moisture, drank up by the cutaneous and pulmonary lymphatics, is poured
into the intestines, by the retrograde motions of the lacteals. This
disease is most similar to the aqueous diabetes, and is frequently
exchanged for it: a distinct instance of this is recorded by Benningerus,
Cent. v. Obs. 98. in which an aqueous diarrhoea succeeded an aqueous
diabetes, and destroyed the patient. There is a curious example of this,
described by Sympson (De Re Medica)--"A young man (says he) was seized with
a fever, upon which a diarrhoea came on, with great stupor; and he refused
to drink any thing, though he was parched up with excessive heat: the
better to supply him with moisture, I directed his feet to be immersed in
cold water; immediately I observed a wonderful decrease of water in the
vessel, and then an impetuous stream of a fluid, scarcely coloured, was
discharged by stool, like a cataract."
7. There is another kind of diarrhoea, which has been called cæliaca; in
this disease the chyle, drank up by the lacteals of the small intestines,
is probably poured into the large intestines, by the retrograde motions of
their lacteals: as in the chyliferous diabetes, the chyle is poured into
the bladder, by the retrograde motions of the urinary branch of absorbents.
The chyliferous diabetes, like this chyliferous diarrhoea, produces sudden
atrophy; since the nourishment, which ought to supply the hourly waste of
the body, is expelled by the bladder, or rectum: whilst the aqueous
diabetes, and the aqueous diarrhoea produce excessive thirst; because the
moisture, which is obtained from the atmosphere, is not conveyed to the
thoracic receptacle, as it ought to be, but to the bladder, or lower
intestines; whence the chyle, blood, and whole system of glands, are robbed
of their proportion of humidity.
8. There is a third species of diabetes, in which the urine is
mucilaginous, and appears ropy in pouring it from one vessel into another;
and will sometimes coagulate over the fire. This disease appears by
intervals, and ceases again, and seems to be occasioned by a previous
dropsy in some part of the body. When such a collection is reabsorbed, it
is not always returned into the circulation; but the same irritation that
stimulates one lymphatic branch to reabsorb the deposited fluid, inverts
the urinary branch, and pours it into the bladder. Hence this mucilaginous
diabetes is a cure, or the consequence of a cure, of a worse disease,
rather than a disease itself.
Dr. Cotunnius gave half an ounce of cream of tartar, every morning, to a
patient, who had the anasarca; and he voided a great quantity of urine; a
part of which, put over the fire, coagulated, on the evaporation of half of
it, so as to look like the white of an egg. De Ischiade Nervos.
This kind of diabetes frequently precedes a dropsy; and has this remarkable
circumstance attending it, that it generally happens in the night; as
during the recumbent state of the body, the fluid, that was accumulated in
the cellular membrane, or in the lungs, is more readily absorbed, as it is
less impeded by its gravity. I have seen more than one instance of this
disease. Mr. D. a man in the decline of life, who had long accustomed
himself to spirituous liquor, had swelled legs, and other symptoms of
approaching anasarca; about once in a week, or ten days, for several
months, he was seized, on going to bed, with great general uneasiness,
which his attendants resembled to an hysteric fit; and which terminated in
a great discharge of viscid urine; his legs became less swelled, and he
continued in better health for some days afterwards. I had not the
opportunity to try if this urine would coagulate over the fire, when part
of it was evaporated, which I imagine would be the criterion of this kind
of diabetes; as the mucilaginous fluid deposited in the cells and cysts of
the body, which have no communication with the external air, seems to
acquire, by stagnation, this property of coagulation by heat, which the
secreted mucus of the intestines and bladder do not appear to possess; as I
have found by experiment: and if any one should suppose this coagulable
urine was separated from the blood by the kidneys, he may recollect, that
in the most inflammatory diseases, in which the blood is most replete or
most ready to part with the coagulable lymph, none of this appears in the
urine.
9. Different kinds of diabetes require different methods of cure. For the
first kind, or chyliferous diabetes, after clearing the stomach and
intestines, by ipecacuanha and rhubarb, to evacuate any acid material,
which may too powerfully stimulate the mouths of the lacteals, repeated and
large doses of tincture of cantharides have been much recommended. The
specific stimulus of this medicine, on the neck of the bladder, is likely
to excite the numerous absorbent vessels, which are spread on that part,
into stronger natural actions, and by that means prevent their retrograde
ones; till, by persisting in the use of the medicine, their natural habits
of motions might again be established. Another indication of cure, requires
such medicines, as by lining the intestines with mucilaginous substances,
or with such as consist of smooth particles, or which chemically destroy
the acrimony of their contents, may prevent the too great action of the
intestinal absorbents. For this purpose, I have found the earth
precipitated from a solution of alum, by means of fixed alcali, given in
the dose of half a dram every six hours, of great advantage, with a few
grains of rhubarb, so as to produce a daily evacuation.
The food should consist of materials that have the least stimulus, with
calcareous water, as of Bristol and Matlock; that the mouths of the
lacteals may be as little stimulated as is necessary for their proper
absorption; lest with their greater exertions, should be connected by
sympathy, the inverted motions of the urinary lymphatics.
The same method may be employed with equal advantage in the aqueous
diabetes, so great is the sympathy between the skin and the stomach. To
which, however, some application to the skin might be usefully added; as
rubbing the patient all over with oil, to prevent the too great action of
the cutaneous absorbents. I knew an experiment of this kind made upon one
patient with apparent advantage.
The mucilaginous diabetes will require the same treatment, which is most
efficacious in the dropsy, and will be described below. I must add, that
the diet and medicines above mentioned, are strongly recommended by various
authors, as by Morgan, Willis, Harris, and Etmuller; but more histories of
the successful treatment of these diseases are wanting to fully ascertain
the most efficacious methods of cure.
In a letter from Mr. Charles Darwin, dated April 24, 1778, Edinburgh, is
the subsequent passage:--"A man who had long laboured under a diabetes died
yesterday in the clinical ward. He had for some time drank four, and passed
twelve pounds of fluid daily; each pound of urine contained an ounce of
sugar. He took, without considerable relief, gum kino, sanguis diaconis
melted with alum, tincture of cantharides, isinglass, gum arabic, crabs
eyes, spirit of hartshorn, and eat ten or fifteen oysters thrice a day. Dr.
Home, having read my thesis, bled him, and found that neither the fresh
blood nor the serum tasted sweet. His body was opened this morning--every
viscus appeared in a sound and natural state, except that the left kidney
had a very small pelvis, and that there was a considerable enlargement of
most of the mesenteric lymphatic glands. I intend to insert this in my
thesis, as it coincides with the experiment, where some asparagus was eaten
at the beginning of intoxication, and its smell perceived in the urine,
though not in the blood."
The following case of chyliferous diabetes is extracted from some letters
of Mr. Hughes, to whose unremitted care the infirmary at Stafford for many
years was much indebted. Dated October 10, 1778.
Richard Davis, aged 33, a whitesmith by trade, had drank hard by intervals;
was much troubled with sweating of his hands, which incommoded him in his
occupation, but which ceased on his frequently dipping them in lime. About
seven months ago he began to make large quantities of water; his legs are
oedematous, his belly tense, and he complains of a rising in his throat,
like the globus hystericus: he eats twice as much as other people, drinks
about fourteen pints of small beer a day, besides a pint of ale, some
milk-porridge, and a bason of broth, and he makes about eighteen pints of
water a day.
He tried alum, dragon's blood, steel, blue vitriol, and cantharides in
large quantities, and duly repeated, under the care of Dr. Underhill, but
without any effect; except that on the day after he omitted the
cantharides, he made but twelve pints of water, but on the next day this
good effect ceased again.
November 21.--He made eighteen pints of water, and he now, at Dr. Darwin's
request, took a grain of opium every four hours, and five grains of aloes
at night; and had a flannel shirt given him.
22.--Made sixteen pints. 23.--Thirteen pints: drinks less.
24.--Increased the opium to a grain and quarter every four hours: he made
twelve pints.
25.--Increased the opium to a grain and half: he now makes ten pints; and
drinks eight pints in a day.
The opium was gradually increased during the next fortnight, till he took
three grains every four hours, but without any further diminution of his
water. During the use of the opium he sweat much in the nights, so as to
have large drops stand on his face and all over him. The quantity of opium
was then gradually decreased, but not totally omitted, as he continued to
take about a grain morning and evening.
January 17.--He makes fourteen pints of water a day. Dr. Underhill now
directed him two scruples of common rosin triturated with as much sugar,
every six hours; and three grains of opium every night.
19.--Makes fifteen pints of water: sweats at night.
21.--Makes seventeen pints of water; has twitchings of his limbs in a
morning, and pains of his legs: he now takes a dram of rosin for a dose,
and continues the opium.
23.--Water more coloured, and reduced to sixteen pints, and he thinks has a
brackish taste.
26.--Water reduced to fourteen pints.
28.--Water thirteen pints: he continues the opium, and takes four scruples
of the rosin for a dose.
February 1.--Water twelve pints.
4.--Water eleven pints: twitchings less; takes five scruples for a dose.
8.--Water ten pints: has had many stools.
12.--Appetite less: purges very much.
After this the rosin either purged him, or would not stay on his stomach;
and he gradually relapsed nearly to his former condition, and in a few
months sunk under the disease.
October 3, Mr. Hughes evaporated two quarts of the water, and obtained from
it four ounces and half of a hard and brittle saccharine mass, like treacle
which had been some time boiled. Four ounces of blood, which he took from
his arm with design to examine it, had the common appearances, except that
the serum resembled cheese-whey; and that on the evidence of four persons,
two of whom did not know what it was they tasted, _the serum had a saltish
taste_.
From hence it appears, that the saccharine matter, with which the urine of
these patients so much abounds, does not enter the blood-vessels like the
nitre and asparagus mentioned above; but that the process of digestion
resembles the process of the germination of vegetables, or of making barley
into malt; as the vast quantity of sugar found in the urine must be made
from the food which he took (which was double that taken by others), and
from the fourteen pints of small beer which he drank. And, secondly, as the
serum of the blood was not sweet, the chyle appears to have been conveyed
to the bladder without entering the circulation of the blood, since so
large a quantity of sugar, as was found in the urine, namely, twenty ounces
a day, could not have previously existed in the blood without being
perceptible to the taste.
November 1. Mr. Hughes dissolved two drams of nitre in a pint of a
decoction of the roots of asparagus, and added to it two ounces of tincture
of rhubarb: the patient took a fourth part of this mixture every five
minutes, till he had taken the whole.--In about half an hour he made
eighteen ounces of water, which was very manifestly tinged with the
rhubarb; the smell of asparagus was doubtful.
