LEpra.

The Leprory.

Lepra, Sauv. gen. 303. Lin. 262. Sag. 129. Lepra Graecorum, Vog. 320.

This distemper is but little known to physicians in the western parts of Europe. Wallis tells us, that it first begins with red pimples, or pustules, breaking out in various parts of the body. Sometimes they appear single; sometimes a great number arise together, especially on the arms and legs; as the disease increases, fresh pimples appear, which, joining the former, make a sort of clutters: all which enlarge their borders, and spread in an orbicular form. The supercicies of these pustules are rough, whitish, and scaly; when they are scratched the scales fall off, upon which a thin ichor oozes out, which soon dries and hardens into a scaly crust. These clutters of pustules are at first small and few; perhaps only three or four in an arm or leg, and of the size of a silver penny. But if the disease be suffered to go on, they become more numerous, and the clutters increase to the size of a crown-piece, but not exactly round. Afterwards the affection increases to such a degree, that the whole body is covered with a leprous surfeit. The cure of this distemper is very much the same with that of the Elephantiasis. Here, however, recourse is frequently had to antimonial and mercurial medicines, continued for a considerable length of time. In conjunction with these, warm bathing, particularly the vapour bath, has often been employed with advantage.

Although what can strictly be called lepra is now, at least, a very rare disease in this country, yet to this general head may be referred a variety of cutaneous affections which are here very common, and which in many instances prove very obstinate. These appear under a variety of different forms; sometimes under that of red pustules; sometimes of white fleurs; sometimes of ulcerations; and not unfrequently a transition takes place from one form to another, so that they cannot be divided into different genera from the external appearance. These affections will often yield to the remedies already mentioned; but where antimonials and mercurials either fail, or from different circumstances are considered as unadvisable, a cure may sometimes be effected by others. In particular cases, purging mineral waters, the decoction of cinchona, the infusion of the cannatha crocata, and various others, have been employed with success. Different external applications also have sometimes been employed with advantage. An article used in this way, known under the name of Gowland's lotion, with the composition of which we are unacquainted, has been much celebrated, and has been said to be employed with great success, particularly against eruptions on the face and nose.

GENUS LXXXIX. FRAMBOESIA.

The Yaws.

Framboesia, Sauv. gen. 125. Sag. 125.

Description. The description which is given of this distemper by the anonymous author of a paper in the Framboesia, 6th volume of the Edinburgh Medical Essays, (art. 76.) differs, in some circumstances, from one that Sauvages received from M. Virgile, an eminent surgeon of Montpelier, who practised twelve years in the island of St Domingo; and therefore he distinguishes the framboesia into two species, Guineensis and Americana.

The framboesia Guineensis is said by the first-mentioned writer to be so common on the coast of Guinea and other parts of Africa, that it seldom fails to attack each individual of both sexes, one time or other, in the course of their lives; but most commonly during childhood or youth. "It makes its appearance in little spots on the cuticle, level with the skin, at first no larger than a pin's head, which increase daily, and become protuberant like pimples; soon after the cuticle frets off, and then, instead of finding pus or ichor, in this small tumor, only white sloughs or sores appear, under which is a small red fungus, growing out of the cutis, increasing gradually to very different magnitudes, some less than the smallest wood strawberry, some as big as a raspberry, and others exceeding in size even the largest mulberries; which berries they very much resemble, being knobby as these are." These protuberances, which give the name to the disease, appear on all parts of the body: but the greatest numbers, and the largest fixed, are generally found in the groins, and about the pudenda or anus, in the armpits, and on the face: when the yaws are very large, they are few in number; and when remarkably numerous, they are less in size. The patients, in all other respects, enjoy good health, do not lose their appetite, and seem to have little other uneasiness than what the fores occasion.

