintli^ $o; leather, $*j. Jn^t rewftf.
From the Preface to the Fifth Edition.
A new eilUioriof Mr PurriMh'sHtiniihird wcuk hiiHlM."on rcnderi'd an im|iemtive fiet'isssity^
I mot only hy tlte bile revUion of the LI. S. F'bjiVTHtict^pipift, but also by the great aiivaneo m
[chemical und phiirraHceiitifnd Miieutx' within the last det-sMle* The change* tfiuu rei)iuretl
have rendereil the task of the editor by no int'uns lights and hiive con^idembly iiicreaBe*!
the sixe of the volume, in sfiite of earnest t^fforts at amdensution nnd the omission of nil
|<ihv>lete matter The new pr<»|ianitinn« of tlie PbannnttHMiMa have bten intrtxlui*e<i, tt>-
ber with its teyta for i'b(*mi<_^l and oflirimil i-om|M>unds, and it>* syylenj of partK bv weight
pbiee of definite qiinntiiits. The entire cbemind se<'tinn Iiuji^ l»een rt^arraritftKl in eon*
formity with the jirenent viewrs of ibnt Hcienre, and the Hubject of testlnpr, Iwjlb qnsilitjitive
and <jujintitative, has W^en rendereil uk wmiplete a^ llie Hiipe of the work would permit and
the wantK of stiidentn are likely to retpiire. AJl ^cnenil pharmat^utind and ebernieal nrt»*
eeaseA have lx;en arran^CHl ta a se|>arate part^ tbtiti faeilitJiting reference and avoiding
re|»etitii)n, while H[»i'ei}*l a|jpuratuK for iiartindiir rhit^sen of preparations b!« been plare^l
tinder those elasst^^. The sylhd»i^ whicli proved *tr> valuable a feature of previous editions,
and on which Pn>fe*kir Mairscb bestoweil s<i niu<b care, ba\e l)een relaine<l; many of them
have l*een rewrif ton und new onen intrtKlnctnl, AH new remedies of interest have l>een
atldetl, and in the cbafrter <m elixirs some new formiilu? of inueb (Mipubirity have Ijeen
^ given. The etlitor need onlv add that he has spared no lnlM»r or cure in the hope of ren-
<)erinL; the work as ait't'ittableaj^t it hui<i liitberto been to the student and the pharniaeeutist*
HERMANN, J>f. l7, '
Profr-e$(jr of Phtntiohnf^f tn the UnirtrHtttf of Zwifh,
Experimental Pharmacology. A Handl»ook of Methods for Detemiining the Physiological Actions of I>rui,'>^. Translated, with the Author's permission^ and with ^xteiLMive additions^ by KfinKRT Meade Smith, M. D., DemoiLstrator of Physiology in the University of Pennsylvania. In one handwnie lUmo. volume of 1^9 PH^^^ "ffiih 32 I il lust rat ions. Cloth, fd.olK Ju»t ready.
^
%
I
The :Jf [^T^Minri 4.f iii.trTmlf-aiid lhelruiftnii|f<>m^nt,
' the pnth^ m and etianjcrf* nf pHufHinTiH
( In the b(>fi . .itHHi nf the !-yinpt<>ni« pr<v
I dar.t<xri hy \s' . , ., . jutitiii^i in ti'^Mii.v in iht^ re-
pn>Jijouvo ftinctioii itiei in 1 , ivction on
fDUf*oh?« j*rid fn nerre;", anu' I '^hemicul
chaii^e." linxirjofd by poi^uu , ... jocosjtively
p|MMJ«ed in rdiriciw In k practical oiHtrtictive fiuthion^
«rhl(ih *i>eak!« well for Imth the Author »nd the
trnni^ltLtrrir. The binik is dciierving of ah cneo*
mium AHi a correct expcmeiU of th« spirit and
tenilencifis of modern phArntAiH:i>loffirAl research.
After closely poriwInB tho i^iiu^eH, nil liMicn to over-
Hovfog with the rk'h St fririi i.f phyttJot«>pi<^iil in-
▼••IllpAtion, and alter following ihe a.>t/»andiriK
nroKToaiB of Umw phiirniHColony a^ revealed hy ihe
author, we f«el that vfe are fitxt ApprnochinK the
rMJixation of that ut(i»pian dream in which we
heboid expcrimentftl and el laical experience timily and inhcparahly aniled. It is a roliahle, concise and practical vatU mrrttm for the tlm»*
S reined worker in the laiioratory. — Xne Ortennt teiiieat awl Sttrfji^^al Journaf, Miiy» IttH-l, Thin munnal in for the purpose i»f InRtriiHlnc
"-■— '•-■► ' ' — * '- ^^"' -'-I" -f ^!-" -»'V^ll'
Of
tlve vrork for one eagaged m on < f"h,
and will h*- foiind very vAlunhlo t« mn.
for there in in it a huge amount ii |Mr>-i i,:iii^Al
informatioit that Im not Ui h« fonnd in ordinary worki* on tdjy(»io|ogy. The IrBaj^latnr hA-n added very conDlAeraMy iit the work. The little «rurk b worthy of the atudy of alt fttudent^ of physiology. — Cinetnnnti Mt»iirfit Xctrt^ March, l*Ki.
MAJSCH, JOHNM., Phar. D.,
f*roffAJinr tif ^fat/ria Mrtiiea and Botam/ in ihf Philati^phin OoUfflf ui Phntman/,
A Manual of Organic Materia Medica; Ik-in^ a Guide to Materia Mediea of
the Vegetable and Aiiiuial Kingdonis. l\ir the use of Htudeuls, Dnijtfgists, Pharmiieijita and PbyHieians. New eititiou. In one hatidsonie royal l2nio, volume. /Veporin^, A few notices of the jirevicais wiition are appended.
A h<x>k evidently written for a purpi^so, aad aot i The above mauaal, by a welhknown autharitffs •Imply for the purpose of writing a book. H in this department and i»ne of the antimrH nf ilia com pre h«»n Hive, inasmuch a* it refers to all, or i iVa/v**;*a/ /5»#^**Tw,*if/^rT^, ij» a work for which nearly all, that h of e<i'>*>cnUal value in organic ma- ' ' leria mediea, clearjirvrl ?*iitjplK in ita i*tyle, concise, •inrt> it would he <fTrfli'n[i tJ>flud in it a superrttious word, and yH HuftSci'uHv i xpUiit to -Ati-fv the mowt criticaL The Itvtt U freely i!hi^tru(nii with Woodcuta^ which caiintj-i fail to tft-Valiiahle in fmiHl- lariftinK rtudentu with the pltyMical. otlcrusoopic and macroRcoplc npp*^tikraiice of dmirM, — Chicatfo Medtrai Journal and Ktntmnf^r, AU)^. lS8'i.
I of pharmm'V shiiuld be grateful ' one in whitb the iK'ncioner needw i
' lii'al liue , ' ktar, noo-t iimi Surg, J
t It not H wiU i-=.p a Miib- litlon the rig A nitn- ■h drug la inttted —
&
GRIFFITH, ROBERT EG LES FIELD, M. />.
A tJoi versa! Formulary, contain inj? the Methods of IVeparing f^ tering Officinal and other Medicineii, The whole adapt e<l to Physicians and lata. Third edition, tboroM^hlv revised, witfi ininierous additions, l^y JoiG Phar. D., Professor of Materia \fedicji and liolany in the PhiladeluhiaColleg"© In one octavo volume of 11 h pages, with iiS tl lust rations. ( lotn, ^Jj^', \wi
con Phar<
8TLLLE, A., M. J>„ Xi. !>., Jb MAISCU, J. Jtf.. rtuir. ».,
Jh-offjutor of the Thtwft and Prarlirf uf Meiliciae nnd of Chnirni Mtdtcwt in the
The National Dispensatory : Containing the Nauinti i ry. Phar*
niftcy, Actions and L*yes+ of Me^licines, incUidinja^ those recognixeLi m un. i i - '5 tif
the I'niieiJ Statff*, ( Treat Brilniii iintl iicniumy, with niinienms rerereiiee^ i ach
GidfX. Tliini etiitioii, thnri uglily revineti nnd f:re:itly tfnhirue<l, f^i i xiA
imperial octavo volume of nlioiit UjUO i»iiges, with several hundred lino «. ' ^«c
Tin? puhlii^liers Jiuve m\w\\ pleut^ure in announcing to thf Minlirat . lii^l
ProfeNtions tiiut a new iHlition (»f this im|X)rtant work ik in prcfi!«, und limt it will u)i)«iir in the Bhortest time i-onfei^lent with llit* ciire requisite for piinting^ « WT>rk of immense detail^ wJiere absolute jiminuy \» «tf b*iirh soprenie inijwirt^ince, Besidt»s its revi^iitm «a the hjiiiiiis of ihe U. 8. Phuiinaeo|.Kviri of 18JS0, it will include alt the lulvaiices nnul«» in iti> deptirlment during the peHiKl ehipsetl ?.ince the prcpanition of thiit wt>rk. T ' A uHX riicrnt medical and pharmaceutical litcj-aturc, tjoth divniestic ami foreign, ' littf-
oujfhlv tiifte<J, and everything that \h new and im^K^ilunt has lietn intr^^i ihet
with the it^Buits of original in vest igjit ions. To awoni with the new Phin the
oflicinnl fonnuhe are jjjiven in pruLs hy weight, hut in every iuMaiue, for il on-
vcnicnce, the same pro[j<>rtion8 arc ^\m expre88e<i in ordinun^ weiudit^ and i Ilie
Thenipeutitiii Index Iia« he^n enlarged so that it eontaini* aU>ut 80CM.) refer- lycd
under an alpludretieal li«t of diseases, thuts placing at tlie disiKisii! of the prattiuoiici, in the mot^t if»nvcnieni manner, the vast fit«>res) of therujieuticsd kn<iwledge eoijsUmtly neeile*! in his daily j>ractiee. The wtvrk may therefore Iw justly rejfurded as u complete Encytio- pnedin of Materia Medira and Thcrapeutici*, inchnling lS8.'t.
The exhauKiiuu oi two very hn"Ke e^^litions of The Natioxal iJiSPEXj^ATnttY •ince- 1870 is the most concluhive testimony as to the necesssity which ilenianded its prepnnUicn und to the admirable manner in which that duty has been perfonned. In this revision the authors have srjughl to add to its usefulne^ by including evervthin^ proi^erly comity within Its 8tv>pe whicli am be of use to the physician or pharinui-ist and at the sanie tirne- by the utnififtt conciat^ness and by the omission of all oliwdete matter to prevent undue increase in thesiy.e of the volume. No eare will lie spareil by the publishers to render its tyjH5graphical execution worthy of its wide reputation and univefsul use M Uit stand a rd authority,
A notice of the previous etiition is appended.
{
The atUhorn liave pmt>raceirl the orvftoitiiaity offpn^fl for R thnroiig}i rerie<ion of the" whtatti work, (ttrivuig (o tric'liale wlUiiri 11 all that mipEht hare br**ii urhitl^d in the former im1 it Fan, louj nil tlml tins newly fipp<»nred of mitfiiricnt 'im\vc^vthuce during tt»e timi? of its collidwtrutioti imd the ^hort itit<*r- ▼•J eliip«ecl fiinM* llit.» previoUB piihlicatron. After hAVitig gon« €Ar^ fully tluougfi ttie volume, we
miiFt admit thiit the authors Imve Inl'orpt! fjillll^ fully und VfiUi rticc*es» in iririint^tinirik: iIh- ln^h chioftrtor of their work a* a lh<* rcqinr<*mfiu» of t}»e -r fiftfply turn in on* *t of thr I c«»rnif>K <?verytli, with Pharmiw?), ^Am. Jour, of 1 I
♦• 111 tjn.iiiti* ' itoa d Th«rupeutica,
JD UJARniN-BEA UMETZ,
Memtter of the Actuif.tutf uf M'ul*rinf.^ Fhtfuirian U* the Ildpifal SL Antmnf, ParU,
Dictionary of Therapeutics, Materia Medica, Pharmacology, Tox- icology and MiDeral Waters. Translated with notes and ndditioDs. Pttpcain^^
BIIUNTON, T. ZAUDEB, M. Ih,
lecturer un Materia Medtca ami ThrrnpcuticJt at St, Barthotomtw*» IfofpHaf^ tte,
A Manual of Materia Medica and Therapeutics, includinir the Phannacy, the Physi^>h^gical Action and the Therapeutical Uses of Dnigs. In one handsome oclJivo vohiine. In preni.
BMUCE. J. MITCHELL, M. D.. E. K. C. P.
Materia Medica and Therapeutics. In ujtth*€prej[Miraii<tn for early pMiciitkm^\
See Siudmh' Series of Mamtul'i, page o.
i
8TILLE, ALFRED, M. !>., LL. D.,
ProfetMor tif Thmtry and Practice of Mat and Qf Clitticat Med, in the VniMh of^^mma,
Therapeutica and Materia Medica. A Systematic Treatise on the Action an Uses of Medirinal Agents, iuchiding their iX'Striiition and History, Fourlli eiiitit»n^ 1 reviscxl and cnlarg^ed. In two large tind handsome ixtavo vohnnes, containing 1936 jmges. Cloth, iflOAHi; leather, |12.00; very handji^inie half Kiise^ia, raided bands, $l,'ltX>.
The mpid extmu*(tion of thr«?e editions and the | multitud** of !tji ritafi '
univfr^-iO fiivor with whk*h the work has b«»en re- reitfarvii into clinical cejv^d hy the medical profesjsiou are pullipienl I It r pfjv*" In tlie phv-
proof of it'* excellence lis t\ r<.'pevu»ri' ot v''^^^^^'^-*'^ ' ■ informatian (or ln«
fully *v\*lttiii* t^^^H v^i\XS.Kiv,—
.^ , ttffttui
nnd iiMefn
edftlon before \i» ,
Amtft'fcan Jovrnai of Fhnnnnei,, Yeb. \Wb, We cnn hardly admVl ♦^lat \t Vva« fcTWfc\\ift«v^
\FAnQlJHARSON, JROBERT, M. I).,
A Guide to Therapeutics and Materia Mediea. Third AmcHcnn e*iition, Fipecially roviiw^fi hy the Author. Enhirijt'*! and i\dA\itvd to the U, S, rjianimcnjMj'ia by [ Frank' Wonimuiiv, M*D. In one handsome 12mo, v<ihiine<»f 524 paj^es* C:ioi Ik 1^11.25.
T.>r F?iirt|f»h!*r»mi> TU*»HV"*tM^« i* rm>fctr«j<^t*»f^l
I of ii]f^4lii'iiie«* Aiul Iho Ul>*r»nk'»t?r| c^urnliitioii^ Iti whicin tlM*y tTitiyt pmve ii»»*'1'mL The doub(»*-«*ol'
phytiioht^KJciil tuniou of tti« mcdieinc. And the otht^r
Ih* »li*f*rt»*«i fn whl<^b f,|.#(f»rvi«r*« rwh^ i^t^ vt^nrtv iil-
■ el-
hiJuk, «iirt pitHtlict for l:
recr. — CttHtvla Mted, *inu
I
WOOnnEAD, G. SIMS, M, D,, F. R, C, P. B„
r^tniinAtraior nf pathnlnfjfj in th6 Vmtertity of Edinhuttfh,
Practical Pathology. A Maniml for Students and rV;u (itinneni* fn one very beRUtiCul tHt-*vo voiunie of 497 page«, with VM'i esiitiiaitiiJy volored iUuHtriitiutijt. (^loth, $6.00, Junt r(€ufy.
GREEN, T. HENRY, M, D.,
Lrrturetr on Patholufju nntl Mt>rhul Arutfi>mtf nt Charinft'Cros'^ Jiintpital Meitient Sfhottl^ tte.
Pathology and Morbid Anatomy. Fifth Ameriam fnmt the *nxth enlarged and i-evise<l J^ncrUnh edition. In one very handst>me octavo voluiiKe of about 3o0 pages, with about L'H^ line t^i^ravings. In prettM. ■
COATS, JOSEPH, M. D., F. F. P. «.,
J*niholtf*tist to (ht Gli\.vjow ^yeAt'trn Infirmary >
A Treatise on Pathology. In one v<try himdsome octuvo volume of 820 pageo with XMi Ipeainiiful illiistriitions. Cloth, $5.50; le^ither, $e>M. Jimt rmdy.
