direct sympathy, are also associated with those of the heart and arteries,
sometimes by reverse and sometimes by direct sympathy; and thus constitute
simple fever. The cold paroxysm of which consists in their torpor, and the
hot one in their orgasm, or increased activity.
I. _Of the Action of Vomiting._
The manner, in which the stomach and the diaphragm and abdominal muscles
acquire their associate action in vomiting, requires some attention. It is
not probable, that this action of vomiting occurs before nativity; as the
uniform application of the nutritive liquor amnii to the mouth of the
foetus, and the uniform expenditure of its nourishment, would not seem to
give occasion to too great temporary repletion of the stomach; and would
preclude the deglutition of any improper material. After nativity the
stomach of the child may be occasionally too much distended with milk; as
previous hunger may induce it to overgorge itself; and by repeated efforts
the act of vomiting is learned, as a means of getting free from a
disagreeable sensation. Thus when any disgustful material, as a bitter
drug, is taken into the mouth; certain retrograde motions of the tongue and
lips are produced, for the purpose of putting the disagreeable material out
of the mouth again.
When the stomach is disagreeably stimulated by the distention or acrimony
of the aliment, a similar effort to regurgitate it must occur; and by
repeated trials the action of the diaphragm and abdominal muscles by
squeezing the stomach assists its retrograde exertion to disgorge its
contents. In the same manner when a piece of gravel is pushed into the
urethra, or a piece of indurated bile into the neck of the gall-bladder,
after they have been in vain pressed forward by the usual motions of those
ducts, they return into the bladders of gall and urine by the retrograde
motions of them.
That this is one mode, in which vomiting is induced, appears from the
instantaneous rejection from the stomach occasioned by some nauseous drug,
or from some nauseous idea; and lastly, from the voluntary power, which
some people have been said to have acquired, of emptying their stomachs,
much in the same manner as ruminating animals bring up the grass from their
first stomach.
There are nevertheless many modes by which these inverted motions of the
stomach and oesophagus are induced, and which it is of consequence to
distinguish from each other. The first is the mode above described, where
an effort is made to dislodge something, which stimulates the stomach into
disagreeable sensation; and which is returned by repeated exertions; as
when a nauseous drug is taken into the mouth, or a bit of sand falls into
the eye, or a drop of water into the wind-pipe. In this the peristaltic
motions of the stomach are first stopped, and then reverted by painful
sensation; and the abdominal muscles and diaphragm by repeated efforts
become associated with them. Now as less sensorial power is expended on the
retrograde actions of the stomach, and of the lymphatics, which open their
mouths on its surface, than by their natural motions, an accumulation of
sensorial power in the fibres of the stomach follows the exhibition of an
emetic, and on that account an emetic will sometimes stop a spontaneous
vomiting which was owing to sensorial deficiency. See Sect. XXXV. 1. 3. and
Art. V. 2. 1.
As bitters and metallic salts, exhibited in small doses, stimulate the
stomach into greater action, as appears by their increasing the power of
digestion, and yet become emetic, when given in larger doses; one might
suspect, that they became emetic by inducing debility, and consequent
retrograde actions of the stomach, by their previously exhausting the
sensorial power by their great stimulus; which might be effected in a
moment without producing pain, and in consequence without our perceiving
it. But on the contrary, there does not in general appear on the exhibition
of emetics to be any previous exhaustion of sensorial power; because there
is evidently an accumulation of it during the sickness, as appears from the
digestion being stronger afterwards; and from the increased action of the
cellular and cutaneous absorbents during its operation. See Art. V. 2. 1.
Another mode, by which vomiting is induced, is owing to debility or
deficiency of sensorial power, from the previous exhaustion of it; as on
the day after intoxication, or which occurs in people enfeebled with the
gout, and in dropsy, and in some fevers with debility. In these, when the
vomiting ceases, there is no appearance of accumulation of sensorial power,
as the digestion still remains weak and imperfect.
Another mode by which sickness or vomiting is induced, is by defect of
stimulus, as in great hunger; and in those, who have been habituated to
spice and spirit with their meals, who are liable to be sick after taking
food without these additional stimuli. Other means of inducing sickness by
vertigo, or by nauseous ideas, will be mentioned below.
We shall only add, that the motions of the muscular fibres of the stomach
are associated with those of the heart and arteries by direct sympathy, as
appears by the weakness of the pulse during the exhibition of an emetic;
and that the absorbents of the stomach are associated with the cellular and
cutaneous absorbents by reverse sympathy, as is shewn by the great
absorption of the mucus of the cells in anasarca during sickness; at the
same time that the absorbents of the stomach invert their actions, and pour
the mucus and water thus absorbed into that viscus.
In cold paroxysms of fever the stomach partakes of the general torpor, and
vomiting is induced by its debility, either by its association with the
torpid capillaries, or other torpid parts, or by its own torpor commencing
first, and causing the cold fit. The disordered motions of the stomach
frequently seem to be the cause or primary seat of fever, as where
contagious miasmata are swallowed with the saliva, and where fever is
produced by sea-sickness, which I once saw. Nevertheless a disorder of the
stomach does not always induce fever, as in that case it should constantly
attend indigestion, and vertigo, and sea-sickness; but is itself frequently
induced by association with the disordered movements of other parts of the
system, as when it arises from gravel in the ureter, or from a percussion
on the head.
The connexion of the motions of the stomach with irritative ideas, or
motions of the organs of sense, in vertigo, is shewn in Sect. XX. and thus
it appears, that many circles of association are either directly or
reversely associated, or catenated, with this viscus; which will much
contribute to unfold some of the symptoms of fever.
K. _Tertian Associations._
The third link of associate trains of motion is sometimes actuated by
reverse sympathy, with the second link, and that by reverse sympathy with
the first link; so that the first and third link may act by direct
sympathy, and the intermediate one by reverse sympathy. Of this instances
are given in the syngultus nephriticus, Class IV. 1. 1. 7. and IV. 2. 1. At
other times the tertian or quartan links of associate motions are actuated
by direct sympathy; and that sometimes forwards and sometimes backwards in
respect to the usual order of those trains of associate motions, as in
Class IV. 1. 2. 1.
SPECIES.
1. _Rubor vultus prandorum._ Flushing of the face after dinner is explained
in Sect. XXXV. 1. In the beginning of intoxication the whole skin becomes
florid from the association of the actions of the cutaneous arteries with
those of the stomach, because vinous spirit excites the fibres of the
stomach into more violent action than the stimulus of common food; and the
cutaneous capillaries of the face, from their more frequent exposure to the
vicissitudes of cold and heat, possess more mobility or irritability than
those of other parts of the skin, as further explained in Sect. XXXIII. 2.
10. Vinegar is liable to produce this flushing of the face, which probably
is owing to the quantity of vinous spirit it contains, as I believe the
unfermented vegetable acids do not produce this effect. In every kind of
blush the arterial blood is propelled into the capillaries faster than the
venous absorption can carry it forwards into the veins, in this respect
resembling the tensio phalli.
Can the beginning vinous or acetous fermentation of the aliment in weak
stomachs contribute to this effect? or is it to be ascribed to the greater
power of association between the arteries of the face and the fibres of the
stomach in some people than in others?
M. M. Eat and drink less at a time, and more frequently. Put 20 drops of
weak acid of vitriol into water to be drank at meals. Let the dress over
the stomach and bowels be loose. Use no fermented liquors, or vinegar, or
spice.
2. _Sudor stragulis immersorum._ Sweat from being covered in bed. In the
commencement of an epidemic fever, in which the perpetual efforts to vomit
was a distressing symptom, Dr. Sydenham discovered, that if the patient's
head was for a short time covered over with the bed clothes, warmth was
produced, and a sweat broke out upon the skin, and the tendency to vomit
ceased. In this curious fact two trains of associated motions are excited
into increased action. First, the vessels of the lungs are known to have
their motion associated with those of the skin by the difficulty of
breathing on going into the cold bath, as described in Sect. XXXII. 3. 2.
Hence, when the vessels of the lungs become excited into stronger action,
by the bad air under the bed clothes, warmed and adulterated by frequent
breathing, those of the external skin soon become excited by their
association into more energetic action, and generate more heat along with a
greater secretion of perspirable matter. Secondly, the sympathy between the
stomach and skin is evident in variety of circumstances; thus the cold air
of frosty days applied to the skin for a short time increases the action of
the stomach by reverse sympathy, but decreases it if continued too long by
direct sympathy; so in the circumstance above mentioned the action of the
stomach is increased by direct sympathy with that of the skin; and the
tendency to vomit, which was owing to its diminished action, ceases.
3. _Cessatio aegritudinis cute excitata._ The cure of sickness by
stimulating the skin. This is explained in the preceding article; and
further noticed in IV. 2. 2. 4. and in IV. 1. 1. f.
Similar to these is the effect of a blister on the back in relieving
sickness, indigestion, and heart-burn; and, on the contrary, by these
symptoms being frequently induced by coldness of the extremities. The
blister stimulates the cutaneous vessels into greater action; whence warmth
and pain are produced at the same time, and the fibres of the stomach are
excited into greater action by their association with those of the skin. It
does not appear, that the concomitant pain of the blister causes the
increased energy of the stomach, because the motions of it are not greater
than natural; though it is sometimes difficult to determine, whether the
primary part of some associated trains be connected with irritative or
sensitive motions.
In the same manner a flannel shirt, to one who has not been in the habit of
wearing one, stimulates the skin by its points, and thus stops vomiting in
some cases; and is particularly efficacious in checking some chronical
diarrhoeas, which are not attended with fever; for the absorbents of the
skin are thus stimulated into greater action, with which those of the
intestines consent by direct sympathy.
This effect cannot be ascribed to the warmth alone of the flannel shirt, as
being a covering of loose texture, and confining air in its pores, like a
sponge, which air is known to be a bad conductor of heat, since in that
case its use should be equally efficacious, if it were worn over a linen
shirt; and an increased warmth of the room of the patient would be equally
serviceable.
4. _Digestio aucta frigore cutaneo._ Digestion increased by coldness of the
skin. Every one has experienced the increase of his appetite after walking
in the cool air in frosty days; for there is at this time not only a saving
of sensorial power by the less exertion of the cutaneous vessels; but, as
these consent with those of the stomach and bowels, this saving of
sensorial power is transferred by reverse sympathy from the cutaneous
capillaries and absorbents to those of the stomach and intestines.
Hence weak people should use the cold air of winter as a cold bath; that
is, they should stay in it but a short time at once, but should immerse
themselves in it many times a day.
5. _Catarrhus a frigore cutaneo._ Catarrh from cold skin. This has been
already explained in Class I. 1. 2. 7. and is further described in Sect.
XXXV. 1. 3. In this disease the vessels of the membrane, which lines the
nostrils, are excited into greater action; when those of the skin, with
which they are associated, are excited into less action by the deficiency
of external heat, by reverse sympathy; and though the pain of cold attends
the torpor of the primary link of this association, yet the increased
motions of the membrane of the nostrils are associated with those of the
cutaneous vessels, and not with the pain of them, because no inflammation
follows.
6. _Absorptio cellularis aucta vomitu._ In the act of vomiting the
irritative motions of the stomach are inverted, and of the absorbents,
which open their mouths into it; while the cutaneous, cellular, and
pulmonary absorbents are induced, by reverse sympathy with them, to act
with greater energy. This is seen in cases of anasarca, when long sickness
and vomiting are caused by squills, or antimonial salts, or most of all by
the decoction of digitalis purpurea, foxglove; and Mr. J. Hunter mentions a
case, in which a large bubo, which was just ready to break, was absorbed in
a few days by sickness at sea. Treatise on the Blood, p. 501, which is thus
accounted for; less sensorial power is expended during sickness by the
decreased action of the fibres of the stomach, and of its absorbents; as
shewn in Sect. XXXV. 1. 3. whence an accumulation of it is produced, and
there is in consequence a greater quantity of sensorial power for the
exertion of those motions, which are associated with the absorbents of the
stomach by reverse sympathy.
