TA / THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA PRESENTED BY PROF. CHARLES A. KOFOID AND MRS. PRUDENCE W. KOFOID r I ffik :ii DESCRIPTIVE, DIAGNOSTIC AND PRACTICAL^ DISORDERS OF THE DIGESTIVE ORGANS AND GENERAL HEALTH, AND PARTICULARLY OF THEIR Nl^EROUS FORMS AJ^D COMPLlCATIOJSrS, CONTRASTED WITH SOME ACUTE JlJ>rn IJ^SIDIOUS DISEASES: 1 BEING AN ATTEMPT TO PROSECUTE THE VIEWS OF DR. HAMILTON AND MR. ABERNETHY, AND A SECOND EDITION OF THE ESSAY ON THE MIMOSES, WITH ADDITIONS. BY MARSHALL HALL, M. D. F. R. S. E. &c. &e. KEENE, N. H. PRINTED AND PUBLISHED BY JOHN PRENTISS. 1833. • ■*» ^. TO " / M. D. F. R. SS. L. AND E. PHYSICIAN EXTRAORDINARY TO THE KING, ^ ETC. ETC. ETCv SIR, TO UR indulgent expression of approbation of my former Work, and your condescending acceptance of the dedication of the present one, constitute at once the most ample reward and the greatest encouragement of my efforts to contribute to the advancement of Diagnosis and the His. tory of Diseases, JVith every sentiment which the most profound respect can inspire, I remain SIR, Your most obliged Servant, MJiRSIMLL HALL, Nottingham, October 2lst, 18^0.. ii o K T i; X T s , OJy THE MIM08ES, §§ 1, 2 4 The General Character, Origin of the Term, . . . The principal Forms of the Mimoses, The Complications, The Object of this Essay, . The Nature of these Afiections, . Their Causes, .... And Pathology, .... Anology for the introduction of a new denomination , ^^ for them. ... J^ i- 7 8 9 10—13, 14—1.7 CHAPTER L OJV THE MIMOSIS JiCVT^. SECTION I. Description, with cases. The General Character, — of the Severe and Less > Severe Forms. List of Complications, Description, Cases, History, Weight of Patients, > 24, 39 34, 41, 150, 153 25 — 42 44_5S 59_64 . p. 45, a note SECTION II. The Diagnosis, with cases. I. The Diagnosis of the General Affection-, 1. From Fevers, ^^ — 70 2. From Organic Disease, . . . . 71, 72 3. From Strumous Disease of the Mesentery in^ ^^ „- Adults 4. From an Effect of Drunkenness, f6 CONTENTS. II. The Diagnosis of the Complicatioiis. 1. With Affection of the Head, 1. of an Apoplectic, . . . . 83, 84 ». of an Eliptic character, . . . 85 88 3. Pain and some other Affections, . 89 — 94 2. With Affection of the Chest, 1. Oppressive Dyspnoea, . . . qq 93 2. Cou^h with Expectoration, . . 99 — 105 3. With Affection of the Heart, 1. Fluttering palpitation, irregular action} ,^^ , , ,, 2, Fainting, 5 106— lU 4. With Affections of the Stomach and Bowels, 1. Hiccough, 115—120 2. Haematemesis, Melaena, 3. Pain, .... 4. Constipation, Diarrhoea, 5. With Icterus, 121 122—125 126—127 ... 128-131 6. With Symptoms of affection of the Bladder, 132 7. With Pain resembling the Tic Douloureux, 133 8. With Convulsive and Spasmodic Affections 135 — 144 9. With Paralytic Weakness, . . 145—146 10. With a singular Tumidity of the face and} , ,„ ^.- General Surface, . . . . ^ 14/— 149 III. The Local Complications, 1. An Arid and Exfoliating state of the Prola^ia, 151 2. An Ulcerated state of the Tongue, . . 152 IV. A Cachectic Form of Mimosis, . ^ 153: 157 SECTION III. The Causes and Treatment. 1. Of the General Affection, . . . 153 174 2-. Of the Complications, . . . 175 xg..'? CHAPTER IL 208— 214; 215— 222 ; 223, 250 229—235, 253 225, 243—246 236, 256—259 260—262 248 226 228 238—262 263—265 235 . . * 266 SECTION IL The Diagnosis, with Cases. I. The Diagnosis of the General Affection, 1 . From Insidious Organic Disease, . 2. From Disease of the Liver, '^ II. The Diagnosis of the Complications, 1. With Sudden Affection of the Head, . 2. With Continued affection of the Head, 3. With Sudden or Continued Cough and^ ^-^ ^g^ Dyspnoea, ..... S ' 4. With Palpitation of the Heart, : . . 281 With Sudden Pain and Tenderness of the Side, 282, 283 With Protracted pain of the Side, . . 284, 285 ^ 26S • 269 271- -275 276- -278 CONTENTS. With Sudden, or Protracted, Pain of the^ ^g^ ^gs Abdomen, ..... ^ ^ ^ WithMelsena, ..... 289—291 With Menorrhagia and Leucorrhoea,' . . 292 SECTION III. The Causes and Treatment. CHAPTER IV. OJV THE MIMOSIS URGEJ^S. SECTION I. The Description. The General Character, .... 307, 324 OftheMild, Severe, > 3JQ 311—322, 329; 323, 330 & Inveterate Forms, 3 ' Copious List of the other Forms, . . . 325 Section II. The Diagnosis* ^ 1. Of the Convulsion, 333 2. Of the Affections of the Head, — Pain, > oq^ qoo Delirium, Stupor, &c. ... 5 3. Of Pain of the Chest, .... 339 4. Of Urgent Dyspnoea, .... 340 5. Of Fits of Coughing, 241 6. Of Suspended Respiration, .... 343 7. Of a painful Affection of the Diaphragm, 344 — 345 M 8. Of the Imitation of Croup, . , 346, 347 *^ 9. Of the Palpitation or Syncope, ... 348 10. Of the Pain of the Abdomen, . . 349, 350 11. Of the Hiccough or Retching, . . . 351 12. Of the Dysury, 352 13. Of the Partial Paralysis, .... 353 14. Of the Trismus, Tetanus, Clenched Hand, > 0^4 okr Contracted Foot, Twisted Legs, &c. > Remark, .357 SECTION IIL The Causes and Treatment, 358—361 POSTSCRIPT. OJV THE MIMOSIS JXqVIETJi. ADVERTISEMENT. / have changed the Title-page of this little work^ hut have retained the term Mimosis in the Text. The reader tvill adopt or reject it as lie deems most proper. I still think it the most appropriaie in itself and the most useful in its practical tendency. The present Essay describes the various affections of the General Health and of different Parts, which arise from the more continued action of Derangement of the Digestive Organs. The Essay alluded to in the Postscript , p. 191, displays the more acute and alarming effects of In- A testinal Load and Irritation, and of Exhaustation from Loss of Blood, or other Causes. These two Classes of Mor- bid Affections ere, as the reader will observe, allied in many respects. M. H. ON THE MIMOSES 1. THERE is a Class of Disorders, each of which consists of a more general morbid affection, usually combined with some topical symptom or symptoms. 2, The general affection is complex and various 5 the complications are multiform and changeable, and, by their incidental predominence, frequently imitate other diseases widely different in their nature. 3. These affections have been variously and per- haps too exclusively attributed, by some authors, to a state of derangement in one or more of the chylo- poetic viscera : and by others, to an unequal and undue distribution of the blood, by which a state of arterial excitement or of venous congestion is induced B 10 ON THE MIMOSES. in some particular organ, or in some particular part of the sanguiferous systenu 1 have scarcely ventured in this work, to enter into any speculation relative to the pathology of the affections of which it treats : for this part of medicine, notwithstanding the ingenuity of some late theorists, seems scarcely to have advanced from the state of conjecture and uncertainty described by Celsus, whose words* are still, in every sense, but too admissable. 4. As the real nature and connexion of the general and tojHcal affections, in tjiese complaints, may thus frequently be dubious, 1 have deemed it advisable to appropriate some new term, which might, without implying any opinion on the subject, sufficiently ex- press a prominent and important feature of this class of morbid affections. The denomination MIMOSIS, from the Greek word Mimos, imitator, v/\\\ at once de» note a remarkable peculiarity, — the multiform charac- ter, — of these disorders, and will serve to impress the mind with the necessity of distinguishing, in * Cum hxc per multa voiumtna, perque inagnEe contenlionis disputantiones, a njedicis scspe ti-actata sint atquc tractentur ; subjiciendum est, quis proxima vei'o videri possint. Ea neque addicta altorutri opiiiioui sunt, neque ab utraque nimium abhorrentia ; media quodammodo inter diversas sentsntias : quod in plurimis coa" tentionibus deprehendere licet, sine ambitione verum scrutantibus, ut in hac ipsa- re. Nam quse dcmum causse, vel secundam valatudinem praestent, vel morboa excitent, ne sapientiae quidera professores scientia comprehendunt, sed conjectura persequuntur. Cujus autem rei non esteerta notitia, ejus opinio eertnm reperire remedium non potest. Veruroque est, ad ipsam curandi rationem nihil plus ©on- fcrre, quam experientiam.— Celsi Prjet. ON THE MIMOSES. li Local Affections, between those which belong to the present Class, and others which are either primary, or have a different origin, — a point of great practical importance. 5. For a similar reason, I have discarded th« terms bilious, spasmodic, &c. as denominations for disea- ses ; and have reserved them only to denote certain tsYMPTOMS of morbid affections. In the latter sense, their import is generally understood, and may, per- haps, be sufficiently definite ; but in th« former, they could only serve to satisfy the mind with vague con- ceptions of the affection, and to check the investiga- tion of its particular and individual nature.* 6. Of the Mimoses 1 have observed five forms ; — ^the Mimosis Acuta, the Mimosis Chronica, the Mimosis Decolor, the Mimosis Urgens, and the Mi- mosis Inquieta, I. The Mimosis Acuta appears to me not to haVe been more fully described in medical writings, un- less this affection be, as I suspect, indentical with the Scorbutus of Willis and other writers of his day.f II. The Mimosis Chronica is the Dyspepsia or Hy- pochondriasis of medical authors. * See the author's Treatise on Diagnosis, pp. x, 2 — 3. .» t See the Edinb. Med. and Surg. Journal, Vol. 16, p. 204; qn the acceptation vof the Term Scobbutu^. i^ ON THE MIMOSES. III. The Mimosis Decolor embraces the Chlorosis of medical writers, together with some other morbid affections, in which the complexion and general sur- face suffer materially, and which have not, I think, been hitherto sufficiently, if sd all distinctly described. IV. The Mimosis Urgens is the Hysteria of authors. Its numerous forms are, I think, more amply collected and described in this than in any former publication. V. The Mimosis Inquieta is, I believe, described in this work for the first time. It appears, in gene- ral, to combine the effects of intestinal irritation and of cxhaustation from loss of blood or other causes.* 7. The COMPLICATIONS of the Mimoses are apt to be mistaken and mistreated for different Inflamma- tory and other Local diseases, and appear to me to constitute a Class of morbid affections scarcely less frequent or less important, and requiring to be distin- guished with the utmost care. For an enumeration of these complications the reader is referred to the table of Contents. 8. The object of this Essay is to establish this Class of general and local morbid affections more dis- • Since the appearance of the first edition of this Essay, I have published a separate tract on this subject, with the following title : — Cases of a Serious Mor- bid AfFeciion, chiefly occurring after Deliveiy, Miscarriage, &c. from vai-ions cau- ses of Irritation and Exhaustation ; and of a Similar Affection, unccnnerted with the Puerirei'al State. ON THE MIMOSES. 13 tinctly and extensively than before, — to collect and embody the system of facts which belong to this part of pathology, — to present accurate descriptions of the different forms, and to trace the diagnosis of the numerous complications of these disorders. « 9. I have thus been very explicit as to the design and pretensions of this little Essay, With regard to the NATURE of these affections, I beg to observe that I consider them all as similar. The Mimosis Acuta differs from the Mimosis Chronica, in affecting the process of assimilation, the strength, and the gene- ral health, more seriously. The Mimosis Decolor presents some extraordinary states of the complexion, the general surface, and the capillary circulation, the cause remaining probably similar. The Mimosis Ur- gens is not necessarily connected with any of these affections of the assimilation or of the surface, and yet the cause may still be, in a general sense, the same. The Mimosis Inquieta conjoins, with this cause, the state of exhaustation. 10. Too much praise cannot be conferred on those members of the profession, who have so well elucidated the. nature and treatment of some of the subjects of the preceding pages. There is no doubt, indeed, that this investigation of the Mimoses was suggested to me by what I have learnt from the invaluable labours of Dr. Hamilton, Mr. Abernethy, and other re- spectable writers. My situation in Nottingham, how- 14 ON THE MIMOSES. ever, has been a principal cause of ixing my attention on a Class of Disorders, of which the usual causes aic sedentariness and coniinement. This town, so cele- brated for its manufactories of cotton stockings and lace, embraces a very extensive population, a great majority of which, — men, women, and children, — are engaged from morning till evening, in the numer- ous sedentary occupations which these manufactories imply, — deprived of the salutary influence of pure air and gentle exercise. 11. To these numbers, which are peculiar to my situation, must be added the sedentary amongst the remaining part of the population, — the literary, per- sons of a delicate mode of life, females in general, tailors, mantua-makers, and the youthful inhabitants of the schools. IS, Nor is sedentariness the only cause of the Mi- moses, the operation of which is peculiarly frequent amongst the poor of Nottingham. I have noticed the frequent occurrence of the Mimosis Decolor in cooks ^nd housemaids ; and the same remark applies equally to those persons Avho are much engaged in ^ ironing,' and, of consequence, much confined to an atmosphere overheated by stoves for the purpose of quickly dry- ing the articles subjected to this process. 13. To this view of the causes of the Mimoses pe- culiar to a manu£acturing town, may be added the ON THE MIMOSJES. i& baneful influence of a confined and impure atmosphere, and an indigestible and poor diet, — an influence which we learn lo estimate more perfectly, by adverting to the impediment they afford to our attempts to cure, and to the beneficial effects of the country air and exercise, with a proper and nutritious diet. 14. A certain activity of the body would appear to be necessary to insure the peristaltic movements of the intestines, and, in consequence, the propulsion of their contents. During sedentariness, these move- ments are probably retarded, the alvine evacuation becomes more scanty or less frequent, and the intes- tines remain loaded. 15. From this loaded state of the bowels, their functions, and those of all the chylopoetic viscera, most probably become deranged. The alvine con- tents become disordered merely by delay ; and their presence induces in its turn, a disordered state of the functions, — or actions, — of all the organs contributory to digestion, and at length of other organs more re- motely situated in the animal frame. 16. The functions of the parts within the mouti^ become obviously disordered. The secretions become morbid ; the tongue becomes loaded and swollen ; the gums red and tumid; the breath tainted; and the saliva sometimes profuse and offensive. The com- plexion and the skin become morbid, and there 16 ON THE MIMOSES. tire the appearances observed in the Mimosis Acuta or the Mimosis Decolor, and frequently cederaa. Thi» condition of the complexion and skin varies with the state of the original disorder, and with that of the tongue and internal mouth, of which it affords indeed an INDEX. With the state of the mouth and skin, that of the secretions and other functions of the whole course of the ALIMENTARY CANAL and the contribu- tory digestive organs, — the liver, the pancreas, &c. may be presumed to be all morbidly affected. Digestion is variously deranged ; the contents of the bowels become unnatural ; and thus reciprocally. Ac- cording to the state of things, nutrition is impaired, or the sensations are uneasy and painful. 17. To term these disorders stomachic, intestinal, hepatic, or bilious, would alike afford partial and in- adequate views of this comprehensive subject. As co-existant or subsequent links of this chain of sym- pathies, the functions of the brain, heart, respi- ration, STOMACH, intestines, UTERUS, BLADDER, Etc, become variously affected. The muscular SYSTEM and the senses also suffer in different instan- ces. And nutrition, absorption, and secretion are impeded or impaired. 18, From this view of the subject, the character of the Mimoses may be deduced. And the recur- rence of this word, leads me once more to apologize for the introduction of a new denomination for these ON THE MIMOSES. 17 -diseases. I have been induced to adopt this term, first,. to prevent a great deal of circumlocution ; and, secondly, because I could find no other in use, which v^^as not objectionable from implying some hypotheti- cal view of the subject. These motives, I still trust, will appear sufficient to justify the innovation. I can at least assert in the words of Morgagni, — longe mihi potior cura est veritatis quam novitatis. 19. It was originally intended to publish tlie fol- lowing Essay in a larger form, accompanied by repre- sentations of the Complexion, Tongue, Tinge of Sur- face and of the Hands. It is now found necessary, however, to leave the task of procuring plates to some one more fortunately situated, or, at least, to a subse- quent period. In the mean time, the text, it is hoped, will be found a faithful portrait from Nature, not un- acceptable to the reader of practical medicine. SO. Before I conclude these few preliminary re- marks, I may be allowed to observe, that there is in tiic profession a two-fold prejudice, respecting medi- cal investigations : — whilst one class of practitioners seem inclined to refer too many morbid affections to a deranged state of the chylopoetic organs, another, — ' contrarium errorem errantes,' — turn their attention too exclusively to such diseases as leave traces under the scalpel of the anatomist. Both parties appear to be in the wrong ; each of these topics deserves and de- mands its due share of attention. The important c 18 ON THE MIMOSES. study of DIAGNOSIS seems to be that by which alone wc may be safely piloted through these opposite dan- gers. — I trust the following pages will serve to illus- trate the force and truth of this remark. f ' CHAPTER I. THE MIMOSIS ACUTA. SECTION I. DESCRIPTION WITH CASES. ^l. FllOM the great diversity and complication of the symptoms of this form of Mimosis, and from the occasional prevalence of one particular symptom over the rest, it is probable that it has sometimes been mistaken for some other affections. With the view of assisting the distinction of this case in future, it will be my object, first to detail tUe symptoms which char- acterize the complaint in general, and in the second place, to enumerate those particular symptoms which are apt, in certain instances, to engross the attention of the patient and of his friends, and even to occasion some difficulty and cmbarrasment in the diagnosis, to the medical practitioner* 22. In order to facilitate the description, the Mi- mosis Acuta will be considered under tv\^ forms, dif- fering only in degree, — in the greater or less severity of its symptoms in general, — and in the presence or absence of some of the severer symptoms. These two forms, of course, sulmit of aU intei*mediate shades ; 20 THE MIMOSIS ACUTA. they are also^ each, apt to be continued in a protract- ed form. ^3. The Mimosis Acuta, even in its severer form, comes on insidiously, and tbe patient gradually be- comes incapacitated for business or his usual exercise : the less severe form occurs more gradually and insidi- ously still. 21. The severer form of the Mimosis Acuta is early and principally characterized and distinguished by the concurrence of the following symptoms, — namely, WEAKNESS, TUEMOR, HEADACH, VERTIGO, FLUTTER- ING, FAIXTISHNESS, TENDENCY TO PERSPIRATION, SUSCEPTIBILITY TO HURRY AND AGITATION, WEARI- NESS, AND LOSS OF FLESH. 25. The countenance is rather pale and thin; the lips are pale, and, with the chin, frequently tremu- lous, especially on speaking ; the surface of the face is generally affected with an appearance of oily, clam- my, and swarthy perspiration, especially near the nose ; there is a loss of coloiir, and usually a degree of sallowness and darkness of the complexion in ge- neral, bat principally about the eyes. The faoe is often bloated, and the skin coarse, at first; after- wards, there is some degree of emaciation. 26. The tongue is almost invariably loaded : — sometimes only slightly, whilst its edges are clean DESCRIPTION, WITH CASES. ^ and red ; — in severe cases, a load has formed over the ton§ue, und has, almost at once, peeled oif, leaving the surface morbidly red, smooth, and tender; — at other times it is more loaded, swollen, and oedematous, formed into deep sulci or plaits, and marked by pres- sure against the contiguous teeth, — the inside of the cheeks being also impressed in the same manner ; the papillae of the tongue are numerous and enlarged ; the gums are red and swollen, and occasionally bleed : the. teeth and the mouth are in general foul, and the breath loaded and foetid ; in a fourth instance, the tongue may, however, be clean, but lobulated, whilst the in- ternal mouth and breath are little affected. The first and second states of the tongue are observed, when the affection has not continued long ; tlie third, when its accession has been particularly slow and gradual ; and the fourth, when a similar but chronic state of disorder has long subsisted, and has, at length, been succeeded by the Mimosis Acuta. S/. There is a tendency to perspiration, on slight exertion, or any surprise, and, sometimes, in the night or early in the morning ; the skin is, in general, cool, rather moist, and clammy ; in some protracted cases, it has become dry and harsh. The hands and feel are apt to be very cold, and the nails occasionally as sume a lilac hue. S8. The patient is usually affected with great tre- mor, observed sometimes in a quivering of the lip, or M THE MIMOSIS ACUTA. dimpling of the chin, but more usually, on holding out the hand, or in carrying a cup of tea, for instance to the mouth, on attempting to stand erect or walk, or on being fatigued or hurried. The tremor, in some protracted cases, has formed the most remarkable feature of the affection ; in otherfe, it has been much less observed, but it is rarely, if ever, entirely absent. The patient is liable to experience faintishness in the lipright position, if sustained for a little time. And he feels unaccountably feeble and weary, and suffers from a sense of aching, after slight exertion. 29. There is an early and daily loss of flesh. Tiiis, as well as the restoration of flesh, during recovery, may be ascertained by weighing, as exemplified in some of the cases of this affection, to be given here- after. 30e The patient experiences head-ach and ver- tigo, and he is nervous, and easily hurried and agi* tated. There is sometimes heaviness for sleep ; some- times great wakefulness and restlessness ; sometimes incubus, rarely delirium 5 sometimes loss of memory and absence of mind. Tiiere is almost universally a peculiar sense of fluttering about the heart and pit of the stomach. And there is frequently an acute pain in some part of the course of the colon. 31. The pulse is generally nearly natural, but it is often rather frequent, and usually easily accelerat- DESCRIPTION, WITH CASES. S8 e'd. There are often great irregularity and intermit - teiice of the pulse. 3S. The appetite is generally much impaired, and there is often loathing of food ; but sometimes the appetite is even greater than natural, and there is almost constant craving. The digestion is various, being sometimes quick, and at other times attended M^ith great sense of load, distention, flatus, eructation, hiccough, and even rumination or vomiting of food. The bowels are at first constipated 5 afterwards con- stipation and diarrhoea alternate, and sometimes the latter symptom becomes nearly permanent : the mo- tions, during the constipation, are small, during the diarrhoea, scanty, extremely foetid, dark coloured, often accompanied by blood, and frequently attended by tenesmus. 33. The urine is extremely loaded in the com- mencement of the MiiQpsis Acuta, but may become perfectly transparent during its continuance ; it is often high coloured ; and like the other symptoms the appearance of this secretion is very liable to change. A continued state of Minu)sis seems to lead to the for* mation of gravel. 34. Besides the symptoms just enumerated, there are others which prevail more or less in almost every case ; but they are, on the whole, less constant and more diversified ; and of these one sometimes predo- 3^ THE JVIIMOSIS ACUTA. minates so much over the rest, as to engross the at- tention of the patient and sometimes of the practi- tioner, too exclusively. The secondary affection 'is then considered as idiopathic, and the symptom is apt to be treated as the disease. It is therefore of the utmost importance to present the reader with the following distinct enumeration of these symptoms : — 1. headach; vertigo; stupor; etc. 2. COUGH ; VISCID expectoration. , 3. paroxysms of oppressive DYSPN(EA. 4. palpitation of the heart; fluttering ; faintishness ; irregularity and frequency of the pulse. 5. FREqUENT and VIOLENT HICCOUGH ; VOMITING OF FOOD. 6. SOME CONVULSIVE AND SPASMODIC AFFECTIONS. 7. PAIN IN THE EPIGASTRIC, OR ONE OR BOTH OF THE HY- FOGHONDRIAC, OR CHONDILIAC REGIONS. 8. CONSTIPATION ; DIAHRHtEA ; TENESMUS. 9. H£MATEM£SIS ; MELiENA. 10. ICTERUS, 11, SEVERE PAIN OF SOME OF THE LIMBS. 13. SUDDEN TUMEFACTION OF THE INTEGUMENTS, ESPBCIALLY OF THE FACE.* 35. The diagnosis in these cases will be attempted in the section appropriated to this subject. At present it is of importance to remark that in most instances, even where one of these symptoms is particularly marked and severe, several concur, and arc experi^ enced in a mitigated form, affording a characteristic feature of this disorder and a principal source of dis- » Sec Secfion II. and the Table of Contents. DESCRIPTION WITH CASES. S^ crimination ; for whilst most local diseases are denoted by being simple and definite, this affection is distin- guislved by its multiplicity, and by apparently con- joining many or all disorders in one, — Ouch ^en ti tun kakon phainetai all' etin ote polla e kai panta. 36. This form of Mimosis is also characterized, although less so perhaps than the more chronic and continued forms of this affection to be described hcre- after> by being variable, — ^better and worse, — with this and that prevailing feeling or symptom, — even du- ring a general recovery; — changes chiefly induced by bodily fatigue, mental agitation, errors in diet, or constipation. 37. It is also to be remarked that, althougli the usual accession of this affection is insidious, as stated § S3, yet when the causes* inducing it are severe, or the patient subject or predisposed to this affection, it may appear in a still .more acute form ; and in this case it assumes, in some instances, even the character of a Febrile disorder ; and in others, that of a serious morbid affection, soon depriving the patient both of strength and of flesh in an alarming degree. 38. By an attention to the circumstances detail- ed § 0% and by a reference to the general symptoms of the Mimosis Acuta, ^^ g4i — 33, the different se- • See Section III. S6 THE MIMOSIS ACUTA. eoudary affections may be generally distinguished and identified, in their connexion with the primary disorder. It should, however, ever be borne in mind that an idiopathic and organic affection of some part may co-exist with the Mimosis Acuta. The diagnosis is then often very difficult. It is frequently only as- certained when the state of disorder constituting Mi- mosis, is removed. The prognosis should therefore be given with caution. — Anotlicr circumstance sug- gesting caution in the prognosis, is the possibility of the transition of the state of disorder into that of DiSEASf:, which is not unusual in those parts and organs which are, at first, only affected in a second- ary and functional manner, 39. In the less severe form of the Mimosis Acuta, the debility, tremor, loss of flesh, and tendency to faintishncss and perspiration, § S4, are less observed,^ although perhaps not altogether absent, 40. In this form of the Mimosis Acuta the coun- tenance is rather sallow, and its surface is more or less affected as in the severer form described above. The tongue and the internal mouth are often affected in the severer degree described ^ S6. The patient is incapable of pursuing any laborious employment. He is prone to perspire from slight exertion or agitation. He perhaps experiences some loss of flesh. He is low spirited and listless. The appetite is sometimes im- paired, but sometimes craving. And he suffers from / DESCRIPTION, WITH CASES. S/' the symptoms described §§ 30 — 33, and from the complications enumerated § 34?, only in a milder and more protracted form than the subject of the severer cases of Mimosis Acuta. 41. Besides the symptoms enumerated § 34, the less severe but more continued form of the Mimosis Acuta, is sometimes attended with one of the follow- ing affections ;— 1. FURUNcuLi ; paronychia; hordeola. 2. ERYSIPELAS ; ERYTHEMA NODOSUM ', URTICARIA CHRO- NICA ; LICHEN. 3. PURPURA. 4. ULCERATIONS AND PUSTULES ON THE CONJUNCTIVA. 5. DECAY OF THE TEETH; A MORBID STATE OF THE GUMS ; CHRONIC SORE THROAT. 6. SOME AFFECTIONS RESEMBLING SYPHILIS.* 42. Persons who have long laboured under a state of Mimosis appear liable to decline, at length, into Phthisis Pulmonalis, or to become the subjects of other organic disease, and especially of the Liver. See Section IL and the Table of Contenls. S8 THE MIMOSIS ACUTA 43. It may now be proper to confirm the dc»y cription of the Mimosis Acuta just given, by a selec- tion from the cases from which it has been taken :- — 44. Case I. The first case of the Mimosis Acuta which I was enabled to distinguish, was that of Mr. M aged 25. — He had, as I understood, been treated for Fever, principally by the pulvis antimonialis, for several weeks. — He was, on my first visit, affected with tremor, debility, tendency to perspiration, and had suffered a considerable loss of flesh. The tongue Avas affected with large papillae, indented, and much loaded; the breath was extremely fcetid. The pulse Avas frequent. He cc^nplained of pain in the left hy- pochondre. — These complaints were soon removed by a course of gentle purgatives. — This patient was em- j)loyed in the sedentary occi^pation of the lace-frame. 45. Case IT. The second case occurred soon after the former, and was noted rather more particularly. — Mr. S, aged Sj, had been indisposed several weeks when I first saw him, and had left Nottingham for the country ; he had taken saline powders principally, and 1 therefore judge that his complaint had been deemed is.tion, &c. At first too, 3ie lost his flesh rather rapidly, to the amount^ as be supposes, of about 14lb. The countenance became palish and sallow, and he was told tlvat he had a Liver Comjplaint, The general weakness increased, and a degree of trembling was observed when he lifted Jhis cup of tea to his mouth, and when he attempted to walk or underwent any fatigue. — At present the pro- labifi are rather pale, the face near the nose is affected with an oily perspiration, the eye-lids are dark, and the general complexion is of a palish, sallow appear- ance. The albuginea is perfectly white. The tongue is white, loaded, and clammy. He perspires more than usual on any exertion. He has no headach or vertigo now, and has had no cough at any time. There is a sense of fluttering about the heart and stomach, especially on lying down. He says that he is low spirited, and does not like to be long alone or still. His appetite is still impaired 5 he complains of a sense of load at the stomach, with eructation, but he has no hiccough. The bowels are open. The jirine was at first much loaded, but it is less so now. Jle complains of shifting pains about the limbs.