The vrork U^fnr*! uh treaU the Btihjer^t of Fntli- | condition ptTVrtcd In Ftrnrtur^H by difwimp-,
In nlitiilitr work^. ^1 piiyHU-<»iri«i, who de^Jii- •nri', thj(,t trrat- « i'*- pAifnu^Mti in It s proli^itv, will r
<N4ny trf'nU^d I
LH w<"ll a«
nr fffnr-
,.. -,. i..iriou«» de-
h iiiiiriiiri JjiitMrtthout
thU one the prefer-
J enoe Ui Any witJi .; ^u^o A<;qualuted. It seta ,a«ouj i-
forth the moHl rc-c«>ni dtf^t^o verier;, t^xhlbitx^ in an Mpiieai £ktui»f OcU liu^, tDt«t'e'»tUiig manner, the changca from a normal I
, nnd
Mhid luit^
do- ited
CORXJL, v., nnd RAJn^ER, X.,
Prof, iti tht patuft*/ of MerL of P<triM. Prof, in the CulUyf. of FranttiL
A Manual of Pathological Histology. Tran^hited, with notes and mlditions,
hy E. O. SfiAKESPKAUE, M. R. Pathnlf»jfLHt iind Ophthnlmlc Surgeon to riiihi^lelpliia HoBpitwl, and hy J. Henry V, yiMKt*, ^I. l>., Denionj^tnitor of Piitholi»gie?d Flistology in f the IJniverRity of PennKvlvaniu. In one very handsome ortavo vnhjine of 800 pii^es^ with [ 800 ilhislnitionB, Cloth, $5,50 ; leather^ l^.iO ; half Russiii, raised bandt*, |T.
We hnvf nn HrNltiitton in f*nrdtrtlTy rf»ii*ommeiid- \ etnhr:i'f'r| xvffhfn It^ rnjif'*! l«i *»"?'<f*titfrtlTy pructtfilL tn^f' i..r> of <%irnl' ' r^i^VPaiho- "' " 'ihefrthot*
io^fi "ji^iheli' liekindin ipiireanf
an> d rv" iftvlju^ -' r^ a tniat- i . i m ftu-m.
WO! 1 ."lihtt ft fM'ifni 'irjii iiolid ba'^ih J r^ns f idf' t>y •si ; ' '^icbI
for 1 T the pnicticAl tteftrinev of jiHAtomy go' hnii : ii of
,^l
■ *.';:
^.ifHcnean JuumaL o/ tht
I If vol urn Of on patbnlop K'\ ' r ^een. The plnnof utiidy
fill pror-***!<*»«« tn <
»drtiii
ill til
KLETN, E., M. />., F. R. «.,
Jmttt LtHurtir on General Annt* and Pht/w., in the M»t Sfhttol of Sf, Bi%rthotiiiHeu:>*» Ii*i*p, LonAm I Elements of Histology. In one luind^tmc ptx^ket iii/.e llinio. vuUimc of 300 )mge8»
with 181 illuiftnttions. Limp cloth, red edgea, $1.50, JiMf rwiWy, (Stne SlutlmUi* Series if Mnnufih^ puR^e 5,)
Altlioritfh jvn "1 f..- ..-..^u ii ;- i , r.,„™... ..,..,.„« ., i ..ii »... ^, ..,,.ij„ ,^ --ti^^rnl
VUperthlnl or n \\p.
Inoon'^l*'^'' IftftgM >>*iy
rejenrdin^ th*' i , ;,-^^.,.-. ,t,,-i,
The illnviiuiiofi Ment. Wo | witli
cotTinii'iid l»r : heartily to and
th** ■'♦"•''•'■' "'' - '.. ' |ift.l*K. >, ,,, ,. ..-. ^,.;m.,
Ti M»y it* ftble ] »t«deijti» «inii practuionen* of
Atitf ^^ contains Sttuthern PractiUutttr, Nov. inOii.
im
I. of
• di*^al
Medicine,— TAi
BCHAFKR'B PRAniCit. HI8TOLOGY. B.dng ftii I n(i iiHiri h^n \/, i!ii' irHeof the MiiToncope. fri 12tno. Yolan^e of 3(08
oitu- - - .V- . - - - ubtOGlCAL HISTOLr
TrauDlatftd. with bi*tc« and addl^
r i.t'M>v \f. D, In on** volume, vf
., with 121) copper >pUtf4
j'd, and dei«itvv^\^« ^W
14 Hknry C. Lka's Son & Co.'8 PoBLtCATiONa — Practice of Med.
FLINT, AUSTIN, M. />.,
/Vo/. of the Principk* (ifvt Prartie^ of Med, mvt of CHn, Mud. iv BHltruA HiyfpUat Medieai Chlltgty Jf . T,
A Treatise oo the Principles and Practice of Medicine. Dcagnoi tor ! the use of Student'* anrl Practitioners of Medicine. With an Appendix on the ReN?anbr8 I of K<X'h,and their l>eiirlng on the Etiology^ Pathology, Diagnotiia and Ttcfitment of I Phthisis. Fifth edition, entirely rewritten and miirh improved. In oo€ Ur^e twir close ly-prinled octavo vcdumo of 1160 piiges. Cloth, |5*50; lentLer, ^^; venr liwiil-1 ftimo half Russia^ raised bands, |i7. JuM rtMidy.
KtK"hR dismven' of the bacillus of tuhen'le gives promine of bein^ the gfcAteai IwHHi ever crjuferred by ^'ienee on humanity^ BiirpaBsine even vaccination in ilfl Wnefito Ib mankind. In the appendix to hi« work, Professor Mint deals with the suhje*.! from
pnn'tical 8tandiH)int» discuj^in^ its Ixnirings on the etiolopy^ ^»athrT ■ ^- ^ pwR^
nasi s and treatment of pnhnon a ry (dilhisi**. Thus enlarged Hnd con i udifil
work will Ih* more than ever a neceiisity to the physician who duly .;^ ,^-. ... ,^, ,he ttr^ f;|)(»{t:^{hility of hirt calling.
Wc <!«nnot conclude^ this nntioe without ejcpregft- in|c our iidmlratioQ for thifl voltjm**, which i« cer- tMitity tmeof tlie AtAodard textbooks on mediclno; iLU*i H .^ niav irftff-h lUHiiTii rhftt, (ftk^»n iUt4:«g*»thcr, it »" ' i'T iw?qtlRiiitanc-ti with re-
el thaa nny Btmilar work
wii , uht€*d, whi].«)t Jit the r»ame
tiiin It oliowip. U.- i^uiL*ii- tvi be p^>^iNei.^^^^^^l of ihf» mre rft'Milti*>(» of fhar ixrHisition, lliou^litful di-^i rinii- nfttiMh and sound j ad giTu-nt.—XoFiJ/m l^ncrf^ July S3, l§!8t. ,
In ft word, wo do not kaow of any nimHar work which is mt onen s4elat>oFat4:!SBd w^ conoiiw*, AofnII «ijd yet no Keen rak^, or whieh in ovory pjirt lenvff* upon the mind th*> impreB^ion of i(f> twinnj^ *^i^' V*r*> dacit of aa author richly t'torod with the fruits of citnifal obaerYfttion, and ati atiepl In the art of con- veying them clc-arly nnd Rtirat'tively to other?*.— Afnfncnn Jowrunl *>/ Malitai ScuntrM^ k\^r\\^ ISSl.
FHtit'fl Trent int- is the work of nn ftcc?ompH»hed ho^'pitlll physkiftn, and i* romarkaliJe for iu m»»- terty deaoriptioDH of diKcano. It iti a work on oUn- tc«l medieino emli>oilylnjn tht* <i»]tporit»nco of a lifetime. It hit-* lieoa efirtfully l>roM(rlit up to the
nr*'K4«nt day, and tho ndditionn and ftit4>ni{iofi» have i miglily pranUcn , < (1(m< \w^\x so groftt tlmt it i« virtuatly mew work, and I forAmeriow] reader*.-
not mcrelv a nevr edi<i**n. Tii rriiRldnc ih*^** %Sun
tionj*. Kl'
txMj eart 1
but hfcs ' !
matured, aud, u^ Jk' beliwei^ n^
carelean of any diitcropancy V-
thoHC ho formerly atlv'ftnced. i it J
io thifl wav could he produce a Wiirk i»urUi^ itfh
\n% looked upon a^ a standard. — Etiinhnfijh Jf«j"
Joumaff Judo, l*Si,
Thii work i§ no widely kaown and aee^pM i the be!»t Amerieao t4?xt-book of tr»e pr«i?tii^ f medicine that it would t*eem harH . ----
give thiw, the ttfth edition, ftoyt pa.'sning notice. Hut even the h< nation flhowM that it ip, i". ' than ft revipitni edition: it work throiighntit, ThU tr continue to h >' I " - * - • of American ji nor mediial w: clearnenw of di regard of tran male of ihe \-a
-^7. louu VI in. Rtr.^}Am
HAJtTSHORNE, HENRY, 31. D.,
Lntfhi Prufr^nor fff Htiijinte itt the Uniffrgttti of Pennatftvania,
Essentials of the Principles and Practice of Medicine. A '*nictitionerw. Fillh etiitittnj 2mo. votunie of 660 pages.
Ha
for Student** and Pnictitionerw. Fillh etiitittnj thoroo^hlv revi»e«l and rewritten.
m pages, Willi 144 illimraliom. Cloth, f2J
tnt
handsome ri>val bound, $3.00."
Tl«c awthor of thij* l>ook weem» to have, spared no pain* to bring tl up to the mcNlern MAndpnint, r»r %a w« turn over it^ pages wt* find many putpjert^i tntriHlttu«d whieh have onty tateiy Iwon hrotiRlit beforf^ tha profe+wion, Cerlfiinly amonpj^Ht book.*) of it« pla*«» it d<&^«*rvi.T* *nd haw oblained a good posi- tion. Oa ih© whole it i** a cart'ful and conscien- tloiij* piev« of work, and may tje commended. — London Jjnnrat^ June 24, 188:2,
Within the com nam of 6(k> pAge« it treats of tho hintory of Hiedtofno, general pathologj*, general iymptonjat<»fogy.Hnd ijTiy.«iciil dJj%gnosiM(inehiding l*rynf^o!*pop^^ --'opo, et^,), general ther-
aiieutt-^**, not*" 'ial pathi«1og>' and prac-
tice. With su /irige, condenpatloo t», of
t30urse,ft necessity, hut tin? author haAendeavorod to make up for ttiie by copious reforooces to original
papers, etc. We c&anot i-n' wonderful Amount of infot work, and that it in one of w© have i»een.— Gtoiw/cnt' J/
An indispensable bo<'k, a bett+*r average "f a- i*^if \ thiv one; and * had a tietter or: condenHJng all intfl a 12mo. TJio i. very u»teful to ^tnd. tiaK as* the name - superitede the text-l but they arw the ni mean«i to seeata gltiii disease, and the nio»t viiUiiiiiLe trt^attnt^it.^^ JUkUeal JtmrnML nmi Efatnimrt.^ April, IftfS.
*«1
BR18TOWE, JOHN SYEJR, ilf. !>., F. M. C. B.,
Phymirian atid Joint LerJuTcr on JifcfUrme at Sf. Thomas* UmpitaL
A Treatise on the Practice of Medicine. Second Ajuerican etiitton, by the Author. E<liietl, with addiiiotw, by James II. HiTTCfnwwfS^M.D., phyraciiin Pennivlvania Hfwpitai In one hand.wme octavo vohime of 108o pages, with tUustivtMiQi- Cloth, $5.t)0- leather, fvlxOO; very handsome half RuE»ia, raised bands, $G.50,
The »eoond edition of thin cjtcfjITent work, like the ftnrt, has received the benefit of Dr. Hutehin- gon'p annotations, by which the pha^<>es of diaea*© which are p4K:uUar to thi* coimtry arc indii^at^el, and thtu* a treatiMo w)n<'h wa^ intended tt*T Hriti^h pni'.*tlttonerH a' ' i - vw made more v^*'i<'^****^y U»ct ft J I on th i ■- w ater . Vi o ftws ii,o t*»ftc*1^
to modify
author in following the latcs^t growth ^ vn^fM pcience. — Btmt&n Medical anti SHrij^eai JiotiwKi, Wmky
Th© reader will find every conceimblej coanect^d with the pracllee of medtnmo* tented, in a ntyle at onrr ' — — «iw\t-'vAv. 'X\\% %AtV\W««i. *' fill
Henry C. Lea'b 8o^
BLIGATiaif^--l
iM^f
IlEYKOLDS, j; ItXJSSELL, M. !>.,
P,x4fA^ifr of the PrinciplM nmt Prtut^^t of Mniidnt ifv Vnivtritty €bK«^ toiwten-
A System of Medicine. With notes ami additions by tlKyRY Hartsiioune^ A. M., M. D., lute Professor of Hypiene in the University of Pennsylvania, In thret* Itirge and liund^onie tx^tvo volumcB, wmtiiining 3050 tluub1e-ct)lumn«l f>ag«», witli 317 iUuKlra- linns. Price |>er vtdnme, clotli, $*5.tK) ; slieeii, $0.00 j very handfitomc lialf Ku.sgiu, mi«ed IwndB, |a.50. Per set, cloth, $i5; sheep, fl8; half Russia,* ^1&.50. Sold oniy 6y nftb^trijHum, Volume L OmtainH General Diseases and Dt!?KA>?Es of the Nervous System. Volume 1 1. CVmtains I>L«iKAats of Rispiratory and Circulatory Systems, Volume 1 H. Contains Diseasb^s OF the Diokstive, Blooev-Glandular, Urinary, Rb- PRotJLTcnvE and Cutaneous Systems* Beynoltbs' System of Medicine, re<.*ently eomplete*!^ has acquired, since the Brtit ap- pe&Tum^ of the first vohime, the well-deHervefl reputiuion of being the work in which modem British njetUcine U presented in its fullest untl mnttt practical fonii. TKia could touce be utherwiae in view of the fuct thut it is the resuU of the colMonition ol the le^ul- ing niinds nf the profeesion, eiich miLject beinj? treated by some jrentleniun who is re^inled an its highest authority. All the leadinj^ schools in Gretil Britain have wnlrihuted their best men, in genero is rivalry, to buiM npihis nionnmentof medical science. That a work oonceiveti in such a spirit and can'ie<I out under such auspices should prove an iiidis- pettsabte treasury of facts and cxpertenL*e, stated to the daily wants of the practitioner^ was iiie?it&Ule; and the success which it li!i« enjoyed in England, and the reputation which it has acf]iiiretl on this siile of the Athmtic, have sealeti it with the upprolmtion of the two pre-eminently pnicliod nntittns.
\t» large she and high price ha^^ing kepi it beyond the reach of many pnictitionere in til is country who desire to jjosfiess It, a demand has arisen for an e<lilion at a price which ahill render it acce^ible to all. To meet this dcmaml tlie present etlition haslw^en umler* en. The tive volumes nnd five thousiinrl pages of the original have, by the use of a Her type and double cnlimioK, been cr>ni|jTei4j*ed into three volumes of over three n<l |Kiges, clearly and haods^jmcly printeiJ, and o(Tere<l at a price whicJi remlers it of the cheapcsit works ever presented to the Anicrimn profespion. Bui not only is the American e<lition more conveuicnt and lower priced than the Eng- j it i« nlsc» l>etter und more e<inj pie te. Some years having elupse«l since the appearance porlionof lliework, additionswere reiiuiretl Ut bring up the subjects to the exiating con- ition of science. Some diseases, alsfi, which are comparatively nnlmporlant in England, jtJtre more elabontte treatnienl to adapt the articlei* devott?*i to them to the wants of the American physici:tn ; and there are mints on which the reeeiveil iiractice in this Ci>untry di6ers from that aflopteti abnmd. The supplying of these deficiencies has been undertaken I by Henry Hart^iiorne, M. I*,, late Professor of Hygiene in the Univereity ot Pennsyl- ' Tania^ who has (endeavored to render the work fully un to tlie day, and a» ust^ful to the L , American iihysician as it hsw prove<i to be to his Englisn brethren. The number of ilhift- ^Untions has also l>een hirgely increased, and no €tlon spared to render the typographii^l ^^txccution unexc'eptinnable in every respect. * Tli*ire In no rnodfcn.! work w)kich wo liave in
pipit more fn^mjcnrly ami fully oonHinlti^cl
i.^'rr.ii^T.'.i t^y doobt« £L<* to trfmm.i*nit or l)y
! jippari^ndy fnPxpticuMe >*ymf>-
tis than "ReynnhlH' HvMem of
iftiiiiH (M«t Ihm kifnil of irifi^rrna-
liictt ti»e l»(Hy iiruciiOMnMr fn-qn+'ntly finds
iJkflf in fit»pri of. Iti ordiM tlifituny *h'fii<'u»nc"i(?fl
i\i.t-i[. [liio ptiblifitiorM lins't? coiiimiuetl
f th» Iwvok fuT iUtu j>rei*n to L»r.