The reverse sympathy between the lacteal and lymphatic branches of the
absorbent system have been produced by the one branch being less excited to
act, when the other supplies sufficient fluid or nutriment to the
sanguiferous vessels. Thus when the stomach is full, and the supply of
chyle and mucus and water is in sufficient quantity; the pulmonary,
cellular, and cutaneous lymphatics are not excited into action; whence the
urine is pale, and the skin moist, from the defect of absorption on those
surfaces.
7. _Syngultus nephriticus._ When a stone irritates the ureter, and that
even without its being attended with pain or fever, sometimes a chronical
hiccough occurs, and continues for days and weeks, instead of sickness or
vomiting; which are the common symptoms. In this case the motions of the
stomach are decreased by their sympathy with those of the ureter, which are
increased by the stimulus of the stone in it; and the increased motions of
the diaphragm seem to exist in consequence of their association with the
stomach by a second reverse sympathy. This hiccough may nevertheless admit
of another explanation, and be supposed to be a convulsive exertion of the
diaphragm to relieve the disagreeable sensation of the stomach in
consequence of its disordered irritative associations; and in that case it
would belong to Class III. 1. 1. See Class IV. 2. 1. for another example of
tertiary association.
M. M. Venesection. Emetic. Calomel. Cathartic, opium, oil of cinnamon from
two to ten drops. Aerated alcaline water. Peruvian bark.
8. _Febris irritativa._ Irritative fever, described in Class I. 1. 1. 1.
The diseases above explained in this genus are chiefly concerning the
sympathies of the absorbent system, or the alimentary canal, which are not
so much associated with the arterial system, as to throw it into disorder,
when they are slightly deranged; but when any great congeries of
conglomerate glands, which may be considered as the extremities of the
arterial system, are affected with torpor, the whole arterial system and
the heart sympathize with the torpid glands, and act with less energy;
which constitutes the cold fit of fever; which is therefore at first a
decreased action of the associate organ; but as this decrease of action is
only a temporary effect, and an increase of exertion both of the torpid
glands, and of the whole arterial system, soon follows; the hot fit of
irritative fever, or fever with strong pulse, properly belongs to this
class and genus of diseases.
* * * * *
ORDO I.
_Increased Associate Motions._
GENUS II.
_Catenated with Sensitive Motions._
The primary links of the associated actions of this genus are either
produced or attended by painful or pleasurable sensation. The secondary
links of the first ten species are attended with increased motions without
inflammation, those of the remainder are attended with inflammation. All
inflammations, which do not arise in the part which was previously torpid,
belong to this genus; as the gout, rheumatism, erysipelas. It is probable
many other inflammations may, by future observation, require to be
transplanted into this class.
The circles of sensitive associate motions consist chiefly of the excretory
ducts of the capillaries and of the mouths of the absorbent vessels, which
constitute the membranes; and which have been induced into action at the
same time; or they consist of the terminations of canals; or of parts which
are endued with greater sensibility than those which form the first link of
the association. An instance of the first of those is the sympathy between
the membranes of the alveolar processes of the jaws, and the membranes
above or beneath the muscles about the temples in hemicrania. An instance
of the second is in the sympathy between the excretory duct of the lacrymal
gland, and the nasal duct of the lacrymal sack. And an instance of the
third is the sympathy between the membranes of the liver, and the skin of
the face in the gutta rosea of inebriates.
SPECIES.
1. _Lacrymarum fluxus sympatheticus._ A flow of tears from grief or joy.
When the termination of the duct of the lacrymal sac in the nostrils
becomes affected either by painful or pleasurable sensations, in
consequence of external stimulus, or by its association with agreeable or
disagreeable ideas, the motions of the lacrymal gland are at the same time
exerted with greater energy, and a profusion of tears succeeds by sensitive
association, as explained in Sect. XVI. 8. 2.
In this case there exists a chain of associated actions, the secretion of
the lacrymal gland is increased by whatever stimulates the surface of the
eye, at the same time the increased abundance of tears stimulates the
puncta lacrymalia into greater action; and the fluid thus absorbed
stimulates the lacrymal sac, and its nasal duct in the nose into greater
action. In a contrary direction of this chain of association the present
increase of action is induced. First, the nasal duct of the lacrymal sac is
excited into increased action by some pleasurable or painful idea, as
described in Sect. XVI. 8. 2. 2d. The puncta lacrymalia or other
extremity of the lacrymal sac sympathizes with it (as the two ends of all
other canals sympathize with each other). 3d. With these increased
motions of the puncta lacrymalia those of the excretory duct of the
lacrymal gland are associated from their having so perpetually acted
together. And, lastly, with the increased actions of the excretory duct of
this gland are associated those of the other end of it by their frequently
acting together; in the same manner as the extremities of other canals are
associated; and thus a greater flow of tears is poured into the eye.
When a flow of tears is produced in grief, it is believed to relieve the
violence of it, which is worthy a further inquiry. Painful sensations, when
great, excite the faculty of volition; and the person continues voluntarily
to call up or perform those ideas, which occasion the painful sensation;
that is, the afflicted person becomes so far insane or melancholy; but
tears are produced by the sensorial faculty of association, and shew that
the pain is so far relieved as not to excite the excessive power of
volition, or insanity, and are therefore a sign of the abatement of the
painful state of grief, rather than a cause of that abatement. See Class
III. 1. 2. 10.
2. _Sternutatio a lumine._ Some persons sneeze from looking up at the light
sky in a morning after coming out of a dark bedroom. The olfactory nerves
are brought into too great action by their sympathy with the optic nerves,
or by their respective sympathies with some intervening parts, as probably
with the two extremities of the lacrymal sac; that is, with the puncta
lacrymalia and the nasal duct. See Class II. 1. 1. 3.
3. _Dolor dentium Stridore._ Tooth-edge from grating sounds, and from the
touch of certain substances, and even from imagination alone, is described
and explained in Sect. XVI. 10. The increased actions of the alveolar
vessels or membranes are associated with the ideas, or sensual motions of
the auditory nerves in the first case; and of those of the sense of touch,
in the second case; and by imagination, or ideas exerted of painful
sensation alone, in the last.
4. _Risus sardonicus._ A disagreeable smile attends inflammations of the
diaphragm arising from the associations of the reiterated exertions of that
muscle with those of the lips and cheeks in laughing. See Diaphragmitis,
Class II. 1. 2. 6.
5. _Salivae fluxus cibo viso._ The flow of saliva into the mouths of hungry
animals at the sight or smell of food is seen in dogs standing round a
dinner-table. The increased actions of the salivary glands have been
usually produced by the stimulus of agreeable food on their excretory ducts
during the mastication of it; and with this increased action of their
excretory ducts the other terminations of those glands in the capillary
arteries have been excited into increased action by the mutual association
of the ends of canals; and at the same time the pleasurable ideas, or
sensual motions, of the sense of smell and of sight have accompanied this
increased secretion of saliva. Hence this chain of motions becomes
associated with those visual or olfactory ideas, or with the pleasure,
which produces or attends them.
6. _Tensio mamularum viso puerulo._ The nipples of lactescent women are
liable to become turgid at the sight of their young offspring. The nipple
has generally been rendered turgid by the titillation of the lips or gums
of the child in giving suck; the visible idea of the child has thus
frequently accompanied this pleasurable sensation of parting with the milk,
and turgescence of the tubes, which constitute the nipple. Hence the visual
idea of the child, and the pleasure which attends it, become associated
with those increased arterial actions, which swell the cells of the mamula,
and extend its tubes; which is very similar to the tensio phalli visa
muliere nuda etiam in insomnio.
7. _Tensio penis in hydrophobia._ An erection of the penis occurs in the
hydrophobia, and is a troublesome symptom, as observed by Coelius
Aurelianus, Fothergill, and Vaughn, and would seem to be produced by an
unexplained sympathy between the sensations about the fauces and the penis.
In men the hair grows about both these parts, the voice changes, and the
neck thickens at puberty. In the mumps, when the swellings about the throat
subsides, the testicles are liable to swell. Venereal infection received by
the penis is very liable to affect the throat with ulcers. Violent coughs,
with soreness or rawness about the fauces are often attended with erection
of the penis; which is also said to happen to male animals, that are
hanged; which last circumstance has generally been ascribed to the
obstruction of the circulation of the blood, but is more probably
occasioned by the stimulus of the cord in compressing the throat; since if
it was owing to impeded circulation it ought equally to occur in drowning
animals.
In men the throat becomes so thickened at the time of puberty, that a
measure of this is used to ascertain the payment of a poll-tax on males in
some of the islands of the Mediterranean, which commences at puberty; a
string is wrapped twice round the thinnest part of the neck, the ends of it
are then put into each corner of the mouth; and if, when thus held in the
teeth, it passes readily over the head, the subject is taxable.
It is difficult to point out by what circumstance the sensitive motions of
the penis and of the throat and nose become associated; I can only observe,
that these parts are subjected to greater pleasurable sensations than any
other parts of the body; one being designed to preserve ourselves by the
pleasure attending the smell and deglutition of food, and the other to
ensure the propagation of our species; and may thus gain an association of
their sensitive motion by their being eminently sensible to pleasure. See
Class I. 3. 1. 11. and III. 1. 1. 15. and Sect. XVI. 5.
In the female sex this association between the face, throat, nose, and
pubis does not exist; whence no hair grows on their chins at the time of
puberty, nor does their voices change, or their necks thicken. This happens
probably from there being in them a more exquisite sensitive sympathy
between the pubis and the breasts. Hence their breasts swell at the time of
puberty, and secrete milk at the time of parturition. And in the parotitis,
or mumps, the breasts of women swell, when the tumor of the parotitis
subsides. See Class I. 1. 2. 15. Whence it would appear, that their breasts
possess an intermediate sympathy between the pubis and the throat; as they
are the seat of a passion, which men do not possess, that of suckling
children.
8. _Tenesmus calculosus._ The sphincter of the rectum becomes painful or
inflamed from the association of its sensitive motions with those of the
sphincter of the bladder, when the latter is stimulated into violent pain
or inflammation by a stone.
9. _Polypus narium ex ascaridibus?_ The stimulation of ascarides in the
rectum produces by sensitive sympathy an itching of the nose, as explained
in IV. 2. 2. 6; and in three children I have seen a polypus in the nose,
who were all affected with ascarides; to the perpetual stimulation of
which, and the consequent sensitive association, I was led to ascribe the
inflammation and thickening of the membrane of the nostrils.
10. _Crampus surarum in cholera._ A cramp of the muscles of the legs occurs
in violent diarrhoea, or cholera, and from the use of too much acid diet in
gouty habits. This seems to sympathize with uneasy sensation in the bowels.
See Class III. 1. 1. 14. This association is not easily accounted for, but
is analogous in some degree to the paralysis of the muscles of the arms in
colica saturnina. It would seem, that the muscles of the legs in walking
get a sympathy with the lower parts of the intestines, and those of the
arms in variety of employment obtain a sympathy with the higher parts of
them. See Cholera and Ileus.
