491. The Hectic FEVER.-Hectica, Sauv. gen. 83. Lin. 24. Vog. 80. Sag. 684.-This disease, fays Dr Cullen, is merely fymptomatic; as indeed feems very probable, fince it very generally accompanies abforptions of pus into the blood from internal fuppurations, or indeed from fuch as are external, provided they be very large or of a bad kind. 492. Defeription. The best description of this diforder is by Dr HEBERDEN. The appearance of the hectic fever (he fays) is not unlike that of the genuine intermittent; from which, however, the difeafe is very different in its nature, while it is much more dangerous. In the true intermittent, the three ftages of cold, heat, and sweat, are far more diftinctly marked; the whole fit is much Longer; the period more conftant and regular, and the intermiffions more perfect, than in the hectic. For in the latter, even in the cleareft re. miffion, there is ufually a feverish quickness in the pulle, which exceeds that of a healthy one by at leaft to ftrokes in a minute. The chilinefs of the hectic fever is fometimes fucceeded by heat, and fometimes by a sweat, without any intermediate ftate of heat. The heat fometimes comes on without any remarkable chillness; and the chillnefs goes off without being followed either by heat or fweat. The duration of thefe ftages is feldom the fame for 3 fits together; and as one of them is fometimes wanting, the length of the whole fit varies much more than in the true inter mittent; but in general it is much fhorter. A patient fubjected to hectic fever is little or nothing relieved by the fweat; but is often as anxious and reftlefs under it as during the chillness or heat. When the fweat is over, the fever Sometimes continues; and in the middle of the fever the chillness will return; which is a moft certain mark of this disease. This fever will return with great exactnefs, like an intermittent, for two or perhaps three fits; but Dr Heberden does not remember ever to have known it keep the fame period for 4 fits fucceffively. The paroxyfm will now and then keep off for 10 or 12 days; but when the patient is very ill, it will retorn fo often on the fame day, that the chillness of a new fit will follow immediately the fweat of the former. It is not unufual to have many threatenings of a fhivering in the fame day; and fome degree of drowfinefs is apt to attend the ceffation of a fit. The urine in a true intermittent clear in the fits, and turbid in the intervals; but in the hectic it is liable to all kinds of irregu larity. It will be equally clear or turbid in both Bages; or turbid in the fits, and clear in the intervals; and fometimes it will be, as in a true intermittent, clear during the fever, and thick at the going off. Hectic patients often complain of pains like thofe of the rheumatism, which either affect by turns almoft every part of the body, or elle return conftantly to the fame part; which is often at a great distance from the feat of the principal diforder, and, as far as is known, without ay peculiar connection with it. Those pains are fa nolent in fome patients, as to require a large quantity of opium. They are moft common where the hectic arifes from fome ulcer open to the external air, as in cancers of the face, breast, &c. Joined with this fever, and arifing probably from the fame cause, he has feen fwellings of the limbs, neck, or trunk, rife up almost inftantly as if the part was all at once grown fatter. Thefe fwellings are not painful, hard, or difcoloured, and they continue for feveral hours. Dr Heber. den has feen this fever attack those who seemed in tolerable health, in a fudden and violent manner, like an inflammatory one; and like that, alfo in a very fhort time bring them into imminent danger of their lives; after which it has begun to abate, and to afford hopes of a recovery. But though the danger might be over for the time, and little fever remain; yet that little has foon demonstrated, that it was kept up by some great mischief within, and, proving invincible by any remedies, has gradually undermined the health of the patient, and never ceafed but with his life. But it much oftener conceals its ftrength at firft, and creeps on fo flowly, that the patients, though not perfectly well, yet for fome months hardly think themfelves ill; complaining only of being fooner tired with exercife than usual, of want of appetite, and of falling away. But gentle as these fymptoms feem, if the pulfe beat 90, or perhaps 120 times in a minute, there is great reafon to fear the event. In no diforder, perhaps, is the pulfe of more ufe to guide our judgment than in the hectic fever; yet we must not truft entirely to this criterion; for one in about 20 patients, with all the worft figns of decay from fome incurable caufe, which irrefiftibly goes on to deftroy his life, will fhow neither quickness, nor any other irregularity of the pulfe, to the day of his death. 