. wliose jndiotoiiipi not^H'H distrilv
. lIm* volunit' nfTortl ii^MiDilnnt evl-
iU«i iiiioronghnt*ii«uf ilie rt<vtHionU) whkJi
bjwiffi il.-^ A meritan Joumat of the Aled-
irc*, Jnn, tssit
rtalnty no work w1l!i which wo nr? npqnnintctl
ev^r lwM»n fci^^'a ttithe IviinrliKh'n'M'linK proffi"
whtch rrt»ftta of st> many diiwa-Hes in a nmnnf^"
HO iH^noi^tp find tharough, and wttKitl 9o lucid nud IniHt worthy. In ilin>t branch of m<di('inei in which
«^t.i-.i , ■ ■- -Vi'
IInIi coirc^to^M^iid ijM of ftiiy
ath«r country wit) I wid Iha
American c^ditor «,: . . - - l ij^Ut ihlli
tiranch up ta the mohl tidvaun'^ed Aiuerit^aa stand*
The^e three volumes arc a wl" '- iii-.-rv in ^md
of Ihcmitelvcfi. Ail wurkK ol in-y are
dpMllncd to Ite for many yom i iwi th«
very hiffhefit -m*i ■ - •- >• « m*
Kua;ec in i-rii aJ
medicine w^ i,., — ,. c .. r,, .,,..■ ,,.,. , ,,.,
tnOODBUJtT, FRAJfK, M. JD.,
^^L Ph'ttieinn tn thr Grrmntt Jlutititnl^ i*hitadeiphia; laU CKitf AnUtant to th* MMitai CUMfin Jtfer^
^^H m/n CMlttfa Hitrpttat^ etc
^K A Handbook of the Principles and Practice of Medicine, For the use
^Ipf Btodentu and pRtctitionera. In one royal 12nio. volume, with iUuslralUms. In preMn,
\WATS02V^, THOMAS, M. I).,
^^_ l^it*^ i*lu/4tfi/tn tn Onhftaft/ ttt the (^uctn.
^■^ I«eoture8 on the Principles and Practice of Physic. IXlivireil u Kiuga
^^nllegef l^ndon, A new Amerimn fnmi the fifth English etlititm, revise*! and enliin™** ^^Pditei], with uHditions^ und I1MJ ilitistrations, by H^iNUY HARrsiiORNE, A. M., H, D ^^PloToHior of Hygiene iu the University of PennHvl vania. In two largo and haruboiati r^c^iiixuM, ccmtmning 1840 page*. Clo'th, $9.00 ;' leather, |l 1 .00.
A CRNTDRV OP ▲MCRJCAM MKDICIHIB, 1770-1816. By Dni, F.. ^. c:a^u«.^
JFOTIIERGILL, J, M., M. JD., XkUtu, M. R. C. P.f Lond.,
Aunt. Phiju. tn the yVeJii Lund. Huttp,^An*t. Ph*f». to the Ctliu of lA>nd. Hmp,, ete^
ThoPractitioner'a Handbook of Treatment ; Or, The Principle* cifThem- peuticsu 8e<H>n<l etiiiUm, revise*! and enhirgecl. In one very Imml^me octuro volume of 651 pages. Clcitli. ^iM\ very handsome half Russia, rimeil \mnds, |o,oO.
A hook w^iicli CRti f^\ve correctly find interoM- | impr- Inpilv. n* writ n* frPicnnfl<'ftlIy, th« nn»tlicHi of | lliori pteiKMiMiiK tn\i\ the nitiunftle of the bof<i th*»m- | »*>Th.
juxt itie work wlurh <»rtch phyniciftT* desires. It h
will hnti ill thl^work^'f ' ' ■ tijch tiu> n
lir H4>»«kn f.tr U\% thor 1 the . Sur^., Uet 18«0.
Irfatmei)! wltifh liff i^<^'' ifin, ,
but tli^ rAlionaleof Uif n-^-ui iii>tu !•- rt" rir-^rjy ex- I
pluin^ti—OoUfard'i MM, Journ.^ Sept. 1880. '
The miftntr rnpriti* »he thftTiks *if tv^ rv w. tl-r..rn- I tAli^tJ pliyyii-'liin fm tiis etforl'* t«nv; th«! ticudnfiii 4 if diNi^ayoH npnri tl, of phyalolugy. Ev«ry cij»pt«r, ovl:^. ..^., ..,.. u.^
,1'-[11U- ,
Tite junior mcml»f r* it a work tiiat f<i!ioiil«l i fully Muaiod. It wlJI seleetion AOrJ <-»i>ri,itttJi-d:
t^C'-^t ftdftfir
-nnftlo the
fuJly.-^i»7, ±..-. _^
-rit« It*
I r f ! I f ' Hi ri " f »* •-.Q i ort vr i 11 find
( <
FLINT, AUSTIN, M. 1>.
Clinical Medicine. A ^Systematic Treatise on the Diiignr>sis and Treatment frf Bisi^ai^tt^. Dtwijtrntwl for i^tudeut^ and Practitioners of Medicine. In une large und hiind-
Cloth, H-50; leather, $5.50 ; h»lf Biiisata, I^KHX
' " '^'?ill ftfid learning cjfthfr tri^ I lie hiv*i Kiv«?n iir (V
The groat ohj*»r't i» tn ^\t^nr^ h^fh,rm lh*i fwiidcr tlu* fjvN'^t ubscnn^' ' ........ i.. f ; -rni«(l
Aiul treatment to sifudontA. It : am! yet jiocondiMi-^- .i up wtih the lecture* • inn other hnini'h*»«.
of th*? prn 't - "
ahje In en
.(.la
:^
rlct
nlQ<
■.;-3
some octavo volume of 799 imgieflv
Jt 1« her cllnieiflii i
honn« i"f I vied^e. exet* llent fur tl
dent, (Mil !i ^-i...' ,,K ... :lie prn*-' ti.uw.* n,.- .-*.,., A lotiie liff* oi Uie iiioNt ftiitl lerifd by an en#T|?v a-* vl|ifil
untlrinie, And weiglipd by aj. *.. i ... . ,i.
than li l» ubdi^erTittlon la cjuiw. — .4 rctuves tfj jk/miicuir^ Prcv IH7».
Tr> jcivc mi ' ■ * - ■ ? .. , ^... . . , if the
«ilen-iVH I , !HMk
ofrKKirdn > inn-
lil^tently vuir. liM^ii^ mm *l-riMi. '>..-., un- •iNh-rent
»nhj««otn and (l<t»ii !*eVf?ral part^ receiving tho
atrentiMii whlrh, leUlively (o their Importanee, I in the inl^
medical opinion claims ftn- them, l^mtill more diffi- wince he cim m i
cnIL 'yUin ta>k. we fee) bound Ut Miy, Iihji t*een j »'r learn the lr»'
executed ^Tith ntore tliAii imi-tml *in'OH«f« hv Dr. i dl!»otv*e.^ whlel»
Flint, whuflQ nfi.n)e is already faniiliar to Rtiuh'nlii I Cinrxttnati J^inftt un* Kifw^ o
By the Same Author.
Essays on Conservative Medicine and Kindred Topics* fome rnyal Vlmu. volume of 210 jutpes. CI<dl), fil.MS.
FINLAYSON, JAMES, M. I)., Editor,
P/iyMinnn and Lffturer an diniral Mciiicint in the Gitugtne WtAttrn i»/lrwwiry, tte.
Clinical Diagnosis. A Handl»ook for Students and Pnu titioners of Metlkind, With Cliapters hy i^mf. (iainlner on the Physiognomy of Dt^eusc ; Prtif. Stcphcnu on Disettsea ol the Female Organs; Dr. RoViertwfn on IniyiHity ; l>r, tieinmeU on l*lir?^jraj DiapnosHis ; Or, Co.nttii no l^iryn^n^copy jind P<iHt-Morlem EximiinnlinnM, mid hy ihe I'^litor on Tuiie-lnkinj?, l'\'iniily Uit^toi^ nnd tSyni(>t< nn of I.>isorder in the Vurioit** SyKtems, In j one liiindsorne TJino. volume of 540 [mgeN, with 85 illustrations. Cloth, $2.63.
In one rery hjuid<
4
i
II
I
Thla is one of the really unefid bonks. It iw nt- Uwlive from pndaoe to the final paste, and ougiii to Im' jiclven a place on every offiee fahl*?, bri-attne it coQtHin'* in a eon denned form all tiii«i is t'alnitljle la H«mefolo>o^ and diaKUosticn to be found In
bulkier roinmeri: and lieeatij^e of lt» «iTatiai»»fT>^nl and eomph''t<' inuex U is nnnf^nally eonvenieni fnr J quirk reference In at>y emerj^eucy thai may cat u|»on the buwy practitioner,— JV, C, Jfoi, Jewrm^l Jan. 1S79.
JFENmCK, S.±3WEL, M. D.,
A*9iAtnnt Phymcian to the Ltjutloti HonptfaL
The Student's Guide to Medical Bia^osis. Frrim the tlurd reviBadl enlargc-'J Knglinh edition. In one very handsome n->yal 12mo, vohtme of tiUS fiti^efi, i 87 iliuiitnitions on wood. Cloth, $2.23.
TANNEK. THOMAS HAWKES, 31 IK
A Manual of Clinical Medicine and Physical Diagnosis. ThirdAmericia' from the seetttid I^mdon tnlition. Revit>ed and enlarged by TiLBi^RY Fox, M. D., Phy- sician to the 8kin DejKtriment in University Oollepe Kospilil^ London, etc. In one siti*U 12mo. volume of 3G2 pages, with illustrations. Cloth, |1.50,
STltBGES' TNTRnrJUtrrmN TO THK STITDY
OF CLINH'AL MKDiri^E. T^e\i\ft a C,n\(\«^ \o
the fnre>*ti|i;ntion of UVnea-He. \n ou*5 \\aud*oTcv« ,
l^mo. volume of l^pftKCH, rV>iV\,%V.'i^- \
BAVIH* CLINICAL lSItURES O^* \*^TMO\i^ \
IMPORTANT DISEASES: beinsr a < \,\\« <::\U\\ckvl Leoturo* del ■ '
Ueilfl
IIehiit C. Lea's Son & Co.'b Publicationb — ^Eteetrtc. Fme., etc It
BICHABDSON, B. W., M.A., M.n., LL. JO., F.B.S,f F,S.A,
F^lhtc vf the Eovai CoUfQ€ of Phi/iiteiaT\8, London,
Preventive Medicioe. In one ot^tavo volnme of about 750 pagua. Clt>lh, |4;
leather, $5 ; ven^ hiindsftme lialf Kiit^tsin, raised bunda^ $fi.5U. JuhI rentiy,
' The ininienKe Btrides tnken by tnetlituil science during tbe hist rjujirtor of » ct^ntUTj
have had no more ccmspicnous fiehl of progrees ihtm tlie canftalidn of dineafie. Not only
hns tlim le«l to markeit sulvance in therapeuticsj but it h«s jiiven rise to a virhmlfv new
i department of medicine — the prevention of difve:ise — more important^ porhnpts in \\» ulti- mute results than even the investii^ition of nimtive pmcessen. Yet tlnJH fnr there bus been pii attempt to (father into a HyKteniutic und tuteHi^ible f«bu(>e the noctiniuhitinn f^f ktumledgo IKH[uire(J on this mt»st inlere*<tin;2: sutijcct. Fortiiniitelv, the tiu*k haK been ut hist under- taken by a writer who, of id I, is perhups l)est qualifieif U^r itn perfonUiinte, and the renuU of hiij hd>or« e:in brmJly fail to mark an cjkicIi in the hii«tory of medical Hcienoe. £xeerpt from Contents. I.^ — Disease as a Unity, witli a variety of PJienomena, The Preventive Scheme of Medicine. General DiHe;L<eii t»f Mankind. L CVmjftJtational Ditieases. 2, Loc:il Di*icase«» 3, DiKe;ises from Niitural Aecirienta, — Lightning — 8unsiF>ke— Starvation — roisouH — Venorn^T^ Poisonous Fooil— Pregnancy. II. Acoiiired E*iseji»i?s of Arliticial Origin; Phennmeua and i-our»e. \, Att(uire*! Diseuaes Irom Inorgjmic and Orgunie PoisonM,^ — 1 Tea^ — Cotfee— AbxJiol— Tol«icc\i — ScMJt — tiiises, 2. Acrpiired BiHeuBes from PJ»v»ical ' A^ncies, Medmnical und t General, — DuRts — i'ressure on Lim^s^ — Q>ncus«i(mH an<i 8hocks — ^Muiiculjir Overwork and Strain — Ac«|iiirod Deform it ies—Phyrtical [njiiries — Surgical Ojx^rationa. 3. Actjuirtxl Dii^ai^es from Mental Agencies, — Mond, Emfitloniil and ^■Habitual. Diseaws lri>m Mental Shock, (tmiw Moral Contatrion^^ — Taranlism — Suicide, ^Kfrom llviiteri'al Emotion, from Pii>«inn, from Habits of Life — !n«i'>mnia — r^emenlia^ ^K^8loth — Luxury — Se^'ret imnn»rtdity. 1 11.^1. Orij^insand iausesof I)iMe«i*e, — t'ongenital, ^Bfiere^litaryor Conwtitminual r'attJii?^; Atmonpherii' and Llitnnlic t'auseA; Parasitic fause^ ^pt— Bacteria—Bacilli— ,Spirilla — Trichina*; Zymotic CaUH4?s; Industriid and Accidental ^^ Cbmeit; Social and Psychical Causes; Senile Degenerative f'auBea, li. Preventions of f I>taea!ie. Prevention of Ilerotlilary or Oon^stitutional Diseases,— Pergonal Rnh*s for Preg- f nancy» Infancy, Adolescence, Maturity ; Pre\*enti*inof Atmospheric ami ritmntic DiHeases; of Par4isitic Disease^ — Personal Hules; of Zymotic Diseai^CM, — L'onta^yUjn— t)ruinatre — L*5«d«tion of Sick — Water and Milk Supply — lltMi^dtalH — Hegisiralitm — Vacciuatinn^ Other Inorulatioii&— Legiylation ; Preventifin of Industrial Dinvasci; — Lend Poi^^^nhv:;-^ I)\i^iA — («L(4e8, etc.; Preventii^n of Social im«l Psychical Di>ejiAes, — Wanning and X'ontila- tioo — Light^ — Water^the Hetl-rcKim — Bread — Abuttoirs — Stdiools — Sepulture — I>riinken- neee; Prevention of Senile Dijjeuse,
The
■eoond «»dltiofi nf thin work fntlowlne no
iARTHOLOW, ROBERTS, A. M., M. D., LL. !>.,
Prof, of M'itrria Me*Ura and Uct\eral Therttpftitica in the Jtfterxon Atcfl. Coff. of Phtin,, tie,
A Practical Treatise on the Applications of Electricity to Medicine id Surgery, Seeoml iMitinn, In one verj* Uundiumic tK-lavo vcdume of 21*2 pj^jct^, with 109 illustrations. Cloth, f2.50,
trlrth to r*Ad n Incld, mAiiagpfkl^ln nionoj^raph na irUs firm ni tt«(Mitp«ialc»,— J/ot nnii Sut*], H^ jHfrier, Nov. I, 1 88*. A m*t»4 oxi'i'Ui-nt work, artdrouMwl hy a prn^'ti-
r!<if3 i t . Ill* f tlow-ptu'tiiiunurii^ ivnd tliertfor* J ,iL 'CUft work nirw bi'fjrt lUI J mwrit of rlctwly ptiinuiii^ out
■ , Ut !>** tioriVoi.! fl'r.mi r-5.v'trlnity
III'' It •'<»rMiiili« till t%ri<t 'M :'<ti.i
I •tillt>nc'r in'fth in <»ni<ir to ' ti-
ritly Ihr nntiiro mul lnw- tf r ' la
lujtklmj; Ufte of, (ir>i1 ft«r (U |m tti jh ill
piw'ticr. la a i'nn*tt'n*<Ml» jm , u pr©-
«<*ntH to tho phyHJcliui nil titi vlnr^ ta
retiKMiilMM jiOrr |HM'tt>(lu;4iiwlk' "ill
elmtrH'iiy, Im-luUitiie lln« ro^ n»
>rff*ti|fntis''n4, It \>» rhi* tnxtU i • ' ■ ht.
an'l tTi' fif u M«*i'un-I
It llM.^
j^rai^tica), Kini* It Ih, innre"
15. UH'i. mHIv !»'
7.:
. .- -'liU Ml t.P'V'f'^ Uuiit
liHNl )tv thi* profoithiou. — Phptif
HABERSHOy, S. O., M. /).,
HtHiftr Phynann to o#«l Uitti t*cL on /Vinf i;^«# and Prartiet of JIffti* at Ouv'* Iffutpitn/, fx'mlt/ft.
On the Diseases of the Abdomen ; Comprising tliowe of the Stomach, and artaofthe Alimentary Canal, i}iM*pl um, InteMtinesand Peritoneum, Sec*md
Rlcan from thinl enlarged and rcvi h edition, Jn one han<lM>nie i»ctav<>
i of 5o4 ptLges, with It lustrations, i. i-vi,, ^.kjO.
BARLOW'S MA?aTAL OF THE PRACTICE OF MEr/ICINE. With »f|flitioti» by a F. ConptE, M, D. 1 rol. Svo., pp. &Xi, Cloth, tLSO.