11. _Zona ignea nephritica._ Nephritic shingles. The external skin about
the loins and sides of the belly I suppose to have greater mobility in
respect to sensitive association, than the external membrane of the kidney;
and that their motions are by some unknown means thus associated. When the
torpor or beginning inflammation of this membrane ceases, the external skin
becomes inflamed, in its stead, and a kind of herpes, called the shingles,
covers the loins and sides of the belly. See Class II. 1. 5. 9.
12. _Eruptio variolarum._ After the inflammation of the inoculated arm has
spread for a quarter of a lunation, it affects the stomach by reverse
sympathy; that is, the actions of the stomach are associated with those of
the skin; and as much sensorial power is now exerted on the inflamed skin,
the other part of this sensitive association is deprived of its natural
share, and becomes torpid, or inverts its motions. After this torpor of the
stomach has continued a time, and much sensorial power is thus accumulated;
other parts of the skin, which are also associated with it, as that of the
face first, are thrown into partial inflammation; that is, the eruptions of
the small-pox appear on the face.
For that the variolous matter affects the stomach previous to its eruption
on the skin appears from the sickness at the commencement of the fever; and
because, when the morbid motions affect the skin, those of the stomach
cease; as in the gout and erysipelas, mentioned below. The consent between
the stomach and the skin appears in variety of other diseases; and as they
both consist of surfaces, which absorb and secrete a quantity of moisture,
their motions must frequently be produced together or in succession; which
is the foundation of all the sympathies of animal motions, whether of the
irritative, sensitive, or voluntary kinds.
Now as the skin, which covers the face, is exposed to greater variations of
heat and cold than any other part of the body; it probably possesses more
mobility to sensitive associations, not only than the stomach, but than any
other part of the skin; and is thence affected at the eruption of the
small-pox with violent action and consequent inflammation, by the
association of its motions with those of the stomach, a day before the
other parts of the skin; and becomes fuller of pustules, than any other
part of the body. See Class II. 1. 3. 9.
It might be supposed, that the successive swelling of the hands, when the
face subsides, at the height of the small-pox, and of the feet, when the
hands subside, were governed by some unknown associations of those parts of
the system; but these successions of tumor and subsidence more evidently
depend on the times of the eruption of the pustules on those parts, as they
appear a day sooner on the face than on the hands, and a day sooner on the
hands than on the feet, owing to the greater comparative mobility of those
parts of the skin.
13. _Gutta rosea stomatica._ Stomatic red face. On drinking cold water, or
cold milk, when heated with exercise, or on eating cold vegetables, as raw
turnips, many people in harvest-time have been afflicted with what has been
called a surfeit. The stomach becomes painful, with indigestion and
flatulency, and after a few days an eruption of the face appears, and
continues with some relief, but not with entire relief; as both the pimpled
face and indigestion are liable to continue even to old age.
M. M. Venesection. A cathartic with calomel. Then half a grain of opium
twice a day for many weeks. If saturated solution of arsenic three or five
drops twice or thrice a day for a week?
14. _Gutta rosea hepatica._ The rosy drop of the face of some drinking
people is produced like the gout described below, in consequence of an
inflamed liver. In these constitutions the skin of the face being exposed
to greater variation of heat and cold than the membranes of the liver,
possesses more mobility than those hepatic membranes; and hence by whatever
means these membranes are induced to sympathize, when this sensitive
association occurs, the cutaneous vessels of the face run into greater
degrees of those motions, which constitute inflammation, than previously
existed in the membranes of the liver; and then those motions of the liver
cease. See Class II. 1. 4. 6.
An inflammation of the liver so frequently attends the great potation of
vinous spirit, there is reason to suspect, that this viscus itself becomes
inflamed by sensitive association with the stomach; or that, when one
termination of the bile-duct, which enters the duodenum is stimulated
violently, the other end may become inflamed by sensitive association.
15. _Podagra._ The gout, except when it affects the liver or stomach, seems
always to be a secondary disease, and, like the rheumatism and erysipelas
mentioned below, begins with the torpor of some distant part of the system.
The most frequent primary seat of the gout I suppose to be the liver, which
is probably affected with torpor not only previous to the annual paroxysms
of the gout, but to every change of its situation from one limb to another.
The reasons, which induce me to suspect the liver to be first affected, are
not only because the jaundice sometimes attends the commencement of gout,
as described in Sect. XXIV. 2. 8. but a pain also over the pit of the
stomach, which I suppose to be of the termination of the bile-duct in the
duodenum, and which is erroneously supposed to be the gout of the stomach,
with indigestion and flatulency, generally attends the commencement of the
inflammation of each limb. See Arthritis ventriculi, Class I. 2. 4. 6. In
the two cases, which I saw, of the gout in the limbs being preceded by
jaundice, there was a cold shivering fit attended the inflammation of the
foot, and a pain at the pit of the stomach; which ceased along with the
jaundice, as soon as the foot became inflamed. This led me to suspect, that
there was a torpor of the liver, and perhaps of the foot also, but
nevertheless the liver might also in this case be previously inflamed, as
observed in Sect. XXIV. 2. 8.
Now as the membranes of the joints of the feet suffer greater variations of
heat and cold than the membranes of the liver, and are more habituated to
extension and contraction than other parts of the skin in their vicinity; I
suppose them to be more mobile, that is, more liable to run into extremes
of exertion or quiescence; and are thence more susceptible of inflammation,
than such parts as are less exposed to great variations of heat and cold,
or of extension and contraction.
When a stone presses into the sphincter of the bladder, the glans penis is
affected with greater pain by sympathy, owing to its greater sensibility,
than the sphincter of the bladder; and when this pain commences, that of
the sphincter ceases, when the stone is not too large, or pushed too far
into the urethra. Thus when the membrane, which covers the ball of the
great toe, sympathizes with some membranous part of a torpid or inflamed
liver; this membrane of the toe falls into that kind of action, whether of
torpor or inflammation, with greater energy, than those actions excited in
the diseased liver; and when this new torpor or inflammation commences,
that with which it sympathises ceases; which I believe to be a general law
of associated inflammations.
The paroxysms of the gout would seem to be catenated with solar influence,
both in respect to their larger annual periods, and to their diurnal
periods--See Sect. XXXVI. 3. 6.--as the former occur about the same season
of the year, and the latter commence about an hour before sun-rise;
nevertheless the annual periods may depend on the succession of great
vicissitudes of cold and heat, and the diurnal ones on our increased
sensibility to internal sensations during sleep, as in the fits of asthma,
and of some epilepsies. See Sect. XVIII. 15.
In respect to the pre-remote cause or disposition to the gout, there can be
no doubt of its individually arising from the potation of fermented or
spirituous liquors in this country; whether opium produces the same effect
in the countries, where it is in daily use, I have never been well
informed. See Sect. XXI. 10, where this subject is treated of; to which I
have to add, that I have seen some, and heard of others, who have moderated
their paroxysms of gout, by diminishing the quantity of fermented liquors,
which they had been accustomed to; and others who, by a total abstinence
from fermented liquors, have entirely freed themselves from this
excruciating malady; which otherwise grows with our years, and curtails or
renders miserable the latter half, or third, of the lives of those, who are
subject to it. The remote cause is whatever induces temporary torpor or
weakness of the system; and the proximate cause is the inirritability, or
defective irritation, of some part of the system; whence torpor and
consequent inflammation. The great Sydenham saw the beneficial effects of
the abstinence from fermented liquors in preventing the gout, and adds, "if
an empiric could give small-beer only to gouty patients as a nostrum, and
persuade them not to drink any other spirituous fluids, that he might
rescue thousands from this disease, and acquire a fortune for his
ingenuity." Yet it is to be lamented, that this accurate observer of
diseases had not resolution to practise his own prescription, and thus to
have set an example to the world of the truth of his doctrine; but, on the
contrary, recommends Madeira, the strongest wine in common use, to be taken
in the fits of the gout, to the detriment of thousands; and is said himself
to have perished a martyr to the disease, which he knew how to subdue!
As example has more forcible effect: than simple assertion, I shall now
concisely relate my own case, and that of one of my most respected friends.
E. D. was about forty years of age, when he was first seized with a fit of
the gout. The ball of his right great toe was very painful, and much
swelled and inflamed, which continued five or six days in spite of
venesection, a brisk cathartic with ten grains of calomel, and the
application of cold air and cold water to his foot. He then ceased to drink
ale or wine alone; confining himself to small beer, or wine diluted with
about thrice its quantity of water. In about a year he suffered two other
fits of the gout, in less violent degree. He then totally abstained from
all fermented liquors, not even tasting small-beer, or a drop of any kind
of wine; but eat plentifully of flesh-meat, and all kinds of vegetables,
and fruit, using for his drink at meals chiefly water alone, or lemonade,
or cream and water; with tea and coffee between them as usual.
By this abstinence from fermented liquors he kept quite free from the gout
for fifteen or sixteen years; and then began to take small-beer mixed with
water occasionally, or wine and water, or perry and water, or cyder and
water; by which indulgence after a few months he had again a paroxysm of
gout, which continued about three days in the ball of his toe; which
occasioned him to return to his habit of drinking water, and has now for
above twenty years kept in perpetual health, except accidental colds from
the changes of the seasons. Before he abstained from fermented or
spirituous liquors, he was frequently subject to the piles, and to the
gravel, neither of which he has since experienced.
In the following case the gout was established by longer habit and greater
violence, and therefore required more cautious treatment. The Rev. R. W.
was seized with the gout about the age of thirty-two, which increased so
rapidly that at the age of forty-one he was confined to his room seven
months in that year; he had some degree of lameness during the intervals,
with chalky swellings of his heels and elbows. As the disease had continued
so long and so violently, and the powers of his digestion were somewhat
weakened, he was advised not entirely to leave off all fermented liquors;
and as small-beer is of such various strength, he was advised to drink
exactly two wine glasses, about four ounces, of wine mixed with three or
four times its quantity of water, with or without lemon and sugar, for his
daily potation at dinner, and no other fermented liquor of any kind; and
was advised to eat flesh-meat with any kind of boiled vegetables, and
fruit, with or without spice. He has now scrupulously continued this
regimen for above five years, and has had an annual moderate gouty paroxysm
of a few weeks, instead of the confinement of so many months, with great
health and good spirits during the intervals.
The following is a more particular account of the history of this case;
being part of a letter which Mr. Wilmot wrote on that subject at my
entreaty.
"I entered into the army with an excellent constitution at the age of
fifteen. The corps I served in was distinguished by its regularity,
that is, the regular allowance of the mess was only one pint of wine
per man each day; unless we had company to dine with us; then, as was
the general custom of the time, the bottle circulated without limit.
