Phlegmatic

“ The others are subject to dysenteries and dry ophthalmies, and some have catarrhs beginning in the head and descending to the lungs. Men of a phlegmatic temperament are likely to have dysenteries; and women, also, from the humidity of their nature, the phlegm descending downwards from the brain; those who are bilious, too, have dry ophthalmies from the heat and dryness of their flesh; the aged, too, have catarrhs from their flabbiness and melting of the veins, so that some of them die suddenly and some become paralytic on the right side or the left. ”

“ The nature and property of the Phlegmatick is moist and cold, the Hair and Skin white, the Wit dull, a dreaming sleepy quality, negligent, carefull of nothing, obstinate, envious, slow, and gross, and unteachable, the Body consists of thick or homely Limbs, and is wont to be troubled with the Scab, Ulcers, and cold Feavers. ’Mongst the Planets the Moon, and ’mongst the Metals, Silver, are supposed not much to differ from their Disposition. ”

“ Now Nature has made no organ for clearing away phlegm, this being cold and moist, and, as it were, half-digested nutriment; such a substance, therefore, does not need to be evacuated, but remains in the body and undergoes alteration there. And perhaps one cannot properly give the name of phlegm to the surplus-substance which runs down from the brain, but one should call it mucus [blenna] or coryza—as, in fact, it is actually termed; in any case it will be pointed out, in the treatise On the Use of Parts, how Nature has provided for the evacuation of this substance. ”

“ The white phlegm, though dangerous when detained within by reason of the air-bubbles, yet if it can communicate with the outside air, is less severe, and only discolours the body, generating leprous eruptions and similar diseases. When it is mingled with black bile and dispersed about the courses of the head, which are the divinest part of us, the attack if coming on in sleep, is not so severe; but when assailing those who are awake it is hard to be got rid of, and being an affection of a sacred part, is most justly called sacred. ”

“ The man becomes speechless when the phlegm, suddenly descending into the veins, shuts out the air, and does not admit it either to the brain or to the vena cava, or to the ventricles, but interrupts the inspiration. For when a person draws in air by the mouth and nostrils, the breath goes first to the brain, then the greater part of it to the internal cavity, and part to the lungs, and part to the veins, and from them it is distributed to the other parts of the body along the veins ”

“ In all these fevers the part inflamed is called a phlegmon, and by its violent actions excites so much pain, that is, so much of the sensorial power of sensation, as to produce more violent actions, and inflammation, throughout the whole system. Whence great heat from the excited capillaries of the skin, large and quick pulsations of the heart, full and hard arteries, with great universal secretions and absorptions. These perpetually continue, though with exacerbations and remissions; which seem to be governed by solar or lunar influence. ”

“ The flux is to the right rather than to the left because the veins there are more capacious and numerous than on the left side, for on the one side they spring from the liver, and on the other from the spleen. The defluxion and melting down take place most especially in the case of children in whom the head is heated either by the sun or by fire, or if the brain suddenly contract a rigor, and then the phlegm is excreted. ”

“ When the external skin is the seat of inflammation, and produces sensitive irritated fever, no collection of matter is formed, as when a phlegmon is situated in the cellular membrane beneath the skin; but the cuticle rises as beneath a blister-plaster, and becomes ruptured; and a yellow material oozes out, and becomes inspissated, and lies upon its surface; as is seen in this kind of erysipelas, and in the confluent small-pox; or if the new vessels are reabsorbed the cuticle peels off in scales. ”

“ Yet again they vex the minor vessels of the ear with superfluity of phlegm; or with the same phlegm they infect the vessels of the lung, so that he coughs and can scarce breathe; and the phlegm may pass thence into the vessels of the heart and give him pain there, or the pain may pass into the side, exciting pleurisy; under such circumstances also, the moon being in defect, the man may lapse into the falling sickness.’106
Sometimes Hildegard’s anatomical ideas can be paralleled among her contemporaries. ”

