Zoonomia; Or, the Laws of Organic Life, Vol. II
Chapter 3
sensorial power in producing unnecessary motions, the animal will probably sooner perish. Thus a moderate quantity of wine or spirit repeated at proper intervals of time might be of service to those, who are long exposed to excessive cold, both by increasing the action of the capillary vessels, and thus producing heat, and perhaps by increasing in some degree the secretion of sensorial power in the brain. But the contrary must happen when taken immoderately, and not at due intervals. A well attested history was once related to me of two men, who set out on foot to travel in the snow, one of whom drank two or three glasses of brandy before they began their journey, the other contented himself with his usual diet and potation; the former of whom perished in spite of any assistance his companion could afford him; and the other performed his journey with safety. In this case the sensorial power was exhausted by the unnecessary motions of incipient intoxication by the stimulus of the brandy, as well as by the exertions of walking; which so weakened the dram-drinker, that the cold sooner destroyed him; that is, he had not power to produce sufficient muscular or arterial action, and in consequence sufficient heat, to supply the great expenditure of it. Hence the capillaries of the skin first cease to act, and become pale and empty; next those which are immediately associated with them, as the extremities of the pulmonary artery, as happens on going into the cold bath. By the continued inaction of these parts of the vascular system the blood becomes accumulated in the internal arteries, and the brain is supposed to be affected by its compression; because these patients are said to sleep, or to become apoplectic, before they die. I overtook a fishman asleep on his panniers on a very cold frosty night, but on waking him he did not appear to be in any degree of stupor. See Class I. 2. 2. 1.
When travellers are benighted in deep snow, they might frequently be saved by covering themselves in it, except a small aperture for air; in which situation the lives of hares, sheep, and other animals, are so often preserved. The snow, both in respect to its component parts, and to the air contained in its pores, is a bad conductor of heat, and will therefore well keep out the external cold; and as the water, when part of it dissolves, is attracted into the pores of the remainder of it, the situation of an animal beneath it is perfectly dry; and, if he is in contact with the earth, he is in a degree of heat between 48, the medium heat of the earth, and 32, the freezing point; that is, in 40 degrees of heat, in which a man thus covered will be as warm as in bed. See Botan. Garden, V. II. notes on Anemone, Barometz, and Muschus. If these facts were more generally understood, it might annually save the lives of many.
After any part of the vascular system of the body has been long exposed to cold, the sensorial power is so much accumulated in it, that on coming into a warm room the pain of hotach is produced, and inflammation, and consequent mortification, owing to the great exertion of those vessels, when again exposed to a moderate degree of warmth. See Sect. XII. 5. Whence the propriety of applying but very low degrees of heat to limbs benumbed with cold at first, as of snow in its state of dissolving, which is at 32 degrees of heat, or of very cold water. A French writer has observed, that if frozen apples be thawed gradually by covering them with thawing snow, or immersing them in very cold water, that they do not lose their taste; if this fact was well ascertained, it might teach us how to preserve other ripe fruits in ice-houses for winter consumption.
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ORDO II.
_Decreased Volition._
GENUS II.
_With decreased Actions of the Organs of Sense._
SPECIES.
1. _Recollectionis jactura._ Loss of recollection. This is the defect of memory in old people, who forget the actions of yesterday, being incapable of voluntary recollection, and yet remember those of their youth, which by frequent repetition are introduced by association or suggestion. This is properly the paralysis of the mind; the organs of sense do not obey the voluntary power; that is, our ideas cannot be recollected, or acted over again by the will.
After an apoplectic attack the patients, on beginning to recover, find themselves most at a loss in recollecting proper names of persons or places; as those words have not been so frequently associated with the ideas they stand for, as the common words of a language. Mr. ----, a man of strong mind, of a short necked family, many of whom had suffered by apoplexy, after an apoplectic fit on his recovering the use of speech, after repeated trials to remember the name of a person or place, applauded himself, when he succeeded, with such a childish smile on the partial return of his sagacity, as very much affected me.--Not long, alas! to return; for another attack in a few weeks destroyed the whole.
I saw a child after the small-pox, which was left in this situation; it was lively, active, and even vigorous; but shewed that kind of surprise, which novelty excites, at every object it viewed; and that as often as it viewed it. I never heard the termination of the case.
2. _Stultitia voluntaria._ Voluntary folly. The absence of voluntary power and consequent incapacity to compare the ideas of present and future good. Brute animals may be said to be in this situation, as they are in general excited into action only by their present painful or pleasurable sensations. Hence though they are liable to surprise, when their passing trains of ideas are dissevered by violent stimuli; yet are they not affected with wonder or astonishment at the novelty of objects; as they possess but in a very inferior degree, that voluntary power of comparing the present ideas with those previously acquired, which distinguishes mankind; and is termed analogical reasoning, when deliberatively exerted; and intuitive analogy, when used without our attention to it, and which always preserves our hourly trains of ideas consistent with truth and nature. See Sect. XVII. 3. 7.
3. _Credulitas._ Credulity. Life is short, opportunities of knowledge rare; our senses are fallacious, our reasonings uncertain, mankind therefore struggles with perpetual error from the cradle to the coffin. He is necessitated to correct experiment by analogy, and analogy by experiment; and not always to rest satisfied in the belief of facts even with this two-fold testimony, till future opportunities, or the observations of others, concur in their support.
Ignorance and credulity have ever been companions, and have misled and enslaved mankind; philosophy has in all ages endeavoured to oppose their progress, and to loosen the shackles they had imposed; philosophers have on this account been called unbelievers: unbelievers of what? of the fictions of fancy, of witchcraft, hobgobblins, apparitions, vampires, fairies; of the influence of stars on human actions, miracles wrought by the bones of saints, the flights of ominous birds, the predictions from the bowels of dying animals, expounders of dreams, fortune-tellers, conjurors, modern prophets, necromancy, cheiromancy, animal magnetism, with endless variety of folly? These they have disbelieved and despised, but have ever bowed their hoary heads to Truth and Nature.
Mankind may be divided in respect to the facility of their belief or conviction into two classes; those, who are ready to assent to single facts from the evidence of their senses, or from the serious assertions of others; and those, who require analogy to corroborate or authenticate them.
Our first knowledge is acquired by our senses; but these are liable to deceive us, and we learn to detect these deceptions by comparing the ideas presented to us by one sense with those presented by another. Thus when we first view a cylinder, it appears to the eye as a flat surface with different shades on it, till we correct this idea by the sense of touch, and find its surface to be circular; that is, having some parts gradually receding further from the eye than others. So when a child, or a cat, or a bird, first sees its own image in a looking-glass, it believes that another animal exists before it, and detects this fallacy by going behind the glass to examine, if another tangible animal really exists there.
Another exuberant source of error consists in the false notions, which we receive in our early years from the design or ignorance of our instructors, which affect all our future reasoning by their perpetual intrusions; as those habits of muscular actions of the face or limbs, which are called tricks, when contracted in infancy continue to the end of our lives.
A third great source of error is the vivacity of our ideas of imagination, which perpetually intrude themselves by various associations, and compose the farrago of our dreams; in which, by the suspension of volition, we are precluded from comparing the ideas of one sense with those of another, or the incongruity of their successions with the usual course of nature, and thus to detect their fallacy. Which we do in our waking hours by a perpetual voluntary exertion, a process of the mind above mentioned, which we have termed intuitive analogy. Sect. XVII. 3. 7.
This analogy presupposes an acquired knowledge of things, hence children and ignorant people are the most credulous, as not possessing much knowledge of the usual course of nature; and secondly, those are most credulous, whose faculty of comparing ideas, or the voluntary exertion of it, is slow or imperfect. Thus if the power of the magnetic needle of turning towards the north, or the shock given by touching both sides of an electrized coated jar, was related for the first time to a philosopher, and to an ignorant person; the former would be less ready to believe them, than the latter; as he would find nothing similar in nature to compare them to, he would again and again repeat the experiment, before he would give it his entire credence; till by these repetitions it would cease to be a single fact, and would therefore gain the evidence of analogy. But the latter, as having less knowledge of nature, and less facility of voluntary exertion, would more readily believe the assertions of others, or a single fact, as presented to his own observation. Of this kind are the bulk of mankind; they continue throughout their lives in a state of childhood, and have thus been the dupes of priests and politicians in all countries and in all ages of the world.
In regard to religious matters, there is an intellectual cowardice instilled into the minds of the people from their infancy; which prevents their inquiry: credulity is made an indispensable virtue; to inquire or exert their reason in religious matters is denounced as sinful; and in the catholic church is punished with more severe penances than moral crimes. But in respect to our belief of the supposed medical facts, which are published by variety of authors; many of whom are ignorant, and therefore credulous; the golden rule of David Hume may be applied with great advantage. "When two miraculous assertions oppose each other, believe the less miraculous." Thus if a person is said to have received the small-pox a second time, and to have gone through all the stages of it, one may thus reason: twenty thousand people have been exposed to the variolous contagion a second time without receiving the variolous fever, to every one who has been said to have thus received it; it appears therefore less miraculous, that the assertor of this supposed fact has been deceived, or wishes to deceive, than that it has so happened contrary to the long experienced order of nature.
M. M. The method of cure is to increase our knowledge of the laws of nature, and our habit of comparing whatever ideas are presented to us with those known laws, and thus to counteract the fallacies of our senses, to emancipate ourselves from the false impressions which we have imbibed in our infancy, and to set the faculty of reason above that of imagination.
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_The Orders and Genera of the Fourth Class of Diseases._
CLASS IV.
DISEASES OF ASSOCIATION.
ORDO I.
_Increased Associate Motions._
GENERA.
1. Catenated with irritative motions. 2. Catenated with sensitive motions. 3. Catenated with voluntary motions. 4. Catenated with external influences.
ORDO II.
_Decreased Associate Motions._
GENERA.
1. Catenated with irritative motions. 2. Catenated with sensitive motions. 3. Catenated with voluntary motions. 4. Catenated with external influences.
ORDO III.
_Retrograde Associate Motions._
GENERA.
1. Catenated with irritative motions. 2. Catenated with sensitive motions. 3. Catenated with voluntary motions. 4. Catenated with external influences.
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_The Orders, Genera, and Species, of the Fourth Class of Diseases._
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CLASS IV.
DISEASES OF ASSOCIATION.
ORDO I.
_Increased Associate Motions._
GENUS I.
_Catenated with Irritative Motions._
SPECIES.
1. _Rubor vultus pransorum._ Flushing of the face after dinner. 2. _Sudor stragulis immersorum._ Sweat from covering the face in bed. 3. _Cessatio aegritudinis cute_ Cure of sickness by stimulating _excitata._ the skin. 4. _Digestio aucta frigore cutaneo._ Digestion increased by coldness of the skin. 5. _Catarrhus a frigore cutaneo._ Catarrh from cold skin. 6. _Absorptio cellularis aucta_ Cellular absorption increased by _vomitu._ vomiting. 7. _Syngultus nephriticus._ Nephritic hiccough. 8. _Febris irritativa._ Irritative fever.
GENUS II.
_Catenated with Sensitive Motions._
SPECIES.
1. _Lacrymarum fluxus_ Sympathetic tears. _sympatheticus._ 2. _Sternutatio a lumine._ Sneezing from light. 3. _Dolor dentium a Stridore._ Tooth-edge from grating sounds. 4. _Risus sardonicus._ Sardonic smile. 5. _Salivae fluxus cibo viso._ Flux of saliva at sight of food. 6. _Tensio mamularum viso puerulo._ Tension of the nipples of lactescent women at sight of the child. 7. _Tensio penis in hydrophobia._ Tension of the penis in hydrophobia. 8. _Tenesmus calculosus._ Tenesmus from stone. 9. _Polypus narium ex ascaride._ Polypus of the nose from ascarides. 10. _Crampus surarum in diarrhoea._ Cramp from diarrhoea. 11. _Zona ignea nephritica._ Nephritic shingles. 12. _Eruptio variolarum._ Eruption of small-pox. 13. _Gutta rosea stomatica._ Stomatic rosy drop. 14. ---- _hepatica._ Hepatic rosy drop. 15. _Podagra._ Gout. 16. _Rheumatismus._ Rheumatism. 17. _Erysipelas._ Erysipelas. 18. _Testium tumor in gonorrhoea._ Swelled testis in gonorrhoea. 19. ---- _in parotitide._ ---- in mumps.
GENUS III.
_Catenated with Voluntary Motions._
SPECIES.
1. _Deglutitio invita._ Involuntary deglutition. 2. _Nictitatio invita._ ---- nictitation. 3. _Risus invitus._ ---- laughter. 4. _Lusus digitorum invitus._ ---- actions with the fingers. 5. _Unguium morsiuncula invita._ ---- biting the nails. 6. _Vigilia invita._ ---- watchfulness.
GENUS IV.
_Catenated with External Influences._
SPECIES.
1. _Vita ovi._ Life of an egg. 2. _Vita hiemi-dormientium._ Life of winter-sleepers. 3. _Pullulatio arborum._ Budding of trees. 4. _Orgasmatis venerei periodus._ Periods of venereal desire. 5. _Brachii concussio electrica._ Electric shock through the arm. 6. _Oxygenatio sanguinis._ Oxygenation of the blood. 7. _Humectatio corporis._ Humectation of the body.
ORDO II.
_Decreased Associate Motions._
GENUS I.
_Catenated with Irritative Motions._
SPECIES.
1. _Cutis frigida pransorum._ Chillness after dinner. 2. _Pallor urinae pransorum._ Pale urine after dinner. 3. ---- _a frigore cutaneo._ ---- from cold skin. 4. _Pallor ex aegritudine._ Paleness from sickness. 5. _Dyspnoea a balneo frigido._ Shortness of breath from cold bathing. 6. _Dyspepsia a pedibus frigidis._ Indigestion from cold feet. 7. _Tussis a pedibus frigidis._ Cough from cold feet. 8. ---- _hepatica._ Liver-cough. 9. ---- _arthritica._ Gout-cough. 10. _Vertigo rotatoria._ Vertigo rotatory. 11. ---- _visualis._ ---- visual. 12. ---- _ebriosa._ ---- inebriate. 13. ---- _febriculosa._ ---- feverish. 14. ---- _cerebrosa._ ---- from the brain. 15. _Murmur aurium vertiginosum._ Noise in the ears. 16. _Tactus, gustus, olfactus_ Vertiginous touch, taste, smell. _vertiginosi._ 17. _Pulsus mollis a vomitione._ Soft pulse in vomiting. 18. ---- _intermittens a ventriculo._ Intermittent pulse from the stomach. 19. _Febris inirritativa._ Inirritative fever.
GENUS II.
_Catenated with Sensitive Motions._
SPECIES.
1. _Torpor genae a dolore dentis._ Coldness of the cheek from tooth-ach. 2. _Stranguria a dolore vesicae._ Strangury from pain of the bladder. 3. ---- _convulsiva._ Convulsive strangury. 4. _Dolor termini ductus_ Pain of the end of the bile-duct. _choledochi._ 5. _Dolor pharyngis ab acido_ Pain of the throat from gastric acid. _gastrico._ 6. _Pruritus narium a vermibus._ Itching of the nose from worms. 7. _Cephalaea._ Head-ach. 8. _Hemicrania et otalgia._ Partial head-ach, and ear-ach. 9. _Dolor humeri in hepatitide._ Pain of shoulder in hepatitis. 10. _Torpor pedum variola_ Cold feet in eruption of small-pox. _erumpente._ 11. _Testium dolor nephriticus._ Nephritic pain of testis. 12. _Dolor digiti minimi_ Pain of little finger from sympathy. _sympatheticus._ 13. _Dolor brachii in hydrope_ Pain of the arm in dropsy of the _pectoris._ chest. 14. _Diarrhoea a dentitione._ Diarrhoea from toothing.
GENUS III.
_Catenated with Voluntary Motions._
SPECIES.
1. _Titubatio linguae._ Impediment of speech. 2. _Chorea sancti viti._ St. Vitus' dance. 3. _Risus._ Laughter. 4. _Tremor ex ira._ Trembling from anger. 5. _Rubor ex ira._ Redness from anger. 6. ---- _criminati._ Blush of guilt. 7. _Tarditas paralytica._ Slowness from palsy. 8. ---- _senilis._ ---- of age.
GENUS IV.
_Catenated with External Influences._
SPECIES.
1. _Somni periodus._ Periods of sleep. 2. _Studii inanis periodus._ ---- of reverie. 3. _Hemicraniae periodus._ ---- of head-ach. 4. _Epilepsiae dolorificae periodus._ ---- of painful epilepsy. 5. _Convulsionis dolorificae periodus._ ---- of painful convulsion. 6. _Tussis periodicae periodus._ ---- of periodic cough. 7. _Catameniae periodus._ ---- of catamenia. 8. _Haemorrhoidis periodus._ ---- of the piles. 9. _Podagrae periodus._ ---- of the gout. 10. _Erysipelatis periodus._ ---- of erysipelas. 11. _Febrium periodus._ ---- of fevers.
ORDO III.
_Retrograde Associate Motions._
GENUS I.
_Catenated with Irritative Motions._
SPECIES.
1. _Diabaetes irritata._ Diabetes from irritation. 2. _Sudor frigidus in asthmate._ Cold sweat in asthma. 3. _Diabaetes a timore._ Diabetes from fear. 4. _Diarrhoea a timore._ Diarrhoea from fear. 5. _Pallor et tremor a timore._ Paleness and trembling from fear. 6. _Palpitatio cordis a timore._ Palpitation of the heart from fear. 7. _Abortio a timore._ Abortion from fear. 8. _Hysteria a timore._ Hysterics from fear.
GENUS II.
_Catenated with Sensitive Motions._
SPECIES.
1. _Nausea idealis._ Nausea from ideas. 2. ---- _a conceptu._ Nausea from conception. 3. _Vomitio vertiginosa._ Vomiting from vertigo. 4. ---- _a calculo in uretere._ ---- from stone in the ureter. 5. ---- _ab insultu paralytico._ ---- from stroke of palsy. 6. ---- _a titilatione faucium._ ---- from tickling the throat. 7. ---- _cute sympathetica._ ---- from sympathy with the skin.
GENUS III.
_Catenated with Voluntary Motions._
SPECIES.
1. _Ruminatio._ Rumination. 2. _Vomitio voluntaria._ Voluntary vomiting. 3. _Eructatio voluntaria._ ---- eructation.
GENUS IV.
_Catenated with External Influences._
SPECIES.
1. _Catarrhus periodicus._ Periodical catarrh. 2. _Tussis periodica._ Periodic cough. 3. _Histeria a frigore._ Hysterics from cold. 4. _Nausea pluvialis._ Sickness against rain.
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CLASS IV.
DISEASES OF ASSOCIATION.
ORDO I.
_Increased Associate Motions._
GENUS I.
_Catenated with Irritative Motion._
The importance of the subsequent class not only consists in its elucidating all the sympathetic diseases, but in its opening _a road to the knowledge of fever_. The difficulty and novelty of the subject must plead in excuse for the present imperfect state of it. The reader is entreated previously to attend to the following circumstances for the greater facility of investigating their intricate connections; which I shall enumerate under the following heads.
A. Associate motions distinguished from catenations. B. Associate motions of three kinds. C. Associations affected by external influences. D. Associations affected by other sensorial motions. E. Associations catenated with sensation. F. Direct and reverse sympathy. G. Associations affected four ways. H. Origin of associations. I. Of the action of vomiting. K. Tertian associations.
A. _Associate Motions distinguished from Catenations._
Associate motions properly mean only those, which are caused by the sensorial power of association. Whence it appears, that those fibrous motions, which constitute the introductory link of an associate train of motions, are excluded from this definition, as not being themselves caused by the sensorial power of association, but by irritation, or sensation, or volition. I shall give for example the flushing of the face after dinner; the capillary vessels of the face increase their actions in consequence of their catenation, not their association, with those of the stomach; which latter are caused to act with greater energy by the irritation excited by the stimulus of food. These capillaries of the face are associated with each other reciprocally, as being all of them excited by the sensorial power of association; but they are only catenated with those of the stomach, which are not in this case associate motions but irritative ones. The common use of the word association for almost every kind of connection has rendered this subject difficult; from which inaccuracy I fear some parts of this work are not exempt.
B. _Associate Motions of three Kinds._
Those trains or tribes of associate motions, whose introductory link consists of an irritative motion, are termed irritative associations; as when the muscles of the eyelids close the eye in common nictitation. Those, whose introductory link consists of a sensitive motion, are termed sensitive associations; as when the pectoral and intercostal muscles act in sneezing. And lastly, those, whose introductory link consists of a voluntary motion, are termed voluntary associations; as when the muscles of the lower limbs act in concert with those of the arm in fencing.
C. _Associations affected by external Influences._
Circles of associate motions, as well as trains and tribes of them, are liable to be affected by external influences, which consist of etherial fluids, and which, by penetrating the system, act upon it perhaps rather as a causa sine qua non of its movements, than directly as a stimulus; except when they are accumulated in unusual quantity. We have a sense adapted to the perception of the excess or defect of one of these fluids; I mean that of elementary heat; in which all things are immersed. See Class IV. 1. 4. 7. But there are others of them, which as we have no power to evade their influence, so we have no sense to perceive it; these are the solar, and lunar, and terrestrial gravitation, in which also all things are immersed; the electric aura, which pervades us, and is perpetually varying, See Class IV. 1. 4. 5; the magnetic fluid, Class IV. 1. 4. 5; and lastly, the great life-preserver oxygen gas, and the aqueous vapour of the atmosphere, see Class IV. 1. 4. 6. and 7. and 2.
Of these external influences those of heat, and of gravity, have diurnal periods of increase and decrease; besides their greater periods of monthly or annual variation. The manner in which they act by periodical increments on the system, till some effect is produced, is spoken of in Sect. XXXII. 3. and 6.
D. _Associations affected by other Sensorial Motions._
Circles and trains of associate motions are also liable to be affected by their catenations with other sensorial powers, as of irritation, or sensation, or volition; which other sensorial powers either thus simply form some of the links of the catenation, or add to the energy of the associated motions. Thus when vomiting is caused by the stimulus of a stone in the ureter, the sensation of pain seems to be a link of the catenation rather than an efficient cause of the vomiting. But when the capillary vessels of the skin increase their action from the influence of external heat, they are excited both by the stimulus of unusual heat, as well as by the stimulus of the blood, and by their accustomed association with the actions of the heart and arteries. And lastly, in the blush of anger the sensorial power of volition is added to that of association, and irritation, to excite the capillaries of the face with increased action. See Class IV. 2. 3. 5.
E. _Associations catenated with Sensation._
Pain frequently accompanies associate trains or circles of motion without its being a cause, or a link, of them, but simply an attendant symptom; though it frequently gives name to the disease, as head-ach. Thus in the cramp of the calves of the legs in diarrhoea, the increased sensorial power of association is the proximate cause; the preceding increased action of the bowels is the remote cause; and the proximate effect is the violent contractions of the musculi gastrocnemii; but the pain of these muscles is only an attendant symptom, or a remote effect. See Sect. XVIII. 15. Other sensitive associations are mentioned in Class IV. 1. 2. and IV. 1. 2. 15.
Thus, if the flushing of the face above mentioned after dinner be called a disease, the immediate or proximate cause is the increased power of association, the remote cause is the increased irritative motions of the stomach in consequence of the stimulus of food and wine. The disease or proximate effect consists in the increased actions of the cutaneous vessels of the face; and the sensation of heat, the existence of heat, and the red colour, are attendants or symptoms, or remote effects, of the increased actions of these cutaneous vessels.
F. _Direct and reverse Sympathy._
The increased actions of the primary part of the trains of associated motions are sometimes succeeded by increased actions of the secondary part of the train; and sometimes by decreased actions of it. So likewise the decreased actions of the primary part of a train of associate motions are sometimes succeeded by decreased actions of the secondary part, and sometimes by increased actions of it. The former of these situations is called direct sympathy, and the latter reverse sympathy. In general I believe, where the primary part of the train of associated motions is exerted more than natural, it produces direct sympathy in strong people, and reverse sympathy in weak ones, as a full meal makes some people hot, and others chill. And where the primary part of the train is exerted less than natural, it produces direct sympathy in weak people, and reverse sympathy in strong ones, as on being exposed for a certain length of time on horseback in a cold day gives indigestion and consequent heart-burn to weak people, and strengthens the digestion, and induces consequent hunger in strong ones. See Sect. XXXV. 1.
This may perhaps be more easily understood, by considering strength and weakness, when applied to animal bodies, as consisting in the quantity of sensorial power residing in the contracting fibres, and the quantity of stimulus applied, as shewn in Sect. XII. 2. 1. Now when defective stimulus, within certain limits, is partially applied to parts subject to perpetual motion, the expenditure of sensorial power is for a while lessened, but not its general production in the brain, nor its derivation into the weakly-stimulated part. Hence in strong people, or such whose fibres abound with sensorial power, if the first tribe of an associate train of motions be deprived in part of its accustomed stimulus, its action becomes diminished; and the sensorial power becomes accumulated, and by its superabundance, or overflowing as it were, increases the action of the second tribe of the associate actions by reverse sympathy. As exposing the warm skin for a moderate time to cold air increases the action of the stomach, and thus strengthens the power of digestion.
On the reverse, when additional stimulus within certain limits is partially applied to parts, which are deficient in respect to the natural quantity of sensorial power, the expenditure of sensorial power is increased, but in a less degree than the increased production of it in the brain, or its increased derivation into the strongly-stimulated organ. Hence in weak people, or such whose fibres are deficient of sensorial power, if the first tribe of an associate train of motions be subjected for a while to greater stimulus than usual, a greater production of sensorial power, or a greater derivation of it into the stimulated parts occurs; which by its excess, or overflowing as it were, increases the actions of the second tribe of the associate motions by direct sympathy. Thus when vomiting occurs with cold extremities, a blister on the back in a few hours occasions universal warmth of the skin, and stops the vomiting. And when a diarrhoea occurs with pale skin and cold extremities, the pricking of the points of a flannel shirt, worn next the skin, occasions universal warmth of it, and checks or cures the diarrhoea.
In some associate trains of action nevertheless reverse sympathies more frequently occur than direct ones, and in others direct ones more frequently than reverse ones. Thus in continued fever with debility there appears to be a reverse sympathy between the capillary vessels of the stomach and those of the skin; because there exists a total aversion to solid food, and constant heat on the surface of the body. Yet these two systems of vessels are at other times actuated by direct sympathy, as when paleness attends sickness, or cold feet induces indigestion. This subject requires to be further investigated, as it probably depends not only on the present or previous plus or minus of the sensorial power of association, but also on the introduction of other kinds of sensorial power, as in Class IV. 1. 1. D; or the increased production of it in the brain, or the greater mobility of one part of a train of actions than another.
Thus when much food or wine is taken into the stomach, if there be no superfluity of sensorial power in the system, that is, none to be spared from the continual actions of it, a paleness and chillness succeeds for a time; because now the expenditure of it by the increased actions of the stomach is greater than the present production of it. In a little time however the stimulus of the food and wine increases the production of sensorial power in the brain, and this produces a superfluity of it in the system; in consequence of which the skin now becomes warm and florid, which was at first cold and pale; and thus the reverse sympathy is shortly converted into a direct one; which is probably owing to the introduction of a second sensorial power, that of pleasurable sensation.
On the contrary, when an emetic drug produces sickness, the skin is at first pale for a time by direct sympathy with the capillaries of the stomach; but in a few minutes, by the accumulation of sensorial power in the stomach during its less active state in sickness, the capillaries of the skin, which are associated with those of the stomach, act with greater energy by reverse sympathy, and a florid colour returns. Where the quantity of action is diminished in the first part of a train of motions, whether by previous diminution of sensorial power, or present diminution of stimulus, the second part of the train becomes torpid by direct sympathy. And when the quantity of action of the first part becomes increased by the accumulation of sensorial power during its previous torpor, or by increase of stimulus, the actions of the second part of it likewise become increased by direct sympathy.
In moderate hunger the skin is pale, as before dinner, and in moderate sickness, as no great accumulation of sensorial power has commenced; but in violent hunger, and in greater torpor of the stomach, as from contagious matter, the accumulation of sensorial power becomes so great as to affect the arterial and capillary system, and fever is produced in both cases.
In contagious fevers with arterial debilities commencing with torpor of the stomach, why is the action of the heart weakened, and that of the capillaries increased? Is it because the mobility of the heart is less than that of the stomach, and the mobility of the capillaries greater? Or is it because the association between the muscular fibres of the stomach and those of the heart have been uniformly associated by direct sympathy; and the capillaries of the stomach and those of the skin have been more frequently associated by reverse sympathy?
Where the actions of the stomach have been previously exhausted by long stimulus, as on the day after intoxication, little or no accumulation of sensorial power occurs, during the torpor of the organ, beyond what is required to replace the deficiency of it, and hence fever seldom follows intoxication. And a repetition of the stimulus sometimes becomes necessary even to induce its natural action, as in dram-drinkers.
Where there has been no previous exhaustion of sensorial power, and the primary link of associate motions is violently actuated by the sensorial power of sensation, the secondary link is also violently actuated by direct sympathy, as in inflammatory fevers. Where however the sensorial power of the system is less than natural, the secondary link of associated motions becomes torpid by reverse sympathy, as in the inoculated small-pox during the eruption on the face the feet are frequently cold.
G. _Associations affected four Ways._
Hence associated trains or circles of motions may be affected four different ways. 1. By the greater or less energy of action of the first link with which they are catenated, and from which they take their names; as irritative, sensitive, or voluntary associations. 2. By being excited by two or more sensorial powers at the same time, as by irritation and association, as in the instance of the application of the stimulus of increased external heat to the cutaneous capillaries. 3. By catenation with other sensorial powers, as with pain or pleasure, which are in this case not the proximate cause of motion, but which, by becoming a link of catenation, excites the sensorial power of association into action; as the pain at the neck of the gall-bladder occasioned by a gall-stone is transferred to the other end of that canal, and becomes a link of catenation between the action of the two extremities of it. 4. The influence of ethereal fluids, as of heat and gravitation. To which last perhaps might be added moisture and oxygen gas as constituting necessary parts of the system, rather than stimuli to excite it into action.
H. _The Origin of Associations._
Some trains or circles of associate motions must have been formed before our nativity, as those of the heart, arteries, and capillaries; others have been associated, as occasion required them, as the muscles of the diaphragm and abdomen in vomiting; and others by perpetual habit, as those of the stomach with the heart and arteries directly, as in weak pulse during sickness; with the capillaries directly, as in the flushed skin after dinner; and lastly, with the cellular absorbents reversely, as in the increased absorption in anasarca during sickness; and with the irritative motions of the organs of sense reversely, as in vertigo, or sea-sickness. Some of these associations shall be here shortly described to facilitate the investigation of others.
First, other congeries of glands occupy but a particular part of the system, or constitute a particular organ, as the liver, or kidneys; but those glands, which secrete the mucus, and perspirable matter, which are called capillaries, are of very great extent; they receive the blood from the arteries, separate from it the mucus, which lines every cell, and covers every cavity of body; and the perspirable matter, which softens and lubricates the whole surface of the skin, and the more extensive surface of the air-vessels, which compose the lungs. These are supplied with blood by the perpetual action of the heart and arteries, and have therefore their motions associated with the former, and with each other, by sympathy, which is sometimes direct, and sometimes reverse.
One branch of this association, the capillaries of the skin, are very irritable by the increased quantities of cold and heat, another branch, that of the lungs, has not the perception of cold and heat, but is liable by direct sympathy to act in concert with the former, as in going into the cold bath. And it is probable the capillaries of the internal membranes are likewise directly affected by their sympathy with those of the skin, as appears from the defect of secretion in ulcers during the cold fits of agues.
The motions of this extensive system of capillaries, thus associated by direct sympathy, are also associated with those of the heart and arteries, sometimes by reverse and sometimes by direct sympathy; and thus constitute simple fever. The cold paroxysm of which consists in their torpor, and the hot one in their orgasm, or increased activity.
I. _Of the Action of Vomiting._
The manner, in which the stomach and the diaphragm and abdominal muscles acquire their associate action in vomiting, requires some attention. It is not probable, that this action of vomiting occurs before nativity; as the uniform application of the nutritive liquor amnii to the mouth of the foetus, and the uniform expenditure of its nourishment, would not seem to give occasion to too great temporary repletion of the stomach; and would preclude the deglutition of any improper material. After nativity the stomach of the child may be occasionally too much distended with milk; as previous hunger may induce it to overgorge itself; and by repeated efforts the act of vomiting is learned, as a means of getting free from a disagreeable sensation. Thus when any disgustful material, as a bitter drug, is taken into the mouth; certain retrograde motions of the tongue and lips are produced, for the purpose of putting the disagreeable material out of the mouth again.
When the stomach is disagreeably stimulated by the distention or acrimony of the aliment, a similar effort to regurgitate it must occur; and by repeated trials the action of the diaphragm and abdominal muscles by squeezing the stomach assists its retrograde exertion to disgorge its contents. In the same manner when a piece of gravel is pushed into the urethra, or a piece of indurated bile into the neck of the gall-bladder, after they have been in vain pressed forward by the usual motions of those ducts, they return into the bladders of gall and urine by the retrograde motions of them.
That this is one mode, in which vomiting is induced, appears from the instantaneous rejection from the stomach occasioned by some nauseous drug, or from some nauseous idea; and lastly, from the voluntary power, which some people have been said to have acquired, of emptying their stomachs, much in the same manner as ruminating animals bring up the grass from their first stomach.
There are nevertheless many modes by which these inverted motions of the stomach and oesophagus are induced, and which it is of consequence to distinguish from each other. The first is the mode above described, where an effort is made to dislodge something, which stimulates the stomach into disagreeable sensation; and which is returned by repeated exertions; as when a nauseous drug is taken into the mouth, or a bit of sand falls into the eye, or a drop of water into the wind-pipe. In this the peristaltic motions of the stomach are first stopped, and then reverted by painful sensation; and the abdominal muscles and diaphragm by repeated efforts become associated with them. Now as less sensorial power is expended on the retrograde actions of the stomach, and of the lymphatics, which open their mouths on its surface, than by their natural motions, an accumulation of sensorial power in the fibres of the stomach follows the exhibition of an emetic, and on that account an emetic will sometimes stop a spontaneous vomiting which was owing to sensorial deficiency. See Sect. XXXV. 1. 3. and Art. V. 2. 1.
As bitters and metallic salts, exhibited in small doses, stimulate the stomach into greater action, as appears by their increasing the power of digestion, and yet become emetic, when given in larger doses; one might suspect, that they became emetic by inducing debility, and consequent retrograde actions of the stomach, by their previously exhausting the sensorial power by their great stimulus; which might be effected in a moment without producing pain, and in consequence without our perceiving it. But on the contrary, there does not in general appear on the exhibition of emetics to be any previous exhaustion of sensorial power; because there is evidently an accumulation of it during the sickness, as appears from the digestion being stronger afterwards; and from the increased action of the cellular and cutaneous absorbents during its operation. See Art. V. 2. 1.
Another mode, by which vomiting is induced, is owing to debility or deficiency of sensorial power, from the previous exhaustion of it; as on the day after intoxication, or which occurs in people enfeebled with the gout, and in dropsy, and in some fevers with debility. In these, when the vomiting ceases, there is no appearance of accumulation of sensorial power, as the digestion still remains weak and imperfect.
Another mode by which sickness or vomiting is induced, is by defect of stimulus, as in great hunger; and in those, who have been habituated to spice and spirit with their meals, who are liable to be sick after taking food without these additional stimuli. Other means of inducing sickness by vertigo, or by nauseous ideas, will be mentioned below.
We shall only add, that the motions of the muscular fibres of the stomach are associated with those of the heart and arteries by direct sympathy, as appears by the weakness of the pulse during the exhibition of an emetic; and that the absorbents of the stomach are associated with the cellular and cutaneous absorbents by reverse sympathy, as is shewn by the great absorption of the mucus of the cells in anasarca during sickness; at the same time that the absorbents of the stomach invert their actions, and pour the mucus and water thus absorbed into that viscus.
In cold paroxysms of fever the stomach partakes of the general torpor, and vomiting is induced by its debility, either by its association with the torpid capillaries, or other torpid parts, or by its own torpor commencing first, and causing the cold fit. The disordered motions of the stomach frequently seem to be the cause or primary seat of fever, as where contagious miasmata are swallowed with the saliva, and where fever is produced by sea-sickness, which I once saw. Nevertheless a disorder of the stomach does not always induce fever, as in that case it should constantly attend indigestion, and vertigo, and sea-sickness; but is itself frequently induced by association with the disordered movements of other parts of the system, as when it arises from gravel in the ureter, or from a percussion on the head.
The connexion of the motions of the stomach with irritative ideas, or motions of the organs of sense, in vertigo, is shewn in Sect. XX. and thus it appears, that many circles of association are either directly or reversely associated, or catenated, with this viscus; which will much contribute to unfold some of the symptoms of fever.
K. _Tertian Associations._
The third link of associate trains of motion is sometimes actuated by reverse sympathy, with the second link, and that by reverse sympathy with the first link; so that the first and third link may act by direct sympathy, and the intermediate one by reverse sympathy. Of this instances are given in the syngultus nephriticus, Class IV. 1. 1. 7. and IV. 2. 1. At other times the tertian or quartan links of associate motions are actuated by direct sympathy; and that sometimes forwards and sometimes backwards in respect to the usual order of those trains of associate motions, as in Class IV. 1. 2. 1.
SPECIES.
1. _Rubor vultus prandorum._ Flushing of the face after dinner is explained in Sect. XXXV. 1. In the beginning of intoxication the whole skin becomes florid from the association of the actions of the cutaneous arteries with those of the stomach, because vinous spirit excites the fibres of the stomach into more violent action than the stimulus of common food; and the cutaneous capillaries of the face, from their more frequent exposure to the vicissitudes of cold and heat, possess more mobility or irritability than those of other parts of the skin, as further explained in Sect. XXXIII. 2. 10. Vinegar is liable to produce this flushing of the face, which probably is owing to the quantity of vinous spirit it contains, as I believe the unfermented vegetable acids do not produce this effect. In every kind of blush the arterial blood is propelled into the capillaries faster than the venous absorption can carry it forwards into the veins, in this respect resembling the tensio phalli.
Can the beginning vinous or acetous fermentation of the aliment in weak stomachs contribute to this effect? or is it to be ascribed to the greater power of association between the arteries of the face and the fibres of the stomach in some people than in others?
M. M. Eat and drink less at a time, and more frequently. Put 20 drops of weak acid of vitriol into water to be drank at meals. Let the dress over the stomach and bowels be loose. Use no fermented liquors, or vinegar, or spice.
2. _Sudor stragulis immersorum._ Sweat from being covered in bed. In the commencement of an epidemic fever, in which the perpetual efforts to vomit was a distressing symptom, Dr. Sydenham discovered, that if the patient's head was for a short time covered over with the bed clothes, warmth was produced, and a sweat broke out upon the skin, and the tendency to vomit ceased. In this curious fact two trains of associated motions are excited into increased action. First, the vessels of the lungs are known to have their motion associated with those of the skin by the difficulty of breathing on going into the cold bath, as described in Sect. XXXII. 3. 2. Hence, when the vessels of the lungs become excited into stronger action, by the bad air under the bed clothes, warmed and adulterated by frequent breathing, those of the external skin soon become excited by their association into more energetic action, and generate more heat along with a greater secretion of perspirable matter. Secondly, the sympathy between the stomach and skin is evident in variety of circumstances; thus the cold air of frosty days applied to the skin for a short time increases the action of the stomach by reverse sympathy, but decreases it if continued too long by direct sympathy; so in the circumstance above mentioned the action of the stomach is increased by direct sympathy with that of the skin; and the tendency to vomit, which was owing to its diminished action, ceases.
3. _Cessatio aegritudinis cute excitata._ The cure of sickness by stimulating the skin. This is explained in the preceding article; and further noticed in IV. 2. 2. 4. and in IV. 1. 1. f.
Similar to these is the effect of a blister on the back in relieving sickness, indigestion, and heart-burn; and, on the contrary, by these symptoms being frequently induced by coldness of the extremities. The blister stimulates the cutaneous vessels into greater action; whence warmth and pain are produced at the same time, and the fibres of the stomach are excited into greater action by their association with those of the skin. It does not appear, that the concomitant pain of the blister causes the increased energy of the stomach, because the motions of it are not greater than natural; though it is sometimes difficult to determine, whether the primary part of some associated trains be connected with irritative or sensitive motions.
In the same manner a flannel shirt, to one who has not been in the habit of wearing one, stimulates the skin by its points, and thus stops vomiting in some cases; and is particularly efficacious in checking some chronical diarrhoeas, which are not attended with fever; for the absorbents of the skin are thus stimulated into greater action, with which those of the intestines consent by direct sympathy.
This effect cannot be ascribed to the warmth alone of the flannel shirt, as being a covering of loose texture, and confining air in its pores, like a sponge, which air is known to be a bad conductor of heat, since in that case its use should be equally efficacious, if it were worn over a linen shirt; and an increased warmth of the room of the patient would be equally serviceable.
4. _Digestio aucta frigore cutaneo._ Digestion increased by coldness of the skin. Every one has experienced the increase of his appetite after walking in the cool air in frosty days; for there is at this time not only a saving of sensorial power by the less exertion of the cutaneous vessels; but, as these consent with those of the stomach and bowels, this saving of sensorial power is transferred by reverse sympathy from the cutaneous capillaries and absorbents to those of the stomach and intestines.
Hence weak people should use the cold air of winter as a cold bath; that is, they should stay in it but a short time at once, but should immerse themselves in it many times a day.
5. _Catarrhus a frigore cutaneo._ Catarrh from cold skin. This has been already explained in Class I. 1. 2. 7. and is further described in Sect. XXXV. 1. 3. In this disease the vessels of the membrane, which lines the nostrils, are excited into greater action; when those of the skin, with which they are associated, are excited into less action by the deficiency of external heat, by reverse sympathy; and though the pain of cold attends the torpor of the primary link of this association, yet the increased motions of the membrane of the nostrils are associated with those of the cutaneous vessels, and not with the pain of them, because no inflammation follows.
6. _Absorptio cellularis aucta vomitu._ In the act of vomiting the irritative motions of the stomach are inverted, and of the absorbents, which open their mouths into it; while the cutaneous, cellular, and pulmonary absorbents are induced, by reverse sympathy with them, to act with greater energy. This is seen in cases of anasarca, when long sickness and vomiting are caused by squills, or antimonial salts, or most of all by the decoction of digitalis purpurea, foxglove; and Mr. J. Hunter mentions a case, in which a large bubo, which was just ready to break, was absorbed in a few days by sickness at sea. Treatise on the Blood, p. 501, which is thus accounted for; less sensorial power is expended during sickness by the decreased action of the fibres of the stomach, and of its absorbents; as shewn in Sect. XXXV. 1. 3. whence an accumulation of it is produced, and there is in consequence a greater quantity of sensorial power for the exertion of those motions, which are associated with the absorbents of the stomach by reverse sympathy.
The reverse sympathy between the lacteal and lymphatic branches of the absorbent system have been produced by the one branch being less excited to act, when the other supplies sufficient fluid or nutriment to the sanguiferous vessels. Thus when the stomach is full, and the supply of chyle and mucus and water is in sufficient quantity; the pulmonary, cellular, and cutaneous lymphatics are not excited into action; whence the urine is pale, and the skin moist, from the defect of absorption on those surfaces.
7. _Syngultus nephriticus._ When a stone irritates the ureter, and that even without its being attended with pain or fever, sometimes a chronical hiccough occurs, and continues for days and weeks, instead of sickness or vomiting; which are the common symptoms. In this case the motions of the stomach are decreased by their sympathy with those of the ureter, which are increased by the stimulus of the stone in it; and the increased motions of the diaphragm seem to exist in consequence of their association with the stomach by a second reverse sympathy. This hiccough may nevertheless admit of another explanation, and be supposed to be a convulsive exertion of the diaphragm to relieve the disagreeable sensation of the stomach in consequence of its disordered irritative associations; and in that case it would belong to Class III. 1. 1. See Class IV. 2. 1. for another example of tertiary association.
M. M. Venesection. Emetic. Calomel. Cathartic, opium, oil of cinnamon from two to ten drops. Aerated alcaline water. Peruvian bark.
8. _Febris irritativa._ Irritative fever, described in Class I. 1. 1. 1. The diseases above explained in this genus are chiefly concerning the sympathies of the absorbent system, or the alimentary canal, which are not so much associated with the arterial system, as to throw it into disorder, when they are slightly deranged; but when any great congeries of conglomerate glands, which may be considered as the extremities of the arterial system, are affected with torpor, the whole arterial system and the heart sympathize with the torpid glands, and act with less energy; which constitutes the cold fit of fever; which is therefore at first a decreased action of the associate organ; but as this decrease of action is only a temporary effect, and an increase of exertion both of the torpid glands, and of the whole arterial system, soon follows; the hot fit of irritative fever, or fever with strong pulse, properly belongs to this class and genus of diseases.
* * * * *
ORDO I.
_Increased Associate Motions._
GENUS II.
_Catenated with Sensitive Motions._
The primary links of the associated actions of this genus are either produced or attended by painful or pleasurable sensation. The secondary links of the first ten species are attended with increased motions without inflammation, those of the remainder are attended with inflammation. All inflammations, which do not arise in the part which was previously torpid, belong to this genus; as the gout, rheumatism, erysipelas. It is probable many other inflammations may, by future observation, require to be transplanted into this class.
The circles of sensitive associate motions consist chiefly of the excretory ducts of the capillaries and of the mouths of the absorbent vessels, which constitute the membranes; and which have been induced into action at the same time; or they consist of the terminations of canals; or of parts which are endued with greater sensibility than those which form the first link of the association. An instance of the first of those is the sympathy between the membranes of the alveolar processes of the jaws, and the membranes above or beneath the muscles about the temples in hemicrania. An instance of the second is in the sympathy between the excretory duct of the lacrymal gland, and the nasal duct of the lacrymal sack. And an instance of the third is the sympathy between the membranes of the liver, and the skin of the face in the gutta rosea of inebriates.
SPECIES.
1. _Lacrymarum fluxus sympatheticus._ A flow of tears from grief or joy. When the termination of the duct of the lacrymal sac in the nostrils becomes affected either by painful or pleasurable sensations, in consequence of external stimulus, or by its association with agreeable or disagreeable ideas, the motions of the lacrymal gland are at the same time exerted with greater energy, and a profusion of tears succeeds by sensitive association, as explained in Sect. XVI. 8. 2.
In this case there exists a chain of associated actions, the secretion of the lacrymal gland is increased by whatever stimulates the surface of the eye, at the same time the increased abundance of tears stimulates the puncta lacrymalia into greater action; and the fluid thus absorbed stimulates the lacrymal sac, and its nasal duct in the nose into greater action. In a contrary direction of this chain of association the present increase of action is induced. First, the nasal duct of the lacrymal sac is excited into increased action by some pleasurable or painful idea, as described in Sect. XVI. 8. 2. 2d. The puncta lacrymalia or other extremity of the lacrymal sac sympathizes with it (as the two ends of all other canals sympathize with each other). 3d. With these increased motions of the puncta lacrymalia those of the excretory duct of the lacrymal gland are associated from their having so perpetually acted together. And, lastly, with the increased actions of the excretory duct of this gland are associated those of the other end of it by their frequently acting together; in the same manner as the extremities of other canals are associated; and thus a greater flow of tears is poured into the eye.