He then lost four ounces of blood, the serum of which was not so opake as
that drawn before, but of a yellowish cast, as the serum of the blood
usually appears.
Paper, dipped three or four times in the tinged urine and dried again, did
not scintillate when it was set on fire; but when the flame was blown out,
the fire ran along the paper for half an inch; which, when the same paper
was unimpregnated, it would not do; nor when the same paper was dipped in
urine made before he took the nitre, and dried in the same manner.
Paper, dipped in the serum of the blood and dried in the same manner as in
the urine, did not scintillate when the flame was blown out, but burnt
exactly in the same manner as the same paper dipped in the serum of blood
drawn from another person.
This experiment, which is copied from a letter of Mr. Hughes, as well as
the former, seems to evince the existence of another passage from the
intestines to the bladder, in this disease, besides that of the
sanguiferous system; and coincides with the curious experiment related in
section the third, except that the smell of the asparagus was not here
perceived, owing perhaps to the roots having been made use of instead of
the heads.
The rising in the throat of this patient, and the twitchings of his limbs,
seem to indicate some similarity between the diabetes and the hysteric
disease, besides the great flow of pale urine, which is common to them
both.
Perhaps if the mesenteric glands were nicely inspected in the dissections
of these patients; and if the thoracic duct, and the larger branches of the
lacteals, and if the lymphatics, which arise from the bladder, were well
examined by injection, or by the knife, the cause of diabetes might be more
certainly understood.
The opium alone, and the opium with the rosin, seem much to have served
this patient, and might probably have effected a cure, if the disease had
been slighter, or the medicine had been exhibited, before it had been
confirmed by habit during the seven months it had continued. The increase
of the quantity of water on beginning the large doses of rosin was probably
owing to his omitting the morning doses of opium.
V. _The Phænomena of Dropsies explained._
I. Some inebriates have their paroxysms of inebriety terminated by much
pale urine, or profuse sweats, or vomiting, or stools; others have their
paroxysms terminated by stupor, or sleep, without the above evacuations.
The former kind of these inebriates have been observed to be more liable to
diabetes and dropsy; and the latter to gout, gravel, and leprosy. Evoe!
attend ye bacchanalians! start at this dark train of evils, and, amid your
immodest jests, and idiot laughter, recollect,
Quem Deus vult perdere, prius dementat.
In those who are subject to diabetes and dropsy, the absorbent vessels are
naturally more irritable than in the latter; and by being frequently
disturbed or inverted by violent stimulus, and by their too great sympathy
with each other, they become at length either entirely paralytic, or are
only susceptible of motion from the stimulus of very acrid materials; as
every part of the body, after having been used to great irritations,
becomes less affected by smaller ones. Thus we cannot distinguish objects
in the night, for some time after we come out of a strong light, though the
iris is presently dilated; and the air of a summer evening appears cold,
after we have been exposed to the heat of the day.
There are no cells in the body, where dropsy may not be produced, if the
lymphatics cease to absorb that mucilaginous fluid, which is perpetually
deposited in them, for the purpose of lubricating their surfaces.
If the lymphatic branch, which opens into the cellular membrane, either
does its office imperfectly, or not at all; these cells become replete with
a mucilaginous fluid, which, after it has stagnated some time in the cells,
will coagulate over the fire; and is erroneously called water. Wherever the
seat of this disease is, (unless in the lungs or other pendent viscera) the
mucilaginous liquid above mentioned will subside to the most depending
parts of the body, as the feet and legs, when those are lower than the head
and trunk; for all these cells have communications with each other.
When the cellular absorbents are become insensible to their usual
irritations, it most frequently happens, but not always, that the cutaneous
branch of absorbents, which is strictly associated with them, suffers the
like inability. And then, as no water is absorbed from the atmosphere, the
urine is not only less diluted at the time of its secretion, and
consequently in less quantity and higher coloured: but great thirst is at
the same time induced, for as no water is absorbed from the atmosphere to
dilute the chyle and blood, the lacteals and other absorbent vessels, which
have not lost their powers, are excited into more constant or more violent
action, to supply this deficiency; whence the urine becomes still less in
quantity, and of a deeper colour, and turbid like the yolk of an egg, owing
to a greater absorption of its thinner parts. From this stronger action of
those absorbents, which still retain their irritability, the fat is also
absorbed, and the whole body becomes emaciated. This increased exertion of
some branches of the lymphatics, while others are totally or partially
paralytic, is resembled by what constantly occurs in the hemiplagia; when
the patient has lost the use of the limbs on one side, he is incessantly
moving those of the other; for the moving power, not having access to the
paralytic limbs, becomes redundant in those which are not diseased.
The paucity of urine and thirst cannot be explained from a greater quantity
of mucilaginous fluid being deposited in the cellular membrane: for though
these symptoms have continued many weeks, or even months, this collection
frequently does not amount to more than very few pints. Hence also the
difficulty of promoting copious sweats in anasarca is accounted for, as
well as the great thirst, paucity of urine, and loss of fat; since, when
the cutaneous branch of absorbents is paralytic, or nearly so, there is
already too small a quantity of aqueous fluid in the blood: nor can these
torpid cutaneous lymphatics be readily excited into retrograde motions.
Hence likewise we understand, why in the ascites, and some other dropsies,
there is often no thirst, and no paucity of urine; in these cases the
cutaneous absorbents continue to do their office.
Some have believed, that dropsies were occasioned by the inability of the
kidneys, from having only observed the paucity of urine; and have thence
laboured much to obtain diuretic medicines; but it is daily observable,
that those who die of a total inability to make water, do not become
dropsical in consequence of it: Fernelius mentions one, who laboured under
a perfect suppression of urine during twenty days before his death, and yet
had no symptoms of dropsy. Pathol. 1. vi. c. 8. From the same idea many
physicians have restrained their patients from drinking, though their
thirst has been very urgent; and some cases have been published, where this
cruel regimen has been thought advantageous: but others of nicer
observation are of opinion, that it has always aggravated the distresses of
the patient; and though it has abated his swellings, yet by inducing a
fever it has hastened his dissolution. See Transactions of the College,
London, vol. ii. p. 235. Cases of Dropsy by Dr. G. Baker.
The cure of anasarca, so far as respects the evacuation of the accumulated
fluid, coincides with the idea of the retrograde action of the lymphatic
system. It is well known that vomits, and other drugs, which induce
sickness or nausea; at the same time that they evacuate the stomach,
produce a great absorption of the lymph accumulated in the cellular
membrane. In the operation of a vomit, not only the motions of the stomach
and duodenum become inverted, but also those of the lymphatics and
lacteals, which belong to them; whence a great quantity of chyle and lymph
is perpetually poured into the stomach and intestines, during the
operation, and evacuated by the mouth. Now at the same time, other branches
of the lymphatic system, viz. those which open on the cellular membrane,
are brought into more energetic action, by the sympathy above mentioned,
and an increase of their absorption is produced.
Hence repeated vomits, and cupreous salts, and small doses of squill or
foxglove, are so efficacious in this disease. And as drastic purges act
also by inverting the motions of the lacteals; and thence the other
branches of lymphatics are induced into more powerful natural action, by
sympathy, and drink up the fluids from all the cells of the body; and by
their anastomoses, pour them into the lacteal branches; which, by their
inverted actions, return them into the intestines; and they are thus
evacuated from the body:--these purges also are used with success in
discharging the accumulated fluid in anasarca.
II. The following cases are related with design to ascertain the particular
kinds of dropsy in which the digitalis purpurea, or common foxglove, is
preferable to squill, or other evacuants, and were first published in 1780,
in a pamphlet entitled Experiments on mucilaginous and purulent Matter, &c.
Cadell. London. Other cases of dropsy, treated with digitalis, were
afterwards published by Dr. Darwin in the Medical Transactions, vol. iii.
in which there is a mistake in respect to the dose of the powder of
foxglove, which should have been from five grains to one, instead of from
five grains to ten.
_Anasarca of the Lungs._
1. A lady, between forty and fifty years of age, had been indisposed some
time, was then seized with cough and fever, and afterwards expectorated
much digested mucus. This expectoration suddenly ceased, and a considerable
difficulty of breathing supervened, with a pulse very irregular both in
velocity and strength; she was much distressed at first lying down, and at
first rising; but after a minute or two bore either of those attitudes with
ease. She had no pain or numbness in her arms; she had no hectic fever, nor
any cold shiverings, and the urine was in due quantity, and of the natural
colour.
The difficulty of breathing was twice considerably relieved by small doses
of ipecacuanha, which operated upwards and downwards, but recurred in a few
days: she was then directed a decoction of foxglove, (digitalis purpurea)
prepared by boiling four ounces of the fresh leaves from two pints of water
to one pint; to which was added two ounces of vinous spirit: she took three
large spoonfuls of this mixture every two hours, till she had taken it four
times; a continued sickness supervened, with frequent vomiting, and a
copious flow of urine: these evacuations continued at intervals for two or
three days, and relieved the difficulty of breathing--She had some relapses
afterwards, which were again relieved by the repetition of the decoction of
foxglove.
2. A gentleman, about sixty years of age, who had been addicted to an
immoderate use of fermented liquors, and had been very corpulent, gradually
lost his strength and flesh, had great difficulty of breathing, with legs
somewhat swelled, and a very irregular pulse. He was very much distressed
at first lying down, and at first rising from his bed, yet in a minute or
two was easy in both those attitudes. He made straw-coloured urine in due
quantity, and had no pain or numbness of his arms.
He took a large spoonful of the decoction of foxglove, as above, every
hour, for ten or twelve successive hours, had incessant sickness for about
two days, and passed a large quantity of urine; upon which his breath
became quite easy, and the swelling of his legs subsided; but as his whole
constitution was already sinking from the previous intemperance of his
life, he did not survive more than three or four months.
_Hydrops Pericardii._
3. A gentleman of temperate life and sedulous application to business,
between thirty and forty years of age, had long been subject, at intervals,
to an irregular pulse: a few months ago he became weak, with difficulty of
breathing, and dry cough. In this situation a physician of eminence
directed him to abstain from all animal food and fermented liquor, during
which regimen all his complaints increased; he now became emaciated, and
totally lost his appetite; his pulse very irregular both in velocity and
strength; with great difficulty of breathing, and some swelling of his
legs; yet he could lie down horizontally in his bed, though he got little
sleep, and passed a due quantity of urine, and of the natural colour: no
fullness or hardness could be perceived about the region of the liver; and
he had no pain or numbness in his arms.
One night he had a most profuse sweat all over his body and limbs, which
quite deluged his bed, and for a day or two somewhat relieved his
difficulty of breathing, and his pulse became less irregular: this copious
sweat recurred three or four times at the intervals of five or six days,
and repeatedly alleviated his symptoms.