M. Virgile describes the species of yaws that is common among the negroes of St Domingo, and which Sauvages has termed framboesia Americana, as beginning from an ulcer that breaks out indiscriminately in different parts of the body, though most commonly on the legs; at first superficial, and not different from a common ulcer in any other circumstance having its not healing by the usual applications; sooner or later, numerous fungous excrescences break out on the surface of the body, as before described, like little berries, moist, with a reddish mucus. Besides these, the soles of the feet and palms of the hands become raw, the skin fretting off, so as to leave the muscles bare; these excoriations are sometimes moist with ichor and sometimes dry, but always painful, and consequently very distressing. They are mentioned also by the author of the article in the Medical Essays; and both he and M. Virgile observe, that there is always one excrescence, or yaw, of an uncommon size, which is longer in falling off than the others, and which is considered as the master-yaw, and so termed. An ingenious inaugural dissertation on the subject of the yaws was lately published at Edinburgh by Dr Jonathan Anderson Ludford, now physician in Jamaica. The author of that dissertation considers Dr Cullen as improperly referring framboesia to the class of cachexiae. He thinks that this disease ought rather to be referred to the exanthemata; for, like the smallpox, he tells us, it has its accesion, height, and decline. It begins with some degree of fever, either more or less violent; it may be propagated by inoculation; and it attacks Impetigo, the same individual only once in the course of a lifetime, those who recover from the disease being never afterwards affected with it. These particulars respecting framboesia are rested not merely on the authority of Dr Ludford, but are supported also by the testimony of Dr William Wright, a physician of distinguished eminence, who, while he resided in Jamaica, had, in the course of extensive practice, many opportunities of observing this disease, and to whom Dr Ludford acknowledges great obligations for having communicated to him many important facts respecting it.

Dr Ludford considers the yaws as being in every instance the consequence of contagion, and as depending on a matter sui generis. He supposes no peculiar predisposition from diet, colour, or other circumstances, as being in any degree necessary. He views the disease as chiefly arising from contact with the matter, in consequence of sleeping in the same bed, bathing in the same vessel with the infected, or the like. In short, the yaws may be communicated by any kind of contact; nay, it is even believed that flies often convey the infection, when, after having gorged themselves with the virulent matter by sucking the ulcers of those who are diseased, they make punctures in the skin of such as are found, and thus inoculate them; in consequence of which the disorder will soon appear.

Prognosis. The yaws are not dangerous, if the cure be skilfully managed at a proper time; but if the patient has been prematurely salivated, or has taken any quantity of mercury, and its skin has been suddenly cleared, the cure will be very difficult, if not impracticable.

Cure. In attempting the cure of this disease, the four following indications are chiefly to be held in view:

1. To support the strength of the patient. 2. To promote excretion by the skin. 3. To correct the vitiated fluids. 4. To remove and counteract the injuries done either to the constitution in general, or to particular parts, by the disease.

With the first of these intentions, a liberal diet, consisting of a considerable quantity of animal food, with a considerable proportion of wine, and gentle exercise, are to be employed; but the cure is principally to be effected by mercurial salivation, after the virulent matter has been completely thrown out to the surface of the body by sudorifics. The following are the particular directions given on this head by the author of the article in the Medical Essays. The yaws being an infectious disease, as soon as they begin to appear on a negro, he must be removed to a house by himself; or, if it is not certain whether the eruption be the yaws or not, shut him up seven days, and look on him again, as the Jews were commanded to do with their lepers, and in that time you may in most cases be certain.

As soon as you are convinced that it is the yaws, give a bolus of flowers of sulphur, with camphor and theriac. Repeat this bolus every night for a fortnight or three weeks, or till the yaws come to the height; that is, when they neither increase in size or number; then throw your patient into a gentle salivation with calomel given in small doses, without farther preparation. Framboesia; five grains repeated once, twice, or thrice a day, is sufficient, as the patient can bear it. If he spits a quart in 24 hours, it is enough. Generally, when the salivation is at this height, all the yaws are covered with dry scaly crusts or scales; which, if numerous, look terribly. These fall off daily in small white scales; and in ten or twelve days leave the skin smooth and clean. Then the calomel may be omitted, and the salivation permitted to go off spontaneously. A dram of corrosive sublimate dissolved in an ounce of rum or brandy, and the solution daubed on the yaws, will, it is said, in general clear the skin in two days' time.

After the salivation, sweat the patient twice or thrice in a frame or chair with spirits of wine; and give an alternative electuary of ethiops and gum guaiac. He may likewise use the decoction of guaiacum and sassafras fermented with molasses, for his constant drink while the electuary is taking, and a week or a fortnight after the electuary is finished.

The master-yaw must be consumed an eighth or a tenth part of an inch below the skin, with Mercur. corrosif. rub. et alium. ufi. part. æqual. and digested with Ung. basil. flav. 3j. and mercur. corrosif. rub. 3j. and catarized with lint pressed out of spirits of wine, and with the sulphate of copper.

After the yaws are cured, some patients are afflicted with carbuncles in their feet; which sometimes render them incapable of walking, unless with pain. The method of cure is, by bathing and paring to destroy the cuticle, and then proceed as in the master-yaw. The gentle escharotics are to be preferred; and all imaginable care is to be taken to avoid the tenons and periosteum.