This mode of living, though by no means considered as excess for men,
was certainly too great for a youth of my age. This style of living I
continued, when with the regiment, till the latter end of the year
1769, when I had the misfortune to sleep in a damp bed at Sheffield on
a journey to York, but arrived there before I felt the ill effects of
it. I was then seized with a violent inflammatory rheumatism with great
inflammation of my eyes, and was attended by Dr. Dealtry; so violent
was the disorder, that I was bled for it eight times in less than a
fortnight; and was three months, before I could consider my health
perfectly re-established. Dr. Dealtry told me, that I should be subject
to similar attacks for many years; and that he had no doubt, from the
tendency he found in my habit to inflammation, that, when I was farther
advanced in life, I should change that complaint for the gout. He
predicted truly; for the three succeeding winters I had the same
complaint, but not so violently; the fourth winter I escaped, and
imputed my escape to the continuance of cold bathing during the whole
of that winter; after that I never escaped it, till I had a regular and
severe fit of the gout: after the first attack of rheumatic fever I was
more abstemious in my manner of living, though when in company I never
subjected myself to any great restraint. In the year 1774 I had quitted
the army, and being in a more retired situation, was seldom led into
any excess; in 1776 and 1777 I was in the habit of drinking a good deal
of wine very frequently, though not constantly. After that period till
the year 1781, I drank a larger quantity of wine regularly, but very
seldom to any degree of intoxication. I lived much at that time in the
society of some gentlemen, who usually drank nearly a bottle of wine
daily after dinner. I must here however observe, that at no part of my
life was I accustomed to drink wine in an evening, and very seldom
drank any thing more than a single half-pint glass of some sort of
spirits diluted with much water. Till the year 1781 I had always been
accustomed to use very violent and continued exercise on horseback; in
the winter months I pursued all field diversions, and in the summer
months I rode frequent and long journeys; and with this exercise was
liable to perspire to great excess; besides which I was subject to very
profuse night-sweats, and had frequently boils break out all over me,
especially in the spring and autumn; for which I took no medicine,
except a little flour of sulphur with cream of tartar in honey.
"You will observe I bring every thing down to the date of 1781. In the
month of October in that year, when I was just entered into the
thirty-second year of my age, I had the first attack of gout; that fit
was very severe, and of many weeks continuance. I now determined upon a
more abstemious method of living, in respect to wine; and indeed the
society, in which I had before been accustomed to live, being
considerably changed, I had less frequent temptations to excess. From
this time I enjoyed the most perfect good state of health till August
1784, when I had my second attack of gout. I never perfectly recovered
from this attack through the succeeding winter, and in March 1785 was
advised to try the Bath waters, and drank them under the direction of
one of the faculty of that place. I was there soon seized with a fever,
and a slight attack of gout in one knee. I should observe, that when I
set out from home, I was in a weak and low state, and unequal to much
fatigue; as appeared by my having a fainting fit one day on the road,
after having travelled only about fifty miles; in the course of the
summer I had two or three more slight attacks of gout of less
consequence, till the month of October; when I was afflicted with it
all over me in such a manner, as to be without the possibility of the
least degree of removal for some days; and was about two months without
being able to get into the air. This was the severest attack I had then
experienced; though I have since had several equally severe. In the
course of this summer I had a fall with my horse; and soon after it,
having discovered an enlargement on one elbow, I concluded I had hurt
it at that time; but in the course of this last attack having a similar
enlargement on the other elbow, I found my mistake, and that they were
collections of gouty matter; these increased to the size of pullet's
eggs, and continue in that state. I had soon after similar enlargements
on my heels; the right heel being severely bruised, I was under the
necessity of having it lanced, and a large quantity of chalky matter
was discharged from it; and have since that time frequently had chalky
matter taken from it, and sometimes small bits of apparently perfect
chalk. My right hand soon was afflicted in the same way, and I have
scarcely a joint on those fingers now in a natural state. My left hand
has escaped tolerably well. After this last attack (viz. October 1785),
I had two or three slight attacks before the month of June 1787, when I
had a very severe intermittent fever; from that time I continued very
well till the latter end of the year, when I began to feel the gout
about me very much, but was not confined by it. I was in this state
advised to try what is called the American Recipe (gum guaiacum and
nitre dissolved in spirits); it had apparently been of essential
service to a friend of mine, who from the inability to walk a mile for
some years, was believed to be restored by the use of this medicine to
a good state of health, so as to walk ten miles a day. In addition to
this medicine I drank, as my common beverage with my meals, spruce
beer. I had so high an opinion of this medicine in the gout, and of
spruce beer as an antiscorbutic, that I contemplated with much
satisfaction, and with very little doubt, the perfect restoration of my
health and strength; but I was miserably deceived; for in September
1788 I was seized with the gout in a degree that none but arthritics,
and indeed but few of those, can easily conceive. From this time till
August 1789 I scarcely ever passed a comfortable day; seven months of
this time I had been confined, my health seemed much impaired, my
strength was diminished, and my appetite almost gone. In this state my
friends pressed me to consult you. I was unwilling for some time to do
it, as I had lost all hope of relief; however, when I had determined to
apply to you, I likewise determined to give up every prejudice of my
own respecting my case, and to adhere most strictly to your advice. On
the 20th of August 1789 I consulted you, on the 25th I entered upon the
regimen, which you prescribed, and which was as follows.
"Drink no malt liquor on any account. Let your beverage at dinner
consist of two glasses of wine diluted with three half-pints of water.
On no account drink any more wine or spirituous liquors in the course
of the day; but, if you want more liquid, take cream and water, or milk
and water, or lemonade, with tea, coffee, chocolate. Use the warm bath
twice a week for half an hour before going to bed, at the degree of
heat which is most grateful to your sensations. Eat meat constantly at
dinner, and with it any kind of tender vegetables you please. Keep the
body open by two evacuations daily, if possible without medicine, if
not take the size of a nutmeg of lenitive electuary occasionally, or
five grains of rhubarb every night. Use no violent exercise, which may
subject yourself to sudden changes from heat to cold; but as much
moderate exercise as may be, without being much fatigued or starved
with cold. Take some supper every night; a small quantity of animal
food is preferred; but if your palate refuses this, take vegetable
food, as fruit pie, or milk; something should be eaten, as it might be
injurious to you to fast too long." To the whole of this I adhered most
scrupulously, and soon found my appetite improve, and with it my
strength and spirits. I had in December a fevere attack, and two or
three slight ones in the course of twelve months; but the improvement
in the general state of my health induced me to persevere. On the 18th
of August 1790 I had another severe attack, but it went off easier than
before, and I soon recovered sufficiently to go to Buxton, which you
advised me to, and from which I reaped great benefit; nevertheless on
the 29th of December I had a slight attack in comparison of some that I
had before experienced, and from that time I was free from gout, and
enjoyed my health perfectly well till the fourth week in October 1791;
from that till the third week in October 1792; from that till the third
week in October 1793; and from that till June 1794. From what happened
for the last three years I dreaded the month of October; but I escaped
then, and have enjoyed my health most perfectly ever since till within
the last week, that I have had a slight attack in one knee, which is
nearly gone, without any symptom to lead me to suppose that it will go
further.
"I adhered to your advice most scrupulously for the first year; and in
regard to the not drinking malt liquor, and taking only the two glasses
of wine with water, I have never deviated but two days; and then the
first day I only drank one glass of ale and one glass of Champaigne; on
the second only one glass of Champaigne. With regard to the warm bath,
I only use it now when I have gouty symptoms upon me, and in such
situations I find it of infinite service; and in other respects I
continue to live according to your direction.
"Many persons have laughed at the idea of my perseverance in a system,
which has not been able to _cure_ the gout after five years trial; but
such persons are either ignorant of what I before suffered, or totally
unacquainted with the nature of the disorder. Under the blessing of
Providence, by an adherence to your advice, I am reaping all the
benefit you flattered me I might expect from it, viz. my attacks less
frequent, my sufferings less acute, and an improvement in the general
state of my health.
"I have been particular in this account of myself at your request, and
am, Sir, &c.
MORLEY, near DERBY,
February 10th, 1795.
ROBERT WILMOT."
There are situations nevertheless in which a paroxysm of gout has been
believed to be desirable, as relieving the patient from other disagreeable
diseases, or debilities, or sensations. Thus when the liver is torpid, a
perpetual uneasiness and depression of spirits occur; which a fit of gout
is supposed to cure by a metastasis of the disease. Others have acquired
epileptic fits, probably from the disagreeable sensation of a chronically
inflamed liver; which they suppose the pain and inflammation of gout would
relieve. When gouty patients become much debilitated by the progress of the
disease, they are liable to dropsy of the chest, which they suppose a fit
of the gout would relieve. But in all these cases the attempt to procure a
paroxysm of gout by wine, or aromatics, or volatiles, or blisters, or
mineral waters, seldom succeeds; and the patients are obliged to apply to
other methods of relief adapted to their particular cases. In the two
former situations small repeated doses of calomel, or mercurial unction on
the region of the liver may succeed, by giving new activity to the vessels
of the liver, either to secrete or to absorb their adapted fluids, and thus
to remove the cause of the gout, rather than to promote a fit of it. In the
last case the tincture of digitalis, and afterwards the class of sorbentia,
must be applied to.
M. M. In young strong patients the gout should be cured by venesection and
cathartics and diluents, with poultices externally. But it has a natural
crisis by producing calcareous matter on the inflamed membrane, and
therefore in old enfeebled people it is safest to wait for this crisis,
attending to the natural evacuations and the degree of fever; and in young
ones, where it is not attended with much fever, it is customary and popular
not to bleed, but only to keep the body open with aloes, to use gentle
sudorifics, as neutral salts, and to give the bark at the decline of the
fit; which is particularly useful where the patient is much debilitated.
See Arthritis ventriculi, Class I. 2. 4. 6. and Sect. XXV. 17.
When there is not much fever, and the patient is debilitated with age, or
the continuance of the disease, a moderate opiate, as twenty drops of
tincture of opium, or one grain of solid opium, may be taken every night
with advantage. Externally a paste made with double the quantity of yeast
is a good poultice; and booterkins made with oiled silk, as they confine
the perspirable matter, keep the part moist and supple, and thence relieve
the pain like poultices.
The only safe way of moderating the disease is by an uniform and equal
diminution, or a total abstinence from fermented liquors, with the cautions
directed in Sect. XII. 7. 8. The continued use of strong bitters, as of
Portland's powder, or bark, has been frequently injurious, as spoken of in
the Materia Medica, Art. IV. 2. 11.
One of my acquaintance, who was much afflicted with the gout, abstained for
about half a year from beer and wine; and not having resolution to persist,
returned to his former habits of potation in less quantity; and observed
that he was then for one winter stronger and freer from the gout than
usual. This however did not long continue, as the disease afterwards
returned with its usual or increased violence. This I think is a
circumstance not unlikely to occur, as opium has a greater effect after its
use has been a while intermitted; and the debility or torpor, which is the
cause of gout, is thus for a few months prevented by the greater
irritability of the system, acquired during the lessened use of fermented
liquor.
For the same reason an ounce of spirituous tincture of guaiacum, or of
bark, is said to have for some time prevented returns of the gout; which
has afterwards, like all other great stimuli when long continued, been
succeeded by greater debility, and destroyed the patient. This seems to
have been exemplified in the case of the ingenious Dr. Bown, see Preface to
his Elementa Medicinae; he found temporary relief from the stimulus of
wine, regardless of its future effects.
16. _Rheumatismus._ Acute rheumatism. There is reason to suspect, that
rheumatic inflammations, like the gouty ones, are not a primary disease;
but that they are the consequence of a translation of morbid action from
one part of the system to another. This idea is countenanced by the
frequent change of place of rheumatic-like gouty inflammations, and from
their attacking two similar parts at the same time, as both ankles and both
wrists, and these attacks being in succession to each other. Whereas it is
not probable that both feet or both hands should at the same time be
equally exposed to any external cause of the disease, as to cold or
moisture; and less so that these should occur in succession. Lastly, from
the inflammatory diathesis in this disease being more difficult to subdue,
and more dangerous in event, than other common inflammations, especially to
pregnant women, and in weak constitutions.
From this idea of the rheumatism being not a primary disease, like the
gout, but a transferred morbid action owing to the previous torpor of some
other part of the system, we perceive why it attacks weak people with
greater pertinacity than strong ones; resisting or recurring again and
again after frequent evacuations, in a manner very different from primary
inflammations; because the cause is not removed, which is at a distance
from the seat of the inflammation.
