1. Anosmia (organica), from a disease in the membrane lining the internal parts of the nostrils.

Varying according to the nature of the disease. 2. Anosmia (atonica), without any evident disease of the membrane of the nose.

Genus XCVIII. Agheustia; a diminution or abolition of the sense of taste.

1. Agheustia (organica), from a disease in the membrane of the tongue, keeping off from the nerves those substances which ought to produce taste.

2. Agheustia (atonica), without any evident disease of the tongue.

Genus XCIX. Anesthesia; a diminution or abolition of the sense of feeling. The species

from Sauvages, adopted by Dr. Cullen, are,

1. Anæsthesia à spina bifida.

2. Anæsthesia plethorica.

3. Anæsthesia nascentium.

4. Anæsthesia melancholica.

Order II. DYSOREXIA; error or defect of appetite.

Sect. I. Appetitus erronei.

Genus C. Bulimia; a desire for food in greater quantities than can be digested. The idiopathic species are,

1. Bulimia (helluonum), an unusual appetite for food, without any disease of the stomach.

2. Bulimia (syncopalis), a frequent desire of meat, on account of a sensation of hunger threatening syncope.

3. Bulimia (emetica), an appetite for a great quantity of meat, which is thrown up immediately after it is taken.

Genus CI. Polydipsia; an appetite for an unusual quantity of drink.

The polydipsia is almost always symptomatic, and varies only according to the nature of the disease which accompanies it.

Genus CII. Pica; a desire of swallowing substances not used as food.

Genus CIII. Satyriasis; an unbounded desire of venery in men. The species are,

1. Satyriasis (juvenilis), an unbounded desire of venery, the body at the same time being little disordered.

2. Satyriasis (furens), a vehement desire of

venery with a great disorder of the body at the same time.

Genus CIV. Nymphomania; an unbounded desire of venery in women.

Varying in degree.

Genus CV. Nostalgia; a violent desire of those who are absent from their country of revisiting it.

1. Nostalgia (simplex), without any other dis

ease.

2. Nostalgia (complicata), accompanied with other diseases.

Sect. II. Appetitus deficientes.

Genus CVI. Anorexia. Want of appetite for food. Always symptomatic.

1. Anorexia (humoralis), from some humor loading the stomach.

2. Anorexia (atonica), from the tone of the fibres of the stomach being lost.

Genus CVII. Adipsia; a want of desire for drink. Always a symptom of some disease affecting the sensorium commune.

Genus CVIII. Anaphrodisia; want of desire for, or impotence to, venery. The true species are,

1. Anaphrodisia paralytica.
2. Anaphrodisia gonorrhoica.
The false ones are,

1. Anaphrodisia à mariscis.

2. Anaphrodisia ab urethræ vitio.

Order III. DYSCINESIE. An impediment, or depravation of motion from a disorder of the organs.

Genus CIX. Aphonia; a total suppression of voice without coma or syncope. The species are,

1. Aphonia (gutturalis), from the fauces or glottis being swelled.

2. Aphonia (trachealis), from a compression of the trachea.

3. Aphonia (atonica), from the nerves of the iarynx being cut.

Genus CX. Mutitas; a want of power to pronounce words. The species are,

1. Mutitas (organica), from the tongue being cut out or destroyed.

2. Mutitas (atonica), from injuries done to the nerves of the tongue.

3. Mutitas (surdorum), from people being born deaf, or the hearing being destroyed during childhood.

Genus CXI. Paraphonia; a depraved sound of the voice. The species are,

1. Paraphonia (puberum), in which, about the time of puberty, the voice from being acute and sweet, becomes more grave and harsh.

2. Paraphonia (rauca), in which, by reason of the dryness or flaccid tumor of the fauces, the voice becomes rough and hoarse.

3. Paraphonia (resonans), in which, by reason of an obstruction of the nostrils, the voice becomes hoarse, with a sound hissing through the nostrils.