To children under six or seven years old, at the proper time of salivating, when the yaws are come to their full growth, give a grain or two of calomel in white sugar, once a day, once in two days, or once in three days, so as only to keep their mouths a little fore till the yaws dry, and, falling off in white scales, leave the skin clean. This succeeds always, but requires a longer time than in adults.

In St Domingo they are salivated byunction; but it does not appear that success always followed this practice. It is also usual in that island to give the solution of corrosive sublimate along with a decoction of farfaparilla. Twelve ounces of this root, and 12 pounds of the coarsest figar, macerated for 15 days in 12 quarts of water, is mentioned as a specific, and said to be the prescription of an English physician; the dose is four ounces every sixth hour.

TRICHOHA.

The Plica Polonica, or Plaited Hair.

Trichoma, Sauv. gen. 311. Sag. 137. Plica, Lin. 313. Plica five Rhopalos, Veg. 323.

This disorder is only met with in Poland and Lithuania, and consists of several blood-vessels running from the head into the ends of the hairs; which cleave together, and hang from the head in broad flat pieces, generally about an ell in length, but sometimes they are Impetigines five or six yards long; one patient has more or less of these, up to 20, and sometimes 30. They are painful to the wearer, and odious to every spectator. At the approach of winter an eruptive fever happens to many in these countries: the eruptions principally infect the head, and when at the height an ichorous humour flows from them. In this state they are too tender to admit of being touched, and the matter running down the hairs mats them together; the skin by degrees, breaking, the ramifications of the capillary vessels following the course of the hair, or prolonged out of the skin, are increased to a vast length.

No method of relief is yet known; for if the discharge be checked, or the vessels cut off, the consequence is an increase of more miserable symptoms, and in the end death. Sennertus says, when all the morbid matter is thrown out of the body the pustules fall off spontaneously. He further observes, that the only safe practice in this case is, to follicle the peccant matter to the hairs, to which it naturally tends; and that this is best answered by lotions of bear's-breech. Some say that a decoction of the herb club-moss, and its seeds, with which the head is to be washed, is a specific.

ICTERUS.

The Jaundice.

Icterus, Lin. 224. Vog. 306. Boerh. 918. Junck. 92.

Aurigo, Sauv. gen. 306. Sag. 132.

Cachexia icterica, Hoffm. III. 301.

Description. The jaundice first shows itself by a listlessness and want of appetite, the patient becomes dull, oppressed, and generally coltive. These symptoms have continued but a very short time, when a yellow colour begins to diffuse itself over the tunicia albuginea, or white part of the eye, and the nails of the fingers; the urine becomes high coloured, with a yellowish sediment capable of giving a yellow tincture to linen; the stools are whitish or grey. In some there is a most violent pain in the epigastric region, which is considerably increased after meals. Sometimes the patient has a continual propensity to sleep; but in others there is too great watchfulness; and sometimes the pain is so great, that though the patient be sleepy he cannot compose himself to rest. The pains come by fits; and most women who have had the jaundice and born children, agree, that they are more violent than labour-pains. As the disease increases, the yellow colour becomes more and more deep; an itching is felt all over the skin; and even the internal membranes of the viscera, the bones, and the brain itself, become tinged, as hath been thrown from dissections, where the bones have been found tinged sometimes for years after the jaundice has been cured.

In like manner, all the secretions are affected with the yellow colour of the bile, which in this disease is diffused throughout the whole mass of fluids. The saliva becomes yellowish and bitter; the urine excessively high coloured, in such a manner as to appear almost black; nay, the blood itself is sometimes said to appear of a yellow colour when drawn from a vein; yet Dr. Heberden says, that he never saw the milk altered in its colour, even in cases of very deep jaundice. In process of time the blood begins to acquire a tendency to dilution and putrefaction; which is known by the patient's colour changing from a deep yellow to a black or dark yellow. Hemorrhages ensue from various parts of the body, and the patients frequently die of an apoplexy; though in some the disease degenerates into an incurable dropsy; and there have not been wanting instances of some who have died of the dropsy after the jaundice itself had been totally removed.