This also accounts for rheumatic inflammations so very rarely terminating
in suppuration, because like the gout the original cause is not in the
inflamed part, and therefore does not continue to act after the
inflammation commences. Instead of suppuration in this disease, as well as
in the gout, a quantity of mucus or coagulable lymph is formed on the
inflamed membrane; which in the gout changes into chalkstones, and in the
rheumatism is either reabsorbed, or lies on the membrane, producing pains
on motion long after the termination of the inflammation, which pains are
called chronic rheumatism. The membranes, which have thus been once or
repeatedly inflamed, become less mobile, or less liable to be affected by
sympathy, as appears by the gout affecting new parts, when the joints of
the foot have been frequently inflamed by it; hence as the cause of the
inflammation does not exist in the inflamed part, and as this part becomes
less liable to future attacks, it seldom suppurates.
Secondly, when rheumatism affects the muscles of the chest, it produces
symptoms similar to pleurisy, but are distinguished from that by the
patient having previously suffered rheumatic affections in other parts, and
by the pertinacity or continuance of the inflammatory state of the patient,
this should be termed pleurodyne rheumatica.
Thirdly, when rheumatic inflammation affects the bowels, it produces a
disease very different from enteritis, or common inflammation of the
bowels, and should be termed enteralgia rheumatica. The pain is less than
in enteritis, and the disease of longer continuance, with harder pulse, and
the blood equally sizy. It is attended with frequent dejections, with much
mucus, and previous griping pains, but without vomiting; and differs
perhaps from dysentery from its not being attended with bloody stools, and
not being infectious.
Fourthly, there is another kind of rheumatism attended with debility, which
suppurates, and should be termed rheumatismus suppurans. It is generally
believed to be the gout, till suppuration takes place on the swelled joint;
and, as the patient sinks, there are sloughs formed over the whole mouth;
and he seems to be destroyed by inflammation or gangrene of the mucous
membranes. I have twice seen this disease in patients about sixty. Some
other diseases are erroneously called rheumatic, as hemicrania, and
odontalgia. See Sect. XXVI. 3.
M.M. In the three former kinds venesection repeatedly. Cathartics.
Antimonials. Diluents. Neutral salts. Oil. Warm bath. Afterwards the bark.
Opium with or without ipecacuanha; but not till the patient is considerably
weakened. Sweats forced early in the disease do injury. Opium given early
in the disease prolongs it. In the last kind, gentle stimulants, as wine
and water, mucilage, sorbentia.
The following is a case of suppurative rheumatism. Mr. F----, about sixty,
was supposed to have the gout in his hand, which however suppurated, and it
was then called the suppurative rheumatism. He had lived rather
intemperately in respect to wine, and was now afflicted with a tendency to
inflammation of the mucous membranes. As he lay on the bed half resupine,
propped up with pillows, and also slept in that posture, his lower jaw
dropped by its own weight, when the voluntary power of the muscles was
suspended. The mucus of his mouth and throat became quite dry, and at
length was succeeded with sloughs; this was a most distressing circumstance
to him, and was in vain endeavoured to be relieved by supporting his jaw by
slender steel springs fixed to his night-cap, and by springs of elastic
gum. The sloughs spread and seemed to accelerate his death. See Class I. 1.
3. 2.
17. _Erysipelas._ The erysipelas differs from the zona ignea, and other
species of herpes, in its being attended with fever, which is sometimes of
the sensitive irritated or inflammatory kind, with strong and full pulse;
and at other times with weak pulse and great inirritability, as when it
precedes or attends mortifications. See Class II. 1. 3. 2.
Like the zona ignea above described, it seems to be a secondary disease,
having for its primary part the torpor or inflammation of some internal or
distant membrane, as appears from its so frequently attending wounds;
sometimes spreading from issues over the whole limb, or back, by sympathy
with a tendon or membrane, which is stimulated by the pease in them. In its
more violent degree I suppose that it sympathizes with some extensive
internal membranes, as of the liver, stomach, or brain. Another reason,
which countenances this idea, is, that the inflammation gradually changes
its situation, one part healing as another inflames; as happens in respect
to more distant parts in gout and rheumatism; and which seems to shew, that
the cause of the disease is not in the same place with the inflammation.
And thirdly, because the erysipelas of the face and head is liable to
affect the membranes of the brain; which were probably in these cases the
original or primary seat of the disease; and lastly, because the fits of
erysipelas, like those of the gout, are liable to return at certain annual
or monthly periods, as further treated of in Class II. 1. 3. 2.
Many cases of erysipelas from wounds or bruises are related in Default's
Surgical Journal, Vol. II. in which poultices are said to do great injury,
as well as oily or fatty applications. Saturnine solutions were sometimes
used with advantage. A grain of emetic tartar given to clear the stomach
and bowels, is said to be of great service.
18. _Testium tumor in gonorrhoea._ Mr. Hunter in his Treatise on the
Venereal Disease observes, that the tumor of the testes in gonorrhoea
arises from their sympathy with the inflammation of the urethra; and that
they are not similar to the actions arising from the application of
venereal matter, whether by absorption or otherwise; as they seldom or
never suppurate; and when suppuration happens, the matter produced is not
venereal. Treatise on Venereal Disease, p. 53.
19. _Testium tumor in parotidite._ The sympathy between some parts about
the throat and the genitals has been treated of in Class IV. 1. 2. 7. The
swelling of the testes, when that of the parotis subsides, seems to arise
from the association of successive action; as the tension of the penis in
hydrophobia appears to arise from the previous synchronous associations of
the sensitive motions of these parts; but the manner of the production of
both these associations is yet very obscure. In women a swelling of the
breasts often succeeds the decline of the mumps by another wonderful
sympathy. See Class IV. 1. 2. 7. and I. 1. 2. 15. In many persons a
delirium succeeds the swelling of the parotis, or the subsequent ones of
the testes or breasts; which is sometimes fatal, and seems to arise from a
sympathy of successive action, and not of synchronous action, of the
membranes of the brain with those of the parotide glands. Sometimes a
stupor comes on instead of this delirium, which is relieved by fomenting
the shaved head for an hour or two. See Class II. 1. 3. 4.
* * * * *
ORDO I.
_Increased Associate Motions._
GENUS III.
_Catenated with Voluntary Motions_
SPECIES.
1. _Deglutitio invita._ When any one is told not to swallow his saliva, and
that especially if his throat be a little sore, he finds a necessity of
immediately swallowing it; and this the more certainly, the more he
voluntarily endeavours not to do so.
In this case the voluntary power exerted by our attention to the pharinx
renders it more sensible to irritation, and therefore occasions it to be
more frequently induced to swallow the saliva. Here the irritation induces
a volition to swallow it, which is more powerful than the desire not to
swallow it. See XXIV. 1. 7. So in reverie, when the voluntary power was
exerted on any of the senses, as of sight or taste, the objects of those
senses became perceived; but not otherwise. Sect. XIX. 6. This is a
troublesome symptom in some sore throats.
M. M. Mucilage, as sugar and gum arabic. Warm water held in the mouth
frequently, as a fomentation to the inflamed throat.
2. _Nictitatio invita._ Involuntary winking with the eye-lids, and
twitchings of the face, are originally induced by an endeavour to relieve
some disagreeable sensations about inflamed eyes, as the dazzling of light;
and afterwards these motions become catenated with other motions or
sensations, so as not to be governed by the will. Here the irritation first
produces a volition to wink, which by habit becomes stronger than the
anti-volition not to wink.
This subject is rendered difficult from the common acceptation of the word,
volition, including previous deliberation, as well as the voluntary
exertion, which succeeds it. In the volitions here spoken of there is no
time for deliberation or choice of objects, but the voluntary act
immediately succeeds the sensation which excites it.
M. M. Cover the affected parts with a sticking plaster or a blister. Pass a
fine needle and thread through a part of the skin over the muscle, which
moves, and attach the other end of the thread by a sticking plaster to a
distant part. An issue behind the ear. To practise daily by a looking-glass
to stop the motions with the hand. See the cure of a case of the leaping of
a muscle of the arm, Sect. XVII. 1. 8. See Convulsio debilis, Class III. 1.
1. 5.
3. _Risus invitus._ Involuntary laughter. When the pleasure arising from
new combinations of words and ideas, as in puns; or of other circumstances,
which are so trivial, as to induce no voluntary exertion to compare or
consider their present importance or their future consequence; the pleasure
is liable to rise into pain; that is, the ideas or sensual motions become
exerted too violently for want of some antithetistic ideas; in the same
manner as those muscles, which have weak antagonists, as those of the calf
of the leg, are liable to fall into cramp or painful contraction. In this
situation a scream is begun to relieve this pain of ideas too violently
exerted, which is stopped again soon, as explained in Sect. XXXIV. 1. 4.
and Class III. 1. 1. 4. and IV. 2. 3. 3.
The pain, into which this pleasure rises, which would excite the scream of
laughter, has been felt forcibly by every one; when they have been under
such circumstances, as have induced them to restrain it by a
counter-volition; till at length the increased associate motions produce so
much pain as to overcome the counter-volition, and the patient bursts out
into indecent laughter, contrary to his will in the common acceptation of
that word.
4. _Lusus digitorum invitus._ An awkward playing with the fingers in
speaking in public. These habits are began through bashfulness, and seem
rather at first designed to engage the attention in part, and thus prevent
the disagreeable ideas of mauvaise hont; as timorous boys whistle, when
they are obliged to walk in the dark; and as it is sometimes necessary to
employ raw soldiers in perpetual manoeuvres, as they advance to the first
charge.
5. _Unguium morsiuncula invita._ Biting the nails is a depraved habit
arising from similar causes as those of the last article.
M. M. Dip the fingers in solution of aloes.
6. _Vigilia invita._ Watchfulness, where the person wishes, and endeavours
to fall asleep, properly belongs to this place, as the wish or volition to
sleep prevents the desired effect; because sleep consists in an abolition
of volition. See Class III. 1. 2. 3.
* * * * *
ORDO I.
_Increased Associate Motions._
GENUS IV.
_Catenated with External Influences._
SPECIES.
1. _Vita ovi._ Life of an egg. The eggs of fowls were shewn by Mr. J.
Hunter to resist the freezing process in their living state more
powerfully, than when they were killed by having the yolk and white shook
together. Philos. Trans. It may be asked, does the heat during the
incubation of eggs act as a stimulus exciting the living principle into
activity? Or does it act simply as a causa sine qua non, as an influence,
which penetrating the mass, removes the particles of it to a greater
distance from each other, so as to allow their movement over each other, in
the same manner as heat is conceived to produce the fluidity of water; not
by stimulus, but by its penetrating influence? Or may elementary heat in
its uncombined state be supposed to act only as an influence necessary to
life in its natural quantity; whence torpor and death follows the eduction
of it from the body; but in its increased state above what is natural, or
usual, that it acts as a stimulus; which we have a sense to perceive; and
which excites many parts of the system into unnatural action? See Class IV.
1. 1. C.
2. _Vita hiemi-dormientium._ The torpor of insects, and birds, and
quadrupeds, during the cold season, has been called sleep; but I suppose it
must differ very much from that state of animal life, since not only all
voluntary power is suspended, but sensation and vascular motion has ceased,
and can only be restored by the influence of heat. There have been related
instances of snails, which have recovered life and motion on being put into
water after having experienced many years of torpidity, or apparent death,
in the cabinets of the curious. Here the water as well as the heat are
required not only as a stimulus, but as a causa sine qua non of fluidity
and motion, and consequent life.