When a flow of tears is produced in grief, it is believed to relieve the violence of it, which is worthy a further inquiry. Painful sensations, when great, excite the faculty of volition; and the person continues voluntarily to call up or perform those ideas, which occasion the painful sensation; that is, the afflicted person becomes so far insane or melancholy; but tears are produced by the sensorial faculty of association, and shew that the pain is so far relieved as not to excite the excessive power of volition, or insanity, and are therefore a sign of the abatement of the painful state of grief, rather than a cause of that abatement. See Class III. 1. 2. 10.
2. _Sternutatio a lumine._ Some persons sneeze from looking up at the light sky in a morning after coming out of a dark bedroom. The olfactory nerves are brought into too great action by their sympathy with the optic nerves, or by their respective sympathies with some intervening parts, as probably with the two extremities of the lacrymal sac; that is, with the puncta lacrymalia and the nasal duct. See Class II. 1. 1. 3.
3. _Dolor dentium Stridore._ Tooth-edge from grating sounds, and from the touch of certain substances, and even from imagination alone, is described and explained in Sect. XVI. 10. The increased actions of the alveolar vessels or membranes are associated with the ideas, or sensual motions of the auditory nerves in the first case; and of those of the sense of touch, in the second case; and by imagination, or ideas exerted of painful sensation alone, in the last.
4. _Risus sardonicus._ A disagreeable smile attends inflammations of the diaphragm arising from the associations of the reiterated exertions of that muscle with those of the lips and cheeks in laughing. See Diaphragmitis, Class II. 1. 2. 6.
5. _Salivae fluxus cibo viso._ The flow of saliva into the mouths of hungry animals at the sight or smell of food is seen in dogs standing round a dinner-table. The increased actions of the salivary glands have been usually produced by the stimulus of agreeable food on their excretory ducts during the mastication of it; and with this increased action of their excretory ducts the other terminations of those glands in the capillary arteries have been excited into increased action by the mutual association of the ends of canals; and at the same time the pleasurable ideas, or sensual motions, of the sense of smell and of sight have accompanied this increased secretion of saliva. Hence this chain of motions becomes associated with those visual or olfactory ideas, or with the pleasure, which produces or attends them.
6. _Tensio mamularum viso puerulo._ The nipples of lactescent women are liable to become turgid at the sight of their young offspring. The nipple has generally been rendered turgid by the titillation of the lips or gums of the child in giving suck; the visible idea of the child has thus frequently accompanied this pleasurable sensation of parting with the milk, and turgescence of the tubes, which constitute the nipple. Hence the visual idea of the child, and the pleasure which attends it, become associated with those increased arterial actions, which swell the cells of the mamula, and extend its tubes; which is very similar to the tensio phalli visa muliere nuda etiam in insomnio.
7. _Tensio penis in hydrophobia._ An erection of the penis occurs in the hydrophobia, and is a troublesome symptom, as observed by Coelius Aurelianus, Fothergill, and Vaughn, and would seem to be produced by an unexplained sympathy between the sensations about the fauces and the penis. In men the hair grows about both these parts, the voice changes, and the neck thickens at puberty. In the mumps, when the swellings about the throat subsides, the testicles are liable to swell. Venereal infection received by the penis is very liable to affect the throat with ulcers. Violent coughs, with soreness or rawness about the fauces are often attended with erection of the penis; which is also said to happen to male animals, that are hanged; which last circumstance has generally been ascribed to the obstruction of the circulation of the blood, but is more probably occasioned by the stimulus of the cord in compressing the throat; since if it was owing to impeded circulation it ought equally to occur in drowning animals.
In men the throat becomes so thickened at the time of puberty, that a measure of this is used to ascertain the payment of a poll-tax on males in some of the islands of the Mediterranean, which commences at puberty; a string is wrapped twice round the thinnest part of the neck, the ends of it are then put into each corner of the mouth; and if, when thus held in the teeth, it passes readily over the head, the subject is taxable.
It is difficult to point out by what circumstance the sensitive motions of the penis and of the throat and nose become associated; I can only observe, that these parts are subjected to greater pleasurable sensations than any other parts of the body; one being designed to preserve ourselves by the pleasure attending the smell and deglutition of food, and the other to ensure the propagation of our species; and may thus gain an association of their sensitive motion by their being eminently sensible to pleasure. See Class I. 3. 1. 11. and III. 1. 1. 15. and Sect. XVI. 5.
In the female sex this association between the face, throat, nose, and pubis does not exist; whence no hair grows on their chins at the time of puberty, nor does their voices change, or their necks thicken. This happens probably from there being in them a more exquisite sensitive sympathy between the pubis and the breasts. Hence their breasts swell at the time of puberty, and secrete milk at the time of parturition. And in the parotitis, or mumps, the breasts of women swell, when the tumor of the parotitis subsides. See Class I. 1. 2. 15. Whence it would appear, that their breasts possess an intermediate sympathy between the pubis and the throat; as they are the seat of a passion, which men do not possess, that of suckling children.
8. _Tenesmus calculosus._ The sphincter of the rectum becomes painful or inflamed from the association of its sensitive motions with those of the sphincter of the bladder, when the latter is stimulated into violent pain or inflammation by a stone.
9. _Polypus narium ex ascaridibus?_ The stimulation of ascarides in the rectum produces by sensitive sympathy an itching of the nose, as explained in IV. 2. 2. 6; and in three children I have seen a polypus in the nose, who were all affected with ascarides; to the perpetual stimulation of which, and the consequent sensitive association, I was led to ascribe the inflammation and thickening of the membrane of the nostrils.
10. _Crampus surarum in cholera._ A cramp of the muscles of the legs occurs in violent diarrhoea, or cholera, and from the use of too much acid diet in gouty habits. This seems to sympathize with uneasy sensation in the bowels. See Class III. 1. 1. 14. This association is not easily accounted for, but is analogous in some degree to the paralysis of the muscles of the arms in colica saturnina. It would seem, that the muscles of the legs in walking get a sympathy with the lower parts of the intestines, and those of the arms in variety of employment obtain a sympathy with the higher parts of them. See Cholera and Ileus.
11. _Zona ignea nephritica._ Nephritic shingles. The external skin about the loins and sides of the belly I suppose to have greater mobility in respect to sensitive association, than the external membrane of the kidney; and that their motions are by some unknown means thus associated. When the torpor or beginning inflammation of this membrane ceases, the external skin becomes inflamed, in its stead, and a kind of herpes, called the shingles, covers the loins and sides of the belly. See Class II. 1. 5. 9.
12. _Eruptio variolarum._ After the inflammation of the inoculated arm has spread for a quarter of a lunation, it affects the stomach by reverse sympathy; that is, the actions of the stomach are associated with those of the skin; and as much sensorial power is now exerted on the inflamed skin, the other part of this sensitive association is deprived of its natural share, and becomes torpid, or inverts its motions. After this torpor of the stomach has continued a time, and much sensorial power is thus accumulated; other parts of the skin, which are also associated with it, as that of the face first, are thrown into partial inflammation; that is, the eruptions of the small-pox appear on the face.
For that the variolous matter affects the stomach previous to its eruption on the skin appears from the sickness at the commencement of the fever; and because, when the morbid motions affect the skin, those of the stomach cease; as in the gout and erysipelas, mentioned below. The consent between the stomach and the skin appears in variety of other diseases; and as they both consist of surfaces, which absorb and secrete a quantity of moisture, their motions must frequently be produced together or in succession; which is the foundation of all the sympathies of animal motions, whether of the irritative, sensitive, or voluntary kinds.
Now as the skin, which covers the face, is exposed to greater variations of heat and cold than any other part of the body; it probably possesses more mobility to sensitive associations, not only than the stomach, but than any other part of the skin; and is thence affected at the eruption of the small-pox with violent action and consequent inflammation, by the association of its motions with those of the stomach, a day before the other parts of the skin; and becomes fuller of pustules, than any other part of the body. See Class II. 1. 3. 9.
It might be supposed, that the successive swelling of the hands, when the face subsides, at the height of the small-pox, and of the feet, when the hands subside, were governed by some unknown associations of those parts of the system; but these successions of tumor and subsidence more evidently depend on the times of the eruption of the pustules on those parts, as they appear a day sooner on the face than on the hands, and a day sooner on the hands than on the feet, owing to the greater comparative mobility of those parts of the skin.
13. _Gutta rosea stomatica._ Stomatic red face. On drinking cold water, or cold milk, when heated with exercise, or on eating cold vegetables, as raw turnips, many people in harvest-time have been afflicted with what has been called a surfeit. The stomach becomes painful, with indigestion and flatulency, and after a few days an eruption of the face appears, and continues with some relief, but not with entire relief; as both the pimpled face and indigestion are liable to continue even to old age.
M. M. Venesection. A cathartic with calomel. Then half a grain of opium twice a day for many weeks. If saturated solution of arsenic three or five drops twice or thrice a day for a week?
14. _Gutta rosea hepatica._ The rosy drop of the face of some drinking people is produced like the gout described below, in consequence of an inflamed liver. In these constitutions the skin of the face being exposed to greater variation of heat and cold than the membranes of the liver, possesses more mobility than those hepatic membranes; and hence by whatever means these membranes are induced to sympathize, when this sensitive association occurs, the cutaneous vessels of the face run into greater degrees of those motions, which constitute inflammation, than previously existed in the membranes of the liver; and then those motions of the liver cease. See Class II. 1. 4. 6.
An inflammation of the liver so frequently attends the great potation of vinous spirit, there is reason to suspect, that this viscus itself becomes inflamed by sensitive association with the stomach; or that, when one termination of the bile-duct, which enters the duodenum is stimulated violently, the other end may become inflamed by sensitive association.
15. _Podagra._ The gout, except when it affects the liver or stomach, seems always to be a secondary disease, and, like the rheumatism and erysipelas mentioned below, begins with the torpor of some distant part of the system.
The most frequent primary seat of the gout I suppose to be the liver, which is probably affected with torpor not only previous to the annual paroxysms of the gout, but to every change of its situation from one limb to another. The reasons, which induce me to suspect the liver to be first affected, are not only because the jaundice sometimes attends the commencement of gout, as described in Sect. XXIV. 2. 8. but a pain also over the pit of the stomach, which I suppose to be of the termination of the bile-duct in the duodenum, and which is erroneously supposed to be the gout of the stomach, with indigestion and flatulency, generally attends the commencement of the inflammation of each limb. See Arthritis ventriculi, Class I. 2. 4. 6. In the two cases, which I saw, of the gout in the limbs being preceded by jaundice, there was a cold shivering fit attended the inflammation of the foot, and a pain at the pit of the stomach; which ceased along with the jaundice, as soon as the foot became inflamed. This led me to suspect, that there was a torpor of the liver, and perhaps of the foot also, but nevertheless the liver might also in this case be previously inflamed, as observed in Sect. XXIV. 2. 8.
Now as the membranes of the joints of the feet suffer greater variations of heat and cold than the membranes of the liver, and are more habituated to extension and contraction than other parts of the skin in their vicinity; I suppose them to be more mobile, that is, more liable to run into extremes of exertion or quiescence; and are thence more susceptible of inflammation, than such parts as are less exposed to great variations of heat and cold, or of extension and contraction.
When a stone presses into the sphincter of the bladder, the glans penis is affected with greater pain by sympathy, owing to its greater sensibility, than the sphincter of the bladder; and when this pain commences, that of the sphincter ceases, when the stone is not too large, or pushed too far into the urethra. Thus when the membrane, which covers the ball of the great toe, sympathizes with some membranous part of a torpid or inflamed liver; this membrane of the toe falls into that kind of action, whether of torpor or inflammation, with greater energy, than those actions excited in the diseased liver; and when this new torpor or inflammation commences, that with which it sympathises ceases; which I believe to be a general law of associated inflammations.
The paroxysms of the gout would seem to be catenated with solar influence, both in respect to their larger annual periods, and to their diurnal periods--See Sect. XXXVI. 3. 6.--as the former occur about the same season of the year, and the latter commence about an hour before sun-rise; nevertheless the annual periods may depend on the succession of great vicissitudes of cold and heat, and the diurnal ones on our increased sensibility to internal sensations during sleep, as in the fits of asthma, and of some epilepsies. See Sect. XVIII. 15.
In respect to the pre-remote cause or disposition to the gout, there can be no doubt of its individually arising from the potation of fermented or spirituous liquors in this country; whether opium produces the same effect in the countries, where it is in daily use, I have never been well informed. See Sect. XXI. 10, where this subject is treated of; to which I have to add, that I have seen some, and heard of others, who have moderated their paroxysms of gout, by diminishing the quantity of fermented liquors, which they had been accustomed to; and others who, by a total abstinence from fermented liquors, have entirely freed themselves from this excruciating malady; which otherwise grows with our years, and curtails or renders miserable the latter half, or third, of the lives of those, who are subject to it. The remote cause is whatever induces temporary torpor or weakness of the system; and the proximate cause is the inirritability, or defective irritation, of some part of the system; whence torpor and consequent inflammation. The great Sydenham saw the beneficial effects of the abstinence from fermented liquors in preventing the gout, and adds, "if an empiric could give small-beer only to gouty patients as a nostrum, and persuade them not to drink any other spirituous fluids, that he might rescue thousands from this disease, and acquire a fortune for his ingenuity." Yet it is to be lamented, that this accurate observer of diseases had not resolution to practise his own prescription, and thus to have set an example to the world of the truth of his doctrine; but, on the contrary, recommends Madeira, the strongest wine in common use, to be taken in the fits of the gout, to the detriment of thousands; and is said himself to have perished a martyr to the disease, which he knew how to subdue!
As example has more forcible effect: than simple assertion, I shall now concisely relate my own case, and that of one of my most respected friends. E. D. was about forty years of age, when he was first seized with a fit of the gout. The ball of his right great toe was very painful, and much swelled and inflamed, which continued five or six days in spite of venesection, a brisk cathartic with ten grains of calomel, and the application of cold air and cold water to his foot. He then ceased to drink ale or wine alone; confining himself to small beer, or wine diluted with about thrice its quantity of water. In about a year he suffered two other fits of the gout, in less violent degree. He then totally abstained from all fermented liquors, not even tasting small-beer, or a drop of any kind of wine; but eat plentifully of flesh-meat, and all kinds of vegetables, and fruit, using for his drink at meals chiefly water alone, or lemonade, or cream and water; with tea and coffee between them as usual.
By this abstinence from fermented liquors he kept quite free from the gout for fifteen or sixteen years; and then began to take small-beer mixed with water occasionally, or wine and water, or perry and water, or cyder and water; by which indulgence after a few months he had again a paroxysm of gout, which continued about three days in the ball of his toe; which occasioned him to return to his habit of drinking water, and has now for above twenty years kept in perpetual health, except accidental colds from the changes of the seasons. Before he abstained from fermented or spirituous liquors, he was frequently subject to the piles, and to the gravel, neither of which he has since experienced.
In the following case the gout was established by longer habit and greater violence, and therefore required more cautious treatment. The Rev. R. W. was seized with the gout about the age of thirty-two, which increased so rapidly that at the age of forty-one he was confined to his room seven months in that year; he had some degree of lameness during the intervals, with chalky swellings of his heels and elbows. As the disease had continued so long and so violently, and the powers of his digestion were somewhat weakened, he was advised not entirely to leave off all fermented liquors; and as small-beer is of such various strength, he was advised to drink exactly two wine glasses, about four ounces, of wine mixed with three or four times its quantity of water, with or without lemon and sugar, for his daily potation at dinner, and no other fermented liquor of any kind; and was advised to eat flesh-meat with any kind of boiled vegetables, and fruit, with or without spice. He has now scrupulously continued this regimen for above five years, and has had an annual moderate gouty paroxysm of a few weeks, instead of the confinement of so many months, with great health and good spirits during the intervals.
The following is a more particular account of the history of this case; being part of a letter which Mr. Wilmot wrote on that subject at my entreaty.
"I entered into the army with an excellent constitution at the age of fifteen. The corps I served in was distinguished by its regularity, that is, the regular allowance of the mess was only one pint of wine per man each day; unless we had company to dine with us; then, as was the general custom of the time, the bottle circulated without limit. This mode of living, though by no means considered as excess for men, was certainly too great for a youth of my age. This style of living I continued, when with the regiment, till the latter end of the year 1769, when I had the misfortune to sleep in a damp bed at Sheffield on a journey to York, but arrived there before I felt the ill effects of it. I was then seized with a violent inflammatory rheumatism with great inflammation of my eyes, and was attended by Dr. Dealtry; so violent was the disorder, that I was bled for it eight times in less than a fortnight; and was three months, before I could consider my health perfectly re-established. Dr. Dealtry told me, that I should be subject to similar attacks for many years; and that he had no doubt, from the tendency he found in my habit to inflammation, that, when I was farther advanced in life, I should change that complaint for the gout. He predicted truly; for the three succeeding winters I had the same complaint, but not so violently; the fourth winter I escaped, and imputed my escape to the continuance of cold bathing during the whole of that winter; after that I never escaped it, till I had a regular and severe fit of the gout: after the first attack of rheumatic fever I was more abstemious in my manner of living, though when in company I never subjected myself to any great restraint. In the year 1774 I had quitted the army, and being in a more retired situation, was seldom led into any excess; in 1776 and 1777 I was in the habit of drinking a good deal of wine very frequently, though not constantly. After that period till the year 1781, I drank a larger quantity of wine regularly, but very seldom to any degree of intoxication. I lived much at that time in the society of some gentlemen, who usually drank nearly a bottle of wine daily after dinner. I must here however observe, that at no part of my life was I accustomed to drink wine in an evening, and very seldom drank any thing more than a single half-pint glass of some sort of spirits diluted with much water. Till the year 1781 I had always been accustomed to use very violent and continued exercise on horseback; in the winter months I pursued all field diversions, and in the summer months I rode frequent and long journeys; and with this exercise was liable to perspire to great excess; besides which I was subject to very profuse night-sweats, and had frequently boils break out all over me, especially in the spring and autumn; for which I took no medicine, except a little flour of sulphur with cream of tartar in honey.
"You will observe I bring every thing down to the date of 1781. In the month of October in that year, when I was just entered into the thirty-second year of my age, I had the first attack of gout; that fit was very severe, and of many weeks continuance. I now determined upon a more abstemious method of living, in respect to wine; and indeed the society, in which I had before been accustomed to live, being considerably changed, I had less frequent temptations to excess. From this time I enjoyed the most perfect good state of health till August 1784, when I had my second attack of gout. I never perfectly recovered from this attack through the succeeding winter, and in March 1785 was advised to try the Bath waters, and drank them under the direction of one of the faculty of that place. I was there soon seized with a fever, and a slight attack of gout in one knee. I should observe, that when I set out from home, I was in a weak and low state, and unequal to much fatigue; as appeared by my having a fainting fit one day on the road, after having travelled only about fifty miles; in the course of the summer I had two or three more slight attacks of gout of less consequence, till the month of October; when I was afflicted with it all over me in such a manner, as to be without the possibility of the least degree of removal for some days; and was about two months without being able to get into the air. This was the severest attack I had then experienced; though I have since had several equally severe. In the course of this summer I had a fall with my horse; and soon after it, having discovered an enlargement on one elbow, I concluded I had hurt it at that time; but in the course of this last attack having a similar enlargement on the other elbow, I found my mistake, and that they were collections of gouty matter; these increased to the size of pullet's eggs, and continue in that state. I had soon after similar enlargements on my heels; the right heel being severely bruised, I was under the necessity of having it lanced, and a large quantity of chalky matter was discharged from it; and have since that time frequently had chalky matter taken from it, and sometimes small bits of apparently perfect chalk. My right hand soon was afflicted in the same way, and I have scarcely a joint on those fingers now in a natural state. My left hand has escaped tolerably well. After this last attack (viz. October 1785), I had two or three slight attacks before the month of June 1787, when I had a very severe intermittent fever; from that time I continued very well till the latter end of the year, when I began to feel the gout about me very much, but was not confined by it. I was in this state advised to try what is called the American Recipe (gum guaiacum and nitre dissolved in spirits); it had apparently been of essential service to a friend of mine, who from the inability to walk a mile for some years, was believed to be restored by the use of this medicine to a good state of health, so as to walk ten miles a day. In addition to this medicine I drank, as my common beverage with my meals, spruce beer. I had so high an opinion of this medicine in the gout, and of spruce beer as an antiscorbutic, that I contemplated with much satisfaction, and with very little doubt, the perfect restoration of my health and strength; but I was miserably deceived; for in September 1788 I was seized with the gout in a degree that none but arthritics, and indeed but few of those, can easily conceive. From this time till August 1789 I scarcely ever passed a comfortable day; seven months of this time I had been confined, my health seemed much impaired, my strength was diminished, and my appetite almost gone. In this state my friends pressed me to consult you. I was unwilling for some time to do it, as I had lost all hope of relief; however, when I had determined to apply to you, I likewise determined to give up every prejudice of my own respecting my case, and to adhere most strictly to your advice. On the 20th of August 1789 I consulted you, on the 25th I entered upon the regimen, which you prescribed, and which was as follows.
"Drink no malt liquor on any account. Let your beverage at dinner consist of two glasses of wine diluted with three half-pints of water. On no account drink any more wine or spirituous liquors in the course of the day; but, if you want more liquid, take cream and water, or milk and water, or lemonade, with tea, coffee, chocolate. Use the warm bath twice a week for half an hour before going to bed, at the degree of heat which is most grateful to your sensations. Eat meat constantly at dinner, and with it any kind of tender vegetables you please. Keep the body open by two evacuations daily, if possible without medicine, if not take the size of a nutmeg of lenitive electuary occasionally, or five grains of rhubarb every night. Use no violent exercise, which may subject yourself to sudden changes from heat to cold; but as much moderate exercise as may be, without being much fatigued or starved with cold. Take some supper every night; a small quantity of animal food is preferred; but if your palate refuses this, take vegetable food, as fruit pie, or milk; something should be eaten, as it might be injurious to you to fast too long." To the whole of this I adhered most scrupulously, and soon found my appetite improve, and with it my strength and spirits. I had in December a fevere attack, and two or three slight ones in the course of twelve months; but the improvement in the general state of my health induced me to persevere. On the 18th of August 1790 I had another severe attack, but it went off easier than before, and I soon recovered sufficiently to go to Buxton, which you advised me to, and from which I reaped great benefit; nevertheless on the 29th of December I had a slight attack in comparison of some that I had before experienced, and from that time I was free from gout, and enjoyed my health perfectly well till the fourth week in October 1791; from that till the third week in October 1792; from that till the third week in October 1793; and from that till June 1794. From what happened for the last three years I dreaded the month of October; but I escaped then, and have enjoyed my health most perfectly ever since till within the last week, that I have had a slight attack in one knee, which is nearly gone, without any symptom to lead me to suppose that it will go further.
"I adhered to your advice most scrupulously for the first year; and in regard to the not drinking malt liquor, and taking only the two glasses of wine with water, I have never deviated but two days; and then the first day I only drank one glass of ale and one glass of Champaigne; on the second only one glass of Champaigne. With regard to the warm bath, I only use it now when I have gouty symptoms upon me, and in such situations I find it of infinite service; and in other respects I continue to live according to your direction.
"Many persons have laughed at the idea of my perseverance in a system, which has not been able to _cure_ the gout after five years trial; but such persons are either ignorant of what I before suffered, or totally unacquainted with the nature of the disorder. Under the blessing of Providence, by an adherence to your advice, I am reaping all the benefit you flattered me I might expect from it, viz. my attacks less frequent, my sufferings less acute, and an improvement in the general state of my health.
"I have been particular in this account of myself at your request, and am, Sir, &c.
MORLEY, near DERBY, February 10th, 1795. ROBERT WILMOT."
There are situations nevertheless in which a paroxysm of gout has been believed to be desirable, as relieving the patient from other disagreeable diseases, or debilities, or sensations. Thus when the liver is torpid, a perpetual uneasiness and depression of spirits occur; which a fit of gout is supposed to cure by a metastasis of the disease. Others have acquired epileptic fits, probably from the disagreeable sensation of a chronically inflamed liver; which they suppose the pain and inflammation of gout would relieve. When gouty patients become much debilitated by the progress of the disease, they are liable to dropsy of the chest, which they suppose a fit of the gout would relieve. But in all these cases the attempt to procure a paroxysm of gout by wine, or aromatics, or volatiles, or blisters, or mineral waters, seldom succeeds; and the patients are obliged to apply to other methods of relief adapted to their particular cases. In the two former situations small repeated doses of calomel, or mercurial unction on the region of the liver may succeed, by giving new activity to the vessels of the liver, either to secrete or to absorb their adapted fluids, and thus to remove the cause of the gout, rather than to promote a fit of it. In the last case the tincture of digitalis, and afterwards the class of sorbentia, must be applied to.
M. M. In young strong patients the gout should be cured by venesection and cathartics and diluents, with poultices externally. But it has a natural crisis by producing calcareous matter on the inflamed membrane, and therefore in old enfeebled people it is safest to wait for this crisis, attending to the natural evacuations and the degree of fever; and in young ones, where it is not attended with much fever, it is customary and popular not to bleed, but only to keep the body open with aloes, to use gentle sudorifics, as neutral salts, and to give the bark at the decline of the fit; which is particularly useful where the patient is much debilitated. See Arthritis ventriculi, Class I. 2. 4. 6. and Sect. XXV. 17.
When there is not much fever, and the patient is debilitated with age, or the continuance of the disease, a moderate opiate, as twenty drops of tincture of opium, or one grain of solid opium, may be taken every night with advantage. Externally a paste made with double the quantity of yeast is a good poultice; and booterkins made with oiled silk, as they confine the perspirable matter, keep the part moist and supple, and thence relieve the pain like poultices.
The only safe way of moderating the disease is by an uniform and equal diminution, or a total abstinence from fermented liquors, with the cautions directed in Sect. XII. 7. 8. The continued use of strong bitters, as of Portland's powder, or bark, has been frequently injurious, as spoken of in the Materia Medica, Art. IV. 2. 11.
One of my acquaintance, who was much afflicted with the gout, abstained for about half a year from beer and wine; and not having resolution to persist, returned to his former habits of potation in less quantity; and observed that he was then for one winter stronger and freer from the gout than usual. This however did not long continue, as the disease afterwards returned with its usual or increased violence. This I think is a circumstance not unlikely to occur, as opium has a greater effect after its use has been a while intermitted; and the debility or torpor, which is the cause of gout, is thus for a few months prevented by the greater irritability of the system, acquired during the lessened use of fermented liquor.
For the same reason an ounce of spirituous tincture of guaiacum, or of bark, is said to have for some time prevented returns of the gout; which has afterwards, like all other great stimuli when long continued, been succeeded by greater debility, and destroyed the patient. This seems to have been exemplified in the case of the ingenious Dr. Bown, see Preface to his Elementa Medicinae; he found temporary relief from the stimulus of wine, regardless of its future effects.
16. _Rheumatismus._ Acute rheumatism. There is reason to suspect, that rheumatic inflammations, like the gouty ones, are not a primary disease; but that they are the consequence of a translation of morbid action from one part of the system to another. This idea is countenanced by the frequent change of place of rheumatic-like gouty inflammations, and from their attacking two similar parts at the same time, as both ankles and both wrists, and these attacks being in succession to each other. Whereas it is not probable that both feet or both hands should at the same time be equally exposed to any external cause of the disease, as to cold or moisture; and less so that these should occur in succession. Lastly, from the inflammatory diathesis in this disease being more difficult to subdue, and more dangerous in event, than other common inflammations, especially to pregnant women, and in weak constitutions.
From this idea of the rheumatism being not a primary disease, like the gout, but a transferred morbid action owing to the previous torpor of some other part of the system, we perceive why it attacks weak people with greater pertinacity than strong ones; resisting or recurring again and again after frequent evacuations, in a manner very different from primary inflammations; because the cause is not removed, which is at a distance from the seat of the inflammation.
This also accounts for rheumatic inflammations so very rarely terminating in suppuration, because like the gout the original cause is not in the inflamed part, and therefore does not continue to act after the inflammation commences. Instead of suppuration in this disease, as well as in the gout, a quantity of mucus or coagulable lymph is formed on the inflamed membrane; which in the gout changes into chalkstones, and in the rheumatism is either reabsorbed, or lies on the membrane, producing pains on motion long after the termination of the inflammation, which pains are called chronic rheumatism. The membranes, which have thus been once or repeatedly inflamed, become less mobile, or less liable to be affected by sympathy, as appears by the gout affecting new parts, when the joints of the foot have been frequently inflamed by it; hence as the cause of the inflammation does not exist in the inflamed part, and as this part becomes less liable to future attacks, it seldom suppurates.
Secondly, when rheumatism affects the muscles of the chest, it produces symptoms similar to pleurisy, but are distinguished from that by the patient having previously suffered rheumatic affections in other parts, and by the pertinacity or continuance of the inflammatory state of the patient, this should be termed pleurodyne rheumatica.
Thirdly, when rheumatic inflammation affects the bowels, it produces a disease very different from enteritis, or common inflammation of the bowels, and should be termed enteralgia rheumatica. The pain is less than in enteritis, and the disease of longer continuance, with harder pulse, and the blood equally sizy. It is attended with frequent dejections, with much mucus, and previous griping pains, but without vomiting; and differs perhaps from dysentery from its not being attended with bloody stools, and not being infectious.
Fourthly, there is another kind of rheumatism attended with debility, which suppurates, and should be termed rheumatismus suppurans. It is generally believed to be the gout, till suppuration takes place on the swelled joint; and, as the patient sinks, there are sloughs formed over the whole mouth; and he seems to be destroyed by inflammation or gangrene of the mucous membranes. I have twice seen this disease in patients about sixty. Some other diseases are erroneously called rheumatic, as hemicrania, and odontalgia. See Sect. XXVI. 3.
M.M. In the three former kinds venesection repeatedly. Cathartics. Antimonials. Diluents. Neutral salts. Oil. Warm bath. Afterwards the bark. Opium with or without ipecacuanha; but not till the patient is considerably weakened. Sweats forced early in the disease do injury. Opium given early in the disease prolongs it. In the last kind, gentle stimulants, as wine and water, mucilage, sorbentia.
The following is a case of suppurative rheumatism. Mr. F----, about sixty, was supposed to have the gout in his hand, which however suppurated, and it was then called the suppurative rheumatism. He had lived rather intemperately in respect to wine, and was now afflicted with a tendency to inflammation of the mucous membranes. As he lay on the bed half resupine, propped up with pillows, and also slept in that posture, his lower jaw dropped by its own weight, when the voluntary power of the muscles was suspended. The mucus of his mouth and throat became quite dry, and at length was succeeded with sloughs; this was a most distressing circumstance to him, and was in vain endeavoured to be relieved by supporting his jaw by slender steel springs fixed to his night-cap, and by springs of elastic gum. The sloughs spread and seemed to accelerate his death. See Class I. 1. 3. 2.
17. _Erysipelas._ The erysipelas differs from the zona ignea, and other species of herpes, in its being attended with fever, which is sometimes of the sensitive irritated or inflammatory kind, with strong and full pulse; and at other times with weak pulse and great inirritability, as when it precedes or attends mortifications. See Class II. 1. 3. 2.
Like the zona ignea above described, it seems to be a secondary disease, having for its primary part the torpor or inflammation of some internal or distant membrane, as appears from its so frequently attending wounds; sometimes spreading from issues over the whole limb, or back, by sympathy with a tendon or membrane, which is stimulated by the pease in them. In its more violent degree I suppose that it sympathizes with some extensive internal membranes, as of the liver, stomach, or brain. Another reason, which countenances this idea, is, that the inflammation gradually changes its situation, one part healing as another inflames; as happens in respect to more distant parts in gout and rheumatism; and which seems to shew, that the cause of the disease is not in the same place with the inflammation. And thirdly, because the erysipelas of the face and head is liable to affect the membranes of the brain; which were probably in these cases the original or primary seat of the disease; and lastly, because the fits of erysipelas, like those of the gout, are liable to return at certain annual or monthly periods, as further treated of in Class II. 1. 3. 2.
Many cases of erysipelas from wounds or bruises are related in Default's Surgical Journal, Vol. II. in which poultices are said to do great injury, as well as oily or fatty applications. Saturnine solutions were sometimes used with advantage. A grain of emetic tartar given to clear the stomach and bowels, is said to be of great service.
18. _Testium tumor in gonorrhoea._ Mr. Hunter in his Treatise on the Venereal Disease observes, that the tumor of the testes in gonorrhoea arises from their sympathy with the inflammation of the urethra; and that they are not similar to the actions arising from the application of venereal matter, whether by absorption or otherwise; as they seldom or never suppurate; and when suppuration happens, the matter produced is not venereal. Treatise on Venereal Disease, p. 53.
19. _Testium tumor in parotidite._ The sympathy between some parts about the throat and the genitals has been treated of in Class IV. 1. 2. 7. The swelling of the testes, when that of the parotis subsides, seems to arise from the association of successive action; as the tension of the penis in hydrophobia appears to arise from the previous synchronous associations of the sensitive motions of these parts; but the manner of the production of both these associations is yet very obscure. In women a swelling of the breasts often succeeds the decline of the mumps by another wonderful sympathy. See Class IV. 1. 2. 7. and I. 1. 2. 15. In many persons a delirium succeeds the swelling of the parotis, or the subsequent ones of the testes or breasts; which is sometimes fatal, and seems to arise from a sympathy of successive action, and not of synchronous action, of the membranes of the brain with those of the parotide glands. Sometimes a stupor comes on instead of this delirium, which is relieved by fomenting the shaved head for an hour or two. See Class II. 1. 3. 4.
* * * * *
ORDO I.
_Increased Associate Motions._
GENUS III.
_Catenated with Voluntary Motions_
SPECIES.
1. _Deglutitio invita._ When any one is told not to swallow his saliva, and that especially if his throat be a little sore, he finds a necessity of immediately swallowing it; and this the more certainly, the more he voluntarily endeavours not to do so.
In this case the voluntary power exerted by our attention to the pharinx renders it more sensible to irritation, and therefore occasions it to be more frequently induced to swallow the saliva. Here the irritation induces a volition to swallow it, which is more powerful than the desire not to swallow it. See XXIV. 1. 7. So in reverie, when the voluntary power was exerted on any of the senses, as of sight or taste, the objects of those senses became perceived; but not otherwise. Sect. XIX. 6. This is a troublesome symptom in some sore throats.
M. M. Mucilage, as sugar and gum arabic. Warm water held in the mouth frequently, as a fomentation to the inflamed throat.
2. _Nictitatio invita._ Involuntary winking with the eye-lids, and twitchings of the face, are originally induced by an endeavour to relieve some disagreeable sensations about inflamed eyes, as the dazzling of light; and afterwards these motions become catenated with other motions or sensations, so as not to be governed by the will. Here the irritation first produces a volition to wink, which by habit becomes stronger than the anti-volition not to wink.
This subject is rendered difficult from the common acceptation of the word, volition, including previous deliberation, as well as the voluntary exertion, which succeeds it. In the volitions here spoken of there is no time for deliberation or choice of objects, but the voluntary act immediately succeeds the sensation which excites it.
M. M. Cover the affected parts with a sticking plaster or a blister. Pass a fine needle and thread through a part of the skin over the muscle, which moves, and attach the other end of the thread by a sticking plaster to a distant part. An issue behind the ear. To practise daily by a looking-glass to stop the motions with the hand. See the cure of a case of the leaping of a muscle of the arm, Sect. XVII. 1. 8. See Convulsio debilis, Class III. 1. 1. 5.
3. _Risus invitus._ Involuntary laughter. When the pleasure arising from new combinations of words and ideas, as in puns; or of other circumstances, which are so trivial, as to induce no voluntary exertion to compare or consider their present importance or their future consequence; the pleasure is liable to rise into pain; that is, the ideas or sensual motions become exerted too violently for want of some antithetistic ideas; in the same manner as those muscles, which have weak antagonists, as those of the calf of the leg, are liable to fall into cramp or painful contraction. In this situation a scream is begun to relieve this pain of ideas too violently exerted, which is stopped again soon, as explained in Sect. XXXIV. 1. 4. and Class III. 1. 1. 4. and IV. 2. 3. 3.
The pain, into which this pleasure rises, which would excite the scream of laughter, has been felt forcibly by every one; when they have been under such circumstances, as have induced them to restrain it by a counter-volition; till at length the increased associate motions produce so much pain as to overcome the counter-volition, and the patient bursts out into indecent laughter, contrary to his will in the common acceptation of that word.
4. _Lusus digitorum invitus._ An awkward playing with the fingers in speaking in public. These habits are began through bashfulness, and seem rather at first designed to engage the attention in part, and thus prevent the disagreeable ideas of mauvaise hont; as timorous boys whistle, when they are obliged to walk in the dark; and as it is sometimes necessary to employ raw soldiers in perpetual manoeuvres, as they advance to the first charge.
5. _Unguium morsiuncula invita._ Biting the nails is a depraved habit arising from similar causes as those of the last article.
M. M. Dip the fingers in solution of aloes.
6. _Vigilia invita._ Watchfulness, where the person wishes, and endeavours to fall asleep, properly belongs to this place, as the wish or volition to sleep prevents the desired effect; because sleep consists in an abolition of volition. See Class III. 1. 2. 3.
* * * * *
ORDO I.
_Increased Associate Motions._
GENUS IV.
_Catenated with External Influences._
SPECIES.
1. _Vita ovi._ Life of an egg. The eggs of fowls were shewn by Mr. J. Hunter to resist the freezing process in their living state more powerfully, than when they were killed by having the yolk and white shook together. Philos. Trans. It may be asked, does the heat during the incubation of eggs act as a stimulus exciting the living principle into activity? Or does it act simply as a causa sine qua non, as an influence, which penetrating the mass, removes the particles of it to a greater distance from each other, so as to allow their movement over each other, in the same manner as heat is conceived to produce the fluidity of water; not by stimulus, but by its penetrating influence? Or may elementary heat in its uncombined state be supposed to act only as an influence necessary to life in its natural quantity; whence torpor and death follows the eduction of it from the body; but in its increased state above what is natural, or usual, that it acts as a stimulus; which we have a sense to perceive; and which excites many parts of the system into unnatural action? See Class IV. 1. 1. C.
2. _Vita hiemi-dormientium._ The torpor of insects, and birds, and quadrupeds, during the cold season, has been called sleep; but I suppose it must differ very much from that state of animal life, since not only all voluntary power is suspended, but sensation and vascular motion has ceased, and can only be restored by the influence of heat. There have been related instances of snails, which have recovered life and motion on being put into water after having experienced many years of torpidity, or apparent death, in the cabinets of the curious. Here the water as well as the heat are required not only as a stimulus, but as a causa sine qua non of fluidity and motion, and consequent life.
3. _Pullulatio arborum._ The annual revivescence of the buds of trees seems not only to be owing to the influence of the returning warmth of the spring, but also to be catenated with solar gravitation; because seeds and roots and buds, which are analogous to the eggs of animals, put forth their shoots by a less quantity of heat in spring, than they had undergone in the latter part of autumn, which may however be ascribed to their previous torpid state, and consequent accumulation of sensorial power, or irritability; as explained in Botanic Garden, Part II. Cant. I. l. 322. note. Other circumstances, which countenance the idea, that vegetation is affected by solar gravitation, as well as by heat, may be observed in the ripening of the seeds of plants both in those countries where the summers are short, and in those where they are long. And by some flowers closing their bells at noon, or soon after; and hence seem to sleep rather at solar diurnal periods, than from the influence of cold, or the deficiency of light.
4. _Orgasmatis venerei periodus._ The venereal orgasm of birds and quadrupeds commences or returns about the vernal or autumnal equinoxes, and thence seems in respect to their great periods to be governed by solar influence. But if this orgasm be disappointed of its object, it is said to recur at about monthly periods, as observed in mares and bitches in this respect resembling the female catamenia. See Sect. XXXVI. 2. 3. and Sect. XVI. 13.
5. _Brachii concussio electrica._ The movement of the arm, even of a paralytic patient, when an electric shock is passed through it, is owing to the stimulus of the excess of electricity. When a piece of zinc and silver, each about the size of a crown-piece, are placed one under the upper lip, and the other on the tongue, so as the outer edges may be brought into contact, there is an appearance of light in the eyes, as often as the outer edges of these metals are brought into contact or separated; which is another instance of the stimulus of the passage of electric shocks through the fibres of the organs of sense, as well as through the muscular fibres. See Sect. XII. 1. 1. and first addit. note to Vol. I. of this work. But in its natural state electricity seems only to act as an influence on animal and vegetable bodies; of the salutary or injurious effects of which we have yet no precise knowledge.
Yet if regular journals were kept of the variations of atmospheric electricity, it is probable some discoveries of its influence on our system might in time be discovered. For this purpose a machine on the principle of Mr. Bennet's electric doubler might be applied to the pendulum of a clock, so as to manifest, and even to record the daily or hourly variations of aerial electricity. Which has already been executed, and applied to the pendulum of a Dutch wooden clock, by Mr. Bennet, curate of Wirksworth in Derbyshire.
Besides the variations of the degree or kind of atmospheric electricity, some animals, and some men, seem to possess a greater power of accumulating this fluid in themselves than others. Of which a famous history of a Russian prince was lately published; who, during the clear and severe frosts of that country, could not move himself in bed without luminous corruscations. Such may have been the case of those people, who have been related to have taken fire spontaneously, and to have been reduced to ashes. The electric concussion from the gymnotus electricus, and torpedo, are other instances of the power of the animal system to accumulate electricity, as in these it is used as a weapon of defence, or for the purpose of taking their prey.
Some have believed that the accumulation or passage of the magnetic fluid might affect the animal system, and have asserted that the application of a large magnet to an aching tooth has quickly effected a cure. If this experiment is again tried in odontalgia, or hemicrania, the painful membrane of the tooth or head should be included between the south and north poles of a horse-shoe magnet, or between the contrary poles of two different magnets, that the magnetism may be accumulated on the torpid part.
6. _Oxygenatio sanguinis._ The variation of the quantity of oxygen gas existing in the atmosphere must affect all breathing animals; in its excess this too must be esteemed a stimulus; but in its natural quantity would seem to act as an influence, or cause, without which, animal life cannot exist even a minute. It is hoped that Dr. Beddoes's plan for a pneumatic infirmary, for the purpose of putting this and various other airs to the test of experiment, will meet with public encouragement, and render consumption, asthma, cancer, and many diseases conquerable, which at present prey with unremitted devastation on all orders and ages of mankind.
7. _Humectatio corporis._ Water, and probably the vapour of water dissolved or diffused in the atmosphere, unites by mechanical attraction with the unorganized cuticle, and softens and enlarges it; as may be seen in the loose and wrinkled skin of the hands of washerwomen; the same probably occurs to the mucous membrane of the lungs in moist weather; and by thickening it increases the difficulty of respiration of some people, who are said to be asthmatical. So far water may be said to act as an influx or influence, but when it is taken up by the mouths of the absorbent system, it must excite those mouths into action, and then acts as a stimulus.
There appears from hence to be four methods by which animal bodies are penetrated by external things. 1. By their stimulus, which induces the absorbent vessels to imbibe them. 2. By mechanical attraction, as when water softens the cuticle. 3. By chemical attraction, as when oxygen passes through the membranes of the air-vessels of the lungs, and combines with the blood. And lastly, by influx without mechanical attraction, chemical combination, or animal absorption, as the universal fluids of heat, gravitation, electricity, magnetism, and perhaps of other ethereal fluids yet unknown.
* * * * *
ORDO II.
_Decreased Associate Motions._
GENUS I.
_Catenated with Irritative Motions._
As irritative muscular motions are attended with pain, when they are exerted too weakly, as well as when they are exerted too strongly; so irritative ideas become attended with sensation, when they are exerted too weakly, as well as when they are exerted too strongly. Which accounts for these ideas being attended with sensation in the various kinds of vertigo described below.
There is great difficulty in tracing the immediate cause of the deficiences of action of some links of the associations of irritative motions; first, because the trains and tribes of motions, which compose these links, are so widely extended as to embrace almost the whole animal system; and secondly, because when the first link of an associated train of actions is exerted with too great energy, the second link by reverse sympathy may be affected with torpor. And then this second link may transmit, as it were, this torpor to a third link, and at the same time regain its own energy of action; and it is possible this third link may in like manner transmit its torpor to a fourth, and thus regain its own natural quantity of motion.
I shall endeavour to explain this by an example taken from sensitive associated motions, as the origin of their disturbed actions is more easily detected. This morning I saw an elderly person, who had gradually lost all the teeth in his upper jaw, and all of the under except three of the molares; the last of these was now loose, and occasionally painful; the fangs of which were almost naked, the gums being much wasted both within and without the jaw. He is a man of attentive observation, and assured me, that he had again and again noticed, that, when a pain commenced in the membranes of the alveolar process of the upper jaw opposite to the loose tooth in the under one (which had frequently occurred for several days past), the pain of the loose tooth ceased. And that, when the pain afterwards extended to the ear and temple on that side, the pain in the membranes of the upper jaw ceased. In this case the membranes of the alveolar process of the upper jaw became torpid, and consequently painful, by their reverse sympathy with the too violent actions of the inflamed membranes of the loose tooth; and then by a secondary sympathy the membranes about the ear and temple became torpid, and painful; and those of the alveolar process of the upper jaw regained their natural quantity of action, and ceased to be painful. A great many more nice and attentive observations are wanted to elucidate these curious circumstances of association, which will be found to be of the greatest importance in the cure of many diseases, and lead us to the knowledge of fever.
SPECIES.
1. _Cutis frigida pransorum._ Chillness after dinner frequently attends weak people, or those who have been exhausted by exercise; it arises from the great expenditure of the sensorial power on the organs of digestion, which are stimulated into violent action by the aliment; and the vessels of the skin, which are associated with them, become in some measure torpid by reverse sympathy; and a consequent chillness succeeds with less absorption of atmospheric moisture. See the subsequent article.
2. _Pallor urinae pransorum._ The paleness of urine after a full meal is an instance of reverse association; where the secondary part of a train of associate motions acts with less energy in consequence of the greater exertions of the primary part. After dinner the absorbent vessels of the stomach and intestines are stimulated into greater action, and drink up the newly taken aliment; while those, which are spread in great number on the neck of the bladder, absorb less of the aqueous part of the urine than usual, which is therefore discharged in a more dilute state; and has been termed crude by some medical writers, but it only indicates, that so great a proportion of the sensorial power is expended on digestion and absorption of the aliment, that other parts of the system act for a time with less energy. See Class IV. I. 1. 6.
3. _Pallor urinae a frigore cutaneo._ There is a temporary discharge of pale water, and a diarrhoea, induced by exposing the skin to the cold air; as is experienced by boys, who strip themselves before bathing. In this case the mouths of the cutaneous lymphatics become torpid by the subduction of their accustomed degree of heat, and those of the bladder and intestines become torpid by direct sympathy; whence less of the thinner part of the urinary secretion, and of the mucus of the intestines, is reabsorbed. See Sect. XXIX. 4. 6. This effect of suddenly cooling the skin by the aspersion of cold water has been used with success in costiveness, and has produced evacuations, when other means have failed. When young infants are afflicted with griping joined with costiveness, I have sometimes directed them to be taken out of a warm bed, and carried about for a few minutes in a cool room, with almost instant relief.
