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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 


136 


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, 


143 


I 


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. 


144 


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. 


148 


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. 


241 


I 


» 


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. 


243 


I 
I 


I 


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, 


245 


I 
I 


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 


* 


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- 


^ 


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 


^1 


BISEASES  OF  THE  SKIX. 


253 


I 

ft 


^ 


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 


I 


I 


) 


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. 


257 


I 


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. 


269 


^ 


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, 


J 


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 


I 


I 

I 
I 


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 


I 
I 
I 

I 

I 


I 
I 


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 


\ 

I 


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 


I 


I 


I 


I 


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. 


C57 


\ 


I 


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 

^^^H                        IkdUBTRIAI*  CiLUSES. 

DtBBABBB  IkDPCKU 

^^^H           Cigar-mtLkinic^ 

r 

^^^H           Lace  frame-making 

Palpitation  and   irregnljit,,^ 

^^^H           Bleat^liing 

action  of  the  heait. 

^^^H           Hat'DmkijQg 

^^^H           Fiir-dyeing 

Intermittent  action  of  th*^^^ 

^^^B           Aniline  d^re-mftking 

heart. 

^^^B           Needlework 

^^^1           Tailoring 

^^^H           Draper's  work 

heart.                   ^H 

^^^H            Dock  labrjrer'B  work 

^^^1 

^^^H           Drayman's  work 

Yalvnlar  dinease.       ^^| 

^^^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              ■ 

^^^H          Bone -boiling 

■ 

^^^H          Blacksmith's  work 

Aneurism.                   M 

^^^H           Farrier's  work 

^^H 

^^^H           Boatman's  work 

Cyanoaia.              ^^H 

^^^H           Lauudry  work 

^^B 

^^^H           Clerk'^  work 

Extreme  fluidity  of  the         ■ 

^^^H           Coal-heayiug 

blood.                 ^^H 

^^^H            Butebering 

^^H 

^^H           Waiting 

Aneemia.               ^^H 

^^^H^          Porter's  work 

■ 

^^^^^^     Pottery  working 

H 

^^^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 

^^^H           Hemp  and  ttax-dret^ing  and 

^^1 

^^^H               spinning 

Bronchitis,  acute  and     ^^B 

^^^H           Rag-working 

i^lirnnii^                             .^1 

^^^H           MiiJing  and  floiur-working 

l,JJ.£UI.Ut^                                                  ^^M 

^^^H           Wooii  and  ivory  turning  and 

^^M 

^^^H              earring 

^^^H          Oigar  and  tobacco  nmnufac- 

Bronchial  phthisis.       ^^B 

^^^H              tnre 

^^^H           Walking-Rtiek-making 

The  Respiratory 
Hvatem. 

Bronchial  irritation.            ■ 

^^^H           Hair-dressing 

►  ^  T  C7  t/i;* -U.J. « 

^^B 

^^^H           Bmsh  making 

^^^H           Fellowsbip  porter's  work 

Emphysema,          ^^H 

^^^H          Burnishing 

^^H 

^^^H          Faper-gtaiBing  and  artificial 
^^^H              flower-making 

^^^1 

^^^H           IVIining 

^^^1 

^^^H          Trimming-making 

Spoamodic  and  Flax     ^^1 

^^^H           Alkali-Tuaking 

Asthma.                 ^^H 

^^^H           Tailoring 

^^H 

^^^H           Dokper'B  work 

^^^1 

^^^H           Clerk's  work 

Chest  spasm.           ^^M 

^^^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 


I 


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 


I 
I 

I 


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 


630 


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. 


as 
he^H 


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. 


r-i       iH  ffl       SO  ?1       go  ^-1  ~- 1-^       t-  ifh  '^  »-<  ^^       » 


•-4  op  •«♦< 


7}  .-fl,  !^  '*:'  [^  r^ 


§0  »* 


^^^l«l^l=i 


*#   O   l«   O    h,    3 


d      d      o      B 


S  8 

ni 


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 


I 


I 
I 


I 


I 


I 


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 


654 


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. 


668 


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. 


I 
I 

I 


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 


I 
I 


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 


f 


I 


IL 

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 


PEEVKNTI0N8  OF  ZYMOTIC  DISEASES. 


675 


I 


I 

I 
I 


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. 


en 


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. 


m 


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. 


681 


I 


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 


I 


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 


PREVENTIONS  OF  2TMOTIO  DISEASES. 


