SPEC. I.

Clonus

How to be treated

mon means

GEN. II. disorder usually yields to very simple antispasmodics, as a draught of cold water, or a dose of camphor or volatile Singultus. spirits. Where these have failed, a nervous action of a Hiccough. different kind, and which seems to operate by revulsion, has often been found to succeed, such as holding the where com- breath, and thus producing a voluntary spasm of a rigid and opposite kind in the diaphragm; or a violent fit of sneezing. An emetic* will sometimes answer the purpose; and still more effectually, a sudden fright, or other emotion of the mind t. If these do not prove sufficient, we must call in the aid of opium: and in the intervals have recourse to tonics internal and external, the warm bitters, bark, pure air, exercise, and cold bathing.

fail.

Hiccough of typhus and other low fevers. Chronic hiccough.

Singular examples.

We have already pointed out the tendency which these irregular actions have to form a habit, and the more so in proportion to the general weakness and irritability of the frame; and hence, indeed, their arising so readily in the later stages of typhus and other low fevers, and their continuing to the last ebb of the living power.

Even where the constitution is possessed of a tolerable share of vigour, hiccough is too apt to become a chronic and periodical affection; and as the frequency of the spasm is also usually increased with the frequency of the series, it has sometimes become almost incessant, and defied every kind of medical treatment that could be devised. As a chronic affection it has been known to return at irregular periods from four to four and twenty years §; and as a permanent attack to continue without ceasing for eight ||, nine, twelve days**, and even three months+t. Dr. Parr tells us that he once knew it continue for a month with scarcely any intermission even at night. "The sleep", says he, " was at last so profound

* Rigaud, Ergo solvunt Singulturn Vomitus et Sternutatio? Paris 1601. + Riedlin, Lin. Med. 1696, p. 276.

Bartholin, Hist. Nat. Cent. 11. Hist. 4.

Alberti, Diss. Casus Singultûs chronici viginti quatuor annorum, Hal. 1743.

Riedlin, Cent. 1. Obs. 15.

Tulpius, Lib. IV. cap. 25.

Act. Nat. Cur. Vol. v. Obs. 108.

tt Schenck, Lib. 111. Obs. 49. ex Fernelio.

GEN. II.

SPEC. I.

Clonus

that the convulsion scarcely awoke the patient." In a few instances it has proved fatal. Poterius mentions one*: and another, produced by cold beverage, occurs in the Singultus. Ephemerides of Natural Curiosities †.

In the Gazette de Santé for 1817, is the case of a young girl who had been tormented for six months with an almost incessant hiccough. It ceased during deglutition, but re-appeared immediately afterwards. The sleep was frequently disturbed. M. Dupuytren, on being consulted, after antispasmodics and the warm-bath had failed, applied an actual cautery to the region of the diaphragm, and the hiccough immediately ceased; but perhaps terror operated in no slight degree in this mode of cure.

Hiccough.

SPECIES II.

CLONUS STERNUTATIO.

Sneezing.

IRRITATION OF THE NOSTRILS, PRODUCING SUDDEN, VIO

LENT, AND SONOROUS EXPIRATION THROUGH THEIR
CHANNEL.

SPEC. II.

Pathology.

SNEEZING is a convulsive motion of the respiratory GEN. II. muscles, commonly excited into action by some irritant applied to the inner membrane of the nose; in the course of which the air from the lungs is sonorously forced forward in this direction as the lower jaw is closed at the time. "In sneezing", says Dr. Young, "the soft palate seems to be the valve which, like the glottis in coughing, is suddenly opened, and allows the air to rush on with a greater velocity than it could have acquired without such an obstruction." +

+

It is a common and rarely a severe affection in its or- Has somedinary course. But from the habit which irregular ac

times be

come a

serious dis

+ Eph. Nat. Cur. Dec. 11. An. i. Obs. 48.

order.

Med. Literat. p. 107.

* Cent. 11. Obs. xxvii.

SPEC. II. Clonus

GEN. II. tions of the irritable fibres are perpetually apt to assume, as we have already explained, and particularly in a reSternutatio. laxed and mobile state of them, sneezing has occasionally Sneezing. become a serious complaint. Forestus, Horstius, Lancini, and many of the German medical miscellaneous collections, give instances of its having been sometimes both permanent and violent; sometimes periodical; and a few cases wherein it proved fatal; which last termination is confirmed by Morgagni. The Ephemerides Naturæ Curiosorum contain one instance in which the sneezings continued for three hundred times in a single paroxysm.

Ordinary

causes.

But when severe,

usually pro

duced by sympathy with some remote and diseased organ.

Origin of

the benediction formerly

bestowed on

sneezing.

to call into

morbid movements formerly associated with it.

