Zoonomia Volume Ii Part 76

After these vessels of the whole surface of the body both absorbent and secretory have been for a time torpid by the application of cold water; and all the internal secerning and absorbent ones have been made torpid from their a.s.sociation with the external; as soon as their usual stimulus of warmth is renewed, they are thrown into more than their usual energy of action; as the hands become hot and painful on approaching the fire after having been immersed some time in snow. Hence the face becomes of a red colour in a cold day on turning from the wind, and the insensible perspiration increased by repeatedly going into frosty air, but not continuing in it too long at a time.

2. When by the too great warmth of a room or of clothes, the secretion of perspirable matter is much increased, the strength of the patient is much exhausted by this unnecessary exertion of the capillary system, and thence of the whole secerning and arterial system by a.s.sociation. The diminution of external heat immediately induces a torpor or quiescence of these unnecessary exertions, and the patient instantly feels himself strengthened, and exhilarated; the animal power, which was thus wasted in vain, being now applied to more useful purposes. Thus when the limbs on one side are disabled by a stroke of the palsy, those of the other side are perpetually in motion. And hence all people bear riding and other exercises best in cold weather.

Patients in fevers, where the skin is hot, are immediately strengthened by cold air; which is therefore of great use in fevers attended with debility and heat; but may perhaps be of temporary disservice, if too hastily applied in some situations of fevers attended with internal topical inflammation, as in peripneumony or pleurisy, where the arterial strength is too great already, and the increased action of the external capillaries being destroyed by the cold, the action of the internal inflamed part may be suddenly increased, unless venesection and other evacuations are applied at the same time. Yet in most cases the application of cold is nevertheless salutary, as by decreasing the heat of the particles of blood in the cutaneous vessels, the stimulus of them, and the distention of the vessels becomes considerably lessened. In external inflammations, as the small-pox, and perhaps the gout and rheumatism, the application of cold air must be of great service by decreasing the action of the inflamed skin, though the contrary is too frequently the practice in those diseases. It must be observed, that for all these purposes the application of it should be continued a long time, otherwise an increased exertion follows the temporary torpor, before the disease is destroyed.

3. After immersion in cold water or in cold air the whole system becomes more exciteable by the natural degree of stimulus, as appears from the subsequent glow on the skin of people otherwise pale; and even by a degree of stimulus less than natural, as appears by their becoming warm in a short time during their continuance in a bath, of about 80 degrees of heat, as in Buxton bath. See Sect XII. 2. 1. x.x.xII. 3. 3.

This increased exertion happens to the absorbent vessels more particularly, as they are first and most affected by these temporary diminutions of heat; and hence like the medicines, which promote absorption, the cold-bath contributes to strengthen the const.i.tution, that is to increase its irritability; for the diseases attended with weakness, as nervous fevers and hysteric diseases, are shewn in Section x.x.xII. 2. 1. to proceed from a want of irritability, not from an excess of it. Hence the digestion is greater in frosty weather, and the quant.i.ty of perspiration. For these purposes the application of cold must not be continued too long. For in riding a journey in cold weather, when the feet are long kept too cold, the digestion is impaired, and cardialgia produced.

4. If the diminution of external heat be too great, produced too hastily, or continued too long, the torpor of the system either becomes so great, that the animal ceases to live; or so great an energy of motion or o.r.g.a.s.m of the vessels succeeds, as to produce fever or inflammation. This most frequently happens after the body has been temporarily heated by exercise, warm rooms, anger, or intemperance. Hence colds are produced in the external air by resting after exercise, or by drinking cold water. See Cla.s.s I. 2. 2. 1.

Frequent cold immersions harden or invigorate the const.i.tution, which they effect by habituating the body to bear a diminution of heat on its surface without being thrown into such extensive torpor or quiescence by the consent of the vessels of the skin with the pulmonary and glandular system; as those experience, who frequently use the cold-bath. At first they have great anhelation and palpitation of heart at their ingress into cold water; but by the habit of a few weeks they are able to bear this diminution of heat with little or no inconvenience; for the power of volition has some influence over the muscles subservient to respiration, and by its counter efforts gradually prevents the quick breathing, and diminishes the a.s.sociations of the pulmonary vessels with the cutaneous ones. And thus though the same quant.i.ty of heat is subducted from the skin, yet the torpor of the pulmonary vessels and internal glands does not follow. Hence during cold immersion less sensorial power is acc.u.mulated, and in consequence, less exertion of it succeeds on emerging from the bath. Whence such people are esteemed hardy, and bear the common variations of atmospheric temperature without inconvenience. See Sect. x.x.xII. 3. 2.

IV. Venesection has a just t.i.tle to be cla.s.sed amongst the torpentia in cases of fever with arterial strength, known by the fulness and hardness of the pulse. In these cases the heat becomes less by its use, and all exuberant secretions, as of bile or sweat, are diminished, and room is made in the blood-vessels for the absorption of mild fluids; and hence the absorption also of new vessels, or extravasated fluids, the produce of inflammation, is promoted. Hence venesection is properly cla.s.sed amongst the sorbentia, as like other evacuations it promotes general absorption, restrains haemorrhages, and cures those pains, which originate from the too great action of the secerning vessels, or from the torpor of the absorbents. I have more than once been witness to the sudden removal of nervous head-achs by venesection, though the patient was already exhausted, pale, and feeble; and to its great use in convulsions and madness, whether the patient was strong or weak; which diseases are the consequence of nervous pains; and to its stopping long debilitating haemorrhages from the uterus, when other means had been in vain essayed. In inflammatory pains, and inflammatory haemorrhages, every one justly applies to it, as the certain and only cure.