— Tiiese complaints have been nearly stationary lately. 3S THE MIMOSIS ACUTA. the progress they appeared to he making at first hav- ing been arrested. — The patient became gradually better, after the date of this report, by taking opening medicines, batliing, and using gentle exercise with a cliange of air. 50. Case VI. Mr. E. J. aged 28, a tailor. This patient has felt indisposed for a year or more, from recurrent pain of the head, and in the left Iiypochon- driac region ; with an irregular state of the bowels,—?- constipation alternating with diarrhoea, — -the stool's being extremely foetid, scanty and dark- coloured. — Five weeks ago he became more seriously indisposed and incapacitated for work, from faintishness, weak- ness, tremor, tendency to sweating, looseness of th6 bowels, a loaded state of the tongue, mouth, and breath, and dryness of the throat, but without any manifest loss of flesh. — At present the countenance appears rather bloated, dark in complexion, with a clammy oily moisture. The tongue, gums, and in- ternal mouth are considerably aiffected, and there is a degree of salivation, which has been observed for a month or two. The skin is cool, and there is a tend- ency to perspiration on any exertion of body or agi- tation of mind. He complains of weakness, trembling, and faintishness : and of sweating whenever he is sur- prised or hurried, which readily happens. liis sleep is sometimes disturbed by dreams. The appetite has always been tolerable. The bowels have generally DESCRIPTION, WITH CASES. 33 been lt)Ose, especially in the niglit, and the stools scanty; offensive, and dark-coloured. — The following is the patient's own account of his complaints : — ^ I have long had occasional pain m the head, and in the left side under the ribs ; my hands tremble very much when I have heen at work ; I feel faint and w^eak : 1 sweat much ; I have suffered much from purging du- ring the last four months, having sometimes had six or seven motions in the course of a night ; I suffer much from a sour and disagreeable taste in ray mouth, and experience dryness with phlegm in my throat, and a sensation of hairs on my tongue.' — This patient's complaints w^ere ascribed to a too assiduous attention to his sedentary business, w hich he w as induced to pay from feeling the pressure of a young and numerous fa.ivily. — He is already much better from employing, only for a short time, mild purgative medicines, gen- tle exercise, daily bathing in the Trent, and a light nutritious diet; but the cure is now less rapidly pro- gressivc than at first, a circunitetance very usual in this affection. 51. Case VII. This case i^ remarkable for the degree of tremor by which it was so long attended. E. W. a tailor, aged 36. August 3rd, 1819. He has been indisposed one year. During the heat of last summer, he became affected with pain of the head which was relieved by a spontaneous diarrhoea, and he lost his flesh and strength, and became affected with great tremor from which he has never recovered. 34 THE MIMOSIS ACUTA. He remained feeble, tremulous, and thiu, and sub- ject to vertigo, fluttering at the scrobiculus cordis, nervousness, impaired appetite, and tendency to con- stipation, — when 1 iirst saw him in February. The degree of tremor was very remarkable ; on being asked to write down his complaints, he gave me the following list ; — < weakness, trembling, being easily overcome, and made to perspire, and frequently fainty and fluttered ;' — the tongue was clammy and slightly indented, the bowels irregular — constipation alter- nating with diarrhoea. Rhubarb, sulphat of magnesia^ calcined magnesia, &c. were prescribed, and the coun- try air recommended. Under this procedure he gain- ed flesh and strength, and his general health improv- ed. He has, however, again experienced some of the priding symptoms since he returne'd to his sedenia- ry occupation. 5^. Case VIII. This case exemplifies the extraor- dinary degree of nervousness which sometimes attends this morbid afiection. I have given one reppit only, for the sak&of brevity ; the subsequent ones were only repetitions of the same symptoms w ith their usual va- riation,— Mi\ H. T. aged 2i. June 25tli, 1819. He states that he had been weak and low for some time, when seven w eeks ago, after reading the account of the assassination of Mr. Percival, he was taken with great alarm, and has since experienced the follow- ing complaints. — He has lost his colour, flesh, and strength. The countenance is palish, and inclined to I DESCRIPTION, WITH CASES. ^5 sallowness ; the prolabia are however of good colour. He thinks he has lost a stone of flesh. He breaks oat into perspiration on the slightest exertion ; the least thing induces alarm, hurry, trembling, fluttering about the heart, nervousness, &c. The tongue is rather white ; the breath feet id ; the mouth clammy und disagreeable. There are headach, heavy pain at the occiput, vertigo, loss of memory, fear of insanity, sleepiness ; oppression about the chest, with sighing breathing ; the pulse is nearly natural ; there was at first, loss of appetite, but this is now rather removed from taking opening medicine ; the bowels were cos- tive ; the urine is different at different times, being liigh-qoloured and pale alternately, and sometimes fcetid. 53. Having thus given a condensed view of seve- ral cases of the Mimosis Acuta, in both Jts forms, I shall now proceed to state the particulars of some other cases more in detail : — 54. Case IX. Mrs. K. aged 32. She was af- fected by a complaint similar to the one about to be described, two years ago. There were tremor, loss of flesh, and great frequency of the pulse. The affection was deemed incipient Phthisis by an eminent practi- tioner. The complaint receded, but returned in Au- gust, 18 17. The first symptoms then observed were a yellowness and darkness of complexion, inducing some apprehension of Jaundice ; loss of flesh ; weak- 36 THE MIMOSIS ACUTA. ness in walking ; a tendency to stooping in walking or sitting ; great tremulousness of the countenance in speaking, and of the hand when held out; tendency lo perspiration both during the night and day. Tliere were occasionally, and especially at first, violent head- achy and at other times, vertigo. Twice on going to bed, there was viok^nt palpitation of the heart, ren- dering the erect position necessary, and attended with coldness of the feet. The pulse varied from 120 to 130. The appetite was greater than natural. The bowels are said to have been regular. — This patient residinn: at a considerable distance from Notlin2;hara, a^id tlie nature of her complaint being unknown to me, 1 corresponded with Mr. K, and in order to as- certain whether a journey to Nottingham were really necessary, I begged that a register might be kept of the WEIGHT of the patient, from time to time. Of this register the follovi:ing is a copy ;-— On ^ivgust the ISth, 1817, ih^ -weJ^ht -ioas 106/*. On - - 25ih, .... 106^/6. A journey having been taken jit this time^ On September the Ist^tlia -.vei^ht teas - - IQSlb, On - . Sth, - - . . 105^^. On October - 6//i, .... 106/6. fThe patient having returned home, On ^'cn^ember Hie 3rd, the Tseightivaa - lOcJJb. On - - 7th^ .... lom. On . . 17 th, .... 98^/5. On . . 26/A, . , . . 96|/A. On December the 1st, - - - . 93i!l'. Oik . . 6/A, . . , - fJ2i/6. DESCRIPTION WITH CASES. ^7 At this period it was judged expedient that Mrs. K. should come to jSoUiugiiam. — The countenance then appeared thin, rather sallow, and with a dark ring round the eyes. The tongue was clean and moist, but lobulated, somewhat in the manner of some parts of the cerebellum. There was considerable tre- mor in speaking and in holding out the hand. There was manifest emaciation, btill some headach and vertigo. The pulse was about 130, sometimes even 140. Some days before there had been palpitation of the heart on going to bed. No cough. No shivering. The appetite was great. The bowels said to be reg- ular. — Mrs. K. was now recommended a course of purgative medicines. — The countenance gradually im- proved, both in flesh and colour ; the strength return- ed ; there was a greater capability of exertion ; the flesh was restored in the following manner : — 0« December the 15/A, the -weight ivas 94lb. On - " - 22d, - . - 06ib. The pulse was often as low as 114 and 116, but was easily accelerated. At this period Mrs. K. re- turned into Lincolnshire. During the week before January 16, 1818, she had gained two pounds. The amendment continued progressive, and in July the weight was stationary at 1061b. The pulse was nearly natural, and the tremor and debility had disappeared. The interval had been occupied in travelling. The use of the purgative medicines had been continued, jaA a little ale and a^ nutritive diet had been allowed. 38 THE MIMOSIS ACUTA. — The affection had been previously deemed "a JJis- ease of the Hearty and had been treated with the di- gitalis. 56. This case was thus so far modified in its differ- ent periods as to assume the characters of three differ- ent diseases, Phthisis, Icterus, and Disease of the Heart. It therefore affords an interesting illustration of the general character of this affection, and of the propriety of the denomination adopted for it. 57. Case X. Mr. D. S. aged 53. He was in- disposed nearly in the manner about to be described, in May, 18 17. The complaint had come on slowly and gradually. It was removed by pills composed of thp pil. hydrag. and rhubarb. — The affection returned, and made at first a slow, and afterwards a more rapid progress. In November last, he became incapable of supporting the fatigue of an easy occupation. About Christmas his complaint made serious advances, and I saw him again on January the 5th. On this day he was affected with an emaciated countenance, a tre- mulous state of the lips, a darkness of complexion, and a clammy perspiration on the cheeks near the nose. ^^he tongue was loaded, especially at the back part, with bright red papillse at the point, and redness of its sides, and it exhaled a halituous moisture ; the breath Avas extremely foetid. He was extremelf^ fee- Ule, almost incapable of walking, and affected with great and constant tremor, and with a sense of weari- DESCRIPTION, WITH CASES. ^ ^^ liess. There had been great loss of flesh : III Sep- tember he weighed 9st. 7lb. and on this day only 8st, lllb. There was great perspiration daring the night, but no febrile heat. The finger nails had assumed ii pale lilac hue. There was little headachy but great ver- tigo, and faintishness when upright. Kestless and sleepless nights. No cough. Frequently rapid, vio- lent, and|irregular paljntaiion of the heart, often with- out external exciting cause. The pulse was frequent and extremely irregular. There has been mucli hic- cough ; at a previous period this symptom had been violent, painful, and almost constant, during fifteen days. Twice there had been vomiting. The appetite was much impaired. The bowels were early laxa- tive ; but the stools were soanty, dark coloured, and. foetid — To this date, January 31, 1818, the symptoms gradually declined : — the countenance is improved^ the strength much restored, the tremor diminished, and he has this day walked a distance of three miles to Nottingha m ; the appetite is better, and the hic- cough has ceased. The stools are more natural in colour, but still offensive. The following is the re- gister of this patient's weight to this period : — In September^ 9s;. 7Jb. On January the 5th, 8s/. Wlb. On - - 12rA, - - Sst. 6lb. On - - 19//,, - 8st eib. On . - 26th, - Sst. 9lb. So that by the use of purgative medicines, the pro- gress of the emaciation has been successively dimi- 40 THE MIMOSIS ACUTA. nished and arrested, and a degree of flesh has heeri restored. February 23. It has been stated that on the day of the last report, the patient walked three miles ; the fatigue of this exertion was too great for his strength although much restored ; and from tliis cause, or from partaking greedily of celery, or from having neglect- ed his purgatives, he experienced a most serious re- lapse. — The ensuing week he lost 31b. in weight. He became affected with a constant and violent liiccoughy which continued night and day. There was a com- plete interruption to sleep and repose. The debility^ weariness, and tremor returned. The head was af- fected with vertigo. The pulse was extremely irre- gular. — The purgatives were repeated ; pills, con- taining opium and hyosciamus were prescribed ; and afterwards an enema with eighty drops of the tinctura opii. — During the second week, he again regained ^Ib, of flesh ; the hiccough ceased ; rest was procured ; and he again became renewed in strength. — This im- provement still continued, and on Fehmary the 16th, Jie roeighed 8«<. 6/^. . 23d, Sat. SW. March tlie 2d, 8st. m. . . . 9lh, Su. m. . 16th, 88t. 9lb. . 23d, . . 8s/. 12 1.21b . 30ih, 98t. Olb. June the' . 30th, . 9st. Alb. DESCRII*TI0N, WITH CASES. 41 It is remarkable however that this patient's im- provement in Hesh was not attended with a propor- tionate amendment in strength and general health. He still remained feeble and tremulous ; he complain- ed extremely of jpam, lameness, and wearineas in the loins^ arms, and legs ; he had once more a severe at- tack of hiccough, which was much relieved by taking white wine vinegar in doses of a teaspoonful.--He continued his opening medicine, which consisted prin- cipally of rhubarb, and he has all along ttaken ale. — The following is the patient's own list of his com- plaints during the course of his indisposition : — ^^ trembling, weakness, weariness, faintishness, loss of flesh, cold and greasy perspirations, sleepless nights pain of the head, dizziness, palpitation of the heart, hiccough, disagreeable breath, loss of appetite, a con- tinued lax, weakness and bearing-down of the bow- els, much pain and lameness of the limbs.'' July 27. This patient has lost 2lb. o^Jlesh during the last month ; 072 Juft/ the iSlhf he weighed . , 9.?/. 5/J. On . 27th, .... 9s.'. 2lb. Oa March WM, 1819, still . . 9i7. 21', but he states that he has gained strength notwith- standing, and that the muscles appear to be firmer on his limbs. The tremor is very much less. His lame- ness, principally in the shoulders, is much diminished and he has now no pain. The tongue is still loaded- #^ THE MIMOSrS ACUTA. The nights still restless. The bowels less loose. The' appetite improved. There has been no hiccough lately. There is still some degree of the sense of flut- tering about the heart, and the pulse is 84, and not quite regular.- "He considers himself better, and in- tends to resume his usual occupation in a few days, Eut he is evidently in a state of health altogether jxrecarioust August 31, My patient has continued to improve in appearance, strength, flesh, and general health, and there is now a hope of permanency in this amend- ment. He has continued to take rhubarb principally, with a little ale, and a nutritious diet ; he is enjoined daily exercise, bathing during the warm season, and sponging when it becomes cold. 58. Case XI. The last case which I shall detail in this place, will afford another instance of the ex- treme diversity in the history of this affection. ---Miss M. A. aged 19, employed at the tambour. Two years and a half ago she became affected with loss of flesh, great weakness, faintishness, palpitation, flut- tering about the heart, vertigo, headach, and general nervousness ; she was at the same time easily startled and. affected with agitation and trembling. Four years ago she was affected with Melcerta, aiid again two years and a half ago, together with the sympr^ tome just detailed. --She seemed to recover from these complaints and waiS in better health during the sum- DESCRIPTION WITH CASES. 43 mcr of 1817 . In October she again became affected with the symptoms of the Mimosis Acuta, and she had again melaena with the other symptoms. She "took the pil. hydrag. with rhubarb; and has never since had any discharge of blood. She recovered rapidly during several weeks. Her complaint then became stationary, and afterwards worse. She took to bed, and continued almost constantly in bed for twelve weeks. She continued her pills, and united the most nourishing diet she could obtain, with a little ale. A month ago she rose from her bed, and has since gradually improved in strength and some- what in flesh,-"At present the countenance is pale ; she is very feeble ; she however trembles less ; she has some appetite ; the bowels are kept open by pills of rhubarb ; the tongue is whitish ^he seems to be recovering, and complains most of vertigo and pain of the head, of fluttering, of occasional palpitation, of faintishness, weakness, &c»— Feb. 22, 1819. This pa- tient has gradually and imperceptibly recovered ; but still remains feeble, tremulous, at times, aiwl pale. The tongue is whitish, the bowels costive ; she com- plains of pain of the head and back ; two weeks ago she again parted with three-fourths of a teacupful of blood, and again ten days and a week ago, with pain in the bowels; without haemorrhoids.- -April ISth. She is still more recovered. ---May 3. She now looks very well, but complains of headach. 41: THE MIMOSIS ACUTA. aO. The extreme variety in the history, the form^ the course and the duration, of the Mimosis Acuta, will be sutTiciently evident from the cases thus detailed. The accession of this affection is usually slow and in- sidious, as before stated ; but it is now and then deve- loped, and apparently occasioned, by the occurrence of some other indisposition, or of an accident. . 60. It is a question of great interest, how far the original affection, the complications, and the changes, in this multifoim complaint, are to be viewed in the light of causes and of effects. But I dare not enter into this discussion at present. I shall only observe that this connexion seems often to be distinctly ob- servable ; and that the functional derangements have appeared, in some instances, to have undergone the changes denoted by the term metastasis, the affection of one organ having been nearly forgotten by the pa- tient, whilst the derangement of another has en- grossed his attention; in one case the patient had labourejl from symptoms of organic disease of the jieart for several years ; this was at length almost for- gotten, and his chief complaint w as an alarming de- gree -of vertigo. 61. The amendment from the employment of the course of gentle tonic purgatives to be noticed more particularly hereafter, is often rapid, and in cases of short duration, and especially in youth, the cure i$ scM)n effected ; but in cases of longer duration, when DESCRIPTION, WITH CASES. 45 the constitution lias suffered materially^ and when the age of the patient is more advanced^ the progress to- wards amendment is slow, and apt to he interrupted, — especially by errors in diet, imprudent exertions, and accidental agitations of mind. The severer form of the Mimosis Acuta is rapid in its course ; the less severe form may continue, or be protracted, for seve- ral years ; the two forms may pass into each other respectively ; and each may be variously complicated at different periods. 6S. Some of the accessory affections too, may as- sume the serious and alarming character of disease, especially those of the head, heart, lungs, liver, sto- mach, or bowels. 63. The chance of cure is in an inverse ratio to the age of the patient, to the previous duration of the complaint, and to its effect in undermining the gene- ral system, or in inducing local organic derangement. *? 64. In conclusion of the History of the Mimesis Acuta, I must regret my ignorance of the morbid anatomy of this affection. This subject Avill not_, however, be neglected if opportunities for dissection should be offered to me hereafter. Q^^I have noticed the Weight of patients affected with the Mimosis AcrxA. I intentl hereafter to pursue tliis subject in relation toCano?«ic Disorders and Diseases in general. The investigation would appear, a priori, to lead to some useful information relative to the Diagnosis and Prognosis. The result of this Uljestigation will be given in another work,— the Principles of Diagnosis. 4^ THE DIAGNOSIS. SECTIOX II. THE DIAGNOSIS. I. THE DIAGNOSIS OF THE GENERAL AFFECTION. 65. THE Mimesis Acuta, in its severer but sim- pler form, has, I think, been generally mistaken for Fever ; in its less severe form it is necessary to dis- tinguish this affection from ohscure and Insidious Organic Disease ; and in its complications, the Mimosis Acuta must be carefully discriminated from an original and local disease of the i>art symptomati- cally affected. 66. From every kind of Idiopathic Fever, with which the Mimosis Acuta agrees in apparently affect- ing the whole system or many organs at once, this affection may be distinguished by an attention to the History of the case, and to the particular con- currence OF symptoms. 67. From the Febris Brevis* the Mimosis Acuta differs entirely in its History ; but it is probable that the nature of these two affections is similar. The for- mer is quick or sudden in its accession, and of short duration 5 the latter is insidious and gradual in its • See the trcatfee on Diagnosis, Part II. § I. THE MIMOSIS ACUTA. 47 jformation, and of more or less considerable continu- ance. The mistake, however, may be made, if refer- ence be not had to this circumstance 5 for the general aspect of the patient, the countenance, the tongue, the. surface, and some of the symptoms, are very similar in both affections. 68. From the Febris Acuta* the Mimosis Acnta is at once distinguished by the absence of the suffusion and tumidity of the countenance, and of the heat, tumidity, softness, injection, and dryness of the gene- ral surface, so characteristic of that kind of Fever. In the Febris Acuta there is more urgency and acute- ness of complaint ; the patient is obliged to beialce himself to bed; the head is more, or more constantly affected ; and the breathing more anxious and hurried, whilst there is an absence of the symptoms detailed^ § 24. The History of the two affections is also very dissimilar, the Febris Acuta generally following some manifest exciting cause, and being formed quickly^ attd thus affording a striking contrast with the insidi- ous formation of the Mimosis Acuta. 69. From the Febris Lentaj the Mimosis Acuta^ is distinguished by an attention to the state of the countenance, of the general surface, and of the tongue ^ to the peculiar concurrence of symptoms ; and to the History of the affection. — In the Febris Lenta thfr countenance is often partially flushed, the surface be- • See the ti'eatise on Diagnosis, Part II. § 2. f Ibid. § 4'. 48 THE DIAGNOSIS. comes dry, with a burning heat, and the skin hat'sh and exfoliating, a state sufficiently contrasted with the cool and clammy condition of tlie countenance and general surfiice, and the tendency to perspiration, ob- served in the Mimosis Acuta ; in the Febris Lenta, the tongue is at first whitish, and afterwards clean, perhaps morbidly clean, red, smooth, and dry, whilst the breath is little tainted, a sufficient contrast to the state of the tongue in the Mimosis Acuta, § S8. In the Febris Lenta the patient suffers perhaps from vertigo, but there is little faintishness or fluttering, and, in general, no tendency to perspiration ; the patient is rather torpid than nervouii, and less alive to those cir- cumstances which are apt to induce so much hurry and agitation in the Mimosis Acuta, and the Fever is altogether a less multiform and multiplex aU'ection. The patient affected Avith the Febris Lenta perhaps sits up for a time ; then becomes gradually worse and obliged to remain in bed and in the horizontal posi- tion ; he is in this manner for a longer or shorter pe- riod in an inactive state, and at length as gradually recovers or sinks ; in the Mimosis Acuta the patient generally remains all along out of bed, or at least much longer than in the former case ; and the affec- tion changes and varies more in its severity and in its form, both in its beginning and decline. 70. The Febris Gravis* is distinguished from the Mimosis Acuta by Uie peculiar aspect and appear- * See tht trcatisg on DrAG:^osis, Fart II. ^§6, Tr THE DUGNOSIS. 49 ance of the patient; which are generally recognized by those who have noticed them with attention: — there is a look of great weakness and oppression, and the patient appears almost incapable of supporting or retaining the erect position, or of undergoing the slightest fatigue. The Febris Gravis is early attended with dulness, pain, or vertigo about the head, and with peculiar aching pains of the limbs and loins. There are sometimes burning heat and a degree of harshness, sometimes a cool moisture of the general surface. The tongue is at first loaded but generally soon becomes parched, dry, and cracked. The bowels are torpid. — The Febris Gravis is generally jprmed ra- pidly, and the patient usually betakes himself early to bed, — These circumstances sufficiently distinguish the Febris Gravis from the Mimosis Acuta. 71. I shall now proceed to draw the Diagnosis between the less severe form of the Mimosis Acuta and Insidious Organic Disease. In the first place the latter affection presents a complete contrast with the character of the Mimosis in general, stated § ^ j^ it is distinguished by its definite form, and by a regu- lar, slow, progressive, and almost unvaried course, during which the patient becomes gradually affected with paleness, debility, and emaciation, with compa- ratively little tremor — The countenance becomes pale and thin, with long and deep wrinkles, but generally semains free from tremor, except in phthisis pulma- ♦ See also the treatise on Diagitosis, Part II, § 1«^ G 50 THE MIMOSIS ACUTA. nalis, and it is peculiarly expressive of disease. The muscular strength becomes gradually much impaired ; but this loss of streugth differs from that observed in tiic Mimosis Acuta, in being less attended with the rcitfarkablc degree of tremor observed in the latter affection. The general surface is without the peculi- arity observed in the Mimosis Acuta, § 27. There is generally an absence of the headach or vertigo, the faintishness, the sense of fluttering, the nervousness, the tendency to cold perspiration, and of the complex- ity, observed in the Mimosis Acuta, §^ S4 — 84. The tongue, internal mouth, and breath are at first com- paratively little affected, but afterwards frequently become covered with aphthae. Tliere are chilliness, spontaneous chills, and flushes, and early- morning perspirations. — At length the emaciation becomes ex- treme ; the ankles become cedematous ; and anasarca, or ascites may supervene. 72. The reader will bear in mind, at the same time, the possibility of the transition of the Mimosis from the state of Disorder to that of Organic Disease, already adverted to, §. 38. • 73. Before I quit the subject of Insidious Organic Diseases, I shall digress somewhat from the proper object of this work, in order to call the reader's at- tention, in a particular manner, to the characteristics of a disease of this nature, the Diagnosis of which is not always, I think, established in practice ;— namely, THE DIAGNOSIS. oi the Strumous Affection of the Mesentery in Adults J — a subject which appears to me to have been, in some degree, neglected by practical writers. 74. This disease is particularly characterized by its very slow and insidious accession and progress ; by an unusual sensibility to cold 5 by a tendency to cold- ness and lividity in the nose and fingers ; by the absence of any affection of the head, or of flutteriug or palpitation of the heart ; by the continued good appetite and the copious, light-coloured, and foetid stools ; perhaps by a fixed tenderness, and perceptible tumor, in some part of the abdomen, which is not tumid generally ; — the tumor in the abdomen is not, however, always perceptible, nor are the alvine evac- uations at all times of the pale and fcetid kind above described. There are a peculiar appearance of the countenance, a peculiar mode of walking, and a pe- culiar attitude and manner in general, — the whole denoting great disease, and a serious state of emaci- ation and debility. — This affection is also character- ized by the circumstances detailed § 71? contrasted with §^ 2, 2% and by resisting the usual remedies of the Mimosis Acuta. 75. I think the Strumous Affection of the Mesen- tery in Adults by no means a rare affection. I have, within the last year and a half, seen it in the persons whose cases have been detailed,* in a young woman * First Edition, pp. 35 — il 52 THE MIMOSIS ACUTA. aged 31, in a young man aged 22, in a soldier aged 30, and in a lady aged 50. Some of the symptoms of Phthisis Pulmonalis are often superadded to those of Diseased Mesentery ; and this disease is often con- joined, in a greater or less degree, with Phthisis. — I intend to republish the cases which were inserted in the first edition of this work, together with some others which I have witnessed more recently, in and- ther place ; they will be contrasted with some cases of Insidious Inflammation of the Peritonaeum. 76. There is an Effect «f Drunkenness which resembles in many symptoms the severer form of the Mimosis Acuta ; and as it admits less readily of cure, it is important to distinguish the two aflPections. — In this Efi'ect of Drunkenness there are great weakness, tremor, and emaciation. The case is characterized by a peculiar state of countenance ; — there is emacia- tion ; the expression is much lost ; the eyes assume a peculiar streaked, yellow colour. The tongue and mouth are loaded, and perhaps dry, and there is a peculiar fcBtor of the breath. The manner of the pa- tient is dull, and often slovenly. There is a consider- able loss of flesh. There is often a total loss of appe- tite. The bowels are generally loose. There are, I think, fewer of the complications noticed § 34, than in the Mimosis Acuta. But there is more frequently organic disease. — Particular inquiry should therefore be made into the Habits of a patient affected with symptoms of the Mimosis Acuta. THE DIAGNOSIS. 53 77. This affection may be exemplified by the fol^ lowing Case : — Mr. S. C. aged 27- He had dmnk excessively of ale for 12 monshs, when he became affected six months ago with lowness, weakness, loss of flesh, fluttering at the heart, loss of appetite, with little affection of the digestion or bowels. He had also an early hoarseness of voice. These symptoms have continued and the loss of strength and flesh has progressively increased to the present time, — he for- merly weighed lOst. 12lbs, and now 8st. 13lbs. The countenance is very thin ; the tongue loaded at the back part 5 the voice hoarse ; pulse 88 ; not much tremor or nervousness. — He has gradually gained strength and flesh since he began a course of tonic purgatives, and relinquished his pernicious habit of drinking. Mf THE MIMOSIS ACUTA. II. THE COMPLICATIONS AND THEIR DIAGNOSIS. 