He was directed one large spoonful of the above decoction of foxglove every
hour, till it procured some considerable evacuation: after he had taken it
eleven successive hours he had a few liquid stools, attended with a great
flow of urine, which last had a dark tinge, as if mixed with a few drops of
blood: he continued sick at intervals for two days, but his breath became
quite easy, and his pulse quite regular, the swelling of his legs
disappeared, and his appetite and sleep returned.
He then took three grains of white vitriol twice a day, with some bitter
medicines, and a grain of opium with five grains of rhubarb every night;
was advised to eat flesh meat, and spice, as his stomach would bear it,
with small beer, and a few glasses of wine; and had issues made in his
thighs; and has suffered no relapse.
4. A lady, about fifty years of age, had for some weeks great difficulty of
breathing, with very irregular pulse, and considerable general debility:
she could lie down in bed, and the urine was in due quantity and of the
natural colour, and she had no pain or numbness of her arms.
She took one large spoonful of the above decoction of foxglove every hour,
for ten or twelve successive hours; was sick, and made a quantity of pale
urine for about two days, and was quite relieved both of the difficulty of
breathing, and the irregularity of her pulse. She then took a grain of
opium, and five grains of rhubarb, every night, night, for many weeks; with
some slight chalybeate and bitter medicines, and has suffered no relapse.
_Hydrops Thoracis._
5. A tradesman, about fifty years of age, became weak and short of breath,
especially on increase of motion, with pain in one arm, about the insertion
of the biceps muscle. He observed he sometimes in the night made an unusual
quantity of pale water. He took calomel, alum, and peruvian bark, and all
his symptoms increased: his legs began to swell considerably; his breath
became more difficult, and he could not lie down in bed; but all this time
he made a due quantity of straw-coloured water.
The decoction of foxglove was given as in the preceding cases, which
operated chiefly by purging, and seemed to relieve his breath for a day or
two; but also seemed to contribute to weaken him.--He became after some
weeks universally dropsical, and died comatous.
6. A young lady of delicate constitution, with light eyes and hair, and who
had perhaps lived too abstemiously both in respect to the quantity and
quality of what she eat and drank, was seized with great difficulty of
breathing, so as to threaten immediate death. Her extremities were quite
cold, and her breath felt cold to the back of one's hand. She had no sweat,
nor could be down for a single moment; and had previously, and at present,
complained of great weakness and pain and numbness of both her arms; had no
swelling of her legs, no thirst, water in due quantity and colour. Her
sister, about a year before, was afflicted with similar symptoms, was
repeatedly blooded, and died universally dropsical.
A grain of opium was given immediately, and repeated every six hours with
evident and amazing advantage; afterwards a blister, with chalybeates,
bitters, and essential oils, were exhibited, but nothing had such eminent
effect in relieving the difficulty of breathing and coldness of her
extremities as opium, by the use of which in a few weeks she perfectly
regained her health, and has suffered no relapse.
_Ascites._
7. A young lady of delicate constitution having been exposed to great fear,
cold, and fatigue, by the overturn of a chaise in the night, began with
pain and tumour in the right hypochondrium: in a few months a fluctuation
was felt throughout the whole abdomen, more distinctly perceptible indeed
about the region of the stomach; since the integuments of the lower part of
the abdomen generally become thickened in this disease by a degree of
anasarca. Her legs were not swelled, no thirst, water in due quantity and
colour.--She took the foxglove so as to induce sickness and stools, but
without abating the swelling, and was obliged at length to submit to the
operation of tapping.
8. A man about sixty-seven, who had long been accustomed to spirituous
potation, had some time laboured under ascites; his legs somewhat swelled;
his breath easy in all attitudes; no appetite; great thirst; urine in
exceedingly small quantity, very deep coloured, and turbid; pulse equal. He
took the foxglove in such quantity as vomited him, and induced sickness for
two days; but procured no flow of urine, or diminution of his swelling; but
was thought to leave him considerably weaker.
9. A corpulent man, accustomed to large potation of fermented liquors, had
vehement cough, difficult breathing, anasarca of his legs, thighs, and
hands, and considerable tumour, with evident fluctuation of his abdomen;
his pulse was equal; his urine in small quantity, of deep colour, and
turbid. These swellings had been twice considerably abated by drastic
cathartics. He took three ounces of a decoction of foxglove (made by
boiling one ounce of the fresh leaves in a pint of water) every three
hours, for two whole days; it then began to vomit and purge him violently,
and promoted a great flow of urine; he was by these evacuations completely
emptied in twelve hours. After two or three months all these symptoms
returned, and were again relieved by the use of the foxglove; and thus in
the space of about three years he was about ten times evacuated, and
continued all that time his usual potations: excepting at first, the
medicine operated only by urine, and did not appear considerably to weaken
him--The last time he took it, it had no effect; and a few weeks afterwards
he vomited a great quantity of blood, and expired.
QUERIES.
1. As the first six of these patients had a due discharge of urine, and of
the natural colour, was not the feat of the disease confined to some part
of the thorax, and the swelling of the legs rather a symptom of the
obstructed circulation of the blood, than of a paralysis of the cellular
lymphatics of those parts?
2. When the original disease is a general anasarca, do not the cutaneous
lymphatics always become paralytic at the same time with the cellular ones,
by their greater sympathy with each other? and hence the paucity of urine,
and the great thirst, distinguish this kind of dropsy?
3. In the anasarca of the lungs, when the disease is not very great, though
the patients have considerable difficulty of breathing at their first lying
down, yet after a minute or two their breath becomes easy again; and the
same occurs at their first rising. Is not this owing to the time necessary
for the fluid in the cells of the lungs to change its place, so as the
least to incommode respiration in the new attitude?
4. In the dropsy of the pericardium does not the patient bear the
horizontal or perpendicular attitude with equal ease? Does this
circumstance distinguish the dropsy of the pericardium from that of the
lungs and of the thorax?
5. Do the universal sweats distinguish the dropsy of the pericardium, or of
the thorax? and those, which cover the upper parts of the body only, the
anasarca of the lungs?
6. When in the dropsy of the thorax, the patient endeavours to lie down,
does not the extravasated fluid compress the upper parts of the bronchia,
and totally preclude the access of air to every part of the lungs; whilst
in the perpendicular attitude the inferior parts of the lungs only are
compressed? Does not something similar to this occur in the anasarca of the
lungs, when the disease is very great, and thus prevent those patients also
from lying down?
7. As a principal branch of the fourth cervical nerve of the left side,
after having joined a branch of the third and of the second cervical
nerves, descending between the subclavian vein and artery, is received in a
groove formed for it in the pericardium, and is obliged to make a
considerable turn outwards to go over the prominent part of it, where the
point of the heart is lodged, in its course to the diaphragm; and as the
other phrenic nerve of the right side has a straight course to the
diaphragm; and as many other considerable branches of this fourth pair of
cervical nerves are spread on the arms; does not a pain in the left arm
distinguish a disease of the pericardium, as in the angina pectoris, or in
the dropsy of the pericardium? and does not a pain or weakness in both arms
distinguish the dropsy of the thorax?
8. Do not the dropsies of the thorax and pericardium frequently exist
together, and thus add to the uncertainty and fatality of the disease?
9. Might not the foxglove be serviceable in hydrocephalus internus, in
hydrocele, and in white swellings of the joints?
VI. _Of cold Sweats._
There have been histories given of chronical immoderate sweatings, which
bear some analogy to the diabetes. Dr. Willis mentions a lady then living,
whose sweats where for many years so profuse, that all her bed-clothes were
not only moistened, but deluged with them every night; and that many
ounces, and sometimes pints, of this sweat, were received in vessels
properly placed, as it trickled down her body. He adds, that she had great
thirst, had taken many medicines, and submitted to various rules of life,
and changes of climate, but still continued to have these immoderate
sweats. Pharmac. ration. de sudore anglico.
Dr. Willis has also observed, that the sudor anglicanus which appeared in
England, in 1483, and continued till 1551, was in some respects similar to
the diabetes; and as Dr. Caius, who saw this disease, mentions the
viscidity, as well as the quantity of these sweats, and adds, that the
extremities were often cold, when the internal parts were burnt up with
heat and thirst, with great and speedy emaciation and debility: there is
great reason to believe, that the fluids were absorbed from the cells of
the body by the cellular and cystic branches of the lymphatics, and poured
on the skin by the retrograde motions of the cutaneous ones.
Sydenham has recorded, in the stationary fever of the year 1685, the viscid
sweats flowing from the head, which were probably from the same source as
those in the sweating plague above mentioned.
It is very common in dropsies of the chest or lungs to have the difficulty
of breathing relieved by copious sweats, flowing from the head and neck.
Mr. P. about 50 years of age, had for many weeks been afflicted with
anasarca of his legs and thighs, attended with difficulty of breathing; and
had repeatedly been relieved by squill, other bitters, and
chalybeates.--One night the difficulty of breathing became so great, that
it was thought he must have expired; but so copious a sweat came out of his
head and neck, that in a few hours some pints, by estimation, were wiped
off from those parts, and his breath was for a time relieved. This dyspnoea
and these sweats recurred at intervals, and after some weeks he ceased to
exist. The skin of his head and neck felt cold to the hand, and appeared
pale at the time these sweats flowed so abundantly; which is a proof, that
they were produced by an inverted motion of the absorbents of those parts:
for sweats, which are the consequence of an increased action of the
sanguiferous system, are always attended with a warmth of the skin, greater
than is natural, and a more florid colour; as the sweats from exercise, or
those that succeed the cold fits of agues. Can any one explain how these
partial sweats should relieve the difficulty of breathing in anasarca, but
by supposing that the pulmonary branch of absorbents drank up the fluid in
the cavity of the thorax, or in the cells of the lungs, and threw it on the
skin, by the retrograde motions of the cutaneous branch? for, if we could
suppose, that the increased action of the cutaneous glands or capillaries
poured upon the skin this fluid, previously absorbed from the lungs; why is
not the whole surface of the body covered with sweat? why is not the skin
warm? Add to this, that the sweats above mentioned were clammy or
glutinous, which the condensed perspirable matter is not; whence it would
seem to have been a different fluid from that of common perspiration.
Dr. Dobson, of Liverpool, has given a very ingenious explanation of the
acid sweats, which he observed in a diabetic patient--he thinks part of the
chyle is secreted by the skin, and afterwards undergoes an acetous
fermentation.--Can the chyle get thither, but by an inverted motion of the
cutaneous lymphatics? in the same manner as it is carried to the bladder,
by the inverted motions of the urinary lymphatics. Medic. Observat. and
Enq. London, vol. v.
Are not the cold sweats in some fainting fits, and in dying people, owing
to an inverted motion of the cutaneous lymphatics? for in these there can
be no increased arterial or glandular action.