V. When the circulation is carried on too violently, as in inflammatory fevers, those medicines, which invert the motions of some parts of the system, r.e.t.a.r.d the motions of some other parts, which are a.s.sociated with them. Hence small doses of emetic tartar, and ipecacuanha, and large doses of nitre, by producing nausea debilitate and lessen the energy of the circulation, and are thence useful in inflammatory diseases. It must be added, that if nitre be swallowed in powder, or soon after it is dissolved, it contributes to lessen the circulation by the cold it generates, like ice-water, or the external application of cold air.

VI. The respiration of air mixed with a greater proportion of azote than is found in the common atmosphere, or of air mixed with hydrogen, or with carbonic acid gas, so that the quant.i.ty of oxygen might be less than usual, would probably act in cases of inflammation with great advantage. In consumptions this might be most conveniently and effectually applied, if a phthisical patient could reside day and night in a porter or ale brewery, where great quant.i.ties of those liquors were perpetually fermenting in vats or open barrels; or in some great manufactory of wines from raisins or from sugar.

Externally the application of carbonic acid gas to cancers and other ulcers instead of atmospheric air may prevent their enlargement, by preventing the union of oxygen with matter, and thus producing a new contagious animal acid.

III. CATALOGUE OF TORPENTIA.

1. Venesection. Arteriotomy.

2. Cold water, cold air, respiration of air with less oxygen.

3. Vegetable mucilages.

a. Seeds.--Barley, oats, rice, young peas, flax, cuc.u.mber, melon, &c.

b. Gums.--Arabic, Tragacanth, Senegal, of cherry-trees.

c. Roots.--Turnip, potatoe, althea, orchis, snow-drop.

d. Herbs.--Spinach, brocoli, mercury.

4. Vegetable acids, lemon, orange, currants, gooseberries, apples, grape, &c. &c.

5. Animal mucus, hartshorn jelly, veal broth, chicken water, oil? fat?

cream?

6. Mineral acids, of vitriol, nitre, sea-salt.

7. Silence, darkness.

8. Invertentia in small doses, nitre, emetic tartar, ipecacuanha given so as to induce nausea.

9. Antacids.--Soap, tin, alcalies, earths.

10. Medicines preventative of fermentation, acid of vitriol.

11. Anthelmintics.--Indian pink, tin, iron, cowhage, amalgama, smoak of tobacco.

12. Lithonthriptics, lixiv. saponarium, aqua calcis, fixable air.

13. Externally, warm bath, and poultices, oil, fat, wax, plasters, oiled silk, carbonic acid gas on cancers, and other ulcers.

ADDENDA.

_Page 625, line 1, after 'number' please to add_, 'except when the patient has naturally a pulse slower than usual in his healthy state.'

_Page 197, after line 8, please to add_, 'Where the difficulty of breathing is very urgent in the croup, bronchotomy is recommended by Mr. Field.'

Memoir of a Medical Society, London, 1773, Vol. IV.

ADDITION.

INABILITY TO EMPTY THE BLADDER.

To be introduced at the end of Cla.s.s III. 2. 1. 6. on Paralysis Vesicae Urinariae.

An inability to empty the bladder frequently occurs to elderly men, and is often fatal. This sometimes arises from their having too long been restrained from making water from accidental confinement in public society, or otherwise; whence the bladder has become so far distended as to become paralytic; and not only this, but the neck of the bladder has become contracted so as to resist the introduction of the catheter. In this deplorable case it has frequently happened, that the forcible efforts to introduce the catheter have perforated the urethra; and the instrument has been supposed to pa.s.s into the bladder when it has only pa.s.sed into the cellular membrane along the side of it; of which I believe I have seen two or three instances; and afterwards the part has become so much inflamed as to render the introduction of the catheter into the bladder impracticable.

In this situation the patients are in imminent danger, and some have advised a trocar to be introduced into the bladder from the r.e.c.t.u.m; which I believe is generally followed by an incurable ulcer. One patient, whom I saw in this situation, began to make a spoonful of water after six or seven days, and gradually in a few days emptied his bladder to about half its size, and recovered; but I believe he never afterwards was able completely to evacuate it.

In this situation I lately advised about two pounds of crude quicksilver to be poured down a gla.s.s tube, which was part of a barometer tube, drawn less at one end, and about two feet long, into the urethra, as the patient lay on his back; which I had previously performed upon a horse; this easily pa.s.sed, as was supposed, into the bladder; on standing erect it did not return, but on kneeling down, and lying horizontally on his hands, the mercury readily returned; and on this account it was believed to have pa.s.sed into the bladder, as it so easily returned, when the neck of the bladder was lower than the fundus of it. But nevertheless as no urine followed the mercury, though the bladder was violently distended, I was led to believe, that the urethra had been perforated by the previous efforts to introduce a catheter and bougee; and that the mercury had pa.s.sed on the outside of the bladder into the cellular membrane.

As the urethra is so liable to be perforated by the forcible efforts to introduce the catheter, when the bladder is violently distended in this deplorable disease, I should strongly recommend the injection of a pound or two of crude mercury into the urethra to open by its weight the neck of the bladder previous to any violent or very frequent essays with a catheter whether of metal or of elastic resin.

LINES

TO BE PLACED AT THE END OF

ZOONOMIA.

_BY A FRIEND._