GEN. X. SPEC. II. than in the acute form: but whatever laxatives are had Dysenteria recourse to, they should always be of as mild a character as possible; and hence rhubarb in combination with small doses of calomel, or Epsom salts, is often found preferable to castor oil. chronica. Chronic dysentery. Treatment. By keeping the bowels free from irritation in this gentle manner we indirectly check the morbid discharges of whatever kind by which the disease is so peculiarly disAstringents. tinguished. And where more direct and powerful means are necessary, the compound chalk mixture with opium, various preparations of kino or catechu, or the acetate of lead, in solution, or pills, as already noticed, may be had recourse to. Diet. valescent The diet should at the same time be equally bland and nutritious, composed chiefly of milk, as recommended by Sir John Pringle, or of vegetable mucilages, as rice, arrow-root, sago and salep. And as soon as the local irritation has manifestly subsided, a more cordial and When con- tonic plan should be entered upon; animal food be allowed; the warmer bitters and metallic roborants be prescribed, as cascarilla, columbo, sulphate of zinc; and such exercise and change of air as may best comport with the patient's constitution and station in life. Dr. O'Brien judiciously recommends him to try a warmer climate if his home be the British isles, and a colder, if he be a resident between the tropics. cordials and tonics. Warm climates. In all situations he must be especially careful to avoid sudden changes of temperature, and particularly a cold damp atmosphere; and maintain a healthy excitement on the skin by flannel socks worn on the feet, and flannel swathing around the body. GENUS XI. BUCNEMIA. Tumid-Leg. TENSE, DIFFUSE, INFLAMMATORY SWelling of A LOWER GEN. XI. Genus new to nosology, THIS genus is new to nosological classifications: but it is necessary, in order to include two diseases which have hitherto been regarded by most writers as totally unconnected, and treated of very remotely from each other; but which, though occurring under very different circum- but necesstances, are marked by the same proximate cause, in most instances affect the same organs, and demand the same local treatment. They consist of the following species: 1. BUCNEMIA SPARGANOSIS. PUERPERAL TUMID-LEG. 2. TROPICA. TUMID-LEG OF HOT CLIMATES. As the present genus is new, it has been necessary to distinguish it by a new name; and on this account the author has made choice of that of Bucnemia, from Bou, a Greek augment, probably derived from the Hebrew ya or ny" to swell, augment, or tumefy", a particle common to the medical vocabulary; and the Greek noun vun, "crus", or "the leg", literally, therefore, bulky or tumid leg". 66 sary. Origin of the generic term. SPEC. I. nexion of this species with the ensuing. SPECIES I. BUCNEMIA SPARGANOSIS. Puerperal Tumid-Leg. THE TUMID LIMB PALE, GLABROUS, EQUABLE, ELASTIC, CHILD-BIRTH. GEN. XI. I HAVE observed above, that the tumid-leg of childNatural con- birth has mostly been contemplated as a very different affection from that of hot climates, and has rarely been treated of in connexion with it. Dr. Thomas, however, has been sensible of their relation, though he has still placed them at a distance from each other. "The disease", says he, "to which in my opinion it bears the strongest resemblance" (meaning the species before us), "is the glandular affection so frequently met with in the island of Barbadoes."* It is singular that, with this impression, so able a writer should still have regarded the latter as a species of elephantiasis, and arranged and described it accordingly. In the present author's first edition of his Nosology the ordinary arrangement was so far yielded to as to place the two species remotely, though a distinction between elephantiasis and the tumidleg was strongly enforced. Synonyms. The tumid-leg of lying-in women has been described by different authors under a variety of names, as phlegmatia dolens, phlegmatia lactea, ecchymoma lymphatica, and by Dr. Cullen, as anasarca serosa; few of which ex • Modern Practice of Physic. Diseases of the Puerperal State, press the real nature of the affection, and some of them a source obviously erroneous. GEN. XI. SPEC. I. Bucnemia of the speci fic term. understood and doubt By Dioscorides it was denominated sparganosis, from sparganosis. Puerperal σnaрyaw, "to tumefy and distend": tumeo et distentus tumid-leg. sum, as rendered by Scapula; and, as the term is suffi- Derivation ciently expressive, it has been preferred on the present occasion to any of the rest; and appropriated to the present disease, instead of being made common, as Dioscorides has made it, to numerous other affections of the chest. By Dioscorides, and most writers till within the last Causes mistwenty or thirty years, the swelling has been ascribed to a redundancy of milk, and a morbid deposition in con- ful. sequence of such redundancy. Mauriceau regarded it in like manner, as a depôt or translation, and Puzos concurred in the same view; whence the French practitioners call it to the present day, after Puzos, depôt laiteux, or lait répandu; and the Germans milchstreichen. A minuter attention, to the subject, however, has sufficiently shown that this complaint has seldom any connexion with the milk: perhaps never. It has occurred where the breasts have been destitute of milk, and where they have overflowed; where suckling has been relinquished, and where it has been continued. It is not long since that I was consulted by a young woman labouring under it, who was suckling her infant without any complaint of the breast whatever. It is as little influenced by the state of the lochia as by that of the milk. It attacks women of all ranks and of all habits; the healthy and the diseased; the lean and the corpulent; the sedentary and the active; the young and the middle-aged. It also occurs at all seasons and situations; and has never perhaps been known to appear in any other part of the body than the lower extremities. ever found My esteemed friends Dr. Hosack and Dr. Francis, of Whether New York, have however ingeniously contended that it in the upper has also been found in the upper as well as in the lower limb. limb, and in males as well as in females: and they especially appeal to one case communicated to them by So affirmed by Hosack and Francis, as also in males. SPEC. I. Bucnemia Puerperal tumid-leg. But the cases doubtful. GEN. XI. Dr. Heermans of Ontario, which, could it be relied on, would go far to settle the question; but as it appears to sparganosis. me that this, like various similar cases that have occurred to the present author, was an instance of erratic or metastatic rheumatism rather than sparganosis, we are not at present authorized to deviate from the ordinary character assigned to the disease, or to generalize it in the manner which this more extended view of its occurrence would demand of us. Other local affections, indeed, make an approach to it, of which Dr. Denmark has described one that occurred in a male, which, however, he prudently avoids calling a phlegmatia dolens, contenting himself with saying that it resembled it; while Dr. Davis, as we shall have to observe presently, seems to have mistaken for this complaint an inflammation of one of the larger veins in the pelvis or its vicinity. Description. In about twelve or fourteen days after delivery, according to the common course of the disease, the patient complains of pain in the groin of one side, accompanied with the general train of pyrectic symptoms, but without the precursive shivering. The part affected soon becomes swelled and distended, the swelling usually extending to the labia pudendi of the same side, and down the inside of the thigh to the leg and foot; in a day or two the limb is double its natural size, is hot, exquisitely tender, and moved with great difficulty. It has not, however, the ordinary external signs of inflammation, but is hard, smooth, glabrous, pale, and equable, except where the conglobate glands are situate, which are corded and knotty, as in the groin, the ham, and the back and fleshy part of the leg. There is, occasionally, an uneasiness in the loins and in the region of the pubes on the same side. The swelling has sometimes appeared as early as twenty-four hours after delivery, and sometimes not till five weeks afterwards. The accompanying fever, which is of a hectic form, usually declines about the fourteenth or twenty-first day, but in some cases runs on for six or eight weeks, and the patient |