3. _Pullulatio arborum._ The annual revivescence of the buds of trees seems
not only to be owing to the influence of the returning warmth of the
spring, but also to be catenated with solar gravitation; because seeds and
roots and buds, which are analogous to the eggs of animals, put forth their
shoots by a less quantity of heat in spring, than they had undergone in the
latter part of autumn, which may however be ascribed to their previous
torpid state, and consequent accumulation of sensorial power, or
irritability; as explained in Botanic Garden, Part II. Cant. I. l. 322.
note. Other circumstances, which countenance the idea, that vegetation is
affected by solar gravitation, as well as by heat, may be observed in the
ripening of the seeds of plants both in those countries where the summers
are short, and in those where they are long. And by some flowers closing
their bells at noon, or soon after; and hence seem to sleep rather at solar
diurnal periods, than from the influence of cold, or the deficiency of
light.
4. _Orgasmatis venerei periodus._ The venereal orgasm of birds and
quadrupeds commences or returns about the vernal or autumnal equinoxes, and
thence seems in respect to their great periods to be governed by solar
influence. But if this orgasm be disappointed of its object, it is said to
recur at about monthly periods, as observed in mares and bitches in this
respect resembling the female catamenia. See Sect. XXXVI. 2. 3. and Sect.
XVI. 13.
5. _Brachii concussio electrica._ The movement of the arm, even of a
paralytic patient, when an electric shock is passed through it, is owing to
the stimulus of the excess of electricity. When a piece of zinc and silver,
each about the size of a crown-piece, are placed one under the upper lip,
and the other on the tongue, so as the outer edges may be brought into
contact, there is an appearance of light in the eyes, as often as the outer
edges of these metals are brought into contact or separated; which is
another instance of the stimulus of the passage of electric shocks through
the fibres of the organs of sense, as well as through the muscular fibres.
See Sect. XII. 1. 1. and first addit. note to Vol. I. of this work. But in
its natural state electricity seems only to act as an influence on animal
and vegetable bodies; of the salutary or injurious effects of which we have
yet no precise knowledge.
Yet if regular journals were kept of the variations of atmospheric
electricity, it is probable some discoveries of its influence on our system
might in time be discovered. For this purpose a machine on the principle of
Mr. Bennet's electric doubler might be applied to the pendulum of a clock,
so as to manifest, and even to record the daily or hourly variations of
aerial electricity. Which has already been executed, and applied to the
pendulum of a Dutch wooden clock, by Mr. Bennet, curate of Wirksworth in
Derbyshire.
Besides the variations of the degree or kind of atmospheric electricity,
some animals, and some men, seem to possess a greater power of accumulating
this fluid in themselves than others. Of which a famous history of a
Russian prince was lately published; who, during the clear and severe
frosts of that country, could not move himself in bed without luminous
corruscations. Such may have been the case of those people, who have been
related to have taken fire spontaneously, and to have been reduced to
ashes. The electric concussion from the gymnotus electricus, and torpedo,
are other instances of the power of the animal system to accumulate
electricity, as in these it is used as a weapon of defence, or for the
purpose of taking their prey.
Some have believed that the accumulation or passage of the magnetic fluid
might affect the animal system, and have asserted that the application of a
large magnet to an aching tooth has quickly effected a cure. If this
experiment is again tried in odontalgia, or hemicrania, the painful
membrane of the tooth or head should be included between the south and
north poles of a horse-shoe magnet, or between the contrary poles of two
different magnets, that the magnetism may be accumulated on the torpid
part.
6. _Oxygenatio sanguinis._ The variation of the quantity of oxygen gas
existing in the atmosphere must affect all breathing animals; in its excess
this too must be esteemed a stimulus; but in its natural quantity would
seem to act as an influence, or cause, without which, animal life cannot
exist even a minute. It is hoped that Dr. Beddoes's plan for a pneumatic
infirmary, for the purpose of putting this and various other airs to the
test of experiment, will meet with public encouragement, and render
consumption, asthma, cancer, and many diseases conquerable, which at
present prey with unremitted devastation on all orders and ages of mankind.
7. _Humectatio corporis._ Water, and probably the vapour of water dissolved
or diffused in the atmosphere, unites by mechanical attraction with the
unorganized cuticle, and softens and enlarges it; as may be seen in the
loose and wrinkled skin of the hands of washerwomen; the same probably
occurs to the mucous membrane of the lungs in moist weather; and by
thickening it increases the difficulty of respiration of some people, who
are said to be asthmatical. So far water may be said to act as an influx or
influence, but when it is taken up by the mouths of the absorbent system,
it must excite those mouths into action, and then acts as a stimulus.
There appears from hence to be four methods by which animal bodies are
penetrated by external things. 1. By their stimulus, which induces the
absorbent vessels to imbibe them. 2. By mechanical attraction, as when
water softens the cuticle. 3. By chemical attraction, as when oxygen passes
through the membranes of the air-vessels of the lungs, and combines with
the blood. And lastly, by influx without mechanical attraction, chemical
combination, or animal absorption, as the universal fluids of heat,
gravitation, electricity, magnetism, and perhaps of other ethereal fluids
yet unknown.
* * * * *
ORDO II.
_Decreased Associate Motions._
GENUS I.
_Catenated with Irritative Motions._
As irritative muscular motions are attended with pain, when they are
exerted too weakly, as well as when they are exerted too strongly; so
irritative ideas become attended with sensation, when they are exerted too
weakly, as well as when they are exerted too strongly. Which accounts for
these ideas being attended with sensation in the various kinds of vertigo
described below.
There is great difficulty in tracing the immediate cause of the deficiences
of action of some links of the associations of irritative motions; first,
because the trains and tribes of motions, which compose these links, are so
widely extended as to embrace almost the whole animal system; and secondly,
because when the first link of an associated train of actions is exerted
with too great energy, the second link by reverse sympathy may be affected
with torpor. And then this second link may transmit, as it were, this
torpor to a third link, and at the same time regain its own energy of
action; and it is possible this third link may in like manner transmit its
torpor to a fourth, and thus regain its own natural quantity of motion.
I shall endeavour to explain this by an example taken from sensitive
associated motions, as the origin of their disturbed actions is more easily
detected. This morning I saw an elderly person, who had gradually lost all
the teeth in his upper jaw, and all of the under except three of the
molares; the last of these was now loose, and occasionally painful; the
fangs of which were almost naked, the gums being much wasted both within
and without the jaw. He is a man of attentive observation, and assured me,
that he had again and again noticed, that, when a pain commenced in the
membranes of the alveolar process of the upper jaw opposite to the loose
tooth in the under one (which had frequently occurred for several days
past), the pain of the loose tooth ceased. And that, when the pain
afterwards extended to the ear and temple on that side, the pain in the
membranes of the upper jaw ceased. In this case the membranes of the
alveolar process of the upper jaw became torpid, and consequently painful,
by their reverse sympathy with the too violent actions of the inflamed
membranes of the loose tooth; and then by a secondary sympathy the
membranes about the ear and temple became torpid, and painful; and those of
the alveolar process of the upper jaw regained their natural quantity of
action, and ceased to be painful. A great many more nice and attentive
observations are wanted to elucidate these curious circumstances of
association, which will be found to be of the greatest importance in the
cure of many diseases, and lead us to the knowledge of fever.
SPECIES.
1. _Cutis frigida pransorum._ Chillness after dinner frequently attends
weak people, or those who have been exhausted by exercise; it arises from
the great expenditure of the sensorial power on the organs of digestion,
which are stimulated into violent action by the aliment; and the vessels of
the skin, which are associated with them, become in some measure torpid by
reverse sympathy; and a consequent chillness succeeds with less absorption
of atmospheric moisture. See the subsequent article.
2. _Pallor urinae pransorum._ The paleness of urine after a full meal is an
instance of reverse association; where the secondary part of a train of
associate motions acts with less energy in consequence of the greater
exertions of the primary part. After dinner the absorbent vessels of the
stomach and intestines are stimulated into greater action, and drink up the
newly taken aliment; while those, which are spread in great number on the
neck of the bladder, absorb less of the aqueous part of the urine than
usual, which is therefore discharged in a more dilute state; and has been
termed crude by some medical writers, but it only indicates, that so great
a proportion of the sensorial power is expended on digestion and absorption
of the aliment, that other parts of the system act for a time with less
energy. See Class IV. I. 1. 6.
3. _Pallor urinae a frigore cutaneo._ There is a temporary discharge of
pale water, and a diarrhoea, induced by exposing the skin to the cold air;
as is experienced by boys, who strip themselves before bathing. In this
case the mouths of the cutaneous lymphatics become torpid by the subduction
of their accustomed degree of heat, and those of the bladder and intestines
become torpid by direct sympathy; whence less of the thinner part of the
urinary secretion, and of the mucus of the intestines, is reabsorbed. See
Sect. XXIX. 4. 6. This effect of suddenly cooling the skin by the aspersion
of cold water has been used with success in costiveness, and has produced
evacuations, when other means have failed. When young infants are afflicted
with griping joined with costiveness, I have sometimes directed them to be
taken out of a warm bed, and carried about for a few minutes in a cool
room, with almost instant relief.
4. _Pallor ex aegritudine._ When sickness of stomach first occurs, a
paleness of the skin attends it; which is owing to the association or
catenation between the capillaries of the stomach and the cutaneous ones;
which at first act by direct sympathy. But in a short time there commences
an accumulation of the sensorial power of association in the cutaneous
capillaries during their state of inactivity, and then the skin begins to
glow, and sweats break out, from the increased action of the cutaneous
glands or capillaries, which is now in reverse sympathy with those of the
stomach. So in continued fevers, when the stomach is totally torpid, which
is known by the total aversion to solid food, the cutaneous capillaries are
by reverse sympathy in a perpetual state of increased activity, as appears
from the heat of the skin.
5. _Dyspnoea a balneo frigido._ The difficulty of breathing on going up to
the middle in cold water is owing to the irritative association or
catenation of the action of the extreme vessels of the lungs with those of
the skin. So that when the latter are rendered torpid or inactive by the
application of sudden cold, the former become inactive at the same time,
and retard the circulation of the blood through the lungs, for this
difficulty of breathing cannot be owing to the pressure of the water
impeding the circulation downwards, as it happens equally by a cold
shower-bath, and is soon conquered by habitual immersions. The capillaries
of the skin are rendered torpid by the subduction of the stimulus of heat,
and by the consequent diminution of the sensorial power of irritation. The
capillaries of the lungs are rendered torpid by the diminution of the
sensorial power of association, which is now excited in less quantity by
the lessened actions of the capillaries of the skin, with which they are
catenated. So that at this time both the cutaneous and pulmonary
capillaries are principally actuated, as far as they have any action, by
the stimulus of the blood. But in a short time the sensorial powers of
irritation, and of association, become accumulated, and very energetic
action of both these membranes succeed. Which thus resemble the cold and
hot fit of an intermittent fever.
6. _Dyspepsia a pedibus frigidis._ When the feet are long cold, as in
riding in cold and wet weather, some people are very liable to indigestion
and consequent heart-burn. The irritative motions of the stomach become
torpid, and do their office of digestion imperfectly, in consequence of
their association with the torpid motions of the vessels of the
extremities. Fear, as it produces paleness and torpidity of the skin,
frequently occasions temporary indigestion in consequence of this
association of the vessels of the skin with those of the stomach; as riding
in very bad roads will give flatulency and indigestion to timorous people.