Cause. As the jaundice consists in a diffusion of the bile throughout the whole system, it thence follows, that whatever may favour the diffusion is also to be reckoned among the causes of jaundice. Many disputes have arisen concerning the manner in which the bile is introduced into the blood; but it is now generally agreed, that it is taken up by the lymphatics of the gall-bladder and biliary ducts. Hence, a jaundice may arise from anything obstructing the passage of the bile into the duodenum, or from anything which alters the state of the lymphatics in such a manner as to make them capable of absorbing the bile in its natural state. Hence the jaundice may arise from scirrhus of the liver or other viscera pressing upon the biliary ducts, and obstructing the passage of the bile; from flatus distending the duodenum, and fluctuating up the entrance of the ductus communis choledochus into it; from the same orifice being plugged up by viscid bile, or other foci; but by far the most frequent cause of jaundice is the formation of calculi, or more properly biliary concretions: for although they were long considered as being of a calcareous nature, yet more accurate experiments have now demonstrated, that they consist principally of a febraceous matter; accordingly, while they are so light as to float in water, they are also highly inflammable. These are found of almost all sizes, from that of a small pea to that of a walnut, or bigger: they are of different colours; and sometimes appear as if formed in the inward part by crystallization, but of lamellae on the outer part; though sometimes the outward part is covered with rough and shining crystals, while the inward part is lamellated. These enter into the biliary ducts, and obstruct them, causing a jaundice, with violent pain for some time; and which can be cured by no means till the concretion is either passed entirely through the ductus communis or returned into the gall-bladder. Sometimes, in the opinion of many celebrated physicians, the jaundice is occasioned by spasmodic contractions of the biliary ducts; but this is denied by others, and it is not yet ascertained whether these ducts are capable of being affected by spasm or not, as the existence of muscular fibres in them has not with certainty been discovered. It cannot, however, be denied, that violent fits of spasm have often produced jaundice, sometimes temporary, but frequently permanent. This has been by some deemed a sufficient proof of the spasmodic contraction of the ducts; but their opponents supposed, that the agitation occasioned by the passion might push forward some biliary concretion into a narrow part of the duct, by which means a jaundice would certainly be produced, till the concretion was either driven backward or forward into the duodenum altogether. But even supposing the ducts themselves to be incapable of spasm, yet there can be no doubt that by a spasm of the intestine's biliary concretions may be retained in the ducts; and Impetigo and indeed it is principally where the duct entering obliquely into the intestine forms as it were a species of valve that these concretions are retained.

In a very relaxed state of the body there is also an absorption of the bile, as in the yellow fever; and indeed in all putrid disorders there is a kind of yellowish tint over the skin, though much less than in the true jaundice. The reason of this is, that in these disorders there is usually an increased secretion of bile, commonly of a thinner consistence than in a healthy state, while the orifices of the lymphatics are probably enlarged, and thus ready to absorb a fluid somewhat thicker than what they ought to take up in a healthy state; but these disorders are of short duration in comparison with the real jaundice, which sometimes lasts for many years. These affections, however, cannot with propriety in any case be considered as real instances of jaundice; for, to constitute that disease bile must not only be present in the blood, but wanting in the alimentary canal.

It is observable, that women are more subject to jaundice than men, which probably arises from their more sedentary life; for this, together with some of the depressing passions of the mind, is found to promote the appearance of the disease, if not absolutely to produce it. Pregnant women also are frequently attacked by the jaundice, which goes off after their delivery.

Prognosis. As jaundice may arise from many different causes, some of which cannot be discovered during the patient's life, the prognosis must on this account be very uncertain. The only cases which admit of a cure are those depending upon biliary concretions, or obstructions of the biliary ducts by viscid bile; for the concretions are seldom of such a size that the ducts will not let them pass through, though frequently not without extreme pain. Indeed this pain, though so violent, and almost intolerable to the sick person, affords the best prognostic; as the physician may readily assure his patient that there is great hope of his being relieved from it. The coming on of a gentle diarrhoea, attended with bilious stools, together with the cessation of pain, are signs of the disease being cured. We are not, however, always to conclude, because the disease is not attended with acute pain, that it is therefore incurable; for frequently the passage of a concretion through the biliary ducts is accompanied only with a sensation of slight uneasiness.

Cure. The great object to be aimed at in the cure of jaundice is unquestionably the removal of the cause which obstructs the passage of bile into the intestines; but before this can be accomplished, practices are often necessary for alleviating urgent symptoms; which may be done sometimes by supplying the want of bile in the alimentary canal, sometimes by affording an exit for bilious matter from the general mass of blood, but most frequently by obviating the effects of dilution and obstruction to the circulation in the system of the liver.

The measures to be employed for the removal of the obstruction must depend very much on the nature of the obstructing cause.