4. Paraphonia (palatina), in which, on account of a defect or division of the uvula, for the most part with a hare-lip, the voice becomes obscure, hoarse, and unpleasant.

5. Paraphonia (clangens), in which the voice is changed to one acute, shrill, and small.

6. Paraphonia (comatosa), in which, from a relaxation of the velum palati and glottis, a sound is produced during inspiration.

Genus CXII. Psellismus; a defect in the articulation of words. The species are,

1. Psellismus (hæsitans), in which the words, especially the first ones of a discourse, are not easily pronounced, and not without a frequent repetition of the first syllable.

2. Psellismus (ringens), in which the sound of the letter R is always aspirated, and, as it were, doubled.

3. Prellismus (lallans), in which the sound of the letter L becomes more liquid, or is pronounced instead of R.

4. Psellismus (emolliens), in which the hard letters are changed into the softer ones, and thus the letter S is much used.

5. Psellismus (balbutiens), in which, by reason of the tongue being large, or swelled, the labial letters are better heard, and often pronounced instead of others.

6. Psellismus (acheilos), in which the labial letters cannot be pronounced at all, or with difficulty. 7. Psellismus (lagostomatum), in which, on account of the division of the palate, the guttural letters are less perfectly pronounced.

Genus CXIII. Strabismus; the optic axes of the eyes not converging. The species are,

1. Strabismus (habitualis), from a bad custom of using only one eye.

2. Strabismus (commodus), from the greater debility or mobility of one eye above the other; so that both eyes cannot be conveniently used. 3. Strabismus (necessarius), from a change in the situation or shape of the parts of the eye. Genus CXIV. Dysphagia; impeded deglutition, without phlegmasia, or the respiration being affected.

Genus CXV. Contractura; a long-continued and rigid contraction of one or more limbs. The species are,

1. Contractura (primaria), from the muscles becoming contracted and rigid.

a, From the muscles becoming rigid by inflam

1. Enuresis (atonica), after diseases injuring the sphincter of the bladder.

2. Enuresis (irritata), from a compression or irritation of the bladder.

Genus CXXI. Gonorrhoea; a preternatural flux of humor from the urethra in men, with or without a desire of venery. The species are,

1. Gonorrhoea (pura), in which, without any impure venery having preceded, a fluid resembling pus, without dysuria or propensity to venery, flows from the urethra.

2. Gonorrhea (impura), in which, after impure vereny, a fluid like pus flows from the urethra with dysuria. The consequence of this is,

Gonorrhoea (mucosa), in which, after an impure gonorrhoea, a mucous humor flows from the urethra with little or no dysuria.

3. Gonorrhoea (laxorum), in which a humor for the most part pellucid, without any erection of the penis, but with a propensity to venery, flows from the urethra while the person is awake.

4. Gonorrhoea (dormientium), in which the seminal liquor is thrown out, with erection and desire of venery, in those who are asleep and have lascivious dreams.

Order V. EPISCHESES; suppressions of evacuations.

Genus CXXII. Obstipatio; the stools either suppressed, or slower than usual. The species are, 1. Obstipatio (debilium), in lax, weak, and for the most part dyspeptic persons.

2. Obstipatio (rigidorum), in people whose fibres are rigid, and frequently of an hypochondriac disposition.

3. Obstipatio (obstructorum), with symptoms of the colica 1st, 2d, 4th, and 7th above-mentioned.

Genus CXXIII. Ischuria; an absolute suppression of urine. The species are,

1. Ischuria (renalis), coming after a disease of the kidneys, with pain, or troublesome sense of weight in the region of the kidneys, and without any swelling of the hypogastrium, or desire of making water.

2. Ischuria (ureterica), coming after a disease of the kidneys, with a sense of pain or uneasiness in some part of the ureter, and without any tumor of the hypogastrium, or desire of making

water.