Is the difficulty of breathing, arising from anasarca of the lungs,
relieved by sweats from the head and neck; whilst that difficulty of
breathing, which arises from a dropsy of the thorax, or pericardium, is
never attended with these sweats of the head? and thence can these diseases
be distinguished from each other? Do the periodic returns of nocturnal
asthma rise from a temporary dropsy of the lungs, collected during their
more torpid state in sound deep, and then re-absorbed by the vehement
efforts of the disordered organs of respiration, and carried off by the
copious sweats about the head and neck?
More extensive and accurate dissections of the lymphatic system are wanting
to enable us to unravel these knots of science.
VII. _Translations of Matter, of Chyle, of Milk, of Urine. Operation of
purging Drugs applied externally._
1. The translations of matter from one part of the body to another, can
only receive an explanation from the doctrine of the occasional retrograde
motions of some branches of the lymphatic system: for how can matter,
absorbed and mixed with the whole mass of blood, be so hastily collected
again in any one part? and is it not an immutable law, in animal bodies,
that each gland can secrete no other, but its own proper fluid? which is,
in part, fabricated in the very gland by an animal process, which it there
undergoes: of these purulent translations innumerable and very remarkable
instances are recorded.
2. The chyle, which is seen among the materials thrown up by violent
vomiting, or in purging stools, can only come thither by its having been
poured into the bowels by the inverted motions of the lacteals: for our
aliment is not converted into chyle in the stomach or intestines by a
chemical process, but is made in the very mouths of the lacteals; or in the
mesenteric glands; in the same manner as other secreted fluids are made by
an animal process in their adapted glands.
Here a curious phænomenon in the exhibition of mercury is worth
explaining:--If a moderate dose of calomel, as six or ten grains, be
swallowed, and within one or two days a cathartic is given, a salivation is
prevented: but after three or four days, a salivation having come on,
repeated purges every day, for a week or two, are required to eliminate the
mercury from the constitution. For this acrid metallic preparation, being
absorbed by the mouth of the lacteals, continues, for a time arrested by
the mesenteric glands, (as the variolous or venereal poisons swell the
subaxillar or inguinal glands): which, during the operation of a cathartic,
is returned into the intestines by the inverted action of the lacteals, and
thus carried out of the system.
Hence we understand the use of vomits or purges, to those who have
swallowed either contagious or poisonous materials, even though exhibited a
day or even two days after such accidents; namely, that by the retrograde
motions of the lacteals and lymphatics, the material still arrested in the
mesenteric, or other glands, may be eliminated from the body.
3. Many instances of milk and chyle found in ulcers are given by Haller,
El. Physiol. t. vii. p. 12, 23, which admit of no other explanation than by
supposing, that the chyle, imbibed by one branch of the absorbent system,
was carried to the ulcer, by the inverted motions of another branch of the
same system.
4. Mrs. P. on the second day after delivery, was seized with a violent
purging, in which, though opiates, mucilages, the bark, and testacea were
profusely used, continued many days, till at length she recovered. During
the time of this purging, no milk could be drawn from her breasts; but the
stools appeared like the curd of milk broken into small pieces. In this
case, was not the milk taken up from the follicles of the pectoral glands,
and thrown on the intestines, by a retrogression of the intestinal
absorbents? for how can we for a moment suspect that the mucous glands of
the intestines could separate pure milk from the blood? Doctor Smelly has
observed, that loose stools, mixed with milk, which is curdled in the
intestines, frequently relieves the turgescency of the breasts of those who
studiously repel their milk. Cases in Midwifery, 43, No. 2. 1.
5. J.F. Meckel observed in a patient, whose urine was in small quantity and
high coloured, that a copious sweat under the arm-pits, of a perfectly
urinous smell, stained the linen; which ceased again when the usual
quantity of urine was discharged by the urethra. Here we must believe from
analogy, that the urine was first secreted in the kidneys, then re-absorbed
by the increased action of the urinary lymphatics, and lastly carried to
the axillae by the retrograde motions of the lymphatic branches of those
parts. As in the jaundice it is necessary, that the bile should first be
secreted by the liver, and re-absorbed into the circulation, to produce the
yellowness of the skin; as was formerly demonstrated by the late Dr. Munro,
(Edin. Medical Essays) and if in this patient the urine had been
re-absorbed into the mass of blood, as the bile in the jaundice, why was it
not detected in other parts of the body, as well as in the arm-pits?
6. Cathartic and vermifuge medicines applied externally to the abdomen,
seem to be taken up by the cutaneous branch of lymphatics, and poured on
the intestines by the retrograde motions of the lacteals, without having
passed the circulation.
For when the drastic purges are taken by the mouth, they excite the
lacteals of the intestines into retrograde motions, as appears from the
chyle, which is found coagulated among the fæces, as was shewn above,
(sect. 2 and 4.) And as the cutaneous lymphatics are joined with the
lacteals of the intestines, by frequent anastomoses; it would be more
extraordinary, when a strong purging drug, absorbed by the skin, is carried
to the anastomosing branches of the lacteals unchanged, if it should not
excite them into retrograde action as efficaciously, as if it was taken by
the mouth, and mixed with the food of the stomach.
VIII. _Circumstances by which the Fluids, that are effused by the
retrograde Motions of the absorbent Vessels, are distinguished._
1. We frequently observe an unusual quantity of mucus or other fluids in
some diseases, although the action of the glands, by which those fluids are
separated from the blood, is not unusually increased; but when the power of
absorption alone is diminished. Thus the catarrhal humour from the nostrils
of some, who ride in frosty weather; and the tears, which run down the
cheeks of those, who have an obstruction of the puncta lacrymalia; and the
ichor of those phagedenic ulcers, which are not attended with inflammation,
are all instances of this circumstance.
These fluids however are easily distinguished from others by their
abounding in ammoniacal or muriatic salts; whence they inflame the
circumjacent skin: thus in the catarrh the upper lip becomes red and
swelled from the acrimony of the mucus, and patients complain of the
saltness of its taste. The eyes and cheeks are red with the corrosive
tears, and the ichor of some herpetic eruptions erodes far and wide the
contiguous parts, and is pungently salt to the taste, as some patients have
informed me.
Whilst, on the contrary, those fluids, which are effused by the retrograde
action of the lymphatics, are for the most part mild and innocent; as
water, chyle, and the natural mucus: or they take their properties from the
materials previously absorbed, as in the coloured or vinous urine, or that
scented with asparagus, described before.
2. Whenever the secretion of any fluid is increased, there is at the same
time an increased heat in the part; for the secreted fluid, as the bile,
did not previously exist in the mass of blood, but a new combination is
produced in the gland. Now as solutions are attended with cold, so
combinations are attended with heat; and it is probable the sum of the heat
given out by all the secreted fluids of animal bodies may be the cause of
their general heat above that of the atmosphere.
Hence the fluids derived from increased secretions are readily
distinguished from those originating from the retrograde motions of the
lymphatics: thus an increase of heat either in the diseased parts, or
diffused over the whole body, is perceptible, when copious bilious stools
are consequent to an inflamed liver; or a copious mucous salivation from
the inflammatory angina.
3. When any secreted fluid is produced in an unusual quantity, and at the
same time the power of absorption is increased in equal proportion, not
only the heat of the gland becomes more intense, but the secreted fluid
becomes thicker and milder, its thinner and saline parts being re-absorbed:
and these are distinguishable both by their greater consistence, and by
their heat, from the fluids, which are effused by the retrograde motions of
the lymphatics; as is observable towards the termination of gonorrhoea,
catarrh, chincough, and in those ulcers, which are said to abound with
laudable pus.
4. When chyle is observed in stools, or among the materials ejected by
vomit, we may be confident it must have been brought thither by the
retrograde motions of the lacteals; for chyle does not previously exist
amid the contents of the intestines, but is made in the very mouths of the
lacteals, as was before explained.
5. When chyle, milk, or other extraneous fluids are found in the urinary
bladder, or in any other excretory receptacle of a gland; no one can for a
moment believe, that these have been collected from the mass of blood by a
morbid secretion, as it contradicts all analogy.
---- Aurea duræ
Mala ferant quercus? Narcisco floreat alnus?
Pinguia corticibus sudent electra myricæ?--VIRGIL.
IX. _Retrograde Motions of Vegetable juices._
There are besides some motions of the sap in vegetables, which bear analogy
to our present subject; and as the vegetable tribes are by many
philosophers held to be inferior animals, it may be a matter of curiosity
at least to observe, that their absorbent vessels seem evidently, at times,
to be capable of a retrograde motion. Mr. Perault cut off a forked branch
of a tree, with the leaves on; and inverting one of the forks into a vessel
of water, observed, that the leaves on the other branch continued green
much longer than those of a similar branch, cut off from the same tree;
which shews, that the water from the vessel was carried up one part of the
forked branch, by the retrograde motion of its vessels, and supplied
nutriment some time to the other part of the branch, which was out of the
water. And the celebrated Dr. Hales found, by numerous very accurate
experiments, that the sap of trees rose upwards during the warmer hours of
the day, and in part descended again during the cooler ones. Vegetable
Statics.
It is well known that the branches of willows, and of many other trees,
will either take root in the earth or engraft on other trees, so as to have
their natural direction inverted, and yet flourish with vigour.
Dr. Hope has also made this pleasing experiment, after the manner of
Hales--he has placed a forked branch, cut from one tree, erect between two
others; then cutting off a part of the bark from one fork applied it to a
similar branch of one of the trees in its vicinity; and the same of the
other fork; so that a tree is seen to grow suspended in the air, between
two other trees; which supply their softer friend with due nourishment.
Miranturque novas frondes, et non sua poma.
All these experiments clearly evince, that the juices of vegetables can
occasionally pass either upwards or downwards in their absorbent system of
vessels.
X. _Objections answered._
The following experiment, at first view, would seem to invalidate this
opinion of the retrograde motions of the lymphatic vessels, in some
diseases.
About a gallon of milk having been giving to an hungry swine, he was
suffered to live about an hour, and was then killed by a stroke or two on
his head with an axe.--On opening his belly the lacteals were well seen
filled with chyle; on irritating many of the branches of them with a knife,
they did not appear to empty themselves hastily; but they did however carry
forwards their contents in a little time.
I then passed a ligature round several branches of lacteals, and irritated
them much with a knife beneath the ligature, but could not make them
regurgitate their contained fluid into the bowels.
I am not indeed certain, that the nerve was not at the same time included
in the ligature, and thus the lymphatic rendered unirritable or lifeless;
but this however is certain, that it is not any quantity of any stimulus,
which induces the vessels of animal bodies to revert their motions; but a
certain quantity of a certain stimulus, as appears from wounds in the
stomach, which do not produce vomiting; and wounds of the intestines, which
do not produce the cholera morbus.