TODD'S CLINICAI. LECTITHES ON CERTAIN
ACUTE DIBKASF^. In oue ocUro \
HOLLAND'S MH:t)lCAL NOTES AND 1 TiONS. 1 vol. tiro,, pp. 493. Cloth^fl^
18
, Lka's Son & Go.'B Pitbuoatioks — ^Throat,
SELLER, CAJtL, M. J)..
Leetiirrr on Lar^pigosroftfj in the Univmit}^ of Pcnngyftfania,
A Handbook of Diagnosis and Treatment of Diseases of the Th Hose and Naso-Pharynx- Scs.-oml edition. In one hondHcjme royal l2mo. \ of 294 pivgcs, with 77 illiiHtrulions. Cltitli, $1.75, Jntd rauhf.
Dr, Seller's book ii^ a cTr^ftr, conf^i^o, prafticftt expM?*ition of the Hiitijeetj *ucIj a-* only a nia.'^tvr of It eoulil have writU'n. It Ih >Hf'tt4»r united to tlui WADle of rtdvanced »tud«nt# mui voung phyfiema» tliAin any other at pr«iaetit in the nandn of tiie pro- f€»«Bioii.— jfwieriean Praetitiunerf Aug, 1883.
Dr. Bf*\h' (he kiinw
one (f «!i deii!
pnnj-nir;* a!l Hir f-:*='nti|
BJIOWNE, LENNOX, F. R. C. S,, Edin.,
S^nifjr Surgeon to the Central London Throat and Ef%r UmpiUit, eie..
The Throat and its Diseas&B. Second American from tlie peooml En^rltHh edi-1 tion, thoroughly reviaetL With 100 typit^ illoalnitions in eolora am! 50 wood en^ruvin{^ deAi^^ied ana executed by the Author. In one ?ery handiKirae imperial octavo volume 6 about 350 pages. Preparing.
FLINT, AUSTIN, M, J).,
Profeuor of the. Principles and Practice of Mfdieine in Sfflrvue Hfjspital M«iitml CtUte^t^ N. 1^'
A Manual of Anectiltation and Perctission ; Of the Physical Di;ij^<T«ii ot Diiicaeee of the Limp; and Heitrt, and of Tlioracin Aneurism. Third editiun. lu one hjuid- some royal 12mo. volume of 240 jmges. Clothe $K«>.'5. Juxt rmrfy.
Thin pnfcftjrBl and jtif«t?y popiiUr mADU&l ifl eon- ▼*olptitly divided into eight chapti?r*»» and the itudf?nt i« frradntdly led up fniin a ifenoral con-
iid**rftt(on of phy.'^lofd siv^nt^ in bcnlih And dl3»^ft»e , «,., ., „^. , ...». ,....
to the difleri'nlial diuprujfii* of dhe«-pd Ci>nditiona rciJatefl to certain fl
by It knowjodjji' of tiie^o v'ly-ifal t^igriii. A» in hl« \ clo*^ study nf the j
COUI>H
ehRr
fif I'nv'tii'al jnK(rupti<»n» wo in MnV Im • ittn is tv» simplify tlj- I'le; Im.) uon aider t!ie dt - of ditterent phywical i
lennlncd l>y analysis'^ nnd a-* t-i^M-^d |.nr*t«HT,tr1v on the variations In th*- of sotindu; to impre^ ftiid rpftdf r That the
k I and di»(.^ati« i» a mnr 1- dlftfrnoitis and treatineuL— 2"/ie JJa^d^cat I April 88, IBts^L
By the Same Author.
Physical Exploration of the Lungs by Means of Auscultation
Percussion. Thret! lurturt^s delivered l^td'ore the iMulmlelpliia County Medical Sod«i 1882r-83. In one hundetmie bquiU Vlmo, voluuie of S3 pages. Cloth, t>l-00.
By the Same Author. A Practical Treatise on the Physical Exploration of the Cheat i the Diagnosis of Diseases Affecting the Respiratory Organs* Second i revi^efi e^fition. In one hauilstjtiie oclavo vtjiuinc of 591 ymges. Cloth, $4.50.
By the Same Author.
Phthisis: Its Morbid Anatomy, Etiology, S3rmptomatic Events^ Complications, Fatality and Prognosis, Treatment and Physical nosis: In a series of Clinical Studies. In one Imndsom© octavo volume of 442 pig^
Ckith, $3.50. —
By the Same Author.
A Practical Treatise on the Dia^osis, Pathology and Treatment of Diseases of the Heart. SiM^ind r ; 1 enlarged editiuiL In one ociavo volume
of 55tt piiges, with a jdate. Cloth, $1.
GliOSS, S. IK, M,D., LL.D., JJJJ.L. Oxon.. LL.jD. Cantab.
A Practical Treatise, on Foreign Bodies in the Air-pasBages. In
octavo volume of 452 pages, with 59 ilUislnilions. Cloth, $2.75.
Fm.LFR ON DISEASES OF THE LUN^S AND A I IM * A BS Mii-:^. Their Pat li olugy, Phy gtcal IH- ai;nriisim, Symptoms and Trnitinc^nL From the »e<H>nd and reviitpd English edition, lo ont* Oictavo volume of 4,1b pa-^ea. Cloth, ?;J/"0.
BLADE ON DIPHTHERIA; it** Nature and Tr^at- mem, witli an af:*ei)unt of the Historv of itj< Pre- valeni-e in Vftnonsiounlries. Seeou eland revised eilition. In one ViTtio. vol., pp. ir*^. Cloth, fl.26,
WILLIAMS ON PULMONARY CONSUMPTION; it* Nature, Varieties* and Treatment. With an analyRirt of one thoufiand cjises to exemplify it* duration. In one Svo. vol. of ana pp. Cloth, tfbLAO.
SMITH ON CONSUMPTION; Hn Early andRero«- dlat.ttj Sta^cjs. 1 vol, 8vo,, pp. 2ra. ti.2fi,
LA HUCHEON PNEUMONIA. 1 vol, 8vo. of 4B0
1
STOKES' LECTURES ON FEVER. Ed»t^ John William Mo-jn\ M. !»,. R K. O. <\ P, one txjtavo volume of 2j^u pag^ti. Cloth, |it«J,
A TREAT IS K ON FEVER, Dv Roamav iX I K. C. C. In one Sru. voL of 3M pp. Lluih, $lA
LECTURES ON THE STUDY OF FEVER. Bj A, HcimuN, M. IK, M. k. L A. In uuei ocU«« volum«» of au8 paiTDP, Cloth, fiLfW^.
L.4 ROPHE ON YELLOW FEV ! r«| ia
it.4 Iiist'>#ra1, Patholn^itmi, Wl4
Therat>eutical Relathm*. In two ..^ ... ; hatule^
0Oin e oc't« vo vol it me;* c f 1 4C8 pp. C U »t h * 17 ■«>.
PAVY'S TREATISE ON TUF Ft TACTION OF Dl OE.STION; ll« lib ' fhcir Treatni(
Fr^vru liie second I n, Jnoiiti
volume of triS page ^ -O,
WAI*SRE ON THE DmE.\ST» OT T^V.Ti^K^T\ev\K^\\V.\\^'>\KSVKV,<Jt UlET ANDll] tkm In I vol. »vo,, 4W pp. C\otK^>»- ^om^v^:%Ai.H^^vi\vwsvy.^^Lv*^ ^::v*i»^'!
HAMILTON, ALLAN McLAIOS, 31, J).,
Attending I'hifixfunn Hi the. Umpittit for Epiteptir* mui ParaiyHi-m^ Bl/iekv>«tr» Itland, N. Y., <tnd Ai the Out-f\itier*t4' Dejiartmrnt (ifthe\\'ap York IIv»pi(aL
Nervous Diseases ; Tlielr Dt?scription and Treatment. Second edition, thorouglil/ revi^e^i and rewritten. In one Imndsoiue octavo volume of 508 pages, witli 72 illustrationft. Cloth, u.
We art? glad to weleotno n second ertUion pf «o iifte- ftilAwork ft* thi!4, to which Dr. nftmilt«n lias *uc-
Oeodc^ til cDndensing liiU> "" - -if limit* the
niMl tmpnrtjtQt of tiierecrt notM in re-
fard to dla«>iwe« ot the aerv of rocent
yesrs orrvou* patholoiey I*.*- i,. i... t to BJi*>h im- portiuicc «» to nec«««itA(e very CAr*-fni d^.*^orlptiun m «p«eliil work*^ and Jimonjc tljpsc thin volume muftt lAkeii hiKh pfnce, Thi^ vohime is on lh<* whol<:* 4»xoelltfUt, and lad "vnid nf that }<pirit of plagiari^im which wre h*TO unfitrtiinatt ly ><*?en v*o niiiohof In oertaJD recent Eni^tiHh wirrk^ on nervoiij!) diHc^oses, —StiiHfturtjh Modtcut Journal, May, ISW2.
When thefir«tediMoii ofihlft f^rnid Ijot^k appeared we fare it our emphatic endt»r<«eniont, und the nreaeiit edition enhmnccH oitr Rpprfcinijon of (ht> book Hnd it?+ (iiitlior aM a safe guid<* to $^tu<lerit« af ellnt - '}jy. OtRi *»f tlio be.>it and mont
crit I -h nonroiogioai jonrnui'*, Hraii\ ha^
char iiti!* honk a-* tht* bf?tt e>r it^ kind iti
any lHn<5uu>;t-, which i^i a hand.*Mnu' endorM<'mcnt from ati exaitod noiircp, Th*! improvemtMiif* in the new edition, and the additions to ii, will \u¥.%\tv i%» purchai!i« even by thoi»o who pn88«ii* tho ol±— ill4«nM/ and NeurUoQUt^ April; \mi.
The l»ook ifli made up of plain iwid practicai de- Mriptioua of tii** chit'f dinordera nf the n**rvoiis ^tetn^wiih int<?re»tinpdistniMiionfiofpothoti»K'''»I point* and rt:ry ftennihle viewM a» to tr«.'iitmeul.
Tt i«a a book which the genera] practitioner it\\\ find offbeat vahie. — *Y. ). Af«/. Jour,, Sept 188E»
The ant' M?on^
DtMe^aAee w . hJte
it la. ot l)h I -ive-
W© nave phui^uro in boanu : ff f
that iii** etforts liave lM»en • -
Ttie VAri^iits ^jjsriis. > havo the direct I w to iwiiviiUl 4* <
no^i» are ind the hint^ in
art'* plaixi. . 1 j-i-iiiid. Puf'ljui'' . 1
bercMiHuf'- ii alljiUrary,
AH Ihc n;i the mofnt
rw^mmon 11 1 the every
day work *ii i\u: iL-ijiii. To hirn. there-
fore, we rtcomr pleasure; in jjict» wo
may go ^Jrther if ,% all thiniqp considered,
it i« for hlB purpose Uie Leal work of tiie Igind now available,— Uin/ida Jour. Med, 5c*tfnc<sr, April, ia»2.
Thitt work in well adapted ti> the wantA of Ihe general praL'titioner, for whom it Hcern*! to have been f^'-pff^ifiUy wrfft^^n. It !»♦ a tliortmiH^hly prac> tie4vl 1 ' ' ' '■ Moh will render
the ' i - the mure easy»
and iuL Tiie l^nik la
ver\ '!Jv 10 the hiiify prao*
titiii ommend W.—Mcdt^
ami . :], lHii\i,
CLOVHTON, THOMAS S., M. ©., F. R. C. P., i. R. C. H.,
LttturcT on Mental DivefturA itt thr l^nucnttttj uf EtUnfmrifh,
Clinical LectiireB on Mental Diseases. With an Apijendix, oontaininjt? an Exhaustive Summary of tlie Lnw.s in Ton'e in the I nited Stules uimhi ihe CVimmit- fuent and t^mlinimiunt of the In^nip. By Chaulks^ V, Ft>ix)M, M. U,, AtM»ihUint I*ro* fefsor of Mt"nt»l ni>*earteR, Me^iicul IH-pttrtincnt cd' f larva ni rniveraity. New edilion. Jn one hand^mie octuvn volume of ul»mu VAiW jiageH, ilhisti-wted with woiKiciits and ei^ht iithoitra^hie pluteSf four i>f whieh nre beantihjJh* folored. In pri'ttt*.
PLAYFATIi, IV. S., M. IK, F. 7^ C. P.
The Systematic Treatment of Nerve Prostration and Hysteria, one hiindftome »*niull 12nio. volume of 1)7 jm^es, t'U^th^ fl.tM). Jit^t ready.
The b<v>k is w»*II worth pernfuL and will rt^pay anyone for tlif" f""- --■—■' i«^ '*- ......f,,i .(,,,.1, 1.,.
aamurh a* ft w; I iJie managenitM.
cian, iivrve (n-osi. ,»,L.., , .,., ,..,.., ,. ;.t-,. ...,
Klren of tlie niann^r of rarryin^oiit the trf^iurncnt. in «rht«'h are added the iiif^^ffiMiii t»f a fininU-r ^'I ea^oii ilhi.Htmtivo of the method iintl it» ro^nli>. An appendix contains a clewcription of th*i mtitlnHl <hf performitif^ maNsaK^*, whii^h in clear and coti'
tn
ei^e,— iVfii- Orleans Medical and Surgteal Joanmi^ '
"i*iic treiitment of nerve, prostrjvt Ion eM|HjuAiled jin>i lliu^.lndcd hv l»r. Plavfait i« a ihera^ieutio
r,,,„l...-..l ..I ..».....M^,„,r ,,r ..tt,.,.! |..,...,r ^f ^
' ri of
-tin-
, .. No
1 1 t:iiin|iar«
rtmlaiiiee.
MITCHELL, S. WEIR, M. D.,
Phymnan tn Orthoptrdic il(»pitnl ntut tht [nfirinfit \j f*tr Ditra^rs of ftte !Vfif-rotm SytUm^ Phila^ Me^
liectures on Diseases of the Nervous System; E«if>eeially in Wonwn. \ 8ec><md edition. In one very kandaome 12mo. volume of about 250 pagea. Prepctrin^.
TUKJS, DANIBL HACK, M. I>.,
Joinf AuOtor of The Manual of P*yehtjtQ^kat MediHne, efr.
IllustrationB of the Influence of the Mind upon the Body in Health
and Disease. iH^iprncd to iUiMmtt' th© Action td' the Imt*j;inution. New editicm. ThonMighly revised und rewritten. In one handsome t>ctttvc) volume. In pre^,
BLANDFORD, G. FIELDING, M. D., F. R. C. P.,
Leeturer on PntfrhttlftgicM MediHne nt the Sehooi of St, OttiT^e'* Umpitnl^ i^ttdon.
Insanity and its Treatment : I^ttures on the Tn- ■ -* ^fed^L1lland Ij>A^ of
[mane Ptttients. With ji Sninmary of I he Lawn in force in 1 i i*^-*-* -^ the CVm*
fiaement of the InaanCi by Isaac Kav, M. D. In one very h e
CLINICAl. OBSERVATIONS O.V FUXCmoN A L 1 Mv a Beeond Amerlqil WBRVttl T}.* I)[SORDKB-«*. by C, HAJfWiai n Jowwi. | pome octavo volume flff
GROSS. S. I>.f M. !>., LL. !>., 1>. C. i. Oxon,, LL, B.
Emerituii J^rofi-^ifor of Surgery in th6 Jt^ertfin Mtdittd QtUt(ft <^f PhUadt^/phbu
A System of Surgery : Fatholopkiil^ PUignostic. Therapeutic uml Sixth ctlitinn, thorotighly revised and greatlv improv«Ml. In two Ur^c and ! primod im|>eriiil cKiuvo V(4ume» nmUiiun^ 2^8*2 pgcs, UluKtnit4J<l hj 1«>2S Btr«>riT5lv *K>»mi1 ?n ItfSther, rtiis^-l JuirnU, ^15; lialf Kiij^ia. rai*«d hatitls. flti*
«!'>■
mill It is >ii;i , ujitii: TfM» f'»n*«tn fur «hi^
mill jiKJuioijiii In lit cliiMlrmH i>u mnrh -;
anil, iitiMVf^ nil, Im-^ >'•> trmh atifl liii't, weighinv
n> I' . ■ ■ '
di
l).;v . ■ ■
Btuti- r..( ,„!! Un,nU.',|^,...-.V.V, /;,..-.H>^, N-.\. lHjv^2. :i^ the t.>-rijt il-v ^ VV> liiwe rutrf«»si?lv lU^vtutni-ii froni I'onnmont t>r I Jmprovenientj* in v chtii^i^m m Thf U>ok iM'f.ii-o un. It jini« jjormerly 1 (-very rr^fwrt tti<? '^ Nh'u tiotlerd nioiv tliAH nriocin Murcotumusand it AinciKiTnn nn'^dic'Al hfirjvtuie — . Im enough uow lo renjRik ihal Lhc (•te^^oiit editiou I Repcirttr. Kov. 11. 1882.