683 


I 


I 


unc 


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 


I 

I 


I 


I 

I 


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* 

I 


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- 


^ 


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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The  iaftft  numb*^  of  inqulrioi  rteeivtd  from  (he  profeMion  for  a  finer  chvm  &f  binding  than  w 

umallij  placed  on  mfdictd  book*  h(ut  itulured  ux  to  pfU  certain  of  our  ntandard  puhlirjitionn  tn 

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^Hf  quackery  and  fraud,  a  scientific  magazine  in  elaboralion,  &i\a\  iil  iie^«y«L^x  vci  «>» 


2       Henry  C.  Lba's  Son  &  Co.'s  Publications — The  Medical  Xews, 


vitaUty.  They  iK'Heve  iKut  in  e?ei7  respect  it  has  fulfilled  iia  promisefl.  Its  readeri  and 
contributors  are  found  in  every  SUUe  aod  Territory ;  its  Editorial  Staff  iDcliid«  iome  of 
the  l«ri|3;htest  minds  in  the  profession,  and  in  every  issue  living  topics  are  editoriativ  dii- 
cusaed  in  a  scholarly  and  pnictiral  manner ;  its  corps  of  qualified  reporters  wid  Offm* 
pon dents  csovers  all  the  medicail  centres  of  both  heiuisiiheres,  wnd  secures  for  iU  ooluimii 
the  earH est  inform Jition  on  matters  of  medical  interest,  and  its  reports  of  Medical  Pro- 
gre88  ;ire  culled  lrt)in  iiW  the  imjiortaut  professional  joiimalB  published  on  both  contiQCDtL 
In  sliort»  its  unrividled  orgunimtion  enables  The  Newb  e^ich  week  to  lay  upon  UiA 
table  of  it8  rcailers  an  epitome  of  a  week^s  advance  of  the  whole  medical  worhl. 

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. 

h.  IIUNCAN  BULK  LEY,  New  York, 
THARLES  H.  BURNETT,  Phlladotplii*. 
8A MITEL  r.  BU9EY,  Wiwhlnnrtoii. 
WILLI  AH  H.  BY  FORD,  Chicftgo, 
P.  8.  CX>NNER,  Ciiicinunti. 
J.  M.  DA  COSTA.  PhiliwiclphfA. 
FREDEHIC  a  DENNIS,  New  York. 
PRANK  DONALDSON,  Baltlmoro. 
LOUIS  A.  IiUHRlNG,  Philadelphia, 
ROBERT  T.  EDE8,  Boston. 
J.  FERGU80N.  Toronto. 
AUSTIN  FLINT,  New  York. 
WILLIAM  GUODELU  PhiUdelphia. 
SAMUEL  D.  GRaSS,  PhlljulotphiiL 
SAMUEL  W.  GROSS,  Pliiladelpliui. 
J.  F.  MEUSTIS,  Mobile,  Ala. 
WILLIAM  Hl^NT,  Philiidelphim. 
JOf^EPH  a  HUTCHISON,  Brooklyn. 
4AME8  NEVINS  HYDE,  Chicago. 
A-  REEVES  JACKSON,  Chiengo. 
EDWARD  W,  JENKS,  Chicago, 
A,  F.  A.  KING,  Washington. 
GEORGE  M.  LEFFERl^,  .New  York. 
WILLIAM  T.  LUSK.  x\ew  York. 
JOHN  M.  MACKENZIE,  Bftltimor«. 
HUNTER  Mc<:iUIRE,  RklmioiKL 


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. 

The  Original  Department  will  consist  of  elaliomte  and  richly  iltuiitrated  articles 
(mm  tbe  pen^  of  tbe  most  eminent  inembern  of  the  profession  in  all  part^  of  the  country. 

The  Review  Department  will  mninUiin  its  well-earned  reputation  for  discernment 
und  impartiality,  and  will  t-ontain  elabt»nite  reviews  of  new  works  and  topics  of  the  day, 
and  numerotm  analytical  and  Ub!i'>grapbical  notices  by  wmpelent  writers. 

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. 

The  subscription  price  of  The  Americak  Joitrnal  of  the  Misi>ical  B<.'1£ncj9s  has 
never  been  raised  during  its  long  career.    It  is  Blill  sent  free  of  i>oBtage  fcir  Five  Dollars 

r  annum  in  advance. 

Taken  together,  the  Journal  and  JJbws  combine  tlie  advantages  of  the  ekl»orate  prej*- 
.ration  that  can  be  devoted  to  a  *|Uitrterly  witb  the  pnimpt  conveyance  of  intelligence 
by  the  weekly;  wliile,  by  Bpecial  mrmagement,  duplication  of  matter  is  rcntlen^  im- 
poflBihie. 

