But whatever may he our determination upon this point, it does not affect the principles upon which we proceed in our treatment of Amenorrlicea, which is to excite the system generally, and the uterus in particular. by the use of those means which may increase the ac tion of the arterial system, and especially of the uterine vessels. The state of the bowels obviously requires purgatives, and those of a stimulating kind ; such as the resins and more acrid extracts, scammony, aloes. colocynth, &c. The degree of flatulence which is ge nerally present, indicates the employment of what have been termed carminatives ; and when there is much pain or irregular action of the parts, we may prescribe anti spasmodics, of which perhaps the most efficacious i asafcetida, with an occasional opiate. Exercise, awl especially horse-exercise, as much as can be borne without exhaustion, is a necessary part of the regimen ; and the diet should he as nutritive as the patient car, bear, without inducing indigestion or any degree of fe brile excitement. We have hitherto taken no notice of that class of remedies that are styled emmenagogues, because we are extremely doubtful whether there be any to which this title ought to be applied, except to some substances, the action of which is so violent as not to be admissible into practice ; we consider the savior; to be of this description. Perhaps there is nothing which is better entitled to the specific appellation of an em menagogue than electricity, and this application may be safely tried in conjunction with purgatives, and the other treatment that has been mentioned above. The warm hip-bath, or even warm water applied to the feet, fric tions with the flesh-brush, and warm clothing, are ge nerally thought to be serviceable. Besides these reme dies, which appear to be more particularly indicated by particular symptoms, we often find it necessary to use stimulants and tonics, as the various kinds of bitters, and the preparations of iron ; with respect to the latter me dicine, it should not be employed until the bowels are rendered completely soluble, and in all cases it may he proper to combine it with aloes, or whh some of the purgative resins or extracts.
Paramorphite. Local Structural Diseases..
Having now, in our five first classes, gone through tire different diseases which proceed from primary af fections of the systems of the blood-vessels and the nerves, the mental faculties, the organs of nutrition, and those of secretion, we now come to the diseases which are of local origin. These form the two classes of the Paramorphix and the Ectopix ; the first denoting a morbid change of structure, the latter a mechanal dis placement of the parts concerned. The greatest num ber of these diseases fall under the province of surgery ; they frequently require the assistance of some manual operation, or of external applications ; and although they are often accompanied by constitutional affections, yet these are obviously sympathetic, so that our main atten tion is to be directed to the topical derangement.
We have divided our class of Paramorphix into Phy mata and Phtharmata ; the first including turnout's of all descriptions ; the second denoting an alteration in the substance or structure of the part, as where a mem brane is converted into a bone, where a soft part be comes rigid, or a hard part becomes soft and ilLxible. Of the different genera which compose this order, per haps the only one which can properly he considered as falling under the province of the physician, is that which consists of the organic affections of the heart. Besides the inflammation of this viscus, which has been already treated of among the Phleginasix, it is subject to many other organic derangements ; its valves, and their appendages, which are subservient to the mechan ism of the circulation, are liable to become ossified, and its large at terial trunks are subject to the same affection. Sometimes, without assuming the bony texture, the membranous parts become rigid and inelastic; some times, on the contrary, the muscles that compose the substance of the heart appear to lose their tone or con tractile power, and are relaxed, so as to admit of the ventricles becoming distended to an enormous size, and besides these, there are different kinds of mal-confor mation in the original construction of the heart, which interfere with the performance of its appropriate func tions. The symptoms that are produced are very va
rious, and often are difficult to be accounted for; they seldom enable us to predict in what state the pal is will be found after death, and even when we have ascertained this point by dissection, it is not always easy to recon cile the symptoms with the actual disease. A very re markable circumstance respecting diseases of the heart, is the disproportion between the violence of the symp toms produced, and the actual alteration in the organ ; even in inflammation, which has been so acute as to in duce suppuration, and finally to prove fatal, that state has frequently not been previously indicated by pain in the part, or even by the state of the pulse. We have already had occasion to remark, that the disease of An gina Pectoris is frequently, if not in every instance, com bined with a structural derangement of the valves, ori fices, or great vascular trunks contiguous to the heart ; and we have reason to believe that many affections, which are referred to the lungs or the stomach, origi nate from the same cause. It must be obvious that the cure of these diseases is, for the most part, beyond the reach of the medical art, and that in most of them we are not able to do much even in palliating their effects. The only general principle upon which we can proceed is, to endeavour to moderate the force of the circula tion without weakening the vital powers ; by avoiding violent exercise and sudden motion, by a strict plan of temperance, by keeping the mind in a tranquil state, in short, by preserving as uniform a degree of motion as possible in the parts concerned in the propulsion of the blood. Unless there should be any peculilr excite ment, bleeding is not indicated, nor are purgatives advise able as a general practice, unless there be an obstruc tion in the bowels, or some feeling of indigestion ; for we may remark, that in order to prevent a plethoric state of the system, it is much more desirable to avoid reple tion of the stomach, than to endeavour to obviate its ef fects. Blisters and issues applied to the chest have been found useful in relieving affections that have cer tainly seemed to proceed from an organic disease of the heat t, and it will therefore he proper to try their effect. As it is so difficult to substantiate the existence of these complaints, we are, for the most part, reduced to the necessity of prescribing for particular symptoms; and al though in this way we can expect to do little more than palliate, it must he admitted Plat very unexpected cures have occasionally resulted. Cases have sometimes oc curred, where every circumstance seemed to indicate a serious organic affection, but where, by the exhibition of some medicines that improved the state of the sto mach, all the alarming symptoms have vanished, and the patient has regained a state of perfect health.
With these observations we shall conclude the sketch that we proposed to offer of the principles of medicine. In a work expressly intended for general perusal, we have abstained from entering into minute details, con vinced, as we are, that popular treatises of practical me dicine are seldom useful and often dangerous. We have endeavoured to produce a work which may mark the present state of medical science, and which may serve as a basis for those who are desirous of entering more minutely into the subject. We have given a concise view of most of the doctrines which have either produ ced any considerable effect upon the state of medical practice, or which, from their real merits, seem to be entitled to our attention. If on many points we have dis sented from the opinion of our predecessors, our apolo gy must be that they, in their day, dissented as much from those who went before them ; and if it be objected that we have frequently confessed the insufficiency of our art, and have left many formidable diseases without indicating an effectual mode of treatment, we may reply, that the science of medicine would probably have attain ed a greater degree of perfection, if writers had more strictly confined themselves within the limits of experi ence and correct deduction, and had not thought it in cumbent upon them to point out a remedy for every disease. (a)