A short exposure to cold air increases digestion, which is then owing to
the reverse sympathy between the capillary vessels of the skin, and of the
stomach. Hence when the body is exposed to cold air, within certain limits
of time and quantity of cold, a reverse sympathy of the stomach and the
skin first occurs, and afterwards a direct sympathy. In the former case the
expenditure of sensorial power by the skin being lessened, but not its
production in the brain; the second link of the association, viz. the
stomach, acquires a greater share of it. In the latter case, by the
continuation of the deficient stimulus of heat, the torpor becomes extended
to the brain itself, or to the trunks of the nerves; and universal
inactivity follows.
7. _Tussis a pedibus frigidis._ On standing with the feet in thawing snow,
many people are liable to incessant coughing. From the torpidity of the
absorbent vessels of the lungs, in consequence of their irritative
associations with those of the skin, they cease to absorb the saline part
of the secreted mucus; and a cough is thus induced by the irritation of
this saline secretion; which is similar to that from the nostrils in frosty
weather, but differs in respect to its immediate cause; the former being
from association with a distant part, and the latter from defect of the
stimulus of heat on the nostrils themselves. See Catarrhus frigidus, Class
I. 2. 3. 3.
8. _Tussis hepatica._ The cough of inebriates, which attends the
enlargement of the liver, or a chronical inflammation of its upper
membrane, is supposed to be produced by the inconvenience the diaphragm
suffers from the compression or heat of the liver. It differs however
essentially from that attending hepatitis, from its not being accompanied
with fever. And is perhaps rather owing to irritative association, or
reverse sympathy, between the lungs and the liver. As occurs in sheep,
which are liable to a perpetual dry cough, when the fleuk-worm is preying
on the substance of their livers. See Class II. 1. 1. 5.
M. M. From half a grain to a grain of opium twice a day. A drachm of
mercurial ointment rubbed on the region of the liver every night for eight
or ten times.
9. _Tussis arthritica._ Gout-cough. I have seen a cough, which twice
recurred at a few years distance in the same person, during his fits of the
gout, with such pertinacity and violence as to resist venesection, opiates,
bark, blisters, mucilages, and all the usual methods employed in coughs. It
was for a time supposed to be the hooping-cough, from the violence of the
action of coughing; it continued two or three weeks, the patient never
being able to sleep more than a few minutes at once during the whole time,
and being propped up in bed with pillows night and day.
As no fever attended this violent cough, and but little expectoration, and
that of a thin and frothy kind, I suspected the membrane of the lungs to be
rather torpid than inflamed, and that the saline part of the mucus not
being absorbed stimulated them into perpetual exertion. And lastly, that
though the lungs are not sensible to cold and heat, and probably therefore
less mobile; yet, as they are nevertheless liable to consent with the
torpor of cold feet, as described in Species 6 of this Genus, I suspected
this torpor of the lungs to succeed the gout in the feet, or to act a
vicarious part for them.
10. _Vertigo rotatoria._ In the vertigo from circumgyration the irritative
motions of vision are increased; which is evinced from the pleasure that
children receive on being rocked in a cradle, or by swinging on a rope. For
whenever sensation arises from the production of irritative motion with
less energy than natural, it is of the disagreeable kind, as from cold or
hunger; but when it arises from their production with greater energy than
natural, if it be confined within certain limits, it is of the pleasurable
kind, as by warmth or wine. With these increased irritative motions of
vision, I suppose those of the stomach are performed with greater energy by
direct sympathy; but when the rotatory motions, which produce this
agreeable vertigo, are continued too long, or are too violent, sickness of
the stomach follows; which is owing to the decreased action of that organ
from its reverse sympathy with the increased actions of the organ of
vision. For the expenditure of sensorial power by the organ of vision is
always very great, as appears by the size of the optic nerves; and is now
so much increased as to deprive the next link of association of its due
share. As mentioned in Article 6 of this Genus.
In the same manner the undulations of water, or the motions of a ship, at
first give pleasure by increasing the irritative motions belonging to the
sense of vision; but produce sickness at length by expending on one part of
the associated train of irritative actions too much of that sensorial
power, which usually served the whole of it; whence some other parts of the
train acquire too little of it, and perform their actions in consequence
too feebly, and thence become attended with disagreeable sensation.
It must also be observed, that when the irritative motions are stimulated
into unusual action, as in inebriation, they become succeeded by sensation,
either of the pleasurable or painful kind; and thus a new link is
introduced between the irritative motions thus excited, and those which
used to succeed them; whence the association is either dissevered or much
weakened, and thus the vomiting in sea-sickness occurs from the defect of
the power of association, rather than from the general deficiency of
sensorial power.
When a blind man turns round, or when one, who is not blind, revolves in
the dark, a vertigo is produced belonging to the sense of touch. A blind
man balances himself by the sense of touch, which being a less perfect
means of determining small quantities of deviation from the perpendicular,
occasions him to walk more carefully upright than those, who balance
themselves by vision. When he revolves, the irritative associations of the
muscular motions, which were used to preserve his perpendicularity, become
disordered by their new modes of successive exertion; and he begins to
fall. For his feet now touch the floor in manners or directions different
from those they have been accustomed to; and in consequence he judges less
perfectly of the situation of the parts of the floor in respect to that of
his own body, and thus loses his perpendicular attitude. This may be
illustrated by the curious experiment of crossing one finger over the next
to it, and feeling of a nut or bullet with the ends of them. When, if the
eyes be closed, the nut or bullet appears to be two, from the deception of
the sense of touch.
In this vertigo from gyration, both of the sense of sight, and of the sense
of touch, the primary link of the associated irritative motions is
increased in energy, and the secondary ones are increased at first by
direct sympathy; but after a time they become decreased by reverse sympathy
with the primary link, owing to the exhaustion of sensorial power in
general, or to the power of association in particular; because in the last
case, either pleasurable or painful sensation has been introduced between
the links of a train of irritative motions, and has dissevered, or much
enfeebled them.
Dr. Smyth, in his Essay on Swinging in Pulmonary Consumption, has observed,
that swinging makes the pulse slower. Dr. Ewart of Bath confirmed this
observation both on himself and on Col. Cathcart, who was then hectic, and
that even on shipboard, where some degree of vertigo might be supposed
previously to exist. Dr. Currie of Liverpool not only confirmed this
observation frequently on himself, when he was also phthisical, but found
that equitation had a similar effect on him, uniformly retarding his pulse.
This curious circumstance cannot arise from the general effect of exercise,
or fatigue, as in those cases the pulse becomes weaker and quicker; it must
therefore be ascribed to a degree of vertigo, which attends all those modes
of motion, which we are not perpetually accustomed to.
Dr. Currie has further observed, that "in cases of great debility the
voluntary muscular exertion requisite in a swing produces weariness, that
is, increases debility; and that in such instances he had frequently
noticed, that the diminution of the frequency of the pulse did not take
place, but the contrary." These circumstances may thus be accounted for.
The links of association, which are effected in the vertigo occasioned by
unusual motion, are the irritative motions of the sense of vision, those of
the stomach, and those of the heart and arteries. When the irritative ideas
of vision are exerted with greater energy at the beginning of vertigo, a
degree of sensation is excited, which is of the pleasurable kind, as above
mentioned; whence the associated trains of irritative motions of the
stomach, and heart, and arteries, act at first with greater energy, both by
direct sympathy; and by the additional sensorial power of sensation. Whence
the pulse of a consumptive patient becomes stronger and consequently
slower.
But if this vertigo becomes much greater in degree or duration, the first
link of this train of associated irritative motions expends too much of the
sensorial power, which was usually employed on the whole train; and the
motions of the stomach become in consequence exerted with less energy. This
appears, because in this degree of vertigo sickness supervenes, as in
sea-sickness, which has been shewn to be owing to less energetic action of
the stomach. And the motions of the heart and arteries then become weaker,
and in consequence more frequent, by their direct sympathy with the
lessened actions of the stomach. See Supplement, I. 12. and Class II. 1. 6.
7. The general weakness from fatigue is owing to a similar cause, that is,
to the too great expenditure of sensorial power in the increased actions of
one part of the system, and the consequent deficiency of it in other parts,
or in the whole.
The abatement of the heat of the skin in hectic fever by swinging, is not
only owing to the increased ventilation of cool air, but to the reverse
sympathy of the motions of the cutaneous capillaries with those of the
heart and arteries; which occurs in all fevers with arterial debility, and
a hot or dry skin. Hence during moderate swinging the action of the heart
and arteries becomes stronger and slower, and the action of the
capillaries, which was before too great, as appeared by the heat of the
skin, now is lessened by their reverse sympathy with that of the heart and
arteries. See Supplement, I. 8.
11. _Vertigo visualis._ Visual vertigo. The vertigo rotatoria described
above, was induced by the rotation or undulation of external objects, and
was attended with increased action of the primary link of the associated
motions belonging to vision, and with consequent pleasure. The vertigo
visualis is owing to less perfect vision, and is not accompanied with
pleasurable sensation. This frequently occurs in strokes of the palsy, and
is then succeeded by vomiting; it sometimes precedes epileptic fits, and
often attends those, whose sight begins to be impaired by age.
In this vertigo the irritative ideas of the apparent motions of objects are
less distinct, and on that account are not succeeded by their usual
irritative associations of motion; but excite our attention. Whence the
objects appear to librate or circulate according to the motions of our
heads, which is called dizziness; and we lose the means of balancing
ourselves, or preserving our perpendicularity, by vision. So that in this
vertigo the motions of the associated organs are decreased by direct
sympathy with their primary link of irritation; as in the preceding case of
sea-sickness they are decreased by reverse sympathy.
When vertigo affects people about fifty years of age, their sight has
generally been suddenly impaired; and from their less accurate vision they
do not soon enough perceive the apparent motions of objects; like a person
in a room, the walls of which are stained with the uniform figures of
lozenges, explained in Sect. XX. 1. This is generally ascribed to
indigestion; but it ceases spontaneously, as the patient acquires the habit
of balancing himself by less distinct objects.
A gentleman about 50 was seized with an uncommon degree of vertigo, so as
to fall on the ground, and not to be able to turn his head, as he sat up
either in his chair or in his bed, and this continued eight or ten weeks.
As he had many decayed teeth in his mouth, and the vertigo was preceded and
sometimes accompanied by pains on one side of his head, the disease of a
tooth was suspected to be the cause. And as his timidity was too great to
admit the extraction of those which were decayed; after the trial of
cupping repeatedly, fomentations on his head, repeated blisters, with
valerian, Peruvian bark, musk, opium, and variety of other medicines;
mercurials were used, both externally and internally, with design to
inflame the membranes of the teeth, and by that means to prevent the torpor
of the action of the membranes about the temple, and parietal bone; which
are catenated with the membranes of the teeth by irritative association,
but not by sensitive association. The event was, that as soon as the gums
became sore with a slight ptyalism, the pains about the head and vertigo
gradually diminished, and during the soreness of his gums entirely ceased;
but I believe recurred afterwards, though in less degree.
The idea of inflaming the membranes of the teeth to produce increased
sensation in them, and thus to prevent their irritative connection with
those of the cranium, was taken from the treatment of trismus, or locked
jaw, by endeavouring to inflame the injured tendon; which is said to
prevent or to remove the spasm of the muscles of the jaw. See Class III. 1.
1. 13. and 15.
M. M. Emetics. Blisters. Issues about the head. Extraction of decayed
teeth. Slight salivation. Sorbentia. Incitantia.
12. _Vertigo ebriosa._ Vertigo from intoxication is owing to the
association of the irritative ideas of vision with the irritative motions
of the stomach. Whence when these latter become much increased by the
immoderate stimulus of wine, the irritative motions of the retina are
produced with less energy by reverse sympathy, and become at the same time
succeeded by sensation in consequence of their decreased action. See Sect.