When the jaundice arises from indurated swellings or scirrhus of the viscera, it is absolutely incurable; nevertheless, as these cannot always be discovered, the physician ought to proceed in every case of jaundice as if it arose from calculi. The indications here are, 1. To dissolve the concretions; and, 2. To prevent their formation a second time. But unhappily the medical art has not yet afforded a solvent for biliary concretions. They cannot even be dissolved when tried out of the body either by acids or alkalies, or anything but a mixture of oil of turpentine and spirit of wine; and these substances are by far too irritating to be given in sufficient quantity to affect a concretion in the biliary ducts. Boerhaave observes, that diseases of the liver are much more difficult to cure than those in any other part of the body; because of the difficulty there is in getting at the part affected, and the tedious and round-about passage the blood has to it. The juice of common grass has indeed been recommended as a specific in the jaundice, but on no good foundation. Glisson observes, that black cattle are subject to biliary concretions when fed with hay or dried straw in winter, but are cured by the succulent grass in the spring; and Van Swieten tells a strange story of a man who cured himself of the jaundice by living almost entirely on grass, of which he devoured such quantities, that the farmers were wont to drive him out of their fields; but other practitioners have by no means found this in any degree effectual. The only method of cure now attempted in the jaundice is to expel the concretion into the intestines; for which vomits and exercise are the principal medicines. The former are justly reckoned the most efficacious medicines, as they powerfully shake all the abdominal and thoracic viscera; and thus tend to dislodge any obstructing matter that may be contained in them. But if there be a tendency to inflammation, vomits must not be exhibited till bleeding has been premised. We must also proceed with caution if the pain be very sharp; for in all cases where the disease is attended with violent pain, it will be necessary to allay it by opiates before the exhibition of an emetic. There is also danger, that, by a continued use of vomits, a concretion which is too large to pass, may be so impacted in the ducts, that it cannot even be returned into the gall-bladder, which would otherwise have happened. In all cases, therefore, if no relief follows the exhibition of the second or third emetic, it will be prudent to forbear their farther use for some time.

Of all kinds of exercise, that of riding on horseback is most to be depended upon in this disease. It operates in the same manner with vomits, namely, by the concussion it gives to the viscera; and therefore the cautions necessary to be observed in the use of vomits are also necessary to be observed in the use of riding. Cathartics also may be of service, by cleansing the prime via, and soliciting a discharge of the bile into the intestines; but they must not be of too drastic a nature, else they may produce incurable obstructions, by bringing forward concretions that are too large to pass. Anodynes and the warm bath are serviceable by their relaxing quality; and there can be no doubt, that, from acting as powerful antispasmodics, they often give an opportunity for the discharge of concretions by very slight causes, when they would otherwise be firmly retained. Soap has been supposed to do service as a solvent; but this is now found to be a mistake, and it acts in no other way than as a relaxant or as a gentle purgative.

But when all means of relief fail, as in cases of scirrhus, we can then only attempt to palliate the symptoms, and preserve the patient's life as long as possible. This is best accomplished by diuretics; for thus a great quantity of bilious matter is evacuated, and the system is freed from the bad consequences which ensue on its stagnation in the habit. But even this is by no means equal to the common evacuation by stool; nor can all the attempts to supply the want of bile in the intestines by bitters and other stimulants restore the patient to his wonted appetite and vigour. If the pain be very violent, we must on all occasions have recourse to opiates; or if the blood has acquired a tendency to dissolution, it must be counteracted by proper antiseptics.

If the disease goes off, its return must be prevented by a course of tonic medicines, particularly the cinchona and antiseptics; but we can by no means be certain that the jaundice will not return, and that at any interval; for there may be a number of concretions in the gall-bladder, and though one has passed, another may very quickly follow, and produce a new fit of jaundice; and thus some people have continued to be affected with the distemper, at short intervals, during life.

In the East Indies, mercury has been lately recommended as exceedingly efficacious in disorders of the liver, especially those which follow intermittent and remitting fevers. Dr Monro, in his Observations on the means of preserving the health of soldiers, acquaints us, that he has seen some icteric cases which, he thought, received benefit from taking a few grains of the submuras hydrargyri at night, and a purge next morning; and this repeated two or three times a-week.

Infants are subject to a temporary jaundice, commonly called the gum, soon after birth; the cause of which is not well understood. It differs remarkably from the common jaundice; as, in the latter, the disease is first discoverable in the white of the eyes; but though the skin of infants in the gum is all over yellow, their eyes always remain clear. The disorder goes off spontaneously, or by the use of a gentle purgative or two.

**Class IV. LOCALES.**

Vitia, Sauv. Clas I. Lin. Clas XI. Vog. Clas X. Sag. Clas I.

Plaga, Sag. Clas II.

Morbi organicici Auctorum.

**Order I. DYSÆSTHESIÆ.**

Dysæsthesiae, Sauv. Clas VI. Ord. I. Sag. Clas IX. Ord. I.

**Genus XCII. CALIGO.**

The Cataract.

Caligo, Sauv. gen. 153. Vog. 288. Sag. gen. 259.