4. _Pallor ex aegritudine._ When sickness of stomach first occurs, a paleness of the skin attends it; which is owing to the association or catenation between the capillaries of the stomach and the cutaneous ones; which at first act by direct sympathy. But in a short time there commences an accumulation of the sensorial power of association in the cutaneous capillaries during their state of inactivity, and then the skin begins to glow, and sweats break out, from the increased action of the cutaneous glands or capillaries, which is now in reverse sympathy with those of the stomach. So in continued fevers, when the stomach is totally torpid, which is known by the total aversion to solid food, the cutaneous capillaries are by reverse sympathy in a perpetual state of increased activity, as appears from the heat of the skin.
5. _Dyspnoea a balneo frigido._ The difficulty of breathing on going up to the middle in cold water is owing to the irritative association or catenation of the action of the extreme vessels of the lungs with those of the skin. So that when the latter are rendered torpid or inactive by the application of sudden cold, the former become inactive at the same time, and retard the circulation of the blood through the lungs, for this difficulty of breathing cannot be owing to the pressure of the water impeding the circulation downwards, as it happens equally by a cold shower-bath, and is soon conquered by habitual immersions. The capillaries of the skin are rendered torpid by the subduction of the stimulus of heat, and by the consequent diminution of the sensorial power of irritation. The capillaries of the lungs are rendered torpid by the diminution of the sensorial power of association, which is now excited in less quantity by the lessened actions of the capillaries of the skin, with which they are catenated. So that at this time both the cutaneous and pulmonary capillaries are principally actuated, as far as they have any action, by the stimulus of the blood. But in a short time the sensorial powers of irritation, and of association, become accumulated, and very energetic action of both these membranes succeed. Which thus resemble the cold and hot fit of an intermittent fever.
6. _Dyspepsia a pedibus frigidis._ When the feet are long cold, as in riding in cold and wet weather, some people are very liable to indigestion and consequent heart-burn. The irritative motions of the stomach become torpid, and do their office of digestion imperfectly, in consequence of their association with the torpid motions of the vessels of the extremities. Fear, as it produces paleness and torpidity of the skin, frequently occasions temporary indigestion in consequence of this association of the vessels of the skin with those of the stomach; as riding in very bad roads will give flatulency and indigestion to timorous people.
A short exposure to cold air increases digestion, which is then owing to the reverse sympathy between the capillary vessels of the skin, and of the stomach. Hence when the body is exposed to cold air, within certain limits of time and quantity of cold, a reverse sympathy of the stomach and the skin first occurs, and afterwards a direct sympathy. In the former case the expenditure of sensorial power by the skin being lessened, but not its production in the brain; the second link of the association, viz. the stomach, acquires a greater share of it. In the latter case, by the continuation of the deficient stimulus of heat, the torpor becomes extended to the brain itself, or to the trunks of the nerves; and universal inactivity follows.
7. _Tussis a pedibus frigidis._ On standing with the feet in thawing snow, many people are liable to incessant coughing. From the torpidity of the absorbent vessels of the lungs, in consequence of their irritative associations with those of the skin, they cease to absorb the saline part of the secreted mucus; and a cough is thus induced by the irritation of this saline secretion; which is similar to that from the nostrils in frosty weather, but differs in respect to its immediate cause; the former being from association with a distant part, and the latter from defect of the stimulus of heat on the nostrils themselves. See Catarrhus frigidus, Class I. 2. 3. 3.
8. _Tussis hepatica._ The cough of inebriates, which attends the enlargement of the liver, or a chronical inflammation of its upper membrane, is supposed to be produced by the inconvenience the diaphragm suffers from the compression or heat of the liver. It differs however essentially from that attending hepatitis, from its not being accompanied with fever. And is perhaps rather owing to irritative association, or reverse sympathy, between the lungs and the liver. As occurs in sheep, which are liable to a perpetual dry cough, when the fleuk-worm is preying on the substance of their livers. See Class II. 1. 1. 5.
M. M. From half a grain to a grain of opium twice a day. A drachm of mercurial ointment rubbed on the region of the liver every night for eight or ten times.
9. _Tussis arthritica._ Gout-cough. I have seen a cough, which twice recurred at a few years distance in the same person, during his fits of the gout, with such pertinacity and violence as to resist venesection, opiates, bark, blisters, mucilages, and all the usual methods employed in coughs. It was for a time supposed to be the hooping-cough, from the violence of the action of coughing; it continued two or three weeks, the patient never being able to sleep more than a few minutes at once during the whole time, and being propped up in bed with pillows night and day.
As no fever attended this violent cough, and but little expectoration, and that of a thin and frothy kind, I suspected the membrane of the lungs to be rather torpid than inflamed, and that the saline part of the mucus not being absorbed stimulated them into perpetual exertion. And lastly, that though the lungs are not sensible to cold and heat, and probably therefore less mobile; yet, as they are nevertheless liable to consent with the torpor of cold feet, as described in Species 6 of this Genus, I suspected this torpor of the lungs to succeed the gout in the feet, or to act a vicarious part for them.
10. _Vertigo rotatoria._ In the vertigo from circumgyration the irritative motions of vision are increased; which is evinced from the pleasure that children receive on being rocked in a cradle, or by swinging on a rope. For whenever sensation arises from the production of irritative motion with less energy than natural, it is of the disagreeable kind, as from cold or hunger; but when it arises from their production with greater energy than natural, if it be confined within certain limits, it is of the pleasurable kind, as by warmth or wine. With these increased irritative motions of vision, I suppose those of the stomach are performed with greater energy by direct sympathy; but when the rotatory motions, which produce this agreeable vertigo, are continued too long, or are too violent, sickness of the stomach follows; which is owing to the decreased action of that organ from its reverse sympathy with the increased actions of the organ of vision. For the expenditure of sensorial power by the organ of vision is always very great, as appears by the size of the optic nerves; and is now so much increased as to deprive the next link of association of its due share. As mentioned in Article 6 of this Genus.
In the same manner the undulations of water, or the motions of a ship, at first give pleasure by increasing the irritative motions belonging to the sense of vision; but produce sickness at length by expending on one part of the associated train of irritative actions too much of that sensorial power, which usually served the whole of it; whence some other parts of the train acquire too little of it, and perform their actions in consequence too feebly, and thence become attended with disagreeable sensation.
It must also be observed, that when the irritative motions are stimulated into unusual action, as in inebriation, they become succeeded by sensation, either of the pleasurable or painful kind; and thus a new link is introduced between the irritative motions thus excited, and those which used to succeed them; whence the association is either dissevered or much weakened, and thus the vomiting in sea-sickness occurs from the defect of the power of association, rather than from the general deficiency of sensorial power.
When a blind man turns round, or when one, who is not blind, revolves in the dark, a vertigo is produced belonging to the sense of touch. A blind man balances himself by the sense of touch, which being a less perfect means of determining small quantities of deviation from the perpendicular, occasions him to walk more carefully upright than those, who balance themselves by vision. When he revolves, the irritative associations of the muscular motions, which were used to preserve his perpendicularity, become disordered by their new modes of successive exertion; and he begins to fall. For his feet now touch the floor in manners or directions different from those they have been accustomed to; and in consequence he judges less perfectly of the situation of the parts of the floor in respect to that of his own body, and thus loses his perpendicular attitude. This may be illustrated by the curious experiment of crossing one finger over the next to it, and feeling of a nut or bullet with the ends of them. When, if the eyes be closed, the nut or bullet appears to be two, from the deception of the sense of touch.
In this vertigo from gyration, both of the sense of sight, and of the sense of touch, the primary link of the associated irritative motions is increased in energy, and the secondary ones are increased at first by direct sympathy; but after a time they become decreased by reverse sympathy with the primary link, owing to the exhaustion of sensorial power in general, or to the power of association in particular; because in the last case, either pleasurable or painful sensation has been introduced between the links of a train of irritative motions, and has dissevered, or much enfeebled them.
Dr. Smyth, in his Essay on Swinging in Pulmonary Consumption, has observed, that swinging makes the pulse slower. Dr. Ewart of Bath confirmed this observation both on himself and on Col. Cathcart, who was then hectic, and that even on shipboard, where some degree of vertigo might be supposed previously to exist. Dr. Currie of Liverpool not only confirmed this observation frequently on himself, when he was also phthisical, but found that equitation had a similar effect on him, uniformly retarding his pulse. This curious circumstance cannot arise from the general effect of exercise, or fatigue, as in those cases the pulse becomes weaker and quicker; it must therefore be ascribed to a degree of vertigo, which attends all those modes of motion, which we are not perpetually accustomed to.
Dr. Currie has further observed, that "in cases of great debility the voluntary muscular exertion requisite in a swing produces weariness, that is, increases debility; and that in such instances he had frequently noticed, that the diminution of the frequency of the pulse did not take place, but the contrary." These circumstances may thus be accounted for.
The links of association, which are effected in the vertigo occasioned by unusual motion, are the irritative motions of the sense of vision, those of the stomach, and those of the heart and arteries. When the irritative ideas of vision are exerted with greater energy at the beginning of vertigo, a degree of sensation is excited, which is of the pleasurable kind, as above mentioned; whence the associated trains of irritative motions of the stomach, and heart, and arteries, act at first with greater energy, both by direct sympathy; and by the additional sensorial power of sensation. Whence the pulse of a consumptive patient becomes stronger and consequently slower.
But if this vertigo becomes much greater in degree or duration, the first link of this train of associated irritative motions expends too much of the sensorial power, which was usually employed on the whole train; and the motions of the stomach become in consequence exerted with less energy. This appears, because in this degree of vertigo sickness supervenes, as in sea-sickness, which has been shewn to be owing to less energetic action of the stomach. And the motions of the heart and arteries then become weaker, and in consequence more frequent, by their direct sympathy with the lessened actions of the stomach. See Supplement, I. 12. and Class II. 1. 6. 7. The general weakness from fatigue is owing to a similar cause, that is, to the too great expenditure of sensorial power in the increased actions of one part of the system, and the consequent deficiency of it in other parts, or in the whole.
The abatement of the heat of the skin in hectic fever by swinging, is not only owing to the increased ventilation of cool air, but to the reverse sympathy of the motions of the cutaneous capillaries with those of the heart and arteries; which occurs in all fevers with arterial debility, and a hot or dry skin. Hence during moderate swinging the action of the heart and arteries becomes stronger and slower, and the action of the capillaries, which was before too great, as appeared by the heat of the skin, now is lessened by their reverse sympathy with that of the heart and arteries. See Supplement, I. 8.
11. _Vertigo visualis._ Visual vertigo. The vertigo rotatoria described above, was induced by the rotation or undulation of external objects, and was attended with increased action of the primary link of the associated motions belonging to vision, and with consequent pleasure. The vertigo visualis is owing to less perfect vision, and is not accompanied with pleasurable sensation. This frequently occurs in strokes of the palsy, and is then succeeded by vomiting; it sometimes precedes epileptic fits, and often attends those, whose sight begins to be impaired by age.
In this vertigo the irritative ideas of the apparent motions of objects are less distinct, and on that account are not succeeded by their usual irritative associations of motion; but excite our attention. Whence the objects appear to librate or circulate according to the motions of our heads, which is called dizziness; and we lose the means of balancing ourselves, or preserving our perpendicularity, by vision. So that in this vertigo the motions of the associated organs are decreased by direct sympathy with their primary link of irritation; as in the preceding case of sea-sickness they are decreased by reverse sympathy.
When vertigo affects people about fifty years of age, their sight has generally been suddenly impaired; and from their less accurate vision they do not soon enough perceive the apparent motions of objects; like a person in a room, the walls of which are stained with the uniform figures of lozenges, explained in Sect. XX. 1. This is generally ascribed to indigestion; but it ceases spontaneously, as the patient acquires the habit of balancing himself by less distinct objects.
A gentleman about 50 was seized with an uncommon degree of vertigo, so as to fall on the ground, and not to be able to turn his head, as he sat up either in his chair or in his bed, and this continued eight or ten weeks. As he had many decayed teeth in his mouth, and the vertigo was preceded and sometimes accompanied by pains on one side of his head, the disease of a tooth was suspected to be the cause. And as his timidity was too great to admit the extraction of those which were decayed; after the trial of cupping repeatedly, fomentations on his head, repeated blisters, with valerian, Peruvian bark, musk, opium, and variety of other medicines; mercurials were used, both externally and internally, with design to inflame the membranes of the teeth, and by that means to prevent the torpor of the action of the membranes about the temple, and parietal bone; which are catenated with the membranes of the teeth by irritative association, but not by sensitive association. The event was, that as soon as the gums became sore with a slight ptyalism, the pains about the head and vertigo gradually diminished, and during the soreness of his gums entirely ceased; but I believe recurred afterwards, though in less degree.
The idea of inflaming the membranes of the teeth to produce increased sensation in them, and thus to prevent their irritative connection with those of the cranium, was taken from the treatment of trismus, or locked jaw, by endeavouring to inflame the injured tendon; which is said to prevent or to remove the spasm of the muscles of the jaw. See Class III. 1. 1. 13. and 15.
M. M. Emetics. Blisters. Issues about the head. Extraction of decayed teeth. Slight salivation. Sorbentia. Incitantia.
12. _Vertigo ebriosa._ Vertigo from intoxication is owing to the association of the irritative ideas of vision with the irritative motions of the stomach. Whence when these latter become much increased by the immoderate stimulus of wine, the irritative motions of the retina are produced with less energy by reverse sympathy, and become at the same time succeeded by sensation in consequence of their decreased action. See Sect. XXI. 3. and XXXV. 1. 2. So conversely when the irritative motions of vision are increased by turning round, or by our unaccustomed agitation at sea, those of the stomach become inverted by reverse sympathy, and are attended in consequence with disagreeable sensation. Which decreased action of the stomach is in consequence of the increased expenditure of the sensorial power on the irritative ideas of vision, as explained in Vertigo rotatoria.
Whence though a certain quantity of vinous spirit stimulates the whole system into increased action, and perhaps even increases the secretion of sensorial power in the brain; yet as soon as any degree of vertigo is produced, it is a proof, that by the too great expenditure of sensorial power by the stomach, and its nearest associated motions, the more distant ones, as those of vision, become imperfectly exerted. From hence may be deduced the necessity of exhibiting wine in fevers with weak pulse in only appropriated quantity; because if the least intoxication be induced, some part of the system must act more feebly from the unnecessary expenditure of sensorial power.
13. _Vertigo febriculosa._ Vertigo in fevers either proceeds from the general deficiency of sensorial power belonging to the irritative associations, or to a greater expenditure of it on some links of the trains and tribes of associated irritative motions. There is however a slighter vertigo attending all people, who have been long confined in bed, on their first rising; owing to their having been so long unused to the apparent motions of objects in their erect posture, or as they pass by them, that they have lost in part the habit of balancing themselves by them.
14. _Vertigo cerebrosa._ Vertigo from injuries of the brain, either from external violence, or which attend paralytic attacks, are owing to the general deficiency of sensorial power. In these distressful situations the vital motions, or those immediately necessary to life, claim their share of sensorial power in the first place, otherwise the patient must die; and those motions, which are less necessary, feel a deficiency of it, as these of the organs of sense and muscles; which constitute vertigo; and lastly the voluntary motions, which are still less immediately necessary to life, are frequently partially destroyed, as in palsy; or totally, as in apoplexy.
15. _Murmur aurium vertiginosum._ The vertiginous murmur in the ears, or noise in the head, is compared to the undulations of the sound of bells, or to the humming of bees. It frequently attends people about 60 years of age; and like the visual vertigo described above is owing to our hearing less perfectly from the gradual inirritability of the organ on the approach of age; and the disagreeable sensation of noise attending it is owing to the less energetic action of these irritative motions; which not being sufficiently distinct to excite their usual associations become succeeded by our attention, like the indistinct view of the apparent motions of objects mentioned in vertigo visualis. This may be better understood from considering the use, which blind men make of these irritative sounds, which they have taught themselves to attend to, but which escape the notice of others. The late blind Justice Fielding walked for the first time into my room, when he once visited me, and after speaking a few words said, "this room is about 22 feet long, 18 wide, and 12 high;" all which he guessed by the ear with great accuracy. Now if these irritative sounds from the partial loss of hearing do not correspond with the size or usual echoes of the places, where we are; their catenation with other irritative ideas, as those of vision, becomes dissevered or disturbed; and we attend to them in consequence, which I think unravels this intricate circumstance of noises being always heard in the head, when the sense of hearing begins to be impaired, from whatever cause it occurs.
This ringing in the ears also attends the vertigo from intoxication; for the irritative ideas of sound are then more weakly excited in consequence of the deficiency of the sensorial power of association. As is known by this also being attended with disagreeable sensation, and by its accompanying other diseases of debility, as strokes on the head, fainting fits, and paralytic seizures. For in this vertigo from intoxication so much sensorial power in general is expended on the increased actions of the stomach, and its nearest connections, as the capillaries of the skin; that there is a deficiency for the purposes of the other irritative associations of motions usually connected with it. This auditory vertigo attends both the rotatory and the visual vertigo above mentioned; in the former it is introduced by reverse sympathy, that is, by the diminution of sensorial power; too great a quantity of it being expended on the increased irritative motions of vision; in the latter it is produced either by the same causes which produce the visual vertigo, or by direct sympathy with it. See Sect. XX. 7.
M. M. Stimulate the internal ear by ether, or with essential oil diluted with expressed oil, or with a solution of opium in wine, or in water. Or with salt and water.
16. _Tactus, gustus, olfactius vertiginosi._ Vertiginous touch, taste, and smell. In the vertigo of intoxication, when the patient lies down in bed, it sometimes happens even in the dark, that the bed seems to librate under him, and he is afraid of falling out of it. The same occurs to people, who are sea-sick, even when they lie down in the dark. In these the irritative motions of the nerves of touch, or irritative tangible ideas, are performed with less energy, in one case by reverse sympathy with the stomach, in the other by reverse sympathy with the nerves of vision, and in consequence become attended with sensation, and produce the fear of falling by other associations.
A vertigo of the sense of touch may be produced, if any one turns round for a time with his eyes shut, and suddenly stops without opening them; for he will for a time seem to be still going forwards; which is difficult to explain. See the notes at the end of the first and second volume belonging to Sect. XX. 6.
In the beginning of some fevers, along with incessant vomiting, the patients complain of disagreeable tastes in their mouth, and disagreeable odours; which are to be ascribed to the general debility of the great trains and tribes of associated irritative motions, and to be explained from their direct sympathy with the decreased action of a sick stomach; or from the less secretion of sensorial power in the brain. These organs of sense are constantly stimulated into action by the saliva or by the air; hence, like the sense of hunger, when they are torpid from want of stimulus, or from want of sensorial power, pain or disagreeable sensation ensues, as of hunger, or faintness, or sickness in one case; and the ideas of bad tastes or odours in the other. This accords with the laws of causation, Sect. IV. 5.
17. _Pulsus mollis in vomitione._ The softness of the pulse in the act of vomiting is caused by direct association between the heart and the stomach; as explained in Sect. XXV. 17. A great slowness of the pulsation of the heart sometimes attends sickness, and even with intermissions of it, as in the exhibition of too great a dose of digitalis.
18. _Pulsus intermittens a ventriculo._ When the pulse first begins to intermit, it is common for the patient to bring up a little air from his stomach; which if he accomplishes before the intermission occurs, always prevents it; whence that this debility of the heart is owing to the direct association of its motions with those of the stomach is well evinced. See Sect. XXV. 17.
I this morning saw Mr. ----, who has long had at times an unequal pulse, with indigestion and flatulency, and occasional asthma; he was seized two days ago with diarrhoea, and this morning with sickness, and his pulse was every way unequal. After an emetic his pulse still continued very intermittent and unequal. He then took some breakfast of toast and butter, and tea, and to my great surprise his pulse became immediately perfectly regular, about 100 in a minute, and not weak, by this stimulus on his stomach.
A person, who for many years had had a frequent intermission of his pulse, and occasional palpitation of his heart, was relieved from them both for a time by taking about four drops of a saturated solution of arsenic three or four times a day for three or four days. As this intermission of the pulse is occasioned by the direct association of the motions of the heart with those of the stomach, the indication of cure must be to strengthen the action of the stomach by the bark. Spice. Moderate quantities of wine. A blister. Half a grain of opium twice a day. Solution of arsenic?
19. _Febris inirritativa._ Inirritative fever described in Class I. 2. 1. 1. belongs to this place, as it consists of disordered trains and tribes of associated irritative motions, with lessened actions of the associated organs. In this fever the pulsations of the heart and arteries are weakened or lessened, not only in the cold paroxysm, as in the irritative fever, but also in the hot paroxysm. The capillary arteries or glands have their actions nevertheless increased after the first cold fit, as appears by the greater production of heat, and the glow of arterial blood, in the cutaneous vessels; and lastly, the action of the stomach is much impaired or destroyed, as appears by the total want of appetite to solid food. Whence it would seem, that the torpid motions of the stomach, whatever may occasion them, are a very frequent cause of continued fever with weak pulse; and that these torpid motions of the stomach do not sufficiently excite the sensorial power of association, which contributes in health to actuate the heart and arteries along with the irritation produced by the stimulus of the blood; and hence the actions of these organs are weaker. And lastly, that the accumulation of the sensorial power of association, which ought to be expended on the motions of the heart and arteries, becomes now exerted on the cutaneous and pulmonary capillaries. See Supplement I. 8. and Sect. XXXV. 1. 1. and XXXIII. 2. 10.
I have dwelt longer on the vertiginous diseases in this genus, both because of their great intricacy, and because they seem to open a road to the knowledge of fever, which consists of associated trains and tribes of irritative or sensitive motions, which are sometimes mixed with the vertiginous ones, and sometimes separate from them.
* * * * *
ORDO II.
_Decreased Associate Motions._
GENUS II.
_Catenated with Sensitive Motions._
In this genus the sensorial power of association is exerted with less energy, and thence the actions produced by it are less than natural; and pain is produced in consequence, according to the fifth law of animal causation, Sect. IV. This pain is generally attended with coldness of the affected part, and is seldom succeeded by inflammation of it. This decreased action of the secondary link of the associated motions, belonging to this genus, is owing to the previous exhaustion of sensorial power either in the increased actions of the primary link of the associated motions, or by the pain which attends them; both which are frequently the consequence of the stimulus of something external to the affected fibres.
As pain is produced either by excess or defect of the natural exertions of the fibres, it is not, considered separately, a criterion of the presence of either. In the associations belonging to this genus the sensation of pain or pleasure produces or attends the primary link of the associated motions, and very often gives name to the disease.
When great pain exists without causing any fibrous motions, I conjecture that it contributes to exhaust or expend the general quantity of sensorial power; because people are fatigued by enduring pain, till at length they sleep. Which is contrary to what I had perhaps erroneously supposed in Sect. XXXV. 2. 3. If it causes fibrous motions, it then takes the name of sensation, according to the definition of sensation in Sect. II. 2. 9.; and increased fibrous action or inflammation is the consequence. This circumstance of the general exhaustion of sensorial power by the existence of pain will assist in explaining many of the diseases of this genus.
Many of the canals of the body, as the urethra, the bile-duct, the throat, have the motions of their two extremities associated by having been accustomed to feel pleasurable or painful sensations at the same time or in succession. This is termed sensitive association, though those painful or pleasurable sensations do not cause the motions, but only attend them; and are thus perhaps, strictly speaking, only catenated with them.
SPECIES.
1. _Torpor genae a dolore dentis._ In tooth-ach there is generally a coldness of the cheek, which is sensible to the hand, and is attended in some degree with the pain of cold. The cheek and tooth have frequently been engaged in pleasurable action at the same time during the masticating of our food; whence they have acquired sensitive associations. The torpor of the cheek may have for its cause the too great expenditure of sensorial power by the painful sensation of the membranes of the diseased tooth; whence the membranes of the cheek associated with those of the alveolar process are deprived of their natural share of it, and become torpid; thus they produce less secretions, and less heat, and the pain of cold is the consequence. This torpor of the vessels of the cheek cannot be produced by the activity of the sensorial power of sensation; for then they would act more violently than natural, or become inflamed. And though the pain by exhausting so much sensorial power may be a remote cause, it is the defeat of the power of association, which is the immediate cause of the torpor of the cheek.
After some hours this pain occasioned by the torpor of the vessels of the cheek either gradually ceases along with the pain of the diseased tooth; or, by the accumulation of sensorial power during their state of torpor, the capillaries of the cheek act with greater violence, and produce more secretions, and heat, and consequent tumour, and inflammation. In this state the pain of the diseased tooth ceases; as the sensorial power of sensation is now expended on the inflamed vessels of the cheek. It is probable that most other internal membranous inflammations begin in a similar manner; whence there may seem to be a double kind of sensitive association; first, with decreased action of the associated organ, and then with increased action of it; but the latter is in this case simply the consequence of the former; that is, the tumor or inflammation of the cheek is in consequence of its previous quiescence or torpor.
2. _Stranguria a dolore vesicae._ The strangury, which has its origin from pain at the neck of the bladder, consists of a pain in the external extremity of the urethra or of the glans penis of men, and probably in the external termination of the urethra or of the clitoris of women; and is owing to the sympathy of these with some distant parts, generally with the other end of the urethra; an endeavour and difficulty of making water attends this pain.
Its remote cause is from the internal or external use of cantharides, which stimulate the neck of the bladder; or from a stone, which whenever it is pushed into the neck of the bladder, gives this pain of strangury, but not at other times; and hence it is felt most severely in this case after having made water.
The sensations or sensitive motions of the glans penis, and of the sphincter of the bladder, have been accustomed to exist together during the discharge of the urine; and hence the two ends of the urethra sympathize by association. When there is a stone at the neck of the bladder, which is not so large or rough as to inflame the part, the sphincter of the bladder becomes stimulated into pain; but as the glans penis is for the purposes of copulation more sensitive than the sphincter of the bladder, as soon as it becomes affected with pain by the association above mentioned, the sensation at the neck of the bladder ceases; and then the pain of the glans penis would seem to be associated with the irritative motions only of the sphincter of the bladder, and not with the sensitive ones of it. But a circumstance similar to this occurs in epileptic fits, which at first are induced by disagreeable sensation, and afterwards seem to occur without previous pain, from the suddenness in which they follow and relieve the pain, which occasioned them. From this analogy I imagine the pain of the glans penis is associated with the pain of the sphincter of the bladder; but that _as soon as the greater pain in a more sensible part is produced; the lesser one, which occasioned it, ceases_; and that this is one of the laws of sensitive association. See Sect. XXXV. 2. 1.
A young man had by an accident swallowed a large spoonful or more of tincture of cantharides; as soon as he began to feel the pain of strangury, he was advised to drink large quantities of warmish water; to which, as soon as it could be got, some gum arabic was added. In an hour or two he drank by intervals of a few minutes about two gallons of water, and discharged his urine every four or five minutes. A little blood was voided towards the end, but he suffered no ill consequence.
M. M. Warm water internally. Clysters of warm water. Fomentation. Opium. Solution of fixed alkali supersaturated with carbonic acid. A bougie may be used to push back a stone into the bladder. See Class I. 1. 3. 10.
3. _Stranguria convulsiva._ The convulsive strangury, like that before described, is probably occasioned by the torpor or defective action of the painful part in consequence of the too great expenditure of sensorial power on the primary link of the associated motions, as no heat or inflammation attends this violent pain. This kind of strangury recurs by stated periods, and sometimes arises to so great a degree, that convulsion or temporary madness terminates each period of it. It affects women oftener than men, is attended with cold extremities without fever, and is distinguished from the stone of the bladder by the regularity of its periods, and by the pain being not increased after making water.
On introducing the catheter sometimes part of the urine will come away and not the whole, which is difficult to explain; but may arise from the weakness of the muscular fibres of the bladder; which are not liable suddenly to contract themselves so far as to exclude the whole of the urine. In some old people, who have experienced a long retention of urine, the bladder never regains the power of completely emptying itself; and many who are beginning to be weak from age can make water a second time, a few minutes after they supposed they had emptied the bladder.
I have believed this pain to originate from sympathy with some distant part, as from ascarides in the rectum, or from piles in women; or from caruncles in the urethra about the caput gallinaginis in men; and that the pain has been in the glans or clitoris by reverse sympathy of these more sensible parts with those above mentioned.
M. M. Venesection. Opium in large quantities. Warm bath. Balsams. Bark. Tincture of cantharides. Bougie, and the treatment for haemorrhoids. Leeches applied to the sphincter ani. Aerated alcaline water. Soap and sal soda. Opium in clysters given an hour before the expected return. Smoke of tobacco in clysters. Arsenic?
4. _Dolor termini intestinalis ductus choledochi._ Pain at the intestinal end of the gall-duct. When a gall-stone is protruded from the gall-bladder a little way into the end of the gall-duct, the pain is felt at the other end of the gall-duct, which terminates in the duodenum. For the actions of the two terminations of this canal are associated together from the same streams of bile passing through them in succession, exactly as the two terminations of the urethra have their actions associated, as described in Species 2 and 3 of this genus. But as the intestinal termination of the bile-duct is made more sensible for the purpose of bringing down more bile, when it is stimulated by new supplies of food from the stomach, it falls into violent pain from association; and then the pain on the region of the gall-bladder ceases, exactly as above explained in the account of the pain of the glans penis from a stone in the sphincter of the bladder.
The common bile-duct opens into the intestine exactly at what is called the pit of the stomach; and hence it has sometimes happened, that this pain from association with the sensation of a gall-stone at the other end of the bile-duct has been mistaken for a pain of the stomach.
For the method of cure see Class I. 1. 3. 8. to which should be added the use of strong electric shocks passed through the bile-duct from the pit of the stomach to the back, and from one side to the other. A case of the good effect of electricity in the jaundice is related in Sect. XXX. 2. And another case, where it promoted the passage of a painful gall-stone, is described by Dr. Hall, experienced on himself. Trans. of the College at Philadelphia, Vol. I. p. 192.
Half a pint of warm water two or three times a day is much recommended to dilute the inspissated bile.
5. _Dolor pharyngis ab acido gastrico._ The two ends of the throat sympathize by sensitive association in the same manner as the other canals above mentioned, namely, the urethra and the bile-duct; hence when too great acidity of undigested aliment, or the carbonic acid air, which escapes in fermentation, stimulates the cardia ventriculi, or lower end of the gula, into pain; the pharinx, or upper end of it, is affected with greater pain, or a disagreeable sensation of heat.
6. _Pruritus narium a vermibus._ The itching of the nose from worms in the intestines is another curious instance of the sensitive associations of the motions of membranes; especially of those which constitute the canals of the body. Previous to the deglutition of agreeable food, as milk in our earliest infancy, an agreeable odour affects the membrane, which lines the nostrils; and hence an association seems to take place between the agreeable sensations produced by food in the stomach and bowels, and the agreeable sensations of the nostrils. The existence of ascarides in the rectum I believe produces this itching of the nostrils more than the worms in other parts of the intestines; as we have already seen, that the terminations of canals sympathize more than their other parts, as in the urethra and gall-ducts. See Class I. 1. 5. 9. IV. 1. 2. 9.
7. _Cephalaea._ Head-ach. In cold fits of the ague, the head-ach arises from consent with some torpid viscus, like the pain of the loins. After drunkenness the head-ach is very common, owing to direct sympathy of the membranes of the head with those of the stomach; which is become torpid after the too violent stimulus of the preceding intoxication; and is hence removeable by spirit of wine, or opium, exhibited in smaller quantities. In some constitutions these head-achs are induced, when the feet are exposed to much external cold; in this case the feet should be covered with oiled silk, which prevents the evaporation of the perspirable matter, and thence diminishes one cause of external cold.
M. M. Valerian in powder two drams three or four times a day is recommended. The bark. Chalybeates. A grain of opium twice a day for a long time. From five to ten drops of the saturated solution of arsenic two or three times a day. See Class I. 2. 4. 11. A lady once assured me, that when her head-ach was coming on, she drank three pints (pounds) of hot water, as hastily as she could; which prevented the progress of the disease. A solution of arsenic is recommended by Dr. Fowler of York. Very strong errhines are said sometimes to cure head-achs taken at the times the pain recurs, till a few drops of blood issue from the nostrils. As one grain of turpeth mineral (vitriolic calx of mercury) mixed with ten grains of fine sugar. Euphorbium or cayan pepper mixed with sugar, and used with caution as an errhine. See the M. M. of the next Species.
8. _Hemicrania._ Pain on one side of the head. This disease is attended with cold skin, and hence whatever may be the remote cause, the immediate one seems to be want of stimulus, either of heat or distention, or of some other unknown stimulus in the painful part; or in those, with which it is associated. The membranes in their natural state are only irritable by distention; in their diseased state, they are sensible like muscular fibres. Hence a diseased tooth may render the neighbouring membranes sensible, and is frequently the cause of this disease.
Sometimes the stomach is torpid along with the pained membrane of the head; and then sickness and inappetency attends either as a cause or consequence. The natural cure of hemicrania is the accumulation of sensorial power during the rest or sickness of the patient. Mrs. ---- is frequently liable to hemicrania with sickness, which is probably owing to a diseased tooth; the paroxysm occurs irregularly, but always after some previous fatigue, or other cause of debility. She lies in bed, sick, and without taking any solid food, and very little of fluids, and those of the aqueous kind, and, after about 48 or 50 hours, rises free from complaint. Similar to this is the recovery from cold paroxysms of fever, from the torpor occasioned by fear, and from syncope; which are all owing to the accumulation of sensorial power during the inactivity of the system. Hence it appears, that, though when the sensorial power of volition is much exhausted by fatigue, it can be restored by eight or ten hours of sleep; yet, when the sensorial power of irritation is exhausted by fatigue, that it requires two whole solar or lunar days of rest, before it can be restored.
The late Dr. Monro asserted in his lectures, that he cured the hemicrania, or megrim, by a strong vomit, and a brisk purge immediately after it. This method succeeds best if opium and the bark are given in due quantity after the operation of the cathartic; and with still more certainty, if bleeding in small quantity is premised, where the pulse will admit of it. See Sect. XXXV. 2. 1.
The pain generally affects one eye, and spreads a little way on that side of the nose, and may sometimes be relieved by pressing or cutting the nerve, where it passes into the bone of the orbit above the eye. When it affects a small defined part on the parietal bone on one side, it is generally termed Clavus hystericus, and is always I believe owing to a diseased dens molaris. The tendons of the muscles, which serve the office of mastication, have been extended into pain at the same time, that the membranous coverings of the roots of the teeth have been compressed into pain, during the biting or mastication of hard bodies. Hence when the membranes, which cover the roots of the teeth, become affected with pain by a beginning decay, or perhaps by the torpor or coldness of the dying part of the tooth, the tendons and membranous fascia of the muscles about the same side of the head become affected with violent pain by their sensitive associations: and as soon as this associated pain takes place, the pain of the tooth entirely ceases, as explained in the second species of this genus.
A remarkable circumstance attends this kind of hemicrania, viz. that it recurs by periods like those of intermittent fevers, as explained in the Section on Catenation of Motions; these periods sometimes correspond with alternate lunar or solar days like tertian agues, and that even when a decaying tooth is evidently the cause; which has been evinced by the cure of the disease by extracting the tooth. At other times they observe the monthly lunations, and seem to be induced by the debility, which attends menstruation.
The dens sapientiae, or last tooth of the upper jaw, frequently decays first, and gives hemicrania over the eye on the same side. The first or second grinder in the under-jaw is liable to give violent pain about the middle of the parietal bone, or side of the head, on the same side, which is generally called the Clavus hystericus, of which an instructive case is related in Sect. XXXV. 2. 1.
M. M. Detect and extract the diseased tooth. Cut the affected nerve, or stimulate the diseased membrane by acu-puncture. Venesection to six ounces by the lancet or by leeches. A strong emetic and a subsequent cathartic; and then an opiate and the bark. Pass small electric shocks through the pained membrane, and through the teeth on the same side. Apply vitriolic ether externally, and a grain of opium with camphor internally, to the cheek on the affected side, where a diseased tooth may be suspected. Foment the head with warm vinegar. Drink two large spoonfuls of vinegar. Stimulate the gums of the suspected teeth by oil of cloves, by opium. See Class I. 1. 4. 4. Snuff volatile spirit of vinegar up the nostrils. Lastly, in permanent head-achs, as in permanent vertigo, I have seen good effect by the use of mercurial ointment rubbed on the shaved head or about the throat, till a mild salivation commences, which by inflaming the membranes of the teeth may prevent their irritative sympathy with those of the cranium. Thus by inflaming the tendon, which is the cause of locked jaw, and probably by inflaming the wound, which is the cause of hydrophobia, those diseases may be cured, by disuniting the irritative sympathy between those parts, which may not possess any sensitive sympathy. This idea is well worth our attention.
_Otalgia._ Ear-ach is another disease occasioned by the sympathy of the membranes of the ear with those which invest or surround a decaying tooth, as I have had frequent reason to believe; and is frequently relieved by filling the ear with tincture of opium. See Class I. 2. 4.
9. _Dolor humeri in hepatitide._ In the efforts of excluding the faeces and urine the muscles of the shoulders are exerted to compress the air in the lungs, that the diaphragm may be pressed down. Hence the distention of the tendons or fibres of these muscles is associated with the distention of the tendons or fibres of the diaphragm; and when the latter are pained by the enlargement or heat of the inflamed liver, the former sympathize with them. Sometimes but one shoulder is affected, sometimes both; it is probable that many other pains, which are termed rheumatic, have a similar origin, viz. from sensitive associations.
As no inflammation is produced in consequence of this pain of the shoulder, it seems to be owing to inaction of the membranous part from defect of the sensorial power of association, of which the primary link is the inflamed membrane of the liver; which now expends so much of the sensorial power in general by its increased action, that the membranes about the shoulder, which are links of association with it, become deprived of their usual share, and consequently fall into torpor.
10. _Torpor pedum in eruptione variolarum._ At the commencement of the eruption of the small-pox, when the face and breast of children are very hot, their extremities are frequently cold. This I ascribe to sensitive association between the different parts of the skin; whence when a part acts too violently, the other part is liable to act too weakly; and the skin of the face being affected first in the eruption of the small-pox, the skin of the feet becomes cold in consequence by reverse sympathy.
M. M. Cover the feet with flannel, and expose the face and bosom to cool air, which in a very short time both warms the feet and cools the face; and hence what is erroneously called a rash, but which is probably a too hasty eruption of the small-pox, disappears; and afterwards fewer and more distinct eruptions of the small-pox supervene.
11. _Testium dolor nephriticus._ The pain and retraction of the testicle on the same side, when there is a stone in the ureter, is to be ascribed to sensitive association; whether the connecting cause be a branch of the same nerve, or from membranes, which have been frequently affected at the same time.
12. _Dolor digiti minimi sympatheticus._ When any one accidentally strikes his elbow against any hard body, a tingling pain runs down to the little finger end. This is owing to sensitive association of motions by means of the same branch of a nerve, as in hemicrania from a decaying tooth the pain is owing to the sensitive association of tendons or membranes.
13. _Dolor brachii in hydrope pectoris._ The pain in the left arm which attends some dropsies of the chest, is explained in Sect. XXIX. 5. 2. 10. which resembles the pain of the little finger from a percussion of the nerve at the elbow in the preceding article. A numbness of this kind is produced over the whole leg, when the crural nerve is much compressed by sitting for a time with one leg crossed over the other.
Mr. ----, about sixty, had for two years been affected with difficulty of respiration on any exertion, with pain about the sternum, and of his left arm; which last was more considerable than is usual in dropsy of the chest; some months ago the pain of his arm, after walking a mile or two, became excessive, with coldness and numbness; and on the next day the back of the hand, and a part of the arm swelled, and became inflamed, which relieved the pain; and was taken for the gout, and continued several days. He after some months became dropsical both in respect to his chest and limbs, and was six or seven times perfectly relieved by one dram of saturated tincture of digitalis, taken two or three times a day for a few days in a glass of peppermint water. He afterwards breathed oxygen gas undiluted, in the quantity of six or eight gallons a day for three or four weeks without any effect, and sunk at length from general debility.
In this instructive case I imagine the pressure or stimulus of one part of the nerve within the chest caused the other part, which serves the arm, to become torpid, and consequently cold by sympathy; and that the inflammation was the consequence of the previous torpor and coldness of the arm, in the same manner as the swelling and inflammation of the cheek in tooth-ach, in the first species of this genus; and that many rheumatic inflammations are thus produced by sympathy with some distant part.
14. _Diarrhoea a dentitione._ The diarrhoea, which frequently attends dentition, is the consequence of indigestion; the aliment acquires chemical changes, and by its acidity acts as a cathartic; and changes the yellow bile into green, which is evacuated along with indigested parts of the coagulum of milk. The indigestion is owing to the torpor of the stomach and intestines caused by their association with the membranes of the gums, which are now stimulated into great exertion with pain; both which contribute to expend the general quantity of sensorial power, which belongs to this membranous association; and thus the stomach and intestines act with less than their natural energy. This is generally esteemed a favourable symptom in difficult dentition, as the pain of the alveolar membranes exhausts the sensorial power without producing convulsions for its relief. See Class I. 1. 4. 5. And the diarrhoea ceases, as the tooth advances.
* * * * *
ORDO II.
_Decreased Associate Motions._
GENUS III.
_Catenated with Voluntary Motions._
SPECIES.
1. _Titubatio linguae._ Impediment of speech is owing to the associations of the motions of the organs of speech being interrupted or dissevered by ill-employed sensation or sensitive motions, as by awe, bashfulness, ambition of shining, or fear of not succeeding, and the person uses voluntary efforts in vain to regain the broken associations, as explained in Sect. XVII. 1. 10. and XVII. 2. 10.
The broken association is generally between the first consonant and the succeeding vowel; as in endeavouring to pronounce the word parable, the p is voluntarily repeated again and again, but the remainder of the word does not follow, because the association between it and the next vowel is dissevered.
M. M. The art of curing this defect is to cause the stammerer to repeat the word, which he finds difficult to speak, eight or ten times without the initial letter, in a strong voice, or with an aspirate before it, as arable, or harable; and at length to speak it very softly with the initial letter p, parable. This should be practised for weeks or months upon every word, which the stammerer hesitates in pronouncing. To this should be added much commerce with mankind, in order to acquire a carelessness about the opinions of others.
2. _Chorea St. Viti._ In the St. Vitus's dance the patient can at any time lie still in bed, which shews the motions not to be convulsive; and he can at different times voluntarily exert every muscle of his body; which evinces, that they are not paralytic. In this disease the principal muscle in any designed motion obeys the will; but those muscles, whose motions were associated with the principal one, do not act; as their association is dissevered, and thus the arm or leg is drawn outward, or inward, or backward, instead of upward or forward, with various gesticulations exactly resembling the impediment of speech.
This disease is frequently left after the itch has been too hastily cured. See Convulsio dolorifica, Class III. 1. 1. 6. A girl about eighteen, after wearing a mercurial girdle to cure the itch, acquired the Chorea St. Viti in so universal a manner, that her speech became affected as well as her limbs; and there was evidently a disunion of the common trains of ideas; as the itch was still among the younger children of the family, she was advised to take her sister as a bedfellow, and thus received the itch again; and the dance of St. Vitus gradually ceased. See Class II. 1. 5. 6.
M. M. Give the patient the itch again. Calomel a grain every night, or sublimate a quarter of a grain twice a day for a fortnight. Steel. Bark. Warm-bath. Cold-bath. Opium. Venesection once at the beginning of the disease. Electricity. Perpetual slow and repeated efforts to move each limb in the designed direction, as in the titubatio linguae above described.
3. _Risus._ Laughter is a perpetual interruption of voluntary exertion by the interposition of pleasurable sensation; which not being checked by any important consequences rises into pain, and requires to be relieved or moderated by the frequent repetition of voluntary exertion. See Sect. XXXIV. 1. 4. and Class III. 1. 1. 4. and IV. 1. 3. 3.
4. _Tremor ex ira._ The trembling of the limbs from anger. The interruption of the voluntary associations of motions by anger, originates from too great a part of the sensorial power being exerted on the organs of sense; whence the muscles, which ought to support the body upright, are deprived of their due quantity, and tremble from debility. See Class III. 2. 1. 1.
5. _Rubor ex ira._ Redness from anger. Anger is an excess of aversion, that is of voluntarity not yet employed. It is excited by the pain of offended pride; when it is employed it becomes outrage, cruelty, insanity. The cutaneous capillaries, especially those of the face, are more mobile, that is, more easily excited into increased action, or more easily become torpid, from less variation of sensorial power, than any other parts of the system, which is owing to their being perpetually subject to the vicissitudes of heat and cold, and of extension and corrugation. Hence, when an excess of voluntarity exists without being immediately expended in the actions of the large muscles, the capillary arteries and glands acquire more energetic action, and a flushed skin is produced, with increased secretion of perspirable matter, and consequent heat, owing to the pause or interruption of voluntary action; and thus the actions of these cutaneous vessels become associated between the irascent ideas and irascent muscular actions, which are thus for a time interrupted.
6. _Rubor criminati._ The blushing of accused people, whether guilty or not, appears to be owing to circumstances similar to that of anger; for in these situations there is always a sudden voluntarity, or wish, of clearing their characters arises in the mind of the accused person; which, before an opportunity is given for it to be expended on the large muscles, influences the capillary arteries and glands, as in the preceding article. Whence the increased actions of the capillaries, and the consequent redness and heat, become exerted between the voluntary ideas of self-defence, and the muscular actions necessary for that purpose; which last are thus for a time interrupted or delayed.
Even in the blush of modesty or bashfulness there is a self-condemnation for some supposed defect or indecorum, and a sudden voluntarity, or wish, of self-defence; which not being expended in actions of the larger muscles excites the capillaries into action; which in these subjects are more mobile than in others.
The blush of young girls on coming into an assembly room, where they expect their dress, and steps, and manner to be examined, as in dancing a minuet, may have another origin; and may be considered as a hot fit of returning confidence, after a previous cold fit of fear.
7. _Tarditas paralytica._ By a stroke of the palsy or apoplexy it frequently happens, that those ideas, which were associated in trains, whose first link was a voluntary idea, have their connection dissevered; and the patient is under the necessity by repeated efforts slowly to renew their associations. In this situation those words, which have the fewest other words associated with them, as the proper names of persons or places, are the most difficult to recollect. And in those efforts of recollection the word opposite to the word required is often produced, as hot for cold, winter for summer, which is owing to our associating our ideas of things by their opposites as well as by their similitudes, and in some instances perhaps more frequently, or more forcibly. Other paralytic patients are liable to give wrong names to external objects, as using the word pigs for sheep, or cows for horses; in this case the association between the idea of the animal and the name of it is dissevered; but the idea of the class or genus of the thing remains; and he takes a name from the first of the species, which presents itself, and sometimes can correct himself, till he finds the true one.
8. _Tarditas senilis._ Slowness of age. The difficulty of associating ideas increases with our age; as may be observed from old people forgetting the business of the last hour, unless they impress it strongly, or by frequent repetition, though they can well recollect the transactions of their youth. I saw an elderly man, who could reason with great clearness and precision and in accurate language on subjects, which he had been accustomed to think upon; and yet did not know, that he had rang the bell by his fire-side in one minute afterwards; nor could then recollect the object he had wanted, when his servant came.
Similar to this is the difficulty which old people experience in learning new bodily movements, that is, in associating new muscular actions, as in learning a new trade or manufactury. The trains of movements, which obey volition, are the last which we acquire; and the first, which are disassociated.
* * * * *
ORDO II.