78. It may be remarked that the complications Avith the Mimosis Acuta in its severe form are, in general, continued, until removed by remedies ; the complications with the less severe form of Mimosis Acuta, are recurrent in paroxysms, until the tendency ta the original disorder is overcome. The former cases sooner take on organic derangement than the latter, and are more immediately serious. 1. Of Affections of the Head. 5^&.''^The affections of the head which occur in con- junction with the Mimosis Acuta, sometimes assume an apoplectic and sometimes an epileptic character ; sometimes there is troublesome pain, or vertigo, or some affection of vision or of the hearing. 80. The Mimosis Acuta complicated with an Af- fection of the Head, is distinguished from an Idio- pathic Disease of the Head, by uniting the char- acters noticed §% 1, S, 24, et seqq. with symptoms of affection of the cncephalon, whilst the latter affection is denoted by its simple, definite, and regular charac- ter, and the absence of those affections. 81. There are two occurrences which ought ever to be present to the mind of the practitioner: — the THE DIAGNOSIS. 55 first is the tendency to the transition of a secondary^ into Organic Affection, which is particularly observ- ed with regard to the Head ; — the second, the possi- bility of the CO- existence of the Mimosis Acuta, and of Idiopathic Disease of the Head. 83. The transition of the secondary affection of the head in the Mimosis Acuta into an Organic Dis- ease, or the co-existence of the latter affection with the former, is to be apprehended on the occurrence of any of the following symptoms in a serious degree and continued form : — A sense of flushing or fulness about the head ; acute pain of the head ; unusual heaviness^ dull headach, or vertigo ; drowsiness, stupor, disturbed sleep, delirium, incubus, stertor ; forgetfulness, timi- dity, confusion of mind, change of affections, tenden- cy to laughter, or tears ; affection of the senses, as temporary loss of sight, flashes of light, double vision, singing or loud noises in the ears, intolerance of light, or sound, — tenderness of the scalp. Many of these symptoms, however, occur in the Mimosis Acuta. It is only when they exist in an eminent degree that they denote danger. But it is best to take an early alarm. The danger of organic affection of the head is less equivocal on the occurrence of an unusual distor-. tion, or an unmeaning expression, of the countenance ; of a defect in articulation ; of a temporary numbness or torpor, or of transient and partial weakness of any of the limbs ; especially if one side of the body alone be affected. The occurrence of stupor, convulsion. M THE MIMOSIS ACUTA. paralysis, or relaxation of the spiacters, leaves little to doubt respecting the existence of internal tlisease of the head. 83. The following melancholy instance of the com- bination of the Mimosis Acuta with an apoplectic Af^ fection of the Head; is particularly 'instructive :— 84. (Iase Xll. Mr. G. aged 33, had experienced symptoms of Mimosis, with a loaded state of the tongue, internal mouthy and breath, for several months ; he had been observed to complain much of the head, fre- quently applying the hand to the forehead, or laying the head on a table, and statins: that he suffered from severe pain. On visiting him he seemed to be affect- ed with symptoms of the febris brevis, but the His- tory agreed more with that of the Mimosis: — the countenance was moistened with a clammy or oily perspiration, the tongue and breath loaded ; he com- plained of dulness about the head, but made light of the affection. His complaints increased notwith- standing the use of very active purgatives ; on minute inquiry he had noticed a defect in vision, — the lines he w as reading sometimes disappearing as if covered by the finger ; he complained of tenderness of the scalp, of sensibility to the light, and he requested that his room might be darkened. Afterwards he was seized with stupor, the pupils dilated, and the pulse became slow — about 55 in the ^pinute. By bleeding blistering, purging, &c. these symptoms disappeared, THE DIAGNOSIS. 4>7 and recognition retarned. But in two days after- wards^ restlessness, delirium, with picking of the bed-clothes, followed by stupor, with ruttliug in the breathing apparently from phlegm in the fauces, came on during the night. The pulse was strong and full at six in the morning. But nothing was done for the patient. The pulse became gradually feeble, the countenance pale and sunk, the respiration labour- ed, with still greater ruttling. About half after ten, some remedies were resorted to, but too late, and in vain. The left side of the face, and the extremities of tjie left side became paralytic, and he expired about twenty-four hours after th.e second attack of stupor. Au examination of the encephalon was refused. 85. The following cases assumed in some degree, the epileptic form. 86. Case XIIE. Mr. E. aged 50, has been sub- ject to derangement of the digestive function for many years, — always increased by anxiety or fatigue, — and requiring a frequent recourse to rhubarb and peppermint water. About six years ago he began to be frequently obliged to leave the desk of the count- ing house, from experiencing confusion of the head. Five years ago, after having suffered during several days from sickness, lassitude, and vertigo, Mr. K. was taken suddenly in church with severe vertigo, fainti- ness, general perspiration, sickness and some vomit- ing :---he asked for a glass of water, rejected it from H 53 THE MIMOSrS ACUTA. the stomacli, and was then relieved, but remained feeble for the rest of the day. From this time Mr. E. experienced, with some of the symptoms just de- tailed, occasional attacks of singing in the ears and glimmering of the sight, but had no severe return of tlje affection until October, 1819, when he suddenly fell down ia the yard, as if he had been shot, — again, in the winter, when sitting near the fire, the feet start- ing upwards and the head falling on the arm of the chair,---and once more in May last. These attacks were anticipated from vertigo and lassitude, and were followed by sickness and perspiration, and for some days, by an unpleasant stupor. On the whole, the affection has increased in ih^ frequency of its returns during the last two years. Mr. E. mentions an over- whelming feeling on awaking which compels him to get up and not to venture ta sleep any more. Fa- tigue, anxiety, and attention of the mind have ap- peared to re-induce the feelings of this distressing complaint. — Leeches, cupping, and venaisection have lieen employed, but only with temporary relief. Re- lief of a more decided and permanent kind has resulted from a course of active purgative medicine, by which much dark and foetid faeces have been evacuated. The tongue and complexion were as usually observed in protracted cases of Mimosis. 87. Case XIV. The following account is given in the patient's own words. ^ The first time I expe- rienced this malady was about the age of 15. It THE DIAGNOSIS. 51) came on during the time I was endeavouring to recol- lect my usual repetition which I had learnt but imper- fectly ; I had been standing some time, and at length sank on the floor, but recovered in a lew minutes. --- These attacks were repeated at remote intervals until I was about 2i or 22, when they became more frequent. — At this time I w as engaged without intermission in the professional duties of an attorney, and was natural- ly of a sedentery disposition, even in my amusements. — I was about this time and previous to it, subject to an almost constant pain in my head and eyes, and occa- sionally to lassitude and w^ant of energy. — I took but little exercise, lived very moderately, but ate heartily. About this time 1 applied to Dr. S. I adhered to his medicine for some time and found myself much bene- fited by it. — I have since that time been attacked more rarely, and during the time I pursued the reme- dies prescribed by you, I do not recollect having any return of the complaints. My general health has been much improved by the medicine which I have taken whenever I found the state of my bowels re- <]uired it. — I had flattered myself tliat 1 should not be again subject to these attacks, but on Wednesday last I experienced another instance of them. 1 had been spending about a week in the country, and living ra- ther more generously than usual, viz. by taking ham or meat with my breakfast, and four or five glasses of ivine after dinner, with meat suppers &c. — On Wed- nesday afternoon I had been standing a considerable ilme exposed to a cold wind, taking sketches of the 60 THE MIMOSIS ACUTA. cliurch, and felt much chilled by it. — In the evening "we had a party of friends and I sang to them for an hour or two until I was rather fatigued. — About 11 o^clock at night, after a supper of fruit pie, the attack came on in the usual way, by an involuntary train of ideas presenting themselves to my mind, which pro- duced a sickening^ effect upon me, accompanied at the same time by a sort of fascination which led me al- most irresistibly to pursue the train of ideas, whieli at the same time I knew would occasion me to faint, — ^I say almost irresistibly, because I have sometimes checked this train, and by rousing myself, prevented the actual faiuting from taking place. — I never can completely recall the train of ideas, and on my en- deavouring to do so, I feel a tendency to a repeti- tion of the attack. — My first sensation on recovering sensibility is an anxious wish to pursue the dream, through curiosity to see the event of it: this is suc- ceeded- instantly by a consciousness of my situation and an anxiety to convince my friends that I have quite recovered from the effects of the attack. I feel a wish for a little cold water and my face is covered by a cold perspiration ; an inclination to lie down and sleep succeeds and in a few minutes I am quite restored. — Previously to the attack on Wednesday I felt a drowsiness and an unusual propensity to gape and stretch my limbs several times. — On my recovery I haf! for several minutes a singing in the back of my head, like the noise of a boiling teakettle, or rather like the gradual escape of fixed air from a bottle when THE DIAGNOSIS. • 6 1 the cork has been gently loosened.---! went to bed soon afterwards and took one of your powders and some peppermint water. I had a good deal of unea- siness at my stomach and bowels and a dislike to the usual pressure of my clothes upon them, which I attributed to flatulency. My feet w ere very cold and I Avas very drowsy. — The medicine operated in the morning and I was tolerably well, but my bowels have not yet recovered their healthy state. — I have no doubt that these attacks proceed from a disordered state of my stomach as they are generally preceded by costi^veness and lieadach.— June 3rd, 1820.' 88. Case XV. Mr. W. of S. aged 32. This young man had been, for some time, affected with confused pain of the head, vertigo, &c. One day he was taken suddenly, fell down on the ground, and lay in a state of insensibility for some time. He recovered, but remains subject to pain, confusion of the head, verti- go, and tendency to fall down. He has become weak, nervous, dispirited, inert, and incapable of business. The tongue is swollen, loaded, indented, and pasty, with deep folds on its surface. The breath exceed- ingly foetid. The countenance has a diffused appear- ance of oiliness and gentle flushing. The stomach and bowels are much disordered. — In this case it was dubious, at first, whether the affection arose merely from disorder of the digestive organs, or was an idio- pathic disease of the head. The state of the tongue^ breath, digestive organs, mind, &c. seemed to indi- 6» • THE MIMOSIS ACUTA. cate a symptomatic affection of the Head, and such the History seems to have proved it ; for the latter symptoms have increased materially since the first time I saw this patient, and the affection has assumed the form of hypochondriasis. 89. The following Cases illustrate some other affections of the head which arise from a state of Mimosis. 90. Case XVI. Mrs. M. October 5, 1818. On being called at 5 p. m. to this patient I found her affected with insensibility and delirium ; pain about the umbilicus ; hurry and rapidity of breathing and a feeling of want of breath with fluttering ; the pulse was 130 ; the countenance rather pale and cool ; she appeared to the byestanders to be faint ; the tongue rather dry. The appearance of this affection was alarming ; more than once she was supposed to be expiring. Five grains of calomel were given ; a suppository of inspissated molasses was introduced into the rectum. They were long in operating but at length produced complete relief. 91. Case XVIL C. H. aged 21. He complains of severe recurrent pain of the head especially of the forehead, with great noise in the head. The tongue is Very loaded, white, and indented. The bowels are costive. He is subject to these complaints and is a THE DIAGNOSIS. 6^ frainework-knitter. — He was relieved by taking two emetics and a course of purgative medicines. 9S. Case XVIII. Mr. B. aged 40. June 8, 1819. He is subject to disorder of the stomach. A few days ago^ on taking cold, this disorder was, as usual, aggravated, and he was aifected with severe pain of the head and of the right side over the false ribs. The skin was moist, and clammy, and the tongue extremely loaded. All these complaints were removed by emetic and purgative medicines in the' course of five days, and he is now free from acute complaint. There was a little eruption of herpes on the lip. 93. In one gentleman there was a state of mind approaching to mental derangement ; in a lady there was an attack of affection of the head with 4^ loss of memory, — apparently the effects of a state of Mimosis. 94. There are few diseases which it is more impor- tant and more difficult to recognize early, than a state of Idiopathic Inflammation or Organic Disease of the Brain.* The Diagnosis is partly negative. For the first question is. Is there a state of Fever, of Mimosis^ or of other Disorder, which may account for the symp- toms of cerebral affection ? If not, there is greater * See Sir G. Blane's paper, in the Trans, of a Soc. for the Imp. of Med. and Surg:. Knowledge, V. 2. p. giO; Abernetliy, V. 1. pp. 202, 106; Bateman's Re- ports; passim ; &c. 64 THE JNllMOSIS ACUTA. apprehension of Idiopathic Disease of the Head, in which there is usually an ahsence of the symptoms oi' Idiopathic, as distinguished from Symptomatic Fe- ver,* and of the symptoms of Mimosis ; — except in the cAses of complication. 2. Of Jffeciions of the Chest. . 93. The affections of the chest which occur ia consequence of a state of Mimosis, are, principally* oppressive dyspnoea resembling Asthma, and coui^h ivith expectoration resembling Phthisis Pulmonalis. 96. The complication of the Mimosis Acuta, with Paroxysms of Oppressive Dyspnoea, resembles Asth- ma in a very high degree. And it is not improbable that xV|^hma properly so called, frequently, if not generally, originates in a complication of this nature^ but is afterwards continued, or repeated, either from a degree of disorganization induced in the heart or lungs, from the influence of the external causes of Asthma, or from the causes of Mimosis. The follow- ing cases sufficiently exemplify the complication al- luded to : — ♦ 97. Case XIX. D. M. aged SO, a tailor. Au- gust 30, 1813. He has complained of pain and other * See tho treatise on Diagnosis, Part II, §§ 1,2, 4, 6, 7, contfastec* with §> ^■', 5, S ; and Midi §§ 107, 108. / THE DIAGNOSIS. 65 affection of the chest for eight or tea days ; but he has been affected, for a much longer period, with vomiting, pyrosis, a loaded state of the breath, mouth, and tongue, constipation of the bowels, &c. Three days ago he was bled, from the idea that the affec- tion was a case of pneumonia. — ^^I was called to him last night : — The breath was extremely foetid, the tongue loaded, the bowels constipated He was af- fected with a paroxysm of urgent dyspnoea, complain- ed of want of air, and said he was dying; the dys- pnoea had begun an hour before, and had become gradually more and more urgent ; there was great anx- iety; the rrfftpiration was very rapid, and seemed a literal gasp for breath. He had also a cough, attend- ed with a dull, hollow, peculiar sound, and with a copious, frothy, mucous expectoration. The pulse was about 100, without sharpness. He was some- what relieved by taking a few drops of aether, and effectually by the operation of a purgative of calomel and jalap. 98. Case XX. The Rev. Mr. A. aged 34. He has long been subject to a state of Mimosis Acuta in its less severe and more continued form, marked by a variable degree of sallowness of the complexion, loaded tongue, foetid breath, and foulness of the mouth in general, without any observable loss of flesh, He is easily hurried by surprise, and fluttered ; his complaints are then aggravated, and accompanied by nervousness and tremor. The same effects are in- 66 THE MIMOSIS ACUTA. (luced hj any uuasual mental or.bodilj exertion.— This gentleman is subject, at tliese times, to a heavy and dull, or to a more acute pain of the occiput, for which cupping has been deemed necessary. The pain has sometimes been relieved by the horizontal posture, and sometimes it has been excited by an empty state of the stomach. ---In other attacks the pain af the occi- put has been absent, and the patient has been affected with dyspnoea, attended with restlessness, a sense of want of air, a necessity for being fanned, &c. The paroxysm has generally taken place about 1 a. m. It has been relieved by coffee. It has usually suc- ceeded to an increase of the state of diiorder consti- tuting Mimosis, and lias been obviated by correcting that state. It has recurred at distant intervals for several years. Formerly the dyspnoBa was attended M'ith cough, but not lately. A degree of oppression has generally been experienced during the day suc- ceeding the paroxysm,* 99. The complication of the Mimosis Acuta with Cough and Expectoration is still more common, espe- cially in protracted cases of this affection, both in its severer and less severe forms. This complication re- quires to be accurately and early distinguished from Phthisis Pulmonalis, or to be accurately traced into a similar state of affection of the general system and of the pulmonary organs. * See further the treatise on Diagsosis^ Part II, pp. 206— to 209, for the Diag- Bosties of Asthma. THE DIAGNOSIS. 67 100, The discrimination is again to be begun hy contrasting the ciiaraetcr of the Mimosis Acuta^ given §§ 2, 24, et seqq. with the general character of Phthisis Pulmonalis, Avhich is very dissimilar, and almost opposite to that of the former affection. Phthi- sis Pulmonalis is simple and definite, in its character ; in general little varied, but rather continually pro- gressive, in its course ; — although this observation has some exceptions; it is comparatively free from the tremor, fluttering, susceptibility to hurry, and general nervousness, observed in the Mimosis Acuta, § 24i ; there is an early loss of flesh, a symptom which ranks amongst the first which arrest attention ; thero is also an early weakness, but this is different from the weakness attending the Mimosis Acuta, being less attended by tremor, faintishness, kc. and the de- gree of remaining muscular strength is even rcmarka-. hie in the latter stage of Phthisis Pulmonalis.* 101. The countenance in Phthisis Pulmonalis early assumes a peculiar and delicate paleness, but is liable to occasional, or spontaneous, gentle blushes. Tliere is often an early movement of the nostrils, induced by the alternate act of respiration, affording one of the earliest diagnostic signs of Phthisis. The hands and general surface are pale and delicate, the roots of the nails frequently rather livid. And there is a charac- * For the Diagnostics of Plithisis Pulmonalis from other diseases which reseioe hie it, sec the late m ork of M. Bayie, Armstrong on Scarlet Fever, &c. RcH's Surgical Reports, Vol. 1, pp. 18, 21 ; and the treatise ou Uxagxosis, Part II, pp. 109-.172, 1S9— 196. 68 THE MIMOSIS ACUTA. Icristlc, irregular, alternation of chilliness, fcverisfej 41CSS, and perspiration. There is an obvious labour in respiration, which is aggravated on going up stairs or using active exertion ; a full inspiration, however, docs not always occasion inconvenience. The cough is slight and tickling at first, perhaps without vio- lence, and is less early attended with expectoration. The pulse is permanently frequent, 10;3. The complication of cough and expectoration may take place in either the more or the less severe form of the Mimosis Acuta, but I think the latter case is the more frequent. — In the severer form of Mimosis Acuta there is sometimes an evident labour in breath- ing which induces a movement and contraction of the nostrils, and there is a degree of cough with the expec- toration of a little viscid mucus. — In the less severe form of this affection there is often, for a considerable period, a copious expectoration of transparent, frothy, and viscid, and, at length, of opaque, and tinged mu- cus. There is a cough, hard-sounding at first, and occurring in fits ; afterwards easier and less in fits as the expectoration assumes more of the puriform ap- pearance 5 and again difficult and in painful fits as the strength of the patient declines. l*he pulse is at first little accelerated ; the respiration little affected, and the nostrils unmoved ; but a degree of movement of the nostrils, of labour in the respiration, and of fre- quency of the pulse, is observed as the expectoration becomes puriform, and streaked with blood, and as 1 THE DIAGNOSIS. ) 69. disease of structure is induced in the luugs. The usual symptoms of the less severe form of tlie Mimosis Acuta are superadded ; — the skin is usually is already described, but sometimes harsh and dry ; tlie tongue is sometimes furred and black at the back part ; and emaciation takes place in a degree commojisurate with the diseased affection of the lungs. The History of the case is peculiar, — the affection is perhaps cured by proper remedies, or becomes stationary and miti- gated for a time, perhaps an apparent or decided amendment occurs even during several weeks, and again the disease proceeds, — so that the physician is alternately elated with hopes and depressed with fears, — circumstances scarcely observed in Phthisis Pulmonalis. 103. Case XXI. The following case presents an eminent example of this last remark relative to the course of the complication of the Mimosis Acuta with cough and expectoration, when the affection termin- ates fatally. Mr. N. aged 39, had long been affected with a loaded state of the tongue, swelling of the gums, fcetor of the breath and other symptoms of the Mimosis Acuta, when he became seized with symptoms of ai inflammatory affection of the chest, which were re- moved by bleeding, and blisters, conjoined with purga- tive medicines. He seemed to get better of the imme- diate inflammatory complaint of the chest, but Ihe looked -for restoration of iK^alth and strength did not ensue, but seemed delayed week after week, without, 76 THE MIMOSIS ACUTA. however, my retrograde change. He recovered, in- deed, a little, and was removed to a short distance into the country. Here a manifest amendment hi point of strength occurred and continued during two or three weeks. But this amendment did not proceed. He be- came stationary once more, and continued in a dubious way for a week or two longer. He then appeared dis- tinctly to lose strength, and for the first time since his recovery was looked for, there was a sensible loss of iMkt ^-Thus five weeks transpired from the abatement of the inflammatory symptoms to the period of the pa- tient^s going into the country, and seven weeks more passed between hopes and fears during his stay from ^Nottingham. — Durmgthe course of this complaint the countenance was affected with an oily perspiration and a sallow or swarthy complexion, with paleness of the prolabia. The mouth, tongue and breath were foul and loaded. The hands and nails pale. There was a most remarkable degree of tremor, which seem- ed particularly to impede the voluntary motions. I' here was at first scarcely any dyspnoea or movement cf the uostrils ; but both these symptoms were observ- el as the affection of the lungs was supposed to pass into organic derangement. There was at iirst a hard coigh, with rather viscid, mucous expectoration, in. cieased when the stomach was empty ; afterwards the expectoration was greater in quantity, more viscid and opaque, and considerably tinged with blood The pulse very frequent. The bowels were kept open by medicine. Tlie appetite was tolerably good. — The THE DIAGNOSIS, 7-1 patient survived nearly three months afier this report, the affection of the lungs becoming inorfr and more coalirmed, the flesh being completely lost, and the strength exhausted. The cough was jometimes less severe; the expectoration variable in quantity, but free from the tinge of blood ; the pulse less frequent ; the bowels sometimes affected with diarrhoea. — An examination of the chest was refused. 104. Case XXIL In another case there were conr siderable loss of flesh and strength, a frequent pulse, much cough with copious, mucous expectoration, and a loaded state of the tongue and breath; with som© other symptoms of the Mimosis Acuta. The affection yielded very favourably to the operatioQ of mild pur- gative medicines conjoined with small doses of opium. 105. Case XXIU. In a third case there were all the symptoms of the severer form of the Mimosis Acuta, together with a slight cough, expectoration of phlegm, and a manifest difficulty in respiration, with movement of the nostrils. The affection yielded most favourably, and the healthy strength, and flesh return-^ ed, by the use of purgative medicines, with a nutri- tious diet, gentle exercise, and the country air.* * See Abernetby, V. l- p. 207; Dr. W. Philip, Med. Cixir. Trans. V. 7. pp. 499, &«. ^% THE MIMOSIS ACUTA. 3. Of Jffections of the Heart. 106. The Sections of the heart which occur in consequence of the Mimosis Acuta, arc fluttering, jpalpitatioriy irregilar action^ and syncope more or less perfect. 107. Fluttering and Palpitation of the Heart, are amongst the most frequent symptoms of the Mimo- sis Acuta ; it is, therefore, scarcely necessary, especial- ly after the detail of Cases IX and X,' to o5er any exemplification of this complication. I shall, how- ever, make a few observations which may conduce to the establishment of a correct Diagnosis. — In the se- verer case of Mimosis Acuta, it will he necessary to wait, and to watch the effect of the remedies in re- moving this disorder ; the palpitation of the heart, if a consequence and effect merely, will be mitigated or removed with the original affection.— In the less severe form of this complaint, the discrimination must he principally founded on a cautious observation of the effect of bodily exercise on the action of the heart when the symptom of palpitation is otherwise abisent, and when the patient is least indisposed, — and on the continued History of the complaint. In Disease of THE Heart the patient often emphatically observes, ^ I should be well if I vegetated only ; it is bodily ex- ertion and mental agitation, which renew and recall the sense of mv dreadful disease.' In the roraplica- THE DIAGNOSIS. ^3 fion of Mimosis with palpitation, the patient, if not prevented by weakness, can, at the time when the liurried movement of the heart is absent, run pretty rapidly, or walk up stairs, without suffering more than is usual ; and periods occur when he has passed several days, weeks, or months, perhaps, without ex- periencing the palpitation. In a disease of the heart, these circumstances are not, I think, observed ; the uneasy sensations which accompany this disease, if absent at times, are always excited on any corporeal exertion ; and, as I have elsewhere observed, disease of this organ is in general highly characterized, and distinguished from certain symptomatic disorders of its functions, by the permanency, of the affection ; by its invariable aggravation on muscular exertion, as well as mental emotion ; and by the particular relipf obtained at first from bloodletting. — Disease of the Heart, although its symptoms may be mitigated at one period and aggravated at another, is however permanent ; the symptoms are never entirely absent ; and they may at any time be renewed, in an aggra- vated form, by muscular exertion. In dubious cases the patient maybe made to 7'un up stairs ; — ^the symp- toms of an organic disease of the heart are invari- ably aggravated by this muscular exertion, the puis- ation of the heart becoming violent, the pulse perhaps irregular, the respiration exceedingly difficult, &c. circumstances not equally observed in symptomatic derangements of the functions of this organ, unless when they are attended with great debility, TUere K 74 THE MIMOSIS ACUTA. i§ almost always^ too, great but transitory relief froist bloodletting — in a degree not observed in the symp- tomatic affections.* 108 Case XXIV. Dr. D. aged about 70. He became affected witli the following symptoms : — loss of flesh, weakness, tremor, tendency to tears, a load- ed state of tlie tongue, mouth, and breath, and disor- der of the bowels with scanty stools ; w^ith these affec- tions there were symptoms which led to the idea of Angina Pectoris, or of Dropsy of the Pericardium. — From the use of gentle rhubarb purgatives, with ex- ercise in the open air, the patient gradually recovered a considerable degree of strength, tlie general health improved, and he has run up a high stair case, with considerable activity, and without feeling any of his former uneasy sensations about the heart. This amendment has now continued at least a year and a half. 109. Case XXV. Capt. B. aged 50, was sup- posed to labour under an Organic Affection of the Heart, induoing palpitation and great irregularity of the pulse, for many years. It has been nearly forgot- ten for some months, and he has suffered exceedingly from attacks of vertigo. The complexion is sallow ; the tongue swollen, lobulated, indented, and loaded ; the breath tainted ; the appetite good ; the digestion * Sec the treatise on Diagxosis, Part II, § 157. THE DrAGNOSIS. ;-' *eftea impaired; and the bowels constipated. His complaints are all mitigated by a course of purgative medicines in which he still perseveres. 