3. Ischuria (vesicalis), with a swelling of the hypogastrium, pain at the neck of the bladder, and a frequent stimulus to make water.

4. Ischuria (urethralis), with a swelling of the hypogastrium, frequent stimulus to make water, and pain in some part of the urethra.

All these species are subdivided into many varieties, according to their different causes.

Genus CXXIV. Dysuria; a painful and somehow impeded emission of urine. The species are, 1. Dysuria (ardens), with heat of urine, without any manifest disorder of the bladder.

2. Dysuria (spasmodica), from a spasm communicated from the other parts to the bladder. 3. Dysuria (compressionis), from the neighbouring parts pressing upon the bladder. 4. Dysuria (phlogistica), from an inflammation of the neighbouring parts.

5. Dysuria (irritata), with signs of a stone i the bladder.

6. Dysuria (mucosa), with a copious excretion of mucus.

Genus CXXV. Dyspermatismus; a slow, impeded, and insufficient emission of semen in the venereal act. The species are,

1. Dyspermatismus (urethralis), from diseases of the urethra.

2. Dyspermatismus (nodosus), from knots on the corpora cavernosa penis.

3. Dyspermatismus (præputialis), from too narrow an orifice of the prepuce.

4. Dyspermatismus (mucosus), from mucus infarcting the urethra.

5. Dyspermatismus (hypertonicus), from too strong an erection of the penis.

6. Dyspermatismus (epilepticus), from a spasmodic epilepsy happening during the time of

coition.

7. Dyspermatismus (apractodes), from an imbecility of the parts of generation.

8. Dyspermatismus (refluus), in which there is no emission of semen, because it returns from the urethra into the bladder.

Genus CXXVI. Amenorrhoea. The menses either flowing more sparingly than usual, or not at all, at their usual time, without pregnancy. The species are,

1. Amenorrhoea (emansionis), in those arrived at puberty, in whom, after the usual time, the menзes have not yet made their appearance, and many different morbid affections have taken place.

2. Amenorrhea (suppressionis), in adults, in whom the menses which had already begun to flow are suppressed.

3. Amenorrhoea (difficilis), in which the menses flow sparingly, and with difficulty. Order VI. TUMORES; an increased magnitude of any part without phlogosis.

soft tumor,

Genus CXXVII. Aneurisma; with pulsation, above an artery. Genus CXXVIII. Varix; a soft tumor, without pulsation, above a vein.

Genus CXXIX. Ecchymoma; a diffused, little eminent, and livid tumor.

Genus CXXX. Schirrus; a hard tumor of some part, generally of a gland, without pain, and difficultly brought to suppuration.

Genus CXXXI. Cancer; a painful tumor of a schirrous nature, and degenerating into an illconditioned ulcer.

Genus CXXXII. Bubo; a suppurating tumor of a conglobate gland.

Genus CXXXIII. Sarcoma; a soft swelling, without pain.

Genus CXXXIV. Verruca; a harder scabrous swelling.

Genus CXXXV. Clavus; a hard, lamellated thickness of the skin.

Order VII. ECTOPIE; tumors occasioned by the removal of some part out of its proper situation. Genus CXLI. Hernia; an ectopia of a soft part as yet covered with skin and integuments. Genus CXLII. Prolapsus; a bare ectopia of some soft part.

Genus CXLIII. Luxatio; the removal of a bone from its place in the joints.

Order VIII. DIALYSES.

A solution of continuity; manifest to the sight or touch. Genus CXLIV. Vulnus; a recent and bloody solution of the unity of some soft part by the motion of some hard body.

Genus CXLV. Ulcus. A purulent or ichorous solution of a soft part.

Genus CXLVI. Herpes; a great number of phlyctenæ or small ulcers, gathering in clusters, creeping, and obstinate.

Genus CXLVII. Tinea; small ulcers among the roots of the hair of the head, pouring out a fluid which changes to a white friable scurf.