493. Causes, &c. This fever will fupervene whenever there is a great collection of matter formed in any part of the body; but it more particularly attends upon the inflammation of a fcirrhous gland, and even upon one that is flight and only juft beginning; the fever growing worse in proportion as the gland becomes more inflamed, ulcerated, or gangrenous. And fuch is the lingering nature of thofe glandular disorders, that the firft of thofe ftages will continue for many months, and the fecond for fome years. If this fcirrhous inflammation be external, or in the lungs, or abdominal vifcera, no doubt can be entertained concerning the caufe of the fever. But if the part affected be not obvious to the fenfes, and its precife functions be not known, the hectic, which is there only part of the train of another difeafe, may be. miftaken for the primary or only one. Lying-in women, on account of the violence fuftained in delivery, generally die when affected with this fever. Women aged 50 and upwards are particularly liable to it. For, upon the ceffation of their natural difcharge, the glands of the breafts, ovaries, or womb, commonly begin to grow fcirrhous, and proceed to be cancerous. Not only thefe, but the glandular parts of all the abdominal vifcera, are difpofed to be affected at this particular time, and to become the feats of incurable diforders. The injuries done to the ftomach and liver by hard drinking are attended with fimilar fymptoms and termination. Dr Heberden obferves, that the flightest wound by a fine pointed inftrument will, upon fome fome occafions, bring on the greatest disturbances, and the most alarming symptoms, nay even death itself. For not only the wounded part will swell and be painful, but by turns almoft every part of the body, and very diftant parts have come even to fuppuration. Thefe fymptoms are conftantly accompanied with this irregular intermittent, which lafts as long as any of them remain. 494. Prognofs. This anomalous fever is never lefs dangerous than when it belongs to a kindly fuppuration, into which all the diseased parts are melted down, and for which there is a proper outlet. The fymptoms and danger from fome fmall punctures, with their concomitant fever, moft frequently give way in a few days; though in fome they have continued for fome months, and in others have proved fatal. The inflammation of internal fcirrhous glands, or of thofe in the breafts, fometimes goes off, and the fever, which depended upon it, ceases; but it much of tener proceeds to cancerous and gangrenous ulcers, and terminates only in death. Death is also, almoft univerfally, the confequence of hectic fever from tubercles of the lungs, which have in general been confidered as glandular bodies in a fcirrhous fate. the Bath waters are peculiarly hurtful in this fever, which they never fail to increase, and thereby ag gravate the sufferings and hasten the death of the patient. a 496. ORDER II. PHLEGMASIÆ.-Phlegmafiæ membranofæ et parenchymatofæ, Sauv.Clafs III. Ord. I. II. Sag. 605.-Morbi febriles phlogiftici, Lin. Class II.-Febres continuæ compofitæ inflammatoriæ, V.-Morbi acuti febriles, Boerh. 770.-Febres inflammatoriæ, Hoffm. II. 105. Junck. 61.-The phlegmafiæ, or topical inflammations, are a very numerous affemblage of 2 difeafes. Their great characteristics are, the general fymptoms of fever, and a topical inflamma- 11 tion, attended with the lefion of fome important function. And in most inftances, when blood is drawn, it is found upon coagulation to be covered with a buffy coat. Under this order, many important genera are comprehended, each requiring a feparate confideration. 497. GENUS VII. PHLOGOSIS. Sp. I. PHLO. GOSIS PHLEGMONE.-Phlegmone auctorum, Sauv. 12 gen. 15. Lin. 39. Vog. 351.-Inflammatio, Lin. 231. Boerh. 370. Junck. 20. 498. Defcription. This disease is a fynocha fe ver, accompanied with an inflammation of fome 495. Cure. A mixture of afa fetida and opium particular part either external or internal, and has in fome cafes been fingularly serviceable, when confequently it varies very much in its form and brought on by a small wound; but in most other the degree of danger attending it, according to cafes the attention of the phyfician must be em- the fituation and functions of the part affected ployed in relieving the fymptoms, by tempering with topical inflammation. To this fpecies, there the heat, preventing both coftivenefs and purging, fore, belong the following diseases.