At Nottingham, a few years ago, two shoemakers quarrelled, and one of them
with a knife, which they use in their occupation, stabbed his companion
about the region of the stomach. On opening the abdomen of the wounded man
after his death the food and medicines he had taken were in part found in
the cavity of the belly, on the outside of the bowels; and there was a
wound about half an inch long at the bottom of the stomach; which I suppose
was distended with liquor and food at the time of the accident; and thence
was more liable to be injured at its bottom: but during the whole time he
lived, which was about ten days, he had no efforts to vomit, nor ever even
complained of being sick at the stomach! Other cases similar to this are
mentioned in the philosophical transactions.
Thus, if you vellicate the throat with a feather, nausea is produced; if
you wound it with a penknife, pain is induced, but not sickness. So if the
soles of the feet of children or their armpits are tickled, convulsive
laughter is excited, which ceases the moment the hand is applied, so as to
rub them more forcibly.
The experiment therefore above related upon the lacteals of a dead pig,
which were included in a strict ligature, proves nothing; as it is not the
quantity, but the kind of stimulus, which excites the lymphatic vessels
into retrograde motion.
XI. _The Causes which induce the retrograde Motions of animal Vessels; and
the Medicines by which the natural Motions are restored._
1. Such is the construction of animal bodies, that all their parts, which
are subjected to less stimuli than nature designed, perform their functions
with less accuracy: thus, when too watery or too acescent food is taken
into the stomach, indigestion, and flatulency, and heartburn succeed.
2. Another law of irritation, connate with our existence, is, that all
those parts of the body, which have previously been exposed to too great a
quantity of such stimuli, as strongly affect them, become for some time
afterwards disobedient to the natural quantity of their adapted
stimuli.--Thus the eye is incapable of seeing objects in an obscure room,
though the iris is quite dilated, after having been exposed to the meridian
sun.
3. There is a third law of irritation, that all the parts of our bodies,
which have been lately subjected to less stimulus, than they have been
accustomed to, when they are exposed to their usual quantity of stimulus,
are excited into more energetic motions: thus when we come from a dusky
cavern into the glare of daylight, our eyes are dazzled; and after emerging
from the cold bath, the skin becomes warm and red.
4. There is a fourth law of irritation, that all the parts of our bodies,
which are subjected to still stronger stimuli for a length of time, become
torpid, and refuse to obey even these stronger stimuli; and thence do their
offices very imperfectly.--Thus, if any one looks earnestly for some
minutes on an area, an inch diameter, of red silk, placed on a sheet of
white paper, the image of the silk will gradually become pale, and at
length totally vanish.
5. Nor is it the nerves of sense alone, as the optic and auditory nerves,
that thus become torpid, when the stimulus is withdrawn or their
irritability decreased; but the motive muscles, when they are deprived of
their natural stimuli, or of their irritability, become torpid and
paralytic; as is seen in the tremulous hand of the drunkard in a morning;
and in the awkward step of age.
The hollow muscles also, of which the various vessels of the body are
constructed, when they are deprived of their natural stimuli, or of their
due degree of irritability, not only become tremulous, as the arterial
pulsations of dying people; but also frequently invert their motions, as in
vomiting, in hysteric suffocations, and diabetes above described.
I must beg your patient attention, for a few moments whilst I endeavour to
explain, how the retrograde actions of our hollow muscles are the
consequence of their debility; as the tremulous actions of the solid
muscles are the consequence of their debility. When, through fatigue, a
muscle can act no longer; the antagonist muscles, either by their inanimate
elasticity, or by their animal action, draw the limb into a contrary
direction: in the solid muscles, as those of locomotion, their actions are
associated in tribes, which have been accustomed to synchronous action
only; hence when they are fatigued, only a single contrary effort takes
place; which is either tremulous, when the fatigued muscles are again
immediately brought into action; or it is a pandiculation, or stretching,
where they are not immediately again brought into action.
Now the motions of the hollow muscles, as they in general propel a fluid
along their cavities, are associated in trains, which have been accustomed
to successive actions: hence when one ring of such a muscle is fatigued
from its too great debility, and is brought into retrograde action, the
next ring from its association falls successively into retrograde action;
and so on throughout the whole canal. See Sect. XXV. 6.
6. But as the retrograde motions of the stomach, oesophagus, and fauces in
vomiting are, as it were, apparent to the eye; we shall consider this
operation more minutely, that the similar operations in the more recondite
parts of our system may be easier understood.
From certain nauseous ideas of the mind, from an ungrateful taste in the
mouth, or from foetid smells, vomiting is sometimes instantly excited; or
even from a stroke on the head, or from the vibratory motions of a ship;
all which originate from association, or sympathy. See Sect. XX. on
Vertigo.
But when the stomach is subjected to a less stimulus than is natural,
according to the first law of irritation mentioned above, its motions
become disturbed, as in hunger; first pain is produced, then sickness, and
at length vain efforts to vomit, as many authors inform us.
But when a great quantity of wine, or of opium, is swallowed, the
retrograde motions of the stomach do not occur till after several minutes,
or even hours; for when the power of so strong a stimulus ceases, according
to the second law of irritation, mentioned above, the peristaltic motions
become tremulous, and at length retrograde; as is well known to the
drunkard, who on the next morning has sickness and vomitings.
When a still greater quantity of wine, or of opium, or when nauseous
vegetables, or strong bitters, or metallic salts, are taken into the
stomach, they quickly induce vomiting; though all these in less doses
excite the stomach into more energetic action, and strengthen the
digestion; as the flowers of chamomile, and the vitriol of zinc: for,
according to the fourth law of irritation, the stomach will not long be
obedient to a stimulus so much greater than is natural; but its action
becomes first tremulous and then retrograde.
7. When the motions of any vessels become retrograde, less heat of the body
is produced; for in paroxysms of vomiting, of hysteric affections, of
diabetes, of asthma, the extremities of the body are cold: hence we may
conclude, that these symptoms arise from the debility of the parts in
action; for an increase of muscular action is always attended with increase
of heat.
8. But as animal debility is owing to defect of stimulus, or to defect of
irritability, as shewn above, the method of cure is easily deduced: when
the vascular muscles are not excited into their due action by the natural
stimuli, we should exhibit those medicines, which possess a still greater
degree of stimulus; amongst these are the foetids, the volatiles,
aromatics, bitters, metallic salts, opiates, wine, which indeed should be
given in small doses, and frequently repeated. To these should be added
constant, but moderate exercise, cheerfulness of mind, and change of
country to a warmer climate; and perhaps occasionally the external stimulus
of blisters.
It is also frequently useful to diminish the quantity of natural stimulus
for a short time, by which afterwards the irritability of the system
becomes increased; according to the third law of irritation
above-mentioned, hence the use of baths somewhat colder than animal heat,
and of equitation in the open air.
_The catalogue of diseases owing to the retrograde motions of lymphatics is
here omitted, as it will appear in the second volume of this work. The
following is the conclusion to this thesis of_ Mr. CHARLES DARWIN.
Thus have I endeavoured in a concise manner to explain the numerous
diseases, which deduce their origin from the inverted motions of the hollow
muscles of our bodies: and it is probable, that Saint Vitus's dance, and
the stammering of speech, originate from a similar, inverted order of the
associated motions of some of the solid muscles; which, as it is foreign to
my present purpose, I shall not here discuss.
I beg, illustrious professors, and ingenious fellow-students, that you will
recollect how difficult a talk I have attempted, to evince the retrograde
motions of the lymphatic vessels, when the vessels themselves for so many
ages escaped the eyes and glasses of philosophers: and if you are not yet
convinced of the truth of this theory, hold, I entreat you, your minds in
suspense, till ANATOMY draws her sword with happier omens, cuts asunder the
knots, which entangle PHYSIOLOGY; and, like an augur inspecting the
immolated victim, announces to mankind the wisdom of HEAVEN.
* * * * *
SECT. XXX.
PARALYSIS OF THE LIVER AND KIDNEYS.
I. 1._Bile-ducts less irritable after having been stimulated much._ 2.
_Jaundice from paralysis of the bile-ducts cured by electric shocks._
3. _From bile-stones. Experiments on bile-stones. Oil vomit._ 4. _Palsy
of the liver, two cases._ 5. _Schirrosity of the liver._ 6. _Large
livers of geese._ II. _Paralysis of the kidneys._ III. _Story of
Prometheus._
I. 1. From the ingurgitation of spirituous liquors into the stomach and
duodenum, the termination of the common bile-duct in that bowel becomes
stimulated into unnatural action, and a greater quantity of bile is
produced from all the secretory vessels of the liver, by the association of
their motions with those of their excretory ducts; as has been explained in
Section XXIV. and XXV. but as all parts of the body, that have been
affected with stronger stimuli for any length of time, become less
susceptible of motion, from their natural weaker stimuli, it follows, that
the motions of the secretory vessels, and in consequence the secretion of
bile, is less than is natural during the intervals of sobriety. 2. If this
ingurgitation of spirituous liquors has been daily continued in
considerable quantity, and is then suddenly intermitted, a languor or
paralysis of the common bile-duct is induced; the bile is prevented from
being poured into the intestines; and as the bilious absorbents are
stimulated into stronger action by its accumulation, and by the acrimony or
viscidity, which it acquires by delay, it is absorbed, and carried to the
receptacle of the chyle; or otherwise the secretory vessels of the liver,
by the above-mentioned stimulus, invert their motions, and regurgitate
their contents into the blood, as sometimes happens to the tears in the
lachrymal sack, see Sect. XXIV. 2. 7. and one kind of jaundice is brought
on.
There is reason to believe, that the bile is most frequently returned into
the circulation by the inverted motions of these hepatic glands, for the
bile does not seem liable to be absorbed by the lymphatics, for it soaks
through the gall-ducts, and is frequently found in the cellular membrane.
This kind of jaundice is not generally attended with pain, neither at the
extremity of the bile-duct, where it enters the duodenum, nor on the region
of the gall-bladder.
Mr. S. a gentleman between 40 and 50 years of age, had had the jaundice
about six weeks, without pain, sickness, or fever; and had taken emetics,
cathartics, mercurials, bitters, chalybeates, essential oil, and ether,
without apparent advantage. On a supposition that the obstruction of the
bile might be owing to the paralysis, or torpid action of the common
bile-duct, and the stimulants taken into the stomach seeming to have no
effect, I directed half a score smart electric shocks from a coated bottle,
which held about a quart, to be passed through the liver, and along the
course of the common gall-duct, as near as could be guessed, and on that
very day the stools became yellow; he continued the electric shocks a few
days more, and his skin gradually became clear.