Cataracta, Lin. 109.

A cataract is an obstruction of the pupil, by the interposition of some opaque substance which either diminishes or totally extinguishes the sight. It is generally an opacity in the crystalline humour. In a recent or beginning cataract, the same medicines are to be used as in the gutta serena; and they will sometimes succeed. But when this does not happen, and the cataract becomes firm, it must be touched, or rather extracted; for which operation, see Surgery.—Dr Buchan says he has resolved a recent cataract by giving the patient some purges with calomel, keeping a poultice of fresh hemlock constantly upon the eye, and a perpetual blister on the neck.

There is, however, but little reason to suppose that these practices will frequently succeed. A resolution can only be effected here by an absorption of the opaque matter; and where this is possible, there is perhaps a better chance of its being effected by the agency of the electric fluid than by any other means. For this purpose electricity is chiefly applied under the form of the electric aura, as it has been called; but even this is very rarely successful.

**Genus XCHII. AMAUROSIS.**

The Gutta Serena.

Amaurosis, Sauv. gen. 155. Lin. 110. Vog. 238.

Sag. 261.

Amblyopia, Lin. 108. Vog. 236.

A gutta serena is an abolition of the sight without any apparent cause or fault in the eyes. In every case it depends on an affection of some part of the optic nerve. But the affections which may produce this disease are of different kinds. When it is owing to a decay or wasting of the optic nerve, it does not admit of a cure; but when it proceeds from a compression of the nerves by redundant humours, these may be in some measure drained off, and the patient relieved. For this purpose, the body must be kept open with the laxative mercurial pills. If the patient be young, and of a sanguine habit, he may be bled. Cupping with scarifications on the back part of the head will likewise be of use. A running at the nose may be promoted by volatile salts, stimulating powders, &c. But the most likely means of relieving the patient, are infusions or blisters kept open for a long time on the back part of the head, behind the ears, or on the neck; which have been known to restore sight even after it had been for a considerable time lost.—Should these fail, recourse must be had to a mercurial salivation; or, what will perhaps answer the purpose better, 12 grains of the corrosive sublimate mercury may be dissolved in an English pint and a half of brandy, and a table spoonful of it taken twice a-day, drinking half a pint of the decoction of sarsaparilla after it.—Of late electricity has been much celebrated as efficacious, when no other thing could do service; and here it has in some degree the same chance of success as in other cases of insensibility, depending on an affection of the nerves, in some of which it has certainly in particular cases been of use.

In the amaurosis, Dr Porterfield observes, that it is of the utmost consequence to know of how long standing the disease has been; which is not always easily done if one eye only be affected. This is a very essential This disorder may proceed from various causes both natural and accidental, some of which admit of no remedy. If it be occasioned by a partial adhesion of the eyelids, the hand of the surgeon is required; if by a transverse position of the pupil, some mechanical contrivance is necessary. If it be owing to an albigo covering part of the pupil, or to a film rendering a portion of the cornea opaque, the remedies for these affections are to be here applied.

PSEUDOBLEPSIS.

IMAGINARY VISION of Objects which do not exist.

Suffusio, Sauv. gen. 217. Sag. 329. Phantasma, Lin. 73. Sag. 289.

This very often takes place when the body is diseased, and then the patient is said to be delirious. Sometimes, however, in these cases, it does not amount to delirium; but the person imagines he sees gnats or other insects flying before his eyes; or sometimes, that everything he looks at has black spots in it, which last is a very dangerous sign. Sometimes also sparks of fire appear before the eyes; which appearances are not to be disregarded, as they frequently precede apoplexy or epilepsy. Sometimes, however, people have been affected in this manner during life without feeling any other inconvenience. Such a disorder can rarely if ever be cured.

PARACUSIS.

DEPRAVATION OF HEARING.

Paracusis, Sauv. gen. 159. Sag. 265. Syrigmus, Sauv. gen. 219. Sag. 231.

The functions of the ear may be injured by wounds, ulcers, or anything that hurts its fabric. The hearing may likewise be hurt by excessive noise; violent colds in the head; fevers; hard wax, or other substances sticking in the cavity of the ear; too great a degree of moisture or dryness of the ear. Deafness is very often the effect of old age, and is incident to most people in the decline of life. Sometimes it is owing to an original fault in the structure or formation of the ear itself. When this is the case it admits of no cure; and the unhappy person not only continues deaf, but generally likewise dumb, for life.