_Decreased Associate Motions._
GENUS IV.
_Catenated with External Influences._
As the diseases, which obey solar or lunar periods, commence with torpor or inactivity, such as the cold paroxysms of fevers, the torpor and consequent pain of hemicrania, and the pains which precede the fits of epilepsy and convulsion, it would seem, that these diseases are more generally owing to the diminution than to the excess of solar or lunar gravitation; as the diseases, which originate from the influence of the matter of heat, are much more generally in this country produced by the defect than by the excess of that fluid.
The periodic returns of so many diseases coincide with the diurnal, monthly, and annual rounds of time; that any one, who would deny the influence of the sun and moon on the periods of quotidian, tertian, and quartan fevers, must deny their effect on the tides, and on the seasons. It has generally been believed, that solar and lunar effect was exerted on the blood; which was thus rendered more or less stimulant to the system, as described in Sect. XXXII. 6. But as the fluid matter of gravitation permeates and covers all things, like the fluid matter of heat; I am induced to believe, that gravitation acts in its medium state rather as a causa sine qua non of animal motion, like heat; which may disorder the system chemically or mechanically, when it is diminished; but may nevertheless stimulate it, when increased, into animal exertion.
Without heat and motion, which some philosophers still believe to be the same thing, as they so perpetually appear together, the particles of matter would attract and move towards each other, and the whole universe freeze or coalesce into one solid mass. These therefore counteract the gravitation of bodies to one center; and not only prevent the planets from falling into the sun, but become either the efficient causes of vegetable and animal life, or the causes without which life cannot exist; as by their means the component particles of matter are enabled to slide over each other with all the various degrees of fluidity and repulsion.
As the attraction of the moon countervails or diminishes the terrene gravitation of bodies on the surface of the earth; a tide rises on that side of the earth, which is turned towards the moon; and follows it, as the earth revolves. Another tide is raised at the same time on the opposite side of the revolving earth; which is owing to the greater centrifugal motion of that side of the earth, which counteracts the gravitation of bodies near its surface. For the earth and moon may be considered as two cannon balls of different sizes held together by a chain, and revolving once a month round a common center of gravity between them, near the earth's surface; at the same time that they perform their annual orbits round the sun. Whence the centrifugal force of that side of the earth, which is farthest from this center of motion, round which the earth and moon monthly revolve, is considerably greater, than the centrifugal force of that side of the earth, which is nearest it; to which should be added, that this centrifugal force not only contributes to diminish the terrene gravitation of bodies on the earth's surface on that side furthest from this center of motion, but also to increase it on that side, which is nearest it.
Another circumstance, which tends to raise the tide on the part of the earth's surface, which is most distant from the moon, is, that the attraction of the moon is less on that part of the ocean, than it is on the other parts of the earth. Thus the moon may be supposed to attract the water on the side of the earth nearest it with a power equal to three; and to attract the central parts of the earth with a power equal to two; and the water on the part of the earth most distant from the moon with a power only equal to one. Hence on the side of the earth most distant from the moon, the moon's attraction is less, and the centrifugal force round their common center of motion is greater; both which contribute to raise the tides on that side of the earth. On the side of the earth nearest the moon, the moon's attraction is so much greater as to raise the tides; though the centrifugal force of the surface of the earth round their common center of motion in some degree opposes this effect.
On these accounts, when the moon is in the zenith or nadir, the gravitation of bodies on the earth's surface will be greatest at the two opposite quadratures; that is, the greatest gravitation of bodies on the earth's surface towards her center during the lunar day is about six hours and an half after the southing, or after the northing of the moon.
Circumstances similar to these, but in a less degree, must occur in respect to the solar influence on terrestrial bodies; that is, there must be a diminution of the gravity of bodies, near the earth's surface at noon, when the sun is over them; and also at midnight from the greater centrifugal force of that side of the earth, which is most distant from the center, round which the earth moves in her annual orbit, than on the side nearest that center. Whence it likewise follows, that the gravitation of bodies towards the earth is greatest about six hours after noon, and after midnight.
Now when the sun and moon have their united gravitation on the same side of the earth, as at the new moon; or when the solar attraction coincides with the greater centrifugal motion of that side of the earth, which is furthest distant from the moon, as at the full moon; and when this happens about noon or midnight, the gravitation of terrene bodies towards the earth will be greater about six hours after noon, and after midnight, than at any other part of the lunar period; because the attraction of both these luminaries is then exerted on those sides of the earth over which they hang, which at other times of the month are more or less exerted on other parts of it.
Lastly, as heat and motion counteract the gravitation of the particles of bodies to each other, and hence become either the efficient causes of vegetable and animal life, or the causes without which life cannot exist, it seems to follow, that when our gravitation towards the earth's center is greatest, the powers of life should be the least; and hence that those diseases, which begin with torpor, should occur about six hours after the solar or lunar noon, or about six hours after the solar or lunar midnight; and this most frequently about six hours after or before the new or full moon; and especially when these happen at noon or at midnight; or lastly, according to the combination of these powers in diminishing or increasing the earth's attraction to bodies on its surface.
The returns or exacerbations of many fevers, both irritative and inflammatory, about six in the evening, and of the periodic cough described in Sect. XXXVI. 3. 9. countenance this theory. Tables might be made out to shew the combined powers of the sun and moon in diminishing the gravitation of bodies on the earth's surface, at every part of their diurnal, monthly, and annual periods; and which might facilitate the elucidation of this subject. But I am well aware of the difficulty of its application to diseases, and hope these conjectures may induce others to publish more numerous observations, and more conclusive reasonings.
SPECIES.
1. _Somni periodus._ The periods of sleeping and of waking are shortened or prolonged by so many other circumstances in animal life, besides the minute difference between diurnal and nocturnal solar gravitation, that it can scarcely be ascribed to this influence. At the same time it is curious to observe, that vegetables in respect to their times of sleeping more regularly observe the hour of the day, than the presence or absence of light, or of heat, as may be seen by consulting the calendar of Flora. Botanic Garden, Part II. Canto 2. l. 165. note.
Some diseases, which at first sight might be supposed to be influenced by solar periods, seem to be induced by the increasing sensibility of the system to pain during our sleeping hours; as explained in Sect. XVIII. 15. Of these are the fits of asthma, of some epilepsies, and of some haemoptoes; all which disturb the patient after some hours sleep, and are therefore to be ascribed to the increase of our dormant sensibility. There may likewise be some doubt, whether the commencement of the pain of gout in the foot, as it generally makes its attack after sleep, should be ascribed to the increased sensibility in sleep, or to solar influence?
M. M. When asthmatic or epileptic fits or haemoptoe occur after a certain number of hours of sleep, the patient should be forcibly awakened before the expected time by an alarm clock, and drink a cup of chocolate or lemonade.--Or a grain of opium should be given at going to bed.--In one case to prevent the too great increase of sensibility by shortening the time of sleep; and in the other by increasing the irritative motions, and expending by that means a part of the sensorial power.
2. _Studii inanis periodus._ Class III. 1. 2. 2. The cataleptic spasm which preceded the reverie and somnambulation in the patient, whose case is related in Sect. XIX. 2. occurred at exactly the same hour, which was about eleven in the morning for many weeks; till those periods were disturbed by large doses of opium; and must therefore be referred to some effect of solar gravitation. In the case of Master A. Sect. XXXIV. 3. as the reverie began early in the morning during sleep, there may be a doubt, whether this commenced with torpor of some organ catenated with solar gravitation; or was caused by the existence of a previous torpid part, which only became so painful as to excite the exertions of reverie by the perpetual increase of sensibility during the continuance of sleep, as in some fits of epilepsy, asthma, and haemoptoe mentioned in the preceding article.
3. _Hemicraniae periodus._ Periods of hemicrania. Class IV. 2. 2. 8. The torpor and consequent pain of some membranes on one side of the head, as over one eye, is frequently occasioned by a decaying tooth, and is liable to return every day, or on alternate days at solar or lunar periods. In this case large quantities of the bark will frequently cure the disease, and especially if preceded by venesection and a brisk cathartic; but if the offending tooth can be detected, the most certain cure is its extraction. These partial head-achs are also liable to return at the greater lunar periods, as about once a month. Five drops from a two-ounce phial of a saturated solution of arsenic twice a day for a week or two have been said to prevent the returns of this disease. See a Treatise on Arsenic by Dr. Fowler, of York. Strong errhines have also been recommended.
4. _Epilepsiae dolorificae periodus._ Class III. 1. 1. 8. The pain which induces after about an hour the violent convulsions or insanity, which constitute the painful epilepsy, generally observe solar diurnal periods for four or five weeks, and are probably governed by solar and lunar times in respect to their greater periods; for I have observed that the daily paroxysms, unless disturbed by large doses of opium, recur at very nearly the same hour, and after a few weeks the patients have recovered to relapse again at the interval of a few months. But more observations are wanted upon this subject, which might be of great advantage in preventing the attacks of this disease; as much less opium given an hour before its expected daily return will prevent the paroxysm, than is necessary to cure it, after it has commenced.
5. _Convulsionis dolorificae periodus._ Class III. 1. 1. 6. The pains, which produce these convulsions, are generally left after rheumatism, and come on when the patients are become warm in bed, or have been for a short time asleep, and are therefore perhaps rather to be ascribed to the increasing sensibility of the system during sleep, than to solar diurnal periods, as in Species first and second of this Genus.
6. _Tussis periodicae periodus._ Periodic cough, Class IV. 2. 1. 9. returns at exact solar periods; that described in Sect. XXXVI. 3. 9. recurred about seven in the afternoon for several weeks, till its periods were disturbed by opium, and then it recurred at eleven at night for about a week, and was then totally destroyed by opium given in very large quantities, after having been previously for a few days omitted.
7. _Catameniae periodus._ Periods of menstruation. The correspondence of the periods of the catamenia with those of the moon was treated of in Sect. XXXII. 6. and can admit of no more doubt, than that the returns of the tides are governed by lunar influence. But the manner in which this is produced, is less evident; it has commonly been ascribed to some effect of the lunar gravitation on the circulating blood, as mentioned in Sect. XXXII. 6. But it is more analogous to other animal phenomena to suppose that the lunar gravitation immediately affects the solids by its influx or stimulus. Which we believe of the fluid element of heat, in which we are equally immersed; and of the electric fluid, which also surrounds and pervades us. See Sect. XXXVI. 2. 3.
If the torpor of the uterine veins, which induces the monthly periods of the catamenia, be governed by the increase of terrene gravitation; that is, by the deficiency of the counter-influence of solar and lunar gravitation; why does not it occur most frequently when the terrene gravitation is the greatest, as about six hours after the new moon, and next to that at about six hours after the full moon? This question has its difficulty; first, if the terrene gravitation be greatest about six hours after the new moon, it must become less and less about the same time every lunar day, till the end of the first quarter, when it will be the least; it must then increase daily till the full. After the full the terrene gravitation must again decrease till the end of the third quarter, when it will again be the least, and must increase again till the new moon; that is, the solar and lunar counter-gravitation is greatest, when those luminaries are vertical, at the new moon, and full moon, and least about six hours afterwards. If it was known, whether more menstruations occur about six hours after the moon is in the zenith or nadir; and in the second and fourth quarters of the moon, than in the first and third; some light would be thrown on this subject; which must in that respect wait for future observations.
Secondly, if the lunar influence produces a very small degree of quiescence, suppose of the uterine veins, at first; and if that recurs at certain periods, as of lunar days, or about 25 hours, even with less power to produce quiescence than at first; yet the quiescence will daily increase by the acquired habit acting at the same time, as explained in Sect. XII. 3. 3. till at length so great a degree of quiescence will be induced as to cause the inaction of the veins of the uterus, and consequent venous haemorrhage. See Sect. XXXII. 6. Class I. 2. 1. 11. IV. 1. 4. 4. See the introduction to this Genus.
8. _Haemorrhoidis periodus._ The periods of the piles depend on the torpor of the veins of the rectum, and are believed to recur nearly at monthly intervals. See Sect. XXVII. 2. and Class I. 2. 1. 6.
9. _Podagrae periodus._ The periods of gout in some patients recur at annual intervals, as in the case related above in Class IV. 1. 2. 15. in which the gouty paroxysm returned for three successive years on nearly the same day of the month. The commencement of the pain of each paroxysm is generally a few hours after midnight, and may thence either be induced by diurnal solar periods, or by the increasing sensibility during sleep, as mentioned in the first species of this genus.
10. _Erysipelatis periodus._ Some kinds of erysipelas which probably originate from the association of the cutaneous vessels with a diseased liver, occur at monthly periods, like the haemorrhois or piles; and others at annual periods like the gout; as a torpor of some part I suppose always precedes the erysipelatous inflammation, the periods should accord with the increasing influence of terrene gravitation, as described in the introduction to this Genus, and in Species the seventh of it. Other periods of diseases referable to solar and lunar influence are mentioned in Sect XXXVI. and many others will probably be discovered by future observation.
11. _Febrium periodus._ Periods of fevers. The commencement of the cold fits of intermittent fevers, and the daily exacerbations of other fevers, so regularly recur at diurnal solar or lunar periods, that it is impossible to deny their connection with gravitation; as explained in Sect. XXXVI. 3. Not only these exacerbations of fever, and their remissions, obey the diurnal solar and lunar periods; but the preparatory circumstances, which introduce fevers, or which determine their crisises, appear to be governed by the parts of monthly lunar periods, and of solar annual ones. Thus the variolous fever in the natural small-pox commences on the 14th day, and in the inoculated small-pox on the seventh day. The fever and eruption in the distinct kind take up another quarter of a lunation, and the maturation another quarter.
The fever, which is termed canine madness, or hydrophobia, is believed to commence near the new or full moon; and, if the cause is not then great enough to bring on the disease, it seems to acquire some strength, or to lie dormant, till another, or perhaps more powerful lunation calls it into action. In the spring, about three or four years ago, a mad dog very much worried one swine confined in a sty, and bit another in the same sty in a less degree; the former became mad, refused his meat, was much convulsed, and died in about four days; this disease commenced about a month after the bite. The other swine began to be ill about a month after the first, and died in the same manner.
* * * * *
ORDO III.
_Retrograde Associate Motions._
GENUS I.
_Catenated with Irritative Motions._
Those retrograde associate motions, the first links of which are catenated with irritative motions, belong to this genus. All the retrograde motions are consequent to debility, or inactivity, of the organ; and therefore properly belong to the genera of decreased actions both in this and the former classes.
SPECIES.
1. _Diabaetes irritata._ When the absorbents of the intestines are stimulated too strongly by spirit of wine, as in the beginning of drunkenness, the urinary absorbents invert their motions. The same happens from worms in the intestines. In other kinds of diabetes may not the remote cause be the too strong action of the cutaneous absorbents, or of the pulmonary ones? May not in such cases oil externally or internally be of service? or warm bathing for an hour at a time? In hysteric inversions of motion is some other part too much stimulated? or pained from the want of stimulus?
2. _Sudor frigidus in asthmate._ The cause of the paroxysms of humoral asthma is not well understood; I suppose it to be owing to a torpidity or inaction of the absorbents belonging to the pulmonary vessels, as happens probably to other viscera at the commencement of intermittent fevers, and to a consequent accumulation of fluids in them; which at length producing great irritation or uneasy sensation causes the violent efforts to produce the absorption of it. The motions of the cutaneous absorbent vessels by their association with those of the pulmonary ones become retrograde, and effuse upon the skin a fluid, which is said to be viscid, and which adheres in drops.
A few days ago I saw a young man of delicate constitution in what was called a fit of the asthma; he had about two months before had a peripneumony, and had been ever since subject to difficult respiration on exertion, with occasional palpitation of his heart. He was now seized about eight at night after some exertion of mind in his business with cold extremities, and difficulty of breathing. He gradually became worse, and in about half an hour, the palpitation of his heart and difficult respiration were very alarming; his whole skin was cold and pale, yet he did not shudder as in cold paroxysm of fever; his tongue from the point to the middle became as cold as his other extremities, with cold breath. He seemed to be in the act of dying, except that his pulse continued equal in time, though very quick. He lost three ounces of blood, and took ten drops of laudanum with musk and salt of hartshorn, and recovered in an hour or two without any cold sweat.
There being no cold sweat seems to indicate, that there was no accumulation of serous fluid in the lungs; and that their inactivity, and the coldness of the breath, was owing to the sympathy of the air-cells with some distant part. There was no shuddering produced, because the lungs are not sensible to heat and cold; as any one may observe by going from a warm room into a frosty air, and the contrary. So the steam of hot tea, which scalds the mouth, does not affect the lungs with the sensation of heat. I was induced to believe, that the whole cold fit might be owing to suppuration in some part of the chest; as the general difficulty of breathing seemed to be increased after a few days with pulse of 120, and other signs of empyema. Does the cold sweat, and the occurrence of the fits of asthma after sleep, distinguish the humoral asthma from the cold paroxysm of intermittents, or which attends suppuration, or which precedes inflammation?--I heard a few weeks afterwards, that he spit up much matter at the time he died.
3. _Diabaetes a timore._ The motions of the absorbent vessels of the neck of the bladder become inverted by their consent with those of the skin; which are become torpid by their reverse sympathy with the painful ideas of fear, as in Sect. XVI. 8. 1. whence there is a great discharge of pale urine, as in hysteric diseases.
The same happens from anxiety, where the painful suspense is continued, even when the degree of fear is small; as in young men about to be examined for a degree at the universities the frequency of making water is very observable. When this anxiety is attended with a sleepless night, the quantity of pale urine is amazingly great in some people, and the micturition very frequent.
M. M. Opium. Joy. Consolations of friendship.
4. _Diarrhoea a timore._ The absorbent vessels of the intestines invert their motions by direct consent with the skin; hence many liquid stools as well as much pale urine are liable to accompany continued fear, along with coldness of the skin. The immediate cause of this is the decreased sensorial power of association, which intervenes between the actions of the absorbents of the cold skin, and those of the intestinal absorbents; the motions of the latter become on that account weakened and at length retrograde. The remote cause is the torpor of the vessels of the skin catenated with the pain of fear, as explained in Sect. XVI. 8. 1.
The capillaries of the skin consent more generally by direct sympathy with those of the lower intestines, and of the bladder; but by reverse sympathy more generally with those of the stomach and upper intestines. As appears in fevers, where the hot skin accompanies indigestion of the stomach; and in diarrhoeas attended with cold extremities.
The remote cause is the torpor of the skin owing to its reverse sympathy with the painful sensual motions, or ideas, of fear; which are now actuated with great energy, so as to deprive the second link of associated motions of their due share of sensorial power. It is also probable, that the pain of fear itself may contribute to exhaust the sensorial power, even when it produces no muscular action. See Class IV. 2. 2.
5. _Pallor et tremor a timore._ A retrograde action of the capillaries of the skin producing paleness, and a torpor of the muscular fibres of the limbs occasioning trembling, are caused by their reverse associations with the ideas or imaginations of fear; which are now actuated with violent energy, and accompanied with great pain. The cause of these associations are explained in Sect XVI. 8. 1.
These torpid actions of the capillaries and muscles of the limbs are not caused immediately by the painful sensation of fear; as in that case they would have been increased and not decreased actions, as occurs in anger; where the painful volition increases the actions of the capillaries, exciting a blush and heat of the skin. Whence we may gain some knowledge of what is meant by depressing and exciting passions; the former confiding of ideas attended with pain, which pain occasions no muscular actions, like the pain of cold head-ach; the latter being attended with volitions, and consequent muscular exertions.
That is, the pain of fear, and the pain of anger, are produced by the exertion of certain ideas, or motions of certain nerves of sense; in the former case, the painful sensation of fear produces no muscular actions, yet it exhausts or employs so much sensorial power, that the whole system acts more feebly, or becomes retrograde; but some parts of it more so than others, according to their early associations described in Sect. XVI. 8. 1. hence the tremor of the limbs, palpitation of heart, and even syncope. In anger the painful volition produces violent muscular actions; but if previous to these any deliberation occurs, a flushed countenance sometimes, and a red skin, are produced by this superabundance of volition exerted on the arterial system; but at other times the skin becomes pale, and the legs tremble, from the exhaustion or expenditure of the sensorial power by the painful volitions of anger on the organs of sense, as by the painful sensations of fear above mentioned.
Where the passion of fear exists in a great degree, it exhausts or expends so much sensorial power, either simply by the pain which attends it, or by the violent and perpetual excitement of the terrific imaginations or ideas, that not only a cold and pale skin, but a retrograde motion of the cutaneous absorbents occurs, and a cold sweat appears upon the whole surface of the body, which probably sometimes increases pulmonary absorption; as in Class II. 1. 6. 4. and as in the cold sweats, which attend the paroxysms of humoral asthma. Hence anxiety, which is a continued pain of fear, so universally debilitates the constitution as to occasion a lingering death; which happens much more frequently than is usually supposed; and these victims of continued anxiety are said to die of a broken heart. Other kinds of paleness are described in Class I. 2. 2. 2.
M. M. Opium. Wine. Food. Joy.
6. _Palpitatio cordis a timore._ The palpitation of the heart from fear is owing to the weak action of it, and perhaps sometimes to the retrograde exertion of the ventricules and auricles; because it seems to be affected by its association with the capillaries, the actions of which, with those of the arteries and veins, constitute one great circle of associate motions. Now when the capillaries of the skin become torpid, coldness and paleness succeed; and with these are associated the capillaries of the lungs, whence difficult respiration; and with these the weak and retrograde actions of the heart. At the same time the absorbents of the skin, and of the bladder, and of the intestines, sometimes become retrograde, and regurgitate their contents; as appears by the pale urine in large quantities, which attends hysteric complaints along with this palpitation of the heart; and from the cold sweats, and diarrhoea; all which, as well as the hysteric complaints, are liable to be induced or attended by fear.
When fear has still more violently affected the system, there have been instances where syncope, and sudden death, or a total stoppage of the circulation, have succeeded: in these last cases, the pain of fear has employed or exhausted the whole of the sensorial power, so that not only those muscular fibres generally exerted by volition cease to act, whence the patient falls down; and those, which constitute the organs of sense, whence syncope; but lastly those, which perform the vital motions, become deprived of sensorial power, and death ensues. See Class. I. 2. 1. 4. and I. 2. 1. 10. Similar to this in some epileptic fits the patient first suddenly falls down, without even endeavouring to save himself by his hands before the convulsive motions come on. In this case the great exertion of some small part in consequence of great irritation or sensation exhausts the whole sensorial power, which was lodged in the extremities of the locomotive nerves, for a short time, as in syncope; and as soon as these muscles are again supplied, convulsions supervene to relieve the painful sensation. See Class III. 1. 1. 7.
7. _Abortio a timore._ Women miscarry much more frequently from a fright, than from bodily injury. A torpor or retrograde motion of the capillary arteries of the internal uterus is probably the immediate cause of these miscarriages, owing to the association of the actions of those vessels with the capillaries of the skin, which are rendered torpid or retrograde by fear. By this contraction of the uterine arteries, the fine vessels of the placenta, which are inserted into them, are detruded, or otherwise so affected, that the placenta separates at this time from the uterus, and the fetus dies from want of oxygenation. A strong young woman, in the fifth or sixth month of her pregnancy, who has since borne many children, went into her cellar to draw beer; one of the servant boys was hid behind a barrel, and started out to surprise her, believing her to be the maid-servant; she began to flood immediately, and miscarried in a few hours. See Sect. XXXIX. 6. 5. and Class I. 2. 1. 14.
8. _Hysteria a timore._ Some delicate ladies are liable to fall into hysteric fits from sudden fright. The peristaltic motions of the bowels and stomach, and those of the oesophagus, make a part of the great circle of irritative motions with those of the skin, and many other membranes. Hence when the cutaneous vessels become torpid from their reverse sympathy with the painful ideas of fear; these of the bowels, and stomach, and oesophagus, become first torpid by direct sympathy with those of the skin, and then feebly and ineffectually invert the order of their motions, which constitutes a paroxysm of the hysteric disease. See Class I. 3. 1. 10. These hysteric paroxysms are sometimes followed by convulsions, which belong to Class III. as they are exertions to relieve pain; and sometimes by death. See Species 9 of this Genus, and Class I. 2. 1. 4.
Indigestion from fear is to be ascribed in the same manner to the torpor of the stomach, owing to its association with the skin. As in Class IV. 1. 2. 5. IV. 2. 1.
* * * * *
ORDO III.
_Retrograde Associate Motions._
GENUS II.
_Catenated with Sensitive Motions._
SPECIES.
1. _Nausea idealis._ Nausea from disgustful ideas, as from nauseous stories, or disgustful sights, or smells, or tastes, as well as vomiting from the same causes, consists in the retrograde actions of the lymphatics of the throat, and of the oesophagus, and stomach; which are associated with the disgustful ideas, or sensual motions of sight, or hearing, or smell, or taste; for as these are decreased motions of the lymphatics, or of the oesophagus, or stomach, they cannot immediately be excited by the sensorial power of painful sensation, as in that case they ought to be increased motions. So much sensorial power is employed for a time on the disgustful idea, or expended in the production of inactive pain, which attends it, that the other parts of the associated chain of action, of which this disgustful idea is now become a link, is deprived of their accustomed share; and therefore first stop, and then invert their motions. Owing to deficiency of sensorial power, as explained more at large in Sect. XXXV. 1. 3.
2. _Nausea a conceptu._ The nausea, which pregnant women are so subject to during the first part of gestation, is owing to the reverse sympathy between the uterus and stomach, so that the increased action of the former, excited by the stimulus of the growing embryon, which I believe is sometimes attended with sensation, produces decreased actions of the latter with the disagreeable sensation of sickness with indigestion and consequent acidity. When the fetus acquires so much muscular power as to move its limbs, or to turn itself, which is called quickening, this sickness of pregnancy generally ceases.
M. M. Calcined magnesia. Rhubarb. Half a grain of opium twice a day. Recumbent posture on a sofa.
3. _Vomitio vertiginosa._ Sea-sickness, the irritative motions of vision, by which we balance ourselves, and preserve our perpendicularity, are disturbed by the indistinctness of their objects; which is either owing to the similarity of them, or to their distance, or to their apparent or unusual motions. Hence these irritative motions of vision are exerted with greater energy, and are in consequence attended with sensation; which, at first is agreeable, as when children swing on a rope; afterwards the irritative motions of the stomach, and of the absorbent vessels, which open their mouths into it, become inverted by their associations with them by reverse sympathy.
For the action of vomiting, as well as the disagreeable sensation of sickness, are shewn to be occasioned by defect of the sensorial power; which in this case is owing to the greater expenditure of it by the sense of vision. On the same account the vomiting, which attends the passage of a stone through the ureter, or from an inflammation of the bowels, or in the commencement of some fevers, is caused by the increased expenditure of the sensorial power by the too great action of some links of the associations of irritative motions; and there being in consequence a deficiency of the quantity required for other links of this great catenation.
It must be observed, that the expenditure of sensorial power by the retinas of the eyes is very great; which may be estimated by the perpetual use of those organs during our waking hours, and during most of our sleeping ones; and by the large diameters of the two optic nerves, which are nearly the size of a quill, or equal to some of the principal nerves, which serve the limbs.
4. _Vomitio a calculo in uretere._ The action of vomiting in consequence of the increased or decreased actions of the ureter, when a stone lodges in it. The natural actions of the stomach, which consist of motions subject to intermitted irritations from the fluids, which pass through it, are associated with those of the ureter; and become torpid, and consequently retrograde, by intervals, when the actions of the ureter becomes torpid owing to previous great stimulus from the stone it contains; as appears from the vomiting existing when the pain is least. When the motions of the ureter are thus lessened, the sensorial power of association, which ought to actuate the stomach along with the sensorial power of irritation, ceases to be excited into action; and in consequence the actions of the stomach become less energetic, and in consequence retrograde.
For as vomiting is a decreased action of the stomach, as explained in Sect. XXXV. 1. 3. it cannot be supposed to be produced by the pain of gravel in the ureter alone, as it should then be an increased action, not a decreased one.
The perpetual vomiting in ileus is caused in like manner by the defective excitement of the sensorial power of association by the bowel, which is torpid during the intervals of pain; and the stomach sympathizes with it. See Enteritis, Class II. 1. 2. 11. Does this symptom of vomiting indicate, whether the disease be above or below the valve of the colon? Does not the softer pulse in some kinds of enteritis depend on the sympathy of the heart and arteries with the sickness of the stomach? See Ileus and Cholera.
Hence this sickness, as well as the sickness in some fevers, cannot be esteemed an effort of nature to dislodge any offensive material; but like the sea-sickness described above, and in Sect. XX. 4. is the consequence of the associations of irritative or sensitive motions. See Class I. 1. 3. 9.
5. _Vomitio ab insultu paralytico._ Paralytic affections generally commence with vomiting, the same frequently happens from a violent blow with a stick on the head; this curious connection of the brain and stomach has not been explained; as it resembles the sickness in consequence of vertigo at sea, it would seem to arise from a similar cause, viz. from disturbed irritative or sensitive associations.
6. _Vomitio a titillatione faucium._ If the throat be slightly tickled with a feather, a nausea is produced, that is, an inverted action of the mouths of the lymphatics of the fauces, and by direct sympathy an inverted action of the stomach ensues. As these parts have frequently been stimulated at the same time into pleasurable action by the deglutition of our daily aliment, their actions become strongly associated. And as all the food, we swallow, is either moist originally, or mixed with our moist saliva in the mouth; a feather, which is originally dry, and which in some measure repels the moist saliva, is disagreeable to the touch of the fauces; at the same time this nausea and vomiting cannot be caused by the disagreeable sensation simply, as then they ought to have been increased exertions, and not decreased ones, as shewn in Section XXXV. 1. 3. But the mouths of the lymphatics of the fauces are stimulated by the dry feather into too great action for a time, and become retrograde afterwards by the debility consequent to too great previous stimulus.
7. _Vomitio cute sympathetica._ Vomiting is successfully stopped by the application of a blister on the back in some fevers, where the extremities are cold, and the skin pale. It was stopped by Sydenham by producing a sweat on the skin by covering the head with the bed-clothes. See Class IV. 1. 1. 3. and Suppl. I. 11. 6.
* * * * *
ORDO III.
_Retrograde Associate Motions._
GENUS III.
_Catenated with Voluntary Motions._
SPECIES.
1. _Ruminatio._ In the rumination of horned cattle the food is brought up from the first stomach by the retrograde motions of the stomach and oesophagus, which are catenated with the voluntary motions of the abdominal muscles.
2. _Vomitio voluntaria._ Voluntary vomiting. Some human subjects have been said to have obtained this power of voluntary action over the retrograde motions of the stomach and oesophagus, and thus to have been able to empty their stomach at pleasure. See Sect. XXV. 6. This voluntary act of emptying the stomach is possessed by some birds, as the pigeon; who has an organ for secreting milk in its stomach, as Mr. Hunter observed; and softens the food for its young by previously swallowing it; and afterwards putting its bill into theirs returns it into their mouths. See Sect. XXXIX. 4. 8. The pelicans use a stomach, or throat bag, for the purpose of bringing the fish, which they catch in the sea to shore, and then eject them, and eat them at their leisure. See Sect. XVI. 11. And I am well informed of a bitch, who having puppies in a stable at a distance from the house, swallowed the flesh-meat, which was given her, in large pieces, and carrying it immediately to her whelps, brought it up out of her stomach, and laid it down before them.
3. _Eructatio voluntaria._ Voluntary eructation. Some, who have weak digestions, and thence have frequently been induced to eruct the quantity of air discharged from the fermenting aliment in their stomachs, have gradually obtained a power of voluntary eructation, and have been able thus to bring up hogsheads of air from their stomachs, whenever they pleased. This great quantity of air is to be ascribed to the increase of the fermentation of the aliment by drawing off the gas as soon as it is produced. See Sect. XXIII. 4.
* * * * *
ORDO III.
_Retrograde Associate Motions._
GENUS. IV.
_Catenated with External Influences._
SPECIES.
1. _Catarrhus periodicus._ Periodical catarrh is not a very uncommon disease; there is a great discharge of a thin saline mucous material from the membranes of the nostrils, and probably from the maxillary and frontal sinuses, which recur once a day at exact solar periods; unless it be disturbed by the exhibition of opium; and resembles the periodic cough mentioned below. See Class I. 3. 2. 1. It is probably owing to the retrograde action of the lymphatics of the membranes affected, and produced immediately by solar influence.
2. _Tussis periodica._ Periodic cough, called nervous cough, and tussis serina. It seems to arise from a periodic retrograde action of the lymphatics of the membrane, which lines the air-cells of the lungs. And the action of coughing, which is violently for an hour or longer, is probably excited by the stimulus of the thin fluid thus produced, as well as by the disagreeable sensation attending membranous inactivity; and resembles periodic catarrh not only in its situation on a mucous membrane, but in the discharge of a thin fluid. As it is partly restrainable, it does not come under the name of convulsion; and as it is not attended with difficult respiration, it cannot be called asthma; it is cured by very large doses of opium, see a case and cure in Sect. XXXVI. 3. 9. see Class IV. 2. 4. 6. and seems immediately to be induced by solar influence.
3. _Histeria a frigore._ Hysteric paroxysms are occasioned by whatever suddenly debilitates the system, as fear, or cold, and perhaps sometimes by external moisture of the air, as all delicate people have their days of greater or less debility, see Class IV. 3. 1. 8.
4. _Nausea pluvialis._ Sickness at the commencement of a rainy season is very common among dogs, who assist themselves by eating the agrostris canina, or dog's grass, and thus empty their stomachs. The same occurs with less frequency to cats, who make use of the same expedient. See Sect. XVI. 11. I have known one person, who from his early years has always been sick at the beginning of wet weather, and still continues so. Is this owing to a sympathy of the mucous membrane of the stomach with the mechanical relaxation of the external cuticle by a moister atmosphere, as is seen in the corrugated cuticle of the hands of washing-women? or does it sympathize with the mucous membrane of the lungs, which must be affected along with the mucus on its surface by the respiration of a moister atmosphere?
* * * * *
SUPPLEMENT TO CLASS IV.
_Sympathetic Theory of Fever._
As fever consists in the increase or diminution of direct or reverse associated motions, whatever may have been the remote cause of them, it properly belongs to the fourth class of diseases; and is introduced at the end of the class, that its great difficulties might receive elucidation from the preceding parts of it. These I shall endeavour to enumerate under the following heads, trusting that the candid reader will discover in these rudiments of the theory of fever a nascent embryon, an infant Hercules, which Time may rear to maturity, and render serviceable to mankind.
I. Simple fever of two kinds. II. Compound fever. III. Termination of the cold fit. IV. Return of the cold fit. V. Sensation excited in fever. VI. Circles of associated motions. VII. Alternations of cold and hot fits. VIII. Orgasm of the capillaries. IX. Torpor of the lungs. X. Torpor of the brain. XI. Torpor of the heart and arteries. XII. Torpor of the stomach and intestines. XIII. Case of continued fever explained. XIV. Termination of continued fever. XV. Inflammation excited in fever. XVI. Recapitulation.
I. _Simple fever._
1. When a small part of the cutaneous capillaries with their mucous or perspirative glands are for a short time exposed to a colder medium, as when the hands are immersed in iced water for a minute, these capillary vessels and their glands become torpid or quiescent, owing to the eduction of the stimulus of heat. The skin then becomes pale, because no blood passes through the external capillaries; and appears shrunk, because their sides are collapsed from inactivity, not contracted by spasm; the roots of the hair are left prominent from the seceding or subsiding of the skin around them; and the pain of coldness is produced.
In this situation, if the usual degree of warmth be applied, these vessels regain their activity; and having now become more irritable from an accumulation of the sensorial power of irritation during their quiescence, a greater exertion of them follows, with an increased glow of the skin, and another kind of pain, which is called the hot-ach; but no fever, properly so called, is yet produced; as this effect is not universal, nor permanent, nor recurrent.
2. If a greater part of the cutaneous capillaries with their mucous and perspirative glands be exposed for a longer time to cold, the torpor or quiescence becomes extended by direct sympathy to the heart and arteries; which is known by the weakness, and consequent frequency of the pulse in cold fits of fever.
This requires to be further explained. The movements of the heart and arteries, and the whole of the circulatory vessels, are in general excited into action by the two sensorial powers of irritation, and of association. The former is excited by stimulus, the latter by the previous actions of a part of the vital circle of motions. In the above situation the capillaries act weakly from defect of irritation, which is caused by deficient stimulus of heat; but the heart and arteries act weakly from defect of association, which is owing to the weak action of the capillaries; which does not now excite the sensorial power of association into action with sufficient energy.
After a time, either by the application of warmth, or by the increase of their irritability owing to the accumulation of the sensorial power of irritation during their previous quiescence, the capillary vessels and glands act with greater energy than natural; whence the red colour and heat of the skin. The heart and arteries acquire a greater strength of pulsation, and continue the frequency of it, owing to the accumulation of the sensorial power of association during their previous torpor, and their consequent greater associability; which is now also more strongly excited by the increased actions of the capillaries. And thus a fit of simple fever is produced, which is termed Febris irritativa; and consists of a torpor of the cutaneous capillaries with their mucous and perspirative glands, accompanied with a torpor of the heart and arteries; and afterwards of an increased action of all these vessels, by what is termed direct sympathy.
This fever, with strong pulse without inflammation, or febris irritativa, described in Class I. 1. 1. 1. is frequently seen in vernal intermittents, as the orgasm of the heart and arteries is then occasioned by their previous state of torpor; but more rarely I believe exists in the type of continued fever, except there be an evident remission, or approximation to a cold fit; at which time a new accumulation of the sensorial power of association is produced; which afterwards actuates the heart and arteries with unnatural vigour; or unless there be some stimulus perpetually acting on the system so as to induce an increased secretion of sensorial power in the brain, as occurs in slight degrees of intoxication. Since without one or other of these circumstances in continued fevers without inflammation, that is, without the additional sensorial power of sensation being introduced, it seems difficult to account for the production of so great a quantity of sensorial power, as must be necessary to give perpetual increase of action to the whole sanguiferous system.
3. On the contrary, while the cutaneous capillaries with their mucous and perspirative glands acquire an increased irritability, as above, by the accumulation of that sensorial power during their previous quiescence, and thus constitute the hot fit of fever; if the heart and arteries do not acquire any increase of associability, but continue in their state of torpor, another kind of simple fever is produced; which is generally of the continued kind, and is termed Febris inirritativa; which consists of a previous torpor of the capillaries of the skin, and of the heart and arteries by direct sympathy with them; and afterwards of an orgasm or increased action of the capillaries of the skin, with a decreased action, or continued torpor, of the heart and arteries by reverse sympathy with them. This orgasm of the cutaneous capillaries, which appears by the blush and heat of the skin, is at first owing to the accumulation of the sensorial power of irritation during their previous torpid state, as in the febris irritata above described; but which is afterwards supported or continued by the reverse sympathy of these capillaries with the torpid state of the heart and arteries, as will be further explained in article 8 of this Supplement.
4. The renovated activity of the capillaries commences as soon or sooner than that of the heart and arteries after the cold fit of irritative fever; and is not owing to their being forced open by the blood being impelled into them mechanically, by the renovated action of the heart and arteries; for these capillaries of the skin have greater mobility than the heart and arteries, as appears in the sudden blush of shame; which may be owing to their being more liable to perpetual varieties of activity from their exposure to the vicissitudes of atmospheric heat. And because in inirritative fevers, or those with arterial debility, the capillaries acquire increased strength, as is evinced by the heat of the skin, while the pulsations of the heart and arteries remain feeble.
5. It was said above, that the cutaneous capillaries, when they were rendered torpid by exposure to cold, either recovered their activity by the reapplication of external warmth; or by their increased irritability, which is caused by the accumulation of that sensorial power during their quiescence. An example of the former of these may be seen on emerging from a very cold bath; which produces a fit of simple fever; the cold fit, and consequent hot fit, of which may be prolonged by continuing in the bath; which has indeed proved fatal to some weak and delicate people, and to others after having been much exhausted by heat and exercise. See Sect. XXXII. 3. 2. An example of the latter may be taken from going into a bath of about eighty degrees of heat, as into the bath at Buxton, where the bather first feels a chill, and after a minute becomes warm, though he remains in the same medium, owing to the increase of irritability from the accumulation of that sensorial power during the short time, which the chilness continued.
6. Hence simple fevers are of two kinds; first, the febris irritativa, or fever with strong pulse; which consists of a previous torpor of the heart, arteries, and capillaries, and a succeeding orgasm of those vessels. Secondly, the febris inirritativa, or fever with weak pulse, which consists of a previous torpor of the heart, arteries, and capillaries; and of a succeeding orgasm of the capillaries, the torpor of the heart and arteries continuing. But as the frequency of the pulse occurs both in the state of torpor, and in that of orgasm, of the heart and arteries; this constitutes a criterion to distinguish fever from other diseases, which are owing to the torpor of some parts of the system, as paresis, and hemicrania.
7. The reader will please to observe, that where the cutaneous or pulmonary capillaries are mentioned, their mucous and perspirative glands are to be understood as included; but that the absorbents belonging to those systems of vessels, and the commencement of the veins, are not always included; as these are liable to torpor separately, as in anasarca, and petechiae; or to orgasm, or increased action, as in the exhibition of strong emetics, or in the application of vinegar to the lips; yet he will also please to observe, that an increased or decreased action of these absorbents and veins generally occurs along with that of the capillaries, as appears by the dry skin in hot fits of fever; and from there being generally at the same time no accumulation of venous blood in the cutaneous vessels, which would appear by its purple colour.
II. _Compound fever._
1. When other parts of the system sympathize with this torpor and orgasm of the cutaneous capillaries, and of the heart and arteries; the fever-fit becomes more complicated and dangerous; and this in proportion to the number and consequence of such affected parts. Thus if the lungs become affected, as in going into very cold water, a shortness of breath occurs; which is owing to the collapse or inactivity (not to the active contraction, or spasm), of the pulmonary capillaries; which, as the lungs are not sensible to cold, are not subject to painful sensation, and consequent shuddering, like the skin. In this case after a time the pulmonary capillaries, like the cutaneous ones, act with increased energy; the breathing, which was before quick, and the air thrown out at each respiration in less quantity, and cool to the back of the hand opposed to it, now becomes larger in quantity, and warmer than natural; which however is not accompanied with the sensation of heat in the membrane, which lines the air-vessels of the lungs, as in the skin.
2. One consequence of this increased heat of the breath is the increased evaporation of the mucus on the tongue and nostrils. A viscid material is secreted by these membranes to preserve them moist and supple, for the purposes of the senses of taste and of smell, which are extended beneath their surfaces; this viscid mucus, when the aqueous part of it is evaporated by the increased heat of the respired air, or is absorbed by the too great action of the mucous absorbents, adheres closely on those membranes, and is not without difficulty to be separated from them. This dryness of the tongue and nostrils is a circumstance therefore worthy to be attended to; as it shews the increased action of the pulmonary capillaries, and the consequent increased heat of the expired air; and may thus indicate, when colder air should be admitted to the patient. See Class I. 1. 3. 1. The middle part of the tongue becomes dry sooner, and recovers its moisture later, than the edges of it; because the currents of respired air pass most over the middle part of it. This however is not the case, when the dryness of the tongue is owing only to the increased mucous absorption. When however a frequent cough attends pulmonary inflammation, the edges of the tongue are liable to be as much furred as the middle of it; as during the action of coughing the middle of the tongue is depressed, so as to form half a cylinder, to give a greater aperture for the emission of air from the larynx; and the edges of it become thus as much exposed to the currents of air, as the middle parts of it.
3. When the internal capillaries or glands sympathize with the cutaneous capillaries; or when any of them are previously affected with torpor, and the external or cutaneous capillaries are affected secondarily; other symptoms are produced, which render the paroxysms of fever still more complicate. Thus if the spleen or pancreas are primarily or secondarily affected, so as to be rendered torpid or quiescent, they are liable to become enlarged, and to remain so even after the extinction of the fever-fit. These in some intermittent fevers are perceptible to the hand, and are called ague-cakes; their tumour seems to be owing to the permanent torpor of the absorbent system, the secerning vessels continuing to act some time afterwards. If the secretory vessels of the liver are affected first with torpor, and afterwards with orgasm, a greater secretion of bile is produced, which sometimes causes a diarrhoea. If a torpor of the kidneys, and of the absorbents of the bladder occurs, either primarily, or by sympathy with the cutaneous capillaries, the urine is in small quantity and pale, as explained in Class I. 2. 2. 5.; and if these secretory vessels of the kidneys, and the absorbents of the bladder act more strongly than natural afterwards by their increased irritability or associability, the urine becomes in larger quantity, and deeper coloured, or deposits its earthy parts, as in Class I. 1. 2. 4. which has been esteemed a favourable circumstance. But if the urine be in small quantity, and no sediment appears in it, after the hot fit is over; it shews, that the secerning vessels of the kidneys and the absorbent vessels of the bladder have not regained the whole of their activity, and thence indicates a greater tendency to a return of the cold fit.
4. When the stomach is affected with torpor either primarily; or secondarily by its sympathy with the cutaneous capillaries; or with some internal viscus; sickness occurs, with a total want of appetite to any thing solid; vomiting then supervenes, which may often be relieved by a blister on the skin, if the skin be cool and pale; but not if it be hot and flushed. The intestines cease to perform their office of absorption from a similar torpor; and a diarrhoea supervenes owing to the acrimony of their putrid, or of their acid contents. The loose undigested or fetid stools indicate the inability of the intestines to perform their proper office; as the mucus and gastric acid, which are vomited up, does that of the stomach; this torpor of the stomach is liable to continue after the cold paroxysm ceases, and to convert intermittent fevers into continued ones by its direct sympathy with the heart and arteries. See article 10 of this Supplement.
5. If the meninges of the brain sympathize with other torpid parts, or are primarily affected, delirium, stupor, and perhaps hydrocephalus internus occur, see Class II. 1. 7. 1. and I. 2. 5. 10; and sometimes the pulse becomes slow, producing paresis instead of fever. But if the membranes, which cover the muscles about the head, or of the pericranium, become torpid by their sympathy with other torpid parts, or are primarily affected, a head-ach supervenes; which however generally ceases with the cold paroxysm of fever. For as when the sensorial power of volition is exhausted by labour, a few hours, or half a solar day, passed in sleep recruits the system by accumulation of this sensorial power; so when the sensorial power of irritation is exhausted, one or two solar or lunar days of rest or quiescence of the affected part will generally restore its action by accumulation of irritability, and consequent increase of association, as in hemicrania, Class IV. 2. 2. 8. But when the heart and arteries become torpid, either primarily, or by their sympathy with the stomach, this accumulation of the sensorial power of irritation can take place but slowly; _as to rest is death_! This explains the cause of the duration of fevers with weak pulse, which continue a quarter, or half, or three quarters, or a whole lunation, or still longer, before sufficient accumulation of irritability can be produced to restore their natural strength of action.
6. If the absorbent vessels, which are spread around the neck of the bladder, become torpid by their direct sympathy with the absorbents of the skin in cold fits of fever; the urine, which is poured into the bladder in but small quantity from the torpid kidneys, has nevertheless none of its aqueous saline part reabsorbed; and this saline part stimulates the bladder to empty itself frequently, though the urine is in small quantity. Which is not therefore owing to any supposed spasm of the bladder, for the action of it in excluding the urine is weak, and as much controlable by the will as in ordinary micturition.