-Furunculus, procuring fleep, and checking the fweats. If, Sauv. pen. 18. Vog. 352.-Terminthus, Vog. 381. fays Dr Heberden, he alfo put the body into ge- -Pupula, Lin. 275. Sauv. p. 6.-Varus, Veg. neral health, by air, exercise, and a proper mild 436. Lin. 269. Sauv. p. 7.-Bacchia, Lin. 270.diet, he may leave all the reft to nature. In fome Gutta Rotea, Sauv. gen. 4.- -Gutta rofacea, Veg. patients, nature seems to have fuch refources, as 437.-Hordeolum, Sauv. gen. 27. Lin. 276. Vog. may afford reason for entertaining hopes of cure, 434-Otalgia, Sauv. gen. 197. Lin. 44. Vog. 148. even in bad cafes. For fome have recovered from Dolor otalgicus, Hoffm. II. 336.-Parulis, Vog. this fever, attended with every symptom of an ab- 362.-Maftodynia, Sauv. gen. 210. Vog. 153dominal vifcus incurably diseased, after all pro- Paronychia, Sauv. gen. 21. Lin. 258. Fog. 345.bable methods of relief from art had been tried Arthrocace. Sauv. gen. 78. Lin. 256.—Pædarthroin vain, and after the flesh and ftrength were fo cace, Vog. 419.-Spina ventofa, Boerh. 526.-Phiexhaufted as to leave scarce any hopes from na mofis, Sauv. gen. 22. Lin. 297. Vog. 348.-Parature. In these deplorable circumftances, there phimofis, Vog. 349. has arisen a fwelling not far from the probable feat of the disorder, and yet without any difcoverable communication with it. This fwelling has come to an abscess; in confequence of which the pulse has foon returned to its natural state, as have alfo the appetite, flesh, and strength. What nature has performed in these rare cafes, Dr Heberden has often endeavoured to imitate, by making iffues or applying blifters near the feat of the disease; but not with the fame fuccefs. Dr Heberden does not remember ever to have feen any good effect from the bark in this fever, unattended with an apparent ulcer; but he owns, that he never faw any harm from it, except a temporary purging or fickness, where it has difagreed with the ftomach, or where the latter has been loaded by taking the medicine too fast, in dry bolufes wrapped in wafer-paper. In hectic illneffes, where all other means have proved ineffectual, a journey to Bath is ufually propofed by the friends, and wished for by the fick; but Dr Heberden juftly obferves, that, befides the fatigue and many inconveniencies of a journey to a dying perfon, 468 499. Cure. Dr CULLEN lays down the following indications: 1. To remove the remote caufes: 2. To take off the phlogistic diathefis affecting the fyftem, or a particular part: 3. To take off the fpafm. Acrid matters must be removed, or their action prevented, by demulcents, Compreffing and overftretching powers muft be taken away; and from their feveral circumftances, the means of doing fo will be obvious. The means of taking off the phlogiftic diathefis are the fame with thofe mentioned for fynocha: The means of taking off the fpafm alfo from the particular part, are much the fame with thofe al ready mentioned. Only cupping with fearifica tions, applying leeches, &c. are in this cafe much more indicated. When a tendency to fuppura tion is perceived, the proper indication is to pro mote the production of perfect pus by such app! cations as may fupport a moderate heat in the part, by fome tenacity confine the perfpirat and by an emollient quality weaken the cche of the teguments, and favour their erosior. all abfceffes are occafioned by the effufion of flu... A fome gentle ftimulating embrocation: which, by exciting a flight irritation upon the furface, especially when affifted by the Peruvian bark, produces fuch a degree of inflammation as is withed for. He has often known a weak solution of fal ammoniac, a drachm of the falt to 2 oz. of vinegar and fix of water, form a mixture of a very proper ftrength for this purpose. Whenever a flight inflammation appears between the diseased and found parts, we may expect, that the parts will be feparated; and when a full fuppuration is once eftablished, the mortified parts will be foon removed. A complete feparation being effected, the fore is to be treated in the manner described under SURGERY, with a proper attention to the fupport of the fyftem by a nourishing diet, and the bark with proper quantities of wine. As to the bark, however, there is another case of mortification in which it is likewife unfuccefsful, as well as in that