130 
PATHOLOGY. 
Epfomfalt. ButinAuguft 1818, he became affeCled with 
fevere and continued diarrhoea, with a lofs of flefh from 
11ft. alb. to ioft. 6lb. and lofs of ftrength, and aching and 
wearinefs, and pain in the fhoulders, fides, and legs. He 
again recovered under fimilar remedies ; but, in Novem¬ 
ber 1818, was taken with feverifhnefs, attended with a 
parched tongue and mouth, fome delirium in the night, 
and further lofs of flefh and of ftrength 5 and, at the 
fame time, there occurred an extenfive ulceration of the 
back part of the pharynx, and a confiderable difcharge 
of bloody mucus from the noftrils. He was reduced 
from 1 oft. plb. to 9ft. alb. This ftate continued, and ic¬ 
terus again occurred, with the ufual appearance of the 
tunica albuginea, ikin, urine, and ftools. Soon after this 
time I made the following lift of appearances and affec¬ 
tions in this poor fufferer’s complaint: 1. Swarthinefs of 
complexion; 2. feverilhnefs, with parched throat and 
mouth, and heat of the forehead and legs ; 3. tendency 
to perfpiration 5 4. quivering of the chin and lips in 
fpeaking, fimilar to that obferved before fhedding tears ; 
5. tremor; 6. fluttering; 7. lofs of flefh ; 8. difcharge of 
bloody mucus from the noftrils, with ulceration ; 9. ul¬ 
ceration of the throat; 10. ifterus; 11. difcharge of 
much blood and mucus from the bowels, preceded and 
attended by pain of the abdomen, with tenefmus and 
forcing; 12. the ftools, otherwife, light coloured; 13. 
fome anafarca; 14. boils ; 15. painful ulcers on the legs.” 
ConneCfed with the fame morbid ftate of the body ge¬ 
nerally, we have to obferve thofe anomalous and diftrefling 
cafes which we denominate fiphilodes. But more of this 
under that term. 
Another cacheCtic difeafe muft be here treated of. We 
have before fhown, that nervous excitement may produce 
the phenomena of hyjleriu, whether it be derived from the 
ftomach or uterus; and, in confidering chlorofis, there 
feetns every reafon for fuppofing that a fimilar circum- 
ftance occurs ; viz. that, while chlorofis is a difeafe gene¬ 
rally caufed by the want of due catamenial difcharges, 
the want of proper digeftion, whether from deficient fen- 
fation or morbid abforption, may fimulate, if not lite¬ 
rally produce, the fame complaint. A fadt refting on 
good authority fpares us the trouble of reafotiing in proof 
of this affertion : it is, that the male fex are by no means 
exempt from attacks of this kind, efipecially the young 
and fedentary. Chlorofis is evidently a bad term for this 
aft'edtion ; nor do we like Dr. Hall’s term, Mimofis deco¬ 
lor, becaufe the expreflion of mimicking difeafe is not quite 
applicable to it. We however borrow from that author 
the defcription of it, and therefore admit for the prefent 
his nomen. 
Th e incipient Jluge of the Mimofis decolor is denoted by 
palenefs of the complexion, an exanguious ftate of the 
prolabia, and a flight appearance of tumidity of the coun¬ 
tenance, and puffinefs of the eye lids, efpecially the upper 
one. There is fometimes a tinge of green, yellow, or 
lead-colour, and frequently darknefs of the eye-lids. 
There is great palenefs of the general furface, hands, 
fingers, and nails; an opaque, white, tumid, and flabby, 
ftate of the flcin ; a tendency to oedema of the calves and 
ankles ; and a certain lofs of flefh. The tongue is white, 
and loaded ; it is fwollen, marked by preffure againft the 
teeth, or varioufly formed into creafes or folds ; its papil¬ 
lae are very numerous, and much enlarged. The gums 
and the infide of the cheeks become tumid ; and the lat¬ 
ter, as well as the former, are fometimes impreffed by the 
teeth. The breath is tainted. The patient is generally 
languid, liftlefs, indifpofed for exertion, eafily overcome 
by exercife, nervous and low-fpirited, drowfy, dizzy, 
fainty, or breathlefs. There is generally fevere head¬ 
ache or vertigo ; the memory and power of attention are 
apt to be impaired ; and there is fometimes.lieavinefs for 
fleep. There is alfo, in different inftances, pain of one 
or both fides about the falfe ribs, or in the hypochondriac 
or chondiliac regions. Sometimes there is cough, diffi- 
Vol. XIX. No. 1293. 