7. If the beginnings or absorbent mouths of the venous system remain torpid, petechiae or vibices are produced in fevers, similar to those which are seen in scurvy without fever. If the skin was frequently moistened for an hour, and at the same time exposed to the common air, or to oxygen gas, it might contribute to turn the black colour of these points of extravasated blood into scarlet, and thus by increasing its stimulus facilitate its reabsorption? For oxygen gas penetrates moist animal membranes though not dry ones, as in the lungs during respiration.
8. When the sensorial power of sensation is introduced into the arterial system, other kinds of compound fevers are produced, which will be spoken of in their place.
III. _Termination of the cold Fit._
1. If all the parts, which were affected with torpor, regain their irritability, and associability, the cold paroxysm of fever ceases; but as some of the parts affected were previously accustomed to incessant action, as the heart and arteries, and others only to intermitted action, as the stomach and intestines; and as those, which are subjected during health to perpetual action, accumulate sensorial power faster, when their motions are impeded, than those which are subjected to intermitted action; it happens, that some of the parts, which were affected with torpor during the cold fit, recover their irritability or associability sooner than others, and more perfectly, or acquire a greater quantity of them than natural; as appears by the partial heat and flushings previous to the general hot fit.
Hence if all the parts, which were previously torpid, regain their due degree of irritability, or of associability, the disease is removed, and health restored. If some or all of them acquire more than their natural degree of these sensorial powers; increased actions, and consequent increased secretions, and greater heat occur, and constitute the hot fit of fever. If after this hot fit of fever all the parts, which had acquired too great irritability, or associability, regain their natural degree of it; the disease is removed, and health restored. But if some of these parts do not regain their natural degree of these sensorial powers, the actions of those parts remain imperfect, and are more or less injurious to the system, according to the importance of their functions.
2. Thus if a torpor of the heart and arteries remains; the quick pulse without strength, which began in the cold fit, persists; and a continued fever is produced. If the torpor of the stomach and intestines remains, which are known by sickness and undigested stools, the fever is liable to be of considerable length and danger; the same if the kidnies and absorbent system retain some degree of torpor, as is shewn by the pale urine in not unusual quantity. If part of the absorbent system remains torpid, as the absorbent vessels of the spleen, a tumour of that viscus occurs, which may be felt by the hand; the same sometimes happens to the liver; and these from their tendency to more complete torpor are afterwards liable to give occasion to a return of the cold fit. If the cellular absorbents do not completely recover their activity, a pale and bloated countenance with swelled legs mark their want of action.
3. As the termination of the cold fit is owing to the accumulation of the sensorial power of irritation and of association during the previous quiescence of the system; and as those parts, which are in perpetual action during health, are more subject to this accumulation during their torpor, or quiescence; one should have imagined, that the heart and arteries would acquire this accumulation of sensorial power sooner or in greater degree than other parts. This indeed so happens, where the pulse is previously strong, as in febris irritativa; or where another sensorial power, as that of sensation, is exerted on the arterial system, as in inflammations. The heart and arteries in these cases soon recover from their torpor, and are exerted with great violence.
Many other parts of the system subject to perpetual motion in health may rest for a time without much inconvenience to the whole; as when the fingers of some people become cold and pale; and during this complete rest great accumulation of irritability may be produced, But where the heart and arteries are previously feeble, they cannot much diminish their actions, and certainly cannot rest entirely, for that would be death; and therefore in this case their accumulation of the sensorial power of irritation or of association is slowly produced, and a long fever supervenes in consequence; or sudden death, as frequently happens, terminates the cold fit.
Whence it appears, that in fevers with weak pulse, if the action of the heart, arteries, and capillaries could be diminished, or stopped for a short time without occasioning the death of the patient, as happens in cold bathing, or to persons apparently drowned, that a great accumulation of the sensorial powers of irritation or of association might soon be produced, and the pulse become stronger, and consequently slower, and the fever cease. Hence cold ablution may be of service in fevers with weak pulse, by preventing the expenditure and producing accumulation of the sensorial power of irritation or association. Stupor may be useful on the same account. Could a centrifugal swing be serviceable for this purpose, either by placing the head or the feet in the outward part of the circle, as described in Art. 15. 7. of this Supplement?
IV. _Return of the cold Fit._
1. If the increased action of the cutaneous and pulmonary capillaries, and of the heart and arteries, in febris irritativa continues long and with violence, a proportional expenditure or exhaustion of sensorial power occurs; which by its tendency to induce torpor of some part, or of the whole, brings on a return of the cold fit.
2. Another cause which contributes to induce torpor of the whole system by the sympathy of its parts with each other, is the remaining torpor of some viscus; which after the last cold paroxysm had not recovered itself, as of the spleen, liver, kidnies, or of the stomach and intestines, or absorbent vessels, as above mentioned.
3. Other causes are the deficiency of the natural stimuli, as hunger, thirst, and want of fresh air. Other causes are great fatigue, want of rest, fear, grief, or anxiety of mind. And lastly, the influence of external ethereal fluids, as the defect of external heat, and of solar or lunar gravitation. Of the latter the return of the paroxysms of continued fevers about six o'clock in the evening, when the solar gravitation is the least, affords an example of the influence of it; and the usual periods of intermittents, whether quotidian, tertian, or quartan, which so regularly obey solar or lunar days, afford instances of the influence of those luminaries on these kinds of fevers.
4. If the tendency to torpor of some viscus is considerable, this will be increased at the time, when the terrene gravitation is greatest, as explained in the introduction to Class IV. 2. 4. and may either produce a cold paroxysm of quotidian fever; or it may not yet be sufficient in quantity for that purpose, but may nevertheless become greater, and continue so till the next period of the greatest terrene gravitation, and may then either produce a paroxysm of tertian fever; or may still become greater, and continue so till the next period of greatest terrene gravitation, and then produce a paroxysm of quartan ague. And lastly, the periodical times of these paroxysms may exceed, or fall short of, the time of greatest diurnal terrene gravitation according to the time of day, or period of the moon, in which the first fit began; that is, whether the diurnal terrene gravitation was then in an increasing or decreasing state.
V. _Sensation excited in Fever._
1. A curious observation is related by Dr. Fordyce in his Tract on Simple fever, page 168. He asserts, that those people, who have been confined some time in a very warm atmosphere, as of 120 or 130 degrees of heat, do not feel cold, nor are subject to paleness of their skins, on coming into a temperature of 30 or 40 degrees; which would produce great paleness and painful sensation of coldness in those, who had been some time confined in an atmosphere of only 86 or 90 degrees. Analogous to this, an observing friend of mine assured me, that once having sat up to a very late hour with three or four very ingenious and humorous companions, and drank a considerable quantity of wine; both contrary to his usual habits of life; and being obliged to rise early, and to ride a long journey on the next day; he expected to have found himself weak and soon fatigued; but on the contrary he performed his journey with unusual ease and alacrity; and frequently laughed, as he rode, at the wit of the preceding evening. In both these cases a degree of pain or pleasure actuated the system; and thus a sensorial power, that of sensation, was superadded to that of irritation, or volition. See Sect. XXXIV. 2. 6.
2. Similar to this, when the energetic exertions of some parts of the system in the hot fit of fever arise to a certain excess, a degree of sensation is produced; as of heat, which particularly increases the actions of the cutaneous vessels, which are more liable to be excited by this stimulus. When this additional sensorial power of sensation exists to a greater degree, the pulse, which was before full, now becomes hard, owing to the inflammation of the vasa vasorum, or coats of the arteries. In these cases, whether there is any topical inflammation or not, the fever ceases to intermit; but nevertheless there are daily remissions and exacerbations of it; which recur for the most part about six in the evening, when the solar gravitation is the least, as mentioned in Sect. XXXVI. 3. 7.
3. Thus the introduction of another sensorial power, that of sensation, converts an intermittent fever into a continued one. If it be attended with strong pulse, it is termed febris sensitiva irritata, or pyrexia, or inflammation; if with a weak pulse, it is termed febris sensitiva inirritata, or typhus gravior, or malignant fever. The seat of the inflammation is in the glandular or capillary system, as it consists in the secretion of new fluids, or new fibres, which form new vessels, as they harden, like the silk of the silk-worm. See Art. 15. of this Supplement.
VI. _Circles of irritative Associate Motions._
1. There are some associate motions, which are perpetually proceeding in our waking hours, and are catenated by their first link, or in some subsequent parts of the chain, with the stimuli or the influence of external things; which we shall here enumerate, as they contribute to the knowledge of fever. Of these are the irritative ideas, or sensual motions of the organs of sense, and the muscular motions associated with them; which, when the chain is disturbed or interrupted, excite the sensorial power of sensation, and proceed in confusion. Thus if the irritative ideas of sight are disturbed, the paralactic motions of objects, which in general are unperceived, become sensible to us; and the locomotive muscles associated with them, which ought to preserve the body erect, stagger from this decrease or interruption of the sensorial power of association; and vertigo is produced.
When the irritative sensual motions, or ideas, belonging to one sense are increased or diminished, the irritative sensual motions, or ideas, of the other senses are liable to become disturbed by their general catenations; whence occur noises in the ears, bad tastes in the mouth, bad odours, and numbness or tingling of the limbs, as a greater or less number of senses are affected. These constitute concomitant circles of disturbed irritative ideas; or make a part of the great circle of irritative ideas, or motions of the organs of sense; and when thus disturbed occasion many kinds of hallucination of our other senses, or attend on the vertigo of vision.
2. Another great circle of irritative associated motions consists of those of the alimentary canal; which are catenated with stimuli or with influences external to the system, but continue to be exerted in our sleeping as well as in our waking hours. When these associations of motion are disturbed by the too great or too small stimulus of the food taken into the stomach, or by the too great excess or deprivation of heat, or by indigestible substances, or by torpor or orgasm occasioned by their association with other parts, various diseases are induced under the names of apepsia, hypochondriasis, hysteria, diarrhoea, cholera, ileus, nephritis, fever.
3. A third circle of irritative associate motions consists of those of the absorbent system; which may be divided into two, the lacteals, and the lymphatics. When the stomach and intestines are recently filled with food and fluid, the lacteal system is stimulated into great action; at the same time the cellular, cutaneous, and pulmonary lymphatics act with less energy; because less fluid is then wanted from those branches, and because more sensorial power is expended by the lacteal branch. On this account these two systems of absorbents are liable to act by reverse sympathy; hence pale urine is made after a full dinner, as less of the aqueous part of it is imbibed by the urinary lymphatics; and hence the water in anasarca of the lungs and limbs is speedily absorbed, when the actions of the lacteals of the stomach or intestines are weakened or inverted by the exhibition of those drugs, which produce nausea, or by violent vomiting, or violent cathartics.
Hence in diabetes the lacteal system acts strongly, at the same time that the urinary lymphatics invert their motions, and transmit the chyle into the bladder; and in diarrhoea from crapula, or too great a quantity of food and fluid taken at a time, the lacteals act strongly, and absorb chyle or fluids from the stomach and upper intestines; while the lymphatics of the lower intestines revert their motions, and transmit this over-repletion into the lower intestines, and thus produce diarrhoea; which accounts for the speedy operation of some cathartic drugs, when much fluid is taken along with them.
4. Other circles of irritative associate motions of great importance are those of the secerning system; of these are the motions of the larger congeries of glands, which form the liver, spleen, pancreas, gastric glands, kidneys, salivary glands, and many others; some of which act by direct and others by reverse sympathy with each other. Thus when the gastric glands act most powerfully, as when the stomach is filled with food, the kidneys act with less energy; as is shewn by the small secretion of urine for the first hour or two after dinner; which reverse sympathy is occasioned by the greater expenditure of sensorial power on the gastric glands, and to the newly absorbed fluids not yet being sufficiently animalized, or otherwise prepared, to stimulate the secretory vessels of the kidneys.
But those very extensive glands, which secrete the perspirable matter of the skin and lungs, with the mucus, which lubricates all the internal cells and cavities of the body, claim our particular attention. These glands, as well as all the others, proceed from the capillary vessels, which unite the arteries with the veins, and are not properly a part of them; the mucous and perspirative glands, which arise from the cutaneous and pulmonary capillaries, are associated by direct sympathy; as appears from immersion in the cold bath, which is therefore attended with a temporary difficult respiration; while those from the capillaries of the stomach and heart and arteries are more generally associated by reverse sympathy with those of the cutaneous capillaries; as appears in fevers with weak pulse and indigestion, and at the same time with a hot and dry skin.
The disturbed actions of this circle of the associate motions of the secerning system, when the sensorial power of sensation is added to that of irritation, frequently produces inflammation, which consists in the secretion of new fluids or new vessels. Nevertheless, if these disturbed actions be of the torpid kind, the pain, which attends them, is seldom productive of inflammation, as in hemicrania; but is liable to excite voluntary actions, and thus to expend much sensorial power, as in the shuddering in cold fits of fever, or in convulsions; or lastly the pain itself, which attends torpid actions, is liable to expend or exhaust much sensorial power without producing any increased actions; whence the low pulse, and cold extremities, which usually attend hemicrania; and hence when inert, or inactive sensation attends one link of associated action, the succeeding link is generally rendered torpid, as a coldness of the cheek attends tooth-ach.
5. A fifth important circle of irritative motions is that of the sanguiferous system, in which the capillary vessels are to be included, which unite the arterial and venous systems, both pulmonary and aortal. The disturbed action of this system of the heart and arteries, and capillaries, constitute simple fever; to which may be added, that the secerning and absorbent vessels appending to the capillaries, and the bibulous mouths of the veins, are in some measure at the same time generally affected.
6. Now, though the links of each of these circles of irritative motions are more strictly associated together, yet are they in greater or less degree associated or catenated with each other by direct or reverse sympathy. Thus the sickness, or inverted irritative motions of the stomach, are associated or catenated with the disturbed irritative ideas, or sensual motions, in vertigo; as in sea-sickness. This sickness of the stomach is also associated or catenated with the torpor of the heart and arteries by direct sympathy, and with the capillaries and absorbents by reverse sympathy; and are thus all of them liable occasionally to be disturbed, when one of them is diseased; and constitute the great variety of the kinds or symptoms of fevers.
VII. _Alternation of the cold and hot Fits._
1. When any cause occurs, which diminishes to a certain degree the supply of sensorial power in respect to the whole system; as suppose a temporary inexertion of the brain; what happens? First, those motions are exerted with less energy, which are not immediately necessary to life, as the locomotive muscles; and those ideas, which are generally excited by volition; at the same time this deficiency of voluntary motion is different from that which occurs in sleep; as in that the movements of the arterial system are increased in energy though not in frequency. Next, the motions of the alimentary canal become performed with less energy, or cease altogether; and a total want of appetite to solid food occurs, or sickness, or a diarrhoea occasioned by the indigested aliment. Then the absorbent vessels cease to act with their due energy; whence thirst, and pale urine, though in small quantities. Fourthly, the secerning vessels become affected by the general diminution of sensorial power; whence all the secreted fluids are produced in less quantity. And lastly, the sanguiferous canals feel the general torpor; the pulsations of the heart and arteries become feeble, and consequently quick; and the capillaries of the skin become inactive, acquire less blood from the arteries, and are consequently paler and shrunk.
In this last circumstance of the torpor of the sanguiferous system consists inirritative fever; as all the others are rather accidental or concomitant symptoms, and not essential ones; as fewer or more of them may be present, or may exist with a greater or less degree of inactivity.
2. Now as the capillaries of the skin are exposed to greater varieties of heat and cold, than the heart and arteries, they are supposed to be more mobile, that is, more susceptible of torpor or exertion, or to inflammation, by external stimuli or influences, than the other parts of the sanguiferous system; and as the skin is more sensible to the presence of heat, than the internal parts of the body, the commencement of the cold paroxysms of fever generally either first exists in, or is first perceived by, the coldness and paleness of the skin; and the commencement of the hot fits by the heat and redness of it.
3. The accumulation of sensorial power occurs in these organs soonest, and in greatest quantity, during their quiescence, which were most perpetually in action during health; hence those parts of the system soonest recover from torpor in intermittent fever, and soonest fall into the contrary extreme of increased activity; as the sanguiferous system of the heart and arteries and capillaries. But of these the capillaries seem first to acquire a renovation of their action, as the heat of the skin becomes first renewed, as well as increased beyond its natural quantity, and this in some parts sooner than in others; which quantity of heat is however not to be estimated simply by the rise of the mercury in the thermometer, but also by the quantity carried away into the atmosphere, or diffused amongst other bodies in a given time; as more heat passes through water, which boils vehemently, than when it boils gently, though the rise of the thermometer in both cases continues the same. This fact may be known by boiling an egg in water, the white of which coagulates in much less time, if the water boils vehemently, than if it boils moderately, though the sensible heat of the water is the same in both cases.
Another cause, which induces the cutaneous capillaries to renew their actions sooner than the heart and arteries after immersion in the cold bath, is, that their torpor was occasioned by defect of irritation; whereas that of the heart and arteries was occasioned by defect of association; which defect of association was owing to the decreased actions of the capillaries, and is now again excited by their renewed action; which excitement must therefore be subsequent to that increased action of the capillaries; and in consequence the increased action of the heart and arteries at the commencement of the hot fit of some fevers is subsequent to the increased action of the cutaneous capillaries. There is, however, in this case an accumulation of the sensorial power of association in the heart and arteries, which must contribute to increase their orgasm in the hot fit, as well as the increased excitement of it by the increased action of the capillaries.
4. Now this increased action of the system, during the hot fit, by exhausting the sensorial powers of irritation and association, contributes to induce a renewal of the cold paroxysm; as the accumulation of those sensorial powers in the cold fit produces the increased actions of the hot fit; which two states of the system reciprocally induce each other by a kind of libration, or a plus and minus, of the sensorial powers of irritation and association.
If the exhaustion of sensorial power during the hot fit of fever only reduces the quantity of irritability and associability to its natural standard, the fever is cured, not being liable to return. If the quantity of these sensorial powers be reduced only so much, as not to produce a second cold fit during the present quantity of external stimuli or influences; yet it may be so far reduced, that a very small subtraction of stimulus, or of influence, may again induce a cold fit; such as the coldness of the night-air, or the diminution of solar or lunar gravitation, as in intermittent fevers.
5. Another cause of the renovation of the cold fits of fever is from some parts of the system not having completely recovered from the former cold paroxysm; as happens to the spleen, liver, or other internal viscus; which sometimes remains tumid, and either occasions a return of the cold fit by direct sympathy with other parts of the body, or by its own want of action causes a diminution of the general quantity of heat, and thus facilitates the renovation of the torpor of the whole system, and gives cause to intermittent fevers catenated with lunar or solar influence.
VIII. _Orgasm of the Capillaries._
As the remaining torpor of some less essential part of the system, as of the spleen, when the hot fit ceases, produces after one, two, or three days a return of cold fit by direct sympathy with the cutaneous capillaries, when joined with some other cause of torpor, as the defect of solar or lunar influences, or the exposure to cold or hunger, and thus gives origin to intermittent fever; so the remaining torpor of some more essential parts of the system, as of the stomach and intestines, is probably the cause of the immediate recurrence of the cold paroxysm, at the time the hot one ceases, by their direct sympathy with the cutaneous capillaries, without the assistance of any other cause of torpor; and thus produces remittent fever. And lastly the remaining torpor of some still more essential parts of the system, as the heart and arteries, after the hot fit ought to cease, is liable by reverse sympathy with the cutaneous capillaries to continue their orgasm, and thus to render a fever continual, which would otherwise remit or intermit.
Many difficulties here occur, which we shall endeavour to throw some light upon, and leave to future investigation; observing only that difficulties were to be expected, otherwise fevers would long since have been understood, as they have employed the unremitted attention of the physicians of all ages of the world.
1. Why do the same parts of successive trains of action sometimes affect each other by direct, and sometimes by reverse sympathy?--1st, When any irritative motion ceases, or becomes torpid, which was before in perpetual action; it is either deprived of its usual stimulus, and thence the sensorial power of irritation is not excited; or it has been previously too much stimulated, and the sensorial power has been thus exhausted.
In the former case an accumulation of sensorial power soon occurs, which is excitable by a renewal of the stimulus; as when the fingers, which have been immersed some time in snow, are again exposed to the usual warmth of a room. Or, secondly, the sensorial power of irritation becomes so much accumulated, that the motions, which were torpid, are now performed by less stimulus than natural; as appears by the warmth, which soon occurs after the first chill in going into frosty air, or into the bath at Buxton, which is about eighty degrees of heat. Or, lastly, this accumulation of the sensorial power of irritation so far abounds, that it increases the action of the next link of the associated train or tribe of motions; thus on exposing the skin to cold air, as in walking out in a frosty morning, the actions of the stomach are increased, and digestion strengthened.
But where the torpor of some irritative motion is owing to the previous exhaustion of the sensorial power of irritation by too great stimulus, the restoration of it occurs either not at all, or much more slowly than in the former instances; thus after intoxication the stomach is very slow in recovering its due quantity of the sensorial power of irritation, and never shews any accumulation of it.
2. When an associate motion, as described in the introduction to Class IV. 1. 1. acts with less energy, the sensorial power of association is either not sufficiently excited by the preceding fibrous motions; or it has been expended or exhausted by the too violent actions of the preceding fibrous motions. In the former case there occurs an accumulation of the sensorial power of association; exactly as, where the usual stimulus is withdrawn, there occurs an accumulation of the sensorial power of irritation. Thus when the actions of the capillaries of the skin are diminished by immersion in cold water, the capillaries of the lungs are rendered torpid by the want of the excitement of the sensorial power of association, owing to the lessened actions of the previous fibrous motions, namely, of those of the skin. Nevertheless as soon as the capillaries of the skin regain their increased activity by the accumulation of the sensorial power of irritation, these capillaries of the lungs act with greater energy also owing to their accumulated sensorial power of association. These are instances of direct sympathy, and constitute the cold and hot paroxysms of intermittent fever; or the first paroxysm of a continued one.
3. When the first link of a train of associated motions, which is subject to perpetual action, becomes a considerable time torpid for want of being excited by the previous exertions of the irritative motions, with which it is catenated; the sensorial power of association becomes accumulated in so great a degree as to affect the second link of the train of associated motions, and to excite it into stronger action. Thus when the stomach is rendered torpid by contagious matter swallowed into it mixed with the saliva, the heart and arteries act more feebly; because the sensorial power of association, which used to be excited by the fibrous motions of the stomach, is not now excited; and in consequence the motions of the heart and arteries act only by the sensorial power of irritation, which is excited by the stimulus of the blood.
But during this torpor of the stomach, and less action of the heart and arteries, so great an accumulation of the sensorial powers of irritation and of association occurs, that it adds to the action of the next link of this vital circle of actions, that is, to that of the cutaneous capillaries. Whence in this situation the torpor of the stomach occasions a diminished action of the heart and arteries by direct sympathy, and may be said to occasion an increased one of the cutaneous capillaries by reverse sympathy; which constitute continued fever with weak pulse.
Nor is this increased action of the capillaries in consequence of the decreased action of the heart and arteries, as in fevers with weak pulse, a single fact in the animal economy; though it exists in this case in the greatest degree or duration, because the heart and arteries are perpetually in greater action than any other part of the system. But a similar circumstance occurs, when the stomach is rendered inactive by defective excitement of the sensorial power of association, as in sea-sickness, or in nephritis. In these cases the sensorial power of association becomes much accumulated in the stomach, and seems by its superabundance to excite the absorbent system, which is so nearly connected with it, into great increase of action; as is known by the great quantity frequently in these situations rejected by vomit, which could not otherways be supplied. It is probable the increase of digestion by walking in frosty air, with many other animal facts, may by future observations be found to be dependent on this principle, as well as the increased action of the capillaries in continued fevers with weak pulse.
Whereas in continued fever with strong pulse, which may perhaps occur sometimes on the first day even of the plague, the stomach with the heart and arteries and the capillaries act by direct sympathy; that is, the stomach is excited into stronger action by increased irritation owing to the stimulus of contagious matter; these stronger irritative motions of the stomach excite a greater quantity of the sensorial power of association, which then actuates the heart and arteries with greater energy, as these are catenated with the stomach; and in the same manner the increased actions of the heart and arteries excite a greater quantity of the sensorial power of association, which actuates the cutaneous capillaries with increase of energy. See Class IV. 1. 1.
4. I shall dwell a little longer on this intricate subject. The commencement of fever-fits is known by the inactivity of the cutaneous capillaries, which inactivity is observable by the paleness and coldness of the skin, and also by the pain of coldness, which attends it. There is nevertheless in most cases, except those which are owing to exposure to external cold, a torpor of the capillaries of some internal viscus preceding this inactivity of the cutaneous capillaries; which is known, by the tumour or hardness of the viscus, or by an aching pain of it. The capillaries of the lungs are at the same time rendered inactive or torpid, as appears by the difficulty of breathing, and coldness of the breath in cold fits of fever, and in going into the cold bath; but the lungs are not affected with the pain either of coldness or of torpor.
One cause of this synchronous or successive inactivity of the cutaneous capillaries, in consequence of the previous torpor of some internal viscus, may be owing to the deficiency of heat; which must occur, when any part becomes inactive; because the secretions of that part cease or are lessened, and the quantity of heat of it in consequence. But the principal cause of it I suppose to be owing to the defect of the sensorial power of association; which power of association is excited by some previous or concomitant motions of the parts of every great circle of actions. This appears on going into the cold bath, because the shortness of breath instantly occurs, sooner than one can conceive the diminution of the heat of the skin could affect the lungs by the want of its stimulus; but not sooner than the defect of the sensorial power of association could affect them; because this must cease to be excited into action on the instant that the cutaneous capillaries cease to act; whence in the first moment of contact of the cold water the cutaneous capillaries cease to act from defect of irritation; which is caused by defect of the stimulus of heat; and in the second moment the capillaries of the lungs cease to act from the defect of association; which is caused by the defect of the motions of the cutaneous capillaries. Thus the universal torpor in the cold paroxysm of fever is an example of direct sympathy, though occasioned in part by defect of irritation, and in part by defect of association.
5. Thus in walking out in a frosty morning the skin is cooled by the contact of the cold air, whence the actions of its capillaries are diminished for want of their usual stimulus of heat to excite a sufficient quantity of the sensorial power of irritation. Hence there is at first a saving of sensorial power of irritation for the purpose of actuating the other parts of the system with greater energy. Secondly the sensorial power of association, which used to be excited by the motions of the cutaneous capillaries, is now not so powerfully excited; and in consequence the parts, which constitute the next links of the circles of associated motions, are for a time actuated with less energy, and a temporary general chillness succeeds; which is so far similar to the cold fit of intermittent fever.
In this situation there is a curious circumstance occurs, which merits peculiar attention: after a short time, though the external skin continues cool by its exposure to the cold air, and the actions of its capillaries are consequently diminished, yet the capillaries of the stomach act with greater energy; as is known by increased digestion and consequent hunger. This is to be ascribed to the accumulation of the sensorial power of irritation, which now excites by its superabundance, or overflowing, as it were, the stomach into increased action; though it is at the same time excited less powerfully than usual by the sensorial power of association. Thus the accumulation of the sensorial power of irritation in the vessels of the skin increases in this case the action of the stomach, in the same manner as an accumulation of the sensorial power of association in the heart and arteries in fevers with weak pulse increases the action of the capillaries.
If nevertheless the coldness of the skin be too long continued, or exists in too great a degree, so as in some measure to impair the life of the part, no further accumulation of the sensorial power of irritation occurs; and in consequence the actions of the stomach become less than natural by the defect of the sensorial power of association; which has ceased to be excited by the want of action of the cutaneous capillaries. Whence continued coldness of the feet is accompanied with indigestion and heartburn. See Class IV. 2. 1. 6.
6. Similar to this when the actions of the stomach are rendered torpid by the previous stimulus of a violent emetic, and its motions become retrograde in consequence, a great quantity of sensorial power is exerted on the lymphatics of the lungs, and other parts of the body; which excites them into greater direct action, as is evinced by the exhibition of digitalis in anasarca. In this situation I suppose the emetic drug stimulates the muscular fibres of the stomach into too great action; and that in consequence a great torpor soon succeeds; and that this inaction of the muscular parts of the stomach is not followed by much accumulation of the sensorial power of irritation; because that sensorial power is in great measure exhausted by the previous excessive stimulus. But the lymphatics of the stomach have their actions lessened by defect of the sensorial power of association, which is not now excited into action, owing to the lessened motions of the muscular parts of it, with which the lymphatics are associated. The sensorial power of association becomes therefore accumulated in these lymphatics of the stomach, because it is not excited into action; exactly as the power of irritation becomes accumulated in the hand, when immersed in snow; and this accumulated sensorial power of association excites the lymphatic of the lungs and of other parts, which are most nearly associated with those of the stomach, into more energetic actions. Thus the muscular fibres of the stomach act with the lymphatics of that organ in direct sympathy; and the lymphatics of the stomach act in reverse sympathy with those of the lungs and of other parts of the body; the former of which is caused by defect of the excitement of the sensorial power of association, and the latter by the accumulation of it.
Besides the efficient cause, as above explained, the final cause, or convenience, of these organic actions are worthy our attention. In this case of an acrid drug swallowed into the stomach the reverted actions of the muscular fibres of the stomach tend to eject its enemy; the reverted actions of its lymphatics pour a great quantity of fluids into the stomach for the purpose of diluting or washing off the noxious drug; and the increased actions of the other lymphatics supply these retrograde ones of the stomach with an inconceivable supply of fluids, as is seen in Ileus and Cholera.
7. The inquisitive reader will excuse my continuing this subject, though perhaps with some repetitions, as it envelopes the very essence of fever. When the first link of a train of actions is excited by excessive stimulus, or excessive irritability, and thus acts with unusual energy by the increased quantity of irritation, these increased motions excite a greater quantity of the sensorial power of association, which causes increased motions in the second link, which is catenated with the first; and then the excessive action of this second link excites also a greater quantity of the sensorial power of association, which increases the motions of the third link of this chain of association, and thus the increase of the stimulus on the irritative motions, to which the chain of association is catenated, increases the action of the whole chain or circle of associated motions.
After a time the irritative motions become torpid by expenditure of the sensorial power of irritation, and then the power of association also becomes less exerted, both because it has been in part exhausted by too great action, and is now less excited by the lessened action of the irritative motions, which used to excite it. These are both instances of direct sympathy, and frequently constitute the cold and hot fit of intermittents.
But though the accumulation of the sensorial power of irritation during the quiescence of some motion owing to want of stimulus generally induces torpor in the first link of the train of associated motions catenated with it; as the capillaries of the lungs become torpid immediately on immersion of the skin into cold water; yet in some situations an orgasm or excess of action is produced in the first link of the associated motions thus catenated with irritative ones; as in the increased action of the stomach, when the skin is for a time exposed to cold air; which may in part be ascribed to the general increase of action of the whole system, owing to the diminished expenditure of sensorial power, but particularly of the parts, which have habitually acted together; as when one arm is paralytic the other is liable to more frequent or almost continual motion; and when one eye becomes blind the other frequently becomes stronger; which is well known to farriers, who are said sometimes to destroy the sight of one eye to strengthen that of the other in diseased horses.
Hence there is sometimes a direct sympathy, and sometimes a reverse one succeeds the torpor occasioned by defect of stimulus, the latter of which is perhaps owing to a certain time being required for the production of an accumulation of the sensorial power of irritation by the nervous branches of the torpid organ; which accumulation is now in part or entirely derived to the next link of the association. Thus in going into a coldish bath, as into a river in the summer months, we at first experience a difficulty of breathing from the torpid action of the pulmonary capillaries, owing to the deficient excitement of the sensorial power of association in consequence of the torpor of the cutaneous capillaries. But in a very short time, as in one minute, the sensorial power of irritation becomes accumulated by the inactivity of the cutaneous capillaries; and as its superabundance becomes now expended on the pulmonary capillaries, the difficult respiration ceases; though the cutaneous capillaries continue torpid by their contact with the cold water, and consequently the sensorial power of association, which used to contribute to actuate the pulmonary capillaries, is less excited.
8. In like manner when there exists an accumulation of the sensorial power of association, owing to defect of its excitement by some previous irritative or associate motions, it is generally accompanied for a certain time by a torpor not only of the link first affected, but of the subsequent parts, or of the whole train of associated motions, as in the cold fits of intermittent fevers. Yet after a time an increased action of the next links of associated motions succeeds the torpor of the first, as the absorbent vessels of the lungs act more violently in consequence of the deficient action of those of the stomach; and the skin at the commencement of sickness is pale and cold, but in a little time becomes flushed and warm.
Thus we see in associate motions, which are rendered torpid by defect of excitement, that sometimes a direct, and sometimes a reverse sympathy succeeds in the subsequent links of the chain. But I believe where a torpor of irritative or of the associate motions is caused by a previous too great expenditure or exhaustion of the sensorial powers of irritation or association, no increase of action in the subsequent link ever occurs, or not till after a very long time.
Thus when the stomach becomes torpid by previous violent exertion, and consequent exhaustion of the sensorial power of irritation, as after intoxication with wine or opium, or after the exhibition of some violent emetic drug, the torpor is communicated to the heart and arteries, as in continued fevers with weak pulse. But where the torpor of the stomach is produced from defective association, as in sea-sickness; or in the sickness which occurs, when a stone stimulates the ureter; no torpor is then communicated to the heart and arteries. For in the former case there is no accumulation of sensorial power in the stomach, which was previously exhausted by too great stimulus; but in the latter case the accumulation of sensorial power in the stomach during its torpor is evinced by this circumstance; that in sea-sickness the patients eat and drink voraciously at intervals; and the pulse is generally not affected by the sickness occasioned by a stone in the ureter. For the action of the stomach is then lessened, and in consequence becomes retrograde, not owing to the exhaustion of the sensorial power of irritation, but to the want of excitement of the sensorial power of association; which is caused by the defective action of the ureter, which becomes occasionally torpid by the great stimulus of the stone it contains; or which is caused by the great exhaustion of sensorial power by the pain; which affects the ureter without exciting inflammation, or increased action of it.
9. Thus though the stomach after the great stimulus of intoxication from excess of wine or opium will continue many hours without accumulation of sensorial power, as appears from the patient's experiencing no appetite at the intervals of sickness; yet after long abstinence from food, at length not only the exhausted quantity of sensorial power is renewed, but an accumulation of it at length occurs, and hunger returns. In this situation the stomach is generally about a whole day before it regains its usual powers of digestion; but if it has been still more violently stimulated, and its actions further impaired, a still more permanent torpor along with a continued fever with weak pulse is liable to occur; and a fourth part, or a half, or three fourths, or a whole lunar period passes, before it recovers its due irritability and consequent action.
In similar manner, after a person has been confined in a very warm room for some hours, the cutaneous capillaries, with their secretory and absorbent vessels, become exhausted of their sensorial power of irritation by the too great violent exertions occasioned by the unusual stimulus of heat; and in coming into a colder atmosphere an inactivity of the cutaneous vessels exists at first for some time without accumulation of sensorial power; as is shewn by the continuance of the pain of cold and the paleness; but after a time both the pain of cold and paleness vanish, which now indicates an accumulation of the sensorial power of irritation, as less degrees of heat stimulate the system into due action.
In the same manner, after any one has been some time in the summer sunshine, on coming into a dark cell he continues much longer before he can clearly distinguish objects, than if his eyes had only been previously exposed to the light of a cloudy day in winter; because the sensorial power of irritation, and consequent sensation, had in the first case been previously much expended or exhausted; and therefore required a much longer time before it could be produced in the brain, or derived to the optic nerves, in such quantity as to restore the deficiency, and to cause an accumulation of it; whereas in the latter case no deficiency had occurred.
10. Thus the accumulation or deficiency of sensorial power in a torpid organ, which had previously been accustomed to perpetual action, depends on the manner in which it becomes torpid; that is, whether by great previous stimulus, or great previous excitement of the power of association; or by defect of its accustomed stimulus, or of its accustomed excitement of the power of association. In the former case the sensorial power is in an exhausted state, and therefore is not likely to become so soon accumulated, as after drunkenness, or exposure to great heat, or to great light; in the latter a great accumulation of sensorial power occurs, as after exposure to cold, or hunger, or darkness.
Hence when the stomach continues torpid by previous violent stimulus, as in the exhibition of digitalis, no accumulation of sensorial power of irritation supervenes; and in consequence the motions of the heart and arteries, which are associated with those of the stomach, become weak, and slow, and intermittent, from the defect of the excitement of the sensorial power of association. But what follows? as the actions of the heart and arteries are lessened by the deficient action of the sensorial power of association, and not by previous increased excitement of it; a great accumulation of the sensorial power of association occurs, which is exerted on the pulmonary and cutaneous absorbents by reverse sympathy, and produces a great absorption of the fluid effused into the cellular membrane in anasarca, with dry skin; constituting one kind of atrophy.
But if at the same time the secerning vessels of the stomach are stimulated into so violent activity as to induce great consequent torpor, as probably happens when contagious matter is swallowed into the stomach with our saliva, those of the heart and arteries act feebly from the deficient excitement of the power of association; and then the cutaneous and pulmonary secerning vessels act with greater force than natural, owing to the accumulation of the sensorial power of association; and unnatural heat of the skin, and of the breath succeed; but without frequency of pulse, constituting the paresis irritativa of Class I. 2. 1. 2. And lastly, if a paucity of blood attends this paresis, or some other cause inducing a frequency of pulse, the febris inirritativa, or fever with weak pulse, is produced.
But on the contrary when the stomach has previously been rendered torpid by defect of stimulus, as by hunger, if food be too hastily supplied, not only great exertion of the stomach itself succeeds, but fever with strong pulse is induced in consequence; that is, the heart and arteries are excited into more energetic action by the excess of the power of association, which catenates their motions with those of the stomach. For the redundancy of sensorial power of irritation, which was accumulated during the inactivity of the stomach, and is now called into action by stimulus, actuates that organ with increased energy, and excites by these increased motions the sensorial power of association; which has also been accumulated during the inactivity of the heart and arteries; and thus these organs also are now excited into greater action.
So after the skin has been exposed some hours to greater heat than natural in the warm room, other parts, as the membranes of the nostrils, or of the lungs, or of the stomach, are liable to become torpid from direct sympathy with it, when we come into air of a moderate temperature; whence catarrhs, coughs, and fevers. But if this torpor be occasioned by defect of stimulus, as after being exposed to frosty air, the accumulation of sensorial power is exerted, and a glow of the skin follows, with increased digestion, full respiration, and more vigorous circulation.
11. It may be asked, Why is there a great and constant accumulation of the sensorial power of association, owing to the torpor of the stomach and heart and arteries, in continued fever with weak pulse; which is exerted on the cutaneous and pulmonary capillaries, so as to excite them into increased action for many weeks, and yet no such exuberance of sensorial power produces fever in winter-sleeping animals, or in chlorosis, or apepsia, or hysteria?
In winter-sleeping animals I suppose the whole nervous system is torpid, or paralysed, as in the sleep of frozen people; and that the stomach is torpid in consequence of the inactivity or quiescence of the brain; and that all other parts of the body, and the cutaneous capillaries with the rest, labour under a similar torpor.
In chlorosis, I imagine, the actions of the heart and arteries, as well as those of the cutaneous and pulmonary capillaries, suffer along with those of the stomach from the deficient stimulus of the pale blood; and that though the liver is probably the seat of the original torpor in this disease, with which all other parts sympathize from defect of the excitation of the sensorial power of association; yet as this torpor occurs in so small a degree as not to excite a shuddering or cold fit, no observable consequences are in general occasioned by the consequent accumulation of sensorial power. Sometimes indeed in chlorosis there does occur a frequent pulse and hot skin; in which circumstances I suppose the heart and arteries are become in some degree torpid by direct sympathy with the torpid liver; and that hence not only the pulse becomes frequent, but the capillaries of the skin act more violently by reverse sympathy with the heart and arteries, owing to the accumulation of the sensorial power of association in them during their torpid state, as occurs in irritative fever. See Article 11 of this Supplement.
In apepsia chronica the actions of the stomach are not so far impaired or destroyed as totally to prevent the excitation of the sensorial power of association, which therefore contributes something towards the actions of the heart and arteries, though less than natural, as a weak pulse always I believe attends this disease.
There is a torpor of the stomach, and of the upper part of the alimentary canal in hysteria, as is evident from the retrograde actions of the duodenum, stomach, and oesophagus, which constitute the globus hystericus, or sensation of a globe rising into the throat. But as these retrograde actions are less than those, which induce sickness or vomiting, and are not occasioned by previous exhaustion of the sensorial power of irritation, they do not so totally prevent the excitement of the sensorial power of association, as to lessen the motion of the heart and arteries so much as to induce fever; yet in this case, as in apepsia, and in chlorosis, the pulsations of the heart and arteries are weaker than natural, and are sometimes attended with occasionally increased action of the capillaries; as appears from the flushings of the face, and hot skin, which generally form an evening febricula in diseases attended with weak digestion.
12. The increased action, or orgasm, of the cutaneous, pulmonary, and cellular capillaries, with their secerning and absorbent vessels, in those fevers which are attended with deficiency of vital action, exhausts the patient both by the additional expenditure of sensorial power on those organs of secretion, and by the too great absorption of the mucus and fat of the body; whence great debility and great emaciation. Hence one great indication of cure of continued fever with arterial debility is to diminish the too great action of the capillaries; which is to be done by frequent ablutions, or bathing the whole skin in tepid or in cold water, as recommended by Dr. Currie of Liverpool (Philos. Trans. for 1792), for half an hour, twice a day, or at those times when the skin feels dryest and hottest. Much cool air should also be admitted, when the breath of the patient feels hot to one's hand; or when the tongue, especially its middle part, is dry, and covered with a crust of indurated mucus; as these indicate the increased action of the pulmonary capillaries; in the same manner as the dry and hot skin indicates the orgasm of the cutaneous capillaries; and the emaciation of the body that of the cellular ones.
For this purpose of abating the action of the capillaries by frequent ablution or fomentation, water of any degree of heat beneath that of the body will be of service, and ought in accurate language to be called a cold bath; but the degree of coldness, where the patient is sensible, should in some measure be governed by his sensations; as it is probable, that the degree of coldness, which is most grateful to him, will also be of the greatest benefit to him. See Class III. 2. 1. 12. and Article 15 of this Supplement.
Another great use of frequent ablutions, or fomentations, or baths, in fevers, where the stomach is in some degree torpid, is to supply the system with aqueous fluid by means of the cutaneous absorbents; which is dissipated faster by the increased action of the secerning capillaries, than the stomach can furnish, and occasions great thirst at the intervals of the sickness.
IX. _Torpor of the Lungs._
1. The lungs in many cases of contagion may first be affected with torpor, and the skin become cold by sympathy; in the same manner as a cold skin on going into the cold bath induces difficulty of breathing. Or the stomach may become affected with torpor by its sympathy with the lungs, as in the experiments of Mr. Watt with hydro-carbonate gas; a few respirations of which induced sickness, and even syncope. When the stomach or skin is thus affected secondarily by association, an accumulation of sensorial power occurs much sooner, than when these parts become torpid in consequence of previous excess of stimulus; and hence they sooner recover their accustomed action, and the fever ceases. The particles of contagious matter thus received by respiration somewhat resemble in their effects the acid gases from burning sulphur, or from charcoal; which, if they do not instantly destroy, induce a fever, and the patient slowly recovers.
2. I was some years ago stooping down to look, which way the water oozed from a morass, as a labourer opened it with a spade, to detect the source of the spring, and inhaled a vapour, which occasioned an instant sense of suffocation. Immediately recoiling I believe I inhaled it but once; yet a few hours afterwards in the cool of the evening, when I returned home rather fatigued and hungry, a shivering and cold fit occurred, which was followed by a hot one; and the whole disease began and terminated in about twelve hours without return. In this case the power of fear, or of imagination, was not concerned; as I neither thought of the bad air of a morass before I perceived it; nor expected a fever-fit, till it occurred.
In this case the torpor commenced in the lungs, and after a few hours, by the addition of fatigue, and cold, and hunger, was propagated by direct sympathy to the rest of the system. An orgasm or increased action of the whole system was then induced by the accumulation of sensorial power of irritation in the lungs, and of association in the other organs; and when these subsided, the disease ceased. It may be asked, could a torpor of the capillaries of the air-vessels of the lungs be so suddenly produced by great stimulation?--It appears probable, that it might, because great exertion of irritative motions may be instantly produced without our perceiving them; that is, without their being attended by sensation, both in the lungs and stomach; and the organs may become torpid by the great expenditure of the sensorial power of irritation in an instant of time; as paralysis frequently instantly follows too great an exertion of voluntary power.
3. When the capillaries of the lungs act too violently, as in some continued fevers; which is known by the heat of the breath, and by the dryness of the tongue, especially of the middle part of it; not only cooler air might be admitted more freely into a sick room to counteract this orgasm of the pulmonary capillaries; but perhaps the patient might breathe with advantage a mixture of carbonic acid gas, or of hydrogene gas, or of azote with atmospheric air. And on the contrary, when there exists an evident torpor of the pulmonary capillaries, which may be known by the correspondent chilness of the skin; and by a tickling cough, which sometimes attends cold paroxysms of fever, and is then owing to the deficient absorption of the pulmonary mucus, the saline parts of which stimulate the bronchiae, or air-vessels; a mixture of one part of oxygen gas with 10 or 20 parts of atmospheric air might probably be breathed with great advantage.
X. _Torpor of the Brain._
As the inactivity or torpor of the absorbent vessels of the brain is the cause of hydrocephalus internus; and as the deficiency of venous absorption in the brain, or torpor of the extremities of its veins, is believed frequently to be the cause of apoplexies; so there is reason to conclude, that the torpor of the secerning vessels of the brain, which are supposed to produce the sensorial power, may constitute the immediate cause of some fevers with arterial debility. And also that the increased action of these secerning vessels may sometimes constitute the immediate cause of fevers with arterial strength.
It is nevertheless probable, that the torpor or orgasm of the sanguiferous, absorbent, or secerning vessels of the brain may frequently exist as a secondary effect, owing to their association with other organs, as the stomach or lungs; and may thus be produced like the torpor of the heart and arteries in inirritative fevers, or like the orgasm of those organs in irritative fevers, or inflammatory ones.
Where there exists a torpor of the brain, might not very slight electric shocks passed frequently through it in all directions be used with advantage? Might not fomentations of 94 or 96 degrees of heat on the head for an hour at a time, and frequently repeated, stimulate the brain into action; as in the revival of winter-sleeping animals by warmth? Ether externally might be frequently applied, and a blister on the shaved head.
Where the secerning vessels of the brain act with too great energy, as in some inflammatory fevers, might it not be diminished by laying the patient horizontally on a mill-stone, and whirling him, till sleep should be produced, as the brain becomes compressed by the centrifugal force? See Article 15 of this Supplement.
XI. _Torpor of the Heart and Arteries._
1. It was shewn in Class IV. 1. 1. 6. in IV. 2. 1. 2. and in Suppl. I. 6. 3. that a reverse sympathy generally exists between the lacteal and lymphatic branches of the absorbent system. Hence, when the motions of the absorbents of the stomach are rendered torpid or retrograde in fevers with arterial debility, those of the skin, lungs, and cellular membrane, act with increased energy. But the actions of the muscular fibres of the heart and arteries are at the same time associated with those of the muscular fibres of the stomach by direct sympathy. Both these actions occur during the operation of powerful emetics, as squill, or digitalis; while the motions of the stomach continue torpid or retrograde, the cellular and cutaneous absorbents act with greater energy, and the pulsations of the heart and arteries become weaker, and sometimes slower.