110. Case XXVI. Mr. D. of L. C aged 34, a farmer and grazier. February 4, 1819. Hix weeks ago, soon after lying down in bed, he became suddenly affected with an indescribable sensation as of approach- ing dissolution ; he got out of bed^ took some warm negus, and began to eructate copiously ; — he had pre- viously complained of vertigo, — once of pain at the stomach ascribed to wind, — and several times he had asked for aloes from being constipated. Soon after taking tlie negus, palpitation of the heart took place,, and increased to a considerable degree of violence. Since that time he has had three other violent attacks of palpitation ; — the second five days after the first, and like it, almost five minutes after lying down in bed ; the third a week after the second, at night, but before he was gone to bed. Since ihese periods he lias also had palpitation, but in a less severe degree. About twenty days ago, he became affected with flut-. tering, referred to the scrobiculus cordis, and lower in the abdomen. At different times he has had the following symptoms : — pain at the stomach, vertigo, pain at the back of the head, restlessness, want of sleep, with starting, twitching, dreaming, alarm, and des- pondency, — and fear of immediate dissolution ; some tremor, and several times wheezing breathing; he lias felt overcome with sleep, which has induced pain \^ 76 THE MIMOSIS ACUTA; of the heart and palpitation, and a feeling as if the heart would burst. — A fortni^^ht ago the skin was dry^ the tongue much loaded and swollen, the bowels con- stipated, with flatus in the bowels, the motions being very offensive and dark coloured, and the water high coloured and once or twice with much sediment. The appetite ha* been good all along. There is consider- able loss of flesh — The tongue is now clean ; the flesh regained, and he is better in every respect. He sleeps still but little. A short time after this report this patient became affected with difficulty of urine. He afterwards became subject to dyspepsia for several months in its ordinary form, but at length recovered completely. in. Case XXVIT. Mr. W. aged 48, from sit- ing in an overheated counting-house, and subsequent exposure to cold, became affected by the following symptoms : — The countenance was rather flushed, but at the same time rather cold and clammy. The tongue was white, loaded, indented, and swollen. He experienced faintishness when upright, and could not bear to approach the fire. Little headach or vertigo. The pulse was rather frequent, and remarkably irreg- ular and intermittent. There was no appetite. These symptoms gradually declined on taking an emetic followed by ^ dose of calomel, and other purgatives. The affection continued about eight days. The tongue got gradually clean from the edges to the centre ; the pulse gradually regular and of natural frequency 5 / THE DIAGNOSIS. 77 the appetite better ; and the patient could in a few days bear the upright posture and being near the fire. January 15, 1819. 113. The cases detailed, §§ 86, 87, seem to have been attended by fainting, as well as the singular affec- tion of the head described. Indeed all these cases are complicated in an eminent degree, and all appear to me to establish the propriety and the importance, in. a practical point of view, of the denomination I have appropriated to them. The following case is however still more particularly a case of fainting ; it is one which 1 have carefully watched ; 1 give it in the pa- tient's own words : — 113. Case XXVIII. Mr. R. H. aged 64. "I have long been subject to a sort of fainting fit, which attacks me very suddenly and affects me in an extra- ordinary manner. 1 suddenly appear to myself to be at the point of death, and to have lost every faculty. I have sometimes completely fainted for a few minutes, and have occasionally vomited ; 1 then experience a sense as of a stick pressing violently upon the funda- ment. On recovering, a copious perspiration bedews my forehead, and I am extremely pale, and feeble. About seven years ago Dr. H. suggested to me that the whole of these complaints- arose from a disordered state of my bowels, and that, by a continual recourse to mild purgatives, they might be prevented. This opinion I have found to be true, having experienced 78 THE MIMOSIS ACUTA. complete relief by following that prescription/^ To this account of the patient's sensations I add the fol- lowing one of the appearances in an attack which I witnessed. He was taken on the evening of the 9th of January, 1819, with a sense of hunger succeeded by severe pain of the stomach ; when I saw him, the countenance was pale, cold and clammy ; the feet cold ; the pulse feeble and intermittent ; the pain much increased. I gave him a dose of ol ricini, and a glass of hot brandy and water. He was soon relieved, and perfectly so on the operation of the medicine.* 4. Of Affections of the Stomach and Bowels. 114. The affections of the Stomach and Bowels in the Mimosis Acuta, besides those comprised in the more general disorder, are numerous. They are chief- ly the following : hiccough, hcematemesis, melcena^ and pain in differerent parts of the tract of the ali- mentary canal, assuming the different characters about to be described. 115. The complication of Mimosis with Hiccough, § 34, has been sufficiently noticed in Case X. But as this symptom is sometimes extremely severe, and as vomiting of food is sometimes superadded in an extraordinary degree, I think it proper to detail a case or two of this affection. • See Bell's Anatomy, V. II, p. 240; Abefnethy, V. I. p. 212; Farre's Patlt, Researches, Ess. I, p. 46, &c. THE DIAGNOSIS. 79 116. Case XXIX. The first case is an instance of violent Hiccough, Mr. C. aged about 50, of Slea- ford, Lincolnshire, after feeling chilly and weak, a& he supposes, from cold, first experienced Hiccough on December the 18th, 1817, at 5 p. m. It was re- moved about 11 p, m. by a little gin and water. It returned on the 19th at 5 a. m. ; it was removed for half an hour by a little rum, but recurred and con- tinued witli little interruption through the day. On the SOth, the Hiccough was arrested for a little time by laudanum and musk, but it again returned. On the Slst, a blister was applied over the stomach, but the Hiccough continued, and was accompanied on this day by a singular sort of crowing noise during inspiration. On the SSnd, snuff was recommended, which arrested the Hiccough for a short time. The affection, however, continued in a violent form through the night. On the 23d, an emetic was given, and six leeches and a blister were applied ; the Hiccough ceased for a time, but recurred with the crowing and continued during the night, preventing the patient from lying in bed. The life of the patient was thought to be in imminent danger. The affection still contin- ued on the S8th, when I recommended purgative doses of calomel and infus. sennse, from the first ope- ration of which the Hiccough entirely ceased with the exception of a slight return once more on the S9th. The purgative was continued for some time, by means of which a loaded state of the tongue and of the bow- els was removed. I should have also stated that a 80 THE MIMOSIS ACUTA. little opium and carbonate of ammonia were given ^ but to these remedies 1 did not ascribe much effect. 117. Case XXX. Mr. G. C. aged S6. Septem- ber 6th, 18 17. This patient had an attack similar to that about to be described, eight years ago ; it contin- cd several weeks. The present attack commenced in March last, and has continued in a more or less {severe form, since that period. After eating he be- comes affected with chilliness, pain at the stomach, nausea, and tumidity of the abdomen ; he is then sud- denly affected with vomiting, and the rejection of much mucus, or there are eructation, retching, and vomiting. He remains poorly for about an hour, during which period there is some pain. lie then pursues his usual occupation. His complaint sgain recurs on eatins:- He is feeble and has lost some de- gree of flesh. The pulse is about 80, and rather fee- ble. The tongue is white and loaded. The bowels constipated. The hands are apt to become cold. — The affection yielded to the remedies to be noticed hereafter. 118. Case XXXI. Mr. B. A. aged S4. He was affected in the following manner about six months ago ; the attack was less severe than the present, and continued one month ; the affection then ceased, but it returned ten days ago. At present, September 9th, I8I7, he becomes affected with vomiting and retch- ing after eating: with these symptoms hiccough is THE DIAGNOSIS. Bi sometimes conjoined, and this is occasionally of the most violent kind, affecting him like a spasui^ draw- ing the body awry, and sometimes throwing him off his chair ; he suffers such excruciating pain as to in- duce a flow of tears ; and the breathing is irregular, rapid, and anxious. The tongue is loaded ; the bow- els costive. The pulse is nearly natural, 'i here are weakness and some loss of flesh. — This affection was removed by the remedies to be noticed hereafter. It recurred after a time and again yielded to medicine. The patient became attacked by a spiisniodic affection of the left arm, so as to deprive him of the use of the hand. 1 his affection yielded to the same purgative remedies, and has since remained well. 119. Case XXXIL Mr. J. R. aged 31.— He i^ naturally thin and feeble. He is at present affected with vomiting after meals, without hiccough. The pulse is natural. The tongue white. The bowels costive. — The affection yielded to the purgative rem- edies. 120. This affection must be carefully distinguish- ed from Organic Disease of the Stomach. Its History, — its cessation for a period and subsequent recurrence^ — its violence even at the beginning, — itii spasmodic character, &c. are sufficiently contrasted with the slow formation and insidious progress, the continued form, the regularly progressive course, and the unceasing character of organic disease. It is fur- H2, THE MlMOSl^ ACUTA. ilier distinguished by some of the symptoms of the Mimosis Acuta; — even the hiccough is, I think, a rave occurrence in the organic affection, which is ra- ther denoted by pain, which gradually increases after eating until the stomach is unloaded by vomiting.* IS I. Mel.ena, ^ 34, is an affection of much more frequent occurrence than is generally imagined. Its existence is, of course, only ascertained by accident. But I have found, on inquiry, that it lias occurred in a great number of the cases of Mimosis Acuta whicli I have treated. It occurs also in the other forms of Mimosis to be descriljed hereafter. It has been a very frequent occurrence during the present summer of 1818. AVith Melsena, H.iiMATEMEsis is not un- frequcutly combined. The two cliseasess appear to be similar affections of different parts of the alimentary canal. The discharge of blood varies greatly in quan- tity and appearance. It yields in general to the employment of purgative medicines, with the pil. hydrarg. See Cases III. & XI. In several cases the patient has awoke in the morning with blood in the mouth. 122. lyiave enumeratetl^ as the next complication of Mimosis Acuta, Pain in the Epigastric, or in one of the Hypochondriac, or Chondiliac Hegions, § 34. This pain is so common that I think few cases of the Mimosis occur without some degree af it. There are • See fintUer the treatise on Diagnosis, Part II, §§ ISr, 188. THE DIAGNOSIS. 83 sometimes all the symptoms of an attack of Gall Stones. Sometimes there is severe pain extendiiiii; across the false ribs, leading to the suspicion of In- flammation OF THE Pleura, or, together Avitli the affection of the complexion, it leads to the sus- picion of Inflammation or Disease of the Liv- er. And its situation sometimes induces an opinion that the Spleen is affected. It is distinguished by being liable to recede and to recur, by varying its situation, frequently by being unattended by tender- ness on pressure when the examination is made witli proper care, and by conjoining the characters, §§ ^, 21, et seqq.^ — This pain has appeared to me to havt its seat in the Colon, some part of whose c^our^ it occupies, § 30, — from the hollow of one ilium round to that of the other. — Pain, tenderness, and even tu- mor, frequently exist in the course of this intestine from the remora of scybalai ; the case is perhaps con- sidered to be an instance of organic enlargement of some viscus in this course ; the cause being removed by thejaction of aperient medicines and by friction^ the tumor is supposed to be discussed by the pil. and the ung. hydrarg. — Pain in some part of the course of the colon, but especially in the seat of the sigmoid flexure, often attends and denotes a loaded or contract- ed state of the Rectum : the real state of this bowel must be ascertained by an examination, and by the aid of enemata. * See further .the tfoatise on Diagnosis, Part II, pp. ir9— 182, 254. 8:1* THE MIMOSIS ACUTA. 1^3. Case XXXIII. Mr. L. aged 40. Novem- ber, 1818. When I first saw him he laboured from tenderness, pain, and fulness at the scrobiculus cordis. A similar pain had affected the right side, — and had been mitigated and had recurred several times. — The countenance was rather leucophlegmatic and bloated ; the tongue loaded ; the breath tainted ; the bowels coustipHted and medicines had acted inefficiently ; the pulse natural in frequency. He had suffered for sev- eral weeks previously to the attack, from lowness of spirits ; tendency to shed tears ; tremor ; nervousness ; vertigo ; fluttering ; and a loaded state of the tongue, breath, and bowels. He was much relieved by leeches and still more effectually by the copious action of draughts with ol. riciui, and pills with the pulvis jalapse. 124, Case XXXIV, Miss B. of K. aged 17, con- suited me in August, for a severe pain with tender- ness in the left hypochondriac and chondiliac re- gions ; the tongue was loaded, swollen, indented, and with enlarged papillae, the gums red and tumid, the breath extremely fostid, the bowels were said not to be much disordered ; the countenance was pale and swarthy ; there was some loss of flesh : the general health was manifestly impaired. The pain was al- most immediately relieved by active purgative medi- cines ; and the health was restored by a perseverance in milder doses of the same remedies. — The symptoms had led to the apprehension of organic disease. They had subsisted for several weeks; or even months. THE DIAGNOSIS. SSf 125. Case XXXV. A. B. aged S5. She com- plains of pain in the left iliac region, accompanied by- considerable tenderness. It was relieved by employ- ing the rectum of Scybalse by means of an enema. 126. It scarcely appears necessary to do more than refer to the enumeration of Constipation, Diarrhoea, and Tenesmus, as occurring in the Mimosis Acuta, § 24; the source of these aftections must be traced to the original disorder, — and it must be distinguished from a diseased state of the rectum. — The constipa- tion is frequently attended by pain deep in the sa- crum, which is apt to be aggravated by the move- ment of a carriage in travelling. — The Diarrhoea in- duces frequent, scanty, liquid, foetid stools, often with mucus, sometimes with more or less of blood ; there are also in different instances, gripings, tenderness, and Tenesmus. The Diarrhoea often occcurs, recedes, and recurs during the course of the Mimosis ; the latter affection is apt, however, to be overlooked, and the former to be treated as a primary affection and confounded with other kinds of Diarrhoea, 127. Case XXXVI. Mr. R. aged 46. He has suffered from the symptoms of the Mimosis Acuta during three months. The affection varied much in severity at different periods. There were unusual weakness, faintiness, weariness, aching pains, loss of flesh, vertigo, and affection of the sight, a most tainted breath, swollen gums; ptyalism; a loaded and swollen 86 THE MIMOSIS ACUTA. tongue, coldness of the hands and feet^ &c. Seven days ago, a regular state of the bowels is said to have yielded to Diarrhoia, with frequent, scanty, mucous, and various stools, which are sometimes foetid, some- times with much filamentous substance, and sometimes bloody. There are great indisposition and an inca- pacity for the slightest exertion.— This affection yields slowly to the pil. hydrarg. with gentle purgative me- dicines, the stools becoming gradually, first faeculent; and then more and more natural. 1^. Icterus has occurred in six persons, in connexion with symptoms of Mimosis Acuta, within the last year. It has appeared principally in the se- dentary ; it has seemed to depend on a loaded state of the intestines ; and it has yielded to active doses of calomel and other purgative medicines. This appears to be by far the most frequent form of Icterus, and is observed in persons of all ages, — in very early youth, 4iud in adult age. 1S9. Cases XXXVII. and XXXVIII. D. G, and S. P. aged about 28, and fellow-workmen in the same shop of lace-frames, have each been affected with Icterus supervening on symptoms of Mimosis Acuta. The Icterus was relieved in both by active doses of purgative medicines, and the primary affec- tion has been totally removed, and any recurrence of it obviated, by perseverance in milder doses of the same remedies. THE DIAGNOSIS. 8? 130. Case XXXIX. Miss W. aged 16, of seden- tery habits, was observed during several months, to lose her wonted appearance of health and strength ; — the countenance became somewhat paler, and thinner ; the mouth, tongue, and breath, loaded and disagree- ble, and the bowels somewhat constipated. At length Icterus supervened, the skin and tunica albuginea be- came greatly tinged with yellow, the urine deep co- loured, the motions pale, and the bowels torpid. The affection was soon removed, and the health greatly improved, by efficient purgative medicines, and she is now ruddy, plump, and active. 131. Case XL. Mr. B. aged 55, has twice la- boured under Icterus as a form of Mimosis, Once he was affected with vertigo, fluttering, nervousness, in- termittent pulse, a loaded state of the breath, mouthy and bowels, and Icterus ; he was incapable of exertion, and perspired profusely on attempting it ; the second time there were violent pain of the head, and excruci- ating pain in the epigastre extending to the back ; in lioth cases the Icterus soon yielded to purgative medi- cines, and in both there wxre the usual symptoms of the Mimosis Acuta. 133. Sometimes there are Symptoms of an Af- ¥ECTioN OF THE Bl ADDER. The Mimosis Acuta has begun with these symptoms in several instances,^ and it has been conjoined, with them in some part of its course. In one case the symptoms of affection of 88 THE MIMOSIS ACUTA. the bladder seemed to depend on a loaded and irrita ble state of the lower intestine, and soon yielded to the remedies of the Mimosis Acuta.* 8ee §. 110. 133. In some instances there have been all the appearances of an attack of Tic Doulouueux with the symptoms of the Mimosis Acuta, the tongue, the breath, the bowels, and the urine being exceedingly loaded and tainted. In two cases the pain was prompt- ly removed by emetic and purgative medicines. One of them was of the most severe and excruciating kind. 134. The next complications with the Mimosis Acuta to be noticed, arc, Some Convulsive and Spasmo- dic Affections. I shall illustrate this subject simply by the brief detail of cases in exemplification : — 13.^, Case XLI. N. M. aged about it, was sud- denly seized in the following manner : — the face and limbs were affected with convulsive motions ; the coun- tenance was extremely distorted, the moutli, nostrils, and clieeks being violently and convulsivel}'^ drawn to the right side ; several persons were occupied in re- straining the violent convulsions of the limbs ; the tongue, breath, and bowels were loaded. The imme- diate attack was relieved by opening the temporal artery, and any return was prevented I)y the use of purgatives. * See EpII's Reports, V. 11. p. 64- THE DIAGNOSIS. 89 136. Case XLII. Mr. A, of B. became affected with iwa irregular spasmodic distortion of the moatii, which was drawn, from time to time, into the most extraordinary forms. The tongue was loaded, the breath tainted, and the bowels disordered. — The af- fection was removed in a few days by mild purgative?, consisting principally of the pil. hydrarg. and rhu- barb. 137. €ase XLIII. Mr. B. is subject to a contin- ued state of Mimosis, which is liable, from cold or other causes, to be considerably augmented.^ At these times, Mr. B. experiences a considerable degree of hesitation and difficulty in articulation, an affection which invariably recedes with the primary disorder. 138. Case XLIV. Mr. A. of C. became affected with violent and most painful cramps of the calf of the right leg and of the thigh. The muscles of the thigh were drawn into a perfect ball. The spasms were somewhat continued, and so violent as to flush the face, cause the respiration to be forcibly arrested, and induce great expression of pain and suffering. The tongue was extremely loaded ; the breath foBtid ; the digestive organs much disordered. He was or- dered half a drachm of ipecacuan, and a calomel purge, and was immediately relieved. 139. Case XLV. Mr. H. of N. on the Soar, had been affected during four weeks, with violent M 90 THE MIMOSIS ACtJTA. and painful spasmodic contractions of the muscles o^ the right thigh. This thigh had long been diseased, a disease of the liip, in early youth, having impeded its growth, and the muscular substance about the thigh, having more recently, although not within the last six years, formed the seat of suppurations. — The spasms were momentary only, but extremely severe, and tlie pain excruciating ; they were apt to be re- peated on moving, or on retaining one position for too long a period ; they were also induced by any sur- piise or hurry of mind, — by the fear of being touched on this i^rt, — and, once, most severely, on being startled by a stone thrown by a boy against an outer wall near his bed. The sleep was interrupted, and but a temporary respite was obtained, and this at first only, by laudanum with aether. The tongue was lit- tle affected ; he Was low-spirited and nervous ; the bowels were loaded and disordered. His complaint was growing daily more and more severe. — It was removed in about a week, by the pil. hydrarg. given every second night, the sulphat of magnesia with in- fus. sennse, every morning, and the effervescing saline medicine. He has now, July 3rd, been in a state of progressive convalescence for a fortnight, recovering gradually the flesh and strength he had lost before. This patient still remains free from complaint, Sep- tember 18th. 140, Case XLVI. Miss M. aged 15. She has ])een subject, during three springs, to the following THE DIAGNOSIS. 91 affection, which is said to have yielded spontane- ously each time, in the course of about three months after its commencement. The hands, and especially the right hand, are apt to be affected witli a rather continued spasmodic contraction ; they are not quite closed, but any thing held in them is not easily re- moved from the grasp. The contraction comes on, recedes and recurs, without any warning. The tongue is much loaded, and, with the gums, considerably swollen, and it is marked by the teeth; the breath is fcetid; the bowels confined ; the catamenia have not yet appeared. The affection has been removed by a month's perseverance in purgative medicines.* 141. Case XLVII. J. A. aged 10, has been sub- ject for a considerable time, to the following affection : — the head is moved rapidly in a repeated, rotatory manner, from side to. side ; the arms and legs are sub- ject to a similar rapid spasmodic action of their mus- cles ; when he sits down, the rectus muscle of each thigh, but especially of the right, leaps continually, a movement best felt on applying the hand about their middle part. — This affection was gradually removed by calomel purgatives. I'^S. Case XLVIII. I hav<5 seeii a similar move- ment of the head in a married woman about 40, which was increased by any mental affection, and par- 4ic^l^rly when remarked by a stranger. This patient * See a case iri Bateroan's tJepDi-ts, p. 11?, 9S THE MIMOSIS ACUTA. did not take any medicine. — I have also been inform- ed of a similar instance of spasmodic affection in a lady about 50. 143. Trismus ; a state of locked hand ; and a contin- ued cramp of the foot, are not very uncommon in con- nexion with a similar state of disorder ; but it does not appear necessary to particularize these affections. 144. Convulsive and Spasmodic affections may anse from Disease within the head, from Local Irri- tation, from a state of Mimosis^ &c. and it is of the utmost importance to ascertain the source and seat of the affection, — ^^ neque enim credo, posse eum scire, quomodo morbos curare conveniat, qui, unde hi sint, ignoret.'"^ 145. In place of a spasmodic affection, there is sometimes Paralytic Weakness of the muscles, espe- cially of the lower extremities. This affection very insidiously and gradually deprives the patient of the use of the limbs. It is often attended by a feeling of stiffness, increased on exposure to cold ; and there are sometimes twitchings, or slight,, rapid contractions of the muscles. The paralysis has in different cases af- fected the bladder, tlie sphincters, and the upper ex- tremities even. 146. This species of Paralytic Affection must be cautiously distinguished from Paralysis arising from UisEASE of the Head ob Spine. The di- THE DIAGNOSIS. OS agnosis must be established by observing the History and Symptoms, and the Effect of Remedies, and by contrasting them with the characters of local affection of the Head and of the Spine, especially the latter.* The presence of the symptoms of Mimosis, and the absence of discoverable local disease, should lead to the trial of the remedies of the former affection ; and this experiment will afford another source of Diagnosis. 147. There is a singular affection, which arises from a disordered state of the stomach and bowels which has not I think been noticed. ^Ihe face, and some parts of the surface of the hodijy become sudden- ly swollen and puffed, 14S. In one case the face and eye-lids were greatly swollen and disfigured. The patient had been at a feast, and felt indisposed some days before. In about half an hour the swelling had begun to subside a lit- tle 5 and it was totally removed by an emetic and purge. This patient had had a similar affection a year and half before. 149. In another case the face, surface of the chest, &c. had become suddenly and enormously puffed up. The extremities were cold, the pulse almost impercep- tible, and the patient appeared to be sinking. The attack was compared to an explosion. The affection was removed by an emetic and purgative medicine* * See the tceatise on I^iAGjrosis, Part II. ^ 206. aud particularly Abcrnethv, V.I. p.-85. , 04 THE MIMOSIS ACUTA. III. THE LOCAL COMPLICATIONS. 150. In § 41, I have enumerated some Topical Af, fections as occurring in cases of Mimosis ; they are principally if not exclusively observed iailiG protracted instances of that affection. 1 do not deem it necessary to give any illustrations of those affections ; these will, I think, be afforded by each practitioner's own experi- ence. I shall only add here an account of a diseased appearance of the Prolabia, and of an ulcerated state of the Tongue, which I do not remember to have seen described. 151. The first is an affection of the Prolabium and immediately adjoining skin. It consists of a repeated, dry, splitting, and exfoliation of the cutis of these parts, and occupies a ring of about one fourth of an inch diameter, all round the mouth ; it varies in seve- rity at different times ; and it is generally long contin- ued. — I have seen this affection in a boy, in a young lady aged 15, in two mamed ladies, and in a servant. It sometimes occupies severely the whole of the pro- labium and a portion of the adjoining skin ; and Jt is sometimes more partial and less severe. 153. Case XLIX. The case of ulceration of the tongue occurred in W. P. aged 27, framework-knit- ter. Upwards of three months ago a small deep ul- cer formed near the point and another on one side of THE LOCAL COMPLICATIONS. 09 the tongue. In about three weeks six other ulcers formed in different parts of the surface of the tongue. He took emetic and purgative medicines, which near- ly removed the affection, the ulcers soon healing* In a week the affection again returned, in the form of a hard lump which suppurated leaving a deep ulcer. The tongue swelled and was loaded ; and there was a copious flow of saliva. I first saw him four weeks ago. The tongue was swollen, loaded and foul. There were two deep ulcers, one near the point, the other on one side. On the Ifft side of the middle of the tongue there was a hardness about the size of a nut ; this afterwards suppurated and formed a similar ulcer. The gums and health not much affected. To- day, August 28, the ulcer at the point of the tongue is better, and the tongue is cleaner. The others are much the same. In a few weeks the ulcers healed under the influence of emetic and purgative medicines. 96 THE MIMOSrS ACUTA. IV. NOTE OX A C AC HECTICAL FORM OF MiMOSIS. 153. The Mimesis Acuta has appeared to degen- erate in some cases into a state of Cachexia, and has been complicated not only with the diseases enu- merated, § 41, but with other morbid affections, — especially of the skin, the mouth and throat, the pe- riosteum, the absorbent glands, &o. Some of these have resembled syphilitic affections ; others have ex- hibited very different appearanees. 1.54. This subject is full of interest, and still pre- sents a wide and extensive field for inquiry. I may perhaps be permitted to recommend to the young student a careful perusal and comparison of the works referred to below;* and of the following Case with those given by Willis, de Scorbuto, Cap. Xf, by Mr. Abernethy, on Diseases resembling Syphilis, Sect. Ill, and in Dr. Bateman's Reports, p. 259. ±55. Case L. E. M. aged 35, a framework- knitter, tall, stout and healthy, was employed in • Willis, and the cotemporary writers, on Scorbutus ; tlie essay on tlie accep- tation of the term Scorbutus, Edinb. Med. Journ. V. xvi, p. 20,4 ; AI)ernethy on the Constitutional Origin of Local Diseases, and on Pseudo-Syphilis; Pearson ou the Cachexia Syphiioidea ; Willan's Reports, on Astlienia ; Dr. Eateman's Re- ports, on Asthenia, and on the Cachexia Syphiioidea; Dr. Philip's paper already referred to, p. 63 ; Dr. Hennen's paper in the Edinburgh Medical Journal, Vol. XIV, p. 201 ; Dr. Ayre on Marasnaus, — on ozsena ; Dr. Crampton's pa^er in the Dublin Hospital Reports, V. I ; he. kc. IN A CACHECTIC FORM. 97 1815, in the most active and laborious manner, in hay-making ; he was exposed to great heat, under- went great fatigue, perspired profusely, and drank copiously of beer and ale. He became affected with weakness, listlessness, loss of flesh, nocturnal perspi- ration, — headach and vertigo, — loss of appetite aud Icterus, with pale-coloured stools and deep-coloured urine. — He recovered from these complaints, but in the year 1816 had the misfortune to break his leg. In consequence of this acciilent and the subsequent confinement, he became and remained indisposed, and gradually lost flesh, and from 14st. weighed be- tween l^st. and 13st. only, and experienced, on tak- ing cold, a loss of appetite and strength, with an inability to work, not known before. In >ioveniber, 1817, he underwent much bodily exertion, and re- mained exposed to the cold and damp. He took cold, and became affected with hoarseness, sore throat, and cough, with cedema of the ankles. These symp- toms ceased, except the oedema, which receded however gradually, but he remained affected with the following complaints which are copied from his own account of them:— ^ loss of flesh, and of strength; a feeling of internal weakness ; feverishness, a pitched and dry state of the throat, and sometimes of the tongue ; sensibility to cold, chilliness, tendency to per- spiration, — especially in the night ; headach ; sleepi- ness ; dulness of spirits ; nervousness ; fluttering at the heart and about the stomach ; cough ; dyspnoea ; a clammy tongue and mouth, and foetid breath : loss of 9S THE IVIIMOSIS ACUTA. appetite, sense of load at the stomachy occasional re- jection of food, constipation, and pain in the chondi^ liac regions.' — This patient became much better from the use of gentle purgatives of calomel, rhubarb, and Epsom salt. But in August, 1818, he became af- fected with severe and continued diarrhoBa, with a loss of jBiesh fioni list. 2lbs. to lOst. 6lbs. and loss of strength, and aching and weariness, and pain in the shoulders, sides, and legs. — He again recovered under similar remedies, but in November, 1818, Avas taken with feverishness, attended with a parched tongue and mouth, some delirium in the night, and further loss of flesh and of strength, and, at the same timc^ there occurred an extensive Ulceration of the back part of the Pharynx, and a considerable discharge of bloody mucus from the Nostrils. He was reduced from lOst. 9lbs. to Ost. Slbs. This state continued^ and Icterus agaia occurred, with the usual appear- ance of the tunica albuginea, skin, urine and stools. 