When deafness is the effect of wounds or ulcers of the ears, or of old age, it is not easily removed. When it proceeds from cold applied to the head, the patient must be careful to keep his head warm, especially in the night; he should likewise take some gentle purges, and keep his feet warm, and bathe them frequently in lukewarm water at bedtime. When deafness is the effect of a fever, it generally goes off after the patient recovers. If it proceed from dry wax sticking in the ears, it may be softened by dropping oil into them; afterwards they must be syringed with warm milk and water.

If deafness proceeds from dryness of the ears, which may may be known by looking into them, half an ounce of the oil of sweet almonds, and the same quantity of camphorated spirit of wine, or tincture of salicetida, may be mixed together, and a few drops of it put into the ear every night at bedtime, stopping them afterwards with a little wool or cotton. Some, instead of oil, put a small slice of the fat of bacon into each ear, which is said to answer the purpose very well.—When the ears abound with moisture, it may be drained off by an inflow or feton, which should be made as near the affected parts as possible.

Some, for the cure of deafness, recommend the gall of an eel mixed with spirit of wine, to be dropped into the ear; others, equal parts of Hungary water and spirit of lavender. Etmuller extols amber and musk; and Brookes says, he has often known hardness of hearing cured by putting a grain or two of musk into the ear with cotton wool. Where, however, an application with considerable stimulant power is necessary, camphorated oil, with the addition of a few drops of volatile alkaline spirit, may be considered as one of the best. It is proper, however, to begin with a small quantity of the alkali, increasing it as the ear is found to bear it. In some instances, where deafness depends on a state of insensibility in the nerves, electricity, particularly under the form either of sparks or of the electric aura, has been employed with great success. Great benefit has also in some cases been derived from galvanism. But these and other applications must be varied according to the cause of the disorder.

Though such applications may sometimes be of service, yet they much oftener fail, and frequently they do hurt. Neither the eyes nor ears ought to be tampered with; they are tender organs, and require a very delicate touch. For this reason, what we would chiefly recommend in deafness, is to keep the head warm. From whatever cause this disorder proceeds, this is always proper; and more benefit has often been derived from it alone, in the most obstinate cases of deafness, than from any medicines whatever.

ANOSMIA.

Defect of Smelling.

Anosmia, Sauv. gen. 156. Lin. 113. Vog. 248. Sag. 262.

Cause. Morbid affections in the sense of smelling, may be considered with respect to their causes, as arising from one of two sources; either from some organic affection of the parts here principally concerned, or from a mere atonic state of the parts without any obvious affection. The sense of smelling may be diminished or destroyed by various diseases of the parts; as, the moisture, dryness, inflammation or suppuration of that membrane which lines the inside of the nose commonly called the olfactory membrane; the compression of the nerves which supply this membrane, or some fault in the brain itself at their origin. A defect, or too great a degree of folidity, of the small spongy bones of the upper jaw, the caverns of the forehead, &c. may likewise impair the sense of smelling. It may also be injured by a collection of fetid matter in those caverns, which keeps constantly exhaling from them. Few things are more hurtful to the sense of smelling than taking great quantities of snuff.

Cure. When the nose abounds with moisture, after gentle evacuations, such things as tend to take off irritation and coagulate the thin sharp serum may be applied; as the oil of anise mixed with fine flour, camphire dissolved in oil of almonds, &c. The vapors of amber, frankincense, gum mastic, and benzoin, may likewise be received into the nose and mouth. For moistening the mucous when it is too dry, some recommend snuff made of the leaves of marjoram, mixed with oil of amber, and aniseed; or a trituratory of calcined sulphate of zinc, 12 grains of which may be mixed with two ounces of marjoram-water and filtrated. The steam or vapour of vinegar thrown upon hot iron received up the nostrils is likewise of use for softening the mucous, opening obstructions, &c.

here be an ulcer in the nose, it ought to be drefled with some emollient ointment, to which, if the pain be very great, a little laudanum may be added. If it be a venereal ulcer, it is not to be cured without mercury. In that case, the solution of the corrosive sublimate in brandy may be taken, as directed in the gutta serena. The ulcer ought likewise to be washed with it; and the fumes of cinnabar may be received up the nostrils.

If there be reason to suspect that the nerves which supply the organs of smelling are inert or want stimulating, volatile salts, strong snuffs, and other things which occasion freezing, may be applied to the nose. The forehead may likewise be anointed with balsam of Peru, to which may be added a little of the oil of amber.

GENUS XCIX. AGEUSTIA.

Defect of Tasting.

Ageustia, Sauv. gen. 157. Sag. 263. Ageustia, Lin. 114. Apogenus, Vog. 449.