2. The increased action of the stomach after a meal, and of the heart and arteries at the same time from the stimulus of the new supply of chyle, seems originally to have produced, and to have established, this direct sympathy between them. As the increased action of the absorbents of the stomach after a meal has been usually attended with diminished action of the other branches of the absorbent system, as mentioned in Class IV. 1. 1. 6. and has thus established a reverse sympathy between them.
2. Besides the reverse sympathy of the absorbent vessels and the muscles of the stomach, and of the heart and arteries, with those of the skin, lungs, and cellular membrane; there exists a similar reverse sympathy between the secerning vessels or glands of the former of these organs with those of the latter; that is the mucous glands of the heart and arteries act generally by direct sympathy with those of the stomach; and the mucous glands of the cellular membrane of the lungs, and of the skin, act by reverse sympathy with them both.
Hence when the stomach is torpid, as in sickness, this torpor sometimes only affects the absorbent vessels of it; and then the absorbents of the cellular membrane and the skin only act with increased energy by reverse sympathy. If the torpor affects the muscular fibres of the stomach, those of the heart and arteries act by direct sympathy with it, and a weak pulse is produced, as in the exhibition of digitalis, but without increase of heat. But if the torpor also affects the glands of the stomach, the cutaneous and pulmonary glands act with greater energy by their reverse sympathy with those of the stomach, and of the heart and arteries; and great heat is produced along with increased perspiration both from the skin and lungs.
3. There is some difficulty in explaining, why the actions of the extensive system of capillary glands, which exist on every other membrane and cell in the body for the purpose of secreting mucus and perspirable matter, should so generally act by reverse sympathy with those of the stomach and upper part of the intestines. It was shewn in Class IV. 1. 1. 6. that when the stomach was filled with solid and fluid aliment, the absorbents of the cellular membrane, and of the bladder, and of the skin acted with less energy; as the fluids they were used to absorb and transmit into the circulation, were now less wanted; and that hence by habit a reverse sympathy obtained between these branches of the absorbents of the alimentary canal, and those of the other parts of the body.
Now, as at this time less fluid was absorbed by the cutaneous and cellular lymphatics, it would happen, that less would be secreted by their correspondent secerning vessels, or capillary glands; and that hence by habit, these secerning vessels would acquire a reverse sympathy of action with the secerning vessels of the alimentary canal.
Thus when the absorption of the tears by the puncta lacrymalia is much increased by the stimulus of snuff; or of an affecting idea, on the nasal dusts, as explained in Sect. XVI. 8. 2. a great increase of the secretion of tears from the lacrymal glands is produced by the direct sympathy of the action of these glands with those of their correspondent absorbents; and that though in this case they are placed at so great a distance from each other.
4. A difficult question here occurs; why does it happen, that in fevers with weak pulse the contractions of the heart and arteries become at the same time more frequent; which also sometimes occurs in chlorosis, and in some hysteric and hypochondriac diseases, and in some insanities; yet at other times the weak pulse becomes at the same time slow, as in the exhibition of digitalis, and in paresis irritativa, described in Class I. 2. 1. 2. which may be termed a fever with slow pulse? this frequency of pulse can not depend on heat, because it sometimes exists without heat, as towards the end of some fevers with debility.
Now as apoplexies, which are sometimes ascribed to fulness of blood, are attended with slow pulse; and as in animals dying in the slaughter house from deficiency of blood the pulse becomes frequent in extreme; may not the frequency of pulse in fevers with arterial debility be in general owing to paucity of blood? as explained in Sect. XXXII. 2. 3. and its slowness in paresis irritativa be caused by the debility being accompanied with due quantity of blood? or may not the former circumstance sometimes depend on a concomitant affection of the brain approaching to sleep? or to the unusual facility of the passage of the blood through the pulmonary and aortal capillaries? in which circumstance the heart may completely empty itself at each pulsation, though its contractions may be weak. While the latter depends on the difficulty of the passage of the blood through the pulmonary or aortal capillaries, as in the cold fits of intermittents, and in some palpitations of the heart, and in some kinds of haemoptoe? in these cases the increased resistance prevents the heart from emptying itself, and in consequence a new diastole sooner occurs, and thus the number of pulsations becomes greater in a given time.
5. In respect to the sympathies of action, which produce or constitute fever with debility, the system may be divided into certain provinces, which are assentient or opposite to each other. First, the lacteals or absorbent vessels of the stomach, and upper part of the intestines; secondly, the lymphatics or all the other branches of the absorbent vessels, which arise from the skin, mucous membranes, cellular membranes, and the various glands. These two divisions act by reverse sympathy with each other in the hot fits of fever with debility, though by direct sympathy in the cold ones. The third division consists of the secerning vessels of the stomach and upper intestines; and the fourth of the secerning vessels of all the other parts of the body, as the capillary glands of the skin, lungs, and cellular membrane, and the various other glands belonging to the sanguiferous system. Many of these frequently, but the capillaries always, act by reverse sympathy with those of the third division above mentioned in the hot fits of fever with debility, though by direct sympathy with them in the cold fits. Fifthly, the muscular fibres of the stomach, and upper intestines; and sixthly, the muscular fibres of the heart and arteries. The actions of these two last divisions of moving fibres act by direct sympathy with each other, both in the cold and hot fits of fevers with debility.
The efficient cause of those apparent sympathies in fevers with weak pulse may be thus understood. In the cold paroxysm of fever with weak pulse the part first affected I believe to be the stomach, and that it has become torpid by previous violent exertion, as by swallowing contagious matter mixed with saliva, and not by defect of stimulus, as from cold or hunger. The actions of this important organ, which sympathizes with almost every part of the body, being thus much diminished or nearly destroyed, the sensorial power of association is not excited; which in health contributes to move the heart and arteries, and all the rest of the system; whence an universal torpor occurs.
When the hot fit approaches, the stomach in fevers with strong pulse regains its activity by the accumulation of the sensorial power of either irritation, if it was the part first affected, or of association if it was affected in sympathy with some other torpid part, as the spleen or liver; which accumulation is produced during its torpor. At the same time all the other parts of the system acquire greater energy of action by the accumulation of the sensorial power of association, which was produced, during their inactivity in the cold fit.
But in fevers with weak pulse the stomach, whose sensorial power of irritation had been previously exhausted by violent action, acquires no such quick accumulation of sensorial power, but remains in a state of torpor after the hot fit commences. The heart and arteries remain also in a state of torpor, because there continues to be no excitement of their power of association owing to the torpid motions of the stomach; but hence it happens, that there exists at this time a great accumulation of the power of association in the less active fibres of the heart and arteries; which, as it is not excited and expended by them, increases the associability of the next link of the associated chain of motions, which consists of the capillaries or other glands; and that in so great a degree as to actuate them with unnatural energy, and thus to produce a perpetual hot fit of fever. Because the associability of the capillaries is so much increased by the accumulation of this power, owing to the lessened activity of the heart and arteries, as to over-balance the lessened excitement of it by the weaker movements of the heart and arteries.
6. When the accumulation of the sensorial power of irritation caused by defect of stimulus is greater in the first link of a train of actions, to which associated motions are catenated, than the deficiency of the excitement of the sensorial power of association in the next link, what happens?--the superabundance of the unemployed sensorial power of the first link is derived to the second; the associability of which thus becomes so greatly increased, that it acts more violently than natural, though the excitement of its power of association by the lessened action of the first link is less than natural. So that in this situation the withdrawing of an accustomed stimulus in some parts of the system will decrease the irritative motions of that part, and at the same time occasion an increase of the associate motion of another part, which is catenated with it.
This circumstance nevertheless can only occur in those parts of the system, whose natural actions are perpetual, and the accumulation of sensorial power on that account very great, when their activity is much lessened by the deduction of their usual stimulus; and are therefore only to be found in the sanguiferous system, or in the alimentary canal, or in the glands and capillaries. Of the first of which the following is an instance.
The respiration of a reduced atmosphere, that is of air mixed with hydrogene or azote, quickens the pulse, as observed in the case of Mrs. Eaton by Dr. Reynolds and Dr. Thornton; to which Dr. Beddoes adds in a note, that "he never saw an instance in which a lowered atmosphere did not at the moment quicken the pulse, while it weakened the action of the heart and arteries." Considerations on Factitious Airs, by Thomas Beddoes and James Watt, Part III. p. 67. Johnson, London. By the assistance of this new fact the curious circumstance of the quick production of warmth of the skin on covering the head under the bed-clothes, which every one must at some time have experienced, receives a more satisfactory explanation, than that which is given in Class IV. 1. 1. 2. which was printed before this part of Dr. Beddoes's Considerations was published.
For if the blood be deprived of its accustomed quantity of oxygen, as in covering the head in bed, and thus breathing an air rendered impure by repeated respiration, or by breathing a factitious air with less proportion of oxygen, which in common respiration passes through the moist membranes of the lungs, and mixes with the blood, the pulsations of the heart and arteries become weaker, and consequently quicker, by the defect of the stimulus of oxygen. And as these vessels are subject to perpetual motion, the accumulation of the sensorial power of irritation becomes so great by their lessened activity, that it excites the vessels next connected, the cutaneous capillaries for instance, into more energetic actions, so as to produce increased heat of the skin, and greater perspiration.
How exactly this resembles a continued fever with weak and quick pulse!--in the latter the action of the heart and arteries are lessened by defect of the excitement of the sensorial power of association, owing to the torpor or lessened actions of the stomach; hence the accumulation of the sensorial power of association in this case, as the accumulation of that of irritation in the former, becomes so abundant as to excite into increased action the parts most nearly connected, as the cutaneous capillaries.
In respect to the circumstance mentioned by Sydenham, that covering the head in bed in a short time relieved the pertinacious sickness of the patient, it must be observed, that when the action of the heart and arteries become weakened by the want of the due stimulus of the proper quantity of oxygen in the blood, that an accumulation of the sensorial power of irritation occurs in the fibres of the heart and arteries, which then is expended on those of the capillary glands, increasing their actions and consequent secretions and heat. And then the stomach is thrown into stronger action, both by the greater excitement of its natural quantity of the sensorial power of association by the increased actions of the capillaries, and also by some increase of associability, as it had been previously a long time in a state of torpor, or less activity than natural, as evinced by its perpetual sickness.
In a manner somewhat similar to this, is the redness of the skin produced in angry people by the superabundance of the unemployed sensorial power of volition, as explained in Class IV. 2. 3. 5. Rubor ex ira. From hence we learn how, when people in fevers with weak pulse, or in dropsies, become insane, the abundance of the unemployed sensorial power of volition increases the actions of the whole moving system, and cures those diseases.
7. As the orgasm of the capillaries in fevers with weak pulse is immediately caused by the torpid actions of the heart and arteries, as above explained, this supplies us with another indication of cure in such fevers, and that is to stimulate these organs. This may probably be done by some kind of medicines, which are known to pass into the blood unchanged in some of their properties. It is possible that nitre, or its acid, may pass into the blood and increase the colour of it, and thus increase its stimulus, and the same may be supposed of other salts, neutral or metallic? As rubia tinctoria, madder, colours the bones of young animals, it must pass into the blood with its colouring matter at least unchanged, and perhaps many other medicines may likewise affect the blood, and thus act by stimulating the heart and arteries, as well as by stimulating the stomach; which circumstance deserves further attention.
Another way of immediately stimulating the heart and arteries would be by transfusing new blood into them. Is it possible that any other fluid besides blood, as chyle, or milk, or water, could, if managed with great art, be introduced safely or advantageously into the vein of a living animal?
A third method of exciting the heart and arteries immediately is by increasing the natural stimulus of the blood, and is well worthy experiment in all fevers with weak pulse; and that consists in supplying the blood with a greater proportion of oxygen; which may be done by respiration, if the patient was to breathe either oxygen gas pure, or diluted with atmospheric air, which might be given to many gallons frequently in a day, and by passing through the moist membranes of the lungs, according to the experiments of Dr. Priestley, and uniting with the blood, might render it more stimulant, and thus excite the heart and arteries into greater action! May not some easier method of exhibiting oxygen gas by respiration be discovered, as by using very small quantities of hyper-oxygenated marine acid gas very much diluted with atmospheric air?
XII. _Torpor of the Stomach and upper Intestines._
1. The principal circumstance, which supports the increased action of the capillaries in continued fever with weak pulse, is their reverse sympathy with those of the stomach and upper intestines, or with those of the heart and arteries. The torpor of the stomach and upper intestines is apparent in continued fevers from the total want of appetite for solid food, besides the sickness with which fevers generally commence, and the frequent diarrhoea with indigested stools, at the same time the thirst of the patient is sometimes urgent at the intervals of the sickness. Why the stomach can at this time take fluids by intervals, and not solids, is difficult to explain; except it be supposed, as some have affirmed, that the lacteal absorbents are a different branch from the lymphatic absorbents, and that in this case the former only are in a state of permanent torpor.
2. The torpor of the heart and arteries is known by the weakness of the pulse. When the actions of the absorbents of the stomach are diminished by the exhibition of small doses of digitalis, or become retrograde by larger ones, the heart and arteries act more feebly by direct sympathy; but the cellular, cutaneous, and pulmonary absorbents are excited into greater action. Whence in anasarca the fluids in the cellular membrane throughout the whole body are absorbed during the sickness, and frequently a great quantity of atmospheric moisture at the same time; as appears by the very great discharge of urine, which sometimes happens in these cases; and in ileus the prodigious evacuations by vomiting, which are often a hundred fold greater than the quantity swallowed, evince the great action of all the other absorbents during the sickness of the stomach.
3. But when the stomach is rendered permanently sick by an emetic drug, as by digitalis, it is not probable, that much accumulation of sensorial power is soon produced in this organ; because its usual quantity of sensorial power is previously exhausted by the great stimulus of the foxglove; and hence it seems probable, that the great accumulation of sensorial power, which now causes the increased action of the absorbents, is produced in consequence of the inactivity of the heart and arteries; which inactivity is induced by deficient excitement of the sensorial power of association between those organs and the stomach, and not by any previous exhaustion of their natural quantity of sensorial power; whereas in ileus, where the torpor of the stomach, and consequent sickness, is induced by reverse sympathy with an inflamed intestine, that is, by dissevered or defective association; the accumulation of sensorial power, which in that disease so violently actuates the cellular, pulmonary, and cutaneous absorbents, is apparently produced by the torpor of the stomach and lacteals, and the consequent accumulation of the sensorial power of association in them owing to their lessened action in sickness.
4. This accounts for the dry skin in fevers with weak pulse, where the stomach and the heart and arteries are in a torpid state, and for the sudden emaciation of the body; because the actions of the cellular and cutaneous absorbents are increased by reverse sympathy with those of the stomach, or with those of the heart and arteries; that is by the expenditure of that sensorial power of association, which is accumulated in consequence of the torpor of the stomach and heart and arteries, or of either of them; this also explains the sudden absorption of the milk in puerperal fevers; and contributes along with the heat of the respired air to the dryness of the mucous membrane of the tongue and nostrils.
5. Besides the reverse sympathy, with which the absorbent vessels of the stomach and upper intestines act in respect to all the other absorbent vessels, as in the exhibition of digitalis, and in ileus; there is another reverse sympathy exists between the capillaries, or secretory vessels of the stomach, and those of the skin. Which may nevertheless be occasioned by the accumulation of sensorial power by the torpor of the heart and arteries, which is induced by direct sympathy with the stomach; thus when the torpor of the stomach remains in a fever-fit which might otherwise have intermitted, the torpor of the heart and arteries remains also by direct sympathy, and the increased cutaneous capillary action, and consequent heat, are produced by reverse sympathy; and the fever is thus rendered continual, owing primarily to the torpor of the stomach.
6. The reverse sympathy, which exists between the capillaries of the stomach and the cutaneous capillaries, appears by the chillness of some people after dinner; and contrary-wise by the digestion being strengthened, when the skin is exposed to cold air for a short time; as mentioned in Class IV. 1. 1. 4. and IV. 2. 1. 1. and from the heat and glow on the skin, which attends the action of vomiting; for though when sickness first commences, the skin is pale and cold; as it then partakes of the general torpor, which induces the sickness; yet after the vomiting has continued some minutes, so that an accumulation of sensorial power exists in the capillaries of the stomach, and of the skin, owing to their diminished action; a glow of the skin succeeds, with sweat, as well as with increased absorption.
7. Nevertheless in some circumstances the stomach and the heart and arteries seem to act by direct sympathy with the cutaneous capillaries, as in the flushing of the face and glow of the skin of some people after dinner; and as in fevers with strong pulse. In these cases there appears to be an increased production of sensorial power, either of sensation, as in the blush of shame; or of volition, as in the blush of anger; or of irritation, as in the flushed face after dinner above mentioned.
This increased action of the capillaries of the skin along with the increased actions of the stomach and heart is perhaps to be esteemed a synchronous increase of action, rather than a sympathy between those organs. Thus the flushing of the face after dinner may be owing to the secretion of sensorial power in the brain being increased by the association of that organ with the stomach, in a greater proportion than the increased expenditure of it, or may be owing also to the stimulus of new chyle received into the blood.
8. When the stomach and the heart and arteries are rendered torpid in fevers, not only the cutaneous, cellular, and pulmonary absorbents are excited to act with greater energy; but also their correspondent capillaries and secerning vessels or glands, especially perhaps those of the skin, are induced into more energetic action. Whence greater heat, a greater secretion of perspirable matter, and of mucus; and a greater absorption of them both, and of aerial moisture. These reverse sympathies coincide with other animal facts, as in eruption of small pox on the face and neck the feet become cold, while the face and neck are much flushed; and in the hemiplagia, when one arm and leg become disobedient to volition, the patient is perpetually moving the other. Which are well accounted for by the accumulation of sensorial power in one part of an associated series of actions, when less of it is expended by another part of it; and by a deficiency of sensorial power in the second link of association, when too much of it is expended by the first.
9. This doctrine of reverse sympathy enables us to account for that difficult problem, why in continued fevers the increased action of the cutaneous, cellular, and pulmonary capillaries proceeds without interruption or return of cold fit; though perhaps with some exacerbations and remissions; and that during a quarter, or half, or three quarters, or a whole lunation; while at the same time the pulsations of the heart and arteries are weaker than natural.
To this should be added the direct sympathy, which exists between the peristaltic motions of the fibres of the stomach, and the pulsations of the heart. And that the stomach has become torpid by the too great stimulus of some poisonous or contagious matter; and this very intricate idea of continued fever with feeble pulse is reduced to curious simplicity.
The direct sympathy of the stomach and heart and arteries not only appears from the stronger and slower pulse of persons exhausted by fatigue, after they have drank a glass of wine, and eaten a few mouthfuls; but appears also from the exhibition of large doses of digitalis; when the patient labours under great and incessant efforts to vomit, at the same time that the actions of the absorbent system are known to be much increased by the hasty absorption of the serous fluid in anasarca, the pulsations of the heart become slow and intermittent to an alarming degree. See Class IV. 2. 1. 17. and 18.
10. It would assist us much in the knowledge and cure of fevers, if we could always determine, which part of the system was primarily affected; and whether the torpor of it was from previous excess or defect of stimulus; which the industry of future observers must discover. Thus if the stomach be affected primarily, and that by previous excess of stimulus, as when certain quantities of opium, or wine, or blue vitriol, or arsenic, are swallowed, it is some time in recovering the quantity of sensorial power previously exhausted by excess of stimulus, before any accumulation of it can occur. But if it be affected with torpor secondarily, by sympathy with some distant part; as with the torpid capillaries of the skin, that is by defective excitement of the sensorial power of association; or if it be affected by defect of stimulus of food or of heat; it sooner acquires so much accumulation of sensorial power, as to be enabled to accommodate itself to its lessened stimulus by increase of its irritability.
Thus in the hemicrania the torpor generally commences in a diseased tooth, and the membranes about the temple, and also those of the stomach become torpid by direct synchronous sympathy; and pain of the head, and sickness supervene; but no fever or quickness of pulse. In this case the torpor of the stomach is owing to defect of the sensorial power of association, which is caused by the too feeble actions of the membranes surrounding the diseased tooth, and thus the train of sympathy ceases here without affecting the motions of the heart and arteries; but where contagious matter is swallowed into the stomach, the stomach after a time becomes torpid from exhaustion of the sensorial power of irritation, and the heart and arteries act feebly from defect of the excitement of the power of association. In the former case the torpor of the stomach is conquered by accumulation of the power of association in one or two whole days; in the latter it recovers by accumulation of the power of irritation in three or four weeks.
In intermittent fevers the stomach is generally I believe affected secondarily by sympathy with the torpid cutaneous capillaries, or with some internal torpid viscus, and on this account an accumulation of sensorial power arises in a few hours sufficient to restore the natural irritability of this organ; and hence the hot fit succeeds, and the fever intermits. Or if this accumulation of sensorial power becomes excessive and permanent, the continued fever with strong pulse is produced, or febris irritativa.
In continued fevers the stomach is frequently I suppose affected with torpor by previous excess of stimulus, and consequent exhaustion of sensorial power, as when contagious matter is swallowed with the saliva, and it is then much slower in producing an accumulation of sensorial power sufficient to restore its healthy irritability; which is a frequent cause of continued fever with weak pulse or febris inirritativa. Which consists, after the cold fit is over, in a more frequent and more feeble action of the heart and arteries, owing to their direct sympathy with the muscular fibres of the torpid stomach; together with an increased action of the capillaries, glands, and absorbents of the skin, and cellular membrane, owing to their reverse sympathy with the torpid capillaries, glands, and absorbents of the stomach, or with those of the heart and arteries.
Or in more accurate language. 1. The febris inirritativa, or fever with weak pulse, commences with torpor of the stomach, occasioned by previous exhaustion of sensorial power of irritation by the stimulus of contagious matter swallowed with the saliva. 2. The whole system becomes torpid from defect of the excitement or the sensorial power of association owing to the too feeble actions of the stomach, this is the cold fit. 3. The whole system, except the stomach with the upper intestines, and the heart and arteries, falls into increased action, or orgasm, owing to accumulation of sensorial power of association during their previous torpor, this is the hot fit. 4. The stomach and upper intestines have not acquired their natural quantity of sensorial power of irritation, which was previously exhausted by violent action in consequence of the stimulus of contagious matter, and the heart and arteries remain torpid from deficient excitement of the sensorial power of association owing to the too feeble actions of the stomach. 5. The accumulation of sensorial power of association in consequence of the torpor of the heart and arteries occasions a perpetual orgasm, or increased action of the capillaries.
11. From hence it may be deducted first, that when the torpor of the stomach first occurs, either as a primary effect, or as a secondary link of some associate train or circle of motions, a general torpor of the system sometimes accompanies it, which constitutes the cold fit of fever; at other times no such general torpor occurs, as during the operation of a weak emetic, or during sea-sickness.
Secondly. After a time it generally happens, that a torpor of the stomach ceases, and its actions are renewed with increase of vigour by accumulation of sensorial power during its quiescence; as after the operation of a weak emetic, or at the intervals of sea-sickness, or after the paroxysm of an intermittent fever.
Thirdly. The stomach is sometimes much slower in recovering from a previous torpor, and is then the remote cause of continued fever with weak pulse; which is owing to a torpor of the heart and arteries, produced in consequence of the deficient excitement of the power of association by the too weak actions of the stomach; and to an orgasm of the capillaries of the other parts of the system, in consequence of the accumulation of sensorial power occasioned by the inactivity of the heart and arteries.
Fourthly. The torpor of the stomach is sometimes so complete, that probably the origin of its nerves is likewise affected, and then no accumulation of sensorial power occurs. In this case the patient dies for want of nourishment; either in three or four weeks, of the inirritative fever; or without quick pulse, by what we have called paresis irritativa. Or he continues many years in a state of total debility. When this torpor suddenly commences, the patient generally suffers epileptic fits or temporary insanity from the disagreeable sensation of so great a torpor of the stomach; which also happens sometimes at the eruption of the distinct small pox; whence we have termed this disease anorexia epileptica. See Class II. 2. 2. 1. and III. 1. 1. 7. and Suppl. I. 14. 3.
Fifthly. When this torpor of the stomach is less in degree or extent, and yet without recovering its natural irritability by accumulation of sensorial power, as it does after the cold fit of intermittent fever, or after the operation of mild emetics, or during syncope; a permanent defect of its activity, and of that of the upper intestines, remains, which constitutes apepsia, cardialgia, hypochondriasis, and hysteria. See Class I. 3. 1. 3. and I. 2. 4. 5.
Sixthly. If the torpor of the stomach be induced by direct sympathy, as in consequence of a previous torpor of the liver, or spleen, or skin, an accumulation of sensorial power will sooner be produced in the stomach; because there has been no previous expenditure of it, the present torpor of the stomach arising from defect of association. Hence some fevers perfectly intermit, the stomach recovering its complete action after the torpor and consequent orgasm, which constitute the paroxysm of fever, are terminated.
Seventhly. If the torpor of the stomach be owing to defect of irritation, as to the want of food, an accumulation of sensorial power soon occurs with an increase of digestion, if food be timely applied; or with violent inflammation, if food be given in too great quantity after very long abstinence.
Eighthly. If the torpor of the stomach be induced by defect of pleasurable sensation, as when sickness is caused by the suggestion of nauseous ideas; an accumulation of sensorial power soon occurs, and the sickness ceases with the return of hunger; for in this case the inactivity of the stomach is occasioned by the subduction of agreeable sensation, which acts as a subduction of stimulus, and not by exhausting the natural quantity of sensorial power in the fibres or nerves of the stomach.
Ninthly. If the torpor of the stomach be induced by a twofold cause, as in sea-sickness. See Vertigo rotatoria. Class IV. 2. 1. 10. in which the first link of association acts too strongly, and in consequence expends more than usual of the sensorial power of irritation; and secondly in which sensation is produced between the links of association, and dissevers or enfeebles them; the accumulation of sensorial power soon occurs in the stomach; as no previous expenditure of it in that organ has occurred. Whence in sea-sickness the persons take food with eagerness at times, when the vertigo eases for a few minutes.
Tenthly. If the gastric torpor be induced by previous violent exertion, as after intoxication, or after contagious matter has been swallowed, or some poisons, as digitalis, or arsenic; an accumulation of sensorial power very slowly succeeds; whence long sickness, or continued fever, because the quantity of sensorial power already wasted must first be renewed, before an accumulation of it can be produced.
12. This leads us to a second indication of cure in continued fevers, which consists in strengthening the actions of the stomach; as the first indication consisted in decreasing the actions of the cutaneous capillaries and absorbents. The actions of the stomach may sometimes be increased by exhibiting a mild emetic; as an accumulation of sensorial power in the fibres of the stomach is produced during their retrograde actions. Besides the evacuation of any noxious material from the stomach and duodenum, and from the absorbents, which open their mouths on their internal surfaces, by their retrograde motion.
It is probable, that when mild emetics are given, as ipecacuanha, or antimonium tartarizatum, or infusion of chamomile, they are rejected by an inverted motion of the stomach and oesophagus in consequence of disagreeable sensation, as dust is excluded from the eye; and these actions having by previous habit been found effectual, and that hence there is no exhaustion of the sensorial power of irritation. But where strong emetics are administered, as digitalis, or contagious matter, the previous exhaustion of the sensorial power of irritation seems to be a cause of the continued retrograde actions and sickness of the stomach. An emetic of the former kind may therefore strengthen the power of the stomach immediately after its operation by the accumulation of sensorial power of irritation during its action. See Class IV. 1. 1.
Another method of decreasing the action of the stomach for a time, and thence of increasing it afterwards, is by the accumulation of the sensorial power of irritation during its torpor; is by giving ice, iced water, iced creams, or iced wine. This accounts for the pleasure, which many people in fevers with weak pulse express on drinking cold beverage of any kind.
A second method of exciting the stomach into action, and of decreasing that of the capillaries in consequence, is by the stimulus of wine, opium, bark, metallic salts of antimony, steel, copper, arsenic, given in small repeated quantities; which so long as they render the pulse slower are certainly of service, and may be given warm or cold, as most agreeable to the patient. For it is possible, that the capillaries of the stomach may act too violently, and produce heat, at the same time that the large muscles of it may be in a torpid state; which curious circumstance future observations must determine.
Thirdly. Hot fomentation on the region of the stomach might be of most essential service by its stimulus, as heat penetrates the system not by the absorbent vessels, but by external influence; whence the use of hot fomentation to the head in torpor of the brain; and the use of hot bath in cases of general debility, which has been much too frequently neglected from a popular error occasioned by the unmeaning application of the word relaxation to animal power. If the fluid of heat could be directed to pass through particular parts of the body with as little diffusion of its influence, as that of electricity in the shocks from the coated jar, it might be employed with still greater advantage.
Fourthly. The use of repeated small electric shocks through the region of the stomach might be of service in fevers with weak pulse, and well deserves a trial; twenty or thirty small shocks twice a day for a week or two would be a promising experiment.
Fifthly. A blister on the back, or sides, or on the pit of the stomach, repeated in succession, by stimulating the skin frequently strengthens the action of the stomach by exciting the sensorial power of association; this especially in those fevers where the skin of the extremities, as of the hands or nose or ears, sooner becomes cold, when exposed to the air, than usual.
Sixthly. The action of the stomach may be increased by preventing too great expenditure of sensorial power in the link of previous motion with which it is catenated, especially if the action of that link be greater than natural. Thus as the capillaries of the skin act too violently in fevers with weak pulse, if these are exposed to cold air or cold water, the sensorial power, which previously occasioned their orgasm, becomes accumulated, and tends to increase the action of the stomach; thus in those fevers with weak pulse and hot skin, if the stomach be stimulated by repeated small doses of bark and wine or opium, and be further excited at the same time by accumulation of sensorial power occasioned by rendering the capillaries torpid by cold air or water, this twofold application is frequently attended with visible good effect.
By thus stimulating the torpid stomach into greater action, the motions of the heart and arteries will likewise be increased by the greater excitement of the power of association. And the capillaries of the skin will cease to act so violently, from their not possessing so great a superfluity of sensorial power as during the greater quiescence of the stomach and of the heart and arteries. Which is in some circumstances similar to the curious phenomenon mentioned in Class IV. 2. 2. 10; where, by covering the chill feet with flannel at the eruption of the small-pox, the points of the flannel stimulate the skin of the feet into greater action, and the quantity of heat, which they possess, is also confined, or insulated, and further increases by its stimulus the activity of the cutaneous vessels of the feet; and by that circumstance abates the too great action of the capillaries of the face, and the consequent heat of it.
XIII. _Case of continued fever._
The following case of continued fever which I frequently saw during its progress, as it is less complicate than usual, may illustrate this doctrine. Master S. D. an active boy about eight years of age, had been much in the snow for many days, and sat in the classical school with wet feet; he had also about a fortnight attended a writing school, where many children of the lower order were instructed. He was seized on February the 8th, 1795, with great languor, and pain in his forehead, with vomiting and perpetual sickness; his pulse weak, but not very frequent. He took an emetic, and on the next day, had a blister, which checked the sickness only for a few hours; his skin became perpetually hot, and dry; and his tongue white and furred; his pulse when asleep about 104 in a minute, and when awake about 112.
Fourth day of the disease. He has had another blister, the pain of his head is gone, but the sickness continues by intervals; he refuses to take any solid food, and will drink nothing but milk, or milk and water, cold. He has two or three very liquid stools every day, which are somtimes green, but generally of a darkish yellow, with great flatulency both upwards and downwards at those times. An antimonial powder was once given, but instantly rejected; a spoonful of decoction of bark was also exhibited with the same event. His legs are bathed, and his hands and face are moistened twice a day for half an hour in warmish water, which is nevertheless much colder than his skin.
Eighth day. His skin continues hot and dry without any observable remissions, with liquid stools and much flatulency and sickness; his water when observed was of a straw colour. He has asked for cyder, and drinks nearly a bottle a day mixed with cold water, and takes three drops of laudanum twice a day.
Twelfth day. He continues much the same, takes no milk, drinks only cyder and water, skin hot and dry, tongue hot and furred, with liquid stools, and sickness always at the same time; sleeps much.
Sixteenth day. Was apparently more torpid, and once rather delirious; pulse 112. Takes only capillaire and water; sleeps much.
Twentieth day. Pulse 100, skin dry but less hot, liquid stools not so frequent, he is emaciated to a great degree, he has eaten half a tea-cup full of custard to day, drinks only capillaire and water, has thrice taken two large spoonfuls of decoction of bark with three drops of laudanum, refuses to have his legs bathed, and will now take nothing but three drops of laudanum twice a day.
Twenty-fourth day. He has gradually taken more custard every day, and began to attend to some new play things, and takes wine syllabub.
Twenty-eighth day. He daily grows stronger, eats eggs, and and butter, and sleeps immediately after his food, can creep on his hands and knees, but cannot stand erect.
Thirty-second day. He cannot yet stand alone safely, but seems hourly to improve in strength of body, and activity of mind.
In this case the remote cause of his fever could not be well ascertained, as it might be from having his feet cold for many successive days, or from contagion; but the latter seems more probable, because his younger brother became ill of a similar fever about three weeks afterwards, and probably received the infection from him. The disease commenced with great torpor of the stomach, which was shewn by his total aversion to solid food, and perpetual sickness; the watery stools, which were sometimes green, or of a darkish yellow, were owing to the acrimony, or acidity, of the contents of the bowels; which as well as the flatulency were occasioned by indigestion. This torpor of the stomach continued throughout the whole fever, and when it ceased, the fever ceased along with it.
The contagious material of this fever I suppose to have been mixed with the saliva, and swallowed into the stomach; that it excited the vessels, which constitute the stomach, into the greatest irritative motion like arsenic; _which might not be perceived, and yet might render that organ paralytic or inirritable in a moment of time_; as animals sometimes die by one single exertion, and consequent paralysis, without a second struggle; as by lightning, or being shot through the back part of the brain; of both which I have seen instances. I had once an opportunity of inspecting two oxen, a few minutes after they were killed by lightning under a crab-tree on moist ground in long grass; and observed, that they could not have struggled, as the grass was not pressed or bent near them; I have also seen two horses shot through the cerebellum, who never once drew in their legs after they first stretched them out, but died instantaneously; in a similar manner the lungs seem to be rendered instantly inanimate by the fumes of burning sulphur.
The lungs may be sometimes primarily affected with contagious matter floating in the atmosphere as well as the stomach, as mentioned in article 9. of this Supplement. But probably this may occur much less frequently, because the oxygene of the atmosphere does not appear to be taken into the blood by animal absorption, as the saliva in the stomach, but passes through the moist membranes into the blood, like the ethereal fluids of electricity or heat, or by chemical attraction, and in consequence the contagious matter may be left behind; except it may sometimes be absorbed along with the mucus; of which however in this case there appeared no symptoms.
The tonsils are other organs liable to receive contagious matter, as in the small-pox, scarlet-fever, and in other sensitive inirritated fevers; but no symptom of this appeared here, as the tonsils were at no time of the fever inflamed, though they were in this child previously uncommonly large.
The pain of the forehead does not seem to have been of the internal parts of the head, because the nerves, which serve the stomach, are not derived from the anterior part of the brain; but it seems to have been owing to a torpor of the external membranes about the forehead from their direct sympathy with those of the stomach; that is, from the deficient excitement of the sensorial power of association; and seemed in some measure to be relieved by the emetics and blisters.
The pulsations of the heart were weaker and in consequence quicker than natural, owing to their direct sympathy with the torpid peristaltic motions of the stomach; that is to the deficient excitement of the sensorial power of association.
The action of the cutaneous capillaries and absorbents were stronger than natural, as appeared by the perpetual heat and dryness of the skin; which was owing to their reverse sympathy with the heart and arteries. This weaker and quicker action of the heart and arteries, and the stronger action of the cutaneous capillaries and absorbents, continued throughout the disease, and may be said to have constituted the fever, of which the torpor of the stomach was the remote cause.
His tongue was not very much furred or very dry, nor his breath very hot; which shewed, that there was no great increase of the action of the mucous absorbents, nor of the pulmonary capillaries, and yet sufficient to produce great emaciation. His urine was nearly natural both in quantity and colour; which shewed, that there was no increase of action either of the kidnies, or of the urinary absorbents.
The bathing his legs and hands and face for half an hour twice a day seemed to refresh him, and sometimes made his pulse slower, and thence I suppose stronger. This seems to have been caused by the water, though subtepid, being much below the heat of his skin, and consequently contributing to cool the capillaries, and by satiating the absorbents to relieve the uneasy sensation from the dryness of the skin.
He continued the use of three drops of tincture of opium from about the eighth day to the twenty-fourth, and for the three preceding days took along with if two large spoonfuls of an infusion of bark in equal parts of wine and water. The former of these by its stimulus seemed to decrease his languor for a time, and the latter to strengthen his returning power of digestion.
The daily exacerbations or remissions were obscure, and not well attended to; but he appeared to be worse on the fourteenth or fifteenth days, as his pulse was then quickest, and his inattention greatest; and he began to get better on the twentieth or twenty-first days of his disease; for the pulse then became less frequent, and his skin cooler, and he took rather more food: these circumstances seemed to observe the quarter periods of lunation.
XIV. _Termination of continued fever._
1. When the stomach is primarily affected with torpor not by defect of stimulus, but in consequence of the previous exhaustion of its sensorial power; and not secondarily by its association with other torpid parts; it seems to be the general cause of the weak pulsations of the heart and arteries, and the consequent increased action of the capillaries, which constitute continued fever with weak pulse. In this situation if the patient recovers, it is owing to the renovation of life in the torpid stomach, as happens to the whole system in winter-sleeping animals. If he perishes, it is owing to the exhaustion of the body for want of nourishment occasioned by indigestion; which is hastened by the increased actions of the capillaries and absorbents.
2. When the stomach is primarily affected by defect of stimulus, as by cold or hunger; or secondarily by defect of the power of association, as in intermittent fevers; or lastly in consequence of the introduction of the sensorial power of sensation, as in inflammatory diseases; the actions of the heart and arteries are not diminished, as when the stomach is primarily affected with torpor by its previous exhaustion of sensorial power, but become greatly increased, producing irritative or inflammatory fever. Where this fever is continued, though with some remissions and exacerbations, the excessive action is at length so much lessened by expenditure of sensorial power, as to gradually terminate in health; or it becomes totally exhausted, and death succeeds the destruction of the irritability and associability of the system.
3. There is also another termination of the diseases in consequence of great torpor of the stomach, which are not always termed fevers; one of these is attended with so great and universal torpor, that the patient dies in the first cold fit; that is, within twelve hours or less of the first seizure; this is commonly termed sudden death. But the quickness of the pulse, and the coldness with shuddering, and with sick stomach, distinguished a case, which I lately saw, from the sudden deaths occasioned by apoplexy, or ruptured blood-vessels.
In hemicrania I believe the stomach is always affected secondarily, as no quickness of pulse generally attends it, and as the stomach recovers its activity in about two whole days. But in the following case, which I saw last week, I suppose the stomach suddenly became paralytic, and caused in about a week the death of the patient. Miss ----, a fine young lady about nineteen, had bathed a few times, about a month before, in a cold spring, and was always much indisposed after it; she was seized with sickness, and cold shuddering, with very quick pulse, which was succeeded by a violent hot fit; during the next cold paroxysm she had a convulsion fit; and after that symptoms of insanity, so as to strike and bite the attendants, and to speak furious language; the same circumstances occurred during a third fit, in which I believe a strait waistcoat was put on, and some blood taken from her; during all this time her stomach would receive no nutriment, except once or twice a little wine and water. On the seventh day of the disease, when I saw her, the extremities were cold, the pulse not to be counted and she was unable to swallow, or to speak; a clyster was used with turpentine and musk and opium, with warm fomentations, but she did not recover from that cold fit.
In this case the convulsion fit and the insanity seem to have been violent efforts to relieve the disagreeable sensation of the paralytic stomach; and the quick pulse, and returning fits of torpor and of orgasm, evinced the disease to be attended with fever, though it might have been called anorexia maniacalis, or epileptica.
4. Might not many be saved in these fevers with weak pulse for a few weeks by the introduction of blood into a vein, once in two or three days; which might thus give further time for the recovery of the torpid stomach? Which seems to require some weeks to acquire its former habits of action, like the muscles of paralytic patients, who have all their habits of voluntary associations to form afresh, as in infancy.
If this experiment be again tried on the human subject, it should be so contrived, that the blood in passing from the well person to the sick one should not be exposed to the air; it should not be cooled or heated; and it should be measured; all which may be done in the following manner. Procure two silver pipes, each about an inch long, in the form of funnels, wide at top, with a tail beneath, the former something wider than a swan-quill, and the latter less than a small crow-quill. Fix one of these silver funnels by its wide end to one end of the gut of a chicken fresh killed about four or six inches long, and the other to the other end of the gut; then introduce the small end of one funnel into the vein of the arm of a well person downwards towards the hand; and laying the gut with the other end on a water-plate heated to 98 degrees in a very warm room; let the blood run through it. Then pressing the finger on the gut near the arm of the well person, slide it along so as to press out one gutful into a cup, in order to ascertain the quantity by weight. Then introduce the other end of the other funnel into a similar vein in the arm of the sick person upwards towards the shoulder; and by sliding one finger, and then another reciprocally, along the chicken's gut, so as to compress it, from the arm of the well person to the arm of the sick one, the blood may be measured, and thus the exact quantity known which is given and received. See Class I. 2. 3. 25.
XV. _Inflammation excited in fever._
1. When the actions of any part of the system of capillaries are excited to a certain degree, sensation is produced, along with a greater quantity of heat, as mentioned in the fifth article of this supplement. When this increased capillary action becomes still more energetic, by the combined sensorial powers of sensation with irritation, new fibres are secreted, or new fluids, (which harden into fibres like the mucus secreted by the silk-worm, or spider, or pinna,) from which new vessels are constructed; it is then termed inflammation: if this exists in the capillary vessels of the cellular membrane or skin only, with feeble pulsations of the heart and arteries, the febris sensitiva inirritata, or malignant fever, occurs; if the coats of the arteries are also inflamed, the febris sensitiva irritata, or inflammatory fever, exists.
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.
2. In this situation there generally, I suppose, exists an increased activity of the secerning vessels of the brain, and consequently an increased production of sensorial power; in less violent quantity of this disease however the increase of the action of the heart and arteries may be owing simply to the accumulation of sensorial power of association in the stomach, when that organ is affected by sympathy with some inflamed part. In the same manner as the capillaries are violently and permanently actuated by the accumulation of the sensorial power of association in the heart and arteries, when the stomach is affected primarily by contagious matter, and the heart and arteries secondarily. Thus I suspect, that in the distinct small-pox the stomach is affected secondarily by sympathy with the infected tonsils or inoculated arm; but that in the confluent small-pox the stomach is affected primarily, as well as the tonsils, by contagious matter mixed with the saliva, and swallowed.
3. In inflammatory fevers with great arterial action, as the stomach is not always affected with torpor, and as there is a direct sympathy between the stomach and heart, some people have believed, that nauseating doses of some emetic drug, as of antimonium tartarizatum, have been administered with advantage, abating by direct sympathy the actions of the heart. This theory is not ill founded, and the use of digitalis, given in small doses, as from half a dram to a dram of the saturated tincture, two or three times a day, as well as other less violent emetic drugs, would be worth the attention of hospital physicians.
Sickness might also be produced probably with advantage by whirling the patient in a chair suspended from the cieling by two parallel cords; which after being revolved fifty or one hundred times in one direction, would return with great circular velocity, and produce vertigo, similar I suppose to sea-sickness. And lastly the sickness produced by respiring an atmosphere mixed with one tenth of carbonated hydrogen, discovered by Mr. Watt, and published by Dr. Beddoes, would be well worthy exact and repeated experiment.
4. Cool air, cool fomentations, or ablutions, are also useful in this inflammatory fever; as by cooling the particles of blood in the cutaneous and pulmonary vessels, they must return to the heart with less stimulus, than when they are heated above the natural degree of ninety-eight. For this purpose snow and ice have been scattered on the patients in Italy; and cold bathing has been used at the eruption of the small pox in China, and both, it is said, with advantage. See Class III. 2. 1. 12. and Suppl. I. 8.
5. The lancet however with repeated mild cathartics is the great agent in destroying this enormous excitement of the system, so long as the strength of the patient will admit of evacuations. Blisters over the painful part, where the phlegmon or topical inflammation is situated, after great evacuation, is of evident service, as in pleurisy. Warm bathing for half an hour twice a day, when the patient becomes enfeebled, is of great benefit, as in peripneumony and rheumatism.
6. When other means fail of success in abating the violent excitement of the system in inflammatory diseases, might not the shaved head be covered with large bladders of cold water, in which ice or salt had been recently dissolved; and changed as often as necessary, till the brain is rendered in some degree torpid by cold?--Might not a greater degree of cold, as iced water, or snow, be applied to the cutaneous capillaries?
7. Another experiment I have frequently wished to try, which cannot be done in private practice, and which I therefore recommend to some hospital physician; and that is, to endeavour to still the violent actions of the heart and arteries, after due evacuations by venesection and cathartics, by gently compressing the brain. This might be done by suspending a bed, so as to whirl the patient round with his head most distant from the center of motion, as if he lay across a millstone, as described in Sect. XVIII. 20. For this purpose a perpendicular shaft armed with iron gudgeons might have one end pass into the floor, and the other into a beam in the cieling, with an horizontal arm, to which a small bed might be readily suspended.
By thus whirling the patient with increasing velocity sleep might be produced, and probably the violence of the actions of the heart and arteries might be diminished in inflammatory fevers; and, as it is believed, that no accumulation of sensorial power would succeed a torpor of the origin of the nerves, either thus procured by mechanical compression, or by the bladder-cap of cold water above described, the lives of thousands might probably be saved by thus extinguishing the exacerbations of febrile paroxysms, or preventing the returns of them.
In fevers with weak pulse sleep, or a degree of stupor, thus produced, might prevent the too great expenditure of sensorial power, and thus contribute to preserve the patient. See Class I. 2. 5. 10. on stupor. What might be the consequence of whirling a person with his head next the center of motion, so as to force the blood from the brain into the other parts of the body, might be discovered by cautious experiment without danger, and might probably add to our ability of curing fever.
XVI. _Recapitulation._
1. The sensorial power causes the contraction of the fibres, and is excited into action by four different circumstances, by the stimulus of external bodies, by pain or pleasure, by desire or aversion, or by the previous motions of other contracting fibres. In the first situation it is called the sensorial power of irritation, in the second the sensorial power of sensation, in the third the sensorial power of volition, and in the fourth the sensorial power of association.
Many parts of the body are excited into perpetual action, as the sanguiferous vessels consisting of the heart, arteries, and veins; others into nearly perpetual action, as the conglomerate and capillary glands; and others into actions still somewhat less frequent, as the alimentary canal, and the lacteal and lymphatic absorbents with their conglobate glands: all these are principally actuated by the sensorial powers of irritation, and of association; but in some degree or at some times by those of sensation, and even of volition. There are three kinds of stimulus, which may easily be occasionally diminished, that of heat on the skin, of food in the stomach, and of the oxygenous part of the atmosphere, which mixes with the blood in respiration, and stimulates the heart and arteries.
2. When any parts, which are naturally excited into perpetual action by stimulus, become torpid or less active from decrease of that stimulus; there first occurs a decrease of the activity of the parts next catenated with them; thus going into cold water produces a torpor of the capillary vessels of the lungs, as is known by the difficult respiration, which immediately occurs; for the sensorial power of association, which naturally contributes to actuate the lungs, is now less excited by the decreased actions of the cutaneous vessels, with which they are catenated. This constitutes the cold fit of fever.