156. Soon after this time I made the following List of appearances and affections in this poor sufferer^s complaint. 1. Swarthiness of completion; 2, fever- isliTfiQss, with parched throat and mouth, and heat of the forehead and legs ; B. tendency to perspiration ; 4. quivering of the chin and lips in speaking, simi- lar to that observed before shedding tears ; 5. tremor ;- 6. fluttering ; 7. loss of flesh ; 8. discharge of bloody mucus from the nostrils, with ulceration ; 9. iilcera- Hon of the throat-; 10. Icterus; 11. discharge of IN A CACHECTIC FORM. 99 much blood and mucus ^ from the bowels, preceded and attended by pain of the abdomen^ with tenesmus and forcing; IS. the stools, otherwise, light-colour- ed ; i'^, some anasarca; i^, boils; 15, 2;ai7?/it2 ul- cers on the legs. 157. Again on the use of similar remedies, these ^ complaints abated, with the feverishness, and he re- covered strength and a good appetite. On January 27% 1819, 1 made the following report. The Nos- trils and throat are nearly free from ulceration. The Icterus has disappeared. The appetite is improved, the tongue clean, the mouth more agreeable, the bowels regular, the stools less pale, the urine pale and clear. He is improved in health, strength and flesh, weighing 9st. 8lbs. In March and May I have re- ported my patient getting gradually better and better, and at present he has indeed little complaint. He weighed on June the S8th, 1819; list. 3lbs. and on August the 2nd, list. 7 ll^s. 'Hi iOO THE MIMOSIS ACUTA SECTIOX m. THE CAUSES AND TREATMENT THE TREATMENT OP THE GENERAL AFFECTION. 158. The most general cause of the Mimosis Acuta is Sedentariness. This affection is there- fore frequently observed in persons of studious habits^ or, of sedentary and inactive occupations ; it has oc- curred particularly in literary persons, in persons eu- gaged in the sedentary employments of the lace-frame, the stocking- frame, the tambour, &c. in tailors, and iu women. 159 Watching, fatigue, anxiety, errors in diet, confined and impure air, and want of CLEANLINESS, are also accessary causes of the Mi- mosis Acuta. This affection has sometimes appeared to have been immediately induced as an effect of cold, of a fit of intemperance, of indigestible diet just taken, or of exposure to much heat ; it has been par- ticularty frequent during the hot summers of 1818 and 1819. And it has occurred from alarm, or accident 160. The treatment of the Mimosis Acuta in its simple form, embraces the administration of Emetic THE TREATMENT. 101 and Purgative Medicines, a particular attention to Diet, Air, Exercise, Bathing or Sponging, AND Sleep and great caution in avoiding the Caus- es of this affection just enumerated. On each of these points I shall make a few observations. 161. In the severer cases an Emetic of Ipecacuan has appeared highly beneficial. To insure its early operation plenty of weak tepid tea may be taken be- fore the emetic draught. iQ2, The Purgative Medicines which I have generally employed have been calomel, the pil. hy- drarg. rhubarb, aloes, senna, the sulphat of magnesia, and pure magnesia. They must be varied according to the previous state of the bowels, and to their effect on the alvine evacuation. This previous condition of the bowels is a state of Constipation, of Diarrhoea, of Tenesmus, or of Melsena, §§ 34, 1S6, 121. 163. In the case of Constipation an active dose of calomel may be given, and if its effect is such as was desired, it may be repeated at first every fifth night, and afterwards once a week, or once in ten days, al- ways insuring its operation, if necessary, by a solution of the sulphat of magnesia in an infusion of senna, ov by pills of aloes and rhubarb. This medicine should also be repeated on the intermediate days. The object I have ever had in view has been to avoid purging, but to induce a large; copious; and consistent lOS THE MIMOSIS ACUTA. EVACUATION DAILY ; and wheu I have been enabled to effect tbis; I have considered it at once- as a source and criterion of increased strength or health of the alimentary canal. Frequently, however, when the patient is very feeble and infirm, the medicine appears to accumulate without operation, and the effect on the bowels is apt, by a repetition of the dose, to be violent ; this event may in general be obviated, ei- ther by the administration of a proper enema at the time when the medicine was expected to move the bowels, or by inserting into the rectum a suppository of tuffy or inspissated molasses, or of soap and honey, and other similar substance. 164. A state of Diarrhoea, with scanty, fcetid, and dark-coloured motions is by no means uncommon. This state of the bowels appears to me to have yielded best to the pil. hydrarg. given every thinl or fifth night, and a dose of rhubarb and calcined magnesia every morning or twice in a day. And, indeed, in all cases where the more active purgative medicines have been employed in the commencement, rhubarb appears to be particularly adapted, from its tonic pro- perties, to complete the cure. In some cases, the state of diarrhoea has demanded the use of opium, which I have then generally united with the pil. hydrarg, The object should still be to induce copious and SOLID EVACUATIONS, and to restore them to their nat- ural appearance, form, colour, and odour. THE TREATMENT. 103 165. In the case of Tenesmus a small opiate ene- ma or suppository affords almost immediate relief: the purgative medicine must of course be given at the same time, and in this case the oleum ricini has a de- cided advantage. 166. The state of Melasna is generally removed by the action of purgative medicines ; the pil. hydrarg. and calomel have^ however, appeared to be particular- ly efficacious. 167. The state of bowels above described^ must be insured until the patient has decidedly recovered his flesh and strength ; and it is incumbent to explain to him the indispensible necessity of attending to this function when he again returns to his usual occupa- tions ; for this complaint, like so many others, is par- ticularly liable to yield imperfectly only, or to return from a repetition of its causes. In the more continu- ed form of Mimosis Acuta this attention to the state of the bowels is still more necessary. 168. I have mentioned the approach, in form, of some cases of Mimosis Acuta, to the appearances of Cachexia, § 153 ; in these and similar cases, and, in- deed, in some other instances, I have been induced to prescribe the sarsaparilla. 169. When the operation of purgative medicine in- duces weakness or faintness, a draught with the tinct*. 104 THE MIMOSIS ACUTA. opii, or tinct. campliorsB comp and the sp. ammoniEe aromat. has afforded great benefit. 170. It appears scarcely necessary to make any observations respecting the absolute necessity of an assiduous attention to the Diet of the patient affected >vith the Mimosis Acuta ; this subject is of acknowl- edged importance, the principles of dietetics are uni- versally known, and little remains but to enforce them with instance and assiduity. The meats cannot be too simply done. Lean beef or mutton, and fowl, are the most unequivocally good ; goose, duck, pork, veal, and even lamb, are the meats most cautiously to be avoided ; vegetables, and especially the uncooked vegetables, are also injurious. 1 have generally re- commended a slice of cold beef or mutton, or a little chicken, to breakfast, instead of bread or toast ; — or biscuit, if meat could not be taken, with tea or coffee : beef, mutton, or chicken to dinner : tea Avith biscuit in the afternoon : a little meat, perhaps, at 11 a. m, and at supper. I have stated the necessity of taking a little nutriment frequently ; of avoiding to load the stomach; and of supplying the place of the evacuations daily procured from the bowels, with proper nourish- ment. And, indeed, an improvement in the appetite is generally an effect of cautiously acting upon the alimentary canal by purgatives. — To these articles of diet I have added, after the bowels have been evacu- ated several times, a little Ale, and I believe, with the greatest advantage. Indeed more than one pa- / THE TREATMENT. 105 tient, ascribe their recovery to the use of ale, by which their strength was sustained, and they were enabled to support the effect of the purgative medicines. — I he importance of an attention to the diet is sufficiently obvious from the dreadful effects frequently observed from negligence or error in this particular; see Case X. 8ome complicated cases have even provetl fatal apparently, from errors of this nature. 171. The effect of the Country Air, and of Gentle Exercise in riding or travelling, has also been extremely marked in many instances. 1 may refer to Case iX, as an exemplification of the benefit resulting from a journey alone ; and a similar advan- tage has been much more remarkable when the coun- try air and exercise has been conjoined with proper remedies and diet. i^2. Bathing in summer, and Sponging the body with cold water, or with vinegar, or salt and water, in the other seasons, is particularly advanta- geous. After bathing or sponging, the surface is to be rubbed wuth a coarshish towel until a glow of warmth is felt over the skin. 173. 1 have mentioned Sleep amongst the reme- dies of the Mimosis Acuta. In cases in w^hich wake- fulness and restlessness prevailed, I have recommended an anodyne draught with the tincture of opium, or the extract of hyosciamus, at bed time. But in other o 106 THE MIMOSIS ACUTA. cases I have endeavoured to procure sleep by enjoin- ing the patient to use exercise in the open air, to bathe or sponge, immediately afterwards to lie down on a sofa or bed, and to foment the feet with hot water. The following plan has been recommended to those pa- tients whose cases seemed to require it : — on awaking in the morning a little warm tea or coffee is to be ta- ken, the body is then to be sponged, and the breakfast finished ; the patient then frequently falls asleep ; — on awaking he is to rise, dress, and ride in the open air, avoiding fatigue ; — on returning he is to take a little nourishment and again to lie down to sleep ; — on again awaking, he is to dine, and afterwards, to ride once more in the open air, and again, on returning, lie down for a time : — the body is again to be spong- ed in the evening on going to bed. In this manner the weakness is often soon diminished and the patient regains his flesh and general health. 174. It is at the same time, of the utmost moment to avoid the causes of this affection, §§ 158, 159, and especially anxiety of mind and fatigue of body. J THE TREATMENT. iO? II. THE TRATMENT OF THE LOCAL AFFECTIONS. 175. In addition to the general treatment of the Mimosis Acuta, its complications with local affection require an additional and particular attention. 176. The Affection of the Head, ^ 79, often re- quires general and topical bleeding, and blisters, to- gether with a more active exhibition of purgative medicines than is usually adopted in the uncomplicat- ed affection ; and of course the necessity for these re- medies is commensurate with the degree and urgency of the local affection. If there is slight pain or ver- tigo, which has already continued some time without increasing materially, a blister applied to the back of the neck, with leeches to the temples, and active pur- gatives, may be sufficient ; but if the accession of this complication has occurred lately, and if the affection itself be severe, with much dulness, acute pain, or au approach to stupor, defective vision, &c. the lancet must be employed freely, cold applications be made to the shaved scalp, cupping, leeches, blistering, and ac- tive purging be instantly enforced, and abstinence and the erect position, as far as possible, enjoined. 177. The Affection of the Chest, § 95, frequently demands the application of blisters, which appear par- ticularly useful in tlus complication; together with i08 THE MIMOSIS ACUTA. the addition of the extr. hyosciami, or opium, to the aperient medicines. It is in this complicated affec- tion, often mistaken for Phthisis Pulmonalis, that tlie sponging recommended by Dr. Stewart* seems to be HO efficacious. 178. The Paroxysm of Dyspnoea, § 96, is relieved by jether and other similar remedies ; but it is remov- ed and its return is obviated by the proper remedies for the Mimosis Acuta. 179. Fluttering and Palpitation of the Heart, § 106, and Hiccough, § 115, are each relieved a little by aether, but only effectually treated by the remedies for the original disorder. 180. la the Convulsive and Spasmodic Affections, § 134, it may be necessary sometimes to employ the lancet, but in general a course of purgatives, and sometimes an emetic, are the most efficient remedies. 181. Pain in the course of the Colon, §§ 30, 12S, is usually removed by the operation of the purga- tive medicines. Friction with a liniment is also use- ful. And if necessary, enemata and suppositories, should be administered. Some attention is due to the mode of applying the friction, and to the posture of the patient after the exhibition of the enema or sup- pository, when the pain is accompanied with tumor * See the Edinb. Med. and Surg. Journal, Vol. 9, p. 356. THE TREATMENT. 109 suspected to arise from the remora of hardened fseces, § ISS. ±82, The treatment of the cases of Constipation^ Diarrhoea, Tenesmus, Melaena, and Icterus, has al- ready been noticed, §§ 164 — 166, 128. 183. In the Pains of the Limbs, § 34, 1 have found an anodyne ammoniacal liniment to afford great relief. This affeetion is sufficiently illustrated by Case X. I shall only remark here that it must be distinguished from the pain of the shoulder in Affections of the Liver, and from Rheumatism, by a reference to the character given, §§ S4^, &c. CHAPTER II. THE MIMOSIS CHRONICA. SECTION I. THE DESCRIPTION. 184. BY the term Mimosis Chronica, it is intend- ed to express the state of disorder which is usually denominated dyspepsia and hypochondriasis. This form of Momosis is intimately allied to the less severe and more continued form of the Mimosis Acuta, des- cribed §§ 39 — 41, from which it may originate, or into which it may pass. But very frequently the Mimosis Chronica begins, and pursues a longer or shorter course, with the character about to be given. 185. The Mimosis Chronica is denoted in general, by FITS OF DESPONDENCY AND GLOOM, OF INVINCI- BLE DISINCLINATION FOR EXERTION, OF PAIN ABOUT THE HEAD, SINKING AT THE PR^CORDIA, AND HEAT OR FULNESS OF THE STOMACH. 186. The countenance is liable to be rather sallow, and occasionally rather pallid ; and there is often a great expression of despondency and lowness. THE DESCRIPTION. Ill 187. The tongue is sometimes affected a little, as described §> 2Q ; but it is frequently characterized by a; different appearance of very minute white grains or points ; it is frequently a little marked by the teeth, and sometimes slightly formed into sulci. 188. There is, in general, no loss of flesh ; or this is at the commencement only, or on any aggravation of the affection, and slight in degree. And there is little tremor or loss of strength. 189. The patient is liable to be affected with ver- tigo or headach. There is often despondency ; a feel- ing of total incapacity for exertion in business or soci- ety ; an impatience and irascibility of temper ; intoler- ance of noise or disturbance ; and an invincible and overwhelming state of inertia or listlessness. There is gaping, and sometimes drowsiness. These affections occur in paroxysms or fits, during the absence of which the patient is more himself, but manifests a constant disposition to speak of his different complaints ^ 190. There are sometimes irregularity of the pulse, and fluttering and irregularity in the beating of the heart. 191. There is often a most oppressive feeling of sinking at the pit of the stomach. There are, at dif- ferent times, and in different instances, heartburn, a sense of heat or burning, acidity, load, distention, in- US THE MIMOSIS CHRONICA. flation, nausea ; sometimes eructation of an acid, at other times, of a nidorous taste, and sometimes the rejection of fluid, or of food. The bowels are often constipated, or there are unsatisfactory evacuations, and the patient feels a sense of load about the rectum ; sometimes there is considerable pain in the bowels. The appetite is in some cases moderate, in others much impaired, and, with the digestion, various at different periods and in different instances. 193. There are many uneasy feelings iu different parts of the body, which vary exceedingly, but always engross the patient's attention in a forcible manner. 193. The Mimosis Chronica, like the Mimosis Acuta, is liable to be obscured by the predominance of some particular symptom. But it docs not appear necessjiry to particularize these cases after the ample detail of similar complications given in the last chapter. 194. A severe form of this affection takes place ia Youths from an indulgence in onanism. It is at- tended with the dread of impotency, and involun- tary emissions of semen during the night, and on hav- ing an alvine evacuation. There are palenees, thin- ness, debility, nervousness, a dreadful state of des- pondency, indigestion, disturbed sleep, palpitation of the heart, &c. THE DESCRIPTION. 113 SECTION II. THE DIAGNOSIS. 19^« The Mimesis Chronica requires to be dis- tinguished from the Miraosis Acuta, and from the in- sidious approach of Obscure Organic Disease. 196. The Mimosis Chronica borders on the more continued and less severe form of the Mimosis Acuta^ described § 39; but it differs materially from the more severe form of that affection characterized § 2^» Notwithstanding the painful and distressing disorder of the function of digestion, nutrition does not ap- pear to be materially interrupted, and the flesh and strength generally remain little impaired, or if a lit- tle flesh is lost at one period of the affection it is regained in another, or the case is stationary. The Mimosis Chronica is, indeed, rather characterized by UNEASY FEELINCS tliaU by REAL IMPEDIMENT to the functions. The mind, temper, and spirits, and the corporal and functional sensations are affected, whilst there is in reality little organic change, or effect in- duced in the process of assimilation.* 197. The Mimosis Chronica is distinguished from Obscure Organic Disease by the contrast drawn, § 71 ? to which may be added, in the present case, tlie absence of loss of flesh, the early and constant Di- agnostic of the latter affection.* * See tlic treatise on Diagstosis, Tart II, §§ 82, 182, 183. P 114 THE MIMOSIS CHRONICA. SECTION m. THE CAUSES AND TREATMENT. 198. The Causes and Treatment of the Mimosis Chronica are the same, mutatis mutandis, as those of the Mimosis Acuta As the affection is of longer con- tinuance, a more persevering use of the pil. bydrarg. and of gentle purgatives of rhuharb and aloes ; and a more constant, and indeed habitual attention to diet with geiitle exercise are necessary. 199. In this disorder the patient must submit to minister to himself in respect to the particulars just mentioned ; for nothing less than this will afford per- manent relief; and it is too usual for patients to ex- pect from medicine, what only can be imparted by proper diet and exercise. 200. Ascidity and heartburn may be relieved by a recourse to the alkalis and the calcined magnesia. The sp. ammoniae arom. is also very useful in these, and in other distressing feelings attending this com- plaint. 201. The load after eating may be much prevented, by taking warm tea, coffee, or negus. 202. Too often, however, this affection is protract- ed by sedentary habits, and cares in business ; or it is renewed by errors in diet and undue exertion. It haa THE TREATMENT. 115 appeared in some cases, to cease spontaneously, or at least after medicine had been abandoned. SOS. The first object ought to be constantly to take nourishment in a simple form and small bulk. For this purpose lean meat is the best adapted. The second object should be to induce a copious alvine evacuation daily, by means of the remedies above mentioned, and by adopting a regular habit in this respect. For the latter purpose it is useful to repair regularly to the water closet every morning within a few minutes after breakfast, until this habit be acquired. By these means this distressing complaint may be mitigated, shorten* ed, and perhaps altogether removed. CHAPTER III. THE MIMOSIS DECOtOR. SECTION I. DESCRIPTION WITH CASES. SOI. THE form of Mimosis of which an account is now to be attempted, and to which I have appro- priated the denomination of Mimosis Decolor, appears to have been very inadequately described by medical writers under the appellation of chlorosis, which is only ONE of the forms of this affection. I shall, there- fore, bestow great pains to place before my reader the characteristics of the different varieties, simple and complicated, of this affection, 205, And, first, I take this early occasion of stat- ing, that the Mimosis Decolor occurs principally in Female Youth ; but frequently in Married Wo- men, both young and old ; and occasionally in the young and sedentrry of the Male Sex, and even in men of adult age, from the influence of sedentary hab- its and mental anxiety. 206. There are two forms of the Mimosis Decolor, of which the first is more acute^ and the second, more DESCRIPTION, WITH CASES. , 117 chronic and protracted. But there is every interme- diate shade, and frequently, the transition of one of these forms into the other. The Mimosis Acuta, also occasionally assumes or conjoins, by an insensible gra- dation, the form of the Mimosis Decolor. 207. The more acute form of the Mimosis Decolor may be described as observing three different stages, — the Incipient, the Confirmed, and the Inveterate. It may be characterized in general as uniting a mor- bid Sl'ATE OF THE COMPLEXION, AND GENERALLY OF THE SURFACE, WITH RECURRENT PAIN OF THE HEAD, AND OF THE SIDE, PALPITATION OF THB HEART, FLUTTERING, AND NERVOUSNESS, AND SOME TENDENCY TO LOSS 01*' FLESH, AND TO CEDEMA. The Incipient Stage of the more acute form of the Mimosis Decolor is denoted by paleness of the complexion, an exanguious state of the prolabia, and a slight appearance of tumidity of the countenance, and puffiuess of the eye-lids, especially the upper one. TherQ is sometimes a tinge of green, or yellow, or of lead colour, and frequently darkness of the eye-lids. S09. There are great paleness of the general sur- face, hands, fingers, and nails ; an opaque, white, tu- mid, and flabby state of the skin 5 and a tendency to eedema of the calves and ankles. And there is a cer- tain loss of flesh. 118 THE MIMOSiS DECOLOR. SIO. The tongue is white^ and loaded ; it is swol- len, marked by pressure against the teeth, or variously formed into creases or folds ; its papillse are very nu- merous and much enlarged. The gums and the inside of the cheeks become tumid, and the latter as well as the former, are sometimes impressed by the teeth. The breath is tainted,, 211. The patient is generally languid, listless, se- dentary, indisposed for exertion, easily overcome by exercise, nervous, and low-spirited, drowsy, * dizzy, fainty, or breathless. There is generally severe head- ach or vertigo ; the memory and power of attention are apt to be impaired 5 and there is sometimes lieavi- ness for sleep. SIS. There is, in difiPerent instances, pain of one or both sides about the false ribs, or in the hypochon- driac or chondiliac regions. Sometimes there is cough, difficulty in breathing, palpitation or irregular action of the heart, or imperfect syncope, and almost univer- sally a sense of fluttering about the prjecordia. 213. The appetite is generally impaired. There is frequently a morbid appetite for acids, or for mag- nesia. The bowels are constipated, a state which sometimes leads to diarrhoea. The faeces are dark-co- loured, foetid; and scanty. The urine is frequently loaded. DESCRIPTION, WITH CASES. 119 514. The catamenia become irregular^ are preced- ed and attended by much pain of the back and re- gion of the uieius, and sometimes, but not always, become slowly defective in quantity, and pale in colour. 51 5. In the Confirmed Stage of this affection the state of the complexion and general surface is still more marked. The countenance is still more pallid, the prolabia and the gums exanguious, or the prola- bia, especially the upper one, have a slight lilac hue, and the integuments are tumid. 216. The skin is smooth, but becomes preternatu- rally dry. The integuments are puffy, opaque, and pale, or yellowish, and there is a tendency to cedema of the feet. There is frequently scarcely any further loss of flesh. 217. The tongue becomes clean and smooth. But it is pale, with a slight but peculiar appearance of transparency, and of a pale lilac hue. And it remains a little swollen and indented. 318, The patient is affected with langaior, lassi- tude, and even serious weakness, being at once reluc- tant and unable to undergo fatigue. 219. There are ojTten attacks of severe pain of the Jiead, or of equally severe pain of the side, and re-^ peated bleeding, leeches, and blisters are usually em' 120 THE MIMOSIS DECOLOR. ployed, affording a temporary respite from these complaints. There are also, sometimes, fits of dys- pnoea, of palpitation of the heart, or of fainting, with beating of the carotids, S20. The pulse is rather frequent, often about 100, and easily accelerated and rendered irregular by men- tal emotion. 221. The appetite is sometimes impaired, occa- sionally greater than natural, and very frequently depraved, inducing a longing or constant desire for some indigestible substance, as acids or pickles, mag- nesia, chalk, cinders, sand, coffee grounds, tea leaves, flour, grits, wheat, &c. which the patient likes to have constantly in her mouth, or to which recourse is had when she suffers from agitation of mind.* The bowels are slow and constipated, a state which some- times alternates with diarrhoea, and induces melsena ; the stools are dark, foetid, and scanty. 222. The catamenia are attended with pain, and become paler, and less in quantity, often cease, and often yield to a state of leucorrhoea which is more or less constant. 223. In the Inveterate Stage of the Mimosis De- color all the symptoms assume an aggravated charac- * In the West Indies an aflFection similar to the present seeras to prevail amongst the Negroes, who are then termed Dirt-e»ters. i Description, with cases. is4 ter. There is a very slow but progressive loss of flesh. The languor becomes a state of permanent debility w The oedema increases and takes on the aggravated form of anasarca. '1 he pulse becomes frequent. There are less of the appearances of mere disorder, and more of the character of disease^ § 71* Or those local af- fections which existed in a less continued manner be-- fore, now became either permanent, or are induced by the slightest causes, and the patient can scarcely bear the most ordinary occurrences of domestic life, and perhaps remains always in bed. Sometimes there is*an almost permanent pain of the head, perhaps with intolerance of light or of noise. Sometimes there is pain of the chest, with tenderness, difficulty in breath- ing, and cough. Frequently there are pain and ten- derness of the abdomen, with sickness and constipa- tion, or with diarrhoea. Different symptoms reigu in different instances,— as some hysteric or spasmodic affection 5 a state of locked jaw, closed hand, contract- ed foot, or twisted limbs ; palpitation of the heart ; hurried, or suspended respiration ; long fits of cough- ing 5 hiccough 5 retention of urine. SS4. Besides the form of the Mimosis Decolor ia its more acute form, just described, there are some varieties which require to be distinctly noticed : — 22o. 1. Sometimes there is less pallor of the coun- tenance and prolabia, but a rin^ of tumid darkness round the eye, and perhaps a tumid state of the upper iJ88 Tlffi ISIIMOSrS DECOLOR. lip. 2. Sometimes the complea^ion is of a more yellow or icierode hue, 3. Sometimes the complexion is of a peculiar lead -colour. 4. Frequently there is a mixture of the state of the complexion observed in the Mimo- sis Acuta, with one or other of those observed in the Miniosis Decolor. 5. There is sometimes a peculiar state of coldness^ cold moisture, and lividity of the hands and fingers, and a lilac hue of the nails, the tips of which often become white and opaque. 6. The state of Mimosis Decolor, consequent on haemorrhagy, also deserves to be distinctly noticed ; there are pale- * ncss and slight yellowness of the complexion, exan- guious prolabia, a greater degree of loss of flesh, and great fluttering and nervousness. 226. Such are the usual symptoms of the different stages of the Mimosis Decolor. But, as in the Mimo- sis Acuta, some of these symptoms are liable to be much aggravated, and to assume the form of serious Local Disease, the following list of these complica- tions possess therefore great interest : — 1. PAIN OF THE HEAD. 2. COUGH AND DYSPNOEA. 3. PALPITATION OF THE HEART. 4. PAIN AND TENDERNESS OF THE SIDE. 5. PAIN AND TENDERNESS OF THE ABDOMEN. 6. CONSTIPATION. 7. DIARRHOEA. 8. MELAENA. 9. MENORRHAGIA. . . ." 10. TENDENCY TO HAEMORRHAGY. '' DESCRIPTION, WITH CASES. i^^ 11. PURPURA. 12. LEUCORRHOEA. 13. HYSTERIC AFFECTIONS. 14. OEDEMA ANASARCA. SS7. These compile ations with the Mimosis De- color must be distinguished from a different set of diseases from those noticed in the first chapter. The complications with the Mimosis Acuta require^ in gen- eral, to be discriminated from acute, those with the Mimosis Decolor must be distinguished from sudden or from insidious, local affections. These distinctions will be attempted in the ensuing section. There is also great danger, in the complications with the Mi- mosis Decolor, as in those of the Mimosis Acuta, of Ahe transition into organic affection. S2S. There is in many cases a remarkable state apparently of tlie capillary system, giving rise to a hsemorrhagic tendency, — to epistaxis, melsena, hieraa- temesis, menorrhagia, and even purpura. In cases of the Mimosis Decolor, the blood discliarged from the nose, or taken from the arm, and tlie catamenia, fre- quently become almost aqueous and colourless, so that this affection presents an instance in which the vital fluid undergoes considerable change. 