"Ml
( I
ASH nun ST, JOHN, Jr,, 31, J>.,
Ptofr^mir of Ctmirat Sarficnf, Umv. r,f Pennn,, Suiifeon ht th« EpUfOpdl Uotpitaf^ PhiJadtiph^
The Pi*inciples and Practice of Surgery, Tlnrt1e«lition,_enlArg«»d und ViBod, In line large smd hamlswinie ottavii volume cif lOGO pii^cs, with 5»jr> iJJu>tr»U( Cloth, ${>; lealher, |7; very hnmlHvine lialf Ku&siii, raised l^nds, $7,50.
Pr. Asbtinr.-il's Surffent iw n erimipnped trc'all?*e "n i^md^nsod Nit cntrixiri*hp'n«tri^ ii«'*»Tfrti'W oovnrliiK il)<!' whol«} (iurnain of the Kcii>n('«> in one the intnlox of miinn(ti^4i] lie volume. 1'Iip present efliiinii ha** har| the tr«Milmeri A lliorong;h r«*vl^ion. The nnviOtiod in finri^lcftl priK'lk-e fiml ttie ifoent olv-eiinHon* in HUncierMl St' If nee Ijftve heen inoorporH(<nl, I mi {he i*iy.e of the TolnnHt hiin not tK*i'n nuiteriiilly hiciriVH^d. Tlie •nlhoi'^t AiTAUncrnii^nt is pens|»louou«, mnii hin ImilCiUiKe t'oiTfrt itniJ clear. An exeellent Intlex closes tlir work, nrml r»Ti itip whole we ronnjtler H the heKi ,, one vohime wtiioh
eniihj I - t of an Anierii^an
atlttior i r7>fjrfrf, Oct, VH/FlJ.
The autlior, luiiu [iUuua il^- a thoronj<h Ptndent of HiirBery, and on^* v( rlie most fl4'0ornp1it*hed ftcliolarM in tjie couiitry, aiiui^ to i^ve in ihm work
expo tii tin
t*M
fto|inlAr3ty v.. rut, in this 1 Iftnpinjr** Ti
-**v<»l|
GLBKBY, F. P., 3t. I>.
Snrtjtfun to thi Ort/toj»mtic IIoKpttat^ New York, eftu
OrthopeediC Surgery. For the use of Pmctitionet^ and SiudenlA. In one band-^ mme octavo volume, pn)msGly illustrated. Ptepanng.
ROBERTS, JOHN B,, A. M„ M, J>,,
Lecturer tm A^mtt^my nn'i on Optn'titive Surgery nt the PMlaHr.lphia School of Anntamff^
The Principles and Practice of Surgery, For the use of Stude Pmclititiners of M*?ilifine and Surtjer}-, Jn one very handaitme octavo volatile of I fMLges, with many illuslrations. Preparing,
PBPFER, A, J., M. B., M. S., F. R. C. S.,
Surf/fOTt ami Ltrturcr at Sf. Mary'^g Hospital, London,
Surgical Pathology. In one jiocket-siie 12mo. volume of oil nafc*, with illiiBlnif lulls. Limp c'luth, rerledsfes, $1.50. Jiiai ready. See Stwlnxtji Serif* of Sfaunal*^ j
TUi!< work on Siirgieal PjithoJoKy is certainly a *• jewel" ofa book, not only for Htiidont-i, hiit aNo •a a work of rcferenee for prfif^titionerM. Though •0 NHiall that il cad cattily be carried in the pocket
for r*>ferenee, yet it i;* qnit
dc'tfiilH. The }<tudciit wl
exam iofttion will keep it u •
Cinemnati MediaU News, Nov&iubef, Ib^X
BELLAMY, EDWARD, F. R, C. S.
Operative Surgery. Inndive preparation. Hee Stftdentt' Seria of ManuaU, \
8TJMSON, LEWIS A., B. A., M. !>.,
Prof, of PiUh'A. At\a\. at tk« Unw. oj the CvtA| of New York, Sytrgttm ami Ciirntfjf to BfU^
A Manual ot Operutwe ^Mi^erj . \\v<^s^^^«^\iw^iWwrvvtx5iiTiswV^sE^ «f 477 psiges, with ^Zl VUufilmtVom. ^ftVVA^^-
x^v\^s
fBJiTAXT. THOMAS, F. Jt. C. S.f
The J of Surgery, Tliird Americsin from llie thini ami rcvbeH Engtlih
.editioru L ^,a>' rtiviseil jiiitl rnucli iiiiprovetl, by JoiiN U. Rt>nEnT>*, A, M,, ^\L fX,
iX^cturer on Anntomr and Ojvenitive Surj^ery in the Piiilu«k'lphiu Aaiiletny ot' l^nrjrvJTr, llti ime Ur^v ;tncl very handjR>me imperial octiivo volume of HmH» jmgos, with 7?^.'"i llhistm- Ct : leiither^ ^T--^**; vvry ImnilBonie hnlf Ru»wiaj ml&eti ' so.
'Iv'- , ' - - ' '•'■ ' '- - 1 ' '■ - " ' ' - and
U if* II vrofk ^9p<»i>mtlv adupiO'l tM tlio wftnU of
of titf. r.ri
It i* thu' h#*j«t nf rU the nii^fohtmewnrk*'>nf«iir- 1 w*tik hri^ i
wry of n(»*'Piiit *]«!*» for the ordiiifin' *wrj?<»on, con* . l«evr» lev*! in , .»„.„„^_. ,
^ttUiiUifC enough of ^tAihohj|i3r^ ik«<tnimte (i<^ttenpljun ' ttrndt^ U* tUiuufrl«Vvi> uh«f»ter. — CtucttuMU Mvdicat I of «urglrul cili^eiuH'M ttud iitjurleit, welUJi«vi»ed | Aftir^, Juti. llkiL
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EBICnSEX, JOHN E„ F. It. S., F. Jt. C. 8.,
I*roJr**ur of Surrfrrif tn Vntcerittty (hffnjf^ Lmulnn^ etc*
The Science and Art of Surgery; Bein^ u Tn^itise on 8iirjrittil Injnrir^ Dis- mmea and Opanitinns. Spei'iully roviseil lly the Author from the eighth and enlnrKed EiikdiBii etliiion. In two hirj^e Jind l>eiuUifuI mt-jtvr* voliinie» of idnnut 2000 pngcs^ Ulu^ Irutttvl with jdixiat OfK) ofiLTjivintTH <m WfKxL Prf'pnrinfi,
edition are u|»|>emfcd. Hi frum pre- rmt oniv m thin connlry, bnt
v, <(iinlify linn I •<k. Wlicn we
;ce an the tending tf^xt-houki ,
Hint It i^ tible tu jvrovt'n \*y tht- Ifi ent edilion lijiu'
iklfLiiiUnt cif Villiiri'''
fnun thJN, •
ri;4 hrtve h*
n fJwi! Brltoln. ii.i .^ uhnndiinllj tht* ni>**
L * entirely
<:SMARCH, nr. FRIEDItlCH,
f\iiff4jtftr of Surgery nt the tlnivrTtittj of Aj>/, ete.
Early Aid in Injuries and Accidents. Five Ambukncxs I^< tiirc«. Trnnt-
Iftted by H. R. IL PiirKrEBS Cuni^riAK. In one h^imWtue MinoU 12jt)(», vohiine of 109
pngi^ with 24 illtiAtrations* Cloth^ 75 cents. JujU rentftf,
T)m ;iM.ok hy Dr. E-imAivh 1 by
l^mnv th^ftr* Mif»* imd pnirii- 'n»W
iro \U
I -OB of
ii**d;
I to ihrlr
(nl. The
xnd good.— Jfadi*
-//'^(^;"
.V-.;/-.
A'!g>
^trufrtion in divided Into flv* The fir>it, i>r intrminctorv
, nf drowtii
jUiiHjnUhins iu Mm.* Uhi); an- *;Unir
oount of the structure nu^ | col Tima and GfLittt1\ Not. 4, {i»2.
The Principles and Practice of Modern Surgery. From the eighilj Ion e^Jilion. In one 8vo. volume of 687 pnges, with 432 jlliii*. Clotli, |4 ; Icwthcr, |6.
'.OF In
CUOPhUH LKi Jl KJ->i o\ (HI ' ^
AND PRAtTK K < *F 8i:KUKin ul,
of T'i7 r«««»H, Cloth, f±m.
8KKY^8 oPKRATIVB SiiRGERY. I«|
'if iU;T 1 n^'-.'K. nirh SI W'M„l-'ljb*, t'l«>U|
Ml PRH In two i
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vo. ¥*A.<4 4^;^ liAkEeM, wiLh.au lihiMLrutlotiK. |
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Clolli |
^.7ft. |
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/rg iMf*. i-rrK OF mTRnEUy. F^firth |
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uii from the In?*! FAllubortfli r «To. vol. of 6*2 pa|t«*s. with |
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1!5^
Hbhbt C. Lra*« Som k Ca.*« Publications — Hur^ery.
oiom
HOLMES, TIMOTWT, M. A.,
Siiirg<DOn ^ftd Lteturtr on Sutgent at SL Georgt^* IIo*pitat^ London.
A ^rstem of Siirgery ; Theoretical and Practical. tN TH p 4 TfSES 1
VARI(»CS ALTTIIOl^. AMEliU'AN edition, THOROUOHLY RKVIStl
bj Joiix 11. Packard, M* IK, Surgetm to the Episcopal and St. J- . -^ ^
Plul»ii»-l|»hia. :u«i$t«ii by a earfja of lliirty-Uiree of tlie ni«i«Et eminenl Aiuerk^a aoq^Jilt. In three largo and very huiulHorue Imperial octavo volumes contalninie: 3137 double' opliinined im^cs, with 97*J illufttnitiom on wood ami 1^ iithogniphic platesy begutfifiillj o>Jr>mi. Prict; per volume, cloth, ?i(>AMJ; leather, ^7.00; hulf Russia, $7^m Per aet, datlif |3K.CK>; leather, $21.00; half Kiissia, $22.50, SoLi only by mhs^riplion.
Volume I. contains (iknekal Pathology, Mokbu> ProcEss^ Ixjurte? up Got-
ETRAL, CoMrLlCATlON!* OK IkJLUIKS AND InJLTIIES OF KeGIOJT^.
\ oLi'ME 11. tx)ntaiiw Dl^eases of ORaAKa op Special Sbxse, CiBcui^iToaT 8»- TiEM, DiGEsn-ivE Tract akd Genito-Ubisary Organs*
VfiLi'MK III. eontaing Diseases of the Kespiratory Organs, Boxes Joistts
Ml'StXES, L>L«EAfiIS OF THE NeRVOU!^ SYSTEM, GlTXSHOT WoCXDS^ Ol'irRATUTE
MiKOR SmoERY, AND Misc'ELLANEOCS ScBJECTS (including ao essay on HoHriTALa), 1
Thi^ l^eat work, iBsued some years since in England, ha« won such univeraal i I rever the language k spoken that it« repiddioition here, in a form mlapted to the wants of the American pnictitioner, has seemed to be a duty 1 I r f; -inn. To arcrmiplish this, each urticle \\ta& been placed in the hantlaiif i iy ci>mi>etent to ireiil it8 Bubject, lunl no liiLior has L»een spared to hfia^
f^A. iji, 1x^1 I :iju itremost level of the times^ and to adapt it thoroughly to the praei*" of the country. In certain ca^os thia hua rendered nece8is;iry the svdjHtitution of an enttl| new es«iy for the original^ as in the case of the articles on ^^kin Diseases and on Dii of the Abesorhent 8j*t4tcni, where the views of the authors have L»een BU|3er¥cded liyj advance of medical science, and new articles have therefore been ppepare*1 by Dth. Kt Van llarlingen and 8. C. Bus*ev, respectively. S«> also in the case of .-Vmwsthetic^ in the| of which .American practice jJirtbrs from that of England, the original has l>een sup menttfd with a new essay by J. C Reeve, M. D. TJie same careful and cons<cient« revtr.ion ha^ been pursued throughout^ leading to an increase of nearly one-fourtb ifl matter, while the series of ill ut$t nit ions has been nearly trebled, and the whole is presented as a i-oinplete exponent of B^tti^h and American Sai^g^ry, adapted to the daily oeedi d the working practitioner.
In order to brinj; it within the reach of every memljcr of the profession, the fire f times of the original have l)een (^impressed into three by employing a doubte-coh roval m-tavo page, and in thL» improvetl form it is otTere*! at le*6 than one-half the pr original, h is printe<l and Umnd to match in every detail with RevnoliV .System \ cine. The work will l>e ^d by subscxiption only, and in due time every memb profesi^ion will he railed upon and ofierod an opjiortunity to stilwcribe.
the ori||in&l Cnf;Ibh edition are iuk io Eii|;laa«l^ and pr PiU'k&rd :ot ia socunn)? n^ hi« AmeriJ-'au men a« Bartholow^ Hyde, Haul, Hiinision, Morton, Hodie^n, .Jewell and
ea'^y reach of Abif r ! b<»en received wi f other side of t!i«^ I SurRery. In the h
fir>t volume we fiii I *iinc(*nnn *■ Sir Ji
their (^oUuAffne?. As a whole, the w»rl< will be
■olid'and KnK«t.«intiu1. and a vaiuiil''^ ■■'.*'■'--- — .^.. . .. ..
the library of t^ny medical man. It and m^-tre (im^ful than the KnjFllnh *■ i
3t ■■ •:*^ -on work '* |>r--'^- ' ■( ' ■- ,,1 iiifrji- iiM-«-[;;iiut sn «L'.\''<_"iii"it '
^- '.rell rejtrew^ ueof <»ur \ nor mfinev aeeni to hav
• . whojjifani aq work» | Unher*. — Att^l. and Surrj.
*iii I" isiiilv well riimirtiit u iM'it'i'wi-*L- iiud hajid- wi9e,~7%* SUdkQt ^Vetci, Jan. 7, 18»2.
This work i? cyolopcFdlc in cliaraeter, and every aubject is treated in an exhanxtive manner. It in «0pecia1ly i,K:>f(igDed for a rt^ferenoe hcNik, which «very practliting surgeon should have nnder hand in caAfta which requira more than ordinanr kaowl* •A^,*^Chie9go Mid, Joum. and ErAm^ Feb. 1BS2.
Great credit is du« to the AmeHean editor and
hi the revision of th«' wit edition not only l»a* prori.««i<i recognition of the advance"* tv. during the tea yearn ."i but aijuci for a preaentji practice whieh charactt'i diMin^uit^h it fh^m thwi ot work IS one which we taki mending to the notion of our clopiedia of nurgical kaowledgo ana {i
his c^vlaborers (or reri«iiif;aDd bringing within SL Louu Oourier of Mcdhcin^, fiov. i£»l
HOLMES, TIMOTHY, 31. A.
Surgery. Its Principles and Practice. In one handaome octavo toIujemi d
968 pages, witli 41 1 illustrationi*. Cloth, $C>.00 ; leather, 17.00 ; half RuMsia, 1^7.50.
Mr. Holmes In aanret?oo of Urge and varied ex- perience, and one of the l»eHt known, and perhaps Ihe moPt brittjant writ4»r upon surgical ,4iitijectrt m England. If i-* n hook for t(tud<*nt:»— and an ad mi- the busy general practitiimer tjl all the knowledj^e needed to lalion. The b«>k fairly J «>4tifio» '»n(* that were fi>rm<'d of it, lt« ijrcit)le, ercn hHlliant at tSrne«, ->«* needed tij hrini; xi within it* proper inii.il/- ria.*< not Impaired itv ff»ree aod Un'^tn*'HK,— ,V r. hftni. Rfr>*r^, April H, IMT'i
It will tie found a mo«rt exr? TIrnt epit'iicnt' ttmo^ j|:ery by the general prtx- ](0 has not tlw
time Ut give Attention t< > ':e and eil4«4'
od workH, and t4> the mo I ^ InCftct.^
know of no one we can up ' Iv reoutB^
mend. The author ha^ auo< ja fi<^
Inic a plain and praiHJie«l wx'y «urglcaJ
injury nud di.^ea^e^and of the trviitrni-ut which t» mr*ft' commonly ad vimibtiK. It will no doub* In*- CHI me & (Hipular work in the ptofeiwion, and «»|pe" cialty M a t«£t^book.— diMia* Jf*l A'mm, kmH,
UCM
1 1MA>e., OpHHiAL
STLMSON, LEWIS A., B. A.^ M. JD,,
A Practical Treadae od Fractures. Its o«ie v^iy han(?^-iin« octavo Ttiluaie of
\ pag«i^ with 360 beautiful iUtxslniioiis. Clodi^ f4.T5 ; leu' Tki« AnllMir ha* glTMi trt the m*».ifn\1 prvifj^^^mn •• tr*»RH«<*^t csn thp > lotliis traitiiiv onf^^ oontr « *t«ii«hinl work • > Bat waiymm^l hf %i\x y> OTi for that iDartrr, enciT^ntvil with ' MMlOerman nir-1
in « •Hon, «ticiei»<- ■■■i»'n-!vt. n
lha( l» known alw t T)i«>r^ ;
•cttiitfor «iiperfi>. it, «# io tu
JmI rastfy
'its
HAMTLTON, FllAyK If., M. !>., ZL. I>^
S^rgmm to B«ll«v«« HotpHal, Sew Yowk,
A Practical Treatifte on Fractures aud Dislocations. Slitk cdilkO|
jhW revbed and much improved. In one \*erv hands^^me octavo Toluttie of 0w
witii 352 iliii8traticni& Cloth, $.\50 ; leather, %^\M \ half Russia, niised Unds, fT.Oft.