attended with a high degree of inflammation; viz. in thofe mortifications of the toes and feet, common in old people, or which arife from any caufe increafing the rigidity of the veffels, to fuch a degree as to prevent the motion of the fluids through them. In this cafe My POTT has difcovered, that all kinds of warm applications are very unfuccefsful; but that by the free ufe of opium, externally applied, he has often feen the tumefaction of the feet and ancles fubfide, the skin recover its natural colour, and all the mortified parts feparate in a very fhort time, leaving a clean fore. But as to fcarifications, or any other attempt to feparate artificially the mortified from the found parts, he thinks them very prejudicial, by giving pain; which is generally of itself violent in this difeafe, and which feems to have a great fhare in producing the other evils. The other terminations of inflammation either do not admit of any treatment, except that of preventing them by refolution, or properly belong to the article SURGERY. and as in the cafe of certain effufions a fuppuration becomes not only unavoidable but defirable, it may be fuppofed that most of the means of procuring a refolution, by diminishing the force of circulation, &c. ought to be avoided. But as, on the one hand, a certain degree of increased im. petus, or of the original fymptoms of inflammation, is neceffary to produce a proper fuppuration, fo it is then especially neceffary to avoid thofe means of refolution which may diminish too much the force of circulation. And on the other hand, as the impetus of the blood, when violent, prevents the proper fuppuration; fo, in fuch cafes, though a tendency to fuppuration may have begun, it may be proper to continue thofe means of refolution which moderate the force of the circulation. As to the opening of abfceffes when completely formed, fee SURGERY, Index. When an inflammation takes a tendency to gangrene, that event is to be prevented by every poffible means; but after a gangrene has taken place, it can be cured only by the feparation of the dead from the living parts. This can be performed mot properly by the knife. It can alfo be done by exciting fuppuratory inflammation on the verge of the living part, whereby its cohesion with the dead part may be every where broken off, fo that the latter may fall off by itself. Meantime, it is proper to prevent the further putrefaction of the part. For this purpofe various antifeptics have been propofed; but Dr CULLEN fays, that while the teguments are entire, thefe can hardly have any effect; and, therefore, the fundamental procedure must be to fcarify the part fo at to reach the living fubftance; and, by the wounds made there, to excite the fuppuration required. By the fame incifions alfo we give accefs to antifeptics, which may both prevent the progrefs of the putrefaction in the dead, and excite the inflammation neceffary on the verge of the living parts. When the gangrene proceeds from lofs of tone, and when this, communicated to the neighbouring parts, prevents that inflammation which is requifite to the feparation of the. Hieropyr. Vag. 344-Anthrax, Sauv. gen. 19. dead parts from the living, it is neceffary to ob- Lin. 272. Vog. 353-Carbo et carbunculus auctoviate this lofs of tone by tonic medicines given in- rum.-Eryth. gangrænofum, Sauv. fp. 7.-Eryth. ternally; and for this purpose the Peruvian bark a frigore.-Eryth. pernio, Sauv. fp. 4.-Pernio, is moft effectual. But when the gangrene arifes Lin. 259. Vog. 350.-Eryth. ambustio, Sauv. fp. 2. from the violence of inflammation, the bark may-Eryf. ambuftio, Sauv. fp. 4.-Combuftura, Lin. aot only fail of curing, but may do harm; for its power as a tonic is especially fuited to thofe cafes gangrene which proceed from an original lofs of tone, as in the cafe of palfy and oedema; or in thofe cafes where a lofs of tone takes place while the original inflammatory fymptoms are removed. On the other hand, Mr BELL is of opinion, that incifions made with a view to admit the operation of antifeptic remedies in gangrenes, 25 well as the remedies themselves, muft be pericious from the irritation they occafion, and from the danger of wounding blood-veffels, nerves, or tendons, and alfo by allowing a free paffage for the putrefcent fluids into the parts not yet affected. And unless they be carried fo deep as to reach the found parts, applications of the antifeptic kind can never have any effect in anfwering the purpose for which they were intended. He therefore prefers, as more eafy and more effectual, VOL. XIV. PART L of 500. Sp. II. PHLOGOSIS ERYTHEMA. Erythema, Sauv. gen. 11.