Genus CXLVIII. Psora. Itchy pustules and little ulcers of an infectious nature, chiefly infecting the hands.

Genus CXLIX. Fractura; bones broken into large fragments.

Genus CL. Caries; an ulceration of a bone.

PART III.

THEORY OF MEDICINE.

Having thus laid before the reader the scheme of arrangement which, for the reasons above named, we adopt for our guide on the present occasion, we shall now proceed to a slight disquisition on the theoretical part of medicine, prior to engaging in the consideration of morbid affections, separately and particularly. It is usual for authors on medicine to engage in topics of physiological bearing when treating on theoryindeed physiology constitutes a great part of medical theory-and we take the opportunity of saying that Dr. Mason Good has much enriched his volumes, published under the title of The Study of Medicine, in preliminary chapters to his pathological and therapeutic disquisitions, with a most interesting sketch of the physiology of all the functions.

In the present case, however, we shall not include physiology, as that science will fall to be treated of in a separate article, but shall limit ourselves to pathological principles; and, in so doing, we propose to avail ourselves of the proem prefixed by Dr. Uwins to his Compendium of Theoretical and Practical Medicine, this author having given a running commentary, which we are about to follow, on the classes and orders of Cullen's Nosology. Dr. U. has likewise en

Genus CXXXVII Ganglion; a hard moveable swelling, adhering to a tendon. Genus CXXXVIII. Hydatis; a cuticular vesicle filled with aqueous humor.

Genus CXXXIX. Hydarthrus; a most painful swelling of the joints, chiefly of the knee, at first scarcely elevated, of the same color with the skin, diminishing the mobility.

Genus CXL. Exostosis; a hard tumo hering to a bone.

ad

the reasons just stated, we shall at present pass over these points.

265. In the first class of Cullen's arrangement, which the reader will recollect is entitled Pyrexia, are comprehended the five following ordersfevers, inflammations, eruptive disorders of an acute kind, hæmorrhages, and fluxes; and, as we slightly go over the pathology of the circulating organs, or, in other words, the theory of their derangement, cach of the above kinds of morbid being will fall under our notice.

266. Pyrexia implies an increase of the body's heat, and it behoves us to enquire in what way this is brought about; but the enquiry is attended with many difficulties, inasmuch as the mode in which the natural heat of the frame is maintained is still a matter of some obscurity. When the chemical changes that take place during respiration had been enquired into, and when it was found that the capacity of carbonic acid for heat was less than that of oxygen, it was supposed that the conversion of oxygen into carbonic acid gas was the cause of the rise of temperature; and, as the heat of the lungs does not exceed that of other parts, it was asserted that the air was absorbed by the blood, and that the production of carbonic acid, and consequent evolution of heat, took place gradually during the circulation. To these opinions many strong objections have, from time to time, been urged by different physiologists, but their complete subversion followed the researches of Mr. Brodie (Phil. Trans. 1812), who found that the heart was capable of retaining its functions for some hours, and of carrying on circulation in a decapitated animal, and consequently independent of the influence of the brain, when respiration was artificially carried on. Under these circumstances it was observed, that, although the change of blood from the venous to the arterial state was perfect, no heat was generated, and that the animal cooled regularly and gradually down to the atmospheric standard. In more than one instance the expired air was examined, and found to contain as much carbonic acid as was produced by the healthy animal; so that here circulation went on, there was the change of oxygen into carbonic acid, and the alteration of color in the blood, and yet no heat whatever appeared to be generated.