Tb« ooly eoiDi^ete vork oo it# ffiiJiji«*«n In i v ' iirn or anr bui^nuiK* o» frmrtnrf* lUiii
i« ti wfinio t« on A nf tF;c« Torv tr»w
' ■ X
g''n*:m\\ |-r,'i'-liri'Mi*'r -a- ID
I whir) I lie cjtnnm mftor'l ^-nl
m^»«t pn*ftlr»Unf.irm»t: i^li
I sndUdotienjmbhc^— A ) i irri, v^i
joIt
Cm* K&gli^n tooKUCk^ and inc|««(l it mav now he «bH Io hp*» thf* mrly work of it* km-l in nny
in ii »nv wd. Tr»f . -v»nrj»nd irii* h»u|c ^*ty« ui I ft or il«» veni*rmbit« auibari—
Sot. HiWL
HAnuitoa L^ Uic Author of the b«st tnodefH
WELLS, J. SOELBEMG, E. R. C. S.,
iVf//«Mor of Of*ht\fiimutotfy in Kintf* CoUe^ Hospital, l>Mwt>», **f,
A Treatise on Diaeaaea of the Eye. Fourth American fn>m the third Lnn«1«o [edition. Thon highly revised, with copious udditiong^ by CiiARt.ti* 8, Brt.i^ M. D., Hurj^wm ami Pathologist to the New York Eye and Eur Infirmary. In nne lar^* and very hand* •omc octavo volume of 822 pajL^^efs, with 257 iUnstmtirmt$ on wf^od^ six colored ptutcs^ jtod ielectiofM from the Test-tyjies of Jue^r ami Snellen. CJotli, $5.00; leaiUier, $0.00; veiy handfiome half Ruseia,* raised liancK $0.50. Ji»*f r<fa</y.
Ttie pf^*eTit CHrliffon Jipfw^fir^ in ^m^ than three treAtiw on di«eitf»^« of the «ye, than whioh Profair
bly aoDt* better exi2<t».—ilfadieiitf i7«air< Aug. la^'O.
Th5'i rrnrn^ftf'^'tit work f* yww ««wH*>«i^ Uia
tM? rt?t:or[!iUi<'t]i(i«-<i; to
•niii>\oi^. I JJ'^'-iT.fn/ ami cnurtTtcdc Ktpijrtvr, auv;ij'-i ». i
TTLESHIP, EDWARD, F. It. C, 8»
Ojikthatmit 9mrg, and Lett, on Ophth, 8uri^. at St. Thomiu' Itoufntnl^ i^ontUm,
The Student's Guide to Diseaaea of the Eye. New e^liiiou. With u cJi,tp- on the Detettinn of ('ol«r- Blindness, hy WiLi.iAM TnoMat>K. M. D, Oj>hthnlm<>]ci>ri^ the Jefferson Medical College. In one royal 12ino. volume of 416 pit^ci, with ISft iusinitiona. Cloth, $2.00, Jwtt ntmiif, ^ TUi*> ^»fmfr?iM* ^iH^I" ^M* frtir t*y >*fo,nn*^ fh€ ' b#*^n i^*»^lfM ?ih/»w* H# r#ft» fMn** *tid thm At>pr«>
Till- ' t4«)Upftlce^,
If^iif-i/ HfftTtt^ Juno irj, 188:1- Thl** Work is ^■^^-trilially a Ptiidi»nt'«s manual of ' opliiliiUmohiKy, and the favor with which U haa .
|>ru'-'i K'l-'. — sjiijjfiiv vut'*.
iRO WNE, EDGAR A .,
Smrgton tft the Liverpool Eije and Ear Infirmary and to tke Ditp^mary fift Sim DUtOMa.
How to Use the Ophth'^'»^'^9oope* Being Eleracntarr Iitetnictiow* in <H»h-
, JmoBC»py, arraniied f*>r tJu Jonts. In one sinall royal 12mo. volume xf 11^
r|Nige«, with 3o illustnitions. < i ^
LAW80N ON INJURIES TO THE EVE, ORBIT
ANtJ EVELlIi^: riiijr lriim»dtnto and Rt-tnoto
Ertf-ctH N ¥••., s U!*. Cloth, t3.fiO.
.LArUKNTK AM IIANL»V LUJUK OF
OPliTUALMlc ..^...^.... for the um of Priws
liliotiora^ B«eonrt edition. Bmtj of '*f! iJUkv?". with Imj CAttl '
In ou. ..-*..^ .,:., ^-,.i,w .-.
24 Henrt C. Ijea's Son & Co.'s Poblioations — Otol., I>ent.. tTrin
POLITZER, ADAM,
Imprrinf'Roffnl Prtff. of Aurat Thernp. in thf Univ. of VKnnn,
A Text-Book of the Ear and its Difleases. TrnnslMc^l, ol the Author'i t^
que ' ' * • ^ Mr>l Pa TTKRHON' CAK=iET.t>, M- t>* ^f* R* ^*' ^* I" 015'
uni' ft>H. with ^''iT on;;)iinl illastrjitions. Cloth, $^i.'>0.
pi \ri's urU-l;ii'i« ti r-i'iun«ioTi a*onc has ever tirM"'iii*>-l. >'
of { ■''\y-i oar will <Unh.Hf on
li^«. I r'> tliAH Kit tif^nl in e^
onl',' ■ _ - UJK rm , ■ .t - itt'ft --
pli\Mifit<.vrv, fill itifs unrJ
ogmriiiv "1" <ii>. . .1 ttMirfi'iiLTlil'
The work iUelf wo do not heflftAt4« to pronntitiff* I he best upon Uiv t*ii)i}vi'l uf aiirul dlsiMiitce which i
tne octavo fol-
JlU(i. — Jw
w; i/*i; Mi.d, -t,f MLa-.-s-jt, Julj,
rcUnbli* i^iiifjtf to thf -:
tiro IN
;i» 4
BURNETT, CHARLES H., A. JIf., Jf, J>»,
ylriru/ Siirf^. tu the I*rffl>. lUap,^ Siirtfeoft-in-rharfte of the In/ir, for />m, of thi JStir, PkHfuitfpM^
The Ear, Its Anatomy, Physiology and DiBeases. A Pnr ' ' T aise for tlie U8e of Mt^Hrnl Shulenls uikI Pntriitionen*, In nne hstmlmime ncUiVf* '»!9
pagei^ with H7 lUuHtnUionH. c .'luth^ $4.50 ; IciitlaT, $5,50 ; hall* KussLi, rais' iXl.
To tJ- ! tl
The mciMpftl profpsHion will wt'h'omf^ ttile new work ♦'»! •'T.lMtry, U'hloh prcficnt-* i^onrly iiml c*oii- cIbi'I It a«LM:»ct, vvliiht eh-arly lu<ll''iitkuK
thi* 1 ^rliU'h liirtKor n^scArt'lieA can Im?
«!">•': , i-iirrieri i»n. t>r liimieii Unn pro
duc<L'<l l\ vvoik vvhlt'h, a-t ft toxl4>xik. stand* /rtc^tf
prinfftut In our InngUftfTP, work I* of Ihf hi^lu'ft vnUw, uil Uhli- U> L»r. Burtiietl will, wc ! totliemnoiinl at l>f>nt*fll ht? f^ir fnl Ntniiy of tfie hook mirJ hcm trustworlUy pftgo*.— i!!4/m6«rj'» .l/c>'
COLEMAN, A. 9 L. R. C. J*., F. R. C. »., Exam. i. I>. S.,
Sf^nhfr Dtnt. Sur*j. nrtd Lett, on Dent, Surtj, nt St. IUrthftt*/mfW'» I{04p. myt th« Dent, ih>«p,^ L&nAviL
A Manual of Dental Snrgery and Pathology. Thoroughly revised imd jidapto<l to ilie UB(» oi Anicriciiii Stiiikntsi, hy Trri>MAs (I Stellwagen/ M, A., M. D^ D. i>. 8., Prof, of Plivftiologry jit the I'hihi'leliihht Ik'nt^il CVjllege, In one hund^onie octavo volume of 4Pi psigeH, with IMU illiistrntion-*. Cloth, ^.25,
This I'otiiTne' J«^»i?rrp(? to mnk nmonj? Itio mo^t irnp^jititht uf THt'eiil i'ontril!H(itlr)n,» to deninil lif^m- ture, Mr. Toloinan lnv» prt?P«iJtivi his moUHHlN of pmclJr!^, for the niof^t pnit. in n |*lAtn pitui (?oir'1«© munftor, nn*t tin- work of lUt* AinfiloftTi *i^»llt'ir Ikv* been oon«cleijtloU''ly pcrfornifU. He Iihjm evidently In^MfltMJ (11 rtr'';-rMl fil^ rinvu'ljO[|l*of iIk' IjosI mtJiloj* of r I ' M.n of (lioHi* r*.jnitnen<»-
liiK >l hti !ijv< friltliirnlly rn-
do(4i dt that he )ju><m>]iifi'ecl
by liU t>M L> uLksturvaUuu nad experience. The? book
i
— /;. .
It tinn. flllll initri
II work, li Uk; sh HtitndArd toxt-l^' put>lioAtioh$« if* r
th»> Tibrury of erery d«iitlft -iion of cir«»ry pm^ll-]
tr^o^, Miti>'i 1
GROSS, S. JD.t 3/. />M LL. D., I}. C. i., etc.
A Pi*actical Treatise on the Diseases^ Injuries and Malformationa of the Urinary Bladder, the Prostate Gland and the Urethra. Third
cflilkin, thortnif^hiy revise*! l*y SAMrKL W, Gnas.^, M, IX, Suffreon U^ ili« Philmleli»hW HospitiiL In inie ncl^ivn vt*hniicof 574 piij^'ii, willi 1T() ilhiHlrathtns, (.1i»th^ H-oO,
%t\n\ a^Jrantnv? of iH^jnf^ r^a^ily ronipr«hf!n<t<rd hf^ the reji^tnifthle ivml pruclUinl mntttier in wlu'h th« vin ioMs wiilijcrt* fire *vt«tcni«ti«fM| und ^unuifvd. ^A timtii ilfntitut JuurmI, Oct. l«m
For refert^nee atjd g<>nf rni iiiforniatiun, the pity-
15 !iii4 Si" wark thrtt tneeU* thwir
mil f hi.«, fv reviserl
■ l»l-'towith fmnd-
■A-, it hiw the ttiiiH
ilclHa or t^niiz' net'ewHiti- ediiioui^f some illM
BOBBRTS, WILLIAM, 31, />.,
L^cture-r tm Metiinti« in the Mancheiter i^fuud of Sfeilitinr^ ttr.
A Practical Treatise on Urinary and Benal Diseases, including Uri- nary Deposits. Foiirtli Amerii-jin from the fourth LoDdon eriiti«7n. Tliustnit^d by numerous engruvings. In oi^e large iind handiscniie ottavo volimie, Prtptirin/f,
THOMPSON, SIR IIE^RY,
Stthjean nnd Profcusor of Clinical Sttrrfcrft to Univfrxityf Otli**je fToitpHat^ Ixindon,
Lectures on Diseases of the Urinary Organs. Het-on*! American fmm th«] thml Kiiflinh edition. In one 8vo. vohiiue of 203 pp., with 25 iHusf rat inns. Clmh, $2.25. |
By the Same Author.
On the Pathology and Treatment of Stricture of the Urethra and
Urinary Fistulas. Irom rlip tliird English edition. In one volume of 359 pagfe, with
4r cuts iind '^ phitts. e\oi\\, %\\m.
BAS2IAM ON UKNAI. Dl^f^EKSFJai K C\\T\\tJ«X Guide to their Dt»gTir«\a «ad 'It«»^«n*uV. \tv
I
Hexst C. Lea's :>ox k Co.'s Ptbucatioxs — Tenerad Dis., «4c. 2S
BUMSTEAJ}, F. J„ and TATLOB, B. W.,
Jf. 1>.. LL. !>., A. jr., Jf. !>.,
IjCt /V«.*«*^ y Vrvreru /jbmmms Arpw^* trt C*<trip» EMp»fnt^ S-rm F^*-*, iVj/ j/
^ :»< fi •'.*/• '.-' iNv»i..*>XM &«< rm«r^m| «-hl .Sfa-i /W«M« ?.t £.!♦ riti»*r»t/y ijfjr
The Pathology and Treatment of Venereal Diseases. Ic^-IukIIdc the resolts •W reo«nc inreid^aU'^ai uwm the stibjev^ Filth etlitlotu r«TfeKd and lu^lr re- wrinoL hr Dr. Tmjltyr. In «>iie Iai^ and haiKidnme txtavo Tolume ot about S9> paces with r?V iUi2«tmiMa% in<i tkine^n vhn»civ.^li;bi.grajhic fijiuresw Cloth, H-~->; leather, ^75; Terv handa*:«iue h^i" Ku^tolau ^Ji^x
Prom the Piefkce to the Fifth Edition.
In this eiliti*:*c I hare can:iV*lly nrriaed the text. an-L wh«n neoeasary. hare changed mod m*:^ii«d it, aoJ making a^idiciiio* where re«i':irvti. I have eodeaT-ored to brin^ it op to our presen; state of kDr>wleii;:e in all partiALiaiK Much new matter will lie tkHind re» latin? u> therapeatiiL^ and in the chapter on the treatment of syphilis a new ailjUTant is 8pr4^en of. The yi^je-.t* oi the in«viilatii« if animal> wiih <yphilis anJ the l^acillus-oriftn of the dt5t:a>«*, whi-.h are at |*rv%^R: attmctin^ miich attention, have C<en invlikied in this editi*.*n. and a chapter on syphiiU and marriace has t<en ap^tended. I am able to give to my rea.iers tw^-» i^sges of chrr.nK>-lith*'craj»hic drawinv:?^ iadnding thirteen tigtires re;'n2«en:inc the (.-hief venereal i«sion5. which I am o>nvincvd will be a great ai«i in the ftudy of the>e ade\-tloa&
No work :.A* t-*«c p'l'-IShed izcn :M» *u^>^ot fifth e»l::ion ^Jiff he*arr>pp»ncdhr Pr.Tayforal'we.
that h.»* *:t*:'.r-i ^.. »,* ■::«.;» ^-ar.dArd a> an xi- M:;ol; mw EdUter wil; N? f>.; d r-? ;%:iui: to :h«ra>
tiiontyA> :. i* J i*. R-.ctrd, V:.;;^. s-ijrriun-J A£iii p*^:..^. ri.e #-.-:k h** l*ra brv'.ic.t {ii,x.ip»
oih«-r>. i-ir •! .-*::< a* a::s:.or::i*« in. vrrlvrta; *:!rc- ::.«• pr-'j^nt >:ac« <i ks «l<>i<^, A.n^«:!. uu.i'.>atc>
til's*, bu: t'.^f * Tiiji of L.oce c-f t.\«-m wcrv so t^*r o^tiuue tt> I* ti;e Fr'.aci(,al aatltonty oa
geciertlij qi^otea and e«:eec::<«l »» lai* •■^ce. The veiierea; dis^as** for a loag time.
COBJiTL, r..
Syphilis, its Morbid Anatomy, Diagnosis and Treatment. Speciallr revised k-y the Auth-r, an«i translated with mtcs and addition:^ ly J. Henry C, SiMSSy M- D., I^emocsirator of Paihtk^cal Hisiok^- in the University of Pennsylvania, and J. WiLLiAiK White, M. D^ Lecturer on Veni-real I^iscases and WmcnstratiT of Siii^nr in the University ••f Pennsylvania. In <.»ne han<isome octavo volume \A 401 (^a^:es» with 84 very beautiful illu<traiiu'ns. Cloth. $3.7-3. Jv«x rriJy.