1 have seen the blood scarcely tinge the sheets, and I have seen it resolve itself almost entirely into serum with scarcely any crassamentum. Bo inadequate " to the subject, ure all the theories of this extraci^dinary affection ! 124 THE MIMOSIS DECOLOR. 239. In the more chronic form of the Mimosis Decolor, there is a continued though variable state of sallowness, of yellowness or icterode hue, of darkness^ or of a wan squalid^ or sordid paleness of complexion ^ or a ring of darkness surrounding the eyes, and ex- tending a little perhaps, towards the temples, and cheeks, and sometimes encircttng the mouth, without tumidity, without the pallidness of the prolabia men- tioned § S08 ; and without much tendency to oedema. S30. The general surface is more or less affected. And in the severer and more continued cases, there is frequently a peculiar deformity of the nails, which fall in irregularly in their middle part, become brittle^ and break off in laminse, so that the patient is almost imable to take a pin out of her dress. There is less pudency to oedema in this, than in the more acute form of the Mimosis Decolor, 231. The state of the tongue is various, — gener- ally but slightly loaded, or perfectly clean and moist, — sometimes of a light green, light lilac, or bright red colour, — smooth and clean with enlarged papillae, — formed into creases, — or into lobules, or other forms, — somewhat swollen in general, and slightly marked by the teeth. 232. There is evidently a state of general weak- Bess and indisposition. The patient suffers from pain of the head, continued, or in paroxysms, and from DESCRIPTION, WITH CASES. 1S5 pain of the right or left side ia the hypochondriac, chondiliac^ or iliac regions ; she is liable to vertigo on stooping, to fluttering on being startled, and to pal- pitation of the heart; the respiration often appears short, and the patient seems out of breath ; sometimes there is paleness with the appearance of faintness. 533. The appetite varies, ^he bowels are affect- ed with alternate constipation and diarrhoea. In the afternoon there is often flatulent distention of the ab- domen, which often obliges the patient to unlace her stays 5 or long continued rumbling or borborigmus. 534. The catamenia are regular in their periods perhaps, but often irregular in their flow, paler and more scanty than natural, and there is often leu- corrhoea, 235. The Mimosis Decolor, in all its varieties, is particularly characterized by being changeable, liable to exacerbations in itself and in its complications, and to the recurrency of its symptoms even during a gen- eral amendment. Repeated bleeding and blis- ters have, in general, been employed for the affec- tion of the head, or of the side, a circumstance which becomes a deplorable characteristic of this affection. 236. In those females wlu) have been married and who have had a family, the complexion has frequent- ly, but by no means always, been icterode ; in one 156 THE MIMOSIS DECOLOR. case the coantcuauce was pale and cxanguious, in an- other, wan and squalid, and in a third, there was much colour, with a ring of deep darkness round the eyes. The affection differs in no essential particular from that of younger and unmarried females ; nor does it at all appear to impede conception. 237. In the Mimesis Decolor I have observed an eruption of urticaria, in very large, elevated wheals, sometimes solitary, and sometimes in considerable number. S38. I shall now proceed to exemplify the des- cription of the Mimesis Decolor, by a series of cases taken succinctly in the presence of the patients them- selves : — 339. Case LI. Miss F. aged S3, of delicate and sedentary habits. She was observed first to lose Ler colour and appearance of good health, several months ago. During this interval the countenance, — cheeks and lips, — the fingers, nails, and general ^drfiice, have become pale and exanguious, and there is a degree of puffiness of the integuments, aad of cedematous swelling of the ankles. The tongue is white, loaded, and impressed somewhat by the teeth. There are headach, and pain of the sides alternately, vertigo, fluttering about the heart, listlessness and sense of fatigue from the slightest exertion, which has seemed to aggravate all her complaints indeed, — con- ( DESCRIPTION, WITH CASES. 1^7 stipation and painful menstruation. — An attack of vi- olent pain and throbbing of the head, with intolerance of light, noise, or disturbance, and great nervousness, lias been quite removed, and the other symptoms much mitigated, by purgative medicines after copious bleed- ing had failed of inducing relief. The amendment in general appearance is also rapidly progressive. S40. Case LIL S. G. aged I7. She has been long employed at the lace frame. The bowels have generally been slow. The catamenia began to ap- pear two years ago. Three months since she began to complain of acute and continued pain of the right side of the head ; she was observed to lose her colour to become weak, and to be easily overcome and ren- dered breathless by exercise. — xlt present the counte- nance is extremely pale, and a little tumid : the prola- bia and gums are exanguious. The tongue is swollen not much indented, but formed into folds and plaits,, perfectly clean, with enlargement of its papillse. The hands and general surface are pale. She has lost flesh considerably. She complains much of the pain of her head, which is always aggravated on walking out. There is no dyspnoea or cough. The pulse i» 96. The appetite is impaired, with a great desire for- acids. The bowels are not costive just now. The catamenia are regular, but have been paler than nat- ural at the two last periods. — This patient recovered rapidly from the use of purgative medicine. The perfect cure was, however, impeded by the necessity . laS THE MiMOSIS DECOLOR. of still sitting much at the lace-frame, and so contiii-» uing the baneful operation of the cause of her com- plaints, an occurrence too frequent amongst this class of patients. 341. Case LIII. M. J. aged 20, housemaid* April 1st, 1818. She became indisposed nine months ago, from headach, sickness, and general feebleness. Her complaints increased gradually until Christmas 1817, when she became more seriously ill, and was placed under the care of an eminent surgeon, who stated her disorder to be a Disease of the Liver. She t?as bled, and took saline medicines ; but her com- plaints augmented. About this period she consulted me, and I made the following statement of the symp- toms : — The face in general, and the lips and gums, are extremely pale and exanguious ; the eye-lids are swollen and puffy, — ^a circumstance most observed ear- ly in the morning, and then both in the eye-lids and lips. The hands are exceedingly pale and colourless ; the skin in general is dry and rough, aud ever free from perspiration even when she takes exercise ; the hands and feet are apt to be cold. The ankles are affected with oedema, especially at night, but even in tike morning she can scarcely put on her shoes. The tongue is exanguious, of a pale lilao colour, semi-trans- parent, smooth, clean and moist. She does not com- plain much of weakness. She has much pain and beating across the forehead, with a sense of weight in the eyes, and sometimes vertigo, — all of which symp- bESCRIPTION, WITH CASES. 1S9 toms are especially experienced on walking about, and from noise, felie has much palpitation of tlie heart, accompanying the pain of the head, and accompanied by pain of the hypochondria. She is easily hurried, and her complaints are then always reproduced if pre- viously absent, or aggravated if present. The bowels are habitually costive. The catamenia are irregular, appearing often only after an interval of nine weeks, and preceded, for some days, by drowsiness and much pain of the loins and in the hypogastric region. She has been affected for four Oi* five months with leueorr- hosa ; this ceases before the appearance of the catame- nia, which gradually resume the appearance of leucorr- hoea. — Since the day she consulted me, she has per- severed in a course of purgative medicine, consisting of aloes and rhubarb, with daily exercise, light meat diet, and a little ale. Bhe has now a natural com- plexion, a return of colour, a healtliy appearance o€ the prolabia, gums, and tongue, and all her com- plaints have ceased with the exception of occasional headach. — October 22. This patient continues well ; but still finds her purgative pills requisite. — The sis- ter of M. J. has lately suffered from a slight attack of this affection. 242. Case LIV. Miss L. aged 25. May 18, 1819. She began to be indisposed three or four years ago. She at first lost her colour and some flesh ; lately she has lost little flesh, but has become very pale. She has complained at different periods of pain of the 130 THE MIINIOSIS DECOLOR. head, — aud of both sides^ and her complaint ha* l>eea considered Infiammation of the Lmigs, aud an •Affection of the Liver She has also suffered from llutteriug aud palpitation, breathlcssness, nervousness, aud faiulishuess. Her appetite has been impaired, she has experienced distention of the abdomen, oblig- her to unlace, and has had much ilatus. She has often violent hiccough. The bowels have been prone to costiveness. At present the countenance and prolabia ace pale ; the complexion is apt however to be yel- lowish, and once she was atated to have had Icterus. The tongue, gums, and inside of the lips are pale ; the tongue is clean but a little creased and with enlarged piipill». The hands, fingers and nails are palish ; the skin rather opaque and dry. There have been attacks of pain of the right side of the liead, generally ascribed to the application of leeches to the side. There have been more severe attacks of pain at the pit of the stomach, of the left side over the false ribs, and of the mammae^ The palpitation and breathless- ness are induced on any hurry, or on w^alking quick. The pulse is usually 108. The hiccough is not ascrib- ed to any particular cause. There is some degree of swelling of the calves and insteps. The urine often deposits a copious sediment of light pink. The cata- menia have become irregular, pale, scanty, — and ar& succeeded by fluor albus. — May 1820. Miss L. has quite recovered under a plan of purgative medicine, and at present appears and feels in perfect health. DESCRIPTION, WITH CASES. iU S43. The three following cases exemplify the first and fifth variety of the Mimosis Decolor alluded to »44. Case LV. Miss B. S. of B. aged 19. December 8th, 1816. This young lady has been slightly indisposed for several years, complaining of languor and indisposition for moving about. Two days ago the ankles became affected with considerable cedema, Avhich has excited alarm. There is occasion- ally an obvious saliowness and darkness of the com- plexion, not very observable at this moment. The tongue is white, doughy, and impressed with the teeth, and the papillae are prominent. The hands and fin- gers are affected with a little tumidity, and with a cool clammy moisture ; they are rather dark coloured, and the nails are a little livid. She is rather heavy fo^* sleep ; there is a little want of mental energy. There is little or no headach, palpitation, or pain of the side, but sometimes hurry in the breathing. The bowels are habitually costive. The abdomen often tumid. The catamenia are regular. — This patient recovered slowly, but completely, from the use of purgative me- dicines, a journey, and continued exercise, with ii strict attention to diet. M5, Case LVI. Miss P. of G, aged 19. De- cember yth, 1816. hhe has been indisposed for a very considerable period. The countenance is palish ; there is a ring of darkness about the eyes and mouth f the 13^ THE MIMOSIS DECOLOR. lips are higli coloured ; the complexion varies^ becom- ing much sallower at times. The tongue is loaded, white, pastjj impressed with the teeth, and displays elongated papillae. She is listless and sedentary^ and easily fatigued. There is some loss of flesh. The hands are apt to be cold, clammy, and deep coloured, with a trifling blueness of the nails ; the feet are also apt to be cold. There is occasionally headach. She has suffered much from pain of the left side over the false ribs, for which fifteen blisters have been applied at different intervals. She has suffered from a severe cough, which has occurred in violent fits, and which lias been generally relieved by inhaling the vapour of ]iot water. Tliere have been irregular palpitation of the heart, and irregularity in the frequency of the pulse, so as to induce a suspicion of Organic Disease of the Heart; but she runs up stairs with rapidity and without unusual distress, and she generally walks quick. The bowels have required opening medicine. The catamcnia are natural. — A nearly similar report was made on January the 9th, I8I7. The pain of the side and chest had varied its seat and severity repeat- edly. Exposure to the frosty air had induced a vio- lent fit of coughing. The other symptoms were nearly as before. — This patient recovered slowly. 246. Case LYII. Miss M. G. aged 18. Novem- ber S7j 18 17. — She was affected with scarlatina near- ly two years ago, and thinks she has never been per- fectly well since that time. Ijately she has been ob- DESCRIPTION, WITH CASES. 1S3 served to change colour and to become occasionally pale and sallow ; she has become nervous ; and she has been subject to variable^ recurrent pain of the stomach, and of each side in the chondiliac regions. At present the countenance is pale in general ; the lips are of a deep red colour ; the eye lids are occupied by an ex- tensive ring of blackness. The tongue is white, but with very lew red points, and with little swelling or indentation. The breath is sometimes tainted. 81ie has lately felt much indisposed to exertion. The hands are generally cold and clammy, the nails are of a light blue or lilac hue, and their tips are white and opaque. The memory of recent events is said to be much impaired, but not that of more remote ones ; she reads, however, and remembers what is read bet- ter than events, tthe is liable to pain of the occiput and in two points on the forehead, the latter being of a beating kind 5 to pain of the stomach of a wearisome nature ; and to pain of the two chondiliac regions in a more acute and less continued form. These pains come and go without manifest cause, and rather sud- denly. They are all, however, most apt to be induc- ed by any thing which hurries and affects the mind. There is no cough. She is much liable to attacks of fluttering about the heart, especially on any recur- rence of distress or mental affection. Her appetite is impaired : she is particularly fond of picJdes, and of cold esculent vegetables uncooked from the garden ; some things are disliked, as pudding. There is occa- sionally a difficulty of making water. The bowels 134 THE MIMOSIS DECOLOR. are costive. The catamenia are rather less frequent, and less in quantity ; and their appearance has always been irregular, at six weeks, or at two months. — The following is my patient's own account 6f her present fitate of health : — * At first I had almost constantly a pain at my stomach, and sometimes in my head ; my hands and feet were generally cold ; 1 had often a fluttering at my heart, and a pain in my side, some- times in the right, and sometimes in the left ; 1 had also very frequently a pain in each side of my back, a little below the shoulder | my appetite was bad, and 1 was altogether exceedingly weak and feeble. My health is now much better ; I very seldom feel any of the complaints which I have mentioned, except the pain in my head ; what I suffer most from now, is the Gravel October SSnd, 1818.'-— February ^Sth, 1819. ^ In reply to your questions I beg to state that I have passed blood five times ; the first time was in the month of January, 1818 ; the second in March, the third in December, the fourth in January 1819. and the last on the 25th and 6th of this month. Previ- ously to passing the blood, I have always a pain on the left side of my bowels,' (the seat of the sigmoid flexure of the colon,) ' but not at any other time, ex- cept on coughing. With respect to the gravel I think that I brought you the first specimen last October, and the last in the beginning of this month.' 2-l<7. Case LVIIL Before I proceed to the exem- plitcation of the other forms of the Mimorls Decolor, DESCRIPTION, WITH CASES. 135 X wish to insert the following interesting case, whicU appears to unite in some degree, the character of thes more continued form of Mimosis Acuta with that of Mimosis Decolor. Mi^^s J aged 18. October the 29th, 1818. The breath has been tainted and the mouth has been foul and disagreeable, for many years* She first began to complain a good deal three or four years ago. During this interval there has been some- times pain of the head with vertigo and intolerance of noise ; sometimes pain of one, and generally but not always of the left, side, striking to the back ; some- times fluttering at the pit of the stomach, especially on lying down ; sometimes faintness ; often distressing fulness from wind at the stomach ; and frequently se- vere hiccough ; sometimes much gaping ; aching, hea- viness, and sense of numbness of the arms. The. nights are restless at first; and she is heavy for sleep in the morning. She is nervous, easily fluttered and startled by a sudden noise or other occurrence. The pulse is generally about 96, and often irregular. The bowels become tumid in the evening ; they are habit- ually costive. — The face is puflPed and bloated in gen- eral, and sometimes to a much greater degree than at present ; the complexion is sallow, with a dark yel- lo vness of the eye-lids and about the mouth ; just now there is a deepish diffused flu«h of the cheeks, but this is rare. The tongue is very white, loaded, and clam- my, with enlargement of the papillse ; the gums ex- ceedingly swollen ; the mouth in general, very dis^ agreeable, and the breath extremely tainted. The 13fl THE MIM05IS DECOLOR. ton«*ue occasionally becomes rather dry. The hands are puffed in a remarkable degree ; the fingers and nails of a light^ delicate blue 5 the tips of the nails white and opaque. The appetite is impaired. The bowels constipated and the operation of medicines scanty. The catamenia have been irregular until the three last periods, which have been regular ; their ap- pearance is natural in quantity and colour. 218. The following case exemplifies the form of Mimosis Decolor as it results from haimorrhagy :— 249. CaseLIX. S. B. aged 27. Dec. 3, 1818. She has been employed in ' mending/ 13 years. Her health suffered about six years ago, and she became affected with headach, and vertigo, the bowels be- came constipated, and the flow of the catamenia was attended with much pain. Three years ago she ceased to have the catamenia regularly, and some- times they were absent three months. About a year and a half ago she became pregnant, and subject to leucarrhcea. She lost much blood during labour, has suckled her infant, but has very little milk. At pre- sent the countenance, prolabia, and tongue, are ex- tremely pale and exauguious, — with a slight tinge of yellow, and a degree of darkness round the eyes. The tongue is pale, of a peculiar pale, transparent, lilac hue, clean, but marked by the teeth at the edges. The feet are slightly cedematous towards evening. The skin is generally dry, but the hands become DESCRIPTION, WITH CASES. 137 moist when she is fluttered. She has still heatlach and vertigo ; and a fluttering about the proccordia on the slightest hurry ; and some dry cough. Slie has also suffered from hiccough, and eructation. Her appetite is tolerable but she experiences a load after eating. The bowels still costive, — often two or three days without a stool. No catamenia since the birth of her infiint. She still continues her se- dentary work, 550. The following cases are examples of the In- veterate Stage of the Mimosis Decolor : — 551. Case LX. Miss M. F, aged 19, sister to the patient wliose case is given § ^39. Her com- plaints began in 1815, three years ago, and have during this interval been so various, multiform, and numerous as almost to preclude description or even a full enumeration. The case affords, however, such a remarkable illustration of the inveterate stage of the Mimosis Decolor, described § SS3, as to render it highly desirable that it should be recorded. — Even before the date of the commencement of this affection, given above, the general appearance of health and spirits in Miss F. was observed to have declined. She gradually lost her Colour and some flesh, became ner- vous, listless, dispirited, and fainty. Since 1815, she has been continually an invalid ; she has kept her room for many months, and her bed, for many weeks together. The countenance, prolabia, guiiis, and 138 THE MIMOSIS DECOLOR. tongue, the hands, fingers, and general surface, have become exanguious ; the face is rather tumid ; the skin opaque and puffy; the legs and ankles very (fidematous. There has been a very slow but gradual loss of flesh. The pulse is frequent, often about 100, but easily accelerated to much greater frequency. The appetite is various, and when any thing is taken, it is generally something of an indigestible nature : — once she took great quantities of pickles ; — at other times toasted cheese, or frizzled meat, is the only thing she can eat. The bowels have always been tor- pid. The catamenia have been suppressed for a con- siderable time. — This patient was confined to her Louse and to her room for several years. She has recovered, however, at length. Her sufferings have sometimes appeared to be partly corporal and partly mental. They were always aggravated by surprise^ agitation f or noise ; they recurred much in the even- ing, and in various succession. They were, as well as the REMEDIES employed, various, and multiform in the greatest degree. The detail will be given un- der the head of the Mimosis Urgens. 252. Case LXI. presents the inveterate stage of the Mimosis Decolor, under a different aspect. — E. B. aged 46, servant. April 10th, 1817. Her com- plaints have come on very gradually, beginning ten years ago. She had, at first, dull pain of the head, * pain of the left side, nausea, and sickness ; the bowels were constipated 5 and there was a difficulty in void- DESCRIPTION, WITH CASES. 139 iiig urine. — At present she has lost all of a good com- plexion ; the countenance is affected with a variable sallowness and yellowness, but the conjunctivaj are untinged ; both eyelids are affected with a puffy swelling, and with a yellow-black hue. The lips and gums are pale ; the mouth clammy ; the tongue is load- ed at the back but less so at the fore part, indented at its sides, and sometimes affected with swelling. The skin is always free from perspiration, and morbidly dry ; on the hands it is yellowish, opaque, and some- times puffy ; the nails have become brittle and break on the slightest occasion. The ankles swell in the evening. I? he is liable to headach. She is easily hurried and fluttered. She has sometimes fits of vio- lent coughing, which continue for half an hour, some- times with retching, but without expectoration. There is no dyspnoea. There is sometimes palpitation of the heart. The pulse is generally 96. The catamcnia are regular in their periods, but Avithout colour, and scanty; at each period the colour and quantity dimin- ish, and the flow is attended with greater nervous- ness. Tiiere is no dysury now, but the urine is scanty. The appetite is various ; she is fond of chewing tea- leaves. The bowels are costive. Purgatives with calomel, rhubarb, and aloes, were prescribed. — On May l6th the following report was made : — The com- plexion is greatly restored; the hands are become moist. She has gained flesh ; and all her complaints are relieved. The medicines were continued. — On August the 30th the following statement was made : — -t 140 THE MIMOSlS DECOLOR. This patient's complaints have varied, being better and worse, since the last report ; but on the whole they are aggravated, and especially lately. The pale- ness of the countenance is augmented, with less yel- lowness ; there is much oedema or rather anasarca, passing up the thighs even ; the pulse is more fre- quent, — about 108 ; the tongue is pale, white, swol- len and indented ; the bowels are kept open ; the catamenia appear regularly but are colourless : the urine is clear ; the apetite moderate. — After this date the anasarca gradually disappeared. But the patient remains still much as she was in May 1817- 253. The ensuing cases present the symptoms and appearances of the chronic form of the Mimosis De- color : — S54. Cask LXIL R. B. aged 33. April 7ib, 1817- She has been engaged in the sedentary occu- pation of chevening during fifteen years. She had formerly a good colour, which began to fade about three years ago. The bowels have generally been constipated. Her complaints have augmented consid- erably during the last year. — At present the counte- nance in general is pale and sallow, and the prolabia and gums are exanguious. The hands are also pale ; the skin dry and often opaque ; the general surface is deprived of its wonted perspiration. There has been some loss of flesh. There is some oedema of the ankles towards evening. The tongue, formerly loaded with DESCRIPTION, WITH CASES. 141 a disagreeable state of the mouth and tainted breath, is now moist and clean. Hhe suffers from variable pain of the head, which is sometimes severe, some- times absent, sometimes gradual, and sometimes sud- den in its attacks. Hhe is nervous. She experiences violent palpitation of the heart at times. No cough. Recurrent pain of each hypochondre, and of the back. The bowels are now regular ; they were formerly con- stipated, but never affected with diarrhoea. Ihe ca- tamenia are less in quantity, light coloured, and at- tended with much pain. The urine deposits a red sediment. — ^^On April the lOth, the complaints remain- ed nearly as before, with the exception of diminished pain of the head. — On May the 13th, all the com- plaints are diminished ; the complexion is much im- proved ; but the skin remains dry ; the headach and nervous symptoms have disappeared ; but she suffers from pain of the back ; she walks with far less fatigue. — The amendment in this patient was long progres- sive ; but she gradually relaxed in taking her gentle purgative medicines and daily exercise, and as she resumed fully her sedentary occupation she became again more or less liable to the symptoms and affec- tions of the chronic form of the Mimosis Decolor. 255, Case LXIII. C. R. aged S8, housemaid. The following complaints began six or seven years ago, and made a slow and varied progress until about a year ago, since which time they have been nearly as about to be described. At first there was a loss of 143 THE MIMOSIS DECOLOR. complexion and a sensible loss of flesh ; attacks of pain of the head and of the right hypochondre ; vertigo ; fluttering, and palpitation of the heart ; fits of violent dry cough, with retching ; alternate constipation and diarrhoea ; the catamenia attended with great pain of the back and lower part of the abdomen, and an ap- pearance of paleness and coldness in the countenance, with bhieness of the lips ; the flow, too, would begin in the morning, cease, and recur when she went to bed, the colour and quantity being nearly natural. — At present the countenance is yellowish and icterodc, with a little redness of the cheeks, but a general ap- pearance of paleness. This colour varies exceedingly, and there are alternations of paleness, and yellowness, w ith darkness of the eye-lids, at different times. The skin is often rather hot. The nails are split, sunk in the middle, and easily broken. The tongue is clean, moist, and almost natural. She su-ffers from attacks of pain occupying the crown of the head, and occur- ring particularly when she is employed near the fire, or more than usual. She experiences vertigo on stoop- ing. The pain of the right hypochondre often occurs during the morning, without obvious cause, and is of an achins: kind. There are sometimes fits of difficul- ty of breathing, which are compared to that of a per- son out of breath from active exertion. The fluttering and palpitation are induced, like the pain of the head, by working too near the fire. The pulse is nearly nat- ural. There has been no loss of flesh daring the last year, except perhaps a little in the face. There was ^^. PP:SCRIPTION, WITH CASES. 14i3 formerly a little oedema^ but not lately. She is affect- ed with leacorrhoea. — These complaints are already mitigated, and the complexion improved by adopting a course of purgative medicine. The leucorrhoca is quite removed by a lotion with sulphat of zinc, insert- ed, by means of a scroll of linen, into the vagina. — A still further amendment takes place in this patient : — the complexion improves, the mammae from being flaccid are now tumid and much enlarged ; she has during the last three weeks gained 2lb. of flesh ; the strength, capability of exertion, and the general health are equally much improved. — It is now fourteen months since she applied to me, and she continues well^ being fresh coloured, jolly, and free from her many painful complaints. The nails have much recovered, and the leucorrhcea is removed. Sj6. The following cases exemplify the appear- ance of the Mimosis Decolor in married females, and illustrate the paragraph, § 236 ; — 257. Case LXIV. Mrs. C. aged 32, and mother of seven children. April, 1816. This patient refers her complaints to mental distress : they took place in- sidiously, about five years ago, and three years and a half ago she was induced to apply to medicine. At first, Mrs. C. was affected with recurrent pain of the head, under the sternum, of the right side, and of the bowels. She was alternately constipated and affected with diarrhoea, but habitually of a costive habit.— At 144? THE MIMOSIS DECOLOK. present there is a pale yellowness of the complexion J the upper and under eye-lids are pulffy and dark co- loured 5 the Conjunctiva is white ; the face is apt to be somewhat swollen in the morning. The lips, guras^ and tongue are pale ; the tongue, formerly loaded, is now clean ; the breath, formerly tainted, is now inof- fensive. The hands ^rc very pale, sometimes a little puiTy. The ankles are apt to be (Edematous in the evening. The skin in general is yellowish and opaque, and always dry. There are great languor, listlessness, incapability for exei'tion ; and some loss of memory and mental energy. Formerly there was acute pain of the head ; lately the pain has been dul- ler, with vertigo, tinnitus, aurium, or a momentary defect of sight. There is some heaviness for sleep. She is easily hurried and fluttered. There is much despondency. The appetite is various, — -sometimes fastidious, sometimes voracious ; she is particularly fond of chewing grits. The alvine evacuation is very offensive. Mrs C's youngest child but two is four years old ; the youngest but one was born a year and a half ago ; the youngest nine weeks ago ; the cata- meaia had generally appeared once between each pregnancy, but this was not the case between the last but one and the last, which was not suspected until far advanced. Mrs. C. has scarcely been able to suckle her three last children. — This patient has recovered in a very great degree from her complaint, by a persevering use of calomel, and of rhubarb and aloe tic pills, and she enjoys at present a very good DESCRIPTION, AVITH CASES. 