-Eryfipelas auctorum, Fog. 343. 245.-Combuftio, Boerh. 476.-Encaufis, Vog. 347.-Erych. ab acri alieno applicato.-Eryf. Chinenfe, Sauv. fp. 7.-Eryth. ab acri inquilino.Eryth. intertrigo, Sauv. fp. 5.-Intertrigo, Lin. 247. Vog. 502.-Eryth. a compreffione.-Eryth. paratrima, Sauv. fp. 6.-Eryth, a punctura, Sauv. fp. 9.-Eryf. a vefpis, Sauv. fp. 19.-Plydracia a vefpis, Sauv. fp. 2.-Eryth. cum phlegmone.Eryf. phlegmonodes auctorum.-Eryth. cum ademate.-Eryf. fymptomaticum, Sauv. fp. 6. 501. ERYTHEMA doth not apply to any primary difeafe, but to a great number of those cutaneous inflammations called ERYSIPELAS, cr St Anthony's fire; and which, being commonly fymptomatic of fome other inflammation or diforder, are to be removed only by removing the primary difeafe. The erythema will fcarcely bear any warm application; and is very apt, if treated as a primary difeafe, to terminate in a gangrene of the the part affected, or fome other diforder fill more dangerous. The difference between the PHLEGMONE(§ 497), and erythema, fays Dr CULLEN, is, that, in the former, the inflammation particularly affects the veffels on the internal furface of the fkin, communicating with the lax adjacent cellular tex. ture; whence a more copions effufion of ferum, convertible into pus, takes place. In the latter, the affection is of the veffels on the external furface, communicating with the rete mucrfum, which does not admit of any effufion but what feparates the cuticle, and occafions the formation of a blifter, while the fmaller fize of the veffels admits only of the effufion of a thin fluid very feldom convertible into pus. For the cure of the fever attended with erythema or erysipelas, fee § 632'; for the external treatment of erythema, fee SUR GERY. 502. GENUS VIII. OPHTHALMIA. Inflammation of the EYES.-Ophthalmia, Sauv. gen. 196. Lin. 43. Vog. 341. Sag. 231. Junck. 24.-Chemofis. Vog 46.-Ophthalmites, Vog. 47.-Inflammatio oculorum, Hoffm. II. 165.-Ophthalmia taraxis, Sauv. fp. 1.-O. humida, Idem, fp. 8.-O. chemofis, fp. 12.-O. eryfipelatofa, fp. 7.-O.puf tulofa, fp. 6.-O. phlyctanodes, fp. 21.-O. cho. roeidea, fp. 13.-O. tenebricofa, fp. 10.-O. trachoma, fp. 4.-O. ficca, fp. 5.-O. angularis, fp. 14.-O. tuberculofa, fp. 3.-O. trichiafis, fp. 2.O. cancrofa, fp. 15.-O. a fynechia, fp. 16.-O. a lagophthalmo, fp. 17.-O. ab elcomate, sp. 18.— O. ab ungue, fp. 19.-O. a corneæ fiftula, fp. 20. -O. uvex, fp. 22.-O. metaftatica, fp. 24-O. fcrophulofa, fp. 9.-O. fyphilitica, fp. 11.-O. febricofa, fp. 23. 503. From this long lift of diftinctions in the ophthalmia, it is evident, that the greatest part of them are fymptomatic, or merely the confequences of other diforders; and therefore the remedies must be directed towards the removal of thefe primary diforders; and when they are removed, the ophthalmia will follow. Dr Cullen obferves, that the inflammation of the eye may be confidered as of two kinds; according as it is feated in the membranes of the ball of the eye, when it is named ophthalmia membranarum; or in the febaceous glands in the tarfus, or edges of the eye-lids, in which cafe it may be termed ophthalmia tarfi. Thefe two kinds are often connected, as the one may excite the other; but they are still to be diftinguished, as the one or the other may be the primary affection. 1. The inflammation of the menbranes of the eye affects efpecially, and ofteneft, the adnata, and appears in a turgefcence of its veffels; fo that the red veffels which are naturally there, become not only increafed in fize, but many more appear than in a natural ftate. This turgefcence is attended with pain upon the motion of the eye-ball; and this irritation produces an effufion of tears from the lachrymal gland. The. inflammation chiefly affects the adnata fpread on the anterior part of the bulb of the eye; but usually spreads alió along the continuation of the adnata on the infide of the palpebræ; and the excretories of the febaceous glands opening there are alfo often affected. When the affection of the adnata is confiderable, it may be communicated to the fubjacent membranes of the eye, and even to the retina itfelf; which thereby acquires fo great fenfibility, that every impreffion of light becomes painful. The inflammation of the membranes is in different degrees, according as the adnata is more or lefs affected, or according as the inflammation is either of the adnata alone, or of the fubjacent membranes alfo; and upon thefe differences, different fpecies have been established; but they all differ only in degree, and are to be cured by the fame remedies. 