“ Now, the vessels are made straiter or closer several ways: sometimes by inflammation, schirrous, or other tumours; sometimes by compressions, scars, or by flesh and membranes that grow after a wound. The signs by which this is known are, the stoppage of the terms, not conceiving, and crudities abounding in the body, which are all shown by particular signs; for if there is a wound, or the secundine pulled out by force, phlegm comes from the wound; if stoppage of the terms be from an old obstruction by humours, it is hard to be cured ”

“ All diseases are said to be derived from phlegm or bile. This seems very unlike the etiology of diseases, as laid down in the true Hippocratic treatises. Pleurisy is to be treated by purgatives and soothing applications, but without any mention of bleeding. The termination of the disease in empyema is described. The symptoms of pneumonia are also given in brief but striking terms. The sputa, at first, are said to consist of phlegm, and are thick and pure, but on the sixth and seventh day they become somewhat bilious and sublivid. This disease is also said to terminate in empyema. ”

“ The left extremity is swollen, stiff, hot, and painful, and cannot be moved, its integuments are white and pallid, and pit on strong pressure. The left labium pudendi is similarly affected. The femoral vein is felt enlarged and indurated in its passage through the groin;—intense pain marks its course down the thigh to the point where it leaves the ham; in this latter situation pressure produces much suffering, as it does down the whole posterior part of the leg. ”

“ Again, the substance which is formed by the liquefaction of new and tender flesh when air is present, if inflated and encased in liquid so as to form bubbles, which separately are invisible owing to their small size, but when collected are of a bulk which is visible, and have a white colour arising out of the generation of foam—all this decomposition of tender flesh when intermingled with air is termed by us white phlegm. ”

“ General malaise, slight fever, and chilliness precede and usher in the disease. Locally, there appears at first a more or less circumscribed, circular redness, with swelling, tenderness, and pain. Soon a phlegmonous inflammation develops, the surface at times showing vesiculation, the lesion involving an area several inches in diameter and of considerable depth. The progress of the disease is not uniform. At the end of a week or two suppuration is fully established, the first signs of this process appearing about the hair-follicles. ”

“ If it be jumping like a frog, or similar to the flight of a crow or a sparrow, it indicates the predominance of bile. When it strikes the finger slowly and resembles the strutting of a peacock, it shows that the phlegm is in excess. ”

“ REMEDIES. What are the Remedies proper for a Phlegmon?
They are of two sorts, viz. General and Particular; the former having regard to the antecedent cause, and the other to the conjunct. The Phlegmon is cur'd in its antecedent Cause, by Phlebotomy or letting Blood, by good Diet, and sometimes by Purgations, by which means the Plethory, Heat, and Alteration of the Blood is diminished; But Fomentations, Cataplasms and Plaisters facilitate the Cure in the conjunct cause, either by dissolving the Tumour, or bringing it to Suppuration. ”

“ As this affection is frequent in the cutaneous, the serous, the mucous systems, &c. so this system, whose functions require but little insensible organic contractility, presents it rarely. Those who open many dead bodies know, that the texture of the heart is hardly ever found inflamed. Nothing is more common than phlegmasia of the external or serous membrane, and of the internal or mucous membrane of the stomach, the intestines, &c.; but nothing is more obscure and less frequently seen than that of their fleshy tunic. ”

“ Touch is useful only within arm’s reach but there gives one a sense of space that sight does not give. It is practically determined by the touch corpuscles, which are found in the skin over almost the entire body, though they are more numerous in some places than in others, the distribution of the corpuscles determining the sensitiveness of the skin. These touch corpuscles are protoplasmic bodies containing nuclei, about which are entwined filaments from the cutaneous nerves. Where the corpuscles are absent the filaments of the cutaneous nerves themselves play an important part. ”