145 state of health. Her complexion is greatly improved ; but it is apt to be affected vvheuever she is accidentally indisposed ; at such times, too, she is reminded of her former painful complaints. 258, Cases LXV, LXVI, LXVII, and LXVIII. Mrs. T, aged 40, mother of a family, {she is affected with great paleness of the countenance, an exanguious state of the lips, gums, and tongue, and paleness of the hands, fingers, and general surface. 1 o these appear- ances are superadded the symptoms of the Mimosis Decolor. — This patient recovered from the administra- tion of gentle purgatives.^ — Mrs. C. aged 27, mother of two children. This is the most marked instance of the pale icterode countenance ; there is considerable darkness of the eye -lids, loss of colour in general, and an exanguious state of the prolabia, with the several symptoms of the Mimosis Decolor. — Gentle purgatives were prescribed, and the complexion and general health were gradually improved. — Mrs. S. aged 50, is affected with squalid paleness of the countenance, and darkness of the eye-lids, united with other ap- pearances, and the usual symptoms of the Mimosis Decolor. — She has begun the plan of gentle purga- tives.— Mrs. H. aged 60, was affected with the state of countenance, tongue, general surface, and symp- toms, observed in the Mimosis Decolor, together with an eruption of Urticaria in large wheals, without redness, sometimes solitary, but sometimes more uu- ^iner(ws, and appearing particularly upon the legs, T 146 THE MIMOSIS DECOLOR. ^9. Case LXIX. E. T. aged 35, engaged at the sedentary occupation of ' mending ^ May ^8j 1816. This patient's complaints began eight years ago. Daring this long interval she has suffered from severe pain of the head, of the left, and sometimes of the right, side ; faintness ; weakness ; nervousness, and despondency. The bowels have always been con- stipated. The catameuia appear regularly, but are very scanty and light coloured. From possessing a fresh complexion, she has become pale and yellow. The tongue, at first loaded, is become clean, and, with the lips and gums, very pale. The face, hamls, and ankles are apt to be swollen ; but especially the eye- lids, and particularly in the morning. The skin is very dry. About two years ago the nails became, from being strong, very thin, brittle, exfoliating in layers, and sunk in the middle. — This patient recov- ered in great measure by a persevering use of gentle purgative medicines. The complexion, surface, cata- menia, and bowels, became more natural -^S lie mar- ried about a year and a half after she became my pa- tient, and is now the mother of a fine boy. S60. The following case exemplifies the occurrence of the Mimosis Decolor, in its most marked form in the Male Sex: — g61. Case LXX. G. S. aged 37. May 5, 1819. Nearly 4 years ago he became affected with vomiting and diarrhoea. Since that time he has lost his health, DESCRIPTION, WITH CASES. 147 add has been subject to disorder of the stomach and bowels---constipation alternating with looseness, — with recurrent pain of the stomach and of the bowels. He lost his colour, flesh, and strength ; but first, and principally, his colour. 8ix weeks ago he was taken in the night with gaping followed by vomiting, by which some blood was raised of a black colour ; the bowels were costive, and he was aftected with vertigo. A month and a fortnight ago he again vomited blood, and the last time he passed blood by stool. He be- came extremely pale and sallow, and very feeble, and lost flesh. He complained of pain dulness, and heav- iness across the temples, and vertigo ; and during the last fortnight he has complained of fluttering and strong beating of the heart : of nervousness ; and some pain of the stomach and bowels.--- When I first saw him thje countenance was extremely pale and yellow, with some darkness of the eye-lids ; the pro- labia exanguious ; tll6 eyes perfectly white. The hands fingers and nails were pale and exanguious. He complained as stated, of the head, and of fluttering at the heart and stomach. Pulse 96 and strong. Tongue pale, white, and furred. No thirst. Stools Tvith flakes of mucus, without odour, and with blood of a dark colour. No disease perceptible in the abdo- men on examination. No cough or dyspncEa, A de- gree of shivering, l)ut no feverishness, or perspiration. He has been better and worse. — He has had haema- temesis three times, at intervals of a fortnight, having })een taken with gaping, nausea, and vomiting of 148 THE MIMOSIS DECOLOR. blood, mucus, and a little food. During one day, he voided blood by stool with mucus ; and he has long voided stools resembling tar in appearance. — 1 his af- fection began three or four years ago, — just at the time he exchanged his point-net frame in which he worked with a double thread, for one in which a single thread was worked. In the latter there is great danger of the thread breaking, by which acci- dent the sacrifice of several inches of the work, and if several perhaps an hour's labour, was obliged to be made. On these occasions, as he states, his heart would jump into his mouth, and his whole frame received a shock from which he did not recover per- haps for a considerable time. He also became ex- tremely timid, apprehensive, and nervous, in a very extraordinary degree. This, together with sendentari- ness, appears to have been the cause of his complaint. May 15. Purgative medicines have been continued regularly. He has had neither hsematemesis nor melseua. The stools for several days were flakes of mucus only ; they have gradually become more fsecu- lent. His complexion, the colour of the hands, appe- tite, and general health are much improved. But there is still much weakness, and some dizziness, and after a stool, a degree of fatigue with slight fluttering. He is far less nervous. He has ceased to lose flesh the last week. September 14, 1819. He has contin- ued uniformly to improve in strength, flesh, com- plexion, appetite, and in every respect, having better health now than for three or four years past. He has DESCRIPTION, WITH CASES. 149 however still occasional returns of paleness and sal- lowness, of dizziness^ and of the feeling of sinking. The pulse is 76 and natural in every respect. 262, The appearances and symptoms of the Mi- mosis llecolor have occurred in a boy of 14, much confined in school ; in a youth of 17? occupied as a tailor ; and in a young man of 20, a painter. 263. The different appearances and forms of the Mimosis Decolor are, I think, sufficiently illustrated by the cases already given ; I suppress, therefore, ma- ny others formerly intended for insertion in this work. The accession of this affection is slow and insidious in the highest degree ; the incipient stage sometimes re- quires many months for its developement, and occu- pies a longer period 5 tl\e confirmed stage frequently subsists for one or two years ; and the inveterate stage for an indefinite period, — being long stationary, lead- ing to the more chronic form, to the slow formation of dropsies, or organic disease^ or of a viscous affection, to a slowly progressive loss of flesh and of the powers of life. 264. The course of this affection is irregular. Sometimes purgatives medicines induce immediate re- lief ; but this does not continue ; a more slow, regular, and progressive amendment is usually more permanent. There are attacks of the urgent symptoms, and the i50 THE MIMOSIS DECOLOR, patienl; is better and worse, even during the general amendment. 265. The more acute form admits more readily of remedies than the more chronic, except in the invete- rate stage. But all our efforts are apt to be thwarted by want of perseverance on the part of the patient, by a return to a sedentary occupation or mode of life, and by a relaxation in taking the gentle, tonic purgatives to be recommended hereafter. 266. June 13, 1819. I have this day had the op- portunity of ascertaining by a caneful dissection, that in a case of Mimosi& Decolor, long considered a case of ' Liver Complaint,' there was no perceptible dis- ease of that or any other viscus. THE DIAGNOSIS. 151 SECTION II. THE DIAGNOSIS^ I. THE DIAGNOSIS OF THE GENERAL AFFECTION. 567. The Mimosis Decolor in general, requires to be particularly distinguished from the most Insidi- ous forms of Organic Disease. Its complications require, as I have stated § 227 ^ to be discriminated both from SuddFiN, and the Insidious, Local Af- fections. 568. From Insidious Organic Disease, the Mirao* sis Decolor is distinguished by the state of the com- plexion, of the general surface, and of the tongue ; by the variety and multiplicity of its symptoms, and of the organs or functions affected ; and by its irregular, varied, and protracted course. In Organic Disease the countenance is pale, perhaps partially flushed, or affected as described § 7% or ^ 101, and there is an expression of pain, uneasiness, or disease, with an ear- ly and progressive emaciation ; whilst there is an ab- sence of the peculiarity of countenance observed in the Mimosis Decolor, §§ 208, 215, 225, 229, 236, The surface in organic affection is equally destitute of the charatters given §^ 209, 216, 230, but, on the con- trary, often remains nearly natural, but is apt to be affect'cd by Hie different states of symptomatic fSr 152 THE MIMOSIS DECOLOR. brile affection. The tongue is free fmra tlie appear- ances described §§ 210, 2i7, S31, except when tlierc is disorder of the stomach superadded to the organic disease. There is an absence of the characters of Mi- mosis and of the Mimosis Decolor, §§ 1, 2, 207^ 235 ; Contrast further the description given of Insidious Organic Disease, §§ 71^ 197- 269. The state of the complexion, the tinge oF surface, and the seat of pain, in the Mimosis Decolor, lias very frequently led to the suspicion of Chronic DisKASE OF THE LiVER. The Diagnosis is made by an attention to the contrast of symptoms drawn in the last paragraph, by observing the state of the pro- labia, conjunctiva, urine, and fences, by ascertaining the recurrent nature of the pain of the side, and by a careful examination of the region of the Liver. — By these means the list of Chronic Diseases of tlie Liver would be considerably curtailed, for I can recall, at ibis moment, numerous instances of this error in Di- agnosis. This subject will be resumed shortly. THE DIAGNOSIS. 453 HE DIAGNOSIS OF THE COMPLICATIONS. S70 The patient affected with the Mimosis Deco- lor is liablfc to sudden attacks of the affections enu- merated § 22Q ; •and h* is liable to these affections in a recurrent or in a more or less continued form. This circumstance renders it necessary to distinguish the complications of this affection from the Sudden and the Chronic^ Local Diseases. S71. The Mimosis Decolor with Affection of the Head, is^ in various instances, mistaken for Sudden Tendencies or Congestions of Blo6d with regard to the Brain, and for Insidious or Chronic Inflammation of this organ. gya. Case LXXT. Mrs. C. of B. aged 15. She is affected with the Mimosis Decolor, characterized by a ring of deep darkness round the eye-lids, and a lit- tle cast of yellow tinge, but united with a full colour of the face and prolabia. The tongue is affected ; and there are the variety of symptoms denoting the Mimo- sis Decolor. This lady has fpr many years been sub- ject to attacks of violent pain of the head, ac- companied with a sense of constriction about the neck, for which bleeding, blisters and a seton, have been va- riously recommended by various practitioners. Thor affection continued to recur notwithstanding, for very many years, always inducing the fear of some attack u 154 THE jNIIMOSIS DECOLOR. of an apoplectic nature. It has yielded, however, to a persevering use of efficient purgative medicines. It has recurred from mental anxiety and the fatigue of company ; and there are shedding of tears, pain at the stomach, headach, &c, the complexion being aftectcd more on each attack. It has also more lately changed its form and induced attacks of pain at the stomach. S73. Case LXXIT. The first case in which I saw the importance of these distinctions, had been succes- sively treated as Inilammation of the lirain, and as lijlhimmatiou of tlie Liver, — by bleeding, leeches, and blisters to an almost incredible extent I 'Ihe patient was first long subject to severe pain of the head, and afterwards to pain of the right side. There were superadded the appearances and symptoms of the Mimosis Decolor. The patient perfectly and even promptly recovered, by pursuing an efficient course of purgative medicines. 274. If, in the sudden cases, the countenance, tongue, surface, and functions be distinctly afl^ected as in the Mimosis Decolor, there is a great jjresumpilon that there are only symptomatic pain and affection of the head. — The history of the case, and of the attack, will also assist the Diagnosis ; — the patient has been repeatedly liable to a similar affection, and the attack has probably been preceded or attended by unequivo- cal symptoms of the Mimosis Decolor* — The effects of THE DIAGNOSIS. , too remedies may also suggest the Diagnosis ; on this point some ohservations will be made in considering the treatment of the complications of the Miniosis Decolor. 275, With these remarks the reader may compare and contrast tlie following character of the Threaten- ing of Apoplexy. — ' An attack of apoplexy, or of paralysis, may be apprehended on the occurrence of any of the following symptoms ; especially if the per- son, by hereditary disposition, constitution, form of boily, age, or habits, be predisposed to these aiFections: — A sense of flushing and of fulness about the head, or epistaxis 5 heaviness, dull headach, vertigo ; un- usual drowsiness, or stupor, disturbed sleep, incubus, stertor ; forgetfulness, timidity, confusion of mind ; change of affections, and tendency to laughter or tears from apparent iuibecility ; affection of the senses, as temporary loss of sight, flashes of light, double vision? singing, or loud noises in the ears : acute pain or ten- derness of the scalp. But no symptoms are so mueh to be dreaded, as temporary numbness or torpor of any of the iimbs, or transient and partial weakness; a (le> feet or loss of voice ; a distortion and an unusual and unmeaning expression of the'coantenance.^ — There are vsomctimes sickness, and faintishness, and generally constipation of the bowels.'* S76. From Insidious or Chronic Inflammation or * Sec the trealise on Dii.a>-osis, Tart II, § 112. •* S 156 THE MIMOSIS DECOLOR. Disease of the Brain^ the complication of the Mimosis Decolor with Affection of the Head is also to be dis- tin2;uished by the state of the complexion, tongue^ and surface ; by the complexity and variety of its symptoms ; by the History of its course ; and by the recurrent nature, or varying degree, of the pain, per- haps with long intervals of ease. 277. The former affection is, on the contrary, de- noted and distinguished from this and from some other cases of complication, by a nearly natural state of the skin over the countenance and general surface, and of the tongue, and by definitiveness in the History and jjymptonis of the affection. Insidious disease of the Brain comes on with pain, variable perhaps in degree, sometimes of a dull and heavv, sometimes of an ex- crnciating kind, attended or succeeded by delirium, but generally soon leading to stupor ; the senses and muscular system are variously affected ; tlie muscular st^^ength, however, is often little impaired : the patient frecjuently takes food throughout the affection ; and there are often distention of the bladder or involun- tary discharges of uVine and faeces, even early in the disease. S78. The complication of Affection of the Head with the Mimosis Decolor, has, like the similar com- plication with the Mimosis Acuta, assumed the char- acter of Organic Disease; but this transition is less observed in the former case than in the latter. THE DIAGNOSIS. 137 579. The Cough and Dyspnoea in the Mimosis Decolor, § 22Q, are sometimes rather sudden, and sometimes more continued, affections. The former case occurs most frequently in the incipient, the latter in the Later stages of the Mimosis Decolor. 580. In the more sudden attack of Cough and Dyspnoea, the respiration is hurried and the nostrils are moved, and the cough is very distressing. This case is distinguished hy the character of the Mimosis Decolor, and by yielding to the exhibition of calomel purgatives. — The more continued case of Dyspnoea and Cough is far more alarming, and is often attended by organic affection within the chest. It is distin- guished from Phthisis Pulmonalis by contrasting the appearances of the Mimosis IJecolor with those des- cribed §§ 100, 101, as characteristic of the former dis- ease. — The Mimosis Decolor may, however, be com- bined or followed by Phthisis Pulmonalis ; the prog- nosis should therefore be very guarded. S81. The Palpitation of the Heart, symptomatic in the Mimosis Decolor, ^ S26, must be discriminated from Organic Disease of this Organ, by contrasting the symptoms of the Mimosis Decolor with tliose de- tailed § 107, as denoting the latter affection.* This complication is most frequent. It occurs in paroxyms, and often from mental causes. * See fiJrther the treatise on Diagxo«is, pp. 213—223, 138 THE MIMOSIS DECOLOR. ass. Pain and tenderness of the Side in the Mi- mesis Decolor, ^ 3S6, may also be sudden, or more or less continued. In the former instance it may be deemed Acute, in the latter. Chronic Inflammation of the Pleura, or of the Liver ; and under this impression, bleeding and blisters are too frequently the remedies employed, and the course of gentle purgatives is too much neglected. This pain is so common as to occur in most cases of the Mimosis Decolor. It is, therefore, doubly important to establish the Diagnosis. 283. The character, the symptoms, the multipli- city of concomitant complaints, and the History, suf- ficiently identify the state of Mimosis Decolor. But the questions remain, — is this affection combined with Inflammation, or is there only an aggravation of the Pain of the Side, so usual in it ? The presumption, a priori, is that the pain is not inflammatory. The Diagnosis may be further assisted by observing that the pain of Inflammation is generally regularly pro- gressive in its . formation and increase; stationary in its situation, and incessant in its duration : it induces a constant expression of pain in the countenance ; it is often aggravated by change of position ; and it oc- casions a cautious and modified state of respiration, arresting the movements of the chest, of the diaphragm, or of the part affected, and checking a full inspiration, cough, or loud expression of pain. The Pain of Side, so usual in the Mimosis Decolor, when it exists in an aggravated form, will be found, on a cautious and vig- THE DIAGNOSIS. 15^ ilant observation, to be various and irregular in its formation, site, degree, duration, and course : — its accession is either sudden or it follows the more com- mon state of Pain of the Side in the Mimosis Decolor ; its situation is varied, the side affected is sometimes changed, or it appears to move to some other part of the course of the colon, up the chest, or towards the back ; it varies in degree, being sometimes less severe, and sometimes excruciating ; its duration is uncertain, and it frequently ceases suddenly, perhaps to recur ; a full inspiration sometimes, although by no means tuiiformly, increases the pain, but a second inspiration usually induces less aggravation of the pain than the first ; there is also more urgent complaint, and more expression of suffering in the manner of the patient, than in Inflammation, which represses the movements of the body, respiration, and voice, implied in the out- ward expression of pain. In Inflammation the pulse is also accelerated, and affected in a degree not ob- served in the complicatioi^f the Mimosis Acuta with Pain of the Side.* 284. The diagnosis of the complication of the more Protracted Pain of the Side in the Mimosis De- color, from Insidious Inflammation of the Pleura, is, if possible, still more important. The character of the case of complication will be readily understood from the preceding observations. That of the latter ease shall now be attempted : — * See further the treatise on Diaojtosis, Part U, pp. 172, 179, 181. 160 THE MIMOSIS DECOLOR. 2B5, 111 Insidious or Protracted Inflammation "of the Pleura, there is an absence of the features of the Mimosis Decolor so often alluded to. The nostrils are rendered acute, and the alse nasi are raised by the influence of continued pain, and sometimes moved by the respiration. In protracted cases there are thin- ness of the face, and partial flushing on the cheeks. The general surface remains long natural, but if the afPection continues or advances, there are emaciation, and tendency to hectic heat of the hands, and perspi- ration more generally. The pain is constant, or con- stantly induced by a full inspiration. There is often a dry painful cough, suppressed by the patient. The pulse is frequent. — This affection sometimes remains stationary for a long period ; in other cases there is a progressive loss of flesh and strength, with chronic symptomatic fever ; and in a third case there is the gradual formation of Hydrothorax.* S86. Pain and tenderoMs of the Abdomen in the Mimosis Decolor, § 226, m distinguished from In- flamation, by the same means as pain and tender- ness of the side, § 283. I shall illustrate the sudden or urgent attack by the following case^ and shall af- terwards give the characteristics of the case of Pro- tracted Inflammation of the Peritonaeum. 287. Case LXXIIT. Mrs. B. of S. aged 45, and mother of five children, has been affected with some * See the treat ;«? on DiARTre^is, Part. IT, § 1?>. THE DIAGNOSIS. 161 part of the following symptoms for several years, and especially since the death of Mr. B. three years ^go. — ihe countenance is pale, wan, and yellowish ; the ' prolahia pale ; the tongue slightly lohulated, and clean ; the bowels irregular. — On heptemher the 3rd, 1818,' »he was seized w ith hurry and difficulty in breathing ; with pain in the bowels, much tenderness of the ab- domen under pressure, and with discharges of blood. The affection was completely removed by calomel, senna, and sulphat of magnesia. A little ptyalism was induced, and the patient abandoned all her med- icines. The affection again returned. A grain of opium was prescribed for the symptoms, which in- duced great sickness and restlessness. Calomel was again resorted to ; and a cautious course of this and other purgative medicines, has entirely removed the more urgent complaints, and greatly improved the general appearance, health, spirits, and strength. 288. Protracted Inflammation of the Peritonaeum is denoted by an expression of pain, of suffering, and of disease, in the countenance, attended by loss of flesh 5 the skin in general is little affected, except at last, when it is modified by a state of chronic symp- tomatic fever ; there is a slow, but progressive ema- ciation ; the pulse becomes very frequent ; there is a diffused tenderness over the abdomen ; there are at- tacks of retching and vomiting, of obstruction of the bowels, or of diarrhoea. — The progress of the case is various : it is sometimes protracted for eight, or ten w 16^ THE MIMOSIS DECOLOR. months, or even longer, when there are complete hec- tic and atrophy.^ — In the Protracted Pain and Ten- derness of the Ahdomen ioi the Mimosis Decolor, there is often a loaded state of the Colon, and sometimes a perceptible tumor in the right or left side or iliac re- gion, or in both, from the remora of faeces in the course of this intestine ; and there is constipation, or diarrhoea, and sometimes Melsena or discharges of blood, sometimes florid, sometimes dark, and some- times tar- like, t 289. Melaeua, § S26, has frequently, but by no means exclusively, occurred in married persons af- fecteil with the Mimosis Decolor. I shall illustrate the subject by the following cases : — 290. Case LXXIV. Mrs. E. of L. aged 40, and mother of a iamily. I was consulted by this lady^ who resides fifteen miles from Nottingham, on the following occasion : — She had been seriously indis- posed for some weeks, during sofiie part of which pe- riod she had kept her bed, and had become extremely weak, and had lost flesh ; the most urgent complaints w ere great irregularity and intermission of the pulse, with a severe sense of fluttering in the chest, which * The subject of Ixsi»ious Inflaxmatiox of the BxcEPaALOX, or the PiECBA, AUB OF THE Pebitosjeum, WHS intended to have been illustrated bj Cases in a note in this place. But it is found too extensive. It is therefore reser- ijed for a future opportuuity. -j- See Miss G*8 case, § 246. THE DIAGNOSIS. 1(].S liad led to the suspicion of Organic Disease of the Heart together with diarrhoea and Jlelcena. — On in- quiring into the History of the affection^ 1 found that Mrs. E. had lost her complexion, appearance of healthy strength, and some flesh, four or five years pre- viously, and that the irregularity of puls€, and the melsena, were not new complaints. The countenance was pale and yellowish ; the prolabia and gums pale ; the tongue formed into lobules ; the hands and gene- ral surface pale and dry. There was some affection of the head and a degree of hurry in the respiration, with some cough. — This affection was soon relieved l)y calomel and gentle purgative medicines ; and the general health and the complexion have been greatly improved by a continuance of the same plan under proper regulations, and with strict attention to diet, air, and exercise. 291. Case LXXV. Mrs. H. aged 55, and the mother of a family, became indisposed, from grief and anxiety, about three years ago. The causes of her com- plaints were repeated, and her indisposition became gradually more and more serious. 8he lost her com- plexion and flesh, became subject to cedematous sv» el- ling of the ankles and legs, to vertigo, fluttering and palpitation, and to a state of diarrhoea attended with discharges of blood, with tenesmus or forcing, and with prolapsus ani. Once the oedema assumed the more serious form of anasarca, but was much dimin- ished, whilst the general health was much restored, 16* THE MIMOSIS DECOLOR. by along journey. For the affection of the bo\vels> IVivs. H. was obliged to have recourse to the tinctura opii. 55Juch was nearly the state of her complaints about a year ago. The countenance was yellow and icterode : the integuments yellowish, puffy and opaque; the conjunctivge quite white. The pulse was a little frequent. Not a day passed without the painful and wcalvening attack of looseness, with discharges of blood, and descent of the rectum. She was recom- mended small doses of the pil. hydrarg. and of rhu- barb ; and to diminish the quantity of laudanum as much as possible. By perseverance in this mode of treatment, the general health and strength are much improved, and all the other symptoms mucli mitigated ; she has been enabled almost to leave off her lauda- num, to walk a distance of three miles to Nottingham and back again in one day, and to superintend her domestic concerns with far more ease and comfort. The complexion is still yellowish : but there is a little return of colour in the cheeks ; and her amendment continues obviously progressive. —The prolapsus ani had taken place previously to the present complaint, but was very much augmented by it. She had also suffered from several miscarriages. 292, Menorrhagia and Leucorrhcea are frequent occurrences in the {♦'iimosis Decolor ; they are fre- quently ihe concealed cause of the inefficacy of reme- dies for the original affection, and of a most distress- ing weakness and pain experienced in the loins. — THE DIAGNOSIS. 163 This affection also occurs from some other causes, as frequent labours, or abortions, too long lactation, or other sources of debility ; it then appears to induce the pain and weakness of the back just mentioned, flut- tering, nervousness, and other symptoms of Mimosis. It is removed, I think, universally, by the remedy to be noticed hereafter. 293. Case LXXVl. E. S. aged 40. May 3, 1819. For half a year she has been affected with menorrha- gia without intermission. Before this she was long affected with Leucorrhoea. Both these complaints have been removed by the zinc lotion and opening medicine, which was required by costiveness. The tongue was lobulated and she had many of the symp- toms of Mimosis, — vertigo, fluttering, &c. 294. The subject of Hysteric Affections, § 226, is reserved for the ensuing chapter. 166 THE MIMOSIS DECOLOR. SECTION UI. THE CAUSES AND TREATMENT. 295. No age, sex, condition, ox mode of life, en- joys a perfect immunity from the Mimosis Decolor ; but it occurs most frequently in female youth, and next, in women in the decline of life. 296. The most frequent cause is Sedentariness. This affection is, therefore, usually observed in schools, in females of a delicate mode of life, or of a sedentary occupation or habit. The Mimosis Decolor is the pre- vailing affection of those females who, in this and other manufacturing towns, are doomed to sit from morning till evening at the lace-frame, or the tam- bour, or engaged in mending, seaming, chevening, &c. — Servants, and especially house-maids and cooks, have also appeared to be particularly liable to the Mimosis Decolor. 297. Confinement ; too long lactation ; fre- quent H-EMORRHAGIES ; PROTRACTED, OR, LONG CON- TINUED HABITS OF MENORRHAGIA, — AND OF LEU- coRRHCEA ; anxiety; fatigue; and loss of rest, have also appeared to induce the Mimosis Decolor in persons more advanced in years. THE TREATMENT. 16? 29S. Tt is needless to say that, in the treatment, it is absolutely necessary to avoid or obviate the causes of the affection; otherwise the complaint continues progressive, or assumes the chronic form. — The treat- ment itself consists in the administration of the reme- dies and regimen already recommended for the Mi- mosis Acuta and Chronica, properly adapted to the case of the Mimosis Decolor.- S99. Five grains of calomel may be given once a week, once in ten days, or once a fortnight. On the intermediate days, a sufficient, consistent al- viNE EVACUATION must be procured by pills of aloes and rhubarb, or by the infus. sennse with the sulphat of magnesia. 300. Daily Exercise, riding or walking, morning, noon, and evening, — and a total change of Air and of Habits must be strenuously recommended. 301, The same attention to Diet is necessary a& before. I«ean mutton, beef, or fowl ; biscuit ; tea, or coffee ; and after a time, a little ale, or negus, are4h& articles of diet principally to be recommended. Veg- etables in general should be avoided as much as pos- sible, especially greens, and even bread. 303. For other observations on the treatment of the Mimosis Decolor, I must refer my readers to the re- marks made formerly, §§ 158 — 183, 198 — 503, which 108 THE MIMOSIS DECOLOR. will sufficiently suggest what I might add in this place. I have also prescribed the preparations of Iron. But as they have never been trusted to alone. 1 have not been able to ascertain precisely the effects of this remedy. 303. The Local Complications in the Mimosis De- color generally yield to the proper treatment of the general affection^ especially purgative doses of calo- mel. And this is satisfactory, and a coniirmation of the Diagnosis. 