The a.'iatonQi''^ and hi<t.:il«'v(c:cal ehar»Lter« of the the whole r.^Iame i* the oJinu-al experiesv^ of th*
hanl .xn-i -*i: *..i-* *re a>lrr.;ra-' i> •iescrir*tl. T*ie a.;:f:"r or thr w;o«* *>j':A:n:An.'* of t.ie ir3ta:ji<a:or»
miiitii >TTri r.i'AT.f-.:. rr.a.'i.fir^i.u:v.n*i>f lae il:«ea^ *:::i !:i»-<J..>-a." ii:«*r3i::;rv tuvrv e^Mrrt l..e a»at-
are d***!! miUt M-c.-'i ip<-:u.y m a n:a*trriy n%\, »et omv. t:ie ZiL^tti'-o. liie mii;***-'^ *:!d t:-* ol::iK-«d
we ftho.i.-i :a.i-^i rxp-::^-t':i.em lc» be, ana' ti.e rr^i: :;«r>»f >ypii:.i>*rv repf«'.'«eat«si in tui^ w^tk lo
•cvompAnyiD^ iii.i«tr^i>a> are execcteu •'anrf.;liy i:.i-.r tue^:, iuoe*t pa»-iu-a! *n«t rv.*4 irj^rruv-iitr*
and well. T:.e -.arli-.:.* nerd-^i-. l*r>i'>n^ wl.ir'i Are f Tm. v^d qo ^>ne w:.." ri*P fr^^ti it* pent^fc" wthout
llie reii^cniz*fi .►^jtcome 'A tr.e «yp!iii:tie dys««^r*'i* ;:.e i«f^:tr.ic t; at hi^' (ra>p of the wide and ^aipor^
are trvatcr<J »it^ ..■».-«• And •■»'n*i.jieruti"U. !»ypli::::u- .*«: * ;tj«vt .^ whK.'U it trca;» 15 a str-.iiicef aad
epilep«>T, |:*ra:y«t.., cer*br*l -typLili?. And loi^ni »!.t '•arer one. — Tu LmrnkM PractUMMtr, Jau. lidi^
ataxia are «ubject« fuii of mtere»t . and now here in .
GBOSS, SAJfUEL W'., A. Jf., JH. D.,
Pruft^^fT oftiu P^-kn^tpia 'j/Surjcry tuvi / C5. «.*•?»» S^-^^rry it f.W J^irfcr% Jted-cni CUV4vr.
A Practical Treatise on Impotence, Sterility, and Allied Disorders of the Male Sexual Organs. Second eiiition, thoroughly revL^ed. In one very hand- some octavo volume of 16^ pages, with 16 illustrations. 1 K^h. $l.ot>, Jm< mufy.
The Anrhor of t!:i* rronrf^fh i* a iran of po*:- Thi< work w:i: di»r:Te TA*:;e frvvr the hich ^tasd-
tire o»nT:f-in.n» A-.d T;ifor"i:> "tj ie. T:ii5* i* ;:.>t;- ir.ic of its author, As:dr from the f».*t I'f i:> fa»iac
fied bv ills ex(-«*ri' u*-^ and i.y I i'-^tirdv, whivN h:v< 5-> r*p:dly into i:* ?e».->>nd t^iilloa. Tuis in indeed,
gone haad in r.An.j »itr» hi.* exf^rienw. In rrga.-.i a to^^k f'a: overj- rhysician w:ll be k'*** I" i"*o«
to the T.iri'i'i^ orciir-;c Afiit f jncti'-na: d^'r.ir.-T^ vf i*: hi* ;:lr»ry. ii- ce rvA-i w:t.» j^ror.t to (.;n-.>*-;C
the ma/e gecf r»':ive ap(.aratit«, he ;.** r,*l ex- and with inva.^■•:'A^ie ler.er't to h.* latienL B*-
ceptionAl «'pj:on initio* ( -r oh— r\Ati-.n, Aid hi? >:Jt'^ c.e *ui.ect> en:b:A T-«i :r. trie ntie, «fi:oh ar*
book >hmw- :.::»: ».e hjv« n-H nei5!^t.-d i.» o^miare trearod tf ;f. ti^eir ^arisw t m.^ and deicrveSfc
hi.>«owD riAw. w:t!. th'-^eof ot'^er AUth--r>*. The sfv.-rr.Atorrhopa And pvfSiArorrf op* Are a-** r.illj
res'Ult i> Aw.rk wr.it-h «»:» l*'>rtf-lv reo.-ni mended ot.»r.*:df rvd. 1 r.e w.^rk :> ihor.^ujchly pra jicaJ m
toU.th pn\Mf a--i' and ••;nce*^u* A- Acui ie m the ehara^ter. And »;".. be esiviialiv u*e|.4i u» th«
trvatment »! ihe <ii«turtan<f* it r^f^r* lo. I: ;* |^*u«^ral |:rac:iuocer.— Jtfrti.os. Sicvni^ Xng, U^
the best treatise on :;.« -ubjei t with which we are Ijrtvt. •cquainieu.— 7A< Mchml .^e1C4,2^l•pt. 1. ISSS.
CLLLEBIER, A., Jt BUJTSTEAD, F. J.. JT.D.. LL.D.,
An Atlas of Venereal Diseases. Translated and edited by Freeman J. Bm- 8TEAD, M. I). In one imperial 4to. volume of 32S |«j:«*. diHible-<x»lum1is» with 26 plates^ containing about LMJ figures, beaiitifullv ci>lored. many ot them the siie of life. Sti\*nglj bound in doth, $17.00. A specimen of the plates and text sent by mail, on receipt i>f 25 eta.
HILLON SYPHILIS AND LOCAL COXTAi-lors FORMS OF LOCAL DISEASE AFFETTIXQ ^DISORDERS, /none«rovol.of479p.aoch,»\.2&. VRlSCl?M-l-\ Tftt O^viK^* O^ ^^^^^^ LEEV LECTVREa OS SYPHILIS AND bU)i£ TVOX. la onft *«^ ^^ ^ *«* \«?»- 0«»^\Mfc*
'EHseaaes of Sldik.'
* :^»^ Mmiitai €>i(r«f)e, Chvntfn.
_Skill< For tfie ns^nfStd uf <jiO fiuic^ wilh ^6 beautiful Jiail riadjf.
'• t^vvl-l Iv- lit short
nun up 1(1 Hie vti%ii43)i "f ♦^eiencie. Tin* 1 i-; liy 1/ (H an em.rt In t»ii U»mj*to>^ rM lie infiH'ifiiH n
in i! r.^nil'Ml'iP'] f "i'lU f!:i.-
P., find irOX, T.C.t Ji.A., M.]
Phynkinn fur Div trtfr^-* of thr Sk i« I
iIMseaaea* With Formulae. For Stmienuaii and enlarged, in one very handsome 12iiick <
tMOMtletl to this work on hoiU sides of tlie Allitiitic l.lfeft«l»I^-t for which it «r;w prepare 1 — to affon! iiasisUftoaTJ
>«f «l«rm itoK>;iy, anl to serve a^ u ai vn tal for re i ^ ^
^p^4k «» ^1^5 ittaod of duty* For this hiUcr purpfi^c it ii;i i ihm anions on treatment ti the form lire ut the en
I thoroughly revlse<l :md Ijarlly lewriUtin, nnd^ to inc UMi, the UhisslHaaion of Dei mul Disea^es^ luJoiited j I Assoeialion, htm l>een introdticed.
UjCOLM, M, i>.,
Mrmahdajfff at isL JIMri/'s Umpitnl Medienl Sehont^ Lotidon^
; lactiuUng ihcir Oefiniliona, Sympttims, Diui^nasisi
^ . '• *^ Miiiitml for StudeiUs and l*raciLtiuner8, li oa
i^«ik mlih i U ufftrutioris. C lot h ^ Iji ) .7 5.
tnlcnowAnincthhig fi*r olcnrn^KP of cxpi-«!««ian nnd melho
ntiigfiiitnit li" ltfit**r ulnph'il in |)ronit>lir|
— (i l>m firth (mil
'1^p> n ["'f'^Mil pri'H
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lUv bfl*^ Inner.'
t«i»fu'i*p(ii»n if <l)itioi)lt loiil t a^oritt nf yh
Tl^c writer Im|n 1 ' Ik li(P'}40 aMittiiMl of SH hi^ lililu fiouk i*ittii| uUfi-Ii lirt>4 CMit:vhulii <l h'lu !:%!-
»t>i ^^|y rtilhi'h'il l*> *Mr**i»Mf nih mi'iii. Tlioi'f H ocnnhkly *'j(ce(iiMii nuiU, bu4>k Nfhjfh Hill «t/ll n-pjiy |»tfru»itJ.— fiu tttuL Suty^ Jttunt,^ Maxell, It^jO,
m&SOX ERASMUS, F. U. S.
fit% Book of Cutaneous Medicine and Diseases of the ^1 oelavo vohime of 5:i5 pti*ies. tloth, $3.50.
MUXIKJ?. THOMAS, M.D.,
tk of Skin Diseases; for Students and Practittonefji. Sceooil^
Henry C. Lea's Son & Co.*8 Publications — Di». of Women. 27
^OT AMEBICAX SYSTEM OF GYNECOLOGY.
A System of OynsBcolo^, in Treatises by Various Authors. In two
haniiHfiine octavo volumes , riclily illustrated. In aciive preparation.
LIST OF CONTRIBUTORS.
FoKDYCE BARKER, M. D., CHARLES CARROLL LKE, M. I>..
ROBERT BATTEV, M. D., WILLIAM T. LUSK, M. I).,
S\MUEL C. BUSEY, M. D., MATTHEW D. MANN, M. !>.,
HENRY F. CAMPBELL, M. D., ROBERT B. MAURY, M. D.,
BENJAMIN F. DAWSON, M. D., C. D. PALMER, M. L>.,
WILLL\M GOODELL, M. I)., WILLIAM M. POLK, M. D.,
HENRY F. GARRIOrFA M. D., THADDEl'S A. REAMY, M. D.,
SAMUEL W. GROSS, M. IK, A. 1). ROCKWELL, M. D.,
JAMF^ B. HUNTEK, M. I)., ALBERT H. SMITH, M. I).,
WILLIAM T. HOWARD, M. D., R. STANSBURY SUTTON, A. M., M. D.,
A. REEVES JACKSON, M. D., T. (iAILLARD THOMAS, M. D.,
EDWARD W. JENKS, M. D., CHARLF.S S. WARD, M. D., W ILLIAM H. WELCH, M. D.
THOMAS, T. GAILlJiBD, 31. 1>., *
Professor of DiAcaMJi of Womey\ m the CbUege of Physiciarut and Surgeons^ X )'.
A Practical Treatise on the Diseases of Women. Fiftli e<lition, thoroughljr revisefl and re^Tittcn. In one large and handsome octavo volume of 810 pages, with 266 illustrations. Cloth, $o.(K) ; leather, $6.00 ; very handsome half Russia, raised bands, $0.50. The wordH which f<»llow ** fifth edition" are in i rioua one. .Ah a book of reference for the busf thlA case no mere formal announcement. The ,' pra<*titioner it i« unequalled. — Boston Medical ana lUteration?* and additions which have l)een made are Surfficnl Journal^ April 7, 188(). both numerou.s and important. The attraction | It hta* been enlarged and ca^c^llIy revised. It i« ftod the permanent character of tlii.o lK>ok lie in , a condeuMod oncycloftrodia of KynuMrological medi- the clearness and truth of the clinical deHcriptions j cine. The .««tyle of arranjrement, the maMt^rly of dineaKen; the fertility of the author in thera- , manner in which each subject is treated, and the
Seutlc resources and the fulness with which the | honest oonvictions derived from probably the etaila of treatment are descril>ed; the <lefinite ■ largest clinical experience in that specialty of any character of the teaching; and last, but not least. | in this country, nil serve to commend it in the the cvi<lent candor which p<?rva<les it. We would i highest terms to the practitioner. — yashvitU Jour. §}ao particularize the fulness with which the his- of Meii. ami Sunf., J&n. 1881.
tory of the subject is gone into, which makes the ■ That the previous editions of the treatise of Dr. book a«iditionaIly mtere.*»ting and gives it value as ! Thomas were thought worthy of translation into A work of reference.— Lomi^/n Mfdical Times and, German, French, Italian antf Spanish, is enough Oautte, July »), 1881. 1 to give it the stamp of genuine merit. At home it
**The determination of the author to keep his ; has made its way into ttie library of every obiftet- Dook foremost in the rank of works on gymecology rician and gyntecologist as a safe guide to practice, is most gratifying. Recognising the fact that this | No small numV>er of additions have l>een made to o«o only be accomplished by frequent and thor- the present edition to make it correspond to re- oagn revision, he ha** spared no pains to make the | cent improvements in treatment.— /\wi/lc MediaU fureaent edition more desirable even than the pre- i awl Surffieat Journal^ Jan. 1881.
MniS, ARTHUR W.,M.~3.^Lmi(1., F.R. C.P., M.R. C.8.,
Assist. Obstetric Pht/sieian to Middlesex Hospital^ late Physician to British Lying-in Hospital. The Diseases of Women. Including their Pathology, Causiition, Symptoms, Diagnosis and Treatment. A Maniuil for Students and Practitioners. In one fian<lsome octavo volume of 57G pages, with 148 illustrations. Cloth, $3.00 ; leiither, $4.0O.
It is a nleasure to read a book so thoroughly , The greatest pains have been taken with the good as this one. The special qualities which are I sections relating to treatment. A lilieral selection conspicuous arc thoroughness in covering the < of remedies is given for each morbid condition, whole ground, clearness of description and c<m* I the strength, nnkle of application and other details claeness of statement. Another marked feature of ■ being fully exjilained. The descriptions of gynie- the book is the attention paid to the details of | cological manipulations and operations are ftiU, many minor surgical operations and procedures. ' clear and practical. Much care has also been be- 1, for instance, the use of tents, application or' stowed on the parts of the lK»ok which deal wiUi
diagnosis — wo note esi>ecially the pages dealing with the dltterentifttion, one from another, of the ditlcrent kin<ls of abdominal tumors. Theprao- titidnerwill t h ere f< ire find in this lK)ok the Kind of knowledge he most needs in liis daily work, and he will be pleased with the elearness and fulness of the informatinn there given.— y'/**- Jtaetitioner^ Feb. 1882.
leeches, and use of hot water injections. These are among the more common methods of treat- ment, and yet very little is said al>out them in many of the text-lK>oks, The iKwk is one to be warmly recommended esi»ocially to students and general practitioners, who need a concise but com- plete rfsum* of the wliole subject. Sjiecialists, too, will find mhny useful hints in its i)ages. — Boston Med. and JSuni' Journ., March 2, 1S82.
BARNES, ROJtERT, M. !>., J<\ R. C. 1*.,
Obstetric J'hynirian to St. Tin, inns" JfospUal^ I^miUm^ etc.
A Clinical Exposition of the Medical and Surgical Diseases of Women. In one handsome ovtavo volume, witli numerous illustrations. New (Klit'um. Prepark
CHAnWICK, JAMES Jt., A. 3/., M. J).
A Manual of the Diseases Peculiar to Women. In nne liandsome ro 12mo. vohiine, with illu-strationa. J*repnrin(j.
WEST, CHAELES, M. I).
Lectures on the Diseases of Women. Third Americun fnmi the thinJ I/o* don edition. In one ottavo V()lun>« of 54.3 })a5:ts. Cloth, $.-».75; leather, $4.75.
EMMET, THOMAS ADDIS, M. !>., LL. X>.,
Surffron in the WomnrCit Jlonpital^ .Vfir Yorlc^ tfc.
The Principles and Practice of GynflBCology ; For the iisc of Simlentii PmctiticHuu'rt nf ^lc<Ut'inL^ Sei-^nid oditioti. 1 buroughly revLMMt In one UrR« andVi ilinn*ist»nii; tM:rnvc) v«*liiuje ol !^Ti)pngcs, with 1:^1 inutitraliuiis. Cloth, $5.01); leotKcr, 16.00;] verv IiuntWmi*' hall lliisJiftiji* §(»..'iU,
No Kvm^rolojyflcnl tr^iUl*e liitji Rppearod which 4!onti\tiifl HO tH^iia) nmointL tif itiiKiniif n.nri i)M4<fui mnt^T; rinr d"*'*' i*i" rn**»nf'(vl \\m\ Hiii«i<'al hi^i^rv of AfMi>il«'n itu'ldd"' n iMMfk Hii«H' iimvi'I wwi (iivtMl Th(< liiSiiliii' jumI "iiiti^liinl iiiCoi iiMiiUHi \?liioh \i coniiiliiM i-M iinvrv*'(Knt«., I><»ili in <iiuvimty m\A U'vn- rivr-y, Aful «*ftjni'»t lie oiJ)<?i-wi»p iluui tiivaluiiLiti^ to f^itiiie invi-'KliKat^i-s. tr i*ft wntk wrhjoli Jfmimtls not i'un'lt"*t** ivailing ImK inuroiMMl "tiidy. lif vithH" AM n t'urUnluiUoii lo jijyniL*t'f*lt»lty i**, piTtin^w, gv»^«ter thun tliitlof lOi |iievUHiH liCemtura on the Auhjtrct oomluiKHl.— t'*<OT'yfj MftiicaL OfuHff, April 6, inmK
III tiQ uotiiili7 of the world h*» g>"TioEcology re-
reivticl moTf> atteollrvn than in Am^ti<%. tX U,\
it n,
m
wp iM'i -:iy r.»;ii f
f.N \«rHtf' o hi fi rtiNii
tli*»llitf>rarv r**r*utiitioti .fi mv n^'t^iuv >fi i.