“ After emerging they break up into a large anterior division and a small posterior division, the posterior branches supplying the spine and the dorsal muscles and skin, the anterior the rest of the trunk and the limbs. The cervical plexus is formed by the anterior divisions of the first four cervical nerves, the brachial plexus by the last four cervical and the first dorsal or thoracic nerves, the lumbar plexus by the four upper lumbar, and the sacral plexus by the last lumbar and the four upper sacral nerves. ”

“ The cellular system not only receives the influence of other organs in its sympathies, but it exercises its own upon them. In phlegmon, which is the inflammatory state of this system, if the tumour is considerable, different alterations are oftentimes discoverable in the functions of the brain, the heart, the liver, the stomach, &c. Sympathetic vomiting, which is called an overflow of bile, delirium, &c. are phenomena that are seen with large phlegmonous swellings without belonging to the disease itself. ”

“ They are Blood, Choler, Phlegm, and Melancholy, every one whereof produceth its particular Tumour: Thus the Blood produces the Phlegmon, Choler the Erysipelas, Phlegm the Oedema, and Melancholy the Scirrhus. The Mixture of these is in like manner the Cause of the Erysipelatous Phlegmon, the Oedomatous Phlegmon or Phlegmonous Erysipelas, and the Phlegmonous Oedema, according to the quality of the Humours which are predominant, from whence the several Tumours take their Names. ”

“ It will, therefore, be manifest, that a remedy, which will remove the offending cause, should never be omitted.
Of the tough Phlegm, which usually precedes an attack of asthma.
Many individuals, especially those far advanced in life, are much subjected to a p. 6collection of tough phlegm, which adheres to the bronchial tube, or inner surface of the windpipe, in the morning, and renders their breathing most difficult and painful; occasioning hoarseness, and producing violent fits of coughing, until the matter is discharged. This affection is not, strictly speaking, a disease ”

“ The pain and swelling of the extremity have been aggravated during the last two days, but they are again diminishing. Induration of the femoral vein with tenderness continues.
23d. The extremity is so completely deprived of all power that it is incapable of supporting the weight of the body. Sense of soreness in the course of the deep seated and superficial veins. In the ham one of these vessels seems to be indurated. There is a cluster of enlarged glands seated over the great vessels in the groin, the whole limb is larger than the other ”

“ She had enjoyed a good state of health during her pregnancy, and every thing proceeded favourably till the eighth day after her confinement, when she was attacked with pain in the left inguinal region, which increased in violence for three or four days, and was accompanied with slight symptoms of fever.
Nov. 28th. Hypogastrium and left iliac region painful on pressure; pain in the direction of the great vessels from the groin downwards, terminating at the point where they pierce the triceps muscle; no perceptible swelling. Pulse eighty-two and full; tongue white; thirst. ”

“ The membrane of each filament is truly in every case a kind of covering that protects its medullary substance, in which the sensibility particularly resides. As to the cellular texture which enters into the composition of nerves, it has, as elsewhere, no connexion with this property. Hence why we can, as I have often done upon a living animal, separate from each other, with the point of a very delicate scalpel, the different filaments of a nerve of some size, of the sciatic, for example, when they have first been laid bare, without giving the animal much pain. ”

“ If we treat Physiognomy as the science of interpreting expression by means of the muscular anatomy of the face, that is a different matter; but the real Physiognomy deals with bones as well as with muscles. If there is doubt as to whether the shape of the bones of the face are indicative of character, there is no doubt that the flesh and muscles of the face form what we call expression of the countenance, and that this can be interpreted with some degree of accuracy. ”

“ In all the motions, the power is always on the side of flexion.
The nerves enter the muscles of the extremities at a very acute angle, because the nervous trunks are in the natural direction of these organs. In the trunk, on the contrary, the nerves going from the spine, the cervical especially, enter their muscles at almost a right angle or one less evidently acute; this circumstance is of no importance. Each branch in the fleshy fibres, is at first divided and then sub-divided in their interstices, and afterwards lost in their texture. Does each fibre receive a small nervous filament? ”