267. Since then, even on the subject of vital temperature, without reference to disease, much remains to be explained, and some positions have been assumed which experiment proves to be untenable, it follows, that to account for the increase of heat as health recedes must be a task of much difficulty; and perhaps very little more at present is known on this point than that an increase of exterior and internal heat accompanies the excitation of certain superficial or interior movements. Indeed, heat from motion, and cold from quiescence, are, with some modification, laws of inorganic matter; so much so, that some philosophers have considered the introduction of a subtile material, as the essence of heat, to be not only gratuitous but unnecessary, and have maintained that heat, like every other incident of bodies, is but a manifestation of altered form or circumstance of the body; and, although inorganic and organised being are regulated by different laws, we see and know enough of the latter to be convinced that action and heat are in some measure connected even in it, in the way of cause and effect. But let us, dismissing the intricate topic of natural and morbid heat, as excited and maintained in an organised body, say a few words in succession on the several discrdered conditions above enumerated, viz. fever, inflammation, eruptive affection, hæmorrhage, and flux. The order, however, of the two

first, for reasons which will soon be obvious, we shall reverse, and treat, in the first place, on inflammation.

268. When treating on the circulation, in the article PHYSIOLOGY, we shall have to state that one of the arguments adduced in favor of an independent power in the arterial system—that is of a power independent of the motive power of the heart-is taken from the circumstance that partial distribution of blood may have place without, in the first instance at least, the heart itself being changed from its steady course of regular procedure. Thus, in a given spot, an increased quantum and momentum of blood shall be discoverable; this augmented momentum and excitement shall bring with them an increase of heat, and eventually all the phenomena shall manifest themselves to which the term inflammation would be applied, merely from topical or local causes, the heart and other parts of the vascular organisation only then coming to be affected when the commotion shall have excited what are called sympathetic or secondary considerations. But inordinate action, and consequent heat, do not of themselves constitute inflammation. Of what then is inflammation actually formed? We may suppose the eye to be suddenly and unexpectedly subjected to an undue quantity of light; inordinate excitation is the immediate consequence, in other words the fibres of which the organ is composed are for a time irritated into more vigorous movement than is ordinarily the case; the volume and force of its circulation are rendered more abundant, and visual perception is in the same ratio increased. All this however may exist without the presence of positive inflammation; we have here augmented, but not otherwise deranged action—the error loci of the schools has not taken place; the component parts of the blood preserve their proportionate relations, and the ordinary standard of circulating power is shortly restored without the intervention of organic derangement.

269. But let the stimulus be applied with more force, or let it be brought to act under greater than usual irritability of the organ, a different state of things will soon commence; the blood vessels, which are usually colorless, will now be seen to convey red blood, new secretions will take place, and in the course of a short time new parts or vessels will be actually formed. If, then, we are asked for a definition of the inflamed state, as opposed to mere excitation or fulness of vessel, we reply that it is such excitation or such plenitude carried up to the extent of actual derangement; the capillaries do not merely momentarily receive, but positively and permanently circulate an unhealthy quantity of blood; while this break-in upon her orderly course nature will not permit, without setting about the work of regeneration in order to be ready, as it were, for the breach that is about to be made.

270. Actual inflammation, then, seems to a certain extent to be disorganisation, and this disorganisation implies a weakened state of the capillary or smaller vessels, either forcibly, induced by the rush of blood into them when the inflammation has been more active, or sthenic,

as some pathologists would call it, or more passively brought about when the impetus has not heen much above its common grade, but when from some circumstances of obstraction, or other accidental conditions, the capillaries are made to receive and transmit such a quantity of blood as to distend them and excite them into perturbed motions; for in either case undue action and irritation seem necessary to the formation of the inflammatory state, otherwise the state would be that of mere fulness or congestion.

271. Why in case either of more active or pas sive inflammation, says the author whom we are now following, there should be the resisting and repairing actions set up which have been above adverted to, there is no possibility of explaining beyond an appeal to final cause, and this Deus intersit language ought never to be introduced when the subject is not morals nor religion but physiology and physics. What, it has been justly remarked, does John Hunter's stimulus of necessity' amount to, as applied to the blood's coagulation, more than that the blood coagulates because it must coagulate?