There next occurs an accumulation of the sensorial power of irritation in the parts, which were torpid from defect of stimulus, as the cutaneous vessels for instance when exposed to cold air; and a similar accumulation of the sensorial power of association occurs in the parts which were catenated with the former, as the vessels of the lungs in the example above mentioned. Whence, if the subduction of stimulus has not been too great, so as to impair the health of the part, the activity of the irritative motions returns, even though the stimulus continues less than usual; and those of the associate motions become considerably increased, because these latter are now excited by the previous fibrous motions, which now act as strong or stronger than formerly, and have also acquired an accumulation of the sensorial power of association. This accounts for the curious event of our becoming warm in a minute or two after remaining in water of about 80 degrees of heat, as in the bath at Buxton; or in the cold air of a frosty morning of about 30 degrees of heat.
But if the parts thus possessed of the accumulated sensorial powers of irritation and of association be exposed again to their natural quantity of stimulus, a great excess of activity supervenes; because the fibres, which possess accumulated irritation, are now excited by their usual quantity of stimulus; and those which possess accumulated association, are now excited by double or treble the quantity of the preceding irritative fibrous motions, with which they are catenated; this constitutes the hot fit of fever.
Another important circumstance occurs, when the parts, which are torpid from decreased stimulus, do not accumulate a quantity of sensorial power sufficient for the purpose of renewing their own natural quantity of action; but are nevertheless not so torpid, as to have the life of the part impaired. In this situation the superabundance of the accumulated power of irritation contributes to actuate the associate motions next catenated with them. Thus, when a person breathes air with less oxygene than natural, as by covering his head in bed, and thus respiring the same atmosphere repeatedly, the heart and arteries become less active by defect of the stimulus of oxygene; and then the accumulation of sensorial power of irritation becomes instantly very great, as these organs are subject to perpetual and energetic action. This accumulation nevertheless is not so great as to renew their own activity under this defect of stimulus, but yet is in sufficient abundance to increase the associability of the next link of catenation, that is, to actuate the capillaries of the skin with great and perpetual increase of energy. This resembles continued fever with weak pulse; in which the accumulation of the sensorial power caused by the lessened motions of the heart and arteries, actuates the capillaries with increase of energy.
3. When the accumulation of the sensorial power of association, which is caused as above explained by deficient excitement owing to the lessened quantity of action of the irritative fibrous motions, with which the associate train is catenated, is not in quantity sufficient to renew the natural actions of the first link of an associate train of motions; it is nevertheless frequently so abundant as to actuate the next link of the associated train with unnatural energy by increasing its associability; and that in a still greater degree if that second link of the associated train was previously in a torpid state, that is, had previously acquired some accumulation of the sensorial power of association. This important circumstance of the animal economy is worthy our most accurate attention. Thus if the heart and arteries are deprived of their due quantity of the stimulus of oxygene in the blood, a weak and quick pulse ensues, with an accumulation of the sensorial power of irritation; next follows an increase of the action of the capillaries by the superabundance of this accumulated power of irritation; but there also exists an accumulation of the power of association in these acting capillaries, which is not now excited by the deficient actions of the heart and arteries; but which by its abundance contributes to actuate the next link of association, which is the sick stomach in the case related from Sydenham in Class IV. 1. 1. 2. and explained in this Supplement I. 4. And as this sick stomach was in a previous state of torpor, it might at the same time possess an accumulation of some sensorial power, which, if it was of association, would be thus more powerfully excited by the increased actions of the capillaries; which existed in consequence of the weak action of the heart and arteries. This also resembles in some respects the continued fevers with weak pulse, and with increased activity of the capillaries.
4. When a torpor of some irritative motions occurs from a previous exhaustion of the sensorial power of irritation by the action of some very great stimulus, it is long before any accumulation of the sensorial power of irritation is produced; as is experienced in the sickness and languor, which continues a whole day after a fit of drunkenness. But nevertheless there occurs an accumulation of the sensorial power of association in the first link of the associate train of motions, which is catenated with these torpid irritative ones; which accumulation is owing to deficient excitement of that sensorial power in the first link of the associate train. This first link therefore exists also in a less active or torpid state, but the accumulation of the sensorial power of association by its superabundance contributes to actuate the second link of the associate train with unnatural quantity of motion; and that though its own natural quantity of the power of association is not excited by the deficient action of preceding fibrous motions.
When this happens to the stomach, as after its irritative motions have been much exerted from the unnatural stimulus of wine, or opium, or of contagious matter mixed with the saliva, a torpor or inactivity of it succeeds for a greater or less length of time; as no accumulation of the sensorial power of irritation can occur, till the natural quantity, which has been previously expended, is first restored. Then the heart and arteries which are next in catenation, become less active from the want of sufficient excitement of the sensorial power of association, which previously contributed to actuate them. This sensorial power of association therefore becomes accumulated, and by its superabundance contributes to actuate the link next in association, which has thus acquired so great a degree of associability, as to overbalance the less quantity of the excitement of it by the torpid action of the previous or first associate link. This happens to the capillaries, when the heart and arteries are affected as above by the torpor of the stomach, when it is occasioned by previous great expenditure of its sensorial power, and thus constitutes fever with weak pulse, which is here termed inirritative fever, typhus mitior.
5. When a deficiency of stimulus is too great or too long continued, so as to impair the life of the part, no further accumulation of sensorial power occurs; as when the skin is long exposed to cold and damp air. In that case the link in catenation, that is, the first of the associate train, is rendered torpid by defect of excitement of its usual quantity of the sensorial power of association, and from there being no accumulation of the sensorial power of irritation to increase its associability, and thus to contribute to actuate it by overbalancing the defect of the excitement of its association.
Thus on riding long and slowly on a cold and damp day, the exhalation of the vapour, which is impinged on the skin, as the traveller proceeds, carries away his warmth faster, than it is generated within the system; and thus the capillaries of the skin have their actions so much impaired after a time, that no accumulation of the sensorial power of irritation occurs; and then the stomach, whose motions are catenated with those of the capillaries, ceases to act from the deficient excitement of the power of association; and indigestion and flatulency succeed, instead of the increased digestion and hunger, which occur, when the cutaneous capillaries are exposed to a less degree of cold, and for a shorter time. In which latter situation the accumulation of the sensorial power of irritation increases by its superabundance the associability of the fibres of the stomach, so as to overbalance the defect of the excitement of their association.
6. The stomach is affected secondarily in fevers with strong pulse, as in those with weak pulse it is affected primarily. To illustrate this doctrine I shall relate the following case of Mr. Y----. He was a young man rather intemperate in the use of wine or beer, and was seized with a cold fit, and with a consequent hot one with strong pulse; on examining his hypochondrium an oblong tumour was distinctly felt on the left side of the stomach, which extended six or eight inches downward, and was believed to be a tumour of the spleen, which thus occasioned by its torpor the cold fit and consequent hot fit of fever with strong pulse. This fever continued, though with remissions, for two or three weeks; and the patient repeatedly lost blood, used cathartics with calomel and sena, and had frequent antimonial and saline medicines. And after he was much weakened by evacuations, the peruvian bark and small doses of steel removed the fever, but the tumour remained many years during the remainder of his life.
In this case the tumour of the spleen was occasioned by the torpor of the absorbent vessels; while the secerning vessels continued somewhat longer to pour their fluids into the cells of it. Then the inactivity of this viscus affected the whole system with torpor by the deficient excitement of the sensorial power of association, which contributes along with the irritation caused by their specific stimuli to actuate the whole sanguiferous, secerning, and absorbent vessels; and along with these the stomach, which possesses perhaps greater mobility, or promptitude to torpor or to orgasm, than any other part. And after a time all these parts recover their actions by the accumulation of their sensorial power of association. But the spleen not recovering its action from the accumulation of its power of irritation, as appeared from the continuance of the tumor, still affects the stomach by its defective irritative motions ceasing to excite the association, which ought to contribute to actuate it.
Hence the stomach continues torpid in respect to its motions, but accumulates its power of association; which is not excited into action by the defective motions of the spleen; this accumulation of the sensorial power of association now by its superabundance actuates the next link of associate motions, which consists of the heart and arteries, into greater energy of action than natural, and thus causes fever with strong pulse; which, as it was supposed to be most frequently excited by increase of irritation, is called irritative fever or synocha.
Similar to this in the small pox, which is given by inoculation, the stomach is affected secondarily, when the fever commences; and hence in this small-pox the pulsations of the heart and arteries are frequently stronger than natural, but never weaker, for the reasons above given. Whereas in that small-pox, which is caused by the stomach being primarily affected, by the contagious matter being swallowed with the saliva, whether the tonsils are at the same time affected or not, the pulsations of the heart and arteries become weak, and the inirritative fever is produced, as explained above, along with the confluent small-pox. This unfolds the cause of the mildness of the inoculated small-pox; because in this disease the stomach is affected secondarily, whereas in the natural small-pox it is frequently affected primarily by swallowing the contagious matter mixed with saliva.
In the measles I suppose the contagious matter to be dissolved in the air, and therefore not liable to be mixed with the saliva; whereas the variolous matter is probably only diffused in the air, and thence more readily mixed with the saliva in the mouth during respiration. This difference appears more probable, as the small-pox I believe is always taken at a less distance from the diseased person than is necessary to acquire the measles. The contagion of the measles affects the membranes of the nostrils, and the secretion of tears in consequence, but never I suspect the stomach primarily, but always secondarily; whence the pulsation of the heart and arteries is always stronger than natural, so as to bear the lancet at any period of the disease.
The great mildness sometimes, and fatality at other times, of the scarlet fever may depend on the same circumstance; that is, on the stomach being primarily or secondarily affected by the contagious matter, observing that the tonsils may be affected at the same time with the stomach. Should this prove to be the case, which future observations must determine, what certain advantage must arise from the inoculation of this disease! When it is received by the skin primarily I suppose no sore throat attends it, nor fever with weak pulse; when it is received by the stomach primarily, the tonsils are affected at the same time, and the torpor of the stomach produces inirritative fever, and the mortification of the tonsils succeeds.
We may hence conclude, that when the torpor of the stomach is either owing to defect of stimulus, which is not so great as to impair the life of the part, as in moderate hunger, or in swallowing iced water, or when its torpor is induced by its catenation or association with other torpid parts, as in the commencement of intermittent fevers, and inoculated small-pox, that the subsequent action of the heart and arteries is generally increased, producing irritative fever. Which is owing to the accumulation, of the sensorial power of irritation in one case, and of association in the other, contributing to actuate the next link of the catenated or associated motions. But when the torpor of the stomach is induced by previous exhaustion of its sensorial powers of irritation or of association by continued violent action, as by the stimulus of digitalis, or of contagious matter, or after intoxication from wine or opium, a weaker action of the heart and arteries succeeds, because there is no accumulation of sensorial power, and a deficient excitement of association. And finally, as this weak action of the heart and arteries is not induced by exhaustion of sensorial power, but by defect of the excitement of association, the accumulation of this power of association increases the action of the capillaries, and thus induces inirritative fever.
7. When any part of the system acts very violently in fevers, the sensorial power of sensation is excited, which increases the actions of the moving system; whereas the pain, which arises from decreased irritative motions, as in hemicrania, seems to exhaust a quantity of sensorial power, without producing or increasing any fibrous actions.
When the stomach is primarily affected, as in inirritative fevers from contagion, and in such a manner as to occasion pain, the action of the capillaries seems to be increased by this additional sensorial power of sensation, whence extensive inflammation or mortification; but when the stomach and consequently the heart and arteries continue their torpidity of action; as in confluent small-pox, and fatal scarlatina; this constitutes sensitive inirritative fever, or typhus gravior.
But when the stomach is secondarily affected, if the sensorial power of sensation is excited, as in pleurisy or peripneumony, the actions of the heart and arteries are violently increased, and of all the moving system along with them. Thus the peripneumony is generally induced by the patient respiring very cold air, and this especially after being long confined to warm air, or after being much fatigued and heated by excessive labour or exercise. For we can cover the skin with more clothes, when we feel ourselves cold; but the lungs not having the perception of cold, we do not think of covering them, nor have the power to cover them, if we desired it; and the torpor, thus produced is greater, or of longer duration, in proportion to the previous expenditure of sensorial power by heat or exercise.
This torpor of the lungs affects the skin with shuddering, and the stomach is also secondarily affected; next follows the violent action of the lungs from the accumulation of the power of irritation, and an inflammation of them follows this violent action. While the stomach recovers its activity by the increase of the excitement of the sensorial power of association, and along with it the heart and arteries, and the whole moving system. Hence this inflammation occurs during the hot fit of fever, and no cold fit succeeds, because the excess of the sensorial power of sensation prevents a succeeding torpor.
These new motions of certain parts of the system produce increased secretions of nutritious or organic mucus, which forms new vessels; these new vessels by their unusual motions produce new kinds of fluids; which are termed contagious, because they have the power, when introduced into a healthy body, of producing similar actions and effects, with or without fever, as in the small-pox and measles, or in the itch and venereal disease.
If any of these contagious matters affect the stomach with torpor either by their stimulus immediately applied, or by its sympathy with the parts first diseased, a fever is produced with sickness and want of appetite; as in small-pox, and scarlatina. If the stomach is not affected by contagious matter, no fever succeeds, as in itch, tinea, syphilis.
All these contagious matters are conceived to be harmless, till they have been exposed to the air, either openly or through a moist membrane; from which they are believed to acquire oxygene, and thence to become some kinds of animal acids. As the preparations of mercury cure venereal ulcers; as a quarter of a grain of sublimate dissolved in wine, and given thrice a day; this effect, seems to be produced either by its stimulating the absorbents in the ulcer to absorb the venereal matter before it has acquired oxygene; or by afterwards uniting with it chemically, and again depriving it of its acquired acidity. On either supposition it might probably be given with advantage in small-pox, and in all infectious diseases, both previous to their commencement, and during their whole progress.
8. The cold fits of intermittent fevers are caused by the torpor of some part owing to deficient irritation, and of the other parts of the system from deficient association. The hot fits are owing first to the accumulation of irritation in the part primarily affected, if it recovers its action, which does not always happen; and secondly to the accumulation of association in the other parts of the system, which during health are subject to perpetual action; and lastly also to the greater excitement of the power of association, when the part primarily affected recovers its irritability, and acts with greater energy than natural.
The deficient secretions in the cold fit depend on the torpor of the glandular system; and the increased secretions in the hot fit on their more energetic action. The thirst in the cold fit is owing to the deficient absorption from the skin, cellular membrane, and bladder; the thirst in the hot fit is owing to the too great dissipation of the aqueous part of the blood. The urine is pale and in small quantity in the cold fit from deficient secretion of it, and from deficient absorption of its aqueous parts; it is high coloured, and sometimes deposits a sediment, in the hot fit from the greater secretion of it in the kidneys, and the greater absorption of its aqueous and saline part in the bladder. The dryness and scurf on the tongue and nostrils is owing to the increased heat of the air expired from the lungs, and consequent greater evaporation of the aqueous part of the mucus. The sweats appear in consequence of the declension of the hot fit, owing to the absorbent vessels of the skin losing their increased action sooner than the secerning ones; and to the evaporation lessening as the skin becomes cooler. The returns of the paroxysms are principally owing to the torpor of some less essential part of the system remaining after the termination of the last fit; and are also dependent on solar or lunar diurnal periods.
The torpor of the part, which induces the cold paroxysm, is owing to deficient irritation occasioned either by the subduction of the natural stimuli of food, or water, or pure air, or by deficiency of external influences, as of heat, or of solar or lunar gravitation. Or secondly, in consequence of the exhaustion of sensorial power by great previous exertions of some parts of the system, as of the limbs by great labour or exercise, or of the stomach by great stimulus, as by contagious matter swallowed with the saliva, or by much wine or opium previously taken into it. Or lastly a torpor of a part may be occasioned by some mechanic injury, as by a compression of the nerves of the part, or of their origin in the brain; as the sitting long with one leg crossed over the other occasions numbness, and as a torpor of the stomach, with vomiting frequently precedes paralytic strokes of the limbs.
As sleep is produced, either by defect of stimulus, or by previous exhaustion of sensorial power; so the accumulation of the sensorial power of volition in those muscles and organs of sense, which are generally obedient to it, awakens the sleeping person; when it has increased the quantity of voluntarity so much as to overbalance the defect of stimulus in one case, and the exhaustion of sensorial power in the other; which latter requires a much longer time of sleep than the former. So the cold paroxysm of fever is produced either by defect of stimulus, or by previous exhaustion of the sensorial power of some part of the system; and the accumulation of the sensorial power of irritation in that part renews the action of it, when it has increased its irritability so much as to overbalance the defect of stimulus in one case and the exhaustion of sensorial power in the other; which latter requires a much longer torpor or cold fit than the former.
But in the cold paroxysm of fever besides the torpor of one part of the system from defect of irritation, the remainder of it becomes torpid owing to defect of excitement of the sensorial power of association by the lessened action of the part first affected. This torpor of the general system remains, till the accumulation of the sensorial power of association has increased the associability so much as to overbalance the defect of the excitement of association; then the torpor ceases, and if the first affected part has recovered its activity the other parts are all thrown into excess of action by their increased associability, and the hot fit of fever is produced.
9. In the continued fevers with strong pulse the stomach is affected secondarily, and thus acts feebly from deficient excitement of the power of association; but the accumulation of the power of association thus produced in an organ subject to perpetual and energetic action, is so great as to affect the next link of the associate train, which consists of the heart and arteries; these therefore are exerted perpetually with increase of action.
In continued fevers with weak pulse the torpid stomach is affected primarily by previous exhaustion of its irritability by stimulus, as of contagious matter swallowed into it. The heart and arteries act feebly from deficient excitement of the power of association, owing to the torpor of the stomach, with which they are catenated; but the accumulation of the power of association, thus produced in organs subject to perpetual and energetic motion, is so great, as to affect the next link of the associate train; which consists of the capillaries of the skin or other glands; these therefore are exerted perpetually with great increase of action.
The continued fevers with strong pulse terminate by the reduction or exhaustion of the sensorial power by violent action of the whole system; which is followed either by return of health with the natural quantity of irritability, and of associability, or by a total destruction of them both, and consequent death.
In continued fevers with weak pulse the stomach remains torpid during the whole course of the fever; and at length by the recovery of its irritability and sensibility effects the cure of it. Which generally happens about the first, second, or third quarter of the lunar period, counted from the commencement of the disease, or continues a whole lunation, and sometimes more; which gave rise to what are termed critical days. See Sect. XXXVI. 4. on this subject. If the stomach does not recover from its torpor, the patient becomes emaciated, and dies exhausted by the continuance of the increased action of the capillaries and absorbents, and the want of nourishment.
The cure of continued fever with weak pulse consists first in weakening the undue action of the capillaries of the skin by ablution with cold water from 32 to 80 degrees of heat; or by exposing them to cool air. Secondly by invigorating the actions of the stomach, by decreasing them for a time, and thence accumulating the power of irritation, as by an emetic, or by iced water, or iced wine. Or by increase of stimulus, as by bark, wine, opium, and food, in small quantities frequently repeated. Or by renewing the action of the stomach by slight electric shocks. Or by fomenting it frequently with water heated to 96 or 100 degrees. Or lastly by exciting its power of association with other parts of the system, as by a blister; which succeeds best when the extremities are cool; or by swinging, as in vertigo rotatoria.
If by the stimulus of the Peruvian bark on the fibres of the stomach, they regain their due action, the heart and arteries also regain their due action; as their sensorial power of association is now excited, and expended as usual. And as there is then no accumulation of sensorial power in the heart and arteries, the capillaries cease to act with too great energy, and the fever is cured.
Thirdly. If the heart and arteries could be themselves stimulated into greater action, although the stomach remained torpid, they might probably by expending a greater quantity of the sensorial power of irritation, prevent an accumulation of the sensorial power of association, (for these may possibly be only different modes of action of the spirit of animation,) and thus the too great action of the capillaries might be prevented and the fever cease. This new mode of cure might possibly be accomplished, if the patient was to breathe a gallon or two of pure or diluted oxygene gas frequently in a day; which by passing through the moist membranes of the lungs and uniting with the blood might render it more stimulant, and thus excite the heart and arteries into greater action.
Fourthly. Greater energy might probably be given to the whole system, and particularly to those parts which act too feebly in fevers, as the stomach and the heart and arteries, if the action of the secerning vessels of the brain could be increased in energy; this is probably one effect of all those drugs, which when given in large quantity induce intoxication, as wine and opium. And when given with great caution in small quantities uniformly repeated, as from three drops to five of the tincture of opium, but not more, every six hours, I believe they supply an efficacious medicine in fevers with great arterial debility; and the more so, if the Peruvian bark be exhibited alternately every six hours along with them. There are other means of exciting the vessels of the brain into action; as first by decreasing the stimulus of heat by temporary cold fomentation; secondly, increasing the stimulus of heat by long continued warm fomentation; thirdly, by electricity, as very small shocks passed through it in all directions; and lastly by blisters on the head. All those require to be used with great caution, and especially where there exists an evident stupor, as the removing of that is I believe frequently injurious. See stupor, Class I. 2. 5. 10.
The cure of fever with strong pulse consists in the repeated use of venesection, gentle cathartics, diluents; medicines producing sickness, as antimonials, digitalis; or the respiration of carbonated hydrogen; or by respiration of atmospheric air lowered by a mixture of hydrogen, azote, or carbonic acid gas, or by compressing the brain by whirling in a decumbent posture, as if lying across an horizontal mill-stone. See the former parts of this supplement for the methods of cure both of fevers with strong and weak pulse.
10. When any difficulty occurs in determining the weak pulse from the strong one, it may generally be assisted by counting its frequency. For when an adult patient lies horizontally in a cool room, and is not hurried or alarmed by the approach of his physician, nor stimulated by wine or opium, the strong pulse seldom exceeds 118 or 120 in a minute; and the weak pulse is generally not much below 130, and often much above that number. Secondly in sitting up in bed, or changing the horizontal to a perpendicular posture, the quickness of the weak pulse is liable immediately to increase 10 or 20 pulsations in a minute, which does not I believe occur in the strong pulse, when the patient has rested himself after the exertion of rising.
XVII. _Conclusion._
Thus have I given an outline of what may be termed the sympathetic theory of fevers, to distinguish it from the mechanic theory of Boerhaave, the spasmodic theory of Hoffman and of Cullen, and the putrid theory of Pringle. What I have thus delivered, I beg to be considered rather as observations and conjectures, than as things explained and demonstrated; to be considered as a foundation and a scaffolding, which may enable future industry to erect a solid and a beautiful edifice, eminent both for its simplicity and utility, as well as for the permanency of its materials,--which may not moulder, like the structures already erected, into the sand of which they were composed; but which may stand unimpaired, like the Newtonian philosophy, a rock amid the waste of ages!
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ADDITIONS.
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ADDITION I.
At the end of the article Canities, in Class I. 2. 2. 11. please to add the following:
As mechanical injury from a percussion, or a wound, or a caustic, is liable to occasion the hair of the part to become grey; so I suspect the compression of parts against each other of some animals in the womb is liable to render the hair of those parts of a lighter colour; as seems often to occur in black cats and dogs. A small terrier bitch now stands by me, which is black on all those parts, which were external, when she was wrapped up in the uterus, teres atque rotunda; and those parts white, which were most constantly pressed together; and those parts tawny, which were generally but less constantly pressed together. Thus the hair of the back from the forehead to the end of the tail is black, as well as that of the sides, and external parts of the legs, both before and behind.
As in the uterus the chin of the whelp is bent down, and lies in contact with the fore part of the neck and breast; the tail is applied close against the division of the thighs behind; the inside of the hinder thighs are pressed close to the sides of the belly, all these parts have white hairs.
The fore-legs in the uterus lie on each side of the face; so that the feet cover part of the temples, and compress the prominent part of the upper eye-brows, but are so placed as to defend the eye-balls from pressure; it is curious to observe, that the hair of the sides of the face, and of the prominent upper eye-brows, are tawny, and of the inside of the feet and legs, which covered them; for as this posture admitted of more change in the latter weeks of gestation, the colour of these parts is not so far removed from black, as of those parts, where the contact or compression was more uniform.
Where this uterine compression of parts has not been so great as to render the hair white in other animals, it frequently happens, that the extremities of the body are white, as the feet, and noses, and tips of the ears of dogs and cats and horses, where the circulation is naturally weaker; whence it would seem, that the capillary glands, which form the hair, are impeded in the first instance by compression, and in the last by the debility of the circulation in them. See Class I. 1. 2. 15.
This day, August 8th, 1794, I have seen a negro, who was born (as he reports) of black parents, both father and mother, at Kingston in Jamaica, who has many large white blotches on the skin of his limbs and body; which I thought felt not so soft to the finger, as the black parts. He has a white divergent blaze from the summit of his nose to the vertex of his head; the upper part of which, where it extends on the hairy scalp, has thick curled hair, like the other part of his head, but quite white. By these marks I supposed him to be the same black, who is described, when only two years old, in the Transactions of the American Philosophical Society, Vol. II. page 292, where a female one is likewise described with nearly similar marks.
The joining of the frontal bones, and the bregma, having been later than that of the other sutures of the cranium, probably gave cause to the whiteness of the hair on these parts by delaying or impeding its growth.
ADDITION II.
The following extract from a letter of Dr. Beddoes on hydrocephalus internus, I esteem a valuable addition to the article on that subject at Class I. 2. 3. 12.
"Master L----, aged 9 years, became suddenly ill in the night about a week before I saw him. On the day before the attack, he had taken opening medicines, and had bathed afterwards. He had complained of violently acute pain in his head, shrieked frequently, ground his teeth hard, could not bear to have his head raised from the pillow, and was torpid or deaf. His tongue was white, pulse 110 in the evening and full. As yet the pupil of the eye was irritable, and he had no strabismus. He had been bled with leeches about the head, and blistered. I directed mercurial inunction, and calomel from 3 to 6 grains to be taken at first every six, and afterwards every three hours. This plan produced no sensible effect, and the patient died on the 18th day after the seizure. He had convulsion fits two days preceding his death, and the well-known symptoms of hydrocephalus internus all made their appearance. From what I had seen and read of this disease, I believed it to belong to inflammations, and at an earlier period I should be tempted to bleed as largely as for pneumonia. The fluid found after death in the ventricules of the brain I impute to debility of the absorbents induced by inflammation. My reasons are briefly these; 1. The acuteness of the pain. 2. The state of the pulse. In the above case for the first 9 or 10 days it did not exceed 110, and was full and strong.
3. To find out whether any febrile alternations took place, Master L.'s feet were frequently felt, and they were found at times cold, and at other times of a dry heat. I have many times seen this disease, but the patients were too young, or too far advanced, to inform me, whether they had chillness succeeded by heat at its onset. 4. The disorders to which the young are more peculiarly liable afford a presumption, that hydrocephalus internus is an inflammatory disease; and this is confirmed by the regularity of the period, within which it finishes its course. And lastly, does it not happen more frequently than is suspected from external injury?
I have just now been well informed, that Dr. Rush has lately cured five out of six patients by copious bleedings. I relate here the reasons for an opinion without pretending to a discovery. Something like this doctrine may be found in certain modern publications, but it is delivered in that vague and diffuse style, which I trust your example will banish from medical literature."
Clifton, near Bristol, _July 28, 1795_.
To this idea of Dr. Beddoes may be added, that the hydrocele generally succeeds an injury, and consequent inflammation of the bag, which contains it. And that other dropsies, which principally attend inebriates, are consequent to too great action of the mucous membranes by the stimulus of beer, wine, and spirits. And lastly, that as these cases of hydrocephalus end so fatally, a new mode of treating them is much to be desired, and deserves to be seriously attended to.
ADDITION III. ON VERTIGO.
_To be placed after the additional Note at the end of Vol. I. on this Subject._
Having reperused the ingenious Essay of Dr. Wells on Single Vision, and his additional observations in the Gentleman's Magazine on the apparent retrogression of objects in vertigo, I am induced to believe, that this apparent retrogression of objects is not always owing to the same cause.
When a person revolves with his eyes closed, till he becomes vertiginous, and then stands still without opening them, he seems for a while to go forward in the same direction. This hallucination of his ideas cannot be owing to ocular spectra, because, as Dr. Wells observes, no such can have been formed; but it must arise from a similar continuance or repetition of ideas belonging to the sense of touch, instead of to the sense of vision; and should therefore be called a tangible, not a visual, vertigo. In common language this belief of continuing to revolve for some time, after he stands still, when a person has turned round for a minute in the dark, would be called a deception of imagination.
Now at this time if he opens his eyes upon a gilt book, placed with other books on a shelf about the height of his eye, the gilt book seems to recede in the contrary direction; though his eyes are at this time kept quite still, as well as the gilt book. For if his eyes were not kept still, other books would fall on them in succession; which, when I repeatedly made the experiment, did not occur; and which thus evinces, that no motion of the eyes is the cause of the apparent retrocession of the gilt book. Why then does it happen?--Certainly from an hallucination of ideas, or in common language the deception of imagination.
The vertiginous person still imagines, that he continues to revolve forwards, after he has opened his eyes; and in consequence that the objects, which his eyes happen to fall upon, are revolving backward; as they would appear to do, if he was actually turning round with his eyes open. For he has been accustomed to observe the motions of bodies, whether apparent or real, so much more frequently by the eye than by the touch; that the present belief of his gyration, occasioned by the hallucinations of the sense of touch, is attended with ideas of such imagined motions of visible objects, as have always accompanied his former gyrations, and have thus been associated with the muscular actions and perceptions of touch, which occurred at the same time.
When the remains of colours are seen in the eye, they are termed ocular spectra; when remaining sounds are heard in the ear, they may be called auricular murmurs; but when the remaining motions, or ideas, of the sense of touch continue, as in this vertigo of a blindfolded person, they have acquired no name, but may be termed evanescent titillations, or tangible hallucinations.
Whence I conclude, that vertigo may have for its cause either the ocular spectra of the sense of vision, when a person revolves with his eyes open; or the auricular murmurs of the sense of hearing, if he is revolved near a cascade; or the evanescent titillations of the sense of touch, if he revolves blindfold. All these I should wish to call vanishing ideas, or sensual motions, of those organs of sense; which, ideas, or sensual motions, have lately been associated in a circle, and therefore for a time continue to be excited. And what are the ideas of colours, when they are excited by imagination or memory, but the repetition of finer ocular spectra? What the idea of sounds, but the repetition of finer auricular murmurs? And what the ideas of tangible objects, but the repetition of finer evanescent titillations?
The tangible, and the auricular, and the visual vertigo, are all perceived by many people for a day or two after long travelling in a boat or coach; the motions of the vessel, or vehicle, or of the surrounding objects, and the noise of the wheels and oars, occur at intervals of reverie, or at the commencement of sleep. See Sect. XX. 5. These ideas, or sensual motions, of sight, of hearing, and of touch, are succeeded by the same effects as the ocular spectra, the auricular murmurs, and the evanescent titillations above mentioned; that is, by a kind of vertigo, and cannot in that respect be distinguished from them. Which is a further confirmation of the truth of the doctrine delivered in Sect. III. of this work, that the colours remaining in the eyes, which are termed ocular spectra, are ideas, or sensual motions, belonging to the sense of vision, which for too long a time continue their activity.
ADDITION IV. OF VOLUNTARY MOTIONS.
A correspondent acquaints me, that he finds difficulty in understanding how the convulsions of the limbs in epilepsy can be induced by voluntary exertions. This I suspect first to have arisen from the double meaning of the words "involuntary motions;" which are sometimes used for those motions, which are performed without the interference of volition, as the pulsations of the heart and arteries; and at other times for those actions, which occur, where two counter volitions oppose each other, and the stronger prevails; as in endeavouring to suppress laughter, and to stop the shudderings, when exposed to cold. Thus when the poet writes,
------video meliora, proboque, Deteriora sequor.----
The stronger volition actuates the system, but not without the counteraction of unavailing smaller ones; which constitute deliberation.
A second difficulty may have arisen from the confined use of the words "to will," which in common discourse generally mean to choose after deliberation; and hence our will or volition is supposed to be always in our own power. But the will or voluntary power, acts always from motive, as explained in Sect. XXXIV. 1. and in Class IV. 1. 3. 2. and III. 2. 1. 12. which motive can frequently be examined previous to action, and balanced against opposite motives, which is called deliberation; at other times the motive is so powerful as immediately to excite the sensorial power of volition into action, without a previous balancing of opposite motives, or counter volitions. The former of these volitions is exercised in the common purposes of life, and the latter in the exertions of epilepsy and insanity.
It is difficult _to think without words_, which however all those must do, who discover new truths by reasoning; and still more difficult, when the words in common use deceive us by their twofold meanings, or by the inaccuracy of the ideas, which they suggest.
ADDITION V. OF FIGURE.
I feel myself much obliged by the accurate attention given to the first volume of Zoonomia, and by the ingenious criticisms bestowed on it, by the learned writers of that article both in the Analytical and English Reviews. Some circumstances, in which their sentiments do not accord with those expressed in the work, I intend to reconsider, and to explain further at some future time. One thing, in which both these gentlemen seem to dissent from me, I shall now mention, it is concerning the manner, in which we acquire the idea of figure; a circumstance of great importance in the knowledge of our intellect, as it shews the cause of the accuracy of our ideas of motion, time, space, number, and of the mathematical sciences, which are concerned in the mensurations or proportions of figure.
This I imagine may have in part arisen from the prepossession, which has almost universally prevailed, that ideas are immaterial beings, and therefore possess no properties in common with solid matter. Which I suppose to be a fanciful hypothesis, like the stories of ghosts and apparitions, which have so long amused, and still amuse, the credulous without any foundation in nature.
The existence of our own bodies, and of their solidity, and of their figure, and of their motions, is taken for granted in my account of ideas; because the ideas themselves are believed to consist of motions or configurations of solid fibres; and the question now proposed is, how we become acquainted with the figures of bodies external to our organs of sense? Which I can only repeat from what is mentioned in Sect. XIV. 2. 2. that if part of an organ of sense be stimulated into action, as of the sense of touch, that part so stimulated into action must possess figure, which must be similar to the figure of the body, which stimulates it.
Another previous prepossession of the mind, which may have rendered the manner of our acquiring the knowledge of figure less intelligible, may have arisen from the common opinion of the perceiving faculty residing in the head; whereas our daily experience shews, that our perception (which consists of an idea, and of the pleasure or pain it occasions) exists principally in the organ of sense, which is stimulated into action; as every one, who burns his finger in the candle, must be bold to deny.
When an ivory triangle is pressed on the palm of the hand, the figure of the surface of the part of the organ of touch thus compressed is a triangle, resembling in figure the figure of the external body, which compresses it. The action of the stimulated fibres, which constitute the idea of hardness and of figure, remains in this part of the sensorium, which forms the sense of touch; but the sensorial motion, which constitutes pleasure or pain, and which is excited in consequence of these fibrous motions of the organ of sense, is propagated to the central parts of the sensorium, or to the whole of it; though this generally occurs in less degree of energy, than it exists in the stimulated organ of sense; as in the instance above mentioned of burning a finger in the candle.
Some, who have espoused the doctrine of the immateriality of ideas, have seriously doubted the existence of a material world, with which only our senses acquaint us; and yet have assented to the existence of spirit, with which our senses cannot acquaint us; and have finally allowed, that all our knowledge is derived through the medium of our senses! They forget, that if the spirit of animation had no properties in common with matter, it could neither affect nor be affected by the material body. But the knowledge of our own material existence being granted, which I suspect few rational persons will seriously deny, the existence of a material external world follows in course; as our perceptions, when we are awake and not insane, are distinguished from those excited by sensation, as in our dreams, and from those excited by volition or by association as in insanity and reverie, by the power we have of comparing the present perceptions of one sense with those of another, as explained in Sect. XIV. 2. 5. And also by comparing the tribes of ideas, which the symbols of pictures, or of languages, suggest to us, by intuitive analogy with our previous experience, that is, with the common course of nature. See Class III. 2. 2. 3. on Credulity.
ADDITION VI.
_Please to add the following in page 14, after line 20._
_Cold and hot Fit._
As the torpor, with which a fit of fever commences, is sometimes owing to defect of stimulus, as in going into the cold-bath; and sometimes to a previous exhaustion of the sensorial power by the action of some violent stimulus, as after coming out of a hot room into cold air; a longer time must elapse, before there can be a sufficient accumulation of sensorial power to produce a hot fit in one case than in the other. Because in the latter case the quantity of sensorial power previously expended must be supplied, before an accumulation can begin.
The cold paroxysm commences, when the torpor of a part becomes so great, and its motions in consequence so slow or feeble, as not to excite the sensorial power of association; which in health contributes to move the rest of the system, which is catenated with it. And the hot fit commences by the accumulation of the sensorial power of irritation of the part first affected, either so as to counteract its deficient stimulus, or its previous waste of sensorial power; and it becomes general by the accumulation of the sensorial power of association; which is excited by the renovated actions of the part first affected; or becomes so great as to overbalance the deficient excitement of it. On all these accounts the hot fit cannot be supposed to bear any proportion to the cold one in length of time, though the latter may be the consequence of the former. See Suppl. I. 16. 8.
ADDITION VII. ON WARMTH.
_To be added at the end of the Species Sudor Calidus, in Class I. 1. 2. 3._
When the heat of the body in weak patients in fevers is increased by the stimulus of the points of flannel, a greater consequent debility succeeds, than when it is produced by the warmth of fire; as in the former the heat is in part owing to the increased activity of the skin, and consequent expenditure of sensorial power; whereas in the latter case it is in part owing to the influx of the fluid matter of heat.
So the warmth produced by equitation, or by rubbing the body and limbs with a smooth brush or hand, as is done after bathing in some parts of the East, does not expend nearly so much sensorial power, as when the warmth is produced by the locomotion of the whole weight of the body by muscular action, as in walking, or running, or swimming. Whence the warmth of a fire is to be preferred to flannel shirts for weak people, and the agitation of a horse to exercise on foot. And I suppose those, who are unfortunately lost in snow, who are on foot, are liable to perish sooner by being exhausted by their muscular exertions; and might frequently preserve themselves by lying on the ground, and covering themselves with snow, before they were too much exhausted by fatigue. See Botan. Garden, Vol. II. the note on Barometz.
ADDITION VIII. PUERPERAL FEVER.
_To be added to Class II. 1. 6. 16._
A very interesting account of the puerperal fever, which was epidemic at Aberdeen, has been lately published by Dr. Alexander Gordon. (Robinson, London.) In several dissections of those, who died of this disease, purulent matter was found in the cavity of the abdomen; which he ascribes to an erysipelatous inflammation of the peritonaeum, as its principal seat, and of its productions, as the omentum, mesentery, and peritonaeal coat of the intestines.
He believes, that it was infectious, and that the contagion was always carried by the accoucheur or the nurse from one lying-in woman to another.
The disease began with violent unremitting pain of the abdomen on the day of delivery, or the next day, with shuddering, and very quick pulse, often 140 in a minute. In this situation, if he saw the patient within 12 or 24 hours of her seizure, he took away from 16 to 24 ounces of blood, which was always sizy. He then immediately gave a cathartic consisting of three grains of calomel, and 40 grains of powder of jalap. After this had operated, he gave an opiate at night; and continued the purging and the opiate for several days.
He asserts, that almost all those, whom he was permitted to treat in this manner early in the disease, recovered to the number of 50; and that almost all the rest died. But that when two or three days were elapsed, the patient became too weak for this method; and the matter was already formed, which destroyed them. Except that he saw two patients, who recovered after discharging a large quantity of matter at the navel. And a few, who were relieved by the appearance of external erysipelas on the extremities.
This disease, consisting of an erysipelatous inflammation, may occasion the great debility sooner to occur than in inflammation of the uterus; which latter is neither erysipelatous, I suppose, nor contagious. And the success of Dr. Gordon's practice seems to correspond with that of Dr. Rush in the contagious fever or plague at Philadelphia; which appeared to be much assisted by early evacuations. One case I saw some time ago, where violent unceasing pain of the whole abdomen occurred a few hours after delivery, with quick pulse; which ceased after the patient had twice lost about eight ounces of blood, and had taken a moderate cathartic with calomel.
This case induces me to think, that it might be safer and equally efficacious, to take less blood at first, than Dr. Gordon mentions, and to repeat the operation in a few hours, if the continuance of the symptoms should require it. And the same in respect to the cathartic, which might perhaps be given in less quantity, and repeated every two or three hours.
Nor should I wish to give an opiate after the first venesection and cathartic; as I suspect that this might be injurious, except those evacuations had emptied the vessels so much, that the stimulus of the opiate should act only by increasing the absorption of the new vessels or fluids produced on the surfaces of the inflamed membranes. In other inflammations of the bowels, and in acute rheumatism, I have seen the disease much prolonged, and I believe sometimes rendered fatal, by the too early administration of opiates, either along with cathartics, or at their intervals; while a small dose of opium given after sufficient evacuations produces absorption only by its stimulus, and much contributes to the cure of the patient. We may have visible testimony of this effect of opium, when a solution of it is put into an inflamed eye; if it be thus used previous to sufficient evacuation, it increases the inflammation; if it be used after sufficient evacuation, it increases absorption only, and clears the eye in a very small time.
I cannot omit observing, from considering these circumstances, how unwise is the common practice of giving an opiate to every woman immediately after her delivery, which must often have been of dangerous consequence.
END OF THE SECOND PART.
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ZOONOMIAE AUCTORI
_S.P.D._
AMICUS.
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_CURRUS TRIUMPHALIS MEDICINAE._
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Currus it Hygeiae, Medicus movet arma triumphans, Undique victa fugit lurida turma mali.---- Laurea dum Phoebi viridis tua tempora cingit, Nec mortale sonans Fama coronat opus; Post equitat trepidans, repetitque Senectus in aurem, Voce canens stridula, "sis memor ipse mori!"
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INDEX OF THE CLASSES.
A.
Abortion, i. 2. 1. 14. ---- from fear, iv. 3. 1. 7. ---- not from epilepsy, iii. 1. 1. 7. ---- not from hepatitis, ii. 1. 2. 12. Absorption of solids, i. 2. 2. 14. ---- of matter, ii. 1. 6. 2. and 6. ---- cellular, iv. 1. 1. 6. ---- from the lungs, iv. 3. 1. 5. Suppl. i. 8. 6. Abstinence of young ladies, ii. 2. 2. 1. Accumulation of feces, ii. 2. 2. 7. Acupuncture, iii. 1. 1. 8. Adipsia, ii. 2. 2. 2. Aegritudo ventriculi, i. 2. 4. 4. ---- See Sickness. Agrypnia. See Vigilia. Ague-cakes, Suppl. i. 2. 3. Alum in ulcers of the mouth, ii. 1. 3. 1. Ambition, iii. 1. 2. 9. Amaurosis, i. 2. 5. 5. Anasarca of the lungs, i. 2. 3. 16. Anger, iii. 1. 2. 17. Anger, tremor of, iv. 2. 3. 4. ---- blush of, iv. 2. 3. 5. Angina. See Tonsillitis. ---- pectoris. See Asthma painful. Anhelitus, ii. 1. 1. 4. Anhelatio spasmodica, i. 3. 3. 3. Annulus repens, ii. 1. 5. 10. Anorexia, ii. 2. 2. 1. ---- maniacalis, Suppl. i. 14. 3. ---- epileptica, ii. 2. 2. 1. iii. 1. 1. 7. Apepsia, i. 3. 1. 3. Suppl. i. 8. 11. Aphtha, ii. 1. 3. 17. Apoplexy, iii. 2. 1. 16. Appetite defective, ii. 2. 2. 1. ---- depraved, iii. 1. 2. 19. ---- from abstinence, ii. 2. 2. 1. ---- destroyed, iii. 1. 2. 20. ---- from epilepsy, ii. 2. 2. 1. Arm, pain of, iv. 2. 2. 13. ---- palsy of, iii. 2. 1. 4. Arsenic in tooth-ach, i. 2. 4. 12. ---- in head-ach, i. 2. 4. 11. Arthrocele, ii. 1. 4. 17. Arthropuosis, ii. 1. 4. 18. Arthritis. See Gout. Ascarides, i. 1. 4. 12. iv. 1. 2. 9. Ascites, i. 2. 3. 13. Associations affected four ways, iv. 1. 1. G. ---- how produced, iv. 1. 1. H. ---- distinct from catenations, iv. 1. 1. A. ---- three kinds of, iv. 1. 1. B. ---- tertian, iv. 1. 1. K. ---- of the fauces and pubis, iv. 1. 2. 7. ---- sensitive, a law of, iv. 2. 2. 2. ---- sensitive iv. 2. 1. ---- accumulates, Suppl. i. 8. 3. i. 11. 4. Asthma humoral, ii. 1. 1. 7. i. 3. 2. 8. ---- of infants, i. 1. 3. 4. ---- convulsive, iii. 1. 1. 10. ---- painful, iii. 1. 1. 11. Auditus acrior, i. 1. 5. 2. ---- imminutus, i. 2. 5. 6. Azote, Suppl. i. 9. 3. i. 11. 6.
B.
Bandages, ill effect of, ii. 1. 1. 12. ---- promote absorption, i. 1. 3. 13. Bath, cold, i. 2. 2. 1. ---- warm, Addit. vii. Beauty, iii. 1. 2. 4. ---- loss of, iii. 1. 2. 12. Bile-duct, pain of, iv. 2. 2. 4. Bile crystalized, i. 1. 3. 8. Bitter taste, i. 1. 3. 1. ---- not from bile, i. 1. 3. 1. Bleeding. See Haemorrhage. Bladder, distention of, ii. 2. 2. 6. ---- stone of, i. 1. 3. 10. ---- catarrh of, ii. 1. 4. 11. Blindness, i. 2. 5. 5. Blush of anger, iv. 2. 3. 5. Suppl. i. 12. 7. ---- of guilt, iv. 2. 3. 6. Suppl. i. 12. 7. Bones, innutrition of, i. 2. 2. 14. ---- caries of, ii. 1. 4. 19. Borborigmus, i. 3. 1. 9. Bougies, ii. 1. 4. 11. Brachiorum paralysis, iii. 2. 1. 4. Brain stimulated, Suppl. i. 16. 9. Bronchocele, i. 2. 3. 20. Burns, i. 1. 3. 13. Butterflies, experiment on, i. 1. 2. 3.
C.