XXI. 3. and XXXV. 1. 2. So conversely when the irritative motions of vision
are increased by turning round, or by our unaccustomed agitation at sea,
those of the stomach become inverted by reverse sympathy, and are attended
in consequence with disagreeable sensation. Which decreased action of the
stomach is in consequence of the increased expenditure of the sensorial
power on the irritative ideas of vision, as explained in Vertigo rotatoria.
Whence though a certain quantity of vinous spirit stimulates the whole
system into increased action, and perhaps even increases the secretion of
sensorial power in the brain; yet as soon as any degree of vertigo is
produced, it is a proof, that by the too great expenditure of sensorial
power by the stomach, and its nearest associated motions, the more distant
ones, as those of vision, become imperfectly exerted. From hence may be
deduced the necessity of exhibiting wine in fevers with weak pulse in only
appropriated quantity; because if the least intoxication be induced, some
part of the system must act more feebly from the unnecessary expenditure of
sensorial power.
13. _Vertigo febriculosa._ Vertigo in fevers either proceeds from the
general deficiency of sensorial power belonging to the irritative
associations, or to a greater expenditure of it on some links of the trains
and tribes of associated irritative motions. There is however a slighter
vertigo attending all people, who have been long confined in bed, on their
first rising; owing to their having been so long unused to the apparent
motions of objects in their erect posture, or as they pass by them, that
they have lost in part the habit of balancing themselves by them.
14. _Vertigo cerebrosa._ Vertigo from injuries of the brain, either from
external violence, or which attend paralytic attacks, are owing to the
general deficiency of sensorial power. In these distressful situations the
vital motions, or those immediately necessary to life, claim their share of
sensorial power in the first place, otherwise the patient must die; and
those motions, which are less necessary, feel a deficiency of it, as these
of the organs of sense and muscles; which constitute vertigo; and lastly
the voluntary motions, which are still less immediately necessary to life,
are frequently partially destroyed, as in palsy; or totally, as in
apoplexy.
15. _Murmur aurium vertiginosum._ The vertiginous murmur in the ears, or
noise in the head, is compared to the undulations of the sound of bells, or
to the humming of bees. It frequently attends people about 60 years of age;
and like the visual vertigo described above is owing to our hearing less
perfectly from the gradual inirritability of the organ on the approach of
age; and the disagreeable sensation of noise attending it is owing to the
less energetic action of these irritative motions; which not being
sufficiently distinct to excite their usual associations become succeeded
by our attention, like the indistinct view of the apparent motions of
objects mentioned in vertigo visualis. This may be better understood from
considering the use, which blind men make of these irritative sounds, which
they have taught themselves to attend to, but which escape the notice of
others. The late blind Justice Fielding walked for the first time into my
room, when he once visited me, and after speaking a few words said, "this
room is about 22 feet long, 18 wide, and 12 high;" all which he guessed by
the ear with great accuracy. Now if these irritative sounds from the
partial loss of hearing do not correspond with the size or usual echoes of
the places, where we are; their catenation with other irritative ideas, as
those of vision, becomes dissevered or disturbed; and we attend to them in
consequence, which I think unravels this intricate circumstance of noises
being always heard in the head, when the sense of hearing begins to be
impaired, from whatever cause it occurs.
This ringing in the ears also attends the vertigo from intoxication; for
the irritative ideas of sound are then more weakly excited in consequence
of the deficiency of the sensorial power of association. As is known by
this also being attended with disagreeable sensation, and by its
accompanying other diseases of debility, as strokes on the head, fainting
fits, and paralytic seizures. For in this vertigo from intoxication so much
sensorial power in general is expended on the increased actions of the
stomach, and its nearest connections, as the capillaries of the skin; that
there is a deficiency for the purposes of the other irritative associations
of motions usually connected with it. This auditory vertigo attends both
the rotatory and the visual vertigo above mentioned; in the former it is
introduced by reverse sympathy, that is, by the diminution of sensorial
power; too great a quantity of it being expended on the increased
irritative motions of vision; in the latter it is produced either by the
same causes which produce the visual vertigo, or by direct sympathy with
it. See Sect. XX. 7.
M. M. Stimulate the internal ear by ether, or with essential oil diluted
with expressed oil, or with a solution of opium in wine, or in water. Or
with salt and water.
16. _Tactus, gustus, olfactius vertiginosi._ Vertiginous touch, taste, and
smell. In the vertigo of intoxication, when the patient lies down in bed,
it sometimes happens even in the dark, that the bed seems to librate under
him, and he is afraid of falling out of it. The same occurs to people, who
are sea-sick, even when they lie down in the dark. In these the irritative
motions of the nerves of touch, or irritative tangible ideas, are performed
with less energy, in one case by reverse sympathy with the stomach, in the
other by reverse sympathy with the nerves of vision, and in consequence
become attended with sensation, and produce the fear of falling by other
associations.
A vertigo of the sense of touch may be produced, if any one turns round for
a time with his eyes shut, and suddenly stops without opening them; for he
will for a time seem to be still going forwards; which is difficult to
explain. See the notes at the end of the first and second volume belonging
to Sect. XX. 6.
In the beginning of some fevers, along with incessant vomiting, the
patients complain of disagreeable tastes in their mouth, and disagreeable
odours; which are to be ascribed to the general debility of the great
trains and tribes of associated irritative motions, and to be explained
from their direct sympathy with the decreased action of a sick stomach; or
from the less secretion of sensorial power in the brain. These organs of
sense are constantly stimulated into action by the saliva or by the air;
hence, like the sense of hunger, when they are torpid from want of
stimulus, or from want of sensorial power, pain or disagreeable sensation
ensues, as of hunger, or faintness, or sickness in one case; and the ideas
of bad tastes or odours in the other. This accords with the laws of
causation, Sect. IV. 5.
17. _Pulsus mollis in vomitione._ The softness of the pulse in the act of
vomiting is caused by direct association between the heart and the stomach;
as explained in Sect. XXV. 17. A great slowness of the pulsation of the
heart sometimes attends sickness, and even with intermissions of it, as in
the exhibition of too great a dose of digitalis.
18. _Pulsus intermittens a ventriculo._ When the pulse first begins to
intermit, it is common for the patient to bring up a little air from his
stomach; which if he accomplishes before the intermission occurs, always
prevents it; whence that this debility of the heart is owing to the direct
association of its motions with those of the stomach is well evinced. See
Sect. XXV. 17.
I this morning saw Mr. ----, who has long had at times an unequal pulse,
with indigestion and flatulency, and occasional asthma; he was seized two
days ago with diarrhoea, and this morning with sickness, and his pulse was
every way unequal. After an emetic his pulse still continued very
intermittent and unequal. He then took some breakfast of toast and butter,
and tea, and to my great surprise his pulse became immediately perfectly
regular, about 100 in a minute, and not weak, by this stimulus on his
stomach.
A person, who for many years had had a frequent intermission of his pulse,
and occasional palpitation of his heart, was relieved from them both for a
time by taking about four drops of a saturated solution of arsenic three or
four times a day for three or four days. As this intermission of the pulse
is occasioned by the direct association of the motions of the heart with
those of the stomach, the indication of cure must be to strengthen the
action of the stomach by the bark. Spice. Moderate quantities of wine. A
blister. Half a grain of opium twice a day. Solution of arsenic?
19. _Febris inirritativa._ Inirritative fever described in Class I. 2. 1.
1. belongs to this place, as it consists of disordered trains and tribes of
associated irritative motions, with lessened actions of the associated
organs. In this fever the pulsations of the heart and arteries are weakened
or lessened, not only in the cold paroxysm, as in the irritative fever, but
also in the hot paroxysm. The capillary arteries or glands have their
actions nevertheless increased after the first cold fit, as appears by the
greater production of heat, and the glow of arterial blood, in the
cutaneous vessels; and lastly, the action of the stomach is much impaired
or destroyed, as appears by the total want of appetite to solid food.
Whence it would seem, that the torpid motions of the stomach, whatever may
occasion them, are a very frequent cause of continued fever with weak
pulse; and that these torpid motions of the stomach do not sufficiently
excite the sensorial power of association, which contributes in health to
actuate the heart and arteries along with the irritation produced by the
stimulus of the blood; and hence the actions of these organs are weaker.
And lastly, that the accumulation of the sensorial power of association,
which ought to be expended on the motions of the heart and arteries,
becomes now exerted on the cutaneous and pulmonary capillaries. See
Supplement I. 8. and Sect. XXXV. 1. 1. and XXXIII. 2. 10.
I have dwelt longer on the vertiginous diseases in this genus, both because
of their great intricacy, and because they seem to open a road to the
knowledge of fever, which consists of associated trains and tribes of
irritative or sensitive motions, which are sometimes mixed with the
vertiginous ones, and sometimes separate from them.
* * * * *
ORDO II.
_Decreased Associate Motions._
GENUS II.
_Catenated with Sensitive Motions._
In this genus the sensorial power of association is exerted with less
energy, and thence the actions produced by it are less than natural; and
pain is produced in consequence, according to the fifth law of animal
causation, Sect. IV. This pain is generally attended with coldness of the
affected part, and is seldom succeeded by inflammation of it. This
decreased action of the secondary link of the associated motions, belonging
to this genus, is owing to the previous exhaustion of sensorial power
either in the increased actions of the primary link of the associated
motions, or by the pain which attends them; both which are frequently the
consequence of the stimulus of something external to the affected fibres.
As pain is produced either by excess or defect of the natural exertions of
the fibres, it is not, considered separately, a criterion of the presence
of either. In the associations belonging to this genus the sensation of
pain or pleasure produces or attends the primary link of the associated
motions, and very often gives name to the disease.
When great pain exists without causing any fibrous motions, I conjecture
that it contributes to exhaust or expend the general quantity of sensorial
power; because people are fatigued by enduring pain, till at length they
sleep. Which is contrary to what I had perhaps erroneously supposed in
Sect. XXXV. 2. 3. If it causes fibrous motions, it then takes the name of
sensation, according to the definition of sensation in Sect. II. 2. 9.; and
increased fibrous action or inflammation is the consequence. This
circumstance of the general exhaustion of sensorial power by the existence
of pain will assist in explaining many of the diseases of this genus.
Many of the canals of the body, as the urethra, the bile-duct, the throat,
have the motions of their two extremities associated by having been
accustomed to feel pleasurable or painful sensations at the same time or in
succession. This is termed sensitive association, though those painful or
pleasurable sensations do not cause the motions, but only attend them; and
are thus perhaps, strictly speaking, only catenated with them.
SPECIES.
1. _Torpor genae a dolore dentis._ In tooth-ach there is generally a
coldness of the cheek, which is sensible to the hand, and is attended in
some degree with the pain of cold. The cheek and tooth have frequently been
engaged in pleasurable action at the same time during the masticating of
our food; whence they have acquired sensitive associations. The torpor of
the cheek may have for its cause the too great expenditure of sensorial
power by the painful sensation of the membranes of the diseased tooth;
whence the membranes of the cheek associated with those of the alveolar
process are deprived of their natural share of it, and become torpid; thus
they produce less secretions, and less heat, and the pain of cold is the
consequence. This torpor of the vessels of the cheek cannot be produced by
the activity of the sensorial power of sensation; for then they would act
more violently than natural, or become inflamed. And though the pain by
exhausting so much sensorial power may be a remote cause, it is the defeat
of the power of association, which is the immediate cause of the torpor of
the cheek.