culty in breathing, palpitation or irregular action of the 
heart, or imperfeCt fyncope, and almoft univerfally a fenfe 
of fluttering about the prsecordia. The appetite is gene¬ 
rally impaired. There is frequently a morbid appetite for 
acids, or for magnefia. The bowels are conftipated, a 
ftate which fometimes leads to diarrhoea ; the fasces are 
dark-coloured, fcetid, and fcanty. The urine is fre¬ 
quently loaded. The catamenia become irregular, are 
preceded and attended by much pain of the back and re¬ 
gion of the uterus, and fometimes, but not always, be¬ 
come flowly defective in quantity, and pale in colour. 
In the confirmed ft age of this affeCtion, the ftate of the 
complexion and general furface is ftill more marked. The 
countenance is more pallid ; the prolabia and the gums 
exanguious; or the prolabia, efpecially the upper one, 
have a flight lilac hue; and the integuments are tumid. 
The flcin is fmooth, but becomes preternaturally dry; 
the integuments are puffy, opaque, and pale, or yellowifh; 
and there is a tendency to cedema of the feet. The 
tongue becomes clean and fmooth ; but it is pale, with a 
flight but peculiar appearance of tranfparency, and of a 
pale lilac hue; and it remains a little fwollen and in¬ 
dented. The patient is now affeCied with languor, laffi- 
tude, and even ferious weaknefs, being at once reluCiant 
and unable to undergo fatigue. There are often attacks 
of fevere pain of the head, or of equally fevere pain of 
the fide ; and repeated bleeding, leeches, and blifters, are 
ufually employed, affording a temporary refpite from 
thefe complaints. There are alfo, fometimes, fits of dyfp- 
ncea, of palpitation of the heart, or of fainting, with 
beating of the carotids. The pulfe is rather frequent, 
often about 100, and eafily accelerated and rendered irre¬ 
gular by mental emotion. The appetite is fometimes 
impaired, occafionally greater than natural, and very fre¬ 
quently depraved, inducing a longing or conftant defire 
for fome indigeftible fubftance, as acids or pickles, mag¬ 
nefia, chalk, cinders, fand, coffee-grounds, tea-leaves, 
flour, grits, wheat, &c. which the patient likes to have 
conftantly in her mouth, or to which recourfe is had when 
Ihe fuffers from agitation of mind, (like the dirt-eating 
negroes, p. 122, 3.) The bowels are flow and conftipated, 
a ftate which fometimes alternates with diarrhoea, and in¬ 
duces melrena; the ftools are dark, foetid, and fcanty. 
The catamenia are attended with pain, and become paler, 
and lefs in quantity, often ceafe, and often yield to a 
ftate of leucorrhoea which is more or lefs conftant. 
In the inveteratefiage, all the fymptoms affume an ag¬ 
gravated character. There is a very flow, but progreffive, 
lofs of flefh. The languor becomes a ftate of permanent 
debility. The cedema increafes, and takes on the aggra¬ 
vated form of anafarca. The pulfe becomes frequent. 
There are lefs of the appearances of mere diforder, and 
more of the charaCterof difeafe; i. e. thofe local affections, 
which exifted in a lefs continued manner before, now be¬ 
came either permanent, or are induced by the ftighteft 
caufes ; and the patient can fcarcely bear the moft ordi¬ 
nary occurrences of domeftic life, and perhaps remains 
always in bed. Sometimes there is an almoft permanent 
pain of the head, perhaps with intolerance of light or of 
noife; fometimes pain of the cheft, with tendernefs, diffi¬ 
culty in breathing, and cough. Frequently there are pain and 
tendernefs of the abdomen, with ficknefs and conftipation, 
or with diarrhoea. Different fymptoms reign in different 
inftances ; as fome hyfteric or fpafmodic affeCtion ; a ftate 
of locked jaw, clofed hand, contracted foot, or twifted 
limbs; palpitation of the heart; hurried or fufpended 
refpiration ; long fits of coughing, hiccough, retention 
of urine. It is worthy of notice, that this chlorotic ftate 
and the cacheCtic difeafes noticed before are often alter¬ 
nate, or run into one another. 
An important connexion feems to exift between the 
pathology of the ftomach and the mucous membrane of 
the lungs. In the firft ftage of indigeftion, an irregular 
and fpafmodic cough is often produced by nervous irrita- 
O tion, 