304. But in dubious cases, it may be advisable io employ remedies for the local affection itself, 'i'hese consist of bleeding, leeches, and blisters, especially the latter. — in the case of Affection of the Head, it is prudent first to bleed and apply a blister in order to remove the immediate attack; and to follow this treatment by the proper remedies for the Mimosis De- color, by means of which the recurrence of affection of the head, and of the necessity for a repetition of the former remedies, may in general be obviated, — The same remarks apply to the Painful Affection of the Side or Abdomen, — In the case of Diarrhoea or Me- Isena, the pil. hydrarg. and calomel afford the most efficient remedies ; they must, however, be conjoined with rhubarb or other gentle purgative, during the intervals of giving the former medicines. 305. The remedy for Menorrhagia and Leucorrhcea formerly alluded to is a continued local application of THE TREATMENT. 169 a solution.of sulphat of zinc, in the proportion of from one to two drams and a half, to a pint of pure water. A similar solution has long been employed in cases of Leucorrhoea, injected by means of a syringe. This mode of application I have found altogether inefficient in protracted cases of the aftecti; n ; the application being momentary only, the effect is transitory and the remedy itself proves inefficient. The mode I have adopted, is to direct the patient to make a scroll of linen, of a form and bulk nearly sufficient to fill the vagina ; this scroll is then fully imbued with the so- lution of sulphat of zinc, inserted, after Washing with cold water, and renewed every three hours. X CHAPTER IV. THE MIMOSIS URGENS. SECTION I. THE DESCRIPTION. 306. I HAVE ventured to substitute this denom- ination for the very objectionable term, Hysteria^ The adjective expresses that character of hurry, and of apparently imminent danger, so usual in almost all the forms of this affection, • and will be understood by every reader by being associated with an English word, to which it gives origin. 307. The Mimosis Urgens, besides the character- istic just mentioned, is generally denoted by combin- ing some considerable emotion of the mind, denoted by SIGHING, SOBBING, TEARS, OR LAUGHTER, WITH A SENSE AND EXPRESSION OF SUFFOCATION, AND WITH SOME URGENT AFFECTION OF THE HEAD, HEART, RESPIRATION, STOMACH, OR MUSCULAR SYSTEM. 308. The Mimosis Urgens most frequently occurs as symptomatic of the Mimosis Decolor, or of the THE DESCRIPTION. m more continued form of the Mimosis Acuta. But it is occasionally induced by severe mental emotions, as excessive joy or grief ; and a less curable form of the affection has been occasioned by surprise, but espe- cially by fright. 309. Of the Mitoosis Urgens there are three fortns, — the Mild, the Severe, and the Inveterate ; and there are mostnumerons modifications, 310. The Mild Form of the Mimosis Urgens sub- isists as a tendency to alternate high and low spirits, to fits of laughter, to frequent deep sigliing, and to tears. A fit of laughter, or of crying, sometimes takes on an aggravated character ; the laughing, or the sobbing, becomes immoderate, convulsive, and involuntary, and there is frequently a peculiar spas- modic chucking in the throat. The countenance changes, being alternately flushed, and pale, and de- noting great anxiety. There is frequently an urgent difficulty in breathing, with much rapid heaving of the chest. Sometimes a dry, spasmodic, and violent fit of coughing occurs. There is generally a sense, and appearance, and an urgent fear of impending suffocation. In different instances there is palpitation, hiccough, retching, or borborygmus. The patient is despondent, and aggravates all her sufferings. 311. The severe Fortii of the Mimosis Urgens Con- sists in a various attack, catenation, or combination of the following symptoms : — 17^ THE MIMOSIS URGENS. 313. The commencement, course, or termination of this and indeed of every form of the Mimosis Ur- gens, is generally marked, and the case distinguished, by the signs of some inordinate mental emotion, — joy, grief, or other affection, — which constitute the most characteristic symptoms of this disorder, and have appeared to be literally hysterical, 313. The attack is frequently ushered m by an unusual appearance of the countenance, — a rapid change of colour, rolling of the eyes, distortion or spasmodic affection of the face. The extremeties are apt to become very cold. 314. A state of general or partial, of violent or of continued convulsion, or of fixed spasmodic contrac- tion, takes place, and displays every possible variety in mode and form. 315, The severe form of the Mimosis Urgeus some- times consists chiefly in a severe, general or partial pain and throbbing of the head. Occasionally this pain is confined to one particular spot, and is so acute as to have obtained the appellation of clavus hysteri- cus. Sometimes there is in olerance of light and noise. Sometimes a state of stupor; sometimes de- lirium, 316. The respiration is frequently much affected ; — an oppressive and suffocative dyspnoea takes place ; THE DESCRIPTION. 173 or the breathing is rapid, anxious, and irregular ; or variously attended with sobbing, sighing, much rapid heaving of the chest, and sometimes with a spasmodic action of the diaphragm inducing a peculiar elevation of the abdomen, or an equally peculiar succusory movement of the trunk in general ; sometimes the respiration appears to be suspended altogether for some time, the pulse Continuing to beat as before. 317. A crowing noise, or screaming, is apt to oc- cur in this affection. There is occasionally. Hoarse- ness, or even an entire Loss of the Voice, continued for some time. 318. There is sometimes a painful, violent, dry, hoarse cough, continued, or recurrent in paroxysms, 319. There is occasionally acute Pain of the Chest or Abdomen. 320. Palpitation of the heart, and syncope arc usual affections in the Mimosis Urgens. The pulse is otherwise little affected. 331. There is frequently an urgent sense of suffo- cation, accompanied with the feeling of a ball ascend- ing into the throat ; this symptom is so peculiar as to have obtained the denomination of globus hystericus, and is considered as diagnostic of this affection. Hic- cough, and violent singultus ; retching and vomiting: 174 THE MIMOSIS URUENS. the sense of a ball rolling within the abdomen 5 bor- borygmus ; a peculiar, great and sudden tumidity of the abdomen, apparently from flatus ; constipation, &c. are usual symptoms in the Mimosis Urgens, and sometimes occur in paroxysms^ and sometimes assume a more continued form. 3S3. There is frequently difficulty or retention of urine, succeeded by a very copious flow of limpid urine. 3S3. The Inveterate Form of the Mimosis Urgens, — id enim vitium quibusdam feminis crebro revertens perpetuum evadit, — consists sometimes in an almost perpetual agitation of some part of the body, the limbs, the respiration, the throat, or the stomach ; — and sometimes in a state of continued contraction of the hand or foot, or of some other part. In different instances too, there is a continued stj^te of nervousness or agitation from tbe slightest noise or otlicr cause, — of paralytic, epileptic, or spasmodic disease^— or of imbecility of the mind. 3^4. The attention has, I think, been too exclu- sively directed to the paroxysm of convulsion in this affection. Some of the other varieties in the attack of the Mimosis Urgens, are almost equally frequent. This affection is characterized, indeed, by affecting in the same, or in different instances, singly or con- jointly, ALL THE SEVERAL SYSTEMS whlch COnsti- THE DESCRIPTION. 175 tute the human frame ; — the organs of animal and of organic life ; — the different sets of muscles, voluntary, involuntary, mixed, and sphincter ; — the faculties of the mind, and the emotions of the heart ; — the func- tions of the head, the heart, the stomach, &c. It is in thus viewing the Mimosis Urgens, that the diag- nosis is often formed between its different and very various attacks, and other affections iiaviug a different origin, but of which it as the imitator — nam nullos fere non cemulattirjdx lis affectibus quibus atteruntur miseri mortales.* S25. The varieties of the Mimosis Urgens are more numerous even than those of the other forms of Mimosis. They are also more acute, urgent^ and vi- olent. The following list it is hoped, will be found tolerably complete : — 1. CONVULSION. 2. PAIN OF THE HEAD. 3. DELIRIUM. 4. STUPOR. 5-. PAIN OF THE CHEST. 6. DYSPNOEiis. 7. VIOLENT COUGH. 3. SUSPENDED RESPIRATION. % A PAINFUL AFFECTION OF THE DIAPHRAGM- 10. IMITATION OF CROUP ; AND OF 11. IMPENDING SUFFOCATION. 12. PALPITATION OF THE HEART. 13. SYNCOPE. * Vide Sydenham: de Affectione Hysterica. 176 THE MIMOSIS URGENS. 14. PAIN OF THE ABDOMEN. 15. HICCOUGH. 16. RETCHING AND VOMITING. 17. DYSURY. 18. RETENTION OF URINE. 19. APPARENT PARALYSIS. 20. TRISMUS. 21. TETANUS. 22. CONTRACTED HAND. 23. DISTORTED FOOT. 24. TWISTED LEGS.t 326. The attack of the Mimosis Urgens^ iindev almost every modification, is acute, sudden, and hur- ried ; the diagnosis must therefore be instituted be- tween this disorder and those morbid affections which occur suddenly or in paroxysms. The diagnostics will be attempted in the ensuing section. 327. It appears needless to exemplify the Mild Form of the Mimosis Urgens, § 310. 328. The Severe Form of this affection, §§ 311 — 322, is exemplified in almost all its varieties, by the following Case, continued from § 251 :— 329. For some time there were returns every morning, of violent pain of the head, with intol- erance of light and sound, — of which she is, indeed generally very susceptible. For several months, there were evening returns of delirium, with incessant f See Section If, THE DESCRIPTION. . 177 talking, singing, crying, or laughing, — usually end- ing in sleep. A number of times, but iiregularly, there were attacks of stupor, from which she could not be roused, and which would continue during two hours. There has often been pain about the STERNUM, spreading over the chest and to the shoul- der points, apparently requiring, and yielding to bleeding from the arm. With pain of the chest, there has often been very rapid, spasmodic breathing, demanding free exposure to the fresh air at an open window. At other times, there has been an apparent suspension of respiration, durihg many minutes, the pulse still, however, beating; the breathiug gradually returned with a sort of crowing noise like the hooping cough. At one period there Avere even- ing returns of violent and incessant coughing, which once continued from 7 p. m. till 3. a. m. with- out intermission ; the cough ceased gradually and at length seemed scarcely to be a cough : it was relieved by bleeding, laudanum, breathing the vapour of hot water, &c. There has been palpitation of the heart, but not in violent attacks. There has not been much fainting affecting the pulse, except from bleeding. For many weeks there have been constant sickness, vomiting, and irritability of the sto- mach, every thing taken being immediately rejected. For a few times, there has been Violent hiccough ; this was arrested by a preparation of opium termed the black drop. There has ever been great consti- pation. Once there were the symptoms of in- Y 178 THE MIMOSIS URGENS. FLAMMATioN IN THE ABDOMEN^ Avitli great ten- derness under pressure. There has sometimes been complete Opisthotonos, the body being drawn and suspended on the occiput and toes for several minutes ; then it would be drawn in a variety of other difterent Mays. Inhere have been general and violent con- vulsions of the body. There has often been Lock- ed-jaw, — once for eight weeks together, and several times for shorter periods ; — the under lip is then some- times drawn between the teeth and bitten. The hands are often clenched, and the limbs drawn in a twisted manner round each other. There has been a loss of sight, of hearing, and of the use of some of the limbs. The catheter was daily used for retention of urine for many months, but at length it became unnecessary. She has twice complained of pain of the spine about the loins, which has, like the other symptoms, disappeared after a time. — From a perusal of this deplorable list of complaints, the young stu- dent will be prepared what to meet in similar cases of Mimosis Urgens. 330. The Inveterate Form, § 323, is also illus- trated by the same case, for it has at length assumed that form. The following case amongst numerous others, also presents an example of this stage of this singular affection : — 331. Case LXXVIT. M. H. aged 30. Septem- ber I6th, 1813. Her mother states that her com- "THE DESCRIPTION. i^O plaint began fifteen years ago, and that during the Isisifive years she has been unable to rise unassisted from her bed. During the whole of this period she has been subject to hsematemesis, retching, and vomit- ing, and to constipation of the bowels. — At present there are great nervousness ; starting from the slight- est noise ; agitation on the approach of a stranger ; general rapid and forcible tremor, so that the pulse can scarcely be felt ; and an almost similar afl'eciiou of the respiration ; there is the strangest alternation of spasmodic heaving of the chest and protrusion of the abdomen ; the nostrils and the head are moved at each respiration ; there is often retching ; aud fre- quently retention of urine. The state of agitation is permanent. The aflection is, at different times, at- tended with pain of the head, and a sense of uneasi- ness about the throat, and at the scrobiculus cordis^ 18a THE MIMOSIS URGENS. SECTION If. THE DIAGNOSIS WITH CASES. 83^. The cases of the Mimesis Urgens requiring to be discrimioated from other morl)id affections, will fee pretty fully understood on a perusal of the list given § 355, The Diagnosis is founded partly on the peculiar and different appearance of the particular cases of the i/iimosis Urgens themselves ; and partly en the precursory, concomitant, or successive occut- rence of some unequivocal symptom of the Mimosis Urgens, and especially of the appearances of mental emotion, &c. noticed § 312, and of hurry and appa- rent urgency of complaint in general. 333. It is, in particular, in this manner that the paroxysm of Convulsion in the Mimosis Urgens, §314, is to be distinguished from Epileptic or Puerperal Convulsion. The case unites the appearances des- cribed, §§ 314, 316, &c. There is probably some symptom of mental emotion ; or some appearance pe- euliar to the Mimosis Urgens, especially the hurried and heaving respiration ; or some circumstance in the History of the attack, which may lead to the Diagno- sis. Otherwise the physician must wait awhile and watch the course of the affection, and the succession of symptoms ; in this manner some symptoms decided- THE DIAGNOSIS, WITH CASES. 181 ly peculiar to the Mimesis Urgens will occur to prompt the discrimination. In the Epileptic or Puerperal Convulsion, there is an absence of these symptoms, — of mental emotion, — and of the appearances formerly deemed hysterical, ^ 31S; and the patient seems to be rather a prey to some power which exerts a violent empire over the source of sense and muscular motion. The Mimosis Urgens may excite alarm ; but the Epi- leptic or Puerperal Convulsion presents a far more dreadful aspect, — the face perhaps becoming deeply flushed and livid, — with foaming at the mouth, — more shocking distortions of the countenance and of the body, and a very diff'erent, and a more serious affection of the respiration.* J3y these means these affections will generally be distinguished. The stu- dent will do well to study the general aspect and course of these affections, in order to attain an aptness in their Diagnosis. 334<. The affection of the Head in the Mimosis Urgens, § S25) is exemplified by the following cases : 335. Case LXXVIII, Miss F. aged S3, the patient whose case has been already noticed, § 239, became affected on September the Slst, 1818, with severe pain, and throbbing of the head, with intolerance of light and noise ; she was bled several times, without relief. I saw her on the S4th. The pain of the head still appeared to be excruciating ; she cried out on its^ * See fuFther the treatise on IMagxosis, Part II, §§ 2('0, 29 1, 18S THE MIiMOSIS URGENS. being moved on the pillow by the nurse ; she experi- enced great throbbing, and intolerance of light and noise, — the curtains were drawn, and the bells in the house were ordered not to be rung. She stated too that she experienced some pain of the left side. On my entering the room, there appeared a slight mental aflection,— and shedding of tears. The pulse was from 110 to 130. The countenance was pale and ex- anguious ; the hands pale, delicate, and puffed. There was a degree of anxiety or hurry. The motions had been scanty, dark coloured, foetid, and scybalous. — This affection yielded most favourably to purgative medicines, as already stated. 336. The occurrence of Delirium is not very fre- quent. But I have w itnessed it repeatedly. The case is identified by the occurrence of some symptoms peculiar to the Mimosis Urgens.— Delirium is noticed as occurring in the case detailed § 329. 337. The occurrence of Stupor as a form of the Mimosis Urgens is by no means unfrequent. The case seems to be of the most urgent nature. 338. Case LXXIX. Some time ago, I received an urgent call to visit a poor woman said to be in an alarming state of insensibility. She was found with- out sense or motion, but, in other respects, unaffected with any particular symptom. The medical attend- ant had prepared his lancet to open a vein in the arm. THE DIAGNOSIS WITH CASES. i83 In a short time, bowever, the patient recovered her- self, and manifested symptoms which are peculiar to the Mimosis Urgens. — In another case which occurred in an aged woman, a vein had heen opened under the idea that she was affected with Apoplexy. Some symptoms of an anomalous kind occurred, and she he- came affected with an unequivocal attack of the Mi- mosis Urgens. — In similar or duhious cases it is pro- per to wait, and observe the change of symptoms, and particular inquiry must be made into the History, mode of attack, &c. of the affection. Perhaps the patient soon opens the eyes, sighs, is affected with dyspnoea, or bursts into tears. In general some un- expected and anomalous symptom occurs, to denote the nature of the affection. 339. In the Pain of the Chest in the Mimosis Ur- gens, enumerated § 335, the countenance is expressive of great anxiety, hurry, and agitation, and the nostrils are moved with rapidity. The patient complains much, manifests great impatience, is urgent for relief, and calls out from the pain. The pain of the chest is extremely acute, and the part affected is described as excruciatingly tender on being touched, and the hand applied to it is usually pushed rudely away. 340. With or without the pain of chest, there is often an urgent Dyspnoea ; the respiration is rapid, hurried, with much characteristic heaving of the chest, sometimes with great and rapid movements both of 18-4 THE MIMOSIS URGENS. the chest and abdomen, and often with a peculiar hissing noise. 341. The Cough occurring as a form of the Mi- mosis Urgens, is exemplified § 3S9, It occurs in continued fits of incessant coughing ; it is frequent, hoarse, and hissing ; — aeger creberrirae tussit, fere sine intermissione, nihil prorsus expectorans. 342. Case LXXX. A. T. aged 2% has long been engaged in a sedentary employment, and has suffered from some of the symptoms of the Mimosis Decolor, — paleness, pain of the side, dry cough, and dyspnoea, and, when visited, was affected in the fol- lowing manner. There were the utmost anxiety of countenance, and great general agitation and impa- tience. The breathing was hurried, with a dry hiss- ing sound in the throat, with much rapid heaving of the chest ; there was a dry, hoarse, frequent, continued cough. The pulse was little affected. The skin na- tural. The bowels constipated. — She was soon re- lieved by an sether draught and liniment, and her general health was restored by purgatives. Previ- ously to the employment of these measures, she had been bled without any good effect, and indeed her symptoms were aggravated rather than relieved. 343. The case of suspended Respiration is noticed § 329. It is not the least urgent of the forms of this affection. THE DIAGNOSIS WITH CASES. 185 341^. The painful aflPection of the Diaphragm in the Mimosis Urgens is attended by the most acute pain in the epigastric region, extending to each side along the false ribs, and to the back ; it is augmented occasionally by moving, or by the action of the dia- phragm in respiration, and causes the patient to cry out; the respiration is irregular, perhaps performed by the chest alone ; the nostrils move, the face is some- times flushed, and there is often shedding of tears. 345. These cases are distinguished from Inflam- mation, by the History, — the occurrence of symptoms peculiar to the Mimosis Urgens,— the mode of attack which is sudden, — and the general aspect of the case which is hurried and urgent, — contrasted with the character of Inflammation already given § ^83 . 346. The Imitation of Croup by the Mimosis Ur- gens takes 'place in such a manner as to deceive a cursory observer. The respiration and the cough have precisely tlie character of these symptoms as occur- ring in Inflammation of the Trachea. It is by in- quiry, waiting, and by cautiously observing the case, that the Diagnosis is to be instituted. On inquiry, the attack will probably be found to have been mark- ed by some symptom or character of the Mimosis Urgens; or by waiting, some such symptoms may occur to develope the mystery. The case is sometimes soui'gent as apparently to demand an operation to prevent an impending suffocation.* * See also Mr. ChuHes Bcirs Reports, Vol. 1. p. 40. Z 186 THE MIMOSIS URGENT. 347. Case LXXXI. In a young woman aged 15^ tlic first symptoms which arrested the attention was a stridulous sound of the respiration ; and circum- stances conduced to render an attack of an inflamma- torjf nature probable, bhc had been conveyed through the cold air, and appeared to be livid from cold. On being seen in bed, however, the nature of the disease became obvious, from the presence then, of globus, from th-e History, by which it was ascertained that other symptoms of the Mimosis Urgens liad occurretl, and from the absence of any affection of the pulse. — The patient was speedily relieved by the operation of a purgative medicine. 318. Palpitation and Syncope in the Mimosis Ur- gens are distinguished on the same principles of ob- serving the History of the case, assisted by the ob- servations made § IO7. 349. The Pain of the Abdomen in the Mimosis Urgens is attended with great urgency of complaint; much anxiety and suffering ; an extreme tenderness, to the slightest touch, rather than under pressure ; a hurried and irregular state of breathing, &c. The countenance is expressive of an urgent anxiety ; the patient is restless, impatient, and irascible, and pushes the hand although gently applied to the abdomen rudely away ; the general surface, and the pulse are, at the same time, little affected ; there is sometimes vomiting, or a sort of retching : the bowels are gene- rally constipated. THE DIAGNOSIS, WITH CASES. 18/ ii50. Case LXXXII. M. W. aged 35, aMd cor- pulent. She has several times been suddenly attacked with the following affection. She complains of great pain and tenderness over the abdomen ; but she mani- fests a tendency to exaggerate all her comphiiuts, which are stated with a degree of instance and impa- tience not observed in inflammation. She refuses to allow any examination of t1ie abdomen, pushing the hand rudely away. There is also a degme of hurry in the breathing. The manner is altogether different from that of a patient affected with inflammation.* — To these symptoms, others peculiar to the Mimosis IJrgens succeed. — The patient was effectually relieved by the operation of a purgative medicine. 351. The Hiccough or the Retching is sometimes of the most violent kind, and is apt to be loog con- tinued. • 353. The Dysury or retention of Urine is very common as a form of the Mimosis Urgens. Its du- ration is usually short. But it has continued occa- sionally for a long period ; see § 3S9. It is distin- guished by being combined with other jsymptoras of this affection. 353. A partial, but transient Paralysis of some of the limbs, § 325, has occasionally occurred in the Mimosis Urgens. * See the Ircalise on Diaoxosis, Piiit JI. § Ifii. 18^ THE MIMOSIS URGENS. 354. Trismus, Tetanus> Clenched Hand, or Con- tracted Foot, §^ 325,339, are not uncommon as forms of the Mirao^is Urgens. Tliese affections generally occur, cease, and recur suddenly and unexpectedly ; but they are often of considerable duration, and some- times even appear to induce a partial dislocation, 355. Cases LXXXIII. and LXXXIV. C. W. aged 20. April 10th, 1812. She has been affected with symptoms of the Mimosis Urgens, and for many weeks, with Locked Jaw. — S. W aged 18. Septem- ber 15th, 1813, became affected with tlie Mimosis Urgens some time ago, from fright. She describes the globus and the fit of convulsion as having occur- red repeatedly — At present the muscles of the face are drawn into a forcible contraction, inducing sharpness and elevatfon of the nostrils. For many weeks there have been locked J#v, and Locked Hands ; the arms are affected with continued spasm, press forcibly against the side, and induce great tenderness ; the thighs are also affected in a similar manner ; they are bound down by means of the sheet, — otherwise they would spring forcibly upwards ; the patella is im- moveable : the toes are drawn forcibly towards the soles of the feet. 356. These affections are, like so many other forms of the Mimosis Urgens, illustrated by § 32^. I think them very common in protracted cases of this disor- der, and could add many other instances if necessary. THE DIAGNOSIS, WITH CASES. im 357. All these forms of the Mimosis Urgens are alike distinguished by the characters given §^ 1^ S, 307? and 313, — by hurry and by urgency. The oc- currence of these symptoms in other forms of the Mi- mosis Urgens, which have possibly been omitted here, may lead to the identification of the affection ; for I cannot hope that the list of the various forms of the Mimosis Urgens given § 3S5, is absolutely complete or even comprehends all the important cases of this multiform disorder. — Dies quidem me deficeret, si omnia quae hos affectus gravant symptomata, enume- rare velira, tam diversa atque rnvicera contraria specie variantia, quam nee Proteus lusit unquam, nee colora- tus spectatur Chamaeleon.* •'Sti)|:3tham de AfftcUone Hysterica,, 190 THE MIMOSIS URGENS. SECTION UI. THE TREATMENT 358. The principal causes of the Miinosis Urgens have beeu enumerated, ^ 308. This aifection has sometimes originated also from causes of weakness, as too long lactation; — and from fatigue, anxiety and watching. 1 have seen this affection in the most de- cided form, in the Male Sex. 359. The Treatment embraces two objects ; 1. the means of affording immediate relief in the paroxysm, and 2* the mode of prevention. 360. The attack of the Mimosis Urgens is reliev- ed by aether, the sp. ammonise,, arom., opium, &c. ; by stimulating liniments containing the same substances ; by fomentation with hot water ; and, if necessary, by blood-letting. 361. The Prophylaxis consists in avoiding the caused, in removing the original disorder, § 308, if the Mimosis Urgens depend on this cause ; but espe- cially in the due administration of Purgative Medi- cines, Diet, Air, and Exercise, the principles of which have been already detailed, §^ 160; 198, 298, etseqq. THE MiMOSIS INQUIETA. 191 rOST^CTllPT. In the former edition of this toork I inserted a sketch of an affection which I de- nominated the MIMOSIS IJ\rQiUIE.T.1. I have more recently publishedx a distinct Essay on that subject as already stated, p. 4, note. Of this Essay Revkivs have appeared in the Medical and Physical Jovrnat, for July, 1820, JVo. 257 ; in the Medico-Chirnrgical Heview, for Septeiu-r ' ber, 1820, J^To. 2 of the Analytical Series ; and in the Medical Repository , for October 1820, j\'o. 82, to -which the reader is referred, and from \:hich the foUoioing extracts are made, *' There is nowhere else sucli an accQrate and lucid view of this disnrdcr ns is here displayed by Dr. Hall, in his general abstract, and in his particular illustra- tions, in the oases which have occurred to his own observation. We agree vith him in his assertion, that " the morbid affection in question constitutes a great propor- ion among puerperal cases, and a great majority among the fatal ones ; aud of these fatal ones, many are daily rendered so by a mistaken use of the lancet ;" and we estimate the work before us very highly, as it miist lessen the frequency of stich occurrences in the practice of those who will peruse it, and who have pursued th(! injurious practice of which the author exposes the impropriety. **The cases which are related in this wo»k form a highly valuable p.-irt of it. The descriptions of the malady, are given in them in very strong tmits, and mark a yare talent for a clinical observation. The deleterious effects of blood-letting are forcibly shown, and well contrasted with the treatment Uie .author advises. The infatuation with which some of the practitioners who attended previously to Dr. Hall had used the lancet in some of them, is lamentable ; and it makes us particu- larly anxious to press nn the attention of our readers this excellent addition to clini- cal medical literature*' The London Medical and Physical Journal, pp. C4, G8. ''The line which separates spasm and irritation from inflammation, is ofien sn ob- rcure, that the man who could lay down an accurate diagnosis on this subject, would do a very great service to the medical profession. We believe it is a maxim pretty gcner.illv acte! ripon in prpctice, to treat a disease as inflammation, when we nrn in- douht n'iiether it be or be not a spasm. This, upon the whole, is a safe rule ; bnt- cases occasionally present tht- niselves, where it is little less destructive fo bleed in irritJtion, than to stimulate in . ifl.nrnmation. It appears to be the object of Dr. H.d!, whose talent for observation and power of discrimination are we!! known, to draw the aitt-ntion of his brethren to tlie above-mentioned cases, by a plain record offafts The motto wlxKk he has prefixed to his work, taken from Dr. Dcnman, is very ajt- propriate. 19S POSTSCRIPT. «VVe thiak the profession is under great obligations to Dr. Hall, for drawing tlieir attention to those puerperal affections where irritation borders on, or even as- sumes the character of inflammation, and where strong depletory measures should be cautiously put in force. The only draw>back on the utility of the publication, is the danger of its embarrasing the inexperienced practitioner, where actual inflam- mation obtains, combined with, or under the guise of irritation. At all events, we trust that the work will tend to effect tlie object designed by the Author, that of ex- citing the minutest attention to the discrimination of diseases." The MecUoo-Chirurgical Reviewypp. 195, 204. "'I'he lancet has been called, "a minute instrument of mighty mischief;'* and 8n we are persuade