504. The proximate caufe of ophthalmia is not different from that of inflammation in general; and the diffe en circumftances may be explained by the difference of its remote caufes, and by the different parts of the eye which it affects. 505. Cure. The great objects to be aimed at in the treatment of ophthalmia, are, firft, the refolution of the inflammation which has already taken place; and, 2d, the removal of those confequences which arife from the inflammation, especially if it has been of long standing. If it has appeared from former obfervation, that there is a peculiar disposi tion to the difeafe, metho's may be fuccef fully em ployed to combat this difpofition, and thus prevent the return of the affection. The ophthalmia membranarum requires the remedies proper for inflammation in general; and when the deeper feated membranes are affected, and especially when a pyrexia is present, large general bleedings may be neceffary. But this is feldom the cafe; and, for the most part, the ophthalmia is merely local, and attended with little or no pyrexia. General bleedings therefore have little effect, and the cure is chiefly to be obtained by blood drawn from the veffels near the inflamed part; and opening the jugular vein, or the temporal artery, may alfo be useful. It is commonly fufficient to apply a number of leeches round the eye; but it is perhaps better to draw blood by cupping and scarifying upon the temples. In fome cafes the most effectual remedy is to fearify the internal furface of the inferior eye-lid, and to cut the turgid veffels upon the adnata itself. Purging, as fuited to inflammation in general, 'has been confidered as peculiarly adapted to ophthalmia; and it is fometimes ufeful, but does not prove fo in any proportion to the evacuation. For relaxing the fpafm in the part, and taking off the deter. mination of the fluids to it, bliftering near the part has been useful. When the inflammation does not yield to blifters after topical bleeding, great benefit is often obtained by an iffue, by which a more permanent determination of blood from the part is obtained. On the fame principit, the good effects of errhine medicines are accounted for. The powder of afarabacca, or the infufion of hippocaftanum, fnuffed up the nose at bed-time in proper dofes, are often productive of the beft effects. Ophthalmia admits of topical applications. All thofe, however, which incres.. the heat and relax the veffels of the part, prov hurtful; and the admiffion of cool air to the ey and the application of cooling and aftringent me dicines, which do not produce irritation, prose ufeful. Of all thefe the folution of acetated lesú is perhaps the beft. In the cure of this difte per, indeed, all irritation muft carefully be 1voided, particularly that of light, by keeping the அ patent in a very dark chamber. 2. In the cph thalmia tarf, the fame medicines may be nicef. fary as for the ophthalmia membranarum. But as the ophthalmia tarfi may often depend upon an acrimony depofited in the sebaceous glands of the part, fo it may require various internal remedies, according to the variety of the acrimony in fault; for which we muft refer to the confideration of fcrophula, fyphilis, or other diseases with which it may be connected; and where thefe fhall not be evident, certain remedies more generally adapted to the evacuation of acrimony, fuch as mercury, may be employed. In the ophthalmia tarfi, it almoft conftantly happens, that fome ul cerations are formed on the tarfus. Thefe require the application of mercury and copper, which alone may fometimes cure the whole affection; and they may be useful even when the aifeafe depends upon a fault of the whole fyftem. Both in the ophthalmia membranarum, and in the ophthalmia tarfi, it is neceffary to obviate that glueing together of the eye lids which happens in fleep; and which may be done by infinuating a little of any mild unctuous medicine between the eye-lids be. for the patient fhall go to fleep. The lighter kinds of inflammation from the duft or the fun, may be removed by fomenting with luke-warm milk and water, adding one 6th part of brandy; and by anointing the borders of the eye lids with unguentum tutia, at night, efpecially when thofe parts are excoriated and fore. But in bad cafes, after the inflammation has yielded a little to evacuations, the cataplafma aluminis of the London pharmacopoeia, fpread on lint, and applied at bedtime, has been found the beft external remedy. Before