3. The bilious vomiting and purging, that affects some people by intervals
of a few weeks, is a less degree of this disease; the bile-duct is less
irritable than natural, and hence the bile becomes accumulated in the
gall-bladder, and hepatic ducts, till by its quantity, acrimony or
viscidity, a greater degree of irritation is produced, and it is suddenly
evacuated, or lastly from the absorption of the more liquid parts of the
bile, the remainder becomes inspissated, and chrystallizes into masses too
large to pass, and forms another kind of jaundice, where the bile-duct is
not quite paralytic, or has regained its irritability.
This disease is attended with much pain, which at first is felt at the pit
of the stomach, exactly in the centre of the body, where the bile-duct
enters the duodenum; afterwards, when the size of the bile-stones increase,
it is also felt on the right side, where the gall-bladder is situated. The
former pain at the pit of the stomach recurs by intervals, as the
bile-stone is pushed against the neck of the duct; like the paroxysms of
the stone in the urinary bladder, the other is a more dull and constant
pain.
Where these bile-stones are too large to pass, and the bile-ducts possess
their sensibility, this becomes a very painful and hopeless disease. I made
the following experiments with a view to their chemical solution.
Some fragments of the same bile-stone were put into the weak spirit of
marine salt, which is sold in the shops, and into solution of mild alcali;
and into a solution of caustic alcali; and into oil of turpentine; without
their being dissolved. All these mixtures were after some time put into a
heat of boiling water, and then the oil of turpentine dissolved its
fragments of bile-stone, but no alteration was produced upon those in the
other liquids except some change of their colour.
Some fragments of the same bile-stone were put into vitriolic æther, and
were quickly dissolved without additional heat. Might not æther mixed with
yolk of egg or with honey be given advantageously in bilious concretions?
I have in two instances seen from 30 to 50 bile-stones come away by stool,
about the size of large peas, after having given six grains of calomel in
the evening, and four ounces of oil of almonds or olives on the succeeding
morning. I have also given half a pint of good olive or almond oil as an
emetic during the painful fit, and repeated it in half an hour, if the
first did not operate, with frequent good effect.
4. Another disease of the liver, which I have several times observed,
consists in the inability or paralysis of the secretory vessels. This
disease has generally the same cause as the preceding one, the too frequent
potation of spirituous liquors, or the too sudden omission of them, after
the habit is confined; and is greater or less in proportion, as the whole
or a part of the liver is affected, and as the inability or paralysis is
more or less complete.
This palsy of the liver is known from these symptoms, the patients have
generally passed the meridian of life, have drank fermented liquors daily,
but perhaps not been opprobrious drunkards; they lose their appetite, then
their flesh and strength diminish in consequence, there appears no bile in
their stools, nor in their urine, nor is any hardness or swelling
perceptible on the region of the liver. But what is peculiar to this
disease, and distinguishes it from all others at the first glance of the
eye, is the bombycinous colour of the skin, which, like that of full-grown
silkworms, has a degree of transparency with a yellow tint not greater than
is natural to the serum of the blood.
Mr. C. and Mr. B. both very strong men, between 50 and 60 years of age, who
had drank ale at their meals instead of small beer, but were not reputed
hard-drinkers, suddenly became weak, lost their appetite, flesh, and
strength, with all the symptoms above enumerated, and died in about two
months from the beginning of their malady. Mr. C. became anasarcous a few
days before his death, and Mr. B. had frequent and great hæmorrhages from
an issue, and some parts of his mouth, a few days before his death. In both
these cases calomel, bitters and chalybeates were repeatedly used without
effect.
One of the patients described above, Mr. C, was by trade a plumber; both of
them could digest no food, and died apparently for want of blood. Might not
the transfusion of blood be used in these cases with advantage?
5. When the paralysis of the hepatic glands is less complete, or less
universal, a schirrosity of some part of the liver is induced; for the
secretory vessels retaining some of their living power take up a fluid from
the circulation, without being sufficiently irritable to carry it forwards
to their excretory ducts; hence the body, or receptacle of each gland,
becomes inflated, and this distension increases, till by its very great
stimulus inflammation is produced, or till those parts of the viscus become
totally paralytic. This disease is distinguishable from the foregoing by
the palpable hardness or largeness of the liver; and as the hepatic glands
are not totally paralytic, or the whole liver not affected, some bile
continues to be made. The inflammations of this viscus, consequent to the
schirrosity of it, belong to the diseases of the sensitive motions, and
will be treated of hereafter.
6. The ancients are said to have possessed an art of increasing the livers
of geese to a size greater than the remainder of the goose. Martial. l. 13.
epig. 58.--This is said to have been done by fat and figs. Horace, l. 2.
sat. 8.--Juvenal sets these large livers before an epicure as a great
rarity. Sat. 5. l. 114; and Persius, sat. 6. l. 71. Pliny says these large
goose-livers were soaked in mulled milk, that is, I suppose, milk mixed
with honey and wine; and adds, "that it is uncertain whether Scipio
Metellus, of consular dignity, or M. Sestius, a Roman knight, was the great
discoverer of this excellent dish." A modern traveller, I believe Mr.
Brydone, asserts that the art of enlarging the livers of geese still exists
in Sicily; and it is to be lamented that he did not import it into his
native country, as some method of affecting the human liver might perhaps
have been collected from it; besides the honour he might have acquired in
improving our giblet pies.
Our wiser caupones, I am told, know how to fatten their fowls, as well as
their geese, for the London markets, by mixing gin instead of figs and fat
with their food; by which they are said to become sleepy, and to fatten
apace, and probably acquire enlarged livers; as the swine are asserted to
do, which are fed on the sediments of barrels in the distilleries; and
which so frequently obtains in those, who ingurgitate much ale, or wine, or
drams.
II. The irritative diseases of the kidneys, pancreas, spleen, and other
glands, are analogous to those of the liver above described, differing only
in the consequences attending their inability to action. For instance, when
the secretory vessels of the kidneys become disobedient to the stimulus of
the passing current of blood, no urine is separated or produced by them;
their excretory mouths become filled with concreted mucus, or calculus
matter, and in eight or ten days stupor and death supervenes in consequence
of the retention of the feculent part of the blood.
This disease in a slighter degree, or when only a part of the kidney is
affected, is succeeded by partial inflammation of the kidney in consequence
of previous torpor. In that case greater actions of the secretory vessels
occur, and the nucleus of gravel is formed by the inflamed mucous membranes
of the tubuli uriniferi, as farther explained in its place.
This torpor, or paralysis of the secretory vessels of the kidneys, like
that of the liver, owes its origin to their being previously habituated to
too great stimulus; which in this country is generally owing to the alcohol
contained in ale or wine; and hence must be registered amongst the diseases
owing to inebriety; though it may be caused by whatever occasionally
inflames the kidney; as too violent riding on horseback, or the cold from a
damp bed, or by sleeping on the cold ground; or perhaps by drinking in
general too little aqueous fluids.
III. I shall conclude this section on the diseases of the liver induced by
spirituous liquors, with the well known story of Prometheus, which seems
indeed to have been invented by physicians in those ancient times, when all
things were clothed in hieroglyphic, or in fable. Prometheus was painted as
stealing fire from heaven, which might well represent the inflammable
spirit produced by fermentation; which may be said to animate or enliven
the man of clay: whence the conquests of Bacchus, as well as the temporary
mirth and noise of his devotees. But the after punishment of those, who
steal this accursed fire, is a vulture gnawing the liver; and well
allegorises the poor inebriate lingering for years under painful hepatic
diseases. When the expediency of laying a further tax on the distillation
of spirituous liquors from grain was canvassed before the House of Commons
some years ago, it was said of the distillers, with great truth, "_They
take the bread from the people, and convert it into poison!_" Yet is this
manufactory of disease permitted to continue, as appears by its paying into
the treasury above 900,000l. near a million of money annually. And thus,
under the names of rum, brandy, gin, whisky, usquebaugh, wine, cyder, beer,
and porter, alcohol is become the bane of the Christian world, as opium of
the Mahometan.
Evoe! parce, liber?
Parce, gravi metuende thirso!--Hor.
* * * * *
SECT. XXXI.
OF TEMPERAMENTS.
I. _The temperament of decreased irritability known by weak pulse,
large pupils of the eyes, cold extremities. Are generally supposed to
be too irritable. Bear pain better than labour. Natives of
North-America contrasted with those upon the coast of Africa. Narrow
and broad shouldered people. Irritable constitutions bear labour better
than pain._ II. _Temperament of increased sensibility. Liable to
intoxication, to inflammation, hæmoptoe, gutta serena, enthusiasm,
delirium, reverie. These constitutions are indolent to voluntary
exertions, and dull to irritations. The natives of South-America, and
brute animals of this temperament._ III. _Of increased voluntarity;
these are subject to locked jaw, convulsions, epilepsy, mania. Are very
active, bear cold, hunger, fatigue. Are suited to great exertions. This
temperament distinguishes mankind from other animals._ IV. _Of
increased association. These have great memories, are liable to quartan
agues, and stronger sympathies of parts with each other._ V. _Change of
temperaments into one another._
Antient writers have spoken much of temperaments, but without sufficient
precision. By temperament of the system should be meant a permanent
predisposition to certain classes of diseases: without this definition a
temporary predisposition to every distinct malady might be termed a
temperament. There are four kinds of constitution, which permanently
deviate from good health, and are perhaps sufficiently marked to be
distinguished from each other, and constitute the temperaments or
predispositions to the irritative, sensitive, voluntary, and associate
classes of diseases.
I. _The Temperament of decreased Irritability._
The diseases, which are caused by irritation, most frequently originate
from the defect of it; for those, which are immediately owing to the excess
of it, as the hot fits of fever, are generally occasioned by an
accumulation of sensorial power in consequence of a previous defect of
irritation, as in the preceding cold fits of fever. Whereas the diseases,
which are caused by sensation and volition, most frequently originate from
the excess of those sensorial powers, as will be explained below.
The temperament of decreased irritability appears from the following
circumstances, which shew that the muscular fibres or organs of sense are
liable to become torpid or quiescent from less defect of stimulation than
is productive of torpor or quiescence in other constitutions.
1. The first is the weak pulse, which in some constitutions is at the same
time quick. 2. The next most marked criterion of this temperament is the
largeness of the aperture of the iris, or pupil of the eye, which has been
reckoned by some a beautiful feature in the female countenance, as an
indication of delicacy, but to an experienced observer it is an indication
of debility, and is therefore a defect, not an excellence. The third most
marked circumstance in this constitution is, that the extremities, as the
hands and feet, or nose and ears, are liable to become cold and pale in
situations in respect to warmth, where those of greater strength are not
affected. Those of this temperament are subject to hysteric affections,
nervous fevers, hydrocephalus, scrophula, and consumption, and to all other
diseases of debility.