It  will  thus  Ix*  wjen  that  for  the  very  moderate  sum  of  NINE  DOLL  A  Its  iu  iidvunce 
tbe  suhBcriber  will  receive  free  of  p«tagc  a  weekly  and  a  quarterly  journal » Ixjlh  relliHting 
the  latest  advances  of  tbe  medical  scienceSj  and  containing  an  eciuivalent  of  moiv  than  4000 
.vo  plages,  stored  witb  the  choicest  material,  original  and  selected^  that  can  be  furnialied 

the  hegt  medical  minds  of  both  hemispheres.  It  would  be  impoHtdble  lo  Und  elsewhere 
io  large  an  amount  of  matter  of  the  same  value  offered  at  so  low  a  price. 

$S^  The  safest  mride  of  remittance  is  by  bank  check  or  |iostal  money  »u*der,  tlrawn  to 
the  order  of  tbe  undersigned;  where  these  are  not  accessible,  remiilant^es  ft>r  wljecri}*- 
muy  Im!  mmle  at  tbe  risk  of  the  publiahenj  by  forwarding  in  rtgUUrM  letter**,  Addre«, 
lIjsKiiy  a  Liu.'3  Son  &  Co.,  Nob.  706  and  70S  Sansom  St**  Phihideljthia,  P.i 


>♦  Gommuuicationa  tobotb  these  periodicals  are  invited  fnim  -       ' 
fthe  country.     Ori^^inal  arttdcs  c^mtrihuted  cxcbiKivcly  lo  cither  i 

aid  for  upon  puUiaition.    When  necessary  to  elucidate  the  text,  ill.,  .,,....  ., 

'nheii  without  ujst  to  the  author. 

Ml  h  Hits  pcrtaininf^  to  the  BUtortai  Ikpartftumt  of  TiiE  Mkdical  ^kws  »nd 

Joins  AT,  OF  TTiE  Mf'DTCAL  BciENCB9  sliould  lie  4pdd  reswd  to  ihe  1  1»1T 

iiOl  Walnut  Street,  Phibwlclphia. 

Aii  letters  pcrtuiniutf  to  the  JitutineMt  Dt^pnrtm*^ni  of  thcKc  journals  pIiouM  Im  jidd 

9eiuMtitiy  lo  IIkkkv  C.  I^A'ti  80K  St  Co.,  700  and  70*J  8imsoni  Street,  \*U\V^^  V-\^ 


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&gtA^  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 


uM-_       It    :.rf,,Ml.    i 

i-fMi.'tiua 

Mir- 

..1i». 

,,s(»« 

.ud 

lilU 

I  r»*» 

.nd 

if^o 

iied 

In   U.Ji.   f.i, 

l,>l« 

IV    lt>Vj*H-t1, 

h»» 

»  MPtftUtlKl'i  ' 

•t'H 

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 


kUi 

Th 

nit' 

vo 

■  ;i^  ii.:;.. 

ILI 

Pnnrih 

An  ' 

-       iitlon.    Id 

our  X 

vo.  ¥*A.<4  4^;^  liAkEeM,  wiLh.au  lihiMLrutlotiK. 

Clolli 

^.7ft. 

ir.T  t 

/rg    iMf*.    i-rrK   OF  mTRnEUy.     F^firth 

•ipi 

uii  from  the  In?*!  FAllubortfli 
r  «To.  vol.  of  6*2  pa|t«*s.  with 

6dt 

SM^. 

^..... .j.4h.  8:i.:a. 

^ 


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 

•ttK  we 
of  Ur. 

\vilt  I  to 

,iH_'   I  hi  -I  I.' (I  an  thr 

.Vti»%  A  put,  tHW). 
a  liTirtuM'N   li»o«*U ;  for  we 
hi4«»  ninm?  iff  rarilli'ul 


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 

j-i  «0t  enotiich  to 


ifM  M.  />., 

ir«rt  fif  fA<  tjnir^rgih/  of  Pinnmutfania^  etc. 

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 


■r-  .  •  •  ''^^^<-' 


■/•»-.-  i-.^*"."  iji.-'i" 


LANE  MEDICAL  UBRARY 


To  ayoid  fine.  Ibis  book  should  be  returned 
on  or  before  the  date  last  stamped  below. 


I.JH 


Tiu 


j^^Oii^ 


e    field   of  diflenae 
623 


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