272. If there be any correctness', he continues, in what has been above advanced in reference to the essentials of inflammation, it would seem, moreover, to follow, that the dispute is somewhat idle and unmeaning, whether inflammation be weakness or strength, action or torpor, obstruction or other impediment; it is all and every thing as the general frame and local incidents shall vary; and both as to pathological essence and practical indications abstract views ought to be kept as much as possible from influencing judgment.

273. In reference to the modes in which inflammation terminates, it may be said, that the term resolution is generally meant to express that recovery from the morbid state which is effected without the intervention of any disorganising process. But this event, strictly speaking, is not perhaps possible, since the existence of the derangement supposes, as above intimated, some degree of disorganisation. Even the most simple case then of resolution seems to imply some degree of absorption, and it is probable that the remedial agents that are had recourse to, under the notion of subduing vascular action, effect their purpose in part by giving an impulse to the absorbing faculty. The readiness with which adhesion takes places under inflammation, between membranes that are in apposition, is a proof of the rapidity with which inflamed vessels pour out lymph; and this lymph, if not again taken up into the circulating mass, often becomes organised in a very few hours; a process this which is one of the most remarkable in the whole circle of animal movements, and which, on account of its important bearing upon pathology generally, we shall illustrate by the recital of a case in proof. A man was operated on for strangulated hernia at seven o'clock in the morning. The hernial sac was laid open, and the gut, which proved to be a portion of the ileum about six inches in length, was attentively examined previously to its being returned into the cavity of the belly. It had the natural polished surface peculiar to intestine, and although its vessels

were tinged with blood it did not appear that they were uncommonly numerous. After the operation the symptoms did not abate so much as might have been expected, and during the afternoon a pain was complained of in the lower part of the belly. There was no passage by stool, and next morning, about seven o'clock, the pulse was scarcely perceptible; the skin was cold and clammy, and at about twelve o'clock at noon the patient died; having lived twentynine hours after the operation.

274. The body was opened, and the portion of gut which had been strangulated was found considerably inflamed, the external surface having lost its natural polish, and having several small portions of exudated coagulable lymph adhering to it. The vessels of the gut were minutely injected; the arteries with a red colored injection, the veins with a yellow one. Upon examination afterwards all these adhering portions of coagulating lymph were found to be injected, having a considerable artery going to each of them, and a returning vein which was larger than the artery. It is evident, therefore, that the coagulating lymph was laid upon the surface of the gut after the operation; and we cannot suppose, says the narrator, that any such process as forming new vessels could have been going on during the last five hours of life, when the pulse at the wrist was scarcely to be felt, and the powers of life were so much weakened in every respect. We must therefore conclude that the whole operation of throwing out coagulable lymph, and supplying it with blood vessels after it had become solid, was effected in less than twenty-four hours!

275. If inflammation be not resolved, or it may not have terminated by effusion, or this new and adhesive action, suppuration, or the formation of pus, is the next step in the process. On the manner in which pus is formed, opinion was exceedingly vague to the time of Dr. Morgan and the justly celebrated Mr. John Hunter. Even Pott, in his estimable works, alludes to the formation of pus as if it were some how or other the consequence of the solid parts being melted down; and in the first lines of Dr. Cullen this same theory is broached. The general sentiment among pathologists of the present day is, that pus is a peculiar secretion from vessels in a certain condition, but what the precise state is which originates pus seems still an unsettled matter. Pus, indeed, is evidently engendered under different circumstances of the vessels, and, although it is usually the result of inflammation, it sometimes seems to be the consequence of an irritative action which is under the grade of positive inflammation; as when it is secreted from mucous surfaces after a long continuance of chronic, but not perhaps truly of inflammatory ailment.

276. Gangrene is in fact the death of the part which the disorder implicates; the rush of the disease has proved too violent for the organs tr bear; the living reaction has failed of accomplishing its purpose and the laws of animal chemistry, thus far held in subjection by the superior sway of the living power, acquire an ascendancy; a play of chemical affinities takes place, and p1trefaction or a decomposition of the organised