Those, who possess this kind of constitution, are popularly supposed to be
more irritable than is natural, but are in reality less so.
This mistake has arisen from their generally having a greater quickness of
pulse, as explained in Sect. XII. 1. 4. XII. 3. 3.; but this frequency of
pulse is not necessary to the temperament, like the debility of it.
Persons of this temperament are frequently found amongst the softer sex,
and amongst narrow-shouldered men; who are said to bear labour worse, and
pain better than others. This last circumstance is supposed to have
prevented the natives of North America from having been made slaves by the
Europeans. They are a narrow-shouldered race of people, and will rather
expire under the lash, than be made to labour. Some nations of Asia have
small hands, as may be seen by the handles of their scymetars; which with
their narrow shoulders shew, that they have not been accustomed to so great
labour with their hands and arms, as the European nations in agriculture,
and those on the coasts of Africa in swimming and rowing. Dr. Maningham, a
popular accoucheur in the beginning of this century, observes in his
aphorisms, that broad-shouldered men procreate broad-shouldered children.
Now as labour strengthens the muscles employed, and increases their bulk,
it would seem that a few generations of labour or of indolence may in this
respect change the form and temperament of the body.
On the contrary, those who are happily possessed of a great degree of
irritability, bear labour better than pain; and are strong, active, and
ingenious. But there is not properly a temperament of increased
irritability tending to disease, because an increased quantity of
irritative motions generally induces an increase of pleasure or pain, as in
intoxication, or inflammation; and then the new motions are the immediate
consequences of increased sensation, not of increased irritation; which
have hence been so perpetually confounded with each other.
II. _Temperament of Sensibility._
There is not properly a temperament, or predisposition to disease, from
decreased sensibility, since irritability and not sensibility is
immediately necessary to bodily health. Hence it is the excess of sensation
alone, as it is the defect of irritation, that most frequently produces
disease. This temperament of increased sensibility is known from the
increased activity of all those motions of the organs of sense and muscles,
which are exerted in consequence of pleasure or pain, as in the beginning
of drunkenness, and in inflammatory fever. Hence those of this constitution
are liable to inflammatory diseases, as hepatitis; and to that kind of
consumption which is hereditary, and commences with slight repeated
hæmoptoe. They have high-coloured lips, frequently dark hair and dark eyes
with large pupils, and are in that case subject to gutta serena. They are
liable to enthusiasm, delirium, and reverie. In this last circumstance they
are liable to start at the clapping of a door; because the more intent any
one is on the passing current of his ideas, the greater surprise he
experiences on their being dissevered by some external violence, as
explained in Sect. XIX. on reverie.
As in these constitutions more than the natural quantities of sensitive
motions are produced by the increased quantity of sensation existing in the
habit, it follows, that the irritative motions will be performed in some
degree with less energy, owing to the great expenditure of sensorial power
on the sensitive ones. Hence those of this temperament do not attend to
slight stimulations, as explained in Sect. XIX. But when a stimulus is so
great as to excite sensation, it produces greater sensitive actions of the
system than in others; such as delirium or inflammation. Hence they are
liable to be absent in company; sit or lie long in one posture; and in
winter have the skin of their legs burnt into various colours by the fire.
Hence also they are fearful of pain; covet music and sleep; and delight in
poetry and romance.
As the motions in consequence of sensation are more than natural, it also
happens from the greater expenditure of sensorial power on them, that the
voluntary motions are less easily exerted. Hence the subjects of this
temperament are indolent in respect to all voluntary exertions, whether of
mind or body.
A race of people of this description seems to have been found by the
Spaniards in the islands of America, where they first landed, ten of whom
are said not to have consumed more food than one Spaniard, nor to have been
capable of more than one tenth of the exertion of a Spaniard. Robertson's
History.--In a state similar to this the greatest part of the animal world
pass their lives, between sleep or inactive reverie, except when they are
excited by the call of hunger.
III. _The Temperament of increased Voluntarity._
Those of this constitution differ from both the last mentioned in this,
that the pain, which gradually subsides in the first, and is productive of
inflammation or delirium in the second, is in this succeeded by the
exertion of the muscles or ideas, which are most frequently connected with
volition; and they are thence subject to locked jaw, convulsions, epilepsy,
and mania, as explained in Sect. XXXIV. Those of this temperament attend to
the slightest irritations or sensations, and immediately exert themselves
to obtain or avoid the objects of them; they can at the same time bear cold
and hunger better than others, of which Charles the Twelfth of Sweden was
an instance. They are suited and generally prompted to all great exertions
of genius or labour, as their desires are more extensive and more vehement,
and their powers of attention and of labour greater. It is this facility of
voluntary exertion, which distinguishes men from brutes, and which has made
them lords of the creation.
IV. _The Temperament of increased Association._
This constitution consists in the too great facility, with which the
fibrous motions acquire habits of association, and by which these
associations become proportionably stronger than in those of the other
temperaments. Those of this temperament are slow in voluntary exertions, or
in those dependent on sensation, or on irritation. Hence great memories
have been said to be attended with less sense and less imagination from
Aristotle down to the present time; for by the word memory these writers
only understood the unmeaning repetition of words or numbers in the order
they were received, without any voluntary efforts of the mind.
In this temperament those associations of motions, which are commonly
termed sympathies, act with greater certainty and energy, as those between
disturbed vision and the inversion of the motion of the stomach, as in
sea-sickness; and the pains in the shoulder from hepatic inflammation. Add
to this, that the catenated circles of actions are of greater extent than
in the other constitutions. Thus if a strong vomit or cathartic be
exhibited in this temperament, a smaller quantity will produce as great an
effect, if it be given some weeks afterwards; whereas in other temperaments
this is only to be expected, if it be exhibited in a few days after the
first dose. Hence quartan agues are formed in those of this temperament, as
explained in Section XXXII. on diseases from irritation, and other
intermittents are liable to recur from slight causes many weeks after they
have been cured by the bark.
V. The first of these temperaments differs from the standard of health from
defect, and the others from excess of sensorial power; but it sometimes
happens that the same individual, from the changes introduced into his
habit by the different seasons of the year, modes or periods of life, or by
accidental diseases, passes from one of these temperaments to another. Thus
a long use of too much fermented liquor produces the temperament of
increased sensibility; great indolence and solitude that of decreased
irritability; and want of the necessaries of life that of increased
voluntarity.
* * * * *
SECT. XXXII.
DISEASES OF IRRITATION.
I. _Irritative fevers with strong pulse. With weak pulse. Symptoms of
fever, Their source._ II. 1. _Quick pulse is owing to decreased
irritability_. 2. _Not in sleep or in apoplexy._ 3. _From inanition.
Owing to deficiency of sensorial power._ III. 1. _Causes of fever. From
defect of heat. Heat from secretions. Pain of cold in the loins and
forehead._ 2. _Great expense of sensorial power in the vital motions.
Immersion in cold water. Succeeding glow of heat. Difficult respiration
in cold bathing explained. Why the cold bath invigorates. Bracing and
relaxation are mechanical terms._ 3. _Uses of cold bathing. Uses of
cold air in fevers._ 4. _Ague fits from cold air. Whence their
periodical returns._ IV. _Defect of distention a cause of fever.
Deficiency of blood. Transfusion of blood._ V. 1. _Defect of momentum
of the blood from mechanic stimuli. 2. Air injected into the
blood-vessels._ 3. _Exercise increases the momentum of the blood._ 4.
_Sometimes bleeding increases the momentum of it._ VI. _Influence of
the sun and moon on diseases. The chemical stimulus of the blood.
Menstruation obeys the lunations. Queries._ VII. _Quiesence of large
glands a cause of fever. Swelling of the præcordia._ VIII. _Other
causes of quiescence, as hunger, bad air, fear, anxiety._ IX. 1.
_Symptoms of the cold fit._ 2. _Of the hot fit._ 3. _Second cold fit
why._ 4. _Inflammation introduced, or delirium, or stupor._ X.
_Recapitulation. Fever not an effort of nature to relieve herself.
Doctrine of spasm._
I. When the contractile sides of the heart and arteries perform a greater
number of pulsations in a given time, and move through a greater area at
each pulsation, whether these motions are occasioned by the stimulus of the
acrimony or quantity of the blood, or by their association with other
irritative motions, or by the increased irritability of the arterial
system, that is, by an increased quantity of sensorial power, one kind of
fever is produced; which may be called Synocha irritativa, or Febris
irritativa pulsu forti, or irritative fever with strong pulse.
When the contractile sides of the heart and arteries perform a greater
number of pulsations in a given time, but move through a much less area at
each pulsation, whether these motions are occasioned by defect of their
natural stimuli, or by the defect of other irritative motions with which
they are associated, or from the inirritability of the arterial system,
that is, from a decreased quantity of sensorial power, another kind of
fever arises; which may be termed, Typhus irritativus, or Febris irritativa
pulsu debili, or irritative fever with weak pulse. The former of these
fevers is the synocha of nosologists, and the latter the typhus mitior, or
nervous fever. In the former there appears to be an increase of sensorial
power, in the latter a deficiency of it; which is shewn to be the immediate
cause of strength and weakness, as defined in Sect. XII. 1. 3.
It should be added, that a temporary quantity of strength or debility may
be induced by the defect or excess of stimulus above what is natural; and
that in the same fever _debility always exists during the cold fit, though
strength does not always exist during the hot fit._
These fevers are always connected with, and generally induced by, the
disordered irritative motions of the organs of sense, or of the intestinal
canal, or of the glandular system, or of the absorbent system; and hence
are always complicated with some or many of these disordered motions, which
are termed the symptoms of the fever, and which compose the great variety
in these diseases.
The irritative fevers both with strong and with weak pulse, as well as the
sensitive fevers with strong and with weak pulse, which are to be described
in the next section, are liable to periodical remissions, and then they
take the name of intermittent fevers, and are distinguished by the
periodical times of their access.
II. For the better illustration of the phenomena of irritative fevers we
must refer the reader to the circumstances of irritation explained in Sect.
XII. and shall commence this intricate subject by speaking of the quick
pulse, and proceed by considering many of the causes, which either
separately or in combination most frequently produce the cold fits of
fevers.
1. If the arteries are dilated but to half their usual diameters, though
they contract twice as frequently in a given time, they will circulate only
half their usual quantity of blood: for as they are cylinders, the blood
which they contain must be as the squares of their diameters. Hence when
the pulse becomes quicker and smaller in the same proportion, the heart and
arteries act with less energy than in their natural state. See Sect. XII.
1. 4.