Cause. This disease also may arise either from an organic affection, or an atonic state of the parts. The taste may be diminished by crusts, filth, mucus, aphtha, pellicles, warts, &c. covering the tongue; it may be depraved by a fault of the saliva, which, being discharged into the mouth, gives the same sensation as if the food which the person takes had really a bad taste; or it may be entirely destroyed by injuries done to the nerves of the tongue and palate. Few things prove more hurtful either to the sense of tasting or smelling than obstinate colds, especially those which affect the head.

Cure. When the taste is diminished by filth, mucus, &c. the tongue ought to be scraped, and frequently washed with a mixture of water, vinegar, and honey, or some other detergent. When the saliva is vitiated, which seldom happens unless in fevers or other diseases, the curing of the disorder is the cure of this symptom. To relieve it, however, in the meantime, the following practices may be of use: if there be a bitter taste, it may be taken away by vomits, purges, and other things which evacuate bile; what is called a niterous taste, arising from putrid humours, Dysorexia is corrected by the juice of citrons, oranges, and other acids; a salt taste is cured by plentiful dilution with watery liquors; an acid taste is destroyed by absorbents and alkaline salts, as powder of oyster-shells, salt of wormwood, &c.

When the sensibility of the nerves which supply the organs of taste is diminished, the chewing of horseradish, and or other stimulating substances, will help to recover it.

GENUS C. ANÆSTHESIA. Defect of the Sense of Feeling. Sauv. gen. 161. Lin. 218. Vog. 267.

Cayes, &c. This sense may be hurt by anything that obstructs the nervous influence, or prevents its being regularly conveyed to the organs of touching, as preasure, extreme cold, &c. It may likewise be hurt by too great a degree of sensibility, when the nerve is not sufficiently covered by the cuticle or scurf-skin, or where there is too great a tension of it, or it is too delicate. Whatever disorders the functions of the brain and nerves, hurts the sense of touching. Hence it appears to proceed from the same general causes as palsy and apoplexy, and requires nearly the same method of treatment.

In a flatus; or defect of touching, which arises from an obstruction of the cutaneous nerves, the patient must first be purged; afterwards such medicines as excite the action of the nerves, or stimulate the system, may be used. For this purpose, the spirit of hartshorn, either by itself or combined with essential oils, horseradish, &c., may be taken inwardly; the disordered parts, at the same time, may be frequently rubbed with fresh nettles or spirit of sal ammoniac. Blistering and liniments applied to the parts will likewise be of use; and also warm bathing, especially in the natural hot baths.

ORDER II. DYSOREXIAE.

SECT. I. APPETITUS ERRONEI.

Morositates, Sauv. Clas VIII. Order II. Sag. Clas XIII. Order II. Pathetici, Lin. Clas V. Order II. Hyperæsthesia, Vog. Clas VII.

GENUS CI. BULIMIA. Insatiable Hunger, or Canine Appetite. Bulimia, Sauv. gen. 223. Lin. 79. Sag. gen. 335. Bulimus, Vog. 296. Adéphagia, Vog. 297. Cynorexia, Vog. 298.

This disease is commonly owing to some fault in the stomach, by which the aliment is thrown out too soon; and unless the person be indulged in his desire for eating, he frequently falls into fainting fits. Sometimes it is attended with such a state of the stomach, that the aliment is rejected by vomit almost immediately after being swallowed; after which the appetite for food returns as violent as ever. But there are many circumstances which seem to render it probable that it more frequently arises from a morbid condition of the secreted fluid poured into the stomach, by means of which the aliment is dissolved. When the activity of this fluid is morbidly increased, it will both produce too sudden a solution of the solid aliment, and likewise operate as a powerful and peculiar stimulus to the stomach, giving an uneasy sensation, similar to that which takes place in natural hunger. Such things are proper for the cure as may enable the stomach to perform its office: chalybeates and other tonics will generally be proper. In some, brandy drunk in a morning has been useful; and frequent smoking tobacco has relieved others. Oil, fat meat, pork, opiates, and in short every thing which in a found person would be most apt to pall the appetite, may also be used as temporary expedients, but cannot be expected to perform a cure. In some, the pylorus has been found too large; in which case the disease must have been incurable.

GENUS CII. POLYDIPSIA. Excessive Thirst. Polydipsia, Sauv. gen. 224. Lin. 80. Vog. 275. Sag. 336.

This is almost always symptomatic; and occurs in fever, dropsy, fluxes, &c. The cure is very generally obtained only by the removal of the primary disease; and it is best palliated by the gradual introduction of diluents: But when these are contraindicated, it may often be successfully obviated by such articles taken into the mouth as have effect in augmenting the flow of saliva.