Aiitl Ulivei Wo(nii*ll hioime»,—lSf%t4AhJi«a.Ji>^
l>t/.VC^JV; J. 31ATTHEWS, 3Ln., LL. J>., F. M. S. J?., ei€.
Clinical Lectures on the Diseases of Women; Delivereti in Snint Ba^ UioIoiiiew*8 IhiisintEiL In one JmmlHoriio octuvo vohinie of 175 |Kiges. Clolh, |1.50. Tln?y aj*e tn every wuy worttiy of their ivnthor; etnmp of iodirirJifAlity thnt. If »ifl«'ly rriwl, ■
Viihiti^jle of 1 1 mHiii?i> of gi<
Btttuv <*f IIm'Ii
nil'. ■ or
r;t*rljiiiilv
.1-
nntimiE the most rhi\v «n? (lit upon
[!i.tl .ii*> not, iTkit a ' n|Hh, I I - itlluT* I th^itjjut'
iMiiHily I Jtjtnnnf, Maivl , -.ji'h- "
.«..., tin
|>reMeiit. diivv-^^V. ) . .Wr^iic
GUSSEItOW, A„
l^ufct^ur i%f Miihnf&rii nnd the. Jii^fftiAfM nf Chihfren nt th« Um\fr9it}( o/ Berlin.
A Practical Treatise on Uterine Tumors. Bpetirtllv revises! • - '' ftjid tranbhited with notes and additions l>y Edmund C, Wendt, .VI. IX, I* St. FninctH iioHjiilal, N. Y., etc., and revised byNxTUAN Bozema^, M. I^, Wtlnuin's. iloKpitjd **f the Sttiteof New York, In one handHotiic octavo voltim^ with i 40 ill ustrut ions. iWpuring.
GYNECOLOGICAL TRANSACTIONS.
Btintf the; Tf tnu(tcttf.'n)( nj the Ametjcan Gf/Hf€ot^icnl Sortefti ffV iht Vef*r 18«2,
VOLUME VI 1, In <me very hnndsfsme wtuvu volume. J^iM muly* Votamtt \ m., IV., V. aiul VI. may also he obtuined. Price, each, hy rnnil, poBtpiiid, $6.00.
HODGE, HLGHL., M, D.,
Emerttutt PraffJinnr of (JtiAtMHcJi^ eU.^ in the l7niP0Ntify 4tf Pmrntflnnnin.
On Diseases Peculiar to Women; Inohidtnj? Displaoements of the Vu Sewnd edition, rtn-ised ;md enlm''j;ed. In one hettutifuUy jnintod octavo volume of 51 piig^ with original illiiHlratiuns. Cloth, $4.ot).
By the Same Author.
The Principles and Practice of Obstetrics. IlUistraied with laiipe litl
grnphic phite'? containing l")D fitriirea from original phoiogn^phs^ nnd with nnnienHi8i cnlH. Jn untr large quarto volume of 542 double-cxduiimed [lagejj. Stnmgly l>uuod clolh, $14AMI.
* ^t * Specimens of the plateft and letter-press will be forwnrded to luiyjiddren^ 1^ by mail, on receipt of six eentii in jwjsUige »tamp«.
MA31SBOTHA3T, FRANCIS H., M. /)•
The Principles and Practice of Obstetric Medicine and Surgeryj In referenee to iliel*nice,H,snf Parturition. A new and enkirg:e<l etiiiinn.tIior*>ujL'li'v .. by the Author With additions hy W. V. Kkati>'u, M. O., Frolessor of ()L«.r, in the Jeflenitin Metlieid College of Pliilfidelj*hia. In tme lar^e ami hancWMm octavo vidume of n4t) |«»i:e?i, with r>4 full-j>{ijie plates anit 43 wtuMlenLs in the text, uniinii ing in all nearly :it)0 beautiful figures. Strongly bound in leather, with ntii»ed band», T
ASHWRTJ/S PRVrnCAL TREATISE ON THE I AND OTHRU Dlf^KASrai PECTm.ua Til WO llhSKASIvS VKAIU.IAU TU VVOMKN. TlOnI M KN. In otiwMvo. vol. of 4fi4 |i»4*?tr*. <*lo(n.| AfiH'tlmn fmin IU« lh\td AnA VfevWd A.wv\o\\ Wy^t^"^ v^>s'VVlV. N\TlTUrC.K|CiNS \Nli TUKAl
64lriioii, In oue «vo. vol., pp, &5U k.\sa\\.\,\h\. \ UY.^"*^ oy ^:.\\\^^v^^^v\ v*v.s\.vu u, o<mi iv
Henrt C. Lba's Son & Co.'s Pcblications — Midwifery 29
PLAYFAUt, W. S., M. D., F. R. C. P.,
Pro/Msor of Obstetric 3Iedictne in Kinrji't OoUege, London^ etc
A Treatise on the Science and Practice of Midwifery. Tliird American edition, revised by the Author. Kdited, with additions, by Robert P. Harris. M. D. In one handsome octavo volume of G59 pages, with 183 illustrations. Cloth, $4 ; leather, $5; half Russia, $5.50.
The mcdicnl profession has« now the opportunity I choose Playfulr's. It \n of convenient site, bat of fuldiuK to tiieir stock of standard medical works | what is of eiiief importance, its treatment of the one of tlie best vohimes on midwifery ever pub- j various subjects is concise and plain. While tlie Ifshed. The subject is taken up with a master, discussions and descriptions are sufficiently ehdjo- faand. The part devoted to labor in all its various ! rate to render a very intelligible idea of them, yet presentations, the management and results, is arl- j all details not necessary for a full understanding mirnbly arranged, anQ the views entertained will , of the subject are omitled.— Cincinnati Medieai be found esseutiallv modern, and the opinions ex- ' News^ Jan. 1880. /
pre»*»ed trustworthy. The work abounds with | it certainly is an admirable exposition of the plates, illustrating various obstetrical positions; , science and practice of midwifery. Of course the thev are admirably wrought, and afford great . additions ma<le by the American editor. Dr. R. P. a8si>.tance to the student.— A. 0. M&lical and Sur- I Harris, who never utters an idle word, and whose gicaf Journal^ March, 1880. | studious researches in some special departments
If inquired of by a medical student what work i of obstetrics are so well known to the profession, on obstetrics we should recommend for him, par I are of great value. — The American Practitioner, excellence, we would undoubtedly advise him to I April, 1880.
KING, A. F. A., m ID.,
Professor of Obstetrics and Diseases of Women tn the Medical Department of the Columbian UniveT' eitj/\ Washington, D. C, aiui in the University of Vermont^ etc.
A Manual of Obstetrics. In one very handsome 12mo. volume of 321 pages, <with 58 illustrations. Cloth, $2.
Though the book appears small externally, it I lent obstetric dictionary, and well suited to the stu- oontains as complete a consideration of obstetric | dent, it is also of value to the general pra(*titioner, subjects as many larger volumes, and this is i who often desires to find a /-^aMm« of informatioa
oliiefly owing to a directness of expression, and an avoidance of repetition and of waste o(^ words. The author endeavors to place theories, causes of diwetvse and methods of treatment in that order whirh, i)y weight of authority, they merit. His oxcellent judgment has availed him well in this ■etfort. While, in one sense, the book is an excel-
upon a given subject. It will be of rurther value to the latter, as, in our opinion, the autlior holds most sensible views on practical matters. The i)ook is ailmirably arranged for refi'rence, i>eing well pamgrauhed, witii suitable sub-divisions, and well mciexea. — American Journal of Obstetrics. Aug, 1882.
JPAJRVIN, THJEOPHILUS, 31. I)., LL. I).,
professor of Obstetrics and the Diseases of Women and Children in the Jefferson Medical College. A Treatise on Midwifery. In one very handsome octavo volume of about 660 ipages, with numerous illustrations. In press.
B Alt NFS, ItOBEBT, M. D., and FANCOUBT, M. J).,
Phus. to the Qencrnl Lying-in llosp.^ Lond. Obstetric Phys. to St. Thomas* Hosp., Lond,
A System of Obstetric Medicine and Surgery, Theoretical and Clin- ical. For the Student and the Pniftitiuner. The Section on Embryology contributed by Prof. Milnea Marsliall. In two handsome octavo volumes, profusely illustrated. In press,
TARNIBB, S., and CHANTBEUIL, G.
A Treatise on the Art of Obstetrics. Translated from the French. In »two large octavo volumes, richly illu.stnited.
BABNES, FANCOUBT, M. I).,
Obstetric Physician to St. Thonuus* Ho-'<pitaf, London.
A Manual of Midwifery for Midwives and Medical Students. In one •royal 12mo. volume of 197 pages, with 50 illustrations. Cloth, $1.25.
JPABBY, JOHN S., 31. I).,
Obstetrician to the Philadelphia Jlctspital, Vice-President of the Obstet. Society of Philadelphia. Extra - Uterine Pregnancy: Its Clinical Ili.story, Diagnosis, Prognosis and Treatment. In one handsome ocUivo volume of 272 pages. Cloth, $2.50.
TJXNBIif THOMAS HAWKES, M. D.
On the Signs and Diseases of Pregnancy. First American from the second Englis!! edition. In one handsome octavo volume of 490 pages, with 4 colored plates and 16 woodcuts. Cloth, $4.25.
WIXCKEL, F.
A Complete Treatise on the Pathology and Treatment of Childbed.
For Students and Practitioners. Translateii, with the consent of the Author, from the ^second German e<iition, by James Read Chadwick, M. D. In one octavo volume of 484 .pages. Cloth, $4.00.
EMytr
;.iii€s of Pregnancy and the
Autlior, vs: fj
1. 1 ml, i-tc, i . Lialions. Clotli, H-^Ui. leatiie
J>/
♦ 'rrTTr pl^tf* in
!U-livntt If'>tpif'it ,\fnitrol r,,f!Hjf, ^\ Y
^0 on the Diseases of Children. V\t
In one handsome (K'tavo voln " ^5if : vtrv lijuuWime half Riij3»i:j
. nywliatiawnnteilbv v
amend
boo OQ it,
» > fci T-i*^** one. —
, 4» t^ ittli^4*CU of
^ •■■it t» vftln« to
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the Management and Feedmg of Infants.
; ;|.es. (loth. $1. IK). ims itri- Hn-' oriiployTn^nt of ft Wf»t-rinrfaii*,*abrMit Vnr> ^>ro||( : u niir«iing r: i, nboiit tlu' I
.1 r,u mrHi
>ttKS, M, J>.,
of Infancy and Childhood* Fifth AmcHa
v^c'l Kn|*lish editiiiD. In one large and hiuirl«>fime
By the Same Author. •^ ! writers of the NeiTOUS System in Childhood. I n fxne i
ClotJi, ^hOO.
vUf^i] i\ndfiii;;RU'iiU*d tn aiii> uctAvo latum
Hbnbt G. Lea's Son & Co.'s Pcblioations — ^Bled. Juris., Miscel. 31
TIDT, CHARLES METMOTT, M. B,, F. C. 8,,
Profetanr of Chemistry and oj Forentic Medicine and Public Health at the London Hospital^ etc Legal Medicine. Volume II. Legitiraacy and Paternity, Pr^ancy, Abor-
tHm, Kape, Indecent Expoeure, Sodomy, Bestiality^ Live Birth, Infanticide^ Asphjxut,
Drowning, Hanging, Strangulation, SiiAbcation. Making a very handsome imperial oo-
tavo volume of 529 pages. Cloth, $6.00; leather, $7.00. Just ready,
VOLUME I. Containing 6G4 imperial octavo pages, with two beautiful, colored
plates. Cloth, $6.00 ; leather, $7.00. Recently issued. He whose inclinationH or neooHsitiea lead him to
•Mume the functioriH of » medical Jiirint wantA a
book encyHopiedio in character, in which he may
bo reai«onahly sure of finding medico-leKal topics
>ly « wlh
opi< ciei
diMiiRrte«l wlh Jiidioijil fairneH!«, with Riifflcient eoropletenetis, and witli due attention to the moMt recent ailrancee in medical science. Mr. Tidy's work bids (air to meet tiiis need satiHCActorily.
The fact that the very numeroas Illustrative cases are drawn from many sources, and are not limited, as in Casper's Handbook, to the author's own ex- perience, and the additional fact that thev are brought down to a very recent date, give them, for purposes of reference, a very obvious value.— Boiton Medical and Surgical Journal^ Feb. 8, 1888.
TAYLOR, ALFRED S., M. D.,
Lecturer on M&Ucal Jurisprudence and Chemistry in Ouy*s Hospital, London.
A Manual of Medical Jurisprudence. Ki&;hth American from the tenth Lon- don edition, thorouglily revised and rewritten. Edited oy John J. Reese, M. D., Professor of Medical Jurisprudence and Toxicology in the University of Pennsylvania. In one large octavo volume of 937 pages, with 70 illustrations. Cloth, $5.00; leather, $6.00; half Bussia, raised bands, $G.50.
only have to seek for laudatory terms.— itmertoan Journal of the Meitical ScUnees, Jan. 1881.
This celebrated work has been the standard ao- thority in its «lopartment for thirty-seven yean, b<nh in Hnxland and America, in both theprofea- sions wliich it cunct;rns, and it is improbable that it will be Hupersoiled in many years. The work is sim ply indispensable to every pnysician, and nearly so to every liberally-educated lawyer, and we hoartily commend the present edition to both pro- fessions.—.4 /ton^ Law Journal, March 26, 1881.
The American editions of this standard manual have for a long time laid claim to the attention of the profession in this country: an<l the eighth eomes l)efore us as em^K>dvin)( the latest thoughts and emendations of Dr. 'tnyUiv upon the subject to which he devoted hi'* lifa with an aHsiduity and •nccesa which made him fncUe prinreps among English writers on medical jurisprudence. li>)tK the author an4l the book have maule a mark too deep to be affected by criticism, wliethor it be ^enaure or praise. In this case, however, we should
By the Same Author.
The Principles and Practice of Medical Jurisprudence. Third edition. In two handsome octavo volumes, containing 1416 pages, with 188 illustrations. Cloth, $10 ; leather, $12. Just ready.
The revision of the third edition of this standard work has been most happily con- fided to a eentleman who was during fourteen years the cuUeamie of the author, and who therefore is thoroughly conversant with the methoils of thought which have everywhere gained for the book an exalted position as a work of reference. In its present form the work is the most complete exixwition of Forensic Medicine in the English language.
Taylor's Treatise at the hands <»f Dr. Stevenson nas undergone a diminution of bulk with an in- crease of mass. This edition only asserts with stronger reason the allowed claims of the lute Dr. Taylor's work to the first position among English
books of its class. Including if ithin its purview, as the subject does, somethmg fh>m every divi- sion of medical science, this exhaustive treatise will ever remain an invaluable collection of <" —JS'ew York Medical Journal, Dec. 1, 1883.
By the Same Author. Poisons in Relation to Medical Jurisprudence and Medicine. Third American, fmm the tliinl and revised English edition, in one large octavo volume of 788 pages. Cloth, $5.50 ; leather, $0.50.
LEA, HENRY C.
Superstition and Force : Essays on The Wager of Law. The Wager of Battle, The Ordeal and Torture. Third revised and enlarged edition, in one handsome niyal Vliwo. vohmie of 552 im^es. Cloth, $2.50.
This valttHble work is in reality a historv of civ- ilization as* iiitorprtUod by the urojcrcs-MofjuriMpru- deiwr. . . In "Siipersiitloii HUil Knr»'e" wo liuvf H
EhiloHophic survey of the Iouk iH'riiMl intervenini( etween primitive JiaHiarity and civilixed enlight- eumenU Tiicre is not a chapter in the work tliat
f»liould not Ik* most carefully studied ; and however well versed the reader may be in the science of jurisprudence, he will find much in Mr. Lea's toI- iirne of which he was previouNly ignorant The ^MM>k in a valuable addition to the literature of w> cial science.— Westminster Review, Jan. 1880.
By the Same Author. Studies in Church History. The Rise of the Temporal Power— Ben-
'~ New edition. In one very handsome royal Ju>st rtddy.
primitive church traced with so much cleameM, and with so definite a pertreption of complex or confiictiuK sources. The fifty pages on the ffrovrtli of the papHi'v, for in.xtance, arc admirable for con- cineness and freedom from prejudice. — Rotiam TraueOer^MayS^lMa.
eflt of Clergy— Excommunication, octavo vohime of (505 pages. Ch>th, $2.50.
The author is pre-eminontiy aschoUr. He takes op every topic allied with the leudiug theme, and tracen it out to the minutest d«'tail with a weallli of knowledice and imi»artiality of treatment tliut compel aiiniiration. Tlifi amount of lutormation eitntprw*f-^d into the book tj* extraordinary. In no otLttr Biagle rolume is the development of the
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LANE MEDICAL UBRARY
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