That this quick small pulse is owing to want of irritability, appears,
first, because it attends other symptoms of want of irritability; and,
secondly, because on the application of a stimulus greater than usual, it
becomes slower and larger. Thus in cold fits of agues, in hysteric
palpitations of the heart, and when the body is much exhausted by
hæmorrhages, or by fatigue, as well as in nervous fevers, the pulse becomes
quick and small; and secondly, in all those cases if an increase of
stimulus be added, by giving a little wine or opium; the quick small pulse
becomes slower and larger, as any one may easily experience on himself, by
counting his pulse after drinking one or two glasses of wine, when he is
faint from hunger or fatigue.
Now nothing can so strongly evince that this quick small pulse is owing to
defect of irritability, than that an additional stimulus, above what is
natural, makes it become slower and larger immediately: for what is meant
by a defect of irritability, but that the arteries and heart are not
excited into their usual exertions by their usual quantity of stimulus? but
if you increase the quantity of stimulus, and they immediately act with
their usual energy, this proves their previous want of their natural degree
of irritability. Thus the trembling hands of drunkards in a morning become
steady, and acquire strength to perform their usual offices, by the
accustomed stimulus of a glass or two of brandy.
2. In sleep and in apoplexy the pulse becomes slower, which is not owing to
defect of irritability, for it is at the same time larger; and thence the
quantity of the circulation is rather increased than diminished. In these
cases the organs of sense are closed, and the voluntary power is suspended,
while the motions dependent on internal irritations, as those of digestion
and secretion, are carried on with more than their usual vigour; which has
led superficial observers to confound these cases with those arising from
want of irritability. Thus if you lift up the eyelid of an apoplectic
patient, who is not actually dying, the iris will, as usual, contract
itself, as this motion is associated with the stimulus of light; but it is
not so in the last stages of nervous fevers, where the pupil of the eye
continues expanded in the broad day-light: in the former case there is a
want of voluntary power, in the latter a want of irritability.
Hence also those constitutions which are deficient in quantity of
irritability, and which possess too great sensibility, as during the pain
of hunger, of hysteric spasms, or nervous headachs, are generally supposed
to have too much irritability; and opium, which in its due dose is a most
powerful stimulant, is erroneously called a sedative; because by increasing
the irritative motions it decreases the pains arising from defect of them.
Why the pulse should become quicker both from an increase of irritation, as
in the synocha irritativa, or irritative fever with strong pulse; and from
the decrease of it, as in the typhus irritativus, or irritative fever with
weak pulse; seems paradoxical. The former circumstance needs no
illustration; since if the stimulus of the blood, or the irritability of
the sanguiferous system be increased, and the strength of the patient not
diminished, it is plain that the motions must be performed quicker and
stronger.
In the latter circumstance the weakness of the muscular power of the heart
is soon over-balanced by the elasticity of the coats of the arteries, which
they possess besides a muscular power of contraction; and hence the
arteries are distended to less than their usual diameters. The heart being
thus stopped, when it is but half emptied, begins sooner to dilate again;
and the arteries being dilated to less than their usual diameters, begin so
much sooner to contract themselves; insomuch, that in the last stages of
fevers with weakness the frequency of pulsation of the heart and arteries
becomes doubled; which, however, is never the case in fevers with strength,
in which they seldom exceed 118 or 120 pulsations in a minute. It must be
added, that in these cases, while the pulse is very small and very quick,
the heart often feels large, and labouring to one's hand; which coincides
with the above explanation, shewing that it does not completely empty
itself.
3. In cases however of debility from paucity of blood, as in animals which
are bleeding to death in the slaughter-house, the quick pulsations of the
heart and arteries may be owing to their not being distended to more than
half their usual diastole; and in consequence they must contract sooner, or
more frequently, in a given time. As weak people are liable to a deficient
quantity of blood, this cause may occasionally contribute to quicken the
pulse in fevers with debility, which may be known by applying one's hand
upon the heart as above; but the principal cause I suppose to consist in
the diminution of sensorial power. When a muscle contains, or is supplied
with but little sensorial power, its contraction soon ceases, and in
consequence may soon recur, as is seen in the trembling hands of people
weakened by age or by drunkenness. See Sect. XII. 1. 4. XII. 3. 4.
It may nevertheless frequently happen, that both the deficiency of
stimulus, as where the quantity of blood is lessened (as described in No.
4. of this section), and the deficiency of sensorial power, as in those of
the temperament of irritability, described in Sect. XXXI. occur at the same
time; which will thus add to the quickness of the pulse and to the danger
of the disease.
III. 1. A certain degree of heat is necessary to muscular motion, and is,
in consequence, essential to life. This is observed in those animals and
insects which pass the cold season in a torpid state, and which revive on
being warmed by the fire. This necessary stimulus of heat has two sources;
one from the fluid atmosphere of heat, in which all things are immersed,
and the other from the internal combinations of the particles, which form
the various fluids, which are produced in the extensive systems of the
glands. When either the external heat, which surrounds us, or the internal
production of it, becomes lessened to a certain degree, the pain of cold is
perceived.
This pain of cold is experienced most sensibly by our teeth, when ice is
held in the mouth; or by our whole system after having been previously
accustomed to much warmth. It is probable, that this pain does not arise
from the mechanical or chemical effects of a deficiency of heat; but that,
like the organs of sense by which we perceive hunger and thirst, this sense
of heat suffers pain, when the stimulus of its object is wanting to excite
the irritative motions of the organ; that is, when the sensorial power
becomes too much accumulated in the quiescent fibres. See Sect. XII. 5. 3.
For as the peristaltic motions of the stomach are lessened, when the pain
of hunger is great, so the action of the cutaneous capillaries are lessened
during the pain of cold; as appears by the paleness of the skin, as
explained in Sect. XIV. 6. on the production of ideas.
The pain in the small of the back and forehead in the cold fits of the
ague, in nervous hemicrania, and in hysteric paroxysms, when all the
irritative motions are much impaired, seems to arise from this cause; the
vessels of these membranes or muscles become torpid by their irritative
associations with other parts of the body, and thence produce less of their
accustomed secretions, and in consequence less heat is evolved, and they
experience the pain of cold; which coldness may often be felt by the hand
applied upon the affected part.
2. The importance of a greater or less deduction of heat from the system
will be more easy to comprehend, if we first consider the great expense of
sensorial power used in carrying on the vital motions; that is, which
circulates, absorbs, secretes, aerates, and elaborates the whole mass of
fluids with unceasing assiduity. The sensorial power, or spirit of
animation, used in giving perpetual and strong motion to the heart, which
overcomes the elasticity and vis inertiæ of the whole arterial system; next
the expense of sensorial power in moving with great force and velocity the
innumerable trunks and ramifications of the arterial system; the expense of
sensorial power in circulating the whole mass of blood through the long and
intricate intortions of the very fine vessels, which compose the glands and
capillaries; then the expense of sensorial power in the exertions of the
absorbent extremities of all the lacteals, and of all the lymphatics, which
open their mouths on the external surface of the skin, and on the internal
surfaces of every cell or interstice of the body; then the expense of
sensorial power in the venous absorption, by which the blood is received
from the capillary vessels, or glands, where the arterial power ceases, and
is drank up, and returned to the heart; next the expense of sensorial power
used by the muscles of respiration in their office of perpetually expanding
the bronchia, or air-vessels, of the lungs; and lastly in the unceasing
peristaltic motions of the stomach and whole system of intestines, and in
all the secretions of bile, gastric juice, mucus, perspirable matter, and
the various excretions from the system. If we consider the ceaseless
expense of sensorial power thus perpetually employed, it will appear to be
much greater in a day than all the voluntary exertions of our muscles and
organs of sense consume in a week; and all this without any sensible
fatigue! Now, if but a part of these vital motions are impeded, or totally
stopped for but a short time, we gain an idea, that there must be a great
accumulation of sensorial power; as its production in these organs, which
are subject to perpetual activity, is continued during their quiescence,
and is in consequence accumulated.
While, on the contrary, where those vital organs act too forcibly by
increase of stimulus without a proportionally-increased production of
sensorial power in the brain, it is evident, that a great deficiency of
action, that is torpor, must soon follow, as in fevers; whereas the
locomotive muscles, which act only by intervals, are neither liable to so
great accumulation of sensorial power during their times of inactivity, nor
to so great an exhaustion of it during their times of action.
Thus, on going into a very cold bath, suppose at 33 degrees of heat on
Fahrenheit's scale, the action of the subcutaneous capillaries, or glands,
and of the mouths of the cutaneous absorbents is diminished, or ceases for
a time. Hence less or no blood passes these capillaries, and paleness
succeeds. But soon after emerging from the bath, a more florid colour and a
greater degree of heat is generated on the skin than was possessed before
immersion; for the capillary glands, after this quiescent state, occasioned
by the want of stimulus, become more irritable than usual to their natural
stimuli, owing to the accumulation of sensorial power, and hence a greater
quantity of blood is transmitted through them, and a greater secretion of
perspirable matter; and, in consequence, a greater degree of heat succeeds.
During the continuance in cold water the breath is cold, and the act of
respiration quick and laborious; which have generally been ascribed to the
obstruction of the circulating fluid by a spasm of the cutaneous vessels,
and by a consequent accumulation of blood in the lungs, occasioned by the
pressure as well as by the coldness of the water. This is not a
satisfactory account of this curious phænomenon, since at this time the
whole circulation is less, as appears from the smallness of the pulse and
coldness of the breath; which shew that less blood passes through the lungs
in a given time; the same laborious breathing immediately occurs when the
paleness of the skin is produced by fear, where no external cold or
pressure are applied.
The minute vessels of the bronchia, through which the blood passes from the
arterial to the venal system, and which correspond with the cutaneous
capillaries, have frequently been exposed to cold air, and become quiescent
along with those of the skin; and hence their motions are so associated
together, that when one is affected either with quiescence or exertion, the
other sympathizes with it, according to the laws of irritative association.
See Sect. XXVII. 1. on hæmorrhages.
Besides the quiescence of the minute vessels of the lungs, there are many
other systems of vessels which become torpid from their irritative
associations with those of the skin, as the absorbents of the bladder and
intestines; whence an evacuation of pale urine occurs, when the naked skin
is exposed only to the coldness of the atmosphere; and sprinkling the naked
body with cold water is known to remove even pertinacious constipation of
the bowels. From the quiescence of such extensive systems of vessels as the
glands and capillaries of the skin, and the minute vessels of the lungs,
with their various absorbent series of vessels, a great accumulation of
sensorial powers is occasioned; part of which is again expended in the
increased exertion of all these vessels, with an universal glow of heat in
consequence of this exertion, and the remainder of it adds vigour to both
the vital and voluntary exertions of the whole day.