The ordinary irritants operating immediately on the Schneiderian membrane or that which lines the interior of the nostrils, are sternutatories, a sharp pungent atmosphere, indurated mucus, the acrimonious fluid secreted in a catarrh or measles, or a morbid sensibility of the Schneiderian membrane itself. But the severest cases have usually been produced by sympathy with some remote organ, as an irritable state of the lungs, stomach, or bowels. For the same reason sneezing often accompanies pregnancy and injuries on the head, and sometimes the last stages of low fevers; and is reported to have proved a sequel to repelled itch. The benediction formerly bestowed with so much courtesy on the act of sneezing is said to have been congratulatory on account of its frequent violence: but we do not seem to be acquainted with the real origin of this custom.

Tendency As sneezing is a symptom of catarrh, if it be repeated in sneezing for some time with quick succession in an irritable habit action other that has been frequently affected with catarrh, it will sometimes, in the most singular manner, call sympathetically into action the whole circle of symptoms with which it has formerly been associated, and the patient will seem at once to be labouring under a very severe cold. An instance of this singular sympathy has ocIllustrated. curred to me while writing. The patient is a lady of about fifty years of age, in good health, but of a highly nervous temperament. She began to sneeze from some trifling and transient cause, and having continued to sneeze for

GEN. II.

SPEC. II. Clonus

five or six times in rapid succession, her eye-lids became swollen, her eyes blood-shot, and full of tears, her nostrils discharged a large quantity of acrid serum, her fauces Sternutatio. were swollen and irritable, and a tickling and irrepressible Sneezing. cough completed the chain of morbid action. The sneezing at length ceased, and, within a quarter of an hour afterwards, the whole tribe of sympathetic symptoms ceased also.

healthy

times trou

Sneezing in its ordinary production, though a convul- Naturally a sive, is a natural and healthy action, intended to throw action, off instinctively from the delicate membrane of the nostrils, whatever irritable or offensive material may chance to be lodged there. But when it proceeds from a morbid cause, or becomes troublesome from habit, we should use our endeavours to remove it.

but someblesome and severe

from habit,

and requires

removal.

Remedial treatment

cases.

When the complaint is idiopathic and acute, or, in other words, when the Schneiderian membrane is mor- in such bidly sensible, or stung with some irritant material, it may be relieved by copiously sniffing warm water up the nostrils, or throwing it up gently with a syringe, or forcing up pellets of lint moistened with opium dissolved in warm water, the pressure of which is sometimes of as much ser vice as the sedative power of the fluid itself. If this do not succeed, leeches or cold epithems should be applied to the nose externally. But a free and spontaneous epistaxis, or hemorrhage from the nostrils, effects the best and speediest cure, of which Riedlin has given an instructive instance. It has been prevented from returning by blisters to the temples and behind the cars, and frequently sniffing up cold water in the course of the day. It has also been attempted to be cured by pungent sternutatories, so that the olfactory nerves may be rendered torpid and even paralyzed by over exertion; but this has rarely answered: for when once a morbid habit is established, it does not require the primary cause or stimulus for its continuance.

When the complaint proceeds from sympathy, the How to be

Lin. Med. 1695. p. 148.

palliated when the

GEN. II. SPEC. II. Clonus

most effectual mean of removing it is by ascertaining the state of the remote organ with which it associates, and Sternutatio. removing the stimulus that gives rise to it. This, howSneezing. ever, cannot always be done; and in such cases camphor affection is in free doses will often prove a good palliative, and if this sympathetic. do not succeed, we must have recourse to opium.

SPEC. III.

Discrepant interpreta

tions of dif

ferent nosologists.

SPECIES III.

CLONUS PALPITATIO.

Palpitation.

SUBSULTORY VIBRATION OF THE HEART OR ARTERIES.

GEN. II. PALMUS or PALPITATIO is used in very different senses by different writers. By Cullen and Parr it is limited to a vehement and irregular motion of the heart alone. By Sauvages and Sagar it is applied to an irregular motion "in the region of the heart". By Linnéus it is denominated "a subsultory motion of the heart or a bowel -cordis viscerisve"; and by Vogel is defined "a temporary agitation of the heart, a bowel, a muscle, a tendon, or an artery."

Sometimes

too contracted:

sometimes

too broad,

The first of these views is too contracted, for palpitations or quick abnormal beats are felt almost as frequently in many other organs, and particularly those of the epigastric region. Yet as in these it seems in every instance, however complicated with other symptoms, to depend upon a morbid state of the heart itself, or of the arteries which supply them, or are in their vicinity, the definitions that extend palpitations to other organs than the heart and arteries, as separate from these, appear to be as much too loose and out of bounds as the first definition is too limited.

The view now offered takes a middle course: it con