ufing the latter, the folution of white vitriol is of advantage; and in violent pains it is of fervice to foment often with a decoction of white poppy heads. One of the most common and moft difagreeable confequences of ophthalmia, is an offufcation of the cornea, fo far obftructing the paffage of light as to diminish or prevent vifion. This is fometimes fo confiderable as to admit of removal by operation: but in flighter cafes it may be removed by gentle efcharotics; and in this way good effects are often obtained, from gently introducing into the eye at bed-time a powder confifting of equal parts of cryftals of tartar and ingar. in cafes of frequent returns of this af fection, the Peruvian bark is often employed with fuccefs; but nothing in general anfwers better than frequent and regular cold bathing of the eyes. 506. GENUS IX. PHRENITIS PHRENZY, or Laflammation of the BRAIN.-Phrenitis, Sauv. gen. 101. Lin. 25. Sag. gen. 301. Boerh. 771. Hoffm. IL 131. Junck. 63.-Phrenifmus, Vog. 45.-Cephalitis, Sauv. gen. 109. Sag. gen. 10-Sphacelifmus, Lin. 32.-Phrenitis vera, Sauv. fp. 1. Borb. 771.-Phrenitis idiopathica, Junck. 63.Cephalalgia inflammatoria, Sauv. fp 9.-CephaFitis fpontanea, Sauv. fp. 3.-Cephalitis firiafis, Sawy. fp. 4.-Siriafis, Vog. 34.-Cephalitis, Littriana, Sauv. fp 5. 507. Dr CULLEN obferves, that the true phretitis, or inflammation of the membranes or fubface of the brain, is very rare as an original dif eafe: but, as a symptom of others, much more frequent; of which the following kinds are enumerated by different authors: Phrenitis fynochæ puriticæ, Sauv. fp. 2.-P fynochæ fanguineæ, Sauv. fp. 4.-P. calentura, Sauv. fp. 11.-P. Indica, Sauv. fp. 12-Cephalitis Egyptiaca, Sauv. fp. 1.-C. epidemica anno 1510, Sauv. fp. 6.--C. verminofa, Sauv. fp. 7.-C. cerebelli, Sauv. fp. 8. -Phrenitis miliaris, Sauv. fp. 3.-P. variolofa, Sauv. fp. 5-P. morbillafa, Sauv. fp. 6.-P. a plica, Sauv. fp. 8.-P. aphrodifiaca, Sauv. fp. 9. P. taran:ifmo, Sauv. fp. 14.-P. hydrophobica, Sauv. fp. 15.-P. a dolore, Sauv. fp. 13.-Cephalitis traumatica, Sauv. fp. 2. 508. Defcription. The figns of an impending phrenitis are immoderate and continual watchings: or if any fleep be obtained, it is difturbed with dreams, and gives no refreshment; acute and lafting pains, especially in the hind part of the head and neck; little thirft; a great and flow refpiration, as if proceding from the bottom of the breaft: the puife fometimes fmall and flow, fometimes quick and frequent; a fuppreffion of urine; and forgetfumefs. The diftemper may be known by the following figns: the veins of the head fwell, and the temporal arteries throb much; the eyes are fixed, sparkle, and have a fierce afpect; the fpeech is incoherent, and the patient behaves very roughly to the by-ftanders, with furious attempts to get out of bed, not indeed continually, but returning by paroxyfms; the tongue is dry, rough, yellow, or black; there is a coldness of the external parts; a pronenefs to anger; chattering of the teeth; a trembling of the hands, with which the fick gather the naps off the bedclothes. 509. Caufes, &c. People of a hot and bilious habit of body, and of a paffionate difpofition, are apt to be affected with phrenitis. In the fame danger are those who ufe much fpices, or are given to fpirituous liquors; and who have been much expofed to the fun, or obliged to undergo immoderate ftudies or watchings; who are fubject to head-achs, or in whom fome cuftomary hemorrhages have been stopped; or the difeafe may arife from fome injury offered to the head externally. Sir J. PRINGLE obferves, that the phrenitis is apt to attack foldiers in fummer, when expofed to the heat of the fun, especially wher afleep and in liquor. A fymptomatic phreniti, is alfo very frequent in the army, on account er the violence done to all fevers when the fick are carried in waggons to an hofpital, where the very noife or light would be fufficient, with delicate people, to raise a phrenzy. Fror, thefe and fimilar caufes, a ftate of active inflammation, affecting fome parts within ' ae cranium, is produced: and from this all he fy ptoms of the difeafe arife, particularly that peculiar delirium which characterifes it. But in what manner local difeafes, even of the 'rain itfelf, produc affections of the mind, we are ftill totally ignorant. 510. Prognofis Every kind of phrenitis, whether idiopath or fymptomatic, is attended with a high degree of danger; and, unless removed before the mening .h day, a gangrene or fphacelus of the s takes place, and the patient dies deliriL12 |