Cacositia, iii. 1. 2. 20. Calculi productio, i. 1. 3. 9. ii. 1. 2. 14. ---- renis, i. 1. 3. 9. iv. 2. 3. 3. ---- vesicae, i. 1. 3. 10. iv. 2. 2. 2. Callico shirts, i. 1. 2. 3. Callus, i. 2. 2. 12. Canities. See Hair grey. Calor febrilis, i. 1. 2. 1. Calves fed on gruel, i. 1. 2. 5. ---- hydatides of, i. 2. 5. 4. Cancer, ii. 1. 4. 16. ii. 1. 6. 13. Cantharides, large dose of, iv. 2. 2. 2. Carbonic acid gas, Suppl. i. 9. 3. Cardialgia, i. 2. 4. 5. Carcinoma, ii. 1. 4. 16. ii. 1. 6. 13. Caries ossium, ii. 1. 4. 19. Cataract, i. 2. 2. 13. Catarrh, warm, i. 1. 2. 7. ---- cold, i. 2. 3. 3. ---- lymphatic, i. 3. 2. 1. ---- sensitive, ii. 1. 3. 5. ---- epidemic, ii. 1. 3. 6. ---- of dogs and horses, ii. 1. 3. 6. ---- from cold skin, iv. 1. 1. 5. ---- periodic, iv. 3. 4. 1. Catamenia, i. 2. 1. 11. iv. 2. 4. 7. Catalepsis, iii. 2. 1. 9. Cats, mumps of, ii. 1. 3. 4. Cephalaea frigida, i. 2. 4. 11. iv. 2. 2. 7. Charcoal tooth-powder, i. 2. 4. 12. Cheek, torpor of, iv. 2. 2. 1. Chicken pox, ii. 1. 3. 15. Chin-cough, ii. 1. 3. 8. Child-bed fever, ii. 1. 6. 16. Children, new born, ii. 1. 1. 12. ---- gripes and purging of, i. 1. 2. 5. Chlorosis, i. 2. 3. 10. Suppl. i. 8. 11. Chorea St. Viti, iv. 2. 3. 2. Citta, iii. 1. 2. 19. Clamor, iii. 1. 1. 3. Clavicular animals, ii. 1. 2. 6. Clavus hystericus, iv. 2. 2. 8. Claudicatio coxaria, i. 2. 2. 17. Cold in the head. See Catarrh. Colic, flatulent, i. 2. 4. 7. ---- from lead, i. 2. 4. 8. ---- hysteric, i. 2. 4. 7. iii. 1. 1. 8. Cold air in fevers, iii. 2. 1. 12. iv. 2. 4. 11. ---- effects of, iii. 2. 1. 17. ---- how to be used, iv. 1. 1. 4. Compassion, iii. 1. 2. 24. Consumption, ii. 1. 6. 7. Convulsion, iii. 1. 1. 5. ---- weak, iii. 1. 1. 5. ---- from bad air, iii. 1. 1. 5. ---- painful, iii. 1. 1. 6. iv. 2. 4. 5. Consternation, i. 1. 5. 11. Constipation, i. 1. 3. 5. ii. 2. 2. 7. Contagious matter of two kinds, ii. 1. 3. ---- is oxygenated, ii. 1. 5. ---- produces fever, how, Suppl. i. 16. 7. Cornea to perforate, i. 1. 3. 14. ---- scars of seen on milk, i. 1. 3. 14. Corpulency, i. 2. 3. 17. Coryza. See Catarrh. Costiveness, i. 1. 3. 5. ii. 2. 2. 7. Cough of drunkards, ii. 1. 1. 5. ---- hooping, ii. 1. 3. 8. ---- hepatic, iv. 2. 1. 8. ---- gouty, iv. 2. 1. 9. ---- periodic, iv. 2. 4. 6. iv. 3. 4. 2. ---- from cold feet, iv. 2. 1. 7. Cows, pestilence of, ii. 1. 3. 13. ---- bloody urine of, ii. 1. 3. 13. Cramp, iii. 1. 1. 13. ---- painful, iii. 1. 1. 14. ---- in diarrhoea, iv. 1. 2. 10. Crab-lice, i. 1. 4. 14. Credulity, iii. 2. 2. 3. Crines novi, i. 1. 2. 15. Croup, i. 1. 3. 4. ii. 1. 2. 4. ii. 1. 3. 3. Crusta lactea, ii. 1. 5. 12. Cutis arida, i. 1. 3. 6. Cynanche. See Tonsillitis. ---- parotidaea. See Parotitis.
D.
Darkness in fevers, i. 2. 5. 3. Deafness, two kinds of, i. 2. 5. 6. Debility, three kinds of, i. 2. 1. ---- and strength metaphors, i. 2. 1. Decussation of nerves, iii. 2. 1. 10. Deglutition, ii. 1. 1. 1. ---- involuntary, iv. 1. 3. 1. Dentition, i. 1. 4. 5. Dentium dolor a stridore, iv. 1. 2. 3. Descent of the uterus, i. 1. 4. 8. Diabetes, i. 3. 2. 6. ---- foul tongue in, i. 1. 3. 1. ---- irritative, iv. 3. 1. 1. ---- from fear, iv. 3. 1. 3. Diarrhoea warm, i. 1. 2. 5. ---- of infants, i. 1. 2. 5. ---- lymphatic, i. 3. 2. 4. ---- chyliferous, i. 3. 2. 5. ---- cold, i. 2. 3. 6. ---- rheumatic, iv. 1. 2. 16. ---- from fear, iv. 3. 1. 4. ---- from toothing, iv. 2. 2. 14. ---- in fevers, Suppl. i. 2. 4. ---- cure of, iv. 1. 1. f. Digestion increased by cold, iv. 1. 1. 4. ---- decreased by cold, iv. 2. 1. 6. Dilirium febrile, ii. 1. 7. 1. ---- of drunkenness, ii. 1. 7. 3. ---- maniacal, ii. 1. 7. 2. ---- in parotitis, iv. 1. 2. 19. Diluents, use of, ii. 1. 2. 1. Distention of the nipples, ii. 1. 7. 10. iv. 1. 2. 7. Diuretics useless in dropsy, i. 1. 3. 7. Dizziness. See Vertigo. Dogs, catarrh of, ii. 1. 3. 6. Dolor digiti sympathet, iv. 2. 2. 12. ---- ductus choledochi, iv. 2. 2. 4. ---- humeri in hepatitide, iv. 2. 2. 9. ---- pharyngis ab acido, iv. 2. 2. 5. ---- testium nephriticus, iv. 2. 2. 11. ---- urens, i. 1. 5. 10. Dracunculus, i. 1. 4. 13. Dreams, ii. 1. 7. 4. Dropsy of the brain, i. 2. 3. 12. ---- of the belly, i. 2. 3. 13. ---- of the chest, i. 2. 3. 14. ---- of the ovary, i. 2. 3. 15. ---- of the lungs, i. 2. 3. 16. ---- of the scrotum, i. 2. 3. 11. Dysentery, ii. 1. 3. 18. Dysmenorrhagia, i. 2. 1. 12. Dyspnoea from cold bath, iv. 2. 1. 5. ---- rheumatica, iv. 1. 2. 16. Dyspepsia, i. 3. 1. 3. ---- a frigore, iv. 2. 1. 6. Dysuria insensitiva, ii. 2. 2. 6.
E.
Ears, discharge behind, i. 1. 2. 9. ---- noise in them, iv. 2. 1. 15. Ear-ach, iv. 2. 2. 8. Ebrietas, i. 1. 1. 2. Education, iii. 2. 1. 8. iii. 1. 2. 24. ---- heroic, iii. 1. 2. 25. Egg boiled for inflamed eyes, ii. 1. 4. 1. ---- boiled soonest, Suppl. i. 7. ---- life of, iv. 1. 4. 1. Electric shocks, iv. 1. 4. 5. Electrized zinc and silver, i. 2. 5. 5. ---- in paralysis, ii. 1. 1. 9. ---- in scrophula, i. 2. 3. 21. ---- in hoarseness, iii. 2. 1. 5. Empyema, ii. 1. 6. 4. Enteralgia rheumatica, iv. 1. 2. 16. Enteritis, ii. 1. 2. 11. ---- superficialis, ii. 1. 3. 20. Epilepsy, iii. 1. 1. 7. iv. 3. 1. 6. ---- painful, iii. 1. 1. 8. iv. 2. 4. 4. ---- terminates with sleep, iii. 1. 1. ---- in parturition, iii. 1. 1. 7. ---- with indigestion, ii. 2. 2. 1. Epistaxis. See Haemorraghia. Epoulosis. See Cicatrix. Erotomania, iii. 1. 2. 4. Eructation, voluntary, iv. 3. 3. 3. Eruption of small-pox, iv. 1. 2. 12. iv. 2. 2. 10. Erysipelas, iv. 1. 2. 17. ii. 1. 3. 2. iv. 2. 4. 10. ---- seldom suppurates, why, ii. 1. 3. 2. Esuries, i. 2. 4. 2. Evil, i. 2. 3. 21. Expectoration, warm, i. 1. 2. 8. ---- solid, i. 1. 3. 4. ---- cold, i. 2. 3. 4. Exsudation behind the ears, i. 1. 2. 9. Eyes, blue under the, i. 2. 2. 2. ii. 1. 4. 4. Eyelid inverted, cure of, ii. 1. 1. 8. ---- coloured with antimony, ii. 1. 4. 3.
F.
Face, pimpled, ii. 1. 4. 6. ---- red after meals, Suppl. i. 12. 7. ---- flushed after dinner, iv. 1. 1. 1. Fat people why short breathed, ii. 1. 1. 4. Fear, syncope from, i. 2. 1. 4. ---- abortion from, iv. 3. 1. 7. ---- produces absorption, ii. 1. 6. 4. ---- paleness in, iv. 3. 1. 5. ---- of death, iii. 1. 2. 14. ---- of hell, iii. 1. 2. 15. ---- of poverty, iii. 1. 2. 13. Feet cold produces heartburn. Suppl. i. 8. 5. ---- fetid, i. 1. 2. 14. ---- cold in small-pox, iv. 2. 2. 10. Fevers, five kinds, ii. 1. 2. Suppl. i. 1. 2. ---- irritative, i. 1. 1. 1. iv. 1. 1. 8. ---- inirritative, i. 2. 1. 1. iv. 2. 1. 19. Suppl. i. 1. 2. ---- sensitive, ii. 1. 6. 1. ---- sensitive irritated, ii. 1. 2. 1. ---- sensitive inirritated, ii. 1. 3. 1. ---- intermit, why, Suppl. i. ---- continue, why, Suppl. i. ---- periods of, iv. 2. 4. 11. ---- simple, Suppl. i. 1. ---- compound, Suppl. i. 2. ---- termination of cold fit, Suppl. i. 3. ---- return of cold fit, Suppl. i. 4. ---- sensation in, Suppl. i. 5. ---- circles of motions in, Suppl. i. 6. ---- cold and hot fits, Suppl. i. 7. ---- continued, Suppl. i. 8. ---- torpor of lungs in, Suppl. i. 9. 1. ---- not determinable in cold fit, i. 1. 1. 1. ---- frequency of pulse in, i. 1. 1. 1. ---- not an effort to cure, i. 1. 2. 3. ---- puerperal, ii. 1. 6. 16. i. 2. 4. 9. ---- from inclosed matter, ii. 1. 6. 2. ---- from aerated matter, ii. 1. 6. 6. ---- from contagious matter, ii. 1. 6. 11. ---- from contagious sanies, ii. 1. 6. 15. ---- torpor of the stomach, Suppl. i. 12. ---- case of, Suppl. i. 13. ---- termination of, Suppl. i. 14. ---- inflammation excited, Suppl. i. 15. ---- returns of, Suppl. i. 4. ---- when cold air in, Suppl. i. 2. 2. ---- sympathetic, theory of, Suppl. i. ---- duration of explained, Suppl. i. 2. 5. Fingers, playing with, iv. 1. 3. 4. ---- pain of, iv. 2. 2. 12. Fish live longer with injured brain, i. 2. 5. 10. Fistula in ano, ii. 1. 4. 10. ---- lacrymalis, ii. 1. 4. 9. ---- urethra, ii. 1. 4. 11. Flannel shirt in diarrhoea, iv. 1. 1. 3. ---- injurious in summer, i. 1. 2. 3. Fluor albus warm, i. 1. 2. 11. ---- cold, i. 2. 3. 7. Frigus febrile, i. 2. 2. 1. ---- chronicum, i. 2. 2. 1.
G.
Gall-stone, i. 1. 3. 8. Gangreen, ii. 1. 6. 17. Gargles, ii. 1. 3. 3. Gastritis, ii. 1. 2. 10. ---- superficialis, ii. 1. 3. 19. Genu tumor albus, i. 2. 3. 19. Gleet. See Gonorrhoea. Globus hystericus, i. 3. 1. 7. Gonorrhoea warm, i. 1. 2. 10. ---- cold, i. 2. 3. 8. Gout, iv. 1. 2. 15. iv. 2. 4. 9. ---- of the liver, ii. 1. 1. 7. ---- cases of, iv. 1. 2. 15. ---- cough, iv. 2. 1. 9. ---- of the stomach, i. 2. 4. 6. ---- haemorrhage in, i. 1. 1. 4. Grace defined, iii. 1. 2. 4. Gravel distinguished from salts, i. 1. 3. 10. Gravitation, iv. 2. 4. Green-sickness. See Chlorosis. Grief, iii. 1. 2. 10. Gripes of children, i. 1. 2. 5. iv. 2. 1. 3. Gustus acrior, i. 1. 5. 4. ---- imminutus, i. 2. 5. 8. Gutta rosea, ii. 1. 4. 6. iv. 1. 2. 13. and 14. ---- serena, i. 2. 5. 5.
H.
Haemorrhage arterial, i. 1. 1. 3. ---- of the lungs, i. 1. 1. 4. ---- of the nose, i. 1. 1. 5. ---- venous, i. 2. 1. 5. ---- of the rectum, i. 2. 1. 6. ---- of the kidnies, i. 2. 1. 7. ---- of the liver, i. 2. 1. 8. Haemoptoe arterial, i. 1. 1. 4. ---- venous, i. 2. 1. 9. Haemorrhois cruenta, i. 2. 1. 6. iv. 2. 4. 8. ---- alba, i. 1. 2. 12. Hair, grey, i. 2. 2. 11. ---- new, i. 1. 2. 15. ---- white by uterine pressure, Addit. i. Hallucination of sight, ii. 1. 7. 5. ---- of hearing, ii. 1. 7. 6. ---- maniacal, iii. 1. 2. 1. ---- studiosa, iii. 1. 2. 2. Harrogate water fact, i. 1. 4. 12. Head-ach. See Hemicrania and Cephalaea. Hearing acuter, i. 1. 5. 2. ---- diminished, i. 2. 5. 6. Heart-burn, i. 2. 4. 5. Heart stimulated, Suppl. i. 11. 7. i. 16. 9. Heat, animal, i. 1. 2. 1. i. 1. 2. 3. ---- sense of acuter, i. 1. 5. 6. ---- elemental, iv. 2. 4. ---- hectic lessened by swinging, iv. 2. 1. 10. ---- not perceived by the lungs, iii. 1. 1. 10. ---- not estimated by thermometers, Suppl. i. 7. ---- of the breath, Suppl. i. 2. 2. Hemicrania, iv. 2. 2. 8. iv. 2. 4. 3. ---- relieved by mercury, iv. 2. 2. 8. Hemiplegia, iii. 2. 1. 10. Hepatis tumor, i. 2. 3. 9. Hepatitis, ii. 1. 2. 12. ---- chronica, ii. 1. 4. 12. Herpes, ii. 1. 5. 8. ---- nephritica, iv. 1. 2. 11. Hiccough, ii. 1. 1. 6. iv. 1. 1. 7. Hip-joint injured, i. 2. 2. 17. Hoarseness, ii. 1. 3. 5. iii. 2. 1. 5. Horses, broken wind of, i. 2. 4. 9. Humectation of the body, iv. 1. 4. 7. Hunger, i. 2. 4. 2. Hydatides in calves, i. 2. 5. 4. Hydrocele, i. 2. 3. 11. Hydrocephalus inter, i. 2. 3. 12. i. 2. 5. 4. iii. 2. 1. 10. ---- from inflammation, Addit. ii. Hydrogene gas. Suppl. i. 9. 3. i. 11. 6. ---- in fevers, Suppl. i. 11. 6. i. 16. 9. Hydrothorax, i. 2. 3. 14. case of, iv. 2. 2. 13. Hydro-carbonate gas, Suppl. i. 9. 1. Suppl. i. 15. 3. Hydrops ovarii, i. 2. 3. 15. Hydrophobia, i. 3. 1. 11. iii. 1. 1. 15. iv. 1. 2. 7. Hypochondriasis, i. 2. 4. 10. Hysteralgia frigida, i. 2. 4. 17. Hysteria, i. 3. 1. 10. Suppl. i. 8. 11. ---- from fear, iv. 3. 1. 8. ---- from cold, iv. 3. 4. 3. ---- convulsions in, iii. 1. 1. 5. ---- laughter in, iii. 1. 1. 5. Hysteritis, ii. 1. 2. 16.
I.
Jactitatio, iii. 1. 1. 1. Jaundice, i. 1. 3. 8. i. 2. 4. 19. Icterus, i. 1. 3. 8. i. 2. 4. 19. Ileus, i. 3. 1. 6. ii. 1. 2. 11. Impotentia, ii. 2. 2. 3. Indigestion, i. 3. 1. 3. ---- See Anorexia and Apepsia. ---- from cold feet, iv. 2. 1. 6. Sup. i. 8. 5. Incubus, iii. 2. 1. 13. Infants, green stools of, i. 1. 2. 5. ---- new born, ii. 1. 1. 12. Inflammation of the eye, ii. 1. 2. 2. ---- superficial, ii. 1. 4. 1. ---- of the brain, ii. 1. 2. 3. ---- of the lungs, ii. 1. 2. 4. ---- superficial, ii. 1. 3. 7. ---- of the pleura, ii. 1. 2. 5. ---- of the diaphragm, ii. 1. 2. 6. ---- of the heart, ii. 1. 2. 7. ---- of the peritoneum, ii. 1. 2. 8. ---- of the mesentery, ii. 1. 2. 9. ---- of the stomach, ii. 1. 2. 10. ---- superficial, ii. 1. 3. 19. ---- of the bowels, ii. 1. 2. 11. ---- superficial, ii. 1. 3. 20. ---- of the liver, ii. 1. 2. 12. ---- chronical, ii. 1. 4. 12. ---- of the spleen, ii. 1. 2. 13. Sup. i. 16. 6. ---- of the kidnies, ii. 1. 2. 14. ---- of the bladder, ii. 1. 2. 15. ---- of the womb, ii. 1. 2. 16. ---- of the tonsils, ii. 1. 3. 3. ---- of the parotis, ii. 1. 3. 4. Inirritability of lacteals, i. 2. 3. 26. ---- of lymphatics, i. 2. 3. 27. ---- of the gall-bladder, i. 2. 4. 19. ---- of the kidney, i. 2. 4. 20. ---- of the spleen, Suppl. i. 16. 6. ---- vicissitudes of, i. 1. 1. Inoculation, ii. 1. 3. 9. Innutrition of bones, i. 2. 2. 14. Insanity, quick pulse in, iii. 1. 1. ---- from parturition, iii. 1. 2. ---- with fever, iii. 1. 2. ---- cure of, iii. 1. 2. ---- confinement in, iii. 1. 2. Insensibility, ii. 2. 1. 1. Ira, iii. 1. 2. 17. Ischias, ii. 1. 2. 18. i. 2. 4. 15. Issues, use of, i. 1. 2. 9. iii. 1. 1. 11. Itch, ii. 1. 5. 6. Itching, i. 1. 5. 9. ---- of the nose, iv. 2. 2. 6.
L.
Lacrymarum fluxus sym. iv. 1. 2. 1. Lameness of the hip, i. 2. 2. 17. Lassitude, iii. 2. 1. 1. Laughter, iv. 2. 3. 3. iii. 1. 1. 4. iv. 1. 3. 3. ---- See Risus. Leg, one shorter, i. 2. 2. 17. Lepra, ii. 1. 5. 3. Lethargus, iii. 2. 1. 14. Lethi timor, iii. 1. 2. 14. Lice, i. 1. 4. 15. Lientery, i. 2. 3. 6. Light debilitates in fevers, i. 2. 5. 3. Lingua arida, i. 1. 3. 1. iv. 2. 4. 11. Liver, torpor of, i. 2. 2. 6. ---- tumor of, i. 2. 3. 9. ---- inflamed, ii. 1. 2. 12. Lochia nimia, i. 2. 1. 13. Locked jaw, iii. 1. 1. 13. Love, sentimental, iii. 1. 2. 4. Lues venerea, ii. 1. 5. 2. ---- imaginaria, iii. 1. 2. 21. Lumbago, ii. 1. 2. 17. iii. 1. 1. 1. ---- cold, i. 2. 4. 16. Lumbricus, i. 1. 4. 10. Lunar influence on the solids, i. 2. 1. 11. Lungs, adhesions of, ii. 1. 2. 5. ---- not sensible to heat, iii. 1. 1. 10. Lusus digitorum invitus, iv. 1. 3. 4.
M.
Maculae vultus, i. 2. 2. 10. Madness, mutable, iii. 1. 2. 1. Mammarum tumor, iv. 1. 2. 19. Mammularum tensio, iv. 1. 2. 6. i. 1. 4. 7. Mania mutabilis, iii. 1. 2. 1. Matter variolous, ii. 1. 3. 9. ---- contagious, ii. 1. 3. ii. 1. 6. 11. ---- inclosed, ii. 1. 6. 2. ---- oxygenated, ii. 1. 6. 6. ---- sanious, ii. 1. 6. 15. Measles, ii. 1. 3. 10. Membranes, what, iv. 1. 2. Menorrhagia, i. 2. 1. 11. Mercury crude, as a clyster, i. 3. 1. 6. ---- in all contagions, Suppl. i. 16. 7. ---- in vertigo, iv. 2. 1. 11. Miliaria, ii. 1. 3. 12. Milk new, for children, i. 1. 2. 5. ---- old, induces costiveness, ii. 2. 2. 7. Milk-crust, ii. 1. 5. 12. Miscarriage. See Abortion. Maeror, iii. 1. 2. 10. Mobility, iv. 1. 2. ---- of the skin, Suppl. i. 7. Mollities ossium, i. 2. 2. 14. Moon, effect of, iv. 2. 4. Morbilli. See Rubeola. Mortification, ii. 1. 6. 17. Morpiones, i. 1. 4. 14. Mucus diminished, i. 2. 2. 4. ---- of the throat cold, i. 2. 3. 1. ---- of the bowels, i. 2. 3. 6. i. 1. 2. 12. ---- of the lungs, i. 1. 3. 4. ---- forms stones, i. 1. 3. 9. ---- distinguished from pus, ii. 1. 6. 6. Mumps, ii. 1. 3. 4. Murmur aurium, iv. 2. 1. 15. Muscae volitantes, i. 2. 5. 3.
N.
Nails, biting of, iv. 1. 3. 5. Nares aridi, i. 1. 3. 3. Nausea, dry, i. 2. 4. 3. ---- humid, i. 3. 2. 3. ---- ideal, iv. 3. 2. 1. ---- from conception, iv. 3. 2. 2. Navel-string of infants, ii. 1. 1. 12. ---- cut too soon, ii. 1. 1. 12. Neck thickens at puberty, iv. 1. 2. 7. Neck-swing, i. 2. 2. 16. Nephritis, ii. 1. 2. 14. i. 1. 3. 9. iii. 2. 1. 14. Nerves decussate, iii. 2. 1. 10. Nictitation irritative, i. 1. 4. 1. ---- sensitive, ii. 1. 1. 8. ---- involuntary, iv. 1. 3. 2. Night-mare, iii. 2. 1. 13. Nipples, tension of, i. 1. 4. 7. iv. 1. 2. 6. Nostalgia, iii. 1. 2. 6. Nostrils, dry, i. 1. 3. 3.
O.
Obesitas, i. 2. 3. 17. Odontitis, ii. 1. 4. 7. Odontalgia, i. 2. 4. 12. Oesophagi schirrus, i. 2. 3. 25. Olfactus acrior, i. 1. 5. 3. ---- imminutus, i. 2. 5. 7. Oil destroys insects, i. 1. 4. 14. ---- essential of animals, i. 1. 2. 14. ---- why injurious in erysipelas, ii. 1. 3. 2. Opium in catarrh, i. 2. 3. 3. ---- in diaphragmitis, ii. 1. 2. 6. Ophthalmy, internal, ii. 1. 2. 2. ---- superficial, ii. 1. 4. 1. Orci timor, iii. 1. 2. 15. Oscitatio, ii. 1. 1. 9. Ossium innutritio, i. 2. 2. 14. Otitis, ii. 1. 4. 8. Otalgia, i. 2. 4. 13. iv. 2. 2. 8. Otopuosis, ii. 1. 4. 8. Ovary, dropsy of, i. 2. 3. 15. ---- exsection of, i. 2. 3. 15. Oxygenation of blood, iv. 1. 4. 6. Oxygen gas, Suppl. i. 9. 3. ---- in fevers, Suppl. i. 11. 7. i. 16. 9.
P.
Pain exhausts sensorial power, iv. 2. 2. ---- greater prevents less, iv. 2. 2. 2. ---- nervous, i. 2. 4. ---- of the little finger, symptom, iv. 2. 2. 12. ---- of arm in hydrothorax, iv. 2. 2. 13. ---- of the bile-duct, iv. 2. 2. 4. ---- of the shoulder, iv. 2. 2. 9. ---- of the pharynx, iv. 2. 2. 5. ---- of the testis, iv. 2. 2. 11. ---- smarting, i. 1. 5. 10. ---- of the side, i. 2. 4. 14. iv. 1. 2. 16. ---- of menstruation, i. 2. 1. 12. ---- use of, iii. 1. 1. 11. i. 1. 2. 9. ---- of the uterus, i. 2. 4. 17. Paint, white, dangerous, ii. 1. 4. 6. Palate, defect of, i. 2. 2. 20. Paleness, i. 2. 2. 2. ---- from fear, iv. 3. 1. 5. ---- from sickness, iv. 2. 1. 4. ---- of urine after dinner, iv. 2. 1. 2. ---- from cold skin, iv. 2. 1. 1. Palpitation of heart, i. 3. 3. 2. i. 2. 1. 10. ---- from fear, iv. 3. 1. 6. ---- relieved by arsenic, iv. 2. 1. 18. Pancreas, torpor of, i. 2. 2. 7. Pandiculatio, ii. 1. 1. 9. Panting, ii. 1. 1. 4. i. 3. 3. 3. Paracentesis at the navel, i. 2. 3. 13. Paralysis, iii. 2. 1. 10. ---- of the bladder, iii. 2. 1. 6. ---- of the rectum, iii. 2. 1. 7. ---- of the hands, iii. 2. 1. 4. ---- cure of, iii. 2. 1. 4. Paraplegia, iii. 2. 1. 11. Paresis inirritativa, i. 2. 1. 2. Suppl. i. 8. 10. ---- sensitiva, ii. 2. 1. 3. ---- voluntaria, iii. 2. 1. 8. Paronychia internal, ii. 1. 2. 19. ---- superficial, ii. 1. 4. 5. Parturition, ii. 1. 1. 12. ii. 1. 2. 16. ---- more fatal in high life, ii. 1. 1. 12. ---- with convulsion, iii. 1. 1. iii. 1. 1. 7. Parotitis, ii. 1. 3. 4. Passions depressing and exciting, iv. 3. 1. 5. Paupertatis timor, iii. 1. 2. 13. Pediculus, i. 1. 4. 15. Pemphigus, ii. 1. 3. 14. Penetration of animal bodies, iv. 1. 4. 7. Peripneumony, ii. 1. 2. 4. ---- tracheal, ii. 1. 2. 4. ---- superficial, ii. 1. 3. 7. ---- inirritated, ii. 1. 2. 4. Peritonitis, ii. 1. 2. 8. Perspiration not an excrement, i. 1. 2. 14. ---- greatest in the hot fit, i. 1. 2. 3. ---- fetid, i. 1. 2. 14. Pertussis, ii. 1. 3. 8. Pestis, ii. 1. 3. 13. Petechiae, i. 2. 1. 17. ---- cure of, Suppl. i. 2. 7. Pharynx, pain of, iv. 2. 2. 5. Phthisis, pulmonary, ii. 1. 6. 7. Pimples on the face, ii. 1. 4. 6. Piles, bleeding, i. 2. 1. 6. ---- white, i. 1. 2. 12. Placenta, ii. 1. 1. 12. ii. 1. 2. 16. Plague, ii. 1. 3. 13. Plasters, why moist, i. 1. 3. 6. Pleurisy, ii. 1. 2. 5. Pleurodyne chronica, i. 2. 4. 14. ---- rheumatica, iv. 1. 2. 16. Podagra, iv. 1. 2. 15. iv. 2. 4. 9. Polypus of the lungs, i. 1. 3. 4. ---- of the nose from worms, iv. 1. 2. 9. Pregnancy, ii. 1. 1. 12. Priapismus, i. 1. 4. 6. ii. 1. 7. 9. Proctalgia, i. 2. 4. 18. Prolapsus ani, i. 1. 4. 9. Pruritus, i. 1. 5. 9. ---- narium a vermibus, iv. 2. 2. 6. Psora, ii. 1. 5. 6. ---- imaginaria, iii. 1. 2. 22. Ptyalismus. See Salivatio. Pubis and throat sympathize, iv. 1. 2. 7. Puerperal fever, i. 2. 4. 9. ii. 1. 6. 16. Add. 8. ---- insanity, iii. 1. 2. 1. Pulchritudinis desiderium, iii. 1. 2. 12. Pullulation of trees, iv. 1. 4. 3. Pulse full, why, i. 1. 1. 1. ---- strong, how determined, i. 1. 1. 1. Suppl. i. 16. 10. ---- soft in vomiting, iv. 2. 1. 17. ---- intermittent, iv. 2. 1. 18. ---- quick from paucity of blood, Suppl. i. 11. 4. ---- quick sometimes in sleep, iii. 2. 1. 12. ---- quick in weak people, iii. 2. 1. Sup. i. 11. 4. ---- slower by swinging, iv. 2. 1. 10. ---- quick in chlorosis, i. 2. 3. 10. Punctae mucosae vultus, i. 2. 2. 9. Purging. See Diarrhoea. Pus diminished, i. 2. 2. 3. ---- distinguished from mucus, ii. 1. 6. 6.
R.
Rabies, iii. 1. 2. 18. Rachitis, i. 2. 2. 15. Raucedo catarrhal, ii. 1. 3. 5. ---- paralytic, iii. 2. 1. 5. Recollection, loss of, iii. 2. 2. 1. Recti paralysis, iii. 2. 1. 7. ---- schirrus, i. 2. 3. 23. Red-gum, ii. 1. 3. 12. i. 1. 2. 3. Redness from heat, ii. 1. 7. 7. ---- of joy, ii. 1. 7. 8. ---- after dinner, iv. 1. 1. 1. ---- of anger, iv. 2. 3. 5. ---- of guilt, iv. 2. 3. 6. ---- of modesty, iv. 2. 3. 6. Respiration, ii. 1. 1. 2. ---- quick in exercise, ii. 1. 1. 4. ---- in softness of bones, i. 2. 2. 14. Restlessness, iii. 1. 1. 1. Reverie, iii. 1. 2. 2. iv. 2. 4. 2. Rhaphania, iii. 1. 1. 6. Rheumatism, iv. 1. 2. 16. ---- of the joints, iv. 1. 2. 16. ---- of the bowels, iv. 1. 2. 16. ---- of the pleura, iv. 1. 2. 16. ---- suppurating, iv. 1. 2. 16. ---- from sympathy, iv. 2. 2. 13. ---- chronical, i. 1. 3. 12. iii. 1. 1. 6. Rickets, i. 2. 2. 15. Ring-worm, ii. 1. 5. 10. Risus, iii. 1. 1. 4. iv. 2. 3. 3. ---- sardonicus, iv. 1. 2. 4. ---- invitus, iv. 1. 3. 3. Rubeola, ii. 1. 3. 10. Rubor a calore, ii. 1. 7. 7. ---- jucunditatis, ii. 1. 7. 8. ---- pransorum, iv. 1. 1. 1. Ructus, i. 3. 1. 2. Ruminatio, i. 3. 1. 1. iv. 3. 3. 1.
S.
Sailing in phthisis, ii. 1. 6. 7. Salivation warm, i. 1. 2. 6. ---- lymphatic, i. 3. 2. 2. ---- sympathetic, iv. 1. 2. 5. ---- in low fevers, i. 1. 2. 6. Salt of urine, i. 1. 2. 4. i. 1. 3. 9. Satyriasis, iii. 1. 2. 16. Scabies. See Psora. Scarlatina, ii. 1. 3. 11. Scarlet fever, ii. 1. 3. 11. Scald-head, ii. 1. 5. 11. Sciatica frigida, i. 2. 4. 15. Schirrus, i. 2. 3. 22. ---- suppurans, ii. 1. 4. 15. ---- of the rectum, i. 2. 3. 23. ---- of the urethra, i. 2. 3. 24. ---- of the oesophagus, i. 2. 3. 25. Scorbutus, i. 2. 1. 15. ---- suppurans, ii. 1. 4. 14. Scrophula, i. 2. 3. 21. ---- suppurating, ii. 1. 4. 14. ---- produces insanity, iii. 1. 2. Scurvy, i. 2. 1. 15. ---- suppurating, ii. 1. 4. 14. Scurf of the head, i. 1. 3. 6. ---- of the tongue, i. 1. 3. 1. Sea air in phthisis, ii. 1. 6. 7. Seat, descent of, i. 1. 4. 9. Seed, ejection of, ii. 1. 1. 11. Sea-sickness, iv. 2. 1. 10. Suppl. i. 8. 3. See-saw of old people, iii. 2. 1. 2. Sensitive association, law of, iv. 2. 2. 2. Sensation inert, Suppl. i. 6. 4. Setons, ii. 1. 6. 6. Shingles, ii. 1. 5. 9. Shoulder, pain of, iv. 2. 2. 9. Shrieking, iii. 1. 1. 3. Sickness, i. 2. 4. 4. i. 3. 2. 3. ---- cured by a blister, iv. 1. 1. 3. ---- by warm skin, iv. 1. 1. 2. Suppl. i. 11. 4. ---- by whirling, i. 1. 1. 4. ---- by swinging, Suppl. i. 15. 3. ---- by hydrocarbonate gas, Suppl. i. 15. 3. ---- See Nausea. Sight acuter, i. 1. 5. 1. ---- impaired, i. 2. 5. 2. Side, chronical pain of, i. 2. 4. 14. Sighing and sobbing, iii. 1. 2. 10. Sitis calida, i. 2. 4. 1. ---- frigida, i. 2. 4. 1. ---- defectus, ii. 2. 2. 2. Skin pale in old age, i. 2. 2. 2. ---- from cold, i. 2. 2. 2. ---- dry, i. 1. 3. 6. ---- yellowish, i. 2. 2. 2. ---- bluish and shrunk, i. 2. 1. 1. ---- reddish, ii. 1. 3. 1. ---- cold after meals, iv. 2. 1. 1. Sleep, iii. 2. 1. 12. ---- interrupted, i. 2. 1. 3. ---- periods in, iv. 2. 4. 1. ---- with quick pulse, iii. 2. 1. 12. ---- disturbed by digestion, iii. 2. 1. 12. Sleep-walkers, iii. 1. 1. 9. Small-pox, ii. 1. 3. 9. ---- why distinct and confluent, Sup. i. 15. 2. ---- secondary fever of, ii. 1. 6. 12. ---- eruption of, iv. 1. 2. 12. Smarting, i. 1. 5. 10. Smell acuter, i. 1. 5. 3. ---- impaired, i. 2. 5. 7. Sneezing, ii. 1. 1. 3. iv. 1. 2. 2. Snow in scrophula, i. 2. 3. 21. ---- in paralysis, iii. 2. 1. 4. Snuff in hydrocephalus, i. 2. 3. 12. Somnambulism, iii. 1. 1. 9. Somnium, ii. 1. 7. 4. Somnus, iii. 2. 1. 12. iv. 2. 4. 1. ---- interruptus, i. 2. 1. 3. Softness of bones, i. 2. 2. 14. Spasm of diaphragm, iii. 1. 1. 11. ---- of the heart, iii. 1. 1. 11. Spine distorted, i. 2. 2. 16. ---- protuberant, i. 2. 2. 18. ---- bifid, i. 2. 2. 19. Spitting blood, i. 1. 1. 4. i. 2. 1. 9. Spleen swelled, i. 2. 3. 18. Suppl. i. 16. 6. Splenitis, ii. 1. 2. 13. Spots on the face, i. 2. 2. 9. Spots seen on bed-clothes, i. 2. 5. 3. Squinting, i. 2. 5. 4. ---- in hydrocephalus, i. 2. 5. 4. Stammering, iv. 2. 3. 1. Stays tight, injurious, ii. 1. 1. 12. Sterility, ii. 2. 2. 4. Sternutatio, ii. 1. 1. 3. iv. 1. 2. 2. ---- a lumine, iv. 1. 2. 2. Stimulants, their twofold effect, ii. 1. 2. 6. Stocks for children dangerous, i. 2. 2. 17. Stomach, torpor of, Suppl. i. 10. i. 16. 6. ---- inflammation of, ii. 1. 2. 10. ii. 1. 3. 19. ---- its association, iv. 1. 1. ---- cause of fever, Suppl. i. 8. 8. Stones in the bladder, See Calculi. ---- in horses, i. 1. 3. 5. i. 1. 3. 10. Strabismus, i. 2. 5. 4. Strangury, ii. 1. 1. 11. iv. 2. 2. 2. ---- convulsive, iv. 2. 2. 3. Strength and debility metaphors, i. 2. 1. Stridor dentium, iii. 1. 1. 12. Studium inane, iii. 1. 2. 2. iv. 2. 4. 2. Stultitia inirritabilis, i. 2. 5. 1. ---- insensibilis, ii. 2. 1. 1. ---- voluntaria, iii. 2. 2. 2. Stupor, i. 2. 5. 10. Suppl. i. 15. Subsultus tendinum, iii. 1. 1. 5. Sudor. See Sweats. Suggestion, slow, Surprise, i. 1. 5. 11. Sweats, warm, i. 1. 2. 3. ---- cold, i. 2. 3. 2. ---- lymphatic, i. 3. 2. 7. ---- asthmatic, i. 3. 2. 8. iv. 3. 1. 2. ---- covered in bed, iv. 1. 1. 2. Suppl. i. 11. 6 ---- in fever fits, why, i. 1. 2. 5. ---- from exercise, i. 1. 2. 3. ---- from heat, i. 1. 2. 3. ---- from medicines, i. 1. 2. 3. Sweaty hands cured, i. 3. 2. 7. Swinging, ii. 1. 6. 7. ---- makes the pulse slower, iv. 2. 1. 10. Swing centrifugal, Suppl. i. 15 and 3. Sympathy direct and reverse, iv. 1. 1. f. ---- with others, iii. 1. 2. 24. ---- of various parts, Suppl. i. 11. 5. ---- reverse of lacteals and lymphatics, Suppl. i. 11. 5 ---- of capillaries, Suppl. i. 11. 5. ---- direct of stomach and heart, Sup. i. 11. 5. ---- of throat and pubis, iv. 1. 2. 7. Syncope, i. 2. 1. 4. ---- epileptic, iii. 2. 1. 15. Syngultus, ii. 1. 1. 6. ---- nephriticus, iv. 1. 1. 7. Syphilis, ii. 1. 5. 2. ---- imaginaria, iii. 1. 2. 21. Syphon capillary of cloth, ii. 1. 3. 1.
T.
Tactus acrior, i. 1. 5. 5. ---- imminutus, i. 2. 5. 6. Tape-worm, i. 1. 4. 11. Tapping at the navel, i. 2. 3. 13. Taste. See Gustus. ---- bitter, not from bile, i. 1. 3. 1. Taedium vitae, ii. 2. 1. 2. Taenia, i. 1. 4. 11. Tears sympathetic, iv. 1. 2. 1. iii. 1. 2. 10. Teeth, to preserve, i. 1. 4. 5. ---- fall out whole, ii. 1. 4. 7. Tenesmus, ii. 1. 1. 10. ---- calculosus, iv. 1. 2. 8. Testium dolor nephriticus, iv. 2. 2. 11. ---- tumor in gonorrhoea, iv. 1. 2. 18. ---- tumor in parotitide, iv. 1. 2. 19. Tetanus trismus, iii. 1. 1. 13. ---- doloroficus, iii. 1. 1. 14. Thirst. See Sitis and Adipsia. Thread-worm, i. 1. 4. 12. Throat swelled, i. 2. 3. 20. ---- thickens at puberty, iv. 2. 1. 7. ---- grown up, i. 2. 3. 25. Thrush, ii. 1. 3. 17. Tickling, i. 1. 5. 8. Timor orci, iii. 1. 2. 15. ---- lethi, iii. 1. 2. 14. ---- paupertatis, iii. 1. 2. 13. Tinea, ii. 1. 5. 11. Tinnitus aurium, iv. 2. 1. 15. Titillatio, i. 1. 5. 8. Titubatio linguae, iv. 2. 3. 1. Tobacco, smoke of in piles, i. 2. 1. 6. Tongue dry, i. 1. 3. 1. Suppl. i. 2. ---- coloured mucus, i. 1. 3. 1. Tonsillitis, ii. 1. 3. 3. Tonsils swelled from bad teeth, i. 2. 3. 21. ii. 1. 3. 3. Torpor of the liver, i. 2. 2. 6. ---- of the pancreas, i. 2. 2. 7. ---- of the lungs, Suppl. 1. 9. ---- of the stomach, Suppl. i. 10. ---- of the heart, Suppl. i. 10. Tooth-ach, i. 2. 4. 12. ii. 1. 4. 7. Tooth-edge, iv. 1. 2. 3. Toothing, i. 1. 4. 5. Tooth-powder, i. 1. 4. 5. Touch. See Tactus. ---- deceived three ways, i. 2. 5. 9. iv. 2. 1. 10. Transfusion of blood, i. 2. 3. 25. Suppl. i. 14. 4. Translation of matter, i. 3. 2. 9. ---- of milk, i. 3. 2. 10. ---- of urine, i. 3. 2. 11. Transparency of cornea, i. 1. 4. 1. ---- of crystalline, i. 2. 2. 13. ---- of air before rain, i. 1. 4. 1. Tremor of old age, iii. 2. 1. 3. ---- of fever, iii. 1. 1. 2. ---- of anger, iv. 2. 3. 4. ---- of fear, iv. 3. 1. 5. Tussis ebriorum, ii. 1. 1. 5. ---- convulsiva, ii. 1. 3. 8. ---- hepatica, iv. 2. 1. 8. ---- arthritica, iv. 2. 1. 9. ---- periodica, iv. 3. 4. 2. ---- a pedibus frigidis, iv. 2. 1. 7. Tympany, i. 2. 4. 9.
U.
Ulcers, healing of, i. 1. 3. 13. ---- of the cornea, i. 1. 3. 14. ---- from burns, i. 1. 3. 13. ---- scrophulous, ii. 1. 4. 13. ---- of the throat, ii. 1. 3. 3. ii. 1. 3. 11. ---- of the legs, ii. 1. 4. 14. Unguium morsiuncula, iv. 1. 3. 5. Urethra, scirrhus of, i. 2. 3. 24. ---- fistula of, ii. 1. 4. 11. Urine copious, coloured, i. 1. 2. 4. ---- copious, pale, i. 2. 3. 5. ---- diminished, coloured, i. 1. 3. 7. ---- diminished, pale, i. 2. 2. 5. ---- its mucus, salts, Prussian blue, i. 1. 2. 4. ---- why less and coloured in dropsies, i. 1. 3. 7. ---- translation of, i. 3. 2. 11. ---- difficulty of, iii. 2. 1. 6. ---- not secreted, i. 2. 2. 8. ---- pale after meals, iv. 2. 1. 2. ---- pale from cold skin, iv. 2. 1. 3. ---- sediment in fevers, Suppl. i. 2. 3. ---- pale in fevers, Suppl. i. 2. 3. and 5. Urticaria, ii. 1. 3. 16. Uteri descensus, i. 1. 4. 8.
V.
Vacillatio senilis, iii. 2. 1. 2. Varicella, ii. 1. 3. 15. Variola, ii. 1. 3. 9. ---- eruption of, iv. 1. 2. 12. Vasorum capil retrogressio, i. 3. 3. 1. Venereal orgasm, iv. 1. 4. 4. ---- disease, ii. 1. 5. 2. ---- imaginary, iii. 1. 2. 21. Ventriculi aegritudo, i. 2. 4. 4. ---- vesicatorio sanata, iv. 1. 1. 3. Vermes, i. 1. 4. 10. Vertigo rotatory, iv. 2. 1. 10. ---- of sight, iv. 2. 1. 11. ---- inebriate, iv. 2. 1. 12. ---- of fever, iv. 2. 1. 13. ---- from the brain, iv. 2. 1. 14. ---- of the ears, iv. 2. 1. 15. ---- of the touch, Addit. iii. ---- of the touch, taste and smell, iv. 2. 1. 16. ---- with vomiting, iv. 3. 2. 3. ---- produces slow pulse, iv. 2. 1. 10. ---- of blind men, iv. 2. 1. 10. ---- use of mercurials in it, iv. 2. 1. 11. ---- from ideas, Addit. iii. Vibices, i. 2. 1. 16. Suppl. i. 2. 7. Vigilia, iii. 1. 2. 3. iv. 1. 3. 6. Vision acuter, i. 1. 5. 1. ---- diminished, i. 2. 5. 2. ---- expends much sensorial power, i. 2. 5. 3. Vita ovi, iv. 1. 4. 1. ---- hiemi-dormientium, iv. 1. 4. 2. Vitus's dance, iv. 2. 3. 2. Volition, three degrees of, iii. 2. 1. 12. ---- lessens fever, iii. 2. 1. 12. Suppl. i. 11. 6. ---- produces fever, iii. 2. 1. 12. ---- without deliberation, iv. 1. 3. 2. Addit. iv. Vomica, ii. 1. 6. 3. Vomitus, i. 3. 1. 4. Vomendi conamen inane, i. 3. 1. 8. Vomiting stopped, iv. 1. 1. 3. iv. 1. 1. f. ---- voluntary, iv. 3. 3. 2. ---- how acquired, iv. 1. 1. 2. ---- vertiginous, iv. 3. 2. 3. ---- from stone in ureter, iv. 3. 2. 4. ---- from paralytic stroke, iv. 3. 2. 5. ---- from tickling the throat, iv. 3. 2. 6. ---- sympathizes with the skin, iv. 3. 2. 7. ---- in haemoptoe, i. 1. 1. 4. ---- from defect of association, iv. 2. 1. 10. Vulnerum cicatrix, i. 1. 3. 13.
W.
Watchfulness, iii. 1. 2. 3. iv. 1. 3. 6. Water-qualm, i. 3. 1. 3. Weakness, three kinds of, i. 2. 1. Whirling-chair, Suppl. i. 15. 3. Whirling-bed, Suppl. i. 15. 7. White swelling of the knee, i. 2. 3. 19. Winking, ii. 1. 1. 8. i. 1. 4. 1. iv. 1. 3. 2. Wine in fevers, ii. 1. 3. 1. iv. 2. 1. 12. Winter-sleeping animals, iv. 1. 4. 2. Witlow, superficial, ii. 1. 4. 5. ---- internal, ii. 1. 2. 19. Womb, descent of, i. 1. 4. 8. ---- inflammation of, ii. 1. 2. 16. Worms, i. 1. 4. 10. ---- mucus counterfeits, i. 1. 3. 4. ---- in sheep, i. 2. 3. 9. Wounds, healing of, i. 1. 3. 13.
Y.
Yawning, ii. 1. 1. 9. Yaws, ii. 1. 5. 5.
Z.
Zona ignea, ii. 1. 5. 9. iv. 1. 2. 11. ii. 1. 2. 14.
* * * * *
ZOONOMIA;
OR,
THE LAWS OF ORGANIC LIFE.